Select Committee Report
Commons Hansard (12 Jul 2000)
Alternative and complementary therapies
House Of Commons Select Committee Report (25 July 2000)
Alternative and complementary therapies!
'.--(1) A person is an alternative or complementary therapist if he is providing or offering for gain or reward services purporting or claiming to alleviate, cure, suppress or improve any condition which is customarily addressed by services of a type provided by health authorities, special health authorities, National Health Service trusts, primary care trusts or by local authorities in the exercise of their social services functions, and who is not required to be registered under section 11 or section 42.
(2) The Commission shall maintain a register of alternative or complementary therapists.
(3) The Secretary of State shall provide by regulations the method by which--
(a) applications for registration shall be made; and
(b) applications for registration shall be determined.
(4) The Secretary of State may by regulations make such provision as he deems necessary to protect the public in respect of--
(a) the description of the services provided by the alternative or complementary therapist;
(b) the claims that may be made in respect of those services;
(c) the techniques which may or (as the case may be) may not be employed in delivery of such services; and
(d) any other matters relating to such services as the Secretary of State may specify.'.--[Mrs. Spelman.]
Brought up, and read the First time.
Mrs. Spelman: I beg to move, That the clause be read a Second time. One of the most intriguing things about this wide-ranging Bill is the opportunities that it provides for mini-debates on quite different subjects. We shall see the advantages of that this evening as Members have the chance to discuss their particular interests, as in the previous debate on adoption and in this one on alternative and complementary therapies. In Committee, we tabled an amendment on alternative and complementary therapies. The Under-Secretary resisted it. First, she said, complementary and alternative medicine is, by definition, evolving and cannot be clearly defined. Secondly, she said that it was neither practical nor justifiable to regulate an ill-defined sector. Having read and considered Hansard, I have moved the new clause because I believe that those arguments are not sufficiently robust.
In Committee, the Minister said:
Services that were considered outlandish several years ago are now almost considered to be part of conventional health care.--[Official Report, Standing Committee G, 6 June 2000; c. 81.]
Within the huge bracket of alternative and complementary medicine, some therapies have been around for a very long time. Acupuncture has existed for at least 2,000 years, but, at the other end of the spectrum, new therapies such as reflexology were probably unheard of by most people as recently as 10 years ago.
Therapies quickly become established. Alternative medicine is growing rapidly. The medical care research unit at Sheffield university estimates that 40 per cent. of general practitioners provide access to some sort of complementary medicine. Already, there is a close interleaving between traditional and complementary medicine. Acupuncture, which I have already said is one of the oldest complementary therapies, is provided by 73 per cent. of primary care groups. Osteopathy, which is 12 Jul 2000 : Column 976
also well established, is provided by 43 per cent., homeopathy by 38 per cent. and chiropractic--which I have had good reason to use--by 23 per cent.
Those therapies are well established and widely used. Members of the public will often consider alternative and complementary therapies when they feel that they have made no progress down the conventional medical route and are prepared to pay their own money to solve the problem or salve the pain that they are experiencing. We all have good anecdotal evidence from friends and relations of success with complementary and alternative medicines.
11.15 pm The Bill offers an opportunity to help to provide a regulatory framework for complementary medicine, some branches of which are long established. There has been no over-arching regulatory framework because different techniques are used and different training courses apply. For example, chiropractors go through undergraduate training to gain a BSc honours degree, but I understand that, in the eyes of those who practise acupuncture, a 24-hour training course will suffice for a certificate of basic competence.
However, the diversity of qualifications should not deter us from drawing alternative and complementary therapies into the Bill. Social care is to be regulated and a distinction made between social care workers and social care assistants who have different qualifications. Therefore, within the logic and principle of the Bill, it is possible to regulate care workers with different qualifications and the different titles resulting from them. I see no logical objection to trying to regulate alternative and complementary medicine.
The availability of alternative and complementary therapies is increasing and people are becoming better informed about fresh approaches to established medical conditions. They avidly read the features pages of the broadsheet newspapers and, if conventional medicine has found no solution, often present their GPs with new findings on long-standing problems. A large number of new practitioners have set up in response to increasing demand. Therefore, it seems logical to provide through legislation adequate protection for the public and regulation that recognises the importance and status of the complementary therapies.
In Committee, my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) pointed out the need to protect the public from the possibility of misleading diagnoses by people who are not properly qualified or who might provide the wrong treatment. He gave an example that drew attention to the potential for serious abuse, given that a lot of therapies are provided one to one. Intimate touching may be part of a therapy and that could put the individual receiving treatment in a risky situation. His constituency example is probably not an isolated case and it should cause us, as legislators, to think about whether to take it as a warning and whether to provide protection for both parties.
In Committee, the Minister gave her reasons for resisting our amendment on alternative and complementary therapies, saying that the original clause 39 would provide adequate scope to cover the issue. The clause referred to services similar to those provided conventionally through health authorities and NHS trusts and also covered the
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example that I gave earlier: 40 per cent. of GPs refer patients to complementary medicine. There are many members of the general public who, without going to a GP, seek treatment from complementary and alternative therapies. In reflecting on the reasons for rejecting our amendment, I am not satisfied that there is adequate protection.
I am sure that my hon. Friend the Member for Bosworth (Mr. Tredinnick) will seek to catch your eye, Mr. Deputy Speaker, because he has an interest in this area. On 6 April, in Westminster Hall, my hon. Friend made some interesting observations about aspects of complementary medicine that are already regulated; homeopathic doctors, since 1950, and osteopathy, since 1993, were examples. Already, some alternative and complementary therapies have a degree of regulation and protection. It is not unreasonable to look for an extension to cover some of the others.
