House of Commons Hansard Debates for 18 Feb 1994

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that orthodox medicine seemed to have failed him and that he had practically been carried into the chiropractor's consulting room, but had managed to walk out, which not only meant freedom from pain, but the ability to continue as a builder and to earn his livelihood. The other patient was a lady suffering from a muscle-wasting disease. She knew that there was no miracle cure, but regular chiropractic treatments had improved the quality of her life to an extent that she, her friends and family and originally even her doctor had thought impossible. She enjoyed independence and got more out of life because of that.

When medical matters are debated, both in Parliament and in the media, we tend to focus on the glamorous side such as organ transplants and pioneering surgical techniques. We forget the millions of people who suffer pain--often excruciating pain--from troubles with their backs or joints in other parts of the body. It is in the interests of patients such as those two whose cases I have just mentioned that I have introduced this Bill and why I commend it to the House.

10.39 am

Ms Liz Lynne (Rochdale) : I shall not detain the House for long because, as the hon. Member for Aylesbury (Mr. Lidington) said, the Bill has all-party support. I commend him for the length and breadth of his speech. On behalf of my party I am pleased to welcome the Bill. I am also pleased to be a sponsor of the Bill and I wish the hon. Member for Aylesbury every success in steering it through the House.

I have long been a user and advocate of alternative and complementary therapies and I welcome the move represented by the Bill and the Osteopaths Act 1993 to give official recognition to those therapies. According to one document that I have read, chiropractors are the third largest health care providers in the western world. Clearly, they are not a marginal or eccentric form of health care.

The Bill marks an attempt both to take chiropractors seriously and to help build confidence among the public in the profession. I regret, however, that it does not improve access to chiropractors on the national health service. I am sure that many hon. Members' constituents have written to them to complain about their local health authority failing to fund health care services out of the extra-contractual referrals budget. Alternative therapies are one of the many services that have been denied to patients because of the tight rein on ECR budgets. That restriction on the availability of chiropractic and other alternative therapies is despite the fact that treatment in a recent Medical Research Council trial was found to be much more effective than hospital out-patient treatment for lower back pain, especially for patients in chronic or severe pain.

Mr. Piers Merchant (Beckenham) : Will the hon. Lady give way ?

Ms Lynne : I should like to get on with my speech. The hon. Member for Aylesbury has taken so long to explain the Bill and gone into such detail that I shall not take interventions, if hon. Members will forgive me. The Bill has all-party support.

The ability effectively to treat members of the public with back pain will be no mean achievement. According to figures provided by the chiropractic registration steering group, 310,000 people in the United Kingdom are off work

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each day with back pain. That costs the country more than £3 billion a year in lost production. Disability from lower back pain is increasing faster than any other form of disability.

In other European countries, chiropractic is part of the overall process of treating back pain. In Sweden, for example, many chiropractors work with orthopaedic surgeons in hospitals where it is often found that chiropractic is a preferable and cheaper option to surgery. It is important to remember that. In the United States, more than 45,000 chiropractors are regulated and licensed by the same authorities as GPs and their fees can be paid under Medicare or Medicaid. In many other countries, chiropractors are registered and their training programmes are licensed.

The Bill brings us into line with many of our European partners. At present, anyone can call himself or herself a chiropractor and practise as one. As currently some 900 chiropractors are registered in this country, that should be a cause of great concern. Given the increasing interest in alternative therapies, it is clearly time to take action. For all the reasons that I have listed, the Bill is to be welcomed.

Nevertheless, I should like more consideration to be given to the rights of patients to know what treatment they can expect and how to complain when their expectations are not met. I should also like consideration to be given to establishing an ombudsman for all alternative therapies, although the Institute of Complementary Therapy hopes to be able to carry out that role on a non-statutory basis.

As the Bill is modelled on the example of the Osteopaths Act, it would be useful to have a report on the success of that Act during our discussions in Committee. If, for example, many osteopaths have not registered but are continuing to practise, we may have to consider tightening the rules as I suggested during the debate on the Osteopaths Bill. I am still convinced that displaying a practitioner's registration in his or her place of work would enable potential patients to know immediately whether the practitioner was suitably qualified.

Despite those small reservations, I very much welcome the Bill and wish it every success in its passage through Parliament. I hope that more resources can be found to enable more NHS patients to make use of chiropractic services.

10.45 am

Mr. Harold Elletson (Blackpool, North) : I congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on introducing the Bill and on the great detail in which he took the House through its various provisions. This is a matter of great concern to many people throughout the country, particularly many of my constituents who have written to me on that subject.

