The third question this morning in the House of Lords Question Time managed to cover astrology, alternative medicine, the views of Prince Charles, mumbo jumbo and quackery, provoked an intervention from the Astronomer Royal and from myself on psychotherapists and so-called “Schools” of psychotherapy and other therapies.

The question and the subsequent supplementaries demonstrated concerns from all parts of the House that alternative therapists need to be regulated in order to protect the public from unscrupulous practitioners and highlighted the importance of better understanding of real (as opposed to pseudo) science by the public and young people in particular.

The full exchanges were as follows:

“Alternative Medicine: Astrologers

Question

11.21 am

Asked By Lord Taverne

To ask Her Majesty’s Government whether, following their proposals to regulate practitioners of alternative medicine, they plan to regulate astrologers.

Baroness Thornton: No, my Lords, the Government have no plans to regulate astrologers.

Lord Taverne: My Lords, I declare an interest as chairman of the charity Sense About Science. The forms of alternative medicine which the Government propose to regulate have as much scientific basis as astrology. As official regulation is likely to give such practices a spurious scientific reliability and respectability, is it not unfair to leave out astrologers? More seriously, will the Government note that august bodies of proper scientists—the Medical Research Council, the Royal College of Pathologists, the Academy of Royal Medical Colleges and other eminent professional bodies—strongly oppose the proposed regulation? Will the Government ignore the assiduous lobbying for pseudoscience from Clarence House?

Baroness Thornton: My Lords, I am aware that the noble Lord is making a wider and serious point about alternative therapies. At present there is no statutory regulatory system in the United Kingdom to govern the practice of complementary and alternative medicine, with the exception of chiropractitioners and osteopaths who are regulated by statute. We are undertaking a consultation exercise to determine whether and, if so, how to regulate the practitioners of acupuncture, herbal medicine and traditional Chinese medicine. The Science and Technology Committee of this House suggested that we should address that issue. No other complementary therapies, including medical astrology, are within the scope of this consultation and we have no proposals to regulate in any of these other groups.

Baroness Pitkeathley: My Lords, I declare an interest as chair of the Council for Healthcare Regulatory Excellence. I remind the House and the noble Lord who asked the Question that the purpose of regulation is to protect the public, and that is what we try to do. However, in order to help me do my job better, can my noble friend give me a definition of medical astrology?

Baroness Thornton: My Lords, medical astrology is traditionally known as iatromathematics and is an ancient medical system associated with various parts of the body, diseases and drugs and the influence of the sun, moon, planets and the 12 astrological signs. For example—I did the research on this issue myself—the noble Lord, Lord Taverne, and I share the same birth sign, Libra, which apparently rules excretory functions through the kidneys and skin. I could go on about lumbar regions but noble Lords will get the picture. I am happy to say that the underlying basis for medical astrology is considered to be a pseudoscience and superstition as there is no scientific basis for its core beliefs. The Government remain neutral on this issue.

Earl Howe: My Lords, does the Minister share my view that this is an uncharacteristically flippant Question from the noble Lord, Lord Taverne? Does she accept that statutory regulation is not a badge of rank but exists, as the noble Baroness, Lady Pitkeathley, has just said, to safeguard the public? The key regulatory bodies—the Health Professions Council and the Medicines and Healthcare products Regulatory Agency—have both concluded that acupuncture and herbal medicine practitioners should be subject to statutory regulation.

Baroness Thornton: The noble Earl is quite correct and I concur with him that this is a very serious matter. Although we do not specifically promote or endorse the use of complementary or alternative medicine, we have to appreciate that a high proportion of the population actually uses these medicines, and our concern, as my noble friend said, is to protect patients. Responsible complementary practitioners adhere to codes of ethics, know the limits of their competence and make appropriate referral of patients to orthodox practitioners where there is potential risk to their health and well-being. However, the noble Earl is completely correct—we have to look to how best to safeguard patients in respect of those complementary medicines such as acupuncture and Chinese herbal medicines that have the potential to cause harm. Therefore we need to take serious action to make sure they are regulated in the correct fashion.

Baroness Tonge: My Lords, I confess to being an Aquarian, and share my birth date with Copernicus and my Auntie Ivy, although I have to say that my Auntie Ivy had much more influence on me than my birth sign. However, on a more serious note, does the Minister agree that the popularity of mumbo-jumbo such as astrology and many forms of alternative medicine is due to the fact that people have very little scientific education at school? Will she say what this Government, in their 10 years in power, have done to further education in science and mathematics?

