NHS

Part of the debate – in the House of Lords at 1:40 pm on 7th December 2006.

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Photo of The Countess of Mar The Countess of Mar Crossbench 1:40 pm, 7th December 2006

My Lords, that was a very salutary speech. Like other speakers, I am most grateful to the noble Lord, Lord Colwyn, for instigating this debate today.

I propose to restrict my speech to two subjects, both of which are described by their detractors as figments of patients' imaginations, so I hope that noble Lords will bear with me. As a result they suffer a lack of establishment support and a serious paucity of funding.

It is only very recently that we have debated the subject of homeopathy. I am raising the subject again today because our homeopathic hospitals are endangered. I do not intend to return to the pros and cons of homeopathy itself. There are five NHS homeopathic hospitals in the UK: in Bristol, Liverpool, London, Tunbridge Wells and Glasgow. All have been part of the NHS since its inception in 1948, though several have existed for over a century.

These consultant-led services are staffed by fully qualified doctors, nurses and other professionals who have additional training in homeopathy and other complementary therapies such as acupuncture. As is usual in the NHS, patients are referred by their GP or specialist. Homeopathic hospitals are a unique asset to the NHS for several reasons: they offer patients genuine choice of treatment by providing evidence-based, highly professional complementary medicine; although small, they are highly innovative—for instance, acupuncture for pain and complementary cancer care, both now widely available in the NHS, were pioneered by the homeopathic hospitals—and they have made important research contributions, such as researching "effectiveness gaps", conditions for which GPs lack effective treatments, and the outcome and cost-effectiveness of complementary medicine.

The NHS homeopathic hospitals help many patients who have been failed by other parts of the NHS, including those suffering from "effectiveness gap" conditions, complex chronic problems, or conditions difficult to label and for whom conventional medicine has proved ineffective or has associated serious side effects. The treatments they offer are complementary to, and integrated with, conventional medicine. Their practitioners are qualified health professionals working within the NHS and communicating with NHS colleagues. Surveys consistently show that 70 to 80 per cent of patients report benefit and around 90 per cent are satisfied with their treatment.

In the past, Governments have reaffirmed their commitment to homeopathy in the NHS, a commitment made originally by Aneurin Bevan. Now, local NHS commissioning and the financial crisis currently affecting the NHS have placed these unique assets at risk. Decisions to refuse funding, which affect patients' ability to choose their treatments, are being made to satisfy short-term financial needs by NHS commissioners with little understanding of the value the hospitals provide. There is concern that commissioners are encouraged in this by a series of high-profile, hostile leaks to the media. These include a leak of a draft of the Smallwood report by the distinguished economist Christopher Smallwood, who highlighted the potential for complementary therapies to provide cost-effective NHS treatment options, which was commissioned by the Prince's Foundation for Integrated Health. The leak appeared on the front page of the Times on 25 August 2005. There was also a letter attacking complementary medicine, which was sent to chief executives of all primary care trusts and leaked on 23 May 2006—again, on the front page of the Times.

While the long-term impact will be the irreversible loss of patient choice, which will leave many patients stranded—in particular, those whom conventional medicine has failed—the amounts of money involved are tiny. West Kent Primary Care Trust wishes to cancel its contract of £160,000 a year with the homeopathic hospital in Tunbridge Wells. This contract accounts for 50 per cent of the patients seen at Tunbridge Wells and its loss would make the service unviable. Local reaction has been very strong: patients have already delivered a 3,000-signature petition to the primary care trust.

Other homeopathic hospitals are facing similar decisions by PCTs seeking to reduce costs. This is being done in the absence of a cost-benefit analysis. Have the additional costs that will be incurred treating patients elsewhere in the NHS been calculated? Because of the fragmented nature of NHS commissioning arrangements, no one body has oversight of this or of the potential consequences of the irreversible loss of these small, unique units that punch far above their weight in terms of patient care, innovation and research.

I ask the Minister whether Her Majesty's Government are still as committed to the continued success of all four hospitals in England, and, if they are, what measures Ministers propose to protect them. Additionally, I seek an assurance from the Minister, already given to the House by two of his recent predecessors, that patients who have started a course of treatment paid for by the NHS, and which is clinically effective, will not have their funding withdrawn by reason of cost alone.

I hope that the Minister has received a copy of the report, published at the end of last month, entitled Inquiry into the Status of CFS/ME andResearch into Causes andTreatment. A group of MPs and Peers, of whom I am one, led by the Minister's honourable friend Dr Ian Gibson MP, read and heard a great deal of evidence from patients, carers, medical practitioners, researchers and others. We found that,

"there exists a serious disease, which causes much suffering for patients, which may be severe and incapacitating and which causes a multitude of symptoms".

We were concerned at the lack of interest shown in the UK in the very large number of peer-reviewed and published papers by researchers from other countries which demonstrated the organic nature of the illness. Instead, there has been a consistent bias towards the psychosocial/behavioural model of the illness promoted by Professor Simon Wessely and his colleagues. We noted that, while more than £11 million had been spent on psychosocial research in recent years, no funding at all had been awarded to at least 10 proposals for biomedical research. The recommendations of the Chief Medical Officer in his report on this illness published three years ago seem to have been totally ignored by the MRC. As well as calling for much more research into the biomedical aspects of the illness, we recommended,

"that this condition be recognised as one which requires an approach as important as heart disease or cancer".

My main reason for adding this section to my speech today is to draw the Minister's attention to our core findings, but I must also express my concern about a series of documents published on 4 October this year under the heading Occupational Aspects of the Management of CFS: A National Guideline. The details in these documents are truly worrying. In essence, they pre-empt the NICE guidelines, currently being finalised. They emphasise the psychosocial model and appear to imply that patients or employees should not be allowed to lie in bed at home or to avoid activity and should be persuaded to undertake a programme of graded exercise (GET) and cognitive behaviour therapy (CBT). There seems to be no differentiation between individuals who have symptoms of chronic fatigue associated with clinical depression—the noble Lord, Lord Layard, mentioned that—for whom these may be a solution, and those who have CFS/ME as described by the World Health Organisation's ICD-10, G93.3, which the Minister will recognise.

I know that at least four individuals whose writ appears to run through the Department for Work and Pensions and the MoD as well as the Department of Health, and who seem to have a consistent interest in preventing the acceptance of anything but the "it's all in your mind" model, have been involved in the production of the publications. May I ask the Minister how many doctors or other advisers who accept CFS/ME as a biomedical illness were involved, how much did the exercise cost, and what will be the standing of the documents once the NICE guidelines have been published?