I beg to move, That the clause be read a Second time.

The proposal is a straightforward one. The Access to Health Records Act 1990 gives patients a right of access to their health records. It applies to records relating to the physical or mental health of an identifiable individual compiled by a health professional in connection with care and treatment. "Health professional" is defined without reference to osteopaths, and records compiled and held by an osteopath are therefore outside the scope of the Act.

As the main purpose of my Bill is to introduce a statutory registration scheme for osteopaths, to place the profession on the same footing as the other key health professions, it seems logical for individuals who have received treatment from an osteopath to be given the legal right of access to the records of that treatment.

The definition of "health professional" is the same across the whole range of legislation that deals with the individual's right of access to information about his own health. For the sake of consistency, it is again logical to include registered osteopaths in all the various legislation—that is especially important in respect of the Data Protection (Subject Access Modification) (Health) Order, as the Access to Health Records Act applies only to records compiled in a written form. An individual's right of access to information held in computerised form is provided by the subject access provisions of the Data Protection Act 1984.

Scanning the horizon for good news this morning, I am happy to light upon the excellent Bill introduced by my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss).

This new clause is an important proposal, which the Government strongly support. For many years, we have openly supported the principle that patients should, as a matter of course, have the right to know what has been written about them. The new clause extends to individuals who receive treatment from osteopaths the existing rights of patients to have access to their health records.

People have had a legal right of access to personal health information for some time now. Health records kept on computer are accessible to patients by means of section 21 of the Data Protection Act 1984, although certain information is exempt by virtue of the Data Protection (Subject Access Modification) (Health) Order 1987. Those exemptions are necessary to protect the subject from serious harm to his physical or mental health and to protect the privacy of other identifiable individuals.

In 1987, the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) successfully piloted on to the statute book the Access to Personal Files Act, which gave individuals the right of access to records not held on computer—usually described by the rather unsophisticated term "manual records"—but that right extended only to those manual records held by local authorities and local social services for the purposes respectively of their housing and social services functions.

Health records were excluded from the Access to Personal Files Act 1987 because, at that stage, the Government wanted to reach an agreement with the medical profession, which had reservations about the idea of a legal right of access to health records. The profession was concerned about the potential effects on patient care of patients being handed that right, and argued that arrangements for access should involve appropriate safeguards for patients, doctors and other health professionals. It recognised that, in any case, many doctors had long practised voluntary disclosure to patients of their personal records, and argued that legislation was not necessarily the right way in which to deal with the issue. Therefore, the Government undertook to enter into talks with the medical profession to see what could be achieved.

After discussions, which extended over two years, with representatives of the profession, a draft code on non-statutory access to health records was produced. That document was circulated widely for comments. The only reservations about the principle of access were raised by the medical profession itself. For that reason, the Government concluded that agreement could not be reached on a non-statutory code which would match the expectations of the public and which would have the unequivocal support of the medical profession.

When the hon. Member for Newcastle upon Tyne, North (Mr. Henderson) presented his Access to Health Records Bill in 1989, the Government decided to support it, subject to necessary safeguards because its provisions were entirely consistent with my Department's policy on access to records. The issue is not just letting patients see their own health records. Medical records are maintained for patient care and are used by doctors and other health professionals to help them in the diagnosis of patients. Records are thus used to record and advise other health professionals on the progress of care and treatment.

However, the primary purpose is to record what is in the best interests of patients and what is in the record may not always be in the best interests of the patient to know. For example, there may be circumstances in which the uncontrolled disclosure of information may cause harm or distress.

Therefore, the problem has been to ensure that information for patients is recorded properly, while providing safeguards for patients against the risks that some disclosures may bring. Some doctors are fond of using phrases and medical jargon in records which many people find incomprehensible. That is why the legislation provides that the applicant should be given a simple and clear explanation of the meaning of the record by a relevant health professional, whether or not the applicant requests clarification.

A right of access to records can be reassuring to patients who know that they may see their records at any time. If patients ask to see their records and detect misleading or inaccurate information, they can request that that information be corrected. The Access to Health Records Act 1987 specifically provides for that. One of the advantages of the right of access is that it forces those who compile records to think rather more carefully about what they write. Openness therefore acts as a safeguard against possible casual, ill-considered personal comments which are sometimes found on health records.

In paying tribute to hon. Members who have successfully introduced Bills that have given individuals greater access to records, I must also acknowledge the work of the Campaign for Freedom of Information in raising public consciousness on this issue. The campaign has argued with much success that people should have the right of access to information that affects them and to information that enables them to take decisions about their lives. Those principles lie at the very heart of the Government's policy on openness.

The patients charter has highlighted the existing right of access to one's own health records. That, coupled with the right to be given detailed information on local health services, enables patients to make more informed decisions and illustrates the development of a more patient-centred health service taking account of the wishes of patients. With access to information, patients are empowered to play a greater role in decisions that affect them.

The issue of patients' access to their own health records is part of the wider issue of the provision of information to patients. Before legislation, there was a great deal of evidence that patients were not given as much information about their condition as they would like. For example, a survey of patients' satisfaction in general practice found that lack of information concerning treatment was the most frequently reported deficiency in the service provided.

Access to health records has provided an important new freedom to people, particularly because we should all be encouraged to take more responsibility for our health. We increasingly want to know what to do to keep ourselves healthy and what we can do to improve our chances of a quick recovery when we are ill. We want to be able to discuss our treatment with doctors and the other health professionals involved in caring for us, to understand what we are being asked to consent to and to know the risks, alternatives and chances of success.

Of course, access to the written record is not an alternative to discussion with professionals. However, I am sure that being able to see and understand what has been recorded about one helps to make that discussion more informed and equal and it will therefore become a more natural process between patient and professional.

The Government welcome and support the new clause. Given the enhanced status that the Bill gives to the profession of osteopathy in the field of health, extending patients' rights of access to the records of a registered osteopath seems the natural and logical progression.

We welcome and support the new clause. As the Minister said, in a Bill that is designed to protect patients' rights and access to osteopaths in terms of training and the quality of service that patients receive from osteopaths, it is entirely right that they should have access to their own records and protection in that way.

I sincerely hope that the positive way in which we have started our discussion on the Bill today is a sign that we shall be able to progress speedily through a Bill which should have been on the statute book a long time ago and which has the support of all parties—although representatives of one party are absent from the Chamber today.

9.45 pm

I expect that the Liberal Democrats are still celebrating, and we would not want to take that from them after their spectacular victories against the Government—[Interruption.] I could recount all the shire counties that were lost—

Order. A general reference to that may be acceptable, but we do not need to explore the depths.

I was encouraged by some sedentary comments, and I stand corrected, Mr. Deputy Speaker.

I can think of no better basis from which the Government can look to the horizon to redeem themselves than to improve and develop the national health service and to take the message from the electorate yesterday that they expect the Government to do that and that they have not approved of the Government's progress thus far. I therefore hope that we shall be able to support all the proposals in the Bill and conclude our business in good time so that we can return to our constituencies and continue the work that we were doing yesterday.

I beg to move, That the clause be read a Second time.

I understand that with this it will be convenient to discuss also the following amendments: No. 18, in clause 30, page 24, line 12 leave out

'of the Health Committee is made under section 23'

and insert

'is made by an appeal tribunal hearing an appeal under section (Appeals against decisions of the Health Committee)'.

The central purpose of the Bill is to establish a statutory registration system for osteopaths to provide members of the public with the assurance that, in the future, anyone calling himself or herself an osteopath, is adequately trained, properly qualified and fully competent to practise osteopathy, and that their professional practice is regulated by effective methods of control.

In addition to providing those safeguards for the public, it is equally important that the statutory scheme protects the human rights of osteopaths and provides them with an appeals system which is firmly rooted in the principles of natural justice.

As currently drafted, the Bill provides an aggrieved osteopath with a right of appeal against decisions of the professional conduct committee and health committee to Her Majesty in Council—that is, to the Judicial Committee of the Privy Council. I remind the House that those two committees are the fitness to practise committees with powers to suspend an osteopath's registration, impose conditions on his or her continuing to practise or, in the case of the professional conduct committee, to erase his or her name from the register.

Providing appeals against decisions of the health committee on matters of fact as well as of law would be a unique feature of the osteopaths' scheme among those governing other health professionals. The Judicial Committee is, however, concerned that appeals on matters of fact are liable to raise complicated issues of technical evidence on someone's medical condition and their consequent ability to practise which would fall outside the scope of its competence to determine. Therefore, new clause 3 seeks to provide an alternative route for appeals against decisions of the health committee.

Under the provisions of new clause 3, an appeal on either a matter of fact or of law would lie to an appeal tribunal. A further right of appeal against a decision of that tribunal on a point of law only would lie to Her Majesty in Council. That would be in line with the practice applying to the other health professionals.

The appeal tribunal would comprise a legally qualified chairman—a senior solicitor or barrister—a fully registered osteopath and a registered medical practitioner, all of whom would be appointed in accordance with rules drawn up by the general council and approved by the Privy Council. In order to ensure the independence of the appeal tribunal from the general council, the rules must specifically prohibit the general council from selecting any member of the appeal tribunal.

A different appeal tribunal will be constituted for each appeal and, subject to any provisions made by the rules, would sit in Northern Ireland in cases where the appeal has been by an osteopath whose registered address is in Northern Ireland, in Scotland if his or her address is in Scotland, and in England or Wales in any other case. Subject again to any provision made by rules, the appeal tribunal will sit in public.

Hon. Members will no doubt have noticed that that is in contrast with the provisions of amendment No. 17, which I shall discuss later. We shall provide for hearings of the health committee to be held in private. That difference does not betray a contradiction in policy. In the first instance, an appeal under this new clause would have been initiated by the osteopath himself rather than by another party, as would be the case with the original allegation.

Also, the provisions have been drafted with an eye on the terms of article 6.1 of the European convention on human rights, which states:

"In the determination of his civil rights and obligations or of any criminal charge against him, everyone is entitled to a fair and public hearing within a reasonable time by an independent and impartial tribunal established by law."

The appeal to the appeal tribunal would be by way of a rehearing at which the general council would be the respondent. The appeal tribunal would possess the same powers as the health committee to require a witness to attend the hearing and give evidence or produce documents. Those powers would be backed up by the provisions of clause 31, making failure to comply a criminal offence.

The appeal tribunal would be empowered to make any decision that the health committee would have the power to make under clause 23. In the same way, the appeal tribunal would have comparable powers of interim suspension, as in relation to the health committee by virtue of clause 24(1)(b).

The other amendments in this group are the consequential amendments required to clauses 30, 31 and 35. In particular, they would provide for the rules to be prepared by the general council under this clause to be subject not only to approval by the Privy Council but to the negative parliamentary procedures. They also provide for the general council to be the respondent to any further appeal made to the Judicial Committee of the Privy Council on a point of law.

Such hearings would normally be adversarial. However, as currently drafted, the Bill provides only that the general council may appear as the respondent. It is now felt, however, that the general council should always be the respondent. By making the general council the respondent, the provisions in clause 30(8) relating to the apportioning of costs are not required. The general council would automatically be a party to the hearing and could therefore be liable to incur the costs of the parties.

I welcome the provisions that my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) has introduced, and I take his point in regard to the reluctance of the Judicial Committee of the Privy Council to be faced with complicated matters of medical fact in which it would not feel itself qualified to make a decision. Thus, it is correct to limit the right of appeal to the Judicial Committee to points of law. There are, however, one or two detailed matters in regard to new clause 3 to which I draw the attention of the House and in particular ask my hon. Friend to address to see whether further amendments could be made at a later stage of the Bill's process.

The first point that worries me is that the general council has virtually unfettered powers to make rules. Therefore, it is very difficult for the House to consider new clause 3 and to satisfy itself that the rules of justice—natural justice—will be fully carried out when the general council makes decisions over which it has no control.

