Orders of the Day — Chiropractors Bill

Part of the debate – in the House of Commons at 9:35 am on 18 February 1994.

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Photo of David Lidington David Lidington , Aylesbury 9:35, 18 February 1994

I know that my hon. Friend follows closely such matters as the system of registration. I ask her to remain patient for a little while because I will deal with that subject soon.

The implementation of the register will depend in part, of course, on the progress made on the Bill, but I hope that the general council will be established within 18 months or two years of the Bill's receiving Royal Assent. The statutory register will probably open 18 months or two years after the general council has been set up. That is the rough timetable.

My hon. Friend's intervention was apposite because I was about to deal with the subject of registration. The Bill will require that a person must be registered with the general council to call himself a chiropractor, and to practise as such.

That requirement will be backed up by the creation of a new criminal offence to be introduced once the initial transitional period had elapsed. That would provide that a person who was not a registered chiropractor but who, after enactment, described himself or herself as a chiropractor either expressly or by implication would be liable on summary conviction to a fine not exceeding level 5 of the standard scale—that is currently £5,000.

My Bill provides for three different categories of registration—full, conditional and provisional. I should like to deal with each category in turn. Entitlement to full registration will primarily be determined by whether or not a person holds a recognised qualification. That will be a qualification which the general council considers provides evidence of reaching a standard of proficiency for the safe and competent practice of chiropractic. In deciding whether it recognises the qualification, the general council will be required to seek the advice of its education committee.

In cases where it wishes to grant recognition, the general council will also be required to obtain the consent of the Privy Council. I will say more about that process of recognition, and withdrawal of recognition, when I come to discuss the role of the education committee.

In addition to holding a recognised qualification, an applicant for full registration would be required to do a number of other things. He must make an application in the form and manner which is required by the general council, and he must pay any fee which may be described. It is of great importance that the applicant satisfies the registrar that he or she is of good character, and is in good physical and mental health. Most of the details determining whether an applicant satisfies those criteria will probably be set down in the rules made by the general council.

I draw the attention of the House to clause 40 of the Bill, which exempts chiropractors from the provisions of the Rehabilitation of Offenders Act 1974. That means that anyone applying for registration will, if asked, be required by law to declare all of his convictions, including those which are otherwise considered to be spent. This is an important provision. The overwhelming majority of chiropractors practise in the private sector, and that position is unlikely to alter markedly even if the Bill succeeds.

Hon. Members will realise that chiropractic is very much a contact form of treatment. Members of the public are entitled to expect a statutory registration scheme to provide them with clear assurances about a practitioner's bona fides.

I have said that entitlement to full registration will be primarily dependent on whether a person holds a recognised qualification. At present, there is no requirement for any person who calls himself a chiropractor to undergo formal training. For that reason, not everybody who is in current practice will necessarily hold a formal qualification. Other chiropractors in Britain may well hold a qualification awarded by a school or an institution in this country or overseas which no longer exists. That does not automatically mean that those chiropractors are unsuitable for registration, or that they are unsafe and incompetent.

The Bill provides transitional arrangements, known as grandfather arrangements, to enable those practitioners who have been practising chiropractic lawfully, safely and competently for a number of years to apply for full registration. The grandfather provisions in the Bill are identical to those which are embodied in the Osteopaths Act 1993. The requirement is that a practitioner has, for at least five years, spent a substantial part of his working time in the lawful, safe and competent practice of chiropractic. To ensure that a practitioner's experience is recent, no account is taken of any work which was done more than seven years prior to the date on which the register opens.

Applications for full registration under the grandfather arrangements would be permitted only during a two-year period following the opening of the register. After the two-year transitional period has elapsed, applications for full registration would be accepted only on the basis that the applicant holds a recognised qualification and satisfies all of the other criteria which I mentioned earlier. The grandfather provisions are designed to enable the transition from the present system of voluntary registration to a future statutory one to take place smoothly.

The second category of registration is known as conditional registration. That is a purely transitional arrangement, and applications for conditional registration will be permitted only during the two-year period immediately following the opening of the register. Conditional registration would enable a practitioner who again is without a recognised qualification and who is unlikely to muster the five years' lawful, safe and competent practice necessary to apply for full registration still to have a route open by which to enter the registered profession.

There are two broad groups of chiropractors for whom the provision is designed. The first group consists of practitioners who just fail to reach the five years out of seven criterion. They can apply for conditional registration if they can satisfy the registrar that they have acquired four years' experience of lawful, safe and competent practice within a period of less than six years before the opening of the register.

