Medicine: Complementary and Conventional Treatments

HL Deb 09 May 1990 vol 518 cc1400-36

5.19 p.m.

Earl Baldwin of Bewdley rose to call attention to recent developments in the field of complementary medicine and its relationship to conventional treatment; and to move for Papers.

The noble Earl said: My Lords, I am deeply grateful for the opportunity to introduce the subject of complementary medicine in your Lordships' House this afternoon. It is two and a half years since it was last debated. It was introduced on that occasion by the noble Lord, Lord Kindersley, who is most disappointed that he cannot take part today because of an engagement this evening.

I was asked by a noble Lord when I spoke briefly on this subject in a debate on the National Health Service recently what was meant by the word "complementary". There have been a number of attempts to define it, but these have often resulted in more confusion than before. It refers to that body of therapies which in the bad old days were known as "fringe", then more recently "alternative", and which are also sometimes described as "natural medicine". I suppose a useful working definition would be those approaches to health care which do not feature in the conventional medical or paramedical curricula. The better known and developed ones are: osteopathy, chiropractic, herbalism, homoeopathy, acupuncture, naturopathy and healing. But this is in no way to play down the many other approaches that have a great deal to offer.

We should not forget that these are unorthodox only by reference to a particular time and place. For example, chiropractic and osteopathy are mainstream medicine in Canada and the USA. Homoeopathy is orthodox in Germany, France and India, while medicine from plants is still the most widely used therapy throughout the world.

My own interest in the subject is threefold. I came to it—as most people do—as a patient. I had a chronic condition which took complementary methods first to diagnose and then painstakingly to clear up. In the course of a personal odyssey I have experienced more therapies from the patient's end than most people. At the same time, I did my best to study and understand what was going on at each stage, to talk to practitioners about their work, to attend courses and conferences. Arising from this, I acquired two particular interests which I ought to declare. I sit on the Research Council for Complementary Medicine and I chair a board which has been set up to accredit the training of acupuncturists. I shall speak more of this later.

Probably the most significant development in the last two and a half years has been in public acceptance of what the complementary therapies have to offer. Surveys show an ever-increasing willingness to use them, now encompassing about one-third of the population, and an even greater wish to see the major ones at least available on the National Health Service. Whenever I talk to Members of your Lordships, House about health problems, I find that more often than not they have consulted an osteopath, an acupuncturist or a healer as well as—and this is the normal pattern—their GP and specialist. It is not just the patients who are involved. It is significant and profoundly encouraging that medical attitudes are changing fast and official attitudes with them. Probably about half of all doctors now wish to learn about complementary therapies, many with a view to practising them after suitable training. This is a big change.

There is a widening use of massage and aromatherapy among nurses. A major study by the Department of Public Health Medicine at the University of Sheffield, though still unpublished, is expected to show much improved communication between complementary and general practitioners. The Department of Health no longer holds totally aloof from complementary developments and the Medical Research Council continues to help with occasional joint funding of projects. All this is most welcome. The number of practitioners has for years been rising at more than 10 per cent. annually and new clinics and health centres are opening all the time to satisfy public demand.

The Government have always been properly concerned about the professional organisation and training of practitioners, since the public must be safeguarded. It is now accepted, I believe, that it is up to each therapy to make its own arrangements in the light of its own peculiar historical and therapeutic circumstances. Some, like the osteopaths, are moving towards statutory registration. A working party has been established for this purpose with medical representatives who include my noble friend Lord Walton of Detchant, supported by the King's Fund. I am sure that the noble Baroness the Minister will be pleased to learn that osteopaths have heeded and acted on the advice of her predecessors.

The body which I chair has arisen from a joint initiative of the Council for Complementary and Alternative Medicine, which continues to be active in promoting educational standards, and the Council for Acupuncture, which represents the major colleges. We are setting up an accreditation board consisting of representatives from acupuncture, the medical profession, education, the other therapies and the public interest, with the aim of establishing professional standards in training and accrediting those colleges which meet the standards. It is a model which is working successfully in the USA and which other therapies may perhaps decide to follow.

Another development of interest is that the healers—who are now far more widely accepted than they were a few years ago—through their umbrella Confederation of Healing Organisations have produced a very thorough code of conduct which has won the approval of the royal colleges. They have also forged links with many hospitals and family practitioner committees. They are in the process of mounting a series of clinical trials into the effectiveness of their work.

This brings me to research. It is a key area in terms of demonstrating what a therapy can or cannot achieve. It is also a difficult area because both money and research expertise are in short supply in the complementary medical world. Drug companies do not give funding to therapies that might put them out of business. The RCCM has been addressing these issues since its beginnings in 1983 and has found money for a number of valuable studies as well as, more fundamentally, for a research methodology fellowship at Glasgow which has just successfully run its course.

We have recently seen the publication of results from Queen's University, Belfast, which show the effectiveness of acupuncture in nausea from cancer chemotherapy and in morning sickness in early pregnancy. In 1988 the British Medical Journal published the results of a successful study in teaching GPs how to teach their patients relaxation techniques to reduce blood pressure. The chiropractic profession's research department at its college in Bournemouth has been running successful projects on back pain and other areas which involve close co-operation with hospitals in 11 health authorities.

A project run from the Centre for the Study of Complementary Medicine in Southampton is busy investigating the body's electro-magnetic fields, which may be able to give advance warning of impending disease. These are just a sample of the research projects which have been mounted over quite a wide area.

Academically the picture is encouraging. Both the Anglo-European College of Chiropractic and the British School of Osteopathy have recently gained degree status for their courses. Complementary medicine is now on the curriculum in Glasgow, the largest medical school in Europe. Exeter University, whose centre for complementary health studies is the only one of its kind in the Western world, will run B.Phil and M.Phil courses from this autumn, looking at complementary health care from a wide perspective. Finally, there is the real possibility of a chair of complementary medicine being established at one of our leading universities.

Co-operative ventures with mainstream medicine are increasing. Those of your Lordships who come to the parliamentary group meetings will have heard of the integration of therapists in the cardiac department of the Charing Cross Hospital and at the Marylebone Health Centre where significant savings are being shown in drugs, hospitalisation and referrals. There is now a fruitful link between the Bristol Cancer Help Centre and the Hammersmith Hospital. That is something that until recently would have been unthinkable, so deep was the philosophic divide. A national consultative council has just been formed to try to bring therapists together on the political front. Through all this the Institute for Complementary Medicine continues to provide an information service for the general public.

It is sad to report that there was no follow-up to the pioneering colloquia under His Royal Highness the Prince of Wales at the Royal Society of Medicine between 1984 and 1987. The doctors in charge at that time seemed to feel that co-operation had gone far enough for the present. However, a good account of proceedings was eventually published. It can be found in the Library under the title Talking Health.

Those in the field of complementary medicine in this country are grateful for the freedom to practise their art under common law. It is a freedom which brings responsibility with it, and I have tried to show how some of this responsibility is being faced. I trust that the Government will continue to defend this freedom and will not give way to sectional interests, whether from this country or abroad, however plausibly represented.

What complementary medicine offers is, I believe, of enormous worth. I am not thinking just of the financial savings which are there for the taking if the massive investment in high technology intervention after the event can be reduced. I am thinking of a different way of looking at things, of innovation, which is a vital ingredient in a profession. In a number of areas modern medicine has become stuck. Cancer is one such area. There are approaches here that merit a lot more investigation than they are getting. Dietary and psychological approaches are just two. It is the fashion to say that health is too important to embark on this kind of approach. I believe it is too important not to. As a patient I also believe that it is too important to be left to doctors. I think doctors would tend increasingly to agree with that.

These other therapies, however, cannot make their full contribution without more funding. We all know that homoeopathy is in theory available on the health service, but the financial disincentives to doctors to train are so dire that in practice there are few of them about. The recent change in the rules on licensing herbal medicines is a sad step in the wrong direction and threatens a whole range of well tried remedies. There are social reasons too. To give one example, once homoeopathy is fully accepted the efficacy of the infinitesimal dose will cast quite a different light on arguments for the safety of pollutants in the environment.

But it is not just a question of money. Despite the many advances I have outlined, there is still a gap of understanding in some scientific quarters. I have thought for some time that this revolves round a confusion between the aims of science and medicine, which are too often treated as though they were the same thing. Science sets out to explain the natural world; medicine sets out to make people well. They often overlap but they are essentially different.

A malign consequence of this confusion is that only one kind of evidence is generally accepted in medical circles. Anything outside this is called "unscientific". That is an unhelpful use of language, as what it usually means is only that the principles are not yet understood. Was the principle of, say, television unscientific in 1900 but scientific by 1940? There is also still a tendency to talk of fraud and charlatanism when what is really involved is, again, a failure to comprehend. Frauds there are of course, but I think they are few. They are far outnumbered by the enthusiasts who may have a valuable therapy but who have also a cavalier attitude to evidence of any kind. That is as unproductive in one direction as the rigid scientific view is in the other.

There is a striking scene in Brecht's Life of Galileo where the scientist is standing in front of his telescope while the academics argue whether or not to look through it. He urges them repeatedly to come and look, but in the end they decide there is no point because they know already that the heavens cannot be as Galileo says they are. Innovators who were likewise pilloried include Pasteur, Lister, Freud and many, many others.

The resisters of change are always there. They are the ones who only ever discuss acupuncture at the level of infected needles, or herbs in the context of an exceptionally rare adverse reaction. They generally take care never to get too close to the phenomena they ridicule. They forget that probably only about 20 per cent. of modern medical techniques have themselves been scientifically validated. That figure was put forward by the conventional physicians in the RSM colloquia I mentioned. They help create the kind of climate in which a majority of patients do not dare to tell their GPs they have sought help elsewhere. I often wonder how many so-called spontaneous remissions may in fact be due to undeclared visits to a healer or herbalist. Of course I do not claim that the seeds of distrust are sown only by the orthodox, because there is fear and incomprehension on the other side too.

Anything the Government can do to help complementary therapists legitimately to find their feet through training, research, registration or other means will, I think, be effort and money well spent. They suffer at present under quite a few handicaps. There is gratitude for what has been done so far and for a new openness to complementary approaches. There is gratitude also for the stance of benign neutrality which contrasts with that of many other governments. If this stance could become a bit more benign and a bit less neutral, I know the country would benefit. I beg to move for Papers.

5.37 p.m.