I am happy that the appeal tribunal should be chaired by a lawyer. It is terribly important—I speak as somebody who practised at the Bar—that people with legal qualifications chair such committees. There is always a temptation to denigrate the legal profession and to underestimate the value of putting lawyers on lay tribunals on which their advice on what is fair, right and in accordance with the concepts of our law can be extremely useful.

I am pleased that the chairman is to be a lawyer, but I am a little less happy that the rules are so clear on what both the other members of the tribunal have to be. There has to be one osteopath, and one registered medical practitioner. It might be appropriate to have somebody with a different background, interest and knowledge on the appeal tribunal in circumstances which I cannot currently guess but which might arise.

My hon. Friend will take the point that the reason why he is leaving the rules so general for the committee to consider later is precisely that, and to fetter the committee in that way on that specific issue seems to be unwise and contrary to the general thinking behind the clause.

The second point, which is possibly more serious, is that new clause 3(4) states:

"The rules may, in particular, make similar provision to that made by virtue of section 26."

There are then many sub-paragraphs. In clause 26, the position is different. It deals with the setting up of the health committee and the rules that the health committee shall decide on. It states:

"The rules shall, in particular, include provision".

There we have the health committee being bound to make rules along the lines of that clause, but that compulsion is removed when it comes to the appeal committee, which has discretion whether to follow the rules laid down in clause 26.

What concerns me in particular is that clause 26(2)(d) states:

"The rules shall, in particular, include provision … entitling the osteopath to be legally represented at any hearing in respect of the allegation".

If I read that clause correctly—I stand to be corrected if somebody can so persuade me—what is substituted for that in new clause 3 is that the rules may, in particular, include a provision entitling the osteopath to be legally represented at any hearing. If that reading is correct, it would, at least in theory, enable the appeal tribunal to refuse legal representation to an osteopath who has appealed to it.

I cannot believe that that is the intention behind the drafting of the Bill, and I should be grateful if my hon. Friend would confirm that, if I am right, that point will be rectified. It would be a most unfortunate lacuna if that went on to the statute book without its being intended to have the effect which I believe it has.

More generally, I very much welcome the setting up of the appeal tribunal. I am sure that it will be invaluable and I am particularly pleased that it is specifically set down that the appeal shall be by way of a rehearing of a case. Therefore, there can be no danger of an osteopath being fobbed off with an appeal that would be taken by way of written evidence, for example, or would look only at the evidence that had been presented to the original hearing. I am confident that the appeal tribunal will offer justice to osteopaths, with the provisions that I have already expressed as being my doubts about it.

I do not need to trouble the House any longer on the new clause, provided that my hon. Friend, who is now consulting his advisers, can satisfy me on those points.

I formally signal the Government's support for the new clause and recognise the co-operation and support of the medical and legal professions, which have been extremely helpful in drawing up the new clause.

I give a warm welcome to the new clause and express my support for it. A rigorous procedure for the appeal system is essential especially as we are giving the osteopathic profession official status. It will certainly give confidence to patients to know that no stone will be left unturned in the system that will determine the fitness of osteopaths to return to the profession.

I should like to respond to my hon. Friend the Member for Upminster (Sir N. Bonsor). His first point was that the council could make its own rules. He felt that that was to give it perhaps a little too much licence. I remind him that any rules which the council may come up with will be subject to the approval of the Privy Council and, of course, as a result may be subject to parliamentary scrutiny.

My hon. Friend referred to the composition of the tribunal. Taking first his point about the chair being a lawyer, I am glad that he declared an interest. But he seemed to speak most of the time about the interests of his profession. We believe that it is extremely important that a lawyer should chair the tribunal. We also believe that the inclusion of an osteopath and a medical adviser is vital. The osteopath could comment on professional matters of osteopathy and the running of the practice by the osteopath. The doctor could advise on health matters. Let us face it: the appeal will be to a health tribunal on health matters.

My hon. Friend raised the difference between the wording "may" and "shall" in terms of making the rules. The general council will be required to make rules and the Privy Council will scrutinise them. It is difficult to believe that the Privy Council would not take the important points that my hon. Friend raised into account. In no circumstances would it countenance an individual not having legal representation on any of the investigatory committees of tribunals.

I beg to move amendment No. 1, in page 5, line 24, at end insert '-(a)'.

With this, it will be convenient to discuss also the following amendments: No. 2, in page 5, line 25, at end insert 'and

(b) the address at which he has his practice or principal practice or, if he is not practising, such address as may be prescribed.

Amendment No. I will require the statutory register to show the osteopath's practice or principal practice address as well as the type of registration—full, conditional or provisional—that he or she holds. The register forms the heart of the statutory scheme. It will provide the assurance to members of the public that a practitioner whose name appears in the register has been appropriately trained, is properly qualified and is fully competent in the practice of osteopathy.

The provisions of clause 37 exempt osteopaths from the rehabilitation of offenders legislation, and place them under an obligation to declare all their criminal convictions, including spent convictions if asked, when applying for registration. So members of the public will be provided with an additional assurance as to a registered practitioner's bona fides and character.

The statutory register will elevate the scheme from the current system of voluntary registration. Voluntary registration has worked exceptionally well for the majority of practitioners. It has also played a key role in paving the way for statutory regulation. However, by its very nature, the voluntary system cannot enforce standards of competence or conduct. If a practitioner chooses not to participate in the scheme, the body that administers the scheme is completely powerless to exercise any jurisdiction over that individual's practice. That fundamental weakness brings into sharp focus the need for a statutory scheme.

As the law currently stands, anyone can call himself an osteopath and set up in practice. There is no obligation to undergo formal training of any nature or to comply with the standards of professional competence. Through the establishment of a statutory register maintained by a statutory council, standards of training, education, proficiency and professional conduct can be enforced throughout the profession in the United Kingdom. The statutory scheme will also require anyone who wishes to practise as an osteopath to conform to the standards set, to be registered on the statutory register and to submit himself to the authority of the statutory council.

Recording the address of a practising osteopath's practice or principal practice will not only provide members of the public with an essential piece of additional information—where to go for treatment—but will play a vital role in the election of members to the general council. The latter point will also apply to the address shown on the register for non-practising osteopaths. The precise detail is set out in the schedule which we shall examine later.

I draw the attention of hon. Members to paragraph 9 of the schedule. It specifies that eight of the osteopathic members of the general council are to be elected by fully registered osteopaths whose registered addresses are in England. Three others are to be elected by fully registered osteopaths with registered addresses in Wales, Scotland and Northern Ireland—one from each of the three countries. The schedule also provides for a 12th member, who must be a registered medical practitioner at the time of his election, to be elected by fully registered osteopaths whose registered addresses are in the United Kingdom.

We spent some time thinking about the address that should appear on the register in the case of a non-practising osteopath. Our initial instinct was to select the osteopath's home address, which would have been defined more precisely in the rules. However, two examples came to mind to discount that option. The first was the case of a practitioner who might no longer be in current practice but was widely respected within the profession and had established a clinic, perhaps under his or her name, which attracted practitioners of the highest calibre and was held in the highest esteem by its clientele.

Although no longer in current practice, the practitioner might continue to hold the reins of the clinic and may be regarded as the driving force behind its success. Such a person would undoubtedly want the address shown in the register against his name to be that of the clinic rather than his home address, regardless of how "home" was described in the rules.

The second example raised arguably more serious anxieties. A practitioner might have received menacing threats sufficient to make him consider temporarily suspending practice or, even worse, to make him cease practising because the threats so affected him that he was no longer able to practice. The worst thing that such a person could face if he decided to withdraw from current practice would be the appearance of his home address in the register because he chose to maintain his registration.

I accept that the examples are fairly extreme. Setting them aside, it is likely that some osteopaths will wish to keep their professional and private lives separate and, for such reasons, will not want their home address to be shown on the register. For all those reasons, it is felt that the matter should be left to the rules. The rules could provide a list of different types of address which a non-practising osteopath could choose to be recorded on the register.

Clause 6 is the heart of the Bill because it establishes the register which distinguishes a professional osteopath from simply anyone who decides to use that term. Clause 6 is extremely important if the Bill is to get on to the statute book. Over the years and the generations, there has been considerable scepticism by the medical profession about osteopathy and practitioners of other forms of what is now called complementary or alternative medicine.

Before I came here to speak today, I took advice from a member of the medical profession for whose judgment I have the highest regard—my father. He tells me that, in 40 years of medical practice, he has never yet referred a patient to an osteopath. He has never yet come across a case in which he believed that the conventional medical disciplines of orthopaedics and physiotherapy were insufficient to deal with the complaints for which osteopaths believe that their talents make them exceptionally qualified. Nevertheless, my father, in common with many members of the medical profession, has an open mind and, what is more, he has no doubt as to the integrity of osteopaths. No doubt there are some bad apples in that profession, just as there are in any other profession or activity.

It can only contribute to the confidence of the public and that of the medical profession to advise people whether an osteopath might be able to contribute something to the treatment and cure of symptoms, if it is absolutely clear who is and who is not an osteopath. Such confidence will also be enhanced if everyone is clear about the definition of the word "osteopath". It is therefore essential that we have such a register.

I congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on his success in steering the Bill through Committee. He has put a great deal of hard work and careful thought into the Bill, and I have considerable regard for his judgment. That encourages me to offer the Bill my general support.

If the general council is to have the responsibilities set out in clause 6 conferred on it, there should be no doubt about its proactive role. There should be no doubt about the precision and rigour with which the register will be drawn up and maintained. It is therefore important that the amendments proposed by my hon. Friend the Member for Upminster (Sir N. Bonsor), in particular amendment No. 2, which leave out "may" and inserts "shall"—

Order. the hon. Gentleman is talking about amendment No. 48, which we have not yet reached. Amendment No. 2 refers to the address of an osteopath.

I hope that I will be able to catch your eye, Mr. Deputy Speaker, when we reach amendment No. 2.

If we are to have a register, a name and address must be provided. There should be no misunderstandings about that address and, therefore, the proposed amendments greatly contribute to the precision and the credibility of the Bill.

I beg to move amendment No. 48, in page 5, line 26, leave out 'may' and insert 'shall'.

I am grateful for all that my hon. Friend the Member for Stamford and Spalding (Mr. Davies) said about the importance of the amendment. I stress, as my hon. Friend did, the importance to the Bill of the register and the concept of registration. My hon. Friend is right to say that they are central to the Bill.

It is also important to ensure that that registration process is open. There is no point in keeping a register if no one is clear about its purpose or the rules that guide its compilation. It is particularly important that people are aware of the rules that guide who may or may not be included on that register. It is for that reason that I have tabled the amendment, which would amend clause 6(2):

"The General Council may make rules in connection with registration and the register and as to the payment of fees"

to read: "The General Council shall" and so on.

I am particularly keen that the rules that apply to registration should be made clear to the public as well as to osteopaths, so that a proper assessment can be made of the value of that registration. If, for example, the general council decided, in its wisdom, not to make rules in connection with some of the matters set out in clause 6(3), the value of the registration would be greatly diminished.

The registration procedure will cover a number of matters. For example, clause 6(3)(e) states that the general council may make rules about

"the manner in which the Registrar is to satisfy himself as to the physical and mental health of any person applying for registration and the procedure for so doing".

Clause 6(3)(d) provides that the general council may make rules about

"the manner in which the Registrar is to satisfy himself as to the good character and competence of any person applying for registration and the procedure for so doing".

Unless people can be satisfied that the registrar has made a proper decision and explored fully the facts behind it, the value of the register will be low.

10.15 am

I am not happy that the general council's ability to make a discretionary ruling as to what is and what is not to be disclosed should be left unfettered. Perhaps my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) can tell me whether it is proposed that the rules that govern the establishment of the register and its contents will be made public. I am concerned about the use of the word "may", because, as I read it, it is possible under the Bill for those rules to be unrecorded and undisclosed.

I hope that the general council will have to make rules that set out clearly the background against which the register has been compiled. I hope that it will also set out clearly the criteria that will be taken into account by the registrar when he sets up the register. The register should be available to anyone who wishes to read it, so that he is clear as to its value. I hope that my hon. Friend the Member for Cambridgeshire, North-East will be able to assure me on those issues.

