§ 5.51 p.m.
§ Lord FERRIER rose to ask Her Majesty's Government whether they are prepared to contemplate any amendment of the Professions Supplementary to Medicine Act 1960 to encourage professions such as chiropractors and osteopaths to qualify for registration. The noble Lord said: My Lords, I beg leave to ask the Unstarred Question standing in my name on the Order Paper. May I in advance thank noble Lords who intend to speak, because I will not have an opportunity of so doing at the end of the debate. I am looking forward to their contributions, and consequently I shall be as brief as I can. When I put down this Question, I expected that Mrs. Joyce Butler's Osteopaths Bill would have been debated in the other place, but last Friday it was objected to and comes up again on 25th June. Consequently, I do not propose to refer to osteopaths, although I have mentioned them in my Question. I will confine myself to the subject of chiropractic.
When I asked a Question on 26th November 1974 regarding the exchange of X-ray records with the National Health Service, a noble Lord asked for a definition of "chiropractic". There is, of course, a complete and necessarily technical definition laid down by the European Chiropractors' Union, of which the British Chiropractors' Association is a member. To save time, I will quote the interpretation used in the New Zealand legislation of 1960. It is:
the examination and adjustment by hand of the segments of the human spinal column and pelvis"—
the emphasis is on manipulation, and on the Greek word "chiros" the hand. To return briefly to the question of non-exchange of X-ray plates between the
National Health Service and the chiropractic profession, this involves unnecessary exposure of patients to the risks inherent in radiography. I will leave it at that, but I feel it is something that should be put right.
§ My Lords, my intention is to divide my speech into three parts: first, how do I come to put down a Question at all? Secondly, why do I ask a Question by reference to the Professions Supplementary to Medicine Act? Thirdly, what amendments to that Act do I suggest? First of all, how am I concerned? Once upon a time and for many years my wife and I were fairly bold horse-persons, which is probably the modern way of putting it. We each had many a tumble, and one of hers ended my wife's riding for ever. It could have been worse; her sense of balance and eyesight were affected and it was only after four or five years' partial disablement that she was advised to consult a chiropractor. Manual adjustment of the vertebrae at the base of her skull provided a remedy, and after adjustments for a week or so, she could drive a car and ride a bicycle.
§ When I later came home from India and had an attack of back trouble which had plagued me since I was bucked off a young horse that I was breaking in 1924, my wife sent to to a chiropractor who dealt with it successfully though we still pay regular visits to keep things in adjustment. I have a neck injury resulting a motor accident which responds to this treatment.
§ But I resist the temptation to go on citing successful cases, of which I know many, because time is short and other noble Lords may feel able to do so. Therefore, I am no more than a satisfied patient. However, I venture to take up your Lordships' time because I happen to have been brought up by an uncle, an eminent physiologist, so I spent my boyhood in an atmosphere of medical research. I concluded my business career as the chairman of a group of pharmaceutical companies, so I know how little I know about healing. But I also know the pitfalls surrounding anyone who asks a Question like the one I am asking in a place like this.
§ Secondly, why do I ask my Question in this form? It is not because we as a family have benefited enormously from this science, but because of my confident 1014 belief that chiropractic has a contribution to make to the nation's health and wealth. A first step to that end might be the amendment of the Professions Supplementary to Medicines Act. It is not everyone who knows chiropraxy—I use this rather quaint French-Canadian word which I culled from Hansard of the Quebec Parliament on the subject. Furthermore, it is not everyone who can afford the treatment, if they know of it. Fees, incidentally, attract VAT, an extra which is surely unnecessary.
Back pain may be an inconvenience to the sportsman or games player, but it is a serious matter in every way when it affects the life and livelihood of working men and women. Last week, I was encouraged when I happened to listen to a BBC programme on Radio 4 called, "Finger on the Pulse", when in a recorded exchange between the BBC interviewer and the Minister of Health, Dr. David Owen, the latter said, inter alia:
We are also slightly worried that, for instance, things like backache, which can cost the nation as a whole anything up to well over £100 million a year, is a very under-researched problem, but you have to have fundamental research, so I am wanting much more public debate at this stage".
§ This was an encouragement to me. I am certain, as he must he, that there are many men and women who have been involved in industrial, agricultural or household strains or accidents, including motor accidents, who suffer the resultant ailments, pain and, indeed, incapacity, who could benefit from more general availability of this form of treatment.
§ It was not injuries to sportsmen that induced the New Zealand Parliament, in the face of bitter opposition from several quarters, to include chiropractic under the New Zealand National Health Scheme in 1960, 16 years ago. Other countries who do the same are Canada, the United States of America, Switzerland, Denmark, South Australia, Western Australia, Mexico—and the number is steadily growing. After all, the importance of the spine in the sphere of general health was recognised by Hippocrates. There are still cries of "quackery", "charlatan", and so on, but these were the rods with which the late Sir Herbert Barker was once chastised. I am now on the brink of one of the pitfalls, which I had better be careful about. One has to admit that up and down the country there are 1015 healers, practitioners who are not members of any discipline and who besides have hardly any specific training. Of course, this does not apply to chiropractors. The amendment of the Act could be a step to correct this difficulty by adding to Section 1(2).
§ In saying this, I do not decry the skills of some of these healers, bone-setters, call them what you will. I know of a shepherd in Tweedside who, apart from being in great demand up and down the Borders for the treatment of dislocations and the like in farm animals, has many successful cases to his credit in dealing with bone injuries to men and women. But, of course, there are people who have not got the experience or the lifelong training and gift that he has in his healing hands. The British Chiropractors' Association have already applied to the Council which is established under this Act, but their application has been refused, and, further, it, the Council, contends that it is not required under Section 10 to state any reason. But this matter is in dispute; I think it may well be that they are wrong in this contention. I had better leave it at that.
