Mr. Paul Tyler, supported by Mr. A. J. Beith, Mr. Matthew Taylor, Mr. Nick Harvey, Mr. Don Foster, Mr. Simon Hughes and Diana Maddock, presented a Bill to amend the Water Industry Act 1991 to prohibit the use by water undertakers of rateable values as a basis for charging from 31st March 1995 ; to provide for charging by water undertakers in accordance with council tax bands ; and for connected purposes : And the same was read the First time ; and ordered to be read a Second time upon Friday 15 July, and to be printed. [Bill 106.]
Mr. Dennis Skinner (Bolsover) : On a point of order, Madam Speaker. I wonder whether you have received any assurances from the appropriate Minister in relation to the Civil Rights (Disabled Persons) Bill, as there was a unanimous vote in the House last week which ordered the
Column 936Government to give adequate time to allow that Bill to be approved and placed on the statute book. The Bill would give equal rights to millions of disabled people up and down the country.
In view of the unusual situation that developed last week--it was the first time in my 24 years in this place that I have seen such a motion passed-- and in view of those instructions, have you been assured by the Minister that the Civil Rights (Disabled Persons) Bill will be given time by the Government so that it reaches the statute book and provides those rights for all those citizens ?
Madam Speaker : It is not normal practice for the Speaker to be assured by the Government on any issue of that nature. It is for the House to determine whether the Bill proceeds speedily through the House today when we arrive at that particular point.
Mr. Alex Carlile (Montgomery) : On a point of order, Madam Speaker. As you have often told us, you are the protector of Back-Bench interests which means that you are the protector of the interests of a constituency to have a Back-Bench Member of Parliament. Can you tell us when you will take the view that there is no further point in the Government's running away from a by-election in Eastleigh which should have been held by now ?
The Government have now been destroyed in the local elections, and particularly in the local elections in Eastleigh, and it is time that they had the courage to face the electorate in a by-election there.
Madam Speaker : I am well aware that election campaigning has been going on for some time outside the House as well as inside it. However, as Speaker, I am certainly not going to be dragged into any campaigning.
Not amended (in the Standing Committee), considered.
. On registering the death of a registered chiropractor, a registrar of births and deaths shall send forthwith by post to the Registrar a copy certified under his hand of the entry relating to the death in the register of deaths ; and the cost of the certificate and of sending it by post shall be payable by the Registrar to the registrar of births and deaths from whom it is received.'.-- [Mr. Spring.]
Brought up, and read the First time.
The new clause duplicates the provisions that obtain in the Opticians Act 1958. It would place a duty on a registrar of births and deaths to notify the Registrar of Chiropractors in any case when the death of a registered chiropractor was recorded. That would lower the risk of fraudulent use of a deceased chiropractor's identity. When dealing with the spine, someone who is perpetrating a fraud can do considerable damage. There must be protection. We are aware of a mental disorder whereby people choose to masquerade as doctors or surgeons. That disorder has been well reported. As opticians deal with a delicate part of the body, they have sought to use a provision which I believe should now be applied to chiropractic. Opticians have sought to protect their patients from exposure to risk and injury and I believe that chiropractors would, through the Bill, wish to do the same.
The Bill specifically contains a provision to prevent fraud. New clause 3 seeks to ensure that the identity of a deceased chiropractor cannot be used to achieve registration by fraudulent means. As registration and the raising of the quality of professionalism of chiropractors is at the very heart of the Bill, I believe that the provision is important.
There is also a simple human aspect to the provision. For the family of a deceased person, it would stop the distress caused by the family continuing to receive, for some time, telephone calls or letters after the death of that person. Of course, the General Chiropractic Council would not be guilty of such an error. The new clause would bring chiropractors into line with another respected group of medical professionals--the opticians. It would bring about good practice, which all of us want to see and which is at the heart of the Bill.
Stealing other people's identities has become big business. We know that it happens in the criminal world, with the stealing of passports ; stealing other people's identities has become a big business among the criminal fraternity. People have stolen the identities of people of comparable age to very negative effect. When we are dealing with health issues, we must ensure that such fraud does not happen and that we protect the public against it.
