Complementary and Alternative Medicines
6:45 pm

Motion made, and Question proposed, That this House do now adjourn. -(Mark Tami.)

7:15 pm
Photo of David Tredinnick

David Tredinnick (Bosworth, Conservative)

I am grateful for the opportunity to address the House on this important issue and I am glad to see the Minister in her place this evening. I wish to consider the House of Lords Science and Technology Committee's report on complementary medicine 10 years on. I shall cover three points: regulation, how we can widen the number of therapies available in the NHS, and the case for more research.

The Committee first met in 1999 and its report states in section 5.53:

"The Osteopathic and Chiropractic professions are now regulated by law. It is our opinion that acupuncture and herbal medicine are the two therapies"-

which at this stage would most benefit from regulation. I shall start by considering the position of osteopathy and then of herbal medicine.

The Osteopaths Act 1993, mentioned in the report, has been a huge success, but there is a postcode lottery at work. Only 16 per cent. of primary care trusts allow GPs to refer patients to osteopaths on the NHS and an additional 25 per cent. allow GPs to refer patients in exceptional cases. That is wrong, and I ask the Minister to address the problem. Where osteopathy is used in the NHS, its use increases year on year, suggesting patient and GP satisfaction, so the barrier is in the approach of the primary care trusts.

The Minister will be aware that the report from the Department of Health steering group on the regulation of acupuncture, herbal medicine and traditional Chinese medicine was published on 16 June. This followed the work done by Professor Pittilo and the late Lord Chan on herbal medicine and Chinese medicine respectively. The report recommended that in the interests of public health and patient safety all practitioners should be required to attain high standards of competence through the Health Professions Council as soon as practicable.

The Government responded by launching a consultation that will seek views on whether a regulatory system should be established. What is the position of that consultation? I suspect that it has been pushed gently into the long grass. The regulation of traditional Chinese medicine, acupuncture and herbal medicine has been a long and arduous process on which many people have worked-I have met many of them-and we need to know whether the Government are still committed to the process. What is the likely timetable? If nothing happens, we will soon be in the ludicrous situation of the herbal medicinal products directive coming into force in 2011 without appropriately regulated practitioners.

Another issue that we need to address this evening is homeopathy. Section 5.50 of the report says that therapies should be able to seek statutory regulation, and homeopathy is the one therapy in group 1 in the report-the Minister will remember that there are different classifications-that is not statutorily regulated. I am informed by the Society of Homeopaths, which is the largest organisation representing non-medical homeopaths, that there is a move towards statutory regulation through the Health Professions Council. Will the Government look favourably on that application?

Homeopathy has had a long tradition in the health service; it was actually used by Aneurin Bevan-all those years ago-who helped to put it in the health service. However, homeopathy has been under attack, despite the new Royal London Homeopathic hospital. The hospital and those who support homeopathy have faced difficult times, not least the attacks by the so-called scientific establishment and a letter that purported to come from the NHS-it had the NHS logo on it-in May 2007 which was signed by many retired professors of medicine. That letter should never have been sent out under the NHS letterhead.

Attacks have also been made on the efficacy of homeopathy. A letter was sent to the World Health Organisation warning against the use of homeopathy, but it ignored the very clear randomised, double-blind trials that proved that it is effective in the particular area of childhood diarrhoea on which it was criticised. Will the Government therefore be robust in their support for homeopathy and consider what can be done so that it is used more effectively in the health service?

There are also serious problems in chiropractic, which one might call an assisted discipline to osteopathy. The General Chiropractic Council has been bombarded by complaints from bloggers-spurious complaints I would say-which it is obliged by law to investigate. I am very concerned that genuine complaints will not get through and that any practitioner against whom a genuine complaint had been lodged could continue to practise. Will the Minister look at this very unsatisfactory situation, which arose following an individual losing a court case against the British Chiropractic Association?

I would like the scope of complementary and alternative medicine to be widened. Way back in 2001, when I spoke on this subject, I quoted a Minister as saying in Committee that:

"Services that were considered outlandish several years ago are now almost considered to be part of conventional health care".-[ Official Report, Standing Committee G, 6 June 2000; c. 81.]

