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House of Commons
Friday 15 January 1993
The House met at half-past Nine o'clock
PRAYERS
[ Madam Speaker-- in the Chair ]
PETITIONS
Local Authority Tenants
9.34 am
Mrs. Anne Campbell (Cambridge) : I wish to present a petition from 500 local authority tenants who reside in the city of Cambridge in my constituency. Their concern is
That Section 105 of the Housing Act 1985, part of the original Tenants Charter of the Housing Act 1980, gives a most important right to council tenants in England and Wales in that it obliges their landlord authority to consult them on matters of housing management. The right of tenants to be consulted and to have their views taken into account when any subsequent decision is made is the foundation for tenant participation in housing management.
Wherefore your Petitioners pray that your honourable House : Will instruct the Government to make no amendment to reduce tenants' rights under Section 105, Housing Act 1985 (1985 c. 68) and to therefore strike out Clause 114(2) of the Housing and Urban Development Bill, published on Thursday, 22nd October 1992, and strike out clause 115(1) of the Bill insofar as it concerns the proposed amendment made in Section 27(AA)4 of the 1985 Act. To lie upon the Table.
Treaty of Maastricht (Referendum)
9.36 am
Mr. Tony Benn (Chesterfield) : I present the second group of petitions signed by many tens of thousands of people from all over the United Kingdom who are in favour of and opposed to the Maastricht treaty and represent a wide range of political opinion. The petitioners state :
That the provisions of the Maastricht Treaty, which was negotiated by the heads of Government of the member states within the European Community, are designed to bring about a European Union, complete with its own constitution, in which all the countries that are party to it, will belong ; That this union, and its laws, will have a profound effect upon the way in which the United Kingdom is governed, and upon the democratic rights of the citizens of this country to elect and remove those who now enact and administer the laws of this nation".
The main point of the petition is
That the British people have been given no right to determine, for themselves, in a democratic vote, whether or not they wish these constitutional changes to be made".
The Petition ends in the traditional way :
Wherefore your petitioners pray that your honourable House : Will ensure that before the Maastricht Treaty, or any modification or amendment of it, is approved by Parliament, or ratified by Her Majesty's Government, the citizens of the United Kingdom shall be given the right to vote for, or against, that Treaty, in a National Referendum, and that the decision reached in that Referendum be accepted as binding upon the Government and Parliament.
And your petitioners, as in duty bound, will ever pray etc. To lie upon the Table.
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Orders of the Day
Osteopaths Bill
Order for Second Reading read.
9.38 am
Mr. Malcolm Moss (Cambridgeshire, North-East) : I beg to move, That the Bill be now read a Second time.
It is a singular privilege for me to have a double opportunity this morning, first to present a private Member's Bill but especially to present such an important piece of legislation which will not only enhance dramatically the professional status of the osteopathic profession but will be a milestone on the road to recognition for complementary medicine as a whole.
I begin by thanking the King's Fund and its working party, and in particular Simon Fielding, who has been a great help to me in the past few months. I am glad that he is present today. I thank officials from the Department of Health, who have given me every assistance possible, and Lord Walton, whose Bill I have taken over because his original Bill fell in the Lords earlier this year. I thank hon. Members of all parties who have supported the Bill, and I especially thank Opposition Members who will speak in its support today.
Some consternation was expressed to me just before Christmas when it was discovered that I was about to embark on a week's skiing with the Lords and Commons ski team. There was the prospect either that I would be standing here with one or more limbs in plaster or that I would be flat on my back, which would not have been the most auspicious circumstances in which to present the Bill.
Osteopathy is a system of diagnosis and treatment which lays its main emphasis on the structural and mechanical problems of the body. It is not regarded as an alternative to conventional medicine, but rather as a complementary therapy, offering patients an additional option in the treatment of certain conditions affecting the body's mechanical functions.
