THE GENERAL COUNCIL AND COMMITTEES (Hansard, 7 May 1993)

HC Deb 07 May 1993 vol 224 cc440-50 440

§ Amendment proposed: No. 32, in page 30, line 14, leave out paragraph 4 and insert—

'4.—(1) This paragraph applies where a member fails to complete his full term of office.
(2) In such circumstances as may be prescribed, if the unexpired term is less than the prescribed period the vacancy need not be filled before the end of that term.
(3) If the member's successor is elected or (as the case may be) appointed during the unexpired term, the successor's term of office shall, subject to paragraphs 5 to 7, be for the residue of the unexpired term.
(4) Rules made by the General Council under sub-paragraph (2) shall not prescribe a period of more than twelve months.
(5) In this paragraph "the unexpired term" means the period beginning with the date on which the member ceased to be a member and ending with the date on which his full term of office would have expired.'.—[Mr. Moss.]

§ Mr. Deputy Speaker
With this it will be convenient to discuss the following amendments: No. 33, in page 30, line 28, after 'osteopath' insert 'at the time of his election'.

§ No. 34, in page 30, leave out line 30.

§ No. 35, in page 31, line 9, leave out sub-paragraph (2).

§ No. 36, in page 31, line 13, after 'practitioner' insert 'at the time of his appointment and shall be'.

§ No. 37, in page 31, line 14, leave out 'Standing'.

§ No. 38, in page 31, line 16, after 'osteopaths' insert 'at the time of their appointment'.

§ No. 39, in page 31, line 25, leave out from 'Committee' to 'training', in line 26 and insert 'to be qualified to advise the General Council on matters relating to education and'.

§ No. 40, in page 31, line 28, leave out from 'consult' to end of line 29 and insert—

(a) those institutions in the United Kingdom by which or under whose direction any relevant course of study is given; and
(b) such other bodies (if any) as the Education Committee considers appropriate.

§ (3) In this paragraph "relevant course of study" has the same meaning as in section 12(2).'.

§ No. 41, in page 31, line 32, leave out 'experienced in the provision of medical education' and insert 'qualified to advise the General Council on matters relating to professional education'.

§ No. 42, in page 34, line 21, leave out sub-paragraphs (3) and (4) and insert— '(3) Where the Chairman of the Committee is prevented by sub-paragraph (1) or (2) from taking part in an appointment the appointment shall be made in accordance with rules made by the General Council.'.

§ No. 43, in page 35, line 22, after 'practitioner' insert 'at the time of his appointment'.

§ No. 44, in page 35, line 33, leave out from '5' to end of line 36 and insert 'none of whom need be registered medical practitioners but at least 3 of whom shall be members of the General Council.'.

§ Mr. Quentin Davies
I shall try to be brief and not detain the House for too long. I am slightly concerned about two of these amendments, Nos. 40 and 44. Paragraph 12(2) of the schedule states: Before making any such appointment, the Committee shall consult those institutions in the United Kingdom which award recognised qualifications. Amendment No. 40 would leave out from "consult" and insert: (a) those institutions in the United Kingdom by which or under whose direction any relevant course of study is given; Both the amendment and the original text refer purely to institutions in the United Kingdom. However, earlier in our debates we recognised that provision had been made for osteopaths qualified elsewhere in the European Community, under Community law, to practise in this country.
It might both benefit the profession and enable it to comply with those aspects of Community law that 442 establish a basis for persons to practise their professions in different Community countries if practitioners from other Community countries were appointed to the general council or if appointments were made to the education committee of members of bodies concerned with the training of osteopaths in other Community countries, whose graduates may exercise their right to practise in this country. It is slightly dubious that we should attempt, by means of the Bill, for all time to exclude the possibility of making appointments from institutions outside the United Kingdom.
I have difficulty in following the logic of amendment No. 44. It appears to provide that the quorum of the health committee should not include a registered medical practitioner. According to paragraph 38 of the schedule, a registered medical practitioner has to be a member of the health committee. However, amendment No. 44 explicitly provides that a registered medical practitioner does not have to be a member of the quorum. Decisions can, therefore, be taken by the health committee without the presence of a registered medical practitioner.
I presume that the purpose of providing for a registered medical practitioner to sit on the health committee is to ensure that a doctor can contribute to the decision on whether somebody's physical or mental health makes it impossible for that person to exercise the profession of osteopath. What is the point of providing by statute for a registered medical practitioner to be a member of the health committee and also providing that he does not have to be a member of the quorum?
The non-medical members of the committee could therefore form a quorum and reach a decision on the medical fitness of an individual to continue to practise as an osteopath without a registered medical practitioner being present and without, therefore, there being any professional medical input into what is effectively a clinical decision by the health committee.

