HL Deb 27 February 1985 vol 460 cc970-92

5.17 p.m.

Viscount Massereene and Ferrard rose to call attention to the recent developments in natural medicine and the need for an independent register of qualified practitioners based on the register of the Institute for Complementary Medicine; and to move for Papers.

The noble Viscount said: My Lords, my reason for putting down this Motion for debate is that I wish to draw attention to the greatly increasing numbers of the public who are now benefiting from the various therapeutic treatment and medicines. The natural medicines, and the therapies, do not impinge in any way on orthodox medicine, surgery, and our excellent emergency services. However, your Lordships may ask why I, of all people, have brought up this matter, since it is not exactly my line of country. I agree, but I have many friends and acquaintances who have had their various aches and pains cured by practitioners in these therapies when their GPs have failed to achieve this.

You may also ask why I have drawn attention to the Institute for Complementary Medicine and why I have put them in my Motion as, in my opinion, they are the most important of the associations dealing in this matter of the therapies. I appreciate that there are other associations and I do not wish to criticise them in any way. All I would say is that I wish that they would all get together and stop being what I would call rather fragmented.

The Institute for Complementary Medicine has 54 branches in the country, apart from its headquarters in Portland Place. Last year it had 4½ million consultations and the numbers of these consultations are apparently growing every year. The institute also has an international network of collaborators. It was the first to institute and initiate pure research into natural therapies in the United Kingdom. It also has a good computer-based reference library, including practitioners and their patients, and an information centre totalling 1,200 organisations. That is the chief reason I chose the Institute for Complementary Medicine, because it appears to me that it is the leader in the therapies, though that is only my opinion.

I have often thought that, with a little official encouragement, treatment by qualified practitioners of the five basic therapies would save the National Health Service many millions of pounds. I have always been interested in trying to make suggestions for cutting down public expenditure. Last year the drug bill for the National Health Service was £1½ billion. That is a staggering figure. That sum would build many new hospitals, probably as many as 50 or 60 or even, I am told, up to 70. It would also equip many hospitals with the most up-to-date electronic instruments. It seems absurd that that vast amount of money should be paid out for drugs.

My only personal experience of being cured by therapy treatment was a long time ago. I put my cartilage out and could not walk because my knee was doubled up. My GP could do nothing about it and neither could another GP to whom I went. I was advised that I should have to be treated by the surgeon's knife. I did not fancy that because I was reasonably young then and quite active. I thought that if the surgeons got at my knee I should probably not be able to climb or run so well. So I went to what in those days was called a "quack". He made up a preparation which appeared to be a mixture of iodine and castor oil. I thought "Oh, my God, he is going to ask me to drink this muck". Of course he did not ask me to do that, but he massaged my knee two or three times with this amazing mixture and I have never again had any trouble since. That made me think a bit. But I would hardly call that a natural medicine; it was a bit too simple for that.

When we speak of natural medicine, I am sure—though I may be wrong—that many of your Lordships do not realise that 39 factories manufacture these natural medicines, with a turnover of £50 million a year. This is increasing every year. The new rules regarding medicine that came in with the 1968 Act and the thalidomide tragedy, which was caused by synthetic medicine, quite rightly made the reviewing of medicines far stricter than perhaps it had been. Under that Act, the Minister was bound to have on his commission of experts representation from the Natural Medicines Group, under whom these factories operate. The Minister had that provision to start with, but apparently today there is no such expert from the Natural Medicines Group to advise the commission. The members of the commission are all experts in their sphere, but their sphere is not natural medicine. It is rather like appointing a zoologist to a committee of botanists. What the Natural Medicines Group wants is to go back to the position that existed after the 1968 Act and to have some representation on the Minister's commission.

I should like to ask the Minister if he will pass that on to the appropriate department in the Department of Health and Social Security to see whether the natural medicines group can be given representation on this commission. It seems wrong that it is not represented. I feel that if it is not, the commission will, in time, phase out natural medicines. That would be a disaster, for there would then be a surge of unlicensed medicines because the public use these medicines and the practice is growing. It would be unfortunate if that happened, because no one wants the market flooded with unlicensed medicines.

The other matter I should like to raise is that I do not understand why there cannot be more harmony between orthodox medicine and the therapy practitioners. It is a growing movement today. Plato said in the Republic in 382 BC that the cure of the part should not be attempted without treatment of the whole. It is a great error of our day in the treatment of the human body that physicians first separate the soul from the body.

I will not go into the details of the therapies because many of your Lordships will know more than I do, but there are basically five therapies, and I may say that their names are very difficult to pronounce: osteopathy, chiropraxis, herbal medicine, homeopathy and acupuncture. The Institute of Complementary Medicine does have leading practitioners in all these services.

I believe we must remember that, in our urban society—and I think that we are 90 per cent. urban in this country—the strains of living in modern society have brought tensions of mind which, of course, also bring physical tensions to the body that were quite unknown to our forefathers. The therapies come into their own here. They play a great part in the nation's health.

The Institute of Complementary Medicine is extremely concerned at the quality of professional practitioners. Training is of particular concern to the institute because, if there is not excellent training and complete safety, the public will not have full confidence. One of the things that the institute is doing as regards education is setting up institutions which have education committees to assess the various curricula. Training in these therapies varies according to the discipline. The study time ranges from two to six years and students also have to understand the essential medical sciences.

My Lords, I think that I have spoken long enough, but I should like to say that I believe there should be some official acknowledgment; for it is very disheartening for students—and some of these young people are brilliant and rise to the heights of their profession—that there is no such acknowledgment. I really cannot see why it should not be granted. I appreciate that some of the associations within the therapies do not always see eye to eye, but I entreat them to try to come together, because otherwise I imagine that they will not get this official acknowledgment—by which I mean that, if they have official acknowledgment, then, like the dentists (and I assume that students in dentistry get grants) they will get grants just as do other students. Even students doing pottery get grants. How much more important, surely, is it that students who are saving people from suffering should get grants? It is not that I am asking for grants. The institute, like many others of these associations, is a charitable effort, for which I think it is much to be admired.

My Lords, I should like to end on the point that, again, I implore the various associations who practise these therapies to try to come together. The Institute of Complementary Medicine obviously has no wish to try to monopolise—in fact, they could not do so—the various other associations; but I feel that it offers a kind of shell within which the various associations could come together and form a loose federation. Eventually it might happen that one day it would become affiliated to the BMA. I have great respect for the BMA, but I hope that it will not follow King Canute in regard to the natural medicines and therapies—because it will not hold back the tide; this is a growing organisation. I beg to move for Papers.

5.36 p.m.

