Sixth Standing Committee on Delegated Legislation


Wednesday 29 January 1997



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The Committee consisted of the following Members:


Barron, Mr. Kevin (Rother Valley)

Bowden, Sir Andrew (Brighton, Kemptown)

Carrington, Mr. Matthew (Fulham)

Churchill, Mr. Winston (Davyhulme)

Coombs, Mr. Simon (Swindon)

Duncan Smith, Mr. lain (Chingford)

Faber, Mr. David (Westbury)

Gale, Mr. Roger (North Thanet)

Gerrard, Mr. Neil (Walthamstow)

Gunnell, Mr. John (Morley and Leeds, South)

Horam, Mr. John (Parliamentary Under-Secretary of State for Health)

Jones, Mr. Martyn (Clwyd, South-West)

Lewis, Mr. Terry (Worsley)

Shepherd, Mr. Richard (Aldridge-Brownhills)

Smith, Mr. Llew (Blaenau Gwent)

Smyth, Rev. Martin (Belfast, South)

Squire, Ms Rachel (Dunfermline, West)

Steen, Mr. Anthony (South Hams)

Wise, Mrs. Audrey (Preston)

Mr. F. A. Cranmer, Committee Clerk.

3 Sixth Standing Committee on Delegated Legislation Wednesday 29 January 1997

[MRS. ANN WINTERTON in the Chair]

Draft Professions Supplementary to Medicine (Prosthetists and Orthotists Board) Order of Council 1997

4.30 pm

The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I beg to move, That the Committee has considered the draft Professions Supplementary to Medicine (Prosthetists and Orthotists Board) Order of Council 1997. The order creates a Prosthetists and Orthotists Board—I am assured that I am pronouncing the names correctly—under the Professions Supplementary to Medicine Act 1960. Prosthetists and Orthotists are specialised health professionals who measure and fit patients for artificial limbs and appliances such as splints, braces and footwear. They specify the design and materials for these devices and evaluate their use. The broad effect of the order is to extend the 1960 Act as if the profession were included alongside those it already covers, namely chiropodists, dietitians, occupational therapists, physiotherapists, radiographers, orthoptists and medical laboratory scientific officers. The board's function will be to promote high standards of professional education and conduct under the umbrella of the Council for Professions Supplementary to Medicine—the CPSM—whose duty it is to co-ordinate and supervise the activities of all the boards. The main duties are to propose and maintain a register; approve training courses leading to state registration and the institutions providing them; determine applications for admission to the register on the basis of qualifications and experience acquired either in the UK or elsewhere; and fourthly set up investigating and disciplinary committees to produce guidance on conduct and to deal with individual cases of misconduct. Practitioners who are registered by the board will be entitled to call themselves state registered prosthetists and orthotists. The use of that title by a person who is not registered will be an offence, as will the use of any title or description which falsely implies that he is registered under the 1960 Act. Prosthetists and orthotists are a small and highly specialised group—there are only about 800 practitioners in the UK. The majority—more than 80 per cent.—are employed by private firms that contract to provide services to the national health service. They provide direct, hands-on care for particularly vulnerable patients of all ages, operating with substantial autonomy within multidisciplinary teams. Their work is commissioned by other clinicians, such 4 as surgeons, but surgeons accept them as the true experts within their field. So what they do, if ill done, presents serious risks of physical and psychological harm to patients arising from defects in the selection, design, manufacture, fitting or evaluation of limbs and appliances. The training required is exacting. The only route to qualification in the UK is through one of two centres at the universities of Strathclyde and of Salford. Each provides a four-year combined honours course, integrating the theoretical, practical and clinical aspects of prosthetics and orthotics. Both centres are strongly supported by the national health service and both have strong international links. The training reflects a unique combination of expertise—precision engineering, materials science, design and production methods, plus a high degree of clinical, communication and teamworking skills. Beyond qualification, the profession deserves credit for combining two disciplines whose training and practice was historically separate into a coherent body of knowledge and experience, represented by a single organisation. It has articulated a comprehensive statement of the ethical and practice standards expected of its members, which are comparable with those of other health professions and consistent with international best practice. It has also consulted widely and thoroughly on the proposal before us. It balloted its members, who overwhelmingly approved it—87 per cent. of those voing were in favour—and it has secured the support of the medical and nursing profession, those groups currently regulated under the 1960 Act, and, significantly, of employers' representatives as well. But the merits begin and end with patients. State registration of prosthetists and orthotists offers the public an objective assurance of the high standards of training, conduct and practice that they can expect. If approved, this measure will provide a scheme of self-regulation at arm's length from Government and funded by practitioners themselves. The Government are satisfied that prosthetists and orthotists have sufficiently developed their standards, identity and purpose to join the family of mature professions already regulated by the CPSM, and I commend the making of this order by the Privy Council.

