Eleventh Standing Committee on Delegated Legislation
Wednesday 9 June 1999
[Mr. Barry Jones in the Chair]
Draft Professions Supplementary to Medicine (Clinical Scientists Board) Order of Council 1999
4.33 pm
The Minister of State, Department of Health (Mr. John Denham): I beg to move,
That the Committee has considered the draft Professions Supplementary to Medicine (Clinical Scientists Board) Order of Council 1999.
The Chairman: With this it will be convenient to consider the draft Professions Supplementary to Medicine (Speech and Language Therapists Board) Order of Council 1999 and the draft Professions Supplementary to Medicine (Paramedics Board) Order of Council 1999.
Mr. Denham: The orders extend state registration under the Professions Supplementary to Medicine Act 1960 to the professions of speech and language therapists, clinical scientists and paramedics. We considered the case for each group on its merits. Their very diversity highlights the enormous range of skill and dedication deployed in the modern health care team.
Some members of this Committee were members also of the Standing Committee that considered the Health Bill, which recently spent many hours debating the need to strengthen and modernise professional self-regulation. The nine professions that are already state-registered are united in warmly supporting the proposal to widen the scope of the regulations to include the three professions that we are debating today. I know that the professions are all anxious to make progress and to update the framework within which they work.
The Health Bill will allow the Government to consult on proposals to bring existing legislation up to date and will reflect the enormous changes in health care provision, professional practice and education that have occurred since the enactment of the 1960 Act. It is right to proceed with the order, not only because of the work that the relevant professions have put into building a case for registration but because they and the public will benefit at the outset from any revised statutory framework.
Speech and language therapists work across the range of communication disorders, although the majority work with children. Communication problems may result from learning difficulties, stroke, head injuries, cancer of the mouth and throat and degenerative disorders such as Parkinson's disease. Speech and language therapists enable clients to communicate to the best of their ability by assessing the nature of the problem and providing treatment, advice and support, sometimes through sign language, communication aids or other methods of communication. They work closely with families, carers and members of other professions in a wide range of settings.
Clinical scientists apply scientific principles to the delivery and development of diagnostic and therapeutic procedures and services, working closely with medical staff and other health care professionals. They develop equipment, participate in problem-orientated research and development and are involved in the audit of the services provided. Clinical scientists practice in one of several disciplines, including audiology, biomedical engineering, clinical biochemistry, clinical physiology, clinical microbiology, embryology, genetics, haematology, immunology and medical physics, working in different ways depending on the speciality. Some clinical scientists interact directly with patients and others give advice on which critical decisions are based.
Paramedics provide immediate care for patients in acute clinical emergencies. They systematically assess, treat and monitor patients according to national clinical protocols, adapted to the requirements of local communities. The treatments provided include invasive procedures such as intravenous cannulation, incubation, the insertion of chest drains and the administration of a specified range of emergency medication, including analgesics. Paramedics would typically be the first health professionals on hand in an emergency.
The broad effect of the order would be to extend the 1960 Act to those professions, alongside the nine that it already covers. Each order establishes a professional board within the umbrella of the Council for Professions Supplementary to Medicine. The function of the boards will be to promote high standards of professional education and conduct, within the framework of the CPSM, which has the duty to co-ordinate and supervise the activities of all boards. Each board will also have a duty to prepare and maintain a register, approve institutions, courses of training and qualifications leading to state registration, determine applications for admission to the register on the basis of qualifications and experience obtained, in the UK or elsewhere and set up investigating and disciplinary committees to produce guidance on conduct and deal with individual cases of misconduct. Once registered, practitioners will be entitled to call themselves state-registered speech and language therapists, state-registered clinical scientists or state-registered paramedics. The use of those titles by unregistered persons will be an offence, as will the use of any title or description that falsely implies that someone is registered under the 1960 Act.
The Act requires that the board should have a majority of members from the professions concerned. The boards will each have a total of 15 members appointed by the CPSM, of whom nine will be nominated in the first instance by the profession and thereafter elected by registrants. The remaining members will include medical practitioners, educationalists—
Mr. Philip Hammond (Runnymede and Weybridge): The Minister has told us that once the order is passed, the professions in question will benefit from protection of common title but he also told the Committee on the Health Bill that the Professions Supplementary to Medicine Act is inadequate, particularly in regard to protection of common title. Why has the Minister chosen to make the order under the Act, rather than waiting for the new legislation?
