§ 5.40 p.m.
§ Baroness Trumpington rose to move, That the draft order laid before the House on 10th March be approved. [15th Report from the Joint Committee.]1202
§ The noble Baroness said: My Lords, this order marks a unique development in the history of the National Health Service which I believe will be welcome to all parts of the House. This is the first occasion on which a profession supplementary to medicine has voluntarily given up its identity and consented to what is effectively a merger with another profession in a way requiring formal ratification by Parliament.
§ The order of Council before you for approval by resolution of this House will amend the Professions Supplementary to Medicine Act 1960 (the 1960 Act) to reflect the merger of the remedial gymnastics profession with the physiotherapy profession, which took place on 16th November 1985. This is a development which has been welcomed by members of both professions throughout the United Kingdom.
§ The 1960 Act provides for the registration of the members of certain professions and for the regulation of their professional education and conduct. It established a board for each profession, to be coordinated and supervised by a Council for Professions Supplementary to Medicine.
§ The purpose of the 1960 Act was two-fold: to ensure that a consistent standard of training, qualification and conduct would be achieved by the registered practitioners of these professions, and to establish state registration as a "kite-mark" by which the public would be able to recognise practitioners who had attained this standard.
§ The Council for Professions Supplementary to Medicine is an independent body financed entirely from initial registration and annual renewal fees from the members of the constituent professions. The proposals which it makes for the revision of students' qualification, examination and training requirements require the ultimate approval of the Privy Council. Section 10 of the 1960 Act provides for the Privy Council, on a recommendation of the Council for Professions Supplementary to Medicine, to make an order to extend or restrict its application, and it is under the power of this section that the order before the House is made. As such an order in effect amends an Act, provision is made for an affirmative resolution of both Houses.
§ A little history is of relevance here. Like so many other developments in medicine, the remedial gymnastics profession had its origin in the special circumstances of the Second World War, when special rehabilitation units of the armed forces were created to tackle the two problems of dealing with recruits of poor physical standard and the ever-increasing numbers of injured personnel who needed to be returned speedily to active duty. These units especially stressed active and group therapy which was in essence a modified form of physical training.
§ So beneficial did this active approach prove to be that after the war the then Ministries of Labour and Health took action to ensure its continuance in civilian life and a course was developed and implemented at Pinderfields General Hospital (as it then was) at Wakefield, as a school of remedial gymnastics, originally as a conversion course for ex-military physical training instructors. This was the origin of the profession, which became one of those covered by the provisions of the 1960 Act.1203
§ In the years since the profession came into being, changes in the activities and clinical practice of remedial gymnastics have brought it into closer relationship with the practice of physiotherapy, to an extent where a measurable degree of overlap prevails. This fact has been recognised for some time and indeed a merger between the two professions was being mooted as far back as 1973, when it received the support of a recommendation by the working group on the remedial professions, set up by the then Secretary of State for Social Services under the chairmanship of Mr. E. L. McMillan. But the Society of Remedial Gymnasts and Recreational Therapists, the body which represented the interests of remedial gymnasts, was a cautious if not a reluctant bride, and progress was slow until 1983 when the Chartered Society of Physiotherapy decided to offer to extend its membership to those remedial gymnasts who would undertake to acquire the additional skills which would bring their training into line with that of physiotherapists. However, the course of true amalgamation still did not run smooth, and because of difficulties connected with the status of the Society of Remedial Gymnasts and Recreational Therapists as a limited company, the knot was not finally tied until 16th November 1985. At an extraordinary general meeting the Society of Remedial Gymnasts and Recreational Therapists Limited, taking note of a ballot of its full membership, which was significantly in favour of merger, decided in an act of great faith in the future to wind itself up.
§ Simultaneously, former members of the Society were offered membership of the Chartered Society of Physiotherapy under the terms of the provisions of their Royal charter. Provision has of course been made for these practitioners to undergo the necessary complementary skills training to allow them to practice as physiotherapists. Within the NHS arrangements have been made for the necessary protection of terms and conditions of service of former remedial gymnasts. I understand no major difficulties have been encountered.