That was in 2001. Now we have a situation in which we can move on even further. The Government have done well with the guidelines from the National Institute for Health and Clinical Excellence that allow for osteopathy and chiropractic for lower back pain. That is definitely a step in the right direction. It has come about only because of the rigorous research carried out, resulting in acupuncture and, as I said, osteopathy and chiropractic being made available.

We now need to bring in other therapies and to ensure that they are made available. That can be done in different ways. The Complementary and Natural Healthcare Council has been set up to regulate some therapies, such as massage therapy, nutritional therapy, reflexology and aromatherapy. However, the numbers are less than expected. Can the Minister help in any way by publicising the benefits of this council to those who might join it?

The Science and Technology Committee reported in four sections. I shall not go through all the different categories, but all those listed-I have reviewed them all-have some validity.

Before turning to research, I want to focus on ethnic treatments, which are used by many people in this country. I am thinking of Chinese and Ayurvedic medicine. I want to look at how they are part of those cultures and at how those cultures look at the sky as part of their medical disciplines. Chinese medicine is closely aligned to feng shui, which is popular in this country and has a sub-discipline called "right directions", and it relies on Chinese astronomy and astrology. I was on the last parliamentary delegation to Hong Kong before we gave it back to the Chinese, where I met Chris Patten's Chinese astronomer and astrologer-it was important to the Chinese that he should have one. Ayurvedic medicine also has a long tradition of looking at astronomical and astrological factors, and Lahiri is the official astrological system of the Indian Government.

In 2001 I raised in the House the influence of the moon, on the basis of the evidence then that at certain phases of the moon there are more accidents. Surgeons will not operate because blood clotting is not effective and the police have to put more people on the street.

I am arguing for more research. I have been criticised for raising the subject, but the criticism is generally based on a misunderstanding. It is based on the idea that I am talking about the stuff that we see in the newspapers about star sign astrology, but I am not. I am talking about a long-standing discipline-an art and a science-that has been with us since ancient Egyptian, Roman, Babylonian and Assyrian times. It is part of the Chinese, Muslim and Hindu cultures. Criticism is deeply offensive to those cultures, and I have a Muslim college in my constituency.

The opposition is based on what I call the SIP formula-superstition, ignorance and prejudice. It tends to be based on superstition, with scientists reacting emotionally, which is always a great irony. They are also ignorant, because they never study the subject and just say that it is all to do with what appears in the newspapers, which it is not, and they are deeply prejudiced, and racially prejudiced too, which is troubling.

Over the past few years I have looked at the issue in detail, as well as at the impact of astronomy and astrology on western herbalism, as taught by Culpeper, whose book "Culpeper's Complete Herbal" has been in print longer than any other book in this country besides the Bible. There are now people who teach, such as Jane Ridder-Patrick, who published "A Handbook of Medical Astrology". They look at aspects of the subject and how it affects people's health. Whatever one believes personally, the issue is one that we should look into and consider. We must get away from this awful, mediaeval superstition.

Finally, I want to appeal to the Minister to fund a little more research. Research into complementary medicine is usually done with individuals, but I am seeking perhaps £5 million and for the research to be placed with the King's Fund, or perhaps another body, for use in universities. It takes about £125,000 to fund a trial. At the moment we just do not know how effective some complementary medicines are in surgeries where different therapies are used. The Government have helped and some useful steps have been taken, but if we are really going to understand the best way of using such therapies, which are increasingly popular, we need more research. I appeal to the genial nature and the good judgment of the Minister to help in this way.

7:28 pm
Photo of Gillian Merron

Gillian Merron (Minister of State (Public Health), Department of Health; Lincoln, Labour)

I congratulate David Tredinnick on securing this debate on the important matter of complementary and alternative medicine, which was the subject of an important report by the House of Lords Science and Technology Committee, which the Government welcomed at the time and responded to in 2001.

I hope that the hon. Gentleman, whom I listened to carefully, will find it reassuring that the Government's position on complementary and alternative medicines, which I shall refer to as CAM, is the same as our position on mainstream medicines. First, decisions about care are best made by clinicians on the ground. Doctors and health professionals are best equipped to make the right choices for their patients, and local NHS services are best placed to decide which treatments will benefit their communities best. Secondly, the decision to embark on any course of treatment has to be made on the basis of robust clinical evidence. That means clinical trials, peer-reviewed papers, and guidance from the National Institute for Health and Clinical Excellence. Thirdly, the way in which the Department funds new research is through the National Institute for Health Research. The NIHR provides substantial funding for a wide variety of studies that meet strict scientific criteria and that reflect the needs of the national health service. Finally, we should always be open to new methods and ideas. That means using the NHS's world-leading innovation and research facilities to ensure that health professionals get the latest and best clinical information, and that patients get the best, safest care available.