Osteopathic treatment predominantly comprises gentle manual methods. It utilises a diagnostic procedure similar to conventional medical examination, but it pays especial attention to the patient's musculo- skeletal system. Osteopathy is the most widely used of the complementary therapies. I am sure that many hon. Members have availed themselves of the services of an osteopath at some time, and many are here today to support the Bill.
It is estimated that there are now well over 2,000 osteopaths practising in the United Kingdom, and that they are visited by 100, 000 patients every week. Given its growing popularity and widespread use, it is of key importance that there should also be safeguards for the public which will ensure, for example, adequate clinical training for all those who are entitled to call themselves osteopaths. An essential element of the training is to equip practitioners with the ability to recognise conditions for which osteopathic treatment is inappropriate and cases in which the patient should be referred to a registered medical practitioner. The final essential component of the safeguards needs to be the provision of effective disciplinary procedures to ensure that the profession achieves and maintains the very highest standards.
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I was encouraged in my decision to take the Bill forward by the support now given by the medical profession to osteopaths in their quest for statutory registration. For some time, the British Medical Association has accepted that there is"an organised, reputable and coherent body of knowledge underlying osteopathic practice".
The BMA has also stated its belief that the increasing practice of cross- referral between general medical practitioners and osteopaths has been of immense benefit to patients.
The support has not always been so warm. Until the mid-1970s, doctors were prevented from referring patients to any practitioner who was not medically qualified. I very much welcome the change of heart which is demonstrated by the increasing interest of doctors in osteopathy, and by an increasing willingness to refer patients to osteopaths. There is also a growing public interest in a variety of complementary therapies, not least osteopathy, which leads me to believe that the Bill is very timely.
The Bill is modelled on the recommendations for statutory regulation presented in the report by the King's Fund working party on osteopathy, which were enshrined in the Bill presented by Lord Walton of Detchant in the previous Session. I know that the osteopathic profession would wish to join me in paying tribute to the King's Fund working party--and especially to its chairman, Sir Thomas Bingham--for its considerable contribution in advancing the cause for statutory regulation of osteopaths.
I appreciate that, at first glance, the similarity between my Bill and Lord Walton's may not be evident. That is primarily because the two pieces of legislation were penned by different hands. However, I can assure the House and the profession that both the fundamental principles and the key purposes of the two Bills are identical. The first purpose is to establish a representative governing body for osteopaths and the second is to set in place a fair and practical system of statutory regulation for the profession.
Mr. Michael Stern (Bristol, North-West) : I welcome the legislation, and especially the part to which my hon. Friend has just referred. Does he agree that a professional body in medicine established now has an opportunity to set new standards for such professional bodies simply by being newly established and by not carrying with it the bag and baggage of some of the older professional bodies in medicine, which have sometimes seemed over-protective of their members?
Mr. Moss : The Bill breaks new ground in setting standards of regulation that have not yet been met by some of the other medical groups. I hope that my hon. Friend the Member for Bristol, North-West (Mr. Stern) will realise as I continue my speech that a great deal of thought has gone into the Bill, not only to make it a landmark for future legislation to encompass more medical groups, but to incorporate in it some clauses that existing medical groups that have regulation may want to take up at a later date.
I also assure the House that the Bill encapsulates the recommendations for initial registration made in the working party's report to enable, as far as possible, osteopaths in current practice to qualify for registration.
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The Bill also extends the provisions to enable certain other practitioners who might not otherwise have been able to meet the conditions for registration to be registered.I shall explain in greater detail later the different ways in which practitioners will be able to qualify for registration. I have mentioned the point now about extending eligibility to illustrate not only how the Bill is firmly rooted in the working party's recommendations, but how it builds on that solid foundation. That reflects the input in policy from across government, the experiences of similar statutory schemes such as the General Medical Council, our European obligations, competition laws and aspects of human rights. The primary object of the Bill is to set in place a professionally led, statutory registration scheme for osteopaths. It would be similar to those existing for many other professional groups, including all the key health professionals. The scheme would be achieved primarily through the establishment of a General Osteopathic Council, which would have the statutory responsibility to develop, to promote and to regulate the profession of osteopathy throughout the United Kingdom, and to set educational standards and standards of professional conduct.
