Osteopaths Bill

HL Deb 27 May 1993 vol 546 cc488-502

5.55 p.m.

Lord Walton of Detchant

My Lords, I beg to move that this Bill be now read a second time.

A little over a year ago I had the privilege of opening the Second Reading debate on a similar Bill standing in my name on the Order Paper. As the House will know, that Bill fell when Parliament was dissolved on the calling of a general election last year. I am, therefore, delighted today to open the Second Reading debate on the new Osteopaths Bill. I am also very pleased that events over the past year have moved ahead considerably and that the osteopathic profession is now closer than ever to achieving the goal of statutory regulation which it has been actively pursuing for the past 60 years.

Osteopathy is a system of diagnosis and treatment which emphasises methods of recognising and alleviating structural and mechanical problems of the body. Within recent years, osteopathic treatment and training have become increasingly scientific and comprehensive and the discipline has become increasingly popular; indeed, it is now the most widely used of the so-called "complementary" therapies. Moreover, in recent years the medical profession has come to recognise osteopathy as a discipline which complements conventional medical treatment and which enhances the range of possible therapeutic options available to patients.

Given the increasingly common instances of cross-referral between general practitioners and osteopaths, it is not now unusual for an osteopath to be treating a patient who is concurrently receiving medication from his or her doctor. That is in stark contrast to the position that prevailed some 20 to 25 years ago when it was regarded as improper for a doctor to associate with complementary practitioners. At that time, a doctor referring a patient to a non-medically qualified osteopath would have fallen foul of the recommendations of the General Medical Council on professional conduct and discipline.

Osteopathic treatment involves the use of predominantly gentle manual methods of manipulation. It utilises a diagnostic procedure similar to conventional medical examination and pays particular attention to obtaining a detailed assessment of the patient's musculoskeletal system. However, as the law currently stands, anyone may call him or herself an osteopath and may then begin practice in the United Kingdom. There is no obligation under law to undergo formal training of any kind, or to comply with standards of professional competence or ethical practice. Thus, a patient has no guarantee that a person claiming to be an osteopath is competent or fit to practise as one.

However a system of voluntary registration operated by several independent registering bodies currently exists. The largest is the General Council and Register of Osteopaths. It has approximately 1,700 members which is about three-quarters of all professionally registered osteopaths. But, by its very nature, a voluntary system is unable to enforce registration or to compel practitioners to comply with standards of competence or conduct.

The central object of the Osteopaths Bill now before your Lordships is to replace those voluntary schemes with a system of statutory registration for osteopaths, similar to those which already exist for many other professional groups, including the key health professions. That would be achieved through the establishment of the General Osteopathic Council which would be responsible for developing, promoting and regulating the education and practice of the profession of osteopathy through the UK. A statutory register of osteopaths would form the core of the proposed scheme. Practitioners wishing to use the professional title of "osteopath" would be required to be on that register which would be maintained by a registrar appointed by the General Osteopathic Council. Copies of the register would be published annually and a master copy would be available for public inspection at any reasonable time.

Entry to the register would be based on prescribed standards of training, good character and good health. An important provision in the Bill would place practitioners under an obligation to declare any previous criminal convictions—including spent convictions—if asked, when applying for registration, thus helping to provide members of the public with an additional assurance as to a registered practitioner's character and bona fides. That is of particular significance given both the contact nature of osteopathic treatment and recognition that most practitioners will continue to practise in the private sector following the introduction of statutory registration.

The Bill also makes provision to ensure that as many osteopaths in current practice as possible, who might not hold a qualification entitling them to automatic registration, may be admitted on to the register and brought within the scope of the statutory scheme on the basis of lawful, safe and competent practice. The Bill would also establish four statutory committees of the General Osteopathic Council—the Education Committee, the Investigating Committee, the Professional Conduct Committee and the Health Committee.

