HL Deb 06 February 1997 vol 577 cc1809-12

6.6 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege) rose to move, That the draft order laid before the House on 13th January be approved. [9th Report from the Joint Committee].

The noble Baroness said: My Lords, the order before your Lordships creates a Prosthetists and Orthotists Board under the Professions Supplementary to Medicine Act 1960. Prosthetists and orthotists are specialised health professionals who measure and fit patients for artificial limbs and appliances such as splints, braces and footwear. They specify the design and materials for those devices and evaluate their use.

The broad effect of the order is to extend the 1960 Act as if the profession were included alongside those it already covers: chiropodists, dietitians, occupational therapists, physiotherapists, radiographers, orthoptists and medical laboratory scientific officers.

The board's function will be to promote high standards of professional education and conduct within the umbrella of the Council for Professions Supplementary to Medicine—the CPSM—whose duty it is to co-ordinate and supervise the activities of all the boards. The main duties are to: prepare and maintain a register; approve training courses leading to state registration and the institutions providing them; determine applications for admission to the register on the basis of qualifications and experience acquired either in the UK or elsewhere; set up investigating and disciplinary committees to produce guidance on conduct and to deal with individual cases of misconduct.

Practitioners who are registered by the board will be entitled to call themselves "State registered prosthetists and orthotists". The use of that title by a person who is not registered will be an offence, as will the use of any title or description which falsely implies that he is registered under the 1960 Act.

The Act requires that the board should have a majority of members from the profession concerned. It will have 13 members appointed by the CPSM, of whom seven will be nominated by the profession in the first instance and thereafter elected by registrants. The remaining members will be two medical practitioners, nominated by the Royal Colleges, two educationists and—an important innovation—one representative of employers and one of patients and carers.

The size of the CPSM itself will also increase from 21 to 24 because the Act requires that all boards have a professional representative on the council, and that the number of medical and professional members should be equal. The third lay member preserves the balance of representation between professional, medical and other members.

I turn to the merits. Statutory regulation is a privilege, not to be granted just because the profession concerned aspires to it, but to be justified because it provides safeguards for the public which would not otherwise be available. How do prosthetists and orthotists match up?

They are a small and highly specialised group. The UK workforce numbers only about 800 practitioners. The majority, over 80 per cent., are employed by private firms who contract to provide services to the NHS. They provide direct, hands-on care for particularly vulnerable patients of all ages, operating with substantial autonomy within multidisciplinary teams. Their work is commissioned by other clinicians, such as surgeons, but surgeons accept them as the true experts within their field. So what they do, if ill done, presents serious risks of physical and psychological harm to patients arising from defects in the selection, design, manufacture, fitting or evaluation of limbs and appliances.

The training required is exacting. The only route to qualification in the UK is through one of the two centres at the universities of Strathclyde and of Salford. Each provides a four-year combined Honours course, integrating the theoretical, practical and clinical aspects of prosthetics and orthotics. Both centres are strongly supported by the NHS and both have strong international links. The training reflects a unique combination of expertise—precision engineering, materials science, design and production methods, plus a high degree of clinical, communication and team-working skills.

Beyond qualification, the profession deserves credit for combining two disciplines whose training and practice was historically separated into a coherent body of knowledge and experience, represented by a single organisation. It has produced a comprehensive statement of the ethical and practice standards expected of its members which are comparable with those of other health professions and consistent with international best practice.

It has also consulted widely and thoroughly on the proposal now before your Lordships. It balloted its members who overwhelmingly approved it (87 per cent. of those voting); and it secured the support of the medical and nursing professions, those groups currently regulated under the 1960 Act and, significantly, of employers' representatives as well.

The profession has also acknowledged that the possession of a qualification alone cannot guarantee safe and effective practice and is currently developing a scheme of continuing education credits. The importance of keeping knowledge and skills updated is fundamental to modern health services, and employers and professions need to work together to foster life-long learning among all staff.

But the merits begin and end with patients. State registration of prosthetists and orthotists offers the public an objective assurance of the high standards of training, conduct and practice that they can expect. It offers, also, incidental benefits: providing a benchmark for employers; assisting in workforce planning by keeping a continuous record of the pool of qualified practitioners; providing an opportunity to strengthen collaboration between the health professions; and providing a coherent mechanism for dealing with overseas qualified practitioners, including those from the European economic area wishing to exercise the right of freedom of movement.

If approved, the measure will provide a scheme of self-regulation at arm's length from government and funded by practitioners themselves. The Government are satisfied that prosthetists and orthotists—indeed, it is just as well that I have my own teeth; otherwise I would be in desperate trouble when pronouncing those words—have sufficiently developed their standards, identity and purpose to join the family of mature professions already regulated by the CPSM. I commend to your Lordships the making of this order by the Privy Council. I beg to move.

Moved, That the draft order laid before the House on 13th January be approved [9th Report from the Joint Committee] .—(Baroness Cumberlege.)

Lord Colwyn

My Lords, when I came into the Chamber I knew what a prosthodontist and an orthodontist was, and I believe that I probably understand now what prosthetists and orthotists are. I am grateful for the comprehensive way that my noble friend the Minister explained the order. However, can she tell me whether these two subject headings include orthodontists and prosthodontists? Having said that, I welcome the order.

Lord Rea

My Lords, on this side of the House we thoroughly welcome the order, which is most useful. It is useful because it will enable recognition of a very important body of highly skilled practitioners as one of the professions supplementary to medicine. As a practitioner in the NHS, I was from time to time very grateful that my patients had the benefit of the skills of prosthetists and orthotists. Very often, it was through the orthopaedic surgeons at Queen Mary's Roehampton, where a large number of patients with artificial limbs are handled so expertly.

I listened to what the Minister said; it was indeed very clear. I do not believe that there is any need for me to elaborate upon it. However, I have one point to make. In the Hansard report in another place, I believe there is a printing error in the information given about the number of people on the CPSM (the Council for Professions Supplementary to Medicine) where it says that there must be two rather than three "O" and "P" representatives, if I may put it that way, because of the need to balance expert and lay representation. I believe that the figure should be three rather than two, but that does not affect the legislation or the schedule. It is only a report in Hansard of the other place and is probably unimportant. Having said that, we support the order and wish it well.

Baroness Cumberlege

My Lords, I am most grateful to my noble friend and to the noble Lord, Lord Rea, for their support for what is an eminently sensible thing to be doing for these two professions. In reply to my noble friend Lord Colwyn, I should say that I believe the answer is no. Perhaps I may tell the noble Lord, Lord Rea, that the size of the CPSM will increase from 21 to 24. He is quite right in that respect. The Act requires that each board has one professional representative on the council and that the number of professional and medical representatives should be equal. Of course, the third lay member preserves the balance of representation among professional, medical and other members. I think that the noble Lord is probably correct and that, very unusually, there has been a typing error in the Official Report of the other place. I commend the order to the House.

On Question, Motion agreed to.