The Bill would also establish four statutory committees of the General Osteopathic Council. The first would be the education committee, which would have the responsibility of promoting high standards of education in osteopathy and of providing the general council with advice on all matters concerning education, training and examinations in osteopathy. The three other committees would be the investigating committee, the professional conduct committee and the health committee, which collectively would provide the
fitness-to-practise machinery.
The three committees would provide the key function of ensuring that an allegation made against an osteopath concerning his professional conduct or competence to practise was properly investigated and dealt with effectively. The committee's remit would also cover allegations that a practitioner had been convicted of a criminal offence, or that he or she was unfit to practise for reasons of ill health.
The statutory scheme would replace the current system of voluntary regulation. That has worked exceptionally well for the majority of practitioners, and it has played a key role in paving the way for statutory regulation. However, by its very nature, a voluntary system is unable to enforce standards of competence or conduct. If a practitioner chooses not to participate in the scheme, the regulatory body is completely powerless to exercise any jurisdiction over that individual's practice.
That fundamental weakness brings into sharp focus the need for the statutory scheme. As the law stands, anyone can call himself or herself an osteopath and set up in practice. There is no obligation to undergo any formal training or to comply with standards of professional competence. Members of the public therefore have no guarantee that a person holding himself out as an osteopath is properly qualified and competent to do so. The only recourse that patients have in the event of mishap is through the common law. Under my Bill, the system of voluntary regulation would be replaced by a single statutory body capable of enforcing standards of training, education, proficiency and professional conduct throughout the profession in the United Kingdom. The body would also have powers to
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require anyone wishing to practise as an osteopath to conform to those standards, be registered with the statutory council and submit himself to its authority. The statutory council would thus have the unique ability to unite the profession and sweep aside the current fragmentation.The achievement of statutory regulation would, I believe, herald the dawn of an exciting new era for the osteopathic profession. It is essential, however, that, in reaching out for the prize of tomorrow, the profession does not let go the trophies that it holds today. I have mentioned that the current systems of voluntary registration have provided the solid foundation for a statutory scheme, but, even assuming the successful passage of the Bill, it could take up to two years before the machinery to drive the statutory scheme is fully in place. I therefore urge individuals in the profession, many of whom are here today, not to abandon the current schemes prematurely. The successful transition to statutory regulation will depend heavily on their continued support and maintenance.
I emphasise that the statutory scheme would be not only led but regulated by the profession. For that reason, 12 of the proposed 24 members of the General Osteopathic Council would be osteopaths elected by the profession itself. Eight of the remaining members would be non-osteopaths, appointed by the Privy Council. Those members would represent wider interests and, in particular, the views of patients. That would help to increase the breadth of experience within the general council and ensure that the profession had a firm and balanced basis on which to develop in future.
The other four members of the general council would include a person with experience in medical education, nominated by the Secretary of State, and three members appointed by the education committee to represent the interests of training institutions in the United Kingdom. The balance of different members is mirrored in all other statutory regulatory schemes ; the scheme, like all its counterparts, would be overseen by the Privy Council.
Eagle-eyed Members may have spotted an omission from the Bill--there are no arrangements for establishing the very first General Osteopathic Council. It is not possible for the arrangements currently in the schedule to apply to the first general council because, at the start of the scheme, there will be no registered osteopaths to be elected or to vote. Special transitional arrangements will therefore need to be provided, and I propose to specify them in an amendment to the schedule in Committee. What I have in mind is that the initial osteopathic and lay members of the general council would be appointed by the Privy Council. That is in keeping with the practice followed in the establishment of other statutory schemes, and was endorsed by the working party in its report.
