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Lord Morris of Manchester moved Amendment No. 79B:

Page 38, line 14, at beginning insert--
(" ( ) Her Majesty shall by Order in Council make such provision relating to the regulation of the profession of chiropody and podiatry as set out in paragraph 1A of Schedule 3.").

The noble Lord said: My Lords, I beg to move Amendment No. 79B. In moving the amendment, I shall also be speaking to the other amendments standing in my name. I have an interest to declare in the debate as president of the Society of Chiropodists and Podiatrists, but the office is honorary and involves no financial interest.

My noble friend will recall that both at Second Reading and in moving my amendments in Committee I raised with her the society's concerns that the Bill made no specific mention of protection of title or of any definition of the future regulatory regime. I made it clear that state registered chiropodists/podiatrists, for whom the society speaks, are wholeheartedly in support of the Government's stated aim of strengthening self-regulation to protect the public. Not unnaturally their principal concern is to ensure that future practice matches current precept in the case of their profession.

My noble friend's response in Committee to my amendment on protection of title on 4th March is welcomed by the society, as I said it would be when withdrawing the amendment. But it is less happy with the response to the amendments that I moved in Committee about the future regulatory structure for the profession once the 1960 Act is repealed. Thus the aim

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of my further amendments today is to clarify the role and powers of any board or committee to be set up to regulate chiropodists/ podiatrists.

The society is by no means alone in believing that a profession ceases to be a profession unless it maintains statutory control of the functions set out in sub-paragraph 8(2) of Schedule 3: namely, keeping the register of members admitted to practice; determining standards of education and training for admission; advising on standards of conduct and performance; and disciplining members.

My noble friend said in Committee that "uni-professional input" would be preserved where appropriate, and that:

    "In some areas, such as fitness to practice, it is absolutely appropriate that they (individual health professions) should be in the majority when considering cases which come before them".
It would be most helpful if she can now provide any more detail on this and, in particular, whether she can say as much today as she did in Committee on "fitness to practice" about how and to what extent she foresees the potential for uni-professional input in the other key areas to which my amendment refers.

If self-regulation is to have any real meaning, then surely at least the functions set out in my amendment ought to be carried out by a statutory committee with a chairman and a majority of members who are state-registered chiropodists/podiatrists. I have said that the Society of Chiropodists and Podiatrists is by no means alone in holding this view. Let me, therefore, quote from a letter I received yesterday from the Chartered Society of Physiotherapy (CSP). It says:

    "As you stated at Committee Stage, one possible option for reform includes the abolition of the individual professional boards in favour of committees on which each profession would have only one or two representatives. If this were to happen, essential functions of self-regulation will have been taken from the profession--against its will.

    "To protect professional self-regulation the Society believes it is essential that physiotherapists constitute a uni-professional majority in all boards/committees that decide on all essential regulatory functions, which obviously include: fitness to practice, educational standards, validation of courses and entry to the profession".

The letter then recalls that the Minister clearly stated in Committee that there should be uni-professional majorities when considering issues of fitness to practice, and it proceeds:

    "However, it is not clear whether other elements of professional self-regulation, educational standards, validation of courses, entry to the profession etc, will be protected. It is of the utmost importance that the Government clarify their intentions".
The CSP's letter concludes,

    "The Government need to go further to reassure this profession that its professional self-regulation is not under threat. In this regard we believe your amendments are proving to be very useful. We would particularly welcome anything you can do at Report Stage to secure more reassurances from the Minister on uni-professional majorities".

State-registered chiropodists/podiatrists diagnose and treat patients independently of medical practitioners. They carry out highly invasive bone surgery and have access to anaesthetics and other prescription-only medicines. That is why a strong regulatory regime, based around self-regulation, is essential for the profession.