Lord Brougham and Vaux

My Lords, it is my great pleasure on behalf of your Lordships to thank the noble Earl, Lord Baldwin, for introducing this debate. As he said, it is the first debate that we have had on complementary medicine in this House for two-and-a-half years. I must first of all apologise to the noble Earl, my noble friend and to the House for the fact that, due to a previous engagement, I shall not be able to stay for very long. Some noble Lords will ask themselves what on earth I am doing speaking on alternative medicine. I too wonder why I am speaking today, but as the immediate past president of the Royal Society for the Prevention of Accidents I hold the safety of the public close to my heart. It was for that reason that I readily agreed to take over the sponsorship of a survey of osteopathic schools from our late dear friend Lady Lane-Fox. Now noble Lords know the reason why I am speaking in this cebate.

I should like to make some general remarks which, while principally concerning the training of osteopaths, do, I think, hold lessons for all the main complementary therapies. I was surprised and not a little disturbed to learn that training courses in osteopathy range from a four-year degree course to part-time and correspondence courses offering little more than a few weekends' training in manipulation. In an independent primary contact profession such as osteopathy it is clearly essential for the safety of patients that all practitioners are trained sufficiently in the skills of diagnosis. This is not to enable them to compete with doctors but to communicate and work more closely with the medical profession, which is clearly of benefit to patients.

Practitioners must be capable of identifying conditions where osteopathic treatment would be inappropriate or even hazardous and thus know when a patient requires immediate referral to his general practitioner. I feel sure that the public interest would be best served by legislation that registered as many practising osteopaths as possible. I am sure that my noble friend the Minister would agree that any system of statutory registration should require and be based upon the highest possible standards of training. I believe that the future of complementary medicine will depend upon its ability to provide credible standards of training and an educational provision based upon the accepted norms within other comparable orthodox health care professions.

I am grateful to the noble Earl, Lord Balwin, for referring to the King's Fund Working Party on Osteopathy, which resulted from discussions that took place after the last debate on complementary medicine initiated by the noble Lord, Lord Kindersley. It seems appropriate that the King's Fund, which is so often at the centre of important developments in the field of health care, should be involved in this initiative. I know that osteopaths would wish me to express their thanks to both the noble Lord, Lord Kindersley, and to His Royal Highness the Prince of Wales, who, as President of the King's Fund, encouraged this important development. Ministers should also be congratulated on their part in supporting the work of the working party by the appointment of two officials from the Department of Health to act as observers to the working party.

I believe that the other main therapy groups will be watching developments within the osteopathic profession with interest. Clearly osteopaths have engaged in the detailed work which will provide a route that others may more easily follow in the future.

5.41 p.m.

Lord Thurlow

My Lords, I too should like to express my appreciation to the noble Earl for giving us the opportunity for this debate. He skilfully outlined the very wide spectrum of different therapies. I should like to confine my remarks to a particular field which the noble Earl mentioned several times, namely that of homoeopathy. I am in no way an expert but my credentials are that I have benefited for the whole of my life, as a patient, from homoeopathic treatment as well as from orthodox medicine.

As the noble Earl said, in the homoeopathic field there is a considerable and growing patient demand. At the same time there is an upsurge of interest among young doctors and medical students. But it is not yet remotely possible to satisfy that growing demand because of the insufficient supply of specialists, educators, research workers and clinical opportunities in hospitals.

However, there are hopeful aspects. In the last year, as the noble Earl indicated, there have been signs of a considerable change of heart among doctors. The medical school of Glasgow, which is the largest medical school in Europe, may be taken as an illustration. It is accepted there by orthodox practitioners that complementary medicine must be evaluated. There are currently 350 places on homoeopathic courses at Glasgow. For the past three-and-a-half years there has been a fellowship to examine this area, 50 per cent. financed by the Medical Research Council. That is very encouraging. The fellowship has been exploring integrated care for the benefit of patients, referring patients either to orthdox practitioners or to forms of complementary medicine as their particular circumstances require. Sometimes in the homoeopathic field and elsewhere in the complementary sector that approach has had enormous success.

Great strides have been made in education in Glasgow. Some 80 medical professionals are about to start on a three-year training course after graduation. The course offers alternatives according to the interest and ability of the trainees and the amount of time they can afford to devote to it. Each of the three years is self-contained. If the trainees attend for just one year they will at least gain an awareness of the potential. They can then direct patients to homoeopathic specialists even though they are not necessarily equipped to practice themselves as specialists. Those who take the full course emerge after their three years of pre-registration medical training and three years orthodox medical training, followed by an additional three or four years of specialist homoeopathic training, with considerable specialist ability.

What incentive is there to potential doctors to embark on such a long course of training when there is still no specialist qualification recognised by the Joint Committee on Higher Medical Training at the end of the tunnel? Three years ago in our last debate I ventured to draw the attention of your Lordships to that anomaly. How much progress has been made in the affairs of the joint committee since then? So far as I know, none whatever. That is profoundly disappointing and is not a credit to the royal colleges and those they designate to serve on the joint committee. I hope very much that the change of heart that we have heard is taking place will be reflected in this field. At the moment, while there is demand for treatment and interest among young doctors, there remains that very serious disincentive.

The needs of the five homoeopathic hospitals in the National Health Service remain acute. Glasgow needs a new hospital. The Royal London Homoeopathic Hospital desperately needs rejuvenation. Its premises have not been touched for over 30 years. I believe that a very difficult situation exists in Bristol.

Here we have a manifestation of the effect of a passive lack of interest on the part of the highest strata in the medical establishment. I know that that is not reflected in many parts of the higher strata, such as the noble Lord sitting beside me, but the fact remains that until there is a change of heart in those circles we shall not see the support for innovation, research and development that we require.

5.50 p.m.

Lord Colwyn

My Lords, I too should like to congratulate the noble Earl, Lord Baldwin of Bewdley, on the comprehensive way in which he introduced our debate this afternoon. I must declare some interests: I am president of the Natural Medicine Society, I am a patron of the Blackie Foundation and, with the noble Lord, Lord Ennals, I am joint president of the Parliamentary All-Party Committee on Alternative and Complementary Medicine. Finally, I try to steer my patients towards complementary therapies whenever possible.

In his address to the British Medical Association in 1983, the Prince of Wales voiced his fear that our current preoccupation with the sophistication of modern medicine would divert our attention from: those ancient, unconscious forces, lying beneath the surface, which will help to shape the psychological attitudes of modern man". Prince Charles went on to suggest that the concept of modern medicine might be slightly off balance. He said that he believed the art of healing should nevertheless take account of the long neglected complementary therapies which, in the right hands, can bring considerable relief, if not hope to an increasing number of people". His Royal Highness used the word "complementary". I think that that is preferable to "alternative", which might seem to represent a position of opposition or even antagonism to orthodoxy. Incidentally, the French call it médecine douce. That composite medicine represents a form of comprehensive diagnosis and treatment, the therapies having not been subjected to the process of "scientification".

Medicine has always been an art. It was not until the advent of statistics and the double blind trial was introduced in the 1940s that technological medicine took over in the form that we know today. Despite the improvements being made in the National Health Service and Community Care Bill, the crisis in health care is still with us. Our debates on so-called health are not about health at all; they are about how much money goes into the orthodox system of health care, which, as noble Lords know only too well, will never be sufficiently funded, whichever administrations are in control.

The modern, research-based scientific advances in medicine over the past 50 years have been spectacular and have brought relief, healing and sometimes health to countless numbers of patients. The growth of knowledge has been such that the different specialties have developed, each competing for and making legitimate demands on the National Health Service budget, which always has fallen short and always will fall short of the personnel and materials needed to benefit all those patients who are perceived by conventional methods of diagnosis to be ill. It has been estimated that about one-third of all patients with chronic symptoms have no organic disease and that another third have symptoms which are unrelated to their organic condition. The skill to understand and relieve the suffering of those patients is just not available within the accepted framework of conventional medicine.

Scientific advances in medicine have also affected the patient-doctor relationship and caused difficulty in communication. Such misconceptions might be why help is sought from practitioners of complementary medicine where patients can at least be assured of a listening ear, despite the fact that the majority declare themselves satisfied with the National Health Service. The complementary therapist has in general more time to talk and inquire into environmental factors which some overburdened general practitioners may overlook or regard as unimportant. The therapy offered usually involves the active participation of the patient. That has obvious appeal in an age when authority, including that of the medical profession, is being challenged and health is considered to lie in self-help.

Noble Lords have heard from the noble Earl, Lord Baldwin, about the work that the individual therapies are doing to put their houses in order. In her address to the Royal Society of Medicine in June 1986, my noble friend Lady Trumpington said: I am firmly of the view that alternative therapists must address the question of standards and qualifications … Many arguments have been put forward for limiting freedom to practise—perhaps through the use of registers". In many therapies that is now the case. Following our last debate on the subject, discussions took place, for example, with Ministers and leading members of the medical profession which culminated in a consensus that osteopaths should work speedily towards a system of statutory registration. Last week, noble Lords from all sides of the House discussed an amendment to the National Health Service and Community Care Bill to enable budget-holding practices and other GPs to buy services from the complementary therapies for their patients. That amendment was rejected by the Government. Perhaps my noble friend could tell me whether an increase in the use of complementary healers by the NHS might be more likely to occur if the process of statutory registration were to be extended to include many more therapies. Can she give me any advice on the Government's views on self-regulation for the therapies and what they should do in the 1990s to obtain government recognition?

I hope that my noble friend the Minister will forgive me if, as president of the Natural Medicine Society, I repeat an argument which I raised during our last debate on the subject in November 1987. We are still concerned that the advisers to the department who are looking at the problems faced by the Department of Health in reviewing and running a licensed medicine system are predominantly experts in orthodox medicine. It must be logical that the assessment of natural and herbal medicines and the vast range of homoeopathic remedies should be carried out by experts who are familiar with their use and practical application.

Perhaps I may repeat my question and ask the Minister why, despite the fact that there is provision for a special advisory committee on alternative medicines under the Medicines Act 1971 and the fact that many other countries have such a committee, the department continues to refuse any contribution by such experts? I shall remind the Minister of the existence of the Medicines Advisory Research Committee within the Natural Medicine Society. It remains a medicines commission in exile, comprised of people who are able to advise the Government on the licensing of medicines when asked to do so. The refusal of the Secretary of State to accept the nominations of any members of that committee remains a strong disappointment to all of us who believe in the use of natural medicines and are concerned about the effects that that might have on the granting of product licences and on the draft EC directive on homoeopathic medicines.