To ensure that the general council reflects a balance of good professional opinion, experience and practice, the initial osteopathic members would, of course, be appointed after consultation with those bodies that administer the current scheme of voluntary registration. The individuals would not, however, be representatives of any particular organisation--nor would they be beholden to any sectoral interests. Instead, they would be selected on the basis of their individual ability and merit and would, in effect, be ambassadors for the profession as a whole.
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The working party on osteopathy regarded the primary objective of any scheme of regulation to be the benefit and protection of patients. Having studied statutory schemes governing other professions, the working party concluded :"for all practical purposes there is no viable alternative to the statutory registration of osteopaths which should be open to inspection by members of the public."
That view was supported by all the organisations consulted by the working party, and I hope that it will be supported by the House today.
A statutory register of osteopaths would therefore form the core of the regulatory scheme. The register would be maintained by the registrar appointed by the general council. In future, all practitioners wishing to call themselves osteopaths would be required to be registered on the register. That requirement would be backed up by a provision in the Bill making it a criminal offence for an unregistered practitioner to use that title or any variation of it. The closure of professional title was one of the key
recommendations in the working party report. It is also a central provision of the Bill. I emphasise, however, that the offence will be related to the use of the title "osteopath". The Bill does not in any way seek to prohibit the use of osteopathic techniques by other manipulative therapists such as physiotherapists, or prevent them from telling their patients that they are using such techniques. That brings me to the nub of the scheme--the proposed criteria for registration, which will clearly be of central concern to many people, not least those in the profession itself. As this is such a crucial part of the regulatory scheme, I should like to explain in detail the different categories of registration proposed under the Bill- -and, in particular, the transitional arrangements that would apply. Application for registration would be on a strictly individual basis. Membership of a particular professional body would not, therefore, confer any automatic right or advantage on an individual, although it is, of course, intended that the statutory scheme should embrace, so far as is practicable, practitioners currently registered under the system of voluntary registration.
The Bill provides for the "full" and "conditional" registration of existing practitioners. That is based on the recommendations made in the working party report, although "conditional registration", as referred to in the Bill, is what the working party called "provisional registration". The different title that we have selected more accurately reflects the conditional nature of that category of registration, and also offers the profession scope to introduce a more familiar system of provisional registration, along the lines of pre-registration for doctors, if it so wishes.
Entitlement to full registration is founded on the same principles of good character, qualification and experience as outlined in the working party's report. The provisions are intended to enable as many osteopaths in current practice as possible to qualify for registration, without compromising the key principle of providing the public with adequate and effective safeguards against inexperienced and untrained practitioners.
The Bill does, however, impose an additional requirement : practitioners would also have to be in good physical and mental health. A similar provision exists in the Dentists Act 1984. The intention is to enable the registrar at the outset to refuse registration to an applicant
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whose known state of health raises serious doubts about his ability to practise. Without such a provision, the registrar might have no other option but to register the practitioner and hope that he would be able to secure an early suspension of the osteopath's registration by immediately referring the matter to the health committee. For an initial two-year transitional period, commencing on the day on which the register opens, a practitioner who does not hold a qualification recognised by the general council as one that equips him or her with the standards of education and training required for the safe and competent practice of osteopathy may still be entitled to full registration. That would be on the basis that he or she can satisfy the registrar that, for at least five of the preceding seven years, he or she has spent a substantial part of his or her working time in the safe, lawful and competent practice of osteopathy. That arrangement follows the working party's recommendation and acknowledges that experienced practitioners who may not have the benefit of a properly structured course of training but who have been practising safely and competently in the name of osteopathy for many years should be brought within the scope of the regulatory scheme. The Bill does, however, require that such practice should have been "lawful". That provision has been included so that the General Osteopathic Council is not, say, placed under an obligation to register an overseas practitioner on the basis of what might have been illegal practice in his home country. Conditional registration would be simply a transitional