Zeno's Blog

Jubilation in the chiropractic world! But, as usual, all is not what it might first seem…

Chiropractors granted Royal Charter:

The College of Chiropractors will soon be given the honour of being named the Royal College of Chiropractors. In doing so, Chiropractors become the first complementary health specialty to be awarded a Royal Charter. It is great news for Chiropractors and the development of the chiropractic profession in general.

Royal Charters have traditionally been awarded to specialty areas of Medicine such as the Royal College of Surgeons or Royal College of Dentists. It recognises the value of the College of Chiropractors unique position as a leader in the profession. (Source)

College of Chiropractors receives Royal Charter. Feels great to now be part of The Royal College of Chiropractors (Source)

The College of Chiropractors have been granted Royal Charter. Congratulations to the Royal College of Chiropractors! (Source)

The College of Chiropractors will soon be given the honour of being named the Royal College of Chiropractors. (Source)

One chiro was quick to update their website (or maybe he always thought it was a Royal College?) with this new imprimatur:

 I am registered with the General Chiropractic Council…and a member of the British Chiropractic Association (BCA) and the Royal College of Chiropractors. (Source)

The British Chiropractic Association (BCA) published a press release (cached) that probably started this all off:

College of Chiropractors granted Royal Charter

Dated: 12 November 2012

At a meeting of the Privy Council on Wednesday, the Queen approved the grant of a Royal Charter to the College of Chiropractors, the first Royal Charter to be granted to a complementary medicine organisation in the UK.

The College is an academic, professional membership body, established along the lines of the Medical Royal Colleges, which over the past 13 years has sought to ensure quality, safety and excellence are at the forefront of chiropractic practice in the public interest.

Chiropractic is regulated by statute and although chiropractors provide their services largely within the private sector, NHS funding for chiropractic treatment is now emerging region by region under the Department of Health’s new commissioning arrangements. Chiropractors specialise in the diagnosis and treatment of problems affecting the joints, muscles and nerves and are probably best known for treating low back pain, a condition which costs the equivalent of between 1% and 2% of the UK GDP and has a significant impact on people’s lives.

Rarely granted, a Royal Charter signals permanence and stability and, in the College of Chiropractors’ case, a clear indication to others of the leadership value and innovative approach the College brings to the development of the chiropractic profession. The Royal Charter essentially formalises the College’s position as a unique, apolitical, consultative body, recognising its role in promoting high practice standards and certifying quality and thus securing public confidence.

Tim Jay, President of the College, said, “The College of Chiropractors’ Royal Charter emphasises to the public and other health bodies that chiropractic is a healthcare profession with parity in the field of musculoskeletal health, providing a viable and recognised option for patients.”

All the usual spin, of course.

It is odd, though, that the College of Chiropractors hasn’t said anything about this themselves on their own website.

From the horse’s mouth

The College of Chiropractors was set up in April 1999, evolving from the Board of Education of the BCA. Matthew Bennett is an officer of the College and Vice-President of the BCA, so he must surely know what he’s talking about?

He pontificated:

“This new award for the College of Chiropractors puts it on a similar footing to the other Royal Colleges in medicine and dentistry. Our team has worked for a decade to achieve this.”

This news item from his own website continued:

Whilst the new College has a long way to go to match the prestige of its bigger brothers it is a big step towards recognising the value that the chiropractic profession can bring to healthcare in the UK.

The ‘other’ Royal Colleges? Its ‘bigger brothers’?

He presumably is referring to the Medical Royal Colleges such as the RCGP, RCS, the RCP and the other eminent Colleges and no doubt would like a seat at the table of the Academy of Medical Royal Colleges to be reserved for ‘Royal’ College of Chiropractors’ President, Tim Jay.

It is indeed a prestigious honour for the College to now be able to call itself the Royal College of Chiropractors and claim parity with all the other Medical Royal Colleges, with all the respectability that would bring.

Or it would be, if it were true.

But it’s not.

As we frequently find with chiropractic, all is not what it seems and the careful reader should not be too willing to believe the spin.

In fact, the granting of a Royal Charter of Incorporation to the College of Chiropractors is not the same as becoming a Royal College.

Royal Charter

The College of Chiropractors has, indeed, been granted a Royal Charter, but it’s a Royal Charter of Incorporation, granted by the Privy Council, with Nick Clegg as Lord President.

What is a Royal Charter?