Once again, I should like to pay tribute this evening to the contributions that my noble friend Lord Ferrier has made over a number of years in campaigning for the acceptance of chiropractic within the NHS. I know that my noble friend Lord Glenarthur will cover that subject in more detail and that my noble friend Lord Ferrier will read our debate. I hope that the Minister will have some encouraging words for him at the end of the debate.

Complementary medicine has a long and distinguished pedigree. It emphasises the holistic approach and the necessity to consider every aspect of the patient, all of which bear on a sense of well-being. It is health and well-being—indefinable terms scientifically—at which complementary medicine aims, with as little interventionist treatment as possible, with a view to enhancing the body's self-healing, self-repairing, self-defending and self-reproducing mechanisms.

In conclusion, I should add my support to that of the noble Earl, Lord Baldwin, and the Research Council for Complementary Medicine in their plea for more government support for research. Up to £500 million is spent each year on orthodox medical research. Just 1 per cent. of that would make a tremendous difference and, incidentally, match the amount given by the German Government to their complementary research programmes.

In debates in this House I am continually impressed by many noble Lords who are classical scholars and are able to use classical quotations. I should like to emulate them this evening and finish with a quotation from Plato. Despite having taken Latin O-level, I shall use the English translation, which reads: The cure of the part should not be attempted without treatment of the whole. No attempt should be made to cure the body without the soul, and if the head and body are to be healthy you must begin by curing the mind, for this is the greatest error of our day in the treatment of the human body that physicians first separate the soul from the body".

5.59 p.m.

Lord Greenway

My Lords, I too should like to thank my noble friend Lord Baldwin of Bewdley for giving us the opportunity to discuss the subject once again. Like many noble Lords, I am a user of complementary medicines, particularly homoeopathy and acupuncture. I am a satisfied user. I discovered just before the debate began that my noble friend knows my acupuncturist very well. Having talked to him on the telephone, I am happy to pay tribute to my noble friend for the work that he is doing as chairman of the accreditation board looking into the training of acupuncturists. Much useful work has already been achieved.

My noble friend made passing mention of the Marylebone health centre where Dr. Patrick Pietroni, who has recently retired as chairman of the Holistic Medical Association, has been running a model to try to address the problem of the economic issue of complementary medicine when combined with an NHS unit. In all three areas of prescribing, referral and admission, there have been substantial reductions due to the complementary therapies. That has resulted in overall savings for the NHS purse. Admittedly, complementary therapies are costly. However, I argue that they are cost effective and have the added advantage of increasing human caring contact with the patient. I stress the word "caring". Therefore, complementary therapies are not only clinically effective; they can also be economically viable within the system.

Under new government plans, GPs are to be given their own budgets. If they were to use therapy as an alternative to drugs, it might be possible to pay the therapists out of the savings gained. However, that depends on the administering authorities which decide how any savings are to be spent. At the moment savings can only remain in a general practice within certain parameters. I suggest that those parameters should be extended to include complementary therapies.

Massage and counselling, in which I include the increasingly important stress management, have been found to be the most useful therapies and are sought after by both patients and GPs. My wife's experience confirms that. She works in both those fields and her work now extends to the terminally ill, with whom there have been some very encouraging results. Both osteopathy and acupuncture also have been found most useful for immediate pain relief.

I conclude by expressing my belief that complementary medicine or therapy is here to stay. Customers want it; there is no doubt about that. It echoes the spirit of the times; it is "green" if I may so describe it; and it coincides with a need to look after our own planet. That is a matter that increasingly concerns us all.

I hope that the noble Baroness who is to reply and her department keep their fingers on what I am sure will be an increasingly strengthening pulse.

6.2 p.m.

Lord Glenarthur

My Lords, as my noble friend foresaw, I should like to deal with one type of complementary medicine that was referred to by the noble Earl when he introduced the debate; namely, chiropractic. My interest almost inevitably stems in part from personal experience. I have undergone that technique to relieve back pain—successfully, I might add—on more than one occasion. But my interest also comes from the fact that for two years I was a Minister in the Department of Health and Social Security. During that time, alternative medicine, as I think it was then called, was part of my policy area. There is a third connection in that my brother is a practitioner of chiropractic. Naturally, much of his enthusiasm has rubbed off on me, let alone his excellent treatment. However, I am not here to give a commercial for him.

I believe that it is important to try to focus a little on the statistics. Recently I read that each year about 2 million people go to their general practitioners with back pain. About 70 per cent. are better in a month and 90 per cent. within three months. But 30 per cent. of them have a recurrence within 12 months. Each year about 400 000 people are referred to hospital with back pain. According to some estimates, the result is that 33 million working days are lost annually. That represents 10 per cent. of all absences from work owing to ill health. According to the Office of Health Economics the cost of back pain amounts to over £1,000 million a year in terms of lost production. Those figures are stark indeed.

If the existing techniques under orthodox medicine cannot be used in full to meet the problem, other techniques will have to be considered and looked at positively. Where does chiropractic fit in? So far as I know there are only two schools of the technique. One is the Institute of Pure Chiropractic, which is often called the McTimoney School, and of which my brother is a practitioner. The other is the British Chiropractic Association which is based at Bournemouth. I have been treated with both techniques and I know of many others who have had one or both of them.

To help reduce the costs and numbers to which I have referred, it was my hope as a health Minister that perhaps one of the techniques most usually recognised as being efficacious in treating back pain might be more formally linked and available to the National Health Service than had been the case. Both osteopathy and chiropractic seemed to fit the bill. But, as I regularly explained to those who encouraged me to make either of those therapies available on the National Health Service, Ministers do not decide which medical treatment should be allowed. That is, or was, a matter for the Committee on Professions Supplementary to Medicine. In other words, it was for doctors to decide. I have to say that doctors were not universally sympathetic.

As I understand it, neither of those two techniques has yet been judged suitable. That is disappointing. The reason lies partly in the fact that the two schools of chiropractic to which I referred do not have a common syllabus, nor do they use precisely the same technique. Although it attempts to do much the same, osteopathy is different again. I urged all of them to reconcile their differences. Indeed, one of the overall problems is, or at least was, that the various proponents of alternative therapies were unable to speak with one coherent voice. That made advances in recognition much more difficult to achieve. The setting up, I think, in January this year, of the national consultative council to which the noble Earl, Lord Baldwin, referred—the National Consultative Council for Alternative and Complementary Medicine—is a welcome step in the right direction. It is an organisation for all therapists and is controlled by the therapists themselves. It aims to allow natural therapies access to a platform from which one voice would come.

I believe that its principal challenge is to incorporate into one organisation disparate therapies at different levels of training and competence. To that extent no doubt it will consider the system of minimum requirements, deal with training, safety, a basic code of ethics, insurance cover, and membership of a properly constituted professional body with complaints and disciplinary procedures.

I believe that the development of the council is encouraging. It deserves support, acknowledgement and the chance to prove itself. I am concerned that restrictive legislation, based on the claims of one specific therapy, or group within a therapy, should not be contemplated before all those concerned get their act together. In replying to the debate, I hope that my noble friend will be able to indicate that she recognises the force of that argument.

I should like to refer briefly to one other related matter: the effects of the EC and 1992 upon this important topic. It is particularly important that all patients should be free to choose a therapy that is appropriate to their needs. That was very much the theme of the noble Earl when he initiated the debate. Therefore I trust that Her Majesty's Government will resist the kind of directive from Europe which many fear and which might limit all therapeutic medicine to fully qualified medical practitioners. There are many people in this country who would testify not only to the expertise of chiropractors, which I have dwelt on today, but also to the success rates of acupuncture, homoeopathy (as we heard), osteopathy and many others. If we do not take care, we may find that many of the very successful practitioners of a number of those therapies were unable to practise. That might be widely regretted. It would be unjust and retrograde.

I hope that my noble friend will bear that point in mind and perhaps assure the House, as the noble Earl, Lord Baldwin, would have her do, that Her Majesty's Government will not be dictated to in a way which disadvantages practitioners who find themselves inadvertently in the forefront of a fundamental fight to preserve the structure of benefits and freedoms in what hitherto has been enshrined in our common law approach to social legislation.

6.11 p.m.

Lord Broadbridge

My Lords, two years ago, on 21st May 1988, Sir Richard Bayliss of the Royal College of Physicians wrote in his college's journal a note of warning about the current increased interest in complementary medicine. He observed that most patients use unconventional treatments to complement, rather than as an exclusive alternative to, orthodox medicine. He has the protection of the word "most" before "patients", but statistics show that many patients enter complementary medical treatment with no prior orthodox treatment or current care—for example, 22 per cent., 27 per cent. and 25 per cent. of those presenting for complementary treatment for neck, back and low back problems respectively. He concluded, however, with the important words: Leaving out blatant charlatanism, the main choices are acupuncture, hypnosis, homoeopathy, osteopathy, chiropraxy, herbalism and megavitamins … the same standards of assessment should be used to determine the efficacy of complementary as of orthodox medicine and drugs". It was for that reason that eight years ago the Research Council for Complementary Medicine (the RCCM) was established. During that period of eight years 109 projects have been presented to the council for a call upon its very limited funds. But in March this year the Department of Health grant of £70,000 towards administrative costs of the council came to an end. Although much appreciated, it pales into insignificance beside the sum of £500 million of government funding and charitable donations for orthodox medical research, about which we have heard already from other noble Lords.

The RCCM has struggled to support some 20 of the proposals put to it on the basis that these would be of primary value in discerning the proper use or mechanism of some of the complementary therapies; and to answer Sir Richard Bayliss's stricture that the same standards of assessment should be used to determine the efficacy of complementary as of orthodox medicine and drugs. But it is difficult to compete with £500 million on a budget of £70,000 plus annual donations.

To me, an exciting example of an easily understood forthcoming project is one to be conducted soon at Huddersfield Polytechnic for a budget of around £5,000, into manipulation for acute back pain. That accounts for a burden estimated by the Office of Health Economics in 1982 at £156 million to the National Health Service. It was alone equivalent to 20 per cent. of the then National Health Service annual capital budget. Remarkably and significantly, in spite of having to pay for the treatment themselves, some three-quarters of a million patients are seen each year by the 330 registered members of the British Chiropractic Association.

