Complementary Medicine Roundup October 2018
by Richard Eaton
Should UK health and social care policymakers and managers do more to embrace Complementary and Alternative Medicine (CAM)? Do UK legislators fully appreciate the social and clinical value of CAM?
As the National Health Service (NHS) celebrates its 70th year and shortly after NHS England has recommended a ban to the commissioning of Homeopathic remedies and Herbal Medicine, it is important to address these questions and to remember there is evidence that CAM can and does deliver cost-effective and valued therapies within the UK health and social care sectors.
For some observations on the current and prospective status of the NHS, refer to the Alliance for Natural Health newsletter (04.07.18), to the King’s Fund publication The public and the NHS: what’s the deal? (25.06.18) and to the projects and blogs posted at the King’s Fund The public and the NHS.
According to Economist David Smith, a third of all spending on public services is on health (Source: David Smith’s EconomicsUK.com posted on 10.06.18).
In the interests not only of chronically understaffed and overworked NHS staff but also of their patients, an extensive research assessment is needed to discover the extent to which the existing and potential contribution of CAM is acknowledged by health and social care policy makers and management and by UK legislators, as is the case in many other jurisdictions.
WHO IS RECEIVING CAM AND WHY
As I have mentioned on previous occasions, informing NHS managers, policy-makers, clinicians and legislators about CAM is prejudiced by the lack of data about its use (refer to my December 2017 blog: THE NEED FOR STATISTICAL ANALYSIS OF THE USE OF CAM IN THE UK).
The reluctance of some professionals to embrace what CAM has to offer is evidenced in the research: Patient choice and evidence based decisions: The case of complementary therapies.
To place these institutional shortcomings into context, the event titled Complementary medicine popular across Europe (26.12.12; Record Number 35388) reported by the Community Research and Development Information Service (CORDIS, European Commission), advised:
‘…Surveys conducted in several European countries have shown a high demand for complementary and alternative medicine (CAM), as an increasing number of citizens seek relief for disorders they feel cannot be treated with conventional therapy. As many as half of those surveyed said they used alternative healthcare for their needs. The European Commission estimates that spending on CAM by consumers now tops EUR 100 million. There are currently more than 150,000 registered medical doctors with additional CAM certification…In Europe, there are more than 180,000 registered and certified non-medical CAM practitioners. This amounts to 65 CAM providers per 100,000 inhabitants, as compared to the EU figures of 95 general medical practitioners per 100,000 inhabitants…’
For a map of CAM provision in the EU search Cambrella, the pan-European research network for Complementary and Alternative Medicine.
To read an analysis about why CAM is a patient choice in primary care and for a description of the positive and negative reasons for patients using CAM therapies and for an explanation as to why these therapies may address important gaps in conventional medicine, refer to the article Complementary and alternative medicine and patient choice in primary care (Helen Barnett, April 2007). This article was published in Quality in Primary Care, an international peer reviewed journal for those researching, teaching or practising in the fields of quality improvement, clinical governance or clinical audit related to primary and pre-hospital care.
Details of a research study involving a survey of the use of CAM in 15 countries may be found in the abstract titled Prevalence of complementary and alternative medicine (CAM) use by the general population: a systematic review and update (Harris PE, Cooper KL, Relton C, Thomas KJ; October 2012), which concluded, among other things, that there was evidence of substantial use of CAM in those countries.
The 2012 research abstract titled Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review (Frass M, Strassl R P, Friehs M, Mullner M, Kundi M, Kaye AD) demonstrated that, from 1990 to 2006, there was an increase in CAM usage in all countries investigated, although with differences between the general population and medical personnel. The research data also demonstrated that chiropractic manipulation, herbal medicine, massage and homeopathy were the most commonly used treatments by the general population and that there was a higher utilization of homeopathy and acupuncture in Germany. Ailments most frequently associated with CAM treatments included back pain or pathology, insomnia, depression, severe headache or migraine and stomach or intestinal illnesses.
Many medical professionals, practising in the UK and elsewhere, are acknowledging the contribution made by CAM. Examine my June 2018 blog for further research abstract links relevant to their use and acceptance of CAM.
