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Westminster Hall

Wednesday 17 July 2002

[Sylvia Heal in the Chair]

Complementary Medicines

Motion made, and Question proposed, that the sitting be now adjourned.—[Mr. Pearson.]

9.30 am

Mr. David Tredinnick (Bosworth): I am grateful to be called to speak in this debate, Madam Deputy Speaker, not least because it is in my name. The debate is on a matter that is crucial for the health of the nation, and I am delighted to see present not an Under-Secretary but the Minister of State, Department of Health. I pay that short compliment to him, because it is good to see him.

While preparing for this debate, I reflected on the fact that 25 years ago I was working in the House of Commons as a research assistant for the then Member for Hastings and Rye, Sir Kenneth Warren. I remember examining issues of police accountability and related matters, and going through Hansard and background papers trying to find definitive moments of change in the political process. It is my belief that, for complementary medicine, today is one of those moments.

There have been three defining moments for complementary medicine in recent years. The first was the publication of the King's fund report. Next was the Lords report. The latest is this morning's debate. It is a defining moment because this is the first time that the official Opposition have got behind this issue and started to consider it from the policy point of view. That should send warning signals to the Government, because it illustrates how the issue has moved up the agenda. I should declare an interest in the matter. Since the 1970s, when I was injured, I have been through the process of learning of just about all the therapies, some of which we shall debate today.

I believe that it is a Conservative issue as much as anything else. I can say to my hon. Friend the Member for North-East Hertfordshire (Mr. Heald) that it is natural Conservative territory, and I am pleased that we have the party with us. It is about choice and self-improvement, as it is about the better use of resources in the national health service and better value for money for Her Majesty's Government. It is also about taking the pressure off doctors and surgeons. It is about using less invasive techniques when possible and about using less toxic treatment when appropriate. In addition, it is about giving doctors new means of treating patients. Further, it is about spreading the burden of health care.

The debate is also about highlighting Conservative achievements in the field and drawing the attention of the House to the woeful shortcomings of the Government's policies. The Conservative Government had three main achievements in this area. The first was in the 1987 Parliament, when a Standing Committee of which I was a member regulated to put osteopaths on a statutory footing, which was hugely beneficial. Secondly, we did the same for chiropractors in the 1992 Parliament; I was a member of that Committee also.

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Thirdly, it was decided to bring GP fundholders into being, which gave doctors new powers to decide how to spend their money, and many GP fundholding practices went on to employ complementary therapists, or to build a link. That came about because of the decision made by my right hon. Friend the Member for Charnwood (Mr. Dorrell), then the Member for Loughborough, when he was Under-Secretary at the Dept of Health, that doctors could channel patients to complementary practitioners provided that they took clinical responsibility. That decision was supported by Tom Sackville, the then hon. Member for Bolton, West, who is sadly no longer in the House. It started the process of introducing complementary medicine into the health service.

I should say as an aside, however, that the person who really got the process going was Aneurin Bevan, who had a homeopathic doctor—the hon. Member for Watford (Claire Ward) is looking quizzically at me, but that is true. Bevan said that homeopathy would be brought into the health service and made available through doctors, and qualified doctors can now prescribe homeopathic medicines on the health service. The only slight problem at the moment is that they cannot get those medicines up on their computers, and the Minister might want to examine that problem. None the less, that was the decision that Bevan made all those years ago.

Whatever shortcomings the Government claim the GP fundholding system had, it gave doctors a certain freedom to take on complementary practitioners in the health service. That was a valuable step in the right direction, which increased supply and choice. Regrettably, the availability of complementary therapies on the health service has declined since primary care groups and primary care trusts came into being. That is because they are under other pressures and do not see integrated health care, complementary therapies and the range of treatments that come under that heading as priorities. It is rare to find a primary care trust that gives priority to such issues, although the Hinckley and Bosworth primary care trust, which is in my constituency and which will cover west Leicestershire, is seriously considering providing acupuncture for pain relief, and a qualified doctor in the constituency wants to use that treatment. The Minister should take that on board, and if he can find a way of encouraging primary care trusts to increase the supply of services rather than reduce it, he will be doing us all a favour. I have written on numerous occasions about the way in which homeopathic services especially have been cut as a result of the introduction of primary care trusts, and we should study the issue.

It is a sad fact that the Government are generally reactive, not proactive, when it comes to complementary therapies, and there is plenty of evidence for that. When the Labour Government came to power, one of the first decisions of the then right hon. Member for Birmingham, Perry Barr, now Lord Rooker, was to restrict the available dosage of vitamin B6. That was a catastrophic decision, which was blown away in the end. The limits that he wanted to impose were based on flawed research and never came into being. There was a huge wrangle over the issue: the industry mobilised, there was an enormous amount of activity, there were parliamentary motions and much energy was expended. It was important that doses were

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not limited to the lower level, because that would have discriminated against poorer people who would have had to buy more of the vitamins that they wanted. That was nonsensical and did the Government no credit.

Two years later, we had the ghastly MLX249 problems. It was proposed that the Medicines Control Agency should be able, on appeal, to redesignate a vitamin supplement compound as a medicine—I may not have the terminology quite right, but it is along those lines. That decision would have placed huge costs on the industry, because supplements that are reclassified as medicines must go through extensive trials, which can cost £100,000 a shot. To get rid of that ludicrous proposal, we had to march from Marble arch to Trafalgar square, where I spoke from between the lions. I heard a crowd of a thousand chanting, "Tony, we want the right to choose." That could be heard in Downing street, and I am told privately that it sent some tremors through the structure at No. 10. Action was soon taken and the proposal was knocked on the head. Now, in the year of our Lord 2002, we have a double threat—the threat to vitamin supplements and the threat to traditional remedies or medicines. The relevant European directive keeps changing its name so I might change my description of it.

I saw the Under-Secretary of State for Health in Committee the other day and I told her that I was grateful to her for having agreed to talk to me, as treasurer of the parliamentary group for alternative and complementary medicine, with an industry expert and a couple of other colleagues the day before. However, I had to warn her that if the issue was not taken seriously, there were people—I did not use the term lightly, it just came out of my head—who were tooling up for war. She looked at me as if to say, "I don't like the sound of that, and I don't like the way in which it has been put across," but when our eyes met, she knew that I was sincere. I was speaking for the vast number of people who see a serious threat to their well-being. Under this European directive, about 160 nutrients, supplements, medical treatments—call them what we might—will be removed once and for all.

