I should like to say a word on this Clause which makes the principal Acts applicable to Northern Ireland. I shall not trouble the Committee with the reasons why we welcome the Bill in Northern Ireland, because they were given during the Second Reading Debate. There is one point, however, which I should like to stress. It arises out of a remark I made during the Second Reading Debate which was taken up by the Attorney-General. I suggested that perhaps there had not been sufficient consultation between the appropriate authorities here and those in Northern Ireland as to the applicability of the Measure to Northern Ireland.

The Attorney-General affected to be somewhat shocked at my proposal that there should have been such consultations, because he suggested, in what I might describe as rather admonitory tones, that if that had been done, it would have meant going behind the back of the Government of Northern Ireland. It is perfectly clear now, from Section 47 of the Government of Ireland Act, 1920, that all matters relating to the Supreme Court of Northern Ireland are reserved matters; that is to say, that the Northern Ireland Government have nothing to do with them from the administrative point of view, and that they come within the exclusive jurisdiction of the Government in this country.

I wish to emphasise that, in the opinion of my hon. Friends who represent Northern Ireland constituencies, it would not have been improper for consultation on the lines I have suggested to have taken place, particularly with the Bar of Northern Ireland. Apart from that observation, I wish to say that we welcome the Clause, which not only applies the Bill to Northern Ireland, but also applies the provisions of the 1926 to 1940 Acts, which we think will afford much needed relief to the individuals concerned who are domiciled in Northern Ireland.

May I ask a question which I raised during the Second Reading, namely, why are the words "Divorce Jurisdiction" in brackets, whereas in previous Acts relating to this matter the words are not put in brackets? Perhaps my right hon. and learned Friend has found out the reason for this by now.

I am sure that it is common form. I do not pretend to understand all these drafting matters. but this is the way these Measures are commonly titled.

Has a bracket any legal significance?

Well!

We think this is a good Bill, complicated though it is. We hope that it will work extremely well in practice. I should like to stress, as I have stressed before, that as soon as possible we should have a consolidation Measure embodying all the Acts this Bill seeks to amend. Whether the Title of the consolidation Measure should include brackets or not, we can leave to further consideration.

I should like to ask one question which arises out of the previous Debate, namely, whether the Financial Secretary can say how much it is proposed to take from the Civil Contingencies Fund before such time as legislation is introduced, and whether such drawings will include both our initial payments by way of subscription and also our initial debit payments.

I am afraid it is impossible to give a detailed answer to that question in terms of figures. Of course, in so far as we need to make advances before legislation effecting the European Payments Union is produced, we shall make use of the Civil Contingency Fund, as my right hon. and learned Friend explained in his recent statement, thereby confirming what was foreshadowed in the previous Debate. However, I am afraid it is impossible at this stage to determine what the amount will be, still less to make a precise public statement to the House. Of course, any amounts involved, together with the other liability, will be within the new total of the Fund.

Would the hon. Gentleman answer the second part of the question, about including the initial debit amount?

It is not possible to foresee that precisely, but I think it is quite probable it will.

This small but very useful Measure I hope will commend itself to all sections of the House. In the first report that was published last November, the Local Government Manpower Committee surveyed the whole field of the relations between local government and the central Government. Most of their recommendations have been put into operation administratively. The only one that requires legislation is that embodied in the Bill. It has been an anomalous position for some time that the Metropolitan Boroughs had to go to the Ministry of Health for certain loan sanctions and to the County Council for others. I know, and I think hon. Members of all parties have known, that the Metropolitan Boroughs have resented this for some years and the County Council has not been anxious to retain it.

It gives rise to confusion and sometimes to duplication. It is vexatious when the Metropolitan Boroughs get loan sanction from the County Council in certain cases and then have to go to the Ministry of Health for compulsory purchase. Therefore, it seems to us it would simplify the procedure; it would be more economical; and it would serve as an additional emollient, if it is required, between the Metropolitan Boroughs and the London County Council if the Metropolitan Boroughs came direct to the Ministry of Health for all loan sanctions. I do not think it is necessary for me to explain any further what is a very simple Measure.

In relation to this Bill, I can speak in almost every relevant capacity, because I represent in this House a London borough, I am a member of its Borough Council and of the London County Council, and also, I think, I am the only Member of the Local Government Manpower Committee who is also a Member of this House. So I am a sort of Pooh-Bah in this matter, but fortunately, like Pooh-Bah, I have found my responsibilities, at any rate on this occasion, in no degree inconsistent with one another, because I think this Bill is welcomed from all quarters.

I would not go so far as the Minister in suggesting that this has long been a matter of very serious resentment amongst the Metropolitan Boroughs. En the London County Council I remember, three years ago, my hon. Friend the Member for Lewisham, West (Mr. H. Price) criticising the existing system because the boroughs found that, since the war at any rate, when they applied to the London County Council for loan sanction for housing schemes, it was a slower business than applying to the Ministry of Health. They had a sneaking feeling that the rest of the local authorities of the country could get their applications granted or returned with the official comments more quickly from the Ministry than could the Metropolitan Boroughs from the London County Council.

The subject arose ultimately almost by a side wind in the deliberations of the Local Government Manpower Committee. The Minister will remember how that Committee, whose recommendations in its first Report he has accepted, made certain suggestions to simplify the whole system of loan sanction applications from local authorities generally. It would have been quite anomalous to adopt those general recommendations and to leave untouched the existing arrangements between the Metropolitan Boroughs and the London County Council, which unfortunately were laid down by Statute, so that they could not be altered without an amending Act.

The London County Council, I know, sees no objection to changing this procedure. Why should it? It saves some manpower, and in that respect, if in no other, it would be welcome to local authorities at the present time. The London Borough Councils, while welcoming the change in procedure, will also watch with hope and interest to see whether their expectations will be fulfilled, and whether the Ministry can give quicker service in this matter than the London County Council has hitherto been able to do. I appreciate very much the decision not only to accept these recommendations but to put into operation the new system so expeditiously. I hope it will come into use from 1st October with the good wishes of all parts of the House.

I should like to know whether the Minister will be able to look favourably upon an Amendment which we have on the Order Paper at a later stage. Clause 1, of course, has been the subject of a great deal of comment and of correspondence with which all hon. Members, or at any rate those hon. Members with some medical qualifications, have been deluged. It seems to us that we could properly discuss many of these matters on the Amendment which we have to a further Clause, but I should not like to allow this Clause to go by default now without discussion, if it were held by the Minister and by you, Sir Charles, that these various points as to the certification should be dealt with here. It will be seen that in Clause 1 it is mentioned:

"… it is certified under the next following section that he has had the experience specified in that section."

We consider that the question, which this Clause undoubtedly raises, would be more appropriately considered under the next Clause where the arrangements for making such a certificate are laid down. If the Minister would agree to that and if you, Sir Charles, would find it in order, it seems to me that that course might be for the convenience of the Committee.

I understand that the right hon. and gallant Gentleman has suggested that I should indicate the attitude of the Government towards certain Amendments to Clause 2, by which the Opposition seek to substitute an affirmative Resolution for the annulment procedure. There is an Amendment on the Order Paper to Clause 2, page 1, line 25, to which the Opposition attach some importance. The question which arises on that is whether the rules governing the intern are to be the subject of affirmative or negative Resolution. I understand that is the the point now put. I do not mind it being discussed, but I will say at once to the Opposition that I am extremely sympathetic to that Amendment. Although it is perfectly true that any hon. Member would always have the opportunity of putting down a Prayer to annul the Order, in this case, as we are starting something extremely novel and exceedingly important to the doctors, the House ought to have it even more in its possession. Therefore I am prepared to accept the Amendment to make it an affirmative Resolution.

I beg to move, in page 1, line 25, at the end, to insert:

(2) No order shall be made under subsection (1) of this section unless a draft thereof has been laid before Parliament and has been approved by resolution of each House of Parliament.

The right hon. Gentleman has just indicated the attitude of the Government to this Amendment, and we on this side of the Committee welcome what he has said. However, it is right that we should have some discussion on this, because it raises important matters of considerable interest outside this House. Clause 1 lays down the general principle that a doctor is not to start independent practice until he has had some experience. It states that in the most general terms, and it is apparent that hon. Members on both sides of the Committee are in full agreement with that general principle.

Clause 2 provides the machinery by which that principle is to be carried into practice. Here we are on much more difficult ground. The Clause is not specific. For instance, it lays downs no precise period for intern service. I do not quarrel with that. Indeed, it is an Amendment made to the Bill in another place and it is right, on the whole, that the machinery provided by this Clause should be thoroughly flexible and capable of Amendment from time to time, in order to meet changing circumstances and to cover what experience may show.

There are, however, quite serious misgivings in various quarters as to how this change will operate in practice. The most obvious misgiving in this connection is that which all hon. Members have had communicated to them by those who are now actually in process of being medical students, who have entered the profession on the basis that they were to do five and a half years under instruction before they could begin to earn money, and now have some apprehension that they may have to do six and a half years.

12.15 p.m.

Unfortunately the hon. Member for Batley and Morley (Dr. Broughton) was not here to move his Amendment to Clause 1, page 1, line 18, so we have not been able to dispose of that point, but it would be helpful if the right hon. Gentleman would indicate when he expects this new arrangement will be brought into operation. It would be unfair to those who are now just about to finish their training to find that they have a long period still to go, so that if the Minister says he does not intend to bring this in for a year or two, it would go a long way to allay misgivings on that score.

Those interested in this matter from a rather different angle are concerned with the position of the hospitals. Are there enough house appointments to provide the further training which this part of the Bill contemplates? I have calculated that it will require three new appointments per group of hospitals. I am not sure whether that figure is accurate. There is misgiving in the medical profession that the effect of this will be to alter the quality of the work to be done by the men now filling house appointments.

I cannot follow the hon. Baronet. This Amendment deals only with affirmative Resolutions, surely?

I have gone beyond the narrow terms of the Amendment, Sir Charles, but I was indicating to the Committee the kind of consideration we would have to bear in mind when the order to be made under this Amendment comes before the House.

Further to that point of order, Sir Charles. It was with the object of having the discussion on this question arising out of Clause 1, that we waived the discussion on that Clause and got straight on to the point of the orders to be made. It was hoped by us that some wider discussion than the narrow one as to the orders might be in order in virtue of that arrangement.

I have already indicated that I am prepared to accept the Amendment in substance, but as usual we would like to look at the words. I accept the purport of the Amendment, which is to make these orders subject to an affirmative Resolution. May I suggest, therefore, that we can dispense with the Amendment, which would not therefore cause trouble with the Chair, and have our discussion on the Question "That the Clause stand part of the Bill," because there is no other Amendment to this Clause.

If that would meet the convenience of the Committee, I am perfectly willing to withdraw the Amendment and then to discuss the matter on the Question "That the Clause stand part of the Bill."

Is it the desire of the Committee that this Amendment be accepted?

In substance, not in form—

On that point, does the Minister indicate that he would wish to move on Report stage an Amendment embodying the affirmative Resolution, but in other words?

Yes.

In that case I think my hon. Friend should be pre- pared to withdraw the Amendment, and accept the suggestion that a more general discussion should take place on the wider question of the Clause standing part.

Perhaps the hon. Member will do that, and then we can carry on.

I want to be quite certain that the general discussion can range over the two Clauses together. We have deferred the discussion on Clause 1, and it would he unfortunate if we could not discuss both Clauses together.

I am in the hands of the Committee and of you, Sir Charles. I have not the slightest objection to the discussion on Clause 2 going as wide as is necessary to ventilate the points which have been raised.