The Education Committee would have the responsibility of promoting high standards of education in osteopathy and of providing the general council with advice on all matters concerning education, training and examinations in osteopathy. The Education Committee would also be empowered to appoint visitors to visit educational institutions providing courses of study, examinations or tests of competence in osteopathy, and to report back to the committee on the nature and quality of the instruction provided.

The Investigating Committee, the Professional Conduct Committee and the Health Committee would collectively provide the "fitness to practise" machinery to ensure that an allegation made against an osteopath concerning his or her professional conduct, competence or fitness to practise osteopathy would be properly investigated and effectively dealt with.

The Bill will therefore provide clear assurances to the public that in future all osteopaths will be appropriately trained, properly qualified and fully competent in all aspects of clinical osteopathic practice and that their professional conduct and continuing competence will be effectively regulated by a statutory council.

This latest Osteopaths Bill—like the one I introduced last Session—is modelled on the recommendations for statutory regulation presented in the report of the Kings Fund Working Party on Osteopathy. This working party was set up in the autumn of 1989 under the very able and distinguished chairmanship of the right honourable Sir Thomas Bingham (then a Lord Justice of Appeal and now Master of the Rolls).

The working party's terms of reference were, 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 and to make recommendations and report". I was pleased to serve as a member of the working party, and I am convinced that its report, published after two years of careful deliberation and very widespread consultation, marked a significant milestone on the osteopathic profession's road to statutory regulation.

Many noble Lords will know that following the publication of the report of the working party on osteopathy, the Kings Fund set up a working party on chiropractic. The report of this working party was published on 5th May this year and similarly recommends the introduction of statutory regulation for that profession. I know that the chiropractors are eagerly hoping to be able to sponsor a similar Bill in the next Session and are following the passage of this Bill with keen interest. Some noble Lords may inquire as to why both professions are not included in this Bill. Quite simply the two professions, though clearly allied, are sufficiently different in several respects to warrant separate consideration. A Bill designed to embrace both would be too detailed and complex to be handled as a private Member's measure.

At the beginning of my speech I referred to a number of very significant developments that have occurred since I last stood here to speak on an Osteopaths Bill. If noble Lords will pardon the metaphor, I should now like to put some flesh on these bones. Following the general election, the osteopathic profession—personified in the form of its dedicated foremost protagonist, Simon Fielding—successfully persuaded the honourable Member for Cambridgeshire North-East to take this Bill through all its stages in another place. As I have said, it was modelled on the recommendations of the working party but has been drafted afresh, taking account of views expressed by about 10 other government departments and the experiences of other statutory bodies, especially the General Medical Council.

It has been scrutinised in the finest detail in another place and is now, I suggest, a formidable and robust piece of legislation embodying the most up-to-date thinking on professional self-regulation. It is a Bill of which the profession and all those who have contributed to its formulation can feel greatly and justly proud.

In moving its Second Reading today I should like to commend the Bill to your Lordships—in the words of the honourable Member the Parliamentary Under-Secretary of State for Health —as "a finished product".

Noble Lords will know that the Bill is a Private Member's Bill and as such has a very fragile existence. Without seeking to dramatise the situation, perhaps I may say that any amendment made to the Bill at this stage could mean gambling on its future success and endangering its chance of returning to another place by 2nd July. If it missed that date, regardless of the reason, or if insufficient time were found to be available for one or more amendments to be debated, the Bill could be lost, even at that late stage.

I do not suggest in any way that we should give this Bill anything less than the same careful consideration that this House gives to all legislation. Neither I, the osteopathic profession nor anyone else involved with the Bill would wish to see a defective or deficient piece of legislation appear on the statute book. However, many people are of the opinion that this particular piece of legislation is long overdue. The statutory scheme proposed in the Bill enjoys all-party support and has been warmly welcomed by many other professional groups, including the medical profession, the allied professions and consumer organisations. Indeed, the BMA has said: The BMA supports this legislation seeking to regulate the education and training of osteopaths in the United Kingdom. We believe it is entirely appropriate that those wishing to practise osteopathy should have to register to do so, and we would welcome such a register as a guarantee of professional conduct and integrity. Regulation of osteopaths by statute should offer greater protection to patients from the potential harm of treatment by unskilled and unauthorised practitioners. The objective of greater safeguards for the public health remains the overriding goal of the Association in all policy matters". Those views are shared by the Conference of Medical Royal Colleges and Faculties and by the senior bodies representing, for example, the nursing profession.

