HC Deb 23 February 1954 vol 524 cc330-60

Postponed proceeding resumed on Question, That an humble Address be presented to Her Majesty, praying that the National Health Service (Medical Auxiliaries) Regulations, 1954 (S.I., 1954, No. 55), dated 18th January, 1954, a copy of which was laid before this House on 19th January, be annulled.—[Mr. Blenkinsop.]

9.57 p.m.

Mr. Blenkinsop

I was explaining, when last I had the honour of addressing the House, earlier this evening, the Regulations which we are praying against this evening arose out of the recommendations of the Cope Committee, which was set up my my right hon. Friend the Member for Ebbw Vale (Mr. Bevan). In making its recommendations on the subject of the qualifications for auxiliaries to be employed in the Health Service, the Cope Committee made the main recommendation that registration machinery should be set up that would be separate entirely from the Ministry of Health. They further explained the qualifications that, in their view, auxiliaries in certain fields should establish before being employed in the National Health Service.

My right hon. Friend the Member for Middlesbrough, East (Mr. Marquand) announced in the House in 1951 the then Government's acceptance in principle of the recommendations of the Cope Committee, and also that there would be consultations and discussions with all the professional bodies concerned in working out the form of any registration machinery. My right hon. Friend also said that a circular was to be sent out to the hospital authorities explaining the Government's attitude towards the Committee's recommendations, and also explaining that in the Government's view the qualifications required by the Cope Committee for these different fields of auxiliaries' work were desirable qualifications.

When the late Government left office representations were being received from some of the professional organisations complaining that the Cope Committee had not adequately considered their particular point of view. It was well known that there were very real differences of opinion among some of the organisations involved, but nevertheless I understand that the present Minister or his immediate predecessor sent out a memorandum to the professional bodies concerned, very largely based upon the Cope Committee's recommendations, and invited their comments.

At that time is was impossible to get any agreement amongst the many professional bodies, and I do not think that anyone could be altogether surprised at that. This covers a wide field of organisation and services at very varying stages of development. I need only read out the list of auxiliaries covered by the Regulations and Members of the House will understand how difficult it would be to frame Regulations covering all of them. The list includes: chiropodists, dietitians, medical laboratory technicians, occupational therapists, physiotherapists, radiographers, remedial gymnasts and speech therapists. So it will be seen that a great variety of medical auxiliaries is covered by these Regulations, and, therefore, it is not surprising that it proved impossible to get agreement amongst the different bodies.

In the meantime, I understand that hospital authorities have been accepting the recommendations offered to them by the late Government to make new appointments in the hospital field broadly on the recommendations of the Cope Committee. But now we are presented with these Regulations. The first point I want to put to the Minister is to ask him why he felt it necessary to introduce Regulations of this kind, which, as I will explain in a moment, makes him the arbiter of standards and qualifications in quite a wide medical field, a duty of which I should have thought he would have wished to divest himself rather than attach it to himself. In view of the fact that negotiations are to be attempted with the different professional bodies again in the hope of establishing some more permanent form of legislation, it seems strange to us that he should have thought it desirable to introduce these Regulations.

I hope the Minister will explain to us why he felt it necessary to bring these Regulations forward and whether he regards them as a temporary measure until some other arrangements can be arrived at. If they are of a temporary character, was it really necessary to bother the House with them at all?

The third paragraph lays down the qualifications that the Minister would accept for these various auxiliaries in the Health Service. I do not think anyone will take any objection to the first two sub-paragraphs which deal with medical auxiliaries who are already working in the Health Service. I have not heard of any suggestion from any quarter that those who are already employed in the Health Service should be displaced because of any new standard of qualification at which we might arrive. I do not think there is any difference of opinion about that.

Rather odd are the later sub-paragraphs of paragraph 3 of these Regulations, the first detail of which lays it down that the Minister shall be the approving body for courses of training and examinations. Later sub-paragraphs lay it down that certain bodies outside this country shall also be accepted for certification, and sub-paragraph (4) gives the Minister completely unfettered freedom to add to the list of accepted practitioners anyone he cares to put on the list.

I do not think that any Minister could have wider powers than the right hon.

Gentleman takes to himself in sub-paragraph (4). There may be some good reason why he feels it necessary to do so, and I am quite sure that he would not have taken these powers without some good reason. Therefore, I hope he will be able to explain to us just precisely why he does it.

I wish to call attention to a matter which to many of us is even more important. We are obviously concerned with standards for this very varied group of auxiliaries because of their importance for the patient. That is what we in this House must be mainly concerned about, and we are naturally anxious to ensure that standards of qualification should be properly maintained.

Therefore, when we see in the First Schedule to these Regulations that two standards of qualification with regard to physiotherapy are apparently to be accepted by the Minister as of equal worth, it gives us some very real anxiety. The requirements set out in column (2) with regard to qualifications for the employment of a physiotherapist in the Health Service are that: He shall have passed the qualifying examination of (1) the Chartered Society of Physiotherapy after attending a full-time day course of training at a school recognised by the Society "— the course for the Chartered Society is, I believe, a three-year course, if notlonger— or (2) the Faculty of Physiotherapists after attending a full-time day course of training at a school recognised by the Faculty "— another body run almost on parallel lines with the Chartered Society— or (3) the Physiotherapists Association after attending a full-time day course of training in physiotherapy of not less than three months duration and working thereafter as a full-time physiotherapist in a hospital for not less than 2years. It is clear that there must be a very great difference in standard between the physiotherapist who has passed the qualifying examination of either of the first two bodies referred to in this Schedule as compared with those who have qualified under the Physiotherapists Association. I do not think it is in any way attacking the Physiotherapists Association, which has attempted to make some provision for those who took up of this kind during the war years, to say that there is a very real distinction indeed between the standards of the two bodies.

The Minister of Health (Mr. Iain Macleod)

I would like to make this point clear, because, to some extent, it is the crux of this argument. The hon. Gentleman will realise, of course, that whereas the certificates of the Chartered Society of Physiotherapy and that of the Faculty of Physiotherapists are accepted, the Physiotherapists Association have to have, as far as the First Schedule is concerned, the additional qualification of service and, presumably, satisfactory service, of two years in a hospital.

