I can answer Deputy McGrath in regard to one portion at all events of his question. The Board of the General Medical Council representing Ireland consists of men who are sent by the Universities and Licensing Bodies. The University of Dublin sends one whom it elects itself. The National University sends another; the College of Physicians sends one; the College of Surgeons sends one; the Apothecaries Hall sends one; and the Queen's University in Belfast sends one. Then there is one representative elected by the general practitioners of Ireland, and finally, there is one who is nominated by the Crown. That answers the question that Deputy McGrath has asked. During the introduction of the Bill the Minister said that he was giving a year to the medical profession in order that they should make up their minds as to what they wanted done in regard to the matter. As far as I know, the medical profession has made up its mind very definitely that it does not want to be placed in any worse position than it is at present. Some months ago the Government asked that a conference of the Universities and the Licensing Bodies concerned should be held to consider this matter. That conference met and spent several months in discussing this question. The conference consisted of two representatives from University College, Dublin; one from University College, Cork; one from University College, Galway; three from Dublin University; three from the College of Physicians; three from the College of Surgeons, and two from the Apothecaries Hall.
The conference which represented at all events the educational part of medicine as far as the Free State is concerned, spent a number of months discussing the question, and in the end it sent an unanimous report to the Government to say that if possible they should remain under the existing conditions and that they wanted no change, as far as it was possible to carry that out. I do not know whether the Dáil would attempt to listen to me, if I attempted to go through the three alternatives which were before this conference before they arrived at the unanimous conclusion that it would be very disastrous to the medical profession, and to medical education in the Saorstát if any change were made. Perhaps I might allude to the matter, because Deputy McGrath has raised the question as to what would happen under certain conditions. The first alternative discussed was the establishment of a separate Medical Council, and a separate Medical Register for the control of medical education, medical examinations, and the medical practitioners of the Saorstát, without relation to the existing Council of Great Britain.
Under this scheme practitioners qualified and registered in the Free State would not be allowed to practice in Great Britain or its Colonies. If such practitioners wished to practice in England they would require to pass an examination in England prescribed by some of the qualifying bodies. This examination would be of such a nature as the qualifying body would determine—at least it would be equal to the final examination. They would have to pay for that examination the fees that are paid for the ordinary diploma, and in addition would have to pay the registration fee. That altogether, I conclude, would amount to something like £100 put on them as an extra fee if they sought to practice in England. The medical students here who have no hope of obtaining employment in the Free State would naturally seek to get qualified in England, or Scotland, or the North of Ireland, so that they could be placed on the General Register. I do not know that I can take time to go into the question of the General Register on which the medical practitioners of England, Ireland, and Scotland, have been placed on an equality up to the present time, or to speak of the Colonial Registers by which Colonials are allowed to register if they sought permission and showed that their examinations are— not necessarily on an equality,—but at all events, of a degree that satisfies the General Medical Council. In order to get on this Colonial List, the Colonies have to apply to the General Medical Council for recognition, and their individual students then have to apply for registration of their diplomas. Then when they get on this Colonial List, the List is regarded as inferior to the general List, because on this List there are numbers of Indians, Canadians, and Australians. When a practitioner is looking for an appointment in England the General Register is looked up, and if his name is not there they rarely think of turning to the Colonial List, and when they do they feel they are turning to something somewhat inferior to the General List.