I have already paid the compliment to my hon. Friend the Member for Upminster (Sir N. Bonsor) of approving his amendment, even before he had a chance to move it. My hon. Friend has made the essential argument in favour of it, and there is not much that I need to say in support.

When we legislate to give a professional body the power to make rules, it is unsatisfactory if we do not stipulate that that body has the responsibility to make those rules and that, therefore, it must make the appropriate rules. Otherwise, we take away with one hand the responsibility that we have appeared to confer with the other. I set some store by my hon. Friend's amendment, and I agree with what he said about tightening the terms of this crucial clause.

My hon. Friend the Member for Upminster (Sir N. Bonsor) may be aware that at least two similar amendments were considered in Committee. My fundamental reason for resisting my hon. Friend's amendment is the same as that which I gave in Committee. Such an amendment would deprive the general council of the responsibility of exercising its own judgment on important matters—for example, the rules connected with registration and the payment of fees.

The Bill is founded on the principle of self-regulation, and it should not render the general council impotent in determining policy and priorities by inflexibly prescribing all its functions in legislation. That would reduce the status of the general council to that of purely an administrative body. The purpose of the Bill is to provide the profession with the statutory framework to enable it to regulate its own activities and chart its future development and growth.

It is worth remembering that the profession itself is seeking the measure. The proposed scheme of statutory regulation will replace the current system of voluntary registration. It is doing so not because, under the voluntary schemes, the profession has failed satisfactorily to register its affairs, but to give it the authority to do more effectively what it has been doing successfully for almost 60 years. Half the members of the general council will be specifically serving the interest of the profession.

Therefore, there is absolutely no basis on which to think that the general council would not make sensible decisions on matters of registration, the payment of fees or other key issues. Furthermore, there is no basis for assuming that such decisions would be detrimental to practitioners. If the profession had any expectation of operating anything but a fair scheme, it would not seek statutory regulation.

My hon. Friend the Member for Upminster asked whether the rules would be made public. I am most happy to confirm that they will.

I am grateful for my hon. Friend's assurance, as the issue of the rules being made public is important for the transparency and the public confidence needed if the new system, envisaged in the Bill, is to work. However, if my hon. Friend can give that clear assurance, why is it not written on the face of the Bill?

I was about to come to that matter.

The profession is also looking to submit itself to the authority of the Privy Council. If the Privy Council felt that the general council was failing to perform a function that it should perform, it would be able to intervene and direct the general council as appropriate. In extreme cases, the Privy Council could step in and take over the general council's responsibilities. Since the profession, through the legislation, is placing itself under the scrutiny of the Privy Council, that council will show the way in which matters are proceeding in the public interest by making a statutory instrument which is in the public domain.

The Bill already provides the necessary safeguards against the concerns of my hon. Friends. It also entrusts to the general council the ability to exercise its judgment in fulfilling its statutory duty to regulate the osteopathic profession.

I must confess that my hon. Friend has not wholly satisfied me on why the Bill contains a great divide between what the general council "shall" do—which applies to about half the provisions—and what the general council "may" do—which applies to the other provisions. I am puzzled over the positioning of the dividing line between discretion and ruling. However, I am grateful to my hon. Friend for giving his assurance about the openness of the rules that lie behind regulation. Therefore, in the light of what my hon. Friend has said, I seek leave to withdraw the amendment.

I beg to move amendment No. 4, in page 7, line 19, leave out 'any' and insert 'an'.

With this it will be convenient to take the following amendments: No. 14, in clause 14, page 11, line 16, leave out 'reaching' and insert 'having reached'.

The group of what might first appear to be small drafting amendments contains two matters of substance. Amendment No. 4 is a simple drafting amendment, but amendment No. 14 will ensure that the same criteria would be applied for the recognition of non-United Kingdom qualifications, other than those covered by Community law, as will be used for the recognition of United Kingdom qualifications.

Similar amendments were made in Committee in respect of United Kingdom qualifications, but it seems that this one slipped through the net. The House has already heard that the registration system proposed in the Bill will ultimately centre on whether or not a practitioner holds a recognised qualification, which equips him or her with the education, training and skills required for the safe and competent practice of osteopathy.

Clause 14 provides the mechanism for recognising the qualifications that meet that standard. Provision is made in clause 16 for withdrawing recognition if that standard is no longer met or the institution involved fails to comply with the conditions attached to the continued recognition of its qualifications. I shall say more about the conditions later.

In Committee, I described how the wording

"evidence of reaching the required standard of proficiency"

was a little too tight, as it demanded that a qualification would have to hit the mark when the application for recognition was being considered. It did not enable a qualification that had previously been met and was meeting the required standard when it was awarded to the osteopath to be recognised if it no longer met the standard or was, perhaps, no longer being awarded. The amendment will extend the same flexibility as is now provided for United Kingdom qualifications to non-United Kingdom qualifications.

Decisions on whether a qualification provides evidence that someone had reached the required standard of proficiency laid down by the general council under clause 13 for the safe and competent practice of ostoepaths—and so should be recognised for the purposes of registration —will initially be made by the education committee. If it is satisfied that the qualification provides such evidence, it will recommend to the general council that the qualification should be a recognised qualification.

In keeping with the practice adopted by schemes governing other health care professions that operate a similar system of recognition, the general council will seek the approval of the Privy Council for the qualification to be recognised. To assist the education committee in that task, clause 12 enables the committee to appoint visitors, who are almost certain to constitute the principal means by which the education committee obtains information on the nature and quality of instruction given by an institution. In turn, that will provide the basis on which the committee can recommend to the general council whether a qualification should be recognised.

While it is envisaged that judgment on the adequacy of overseas qualifications would normally be made on the basis of information supplied by the institution rather than by means of an overseas visit, clause 12 was amended in Committee to remove the previous limitation restricting the scope of those visits to those institutions in the United Kingdom.

Amendment No. 16 provides an osteopath making an application to the health committee for a conditions of practice or suspension order, made under clause 23, to be reviewed, with the right to a hearing. As we have already discussed this morning, the health committee will form an important part of the statutory scheme's fitness-to-practise machinery. Its function is to investigate allegations made against an osteopath that his or her ability to practise is seriously impaired because of physical or mental health and consequently poses a threat to the safety and well-being of his or her patients.

Unlike its sister committee, the professional conduct committee, the health committee's role is not disciplinary. Instead, it ensures that proper and adequate safeguards are provided for patients. For that reason, the health committee will be required to ensure that any action that it takes in terms of suspending an osteopath's registration or imposing conditions on his or her continued practice has to be proportional to the risk that he or she is considered to represent to his or her patients. As the committee's function is not disciplinary, it will have no powers of erasure.

The Bill also makes provision to ensure that the osteopath is provided with the full details of the allegation made against him or her and given the opportunity to state his or her case at a hearing at which he or her—sorry, he or she—may be legally represented if he or she should so chooses. I think that I shall just stick to "he" as it will be more simple—although I may be picked up by my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland).

My hon. Friend will note that, despite the best efforts of the feminists, "he" still includes "she" for the purposes of legal definition.

I am extremely grateful to my hon. Friend for his direction.

May I reassure my hon. Friend that I have no feminist angst about the use of "he" or "she"? I do not believe in butchering the English language, and think that it is appropriate at times to use the generic term. "He" will suffice very nicely here.

The Bill also makes provision to ensure that the osteopath is provided with full details of the allegation against him and is given an opportunity to state his case at a hearing, at which he may be legally represented if he so chooses, as well as the right of appeal to the appeal tribunal against decisions of the health committee. The Bill also provides an opportunity for the osteopath to make an application to the health committee once a year for the order made against him to be reviewed. As drafted, the Bill does not provide the osteopath with an opportunity to put his case at a hearing before the health committee comes to a decision on such an application.

10.30 am

It has never been our intention to deprive the osteopath of this opportunity. Such an intention would run contrary to the spirit of natural justice, one of the key principles on which the scheme is to be founded. The amendment therefore extends the practitioner' rights to a hearing to include such applications, thereby ensuring that the workings of the health committee will be open and fair, in theory and in practice.

Before my hon. Friend leaves the subject, will he give the House some examples of the sort of offences for which he considers removal from the register appropriate? Does he believe that it is the likely intention of the council—I say "likely", because it does not yet exist—to incorporate the sort of moral and non-clinical offences that the BMA has in the past considered grounds for disbarring doctors?

We are talking about the health committee at the moment. I have already said that it is not a disciplinary body—it has no powers of erasure from the register. The other "fitness to practise" committees, particularly the professional conduct committee, have powers to erase from the register if, at a hearing, an osteopath is found to have broken the rules. He can therefore be removed from the register. He can reapply at some stage in the future, but conditions may he set governing the standards of proficiency that he needs to meet to re-enter the register.

Amendments Nos. 26 and 27 provide me with an opportunity to remind the House of the important role that the Privy Council will play in the operation of the statutory scheme. In keeping with the other statutory schemes governing health professions, the work of the General Osteopathic Council and its four statutory committees will be overseen by the Privy Council. One of the Privy Council's key functions will be to approve the rules drawn up by the general council.

These rules will cover the entire range of the general council's responsibilities, including registration, post-registration training and the procedural rules of the four statutory committees. When we come to look at the schedule, especially the provisions for establishing the first General Osteopathic Council, we shall see other ways in which the Privy Council will be involved in the scheme.

Clause 33 provides for the Privy Council to be granted default powers to enable it to direct the General Osteopathic Council to perform any function under the Act that the Privy Council considers the general council should have done but has failed to do. If the general council refused to respond to this direction, the Privy Council would he empowered to step in and take over the functions of the general council and do anything that the latter could have done under the Act.

The Privy Council possesses default powers similar to those under the statutory schemes of other health professions. To set these key provisions in context, I should add that there are no known cases of the Privy Council having had to exercise its default powers in relation to a statutory scheme. Although the osteopaths can take pride in being first in respect of a number of new ideas in the area of statutory regulation, I am confident that this is one first which they have no intention of trying to achieve.

I do not intend to enter the discussion of "he" and "she". I am happy to accept the learned definition offered by my hon. Friend the Member for Upminster (Sir N. Bonsor). I have always believed that "she who must be obeyed" goes back to Rider Haggard, reiterated by Bernard Shaw in "Getting Married"—but for today we will stick to the legal definition.

I want to ask for some reassurance and, I hope, support from my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss). Unlike my hon. Friend the Member for Stamford and Spalding (Mr. Davies), I have no parental examples to offer, but some of my constituents are training to become osteopaths, and they have asked me about the recognition of qualifications with particular reference to training grants.

The British School of Osteopathy, which I imagine offers the sort of qualifications to which the amendments refer, attracts students from around the country. Those students receive grants from local education authorities, but not full grants. The fees alone are about £5,000, but my constituents get grants of between £600 and £700, leaving them a great deal of money to find so that they can qualify and met the high standards which the Bill rightly seeks to establish.

I hope that my hon. Friend has managed to obtain reassurances from the Government on this score. The issue partly comes under the responsibilities of the Department for Education and certain other Departments of State. I hope that my hon. Friend will join me in pressing for recognition of such qualifications for eligibility for full and mandatory grants. I hope that these courses will be recognised under the new law and that mandatory awards will be given for them.

I support this group of amendments and I wish to draw attention to the importance of ensuring that overseas applicants to join the osteopathic profession maintain our standards of professionalism. It has become abundantly evident that there is a wide variation in training standards. A properly qualified osteopath has to undergo four years' training, which hardly compares with the gentleman who decides to set himself up with no experience but with a sign outside the door. We do not want to return to the days when a dentist's sole claim to expertise rested on the fact that he pulled teeth.

Professional standards are important. Those with overseas experience may well reach our standards, but we need to be certain that they conform to the rigorous criteria to be imposed by the newly formed osteopathic governing bodies.