§ Mr. Sackville
I am grateful to my hon. Friend for upholding the rights and privileges of the medical profession, but I am sure that the chairman of the medical committee will be able to decide who should attend what meetings, and when.
My hon. Friend's point about Europe sounds dangerously federalist. In general, though, I think that it is time that we sent the Bill to another place.

§ Amendment agreed to.

§ Amendments made:

§ No. 33, in page 30, line 28, after 'osteopath' insert 'at the time of his election'.

§ No. 34, in page 30, leave out line 30.

§ No. 35, in page 31, line 9, leave out sub-paragraph (2).

§ No. 36, in page 31, line 13, after 'practitioner' insert 'at the time of his appointment and shall be'.

§ No. 37, in page 31, line 14, leave out 'Standing'.

§ No. 38, in page 31, line 16, after 'osteopaths' insert 'at the time of their appointment'.

§ No. 39, in page 31, line 25, leave out from 'Committee' to 'training', in line 26 and insert 'to be qualified to advise the General Council on matters relating to education and'.

§ No. 40, in page 31, line 28, leave out from 'consult' to end of line 29 and insert'—

(a) those institutions in the United Kingdom by which or under whose direction any relevant course of study is given; and
(b) such other bodies (if any) as the Education Committee considers appropriate.

443

§ (3) In this paragraph "relevant course of study" has the same meaning as in section 12(2).'.

§ No. 41, in page 31, line 32, leave out 'experienced in the provision of medical education' and insert 'qualified to advise the General Council on matters relating to professional education'.

§ No. 43, in page 35, line 22, after 'practitioner' insert 'at the time of his appointment'.

§ Order for Third Reading read.

§ Motion made, and Question proposed, That the Bill be now read the Third time.—[Mr. Moss.]

12.38 pm

§ Mr. Sackville
I congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on having brought what I believe to be the largest private Member's Bill in Parliament's history—I hesitate to say that, given the long history of this Parliament—to a successful conclusion. The Department of Health, which occasionally responded to requests for help in drafting the Bill, supports it. The Bill also reflects the input of 10 Government Departments. The fact that my hon. Friend looks so healthy at the end of all this is a tribute to his resilience.
This is a robust piece of legislation, which weaves through a large number of provisions and policies. It has been carefully considered by the House and has been amended in fairly fine detail. The Government therefore commend the Bill as a finished product, and we are glad to send it in that form to another place.

12.39 pm

§ Ms Primarolo
I am delighted that we have almost reached the end of our considerations of this excellent Bill, which began its progress through the House with all-party support. Many people outside the House will understand why it takes so long to discuss other pieces of legislation in view of the time that it has taken us to consider a Bill on which initially we apparently all agreed.
I absolutely agree with the Minister. I hope that we have the finished product before us and that it will complete its remaining stages speedily. The Bill builds on the excellent King's Fund report on over 50 years' experience in osteopathy, and it has the support of the British Medical Association and, not least, the support of patients and patient organisations. There are 4 million-plus consultations for back pain every year and the overwhelming majority of those involve osteopaths.
If further recommendation for the Bill is needed, hon. Members should consider the report produced by NAHAT, the National Association of Health Authorities and Trusts. The report clearly demonstrates that patients not only have a desire to use osteopaths and complementary medicines, but are using them, that GPs wish to use those services, that health authorities wish to 444 commission those services and that the medical profession recognises the importance of the contribution of osteopathy and of complementary medicines.
The NAHAT report recommends that those services should be available within the national health service. Therefore, I hope not only that the Bill will rapidly reach the statute book, but that it will be the first in a series of Bills to regulate complementary medicines and to ensure that patients are protected, that they have access to properly qualified professionals and that our health service is offering the full range of available medical treatments.
I congratulate the hon. Member for Cambridgeshire, North-East (Mr. Moss) on his patience and on his dedication in getting the Bill through. I sincerely hope that the slight delay in progress because of the thoroughness of our consideration this morning has not marred his experience of promoting the Bill, and that he may later even consider a Bill to regulate homoeopathy.

