§ 1.47 p.m.
§ Lord Walton of Detchant
My Lords, I beg to move that this Bill be now read a second time.
Exactly a year ago I had the privilege of standing before your Lordships' House to open the Second Reading debate on the Osteopaths Bill. I little thought then that I should be performing a similar role so soon on behalf of the chiropractic profession. I am however delighted to be opening this debate on the Chiropractors Bill. My sense of pleasure is enhanced because, as many noble Lords will know, I had the honour to serve on the two working parties set up by the King's Fund to look into the question of statutory regulation for the osteopathic and the chiropractic professions. Both working parties were chaired by the right honourable Sir Thomas Bingham, now Master of the Rolls. I would like 893 to record, on behalf of both the professions and myself, our appreciation of his sterling work. I think it is fair to say that had the King's Fund not taken the initiative and set: up the working parties, neither profession would be where it is today.
Before I move on to the Bill itself, may I remark how swiftly things have changed in the field of complemen-tary medicine. Thirty years ago, American chiropractors in some states of the USA were convicted of practising medicine without a licence. A little under 10 years ago the then mainstream attitude among my colleagues in the medical profession gave no indication of the great developments that were in store. Today, by contrast, the Osteopaths Act is already on the statute book and the chiropractors stand poised to become, should this Bill be successful, the second profession from the complementary medicine field to achieve statutory regulation.
Complementary medicine does, of course, cover a very wide range of approaches and professional activities. In many ways the only thing which all practitioners of complementary medicine have in common is that they do not form part of orthodox medical treatment as it is practised in most European, and indeed most Western, countries.
Chiropractic itself is a bio-mechanical therapy based on the premise that the spine carries and protects a large part of the body's central nervous system, a matter with which as a neurologist I am much concerned. Therefore it has a key role in maintaining the body's effective functioning. When the mobility of the spine is affected either by becoming inflexible and stiff or even by becoming too mobile, the nervous system may also be affected in turn. In many cases severe pain can result, but it is often experienced not only in the back but also in the limbs or indeed in other parts of the body. Chiropractic treatment provides a means of assessing the position of the spine to discover the presence of such a condition and then making an adjustment or manipulation to correct it.
That very brief explanation makes chiropractic sound very like osteopathy. It is true that the two professions share many similar concepts and procedures. While it is very difficult to define briefly what precisely distinguishes the two professions, it is fair to say that they have somewhat different philosophical and practical approaches to training and to the exact types of manipulative techniques that they use. Their own history, especially in their separate development as professions, means that the two professions will often approach the same problem from rather different angles.
I have come across a rather endearing story which is somewhat analogous to the situation and which, like all similar anecdotes, might upset the purists but should appeal to others as possibly coming close to the truth. It relates to a small railway station in the west of Ireland which had two station clocks showing different times. A traveller who was unfamiliar with the local ethos asked the station master why there were two clocks and why they each told a different time. "Well," said the station master, "if they both told the same time, we would only need one of them."
894 Returning to more serious issues, perhaps I may say first that having personally visited the Anglo-European College of Chiropractic in Bournemouth, I was much impressed by the quality of instruction and the rigorous application of scientific methods which I saw there. The King's Fund working party came to the conclusion that the differences between osteopathy and chiropractic, though relatively minor, fully justified independent regulatory machinery for each profession. Many noble Lords will be aware that a few years ago a Medical Research Council trial, which compared the manage-ment of low back pain by chiropractic, on the one hand, and by more traditional hospital-based techniques such as physiotherapy, on the other, demonstrated that chiropractic was significantly superior.
The Bill seeks to establish a statutory registration scheme for chiropractors which will regulate the profession and require all persons calling themselves chiropractors to be registered with a new statutory council. That new statutory body, the General Chiropractic Council, will have the duty to regulate, promote and develop the profession of chiropractic and lay down standards of professional conduct and education.
The Bill also provides for the establishment of four statutory committees to advise the general council on matters relating to chiropractic education and training and to ensure that any complaint or allegation made about a registered practitioner's fitness to practise chiropractic is properly investigated and effectively resolved. The general council itself is to consist of 10 chiropractors elected by the profession, six lay members representing the interests of patients and consumers and four members, one of whom will be appointed by the Secretary of State for Education, to advise on matters of chiropractic and professional education. The general council's statutory duties will include preparing and publishing a professional code of conduct and a standard of proficiency required for the safe and competent practice of chiropractic; appointing a registrar to establish and maintain a register of practitioners; and appointing members of the Education, Investigating, Professional Conduct and Health Committees.
Entitlement to registration is to be determined primarily on whether a person holds a "recognised" qualification. For example, the Anglo-European college in Bournemouth now offers a four-year honours degree course followed by one year of practice under supervision before full registration would become possible. The qualifications to be accepted under the terms of the Bill will be any qualification which the general council, on the advice of its education committee and with the approval of the Privy Council, "recognises" as equipping the practitioner with the education, training and skills necessary for the safe and competent practice of chiropractic.
The Bill also provides transitional arrangements to enable those practitioners who may not now hold a recognised qualification but who have been practising chiropractic lawfully, safely and competently over a period of years to be registered. The Bill further enables the general council to introduce, after consultation with 895 the profession, a system of provisional registration— normally a year—during which a practitioner will be entitled to practise only under the supervision of a fully registered chiropractor; and to make continued registration subject to the condition that the practitioner undergoes regular post-registration training.
The Education Committee is to be responsible for promoting and reviewing standards of education and training in chiropractic and for advising the general council on all matters relating to chiropractic education and training, in particular the qualifications entitling a practitioner to be registered. To assist it in fulfilling those duties, the education committee will be empowered to request, from training institutions offering or seeking to offer recognised qualifications or post-registration training et cetera, information on the courses and facilities that they provide and to appoint visitors to report on the standard of training given.
