ORTHOPTISTS (Hansard, 25 July 1966)

§ The Parliamentary Secretary to the Ministry of Health (Mr. Charles Loughlin)
I beg to move, That the Professions Supplementary to Medicine (Orthoptists) Board Order of Council, 1966, a draft of which was laid before this House on 27th June, be approved.
The purpose of the draft Order is to bring orthoptists in England, Wales, Scotland and Northern Ireland under the Professions Supplementary to Medicine Act, 1960. For hon. Members who have not come into contact with an orthoptist I should explain that she undertakes the diagnosis and treatment of squints and other eye conditions under the direction of an ophthalmic surgeon or medical practitioner.
The profession is a small one, though no smaller than some of the professions already included under the Act, and the draft Order may affect no more than 400 people. Most orthoptists are employed in hospitals and local authority child welfare and school health clinics, and for the most part their patients are children. This is virtually an entirely female profession.
The Professions Supplementary to Medicine Act implemented a recommendation in the Reports of the Committees on Medical Auxiliaries that State registration was the best means of securing uniformly adequate standards of qualification for members of the professions employed in the National Health Service. It introduced State registration for seven professions initially—chiropodists, dietitians, medical laboratory technicians, occupational therapists, physiotherapists, radiographers and remedial gymnasts—and established a registration board for each of them under the general supervision of the Council for Professions Supplementary to Medicine.
1393 It is the duty of the Boards to establish registers and to approve courses of training and qualifications for registration.
The Act also imposes a general duty on them to promote high standards of professional education and professional conduct among members of the relevant profession". I was recently given the opportunity to meet members of both Council and Boards. This machinery established by the Act is now going strong and both Boards and Council have already made a valuable contribution to the professions they represent.
There is not a great deal to say about the Order itself. Paragraph 1 provides that the Act shall have effect as if orthoptists were mentioned under Section 1 of the Act, and paragraph 2 gives the title and day of coming into operation of the Order. The Schedule sets out the composition of the Orthoptists' Board and the changes necessary to provide an extra representative and medical member from the Council. It also lists certain minor amendments consequent on the addition of the orthoptists to the Act.
The Order is made under Section 10 of the Act, which provides for the extension of the Act to new professions up to a maximum of 12 provided that certain requirements are satisfied. The Council for Professions Supplementary to Medicine considers that the profession of orthoptists is a profession supplementary to medicine, that it has reached maturity and that it already has a satisfactory scheme of training and qualifications and a proper code of professional conduct. The Privy Council accepted the recommendation of the Council for the Professions Supplementary to Medicine and the Health Departments supported it.
Full consultation on both the principle and the drafting of the Order has been undertaken by my Department at the request of the Privy Council and the views of numerous medical and optical organisations, including the British Medical Association and the General Optical Council, as well as those of Government Departments and other interested bodies have been sought. A wide measure of agreement has been achieved, but consultations have necessarily taken a 1394 considerable time and I apologise to those most closely affected by the Order.
I remind hon. Members that the Act itself does not affect the employment of unregistered persons in the National Health Service or elsewhere, nor does it prevent their practising privately. However, in accordance with an undertaking given to Parliament when the Bill was introduced, the Minister of Health and the Secretary of State for Scotland made Regulations in 1964 making State registration a condition of employment in the National Health Service for the seven professions already covered by the Act. Similar regulations in respect of orthopists will need to be considered later, but will not be introduced without full consultation with the interested bodies, including the Council for Professions Supplementary to Medicine, the Orthoptists Board and the General Optical Council.
I hope that the House can now approve this Order and I recommend that it should do so.

