Boo Armstrong is on a mission to bring free complementary therapies on the NHS to the whole of Britain. She has two pilot projects running in North London and says that, optimistically, she could achieve her mission within three years. She would have to be an optimist to believe it because the health service’s attitude towards alternative medicine is characterised by confusion, denial and ignorance.
It should be simple enough to ask what complementary therapies one can get on the NHS. But it is a lottery: some GPs dismiss alternative medicine but some are willing even to send you to a spiritual healer. Some would love to refer you for it but their local primary care trust, which holds the purse strings, won’t let them. The Government is strangely hands-off about complementary therapies. It does not want to introduce firm guidelines — and it certainly does not want to start trying to work out which complementary therapies are worth paying for with taxpayers’ money, and which aren’t.
Armstrong is the managing director of Get Well UK, which acts as a brokerage between GPs and complementary therapists. It has just received a £350,000 grant from Futurebuilders, which supports community-based charities that deliver public services. Armstrong started off running a charity offering low-cost alternative care to women in Camden, North London. “Then I started selling service contracts to local health services who did not know which complementary therapies worked for what ailments, what standards should be required and what they should cost,” she says. “I developed a brokering agency to enable the NHS to commission complementary care effectively.”
Her first pilot project opened in Haringey a year ago, and a new one opened in Islington in January. They offer local NHS patients five free therapies that the organisation believes are research-proven for a limited number of conditions: acupuncture, aromatherapy, homoeopathy, massage and osteopathy. The conditions they treat are: back and neck pain; headaches; depression; stress and tension; joint problems; and menstrual and menopausal trouble.
Professor Nicole Robinson, of Thames Valley University, is conducting a study of their patients six months after referral and this shows significant health improvements and reduction in worry, says Armstrong. “We plan to roll out the service nationally — optimistically that would take three years, realistically five years.”
A major obstacle will be NHS indifference. Her projects aren’t funded by primary care trusts. Instead they are paid for by New Deal regeneration money — cash given only on an annual basis. This reflects the lack of interest from the Department of Health and doctors’ organisations in developing ways to buy effective complementary therapies. A Sheffield University study showed that in 2001, 49 per cent of GPs in England gave access to some form of complementary therapy. No one knows whether this has grown or shrunk since primary care trusts took over commissioning powers from GP practices. No one has looked. That’s despite a decree from the House of Lords in 2000 that patients be given greater access to complementary therapies on the NHS.
The Royal College of General Practitioners did set up a committee to discuss GPs’ use of complementary therapies but Edzard Ernst, a committee member and the professor of complementary medicine at the universities of Exeter and Plymouth, says it never got off the ground: “There is no funding. We never met.”
Indeed, the RCGP’s press office did not know of the committee’s existence. Ernst calls this typical of Britain’s ad-hoc approach. “There is inconsistency right across the country. In Devon the primary care trust will pay for a spiritual healer. But you won’t get that in many other places. Doctors will often advise patients to see complementary therapists but say they will have to pay for it themselves.”
Because there is no national policy on complementary therapy pricing, quality or standards, we can’t know if the NHS is getting value for money, whether it works or if it is safe — because like cannot be compared with like.
“We need commissioning based on proper research,” says Ernst. “Very complex assessments need to be made by GPs about which therapies work for which conditions. This requires independent, transparent studies, rather than the simplistic, sledgehammer approach of sending patients to complementary therapists to ‘see if it works for them’. This does not do complementary therapy any favours in the long run.”
GPs have an acronym for this form of referral — Teeth: “tried everything else, try homoeopathy”. This may not change soon. The Government relies on the National Institute for Clinical Excellence to trawl research evidence for orthodox medical treatments to see if the NHS should provide them but it has no plans to do this for complementary therapies.
This leaves us largely paying for our own alternative care — without knowing if it is worth it. A 2003 survey by the Prince of Wales’s Foundation for Integrated Medicine found that we pay for 79 per cent of alternative care, at an average of £13.62 per month. The NHS pays for only about one in ten consultations.
This is not to deny that hotspots of innovation exist around the NHS. In April 2004, the UK’s first complementary cancer care assessment clinic opened at the Middlesex Hospital. The clinic advises patients with cancer on the complementary therapies that can be safely integrated into their conventional care. They can be referred to an NHS clinic offering homoeopathy, Reiki healing, acupuncture and shiatsu.
And we should not forget that the NHS has, since its inception in 1948, backed homoeopathy. There are five NHS homoeopathic hospitals in the UK. When the NHS Act was first debated, the Government said homoeopathy would continue to be available on the health service as long as there were “patients wishing to receive it and doctors willing to provide it”.
That spirit should live on: patients wish to receive complementary therapies, the NHS should provide them — but the health department must now start working to discover which ones are safe, effective and efficient.