Baroness Thornton: We have done a great deal for further education in science and mathematics, although that is not exactly what this Question was about. I agree with the noble Baroness that of course people often turn to things like medical astrology because they do not understand the basis of whatever ailment it is they are looking at, and that can be a risky thing to do. However, I simply do not accept this Government have not put a significant amount of investment into mathematics and science in our schools.

Baroness McIntosh of Hudnall: My Lords—

Lord Rees of Ludlow: My Lords—

The Minister of State, Department of Energy and Climate Change (Lord Hunt of Kings Heath): My Lords, we have not heard from the Cross Benches yet.

Lord Rees of Ludlow: My Lords, I declare an interest as Astronomer Royal, and therefore as someone who could enhance his income hugely by becoming an astrologer and offering horoscopes. Does the Minister agree that, even though were we in India it might be appropriate to regulate astrology because government ministers there, one is told, are heavily guided by it, in this country to do so might imply that the problem has rather more seriousness that it really deserves?

Baroness Thornton: The noble Lord is completely correct.

Baroness McIntosh of Hudnall: My Lords, does my noble friend agree that we should indeed have no truck with pseudoscience? As it happens, I have some sympathy with the point that the noble Baroness, Lady Tonge, raised about the teaching of science and mathematics. None the less, there are, as Hamlet observed,

“more things in heaven and earth … than are dreamt of in your philosophy”,

and some very respectable branches of medicine were once alternative in their day. Therefore, it is important that we keep an eye on the things in which people invest confidence, and make sure, as my noble friend Lady Pitkeathley observed, that they do not cause harm.

Baroness Thornton: My noble friend is right. Complementary and alternative medicine therapies have proven to be effective, cost-effective and safe. Decisions about which treatments to commission and fund, for example, are the responsibility of the NHS locally, and indeed primary care trusts often have their own policies about funding complementary medicine such as osteopathy or chiropractic. Indeed, we are funding research into complementary therapies, for example in the care of cancer patients.

Lord Harris of Haringey: My Lords, I speak to the Minister as a fellow Libran. Is she satisfied with the quality of regulation of therapies such as psychotherapy? Is it still the case that anyone can set themselves up as a college of psychotherapy or any other therapy, and offer diplomas and apparent validation to practitioners whose skills may be negligible?

Baroness Thornton: My noble friend raises an important point, which the House has discussed in the past year. I had a huge postbag about that; I was inundated by suggestions from psychotherapists of all different kinds on this issue. My noble friend is quite right that there is an issue, and the department is looking at it.”

Parliament has been prorogued. The 2008/9 Parliamentary Session ended on 12^th November 2009 and the new Session begins with the Queen’s Speech on 18^th November 2009.  I suspect the 2008/9 Session will be remembered for the expenses and other scandals that engulfed both House rather than for the legislation enacted during it.  However, some major Bills were passed and became Acts of Parliament.  These included the:

• Apprenticeships, Skills, Children and Learning Act:  this provides a statutory framework for and a right for 16-18 year-olds to apprenticeships; gives employees a right to request time-off for training; gives local government responsibility for funding education and training for 16-18 year olds; changes school inspection arrangements; creates a new parental complaints service; and strengthens accountability.
• Banking Act:  this provides a permanent system for dealing with failing banks; and gives the Bank of England a new “financial stability” objective.
• Borders, Citizenship and Immigration Act:  this changes the rules on naturalisation; gives new functions (and new duty to safeguard children) to the UK Border Agency; and introduces powers to control all those arriving in the UK from the rest of the Common Travel Area.
• Business Rate Supplements Act:  this gives upper tier local authorities (in London, the Greater London Authority) the power, following consultation, to levy an additional business rate for economic development purposes (including Crossrail in London).
• Coroners and Justice Act:  this reforms and updates the law on coroners; extends the laws on child pornography to cover non-photographic images; increases the flexibility on hearing evidence from vulnerable witnesses etc.
• Health Act:  this gives statutory force to the new NHS Constitution and sets out the responsibilities of patients and staff; introduces direct payments for health services to give patients greater control over the services they receive; makes provision for more information on service quality to be made available to patients and others; and introduces new measures to protect young people from the harm caused by smoking.
• Local Democracy, Economic Development and Construction Act: this makes provisions to encourage the greater involvement of people in local authority decision-making; creates an obligation on councils to respond to petitions; establishes a new body to represent the interests of tenants; and places a new duty on local authorities to assess economic conditions in their area and to work with Regional Development Agencies to produce a single regional strategy.
• Marine and Coastal Access Act:  this reforms the law on marine regulation, fisheries management and marine conservation; and enables the creation of a walkable route around the English coast.
• Parliamentary Standards Act: this created the Independent Parliamentary Standards Authority.
• Policing and Crime Act: this strengthens police accountability; creates an offence of paying for sex with trafficked or coerced women; tightens regulation of lap-dancing clubs; and amends police powers for dealing with young people drinking in public.
• Political Parties and Elections Act: this strengthens the powers of the Electoral Commission; alters the definition of election expenses; and requires greater clarity on the source of political donations.
• Welfare Reform Act: this abolishes Income Support and moves all claimants on to either Jobseekers’ Allowance or, if sick, on to Employment and Support Allowance; introduces a new regime of sanctions for non-attendance at JobCentres; and provides additional powers for the enforcement of child maintenance arrears.