If it be the wish of the Committee, the discussion can be as wide as necessary on the Question "That the Clause stand part of the Bill."

I beg to ask leave to withdraw the Amendment.

I beg to move, in page 2, line 21, to leave out from "applicant," to the first "the," in line 23, and to insert

"who has been engaged in medicine has also been engaged in surgery or in midwifery or both, or an applicant who has been engaged in surgery has also been engaged in midwifery."

This Amendment is intended to remedy an omission in the existing subsection, which, as it stands, provides for the way in which a doctor who engages during his intern service, in work which is a combination of medicine and surgery, or of medicine, surgery and midwifery, is to have that period of employment divided into so much time on medicine, surgery, and, where appropriate, midwifery, respectively. It makes no provision for the doctor who engages in work which combines only medicine and midwifery or surgery and midwifery. The Amendment ensures that the same arrangement shall operate in all three cases.

I have always been in a little difficulty about this, because it cannot be said that the intern is having proper experience if most of his experience is confined to a certain speciality. Therefore, it is necessary that there should be a proper division of time over the whole of the work, in order that he might take full advantage of the intern service.

It has been put to me in several quarters that unless proper arrangements are made—and this is the reason we attach very great importance indeed to the inspection of hospitals where the intern service is given—an intern might be confined to certain beds in the hospital which are dedicated to only one speciality. It is essential, therefore, that his experience should be spread as far as possible and that arrangements be made for the spreading to be done.

I think that the Amendment is reasonable. It is the first time that this question of the duties of the intern, which will of course be rather different from the duties of the houseman because they will be an integral part of the professional training necessary to obtain his certificate, has arisen; and I think it is a good thing that the Minister should have taken the step which he has done here.

We shall, of course, have to consider, both during the remaining proceedings on the Bill and later when the proposals of the Minister come up for affirmative Resolution, how the duties of the new intern are being worked out, because, as was pointed out on Second Reading, the intern is a new figure in our professional life, and in the hospital especially. It is certainly very necessary that he should have a wide general training and not merely specialist training which might easily happen if, for instance, he were in a ward connected with skin diseases. He might have six months' service exclusively on that, which would be of great importance if he were taking up that field of work later on, but might not be of any great advantage to him if he were trying to deliver a baby.

I think most of us would agree on the dangers of too early specialisation, and that however a doctor decides to specialise eventually, whether in administration, psychiatry, medicine or anything else, he ought to have a general knowledge of the background of medical practice and of the health needs of the people. Without this background he will not have the right perspective in the study and practice of whatever branch he decides to undertake.

I think that my hon. Friend is perhaps concentrating on the wrong Amendment.

The Amendment which I called was that to page 2, line 26.

That is why I think that my hon. Friend is addressing his remarks to the next Amendment: In Clause 3, page 3, line 14, leave out paragraph (b).

No, I am not.

The Amendment we are discussing reads:

"Where physical disability renders an appointment in surgery or midwifery impossible. …"

I propose to accept this Amendment in principle. The next one, of course, is much wider.

May I continue my argument in favour of the one we are discussing?

I am accepting it.

Thank you. Then I need not waste time in arguing the case.

I wish to refer for a moment to a point that would have been covered by the Amendment to Clause 1 in the name of the hon. Member for Batley and Morley (Dr. Broughton) which was not moved. I would like to draw attention to one group of people who are very worried about how the compulsory period of resident experience in hospitals will operate in practice.

I ask the Minister to consider particularly those whose medical studies were interrupted by the war, and especially those who, if they had not volunteered to join the Services during their medical training, would have qualified before the Bill comes into force. Many of these people are very keen to get into practice as soon as possible. They are older now than the age at which they would have qualified but for the interruption in their training; they probably have wives and families to support, and they are worried that they may be held up now for an unexpected period in hospital. I ask the Minister to bear this in mind. I fully realise the importance of the period of residence in hospital, but I hope that the Minister will make the whole scheme as flexible as possible, so that the particular group to which I have drawn attention will suffer as little hardship as possible.

As has already been pointed out, present-day students are a little disturbed, although perhaps unnecessarily, in that those who have already planned their lives, particularly those who are married, would find it difficult if there was to be separation or break-up of their domestic life in order to serve for a year inside a hospital. Although they are not many in number, I hope that my right hon. Friend will bear them in mind and give them an opportunity of opting out of this provision, which would, I think, meet their case.

12.30 p.m.

Apart from this, I think that students may be reassured on the effects of the Clause. After all, it offers them full employment at, I hope, a suitable rate of remuneration. Apart from the married men to whom I have referred they have not, therefore, a great deal to worry about. We have already had some reference by my hon. Friend the Member for Barking (Mr. Hastings)—and the Minister accepted his Amendment—to difficulties which might arise where men have physical disabilities. But this matter should be taken a little further than illness and physical disability. Not all medical students are quite alike, nor are they likely to find an equal amount of favour among those who might accept them. They may differ a little in stature, or in colour, and we ought to have some assurance that there is room for all of them when this provision comes into force.

Not everyone wants to be fully registered forever in his life in the full sense to which we are referring. If a man has completed his medical studies and obtained his degree, he may wish to work as a physiologist for the remainder of his life, or to go on to biochemistry. He may never want to practise. If, however, he wanted to come back into practice he could do so by obeying the rule we are making. I hope the Minister will give an assurance that in all these cases where the man is going into a sister profession, he need not register fully.

I know it is not possible to get an actual definition of "satisfactory service." If my hon. Friend the Member for Warrington (Dr. Morgan) had been present a little earlier, I think he would have discussed this point quite fully. It may well be that the individual should have a right of appeal against a decision that his service was not satisfactory. If that were possible, I think hon. Members would agree. I have bitter memories of the time when I was a medical student. Our teachers are human beings after all and show some favouritism sometimes. I was a victim of favouritism, that is to say, I was favoured at times and other people did not like me so much and I was not favoured by them. Looking back on my career as a student, I wonder whether this provision is going to be quite fair to everybody. It means that if the person who is to sign a certificate, does not like the student, may be—I put it no higher—a little biased or prejudiced against him. Can we not insert a safeguard for the man who has registered and done his full year and asks for full registration, so that there should be some method by which he could say, "I do not think this is correct, I do not think this is justice?"

The proposals for an intern year have been almost unanimously accepted as a wise addition to medical education by the informed section of the medical profession accustomed to deal with the training schools and medical education. At the same time, a large number of people in the medical profession, and some of the medical students, have failed to appreciate all that is involved in this matter. Many of them have false ideas of what the new proposals will mean and I do not think the Committee would be wasting time this morning if we examined in some detail with the Minister what his intentions are and if, as a result of that examination, we cleared away some of the misunderstanding which appears to be giving rise to objections.

I have found the objections extremely well summarised in a letter which appeared in "The Times" yesterday, with no fewer than seven points. If the Minister finds it possible to deal with the bulk of those objections in a comprehensive statement I think it will be very well worth while and will clear the air a great deal. I shall mention some of those objections in order to provide an opportunity to whoever is replying for the Government. The letter deals with the point raised earlier by my hon. Friend the Member for Hendon, South (Sir H. Lucas-Tooth) on the possibility of this extra year being a breach of faith with existing medical students. I have no doubt the Minister has some period of time in mind before this is brought into operation, which will remove any suggestion that there is here a breach of faith. Nevertheless, I hope he will be able to say something authoritative about that.

The next point which is raised is that of the power given to prescribe the period of internship is a power with no limit. The writer of the letter said:

"With the approval of the Privy Council the General Medical Council is empowered to extend indefinitely this period of tutelage."

I am quite certain that the answer to that is that both the Privy Council and the General Medical Council can be assumed to be responsible bodies who will not use the important power given to them in any callous way. Nevertheless, if the Minister can indicate that there is a limit of a year in his mind, it would remove that objection.

The next point is one to which I know students attach considerable importance. That is the question of satisfactory service. They want to know what their position will be if, after they have completed their qualifying examination and obtained provisional registration and served their intern year, a certificate of satisfactory service is refused them. Is there to be an appeal, or are they completely at the mercy of the hospital or the qualifying body under whom this period of internship is served? Have they no redress if the certificate is refused?

Then there is the question of the standing of the men and women in the service. They will be provisionally registered; will that entitle them to sign death certificates within the institution in which they are serving their year? Will it entitle them to prescribe dangerous drugs? Those are the outward and visible signs of statutory recognition and I hope the Minister will make it clear that within the institution, they can do those things and that provisional registration gives them that status.

Linked with that is the question of remuneration. The Minister told the House during Second Reading that these young men and women are to be remunerated. Can he give some indication of the type of remuneration? Is it to be merely the pocket-money remuneration of the old house physician and house surgeon, or will it be sufficient to enable these people to live with some reasonable degree of freedom? There is also the question put in this letter and put, I think, by the British Medical Students' Association of what guarantee they have that there are enough jobs to go round. I agree with my hon. Friend the Member for Hendon, South, that there should be very little difficulty in getting three or four of these people into each of the hospital groups of the country. But some reassurance from the Minister on that point would be extremely useful and certainly there should be an indication that, until he knows the posts are there, he will not begin to impose this period of training.

There are two other points which I will mention. One is the application of the Bill to different parts of the country at different times. That can give rise to a certain amount of misunderstanding and indeed of heartburning amongst students. A man in Scotland may find that it takes him a year longer to become fully registered compared with a man in England. The Minister ought to expound a little his views on that provision of the Bill.

Finally, attention is drawn in the letter to the separation of the married student from his family during this extra year. This extra year puts on the Minister an obligation to make certain that married quarters are available for any of these students who are married and who are so to speak confined to hospital for a whole year, with the possible breaking up of their family life. I have taken a good deal of time in elaborating these points because I know they are points which are misunderstood, and that it is well worth spending time over them. Any time that the Minister spends in making his intentions clear upon them will be time well spent.

I am sure that the hon. Member has not in mind the idea that students should take their wives with them into the hospital and that married quarters should be attached to the hospital? Will the hon. Gentleman say whether what he has in mind is that there should be available rooms reasonably near to the hospital where the students can live out, while they are working in the hospital?

What I have in mind is not the important consideration here. These are misgivings which are quite widely held and it is what the Minister has in mind which is the really important thing. That is what we want to find out today.

I should like to apologise to you, Sir Charles, for not being in my place to move the Amendment to Clause 1 standing in my name when it was called. This Clause and Clause 1 are closely related, and perhaps I might refer to Clause 1 in a general way when speaking about Clause 2.

It was arranged that there should be a wide Debate on Clauses 1 and 2 upon the Motion "That Clause 2, as amended, stand part of the Bill."

I remember that when I was studying medicine I had a fellow-student about 15 years older than myself. He was in Holy Orders and desired to go abroad into the field of missionary work. He wished to be able to give his attention to the physical as well as to the spiritual needs of the people. He had saved just enough money to be able to afford a medical education, he thought that he could spare just that amount of time. I am pleased to add that he achieved his ambition, he qualified in medicine and became registered, and I have no doubt that he is at present abroad doing most useful work in attending to the physical and spiritual needs of people. But if an additional period of time, even six months let alone a year, had been imposed whilst he was in training it would have wrecked his plans.

I hope, therefore, that the Minister of Health will give most careful consideration to the cases of hardship that may arise if this Clause is left without some amendment at a later stage. I said during the Second Reading Debate on this Bill that I wholeheartedly supported the suggestion that there should be a period of intern work after qualification. I repeat that. I can see the benefits that will flow from it, but I fear that there may be injustice inflicted in a few cases unless students are granted the right of appeal against it. When I say students I mean present students. Reference has already been made to the correspondence which has appeared recently in "The Times." Those letters state the case of the present-day students quite clearly, and I hope that the Minister of Health has read them.

