RESTORATION TO THE REGISTER OF OSTEOPATHS WHO HAVE BEEN STRUCK OFF (Hansard, 7 May 1993)

§ Mr. Moss
I beg to move amendment No. 4, in page 7, line 19, leave out 'any' and insert 'an'.

§ Mr. Deputy Speaker
With this it will be convenient to take the following amendments: No. 14, in clause 14, page 11, line 16, leave out 'reaching' and insert 'having reached'.

§ Mr. Moss
The group of what might first appear to be small drafting amendments contains two matters of substance. Amendment No. 4 is a simple drafting amendment, but amendment No. 14 will ensure that the same criteria would be applied for the recognition of non-United Kingdom qualifications, other than those covered by Community law, as will be used for the recognition of United Kingdom qualifications.
Similar amendments were made in Committee in respect of United Kingdom qualifications, but it seems that this one slipped through the net. The House has already heard that the registration system proposed in the Bill will ultimately centre on whether or not a practitioner holds a recognised qualification, which equips him or her with the education, training and skills required for the safe and competent practice of osteopathy.
Clause 14 provides the mechanism for recognising the qualifications that meet that standard. Provision is made in clause 16 for withdrawing recognition if that standard is no longer met or the institution involved fails to comply with the conditions attached to the continued recognition of its qualifications. I shall say more about the conditions later.
In Committee, I described how the wording evidence of reaching the required standard of proficiency was a little too tight, as it demanded that a qualification would have to hit the mark when the application for recognition was being considered. It did not enable a qualification that had previously been met and was meeting the required standard when it was awarded to the osteopath to be recognised if it no longer met the standard or was, perhaps, no longer being awarded. The amendment will extend the same flexibility as is now provided for United Kingdom qualifications to non-United Kingdom qualifications.
Decisions on whether a qualification provides evidence that someone had reached the required standard of proficiency laid down by the general council under clause 13 for the safe and competent practice of ostoepaths—and so should be recognised for the purposes of registration —will initially be made by the education committee. If it 406 is satisfied that the qualification provides such evidence, it will recommend to the general council that the qualification should be a recognised qualification.
In keeping with the practice adopted by schemes governing other health care professions that operate a similar system of recognition, the general council will seek the approval of the Privy Council for the qualification to be recognised. To assist the education committee in that task, clause 12 enables the committee to appoint visitors, who are almost certain to constitute the principal means by which the education committee obtains information on the nature and quality of instruction given by an institution. In turn, that will provide the basis on which the committee can recommend to the general council whether a qualification should be recognised.
While it is envisaged that judgment on the adequacy of overseas qualifications would normally be made on the basis of information supplied by the institution rather than by means of an overseas visit, clause 12 was amended in Committee to remove the previous limitation restricting the scope of those visits to those institutions in the United Kingdom.
Amendment No. 16 provides an osteopath making an application to the health committee for a conditions of practice or suspension order, made under clause 23, to be reviewed, with the right to a hearing. As we have already discussed this morning, the health committee will form an important part of the statutory scheme's fitness-to-practise machinery. Its function is to investigate allegations made against an osteopath that his or her ability to practise is seriously impaired because of physical or mental health and consequently poses a threat to the safety and well-being of his or her patients.
Unlike its sister committee, the professional conduct committee, the health committee's role is not disciplinary. Instead, it ensures that proper and adequate safeguards are provided for patients. For that reason, the health committee will be required to ensure that any action that it takes in terms of suspending an osteopath's registration or imposing conditions on his or her continued practice has to be proportional to the risk that he or she is considered to represent to his or her patients. As the committee's function is not disciplinary, it will have no powers of erasure.
The Bill also makes provision to ensure that the osteopath is provided with the full details of the allegation made against him or her and given the opportunity to state his or her case at a hearing at which he or her—sorry, he or she—may be legally represented if he or she should so chooses. I think that I shall just stick to "he" as it will be more simple—although I may be picked up by my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland).

§ Sir Nicholas Bonsor
My hon. Friend will note that, despite the best efforts of the feminists, "he" still includes "she" for the purposes of legal definition.

§ Mr. Moss
I am extremely grateful to my hon. Friend for his direction.

§ Lady Olga Maitland
May I reassure my hon. Friend that I have no feminist angst about the use of "he" or "she"? I do not believe in butchering the English language, and think that it is appropriate at times to use the generic term. "He" will suffice very nicely here.