In addition, the House of Lords spent seven full days debating the Postal Services Bill, which would have enabled a minority stake in the Royal Mail Group to be sold whilst ensuring that the Group remained in public ownership, would have transferred the Royal Mail’s historic pension deficit to the Government and would have created a regulatory regime for the postal services sector under OFCOM.  In the event, the Bill, having passed all its stages in the Lords, was introduced in the House of Commons and then abandoned.  The Bill has now fallen with the end of the Parliamentary Session. Three major Bills that have had their Second Reading debates and some Committee discussion in the House of Commons have been the subject of Carry Over motions, which means that they have not fallen with the end of the Parliamentary Session and their progress through Parliament can be resumed in the new Session.  These are the:

• Child Poverty Bill:  this would give statutory force to the Government’s 1999 commitment to eradicate child poverty by 2020, placing a duty on Ministers to meet income poverty targets and requiring the regular production of a child poverty strategy.
• Constitutional Reform and Governance Bill:  this would end “by-elections” to replace the remaining hereditary peers that sit in the Lords when they die; would make it possible for members of the Lords to resign or to be suspended/expelled; introduce a new Parliamentary process for the ratification of Treaties; establish a statutory basis for the running of the civil service; end the Prime Minister’s role in appointing senior judges; introduce new rules on protests around Parliament and a variety of other constitutional adjustments.
• Equality Bill:  this would harmonise and extend anti-discrimination legislation; would place a unified duty on public bodies; extend discrimination protection to the membership of private clubs; require employers to review and publish gender pay differences within their organisations; extends age discrimination legislation outside the workplace; and much else besides.

The number of defeats suffered by the Government this session is the lowest in any full session since the Labour Government was elected in 1997.  This session the Government was defeated on 24 occasions (out of 89 votes in total).  Last session there were 29 defeats.   By contrast there were 45 Government defeats in the 2006/7 session and 62 in the 2005/6 session.  To put these numbers in context: the last Conservative Government under John Major suffered only 62 defeats in the entire 1992-97 Parliament.

Labour now has 212 members in the Lords and is the largest Party, but this only amounts to 30% of the total membership of 705.  There are 190 Conservative peers (27%), 183 cross-benchers (26%), and 71 LibDems (10%) – the remainder comprise 26 Church of England bishops/archbishops and 23 non-affiliated or other. The reality of these numbers is that the Government does not have an automatic majority to carry through its legislation.  At any one time, the opposition parties can combine to defeat the Government, particularly as a significant proportion of the cross-benchers will usually vote with the opposition, depending on the issue.

Local Government Chronicle is reporting that plans are nearly finalised for a “health integration board” covering fifteen London Borough Councils and their respective NHS Primary Care Trusts.  To be honest the article is rather fuzzy as to what precisely is happening, but the idea is clearly to look at ways of integrating the work of commissioning local health services with the similar work that the Boroughs do in respect of social care.  Already the Chief Executive of Hammersmith and Fulham Council doubles as Chief Executive of the Primary Care Trust and there are a number of models of joint commissioning around in London and elsewhere.

The key point in this is that it will be a move to providing some local democratic ownership of NHS decision-making.  It runs rather contrary to the approach that is being promoted by the Department of Communities and Local Government whereby local authorities are taking on a wider scrutiny role for local public services in their area (which would obviously includes health).  However, as far as the public are concerned, a model that enables their democratically-elected local councillors to take the strategic decisions about the shape of local healthcare is probably more transparent and attractive than a model where those same councillors are merely empowered to ask questions of the unelected bodies that are responsible for the NHS.

The long-term direction of travel remains unresolved and a London Health Integration Board will certainly be worth watching to see what it delivers.