Mr. Blenkinsop

That may be, but, even so, many of those who are concerned with this matter, both on the medical side and on the lay side, are far from satisfied that the requirement of two years' experience in a hospital is anything like adequate compared with the long period of detailed training provided by the Chartered Society. I should be the last to urge that only one organisation should be recognised for this sort of purpose, but I think it is vitally important that we should protect standards. I would put to the Minister in a friendly spirit, so that he may give an explanation and so inform the House, whether there is not a danger, if these Regulations are accepted by the House, and become the general basis of operation throughout the hospitals, that the hospital authorities will appoint those with lower standards of qualification, and be able to employ staff at lower rates of pay.

This is surely a matter that must be of real concern. Hospital authorities are extremely anxious to save money wherever they can. I do not blame them. Is there not some danger that, if these Regulations go through, they may seek to fill their complement of staff with those who have not the same standard of training and do not command the same rates of pay, and that they will do so to achieve financial savings? I hope that will not be true. Nevertheless, it is a danger the Minister must see exists.

It is because of our anxiety about these matters that we put down this Prayer, to get an explanation from the Minister of what his intentions are and of what action he intends to take about setting up some more satisfactory registration machinery in the future. I am assuming that he intends these Regulations to operate for a relatively short period, and that he intends to replace them with more permanent provisions. Naturally, we are hoping to get the agreement of the professional bodies to set up registration machinery. I have just suggested that the Regulations cover such a wide variety of bodies that it may not be practicable to get one central body to cover the lot, because they are of varying stages of development and standing. We may have to consider the establishment of registration machinery for only one or two sections of auxiliaries, and consider others later.

However, I should have thought that the Minister would have agreed with me that it is very desirable that he should divest himself as soon as possible of responsibility for deciding the standards of qualification and training. Ministers have assured the House that they do not wish to enter into other medical fields. That was very natural and desirable. I hope that the present Minister will do the same, at least over as much of the field as he practically can. By these Regulations he claps upon his own shoulders a responsibility of which I hope he will divest himself.

So I move the Prayer to elicit information from the Minister, and I hope that hon. Members on both sides of the House will express their views, varying views as they may very well be, so that we may have a chance of discussing this important question of standards of qualifications in the National Health Service.

10.15 p.m.

Sir Frederick Messer (Tottenham)

I beg to second the Motion.

The peculiarities of the negative Resolution procedure give the impression that when a Prayer is put down it is put down in a hostile spirit. The truth is that it is the only means by which we can get information that cannot possibly be in the Regulations. In seconding this Motion, therefore, I want to pose one or two questions, the answers to which will then be on record.

In my view the step taken by the Minister is very important. Recognition of the medical auxiliaries is long overdue. They now form, and have done for a long time, an important part of our Health Service. They seem to have developed rather accidentally and I realise that it is impossible for us to expect that we can at the present time get what we have in the older ranks of the profession, such as the General Medical Council, the General Nursing Council, the Society of Pharmacists and other recognised bodies.

At the same time, we have to be careful about the standard of attainment, for these people come into actual contact with the patients and they have a tremendous responsibility. This is not so much true of the speech therapists as the chiropodists. There are two bodies, the Council and the Society. I do not know what difference there is in the standard of attainment necessary to pass a qualifying examination, but everybody will agree that it is risky if we give recognition to a standard in that field which might have serious consequences.

I know that we are faced with many difficulties here, one of which is a shortage of those in the professions. So far as chiropody is concerned, there is urgent need for an extension of that service and the Minister has taken a step forward in bringing these Regulations, in that he is introducing into the National Health Service a part of the service that should have been in at the very beginning.

One of the difficulties of our ageing population is that of the care of their feet, and yet chiropody is not recognised as a free service. I am hoping that as time goes on these different bodies will get together and that there will be a measure of agreement as to their standards. But if chiropody is important, physiotherapy is much more important, for now there is usually included in the physiotherapy department of a modern hospital the actinic rays—the ultra-violet rays, the infra-red rays, and so on, apart altogether from the electro-therapy, massage and physiotherapy.

In that field there is a danger that if people who are not qualified are given work which is beyond their knowledge actual damage might result. I do not know how true it is, but I have heard it argued that the standard of the chartered society is really too high, that it is an unreal standard and that the period of training is too long and is not required. That may be true. I have heard the same thing said about the faculty, but I have also heard it said that the Association of Physiotherapists has a standard which is too low. The Minister has attempted to meet that by saying that if a physio- therapist has had three months' training and two years' experience as a physiotherapist in a hospital, then under the Regulations he or she can be admitted and recognised for employment by the employing authority.

Perhaps the Minister will say whether he is going to issue any instruction or circular to ensure that two years experience in a hospital as a physiotherapist means that that two years will be two years of the type of work that would be done by a fully qualified physiotherapist, for in the physiotherapy department there is a lot of work of a repetitive character that does not call for a high standard of qualification. If satisfaction can be given on these points, I am sure that it will be welcomed.

I am not seconding this Prayer for the rejection of the Regulations because I feel that they ought to be rejected, but because it is necessary to move the Prayer to obtain the information that we require. The Minister may have done one good thing. He may have shown these auxiliary organisations that the time has arrived when, by some means, they should get together to agree on a form of council that can be a registering body. If that can be done, good will result. I am hoping that on these points we shall have satisfaction not merely for ourselves, but also for those engaged in the profession.

10.22 p.m.

The Minister of Health (Mr. Iain Macleod)

It is desirable that in a matter which is as complicated as this that the House should have at the earliest possible stage a statement from the Minister on the meaning of the Regulations in so far as he can make that statement in answer to some of the questions that have been raised. In the same way as the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) did not launch an enthusiastic attack on the Regulations so, to preserve the symmetry, I will not make an enthusiastic defence of them.

Quite frankly, I regard part of this procedure as unsatisfactory, and I am quite prepared to explain why to the House. All that I will say is that in my view this is the best, or, anyway, the least undesirable, of the courses that are open to me in this situation.