The following is an excerpt from the German Medical Journal “a view from the Doctor’s office in America” (13.04.18) [Note: a translation is available]:
‘…many patients feel abandoned by conventional medicine. One complains about the side effects of the drugs, which continue to appear more and more expensive. Society seems to have more and more obese and multimorbid people, and proper healing is rare. Doctors seem to be less responsive and often entrench themselves behind screens in the case history or even in robotic surgeries. Instead of a quick answer one is sent from specialist to specialist,
But people long for health and a good life, and if they do not find this in conventional medicine, then they turn away from it. This is one of the reasons why more and more doctors’ practices in the United States are committed to holistic therapy. Some want to achieve a cure for humans through dietary supplements, others through stress relief therapies such as meditation or autogenic training, while others choose the path of Chinese medicine with acupuncture or herbal therapy…’
Contrast this approach with the recommendation by NHS England to ban homeopathic remedies and herbal medicine and compare it to the case for homeopathy in the US, where, according to the study (below), it is used by just over 2% of the population and where research data suggests it has potential for public health benefit, especially for conditions such as upper respiratory infections and fibromyalgia. Clinical trials have highlighted areas in which homeopathy may play a role in improving public health, including for infectious diseases, pain management, mental health and cancer care. For an abstract of this research, refer to Homeopathy Use in the United States and Implications for Public Health: A Review (Dossett ML, Yeh GY; February 2018).
The renowned Karl and Veronica Carstens Foundation reported [note: translation option is available] in the Press Review (June 2018) section of its July 2018 newsletter, an interview with Professor Dr Andreas Michalsen titled Doctors are becoming more open to natural medicine (Health City Berlin, 16.06.18). In his book Healing with the power of nature he advocates that conventional medicine and naturopathy belong together and that doctors are becoming more open to naturopathy while the “camp of skeptics is getting smaller”.
The comprehensive (at 193 pages) Smallwood Report 2005 (The Role of Complementary and Alternative Medicine in the NHS) commissioned by HRH The Prince of Wales includes, at page 7, the statement by the (then) President of the General Medical Council, Professor Sir Graeme Catto:
‘…All clinicians must be aware that many patients are interested in and choose to use a range of alternative and complementary therapies. Those practising orthodox medicine must be aware of the existence and range of such therapies, why some patients use them, and how these might affect other types of treatment that patients are receiving. Increasingly, complementary and alternative options are offered alongside conventional treatment in general practice, palliative care and elsewhere…this Report, commissioned by the Prince of Wales, is a welcome addition to that debate. The aim of the Enquiry, to assess the extent to which complementary and alternative approaches might help the NHS meet patient needs cost-effectively, is an important and relevant issue to address…’
“A PRELIMINARY SURVEY OF THE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINES IN CHILDBEARING WOMEN”: NHS PATIENTS DEMAND CAM
A research paper authored by Catriona Jones, Julie Jomeen and Olga Ogbuehl and published by The Royal College of Midwives on 26.11.13, also demonstrates patient demand for CAM services. It may be viewed here. Although it is limited by the small size of its sample, its data may nevertheless encourage NHS providers and managers to commission CAM services.
The research findings included as follows:
‘… Questionnaire data revealed that 17 out of 40 women (42.5%) engaged with CAM. A total of 11 (27.5%) had been offered CAM as part of their routine NHS care. Seven women (17.5%) used CAM after suggestion from a midwife, five (12.5%) used CAM by personal choice, and three (7.5%) had been encouraged by a friend or relative or ‘another source’ to use a form of CAM. In 11 (27.5%) cases, a midwife was aware of the use of CAM. However, four women (10%) stated they did not inform their midwife that they were using CAM…’
These findings demonstrate patient engagement with CAM within a NHS midwifery setting. The research goes on to find:
‘…Women were asked to provide some details about CAM treatments and therapies they would like to see made available on the NHS. The majority requested the use of essential oils in the bath 9 out of 40 (47.5%) [sic] and massage 18 out of 40 (45%), aromatherapy 12 out of 40 (30%) and essential oils on a perineal pad applied to the perineum 9 out of 40 (22.5%). While two requested acupuncture and two requested hypnotherapy…what is important is that NHS provision appears to be fairly accurate in meeting the needs of this group of women…’
The research paper concluded with the following statement of the implications for research and practice:
• Researchers and practitioners should gain more insight into how women engage with, and want to engage with CAM
• Midwifery research needs to effectively engage with the issue of consumer demand, and distinguish this from consumer interest
• Further research is required in relation to midwives and their pseudo consumer role of CAM use
• There are growing opportunities to design and deliver relatively simple CAM treatments that integrate around women’s needs
• Midwives could use the booking interview and antenatal consultations to encourage women who are engaging with CAM to seek advice from the appropriate CAM practitioner in relation to safety and efficacy.