This morning I reported my continuing concerns about computer repairers like “The Geek Squad” and “The Tech Guys”.  Now I see that my good friends at FaberBrent (whose Advisory Board I have just joined) have quite independently reported a Sky undercover exercise on a laptop repairer who caught the” repairer” trawling through files for personal data and banking details.  So I am right to be worried and some system of regulation and certification seems essential.

When the Digital Britain White Paper was published on 16th June, I raised some concerns about the White Paper’s apparent endorsement of “The Geek Squad” and “The Tech Guys”.

I have now received from Lord Stephen Carter a response to the points I made in the debate.  Unfortunately, the response slightly misses the point (by about a mile, actually).  It sets out the measures being introduced to improve the enforcement of consumer law applying to on-line transactions.  This is all good stuff – a single online complaints register for people encountering an online scam; investment in new equipment, training and staff for on-line consumer law enforcers; and a review of enforcement powers in an on-line world.  However, this is not really going to provide much reassurance for people nervous about letting an unknown person into their homes to fidedle around with their computer systems.

I have now written back to Stephen Carter – although my letter may well have arrived after his last day in office (he is one of the GOAT ministers who is resigning this month).  My letter says:

“Thank you for your letter of 8th July.  I am grateful for the clarification you have provided on the points I raised following your statement to the House on 16th June.

 

However, I would like to come back on the second issue I raised.  This related to the need to ensure that consumers have adequate protection when dealing with suppliers, such as “The Geek Squad” or “The Tech Guys” – both specifically mentioned in “Digital Britain”.

 

In your response, you mention the measures being taken to improve enforcement of consumer law applying to on-line transactions.  Whilst these measures are valuable, they rather miss the point of my concerns.  Both “The Geek Squad” and “The Tech Guys” involve the consumer permitting individuals to access their computer equipment (and usually their homes).  Such individuals are being given a position of trust by the consumers concerned, who will assume that they are (1) honest and (2) know what they are doing.  As far as these points are concerned, it is extremely unlikely that the consumer will have the technical knowledge to understand (or indeed to be able to detect) what has been done to their equipment – that is after all why they have asked “The Geek Squad” or “The Tech Guys” to visit or to look at their equipment.

 

If you engage a security guard from a security firm, the individuals engaged are required to be registered with the Security Industry Authority and will have been vetted for criminality and there are requirements relating to their training.  Yet the activities of most security personnel will usually be visible and will normally be comprehensible to the person engaging them.  Should there not be some similar system of regulation and customer assurance of the quality of work in place for those individuals engaged by “The Geek Squad”, “The Tech Guys” or any other similar service?  If no such system is in place, most customers – who are likely not to be skilled technically – will be vulnerable to data being stolen from them, to malicious code being placed on their machines or to more traditional forms of criminality.

 

I would welcome your comments on what can be done to address this.  I am copying this letter to Lord West of Spithead (in view of the information security implications) and to Alun Michael MP (in view of his role chairing the Tripartite Internet Crime and Security Initiative).”

I will be interested to see if the civil servants get the point this time.

Today’s “Digital Britain” report has an interesting paragraph on “Securing Home Networks” which says:

“In addition, the market is increasingly providing a high level of after sales support to its customers through additional assistance in relation to dealing with technical complexity – a sort of “AA breakdown” assistance for your personal networking needs. As home networks become more complex, it is legitimate to expect that these types of service will continue to grow. Services such as “the Geek Squad” from Carphone Warehouse and “Tech Guys” at PC World provide consumers with fast and effective advice on a range of issues including computer optimisation, device set-up, software installation, parental control set-up and tuition, security and software installation, back-up services and many others.”

I expressed some reservations about this when the report was introduced in the House of Lords this afternoon by Lord Stephen Carter. saying:

“I note in the report the support for the after-sales services provided by a number of computer retailers, such as the Geek Squad, the Tech Guys and so forth.  Have the Government given any thought to the personnel who visit people in their homes and put things on their computers?  What steps are being taken to ensure that those individuals are quality-assured and regulated in the same way that physical security personnel are regulated by the Security Industry Authority? “

My concern was that at present the individuals who work in such areas are unregulated, there is no agreed quyalification standard, and there is no guarantee that they are honest.  Those people who rely on such services to protect or maintain their IT equipment are the least likely individuals to know whether something adverse (such as installing a key-logger) has been done to their systems.