I endorse the remarks of my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland). I myself tabled an amendment which was not selected but which had to do with practitioners' ability to speak our native language. [Interruption.] I hear some tut-tutting from the Labour Front Bench. It is astonishing that the Labour party should wish to put into our medical profession people who cannot communicate properly with our patients. It is amazing that such crass stupidity can form part of Labour party policy—

If the hon. Gentleman has read the Bill he will know that it contains regulations and conditions which apply to osteopaths the same standards of education and training as are applied to all the medical professions in this country. So his comments about communicating in the same language are misplaced and irrelevant to the debate. That is why I tut-tutted.

I am sorry that I gave way—

Order. The hon. Gentleman's amendment was ruled out of order, so he cannot now speak to it.

I would not dream of speaking to my amendment, Mr. Deputy Speaker. I was merely enlarging on my hon. Friend's remarks about practitioners' general qualifications. And it is certainly a matter of great concern that many people who practise medicine in this country cannot communicate with their patients. The Government should turn their attention to that.

Does my hon. Friend agree that fluent English is vital for the successful outcome of treatment and that misunderstandings often arise because of poor communication between practitioner and patient?

I whole-heartedly agree. No one can prescribe the right treatment if he cannot understand what the patient is telling him about his ailment. As my hon. Friend says, it is regrettable that all too often that is the case. I hope that the Bill will contain some provision to control standards of education in the profession.

Unless I have misunderstood the Bill, the method of getting to a disciplinary hearing seems rather clumsy. Clause 23 says that the health committee shall take certain action on allegations referred to it under section 20. Section 20 sets out the allegations which will lead to disciplinary action by the general council. It states:

"This section applies where any allegation is made against a registered osteopath to the effect that—

(a) he has been guilty of conduct which falls short of the standard required by a registered osteopath;

(b) he has been guilty of professional incompetence;

(c) he has been convicted (at any time) in the United Kingdom of a criminal offence".

I am glad to say that elsewhere in the Bill that is limited to a relevant criminal offence.

A complaint under those headings may be made not to the investigations committee or to the professional conduct committee, but to the health committee. According to clause 23, the health committee can then take certain actions including the possible suspension of the osteopath, and I presume that it would then refer the matter to the investigations committee or the professional conduct committee for action. I am puzzled about why such a roundabout route should be adopted and why allegations under section 20 should not be made directly to those who will deal with them.

My hon. Friend the Member for Battersea (Mr. Bowis) asked about student funding. I understand that in the past the profession made continuous representations about the sort of student funding that my hon. Friend mentions. Unfortunately, to date the answer has been a firm no. However, more recent approaches have elicited a different response and the profession has been told that if it regulates itself under some sort of statutory regime its request will be viewed more favourably.

The osteopaths have organised and pressed for a statutory regulation system. I wish them every success, when that has been achieved, in approaching the Department for proper funding for students, many of whom follow four-year degree courses. One of the colleges was mentioned by my hon. Friend the Member for Battersea, but there are others. The level of qualification is high and every encouragement should be given by the system to enable more and more students to qualify at the highest level.

My hon. Friend the Member for Upminster (Sir N. Bonsor) spoke about the tortuous route for complaints. Allegations about health matters can be made by patients or by a fellow professional. The personal problem of the osteopath's health may have a bearing on whether he can carry out his job to the required level.

Section 20 lists other less personal and perhaps equally significant matters which bear on whether the osteopath can properly practise. A conviction for a criminal offence is mentioned, and I do not see why that should go through the health committee.

I do not think that it does. Clause 20 requires only allegations about an osteopath's health to be referred to the health committee. Other allegations will not be directed along that route. The investigations committee acts to ensure that there is a case to answer and that the health committee is not being asked to look at cases that are outside its powers.

I beg to move, amendment No. 5, in page 7, line 36, leave out subsection (2) and insert—

'(2) Any person who asks the General Council for a copy of the most recently published register shall be entitled to have one on payment of such reasonable fee as the Council may determine.

(2A) Subsection (2) shall not be taken as preventing the General Council from providing copies of the register free of charge whenever it considers it appropriate.'.

The amendment will enable the general council to make copies of the register available free of charge when it considers that appropriate. Although the existing wording of the clause might have been sufficient to enable the general council to do that, some doubt may have existed because of an amendment in Committee to clause 19 which concerns the code of practice that the general council will be required to prepare and publish. That amendment was made specifically to ensure that the general council could provide copies of the code free of charge.

Taking one's own Bill through Parliament certainly opens one's eyes to the finer points of legislation and especially to the nuances of drafting. Because the Bill is now quite specific in enabling the general council to make the code of practice available free of charge, it could have been argued that because the subsection on the register was not as clear as intended it would not give the general council the same freedom in respect of the register. That is certainly not our intention. I made it clear during the clause stand part debate in Committee that the intention was for the general council to have this discretion. I said that the clause imposed a duty on the general council to publish a copy of the register annually and to make copies available for sale or distribution free of charge as it thinks fit.

The amendment removes any doubt and will give to the general council the statutory freedom that had always been intended.

I beg to move amendment No. 6, in page 8, line 6, leave out from 'The' to 'at', in line 12, and insert—

'Registrar shall investigate any allegation that an entry in the register has been fraudulently procured or incorrectly made and report on the result of his investigation to the General Council.

(1A) An entry which has been restored to the register under section 6(5) or 8, or under rules made by virtue of section 8(8), may be treated for the purposes of this section as having been fraudulently procured or incorrectly made if any previous entry from which the restored entry is derived was fraudulently procured or incorrectly made.

(2) The Registrar may'.

With this we may consider the following amendments: No. 7, in page 8, line 13, leave out 'to'.

The amendments seek to streamline the provisions of clause 10. They will do that by giving the registrar the direct power and responsibility to investigate an allegation that an entry in the register has been incorrectly made or fraudulently obtained. As drafted, the Bill provides for such power and responsiblity to be conferred on the general council, with an ability for the council to make laws for these to be exercised by the registrar.

This is an important change, but it is consistent with other themes in the Bill. For example, it will be the registrar who will be charged under clause 2 with the statutory duty of establishing and maintaining the register of osteopaths. Therefore, it would not be unreasonable for the registrar to be able to initiate action to be satisfied about the correctness of the entries in the register. The amendments will achieve that purpose.

The resulting change should also mean that any investigation will be carried out far more speedily, as the registrar will be able to carry out an immediate investigation into such an allegation without having to wait for the general council to meet and consider the matter first. That would avoid any unnecessary delay which might have arisen if the general council's periodic meetings turn out to be fairly infrequent.

When the registrar has completed his investigation, he is to report on the matter to the general council. If, having considered the registrar's report, the general council is satisfied that the entry in question has been incorrectly made or fraudulently obtained, it may order the registrar to remove it. The osteopath would have a right of appeal against that decision to the Judicial Committee of the Privy Council.

As part of the package, the registrar would have the authority to order the immediate suspension of an osteopath's registration, pending investigation, where he is satisfied that such action is necessary to protect members of the public. That would place the registrar of the General Osteopathic Council in a unique position vis-a-vis the registrars of similar schemes for health care professionals.

The House will see, however, that the registrar is not given a completely free hand to cut a swathe through the names of the osteopaths appearing in the register. He will be permitted to take that action only when he is satisfied that it is justified in terms of protecting the public. His powers will also be contained within the limits prescribed by the rules to ensure that, in instances where he proposes to exercise his powers—which must, by definition, be before he imposes such an order—the practitioner in question will be given an opportunity to appear in front of the investigating committee supported by legal representation, if he so chooses, to argue his case against suspension.

That is an important provision. In ensuring that the statutory scheme provides protection for the public, it is also important to ensure that the human rights of the osteopath are protected. In that way, the public and the profession will be able to have the utmost confidence in the scheme.

It may at first sight seem a little odd for the practitioners' objections to the making of a suspension order to be heard by the investigating committee. The reason for this decision is that the investigating committee will already have in place the machinery, set out in clause 21, to hold such hearings. The registrar is required to report the outcome of his investigations to the general council. If, having considered his report, the general council is satisfied that any entry in the register has been incorrectly made or fraudulently obtained, it may order the registrar to remove it.

The osteopath has a right of appeal to the Judicial Committee of the Privy Council against a decision to remove his name from the register. Such hearings would normally be adversarial. As drafted, the Bill provides only that the general council may appear as respondent. In keeping with what I said earlier, we now feel that the general council ought always to be the respondent, if only for this simple reason: if it is not, who is?

By making the general council a respondent, the provisions in clause 10(11) relating to the apportioning of costs are not required. The general council would automatically be a party to the hearing and could, therefore, be liable to incur the costs of the parties. The amendments, and the clause, further strengthen the status of the statutory register. The provisions also ensure that they apply to an entry that has been restored to the register by virtue of clause 6(5)—which enables an osteopath who has failed to renew his registration under clause 8, which deals with the registering of an osteopath who has been struck of—if the original entry was incorrectly made or fraudulently obtained.

I support the amendments. It is important that the public have a right to be protected from fraudulent entries that have got on to the register. It is also important that we should take into account all the different kinds of abuses of the profession that might be perpetrated. I take it that this refers to criminal offences, to fraud and to the breakdown of discipline between the osteopath and the patient, particularly when that discipline is a matter of trust and that trust has been abused, especially through very personal relationships. When all those factors are taken into account, and we bear in mind the worthless qualifications that can be used, it is essential that the House should agree to the amendments.

The amendments incoprporate the Upminster doctrine by removing a "may" and inserting a "shall". No doubt my hon. Friend the Member for Upminster (Sir N. Bonsor) will welcome that. I am sure that he is right in that case. I am equally certain that the amendment, which tightens that process up, is correct. If we are to have a properly regulated profession, there must be no question of anyone being able fraudulently to get on to the list, which the public ought to come to trust. That is particularly the case if the fraud applies to any claims of professional qualifications, quite apart from any criminal offences that are deemed to be relevant.

However, I seek the reassurance of my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on the other side of the coin. It is possible that the clause will provide opportunities for those who have professional jealousies to make frivolous or mischievous claims against a properly qualified person. I am sure that the procedures will ensure that such claims are dismissed, but I seek my hon. Friend's assurance that speed will be of the essence, because somebody's career and professional standing could be at risk if such a claim were made against him by a professional rival.

The clause does not contain a speed element. I hope that there will be a quick look at each case by the registrar to see whether it should be considered further—a sort of procurator fiscal look at the case. If there is a case to be answered, it should be investigated fully and properly. However, that initial speed is necessary.

I have some doubts about the circumstances in which the registrar would intervene, as set out in the clause and the amendments to it. Some of the circumstances are defined in clause 20, which speaks of

"conduct which falls short of the standard required of a registered osteopath".

However, as far as I can see from reading through the Bill, such conduct is nowhere defined. In other words, there is an extraordinarily wide area in which the registrar could say that the osteopath had been guilty of conduct falling below the required standard. Could my hon. Friend give us some illustrations as to what conduct that might be? For example, would it include allegations about drunkenness or sexual misconduct? What does my hon. Friend envisage are standards of conduct, not involving a relevant criminal offence, that would require a registrar to suspend an osteopath?

The comments by my hon. Friend the Member for Battersea (Mr. Bowis) go to the heart of the amendments. We have tabled them in an attempt to streamline the process set out in clause 10. He may feel that, because we have not set a time limit in law, we have not gone far enough, but I assure him that the purpose of the amendments is to make sure that any allegation of the kind that he talked about, certainly those involving an entry on the register, can be picked up immediately by the registrar and acted on, rather than those involved having to wait, perhaps for a meeting of the general council to come round, before the process of investigation can be activated. We put the registrar at the heart of the preliminary look at what is, after all, a key element of the Bill—the accuracy of the entry in the register.

I take my hon. Friend's point about the investigation by the registrar and about increasing the speed with which such allegations can be dealt with. I welcome the change that the amendment will make. However, will he readdress the question that I put to him a little earlier about the health committee? I have now read clause 20 carefully. Nothing in it suggests that only serious impairment of the ability to practise as an osteopath because of a physical and mental condition should lead to a referral to the health committee. Anything under section 20 can be referred to the health committee and that goes against the desire to speed up investigations.