Lord Winstanley

My Lords, I am sure that I speak for all noble Lords when I say how delighted I was to hear that the noble Viscount had been saved those years ago from the surgeon's knife. The story that the noble Viscount told is one which, as a doctor, I have heard on many occasions. But I say that it is an important story and the message contained in it should not be lost on any of us. The noble Viscount, Lord Massereene and Ferrard, has done us all a service by raising a matter of the utmost importance but also one of very considerble complexity

I hope that the noble Viscount will forgive me if I say that I am not yet entirely convinced that the method he has seized upon—that is via the register of the Institute of Complementary Medicine—is necessarily the right method whereby we should deal with this whole business. But I do say that a method must be found and, when found, that that method should cover not just "natural medicine"—whatever that is; it is referred to specifically in the Motion—but, of course, other new forms of treatment as well.

These new forms of treatment—some of them are not all that new; some are very old indeed—are more usually referred to collectively as alternative medicine. Some refer to this by other titles, such as complementary medicine, fringe medicine, natural medicine, and so on; while opponents still talk bluntly of quacks. I am not one of the opponents but I should like to begin by underlining some of the snags which lie in the way of opening the doors of medicine to unorthodox practitioners.

There have always been fully qualified, properly registered, doctors whose methods of treatment were very far from orthodox. In fact, progress is only made by people having the courage and the independence to escape from orthodoxy. In his day, for example, Jenner, whose work saw the end of smallpox, was regarded as highly unorthodox; and Pasteur and Freud were dismissed by some as dangerous quacks. If, once accepted, methods of medical practice were regarded as accepted for all time, we should still be back in the days of Galen—and those who know anything at all about medicine will know that that was indeed a very long time ago.

Thus, I say that it is extremely dangerous, in my view, to acquire the habit of automatically resisting anything new. That is something of which my profession has very often been accused, sometimes, I acknowledge, with justification. On the other hand—and I say this as a matter of some importance—it seems to me that there are equal dangers in embracing every new idea with uncritical enthusiasm. So where does that leave things like acupuncture, faith healing, chiropraxis, naturopathy, homeopathy, and all the others which may receive mention in our debate in the House today?

It is still not fully understood by the lay public, nor is it understood even by some doctors, that the law does not give doctors a monopoly over the treatment of patients. The Dental Act, on the other hand, makes it a criminal offence for any but a registered dental practitioner to carry out dental treatment, except for those working legitimately under the direct control and supervision of dentists. Similarly, the Opticians Act gives opticians a monopoly, which Parliament has recently, and wisely in my view, weakened—a monopoly over optometry and related matters. Qualified and registered pharmacists have a monopoly over the sale and dispensing of certain drugs. Solicitors still have, but only just, a monopoly over house conveyancing.

What surprises many people is that it is not an offence for anybody to examine and treat patients, provided that teeth and eyes are not treated and that controlled drugs are not used. If my recollection is correct, the only other legal restraints are that it is an offence for unregistered people to treat pulmonary tuberculosis or venereal disease. Otherwise the sky is the limit and an engine driver is perfectly free to diagnose and treat cancer or diabetes, although he cannot represent himself as being a registered medical practitioner when he is not: nor, of course, is he immune from prosecution for damages should he cause damage.

As an example, many years ago in North Wales, a very severely injured miner used his compensation money, which was quite considerable, to purchase and set up a shop as a herbalist. He treated anything: he treated anybody who came into the shop. When fire destroyed his premises at the end of his first year in business, his loss-of-profits claim, as settled by insurers—I know this as a matter of fact—amounted to £200 per week. That was in the 1930s and that man had no training, except as a collier, and he may very well have had no skills.

I am not making any plea here for the law to be altered to make granny a criminal if she advises her grandchildren about their warts; but this does indicate that there are two sides to this argument about opening our doors to all exponents of alternative medicine. My view, as a doctor, is clear. If people have skills which can help our patients—and thus help us as doctors—they should be enabled to use those skills. And if those skills are worth having, they are worth having in the National Health Service. Some, though not all, chiropractors have proved beyond peradventure that they have skills which we doctors do not possess, and it is foolish to deny our patients access to those skills.

But which chiropractors and which osteopaths? Therein lies the problem. Some are highly trained and highly qualified, but others merely call themselves osteopaths—and the chap next door can do that whenever he likes. The Professions Supplementary to Medicine Act provides for the proper recognition of those professions which have put their own houses in order by setting standards of training and qualification and by imposing standards of conduct on their members. The Act came into force in 1960 and I think it has been subject to perhaps one amendment since. I think it is clearly time that other skills and other groups of practitioners were added to it.

It is well known (no doubt the noble Lord, Lord Ferrier, when he comes to speak will also refer to this) that in New Zealand the chiropractors have done exactly that: in other words, they have put their own house in order. The result is that New Zealand citizens can now have access to them in the same way as they have access to doctors. Here in Britain nearly all these professions (if that is the right word) of alternative medicine are at present in an uncontrolled state, similar to the uncontrolled state of the estate agents. For years and years, in your Lordships' House and in another place, Members have been talking about the need for some kind of regulation of the estate agents. It cannot be done until they put their own house in order. The same applies to some of the practitioners who have real skills and real ability. But they, too, collectively, must put their own house in order. Until their ranks are organised and their people are trained and registered, they cannot really be let in, if I may use that phrase, if the public are to be protected against fraud, exploitation and incompetence.

I think we should proceed by way of the Professions Supplementary to Medicine Act, which was passed, as I said, in 1960. It is high time that some of the professions (again, if that is the proper word) which we are now considering organised themselves in such a way that the 1960 Act could deal with them. The early part of the Act deals with the establishment and maintenance of registers, qualifications for registration, approval of courses, qualifications and institutions, supervision of approved institutions and examinations for approved qualifications, and so on. There are disciplinary provisions for investigating complaints and for the removal of names from the register for crime, infamous conduct, and so on.

What is needed is, first, to guarantee to the public that people who are giving treatment of one form or another possess the necessary degree of skill, and, secondly, that they are operating within clearly defined guidelines of ethical and professional conduct. Until that can be done, I do not feel we can make a great deal of progress. I think I should say here that it is recognised that fully registered doctors have been trained in, and have practised, homoeopathy, acupuncture and osteopathy for years, and now our profession seems to be encouraging doctors to acquire those skills. There are some who may say that that is just an attempt to keep others out. I hope not. Perhaps it might indicate a new spirit of liberalism among doctors.

