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House of Commons

Friday 18 February 1994

The House met at half-past Nine o'clock

PRAYERS

[ Madam Speaker-- -- in the Chair ]

Petition --

National Health Service (Greenwich)

9.33 am

Mr. John Austin-Walker (Woolwich) : Madam Speaker, I have a petition in the prescribed form, supported by 16,000 signatures on further petitions, which expresses the widespread concern in Greenwich and Woolwich regarding the impact of the Government's reforms of the national health service and of the reneging on the pledges given when the Greenwich health care trust was established. A pledge was given to develop on the Brook hospital site an elective resource centre, an integral part of which was to be the regional specialty cardio-thoracic service.

The petition reads :

Wherefore your Petitioners pray that your Honourable House will appeal to the Secretary of State for Health to intervene to stop possible closures of the Brook, Memorial and Greenwich district hospitals and to establish a public inquiry into the state of the national health service in the Greenwich health district. And your Petitioners, as in duty bound, will ever pray, etc, To lie upon the Table .

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Orders of the Day

Chiropractors Bill

Order for Second Reading read .

9.35 am

Mr. David Lidington (Aylesbury) : I beg to move, That the Bill be now read a Second time.

The central purpose of my Bill is to establish a statutory registration scheme for chiropractors, to regulate the profession and to require all persons calling themselves chiropractors to register 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 to lay down standards of professional conduct and education.

My 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 dealt with.

In the current week, as in every other week in the present year, more than 75,000 patients in the United Kingdom will have had chiropractic treatment. Since agreeing, at the urging of the profession, to introduce the Bill, I have been amazed and delighted by the number of friends, members of my family and hon. Members on both sides of the Chamber who have approached me and told me of the treatment that they have received from a chiropractor. No one has had anything but praise for the efficient and effective care that they have received. Chiropractic is already, after osteopathy, the second most widely used complementary therapy in the country.

The statutory scheme set out in the Bill reflects closely that of the Osteopaths Act 1993. As the House will know, that Act was introduced as a private Member's Bill by my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss). He has written to me to explain that, due to constituency engagements, he cannot be present today, but I was delighted that he was willing to act as one of my sponsors and I am grateful to him for blazing a trail which I am now able to follow.

Chiropractic comes in the range of therapies and treatments referred to as alternative and complementary medicine. It 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 and consequently has a key role in ensuring that the body functions effectively. If the spine becomes too rigid, or too mobile, the nervous system may be affected and such a condition can certainly cause pain, not merely in the back, but in other parts of the body as well. Chiropractic is a means of diagnosing the presence of such a condition and of making various adjustments or manipulations of the vertebrae to correct it.

One or two of my hon. Friends may conceivably ask why, if things are working so well at the moment, the chiropractic profession is seeking statutory regulation. The answer is straightforward. At present there is nothing to prevent me, or you, Mr. Deputy Speaker, or anyone else in the Chamber or elsewhere, from simply fixing a brass plate with the title "chiropractor" to our gatepost and immediately offering to treat anyone who was unwise or

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unfortunate enough to come through the door and take the risk. No minimum standards are required ; no training is necessary. From the little that I have said already about what happens during chiropractic treatment, it must be obvious that there is potential, in untrained hands, to do a great deal of harm. The manipulation of necks and backs could be lethal without the proper degree of skill. Even relatively minor adjustments to limbs, if attempted in ignorance, could result in severe damage.

Equally important, serious underlying conditions--for example, cancer--can present symptoms very similar to back pain and an untrained manipulator might, therefore, persist in treatment that has no prospect of helping the patient. He or she ought to advise the patient to go immediately to his doctor. Regrettably, cases have been reported where what appeared to be a bad back masked much more serious illness, so it is not just a matter of chiropractors treating bad backs.

Fundamental to a chiropractor's skill is the ability to make what is known as differential diagnoses--in layman's language, the ability to diagnose conditions that will not respond to the chiropractor's skills and conditions that should be referred immediately for orthodox medical treatment.

A good, responsible chiropractor will take a careful case history and carry out a thorough physical examination of each patient before commencing treatment. Some chiropractors may also make use of other diagnostic tests such as X-rays or blood and urine analysis, but by far the most important diagnostic tools for all chiropractors are the practitioner's hands.

Virtually every chiropractor treatment is given to relieve joint, bone, muscle or tendon pain in one of the many forms in which it can occur. Almost half of all cases concern problems with the lower back and pelvis, including cases where the source of trouble is in those parts of the body but the pain is felt by the patient elsewhere--in the groin, thighs, legs or feet. About a quarter of treatments are for neck problems, which either cause pain in the back or referred pain in the shoulders, chest, arms or hands. About one in 10 treatments is for headaches and migraines, and chiropractors will also give treatment for thoracic pain and for local injuries to limbs not directly affected by the spine. Those are general figures, which do not reflect the fact that many patients arrive at their chiropractor with a combination of head, neck, thoracic and lumbar pain and perhaps co-existing organic problems.

