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Lord Skelmersdale: Before the noble Lord withdraws his amendment, I am absolutely delighted that the Government have taken cognisance of what was said by the committee on delegated powers. I am sure that the Committee will agree with that. I also go along with 99 per cent. of what the noble Baroness has just said. However, I understood her to say that the Bill gives power to regulate a profession for the first time by statutory instrument. Can she tell me where in the Bill that is to be found? I find that very undesirable indeed. For example, acupuncturists are in the queue for regulation. It is perfectly acceptable to alter the primary regulation by statutory instrument, with the safeguards that the noble Baroness has just agreed; but I do not find it acceptable to regulate in the first instance by a piece of legislation which cannot be amended by Parliament. I would be very firm on having the first regulation by the Bill.

Baroness Hayman: I am grateful to the noble Lord. As I understand it, Clause 47(3)(b) envisages the possibility of regulation for the first time. That would be in two possible circumstances. It might well be that a profession joins a successor body of the CPSM. At the moment it is possible, by secondary legislation, for a new profession to be regulated for the first time. It has been done with the art therapists recently. There are now three applications to the Privy Council including one from clinical scientists. It would not be a new provision for a profession to be regulated for the first time by secondary legislation. The noble Lord is right for it to be made transparent that it is inherent within the powers of the Bill, as drafted.

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3.45 p.m.

Baroness Carnegy of Lour: Can the Minister say how Clause 47 and the Scottish legislation interact? She has the noble Lord, Lord Macdonald, sitting beside her so he may be able to help. I hope that I am asking the question at the right moment. It is a little difficult for me to judge whether it would be more appropriate to do so in connection with another amendment. The British Medical Association is extremely anxious that the General Medical Council should remain a United Kingdom-wide body and that it should not have a separate entity for Scotland. This matter is causing great anxiety for that body.

The Scotland Act establishes that the regulation of the profession is included in Schedule 5 of that legislation. It states that it is a reserved matter to the United Kingdom Parliament. The regulation of the professions can only be changed by order agreed by both Houses of the Westminster Parliament. The BMA is anxious whether Clause 47 and Schedule 3, about which the noble Baroness has just been speaking, clash in any way with that provision or alter it. Can the noble Baroness say whether the GMC is secure in believing that its arrangements can only be altered by the Westminster Parliament? In other words, can the Scottish parliament separate the General Medical Council even if Westminster did not want to?

Baroness Hayman: Perhaps my noble friend will give further details on that when we deal with some of the Scottish issues. We have always made it clear that devolution will not undermine the principle of a UK-wide National Health Service and will ensure consistently high standards throughout the United Kingdom. The regulation of the health profession will remain, as now, a matter for the UK Parliament. It is not being devolved to either the Scottish Parliament or the National Assembly for Wales. As regards existing professions, there is no doubt and no uncertainty about that. It is a reserved matter.

I should perhaps flag-up to the House the fact that there is a complication as regards a new profession that might join those currently under the CPSM. Because the transfer of functions deals with the professions as regulated at the moment, in order to have UK-wide regulation for a new profession, not a medical profession such as those already regulated, there would have to be a specific decision by the Scottish Parliament so to do.

That is my understanding--I am sure I shall be corrected if I am wrong--about a new profession which is to be regulated for the first time, whose regulation is not already covered within the provisions of the Scotland Act. In relation to the basics of self-regulation for existing professionals, that is a reserved UK matter.

Baroness McFarlane of Llandaff: Perhaps I may return to the force of the order-making powers. Will the Minister give us an assurance that those bodies whose

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regulatory powers are established under an order will have the same protection of their regulatory function as those professions which appear on the face of the Bill?

Baroness Hayman: We shall deal with some of those issues at a later point. It is our intention, when we talk about replacement bodies for perhaps the CPSM, and nurses, midwives and health visitors and therefore the UKCC, that they should have the same protection.