I shall first answer the question put by my hon. Friend the Member for Stamford and Spalding (Mr. Davies), who asked about misconduct that would necessarily result in referral to one of the committees. We are dealing with amendments to clause 10, which relates only to entries fraudulently obtained and not to disciplinary offences, which come under clause 20, to which my hon. Friend the Member for Upminster (Sir N. Bonsor) referred. Clause 20(12) says:

"Where the Investigating Committee concludes that there is a case to answer, it shall …

(b) refer the allegation as formulated by the investigating Committee—

(i) to the Health Committee, in the case of an allegation of a kind mentioned in subsection (1)(d)".

Therefore, it is extremely specific on what can be referred to the health committee.

Unless I have grossly mistaken the position, there is nothing in clause 20 to prevent a person from making an allegation directly to the health committee. I do not think that the clause relates only to matters that have already been before the investigating committee. As I read it, it is for the health committee to decide whether to refer a case to the investigating committee, not vice versa. Subsection (3) states:

"Where an allegation is made to the General Council, or to any of its committees (other than the Investigating Committee), it shall be the duty of the … committee to refer the allegation to the Investigating Committee."

The clause to which my hon. Friend referred in fact relates to what happens at a later stage, when the investigating committee has a matter referred to it by the health committee.

I take my hon. Friend's point. Initially, a case would be refered to the investigating committee, which would then decide under clause 20(12)(b)(i) whether it is a matter specific to the health committee under clause 20(1)(d). If it is, it will send the case to the health committee for further inquiry.

I want to challenge the interpretation that my hon. Friend put on my last question to him. He said that clause 10 provides for the registrar to suspend an osteopath if evidence is produced showing that a registration has been fraudulently procured or incorrectly made. Subsection (2) provides for the registrar

"to have power, at any time during his investigation, to suspend the registration in question if he is satisfied that it is necessary to do so in order to protect members of the public."

The registrar will have wide powers. If it were alleged that a registration was improperly made, he would have the power to anticipate the decision of the general council or its committees and suspend that registration.

Does the registrar have to give specific grounds for such a suspension? Does he have to define in what way he feels the public are endangered? From my reading of the clause, that does not appear to be the case. Should he incorrectly suspend an osteopath and subsequently discover that the registration was valid, and therefore the suspension should not have been made, is there any provision for compensation for the osteopath concerned? After all, he could have lost considerable revenue during his suspension, which was based on a mistaken decision by the registrar.

The title of clause 10 refers to

"Fraud or error in relation to registration."

Although subsection (2) provides the registrar with power to suspend, he would not do that unless there were very strong grounds for suspecting that there had been a fraudulent entry.

There is no provision for compensation, but there are many checks and balances in the Bill to ensure that accusations filter through the system in a way that gives the osteopath every opportunity to make his case. Of course, very often he is backed by legal advice.

My hon. Friend says—and I have no reason to doubt him—that the registrar would be extremely careful before using the powers under the clause. However, subsection (2) is so widely drawn that we have to place confidence in the good sense and integrity of the registrar. His powers are not limited during the investigation. He could take a purely arbitrary decsion to suspend if he so wished.

I have nothing further to add to that point.

I am sorry to pester my hon. Friend, but it is important to clarify the issues surrounding clauses 20 and 23. We need to be absolutely clear about what clause 23 means; I do not think that that is clear at the moment. It would make the meaning absolutely clear if subsection (1), line 2, were amended to read "under section 20(12)". That would make the position what my hon. Friend has stated it to be, rather than as I originally perceived it to be.

The provisions of clause 23 would then apply only to any matters referred to the health committee by the investigating committee, rather than the alternative interpretation which currently could be thought to mean that any allegation under clause 20(1) should be dealt with by the health committee.

I do not ask my hon. Friend for an immediate answer to my suggestion, but I should be grateful if he would consider it.

I am grateful to my hon. Friend.

My hon. Friend the Member for Stamford and Spalding (Mr. Davies) said that clause 10(2) provided wide-ranging powers for the registrar. However, subsection (3) makes provision for the osteopath to appear before the investigating committee to state his case before an order is made.

I beg to move amendment No. 15, in page 12, line 29, at end insert—

'() The General Council shall not exercise any of its functions under subsection (4) or (5) without the approval of the Privy Council.'.

The purpose of the amendment is to provide that the general council can exercise its powers to impose or remove conditions on the continued recognition of a qualification, with the approval of the Privy Council. The ability to impose conditions on the continued recognition of a qualification will be one of the tools in the general council's kitbag to ensure that high standards of education are achieved and maintained.

The sort of conditions that the general council could apply will be wide and varied, for example, when a new course is getting off the ground. One of the amendments made in Committee to clause 14 gives the general council, with the approval of the Privy Council, the ability to recognise a qualification prospectively. That would be on the basis that the information available at the time to the education committee and the general council was sufficient to demonstrate that when the qualification was eventually awarded, it would reach a standard of proficiency required by the general council for the safe and competent practice of osteopathy.

That was an important amendment to make, because before it was incorporated into the Bill only qualifications presented to the general council could be considered for recognition. In the case of a new course, there would have been no qualification until the first cohort of students had graduated. However, unless there were the certainty that the qualification would be recognised, it is doubtful whether anyone would enrol for the course.

Granting recognition to an as yet non-existent qualification on the basis that when it eventually came to be awarded there was likely to be evidence of it having reached the desired standard could be regarded by some as akin to signing a blank cheque. Although the general council would be able to initiate action to withdraw recognition once the qualification was awarded, that would be an extreme step taken too late to help students. The ability to impose conditions covers that middle ground. The amended provisions mean that the education committee can check that the course is developing as planned and provide it with the necessary levers to encourage the institution concerned to take remedial action if things go awry.

However, it will not be only in the case of new qualifications that the general council will be likely to want to impose conditions. Indeed, there may be general standards that the general council will wish to apply to the continued recognition of all recognised qualifications. These might include the ability of the education committee to appoint external examiners, to participate in the final clinical examinations or to require an institution to provide the education committee with, say, an annual report.

The ability to impose conditions will provide the education committee with very powerful levers to ensure that high standards of education are achieved and maintained. Failure to comply would be sufficient for the education committee and the general council to begin taking steps to withdraw recognition from the qualification.

Clause 15 requires that any conditions are to be imposed at the time that a qualification is granted recognition and for the institution concerned to be notified of their imposition as soon as possible. This, therefore, makes them part and parcel of the recognition process. Given that clause 14 provides for the recognition of a qualification to require the approval of the Privy Council, it would seem appropriate that any conditions imposed under clause 15 should similarly be subject to the Privy Council's approval. That is what the amendment will achieve. It will also place the general council's power under subsection (5) to remove conditions under the same regime.

The recognition of qualifications is crucial to the credibility of the register and, therefore, of the osteopathic profession. My hon. Friend mentioned a number of issues that arise in this context, including the prospective recognition of such qualifications which it seems to be necessary to accommodate, for the reasons that he mentioned. However, may I ask my hon. Friend to explain the international context of the amendment.

Under freedom of establishment, would osteopaths from the continent be able to establish themselves here? Is it envisaged that the education committee would recognise continental qualifications and thereby allow those who have graduated in osteopathy in continental centres of education and who call themselves osteopaths to be part of the register in this country, whether they practise here or on the continent, and to use their presence on the register and the recognition of their qualifications by the general council as the basis for the professional credibility as osteopaths elsewhere in the European Community? This is an important dimension to the issue of recognition of qualifications which is not dealt with specifically on the face of the Bill or in my hon. Friend's amendments to the clause. It ought to be dealt with before the House allows the Bill to proceed.

The Government support the amendment. The use of a recognised qualification as providing the principal means whereby practitioners are entitled to be registered is a key feature of all other health care statutory schemes. Just as entry on to the register will be the prize sought by practitioners, obtaining recognition of their qualification will be the accolade sought by education institutions. It will be a key factor in determining the reputation of the institution. It will be the principal means by which it will be able to attract students and help to ensure its future viability. Simply put, it will make or break an institution. It is therefore vital that the institutions concerned can be assured of the fairness by which the system of recognition will operate.

When my hon. Friend described the process at Second Reading, he emphasised that the requirement on the general council to secure the approval of the Privy Council before a qualification is afforded recognition would ensure that all such decisions would be impartial, but the provisions for fair play in the Bill go beyond that. Under clause 14, the general council would be required to maintain and publish a list of the recognised qualifications. That will provide an open system and will enable one institution to compare its standards with another.

Clause 14 also provides for the general council to require the education committee to publish a statement on the criteria that it will use when advising the general council on whether a qualification should be recognised. That will provide education institutions with a level playing field and ensure that they are fully aware of the standards for which they must aim.

Clause 15 would place the general council under an obligation to notify an institution of the outcome of its application to have its qualification recognised as quickly as possible. It would also require the general council to give full reasons for its decision, in cases where it decided not to grant recognition.

These assurances could, however, be weakened if the general council's ability to impose conditions on the continued recognition of a qualification remained unchecked. Institutions may be alarmed at the admittedly extreme prospect of having burdensome conditions imposed, or of their being perversely applied in cases where the general council did not want to grant recognition but could find no reason for not doing so, in order to use them as the means by which to seek to withdraw recognition on the ground of failure to comply.

The amendment would remove any such anxieties. Collectively, the provisions for recognising qualifications will give the firm foundation on which the osteopath scheme will be built and will provide the necessary building blocks to ensure that, in future, osteopaths are fully trained and properly qualified to practise osteopathy. For all those reasons, the Government support the amendment.

I support the amendment. It is vital that the general council should ensure the highest standards of training. It is important to ensure that a battleground does not develop between the general council and the institutions. I hope that the institutions will develop training programmes of such quality that by the time their students graduate, they will have achieved the rigorous standards demanded by the general council.

My hon. Friend the Member for Stamford and Spalding (Mr. Davies) asked about European Community regulations and laws. If he refers to page 12, he will see that subsections (10) and (11) of clause 14 deal with that matter.

I beg to move amendment No. 59, in page 17, line 24, after 'section', insert

'or by virtue of a recommendation under section 30(7)(c)'.

With this, it will be convenient to consider the following amendments: No. 60, in page 17, line 39, after 'section', insert

'or by virtue of a recommendation under section 30(7)(c)'.

Clauses 22 and 23 empower the professional conduct committee and the health committee to make a conditions of practise order, or a suspension order in cases where they consider that an allegation made against an osteopath to be well founded. They also enable each committee to review an order while it is still current and to consider whether it should be renewed or, within certain limits, replaced by a different order, or otherwise modified or even revoked.

The wording of each clause, however, is tightly drafted. In each case, it limits the committee's powers of review to orders, in the case of the professional conduct committee, made under clause 22 and, in the case of the health committee, to those made under clause 23. Under normal circumstances, that is unlikely to create any difficulty. However, in cases where an appeal had been made—for example, to the appeal tribunal against a decision of the health committee—the order in force would not, strictly speaking, be one made under clause 23 but under what is currently new clause 3. The same point would also apply to orders made on appeal to Her Majesty in Council under clause 30.

The question has been raised, therefore, whether the professional conduct committee and the health committee would have the power to review orders made on appeal under the provisions of another clause as to the way that they could review those that they had made. They ought to have that power. It was always our intention that they should have that power.

The amendments, therefore, remove any uncertainty about the position by including a reference to those orders made on appeal under the provisions of other specific clauses.

Will my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) consider carefully a point that is not covered by the amendments? I have referred to equity for those who are accused of an offence. They may be accused of having obtained their registration improperly or fraudulently, they may be accused of having subsequently committed a criminal offence or they may be accused of having subsequently been guilty of professional misconduct. The procedures set out in clause 22, in clause 10 and in clause 21 would then begin, depending on which particular 'committee was handling the case.