I have been fortunate, in the past few weeks, since agreeing to take on the Bill, to have been given permission by some chiropractic patients to observe their treatment taking place. I have been struck by the way in which chiropractic not only can be used effectively to treat backs and joints, but can play an important role in helping people suffering from chronic organic disease to remain mobile, and so retain their much-prized independence longer than might otherwise be the case.

Chiropractic is, therefore, a therapy that deals with a large number of people who experience considerable pain and discomfort. The therapeutic techniques that are used could be dangerous in unskilled hands and there is a need to ensure that other serious conditions are not overlooked in the analysis of the patient.

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While the profession remained small, it was difficult for an untrained or incompetent practitioner to pass unnoticed. However, as more patients have chosen to have chiropractic treatment, the number of practitioners in the country has grown rapidly. Today there are more than 900 chiropractors in all parts of the United Kingdom and, as the profession expands rapidly, the likelihood increases of someone continuing in incompetent practice for longer, or even of an untrained person setting up in practice.

Virtually every practising chiropractor in the kingdom is already a member of a voluntary registration scheme, but the profession recognises that a voluntary system of control is now inadequate. A voluntary system cannot provide members of the public with the level of assurance that many people would wish to have about their practitioner. If, for example, an incompetent practitioner were struck off a voluntary register, he or she would remain free under the present law to continue in practice, and to continue describing himself or herself, perfectly legally, as a chiropractor, and a patient who was injured in such circumstances by an incompetent practitioner would have no opportunity for redress apart from a civil action through the courts, with all the expense and delay that would entail.

My Bill would replace the present system of voluntary registration by a single statutory council, to be known as the General Chiropractic Council. As I have mentioned, the statutory organisation will have the duty to develop, promote and regulate the profession of chiropractic and to lay down standards of professional conduct and standards for the education and training of practitioners. As mentioned previously, the Osteopaths Act 1993 has provided a pattern for other professional groups to follow. My Bill, like that Act, has its antecedents in a report of an expert working party set up under the aegis of the King's Fund to bring forward

recommendations for the statutory regulation of the profession. It is a tribute to the chiropractic profession that it was able to secure the agreement of the King's Fund to set up a working party so shortly after the working party on osteopathy had reported, and while the recommendations of that report were still being considered by Parliament in the form of the Bill presented by my hon. Friend the Member for Cambridgeshire, North-East.

The working party on the chiropractic profession included representatives in the chiropractic profession and the medical profession, as well as members reflecting the interests of patients and of the general public. I know that the chiropractic profession would wish me to take the opportunity to express, on its behalf, its thanks to the King's Fund and to the members of its working party, especially the chairman, the right hon. Sir Thomas Bingham. Like other similar statutory schemes, the general council's activities would be overseen by the Privy Council. My Bill therefore confers powers, known as default powers, on the Privy Council, which it would be able to exercise in the extremely unlikely event that the general council failed to carry out its statutory responsibilities or functions properly. Those powers will enable the Privy Council to direct the general council as to the proper exercise of its functions under the Act and, if necessary, as a last resort, the Privy Council could step in, take over the responsibilities of the general council and do anything that the general council would have the power to do.

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I ought to emphasise that there is no known case of the Privy Council having to exercise its default powers in respect of other similar statutory schemes. However, as a result of the remote possibility that might happen, the Bill has public expenditure implications. Such public expenditure would be necessary only to cover the costs incurred by the Privy Council if those default powers were triggered. In all other respects, the regulatory system that I propose would be self- financed through the annual registration fees paid by chiropractors.