arrangement, with applications for that category of registration being permitted only during the two-year transitional period which I mentioned a few moments ago. I have already said that conditional registration is modelled closely on the working party's recommendations for provisional registration. The purpose of conditional registration is to enable registration of practitioners who do not hold a recognised qualification, and who are unable to muster the five years out of seven safe, lawful and competent practice of osteopathy required for full registration. It is not in any way intended to create a two-tier system of registration, but was recommended by the working party as a mechanism to ensure that as many practitioners as possible are included under the Act.Practitioners who are registered with conditional registration would fall into two categories. The first will be those who just fail to meet the five years out of seven criterion for full registration. Those practitioners will be eligible for full registration if they have spent a substantial part of their working time in the safe, lawful and competent practice of osteopathy for a total of four years out of the six years preceding the opening of the register. In addition, they may be required to undergo a test of competence and give an undertaking that, within a specified period, which would not exceed five years from the opening of the register, they will complete any further training and acquire such additional experience as specified by the registrar. I should add that, if a practitioner were found to be fully competent in the skills
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and knowledge required for full registration, no additional training would be specified, and he would be able to apply to have his registration suitably converted.I said that the grounds under which practitioners will be able to qualify for registration had been extended to include a group that might not otherwise have been eligible. To be more accurate, practitioners in that group were more likely to have fallen between two stools. It had been assumed that all qualifications would be either recognised or rejected for recognition. On that basis, if a practitioner were told that his qualification was not a recognised one, he could still hope to qualify for registration on the strength of current or recent practice if an application were made within the two-year transitional period.
As a result of representations made to me, it became evident that practitioners may possess qualifications from an institution that has perhaps ceased to exist and that they may not have been in current or recent practice--because, for example, they have been bringing up their family or caring for sick or elderly relatives. Such practitioners face a potentially no-win situation.
On the one hand, the general council and the education committee might not have been able to find sufficient information about the qualification to decide whether it should be recognised. On the other, the practitioner might have no means of being able to satisfy the practice criteria for registration. Such practitioners will therefore be unable to get on the register unless they obtain another recognised qualification, although they may be perfectly competent. Although that group is expected to comprise only a small number of individuals, the Bill now extends the provisions of conditional registration so as not to exclude them.
Consequently, practitioners who are unable to satisfy the practice criteria for either full or conditional registration will still be eligible for conditional registration if they hold a qualification for osteopathy that has not been refused recognition, although it is not a recognised qualification. Practitioners who qualify for registration on those grounds will be subject to the same conditions of further training and acquiring the additional experience which I described earlier.
Dr. Liam Fox (Woodspring) : I wonder whether my hon. Friend could clarify one point. Is it intended that osteopaths will be required to carry professional indemnity cover during the preliminary period?
Mr. Moss : I thank my hon. Friend for raising that point, which I shall come to later in my speech. It is an important part of the Bill, and I will explain its ramifications later.
Mr. Toby Jessel (Twickenham) : On such an important Bill, which affects the welfare of millions of our fellow citizens who suffer from back pain, is my hon. Friend aware that there are no less than 16 hon. Members present in the House but only two Opposition Members, although it is Friday? Does that not show that Conservative Members have a much greater interest than Labour Members in such an important Bill?
Mr. Moss : I am not sure whether that comment means that Conservative Members have a greater interest in such matters, or that they suffer more from back pain.
I have referred several times to recognised qualifications. I am aware that feelings of uncertainty exist in
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certain quarters about how that aspect of the scheme will operate. It may help if I begin with the European dimension. European Community qualifications will automatically be recognised by virtue of enforceable Community rights or obligations.The recognition of other qualifications will depend on whether the General Osteopathic Council, in consultation with its education committee, considers that such qualifications meet the standards of education, training and proficiency specified by the general council for the safe and competent practise of osteopathy. To ensure that such decisions will be impartial, no qualification will be afforded recognition until the general council has sought and secured the consent of the Privy Council.