My hon. Friend has told the House that the Bill does not provide for compensation if a practitioner is suspended and it is then found that there is no ground for his suspension. There may have been no merit in the complaint, but the practitioner may have lost considerably in the meantime. It is unsatisfactory that there should be no time frame within which the procedures set out in clause 22 must be completed. It would be possible for the registrar under clause 10 and for the professional conduct committee under clause 22 to take any amount of time to consider such matters.

The process could go on for weeks, for months or for years. Even if the practitioner against whom the procedure was initiated were wholly guiltless, he might have been deprived of the right to practise his profession in the interim, possibly for years, and he might never be able to resume his profession although it had been found that there was no substance in the original complaints against him.

My hon. Friend the Member for Cambridgeshire, North-East has said several times that he intends that the quasi-judicial disciplinary procedures in the Bill should observe the principles of natural justice. I know that my hon. Friend is sincere in that intention and that there are many reflections of that principle in the Bill. Will he reflect on the point that there is an important dimension of which the Bill does not take account? If the amendment is agreed to, the Bill, for the best possible motives and in the highest-minded fashion, will have laid the basis for some appalling miscarriages of justice, not because the procedures will not be observed and not because the people who are involved in the committees intend that there should be any injustice, but simply because investigations will drag on.

The main priority of practising osteopaths will not be to spend time on the professional conduct committee. There will always be the temptation to suspend investigations because of Christmas or Easter. The procedure will drag on and a wholly innocent osteopath who has had an appalling cloud over him for a long time—he may have been suspended by the registrar under clause 10 and he will not have been able to practise in the interim—will lose a lot of money. There will be no redress for the consequential loss of income.

The osteopath will find that he cannot refer to the Bill and say, "Look, the procedures laid down have a time scale attached to them, so I insist that justice is done and that the matter is brought to a conclusion one way or another within that time scale." The absence of a time scale is in conflict with my hon. Friend's laudable intention that justice should be done and that those who are subsequently proved to be completely blameless and against whom unjustified complaints have been made are not damaged.

I entirely agree with my hon. Friend the Member for Stamford and Spalding (Mr. Davies). I served on the investigations committee of the Lloyd's council for two or three years and I am well aware how long investigations can drag on despite the best intentions of all involved to make them as speedy as possible. In addition to the difficulties mentioned by my hon. Friend, there is the substantial difficulty of obtaining evidence from all the witnesses who may wish to give evidence, of finding out who they are and of ensuring that they have an opportunity to present their case to the investigations committee. These things tend to take a great deal of time and unless substantial incentives or penalties are attached—I share my hon. Friend's concern—people could be grossly out of pocket and badly treated by an investigation into a complaint that ultimately proved groundless or ultimately proved to have been started maliciously by someone who had some reason to wish the practitioner concerned ill.

I am grateful for my hon. Friend's support. Does he agree that there is an inter-relationship between compensation for loss of revenue as a result of a complaint that is subsequently deemed to have been quite unjustified and uncalled for—because the practitioner had committed no offence and because there was no impropriety in the way in which he was registered—and the time scale, to which we attach great importance? If there was provision for compensation, the osteopath who was suspended would find that his claim for compensation would increase with the time taken by the investigation because he would lose more patients and more revenue. The bill would clock up. Would that not act as a major inducement for those carrying out the investigation on behalf of the general council, whether the registrar and his staff or the members serving on the professional conduct committee, to get on with the investigation and to ensure that there were no unreasonable delays in the investigations and the conclusions?

I am grateful to my hon. Friend for expanding on the theme. He is absolutely right to say that a provision should be inserted to safeguard the interests of the osteopaths.

Could my hon. Friend draw a parallel with any other professional body and with how it deals with the problem? The General Medical Council might be one such example.

I am afraid that my hon. Friend has asked the wrong person. That question could be addressed to my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) or to the Minister. I cannot draw a parallel with the General Medical Council because I am not sure how it deals with this problem.

Exactly.

The hon. Lady says, "Exactly". None the less, the point remains a matter of concern. My hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) has asked a valuable question and I hope that we shall be given an answer by someone who is able to do so.

My detailed concern relates to the consequence of agreeing to the amendment. Under clause 30, which deals with appeals against the decisions of the professional conduct committee or of the health committee, the way in which the Judicial Committee of the Privy Council will deal with appeals is set out in subsection (7). It says, "Without prejudice to the application of that Act, on an appeal under this section to Her Majesty in Council, the Judicial Committee may in their report recommend to Her Majesty in Council—

(a) that the appeal be dismissed;

(b) that the appeal be allowed and the decision questioned by the appeal quashed;

(c) "—

this is the point with which we are concerned—

"that such other decision as the Professional Conduct Committee or (as the case may be) Health Committee could have made be substituted for the decision questioned by the appeal; or

(d) that the case be remitted to the Committee concerned to be disposed of in accordance with the directions of the Judicial Committee."

Let us suppose that the Judicial Committee decided to adopt a course under subsection (7)(c) and that it substituted what it considered to be the appropriate response to the allegation against which the appeal was formed. The Judicial Committee of the Privy Council decides what is the appropriate penalty to impose or the appropriate step to take.

Once that stage has been reached under amendment No. 59, clause 22(6) will be affected. If unamended, that subsection will deal only with decisions made in the first instance by the professional conduct committee or the health committee. When those committees reach a conclusion,

"At any time while a conditions of practice order is in force under this section, the Committee may (whether or not of its own motion)—

(a) extend, or further extend, the period for which the order has effect;

(b) revoke or vary any of the conditions;

(c) require the osteopath concerned to pass a test of competence specfied by the Committee;

(d) reduce the period for which the order has effect; or

(e) revoke the order."

It is clear that the amendment, if passed, will undermine the purpose of taking appeals to the committee of the Privy Council. If that committee then substitutes an order that, in its view, should have been made by the health committee or the professional conduct committee in the first place, it can override, reverse or otherwise interfere with the original decision.

11.30 am

The amendment cannot possibly have been intended so to undermine the value of the process of appealing to the committee of the Privy Council. I urge my hon. Friend to give careful consideration to the consequences of his proposal and to ensure that it is further amended to avoid those consequences. The matter is complicated and I do not expect an immediate response—which, in any case, would not be possible under the rules of the House. However, I urge my hon. Friend to ensure that the amendment is itself amended—although I appreciate the merit of what it attempts to achieve. Its drafting is clearly deficient.

I shall attempt to answer some of the points raised by my hon. Friends the Members for Upminster (Sir N. Bonsor) and for Stamford and Spalding (Mr. Davies).

The issue of compensation has been raised twice. Let me repeat what I said earlier: the Bill provides no grounds for compensation at any stage. However, in all other statutory regulation schemes affecting the health professions there is also no compensation clause. The insertion of such a clause in this Bill would be a first.

My hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) asked about the General Medical Council. I suggest that my hon. Friend the Member for Stamford and Spalding consult his father, who will tell him that no compensation scheme is paid under the GMC's procedures. I would have expected my hon. Friend the Member for Stamford and Spalding to know that.

rose—

Before my hon. Friend leaps to refute my scurrilous allegation of a shortage of knowledge to which I myself am happy to admit, let me explain that the crux of my hon. Friend's point—the part that I was endorsing—related not to a desire for a compensation clause, but to a desire for a mechanism limiting the time that could be taken.

I was coming to that. Clause 24(4) states:

"Before making an interim suspension order, the Committee shall give the osteopath in question an opportunity to appear before it and tc argue his case against the making of the proposed order."

Under subsection (5),

"At any such hearing the osteopath shall be entitled to be legally represented."

There is an appeal procedure, again with legal representation. Under clause 31(3),

"The order shall specify the period of the suspension, which shall not exceed two months beginning with the date on which the order is made."

I beg to move amendment No. 17, in page 21, line 42, leave out paragraph (e) and insert—

'(e) securing that —

(i) any hearing before the Professional Conduct Committee is held in public unless the Committee decides that it is in the interests of the person making the allegation, or of any person giving evidence or of any patient, to hold the hearing or any part of it in private; and

(ii) any hearing before the Health Committee is held in private unless the Committee considers that it is appropriate to hold the hearing or any part of it in public;'.

Amendment No. 17 is concerned with the hearings of the professional conduct and health committees. As currently drafted, the Bill provides for either committee to hold its hearings in public unless it considers it appropriate for a particular hearing to be held in private. In deciding whether to hold a hearing in private, the committees will be able to take into consideration the interests of the person making the allegation, or of any patient or other person giving evidence—or, in the case of the health committee, the interests of the osteopath concerned.

The amendment has two purposes. First, it builds in a degree of flexibility to enable either committee to hold part of the hearing—as distinct from all of it—in public or in private. Secondly, it changes the default position of the health committee's hearings by providing for them to be held in private unless the committee considers it appropriate to hold all or part of them in public.

The second feature is the more significant. Health committee hearings are likely to raise matters of a personal and sensitive nature. They could, for example, shine a spotlight on a medical problem which, until then, the osteopath had refused to recognise. It may also be necessary to discuss, or ask for evidence to be produced about, matters of a very personal nature. That could make the whole procedure rather traumatic.

It is important for the Bill to recognise that proceedings before the health committee would be completely different from those that take place before the professional conduct committee. The professional conduct committee hearings will focus on allegations of misconduct, incompetence and conviction of a criminal offence: they will be concerned with matters of professional discipline. That will not apply to health committee hearings. For the reasons that I mentioned earlier, there will be an imperative need for confidentiality; without that, the procedures would risk failing to win the confidence of the profession. It could also mean that any encouragement that the GOC may try to give the profession in the future to refer cases of sick colleagues would be met by a wall of silence. Changing the default position of the health committees' hearings in this way would overcome those concerns, and would also bring the osteopaths scheme into line with the practice adopted by other statutory schemes for health professionals which make provision for a similar committee.

I have some problems with the amendment. The assumption behind it is that, whereas it may be a matter of public interest for a case to be heard by the professional conduct committee—in the sense that unprofessional or criminal conduct on the part of the practitioner may be alleged—the health of a practitioner is not a matter of public interest.

Is it not a matter of public interest that, for example, a practitioner may have AIDS? I cannot comment on the possibility of HIV being transmitted from practitioner to patient during a course of osteopathic treatment, but I shall be interested to hear what my hon. Friend has to say about that. As my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) knows, the question whether medical practitioners have an infectious disease has become a matter of intense public interest in recent months. That must be especially true in the case of a disease such as HIV, for which there is no cure and in respect of which the prognosis is always fatal.

No doubt my hon. Friend will respond with his usual courtesy and knowledge of the subject. I hope that, in doing so, he will not refer me again to the practice of the medical profession and the BMA general council and disciplinary committee—for several reasons. First, I do not pretend to hold a brief—and nor, I think, would my father wish to say that he held a particular brief—for the BMA.

Secondly, the BMA and the royal college have existed for many generatns. There is therefore an established jurisprudence: we can see how in practice the BMA handles allegations of professional misconduct and so on. That means that concerns such as those expressed today about, for example, the time that investigations will take and about compensation do not necessarily arise with the same force. We have a whole record of historic experience of the BMA, whereas in the Bill, however, we are setting up a completely new and untested body. There will be some comfort to be taken from the fact that the body will be under the supervision of the Privy Council, but we do not know who the members of the council will be. Osteopaths have no record of supervising themselves and their profession. I am sure that they will make a great success of it, but if we are to set the new body on the right course, it is appropriate for such questions to be asked and that they should be convincingly and adequately answered.

Finally, doctors in particular would find it especially ironic were they told that osteopaths would never aspire to higher standards than the medical profession and that, where the medical profession has certain established procedures—for example, for disciplinary hearings—higher standards could not possibly be set in a new Bill to establish a new professional body for a new profession.

In considering when evidence should be given in public and when in private, it is extremely important both to prevent a witch hunt and to keep the public interest very much in mind. There must be a careful delineation and a careful judgment about when each is appropriate. I imagine that a patient would find it well-nigh impossible to give evidence on very personal matters if he knew that the information would be in the public domain. That point of view must be respected if, without such evidence, the investigation could not continue.

