§ 2.9 p.m.
§ Lord Walton of Detchant
My Lords, I beg to move that this Bill be now read a second time.
I regard it as a singular honour and privilege to be given the opportunity of introducing this Bill into your Lordships' House. Traditionalists may think it remarkable that a doctor and former President of the General Medical Council should now be promoting enthusiastically a Bill which aims to develop, promote and regulate the profession of osteopathy. However, as Professor Ralf Dahrendorf (subsequently Sir Ralf) said in his Jephcott Lecture to the Royal Society of Medicine some years ago, professional self-regulation is one of the glories of a learned and civilised society. In an article entitled How to ruin the professions published in the Spectator in 1988 the noble and learned Lord, Lord Hailsham, expressed a similar opinion. He pointed out that in the United Kingdom many of our professions have that cherished privilege of being self-regulating.
Professor Dahrendorf contrasted the position in the UK with that in many other countries, including his native Germany, where the professions are regulated by the state. That was a position which he regarded in many respects as being fearful. The noble and learned Lord in his article made clear his view which I share. It was that while the privilege is cherished by the professions, including his and mine, it imposes significant responsibilities upon them in that the regulatory power which they possess must take full account of the needs, aspirations and interests of those with whom they deal; namely, their clients and their patients. It is therefore important that the professions, in fulfilling the statutory responsibilities imposed upon them by law, should take full account of informed lay opinion and advice.
The Bill is based upon a report of a working party on osteopathy established by King Edward's Hospital Fund for London. It had the following terms of reference:Having regard to the growing public demand for osteopathic treatment and increasing support, both professional and political, for early legislation to establish a statutory register to regulate the education, training and practice of osteopathy for the benefit and protection of patients, to consider the scope and content of such legislation, to make recommendations and report".That working party, of which I was a member, was skilfully and judicially chaired by Sir Thomas Bingham, a Lord Justice of Appeal. It spent some two years collecting information and evidence before formulating its recommendations. I wish to pay a 1593 warm tribute to the chairman and to the hard working members of the working party, to Robert Maxwell and Norman Illingworth of the King's Fund and to Simon Fielding whose spirited advocacy on behalf of his profession was throughout so carefully balanced and yet utterly persuasive.
The Bill now before your Lordships embodies the 62 recommendations set out in that report. I mentioned at the outset that traditionalists might be surprised to learn that this proposal now has the support of the medical profession. Some 20 to 25 years ago it was regarded as improper for a doctor to associate with complementary practitioners. Indeed, a doctor referring a patient to an osteopath without medical qualifications would have fallen foul of the recommendations of the General Medical Council on professional conduct and discipline.
Since that time members of my profession recognising, as the King's Fund report stated, that osteopathy is a system of diagnosis and treatment which lays its main emphasis on the structural and mechanical problems of the body, have recognised that this discipline is not an alternative to conventional medicine but it is a complementary one which offers patients an additional treatment option for certain conditions which can affect the body's framework.
Osteopathic treatment involves the use of predominantly gentle manual methods of treatment. It utilises a diagnostic procedure similar to a conventional medical examination but it pays particular attention to detailed assessment of the patient's musculoskeletal system. Throughout the years some doctors and orthopaedic surgeons have sought formal training in osteopathic techniques. They have begun to apply those more and more often in the course of their professional practice. Others, recognising the increasingly comprehensive and detailed programme of treatment now being undertaken by osteopaths without medical qualifications, have referred their patients to such practitioners in whose professional competence they have full competence with the approval of the General Medical Council, while retaining ultimate clinical responsibility for the patient's management.
In other words, collaboration between the medical and osteopathic professions has become much closer and friendlier. I am happy to report to your Lordships that this Bill, based upon the King's Fund report, now has the warm support of the British Medical Association and the Conference of Medical Royal Colleges and Faculties.
It is also enthusiastically endorsed by all the bodies at present representing osteopaths. They each see the need to create a unified profession with common educational standards and a single statutory body replacing the present voluntary registration system.
I hope and believe that the Bill will commend itself to Her Majesty's Government. Following some discussions with lawyers from the Department of Health, I understand that I shall be invited to propose a number of amendments in Committee—many of them purely technical —either in order to clarify the 1594 import of certain clauses, especially in a European dimension, or to meet one or two anxieties expressed on behalf of Her Majesty's Government and the Privy Council where potential inconsistencies may conceivably arise. I shall be glad to do that.
Some of your Lordships may ask why this Bill deals solely with the osteopathic profession and why no attempt has been made to embrace within its provisions the regulation of other closely related professions such as that of chiropractic. That issue was carefully considered in the deliberations of the King's Fund working party; but after detailed consultations, it emerged that there were sufficient differences between the two professions to make it impractical for both to be covered by a single Bill. However, I can inform your Lordships, first, that the chiropractors warmly support this Bill and, secondly, that the King's Fund has now established a further working party to examine the profession of chiropractic in the hope that ultimately recommendations for the self-regulation of that profession will also emerge.
Finally, I turn to the Bill itself. Perhaps I may be so bold as to borrow a well-known phrase from the legal profession—res ipsa loquitur—it speaks for itself. In almost all respects its provisions are comparable to those at present governing the medical and dental professions through the General Medical Council and General Dental Council respectively. As the Financial and Explanatory Memorandum makes clear, the Bill provides for the establishment of a General Osteopathic Council which will have:the general function of developing, promoting and regulating the profession of osteopathy".In its members the council will include doctors, lay people and educationists in addition to osteopaths.
The Bill also proposes the establishment of four committees; namely, the education committee, the investigating committee, the professional conduct committee and the health committee. It enables the council to appoint other committees where appropriate.
The education committee will have the general function of promoting and co-ordinating education in osteopathy. That committee will have the power to require that educational institutions granting qualifications shall report details of their courses of instruction to the education committee which in turn will be empowered to appoint visitors to visit such institutions in order to be satisfied that the instruction and examinations offered by those bodies are of appropriate quality.
Should that committee conclude that they are not, it may report its views to the general council which in turn would have the authority to recommend, ultimately to the Privy Council, that recognition of the qualifications conferred by that institution should no longer be recognised for registration.
Provisions are made in the Bill for the provisional registration of those not at present possessing a formal qualification in osteopathy but who have been in practice for a number of years. The general council would also be empowered to make rules about 1595 conditions of registration just as it would be empowered to give guidance about professional conduct and ethics.
Where allegations are made to suggest that a registered osteopath may have been guilty of unacceptable professional conduct, such allegations would be examined, first, by the investigating committee which would then have the power to refer such a case for a formal hearing before the professional conduct committee. I have been asked by some of your Lordships what is the meaning of unacceptable professional conduct. I simply go back to the famous quote many years ago in relation to the medical profession by Lord Justice Lopes, who defined the somewhat archaic term used in an early medical Act, "infamous conduct in a professional respect". He said that that meant:no more and no less than conduct judged as infamous by an informed body of medical opinion".I would refer to the definition of "unacceptable professional conduct" as being subject to a similar definition.