The therapies are new and evolving; reflexology, for example, has been around for about 10 years and is now well understood by the public. I cannot see the argument that it is too new to be the subject of some protective legislation, similar to other alternative therapies.
Mr. Swayne: My hon. Friend makes a powerful case that the Bill provides the opportunity for such regulation, but not all of us are persuaded that, because the opportunity to regulate exists, it should be taken up. There are those of us on the Opposition Benches who are not entirely disposed to regulation for its own sake. If my hon. Friend could outline some of the regulations that she thinks might be made under the new clause, it would give us a greater sense of confidence in what she is spelling out.
Mrs. Spelman: I understand exactly where my hon. Friend is coming from. Ours is not a party that seeks to legislate unnecessarily; in fact, it is committed to trying to remove as much unnecessary legislation as possible. However, I referred earlier to a genuine constituency case, in which there has been a claim of serious abuse in a situation where an alternative therapy was being provided. A therapist was providing one-on-one treatment to someone who, in good faith, placed their trust in the practitioner as they would with a medical practitioner. Undoubtedly, members of the public would expect that trust not to be abused. However, it is claimed that it was. We must take that seriously, as it is likely that other examples exist. I can see the potential risk that that represents.
Mr. Burns: Does my hon. Friend agree that, as well as giving protection and peace of mind to the patient, the measure will give protection to the practitioner?
Mrs. Spelman: My hon. Friend makes exactly the point that I tried to make earlier; the new clause cuts both ways. It provides protection for the person seeking help through the therapy, but it also provides important protection--a title, in due course--for the practitioner, and sets out the necessary qualifications to assume the title. That helps to raise the status of that profession, and is entirely consistent with legislation introduced for the professions allied to medicine.
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There are some difficulties in getting what was envisaged in the Health Act 1999 to work, and there are a lot of difficulties in devising the right structure for a diverse group of professions allied to medicine. None the less, the practitioners of those professions recognise the advantage that the measure gives to them; the protection of a title and a clear definition of their therapy and skills.
I do not think that the new clause falls into the category of onerous and unnecessary regulation. On the contrary, there is a need to protect patients who place themselves in a position of potential risk, trusting the professional in whose hands they have placed themselves not to abuse that trust. As I have said, we have examples of such abuse. I feel comfortable about promoting a new clause that would benefit both patients and practitioners of the new therapies.
We intend to remain entirely within the guiding principles of the Bill, which are extensive. The Bill proposes the establishment of a commission to regulate diverse types of care. It seeks to remedy some of the abuses that have occurred, in regard to which there is a consensus that additional protection should be provided. I am thinking particularly of children's homes. It also creates an opportunity for complementary and alternative medicines--some of which have been around for a long time--to be included in the legislation. I believe that failure to include them would constitute yet another inconsistency of the type that we have tried so hard to address from the outset of our debates on the Bill. The most notable inconsistency is the Government's willingness to regulate public and private care homes uniformly, along with their rejection of the application of the same principle to private and public hospitals.
I fear that, unless the new clause is accepted, practitioners in professions allied to medicine--and those seeking therapy from them--will be protected in terms of title and the definition of the qualifications necessary for practice, but complementary and alternative therapists will be out in the cold. Here is a legislative opportunity to put that right. It is not superfluous, and it is supported by the Institute for Complementary Medicine, which was pleased to observe an attempt to fill what it sees as a gap in the law. I therefore feel confident in asking the Minister to look at the matter again, and to reconsider her reasons for objecting to our original amendment. I hope that, following that reconsideration, she will have a change of heart.
Mr. Tredinnick: I welcome the new clause. I have been closely involved in complementary and alternative medicine in three Parliaments, as an officer of the all-party parliamentary group for alternative and complementary medicine. The new clause reflects the new-found importance of such medicine and its new-found status in this country.
There are three main reasons why we should welcome new clause 7. First, more and more people in Britain are using complementary and alternative medicine: it is no longer something for minority groups. It is now very much part of the nation's way of life and as such, it requires more attention. That is illustrated here by the fact that acupressure is now available in the House of Commons gym. There is a practitioner there, and some of us will have read in his leaflet the statement from an unnamed Member that it is the only way in which he or she can find any relief from stress. I think that I see the
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Minister smiling, which is always encouraging. Perhaps she will let the new clause go through on the nod. I am sure that Conservative Members would welcome that.
Mr. Swayne: Will my hon. Friend let us know what acupressure is and precisely how the service that is provided in the gym will be augmented or enhanced by the regulation consequent upon the new clause, particularly as it seems to be so successful without the new clause?
Mr. Tredinnick: I am grateful to my hon. Friend for trying to help me along. Of course, I am just setting out, but all I say to him is that, if he had a headache, the practitioner might apply two thumbs either side of his head and produce a remarkable effect. [Interruption.] I shall give way to the hon. Member for Stroud (Mr. Drew) if he wants to contribute, albeit briefly, although if he does so, he may find that he is not promoted very quickly; I guess that the Government Whips will not approve. I recommend that my hon. Friend the Member for New Forest, West (Mr. Swayne) tries that acupressure method. It is an illustration of how one can become more relaxed. I am not suggesting that he is not relaxed. In fact, I have always seen him as one of my more relaxed colleagues in the House and I always enjoy sitting next to him. Indeed, I could say, as a new ager might say leaving the Glastonbury festival, "I can feel the vibe sometimes." It is very relaxing being near my hon. Friend. However, we must not get too sidetracked. I would not want you, Mr. Deputy Speaker, to call me to order so early on.