I am puzzled about the logic and one of the consequences of the amendments. As I understand it, the original hearing will be in private if it is before the health committee, but the appeal will be in public. My hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) said earlier that he thought that there was a difference, in the sense that the original hearing was at the instigation of someone who was making a complaint whereas the appeal was at the instigation of the osteopath against whom the complaint was made. Presumably, we are supposed to think that that justifies the fact that the second hearing will be in public whereas the first has been in private. I do not follow the logic of that.

It is true that it is the osteopath who brings the appeal, but he would not have to bring the appeal if he did not feel aggrieved by the judgment in the first hearing. I do not see why he should be forced, by the application of a different criterion, to bring all these matters out into the open, having been able to keep them within the privacy of the general council in the first instance.

I take the points made by my hon. Friends the Members for Stamford and Spalding (Mr. Davies) and for Sutton and Cheam (Lady Olga Maitland). None the less, I feel that the osteopath should have a right of privacy and, in circumstances in which it is held to be correct that he should be allowed to have a hearing in private in the first instance, there is a lack of justice in the matter being forced into the open on appeal.

We are discussing the important question of fitness to practise. The King's Fund working party described the need to secure a high standard of professional conduct among registered practitioners as

"one of the primary functions of the Council of a self-regulating profession."

It went on:

"Although detailed arrangements for ensuring this vary slightly from one profession to another, the features common to most professions are: first, the promulgation of ethical notes for the guidance of practitioners or rules of professional conduct; secondly, machinery for investigating allegations of unacceptable professional conduct; and, thirdly, procedures governing the preferment of charges before, and the hearing of charges and the imposition of penalties by, a suitably constituted domestic tribunal."

Readers of the Bill will be aware that those are all important elements of the proposed statutory scheme.

My hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) has already said that not all other similar statutory schemes make provision for a health committee. The King's Fund working party commented that the statutory provision of a health committee has been made in more recent times

"for the better protection of both practitioners and the public … to deal with those practitioners who should not be allowed to practise for reasons of ill health."

The King's Fund working party went on to recommend the establishment of a health committee which would be

"responsible for hearing cases referred to it by the Investigating Committee where it seems to the latter that there is prima facie evidence of ill health sufficient to warrant suspending a practitioner's right to practise altogether or requiring him or her as a condition of continuing registration to comply with certain conditions (for example to practise under supervision)".

Once again, my hon. Friend's Bill incorporates a key recommendation of the working party. In addition to ensuring that the fitness-to-practise machinery provides adequate safeguards for members of the public, it is important that it has the ability to take account of the needs of osteopaths in appropriate circumstances. My hon. Friend has described the need to provide for hearings of the health committee to be in private unless the committee considers it appropriate for all or part of a hearing to be in public. I fully support his argument. Such hearings are likely to touch on sensitive and personal matters that neither have a place within, nor a need to be brought into, the public domain.

Will my hon. Friend the Minister concede that if an osteopath has an infectious and extremely dangerous disease that he might have passed on to his patients, it would be a matter of concern, at least to his patients, to know whether they had contracted that particular virus or bacterium? In those circumstances, it would not be right to keep the facts of the case purely to the privacy of the health committee meeting.

My hon. Friend makes a fair point. However, I refer him to the guidelines for the medical profession, that make a clear distinction between procedures that are invasive and likely to give rise to the transmission of HIV or similar infections and procedures that are not. Those guidelines are very clear. I also remind my hon. Friend of recent announcements that put into perspective the whole question of the infectiveness of those who carry the HIV virus.

In addition to ensuring the fitness to practise machinery to provide safeguards, it is important to take the needs into account. I welcome the flexibility that the amendment provides in balancing the wider public interest with that of an individual witness appearing before the professional conduct committee. Without the amendment, the committee would have the choice only between holding the entire hearing in public or in private. If the amendment is accepted, it will enable the committee to take that decision in respect of different parts of the hearing.

Therefore, the amendment is important to fine tune the provisions of the fitness to practise machinery. I join my hon. Friend the Member for Cambridgeshire, North-East in urging the House to accept it.

The question raised by my hon. Friend the Member for Stamford and Spalding (Mr. Davies) about HIV status has been clarified by my hon. Friend the Minister.

The Minister said that the guidelines laid down for the medical profession which distinguish between diseases that hold some hazard for patients and those that do not are very clear. He is right: they are clear. My point is that they are not clear in respect of the osteopathy profession for which we are now legislating. Should not the clarity that exists in the medical profession be introduced into the osteopathic profession by virtue of the Bill?

My hon. Friend the Minister made it quite clear that the rules and guidelines issued by the Department of Health are clear cut. As osteopaths do not use invasive procedures, they do not come within the ambit of the Department's guidelines.

My hon. Friend the Member for Stamford and Spalding (Mr. Davies) was mistaken when he referred to diseases. He should have referred to the procedures. That is the differentiation which must be made.

My hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) made an excellent point. She was absolutely right, and her point goes to the heart of the amendment. We want to establish a situation in which the choice exists with relation to investigations before the health committee. We are not saying that the hearing must be in private or in public. We are saying that it can be held in private unless the committee considers it appropriate to hold the hearing, or any part of it, in public. The choice is there.

My hon. Friend the Member for Upminster (Sir N. Bonsor) drew attention not to a discrepancy, but to a difference in relation to the wording of new clause 3 about appeals that are held in public and the opportunity for hearings to be heard in private in respect of the health committee investigation. The appeal in public in respect of the health committee is subject to rules covered in the Bill. Those rules could say that the appeal should be in private if the osteopath so requests.

I beg to move amendment No. 52, in page 23, line 40 leave out 'on a point of law'.

The amendment deals with the question of an appeal to an appropriate court in the event of a registrar refusing to register an applicant or to take some of the other steps open to him that might leave the applicant aggrieved. If that happens, the applicant should appeal to the general council.

Under clause 29, an appeal to the general council will be

"subject to such rules as the General Council may make for the purpose of regulating appeals under this section."

That relates to the point very fully and ably made by my hon. Friend the Member for Stamford and Spalding (Mr. Davies) about the way in which we are taking the Bill forward.

It is far from clear—and we have no guidance about this—what rules the general council may make in those circumstances. In respect of the clauses that deal with what the general council can do with regard to the health committee and the committee that deals with complaints of a criminal or disciplinary nature, there is a long list of things about which the council may or shall make rules. I have already expressed at length my reservations about the flexibility which is allowed to it even in those circumstances, but in these circumstances there are absolutely no rules limiting what the general council can do. Under subsection (2), it is clear that it may make such rules as it wishes.

I take into account the fact that the general council will be a very worthy body, and that it will have not the slightest desire to make any rules that are not in the interests of justice or the interests of those who are to be subject to these procedures. None the less, the members will not be legally qualified. It must be a matter of concern that, in something that is starting from an entirely clean sheet and in respect of which there are no precedents, there is no measure by which we can judge the way in which the council is likely to proceed. We must have substantial concern about whether justice will be done in such circumstances.

It is the core of the Bill that there should be a properly compiled register, that the terms of registration should be subject to rules and that the ways in which registration is dealt with are properly administered. It is no good at all arriving at that stage and finding that, when an appeal is made because something has gone wrong, those rules go out the window and other rules are substituted that might fall very far short of the standard that we would require.

Is not the substance of the clause unamended and the problem, therefore, that my hon. Friend is addressing in his amendment the fact that the existing text of the Bill is, in effect, an attempt to prejudice the decision of a court—or rather, to use statute in an effort to prevent a court from subsequently accepting jurisdiction as it might choose otherwise to do on any appeal or on any event arising from an alleged breach of justice during the procedures that have been laid down in the Bill—that is, the disciplinary procedures and the appeals on them? Is it not thoroughly unsatisfactory that we should legislate in this way, by explicit legislation of this kind, to try to prevent a court from subsequently accepting jurisdiction and examining the full facts of the case, as that court might decide it is appropriate to do in the circumstances at the time?

My hon. Friend has a very good habit of anticipating everything that I wish to put before the House. Of course he is right. I am now coming to the point of my amendment, which is specific, relating to clause 29(4), which, as unamended, states:

"Any person aggrieved by the decision of the General Council on an appeal under this section may appeal, on a point of law, to the appropriate court"—

that is, appeal on a point of law only to an appropriate court.

If the general council and the registrar were in error of fact, the court—whichever court would be the appropriate one; almost certainly it would be the High Court of Justice —would be debarred from hearing a case in which the grounds of the appellant's reasoning to try to go to that court were based on art error of fact.

We do not know what rules the general council will make with regard to appeals against the decision of the registrar, but it would not be acting in any way out of precedents from other organisations were it to adopt a procedure that is limited to taking evidence in writing, for example. There are many instances in quasi-judicial bodies in which evidence in writing is all that is considered by the regulatory body, and no opportunity is given to the person who is aggrieved to give evidence in person, to call witnesses to answer questions, or to cross-question those who oppose a decision.

Will my hon. Friend explain whether the aggrieved person could be the registrar, on the assumption that the previously aggrieved person has won one stage of the appeal and therefore the registrar could be the aggrieved person at the next stage? I do not understand the relationship between subsection (4) and the next one, which appears to suggest that subsection (4) is in addition to any right of appeal elsewhere. Does that cover my hon. Friend's point? If so, there appears to be legal complexity and confusion that need to be clarified.

In response to the first of the two questions that my hon. Friend put, clearly the registrar could not be the aggrieved person, because subsection (4) deals only with matters arising out of subsection (1). The contents of subsection (1) relate entirely to what the registrar has decided to do. The chances of the registrar appealing vigorously against his own decision seem unlikely—indeed, impossible. The answer to my hon. Friend's first question is that the appeal will take place only when the registrar has done something which, in the view of the person whom he has damaged, he should not have done.

12 noon

In response to my hon. Friend's second question, I am not absolutely clear, to be honest, why subsection (5) has been put in. If there is a small claim that could go to a county court instead of the High Court, subsection (5) seems to exclude the limitations of subsection (4), so that, in the event of a small claim, it would appear that, on a matter of fact, the appellant could still take the case to court.

However, if an osteopath is not registered by the registrar, and if that is wrongful, the level of damage that the osteopath will suffer will be way beyond anything that it is within the competence of the county court to amend or give adequate damages for. So the significance of subsection (4) is that in a matter that could have serious financial consequences, the person involved will be debarred from taking any case to court unless he can find a point of law on which he can base his claim for redress. I fear that it will often not be possible to do so, because most of the decisions do not turn on points of law such as whether the tribunal acted outside its powers or whether something was done that the laws of the land say should not have been done.

It is much more likely that the registrar will base his decision on a fact that the aggrieved person alleges to be false. I can think of few circumstances in which subsection (4) would allow an appeal against the decision. Therefore, I am extremely concerned that the amendment should be accepted and that "on a point of law" should be deleted from the clause.

Earlier today, my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) said that appeals to the Judicial Committee of the Privy Council should be only on a point of law, because the committee did not want to have to find on detailed matters of medical fact. From several years of experience of practice in English law, I can assure my hon. Friend that the High Court has no such inhibition. If it did, many people who have been injured by the medical profession would find it difficult if not impossible to achieve redress, because they would not find a judge who was willing to set himself up to try such a case. That is not how English law operates.

In English law, the judge sits in court and takes evidence from experts in the medical field and comes to a proper conclusion. If he does not, one can go to the Court of Appeal. So, whatever may or may not be the case for an appeal to the Judicial Committee of the Privy Council, the reason that my hon. Friend gave cannot justify removing the right of an aggrieved person to take an appeal from the general council to the High Court. I hope that my hon. Friend will take that point.

I rise tentatively to answer my hon.—and learned—Friend after five minutes of learned exposition. As he said, the amendment seeks to provide for the appeal to the High Court, or its equivalent under the clause, to be permitted on any ground and not merely on a point of law. Clause 29 deals with appeals against a decision of the registrar connected with registration. The appeal to the High Court is neither the only answer nor the first appeal provided against a decision that the registrar might make under clause 29.