The conduct committee would in turn have the power to admonish, to attach conditions to the osteopath's registration, to impose a fine or to cancel or suspend the individual's registration. Clauses are also included, such as those relating to the proposed health committee, to enable appropriate action to be taken in the case of an osteopath in whose case there was evidence to suggest that his or her health was so impaired as to constitute a danger to patients.
I trust that your Lordships will agree that it would be inappropriate for me to go into further detail in regard to the minutiae of the various clauses of this important Bill. I look forward to hearing your Lordships' comments upon it. Perhaps I may say how much I look forward to the maiden speech of the noble Lord, Lord Rennell. I am glad that he has chosen the Second Reading of this Bill to make his first contribution to the debates in your Lordships' House.
I believe that the Bill represents an important milestone which I trust will lead to formal recognition of the osteopathic profession, which has made, and is continuing to make, such an important contribution to the treatment of many musculoskeletal disorders. I beg to move.
Moved, That the Bill be now read a second time. —(Lord Walton of Detchant.)
§ 2.21 p.m.
§ Lord Rennell
My Lords, I am most grateful to the noble Lord, Lord Walton, for introducing the Osteopaths Bill and so giving me the opportunity and privilege of making my maiden speech on a subject dear to my heart. I should like to thank him for his few kind words to me a moment ago.
I am particularly grateful because 10 years ago, just over one year after I had taken my seat in your Lordships' House, I met my friend the noble Earl, Lord Longford, who, in his most charming and always inquisitive manner, asked whether I had yet made my maiden speech. I said "no" and mumbled that nothing I knew anything about or was particularly interested in had come up for debate. The noble Earl, the kindest 1596 of men, said that it was quite unimportant to select a subject one knew about or indeed was interested in. The important thing to do was to get on with it and do it with the minimum of fuss. Here I am, 10 years later, indeed without fuss but speaking on a subject which interests me greatly.
Eighteen months ago, in May 1990, there was a brilliant debate in this House introduced by the noble Earl, Lord Baldwin, during which a number of noble Lords—some of whom, including the noble Earl, are speaking again today—put forward strong and compelling reasons for bringing together orthodox and complementary medicine. In his speech that day the noble Viscount, Lord Tenby, said: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 ultimately 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".—[Official Report, 9/5/90; col. 1419.]I agree entirely with those sentiments as indeed, if I judge correctly, did the vast majority of noble Lords who spoke in that debate. I understand that there are similar feelings on the subject in another place. The conclusions at the end of the debate, however, were twofold: first, that each different type of complementary practice should present its own case for acceptance within the so-called orthodox fold; and secondly, that the Secretary of State for Health has the onerous duty of safeguarding the health of the nation.
The first of the two conclusions is very much up and running, as evidenced by today's Second Reading and thanks to the truly sterling work of the working party on osteopathy, chaired by the right honourable Sir Thomas Bingham. The working party included the noble Lord, Lord Walton, and Simon Fielding. I would like to endorse the statement of the noble Lord, Lord Walton. I congratulate the team for such good work in a relatively short period of time. It has produced,a fair and practicable framework for the statutory regulation of osteopaths which has the support of both the medical and osteopathic professions".Unlike noble Lords who will speak after me, I cannot declare or claim any learned or scientific knowledge of the subject of this debate. I can however claim 30 years' or so practical knowledge of the need for it. I was first introduced to an osteopath in 1962. I had just left the Royal Navy after 10 years. As a fit young man, I had taken part in every sort of sporting activity one can imagine. My only serious damage had been caused by a very large and annoying Army rugby player who jumped on my shoulder as I was picking myself up from a hard pitch in Hong Kong.
On leaving the Navy I continued to play rugby for five years and I remain an active sportsman. Having seen the rugby World Cup this year, I know that noble Lords will have no difficulty in picturing me, back in the 60s, facing packs of fearsomely ferocious and heavy rugby forwards from all over the world with very little on their minds other than burying a diminutive and very frightened scrum-half beneath them. I needed help from time to time—medical help that would work quickly to enable me to face the onslaught again the following week or even sooner. 1597 The first time I visited the osteopath back in 1962, two interesting things happened. I went with a bad back and came out seven minutes later completely cured. The other point was that I had to pay for the treatment. I had been in the Royal Navy which previously had paid everything. In this case I found that I had to pay even though my employers had provided me with private health cover.
Both two points will be affected by the Bill we are debating today. I had hoped that osteopathy would become available on the National Health Service. It would then be available to all and it would be free. I understand that at this stage that is not the case and that it will not be available on the National Health Service. We shall have to try to do something about that.
Perhaps I may revert to the safeguards for the safety of the nation. At the turn of the century, George Bernard Shaw was on the war path and not necessarily on the side of orthodox medicine. I crave the indulgence of the noble Lord, Lord Walton, in bringing this to your Lordships' attention. In Shaw's preface on doctors, he says:The distinction between a quack doctor and a qualified one is mainly that only the qualified one is authorised to sign death certificates—for which both sorts seem to have about equal occasion".Bernard Shaw despairs at giving a surgeon a pecuniary interest in, for instance, cutting off your leg and the fact that the more appalling the mutilation the more the mutilator is paid. In The Doctor's Dilemma, Sir Patrick Cullen, on the recent discovery of inoculation, says:I've tried these modern inoculations a bit myself; I've killed people with them; and I've cured people with them; but I gave them up because I never could tell which I was going to do".I am sure that the safeguards promised by the proposed General Osteopathic Council will satisfy the Secretary of State for Health. The working party has come so far, and it is so important for it. I am sure that it will not be found wanting.
I hope that the noble Baroness, Lady Hooper, who was so supportive of the osteopaths in May 1990 when she said that they have clearly shown the way forward, will feel confident that she can persuade her right honourable friend the Secretary of State for Health that this Bill is a big step forward for the good of the health of the nation.
§ 2.30 p.m.
§ Lord Ennals
My Lords, not surprisingly I want to start by congratulating the noble Lord, Lord Rennell, on behalf of the whole House on the speech that he has just delivered. It was eloquent and witty and carried with it his own personal experience. My only complaint is, why in heaven's name have we had to wait for 10 years for the noble Lord to make his maiden speech? I hope that we do not have to wait another 10 years before he speaks again. Anyone who brings as much enthusiasm, experience and humour into a maiden speech will be able to do so time and time again. So for heaven's sake, stick with us; be one of us. However, he chose a very good subject on which to make his maiden speech.
1598 Next I should like to congratulate my noble friend Lord Walton for admirably presenting the Bill. It is very appropriate that, with his own medical experience, and as a former president of the BMA, he should do so. It helps to show that at last, and very positively, the appropriate alternative therapies and the medical profession are coming together. I congratulate the noble Lord on the part that he played on the working party and express my thanks also to the chairman, Sir Thomas Bingham. Also, for the third time, Simon Fielding is going to get my congratulations. I do not guarantee that he will receive congratulations on each speech that he has made, but certainly he does from those who know the work that he has been doing.