12.45 p.m.

I have been approached by a medical student who is a retired barrister. I can give an indication of his age by informing the Committee that he will draw his postwar credit very soon. He wishes to spend the remainder of his life as a medical missionary in India. He tells me that if he has to put in an extra year's work of intern duties after qualification all his plans will be upset. He told me that had he known before he began his medical training that it would be necessary for him to spend seven years on the course he would not have started.

I have given just a few examples of the type of cases in which injustice may be suffered if Clauses 1 and 2 remain as they are. I hope that the Minister of Health will allow some Amendments at a later stage. Had I the eloquence of the Minister of Health, I feel that I could make a moving appeal for those students who might suffer hardship under the present provisions of the Bill. I have tried to put the case for them as best I can, and I hope that the justice of my claim has been understood. I would inform the Minister that the British Medical Students Association desire that all present medical students should be exempted from the provisions of Clause 1 and Clause 2. He will fail to satisfy them unless he grants that. My own view is that it would be unnecessary to go so far, but I hope that some right of appeal will be allowed in respect of those who would suffer by the operation of the Bill as it stands at present.

I should like to add such little weight as I command to the plea of the hon. Member for Stoke-on-Trent, Central (Dr. Stross) on behalf of those who may not intend to practise clinical medicine after they have finished their training. Is the Minister likely to be able to make any categorical statement about whether or not they will have to comply with the internship provision?

The other point I should like to stress was made by my hon. Friend the Member for Putney (Mr. Linstead) about the question of satisfactory service. I should like to invert the way in which he expressed the point and ask whether the Minister, in framing these Clauses, has had in mind any specific ways in which dissatisfaction may be given? What will constitute "unsatisfactory service"? Or is it entirely a matter for the judgment of the employers of the intern in question.

My third point is whether the right hon. Gentleman can yet give us any indication of what will be the length of the term of service of an intern. Is the right hon. Gentleman likely to start the ball rolling with a full year, or will six months or even three months be more likely to represent the period of the first term?

I apologise for being late in coming from hospital this morning. I think there must have been some misunderstanding about the time, because I was told to be here not later than 12.30 p.m. and I kept to that time; but I apologise for not being here to move my Amendments which, had they been taken, would have dealt with many of the points now under discussion.

I wish especially to deal with the question of unsatisfactory service during this year of provisional service. I would ask the Minister to consider if he can, having regard to the source from which it comes, the question of granting the right of appeal to all medical students who are alleged not to have rendered satisfactory service during the year of provisional registration. As has been said, some of us have had that experience. I had a nice time at my university—Glasgow University, said to be one of the best in the country—but when I came out to get a resident appointment post in a hospital, because the religion of the country was different from my religion and because my politics were extremely different, I could not get a look in.

I remember how enraged was one of my professors to think, after everything I had done, that that should debar me and that I must go elsewhere to get an appointment. I even thought of going to Ireland where, no doubt, in the home of tolerance, I should have been much more cordially received. I would therefore ask the Minister to consider the question of giving to a student debarred during the course of his year for allegedly not having rendered satisfactory service, the right of appeal; with a sworn statement from whoever came to the decision so that the student may have the opportunity of answering the case against him.

A man may render certain "unsatisfactory service" because of his medical theories. I remember in the course of my training as a medical student, the great Professor MacEwen, one of the finest surgeons that Scotland has produced, telling a class quite candidly that when he was being examined in England for his F.R.C.S., and he gave his method of operation for certain things such as the brain and for hernia and things of that kind, he was laughed at. When he was asked, "Whose operation is that?" he said, "Mine" and they told him he was talking nonsense. He replied, "Well, I have done 300 or 400 cases already," and he was laughed at still more. But MacEwen's operation became a recognised operation—not so much in England, but it is still being performed in a modified form in Scotland. His brain surgery stands on record for ever and ever. There was a man with skill, knowledge and inventive ideas who was, so to speak, turned down on the grounds of—in those days—unsatisfactory service. The same thing might happen now during the provisional registration period.

There are not likely to be sufficient hospitals to which these men may go and what will happen then? Suppose this man cannot get into an institution because of the number of students vis-é-vis the number of vacancies? Is he to be kept waiting for his appointment, just as at present many men cannot get into a medical school for studentship? When a man is qualified, he may have great difficulty in finding a hospital recognised for the purpose of giving him his provisional registration. These points may have been covered in previous discussion, and if so I am sorry, but I do want the Minister to keep them in mind, because one of my Amendments sought to give a man the right to appeal to a special tribunal, and it would have covered that point.

A student may have gone to considerable expense to plan not only his studies but his finance without having taken into account this extra period. I know he will get £350, but he may have borrowed the money from his parents, or won a scholarship which does not take him further than three years. I know that I shall be told that certain local authorities will come to his assistance. But so far as I know—it may be changed since the time I got into Parliament and left my local authority experience behind—when giving grants of this description, local authorities have to do so with an eye on the auditor. or they may be reported as having dispensed local authority finance unjustifiably.

I hope the Minister will look at this Clause again and give an opportunity for revision and if necessary Amendment. The important point is the hardship incurred by a man who is declared unsatisfactory or to have given unsatisfactory service, when, before any fair board, he would be recognised as an efficient man, capable of doing his work.

If I may complete the speech which I started to make on an earlier Amendment and adapt what I have said, I would point out that this is of course a machinery Clause with which we are now dealing. Discussion has ranged over the general merits of the case, but it is important that we should have some regard to the actual mechanism.

If we look at subsection (1) we see that the order to be made under that sub- section is an order which apparently is to relate only to the period during which the intern service is to be performed. In terms, I think, that is the effect of this subsection. But it is also true that the appointed day, under Clause 1 of the Bill, is to be made by, I think, an order of the Privy Council, and will presumably come before the House. I am not sure whether it will be necessary to incorporate it in the order under Clause 2 of the Bill or whether it will be a separate order. But it is important when an order is brought forward to bring this Clause into effect it should contain as much as possible of the machinery which is being brought into operation.

So far as I know, the question of the payment of a provisionally registered doctor during this period will not necessarily come before the House at all. I would ask the right hon. Gentleman whether that is his intention. It seems to me, on the whole, that it would be a good thing if the order did contain general provisions regarding such payment. I am not certain how the payment is to be arranged for. It may be through the ordinary administration of the hospital or it may have to be by some order. It would be interesting if the right hon. Gentleman would tell us, and we should all like to consider the matter before we reach a later stage in the Bill.

There is also the question of the possibility of allowances being paid during this period. I do not know whether allowances would be payable especially, or whether they would be payable by the employing hospital or health centre, or whether they would be dealt with in the order. It would be essential to provide substantial allowances in some cases. For instance, where a rather older man comes in and he has a wife and children, he would have to have something over and above what would be a proper payment to a young man who was simply doing a preliminary period of one year's service. Would that be covered by the Order? If not, how would it be dealt with? I hope that the right hon. Gentleman will answer those questions.

I am delighted that the Minister has accepted the principal Amendment to this Clause, because a method of medical administration which may have been appropriate to the Acts of 1858 and 1886 has been inappropriate since 5th July, 1948, when the Minister took a much more intimate responsibility for the health of the people. I should like to emphasise the point made by my hon. Friend the Member for Hendon, South (Sir H. Lucas-Tooth) that, as matters are at the moment—and it may well be a flaw in the drafting of the Amendment we put before the Committee—it appears that Parliament is only to have control of the actual period of intern service. I think that hon. Members on both sides would like to go rather more deeply into the matter than that. When this period starts, there will be a wastage, for one year at least, of general practitioners entering the Service. It is a matter for Parliament to discuss at what point in the development of the National Health Service we can afford that wastage.

The question of universal service has been discussed. Clause 34 gives permission to introduce different dates for different parts of the country, and Northern Ireland was quoted as an example. I suggest that the differences are not all purely in time or in geography. The question of universal service is well worthy of consideration. For example, it might be expedient, for a limited period, to allow doctors who have completed their ordinary training to go into practice in under-doctored areas. It might be expedient to allow them to act as assistants to group practices or, perhaps, in the few health centres which we have and which we hope will increase in number.

The advantage of that method is that we should get more quickly the doctors we need in the places where we need them. The disadvantage, which I need not stress, is that some men might not be as highly qualified and they would, in any case, lack intern service.

It is my view, from such researches as one is able to make without official services being open to one, that there are enough posts available for these men and women. But in this matter we cannot simply equate vacancies with candidates. We may well find that, both temperamentally and medically, we have at the end a number of round holes and only square pegs to fit them, where it would be unfair for a man to have to take the only vacancy open to him. I think the Minister might consider whether exemptions cannot properly be made.

I appreciate that the Minister may not be able to answer all the questions put to him today, but I think the question of salaries is by far the most important point which we shall discuss during the Committee stage of this Bill. There is some anxiety outside. The Goodenough Committee recommended that free board and lodging and something between £75 and £100 should be paid. If we put that in terms of the value of money today, it might be £150 to £200. Even that is considerably below the amount of money paid to some one holding a house appointment. Nothing would do more to remove the uneasiness than a clear statement about salaries.

There are a number of medical men in this House. There are half a dozen in the Chamber at the moment. It is one thing for organisations who gave evidence before the Goodenough Committee from their established positions, to say that it is desirable for this extra year to be added to a student's training. It is another thing when a man has planned his life, perhaps planned his marriage on graduation and his National Service, so far as he is capable of planning that to fit in with his training, if he finds that there is to be another year of training. Perhaps he may be getting to the end not only of what he thought was his medical training, but also of his own and perhaps his parents' savings as well.

I strongly endorse the suggestion that those at present engaged in medical training should not have this extra year put on to them. I agree that the students' committee before the Goodenough Committee recommended this, but any association or trade union invariably recommends, on Benthamite lines, what they think is for the greatest good of the greatest number. However, there are people undergoing medical training, to whom this is a new conception, who may well be penalised by the imposition of an extra year or indeed more.

As one who has spent the greater part of his life in the training of house surgeons, I should like to say a few words especially about satisfactory service and the right of appeal. There will be very few cases in which a surgeon or physician in charge will feel justified in saying that a man's service was unsatisfactory, and if the right of appeal were agreed to, there would be even fewer. One must remember that if the right of appeal is granted, the chief would be put into the witness box, presumably, and asked all sorts of questions about his house surgeon and, possibly, even submitted to an action for libel.

Looking back through my medical history, I can remember only one case in which the service of a house surgeon was really unsatisfactory. The surgeon was an individual in a children's hospital, and perhaps the most charitable thing to say would be that she failed to prevent the deaths of four children in a fortnight, and then she was asked to resign. That is the only case in my experience where I could have said that the service was unsatisfactory. In an event such as that, I think that the right step to take would be to let the house surgeon have another try at another hospital. Even if a surgeon has fallen down once, that is not sufficient to prevent his becoming a registered medical practitioner. I hope that this point will be left as vague as possible and that it will be for the medical or surgical chief to say whether the service is satisfactory. I do not think that there will be many unsatisfactory cases.