I hope that it would not be out of place for me to say that this House has already indicated its approval of and support for the principles underpinning the scheme when it gave a Second Reading and approved amendments in Committee to the Bill which I introduced in the last Session.

I have mentioned that this latest Bill has been meticulously scrutinised by all relevant government departments and in another place. I should perhaps add that that scrutiny took place outside the strictures of traditional party influences and with the express purpose of providing the profession with the finest possible piece of legislation. I believe that that aim has been achieved and it is on that basis that I urge noble Lords to give this Bill a fair wind and a safe and speedy passage. I beg to move.

Moved, that the Bill be now read a second time. —(Lord Walton of Detchant.)

6.8 p.m.

Lord Ennals

My Lords, I shall be brief, but I want to congratulate once again the noble Lord, Lord Walton, on bringing in this slightly different and improved version of the Bill which he presented to your Lordships' House on 31st January 1992. On that occasion several of us said that it was appropriate that the noble Lord, Lord Walton, as a former president of the BMA with distinguished medical experience should introduce a Bill of this nature and that that showed the extent to which the medical profession and osteopaths had come together. I congratulate the noble Lord on sustaining the Bill with enthusiasm.

I wish to endorse the noble Lord's plea—although he said that it was not a plea—that the Bill should not be amended so that the Bill does not have to return to another place. We know what they always do to legislation which we send back from this House. Let us send back a clean piece of paper.

As the noble Lord said, since January 1992 there have been very significant developments. First, there is the progress by the osteopaths themselves. They are far more ready and prepared for the application of the Bill. As has also been said, since 1992 the chiropractics are ready.

I am grateful, as I am sure we all are, to the King's Fund for having sponsored the working party and the Bill which has now been presented; and for the fact that the Prince of Wales lent his support to the Bill now before us. I believe that Her Royal Highness the Princess of Wales is giving her support to the chiropractic Bill, which I hope will come before us in the next Session.

As I said on the last occasion, I believe that if the Government support the Bill it should be introduced by the Government. It is a pity that the chiropractic Bill should depend upon the vagaries—the good luck or otherwise—of those whose names are in the ballot for Private Members' Bills.

Finally, I wish to quote what I believe to be the very important statement that was quoted in the previous debate. It indicates the way in which treatments carried out by osteopaths may come within the scope of the National Health Service. One presumes that it will apply to other complementary therapies when they receive the same treatment in both Houses of Parliament. The statement was made on 3rd December in a letter sent by the then Parliamentary Under-Secretary of State at the Department of Health to the then chairman of the all-party parliamentary group on alternative and complementary therapies. Incidentally, I had intended to state at the beginning of my speech that it is in my capacity as joint president of the all-party parliamentary group with the noble Lord, Lord Colwyn, that I welcome the Bill. The statement reads: Any GP therefore may employ a complementary therapist to offer NHS treatment within his practice … 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".— [Official Report, 31/1/92; col. 1599.] When that statement was made, it was an important step forward for alternative and complementary therapists, provided that they receive the approval which I hope the Bill will provide. When the Minister replies I hope that she will confirm that what was said by the Parliamentary Under-Secretary at that time still stands today. I hope that the Bill has every possible success.

6.12 p.m.

Lord Beaumont of Whitley

My Lords, I am empowered to say that, although this is a Private Member's Bill, my party is wholly behind it. I also convey the good wishes of the noble Lord, Lord Winstanley. He too would have spoken in favour of it if he had been able to be present. We are sorry that he cannot be present.