I shall be very brief because the Bill has been admirably presented. No one here has not read the excellent report and I add our thanks to the King's Fund for having brought it together and to His Royal Highness Prince Charles for having launched it at the quite memorable occasion just a few weeks ago.
I have to make my apologies as I shall not be here at the end of the debate. I am visiting a hospital for elderly people and I know that no one here would want to keep me away from my duty, which is at half-past-two this afternoon. I am going to be a little late, that is quite clear.
I should like to make a few general comments. Having offered my congratulations, my second point is to express our regret that the Bill has not been presented by the Government. I am delighted that the Government are, I believe, to give it their support and I hope that they will facilitate the passing of the Bill through this place. The noble Lord, Lord Walton, said that there are a few amendments and that he is likely to support them. I am certain that we all want to see the Bill go as quickly as possible to another place. I urge the Minister to do her best to see that it does so that the Bill can become law before this Parliament actually ends, as it must do soon.
The Bill is very important. As the noble Lord, Lord Walton, said, it paves the way. My next point, therefore, is to agree with him that this should pave the way for other professions to enter into the regulatory task. I am certain that regulation is right. I do not think that we shall ever get a situation in which complementary therapies will be generally accepted unless we are satisfied, and the public are satisfied, that what is being done is based on training, experience and high standards. I know that the chiropractics are ready and waiting and I was delighted to know that the King's Fund has set up a working party.
However, I should have liked it to have been a Government Bill. I hope that the Government of the day will not require the vagaries of a Private Member's Bill, which can always produce uncertainties, for the chiropractics and others who I hope will follow.
I should like to say a few words about remuneration, to which the noble Lord, Lord Rennell, also referred. As I understand it, the Bill does not deal with remuneration. However, I was glad to see an important statement made by the Parliamentary Under-Secretary of State for Health, Mr. Stephen Dorrell, in response to pressures upon him from the 1599 All-Party Parliamentary Group on alternative and complementary therapies. I should, perhaps, have declared an interest at the beginning of my remarks. It is not a professional interest, but it is one that I share with the noble Lord, Lord Colwyn. With him, I have the privilege of being joint president of the all-party parliamentary group. The group is delighted that the Bill is here and that the noble Lord, Lord Walton, has put it forward.
However, I return to this most interesting statement. It was made on 3rd December in a letter to the chairman of the all-party group, Mr. Peter Rost, MP. I should like to read to your Lordships just two extracts from it. The first is:Any GP therefore may employ a complementary therapist to offer NHS treatment within his practice".It then continues, in a further paragraph, to explain:The critical point in the case of both fundholding and nonfundholding GPs, is that the GP remains clinically accountable for the care offered by the complementary therapist. It is not a 'referral' system whereby one registered practitioner refers a patient for treatment to another. It is a 'delegation' system where the GP asks another professional to provide care for which he remains clinically accountable. It is therefore for the individual GP to decide in the case of each individual patient whether the alternative therapist offers the most appropriate care to treat that patient's condition".Therefore, we can see the way forward for those therapies that have been approved and regulated, where the GP is prepared, as the letter says, to delegate and therefore share the responsibility with the alternative therapist. We can see that alternative and complementary therapies can become a responsibility of the National Health Service, as I am sure they should be. It is neither right nor fair that such forms of treatment—and we are dealing only with homeopathy at present—should depend entirely on the patient's ability to pay. If the Minister can find the opportunity in her response to comment upon the remuneration aspect of the Bill, I should be grateful.
However. in every sense I warmly welcome the Bill. I hope that it will pass through all its stages in both Houses, that it will become law and that it will pave the way for other professions to be able to move in the same direction. In conclusion, I should like again to express my thanks to my noble friend and again congratulate the noble Lord, Lord Rennell.
§ 2.35 p.m.
Earl Baldwin of Bewdley
My Lords, it is a Friday afternoon and I shall be brief. Like most of your Lordships, I warmly welcome the Bill. Osteopathy has been with us for a long time. Its founder, after all, was a contemporary of Lister and Pasteur. It therefore antedates the drugs revolution and most of the advances of modern medicine. Its genius is that it reaches those parts that other medical systems cannot reach. It keeps your Lordships' House ticking over. It is strongly to be commended, and it is a welcome sign of the times that the medical profession, and officialdom in general, now also thinks so.
What takes a little of the gilt off the gingerbread, as the noble Lord, Lord Ennals, pointed out, is the fact that the Government do not think so strongly enough to adopt the Bill. The Government have a responsibility for the health of the nation. It is now 1600 generally accepted that the promotion and the regulation of the osteopathic profession would contribute positively towards that. Therefore, I think that it is fair to argue that the Government are ducking their responsibility in leaving matters to the mercies of a Private Member's Bill, however ably introduced by my noble friend Lord Walton of Detchant.
In the debate that I initiated on 9th May 1990 on complementary medicine and its relationship to conventional treatment, to which the noble Lord, Lord Rennell, referred in a maiden speech which I enormously enjoyed, I appealed to the Government to make their stance a little more benign and a little less neutral. I repeat that plea today.
What of the future? Osteopathy within the National Health Service must be a goal to aim at. But we have here a first step, as the most orthodox of the unorthodox professions makes its way towards public respectability. Sometimes respectability exacts a price, and I hope that the profession will not lose its soul as it gains its place in the sun. That has been known to happen. The trail that is being broken by the osteopaths will in all probability be followed quite soon by the chiropractors —those other successful manipulators, using that word in its best sense. After an interval we may see the acupuncturists coming along. I must declare an interest in that I chair a board recently set up by that profession to regulate its training and accredit its institutions. Doubtless other therapies will follow.
This must be the right route for the professions of complementary medicine as a prelude to official recognition. Banning the unorthodox is not the right way. Setting high standards and regulating the professions so the public can see clearly and choose freely is surely the proper way. This the osteopaths have done and are doing, and they deserve our congratulations, as do the members of the King's Fund working party who have produced such a clear report. I support the Bill.
§ 2.41 p.m.
§ Lord Cullen of Ashbourne
My Lords, about 30 years ago I had an arthritic hip and I went to see a brilliant osteopath who in a miraculous way cured the condition in half a dozen sessions. While she was working on my body she said, "Will you become a member of the Council of the Osteopathic Education Foundation?" I felt I was in no position to refuse, and for the past 25 years I have been chairman of that body.
§ Lord Cullen of Ashbourne
I am still around! My Lords, during that time I have seen the number of qualified osteopaths increase considerably and the medical profession become more and more prepared to recognise the benefits of osteopathy. I am pleased to be able very briefly to participate in the debate today.
