§ Order for Second Reading read.9.38 am
§ Mr. Malcolm Moss (Cambridgeshire, North-East)
I beg to move, That the Bill be now read a Second time.
It is a singular privilege for me to have a double opportunity this morning, first to present a private Member's Bill but especially to present such an important piece of legislation which will not only enhance dramatically the professional status of the osteopathic profession but will be a milestone on the road to recognition for complementary medicine as a whole.
I begin by thanking the King's Fund and its working party, and in particular Simon Fielding, who has been a great help to me in the past few months. I am glad that he is present today. I thank officials from the Department of Health, who have given me every assistance possible, and Lord Walton, whose Bill I have taken over because his original Bill fell in the Lords earlier this year. I thank hon. Members of all parties who have supported the Bill, and I especially thank Opposition Members who will speak in its support today.
Some consternation was expressed to me just before Christmas when it was discovered that I was about to embark on a week's skiing with the Lords and Commons ski team. There was the prospect either that I would be standing here with one or more limbs in plaster or that I would be flat on my back, which would not have been the most auspicious circumstances in which to present the Bill.
Osteopathy is a system of diagnosis and treatment which lays its main emphasis on the structural and mechanical problems of the body. It is not regarded as an alternative to conventional medicine, but rather as a complementary therapy, offering patients an additional option in the treatment of certain conditions affecting the body's mechanical functions.
Osteopathic treatment predominantly comprises gentle manual methods. It utilises a diagnostic procedure similar to conventional medical examination, but it pays especial attention to the patient's musculo-skeletal system. Osteopathy is the most widely used of the complementary therapies. I am sure that many hon. Members have availed themselves of the services of an osteopath at some time, and many are here today to support the Bill.
It is estimated that there are now well over 2,000 osteopaths practising in the United Kingdom, and that they are visited by 100,000 patients every week. Given its growing popularity and widespread use, it is of key importance that there should also be safeguards for the public which will ensure, for example, adequate clinical training for all those who are entitled to call themselves osteopaths.
An essential element of the training is to equip practitioners with the ability to recognise conditions for which osteopathic treatment is inappropriate and cases in which the patient should be referred to a registered medical practitioner. The final essential component of the safeguards needs to be the provision of effective disciplinary procedures to ensure that the profession achieves and maintains the very highest standards.
1171 I was encouraged in my decision to take the Bill forward by the support now given by the medical profession to osteopaths in their quest for statutory registration. For some time, the British Medical Association has accepted that there is'an organised, reputable and coherent body of knowledge underlying osteopathic practice".The BMA has also stated its belief that the increasing practice of cross-referral between general medical practitioners and osteopaths has been of immense benefit to patients.
The support has not always been so warm. Until the mid-1970s, doctors were prevented from referring patients to any practitioner who was not medically qualified. I very much welcome the change of heart which is demonstrated by the increasing interest of doctors in osteopathy, and by an increasing willingness to refer patients to osteopaths. There is also a growing public interest in a variety of complementary therapies, not least osteopathy, which leads me to believe that the Bill is very timely.
The Bill is modelled on the recommendations for statutory regulation presented in the report by the King's Fund working party on osteopathy, which were enshrined in the Bill presented by Lord Walton of Detchant in the previous Session. I know that the osteopathic profession would wish to join me in paying tribute to the King's Fund working party—and especially to its chairman, Sir Thomas Bingham—for its considerable contribution in advancing the cause for statutory regulation of osteopaths.
I appreciate that, at first glance, the similarity between my Bill and Lord Walton's may not be evident. That is primarily because the two pieces of legislation were penned by different hands. However, I can assure the House and the profession that both the fundamental principles and the key purposes of the two Bills are identical. The first purpose is to establish a representative governing body for osteopaths and the second is to set in place a fair and practical system of statutory regulation for the profession.
§ Mr. Michael Stern (Bristol, North-West)
I welcome the legislation, and especially the part to which my hon. Friend has just referred. Does he agree that a professional body in medicine established now has an opportunity to set new standards for such professional bodies simply by being newly established and by not carrying with it the bag and baggage of some of the older professional bodies in medicine, which have sometimes seemed over-protective of their members?
§ Mr. Moss
The Bill breaks new ground in setting standards of regulation that have not yet been met by some of the other medical groups. I hope that my hon. Friend the Member for Bristol, North-West (Mr. Stern) will realise as I continue my speech that a great deal of thought has gone into the Bill, not only to make it a landmark for future legislation to encompass more medical groups, but to incorporate in it some clauses that existing medical groups that have regulation may want to take up at a later date.
I also assure the House that the Bill encapsulates the recommendations for initial registration made in the working party's report to enable, as far as possible, osteopaths in current practice to qualify for registration. 1172 The Bill also extends the provisions to enable certain other practitioners who might not otherwise have been able to meet the conditions for registration to be registered.
I shall explain in greater detail later the different ways in which practitioners will be able to qualify for registration. I have mentioned the point now about extending eligibility to illustrate not only how the Bill is firmly rooted in the working party's recommendations, but how it builds on that solid foundation. That reflects the input in policy from across government, the experiences of similar statutory schemes such as the General Medical Council, our European obligations, competition laws and aspects of human rights.
The primary object of the Bill is to set in place a professionally led, statutory registration scheme for osteopaths. It would be similar to those existing for many other professional groups, including all the key health professionals. The scheme would be achieved primarily through the establishment of a General Osteopathic Council, which would have the statutory responsibility to develop, to promote and to regulate the profession of osteopathy throughout the United Kingdom, and to set educational standards and standards of professional conduct.
The Bill would also establish four statutory committees of the General Osteopathic Council. The first would be the education committee, which would have the responsibility of promoting high standards of education in osteopathy and of providing the general council with advice on all matters concerning education, training and examinations in osteopathy. The three other committees would be the investigating committee, the professional conduct committee and the health committee, which collectively would provide the fitness-to-practise machinery.
The three committees would provide the key function of ensuring that an allegation made against an osteopath concerning his professional conduct or competence to practise was properly investigated and dealt with effectively. The committee's remit would also cover allegations that a practitioner had been convicted of a criminal offence, or that he or she was unfit to practise for reasons of ill health.
The statutory scheme would replace the current system of voluntary regulation. That has worked exceptionally well for the majority of practitioners, and it has played a key role in paving the way for statutory regulation. However, by its very nature, a voluntary system is unable to enforce standards of competence or conduct. If a practitioner chooses not to participate in the scheme, the regulatory body is completely powerless to exercise any jurisdiction over that individual's practice.
That fundamental weakness brings into sharp focus the need for the statutory scheme. As the law stands, anyone can call himself or herself an osteopath and set up in practice. There is no obligation to undergo any formal training or to comply with standards of professional competence. Members of the public therefore have no guarantee that a person holding himself out as an osteopath is properly qualified and competent to do so. The only recourse that patients have in the event of mishap is through the common law.
Under my Bill, the system of voluntary regulation would be replaced by a single statutory body capable of enforcing standards of training, education, proficiency and professional conduct throughout the profession in the United Kingdom. The body would also have powers to 1173 require anyone wishing to practise as an osteopath to conform to those standards, be registered with the statutory council and submit himself to its authority. The statutory council would thus have the unique ability to unite the profession and sweep aside the current fragmentation.
The achievement of statutory regulation would, I believe, herald the dawn of an exciting new era for the osteopathic profession. It is essential, however, that, in reaching out for the prize of tomorrow, the profession does not let go the trophies that it holds today.
I have mentioned that the current systems of voluntary registration have provided the solid foundation for a statutory scheme, but, even assuming the successful passage of the Bill, it could take up to two years before the machinery to drive the statutory scheme is fully in place. I therefore urge individuals in the profession, many of whom are here today, not to abandon the current schemes prematurely. The successful transition to statutory regulation will depend heavily on their continued support and maintenance.
I emphasise that the statutory scheme would be not only led but regulated by the profession. For that reason, 12 of the proposed 24 members of the General Osteopathic Council would be osteopaths elected by the profession itself. Eight of the remaining members would be non-osteopaths, appointed by the Privy Council. Those members would represent wider interests and, in particular, the views of patients. That would help to increase the breadth of experience within the general council and ensure that the profession had a firm and balanced basis on which to develop in future.
The other four members of the general council would include a person with experience in medical education, nominated by the Secretary of State, and three members appointed by the education committee to represent the interests of training institutions in the United Kingdom. The balance of different members is mirrored in all other statutory regulatory schemes; the scheme, like all its counterparts, would be overseen by the Privy Council.
Eagle-eyed Members may have spotted an omission from the Bill—there are no arrangements for establishing the very first General Osteopathic Council. It is not possible for the arrangements currently in the schedule to apply to the first general council because, at the start of the scheme, there will be no registered osteopaths to be elected or to vote. Special transitional arrangements will therefore need to be provided, and I propose to specify them in an amendment to the schedule in Committee.
What I have in mind is that the initial osteopathic and lay members of the general council would be appointed by the Privy Council. That is in keeping with the practice followed in the establishment of other statutory schemes, and was endorsed by the working party in its report.
To ensure that the general council reflects a balance of good professional opinion, experience and practice, the initial osteopathic members would, of course, be appointed after consultation with those bodies that administer the current scheme of voluntary registration. The individuals would not, however, be representatives of any particular organisation—nor would they be beholden to any sectoral interests. Instead, they would be selected on the basis of their individual ability and merit and would, in effect, be ambassadors for the profession as a whole.
1174 The working party on osteopathy regarded the primary objective of any scheme of regulation to be the benefit and protection of patients. Having studied statutory schemes governing other professions, the working party concluded:'for all practical purposes there is no viable alternative to the statutory registration of osteopaths which should be open to inspection by members of the public.That view was supported by all the organisations consulted by the working party, and I hope that it will be supported by the House today.
A statutory register of osteopaths would therefore form the core of the regulatory scheme. The register would be maintained by the registrar appointed by the general council. In future, all practitioners wishing to call themselves osteopaths would be required to be registered on the register. That requirement would be backed up by a provision in the Bill making it a criminal offence for an unregistered practitioner to use that title or any variation of it.
The closure of professional title was one of the key recommendations in the working party report. It is also a central provision of the Bill. I emphasise, however, that the offence will be related to the use of the title "osteopath". The Bill does not in any way seek to prohibit the use of osteopathic techniques by other manipulative therapists such as physiotherapists, or prevent them from telling their patients that they are using such techniques.
That brings me to the nub of the scheme—the proposed criteria for registration, which will clearly be of central concern to many people, not least those in the profession itself. As this is such a crucial part of the regulatory scheme, I should like to explain in detail the different categories of registration proposed under the Bill—and, in particular, the transitional arrangements that would apply.
Application for registration would be on a strictly individual basis. Membership of a particular professional body would not, therefore, confer any automatic right or advantage on an individual, although it is, of course, intended that the statutory scheme should embrace, so far as is practicable, practitioners currently registered under the system of voluntary registration.
The Bill provides for the "full" and "conditional" registration of existing practitioners. That is based on the recommendations made in the working party report, although "conditional registration", as referred to in the Bill, is what the working party called "provisional registration". The different title that we have selected more accurately reflects the conditional nature of that category of registration, and also offers the profession scope to introduce a more familiar system of provisional registration, along the lines of pre-registration for doctors, if it so wishes.