We have had an extremely useful and necessary discussion. A lot of anxiety has been expressed on a number of points and it is just as well—in fact, not only just as well but highly desirable—that that anxiety should be allayed as far as possible. However. I would point out that, as the hon. Member for Hendon, South (Sir H. Lucas-Tooth) said, this is a machinery Bill. Very largely, it is an enabling Bill. The Minister of Health is not accepting any additional academic responsibilities. He is accepting none at all, because it has been not only the theory but the practice of our constitution that the Government does not intervene either in the organisation or the content of the curricula of our educational establishments. They are under the great educational corporations and the universities.

Therefore, I would at the very outset try to get rid of the idea if there be any misapprehension about it—that the Minister of Health is here accepting responsibility for the content and management of medical education, because he is not. This is being still entrusted, some part to the Privy Council and some part to the medical corporations, all of them acting jointly, and especially where we come to inspection in the later parts of the Bill. I thought it necessary to make that quite clear at the very outset, because I see that the Minister of Health, as usual, has been selected for certain remarks which have now become almost habitual—I do not mean from the salubrious seaside resort from which the hon. Member for Luton (Dr. Hill) has come—but by some who have written to the newspapers.

Let me say at once that it is necessary for us to have a sense of proportion and keep an even balance between the legitimate affairs of the medical students and the requirements of the public. We are, in this House of Commons today, the trustees of the general public, and we must always have regard to the fact that it is not our duty to let loose upon the community what might be regarded as under-educated doctors, nor to protect individual doctors from what might appear to be hardship. It is always the case that the corporate body has a voice in the House of Commons, but the only way in which the general public can have a voice is by our zeal on their behalf, and we must always keep that before us.

On the other hand, it is perfectly true, that the implementing of the Goodenough proposals does mean that the State intervenes and alters the plans which the private citizen makes for himself when he intends to go in for medical training. Therefore, what we must do is to try to mitigate the hardship as much as possible and see to it that the arrangements made bear as little harshly upon the citizen as is consistent with the public interest.

In the first place, this is not going to be sprung upon the student immediately. It is going to take between a year and two years to make these arrangements, because, of course—and this answers one of the questions put to me—it will be quite improper for the State to say that a doctor cannot be fully registered and enter into general practice unless he has an intern year in an approved establishment which has failed to find a place for him. Both must go together. It must be made quite clear that it would be intolerable if we said to him "You have not qualified, but we do not propose to give you the opportunity of doing so." It must be quite clear that we cannot fix the period when it starts to operate until we have reviewed the establishments and made the posts available. I hope this will also assimilate part of the trouble that was raised by the hon. and gallant Member for Chelsea (Commander Noble) about ex-Service men. I should have thought that, by the effluxion of another year or two, most ex-Service men would have passed from the schools, and that there would not be very much hardship there.

In the next place, not only have we to provide the posts in hospitals, but it is quite clear that, at the same time, we must also be able to see to it that the hardship is mitigated as much as possible on the financial side. It is. therefore, proposed, to create posts carrying £350 a year for the first six months and £400 a year for the second six months, with a deduction of £100 for board and lodging. I think the Committee will agree that these are fairly generous sums to be paid, and, indeed, many general practitioners will say that it is more money than they earn in their first year of general practice before the war, at any rate. I think, therefore, that we complain that, so far as we can. we have gone some distance to meet the hardship that would fall upon the student. I hope that, after that, I shall not be pressed to make exceptions.

Before the right hon. Gentleman leaves the financial part, will he say whether there will be any arrangements for allowances in the case of those who are married?

I am afraid not; at least, it is not our present intention. After all, some of the students will be married already, and its does not necessarily follow that we are imposing a hardship. We are giving £350 and £400 a year, and, at any rate, I dare say that, as this is a machinery Bill, these conditions, therefore, are not conditions which I impose. At the moment, I am merely telling the House what the general intention is. We shall have a look at the point, however, and see whether anything further can be done in that regard.

Will this be technically applied at the beginning of a provisional post, for entry into the National Health Service Scheme? It is the superannuation implication which I have in mind.

That is a very special point, but I should have thought it would be understood that these sums must be carried on the Ministry of Health Vote and not on the University Vote or the Education Vote. Therefore, those doctors who are provisionally registered, will be employees of the hospital, and I should have thought that it follows almost inevitably from that that the term of service in the National Health Service would date from the beginning of the internship. But I hope the hon. Gentleman will not keep me strictly to that. I should have thought that it would be a logical inference, and it may be that the logical inferences of the Minister of Health may be regarded, by some pepole, as an indication of what might happen.

The internship period is also necessary because, for the purposes of his post as a fully qualified doctor, he has not yet gone into general practice, but, of course, for all the purposes connected with his work in the hospital and in connection with any work which might be given to him arising out of his internship, he is a doctor, and hon. Members will see in different parts of the Bill how that is provided for. Of course, some people have asked if it is fair to a person who has made his plans, based upon the assumption that his training is going to come to an end, that we have added another year, but we have got to start sometime, somewhere. If we are to carry out the recommendations of the Goodenough Committee, we must begin at some point or another.

The suggestion is that we should begin with the student coming in, and that means that our scheme will not come into full operation for seven or eight years. Surely, that is going far too far, because he is a person who will have made his initial plans, and who knows that he is going to study to be a doctor, in the light of what he considers to be the number of years which he will have in which to qualify. We are adding a year to that. But I should not have thought that he would want to go back as far as that. I hope I shall not be pressed to give concessions on grounds of hardship. Why should this House send out into the world of general practice one who is less well-trained than we think he ought to be? That, surely, is to the detriment of the patient, and is not good for the doctor. When the date falls, it should fall upon all the medical students, as, otherwise, one medical student will go through his life with a black mark. It will be said, "Oh, you did not have the year's intern, but your colleague had it." Therefore, I should not think it would be wise to invite the medical student, because of some temporary embarrassment to handicap himself by not having the benefit of the one year, and I hope we shall not be pressed in that respect.

There is a good deal of anxiety about this business of satisfactory service. Of course, it is almost a subjective term, and because it is subjective, it is the very one that causes most fear. All of us can understand it, because it is so difficult to define. Nevertheless, it is already in use. I have asked for information about this, and I am informed that it is similar to the signing of certificates now required to show a satisfactory attendance at courses of instruction before a student can sit for his final examinations.

These certificates cover conduct as well as attendance. They represent the opinions of all the people under whom the student has worked. Similarly, certificates of satisfaction will reflect a number of opinions, and there should be no possibility of victimisation by a single individual on personal grounds. The certificate itself is given by the licensing body, that is, by the medical corporation immediately concerned. Therefore, there can be no possibility—indeed, it would be frightening if there were—of a superintendent of a hospital, who might have developed a "grouch" against an intern, reporting upon him unsatisfactorily, because he would, surely, have the collective opinions of all those with whom the provisional doctor had worked in the whole of the year.

I hope, therefore, that we shall not be pressed to give a right of appeal. With whom could an appeal lodge? We cannot have an appeal against a board of examiners—I do not think the animal exists in the whole academic body. The examination takes place, and, I should have thought, takes place as objectively as possible, and sometimes, as we all know, as impersonally as possible, so that the name of the examinee does not appear. I should not have thought, therefore, it was possible to think of a body to whom an appeal could be made which would not detract from the authority of the examining body itself.

Will there be an examination in this case?

No, it is a report. As we all know, under the normal school system, the certificate is not validated until a year's satisfactory service is given in the schools, and the inspector reports upon the teacher. If that happens with regard to a school teacher, how very much more important it is in the case of a person to whom we are entrusting the welfare and the lives of the whole population. Therefore, I hope that we shall not be pressed on this matter of appeal.

I hope I have said enough to reassure the student that he is not putting himself in the hands of some individual who might have a spite against him. We must remember that when a person reaches this stage, he is provisionally registered. The intention is not to put up another hoop through which he has to jump; the intention is to give him a year's experience in association with specialists and with a diverse kind of hospital work, so that when he goes out into the world as a general practitioner he will be a better craftsman. It is not intended to put another obstacle in his way; it is intended to be, as it were, the consummation of his general medical training. Further, if an appeal can be made against the report on the student, would there not be a disposition to say, "Oh, well, he can appeal."? There may be a tendency to increase the number of adverse reports if it be present in the mind of the person sending in a report that, after all, an appeal can be made. I should have thought that, having regard to all these matters, the Committee might perhaps permit us to go on with the Committee stage.

Would the right hon. Gentleman answer one question for me on this? Is it possible for the intern who gets an unsatisfactory report, to seek another post at which he can have a second year?

Certainly; there is no reason at all why if he has "blobbed it," he should not have another opportunity. Anything can happen to a young man or woman at that time. They may have got themselves into a very unsatisfactory set of domestic circumstances or bad companionship. Any kind of thing can happen. Anything can happen to all of us; it sometimes happens in Committees that we get at odds with the world. Therefore, if a person has had a bad time, he ought to be given another chance in another hospital so that he can serve another year.

There is one thing about which I have been rather worried since we made the Amendment, and that is its coming into operation at different times at different places. For the life of me, I cannot see how it is to operate, and also I do not see how it is going to operate with reference to reciprocity with Eire. I think the present intention is to bring this into operation everywhere at once. I just do not see how it is possible for us not to have all kinds of discriminatory, charges, when a doctor goes straight into general practice in one part of the country and another doctor, in another part of the country, is kept back a year. Having regard to all the administrative perplexities, we come down on the side of applying it universally. The power to vary the period is merely for the purpose of emergency.

I think that the Minister has performed a very useful function today in giving us a forecast of what he has in view. I trust he will be able to answer the point pressed by one of my hon. Friends, and which, I gather, he did not answer, namely that the affirmative procedure would not be so narrowly drawn as merely to cover the time, but that the regulations which were being submitted to the House for affirmative Resolution would take into consideration some of the points which he has been laying before us this afternoon.

I am very glad I was asked that question. The answer is, as the right hon. and gallant Gentleman knows, that if we put too much of what might be regarded as rules into the orders, they cannot be varied without another order. Therefore, to some extent, it would handicap the administration, which would need to be as flexible as possible. For example. if we put the terms of remuneration in the order, we could not alter them without coming to Parliament. Therefore, any negotiations that took place could always be subject to legislative approval. I doubt very much whether we want to put too much of that detail in the order, but what we will have to put in the order will be the intern period, and things connected with that.

There is a point on this which the Minister may not be able to answer now, but I should be grateful if he will look into it. In Clause 2 (1) there is a reference to regulations of the Council approved by order of the Privy Council. That brings Parliament into the picture, but in Clause 2 (2) in line 7 there are regulations of the Council without any conditions of approval by order of the Privy Council. Similarly, in line 17 there are regulations of the Council again not to be approved by the Privy Council. Therefore, it looks at first sight, at any rate, that in the case of those two regulations Parliament is left out of the picture. Is that right and, if so, is there any reason for it?

Yes. Parliament is left out of the picture quite frequently when rules are made. When regulations are made—they are not rules usually—they can be prayed against. Where they are rules, Parliament is not brought into the picture, except by raising the matter with the Minister either on Supply, or in another way, because, as hon. Members will appreciate, it would be very difficult if Parliament tried to concern itself with such minutiae as that.

But these are all concerned with periods of time and nothing more.

Is it the intern time that the hon. Member has in mind?

Intern time must be approved by order of the Privy Council, but the other two periods, which are only periods of time and nothing else, are left entirely to the discretion of the Council.

May I ask if the Minister would have in mind in this connection the question of the exemption of the "deviationists" who go into biochemistry and other things?

We could not possibly do that. If a man said he had qualified and wanted to be exempted from the intern year, because he did not want to practise clinically, he would be a very queer kind of medical animal. We should not know what to do with him afterwards.

The universities are full of them.