As we all know, many people suffer from back and neck trouble and have occasion to consult either an osteopath or a chiropractor. Many of our hon. Friends also suffer from back problems, particularly those of us fortunate enough to be involved in the backbreaking work of the Standing Committee on the Local Government etc (Scotland) Bill.

As my hon. Friend the Member for Aylesbury pointed out, chiropractic is the second most widely used branch of complementary medicine and some 25,000 people in this country consult a chiropractor every week. Of most concern to us, however, is the fact that, although the

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overwhelming majority of people who practise chiropractic do an extremely good job, when people consult a chiropractor they cannot be sure that the person treating them is properly competent. That is frightening because treatment is applied manually directly to the spine, which is connected to the central nervous system. I suppose that the equivalent of allowing an untrained person manually to treat the central nervous system would be to let the Labour party loose on the economy.

If treatment goes wrong, the only recourse that a patient has is through the common law. The Bill is important because it seeks to establish statutory regulations that would give patients the assurance that they need that the person treating them is properly qualified. As my hon. Friend said earlier, the current voluntary system cannot provide that degree of assurance. I understand that many hon. Members, particularly in the present climate, will be somewhat hesitant about introducing an extra system of regulation. The report of the King's Fund deals with that subject. Unfortunately, its chief executive is called Robert Maxwell. It is not his fault but I was alarmed to see that the chief executive of the King's or any other fund should be called Robert Maxwell. He is, however, a far more distinguished, competent and honest person than the former Robert Maxwell, who is so well known to all of us.

The chief executive rightly said that any branch of complementary medicine that met three criteria, which he outlined, should be recognised and regulated by statute. First, the therapeutic practice concerned should rest on solid foundations and science and have examinable knowledge and skills. Secondly, it must be able to demonstrate by objective standards that it can cure or alleviate pain and suffering when practised skilfully, and that it has power to do harm in the wrong hands. Thirdly, there must be significant public demand for it ; it must be shown that the public require help in differentiating reliable from unreliable practice and would be best protected by publicly accountable self-regulation by the professional concerned. The chief executive said :

"These criteria do not apply equally to all branches of complementary medicine but they do apply to chiropractic as to osteopathy."

The Bill provides an appropriate level of regulation. My hon. Friend has been careful not to overregulate and introduce an unacceptable amount of bureaucracy, and the Bill ensures that the general council is self- financing. He has sought to introduce a light-touch form of regulation. Essentially, the Bill is not so much about regulating the practice of chiropractic as about dealing with the whole question of the closure of title, the use of the word "chiropractor". That is the essence of the matter. When a patient goes to a person who holds himself out as a chiropractor, the patient should be absolutely sure that he can rely on a certain level of service and specific standards.

I congratulate my hon. Friend on his Bill. I offer him my full support and commend the Bill to the House.

10.51 am

Mrs. Audrey Wise (Preston) : I welcome the Bill, which is both desirable and necessary, and important for the future of health care. It is desirable because it deals with an important treatment that is increasingly widely used and that can be extremely beneficial, but that could be harmful

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in the wrong hands. I speak as someone who uses chiropractic. My interest was first aroused simply by reading and when the representatives of the British Chiropractic Association came to the House to give a demonstration to hon. Members, I decided to attend. That extremely interesting demonstration aroused my interest even more, since when I have read a considerable amount on the subject. The Medical Research Council carried out some famous research--a randomised controlled trial, which lasted at least two years and from which chiropractic emerged with flying colours as an extremely effective way to treat a great many problems. It is a legitimate form of treatment, but until now it has not been properly recognised as fully legitimate. When I developed some problems with my shoulder, I thought, "Here is your chance to show practical as well as theoretical support and to demonstrate that you have confidence rather than just saying so."

I put myself in the hands of a local chiropractor and I was immeasurably impressed by the treatment and the style of treatment. My mother and my son -in-law also have treatment, which means that three generations of my family are benefiting from chiropractic. The treatment is suitable and important for all ages.

I am particularly impressed by the fact that chiropractic is a communicative form of treatment. One is not simply a passive recipient but is involved and informed and leaves the chiropractor knowing a great deal more about one's body and with suggestions about self-help. That is an important feature that is rarely a part of orthodox medicine, which often regards people as passive receivers of treatment. In that respect, chiropractic has lessons for health care in general. The chiropractor seeks to enlist a person's body and physical resources in helping with the treatment.