Mr. Denham: For clarification, I did not say that the order will lead to protection of common title because it will not. It will lead to protection of the title of ``state-registered''. Given the imminence of the Health Bill and its order-making powers, we consider whether it would be better for the protection of the public, which is the central issue that we are addressing, to proceed with registration under the 1960 Act, thereby putting these professions, which have developed to the point at which they should be registered, in a good position to benefit from the new changes, or whether it would be better to take no further action until the order-making powers under the Health Bill could be used.
We took the view that in the interests of the protection of the public, it was better to move ahead, even though some way down the line, further changes will need to be made, as we discussed during the Committee stage of the Health Bill.
4.40 pm
Dr. Evan Harris (Oxford, West and Abingdon): While we are on the subject of the protection of common title, it is a good time to question the Minister about his future intentions with regard to the protection of title. He said that all that can be protected under the existing legislation is the title, ``state registered'', and we discussed during the proceedings on the Health Bill whether it was possible to protect the actual title, such as physiotherapist, as well. Will the Minister clarify whether he envisages that the statement will include not merely the words ``clinical scientist'' for that group, but will include hospital physicist, clinical biochemist and clinical geneticist, so that the public are not duped simply because the words ``state registered'' are not on the plaque?
Mr. Denham: It would be wrong to suggest that we have resolved the question that we discussed in Committee about the range of titles that should be protected. I freely acknowledge that it is an important point that will have to be considered for each profession, especially when the use of a common alternative title is perhaps increasing. In the Health Committee, we discussed the development of the term ``physical therapist'' as an alternative to physiotherapist.
It is not an issue that I would dismiss, but it is one that needs to be examined carefully as we develop the order-making powers and use them for each profession. We may have to revisit the issue from time to time if new terms are used. We discussed the difficulty of putting into legislation the protection of generic titles, such as ``practitioner''. I acknowledge the point made by the hon. Member for Oxford, West and Abindgon (Dr. Harris) and accept that we shall have to consider the matter carefully in consultation with the professions when we come to use the order-making powers under the Health Bill.
I was discussing the make-up of the members of the board in each case. Eight from the profession concerned will form a majority. They will be nominated by the profession in the first instance and elected thereafter by registrants. The remaining members will include medical practitioners, educationalists, representatives with special interests in each profession and, in a development strongly supported by the Government, representatives of employers, patients and carers.
If each measure is approved, the membership of the CPSM will also increase from 27 to 36 because the Act requires that all boards have a professional representative on the council, and that the number of medical and professional members should be equal. The third lay member of each board preserves the balance of representation between professional, medical and other members.
Statutory regulation is a privilege and should not be granted merely because the profession concerned aspires to it. It should be justified because it provides safeguards to the public that would not otherwise be available. We are satisfied that unlicensed practice in any of those fields has the potential to harm patients and that state registration provides better protection for patients and the general public.
Currently 7,500 speech and language therapists are registered with the Royal College of Speech and Language Therapists. The training required is exacting and the route to qualification is a four-year honours degree course, leading to a certificate to practice issued by the college. Speech and language therapists work with some of the most vulnerable members of the population, including children in pre-school settings, nurseries and community clinics, and in mainstream and special schools, with children who have communicated difficulties that may be part of a physical, learning or emotional difficulty. Some of the children seen may have autistic spectrum, stammering or severe language disorders, which make access to the school curriculum difficult. Adults with learning difficulties may be seen in their own homes, while adults with neurological problems may be seen in an acute hospital setting.
Perhaps the most common danger to the public is the promise of easy cures or simplistic diagnosis, leading to psychological damage, financial loss and deterioration in the patient's condition. Patients and their carers need to know that a registered speech and language therapist will offer a service based on accredited training and professional guidelines, and that complaints will be appropriately dealt with.
The national health service in Great Britain employs an estimated 2,500 clinical scientists, of whom 1,700 are voluntarily registered. All entrants to basic training require a first degree in an approved science subject. Following the satisfactory completion of designated vocational training, graduates are eligible to join the voluntary register held by the Registration Council for Scientists in Health Care.
Clinical scientists work with a broad range of patient groups, from before birth to extreme old age. Most clinical conditions directly or indirectly involve the services of clinical scientists, who provide advice directly to doctors, and apply scientific principles to the delivery and development of diagnostic and therapeutic procedures and services. It follows that clinical scientists have a great capacity to do harm if they lack or misapply the skills required of them. Protection of the public can be achieved only if high standards of education, training and conduct are applied to ensure that clinical scientists are competent to practise.
An estimated 9,000—
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