That may be so but, as far as I know, nothing at present stops their practising clinically if they want to do so. There is no law—

There is no law against anybody practising, qualified or unqualified.

Yes we know. What we mean is that they are on the Medical Register, and therefore can practise clinically. Would those persons say they would not want to be put on the Medical Register? I think it would be found that we could not frame an Act which would put them in suspense, as it were. They are so difficult to define. They would be like Mahomet's coffin. They must come down on one side or the other, otherwise we might have some who do and some who do not intend to go into clinical work, or some who do not but who might.

I will, if I may depart from consideration of Mahomet's coffin. You may not know, Major Milner, that I did catch your predecessor's eye, and what was going on just now was a series of sub-committee meetings of the Committee. The particular point I was raising with the Minister was whether the regulations should only cover the time or go a little wider. I agree with him that one does not wish to be too meticulous, because the old maxim that to include one thing is to exclude another holds terribly true in these things. If the Bill permitted discussion of these regulations to range wider, it would be to the advantage of all of us.

Obviously, before such regulations were drawn, they would be the subject of close consultations with my hon. Friend the Member for Luton (Dr. Hill), in some of his other incarnations, or possibly with his successor. But I think it would be desirable that here in public we should have the opportunity of reviewing the matter. The Minister knows, as well as I do, that when an affirmative Resolution covering something is submitted, it may be a narrow Parliamentary opportunity. The things we have to review are not narrow. I am sure it would be to the advantage of the Minister, and certainly to the advantage of the House and the country, that discussion should further enlighten all those concerned, as discussion this afternoon is further enlightening all of us who are taking part in it.

I do not wish that these things should be written into regulations, but that the regulations should be so drawn that they do not limit Parliamentary discussion so closely that it would be impossible to raise these matters on the Floor of the House. I should be glad if the Minister could keep that in mind. Obviously, this will not arise immediately, because, as he says, it will be a year or two before such regulations have to be laid before the House. If words like "and connected therewith" could be introduced to enable these difficult points to be raised, it would be to the advantage of all of us concerned.

I am sure the Committee is working at its very best today. It has a piece of ironwork on the anvil before it, and is actually hammering it out here. Several points have been raised on which I think we, on this side of the House, are agreed with the arguments the Minister advanced. There is, for instance, the point about appeal. I do not see how an appeal from an examiner can lie. I think the Minister went far to meet that point when he said it would "encloak," so to speak, the views of a number of persons, and would be similar to the certificate of satisfactory service which an inspector gives in the case of a school. I think an appeal to an outside body, which could not possibly have the same opportunities of examining or considering the work of the person as those who have originally been in the position of giving the certificate, would put the unfortunate man almost in the position of doing another term of service under the supervision of an examining body. It might lead to confusion worse confounded.

It is for the reason that these will be discussed closely between representatives of the student body, the professional bodies, and the Department that freer discussion on these points, when these regulations come up for affirmative Resolution, will be of very great advantage to all concerned. Again, I think the Minister was probably right when he said that the scheme will have to come into operation everywhere at the same time. A provincial qualification or relaxation would be a most difficult thing to operate. I believe that in the University of Bologna a student who did not entirely satisfy his examiner was given a certificate marked. "Bon pour l'Orient" or "All right for the East." And "Exempted from intern service because no post available" would be an awkward endorsement to have on a certificate for any of us.

The Minister is probably right on the point made, on this side, that those not desiring to go on with this, or those desiring to go in for something like special service of one kind or another, should be exempt. The simple line on that is not to have one's name entered on the Medical Register. I do not think that it is possible to say that a man who may afterwards change his plans and not desire to go on with his particular special qualification should be entered as a fully-qualified man, when in fact his qualification was less than that of one who had studied alongside him. I think that if on a subsequent occasion he wished to enter into general practice, it would not be possible for him to do that houseman training. I think that it would be very necessary indeed, if he was going to enter into general practice, that he should have some kind of refresher course, because a long period in research severs one very much from the rough-and-tumble of the actual practice of medicine.

I remember Lord Boyd Orr telling me of his mental distress when, having spent his early years after qualification in high research, he found when he entered the Army that on account of his singular qualifications he was immediately put in charge of wards containing a number of acutely ill people, and told he must be properly able to look after them. This caused him mental anguish and distress, and a great deal of hard work while he was polishing up his rather rusty medical knowledge.

The right hon. and gallant Gentleman is talking of men who are going into research. Let us take the man who wants to go into tropical medicine. Why should that man, in view of the limited number of hospitals here, have to go into hospital and serve his term of probationary service when he wants to get into tropical institutions here. If he can get into them, let him do so, but if he cannot, then let him go straight to the tropics.

Surely, anyone going out to places far removed from the medical schools to take up tropical medicine, ought to have an acquaintance with general medicine, because he will have this work thrust upon him at short notice by people who trust very deeply to a medical qualification, and who may feel justly aggrieved if they find that he has escaped some particular course of training, which another man beside him may have taken.

I think that the right hon. and gallant Gentleman is doing an injustice to the medical schools if he thinks that a man after five years of study—despite the year he has not spent in a resident medical capacity in a hospital—has no knowledge of medicine at all. That man up to the present will have done excellent service and will have excellent knowledge.

It is straining it to say "no knowledge of medicine at all." It is a recommendation of the Committee that this extra refinement of medical education should be universally applied, and, if it were, I cannot conceive any person to whom it would be more rightly applied than to the man going abroad, who is severing himself from immediate contact with the great apparatus of healing available at short notice in this country. That is a difference of opinion. I only say that, on this, I myself would share the view which the Minister has put forward.

The suggestion as to remuneration has been worked out fairly closely by hon. Members on this side, and the remuneration in terms of cash now would be about £150. The sum suggested is about £200 with a reduction of £150 for board and lodging. I hope that the Minister will keep his mind open as to the possibility of a supplementary allowance of one kind or another. There are a number of people of considerable seniority who are now graduating and who have wives and families. A man with a wife, and possibly with a family, who is not able to get accommodation in married quarters, would find the sum of £200 small enough, to maintain his household in separate quarters. The Minister intimated that he would keep that in mind, and I trust that he will. All these are matters which will he threshed out in the year or two that lie immediately ahead of us. I think that this is as far as we can usefully carry the discussion on this particular point this forenoon.

Another opportunity will certainly arise, and for that we are grateful to the Minister for accepting our Amendment that when the affirmative resolutions come up to be debated and the actual enabling Bill has enabled the machinery to be set in motion, and the actual proposals affecting the individual lives of the graduates are before us for consideration, we shall have an opportunity to review these matters. I am sure that a useful purpose has been served by the discussion this morning. and that many of the doubts and fears put up to us by the Students' Association and others have been dispelled today.

I beg to move, in page 3. line 14, to leave out paragraph (b).

I hope that I may be permitted very briefly to put my case before the Minister, and that he will unequivocally accept my Amendment, as I have no doubt he will, when he has heard the arguments. I agree entirely that there can be no better training for a general practitioner than to take part in the general work of a health centre, to undertake substitution duty for all those working there, and to be specially attached to perhaps one or two of the senior members. In my view no better training can be imagined for general practice.

But when we come to the special departments which, we hope, will be working in the health centres, and where on one or two days a week, the skin man, or the nose and throat man, or the eye man from the hospital comes to the health centre to see, not just ordinary cases but cases sent on by the general staff of the health centre, about which their combined wisdom cannot find an efficient answer, and the needs of the services of a specialist are required—in such cases, I regard the work in the specialised departments as first-class training for young specialists but not for the provisionally registered doctor who is wanting to obtain a complete registration. Therefore, I hope that the Minister will agree with me in proposing the deletion of paragraph (b).

It will be within the knowledge, I am sure, of hon. Members that the provision relating to health centres was put into the Bill in another place. I accepted it, but I am bound to say I did so with considerable misgivings. I thought that it would have the consequence of detracting from the value of the Bill itself unless it was handled with extreme care.

First of all, it is the hope—although I think that we must keep some sense of proportion about it—that subsequently most general practitioners will be engaged in group practice, and will be operating from a building which might be described as a health centre; but everyone knows that health centres can be variously defined. We can have a very big polyclinic centre, in which there is a considerable variety of diagnostic facilities alongside maternity and child welfare centres, local authority dental and ophthalmic services, and the whole range of personal medical services outside the hospitals. It might be possible to find a health centre of that sort as a place where the year intern service could be served, but we have none of them at the moment, as far as I know, and it will be a very long time indeed before the country is going to have them, if ever it does have them.

These are institutions which ought to be examined further before we embark upon them, because unless we are careful they will be merely reproductions of the hospital itself, apart from the fact that they will not have patients staying in them. I am extremely doubtful about this proposal, and I hope that when these institutions come to he approved it will be done with extreme frugality. I should have thought that one of the main purposes was to bring the would-be general practitioner into daily contact with the specialist services. The effect of the Amendment will be to deny to the intern physical access to the work of the specialists if he happens to be in an outpatients department of a health centre. That would surely be a distortion of the whole thing, and would merely mean prescribing an assistantship only for the internee year.

May I point out that the Clause does not say "employment in the general service and employment in such out-patient services," but either employment in the general service or in such out-patient services? I take it, therefore, that the meaning of paragraph (b) is that employment in the special out-patient services takes place only in a health centre, and will qualify as an intern period.

If we had to choose between the two, I would select paragraph (b) as against paragraph (a), because in the case of paragraph (b) the intern would be in daily association with the specialists, whereas in the case of paragraph (a) he would be in daily association with general practitioners. If it be the fact that ultimately we want all doctors to work in group practices from health centres, we shall be prescribing that the intern year shall normally be service with general practitioners. We do not want the interns to serve in health centres, but to have a full variety of experience of all the services.

I think that the Minister's arguments are unanswerable. It is desirable, most of all, that this intern period shall be spent in a hospital, and that it shall not be merely a year attached to the end of a man's training. I agree that if there is to be a second-best and a third-best, this opportunity for specialist work in the out-patient department, particularly in the field the hon. Member for Barking (Mr. Hastings) suggests, is the second-best. I wish to underline what the Minister has said—that these alternatives are less desirable than the hospital. I hope that we shall not get into the habit of regarding this as a year added to the ordinary medical education, but rather as a phase of responsible work. I suggest that paragraph (b) is important, but that both are less important than the main theme.

I so seldom agree with the Minister on this Bill, that I should like to say that on this occasion, like the hon. Member for Luton (Dr. Hill), I think his answer is unanswerable. In an institution an intern may get every practical phase of medical diagnostic skill portrayed to him. He may even get mental cases, but at a health centre he is very unlikely to have any experience of such cases, even if a psychiatrist were at the health centre. I hope that when a man wants to specialise he will go into a mental institution after his period of service is over, and that he will not spend this extra year in a mental institution. If he wants to specialise, he should go to an institution after his training.

In view of the fact that the danger which I so seriously apprehend is not likely to come about until there are more health centres, I beg to ask leave to withdraw the Amendment.

I beg to move, in page 4, line 20, to leave out from "registered)," to "registered," in line 22, and to insert

"for the words 'under this Act' there shall be substituted the words under the Medical Acts or provisionally so.'"

Perhaps the Committee will permit me to explain the purpose of this Amendment and the following few Amendments standing on the Order Paper. They are not as formidable as they look, nor are they the result of second thoughts about the Bill. On the contrary, they are the result of the fact that, after the Bill emerged amended from another place, the Parliamentary draftsmen sought to take this opportunity of anticipating consolidation, and therefore to alter the nomenclature so that the work will be simplified when consolidation takes place.