A key function of the committee will be to advise the general council on the recognition of qualifications offered by training establishments. It is to do that on the basis of whether the qualification provides evidence of having reached the standard of proficiency laid down by the general council for the safe and competent practice of chiropractic.
The investigating, professional conduct and health committees are to investigate and, if necessary, take action on allegations made against a registered chiropractor concerning his or her professional conduct, competence or fitness to practice. In carrying out investigations, the committees would have the power to order the immediate suspension of a chiropractor's registration where such action is considered necessary for the protection of members of the public. To protect the interests of the practitioner, the Bill provides a right to a hearing with legal representation if the practitioner so chooses and with full rights of appeal before such a suspension is imposed.
The Privy Council is to be given the responsibility of overseeing the work of the general council and its four committees. If the Privy Council believes that the general council is failing in its duties, it will have the power to direct the general council to perform any of its statutory functions. In the last resort the Privy Council would be able to take over entirely the functions of the general council and do anything that the general council is able to do. That supervisory role and the accompanying powers are similar to those exercised by the Privy Council under the regulatory schemes of other groups of health care professionals. However, I have to say that there is no known case of the Privy Council ever having to use its default powers in that way.
The reason that statutory regulation is being sought by the profession is quite simple. As the honourable Member for Aylesbury said when the Bill had its Second Reading in another place, there is at present nothing to stop anyone fixing a brass plate to his gatepost and immediately setting himself up in practice as a chiropractor. That poses a real risk to anyone unlucky enough to find himself in the hands of such a person. The manipulation of necks, backs or even limbs by the hands of an untrained person could have very 896 serious consequences. In addition, a considerable part of chiropractic training is devoted to the recognition of those conditions which chiropractic cannot treat, and especially those where immediate referral to a medical practitioner is warranted. The potential risk to a patient of a serious condition remaining undetected by an untrained manipulator is obvious. While the profession remains small, it would have been more difficult to practise, but with the recent expansion of the profession, the possibilities for bogus or cowboy chiropractors, if I may use those terms, will increase.
There are now around 900 chiropractors currently working in the UK, about twice the number there were only a few years ago. If we add in the number of students currently on chiropractic training courses, the profession may well be set to double in size again before the end of the century. The achievement of statutory regulation would, furthermore, enable chiropractors to take their proper place alongside those in other long-established caring vocations. They would be recognised as a mature and responsible profession, capable of being entrusted with the regulation of their own affairs within the framework provided by the Bill. Statutory regulation would also provide patients with the necessary assurance that their treatment was skilled, competent and appropriate, and may well encourage more people to take up chiropractic as a career.
By far the majority of, if not all, practising chiropractors in the UK are at present members of a voluntary registration scheme. The profession recog-nises, however, that a voluntary system of control is inadequate in that it cannot provide members of the public with the level of assurance many would wish to have about their personal practitioner. For example, if an incompetent practitioner were to be struck off a voluntary register, he or she would remain free to continue in practice and to continue describing himself or herself, perfectly legally, as a chiropractor. A patient injured in those circumstances by an incompetent practitioner has no opportunity for redress outside the civil law. As around 75,000 patients consult chiropractors each week, I am sure noble Lords will agree that the profession's pursuit of statutory regulation is entirely appropriate.
As I mentioned earlier, the Bill follows closely the precepts of the Osteopaths Act and indeed, like the latter Act, is broadly modelled upon the medical Acts which regulate the function of the General Medical Council, of which I had the honour to be president from 1982 to 1989. The system of regulation which it contains may serve in future as a model which other professions may choose to adopt should they in the future seek to follow the lead of the osteopaths and chiropractors. It would therefore, I believe, be wise to take advantage of the unique opportunity presented by the Chiropractors Bill to make a small number of what have been described as fine-tuning amendments to the Osteopaths Act. Those have also been incorporated in the Bill which is before your Lordships today.
The Bill received detailed examination as it passed through its stages in another place. It is a striking and substantial example of current thinking on the question of professional self-regulation. It is a Bill in which the 897 profession and all who contributed to it can be confident and by which they may feel duly rewarded for all their efforts. It would be appropriate for me to mention in particular at this point the quite remarkable and dedicated work done by members of the Chiropractic Registration Steering Group, some of whom were also members of the King's Fund Working Party. The profession and all patients of chiropractors owe them, and notably the assiduous Ian Hutchinson, a sincere debt of gratitude for all their hard work.
Should the Bill succeed, as I fervently hope it will —Private Members' Bills are delicate objects at the best of times—it will, in addition to achieving the result for which the profession has worked tirelessly, mark and recognise that this model of regulation, already enshrined in the Osteopaths Act, is both workable and sound. I commend the Bill to your Lordships' House.
Moved, That the Bill be now read a second time. —(Lord Walton of Detchant.)
§ 2.4 p.m.
The Earl of Clanwilliam
My Lords, it is my privilege to be the first to follow the noble Lord, Lord Walton of Detchant, and to thank him and congratulate him on the preparation and content of the Bill. I am sure your Lordships will agree that he does himself little justice in praising so many other people. We all know that it was his driving force that brought forward both the Osteopaths and Chiropractors Bills and we thank him for doing so.
On a personal note, I should perhaps thank the noble Lord for coming to the Chamber at all today. I understand that Lady Walton is not well and it must be an extremely difficult time for him. I was told that Her Ladyship was a little better today and I am sure that the whole House joins me in wishing her well.
I speak not as a practitioner of this activity, but as a lay promoter of alternative medicine. The noble Lord gave a comprehensive review and referred to the similarity of this Bill with that of the Osteopaths Act. It is good news that both services will now be available both to NHS hospitals and fundholders alike. I am sure that there will be great relief in the minds of all existing practitioners that they will not have to go back to school for another four years.