All of us who have had chiropractic treatment know that in the process of manipulation, there is a delicate balance to be achieved in relieving stiffness and tension in the spine. If it is not done professionally, it can lead to
Column 938considerable damage. The Bill, in ensuring a proper register to give people the assurance that properly trained and recognised individuals will be the only practitioners, requires the new clause. It would prevent frauds from being perpetrated, with all the unhappy consequences. It would remove the threat of a false identity being assumed after the death of a chiropractor.
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : I thank my hon. Friend the Member for Bury St. Edmunds (Mr. Spring) for tabling the new clause, although I have several points to make about it. There are, of course, already many ways in which the Bill, as drafted, would ensure that the good character and suitability of chiropractors was recognised. There are many safeguards in it to ensure that
Mr. Alfred Morris (Manchester, Wythenshawe) : Is the Minister aware that the best way of helping people with spinal difficulties today in this House is to be as quick as possible in dealing with this Bill to get on to the Civil Rights (Disabled Persons) Bill, which otherwise will be endangered ?
Mr. Sackville : A new clause has been tabled and I have to put the Government's view, which I shall do as briefly as I can. There are many provisions in the Bill that would prevent the fraudulent registration of a chiropractor. In the very unlikely event that the whole process, as contained in the Bill, were bypassed, there would be other factors at work which would make the new clause unnecessary.
There is a published register of chiropractors, which is an extract from the main register. If a colleague died, it is very unlikely that members of this close-knit profession would not become aware of that death. There are newsletters and all sorts of ways in which the death would become apparent.
Mr. Roger Knapman (Stroud) : My hon. Friend will be aware that the Bill would set up quite a bureaucracy, with a large council of 19 members to look after 900 people. Will my hon. Friend comment on the fact that the new clause would place obligations and, presumably, costs on the registrar of births and deaths ?
Mr. Sackville : Indeed, the new clause is unnecessarily regulatory. It would add nothing to the security of registration of the profession. The most likely source of a fraudulent registration would be the death of an overseas chiropractor after which someone passed himself off as that person and set up in practice. We have no assurance that the new clause would prevent that from happening. The new clause is unnecessary and adds nothing to what is already in the Bill. I therefore advise the House to reject it.
Motion and clause, by leave, withdrawn.
Mr. Spring rose -- [Interruption.]
Mr. David Hinchliffe (Wakefield) : On a point of order, Mr. Deputy Speaker. The hon. Member for Bury St. Edmunds (Mr. Spring) clearly has no intention of moving the amendment. He is simply wasting the House's time. I urge you, Mr. Deputy Speaker, to move on to the next business.
(1A) The General Council shall not appoint a person under subsection (1) unless he is a qualified solicitor or is otherwise legally qualified.'.
(7) The General Council shall appoint a person to be deputy to the Registrar ; and a person so appointed shall be known as the Deputy Registrar, shall hold office for such period and on such terms as the General Council may determine and shall exercise such functions (including, in particular, the function of deputising for the Registrar when the Registrar is absent or otherwise unable to act) as the General Council may determine.'.
Mr. Spring : The amendment proposes that the general council should not appoint a person under subsection (1) unless he is a qualified solicitor or otherwise legally qualified. Hon. Members know that we have a superabundance of lawyers here. We may be tempted, therefore, to think that we do not need any more lawyers to be involved in any proceedings. However, the fact is that the amendment
Mr. Alex Carlile (Montgomery) : Does the hon. Gentleman realise the fatuousness of the amendment ? The registrar of the General Medical Council has never been a qualified lawyer. This is the most absurd, time-wasting nonsense.
Mr. Knapman : Will my hon. Friend consider the point that the hon. and learned Member for Montgomery (Mr. Carlile) has already made points of order and interventions, and has taken up far more of the House's time than has any other hon. Member present ? With respect, that is not in any way unusual-- [Interruption.]
Mr. Deputy Speaker : Order. Let us be clear. Hon. Members have the right to be heard in the House. We have a Bill before us and we have amendments that are in order. As long as amendments are moved--this one is being moved--the House must listen. I am not prepared to listen to sedentary comments from certain quarters of the House any further this morning.