The second group consists of a small number of practitioners who could fall between two stools. They hold a qualification in chiropractic, but it is a qualification about which the general council and the education committee know little. Again, the institution which awarded the qualification may well no longer exist. A practitioner in that category may be unable to satisfy even the four years out of six criterion which I have just described.

Such a chiropractor could be a woman who qualified in chiropractic some years ago from a school or training institution which may no longer exist. She has taken some years out of the profession to bring up a family, and now wants to return to practise. Such people, and others in comparable positions, will be permitted to apply for conditional registration.

The precise criteria will be that they are unable to satisfy the four years out of six criterion, and that they hold a qualification in chiropractic which, while not a recognised qualification, is not something which has been examined by the education committee of the general council and then refused recognition. It is important to note that I am not seeking to open a back door for applicants who have qualifications which the general council and the education committee have judged to be inadequate.

Any applicant for conditional registration will have to fulfil exactly the same conditions of good health and character as are required for applicants for full registration. In addition, the registrar can require them to take and pass a test of competence to his satisfaction, and require them to enter into a formal undertaking to complete such extra training or acquire such additional experience as he may specify. Applicants will have a maximum of five years after the opening of the register to fulfil the obligations, although the registrar will be able to specify a shorter time scale if he thinks that that is right.

All conditional registrations without exception will lapse automatically at the end of five years, and anyone failing to have a registration made up from conditional to full will automatically cease to be a registered chiropractor.

The final category of registration is provisional and it is a little different. It is intended to allow the general council to require a chiropractor who would otherwise be entitled to full registration to be registered instead for an initial period of one year only with provisional registration.

While registered provisionally, a chiropractor would be allowed to practise only under the supervision of a practitioner who was fully registered under the terms set by the general council. Typically, provisional registration would apply to the first year of practice following the qualification of a student coming straight out of chiropractic college. Obviously, the provision also could be applied to other groups of practitioners. The system of provisional registration is modelled on the system which is already in place among voluntary associations operated by the chiropractic profession in this country. It clearly benefits practitioners and patients alike.

The Bill does not seek to impose automatically a provisional registration scheme, but it allows the general council discretion to introduce a system through rules that it makes in the future. It will have to consult the profession before it makes any such rules. The rules on professional registration would not only require the approval of the Privy Council but would be subject to the negative parliamentary procedure.

The Bill seeks to establish four statutory committees of the general council: the education committee, the investigating committee, the professional conduct committee and the health committee. The education committee will have a general duty to promote high standards of education and training in chiropractic, and to keep the provision of such training under review. Its responsibilities would also cover such things as examinations in chiropractic, tests of competence and post-registration training courses.

The education committee will have the prime responsibility of advising the general council whether a qualification provides evidence of reaching the standard of proficiency required for the safe and competent practice of chiropractic and, consequently, whether that qualification should be formally recognised. In the same way, the committee will also have a responsibility to bring to the attention of the general council any shortcomings in a recognised qualification, especially if they are so serious as to justify action to withdraw recognition.

To help the education committee carry out its statutory duties, the committee will have the power to appoint visitors to go to educational institutions and report back on the adequacy of the training and facilities provided. That provision will be the principal means by which the education committee will be able to acquire first-hand knowledge of the nature and quality of the instruction given.

The Bill also imposes a duty on training institutions which either provide or intend to provide chiropractic education and training to provide the education committee with any information that it might reasonably require in order to carry out its statutory duties. If a training institution fails to comply with such a request, that in itself will be sufficient ground for a recommendation to the general council that recognition be either withheld or withdrawn.

For the sake of completeness, I should perhaps add that a decision to recognise or withdraw recognition from any qualification would require the consent of the Privy Council. To enable the Privy Council to come to a decision on the matter, the general council would be required to provide it with all the information available to the general council and on which the recommendation was based. Where consent is sought for a qualification to be recognised, however, the Privy Council may be content to accept a summary of that information.

Before leaving the subject of education and training, I should mention briefly the existence of different groups of chiropractors in the United Kingdom. The groups have developed along separate and distinct lines over the years. In 1991 they came together to form the chiropractic registration steering group. The differences between the various groups have traditionally been reflected in their different approaches to education and training. One of the fundamental agreements that has been made between members of the steering group is that all United Kingdom schools of chiropractic represented by the various members of the group will achieve a levelling up of standards within five years of legislation to regulate the profession coming into force.