Entitlement to full registration is founded on the same principles of good character, qualification and experience as outlined in the working party's report. The provisions are intended to enable as many osteopaths in current practice as possible to qualify for registration, without compromising the key principle of providing the public with adequate and effective safeguards against inexperienced and untrained practitioners.
The Bill does, however, impose an additional requirement: practitioners would also have to be in good physical and mental health. A similar provision exists in the Dentists Act 1984. The intention is to enable the registrar at the outset to refuse registration to an applicant 1175 whose known state of health raises serious doubts about his ability to practise. Without such a provision, the registrar might have no other option but to register the practitioner and hope that he would be able to secure an early suspension of the osteopath's registration by immediately referring the matter to the health committee.
For an initial two-year transitional period, commencing on the day on which the register opens, a practitioner who does not hold a qualification recognised by the general council as one that equips him or her with the standards of education and training required for the safe and competent practice of osteopathy may still be entitled to full registration. That would be on the basis that he or she can satisfy the registrar that, for at least five of the preceding seven years, he or she has spent a substantial part of his or her working time in the safe, lawful and competent practice of osteopathy.
That arrangement follows the working party's recommendation and acknowledges that experienced practitioners who may not have the benefit of a properly structured course of training but who have been practising safely and competently in the name of osteopathy for many years should be brought within the scope of the regulatory scheme.
The Bill does, however, require that such practice should have been "lawful". That provision has been included so that the General Osteopathic Council is not, say, placed under an obligation to register an overseas practitioner on the basis of what might have been illegal practice in his home country. Conditional registration would be simply a transitional arrangement, with applications for that category of registration being permitted only during the two-year transitional period which I mentioned a few moments ago. I have already said that conditional registration is modelled closely on the working party's recommendations for provisional registration.
The purpose of conditional registration is to enable registration of practitioners who do not hold a recognised qualification, and who are unable to muster the five years out of seven safe, lawful and competent practice of osteopathy required for full registration. It is not in any way intended to create a two-tier system of registration, but was recommended by the working party as a mechanism to ensure that as many practitioners as possible are included under the Act.
Practitioners who are registered with conditional registration would fall into two categories. The first will be those who just fail to meet the five years out of seven criterion for full registration. Those practitioners will be eligible for full registration if they have spent a substantial part of their working time in the safe, lawful and competent practice of osteopathy for a total of four years out of the six years preceding the opening of the register. In addition, they may be required to undergo a test of competence and give an undertaking that, within a specified period, which would not exceed five years from the opening of the register, they will complete any further training and acquire such additional experience as specified by the registrar. I should add that, if a practitioner were found to be fully competent in the skills 1176 and knowledge required for full registration, no additional training would be specified, and he would be able to apply to have his registration suitably converted.
I said that the grounds under which practitioners will be able to qualify for registration had been extended to include a group that might not otherwise have been eligible. To be more accurate, practitioners in that group were more likely to have fallen between two stools. It had been assumed that all qualifications would be either recognised or rejected for recognition. On that basis, if a practitioner were told that his qualification was not a recognised one, he could still hope to qualify for registration on the strength of current or recent practice if an application were made within the two-year transitional period.
As a result of representations made to me, it became evident that practitioners may possess qualifications from an institution that has perhaps ceased to exist and that they may not have been in current or recent practice—because, for example, they have been bringing up their family or caring for sick or elderly relatives. Such practitioners face a potentially no-win situation.
On the one hand, the general council and the education committee might not have been able to find sufficient information about the qualification to decide whether it should be recognised. On the other, the practitioner might have no means of being able to satisfy the practice criteria for registration. Such practitioners will therefore be unable to get on the register unless they obtain another recognised qualification, although they may be perfectly competent. Although that group is expected to comprise only a small number of individuals, the Bill now extends the provisions of conditional registration so as not to exclude them.
Consequently, practitioners who are unable to satisfy the practice criteria for either full or conditional registration will still be eligible for conditional registration if they hold a qualification for osteopathy that has not been refused recognition, although it is not a recognised qualification. Practitioners who qualify for registration on those grounds will be subject to the same conditions of further training and acquiring the additional experience which I described earlier.
§ Dr. Liam Fox (Woodspring)
I wonder whether my hon. Friend could clarify one point. Is it intended that osteopaths will be required to carry professional indemnity cover during the preliminary period?
§ Mr. Toby Jessel (Twickenham)
On such an important Bill, which affects the welfare of millions of our fellow citizens who suffer from back pain, is my hon. Friend aware that there are no less than 16 hon. Members present in the House but only two Opposition Members, although it is Friday? Does that not show that Conservative Members have a much greater interest than Labour Members in such an important Bill?
§ Mr. Moss
I am not sure whether that comment means that Conservative Members have a greater interest in such matters, or that they suffer more from back pain.
I have referred several times to recognised qualifications. I am aware that feelings of uncertainty exist in 1177 certain quarters about how that aspect of the scheme will operate. It may help if I begin with the European dimension. European Community qualifications will automatically be recognised by virtue of enforceable Community rights or obligations.
The recognition of other qualifications will depend on whether the General Osteopathic Council, in consultation with its education committee, considers that such qualifications meet the standards of education, training and proficiency specified by the general council for the safe and competent practise of osteopathy. To ensure that such decisions will be impartial, no qualification will be afforded recognition until the general council has sought and secured the consent of the Privy Council.
While I am on the subject of professional education, I should mention that, although it will be the responsibility of the education committee to satisfy itself that those schools whose qualifications have been recognised continue to meet the required standards of proficiency, it will not be for the committee or the General Osteopathic Council to prescribe how the curriculum is taught.
Diversity of approach stimulates innovation. In medical schools, considerable differences in emphasis exist for specific elements of the curriculum and the way in which they are taught. However, they all produce safe and competent doctors. Therefore, it is essential that a similar diversity be allowed to flourish under the osteopaths statutory scheme.
The newest category of registration is provisional registration. As I have already mentioned, care must be taken not to confuse provisional registration as provided in the Bill with the concept of provisional registration set out in the working party's report and Lord Walton's Bill in the last session.
An initial year of supervised practise is rapidly becoming the norm in a growing number of professional groups. It offers practitioners the advantages of being able to widen gradually their field of experience, especially in the running of a practice, and have the support and advice of more experienced colleagues readily available.
I appreciate that provisional registration does not exist in the profession's current system of voluntary registration. However, it may be one which the profession would wish to adopt in time. One of the disadvantages of a statutory scheme is that, once it is set in place, it can subsequently prove to be difficult to amend. Therefore, I have tried to provide now for the future.
The provision in the Bill is an enabling one. It will give the general council the necessary scope to introduce a system of provisional registration at a later date if it so chooses and after it has consulted the profession and provided Parliament with an opportunity to scrutinise its proposals.
§ Mr. Andrew Hunter (Basingstoke)
Can my hon. Friend expand his arguments and explain why he decided not to incorporate in his Bill the requirement of a provisional registration state as opposed to leaving the option open for the future if the council chooses to implement it?
§ Mr. Moss
Initially, we felt that the Bill incorporated a great number of different clauses which advanced the progress and tightness of the regulations. It was important to get the basics on the statute book, introduce conditional registration, which is a new idea, and make provision to enable the profession to introduce the provisional category 1178 at a later date if it so chooses. It is questionable whether the profession can accommodate the changes in one go during the early period—certainly the transitional period. It is much more sensible to get the basics in place and then allow the profession to move in a direction which it so chooses at its own pace.
Provisional registration will apply for the initial year of registration. During that time, osteopaths will be permitted to practise only under the supervision of a fully registered osteopath. For many practitioners, that will coincide with their first postgraduate year. However, the provisions in the Bill are sufficiently broad to include practitioners who are returning to the profession after an absence of some years—because, for example, they have been bringing up a family—and those who are applying for registration for the first time. Again, that is recognised as good practice among many professions and is a matter which the general council may wish to consider if and when it ever decided to go down this road.
Before leaving the subject of registration, I should like briefly to mention three other matters. My hon. Friend the Member for Woodspring (Dr. Fox) raised a point about professional indemnity insurance. That was considered by the working party to be of such key importance in securing better protection for patients that it recommended that such insurance should be held as a condition of registration. Unfortunately, making that a statutory requirement could distort the otherwise free workings of the insurance market, potentially to the detriment of both insurers and osteopaths.
In order to square that circle, the Bill would empower the General Osteopathic Council through its rules of registration to require professional indemnity insurance to be held by practising osteopaths. The general council would also have the power to check that a practitioner had renewed his cover at the appropriate time and, most importantly, to initiate disciplinary proceedings in cases where he had not.
Linking the need to hold insurance with the right to practise would give osteopaths who have retired or are taking time out to bring up a family the possibility of maintaining their registration without having to take out what would otherwise be unnecessary insurance cover.
The second matter is post-registration training. The working party recommended that a practitioner's continued registration should be made subject to him or her satisfactorily completing post-graduate training or refresher courses. In that way, members of the public could be assured that practitioners were keeping up to date with the latest techniques and developments in their field. That is one of the many areas in which the working party's recommendations broke new ground in the realm of professional self-regulation.
However, the working party also recognised that that recommendation could not be introduced immediately, because the profession's training and education resources would need to be devoted to existing practitioners who will hold conditional registration during the first few years of the scheme.
In order to avoid the need to make a specific amendment to the Act at a later date, clause 16 of the Bill will permit the General Osteopathic Council to introduce a scheme of post-registration training in the future if the profession so wishes. However, once again, the general council would first be required to consult the profession and, in this case, any other parties that it might think 1179 appropriate, such as other groups of health care professionals. The council would also have to obtain the consent of the Privy Council and give Parliament an opportunity to scrutinise the detail of its proposals before it could introduce such a scheme.
The third postscript on registration involves fraudulent registration. The Bill contains a provision similar to section 39(1) of the Medical Act 1983 to enable the general council to erase from the register the name of a practitioner who obtained registration by fraudulent means. However, the register would have in addition to that power, the power to impose an immediate suspension of a practitioner's registration while the allegation was being investigated, if he was satisfied that such action was necessary for the protection of members of the public.
I hope that the House will agree that all the provisions to which I have referred would form a fair and just system of registration and would provide the cornerstone of a statutory scheme. They seek to bring as many bona fide practitioners of osteopathy as possible within its scope. That is not only of key importance to practitioners but would benefit the public, as it is far better to have all the practitioners of a profession governed by a single statutory body capable of enforcing appropriate standards of practice.
The other essential component of the regulatory scheme is a mechanism to ensure that high standards of professional conduct and competence are maintained and that members of the public are not put at risk by practitioners who are unfit to practise for reasons of ill health. That would be provided by the General Osteopathic Council's investigating, professional conduct and health committees. Broadly speaking, those comittees would perform the same function as their counterparts in other schemes. Allegations would initially be considered by the investigating committee. They would then be referred, as appropriate, to the professional conduct or health committee for further investigation and action. However, I should like to highlight some important differences in the powers that the committees would be able to exercise—differences which illustrate yet again where the osteopaths scheme would break new ground.