Mr. Spring : The point is that the amendment would ensure that the general council had someone who was legally qualified and with an appropriate breadth of knowledge ; knowledge of the law would be helpful. Through the Bill, we are trying to upgrade the reputation of chiropractors. We have looked at the whole question of health, and at the whole question of raising the
Column 940professionalism of chiropractors and their recognition in the community. It is now important that someone who is at the centre of the process should be legally qualified.
We live in a time of considerable litigation against individuals who practise various forms of medicine, whether complementary medicine, veterinary medicine or any other kind. It is important, therefore, that the individual who is at the centre of the general council should have knowledge of the law. That would be extremely helpful to members of the chiropractic profession. Given the nature of society and the potential for law suits, an understanding of the law would be extremely helpful.
The amendment would achieve something else. It would strengthen the feeling among those who use chiropractors, of whom there are an increasing number, that there is someone centrally placed who understands what the law is about. I believe that that presents a valid safeguard.
Chiropractors have been around for almost 100 years, but it is only now that the medical profession is accepting them as a form of complementary medicine. Therefore, it would be helpful to assist the encouragement of general practitioners and the general public to accept them by making sure that the individual who supervises and regulates the profession has a knowledge of the law. That would be useful and important, especially in view of the history of chiropractic in Britain. After all, the registrar maintains the register of chiropractors and fulfils other duties placed on him by the general council.
As I said, people may laugh about the superabundance of lawyers in the House or outside, but the fact remains that in every aspect of our national life, knowledge of the law is becoming increasingly important. We are an increasingly litigious society. People who may be dissatisfied, for example, with the service that they receive from chiropractors will have the assurance that the person at the heart of the regulatory organisation has a profound knowledge of the law. That is why I have moved the amendment.
Mr. David Lidington (Aylesbury) : While I am sure that my hon. Friend has good intentions, I hope that, on consideration, he will withdraw his amendment. If he does not, I shall ask the House to reject it.
There are three reasons why the amendment is unnecessary. First, the post of registrar will encompass not simply giving legal advice to the general council but a range of administrative and executive tasks, not all of which require legal experience.
Secondly, conditions of employment are already subject to the decision of the general council, which is, in turn, subject to the Privy Council. If the general council feels that a lawyer is the best candidate for the job, it has the right to appoint one, but it should not be prevented by statute from appointing a non-lawyer if that person is the best candidate for the job.
Mr. Lidington : It is simply a matter of following the precedent of other self-regulating medical professions. We have followed the procedure under the Osteopaths Act 1993 and that for the General Medical Council.
Column 941The third reason why the clause is unnecessary is that the Bill provides for the general council to appoint expert legal assessors. That is a duty of the general council under the Bill. Therefore, the general council and the registrar will have expert legal advice available to them without the need for the amendment.
Amendment No. 8 refers to the deputy registrar. It is not a sensible use of legislation to provide for every eventuality. The Bill allows the general council to appoint and employ staff in addition to the registrar. It will almost certainly need to do so and it should be left to the council's discretion.
Mr. Sackville : I should like to respond. The amendment has been tabled by my hon. Friend the Member for Bury St. Edmunds (Mr. Spring). I can certainly understand the reasons behind it. There is no doubt that a legal training is of enormous importance in many administrative functions, but the amendment is probably over-prescriptive. The general council should be allowed the freedom to decide who is the best candidate. Therefore, I advise the House to reject the amendment.
I have no wish to denigrate the legal profession, which is well represented on both sides of the House. I think that the only reason why I had the honour of being selected for my seat was that the boundary changes to the Bolton, West constituency failed to penetrate the inner recesses of the Inner Temple back in 1983.
The system of regulation, as seen first in the Osteopaths Act 1993, which is reflected in the Bill, marks a fresh approach to professional self- regulation. That is central to the reason why I advise the House to reject my hon. Friend's amendment. There will be no well-established precedents set to guide decisions. To a great extent, the general council would have to advance across unknown territory. The same point could easily be made in connection with the post and duties of the registrar, who will arguably be the second most important post in the statutory scheme, after the chairman of the general council.
