Integrated Health Care

– in the House of Commons at 10:00 pm on 2 June 2010.

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Motion made, and Question proposed, That this House do now adjourn. -( Miss Chloe Smith .)

Photo of David Tredinnick David Tredinnick Conservative, Bosworth

I count myself lucky to have secured this debate on the day that we have debated health matters in the Queen's Speech, and to discuss integrated health care for the first time in this Parliament. I am fortunate to be- [ Interruption. ]

Photo of John Bercow John Bercow Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Speaker of the House of Commons, Chair, Speaker's Committee on the Electoral Commission

Order. I apologise for interrupting the hon. Gentleman. This has been a stimulating and, for many, a rewarding day, but if Members who are leaving the Chamber could please do so quickly and quietly, the House will benefit from the words of the hon. Gentleman.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth

I am flattered to have the Secretary of State for Health on the Front Bench, the shadow Secretary of State for Health on the Opposition Front Bench and, to my left, a former Secretary of State for Health, my right hon. Friend Mr Dorrell. It is perhaps pertinent that it was him-then the Member for Loughborough-who, as an Under-Secretary, first made it possible for GPs to refer patients to practitioners who were regarded as complementary and alternative, if they took clinical responsibility. That was the Conservative policy that he instituted way back in 1990.

This debate fits so well with my right hon. Friend the Secretary of State's determination that, in the words of Queen's Speech,

"The voice of patients and the role of doctors will be strengthened".-[ Hansard, 25 May 2010; Vol. 510, c. 31.]

This evening I would like principally to address three related issues: the situation regarding homeopathy and homeopathic hospitals; the regulation of herbal medicine and acupuncture; and the consideration of other available models, particularly in Australia and the United States.

Let me start by welcoming my hon. Friend the Under-Secretary to her place. In a sense, this was an integrated health care general election, because the arch-opponent of anything to do with non-orthodox medicine, the former Member for Oxford West and Abingdon, was defeated and the gentleman who stood against me on an anti-alternative medicine ticket lost his deposit. That was because people are increasingly in favour of having alternatives in the health service. Indeed, 50% of the population have at some stage tried one form of integrated health care or another-acupuncture, herbal medicine or homeopathy-or a back treatment.

The Secretary of State's proposal for an independent national health service board to allocate resources, provide commissioning guidance and allow GPs to commission services on behalf of patients is the ideal vehicle to give guidance. The first point that I would like to make to my hon. Friend the Under-Secretary is that the new board, when instituted, should offer guidance, through the primary care trusts, on what is available in the health service and stress why integrated health care is so important, for which I would suggest there are three principal reasons. First, people often turn to the alternatives when mainstream medicine has not succeeded. Secondly, conditions often fall into what is known as the effectiveness gap-that is, a category that conventional treatment is unable to help. Thirdly, people might not have benefited from conventional treatments or they might have experienced adverse effects owing to drug reactions.

Another important point, which fits the new coalition Government's proposal for cost-effectiveness, is that the alternative disciplines-herbal medicine, aromatherapy, homeopathy, osteopathy, chiropractic-are very cost-effective. They are often cheaper than other treatments and, if used in conjunction with mainstream medicine, can be very effective in reducing the effects of heart disease, asthma, back pain and stress, for example. An integrated approach will offer my hon. Friend the Minister and my right hon. Friend the Secretary of State new weapons in the armoury of health care.

In the past few years, there has been a concerted attack on the homeopathic hospitals in this country, which go back to the formation of the health service, and on homeopathic treatments generally, on the ground that the science is weak and does not demonstrate that they are effective. This has manifested itself in bogus Department of Health circulars, in the fact that the British Medical Association's conferences have tabled motions on the subject, and in the Science and Technology Committee's recent highly controversial report claiming that homeopathy was a placebo.

The effect of that has been to reduce the number of referrals from primary care trusts in London, particularly to the Royal London Homeopathic hospital. Glenda Jackson took up that matter. In other parts of the country, pressure has been put on training. I encourage my hon. Friend the Minister to make a statement tonight that the Government are supportive of the homeopathic discipline, as they said they were before the general election.

The problem with the report that the Science and Technology Committee produced was that it did not take evidence from primary care trusts or from the Society of Homeopaths, and it ignored completely the evidence from abroad, which shows a greatly increased use of homeopathic treatments. For example, in France, homeopathy is taught in seven medical schools and practised by 25,000 doctors. In India, it is part of the health service. There are 180 colleges teaching homeopathy there, and more than 300,000 practitioners. Whatever the merits of the scientific research, the fact is that there are 500 doctors in Britain who choose to use homeopathic treatments as part of their work. Whatever the science says-whether it is proven or not-those people believe that homeopathy works, and that is important.