The effect of these Regulations, which come into operation unless they are annulled by the House—and it is important that people outside the House should realise the point made by the seconder of the Motion that, according to our procedure, the only way in which one can obtain information on these matters is to put down a Prayer which, on the face of it, opposes the Regulations themselves—is to make it illegal for any board or committee, hospital or local health authority to employ an auxiliary who is not qualified in accordance with the Regulations. We must also take note of the fact that these authorities are left completely free to select the persons they employ and they are of course most competent bodies who will take into account all the matters they should when they appoint an employee.

As the hon. Member for Newcastle-upon-Tyne, East said, these Regulations originally arose from the recommendations of the various committees under Mr., now Sir, Zachary Cope, appointed in 1949 by the right hon. Member for Ebbw Vale (Mr. Bevan) and four Ministers of Health have been concerned in one capacity or another with this problem.

In effect the Cope Report was in two parts. The first looked at the acceptability of the existing systems of training and qualification and suggested what should, and to some extent what should not, be regarded as adequate for employment in the National Health Service. They were secondly concerned with the longer term problem of identifying qualified auxiliaries and supervising training and qualifications for the future. They recommended in short that this, the second part, of the problem should be the duty of a statutory body under the aegis, as these matters usually are, of the Privy Council.

That Report had a number of minority reports attached to it. The minority reports, including in particular the physiotherapists which have been mentioned tonight, were in general in favour of a separate registering body for each of the different groups and were rather critical of the council proposals that the Cope Committee put forward.

That was the situation which had to be dealt with by the right hon. Member for Middlesbrough, East (Mr. Marquand) when he was Minister. By and large his solution, with which I do not quarrel at all, was to say that we should have a look at the majority recommendations as a basis for legislation and in the meantime have a sort of standstill position so that the recommendations of the Cope Committee could be taken for future entrants into the Health Service. As I say, I do not quarrel with that at all, but I invite the House to notice that that was laid down by circular. Whatever may be said of regulations as an unsatisfactory form of legislation, at least that is part of the ordinary body of the law of this country and nothing could be more unsatisfactory, other than for a short time, than Government by circular. I am sure the right hon. Member agrees and he meant his circular to last for a short time.

The General Election came a month or two later and proposals were put forward by my predecessor, now the Lord Privy Seal, in December, 1951, to the various interested bodies. Those proposals modified the Cope Report. Broadly, without going into detail, they were in favour so far as the representation on the council was concerned, of the medical auxiliaries and throughout that year discussion took place. I became Minister of Health in May of that year, 1952.

At the end of that year, almost exactly a year ago, the problem was brought to me and I was told, "We have tried to get agreement on the basis of the 1951 suggestions "—which were more favourable to medical auxiliaries than the Cope Report—" and, with the best will in the world we have failed, and, by and large, the position remains as it was in the Cope Report." I was by this time the fourth Minister of Health, and I had to take a decision. It is this decision which is the essence of the dilemma which I put to the House tonight. I am entitled to say to the House, "If you do not accept my solution—which I do not say is perfect—which of the other solutions do you prefer?"

As I see it, there were four things that I could do. I could push ahead with Cope, either on its original basis or as modified in December, 1951, and today, in face of the known hostility of a great number, including some of the most important, of the bodies concerned, which would clearly have been disastrous. Secondly, I could have established— assuming that one could have obtained time for the necessary legislation—a system of statutory registrations which would have given different registers for each of the groups concerned.

In my view, there are two overwhelming objections to that. The first is that there must be consultation in between the groups; that is to say, the qualifications for the groups must not be considered in isolation but as manifold auxiliary divisions. The second is the sheer practical difficulty that in many of the cases the numbers concerned are much too small to justify or to support financially such a proposal. There are, for example, only 500 dietitians and 400 speech therapists.

The third proposal was to do nothing. Perhaps I am wrong, but I thought that the opening speech on this Prayer hinted that that was perhaps the right thing to do. I could have gone on relying on the 1951 Circular, although government by circular is a very bad thing, in which I am sure the House would agree with me. It had become abundantly clear, as indeed one would expect, that isolated cases of unfairness were arising as a result of the circular, which prevented people from obtaining posts in the Health Service which otherwise they might have had. The right hon. Member for Middles-brough, East intended his circular to be temporary, carrying on with negotiations. After a year of hard work that proved useless, and is not a course one would commend to the House.

So I am left with the powers under the 1946 Health Act, Section 66 of which empowers me to lay down qualifications. This is not a new procedure. It is not the first time that a Minister of Health has used that Section. The right hon. Member for Ebbw Vale used it for the qualifications of health visitors and for other purposes under the 1948 Act. But I should also say that I regarded it as highly undesirable that the Minister of Health should concern himself with qualifications in this sort of field, unless it were unavoidable.

The whole basis of my case is that this is only a temporary measure, and must be considered as such, and that as soon as possible the Minister of Health should not have to concern himself with this sort of standard. Therefore, I decided, and announced to the House as I did, that I proposed to take what we may call "course 4" of the ones I have indicated. I sent my rough ideas to the organisations concerned, asked for their comments and have told them in recent correspondence that I intend to set up a working party to continue the probe, and I am hopeful of results, to try to get agreement. It is important to note that a solution did emerge from the organisations concerned, partly, I have no doubt as a result of the catalyst of these Regulations.

Although this point was not raised, but because the debate will be read outside the House, I should make it plain that we have excluded almoners, although the Cope Committee included them. I think that is right, because most people would agree that an almoner is not a medical auxiliary, but a social worker in the medical sphere, and I do not think it would be proper to deal with them in these terms. We have included remedial gymnasts who were included under the physiotherapists' umbrella by the Cope Committee as a result of our subsequent examination.

The points raised by the mover and seconder of the Motion largely concerned the admission in certain circumstances of the Physiotherapists' Association in the First Schedule. It is most important, as, indeed, I interrupted the hon. Member for Newcastle-upon-Tyne, East to make clear, that it should be clearly understood that the qualification of the Chartered Society of Physiotherapy is accepted, and the qualification from the Faculty of Physiotherapists is accepted. In the case of the Physiotherapists Association there has to be something in addition. I went into that very carefully, and it has been included in the Regulations as "working thereafter as a full time physiotherapist in a hospital for not less than two years."