It would clearly be in the interests of the profession and the general council to ensure, for example, that the person appointed was conversant with both the legal obligations arising out of the scheme and the particular challenges presented by the administrative requirements of a health profession.
I also have some worries about the impression that might be created if the duties of the registrar were seen as purely legalistic. The post of registrar, who is responsible for the direction of the general council, has considerable flexibility. If the post was always filled by a person with a legal qualification, it might be expected that his duties were primarily legalistic. I am sure that that is not the overall intention of the Bill. Indeed, the amendment calls into question the requirement in clause 27 to appoint legal assessors to provide advice to the registrar, in addition to the various statutory committees.
I do not wish to imply that a lawyer could not fill the post effectively, but I am sure that many other individuals would also be eminently suitable. Therefore, to restrict the appointment to a lawyer would place a significant limit on the council's freedom of action and arbitrarily rule out of contention many candidates who would be suitable. Therefore, I do not believe that the amendment would serve a particularly useful purpose.
Column 942The general council would be able to appoint a lawyer if it thought that such a person was the most suitable. There would be little to be gained and, in my opinion, something to be lost in making the post of registrar a closed shop. It would cut across the self- regulatory nature of the scheme that lies at the heart of the Bill and has been shown to be successful in the Osteopaths Act, which was passed by the House last year.
The principle of statutory regulation implies that Parliament entrusts that profession with its own regulation and development. In the case of the chiropractic profession, that is a suitable way of doing it. For that reason, we have not sought to incorporate every last detail in the Bill. We must leave the profession a lot of room for discretion and to find out what requirements it will have in practice.
At first sight, it might be said that amendment No. 8, which refers to the deputy registrar, seems sensible, but, again, it is overly prescriptive. That amendment and the imposition of the need for a lawyer to serve as registrar are both proposals which I would advise the House to reject.
Amendment, by leave, withdrawn.
Order for Third Reading read.
The contents of the Bill have been fully discussed in previous stages and I shall not add anything to what has been said. However, I wish to take a few minutes, for reasons that I have discussed with the hon. Member for Kingswood (Mr. Berry), to dwell on the future of the chiropractic profession and to respond to some serious anxieties expressed by members of the profession during the Bill's progress through the House.
The chiropractic profession sought statutory regulation and its ardent advocacy persuaded me to take up the Bill in the first place. The profession has aimed to ensure high standards for patients and to protect its good name against any possibility of infiltration by quacks and charlatans, taking advantage of the increasing popularity of chiropractic among patients. The third aim has been to bring chiropractic still closer to the mainstream of medicine and to make it more trusted by doctors, by virtue of statutory protection and the assurance of common standards of competence and training. The various voluntary associations pulled together to campaign for the Bill through the chiropractic registration steering group. I congratulate the group on its work. The co-operation between different schools of chiropractic and mutual respect among chiropractors from the different schools are encouraging signs for the future. I hope that the profession will continue along that road.
If the Bill is enacted--I hope that it will be--the role of those voluntary associations is bound to change. In the short term, the profession could still determine certain things collectively ; it might draw up standards of proficiency based on existing competency, of a standard common to the various chiropractic schools, and it could draft a shared code of professional ethics.
It is important for the profession to beware trying to judge matters that will become the proper responsibility of the general council if the Bill is enacted. Under the Bill, the
Column 943general council will have the responsibility of setting professional and educational standards for the entire profession. I will give the House a practical example. Some years ago, the various voluntary associations agreed that all chiropractic schools should achieve common standards within five years of any statutory system of regulation coming into force. The standard was that set by the European Council on Chiropractic Education--as it existed in 1991.
Today, we find that the Anglo-European college in Bournemouth is the only school in Europe, let alone the United Kingdom, to meet that standard, so the Bournemouth standard could be said to be the gold standard for chiropractic. It would be wrong to assume, however, that the Bournemouth standard must be taken as the minimum standard throughout the chiropractic profession, whatever may happen. The general council, representing the entire profession, must set the standard of professional education, to protect the interests of patients and the reputation of the profession alike. Those standards and the type of courses that will train students to meet them are bound to change as medicine and chiropractic techniques develop and evolve. That is why no educational standard is described in the Bill. Instead, that task is rightly left to the general council and the education committee when the Bill becomes law, as we hope it will. Recognition of qualifications should be based on the outcome of training-- not on the process by which training is carried out--and the standards achieved. There is, therefore, no reason in principle why some courses should not continue to be part time, to include distance learning or to be of any duration. The key is that every course should meet the standards of proficiency laid down by the general council for safe and competent chiropractic practice.