My hon. Friend the Member for North-East Hertfordshire might want to develop the point further, so I shall just say to the Minister that he got it wrong on vitamin B6 and he got it wrong on MLX249. He should be careful this time; it is a big issue.

Mr. Oliver Heald (North-East Hertfordshire): Does my hon. Friend take some heart from the fact that, about a week after the discussion in European Standing Committee C during which he made that last point, Lord Hunt of Kings Heath, the health Minister who deals with such issues, called for a further round of discussions and put back the consultation period on the traditional herbal medicinal products directive until the end of this month?

Mr. Tredinnick : My hon. Friend, as ever, is right. The Government have recognised the seriousness of the situation and extended the consultation period. I shall say a word about the industry's view of the meeting that its representatives were granted with the Minister. Generally speaking, the Government are reactive and

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not proactive with regard to complementary medicine and integrated health care. They had to react to the Lords report. Fortunately, they took advice and the response was broadly right. The Secretary of State is very defensive on the issue. When he sees me and thinks that I am about to raise some of these points in the Chamber, I get the feeling that I should have no confidence that he is behind the idea of an integrated health service, which must have an effect on his Department and its officials.

The Lords report, the needling from His Royal Highness Prince Charles and some of the pressures in the Chamber have had an effect. I was touched, just before the last election, when the right hon. Member for Southampton, Itchen (Mr. Denham), who is now the Minister for Policing, Crime Reduction and Community Safety, described me as the hon. Member for Holland and Barrett. It was fun for hon. Members in the Chamber, no doubt, but it played very well on the ground because what I am sure that he did not realise is that I have the headquarters of Holland and Barrett in my constituency. I do not say that the fact that my majority doubled at the last general election was all down to the right hon. Gentleman, but I could have called him a right hon. Friend as I watched the boxes at the count.

I shall move on to the promotion of good health, which is so important. Health care should really start with the promotion of good health. If people are encouraged to take responsibility for their own health, it will prevent many patients from needing access to the NHS. People must be persuaded to change their behaviour, and that cannot be done overnight, but 5 million people each year choose to use complementary therapies. That is a way of taking pressure off the health service and getting people to take responsibility for their own health. People usually have to seek those therapies because they are not widely available, although they are sometimes recommended. One of the great challenges for the Government is to move the focus for those 5 million people to within the remit of the NHS. Surely that would be a vote winner from a political point of view.

Mrs. Cheryl Gillan (Chesham and Amersham): I am most grateful to my hon. Friend for giving way because I shall not be able to stay for the whole debate. Does he agree that it is important that when people develop conditions such as MS, they should pay attention to their regime and diet, which, in some instances, may reduce the costs to the health service by keeping people healthy for longer?

An extremely brave woman suffering from MS came to see me at my constituency surgery. She wanted me to pass on to the Minister the regime and diet that she was following because she was convinced that, in addition to beta interferon, it was keeping her healthy. I hope to be able to pass on to the Minister the regime that my constituent is following because that sort of complementary approach could benefit many other people.

Mr. Tredinnick : My hon. Friend is right. That brings into play another ball—the issue of diet and health. Last night, there was a meeting of the new obesity group in the House. The problems of people who are overweight

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largely result from the consumption of far too much fat and, secondly, from the consumption of E additives. There are far too many additives in food, many of which cause dysfunctional behaviour in school children. All the issues are interrelated, but if we are trying to reduce problems in schools, we should pay much more attention to diet and to the strange effects of additives, which can cause costly disruptive behaviour. So my hon. Friend is absolutely right.

One of the ways in which people can improve their well-being is through taking supplements. Two recent studies point to the need for something specific from the Government. The Oxford study purported to show that certain supplements had no effect on reducing the symptoms of patients with heart problems. It was a limited study and was properly carried out. It did not say that supplements did any harm, just that no benefit could be found. Contrast that with the other survey, which showed that vitamin supplements taken by prisoners were very effective, reduced dysfunctional behaviour and made them easier to manage.

The Minister must commission more research into that because there is surely some confusion there. I take supplements myself—I suppose that is no surprise—and I think that most people who take them believe, and have good reason to believe, that they help. The size of the demand and the size of the industry suggests that not everyone is an idiot, and when people have taken them, they perceive some difference. They understand that they have improved or feel better. That is why they continue buying them, but we need more research on that.

To go back to the traditional medicines directive, as I understand it, the Government's position has completely shifted. The Under-Secretary of State for Health, who was parachuted into the debate on the issue after the last reshuffle, has really tried to get a grip of the issue, but she was not well advised initially. The Department had not consulted the key people in the industry. The decision makers in the Department—the advisers—had not cast their net to ascertain what was happening. It was not until the meeting with the Department and the debate in the European Standing Committee that the Under-Secretary of State understood the sheer weight of opinion and the scale of the problem. That was when she decided to motor on the matter, and it is clear from yesterday's Hansard that things have moved on and that she is trying to get on top of the issue. The message that I got from the meeting with the officials of the Medicines Control Agency and the people who represent the consumer groups and manufacturers was that they feel that the Government have shifted substantially on the matter. The MCA has been pretty much instructed to work with the industry retailers and consumers over the next few weeks to quantify the problems and come up with solutions.

The future of health care is inextricably linked to the integration of complementary therapies in the health service. It is impossible for the Minister's Department to meet public demand and manifesto commitments unless it embraces more fully the integrated health care concept and draws on the 50,000 practitioners who largely practise in the private sector.

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As politicians, we all look for a bit of luck. I believe that it was the Duke of Wellington who was once asked how he chose his generals. He said that he would prefer a lucky general to a good general. I had a bit of luck yesterday while wearing another hat. I am the Chairman of the Joint Committee on Statutory Instruments, and I serve on the Liaison Committee. Colleagues may have noticed that yesterday the Liaison Committee met, and for the first time in 50 years the Prime Minister attended—not for 20 minutes or half an hour, but for two and a half hours. Luck again came to my aid, and I had the chance to ask him a question. I did not ask about statutory instruments, because I did not feel that the Committee needed to ask him about such matters. However, I asked him about complementary medicine.