While I am on the subject of professional education, I should mention that, although it will be the responsibility of the education committee to satisfy itself that those schools whose qualifications have been recognised continue to meet the required standards of proficiency, it will not be for the committee or the General Osteopathic Council to prescribe how the curriculum is taught. Diversity of approach stimulates innovation. In medical schools, considerable differences in emphasis exist for specific elements of the curriculum and the way in which they are taught. However, they all produce safe and competent doctors. Therefore, it is essential that a similar diversity be allowed to flourish under the osteopaths statutory scheme.
The newest category of registration is provisional registration. As I have already mentioned, care must be taken not to confuse provisional registration as provided in the Bill with the concept of provisional registration set out in the working party's report and Lord Walton's Bill in the last session.
An initial year of supervised practise is rapidly becoming the norm in a growing number of professional groups. It offers practitioners the advantages of being able to widen gradually their field of experience, especially in the running of a practice, and have the support and advice of more experienced colleagues readily available. I appreciate that provisional registration does not exist in the profession's current system of voluntary registration. However, it may be one which the profession would wish to adopt in time. One of the disadvantages of a statutory scheme is that, once it is set in place, it can subsequently prove to be difficult to amend. Therefore, I have tried to provide now for the future.
The provision in the Bill is an enabling one. It will give the general council the necessary scope to introduce a system of provisional registration at a later date if it so chooses and after it has consulted the profession and provided Parliament with an opportunity to scrutinise its proposals.
Mr. Andrew Hunter (Basingstoke) : Can my hon. Friend expand his arguments and explain why he decided not to incorporate in his Bill the requirement of a provisional registration state as opposed to leaving the option open for the future if the council chooses to implement it?
Mr. Moss : Initially, we felt that the Bill incorporated a great number of different clauses which advanced the progress and tightness of the regulations. It was important to get the basics on the statute book, introduce conditional registration, which is a new idea, and make provision to enable the profession to introduce the provisional category
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at a later date if it so chooses. It is questionable whether the profession can accommodate the changes in one go during the early period--certainly the transitional period. It is much more sensible to get the basics in place and then allow the profession to move in a direction which it so chooses at its own pace.Provisional registration will apply for the initial year of registration. During that time, osteopaths will be permitted to practise only under the supervision of a fully registered osteopath. For many practitioners, that will coincide with their first postgraduate year. However, the provisions in the Bill are sufficiently broad to include practitioners who are returning to the profession after an absence of some years--because, for example, they have been bringing up a family--and those who are applying for registration for the first time. Again, that is recognised as good practice among many professions and is a matter which the general council may wish to consider if and when it ever decided to go down this road.
Before leaving the subject of registration, I should like briefly to mention three other matters. My hon. Friend the Member for Woodspring (Dr. Fox) raised a point about professional indemnity insurance. That was considered by the working party to be of such key importance in securing better protection for patients that it recommended that such insurance should be held as a condition of registration. Unfortunately, making that a statutory requirement could distort the otherwise free workings of the insurance market, potentially to the detriment of both insurers and osteopaths. In order to square that circle, the Bill would empower the General Osteopathic Council through its rules of registration to require professional indemnity insurance to be held by practising osteopaths. The general council would also have the power to check that a practitioner had renewed his cover at the appropriate time and, most importantly, to initiate disciplinary proceedings in cases where he had not.
Linking the need to hold insurance with the right to practise would give osteopaths who have retired or are taking time out to bring up a family the possibility of maintaining their registration without having to take out what would otherwise be unnecessary insurance cover.
The second matter is post-registration training. The working party recommended that a practitioner's continued registration should be made subject to him or her satisfactorily completing post-graduate training or refresher courses. In that way, members of the public could be assured that practitioners were keeping up to date with the latest techniques and developments in their field. That is one of the many areas in which the working party's recommendations broke new ground in the realm of professional self-regulation.