§ To digress for a moment, surprisingly one must realise that it is possible today for an official study on the subject of sciatica to be made without involving chiropractors at all, as your Lordships can see from the Answer to my Question for Written Answer which was given on 22nd January last year. This, to me, is an extraordinary situation. I have here some figures about the training of chiropractors under their present discipline, in which their course, in the Anglo-European College, involves 4,416 hours, compared with the Edinburgh University's medical course of 4,899 hours. Substantial training of this measure is not commonly known. I have here some figures about the doctors of chiropractic per head of population in different countries: USA, 1 to every 13,000; Canada, 1 to 20,000; New Zealand, 1 to 45,000; Denmark, 1 to 46,000; Australia, 1 to 56,000; Switzerland, 1 to 74,000; Norway, 1 to 81,000; Belgium, 1 to 125,000; Sweden, 1 to 336,000; France, 1 to 500,000; England and Wales, 1 to 635,000; Scotland, 1 to 871,000. They are interesting figures, which I mention only in passing.1016
Finally, my Lords, I turn to the third part of my contention. What Amendments to the PSM Act—I call it that for brevity's sake—do I suggest, if indeed they are necessary at all, to secure the registration of chiropractors? Basically I think that Section 1(2) should be extended to include chiropractors. The section is quite a short one, but rather interesting. It reads as follows:
For each of the following professions, that is to say, chiropodists, dietitians, medical laboratory technicians, occupational therapists, physiotherapists, radiographers and remedial gymnasts, there shall be a body, to be called the Chiropodists Board, the Dietitians Board, and similarly for the other professions, which shall have the general function of promoting high standards of professional education and professional conduct among members of the relevant profession, and the additional functions assigned to it by this Act.
Section 10 of the Act, to which I have already referred, gives overwhelming powers to the Council. Should not this section be overhauled to make it clear that the Department of Health, namely Parliament itself, should be the ultimate arbiter? Indeed, as I read the Act, Section 10 is quite specific. Under subsection (1)(a) the Council are empowered to extend the number of professions up to 12. There are only seven in the list I read to your Lordships from Section 1. Section 10 is a long one; only subsection (1)(a) is of importance to us. It says:
If the Council considers it appropriate, after consulting any existing boards appearing to the Council to be concerned—
§ I should not be surprised if the noble Lord who is to reply tells the House that there is no room in the legislative timetable for an amending Bill of this nature. This may be so. If so, it is a pity. But I make bold to suggest that the recognition of chiropractic is a matter of such immense importance that it should be tackled without delay. Can this be done without amending the Act? Cannot the Department of Health act independently of the Council? Of course, we have a Royal Commission in the offing, and presumably this matter will be part of its remit; I mean the matter of including chiropractic under the supplementary 1017 professions. But a Royal Commission means years of delay. I have here a copy of the Canadian Chiropractic Association's journal of May 1962 containing that Association's brief to the Canadian Royal Commission on the health service. I see that the Commission's public hearings lasted from June 1961 to June 1962, with evidence amounting to 3½ million words. But in addition 27 separate research studies were ordered by the Commission, one of which was a study of the chiropractic profession. Anyway, the outcome was a recognition of the profession throughout Canada, as I have said.
I feel that in the light of recent world experience and research there may he no need for this country to take so long. Of course, there are difficulties over some operators with minimal training, as I have mentioned, but this does not apply to qualified chiropractors, a number of whom are doctors of medicine. I remember that the first one to treat me was a doctor of medicine as well. A number of doctors of medicine are also chiropractors. The British Association has its own college and discipline and faculty. As someone wrote the other day:
There is a momentum in the chiropractic profession which makes it a dynamic and exciting one in which to be involved at this time.
§ In conclusion, I am no more than a satisfied customer, as I said. I do not even claim to be much of a politician, but your Lordships can include me in an answer Sir Geoffrey Howe gave on television the other day, when he was asked why he became a politician; he replied, "Because I care deeply about the society in which I live". Whatever may he the errors of chiropractors' ways, if there are any, I myself feel like the man whose outburst is described by Saint John in his Gospel, chapter IX, verse 25. My Lords, I beg to ask my Question.
§ 6.10 p.m.
§ Lord SANDYS
My Lords, the House will indeed be grateful to my noble friend Lord Ferrier for introducing this Question to your Lordships this evening. I must say that I think he has expanded the debate on health in an area which is very little explored. In this regard the Government must surely be particularly pleased that he has done so, being very much in line with what the Minister, Dr. David Owen, 1018 said in his broadcast so recently, as quoted by my noble friend Lord Ferrier. My noble friend has suggested to the Government that it might be a good idea to contemplate an amendment to an Act of Parliament, the Professions Supplementary to Medicine Act 1960. In your Lordships' House I think we consider our legislative role with great seriousness, and perhaps it would be of some benefit to relate this to the questions brought up in Sir David Renton's report on the preparation of legislation. Turning to Chapter 13 of that report, which I shall not quote, we have the subject title, "Amending Legislation", and it is a subject which we should approach with some trepidation. I am particularly grateful to my noble friend for bringing this subject forward so that we can air it, and I hope we shall follow the recommendations of Sir David Renton's Committee and consider the matter with care before contemplating any such change.
Alternative medicine is a subject which I think is of compelling interest to every one of us. Two sides of this field have been mentioned in my noble friend's Question, the professions of chiropraxis and osteopathy. I shall concentrate, in my short remarks, on osteopathy. An interesting article appeared in the Nursing Times so recently as 29th January this year. The subject of that article was to lay stress on the fact that osteopathy can cure such diverse conditions as asthma, migraine, sinusitis and similar conditions. But, as a whole, osteopathic medicine is a complete school of medical practice. It utilises scientifically accepted medical practice such as X-rays, and it lays particular emphasis on the muscular/skeletal structure of the human body and its relation to organ functions. On the skills demonstrated by osteopaths I am in no position to comment, since I am not an osteopath myself, but I believe that the manipulative skills are demonstrated very well in those who are cured patients, and I am particularly glad that my noble friend Lord Ferrier stands before us this evening as a cured patient of a sister profession.
One thing I think should be very clearly set out here in regard to the osteopath's profession is that the General Council and the Register of Osteopaths do their utmost to see that the standards of training and ethical behaviour are observed by members. It is of the 1019 greatest importance that the public should be protected by the highest professional standards; and it is of particular significance that a school was set up in this country, that a register has existed for over 40 years, and that the profession have maintained their own standards to the complete satisfaction of both the Department of Education and Science and local authorities, who are pleased to bring forward candidates.