Lord Clement-Jones: I thank the Minister for the generous spirit in which she accepted the recommendations of the deregulation committee. I take that as an appetising hors-d'oeuvre to our debate today, though we are looking perhaps for a three course meal in the course of this Committee stage. There are many other aspects to consider but that is an excellent start. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Morris of Manchester moved Amendment No. 195:


Page 38, line 14, at end insert--
("(za) regulating and modifying the regulation of any profession to which subsection (1A) applies,").

The noble Lord said: In moving this amendment, I will also be speaking to the other amendments standing in my name.

I have an interest to declare as President of the Society of Chiropodists & Podiatrists: not a financial interest, but one founded on my admiration of the society's undeviating commitment to high professional standards and its genuine respect for the founding principles of the NHS.

My noble friend will recall that, at Second Reading, I raised with her the society's concerns that the Bill makes no specific mention of protection of title or of any definition of the future regulatory regime. Hence my amendments. Their purpose is to seek firm assurances on the two issues, either in the Minister's reply to this debate or subsequently by letter, so that the society can decide whether to return to these important issues at the Report stage. The society speaks representatively of state registered chiropodists in wholeheartedly supporting the Government's stated aim of strengthening self-regulation to protect the public. Its principal concern is whether this legislation will achieve that end for chiropody.

At present, chiropodists are regulated by the Chiropodists Board, under the Professions Supplementary to Medicine Act 1960. The board's chairman and the majority of its members are state registered chiropodists elected by their peers. This is what the society means by self-regulation; namely, that a majority of the regulatory body's members are of the same profession. Doctors, dentists, pharmacists, nurses, osteopaths and chiropractors have this form of self-regulation and, under the Bill's proposals, it appears they will continue to do so.

Yet for the professions supplementary to medicine, including chiropodists, the Government appear to be proposing to abolish the individual boards and to create

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a generic council, on which each profession would have only one or two representatives. The individual professional boards appear set to be replaced by merely advisory bodies and the Society of Chiropodists and Podiatrists is concerned that self-regulation, properly so-called, would then cease to exist. In the society's view this would not provide the protection for the public to which the Government are committed and on which Parliament should insist.

The aims of my amendments are twofold. First, they would have the effect of separating chiropody from the other professions supplementary to medicine and aligning it with doctors, dentists, pharmacists, nurses, osteopaths and chiropractors, with the advantage, as it appears, of retaining for the profession a self-regulating board with a majority of state registered chiropodists. And secondly, the amendments would ensure protection of title for "chiropodists" and "podiatrists".

The society believes that both self-regulation and protection of title are essential safeguards in protecting the public. At present, the Chiropodists Board has the power to decide fitness to practise; to determine educational standards and entry to the profession; and to adjudicate all professional disciplinary matters. For the profession of chiropody/podiatry to lose that power would not be in the public interest and I trust we shall now be assured that it will retain that power.

State registered chiropodists have the right to diagnose and treat patients independently of medical practitioners. They are able to carry out invasive bone surgery, such as bunion surgery, and to use local anaesthetics and other prescription-only medicines. They also provide special clinics for diabetes, a condition which afflicts about 3 per cent. of the adult population. As many of your Lordships will know, preventive health care of this kind can avoid serious conditions which may result in amputation of a leg. Indeed some research carried out in Manchester, of which I heard recently when performing the official opening of Manchester's new Foot Hospital, showed that amputations increased by 50 per cent. in the absence of timely intervention and appropriate treatment. What could more starkly emphasise the crucial need, in the public interest, for professionals with such responsibilities to be effectively regulated?

It is important also, if the public are to be properly protected from malpractice, that the professional titles "chiropodist" and "podiatrist" are protected. At present, an individual who is unqualified can establish a private chiropody/podiatry practice; and in fact a registrant who is struck off the register can continue to practise and to use the titles "chiropodist" and "podiatrist". European Union regulations require those who treat horses' hooves to be properly qualified. Speaking as a former member for six years of the Council of the Royal College of Veterinary Surgeons, representing the Privy Council, and now as an Honorary Associate of the British Veterinary Association, I rejoice that this is so. Surely the same regulations should, however, apply to those who care for human feet!

