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Lord Clement-Jones: I very much support the amendment moved by the noble Lord, Lord Morris of Manchester, and my noble friend Lady Sharp of Guildford. The Chiropodists' Board under the existing CPSM is currently the effective regulatory body for chiropodists and podiatrists. It appears, however, that the Government are acting on the recommendations of the 1996 J M Consulting report which recommended the creation of a new umbrella council with stronger powers, but the abolition of those individual boards of the professions described in the Act as supplementary to medicine, though I know the professions would prefer to be known as the professions allied to medicine.

Looking at the original J. M. Consulting report, I believe that it was rather dismissive of the need for those individual separate boards. Most of the professions allied to medicine appear, however, to be able to live with that new regime. The chiropodists and podiatrists are not, and they do not see why they should have to be subsumed against their wishes, in a wider council when professions such as osteopaths and chiropractors do not. What makes their position so very different?

As the noble Lord, Lord Morris, and the noble Viscount, Lord Astor, have explained, chiropodists and podiatrists are unique. They have the right to do certain things that no other profession allied to medicine does.

We also support the protection of the titles of chiropodist and podiatrist, but we believe that there are issues here relating to a great many other professions

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allied to medicine. I shall keep my remarks on that particular matter to a later amendment. I urge the Committee to support these amendments.

Lord Milverton: I rise to support the amendments of the noble Lord, Lord Morris. They are sound in principle in every way. I hope that the Government will be able to accept them.

Baroness Fookes: There was in my former constituency a school of podiatry and I had an opportunity to talk to the head of that school on many occasions. I was frankly amazed at the type of work that was undertaken by podiatrists, which went far beyond my superficial view that it was a matter of cutting toe-nails or hard skin from the feet of ladies who wore high heels. It is an extremely important profession and it deserves to be treated as a profession in its own right.

I am particularly concerned that there should be the ability to protect the title of chiropodist or podiatrist. I still have difficulties with "podiatrist", but I know that the profession itself prefers the term. Whichever title is used, it is very important that it should be protected. The work they do relating to foot problems is far too important to allow unqualified or insufficiently qualified people to tackle it.

Lord Colwyn: At an earlier stage my noble friend Lady Gardner explained the difference between dentists and dental surgeons. I wonder if the noble Lord, Lord Morris, could explain to me the difference between these two categories of people who look after feet.

Lord Morris of Manchester: Some people use the terms interchangeably. The society changed its name in order to make it clear that, whether people speak of "chiropodist" or "podiatrist" they are talking about fully qualified members of the same wider profession which the two titles describe.

To some extent any confusion is caused by people in the private sector who give the impression that there is something far more prestigious in describing themselves as one rather than the other. I hope the noble Lord will have no further difficulties.

The society, by changing its title, simply wanted to remove any doubt that whether the term "chiropodist" or "podiatrist" is used it both represents and speaks for them.

Lord Walton of Detchant: With respect to what the noble Lord, Lord Morris, has just said, is it not the case that training in chiropody is a primary qualification which allows a registered chiropodist to undertake relatively minor procedures but that those trained in podiatry undertake an extended period of training, often in collaboration with surgeons and medical practitioners, which enables them to carry out more extensive minor surgery on the feet under local anaesthesia?

Lord Morris of Manchester: Of course, I have great respect for my good and noble friend Lord Walton. It

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arises from our work together in the service of the Muscular Dystrophy Group of Great Britain. All of us respect his view.

As I explained to the noble Lord, Lord Colwyn, the society wanted to make it absolutely clear that it comprises fully qualified members of the same wider profession which the two titles describe. I am sure everyone here is totally appalled at the prospect that an unqualified and uninsured practitioner could, in some circumstances, advise a diabetic. That must be a very serious matter. Quite clearly, it is not in the public interest.

Baroness Hayman: I am grateful to my noble friend for allowing the Committee to debate these issues and to recognise the important role in healthcare played by both chiropodists and podiatrists. Like the noble Baroness, Lady Fookes, I had some relationship with a school of podiatry. I, too, recognise how wide and highly skilled the role of qualified podiatrists is today and the areas of healthcare in which they make such an important contribution. However, I have to tell Members of the Committee that that is also true of some of the other professions allied to medicine who also take enormous responsibilities for patient care. That is part, perhaps, of the rejuggling of boundaries between professionals that has taken place as training has developed over the years.

On the issue regarding the protection of title for chiropodists and podiatrists to which we have returned several times, perhaps I should point out that that is equally strongly felt by physiotherapists, who also have the choice of title of physical therapist, which is the international title, and by other groups of professions allied to medicine. Indeed, one of the main reasons for the review of the Professions Supplementary to Medicine Act was the very strong recommendation that it does not give adequate protection of title for the professions supplementary to medicine; it is inadequate in that respect. We need new legislation which will give patients better protection. That is probably one of the strongest reasons for the review.

Some confusion has arisen as regards the different stages of the process in terms of debating the specific issues relating to chiropodists and how they might be treated under secondary legislation which may be brought forward after the order-making power in the Bill is enacted. We shall deal later with the protection of core functions to which my noble friend alluded. We have made it very clear that we want to protect those core functions of professional regulatory bodies.