My noble friend said that backache costs this country over £100 million a year. Surely on grounds of curing human suffering alone, quite apart from the financial aspect, we should consider all available means to see how this can be achieved. If, as my noble friend suggests, it would be a good idea to amend the law, that that would enable these two professions to be conducted in a better manner, then I hope that the Government will bring forward their suggestions. If, on the other hand, the Government feel that the state of the law is entirely satisfactory, I hope that they will say so.
§ 6.15 p.m.
§ Lord SOPER
My Lords, when I first saw this Notice of Question on the Order Paper I was attracted to it not least because of the overtones and undertones of meaning significance which I think lie above and below it. I am the more grateful for the introduction of this Question by the noble Lord, Lord Ferrier, and the way in which he has set out the areas in which the debate can profitably continue. I have no competence in this field. My therapy, such as it is, is directed to other organs of the human body than the spinal column, though we are in Scripture bidden to make the dry bones live. But I have evidence, which think is worth passing on to your Lordships, of the efficacy of chiropractic treatment and of the efficacy of osteopathic treatment.
I belong to the generation which enjoyed, and was sometimes I think exasperated by, the controversy between men like Barker and that Guernsey peasant De Putron Rabey, who was in many respects as competent in the effects he produced as was his more closely educated and equipped fellow practitioner. In this record of past events I could claim 1020 knowledge of many who have been materially, and in every other way, improved by chiropractic exercises, and indeed by osteopaths in general. It is for that reason that I am the more concerned that they should receive the kind of justification for, and should be enabled to be entitled to the same kind of status to which I believe they are now fully equipped and entitled.
May I delay your Lordships to make one comment about the twin areas of chiropraxis and osteopathy. There is one redeeming feature in the otherwise somewhat murky story now of the military achievements of Field Marshal J. C. Smuts which is often forgotten. I believe he was a great philosopher. His doctrine of holism has been underrated, even if it has been read at all. I think that the chiropractor and the osteopath are probably in touch with the inner meaning, or one of the inner meanings, of this philosophical idea.
Let me expatiate on it just a little. I have a very common gift which is called an ear for music; that is to say, if I hear one note I can hear the other notes that accompany it in the whole harmonic scale. Incidentally, it interests me that in the previous debate my noble friend Lord Davies of Leek was referring to the need for harmony; but he said he required both the white notes and the black notes, quite forgetting that for 3 keys at least you do not require the black notes at all, but you do require a sense of the whole of the harmonic entity. You have to possess what is called, I suppose, tonal sympathy.
It was none other than De Putron Rabey who told me that when he felt one bone he had a sense of feeling the whole structure of the system of bones. I cannot comment on that, except to say that it would not surprise me if what Field Marshal Smuts was saying about the doctrine of holism has a very relevant and impressive part to play in the further explication of this area of healing and therapy. Therefore, for that reason, what is a more profound one, I am disappointed that the Council set up by the Act of 1960 has refused the application of the chiropractors and has, what is more, as the noble Lord said, given no reason for so doing. Is there any right of appeal in this matter? The position seems to be quite unsatisfactory as it exists.
1021 I understand that osteopaths are not anxious at the moment to apply for permission to be added to the seven, to become nine, under the first section of the Act, but I am sure that the noble Lord is right when he insists that it would be very helpful during the Royal Commission's deliberations on the National Health Service if it took this matter into account. I do not find that there is sufficient evidence to amend the law—I think it is applicable as it stands—but I would ask the Minister by what means it could be facilitated in order to include, if he thinks it should, the very reputable area of chiropraxis and osteopathy.
The comment I wish to make now is, so to speak, professionally more in my line. There is a widespread increase of superstition at the moment, partly consequent on the failure of many organised religious beliefs in the minds of contemporary people and partly because of the charismatic movement, and it has been expressed in some of the exorcist controversies, of which your Lordships will know something. There is a tendency, to which I give evidence, to be much more superstitious in matters of medicine, and it would be a discipline on the part of those who practise chiropraxis and osteopathy if they could enjoy the kind of status by which they could be distinguished from the quacks, of whom there are many, and the number of those—for whom, as a social worker, I seek very imperfectly to do something—who suffer because of the predatory habits not only of the minor prophets but of the false prophets. This is a serious concern and growing menace and to distinguish between the sheep and the goats, to be represented in an organisation for therapy which has the imprimatur of recognition because it has undergone the disciplines required in order to be certificated is, I believe, one of the ways in which we ought—and I speak now for the profession to which I belong—to be urging the Government to do what they can to make it possible that in the field of medicine we do not lag behind those who, though they may not be able fully to express their discoveries in the scientific terms which would be required in an examination paper, nevertheless are in touch with realities which are still beyond the competence of many people in the traditional medical service.
1022 My Lords, I conclude by saying that there has always been a controversy between justification by faith and justification by works. We know now that faith owes its dynamic in many cases to the exercise of faith rather than to the direction of it, but the long-term effects of a misdirected faith are very dangerous. To be disciplined by the works that can be expressed within the framework (shall we say?) of the medical profession—the marriage of faith and works—is still one of the supreme requirements of an intelligent and helpful public service in relation to the health of the community. I believe that the medical profession will itself profit by the benefactions that can come from these new ways of expressing therapy, and I believe that those who are to be the recipients of this kind of help can be better protected if those who are qualified so to help them are disciplined in such a way as to leave out of account and to preclude the intrusion of the quack from whom we now suffer. I am glad that this Question has been raised, and once again I thank the noble Lord for raising it.
§ 6.24 p.m.
§ Lord PLATT
My Lords, I always find it difficult to speak following any speech made by the noble Lord, Lord Soper, and certainly I agreed with almost everything he said. I think, however, that there are things to be said, not on the other side—I do not want to make an antithesis of it—but about things which perhaps point in different directions. In passing, I would ask the noble Lord which three scales can be played without the use of black notes, but perhaps he would rather let me know in private after the debate.
