HL Deb 19 July 1982 vol 433 cc691-702

7.33 p.m.

Lord Seebohm rose to move, That this House takes note of the Report of the European Communities Committee on Radiation Protection (11th Report, 1981–82, H.L. 108).

The noble Lord said: My Lords, if I may start in a somewhat Irish manner, before I speak, may I say something. I believe we have only an hour for this debate, and therefore the speeches must be very short. I myself shall be very brief. Not only do we have to speak but also we have to have a reply from the Government Bench. I suggest that something like eight minutes is about the right length for any one speech.

The Select Committee on the European Communities has been examining a proposal for a Council directive laying down basic measures for the radiation protection of persons undergoing medical examination or treatment. The Select Committee's report has now been published, and the Government's views are sought on the acceptability of the conclusions and recommendations.

The subject is a highly technical one and it was several weeks before such phrases as a computerised tomological radiographical examination tripped lightly off the tongue. However, we were extremely lucky in obtaining the assistance of Sir Brian Windeyer, and internationally renowned radiologist, as our technical adviser. The committee is also indebted to the noble Lords, Lord Richardson and Lord Hill of Luton, who joined the sub-committee for the duration of the exercise. In addition, of course, we had oral and written evidence from a large number of bodies. I will not mention them all, but, among others, we heard from the DHSS, the Royal College of Radiologists, the National Radiological Protection Board, the Health and Safety Executive, the British Chiropractors Association, the British Acupuncture Association the Osteopathic Associates and the College of Osteopaths, the College of Radiographers, the British Medical Council, the General Medical Council, the General Dental Council, the Consumer Council, and so on. We therefore covered a fairly wide field.

The committee gained the impression that much legislation, and the work of the National Radiological Protection Board and the Health and Safety Executive, was primarily directed to the protection of the worker and practitioner rather than to the patient, and I give as an example the experience of a Member of your Lordships' House. He was having a tomological examination, which, as all your Lordships' know, is being photographed from a large number of angles, basically computerised, to help the diagnostician. He asked the radiographer whether she knew all about the dangers of radiation, and she said, "Oh, Yes, you do not have to worry; I am examined every month and if anything is wrong with me it will be found at once". So he said, "Well, what about me?" and the answer was, "Well,", and that was the end of the conversation.

This is not to say that the protection of patients in Great Britain is unsatisfactory; far from it. I would say that it probably compares more than favourably with any other European country. But, like most things, it could be improved. The reasons why the committee place such importance on the matter are these. First, the committee was informed that exposure to any dose of ionising radiation must be considered to be of danger to health, and there is no threshold below which there will be no effect. Secondly, radiation protection is based on the thesis that any dose in excess of natural radiation is potentially dangerous, not only to the recipient, but damaging effects could be passed on to future generations. Thirdly, the National Radiological Protection Board suggest that genetically significant doses could be reduced by 30 per cent. if greater attention were paid to protective techniques. For these and other reasons, and particularly for flexibility and for future development, and there are many developments on the stocks, it is very necessary that knowledge of these hazards should be widely disseminated.

As regards the directive itself, the committee concluded that the general principle of providing greater protection in the community should be strongly supported, but that the Government are right in opposing the original draft and in suggesting that a greatly shortened and simplified directive should be produced. It is understood that a number of amendments have already been discussed at expert level, although no revised draft has yet been issued by the secretariat. For instance, British radiological practice would not be able to carry on under the directive as originally drafted, but apparently the United Kingdom objections would largely be met from the new proposals, though I am not quite clear whether they go far enough.

These new proposals would appear to accord with the committee's views. Article 3 now appears likely to be largely altered so that British radiographers will be able to continue operating as at present, which they certainly would not under the directive that the committee have seen. Similarly under the same article as at present drafted, various users of radiological examinations, such as members of the British Chiropractors Association, and the osteopaths and the acupuncturists, would be stopped from continuing to practise as at present.

A later speaker will, I understand, be dealing with some of the alarming and costly administrative changes that would result from the adoption of the unamended directive, but it is the committee's view that this also is a very serious matter. Other points I think worth mentioning relate to the following articles. Article 2 has implications for the examination of immigrants and for fitness for employment. Under this article an individual would have the right to refuse to be examined by X-rays, but insurance companies consider that they would in consequence have the right to refuse to accept the contract or to raise the premium, and suggest that this sentence is the article be deleted.