As with other statutory schemes of that type, the Bill will provide a broad framework in which the statutory scheme will operate. The more detailed, day-to-day aspects of the scheme will be set down in rules made by the general council. Another duty of the Privy Council will be to approve those rules, which will cover the entire range of the general council's responsibilities, as well as the procedural rules of the four statutory committees. Those rules would take the form of statutory instruments, which, in a handful of specific cases, would also be subject to the negative parliamentary procedures. Arising from the rule-making powers of the general council, it is necessary for me to refer to the position regarding monopolies and competition law, especially in the light of the recent Monopolies and Mergers Commission report on private medical services. If my Bill is enacted, the same position will exist for chiropractors as now exists for private medical services. My Bill contains a provision in clause 33 to ensure that the establishment of a statutory organisation with the power to make rules and give guidance to the profession will not prevent the application of fair trading and competition law. The Secretary of State for Trade and Industry will be able to require the general council, as he has recently required the British Medical Association, to make any changes that he considers necessary to rules or guidance if such rules or guidance are found in a Monopolies and Mergers Commission report to be against the public interest. That does not change the present position. Voluntary associations of chiropractors are already subject to the monopoly provisions of the Fair Trading Act 1973 and the provisions relating to anti-competitive practices in the Competition Act 1980. Let me say a few words about the general council. It will comprise 20 members made up of three groups. The largest group will be 10 chiropractors elected by fully registered practitioners to represent the profession. Then there will be four educational members, three of whom will be appointed by the education committee of the general council to advise on matters relating to chiropractic education and training, while the fourth education member will be appointed by the Secretary of State to advise on professional education matters. The last group on the general council will be six lay members. They will not be registered chiropractors and will be appointed by the Privy Council to represent the interests of patients, consumers and the general public. There will be a requirement for one of the lay members to be a registered medical practitioner.

The groups mirror those set out in the Osteopaths Act 1993 and will provide the general council with a broad breadth of experience, thereby ensuring that the profession has a firm and balanced basis from which to develop in the future.

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Lady Olga Maitland (Sutton and Cheam) : I thank my hon. Friend for giving way in a most important speech on a Bill which is enormously welcome. Could he possibly tell the House what the costs are likely to be for establishing the general council and where that money will come from ?

Mr. Lidington : My hon. Friend makes an important point. At this stage, it is impossible to predict exactly what the costs will be, but, as I said, they will be borne by the chiropractic profession. The various voluntary associations--there are three in this country--already charge their members an annual subscription. In the case of the largest association, the British Chiropractic Association, the fee is just under £1,000 a year. Although one can never be certain about these things, the charge will be a matter for the profession and the general council when it is established. The anticipated subscription would be the BCA level or more once the statutory scheme comes into being.

I must emphasise that my Bill is not about imposing a statutory scheme on chiropractors. It is about--the intervention of my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) gives way to this point--enabling the profession to chart its own destiny within a framework laid down in statute.

In the beginning, there will be neither the election machinery nor the electorate of registered practitioners to elect the first group of chiropractic members of the general council and there will need to be some transitional arrangements. The first general council therefore will be appointed in its entirety by the Privy Council, and the first elected chiropractic members of the general council will take up office following elections which will be held three years after the opening of the register.

As I said, there are a number of bodies administering a voluntary registration scheme among British practitioners. Chiropractic in the United Kingdom has developed along three distinctive paths. Each group of practitioners has its own system of voluntary registration, and a fourth separate organisation is based in Scotland for Scottish chiropractors. These groups vary in size and strength.

Not unreasonably, the smaller groups have at times been concerned that they might not be able to retain their individuality in the future. It is therefore a tribute to the profession, and especially to the chiropractic registration steering group, which was founded in 1991 to provide the focus for pursuing the objective of statutory regulation, that the whole profession is working to achieve statutory regulation for all parts of the profession. There is co-operation among the three different strands of British chiropractic to achieve that purpose.

When I have met chiropractors from different branches of the profession and visited their schools, I have been impressed by the diversity among the different groups and the strengths which each of them brings to the chiropractic profession. I emphasise that the general council's statutory duties to develop, regulate and promote the chiropractic profession extend equally to all parts of the profession.

Before I move on to the nuts and bolts of the Bill, I draw the attention of hon. Members to one or two apparently minor yet significant details. First, the Bill includes a number of amendments to the Osteopaths Act 1993. They are what could be described as fine-tuning amendments to enable the osteopath registration scheme to run more smoothly. Secondly, my Bill contains a provision to amend the Video Recordings Act 1984. Given the public

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controversy about the whole topic of video recordings at present, I state firmly that my Bill does not seek to amend the Video Recordings Act or the rules that it embodies. There is no question of opening any loophole that could be exploited by unscrupulous people. The Video Recordings Act carries an exemption with regard to video recordings for training in or carrying on any medical or related occupation. Clause 39 of the Bill would extend the exemption to registered chiropractors and registered osteopaths whose training videos would then be treated like training videos for members of the orthodox medical profession, who are already granted such an exemption.

I turn to the code of conduct. The principal statutory duty that will be conferred on the general council by my Bill will be a requirement to prepare and publish a code of professional conduct and a standard of proficiency. The code of conduct will set out the standards of conduct and practice expected of a registered chiropractor and will give advice on the practice of chiropractic. When the general council draws up the code, it will have a statutory duty to consult representatives of the profession. Failure by a practitioner to comply with the code will not in itself be a disciplinary offence but will stand to be taken into account in any disciplinary proceedings that might subsequently be initiated against a chiropractor under the fitness-to-practise provisions of the Bill.