The conditional registration arrangements are also generous and encouraging to younger and less experienced practitioners. The new register will have important provisions to declare full details of practitioners' qualifications which will be available to the public in order to provide complete transparency. Chiropractors have an existing, well established and excellent school at Bournemouth. The noble Lord complimented them upon the school and it is right that he should do so. They have made great efforts to promote the school and have prepared a system of registration and preparation for all chiropractors of which we, as a nation, can be proud.
The professional conduct and health committees' powers to regulate members is a reflection of the increasingly important need to protect the public. In many ways I am against the promotion of the nanny state which attempts to remove all responsibility from 898 the individual. But reluctantly I must say that in this instance it is not only good and laudable, but vital. The problem of perceived success or failure in any medical treatment is often extremely subjective, especially where the patient believes that he or she is the victim. In that situation there must be clear evidence of the treatment given and the case history for judgment by the committees to maintain public confidence in the practice of chiropractic whose long history and record of success is now being recognised.
We should have short speeches—I am sure that the noble Lord is anxious to get home to the bedside of his wife—but I would say that there are other therapies, particularly in the alternative medicine field, which I should like to bring to the attention of my noble friend the Minister, especially the Chinese system where a combination of modern medicine, herbal medicine and acupuncture provide a remarkable source of successful medical practice which is already in use in some parts of the country. I would hope that that might soon also be recognised by the medical profession.
§ 2.8 p.m.
§ Lord Ennals
My Lords, it is also my pleasure to congratulate the noble Lord, Lord Walton, on introducing this Bill with a very lucid explanation—no less so than when, as he said, a year ago he put before your Lordships' House the Osteopaths Bill. It is a very happy occasion that with only a year in between we are seeking to put on the statute book a system for the control and training of chiropractics as already exists for osteopaths. I should like to add my thanks to the King's Fund, which by its studies has initiated both these Bills, and to Sir Thomas Bingham as chairman of the working party. I do not think we should allow the occasion to pass without congratulating David Lidington, a Member of Parliament in another place, who piloted the Bill through another place with considerable success.
I very much agree with the noble Earl, Lord Clanwilliam, in that many of us hope that we have notched up two on the ladder and that the ladder will go higher. He is right in saying that we should be looking at acupuncture as the second choice. I am glad that the noble Earl, Lord Baldwin of Bewdley, is here to speak in view of his excellent work in terms of registration of those who are practitioners of acupuncture.
The proposed legislation has received widespread support from other health service professions. I was particularly glad to see the comments of the physiotherapists, who in a sense would like to have had a Bill for themselves. They would like to see regulation because they have no control over the many people who claim to be physiotherapists but have not necessarily undertaken the training. To that extent chiropractics will be at an advantage as a profession. It is good for the professions that they should have rules and regulations to provide for the confidence of the public.
There is no doubt that there is a need for the profession of chiropractic. I was looking at some facts which show that 310,000 people in the United Kingdom are off work each day with back pain. Not necessarily all but most of those cases could be treated by chiropractic. Back pain costs the country more than £3 million in lost 899 production every year. Disability from low back pain is increasing faster than any other form of disability. In fact, the incidence has doubled in the past 10 years. It would be interesting if the Minister could give some explanation for that remarkable and disturbing increase.
There has been great progress by the profession. There are now about 900 chiropractors working in Britain. About 75,000 patients consult a chiropractor each week. We can see, therefore, that the numbers dependent on this form of manipulative treatment are very large. A recent study by Which? in November 1992 showed that chiropractic was the second most frequently used complementary therapy. The Medical Research Council's clinical trial, reported in the British Medical Journal on 2nd June 1990, found chiropractic to be considerably more effective than hospital outpatient treatment for low back pain, particularly for those with chronic or severe pain. That was the first large-scale trial to compare a complementary method with orthodox medical treatment. It came out with flying colours. I very much agree with the noble Lord, Lord Walton, that it is encouraging that public attitudes, and particularly the attitudes of the medical profession, towards complementary therapies have gone through tremendous change. That is enormously encouraging. Were that not the case we would not have this Bill before us today. The very fact that it is the noble Lord, Lord Walton—a former president of the British Medical Association—who has piloted both Bills through the House means that he more than anyone else has led to this great improvement in relationships and understanding.
A report on back pain which was published in August 1993, commissioned by the Canadian Government, stated that,the safety of chiropractic care and higher satisfaction levels expressed by patients offer an overwhelming case in favour of much greater use of chiropractic".It is a very happy occurrence that this Bill is introduced now because chiropractic celebrates its centenary in 1995. It will be very nice if it is able to implement the Act, as it then will be, in the year in which it celebrates its centenary. I am certain that the House, with the extraordinary generosity which it always shows, would want to say to the profession, "A happy 100th birthday".
I end by quoting three short paragraphs from Sir Thomas Bingham's report. They are paragraphs 17, 18 and 19. Paragraph 17 says:We are of opinion that legislation to regulate the practice of a profession such as chiropractic which offers manipulative techniques which, if wrongly applied, could be harmful is necessary for the protection of patients. Although the profession is small in number, demand for chiropractic treatment is growing and the number of students in training increasing at such a rate that the profession is likely to double in size in the next five years".Paragraph 18 states:Chiropractic is statutorily regulated in most countries where it is practised. Alone among English speaking nations, Great Britain and Northern Ireland are content to rely on voluntary arrangements".We are not content to rely on voluntary arrangements which is why we hope that the Bill will go on to the statute book. Paragraph 19 also states: 900Voluntary arrangements of this kind do not work in practice. Voluntary registering bodies have no effective sanctions against unlicensed, untrained or professionally negligent practitioners. They cannot prevent such practitioners from continuing to practice even though it is against the interests of patients for them to do so".I believe that these are most powerful arguments for a statutory regulation system. The profession itself wants to see the change as did the osteopaths.