I beg to move, in page 4, line 46, at the end, to add:

(8) A person provisionally registered under this Act shall have all the duties and privileges of a registered medical practitioner but only while serving in an approved hospital or institution as defined in Section one.

What medical students are everywhere asking is what will be their powers and duties when they are provisionally registered. The Committee ought to know what it will be possible for a provisionally registered doctor to do. I do not think we are justified in leaving this matter entirely to a question of regulations. I suggest that a provisionally registered doctor will have the powers of a fully registered doctor only when serving as an intern in the institution to which he is attached. In other words, if he goes away for a weekend as a locum he will not be able to sign death certificates and order poisonous and dangerous drugs. What I feel very strongly is that while this man is serving in hospital he should have the full powers and duties of a medical practitioner.

2.0 p.m.

Might I make two points? First, there is the question of ordering dangerous drugs. I do not think a man can do his duty in an intern hospital without that power. He may get a case coming in suddenly of a bad accident or an individual with coronary thrombosis in the most acute pain which anyone can suffer, and he ought to be able to give morphia in such cases without waiting to send to his chief for permission.

There is then the question of the signing of death certificates. I feel that that should be permitted to him, too. A case could happen concerning an individual attending the outpatient department with some kind of heart affliction. The person comes into the hospital, but before the chief can be called he dies. The provisionally registered doctor knows about the case; there is a full record, but the only person who has seen him is this provisionally registered doctor. I feel that in such cases he should have the right to sign the death certificate. I feel, too, that everybody, including the public, should know exactly what are the powers of the provisionally registered doctor, and that these should not be left to be defined by regulations.

I agree with all that has been said, and I think it rather hard lines if a man, after his medical training and after getting his certificate, decides not to accept these terms, because he will have to get into another profession. The only difference between my hon. Friend the Member for Barking (Mr. Hastings) and myself is on his point that this must apply only to the institution to which the provisionally registered man has been attached. Under the National Health Service, some of these men may be appointed under a regional board which has several hospitals under its jurisdiction. The man may serve for a time in one institution and then the board may want to change him to another institution, in which event he comes under the ban mentioned by my hon. Friend, and cannot continue in his job.

Some laxity should be allowed, and I think the Clause should stand as it is. Of course, I should like my Amendment to be made, but I am prepared to let that go. The Amendment now under discussion will, in my opinion, do the Service harm and the man an injustice, if he has to stick to a particular hospital to which he is attached after being provisionally registered. I, therefore, hope that my hon. Friend will not succeed in his Amendment.

There is a point to be cleared up here, and I do not know whether the Minister can consider it between now and the Report stage. It is that the public and other doctors should know clearly whether people who call themselves doctors, are in fact qualified to treat and to give orders in respect of, say, a street accident. I had the misfortune to break my leg on the football field, and people immediately jumped in to assist. It may well be that Dr. Fleming, of penicillin fame, might be the head of a medical faculty and not be qualified to do anything outside his particular hospital. There might be other doctors who would come up later. They see Dr. Fleming in charge, giving orders to the Saint John's Ambulance people and others.

There is no clarity of power and responsibility as between the various people in such an emergency. The word "Doctor" is loosely enough used as it is, and I think there is in this very great danger for legal actions to be based on a doctor following what he believes to be the orders of a fully qualified practitioner, who turns out subsequently to be one of those curious, non-professional men, who are neither fish, flesh, nor fowl, who has not done his year but has gone into university research and is not, therefore, properly qualified to give orders either to doctors or nurses.

I should like to join issue on one point with the hon. Member for Warrington (Dr. Morgan). He suggests that if an intern doctor is permitted to carry out full medical functions at one hospital, on transfer to a hospital where he becomes an employee of a regional hospital board he loses that power. It is only consultants and senior hospital medical officers who are employed by the regional boards, and all the junior ranks are taken on by the hospital at which they work.

I am rather uneasy about this. If it is agreed that the practitioner on becoming provisionally registered should be regarded as a registered medical practitioner for a fairly wide range of purposes, then this year may fall into disrespect. I believe it must be regarded as an essential part of medical education, and at the risk of repetition, I say that to equate the provisionally registered with the permanently registered man, merely leaving an interval of time to pass between them, seems to suggest that the standard of registration is reached with provisional registration, and that this final year is a kind of burden or testing time imposed by the State.

We must get it into our minds that this year is part of the medical education, and we ought not to determine, without very careful consideration, those purposes and functions that are reserved to registered medical practitioners, to pass them automatically to the provisionally registered man, even though he is in a hospital. I confess I prefer the words here, because the Clause that follows possibly needs a certain amount of further consideration. Indeed, until we see the picture of this provisional year, and until we see the form that the internship takes, I doubt whether we are in a position firmly to decide that all the privileges of registration should go with provisional registration. It needs more thought and more consideration before such a decision can be reached.

I am in fairly general agreement with what the hon. Member for Luton (Dr. Hill) has just said. Unless we are exceedingly careful, this intern year will lose its status. After all I know it is difficult to describe it except that it exists in other academic fields. It is not that the doctor is not fully educated when put on the provisional register, but it is considered that a year's satisfactory experience of this sort is necessary for his final equipment as a general practitioner. That is the kind of reasoning that lies behind the Goodenough recommendation. I explained earlier that for purposes of his intern year he is a fully qualified doctor. In the institution he can sign death certificates if it is appropriate for him to do so in the circumstances of the case, and he can give drugs. He can do all those things which are appropriate to his position as a doctor on the staff of that hospital, which indeed he is, and he is paid by the hospital. Therefore, his status in the hospital is fully protected.

Also, the status of the intern year is protected by confining his powers to his internship and saying that outside, he cannot act as a fully qualified practitioner. In other words, it means that he has not got on to the Medical Register but only on to the provisional register. The difference is that until he has served this further year he cannot get on to this further register. Here it is stated positively, as in most Acts of Parliament, not negatively. What is not stated here, he is assumed not to possess. Subsection (3) says:

"Persons provisionally registered shall be deemed to be registered so far as is neces-sary—

(a) to enable them to be employed as mentioned in subsection (1) of section two of this Act,"

Where it is not stated, they are assumed not to be, because registration and qualification are qualifications and not negative rejections. Therefore, I prefer the words here.

Would the Minister make it clear whether it is a single institution?

An institution for purposes of the statute is not a building, and therefore an institution for this purpose could comprise several hospitals or any of those hospitals that are approved for this purpose.

Is the right hon. Gentleman completely satisfied that the rights and interests of third parties vis à vis these hybrid individuals are safe? They may find that a person provisionally registered purports properly to act as a doctor in one case and is unable to do so in another case. That may be difficult as far as third parties are concerned.

I am not a lawyer and I cannot say how far third parties are affected by this, but there is nothing to prevent any citizen from coming to the medical assistance of any other citizen. He can do that, but he cannot claim that for those purposes he is a fully qualified registered medical practitioner. Therefore, in so far as that would affect the rights of a citizen whom he attends, that risk would be carried. I should doubt, however, whether any legal burdens would follow because if someone in the absence of anybody else gave any skill at his disposal to an afflicted person, he would be an extremely unChristian person who would then proceed against that man because he had made a mistake.

I see the Minister's point but there is nevertheless a point of third party relationship. There may be several doctors who leap to the case, one of whom appears to be the senior and he may get on the scene first. It may well be that the relationships between third parties would be befuddled by this lack of extension of the powers of the provisionally registered man to emergency cases of this kind, and it may well be worth looking into.

I will certainly look into it, but I cannot see, for the life of me, how we could protect ourselves against it.

If I heard the Minister aright, he agreed with me completely on the substance of my Amendment. Would he consider putting this in the Bill or, at any rate in the regulations which will be framed eventually? If the Minister agrees to do that, I should like to withdraw my Amendment.

I understand on my reading of it that it is in the Bill now.

Then I beg to ask leave to withdraw the Amendment.

I have referred to Clause 2, and a little earlier the question was raised of the practitioner who, after passing his examinations, wished to go into laboratory work, into research, tropical medicine and the like. The substance of the Minister's answer—I believe I am right in attributing it to the right hon. Gentleman—was that the man might become provisionally registered and enter his field of work without becoming permanently registered, and if subsequently he decided to practise clinical medicine, it would be necessary for him to do his intern year. With that contention I agree, but, as the Clause is worded, on passing his examinations the individual will be required to apply for and obtain a post. The relevant words are:

Provided that he produces evidence satisfactory to the registrar that he has been selected for such employment as is mentioned in subsection (1) of section two of this Act,"

It seems to me to be a difficulty that passing the examinations and obtaining the diploma, in the university sense, of itself does not entitle a man to provisional registration. Even though he is going straight into laboratory work, he has to apply for and obtain a post. This is worth reconsideration so as to make possible the idea expressed earlier. As matters stand, passing the examinations, of itself entitles the person to nothing, not even provisional registration. He has subsequently to apply for and get a job.

There is a point arising on my Amendment. A man may apply for a post in order to get permanent registration and may not succeed, but equally he may not apply. What is to be done with a man who has all his degrees and does not apply to be put on the provisional register? Is that man to be wasted in a period when there is a shortage of medical practitioners? Would the Minister explain that?

As I understand it, the argument is this: the person has passed his examinations and at that stage he asks himself what his future course will be. He may decide not to go in for clinical practice but for research work. Therefore he does not want to serve his intern because the intern year is for the purpose of getting him on the medical register which is not essential for the specialised work he proposes to do. Therefore he wants to be exempted from the necessity of serving the intern. At some later stage, however, he may want to become fully qualified, so he ought to be allowed to apply to be put on the provisional register at any time.

I think there is some substance in that argument. Of course there is no reason why he should apply for the provisional register. I see that the man's future rights need some protection, because—I am thinking aloud for a moment—he ought to be able to complete his training at some future period if he so wished. I will look into the matter to see whether this would be covered.

In particular there is the case of the man who is qualified by examination in this country and who may wish to do his intern service overseas.

In that case, it is not so difficult.

But it would be extremely useful to the man if he were able to produce evidence of provisional registration instead of showing merely that he had passed the examination.

Yes. It is not always easy, when looking at these very technical Bills, to see what construction they bear. As I understand it, there is nothing to prevent a man from postponing his application to be put on the provisional register almost indefinitely, so that his rights are kept alive. I will, however, see whether it bears that interpretation.

Would the Minister, in reconsidering the matter, give a thought to the suggestion that provisional registration should be obtainable on a man's satisfying his examination for his diploma? After all, it is provisional registration and nothing more. Thereafter, the man has to apply for and to get his appointment and to hold it for the specified period before full registration is granted.

I see some difficulty here. The educational authorities must have some assurances that the posts they are making available are going to be used, because the assumption is that when a man applies to be put on the provisional register, he wishes to have a post to complete his intern year. Nevertheless, I see no great administrative problem here. The man could indicate whether he proposes to take up the post at once, so as to give the authorities the necessary information. In any event, I will see whether this position can be cleared up.

I want to make a point about homoeopaths. There may not be sufficient posts in institutions to enable them to serve their year of provisional registration. Sometimes the waiting lists would involve a wait, not merely of one year, but perhaps of two or three years, before a man could enter a homoeopathic institution in order to qualify under the Bill.

Now we are treading on dangerous ground and I move gingerly as though I were treading on the fields of asphodel. When we come to consider homoeopathy and more orthodox medical practices, this is where a layman refuses to express any opinion at all if he has any sense—and I have quite a bit of sense in this field in the last five years at least. I should have thought that homoeopathic medicine is not necessarily excluded by learning all medicine. Thinking aloud once again, I see no reason at all why the intern year could not be served in a general hospital, and homoeopathic practice is merely a matter for the individual doctor to decide to do as a doctor when he has qualified. Over that, we have not the slightest control.