Lady Olga Maitland : I thank my hon. Friend for being patient and for allowing me to intervene again on the important point about disciplinary measures. Can he tell the House what sort of offence would require disciplinary measures ? For example, if a chiropractor commits a driving offence, is that considered sufficiently serious, or would the general council be looking at offences such as drink offences and fraud ?

Mr. Lidington : I intend to deal later in more detail with the disciplinary and investigative procedures. The key principle is that an action or an offence would be relevant if it were important to a chiropractor's fitness to practise. An error or misdeed on his part which is completely irrelevant to his fitness to practise would be considered by the investigating committee and probably dismissed by that committee as something which should not be considered further under the disciplinary procedure.

I alluded to the standard of proficiency. As the name implies, this will be a benchmark for what the general council considers to be safe and competent practice. The standard of proficiency lies at the heart of the statutory scheme. It will be used to judge whether a qualification should be recognised or remain recognised for the purposes of entitling a practitioner to be registered under the Act. It will serve as a means to enable a practitioner to know whether his or her competencies are up to scratch. It will determine whether an allegation of incompetence or malpractice is well founded. It will be used to highlight possible subjects for post-registration training courses. Under the transitional arrangements that will follow the opening of the register--nicknamed the transitional arrangements--the standard of proficiency will be used to decide whether an applicant should be granted registration on the basis of his or her previous practice. The general

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council will be obliged to keep the standard of proficiency under review and to update it as and when it considers necessary. In updating the standard, the general council will be required to publish both the statement setting out the new standard and the accompanying statement explaining how the new standard differs from its predecessor. The power to review and revise the standard of proficiency will give the general council the means by which to develop the profession and to improve the skills and competency of practitioners. To avoid abrupt changes, especially for chiropractic schools and other training institutions, which need time to make any adjustment in their courses, a period of one year will separate the publication of any revised standard from the time when it comes into force.

The statutory registrar will have the duty to establish and maintain the official register of people who are entitled to practise chiropractic in the United Kingdom. He or she will be appointed by the general council. To assist the registrar, the general council will appoint experienced professional, legal and medical assessors. Appeals by practitioners against a decision of the registrar to refuse, for example, to register them or to register them in a particular category will lie first with the general council and thereafter either with the Privy Council or High Court in England and Wales, or the equivalent in Scotland and Northern Ireland.

Lady Olga Maitland : I thank my hon. Friend for again allowing me to intervene as I want to raise an important matter. Will a chiropractor who is registered in this country be able to practise in the European Community ? By the same token, will a chiropractor who is registered in another country in the European Community be able to practise in the UK ?

Mr. Lidington : The position is slightly complicated. Chiropractic is conducted by non-medically qualified practitioners in a few other EC member states, although it is thought that liberalising forces are at work there. The regulation of the chiropractic profession in the United Kingdom will not automatically give non-medically qualified chiropractors in Britain the right to work in other member states in which the practice of chiropractic is legally restricted to those who are medically qualified. In France, for example, one must be a qualified medical practitioner before one is allowed to work as a chiropractor. The automatic reciprocity that exists in some other professions does not apply.

It will be up to the general council, under its rule-making powers, to decide how it keeps the register--whether it is bound in a great leather ledger, with names filled in by quill pen, or whether the information is kept on a sparkling new video computer database. The general council will also be able to make decisions on such matters as the fee to be charged for entry in the register and additional information that it wants to appear in it. Such information could include other qualifications held by a registered chiropractor or the additional addresses of a registered chiropractor if he operates from more than one premise.

The Bill lays down certain details on all practitioners that must by law appear on the register. Some of those details are obvious. They include the name of the practitioner, the level of registration that he or she holds-- full, conditional, or provisional--and the registered

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address, which will be the location of the chiropractor's principal practice. The registrar will also be required to place on the register any period during which the chiropractor's registration has been suspended and to show under which provision of the legislation the suspension has been made. While suspended, a chiropractor will cease to be registered and will therefore not be permitted to continue in practice.

The register will be available for public inspection at all reasonable times to provide members of the public with a means of checking the bona fides of people calling themselves chiropractors. In addition, the Bill makes provision for the general council to publish annually a list of names and to register addresses of everyone who, at the time of publication, is a registered chiropractor. One might call that list the published register, or the popular version. It will be for the general council to determine whether the list should also include additional information derived from the register. A woman chiropractor who wishes to practise under both her maiden name and her married name may have that fact reflected in the published version of the register. Under the Bill, it would be possible for the published copy to be sold or given to members of the public, and supplied to public libraries, GPs' surgeries and other health professionals.