Perhaps before I finish, which will be very shortly, I might just refer to one other point which was raised by the noble Viscount. He referred to the nation's drug bill and to our dependence, as a nation, on physical remedies of one kind or another. I think he made a very important point indeed there—and I can assure the noble Lord, Lord Glenarthur, that I am not going to start talking about restricted lists, be they black or white, or about any of the other controversial matters about which we have had so much discussion recently. But the noble Viscount was quite right: the drugs bill is too high. In part the responsibility rests with my profession of medicine, because it is so much simpler and easier to give a patient a bottle of inert medicine than to spend 20 minutes explaining that he does not need any medicine at all and that the condition will get better on its own. So, in a sense, to the extent to which members of the medical profession, as it were, have been ready to cut down the time of their work by dishing out physical remedies, they have reinforced the faith of our public in medicines and drugs as a sort of magic talisman to ward off all illness. That is something that we must get away from as a society as a whole. With these new developments in alternative medicines and these new attitudes—holistic medicine and all the other phrases which are used—we may gradually be encouraging a slightly more healthy attitude towards illness and about health among the public as a whole.

I think the noble Viscount's Motion has done a very useful service in drawing attention to matters which are very complex. We must do two things. First, we must make sure that skills which are valuable are made readily available to those people who can benefit from those skills. Secondly, we must make sure that the public are protected from fraud, exploitation and from work of people who do not possess the skills which are necessary.

Lord O'Brien of Lothbury

My Lords, before the noble Lord sits down, may I be permitted to ask him a question? In view of what he said about the fact that the medical profession has no monopoly in its particular field, under the law is it regarded as a privileged therapeutic assault if someone who is not a qualified graduate from, say, the Royal College of Surgeons, inserts a knife into a consenting patient, presuming to give him an operation which will cure his malady?

Lord Winstanley

My Lords, I am not a lawyer but to the best of my knowledge—which is, if I may say so, considerable on this point—the law does not make it an offence for an unqualified person to operate on a patient. The law provides no protection for the person who does that if something goes wrong—and it might very well go wrong—and of course the person is not qualified to sign a death certificate or to do certain other things which might be a necessary consequence of the action the noble Lord referred to. But it is a fact that the general assumption that the law somewhere has given doctors a monopoly, is false. There is no monopoly. Anybody is entitled to treat patients, but a person is not entitled to pose as a registered medical practitioner when he is not. He is entitled to treat patients; and many do.

5.50 p.m.

Lord Colwyn

My Lords, I have been boring my friends, relatives, patients and Members of your Lordships' House for many years on the subject introduced by my noble friend Lord Massereene and Ferrard this afternoon. Now I have a splendid opportunity to address a captive audience, however small, who probably will not interrupt me on a subject which has radically changed my personal and professional life over the last five years or six years.

I must declare an interest in that, as a practising dental surgeon, I use complementary or alternative methods of treatment for some of my patients, and I am also involved as a founder committee member of the British Dental Society for Clinical Nutrition—a society set up to advise members of the dental and allied professions of the importance that dietary and environmental factors play in the concept of total health for our patients. I make no apology for being influenced by, among others, George Vithoulkas, whose book The Science of Homeopathy forms the basis of much of what I have to say this afternoon.

I do not wish to appear to be against orthodox medicine or to offend the noble Lords, Lord Winstanley or Lord Pitt of Hampstead, but I feel that the harmony which my noble friend Lord Massereene talked about in his introduction between the orthodox and the complementary sciences would be of great benefit to us all. Until recently the human race has done very little effectively to ensure good health. Despite modern advances in dealing with acute illness, the massive proportion of chronic disease today makes one worry that the human race may be losing its health for good. As throughout history, modern treatment therapy is quite helpless when faced with crippling chronic diseases and is consequently reduced to providing merely palliative, rather than curative, treatment.

Recently, great interest has been shown all over the world concerning the fundamental assumptions underlying medical care, as a result, I am sure, of the enormous amount of suffering that people are undergoing today in the face of a disproportionately small amount of relief available through the various accepted therapies. Because of the emergence of such doubts, alternative therapies have become popular and, in desperation, people are trying them indiscriminately. Once loss of confidence in orthodox approaches occurs, one is then at a loss to evaluate accurately the efficacy and safety of the alternatives. Thus, by contrast, it becomes clear that the prevailing medical system has not explained the laws and principles governing health and disease. Such an explanation has not been forthcoming, because in fact it has never been formulated even within the medical profession iself.

Looking back into medical history, one can find volumes of empirical data and experimental results, but no general laws or principles to support them or arising from them. It is not unreasonable to conclude that medicine is the only branch of science that has based its structure on opinions and suppositions, rather than on laws and principles. Owing to this weakness of conception, our medical system is failing to persuade the population in its efficacy or ability to produce satisfactory and continuous therapeutic results, especially in the face of one of the most frustrating and rapidly increasing crises facing medicine today—that of chronic disease.

In the 18th and 19th centuries Samuel Hahnemann formulated for the first time in the history of medicine the complete laws and principles governing health and disease and proved them in actual clinical experience. Nobody listened to him. Apparently his ideas were too advanced for the primitive state of mind in which his colleagues lived. They were unable to grasp an idea centuries in advance of their thinking. Instead the more materialistic concepts put forward by Louis Pasteur were accepted. These concepts fitted more adequately the need for concrete conceptualisation. Pasteur's theories and research into the nature of microbes led everyone to believe that the cause of illness had been explained.

As the modern science of bacteriology has advanced, however, it has come to the conclusion that both the microbe and constitutional susceptibility are necessary to initiate the disease process. Yet modern physicians seem to have closed their eyes to this fact. They continue to hunt down new microbes, viruses, bacteria, etc., and then develop powerful drugs with which to kill them.

An example of this is the massive effort to explain the cause of Legionnaires' disease or, more recently, AIDS, where the entire effort has been focused on the microbial cause and has largely ignored the constitutional susceptibility of the victims. Another perfectly valid approach, which might even produce better results, would be to study the relative resistance of the survivors of the supposedly virulent organism. Unfortunately, the obsession of medical researchers with their determination to pursue the erroneous idea of microbes and concrete causative factors in illness, despite increasingly disappointing results especially in chronic disease, is leading progressively to the development of increasingly toxic drugs which themselves are becoming a significant public health menace.

It must be evident to most thoughtful patients today that the obsessive search for concrete cause of illness is, in fact, not really the basis of modern therapeutics anyway. The vast majority of drugs prescribed for illnesses such as arthritis, asthma, colitis, ulcers, heart disease, epilepsy, anxiety and depression are not designed to be curative even in their original conception. They do not strike at the cause at all, but merely offer a rather pallid hope for relief—even if the danger of side effects is disregarded. This, in itself, is a sign of the helplessness of modern medicine to deal effectively with disease.

Consider, for a moment, my Lords, what the ideal therapeutic system should be. Of course, it must be effective, but it must be effective with minimal risk, or ideally no risk, to the patient. Its effectiveness must be based upon not merely the alleviation or absence of symptoms, but upon the enhanced constitutional strength and well-being of the individual—on the increased ability of the individual to live life to the fullest. It should not be prohibitively expensive and it should be readily accessible and understandable to all members of the population.