What we are doing today in this Bill represents the first stage in quite a long process, as I suggested earlier. The order-making power will provide the mechanism by which changes can be made to legislation governing professional self-regulation, including that covering the professions supplementary to medicine. However, it does not deal in detail with the proposals regarding what those changes should be. I can quite understand that chiropodists will want to know how they will be affected by the changes that we wish to make to the Professions Supplementary to Medicine Act. That is why we have made it quite clear that we are committed

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to consulting the individual professions concerned in developing any proposals to replace the CPSM, as well as consulting them on the draft order itself.

I was pleased to have the opportunity to meet members of the Society of Chiropodists and Podiatrists last week in order to discuss the issues of importance to them. I look forward to further discussions with the society on the detailed proposals that come forward in due course. However, I am certain that the other professions supplementary to medicine equally have individual issues with which they are concerned, so I am not sure that it is appropriate to have that debate at this stage of the Bill's proceedings. The examples given during our short debate today are perhaps not totally apposite. Both the osteopaths and the chiropractors have their own boards because they have their own legislation. One of their reasons for pursuing individual legislation was that when they were looking for self-regulation they did not think that the PSM Act gave them sufficient protection. However, it is not that we are treating chiropodists differently from them; indeed, we are certainly not suggesting treating them differently from all the range of professions governed by the Act at present. These include dieticians, occupational therapists, physiotherapists, medical laboratory scientific officers, radiographers, and others. There is certainly no suggestion that we will be treating chiropodists less well than them. Nor, I have to say, are nurses totally separately regulated under the Nurses, Midwives and Health Visitors Act. The UKCC is a joint regulatory body for nurses, midwives and health visitors. Some of these issues about how individual professions within joint working are properly protected are common in that respect.

I understand the chiropodists' concerns about retaining professional independence. We recognise that they wish, correctly, to retain a distinctive voice in the regulation of their own profession. There is widespread agreement within that context that there are important benefits for patients and for the professions to be gained from reforming the PSM Act to create a better, multi-professional legislative framework, based on collaboration and common aims and values. That was one of the fundamental recommendations of the review of the Act. The review recommended a new and stronger council which would be able to influence and co-ordinate the regulation of individual professions.

A modernised and multi-professional structure for the professions supplementary to medicine will build on the traditions of many years of partnership working under the existing legislation. Benefits are obtained from common values and approaches and the formulation of cross-professional policies. A reformed body will provide a stronger voice for these professions--the chiropodists, podiatrists, dieticians, occupational therapists, orthoptists, physiotherapists, prosthetists and orthetists, arts therapists, medical laboratory scientific officers and radiographers. Some of those groups are very small professions for which, I suggest, separate and individual regulatory bodies would not be a sensible way forward. I have made it clear that

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it is our intention to repeal the PSM Act and replace it with new legislation to regulate these professions. That will be a priority for the use of the order-making power.

As I said, the details of the replacement framework are a matter for the future. However, I understand the concerns of chiropodists that the distinctive contribution of each profession, within a joint regulatory framework, should be properly acknowledged. The successor body to the CPSM will need to be sufficiently flexible to ensure that uni-professional input is preserved where appropriate. It will be one of our key aims in working with the professions to develop the proposals to ensure that future arrangements strike the right balance in that respect. I can assure my noble friend and others who have spoken that we will take into account the views that have been expressed in developing proposals upon which we shall be consulting. I believe it is possible to ensure that there are safeguards for the distinctive voices of all the individual professions. In some areas, such as fitness to practise it is absolutely appropriate that they should be in the majority when considering cases which come before them. I believe that within the new structure we can find an appropriate balance.

On the question of protection of title, I am in total agreement with my noble friend that the protection afforded at present is completely insufficient. As he said, the title currently protected is "state registered chiropodist". We can ensure within the health service that only state registered chiropodists are employed. However, we do that by direction. That is not the same as the powers that will be available for the professions themselves after new legislation is introduced for the professions supplementary to medicine. At the moment any individual can set up in practice and call himself a chiropodist. My noble friend is quite right to point out that that has dangers for the public. It is something we are anxious to change. I reassure him that the order-making power in the Bill will enable us to do that. Paragraph 1(d) of Schedule 3 to the Bill, referring to the,

    "privileges of members admitted to practice",
is the relevant provision. It is rather sad that we did not make it clearer in the Explanatory Notes that this measure concerns protection of title, as I know that is an important issue for all the professions. The draftsmen assure me that this is the right way to deal with the matter. However, we could have pointed out in the Explanatory Notes that,

    "privileges of members admitted to practice",
covers this important issue as it is fundamental to the protection of patients and it is one of the key reasons for going ahead with the plans that we have.

I suggest that a separate professional regulatory body for chiropodists alone is not a sensible way forward given the history of multi-professional co-operation within the ambit of the professions supplementary to medicine. I hope that when we bring forward proposals we can do so in a way that reassures chiropodists and podiatrists--and indeed the other professional groups within the ambit of these provisions--that they will have appropriate input into the areas which are of concern to

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them. I hope that in the light of those assurances my noble friend will not feel the need to press these amendments further.

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