The key difference between the published version of the register and the central statutory register is that the published register will not include details of any practitioner who is currently suspended from practice. That is because the practitioner should not be exposed to a form of double jeopardy. Registration may be suspended for a number of reasons. An investigation may be carried out into an allegation against a practitioner and an interim suspension may be imposed to protect members of the public while that investigation takes place. But the outcome of that investigation might clear the chiropractor's name, in which case the entry made against his or her name in the master register will immediately be removed.

The published register will be published only once each year. It would therefore be possible, if my Bill did not provide otherwise, for a reference to the suspension of a chiropractor whose name had been cleared to appear in the out-of-date published register. The inaccurate public version might still be in circulation when the next edition was published and distributed. There would be a risk, therefore, of an unwarranted doubt being cast on the name of a practitioner. The safeguard of holding back suspended practitioners' names from the published version of the register is included in the Bill ; such safeguards are a feature of other similar statutory schemes.

Lady Olga Maitland : When will the register come into force and what will happen to those chiropractors who are registered with the three voluntary organisations that exist ? How will they make the transition from the voluntary organisations to the official register, and is there any danger of confusion between the two ?

Mr. Lidington : I know that my hon. Friend follows closely such matters as the system of registration. I ask her to remain patient for a little while because I will deal with that subject soon. The implementation of the register will depend in part, of course, on the progress made on the Bill, but I hope that the general council will be established within 18 months or two years of the Bill's receiving Royal Assent. The

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statutory register will probably open 18 months or two years after the general council has been set up. That is the rough timetable. My hon. Friend's intervention was apposite because I was about to deal with the subject of registration. The Bill will require that a person must be registered with the general council to call himself a chiropractor, and to practise as such.

That requirement will be backed up by the creation of a new criminal offence to be introduced once the initial transitional period had elapsed. That would provide that a person who was not a registered chiropractor but who, after enactment, described himself or herself as a chiropractor either expressly or by implication would be liable on summary conviction to a fine not exceeding level 5 of the standard scale--that is currently £5,000.

My Bill provides for three different categories of

registration--full, conditional and provisional. I should like to deal with each category in turn. Entitlement to full registration will primarily be determined by whether or not a person holds a recognised qualification. That will be a qualification which the general council considers provides evidence of reaching a standard of proficiency for the safe and competent practice of chiropractic. In deciding whether it recognises the qualification, the general council will be required to seek will say more about that process of recognition, and withdrawal of recognition, when I come to discuss the role of the education committee.

In addition to holding a recognised qualification, an applicant for full registration would be required to do a number of other things. He must make an application in the form and manner which is required by the general council, and he must pay any fee which may be described. It is of great importance that the applicant satisfies the registrar that he or she is of good character, and is in good physical and mental health. Most of the details determining whether an applicant satisfies those criteria will probably be set down in the rules made by the general council.

I draw the attention of the House to clause 40 of the Bill, which exempts chiropractors from the provisions of the Rehabilitation of Offenders Act 1974. That means that anyone applying for registration will, if asked, be required by law to declare all of his convictions, including those which are otherwise considered to be spent. This is an important provision. The overwhelming majority of chiropractors practise in the private sector, and that position is unlikely to alter markedly even if the Bill succeeds.

Hon. Members will realise that chiropractic is very much a contact form of treatment. Members of the public are entitled to expect a statutory registration scheme to provide them with clear assurances about a practitioner's bona fides.

I have said that entitlement to full registration will be primarily dependent on whether a person holds a recognised qualification. At present, there is no requirement for any person who calls himself a chiropractor to undergo formal training. For that reason, not everybody who is in current practice will necessarily hold a formal qualification. Other chiropractors in Britain may well hold a qualification awarded by a school or an institution in this country or overseas which no longer

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exists. That does not automatically mean that those chiropractors are unsuitable for registration, or that they are unsafe and incompetent.

The Bill provides transitional arrangements, known as grandfather arrangements, to enable those practitioners who have been practising chiropractic lawfully, safely and competently for a number of years to apply for full registration. The grandfather provisions in the Bill are identical to those which are embodied in the Osteopaths Act 1993. The requirement is that a practitioner has, for at least five years, spent a substantial part of his working time in the lawful, safe and competent practice of chiropractic. To ensure that a practitioner's experience is recent, no account is taken of any work which was done more than seven years prior to the date on which the register opens.