For the first time under any statutory scheme governing the health professions, professional incompetence would be specifically identified as a trigger point for disciplinary investigation. I know that other professional groups—in particular the medical profession—are considering the introduction of a similar concept for its members. Their solutions may be different, but the osteopaths can take justifiable pride in being the first health care profession to make the concept an integral part of its statutory scheme.
Another matter on which the osteopaths scheme scores a first is the breadth of the powers of the professional conduct and health committees to take immediate action to suspend an osteopath's registration where they considered such action to be necessary for the protection of members of the public. The power proposed for the investigating committees—the ability to impose an immediate suspension of up to two months—would be similar to that exercised, for example, by the General Medical Council's equivalent committee.
However, for the first time, the professional conduct and health committees would be able to impose their own 1180 suspension where they considered such action to be necessary to protect members of the public and to do so before they investigated the allegation. Although likely to be exercised only rarely, the power might be used, for example, where the allegation made against an osteopath was also the subject of a series criminal investigation. In such a case, the professional conduct committee might choose to defer its proceedings until after the criminal proceedings had been dealth with. In a similar way, the health committee might decide that an allegation about an osteopath's health was such that he or she posed an obvious and definite risk to his or her patients.
In making provisions for those powers, the Bill also ensures that the practitioner's rights are protected. For example, before a suspension order could be imposed, a practitioner would first have to be given an opportunity to appear before the relevant committee to state why he or she considered such action to be unnecessary. The pratitioner would be entitled to be legally represented at such a hearing and would have an additional right of appeal to the courts.
Like their counterparts in other statutory schemes, the professional conduct and health committees would be able to suspend an osteopath's registration or impose conditions on his or her right to practise if they determined that the allegation against him or her was proven. The professional conduct committee would in addition be able to admonish the osteopath or order his name to be erased from the register.
Another first for the osteopaths scheme is the proposal to give the professional conduct committee the explicit power to impose conditions on an osteopath's right to practise following a period of erasure. As the Bill reinforces the powers of fitness-to-practise committees in those ways, the public will be able to exercise the utmost confidence in the statutory scheme and be assured that it affords them the highest level of protection of any of today's regulatory schemes.
I have mentioned briefly that the Bill makes provision to safeguard the human rights of osteopaths. That is of key importance. I can assure the House and the profession that great care has been taken to ensure that the panoply of appeal provisions within the Bill are founded firmly on the principles of natural justice and reflect European law on human rights. In that way, members of the profession can likewise be fully confident that the statutory scheme would rigorously protect their interests and be one in which they can take justifiable pride.
I mentioned that, in keeping with other statutory schemes, the work of the General Osteopathic Council and its four statutory committees would be overseen by the Privy Council. In the unlikely event that the council failed to perform its functions under the Act, the Privy Council would have the power to direct it to perform any of its functions that the Privy Council considered that it had failed to fulfil. As a final resort, the Privy Council would be able to step in and take over the functions of the council and do anything that it could have done under the Act.
Let me end where I began. Due to the sterling work of the working party on osteopathy, the profession has a well thought out and carefully structured scheme that reflects the most up-to-date thinking on professional self-regulation. I hope that the House and the profession will agree that the proposals will not only provide the means to enable the profession to control its destiny and set its future direction but secure better patient protection, 1181 safeguard the interests of the public and provide a model for other statutory self-regulatory schemes for the 1990s and beyond.
§ Dr. Ian Twinn (Edmonton)
I must declare an interest as I am one of two parliamentary advisers to the Chartered Society of Physiotherapy.
I congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on introducing the Bill. Although I do not suffer from back pain—having voted for the Maastricht measures so far—I suspect that many of our colleagues may well need the services of professions that specialise in the manipulative therapies, something of which the Conservative Front Bench is only too well aware.
The Chartered Society of Physiotherapy is supportive of the moves by its sister profession to introduce regulation. There are estimated to be about 2,000 osteopaths, the Chartered Society of Physiotherapy has 24,000 members and there are about 700 chiropractors, which demonstrates that at least three professions are intimately involved with such work.
Physiotherapists work in hospitals and in private practice and about a third of their number are actively involved with the manipulation of the back and the neck. Among physiotherapists there is a view that it would have been better for the three professions to come together for regulation rather than moving separately, but that does not mean that the Bill is not welcome.
There is a substantial overlap between osteopaths, chiropractors and physiotherapists, and the latter do everything that osteopaths can do and considerably more.
Physiotherapists are regulated by the Professions Supplementary to Medicine Act 1960, which is now rather out of date. It was introduced when physiotherapists principally worked in hospitals and doctors prescribed their work for them. Their regulatory framework is therefore seriously outmoded and needs to be updated. For that reason, I believe that the King's Fund rejected using the 1960 Act for the regulation of osteopaths and that there is now a case for the urgent revision of that Act.
The Bill will introduce modern, regulatory structures for osteopaths and we should like those provisions to be extended to physiotherapists as soon as possible. We congratulate the osteopaths on achieving the Bill. As my hon. Friend the Member for Cambridgeshire, North-East said, it will be the first profession to have that modern structure, which is very welcome.
There is concern that the protection in clause 29 of the title osteopath might lead to problems for other professions, including medical practitioners and physiotherapists, as it might prevent such professions from claiming to use osteopathic techniques. My hon. Friend may wish to return to that subject in Committee so that there may be a clear understanding that other professions are already using such techniques and that they should not be prevented from making such a claim although they are not osteopaths. A comment on that subject from my hon. Friend the Minister would also be welcome.
Title protection is to be given to osteopaths, but the title of physiotherapist is not protected and anyone can practise as such or claim to be a physiotherapist. Only the terms "state registered physiotherapist" or "chartered physiotherapist" are protected by the 1960 Act, so the Chartered 1182 Society of Physiotherapy looks at the Bill with some envy and would like equal protection to be given to the short titles of all the professions involved. If that could be achieved it would be in the public interest.
My hon. Friend the Member for Cambridgeshire, North-East mentioned the disciplinary procedures in the Bill, which are very welcome. Physiotherapists feel that they do not have sufficient powers to discipline their own profession or, for example, to investigate the claims of overseas practitioners in physiotherapy. Again, he is setting out procedures that will be helpful to the profession and we should like that to be reflected in the Minister's remarks.
I thank my hon. Friend the Member for Cambridgeshire, North-East and the working party of osteopaths for their work. I urge all the professions practising such techniques to get together so that we can set down new regulations for them all as soon as possible, as that will be in the public interest.
§ Ms. Liz Lynne (Rochdale)
I extend my support and that of my party to the Bill, which is a most welcome response to the King's Fund report on osteopathy and the subsequent Bill that was introduced by Lord Walton in another place in December 1991. I also thank the hon. Member for Cambridgeshire, North-East (Mr. Moss) for his work thus far on the Bill. I hope that he steers it through the House to a successful conclusion.
Osteopathy came to Britain at the turn of the century and the first attempt to put it on a statutory footing was in 1931. Just over 60 years later it looks as if we shall at last be successful—another fine example of the British Parliament responding rapidly to new ideas and changing circumstances.
§ Lady Olga Maitland (Sutton and Cheam)
I thank the hon. Lady for her comments on the Bill, and must add to her reflections about its popularity. A MORI poll has shown that osteopathy is the most popular complementary medicine, and 63 per cent. of those polled were very satisifed and only 9 per cent. dissatisfied.
§ Ms. Lynne
I am grateful to the hon. Lady. Osteopaths responded to Parliament's inaction by establishing registering bodies and it is to their credit that the profession is among the leading advocates of statutory regulation.
The Bill is of particular importance, as it represents the first statutory recognition of the role of complementary medicine in the health of the nation. I hope and expect it to become a model for future Bills.
It is well known that the Chiropractic Advancement Association is hoping for official regulation soon after the Bill is enacted. Initially, it was thought that chiropractors could be included in the Bill introduced in December 1991. The Government have given some indications that they might soon be recognised, but I am a little concerned about the statement by Baroness Hooper, in a Lords debate on complementary medicine in May 1990, that an appropriate level of maturity is required on the part of the relevant professions before legislation would be considered. I should have thought that when professions are immature they can do the most harm and that that is when they need the most regulation. While I recognise the practical difficulties of proceeding along the path of 1183 regulation too soon, I hope that the Government will take a more active role to bring the various complementary therapies into a statutory framework.
The key points in the Bill are those dealing with the registration and education of osteopaths. Both aspects of the Bill are greatly to be welcomed. I am particularly pleased about the proposal that the General Osteopathic Council may require osteopaths to have further training after registration.
While it is clear that only accredited qualifications will be acceptable, and that educational establishments will have independent assessors, the Bill does not state that such establishments will be accredited. That would seem to be a logical extension of the existing proposals and it might clear up any confusion for anyone wishing to train as an osteopath.
In addition to my general comments, I have some specific remarks to make on the Bill. The Bill contains no definition of osteopathy. Only after detailed consultation was it decided that there were sufficient differences between osteopathy and chiropractic for them not to be covered by the same Bill. A definition is important because, without it, I cannot see how an effective code of practice can be established.
I should like the general council that the Bill will establish to ensure that, in drawing up the code of practice, there are the widest possible consultations with users of the service and their representatives. Once produced, the code of practice should be made easily available to members of the public, preferably free or via public libraries, but, if necessary, at a reasonable cost as stated in the Bill. The Bill does not say whether a "reasonable" cost is reasonable in the view of the council or the user.
I naturally agree with the establishment of a register of osteopaths, but, as in the case of the code of practice, the register should be easily available for inspection. The Bill allows for that to happen, but does not say where the register will be available, although I assume that it may be at the general council's offices. Perhaps consideration should be given to making it available at major libraries. I should also like to see a provision in the Bill or a declaration from the general council stating that osteopaths must display their registration at their place of work and clearly indicate their category of registration.
There should also be further protection for prospective patients. Last year in the United States, for instance, guidelines for quality assurance and practice were laid down. The document that was produced ran to some 200 pages. In particular, it was recommended that practitioners provide a written diagnosis for the patients and tell them what to do if the treatment does not work in two weeks and when to ask for a second opinion. In addition, particular emphasis should be placed on making it clear to patients how a complaint should be made.
With so many functions proposed in the Bill, I am concerned that the general council may not have enough resources to carry them all out effectively. I presume that the council is expected to be self-financing and I am therefore a little worried that it may have difficulties performing all its tasks. Experience in America, where legislation has been in place for more than 20 years, is that 1184 practitioners do not have the time or training to administer such a body effectively. I hope that that question will be dealt with in this country.
Could some light be shed on whether cranial osteopathy will be covered by the Bill? An article in The Guardian on 12 January says that there is some debate among osteopaths themselves about its value.
Despite the points that I have raised, the Bill is a major step forward and points the way for many complementary therapies. I urge all hon. Members to support it.
§ Mr. Toby Jessel (Twickenham)
I must declare an interest as a patron of the National Back Pain Association, the headquarters of which is in Teddington in my constituency. I warmly congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on this excellent Bill. I wish it every success and I hope that it will go on to the statute book without delay. However, my hon. Friend's speech dealt largely with internal, structural and technical matters to do with the osteopathy profession. It was almost as if he had received a large amount of briefing from that profession. It is important for the House to see the wood as well as the trees with which he dealt so extensively. I know that he will not mind if I say that much of what he said was on Committee points.