The Prime Minister waxed lyrical at the meeting about how he personally—ipse, as they say in Latin—had had an influence on the primary care trust system. Yes, his hand had touched the reforms. He also admitted that there were too few doctors, nurses and ancillary nurses. I asked, "Prime Minister, in the course of your deliberations, did you consider making more effective use of the 50,000 complementary practitioners? We know that the Department has already decided to embrace—literally gobble up—all the beds in the private sector. If you are going to do that, why don't you take on the practitioners as well?" I shall be kind and say that I had a holding reply.

The Prime Minister had not been briefed on that issue, but he may want to be because in six months he will come back before the Liaison Committee. Aneurin Bevan said, "Why look into the crystal ball when you can read the book?" I cannot gaze into the crystal ball and say what will happen during that meeting. The Minister might want to tune into what I am saying because it might help his promotion. I may feel pressed to talk about the problems of statutory instruments, which is my right, but there is an outside chance that I will press him on the issue of complementary medicine.

The hon. Member for Watford is smiling again—she is always smiling, which is always good. I am trying to make a serious point in a flippant way, as it is important to try to lighten proceedings on occasions, especially in this area, which can be very entertaining and enjoyable.

I touched on the question of staff shortages, referring to the Prime Minister's comments in yesterday's sitting of the Liaison Committee. The figures involved are incredible. The Government are spending £300 million a year on agency staff to plug gaps in the health service. Hospital managers frequently tell me that the costs due to paying short-term rates for staff are huge. The Minister could make much better use of qualified herbalists and acupuncturists. He does not have to wait for statutory regulation, as many of them are regulated and properly trained. Not all complementary medicines are regulated, but he could bring some such practitioners into the health service now.

The right hon. Gentleman can help himself by proceeding with regulation at a faster pace. He might say something about that today. It is a key issue in the Lords report, and much good work has been done. Both the acupuncture and herbal medicine practitioners are in favour of such moves, although they are partly regulated under the old regime. The herbal medicine practitioners are starting on an ambitious route towards

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self-regulation. The new independent chairman of the regulatory working group is Professor Michael Pittilo. I had lunch with him, and I thank him for trying to put things in perspective. He is working on a detailed plan for herbal practitioners, and perhaps the right hon. Gentleman will say something about that. The acupuncture profession is following closely behind.

Mr. Heald : My hon. Friend must not forget aromatherapists. The Aromatherapy Organisations Council has done a great deal of work to move towards regulation of the profession, and would be interested to hear the Minister's remarks on that.

Mr. Tredinnick : I have Shirley Price's international college of aromatherapy in my constituency, which is one of the leading aromatherapy schools. Regulation has been an awful mess, with five or six different regulatory bodies, so I would welcome proper regulation. Aromatherapy is extremely valuable. I was not going to talk about it, but aromatherapists can be of particular help to people before operations. By gentle massage and use of oils, they can change people's moods and reassure them. They are also important in post-operative care.

I first consulted an osteopath in the 1970s, when that was seen as completely beyond the pale. People would never tell their doctor that they were seeing an osteopath, as they would pretty much be taken off the list. Since regulation, osteopaths have become much more involved in the health service, received much more respect and set up better links with surgeons. The process has worked well, although chiropractors are a little way behind.

I have no doubt, however, that if self-regulation can be speeded up—which perhaps means that the Government will have to spend more money on it—integration of the health service can be achieved in a painless way that meets everyone's requirements. Doctors are often nervous about referring, because they are not sure of the legal status. That is becoming more important because of the litigious nature of our nation. We seem to be following in the footsteps of the United States.

A word on cost-effectiveness will illustrate my point. About 5 million prescriptions are issued for painkillers each year, at a cost of £265 million. A further £370 million is spent on painkillers in pharmacies and supermarkets. Treatment of side effects arising from painkillers costs the NHS anything between £170 million and £350 million a year. Complementary therapies often remove the need for further medical investigation or surgical intervention.

According to the CBI, back pain is emerging as the greatest health concern for employers across all sectors, causing at least 5 million adults to consult their general practitioners annually. That costs a staggering £140 million in primary care. It is estimated that the Government spend more than £480 million a year on services used by sufferers of back pain alone. That includes about 14 million GP consultations, 7 million physical therapy sessions and the use of 800,000 in-patient beds. At any one time, 430,000 people in the UK

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are receiving social security payments primarily as a consequence of back pain. Industry pays the bill in lost work force days, then it pays again through the money needed to fund the health service to rectify the problem. Timely and appropriate preventive care could save Britain's economy millions.

That illustration could easily be applied to many of the other complementary therapies. The Public Accounts Committee ought to examine the relationship between the costs of complementary care and those of modern medicines. Complementary therapies are often much less expensive.

Sandra Gidley (Romsey): The hon. Gentleman mentioned the Public Accounts Committee. Would he be happy for the National Institute for Clinical Excellence to investigate complementary therapies in the context of current technologies?

Mr. Tredinnick : I would not disagree with the hon. Lady's point. NICE could examine the matter, but I was looking for a bigger weapon in the Public Accounts Committee, which is supposed to monitor the nation's books. It launches inquiries to establish whether the Government's spending is cost-effective. I was suggesting that that might be a way forward, but I do not disagree with what the hon. Lady said.

The health service performs more than 300,000 hip replacements each year, mainly on the elderly. Waiting times can be long, and I have received a number of complaints about waiting lists for that operation. Referral to an osteopath can help to keep patients active and mobile while they await the surgery and help to return them to health when they come out of the theatre. It takes the pressure off surgeons and the orthopaedic department. The Minister should consider the self-evident knock-on advantages in terms of reducing bed blocking in hospitals and care homes and for patients and their families.

Bob Spink (Castle Point): My hon. Friend has secured a debate on an important matter on which I have received many letters, as no doubt many other hon. Members have. He mentioned osteopaths and back pain. Is he aware of the Alexander technique and the great benefits that that can bring in prevention and in giving relief, taking the burden off the osteopathic departments in our hospitals by teaching people to use posture and to use their bodies effectively so that they avoid back troubles or minimise their consequences if they already have them?

Mr. Tredinnick : My hon. Friend raises a point that is valuable in two ways. First, he talks about a treatment and its effectiveness and secondly, he illustrates that in the complementary debate we have not really discussed many of the therapies, certainly not those in category 2 or 3 of the Lords report.

Alexander was a remarkable man. He was an opera singer who could not sing. He realised that he had a major problem and he developed a technique of breathing and relaxation particularly involving stretching the shoulders and the spine, which enables the lungs to open up. There is a fair number of Alexander technique practitioners in London and the home counties.