Applications for full registration under the grandfather arrangements would be permitted only during a two-year period following the opening of the register. After the two-year transitional period has elapsed, applications for full registration would be accepted only on the basis that the applicant holds a recognised qualification and satisfies all of the other criteria which I mentioned earlier. The grandfather provisions are designed to enable the transition from the present system of voluntary registration to a future statutory one to take place smoothly. The second category of registration is known as conditional registration. That is a purely transitional arrangement, and applications for conditional registration will be permitted only during the two-year period immediately following the opening of the register. Conditional registration would enable a practitioner who again is without a recognised qualification and who is unlikely to muster the five years' lawful, safe and competent practice necessary to apply for full registration still to have a route open by which to enter the registered profession.

There are two broad groups of chiropractors for whom the provision is designed. The first group consists of practitioners who just fail to reach the five years out of seven criterion. They can apply for conditional registration if they can satisfy the registrar that they have acquired four years' experience of lawful, safe and competent practice within a period of less than six years before the opening of the register.

The second group consists of a small number of practitioners who could fall between two stools. They hold a qualification in chiropractic, but it is a qualification about which the general council and the education committee know little. Again, the institution which awarded the qualification may well no longer exist. A practitioner in that category may be unable to satisfy even the four years out of six criterion which I have just described. Such a chiropractor could be a woman who qualified in chiropractic some years ago from a school or training institution which may no longer exist. She has taken some years out of the profession to bring up a family, and now wants to return to practise. Such people, and others in comparable positions, will be permitted to apply for conditional registration.

The precise criteria will be that they are unable to satisfy the four years out of six criterion, and that they hold a qualification in chiropractic which, while not a recognised qualification, is not something which has been examined

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by the education committee of the general council and then refused recognition. It is important to note that I am not seeking to open a back door for applicants who have qualifications which the general council and the education committee have judged to be inadequate. Any applicant for conditional registration will have to fulfil exactly the same conditions of good health and character as are required for applicants for full registration. In addition, the registrar can require them to take and pass a test of competence to his satisfaction, and require them to enter into a formal undertaking to complete such extra training or acquire such additional experience as he may specify. Applicants will have a maximum of five years after the opening of the register to fulfil the obligations, although the registrar will be able to specify a shorter time scale if he thinks that is right.

All conditional registrations without exception will lapse automatically at the end of five years, and anyone failing to have a registration made up from conditional to full will automatically cease to be a registered chiropractor.

The final category of registration is provisional and it is a little different. It is intended to allow the general council to require a chiropractor who would otherwise be entitled to full registration to be registered instead for an initial period of one year only with provisional registration.

While registered provisionally, a chiropractor would be allowed to practise only under the supervision of a practitioner who was fully registered under the terms set by the general council. Typically, provisional registration would apply to the first year of practice following the qualification of a student coming straight out of chiropractic college. Obviously, the provision also could be applied to other groups of practitioners. The system of provisional registration is modelled on the system which is already in place among voluntary associations operated by the chiropractic profession in this country. It clearly benefits practitioners and patients alike.

The Bill does not seek to impose automatically a provisional registration scheme, but it allows the general council discretion to introduce a system through rules that it makes in the future. It will have to consult the profession before it makes any such rules. The rules on professional registration would not only require the approval of the Privy Council but would be subject to the negative parliamentary procedure.

The Bill seeks to establish four statutory committees of the general council : the education committee, the investigating committee, the professional conduct committee and the health committee. The education committee will have a general duty to promote high standards of education and training in chiropractic, and to keep the provision of such training under review. Its responsibilities would also cover such things as examinations in chiropractic, tests of competence and post-registration training courses.

The education committee will have the prime responsibility of advising the general council whether a qualification provides evidence of reaching the standard of proficiency required for the safe and competent practice of chiropractic and, consequently, whether that qualification should be formally recognised. In the same way, the committee will also have a responsibility to bring to the attention of the general council any shortcomings in a recognised qualification, especially if they are so serious as to justify action to withdraw recognition.

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To help the education committee carry out its statutory duties, the committee will have the power to appoint visitors to go to educational institutions and report back on the adequacy of the training and facilities provided. That provision will be the principal means by which the education committee will be able to acquire first-hand knowledge of the nature and quality of the instruction given.

The Bill also imposes a duty on training institutions which either provide or intend to provide chiropractic education and training to provide the education committee with any information that it might reasonably require in order to carry out its statutory duties. If a training institution fails to comply with such a request, that in itself will be sufficient ground for a recommendation to the general council that recognition be either withheld or withdrawn. For the sake of completeness, I should perhaps add that a decision to recognise or withdraw recognition from any qualification would require the consent of the Privy Council. To enable the Privy Council to come to a decision on the matter, the general council would be required to provide it with all the information available to the general council and on which the recommendation was based. Where consent is sought for a qualification to be recognised, however, the Privy Council may be content to accept a summary of that information.