In my experience, chiropractors are anxious to be part of the general medical or health care team and communicate with general practitioners. Some GPs welcome that communication but others probably put it in the bin. I hope that latter practice will end. The recognition afforded by registration under the procedures set out in the Bill will help to establish chiropractic not only with the public but with the other health care professionals.

The Bill is necessary as well as desirable because of the passing of the Osteopaths Act 1993. I support that legislation but I recognise that it poses dangers for chiropractic and for people who consult chiropractors. Some people who are unable to call themselves osteopaths and cannot be registered if their qualifications do not warrant it may decide to call themselves chiropractors. The fact that profession has been regulated makes it even more important to regulate the closely allied profession. It would be an undesirable spin-off from an otherwise good Act if people seeking chiropractic treatment were open to treatment by charlatans who are not properly trained and qualified.

For two reasons, the Bill is urgent and important for the future of health care. The first reason is that, as has been said, an enormous number of people suffer from back pain and from troubles related to the spine and the skeletal framework. People who suffer from such problems often have difficulty because those problems are not always obvious to the layman's eye. They are not always obvious to people such as Secretaries of State for Social Security, who are apt to add to the all-too-common view that suffering from back pain is just a form of malingering.

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Those of us who are interested in the Bill know that is not so, that back pain is extremely disabling and that, rather than being fobbed off with painkillers, people with back pain, which can lead to chronic disability, should have full positive treatment.

Orthodox medicine does not offer much to those who suffer from such problems. That was borne out by the results of the Medical Research Council's randomised controlled trial to which I have referred. Chiropractic is a good form of treatment.

The Bill is important to the future of health care. I see it as the first step towards making chiropractic more generally available. In an otherwise good and informative speech, the hon. Member for Aylesbury (Mr. Lidington), who introduced the Bill, made a throwaway remark : that most chiropractors practise in the private sector and that is unlikely to change. That suggestion is unwarranted, because it carries with it the implication that the Bill will make chiropractic safe and accessible to those who can pay. I want chiropractic to be safe and accessible to all who need it. Those two are not the same thing.

In my advice sessions--most hon. Members probably find the same--I frequently see people who are suffering from severe back problems, which often arise from occupational injury or occupational distortion. Frequently, it seems patently obvious that the person sitting opposite me would benefit enormously from chiropractic treatment--I feel that even more strongly since I have become a user of chiropractic--but what can be said to them ? Often, the people who are suffering have lost the capacity to earn their living, and often the way that they earned their living in the first place is the cause of their incapacity. Why should the House assume that chiropractic should be available only to a person who can pay ? Clearly, it would not be proper or possible to make chiropractic available widely on the national health service unless

Mr. Merchant : Will the hon. Lady give way ?

Mrs. Wise : I think that I saw the hon. Member rise to catch the Speaker's eye. If that is so, he can make his point in his own speech. If he wants to intervene and not make a speech, I will gladly give way.

It would not be proper or possible to make chiropractic widely available to patients free of charge through the NHS unless the profession were regulated in the way proposed in the Bill. I see that as a valuable step on the way to making chiropractic fully recognised and acceptable to people, regardless of their ability to pay. In saying that, I must make it clear that is not to be misunderstood. I do not want chiropractic, when it becomes available through the NHS, to be subsumed under the auspices of the medical profession. That would not be appropriate. Chiropractic is a fully trained profession in its own right. I believe that its practitioners are amply capable of autonomous practice, provided that they are regulated. If the hon. Member for Aylesbury had said that chiropractors would remain autonomous practitioners, as they are at present, I would have whole- heartedly agreed. Perhaps he had that in mind when he made his rather throwaway remark.

Being an autonomous practitioner should not imply that one will see patients only if they can pay directly. I believe that the Bill opens the door to the full recognition of a valuable profession, able to do untold good to many millions of people. It is a growing profession. People are voting with their feet, even though the treatment is

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available only privately except on the odd occasion. My local practice is extremely busy. People often make great sacrifices to consult chiropractors because they find the treatment so valuable. I look forward to making it even safer through the proper registration of practitioners. I look forward to the Bill being the first step along the road to making chiropractic accessible to all, regardless of ability to pay.

