I am grateful for the opportunity to raise the question of the registration of acupuncturists and the control of their premises. This is a subject of great public importance in the context of health and safety.

First, I want to refer to the outbreak of viral hepatitis B, relating to the practice of acupuncture in the Birmingham area in the past few months. The area medical officer to the Birmingham Health Authority has reported upon 20 clinical cases of viral hepatitis B, all of them traced to the same acupuncturist. He states that he is not aware how many of them have been primary cases or how many have been secondary cases—silent carriers of the virus—but when I spoke to him on Tuesday he confirmed that there is a total of 35 cases and that he does not know where the chain will end.

Viral hepatitis B is one form of infective hepatitis transmitted by direct injection with infected blood or blood products. It usually has a long incubation period of between six weeks and six months, and carriers of the virus are often unaware that they are carriers. The fatality rate is high, and the infection may also be associated with progression to chronic liver disease, including liver cancer. It is a notifiable disease and must be regarded as a potentially serious one. That is why I am speaking today.

The medical officer claims that acupuncture, tattooing and ear-piercing can, if done by unskilled persons, cause serious outbreaks of the infection. I do not want to dwell too much on tattooing or ear-piercing, but he is concerned at what he considers to be the contribution that they make to the viral hepatitis virus.

The outbreak of viral hepatitis B related to the practice of acupuncture is just one instance where unskilled persons using unsterile instruments, and working in unhygienic surroundings can cause serious lethal hazards within the community. The practice of the acupuncturist to whom these cases are related is conducted in the front living room of his home. A mattress on the floor serves as a couch. There is no wash basin in the room. The state of cleanliness leaves a great deal to be desired.

On submitting himself to medical examination at the time of the outbreak, he himself was free of the disease, and it seems fairly obvious in the circumstances that he must have contaminated his needles unwittingly on a carrier, and then used them on other patients without adequately sterilising them, thus perpetuating the infection.

One of the difficulties about this practice was that the acupuncturist concerned kept no records at all of his patients, their visits, the dates, and so on. Obviously, this created difficulty in trying to trace patients and thus institute preventive measures. This outbreak of hepatitis associated with acupuncture came as no surprise to the medical profession, according to the medical officer in Birmingham, as the practice of acupuncture has not been regulated or checked in any way in this country. As he has told me, the medical profession can move in only when the damage has been done. That is a rather serious situation. When the authorities moved in, they were frustrated. They could not carry out a follow-up operation because of an absence of records of the acupuncturist's patients.

At present there is nothing that can be done to prevent a similar situation from arising. That is the gravity of the situation. There is no legislation to control the practice and practitioners of acupuncture—or is there? There appears to be some confusion. Government Departments are not clear. Some think "Yes" and some think "No". I refer to my Question in the House on 7th July when I asked the Secretary of State for Health and Social Services if he will introduce legislation to seek to compel the registration of acupuncturists and enfore proper standards of hygiene and safety in their practice." My hon. Friend, the Under-Secretary replied: My right hon. Friend does not consider that new legislation to introduce compulsory registration of acupuncturists would be justified. Application of the Professions Supplementary to Medicine Act 1960 can be extended to provide for the creation of a registration board for acupuncturists should they themselves seek this and should the Council for Professions Supplementary to Medicine and the Privy Council agree following consultation with existing registration boards for other professions registered under the Act. I do not want to pursue that part of the answer in great detail. I want to base my submission today on the premises rather than the theoretical argument about the registration of acupuncturists.

The rest of the answer to my Question—which is the most important part—continues: Registration would not in itself ensure hygiene. I accept that. I think that is readily understandable. The answer continues: A self-employed acupuncturist offering services to the public already has a responsibility under Section 3 of the Health and Safety at Work Act 1974 'to conduct his undertakings in such a way as to ensure, so far as is reasonably practical, that he and other persons (not being his employees) who may be affected thereby are not thereby exposed to risks to their health or safety '. Failure to comply with the provision of the Act can lead to prosecution which is the responsibility of my right hon. Friend the Secretary of State for Employment."—[Official Report, 22nd July 1977; Vol. 935, c. 754–5.] On receipt of that answer I turned my attention to the Health and Safety Executive. First, I contacted the department in the West Midlands. I raised the issue of the acupuncturist and Section 3 of the Health and Safety at Work, etc. Act 1974. The reply that I received from the Health and Safety Executive of the West Midlands stated: The proposition that the Health and Safety at Work Act might be used to control the work of a person offering professional advice or treatment is a difficult one. On the plain words of Section 3(2) of the Act it would appear that a self-employed practitioner has a duty under the Act to conduct his undertaking in such a way as to ensure, so far as is reasonably practicable, that other persons are not thereby exposed to risks to their health and safety. This duty would appear to extend across the whole field of medical treatment and service as well as consultancies of all sorts. You will appreciate, therefore, that the issue is one of considerable importance.The proposition has not been tested in law so that there is, as yet, no authoritative interpretation of the Section. The Health and Safety Executive is, however, actively considering its implications and I will bring your interest to the notice of the persons concerned at my Headquarters. I have referred the content of my correspondence to the Health and Safety Executive at national level, but as yet I have not received a reply to my representations.