12.42 pm

§ Mr. Michael Jopling (Westmorland and Lonsdale)
I am glad to have the opportunity to speak on Third Reading because of a situation in my constituency about which I have recently received a number of letters, to which I wish to draw the Minister's attention. It is important to know how the situation in my constituency will be affected by the Bill, because it is causing a good deal of concern.
I, too, congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on his good fortune in the ballot, on his wisdom in selecting this subject for legislation and on his skill in promoting the Bill. I wish him well and I wish the Bill well. I welcome the Bill, although I have some reservations about osteopaths. I know that there are differing views about them. Some think that they are God's gift and some take the opposite view. My inclination is to take the opposite view. I have been to an osteopath only once, and I wish that I had never done so.
While canvassing during the general election of 1964, in which I was first elected to the House, I unfortunately fell heavily on a pavement and suffered acute pain in my back from that moment on. After I had put up with the pain for about a week, someone told me that I should go to an osteopath, and told me where I could find a good one.
Before my hon. Friend introduced measures requiring codes of practice and procedures to check osteopaths' fitness to practice, the greatest accolade accorded to a London osteopath was, "All the ballet dancers go to him or her"; for those in the north, where I live, it was, "All the jockeys go to him or her." I was directed to an osteopath to whom, apparently, all the jockeys went.
The man looked at my back. He felt it, prodded it and twisted me this way and that. Then he said, "I can feel it; you have upset a bone in your back. You have slipped a disc. As you are in the middle of an election campaign, you must wrap cotton wool tightly around the small of your back to keep the heat in. Come back in a week." When I returned in a week, he took all the cotton wool off my back and said, "That's funny—it has come out in a rash. I suppose that it is the badness coming out." I did not quite know what he meant, but I was in a state of total agony, which late at night was relieved only by copious amounts of Scotch whisky.
445 After the osteopath had twisted me around a second time in return for a large fee, I put up with the final week of the election campaign. Then came polling day, when, mercifully, I was elected to the House for the first time. The very next day, I happened to see a doctor, and asked him if he would be kind enough to look at my back. He said, "Why—what is wrong with it?" I told him that I had been in agony for the past two and a half weeks after falling on it. "Let me look at it," he said.
I took off my shirt and removed all the wrappings, exposing the nasty rash which was still on my back. The doctor said, "How long have you had shingles?" I had had shingles all the time that I had been going to that ridiculous osteopath. Ever since then, I have had a very warped view of osteopaths.
Let me turn to a serious issue raised by an osteopath with a very good reputation—not the one I visited; I should add that that one did not work in my constituency. This osteopath, Mr. Sutton, wrote to me from Windermere to draw my attention to a worthwhile scheme that has operated there for the past 15 months. Osteopathic treatment on the national health service is being offered at the local health centre.
I gather that the scheme has been tremendously successful and that 90 of the 120 patients treated in the first 12 months experienced an improvement of more than 80 per cent. That is an impressive result. Mr. Sutton's patients are selected by their GPs, the criterion being that they have not the means to see him privately.
It appears—I want the Minister to pay particular attention here—that, after 30 June this year, the service will have to stop. That is causing great concern to doctors, to Mr. Sutton himself and, most important, to the patients, who are particularly disappointed. I have had a letter from an extremely well-known doctor in Windermere, Dr. Oakden, drawing my attention to the scheme. He tells me that everyone thought that it was a most enlightened step when the Cumbria family health services authority made funds available under the health promotion scheme for the establishment of the clinic, which is an innovation in Cumbria and, I suspect, elsewhere.
Dr. Oakden tells me that the clinic has been a great success, is used by all the doctors practising in Windermere and has significantly reduced the number of patients needing referral to hospital services for physiotherapy and/or the opinion of a consultant orthopaedic surgeon. It would appear that the scheme therefore represents good value for money for the national health service, too. Dr. Oakden tells me that it may be possible to continue with the clinics, under the arrangements for transitional payments, until April 1994, but that the family health services authority has already told him that it will be unable to find funds thereafter. Dr. Oakden feels that that would be a very great shame.
Dr. Oakden very much endorses Mr. Sutton's request to me for my assistance, which is why I am raising the matter in the House. I want the Minister to give me some indication of how he may be able to help this novel service in the light of a Bill that endorses the competence and public stature of osteopathy—which, as I said, I warmly welcome—