A Royal Charter is a way of incorporating a body, that is turning it from a collection of individuals into a single legal entity. A body incorporated by Royal Charter has all the powers of a natural person, including the power to sue and be sued in its own right. Royal Charters were at one time the only means of incorporating a body, but there are now other means (becoming a registered company, for example), so the grant of new Charters is comparatively rare. New grants of Royal Charters are these days reserved for eminent professional bodies or charities which have a solid record of achievement and are financially sound. In the case of professional bodies they should represent a field of activity which is unique and not covered by other professional bodies.

The first Royal Charter was granted to the University of Cambridge in 1231, followed by the University of Oxford in 1248 and there are currently just under 1,000 still in existence.

The College of Chiropractors has been a private company, limited by guarantee incorporated in 1998 (and a registered charity), but they presumably want the prestige they think being incorporated under a Royal Charter will bring.

Requirements and eligibility

The Privy Council website explains the process of applying for a Royal Charter and gives the necessary conditions:

…in the case of professional institutions the main criteria are:

(a) the institution concerned should comprise members of a unique profession, and should have as members most of the eligible field for membership, without significant overlap with other bodies.

(b) corporate members of the institution should be qualified to at least first degree level in a relevant discipline;

(c) the institution should be financially sound and able to demonstrate a track record of achievement over a number of years;

(d) incorporation by Charter is a form of Government regulation as future amendments to the Charter and by-laws of the body require Privy Council (ie Government) approval. There therefore needs to be a convincing case that it would be in the public interest to regulate the body in this way;

(e) the institution is normally expected to be of substantial size (5,000 members or more).

This raises several rather obvious questions:

1. Are they a ‘unique profession’? Well, they certainly never seem to tire of telling us they are not osteopaths, not physiotherapists and certainly not drug-pushing doctors or slashing surgeons!

2. Does it “have as members most of the eligible field for membership” and do they have the requisite 5,000 members?

The College claims it “currently has more than 1500 UK members and 2800 members worldwide.” That adds up to just 4,300 members (with only 1,500 in the UK), somewhat short of the requisite 5,000. Or does that 2,800 include its 1,500 UK members? In which case, it’s even further off meeting the 5,000 requirement.

But why only 1,500 members in the UK? There are 3,374 chiropractors registered with the General Chiropractic Council (click here and click on the ‘Search’ button without entering any text to see the number of registrants), so the College of Chiropractors doesn’t even represent half of the chiropractors in the UK. Is this further evidence to the split between the different chiro factions?

But much more is revealed by their accounts. In their last financial year, their income from fees and subscriptions was £287,922. Their current subscriptions rates (which haven’t changed much over recent years) are £248 for a UK member and £105 for an overseas member. And free to students.

They have some additional fees for Faculty (£50) and Society (£15) membership, but we can ignore these for some simple arithmetic…

Assuming:

1. that all overseas members pay the £105;
2. that there are 1,300 overseas members (taken from above: 2,800 members worldwide less the 1,500 UK members).

The total income from overseas members is 1,300 × £105 = £136,500

They declare their total fee and subscription income to be £287,922, so this leaves £287,922 – £136,500 = £151,422 as income from UK members. At £248 per fee-paying member, this gives a grand total of a mere 610 fee-paying members and 1,500 – 610 = 890 students — more student members than fee-paying UK members!

If some of the overseas members are also students and given free membership, that will affect the arithmetic, but not by a great deal. Say 50% of non-UK members were students, the same arithmetic gives 886 fee-paying UK members; still not very many compared to the total number of chiropractors in the UK.

Although these 890 students may well be members of the College of Chiropractors, they cannot register with the General Chiropractic Council and cannot call themselves chiropractors, so it’s difficult to see how the Privy Council could count them in trying to reach the 5,000 eligible members required or how they met the criterion of having “as members most of the eligible field for membership”.

The 610 are a mere 18% of UK chiropractors.

This is baffling.

Or maybe it’s easily explained — see Meddling, below.

3. Are their members qualified to first degree level? Only if you consider chiro qualifications to be worthy of being called first degrees. Apparently the Privy Council does.

4. Are they financially sound and able to demonstrate a track record of achievement over a number of years. I’ll leave that to you to decide.

Further information from the Privy Council tell us they have to hand over some of their independence to the Privy Council — for good reason —  as they explain:

Finally, both in the case of charities and professional bodies, incorporation by Charter should be in the public interest.