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One of Alexander's discoveries was that, generally speaking, we do not stand properly. Most of us stand in such a way that our hips are dislocated from our back. He found that if one repositions oneself with a slight bend in the knees, one is better balanced. It takes the pressure off the spine and releases the muscles, which in turn releases the constriction across the chest and enables people to sing if they want to.

That technique, which I have studied and occasionally used, is very effective. Sometimes when I hear constriction in voices in the Chamber, I wonder whether some hon. Members would not benefit from the Alexander technique, which was intended as a solution for that specific problem. It can also release many tensions for those at work. A common problem is shoulder tension, which comes from modern working conditions and working long hours. Alexander's idea is suited to tackling that.

I cross-examined the Prime Minister yesterday—that sounds great, but is not entirely accurate. As Chairman of the Joint Committee on Statutory Instruments, I am a member of the Liaison Committee, and yesterday I had a chance to question the Prime Minister about health care. He told us that 75 per cent. of the health budget now goes through the primary care trusts. He also said that his hand had touched the decision-making process, so I was happy to ask him about that. As I said to him yesterday, if 75 per cent. of the budget is devolved to primary care trusts, surely advice should also be devolved and that advice should be to consider different therapies.

In the west country around Devon, many herbal practitioners are considering giving up because they cannot make ends meet in the private sector. I represent part of Leicestershire, but Ottery St. Mary has always been a centre for herbal practitioners, as hon. Members who represent constituencies down there know. Some practitioners are thinking of giving up because they cannot support themselves, yet they have had extensive training in herbal therapy. I can think of one practitioner whose is qualified in phytotherapy, English herbal medicine and traditional Chinese medicine. It is a great tragedy. Those people are out there waiting to be taken on board and it would free up so many doctors and surgeons if complementary therapy was embraced more thoroughly.

Other groups have been working hard to bring complementary therapy online. The Prince of Wales set up the Foundation For Integrated Medicine and one of the programmes it set up is a primary care collaborative. The Government would do well to mark what has happened there. For some years, doctors and health care professionals have worked alongside complementary therapists and the scheme allows evaluation of the effectiveness of working together. The resultant savings shown by the survey prove my point. There are fewer demands on GP time and fewer referrals for secondary care. However, recent research shows that only one in 10 primary care trusts is seeking to establish PCT-wide complementary health care services. Many integrated services are also being established in health centres, and other initiatives are being set up to combat health inequalities. The message is twofold. First, valuable research has been carried out by the collaborative initiative, and secondly, not enough has been done to make use of that research in the health service.

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The Government should introduce statutory regulation. Some work is taking place—I refer to Professor Michael Pitillo—and an easy bull for the Minister to hit is the one that moves statutory regulation along. The Foundation For Integrated Medicine has run seminars. I have attended some of them and they have been an effective force. More doctors must be trained, with courses for older doctors so that they at least know to whom to refer patients. They do not need to train in the discipline, but they should have better awareness of what is available and where to refer.

The Government must make it easier for complementary practitioners to practise in the NHS. Now that the primary care trust system is up and running, the very least the Minister should do is to send a memorandum to primary care trusts instructing them to look carefully at complementary therapies.

Finally, more research is necessary into complementary medicine generally. There was the Oxford survey on the use of vitamins and another conducted on prisoners, but if we are receiving conflicting messages, we need more research into how and where different supplements are effective. The Lords report came up with three categories, but we are really discussing only the first category here. There are many other disciplines. My hon. Friend the Member for Castle Point referred to the Alexander technique. I think that kinesiology, a form of muscle testing, is very valuable in establishing what the problems are. Another discipline that has not really been looked at seriously is iridology. That is about looking in the eyes in order to spot problems with various organs. I attended a demonstration at which 40 people were chosen to be studied. After a two-minute appraisal, about 70 per cent. of them said that the diagnosis was accurate.

We sometimes talk about loose cannons in the House. The origin of that phrase is 19th-century warships. A first-rate ship had 100 guns: on one side on the top deck were the 16-pounders, underneath were the 32-pounders and on the bottom deck were the 64-pounders, so called because they could throw a spherical ball of 64 lb in weight. The one thing that the ratings on those ships feared more than the French was a loose gun on the bottom deck. A gun that could fire 64 lb and that got loose—as you will recall, Mr. Deputy Speaker, the guns had to be run with ropes—was a terrifying thing, which could kill a lot of people. The directives that the Minister's Department are considering at the moment are 64-pounders. They are not secured on the bottom deck, and if he is not careful they will cause a lot of damage.

Mr. Deputy Speaker (Mr John McWilliam) : I hope that the hon. Gentleman was not suggesting that I served in Nelson's day.

10.11 am

Sandra Gidley (Romsey): I congratulate the hon. Member for Bosworth (Mr. Tredinnick) on securing this debate. When we saw his name, the subject was of no surprise, but I have to admire his tenacity on the topic. I want to talk about the place of complementary therapies in medicine and briefly mention the EU directives that are coming down the tracks.

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We cannot get away from the fact that there has been a growing interest in the subject during recent years. Travel broadens the mind, but the biggest contributory factor has been the emerging mindset, which I welcome, that doctors are no longer regarded as gods. Patients have been helped by an explosion of lifestyle magazines, and there is also the internet, although that is a double-edged sword, because there is much rubbish on it. We question things much more nowadays and expect to have answers, and to have more involvement in our treatment.

I used to work as a community pharmacist. In the 20 or so years since I first qualified, there has been an absolute explosion of new products in the vitamins, minerals and herbal sector. I could be cynical and say that such things are sold not because they do any good but because people think that they do, but what is the harm in that? Pharmacists make a lot of money from those products. More and more, however, are also selling homeopathic products. I have taken some interest in complementary therapies, and it annoys me that homeopathic products are often sold completely wrongly in pharmacies. If one takes the time to study what homeopathy is about, one realises that it involves treating a person as an individual rather than as a case of indigestion, or whatever it might be. There must be training if those therapies are to be used properly.

If one walks into a pharmacy now, one finds aromatherapy oils and even devices based on the age-old practice of acupressure, to cure seasickness. I used to do a lot of work with pregnant women. One problem is that such women cannot take any drugs any more. Manufacturers have often not been able to trial their drugs, for very good reasons. That sector of the public increasingly looks to complementary therapies. Morning sickness is dreadful and many women try acupressure bands, ginger and raspberry leaf tea when they are approaching giving birth, and use homeopathy.