The whole purpose of osteopathy is to relieve back pain in people. Osteopaths are not an end in themselves but a means to an end. Back pain is a scourge and a pestilence which afflicts millions of our fellow citizens, including the Under-Secretary of State for Health, my hon. Friend the Member for Bolton, West (Mr. Sackville), and myself.
§ Lady Olga Maitland
May I add to my hon. Friend's comments the fact that in 1979, 11.5 million working days were lost through back pain? That was a great loss to the country and cost our social security system enormous sums.
§ Mr. Jessel
I am grateful to my hon. Friend. I believe that the figure is even greater. The figure that I have seen is 230,000 people per working day. Multiplied by the number of working days, that comes to considerably more than 11.5 million. There is doubtless a substantial loss to the country in terms of days off work, and I believe that, proportionately, women are affected even more than men.
A huge amount of pain and discomfort is caused, but because the causes are complicated and it is not a "glamour" welfare cause such as a disease affecting children, heart attacks or cancer, which cause death—[Interruption] It is a little trying for me to have my hon. Friend the Member for Cambridgeshire, North-East carrying on a conversation just four yards away from me.
Because back pain affects such a large number of people and is not a "glamour" welfare cause afflicting children or resulting in death, it is difficult to get the body politic or the public generally to pay as much attention to it as it deserves, despite the large number of people whom it affects. That is why the debate on the Bill is welcome, even if it is somewhat narrow. I happen to go to a chiropractor and I think that they are at least as good as osteopaths, if not better. I am sorry that they could not be included in the Bill, but I hope that there will be as little delay as possible before a Bill is introduced on chiropractic.
1185 The Government's White Paper, "The Health of the Nation", published last year, singled out five key areas for priority action: coronary heart disease and strokes; cancer; mental illness; AIDS; and accidents. However, the document also referred to five other candidates with a strong claim to key area status next: rehabilitation; the health of elderly people; asthma; drug misuse; and back pain. The inclusion of back pain in that list followed a meeting between Mr. Stanley Grundy CBE, founder of the National Back Pain Association, his director Dr. Mervyn Bryn Jones, Lord Joseph and myself with my right hon. Friend the Member for Bristol, West (Mr. Waldegrave), the Secretary of State for Health in the last Parliament. The meeting was to stress the great importance of back pain.
I hope that my hon. Friend the Under-Secretary of State will be kind enough to explain the position of that second grouping of five priority areas, and say what he thinks the Government can do to focus attention on it and to make progress as fast as possible in dealing with the scourge of back pain.
My hon. Friend the Minister has shown a tremendous interest in the problem of back pain, having attended and addressed the association's conference in central London last November. He has also seen Mr. Grundy several times, and I understand that my hon. Friend hopes, within his busy programme, to find time to visit the association's headquarters before long.
The association promotes research, whether by osteopaths, doctors, or chiropractors; it establishes branches throughout the country to promote interest in back pain, to provide means by which people can exercise, and to spread information; and it publishes educational material—such as a most useful recent manual for nurses on the correct way to lift patients. The national health service suffers a considerable loss of nurses' time when they hurt their backs lifting patients. I understand that 5,000 copies of that manual have already been sold.
Can my hon. Friend the Minister make it clear that general practitioners who are health service budget holders may use their budgets to refer patients both to osteopaths and to chiropractors? Will he also make clear the position in respect of value added tax on fees paid privately, whether under insurance policies or otherwise, both to osteopaths and to chiropractors? For many years the Department of Health has discussed that question with the Treasury, which decides in the light of legislation whether VAT should be attached to such fees. The Treasury has sought advice from the Department as to what is and is not deemed medical, because that affects whether or not VAT is applied. The Department has in turn referred the matter to a somewhat moribund body called the Council for Professions Supplementary to Medicine. The medical professions as well as the supplementary professions are represented on that council, and for years that body has put a stop on exempting osteopathy and chiropractic from VAT.
§ Mr. Jessel
I am grateful for my hon. Friend's clarification. It is nonsensical that physiotherapists approved by that council do not have to charge VAT while 1186 osteopaths and chiropractors, who are not so approved, must do so. I hope that the Department will indicate that if the Bill becomes law it will draw that matter to the attention of the Treasury so that it can be reviewed without delay.
If the Bill is passed and osteopaths become, in the eyes of the law, members of a profession, I hope that it will not go to their heads. In Britain, professionalism has an up side and a down side. The up side is that members of any profession—barristers, solicitors, accountants, doctors or dentists—endeavour to uphold standards. The down side is that they become somewhat introverted, in that they care about one another's good opinion rather than that of the public. Barristers care mainly about the good opinion of other barristers, doctors about the good opinion of other doctors, and so on. They tend to assume that qualification, which is essential in any profession, is so all-important that nothing else much matters. It is thought that a person who is qualified must be good and one who is not qualified must be no good at all.
Professional qualification is a necessary condition, but it is not a sufficient condition for professional competence. It remains vital for any professional, if he or she is to be good at his or her work, to possess flair, zest, and insight, among other gifts. I hope that there will not be so much harping on professional qualifications to the extent that those other qualities are played down. That would not be in the interests of the public. I hope that osteopaths will regard their professional status as a means of improvement and not take it to mean that everything has now been done. It is only a step.
§ Mr. David Atkinson (Bournemouth, East)
I congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on his good fortune in the ballot and on his choice of Bill. I was grateful for his invitation to be a sponsor, because, as he knows, I am particularly interested in the greater recognition of another so-called complementary profession—chiropractic. From my personal experience and that of many of my constituents and others, I am as fully convinced of the benefits of chiropractic as I am of osteopathy. I am privileged to have the Anglo-European College of Chiropractic in my constituency, which I hope right hon. and hon. Members will visit.
Both osteopathy and chiropractic were founded in the belief that many everyday disorders are caused by spinal defects impeding the work of our immune system. I welcome the Bill not only for the undoubted benefits that it will bring to patients in the proper regulation, registration and, above all, recognition of osteopaths but because it will pave the way for a similar Bill for chiropractors, which the King's Fund working party will also draft—based on what we hope will be the successful outcome of this Bill. I hope that it will be taken on board by one of my ballot-lucky right hon. or hon. Friends in the next Session.
I take this opportunity to express my deep regret that the complementary professions have been denied recognition for so long because of the failure of successive Governments to pass appropriate legislation on their behalf. Instead, each of those professions is being advised to pursue its own Bill, such as that before us. That will take years, which I find totally unacceptable. I am certain that 1187 any Government initiative to legislate for other uncontroversial complementary professions, given their ever-growing use and appreciation by patients—who find them successful where NHS-prescribed conventional surgery or drugs have failed—would be widely welcomed. Unfortunately, as my hon. Friend the Member for Twickenham (Mr. Jessel) implied, the so-called orthodox professions, as represented on the Medical Research Council and the Council for Professions Supplementary to Medicine, continue to withhold their sanction and support —thus sabotaging proper recognition of those who are properly qualified, to the detriment of patients.
In so doing, they are allowing unqualified cowboys and unscrupulous quacks to do untold damage to those members of the public who use them, and who find it extremely difficult to obtain legal redress. It is time to end that closed shop in the medical profession, which inhibits such competition.
I very much hope that my hon. Friend the Minister will stop sitting on the fence of Government neutrality towards the complementary professions. He could do that by renewing his Department's grant to the Research Council for Complementary Medicine; its recent termination is incomprehensible, given the enormous sums that are rightly spent on orthodox medical research and the amounts spent by other European Governments on research into complementary medicines. Moreover, the termination of the grant is contrary to the recommendations made some years ago by the Department's own working group on back pain.
My hon. Friend the Minister could also announce that the Government now intend to extend the Professions Supplementary to Medicines Act 1960 to include complementary medicines, and he could invite the research council to make appropriate recommendations to him. As my hon. Friend the Member for Twickenham pointed out, after 33 years there is now an overwhelming case for a review of the Act. Alternatively, my hon. Friend the Minister could announce a Government inquiry into the most popular complementary medicines, to subject them to scientific validation with the ultimate aim of integrating orthodox and complementary medicines. Such integration has already taken place in the Netherlands.
My hon. Friend the Member for Cambridgeshire, North-East has made an outstanding case for the benefits to patients that would undoubtedly result from the legislation. The statutory recognition of osteopaths would encourage more patients to use their services—especially now that fund-holding GPs can pay for them out of their own budgets: I commend the action taken last year by the Minister's predecessor, my hon. Friend the Member for Loughborough (Mr. Dorrell), to allow them to do so. The Bill will, I hope, encourage health authorities, hospital staff and doctors to work more closely with the osteopathic profession. As osteopathy, chiropractic and other such therapies do not require such expensive equipment as national health service treatment, and also do not require increasingly expensive drugs, their statutory recognition would result in enormous savings in the health service, despite patients having to bear the cost of treatment.
1188 My hon. Friend the Member for Twickenham rightly enjoined the Minister to urge our right hon. Friend the Chancellor of the Exchequer to consider whether the cost of alternative treatment should be exempt from VAT.
§ Mr. William Cash (Stafford)
My hon. Friend and I have travelled down the path of complementary medicine for many years. Does he agree that the new arrangements for fund holders could be used to enable patients to receive the complementary and alternative treatment that they want through their local GPs? I believe that that is already happening to some extent. Appropriate arrangements could be set up with complementary and alternative practitioners.
§ Mr. Atkinson
That is still a back-door method. My hon. Friend and I have been working for years to try to bring about proper recognition of complementary medicine: I pay tribute to the work that has been done to enable Bills such as this—and, we hope, subsequent Bills —to establish such recognition. He was engaged in that work long before he became a Member of Parliament.
I hope that the Bill will also encourage companies to become more aware of the opportunities for them to refer employees to osteopaths or chiropractors. Widespread absenteeism resulting from back pain is costing the national economy an enormous amount. I am sure that if the Bill is passed, more and more operators of private health insurance schemes will be encouraged to reimburse subscribers for the cost of osteopathic treatment. I also believe that increasing use of osteopathy and other complementary treatments will lead to greater accuracy in the diagnosis of disorders that still baffle the NHS, such as allergies and ME.
I hope that the Bill will be given an unimpeded passage through both Houses. Let me again congratulate my hon. Friend the Member for Cambridgeshire, North-East—and Lord Walton on his pioneering work in introducing a similar Bill last year in the other place. I also pay tribute to the work of the King's Fund.
I hope that a similar Bill to deal with chiropractic will follow this one—or that, better still, the Government will present a Bill to give proper statutory recognition to all the complementary medical professions, for which an increasing number of our constituents are voting with their feet.
§ Mr. David Tredinnick (Bosworth)
There is no doubt in my mind that, indirectly, I owe my seat in the House to the work of chiropractors and osteopaths. Fifteen years ago, I suffered an accident and broke three vertebrae in my back. Having lain in bed for several months, I was put back together by such practitioners, and I therefore owe them a particular personal debt.