As I say, I hope that we shall now have on the statute book the second of what I hope will be a series of measures. It is right to take them one by one although I must add, as I did in the debate about a year ago, that I do not believe that it should be dependent on the vagaries of the system of Private Members' Bills. In the past two or three weeks we have been very tragically reminded how a good Bill can be lost in the processes of another place. Thank Heavens your Lordships do not treat Bills in that sort of derisory way. I wish this could have been a Government Bill. It is really the luck of the draw if one can persuade a Member of another place to take up this particular cause out of the 13 Bills which are likely to succeed. We were fortunate that it happened. I hope that the noble Lord, Lord Walton, is right in thinking and hoping that this measure will reach the statute book. If it is, it owes very much to his work and commitment.
§ 2.17 p.m.
Earl Baldwin of Bewdley
My Lords, I welcome this Bill and congratulate all those whose hard work has made it possible. With the Osteopaths Act of last year to light the way we are now within reach of seeing both sets of manipulators—I say that in the best sense of the term—safely on to the statute book. This is surely the right road to take. The more that standards are established for all to see, the greater the protection for everyone concerned and the less the need to go down the route of banning therapies with all the restrictions on innovation and freedom that that entails.
It is an admirable Bill, as was the Osteopaths Bill. It will not come cheap for the profession, but that is the sort of price that complementary therapists will expect to have to pay for any worthwhile self-regulation. There are no short cuts.
Although I wear the hats of Joint Chairman of the Parliamentary Group for Alternative and Complementary Medicine and Chairman of the British Acupuncture Accreditation Board, I see these things mainly through the eyes of a patient. I have two concerns here, one of which I voiced at the time of the Osteopaths Act. In gaining your place in the sun it is easy to lose your soul. Something of the kind has happened in the USA. If I go to a chiropractor, I do not want to find a watered down medical practitioner by another name. There are skills and attitudes to chiropractic which are worth preserving, and I hope they will be preserved.
In the case of chiropractic, there are three schools with different approaches. The King's Fund Report commented rightly that there was no intention, in levelling standards, to do away with diversity. It even suggested that the professional register should show what school a practitioner came from, but I do not see 901 this carried forward into the Bill. I do hope that individualities will not be lost among the unequal size of the three schools. I believe that the public are more concerned and discriminating here than one might actually expect.
It is nearly a hundred years since the birth of chiropractic, and it is worth commenting again that this is an extremely long time to have to wait for acceptance from an orthodoxy which for most of that time regarded it as dangerous quackery. My noble friend Lord Walton alluded to that in passing but without drawing any particular conclusion from it. If we have patients' interests at heart we may have to look hard and long at the attitudes and methods of assessment which produce this kind of situation.
I say this, my Lords, because it has lessons for the future. As the noble Earl, Lord Clanwilliam, and the noble Lord, Lord Ennals, have already mentioned, other professions are already on the road, notably the accupuncturists, the herbalists and the homeopaths. Various authorities have been staking out the conditions which they believe must be fulfilled before a profession can be regulated. I think we must look at these critically, always with the patients' interest at the front of our minds. The Secretary to the King's Fund, in his foreword to the chiropractic report, insists on solid foundations in science. In one sense, of course, this is unobjectionable. But the trouble is that it is too often interpreted to mean the-body-of-knowledge-as-it-is-currently-understood-in-the-Western-world, which is not quite the same thing though it may be convenient for the medical scientists of 1994. All too often the question How does it work? is put before Does it work? It is the latter that is important, and that brings patients to chiropractic, acupuncture, healing and the rest.
Another condition comes from government, and was restated by the Minister, Mr. Tom Sackville, at Second Reading in another place. It is that the profession concerned should secure the support and acceptance of the medical profession. My Lords, this is highly desirable, and there could be real difficulties if it were not done. But in view of the past track record which I have alluded to, I just wonder whether the Government are wise to elevate this to the status of a firm principle. I would like to hear a bit more argument about this some time.
This brings me to a final plea, which I have made before. The Government have stated in the past that they are "benignly neutral" towards complementary medi-cine. Since the health of the nation is involved, could they not be a little more benign and a little less neutral? We all now accept that chiropractic is a "Good Thing". Should not this have been a Government Bill, as the noble Lord, Lord Ennals, asked? In view of the large and growing public use of complementary therapies, which has national policy implications and will not go away, I feel sure it would be in the general interest if government made it easier for the up-and-coming professions which have always lacked money and research expertise to establish just what they can and cannot do. Good health is too important to leave solely to the market place.
902 Meanwhile, my Lords, we have an excellent measure before us, most clearly and ably introduced by my noble friend Lord Walton of Detchant under severe personal difficulties with which we greatly sympathise, and I am sure we will all wish the Bill a speedy passage.
§ 2.23 p.m.
§ Lord Harmsworth
My Lords, I speak not as any kind of expert, but as a very satisfied patient of the British School of Osteopathy, a profession which has already jumped the various and well thought-out hurdles which ended in the 1993 Osteopaths Act.
In a previous incarnation at the then Department of Health and Social Security, I was for a time the source of some merriment owing to my habit of lying on my back in my office, papers aloft, as I suffered what was to become excruciating back pain. It is no small tribute to the department that, while I was there, I was never able to detect any prejudice against what is known as "complementary medicine": uncompromising scrutiny of efficacy, perhaps, but not the kind of attitude that might close the mind to initially doubtful-seeming approaches to therapy, some of which have achieved respectability with time.
I suspect that your Lordships' House is no place in which to make remarks off the record, but if I may lower my voice slightly, it was on the unofficial advice (many moons ago and well before the Osteopaths Act) of a very good friend and colleague of mine—I hasten to state that it was a colleague on the administrative, not medical, side of the department—that I hurried off to obtain the treatment for which I shall for ever be grateful.