Many pregnant women enjoy aromatherapy. A good aromatherapist will not use certain oils on a pregnant woman, which is fundamental. Unfortunately, some people have the mindset that something natural must always be good and should not be questioned. The scientist in me says that if something can do good it also has the potential to do harm. In 1999, a survey of British adults showed that herbal medicines were the most commonly used form of complementary medicine. I am concerned that about one third of adults have accessed herbal medicines, because there is a large amount of ignorance. As a pharmacist, I know that herbal products can be of great benefit and much of the modern pharmacopoeia derives from them. I spent far too many hours during my three years at university doing strange things with bits of leaf.

Many members of the public are labouring under the mistaken belief that herbal medicines are safe and are without side effects. In many cases the effects of herbal medicines are more unpredictable because the amount of active ingredient in herbal material varies. Although there is some quality control, the amount of active ingredient in any particular product varies. Somebody taking herbal medicine does not always get a consistent effect and the pharmaceutical sector controls the amount of a drug more stringently than the herbal

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sector. That is bad enough, but there is also the mindset that natural products are without side effects, which is clearly rubbish. If a preparation has a physiological effect and has the power to cure, by definition there must be the potential for adverse effects. We have to get away from the idea that healthy products are natural. There is a huge place for complementary medicines, but we have to make sure that the public are protected.

The situation is changing. Over the past 20 years many therapies have gained a professional respect that was previously absent. Nowadays it is commonplace for pain clinics to use acupuncture whereas 20 years ago it was regarded as strange and quirky. Chiropractors now have a useful place and even homeopathy and osteopathy have gained a professional respect. That is acknowledged in the Lords Select Committee report, which is a good piece of work although some of my hon. Friends think that the Lords have been too kind in giving credence to some therapies.

I agree with the hon. Member for Bosworth that more research needs to be done. Much of the available research is conflicting and—we all do this; politicians love to do this so why should the complementary medicines lobby not do this?—people cherry pick the studies that prove their particular point. Many complementary medicines can be used as an adjunct to traditional therapy. The hon. Member for Bosworth mentioned aromatherapy, which I use. It can be used to relax patients and a strong case could be made that fewer drugs would be prescribed because if patients feel relaxed they may not need tranquillisers. There is no evidence to prove that that happens; it is just a gut feeling that I have. It would be nice to see someone carry out a trial to study the difference between two groups of people, one treated by aromatherapists and the other treated by conventional pharmaceuticals. If patients are terminally ill, why should they not be allowed to access the alternative treatment of their choice on the NHS, if they think that is going to help them? There is often little hope for some people. They may not want to go down the route of chemotherapy which, although useful, can be very traumatic. Some people do not want to do that, so the alternative route could be worth looking at.

I briefly want to consider the medicines directive. I was reassured by the approach of the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), during yesterday's health questions. The directive as it stood was overbearing. There has been quite an effective lobbying campaign organised by Consumers for Health Choice. I was taken in by this group because I thought that it was a consumer organisation. However, close examination shows that it is largely a lobbying group on behalf of the health food industry. I am not sure whether many of my colleagues who have been lobbied are fully aware of that. Even bearing in mind the fact that there are quite significant vested interests involved, the directive is a classic example of a case where some compromise should be reached. We need good evidence that some of the larger doses of vitamins are safe.

The hon. Member for Bosworth mentioned vitamin B6. I agree that we did get it wrong on that, but many people were unaware that vitamin B6 has significant side effects in large doses. Often, women were taking quite hefty doses. They thought that because it was a vitamin, it must be safe and have no side effects. They could not

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understand why their pre-menstrual tension or post-natal depression had eased, but they were still feeling grotty for some other reason. We must not fall into the trap of believing that vitamins are safe at all doses, at all levels. Once we have an evidence base, it would be clearly ludicrous if every individual or small manufacturer had to go through the licensing procedure separately.

I now start to disagree with the hon. Member for Bosworth. He said that better use of resources for the NHS could be achieved by using such therapies. I would like to support him, but there is a limited pot of money in the NHS, and we have to have a firmer evidence base for some of the technologies. Where there is a proof that a technology is useful, it is already being used—for example, acupuncture.

Mr. Heald : A few years ago there was a growing use by GPs of acupuncture and other complementary therapies because they had the freedom to do so. It is a matter of concern that since we have had primary care groups, and now primary care trusts, that trend has reversed, so we are now losing the use of those therapies in the NHS, which doctors find useful.

Sandra Gidley : I was coming on to primary care trusts. There is nothing to stop doctors using such therapies if they want to. A small group of local surgeries in my constituency took part in the total purchasing projects—a Conservative idea. That local group had won awards for the way in which they approached the matter. One of the innovative things that it did was to provide exercise on prescription. At the time, the group found that that led to real benefits. Having been given a free course, people very often completely changed their lifestyle and carried it on of their own volition because they realised the difference that it made to their lives. They were very upset when they were told that the TPPs were not to continue. They have been shackled in recent years, and have had to concentrate on what could be called core Government priorities. Recently, I spoke to some of those doctors and they were looking forward to 75 per cent. of the budget being devolved. They were keeping their fingers crossed that that money would not be earmarked. They want to return to having more freedom and to try prescribing some of these therapies.

We must not forget that the GP contract is being changed. It is likely that soon people will register with a surgery instead of an individual GP. That change could increase the use of complementary therapies. In the past, I worked alongside a surgery that had one doctor who was keen on homeopathy. Patients were queueing to see him because they wanted to access homeopathy first. They often found that the medicine was beneficial. I do not know whether those patients experienced a placebo effect, but they certainly did not return to that surgery for drugs of the traditional kind.

I welcome greater use of complementary therapies, but if primary care trusts and health professionals are to embrace them, it would be useful to establish a larger evidence base. I was disappointed after an earlier debate when I did not receive the evidence that the hon. Member for Bosworth promised to send me. I hope that he will put that right, because I have a genuine interest.

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The hon. Gentleman mentioned supplements for prisoners. However, prisoners have an appalling diet, so perhaps it would be better to scrap supplements and ensure that they get enough fresh fruit and vegetables. There is more than one way to look at a problem. The hon. Gentleman may remember that a few years ago there was a survey of school children that showed that giving children certain blends of vitamins improved their IQ. I could say that giving them a proper diet, rather than Big Macs, would have achieved the same result. It will be difficult to find evidence, but if we want to offer choice to the public, it is well worth investing in research to establish the true place of such therapies in the NHS.