§ Lord PLATT
The noble Lord and I can discuss that later. I regret that the noble Lord, Lord Amulree, is unable to be present for the debate, although he had put his name down to speak; he might have added considerably to our deliberations. I am also sad that the noble Lord, Lord Hunt of Fawley, who is one of the outstanding general practitioners in this country, is also unable to be here because I am sure that he would have been able to give us a most balanced picture of the present attitude of the medical practitioner to the question of 1023 chiropraxy and osteopathy. Having consulted the Concise Oxford Dictionary, which is not necessarily always right, I find that chiropraxis is manipulation of the spinal column as a method of curing disease, whereas osteopathy is manipulative surgery as a profession. This makes a certain distinction between the two; I suggest that it is a distinction of philosophy and belief which is rather important from the point of view of the members of the medical profession.
In other words, we are left with the impression—though as I said, the Dictionary is not always right—that the chiropractic really believes that he can cure disease by manipulation of the spinal column. What the disease is, of course, is not stated and it is not very clear from any of the chiropractors' literature which I have read. Osteopathy is given as manipulative surgery as a profession. In other words, the osteopath claims to have found some lesion which can be put right whereas the chiropractor tends to think that most disease can be influenced by manipulation of the spinal column. Those who, like myself and other members of the medical profession, have been brought up in a belief that what we do is based on scientific principles of anatomy and physiology, find it difficult to accept some of the claims of either of those professions, especially when, for example, they find some displacement of vertebrae which is not confirmed by some of the most distinguished radiologists in the profession.
None of this is to be construed as saying that I do not believe that some of these cures can be effected. Indeed, I am sure that the kind of experiences which have been told to us by the noble Lord, Lord Ferrier, have actually come about, and I believe that in the last 10 to 15 years or so the medical profession has had a rather changed attitude towards osteopathy and perhaps to a less extent chiropraxis in that it acknowledges, let us face it, that the medical profession is not very good at treating many things, including backache, and that people who have been brought up to study these conditions, even in a somewhat unorthodox way, can effect cures where the medical profession has signally failed to do so. So do not let anybody think that I rule the whole lot out on some kind of conventional medical law.
1024 So far as the actual practice of this subject is concerned, the law of the land does not prevent anybody from practising anything, nor anyone—qualified or not—from claiming to cure or to set out to cure a disease. That has certain exceptions, in that one may not advertise cancer cures because a very serious situation was beginning to develop and many people who were in agonies over their own or their relatives' illness were paying a great deal of money for quack remedies. So cancer cures are ruled out. Also, anybody who is not qualified in medicine and who professes to treat or to cure disease—which he has a perfect right to do—is up against certain limitations, in that he may not use certain dangerous drugs and cannot sign a death certificate, which is a little restriction on the complete freedom of treatment.
There have always been unorthodox practitioners and, in the long history of medicine and allied subjects, it has been known that the unorthodox has proved its case and been adopted as a recognised form of treatment. I would especially call your Lordships' attention to the question of acupuncture, which is now recognised as being a most interesting way of relieving pain—even of relieving pain during a major operation. So much is this so that medical scientists who have gone with an open mind to look at acupuncture have come back not only with the view that it can in certain cases do what it sets out to do but also believing that there are reasons for it. Those reasons are rather complicated to go into now and they reside in the question of pain fibres and the central nervous system. However, where the medical profession would at once depart from the acupuncture people is in certain beliefs which we find it very difficult to follow. For instance, they say that if one wants to cure the eyes one must put one's needle in in a certain place and if one wants to cure something else one must put it in somewhere else. This seems to us to be a combination of a built-up lore and—I will not go so far as to call it witch-doctoring—a belief in the supernatural which detracts from the real value of acupuncture.
We must face the fact that there is of course a slightly general disapproval on the part of the medical profession of unorthodox practices. Ruling out all those who have absolutely fixed views on 1025 all these matters and listening to those who have given them some study, I believe that the reasons for the disapproval of the medical profession are twofold. The first is, as I have said, that a certain number of claims for osteopathy and chiropraxis are based on principles which those who have been brought up in the science of medicine, anatomy and physiology, cannot accept. The second is that they may do harm. A doctor has always to be very careful that what he advises in the way of treatment will not do harm. He can never be quite sure and, in these days of modern medical science, he is even less sure that he is not doing harm. But the more ignorant end of the scale of unorthodox practitioners is in danger of doing harm. For instance, a continual pain in the back for which an osteopath may manipulate the spine could be due to a cancer of the prostate or elsewhere with secondaries in the spinal cord.
However, there are of course osteopaths who are medically qualified and, as far as I know, they are entirely reputable people. People in my own profession will recommend their patients to go to such osteopaths. As to the unqualified osteopaths, people in my own profession often say to their patients, "Why not see whether this man can do more for you than I have been able to do?" I believe that in the profession there has been a more liberal attitude towards osteopathy than was the case some time ago. However, I feel that a doctor should not delegate his authority to an unqualified practitioner. If his patient prefers to go to an osteopath or a chiropractor, I do not see why the doctor should stand in his way, but I do not feel that he should delegate his authority.
This brings me to the question of what happens in other countries. I have been in touch with an American professor who has a great knowledge of the practice of medicine in the United States. I brought up this question with him and he replied, "To us, this question of osteopaths and chiropractors is a State matter." In other words, it is not a Federal matter and the practice varies from State to State. Such is the chaotic state of medicine in the United States that there are States and large districts and regions which are completely under-doctored. Some have 1026 tried the experiment of allowing chiropractors to practice medicine after a sort of crash course, for instance, in the sort of things that one must know about modern antibiotics and so on. In the opinion of my friend, who is a person of very balanced opinions—and not a member of the AMA as far as I know—this has not really been a success, except that it may have done some good in cases where doctors were otherwise unobtainable.
I have also appealed to a personal friend who practises medicine in Canada and he told me much the same story. Chiropraxis has been registered in most of the Provinces of Canada. The doctors are mainly antagonistic, but that may be due to the entrenched positions which they hold. My friend suggests that the situation is far from satisfactory and asks why there should not be a collaborative investigation of the claims of chiropraxis. If its practitioners want to establish their position in the healing arts, they should be open to inspection by some kind of inquiry which would be as unprejudiced as it was possible to be. Osteopaths already have their own register, and there are many osteopaths medically qualified.