I give another illustration of how complementary and alternative medicine has been received in the House. Recently, we had an exhibition in the Upper Waiting Hall, which was well supported by colleagues. Several Members from both Houses availed themselves of the treatments that were available. Colleagues do not normally bare their feet in public in the Upper Waiting Hall without good reason. Many colleagues, including me, queued up for the reflexology that was available on that occasion. [Interruption.] They did not include my hon. Friend the Member for West Chelmsford (Mr. Burns). I thought that he was nodding. Perhaps he hoped to have the treatment, but did not get it, or perhaps he is astonished at my suggestion.
The group provided treatment in the House. Whereas in the past, some of those treatments would have been seen as absolute quackery--if one discussed them with one's doctor, one would perhaps have been struck off the patients list--they are now the type of treatment that people expect to be available, and they have been available in the House of Commons.
The second reason why the new clause is relevant to the Bill is the greater use of complementary and alternative medicine in the national health service generally. The greater use of CAM in the health service started with fundholding GPs and has been taken up, with varying degrees of success, by primary care groups and, perhaps, primary care trusts. More and more people are using complementary and alternative medicine, and we now have greater use of complementary and alternative medicine in the NHS. Thirdly, we are looking at a new style of health provision overall--what is termed integrated health care: the combined use of conventional and complementary medicines.
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My hon. Friend the Member for Meriden (Mrs. Spelman) touched on the exponential growth in the use and acceptance of complementary and alternative medicine. She gave some examples from the Sheffield study of the use of CAM by doctors. I could add to what she said. It has been established by a survey that 75 per cent. of the population want complementary and alternative medicine to be available on the NHS, and that between 20 and 25 per cent. of the population already use one form or another of complementary and alternative medicine. I need hardly tell colleagues that the fact that complementary and alternative medicine is a key interest for one quarter of the British population has profound political implications. My hon. Friend the Member for Meriden also mentioned newspapers' interest in complementary and alternative medicine. The tabloid newspapers--such as the Daily Mail and the Daily Express, but also the others--have regular features on complementary and alternative medicine. The articles are not just one column long; they are usually four pages long. The Sunday newspapers, too, often have features on complementary and alternative medicine.
I have always felt that, in a sense, public opinion is ahead of the House on the subject of complementary and alternative medicine; unfortunately, we have often been behind on it.
Mr. Burns: How is it possible to judge successful treatment outcomes in alternative medicine compared with outcomes in more conventional medicine?
Mr. Tredinnick: There are many different complementary and alternative medicines, and outcomes are judged in different ways. The evaluations, too, are very different. One of the targets of the complementary and alternative medicine disciplines is to develop greater transparency, greater understanding of what works and--this is the subject of new clause 7--better, more effective regulation of complementary and alternative medicine providers. One of the points that I hope to develop later in my speech is that we are gradually establishing some order in the mass of those different disciplines.
The issue is important because of the great interest in complementary and alternative medicine. The United Kingdom population is voting with its feet on the issue. One can barely walk down a high street in Britain without coming across a health food shop selling complementary and alternative medicine products. One cannot go into a conventional chemist, such as Boots, without finding a whole range of homoeopathic preparations by one of the well-known providers, such as Nelsons. One can find Bach flower remedies and vitamins of every description on the high street. People are not mugs--they would not buy those things if they did not work. The fact is that there is great interest in and great demand for complementary and alternative medicine. The concept of integrated health care is here to stay. Not only the Government but the Opposition have been addressing the issue of integrated health care. Way back in 1987, the all-party parliamentary group for alternative and complementary medicine set integrated health care as one of its principal targets. Undoubtedly, some of our distinguished colleagues, who are no longer with us, had vision and could see the issue's importance. It was only
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10 years later that a watershed report on the issue was published by the Foundation for Integrated Medicine--which is the group that was established by the Prince of Wales, and has subsequently done much with the King's Fund to produce ideas on regulation that are acceptable both to conventional practitioners and to complementary practitioners.
The report--entitled "Integrated Healthcare: A Way Forward for the Next Five Years?"--was launched, at the Queen Elizabeth II conference centre, by the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson). He not only spoke in favour of the report, but gave some money for research in complementary and alternative medicine. The report gave the medical profession a benchmark to work by. The very fact that those who ran the royal colleges and many highly respected medical practitioners were involved in the report has given it great credibility. The report has been fundamental in the acceptance and development of complementary and alternative medicine.
Earlier this week, at its request, I met the Royal Pharmaceutical Society of Great Britain, the offices of which are just over Lambeth bridge. I never thought of the society as being particularly interested in complementary and alternative medicine. However, it is the professional and regulatory body for all of Britain's pharmacists. Professor William Dawson, who invited me to the society's offices, wrote:
We believe that there should be greater integration of complementary medicine into health care and that practitioners of orthodox and complementary medicine need to be encouraged to work together in all areas of practice.
When I met the professor and his team, he made it perfectly clear that he wanted pharmacists to act as a bridge between conventional and complementary medicine, and that he had every intention of facilitating better understanding of alternative therapies. It is instructive to us all and most encouraging that such an important society should be going down that track. The next point in my argument supporting the new clause relates to the increased use of complementary and alternative medicine in the national health service. The person who really got the ball rolling--not in the last Parliament, but the one before--was the then hon. Member for Loughborough, now my right hon. Friend the Member for Charnwood (Mr. Dorrell), who as Under- Secretary, following meetings with the parliamentary group and others, produced a health service directive to the effect that if conventional practitioners took clinical responsibility for the actions of complementary therapists, they could engage their services and pay them out of the national health service budget. That was a significant breakthrough in the use of complementary and alternative medicine in the health service. When right hon. Friend became Secretary of State, he always kept a wary eye on that issue, supported by the then hon. Member for Bolton, West, Tom Sackville.