I want to address the main points that the hon. Gentleman has raised. On the question of research, as he has pointed out, the Lords Select Committee report made recommendations on strengthening the evidence base and investing more to encourage new research. The Department of Health is one of the largest mainstream UK funders of research into CAM. It is investing record sums in health research in general, with the NIHR spending nearly £1 billion in 2010-11. Our research strategy, Best Research for Best Health, is being delivered by the NIHR and has resulted in significant new funding opportunities for health research. A number of awards have been made in the past year or so in support of studies directly concerned with demonstrating whether specific CAM therapies work and whether they represent good value. That builds on the 100-plus projects that were funded in the past 12 years and recorded in the national research register.

Current projects funded by the NIHR include a £1.3 million study into the effectiveness and cost of acupuncture, a £500,000 clinical trial into acupressure for the control and management of chemotherapy-related nausea and a clinical trial looking at the use of self-hypnosis by pregnant women to reduce pain and anxiety during labour. In each case, these awards have been made following rigorous peer review and in open competition.

The Government also run a £3.4 million award scheme, which has supported 18 researchers, including those engaged in post-doctoral studies. They have completed a number of reports on topics ranging from acupuncture to Chinese medicine. In addition, the Department has funded research on the role of CAM in the care of cancer patients, and on the use of complementary medicine in primary care. It is safe to say that, if CAM researchers continue to come up with high quality proposals, there is no reason why they should not continue to attract NIHR support.

The hon. Gentleman also referred to the roles that astrology and astronomy can play. I acknowledge that some forms of complementary and alternative medicines and thought consider that there is a link or relationship between astrology and their practice. An example is Indian ayurvedic medicine. I would say to him that, with this as with any other CAM, any proposals for research would be considered on their merits.

The hon. Gentleman also raised the matter of access to CAM therapies. I confirm that we are committed to providing the most appropriate and effective treatments for patients. Complementary and alternative medicine therapies that have been proven to be effective, cost-effective and safe will be made available to patients. As he will know, it is a matter for local NHS organisations to commission health care treatments for NHS patients, as they are best placed to make decisions in the interests of their local communities. Primary care trusts manage 80 per cent. of the national health service budgets, and they are responsible for making the decisions on what treatments to commission and fund. They often have specific policies on the commissioning and provision of CAM. Within these policies, GPs can give access to specific therapies, provided that they are in the patient's interest. If someone wishes to receive a specific CAM treatment on the NHS, they should discuss this with their GP. Clinical responsibility for an individual's health rests with their GP, who must be able justify to clinically any treatment referral.

I want to address the National Institute for Health and Clinical Excellence guidelines on complementary and alternative medicines. NICE has already agreed that where there is sufficient evidence to look at specific complementary therapies when developing clinical guidance for particular conditions, it will do so. The guidance focuses on a particular illness or condition rather than on the treatment or therapy. A good example are the recent guidelines produced by NICE on the management of non-specific lower back pain, of which I know the hon. Gentleman will be aware. These guidelines include consideration of treatments such as osteopathy, spinal manipulation and massage. NICE has already issued guidance on whether some complementary therapies do or do not add benefit in respect of specific conditions, including multiple sclerosis, antenatal care and palliative care.

The hon. Gentleman raised a number of important points about the regulation of CAM. Regulation, whether it is statutory or voluntary, is primarily, of course, about patient safety. It is our duty to protect the public from poor or potentially unsafe practices. I note the hon. Gentleman's point about osteopathy and chiropractic treatments, which are currently regulated by law. Any future review of regulation would most likely examine whether the current arrangements are the most cost-effective way to manage public safety. No decisions have yet been taken.

The Government have no current plans to extend statutory regulation to homeopathy. The hon. Gentleman raised concerns about a document recommending disinvestment from homeopathy, which was circulated using the NHS logo. I can confirm that our inquiries found no record of the Department having authorised the use of the NHS logo and that those who originated the document were asked not to circulate it any further. They were advised about the use of the logo in future and chief executives of trusts were also informed that the document does not represent Government policy.