10.28 am

Bob Spink (Castle Point): It is a pleasure to follow two hon. Members who spoke with great knowledge and fluidity. I congratulate my hon. Friend the Member for Bosworth (Mr. Tredinnick) on securing the debate.

I apologise for starting on what may seem to be a discordant note, given that the two previous speakers dealt with the subject with a laudable lightness of touch. The debate is about choice and the freedom to act for one's individual needs and to make decisions about how one treats oneself, especially one's body. There is a growing and regrettable tendency for Governments to over-regulate every aspect of our lives; they want to control what people do, eat, where they go and whether they can sing in pubs. Generally, they want to dominate people's lives. The tendency is to swamp society with controls and over-burdensome bureaucracy. The present Government are one of the worst in history for doing that, and they are driven by the European Union to push forward directive after directive. They swallow them all whole. I would say, why fix it if it ain't broke? Complementary medicines and therapies are not broke. The Minister is scribbling, no doubt preparing his riposte to my attack, but I do not include him in my comments. I know him of old, and he is a good man. He is not an over-regulator by instinct, and I hope, therefore, that he will take the message to the Government.

Many doctors know how important complementary medicines can be in building a patient's confidence and self-esteem. Patients get not just choice but the important element of ownership of their treatment—they have a degree of control and choice. If such medicines are safe, use of them should not in any way be stymied, as they are very good and can help in many ways in building feelings of well-being in patients. There is much more to the treatment of disease and symptoms than any of us knows. At present, we do not understand the processes very well. Although we do not understand how, we know that the psychological effect is enormously important in the progress of disease and the effects of symptoms. If complementary medicines and therapies can help to alleviate and control the progress of disease, we should celebrate that and not seek in any way to control the process too much. All that matters is that it works.

Complementary medicines cover many areas of treatment. We have heard that aromatherapy can give relaxation and relief and help in many subtle ways in pre-operative situations, in pregnancy and so on. I have never personally used aromatherapy. I do not know whether

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other hon. Members have, but I have not had that pleasure. I was delighted to hear that the hon. Member for Romsey (Sandra Gidley) is an expert in the area. I would subject myself to some hands-on experience to learn first-hand how important aromatherapy is, were she willing to introduce me to it. Putting humour aside, if people enjoy it and it gives self-esteem or relaxation before an operation, why not use it?

Food supplements can be helpful, providing they are safe. I do not believe that there is any great evidence that food substances are abused. Vitamins are essential. Some people like to use vitamins to supplement their diet or as an aid when they get older. For instance, older people need more calcium to keep the density of their bones intact, and I do not see anything wrong in that. Traditional eastern medicines and therapies have been around for hundreds if not thousands of years. We do not know how they work, but we know that they have a significant effect and give great help and relief to patients. I do not understand why we should over-regulate them if it is not necessary. Acupuncture has been used for thousands of years. We do not know how or why it works, but we know that it can have an important effect on some patients. If it works, let it work.

There are several issues to be considered. If we can use medicines, including complementary medicines, in a preventive way, we should do so more. We should seek to prevent rather than to treat disease, and I hope that the health service will grow most in that area in the next 20 to 30 years. Otherwise, we will look back and realise that we did not get on with prevention soon enough or aggressively enough. Complementary medicines can be preventive. We should promote, not inhibit, the use of vitamin and diet supplements. We should also promote self-control and individual control where that is possible and safe.

We need the Government to give us advice and information, but not to over-regulate and control us. They could, for instance, give us more of a lead on diet. Hon. Members will know from my accent that I come from up north, so I feel able to say that diet is a particular problem there. The Government could give a lead on that, but I do not want them to regulate against fish-and-chip shops, or fried Mars bars in Glasgow. I am a great advocate and fan of fish-and-chip shops, although I cannot imagine why anyone would want a fried Mars bar. None the less, why should the Government regulate such things if people want them? Indeed, the Government are not rushing to regulate them, even though they probably damage the population's health much more than complementary medicines do. I do not see, therefore, why the Government should regulate complementary medicines, unless they want to develop a nanny state.

The bottom line is that patient choice should be welcomed and allowed where it is safe, because it will give patients control of their situation and self-esteem.

Sandra Gidley : I take what you said about choice, but it was the Conservative Government who reduced the number of vitamin preparations available on prescription and who put some of them on the black list.

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Mr. Deputy Speaker : Order. We are getting a bit slack. When the hon. Lady says "you", she is referring to me, and I have not said a word.

Bob Spink : Were you, Mr. Deputy Speaker, to answer the hon. Lady, you would do so far more eloquently than I ever could. However, she makes a good point, and I do not seek to defend what previous Conservative Governments did. I would say, however, that we are listening to what the people say. We all know that our mailbags have been inundated with letters from people who want us not to stop or control complementary medicines and therapies, but to resist the European Union's rather silly directives, because they are unnecessary, smack of the nanny state, prevent choice and will, on balance, harm the health service. I rest my case, Mr. Deputy Speaker. Thank you for hearing me.

10.37 am

Mr. Oliver Heald (North-East Hertfordshire): We have had an excellent and important debate, and I congratulate my hon. Friend the Member for Bosworth (Mr. Tredinnick) on securing it and on speaking so comprehensively.

My hon. Friend started—it is perhaps not a bad place for me to start—by noting that the period of Conservative government that started in 1979 was marked by important achievements in complementary medicine, and we do not need to apologise for what Conservative Governments did. As the hon. Member for Romsey (Sandra Gidley) said, the acceptance of osteopaths and chiropractors was sealed by the Acts that were passed during those years. Equally, GP fundholding, whatever the Minister's criticisms of it, allowed GPs to use complementary therapies in a way that had not been seen before. That is one reason why we now see that wide range of treatments being used in practice.

As my hon. Friend the Member for Castle Point (Bob Spink) said, it is vital to recognise that we are dealing with an important issue of individual choice. It was not by chance that 1,000 people marched to Trafalgar square shouting, "Tony, we want the right to choose." Those people felt strongly that they should be able to use certain therapies and that the Government should not interfere unnecessarily in a nanny-state way or in an orgy of regulation. My hon. Friend made a valid point when he said that the instincts of the Government are all too often to regulate rather than to allow individual freedom and choice. My hon. Friend the Member for Bosworth, echoed by my hon. Friends the Members for Chesham and Amersham (Mrs. Gillan) and for Castle Point, also made the excellent point that there is a need to promote good health, and that diet and the way in which one approaches it are vital.