As the noble Lord, Lord Walton, said, the Bill will mark a significant milestone in the history of the osteopathic profession. I read the King's Fund Report on Osteopathy with very great interest, and I was 1601 much impressed by the results of their deliberations and exhaustive consultations. The working party have achieved a remarkable consensus for their proposals which are encapsulated within the Bill before your Lordships' House today. Sincere thanks are due to all members of the working party for their hard work which has resulted in this most sensible and long overdue measure.
I should like to echo the tribute to Simon Fielding. He was not only on the working party but for several years has been a member of the Council of the Osteopathic Educational Foundation and has kindly kept me in touch with his indefatigable efforts behind the scenes. I feel that if it had not been for him we would not be here today debating the Second Reading of the Bill.
It is also extremely encouraging that the provisions for the regulation of osteopaths have attracted such support from the medical profession. In particular, I note that the secretary of the BMA has written to the King's Fund to confirm the BMA's support for legislation seeking to regulate the education and training of osteopaths. That is a major step forward and is not only a tribute to the Kings's Fund working party but also to the responsible and far-sighted attitude of those at the BMA.
Credit too must go to the osteopathic profession, which over the past few years has acted decisively upon the advice of Government Ministers and has now fulfilled all the criteria necessary for the swift passage of the Bill.
I recall the words of my noble friend Lady Hooper, when speaking on behalf of the Government in May 1990. She told your Lordships' House that members of the public who chose to avail themselves of treatment from osteopaths, for example, have a right to be safeguarded in the same way as those using the NHS professions.
I thoroughly agree with that view and believe that the Bill represents an eminently fair and practical way of achieving those safeguards for patients. This surely is a simple and common-sense measure which should I believe command the unanimous support of the House.
§ 2.46 p.m.
§ Lord Colwyn
My Lords, I too should like to thank the noble Lord, Lord Walton, for the way he explained the Bill and for the work that he and the working party on osteopathy, set up by the King's Fund, were able to achieve. I must congratulate him on the way he has been able to persuade the Government to find time for the Bill, and hope that he has been sufficiently persuasive to ensure that the Bill will complete its passage before the general election, or at least go sufficiently far down the path that there is no chance of it being unduly delayed.
Before saying something about the Bill, I should like to pay tribute —along with the noble Lord, Lord Ennals—to the Prince of Wales, President of the King's Fund, for all his help, encouragement and 1602 belief that osteopathy deserved greater recognition, and also to my noble friend Lord Ferrier, who I know will read this debate when he receives Hansard.
Ever since I have been a member of your Lordships' House—and it is now nearly 25 years—I have been aware of my noble friend's constant pressure on Governments of both sides, to allow the use of manipulative techniques—and I know that my noble friend Lord Ferrier was an exponent of chiropractic —in the National Health Service. The King's Fund recommendations do not provide for any inclusion of osteopathy within the NHS, and the Bill has nothing to do with the recognition of osteopathy. It is merely a mechanism to ensure that there is adequate regulation of an increasingly accepted form of treatment. There is no doubt, however, that the consideration of this legislation is a major step towards my noble friend's ultimate goal. Our debate today is particularly fitting as it was my noble friend's 90th birthday Wednesday last and I am unable to think of a better present for him. I am grateful for all he has done.
I should also like to congratulate the Government on their farsightedness in allowing time for this Bill. In her speech to the House on the 9th May last year, during the debate on complementary and conventional medical treatments, my noble friend said,We have eyed the 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".—[Official Report, 9/5/90; col. 1432.]I hope that, after the election, she will find time to allow similar legislation for chiropractic, acupuncture and other therapies.
My noble friend will recall that with the noble Lord, Lord Ennals, and my noble friend Lord Baldwin, we were very close to inserting an amendment into the Health Services Bill which would have allowed fund-holding GP's to refer patients to alternative and complementary practitioners, outside their practices but within their budgets, rather than delegate an alternative therapist, as is the situation at present.
I should like to think that this is a first step towards that, and a government recognition of many of the complementary therapies which provide treatment at much less cost than orthodox medicine. During our frequent debates on health in the House, I have repeatedly pointed out to the Government that the continual cost crisis in the NHS will never be solved by throwing in more cash. We hear from doctors and politicians that all we need is more cash to purchase more equipment and hospitals, and to pay more staff, implying that, if only medicine had all the resources it needed, all our health problems would be solved. Nothing could be further from the truth. The NHS has evolved as a service with very little to do with health—waiting for people to fall ill before taking any action.
The working group on back pain which reported in 1979—and I do not have any more up-to-date figures —showed that more than 375,000 people a year, 1 per 1603 cent. of the population, experienced a spell of certified sickness incapacity because of back pain, leading to a loss of more than 11.5 million days from work and costing £220 million a year in lost output. In 1979 this cost the social security system over £40 million in sickness and invalidity benefits and disablement pensions. My noble friend will no doubt know how this problem is affecting us now. I suspect that it is more depressing.
In 1979, the working group's recommendations included the setting up of special back pain research centres, control by primary prevention and the initiation of comparative trials of manipulative treatment, including both orthodox and other means.
In 1986 in the British Medical Association report on alternative therapy, which was produced almost certainly as a direct result of Prince Charles's intervention, was criticised for being limited in its understanding and prejudiced in its approach. But it highlighted a number of common features in many of the techniques used, and suggested that the popularity of alternative medicine lay in the amount of time available to patients, the use of touch, the magical qualities surrounding alternative practitioners and the authoritative attitude and belief in their models and methods of healing. The report stated that there was,no substance in the theory that advances manipulation as a system of healing".It went on to say,The core of the problem of the lay osteopathic manipulator rests not with whether these services are useful, for there are probably at least 2,000 in practice in Britain, but in that only some hundreds are registered as having had formal instruction".They concluded however, by saying,the registered lay manipulator probably provides the community with a generally safe and helpful service".I am delighted to hear from my noble friend Lord Cullen that the BMA gives the Bill some support. It has always been government policy that the individual should be free to seek the benefits of alternative medicines and therapies. In her address on 13th June 1986 to the Royal Society of Medicine, my noble friend Lady Trumpington said:Some people argue that it is the Government's responsibility to register alternative therapists. It may come to that one day, but, if it does, it will be because the alternative community has been unable to put its own house in order… I am firmly of the view that alternative therapists must themselves address the question of standards and qualification".The osteopaths have taken that advice. I hope that there will be no delay in the implementation of this innovative legislation.
§ 2.53 p.m.
§ Lord Brougham and Vaux
My Lords, noble Lords will be aware that I have some knowledge of the osteopathic profession as a few years ago I took over the sponsorship of a survey of osteopathic schools from our late friend Baroness Lane-Fox.
The recent publication of the report of the King's Fund Working Party on Osteopathy, under the chairmanship of Sir Thomas Bingham, demonstrates quite clearly that the case for the immediate statutory regulation of osteopathy is proven. Members of the 1604 working party should be congratulated upon the way in which they went about their task and for their most cogent and well presented report.
The working party's report proposes a fair, simple and, I believe, uncontentious mechanism to achieve the regulation of what is, after all, an important and increasingly popular form of treatment.