At present we find ourselves in the midst of disorder and disease. In an age of unprecedented technological advance we also see unprecedented damage being done to the atmosphere, the water and the land. Because human violations of the laws of nature result in the contamination of the environment and, in turn, place an increased stress on the ability of the individual to function, and the fact that mankind has gradually lost the inner awareness which would have enabled the correct perception of the laws of nature which must be respected, we see, collectively and individually, human beings both affecting and being affected by the environment. As we deviate increasingly from the laws of nature, a vicious cycle is established which requires great insight and energy to correct.

For each individual in this situation there may be a wide variety of possible responses to external stresses. Some people seem to be relatively unaffected by external or internal disturbances. They are in a state of relative balance which is maintained with minimal effort. Most people, on the other hand, experience degrees of imbalance ranging from slight to very severe. These are the people we consider diseased in the broadest use of the term. In such people the disturbance manifests itself in a highly individualistic and varied manner, but always the disturbance can be viewed as an imbalance of the organism's ability to cope with internal influences.

The basic question of why some people can cope with stresses effortlessly and others become disturbed easily has separated the major traditions of medical thinking throughout medical history. On the one hand, the rationalist tradition, which leads to modern orthodox medical thinking, focuses on what concrete factors lead to sickness in a person, in the hope that somehow understanding the exciting cause of illness will enable curative intervention. This approach has been tested quite adequately throughout history, yet we still see a steady and alarming increase of crippling degenerative disease. On the other hand, the empiric tradition of thought focuses on the question: what enables a person to remain healthy despite many noxious influences? This question and its answer form much of the basis for the complementary medicine practised today.

I have said many times in your Lordships' House that I am convinced that the influence of our complementary practitioners will play an ever-increasing role in the nation's health in the future. A topical example of this is the recent closure of the Selly Oak Hospital in Birmingham for three weeks, while they deal with a massive backlog of young patients with infected middle ear problems. This is a classic osteopathic problem which can be treated by an osteopath, knowledgable in the skills of cranial osteopathy, in a very few minutes, with no hospital beds, no surgeons, no anaesthetists and at minimal cost.

A register is a good idea as members of the public, who are at their most vulnerable when they tend to turn to alternative medicine, and orthodox practitioners, can be offered some guidance as to the expertise of the alternative sources of treatment. There will always be complementary medicine, however recognised the established alternatives become. I know of quite remarkable results achieved by alternative practitioners who would never be acceptable to a central register.

As the noble Lord, Lord Winstanley, and the noble Viscount, Lord Massereene and Ferrard, said, the individual associations must put their own houses in order. They must establish criteria for training and experience before being registered by the Institute for Complementary Medicine, as in the subject of our debate, or the newly formed Council for Complementary Medicine whose press conference I attended yesterday. I have to make the comment that these two bodies seem to be in total disagreement while both claim to represent the alternatives. A great number now have transferred their allegiance to the Council for Complementary Medicine. They must get their act together.

In the future I hope that the Government may be able to consider setting up a Royal Commission or similar body to advise on the possible formation of a self-regulating governing council such as the General Medical Council or the General Dental Council which will then be able to have its own statutory registration. I thank my noble friend Lord Massereene and Ferrard for introducing our debate this afternoon. I know of the great interest of my noble friend the Minister in alternative medicine, and I hope that he will be sympathetic if this subject comes up again; for without any doubt the future of the nation's health and that of orthodox medicine will become more and more dependent on the alternative holistic approach to good health.

6.2 p.m.

Lord Ferrier

My Lords, I also join the other speakers in thanking the noble Viscount for bringing forward this matter for discussion in your Lordships' House. Strongly as I support the case for complementary medicine, I am not willing at this stage to support his suggestion about a register for the Institute for Complementary Medicine. I was much persuaded by what the noble Lord, Lord Colwyn, said—that a register would be of great benefit, but "register" to what end?

The difficulty about the wording of the Motion before your Lordships is the use of the words "qualified practitioners". Qualified by whom? To what end? For this reason I think that what the noble Lord, Lord Winstanley, said goes a long way—namely, that the associations of these therapists may perhaps have to put their case in order. But the issue must be much more narrow than is indicated by a register for the Institute for Complementary Medicine.

The fact is that, of the therapies to which reference is made, only two are really near the position of being able to prepare a register. Those are the ones which the noble Lord, Lord Winstanley, has mentioned; chiropractic and osteopathy—not that I am unsympathetic to acupuncture. My late wife was greatly relieved of pain for many moons at the end of her life by acupuncture; she benefited at one time from radionics; but it seems to me that the only two therapies which are sitting there ready for registration and acceptance by the National Health Service are chiropractic and osteopathy.

Your Lordships know of my track record and you would be surprised if I addressed the House in any other terms. As the years have gone by I have urged the advantages of manipulative therapy as the main feature of complementary medicine, not only for its value in relieving pain but for the fact that in saving pain and saving distress it saves money in avoiding periods of inactivity, in avoiding sick leave and consequent loss of earnings and production. Experience in terms of such therapies shows savings in the use of drugs and the like.

The noble Lord, Lord Colwyn, mentioned to me the other day the case of queues of children waiting for some particular treatment which could have been avoided if manipulative therapy had been available. The same applies to a great many of the illnesses which are prevalent today. For the reasons which I have described in previous debates, my family have relied on chiropractic treatments to keep us in action despite various injuries over the years.

Ten years ago my chiropractor complained to me that a back pain sufferer who had failed to obtain relief from the health service came to him. He asked for the X-rays for her case from the infirmary, but the request was refused. I actually put down a Question on this subject in your Lordships' House. The Answer was quite plain: that the National Health Service would not part with material which might fall into unqualified hands.

This Question and Answer on X-rays was followed by a debate in 1976, since when interest in the manifest advantages of manipulative therapy has changed the general attitude of the public and—dare I say so?—of the medical profession to the whole question of using complementary medicine. I emphasise the word "complementary" because it is different from supplementary medicine. There are therapies in this list—I cite chiropractic and osteopathy—which are manifestly complementary rather than merely supplementary.

Whereas 10 years ago it was not a question of whether these therapies would be accepted, now the question is: when are they going to be accepted? They are bound to be accepted; the time is coming. After all, the part of the complementary medicine in the treatment of many ailments is recognised almost all round the world—this country being almost alone in disregarding it.

The Motion of my noble friend is a step in the direction required, but the idea of a register seems to be an over-simplification. The problem is the use of the words "qualified practitioner". Qualified by whom? How qualified? And qualified to what end?

