HC Deb 06 May 1994 vol 242 cc938-57
Mr. Deputy Speaker (Mr. Michael Morris)

We now come to amendment No. 9, with which it will be convenient to take amendment No. 8. I call Mr. Spring.

Mr. Spring


Mr. David Hinchliffe (Wakefield)

On a point of order, Mr. Deputy Speaker. The hon. Member for Bury St. Edmunds (Mr. Spring) clearly has no intention of moving the amendment. He is simply wasting the House's time. I urge you, Mr. Deputy Speaker, to move on to the next business.

Mr. Deputy Speaker

It seemed to me that the hon. Member for Bury St. Edmunds had risen in his place. He is assembling his notes and I imagine that he is now ready to move the amendment.

Mr. Spring

I beg to move amendment No. 9, in page 2, line 18, at end insert— '(1A) The General Council shall not appoint a person under subsection (1) unless he is a qualified solicitor or is otherwise legally qualified.'.

Mr. Deputy Speaker

With this, it will be convenient to take amendment No. 8, in page 2, line 35, at end insert— '(7) The General Council shall appoint a person to be deputy to the Registrar; and a person so appointed shall be known as the Deputy Registrar, shall hold office for such period and on such terms as the General Council may determine and shall exercise such functions (including, in particular, the function of deputising for the Registrar when the Registrar is absent or otherwise unable to act) as the General Council may determine.'.

9.45 am
Mr. Spring

The amendment proposes that the general council should not appoint a person under subsection (1) unless he is a qualified solicitor or otherwise legally qualified. Hon. Members know that we have a superabundance of lawyers here. We may be tempted, therefore, to think that we do not need any more lawyers to be involved in any proceedings. However, the fact is that the amendment—

Mr. Alex Carlile (Montgomery)

Does the hon. Gentleman realise the fatuousness of the amendment? The registrar of the General Medical Council has never been a qualified lawyer. This is the most absurd, time-wasting nonsense.

Mr. Spring

If the hon. and learned Gentleman will wait a moment, he will hear me discuss this point and why it is important to consider it.

Mr. Knapman

Will my hon. Friend consider the point that the hon. and learned Member for Montgomery (Mr. Carlile) has already made points of order and interventions, and has taken up far more of the House's time than has any other hon. Member present? With respect, that is not in any way unusual—[Interruption.]

Mr. Deputy Speaker

Order. Let us be clear. Hon. Members have the right to be heard in the House. We have a Bill before us and we have amendments that are in order. As long as amendments are moved—this one is being moved—the House must listen. I am not prepared to listen to sedentary comments from certain quarters of the House any further this morning.

Mr. Spring

The point is that the amendment would ensure that the general council had someone who was legally qualified and with an appropriate breadth of knowledge; knowledge of the law would be helpful. Through the Bill, we are trying to upgrade the reputation of chiropractors. We have looked at the whole question of health, and at the whole question of raising the professionalism of chiropractors and their recognition in the community. It is now important that someone who is at the centre of the process should be legally qualified.

We live in a time of considerable litigation against individuals who practise various forms of medicine, whether complementary medicine, veterinary medicine or any other kind. It is important, therefore, that the individual who is at the centre of the general council should have knowledge of the law. That would be extremely helpful to members of the chiropractic profession. Given the nature of society and the potential for law suits, an understanding of the law would be extremely helpful.

The amendment would achieve something else. It would strengthen the feeling among those who use chiropractors, of whom there are an increasing number, that there is someone centrally placed who understands what the law is about. I believe that that presents a valid safeguard.

Chiropractors have been around for almost 100 years, but it is only now that the medical profession is accepting them as a form of complementary medicine. Therefore, it would be helpful to assist the encouragement of general practitioners and the general public to accept them by making sure that the individual who supervises and regulates the profession has a knowledge of the law. That would be useful and important, especially in view of the history of chiropractic in Britain. After all, the registrar maintains the register of chiropractors and fulfils other duties placed on him by the general council.

As I said, people may laugh about the superabundance of lawyers in the House or outside, but the fact remains that in every aspect of our national life, knowledge of the law is becoming increasingly important. We are an increasingly litigious society. People who may be dissatisfied, for example, with the service that they receive from chiropractors will have the assurance that the person at the heart of the regulatory organisation has a profound knowledge of the law. That is why I have moved the amendment.

Mr. David Lidington (Aylesbury)

While I am sure that my hon. Friend has good intentions, I hope that, on consideration, he will withdraw his amendment. If he does not, I shall ask the House to reject it.

There are three reasons why the amendment is unnecessary. First, the post of registrar will encompass not simply giving legal advice to the general council but a range of administrative and executive tasks, not all of which require legal experience.

Secondly, conditions of employment are already subject to the decision of the general council, which is, in turn, subject to the Privy Council. If the general council feels that a lawyer is the best candidate for the job, it has the right to appoint one, but it should not be prevented by statute from appointing a non-lawyer if that person is the best candidate for the job.

Mr. Knapman

Will my hon. Friend expand a little on why the Privy Council should select members instead of the Secretary of State, who could be questioned in this place?

Mr. Lidington

It is simply a matter of following the precedent of other self-regulating medical professions. We have followed the procedure under the Osteopaths Act 1993 and that for the General Medical Council.

The third reason why the clause is unnecessary is that the Bill provides for the general council to appoint expert legal assessors. That is a duty of the general council under the Bill. Therefore, the general council and the registrar will have expert legal advice available to them without the need for the amendment.

Amendment No. 8 refers to the deputy registrar. It is not a sensible use of legislation to provide for every eventuality. The Bill allows the general council to appoint and employ staff in addition to the registrar. It will almost certainly need to do so and it should be left to the council's discretion.

