REGISTRATION OF CHIROPODISTS (Hansard, 21 October 1969)

§ Mr. Sydney Bidwell (Southall)

I beg to move, That leave be given to bring in a Bill to provide for the compulsory registration of chiropodists; to provide for the introduction of minimum standards of training and minimum qualifications for registered chiropodists; and for connected purposes. My Bill has nothing to do with the health of the £. It is to do with the health of the feet.

I am grateful to you, Mr. Speaker, and to the House, for giving me this opportunity to ask leave to bring in my Bill for the registration of all those practising chiropody, the Long Title of which hon. Members will see in the Motion which I am moving.

Optimism is a useful thing to have in this House, but I would be very optimistic if I thought that I could get this Bill put into law this Session. I am, nevertheless, very grateful to you, Mr. Speaker. Let us say that the possibility is not entirely excluded, but remains, nevertheless, very remote.

I wish to inform the House of the way in which I first became anxious about this matter. A constituent of mine came to me pointing out that a great deal of chiropody in this country is practised without qualifications, with all the attendant dangers to the health of the foot and the effects that that would have on general physique. From then on I became greatly interested. As a result of my desire to present this Bill, I have had a number of communications and some of them have even alleged that the maltreatment of feet has led to great difficulties, even so far as losing a limb. I do not want to over-dramatise the position, because there would be no proof, and, also, practices by unqualified people are quite legal at present.

The House should appreciate what chiropody really is. It includes the provision of skilled care for painful and deforming conditions which afflict the human foot. It provides a service which is essential to a large proportion of the population, and one which is provided from no other source. The scope of practice includes diagnosis and treatment of superficial inflammatory and infective 962 conditions, of structural and functional derangements of the foot, and the management of feet affected by general medical and surgical states, such as rheumatoid arthritis, diabetes and circulatory and nervous disorders. The profession is technically equipped to provide a comprehensive foot care service for all ages from the very young to the very old.

The recognised course of training consists of three years' intensive full-time study. It includes basic sciences and relevant medical subjects and, in particular, the detailed anatomy of the lower limb. Students with the necessary educational attainments are instructed by appropriately qualified scientists, physicians, surgeons and chiropodists. The course also ensures thorough clinical training and practice. The level of professional education is tested each year by examinations conducted by independent examiners in each subject. This level of training is necessary because chiropodists are not only therapists, but also diagnosticians.

With few exceptions, their patients come to them directly, and in this respect they are unique among the para-medical profession. Obviously, they have to diagnose what is wrong with the foot before they can treat it adequately, but, in addition, they are often the first professional people to be consulted about symptoms occurring in the feet indicating general systemic disease requiring medical investigation and treatment. In other words, they often have to decide whether it falls within their province to treat or not to treat.

The fact that persons with little or no proper training are free at present to set themselves up and purport to practise as chiropodists means that the public are exposed to a threefold risk. They are at risk from unskilled and inefficient treatment, and it must be remembered that chiropodists use a variety of sharp cutting instruments and potentially dangerous substances such as acids. They are at risk because of the absence of skilled diagnosis; and they are at risk of commercial exploitation by unregistered practitioners who are subject to no professional or ethical sanctions. The general public deserves to be protected from these risks and to be assured of minimum standards of professional competence when they consult a chiropodist.

963 In 1960, Parliament passed the Professions Supplementary to Medicine Act. It provided for the setting up of a number of boards, including a Chiropodists Board. The board has power to register persons who have taken a course of training and passed an examination of which it approves. The board can also register persons who are able to satisfy it that on 30th June, 1963, they were competent to practise the profession by virtue of their training and/or practical experience. I mention that because I do not wish, by my proposal today, to deprive of a living people who are doing a good job. I am sure that they could be accommodated within the ambit of my Bill.

Registration is voluntary. Apart from a few areas in which a local authority has power to license chiropodists, anyone without any formal training or experience can set up in practice and describe himself as a chiropodist. By Statutory Instrument in 1964, the Health Ministers directed that State registration was to be a condition of employment in the National Health Service. It is extraordinary that in the public services, where contact with the medical profession is likely to be close, a standard is required, but in private practice, where contact with the medical profession may be slight or even non-existent, no standards of any sort are required. It is to set that right that I ask leave to bring in the Bill.

The present situation allows entry of persons into the profession of chiropody, some of whom have had only minimal training and experience, and some having had no training at all. It is not known exactly how many persons there are in these categories, but it is thought that they are numerous. They are answerable to no one, and their professional standards and conduct are subject to no control. There is evidence to suggest that the public assume that anyone practising as a chiropodist must be properly qualified to do so. The other day, the wife of an hon. Member said to me that she took it for granted that every person practising chiropody would be so qualified.

The fact that persons who have not taken a course of training may set up in practice and style themselves chiropodists discourages many who might other- 964 wise enter the profession. The continuing legal existence of a group of unqualified practitioners must inhibit the development of the profession and encourage the sponsors of courses which are substantially less in content than that approved by the Chiropodists Board.

The public must be at risk from the situation which I have outlined. My Bill would extend the principle which Parliament has established by requiring that there should be compulsory regisration for chiropodists. This can be achieved without prejudice to the livelihood of those at present unregistered. As a result, and in time, the standards of all who practise will be raised, to the greater benefit of the community, and I believe that an important social safeguard will be secured thereby.