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and on car seats which support the lumbar regions, the spine and the thighs. It advises patients to sleep with one pillow only and always to have a good, hard mattress.

The wonderful news about chiropractic is that it has come in from the cold. For years, chiropractic treatment has been ostracised by conventional medicine, but attitudes have moved on. In 1986, the British Medical Association dismissed complementary medicine with olympian disdain, despite the fact that in 1981 the British Chiropractic Association approached the Medical Research Council to evaluate chiropractic for low back pain.

Mr. Elletson : I am sure that we were all interested in what my hon. Friend was saying about posture and I compliment her on her posture, which is especially elegant. I was very disturbed by what she had to say about the possible threats to her posture caused by the heavy equipment that she was accustomed to lift around her house in her capacity as a housewife, and I am sure that my hon. Friends and I would want to assure her that any time that she wants help to lift heavy equipment we would be delighted to oblige.

Lady Olga Maitland : I thank my hon. Friend for his kind offer and naturally I will take up his assistance any time--it is more likely to be in the House of Commons when lifting typewriters.

I shall return to discussing the valuable work conducted by the Medical Research Council in evaluating the efficacy of chiropractic. It studied 741 patients with back pain, who were randomly selected and allocated to chiropractors or to the usual hospital out-patient treatment centres in 11 localities across the country. The patients were asked to respond to a questionnaire about their pain and disability. The results showed that chiropractic was considerably more effective than orthodox hospital out- patient treatment. Patients said that they experienced

"large benefits in relief of pain and increased activity." That contributed to the improvement in the patient's quality of life. The MRC report said :

"There may be substantial economic benefits arising from the introduction of chiropractic into the NHS."

Although that could add about £4 million at 1989 prices if it were extended in a full breadth, it should be pointed out that if it provided for

"the 72,000 referrals per annum who would be suitable for chiropractic treatment it would be offset by savings of around £13 million"

a year

"in lost output and £2.5 million in social security payments". I trust that the Minister will tell us of his hopes to expand the availability of chiropractic treatment in the health service, although it has already been pointed out that GP fundholders take advantage of their budgets to send patients for chiropractic treatment. It could be that the passionate remarks made by the hon. Member for Preston about the lack of NHS treatment for her constituents are a result of the fact that in her constituency there are no GP fundholders. The reasons could be political rather than medical. A total saving to the country of nearly £16 million a year is worth making ; hence there is a powerful case for chiropractic being medically and economically sound.

The success of the treatment is not lost on a whole range of people apart from the royal family. I can give the

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example of a leading actress, Helena Bonham -Carter, who is a devotee of chiropractic after having been relieved of the back pain that plagued her in her early twenties.

The Medical Research Council, in the conclusion of its report, said :

"The results of the trial leave little doubt that chiropractic is more effective than conventional hospital treatment."

It is gratifying that the British Medical Journal published a research paper which said that chiropractic works so well that it should be considered widely in the national health service. In a letter to The Times in July 1993, Dr. Fleur Fisher, the head of ethics, science and information at the British Medical Association, supported the regulation of complementary therapies and said : "There is no war against therapies that may indeed be complementary. Our report recommended that closer collaboration between the medical profession and practitioners of non- conventional medicine should be encouraged in research."

About two thirds of family health service authorities, general practice fundholders and district health authorities think that complementary medicine, and within that chiropractic, has a valued place.

I want to make a proud boast. One of the largest chiropratic practitioners in the country is in my constituency, in Sutton. The practice is headed by Dr. Brian Hammond in the Brighton road, in a building that is a familiar landmark to my local community. Out of 166,000 people in Sutton, the practice has now treated 16,000 patients ; that is one in 11. The practice sees about 500 people a week, 65 per cent. of whom come to the practice directly as the first port of call and 35 per cent. of whom come as general practitioner referrals. Five years ago, the picture was quite different ; in those days, 80 per cent. made their own way to the chiropractor and only 20 per cent. were referred by their GP. Ten years ago, the picture was even worse ; about 95 per cent. had to use their initiative and make their way there, with five per cent. only being sent by their GP. It is remarkable to see the rapid acceleration and acceptance of the chiropratic profession within the health profession.

Dr. Hammond made his contribution to chiropractic medicine by selecting for his PhD thesis the examination of methods of identifying people who might develop back pain in the future. In other words, he was looking at preventative medicine. Time prevents me from discussing that further, but it must be said that Dr. Hammond is a key figure in this field. I believe that he is one of the examiners at the college in Bournemouth.

It is significant that, although chiropractic treatment is largely paid for by patients, it should be taken on board that the cost is manageable. Certainly, in Sutton, patients pay on average about £20-plus--I have to say that the plus is for value added tax. Herein lies the rub. Practitioners are treated as small business men and are therefore required to pay VAT on the services that they offer, which puts up the price. There is welcome news in that, once the statutory register is open, I understand that Customs and Excise will recognise chiropractic practitioners as health professionals and therefore VAT need not be charged. That means that chiropractors will catch up with dietitians, chiropodists, occupational therapists, orthoptists, physiotherapists and radiographers.