I say emphatically that this predicament must be resolved. The public cannot be so blatantly exposed to such health and safety risks. I know that there is a measure of disagreement about the practice of acupuncture. Members of the public have written to me to say that acupuncture treatment has helped them. A number of people in the Birmingham area have done that. I do not wish to disagree with them. I cannot adjudicate on the subject. Some people have said the opposite, and some are dubious. It is like many other issues that become controversial. I am not a medical man and I do not set myself up as an authority. I am merely concerned with the health and safety of my constituents and the public at large.

In the West Midlands there is one medically trained person, a doctor, who specialises in acupuncture. He is in full-time National Health Service general practice. He informs me in correspondence that he is against any form of registration of non-medically qualified acupuncturists. He seems to think that it will give them a standing of respectability within the profession that they have not earned and do not deserve. He says that the Medical Acupuncture Society, the local medical committee and the local branch of the British Medical Association take the same view. I can understand why my hon. Friend's Department takes that view. It is perhaps to be expected when the profession as a whole seems opposed to the registration of acupuncturists.

It is clear that to deal with the individual acupuncturist is a complicated exercise. Obviously, there is a great deal of resistance to registration within the medical profession. However, in my view, there is no reason why we cannot insist on clean and disease-free premises. The seriousness of the outbreak in the Birmingham area has led the county authority to include a section on the control of acupuncture in the West Midlands County Council Bill.

As I understand it, the Bill has already been deposited in Parliament. I have read the section relating to acupuncture, and the clauses seek to establish that there will be no practice of acupuncture in a district unless the practitioner is registered by the district council. Under the terms of the Bill, the district council may make byelaws for the purpose of securing the cleanliness of premises that are required to be registered as well as the instruments, materials, towels and other items. It concerns itself with the cleanliness of the persons employed in regard to themselves and their clothing. Appropriate penalties for non-adherence are included in the Bill.

The Bill is to be welcomed. It is positive and clear and meets a genuine need. No doubt the West Midlands County Council has included the acupuncture provisions in the Bill because of the seriousness of the situation in the West Midlands and Birmingham area. Nevertheless, the Bill contains 189 clauses covering a multiplicity of other subjects. It is primarily an exercise of consolidation. The tortuous journey through this place and the waylaying in another place constitute major hazards for any Bill, and certainly one with 189 clauses. The House will recall that the previous West Midlands Bill never got off the ground. It was a consolidation measure and parts of it were found acceptable and other parts were found to be unacceptable. On balance, it appeared that too many parts were unacceptable and the Bill was lost. In fact, it never got on its way.

Except for one local authority, I understand that authorities do not have bye-laws requiring the premises used by acupuncturists to be registered. There seems to be a great need for some urgent and positive Government action to deal with the problem. I raise that especially with my hon. Friend and his Department.

The area medical officer in Birmingham, in correspondence that I have had with him, states: There is no doubt that there is a rising reservoir of viral hepatitis B in this country The current incidence of acupuncture, tattooing and ear piercing only contributes to the bank of carriers. It is now accepted that hepatitis B is probably responsible for a very much larger proportion of chronic liver diseases than is generally regarded. Perhaps the Government should investigate what I call the needle men—the acupuncturists, the tattooists and the ear piercers—and determine standards of hygiene and safety. Certainly—this is the most important matter in my contribution—there should be some control over non-qualified acupuncturists and some check on how many there are in the country at large. The Government ought to legislate in the interests of the health and safety of the public and not leave it to local authorities to decide whether to do something about the problem.

As I have pointed out, it is not easy for local authorities to acquire the byelaws that they need. Even those which have acknowledged the seriousness of the problem and want to do something about it face difficulties in getting the appropriate byelaws and powers through this House, I revert to the point about the differences between the Departments or the difficulty of one Department enforcing legislation which has been in operation since 1974. The existing legislation—Section 3 of the Health and Safety at Work, etc. Act 1974—must be activated and, where necessary, the premises of acupuncturists must be brought up to standard.