It is absolutely right that the osteopathic profession, which has proved itself over a long period of time, should be recognised in this way. It is right in principle. I have a long history of being looked after by a qualified osteopath, as has my family, and she has kept us in good health. I speak therefore with gratitude today.

I shall not venture to go through all the matters that I raised on the previous Second Reading in your Lordships' House. If any noble Lords should be so curious that they wish to know, they can read my speech in Hansard. I wish the Bill a good wind. I hope that no one delays it in any way. I hope that it is speedily followed by the chiropractors' Bill.

6.15 p.m.

Earl Baldwin of Bewdley

My Lords, I warmly welcome this Bill as it reappears in altered form in your Lordships' House after an interval of 16 months. I congratulate the King's Fund for taking on the task of surveying the field of osteopathy and, under Sir Thomas Bingham, producing an admirable report which has led to the Bill which is now before us; and I congratulate my noble friend Lord Walton of Detchant on all his hard work and on the clarity and skill with which he has once again introduced this Bill. I should also like to join in paying a special tribute to Simon Fielding, who has worked so tirelessly on behalf of his fellow osteopaths to get and keep this whole show on the road.

I speak, like many of your Lordships, as a satisfied customer of this most orthodox of the unorthodox professions, and also as joint chairman of the Parliamentary Group for Alternative and Complementary Medicine. As Chairman of the British Acupuncture Accreditation Board, I have a particular interest in seeing how complementary health care professions can regulate their affairs, unite their members, and gain acceptance from society and government. In saying this I should like to repeat what I said on the last occasion about the dangers of public acceptability. In welcoming osteopathy to its place in the sun, with all its attendant benefits, we should do nothing that could lead it to lose its soul or, to put it another way, to abandon its unique therapeutic flavour. In the drive for respectability this can all too easily happen.

It is interesting to note how new ideas and techniques gain acceptance, particularly in the world of medicine. At first the newcomer is ignored. If he does not go away, he is rubbished—"dangerous quackery", "no scientific basis", and so on. If he still does not go away, after a period of time there are small pockets of acceptance: "some usefulness in a limited range of conditions". Eventually, with the passage of time and the retirement of the old guard, acceptance becomes general. It is not scientific logic that drives this process. Nothing significant has changed in the technique or therapy itself. It is the climate surrounding it that changes.

I believe this has lessons for the future. Osteopathy began in the last century, in the days of Lister and Pasteur. Less than 20 years ago, sections of the medical profession were still refusing to have anything to do with it. If patients are to be well served—and this, after all, is what the whole business is about—we must see a drastic shortening of this timescale. As I said, this has to do with attitudes of mind. The chiropractors (as we have heard, another 100 year-old profession) will soon be coming forward with their own Bill, thanks again to the support of the King's Fund. Acupuncture, homoeopathy and others may come after. But they will not do so unless from the side of medical science there is a real willingness to engage with hitherto unfamiliar concepts. There are signs in the air of a new openness, and this is encouraging. Without it, it is patients in the end who will suffer.

This Bill is a landmark. The fact that it might have come a generation or two ago should not prevent us from rejoicing today. It could be said to have broken the back of the resistance to non-mainstream methods of healing, if that is not the wrong metaphor to use in an osteopathic context. I am sure that we will all wish it a speedy passage through its remaining stages on to the statute book.

6.18 p.m.

The Earl of Kintore

My Lords, I should like, as another grateful patient, to welcome this Bill. In November last year I had a very painful back. The banqueting manager of my club, noticing my problem, told me that when he put his back out carrying cases of champagne about, he went to the British School of Osteopathy in Suffolk Street to be put right. Before treatment I could barely sit in the Chamber without pain for more than 15 minutes at a time. After two treatments, I was able to sit in my place for the entire Second Reading proceedings of the Bankruptcy (Scotland) Bill.