Dr. Hammond, in common with all his colleagues, is delighted that the regulation of chiropractic as a profession will outlaw rogue practitioners. He wants to see the highest standards maintained because he is deeply aware of the dangers of rogue quacks, which are fairly obvious.

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Patients put their trust in chiropractors and, as my hon. Friend the Member for Beckenham (Mr. Merchant) described so vividly, that trust can be totally abused. With chiropractors having no recognised training and simply putting up name plates, they can abuse that confidence and dangerously mis-diagnose patients. They could overlook a serious condition and, indeed, fail to send patients to a GP. It has already been recognised that severe back pain can often mask other serious conditions, even cancer.

Proper and conscientious chiropractors with six years of training behind them carry out their work in a detailed and careful way. They carry out many tests, including X-rays and blood and urine tests, which quickly identify any serious medical mischief that needs to be tended to. However, it is unlikely that practitioners with only brass name plates to their names will go to that trouble.

The Bill is especially welcome. As the report of the King's Fund recognised, the demand for the services of chiropractors is set to double over the next five years. I congratulate Sir Thomas Bingham, who is now Master of the Rolls, on chairing such a distinguished team. I also welcome the presence in the Gallery today of Mr. Simon Fielding, who is an observer --

Mr. Deputy Speaker : Order. The hon. Lady must not refer to people in the Gallery.

Lady Olga Maitland : I stand corrected. I am delighted that those who are observing the proceedings today will see that their own work has been fully recognised. Chiropractic will now catch up and be statutorily regulated, as it is in 17 countries, including most of Europe. It is entirely appropriate that Great Britain and Northern Ireland, which were almost alone among English-speaking countries in not recognising chiropractic, are now following other countries. I wish my hon. Friend the Member for Aylesbury every good speed in piloting the Bill though its remaining stages.

11.58 am

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : I start by adding my congratulations to my hon. Friend the Member for Aylesbury (Mr. Lidington) on both his success in the ballot and his excellent choice of Bill. May I say straight away that the Government fully support the Bill and hope that it will receive the support of the House.

Chiropractic is an important topic because it would appear that almost since the birth of time physicians have used manipulative techniques in the treatment of patients. The earliest recordings are contained in Chinese writings dating back to 2700 BC. Hippocrates and Galen both wrote on the benefits of manipulating the spine. Throughout medieval times and into living memory, local "bonesetters", as they were sometimes called, practised techniques that were to become the early precursors of modern chiropractic and osteopathy. Chiropractic was developed in the United States in the latter years of the last century. The first person to benefit from chiropractic treatment as we know it today was said to be Harvey Lillard, who had become deaf following an injury to his spine. On 18 September 1895, his spine was manipulated by Daniel David Palmer, the father of modern chiropractic, and his hearing was restored. I trust that my

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hon. Friend's Bill will be successful in reaching the statute book in time for the profession's centenary celebrations next year. Chiropractic arrived in Britain in the early years of this century. In 1925, the first voluntary professional association for chiropractors, the British Chiropractic Association, was founded. It was not until 1965, however, that, after several unsuccessful attempts to set up training institutions in this country, the first permanent school, the Anglo-European College of Chiropractic, which is now in Bournemouth and to which several hon. Members have referred, was established. Prior to that, chiropractors wishing to practise or to learn generally had to travel to the United States to receive formal training. In 1988, the college's degree course was validated and approved by the Council for National Academic Awards, becoming the first degree course in complementary medicine to be recognised in this country.

For many years, the Anglo-European college provided the only training in chiropractic in the United Kingdom. In 1972, however, in response to popular demand, John McTimoney, a former jeweller and silversmith who had benefited from chiropractic treatment, opened a school in Oxford. Although he received his training from a graduate of the original Palmer school, Dr. Mary Walker, he developed a technique that differed from those being taught and used by other chiropractors at that time.

In 1984, a further school, the Witney School of Chiropractic, was founded in Oxford by Hugh Corley. He had trained at the McTimoney school under McTimoney, under whose guidance he went on to refine and develop a further variation of manipulation, now known as the McTimoney-Corley technique. Both the McTimoney and Witney schools are working towards securing validation of their respective courses. Holders of diplomas from those schools also participate in systems of voluntary registration. McTimoney chiropractors are registered with the Institute of Pure Chiropractic and McTimoney-Corley chiropractors belong to the British Association of Applied Chiropractic. The profession has continued to grow and develop. There are now more than 900 chiropractors working in the United Kingdom, twice the number who were practising five years ago, with the number of practitioners likely to double again before the next century. It is estimated that about 75,000 men and women each week from all walks of life and across a wide section of the population consult a chiropractor. That figure is perhaps three times higher than the figure given by my hon. Friend the Member for Blackpool, North (Mr. Elletson) in his otherwise accurate and interesting speech. That makes chiropractic the most widely used complementary therapy after osteopathy. I now declare an interest, in that I am a long-term sufferer of back pain. There have been a number of attempts to sort me out over the years, and I remember when I was about eight it was decided that one of my legs was shorter than the other. I was given built-up shoes, which gave me nothing except an inferiority complex. I discovered the chiropractic profession through my good friend Stanley Grundy at the National Back Pain Association, who arranged for me to travel to Sutton to be treated at the excellent practice which was referred to by my hon. Friend the Member for Sutton and Cheam (Lady

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Olga Maitland). I failed to ask my hon. Friend's permission or approval before I made what was a partly medical, partly ministerial visit to her constituency, and I apologise.