What is also clear is that these proposals, which are incorporated in the Bill of my noble friend Lord Walton, have the strong support not only of the osteopathic profession but also the medical profession.
As a former president of the Royal Society for the Prevention of Accidents, I am particularly interested in any measures which are designed to give greater protection to the public. In my view, the Bill will provide osteopathic patients with the safeguards that they deserve and it is quite right that this House and the Government should support this eminently sensible and straightforward measure.
§ 2.55 p.m.
§ Lord Kindersley
My Lords, much has been said on this subject that I should have liked to say. I shall try not to repeat what has already gone before, in particular as regards the reference that has been made to those who have spent so many hours and such hard work in reaching the point we have today of this Private Bill.
Perhaps not sufficient mention has been made of His Royal Highness the Prince of Wales who, when he was president of the BMA, delivered a speech which set the ball rolling in a way it would not have done if the speech had come from any other source. There followed from that speech a series of dinner parties in Kensington Palace and a series of colloquia in the Royal Society of Medicine which have garnered tremendous interest in the conventional medical field and have enabled people who 20 years ago would not have thought of supporting complementary medicine —the noble Lord, Lord Walton, mentioned that fact —to become relatively enthusiastic supporters of it. A remarkable transformation has taken place.
I thank not only the noble Lord, Lord Walton, but also Mr. Simon Fielding, who is in the gallery today, for their efforts on this subject. I also wish to thank the chairman of the working party, Sir Thomas Bingham, for spending much precious time on the affairs of the working party and also for agreeing to chair the working party on the chiropractic Bill which is now under way.
The noble Lord, Lord Walton, has drawn attention to the change of attitude that has occurred on this matter. It is encouraging that, chiropractors are so close behind in that regard. One can only hope that within not too long a passage of time all the disciplines of complementary medicines will proceed down the same path with their own regulations. The noble Lord, Lord Walton, also referred to the opportunity to table amendments to the Bill in Committee.
I wish to declare an interest in this matter. I support complementary medicine and I am a director of the Sun Alliance insurance group. I wish to register a point relating to compulsory insurance. That is 1605 referred to in the Bill. I recognise the need for osteopaths to have insurance cover but I believe it is undesirable to require it by statute. Insurers should retain the right to decline cover. That might even be a help to the General Osteopathic Council in ensuring that the highest standards are maintained in its membership. I therefore wish to suggest that the requirement for insurance cover be a matter for the General Osteopathic Council to administer. The council would appear to have that power under Clause 8(2) (f) of the Bill. It would therefore only be necessary to remove paragraphs (1) (c) and (2) (c) of Clause 7 to achieve that objective.
I wish to refer to the Research Council for Complementary Medicine. As statutory recognition and regulation of the different disciplines in complementary medicines are granted, it is extremely important that money is spent on projects in those fields. The research council was set up some five or six years ago and is composed of distinguished members from both the conventional and complementary fields. It is being run on a shoestring and it has countless research projects put before it which cannot get off the ground as there are insufficient funds for that to happen. Some of the projects are under way but many more need to be started. I hope it will be possible for the Medical Research Council to start using even a minuscule amount of its funds in the field of complementary medicine.
My noble friend Lord Jellicoe, who is in the House today, was chairman of the Medical Research Council and made stout efforts to try to achieve that. He got one research project off the ground while he was chairman but I have not heard of any more. I hope that there will be renewed impetus in the Medical Research Council towards the complementary field. I am fully in support of the Bill.
§ 3 p.m.
The Earl of Clanwilliam
My Lords, I apologise to your Lordships' House for being late on parade due to the vagaries of British Rail—an engine caught fire at Exeter station. I must also apologise to the noble Lord, Lord Walton, for missing his speech and to the noble Lord, Lord Rennell, for missing his maiden speech, which I regret especially.
I should like to congratulate the noble Lord, Lord Walton, on the introduction of the Bill. I should also like to congratulate the committee of the King's Fund, as have all other noble Lords who have spoken. I have been a user of osteopathy for some 35 years. The fact that your Lordships see me standing before you demonstrates how successful osteopathy has been. It is only surprising that it has taken so long for such a Bill to come forward on to the statute book. Naturally I thoroughly recommend it to your Lordships.
The noble Lord, Lord Colwyn, pointed out that some 11 million working days are lost each year as a result of back pain. Osteopathy, and perhaps I may add chiropractic, can cure those problems. They do so more cheaply, quickly and easily than the other professions. I am sorry that chiropractors could not bring themselves to be aligned with the osteopaths in 1606 this Bill. There appears to be very little difference between them apart from a question of whether or not one wants to be x-rayed. It is sad that the vitally important complementary therapies are so divided by such small differences and are unable to come together. However, I believe, as has been said, that chiropractic is to be the subject of the next report. That is excellent news. The King's Fund and the Bill have set a simple, straightforward and obvious precedent for all therapies which wish to come before your Lordships and the country in future. It provides all the necessary controls and would provide the format for a similar Bill covering homeopathy, medical herbalism or even acupuncture.
I note that the Bill provides for a council consisting of 24 people. Perhaps the prospect of 24 osteopaths in one room is daunting. However, the council will not be made up of 24 osteopaths but merely a number of osteopaths. The remainder of the members of the council would be equally able to perform the necessary tasks in relation to chiropractors, medical herbalists, homeopaths or whatever.
I do not wish to detain the House any longer. I apologise again for being late on parade. I thoroughly recommend the Bill to your Lordships' House.
§ 3.4 p.m.
§ Lord Glenarthur
My Lords, my noble friend apologised for being late on parade. But nobody could have been later than me, and I am extremely grateful to my noble friend. I apologise to the House. It is a discourtesy to turn up at the last moment. However, I particularly wanted to say a few words on this important matter and I hope that my noble friend on the Front Bench and the noble Lord, Lord Walton of Detchant, will forgive me for not being present to hear the debate on the important matters which have been discussed.
I very much welcome this important Bill. While I was a Minister in the then DHSS from 1983 to 1985 I had a policy responsibility towards the rather fraught matter of alternative therapies. In a sense the King's Fund report stemmed from at least some of the discussions and initiatives which had been considered in the department and elsewhere round about that time. My own belief is that alternative therapies have a great deal to offer. I remember discussing which of those therapies might stand the best chance of finding some way of being recognised by the Council for Professions Supplementary to Medicine. Osteopathy and chiropractic seemed the most promising.
The exceedingly thorough King's Fund report is a major step in the direction that many want to see taken. This Bill—which establishes the General Osteopathic Council, sets up a register and deals, among other things, with requirements for training —is the fruit of the labours of Sir Thomas Bingham and his team. There are many who believe—as I said, I am one of them—that a case exists for a similar piece of legislation for chiropractic. That was no doubt referred to by other speakers today. I believe that it is long overdue.