The costs involved are absolutely minimal. The cost per year to the national health service of homeopathic medicines is £152,000, out of a budget of £11 billion. Over the three years from 2005 to 2008, the hospitals themselves cost the nation £12 million-£4 million a year. These are very small costs, and we really need to take that on board. We must also recognise that there are new approvals coming on stream. At Sao Paolo university in Brazil, homeopathic treatments have been found to be effective in treating depression, instead of Prozac, and the university of Texas has shown the positive effect of homeopathic treatments in killing cancer cells while maintaining good cells. There is a lot to look at there, and the message should be that doctors who wish to use these therapies should do so and should be free to refer. If we can get that simple message across, we will have performed a great service. I am of course speaking to my hon. Friend on the Front Bench.

The regulation of herbal medicine and acupuncture is a crucial area. The previous Government spent for ever debating the matter and calling various professors to look into it. They asked for more and more information, and the final recommendations, produced by Professor Pitillo and Lord Chan, were that these areas should be regulated by the Health Professions Council so that there could be an interface with European legislation next year. However, the recommendation of the outgoing Government was that these matters should be regulated by the Complementary and Natural Healthcare Council instead. I think that that would be a mistake; I believe that we should go for stricter regulation. All the other disciplines could join the 3,000 now registered on the CNHC register. That would be the way forward. Certainly, all the organisations in the field-including the Association of Traditional Chinese Medicine and the European herbal medicine and acupuncture societies-want statutory regulation.

Finally, I turn to deal with what is happening in the rest of the world. I have already referred to the fact that we should take note of the widespread and increasing use of homeopathy in France-I did not mention Germany -and India, while we should also look at what is happening in Australia, which has been a leader. In Australia, according to Government reports, 50% of the population are now using herbal or complementary medicines. There are a number of colleges where these disciplines can be studied and a Complementary Medicine Evaluation committee has been set up; the Australians also have a Therapeutic Goods Administration committee. Herbal medicines are considered by the TGA of Australia to be

"reasonably safe with less adverse reactions than conventional pharmaceutical treatment"- this is the big hint that we should look seriously at these treatments-and Sydney university has established the herbal medicines research and education centre

"to promote high-quality scholarship and research excellence in herbal medicines through teaching, research and international linkages."

In fairness to the former Secretary of State, Andy Burnham, who has just left the Chamber, I should say that he introduced a number of surveys, through the National Institute for Health and Clinical Excellence, which was a welcome development. I think, however, that my hon. Friend the Minister could do more, and I hope that she will. The Australian institutions were given a lot of money. I am not suggesting that there is a lot of money around at the moment, but if Australia can provide $4 million to start up and get going its National Institute of Complementary Medicine, it is something that we should also consider doing.

The other country way ahead of us is the United States of America, which now has a National Centre for Complementary and Alternative Medicine, the federal Government's lead agency for scientific research on complementary and alternative medicine. It is one of 27 institutes that make up the National Institute of Health in the US and it is statutorily regulated. The mission is to explore

"complementary and alternative healing practices in the context of rigorous science... train complementary and alternative medicine researchers and... disseminate authoritative information to the public and professionals."

It conducts research using scientific methods and advanced technologies to study CAM. I believe that we should follow that model.

During my time in the House, I have had the honour to chair and be an officer of the parliamentary group for integrated and complementary healthcare and the old parliamentary group for alternative and complementary medicine. Over a period of more than 20 years, we have seen these disciplines come in from out of the cold to complement and augment the wonderful work of our national health service. With our very liberal approach to empowering doctors and to giving patients greater choices in what they want, we have a great opportunity to draw on the wonderful resources we now have vested in our homeopathic hospitals, which offer many other treatments besides homeopathy, and in our 20,000 to 30,000 practitioners out there in the field who can offer herbal medicine and acupuncture.

The Minister now has a great opportunity to grasp the nettle and complete the great work that was started when my right hon. Friend the Member for Charnwood-originally the Member for Loughborough-agreed that doctors taking clinical responsibility could refer to these practitioners. We need to move 20 years ahead, and complete this process with statutory regulation for herbalists and acupuncturists, proper referrals and an acceptance that our 500 homeopathic doctors can refer patients if they want to do so. If we do that, my hon. Friend the Minister will be well remembered in years to come.


