I take it that on amendment 1 to Section 3 it will be necessary for Deputy Hennessy to discuss amendment 4 as well.
MEDICAL PRACTITIONERS BILL, 1927—COMMITTEE.
The Dáil went into Committee.
Section 1 and 2 agreed to.
SECTION 3.
(1) A council to be styled the Medical Registration Council (in this Act referred to as the Council) shall be established in accordance with this Act to fulfil the functions assigned to it by this Act.
(2) The Council shall be a body corporate having perpetual succession and may provide itself with a seal and may sue and be sued under its said style and name.
(3) The Council shall consist of nine members nominated or elected from time to time as follows, that is to say:—
(a) one shall be nominated by the Executive Council,
(b) one shall be nominated by each of the following bodies, that is to say, University College, Dublin, University College, Cork, University College, Galway, the University of Dublin, and the Apothecaries Hall of Ireland,
(c) one shall be nominated jointly by the Royal College of Surgeons in Ireland, and the Royal College of Physicians in Ireland, and
(d) two, who shall be registered medical practitioners resident in Saorstát Eireann, (in this Act referred to as direct representatives) shall be elected by the persons who are for the time being registered medical practitioners resident in Saorstát Eireann.
I suggest that you leave Deputy Hennessy's amendment and my first one over until it has been decided whether our other amendments will be accepted. Could not we go back on them after the other amendments have been discussed?
It amounts to the same thing if Deputy Hennessy deals with the whole matter on amendment 1, as his proposal is to increase the Council by two, in order to have four elected representatives.
I move amendment 1.
In sub-section (3), line 24, to delete the word "nine" and substitute therefor the word "eleven."
My idea is to increase the direct representation of the general practitioners from two to four. The number they are allowed under the Bill is altogether inadequate when we remember that there are about 2,400 practitioners in the Free State. I admit that the Minister had some difficulty in allocating the representation amongst the licensing bodies and the medical schools.
He had to find reason for giving the teaching bodies representation as distinct from the licensing bodies, and in making that provision there did arise some apparent inequality in the representation. I do not see, however, that the interests of the teaching bodies of the constituent colleges of the National University are identical. For instance, the interests of the medical school of University College, Cork, are not identical with the interests of the medical school of University College, Dublin. We know that Cork men have a big outlook—a national outlook, a world-wide outlook—and I am almost surprised that they are satisfied with even one representative. Be that as it may, I think the medical practitioners are entitled to four representatives, and I hope the Minister will accept my amendment.
Deputy Hennessy has based his amendment upon the fact that there are 2,400 practitioners resident in the Free State. I do not think the numbers are an important factor in the consideration. What has the Council to deal with? It has to deal with (1) the system of education, and (2) the control of the practitioners in their professional capacity. To do that there is suggested here a council of nine, of whom one is to be the nomination of the Executive Council, two directly representative of the profession, and a certain number of others to be nominated, each by certain licensing corporations. From the educational point of view, there can be hardly any argument put up against the suggestion that the licensing corporations are the people who should have the biggest say—that their voice should have the greatest weight in that matter. Even when it comes to the question of the control of the profession in their professional lives. I would urge that it is the licensing corporations who would have the better idea, first of all, of the standard of education that I referred to, and, secondly, of the standard of professional conduct to be observed. The one who is to be nominated by the Executive Council, I would imagine, would ordinarily be a man chosen, not from the licensing corporations, but from the general practitioners. So that to that extent you would have actually two directly representative of the profession, and one who normally would be representative of the profession appointed by the Executive Council. In other words, the profession, apart from the licensing corporations, would have three out of a total of nine, and it was considered that that was a sufficient number to give to them. Is it possible on this amendment to discuss the Council as a whole, or am I confined to the particular point of the number to be appointed by the profession direct?
I would like to keep to the question of how many the profession should appoint, or what proportion they should appoint, but, as the amendments deal with the composition of the Council, if it seems more satisfactory to take it all together there is no objection.
I was going to suggest just what my own attitude towards this Council, as a complete body, would be after representations made to me. I have had the advantage in the last couple of days of having met representatives of certain of the bodies mentioned in sub-sections (b) and (c), and I would be prepared to agree, in fact to suggest to the Dáil, that they should agree to a Council of eleven, to be composed in the following way: two nominated by the Executive Council; one by each of the bodies named in paragraph (b); one by each of the bodies named in paragraph (c), and two direct representatives. We would then arrive at a Council on my suggestion—if I might get back to direct representation—of eleven, of whom two would directly represent the profession, and of the others, the two to be appointed by the Executive Council would, in fact, be representatives of the profession, apart from the licensing corporations, so that the representation under this new suggestion would be four out of eleven instead of three out of nine. That is my suggestion for the Council as a whole.
I take it the Minister is not going to accept my amendment, and as I have no desire to precipitate a dissolution I shall withdraw it, with the leave of the House.
Amendment, by leave, withdrawn.
I move amendment 2:—
In sub-section (3), line 24, to delete the word "nine" and substitute therefor the word "ten."
A good deal of trouble has been removed from my shoulders by the acceptance by the Minister of the amendment that I have put down here. It deprives me of the opportunity of going into certain matters that I intended to go into, but I should like, sir, if you would allow me to say what I should have said on the Second Reading, if I had the opportunity. I feel that many people considered that there was no need for the formation of a new Council. That was not the view taken by the Executive Council, but since they did establish the basis after negotiations which they held with the medical men in the Free State, I want to say that I cannot give the Executive Council too much credit for the determination with which they worked to overcome many difficult obstacles, and to secure a solution of the medical registration problem which has proved to be eminently satisfactory. Briefly put, the position now is that medical graduates and licentiates in the Free State will be able to register on the General Register as heretofore.