I end with the question of whether any action is due at all. People are free to practise medicine as they wish; patients are free to go to what kind of practitioner they like. If these practitioners of rather unorthodox medicine want to establish their position, it is up to them to take steps to do so.
§ Lord FERRIER
My Lords, I should like to raise a point with the noble Lord before he sits down. He referred to the delegating by the medical profession to other professions. But what of these professions mentioned in the Act; for instance, occupational therapists, physiotherapists, and remedial gymnasts? The medical profession does not hesitate to delegate some responsibility to them, does it?
§ Lord PLATT
My Lords, with respect to the noble Lord, that is just not so. They delegate certain treatment, just as one may delegate certain treatment to a nurse; that she must, for instance, give an injection to a certain patient every four hours. But they do not relax their own authority over the patient.
§ 6.42 p.m.
§ Lord CULLEN of ASHBOURNE
My Lords, I feel very much a layman after the very educational speech of the noble Lord, Lord Platt. I wish to thank my noble friend Lord Ferrier for introducing this debate. He limited himself to speaking about chiropractors, of which I know nothing personally, and I am speaking today only because for some years I have been chairman of the Osteopathic Educational Foundation, which is a registered charity involved in raising finance for the osteopathic profession. As the noble Lord, Lord Platt, mentioned, there has been an osteopathic register for 40 years, and I am glad to see the noble Lord, Lord Boothby, sitting in his place because it was he who first started this idea.
The objects of the register are:
First, to establish and maintain standards of education for practitioners of osteopathy, for the protection and benefit of the public. Secondly, to promote, assist, approve or co-operate with any universities, colleges, schools, hospitals, clinics or other bodies, institutions or establishments which may conform with the standards of the register in the matter of osteopathic education, research or practice. Thirdly, to keep a register of persons qualified to practice osteopathy in conformity with the standards of the register and to grant to such persons the right to use after their names any letters or additions showing they are admitted to membership of the register.Over many years this register has faithfully carried out its duties and has conscientiously ensured that high standards are maintained, or improved, as new techniques are developed. Members of the register come from two sources: first, the British School of Osteopathy, where students who need five "0" levels and two "A" levels to be eligible, do a four-year course of training; and, secondly, from the London College of Osteopathy where a one-year course of osteopathic training is given to registered medical practitioners.
I think that the best indication that the present system works satisfactorily is the fact that the relationship between doctors and osteopaths has improved so much in recent years. More and more doctors now send their patients for treatment for particular ailments, such as back pain, stiff necks et cetera, to osteopaths who are members of the register and hence have the letters "MRO" after their names. On the other side of that coin, patients now admit quite freely to their doctors that they have been treated by an osteopath 1028 or that they wish to have one recommended to them.
Therefore, I suggest to your Lordships that the present position as to the registration of osteopaths needs no alteration. If it is thought that some similar system should be instituted for chiropractors—which may, for all I know, be the case—I think that the register for osteopaths could be used as a model.
§ 6.45 p.m.
§ Lord BOOTHBY
My Lords, I wish to speak for only a few minutes. Many years ago, long before the war, I introduced in another place a Bill designed to give qualified osteopaths, after they had undergone whatever examination was required, the status that was necessary. Unfortunately, the Bill was rejected, and since then osteopaths who are not medically qualified have had a fairly raw deal. Like the noble Lord, Lord Platt, I know many osteopaths who are also medically qualified—Dr. Ronald Barbor for one—and they are first class. But there are many osteopaths who have no status at all. They are left out in the cold. They cannot qualify by any examination for any kind of status, and that is bad because I believe that they have a great part to play.
Some of my medical friends have told me that in certain cases, particularly in those of back trouble, surgery is seldom effective but manipulation is almost always successful. The osteopaths have had a raw deal, and I hope that the Government will look seriously at this matter. For some years I was the chairman of an association—of which Dr. Barbor was a member—which was set up for osteopaths and for the promotion of their cause and case, and I believe that everything that the noble Lord, Lord Ferrier, said is right. Why should these people not be given a status? My medical friends tell me that they have a real part to play, and I think that they have not had a square deal. Therefore I hope that Her Majesty's Government will follow up the suggestion of the noble Lord, Lord Ferrier, and reconsider the position of osteopaths.
§ 6.47 p.m.
My Lords, at this hour I do not wish to detain your 1029 Lordships, but as a doctor practising in a group general practice in an urban and mining area of the industrial North, in which we see many bad and painful backs, I welcome the opportunity to say a few words on this subject. I like to think that while perhaps I do not cure many, as the noble Lord, Lord Platt said, I do not make many of them worse. Practising in the circumstances I have described, I am increasingly made aware of the ever-widening gap between our present health resources and the ever-increasing work load in the field of health. When I look at that gap and at the difficulty which orthodox medicine has at the moment in coping with its workload, I must say that no doctor in his right mind would place any impediment in the way of any person or group of persons who want to do some of our work. So I accept that if people can help they should be enabled to do so.
I take the point made by the noble Lord, Lord Cullen of Ashbourne, that there is a register for osteopaths, and that may be satisfactory so far as it goes. But it does not go very far. If we once accept that any form of treatment is advantageous, efficient or efficacious—albeit for a minor group of conditions, or possibly a large group—and if there is a form of treatment which is valuable and which can help people, then it ought to be available not just generally but within the National Health Service. There is no way of making these things available within the National Health Service unless we proceed to a more elaborate form of registration.
There are two things to do here. First, there is the need to make the form of treatment available. Secondly, as has become clear already from what noble Lords have said, there is again the need to protect the public from exploitation and fraud. That, of course, is a very real need, and the noble Lord, Lord Platt, has referred to it. I think there is nothing more tragic than the sight of suffering, confused people, perhaps dealing with a child with an incurable condition, dragging the child round and round the world, clutching at fruitless straws and being exploited by people who are perfectly content to batten on the sufferings of human beings in that way. So there is a need for safeguards.