The visit was worthwhile because it gave me an insight into the subtlety and the efficacy of chiropractic, and into the excellence of the profession. Most people like me consult a chiropractor because of lower back pain, but, as has been said, chiropractic treatment can be also used to treat head injuries, neck and upper body pain, rheumatism and sports injuries.

In 1990 the British Medical Journal published the results of the first clinical trials of chiropractic in this country. The trials compared chiropractic treatment with hospital out-patient management of lower pain back in 741 patients across 11 centres. As the hon. Member for Preston (Mrs. Wise) pointed out, the results showed that only one hospital department appeared to get better results than chiropractic. Improvements persisted over time, and chiropractic patients also benefited from a reduced chance of needing further treatment.

I am not aware of another discipline within complementary medicine which has taken the bold step of allowing its practice and treatment skills to be tested in this way against mainstream medicine. In 1990, a poll conducted by The Times and MORI suggested that 93 per cent. of those consulting a chiropractor were satisfied with the treatment they had received, and I would include myself in that.

The value of such treatment has also been recognised within industry. It is perhaps not widely known that the Taunton Cider Company has, for the past 10 years, engaged chiropractors to treat its work force. Similarly, the Saccenda factory in Northamptonshire took part in a small pilot project to provide chiropractic treatment for its employees.

Those employers, as well as others such as St. Ivel, British Cellophane and the South West electricity board, believe that making chiropractic treatment available to their work forces clearly provides a cost-effective way of ameliorating the effects of industrial injuries, and reduces the time and the production lost through sickness. Many would say that also reflects good industrial relations, and makes an important contribution towards meeting "The Health of the Nation" targets by improving the overall health of the work force.

Chiropractic has similarly continued to grow in stature in the eyes of the medical profession. Lord Walton said in another place : "Some 20 to 25 years ago it was regarded as improper for a doctor to associate with complementary practitioners".--[ Official Report, House of Lords, 31 January 1992 ; Vol. 534, c. 1593.]

He went on to say that at that time a doctor referring a patient to a non- medically qualified practitioner would have fallen foul of the recommendations of the General Medical Council on professional conduct and discipline.

Today, however, the medical profession regards chiropractic as complementary to the treatment provided by medical practitioners and a treatment that enhances the range of possible treatments available to patients. Cross-referrals between GPs and chiropractors are becoming more common. These days it would not be unusual for a chiropractor to treat a patient who is concurrently receiving medication from his or her general practitioner.

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As many will know, "chiropractic" literally means "treatment by hand". It involves assessing the patient's condition and making a manipulation or adjustment to correct it. Chiropractors will not provide treatment where there are signs of other complications such as inflammatory disease, infection or indications of a tumour in the spine. In the same way, chiropractors will not use some of the more vigorous techniques if there is evidence of osteoporosis, damage to ligaments or recent fractures to bones. Chiropractors also take particular care if the patient has a history of circulatory problems, including aneurisms.

Before commencing treatment, a chiropractor will take a detailed life history from the patient, making observations on such matters as lifestyle, posture and gait. Some chiropractors may also make use of X-rays, but the principal assessment and treatment tool for all chiropractors is their hands. Should the chiropractor come across something that suggests that chiropractic treatment would be inappropriate, or discovers evidence of a more serious underlying health problem, he or she will refer the patient to a medical practitioner.

Once all the stages that I have described have been completed, treatment may begin. Within the range available to a chiropractor are such techniques as mobilisation, which involves moving joints to their full extent, manipulation or adjustments that return misplaced or badly aligned joints to their correct position. Those techniques all require absolute precision and the highest level of skill. As my hon. Friend the Member for Aylesbury has said and other hon. Members have reiterated, at present anyone can call himself or herself a chiropractor and set up in practice. There is no obligation for practitioners to undergo any formal training or to comply with any standards of professional competence or ethical practice. Although the current voluntary regulation schemes have been well supported and, to their credit, reasonably successful, they cannot enforce standards of competence or conduct because at the end of the day a practitioner can simply decide to opt out of membership. Therefore, the public have no guarantee that people calling themselves chiropractors are properly qualified or competent in either the practice of chiropractic or the skills of differential diagnosis, which is knowing when chiropractic treatment is inappropriate and medical attention is more properly and perhaps more urgently required. My hon. Friend's Bill will enable such doubts to be eradicated.

The Bill is the first to be introduced with the aim of securing statutory regulation for the chiropractic profession. Statutory regulation is a goal for which the profession has been striving for some years. In the past, however, such efforts have been pursued in a somewhat piecemeal fashion by one part or other of the profession acting independently. For example, in 1975 the British Chiropractic Association applied unsuccessfully to be included as one of the professions regulated under the Professions Supplementary to Medicine Act 1960. It would therefore be fair to say that chiropractors, as represented by the present association, have not always seen eye to eye on the way forward for the profession.