For my part, the Bill's promoters are, as it were, preaching to the converted. I have no direct experience of chiropractic as differentiated from osteopathy, and I thank the noble Lord, Lord Walton, for his valiant attempt to put us all right on that score. To my untutored eye, the two activities seem sufficiently similar, and their supporters adequately and equally enthusiastic. I hope that your Lordships will forgive me if, for the purposes of the Bill, I take for granted the bona fides of the practitioners of chiropractic. In 1990 the Medical Research Council largely endorsed what many individual patients have experienced in practice. I am in good company.
There are areas upon which I should like to hear from my noble friend the Minister. I am in no doubt that joint adjusting procedures, manipulation, massage and other techniques to treat muscular/skeletal complaints are cost-effective for the nation. Treatment is already available under the NHS through fundholding GPs and non-fundholding GPs if, in most cases, FHSAs can be persuaded to reimburse the cost from cash-limited funds for GP staff and premises, and DHAs. There is a shortage of practitioners in the specialty. What measures and encouragement are in place for a better supply of the service?
Secondly, will my noble friend assure the House that adequate safeguards are in place to protect not just the public from malpractice—I am content on that score —but the practitioner from vexatious accusations on grounds that would be the concern of the professional 903 conduct committee. There is much at stake for the practitioner and much scope for misplaced troublemak-ing in such a "hands-on" activity.
Thirdly, I am in some confusion over the evidently subtle distinction between, first, osteopaths and chiropractors, and, secondly, the several schools of chiropractic. Now is not the time or place to explore the merits of the two practices amalgamating both legislatively and administratively, but might there be some benefit to the patient if they did so eventually?
This is a worthwhile Bill. I congratulate its promoter in another place, my honourable friend David Lidington; and the noble Lord, Lord Walton, on steering it through your Lordships' House. I am sure that he will do so as deftly as he did the Osteopaths Bill. I wish him and the Bill well.
§ 2.28 p.m.
§ The Earl of Kintore
My Lords, I welcome the Bill. I use a chiropractor in Scotland. Although I enjoy excellent general health, following some overweight parachuting, compounded by falling off an army horse on my 23rd birthday, my spine is weak in places. A review of my X-rays usually results in a certain amount of tongue clicking. Some years ago there was always a petition to sign at the chiropractic clinic to get recognition for the profession as an acceptable alternative therapy. I hope that the Bill gives the chiropractic profession the recognition that it desires and deserves. I congratulate my noble friend Lord Walton of Detchant and everyone else involved on getting the Bill this far.
All the chiropractors whom I know will have no trouble in complying with their new responsibilities under the Bill, and, once passed, chiropractic skills will be recognised as an acceptable form of alternative medicine which will be available to many more patients if they are referred by their GPs. Horses also benefit from chiropractic skills. Presumably horses must be referred by their veterinary surgeons.
§ 2.30 p.m.
§ Lord Colwyn
My Lords, once again I too am delighted to be able to make a contribution to the process which will establish statutory registration for chiropractors. I say "once again" as I have supported the case for the statutory regulation of osteopaths and chiropractors on several occasions since taking my place in your Lordships' House in the mid-1960s. I must congratulate the noble Lord, Lord Walton, on the way in which he introduced the Bill and say how much I admire the way in which he has taken up the cause for the chiropractors in the same way as he did for the osteopaths. His explanation was clear, erudite and concise and left little extra to be said.
As joint president of the all-party parliamentary group for alternative and complementary medicine, I wish to associate myself with the remarks of the noble Lord, Lord Ennals, and the noble Earl, Lord Baldwin. This Bill has all-party support and I am glad to hear that 904 much of the work has been covered with the osteopaths and that there are very few differences between that Act and the Bill before us today.
I know that my noble friend Lady Hooper is sorry not to be here—she has a previous appointment. She would join me in saying how much I regret that my friend Lord Ferrier did not live long enough to be able to take part in our debate today. He was a tireless supporter of chiropractic. He regularly initiated debates and asked Questions to successive Ministers in successive governments about the availability of chiropractic and its integration into the NHS. The Library has kindly supplied me with copies of two debates which he initiated; one in May 1976 and one in November 1979, to which I was privileged to be able to make a contribution. I hope that noble Lords will forgive me if I mention two occasions on which Lord Ferrier debated chiropractic. I know that he would have seen today and the passage of this Bill as a culmination of his great support of the profession.
In May 1976 Lord Ferrier asked Her Majesty's Government whether they would be prepared to contemplate any amendment to the Professions Supplementary to Medicine Act 1960 to encourage osteopaths and chiropractors to qualify for registration. The noble Lord, Lord Wells-Pestell, replied on behalf of the Government. He stated:There is nothing to prevent any group from beginning themselves the process of self-regulation; indeed, this is commonly the way in which professions set about establishing themselves".—[Official Report, 12/5/76; col. 1038.]He went on to say that the Government had approached the Medical Research Council with a view to having some planned research done and they expected much more research to take place on the matter.
In 1979 Lord Ferrier asked what plans the Government had to integrate chiropractic into the NHS. This time the noble Lord, Lord Wells-Pestell, was in opposition and was much more supportive. He quoted figures from the Cochrane Report which had been set up by the noble Lord, Lord Owen, who was Minister of Health in 1976. He urged the Government to implement the recommendations of the Cochrane Committee and stressed the importance of setting up without delay trials by the three non-medical organisations—the osteopaths, the chiropractors and the acupuncturists—with the co-operation of the General Medical Council.