I note with interest that other hon. Members—for instance, my hon. Friend the Parliamentary Under-Secretary of State and my hon. Friends the Members for Twickenham (Mr. Jessel), for Bolton, North-East (Mr. Thurnham) and for Edmonton (Dr. Twinn)—suffer from back problems. My hon. Friend the Member for Edmonton mentioned the impact of the European Communities (Amendment) Bill: having looked at next week's business, I think that hon. Members on both sides 1189 of the House may need the services of osteopaths and chiropractors, but not every Conservative Member may agree with that.
Apart from the treatment that I received at the time of my accident, the treatment that I have received in subsequent years has been very important. My message to the public is that the disciplines of osteopathy and chiropractic can be enormously beneficial.
I also speak as treasurer of the all-party parliamentary group for alternative and complementary medicine. I pay tribute to my hon. Friend the Member for Stafford (Mr. Cash), who is sitting beside me on the Back Benches—
§ Mr. Tredinnick
I had better not comment on that.
However, I pay tribute to my hon. Friend's work on alternative medicine, and to that of my hon. Friend the Member for Bournemouth, East (Mr. Atkinson). I believe that my hon. Friend the Member for Stafford and I were the only two Members of Parliament who attended the launch of the King's Fund by the Prince of Wales in December 1991. We were also involved in the attempt to take Lord Walton's Bill through the House of Commons; it fell at the last general election.
I welcome the Bill particularly because I think that it will shake out the tiny minority of charlatans in the profession. My hon. Friend the Member for Bournemouth, East referred to unqualified quacks, and there are certainly a few unscrupulous people around. The Bill will also provide an understandable framework, and will encourage the use of osteopathy to relieve the pain described by my hon. Friend the Member for Twickenham. I understand that he had an accident that hurt him quite badly, and he has probably suffered considerable pain over the past two weeks.
The Bill will also give confidence to people who were wondering how to solve their back problems. Only yesterday, I spoke to a senior Canadian Member of Parliament who suffers from muscular and skeletal pain. I asked him why he did not see an osteopath or chiropractor. He said, 'I am not sure about these people; they are not regulated."
That is the nub of the problem: if people were made confident by regulation, more of them would take advantage of such treatment. We have already heard from my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) about the large number of people who are attracted to osteopathy, and I believe that, with regulation, many more will follow.
In my experience, GPs have no great understanding of back problems unless they are specialists. A close supporter of mine in the general election campaign suddenly developed great back pain. She was advised to rest for two weeks, which was not possible during the campaign. She went to a osteopath who was a chiropractor, and within a day some relief had been given and she was back on the road.
Just after Christmas, my five-year-old daughter was acting out the part of a children's play with a big cushion on her head when she suddenly developed acute pain. She was checked by a doctor who, fortunately, found nothing serious. The doctor said, 'The problem will go away with time; children at this age are very resilient." I took her to an osteopath in Leinster square who was open on the Saturday after the new year, and two osteopaths kindly 1190 treated her. She came away an hour later and has not mentioned that back pain again. Those are practical demonstrations of how people can benefit from such treatment.
Over the years, there has been a marked shift of opinion towards alternative and complementary medicine and osteopathy. In its 1986 report, the British Medical Association dismissed alternative medicine as a passing fashion. A number of surveys showed otherwise, and gradually medical opinion has shifted ground. For example, a 1986 Which? survey suggested that osteopathy was the most widely used complementary therapy, and 82 per cent. of patients interviewed claimed to have been cured or improved by the treatment.
Another Which? survey last November reported that each year one in four readers visited an alternative practitioner, which includes osteopathy—twice as many as the 1986 survey—and were highly satisfied. Four out of five users claim to have been improved or cured by alternative treatments; three out of four would use this form of treatment again.
Those findings confirm the results of the 1989 MORI survey, which revealed that 93 per cent. of users were satisfied with chiropractic treatment and 83 per cent. of users were satisfied with osteopathy. My hon. Friend the Member for Sutton and Cheam dropped 20 per cent. when she gave her figure. The figure that I have is 83 per cent., not 63 per cent. Some 80 per cent. were satisfied with homoeopathic treatment. The MORI survey showed that homoeopathy, osteopathy and acupuncture were the most widely used alternative medicines.
§ Mr. George Kynoch (Kincardine and Deeside)
My hon. Friend has used the term 'alternative medicine" several times. Does he intend to use the term 'complementary medicine"? Many of the forms of treatment that he has mentioned are complementary rather than alternative.
§ Mr. Tredinnick
My hon. Friend is absolutely correct. I have used the term 'alternative medicine" as the shortened version of 'alternative and complementary medicine". He will recall that I referred to the fact that I am treasurer of the all-party group for alternative and complementary medicine. There is a debate about what is alternative and what is complementary, but I certainly speak for both.
Last November's Which? survey quoted a study in which four out of five medical students said that they would like some form of alternative training incorporated into their course.
I argue that the Bill is not the end of a road but very much the beginning of a new relationship between alternative and complementary medicine, including osteopathy, and the health service. I am delighted to see my old and hon. Friend the Under-Secretary in his place on the Front Bench. [HON. MEMBERS: "Not too old."] I think that I can count him as an old friend; we have known each other for 25 years.
I firmly believe that the Bill is the start of a new relationship between alternative and complementary medicine and the health service. With the greater recognition and regulation that the Bill will give, it should be possible to achieve greater integration of the work of osteopaths and other alternative practitioners within the health service.
The previous Under-Secretary, my hon. Friend the Member for Loughborough (Mr. Dorrell), made a 1191 significant contribution towards achieving that integration when he ruled in the last Parliament that GP fund holders could employ alternative practitioners, which of course includes osteopaths, if they took clinical responsibility. I hope that my hon. Friend the Under-Secretary will see fit to go further and make it possible for other general practitioners to use the services of alternative and complementary practitioners. I believe that that is very important. I tell my hon. Friend the Under-Secretary, in the presence of its chairman, my hon. Friend the Member for Stafford, that the all-party parliamentary group aims to achieve full integration of most of the various alternative disciplines in the health service.
The House will consider other Bills in the future. At one stage, chiropractors hoped that their work would be included in the Bill. The different schools of chiropractic, such as the McTimoney school and others, have taken tremendous strides towards bringing their disciplines together in an understandable framework.
§ Mr. Tredinnick
My hon. Friend the Member for Bournemouth, East nods in assent.
They have put their house in order, as requested by the Department, and I hope that the next Bill will be for chiropractors.
Other disciplines such as acupuncture may benefit from such regulation. My hon. Friend the Member for Edmonton referred to physiotherapy, which is important. In addition, there are disciplines such as aromatherapy. I have the largest factory of aromatherapy and essential oils and the largest practice in the world in my constituency. I opened its new premises yesterday. It used to work out of an attic in a disused hosiery factory, but it now has a splendid new building. It is training not only lay practitioners who express an interest but is teaching medical practitioners; nurses are being taught these skills. The work of aromatherapy is relevant to osteopathy because before treatment an osteopath can use oils such as roman chamomile, juniper berry, lavender and sweet marjoram to relax and warm up muscles.
§ Mr. Tredinnick
I thought that my hon. Friend the Member for Rutland and Melton (Mr. Duncan) might find this amusing, but it is not amusing to someone suffering from pain.
My hon. Friend makes the point well: any hon. Member who had talked about osteopathy or chiropractory in the House 10 years ago would have been laughed at. I say to my hon. Friend the Member for Rutland and Melton, as I strike him with a rubber mallet, that these disciplines, which may seem a little weird to the majority, will eventually become mainstream.
Some say that by iridology, the study of the colours of eyes and shape of pupils, one can diagnose different ailments that affect the body. I venture to suggest that that and phrenology, the study of the shape and condition of the head, will eventually come within the scope of the health service.
My hon. Friend the Under-Secretary will find a tremendous opportunity to save costs if he pursues this route, because it has been found that alternative 1192 practitioners who are medically qualified issue far fewer prescriptions. Furthermore, homoeopathic prescriptions are less expensive, and homoeopathic preparations are increasingly available in the huge number of homoeopathic shops that are bursting into bloom all over the country as a result of public demand. This move is market-led—I say that although I do not want to upset the hon. Member for Makerfield (Mr. McCartney), whom I have in the past seen stand on a bench to make a point.
The serious point to all this is that cost savings can be made, much happiness can be given, and many problems can be solved by alternative and complementary medicine, including osteopathy. I appeal to the House to take the alternative and complementary medicine much more seriously than it has been taken. I welcome the Bill, which is a major step forward. I pay tribute to my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss), and look forward to the successful passage of the Bill through all its stages.
§ Mr. William Cash (Stafford)
I join other hon. Members in congratulating my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) not only on promoting the Bill but on the way in which he has tackled the subject. Over the past nearly 20 years, I have been the legal adviser in relation to complementary and alternative medicine. I started in the days when, as my hon. Friend the Member for Bosworth (Mr. Tredinnick) said, one could not talk about it easily because people either did not know about it or thought that it was based on quackery, which it was not.
My hon. Friend the Member for Bournemouth, East (Mr. Atkinson) played an important part in the beginnings of the objective analysis of complementary medicine. He served on the Committee—which took evidence—that examined a private Bill, in which I also happened to be involved, back in about 1975. That Bill was aimed at driving acupuncturists out of business and was strongly attacked. My hon. Friend listened to the cross-examination of witnesses from both the medical profession and acupuncturists. The Committee unanimously concluded that the acupuncturists had a good case. I give that as an example of the way in which Parliament has helped to break down the barriers and I pay tribute to my hon. Friend and to other distinguished Members who have joined me in the all-party group on complementary and alternative medicine, of which I have the honour to be joint chairman with the right hon. Earl Baldwin of Bewdley. I should declare an interest in that I give continuing legal advice on these matters.
Let me also pay tribute to Simon Fielding, who is here in the House under the Gallery. I have known him for a long time and those who know about the Bill and the work that he has put into ensuring that osteopathy should be—
§ Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)
Order. I hesitate to interrupt the hon. Gentleman, but he has been here a long time and should be aware that he is not supposed to refer to people in the Gallery.
§ Mr. Cash
I have made my point, but I withdraw the reference on that basis.
I congratulate the Department on the way in which it has moved in relation to complementary and alternative 1193 medicine. The atmosphere has changed greatly and much diligent and effective thinking has been given to those matters. I am delighted that my hon. Friend the Minister will be giving the Bill the additional support that it will require to ensure that it gets on to the statute book.
I have no intention or desire to go through all the points that have been made by my hon. Friends the Members for Cambridgeshire, North-East, for Bosworth, for Bournemouth, East, and for Twickenham (Mr. Jessel). However, I wish to get one or two points on the record because there has been a significant change in the policy on osteopathy over the past 20 years. Back in the mid-1970s, the BMA handbook said that doctors should have nothing to do with osteopaths because osteopathy was not a science. This was put in extremely strong language. The General Medical Council took a rather different view. The Bill is a testament to the work of osteopaths and demonstrates how attitudes in the medical profession have changed substantially in the past 20 years.