Mr. Sackville

I should like to respond. The amendment has been tabled by my hon. Friend the Member for Bury St. Edmunds (Mr. Spring). I can certainly understand the reasons behind it. There is no doubt that a legal training is of enormous importance in many administrative functions, but the amendment is probably over-prescriptive. The general council should be allowed the freedom to decide who is the best candidate. Therefore, I advise the House to reject the amendment.

I have no wish to denigrate the legal profession, which is well represented on both sides of the House. I think that the only reason why I had the honour of being selected for my seat was that the boundary changes to the Bolton, West constituency failed to penetrate the inner recesses of the Inner Temple back in 1983.

The system of regulation, as seen first in the Osteopaths Act 1993, which is reflected in the Bill, marks a fresh approach to professional self-regulation. That is central to the reason why I advise the House to reject my hon. Friend's amendment. There will be no well-established precedents set to guide decisions. To a great extent, the general council would have to advance across unknown territory. The same point could easily be made in connection with the post and duties of the registrar, who will arguably be the second most important post in the statutory scheme, after the chairman of the general council.

It would clearly be in the interests of the profession and the general council to ensure, for example, that the person appointed was conversant with both the legal obligations arising out of the scheme and the particular challenges presented by the administrative requirements of a health profession.

I also have some worries about the impression that might be created if the duties of the registrar were seen as purely legalistic. The post of registrar, who is responsible for the direction of the general council, has considerable flexibility. If the post was always filled by a person with a legal qualification, it might be expected that his duties were primarily legalistic. I am sure that that is not the overall intention of the Bill. Indeed, the amendment calls into question the requirement in clause 27 to appoint legal assessors to provide advice to the registrar, in addition to the various statutory committees.

I do not wish to imply that a lawyer could not fill the post effectively, but I am sure that many other individuals would also be eminently suitable. Therefore, to restrict the appointment to a lawyer would place a significant limit on the council's freedom of action and arbitrarily rule out of contention many candidates who would be suitable. Therefore, I do not believe that the amendment would serve a particularly useful purpose.

The general council would be able to appoint a lawyer if it thought that such a person was the most suitable. There would be little to be gained and, in my opinion, something to be lost in making the post of registrar a closed shop. It would cut across the self-regulatory nature of the scheme that lies at the heart of the Bill and has been shown to be successful in the Osteopaths Act, which was passed by the House last year.

The principle of statutory regulation implies that Parliament entrusts that profession with its own regulation and development. In the case of the chiropractic profession, that is a suitable way of doing it. For that reason, we have not sought to incorporate every last detail in the Bill. We must leave the profession a lot of room for discretion and to find out what requirements it will have in practice.

At first sight, it might be said that amendment No. 8, which refers to the deputy registrar, seems sensible, but, again, it is overly prescriptive. That amendment and the imposition of the need for a lawyer to serve as registrar are both proposals which I would advise the House to reject.

Mr. Spring

In view of my hon. Friend's comments, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Order for Third Reading read.

9.58 am
Mr. Lidington

I beg to move, That the Bill be now read the Third time.

The contents of the Bill have been fully discussed in previous stages and I shall not add anything to what has been said. However, I wish to take a few minutes, for reasons that I have discussed with the hon. Member for Kingswood (Mr. Berry), to dwell on the future of the chiropractic profession and to respond to some serious anxieties expressed by members of the profession during the Bill's progress through the House.

The chiropractic profession sought statutory regulation and its ardent advocacy persuaded me to take up the Bill in the first place. The profession has aimed to ensure high standards for patients and to protect its good name against any possibility of infiltration by quacks and charlatans, taking advantage of the increasing popularity of chiropractic among patients. The third aim has been to bring chiropractic still closer to the mainstream of medicine and to make it more trusted by doctors, by virtue of statutory protection and the assurance of common standards of competence and training.

The various voluntary associations pulled together to campaign for the Bill through the chiropractic registration steering group. I congratulate the group on its work. The co-operation between different schools of chiropractic and mutual respect among chiropractors from the different schools are encouraging signs for the future. I hope that the profession will continue along that road.

If the Bill is enacted—I hope that it will be—the role of those voluntary associations is bound to change. In the short term, the profession could still determine certain things collectively; it might draw up standards of proficiency based on existing competency, of a standard common to the various chiropractic schools, and it could draft a shared code of professional ethics.

It is important for the profession to beware trying to judge matters that will become the proper responsibility of the general council if the Bill is enacted. Under the Bill, the general council will have the responsibility of setting professional and educational standards for the entire profession.

I will give the House a practical example. Some years ago, the various voluntary associations agreed that all chiropractic schools should achieve common standards within five years of any statutory system of regulation coming into force. The standard was that set by the European Council on Chiropractic Education—as it existed in 1991.

Today, we find that the Anglo-European college in Bournemouth is the only school in Europe, let alone the United Kingdom, to meet that standard, so the Bournemouth standard could be said to be the gold standard for chiropractic. It would be wrong to assume, however, that the Bournemouth standard must be taken as the minimum standard throughout the chiropractic profession, whatever may happen.

The general council, representing the entire profession, must set the standard of professional education, to protect the interests of patients and the reputation of the profession alike. Those standards and the type of courses that will train students to meet them are bound to change as medicine and chiropractic techniques develop and evolve. That is why no educational standard is described in the Bill. Instead, that task is rightly left to the general council and the education committee when the Bill becomes law, as we hope it will.

Recognition of qualifications should be based on the outcome of training—not on the process by which training is carried out—and the standards achieved. There is, therefore, no reason in principle why some courses should not continue to be part time, to include distance learning or to be of any duration. The key is that every course should meet the standards of proficiency laid down by the general council for safe and competent chiropractic practice.