The subject of Statutory Regulation for Herbal Medicine, Acupuncture and Traditional Chinese Medicine has been a matter of intense debate amongst herbalists. The concept of statutory regulating this narrow band of therapies under "Protected Title" would have Traditional Western Herbal Medicine practitioners. Apart from anything else, this concept would have been highly divisive, in itself, and would have automatically created a two tier hierarchy in herbal medicine.

At present the ANH is preparing a case against the introduction of THMPD as being illegal under the European Treaty, precisely because of this consideration, as this in combination with the proposals for SR would effectively constitute an act of discrimination against a major part of the immigrant population on both cultural and religious grounds. These measures would also constitute a breach of the requirement enshrined in European treaties to protect cultural diversity. Here it should also be acknowledged that the Royal charter under Henry VIII protecting the practice of herbal medicine within the nations of which he was soverign formally recognized in law the already long established practice of traditional herbal medicine within English culture.

As has been pointed out in the debate, and there is a requirement, under the regulations of the Health Professionals Council, that any statutory regulated therapy should, amongst other things, produced evidence of efficacy within the prescribed criteria. It has also been well-established that the terms of reference for the officially accepted criteria for evidence of efficacy cannot be applied to traditional medicine which operates in a paradigm totally alien to that of allopathic medicine for which these criteria were developed. From this it follows that the HPC could only regulate these therapies by breaching its own rules and regulations.

The desirability of integrating Traditional Herbal Medicine within the NHS is itself a matter of considerable contention. Many of the most frequently presented problems, with which herbalist required to deal,are the toxic effects of allopathic medicine. Because of this, it is almost impossible to conceive of an approach that would integrate one form medicine with another which is seen as the cause of the majority of problems in the first place. Any move to curtail the right of any individual to use traditional herbal medicine could not but constitute a gross infringement of civil liberties and freedom of choice, particularly as so many medicinal flowers herbs and trees can be found growing on window sills, in gardens and throughout the countryside.

Because of the above, any notion of integrating traditional medicine within the NHS would not only be a disaster for traditional medicine itself through having vital components of its nature is eliminated for the sake of conformity with an inapplicable regime of evidence of efficacy, but it would also involve the imposition of an unacceptable degree of Draconian oppressive regulation.

One of the major (but totally misleading) arguments that has been put forward in support of statutory regulation, has been the erroneous belief that such a provision would have prevented the serious toxic side-effects that have been caused by some imported Traditional Chinese Medicine manufactured products. The problems that have arisen with these products has for the most part been the result of their contamination with a highly potent biochemical components that were not listed within the ingredients. As it has been put forward that an approved level of regulation of the practitioner would allow him/her to continue to have access to unlicensed (and therefore potentially dangerous) herbal medicine products over which the practitioner has no control, it can be demonstrated that such a course of action would actually put the public at risk said providing them with a modicum of protection. There have been no reported instances of any serious problem arising from the use of traditional herbal medicine other than TCM. Such problems that have arisen TCM have originated outside this country.

It is therefore totally inappropriate to "punish" all forms of traditional herbal medicine because of the aberrant practice of Chinese manufacturers. Here we are reminded that in very decent history there has been a major panic over the contamination of Chinese manufactured baby milk, when low-grade milk was intentionally contaminated with a toxic protein in order to raise the protein reading of the product to enhance its market value. The only imagined offence against this sort of danger would be the licensing and close control of imported Chinese herbal medicine products. Such a move might of course be seen as constituting a barrier to free trade and give rise to adverse reaction by the Chinese government. As China is seen as an area of major export potential, the political and economic fallout might be seen as unacceptable. This particular aspect might be seen as "the elephant in the corner" but it should not be permitted to colour the argument of the appropriate level of regulation for herbal medicine or the licensing requirements for manufactured products, which is after all a completely separate, although indirectly associated subject.

As mentioned in a House of Commons debate, homoeopathy has also been completely misrepresented. Again this extremely valuable and effective method of treatment might be seen as challenging the dominance of allopathic medicine. I am well aware of a charity based project, currently running in Africa, which is proving to be highly effective in the treatment of AIDS sufferers. Apparently direct example is not excepted as evidence of efficacy. It is therefore a matter of no surprise that some allopathic practitioners, in line with some herbalists, have tried to pursue the path of statutory regulation, in the belief that regulation would denote some form of official recognition and approval. As was clearly spelt out in the report from the Working Group on Extending Professional Regulation, regulation does not denote any concept of recognition or approval for the regulated therapy. This whole subject has become lost and confused in a maze of conflicting dis-information. None of the proposals put forward to date could do anything other than bring forward a great harm to the future health provision of the British people.