446

§ Mr. Sackville
My right hon. Friend is telling us about the provision of osteopathy in a particular area. I shall look into the matter, but it has precious little to do with the Bill, which is about the regulation and recognition of the profession. There is a certain cross-over, but, in essence, my right hon. Friend is talking about choices made by local health authorities or family health services, authorities about the provision of osteopathy in a particular area.

§ Mr. Jopling
I understand that, and I am grateful for the Minister's comment. When the Bill reaches the statute book—as we all hope it will—it will mean a greater recognition of the competence of osteopaths and, as a direct consequence, there will be much more demand for such services within the national health service. I am glad to see the Minister nodding.
I have had a response from the Cumbria family health services authority, with which I had taken up the issue. The authority tells me that, when the Government introduced the general practitioner contract in 1990, part of that contract allowed for the development of health promotion activity in general practice. Included under the umbrella of health promotion activity was a degree of flexibility, allowing general practitioners and the family health services authorities to develop services which, in the widest sense, could be classed as health promotion, as well as more usually accepted activities such as screening and the prevention of heart disease.
In 1991, the family health services authority was approached by the Windermere practitioners who proposed the plan. Everyone, including the FHSA, understands how effective it can be. The FHSA has pointed out that the Department of Health, in consultation with the professions, has decided that health promotion in general practice should be refocused to emphasise the aspirations set out in the White Paper "The Health of the Nation".
In agreement with the British Medical Association and other representative bodies, the Department has proposed a new system of remuneration for health promotion activity which aims to remunerate practices for providing programmes designed to lower the incidence of heart disease and strokes in the community.
If, as a consequence of the Bill, we find a much greater demand for the services of osteopaths, it is important that the Department of Health and the FHSAs recognise that many worthwhile projects, including the project in Windermere to which I have referred, should develop in the future.
To that end, I hope that my hon. Friend the Minister will consider the situation that I have explained to him. I will send him the correspondence, as I heard only a few days ago from the FHSA. I am most grateful to my hon. Friend the Minister for offering to look into the matter, because this is an exciting new way in which the services of osteopaths can be made available. I commend the experience in my constituency to the House and to the Minister. I hope that those services will not have to be closed down as a result of Government policy, as it affects the way in which FHSAs carry out their business.
On that note, I am delighted to endorse the Bill and to wish it well.

447 12.56 pm

§ Lady Olga Maitland
I warmly congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on steering the Bill through to the statute book. His tremendous effort will be justified by the results.
I want also to congratulate the King's Fund on its report on osteopathy, which helped to set the Bill on the road. The inquiry was chaired so ably by Sir Thomas Bingham and was given a tremendous kick start by the Prince of Wales, who has never made a secret of his temendous faith and belief in the efficacy of osteopathy. Indeed, he sought osteopathic treatment for his broken arm.
The Prince of Wales is well aware of the effect of crippling pain. In 1979, crippling pain led to the loss of 11.5 million working days. More recent figures show that 230,000 people are off work every working day of the year as a result of back pain.
It has always been a tragedy in the past that patients would hobble in agony to the doctor, then waste valuable time before it occurred to them to go to an osteopath. Three sessions with an osteopath could have cured misery which more conventional medicines were unable to help or relieve.
The Bill is long overdue. There have been six attempts since 1931 to introduce legislation on the matter. The last attempt was in December 1991, when Lord Walton of Detchant introduced a Bill in the other place. It was significant that he was so effective, because he is a past president of the General Medical Council. The General Medical Council's support for the osteopathy profession is a sign of the enormous step that it has taken towards general acceptance. Therefore, the Bill marks a coming of age.
There has been debate about the use of the terms "complementary medicine" and "alternative medicine". Now it is clear that osteopathy is truly complementary to conventional medicine. No longer will it be regarded as a fringe source of help. It will truly be part of the mainstream of the medical world. It is significant that more and more GPs refer patients to osteopaths. That is certainly a tremendous improvement on what happened in the past, when a GP would stand almost in pain of professional death if he dared to recommend a patient to another medical profession.
I sought advice from osteopaths in my constituency. They are enthusiastic about the Bill. My right hon. Friend the Member for Westmorland and Lonsdale (Mr. Jopling) referred to an osteopath in his constituency.