Let me say to the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart), that there has been a progression in the thinking in the Department of Health--a gradual move towards integration of the use of complementary and alternative
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medicine in the national health service and integration of conventional and complementary therapies in mainstream medicine. That is our starting point. The major development that followed my right hon. Friend's initiative was the introduction of GP fundholders, who were instrumental in spreading dramatically the use of complementary and alternative medicine. Under the arrangements that many of my hon. Friends will remember--and others who were not in the House at the time may not remember so fondly--a small number of doctors could get together and become GP fundholders. Therefore, doctors who were strongly in favour of complementary and alternative medicine could become fundholders and allocate a proportion of their budget to those therapies.
Mr. Deputy Speaker (Mr. Michael J. Martin): Order. The hon. Gentleman is straying from the new clause. Whether or not doctors support complementary medicine is neither here nor there. The new clause deals with registration and the hon. Gentleman must relate his comments to that.
Mr. Tredinnick: I am most grateful, Mr. Deputy Speaker. You are absolutely right to draw my attention to the new clause. I was talking about a type of registration, however, because those doctors could not practise unless they were registered as fundholders. The fact that they registered as fundholders provides the building block for some of the remarks that I want to make about the new clause, and I cannot make those points unless I refer to GP fundholders and primary care groups. Another reason why we need the new clause relates to the primary care group system introduced by the present Government. New clause 7 deals with the registration of complementary and alternative medicine. However, there has been a real problem with primary care groups since the switch from fundholding. The reason for that is that the new boards are much larger and many of the health care professionals on them are not sympathetic to complementary therapies. Demand for complementary medicine has therefore dipped since primary care groups were introduced.
A positive aspect of the Government's approach to the matter has been the initiation of trials using NHS funds. For example, the acupuncture trial was funded by the NHS executive in collaboration with the Foundation for Traditional Chinese Medicine. Such trials are very important in relation to registration. A stamp of approval from the NHS means that the treatments would be more acceptable to people.
The Minister knows that I have been saying for many years that there is not enough money for research. If registers and better regulation are to be introduced, more research into complementary and alternative medical therapies is needed. My hon. Friend the Member for West Chelmsford is always helpful, and he asked earlier how we can know whether alternative therapies are effective. One way is through trials, and we need more of them. However, this is the same old chicken and egg problem: the Department
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asks where the evidence is, and the complementary and alternative practitioners ask for money so that they can provide it. Mr. Swayne: Will my hon. Friend give way?
Mr. Tredinnick: I see that I have stimulated my hon. Friend, without acupressure. I have not even had to put my thumbs to his temples.
Mr. Swayne: My hon. Friend says that the techniques are effective. I do not doubt that, but why should the Secretary of State be given the power to determine whether they are used? That power would be afforded to him in this awful new clause. Mr. Tredinnick: My hon. Friend is emitting a different vibration. I do not pretend to be the most sensitive person, but I have noted the change in feeling on this Back Bench.
Mr. Bercow: My intervention will be comparatively prosaic, but new clause 7(3) confers on the Secretary of State the right to determine by regulation the method of application for registration and the means of its determination. I return to my usual hobbyhorse: does my hon. Friend agree that the regulations should be subject to the affirmative procedure of the House, and that they should not be left to the administrative fiat of a Secretary of State?
Mr. Tredinnick: My hon. Friend tempts me. I am Chairman of the Joint Committee on Statutory Instruments and of the House of Commons Select Committee on Statutory Instruments, and I have a great interest in affirmative and negative resolution procedures. I agree that an affirmative resolution procedure would be desirable in this case.
I have to declare another interest. I hesitate to answer his query in any other than a very friendly way, as my hon. Friend the Member for Buckingham (Mr. Bercow) is due to speak in my constituency on Friday. It is therefore especially important that I do not upset him, for fear that he will not make the kindly opening remarks that colleagues occasionally make about each other. That might not be helpful in the run-up to the general election, whose date was let out of the bag by the Minister of State, Foreign and Commonwealth Office, the hon. Member for Leicester, East (Mr. Vaz).
Let us be serious about this: my hon. Friend the Member for New Forest, West and other colleagues are on the right track about how the regulation works. I want to address that in a moment--[Interruption.] The Minister appears to be imitating my right hon. Friend the Member for Old Bexley and Sidcup (Sir E. Heath) when he occasionally enjoys a joke. Was it something that my hon. Friend the Member for New Forest, West did? Or was it something that I said? To consider regulation and registration, we must, as my hon. Friend the Member for West Chelmsford said, deal with how complementary therapies interrelate and how they relate to conventional medicine. One of the difficulties of regulation is that complementary and alternative practitioners and patients tend not just to use one therapy, but to move between therapies until they find the one that works for a given ailment.