Mr. Ian McCartney (Makerfield) : On a point of order, Mr. Deputy Speaker. I thank the House for indulging me for a few moments. Have you, Mr. Deputy Speaker, received any notice in relation to early-day motions 636, 637 and 638, about the conspiracy at the heart of the North Hertfordshire NHS trust on the privatisation of its pathology services and the involvement of senior regional health authority officials

Mr. Deputy Speaker : Order. Did I understand the hon. Gentleman to ask in his opening remarks whether the Chair had received any information ?

Mr. McCartney : I want to know whether you, Mr. Deputy Speaker, have had notice of a statement in respect of the serious issues raised in those early-day motions, in particular the involvement of a senior regional health authority official in secretly promoting the privatisation of pathology services

Mr. Deputy Speaker : Order. That is not really a point of order for the Chair.

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : Further to that point of order, Mr. Deputy Speaker

Mr. Deputy Speaker : Order. There cannot be a further point of order to a point of order that never was.

11.5 am

Mr. David Atkinson (Bournemouth, East) : I congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on his good fortune in the ballot for private Members' Bills, his choice of Bill and his impressive presentation of it today. As he may know, I was personally committed to introducing it, were I to have been so fortunate. I am grateful for his invitation to be a sponsor.

Chiropractic was founded in the belief that a great many every-day disorders are caused by spinal defects impeding the work of our immune system. My personal experience, and that of many of my constituents and those of many hon. Members who have spoken in the debate, shows that a growing number of people are fully convinced of the benefits of chiropractic care. I am absolutely delighted that, at last, the prospect of the proper regulation, registration and, above all, recognition of chiropractors is now in sight. My hon. Friend's Bill, when it passes into legislation, will represent a fitting celebration of the centenary of chiropractic next year.

I am privileged to have located in my constituency, as my hon. Friend has already informed the House, the Anglo-European College of Chiropractic. It is one of three chiropractic colleges in the country and the only one to offer a university-validated five-year BSc honours degree course--a course that has been designated by the Department for Education to receive mandatory grants. I know that my hon. Friend has already told the House that he was impressed by what he saw at the college when he

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visited it last week. As a result of his Bill, today's graduates, their predecessors and successors will have their long and thorough training and education vindicated and recognised.

As you will know, Mr. Deputy Speaker, Bournemouth is a well-deserved favourite venue for the three political parties, which have their annual conferences at the Bournemouth international centre. When hon. Members visit Bournemouth to take part in those conferences, I very much hope that they will use that opportunity to visit the college in Parkwood road in Boscombe. I know that they will be welcome to see the impressive work and education that is undertaken there.

My hon. Friend's Bill is long overdue. As he has reminded us, the path to its introduction was well paved by the Osteopaths Act 1993, which was introduced by my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) last year. If no hon. Member had selected the Bill this year, chiropractic would have remained in the limbo land of non-recognition for another year and perhaps more years to come. That still applies to all the other leading complementary treatments, such as acupuncture, homeopathy, herbalism, aromatherapy and reflexology--all of which have important contributions to make to the health services.

To its credit, the British Medical Association recognised the position in a report published last year, which called for the compulsory registration of all the leading complementary medicines. That represented a welcome about- face from the BMA's 1986 report, which described such medicines as

"a reversion to primitive beliefs."

That, of course, was a veiled recognition that many of them are far older and more established than many current, conventional remedies. The BMA was only responding to a growing number of our constituents who--as the hon. Member for Preston (Mrs. Wise) said--have voted with their feet. Unfortunately, in some cases they have voted with their pockets as well, in finding relief and recovery when orthodox medicines have failed. The BMA was also responding to a growing number of its own members--general practitioners--who are referring patients to registered complementary practitioners such as chiropractors, employing such practitioners and, indeed, becoming registered complementary practitioners themselves. If they are fundholders, they are providing their patients with a free NHS service, contrary to the impression given by the hon. Members for Preston and for Rochdale (Ms Lynne).

Each of those professions, however, waits its turn in the queue for private Members' legislation, hoping for a Bill like this, or like last year's Osteopaths Bill. The process could--indeed, will--take years, which is entirely unacceptable. The Government should tolerate the current position no longer. A way forward has been provided by the enactment of the Osteopaths Bill and it will be confirmed by the passage of this Bill, which will emphasise the need to reform the Act that governs the professions supplementary to medicine.

Physiotherapists, for example, now suggest that the present Council for the Professions Supplementary to Medicine is not working well. They consider it unfair that complementary medicines such as osteopathy and chiropractic should now achieve clearer recognition and

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more straightforward self-governance than they themselves enjoy. Such long-overdue reforms, however, can be undertaken only by the Government, in Government time.