A significant breakthrough occurred in 1991, when representatives from all the chiropractic associations came together to form the chiropractic registration steering group. That organisation, which is now a limited company,

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represents the unified voice of the chiropractic profession and exists for the single purpose of paving the way for the statutory regulation of the profession.

The profession can be justly proud of the chiropractic registration steering group and its achievements. Many people would agree that the profession would not be where it is today if it were not for the determination and commitment of members of the group. It has moved rapidly and with authority to achieve consensus within the profession. Education and training is the most significant area in which it has made inroads. It has agreed that, within five years of legislation regulating the profession coming into force, all chiropractic education and training institutions in the United Kingdom represented by members of the steering group will have levelled-up standards, for the benefit of patients and the profession alike. That is not to say that chiropractors registered within one of the registering bodies are not properly trained, but is an acknowledgement of the fact that the profession has developed in the United Kingdom along distinct and separate lines and that it now wishes to pull together in the same direction.

Nor does the agreement mean that the McTimoney and McTimoney-Corley schools will lose their individualism. The Bill is not an attempt to dictate the curricula to be taught. Diversity of approach stimulates innovation. For instance, medical schools differ considerably in their emphasis over elements of the curriculum and the way in which they are taught, but they all produce safe and competent doctors. It is therefore essential that the diversity that already exists within the chiropractic profession continues to flourish under the proposed statutory scheme.

I underscore the importance of the chiropractic profession continuing to build on and exploit the unity that it has achieved through the steering group. My hon. Friend's Bill is the means that could cement that unity and lead the profession on into the future. I therefore take this opportunity to urge all chiropractors to support the contribution that their organisation is making to the work of the steering group.

The Bill will preserve patients' freedom to choose the type of chiropractor they consult, while meeting the concerns that the profession rightly has to ensure that there are adequate safeguards. Under the terms of the Bill a single statutory body, the General Chiropractic Council, will be established to develop, promote and regulate the chiropractic profession and set standards for educational and professional competence. The general council will be the vanguard of the profession and will play a key role, especially during the scheme's formative years, to help to raise the profile of chiropractic as it is practised in all its various forms in the United Kingdom.

As my hon. Friend the Member for Aylesbury said, the initial chiropractic members of the general council will be appointed by the Privy Council, after consultation with those organisations that administer the present voluntary registration schemes.

I understand that when the King's Fund working party made recommendations on membership of the first general council, consideration was given to granting each of the existing voluntary registration groups a proportion of the seats on a pro-rata basis. The working party's final recommendation, however, was that the Privy Council should appoint the first chiropractic members after consulting with those bodies

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that operate the voluntary registration schemes, not as representatives of a particular organisation but on the basis of their individual ability and merit. Those members will, therefore, be selected to represent the different branches of chiropractic in the United Kingdom and for their ability to help to secure the highest standards of clinical practice and bring out the very best ideas from all quarters of the profession.

That members will be neither delegates or representatives of a particular organisation nor beholden to any sectoral interests will be of key interest in enabling the profession to move forward to the next stage of its history. So it is worth making the point again that members will be selected on the basis of their individual ability and merit to be ambassadors for the whole profession.

At about this time last year, the House had the privilege to debate a Bill introduced by my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss). His Bill successfully went on to complete all its stages and became the Osteopaths Act 1993. It has provided a model not only for the chiropractic profession but for all the professions of non-conventional medicine to follow. I had the honour, as did the Opposition spokesman, the hon. Member for Bristol, South (Ms Primarolo), to contribute to the debate and support that Bill. It builds on the stepping stones to statutory regulation described in 1985 by my noble Friend Lord Glenarthur, the then Under-Secretary of State in what was in those days the Department of Health and Social Security. Those set out the criteria which the Government expected professions of non-conventional medicine to fulfil before they could be considered for statutory regulation.

The same principles apply today and it may help the House and my hon. Friend the Member for Bournemouth, East (Mr. Atkinson), who asked about complementary medicine in general, if I set out those principles this afternoon. First, the therapy should be founded on a systematic body of knowledge. Secondly, there should be in place a recognised system of voluntary registration that embraces an appropriate and enforceable code of conduct. Thirdly, the move to statutory regulation should be supported by members of the profession--I have already touched on the need for unity within the chiropractic profession. Fourthly, the profession should secure the support and acceptance of the medical profession. Finally, the profession should go on to test the will of Parliament by means of legislation.

Like the osteopathic profession, the chiropractic profession has been working at and meeting those criteria for a number of years. In December 1991, the chiropractic profession trod the pathway laid by osteopathy by securing the agreement of the King's Fund to set up a working party on chiropractic to consider the case for statutory regulation. Like the working party on osteopathy, that working party was chaired by the right hon. Sir Thomas Bingham, Master of the Rolls. The working party published its report in May last year and recommended the establishment of a statutory scheme that mirrored the provisions of the Osteopaths Act.