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I should like to illustrate this with the true story of a child whose severely broken leg was repaired, with great skill, by a great surgeon. The child's parents wanted to do everything possible to help his leg repair. To support the surgeon's work, and with his agreement, they looked to complementary therapies to speed up the repair of the leg. To start with, they relieved some of the boy's aches and pains with the homoeopathic medicine arnica and used symphytum to help heal the wound, because the leg had been pinned. To encourage the bone to repair faster, they looked to traditional Chinese and ayurvedic medicine, which teach that one of the first things to do with a broken bone is to use frankincense and myrrh, which were, as we know, potent in biblical times. However, I am told by experts in traditional Chinese medicine that frankincense and myrrh bind bones. They are resins which help bone binding and encourage the healing process. Another aspect that had to be addressed was the child's moods. They were helped using certain aromatherapy oils, such as lavender and mandarin.
Mr. Deputy Speaker: Order. I have to say that this is very interesting. I have listened to the hon. Gentleman speak in Adjournment debates, and I know that this is a favourite subject of his. However, alternative medicine is not specifically what we are debating in the new clause; we are debating registration. I cannot allow the hon. Gentleman to go into detail about the great things that alternative medicine does for people--perhaps another time.
Mr. Tredinnick: I am grateful to you for guiding me back on to the rails, Mr. Deputy Speaker. I will not pursue that line further, other than to say that, in the registration of practitioners and the way in which we regulate, we must bear in mind that there is often no clear distinction between the various therapies because they are used in combination. That is a fundamental issue which relates to the new clause that I wish to deal with in a moment.
Before I do that--and I hope it is in order--I wish to refer to the Select Committee in the other place. I think that I am allowed to call it the House of Lords, nowadays. You would have called me to order, Mr. Deputy Speaker, if I had called it anything other than the other place not long ago, and I am nervous because I do not want to be told that I am out of order. In any event, the Select Committee on Science and Technology in the other place is currently considering complementary and alternative medicine and will soon produce its report. One of the issues that the Committee had to address was what is complementary or alternative medicine. That is germane to this debate on registration and regulation. What exactly are we regulating?
In 1976, I damaged my back in an accident and turned to a chiropractor, but I did not tell my GP. If I had done so, I would certainly have been ruled out of order. He would have told me that he would not treat me any more. That is how serious such matters were--it would have been the equivalent of suspension. However, under subsequent legislation--including the Osteopaths Act 1993 promoted by my hon. Friend the Member for North-East Cambridgeshire (Mr. Moss)--such therapies are regulated by statute. A person falsely claiming to be an osteopath commits a criminal offence and could incur a heavy penalty.
Mr. Swayne: There is more than one way to skin a cat. My hon. Friend points out that some years ago the doctor
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avoided competition by refusing to treat him. However, have we not strung together those alternative professions under statutory regulation by the medical profession?
Mr. Tredinnick: My hon. Friend may be treading on politically incorrect ground by talking about stringing things together with catgut. As I am afraid of being called to order, I shall not pursue that point, if he will forgive me. I have lost my place in my speech. When that happened to me some years ago, one of my hon. Friends helpfully intervened to remind me of what I had been saying. None of my hon. Friends is rising to do that. It is a bitter disappointment. Mr. Burns: My hon. Friend was talking about his back.
Mr. Tredinnick: I am most grateful to my hon. Friend. The serious point is that osteopaths and chiropractors are no longer considered to be beyond the pale; they have been integrated into conventional medicine. It is now debatable whether osteopaths are complementary practitioners at all. Furthermore, some therapies that were not even included in the list being considered for regulation by the House of Lords Select Committee--for example, crystal therapy, which is believed by some people to be beneficial--will probably enter mainstream medicine in the future.
After those brief introductory remarks, I shall turn to the body of my speech--[Laughter.] That is an old line, but it always works--especially when it is late and the House is exhausted. I definitely support new clause 7. We have heard about joined-up government; I am trying to achieve some joined-up opposition, so I point out to my hon. Friend the Member for Meriden that the new clause may need some fine tuning.
Many alternative and complementary therapists provide their services not only through the NHS, but in prisons and other places free of charge. To classify such a therapist automatically as someone who is providing or offering for gain or reward services purporting or claiming to alleviate, cure, suppress or improve any condition is not wholly accurate. I hope that the new clause is accepted on the nod, but that point may need to be addressed in another place.
I strongly support the proposal for a register of alternative and complementary therapists. There are about 50,000 complementary medical practitioners in the United Kingdom and it would definitely be appropriate to have some form of register.
I now come to the points of my hon. Friend the Member for New Forest, West about the style of regulation. I do not think that we should have a register that merely says that certain people are complementary practitioners. That would be impractical, misleading, dangerous and counter-productive. We have to draw on the way in which regulation has come about. That generally means that groups have bound together and agreed some form of self-regulation. They have then gone on to NVQ status-- Mr. Bercow: National vocational qualification.
Mr. Tredinnick: I am grateful to my hon. Friend.
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The groups move from voluntary to statutory regulation and they can achieve that through the legislation that the Government, to their credit, introduced in the previous Session. They can achieve statutory regulation in a gradual way by binding together. We will face major problems if we try to have one register. At the moment, there are 120 organisations representing alternative and complementary practitioners. The way forward is for the different groups in a particular discipline--for example, aromatherapy has four or five governing bodies--to work together progressively. That is what the chiropractors did. They were at loggerheads with each other and unfortunately they are at loggerheads again, but they at least came together to achieve regulation. The only practical way to proceed is to persuade organisations to work progressively towards statutory regulation. I want a register to be in place to denote the therapies in which the practitioners are qualified. It is not right to have just a general register.