During those treatments by a senior tutor and female student from New Zealand, there was discussion on the Bill previous to this one, also piloted through this House by my noble friend Lord Walton of Detchant. It became clear to me that osteopaths are proud of the recognition that this Bill will give them as members of a disciplined and caring profession. I hope, therefore, that the Bill will complete its parliamentary passage quickly.

6.20 p.m.

Lord Cullen of Ashbourne

My Lords, as many noble Lords know, I have an interest to declare in that I have been for many years associated with the Osteopathic Educational Foundation. That has brought me into close contact with the work and organisation of the profession. I should like to thank the noble Lord, Lord Walton, for all his very hard work on behalf of osteopathy and for bringing back to this House this new and improved version of the Bill.

It goes without saying that I wholeheartedly support this impressive piece of legislation. I am sure that noble Lords will agree with the noble Lord, Lord Walton, that it is long overdue. I extend my thanks not only to the King's Fund, and in particular to the chief executive, Robert Maxwell, but also to Her Majesty's Government and the Department of Health for all their support and hard work which will, I believe, ensure that this Bill safely reaches the statute book. We should also acknowledge the central role played by His Royal Highness the Prince of Wales, in the establishment of the original King's Fund Working Party on Osteopathy, which was so ably chaired by Lord Justice Bingham. I should also like to say that had it not been for the virtually single-handed efforts over the past seven years of Simon Fielding, we should not be debating this Bill today.

Perhaps I may return for a moment to the work of the Osteopathic Educational Foundation, which I mentioned a moment ago. I am proud to have been its chairman for some 25 years. The foundation was originally established 46 years ago to help support and develop the educational infrastructure of the osteopathic profession.

In recent years, however, it has become increasingly necessary for it to divert considerable amounts of money to support students enrolled upon full-time courses, who, through no fault of their own, suddenly find themselves unable to pay their fees and support themselves. That situation has been greatly exacerbated following the Government's decision three years ago to introduce a scheme which has now become known as the "switch to fees" policy. This policy aimed to reduce the degree of centralised funding for public sector higher education institutions while increasing the level of grant for individual students. Thus it was hoped to reward those institutions which could attract higher numbers of students.

However, in practice the policy penalises severely those students who attend full-time degree courses in osteopathy at the major private teaching institutions. Students at these schools receive only a fraction of the grant awarded to students attending public sector institutions. For example, students embarking upon a four-year full-time degree course in osteopathy receive only £695 towards fees which are currently in the region of £5,000 a year. It is worth noting that students who undertake a clinical course at a public sector institution receive grants well in excess of £4,000. I should add that the costs of training and the level of fees charged by private institutions compare very favourably with the cost of training comparable health care professionals in the public sector.

The other side of this coin is the difficulty that private osteopathic schools face in attracting a steady flow of students who have not only the necessary qualifications but also the financial resources that are required. It seems to me inconsistent for the Government on the one hand to support the establishment of osteopathy as a recognised profession regulated by statute and, on the other hand, to deny an appropriate level of student funding to allow young men and women to train for this most worthwhile profession.

I therefore ask my noble friend whether she would take up this important matter with her colleagues in the Department for Education. I sincerely hope that after enactment of the Bill, students wishing to study for a career in osteopathy will be eligible for the same amount of grant funding as clinical students attending public sector institutions. I am sure that your Lordships will agree that it would be a tragedy if, at the moment of its coming of age, osteopathy were to be starved of new graduates, who are the very life-blood of any profession.

6.25 p.m.

The Earl of Clanwilliam

My Lords, I hope that your Lordships will allow a second intervention. I congratulate the noble Lord, Lord Walton of Detchant, on the skilful preparation of this Bill and the simple way in which a complex problem has been resolved. I was particularly gratified to hear the noble Lord confess the gradual conversion of the medical profession to some of the complementary systems. Long may it continue.

There are many other disciplines of complementary medicine which have formal training, general councils, rules of conduct and professional qualifications of university standard. I look forward to the day when they, too, are all brought forward to professional status and recognition by the BMA.