I have already mentioned the position of radiographers and other paramedicals under Article 3, but this article also affects osteopaths, chiropractors and acupuncturists for the same reason. The committee, therefore, conclude that the introduction of some form of recognition on this context for paramedicals who conduct X-ray examinations should be considered by the Department of Health and Social Security in conjunction with the appropriate professional bodies concerned.

Article 5 deals with the exchange of information which is important in achieving a reduction in the duplication of X-ray examinations. It has been suggested that the carrying of cards, like vaccination cards, should be introduced, although we were told that it would probably be impracticable. On the other hand, I have heard in recent days that it is, in fact, in practice in France and it has not been found entirely unsatisfactory.

I shall leave Articles 6 and 7 to subsequent speakers. 'Therefore, while the committee believe that this country is not in need of a directive, the evidence shows that several of the other member states are far behind in these protective measures and from a Community point of view some direction could be beneficial, if not essential.

I shall leave the matter there. I have spoken in rather general terms, but others who have more expert knowledge will fill in the gaps. I look forward to hearing what they have to say and also to the Government's conclusions on our report. I have taken under eight minutes. My Lords, I beg to move.

Moved, That this House takes note of the report of the European Communities Committee on Radiation Protection (11th Report 1981–82, H.L. 108)—(Lord Seebohm.)

7.41 p.m.

Lord Richardson

My Lords, I speak as a doctor and therefore I want to emphasise some of the points that have been so ably made by the noble Lord, Lord Seebohm, that affect the practice of medicine particularly in this country. Radiographers are the people who take the photographs when we go to hospital and they, in their practice, are quite essential to the whole of radiography in this country. They are an independent profession although they are answerable to radiologists who are, of course, fully qualified and specialist qualified doctors.

Radiographers became a profession by the will of Parliament in 1960 and they set up a regulating body similar to other professional regulating bodies, such as the General Medical Council, under the Professions Supplementary to Medicine Act 1960. Their position, therefore, is essential to this country's medical services and must be firmly established.

A large number of people are treated by paramedical professional people such as oestopaths and chiropractors—literally manual practice. Their position is different in that they do not have a single registration body and they do not even have a single organisation for each discipline. This makes the position for them so much the more difficult and it was emphasised in evidence to us that some are well trained in radiological protection and, in fact, meet the requirements of the National Radiological Protection Board. However, this does not apply to them all. It would seem wrong to allow those who have not had satisfactory training in the protection of their patients, to use X-ray equipment. But, likewise, it would seem to be against the public interest to stop those who, after all, are legally entitled to practice medicine—as are most of the members of your Lordships' House here this evening—and who have been properly trained in radiological protection, to continue their practice as at present because much good practice by these people depends on good radiology. The noble Lord, Lord Seebohm, has drawn your Lordships' attention to the recommendation that consideration should be given to some recognition of the people engaged in paramedical fields.

On a broader canvas is the question of the results that could arise from the excellent intentions of some of the articles of the proposed directives. These, although unexceptionable at first glance, raise anxieties in the minds of those who can visualise them in practice. Everyone is anxious to raise standards. However, we are also anxious in case the directive should reduce standards by rigidity of performance and enforcement. The noble Lord, Lord Seebohm, mentioned the word "flexibility ".

The possibility of rigid application leads to anxiety under two headings. The first is the use of resources. Resources are, of course, scarce and I think always will be scarce. Moreover, expensive activities—and they will be dealt with, as the noble Lord, Lord Seebohm, has indicated by another of the noble Lords who is to speak tonight—can involve loss to other fields and the loss of the powers of decision as to how priorities for expenditure should best be distributed. The matters of which I am thinking come under Article 5: ensuring the availability of information about previous diagnostic radiological exposure—on the face of it quite unexceptionable; and under Article 6, dealing with an inventory to help decide what equipment is useful, effective and safe. Both are highly desirable but, as I believe we shall be told, highly expensive.

On the clinical side Article 2 with its list of desirable principles—namely, to give no more radiation than is required and so on—is again admirable but if too rigidly applied might lead to inefficient radiology and to the stultification of thinking both in a research sense and, indeed, in the case of the individual patient. There would be a loss of flexibility.

Going back to Article 5 and the question of the records, here again there would be a complication because information that would give, and most desirably give, a record of previous exposure, could lead to the deduction of a great deal about the individual—both physical and psychological—through the simple study of dates, the frequency of investigations and the nature of the examination. Thus it would not only pose a real threat to confidentiality with all the anxiety that that would raise in the minds of the individual patients, but it would also cause great concern to my profession who sets so much store by preserving the confidentiality of their patients.