In winding up the debate, my noble friend Lord Cullen of Ashbourne, stated:I am aware … that chiropractors have sought to secure state registration as members of a profession supplementary to medicine under the provisions of the Professions Supplementary to Medicine Act 1960. I am equally aware that, when the Council for Professions Supplementary to Medicine rejected their application, it declined, and could not be compelled by the Privy Council, to give its reasons for doing so, and that chiropractors and the Chiropractic Advancement Association are aggrieved. However, I believe that, if the chiropractors sought by their application to achieve a longer-term acceptance by the medical profession of what they have to offer and their own ultimate integration into the National Health Service, then their action in making the application was correct. My right honourable friend the Minister of Health has already commended to them that they should seriously consider making a further application".— [Official Report, 21/11/79; col. 270.]That was 15 years ago.
905 Several speakers suggested that moves to statutory regulation should be set up without delay and the Minister was very supportive. I suppose that 15 years in government timing is without delay. We have the osteopaths on the statute book and this Bill is for the chiropractors. I look forward to similar moves with regard to acupuncturists, homeopaths and herbalists in the near future.
In 1979 back pain cost Britain 18 million lost working days; £900 million in lost production; and £90 million in social security payments. Today, 310,000 working days per day are lost at a cost of £3 billion. I believe that the noble Lord, Lord Ennals, may have given the figure as £3 million but it is in fact £3 billion. Statutory recognition of osteopaths and chiropractors must go some way towards dealing with that problem.
It is a pleasure to see another complementary therapy about to achieve statutory recognition. Noble Lords must appreciate how much pleasure it gives those of us who have long supported natural medicine to see the way in which orthodox medicine is finally recognising and realising the potential of many of the complemen-tary therapies. I wish the Bill a speedy passage through this House.
§ 2.36 p.m.
§ Baroness Robson of Kiddington
My Lords, I join other noble Lords in thanking the noble Lord, Lord Walton of Detchant, for introducing the Bill and for explaining so clearly its aims and purposes. The make-up of the council, the rules of registration and the educational requirements are all in line with the Act governing the profession of osteopathy. I welcome also the amendments which have been made to the Osteopaths Act in the present Bill.
I hope that the House will forgive me if I refer to a profession which the noble Lord, Lord Ennals, mentioned; namely, that of chartered physiotherapists in this country. I must declare an interest because I am president of the Chartered Society of Physiotherapy.
That is one of the largest professions complementary to medicine. There are 25,500 chartered physiotherap-ists in Britain compared with what I am told is something like 700 chiropractors. Some 5,000 chartered physiotherapists are in private practice mainly dealing with bad backs, necks and other skeletal problems. While the NHS and independent hospitals insist that all physiotherapists employed by them are state registered —that is, properly qualified—there are no regulations governing the private practice of physiotherapists in this country. Anyone can call himself a physiotherapist and practise privately. There are probably over 1,000 such people who have either no qualification at all or who have been on a variety of short, unrecognised courses.
That situation does not apply to chiropractic or osteopathy because there is no evidence of any unqualified people according to David Lidington. They do not have that problem. The Chartered Society of Physiotherapy merely asks for the same protection for the patients of physiotherapists —and there are many times more people at risk—as exists in relation to osteopaths and chiropractors.
906 Chartered physiotherapists in private practice and those who are unregistered treat a wide range of conditions, including spinal and joint problems, shoulder and back pain and use a range of techniques including manipulation. It is obviously right that all professions complementary to medicine should be properly registered to protect the public and to guarantee that practitioners receive adequate training, both if they wish to work in the NHS or in private practice. I hope that the Minister will take that problem on board.
§ 2.40 p.m.
§ Lord Rea
My Lords, I am sure that the whole House —though I am afraid that much of it is not present today as it is the last day of term—and, even more so, the whole profession of chiropractors and their patients will be grateful to the noble Lord, Lord Walton, for the time that he has put in as regards the preparation of the Bill and its predecessor the Osteopaths Bill. I am sure that all of us are grateful to him for the very clear way that he presented the Bill. As other speakers have said, we are especially grateful to him for his presence here today because of the serious illness of his wife. I join other noble Lords in sending out strong messages of support to the noble Lord and to Lady Walton, together with hopes for the continued improvement which I am pleased to hear is occurring.
As a general practitioner with more than a third of a century's experience, I welcome on board any body of men and women who can help to calm the rough sea of symptoms which sometimes seem overwhelming to those of us who are on the beach facing the breakers of complaints coming at us from patients. There is no doubt that GPs and the National Health Service as a whole cannot, and probably never will, be able to relieve everyone's pain. That is partly because we do not have enough time with our patients, but also because we do not have the training—or sometimes the patience—to cope with many of the chronic symptoms, especially back pain, which patients continue to present even when serious or life-threatening disease has been excluded or treated.
Chiropractors are one of several bodies of practitioners of alternative—or, like other speakers, I prefer the term "complementary"—medicine who have disciplines and skills which can tackle some of those intractable problems which doctors seem unable to cope with, where often bodily symptoms and psychological stress merge and are difficult to separate. I am strongly of the opinion that depression and anxiety underlie and exacerbate much chronic physical pain. But many people do not wish to go down the psychotherapeutic road and strongly deny that there is anything wrong with their mental or emotional balance. I have to say here that perhaps many people protest too much, for which of us is not vulnerable at some level? However that may be, attention to physical symptoms is often of enormous help. If the practitioner has a healing disposition, the whole person is helped while the bodily pain is being attended to.
There is no doubt that many people have been greatly helped by chiropractors. The Medical Research Council trial which was mentioned by at least three noble Lords 907 demonstrates that fact. I have no doubt that similar studies could—and should—be mounted by the other strands of complementary medicine. Like the osteo-paths, chiropractors have got their house in order and have shown that they can conform to the quite exacting (but I think necessary) framework for registration and regulation which this Bill constitutes.
As well as the osteopaths, the psychotherapists and the psychoanalysts are also going down similar roads, so that there is now an increasing group of professions allied and complementary to medicine to which patients and their doctors can safely turn. I very much back the plea made by the noble Baroness, Lady Robson, for physiotherapists. I believe that that also applies to a number of other professions allied to medicine.