Let me say with regard to this, that there are at least 1,000 medical students in the Free State, and they are spending at least £150 a year each, and if they are driven elsewhere for education so as to get employment the Free State is going to lose a considerable amount of money. I calculate that £150,000 a year is spent by the parents on the medical students in the Free State. I think one might also, perhaps. assume that in many cases where parents are not tied in any way, and their sons and daughters have to go elsewhere to look for their education, the possibility is that these parents will follow them to the seat of their education in order to live at a cheaper rate, or to allow the students to live at a cheaper rate. That was the first alternative which was discussed by this conference. The second alternative was to establish a separate Medical Council and a separate register for the Saorstát, which should seek for and obtain from the General Medical Council of Great Britain reciprocity similar to that which now obtains between Great Britain and her Colonies. I might explain that if we were placed in the position of Canada or Australia we would have to apply to the Privy Council for recognition and then to the English Medical Council for recognition of our universities. At all events it is not compulsory on the council to recognise all the institutions in the Free State. It would be quite within their rights to fail to give recognition to certain of the licensing institutions here. As far as the reciprocity that has been spoken about is concerned, there must be under the existing circumstances application to the Privy Council, application to the Council of Universities, or Licensing Bodies, application even by the students, and even when that is obtained the name would only appear on the Colonial List.
The third proposal made would be the ideal one, and many of us when we began to consider this matter after the Treaty were fairly satisfied that it might be obtained. But the more we studied the matter the more we came to the conclusion that it would be impossible of attainment, namely, establishment of a separate Medical Council and a register for the Saorstát, with absolute control over the education and registration of the practitioners who qualified in its schools, while at the same time the registration of such practitioners in one country would give them ipso facto the right of registration in the other. Of course, this would require new and agreed legislation and it is essential that effective reciprocity should be assured before any change is made. We have nothing to offer the English Council in giving reciprocity to us. I think there is no doubt that if we asked and even if we were able to obtain reciprocity, so that all our graduates and diplomees would be placed upon the General Register, that the Colonies would come in and endeavour to claim a similar right. The General Medical Council have always set their faces against giving equality to the Colonies. I may say also that the establishment of a General Council and Register here would either cost the State a considerable amount of money or else the practitioners throughout the country would have to pay a yearly sum in order to run this Council.
As far as the distribution of those who qualified in the Free State is concerned, in the Register of 1922 there were 6,599 students who had qualified in the Free State. Of these there were resident outside of Ireland 52 per cent.; resident in Northern Ireland, 12½ per cent.; and resident in the Free State, 35 per cent. So that more than 50 per cent. of the students who qualified in the Free State are living outside of Ireland. A point that was made during the conference was that of the total number on the Register the number of Irish practitioners was slightly under 7 per cent., whereas the percentage of representatives on the General Medical Council, so far as Ireland is concerned, amounts to twenty-one per cent. So that we have at present a good deal more control, than the number of practitioners would entitle us to. There is no doubt that if we gave up association with the British Council we would lose entire control over the practitioners of Irish extraction and with Irish qualifications who are practising elsewhere.
It may not be out of place to say, as far as the penal clauses are concerned, that although reports are given of men in Ireland who have committed felony, or murder, or anything of that kind— although such cases as those are dealt with by the General Medical Council— there has never been any instance in which any practitioner has been brought before the Council for anything in the nature of political offence. As I started, I want to finish by saying that this Conference, representing all the Licensing Bodies in the Free State, was unanimous in the conclusion that it would be a very disastrous thing for any change to be made at present. They considered that the third proposition put forward would be the ideal one, but they would be the ideal one, but they would be very slow, indeed, to give up the existing conditions unless they were perfectly satisfied that the free reciprocity spoken of in that clause were assured. It would be a very serious thing for us to give up any rights we have unless we are assured that we are going to get equal rights in future.
In addition to this Conference I have a letter here from the Irish Medical Association, which represents the general practitioners throughout the country. The Irish Medical Association, at their annual meeting, last month I think it was, passed the following resolution:—
"That this meeting expresses the hope that no change will be made in the system of medical registration in the Irish Free State which would interfere with the right at present possessed by medical men qualified in Ireland who practise in Great Britain and the Dominions."
As far as the medical profession is concerned, we have here the Association which represents the entire profession throughout the country and we have also the opinion of the people engaged in teaching and who are connected with the Universities and Licensing Bodies. I have pleasure in supporting the Second Reading of the Bill. I am not explaining why it was necessary this Bill should be rushed, as I think the Minister did that sufficiently when he was introducing it.