Practitioners often face few formal obligations to meet a level of standards. It is possible for people to break away from one organisation to join another if they so wish. That is not good for public safety. We should move to 10 separate registers and perhaps then move to five separate registers, but the disciplines must be clearly delineated. Self-regulation is the best and most appropriate form of regulation for complementary medical therapies. As I said, osteopathists and chiropractors have taken that approach, and I could have talked about the national occupational standards that homoeopathy, reflexology, hydrotherapy and aromatherapy have achieved. Each profession is developing at a different pace. One of my colleagues touched on the issue of insurance, which is one of the ways in which practitioners become regulated. Insurance companies will not insure them unless they reach certain standards. More could be done to consider the way in which insurance companies are used.
I am slightly concerned at any proposal that will give the Secretary of State the power to decide the techniques that may or may not be employed in the delivery of services--although I was nearly called to order when I tried to develop that argument. Many services and disciplines overlap, which can create problems because it is a complex matter. For example, the National Institute for Clinical Excellence does not have the machinery to assess homoeopathic medicines at, let us say, 1M. It has no chance because all its equipment will say that there is nothing in them. However, a homoeopathic medicine functioning at 1M is working at a level higher than the physical body. Bach flower remedies and Australian bushfire essences cannot be detected using conventional measures, so we need to think of new ways of assessing those medicines. Mr. Swayne: Am I correct in my analysis that although he began by saying that he welcomed the new clause, my hon. Friend has, after detaining the House for half an hour, come around to opposing it, as I do? Mr. Tredinnick: I would hate to be accused of having the two faces of Janus, the Greek god who faced in opposite directions. I welcome the new clause, and the fact that my hon. Friend the Member for Meriden has
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tabled it in the proceedings on this Bill is a great milestone. Maintaining a register of alternative and complementary therapists is a good idea. However, I am slightly nervous about the Stalinist imposition of these measures through statutory instruments subject to the negative procedure. This is a complex matter, and my hon. Friend the Member for New Forest, West has, in a sense, helped me. On the continent, draconian sanctions are in place against some therapists. Such sanctions are unnecessary. We would be better sticking to statutory regulation, but there should be flexibility in that. The Under-Secretary of State for Health said that a complementary practitioner had been found to have acted improperly. What about all the doctors who have acted improperly? That is not a valid argument at all. There are policemen who act improperly. Normal mathematical distribution means that there are such people in every walk of life. I say to my hon. Friend the Member for Meriden that I welcome the tabling and consideration of the new clause, and I say to the Under-Secretary that it requires careful consideration and a measured reply. I commend the new clause to the House.
Mr. Bercow rose--
Mr. Tredinnick: I give way to my hon. Friend.
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. I thought that the hon. Gentleman had concluded his speech. Mr. Tredinnick: I had not sat down, Mr. Deputy Speaker. Mr. Deputy Speaker: Will the hon. Gentleman advise the Chair what he is seeking to do? It seems that he has finished his speech but is trying to give way to the hon. Member for Buckingham (Mr. Bercow). Mr. Tredinnick: Out of courtesy to you, Mr. Deputy Speaker, I was not on my feet when you were on yours. I must admit that I had been about to sit down, but my hon. Friend wanted to intervene, and I felt that it would be a discourtesy on my part not to let him do so.
Mr. Bercow: I am grateful to my hon. Friend, whose courtesy and generosity are unsurpassed in the House. As the new clause requires the Secretary of State to determine the regulations, how does my hon. Friend think the experience of the right hon. Member for Darlington (Mr. Milburn) at John Marlay school, Stokesley comprehensive school, Newcastle university and Lancaster university, and as a senior business development officer in north Tyneside, has equipped him to determine regulations on alternative medicine and complementary therapy?
Mr. Tredinnick: My hon. Friend is helpful and raises an important point. It has long been a contentious issue between those in complementary and alternative medicine and Ministers in the Ministry of Agriculture, Fisheries and Food and the Department of Health that the committees that adjudicate on such medicine are not staffed by those
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who understand the disciplines. In fairness to the Government, I acknowledge that the issue has been addressed, and new committees have been set up. My hon. Friend has made a valuable point, and I now intend to conclude my speech. Dr. Brand: I am glad that the previous speech did not end prematurely. I have absolutely no doubt that alternative and complementary therapies make an enormous contribution to people's feeling of health and well-being.
The definition set out in new clause 7(1) would catch almost any activity, because the national health service and all the other bodies set out in that subsection treat conditions such as feeling unhappy, feeling unwell, feeling unfit and not getting enough sleep, all of which are amenable to alternative and complementary therapies, just as they are amenable to food, wine, other drink--in moderation--and going to the hairdressers. There might be a need to ensure consumer protection in relation to the wide range of interventions to which we all submit ourselves--hairdressers should be just as much at risk of having their collars felt if they do something wrong as those who are in the business of tickling people's feet--but market forces could determine what is effective and what is not, and what is appreciated and what is not. The real problem is some of the claims made by some therapists.
Within my practice for the past 10 years--preceding fundholding--acupuncture, manipulative therapies, homoeopathy and hydrotherapy have been available to our patients. That has been achieved through clever arrangements with the private sector, whereby we sent them the odd patient who paid and they then saw our NHS patients. That arrangement worked extremely well.
Mr. Swayne: The hon. Gentleman is a physician. He is discussing complementary therapies, which are also competing therapies. Does he admit that if such therapies are to be regulated, that must be achieved without the influence of their competitors--physicians such as himself--affecting that regulation?