I do not know how many noble Lords have access to BUPA's new Manual of Fitness and Well-Being, but I could not resist bringing to the attention of your Lordships a paragraph on page 272 referring to techniques of chiropractic, which states: Chiropractic is the most widely recognised form of alternative, drugless medicine in the world, with more than eight million Americans currently receiving treatment. Unlike osteopathy, which is confined to the treatment of mechanical disorders, it is concerned with a 'system' of disease, and its treatments have a wider scope". This is an indication of how the climate—if I may use that word—has changed. It is now a question of when we shall be able to see to it that the public have access to manipulative therapy in terms of the National Health Service.

There is no doubt that the attitude of the public has changed over the past year or two. Evidence of changing opinion on this subject is that we now speak of complementary medicine rather than supplementary medicine. We owe a great debt of gratitude to His Royal Highness the Prince of Wales for concentrating the thoughts of the public and the press on the question of the use of complementary medicine.

The subject of chiropractic X-rays, to which I have referred, is an interesting one. In a Question in your Lordships' House on 26th November 1974, I asked the Minister concerned, whether or not he agrees that the time has come for chiropractors to be recognised as an integral part of our National Health system, and that legislation might be comtemplated to this end, as it has been in a number of other countries".—[Official Report, 26/11/74; col. 1233.] I look forward to hearing the Minister's reply on this occasion, and before that I look forward to hearing from my noble friend Lord Cullen, with his extensive knowledge of the business of Government at that end of the spectrum, and of the problems facing supplementary medicines. (Your Lordships will forgive me for displaying the effects of an infection in my throat.)

It is no use creating about this therapy or that therapy before the BMA has been persuaded of the case being made. My personal view is that the association is not likely to be persuaded in respect of any therapy, except by positive proof that the same is scientifically sound. No amount of sentimental enthusiasm can take the place of scientific justification.

Without casting aspersions against any of the therapists listed among the supporters of the institute, I believe that only chiropractic and osteopathic practitioners with the background of a successful training college rank further consideration in this respect. The Bournemouth College, through its relations with the EEC (which is a point that must be borne in mind now that we are members of the Common Market), and enjoying as it does worldwide recognition, ranks as a candidate for acceptance by the Department of Health. Incidentally, the dean of that college is a Dane.

I hold no brief for the DHS—rather the reverse—over the cost of spectacles and the muddle about the selection of prescription rights, which do not seem to hold out much hope of savings in the end. The reverse would he the case if manipulative therapy could be made available. I am certain that it is rich in its possibilities. My noble friend Lord Colwyn has made several points in this respect. My heart goes out to the Ministers on the Front Bench when their job is to defend the department. What is the department doing about the suggestion made by the noble Lord, Lord Winstanley, that therapists should set their house in order? Is there any encouragement coming from that quarter? The answer is, no, none at all.

I look forward to what is to be said at the end of this debate. I believe I am right in saying that a number of the private health funds are now recognising fees for chiropractic and osteopathic attention as a liability. They ought to know, when they do that, that it will pay. I thank the noble Viscount for moving this Motion, and although I support the main trend of his thoughts, I do not like the idea of making the institute the source of a register.

6.16 p.m.

Lord Cullen of Ashbourne

My Lords, I should like to add my thanks to my noble friend Lord Massereene and Ferrard for initiating this debate and for giving me the opportunity to make a very short contribution. Perhaps I should begin by declaring my interest in this subject. For many years I have been chairman of the Osteopathic Educational Foundation and as a result have been in close contact with the General Council for the Register of Osteopaths; or the GCRO.

The GCRO represents the vast majority of osteopaths who have been trained on the full four-year course or who, as registered medical practitioners, have completed a 13-month postgraduate course at the London College of Osteopathic Medicine. The GCRO was set up as an independent register in 1936, virtually 50 years ago, following a recommendation made by a Select Committee of your Lordships' House. It maintains a rigid code of ethics and inspects those schools from which it draws its members at regular intervals. To use the words of the noble Lord, Lord Winstanley, qualified osteopaths have put their house in order.

As far as I know, the GCRO is the only organisation in the field of complementary medicine which has such a wide base, and therefore it sees no advantage to the public or to its members in being drawn into any organisation of various therapies with varying standards of training and education. Accordingly, the GCRO has at no time permitted the Institute of Complementary Medicine to publish the details contained in its own directory of members issued annually.

It was made clear in a press release published in October 1983 that the Faculty of Homoeopathy, the British Osteopaths Association and the British Naturopath and Osteopathic Association, together with the GCRO, did not wish to be associated with the ICM. My noble friend Lord Ferrier has today confirmed my understanding that the chiropractors are of the same mind. Therefore, it is really not clear to me on what grounds we are being asked to consider this matter today. Not only does the GCRO not wish to be associated with the ICM, but nor does it wish to be associated with another organisation, launched only yesterday, claiming to represent a number of therapies including osteopathy. The noble Lord, Lord Colwyn, referred to this in his extremely interesting speech.

There seems to be a very confused state of affairs when both the ICM and the Council for Complementary and Alternative Medicine—called the CCAM—are both claiming to represent the osteopaths, among others. I am told that the number of practitioners of all therapies who have joined the CCAM is about 1,200; whereas the GCRO has over 650 registered osteopaths. Perhaps the suggestion by the CCAM that an independent Government inquiry into alternative therapies should be undertaken is worthy of consideration. It might at least clear the air. Whether some umbrella organisation would be useful in helping some therapies to develop I am not competent to say. However, I am authorised to say that the GCRO, for the present at any rate, wishes to remain independent. I look forward to hearing the views of Her Majesty's Government, and I hope some clarification of what is taking place.

Lord Ferrier

My Lords, before the noble Lord sits down may I correct a misunderstanding? What I said about the British Chiropractors Association not wanting to be associated with the association is my view based on the opinion which was expressed to us that the Professions Supplementary to Medicine Act is not acceptable to people who insist that they should continue to have the right to see the patient directly and not always after referral from a doctor. I believe that last year's chairman of the BCA is a member of the Council of Complementary and Alternative Medicine to which my noble friend Lord Colwyn referred.

Lord Cullen of Ashbourne

I am grateful, my Lords.

6.22 p.m.

Lord Prys-Davies

My Lords, I, too, pay tribute to the noble Viscount, Lord Massereene and Ferrard, for having brought this subject before your Lordships' House this evening. I hope that the debate will serve a useful purpose. It will have served such a purpose if it gives encouragement to the considerable and growing body of opinion among practitioners of the natural therapies who want to see natural medicine taking its place as a profession among other disciplines. However, that implies more than the register—and I very much agree with the noble Lord, Lord Ferrier. It has implications for the training institutions, for the syllabus, the qualifications and agreed standards of practice and agreed codes of ethics. I believe that this is what this debate is fundamentally about.