Like the King's Fund working party, I believe that the initial standards of proficiency will need to reflect existing standards in the profession. That will ensure that the profession moves forward together from a basis founded on the reality of practice and not on a vision of what it might or ought to be like in the future—a future which, because of developments in chiropractic and medicine, could be impossible to predict with certainty.

The general council should be free to adopt a dynamic strategy based on its assessment of the present needs of the profession. It should not be constrained to a rigid commitment to a standard that it played no part in drawing up and which might be out of date when the relevant decisions have to be made.

The intention behind the voluntary agreement between chiropractic associations remains as valid as ever and it is embodied in my Bill. The intention is to provide a guarantee to the profession, the public and patients that standards will not simply be maintained, but will rise and be encouraged to rise.

Some chiropractors may exceed the standards set by the general council. That is welcome and it is only to be expected. No chiropractor will be penalised for being ahead of the game. Such a chiropractor may have much to offer his or her colleagues when the general council introduces rules on the supervision of professionally registered chiropractors in due course. The profession will be able gradually to achieve its long-term goal to raise standards across the board by a process of evolution.

The voluntary associations may well continue. Indeed, it is important that they should do so and that chiropractors should continue to belong to them, at least until the register is opened. In that way, we will ensure a smooth transition from a voluntary to a statutory scheme.

The role of the voluntary associations is bound to change, however, and the general council will take over many of their functions. If the Bill is successful, the council will be the means by which all chiropractors are represented and by which they will represent themselves to others. All members of the general council will be required to act as ambassadors for the profession and to set aside previous loyalties to the school where they were trained or the voluntary association to which they belonged. All registered chiropractors will owe a duty of professional respect to their registered colleagues, similar to the duty and respect owed to colleagues in a voluntary association at present.

If the progress that the associations have already made, by gradually working together and harmonising their approaches, is continued and consolidated, the general council will find it increasingly easy to take up and perform its statutory duties, which can only be in the interests of the chiropractic profession and the patients it serves.

Throughout proceedings on the Bill, I have been heartened by the support that I have received from all quarters of the House. I must also place on record my thanks to the schools of chiropractic, to many chiropractors and to patients who have given up their time to discuss with me the challenges facing the profession.

I have been enormously impressed by the dedication of chiropractors in this country and by their commitment to serving their patients and enhancing the standing of their profession. I have also been impressed by their optimism and their constructive approach towards the development of chiropractic in the United Kingdom. I wish the profession well and I commend the Bill to the House.

10.7 am

Mr. Hinchliffe

I apologise for the absence of my hon. Friend the Member for Bristol, South (Ms Primarolo), who has led for the Opposition during the Bill's previous stages. Unfortunately, she had a constituency commitment that she could not avoid. The Opposition made clear their full support for the measure during the previous stages.

My hon. Friend the Member for Bristol, South spoke for a mere six minutes on Second Reading and for less than one minute in Committee. I shall follow her example in terms of brevity, not least because of the Opposition's strong desire to see the measure on the statute book and also because I am a sponsor of the Bill that the House is to discuss next which was introduced by hon. Friend the Member for Kingswood (Mr. Berry).

The House and the public will not forgive any hon. Member who attempts to delay this measure as a way of wrecking my hon. Friend's Bill. Hon. Members would do well to look at examples of what has happened to Members of this place who have attempted to wreck the measure. I assure any hon. Members with those intentions that we will do all in our power to ensure that their constituents are well aware of their activities.

On behalf of the Opposition, I am happy to support the Bill and I wish it well.

10.9 am

Lady Olga Maitland (Sutton and Cheam)

I offer a warm welcome to the Bill and I congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on his success. I was proud to serve on the Standing Committee that examined the Bill for one special reason: one of the leading chiropractors in the country, Dr. Brian Hammond, is based in my constituency. I have heard from his many patients and others within the community what an absolute blessing chiropractic treatment has been to them and it therefore follows that that treatment should be offered proper recognition. That is what the Bill is designed to achieve.

In the past few decades, an enormous amount of progress has been made because the medical world now accepts that complementary medicine has a role to play. It has been heartening to note that the national health service, which was hesitant in supporting complementary medicine, is now offering whole-hearted support for chiropractic treatment. In many cases, people who have gone to see their doctor and sought treatment from conventional medicines in hospital have been advised to seek the help of a chiropractor and found immediate relief.

The practice in Sutton is of such stature that it has treated 16,000 people in about 15 years, which works out at an average of around 500 people a week. The numbers treated demonstrates the important role that chiropractic treatment has in medicine today, especially when we bear in mind the misery that back pain can cause. Although chiropractors treat all forms of pain, their treatment is particularly beneficial for those suffering from back pain. The chiropractor registrar noted earlier this year that 310,000 people in Britain alone are off work each day with back pain. It is estimated that back pain costs the country £3 billion in lost production every year. Those figures speak for themselves and reveal how important it is that chiropractors should be properly recognised and have their own general council.

With the compilation of a formal register, chiropractors will be able to ensure that rogue practitioners will be prevented from registering. That will stop patients or potential patients being put at serious risk. Dr. Brian Hammond has told me of several people who came along to him in great pain having first been treated by a rogue practitioner. The Bill will regulate an important part of what I call the medical profession and I therefore give it a warm welcome.

I congratulate my hon. Friend the Member for Aylesbury on his tremendous determination to push the Bill through. When his chance came up in the ballot, he selected a Bill that went right to the back pain of Britain, the heart of Britain. His Bill will offer tremendous relief to many people who have always felt that their source of medical help has been on the fringes of medicine. It will now be within the heart of it.

10.13 am
Mr. John Sykes (Scarborough)

I support the Bill, which my hon. Friend for Aylesbury (Mr. Lidington), has promoted because, in 1978, I obtained my class 1 heavy goods vehicle licence—I must be one of the only hon. Members to have done so—and I know full well what driving long hours can do to one's back. I also support the Bill because, last year, I had the privilege to serve on the Standing Committee that considered the Osteopaths Bill, which has served that profession well.