It is important to regulate professions so that they can be seen to be acceptable. That is how osteopaths and chiropractors were able to make progress. Can the Minister tell us what the proposals are for the other professions that have been mentioned during the course of the debate? I include aromatherapy, which I mentioned earlier. With regard to back pain and the Alexander technique, I know from meeting people who are involved in pain management that back pain is the largest problem of all. If research can help in that area by examining complementary therapies and providing them, that would be an economic use of resources.

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The hon. Member for Romsey said that there has been an explosion in the use of complementary therapies and in the number of products that are available in pharmacies. We must not forget that we need to be careful about their use. I agree that safety is important; she made that point very fully. That does not mean that we should accept everything that is coming from Europe—the food supplements directive, the traditional herbal medicinal products directive and the European Commission's proposals to amend the EC medicines regulatory system. We have been concerned for a long time that the combination of those measures will lead to many products becoming unavailable, which will hit the retail sector. The Government have not yet given a solidly founded explanation of the dangers of these products. When we debated the matter in European Standing Committee C in June, I asked the Under-Secretary of State for Health whether she could point to solid scientific evidence that traditional herbal medicinal products were dangerous. We were given a few anecdotal examples about Aristolochia in Belgium, but that was not the sort of detailed, scientific report that one would expect from a Government who supported measures that could hugely limit consumer choice and put a number of firms out of business.

Mr. Tredinnick : The Aristolochia case is often quoted, and it is misused. That was a case of the wrong drug being over-prescribed by the wrong people.

Mr. Heald : That is the point that my hon. Friend made very tellingly.

There are some welcome signs. As I mentioned earlier, Lord Hunt of Kings Heath has called for a further round of discussions on the traditional herbal medicinal products directive, I understand that the Medicines Control Agency consultation has been extended and we hear that the Health Food Manufacturers Association is to meet the Minister on 24 July.

Can the Minister tell us what is really going on? What meetings have there been with interested groups, what meetings are planned, and is there emerging thinking from the Government that is more conciliatory on the issue? Will we see sound statistical medical evidence produced in this area? The principle should be that it is reasonable to request hard evidence if one is to outlaw products that are currently on sale; the burden should not be the other way. If something is being sold, and there is no evidence that it is doing harm, it is hard of a Government to say that they will introduce heavy-handed regulations without any sound basis. The Minister should be aware that a huge body of people are against the Government on these issues. They include the National Association of Health Stores, Consumers for Health Choice and people in the industry, as well as numerous consumers who write to Members of Parliament. The issue currently forms the largest postbag. One cannot merely say that those people have vested interests; they are the millions of people who use the products and who feel strongly about the issue. There is a burden on the Government to prove their case, which they have not yet done.

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The European Commission proposes to amend the EC medicines regulatory system. The whole system seems to be becoming more centralised and the definition of a medicine is being expanded, so that it might include products from the arena of complementary medicines. I should be grateful if the Minister were to tell us whether the Government have made any progress in their opposition to the process. The Under-Secretary of State for Health told us that the Government had some concerns about the process, and I should like to know what progress has been made.

On the EU directive, will the Minister tell us the Government's view of the provisional findings of the European Union Scientific Committee on Food? The Government promised to tell us their view during the summer, once the expert group on vitamins and minerals had given its advice. We are getting into the dog days of summer in terms of parliamentary time, with only five days left, so we need to know the answer.

On the cosmetics directive, there are concerns about essential oils not being available because of new regulations on allergens. I wrote to the Secretary of State about that in June, but will the Minister tell us the Government's view of that directive?

Overall, will the Minister give us a commitment that the Government are reflecting on their strategy in this area, and will he commit himself to moving the Government's agenda towards choice and away from regulation? This is an important issue about choice and individual freedom, and unless the Government do something, they are likely to find more people marching through London shouting, "Tony, we want the choice." I am sure that the Prime Minister would not want that.

10.48 am

The Minister of State, Department of Health (Mr. John Hutton) : First, I join in the warm, generous and entirely appropriate remarks that have been made by hon. Members towards the hon. Member for Bosworth (Mr. Tredinnick), not only for raising the debate today and on many previous occasions but, as the hon. Member for Romsey (Sandra Gidley) said, for doing so with a tenacity and perseverance that is a credit to him. People often challenge the efficacy of Members and the contribution that individual Members play. The hon. Gentleman's campaign on complementary and alternative medicine provides evidence of how wrong those people are.

The hon. Gentleman and the hon. Member for North-East Hertfordshire (Mr. Heald) drew attention to what they described as the achievements of the previous Conservative Administration in this area. I shall not quibble with the substance of that analysis, particularly in relation to the regulation of osteopathy and chiropractic. As the hon. Gentleman will be aware, measures on both were introduced by private Member's Bills, so we need to proceed with some caution in claiming them as successes of the Conservative Administration. I am sure that they enjoyed the support of Ministers, but we need to put that on the record.

I take a slightly different view of the contribution of GP fundholding, which will not be a surprise either to the hon. Gentleman or to his hon. Friends. Rather than re-run the argument about fundholding and its merits or otherwise, I should put on the record that there were

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significant disagreements among general practitioners about the direction of that policy and whether it was beneficial to general practice or primary care. I shall touch on the point that the hon. Gentleman rightly raised on the accessibility and availability of complementary medicine within the NHS.

The hon. Gentleman referred to our approach to what he called integrated health care, and I agree with him in many respects on that. He will be aware that the Department now co-sponsors an award scheme on integrated health care. There have been a number of noticeable NHS achievements in that regard, of which the hon. Gentleman is perhaps unaware.

Last year, there were two winners of the award. One was the Blackthorn medical centre in Kent, which offers an anthroposophic approach to treatment, rehab and support employment for patients suffering from chronic illness. The other winner was the maternity acupuncture service provided at the maternity unit at Derriford hospital in Plymouth, where acupuncture was originally offered to provide greater choice of pain relief for women but was extended to a popular out and in-patient service for ante and post-natal problems. More than 4,000 women have been treated by that service, so there is evidence of progress.