§ Mr. Moss
The Bill also makes provision to ensure that the osteopath is provided with full details of the allegation against him and is given an opportunity to state his case at a hearing, at which he may be legally represented if he so chooses, as well as the right of appeal to the appeal tribunal against decisions of the health committee. The Bill also provides an opportunity for the osteopath to make an application to the health committee once a year for the order made against him to be reviewed. As drafted, the Bill does not provide the osteopath with an opportunity to put his case at a hearing before the health committee comes to a decision on such an application.
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It has never been our intention to deprive the osteopath of this opportunity. Such an intention would run contrary to the spirit of natural justice, one of the key principles on which the scheme is to be founded. The amendment therefore extends the practitioner' rights to a hearing to include such applications, thereby ensuring that the workings of the health committee will be open and fair, in theory and in practice.

§ Mr. Quentin Davies
Before my hon. Friend leaves the subject, will he give the House some examples of the sort of offences for which he considers removal from the register appropriate? Does he believe that it is the likely intention of the council—I say "likely", because it does not yet exist—to incorporate the sort of moral and non-clinical offences that the BMA has in the past considered grounds for disbarring doctors?

§ Mr. Moss
We are talking about the health committee at the moment. I have already said that it is not a disciplinary body—it has no powers of erasure from the register. The other "fitness to practise" committees, particularly the professional conduct committee, have powers to erase from the register if, at a hearing, an osteopath is found to have broken the rules. He can therefore be removed from the register. He can reapply at some stage in the future, but conditions may he set governing the standards of proficiency that he needs to meet to re-enter the register.
Amendments Nos. 26 and 27 provide me with an opportunity to remind the House of the important role that the Privy Council will play in the operation of the statutory scheme. In keeping with the other statutory schemes governing health professions, the work of the General Osteopathic Council and its four statutory committees will be overseen by the Privy Council. One of the Privy Council's key functions will be to approve the rules drawn up by the general council.
These rules will cover the entire range of the general council's responsibilities, including registration, post-registration training and the procedural rules of the four statutory committees. When we come to look at the schedule, especially the provisions for establishing the first General Osteopathic Council, we shall see other ways in which the Privy Council will be involved in the scheme.
Clause 33 provides for the Privy Council to be granted default powers to enable it to direct the General Osteopathic Council to perform any function under the Act that the Privy Council considers the general council should have done but has failed to do. If the general council refused to respond to this direction, the Privy 408 Council would he empowered to step in and take over the functions of the general council and do anything that the latter could have done under the Act.
The Privy Council possesses default powers similar to those under the statutory schemes of other health professions. To set these key provisions in context, I should add that there are no known cases of the Privy Council having had to exercise its default powers in relation to a statutory scheme. Although the osteopaths can take pride in being first in respect of a number of new ideas in the area of statutory regulation, I am confident that this is one first which they have no intention of trying to achieve.

§ Mr. John Bowis (Battersea)
I do not intend to enter the discussion of "he" and "she". I am happy to accept the learned definition offered by my hon. Friend the Member for Upminster (Sir N. Bonsor). I have always believed that "she who must be obeyed" goes back to Rider Haggard, reiterated by Bernard Shaw in "Getting Married"—but for today we will stick to the legal definition.
I want to ask for some reassurance and, I hope, support from my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss). Unlike my hon. Friend the Member for Stamford and Spalding (Mr. Davies), I have no parental examples to offer, but some of my constituents are training to become osteopaths, and they have asked me about the recognition of qualifications with particular reference to training grants.
The British School of Osteopathy, which I imagine offers the sort of qualifications to which the amendments refer, attracts students from around the country. Those students receive grants from local education authorities, but not full grants. The fees alone are about £5,000, but my constituents get grants of between £600 and £700, leaving them a great deal of money to find so that they can qualify and met the high standards which the Bill rightly seeks to establish.
I hope that my hon. Friend has managed to obtain reassurances from the Government on this score. The issue partly comes under the responsibilities of the Department for Education and certain other Departments of State. I hope that my hon. Friend will join me in pressing for recognition of such qualifications for eligibility for full and mandatory grants. I hope that these courses will be recognised under the new law and that mandatory awards will be given for them.