Whether by hard work, subtle diplomacy, opportune timing or a combination of all those factors, a variety of interested organisations have come together in recent months to debate the statutory regulation of the chiropractic profession in a rare atmosphere of accord. On those grounds alone, there is much to commend.

A sea change in the opinion of the British Medical Association towards alternative and complementary medicine has come about. For some time, surveys have reported positive findings concerning the efficacy of complementary medicine. The nation's health care system is under a period of intense scrutiny and either the nation is turning progressively spineless or, as a result of what appears to be a series of amazing coincidences, complementary medicine is enjoying greater public confidence than at any other time. Chiropractic treatment is experiencing not so much a fad as a boom.

Of the 310,000 people who are off work each day because of back pain, 75,000 receive weekly chiropractic treatment. In a previous debate on the Bill, my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) said that it cost £20 per hour for treatment at the National Back Pain Association in her constituency. If one takes that rate as a hypothetical mean rate, the chiropractic profession starts to turn from a strand of complementary medicine into a multi-million pound industry. That alone is not, however, a sufficient reason for the statutory regulation of chiropractic.

The 75,000 people who receive weekly chiropractic treatment are administered to by 900 practitioners, who are qualified in a variety of ways and registered by a number of voluntary bodies. The size of the chiropractic profession and the volume of its work have outgrown the voluntary status that was a perfectly satisfactory means of self-regulation for many years. The arrangements are in need of review at least, if not statutory regulation as the Bill proposes.

The chiropractic registration steering group has calculated that 310,000 people are off work each day through back pain and that that costs the country £3 billion annually in lost production. That is undesirable and the problem could be greatly relieved by the statutory regulation contained in the Bill.

With the debate on the future of the NHS and social security provision continuing to roll on, the remaining stages of the Bill should take account of the important fact that it is no longer taken for granted that traditional forms of treatment are more effective than complementary medicine, although they are often considerably more expensive.

Mr. Hinchliffe

Will the hon. Gentleman give way?

Mr. Sykes

No, I must make progress.

The successful passage of the Bill so far perhaps results from the fact that its origins lie in an initiative started within the chiropractic profession.

Mr. Hinchliffe

On a point of order, Mr. Deputy Speaker. Is it in order for Government Whips to supply briefing material to Government Back Benchers, who have not shown the slightest interest in the Bill's previous stages? They have done so in an attempt to block the Civil Rights (Disabled Persons) Bill, promoted by my hon.

Friend the Member for Kingswood (Mr. Berry). I witnessed the hon. Member for Scarborough (Mr. Sykes) being supplied with briefing material on Tuesday by the hon. Member for Harrow, West (Mr. Hughes). The hon. Member for Scarborough has not shown a scrap of interest in the Bill before now and his speech is a disgraceful attempt to delay business and block the Civil Rights (Disabled Persons) Bill.

Mr. Deputy Speaker

That has absolutely nothing to do with the Chair.

Mr. Sykes

That was an unworthy point of order, but it was entirely in keeping with the stature of the hon. Member for Wakefield (Mr. Hinchliffe) in the House. He obviously was not listening to the start of my speech, when I said quite clearly that I served on the Standing Committee that considered the Osteopaths Bill last year. Every day 310,000 suffer from back pain; there are as many people who suffer from back pain as there are disabled and they should have their say.

The successful passage of the Bill so far perhaps results from the fact that its origins lie with an initiative started within the chiropractic profession. The Bill is not a coercive measure or an unpopular one. It has support through the chiropractic profession and enjoys cross-party support in the House.

The prestigious King's Fund management committee, impressed by the co-operation that it saw from all the different parts of the chiropractic profession, decided to set up a working party to investigate the possibility of statutory regulation. It found in favour. The report, provided under the auspices of its chairman, Sir Thomas Bingham, has subsequently provided much of the substance and thought behind my hon. Friend's Bill.

Mr. John Austin-Walker (Woolwich)

Will the hon. Gentleman give way?

Mr. Sykes

I have already said that I will not give way.

Mr. Austin-Walker

What is the hon. Gentleman afraid of?

Mr. Sykes

The hon. Member wants to proceed to discuss the Civil Rights (Disabled Persons) Bill, but I want to conclude my remarks on the Chiropractors Bill.

It is perhaps unnecessary to stress the intellectual and philosophical pedigree behind the Bill, because, as has often been said during its passage, the popularity and confidence that the profession enjoy among the public are now indisputable. The Bill is not merely concerned with legislating for a flash-in-the-pan fad. A huge change has occurred in the attitude of the medical disciplines towards alternative and complementary medicine. As the number of people receiving treatment continues to rise, so does the number of referrals from orthodox doctors, a theme to which I shall return in a moment.

At times like this, it is tempting to resort to the old adage, If it ain't broke, don't fix it. However, statutory registration will prolong the smooth running of chiropractic treatment. Indicative of that truth are the lengths to which the various chiropractic bodies went to gain agreement about the setting of common standards for education and training of chiropractors. The chiropractic registration steering group dismissed all professional jealousy and competitiveness to gain agreement that, within five years of legislation coming into force, all schools of chiropractic in the United Kingdom would have minimum standards in accordance with those set down by the European Council on Chiropractic Education.

The other measures that my hon. Friend the Member for Aylesbury has chosen for inclusion in his Bill are indicative of the same need for statutory regulation. Through the creation of a General Chiropractic Council, as recommended in the King's Fund report, and a group of four subsidiary committees, a sophisticated self-governing watchdog system can be put in place. That is of major concern to the profession, whose method of treatment could be highly dangerous in the hands of the unqualified.