The BMA set up an inquiry seven years ago in which there was a general attack on complementary and alternative medicine. I tabled an early-day motion, which about 150 Members of Parliament supported, and we saw off that attack pretty well. I do not wish to cast aspersions on the medical peofession in this context because there has been a learning curve. There was bias, but there has been a significant change in the attitude of doctors towards osteopathy and other complementary therapies.
I intervened in the speech of my hon. Friend the Member for Bournemouth, East to speak about general practitioner fund-holding arrangements to which I strongly believe that serious attention should be given. We had an interesting meeting the other day with Baroness Cumberlege, the Parliamentary Under-Secretary of State for Health, in which some of those ideas were developed. We have already heard questions about whether grants could or should be made. The withdrawal of grant aid was not a sensible move, and I strongly opposed it. However, through the aegis of the Medical Research Council, further funds could and should be made available.
Osteopathy, along with chiropractic, acupuncture and herbal remedies, has to be taken seriously. Therefore, we must give those sectors a reasonable amount of help because they have nothing to fall back on. It is not as though they have the large funds of the Medical Research Council behind them. Those who know just how large those funds are will agree that reasonable help should be given, and my urgent plea is that it should be, because that would be in the interests of everybody, including the medical profession. My hon. Friend the Member for Kincardine and Deeside (Mr. Kynoch) is a doctor.
§ Mr. Kynoch
I should declare my interest. My wife is a doctor. I am sure that my hon. Friend will agree that the medical profession has accepted osteopathy because it is seen as a complementary rather than, as it was portrayed years ago, an alternative medicine. Is not that an important point?
§ Mr. Cash
I agree. It is very important to stress that aspect, because there is a mutuality. Each can learn from 1194 the other and there is a learning curve all round. The Bill represents the culmination of a great deal of hard work on that learning curve.
Important questions arise in relation to other member states of the European Community and their approach to these issues. If we pass an Act of Parliament, we should bear in mind that if there were an extension of competence in the Community to embrace health generally and that fell within the single market—as the herbal remedy question does at the moment—an application of article 100a through a directive could, in theory, override the provisions of the Bill.
I leave that point on the table for consideration. We must bear in mind the fact that we can work together in the European Community with other member states as we want to and not be disadvantaged, as might be the case if a regulation or directive of the type that I have described were to emerge. I exhort my hon. Friend the Minister, as he has a good nose for such things, to keep a watchful eye on that aspect of complementary and alternative medicine in its application to the United Kingdom.
I trust and believe that self-regulation in osteopathy is about to become a reality. My hon. Friend the Member for Cambridgeshire, North-East, all hon. Members involved in the exercise and everyone in the complementary field who has helped to push the Bill along deserve credit for what they have achieved.
We should remember what happened to George III around 1800 and the way that he was treated. By the 1840s and 1850s, things had begun to change. After the Medical Act 1858 was passed, huge arguments developed between different parts of the medical profession. Each side believed that it knew best. The lesson that we must learn from the way in which medicine has developed is that it must do so on an open and reasonable basis, learning from the complementary side as well as giving to it.
On that note, I strongly recommend that the Bill should reach the statute book. I congratulate everyone concerned and the Department on the helpful way in which they have accelerated the Bill's progress.
§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
On behalf of the Government, I also congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on his success in the ballot and on his choice of Bill. I begin by stating that the Government fully support the Bill and hope that it will also receive the support of the House.
Osteopathy was developed by an American doctor called Andrew Taylor Still and first came to Britain around the turn of the century. It was brought over by a group of American-trained practitioners who later formed the British Osteopathic Association. The first osteopathic training institution—the British School of Osteopathy— was founded in London in 1917 by Doctor J. Martin Littlejohn who had studied under Andrew Taylor Still.
Today, the medical profession regards osteopathy as truly complementary to the treatment provided by medical practitioners and one which enhances the range of possible treatment options available to patients. Given the increasingly common instances of cross-referral between general practitioners and osteopaths, it would not be 1195 unusual these days for an osteopath to be treating a patient who is currently receiving medication from his or her doctor.
Each week, around 100,000 men and women from all walks of life and from across a wide section of the population consult an osteopath. About half of them do so because of low back pain. Of those, nearly 90 per cent. claim to be cured or to experience an improvement in their condition as a result of treatment.
However, the gentle manual manipulative techniques which comprise osteopathy have also proved to be effective in the treatment of tension headaches, neck and shoulder pains, for many types of joint strains such as in the wrists, elbows, knees, ankles and feet—indeed, anything to do with the biomechanics of the body and its mechanical functions.
For example, many women choose osteopathic treatment as an alternative to drugs for the relief of aches and pains and other discomforts often associated with pregnancy. Sportsmen and women often consult an osteopath following injuries or to help alleviate problems that have previously prevented them from performing at their best.
However, as my hon. Friend the Member for Cambridgeshire, North-East has already said, at the present time anyone can call himself or herself an osteopath and set up in practice. There is no obligation for practitioners to undergo formal training of any kind or to comply with any standards of professional competence or ethical practice. Members of the public, therefore, have no guarantee that a person calling himself or herself an osteopath is either properly qualified or competent in the practice of osteopathy or in the skills of differential diagnosis to know when osteopathy is inappropriate or when medical attention is more properly and, perhaps, more urgently required.
§ Mrs. Judith Chaplin (Newbury)
My hon. Friend the Minister has just said that it is important that there is a correct standard of qualification. Will he reconsider the way in which qualifications are supported by the Government? A constituent of mine gained a place to study physiotherapy for which her fees would have been paid under the mandatory award system. However, she also gained a place at the British School of Osteopathy where she would have received only £695 a year towards her fees. If we want the high standard of qualification necessary to put in place the admirable benefits of the Bill, we must ensure that there is proper support for those who wish to study in this area.
§ Mr. Sackville
My hon. Friend has made an important point which we should certainly address.
While it is widely accepted that patients should have the freedom to choose whom they consult, the osteopathic profession is concerned that there should be adequate safeguards. Under the terms of the Bill a single statutory body—the General Osteopathic Council—will be established to develop, promote and regulate the profession of osteopathy and to set educational standards and standards of professional competence. The general council will also be the shop window of the profession and will play a key role in helping to raise the profile of osteopathy, especially during the formative years of the scheme.
1196 As has been said, the osteopathic profession has been seeking statutory regulation for the past 60 years. Throughout this time no fewer than six private Members' Bills have been introduced to Parliament in an effort to achieve this goal—this compares with the 20 attempts it took to pass the first Medical Act—and that demonstrates a determination and perseverance which have become the hallmarks of the profession.
In 1935, an Osteopaths Bill introduced by the late Viscount Elibank, successfully gained its Second Reading in the House of Lords. It was then referred to a Select Committee where it was felt that'a sufficiently strong case had not been made for the proposals in the Bill at that time".As a result the Bill was withdrawn, but its supporters responded swiftly to a suggestion made by the then Minister of Health for the establishment of a voluntary register of osteopaths which should require its members to achieve a level of excellence in training, practice and professional behaviour. In June 1935, a decision was taken to implement this recommendation and in 1936 the General Council and Register of Osteopaths was formed. While that body governs the majority of professional regulated osteopaths, there are also a number of other, smaller bona fide osteopathic registering bodies which regulate and represent the interests of their members. I believe that it is a cherished hope of all those groups that one day their roles might be superseded by the establishment of a single statutory regulatory body which would incorporate the breadth and experience of expertise contained in all branches of the profession. The Bill will, I hope, make that longed-for day a reality.
In 1985, Lord Glenarthur, the Under-Secretary of State in what was then the Department of Health and Social Security, outlined the criteria that the Government expected professions of non-conventional medicine to fulfil before being considered suitable for statutory regulation. The osteopathic profession has been fulfilling those criteria now for a number of years.
However, without doubt, the watershed came in 1988 when the Prince of Wales hosted a luncheon at Kensington palace attended by Health Ministers, presidents of the royal medical colleges and the president of the General Medical Council. At that lunch, the presidents discussed the difference between the therapies that the medical profession considered alternative to orthodox medicine and those that they regarded as complementary. At the end of their discussion, the presidents said that they believed that the way was clear to proceed with proposals to secure the statutory regulation of the osteopathic profession.
It was following a suggestion from his royal highness that the best way forward might be to set up a working party to consider the case for legislation that, in the autumn of 1989, the King's Fund set up its working party on osteopathy. It was chaired by Sir Thomas Bingham, who was then a Lord Justice of Appeal and is now Master of the Rolls.
The King's Fund working party report was launched at a major press conference on 3 December 1991. The conference was attended by the Prince of Wales and a stunning array of dignitaries, royal college presidents and elder statesmen of the medical profession. The Prince of Wales paid tribute on that occasion to the many years 1197 during which the osteopathic profession had been providing high standards of responsible care and conduct which, he said,'had been of real value to a large number of people".He congratulated the working party on its report and expressed his hope that, after all its hard work, legislation would follow at an early date. On 17 December Lord Walton introduced the Osteopaths Bill, which the working party had appended to its report, as a private peer's Bill in another place.
Before leaving that subject, I again express the Government's thanks to the working party's chairman, Sir Thomas Bingham, its members and the King's Fund. The working party unquestionably made a significant and central contribution to the osteopaths' pursuit of statutory regulation. The policy underpinning the proposals in the Bill are modelled principally on its recommendations which have provided a fair, sound and practical basis for statutory regulation of established practitioners and provide the public with safeguards for the future.
As the House already knows, the King's Fund has set up a further working party to consider proposals for the statutory regulation of the chiropractic profession. That working party is also chaired by Sir Thomas Bingham and we look forward to receiving its recommendations when it reports shortly. The Government's gratitude to Sir Thomas for his interest in complementary medicine has already been recorded.
I also add my congratulations on the sterling work performed by Simon Fielding in the profession's quest for statutory regulation. Mr. Fielding, himself an osteopath, has worked ceaselessly for that cause virtually all his professional life. He was a key member of the King's Fund working party and also played a vital role in persuading my hon. Friend the Member for Cambridgeshire, North-East to sponsor his current Bill. It is not only fitting but justly deserved that he has recently been appointed chairman of the General Council and Register of Osteopaths.
I have mentioned Lord Walton's Bill in the previous Session. It attracted all-party and Government support and brought to life the recommendations presented in the working party's report. The Bill went on to complete a successful Committee stage before the dissolution of Parliament last March and, in its own right, played a pivotal role in the profession's quest. I am pleased that the noble Lord has agreed to steer the latest Osteopaths Bill on its journey through another place following what we hope will be its successful passage through this House.
I shall now deal with the current Bill, the seventh and latest. My hon. Friend the Member for Cambridgeshire, North-East has already outlined the purpose and content of the Bill and its major provisions. The regulatory system proposed for the osteopathic profession is, of course, modelled closely on that which exists for other major professions, including key health care professions. It also follows the principles for statutory regulation recommended by the King's Fund working party. However, I can confirm that, thanks to the working party, it embodies the most up-to-date thinking on professional self-regulation and will, as my hon. Friend said, provide a model for others to follow.
The Bill explicitly designates professional incompetence as a basis for a disciplinary investigation. I know that other professions, in particular the medical profession, are also investigating ways of introducing that concept for 1198 their own members. The solutions reached may be different for the different professions, but I believe that osteopaths can take credit for the fact that the scheme that they propose seeks to provide the public with the protection that the provision can offer from the outset of the statutory scheme.