It is as if, in another field, we had said that we would take any form of degree from an established university, but from a faculty which might not have as wide a repute we would only take first-class honours. I am satisfied that although the number involved is small they are people mainly, if not exclusively, who have been employed in service hospitals, and those mainly, if not exclusively, are ex-Service men, to whom it would be wrong to deny the possibility of service under the National Health scheme.

That, in part, answers the question put by the hon. Gentleman the Member for Tottenham (Sir F. Messer) about the standards of the Physiotherapists Association. I would also quote to him paragraph 462 of the Cope Report, which says: We were told that the Physiotherapists Association's examinations are conducted by an examinations board. During the year 1948, 19 persons sat for the examination and five passed. In 1949, 45 sat and 18 passed. So it does not really look from that as if the qualification is one that is lightly granted. It is also fair to point out that the Cope Committee was appointed nearly five years ago, and it may well be that the standards of some of the bodies concerned have considerably improved since then.

But the most important thing to remember, in my view, is to consider what is to happen after 31st March—that is, from Regulation 3 (3) and the Second Schedule. A number of bodies are there laid down as appropriate bodies, and if someone has, first of all, attended a course of training, secondly has passed the examination, and, thirdly, if that course of training and examination have been approved by the Minister, then he may qualify for the National Health Service.

Let me make it absolutely clear that inclusion in the Second Schedule does not mean that I will necessarily approve the syllabus of the bodies concerned, and it is right that I should tell the House— because this, I think, is the main worry— what I have in mind. First, approval has to be given fairly quickly—that is, before 1st April—to those existing courses of training which are adequate, so that students who have already embarked on a course shall not be frustrated. All the bodies have been asked to send to me, by 28th February, particulars of their courses and examinations.

More important than that, I must look at the qualifications of these bodies for the future. I intend to invite those who specially advise me in this field, assisted by my consultant advisers, to examine the course and the examinations of the representative training schools, where they exist, so that I may be advised upon these matters. Since we have been most closely concerned with physiotherapists, perhaps I can say that in this field I will ask the advice of my consultant adviser, Dr. Cooksey, the Director of the Department of Physical Medicine at King's, and also of Sir Harry Platt, Emeritus Professor of Orthopaedics at Manchester.

The right hon. Gentleman and, of course, his hon. Friend who have been at the Ministry, know the standing of those two names I have mentioned. They know perfectly well that it is inconceivable that they would give me advice that would be inappropriate in this field, and they know also that it is equally inconceivable that the Minister would act otherwise than with and on the advice that is, in fact, given to him. I understand the worries that people may have, but I do not think that there is the slightest risk that the Minister will accept standards in this field that are too low.

One or two last points. The hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) raised the question of the very wide qualification of Regulation 3 (4). I agree with him that it is wide. Quite frankly, it is a safety valve. It is obviously possible to conceive of cases of people who because they have been living abroad or for other reasons, have not been able to obtain the particular qualifications that are suggested in the earlier Regulations, but who might yet be fully worthy of inclusion in the list. If such a list comes into being it will indeed be very small; there is no suggestion that it should be used other than as a means of ensuring that unfairness is not caused in the most exceptional cases that might well arise.

Let me sum up. I agree that it is undesirable that this sort of thing should be done by Regulations, but I submit that it is a good deal more desirable that it should be done by Regulations than by circular, which, after all, is the present position. Secondly, I would like to make it clear—and I am obliged to the hon. Member for Newcastle-upon-Tyne, East for putting the point—that, to me, this is, and must be, a temporary measure. I have by no means given up hope of complete success in this field: for, although I do not know what final form of groupings will come about, I do know that some of these bodies have obvious affinities and some may eventually come together and achieve statutory registration.

As I have said, I am setting up the working party which will do everything possible to bring about a successful solution to this dilemma. But I think hon. Members will agree from what I have said that standards which are too low will not be accepted. I have spoken chiefly about the physiotherapists, but the same things could be said in the other fields. There should be no fear on that point, and I should like to quote from a leading article in the "British Medical Journal" of 6th February, 1954, where, in the last few lines, it is stated that "There is now undoubtedly an opportunity for the Minister to achieve a piece of constructive statesmanship which will bring the position of medical auxiliaries into line with the other professions in the National Health Service."

That is what I should like to achieve, and I would emphasise that I think it is a great pity if we decide to divide on the issue tonight because that Division would not be understood outside this House; or, perhaps I should say, it would not be understood correctly. I regard this as a temporary measure. That is the first point, and secondly, I will do my best in trying to reach a final solution to this difficult problem. Thirdly, in the question of consideration of standards, I will first be guided by the findings of the Cope Committees and will then act on the very best advice available to me.

Mr. Blenkinsop

In order to re-assure the Minister and to relieve the suffering of some of his hon. Friends who may have no concern with this matter, may I say that we do not intend to divide the House, and that they may, therefore, go home?

10.48 p.m.

Mr. Somerville Hastings (Barking)

I will be very brief in what I have to say. I should like to speak of one group of medical auxiliaries only, and that is the chiropodists. I should declare an interest, although not a financial one, because I happen to be a patron of the Joint Council of Chiropodists. That is one of the two organisations which cater for these medical auxiliaries, but in the representations before the Committee presided over by Sir Zachary Cope which dealt with chiropody, only one of these two organisations was represented. That one was the Society of Chiropodists, and that Society decided to make hay while the sun shone; for, in the Report, these words occur: The examinations sponsored by the Society of Chiropodists for students from schools it recognises provide an adequate test for chiropodists wishing to be employed in the National Health Service … We are not satisfied that the qualifications offered by other organisations provide an adequate criterion of competence for employment in the National Health Service. A few pages earlier one reads: Students who pass the first provisional examination of the Society of Chiropodists are required immediately to apply for membership. Therefore, what this Report does is to provide a completely closed shop for the Society of Chiropodists. I congratulate the Minister most heartily on not having walked into that trap.

Although about half of the members of each of the two societies have passed the qualifying examination of the society to which they belong, the other half, approximately, in each case have never passed any examination at all, although they are members of one of the two bodies and may have been working in their profession for many years.

