Homeopathy and the NHS

Part of the debate – in Westminster Hall at 11:21 am on 29th March 2017.

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Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health 11:21 am, 29th March 2017

It is a pleasure to serve under your chairmanship, Mr Hanson. I congratulate my hon. Friend David Tredinnick on yet again leading the charge—we have debated this issue in various parts of Parliament—and on securing this debate in close proximity to Homeopathy Awareness Week, which starts on 10 April. He normally corresponds with my colleague, the Minister for Public Health and Innovation. I apologise that he has to put up with me today, but I will do my best to address the points he raised and set out as specifically as possible the Government’s and the NHS’s position on homeopathic remedies.

The Government have no particular position on the efficacy or not of any type of treatment, but we have a position on evidence-based medicine, and I will come on to talk about how we expect an evidence base to determine how we spend public money. There is an acceptance that there is great popularity for some parts of this medicine across the world, as my hon. Friend said. The Government have no particular control over how people spend their money in terms of these treatments. He was involved in the Walker report and review, which put in place a regulatory environment involving the Professional Standards Authority system and the voluntary lists for that.

As well as that popularity-led issue, there is the issue of how we spend public money in the NHS. I will come on to that process, but it is about the evidence base. It is right that there is a method of evaluating competing drugs, technologies and treatments. I will come on to talk about that and what it means in this context. We have no overall position on this issue. My hon. Friend made a good point about the over-prescription of antibiotics. He said that, in certain areas, homeopathic remedies may be an alternative.

I used the phrase “evidence-based medicine”, which means that the medicine is clinically cost-effective. Typically, the drugs that are used across the NHS are subject to trials—possibly lasting many, many years and involving large populations, statistically clear correlation and all that goes with it. A requirement of those drug trials is that their results are not anecdotal, but clearly repeatable. The drugs must demonstrate efficacy. When the National Institute for Health and Care Excellence evaluates them, it uses a threshold to measure their cost versus the quality of life and the years that are obtained by their use. Precisely the same criteria would be applied to any homeopathic or alternative remedy; they would be evaluated in that way. The Department’s position is that medicine must be evidence-based. Within that constraint, we use what the evidence tells us to use. For non-NHS expenditure, it is up to the public to buy what they wish, provided it is safe. There are some controls, and if I have time I will talk a little about the Walker review and what the controls are.

The NHS’s commissioning power is set locally by CCGs, which are GP-led. They set out their policies, in terms of what the CCG uses, but as they do that we expect them to be advised and informed by best practice and, where they are available, by NICE guidelines. Within that, GPs have considerable discretion. As my hon. Friend knows, some GPs still prescribe such remedies, where that is permitted by the CCG. That is not something that the Government have chosen to interfere with, although the drive towards evidence-based medicine means that over the past decade the amount of prescribing has decreased considerably. Last year, something like 9,000 separate prescriptions were made in primary medicine at a cost of about £100,000. A decade ago, the figure was nearer £150,000. That decline has been driven not by a Government diktat, but by our requirement that all CCGs use an evidence base for their decisions.

My hon. Friend gave various views about the evidence base. In 2010, the House of Lords Science and Technology Committee said:

“There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious.”

More recently, NICE said that it is not aware of any evidence that demonstrates therapeutic effectiveness, and it does not currently recommend that homeopathy should be used as a treatment for any health condition. As a consequence, there has been a tail-off in the use of such remedies.

I accept that, in certain circumstances, patients may feel that they have tried many other things, and a physician working with them might say, “Let’s have a go at one of these things. What have we got to lose?” As I say, it is not the Government’s job to stop a GP taking that position in that situation. Very often, that will be done in conjunction with a patient who, as my hon. Friend said, feels as though they have tried everything else, and will have a go at it as a last resort. It may well be that, anecdotally, it works, whether that is through a placebo effect or for whatever other reason. It is not the Government’s job to stop that.

In the last minute that I have, I want to talk about the Walker review, of which I think my hon. Friend was the vice-chairman—he certainly helped to inform it. A system of regulation was brought in. We have been talking about the potential need for statutory regulation of the use of such remedies outside the health service. The Walker review looked at a variety of issues with respect to such medicines and concluded that we should put in place a voluntary system of regulation accredited by the PSA—something of a middle way.