Similarly, the Bill contains a provision for the introduction of compulsory refresher training as a condition of continuing registration. Again, I know that that is in line with current thinking in a number of health care professions, offering the reassurance to the public that the practitioners whom they consult are keeping up to date in their fields.
Perhaps one of the most important elements of the Bill is the creation of an offence of using the title "osteopath", or any variation of the term, without being a registered osteopath. I know that that provision is of interest to many related professions. I reiterate the fact that that is not intended to prevent other professionals such as physiotherapists using osteopathic techniques in their practice or telling patients that they are using such techniques.
The offence provides for closure of title, not closure of function. I hope that my remarks will provide some reassurance for those involved. I know that other professions are anxious to secure the closure of their professional title. Our advice to them is to follow the example of the osteopaths and to seek their goal through private Member's legislation.
As careful readers will have noted, the Bill also contains a panoply of appeal rights at various stages of the proposed disciplinary procedures and as part of the registration process. The Government's view is that they are desirable and necessary to fulfil our obligations in human rights terms. The Bill also reflects our European Community obligations in relation to the recognition of professional qualifications.
Added protection for the public is provided through the exemption of registered osteopaths from the Rehabilitation of Offenders Act 1974. That will bring osteopaths into line with other health care professionals and will mean that practitioners will be required to declare all their criminal convictions, including spent convictions, if asked to do so when applying for registration. The General Osteopathic Council will also have the power to ensure that practising osteopaths hold professional indemnity insurance and to take disciplinary proceedings against a practitioner who fails to comply with that requirement.
Nothing in the Bill affects the rights of members of the public to consult osteopaths directly or the osteopaths' professional freedom to treat patients. With all its statutory powers, the General Osteopathic Council will not be able to interfere with the free market in terms of the scale of fees osteopaths may charge. Should the need ever arise, powers of intervention are provided against any anti-competitive practices that the General Osteopathic Council may contemplate.
My hon. Friend the Member for Cambridgeshire, North-East has already drawn attention to the fact that the Bill is expected to have only minor implications for public expenditure. That would arise only in the unlikely event of the Privy Council having to exercise its default powers over the General Osteopathic Council. I confirm that assessment.
The passage of the Bill is not related to the availability or otherwise of osteopathy on the NHS, because, as with 1199 all other services, the purchase of osteopathy is a matter for local decision based on the assessed health needs of the local population, competing priorities and resources. However, we hope that statutory regulation will stimulate the continued growth of the profession and will encourage more people to consider osteopathy as a career.
§ Mr. Rod Richards (Clwyd, North-West)
Does my hon. Friend believe that the Bill will make osteopathy more easily available on the NHS—perhaps as easily available as conventional treatment is?
§ Mr. Sackville
I cannot go further than what I have just said, which is that the Bill will further encourage district health authorities to consider making osteopathy available. It will remain a matter for local choice.
§ Mr. Jessel
Will general practitioners who are budget holders be able to use their budgets to send their patients to osteopaths if the Bill is passed?
§ Mr. Sackville
General practitioners have the right to employ osteopaths. I confirm that that is already the case.
The statutory regulations will help to foster closer working relationships between doctors and the profession. I reiterate the point made by my hon. Friend the Member for Cambridgeshire, North-East about the professional and lay members of the first General Osteopathic Council. They will be appointed by the Privy Council after consultation not only with the bodies that currently administer the systems of voluntary registration, but with those that reflect wider views, such as those of the public, of educationists and of the medical profession. The initial members will be appointed on the basis of their individual merit, and for their ability to help to secure the highest standards of clinical practice and to bring out the best ideas from all quarters of the profession.
I underscore the importance of the point made by my hon. Friend the Member for Cambridgeshire, North-East, that the profession should not upset the stability it currently enjoys through the premature anticipation of future change. It is important that individual members of the osteopathic profession continue to support the existing schemes of voluntary registration right up to the time when the new General Osteopathic Council takes on its statutory responsibilities. Failure to do that would result in a loss of public confidence in the profession, it would undermine all that has been achieved so far and it would call into question the professional integrity of those who abandoned a scheme that had brought them and their profession to the brink of achieving their ultimate goal.
I thank hon. Members who have taken part in the debate, in which a number of interesting points have been made. My hon. Friend the Member for Twickenham (Mr. Jessel) mentioned apparent anomalies in terms of VAT. I shall investigate the matter and write to him. My hon. Friend also mentioned the various key areas and targets set in the White Paper 'The Health of the Nation". Further targets, as he probably knows, are under discussion, especially on the question of back pain in which my hon. Friend expresses great interest. He will know that the clinical standards advisory committee is studying the area as one of its special areas of interest. I 1200 hope that we shall have more to say on that. My hon. Friend the Member for Twickenham also mentioned the question of GPs with which I have just dealt.
I welcome what was said by my hon. Friend the Member for Bosworth (Mr. Tredinnick), who has taken an active interest in the House in complementary and alternative medicines. I reiterate his hope that the Bill will take alternative and complementary medicine a little further down the road of acceptance by the medical profession.
We also heard a speech by my hon. Friend the Member for Stafford (Mr. Cash), who is taking a rest from his usual nightly exertions in the House. Some of us were relieved to hear him say that he would leave the European ramifications of the Bill on the table. I am sure that my hon. Friend the Member for Cambridgeshire, North-East is grateful for that. Yet again, I congratulate my hon. Friend on introducing the Bill.
I should declare a personal, family interest. I have just discovered—to my shame, only a few minutes ago—that my late father was the president of the General Council and Register of Osteopaths—[Laughter.] He was a dark horse. I was aware that he was active in another place in promoting the interests of the profession, but the fact that he reached such heights has only just come to my attention.
The osteopathic profession has been running the race in pursuit of statutory legislation for more than 60 years. The Government believe that the case presented by the profession is deserving and justifiable. The King's Fund working party report and the Bill introduced by Lord Walton in the previous Session have taken the profession down the back straight. It is our hope that the Bill will bring the profession not only round the final bend and along the home stretch, but across the finishing line where it can hold aloft the long-sought prize of the Osteopaths Act 1993.
§ Ms. Dawn Primarolo (Bristol, South)
My remarks will be briefer than I had intended because many hon. Members have made the points in the debate. It is not worth detaining the House on legislation for which clearly there is so much support.
It is a shame that the Minister drew an analogy between complementary medicines and crossing the finishing line in a horse race. It should have been Government policy to address the important points made today about complementary and alternative medicine. There should have been a positive lead from the Government on how to incorporate the valuable contributions made to the NHS by those medicines.
The hon. Member for Cambridgeshire, North-East (Mr. Moss) has received many accolades this morning. I congratulate him on the Bill, and on his thorough and clear explanation of the range of the Bill, of its intentions and of the clear benefits, especially for osteopaths. Qualification for registration is important. It is important that it should be an offence for anybody to call himself an osteopath without being registered. The whole point of the legislation is to provide protection for the patient.
I hope that, when the Bill is in Committee, the important points made by the hon. Member for Rochdale (Ms. Lynne) will be taken on board. The Bill will then be improved as it makes its speedy way through Committee.
1201 The hon. Member for Edmonton (Dr. Twinn) referred to chiropractors and physiotherapists as well as osteopaths. Physiotherapists have made the same points to Opposition Members, expressing their support for and envy of the provisions envisaged for osteopaths. I sincerely hope that we shall make rapid progress in addressing those matters.
The hon. Member for Twickenham (Mr. Jessel) made an important contribution to the debate, in which he drew attention to the suffering and problems that back pain causes. Back pain is not a fringe consideration: it affects people's lives, work and ability to take part in other activities. We do not pay enough attention to that fact and I hope that, in considering "The Health of the Nation" and improvements in the national health service, we shall bear it in mind.
Before I speak glowingly of osteopaths' contribution, I have been advised to give as my definition of osteopathy that which appears in the King's Fund report, which makes clear the complementary nature of the discipline. Page 10 of the report states:Osteopathy is a system of diagnosis and treatment which lays its main emphasis on structural and mechanical problems of the body. It is not an alternative to conventional medicine but a complementary discipline which offers patients an additional treatment option for certain conditions which can affect the body's framework. In short, osteopaths are concerned with the biochemics of the body and the maintenance of proper mechanical function.This is not a debate about complementary medicine, although we urgently need such a debate, as complementary medicine should be available within the NHS.
In expressing its support for the Bill, the British Medical Association has made it clear that it recognises the regulation, education and training of osteopaths in the United Kingdom as most important and believes it to be entirely appropriate that those wishing to practise osteopathy should have to register to do so. It welcomes the establishment of such a register as a guarantee of professional conduct and integrity, which will also afford greater protection to the patient from the potential harm of treatments by unskilled and unauthorised practitioners. The BMA goes on to say that it is currently investigating the control and practice of a wide range of complementary therapies. I suggest that this House, too, should turn its attention to that matter.
A senior clinical tutor at the London College of Osteopathic Medicine tells me that Bernard Shaw performed the opening ceremony at the association's clinic in Vincent square in 1927. I shall not be giving a complete history of osteopathy—although I must say that I am surprised that the Minister omitted his grandfather from the history he gave, and I am glad that he was informed of the fact in time.
On top of his many other talents, Bernard Shaw was a health enthusiasts. Indeed, the reference in the introduc-tion to "The Doctor's Dilemma" to the doctors who were not registered by the General Medical Council but 'who were "rather more successful" than some of their registered colleagues is thought to refer to doctors of osteopathy.
Many people use osteopathy, and the Bill is intended to ensure that greater protection is afforded to them as patients. A study published in this month's British Journal of General Practice draws together some important evidence about the work of osteopaths: 1202Most of the estimated four million consultations per year in the United Kingdom for complementary medicine are for pain. There are 1,706 registered osteopaths, more than any other group of complementary therapists. Of general practitioners in England, 72 per cent. refer patients to complementary therapy, most commonly for manipulation".Some practices are already sufficiently convinced of the benefits of osteopathy to offer the service free of charge to their patients within the national health service.
Osteopathy is a little-researched adjunct to conventional primary care. It seems to me that we should be considering the role that it has to play in primary care. It is predominantly used by patients in their working years, especially those with spinal problems, which are often self-limiting. The study reported in the British Journal of General Practice suggests that three visits were usually sufficient to improve the symptoms, and that in respect of women, who attended more frequently than men, the improvement was considerably more marked.
The Bill makes no difference to the availability of osteopathy under the NHS. In considering "The Health of the Nation", we must examine the arguments—and remember the speech made by the hon. Member for Twickenham. Osteopathy has a very good success rate, particulary in relieving spinal pain. In addition to regulation and registration, we should urgently consider including osteopathy in an extended primary health care team and, in the acute sector, as part of the muscle and joint team—rheumatology, orthopaedics, physiotherapy and occupational therapy.
§ Mr. Tredinnick
Is the hon. Lady aware that a recent survey showed that, in some hospitals, it was found more effective to send patients suffering from back pain to an osteopath rather than giving them the traditional out-patient care? Does she agree that that further illustrates the effectiveness of osteopathy and tells us how important it is that it should be further integrated into the health service?