Like the King's Fund working party, I believe that the initial standards of proficiency will need to reflect existing standards in the profession. That will ensure that the profession moves forward together from a basis founded on the reality of practice and not on a vision of what it might or ought to be like in the future--a future which, because of developments in chiropractic and medicine, could be impossible to predict with certainty.
The general council should be free to adopt a dynamic strategy based on its assessment of the present needs of the profession. It should not be constrained to a rigid commitment to a standard that it played no part in drawing up and which might be out of date when the relevant decisions have to be made.
The intention behind the voluntary agreement between chiropractic associations remains as valid as ever and it is embodied in my Bill. The intention is to provide a guarantee to the profession, the public and patients that standards will not simply be maintained, but will rise and be encouraged to rise.
Some chiropractors may exceed the standards set by the general council. That is welcome and it is only to be expected. No chiropractor will be penalised for being ahead of the game. Such a chiropractor may have much to offer his or her colleagues when the general council introduces rules on the supervision of professionally registered chiropractors in due course. The profession will be able gradually to achieve its long-term goal to raise standards across the board by a process of evolution.
Column 944The voluntary associations may well continue. Indeed, it is important that they should do so and that chiropractors should continue to belong to them, at least until the register is opened. In that way, we will ensure a smooth transition from a voluntary to a statutory scheme.
The role of the voluntary associations is bound to change, however, and the general council will take over many of their functions. If the Bill is successful, the council will be the means by which all chiropractors are represented and by which they will represent themselves to others. All members of the general council will be required to act as ambassadors for the profession and to set aside previous loyalties to the school where they were trained or the voluntary association to which they belonged. All registered chiropractors will owe a duty of professional respect to their registered colleagues, similar to the duty and respect owed to colleagues in a voluntary association at present.
If the progress that the associations have already made, by gradually working together and harmonising their approaches, is continued and consolidated, the general council will find it increasingly easy to take up and perform its statutory duties, which can only be in the interests of the chiropractic profession and the patients it serves.
Throughout proceedings on the Bill, I have been heartened by the support that I have received from all quarters of the House. I must also place on record my thanks to the schools of chiropractic, to many chiropractors and to patients who have given up their time to discuss with me the challenges facing the profession.
I have been enormously impressed by the dedication of chiropractors in this country and by their commitment to serving their patients and enhancing the standing of their profession. I have also been impressed by their optimism and their constructive approach towards the development of chiropractic in the United Kingdom. I wish the profession well and I commend the Bill to the House.
Mr. Hinchliffe : I apologise for the absence of my hon. Friend the Member for Bristol, South (Ms Primarolo), who has led for the Opposition during the Bill's previous stages. Unfortunately, she had a constituency commitment that she could not avoid. The Opposition made clear their full support for the measure during the previous stages.
My hon. Friend the Member for Bristol, South spoke for a mere six minutes on Second Reading and for less than one minute in Committee. I shall follow her example in terms of brevity, not least because of the Opposition's strong desire to see the measure on the statute book and also because I am a sponsor of the Bill that the House is to discuss next which was introduced by hon. Friend the Member for Kingswood (Mr. Berry).
The House and the public will not forgive any hon. Member who attempts to delay this measure as a way of wrecking my hon. Friend's Bill. Hon. Members would do well to look at examples of what has happened to Members of this place who have attempted to wreck the measure. I assure any hon. Members with those intentions that we will do all in our power to ensure that their constituents are well aware of their activities.
On behalf of the Opposition, I am happy to support the Bill and I wish it well.
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Lady Olga Maitland (Sutton and Cheam) : I offer a warm welcome to the Bill and I congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on his success. I was proud to serve on the Standing Committee that examined the Bill for one special reason : one of the leading chiropractors in the country, Dr. Brian Hammond, is based in my constituency. I have heard from his many patients and others within the community what an absolute blessing chiropractic treatment has been to them and it therefore follows that that treatment should be offered proper recognition. That is what the Bill is designed to achieve.