The noble Viscount and other noble Lords have given us a pretty clear picture of what is happening in the United Kingdom. During recent years, natural medicine—call it alternative medicine or complementary medicine; these terms have yet to be defined—has been a rapidly growing area of health care; as, indeed, it has been in all countries of Western Europe. In third world countries and many countries in Asia it is making a substantial contribution to health care. A report published in 1983 by the Council of Europe reviewing the role of natural medicine in Europe concluded that the growing demand by the public for alternative medicine cannot simply be dismissed. I quote from the report: It is not possible to consider this as a medical side-issue. Its permanence reflects an existing public need which is in urgent need of definition and analysis. For that reason I very much welcome the BMA inquiry which was set up in 1982 or 1983. I hope that when its report is published later this year the alternative therapists will have no reasonable cause to be suspicious of the medical establishment.

The point has been made, and I am sure there is a great deal of truth in it, that there is a lack of harmony and there is suspicion between orthodox medicine and non-orthodox medicine. In the light of the BMA report, when it sees the light of day, and in the light of the report of the Council of Europe it may well be that the Government themselves should set up a much fuller inquiry to consider the contribution which natural medicine can make to the greater efficiency or effectiveness of the National Health Service, and indeed to bring about a better degree of self-government within the area of natural medicine. The point has been made by all speakers this evening that the time may well be upon us when the Government ought to be setting up a fuller inquiry.

We know that at least 1 million people a year—I understand the figure could be very much higher and as high as 2½ million—each paying an initial consultation fee of about £11 or £15 and a fee of about £6 or £10 for subsequent visits (the service is not available on the NHS) are looking to natural medicine for relief from pain and suffering. It is estimated that this number is increasing by about 15 per cent. per annum. That is why alternative medicine has been described as the second biggest growth industry in Britain; second only to that of computer technology. It is paradoxical—and this point has been made—that there should be this rapid growth in natural medicine in our country although we have one of the best health services in the world. In common with the vast majority of our people I give the NHS my fullest support.

Therefore, why has a trickle of interest in alternative medicine become, in recent years, a flood? The noble Lord, Lord Colwyn, devoted a substantial part of his notable speech to an analysis of the reasons why we have seen this growth in natural medicine. I merely refer to the main issues which the noble Lord, Lord Colwyn, identified. There are the deep fears of the side effects of powerful drugs and there is dismay at the apparent inability of orthodox medicine to cure backaches, migraine and crippling degenerative conditions. I merely ask: is it possible that we may have over-concentrated on technology to the relative neglect of some other aspects of healing?

The Council of Europe report to which I have already referred—and I am grateful to the DHSS for having sent me a copy of it—estimates that there are in this country about 7,800 full and part-time therapists of alternative medicine, of which 4,100 are practising members of professional bodies. In addition, it is estimated that there are about 20,000 men and women practising healing of one form or another.

I now come to the point which has been made forcefully by the noble Lord, Lord Winstanley. There are among the almost 30,000 quacks and bogus therapists offering their services. Anyone can set up in business and call himself or herself a therapist of alternative medicine. Anyone can pose as a therapist of alternative medicine without let or hindrance, whether or not he has received any training at all or whether or not he has any kind of qualifications, provided that he does not use the title "doctor". I acknowledge the intervention from the Cross-Benches, but I was under the impression that one could not undertake surgery unless one was a surgeon. But the noble Lord has associations with the Royal college and no doubt the Minister will have something to say on this when he comes to answer.

Although alternative medicine has a respectable ancestry, there is in our country no preventive legislation affecting that area of health care. Except for a few honourable exceptions, there is very little disciplinary control within the main groups of alternative medicine, which are represented by over 50 separate associations and which vary from very large organisations to very small groups. For all our just and proper concern to establish and maintain standards in the NHS, we have not bothered with the standards of the therapists of complementary medicine outside the NHS, with one or two exceptions. Therefore the position is unsatisfactory.

There are 44 colleges which teach one or more of the natural therapies. About a dozen to 15 offer full-time courses. Three of the institutions confine their intake of students to medical doctors. It is never an easy task to find teachers of quality in any discipline. I understand that some of the training institutes are very good indeed, but I also understand that standards in others, where the standards are known, are very uneven. I am told that there is no agreed syllabus, there is no external professional control over training and there is no external monitoring of examination standards.

There is therefore an urgent need for a survey or investigation of the education and training available at the numerous private commercial institutes, possibly in the same way as medical education in the United States and Europe was surveyed by Flexner in the early part of this century. I have a feeling—and it is no more than a feeling—that, if the department were to establish such an investigation, within a year or two some of those colleges would close their doors for ever and others would be radically reorganised.

Given the growing demand by the public for alternative medicine, we need safeguards for the public. Here I go along entirely with the noble Lord, Lord Winstanley. Yes, we want minimum standards of training. Yes, qualifying examinations need to be standardised. Yes, there is a need at the end of the day to introduce a system of registration of suitably qualified practitioners of alternative medicine.

The Motion refers to the Institute for Complementary Medicine. I understand that within the limits of its modest budget that charity has done splendid work. It came unheralded on the scene a few years ago and has sought to be a guardian of the public interest. But then we heard yesterday that in this city a Council for Complementary and Alternative Medicine was launched, with the blessing of the noble Lord, Lord Home of the Hirsel, to maintain awareness of the disciplines of complementary and alternative medicine and to raise standards. Although that is evidence of a division—of a house which is divided—nevertheless, I believe that it is also an indication of the growing self-confidence among reputable therapists that at least alternative medicine is coming in from the cold and that it is here to stay. But I would agree with the noble Lords that the institute and the council ought to be getting their act together.

I have therefore no doubt that the therapists of natural medicine who seek a recognised status as professionals are now at the same stage, or will very shortly be at the same stage, as the doctors almost a century ago, the dentists about half a century ago, I think, and the opticians about 30 years ago when they were called upon to take a firm decision to put their house in order. That is another message which is coming through loud and clear this evening in this debate—that the therapists must put their house in order.

The noble Viscount, Lord Massereene and Ferrard, has done natural medicine a great service by initiating this debate, which he did with firmness and good humour.

6.36 p.m.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Glenarthur)

My Lords, I certainly join with all those who have thanked my noble friend Lord Massereene and Ferrard for introducing this debate today. We have had a useful and, I think, a constructive airing of a topic of increasing interest not just to your Lordships but to the public at large.