What is going to happen to those individuals? This is not clear, at least as far as I am concerned, because under these Regulations the Minister takes power to put on the list of those to be employed individuals whose names are included in a List kept by the Minister of persons not qualified in accordance with the foregoing provisions of this regulation, who have satisfied him that their training and experience are adequate for employment as members of that class. I may have misheard the right hon. Gentleman, but I did not hear him explain, as I should like to have done, how he will prepare that list and what will be the qualifications that he will require a person to have before putting him on that list. Quite clearly, there are individuals who in many cases have been in the profession for years, and who are, perhaps, among the most distinguished members of these various branches. Therefore, I ask the right hon. Gentleman to give very careful consideration to the preparation of that list, because I feel sure that on it he will wish to put a good many people who have never passed the examination in chiropody of either of the two bodies to which I have referred.

One word about the general question of medical auxiliaries. I realise the difficulty of the Minister because new varieties are constantly cropping up. There are now the electro-encephalogists —if that is the right term—those who not being medical men deal with the electro-encephalograph which is used a great deal in psychiatric departments today. Then there are the orthoptists who I do not think are included either.

I suggest to the Minister that there are certain classes which are ripe for registration in the same way that nurses and dentists and others, who years ago we might have called medical auxiliaries, are registered. I suggest that chiropodists and physiotherapists should come into that class, and I think that legislation should be prepared for the registration and proper training in the future of these two bodies. As their qualifications and duties become more definite they also, I believe, will rank for registration by special legislation.

I wish to end by saying that the statement of the Minister has cleared up a good many of my doubts, but that there still remains a doubt in my mind regarding what is meant by paragraph (4) of Regulation 3.

10.55 p.m.

Miss Irene Ward (Tynemouth)

I should like first to say that I am a member of the Council of the Chartered Society of Physiotherapists. I think I ought to say to the House that they were not anxious for a Prayer to be tabled against these Regulations, though I am bound to say that when the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) moved the Prayer in the terms in which he did, I think everyone in the House would agree that it has been a most useful debate. I am certain that the various bodies who compose the medical auxiliaries mentioned in the Regulations will be grateful for the opportunity that has been given to hear both the speech made by the hon. Member and that made by my right hon. Friend the Minister of Health. So far, so good.

I wanted to make it quite clear that the Chartered Society of Physiotherapists were not desirous of having a Prayer put down against the Regulations. But that does not mean to say that they have not extremely strong opinions. I felt it only right that I should briefly state what I believe to be their case. They are, as are most of us—and I think my right hon. Friend also confirmed it as his view —not in agreement with government by regulation. My right hon. Friend made it perfectly clear what his dilemma was, but that does not detract from the feeling that government by regulation is not a very appropriate way of proceeding. Also, the Chartered Society of Physiotherapists are opposed to the powers taken by the Minister to lay down standards.

If I may, I should like to congratulate my right hon. Friend on his decision to set up a working party. I think that was a most valuable suggestion which went a very long way to reconciling the body I represent to the decision to introduce the Regulations. But we do feel that it is not right or wise for the future that the Minister, or any Minister, should take power to set standards. Of course, over a very long period of years—and I am speaking only for the physiotherapists, because I have no knowledge of the attitude of the other bodies covered by the Regulations—the Chartered Society of Physiotherapists, starting as long ago as 1895, have been building up a standard of practice for physiotherapy which is invaluable to those who use the service. Throughout the country they have got their teaching schools attached, in many cases, to teaching hospitals, and they do feel that they have established a very high standard. Their only concern at the present time is that the maintenance of this high standard, in the interests of the patients especially, shall be adequately safeguarded and maintained.

There is just one other point we should like to make in this connection, and this was touched on by the hon. Member for Tottenham (Sir F. Messer). It is not only that dangers to patients may arise from treatment which is not given by fully-qualified persons, but that one can waste both time and money and not produce either efficient or economical treatment by employing people who are not fully qualified. The object of the Chartered Society is to ensure that standards are maintained. I am sure that will be the wish of everyone.

My right hon. Friend made a most admirable case. I say that with, of course, the reservations I have just made. He found himself in a very difficult position, I think. He told us who his advisers were —men of high distinction and ability. However, I think it would have been more helpful if my right hon. Friend had decided also to seek the advice of members of the Chartered Society of Physiotherapy, who would be in a position to add advice to that which my right hon. Friend seeks from Departmental advisers. I hope he will be able in some way or another to consult the fully qualified physiotherapists and other medical auxiliaries representing the various groups we are discussing, because that will show that my right hon. Friend himself realises that the medical auxiliaries of all sections have been working to establish a standard which is in the interests of their patients.

I regret having to make this point, but I think it wise to do so, because I have had many dealings with the Minister and the Department. When discussing questions of this kind, full of complication and difficulty, it would be helpful, and would create confidence in his policy, if he were at an early stage to meet the branches of the medical auxiliaries concerned. It may be that he has met all the other auxiliaries, but he knows it took me some considerable time to get him to meet a deputation of the Chartered Society.

We in this country believe in progressing by consultation and co-operation. I have had a long experience of the Ministry of Health, longer, perhaps, I may say with all modesty, than my right hon. Friend, though in a lesser capacity. There have been occasions, dating back to prewar times, when the nursing profession and other professions have had some difficulty in establishing their right of access to the Minister. I hope that in the future we shall have no further cause for suggesting that a little closer co-operation and consultation between the Department and those who are seeking to serve the National Health Service ought to be forthcoming.

I should like my right hon. Friend to give us some idea of when he will set up the working party, of its composition, and of how long he expects it will be before he receives its report. This debate has been most useful. If it gives confidence to those outside it will have done nothing but good.

11.4 p.m.

Mr. M. Turner-Samuels (Gloucester)

These are very proper and timely Regulations. I would convey to the Minister my personal thanks for the very careful and objective way in which he dealt with the difficulties with which he was beset over this matter. I raised the question as far back as 15th March, 1953, and I know that subsequently considerable negotiations ensued. These Regulations are a just result of the facts the Minister ascertained through those negotiations. I must criticise certain observations made in the course of his speech by the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop). A good deal has been said, indeed it has occupied the bulk of this debate, about the Chartered Society, as though it possessed some magic wand which it waved over its patients and proceedings, and as though no other organisation entered into the picture. That is not right. Indeed, it is a very wrong view.