The hon. Gentleman drew attention also to the need for more research, and I agree with him on that. I shall touch on what the Government are doing to encourage that. He stressed the importance of effective regulation, and I strongly agree with him on that.

I might have been a little unkind to the hon. Member for Romsey in our previous debate on the role of the private sector in the NHS. This time, I am happy to say that I agreed with almost all her comments. I hope that our relationship is now on a stronger footing, although if I were her I would be more worried about a relationship with the hon. Member for Castle Point (Bob Spink).

The hon. Gentleman took a perfectly reasonable position on regulation. He is against it, almost as a matter of ideology. He prefers the freedom of the market and the freedom of consumers to choose. That is a perfectly defensible ideological position, but events over the past 200 years might have provided some evidence that that is not always the best way to proceed.

The hon. Member for Bosworth, in his support for statutory regulation of some of the key therapists, takes a very different view from that of the hon. Member for Castle Point, and I agree with the hon. Member for Bosworth. The important point is that if we are to regulate, we should always do so proportionately. We should always try strongly to support the basic principles of choice and consumer freedom. Everyone would want to sign up to those basic principles, whatever side of the House they sit on.

I have a great deal of respect for the hon. Member for Castle Point, but I do not think that the positions in this instance are absolutely fixed. We need to approach this subject with a degree of pragmatism. We should be clear about our overall objectives but be prepared to regulate, to intervene and to use our powers to establish proper minimum national standards, where that is in the interests of consumers and will support the exercise of

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effective choice rather than undermine it. I can reassure the hon. Gentleman, however, that we have no plans to regulate the sale of fried Mars bars, if that was of concern to him.

The hon. Member for North-East Hertfordshire referred to several developments at European Union level, which I shall deal with in a few minutes. He was concerned about the Government's evidence on the safety of herbal medicines. He will remember, because he was present at the European Standing Committee debate, that my hon. Friend the Under-Secretary of State for Health pledged to place a summary of safety information relating to herbal medicines in the Libraries of both Houses. The Medicines Control Agency intends to provide that information by the end of this month, so I hope that that will clear up some of his concerns.

I am not sure that I can be helpful to the hon. Gentleman today on cosmetics, as I know diddly squat about that subject.

Mr. Heald : Will the Minister inquire into what happened to the correspondence I had with the Secretary of State in June and give it a push, so that I get a quick reply?

Mr. Hutton : I will certainly do that.

The hon. Gentleman asked me a specific question about the regulation of aromatherapists. They have set up a working group with an independent chairman. The first objective is to work together to create a system of voluntary regulation. If that can be done, we shall consider the case for any further form of regulation. Any scheme that they put in place themselves as an initial first step would form the basis of further progress.

Unfortunately, I have only five more minutes in which to respond to this important debate. First, I should say that there is no question in my mind but that evidence-based complementary and alternative medicine treatments provided by properly qualified and regulated practitioners can make a positive contribution to improving the health and well-being of people in this country. That is the Government's view. There is also no doubt that patients should always have the maximum possible choice of the range and types of treatments available; that is not only a Conservative set of principles but a Labour set of principles.

Our goal should be to support choice, diversity and safety in health care provision. As hon. Members know, primary care trusts have the primary responsibility for ensuring that that happens at a local level. It is widely accepted that people with cancer often find that complementary and alternative medicine treatments such as aromatherapy and reflexology, from which I have personally benefited and rate highly, help them to cope better with the trauma and anxiety that follow the diagnosis of that terrible disease, as well as easing the debilitating effect of the treatment that they undergo.

For that reason, the guidelines on supportive and palliative care for cancer patients that the National Institute for Clinical Excellence will publish next year will include a section on complementary and alternative medicine. I hope that the guidelines will clarify the roles that various complementary and alternative medicine therapies can usefully play in the supportive and

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palliative care not only of cancer patients but of those afflicted by other chronic illnesses that are difficult to treat.

The hon. Member for Bosworth was concerned about the availability of complementary and alternative medicine provision throughout the NHS. He will be interested to know that we have commissioned research from Sheffield university on the subject that shows that a small increase has taken place in the provision of those therapies. It suggests that about half of general practitioners provide access to some form of complementary and alternative medicine. The hon. Gentleman will probably say that that is not enough, but I hope that he takes some reassurance that the indicators are pointing in a more favourable direction from his point of view. When the research information becomes available later in the summer, I shall ensure that he sees it.

It is not only what we are doing within the NHS that is important. The Department is working with the King's fund on a collaborative project led by Westminster university to create a network of primary care trusts that will identify and share good practice in the clinical governance of complementary and alternative medicine as a major contributor to NHS primary care. The two-year project began earlier this year and its results are expected next year. Other organisations such as the NHS Alliance and the Prince of Wales Foundation for Integrated Health are working in partnership on the project.

Much concern was expressed about the regulation of practitioners. No debate on the subject would be complete without a proper analysis of the pros and cons of that matter. We continue to regard regulation of complementary and alternative medicine professions as an important objective, so I am pleased to be able to describe the progress being made towards statutory regulation of herbalists and acupuncturists.

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The independent herbal medicine regulatory working group has been in existence since January. There are important and sensitive issues to be resolved, especially in relation to relationships between the different traditions of herbal medicine. However, I hope that all traditions represented on the working group will continue to work together to achieve a sensible conclusion. If possible, the Government would like a statutory scheme to be established that encompasses and retains the unique characteristics of all traditions of herbal medicine, including the practice of traditional Chinese medicine. With good will and constructive participation all round, we can achieve something to provide much greater protection for patients and the public generally.

On the subject of acupuncture, a new regulatory working group is being assembled and will hold an initial meeting soon. I am pleased that both working groups are led by experienced independent chairmen, and I am confident that they will lead the professions involved to a position on which we can build. Once the working groups have made their recommendations, we will use them as a basis for wider consultation before preparing a suitable legislative vehicle to put before Parliament.

There is also the important subject of product regulation. My hon. Friend the Under-Secretary of State for Health made it clear yesterday on the Floor of the House that our overall aim on herbal remedies is to achieve an effective balance between public health and consumer choice. They are not exclusive options, as the hon. Member for Castle Point tried to assert.

I accept that the balancing act is difficult. There are many effective advocates of consumer choice, and we acknowledge that many people have strong feelings on the issue.

Mr. Deputy Speaker : Order.

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