At the heart of the agreement is the intention that the qualifications currently awarded by three main United Kingdom schools of chiropractic—the Anglo-European college in Bournemouth, the McTimoney school and the Witney school—will be granted the status of recognised qualifications. That decision will ultimately be one for the general council and the education committee to take, but I hope that if my Bill is successful the profession will take it as a clear signal that Parliament expects that aspect of the agreement to be honoured.

In the past two weeks I have spent a happy half day in the constituency of my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) at the Anglo-European college. A few days ago I visited the Witney school in Oxford to see how its training system operates. The schools have two different approaches, but during each visit I was struck by the dedication, commitment and professionalism of all who were involved.

I turn now to the committee whose role will be to investigate complaints against practitioners. It takes us back to a point made earlier by my hon. Friend the Member for Sutton and Cheam. My Bill establishes an investigative and disciplinary procedure to deal with three sorts of allegation: first, allegations of unacceptable professional conduct; secondly, allegations of professional incompetence; and, thirdly, allegations that a chiropractor has been convicted in the United Kingdom of a criminal offence or is unfit to practise due to his physical or mental condition.

To ensure that the fitness-to-practise scheme has some real teeth, it will be an offence for anyone not to comply with a request from the professional conduct committee, the health committee or the appeal tribunal to attend a hearing to give evidence or produce documents. As with the offence of wrongly claiming to be a chiropractor, that offence would be punishable on summary conviction with a £5,000 fine—level 5 on the standard scale.

Let me summarise how a complaint from an individual would be handled. First, the general council could appoint a screener to decide whether the case even came within the scope of the fitness-to-practise machinery. As my hon. Friend the Member for Sutton and Cheam said, a complaint could be made about a chiropractor that had nothing to do with the general council or the registration scheme of the profession. Someone could complain bitterly that his chiropractor was an active member of a particular political party, for instance. It would be the job of the screener to decide whether the nature of the complaint brought it within the statutory scheme. If it did, and only if it did, the investigating committee, which acts as the CID and Crown Prosecution Service of the scheme, would take over the matter and conduct a preliminary investigation.

The investigating committee would then gather information and evidence, look at that evidence and decide whether there was a case to answer. If there was a case to answer, the investigating committee would determine whether the professional conduct committee or the health committee was the appropriate one to deal with that case.

The investigating committee could suspend registration and, therefore, the ability to practise pending or during investigation, if it decided that it was necessary for the protection of the public. The obvious case in which that power would be invoked would be a serious allegation against a chiropractor, for example, of sexual assault on a patient. There would then be an urgent need to be absolutely certain that the public were protected.

The Bill specifies that an interim suspension imposed by the investigating committee would have a maximum duration of only two months. The reason for that is to make sure that the investigating committee gets on with its job and refers cases onwards quickly and efficiently for resolution by either the professional conduct committee or the health committee. Those committees in turn will have similar powers of interim suspension for the same reasons of protection of the public, but no maximum duration is set. So suspension imposed by the investigating committee could be maintained by either the professional conduct committee or the health committee if it thought that that was right.

A practitioner would have a right to appeal against suspension by any of the committees by going to the High Court or its equivalent in Scotland and Northern Ireland. However, there would be no appeal against the interim suspension imposed in the first instance by the investigating committee. I judge that the two-month maximum duration is adequate protection there.

Any allegation of unacceptable professional conduct, professional incompetence or that a chiropractor had been convicted in this country of a criminal offence would be referred to the professional conduct committee. The practitioner would be entitled to know the details of the case against him, and would have the right to a hearing and legal representation if he or she so chose. The committee will be barred from taking action when it is proved that the offence is irrelevant to the practitioner's fitness to practise. That deals with the point of my hon. Friend the Member for Sutton and Cheam about a chiropractor who is convicted for speeding.

If the professional conduct committee finds against a practitioner, it will be given certain disciplinary powers and will be able to strike his or her name off the register. It will also have the power to suspend a practitioner for up to three years, to impose conditions on future registration or simply to admonish the chiropractor.

During the suspension period, the professional conduct committee will be able to extend suspension for a further three years or impose conditions for registration once it has expired. Again, the chiropractor concerned would have the right to a hearing and to legal representation.

The idea is that the power to extend the suspension period would apply to cases which had been heard and determined by the professional conduct committee, which had imposed a suspension but further, and perhaps even more serious allegations, had then come to light. The committee would be able to extend the suspension period, without the case having to begin again at the start of the procedure.