§ Mr. Jopling
He was a disaster.

§ Lady Olga Maitland
There was another osteopath in my right hon. Friend's constituency. I am not talking about the one who was a disaster.
I spoke to Mr. Midgley in my constituency. He made some relevant points about the Bill, and said that at long last there will be real regulation and standards. He felt very keenly that rogue professionals could attempt some very delicate work and either misdiagnose or create general harm
Osteopathy is the mechanical treatment of the body. It concentrates on the manipulation of sensitive joints and tendons. Enormous damage can be done if a practitioner 448 is poorly trained or, indeed, untrained. Severe manipulation can result in spinal fractures or even paralysis. That applies in particular to people who suffer from osteoporosis or thinning of the bones.
Similarly, it was pointed out to me that someone suffering from secondary cancers, for example, would suffer if the osteopath were unable to read X-rays. By reading X-rays, an osteopath is able to pick up abnormalities and make recommendations to other forms of medicine. It is terrifying that some osteopaths have abused their patients' trust. Thanks to the enormous work that has gone into the Bill, there will be rigorous standards and a proper register, which will eliminate the dark horses.
It is very interesting that not only have general practitioners accepted the importance of osteopaths but budget-holding GPs have made advances in using osteopathic services. Non-budget-holding GPs may employ the services of an osteopath, particularly if the family health services authority agrees. It is very much a matter of professional judgment.
There are now more than 2,000 practitioners of osteopathy, and the number is increasing. The number advertising their services in my area in Sutton, which covers the whole of south-west London, runs to nearly three pages in the "Yellow Pages". It is estimated that more than 100,000 people seek osteopathic advice each week. The success rate is worth taking into account. In 1989, a MORI poll revealed that 83 per cent. of users were satisfied with their treatment. As the number of osteopaths and their patients increases, the need for consumers to be protected by statutory regulation will increase, as will the satisfaction rate.
The Bill is welcome, because at present any person can set himself up with just a notice on the door. Now the suitability of osteopaths will be carefully examined, and they will have to undergo rigorous training, as we discussed in considerable detail earlier. That is important. The law of negligence insists that osteopaths should be fit and competent and it places on them a duty of care. In the absence of an accepted level of training, it is not clear what the accepted standards are. It is important that we get the standards absolutely right.
There are nine voluntary bodies that osteopaths can join. The principal organisation is the general council and the register of osteopaths, which has about 1,400 members. However, as the Bingham report said, those bodies have no effective sanctions to enforce minimum standards of education, training or competence. That is why I commend the Bill on putting all those matters right.
The Bill also breaks new ground in professional registration by taking powers to suspend osteopaths immediately when the public are thought to be at risk. It also provides the power to impose conditions so that the right people can re-enter the profession after a period of suspension, provided that they have reached the appropriate standards.
Mention was made of the relief given to back pain sufferers and many other patients by osteopaths. I wish to make one special plea. We have broken important new ground. The time has come to give the profession support in providing research facilities. Research into osteopathy has largely been ignored over the years, simply because the practitioners never had the resources to undertake serious research. Research was always done by rule of thumb. I feel that medical research and resources for it will be forthcoming now that the osteopathic profession is fully 449 recognised and part of the main stream. If the profession is to develop with the energy, enterprise and innovation that it has shown so far, it needs that extra back-up.
I believe that the Bill will set osteopaths new horizons and a new future. I join all hon. Members in commending the path of the Bill so far. I wish it good luck in another place.