I should like to express the Government's thanks to the working party, the right hon. Sir Thomas Bingham and other members, and to the King's Fund. Without doubt they made a significant and central contribution to the chiropractor's pursuit of statutory regulation. Having satisfied the criteria that I have described, the Government believe that the most suitable way for a

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profession to pursue its quest for statutory regulation is by way of a private Member's Bill. I know that some hon. Members hold the view that a Bill as detailed and complex as this one should be a Government Bill. I assure the House that, as with the Osteopaths Bill, we gave this matter careful consideration. The fears of some hon. Members about supporting a private Member's Bill of such length and complexity as that of the one for osteopaths proved to be unfounded. I hope that such fears in connection with this Bill will also be unfounded.

We concurred with the view, held over many years by successive Ministers, that professional regulation, particularly the regulation of a non-orthodox medical profession, should be pursued by the private Member's route. That frees Parliament from traditional party influences, allowing it to make up its own mind on this important issue according to the merits of the case. As I have said, the shining example of the Osteopaths Act clearly demonstrates that approach can be successful. I hope that my hon. Friend's Bill will build on that example and will give further encouragement to those practitioners in complementary medicine who wish to pursue this aim. I shall now deal briefly with the contents of the Bill. My hon. Friend the Member for Aylesbury has outlined its purpose and content and its major provisions. The regulatory system proposed for chiropractors is, of course, closely modelled on those that exist for other major professions, including all the key health care professions. In particular, it follows the pattern of statutory regulation enshrined in the Osteopaths Act, reinforcing that as the model for other groups.

In common with the Osteopaths Act, my hon. Friend's Bill explicitly designates professional incompetence as a basis for disciplinary investigation. I know that other professions have been encouraged to investigate ways and means of introducing that concept for their members. The solutions reached may be different from the different professions, but osteopaths and chiropractors can take pride in the fact that they propose to include this provision from the outset of their statutory scheme for the benefit of their patients. Similarly, the Bill contains a provision for the future introduction of compulsory refresher training as a condition of continuing registration. That is in line with current thinking in a number of health care professions, and follows the precedent set in the Osteopaths Act. That provision will help to reassure the public that the practitioners whom they consult are keeping up to date with knowledge and developments in their fields.

Perhaps one of the most important elements of the Bill is its provision to protect the title "chiropractor" or any variations of the term, and to make it a criminal offence for other than a registered practitioner to call himself by that name. I know that provision interests many related professions. I confirm that it is not intended to prevent other professionals such as physiotherapists from using chiropractic techniques in the course of their practice or from telling their patients that they are using such techniques. The offence provides specifically for closure of title, not closure of function. I hope that my remarks will reassure those who are concerned about that. Other professions are anxious to secure closure of their professional title. Our advice to them is to follow the

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examples of osteopaths and chiropractors and to seek that goal through private Member's legislation. I see, for example, that podiatrists have followed that advice and are seeking to secure closure of their title through the Bill that was introduced by the right hon. Member for Manchester, Wythenshawe (Mr. Morris). As careful readers of the Bill will have noted, it also contains a panoply of appeal rights--for example, at various stages of the proposed fitness-to-practise procedures--against a decision of the general council to remove a name from the register that has been fraudulently or incorrectly made, and as part of the registration process. The Government's view is that those are desirable and necessary to fulfil our human rights obligations. The Bill also reflects our European obligations in respect of the recognition of professional qualifications.

As my hon. Friend the Member for Aylesbury has already remarked, added protection for the public is provided through the exemption of registered chiropractors from the Rehabilitation of Offenders Act 1974. That will bring chiropractors into line with other health care professionals and will mean that applicants for registration will, if asked, be required to declare all their criminal convictions, including spent convictions. The General Chiropractic Council will also have the power, through rules approved by the Privy Council, to ensure that practising chiropractors hold professional indemnity insurance. The scope of these rule-making powers will be sufficiently wide to enable the general council to check that requirement is being complied with and initiate disciplinary proceedings against a practitioner where it is not.

There is nothing in the Bill to affect the rights of members of the public to consult chiropractors direct, nor chiropractors' professional freedom to treat their patients. With all its statutory powers, the General Chiropractic Council will not be able to interfere with the free market that currently exists in terms of the scale of fees that chiropractors may charge. As my hon. Friend has already remarked, should the need ever arise, powers of intervention are provided against any anti-competitive practices that the general council might contemplate. My hon. Friend has already drawn attention to the fact that it is anticipated that the Bill will have only minor implications for public expenditure, which would arise only in the unlikely event of the Privy Council having to exercise its default powers over the General Chiropractic Council. I can confirm that assessment from the Government's viewpoint.

The House will be reassured to know that on no known occasion has the Privy Council had to exercise similarly held powers in respect of other statutory schemes. I am sure that the chiropractic profession has no desire to achieve a first in that respect. The passage of the Bill is not in any way related to the availability or otherwise of chiropractic on the NHS. Having heard of the many benefits that chiropractic can offer, I suspect that many people--as we have heard from some hon. Members today--may feel that the treatment should be provided more widely on the NHS.