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In Committee I pointed to some recent research at Manchester University showing that, among patients with diabetes, leg amputations increased by 50 per cent. in the absence of timely intervention and appropriate treatment by a qualified chiropodist/podiatrist. And I make no apology for recalling today a statement made to me during this Bill's Committee stage by Mrs. Sue Sharpe, the Director of Professional Standards of the Royal Pharmaceutical Society of Great Britain, on the danger to patients of using non-state-registered chiropodists, and her advice to members of her society to promote the services only of state-registered chiropodists. She wrote:

    "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".
Nothing could more strongly emphasise how important it is in the public interest for fully qualified and insured chiropodists/podiatrists to play their rightful part in effectively regulating their profession.

Since moving my amendment in Committee, I have also heard most helpfully from Professor Andrew J. M. Boulton, MD, FRCP, Professor of Medicine at Manchester University and consultant physician at the Manchester Royal Infirmary, who writes:

    "Foot problems remain the commonest cause of hospital admission amongst diabetic patients in this country. They account for 1 in 5 of admissions. Ensuring a quality foot care service for patients with diabetes is, therefore, essential for both medical and economic reasons".
He goes on to say that chiropodists/podiatrists form a pivotal part of the footcare team and that indeed many teams are led by members of the profession. He adds:

    "It is essential also that a fully informed regulatory body is responsible for entry into the profession and also for overseeing standards of training to avoid anomalous situations that exist today, when individuals can self-proclaim themselves as chiropodists after the shortest of courses.

    "Whereas most State-Registered practitioners provide an invaluable service to diabetic foot care, there are some individuals who lack sufficient experience in such care and can cause irreparable damage to diabetic feet, resulting in devastating end points such as gangrene and even amputation".

Professor Boulton also has the distinction of being Chairman of Post-Graduate Education for the European Association for the Study of Diabetes and chairs its Diabetic Foot Study Group. I am sure noble Lords in all parts of the House will be grateful to him for this eloquent and authoritative testimony to the importance of effective self-regulation for the profession of chiropody/podiatry.

I know my noble friend appreciates that state-registered chiropodists/podiatrists are not seeking aggrandizement for their profession and that any suggestion that they are being unhelpful in pressing their concerns is totally unwarranted. Their abiding concern is to protect professional standards in the public interest and Professor Boulton's letter to me shows how vitally important that is to people whose disabilities make them at once highly vulnerable and vitally dependent on fully qualified help.

I look forward to hearing from my noble friend that her objectives on self-regulation are identical to those of the profession. Perhaps she would also now confirm that

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it will be the Government's intention to continue the Privy Council's role in relation to the profession of chiropody/podiatry as well as to the medical profession. Meanwhile, I conclude by thanking her again for what she has already done in relation to protection of title and for her readiness to arrange further dialogue with the society. I beg to move.

Lord Walton of Detchant: My Lords, it has been drawn to my attention that when the noble Lord, Lord Morris of Manchester, proposed amendments on this topic at Committee stage, I made a comment which may now be regarded as being outdated.

Some years ago, when I was consulted by the Society of Chiropodists and Podiatrists, it was then the case that the chiropodists with the primary qualification undertook minor procedures on the feet, whereas those who called themselves at that time podiatrists, undertook an additional period of post-graduate training, often of some two years, with surgical training as part of that to enable them to use local anaesthetics and to carry out surgical procedures of a much more invasive nature. That was the case several years ago; but, in fact, the term "podiatry" has become internationally recognised as being virtually synonymous with chiropody as it stands in this country. So, as the noble Lord said in Committee, the terms are now interchangeable.

However, when the issue of self-regulation of this profession is further considered under that body which is instituted under the Bill in succession to the Professions Supplementary to Medicine Act, I hope that it will, like the other professions--such as, physiotherapy, and so on--receive separate consideration. When that happens, I trust that those chiropodists and podiatrists who have undergone that specific period of post-graduate training to enable them to carry out surgical procedures on the feet will be properly and separately identified in any register which may be established. I know that this is a matter of concern to the Royal College of Surgeons and to the British Orthopaedic Association.

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