The many users of complementary medicine are already converted but I fear that the BMA still has a few miles to go along that particular damascene road. The noble Lord is assured of my greatest support in helping it along that road. I wish the Bill well.

6.26 p.m.

Lord Williams of Mostyn

My Lords, we support this measure without reservation. I ought to say how grateful we are to the noble Lord, Lord Walton of Detchant, for his masterly exposition, which was clear, precise and short—which is not always our experience. Apart from that, he has laboured mightily and long in this particular vineyard and I hope that he now sees the fruits within his grasp. In particular we ought to recognise the contribution of Sir Thomas Bingham, who is now Master of the Rolls. He offers another example of the enormous service that the senior judiciary give to the public in this country quite apart from their judicial duties. He is only the last of a series which includes the noble and learned Lord, Lord Taylor, on Hillsborough; Lord Justice Butler-Sloss on Cleveland; and Mr. Justice Popplewell on Bradford, to pick just a few examples at random.

This is legislation which follows the earlier models in respect of doctors, pharmacists and veterinary surgeons, among others. It seems to us that the principle which underlies it and which we support is that there cannot be an unrestricted free market in the provision of services without regulation in the field of health care and medicine. It is very good for us therefore, after this long day that we have shared together, to see that all sides of your Lordships' House recognise and endorse that fundamental socialist principle. It is a comfort at this time of the evening.

There is only one question. It will not be the subject of amendment for the reasons indicated by the noble Lord, Lord Walton of Detchant. There is a possible source of injustice. In Clause 30(14) there is a specific power for an appeal tribunal to award costs; that is, for or against the appellant. There is no such specific provision earlier. It is capable of bringing about injustice. On occasions I have professionally represented veterinary surgeons, doctors and pharmacists in front of the equivalents of the professional conduct committees. Needless to say those people were all acquitted. But on their acquittal there was a gap which did not allow them to recover their costs at that stage before going to the appeal tribunal.

By way of seeking to be helpful, I respectfully suggest that in the rule giving opportunities and powers in Clause 26, some thought should be given to the provision of a power either from the health committee or the professional conduct committee—it should be both—to award costs in circumstances where the charges are dismissed. Other than that, we hope that the Bill will have a safe passage and we repeat our gratitude to the noble Lord, Lord Walton of Detchant, and his colleagues on the working party.

6.30 p.m.

Baroness Cumberlege

My Lords, I should like to begin my remarks by echoing the words of congratulation and support to the noble Lord, Lord Walton of Detchant, on bringing this excellent Bill to your Lordships' House. His tenacity and determination are to be admired. He has lived by the adage of, "If at first you don't succeed, try, try and try again". I share the view of the noble Lord, Lord Ennals, that it is most fitting that a physician of the distinction and eminence of the noble Lord, Lord Walton, should be guiding this specific Bill through your Lordships' House.

The Osteopaths Bill is a first-class piece of legislation which the Government not only wholly support, but are keen to see take its place on the statute book. The current Bill builds on the solid foundations laid by the Kings Fund Working Party on Osteopathy—of which the noble Lord, Lord Walton, was a member—to become the most modern Bill of its kind, and possibly, too, the envy of other professional groups.

The noble Lord, Lord Walton, has already described how osteopathy is a system of diagnosis and treatment which lays its main emphasis on the structural and mechanical problems of the body. Given that anthropologists believe the human frame has still not adapted to the upright position, despite nearly a million years of practice, it is surprising to learn that osteopathy was developed only a century or so ago in the United States of America. As a word of encouragement to the osteopathic profession, I understand that the same anthropologists believe that it will take a further million years before we finally master the art of standing properly: we shall therefore be calling on the services of osteopaths for a good many years to come.