This last consideration is important, since once incorporated by Royal Charter a body surrenders significant aspects of the control of its internal affairs to the Privy Council. Amendments to Charters can be made only with the agreement of The Queen in Council, and amendments to the body’s by-laws require the approval of the Council (though not normally of Her Majesty). This effectively means a significant degree of Government regulation of the affairs of the body, and the Privy Council will therefore wish to be satisfied that such regulation accords with public policy.

5. Overall, is this in the public interest? Well…

What’s in a name?

So how do I know that a Royal Charter of Incorporation doesn’t allow an organisation to use the word ‘Royal’ in it?

I asked the Privy Council and was told:

 The grant of a Charter does not entitle the body concerned to use the prefix ‘Royal’ in its title.

Plain and simple.

This is also made very clear in the Chiropractors Draft Charter:

Meddling

It looks like it’s been a long and winding road for the College.

In 2004, in an address to the College, Michael Dixon, Chair of NHS Alliance (which is not part of the NHS) and now also Chair of the College of Medicine, predicted:

Indeed, you have made chiropractic orthodox, in the best sense of the word and I believe that it will be a very small time before this is the Royal College of Chiropractors.

A bulletin, issued by the Council of the General Chiropractic Council on 5 September 2007, stated:

College of Chiropractors’ bid for Royal Charter status
Council re-iterated its warm support for the College’s application to the Privy Council.

Why a statutory regulator was concerning itself with — and indeed supporting — the internal affairs of a trade body of just some of its registrants is anyone’s guess. It was within their remit to promote the profession up until 8 July 2008, but I’d have thought that should have been done in a non-partisan way.

Liberal Democrat MP Mike Hancock tried to gather support for this move in 2008 from both the Secretary of State for Health and the the Secretary of State for Lifelong Learning, Further and Higher Education, asking, in the House of Commons, if they would support this application. They, of course, declined, pointing out it was a matter for the Privy Council.

The Privy Council Order itself states:

The minutes of a meeting of the Council of the General Chiropractic Council on 17 February 2010 stated:

The application [by the College of Chiropractors] for the Royal Charter was unsuccessful, but the initiative is still alive and when the time is right a further application will be made.

Unfortunately, we don’t have details of why they failed on this occasion.

But why has it now been granted? After previous attempts and low membership numbers, what changed the Privy Council’s mind?

An FOIA response from the Privy Council to a request by Prof David Colquhoun provides the answer:

I can confirm that the College of Chiropractors petitioned for a Royal Charter in August 2007 and the case has be in and out a abeyance a couple of times [sic]. The grant of the Royal Charter on 7th November followed a letter of support from Department of Health dated 26th September 2012 to the President of the College to say the Department would be advising the Privy Council that the College’s charter application should be taken out of abeyance. (My emphasis)

So, despite the College failing to meet the requirements set out by the Privy Council, it was interference in that process by the DoH that produced the Royal Charter a mere six weeks later.

Once we have that letter, we’ll let you know what it says.

Meddling, anyone?

The Royal College of Chiropractors?

Now that the College has its Royal Charter of Incorporation, might it now be applying to use ‘Royal’ in their title?

The Privy Council told me:

The grant of permission to use the prefix ‘Royal’ in the title of a Company or Organisation is not dealt with by the Privy Council Office.  Applications are processed by the Constitutional Policy Team, Parliament and Constitution Division.

This is confirmed here. Although Nick Clegg seems to have a say in this as well, I assume the Queen is consulted. Given the predilection of some members of the Royal Family for all things pseudo scientific, the Queen may be well disposed to grant this false imprimatur to them.

Have they applied? I’m waiting to find out and I’ll let you know when I do.

Parity?

The Officer of the College of Chiropractors, Matthew Bennett, tried to assert that their Royal Charter put them on a similar footing to the other Royal Medical Colleges. Their President, Tim Jay, tried to assert that chiropractic now had parity with other health bodies in the field of musculoskeletal health.

As we now know, the Royal Charter does no such thing.

Looking at other grantees of Royal Charters, we see it simply puts them on a par with the likes of:

• London Homoeopathic Hospital
• The Worshipful Company of Launderers
• The Worshipful Company of International Bankers
• Worshipful Company of Builders’ Merchants
• Society for Promoting Christian Knowledge
• Worshipful Company of Basketmakers
• The Worshipful Company of Marketors
• Basildon Borough
• Girl Guides Association
• The Worshipful Company of Tax Advisers

No offence to members of these esteemed organisations.

Acknowledgements

Thanks to Blue Wode for help with the research and providing critical feedback.