The simple fact is that chiropractic can already be obtained on the NHS. The hon. Member for Rochdale (Ms Lynne) said that she felt that nothing in the Bill widened that availability. She is mistaken. One of the principal effects of the closure of title and the regulation of the chiropractic profession is precisely to give medical

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practitioners and the public greater confidence that, when referred to a chiropractor for treatment, they will go to a professional person who has the backing of a statutory body, has the necessary training and, perhaps more importantly, is subject to the disciplinary proceedings that body may bring against that practitioner if there is any form of indiscipline or abuse. That is an important point. Many members of the medical profession take a deeply conservative view of medical treatments, as is demonstrated by the contrast between the rates of introduction of new pharmaceutical products here and in other parts of Europe. Many of those people will need the reassurance of knowing that, if they refer patients, they can be certain that they are referring them to practitioners who will be thoroughly competent and held to account for their actions.

I hope that I have gone some way to convincing the hon. Lady that the Bill takes a major step forward in making chiropractic more generally available on the NHS. That will require the co-operation of the medical profession and, indeed, of NHS managers.

As I said, chiropractic can be obtained on the NHS. General practice fundholders can use the staff element of their budgets to employ chiropractors ; non-fundholders may also employ them, although many will do so only if their local family health service authorities can reimburse the costs of the therapists' salaries from their cash-limited funds for GP staff and premises. The message is, however, that it is up to any GP fundholder or district health authority to conclude that the treatment should be made available to patients. The Bill will make many of them much more confident about referring patients.

In the hospital sector and elsewhere in the NHS, the only constraint on the provision of chiropractic--or any other service deemed to be of benefit to patients--is the requirement for the local health authority to consider its provision necessary to meet the reasonable demands of the public. Chiropractic is therefore no different from any other forms of treatment. It is up to the profession to convince those who make decisions--whether they are health service managers or practitioners and others in the medical world--that chiropractic will indeed be of value to patients. Whether it should be commissioned is a matter for local decision making, and must remain so ; people will have to assess locally the extent to which it is beneficial.

Audit studies are already being carried out in several parts of the country by district health authorities such as the Dorset, Bath and Wiltshire health commissions. I do not know the reason for the concentration on the south-west ; others may be able to enlighten me. I note that there seems to be a concentration of hon. Members from that area in the Chamber today. The commissions are examining the feasibility of purchasing chiropractic for their local populations. This country has only about 900 chiropractors. If the greater part of the NHS considered purchasing chiropractic, initially there would not be enough practitioners to go round ; if the Bill succeeds, however--as I hope it will--there is every likelihood that statutory regulations will have the additional effect of stimulating the continued growth of the profession, and spurring on many more people to consider chiropractic as a career. Statutory regulation can also be expected to encourage closer working relationships between doctors and the profession.

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I am sure that the House will forgive me if I briefly mention the general subject of alternative and complementary medicine, and especially the benefits to the NHS that many of its supporters--we have several in the House today--believe that it could bring. I appreciate that this is a subject on which people hold strong views which arise from a genuine concern that NHS patients should receive the very best treatment. One of the criticisms often levelled at orthodox medicine is that it fails to recognise the individuality of the patient and instead focuses on his or her particular problems in a somewhat impersonal way. There may be some important lessons to learn here about the way in which patients wish to be treated. Some take the rather extreme view that orthodox medicine all too often resorts simply to pumping patients full of drugs or to lopping off those bits that no longer function properly. Many supporters of alternative and complementary medicine feel that there is another and better way in which to approach sickness and illness. They believe that if the range and availability of such treatments on the NHS were increased, the NHS would save money on the ever-spiralling cost of drugs and prescriptions, the need for unnecessary surgery and other invasive procedures would be reduced and there would be an improvement in the overall quality of life for patients. Those are laudable intentions.

Research suggests that people consult alternative and complementary practitioners in addition to receiving orthodox treatment on the NHS. We are keen to explore the question and to find out whether alternative and complementary medicine available in one part of the NHS impacts on other parts and, if so, in what ways. We have, therefore, commissioned the medical care research unit at Sheffield university to carry out research into the impact within general practice that complementary therapists such as osteopaths, chiropractors, acupuncturists and herbalists have on hospital referrals, prescribing and drug costs and patient satisfaction. The project began last December and will take two years to complete. I hope that I have established to a small degree our credentials on alternative medicine. One of my parents was once president of the General Council and Register of Osteopaths and the other ran the homeopathic hospital in Tunbridge Wells, so I am not entirely divorced from these matters despite being connected with the Department of Health.

How are the Government able to support the chiropractors' quest for statutory regulation when we are pursuing deregulation elsewhere? The aim of the Government's deregulation initiative is to reduce the burden of existing regulations and to ensure that unnecessary new regulation is avoided. Our aim is to deliver better goal-based regulation in proportion to the risk involved, especially where there is a need to protect members of the public. The Bill is not an attempt, as my hon. Friend the Member for Aylesbury assured us, to impose a heavy-handed regulation that dictates everything from the size of the treatment table to the content of the practitioners' training. Instead, it is about entrusting to the professionals the means to regulate more effectively and enabling them, within a statutory framework, to chart their own destiny. The Bill will also provide adequate assurances to the public about the education, training and competence of chiropractors.

