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Clause 21—(Appointment Of Visitors Of Medical Schools)

Volume 477: debated on Friday 21 July 1950

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I beg to move, in page 14, line 2, to leave out Clause 21.

You may remember, Mr. Deputy-Speaker, that on the Committee stage the right hon. Gentleman very kindly undertook to find out what were the views of the Vice-Chancellors of the Universities concerned in this matter and I am very grateful to you, Sir, for allowing us to move this Amendment at this stage, so that we have the opportunity of getting the Minister to agree to cut out the Clause rather than to deal with it on Third Reading, when we shall have to oppose the whole Bill over what is really only a very minor detail in it.

Now, it does seem to me, from my information obtained in the meantime, that the situation is that the Vice-Chancellors are definitely against this Clause, but that, as gentlemen, they cannot very well go back on what they have said so far. As the Minister rightly said, this has been gestating a very long time now, and it places them in an extremely awkward situation to object only at this very late hour.

I am bound to admit that there is a considerable degree of explanation of that in the change from the word "inspection" to the word "visit." In the Goodenough Committee, it was quite clear that the intention was to inspect the universities whereas in this Clause it is not made clear. In point of fact, it is in effect an inspection Clause and not a visiting Clause, although the word "visiting" is used in this particular context. I think they have been misled into thinking that the Clause is not as bad as it is; and equally they have thought that possibly the trigger of the Privy Council will never be pulled.

It seems to me that if we are passing Bills in this House and making them Acts, we have got to assume that sooner or later, if the General Medical Council continue to bring pressure, that the Privy Council must necessarily agree to pull the trigger and to let such inspection take place. So I think we must look at it from the point of view of assuming that such inspection is going to take place, and we must have regard to the very wide terms in which that inspection is drawn. It is entirely unlimited, because the Clause says:
"…as to the sufficiency of the instruction and as to any other matters relating to such instruction…"
Now, the difficulty, of course, that the Vice-Chancellors and the General Medical Council are in is this. Sir William Goodenough is chairman of one of the big banks, and he sends his own inspectors round his branches, and he has power and responsibility, the two being linked properly together. He has the power to replace a bank manager; he has the power to tell him the methods; he has power to tell him about accommodation and how he should use it. Arising out of the inspection every thing of that kind is under his responsibility and full power. But in the case of his relationships with the Bank of England, they have, admittedly, rights of general direction in regard to policy, but they very wisely, I submit, confine their powers of direction to that, and do not seek to interfere in the day-to-day management. I think Sir William Goodenough would be the first to agree that, in point of fact, when we do set up such an inspection in day-to-day matters—personnel, subjects to be taught, hours to be kept, and the full range of the day-to-day conduct of the medical school—we are in point of fact, dividing responsibility so that the General Medical Council has part and the university another part but without clarity of responsibility for either.

Now, the Chancellor of the Exchequer is good enough to continue to regard me in a certain light as knowing something about organisation and to continue to refer problems to me. I think that the Minister would say that within his own Department he can have the Public Accounts Committee and the Estimates Committee, thinking in terms of control of the purse strings; and, admittedly, that is one of the things that remain; but that he just cannot have people coming in and telling him who is to be his chief establishment officer, in which room he should sit, how many hours a day he should work, and whether he should have this particular form—form 67A, or whatever it is.

It does seem to me that we in this House really ought to take very seriously this division of responsibility. But I would maintain that the General Medical Council ought not really to welcome this Clause, but ought to run away from it as fast as they possibly can. Their power will be reduced not increased and they will have responsibility passed to them when they do not want it. I hope the Minister will allow the House not to put through what is, in essence, a bad Clause, merely because with insufficient consideration by the Goodenough Committee and insufficient consideration by the other bodies since, it has not met with the reaction which it ought to have received.

2.0 p.m.

I am a bit confused over this Clause, as I am about everything else in the Bill, for I have reservations about it throughout the whole of its verbiage. When the General Medical Council appoint these visitors and they report back to the General Medical Council, who then pass on that report or any observations to the Privy Council, suppose the Privy Council do nothing. What happens then? Suppose an adverse report is made on a school and the Privy Council do nothing. I do not know what will happen if several schools have adverse reports made about them as to some deficiency in the teaching and the Privy Council do nothing after the report is sent to them by the General Medical Council.

I wonder what the Minister thinks will happen. Have the Privy Council got power over the General Medical Council to insist that on certain reforms pointed out by the visitor or inspector action shall be taken? Up to the present these things have happened; reports have been made and the General Medical Council have advised particular schools to make some amendment in their teaching, but those schools have just done nothing. What, will happen here? Suppose the Privy Council interfere. What power have they got over the school? What power have the General Medical Council got over the teaching in schools. I should like some information on what the position is if no action is taken on these reports by either the General Medical Council or the Privy Council.

We had considerable discussion upon this matter in Committee, and I gather that this Amendment has been called for re-discussion because I did say in Committee that we would satisfy ourselves that there was not any considerable resentment among the universities. I have looked at it again, and of course I do not suggest for a single moment that the universities are enthuiastic about it, because no institution is enthusiastic if some other institution shares some of its own prerogatives. Indeed, as the hon. Member for Bath (Mr. Pitman) has said, we do not want to get the wires crossed; we want institutions to act with responsibility, because once responsibility is shared, or it is not possible to say quite clearly where it lies, we get into trouble, and I quite agree it is better that we should not mix up the functions.