Therefore, the risks of lack of flexibility, of rigidity, damaging practice are not illusory and the committee has given expression to this in its recommendation that the directive should be shortened and simplified but nevertheless should oblige member states to carry out, domestically, the general objective. The Committee and our witnesses, although seeing difficulties—as I have endeavoured to indicate—feel that where less organisation of these matters exists, something positive but simple and clear should be done.

7.50 p.m.

Lord McGregor of Durris

My Lords, the report of your committee carries on page 5 a remarkable table which shows the frequency of radiological examinations per thousand of the population among most of the developed societies. It demonstrates, provided that the data are accurate, that the Netherlands has nearly three times the frequency of examinations as does Great Britain; Switzerland has exactly three times; and Germany has four times the British frequency. Your committee had no evidence that the explanation for Britain being at the bottom of this league was to be found in public meanness or public thrift, rather, to the contrary, that the low rate was held to be evidence of the superior protection of citizens in this respect, which has been stressed by both the noble Lord, Lord Seebohm, and the noble Lord, Lord Richardson.

It is hard to know wherein the explanation lies. It may be that the explanation is within the organisation of health care or in circumstances which affect doctors' attitudes. It may well be, for example, that if they fear litigation for negligence, they may seek protection in undertaking a very large number of examinations which may be unnecessary. As the noble Lord, Lord Seebohm—the chairman of the committee—pointed out, it is very desirable to regulate exposure, because the committee was told that every exposure to ionising radiation carries with it a risk not only to the person being examined, but a risk of genetic hazard as well. Thus, examinations should only be undertaken if the benefits are likely to exceed the potential risks.

Many people nowadays fear radiation, and sensibly so. But properly used, surely these developments have been a tremendous advantage to mankind in the alleviation of suffering and it is, therefore, very necessary to retain a sense of proportion in assessing risks. Some doctors, skilled in this branch of medicine, believe that there would be great advantage in having many more critical evaluations of the usefulness of radiological investigations carried out on patients. One glance at the table that I mentioned must underline this point. How does one explain such remarkable differences in the frequency of investigations in countries practising the same medicine by doctors with much the same training and with a citizen body having much the same access to medical facilities?

But if one accepted that it would be useful to have more scientific inquiries rather than better regulations, or more regulations, one is then faced with what I understand to be a shortage of radiologists in this country. I am told that there are at the moment 117 vacancies for consultants in the specialty in the United Kingdom. This is a very surprising situation if one considers the usefulness of such a specialty for married women, who are at the stage of their careers of having families. It would seem, to a layman at any rate, that here is a field in which part-time work, or work at odd hours, could very usefully be performed without any interference, or without much interference, with normal routines. Nevertheless, we have a severe shortage.

If one turns from that sort of consideration—and I shall be very brief—to what, as a layman, again seems to me to be a vital aspect of the way in which the directive, as originally conceived, would impinge upon our arrangements, and if one examines—as the committee did—the arrangements for regulating the amount of ionising radiation to which citizens are opposed, at first sight there appears to be a hotch-potch of statutory provisions, codes of practice, professional standards and even suggestions coming from ethical committees. But if one attempts to disentangle the superficial appearance of chaos, what I think emerges is a characteristic situation in this country in which regulation is achieved by a variety of means within a framework—often a very small framework—of statute law.

It is clear from the evidence given to the committee that our system of regulation works very effectively. It has given us, so we are assured, the best system in Europe, and I very much hope that the Government will resist any suggestion of introducing the sort of rigidities into the system to which the noble Lord. Lord Richardson, referred.

7.58 p.m.

Lord Allen of Abbeydale

My Lords, one is bound to have sympathy with the underlying purpose of this draft directive and to acknowledge, notwithstanding what we have just heard, that there is quite considerable room for improvement in this country. But, as the report of the committee says, the draft seems to be somewhat over-rigid and, for my part, I should like to comment quite briefly on two aspects where I think there is a risk of the bureaucracy simply overdoing it. I speak as a bureaucrat of some years' standing.

The first is the requirement in Article 5(a), which would oblige member states to set up a system: allowing any practitioner who may be consulted to ascertain what previous radiological examinations a patient has undergone. One idea which was floated to us was mentioned by the noble Lord, Lord Seebohm; that is, that we should all have cards on which a note would be entered of any radiological examinations we undergo as the years roll on. Whatever happens in France or Germany, we had quite impressive evidence about the practical difficulties in this country of relying on every citizen keeping such a card up-to-date and remembering to have it available at the right time. I cannot imagine what would happen to immigrants and other people who did not have the great fortune to be brought up in an EEC country.