Some people in Whitehall seem to think that, because there is no evidence of negligence cases against non-state registered practitioners, the public is not at

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risk. But the reason for this is that there is no statutory regulation of the private sector and thus claims made against non-state registered practitioners are not in the public domain.

In this regard I have received a letter from Mrs. Sue Sharpe, the Director of Professional Standards of the Royal Pharmaceutical Society of Great Britain, who is held in high regard on both sides of your Lordships' House. She writes in support of my amendments on the grounds that there can be considerable danger to patients in using non-state registered chiropodists. She tells me of a notice circulated to members of the Royal Pharmaceutical Society, advising them only to promote the services of state registered chiropodists. This provoked an outraged response from a non-state registered chiropodist who said that the Council for the Professions Supplementary to Medicine had no control over the private sector and no business to interfere. What some in the private sector clearly want is carte blanche: more and more deregulation which, in terms of the public interest, makes about as much sense as deregulating Big Ben.

Referring to the vital importance to diabetics of timely and appropriate treatment, Mrs. Sharpe states:


    "This outraged reaction to our advice makes the case for your amendments when you consider the possible consequence of services for diabetics being provided by individuals who may have no insurance and no qualifications".

She goes on to say that effective regulation of the health professions is an important matter of public concern and, if the Government were to propose a fundamental change by transferring to others any of the core duties of regulating the principal professions from those presently charged by statute with these duties, then it should be a matter for primary legislation. With the order-making power conferred by the Bill in place, she argues, primary legislation need not be lengthy and detailed: a short Bill would suffice.

Mrs. Sharpe concludes:


    "We are all at some stage dependent on the quality of services provided by the health professions and to ensure that those who regulate them properly represent our interests. That is why a change of such magnitude as transferring core functions to another body should be reserved to statute".

That is eloquent testimony to the need for the firm assurance I am seeking that there will be a minimum common legal qualification for a chiropodist/podiatrist and that the use of titles will be limited accordingly. The non-state registered sector could be integrated into regulation through a process of "grandfathering" and they would, I understand, support this move.

I welcome the Government's decision to deal with the need to reform legislation which was enacted nearly 40 years ago and is now thoroughly out of date. Some of your Lordships may recall that I introduced a Private Member's Bill in 1994 to provide effective regulation for chiropodists. My promotion of that Bill explains why I am anxious now to achieve total clarity about what is being proposed in terms both of protection of title and the future regulatory regime.

State registered chiropodists are not seeking aggrandisement for their profession. On the contrary their aim, for which I know your Lordships' House will

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honour them, is to protect professional standards and the public interest. I know my noble friend will want to reply to the amendments both positively and helpfully. I beg to move.

4 p.m.

Lord Astor of Hever: I rise to support Amendment No. 200. The Government's proposals for the future regulation of chiropodists and podiatrists and the other professions supplementary to medicine are not clear on the face of the Bill. What is clear is that the present Chiropodists' Board, set up under the Professions Supplementary to Medicines Act 1960, would be abolished. It appears that it would be replaced by a generic council of 42 members with a maximum of only two chiropodists as members. This would mean the end of self-regulation for the profession.

I support the aims of the amendment of the noble Lord, Lord Morris of Manchester. I also believe that the chiropody profession should be grouped with doctors, dentists, pharmacists, nurses, osteopaths and chiropractors, who appear to be set to continue with self-regulating boards consisting of a majority of members from their own profession.

I also believe that protection of title for chiropodists and podiatrists is vital to ensure that patients are properly protected from unqualified practitioners. I want to be certain, as I am sure do all noble Lords, that those who treat our feet, including carrying out surgery, are properly qualified to do so.


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