In the first instance, the osteopath would have a right of appeal to the general council. It would be an open appeal that would not be restricted to points of law and would amount to a complete re-examination of the case in question. In addition to an appeal being permitted from the council on the ground that the council had got the law wrong—

Will my hon. Friend give way?

If my hon. Friend will forgive me, I am in mid-sentence. I do not mind being subject to a hard time, but being stopped in full flow is a little off-putting.

An appeal could be permitted if it were felt that the general council had got the law wrong. In addition, a decision of the general council that was so unreasonable as to be perverse would also be eligible for appeal to the High Court, because that would involve a point of law.

I apologise to my hon. Friend, but I tried to interrupt him before he had completed that sentence because he had moved off the point on which I wanted to intervene about a full re-examination of an appellant's case by the general council.

That relates to my concern about there being no guarantee under clause 29(2) about how the general council will make the rules about an appeal. There are plenty of precedents in other circumstances where such an appeal did not amount to a full rehearing of a case. My hon. Friend is not in a position to assure the House that that will not be the case under the Bill, because it is subject to a decision that the general council has not yet been called upon to make. My concern is that we are putting on the statute book a Bill which cannot guarantee an aggrieved person the rights that my hon. Friend has told us that that person will have.

I hear what my hon. Friend says, but he has omitted to say that all the rules that the general council will introduce, in good time, will be looked at most carefully by the Privy Council. If it feels that the general council is not moving in the right direction, it can intervene in the interests of natural justice.

Although I concur with the intention behind my hon. Friend's amendment, it is unnecessary for the appeal to the High Court or its equivalent to amount to a secondary consideration of the matter. I urge the House to reject the amendment.

I remain profoundly disturbed by this part of the Bill and I fear that injustice may result from it. In the light of what my hon. Friend has said, however, and the assurances that he has given, I, with some reluctance, beg to ask leave to withdraw the amendment.

I beg to move amendment No. 25, in page 25, line 31, at end insert—

'() For the purposes of any order under section 56 of the Act of 1973 or section 10 of the Act of 1980, section 90(4) of the Act (power to apply orders to existing agreements) shall have effect in relation to a regulatory provision as it has effect in relation to an agreement.'.

At present non-statutory professional associations of osteopaths are subject to the monopoly provisions of the Fair Trading Act 1973 and the provisions concerning anti-competitive practices in the Competition Act 1980.

The Secretary of State for Trade and Industry has the authority to make orders by statutory instrument to require the associations to make any changes to their rules or guidance, that the Secretary of State considers necessary, to remedy effects that a Monopolies and Mergers Commission report have found to be adverse to the public interest.

The purpose of clause 32 is to ensure that the statutory regulations of the osteopathic profession should not remove the rules of the profession from the scope of competition law. That would be the result if rules made under statutory authority were not considered to be agreements for the purposes of the Fair Trading Act 1973.

Clause 32 empowers the Secretary of State to make a competition order under the provisions of the Fair Trading Act or the Competition Act in respect of any regulatory provisions made by the general council and its statutory committees—the education committee, the investigating committee, the professional conduct committee and health committee—or any of its other committees, including sub-committees.

The amendment makes it clear that the principle is that regulatory provisions, as defined under clause 32(1) shall be treated as agreements—the purpose of orders made by the Secretary of State follow reports by the Monopolies and Mergers Commission under the Fair Trading Act 1973 or the Competition Act 1980. The amendment makes it clear that the principle applies to section 90(4) of the Fair Trading Act.

I beg to move amendment No. 54, in page 26, line 33, leave out 'may' and insert 'shall'.

I return to my favourite hobby horse—the difference between "may" and "shall" under clause 36, which is designed to ensure that practising osteopaths are properly insured should anything horrible happen to their patients. I declare an interest in that I am a member of Lloyd's and could be said to have an minor vested interest in whether people insure themselves. My hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) has a more direct interest, as a broker, in seeing that people are properly insured.

Putting aside all such personal interests, I believe that there can be no doubt that it is in the interests of patients for osteopaths to be adequately insured so that, in the awful event of their being negligent and something happening to their clients, they can obtain a remedy in the courts for their injuries. We should not have the appalling incidents, that sometimes occur, where patients successfully sue, but then find that the person sued is a man of straw. In those cases, such patients cannot obtain redress.

Therefore, I am profoundly unhappy that, under clause 36, the general council is left with the discretion to decide whether to ensure that its osteopath members are insured. While osteopathy is a science, not an art, it is an imprecise science. There is no doubt that there are instances where the treatment does not work and those being treated come out worse than when they went in. That is true of most professions and I am not singling out osteopathy, which can be beneficial but can also be harmful.

As a result of my indiscretions as a youth when I drove a fast car, I am a frequent client of osteopaths and, over the years, I have found them to be a mixed bunch. Some of them have done me much good. However, one osteopath who treated me 10 or 12 years ago in Cheshire, who was much used by the Cheshire hunt and had a superb reputation, left me in a state of almost total immobility. I spent half an hour on his couch and came away in excrutiating agony. I returned to London and, following a visit to my usual osteopath, emerged more or less in one piece.

There is no doubt that there are likely to be cases in which osteopaths are sued for what they have done and it is extremely important that they should have the resources behind them so that the person whom they have injured can obtain financial compensation. It is unsatisfactory for the general council to be left with discretion in that matter. I hope that the House and my hon. Friend the Member for Cambridgeshire, North-East will accept the amendment.

I entirely endorse the issues raised by my hon. Friend the Member for Upminster (Sir N. Bonsor). It seems osteopathy is now becoming a profession which should require professional indemnity insurance. My hon. Friend mentioned the rules governing insurance brokers, and such insurance is required for them. It is common among professions for indemnity to be a requirement and I see no reason why it should be an option for osteopaths. If the Government have any doubts, I should point out that in previous cases where insurance policies have been lacking, it is inevitably the Government who are asked by the public to compensate someone for something that has gone wrong. It is in the interests of the Government, the profession and the patients that the Bill should read "shall", not "may".

I must remind my hon. Friends the Members for Upminster (Sir N. Bonsor) and for Battersea (Mr. Bowis) that the Bill is about self-regulation, not about laying down in detail every aspect of how the profession should be run. The Bill builds on almost half a century of successful self-regulation by the profession, so it would be out of place if we began now to lay specific duties on the profession in respect of insurance. I should like the House to consider the amendment in that light and I ask my hon. Friend not to press it.

With this amendment my hon. Friend the Member for Upminster raises one of the most important aspects of the legislation. I appreciate the sensitivities that surround the important subject of professional indemnity insurance. I know that the profession takes the matter seriously and I am sure that the general council will consider it with equal seriousness. The profession clearly demonstrated through its voluntary registration scheme that it has a responsible attitude towards patient safety.

The need for practitioners to hold professional indemnity insurance was also a key recommendation of the King's Fund working party report. I am confident, however, that the recommendation did not emanate from a concern that the professionals' attitude was in any way lacking in this area. The amendment brings us back to the debate on whether the general council should be required to make rules or should be allowed to make up its own mind.

I have already made clear my reasons for believing that it would be a mistake to remove from the general council the responsibility for making this decision. Agreeing to the amendment would be to tell the council that we do not trust it to make a sensible decision—a terrible indictment of both council and profession. It would also cut across the principle of self-regulation on which the scheme is to be founded.

I remind the House that the provisions of clause 36 are perhaps the most comprehensive in any health care statutory scheme. They would enable the general council to make rules to require practising osteopaths to hold professional indemnity insurance. The general council would also have the power to check that a practitioner had renewed his cover at the right time and, most important, to initiate disciplinary proceedings if he had not.

My hon. Friend the Member for Upminster referred to a connection with the insurance industry which he and I might have. I remind him that the industry itself is wholly against any mandatory requirement in the legislation requiring insurance of any kind, because that runs counter to selectivity.

I have received a letter from the deputy chief executive of the Association of British Insurers. I received it during the Committee stage, but it is relevant to my hon. Friend's point:

"I thought that it would be of assistance to you to be aware that the ABI is pleased to see that regulation now leaves the question of professional indemnity insurance to the discretion of the general osteopathic council. This satisfactorily avoids the insurance industry being placed in the position where a refusal to provide professional indemnity to an osteopath might lead to an accusation that he was being deprived of his livelihood by non-availability of insurance. Insurers must retain the right to decline to provide insurance in individual cases and to charge a premium at a level they regard as appropriate but which an osteopath might regard as excessive in his particular case."

I hope that we are not seeking to establish the principle that there should never be a requirement for insurance. The cost of insurance may reflect the status and standing of a person or business seeking the cover. That should not be a reason for not requiring insurance but for making sure that those seeking cover reach the required standards. In many instances, legislation requires insurance by employers and public liability companies or professions. I accept what the Minister said about self-regulation. That may be a strong steer from the House that we expect rather than require the taking out of insurance.

As my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) has not risen, I assume that he does not wish to reply to the last point by my hon. Friend the Member for Battersea (Mr. Bowis). I take issue with the Minister who seemed to imply that, because the Bill is self-regulatory, the House should not lay down any principle by which the excellent people who will make up the general council should abide. The Bill is littered with requirements. Clause 6 states what the register shall show and clause 19 states:

"The General Council shall prepare and from time to time publish a Code of Practice"

It also states what the code of practice shall be. Clause 20(12) states:

"Where the Investigating Committee concludes that there is a case to answer".

Throughout the Bill, Parliament in its wisdom has decided what the general council shall do, and rightly so. Although there is to be self-regulation, there is a clear need for central guidance so that the public and the House can have confidence in that self-regulation.

I take note of what my hon. Friend the Member for Cambridgeshire, North-East said about insurance. I also note the desire of the Association of British Insurers that insurance should not be compulsory. I entirely take that point, but I am concerned that the less insurable the osteopath, if I may put it that way, the greater the risk to his patient. If an osteopath is so uninsurable as to make his practice unviable, his clients should be placed in a strong state of red alert before they lie on his couch.

Did my hon. Friend have the same difficulty as I had in following the logic of the letter from the deputy chief executive of the Association of British Insurers which was read to us by my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss)? The general council, using the discretion that my hon. Friend would like to see in his Bill, may decide that a rule for registration is that every practising osteopath shall carry professional liability insurance. If that rule emanates from the general council rather than from statute, it will be open to an osteopath who has been refused insurance to claim that the insurance industry is depriving him of his livelihood. The effect on the registered osteopath who has been denied insurance will be the same whether the rule that he has to carry insurance is imposed by the general council or by statute. The difference that the amendment would make to the text of the Bill should make us consider whether we would feel confident that, in all circumstances, osteopaths will carry insurance or whether we have to take it on trust that the general council will use its best judgment in deciding whether to impose such a rule. That is a different issue from the one that was addressed in the letter from the ABI.

My hon. Friend is right. The logic of the letter from the ABI is that the osteopath should have insurance, but it should not be compulsory. The true state of affairs is that it is more than likely that the osteopath will not have any insurance at all, but that the client will not know that. That is the focus of my concern. I fear that we shall end up with people practising on the margin of their profession, probably with very few personal assets, and that their clients will be at substantial risk.

In the light of what has been said, my amendment would not be appropriate. I ask my hon. Friend the Member for Cambridgeshire, North-East to see whether there is a way to safeguard the client's position in the event of an osteopath practising neither with substantial personal wealth nor with an insurance policy that will cover his client against the consequences of any negligence on his part or any legal liability arising. I hope that the Bill will not proceed through the other place without an appropriate amendment being inserted. I beg to ask leave to withdraw the amendment.

I beg to move amendment No. 30, in page 29, line 1, leave out subsection (6) and insert—

'(6) The transitional provisions of Part III of the Schedule shall have effect.'.

With this, it will be convenient to take amendment No. 45, in page 35, line 36, at end insert—