I have sometimes heard the suggestion—and I think that my noble friend seemed to indicate this—that the distinction between alternative therapies and conventional medicine is that conventional medicine looks at the special condition and tries to treat or cure that, whereas the alternative therapist takes a holistic approach to the patient. That, it is suggested, is why there is such an increasing interest in the alternative therapy movement. I would not accept such a distinction; neither would the vast majority of the medical profession. Since the time of Hippocrates himself, medicine has been a holistic profession. The medical practitioner must be concerned with appropriate care. Appropriate in this context means not just for the presenting condition, but for the whole of the patient as an individual in the context of family, friends and community. I know of nothing in the advent of the scientific method, or indeed of high technology, that in any way affects that traditional approach of the healer to his patient. Conventional medicine is, and must be, holistic in this sense.

The prime concern of my right honourable friend the Secretary of State, and my fellow Ministers must be for the National Health Service for which we have statutory responsibility. It is sometimes suggested—and it has been suggested again today—that some of these alternative therapies ought to be available within the National Health Service. I can understand these points of view. To a very large extent, however, that is in the hands not of Government but of the practitioners of these alternative therapies themselves and of their professional organisations. As the noble Lord, Lord Winstanley, said, we should all like to see available in the health service as wide a range of effective treatments and therapies as possible. But Ministers cannot simply dictate what treatment shall be prescribed or provided; nor can we force upon the medical and other professions already practising within the health service the services of other practitioners.

The noble Lord, Lord Winstanley, raised the question of the Council for the Professions Supplementary to Medicine. So far as that is concerned, I understand that the council is still ready to consider applications from groups representing alternative therapies, should they wish to apply. The adoption a few years ago of a set of criteria for applicants means that such groups can now see what is expected of them, and I understand that the registrar is always willing to have informal discussions before any formal application is made. Such groups need not therefore risk a public rejection.

Health service medical care is based on treatment by registered medical practitioners, either as general practitioners in the community, or as hospital doctors. It is a basic principle that the decisions on the treatment a patient receives, and who provides it rest with the doctor concerned. It must be recognised that at present many doctors, and others, are highly sceptical about some of the alternative therapies and are quite unable to accept the principles upon which they are based. On the other hand, there is growing recognition by others that particular therapies do employ some methods that can bring relief to patients where other methods of treatment have not succeeded. Some doctors do themselves employ alternative therapies. If they wish to see wider use of these methods, then it is up to those medical practitioners who employ them to convince more of their colleagues of the effectiveness and efficacy of this form of treatment.

Here, I think, we come to a basic problem. The range of therapies practised is very wide. Indeed, many of them are based upon different principles and different methods. Should we not therefore concentrate on greater recognition of individual therapies or even of particular techniques within particular therapies? I realise, of course, that increasingly some alternative therapists are seeking to employ a range of different techniques. That must be a matter for them and they are quite at liberty to practise within the constraints of commom law. Yet it does cause problems for greater recognition which would be a necessary first step towards wider use of therapies within the health service.

My noble friend Lord Massereene and Ferrard and the noble Lord, Lord Winstanley, raised the question of the availability of natural medicines and similar products. I can say that the Government have no wish whatever to interfere with the rights of the individual to buy them and to use them. However, obviously we have a duty to protect the public from harmful products, and the Medicines Act exists for that purpose. These medicines are therefore subject to its provisions. Provided they meet acceptable standards of efficacy, safety and quality, suppliers and patients need have no fears. So far as the particular point which my noble friend Lord Massereene and Ferrard made about the membership of committees set up under the Medicines Act 1968 is concerned, those committees and the officials serving them are of course aware of the public interest in alternative medicines. Their responsibilities under the Act are directed towards safeguarding patients' safety and they make no recommendations regarding the relative efficacy of individual medicines or of one form of treatment compared with another. But I have no doubt that they would give sympathetic consideration to any points put to them by those who favour the natural medicines.

I think it worth while to return for a moment to the question of greater recognition for particular therapies. I have to say to my noble friend Lord Ferrier that whether they be complementary, supplementary or merely alternative is really a matter for practitioners to decide for themselves. Yet there are a number of basic principles that any profession would need to demonstrate before it is worth even considering their role within the spectrum of health care. The first and foremost is that the therapy treats adequately a particular specific condition. I think this was a point made by my noble friend Lord Colwyn. It sounds obvious and yet it has been one of the most significant barriers to any form of recognition for particular alternative therapies. Blind faith is not enough. Medical care is too important to be dealt with purely on the basis of unsupported claims. The proponents of a particular therapy need to be able to demonstrate beyond doubt the efficacy of their treatment, however difficult that must be. Yet there are hopeful developments.

The noble Lord, Lord Prys-Davies, and my noble friend Lord Ferrier referred to the establishment by the British Medical Association of their working party to consider the efficacy of alternative therapies. It is, in my view too, to be greatly welcomed. It will provide an independent evaluation. So far as concerns the suggestion made by my noble friend Lord Cullen and my noble friend Lord Colwyn about an independent Government inquiry or a Royal Commission, I do not see any compelling reason to hold one at the moment, at least until we have the results of the BMA inquiry. Inquiries in other countries, such as New Zealand, have focused on whether the cost of alternative care, such as chiropractic, could be paid for through their health insurance reimbursement schemes. This, of course, does not arise in the context of our National Health Service structure. It must be for the professions themselves to prove their case, and they might even have to do it therapy by therapy.

A second development to be welcomed is one within the alternative therapy movement itself. I understand that a group of representatives from leading alternative therapies have come together to form the Research Council for Complementary Medicine. The council's purpose is to raise funds for research and to investigate ways in which it is possible for the therapeutic effectiveness of complementary approaches to health care to be assessed. I know it is not the only group with that aim, but nevertheless the approach seems commendable. I understand that the council intends to recruit a research fellow to study existing and innovative research techniques and to advise on methodologies appropriate to the field of complementary medicine. I am particularly glad to note that the project is supported by the Medical Research Council, which is, I understand, to contribute to the funding of the research fellow.

Demonstrating the efficacy of the therapy is a first essential, but there are other things that a profession must do before it can be given proper recognition. It must show—I think that the noble Lord, Lord Winstanley, and the noble Lord, Lord Prys-Davies, will agree with this—that it has reached maturity and, for example, has an established and recognised governing body. It must show that the therapy is based upon a systematic body of knowledge, and, while that may not be wholly scientific in character, it must be compatible with the general body of knowledge acknowledged as the basis of contemporary medical practice.

Such a profession must have an accepted working relationship with the organisations of medical practitioners. It must have recognised courses of training which must be generally recognised to be adequate. Examinations must be demonstrably adequate and properly constructed and should, for instance, make use of external examiners. A profession ought to have an appropriate and acceptable code of conduct, regulating relationships with patients and members of other professions. I believe it would also need to show that the members of the profession were willing to be governed by that code. Fine words in this case are not enough. But I was encouraged by what my noble friend Lord Cullen said about the osteopaths.