I think, however, the hon. Gentleman was perhaps, if not quite gilding the lily at least adorning the tale when he was using the professional occupation of Sir William Goodenough as an illustration, because Sir William Goodenough was not on the Committee alone. If Sir William Goodenough was too much influenced by his business pre-occupations, there were other members of the Committee who would modify it from their own experience. Sir John Stopford was on the Goodenough Committee, and so was Dr. Janet Vaughan, who is now the new principal of Somerville College, Oxford; so also was Sir Wilson Jameson, who as hon. Members know had a very long academic career. There were, therefore, members of the Committee who could be trusted to keep the university angle before the Committee. Nevertheless, they did decide that this was a reform to make; that the General Medical Council should not be confined merely to inspecting the examinations but should also inspect the institutions where the education was given.

Yes. I am also clear that the recommendations of the Goodenough Committee in this respect were not confined to extra-mural studies, and I am informed that Sir Wilson Jameson assured the present Vice-Chancellor of London University in April of this year. I understand that the Ministry of Health consulted the Committee of Vice-Chancellors of Universities on the Bill in December, 1946, and the Committee replied that they had no observations. The General Medical Council, on their own initiative, consulted the individual universities of England and Wales, the Department of Health for Scotland consulted the Scottish universities, and the Irish authorities consulted the universities in Ireland. Of the universities in Great Britain, six, including London, either did not comment on or approved of the proposal regarding inspection; two, while not objecting to the proposal, suggested safeguards to ensure that there should be no encroachment on the universities' liberty of action or attempted standardisation; four either objected to the proposal or thought it unnecessary; the Irish universities did not comment.

Nothing further was heard from these various institutions until the Debate in Parliament. I therefore think it can be taken for granted that, while there are natural fears, with which everybody will sympathise, there is no deep resentment. I should have thought that if the institutions work in a commonsense way friction ought not to arise, and that it may not be necessary to invoke the powers of the Privy Council at all. But they are there to be invoked if any difficulty arises.

I was asked by my hon. Friend the Member for Warrington (Dr. Morgan) what would happen supposing the General Medical Council felt that things were not right. Well, the answer, of course, is that the Privy Council could take action.

By withdrawing registration. They have that power. Therefore, the problem has already been met. I hope that with that explanation we may be able to get on.

What happens when registration is refused to a student who has done six years, to take an individual case?

The Minister has fully discharged the undertaking he gave to the Committee to go further into this and to make a further statement when it came before the House again. The statement he has made is of much interest. I think it is crystallised in another of his obiter dicta—with which we find ourselves in unusual accord on this Measure—that if it is worked in a commonsense way, friction will not arise. I think that is what we shall need to trust to because, as the Minister has said, two universities asked for safeguards and four actually objected or thought the thing unnecessary, and one of those which did not comment on it—London—has since found itself fairly actively concerned about it.

The fact that it came up in 1946, when the pressure of events was very great, probably led somewhat to the same set of circumstances as reduce us to accepting a speaking engagement in the country if it is at a sufficiently distant date, hoping that the world will come to an end before that time, or that some other circumstance will arise to make it unnecessary for us to fulfil our engagement. The fact is, there was no immediate prospect of action, and the Vice-Chancellors therefore did not go into it. Multiplicity of inspections is an undesirable thing, and if worked in a foolish way could give rise to a great deal of difficulty. That, none of us will deny. I think, however, that we may trust that these eminent gentlemen will work this in a freindly and commonsense manner, as the Minister has said. Perhaps in the circumstances it might be unnecessary for my hon. Friend to press his Amendment.

May I ask the Minister for clarity on this point? When I asked what action the Privy Council would take, he said that they would take action on registration, and when I pointed out that this would not affect the university but the graduates of the university, he pointed out that the action would be against the university. I think that what the Minister meant was that the Privy Council would withdraw their recognition of the gradua- ting school and by doing so would affect the registration of any graduate from that school. I think that there is a distinction between recognition by the Privy Council of the school and registration of the individual.

It amounts to the same thing. I was short-circuiting it as much as I could. If the Privy Council refused to recognise the qualifications, it would kill the school as a medical school. What would happen in practice I should think is this: The inspection would call the attention of the authorities to the deficiencies in a particular course of training and would attempt to get those deficiencies made good. If, however, the medical school in question was persistent and did not make good the deficiencies, then the Privy Council would intimate that this might lead to the student who had gone through that examination not being qualified and the Privy Council not recognising the course as suitable for qualification and, therefore, registration. I cannot imagine that the innocent student would be made the victim of the failure on the part of the institution to behave reasonably, and the Privy Council would not therefore take retrospective action. I cannot conceive a British institution proceeding in a course of study which the competent study authority had declared would not qualify those who had passed in it.

In the hope and expectation of wisdom among the General Medical Council and the Privy Council and those who do the inspection, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.