Medical Qualifications (Amendment) Bill [H.L.] (Hansard, 17 May 1991)

§ Lord McColl of Dulwich
My Lords, I beg to move that this Bill be now read a second time. At the outset I should declare an interest in that I am a member of the Council of the Royal College of Surgeons which is unanimously in favour of this Bill, which seeks to change the title of the licencing diploma of the RCS (Eng) from member of the Royal College of Surgeons to licentiate of the Royal College of Surgeons.
Since 1800 the college has had two classes of membership—members and fellows—and two diplomas, the MRCS and the FRCS. The membership is awarded on completion of undergraduate training and, together with the Diploma of Licentiate of the Royal College of Physicians makes up what is called the conjoint diploma of LRCP and MRCS. The conjoint diploma is registrable by the General Medical Council under the Medical Act as a licensing diploma.
The FRCS diploma used to be awarded towards the end of surgical training. As surgery has expanded and postgraduate surgical training has become more complex, it is now clearly divisible into two parts, basic surgical training and higher specialist training. The FRCS has evolved into a test of basic training, leaving the college nothing to award as a mark of completion of specialist training. In other words, there are now three parts to training—undergraduate, basic and higher—and we have only two classes of membership and two diplomas. Clearly we need an additional class of membership and a third diploma.
The obvious solution, and the one that will bring the college into line with the other surgical colleges elsewhere in the world and with the Royal College of Physicians, is to call the additional class "licentiates" and, consequently, the licensing diplomas for undergraduate qualification, the licentiate of the Royal College of Surgeons (England).
That is the change proposed in the Bill. It is solely a change of name. The training regulations and examinations currently applicable to the membership of the Royal College of Surgeons would be applied unchanged to the new LRCS.
The General Medical Council approves of this change because it is logical and makes the titles of the diplomas of all the colleges—both medical and surgical—similar. The new licensing registrable conjoint diploma would then become licentiate of the Royal College of Surgeons and licentiate of the Royal College of Physicians.
1899 In the next few years, in unison with our sister surgical colleges in Scotland, we anticipate using the liberated membership diploma to mark the completion of basic surgical training, and the fellowship to mark the completion of higher surgical training. The FRCS will then become the hallmark of the fully trained surgical specialist and together with the Certificate of Accreditation will be the indicator that the General Medical Council will use in its new register of specialist training.
As your Lordships know, the Royal College of Surgeons is a body incorporated by Royal Charter which will require amendment to create the additional class of membership to be called the licentiate. If there proves to be any difficulty in the timing of these changes, I would, of course be ready to table an amendment to delay the commencement order.
I hope that your Lordships will accept the logic of the Bill. The college gives its unequivocal assurance that this in no way alters the purpose, meaning or function of the Medical Act.

§ Lord Ennals
My Lords, it will be known that the noble Lord, Lord McColl, and I do not always agree, but we do today. I have had the opportunity of consulting with the Royal College of Surgeons, for which I have the greatest respect. Its members have rendered a significant service to the medical community and indeed to the community at large for nearly 200 years.
As the noble Lord, Lord McColl, said, surgery has expanded; post-graduate surgical training has become longer and it is clearly right that there should be an additional class of membership with a third diploma. The noble Lord, Lord McColl, spelt it out very clearly. There is no issue of principle here. The amendment brings the college up to date and in line with other surgical colleges, not only elsewhere in Britain but also elsewhere in the world and with the Royal College of Physicians.
I have no doubt that it is a wise move. I congratulate the noble Lord, Lord McColl, on seizing this bit of parliamentary time when we are waiting for other things to happen. We can fill in with useful bits of legislation that help people on their way. It is with much pleasure therefore that I not only congratulate him on seizing the opportunity, but say that from this side of the House we warmly support the Bill.

§ Lord Cavendish of Furness
My Lords, my noble friend Lord McColl very helpfully explained the background to this Bill. It is proposed to bring the college's primary qualification into line with those of the Royal College of Physicians, the Society of 1900 Apothecaries and the equivalent Royal colleges in Scotland, all of whose basic qualifications are shown as "licentiate" in the Medical Act 1983. For historical reasons, the Royal College of Surgeons has continued to award the membership, and they feel that the time has come to rectify the position. This therefore appears at first sight to be a simple technical amendment.
However, the matter is not without its complications. I have to say to my noble friend that the Government have some reservations about the way in which it is proposed that we should now proceed. The Royal College of Surgeons is a body incorporated by Royal Charter. I am advised that its charter would require amendment before the college could change the designations of its qualifications. Any petition for an amendment to the charter would, we think, require the support of the college's members. We understand, however, that the college has not yet consulted its membership. The very essence of the amendment which the Bill seeks to make therefore appears to be dependent on an appropriate amendment being made to the charter.
It is therefore arguable that we shall be putting the cart before the horse in going down this legislative route before all the necessary groundwork has been completed, including the consultations required under the college's charter. It will put the college in a somewhat anomalous position. I hope my noble friend will consider these points, and reflect in particular on whether legislation at this stage is necessarily the best way to proceed.

§ Lord McColl of Dulwich
My Lords, I thank noble Lords for their invaluable contributions to the debate and the noble Lord, Lord Ennals, for his support. In answer to my noble friend the Minister I point out that the problem in getting anything of this nature changed, even though it means only changing an "M" to an "L", is that it takes forever. The college feels that we have to drive this matter forward otherwise it may take an inordinate length of time. The council which made the decision is a body elected by the fellows of the college. We therefore feel that we are representative. However, we take the point that it may be wise to have a referendum of all the members as well as the fellows in order to make quite sure.
I.feel that that is not a reason for delaying the Bill at the moment. As I mentioned, we shall be very happy to table an amendment to delay the commencement order. I believe that that would get over the difficulty.