Before leaving the subject of education and training, I should mention briefly the existence of different groups of chiropractors in the United Kingdom. The groups have developed along separate and distinct lines over the years. In 1991 they came together to form the chiropractic registration steering group. The differences between the various groups have traditionally been reflected in their different approaches to education and training. One of the fundamental agreements that has been made between members of the steering group is that all United Kingdom schools of chiropractic represented by the various members of the group will achieve a levelling up of standards within five years of legislation to regulate the profession coming into force.

At the heart of the agreement is the intention that the qualifications currently awarded by three main United Kingdom schools of chiropractic--the Anglo-European college in Bournemouth, the McTimoney school and the Witney school--will be granted the status of recognised qualifications. That decision will ultimately be one for the general council and the education committee to take, but I hope that if my Bill is successful the profession will take it as a clear signal that Parliament expects that aspect of the agreement to be honoured.

In the past two weeks I have spent a happy half day in the constituency of my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) at the Anglo -European college. A few days ago I visited the Witney school in Oxford to see how its training system operates. The schools have two different approaches, but during each visit I was struck by the dedication, commitment and professionalism of all who were involved.

I turn now to the committee whose role will be to investigate complaints against practitioners. It takes us back to a point made earlier by my hon. Friend the Member for Sutton and Cheam. My Bill establishes an investigative and disciplinary procedure to deal with three sorts of allegation : first, allegations of unacceptable professional

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conduct ; secondly, allegations of professional incompetence ; and, thirdly, allegations that a chiropractor has been convicted in the United Kingdom of a criminal offence or is unfit to practise due to his physical or mental condition.

To ensure that the fitness-to-practise scheme has some real teeth, it will be an offence for anyone not to comply with a request from the professional conduct committee, the health committee or the appeal tribunal to attend a hearing to give evidence or produce documents. As with the offence of wrongly claiming to be a chiropractor, that offence would be punishable on summary conviction with a £5,000 fine--level 5 on the standard scale.

Let me summarise how a complaint from an individual would be handled. First, the general council could appoint a screener to decide whether the case even came within the scope of the fitness-to-practise machinery. As my hon. Friend the Member for Sutton and Cheam said, a complaint could be made about a chiropractor that had nothing to do with the general council or the registration scheme of the profession. Someone could complain bitterly that his chiropractor was an active member of a particular political party, for instance. It would be the job of the screener to decide whether the nature of the complaint brought it within the statutory scheme. If it did, and only if it did, the investigating committee, which acts as the CID and Crown Prosecution Service of the scheme, would take over the matter and conduct a preliminary investigation. The investigating committee would then gather information and evidence, look at that evidence and decide whether there was a case to answer. If there was a case to answer, the investigating committee would determine whether the professional conduct committee or the health committee was the appropriate one to deal with that case. The investigating committee could suspend registration and, therefore, the ability to practise pending or during investigation, if it decided that it was necessary for the protection of the public. The obvious case in which that power would be invoked would be a serious allegation against a chiropractor, for example, of sexual assault on a patient. There would then be an urgent need to be absolutely certain that the public were protected.

The Bill specifies that an interim suspension imposed by the investigating committee would have a maximum duration of only two months. The reason for that is to make sure that the investigating committee gets on with its job and refers cases onwards quickly and efficiently for resolution by either the professional conduct committee or the health committee. Those committees in turn will have similar powers of interim suspension for the same reasons of protection of the public, but no maximum duration is set. So suspension imposed by the investigating committee could be maintained by either the professional conduct committee or the health committee if it thought that was right.

A practitioner would have a right to appeal against suspension by any of the committees by going to the High Court or its equivalent in Scotland and Northern Ireland. However, there would be no appeal against the interim suspension imposed in the first instance by the investigating committee. I judge that the two-month maximum duration is adequate protection there.

Any allegation of unacceptable professional conduct, professional incompetence or that a chiropractor had been convicted in this country of a criminal offence would be referred to the professional conduct committee. The practitioner would be entitled to know the details of the

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case against him, and would have the right to a hearing and legal representation if he or she so chose. The committee will be barred from taking action when it is proved that the offence is irrelevant to the practitioner's fitness to practise. That deals with the point of my hon. Friend the Member for Sutton and Cheam about a chiropractor who is convicted for speeding.