The various schools of chiropractic have gone a long way toward reconciling any differences that there 1607 may have been among them. That is wholly to be applauded. Among those differences, the differing attitudes toward training have been a major cause of concern. I am delighted to note that a working party on chiropractic, also chaired by Sir Thomas Bingham, has been appointed and will report in the summer or perhaps earlier.
More and more conventional doctors are beginning to accept the advantages of the two therapies of chiropractic and osteopathy. It is right, however, that both of them should be fully scrutinised for their efficacy, the training and registration of those who practise them and for suitable means of protecting the public from those who are inadequate practitioners.
I wholly welcome this admirable Bill. I wish it all speed in getting on the statute book and I look forward to a similar Bill before too long for chiropractors. Again, I apologise profusely to the House for not having been able to be here earlier. I had a longstanding engagement which unfortunately made it quite impossible. I look forward with keen anticipation to the comments of my noble friend Lady Hooper from the Front Bench.
§ 3.7 p.m.
My Lords, I have two apologies to make to your Lordships. The first is for being late on parade and I see that I join good company; the second is for not having put my name on the List of Speakers.
I should like to say that I warmly support the Bill. In my day I have suffered, at times considerably, from back pain. I remember vividly once hoping to take a train from Paddington to my station in Wiltshire and attempting to buy a paper at W.H. Smith or Menzies (I forget which one it was). The lady at the counter was a little surprised to find that suddenly I was no longer above the parapet. I had fallen over backwards with a rather acute onset of back pain. For a moment she thought that I was suffering from some other ailment.
As someone who has suffered from back pain, I am very aware of the benefits which the profession can accord. I have been accorded those benefits. In my time I have also been involved with the profession in an organisational way. As my noble friend Lord Kindersley said, I achieved a mite—but it was like moving a mountain to achieve that mite—in the Medical Research Council by getting it to undertake at long last one serious study of back pain. I apologise to my noble friend for not having achieved more.
Having said that, I should like to add my voice to those which have so warmly commended the Bill introduced by the noble Lord, Lord Walton.
§ 3.10 p.m.
§ Lord Beaumont of Whitley
My Lords, I too should like to thank the noble Lord, Lord Walton, for introducing the Bill. I welcome the opportunity to share in the debate with so many noble Lords. I welcome the extremely interesting speech of the noble Lord, Lord Rennell. My noble friend Lord Falkland told me in advance to expect that it would be both informative and amusing; and indeed it was.
To a large extent it is a congratulatory debate. However, we thank not only His Royal Highness the 1608 Prince of Wales—he has been mentioned—but also his sister and his wife, both of whom have taken an interest in the matter. Indeed, the whole Royal Family have not been backward in expressing their support for extending the barriers of medicine.
My party welcomes the Bill. That is not just a personal statement; I speak on behalf of my party. My noble friend Lord Winstanley is unable to be here because unfortunately he is ill. I am sure that all our thoughts go out to him. It is a proof that even doctors are not immune from ill health. On my noble friend's behalf, I should like to say that he too, as a doctor, welcomes the Bill.
However, even if I were not speaking on behalf of my party, I would have wished to speak. Twenty years ago a distinguished Harley Street consultant put me in a corset and told me that my back would inevitably deteriorate, and that by the time I was my present age it no doubt would have deteriorated a great deal.
Today my back needs the attention of an osteopath about every three or four years. Thanks to her, I am fit for all these exercises to which I am inclined. Indeed, I no longer have the excuse of a bad back for those to which I am disinclined. She also looks after the backs of my wife, my two daughters, my two brothers-in-law and various other members of my family and friends. Although her charges are reasonable (as I believe are those of most osteopaths) it is not surprising that I too am quite keen that all that should come on to the National Health.
My osteopath tells me that 30 years ago—the noble Lord, Lord Walton, stated it too—the medical profession could not refer people to her and her colleagues; nor could she refer people to the medical profession. Doctors were forbidden to have any dealings with her on pain of instant execution—not quite that, but, professionally, very much the same. However, in the past 20 years the profession of osteopathy —it is a profession—has proved itself. Now surgeons refer patients to her before deciding whether to operate.
Today the profession comes of age. Those who are helping it are the doctors and surgeons. That is the good news. It gives us all a great pleasure to welcome that change of heart. There is more joy in heaven over one sinner who repenteth. But the debate is not a doctor-bashing exercise; it is to congratulate all the healing professions for getting together to put forward the Bill.
Many methods of healing are being tried today. Some, it is true, are in the hands of charlatans. Some have not yet proved themselves. Some of them operate in those areas where it is difficult to apply any scientific tests. Such methods may or may not be valid. But where they have proved themselves, as osteopathy has, they must be admitted to the brotherhood and sisterhood of those who strive to make people whole. The Bill gives privileges which have already been earned. It imposes responsibilities which I have no doubt will be fulfilled. It should certainly be supported by your Lordships' House.
§ 3.15 p.m
§ Lord Carter
My Lords, I too thank the noble Lord, Lord Walton of Detchant, for introducing this important Bill and for giving the House such a clear exposition of its contents, and I too am surprised that it is not a government Bill. I hope that in reply the Minister will say that it has the support of the Government who intend to find the time to see it through the House.
When speaking on a Private Member's Bill from this Dispatch Box, I must say that I am speaking in my personal capacity. However, I wish to quote from the Labour Party statement, A Fresh Start for Health. It states that Labour would be willing to give legislative backing to the progress towards self-regulation within the complementary medicine disciplines,by introducing national systems of accreditation and registration for those disciplines which have developed high standards of training and practice such as chiropractice, osteopathy, homeopathy and acupuncture".Therefore, your Lordships will not be surprised to learn that if I had been speaking as the Opposition spokesman my speech would be similar to that which I am about to make.
We have had an excellent debate with many notable speeches. As I expected, they contained some wince-provoking osteopathic anecdotes. However, no speech was more notable than the maiden speech of the noble Lord, Lord Rennell. I join with my noble friend Lord Ennals in saying that the noble Lord must not wait another 10 years before speaking again.
The Bill is a most welcome and sensible measure. It is based on the excellent report of the King's Fund. Most points have been well covered but I wish to raise some points of detail. The statutory register of osteopaths is the first for complementary medicine and others will surely follow. As was said by His Royal Highness the Prince of Wales, such a register will,consolidate the professional base of osteopathy and protect the public".The Bill also marks a much healthier relationship between the medical professional generally and complementary medicine. That can result only in a general improvement in health care. Perhaps I may say as a layman that it appears that the medical profession is now prepared to admit that there are more things in heaven and earth than were dreamt of in its philosophy.