The criticism which the hon. Member for Newcastle-upon-Tyne, East made was, in my submission, made without the exercise of due judgment, and must have been based upon inadequate information. I say this advisedly, because I do not think it is right for anyone to belittle an organisation unless one has the fullest information on which to justify that course. It is serious to strike at the livelihood of anyone; and in the House of Commons it is wrong to throw doubt upon the competence of people who are members of a certain organisation as regards their fitness for the work they are doing unless to do so can be justified to the hilt. I am alluding to what was said by the hon. Member for Newcastle-upon-Tyne, East about the Physiotherapists Association. There it was obvious that the hon. Gentleman was not only ill-informed but mis-informed, otherwise he could not have made the observations he did.

Mr. Blenkinsop

I only want to explain that I did not attack this body. I was scrupulously careful not to do so. I pointed out the difference in standards, which I think they themselves accept, and explained the anxieties which I think were held generally about the outcome of this matter, which the Minister has largely dispelled.

Mr. Turner-Samuels

The hon. Gentleman has made matters worse by repeating what he said, which was incorrect and unjustified. The standard of qualifications required by the Physiotherapists Association is certainly already high, but in these Regulations the Minister has put on; them an added obligation, a further qualification, in order that there can be no doubt about the competency and reliability of their work. I say that it was because of a misunderstanding of the real facts and because of misinformation or bad information, that this Prayer was put down.

Let me indicate what the obligation of a member of the Physiotherapists Association is before he can qualify for membership. It is true there is a reference in the regulations to three months, but it is interesting to note that that is governed in any case by the very first words which state "shall have passed the qualifying examination." So in any case the protection is there, because the qualifying examination has to be of a standard of which the Minister approves. My hon. Friend ought to have informed himself on this, and it is not fair to indicate that the standard is merely a three months' one. My hon. Friend will find on inquiry that the three months' training under the regulations is not three months' training and nothing more, but that it has to be followed by three years' hospital training and that two examinations have to be passed after that. First of all, there is a Forces examination, and then the open examination of the Association before membership can be obtained.

Mr. W. Griffiths (Manchester, Exchange)

I think it is two years' training in hospital.

Mr. Turner-Samuels

Under the regulations it is two years, but the Association insists on three years. So it is a complete misrepresentation to suggest that training is limited to three months.

Mrs. Eveline Hill (Manchester, Wythenshawe)

Will the hon. and learned Gentleman tell us where members of the Association train? What is its training school?

Mr. Turner-Samuels

The Association has got a proper system of education and students are attached to hospitals for training. In any case, that is not a question for me but for the Minister, because he would not have accepted this unless he was satisfied about it.

I regret that the hon. Gentleman the Member for Newcastle-upon-Tyne, East committed himself to a statement which was wrong without making the most careful inquiries first. I hope it will go out to the public that no one is allowed to become a member of the Physiotherapists Association, or to practise physiotherapy, unless toe is absolutely competent and proficient to do so—equally competent and proficient as a member of any other association.

I want to thank the Minister once again, because he has, by the Regulations we are discussing, undoubtedly removed many unjust cases connected with ex-Service men. It should also be remembered that most of the members of the Physiotherapists Association are ex-Service men, and I think it is a very poor reward for the service they have rendered their country that, without any foundation at all, anyone should come to the House and belittle the work they are doing.

11.14 p.m.

Sir Ian Fraser (Morecambe and Lonsdale)

I would claim to be as earnest as any Member in upholding the rights and dignities of ex-Service men, but it does not seem that the fact of serving in the Armed Forces necessarily qualifies a person for particular professions. I should be surprised if the hon. and learned Gentleman the Member for Gloucester (Mr. Turner-Samuels), who is a barrister, as I am, would consider that serving gallantly and with distinction in the Armed Forces necessarily qualifies a man to plead in the courts of Great Britain, without reading law and eating the dinners at the Inns of Court, as he and I did. I should be surprised if attendance at a court three months after passing an examination would seem to the hon. and learned Gentleman and to the Bar Council as adequate, by comparison with the generally recognised standards in the profession. To say that they could then go into the courts and plead for three years and thus learn how to do it, is not the same thing as saying that they are qualified to do it.

Mr. Turner-Samuels

After three years they would then have had experience, but it is two years, according to the Regulations.

Sir I. Fraser

The Minister is proposing to call them "physiotherapists" after three months. [HON. MEMBERS: "No."] Oh, is he not? I thought he said that.

Mr. Iain Macleod

The point is that, as far as the Physiotherapy Association is concerned, they must not only have a minimum period of three months but in addition have two years, presumably of satisfactory service in a hospital.

Sir I. Fraser

Then the Minister is not going to call them "physiotherapists" after three months? Do we understand each other? Or is he?

Mr. Macleod

I do not understand this point at all, I am not calling them anything at all. All I am saying is that if they have these particular qualifications a responsible hospital body or a local authority may appoint them.

Sir I. Fraser

It does not seem important to the Minister what he calls them. That is part of my complaint. My right hon. Friend is in a difficulty. I do not want to prolong this debate unduly or embarrass my right hon. Friend, but these are questions of importance which I bring forward most sincerely and which I ask him to attend to.

He himself said that what he proposed to do would be like choosing people from one of a number of universities, but would he choose people from universities who had not been there for two years and probably for three years, before they got their degree? If a graduate was required, could he find one from some university after three months. In the United States if you had a couple of guineas in Louisville, you could become a "Kentucky Colonel." My right hon. Friend cannot sustain this argument about "any university," but only about one that is properly recognised.

It shocks me very much to think that he is going to regard three months as adequate for taking one of these persons into a hospital and recognising him as a physiotherapist. If he said he would recognise them as apprentices, or students, or unskilled persons under tuition, it would be a different matter, but that is not what he said.

My reason for raising this matter is that there are in England, Scotland and Northern Ireland some 300 blind persons, two-fifths of them blinded soldiers, sailors and airmen, and the other three-fifths blind civilians, all of whom, after passing severe literary and educational examinations, go to the school which is recognised for the purpose and sit for the examination of the Chartered Society of Physiotherapists. They have all sat for this examination and they passed with distinction. Some hon. Members have spoken as if this profession of physiotherapy were not of very much importance; but it is.