With reference to the project, it is believed that back pain patients have abnormal patterns of spinal movement which distinguish different kinds of back trouble and that these patterns can identify patients who will respond well to manipulative treatment. The project seeks to justify those beliefs scientifically. Using an electromagnetic movement analyser developed initially for the aerospace industry, the spinal movement patterns of back pain patients, will be monitored for some months to determine the characteristics of those who respond well to treatment. It is anticipated that the project will not only increase understanding of the types of back trouble but will also enable descriptions to be made of those for whom early manipulative treatment will reduce suffering and incapacity and thus loss of work time. That is all for the sum of £5,000 in contrast to £500 million for conventional medicine.

Demand for complementary medicine and complementary therapies is growing consistently and rapidly in terms of numbers of practitioners, statistically recorded consultations, and surveys in opinion polls. Six months ago a MORI poll recorded that an average of one in three would consider using acupuncture, homoeopathy and osteopathy, and that the vast majority who used complementary therapists—up to 93 per cent. of chiropractic patients—were very satisfied or fairly satisfied. One in three on a national representative basis is about 15 million people.

A slightly earlier attitude study by the City Health Centre in 1988 concluded that the majority—across age, sex, income and occupation—wanted complementary medicine to be available on the NHS and on private health insurance schemes. That was coupled with the key finding that complementary medicine is now a significant health care resource viewed with respect and confidence by a large section of the population.

The European view is still more emphatically towards complementary medicine both in practitioner numbers and in funding. With the approach of 1992 and our ever-increasing links with Europe there is a real need for a co-ordinated research programme into the various complementary therapies that are proving ever more popular through Europe and beyond. France has 10,000 doctors who also practice homoeopathy. We have 500. Validity of homoeopathy and acupuncture is accepted by the French Academy of Science and the prescriptions and consultations to which they give rise are reimbursed by social security payments. In Germany, naturopathy and nature cure are the dominant therapies. Its government are spending 800,000 deutschmarks on complementary medical research, rising to 3 million deutschmarks after three years. In the Eastern bloc, herbalism is very popular. In Switzerland, acupuncture and homoeopathy are widely practised. In Britain, oesteopathy and homoeopathy are perhaps the most consulted therapies.

In conclusion, I believe that additional government funding for the RCCM in Britain would guarantee that adequate research is done, protecting patients from exploitation and encouraging authentic therapeutic practitioners, leading also to greater co-operation between orthodox and complementary practitioners and, importantly, to considerable economies for the NHS, in particular for the drug bill.

The doubters and the unsympathetic would do well to remember that in a Gallup poll four years ago, 50 per cent. agreed with the statement that, Human nature is such that we are frequently prevented from seeing that that which is taken for today's unorthodoxy is probably going to be tomorrow's convention".

6.18 p.m.

Lord Cullen of Ashbourne

My Lords, many of your Lordships will know of my long-standing interest in osteopathy. I am extremely grateful to the noble Earl, Lord Baldwin, for initiating the debate today and for drawing attention to the exciting development of the King's Fund Working Party on the regulation of that profession.

There are a number of other issues affecting the osteopathic profession which I should like to draw to your Lordships' attention. The vast majority of health insurance companies now pay benefit for treatment given by osteopaths registered with the General Council and Register of Osteopaths provided that the patient has been referred by his doctor. BUPA, however, will pay benefit only if the registered osteopath providing the treatment is also a registered medical practitioner. That is anti-competitive because not only does it discriminate against different members of the same register, it also distorts competition between osteopaths and physiotherapists whose treatment costs are reimbursed under BUPA policies. If, as I suspect, in winding up my noble friend says that it is a matter for BUPA and not for the Government, I should ask them to exert their influence on BUPA to come into line with the other health insurance companies.

There is another issue which relates to health insurance. The Government have recently introduced a system of tax relief on private medical insurance policies for the over-60s. Provision for alternative medicine, which in this instance includes the practice of osteopathy is, however, excluded from policies which are eligible for tax relief. The Inland Revenue argues that it wishes to target tax relief on to areas that will result in the relieving of pressure on NHS resources. The Inland Revenue appears to have failed to appreciate that the 3 million treatments given by registered osteopaths each year do indeed relieve the pressure on the NHS.

That regulation does not allow registered osteopaths or other complementary therapists to compete on an equal basis with other paramedical professions such as physiotherapy within the private sector. Surely it is for the insurance companies to determine which treatments should be made available to their clients and for doctors—not the Inland Revenue—to determine which forms of treatment might benefit their patients.

There is also a very serious problem which could have profound implications for the general public. In March 1989 the Monopolies and Mergers Commission reported on the services of professionally regulated osteopaths. Since then the General Council and Register of Osteopaths, which represents 75 per cent. of all regulated osteopaths, has been engaged in negotiations with the Office of Fair Trading regarding the relaxation of its rules on advertising. The general council has now agreed with the Office of Fair Trading the complete text of its new advertising rules with the exception of the use of unsolicited direct mailshots. The general council believes that to allow direct mailshots by practitioners would be against the public interest, as patients who consult an osteopath are already anxious about some aspect of their health and are thus vulnerable to exploitation.

The Monopolies and Mergers Commission has recognised the argument, which is supported by the Department of Health, in relation to the advertising by medical specialists. However, the same argument applies equally to the services provided by osteopaths because patients do not register with a particular osteopathic practice as they do with a general practitioner. They consult an osteopath only when they are in pain or distress.

It appears to be wholly inappropriate for a health care profession such as osteopathy, which is not yet regulated by statute, to be forced to allow the use of unsolicited direct mail to members of the public. In the absence of statutory regulation the osteopathic profession simply does not have the ability to control, or to impose effective sanctions for, abuses of this form of advertising. If responsible osteopaths were forced to allow the use of unsolicited mailshots other groups in alternative medicine would undoubtedly follow. The General Council and Register of Osteopaths firmly believes that it would be failing in its duty to protect the public if it were to accede to the demands of the Office of Fair Trading.

I understand that the Office of Fair Trading has now reported to the Department of Trade and Industry and that representatives of the General Council and Register of Osteopaths will be meeting the Minister responsible later this month. I hope that the Minister will give serious consideration to the very real problems which will be created for both the osteopaths and the general public if the profession is forced by the Secretary of State for Trade and Industry to allow the use of unsolicited mailshots. I should be grateful if the Minister would look into that matter and explain to her colleagues at the Department of Trade and Industry that osteopaths are working hard towards a system of statutory registration and that now is not the appropriate time to force the issue of direct mail.

Finally, we have heard today about the many different therapy groups and organisations which purport to represent them. In the previous debate on complementary medicine my noble friend Lord Skelmersdale, speaking on behalf of the Government, mentioned the apparent confusion that existed between those therapy groups which favoured an umbrella approach and those which favoured a group-by-group approach to both regulation and liaison with government. I am sure that all those involved with the natural therapies will welcome clarification of the Government's view of the matter.

6.26 p.m.

Viscount Tenby

My Lords, I declare an interest in the matter. I am a trustee of the Research Fund for Complementary Medicine, which is a body that raises money for the Research Council for Complementary Medicine. I congratulate my noble friend Lord Baldwin on initiating the debate and on the speech which launched it.

It is appropriate that we should be discussing complementary medicine because clearly it has a great fund of good will in this House as evidenced by a debate on the subject two-and-a-half years ago. Indeed, the well-attended meetings of the Parliamentary Group for Alternative and Complementary Medicine show that there is also a great deal of interest in the subject in another place. Nor—and we are grateful—is there any lack of sympathy in government circles. It is right that that should he so. Complementary medicine provides a means by which some of the intolerable and in financial terms infinite burdens on the National Health Service can be reduced.

In short, it is a situation in which comparatively modest expenditure on properly controlled research and practice—which is what the RCCM exists to carry out—can result in considerable savings to the national health bill. Complementary medicine can effect savings not only because of its emphasis on preventive medicine and treatment, dealing with some symptoms before they reach the stage where they might require expensive orthodox treatment, but also in reducing the size of the drugs bill. For example, the use of expert osteopathy on a difficult back instead of repeated doses of painkillers is in the long run cheaper and almost certainly more effective. That would be a desirable solution, would it not, in most cases? But its efficacy is inevitably reduced by the fact that such treatment is almost always available only for paying patients and is rarely to be found within the National Health Service.

The position of orthodox and complementary disciplines has been bedevilled in the past because of misunderstanding. As the noble Earl said, the terminology used to describe those practising natural therapies proves the point. From being described as "fringe" medicine in the 1960s, it moved to "alternative" in the 1970s, before reaching today its eminently more sensible description of "complementary" medicine. The use of "fringe" to describe an extensive corpus of natural medical disciplines, some with proven pedigrees going back for many hundreds of years, is patently ill informed and in some ways mischievous, implying as it does some element of quackery, which, although present to a small degree, does great disservice to the overwhelming number of skilled and honourable practitioners. More recently there has been extensive use of the word "alternative", which in its own way is just as damaging, implying as it does an either/or choice—a confrontational stance which cuts to the very heart of what complementary medicine stands for. I very much hope that all that is now behind us.

For example, it is good to detect a certain softening in the stance of some bodies representing orthodox medicine. The truth is that general practitioners have often been ahead of their own representatives in seeing benefits to some of their patients by referral to complementary practitioners. One must admit with some sadness that in former years the attitude of, for example, the British Medical Association has been unhelpful. It is rather as if on the field of Waterloo Wellington turned away Blüicher's troops because they were not wearing the right boots. Happily, it seems that they are now listening to their own troops anxious to win the battle against the common enemy—ill-health.

I referred earlier to the aura surrounding natural medicine encapsulated in its description as "fringe". Of course in the past practitioners have acted in what I regret to say was an unprofessional manner. It seems likely that the individual disciplines which come within the complementary medicine fold are well able to set their own standards and, indeed, are doing so at present.

In addition, I am in favour of the creation of an umbrella organisation representing all sides of complementary medicine with which government can deal. I must add, however, that in what is inevitably a fragmented and fiercely independent sector, that will require a substantial act of faith, much patience and no little tact.

Today we have an ironic and paradoxical situation. I have already referred to the fact that the last time the subject was debated in this House there were professions of good will towards complementary medicine from all sides. I am confident that that will be so today and, indeed. there have been already. Some noble Lords have experience of homoeopathy, others of acupuncture and osteopathy. All know something about the subject and most have good words to say about it.

However, at the end of the day the brutal truth remains. Complementary medicine is not just underfunded; it is barely funded at all. However, at this point I must mention that all in the field of complementary medicine were very grateful to the Government for two sums of £40,000 and £20,000 given in the past two years towards the administrative costs of the RCCM.