The measure leads to the obvious question of whether such a properly regulated and controlled treatment should become available through the National Health Service. I shall welcome the Minister's comments on the Government's view about the relationship between the registered osteopaths and the health service if the Bill becomes law. We have heard already that a GP fundholder or a GP under the health authorities can use part of the fundholding budget or the direct fund to pay for osteopathic services. My noble friend Lord Ennals referred to the letter from the Minister, Mr. Stephen Dorrell, in which he explained how a GP can use a complementary therapist. The letter covers the process of bidding for the payment of a complementary therapist. Will the Minister tell the House what 1610 judgment is exercised in the use of that therapist? Is it left entirely to the GP or is there some other procedure for ensuring that the complementary therapist is up to standard? For example, is the use controlled by the professions supplementary to those covered by the Medicine Act or is there some other device?
The Bill is extremely well drafted but I wish to ask a few questions. What sanctions will the proposed general council have if an educational institution falls below the standard which the council decides is appropriate? Will such an institution be barred from offering the courses and examinations in osteopathy? There are provisions in Clause 5 for dealing with the standard of qualifications but I cannot see the sanction which deals with the education institution itself. Perhaps the provision in Clause 5(3) is sufficient for the purpose. I should be grateful if the Minister would confirm that.
It seems that the initial full register will include unqualified osteopaths. That follows the recommendation made by the King's Fund working group. As I read it, the register will include unqualified osteopaths. Is the requirement of safe and competent practice for not less than five years, which need not be continuous, regarded as a sufficient safeguard for the osteopaths who appear on the initial full register?
The proposals in Clause 10 to separate the responsibilities of the investigating committee and the health committee are eminently sensible. They allow a distinction between osteopaths who are professionally unacceptable and those who are ill.
Perhaps I may say in passing to the Minister that in Clause 11(2) there are five sanctions on unacceptable professional conduct. I am sure that she recalls our discussions on the Nurses, Midwives and Health Visitors Bill about cautions, reprimands and so on, which eventually required an amendment to the Bill. This Bill sets out the sanctions available to the general council extremely clearly.
As regards the health committee, unlike the professional conduct committee there is no mention of legal or medical representation to assist the osteopath who is being investigated. Is the ability of the individual to call witnesses, which is mentioned twice in Clause 12, deemed to be a sufficient safeguard of the individual's rights at law?
I said that I would be brief because the matters raised by the Bill have been well covered by the debate. It is an extremely useful Bill which is well drafted and clearly explained. It deserves the support of this House and another place and we must hope that the electoral timetable does not prevent it reaching the statute book.
§ 3.22 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, I too thank the noble Lord, Lord Walton of Detchant, for bringing this Bill to the House and for outlining its provisions and purposes so clearly. I add my congratulations to my noble friend Lord Rennell on his exemplary maiden speech. I hope that he will consider health topics to be a firm interest in the future. 1611 I am glad too that my noble friend Lord Colwyn reminded us of another absent friend—my noble friend Lord Ferrier. In view of all his activity in this sphere in the past, I am sure that he would have participated with vigour in today's debate. Perhaps I may also take the opportunity to correct the record because my noble friend celebrated his 92nd birthday last Wednesday. It was good too to be reminded by my noble friend Lord Brougham and Vaux of the contributions made by the late Lady Lane-Fox in this important area.
I say straight away that the Government support the Bill in principle and they hope that it will receive the support of this House. From the comments already made, that seems to be without question.
Much has been said about the history and background of the Bill. I shall endeavour not to repeat what has been said but perhaps I may add my mite to the background because the regulation of osteopaths is an issue which has been around for some 60 years. Bills seeking to regulate the profession were presented to Parliament in 1931, 1933 and 1934. There was in fact a second attempt in 1934 when the late Lord Elisant re-introduced a Bill into this House. That Bill received a Second Reading but after Ministerial criticism was withdrawn.
However, on the suggestion of the then Minister of Health, supporters of the Bill set up a voluntary register of osteopaths. This body, known as the General Council and Register of Osteopaths, now governs the majority of professionally regulated osteopaths. There are in addition a number of other smaller bona fide osteopathic registering bodies which regulate and represent the interests of their members. I know that all those groups have long cherished the hope that one day they might achieve statutory regulation, their roles thus superseded by a single statutory regulatory body which would incorporate the breadth of experience and expertise contained within all branches of the profession.
Progress has perhaps been slow but there were many hurdles to surmount—the difficulty of bringing together the various groups within the professions, the attempts to achieve a consensus among all osteopaths and to obtain the agreement and support of the medical profession and its recognition of the value of osteopathy, about which we have heard.
Although 60 years may seem a long time to have taken to accomplish those goals, the difficulties were very real. It is in recognising that that I wish to add my thanks to the King's Fund and to all those concerned with the preparation of the report and the draft Bill. I should particularly like to congratulate Sir Thomas Bingham, Mr. Fielding and other osteopaths, the noble Lord, Lord Walton, and other representatives from the medical associations and two observers from my department who participated in the working group and made it such a success. They consulted widely and their proposals met with widespread support, not only from the osteopathic profession as we have heard, but most importantly from the principal bodies within the medical profession. As was stated in the report, all the conditions were satisfied that the Government believed must be met before legislation could be 1612 contemplated. The proposals provide a fair and practical basis for statutory regulation which will include all established osteopaths and provide patients with real safeguards for the future. Sixty years of gestation may be coming to an end with, if I may be permitted to put it in this way, the noble Lord, Lord Walton, in the guise of the midwife.
I turn to the Government's part in all this. During the debate in your Lordships' House in May 1990, introduced by the noble Earl, Lord Baldwin, I informed the House that Ministers had been kept fully informed of the progress of the working party on osteopathy, and we awaited its report with interest. I can now say that we follow with equal interest the new King's Fund Working Party, again chaired by Sir Thomas Bingham, which seeks to make progress for chiropractors. I hope that that will reassure my noble friend Lord Clanwilliam and others that those other professions are not being missed out.
To answer a question raised by the noble Earl, Lord Baldwin, we have long said that regulation of the complementary therapy professions should be by way of Private Member legislation, so that Parliament can make up its own mind on this important issue without political inferences. We remain of that view. Nevertheless, I hope that Parliament will feel able to give the Bill its safe passage. I appreciate also and must point out the difficulties in a measure of this sort being piloted through a short and extremely busy Session. If strong support is shown for the Bill, but it unfortunately runs out of time or fails for some procedural reason to complete its course, we may need to look again and consider the case for introducing a Government Bill in a future Parliament.
In the time available since the publication of the report last December—less than two months ago—we have not been able to look as closely at the detail of the Bill as we would have liked. However, it is already apparent that there is a significant number of amendments, mainly technical and consequential as the noble Lord, Lord Walton, pointed out, but which would nevertheless be necessary. Indeed the noble Lord, Lord Carter, pointed to other areas of anxiety which will require consideration. It is particularly important also to ensure that the Bill conforms to the requirements of the European Community legislation and is broadly similar to other professional regulatory systems. So your Lordships' House will be quite busy during the Committee stage of the Bill in seeking to ensure that it is perfected.