§ Mr. Bernard Braine (Essex, South-East)
At the end of what has been a long day for all of us, it is very agreeable to find a subject on which we on this side of the House can agree completely with the Government. We for our part warmly welcome this Order which adds orthoptists to the seven professions supplementary to medicine already included under the Act of 1960. As I think the hon. Gentleman indicated, this must be the first new Profession to be added since the original seven were brought into the scheme for registration.
I think it inevitable that as a profession gains in status it assumes greater responsibilities. This involves acceptance of general standards and common procedures which in turn require registration, recognised qualifications, approved courses of training, and jealously guarded codes of professional conduct.
Indeed, as the frontiers of medicine are pushed back and new techniques of diagnosis and treatment are advanced, we can expect more and more specialised services requiring highly specialised skills to develop. Equally, as more and more specialised services develop, it becomes necessary to ensure proper machinery to 1395 safeguard the patient who, while he may have perfect confidence in doctors and nurses and the older professions supplementary to medicine, has no means of evaluating the training and skills of the new practitioners.
I am stating a purely personal view when I say that I believe it is a pity that Parliament originally approved the use of the word "supplementary" in this connection. It could be taken to mean "subordinate" instead of its true meaning—the bringing of help to the medical profession. The fact is that members of these professions are members of a team of which, no doubt, the physician and the surgeon are heads. The orthoptist, as I understand it, is an essential element in the ophthalmic team and is responsible for a great deal of diagnosis and treatment of eye complaints and therefore makes an increasingly and extremely valuable contribution to health.
There are two questions which occur to me. The first is whether the profession is completely happy about its representation on the Council. I hope the hon. Gentleman can give us an assurance on that. Secondly, though he said something about the position of practitioners who did not qualify for registration, perhaps he would spell this out a little more. The House has always been jealous of the rights of people who have practiced for many years and then, for one reason or another, find that they do not satisfy the qualifications of registration.
It may well be that, in the highly developed profession of orthoptics, there will not be anyone practising or seeking to practise outside the National Health Service but we are anxious to know from the hon. Gentleman whether there will be any and, if there are, whether they can continue to practice.
Subject to that, I repeat that the Opposition warmly welcome this move as making a valuable new contribution to the improvement of the National Health Service.

§ Dr. M. P. Winstanley (Cheadle)
I rise briefly, having listened to the hon. Member for Essex, South-East (Mr. Braine) speaking on behalf of the Conservative Party, to welcome, on behalf of the Liberal Party, this profession on its emer- 1396 gence and at the same time express the hope that, in becoming a profession in this sense, it will not join the older professions which, at the moment, we are apt to criticise for the preservation of restrictive practices of one kind or another.
I am sure that the Parliamentary Secretary will recall that, at the time of the original Act, when we registered a number of new professions, such as the chiropodists and the physiotherapists, we had, by coincidence no doubt, a gradual disappearance of these various people and a shortage developing which has become alarming.
I do not lay the responsibility for this in any particular quarter but there is no doubt that the National Health Service, for its efficiency, depends every bit as much on these supplementary professions, as they are called—chiropodists, physiotherapists, radiographers and so on—as it does on the better-known professions, such as doctors and nurses.
We have a desperate shortage of doctors and those we have are not perhaps as well distributed as they might be. We also have a desperate shortage of nurses and they, too, are not as well distributed as they might be. In addition to these well-known shortages, we now have shortages arising amongst the supplementary professions. We have excellent radiography departments in certain parts of the country—

§ Mr. Deputy Speaker (Sir Eric Fletcher)
Order. That may be so but it does not arise on this Order. The only question is whether the Order be approved.

§ Dr. Winstanley
I bow to your Ruling, Mr. Deputy Speaker. What I wished to say was that I hope that in arranging the emergence of this new profession of orthoptists the Minister will at the same time ensure that it is made sufficiently attractive to be able to maintain its ranks. Th. hon. Gentleman spoke of roughly 400 persons. I believe that he will not be able to maintain the numbers at 400 unless he looks carefully at the career structure within this supplementary profession.
As to the Act, it seems that there has already been criticisms of the career structure with regard to the other supplementary professions. I merely express the hope that with regard to this particular profession the Minister will take every 1397 possible care to ensure that, have registered it, its standards are maintained so that its numbers can also be maintained.

§ Mr. Loughlin
With your permission, Mr. Deputy Speaker, and that of the House, I rise to make one or two observations on the remarks made by the hon. Gentlemen representing the two parties opposite. I thank them for the support given to the Order.
The question whether registration reduces the number of recruits is debatable. it may be that registration proves to some extent the inadequacy of the total numbers available within the service and outside it. Two professions with which we have had some difficulty are chiropodists and physiotherapists, but I can assure the hon. Member for Cheadle (Dr. Winstanley) that we shall do everything we possibly can to ensure that there are sufficient recruits to this branch of the professions supplementary to medicine. We shall watch as far as it is possible for us to do the career structure to ensure that more than the existing 400 persons come into the profession.
On the two points raised by the hon. Member for Essex, South-East (Mr. Braine), I doubt very much—I use the words deliberately—whether there are any orthoptists who are engaged outside the National Health Service and local authority and school clinics. As to whether everybody is completely satisfied, all I can tell him is that on the present set of consultations we have reached almost unanimity. One cannot always get complete unanimity. In future consultations to be conducted before bringing into effect regulations arising out of the Order, I can give him an absolute assurance that we shall do whatever we possibly can to meet the wishes of the profession in the regulations, and in safeguarding the quality of those coming into the profession. Obviously, we shall have to be guided to a large extent by the professional organisations which represent them.