Dr. Brand: That is very difficult intervention to answer. I do not regard looking after people as a competitive event. I am always delighted when someone else can do it better than I can, because it means that they will have the hassle, not me--and the same is probably true of most of my colleagues. I am not sure that the hon. Gentleman has made a valid point. The Prince of Wales's think tank produced an excellent paper, "Integrated Medicine", and I was present at its initial launch at St. James's Palace. The only therapies mentioned during that event, and those that formed the substance of the opus itself, were acupuncture, manipulative medicine, homoeopathy and hydrotherapy. That is not surprising, given that those four disciplines are well established: a body of work has been produced that shows that they have an effect and that, when handled responsibly, they are safe--in fact, far safer that some of the things that bog-standard medicine gets up to. Incidentally, as the hon. Member for Bosworth (Mr. Tredinnick) says, acupuncturists, osteopaths and chiropractors are all adopting the PAMs--professions allied to medicine--route, whereby they become
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registered and gain protection of title. They tend to be insured, and the insurance company will ensure that they have a certain competence. My problem is with the phrasing of new clause 7, because its definition of an alternative or complementary therapist is someone who is providing or offering for gain or reward services purporting or claiming to alleviate, cure and so on. That basically means that anyone who says "I can make you better" becomes an alternative or complementary therapeutic specialist, and subsection (2) provides that the commission "shall maintain" such a person on a register--there is no condition attached. If I said that a Mars bar a day helped you work, rest and play, that would constitute a claim to offer better health, so I would be able to go to the commission and say that I wanted to be registered as a Mars bar therapist. The commission could do nothing about that. Under the new clause, it would have to register me. Subsection (3) states: applications for registration shall be made, so presumably the Secretary of State has an option whether I make the claim by post or turn up in person to demonstrate the size of my Mars bar.
We have a well-meaning attempt to introduce a measure of consumer protection where people are at risk of being ripped off or emotionally and physically abused, which does happen, with little sanction other than in criminal law or under trading standards. There should be a more established way in which some of the alternative therapies could be recognised as mainstream. We have already seen that with some of the manipulative interventions, and I have no doubt that others will follow suit. We have had an in-depth and entertaining debate, which has taken us into the next day, but the new clause does not meet the requirements of the Bill, and I shall be surprised if the hon. Member for Meriden (Mrs. Spelman) pursues it. Mr. Swayne: I shall confine myself exclusively to the new clause and avoid the wide-ranging analysis of the complementary therapies that my hon. Friend the Member for Bosworth (Mr. Tredinnick) drew to our attention. I mean no criticism--I found his exposition fascinating--I simply do not have the breadth of knowledge to comment on the areas on which he touched. I am not hostile to these therapies. The key issue is whether the therapies will be improved by being regulated under the new clause. I took my son to an osteopath after a diagnosis that he needed grommets, and his head was manipulated. The hearing test was subsequently repeated by a conventional ear, nose and throat consultant, and--lo and behold--grommets were no longer necessary. So I have every confidence that many of these therapies work. The issue is entirely whether they will be assisted by the new clause.
My hon. Friend was eloquent in pointing out how these therapies have grown in status and extent during recent years. But that has happened without the benefit of the new clause, by which he laid so much store. I do not see
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by what process the new clause would make matters so much better. When he told us of the acupressure available in the Palace of Westminster, I asked what it was and how it would be changed by and benefit from the regulations specified in the new clause. Interestingly, he answered only the first part of the question. He told me what it was; he did not go on to expand on how it would be improved or changed by the regulation to which he drew attention.
Mr. Tredinnick: I should have said that this type of acupressure adjusts the meridians, which are the energy lines in the body. According to traditional Chinese medicine there are a number of meridians. They are like different pulses. A traditional Chinese medical practitioner would take a range of different pulses. Through the massage of the feet-- Mr. Deputy Speaker (Sir Alan Haselhurst): Order. The hon. Gentleman is going into far too much detail, and away from the substance of the new clause. I cannot permit further discussion down that line.
Mr. Swayne: My hon. Friend has helped us enormously. The new clause provides an overarching regulatory framework for all those therapies. He has just described a therapy that does not lend itself in any way to the regulation of technique or of description, as specified in the new clause. The description that we have just heard is testimony to the fact that the therapies cover a wide range. We were told earlier of crystal therapy, whatever that might be. The idea that such vastly disparate therapies could be covered by the same regulatory framework, as specified in the clause, is manifest nonsense. They are a consequence of very different life styles and religious backgrounds. I do not believe that they lend themselves to regulation in any way.
If we attend to the clause in some depth--I promise to be brief, as I see that some hon. Members are enjoining me to be so--we see that subsection (1) outlines the therapies that will be covered by the new provision. As the hon. Member for Isle of Wight (Dr. Brand) pointed out, it is extremely widely drawn. That subsection would encompass the healing ministry of evangelical priests. They would be included as healing practitioners. Of course, alternative or complementary medicine derives part of its attraction from being precisely that: alternative. Much of its attraction might be jeopardised by bringing it into the medical establishment by such overarching regulation as is outlined in the new clause.
Subsection (3) states:
The Secretary of state shall provide by regulations the method by which--
(a) applications for registration shall be made--
that seems innocuous enough and entirely proper, but it continues: (b) applications for registration shall be determined. The Secretary of State will determine how applications for registration are to be determined--by what test, criteria or validity. We have just heard my hon. Friend's exposition about energies, crystals and all the rest. How on earth is the Secretary of State to draw up regulations to govern such things?
Subsection (4)(a) refers to
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the description of the services provided by the alternative or complementary therapist.