My only quibble with the Bill is that chiropractors have been allowed to get away with their misuse of the customary way that Greek is incorporated into the English language. Perhaps that is because chiropractic originated across the Atlantic in the United States. I am not a general practor, nor do I undertake general practic. Why can we not have chiropractitioners who undertake chiropractice?
The noble Earl, Lord Baldwin, said that he did not wish to see chiropractors behaving as watered down doctors, as they sometimes do in the United States. That is partly because in the United States there is not a good system of primary health care and the chiropractors have taken over that role. Is the word chiropractor not perhaps derived from doctor? Perhaps there is something in that because in the United States chiropractors sometimes take on a rather wider role than we would like to see them take on here.
Leaving that aside, we on these Benches are basically very happy with the Bill and wish chiropractors in this country well. Like the noble Lord, Lord Colwyn, I hope that further similar Bills will come before Parliament to allow statutory self-regulation for the other main branches of complementary medicine when they are ready. The Osteopaths Bill and this Bill should stimulate that process.
§ 2.45 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, perhaps I may begin by adding my congratula-tions to those which have already been expressed to the noble Lord, Lord Walton, on bringing this Bill before your Lordships' House. I am sure the noble Lord will play a fundamental role in the success of this Bill as he did for its forerunner, now the Osteopaths Act. He has been an outstanding member of both the working parties set up by the King's Fund to examine chiropractic and osteopathy. In addition I am aware, as many of your Lordships will be, that he has been an unfailing source of support and advice for both professions as they have moved towards their goal. The Government fully support this Bill and hope that it will speedily take its place alongside the Osteopaths Act on the statute book. As the noble Lord, Lord Ennals, said, this is indeed a 908 happy day. I share his aspiration that other professions should grow in stature and retain the confidence of the public.
Chiropractors have a very important role to play in helping people to remain mobile and free from discomfort and pain. However, I could not help but smile the other day when I saw a newspaper report on the Second Reading debate in the other place headlined:Welcome for Bill on Care of Feet".There are issues of semantics here but I shall not go into the same detail as the noble Lord, Lord Rea, did.
The noble Lord, Lord Walton, has already described in detail what the Bill would entail. He has also been careful to outline a description of chiropractic as a therapy. As the noble Lord, Lord Ennals, said, chiropractic is probably the second most widely used complementary therapy. When we are fit and well and free from pain we rarely stop to ask ourselves how or why that is, but an increasing number of people owe their continued good health to the skilled intervention of a chiropractor. It never fails to astonish me how many people, including some of your Lordships, have benefited from treatment by a chiropractor. My sympathy lies with my noble friend Lord Harmsworth and the noble Earl, Lord Kintore, whose experience brought into sharp and painful focus the need for promoting and regulating chiropractic.
I recently heard of two cases of members of Her Majesty's Armed Forces who are responding well to courses of chiropractic treatment. These servicemen are not people who spend all day lifting heavy objects. One is a naval helicopter pilot and the other an RAF electronics flight engineer. Both have cost the country millions of pounds to train, and yet both face the possibility of being discharged because of a bad back, exacerbated by the need to sit for hours in their aircraft. After chiropractic treatment one has already returned to full duties and, although it is still too early to be absolutely sure, there is every indication that the other will soon join him back at work. I am sure that your Lordships will know of other examples where chiropractic treatment has made a crucial difference to the quality of people's lives.
The noble Lord, Lord Ennals, raised the issue of the increasing incidence of back pain and asked whether we knew the reason. It is a difficult question since the increasing levels of disability due to back pain are the result of a complex mixture of physical, psychological and social factors. The problem has been recognised by the Clinical Standards Advisory Group, which is a statutory multi-professional group set up by the Chief Medical Officer and Chief Nursing Officer. A report from that group is currently being considered by the Secretary of State, so perhaps we shall be able to enlighten the noble Lord in due course.
As the noble Lord, Lord Walton, has said, medical opinion has undergone something of a sea-change in recent years. This has been strongly influenced by the growing experience which many doctors have of patients being successfully treated by chiropractors. Perhaps more importantly, there is now sound scientific evidence of the effectiveness of chiropractic. The most significant example is contained in the 1990 report of 909 the Medical Research Council's trial. This compared the recovery from low back pain using chiropractic techniques with traditional hospital outpatient treat-ment. The report concluded that for those with low back pain chiropractic "almost certainly" conferred worth-while, long-term benefit, especially for those experiencing chronic or severe pain.
The report also stated that consideration should be given to introducing chiropractic into NHS practice. Last year the National Association of Health Authorities and Trusts published its report Complementary Therapies in the NHS. This showed that the NHS is prepared to purchase more complementary therapies. It also made the point that health authorities would welcome continuing thorough review of therapies in order to be able to assess their effectiveness. The Clinical Standards Advisory Group has recently submitted a report on the management of back pain to the Secretary of State. It is likely that this will also add weight to the argument that manipulation by appropriately trained therapists or practitioners should be more widely available on the NHS.
My noble friend Lord Clanwilliam described himself as a promoter of alternative medicine—and I would add, an energetic and doughty promoter. He expressed his pleasure in the widening use of alternative therapies in the NHS. We share his views. The NHS reforms have enabled health authorities and GPs to purchase a wider range of alternative and complementary medicine, including chiropractic. For example, GP fund-holders, with their new freedoms are employing complementary practitioners on a sessional basis. As the noble Lord, Lord Rea, said, alternative therapists are extremely valuable as part of the primary healthcare team. We endorse that. Hospital and community based provision depends on the professional clinical judgment of clinicians and on decisions taken locally by district health authorities on how best to meet the health needs of their population.