1030 But looking at the broader question, I say this. Looking at the future and at how we in medicine are to cope—and I think the Royal Commission, which has already been referred to, must look at this—we have to wonder how we can bridge the gap over the next few years when we have inadequate resources, on the one side, and an ever-increasing workload, on the other. It seems to me, my Lords, that there are two ways. One (which is wandering from the subject a little) is that perhaps we must encourage more and more people to realise and to understand that many medical conditions do not in point of fact need any treatment at all. I am not here making an impassioned plea for self-medication, but I am bound to say that the ideal self-medication is some substance which enables a person to pass the time profitably, beneficially and comfortably between the onset of some minor malady and its subsequent spontaneous recovery. So that is one thing, perhaps, which can do something to lighten the burden: the education of people to look after themselves. With that, of course, must go the education of people so that they will recognise danger signals which should prompt them to seek attention. That is one way.
The other way, I am absolutely sure, is by ensuring that more and more people are brought, in one way or another, into the field of health care. Every day in my practice I am conscious of the fact that the work I am doing could very often be done better by somebody else; perhaps by a social worker, perhaps by a marriage guidance counsellor, perhaps by an occupational therapist—by a whole number of people of that kind. I should not like to see medicine move to a whole series of specialists of one kind or another so that we had foot doctors, hand doctors, back doctors and so on. Somewhere, my Lords, there must be somebody who is going to be responsible, and continually responsible, for a whole patient, not a lot of little bits of a patient. But, accepting that it is the general practitioner who has to accept that total responsibility for the whole patient, then he needs as much assistance as he can have with different aspects of the patient's illness, and of the patient's life in general.
One of these aspects, of course, is this question of back pain. It is a subject 1031 which we understand very little about, as the noble Lord, Lord Platt, has said. But one thing we do know is that there is a great deal of it. Perhaps it is related to the fact that human connective tissue is probably constructed to last for about 40 years. Indeed, for millions of years that is all it did last; and perhaps, my Lords, many of us are now living on borrowed time, which is why our hair, our teeth, our joints and our muscles wear out. We have to accept it, I think, that human connective tissue does wear out, and there is a great deal of back pain in modern Western society. Perhaps it is a reflection of the way in which we live. We do funny jobs. We have miners working underground in bent conditions, abusing their bodies and their skeletons in all sorts of varieties of ways.
Indeed in many ways, my Lords, we abuse our bodies, and perhaps back pain is a product of our mechanised kind of life. If we all went back to walking on all fours, there might be less of it. But the fact remains that there is a great deal of it; and the fact also remains that it is utterly clear—and I cannot always understand why—that many so-called osteopaths or chiropractors (call them what you will) very often deal with this effectively when I cannot deal with it at all. If this is a fact, if it is established that these practitioners are able to give relief to patients suffering in this kind of way, then surely we must take some kind of step to see that they are enabled to give that relief within the orbit of the National Health Service, and to give it free. Why should the general practitioner's services he free, and the services of the dentists, the physiotherapists within the Hospital Service, the vocational guidance experts, speech therapists and so on? If it is established that the osteopath is valuable in a certain field of conditions, then surely we must take steps to see that his services are made available within the National Health Service; and that can be done only by the kind of system which we have introduced in the case of other professions covered by the Professions Suplementary to Medicine Act.
Therefore, my Lords, as I see it we have two needs in the future. The first is to 1032 recruit the aid, within the National Health Service, of all those who can assist in the general field of health care. Secondly, we have the need to protect the public from exploitation and from fraud. One of the difficulties which faces us—and the noble Lord, Lord Platt, has commented on this—is the question of definition. If we look back to a debate about osteopaths which took place in your Lordships' House more than 40 years ago—and I read that debate a long time ago—we see that osteopaths were very different things from what they are now. There was a time when people claimed, as osteopaths, that all illness was due to some kind of spinal malfunction, malformation or malposition; but I think things have changed, and so long as we see to it that the scrutiny is adequate and that the education of these people, again, is adequate, that their training is adequate and that they practise safely, then I believe that obstacles should not be placed in the way of their practising within the National Health Service. I put it no higher than that, my Lords.
There is a lot of work to be done, because not only must we look at the training arrangements; we must also see, too, that it is not too restrictive and that we do not create another closed shop. I am not referring to my own branch of the medical profession as a closed shop, though I do know that we look with certain suspicion at unorthodox practitioners. So do all professional people, be they solicitors or be they anything else; they look askance, I think, at anybody who is creeping in, unqualified in any kind of way. But I think there are benefits for the community as a whole to be had from looking at this kind of development.
Therefore, I welcome the move of the noble Lord in bringing this subject forward, because it has given us an opportunity to look at it. All I want to do is to make it clear that I believe the bulk of my profession would now approach this subject with a much more flexible, a much more liberal, attitude than they might have done in the past; and I hope that in the future we will have the open-door kind of policy, provided we have adequate scrutiny so as to protect the public from the very real dangers of exploitation and fraud which I do not need to go into in order to show your Lordships do genuinely exist.
§ Baroness GAITSKELL
My Lords, before the noble Lord sits down, may I ask him one very short question? From the Liberal Benches there has been more than a liberal attitude towards registration—an almost indulgent attitude—both by the noble Lord, Lord Winstanley, and the noble Lord, Lord Cullen of Ashbourne. I am sorry; I beg Lord Cullen's pardon. Surely, the public should be protected in this matter, especially if we are to have any of this under the National Health; because when we think of scientology, which takes unto itself both the word "church", and speaks from a religious point of view, and the word "psychotherapy", and also uses that, I think the public needs a lot of protection. I am all for the noble Lord, Lord Ferrier, and his attitude towards this.
My Lords, perhaps I may take up that point, because I understand the noble Lord, Lord Cullen of Ashbourne, is on the transfer list, though I am not quite sure. The point is one which, indeed, I endeavoured to make. I agree that, if we are to have the open-door policy, certainly we must have very careful scrutiny to see to it that the wrong things do not get through. I entirely agree with the noble Baroness.
§ 7 p.m.