There may be force in the argument put to us by the Consumers' Association for a voluntary scheme which left the initiative to the individual, but that hardly amounts to having a system as required under the present draft. There was an alternative suggestion. That was to have a Swansea type computer, only bigger and better, which would maintain a central record of every examination in the National Health Service, private practice, the Services, in the dentist's surgery, by the osteopath and acupuncturist, and so on, and then all practitioners would be given access as occasion arose and, unlike Swansea, would be given an immediate reply. The cost and the practical problems of identification would be enormous. Then, on either course, card or computer, substantial problems would still remain.

I was impressed by the expert evidence that the chances of any such record being sufficiently accurate and detailed to be of real use were not all that great, and that the analogy with the simple, factual record of the vaccination certificate is really not a good one. The more sophisticated the record became the more this would aggravate the difficulty to which the noble Lord, Lord Richardson, has already referred; the confidentiality of medical records. Therefore, I think that this draft article in its present form gives rise to genuine practical difficulties and calls for rather more thought.

The second point relates to the draft Article 6, to which reference has already been made. This would require a member state to draw up an inventory of medical and dental equipment and to arrange for its surveillance. It is a subject already covered to some extent by the agreed 1978 directive, but the evidence brought it out that our current dispositions in this country fall short of perfection. It may be my fault, but it seemed to me that the present arrangements between the Health and Safety Executive, with their primary concern for the staff, and the National Radiological Protection Board, who in some respects act as the agents of the executive, are a bit hazy at the edges.

I also have the impression that there is hardly an abundance of qualified inspectors on either organisation and that dentists, for example, are not likely to be overburdened by visits from inspectors. At present, the executive simply does not know all the people who are using ionising radiation. Having said all that, however, considerable efforts are currently being made in the way of tightening up legal requirements, for example over notification, and issuing better and up-to-date guidelines. Like the noble Lord, Lord McGregor, I found it a bit of a morass. Things are being done. Admittedly, they are taking time, and quite a long time, but it is as nothing compared with the task of literally carrying out the draft directive. This task would be enormous and would raisea number of problems to which no one at present knows the answer, such as codifying the criteria in the highly complex area for the replacement of installations. We in this country can take a certain pride in the fact that if we enact a law, or enter into a treaty obligation, we make a conscientious attempt to carry out our obligations. I think that the obligations of these two articles in their present form are beyond us.

8.5 p.m.

Lord Alexander of Potterhill

My Lords, I joined Sub-Committee C, which prepared this report, because I had some experience and education. I am bound to say that as a member of Sub-Committee C I have been better educated on things about which I had very little knowledge than I had expected. My concern with this report is for the paramedicals, and particularly the osteopaths. Unless I misunderstand it, there is a danger, as the directive is drafted, that they would be debarred from what is now fairly regular practice. It is argued that some of the people who call themselves osteopaths are not properly qualified, and this is true. Anybody can put up a board and say that he is an osteopath. But, unless I am misinformed, you can equally put up a board and say you are a doctor, and nobody can stop you.

My concern is with the British School of Osteopathy which trains these people, and in my judgment effectively, and whose principal, Sir Norman Lindop, is a man for whom I have the highest respect, and who was principal of Hatfield Polytechnic for many years. The school has an X-ray clinic supervised by fully qualified radiologists and radiographers, and whose members, when they leave the college, are perfectly competent not necessarily to take X-rays—I do not think that is the issue—but to read X-rays, which is imperative if they are to do their work effectively. They must have access to X-rays. If this directive is carried out as at present drafted, unless I misunderstand it, they would be debarred from so doing. I would therefore hope, as the noble Lord, Lord Seebohm, has suggested, that the directive would be sufficiently amended to provide for that.

Our recommendation includes the suggestion that some appropriate form of recognition should be given to those in the paramedical group, and I think particularly of osteopaths, who have been appropriately trained. It has been suggested that this could mean giving them recognition in terms of the General Medical Council. I find this difficult to understand. Surely we can distinguish between osteopaths or other paramedicals who have been reasonably well-trained and who are satisfying appropriate requirements from those who have no such training. If that were done, then I see no difficulty in securing that access to the necessary X-ray information would enable osteopaths to do their work effectively.