If the professional conduct committee finds against a practitioner, it will be given certain disciplinary powers and will be able to strike his or her name off the register. It will also have the power to suspend a practitioner for up to three years, to impose conditions on future registration or simply to admonish the chiropractor. During the suspension period, the professional conduct committee will be able to extend suspension for a further three years or impose conditions for registration once it has expired. Again, the chiropractor concerned would have the right to a hearing and to legal representation.

The idea is that the power to extend the suspension period would apply to cases which had been heard and determined by the professional conduct committee, which had imposed a suspension but further, and perhaps even more serious allegations, had then come to light. The committee would be able to extend the suspension period, without the case having to begin again at the start of the procedure.

Mr. Harold Elletson (Blackpool, North) : I do not wish to deflect my hon. Friend from his theme, but he is talking in great detail about the functions of the general council's various committees, and there is a more fundamental concern about financing the council and especially about the initial start-up costs. I understand that no Government money will be available to assist with that. Will he deal with those start-up costs, and does he feel that the general council will be able to rely on using some of its existing rolling stock and funds from existing voluntary organisations ?

Mr. Lidington : Unless my hon. Friend the Minister has changed his mind since we last spoke, I understand that no Government money will be available for the establishment of the General Chiropractic Council. It will therefore be up to the profession to finance the start-up costs from its resources. That profession, or part of it, is strongly behind the scheme for statutory registration that is embodied in the Bill and sees it as a way to ensure that patients are adequately protected and that the good name of the British chiropractic profession, which it has built up painstakingly for some years, is also protected. The profession feels that it is able and willing to meet the costs that will be incurred.

The health committee will consider cases in which a chiropractor's physical or mental health gives cause for concern. The chiropractor involved will again have the right to a hearing and to legal representation. The health committee and the professional conduct committee will have different philosophies and remits. The PCC will have powers to punish practitioners for wrongdoing, but the health committee will exist to protect the public against chiropractors who become a potential risk to their patients through ill health. If the health committee finds a case proven against a practitioner, it must suspend him or her, or impose conditions on registration for a definite period of up to

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three years. The committee will be able to renew orders of that sort, as long as they are considered necessary for the safety of the public.

At first sight that sentence might seem draconian as it does not allow the practitioner the chance to renew his practice. However, the case may be reviewed and that will provide a sufficient safeguard for both practitioners and the public. Let us consider the example of a chiropractor who suffers a mental breakdown. It is not in his interests or that of his patients that he continues to treat them and he should be suspended. With time or treatment, however, his condition might improve to the point that the health committee, after reviewing the case, would feel able to remove the suspension and allow him to practise again. Initially, the practitioner might be subject to conditions, for example, that he work only under the supervision of another chiropractor or as part of a group practice. When a chiropractor wishes to contest a decision taken by the health committee, he or she would have the right of appeal to an independent appeals tribunal, consisting of an experienced lawyer, a medical practitioner and a chiropractor. The tribunal's function will be to provide a body independent of the general council to deal with all appeals from the health committee. To provide a double assurance, a further appeal could be made to the Privy Council on points of law.

I apologise for the length of time that I have taken. The Chiropractors Bill, like the Osteopaths Act 1993, is rather a lengthy document for a piece of private Member's legislation and it is important that the House should understand what is proposed. Before I sit down, I must acknowledge the debt of thanks that I owe to the many people who have offered me help, advice and support in recent months. Members of the chiropractic profession and the steering group, under the chairmanship of Ian Hutchinson, have been enthusiastic, supportive and full of information. The team of officials at the Department of Health who helped with the preparation of the Bill--led by Mr. Kenneth Allan--put up with my questions and responded promptly and efficiently to my requests for information and briefing. It got on with the job of assisting me to draft the Bill with great expedition, and I am grateful.

At the risk of turning this into a bridegroom's speech, may I say that thanks are also due to my supporters on both sides of the House. I have been struck by the extent to which the measure has support across party lines--from my hon. Friend the Under-Secretary of State, from the hon. Member for Bristol, South (Ms Primarolo) on behalf of the Opposition Front Bench and from the hon. Member for Rochdale (Ms Lynne), who is her party's spokesman on health matters and has agreed to act as one of my sponsors. I see that the hon. Member for Preston (Mrs. Wise) is also in her place. Thanks are due to her, as well as to those of my right hon. and hon. Friends who supported me in introducing the measure.

Although the Bill is quite long and technical, it is designed to deal with a very real problem which is a challenge to our health care. Chiropractic, like other forms of complementary medicine, has come of age and increasingly is seen to offer treatments that are efficacious and valuable to orthodox medicine. We need to ensure that the reputations of good and dedicated practitioners are protected and that patients are safeguarded.

In recent weeks I have met two patients. One was a middle-aged man--a self- employed builder--who told me

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