The general council will regulate, develop and promote chiropractic treatment. The subsidiary groups will form layers of defence against potential abuse and provide breadth of expertise, which will ensure that the profession has a solid and legitimate basis from which to meet the increased demands that the future is likely to bring.

The Bill seeks to bring reassurance to patient and practitioner alike. Statutory regulation would offer reassurance to the patient that the registered practitioner was properly qualified. The obligation to retrain will further ensure that reassurance. The Bill will give the practitioner official recognition and respectability, which can only improve the chances of a member of the profession playing a more integral role in the health care system of the nation.

In the light of the recent debate about deregulation, it can also be assured that provisions of the Bill show a laudable tendency for self-government. The financial onus of the general council is placed entirely on the shoulders of the profession through subscription rates, except where the Privy Council is required to intervene, and the work of the general council and its committees is prescribed to be proactive and progressive.

The incorporation of alternative and complementary medicine into mainstream UK health care has been helped by a number of changes of perception in established views. An especially influential article, with vast implications, was a study published in the British Medical Journal in 1990 and conducted by the Medical Research Council. It found that in a comparative study of the treatment received in hospital through traditional medicine with the treatment received from chiropractors, only one of the 11 hospital centres could claim to perform better than chiropractors. There was an insignificant difference between the performance of two sets of the other centres and chiropractors, although the study found that 741 patients studied between the ages of 18 and 65 received "significantly more effective" treatment from chiropractors than from eight of the hospitals.

Chiropractic is, in many such ways, receiving greater attention and recognition for its successful treatment of what is now a widespread problem—back-related ailments. Some of the hon. Members in the House today are still worried about the extent to which complementary medicine will be made available on the national health service, especially those medicines that are to be, or have been, statutorily regulated.

I believe that that is merely a case of counting chickens. Before chiropractic is incorporated completely into established patterns of health care, it must first achieve statutory recognition. It must then be allowed a period of assessment, to discern the true extent of its need.

A more prescient question might be about the way in which a proportion of the 60 million working days are lost each year as a result of back pain could be recovered. Schemes for chiropractic treatment at the workplace, which the Minister outlined during the previous debate, represent only one response to that large problem.

Far from exhibiting a reversion to primitive beliefs", as the BMA thought as recently as 1976, complementary medicine could contain many answers to our anxieties about welfare expenditure. My hon. Friend the Member for Sutton and Cheam believes that there are savings to be made. On Second Reading, she said that she believed that £13 million could be saved in lost output and £2.5 million in social security payments, against an additional cost of about £4 million from the introduction of chiropractic in the national health service.

Various pithy guidelines were produced during the previous debate to illustrate the readiness of the chiropractic profession to receive statutory regulation. It must now be obvious to all that that is the case. Likewise, I believe that the Bill in its present state is more than ready for statutory recognition and hence I commend it to the House.

10.23 am
Mr. John Austin-Walker (Woolwich)

Like hon. Members who spoke earlier, I welcome the Bill and want it to be brought into force as soon as possible. I recognise the importance of chiropractic to many people who are disabled by severe back and other pain, but there is no dispute in the House about the importance of the Bill and the importance of its coming into law.

No debate is necessary on the Bill and I hope that, after this long debate, the House will recognise that the tactics of the Conservative Members are not to add anything to the Chiropractors Bill. They intend to block the Civil Rights (Disabled Persons) Bill, which would bring benefit to millions of disabled people in the country.

10.24 am
Mr. Spring

I congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on successfully sponsoring the Bill, and on presenting his case so admirably at every stage.

Although, 20 years on, the BMA remains agnostic about complementary medicine, I have a personal observation to make. About 20 years ago, when I started working, I had an injury which resulted in the most appalling headache. I visited countless doctors and specialists, none of whom could find anything wrong. Therefore, I speak with considerable feeling when I say that a chiropractor solved that problem. I am not alone in that. It was an appalling experience of six months of considerable pain.

Complementary medicine has been brought substantially into the main stream and I welcome the fact that the cure of pain through chiropractic can be achieved without the use of pills, which have become a considerable problem in our country. In the old days, chiropractic and osteopathy were considered to be off-beam and eccentric. They were unloved and held in deep suspicion.

On a final personal note, when I telephoned my doctor to say that I had got rid of that excruciating pain via manipulation of the spine, he was horrified. I do not believe that today a general practitioner would react in that way.

The thrust of the Bill, therefore, is to recognise the achievements of chiropractors by upgrading their reputation and giving them the professional status that they deserve because they have helped so many people such as myself.

Increasingly, medicine takes an holistic view of people. We know that illness can be psychosomatic in many respects, but we know that the spine is the conduit for the nervous system and can have an impact on the immune system. Indeed, the huge volume of back pain which is so noteworthy of contemporary Britain is increasingly treated by chiropractors without recourse to tranquillisers.

Last night, I initiated an Adjournment debate about substance abuse. One aspect of substance abuse that is an increasing problem in this country is the overuse of tranquillisers and painkillers. That is where alternative medicine has an important part to play.

In my constituency a few months ago, I visited the Bury St. Edmunds chiropractic practice and met an elderly gentleman, who had for years been in agony and was now being successfully treated. He wanted me to see the treatment that he had been undertaking. Increasingly, GPs and chiropractors work hand in glove. It is no coincidence that, in my constituency, the Bury chiropractic practice is now cheek by jowl with a new GP's surgery. I believe that that is the way for the future.

In the past 20 years, there has been a sea change. People live longer. Better health is expected. However, as a result of rising living standards and people's desire for good health, the risk of the charlatan remains. One only has to read newspapers and magazines that discuss health to read the names of countless individuals offering therapies, hypnotism and so on. There is an explosion in such treatments, which are beneficial in many respects as part of complementary medicine, but also have their dangers. That is why the Bill is so important in creating parameters for the professionalism of chiropractors.