I should add one thing—and I add it from personal experience. The medical profession must not claim that they are the only people who can deal with problems relating to health. I have three friends all of whom suffered from serious back troubles, including my own wife. She reached the stage where the medical profession proposed to operate after five months of trying to do something about it. By the grace of God she was cured in two weeks by an osteopath.

Lord Richardson

My Lords, before the noble Lord sits down, may I ask him a question? When he said that anyone could put the name or the title "doctor" legally in front of his name in this country, he does not recognise that it is a criminal offence to pretend to be a registered medical practitioner when not one. Anyone may practise medicine, but no one other than a registered medical practitioner may claim to be a registered medical practitioner.

Lord Alexander of Potterhill

My Lords, I fully accept that. I did not say that he would claim to be a registered medical practitioner. I said he could put up a board which says he is a doctor. So, can somebody put up a board and say that he is an osteopath, and he has no right to claim it, if he has no training, any more than the other.

8.10 p.m.

Lord Lyell

My Lords, the House will be very grateful indeed to my noble friend Lord Seebohm for introducing this subject today and, above all, for giving the House the opportunity to debate the report on radiation protection produced by the European Communities Select Committee of your Lordships' House, so ably chaired by Lord Seebohm. All of your Lordships who are responsible for the report are to be congratulated very warmly on preparing a document which, as we might have expected, is clear, concise and, above all, helpful.

The first of the Select Committee's recommendations is one with which the Government warmly agree. In discussions in Brussels our representatives have placed great emphasis on our concern for the well-being of people undergoing radiological diagnosis and treatment. They have stressed our resolve to maintain and, when we can reasonably do so, improve standards of radiation protection in the United Kingdom. But, like my noble friend and his companions on the Select Committee, the Government do not believe that the Commission has proposed the most suitable means of achieving these objectives.

I hope your Lordships will bear with me if I add a few points to the report's admirable sketch of the background to the proposal for a directive on radiation protection. The European Commission proposed a directive laying down basic measures for the radiation protection of persons undergoing medical examination or treatment. The proposal was referred by the Council of the European Communities to its Working Party on Atomic Questions—a title which filled me with considerable apprehension, but having read the report I was entirely mollified. From November last year until June this year, the draft was considered by an expert group set up by the working party. The expert group has now reported back to the working party, where the draft is due for further consideration.

At the first meeting of the expert group, the United Kingdom entered a general reservation regarding the proposed directive. This reservation still stands. We nevertheless took part in discussions of the articles of the draft directive, and our representatives were able to secure a number of significant changes in the draft. If the recommendations made by the expert group to the Working Party on Atomic Questions were adopted, they would result in a document differing substantially from the one initially drawn up by the Commission, and from the set of proposals which were available to the Select Committee.

I must tell your Lordships that there is some difficulty about the recommendations submitted by the expert group. The English text of a working document presented to the working party differs in a number of important respects from what the United Kingdom representatives understood to have been drawn up at the last meeting of the expert group. We are therefore asking for some corrections to be made. Assuming, however, that a new document is presented to the working party in a properly corrected form, it could result in the removal of many of the objectionable features of the original draft directive.

Paragraph 22 of the Select Committee's report quite rightly stresses that, if Article 1 of the draft directive were adopted in the form proposed when they were considering the matter, it would interfere with the radiological practice in this country. We think it would interfere to no great purpose, and to the detriment of some of the professions involved. It could limit the range of choice which people in this country have in seeking examination and treatment. If the expert group's recommendations were followed, Article 1 would be redrafted to allow medical procedures involving ionizing radiation to be carried out under suitably trained and competent practitioners other than doctors and dentists. The position of the paramedical professions, about which the noble Lord, Lord Alexander, in particular, expressed concern, would be more satisfactory if the expert group's recommendations were followed.

Article 2, as the Select Committee noted, suffered from a variety of defects. The expert group has proposed that it should be simplified. It would then refer to, and accord with, good medical and dental practice, in seeking to minimise patients' exposure to radiation. So would Article 4, in requiring a sound justification for the use of procedures involving radiation. Article 5, dealing with the exchange of information between practitioners about the radiation to which a patient has been subjected, would again be simplified, and would no longer demand the impracticable and expensive measures which the Select Committee rightly criticised.

