§ Motion made, and Question proposed, That this House do now adjourn.—[Mrs. McGuire.]
10.15 pm§ Mr. David Tredinnick (Bosworth)I am delighted to see you, Mr. Speaker, in your place at this late hour to chair the debate. I am also delighted to see the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), with whom I have debated before, in her place to respond to the important issue of the regulation of acupuncture, because there has been a seismic change in Government policy in the past few weeks. I shall explain why I think that that is the case in a few moments.
In the past year or so, much has been going on in complementary and alternative medicine, not least the House of Lords Science and Technology Committee's report on complementary and alternative medicine, most of which the Government accepted. As a result, the Government have now got themselves a new committee to help take forward the process of statutory self-regulation for two key and related parts of the complementary and alternative process: acupuncture and herbal medicine. Although herbal medicine is slightly ahead of acupuncture, we must treat them as a whole tonight; we cannot divorce one from the other.
I believe that statutory self-regulation is so important and the way forward because, two Parliaments ago, I sat on the Standing Committees for both the Osteopaths Bill and the Chiropractors Bill and saw them enacted. I know what a difference it has made to have statutory regulations for osteopathy and chiropractic. Having been treasurer of the parliamentary group for complementary and alternative medicine since 1987, I know how crucial it is that we build confidence among not just patients seeking treatment but qualified medical practitioners to refer cases to other disciplines, such as acupuncture and herbal medicine.
The story so far is that both acupuncture and herbal medicine practitioners are in favour of such moves and are making significant progress. Herbal medicine and acupuncture are inextricably linked. In traditional Chinese medicine, the prescription of herbs and the use of acupuncture—inserting needles to regulate the flow of "chi", or energy—are intertwined, although in the west, herbal medicine does not necessarily involve the use of acupuncture.
Herbal medicine practitioners, with whom I shall deal first, have just completed a scoping document with the Department, which sets an ambitious and demanding route to statutory self-regulation for the herbal profession. The Department is to be congratulated—I have not used that word often—on setting up a regulatory working group for herbal medicine. It is significant and important that the Government have had the foresight to make it clear that that group will have the capacity to assess the needs of other disciplines, such as aromatherapy, for statutory self-regulation.
It is also helpful that Professor Michael Pittilo has been appointed to take over the detailed work of preparing herbal medicine for statutory self-regulation. I applaud the bringing in of representatives of the Foundation for Integrated Medicine and other lay advisers, because one 646 of the criticisms that the parliamentary group has always had of the Department is that it has never had on board enough people who understand the issues. That is a step in the right direction. I am pleased by that positive response, but I must tell the Minister that the Conservative manifesto at the election said that complementary and alternative medicine should be made much more available in the health service. The pressure that has been applied to the Government from those on the Conservative Benches over the years has probably had some effect. I do not want the Minister to raise her eyebrows too much, because we have had a good relationship in discussions in the past, but I want to make that one political point.
I was astonished to read over my cornflakes before Christmas that the Government have now apparently embraced complementary and alternative medicine, and integrated health care generally, so dramatically. The reports said:
Herbal drugs may become routine NHS treatment",Ministers call for herbal cures on NHS" andHopes for herb cures on the NHS".It was also claimed that yoga may become a treatment on the NHS and that the Secretary of State wants to set up contracts with licensed alternative therapists. That is a dramatic change. Normally the Government like to bury the bad news in the busy weeks, but this time they have slipped out some good news. It may have gone unnoticed, but it has the potential to make a significant shift in the way in which patients are treated by the health service.If the Minister and her colleagues will really embrace the 50,000 complementary practitioners, waiting lists will fall. One point that emerges strongly from the submissions made by complementary practitioners, especially acupuncturists, is that they believe that they achieve a 30 per cent. improvement rate when treating patients. Other benefits would include reductions in drugs bills.
Acupuncture is so important because it can treat many different afflictions that it is sometimes difficult to treat within the health service, possibly because of lack of resources and overstretched doctors and sometimes because other treatments are not successful. Acupuncture has been successfully used in drug addiction, treatment of pain, musculoskeletal problems and asthma.
The Minister may not be aware of the following three examples. A team at Derriford hospital in Devon, headed by Sarah Budd, who recently won an integrated health care award, provides a maternity acupuncture service. The hospital has about 4,500 births a year and the service offers a choice of pain relief for women in labour. Because it was such a success, it was expanded to a popular in-patient and out-patient service for antenatal and post-natal problems. Nearer to my Leicestershire constituency, the Kingsmill hospital in Sutton in Ashfield, which is in Nottinghamshire, has been treating eight pregnant ladies for back pain, and that also has been very successful. Those projects should be encouraged, as should the project at the Claydon health centre in Manchester, which uses acupuncture alongside hypnotherapy in smoking cessation treatment. I have given up smoking and I know how hard it is. The Government have a project to reduce smoking—I have raised the issue twice at recent Question Times—and the Minister should consider incorporating acupuncture in that plan 647 The British Academy of Western Acupuncture gave me a list of the different afflictions that acupuncture can treat, and they include migraine, trigeminal neuralgia, asthma, bronchitis, menopausal problems, digestive problems, hiatus hernia, colitis, nausea, vomiting, recurrent cystitis, bed-wetting, eczema, psoriasis, hay fever, sinusitis and anxiety. Just about every treatment can be treated using acupuncture.