I was speaking of the qualified doctor who had taken all his medical examinations.

No. We have just said that a person is not qualified for general practice until he has served an intern year. What I am now asked to do is to make sure that arrangements are going to be made for him to serve that intern year in a homoeopathic hospital. I am afraid that I cannot give such a guarantee at this moment. As has been said, there might not be enough posts.

The problem which was raised by my hon. Friend the Member for Luton (Dr. Hill) might not appear so awkward if it were made clear that university and research authorities, when seeking people holding medical degrees to go on to their staffs, asked for people holding degrees or diplomas rather than for people who were on the provisional register. If it is only the possession of a degree that is necessary for research, then I think that the question of a provisional register would not arise.

I beg to move, in page 5, line 19, at the end, to insert:

"() In relation to any such person as is mentioned in subsection (1) of this section—

(a) subsection (1) of section three of this Act shall have effect as if the reference in that subsection to centres provided under the enactments specified therein included a reference to health centres provided under the law of the Republic of Ireland, and

(b) subsection (2) of the said section three shall have effect, in relation to a health centre provided under the said law, as if for the employment specified in paragraphs (a) and (b) of the said subsection (2) there were substituted employment certified by the said Medical Registration Council or a body acting on behalf of that Council to correspond to the employment specified as aforesaid."

The Amendment should not take up time. It merely extends to the Republic of Ireland the same provisions that we have extended to health centres in England and Wales.

I asked on Second Reading whether the Republic of Ireland would be altering its medical curriculum in step with ours in order that the Clause might have full application. Clearly, if Ireland is not going to do so, we should have to make some alternative provisions. I think that the reply which I had on that occasion was that the Republic of Ireland was likely to do so, but there was nothing very conclusive about it. May I have an assurance that the Republic of Ireland will, in fact, be altering its medical curriculum in step with ours?

I understand that that is indeed the position.

I am not quite clear about the meaning of the last two lines of subsection (2). The assumption in the Clause is that the Republic of Ireland has passed similar legislation, and on that assumption, the Clause goes on to say:

"No such person shall"—

after such legislation has been passed—

"become provisionally registered"—

presumably, here—

"unless he is registered by virtue of the said provision of the law of the Republic of Ireland."

The intention, it occurs to me, was that a man should not become provisionally registered here unless he is provisionally registered

"by virtue of the said provision of the law of the Republic of Ireland."

I may have the point wrong, but it is important in the Bill clearly to distinguish between provisional registration and registration in every place. I ask the Parliamentary Secretary to explain the intention of the two lines I have quoted and to say whether the words fully express the meaning.

I will certainly look into that point and make sure about that. Obviously, we are trying to get the arrangements in both countries to run on the same basis, and I imagine that that is the position here. I will check it up before the next stage of the Bill.

I do not want to interfere in the discussions now taking place in the provinces, of which I have no particular knowledge, but I should like to ask the Committee to be very careful about the matter which has been raised, unless they have a full guarantee about it. When the law concerning trade unions was annulled in the House, some of us were anxious to find out whether. since Northern Ireland passed the original Act because we did, they would annul for like reason. Up to now, however, we have not got that satisfaction.

I am still not quite clear. There is no provisional registration at present in Ireland. Therefore, if a man who is fully registered in Ireland comes to this country, as I understand the Bill, he will have to register here provisionally and then to serve his year of registration either here or in Ireland then he will be qualified to become fully registered on the complete register in this country. This is understandable, because otherwise the Irish graduate, being registered on the one register in Ireland, would be able to come over here and claim to be enrolled on the full register in Great Britain, and legally he would be entitled to do so according to the agreement between Ireland and this country.

I do not want to emphasise the same point again, but, as has been made quite clear, the assumption is—and we have the undertaking that this will in fact be carried out—that there will be provision of provisional registration in Ireland as it will be provided here. Therefore, the point referred to by my hon. Friend will not in fact arise.

Will the hon. Gentleman allow his imagination to run riot for a moment without creating an international incident. Should it happen that because of circumstances over which we have no control and for arguments which we do not appreciate, the Republic of Ireland does not do this, would it mean that graduates from Ireland who find their way to the Irish register without an intern year, would be able, as the hon. Member for Warrington (Dr. Morgan) suggested, to come over here and, by the arrangement of reciprocity, find their way on to the British register, so stealing an advantage—if it is an advantage—over corresponding British graduates? Will the hon. Gentleman answer the question of what would be the position, should the impossible happen and the Republic of Ireland not pass the necessary legislation?

I hope no hon. Member of the Committee will invite me to make speeches about all the hypothetical possibilities which might conceivably arise and which the hon. Member for Luton (Dr. Hill) says will not arise anyhow. I agree with him that this will not arise but, should it arise, it would obviously be necessary to consider some amending Measure to deal with it. We have the very definite assurance that this is already being taken care of, but should there be such a difficulty we would have to come to the House again.

I beg to move, in page 6, line 5, to leave out, "in the medical register" and to insert "under the Medical Acts."

This is a drafting Amendment which, I think, was fully explained by my right hon. Friend.

I beg to move, in page 6, line 14, to leave out the second "and."

I wonder if it would meet with your approval, Major Milner, and be to the convenience of the Committee, if this Amendment were considered together with the following two Amendments in my name—

In line 15, at end, to insert:

"and

(c) in Northern Ireland and the Republic of Ireland shall be increased to two";

In line 25, after "Wales," to insert:

"and of the persons elected in pursuance of paragraph (c) of the last foregoing subsection, one shall be elected as a person resident in the Republic of Ireland and one as a person resident in Northern Ireland."

indicated assent.

I am very much obliged. I think we are in agreement that any increase in the number of directly elected members of the Council is a desirable thing so long as the number is kept within reasonable bounds. As the Clause stands, the number is 10 and it is noted that two are elected from Scotland, eight from England and Wales and, in lines 24 and 25, there is a special mention of Wales. The wording is:

"one shall he elected as a person resident in Wales;"

I remember that on Second Reading my right hon. Friend wondered whether that was necessary. I think his sense of local feeling for Wales made him suggest that even if those words had not been inserted. Wales would have found it quite easy to contribute at least one member, even if no one had ever thought of it before, and certainly without the words being in the Bill.

I wonder, therefore, why we have not some similar reference to Northern Ireland and the Republic of Ireland. Is it because everyone expects that names like Moynihan and Mayo still so resound in our ears, that there can be no doubt that Northern Ireland and the Republic of Ireland will have proper proportions, because this matter will be raised in Northern Ireland and in the Republic? The Parliamentary Secretary told the Committee that he thought everything was going on all right and that there would be no difficulty about reciprocity between the two countries. He suggested that legislation would follow on a par with what we are considering today. If that is the case, it seems all the more reason why the Minister should consider the Amendment I have put down.

In two ways I think the Bill might be improved by these three Amendments. First, there is the fact that the number of members directly elected would be 12 instead of 10 and in this respect I would bring to the notice of the Committee and the Minister this interesting and important point. In a Clause which we shall reach later we shall be discussing the question of illness or death of elected members and how their places shall be filled. There will be a time-lag, and I suggest there may well occur times when it will be difficult, as a result of death or illness, to maintain a full disciplinary medical committee in accordance with the defined constitution of that committee. That is all the more reason to push up the number from 10 to 12.

I wish to support this Amendment. I cannot understand why Ireland has been omitted from this part of the Bill. Northern Ireland is a part of the United Kingdom, and in Belfast there is a great medical school. I should like to see Northern Ireland represented in this way.

During the Second Reading of the Bill my right hon. Friend the Minister said:

"The General Medical Council still exercises some jurisdiction in relation to the Republic of Ireland, under an agreement entered into between the United Kingdom and the Irish Free State, as it then was, in 1927."

He went on to say:

"It has, therefore, been necessary to enter into consultations with the Government of the Republic to ensure that the present arrangements outlined in the Bill are acceptable to them and that they for their part would similarly he willing to amend their own law as necessary."—[OFFICIAL REPORT, 27th June, 1950; Vol. 476, c. 2186-7.]

In the Debate on Clause 6 my hon. Friend the Parliamentary Secretary said that the assumption is that the arrangements in both countries will be on the same basis. If that is so, I think it would be not only a kindly gesture, but a very wise move to have an elected representative from the Republic of Ireland. That would help to maintain the close cooperation which is desirable.

In one or two sentences I wish to put forward reasons which I think are of weight against this proposal. First, on principle, I think it is a bad thing to have a sort of Dutch auction with all the competing interests for seats on this body.

Anyone who remembers the Committee stage of the parent Bill, the National Health Service Bill, will remember the interminable arguments for what one could call the vested interests. I know this suggestion is welcomed by the British Medical Association, which, for obvious reasons, is not surprising, but previously there were to be seven elected members on this committee, six for England and Wales and one represented Scotland and Ireland. The Bill originally increased the number to nine, and another place has made it 11. I should have thought that the time had come to call a halt to that process.

I very much doubt whether it is constitutionally proper to put into the Bill in the Committee stage such a suggestion in relation to a country which, apart from various statutory provisions, is virtually a foreign country. I do not think we can legislate in regard to a country which has entirely severed itself from us. I do not think we can put into our legislation, at least without prior agreement, a suggestion allowing them to put forward one extra nominee to the Council.

Finally, as the 1886 Act stands, there is already one representative of the whole of Ireland without division, because of course the Republic of Ireland and the province of Northern Ireland did not then exist. I see no reason why we should disturb an arrangement which requires them to agree on their representative. Almost the only other example of such agreement is their Rugby football team, which they select jointly. If they have an agreement that in ways best known to themselves they select a representative from Ireland in its geographical sense, I think that arrangement should stand. On grounds of numbers I can see a certain case for increasing the representation to two but that is not the point which this Amendment puts forward. It would be wrong and constitutionally improper to suggest that one representative should come from each of the two constituent parts of geographical Ireland, and I hope that the Parliamentary Secretary will not agree to the suggestion.

I hope that my hon. Friend will not press this Amendment. It is the case, as the hon. Member for Enfield, West (Mr. Iain MacLeod) has said, that Ireland has always been a unity in respect of medical education. The hon. Member instanced the further example of Rugby football. We on our side would not wish to make any alteration in the present position. A further and rather more important point is that if we were to raise this matter now, we should have to re-open the agreement we have made with the Republic of Ireland, upon which the whole of this Bill is based.

We have had long and very friendly discussions with the Republic of Ireland and with their representatives, and we understand that this position is fully satisfactory to them. I feel that the only result of making any alteration now would be that we should have to enter into further discussions for which at this moment there is frankly not time. Nor do I think it would be desirable if we were to argue this matter on the basis of numbers. I am doubtful whether, even on that basis, the addition of a further member for Ireland could be justified. On these grounds, I hope that the Amendment will not be pressed.

In view of what the Parliamentary Secretary has said, and the reasons he has given, I beg to ask leave to withdraw the Amendment.

I beg to move, in page 7, line 6, to leave out subsection (3).

This subsection provides for vacancies to be left should elected members die or otherwise vacate their office before the end of their full term of office. Of the 47 members of the Council only 11 are elected, and of that 11, at least six must be on the Medical Disciplinary Committee. It seems to me to be important that this number of elected members should be maintained at full strength—there are not many of them—rather than let a vacancy by death or for other reasons remain for the best part of 12 months. Indeed, if several elected members of the Council died in the last 12 months of their term of office or retired for some reason during those 12 months, it might be exceedingly difficult for the Medical Disciplinary Committee to be properly and fully manned to discharge its duties.