Any legislation amending the Professions Supplementary to Medicines Act 1960 can surely embrace the BMA's call for regulation of all the leading complementary medicines. My hon. Friend the Minister can invite the Research Council for Complementary Medicine to make appropriate recommendations to him ; alternatively, he can announce a Government inquiry into the most popular complementary medicines to subject them to scientific validation, with the ultimate aim of integrating orthodox with complementary medicines. Such integration has already taken place in the Netherlands. To do nothing, however, is no longer an option. I look forward to my hon. Friend the Minister's response.

My hon. Friend the Member for Aylesbury has made an excellent case for the benefits for patients that would undoubtedly result from the passage of his Bill. As he has said, it will effectively outlaw quacks who can set themselves up in a practice with a chiropractic nameplate, with no qualifications or competence and providing no realistic opportunity of redress if anything goes wrong.

I shall never forget a constituent who came to my surgery several years ago because of permanent disabilities arising from his so-called treatment--for which, of course, he was obliged to pay--by someone who was neither qualified nor competent. His was a very sad situation. Let me emphasise that practitioner was unqualified and clearly incompetent. My hon. Friend's Bill will effectively end such problems by ending the irresponsible use of the term "chiropractor". I hope that the Bill will encourage health authorities, hospital staff and yet more general practices to work more closely with the chiropractic profession. Chiropractic, osteopathy and other such complementary therapies require neither the expensive equipment used in NHS treatments nor the increasingly expensive use of drugs. Their statutory recognition will lead to enormous savings in our health services.

I believe that more widespread use of complementary treatments will also lead to greater accuracy in the diagnosis of disorders that still baffle the NHS, such as allergies and myalgic encephalomyelitis, or ME. I hope that the Bill will encourage companies to become more aware of the opportunities for them to refer employees to chiropractic. My hon. Friend the Minister expects to receive in the summer a report from his Department's clinical standards advisory committee inquiry into back pain. It will probably confirm that tens of thousands of people are off work with back pain every day, costing billions of pounds in lost production each year.

I hope that the Bill will encourage more private insurers to cover chiropractic treatment, because they will judge it more cost-effective than orthodox medical treatment. I understand that more than 30 private United Kingdom health insurance companies now reimburse the cost of such treatment.

Let me end by placing my hon. Friend's initiative within the wider context of the position of the chiropractic profession in Europe, about which my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) inquired. Unfortunately, enormous differences remain in Europe between the practice and controls of complementary medicines, which range from the very liberal to the very restrictive. Equally wide is the variation in the

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availability of access for patients to such medicines through national health services. There is no single market for health for European Union citizens. Surely, as citizens, we should be entitled to benefit from the same standard of complementary medicine--as well as orthodox medicine--in every member state.

It was for those reasons that, three weeks ago at the last session of the Parliamentary Assembly of the Council of Europe in Strasbourg, I tabled a motion for a resolution, which will now go before the appropriate committee for a report and a recommendation. It calls for a new European convention to provide every citizen with the right to benefit from complementary medicines and for a common approach to the recognition and registration of practitioners. Such a convention will, of course, require member Governments such as ours to implement its terms and conditions in national laws. There will then be no need for the piecemeal approach, in this country and throughout Europe, which has made my hon. Friend's Bill so necessary.

In the meantime, I wish my hon. Friend's Bill every success. I hope that it will have an unopposed and unimpeded passage through both Houses.

11.19 am

Mr. Piers Merchant (Beckenham) : I am delighted to be able to participate in this debate because I was so impressed by the competent and effective way in which my hon. Friend the Member for Aylesbury (Mr. Lidington) introduced the Bill this morning. I congratulate him on his wisdom in selecting this topic, which had become overdue for consideration. Unlike him, I rise without particular expertise in the topic--certainly not the expertise that my hon. Friend displayed. Until last summer, I knew little more than the fact that there was a difference between chiropractic and chiropody. I had no idea what techniques the practitioners carried out and I merely include chiropractic in the category of alternative medicine. I am glad to say that I was enlightened by a constituent, Clare Metcalfe, who runs the Beckenham and Bromley chiropractic clinic. In the summer, she had the wisdom to invite me to her clinic to see the work that she does and to learn a little about the art. I was extremely impressed, not least by the scientific approach behind this form of medicine. I was also impressed by the high professional standards which were clearly evident at the clinic and by the arguments for registration which Clare Metcalfe and the vast majority of her professional colleagues are strongly behind.