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In the past two years, two groups of alternative complementary medical practitioners have sought statutory regulation. That may conjure up in the minds of hon. Members a picture of a queue of those professions standing in the wings, waiting for their turn on the parliamentary stage. Although I have no crystal ball in which to gaze, I suspect that it may be some time before the next profession is in a position to pursue similar legislation. That does not mean that other health care professions may not consider modernising their statutory schemes, but I do not foresee a completely new group coming into view on the horizon, possibly for some years to come. That raises the question whether the Government should be considering statutorily regulating other groups. I know that is the view held by some hon. Members, including, I believe, my hon. Friend the Member for Bournemouth, East. We believe that, in the context of the health care professions, statutory regulation should not impose restrictions but provide freedoms. For example, the osteopathic profession can regard having achieved statutory regulation as a prize or reward for a job well done. It is something for which it has striven for more than 60 years, and it builds on a very successful system of voluntary registration and regulation.

Mr. David Atkinson : I hear what my hon. Friend says, but does he agree that after 30 years the Professions Supplementary to Medicine Act 1960 deserves a review, especially in view of the concerns being expressed by physiotherapists to which I referred earlier?

Mr. Sackville : I believe that it would be most appropriate for professions to consider private Members' legislation, such as that which we are discussing today, as a means of achieving protection of title, if that is what they wish. My hon. Friend will remember that was the case with the Bill relating to podiatrists which was introduced by the right hon. Member for Wythenshawe. Any review of the Professions Supplementary to Medicine Act 1960 would raise many wider issues and could be undertaken sensibly only in the light of a thorough evaluation of how it would fit in with the Government's health service reforms and the effects of changes in community care. As I said, osteopaths are now statutorily regulated, not because they are hot-headed individuals who are wielding a dangerous or violent form of treatment that needs to be controlled, but merely in order to enable them to regulate and develop their profession more effectively. Such a framework will provide safeguards for the public by assuring continuity in the quality and standard of treatment that they can expect to receive.

Statutory registration, based on the principle that an individual practitioner has demonstrated that he or she has undergone acceptable courses of training and achieved the required standard of competence, provides that assurance. It also provides an effective system of redress in the event that something goes wrong. As I said to the hon. Member for Rochdale, they are two vital contributions to building the confidence of the medical profession and the public in a profession or form of treatment which has up to now been considered to be outside the mainstream of the medical profession.

In that context, we therefore view statutory regulation as the logical next step to a system of voluntary registration

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supported by the majority of practitioners of any particular profession. It is precisely for the reasons that I have just described that chiropractors wish to follow the osteopaths and secure statutory regulation for the profession.

Imposing statutory regulation on a profession that neither desires it nor is capable of administering it would be unwieldy, expensive and difficult to police. It would also take away from the profession the right and ability to control its own destiny. Such a situation is clearly far removed from the system of statutory regulation enshrined in the Osteopaths Act 1993 and in the Bill introduced by my hon. Friend the Member for Aylesbury. Those measures are founded firmly on the principles of professional self- regulation.

We believe that a system which embraces high standards of education, of training and of clinical practice, alongside the development of an enforceable code of practice that provides proper safeguards for patients, is the hallmark of a responsible profession. We have therefore welcomed the progress which many of the alternative and complementary professions have made along the path of voluntary self-regulation, but we remain firmly of the opinion that the question of statutory regulation must remain one for the professions themselves to consider whether to pursue.

The examples of the osteopaths and the chiropractors may lead other groups to consider the question afresh and perhaps with greater urgency. I also suggest that if purchasers of health care services, such as district health authorities and GP fundholders, take the view that to be assured of the quality of service that they are buying they would purchase alternative and complementary therapies only from those groups which are statutorily regulated, it would add further impetus for such groups to consider the matter.

My hon. Friend the Member for Aylesbury has already said that his Bill contains a handful of fine-tuning amendments of the Osteopaths Act. That Act was a mould-breaking piece of legislation and introduced a number of innovatory ideas for the regulation of health care professions. The powers of the fitness-to-practise committees, for example, to take immediate action to protect members of the public are perhaps the most comprehensive in any statutory scheme. The Chiropractors Bill, which effectively reproduces the provisions of the Osteopaths Act, has provided an almost unprecedented opportunity to reconsider the detail underpinning both the statutory schemes.

I am sure that many hon. Members who have sponsored private Members' Bills would have welcomed the opportunity to twiddle with their piece of legislation once it had reached the statute book. Some hon. Members may well think that probably a number of Ministers would also welcome such an opportunity. Whatever they may think, all I can say is that I cannot possibly comment. It is a tribute to the robustness of the Osteopaths Act and to my hon. Friend the Member for Cambridgeshire, North-East that there are so few amendments to be made, many of which are simple, drafting amendments to fine-tune the scheme and to make a first class piece of legislation even better. May I conclude--[ Hon. Members :-- "Hear, hear!"]--by reminding the House of what the Bill is all about. It is principally about the back pain that many people suffer all over the world, but is probably aggravated by the way in which many of us sit around--[ Hon. Members : -- "Hear,

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hear!"]--like today, and remain for long periods in a sedentary position. For that reason, an increasing number of people in the country would probably benefit from an enlargement and a development of the profession of chiropractic.