There is evidently demand by both NHS patients and professionals to properly integrate CAM services into NHS healthcare provision. For more information, refer to the section of my December 2017 blog headed NHS ALLIED HEALTH PROFESSIONS SHOULD INCLUDE CAM PROFESSIONS?
COMPLEMENTARY MEDICINE & THE WORLD HEALTH ORGANISATION (WHO): ARE UK HEALTH AND SOCIAL CARE LEGISLATORS, POLICY MAKERS AND MANAGERS AWARE?
The WHO defines the standards it has produced as, among other things:
‘…From the very beginning, WHO has brought together the world’s top health experts to produce international reference materials and to make recommendations to bring better health to people throughout the world…’
This worldwide and respected organisation promotes universal health coverage, including by integrating traditional and complementary medicine services. WHO information and research about CAM may be viewed here.
A list of WHO Executive Board and World Health Assembly Resolutions on Traditional Medicine, including CAM, may be searched here. This list includes a link to the Executive Board recommendation EB134.R6 dated 23.01.14 that took note and requested as follows [extracts]:
‘…Noting the heightened level of interest in aspects of traditional and complementary medicine practices and in their practitioners, and related demand from consumers and governments that consideration be given to integration of those elements into health service delivery…’
‘…Requesting the Director-General…(2) to continue to provide policy guidance to Member States on how to integrate traditional and complementary medicine services within their national and/or subnational health care system(s), as well as the technical guidance that would ensure the safety, quality and effectiveness of such traditional and complementary medicine services…’ [and] ‘…(4) to monitor the implementation of the WHO traditional medicine strategy: 2014–2023…’
[Note: bolding of text added by me]
Are those responsible for implementing UK health and social care legislation and policy aware of the WHO position and, if so, do they take it into account? On the evidence to date, this does not seem to be the case. They should engage with CAM.
For more information about the WHO Traditional Medicine Strategy 2014-2023, please refer to my November 2016 blog. See also the WHO Global Atlas of Traditional, Complementary and Alternative Medicine.
CAM PRACTITIONERS AND NHS MANAGEMENT POLICY: MULTI-DISCIPLINARY TEAMS AND HOLISTIC NEEDS ASSESSMENTS
One clinical area in which CAM already has a proven role is cancer palliative care. There are, of course, other areas where the use of CAM is appropriate.
In June 2018, the King’s Fund published its Report titled Advancing Care, Advancing Years: Improving Cancer treatment and care for an ageing population based on research commissioned by Cancer Research UK.