§ Lady Olga Maitland
I support this group of amendments and I wish to draw attention to the importance of ensuring that overseas applicants to join the osteopathic profession maintain our standards of professionalism. It has become abundantly evident that there is a wide variation in training standards. A properly qualified osteopath has to undergo four years' training, which hardly compares with the gentleman who decides to set himself up with no experience but with a sign outside the door. We do not want to return to the days when a dentist's sole claim to expertise rested on the fact that he pulled teeth.
Professional standards are important. Those with overseas experience may well reach our standards, but we need to be certain that they conform to the rigorous criteria to be imposed by the newly formed osteopathic governing bodies.

§ Sir Nicholas Bonsor
I endorse the remarks of my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland). I myself tabled an amendment which was not selected but which had to do with practitioners' ability to speak our native language. [Interruption.] I hear some tut-tutting from the Labour Front Bench. It is astonishing that the Labour party should wish to put into our medical profession people who cannot communicate properly with our patients. It is amazing that such crass stupidity can form part of Labour party policy—

§ Ms Primarolo
If the hon. Gentleman has read the Bill he will know that it contains regulations and conditions which apply to osteopaths the same standards of education and training as are applied to all the medical professions in this country. So his comments about communicating in the same language are misplaced and irrelevant to the debate. That is why I tut-tutted.

§ Sir Nicholas Bonsor
I am sorry that I gave way—

§ Mr. Deputy Speaker
Order. The hon. Gentleman's amendment was ruled out of order, so he cannot now speak to it.

§ Sir Nicholas Bonsor
I would not dream of speaking to my amendment, Mr. Deputy Speaker. I was merely enlarging on my hon. Friend's remarks about practitioners' general qualifications. And it is certainly a matter of great concern that many people who practise medicine in this country cannot communicate with their patients. The Government should turn their attention to that.

§ Lady Olga Maitland
Does my hon. Friend agree that fluent English is vital for the successful outcome of treatment and that misunderstandings often arise because of poor communication between practitioner and patient?

§ Sir Nicholas Bonsor
I whole-heartedly agree. No one can prescribe the right treatment if he cannot understand what the patient is telling him about his ailment. As my hon. Friend says, it is regrettable that all too often that is the case. I hope that the Bill will contain some provision to control standards of education in the profession.
Unless I have misunderstood the Bill, the method of getting to a disciplinary hearing seems rather clumsy. Clause 23 says that the health committee shall take certain action on allegations referred to it under section 20. Section 20 sets out the allegations which will lead to disciplinary action by the general council. It states: This section applies where any allegation is made against a registered osteopath to the effect that—

(a) he has been guilty of conduct which falls short of the standard required by a registered osteopath;

(b) he has been guilty of professional incompetence;

(c) he has been convicted (at any time) in the United Kingdom of a criminal offence".
I am glad to say that elsewhere in the Bill that is limited to a relevant criminal offence.
A complaint under those headings may be made not to the investigations committee or to the professional conduct committee, but to the health committee. According to clause 23, the health committee can then take certain actions including the possible suspension of the osteopath, and I presume that it would then refer the matter to the investigations committee or the professional conduct committee for action. I am puzzled about why such a roundabout route should be adopted and why allegations under section 20 should not be made directly to those who will deal with them.

§ Mr. Moss
My hon. Friend the Member for Battersea (Mr. Bowis) asked about student funding. I understand that in the past the profession made continuous representations about the sort of student funding that my hon. Friend mentions. Unfortunately, to date the answer has been a firm no. However, more recent approaches have elicited a different response and the profession has been told that if it regulates itself under some sort of statutory regime its request will be viewed more favourably.
The osteopaths have organised and pressed for a statutory regulation system. I wish them every success, when that has been achieved, in approaching the Department for proper funding for students, many of whom follow four-year degree courses. One of the colleges was mentioned by my hon. Friend the Member for Battersea, but there are others. The level of qualification is high and every encouragement should be given by the system to enable more and more students to qualify at the highest level.
My hon. Friend the Member for Upminster (Sir N. Bonsor) spoke about the tortuous route for complaints. Allegations about health matters can be made by patients or by a fellow professional. The personal problem of the osteopath's health may have a bearing on whether he can carry out his job to the required level.

§ Sir Nicholas Bonsor
Section 20 lists other less personal and perhaps equally significant matters which bear on whether the osteopath can properly practise. A conviction for a criminal offence is mentioned, and I do not see why that should go through the health committee.

§ Mr. Moss
I do not think that it does. Clause 20 requires only allegations about an osteopath's health to be referred to the health committee. Other allegations will not be directed along that route. The investigations committee acts to ensure that there is a case to answer and that the health committee is not being asked to look at cases that are outside its powers.