The Medical Research Council, during a two-year trial, gave complete credence to the use of chiropractic in returning patients to good health. The medical profession, in contrast with 15 to 20 years ago, is no longer dismissive. Increasingly, younger doctors take an admirable holistic approach. Clinics offering complementary medicine are increasing and are working closely with the existing medical profession.

The chief executive of the King's fund said that complementary medicine should be regulated and recognised by statute, provided that it met three important criteria. First, it should rest on a solid professional basis with knowledge and skills that could be examined. All hon. Members would agree with that. Secondly, it should be able to cure pain by any objective assessment. We know that chiropractors can achieve that. Thirdly, there should be a public demand for it. The public require a proper understanding and feeling of security, and the difference between good and bad practice should be made clear. Publicly accountable self-regulation is, therefore, part and parcel of that.

The Bill appears properly to fulfil those themes. It gives assurance to the public and greater self confidence to the profession; it weeds out the charlatans; and the general council will be self financing. We are not discussing some overweening new statutory body that is introducing a host of unwelcome legislation, full of bureaucratic intent. As my hon. Friend the Member for Scarborough (Mr. Sykes) said, 75,000 people a week visit chiropractors. However, there are only 900 chiropractors in Britain and, considering the demand and the good that they do, that number is inadequate.

With a proper status and self-regulating framework, GPs and the public will increasingly accept the profession. The increased number of GP fundholders using complementary medicine will undoubtedly attract further people. I welcome the fact that the Bill itself will attract people to become chiropractors, given the shortage that exists.

In 1975, the British Chiropractic Association applied unsuccessfully for inclusion as one of the professions regulated under the Professions Supplementary to Medicine Act 1960. At that time, there was a division about the way forward for the profession, born largely of a contradictory self image. As a result of the Bill, that will no longer be the case. Complementary medicine is in place and the General Chiropractic Council will give it form and structure.

A poll conducted by The Times and MORI showed that 93 per cent. of those consulting a chiropractor were satisfied with their treatment. I doubt whether many professions in Britain enjoy that level of satisfaction and acceptance, despite the fact that, hitherto, anybody could call himself or herself a chiropractor. Despite the high satisfaction, those who were unsatisfied could have recourse under common law alone, which is an important point. The additional assurance of proper registration and regulation of the profession springs directly from the Bill, under which the General Chiropractic Council can decide whether to introduce disciplinary proceedings. I welcome that arms'-length principle.

The Bill neither defines nor describes chiropractic, the practice of which will be regulated by the General Chiropractic Council. I welcome the comprehensive machinery on fitness to practise to ensure high standards and that other patients are not at risk by the illness of a chiropractor. Allegations may lead to the suspension of practitioners immediately, pending an inquiry into the allegation, which is wholly to the good. All that will add to the public's perception of the profession as being of the highest quality.

As my hon. Friend the Member for Scarborough said, 310,000 people in the United Kingdom are off work each day with back pain, which costs the nation £3 billion a year in lost production. The incidence of back pain in Britain is increasing at a faster rate than any other disability. In November 1992, a survey conducted by Which? magazine showed that chiropractic was the second most frequently used complementary therapy. It is now 99 years old, with statutory regulation in 17 other countries. This is a Bill whose time has come.

10.34 am
Mr. Knapman

Earlier comments show that all Conservative Members are pleased to see in his place the Minister of State with responsibility for disabled people. In 1979, no such post existed and the budget for disabled people has risen from £1 billion to roughly 10 times as much. So we need no lectures from Opposition Members about looking after disabled people.

Over the past few months, I have had the privilege of serving on the Committee discussing the Local Government etc. (Scotland) Bill, which prevented me, until now, from commenting as fully as I would wish on important legislation such as this. The fact that that Committee sat for 177 hours taught me how important the Labour party feels it is to scrutinise carefully important legislation. I am, therefore, sure that they will not criticise us for carefully scrutinising this Bill.

Mr. Sykes

On a point of order, Mr. Deputy Speaker. May I draw your attention to the fact that my hon. Friend the Member for Stroud (Mr. Knapman) is speaking, whereas the annunciator shows that my hon. Friend the Member for Hertsmere (Mr. Clappison) is speaking.

Mr. Deputy Speaker

The Chair is not responsible for the annunciator. He is responsible for more than enough this morning.

Mr. Knapman

I shall try not to add to your burdens, Mr. Deputy Speaker.

This is an important Bill. All those who have spoken have had back problems at some stage. I spent the last election campaign flat on my back in Frenchay hospital with muscle spasms in the back, which is extremely painful. My agent was unkind enough to suggest that my majority went up due to that fact. However, I was grateful for the treatment that I received in the hospital and from chiropractors soon afterwards.

I find the Bill somewhat contentious, so I hope that my hon. Friend the Minister will comment on the points that I wish to raise. I shall not take long to raise those points.

It is fair to say that a move to statutory regulation can be seen as a change in the method of regulation, rather than an extension of regulation. That is what we are told, but when we read the Bill carefully, we see that clause 1 provides for the establishment of a General Chiropractic Council and four committees. Indeed, an amendment that was not selected this morning sought to establish five committees. Clause after clause then sets up registers, annual registers, the suspension of registration and so on. How will that all be paid for?

Nineteen people are to sit on the general council, whereas the average size of a council is 10 to 12 people. With a little practice, 19 people could create nearly as much hot air as we do in this place. Is all that to be paid for by 900 people?

That matter has no doubt been considered and I pay tribute to my hon. Friend the Member for Aylesbury (Mr. Lidington) who has been as splendid in taking this Bill through the House as my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) was at taking the Osteopathy Bill through the House last year.