§ 1.7 pm

§ Mr. Quentin Davies
My hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) has received some glowing compliments during the debate from hon. Members, including the Minister and the hon. Member for Bristol, South (Ms Primarolo), who speaks for the Opposition. He thoroughly deserves all of them. The hon. Member for Bristol, South expressed the fear that the questioning to which my hon. Friend was subjected this morning might have, to use her phrase, "marred the experience" for him. I thought, rather the reverse.
The great ability with which my hon. Friend dealt with all the questions this morning will have even further enhanced his standing and reputation as a great expert in this field. He showed great dexterity in handling the House. The Bill will be a considerable personal achievement for him and one for which he will be remembered by the profession and its patients for a long time.
In the proceedings on Report I expressed a few pesonal reservations about detailed aspects of the Bill. However, I welcome the Bill. It addresses the essential problem of the lack of credibility which osteopaths have suffered in the past. It has been impossible for the public to distinguish between competent and incompetent osteopaths. There have been too many stories of the type which my right hon. Friend the Member for Westmorland and Lonsdale (Mr. Jopling) told us earlier.
I have no doubt that a clearly defined register of osteopaths and clearly established standards on their qualification, training and education will greatly enhance the credibility of that profession. Those changes will also make it much easier for medical practitioners to refer their patients to osteopaths because they will know that those osteopaths are registered and qualified. There will be no ambiguity about that. That may even make it easier for fund-holding practices to contract with osteopaths under the Government's new rules. It has already been suggested that that may become an ever more frequent practice in the future. Those changes will, above all, greatly increase the confidence of patients when they put themselves in the hands of osteopaths.
A Bill that serves, at the same time, the interests of patients, practitioners of osteopathy and the good health of the nation represents a useful day's work. I add my tributes to those paid to my hon. Friend the Member for Cambridgeshire, North-East for having made that possible.

1.10 pm

§ Sir Nicholas Bonsor
I do not intend to delay the House, but I could not resist the temptation to add my voice to those who have expressed their admiration for the work 450 done by my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss), who specifically asked me not to do so. The temptation, therefore, became irresistible.
The Bill is a superb example of how a private Member's Bill should be run. As my hon. Friend the Minister has said, it is a complicated Bill and one which does not come directly within the knowledge of my hon. Friend.

§ Mr. Moss
It does now.

§ Sir Nicholas Bonsor
After Committee and Report, my hon. Friend has certainly mastered this complex issue. The Bill will greatly enhance the standing of the osteopathy profession and that of my hon. Friend.
In Committee and on Report, we have considered the clauses in great detail. I do not need to go over the ground that we have covered, but I have one word of caution in my general welcome to the Bill. We have given the general council an enormous amount of discretion, more discretion than I should like, as was apparent from my earlier remarks.
I hope that the confidence that the House has expressed about the ability of those who will serve on the general council to fulfil the onerous duties that are being put on them, will be fully justified. I wish them well, and I hope that the profession of osteopathy will thrive. I have personal experience of osteopaths and I know that, for several more years at least, I shall have dire need of one. I hope that the profession will benefit from what we have done today.

1.12 pm

§ Mr. Moss
I am most grateful for the kind comments of my hon. Friends and those of the hon. Member for Bristol, South (Ms Primarolo), who served on the Committee. I thank the hon. Lady and our absent friends from the Liberal Democrats who gave the Bill all-party support at all stages.
I do not wish to detain the House, because I know that other hon. Members are itching to deliberate on the Hedgerows Bill. I feel that I have been dragged through several, such has been the detailed examination of the Bill that I have had to endure this morning. It has, however, been to good effect.
I extend my thanks to the King's Fund working party for providing the framework for the Bill. It is a tribute to its dedication and firmness. I also extend my thanks to the osteopathic profession for its encouragement. I should also like to thank my right hon. Friend the Leader of the House, who, in his previous capacity as Secretary of State for Health, was instrumental in making it possible for the profession to take matters forward.
I congratulate those who served on the Committee, and I thank them for their efforts. I pay tribute to Simon Fielding for his personal commitment and dedication in seeking to acquire statutory regulations for his profession. I also thank officials of the Department of Health, whose contributions have been invaluable.
I wish the Bill a speedy passage through the other place, where Lord Walton has agreed to take it on. I hope that their Lordships do not wish to amend the Bill, which has already been amended and has 42 clauses. I think that we have done the job properly, and I look forward to the Bill receiving Royal Assent.

§ Question put and agreed to.

§ Bill read the Third time, and passed.