§ There remain a number of legal steps which require to be taken to wind up the state registration machinery for this profession. Some of these are related to the amendment of a number of internal rules of the Council for Professions Supplementary to Medicine and its boards and there are others which do not require an affirmative resolution of both Houses. The significant step of abolishing the registration board of the remedial gymnastics profession itself however requires, as I mentioned earlier, such an affirmative resolution. The order before the House will cause the provisions of the 1960 Act to cease to refer to the profession of remedial gymnastics. It will also abolish the remedial gymnasts board and extend the function and membership of the physiotherapists board to cover former registered remedial gymnasts, enabling them to register as physiotherapists.
§ At this point I should like again to acknowledge both the courage of the members of the remedial gymnastics profession in taking the unique step of voluntarily relinquishing their identity and casting their lot in with another larger professsion, and the far-sightedness of the Chartered Society of Physiotherapy in making the proposal of marriage. It 1204 is not that the philosophy of remedial gymnastics will be lost. It will continue to be acknowledged within physiotherapy. Moreover, Pinderfields School in the Wakefield Health Authority, long the leading centre for remedial gymnastics training, is being converted, with financial help from the Department of Health and Social Security and from the Yorkshire Regional Health Authority, to a physiotherapy school, to function in that role from the beginning of the academic year 1986–87. It will continue to give due emphasis to the philosophy and practice of remedial gymnastics.
§ I wish also to use this opportunity to recognise the work of past and present members of the remedial gymnasts board, particularly its chairmen, and to thank all the members of the remedial gymnastics profession for their valued contribution to health care. I am sure that your Lordships would like to join with me in wishing the amalgamated group of physiotherapists and remedial gymnasts all good fortune in the future.
§ In view, therefore, of the decision to join ranks by the two professions concerned and of the support that their action has received from the Council for Professions Supplementary to Medicine and the Privy Council (after due consultation with the appropriate professional boards), I ask your Lordships to make an affirmative resolution to approve the draft order of the Council. I beg to move.
§ Moved, That the draft order laid before the House on 10th March be approved. [15th Report from the Joint Committee.]—(Baroness Trumpington.)
§ Lord Ennals
My Lords, it is not always that the noble Baroness and I are in total agreement, but we are in absolute agreement on the order that is laid before us. Not only do I want warmly to support the noble Baroness in her proposal but I should like to express my gratitude to her for giving us a little bit of the history that led to this amalgamation. I would agree with her that amalgamations are always welcome where they are due to the success of those concerned; all too often organisations of one sort or another find themselves open to splitting or to multiplying, and actually to get them to come together is always a difficult task. I think that both organisations are entitled to the thanks and congratulations not only of the whole House but of the National Health Service. This does enable us just to say a few words, as the noble Baroness did, of thanks and congratulations to both organisations.
Obviously, the occupational therapists are the major organisation of the two, with roughly 22,000 occupational therapists operating in the country, while the remedial gymnasts only have about 700. But it was not a takeover bid in the sense that made the remedial gymnasts feel that their work had not been apreciated. It was that as the physiotherapists gradually and steadily increased their skills they incorporated the skills which are held by the remedial gymnasts. I should like to pay my own personal tribute to the physiotherapists and now the remedial gymnasts who have joined them. I cannot claim that I was ever knowingly treated by a remedial gymnast, but over 40 years ago at the end of the war, when I suffered serious injuries, I had reason to be thankful to the 1205 physiotherapists; and in very recent times—nay, this week—I have had reason to be thankful to the physiotherapists.
I understand that both the noble Baroness and I shall be invited to share the celebration of the union between the two organisations on 28th April. I hope that the noble Baroness will be able to accept, and I hope that I shall.
I have only one other comment which I should like to make to your Lordships: that is, that if we ever come to make a change again I should like to see the title changed. I would rather see "Professions Complementary to Medicine" than "Professions Supplementary to Medicine". I recognise that these professions act under medical advice, but they have skills which the medical profession do not have, and they are often very precious skills. So I simply say to the noble Baroness that, if she is in her place at a time when any further change has to be made, I hope she will think of calling them professions "complementary to" rather than "supplementary to" medicine. I only say that as an additional tribute to two professions which have come together for the mutual benefit of each of them.
§ On Question. Motion agreed to.