However, the working party also recognised that that recommendation could not be introduced immediately, because the profession's training and education resources would need to be devoted to existing practitioners who will hold conditional registration during the first few years of the scheme.
In order to avoid the need to make a specific amendment to the Act at a later date, clause 16 of the Bill will permit the General Osteopathic Council to introduce a scheme of post-registration training in the future if the profession so wishes. However, once again, the general council would first be required to consult the profession and, in this case, any other parties that it might think
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appropriate, such as other groups of health care professionals. The council would also have to obtain the consent of the Privy Council and give Parliament an opportunity to scrutinise the detail of its proposals before it could introduce such a scheme.The third postscript on registration involves fraudulent registration. The Bill contains a provision similar to section 39(1) of the Medical Act 1983 to enable the general council to erase from the register the name of a practitioner who obtained registration by fraudulent means. However, the register would have in addition to that power, the power to impose an immediate suspension of a practitioner's registration while the allegation was being investigated, if he was satisfied that such action was necessary for the protection of members of the public.
I hope that the House will agree that all the provisions to which I have referred would form a fair and just system of registration and would provide the cornerstone of a statutory scheme. They seek to bring as many bona fide practitioners of osteopathy as possible within its scope. That is not only of key importance to practitioners but would benefit the public, as it is far better to have all the practitioners of a profession governed by a single statutory body capable of enforcing appropriate standards of practice.
The other essential component of the regulatory scheme is a mechanism to ensure that high standards of professional conduct and competence are maintained and that members of the public are not put at risk by practitioners who are unfit to practise for reasons of ill health. That would be provided by the General Osteopathic Council's investigating, professional conduct and health committees. Broadly speaking, those comittees would perform the same function as their counterparts in other schemes. Allegations would initially be considered by the investigating committee. They would then be referred, as appropriate, to the professional conduct or health committee for further investigation and action. However, I should like to highlight some important differences in the powers that the committees would be able to exercise--differences which illustrate yet again where the osteopaths scheme would break new ground. For the first time under any statutory scheme governing the health professions, professional incompetence would be specifically identified as a trigger point for disciplinary investigation. I know that other professional groups --in particular the medical profession--are considering the introduction of a similar concept for its members. Their solutions may be different, but the osteopaths can take justifiable pride in being the first health care profession to make the concept an integral part of its statutory scheme. Another matter on which the osteopaths scheme scores a first is the breadth of the powers of the professional conduct and health committees to take immediate action to suspend an osteopath's registration where they considered such action to be necessary for the protection of members of the public. The power proposed for the investigating committees--the ability to impose an immediate suspension of up to two months--would be similar to that exercised, for example, by the General Medical Council's equivalent committee. However, for the first time, the professional conduct and health committees would be able to impose their own
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suspension where they considered such action to be necessary to protect members of the public and to do so before they investigated the allegation. Although likely to be exercised only rarely, the power might be used, for example, where the allegation made against an osteopath was also the subject of a series criminal investigation. In such a case, the professional conduct committee might choose to defer its proceedings until after the criminal proceedings had been dealth with. In a similar way, the health committee might decide that an allegation about an osteopath's health was such that he or she posed an obvious and definite risk to his or her patients. In making provisions for those powers, the Bill also ensures that the practitioner's rights are protected. For example, before a suspension order could be imposed, a practitioner would first have to be given an opportunity to appear before the relevant committee to state why he or she considered such action to be unnecessary. The pratitioner would be entitled to be legally represented at such a hearing and would have an additional right of appeal to the courts. Like their counterparts in other statutory schemes, the professional conduct and health committees would be able to suspend an osteopath's registration or impose conditions on his or her right to practise if they determined that the allegation against him or her was proven. The professional conduct committee would in addition be able to admonish the osteopath or order his name to be erased from the register.Another first for the osteopaths scheme is the proposal to give the professional conduct committee the explicit power to impose conditions on an osteopath's right to practise following a period of erasure. As the Bill reinforces the powers of fitness-to-practise committees in those ways, the public will be able to exercise the utmost confidence in the statutory scheme and be assured that it affords them the highest level of protection of any of today's regulatory schemes.