I started with a degree of suspicion about alternative medicine--a suspicion that is shared by many people. It probably comes from the prejudices that are inculcated in a modern scientific education which tends to exclude anything that is not orthodox. However, it is important always to retain an open mind and the more I look at the various practices of alternative medicine that are available, the more I see that there are options which are away from the orthodox path but clearly carry much merit. I very much accept the redefinition of chiropractic as a complementary form of medicine rather than an alternative, the stress being on the fact that it runs in parallel to traditional medicine rather than against it. Treatment can easily be carried out in harmony with existing orthodox medical practice.

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I have learnt that there are about 900 chiropractors in this country and that they treat about 75,000 patients a week. Chiropractic is a much larger area of complementary medicine than I had previously realised. I should like to correct the hon. Members for Rochdale (Ms Lynne) and for Preston (Mrs. Wise), who were not prepared to allow me to intervene. I intended to do so in a gentle manner merely to point out that it is possible to have treatment under the NHS system at present.

The hon. Member for Rochdale gave the impression that the Bill would do nothing to encourage treatment under the NHS. I beg to differ. Introducing a formal system of registration will automatically increase the status and prestige of this form of medicine and, in doing so, will encourage GPs to exercise their right to refer. That is significant because one of the barriers to the expansion and growth of respectability of chiropractic has been that many GPs have not been prepared to refer patients and in some cases they have not been prepared to acknowledge the benefits of chiropractic. The Bill will help to involve the NHS more. The hon. Member for Preston was simply wrong when she stated as a matter of fact that people have to pay for chiropractic. That is not the case. The practice I visited was receiving increasing numbers of referrals directly from GPs. GPs with fundholding budgets are able to use the staff element of the budget to pay directly for the treatment so the patient is treated on the NHS and does not have to pay. Non-fundholding GPs are able, with the agreement of the family health services authority, to transfer the cost of treatment to the NHS. I do not know whether any hospitals are using chiropractic. However, it is possible for hospitals to include chiropractic as long as a local decision has been made to that effect.

Mr. Alan Duncan (Rutland and Melton) : In support of my hon. Friend's argument and to give clear evidence to back up what he says, may I point out to him that my medium-sized surgery in Uppingham provides physiotherapy, chiropractic and even acupuncture on the NHS ? It is not yet a fundholding surgery, although I hope that it will be in due course. I also hope that acupuncture will in due course be the subject of a Bill similar to this one.

Mr. Merchant : I am delighted to hear my hon. Friend's information on that point. It is further evidence that chiropractic is increasingly being accepted within the NHS system. The driving force will be the demand and the recognition of the demand for these forms of complementary medicine. The Bill has an important part to play in that it increasingly puts chiropractic on a formal basis. My hon. Friend the Member for Rutland and Melton (Mr. Duncan) may know that three studies have recently been carried out which have a bearing on the Bill and on this form of medicine. The first is the Medical Research Council's study, to which the hon. Member for Preston referred. It was reported in the 1990 British Medical Journal . A team of epidemiologists and a rheumatologist studied 741 patients between the ages of 18 and 65. They compared the treatment received in hospital through traditional medicine with the treatment received from chiropractors. The study revealed that only one of the 11 hospital centres could perform better than the chiropractors. There was an insignificant difference between the performance of two of the hospitals and the chiropractors. The chiropractors were "significantly more effective" than

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eight of the hospitals. That demonstrates clearly to me that traditional medicine has recognised the benefits of chiropractic. The second formal study to which I shall refer, which is not a medical one, is the King's Fund study which looked at chiropractic. The researchers formed the view that registration along the lines proposed in the Bill would distinctly enhance the practice. The third study is a Department of Health-funded study by the medical care research unit at the university of Sheffield. It is looking at the impact on the NHS of the provision of chiropractic as an alternative. It is looking at, for example, the impact on GP prescribing, on the drugs budget, on hospital referrals, on patient satisfaction and on repeat attendances. The study may well demonstrate that chiropractic has a great deal to offer in terms not only of health but of the efficient use of resources within the health service system. Why is legislation required ? Is legislation automatically needed just because one recognises that a part of complementary medicine is useful ? The Bill is supported by chiropractors themselves. They recognise that the registration system proposed in the Bill will bring protection to patients and to chiropractors. I shall deal with the two points separately, although they are linked to some extent. The potential patient needs to know that, if he visits a chiropractor, he can be assured of a basic level of competence. As we have heard this morning, although the vast majority of chiropractors live up to that standard, there is nothing preventing someone from starting a practice and advertising it although he has no competence at all. The Bill will assure a basic level of competence for the patient.