In the past few decades, an enormous amount of progress has been made because the medical world now accepts that complementary medicine has a role to play. It has been heartening to note that the national health service, which was hesitant in supporting complementary medicine, is now offering whole-hearted support for chiropractic treatment. In many cases, people who have gone to see their doctor and sought treatment from conventional medicines in hospital have been advised to seek the help of a chiropractor and found immediate relief.
The practice in Sutton is of such stature that it has treated 16, 000 people in about 15 years, which works out at an average of around 500 people a week. The numbers treated demonstrates the important role that chiropractic treatment has in medicine today, especially when we bear in mind the misery that back pain can cause. Although chiropractors treat all forms of pain, their treatment is particularly beneficial for those suffering from back pain. The chiropractor registrar noted earlier this year that 310,000 people in Britain alone are off work each day with back pain. It is estimated that back pain costs the country £3 billion in lost production every year. Those figures speak for themselves and reveal how important it is that chiropractors should be properly recognised and have their own general council.
With the compilation of a formal register, chiropractors will be able to ensure that rogue practitioners will be prevented from registering. That will stop patients or potential patients being put at serious risk. Dr. Brian Hammond has told me of several people who came along to him in great pain having first been treated by a rogue practitioner. The Bill will regulate an important part of what I call the medical profession and I therefore give it a warm welcome. I congratulate my hon. Friend the Member for Aylesbury on his tremendous determination to push the Bill through. When his chance came up in the ballot, he selected a Bill that went right to the back pain of Britain, the heart of Britain. His Bill will offer tremendous relief to many people who have always felt that their source of medical help has been on the fringes of medicine. It will now be within the heart of it.
Mr. John Sykes (Scarborough) : I support the Bill, which my hon. Friend for Aylesbury (Mr. Lidington), has promoted because, in 1978, I obtained my class 1 heavy goods vehicle licence--I must be one of the only hon. Members to have done so--and I know full well what driving long hours can do to one's back. I also support the
Column 946Bill because, last year, I had the privilege to serve on the Standing Committee that considered the Osteopaths Bill, which has served that profession well.
Whether by hard work, subtle diplomacy, opportune timing or a combination of all those factors, a variety of interested organisations have come together in recent months to debate the statutory regulation of the chiropractic profession in a rare atmosphere of accord. On those grounds alone, there is much to commend.
A sea change in the opinion of the British Medical Association towards alternative and complementary medicine has come about. For some time, surveys have reported positive findings concerning the efficacy of complementary medicine. The nation's health care system is under a period of intense scrutiny and either the nation is turning progressively spineless or, as a result of what appears to be a series of amazing coincidences, complementary medicine is enjoying greater public confidence than at any other time. Chiropractic treatment is experiencing not so much a fad as a boom.
Of the 310,000 people who are off work each day because of back pain, 75,000 receive weekly chiropractic treatment. In a previous debate on the Bill, my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) said that it cost £20 per hour for treatment at the National Back Pain Association in her constituency. If one takes that rate as a hypothetical mean rate, the chiropractic profession starts to turn from a strand of complementary medicine into a multi-million pound industry. That alone is not, however, a sufficient reason for the statutory regulation of chiropractic. The 75,000 people who receive weekly chiropractic treatment are administered to by 900 practitioners, who are qualified in a variety of ways and registered by a number of voluntary bodies. The size of the chiropractic profession and the volume of its work have outgrown the voluntary status that was a perfectly satisfactory means of self-regulation for many years. The arrangements are in need of review at least, if not statutory regulation as the Bill proposes. The chiropractic registration steering group has calculated that 310,000 people are off work each day through back pain and that that costs the country £3 billion annually in lost production. That is undesirable and the problem could be greatly relieved by the statutory regulation contained in the Bill.
With the debate on the future of the NHS and social security provision continuing to roll on, the remaining stages of the Bill should take account of the important fact that it is no longer taken for granted that traditional forms of treatment are more effective than complementary medicine, although they are often considerably more expensive.