Among other things, the Report found that:
‘…Around 360,000 people in the UK were diagnosed with cancer in 2015. By 2035 this number could reach 500,000 – mostly because of the ageing population, but also partly due to lifestyle changes [Note: page19, paragraph 1.1]…Cancer Research UK commissioned an independent research team from the University of Birmingham’s Health Service Management Centre and ICF International for this research. The aim of the project was to understand clinical decision-making for older people with cancer across the UK and to identify barriers to optimal decision-making…’ [Note: page 21, paragraph 1.1]
Although not recommended in the Report, there is a clear case for CAM practitioners to be included in the cancer palliative care management process at the Holistic Needs Assessment (HNA) stage and at Multidisciplinary Team (MDT) meetings, which are respectively referred to in the Report as follows:
At page 41, paragraph 3.3.4:
‘…3.3.4 HOLISTIC NEEDS ASSESSMENT A Holistic Needs Assessment (HNA) is a wide-ranging assessment that considers physical and practical concerns, as well as the patient’s emotional and information needs. This is often linked to the development of a care plan that takes these factors into account…’
At page 45, paragraph 4.2:
MULTIDISCIPLINARY TEAM: ‘…Every patient diagnosed with cancer in the UK has their case discussed at a MDT meeting. An MDT is made up of a variety of health professionals involved in treating and caring for patients. The MDT meets, most often weekly, to discuss individual patients’ cases and make treatment recommendations…’
[Note: an explanation of the role of the MDT is defined on page 22, paragraph 1.3].
“Having confidence in Accredited Registers covering health sciences, talking therapies, physical therapies and a range of complementary therapies means that we no longer have to depend solely on doctors and nurses but can create broader multidisciplinary teams. We must invest in prevention and wellbeing to deliver healthcare for the 21st century, and that means taking a wider view of the health and care workforce.”
[Note: the bolding of the text is added]
Including a CAM practitioner(s) at the MDT and HNA stages is especially appropriate because many elderly patients will have previously received CAM treatments (some for many years), maybe as part of a NHS integrated care treatment plan.
For evidence where the NHS has both employed CAM practitioners and included them in a MDT, refer to the article Shining Example by Jane Sheehan MFHT published in the Summer 2018 edition of International Therapist Magazine (pages 28 to 31) in which the author talks about establishing a new delivery model for a complementary therapy service within an NHS palliative care unit. She writes as follows:
‘…This decision by senior management to employ therapists brought about a huge change in the structure of the complementary therapy service. I had not anticipated the length of time that it can sometimes take to achieve such goals, but eventually the model was adopted where the therapists are still paid for by the support group but employed by the NHS, which means that they are fully integrated into the multidisciplinary team providing care for patients in this palliative care setting…’
Earlier in her article, the author writes:
‘…A complementary therapy policy was developed to formalise its delivery. It ensures a consistent approach to provide safe and effective complementary therapy for anyone using it with this client group and is based on the National Institute and Care Excellence (NICE) and the Prince of Wales Foundation for Integrated Health national guidelines…’
The NICE guidelines that Jane Sheehan refers to are those dated 2004 on improving supportive and palliative care for adults with cancer. The Prince of Wales’s Foundation for Integrated Health National Guidelines for the Use of Complementary Therapies in Supportive and Palliative Care (May 2003) may be accessed on the SCRIBD subscription website here.
The scope of the MDT is also defined (using case studies) in the article Delivering integrated care: the role of the multidisciplinary team published in July 2018 (SCIE Highlights No 4) by the Social Care Institute for Excellence which acknowledges the importance of a “sufficient diversity of professions and disciplines”.
For more information about CAM and cancer, including the legislative process applied by the Cancer Act 1939, please refer to my March 2018 blog.
OBSERVATIONS ON CAM: IN A GERMAN LEGISLATIVE DEBATE AND AT A EUROPEAN UNION (EU) POLICY WORKSHOP
For a review of a legislative debate about CAM in Germany, refer to the hearing of the Social Committee of the State Parliament in Baden – Wuerttemberg as reported at Becker: “Complementary Medicine is an economic factor for pharmacies” (Fritz Becker, Berlin on 20.04.18 on page 2) [Note: a translation is available], which, in particular, underlined the importance of complementary medicine for pharmacists, as follows:
‘…Minister Manne Lucha took a stand and clearly sided with the pharmacists and manufacturers. Lucha said that many citizens wanted recognition and reimbursement of complementary medicine. And: “In Baden-Württemberg there are 1678 doctors of natural medicine. That’s a lot”, says Lucha. The Minister also pointed out the economic importance of the industry: “Baden-Württemberg is Europe’s leading location: Wala, DHU, Weleda – just to name a few.”