Some may emphasise certain of those points more than others, but they are all criteria against which the existing bodies and professions within the alternative therapy field could usefully match themselves, and against which they will be judged by conventional practitioners.

In all that I have said so far, I have tried to show that the necessary action and the initiative are entirely in the hands of the alternative practitioners themselves. The main interest of Her Majesty's Government must be in the National Health Service itself and in promoting as wide a range of therapies as possible within that service for the effective treatment of patients. The alternative therapies I have discussed so far are, in the main, outside the remit of the National Health Service. We would hope that any patient who wishes to make use of an alternative practitioner would first go to see his general practitioner to ensure that there is not some underlying condition which could be missed by a lay practitioner without conventional medical qualifications.

My noble friend Lord Massereene and Ferrard and one other speaker raised the question of a saving of money through alternative therapies. I note the points that were made but most alternative medicine is provided privately at present. If this was undertaken within the health service it would result in an additional load on public resources. Many alternative therapies are in fact quite labour intensive because of their one-to-one nature and the longer consultation process which they need. This, too, does bring its own high cost, but I would not deny that there may be some potential for savings. However, we have to rely, at the end of the day, on doctors' clinical judgment of whether such treatment is suitable for their patients.

The noble Lord, Lord Winstanley, gave some examples of the freedom to practise to which I referred. He in fact referred to two or three examples where there were statutory reasons why one could not practise certain things. Two of them which I think I ought to mention are, of course, created by the Venereal Diseases Act and the Cancer Act, which I think is an important point to put across. I think that that perhaps answers the point that was made by the noble Lord, Lord O'Brien of Lothbury.

But there is generally a perfect right to practise under common law. I can see little advantage in attempting to change that position with regard to alternative therapies. In general I can see no justification now for affording to alternative therapies in general any wider powers than those they already have by common law. Neither am I convinced that there is any case for seeking to impose, by statute, any further regulation of alternative therapy.

It might be, of course, that some particular profession or group of professions would decide that in their own interests and those of their patients they needed to pursue a tighter regulation of their affairs. One way of doing that could be some form of registration, statutory or otherwise. In regard to statutory registration, we could undertake only to consider the proposals on their merits. We should of course also need to take fully into account the views of others, including the medical profession. In regard to non-statutory registration—and this is particularly relevant to my noble friend's Motion—it is important that the register should inspire the full confidence of the major professions and organisations concerned.

My noble friend's Motion mentions the Institute for Complementary Medicine and its register. I understand that not all the major organisations in the field are included in that, nor would they always endorse the qualification's of others on the register. That can only cast doubt in the mind of the public, who can legitimately expect the professions to get together and put forward commonly-acceptable proposals. To that extent, I endorse my noble friend's views and those of my noble friend Lord Colwyn and other noble Lords who have spoken this afternoon.

I was interested to hear that yesterday a new organisation was launched—the Council for Complementary and Alternative Medicine, which was referred to by my noble friend Lord Colwyn. It, too, I understand, hopes to develop a register which will be policed and endorsed by eight of the leading organisations. Its objective of raising and maintaining standards is certainly to be welcomed, but my hope is that the public are not to be faced with two or even more rival registers. That would definitely not be in the interests of either patients or practitioners.

Our position must be that if people want National Health Service care, then it is available and is provided by people who hold statutorily-recognised qualifications. If they seek care outside the NHS, then the prime responsibility lies with the individual patient to satisfy himself about the standards of the person concerned. It is in the interests of private patients of alternative practitioners to take the trouble to find out enough about it to be clear which are the well-established bodies in a particular field and then consult a member of one of those bodies. Having said that, I must say that we have no evidence of people being injured or harmed by inadequately-qualified alternative practitioners. I must repeat that the true protection for a patient wishing to see an alternative practitioner is, first, to see his or her general practitioner in case a condition exists which the lay practitioner may not recognise.

I have discussed alternative therapies as if they existed solely outside the National Health Service. But that is not the case. Over the years some fringe medical practices have come to be accepted as part of conventional medical treatment. Medical science and healing are also a developing art. I know that there are some medical practitioners who practise manipulative techniques themselves which are little different from osteopathy or chiropractic. Some doctors practise acupuncture. Many doctors practise homoeopathy, and there are indeed four hospitals within the National Health Service where homoeopathic treatment is available. That has been the case since 1948.

It is always dangerous to speculate about the future, but, if the alternative therapy professions remain committed to demonstrating beyond reasonable doubt the efficacy of their therapies, then that ought to lead to a better meeting of minds between all those concerned with provision of good health care. Meanwhile, the general attitude of Her Majesty's Government towards alternative therapy must be one of benign neutrality. What we all want to see is the best possible treatment available for patients provided in the most cost- effective way by those best able to provide it. That is a considerable challenge to conventional and alternative practitioners alike.

6.54 p.m.

Viscount Massereene and Ferrard

My Lords, I should like to thank all noble Lords who have spoken in this debate. The noble Lord, Lord Winstanley, has taught me something. I am sure he could teach me a lot about medicine; I know very little about it. I was never under the impression that someone without any qualification at all could treat people. It is extraordinary. I should have thought he would be had up for fraud.

I have learnt quite a lot in this debate. I enjoyed very much the speech by my noble friend Lord Colwyn, which was really expert. I felt that he was on the side of alternative medicine. I am afraid that my noble friend Lord Cullen of Ashbourne was not on the side of my Motion but was on the side of one of the therapies. My noble friend Lord Ferrier knows a great deal about this subject and I felt that he, too, was in favour of alternative medicine. I was very pleased that the noble Lord, Lord Prys-Davies, appeared to be in favour of alternative medicine. He made some kind remarks about the Institute for Complementary Medicine.

I shall now turn to my noble friend Lord Glenarthur, who made his usual very good speech. I should like to say to him, in regard to the manufacture of natural medicines, that he may like to know that some European countries—for instance, Germany—have on their commission of experts representatives of those advocating natural medicine. Germany is not the only such country. I feel that the DHSS could be more forthcoming to help alternative medicine. On the other hand, as I said in my speech, unless those concerned stop their in-fighting and come together it will be difficult to have them officially recognised and qualified. As I pointed out, it really rests on the question of harmony—harmony with orthodox medicine and harmony among all the alternative medicines.

In regard to the idea that Her Majesty's Government should set up a commission to look into alternative medicines, I want to say that I should be in favour of a Royal Commission, but of course the history of so many Royal Commissions is that they take two or three years and then their reports are pigeon-holed. Certainly I should be extremely pleased to see a Royal Commission on this question of alternative medicine.

There is a further debate to come after this one and I do not want to delay the House any longer. I should like to thank again all noble Lords who have spoken for their extremely good speeches, which were far better than mine. With that, I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.