The Bill will also enable patients to know that the chiropractors whom they visit have been trained to a certain standard and can provide care of a certain minimum quality. It would mean that the chiropractors' training was recognised and approved and would not therefore take the would-be chiropractor in a totally different direction from mainstream practice.

In addition, patients need to know that they can trust a chiropractor. The Bill would ensure a proper system of registration which would bring with it a proper system of discipline, thus ensuring that there were no people practising who should not be doing so.

What about chiropractors themselves? The most important thing is that the Bill would give them a clear status and protection against their reputation being somehow impaired by people who set themselves up as chiropractors without having the right to do so. Let me cite an example. Under the existing law, in the very unlikely event of my losing my seat, I could decide to make as little money by setting myself up as a chiropractor. Without any legal hindrance, I could have a little brass plate made and stuck on the front of my house and describe myself as a chiropractor. I could invite people into my front room and treat them.

In losing my seat, I might have become mentally deranged and I might start behaving rather peculiarly with my patients and doing all sorts of strange things to them which could harm them medically, apart from having little to do with the art of chiropractic. Even worse, I might develop a very unhealthy interest in massaging the backs of young ladies and might invite them into my front room

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solely for that purpose while posing as a practitioner of alternative medicine. As long as I broke no other law, I could not be struck off because there would be no register from which to strike my name.

The system of registration would involve a system of committees observing practitioners and thus a system of proper discipline. The public would be safeguarded, and future and existing chiropractors could be assured that anyone coming il body and, as I said earlier, treatment would be more widely available under the NHS.

Mr. Elletson : The doctor who runs the Blackpool chiropractic centre in my constituency is an American. He is also a general medical practitioner who specialises in chiropractic. When he arrived in this country he was astonished to find that, unlike America, where very strict regulations govern chiropractic, there is nothing here to protect the public from charlatans. Why does my hon. Friend believe that is so? The Bill is trying to ensure that we are protected from charlatans. It would mean that Britain would no longer be out on a limb and so unusual in having no regulation governing this practice.

Mr. Merchant : I agree with my hon. Friend. We need to protect the public and the profession against the small number of quacks who are always liable to be attracted to something from which they might be able to make money without performing a service. The same is true of many other areas of activity.

I am in no sense a regulator ; I do not wish to introduce rules, regulations or legislation unless absolutely necessary, but in medicine, when we are dealing with people who are vulnerable, especially when they are ill and need treatment, the public are very much at the mercy of people who set themselves up as being able to help in some way. Unless there is a formal system to prevent that, the public are in potential danger. The Bill deals neatly with that problem.

The system of registration is well tried and tested and strikes me as a sensible way of tackling the problem. It does so with sensitivity because it does not seek to intervene in the medical aspect or determine exactly what chiropractic is or should be. Instead, it allows the profession to decide that, as it should. As my hon. Friend the Member for Blackpool, North (Mr. Elletson) said, the Bill seeks merely to define and limit the use of the word "chiropractor". In the proposed legislation, the so-called "grandfather clauses" would also protect the practitioners who have had some training but who do not immediately fall within its strict requirements. It offers a gentle way in which to proceed which would nevertheless achieve the objective without discriminating against genuine chiropractors who have been practising but have not gone through the mainstream system.

The education committee will ensure that training is promoted and that standards are kept at a high level. The investigating committee will in various ways protect against unacceptable professional conduct and professional incompetence and will prevent chiropractors who have been convicted of criminal offences continuing to practise.

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It will also regulate those who are unfit because of a medical or mental condition. High standards will be ensured for practitioners and the public.

The Bill will give official respectability to a profession which is already a great success and which is recognised as such by the general public. It will provide faith in a relatively newly accepted form of medicine. In particular, it will enable chiropractic to grow within a formal framework which will nevertheless not place draconian restrictions on it. It will protect without limiting, which is the essence of good regulation. For those reasons, I have no hesitation in supporting this excellent Bill, and I wish it a swift passage through Parliament.

11.37 am

Lady Olga Maitland (Sutton and Cheam) : I am sorry that my hon. Friend the Member for Aylesbury (Mr. Lidington) is not in the Chamber at the moment because I wish to put on record my congratulations to him on his masterly delivery of his brief and on his stylish presentation.