The herbalists are likely to achieve self-regulation first, followed by the acupuncturists, but the Minister must focus on the issue of managing two registers. Broadly speaking, it has been agreed in the Department that herbal medicine—a category that includes western herbal medicine, the Indian Ayurveda discipline and the traditional Chinese herbalism—should all be regulated as one group. The three different disciplines would be treated in a sort of federal way, with one system of regulation.
Acupuncture should be treated separately. That is my view: some people disagree, but the Minister should not be blown off course. She must stick with the two registers, one for herbalists and one for acupuncturists. The experts in this country who have been taking the matter forward have produced a scheme that has required a lot of careful negotiation.
However, we must find a mechanism to ensure that those who practise both disciplines do not have to pay two registration fees. That was a problem for osteopaths and chiropractors, who found the combined fee for the two registers to which they belonged of more than £1,000 to be prohibitive.
Secondly, the acupuncturists' register must be all-inclusive and embrace all the different bodies. In particular, it must cover the British Medical Acupuncture Society, the Acupuncture Association of Chartered Physiotherapists and the British Acupuncture Council. Each of those bodies has some 2,000 members, but the other, smaller groups are no less important.
Regulation is important because it builds confidence. It gives patients the confidence to go to these practitioners, and it makes it much more likely that doctors will be prepared to refer patients to complementary practitioners. I hope that that will make possible a dramatic increase in the numbers of people treated on the NHS. I think that acupuncture should be available, free at the point of delivery, at most GPs' surgeries and most NHS hospitals. That should be the objective.
Regulatory bodies have to be financed. I hope that the Minister will say whether the Government would be prepared to produce some of the funding for the registers for acupuncturists and for herbalists. That matter needs to be resolved at an early stage.
I shall not say too much more, as I want the Minister to have a proper chance to answer the debate. It is always unfortunate when Ministers get squeezed for time at the end of Adjournment debates, so I shall give her the best part of a quarter of an hour to reply. However, research is a key issue. People ask where the research on acupuncture can be found, as they do not know enough about it, but the answer is that a lot of research has been done.
We sometimes forget that the People's Republic of China, the origin of Chinese medicine and acupuncture, has a population of 1.273 billion people. The country has 648 67,000 hospitals, and the anecdotal evidence gathered over the 2,000 years for which acupuncture has been used is overwhelming. There must be studies in Chinese that could be translated into English. Instead of initiating new studies, I believe that we should get our embassy in China to translate some existing surveys. That would engender confidence in this country, and help to take acupuncture forward.
Finally, some other organisations have raised some points to which I should like to refer. The European Federation of Modern Acupuncture has argued that there should be a complete audit of how acupuncture is used in the private sector, to determine how best to use it in the public sector. It also suggested that the more controversial acupuncture treatments—such as the Voll technique, which tries to identify health dysfunction by the reaction to needles—should be thoroughly analysed. I support that.
The Modern Acupuncture Association has stated that its practitioners can improve the health of at least 30 per cent. of people referred to them. It added:
In chronic diseases, acupuncture may reduce the need for drugs in 30 per cent. of patients involving acute conditions such as sciatic, headaches, glandular disfunctions".Another key point concerns the costs that can be saved, as the needles are extremely inexpensive when compared to some vastly expensive drugs. That is why in the past the drugs industry has, generally speaking, taken a disparaging view of complementary medicine and pooh-poohed it. Fortunately, that situation has changed.The British Academy of Western Acupuncture has written to say that the tendency in the national health service is to refer a patient to the acupuncturist when all else has failed. Mr. George Nieman, the principal, writes:
I can assure you that the results are very favourable but there is little doubt that if the patients were referred to the acupuncturists first, a better result could be achieved.He also talks about expenditure and points out that under current arrangements, treatments are frequently rationed to six only, whereas an acupuncturist needs about 10 treatments to make an impact. Perhaps the Minister will address that point.The British Acupuncture Council argues that doctors should at least be able to meet World Health Organisation standards of acupuncture education. That should be the minimum requirement. I think that the time has gone for doctors merely to say, "It probably won't do you any harm." Doctors have to know how homeopathy works and about the principles of herbal medicine, the pulses and chi in Chinese medicine. It is no good telling patients that such treatments will probably do them no harm.