§ Ms. Primarolo
I have not seen that survey, but I agree with the hon. Gentleman that we should not neglect the skills, talents and abilities of osteopaths to deal with some types of back pain and spinal injury but should use them to the full. That would have clear benefits not only for patients but for the NHS.
The study to which I have referred shows that spinal joint strain—back problems—shows significantly better symptom improvement at four months with osteopathy than with drug therapy. We must investigate this matter further because if it is true that osteopathy is more effective, there will be bonuses to patients and the NHS alike. For instance, if, in some cases, the complementary use of osteopathy rendered drug therapy unnecessary, there would be a significant saving to the NHS drugs budget. The drug therapies prescribed are often both expensive for the NHS and traumatic for the patient. I do not suggest that the process should be automatic—merely that the possibility needs to be investigated. Moreover, if that were shown to be the case, the dreadful side effects that sometimes result from the use of drug therapies might be prevented.
There is a strong case, on the basis of prevention, health promotion and cure, for examining the role of osteopathy and the other forms of complementary medicines that are available. We agree with the Government that the Bill should have the wholehearted support of the House and that its Committee stage should proceed as quickly as 1203 possible. The Bill demonstrates the way forward for incorporating complementary medicines into the national health service—a debate which the House should have had a long time ago. I hope that after prodding from the hon. Member for Cambridgeshire, North-East we will not shirk the consideration of other complementary medicines. Again, I congratulate the hon. Gentleman on the excellent debate which he initiated this morning.
§ 12.1 pm
§ Mr. Andrew Hunter (Basingstoke)
I am glad to have the opportunity to add my voice to the supporting choir of hon. Members on both sides of the House, and many organisations and individuals outside the House, in welcoming the Bill. I add my congratulations to those already extended to my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss). I wish him well, and I wish the Bill a speedy and successful passage through the House.
The hon. Member for Rochdale (Ms. Lynne) reminded us of the lengthy process before the Bill came before us. Undoubtedly, that lengthy time is regretted. Perhaps the hon. Lady and the hon. Member for Bristol, South (Ms. Primarolo) were over-generous in not being more regretful that the Government have not found the opportunity over the years to introduce this measure and that they rely on my hon. Friend the Member for Cambridgeshire, North-East to make amends for that.
Without detracting from the applause which is rightly due to my hon. Friend, I wish to refer to one or two parts of the Bill on which it would be profitable to have a lengthy debate in Committee. I shall be selective; I am aware that other hon. Members have referred to many of the salient features of the Bill. Important business is to follow this debate, and undoubtedly one or two other hon. Members also wish to catch Mr. Deputy Speaker's eye.
I shall refer to the register and the principles of registration. Essentially, the kernel of the Bill is the establishment of a register of lawful practitioners and how such a register will be operated. I do not for one moment quarrel with the principle of the establishment of a register. I think that it is right, and I welcome it.
I share the view of my hon. Friend the Member for Cambridgeshire, North-East that it is right to enshrine two categories of registration. One category is for those practitioners who fully and immediately satisfy the qualification, experience and character requirements. It is right that there should be a category of provisional registration for practitioners who do not fully and immediately satisfy the requirements.
In an intervention to my hon. Friend I suggested that perhaps the Bill would be better if it incorporated provisional registration. I accepted my hon. Friend's reply. In an ideal world, the Bill would incorporate provisional registration, but I accept that perhaps it would be too much to ask the profession to accept that innovation initially, as well as many other innovations.
I seek further reassurance that there will be sufficient protection of the interests of patients during the two-year transitional period. Conditional registration is defined in clause 4(2)(d) which deals with practitioners who are deemed not to have spent a substantial part of their working time over a period of four or more years in the 1204 lawful, safe and competent practice of osteopathy. I doubt whether there is sufficient protection for patients while a register is being compiled in the transitional phase.
After studying the Bill carefully, I am not sure how the disciplinary measures in clauses 19 to 24 will apply during the registration period before the register is complete. If the House permits my hon. Friend to speak again in this debate, perhaps he can clarify the extent to which the regulations in clauses 19 to 24 will be applied before the register is completed.
I believe that clause 4(2)(f) requires greater clarification because it seems to hang at the end of the clause. That provision says:gives the required undertaking.In the previous 93 lines in the Bill, there is no reference to any undertaking. What is meant to be undertaken, by whom and in what circumstances? It is hard to follow that provision, and I seek clarification on it.
There is another potential conflict in the Bill. I am aware that my hon. Friend the Member for Twickenham (Mr. Jessel) urged us not to raise Committee points on Second Reading. However, we will not all have the opportunity to participate in the Committee. The potential conflict is between clauses 3 and 4 and the clause which relates to allegations of criminal conviction. Is the concept of the lawful practice of osteopathy in clauses 3 and 4 inclusive or exclusive of unlawful practice overseas? The distinction that unlawful overseas practices are included is made clear later in the Bill. Is that also the case in clauses 3 and 4?
Moving away from the question of the register and the process of registration, I should like to address the issue of post-registration training. It can be argued that the general council should give a greater statutory commitment to post-registration than the Bill provides at present. As hon. Members will know, the working party dealt with that measure in paragraph 47 on pages 28 and 29 of its report. For the sake of brevity, I will not quote the relevant sections of the report. It is available for hon. Members to read if they have not already done so.
Clearly, the working party approached the issue of post-registration training with the view that significant demands should be imposed on the council. In the course of its inquiry, the working party diluted its understanding and its demands until we have the wording in the Bill. Clause 16 would be much better if it read not that:The General Council may make rules requiring registered osteopaths to undertake further courses of trainingbut rather "shall make". The working party said that that had changed and that the efforts of the council and the education and training would be directed at raising conditional registration to full registration. That can be accommodated by introducing a time factor—by saying that the post-registration training should start after a certain length of time, following the implementation of the register. I hope that the House will re-examine the "shall" and "may" factor in clause 16.
I shall select one point from those which I intended to make about which I feel strongly. I refer to clause 19(1)(c). The allegations against a registered osteopath which will trigger the disciplinary machinery include the allegation that he has been convicted of a criminal offence. Lord Walton's Bill provided that overseas convictions should be included. This Bill is restricted to criminal convictions in 1205 the United Kingdom. In the helpful notes that my hon. Friend the Member for Cambridgeshire, North-East gave to many of us, he offers justification for that:
Given, however, the differences that exist between the United Kingdom's judicial system and those of other countries it is felt that this could prove too difficult to implement without the Professional Conduct Committee assuming the role of quasi-judicial body, which is not what it is intended to be.With great respect to my hon. Friend, I quarrel with him on this point. I can clearly envisage criminal offences committed overseas which his Bill would exclude from consideration but which would seriously affect the right of someone to practise osteopathy in Britain. Therefore, I urge that that point be reconsidered. It is in the interests of the patients, and therefore in the long-term interests of the profession, that it is reconsidered. The point which Lord Walton sought to make in his Bill should be restated in this Bill.
I stress that I warmly welcome the Bill. It is long overdue. However, I feel that there are one or two points on which we could have further profitable debate.
§ 12.9 pm
§ Mr. Moss
With leave of the House. I should like to thank hon. Members on both sides of the House for their excellent speeches in the interesting and wide-ranging, as well as long overdue, debate that we have had on this important matter. I thank the Labour and Liberal Front-Bench spokesmen for their speeches and support. I assure the hon. Member for Rochdale (Ms. Lynne) that the matters that she raised will be examined in detail in Committee. I hope that she will be a member of that Committee and bring her expert knowledge to it.
I also thank my hon. Friend the Minister for his speech and for the support of his Department. In all under takings one usually looks for a sign of the outcome. When my hon. Friend revealed his auspicious link with the osteopathic profession through his illustrious forebear, I knew that, rather than the winning post rushing forward, here was a star on the route to Bethlehem which told me that my Bill would have an easy passage through this morning's proceedings and the Committee stage. I thank my hon. Friend for all his contributions to the Bill.
I thank the sponsors of my Bill, many of whom have been present this morning. I thank my hon. Friends the Members for Bournemouth, East (Mr. Atkinson) and for Rutland and Melton (Mr. Duncan) for attending the debate. I thank my hon. Friends the Members for Falmouth and Camborne (Mr. Coe), and for Reading, West (Sir A. Durant), the hon. Member for Birkenhead (Mr. Field), my hon. Friends the Members for Woodspring (Dr. Fox), for Harlow (Mr. Hayes), for Broxbourne (Mrs. Roe), for Bolton, North-East (Mr. Thurnham) and for Bridlington (Mr. Townend) for agreeing to sponsor this important legislation.
My hon. Friend the Member for Edmonton (Dr. Twinn) rightly said that the physiotherapists were worried that they did not have a protected title—something which the Bill gives to the osteopathic profession. But I point my 1206 hon. Friend in the direction of the inadequacy of the Professions Supplementary to Medicine Act 1960, which needs some improvement. My hon. Friend the Member for Twickenham (Mr. Jesse') also referred to that Act.
My hon. Friend the Member for Twickenham also raised the important issue of value added tax on osteopaths' bills. Physiotherapists do not have to charge VAT. I was delighted that my hon. Friend attended the debate this morning. He, too, was a member of the Lords and Commons ski team in Devosse. He fell in a race with the Swiss parliamentarians and ended up in Devosse hospital. I was told that he was receiving excellent physiotherapy treatment under water. One wag in our party was heard to ask how long he had to hold his breath for that treatment.
I thank my hon. Friend the Member for Bournemouth, East for his speech. He referred to chiropractors. I assure him that the King's Fund is to report on the position of chiropractors, in the spring, we hope. There is every sign that the model that we have discussed today will be adopted for that profession.
I thank my hon. Friend the Member for Bosworth (Mr. Tredinnick). I welcomed his speech as the treasurer of the all-party parliamentary group on complementary medicine. He spoke eloquently about the progress and growing acceptance of complementary medicine, and rightly said that the Bill could be an important forerunner of legislation for other groups in the future.
My hon. Friend the Member for Stafford (Mr. Cash) is the chairman of the all-party group. He recognised the sea change in attitude among the public and in the British Medical Association to complementary medicine. I confirm that by reading from a letter from the BMA which I received the other day:The BMA supports the legislation which seeks to regulate the education and training of osteopaths in the United Kingdom. We believe it is entirely appropriate that those wishing to practise osteopathy should have to register to do so and would welcome such a register as a guarantee of professional conduct and integrity … The BMA's Board of Science and Education is currently investigating the control and practice of a wide range of complementary therapies and will produce a comprehensive report in June 1993.So my hon. Friend was right to point out that there has been a dramatic change in the attitude of the medical profession.
My hon. Friend the Member for Basingstoke (Mr. Hunter) made a detailed speech. I am mindful of all the issues that he raised. I assure him that if he tables amendments on the points that he made, they will be considered carefully in Committee.
Judging from the speeches of support that have been made today, it appears that the Bill will achieve its Second Reading. That is testimony to the tremendous efforts of many people associated with the osteopathic profession over many years. If congratulations are in order, it is entirely due to them.
§ Question put and agreed to.
§ Bill accordingly read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 61 (Committal of Bills).