I have mentioned briefly that the Bill makes provision to safeguard the human rights of osteopaths. That is of key importance. I can assure the House and the profession that great care has been taken to ensure that the panoply of appeal provisions within the Bill are founded firmly on the principles of natural justice and reflect European law on human rights. In that way, members of the profession can likewise be fully confident that the statutory scheme would rigorously protect their interests and be one in which they can take justifiable pride.
I mentioned that, in keeping with other statutory schemes, the work of the General Osteopathic Council and its four statutory committees would be overseen by the Privy Council. In the unlikely event that the council failed to perform its functions under the Act, the Privy Council would have the power to direct it to perform any of its functions that the Privy Council considered that it had failed to fulfil. As a final resort, the Privy Council would be able to step in and take over the functions of the council and do anything that it could have done under the Act.
Let me end where I began. Due to the sterling work of the working party on osteopathy, the profession has a well thought out and carefully structured scheme that reflects the most up-to-date thinking on professional self- regulation. I hope that the House and the profession will agree that the proposals will not only provide the means to enable the profession to control its destiny and set its future direction but secure better patient protection,
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safeguard the interests of the public and provide a model for other statutory self-regulatory schemes for the 1990s and beyond. 10.19 amDr. Ian Twinn (Edmonton) : I must declare an interest as I am one of two parliamentary advisers to the Chartered Society of Physiotherapy.
I congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on introducing the Bill. Although I do not suffer from back pain --having voted for the Maastricht measures so far--I suspect that many of our colleagues may well need the services of professions that specialise in the manipulative therapies, something of which the Conservative Front Bench is only too well aware.
The Chartered Society of Physiotherapy is supportive of the moves by its sister profession to introduce regulation. There are estimated to be about 2,000 osteopaths, the Chartered Society of Physiotherapy has 24,000 members and there are about 700 chiropractors, which demonstrates that at least three professions are intimately involved with such work.
Physiotherapists work in hospitals and in private practice and about a third of their number are actively involved with the manipulation of the back and the neck. Among physiotherapists there is a view that it would have been better for the three professions to come together for regulation rather than moving separately, but that does not mean that the Bill is not welcome.
There is a substantial overlap between osteopaths, chiropractors and physiotherapists, and the latter do everything that osteopaths can do and considerably more.
Physiotherapists are regulated by the Professions Supplementary to Medicine Act 1960, which is now rather out of date. It was introduced when physiotherapists principally worked in hospitals and doctors prescribed their work for them. Their regulatory framework is therefore seriously outmoded and needs to be updated. For that reason, I believe that the King's Fund rejected using the 1960 Act for the regulation of osteopaths and that there is now a case for the urgent revision of that Act.
The Bill will introduce modern, regulatory structures for osteopaths and we should like those provisions to be extended to physiotherapists as soon as possible. We congratulate the osteopaths on achieving the Bill. As my hon. Friend the Member for Cambridgeshire, North-East said, it will be the first profession to have that modern structure, which is very welcome.
There is concern that the protection in clause 29 of the title osteopath might lead to problems for other professions, including medical practitioners and physiotherapists, as it might prevent such professions from claiming to use osteopathic techniques. My hon. Friend may wish to return to that subject in Committee so that there may be a clear understanding that other professions are already using such techniques and that they should not be prevented from making such a claim although they are not osteopaths. A comment on that subject from my hon. Friend the Minister would also be welcome. Title protection is to be given to osteopaths, but the title of physiotherapist is not protected and anyone can practise as such or claim to be a physiotherapist. Only the terms "state registered physiotherapist" or "chartered physiotherapist" are protected by the 1960 Act, so the Chartered
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