I have initiated this debate because I think that it is crucial to have statutory self-regulation to improve the way in which acupuncture is delivered in this country. I also think that, at a time when the Secretary of State for Health is sending patients abroad for treatment, it is crucial to make better use of the roughly 10,000 acupuncturists who are available to work in the health service.
I shall finish by paraphrasing passages from a lovely book called "The Watching Tree" by Adeline Yen Mah, a Chinese lady who was brought up in Shanghai and Hong Kong and came to live in the west. She went with her aunt, who had developed a lump in her breast, to see a Chinese physician in Shanghai. The doctor did not examine her at all but simply took her hand for 10 minutes 649 and studied it. Mrs. Yen Mah could see her aunt getting nervous. The practitioner said that he was well aware that her aunt had a lump. He continued:
When you are older, you will come to realise that everything in one's body depends on the flow of qi—or energy. He continued:That flow is carried by blood and reflected in the twenty-eight types of pulses which I can differentiate. By her pulse, I can detect any type of illness she may be suffering from. In a way, you can say that her pulse is tapping out her diagnosis and transmitting it to me through my fingers.After the consultation, the aunt received herbs from what was described as a strange looking cabinet. Mrs. Yen Mah said:We left the doctor's office without him examining any part of Aunt Baba but her wrist.The aunt took the medicine. The author says:We met again thirty-one years later. I asked Aunt Baba about her breast mass. She told me it had never gone away but had remained the same all those years.She lived to tell the tale. That wonderful system of medicine, about which we in the west do not have a great enough awareness as yet, saved that person's life.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)I am grateful to the hon. Member for Bosworth (Mr. Tredinnick) for raising the regulation of acupuncture and its use in the NHS. I pay tribute to his unflagging enthusiasm for complementary and alternative therapies. He has raised them on a number of occasions and we have discussed them. Let me, however, sound a small note of caution at the outset. I would not like him to run away with the idea that complementary and alternative therapies are the answer to all our problems in the national health service, although they can clearly make a significant contribution.
A number of therapies which not very many years ago would have been dismissed as fringe activities are beginning to be taken seriously by orthodox medicine. Osteopathy and chiropractic have joined the established health professions by gaining statutory recognition. As the hon. Gentleman pointed out, herbal medicine and acupuncture are now making serious preparations to gain that ultimate recognition. Other therapies are beginning to strengthen their regulation—by bringing together a range of the diverse bodies involved to hold joint discussions—and that is much to be welcomed.
Acupuncture has already attracted interest in the NHS. A BMA report on acupuncture, published in June 2000, identified a growing interest in acupuncture among GPs, and called for improvements and strengthening of its regulation. Acupuncture was one of the therapies included in the complementary medicine information pack that was sent to primary care groups in July 2000. The pack outlines a range of complementary therapies; it describes what is involved and sets out how primary care groups—and now primary care trusts—can begin to commission such services. It does not pretend to act as formal guidance, but highlights where complementary and alternative therapies can be useful.
The fact that acupuncture can help in treating nausea, back pain, tooth pain, migraine and other forms of pain is well recognised. It was the subject of a complete review of the evidence base that was published last November. 650 There is a developing recognition of the evidence base for acupuncture. It is important to note, however, that the therapy cannot apply to the whole range of ailments. It is essential that we have a good, strong, well recognised evidence base for such therapies.
The hon. Gentleman mentioned smoking cessation. A review of the evidence revealed that in 21 trials acupuncture was no better than placebos in securing long-term abstinence from smoking. In fact, it was less successful than nicotine replacement therapy. We must be aware of the contribution that can be made by acupuncture, while also being rigorous about the process. It is through such rigour that there will be acceptance, and people will feel confident and safe in making referrals. We need a balanced consideration of the issues.
Other sources have publicised the effective use of acupuncture. NHS Direct Online, in its new health encyclopaedia, includes advice on the use of acupuncture. It focuses mainly on types of pain relief, where it has been proven to be of most use.
As the hon. Gentleman said, the recent awards for good practice in integrated health care highlighted the work carried out in maternity provision at Derriford hospital. It has been suggested that the hospital might consider applying for beacon status, as a means of achieving wider dissemination and knowledge of the services provided in its maternity unit.
Acupuncture is already used by many, many NHS professionals. It would certainly be desirable if more of them could provide acupuncture. The hon. Gentleman mentioned the importance of doctor training and of ensuring that, through their curriculum and their education, doctors are made aware of the range of complementary therapies. The final draft of "Tomorrow's Doctors", currently being prepared by the professions, refers to the possibility of background instruction in complementary and alternative therapies for trainee doctors. That is an important step in ensuring that doctors are aware of the evidence base and the available therapies.