Although we have committed to considering statutory regulation for herbal medicine and acupuncture, which carry significant risk because they involve skin piercing and/or the ingestion of potentially harmful substances, we have no current plans, as I have said, to include homeopathy. To clarify, that is because statutory regulations are a priority, I believe, for those conditions where there is a particular risk of harm if treatment is placed in the wrong hands. A consultation has been launched on whether practitioners of acupuncture, herbal medicine and traditional Chinese medicine should be regulated by statute. It closes on 2 November this year, and we will respond in due course.

Other schemes that the Department supports include the Medicines and Healthcare products Regulatory Agency's new traditional herbal medicines registration scheme, which will make it easier for consumers to identify regulated products. We will also continue to support the work of the Complementary and Natural Healthcare Council, and we have funded its start-up costs. The CNHC is a voluntary registration body that is open to massage, nutritional, aromatherapy and reflexology therapists. It will open to more therapies in due course. Registration means that the practitioner has met certain entry standards, including accredited qualification, and subscribes to a set of professional standards. The Department meets the CNHC regularly to discuss progress.

CAM, of course, covers a wide range of disciplines, and I believe that it is right to keep our options open and to continue to support research into new therapies and treatments. It is also right that we choose and fund those treatments that are effective, cost-effective and safe. That decision must be based on robust clinical standards, backed up by rigorous and evidence-based scientific assessment. I thank the hon. Gentleman for raising such an important issue this evening.

Photo of David Tredinnick

David Tredinnick (Bosworth, Conservative)

I notice that we have a little time left. I am grateful to the Minister for her helpful response. A number of disciplines were mentioned and I could have referred to radionics, for example, for which a double-blind trial is almost impossible, yet it is very popular because people believe that it gives them the ability to get remote healing. We need to think out of the box here. As with healers who can do remote healing, it is no good people saying that just because we cannot prove something, it does not work. The anecdotal evidence that it does is enormous. I know that the Minister is a forward thinker, and I believe that the Department needs to be very open to the idea of energy transfers and the people who work in that sphere. Will she comment further on that?

Photo of Gillian Merron

Gillian Merron (Minister of State (Public Health), Department of Health; Lincoln, Labour)

I think we could all do with a bit of that this week. I thank the hon. Gentleman for his offer.

As I said earlier, and as the hon. Gentleman knows, the Government do not take a position on specific complementary and alternative medicines. That is left to GPs and local health centres. I think that that is right, but I also think it right for us to provide the information to which I have referred. Let me recap briefly: we provide information on safety, clinical effectiveness, cost-effectiveness and the availability of suitably qualified or regulated practitioners, and I think that that puts us in about the right place.

As I was saying, the hon. Gentleman is a great ambassador and is very knowledgeable about this subject.

Photo of Gillian Merron

Gillian Merron (Minister of State (Public Health), Department of Health; Lincoln, Labour)

And I think that the House will want to hear a further intervention from him.

Photo of David Tredinnick

David Tredinnick (Bosworth, Conservative)

I am very grateful for the opportunity, Madam Deputy Speaker. Having been in the House for a while, I look for such opportunities.

I have mentioned the problems of negative information, particularly in the context of the Royal London homeopathic hospital and homeopathy generally, and of what is effectively an attack on a statutorily regulated body dealing with chiropractic. Will the Minister offer to look into the position, and perhaps write to me about both the state of the Royal London and the disinformation that has been issued and the chiropractic regulatory council?

Photo of Gillian Merron

Gillian Merron (Minister of State (Public Health), Department of Health; Lincoln, Labour)

I think that that intervention demonstrates why it is so important for the Government to take the position of not being for or against specific complementary and alternative medicine, and-as I said at the beginning of my speech-treating it in the same way as mainstream medicine. I am aware of the other matter that the hon. Gentleman mentioned, but obviously neither I nor the Government can control what people put in blogs or letters. What we can do, I think, is rise above it, and I believe that that is what we have done by providing the information that we have provided.

I thank the hon. Gentleman for initiating the debate. He has made a great contribution and a strong case for the views that he holds, and I know that the House will be grateful for that.

Question put and agreed to.

House adjourned.