These persons treat fractures very soon after they occur. They treat all kinds of medical and surgical conditions. They must be extremely skilful if they are not to do harm to their patients. Although they work under the direction of and after diagnosis by doctors, they normally treat patients on their own. It is a shocking thought to me that the Minister will put on a level with the persons in whom I am interested, and who have been three years learning anatomy and physiology, studying very hard to reach a high standard of technical efficiency and knowledge, of a particular subject, persons who have done three months' training in a school which apparently does not exist, and who, I assume, for the following two years will be operating in hospitals and learning something about it.

Mr. Macleod

Perhaps I had better make the point clear. My hon. Friend has completely misunderstood the First Schedule. In so far as the Physiotherapists Association is concerned, it is not a question of having a minimum period of training, whether it be three months or three years, and then doing two years before being called physiotherapists. Before being employed they must have two qualifications; they must have passed the examination, studied a course, whether of three months or three years, arid must already have served two years in an existing hospital which already will have been a services hospital outside the National Health Service. It is not a case of taking somebody else in.

Sir I. Fraser

Does my right hon. Friend believe that on one of Her Majesty's ships or at Gibraltar, under the aegis of the Royal Army Medical Corps or the Naval surgeons, it is credible that a sick berth attendant could possibly attain the skill which my friends, although blind, or perhaps because they are blind, have secured after three years of highly specialised training? I know that in a battle a sick berth attendant can undertake an operation, but it does not follow that he can become a surgeon on leaving the Navy. I realise that there are a number of these persons who served during the war and got into the service, and I have no doubt they have done many years of skilled work in hospitals and in their jobs.

It is a good English tradition that when a profession is closed or a register established those who are doing the work are recognised. It was done with the dentists, and it will be done if another profession is closed, and thereafter only persons who have reached the highest standards should be admitted. I am in favour of giving recognition to all those who are now in, and are doing good work and of admitting persons who have analogous qualifications in other countries, especially the Commonwealth. We want reciprocity. We are not in favour of admitting persons whose standards are not comparable to the best.

It is for that reason that I ask my right hon. Friend for an assurance that he will give the widest possible terms of reference to those experts he asks to advise him about this matter, and will not, for example, ask them to consider whether less skilled persons could do less responsible work in hospitals, but that they will find some kind of comparable standard between the scale that can be accepted, and which he seems to favour, and that which the Chartered Society favours. I wonder if my right hon. Friend knows about these examinations in anatomy, physiology and the rest? It seems incredible to me that he could be making these proposals—but he is very busy and I suppose that he does not know.

If this body of persons were not merely 300 blind persons, or a few thousand men and women associated with a body called the Chartered Society of Physiotherapy, auxiliaries subordinate to the medical profession and not widely known, but were instead the Electrical Trades Union, or the doctors, the lawyers or the boilermakers—or any other group of persons who have a special skill—is it to be supposed for one moment that they would allow the Minister of Health of any party to proceed to dilute their skill in the manner now proposed? To make journeymen of persons who have hardly had a proper apprenticeship? Of course they would not. It is only because these are small, defenceless—though extremely useful—people that the Minister can be contemplating this highhanded action.

I ask him seriously to consider that he will for all time be lowering the standard of one of the most important of our medical auxiliary services, built up so painstakingly by the Chartered Society over the years; that he will be acting detrimentally, not only to my 300-odd blinded people who so ably carry out this most valuable work, but to all the other members of this Society, which has such a very high standard.

If I have appeared a little cross with my right hon. Friend, let me say that I am most grateful to him, and to previous Ministers of Health, for the consideration which they have given to these blind people, who are employed on level terms throughout the Health Service, and who also have private practices of their own in which they thrive and do well—where they carry out this valuable healing service to their own great benefit and to the enormous benefit of their patients.

11.27 p.m.

Sir Hugh Linstead (Putney)

My only excuse for prolonging the debate at this very late hour is that the subject is of great importance to the professions involved, and of very considerable importance to the Health Service. I wish to suggest, not the approach of the National Health Service—which is the approach which we have so far been making—but the approach of the professions with which this set of Regulations is concerned.

Before doing that, I should like to follow the remarks of my hon. Friend the Member for Morecambe and Lons-dale (Sir I. Fraser) about the position of the Physiotherapists Association in the First Schedule. I believe there is a misunderstanding there which it may still be possible for my right hon. Friend to clear up. The hon. and learned Mem- ber for Gloucester (Mr. Turner-Samuels), in his spirited defence of this Association, did not make clear what ought to be understood by the House— that at the moment the Association has no training school. No doubt, under the stimulus of these Regulations, it will do something to revise its training and bring it into better form.

Mr. Turner-Samuels

They have, of course, a system of training and have been holding an examination over the years.

Sir H. Linstead

I was making a differentiation between a system of training and a standard of examination.

It is against this background, and these words in column 2 of the First Schedule, that I think some misunderstanding has arisen. On page 3 of the Regulation, in column (2), referring to the Physiotherapists Association, it is stated that …after attending a full-time day course of training in physiotherapy of not less than three months duration and working thereafter as a full-time physiotherapist in a hospital for not less than two years. It is because of these words that some members of the Chartered Society of Physiotherapists feel that somebody, after three months' training, will go into a hospital, not as a student, but as a physiotherapist. I think that the First Schedule applies only to existing practitioners and that nobody who is a student will be "picked up" by that Schedule but by the later powers which the Minister has under paragraph (3) of the Regulation. But there is this misunderstanding, and I hope the Minister can explain it.

I believe the Minister is entirely justified in bringing these Regulations before the House in the interests of the professions themselves—which are still in a formative stage of development. Even under the stimulus of the Cope Report they could not agree about their future; but under the stimulus of these Regulations, and with the help of the working party, the Minister may be able to do what the bodies themselves would wish to see done but have not had the coherence to do; and what, I feel, hon. Members on both sides of this House want to see done, and that is the substitution of the registration of these bodies not by Regulation, but by Statute. Of course, I realise that it may be difficult to get time for a Registration Bill; but, if the working party can come to a series of recommendations which are agreed, it should be possible, by good will—not only on the part of the Minister, which I know is there—to get a Bill drafted. Possibly the Private Member's procedure might be a means by which such a Measure could reach the Statute Book.