The description that we heard was alternative enough. I listened to an exposition of what the osteopath had done to my child. I accept entirely that what he did worked, and that, as the Prime Minister says, what is right is what works--but the description was utter mumbo-jumbo. One might as well try to regulate witchcraft. The fact is that the descriptions defy regulation. It is nonsense to provide the Secretary of State with a power to determine what the description should be and what is acceptable.
Mr. Tredinnick: May I ask my hon. Friend to put away his box of matches for a moment? I support what he said earlier about grommets. There is a well-documented case of a child being given one dose of a homoeopathic medicine and having the problem solved. Mr. Swayne: I understand that. I do not dispute for a moment the effectiveness of alternative treatments. I know that they are effective. I have had experience of them in my own family, What I question is whether the Secretary of State is competent to regulate them in his capacity under the clause. The point is absolutely clear. Subsection (4)(c) refers to the techniques which may or may not (as the case may be) be employed in delivery of such services. It is not up to the Secretary of State to determine how therapies should be applied. In fact, having given his exposition on the therapies, my hon. Friend hit the nail on the head. He said that he supported the new clause, but came round at the end to saying, extremely lucidly, that regulation should not be as described in the clause, but should be self-regulation. That is what he said, and it is entirely proper.
Therapists should regulate themselves. I do not believe that an acupressurist could in any way regulate an acupuncturist. They are clearly separate therapies with quite different philosophies. They do not lend themselves to the sort of regulation outlined in the new clause. Subsection (4)(d) contains an absolutely extraordinary provision, allowing for any other matters relating to such services as the Secretary of State may specify. If I were the Minister, I should leap at that with alacrity. Just think of the power being ceded to Ministers. I look to my own Front-Bench spokesmen for some explanation of the justification for giving Ministers such enormous powers.
Mr. Bercow: They will be the Ministers next year.
Mr. Swayne: Indeed, they will be in a position to exercise that extraordinary power, but I should like to know about their plans for doing so. The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): This has been a most interesting debate. At times, I felt in need of a dose of Bach rescue remedy, which I am sure is available not far from here. New clause 7 seeks to give the National Care Standards Commission the responsibility to maintain a register of complementary or alternative therapists. As has been
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amply illustrated, it would require the Secretary of State to make regulations providing for the method of registering and determining applications. It would further require the Secretary of State to make regulations as to the descriptions, claims and techniques used by therapists, and any other matters pertaining to them that he may specify. We do not think the new clause necessary. We recognise that developments are moving apace in the provision of treatment and care services; in the range of settings in which they are provided; and in the equipment, techniques and technology through which they are delivered. We also recognise the need to ensure that the door is open to extend the range of services to be regulated in future, if and when necessary.
For that reason, the Bill already contains clause 42, which demonstrates the Government's forward-thinking approach to the regulation of social care and independent health care. It shows that we are building a new regulatory system that will last because it will have the flexibility to move with the times. Clause 42 provides for regulations to be made to bring further health care services within the new regulatory system, if or when considered appropriate at some time in the future. The clause must indicate the parameters of what that means. It has been drafted to refer to health care services that would include those that the hon. Member for Runnymede and Weybridge (Mr. Hammond) seeks to bring within the National Care Standards Commission's remit under new clause 7.
Independent health care services and establishments that will come within the new regulatory system from the outset are described in clause 2. Those services and establishments are those that we consider, having taken account of the consultation exercise held last year, to have the most pressing need to be regulated. They do not include complementary or alternative therapies. Bearing in mind the flexibilities in clause 42 to extend the regulatory scope of the National Care Standards Commission in future, we see no pressing reason to include such services in the Bill. Provision already exists to allow movement in that direction.
Mr. Hammond: Does the Minister acknowledge that the scope of private sector provision that can be regulated would be determined wholly by what the NHS chose to make available, or not to make available?
Ms Stuart: Some alternative therapies are already available in the NHS, but we simply do not think that the new clause is necessary.
The Government issued guidelines on professional self-regulation in complementary and alternative therapy that encouraged the formation of a single lead body to take forward self-regulation in each therapy. Steady progress is being made, particularly among the more popular therapies, and therapist registers are maintained by the lead bodies for each field. In addition to professional self-regulation, all practitioners of complementary and alternative medicines are subject to a range of general legislation that regulates the claims that they can make publicly, health and safety and the prescribing of medical products. The new clause would give the National Care Standards Commission the responsibility to maintain a register of alternative and complementary therapists and to regulate
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them. As I have explained, the consultation that we undertook on the regulation of independent health care indicated no pressing need for such measures. The Science and Technology Committee in the other place is currently conducting an inquiry into complementary and alternative medicine, and regulation of the professions is a major theme. In its hearings so far, the Committee has shown no sympathy for the idea of a single body to regulate all therapies. For that reason, the new clause is neither necessary nor appropriate and I ask the House to reject it. Mrs. Spelman: I have, of course, listened to the observations made on all sides, and I would not pretend to have tabled a perfectly drafted measure. I have a residual concern: when tabloid newspaper headlines refer to one or perhaps more proven cases of abuse involving a therapist, the Government may regret dismissing so lightly the risk faced by the significant number of patients who seek alternative therapies without going through the NHS or the gateway of a GP. Clause 42, which refers to provision through the NHS or primary care trusts, does not cover such circumstances. We have tried to warn the Government of the risks of leaving a wide range of therapies completely unregulated. I draw to the Minister's attention the example of hypnosis. Members of the public will be left exposed, and an opportunity to raise the status of some long-standing therapies has been missed. However, in the interests of making progress, I beg to ask leave to withdraw the motion.
Motion and clause, by leave, withdrawn.
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