As I disclosed an earlier interest as a fund-raiser for that body, noble Lords may be forgiven for repeating the well known phrase, "Well, he would say that, wouldn't he?" Be that as it may, nevertheless, I must emphasise, with the honourable exception to which I have just referred, that every penny which the RCCM receives comes from private and corporate donations. The task is certainly daunting. The RCCM is now firmly established thanks to the far sightedness and dedication of Dr. Richard Thompkins and others and is playing in its own field a role similar to that of the Medical Research Council.

However, the latter receives, as noble Lords have already said—but good tunes stand replaying so I make no apology for repeating the figures—approximately £500 million per year from the Government, the pharmaceutical industry and other sources. Noble Lords have said too that just 1 per cent. of that total would transform the whole position of complementary medicine. If it is thought that that figure is pie in the sky, repeating the figures again, I must point out that the German Government are spending 800,000 deutschmarks on natural therapies, rising in three years to 3 million deutschmarks. Even allowing for what some may feel, perhaps ungenerously, is a more prosperous economy than ours and a different system of priorities, such a commitment is in stark contrast to our reluctance to give support to what is an increasingly popular complementary medical service.

As the popularity of complementary medicine increases, as it surely will—your Lordships need only look at the dramatic leap forward in the past 20 years—so the pressure will increase from the public for adequate control and research. Patients have a right to expect that everything that can be done will be done. If complementary medicine is given appropriate and imaginative support, I am confident that the means exist to ensure that that need will be met in full.

The way forward is to see the two bodies—orthodox and complementary medicine—working together, each with respect for the other's skills in a fruitful partnership which can only ultimate be of benefit to those who matter most, the patients. I look forward to the day when they are as one and have ceased to be separate entities.

6.35 p.m.

The Earl of Clanwilliam

My Lords, I thank the noble Earl, Lord Baldwin, for giving us the opportunity of this debate. I have been interested to hear remarks by noble Lords from all sides of the House with which I am in total agreement. Much of what I intended to say has already been said. I should like however to speak about medical herbalists. I am not one myself; but I have been connected with medical herbalism in its various forms for the past 20 years. Its practitioners are the legatees of very ancient arts. Most of the information of the ancient healers of Galen and Pliny was lost in the Middle Ages but recovered by the great herbalists of the 16th and 17th centuries whose names will be known to your Lordships. Great strides have been made in research in the past 40 years.

As with other disciplines in the field of the public need, more protection is required. That protection should perhaps be in the form of the registration of practitioners. There are doubts among various practitioners of herbal medicine about registration because they are reluctant to lose the benefits of common law which have supported them for so long. However, registration could be made by schools of practice which in turn would need an academic basis. Many schools have been mentioned today. For instance, the Glasgow school which already has agreed recognition. However, in terms of medical herbalism, if a school in Kent started and developed by medical herbalists from funds supplied by patients—another illustration of how badly funded is the sphere of complementary medicine—could be given academic status, it would be in a position to supply degrees instead of diplomas. Those qualifications might then receive a status equivalent to a certificate in the medical profession.

As noble Lords have said, many schools are in existence. However, further funding is required. Of course, the schools would provide scientific research into therapeutic efficiency, so regularly called for in the face of rising public perception of and demand for complementary medicine. The Centre for Complementary Health Studies at Exeter, which has already been mentioned, is a vital source of research and covers all therapies mentioned by your Lordships. The herbalists have produced the British Herbal Pharmacopoeia which has some 90 items attached to it, and the Centre for Complementary Health Studies is producing a compendium which will give support for that pharmacopoeia.

That is all being paid for out of patients' fees. There is no support from the Government. While we may not ask for a National Health Service payment for complementary health therapies and fees, welcome though that would be, there could arise the situation—which we hope will occur in the future—where general practitioners will refer their patients to a registered recognised complementary practitioner. In that event some arrangement will be needed, especially if the GP is in a fundholding practice, a matter discussed in an earlier debate.

I shall not have the temerity to nominate the complementary treatments that apply to various disorders, but I am a great devotee of the osteopath. I suffer a displaced disc now and again and when that happens I may crawl crabwise on to the osteopath's table. However, after 20 minutes of grinding noises and cracking necks, I walk out upright, if somewhat pained. I believe the alternative would be to spend 10 days in a national health hospital bed under traction consuming vast numbers of unnecessary pills. I also suffer periodically from a certain amount of cramp. For that I receive quinine, from both my GP and the herbal practitioner.

Perhaps I could pay a tribute to the local general practice in my village at Tisbury, which performs a magificent service. I have no wish to detract from that service which helps with the principle of healthy lifestyle, promoted as part of the natural process. The herbalist perhaps creates the idea of the natural healthy lifestyle more than any other. He provides a modus vivendi which helps the immune system to be kept regularly in tune. When in tune it is more able to resist casually contracted ailments, and of course involves the patient in becoming more of a client in an on going situation rather than the occasional patient. The regular checks and balances offered by medical practitioners in the medical herbalist field help the healthy client to live to an active old age and be less dependent upon society.

The National Health Service has to deal with illness, accident, surgery and other emergencies which are not the remit of any part of the complementary services. However, as many noble Lords have pointed out, there are millions of patients today who want, need and receive therapies which modern medicine does not recognise. I hope that the medical authorities will help to recognise the importance of these therapies. If they do, they will recognise the call of the people for ready access to their chosen therapy which conserves National Health Service money, reduces waiting lists and actually cures people with medicines which do not carry a health warning on the label.

There is a great deal to be done; a great deal of funding is needed, as always. I ask your Lordships to support this excellent cause.

6.44 p.m.

Lord Clifford of Chudleigh

My Lords, previous speakers introduced many instructive and worthy details relating to the many types and qualities of alternative or complementary medicine, for which details we are all most grateful. I may repeat certain points. Being of "an olde family", I often recourse to the often used, well-tested alternative means of curing such basic ills as the common cold; I indulge in a good brew of hot toddy, or two, or three!

A Scotsman in his sixties (and I hope not to cause offence to the noble Members of this House whose families hail from that wonderful part of the United Kingdom) was being lectured by an enthusiastic general practitioner about the benefits of new medicines and drugs. After the doctor had finished his oration the listener was asked for his opinion. His answer was simple. "My father", said he, "believed in a stiff measure of whisky per day. He was rarely sick. He died when 96 years old and three days after his death he looked a good deal fresher than you do now!"

Few of us deny that to boost one's moral, help relieve a sore throat, we have indulged in alcohol, but we are only attempting to cure a cold, a disease. Disorders can be and are often cured by hand, by manipulators—by osteopaths or chiropractors, the two areas I wish to discuss.

Certain of your Lordships had the opportunity of listening to and questioning the Secretary of State for Health at a private meeting in the corridors of this fine Palace and heard his reaction to osteopaths and to chiropractors. He spoke of them as one body. That is not a fact as, although both may manipulate the bones, the chiropractors are aware of and so also treat the nerves, tissues and muscles relating to those bones. The most important structural bone conglomeration is our spine, a gathering of 24 vertebrae and 23 discs. That does not include the lower sacrum and the coccyx. Both osteopaths and chiropractors have to attend a college of education and receive the same bachelor of science degree as our other 12 royal colleges of medicine.

I should like to bring to the attention of the noble Baroness a matter which is of concern to the private training institutions within complementary medicine which offer approved degree courses. Those schools with formally validated degree courses may apply for recognition for mandatory student grants. However, the Secretary of State at the Department of Education and Science said that I whereas for universities and polytechnics the fee element in a mandatory award will rise in 1990 from £607 per annum to £1,675 per annum, for students at private institutions it will remain at £607 per annum Students at schools such as the British School of Osteopathy and the Anglo-European College of Chiropractic will therefore have to meet virtually the full cost of their course, receiving only £607 towards the real fees of over £4,000 per annum.

As well as the obvious injustice of that situation, it seems odd that a Government who are trying to get institutions of higher education to be more market orientated should discriminate against institutions which have demonstrated their independence and willingness to help themselves. I should be most grateful if the Minister would bring that anomaly to the attention of her colleagues in the appropriate department.

There is generally a certain scepticism shown by the general practitioner towards such alternative medicines as, for instance, osteopathy and chiropractic, but there are signs that that mistrust is breaking down. Many more general practitioners are referring patients with back pains to either osteopaths or chiropractics. In Avon, of the general practioners questioned during a survey about alternative-complementary medicine, 93 per cent. believed that complementary practitioners needed statutory regulation.

Should the osteopath or chiropractor feel that there would be a medical contra-indication resulting from their treatment, they will recommend that the patient see his general practitioner. I am sure that going through the minds of many noble Lords are stories of those who purport to hold qualifications to practise the art of chiropractic or osteopathy. As already mentioned, before one can honestly practise these alternative medicines one must have passed the four-year degree course and earned the B.Sc. qualification. Correspondence courses in such complementary medicines exist. This "quickie" qualification takes six months for the person interested in chiropractic. These six-month people are therapists but they are not doctors or chiroprac-tors.

The properly qualified osteopaths and chiropractors are keen to establish a system of statutory regulation for the safety and protection of their patients, which is another obvious and essential ingredient in their case for registration. It must be remembered that registration, not membership of the National Health Service, is what is sought at present by osteopaths and chiropractors.

It may be that certain statistics give extra power to the argument for the registration of these alternative or complementry medicines. In remembering that general practitioners generally deal with diseases and that osteopaths and chiropractors deal with disorders, one must also bear in mind that over 46 million days are lost each year through back pains. That is a slightly updated figure from that given by the noble Lord, Lord Glenarthur. It combines the two. Three million treatments are given annually by osteopaths.

Back pains in patients cost the National Health Service about £160 million each year. One should consider the lost production when the labour force is so affected and the amount of money lost in benefit payments to those unable to work. That is 46 million working days at £10-50—the standard statutory sickness benefit per day—which equals £483 million. We have heard from all speakers about the benefit that the nation can gain from complementary and alternative medicine when practised by qualified practitioners. The cost savings to the National Health Service and the DHSS have been outlined.

But what about the patient? The cost of treatment is not cheap. There already exist in this country health insurance schemes which will cover treatment from an osteopath or chiropractor. Have the Government thought of introducing something similar (though much broader) to the scheme which exists in the United States of America? In that country, those with an income below a certain level receive Medicaid to cover their insurance. Those who are old age pensioners or who are disabled receive Medicare.