But these Regulations point the way along which agreement may be found. It is clear that there is one group of these auxiliaries, represented by the physiotherapists and the remedial gymnasts, who are of one mind; and it may well be that they can be brought together in one registration scheme. Under another Act of Parliament it may be that the almoners and the psychiatric social workers can be brought together and, by way of a generality, I would say that I hope this can be done by way of some registration board acting as a buffer between the Minister and the profession. As he says, the Minister should not be in the position of functioning as a registering body. There should be a buffer between. But under a registration board the professions could be left with their own freedom in setting educational and professional standards, and could become recognised as completely fully-fledged professions.

I hope, therefore, that these Regulations will be temporary and that by good will on the part of the Minister they can be replaced by Statutory Regulations. If that can be done, then these Regulations will have served a very good purpose in applying a stimulus where it is still needed.

11.36 p.m.

Mr. Iain Macleod

With the leave of the House, I will reply to one or two of the points raised. First, with regard to the comments made about Regulation 3 (4), I wish to say that it is not intended in any way that this list shall become an umbrella—if a list can become an umbrella—for those people who cannot qualify under any other Act It is only for the very rarest case that it is possible to imagine that somebody would be entitled to submit their name to me either independently or through an association and to have it put on the list.

My hon. Friend the Member for Tyne-mouth (Miss Ward) raised points about the working party. All I can say is that it will be appointed as soon as possible, and I would not like to guess when it will produce an answer. For 18 months the different bodies and my Department have mulled over the Cope Report without results.

As I have said, I think that these Regulations have brought us nearer to a solution by the mere fact of their imposing an answer that everybody recognises not to be wholly desirable. I think, therefore, that in the future the consultations will have a sense of urgency which they have not had before. All I can say is that I hope they will produce results as soon as possible.

With regard to the question raised about pay and whether it was possible that bodies might be encouraged to engage auxiliaries at other rates of pay, it is true that a differential exists at the moment. But, presumably, if in the future new bodies ever achieved the status of the existing ones, that differential would disappear. The matter of pay is, of course, essentially one for the Whitley organisation.

The main point about which I want to say a word tonight was, in fact, very well put by my hon. Friend the Member for Putney (Sir H. Linstead). I do not want to enter into any argument between the Chartered Society and the Association. Obviously, I am not holding a brief for either party. My aim is to get the best people into the National Health Service, and to be certain that no unfairness is caused by the operation of any arbitrary law.

My hon. Friend the Member for More-cambe and Lonsdale (Sir I. Fraser) really misunderstood the First Schedule exactly in the way that my hon. Friend the Member for Putney indicated. The clue to it are the words in paragraph 3 (2) that he satisfied on the thirty-first day of March,1954. Those are the key words. It is not a question of the future. The position is that if on that day somebody is employed in a hospital within the National Health Service, then he is accepted.

The second qualification is that it must be somebody who on 31st March, 1954, has the qualifications in the First Schedule, that is to say, in the cases with which we have been particularly concerned tonight, and who has taken an examination, full-time course of training, whatever length it may have been, and has thereafter—before of course, 31st March, 1954—spent not less than two years as a full-time physiotherapist in a hospital, and not as a sick bay attendant as my hon. Friend indicated. Therefore, the position is that it is only for those people who are either in post on that day or who could be in post if they chose to apply.

As far as the future is concerned, I have made it clear, and I again do so now, that the fact that a body is put down as an appropriate body in the Second Schedule does not mean that I shall necessarily approve their examination or their courses of instruction. That is a matter for the future and will be taken only on the advice of such people as those to whom I referred in my earlier speech.

Sir I. Fraser

I and my hon. Friends have no objection to Regulations 1 and 2 coming in, and my right hon. Friend's assurance that he will not let persons such as we have been talking about come in in the future goes a very long way towards satisfying us.

Mr. Macleod

I am afraid that is not quite what I said. I said that it would not be assumed that because a body appeared in the Second Schedule they were automatically going to be approved. The inclusion in the Schedule merely means that I think those bodies have a right to put forward to me and my advisers their course of training, and their methods of examinations, and to give me the information I shall require about all their methods of training, on which I alone, on advice, of course, can base the final decision after 1st April.

I do agree with my hon. Friend the Member for Putney that these Regulations point the way to what we want. It is not the answer; I know it is not, and I have not pretended that it is. But it is the best possible answer a Minister could produce at the moment, and, with all its faults, I think it possibly has within it the seeds of the solution.

Mr. Hastings

What about the large number of chiropodists, about half the membership of the two associations, who have been in practice for many years, who have never taken any examination at all? They were in practice; the societies were formed; they joined the societies, and some of these are the most respected members of the profession. Are they included in No. 4, the list kept by the Minister? If not, how can they get their names included in such a list?

Mr. Macleod

The answer to that is not that they are included, but that they are not excluded. As far as the First Schedule is concerned, that depends on passing the qualifying examination of the two bodies. As far as the Second Schedule is concerned, that is in the future, after 1st April, and depends on my approval of the methods of the two bodies. If there are such persons, who are deeply experienced in this field, but who have not yet taken the appropriate examinations, it is open to them to apply to me in due course to be recognised on the list under Subsection (4).

11.43 p.m.

Mr. Blenkinsop

I think we all feel that there has been a most useful debate here this evening on this subject which, if we had not put down this Prayer, we could not have had, owing to the procedure of this House. I think both the members of all the professional bodies concerned, and the public outside, will be glad to have had the assurances that the Minister has given, which, I think, have gone a long way to meeting some of the anxieties that they may have had in the past. As we in this House must be chiefly concerned with the welfare of the patients in the hospitals who are to be treated by members of these various auxiliary bodies, and because the Minister expresses his own desire to establish, as soon as possible, some form of registration authority, I beg to ask leave to withdraw the Motion.

Motion, by leave, withdrawn.