I listened with interest to noble Lords who have benefited from osteopathic treatment, including the noble Earl, Lord Kintore. The need for such treatment is perhaps not altogether surprising given the "semi-recumbent posture" many of us are forced to adopt in a vain effort to get comfortable on seats described by one osteopath as "an ergonomist's nightmare". Since the earliest days of its development, osteopathic treatment has been popular with the public. As the noble Lord, Lord Walton, said, it is the most widely used of the treatments many refer to as "complementary therapies".

The Bill is designed not only to protect the public, but to encourage the General Osteopathic Council to develop and promote the profession still further. That is a much broader remit than the statutory bodies of other comparable schemes and signals a new and exciting model for self-regulation for the future. The General Osteopathic Council would, if the Bill were enacted, be the flag-ship of the profession. Unlike, say, doctors, who have the General Medical Council and the British Medical Association, registered osteopaths cannot hope or be expected to support a large professional infrastructure. The profession's limited resources will therefore need to be concentrated within the General Osteopathic Council to ensure that the new and innovative statutory scheme starts life on a firm footing.

All that points to the prospect of great change for the profession. However, I should like to urge the profession not to jeopardise its current stability through premature action. The existing registering and professional bodies need to retain their current standards and identity, and individual practitioners to continue to support their current registering bodies. Not to do so could undermine all that has been achieved so far. It could also call into question the professional integrity and character of those who abandon their voluntary schemes.

I should also like to encourage the profession to exercise patience. If the Bill is successful, it could be well into 1994 before the General Osteopathic Council meets for the first time, and possibly two years or more before the statutory register opens.

Statutory regulation will also bring a set of new and quite different challenges. A brand new council will replace the current systems of voluntary registration. As the transition takes place, the council will be in need of encouragement and support, both practical and moral. Such support would not only need to come from individual members of the profession but also from the existing registering bodies. It might also need to be of a sacrificial nature to ensure that the statutory scheme gets off to a sound start. This might mean, for example, sharing manpower resources and expertise with the General Osteopathic Council until it finds a permanent home and its own staff. Those appointed to serve on the new council, and especially the osteopathic members, will need to be prepared to dedicate a considerable amount of time to their council duties. In the early stages of the scheme, some may have the additional burden of continuing to serve on one of the voluntary registration bodies.

Financial challenges would also need to be met, such as the initial setting up and running costs and any research and educational initiatives. Osteopathy is an energetic and fast developing profession. I am sure that many members of the public as well as commerce and industry would wish to be associated with, and help to support financially, the establishment of the new General Osteopathic Council.

I should perhaps mention that the passage of the Bill is not in any way related to the availability or otherwise of osteopathy in the NHS. But to put the mind of the noble Lord, Lord Ennals, at rest I endorse the views contained in the letter of my ministerial colleague and would also add that we are aware that a growing number of general practitioners who are fund holders are employing the services of osteopaths. But as with all other services, the purchase of osteopathy is a matter for local 'decision based on the assessed health needs of the local population, competing priorities and available resources.

I have mentioned already that osteopathy is still a relatively young profession. In the United Kingdom, over half the profession has been qualified for less than 10 years. There is, therefore, much to be said for encouraging the development of group osteopathic practices which combine a spread of experience and expertise. This would provide younger members of the profession with contact with peers and senior colleagues and give them the opportunity to enhance their professional development. Such local practices could also provide a single central resource both for the public and local GPs.

It is hoped that statutory regulation will stimulate the continued growth of the profession and encourage more people to consider osteopathy as a career. We also anticipate that statutory regulation will help to foster closer working relationships between doctors and the osteopathic profession.

I know that the passage of the Bill has sparked off discussions on the wider subject of alternative and complementary therapies which have been mentioned in the debates. Your Lordships are no doubt aware of the recent report Complementary Therapies in the NHS published by the National Association of Health Authorities and Trusts. This shows that the NHS is prepared to purchase more complementary therapies but also reveals that NHS authorities want a more thorough review of all the available evidence to assess the effectiveness of those treatments.