I therefore strongly commend my hon. Friend's Bill to the House, and I commend all his supporters and sponsors who are here to cheer him on today. I sincerely believe that the Bill's provisions will apply to all members of the profession in a way which is valuable to them.

The provisions embrace chiropractic in the different forms in which it is practised today. Indeed, my hon. Friend's Bill is a very British solution to a very British problem.

Although the general council's responsibilities on the regulation, development and promotion of the profession will gradually subsume many of the functions of the voluntary registration systems, the variety of techniques and styles that constitute chiropractic in the United Kingdom can continue to flourish within an overall regulatory framework. That will enable today's patients and the generations of patients to come to choose the form of chiropractic treatment best suited to their individual and particular needs, in the certain knowledge that they will receive the greatest and highest quality of care from appropriately trained practitioners. For those reasons, I congratulate my hon. Friend on his Bill and warmly commend it to the House.

12.55 pm

Ms Dawn Primarolo (Bristol, South) : As the Bill has all-party support, I think that it was unnecessary for the Minister to read his speech twice. I congratulate the hon. Member for Aylesbury (Mr. Lidington) on the Bill and on his comprehensive explanation of the clauses. Indeed, I felt at times that I was experiencing de ja vu, and when I checked Hansard, I found that I was hearing again the debate on the then Osteopaths Bill. Lessons were learnt in debates in the Committee of that Bill and I commend the hon. Member for Aylesbury for taking those arguments on board.

The Bill is about the regulation of a therapy and treatment that is being used by hundreds of thousands of people. The efficacy of that treatment is clearly demonstrated and the Bill proposes to include regulations for the protection not only of the public, so that they can be sure that they are consulting someone who is properly qualified, but of chiropractors.

There has been much discussion about the availability on the national health service of what are commonly called complementary therapies. We should put aside the idea that the medicine offered in the national health service is all conventional or orthodox and is the only type of medicine that works and is acceptable. They are complementary therapies that should be part of the NHS because they work ; they are appropriate treatments, and the NHS is about offering to the public a comprehensive service of medical treatment that is free at the point of need. The surveys mentioned have shown that 70 per cent. of family health service authorities and 65 per cent. of district health authorities are in favour of all the complementary therapy services being made available freely at the point of contact. That is entirely different from referral on contact.

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The national health service should offer such services. More than 900 practitioners give 75,000 consultations a week, and 310,000 people in the United Kingdom are off work each day because of lower back pain. The complaint costs the country more than £3 billion in lost production each year. In addition, there is the cost to the health service of providing treatments that are sometimes inappropriate and often expensive and that often cause unnecessary and undesirable side effects.

Disability from lower back pain in Britain is increasing faster than any other form of disability--the incidence has doubled in the past 10 years. Today's debate is not just about regulation, important though that is, but about what is available on the national health service and whether it is free and not subject to contract exchanges.

The British Medical Association has made its position clear. It states :

"It is difficult at present for individuals to be certain that the therapist whom they are consulting is competent to practise. Similarly, it is not easy for doctors to ensure that the therapists to whom they transfer care of patients are competent. The present situation, in which anyone is free to practise, irrespective of their training or experience, is unacceptable. Where individuals undergo courses of training designed to equip them for the practice of particular therapies, these should conform to minimum standards appropriate to the responsibilities and demands of that therapy." The Bill is an attempt to introduce such provisions into chiropractic.

Unfortunately, the Bill does not make such provisions freely available within the national health service. The Government are silent on the provision of money for the training of chiropractors and the Bill does not make that money available. If one wishes to be a chiropractor, one has to become one at one's own expense. The Bill is silent, and the Government have been silent, on the further research needed to ensure that the practice is available within the national health service. The Bill is silent on the need to ensure that we understand the potential of chiropractors in the NHS at both primary and secondary level.

The Labour party has consulted widely on making complementary therapies available in the NHS. The Royal College of General Practitioners welcomed our report and said :

"A wide choice of therapeutic approaches is a necessary part of good practice,"

and therefore should be available inside the national health service. My hon. Friend the Member for Preston (Mrs. Wise) referred to her experiences with a complementary therapist--a chiropractor. She mentioned, as have many other hon. Members, the involvement and partnership between patient and therapist--a relationship that should exist in all forms of medicine. Unfortunately, it does not always do so. The NHS could be greatly strengthened by the integration at all levels of complementary therapies available as part of a comprehensive health system.

The Bill is widely supported and will pass into Committee. A number of hours have already been spent debating it and all who have spoken have been in favour of its proposals. I sincerely hope that the House will accept the Bill and proceed swiftly to ensure its passage. I hope that it quickly returns to the Floor of the House to be given our final approval before gaining Royal Assent.

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