Her Majesty's Government set a precedent in 1988 by allowing employers and individuals partially to opt out from the national insurance charge payable for pension benefits by adopting a private pension arrangement. Many insurance companies are involved in that scheme. If the Government required all the parties—not stopping at those who earn £360 per week but including the many who earn more than that—to pay a common fixed percentage of their gross weekly income into a health insurance fund the whole population would have the benefit of health care coverage.

As with the existing major health insurance companies such as BUPA and PPP, the profits made by the scheme would be ploughed back into it. That would include the National Health Service in the case of the government-run health insurance scheme. We should remember the number of health authorities and hospitals that have been sued for wrongful medical practice. That would be covered by the insurance scheme and the costs would not be drawn out of the national health compensation fund. The registration of osteopaths and chiropractors makes both financial and health care sense.

6.53 p.m.

Lord Hunter of Newington

My Lords, once again my noble friend Lord Baldwin has not disappointed us. He gave a brilliant introduction. I do not know whether I agree entirely with everything he said. However, he was at his best this evening.

Why do I rise to speak tonight? It is mainly to congratulate those who have agreed with the Royal College of General Practitioners, the King's Fund and others to conduct controlled studies in complementary medicine in relation to the efficacy of treatments. We have heard a great deal tonight almost entirely concerned with the treatment of people where presumably the diagnosis is certain. We have heard little about diagnosis except that two speakers mentioned sending patients back to their general practitioners. I should like to hear my noble friend say a little more on this point because it seems that to a large degree the system might depend on collaboration between the general practitioners and the therapists. In other countries, of course, many who are medically qualified take up different forms of therapy.

As a professor of materia medica who had given it up at one time in my life, I thought I would say a few words about that and some of the difficulties. I entered medical school in the 1930s. By that time wise physicians had discarded the materia medica of the 18th and 19th centuries and were discriminating. They recognised that there were perhaps five or six drugs which were efficacious. One was quinine, which was a drug that cured malaria. Another was morphia, or laudanum, which was a painkiller and so useful as a symptomatic treatment for distressing symptons. Those are two important categories of drug.

A little later on in my professional career sulphonamide drugs were discovered by the fine chemical industry in Germany. They were active against bacteria in infections. Many studies were enthusiastically started into the sulphonamide drugs to find out their effects on different diseases. They were, in effect, uncontrolled clinical trials. Some years later, a good friend of mine, Professor McKeown of Birmingham, pointed out the claims being made for sulphonamide drugs and their use. In fact, the mortality rate for certain diseases had fallen many years before the introduction of sulphonamide drugs. Those figures correlated accurately with the improved water supply and better nutrition. It was those factors which had reduced the mortality rate in the first instance.

All this had happened before the drugs were discovered. That is just a reminder of the need for careful controls. I can remember very vividly the first clinical trials that I did with a new drug. There was an unexplained improvement in the control group which had been given a placebo. Was that due to the psychological effect on the patients or the effect of the doctors' charm on their confidence? There is another factor which must be included even with complementary therapies. There is a need for controls. In my professional life, penicillin, antihistamine drugs and a whole range of new analgesics have been introduced into this country. Large numbers of antibiotics have been produced by the pharmaceutical industry.

How did one find out whether the drugs produced toxic effects in human beings; whether they were therapeutically active and what was to be done in a situation where the drug was toxic but effective therapeutically? Into this area came the Committee on the Safety of Medicines, ably guided by Sir Austin Bradford Hill, a statistician, and his pupil, Richard Doll. They had produced dramatic results demonstrating the effect of smoking in causing lung cancer. Tony Bradford Hill is still alive. He is well over 90 years of age. He has demanded that I send him a copy of this debate.

The Committee on the Safety of Medicines was succeeded by the Medicines Commission, which monitors the situation today. So traditional treatments, as they have been called here, have been scrutinised and examined by this system, as has the pharmaceutical industry. Modern biotechnology is now facing up to the complicated challenge of what happens in the nervous system and inside the cell. Perhaps in 20 years' time one will know about the inheritance of diseases—the family trait—which may explain a great deal in new therapies. Perhaps that will be better understood. Also it may be that the cause of cancer can be identified at cellular level.

One of the inevitable results of controlled clinical and therapeutic trials is their inadequacy. The results show the inadequacy of modern medicine. Under these circumstances no sincere or conscientious doctor would deny his patient, if the evidence is there, one form of treatment or another. There is no difference between us in relation to treatment if the evidence is available to support the use of that treatment. What is most important for complementary medicine and its future is for it to subject itself to the same therapeutic trials and examinations as occur in what we call orthodox medicine. I am told that one stumbling block is the idea of tailoring the whole treatment to the patient's individual needs. But I do not think that is a problem. It is still possible to have "double blind" controlled trials under these circumstances.

My only hope is that by this and other means we can extend the range of treatments available to sick people. My continuing lingering fear is that, without detailed examination, grave disease masquerading as back pain or something like that may occasionally be missed.

7 p.m.

Lord Ritchie of Dundee

My Lords, I should like to add my congratulations to the noble Earl, Lord Baldwin, on introducing the debate and on doing so with such an excellent and comprehensive survey of the present position. I should not like any doctors to be present, I am not quite sure how many are—I can count two—on a kind of doctor bashing occasion. My life has been saved by the medical profession on one occasion for certain. It has probably been saved on others too as one never knows what might have happened if one had not gone to the doctor. Nevertheless, there are reasons why a large number of us consult complementary practitioners when orthodox medicine seems to have failed us.

There is an unresolved conflict which has been touched on by several noble Lords. We tend to feel—perhaps justly, perhaps not—that orthodox medicine believes that if it cannot find out what is wrong, then nothing is wrong; and that if one cannot prove scientifically that such and such a therapy works, then it does not work. Those two propositions are questionable. Complementary medicine is readier to accept that there may well be disease which is not easily definable. It can bring an easing or elimination of disease without clear evidence as to how it is done. A patient consulting a practitioner in a complementary therapy knows that he will be given time to tell his troubles and have them listened to. This point has already been made by one noble Lord.

Most complementary therapies have the holistic approach. It makes sense that the therapist should approach a human being, not just a symptom. Another benefit is hope—the hope of a remedy and not just a symptom suppressor or a painkiller. When people are old they do not want to be told by their GPs, as I am sorry to say a number of old people are, that their ailments are only to be expected at their age, that there is nothing that can be done about them, and that they must learn to live with them. That is not a consoling result of going to the surgery.

A number of complementary therapists are keen to convey to their patients the idea that they must play an active part in their own therapy. That is an excellent principle. Even if it helps only the mental attitude, it is a crucial factor in any healing process. The idea of self-help leads me to speak briefly on a subject I have mentioned before in your Lordships' House. I refer to the Alexander technique. It is not strictly speaking a therapy. It is a re-education. Those who practise the technique are particular not to class themselves with other complementary therapists. Nevertheless, I do not think they would mind their being talked about briefly.

Noble Lords will probably know about the little Australian actor who was born in 1869. He was just beginning his career in Melbourne when he was suddenly stopped short by a failure in vocal control. He would start a recitation with his voice in perfectly good trim but by the end of the evening he would become so hoarse that he was practically speechless. He could not discover why this happened. He consulted doctors, who gave him medicines, gargles and throat sprays, but there was no difference. He decided—and this shows that he was an exceptional man—that he must find out for himself.

He set up an elaborate arrangement of mirrors and, believe it or not, sat in front of them, whenever he had a spare moment, for nine years. He was looking to see precisely what happened when he recited. He watched his minutest movement. In the end he stumbled on the discovery that has given rise to the enormous spread of what is known as the Alexander technique. He discovered that as he recited he thrust his head slightly backwards and down. This constricted the free passage of his vocal powers.

He discovered later than not only did he do this when he was speaking but also with every action—when he sat down, when he got up and when he did anything else. There was an infinitesimal and almost imperceptible backward thrust of the head. He came to the conclusion that it had bad effects on the body as a whole. It compressed the spine and the whole upper part of the body so that he could not breathe properly. The internal organs were compressed as well.

His final discovery was that he was not unique. He discovered that all his friends were doing the same thing. He became so interested that he gave up all idea of being an actor. He decided to learn how to help himself and others to overcome this difficulty by using the body more effectively. His methods were extremely subtle and involved the utmost sensitivity of the hands, which guided his pupils—those who learn the technique are pupils and not patients—into the correct use of the body. Incidentally, it is not, as many people think, a relaxing process; it is a process of releasing energy, which is much more interesting. He devoted the rest of his life to it.

The technique has been found to be beneficial in numerous ways. It facilitates correct breathing, an essential to health, and eases back problems. The noble Earl, Lord Clanwilliam, and the noble Lords, Lord Glenarthur and Lord Clifford, referred to the economic as well as the human cost of back pain. I venture to say that had many people been lucky enough to be pupils of the Alexander technique they would never have gone so far as to see an osteopath. It is also thought to have been helpful in blood pressure problems, insomnia and circulation defects. It leads to an upright and most graceful carriage, which is why it is of interest to actors and why most drama schools have the use of an Alexander technique teacher.

I have run short of time but I should like to express a strong hope. The Research Council for Complementary Medicine has at the moment an application for funds for a research project into the technique. It is hoped that that will be successful. It is a move in the right direction. One hopes that ultimately the technique will become recognised, like the other therapies about which your Lordships have been speaking this afternoon, and that it will be available to all under the National Health Service.

7.10 p.m.

Lord Ennals

My Lords, it is my pleasure to conclude the debate from this side of the House. I should first declare an interest. As the noble Lord, Lord Colwyn, said, both he and I are joint presidents of the All-Party Parliamentary Group on Complementary Medicine. Moreover, although he did not say so, we are also both patrons of the Research Council for Complementary Medicine, which was referred to by other noble Lords.

I should like to congratulate the noble Earl, Lord Baldwin of Bewdley, not only on choosing the subject but also on the eloquence of his presentation. In my view, it was partly that eloquence which led to such well-informed contributions from all sides of the House. Indeed, we have heard some excellent speeches, with noble Lords often speaking from their own experience.

The noble Earl also showed excellent timing in managing to arrange for the debate to be tabled today. As some noble Lords will know, it comes after the debate on an amendment proposed by the noble Lord, Lord Colwyn, myself and other noble Lords to the National Health Service and Community Care Bill and before the Report stage of that legislation. I think, and I think that he thinks, and I also hope that your Lordships will think, that it is important to have some reference to complementary therapies on the face of the Bill. We must devise a means to do so which will convince the Government of the wisdom of such action.