My noble friend Lord Harmsworth asked how we could further encourage the greater use of chiropractors in the NHS. But that is likely to depend largely on those doctors who already make use of them persuading more of their colleagues of their effectiveness. However, we expect that by establishing statutory schemes, the development of closer links between chiropractors and the medical profession will be established and encouraged.
The Bill is not designed to affect the provision of chiropractic services in the NHS. What it will do is to provide a system which enables the General Chiropractic Council to regulate, promote and develop the profession. The general council will act as the standard bearer, with the responsibility for raising standards, leading the profession and improving the quality of service offered to patients.
The coming years will be a time of great change for chiropractors. The system of voluntary registration, which has in one case existed since 1925, will be overtaken by statutory regulation backed by provisions to ensure that only those practitioners registered with 910 the general council are entitled to call themselves chiropractors. The four associations will transfer most, if not all, of their duties to the new council.
It would be understandable if some people in the profession, perhaps those about to embark on their career or even students still in training, were to feel uncertain about the future. There is no attempt in this Bill to be prescriptive, nor to dictate to chiropractors how professional issues should be handled. That will be the responsibility of the general council, at least half of whom will be practising chiropractors elected by the profession.
The noble Earl, Lord Baldwin—whose chairmanship of the all-party group, I have to say, is masterly and much valued by myself—and the noble Lord, Lord Ennals, suggested that the Bill should be a government Bill. We gave this matter careful consideration. However, we believe that the route of Private Members' legislation is the correct one as it frees Parliament from traditional party influences, allowing it to make up its own mind on this important issue on the merits of the case.
The noble Earl and the noble Baroness, Lady Robson, asked about other therapists who seek to close their title. Other therapy professions which seek statutory regulation are advised to follow the same route as both the chiropractors and the osteopaths, but first they must reach a consensus within the profession, agree on the need for common standards of education, training and professional conduct and seek the support of the medical profession. Then, if the way seems clear, they need to test the will of Parliament through a Private Member's Bill.
I am grateful to my noble friend Lord Colwyn for putting the Bill in its historic context. I am conscious that I am a johnny-come-lately to your Lordships' House, but like my noble friend I wish to pay tribute to all those who have broken the ground and worked so hard over the past 15 years to achieve the Second Reading of the Bill. We hope to see in enacted.
In conclusion, however quickly the profession has moved in recent years, chiropractic as a therapy is not new. It has been in existence for almost a hundred years. In fact, the profession worldwide plans to celebrate its centenary next year. What better reward could British chiropractors have than the achievement of statutory self-regulation through this Bill? I commend it: to your Lordships' House.
§ 2.56 p.m.
§ Lord Walton of Detchant
My Lords, I am deeply grateful to the noble Earl, Lord Clanwilliam, and others for their kind personal message to my wife. Over the past two weeks she has been desperately ill but has received the most skilled, dedicated care in the John Radcliffe Hospital in Oxford and I am glad to say that she is now well on the road to recovery. Thank you for your kind words.
I also thank all noble Lords who have spoken in the debate for the support which they have given to the Bill. Like the Osteopaths Bill, which is now an Act, this Bill is in a sense another historic step on the road towards the 911 formal recognition by Parliament of complementary medicine and its role in assisting the improvement of human health.
Like the noble Lord,Lord Ennals, I wish to pay a special tribute not only to other members of the King's Fund working party but also to David Lidington for the way in which he steered the Bill so effectively through another place. To the noble Earl, Lord Baldwin, I say that the purpose of the Bill is to regulate the entire profession of chiropractic, with every intention to preserve the interests of those who are educated in the three schools of chiropractic in the United Kingdom. That is, not just the Bournemouth school but the other two to which he referred. I believe that the standards they provide will be protected by the Bill.
Of course, every doctor is delighted to receive comments from grateful patients. I am sure that the speeches made by the noble Lord, Lord Harmsworth and the noble Earl, Lord Kintore, will have left chiropractors who may have listened to or read the debate feeling a sense of gratitude to them both for their kind comments. The sea change which has taken place in the attitude of the medical profession to which many noble Lords have referred resulted not long ago in a member of my family being referred by an excellent GP to a chiropractor. I am glad to say that there was effective treatment of low back pain. In that regard, it was fascinating to hear the historical background narrated so clearly by the noble Lord, Lord Colwyn, of which I was not previously fully aware.
I entirely share the views of the noble Baroness, Lady Robson and the noble Lord, Lord Ennals, about the outstanding contributions made physiotherapists in this country. In the National Health Service, their activities are regulated by the Professions Supplementary to Medicine Act 1960, but the point which the noble Baroness made that many now practise outside the NHS should, I am sure, be noted. Those involved may well wish to move along a similar road towards professional self-regulation.
I am very grateful to the noble Lord, Lord Rea, for his support as a general practitioner and for his lesson in etymology. A rose by any other name would smell as sweet, but the terms "chiropractic" and "chiropractor" are hallowed in usage. They are like the word "doctor", meaning a doctor of medicine, not of philosophy or literature, which is also hallowed by usage. I believe that the Bill properly hallows that group of traditional terms.
I am particularly grateful to the noble Baroness the Minister for the outstanding support that she has given, and for the way in which she has made it clear that the Government support this Bill. I wish to say in passing how much I appreciate the very great help that members of her department have given in providing very detailed notes relating to the content of the Bill and its purpose. I trust that she will pass on to them my sincere thanks and, I am sure, the thanks of all those who are involved.
It only remains to me to say that I trust that your Lordships' House will give this Bill a fair wind and that we may see its progress, unamended, through this House so that very soon it will be, like the Osteopaths Act, on the statute book. That is something which I 912 know the chiropractic profession and the medical profession, and indeed the caring professions in general, will welcome. In the meantime I ask, having been privileged to present this Bill for its Second Reading in this House, that the House should give it a Second Reading.
On Question, Bill read a second time, and committed to a Committee of the Whole House.