And so he made the homeopathic manufacturers and patients even hope: “We want to integrate the long-term alternative medicines in the standard care and include in the range of benefits of the statutory health insurance…”
This is evidence that effective lobbying, including by business suppliers which, for instance, manufacture CAM remedies and equipment, can help to secure the freedom to practise and to receive CAM.
The background of another German research study relating to the paediatric use of CAM and titled Utilization of complementary and alternative medicine (CAM) among children from a German birth cohort (GINIplus): patterns, costs, and trends of use (Italia S et al, March 2015) is reported as follows:
‘…The use of complementary and alternative medicine (CAM) is widespread among children in Germany and other European countries. Only a few studies are available on trends in paediatric CAM use over time. The study’s objective was to present updated results for prevalence, predictors, and costs of CAM use among German children and a comparison with findings from a previous follow-up of the same birth cohort…’
The study goes on to conclude:
‘…CAM use among 15-year-old children in the GINIplus cohort is popular, but decreased noticeably compared with children from the same cohort at the age of 10 years. This is possibly mainly because German health legislation normally covers CAM for children younger than 12 years only…’
[Note: bolding of the text has been added by me].
So, as well as acknowledging the use of CAM (including homeopathic remedies and herbal drugs) is “widespread among children in Germany and other European countries”, this research also demonstrates the effect that legislation can have on such use, in this case by stipulating the age at which “German health legislation normally covers CAM for children”.
For another European Union (EU) based perspective, refer to the EU workshop report titled Complementary and Alternative Medicine Therapies for Patients Today and Tomorrow, held at The European Parliament on 16th October 2017 and published by the Directorate General for Internal Policies, Policy Department A: Economic and Scientific Policy. The workshop report (IP/A/ENVI/2017-10, PE 614.180) states the closing remarks of the Chair (at paragraph 1.3.4, pages 18 & 19), as follows:
‘…Mr Peterle thanked the speakers for their contributions and for sharing their knowledge on the topic. He remarked that both the Western and CAM medicine systems are part of what he describes as ‘medicinal pluralism’, implying that in democratic societies choice is preferred over monopolies. This choice should be made available to the patients that need it, while respecting certain criteria and principles (i.e. safety). MS [Member States] should overcome their differences and share good practices, with the help of the European Commission. He mentioned the example of the Italian region of Tuscany, where the integrative medicine model has been introduced, as a good practice. The majority of hospitals there offer conventional and CAM therapies, with doctors referring patients to both. Mr Peterle concluded by stating that efficacy and patient centeredness are two elements that should be prioritised in the future, in order to accelerate the progress in MS uptake of CAM therapies…’
The views expressed and the evidence identified in this EU report are very encouraging for CAM practitioners, regardless of the currently unknown implications of Brexit for CAM practitioners in the UK.
In the event that UK legislators decide to impose legislation, whether primary or secondary, relating to CAM, they would do well to adopt the criteria accepted within the German legislative process together with the conclusions presented at the EU workshop. In the meantime, sceptical NHS policymakers and clinicians should be required to take note.
UK CAM practitioners and the suppliers of their remedies and equipment might also want to lobby with the above criteria in mind.
HOUSE OF COMMONS HEALTH AND SOCIAL CARE COMMITTEE 7th REPORT, “INTEGRATED CARE: ORGANISATIONS, PARTNERSHIPS AND SYSTEMS”: WHY IS THERE IS NO MENTION OF CAM?
When reading the following it must be remembered that, so far as NHS England is concerned, the definition “integrated health and care” does not expressly embrace CAM.
I set out below, with the text bolded and italicised by me, some extracts from the Report where I believe a contribution by CAM could be relevant and welcomed by patients.