Not only is there a continuing increase in public interest and support for natural therapies. There are also two other conclusions which I should like to mention at the beginning of my contribution. The first is the recognition that as a nation we are inclined to take far too many pharmaceutical prescriptions. The Government are perhaps mainly worried about the cost of such prescriptions, as indeed am I. However, I am also worried by the thought that people increasingly think that for every problem what is needed is a pill. In fact, the alternative complementary therapists are often able to produce a solution which no pharmaceutical product could achieve. Some of those products—I am thinking now of tranquillisers—can be addictive and others can literally cause damage, especially if taken in doses in excess of those laid down by the doctor. Therefore, there is a general wish to cut down on the amount and the cost of medication.

My second observation concerns a fear which I have that an increase in the private sector of the health service, perhaps in the wake of the National Health Service and Community Care Bill, will lead to unnecessary surgery, of which the United States is a warning to us all. It is clear that the more people go to private hospitals, whether it be in Britain or elsewhere, the more they are likely to have expensive surgery, which many people believe could be avoided, quite apart from the fact that the need could be met by alternative treatment.

In winding up the debate for the Opposition I should like to emphasise the need for all of us—the therapists, the Government and the public—to prepare carefully for the possible consequences of the single European market in 1992. The most direct reference to this was made by the noble Lord, Lord Glenarthur. We must, as must the therapists, face up to the challenges, the dangers and the benefits of the market after 1992. Bearing in mind the differing legal status of practitioners in the United Kingdom with this unlimited freedom compared with the Continental nations, we must ask whether 1992 will be the beginning of the end for the traditional UK freedom to practice what medicine we like and to receive what treatment we like or whether it will be the start of a bright new era of health care in which the natural therapies and those who practise them will be elevated to their just status in a fresh and newly enlightened society. If it is to be the latter—that glorious future—a great deal of work will have to be carried out between now and then.

The question is: how do we ensure that natural and holistic therapies continue to be available while satisfying the needs of the European Community policy? It is a question both for the Government and for the practitioners. They must both be prepared, without delay, to accept that increasingly policy affecting Britain comes from Brussels and not from London.

Clearly the most satisfactory way forward is to ensure that all non-registered practitioners belong to organisations which have strict codes of conduct and high standards of membership. Training and accreditation will and must be the name of the game. If the various therapies can measure up to the standards and compare, for instance, with those of the Society of Homoeopathy, which has been referred to by many noble Lords, they may be able to protect themselves and their members from accusations of malpractice. The year 1992 may act as a stimulus to the therapies to do what some have been slow to do in the past—to get themselves organised and get their act together. What may seem to some of them to be threats may to others be the stimulus to seize the opportunities which are now opening up.

There are developments among the therapists. Apart from the Research Council for Complementary Medicine to which the noble Viscount, Lord Tenby, the noble Lord, Lord Colwyn, and others referred and which has now, as we have been reminded, received its first research grant from the Department of Health, there is the Institute for Complementary Medicine and the newly established National Consultative Council for Alternative and Complementary Medicines, which was also referred to by the noble Lord, Lord Glenarthur.

It is interesting to note the change in public attitudes. Together with that there is the increase in the use of complementary therapies. I am informed that the use of complementary treatments is increasing at the rate of about 15 per cent. per year. There are probably already 7 million to 8 million treatments given annually in the United Kingdom. It is therefore likely that the growth of complementary treatment will continue until it has reached the point of saturation, which could come in the next quarter of a century. Those assumptions are well supported by available data.

I must say that I was delighted that the noble Lord, Lord Hunter of Newington, was able to take part in the debate. If I remember correctly, no doctor took part in the debate in this House two-and-a-half years ago. His wise and cautionary words, both of which qualities we usually get from the noble Lord, were most helpful to us this afternoon.

Doctors will be able to concentrate on surgical operations and acute medical conditions, where their training makes them supreme. The specialist complementary practitioners would concentrate upon the wide range of chronic conditions such as aches and pains and back pains about which we have been talking. I have a special interest in back pains, not just because I have ankylosing spondylitis and will suffer from back pain for ever but also because when I was Secretary of State for Social Services I set up the working party on back pain. It did not stop back pain out as least we know a little more about the subject than we did.

As I said, the specialist complementary practitioners would concentrate on a wide range of chronic conditions, not only aches and pains but body misalignments and degenerative and emotional problems. For example, it is not reasonable that a doctor trained over a six to nine-year period in allopathic medicine should be expected to undergo additional training to treat a condition which a specialist osteopath can correct. Equally, chronic complaints should not occupy allopathically trained people who have little training in counselling, nutrition, hypnosis or the Alexander technique, to which a most interesting reference was made by the noble Lord, Lord Ritchie of Dundee.

I mentioned the Institute for Complementary Medicine. It has set up the first British register, with a comprehensive list of qualified practitioners in most complementary medicine disciplines. Sections of the register include osteopathy, chiropractic, traditional Chinese medicine, homoeopathy, hypnotherapy, psychotherapy, nutrition, reflexology, medical massage, radionics and others. Others are being added to the list.

There is also, as has been said, the newly established National Consultative Council for Alternative and Complementary Medicines, which has some 39 affiliated organisations. It is interested in inter-organisational co-operation, training and education in the natural therapies, leading to accreditation and registration, codes of practice, research and development and the setting up of independent councils for every therapy. It is important that such bodies should, as I said, get their act together. In the end, the getting of their act together has to be in association with the medical profession. I am satisfied that when we talk about complementary medicines we are talking about the necessity for a basis of collaboration with medicine. They also have to satisfy government. By "government' I mean whatever government: this Government or the next government, a Conservative Government or a Labour Government.

We should be talking about including those therapies as part of the NHS if they are therapies and proved as such—the noble Lord, Lord Hunter, referred to the need for proof—which is sometimes difficult because I might find it difficult to prove the efficacy of some medical treatments. Nevertheless, they must be proven. If it is ever to become an expense upon the NHS, government of whatever colour must be satisfied.

I welcome the extent to which the organisations of different complementary therapies are trying to get their act together. I referred to two bodies which have similar objectives. I am not certain that there is a place for two competing organisations. Heads have to be knocked together. I shall not offer to do it. I do not suppose that the Minister will offer to do it when she replies. The parliamentary group may have to try to do it. A house divided against itself cannot survive. The movement must realise that not only has it to face up to the European scene; it has to come to terms with government of whatever party. That is the lesson it has to learn. The year 1992 is close. As I said earlier, on the one hand it is a threat but on the other it is an opportunity. In the same way as for business and the world of commerce 1992 is a threat and an opportunity, so must it been seen to be for the complementary therapies.

If ever there was a need for a debate in order to encourage people who believe in complementary medicine and those who practise it to get their act together and think of the future, now is the time. So we are especially grateful to the noble Earl, Lord Baldwin of Bewdley, for having introduced this debate on such a timely occasion.

7.25 p.m.

Baroness Hooper

My Lords, perhaps I may join all those who have expressed their gratitude to the noble Earl, Lord Baldwin, for introducing the debate. We have had a wide-ranging and stimulating discussion on a matter which attracts considerable public interest. Almost everyone who has participated has done so with the benefit of personal experience.

At the outset the noble Earl referred to confusion over the various terms which are used to describe alternative and complementary therapies. Perhaps I may follow the example of my noble friend Lord Skelmersdale on a previous occasion and plump for the term "natural therapies" as one which appears to embrace all the various concepts.

There are many calls for the greater availability of natural techniques and medicines within the NHS and that is reflected in the speeches today of a number of noble Lords. It seems right for me, therefore, to restate at the outset the Government's stance on natural therapies and medicines both in relation to the NHS and also to private practice. My right honourable friend the Secretary of State for Health has a statutory duty laid upon him to provide a comprehensive health service; but that duty, onerous in itself, also carries with it the wider one of safeguarding the health of the nation. Those two factors must always govern any discussion about provision.

It cannot be stated too often that by law all medical treatment under the NHS must be given by a registered medical practitioner. That is the "who": the "what" is more complex. Registered medical practitioners can provide any treatment they wish, including the use of natural techniques, if they feel competent to do so and provided that in their professional opinion it will help the patient. A small but growing number of registered medical practitioners are practising natural techniques and the use of these techniques within the NHS is increasing. The noble Earl referred to that fact. The rate of growth must, however, depend upon those doctors who use natural techniques persuading more of their fellow practitioners of their benefits and effectiveness. However, I must sound a note of caution. Many doctors remain unconvinced that there is scientifically sound evidence to show that the vast majority of the natural therapies and medicines are effective.

As your Lordships are aware, practitioners of natural therapies who are not registered medical practitioners are still permitted to practise under United Kingdom common law. There are restrictions on certain forms of treatment; for example, those for cancer, venereal disease, TB, diabetes and epilepsy, and in some areas covered by the Medicines Act concerned with the giving of injections. There are restrictions too on who may practise certain professions. Those who are unqualified are not permitted to practise, for example, as dentists, midwives, pharmacists or veterinary surgeons. Other than those however, the Government have no wish to place any restriction on natural therapy practitioners or to curtail in any way the freedom of the individual to seek the benefits of natural therapy. We do, however, believe that members of the public using those therapists have a right to be safeguarded in the same way as those using the NHS professions. That is the challenge to the natural therapy professions and one which in the Government's view needs to be addressed by each profession acting independently rather than, as some, including my noble friend Lord Glenarthur and the noble Viscount, Lord Tenby, advocate, action by associations seeking to represent all or most of the natural therapy professions.

I am aware of the National Consultative Council, which was set up some 12 months ago, and of the fact that the council sees itself as a response to past ministerial pleas for a single source of advice on the natural therapies. I am also aware of the Institute for Complementary Medicine to which the noble Lord, Lord Ennals, referred.

However, the Government's stance on umbrella bodies has changed in recent years. There is little homogeneity among the various natural therapy professions, and the major groups now see their way forward not through umbrella organisations but by a group by group approach following consensus within their ranks. After all, if we look at orthodox medicine for a model, we see, for example, that the medical and dental practitioners, clinical psychologists and opthalmologists have far more in common with one another than the vast majority of natural therapists. Yet they all have independent and individual governing and registering bodies and associations which represent their interests.

At one time, we were of the view that there might be advantages if all the natural therapies came together in mutual understanding. But, given the diversity, practice and aspirations of those professions—coupled perhaps with their increasing proliferation—we now believe very firmly that it must be for each therapy group to determine its own future development.