Even with more qualified NHS staff, however, there will be a need to expand the range of professional acupuncturists—those who practise that therapy exclusively—and there should be more scope for NHS providers to engage their services. That is why a new, professional, regulator of acupuncture could help the NHS by advising on the training and competencies needed by NHS staff to carry out those services. As the profession grows, equality of access to acupuncture on the NHS will ease considerably. Access is not universal and it will increase as the profession becomes more established and acquires more publicity and greater standing through regulation.
Acupuncture is generally considered relatively safe compared with other forms of treatment. However, in a few cases it has been known to have serious adverse effects, and its reliance on the insertion of needles clearly poses a risk to patients. Risk can be minimised by ensuring that acupuncture is administered to high standards of safety and competence by properly trained therapists. That requires effective regulation to define that competence and the necessary training standards, so that patients and the public can rely on the safety of the service.
By comparison with some of the other therapies, acupuncture already has in place many of the features that provide effective regulation on a voluntary basis. Most of 651 those who practise acupuncture full time are regulated by the British Acupuncture Council—an organisation of some 2,200 members that was formed in 1995 by bringing together the membership of five disparate professional groups. The council was favourably mentioned in a House of Lords Select Committee report, not least because the council had formed an independent accreditation board for educational standards and was well on the way to setting up proper regulation.
In this country, two different groups use acupuncture in different ways. One group consists mostly of professional acupuncturists, who are fully trained in the holistic Chinese approach. The hon. Gentleman has mentioned the relationship between traditional Chinese herbal medicine and acupuncture. The other group consists of established conventional health professionals, who are already regulated on a statutory basis in connection with their majority employment. Whether they are nurses, physiotherapists or general practitioners, they use acupuncture in their more conventional practice. They may have had more limited training and may make more limited use of acupuncture than the professional acupuncturists who operate full time.
It is very important that those two groups come together and collaborate. They have already carried out joint research, illustrated by articles published in the British Medical Journal in September last year, so the groups are considering such issues together. It is important that, when we begin to develop the regulation, damaging splits should not occur between the different forms of practice. Those groups have many issues in common, and they can come together to help to make the regulation effective, safe and of comfort to patients; and to ensure that the whole acupuncture profession can function properly in the future.
Safety is clearly a key issue for the Government. That is why we want to try to appoint a single, authentic source of professional expertise to protect patients' interests. I am extremely pleased that members of the British Acupuncture Council have supported the case for strong self-regulation. At its recent annual general meeting, the ballot was overwhelmingly in favour of taking forward such steps.
We want to ensure that we create the body with professional expertise, so that it can speak with authority on behalf of acupuncture as practised in the United Kingdom, and so that it can encourage competent practice. We also want to try to ensure that we embrace the whole range of approaches to acupuncture in taking that forward. We can build on the approach that has been taken in relation to herbal medicine by ensuring that we set up proper working groups to consider the issues, that those groups meet regularly and make recommendations, and that the Department of Health is involved.
652 The way in which herbal medicine has been taken forward—we are involving lay people—provides an important model to ensure that we have the widest possible agreement on such issues. A working group has been appointed to consider herbal medicine, and it is a little in advance of the one considering acupuncture at the moment, but I hope that both bodies can learn from their joint experience as they progress.
The working group on herbal medicine will make recommendations which will form the basis for a subsequent order under section 60 of the Health Act 1999. Clearly, there will be a great deal of work to do before we reach that point, but it is important that this be a joint enterprise with the Government, so that we can embrace the recommendations from the consultation exercise properly in the necessary legislation to give the professions a proper statutory footing.
It is important that the bodies play a major role in deciding how to make progress. This is not a matter for the Government to dictate; it is for the people involved in the service in the professions—the people who treat patients—to make their recommendations. I understand that there will be a meeting on 31 January when all the parties will get together. The Department of Health will be fully represented at that meeting, and we will begin to see dramatic progress.
I can tell the hon. Gentleman that we already support a great deal of research in this area. There are two major research projects, and about £350,000 is being spent on research, but clearly more work remains to be done. I understand that the hon. Gentleman was involved in preparations for the regulation of osteopathy and chiropractic medicine, and I am sure that his contributions will continue to be extremely helpful in developing the statutory regulation of herbal medicines and acupuncture. I urge him to maintain his involvement and to ensure that he continues to contribute to that process as it develops. Indeed, I urge other hon. Members who are members of the all-party group who have an interest in such issues to ensure that they take part in the consultation that takes place.
The hon. Gentleman asks about the Government's contribution to the cost of regulation. Clearly, regulation costs money. As professions become increasingly successful, the unit costs can be spread more widely and thus perhaps become more manageable. We will make a contribution in the form of the section 60 order, the preparations, and the consultation process. If there is a good, strong case for us to contribute to the profession's infrastructure, we shall certainly consider that in so far as we can.
§ The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at fifteen minutes to Eleven o'clock.