§ Lord WELLS-PESTELL
My Lords, I wish to remind your Lordships of the Question, which is:To ask Her Majesty's Government whether they are prepared to contemplate any amendment of the Professions Supplementary to Medicine Act 1960 to encourage professions such as chiropractors and osteopaths to qualify for registration.This is a matter that the Government have been asked to pronounce upon. I want to resist the temptation to be drawn into any discussion or even to give an opinion upon the value or otherwise of chiropractic work. For the benefit of those of your Lordships who may not be familiar with the background of this discussion, perhaps your Lordships will allow me just to say that the Professions Supplementary to Medicine Act 1960 was passed, with the agreement of the professions concerned, in order to establish statutory registration as a means of securing adequate standards of qualification.
The Act makes registration boards
1034 responsible for the standards of professional education and professional conduct of eight of the health professions: namely, chiropodists, dietitians, medical laboratory technicians, occupational therapists, orthoptists, physiotherapists, radiographers and remedial gymnasts. It is the duty of each board to maintain a register of all those who are entitled to be registered; which is to say, essentially, all those who have attended a course of training and obtained a qualification approved in each case by the board and who have, obviously, paid the necessary fees—that is always important. The Act also provides for a Council for "Professions Supplementary to Medicine" with the general function of co-ordinating and supervising the activities, standard of selection and training of the eight boards that form the Council. I ought to say that the Council is made up of 23 members; 8 drawn from the medical profession, 8 representatives from each of the boards, and 7 lay members. I will not go into the details of by whom they are appointed; but there are 8 medical members, 8 representatives—one from each of the boards and 7 lay members, who make whatever decisions must be made.
§ Lord BOOTHBY
My Lords, may I ask the noble Lord one question? Where do the osteopaths come in? Are they represented?
§ Lord WELLS-PESTELL
My Lords, they are not represented for the simple reason that they are not one of the eight boards. I thinks I am right in saying to the noble Lord and if I am wrong I shall be corrected in due course that they have never attempted, and have never applied, to be registered as a statutory body. Therefore they are not one of the eight boards; in which case they are not represented. I hope that that satisfies the noble Lord.
My Lords, the Council places no restriction on practice in these professions by unregistered practitioners; although it is an offence for an unregistered practitioner falsely to represent himself as registered. Regulations made under the National Health Service Reorganisation Act restrict NHS employment to statutory registered members of the eight professions. That is the restriction. It restricts the employment of statutory-registered members to the eight professions.
1035 The first point that I should like to make is that the 1960 Act itself provides for an extension of its application to other professions which appear to the Council to be "supplementary to medicine" within a limit of 12 registration boards at any one time; so that it could be argued that there are four vacancies. They can admit 12 boards; at the present moment there are only eight. But in admitting another organisation as a statutory body and statutory board they would have to satisfy the Council that they meet whatever requirements the Council lays down. The machinery laid down provides for the initiative for such changes to emanate from the Council. This is the point that I want to make to the noble Lord, Lord Ferrier: that the machinery provides for the initiative for such changes to emanate from the Council in the form of a recommendation to the Privy Council. Both Councils are required to consult any existing registration boards which appear to be concerned. Changes are implemented by order made by the Privy Council subject to Affirmative Resolution of both Houses of Parliament. This procedure has already been used—in fact it was used as recently as 1966—to add orthoptists to those covered by the Act. The noble Lord, Lord Ferrier, if I remember correctly, suggested that this should be the function of Parliament; that it is really a matter for Parliament, for both Houses, to decide who should be accepted or who should not be accepted.
§ Lord FERRIER
My Lords, what I intended to indicate is that I am informed there is some doubt legally about the interpretation of the Act. I suggested that if this doubt does exist, to leave it entirely with the Council might even be interpreted as saying that it is not with Parliament to say that we must have osteopaths and chiropractors as "supplementary".
§ Lord WELLS-PESTELL
My Lords, I take the noble Lord's point. But he is a very experienced Member of this House, and he will know better than many of us without his experience, that it is quite impossible for Parliament to accept responsibility for everything done. The most that Parliament can do is to prepare a Bill, to get that Bill through Parliament 1036 so that it becomes an Act, giving authorities at various levels the power to do certain things and, in some cases, to make those actions mandatory. We could not, as Parliament, be responsible for passing legislation to meet every kind of situation. What I want to suggest is that this Act, the Professions Supplementary to Medicine Act, lays down procedures whereby bodies which can render some useful service and, in some cases, expert service to the medical profession can apply to be created members of the Council by being made statutory boards. I do not think that Parliament can go much beyond that. It gives this to the Council and the Privy Council has some control over that Council. I should have thought that that in itself would be as far as Parliament could go. It could not take upon itself the responsibility of deciding on all the small issues.
There were two particular professions mentioned in the noble Lord's Question—and I am not saying this unkindly; but I do not think he mentioned osteopathy which was one of them. The one he dwelt on was chiropractice. He mentioned that they approached the Council for Professions Supplementary to Medicines last year, with a view to setting machinery in motion; but I understand, as the noble Lord rightly pointed out, that the application by the British Chiropractors' Association did not meet with success. Nevertheless, while I take the point that he made, the Government do not regard it as desirable in consequence of the refusal by the Council to consider amending the Act itself, to make it easier for such groups to be brought within its scope. I think that it was implicit in what the noble Lord said that something ought to be done to make it easier. If I may say so, I hope, kindly, the last thing that we want to do and which your Lordships want to do, would be to take some action which would open the door wider when it ought to be (shall I say?) pretty tight; and the only thing that I can say at this stage is that, as I understand the Act, there is nothing to prevent the British Chiropractic Association from appealing to the Privy Council. As I understand the situation—and again I must confess it is my interpretation rather than that of anybody else; I wish the noble and learned Lord had the Act in front of him—
§ Lord FERRIER
My Lords, what I have heard is possibly what is going to happen—an appeal to the Privy Council.