Article 6 would undergo the least change as the result of proposals made by the expert group. It would still require the drawing up of inventories of radiological equipment and nuclear medical installations, and would still require all installations in use to be kept under surveillance with regard to radiological protection. The withdrawal or replacement of inadequate installations could be demanded under its provisions. The draft of Article 7 would, by contrast, require simply that member states should discourage the unnecessary proliferation of radiological equipment. It would also require that departments of radiotherapy and nuclear medicine should have a qualified expert in radiophysics readily available to them. In this form, it seems to be unexceptionable.

Your Lordships will see that the provisions of the draft directive in the form proposed by the expert group would be considerably more suitable to the situation in the United Kingdom than those of the original draft. Why, then, have we maintained our reservation regarding a directive? There are a number of reasons for this. First, we shall have to see what happens in the Working Party on Atomic Questions, where further discussion of the expert group's proposals is to take place, although, even if those proposals were accepted, there would be some problems with the draft. It is almost inevitable that a document prepared by a large multilingual committee should be less than elegantly drafted or consistent, but we hope such problems will be cleared up.

There are other, more fundamental, reasons for our stand. In the United Kingdom we take seriously our responsibilities in relation to European directives. We should expect to do everything necessary to comply fully with the requirements of any directive on radiation protection. We are advised that this would almost certainly require legislation. The implementation of such legislation could very well entail effort and expenditure out of all proportion to any benefits that could be gained in a field where the United Kingdom has a good record. For a long while we have had a code of practice for the protection of persons against ionizing radiations arising from medical and dental use. Figures show that radiological examinations occur less frequently in this country than in most others, as has been pointed out forcibly this evening. If we take an example, in relation to Article 6, we should need to be very sure that the expense of compiling full inventories of equipment was justified by a commensurate gain in radiation protection. There would be other objections to legislation. We find it difficult to see at present how some of the proposed provisions could satisfactory be embodied in it, or effectively enforced if they were.

We take the view taken by my noble friend Lord Seebohm and other members of the Select Committee when they said: The legislative or administrative means to pursue the underlying objectives of the draft Directive should be kept to Member States to decide". The situation is different in different countries. A directive at Community level is inappropriate. It is up to individual member states to decide on means, suitable to their own circumstances, of improving radiation protection.

Nothing I have said should suggest that, despite our good record, we or the medical profession are complacent. Far from it. Although we are justly proud of our position regarding the radiation protection of people under-going medical examinations or treatment, there is evidence that there is scope for reducing still further the number of x-rays taken. Studies by the Royal College of Radiologists and others suggest that not all radiological examinations are clinically necessary. This obviously requires careful consideration because it involves issues of clinical judgment. The Royal College is already aware of the problem and is considering what further study is necessary and what advice may need to be given to clinicians.

We should very much prefer that improvements in practice should be sought along lines such as these. As I said, we see considerable difficulties in trying to give effective legal form to some of the requirements of the proposed directive and in trying to implement them. The view which our representatives have put forward in the expert group, and in the Working Party on Atomic Questions, is that it would be sufficient to have from the Council a recommendation that the measures outlined in the draft should be introduced where appropriate. There are precedents for a recommendation of this kind. It would do nothing to prevent those countries which see a need for stronger action from taking it individually, but it would avoid the imposition on us of legislation which we believe to be quite necessary—I apologise to your Lordships; I should have said, "quite unnecessary". I was hastening both to cover the Government's view and to leave the noble Lord, Lord Seebohm, at least a moment or two to reflect upon it.

I am sure that your Lordships understand that the report before us can be no more than a progress report, since discussions are still continuing in the Working Party on Atomic Questions. However, I believe that there is support for our views among some other member states, and I trust that they will have the support of your Lordships' House for as long as we find it necessary to maintain them.

8.21 p.m.

Lord Seebohm

My Lords, I thank the noble Lord very warmly for his welcoming our report and for what he has said, which encourages us to realise that considerable studies and thought are continuing on this particular subject. I should like to leave with him two points about which we feel very strongly, as will be evident from what has been said today. One relates to the position of the radiographers, and the other is concerned with the position of the people who are so inelegantly, and inappropriately, called paramedics. Apart from that, I should like to thank very warmly my colleagues who have put such good flesh on the very bare bones of my remarks.

On Question, Motion agreed to.

Lord Skelmersdale

My Lords, I hope that your Lordships will not consider it inopportune for me to congratulate you upon the speed, succinctness and lucidity that you have displayed in regard to the complicated subject which has just been debated. Having said that, I beg to move that the House do now adjourn during pleasure until 8.35.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended front 8.22 until 8.35 p.m.]