‘…There are numerous definitions of integrated care. There are also different levels at which care can be integrated: patient-level, service-level and organisational-level (see Chapter 2). NHS England’s current definition of integrated care is care that is “person-centred, coordinated, and tailored to the needs and preferences of the individual, their carer and family. It means moving away from episodic care to a more holistic approach to health, care and support needs, that puts the needs and experience of people at the centre of how services are organised and delivered…’
The following extracts are also taken from the Report, using the paragraph numbering given in the Report:
‘…113. The new models of care programme built on pre-existing partnerships between local services in some parts of the country and encouraged the development of partnerships in others. These partnerships were recently defined by The King’s Fund as:
‘…alliances of NHS providers that work together to deliver care by agreeing to collaborate rather than compete. These providers include hospitals, community services, mental health services and GPs. Social care and independent and third sector providers may also be involved…’
‘…114. Some of these partnerships have emerged out of the new care models programme, although many predated the new care models initiative. These integrated care partnerships are delivering integrated care without the need to form a single organisation. We heard during our inquiry that by using flexibilities within the current legislation to form alliances, services within the partnerships can agree to collaborate rather than compete…’
‘…221. Integrated care at the patient, service or organisational level is dependent on relationships between people working in health and social care. Whether patients experience holistic, coordinated and person-centred care depends on staff working together across acute, community, primary care, mental health, social care services and the voluntary sector…’
‘…307. Patient care must remain the focus. Delivering better care for patients at the front line is what motivates and unites health and care professionals and the wider sector. Integration depends on services putting patients at the centre, joining up around them, sharing information and working with them to meet their needs, priorities and goals. The recommendations of this report are intended to assist the Department of Health and Social Care, national bodies, local NHS organisations and local government to achieve those aims. The most important test of all, however, is whether this translates into better care for patients…’
The following is an extract from the Report’s conclusion:
‘…5. We support the move towards integrated, collaborative, place-based care. To help deliver more integrated care for patients we advocate the cultivation of diverse local health and economies, comprised of mostly public, but also some non-statutory provision, in which the organising principle is centred on collaboration and quality rather than financial competition. We consider that this diversity is important for protecting patient choice and with proper oversight and collaborative working may facilitate, rather than impede, joined-up, patient-centred and co-ordinated care. (Paragraph 44)…’
For me, the wording that particularly stands out from the above extracts as potentially facilitating the integration of CAM are: “community services”, “holistic approach to health”, “development of partnerships”, “collaborative working”, “diversity”, “independent…providers”, “the needs and preferences of the individual“ and “patient choice”, all of which indicate that there is a role for CAM within the NHS provision of integrated health and care.
For further discussion relevant to this topic, refer to the sections in my December 2017 blog headed A HEALTHCARE WORKFORCE IS READY AND WAITING and SOCIAL PRESCRIBING: HEALTH CREATION AS A COMMUNITY SERVICE.
I suggest the King’s Fund event described in the next section is also relevant to the (above) proposal to move “away from episodic care to a more holistic approach”.
THE NEED TO RECOGNISE CAM AT HEALTHCARE EVENTS AND IN POLICY PAPERS
For instance, at events and in health policy papers respectively hosted and published by the King’s Fund, such as:
(1) Community is the best medicine: making a reality of community-based health (event on 09.10.18) and
(2) The NHS 10-year plan: How should the extra funding be spent? (12.07.18).
If the interests of patients are to be properly served, CAM must receive the recognition it deserves in policy papers and at events that seek to influence health and care policy.
The Complementary and Natural Healthcare Council (CNHC) will be exhibiting at the event [numbered 1 above] which will explore the role of communities in health and care. This event will examine how to create sustainable, community-based health and care and share learning from areas where communities are taking a key role in improving and sustaining good health.
The CNHC will no doubt make an impression on delegates responsible for health and care in the community, thereby resulting in benefits to patients desiring CAM treatments.
And yet, in its publication [numbered 2 above] The NHS 10-year plan: how should the extra funding be spent? (12.07.18), the King’s Fund authors fail to make any mention of CAM but opine:
‘…Action is required across government as well as in the NHS in order to give greater priority to prevention and to tackle the wider determinants of health and wellbeing. Goals for improving health should be set following widespread consultation with the public and stakeholders…Our view is that reforming the NHS from within needs much more emphasis, drawing on the intrinsic motivation of staff and supporting them to improve health and care. The NHS and its partners must also work closely with people and communities, understanding what matters to them and supporting people to take more control of their health and wellbeing as part of a new deal with the public…’
[Note: bolding of text added by me].