§ Lord WELLS-PESTELL
My Lords, I wonder if I might read from Section 11 of the Act to get it on the record, mainly for the benefit of noble Lords who are interested and who have not participated in this debate:If it appears to the Privy Council, either in consequence of representations made to them or for any other reason, that the Council"—that is the Council responsible for the statutory boards—or a board has failed either generally or in a particular case to do, or to do satisfactorily, any thing which under this Act that body has a power or a duty to do, the Privy Council may if they think fit, subject to subsection (3) of this section, direct that body to do the thing in such manner and within such period as may be specified by the directions; and any such directions should be enforceable by mandamus on the application of the Privy Council".
§ Lord BOOTHBY
My Lords, I hope that the noble Lord will forgive me if I interrupt him once again. Does what he is saying now also apply to the osteopaths if they chose to apply to the Privy Council?
§ Lord WELLS-PESTELL
My Lords, my understanding of the Act is they would have to apply to the Council for the professions supplementary to medicine for acceptance as a statutory body. If they were turned down then I am suggesting that they would have a right of appeal to the Privy Council. The one has to come before the other.
§ Lord CULLEN of ASHBOURNE
My Lords, may I make it clear that, so far as I know, the osteopathic profession does not want to be included in the same way as the chiropractors evidently do. They are very happy with the arrangement as it now stands.
§ Lord WELLS-PESTELL
My Lords, I am being very good tempered. I am supposed to be replying to an Unstarred Question. This is not really a debate. I think I must continue otherwise I shall lose the thread of what I am saying. It would, in the Government's opinion, breach the spirit of the Act of Parliament to present the professions who are currently covered with an amended Act which 1038 would encourage or compel the Council to accept extensions they may feel unable to accept as the Act stands, or solely designed to make its provisions more acceptable to other professions who are seeking a system of registration. It could certainly not be done without the fullest consent and consultation with the Council itself and with the professions. The Government's view is that, if a new profession is not or cannot be brought within the scope of the 1960 Act by means of the machinery already provided, a solution to that profession's problems must be sought by means other than legislation. I think this was the point which the noble Lord, Lord Cullen of Ashbourne, was making a moment ago.
Mention of the principle of self-governing professions prompts me to suggest an alternative line of approach. There is nothing to prevent any group from beginning themselves the process of self-regulation; indeed, this is commonly the way in which professions set about establishing themselves. The other particular profession referred to in the noble Lord's Question but, as I said, not in his speech, the osteopaths, are certainly a case in point. There already exists the non-statutory General Council and Register of Osteopaths set up in 1936, following a recommendation by the then Ministry of Health to a Select Committee of Inquiry of the House of Lords into a Bill introduced by the late Lord Elibank to regulate osteopathy. The objects of this register are threefold: first, to establish and maintain standards of education for practitioners of osteopathy for the protection and benefit of the public; secondly, to promote, assist, approve or co-operate with any institutions or establishments which may conform with the standards of the Register and to grant to such persons the right to use after their names any letters or additions showing that they are admitted to membership of the Register. So far as the Government are aware, the Register is fulfilling its original aims to the satisfaction of its practising osteopathic members.
I am aware that there are practising osteopaths who are not on the Register, and some of them would welcome statutory registration. This was the point which the noble Lord, Lord Boothby, raised. But I have to say in fairness that differences of view on this and on standards of training 1039 issues for the osteopathic organisations themselves, and before anything further can be done they have to resolve their own difficulties on this matter. A broad measure of agreement within the profession as to what is required seems to me to be a prerequisite to any detailed consideration of proposals for statutory registration. As the noble Lord, Lord Cullen of Ash-bourne, pointed out a moment ago, they do not want to be a statutory board; they are content to go on with things as they are now.
I want to try to answer one or two matters which have been raised which I have not dealt with, although in my main reply I have dealt with a number of them. There was the matter raised by the noble Lord, Lord Ferrier, and by my noble friend Lord Soper about the Royal Commission. My understanding of the situation is that the Royal Commission has an authority to look at anything and everything that impinges not only on the National Health Service, but upon what is good for people. I have before me a statement made recently by the Chairman of the Royal Commission, Sir Alec Merrison, which says:Our terms of reference cover all—and I stress the word—matters which are properly the concern of patients and National Health Service Workers…It will be of crucial importance to our work to get the views of all those concerned with the National Health Service".And this may be helpful to both noble Lords:
Consequently we want to involve the public as far as possible in the exercise. We hope therefore that anybody who has opinions to offer will not hesitate to write to us.I can see no reason at all why the British Chiropractic Association should not submit a Memorandum to the Royal Commission. I do not know whether it would be acceptable. I say that I see no reason why anybody who feels they have a contribution to make to the National Health Service in the future should not be asked to be seen and heard. I must leave this to both noble Lords to pursue if they think it desirable to do so. The noble Lord, Lord Ferrier—I am speaking from memory—mentioned the cost of something like £100 million a year.
§ Lord FERRIER
My Lords, the figure was mentioned by Dr. David Owen, the 1040 Minister. He said something over £100 million a year.
§ Lord WELLS-PESTELL
My Lords, I have the statement in front of me now. I could not remember whether or not the noble Lord mentioned it. Among other things, my honourable friend the Minister of State said, on 5th May:We are…worried that, for instance, things like backache which can cost the nation as a whole anything up to well over £100 million a year is a very under-researched problem…My Lords, one may say, "What are the Government doing about it?" I said I wanted to avoid making any judgments about the two matters which are before us this afternoon, I am only concerned with the Question. We feel, both as a Department and a Government, that there has to be fundamental research into this matter. The noble Lord, Lord Platt, emphasised that, whatever we think we may know, we have to know a great deal more. I think that I am at liberty to say that my honourable friend the Minister of State for Health wants more and more public debate on this matter.
Some time ago, although not as a result of this Question, we approached the Medical Research Council with a view to having some planned research done in depth into this matter. I mention that because we feel this is the way to go about it; and I mention it also so that noble Lords may be assured that these are not just pious words expressing the Government's intention, but that they have been translated into action. My personal feeling is that the noble Lord, Lord Ferrier, if I may say so without impertinence, has served a very useful purpose this afternoon, because he is doing what my honourable friend the Minister of State wants; in other words, enabling more and more public debate to take place on this matter.