I am pleased to announce today that the department is planning to fund a research project that will look at the impact complementary therapists—such as osteopaths, chiropractors, acupuncturists and homoeopathy—have on prescribing patterns, cost of drugs, hospital referral practices, patient satisfaction and repeat attendances, by surveying a representative sample of GP practices. The study will be carried out by the Medical Care Research Unit in Sheffield. It will cost £80,000 and take two years to complete.

Lord Ennals

My Lords, I congratulate the noble Baroness on the announcement that she has just made. It is very good news indeed.

Baroness Cumberlege

My Lords, I am grateful to the noble Lord. My noble friend Lord Cullen of Ashbourne, who has worked so tirelessly for the osteopathic profession for nearly a quarter of a century, raised the question of the switch of fees and the policy that was introduced by the Department of Education in 1990–91. The purpose of the switch was to promote effectiveness of institutions of higher education and to encourage them to exploit spare capacity. In principle the policy is neutral in financial terms although I sympathise with the situation of the students affected, as mentioned by my noble friend, since this mechanism cannot be applied to private colleges as the colleges do not receive any direct government funding. But I am prepared to accede to the request made by my noble friend and to take it up with my noble friend the Minister for Education.

The noble Lord, Lord Williams of Mostyn, mentioned the right of appeal and attendant costs. Although I can appreciate that there is an issue here, I am very pleased that he has given us an assurance that he will not press it because, as is very apparent this afternoon in your Lordships' House, we are all very anxious that this Bill should be passed and enacted.

Finally, I should like to underscore what the noble Lord, Lord Walton of Detchant, said about your Lordships' consideration of this Bill. The Bill has been exhaustively considered during its passage in another place. It is based on the same principles as the noble Lord's Bill in the last Session to which your Lordships gave considerable encouragement and support. On behalf of the Government, and in the knowledge that the Bill has all-party support, I commend it to the House as a finished product.

Perhaps I may just add that many of your Lordships—it was also mentioned this evening—will be aware of the personal commitment Simon Fielding has put into securing statutory regulation for the osteopathic profession. Last Christmas he sent me a Christmas card. On it was depicted a cartoon drawing of the Palace of Westminster in silhouette, with two voices coming from the inside. The first said "What about the Osteopaths Bill?" to which the second replied, "Pay it! Pay it!" In asking the same question, "What about the Osteopaths Bill?" to your Lordships this evening, I would urge the reply to be "Pass it! Pass it!".

6.41 p.m.

Lord Walton of Detchant

My Lords, I do not propose to detain your Lordships for very much longer. I simply thank those of your Lordships who felt able to support this Bill in tonight's debate. I wish also to reiterate the thanks and the gratitude which I feel not only to Simon Fielding, Robert Maxwell of the King's Fund and Sir Thomas Bingham for initiating the process which has finally led to this piece of legislation getting this far. I shall also be grateful if the Minister will convey my personal thanks to the staff of her department who have worked so hard on this Bill in preparing it and in seeing that it was acceptable to so many government departments.

I want only to respond to the points made by the noble Earl, Lord Baldwin, by saying that I personally hope, as a member of the medical profession, to do what I can to collaborate with, and to see the furtherance of the ambitions of, the complementary therapists to whose work he has referred. This is subject only to our being satisfied, as we are now with the osteopaths and the chiropractors, that these therapies are of demonstrable effectiveness and that they will contribute, as we all wish to see, to the future improvement of human health. I am sure that that is something which I would wish to promote to the best of my ability.

I also say to the noble Lord, Lord Williams, that I appreciate the point he has made about the potential injustice which might arise. My belief is that that issue is one which, if it were passed on to the osteopathic council, when established, could be met by a modification in the rules that the council may make. I do not believe that it would require any amendment on the face of the Bill.

I again thank all noble Lords for the work which has gone into this Bill. I very much hope that your Lordships will agree that the Bill should now be read a second time.

On Question, Bill read a second time, and committed to a Committee of the Whole House.