Robert Scott (author of Decoding Myth-Information)

Submitted by Robert Scott

Photo of Anne Milton Anne Milton The Parliamentary Under-Secretary of State for Health 10:14, 2 June 2010

I congratulate my hon. Friend David Tredinnick on securing this Adjournment debate on complementary and alternative medicine and integrated health care-a subject that I know is close to his heart. His continued interest and continued efforts to raise the matter in this House, as well as his determination to keep the issue alive and uppermost in our minds, is legendary. He commented himself on his 20 years of campaigning on this issue. It is important to note that it is the efforts of individual Members-their continued efforts, sometimes against the odds-that keep these issues uppermost and alive in our minds.

My hon. Friend may be interested to know that although I trained as a nurse and worked in the NHS for 25 years in conventional medicine, my grandmother trained at the homeopathic hospital in London, and was herself a homeopathic nurse. Later, she became a Christian Scientist. I am therefore not without my own roots in alternative therapies. My hon. Friend may also be interested to know that my grandmother never, until her death at the age of 89, took any conventional medicine.

My hon. Friend raised the issue of homeopathic hospitals and his concern about them. I understand that there are five such hospitals in the United Kingdom, based in London, Bristol, Tunbridge Wells, Liverpool and Glasgow. However, the Tunbridge Wells homeopathic hospital stopped providing services in March 2009 owing to the primary care trust's decision to end funding. All the hospitals have experienced a reduction in the number of referrals over the past three years, and it has been claimed that all of them are now in a precarious position as a result of such significant funding losses. That is a matter of concern, given that they have clearly offered valuable treatments to patients.

My hon. Friend said that a number of people turn to alternative therapies when they have either been failed by conventional medicine or have adverse responses to it. Although he referred to the current position, it may help if I make some more general points connected with our approach to health care.

Decisions about patient care are best made by clinicians. Local practitioners are best equipped to decide which therapies will ensure the best outcomes for individual cases, and are best placed to decide which services can cater for their areas' health needs-in conjunction, of course, with patients themselves. The Government's role in all that is to empower patients and professionals to take control of the funding and provision of health services in their areas, to encourage further research on new treatments and therapies, to support the local NHS by providing information on the clinical effectiveness and cost-effectiveness of various treatments, and, of course, to protect the public by ensuring that those treatments are safe. We do that through the National Institute for Health and Clinical Excellence, which is responsible for making recommendations on treatments to the NHS, and through the Medicines and Healthcare products Regulatory Agency, which is responsible for regulating the safety of medicines and treatments. The Government also encourage research on new medical treatments and technologies, primarily through the National Institute for Health Research. Research proposals are assessed in open competition, on the basis of scientific quality, and are subject to peer review.

My hon. Friend raised the issues of choice and cost-effectiveness. He observed that complementary and alternative medicines were often very cost-effective, and that the methods of treatment often involved limited invasiveness. It may be useful to deal with those two issues together, as they go to the heart of my hon. Friend's concern: the fact that PCTs are not commissioning or fully using complementary and alternative medicines.

As I stated earlier, we believe that local practitioners are best placed to make decisions about individual care, and that GPs are often most in touch with the health needs of their local populations. That is why it is so important that this Government will seek to give GPs more power to commission services, and patients more power to choose health care providers. By bringing together groups of general practitioners and giving them direct control over the health budgets of their patients, we will push the decision-making process closer to patients-closer to the heart of the problem. GPs will have the power to choose how to spend resources in order to achieve the best health outcomes, and we will ensure that PCT boards include directly elected individuals who can speak for patients at board level so that local people have a voice when decisions are made about local health provision.

Giving GPs more responsibility and more control over how NHS resources are used in their areas, and giving patients the power to choose any provider that meets NHS standards, will result in a health service that is not only more flexible, which is what my hon. Friend wants, but more responsive to patient need. As he will be aware, the decision to commit NHS resources cannot be taken lightly, especially during a period when the NHS as a whole must find considerable efficiency savings. Commissioners must be sure they are funding treatments that will result in the best health outcomes. That is what we all want. They must be sure of the safety, clinical and cost effectiveness, and availability and evidence in support of any therapy, and they must be sure that there are suitable practitioners in their area to deliver it.