4.34 pm

Mr. Kevin Barron (Rother Valley): I do not intend to keep the Committee long. Professions supplementary to medicine play an important role in health care in this country and it is right and proper that prosthetists and orthotists should be represented on the board. The draft order, however, will increase the number of representatives to the Council for Professions Supplementary to Medicine. The Minister will know that there are other professions also seeking entry to the council and which, in due course, are likely to be admitted. Will he say, therefore, whether he has taken a view on the overall size and composition of the council in light of this draft order and, indeed, other orders that may be 5 pending? In addition, will he say what cost implications, if any, arise from the approval of the draft order? Finally, when does he expect to announce future additions to the Council for Professions Supplementary to Medicine? I am sure that many organisations will be interested in his answer. The Opposition are happy to see the draft order approved and we look forward to its swift implementation.

4.35 pm

Mr. Roger Gale (North Thanet): My hon. Friend the Minister will know that the former Royal Sea Bathing hospital is in my constituency. For many years, that hospital had a justified reputation for prosthetics and orthotics. It closed when its work was transferred to the recently rebuilt Queen Elizabeth the Queen Mother hospital in Margate. The prosthetics and orthotics department was moved to a fine new building at the Queen Victoria hospital, Herne Bay, which was opened not so long ago by Lord Tonypandy. It is an excellent facility, staffed by highly professional people who provide a superb service for the whole of east Kent. I simply seek an assurance from my hon. Friend that the order before the Committee—which I understand to be a very welcome professional recognition of the people involved—will not impact on any of the highly professional people presently working in those services.

4.36 pm

Mr. Horam: I can give my hon. Friend a categorical assurance that the order will not impact on the people who work in that sector at present. Indeed, 6 experienced people who are well equipped to practise can be "grandfathered in", to use a wonderful phrase of which I am rather fond. I am sure that any difficulties will be considered sympathetically by the new board. Certainly, I am well aware of the high standards at the hospital mentioned by my hon. Friend, which is a credit to the national health service. I can tell the hon. Member for Rother Valley (Mr. Barron) that the order will increase the membership of the CPSM from 21 to 24. That is not a large increase, but I agree that the council cannot keep on growing without some thought being given to the question of whether it has become unwieldy and overlarge. That matter will be kept under review. There must be two rather than three O and P representatives because of the need to balance expert and lay representation. At present, arts therapists are the only professional group actively seeking state registration, but other potential candidates include clinical psychologists, speech and language therapists, clinical scientists, ambulance paramedics and operating department assistants. As to costs, the measure is entirely self-regulating. The fee for membership of the body is £17.

Question put and agreed to.

Resolved, That the Committee has considered the draft Professions Supplementary to Medicine (Prosthetists and Orthotists Board) Order of Council 1997.

Committee rose at twenty-one minutes to Five o'clock.



Winterton, Mrs. Ann (Chairman)

Barron, Mr.

Faber, Mr.

Bowden, Sir Andrew

Carrington, Mr.

Churchill, Mr.

Coombs, Mr. Simon

Duncan Smith, Mr.

Faber, Mr.

Gale, Mr.

Horam, Mr.

Shepherd, Mr. Richard

Smyth, Rev. Martin