The Bill is long overdue. Last year, I had the honour to serve on the Committee that debated the Osteopaths Act 1993 and I was well aware that this Bill, which was waiting in the wings, would have its day. That day has now come. It is right that the Bill should not have been confused or merged with the Osteopaths Act for the sake of convenience, as some people suggested. Osteopathy and chiropractic are different disciplines, although they operate within the same sphere. Chiropractic, however, stands on its own merits.

I welcome the fact that the legislation will give doctors confidence which they might not otherwise have had to refer their patients to chiropractors because they will know that the practitioners are registered and have achieved the highest professional standards. Such a development is welcomed by the British Medical Association and the Royal College of Surgeons. In turn, patients will be protected in the knowledge that their practitioner has been trained to high standards. As has been explained, a practitioner could also be subject to professional discipline should things go wrong.

Chiropractic is a growing profession. As has already been said, there are 900 chiropractors on voluntary lists, which are maintained by three organisations, and it is estimated that each week 75,000 patients consult chiropractors. The history of chiropractic goes back a long way. It began in the past century in Iowa in the United States and celebrates its centenary next year. There are more chiropractors in the United States than there are osteopaths--the reverse of Britain. None the less, a Which? survey in 1992 showed that in Britain chiropractic was the second most frequently used complementary therapy. I emphasise that it is complementary, not alternative, therapy. It offers the patient an additional option of treatment for certain conditions by which they have been afflicted. The cause that drives patients to a chiropractic is a pain which is almost impossible to describe. It is widespread, it is a misery and it can be utterly crippling. It is extremely difficult to cure back pain. It is like trying to cure a leak in a roof. Moreover, the victims of back pain suffer because it is not glamorous. Unlike a leg in plaster, one cannot see it. Back pain does not kill and it is not a terminal illness,

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but it can be such hell that there have been recorded incidents of patients being driven to suicide through suffering pain.

I congratulate the Government on recognising the importance of back pain. Indeed, the White Paper "The Health of the Nation" stated that back pain had a strong claim for priority action. The successful treatment of back pain by chiropractors has been recorded. In 1989, a MORI poll showed that 93 per cent. of users were satisfied with their chiropractic treatment.

There is more to the treatment than simply relieving people of the miserable pain. Relieving people of that pain means that we can get them back to work. Days off work as a result of crippling back pain are astronomical. One can find all sorts of different estimates, but it is reckoned that 310,000 people are off work every day with some kind of back problem. If one uses a pocket calculator and multiplies those figures, we may conclude that millions of working days are lost annually through back pain. It has been estimated that the country has suffered a loss of more than £3 billion every year in lost production.

To put it another way, it is estimated that four out of five people experience back pain at some time in their lives. I shall add my mercifully short-lived experience--it lasted only 10 days. I have never known such pain. I was fortunate that it resolved itself, but I have an inkling of what other people go through.

The people most likely to be at risk from back pain tend to be athletes, who, by the nature of their activities, push their bodies hard ; nurses, who have the task of lifting heavy patients ; and housewives--I am proud to be a housewife on top of my other duties--who experience the hard work of lifting equipment in the house and heaving children on the hip, which is certainly not good for us. We also drive ourselves to becoming victims of back pain through poor posture, by falling, by driving cars with badly designed seats in our car-crazed society and by sitting long hours in front of a computer terminal or a typewriter, which can cause spine, neck and shoulder problems. Severe problems may be caused by sciatica, arthritis and rheumatism. The hon. Member for Preston (Mrs. Wise) pointed out that those conditions do not respond well to rest and pain killers and we must use alternative help--hence the important role of chiropractic.

Complementary medicine is not new and some unlikely names have resorted to it. I can go no higher than Her Majesty the Queen, whose support for homeopathy is well known. His Royal Highness the Prince of Wales supports osteopaths, but the chiropractic profession is not to be outdone, because Her Royal Highness the Princess of Wales is its patron.

My hon. Friend the Member for Bournemouth, East (Mr. Atkinson) described the work of the Anglo-European College of Chiropractic. That college has world recognition and has made a large contribution to research. It provides advice on how to avoid pain by standing correctly with evenly distributed bodyweight, how to ensure that our necks and backs are in straight lines--even as I speak, I am trying to practise what I preach--and how to sit straight in chairs with the base of the spine well-supported. Considering that we spend so many hours in the Chamber, I am glad to see that the green Benches are designed to give us more support, although it is sometimes a little hard. The college also advises car manufacturers on driving positions which avoid having to stretch the neck

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