The issue of regulation was raised, and it is a thorny one. When I was a shadow Health Minister, I met on numerous occasions psychologists, psychotherapists and counsellors who were very concerned about the regulation of their professions. Across the professions allied to health care, there are those who are keen on regulation and those who feel regulation would be wrong and would be unable to deal with the intricacies of their work. There is no doubt that vulnerable people are often preyed upon by unskilled and unscrupulous practitioners, and I think that professions wanting to achieve the highest standards will welcome proper regulation. The issue for Government is always whether statutory regulation is the most appropriate way of dealing with that risk, or if a lighter-touch approach would be more appropriate. That is why, as I understand it, last year the Department of Health, along with devolved Departments, consulted on the regulation of practitioners of acupuncture, herbal medicine and traditional Chinese medicine. As my hon. Friend will be aware, the consultation closed in November, and more than 6,000 responses were received. The high response rate is a testament to the strength of feeling about public access to complementary and alternative medicines; I am sure I am not alone in having received a huge number of letters on the subject.

The consultation examined in detail the options for regulation, including alternatives to statutory regulation. Once the Government have considered the consultation responses, we will make clear the next steps in the regulatory process. In acknowledgment of my hon. Friend's keen interest in the matter, I am very happy to keep in touch with him about it. In the meantime, the Complementary and Natural Healthcare Council provides for voluntary registration for practitioners from nine complementary therapy disciplines. I appreciate that my hon. Friend feels that that is not sufficient, but that is in place for the moment while we consider the consultation that has taken place and make a decision on what the next steps should be.

I note my hon. Friend's comments on the Lords Science and Technology Committee report on homeopathy, and I am aware that it caused quite a lot of concern. It was published on 22 February, and we are still considering it and will formally respond in due course. He raised considerable concerns about the report, and highlighted the low cost of many alternative therapies and the important contributions they make. He also made reference to experiences from around the world-he mentioned Australia in particular, and also the USA-and he made an important point about the open-mindedness of some countries to alternative therapies.

In considering outcomes, patient-reported outcome measures must be an important factor. As my hon. Friend rightly said-and as I mentioned-individuals' own experiences are very important, and if we want to achieve the best outcomes, one step we must take is to ask the patient whether they actually got better.

In conclusion, I wish to thank my hon. Friend for his contribution to the debate and to suggest that perhaps the picture is not as bleak as he fears-I noted a certain weariness in his voice; he feels that he has raised this issue on so many occasions and it has fallen on deaf ears.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth

As I have been in this position before, I was nervous that the Minister might sit down before I had the chance to make a final intervention. I wish to make one plea to her. I listened carefully to what she said in the past five minutes and I wish to suggest to her that it would be enormously helpful if the Department were to issue a circular to primary care trusts saying that it is not against these therapies and it is up to doctors to decide whether or not they can be used, that it has no bias against them and that it is leaving it to the clinicians to decide whether or not they wish referrals to be made to PCTs and on to hospitals. A great fog surrounds this issue. Nothing may come out of tonight's debate apart from the fact that we have discussed the matter, but it would be very helpful if she could consider issuing a direction saying, "It's over to you. We are not objecting to this."

Photo of Anne Milton Anne Milton The Parliamentary Under-Secretary of State for Health

I thank my hon. Friend for that intervention. As the new Minister in this post, I am hesitant to commit to things that I feel might be above my pay grade.

Photo of Anne Milton Anne Milton The Parliamentary Under-Secretary of State for Health

I think that I am quite right about that, because that sort of thing is, in general, a career-limiting move. I think that what my hon. Friend the Member for Bosworth is saying, what his concern is and why he feels that the picture is rather bleak is that he has encountered minds that are closed to alternative therapies. That will not be solved by the Government issuing directives, because a number of issues need to be considered, one of which is the training of doctors and those in other professions allied to health care. Our move towards GPs having more power and control, and towards their having the ability to commission services, will, in itself, loosen the ties on how they think about where the best treatment will be found.

I am sure that my hon. Friend will be pleased that acupuncture is used widely in pain clinics and even in some maternity services, and that the Department of Health continues to fund research into new treatments, through the National Institute for Health Research, and to award funding for studies into the efficacy and value of complementary and alternative medicines. The National Institute for Health and Clinical Excellence has already published guidance that refers to complementary therapies-for example, those relating to lower back pain, multiple sclerosis, antenatal and palliative care. Our approach to all treatments, be they complementary, alternative or mainstream, is the same. Treatments must be supported by robust evidence, and they must meet safety, quality, clinical and cost-effectiveness criteria. If they are then called for by clinicians on the ground, they should be, can be and will be used in the NHS.

Question put and agreed to.

House adjourned.