However, all the clauses up to clause 13, and again in clauses 20 to 26, which provide for machinery to investigate allegations of unacceptable professional conduct, have cost implications. What are those cost implications? We are led to believe that discussions between officials and representatives of the profession indicate that statutory regulation would have no net adverse cost effect on business. As Mandy Rice-Davies in the pre-"back to basics" era might have said, "Well, they would say that, wouldn't they?" Some 900 members will have to pay for a vast bureaucracy so I presume that, ultimately, the patient will pay.

I have concerns about the Bill. I welcome the thrust of it and what it seeks to achieve, but I query the number of committees and the size of the council. I wonder whether 900 practitioners can reasonably be expected to pay for it. I suspect that in two or three years' time, the cost of visiting a chiropractor will be considerably more than it is today.

I am sorry that today we could not could not cover new clause 2 which involves animal chiropractors—

Mr. Deputy Speaker

Order. The reason that we could not cover new clause 2 was that it would be out of order to do so. It is certainly not in order on Third Reading.

Mr. Knapman

I thought that I said that I was merely sorry that new clause 2 had not been called today, but I shall not continue on that subject.

I think that I am entitled to ask whether the Government intend to allow the Royal College of Veterinary Surgeons to appoint someone to the committees. If there are animal chiropractors, surely the Royal College of Veterinary Surgeons should be given the same privileges and rights as the doctors' representatives are given in another clause.

Mr. Alfred Morris

Would the hon. Gentleman respond favourably to an appeal from the Bill's promoter, the hon. Member for Aylesbury (Mr. Lidington), to reduce the length of his speech in order not to endanger the Civil Rights (Disabled Persons) Bill? If an appeal is made by the Bill's promoter, who spoke more briefly than some of his colleagues, would the hon. Member for Stroud (Mr. Knapman) respond favourably?

Mr. Knapman

I have already said that I have no intention of speaking for any great length of time. Bearing in mind that, for some minutes when I started speaking, the monitor showed the wrong name, I am the last person to be accused of seeking to detain the House unnecessarily. With one possible exception in relation to a specific Bill, I have never tried to delay the House for any great period. I am sorry that my anonymity should have prevented me from continuing along that line. I merely wonder whether veterinary surgeons should have the opportunity of nominating one member.

I am also concerned about why the Bill involves the Privy Council and a negative resolution of the House. Why are the names proposed not put forward by the Secretary of State in the normal way so that we can ask questions in the House about the Bill's effects? I appreciate that sometimes one avenue of approach is used and sometimes another, but I wonder why, on this occasion, the Privy Council is involved, rather than the Secretary of State.

I hope that the right hon. Member for Manchester, Wythenshawe (Mr. Morris) appreciates that I have no further points to make other than to say that back pains lead to the loss of far more working hours than almost any other ailment. I am sure that the hon. Member for Rochdale (Ms Lynne) will wish to make a contribution. I see in the Rochdale and Heywood Express, under the heading, "Liz backs bill" that she gives her full support to the Bill. I am sure that she will wish to make a few comments on Third Reading.

Ms Liz Lynne (Rochdale)

I support the Bill, but I also fully support the Civil Rights (Disabled Persons) Bill. The delaying tactics being used are not worthy of any hon. Member.

Mr. Knapman

It seems that when Liberal Democrat Members support a Bill, they no longer express their support in the House of Commons, but issue press releases to the Rochdale and Heywood Express stating that they support everything.

Ms Lynne

Some of us spoke in Committee.

Mr. Knapman

If the hon. Lady had been in her place earlier, she would have heard me explain that the rest of us also serve on Committees.

I hope that my hon. Friend the Minister will consider what I have said and respond.

10.43 am
Mr. James Clappison (Hertsmere)

I do not intend to delay the House, but I have one short point to make. I congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on the Bill. He has chosen to follow the path recommended by many eminent authorities and put in place a system of regulation for chiropractors similar to, but separate from, that for osteopaths. The question I pose to him and the Minister is that, since the central purpose of the provision is to protect the public from rogue practitioners and the like, would it not be desirable to have the fullest co-operation between osteopaths and chiropractors? [Interruption.] Before the hon. Member for Rochdale (Ms Lynne) becomes much more excited, may I say that the issue is of some interest to people who suffer from back pain. The issue was raised in the debate on Second Reading, and I have taken less time to make my speech than her hon. and learned Friend the Member for Montgomery (Mr. Carlile) took to make his point of order earlier this morning, which was not related to back pain or disability. The hon. Lady knows what it involved.

10.46 am
Mr. Sackville

It is with great pleasure that I rise to respond on behalf of the Government and also in my role as the junior health Minister with responsibility for back pain, which seems to be a growing problem. Perhaps the problem is increasing because we live longer and are wearing out our backs or perhaps we abuse our backs through the way we live. I do not know the answer, but it is a large and growing problem to which the Department of Health must give greater attention.

I congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on his choice of Bill and the efforts that he has made in steering it through the House. Today is an important day because the chiropractic profession helps a great many people who suffer from back pain. The Bill will undoubtedly strengthen that profession and make it more accessible to the NHS and to more patients. For those reasons, I intend to respond for a few minutes. It is fitting that I should do so, although I am aware of the need to leave time for other business later.

My hon. Friend the Member for Aylesbury did extremely well in the ballot—the same cannot be said of all ballots. He therefore has precedence today and I shall respond briefly to him.

Lady Olga Maitland

Will my hon. Friend spell out clearly the fact that any patient is entitled to receive chiropractic treatment on the NHS, particularly through a fundholding GP?

Mr. Sackville

Fund holders have absolute freedom to buy the services of chiropractors, just as the family health services authorities have absolute freedom to decide that non-fundholding GPs should have their costs reimbursed —there is access. The Bill gives people—practitioners and public—the confidence to seek to use chiropractic on the NHS. That has not happened to a great extent until now.