Perhaps I may respond to one or two specific points and questions that were raised. My noble friend Lord Kindersley raised the issue of compulsory insurance. We are aware of the anxieties about the possibility that the Bill would introduce compulsory insurance for osteopaths as a condition of registration. Again, that is one of the details of the Bill of which we are aware and which will need careful scrutiny at Committee stage. In that regard, I expect to see an amendment introduced.
My noble friend also made reference to research. Although that is not precisely within the scope of this Bill, I feel sure that his message will be heard and echoed outside the walls of your Lordships' House. I 1613 believe that my noble friend Lord Jellicoe would confirm that the MRC is always willing to consider good protocol for clinical research, including research into complementary medicine.
As regards the subject raised by my noble friend Lord Rennell of what availability there will be for osteopathy services on the National Health Service, since the Bill is solely concerned with the regulation of the profession, it does not deal with the supply of NHS services. Therefore, it will not directly affect the provision of osteopathy services in the National Health Service. However, in view of my noble friend's remarks and those of the noble Lords, Lord Beaumont of Whitley and Lord Carter, I outline what happens at present regarding the National Health Service and osteopathy services.
Currently, fund-holding general practitioners may already directly employ complementary therapists using the staff element of their practice budget in the same way as they might employ other practice staff such as nurses or chiropodists. Non-fund holding GPs may also employ complementary therapists to provide treatment for NHS patients if their Family Health Service Authority will agree to pay for that provision. We are aware of a growing number of practices where that already takes place. To respond specifically to the noble Lord, Lord Carter, that means that it is a matter for the professional judgment of the GP concerned. I have no doubt that the better the regulation of the profession with the clearer standards that have to be achieved, we shall see that trend continue.
As I said at the beginning of my contribution, the Government welcome the Bill in principle. I can express my personal hope that it will prove possible to secure the necessary changes during later stages of the Bill. I hope that we shall be able to ensure the Bill's safe passage through your Lordships' House and that it will pass rapidly through another place.
§ 3.34 p.m.
§ Lord Walton of Detchant
My Lords, I am very grateful for the warm and generous support which this Bill has received from so many quarters of your Lordships' House. I would like to add my personal congratulations to the noble Lord, Lord Rennell, on his most interesting and stimulating maiden speech. He will not expect me to spring to the defence of the medical profession in reply to his comments quoted from the late George Bernard Shaw. That would perhaps be appropriate on some other occasion. However, I cannot forbear mentioning the fact that one of my most distinguished teachers, a professor of pathology, was called Arthur Frederick Bernard Shaw—GBS was his uncle. When asked whether he had any relationship to the George Bernard Shaw, he used to say, with typical medical modest terminology, "I am the Bernard Shaw".
We have had a great deal of support from many quarters of the House. I should particularly like to thank all of those who have spoken so enthusiastically. I am especially grateful to the noble Lords, Lord Ennals, Lord Colwyn and Lord Kindersley, for drawing to the attention of the House the important 1614 role played in this regard by His Royal Highness the Prince of Wales, not only in his capacity as president of the King's Fund but also in his capacity as a former president of the BMA. I had the privilege of handing over personally to him the presidential chain of office in 1982 when he made that most notable speech on complementary medicine which led to so many important developments. I believe that in those capacities he would have been very keen to contribute to your Lordships' debate today were it not for the fact that he is visiting, on a long-standing engagement, the Royal Victoria Infirmary in Newcastle, where I trained in medicine.
Having made those introductory remarks in reply to the debate perhaps I may pick out one or two points of importance. I am glad to hear that many noble Lords were interested in the possibility that ultimately osteopathy may become available on the National Health Service other than through the reference and delegation of authority by a general medical practitioner, which is possible at present. But of course that is a totally different issue. The Bill deals with the regulation and education of the profession and not with the provision of services. Therefore, that matter should be discussed on another occasion and under separate consideration. I trust that no such considerations will in any way delay the progress of this Bill through your Lordships' House and another place.
In reply to the noble Earl, Lord Jellicoe, and others who raised the important issue of research referred to by the Minister, I can only confirm, as a former member of the Medical Research Council, that the council will, I have no doubt, be willing to support well-conceived and well-constructed research projects in the field of complementary medicine to which it is always open. Many people in this House will have heard of the well-publicised trial conducted by the MRC into the effects of chiropractic on low back pain which demonstrated the beneficial results of that form of treatment.
I now turn to some points of detail raised by certain noble Lords, I say at once to the noble Lord, Lord Kindersley, that the issue of insurance is one of which I and the other supporters of the Bill are only too well aware. That clause in the Bill was specifically included at the request of the osteopathic profession because its services are at present wholly private. In other professions, as in mine, the requirement to have a form of insurance is a requirement of employment within the National Health Service. The osteopaths were particularly keen to see such a provision included. I am sure that they now recognise that such a provision ought not to be, as the Association of British Insurers has said, on the face of the Bill. It is something which might perhaps be pursued by the general council under its rules, but I wholly agree that under a proposed amendment it should be removed.
To answer points made by the noble Lord, Lord Carter. I confirm that under Clauses 4 and 5 of the Bill that if the education committee had evidence from visitations or other evidence to suggest that an educational institution was not providing instruction or examinations of an appropriate standard, that 1615 committee would have the power to recommend to the general council that the qualifications conferred by such an institution should no longer be registered. That is on the face of the Bill. Secondly, I take his point about the health committee. There is a series of long subsections in Clause 12 relating to the health committee. Those subsections make it quite clear that the osteopath whose health may be called into question has the power to present a case. I take it that that may well include legal representation. But at the end of the clause there is a phrase which states that the osteopath would be entitled to legal representation. The way I read it, the provision at the end of Clause 12 applies to the whole of the clause. However, I may be mistaken and if I am I shall certainly look at that before we come to the Committee stage.
In conclusion I should like to tell the Minister how much I appreciate the fact that the Government support the Bill in principle. The history is most interesting. Perhaps I may remind the noble Baroness that before the medical Act 1858 to regulate the medical profession had been published and was accepted by Parliament, no fewer than 20 medical Acts had been introduced into Parliament and each had fallen by the wayside. I trust, as the noble Baroness was willing to suggest, that this will be the 1616 end of the road and that we are approaching the moment when the osteopathic profession will receive its well-deserved recognition and the statutory control of its activities which the Bill would provide.
In thanking the Minister for her comments on the role that I personally played as regards the Bill, I should just tell her that my last practical experience in midwifery was in general practice in 1945. Nevertheless, what the noble Baroness suggested in relation to the progress of the Bill is something that I hope I shall be able to achieve. I am most grateful for the suggestion that she made that if, for legislative and other reasons such as pressure of government business, the Bill was significantly delayed in its progress, consideration would be given to the introduction of a government Bill. I trust that that will not be necessary and that we can, after today's debate, see the Bill proceed rapidly through its various stages in this House, to be quickly followed by similar progress in another place.
I trust that your Lordships will agree to give the Bill a Second Reading.
On Question, Bill read a second time, and committed to a Committee of the Whole House.
House adjourned at nineteen minutes before four o'clock.