The Minister’s response recognised that there was an issue, although he sidestepped the point about regulation,:

“I do not know what checks and balances those operators put in place, but I will do further due diligence to find out. My noble friend raises an interesting question; as people’s domestic IT systems become more and more sophisticated—which they will—the level of complexity, and therefore the level of security and trust that people will want to have with the providers of those services, will only increase. My view is that it will be four or five years before we have a sort of AA or RAC of the IT world providing that level of assistance at scale for many homes. It is an intriguing question.”

The issue may well be worth pursuing ….

I have just met my local MP (Lynne Featherstone) in the supermarket (Marks and Spencer). I tried to interest her in running a campaign (isn’t that what LibDem MPs do?) against the strange new lay-out of the store (vegetables in three separate sections, two separated deli areas etc). She said she agreed with me (isn’t that what LibDem MPs do?), but seemed reluctant to follow through with a campaign. Maybe she suspected my motives, but why would I want her to seem like a light-weight frivolous climber-on of point-less bandwagons? Isn’t that what ….

I have just finished reading Ben Goldacre’s book, ‘Bad Science’. Much of the book will be familiar to assiduous readers of his regular column in ‘The Guardian’ each Saturday, but even for them it is worth having all the arguments in a fuller form with the detailed references cited.
Ben Goldacre should be essential reading for all ‘opinion formers’ and indeed, given the prevalence in the media of misrepresentation of scientific stories and of pseudo-science masquerading as fact, we would all benefit from the crash course that Goldacre offers.

The book takes the reader through what constitutes a good scientific experiment and a meaningful clinical trial and then looks at how various widely-reported issues measure up. Along the way ear candles, the Brain Gym (shamefully promoted – with the connivance of the Department of Children, Schools and Families – throughout the school system), homeopathy, and most commercial nutritionism are systematically debunked. This leads into a discussion on the ways in which the pharmaceutical industry’s products are promoted and concludes with the way in which the media hyped up a manufactured scare about the MMR vaccine.

So why are people so taken in by pseudo-science, by health scares and health fads? I suspect, while the media should take a large chunk of the blame, the real reason is that as a society we have been collectively undervaluing science and technology for several decades. Not enough is done in schools to promote not only the wonder and excitement of science, but also a basic understanding of scientific principles and method. Perhaps as a first step Ed Balls and senior officials at the DCSF should have as their New Year Resolution to read ‘Bad Science’ and figure out how to include its central message in the National Curriculum.

I have just been to a meeting of the All-Party Parliamentary Group for Patient and Public Involvement in Health, which heard from representatives of the National Association of LINks’ Members. 

For those with long memories, each health district used to have a local Community Health Council (CHC) which was there to represent the interests of NHS users in that area (I should declare an interest in that from 1987 to 1998, I was the Director of the Association of CHCs for England and Wales.)  In 1999, the Government decided to abolish CHCs on the basis that the reforms then being introduced in the NHS would make separate patients’ representation unnecessary.  After a big campaign, the Government conceded that, while CHCs in England would still be abolished, new structures called Patient and Public Involvement Forums would replace them around the country.  These were still finding their feet (and were still in many instances weak and watery substitutes for the old-style CHCs) when their abolition in turn was announced.  Again there was a campaign and as a result the Forums did not finally close until the end of March this year.  In the Forums’ place were to be new structures to be called Local Involvement Networks (LINks).   These would be funded via a Department of Health allocation to the local authorities in their areas.  The local authorities would then contract with another organisation to “host” the LINk for the area.

Inevitably, the new arrangements took some time to be set up and the Department of Health has acknowleded that they will not really be ready to operate until next year – leaving a gap of nine months to a year when there will have been no formal mechanism for patient representation in place.

The evidence from the National Association of LINks’ Members (an informal grouping of individuals who were involved in the Forums and want to see the new system work as well as it can) is that there are huge variations around the country in what has been done to get LINks up and running.  As indicated above, the process is a convoluted one: local councils receive an allocation for this work and must appoint a “host” organisation to run the local network.  According to the Association, some local authorities have retained substantial sums for “administration” and have not passed all of the allocation on to the “hosts”.  There is in most parts of the country a lack of clarity about what the “hosts” will provide for their allocation of money (what guidelines there are from the Department of Health are very permissive to allow local variation).  The Association feel that some “hosts” see their role as a money-making venture for their organisations (and in a number of instances have bidded to act as “hosts” in several local authority areas) and that often only limited resources have been made available to support the local volunteers who are trying to act as patient representatives and visit/inspect healthcare establishments.

All in all the Association presented a picture of precisely the sort of chaos that was predicted when the legislation went through Parliament.