Anyone picking up my hon. Friend's admirable Bill would immediately be struck by its size and scope. It probably holds the record for the largest private Member's Bill that the House has ever seen—the records of the House suggest that that is so.

The chiropractic profession will shortly be celebrating its centenary and I can think of no other more suitable event to mark that occasion than the successful achievement of statutory regulation of the profession in the United Kingdom. Within the sphere of health care, statutory regulation often marks the occasion of a profession's coming of age. Through the years, chiropractors have worked diligently, often in the face of opposition, to have their skills accepted and their contribution to health care recognised. Not that long ago —only 30 years ago—chiropractors in some parts of the United States were convicted of practising medicine illegally. The profession is to be commended for holding firmly to its faith and its belief that one day it would win through. That is why today is important.

There is no doubt that chiropractic has an important role in helping increasing numbers of people remain mobile and free from discomfort. Those who have benefited from chiropractic treatment—we have heard from some today and I include myself in that number—are eager to testify to its benefits. It was probably not until June 1990, when the British Medical Journal published the results of a Medical Research Council trial on lower back pain that the medical profession in this country sat up and took notice. The MRC trial was the first large-scale comparative study of orthodox and complementary medical treatment of a particular condition, and it compared chiropractic management with hospital out-patient management of back pain. The report by the King's Fund working party remarked: The decision to conduct this trial reflected steadily growing public demand for chiropractic treatment, a marked shift in the attitude of the medical profession towards chiropractic, the readiness of chiropractors to subject their treatment techniques to clinical trial and the willingness of chiropractors, hospital consultants, general medical practitioners and state-registered physiotherapists to work closely together. I take this opportunity to pay tribute to the King's Fund for the considerable contribution that it has made to the Bill. It is also fitting that I should congratulate the chiropractic profession on its success thus far and on its skill in persuading my hon. Friend the Member for Aylesbury to take up the Bill.

The formation in 1991 of the chiropractic registration steering group marked a significant step in the development of chiropractic in this country. Its members are drawn from all the voluntary associations that represent chiropractors. It is a very diverse profession; to some extent that answers the view expressed by my hon. Friend the Member for Stroud (Mr. Knapman) that it is top heavy. There are different parts of the profession; everyone needs to be involved. I do not think my hon. Friend will find that the general council will be unwieldy or over-expensive. It will do its job economically.

Together, all these people have been tireless representatives of the profession and a consistent and dependable source of information about chiropractic treatment and the way it is practised in the United Kingdom. The steering group was formed with the single purpose of preparing the way for statutory regulation. It was a great asset to the King's Fund working party, and I know that it has served my hon. Friend and officials from my Department very well.

The steering group has been, however, more than a collection of like-minded people. It represents a change of attitude on the part of members of a profession who have in the past been divided, sometimes bitterly, by their common title of chiropractor. Through the steering group, bridges have been built and a common way forward has been agreed. The success of any statutory scheme will depend on a united profession.

My hon. Friend made some timely and well-observed comments on the future of the profession, and I in turn should like to add some of my own. I have already mentioned changes that have taken place in the profession, as shown by the formation of the steering group. Together, all these developments amount to a life-changing experience. The profession has already started down a new path which promises an exciting future. In the unlikely event that the Bill were to fall, the profession has already come too far ever to be the same again.

The profession ought, therefore, to be setting its sights on how it will shape the future for the benefit of the whole profession. I do not suggest that it should attempt to pre-empt the role of the council; rather, it should build on and develop the spirit of working together that has already taken hold. Increasing each chiropractor's sense of belonging to a single profession should not make practitioners fearful of losing their identity as particular types of chiropractor. After all, geriatricians and obstetricians are trained in and work in very different ways. Both, however, have to register with the General Medical Council, so the analogy is a fair one.

I am aware that times of change can bring uncertainty and that some chiropractic students are anxious about their future. Nothing in the Bill should lend credence to such fears. Should my hon. Friend's Bill be successful, as I hope it will be, there will follow an indeterminate period before the general council can be set up. We discovered from the experience last year with the osteopaths that, even with the best will, it takes a great deal of time for members of the first general council to be identified and appointed.

It needs to be borne in mind, however, that the first council will have an unprecedented role, taking the profession through the transition from voluntary registration to statutory regulation and into the formative years of the new scheme. Although everyone wants the expeditious establishment of the new council, it will be of far greater importance to ensure that those appointed to serve on it are of the correct calibre and possess the breadth of experience necessary to meet their responsibilities.

Running in parallel with the appointment of the general council is the need for the profession to raise the necessary finance to run the statutory scheme. Once the council is established, it could be 18 months to two years before the register opens. In the meantime, the general council will have had to draw up—and have approved by the Privy Council—its rules, of which there are necessarily many. It will also need to have determined and published the standard of proficiency for safe and competent practice. Its education committee will need to have appointed visitors to visit educational institutions and make recommendations to the general council about courses that provide evidence of having reached that standard of proficiency and which, subject to the approval of the Privy Council, should result in recognised qualifications under the Act. Premises may need to be secured, the registrar and other staff will need to be appointed, equipment and stationery will have to be purchased, and so on.

All that will require time. Until the registration fees start to come in, the general council will need to find money from other sources. In addition to the fees, the council will also need enough reserves to finance its fitness-to-practise machinery.

I welcome the Bill and I believe that it will be very beneficial to the chiropractic profession. The widening and growth of that profession will do a great deal for those who suffer from back pain. I commend the Bill to the House; I hope this is the last time we shall see it here, and that it will have a speedy passage through another place.

Question put and agreed to.

Bill accordingly read the Third time, and passed.

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