That leads me on quite naturally to statutory regulation. When the subject was last debated, my noble friend Lord Skelmersdale went into the matter in some detail. He welcomed the possibility of self-regulation on the part of the natural therapy professions, but only if it achieved common recognised standards for all to see and to which all practitioners subscribed. He accepted that this would, at some stage, probably require the force of law. He also mentioned meeting representatives of osteopaths when they had aired their plans for statutory regulation.

As a number of your Lordships have said, the osteopaths have made considerable progress in the intervening two and half years. They have secured a large measure of agreement within the profession on common standards of education and training; they have secured the support of the medical profession; and, as we have heard, a joint working group to look at the mechanics of statutory regulation has been established. The osteopaths have kept Ministers fully informed of developments and we shall await with interest the report of the working group and hope that it will point the way to statutory regulation.

We have eyed developments within the osteopathy profession with considerable interest, not only from the osteopaths' point of view but also as a possible model for other professions, particularly those which have reached an appropriate level of maturity with an established form of voluntary regulation and infrastructure and which wish to pursue the path to regulation. I know that several other groups are interested in statutory regulation; one group of chiropractors in particular has made plain in recent months its desire for regulation. The osteopaths have clearly shown the way forward and it is for others to follow.

Perhaps I may now speak of Europe, of 1992 and all that. The noble Lord, Lord Ennals, has drawn attention to this aspect, along with others in the course of the debate. I know that there is a very real concern among the natural therapies and those who use their services about the fate of natural therapies and medicines after harmonisation in 1992. Some of our fellow member states are considered to be antagonistic towards British-style unlicensed practitioners of natural therapy and the fear is that they could take the opportunity afforded by harmonisation to remove the right to practise for all but those who are medically qualified. That fear emanates, it seems, from two directives adopted by the European Commission—a directive on higher education diplomas and another on homoeopathic medicines.

So far as the Government are aware there is no European Community legislation in prospect which would restrict the practice of natural therapy in this country or choice by the public in using such services. I can reassure my noble friend Lord Glenarthur that we shall certainly continue in our European Community negotiations to press for something compatible with UK interests and traditions. I can assure your Lordships also that the Commission has repeatedly made it clear that at present it has no intention of introducing centralised legislation on the ground that the fundamental divergence between member states' legislation in this area would make it difficult to envisage harmonisation at Community level.

Perhaps I may take this opportunity to say a little about alternative medicines. I refer to the medicinal substances used as opposed to the practice of the alternative therapies themselves, because there are special points to consider here. When the government attitude towards alternative therapies is debated, there is a tendency sometimes to think in general terms, as if what applies to, say, acupuncture should also apply to homoeopathy; or that what is good for osteopathy should apply to herbalism. In many ways, of course, some of these philosophies are similar, but in one important aspect the alternative therapies fall into two clear categories—those which use actual medicinal substances and those which do not.

We all know that in spite of what the advocates have said today, many people harbour a deep scepticism and indeed open hostility towards alternative treatments and will use any argument, no matter how specious, to denigrate them. It is not for the Government to take sides here, but it is a simple fact that one argument that cannot be used against chiropractic or osteopathy for example is that it may poison patients. But homoeopathy and herbalism are open to this charge, either because of what is in the medicinal product used or because of the way it is prepared, simply because the treatment usually involved the patient swallowing or being injected with something. The Government have an obvious responsibility here to protect the public health; yet the controls which have to be exercised through the Medicines Act 1968 are often resented by the people who use or produce the medicines concerned. They argue that because these products are natural and traditional, their safety can be assumed. This, we believe, is a fallacious notion, since any active substance has the potential to be harmful as well as beneficial.

Health Ministers have a duty, under the Medicines Act 1968, to look at the safety, quality and efficacy of all medicines in any decision they have to make about entry to, or removal from, the market. That is inescapable and, as I have said, a proper duty of government, but we undertake that duty, I hope, with sensitivity. With regard to herbals, for example—currently the only alternative products subject to a European Community requirement to review—in 1985 my noble friend Lady Trumpington approved guidelines agreed with the herbal industry which took account of the traditional nature of these products in relation to their efficacy. On safety and quality we cannot compromise, and it seems to me that it is to the benefit of the industry as well as the general public that a reviewed product licence means that the product has been examined critically by a government agency and "passed the test" as it were. I confirm to the noble Earl, Lord Baldwin, that there has been no change in these guidelines. They still apply.

My noble friend Lord Colwyn raised the question of membership of the advisory committees to the licensing authority and questioned the fact that the nominees of the National Medicines Society and its own advisory committee were not represented. I believe that it is a mistake to think in terms of nominating bodies being represented on the committees, as your Lordships will remember. These committees have to be expert, not representative. Committee members advise impartially in the sphere of their expertise and we are satisfied that the existing membership contains the best available expertise to advise the licensing authority on the safety, quality and efficacy of all medicinal products.

The fact that the nominees of a particular body were not appointed should not be taken as implying that they were not considered. All nominations are considered. The criteria of safety and quality are, as I have indicated, the same for all medicinal products, natural or synthetic. We cannot budge on that. As far as concerns efficacy, since 1985 we have recognised the special considerations for herbals.

With regard to homoeopathic products, the position is less settled. Unlike herbals, these products have not been subject to review but the European Commission has had a commitment since 1986 to produce proposals to harmonise the conditions for the manufacturing and marketing of these and other products exempted from existing directives. As I mentioned, the Commission has produced a draft which was laid before the Council of Ministers in March and which will of course be scrutinised by Parliament in the usual way.

I now turn to some of the specific points that were raised in the course of our debate. My noble friend Lord Cullen referred to tax relief on private medical cover. The Government's objective in introducing tax relief is to enable people who have purchased private medical cover during their working lives to continue to do so in retirement and thus help reduce pressure on the National Health Service. In considering what forms of treatment should be permissible, we decided that only treatments which are normally provided free under the National Health Service should qualify. To allow for alternative treatments would not only create all kinds of difficulties between what might and might not be permissible but, fundamentally, it would not meet our prime objective of reducing demands upon the National Health Service. I know that some of the natural therapy professions feel that this might create difficulties for them under their health insurance contracts, but I am sure your Lordships will appreciate the reasons for taking the line that we have.

My noble friend also raised the question of the report of the Monopolies and Mergers Commission. That report was accepted by Ministers, and the Director General of Fair Trading was instructed to negotiate the removal of the restrictions. The director general has just reported on the outcome of his negotiations and that report is currently under consideration by the Department of Trade and Industry and the Department of Health. As your Lordships will appreciate, I am unable to comment on the report or on the likely reaction of the two departments at this moment.

The noble Lord, Lord Greenway, referred to the provision of natural therapy by fund-holding GPs. That was referred to again later in the course of the debate. We investigated this matter when my noble friend Lord Colwyn moved his amendment to the National Health Service and Community Care Bill. The gist of the Government's argument is that alternative and complementary therapies are not among the range of treatments for which a GP can directly refer patients. These natural therapies are not available under the National Health Service and if fund-holding GPs were able to purchase such services—this could not be done by non-fund holding practices—it would, in effect, create a two-tier service. However, should my right honourable friend the Secretary of State wish at any time to extend the range of services available under the National Health Service, there are powers under Section 3 of the National Health Service Act 1977 which would enable him to do so. I hope that that also answers the point raised by the noble Lord, Lord Ennals.

The noble Earl, Lord Baldwin, mentioned problems with homoeopathy training. I would point out that the role of government in medical training in general is restricted to providing the facilities and resources. The substance of training is for the professions and their educational bodies. There are arrangements for the postgraduate training of doctors who wish to obtain qualifications in homoeopathy and indeed in osteopathy. That point was mentioned by my noble friend Lord Brougham and Vaux.

The noble Lord, Lord Clifford, referred to fees for private institutions. The purpose of the changes which are to take place in the forthcoming academic year is to shift the balance of public funding of higher education to a fees basis. Representations have been made to my right honourable friend the Secretary of State for Education and Science that, for students at private institutions such as those which provide tuition for members of the natural therapy professions, the fee element will be considerably lower than at state supported institutions. They believe that the effect of this will mean the loss of many highly motivated students of good quality. I understand that the matter is still being discussed and that my right honourable friend is giving careful consideration to all the representations he has received. However, at present there seems little prospect of finding additional funds, given the many other calls on resources.

The public demands the right to choose which type of medicine it prefers to use. However, we also have the right to expect that when we do so we are safeguarded by professions which are well regulated, whether on a statutory or on a voluntary basis. Consideration of that factor is the basis of the Government's attitude. I believe that this debate has highlighted the difficulties as well as the benefits of natural therapies. It has also most certainly called attention to recent developments and, as a result, I believe it has been most worth while.

Earl Baldwin of Bewdley

My Lords, I am most grateful for the wide-ranging participation and support of so many of your Lordships this evening. At the risk of seeming invidious, I wish to echo the words of the noble Lord, Lord Ennals, and say how particularly glad I was that my noble friend Lord Hunter took the time to participate in the debate. He has been very busy with the National Health Service Bill but we appreciate the fact that he took time to contribute to the debate from his rather more mainstream stance. I should like to go into the question of diagnosis, which the noble Lord invited me to discuss. However, I do not think we have the time to do so this evening. It would not be an easy answer because, again, the therapies have their different ways of looking at things. An acupuncturist would have a completely different scheme of diagnosis from many other people. The healers, for example, specifically set their face against diagnosis. They say that that is a job for the doctors.

I cannot resist making the observation that in the different estimates that I have read of the accuracy of orthodox medical diagnosis, the method has never achieved even as high a rate as 50 per cent. There is obviously room for some give and take as regards the different schemes of diagnosis. But perhaps that is for another time.

I am also grateful to have been supported by a distinguished former Secretary of State for Health in the shape of the noble Lord, Lord Ennals. I was grateful for his wise words. We were all naturally most interested in the remarks of the Minister. I know we shall study them with care in the written record. I found what the noble Baroness said on Europe particularly encouraging. However, I still think she is quite wrong as regards the Medicines Commission.

There has been a large degree of unanimity this evening but we should not delude ourselves into thinking that beyond the ranks of the converted, who, significantly, consist mainly of people with first-hand experience, things are quite so straightforward. Statistics certainly show increasing interest and participation, but there is some way to go before complementary therapies are widely available on an affordable basis. It is towards that that we should particularly work, as the noble Viscount, Lord Tenby, indicated. The question is whether orthodoxy will now work with the tide. I believe that it will and that we shall not always have to talk about two sides in matters of health care. I am most grateful for the opportunity of holding this debate. I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.