There is just one point with which I am sorry I cannot quite agree, as far as the Minister's proposal is concerned. He suggests that a second nomination should be given to the Executive Council. I think that this second nomination should be given to the University of Dublin. I want to allude to a matter that is of some importance. The students that are registering in the colleges of the various institutions at present are an indication of what will come out of those colleges three years or six years hence, as the case may be. Last year the number entered on the student's register in University College, Galway, was 2; in University College, Cork, 14; in University College, Dublin, 27; a total of 43. These included medical and dental students. In Dublin University or Trinity College the number of entrants was 51; in the Royal College of Surgeons 56. I will take the average of the three years, which is a fairer basis to go upon. The average number of students entering University College, Galway, for the three years was 4; University College, Cork, 20; University College, Dublin, 38; a total of 62 in the three University Colleges. In Trinity College, Dublin, the average for the three years was 53, and in the College of Surgeons 20. Even granting that more of the Trinity College graduates leave the country than those who graduate in the National University, the difference between 62 for the three colleges of the National University and 53 for Trinity College does not, in my opinion, constitute a reason for giving the University Colleges three representatives as against one for Trinity College. I say that a proportion of two to one would be fairer, and I would have been prepared to suggest that the Minister should give one representative to the National University, and one each to its three colleges—four in all—if he would consent to give two to Dublin University, because, as I say, these numbers represent the students that would be graduating three years or six years hence.
These are the actual figures. The point was made—it was right to make it—that a greater proportion of the Trinity College students leave the country than the National University students. I admit that. But even if the number who leave the country were 60 per cent. of Trinity College students and 40 per cent. of the others that still leaves a margin. These graduates will be under the control of this Council afterwards. The great function of the Council will be to control the conduct of those people and, to some extent, to regulate their education. But the chief function of the Council will be the control of graduates. If the Minister wants to be quite fair, I think he should give representation in the proportion of two representatives to the National University for every one given to Dublin University. Instead, therefore, of giving this extra representative to the Executive Council, I would suggest that the Minister give the extra one to Trinity College and that he give four to the National University.
I should just like to refer to one other matter—that is, in connection with the Apothecaries' Hall. The statement was made that the Executive Council decided not to give nominations any longer to the body that granted the licence or the qualification which allowed people to be put upon the register. That was one statement. The other statement was that they would only give nomination to bodies that were entitled to give a complete qualification. We all know that none of the University Colleges is capable of doing more than teaching. These Colleges have nothing to do with the giving of the qualifications which entitle graduates to be placed on the register. Therefore, the National University is being disfranchised by this method of allotment here—giving representation to the three University Colleges has removed nominations from the body that gives the necessary qualifications to these graduates who are to be placed on the register. It would be a fair thing to give representation to the National University, and it would be fair to give one more representative to Dublin University—that is, one to the University and one to the school. Now, I come to deal with the question of the Apothecaries' Hall. There is no necessity to go into figures, because it is well known that they do not register on an average, more than about four each year. They have no school. Therefore, representation could not be given to them on the ground on which it was given to the University Colleges, which have schools. They have no claim to representation so far as a school is concerned. When it comes to the question of giving register qualifications, they have no power to do that either.
They are only capable, at the present time, of giving a qualification to men to be placed on the register by reason of the fact that under the Medical Act of 1886 there was provision whereby any body going only for a single licence were enabled to make arrangements with another body. They could apply to the General Medical Council, and the General Medical Council could appoint assistant examiners in the subject in which they were incapable of examining. In the case of the Apothecaries' Hall, that is being done, and the two assistant examiners are examiners in surgery, so that the Apothecaries' Hall is not able to give a qualification to any of its licensees, or so-called licensees, to be placed on the register. I see no reason why representation to the Apothecaries' Hall should be continued. I should prefer to see it in the hands of the colleges, which are more interested in teaching, and who have a larger number of students on the register. Therefore, they would take a much greater interest in the welfare of these institutions. The Minister has accepted my amendment to give a single representative to each of the two professional colleges which had representation since their foundation, and which are really two separate bodies. Having accepted that amendment, I would ask him to consider for Report Stage the suggestion I have made—to give a nomination to the National University and to give a nomination to the Trinity College Medical School, as apart from the University.
I have heard for the first time to-day the suggestion as regards giving representation not merely to the Colleges of the two Universities, but also to the two Universities as corporations. That is a question which we might discuss on Report. For the time being, I would rather regularise the matter by having the amendment I outlined made. The amendment would be:—In line 24, to change the word "nine" to the word "eleven;" in item (a) to change the word "one" to the word "two;" the word "and," in line 30, to be deleted, as well as the words in line 31, "one shall be nominated jointly by." That would leave a Council of eleven: two nominated by the Executive Council, two directly by medical practitioners, and one each by certain named corporations. If the matter were regularised in that way, we could consider the other suggestion on Report.
The Minister has, I think, decidedly improved the Constitution of the Council. The suggestion that direct representation should be given to the actual licensing body is a very important one, and is worthy of all the consideration which he can give it. I think the number—eleven— could still be secured. In the figures quoted by Deputy Sir James Craig allowance must be made for the number of dental students, because we are actually dealing here with medical students. It would strengthen Deputy Sir James Craig's case if allowance were made for the dental students. The figures given by the Minister on Second Reading cannot be taken as a reliable guide, because of the effect of war conditions on the medical schools at the time.
Amendment 2, by leave, withdrawn.
We will take the amendment by the Minister, in the form which he has suggested, to-morrow.
Ordered that progress be reported.
The Dáil went out of Committee.
Progress reported.
Committee to sit again to-morrow.