Furthermore, by the terms of the consequential Amendment which we have put down, in page 7, line 26, to leave out from "resignation," to the end of line 28, it would be possible to put into operation the machinery for electing a new member to a vacancy before the end of the 12 months' period. I commend the Amendment to the Committee. It is designed to keep the relatively small numbers of elected members at full strength during the whole life of the Council.

While I appreciate the point which Members opposite have in mind in putting down this Amendment, and their natural desire to ensure that there should be at least six elected members available, I very much doubt whether it would be desirable to agree to this Amendment. In the first place the contingency which is visualised is highly unlikely. It assumes that 11 members are to be reduced to six within the last year of their period of office. I should have thought that almost inconceivable, but even if it were to happen, the committee would still be able to carry on its functions. I agree that it would mean that the number of elected members would be reduced, but there would be no automatic "seize-up" of the activities of the committee.

We must bear in mind the fact that the elections are expensive to carry out. It seemed to us reasonable that we should try to avoid unnecessary elections in the last year of the term of office. Although, as I say, I appreciate the point which hon. Members have in mind, I think that balancing it with the other factors and the extreme improbability of it ever occurring—

Can the Parliamentary Secretary give us some idea of the cost?

Yes, I gather that the cost of an election to fill a casual vacancy in England, including Wales, would, on the basis of the latest experience be £1,245. The cost in Scotland would be a good deal less. I hope that suggests that this proposal may be regarded as unnecessary.

Would the Parliamentary Secretary say whether the Irish doctors are happy about this, because they are in the peculiar position of having only one representative and in the circumstances envisaged by my hon. Friend the Member for Clitheroe (Mr. Fort) they might be without a representative for nearly a year? If they are satisfied, I shall be content with the Parliamentary Secretary's answer.

I understand that they are quite satisfied.

Will the Parliamentary Secretary clear up one point? The question of cost is formidable if it be as real a point as that which the Parliamentary Secretary put forward. As I understand the matter, these members are not all elected together to serve for a particular period, so that to leave the vacancy would only postpone for a month, six months or, in an extreme case for between 11 and 12 months the expenditure of £1,245, which would in any case have to be expended. I may be on a wrong point but that is how it seems to me. if that be so, if that premise be sound, surely the Parliamentary Secretary will have to look at this again, because the method put forward is a great deal tidier and less cumbersome than the one at present in the Bill.

The expense involved is the expense of sending out ballot papers and so on, which is almost as great in sending out for one, as it is in sending out for many, when the general election takes place.

I see the point as to the expense but if a member disapproved of something being done. there is the very powerful sanction of resignation. No one wishes to resign and merely allow the body to whose action he objects, to carry on without his presence—no one except perhaps Mr. Molotov. It seems to me to be a valid point that a person who disapproves can resign and thereby bring about a by-election.

And stand again.

He could stand again if necessary but he would produce a by-election and this procedure would avoid a by-election.

In the last year.

Well, there are times when a by-election is no bad thing, and it is part of the sanction of an elected member that he can refuse to take further part in the proceedings of the Council and refer the matter again to the judgment of the electors. This, for what it is worth, would deprive the electors of that chance to decide in the last 12 months. One can imagine cases where it might be desirable that such an election should take place, and I hope that the Minister will give this a little further thought.

Hon. Members should realise that it is still possible for six members either to resign, or for vacancies to be caused by some other reason, before this particular difficulty arose; and also it is only within the last 12-month period that it can arise. I feel, taking everything into account, plus the cost involved, that the present position is reasonable.

I do not quite understand the point about "six."

Well, eleven down to six—five at any rate.

I was making the point about the protest of an individual which might well be a protest against the action of the other five elected members; and to refer it to the electorate is the constitutional way of assuring oneself as to who is expressing the view of the persons represented. I wish the Minister would look at this again. He may put in something to the effect that if the member quitting office desires it should not be filled until the end of his full time of office. That would obviate the difficulty to some extent. But the Minister should give further thought to this because the purpose of the Bill is really to strengthen the position of the elected Member, and this is one of the ways in which a single individual member can disagree with all the others. Sometimes in affairs it is a case of Athanasius contra mundum. Sometimes it is Athanasius who is right and the rest of the world wrong. It might well be that some obstinate and stubborn individual may be expressing a valuable point of view.

I wish that the Parliamentary Secretary would consent to look at this again. The action of the Government is very peculiar. It is always being said that we want the professions to do their democratic work themselves, and now we are proposing to deprive them of an opportunity of so doing. The position is especially peculiar with regard to Ireland. Here we are asking that a man who has a legitimate grievance on one side ought to be able to give it prominence by resigning, and, as I said in an interjection, standing again to prove he is right. It is a little indiscreet of the Government having regard to the position in Ireland and I wish that the Minister would look at it again.

This is not a matter about which we wish to argue unduly. I am sure my right hon. Friend would be prepared to look at the point again, but I cannot give any sort of guarantee. I still think that, on balance, it is desirable that this position should be maintained.

I beg to move, in page 8, line 6, to leave out "Disciplinary," and to insert "Penal Cases."

I do not wish the disciplinary committee to have anything to do with this. I wish the penal cases committee to investigate first whether there is a prima facie case for the accused person to answer and if the penal cases committee finds there is a prima facie case, then this Amendment asks that a certain procedure should be adopted. I want the word "Disciplinary" to be deleted, so that the committee will not have powers of discipline and will be a committee for investigating penal cases, with a view to discovering whether there is a prima facie case to answer.

This innocent-looking Amendment is aimed at the whole structure of this part of the Bill. This recasting of the disciplinary machinery, and the establishment of a body smaller than the General Medical Council for this purpose, are among the most important parts of the Bill, and I hope that they will be left untouched.

The hon. Gentleman is speaking against a committee of his own organisation.

I am expressing the views I hold, however they may conflict with those of anybody else. The Council has a penal cases committee which advises the President and sorts out the frivolous from the real complaints. Reference will be made to that in a later Amendment. The structure under which the penal cases committee, in consultation with the President, sorts out the complaints made against practitioners, and in addition to which there is a separate body which hears the cases, should commend itself even to the hon. Member for Warrington (Dr. Morgan). It certainly represents a considerable advance in the technique and methods of the General Medical Council.

I hope that my hon. Friend will not press this Amendment. This part of the Bill—and indeed all the rest of it—has been arrived at by general agreement with those concerned. This part of the Bill would be torpedoed if we accepted this Amendment. It must always be borne in mind that the function of the General Medical Council is to maintain, and even to raise, the general standards of the medical profession, and to protect the public—the two things together. Sometimes the last is forgotten and only the first remembered, and sometimes the first is forgotten and the last remembered. In holding the balance even, we have tried to provide the General Medical Council with the best procedure and machinery. I hope that at this late stage, we shall not make this major alteration.

On principle, I cannot withdraw the Amendment. I do not wish the General Medical Council to have in their hands the power to take action for an alleged offence which may affect not only a man's career, but his wife and children who have to bear the burden of his removal from the Register, if the penalty is as big as that. I want that power to be taken completely out of their hands. I suggest that they should have only the power of investigation, the power to say whether there is a prima facie case for a man to answer. If there is a case to answer, then it should go before another body which would try him properly. I am speaking, I think, to a decision arrived at by a committee of the British Medical Association of which I was a member, and I do not think that the hon. Member for Luton (Dr. Hill) was present. I am sorry to have to disturb the Government on this matter. I feel most strongly about it, and I cannot agree that the Amendment should be withdrawn.

I beg to move, in page 8, line 28, after "five," to insert:

"of whom two shall he elected members of the Council."

At the same time, it might be convenient for the Committee to discuss the next Amendment in the name of the hon. Member, in line 33, at the end, to insert:

"of whom three shall be elected members of the Council."

and the Amendment in the name of the right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot), in line 35, after "hearing," to insert:

"at least two elected members of the Council and."

The purpose of the two Amendments in my name is simple and straightforward, and I hope that they will be accepted. We all agree that it is desirable to see an increase in the number of elected members of the Council. That is embodied in the Bill. Here we are dealing with a very important part of the machinery, the constitution of the Medical Disciplinary Committee, and its functions, and I therefore thought it proper to put in these small Amendments.

I am suggesting that, where the Committee normally consists of nine members, unless the circumstances are exceptional,—when the president or his nominee may increase the number—three members should be elected representatives, and, since the quorum is to be five, I have suggested that two shall be elected members. There is probably common agreement about this, and I do not think there would be any difficulty in finding these proportions of two out of five and three out of nine.

I am afraid my hon. Friend is asking me to give him a little too much. I am prepared to have a look at the second Amendment, but I could not accept the first, because it might be entirely unworkable. The assumption is that two elected persons must be present. We must remember what we are dealing with here. We are dealing with a situation in which the accused person is summoned to be present, along with any witnesses who support him, and they may have travelled very considerable distances; yet, because of some reason over which neither the accused nor anybody else has any control, if two out of the five persons are not elected representatives, the proceedings cannot go forward. This is administratively an exceedingly difficult principle to operate, and I therefore hope it will not be pressed. After all, we have gone a very considerable way here in increasing the number of elected members. Surely, it is the duty of elected members to attend, and we ought not to impose a hardship or victimise those who have to be subjected to these proceedings if the elected persons do not do their duty.

When we come to the other Amendment, it is very much easier, because the idea is to ensure that the nine members who will be invited to hear most of the disciplinary cases might include three elected members. That is all right. Here we have an invitation, but in the other case it was a statutory command, and the two do not run together. I hope my hon. Friend will withdraw his first Amendment, and, if we are taking the two together, I will accept the second in principle.

Since the Amendment in the name of my right hon. and gallant Friend the Member for Kelvingrove (Lieut.-Colonel Elliot) is being discussed with those of the hon. Gentleman opposite and is concerned with substantially the same point, I should like to draw attention to its purely permissive quality, as compared with the compulsory nature of that of the hon. Member for Stoke-on-Trent, Central (Dr. Stross).

It is clear that the elected members are a most valuable element in the constitution of the disciplinary committee, because the members of the General Medical Council, by and large, belong to very academic and learned bodies which in practice take different views on the various forms of misconduct. The Minister has stressed the point that the proceedings would come to a standstill in the absence of the requisite number of elected representatives, if their attendance was compulsory and if they were to be a certain proportion of the whole. The Amendment in the name of the right hon. and gallant Member for Kelvingrove, to which my name is attached, would provide that at least two elected members should sit, but that the proceedings do not fall down if they are not present.

The remarks I made on the second Amendment apply also to this one. We are prepared to accept it in principle, although, perhaps, we should put "two" instead of "three."

Finding myself quite convinced by the Minister and accepting his compromise, I beg to ask leave to withdraw the Amendment.

I do not propose to call the Amendment in page 8, line 39, in the name of the hon. Member for Warrington (Dr. Morgan) because it is inconsistent with the decision arrived at on an earlier Clause.

Did you say, Sir Charles, that the decision on the earlier Clause was against my Amendment on this Clause?

I am afraid the Amendment is inconsistent with the decision arrived at on Clause 13.

With great respect, Sir Charles, I submit that this Amendment is entirely different from the first one. It is asking that the disciplinary committee should be called the "penal cases committee." It is a very special committee.

I am afraid that as it was only put on the Order Paper this morning, I did not have time to study it properly. I thought it was out of order.