An example of where the King’s Fund has “stepped beyond the bounds of conventional health services” may be found in its report titled: The Montefiore Health System in New York: a case study (27.07.18), which builds on the overview of the Montefiore Health System that it published in April 2018. I suggest it is time that the King’s Fund evaluated and published a new, updated report on the contribution made by CAM (refer to the section of my December 2017 blog headed: THE KINGS FUND: COMMITTED TO EXCELLENCE & INTEGRITY).
Clinical Commissioning Groups and health and social care stakeholders need to engage now with CAM practitioners and their professional organisations and regulators, including those accredited by the Professional Standards Authority (view press release dated 12.03.15).
As I have commented on previous occasions, these practitioners provide a professionally qualified, insured but ‘untapped’ workforce that is available to the public health (including the NHS) and social care sectors. For more information, refer to the section of my March 2018 blog headed COMPLEMENTARY THERAPIES IN NURSING, MIDWIFERY AND HEALTH VISITING PRACTICE: THE NEED FOR RCN GUIDANCE and to the section of my December 2017 blog headed A HEALTHCARE WORKFORCE IS READY AND WAITING.
CONTINUITY OF CARE: THE CAM PRACTITIONERS’ APPROACH IS VINDICATED
As conventional medical practice moves away from an established doctor-patient professional relationship towards drop-in GP Health Centres, medical call-centres, online apps and the adoption and accelerated use of digital services as part of a wider vision for primary care (for instance to create a digital charting system to monitor patients’ vital signs), recent research confirms what CAM practitioners and their patients have always known and valued, namely that continuity of care provided in a personal but professional patient-centred context promotes healing and can even save lives.
The Discussion/Principal Findings (page 11) of the wide-ranging (BMJ Open: accepted 20.04.18) research abstract Continuity of care with doctors – a matter of life and death? A systematic review of continuity of care and mortality (Denis J Pereira Gray, Kate Sidaway-Lee, Eleanor White, Angus Thorne, Philip H Evans) states, in the context of conventional medicine but without mentioning CAM, as follows:
‘…Continuity of care is associated with patients perceiving that the doctor has become more responsive. Patients then disclose more and medical management is more likely to be tailored to the needs of the patient as a person. The increased patient satisfaction may also be associated with an ‘optimism’ boost to health…We have previously suggested that ‘doctors tend to overestimate their effectiveness when consulting with patients they do not know, and underestimate their effectiveness when consulting with patients they know’… The cumulative impact of these multiple gains may then be reflected in reduced mortality… For 200 years, medical advances have been mainly technical and impersonal which has reduced attention to the human side of medicine. This systematic review reveals that despite numerous technical advances, continuity of care is an important feature of medical practice, and potentially a matter of life and death…’ (Page 11).
‘…Conclusions: This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important…’
Since it is relevant to the above, take the opportunity to read the article in Pulse Magazine (07.12.17) by Dr Michael Dixon: General Practice is doomed unless we change direction. I previously mentioned this article on page 6 of my June 2018 blog.
CAM practitioners and their patients highly value the pursuit of continuity of care. There should be further extensive research into how, why and when continuity of care benefits patients’ of both conventional medicine and CAM, including where these are combined to deliver an integrated and cost-effective treatment plan.
Such research would provide NHS and social care policymakers with the information they need to enable continuity of care that included the delivery of CAM. At the event reported by CORDIS: Complementary Medicine popular across Europe (see above), Professor Benno Brinkhaus, who led the event, concludes:
‘…If CAM is to be employed as part of the solution to the healthcare challenges we face in 2020, it is vital to obtain reliable information on its cost, safety and effectiveness in real world settings. CAMbrella’s vision is for an evidence base which enables European citizens and policymakers to make informed decisions about CAM…’
THE PROPOSAL FOR A CAM LOBBY GROUP: INCLUDE REPRESENTATIVES FROM BUSINESS ORGANISATIONS SUPPLYING REMEDIES AND EQUIPMENT TO CAM PRACTITIONERS?
In my June 2018 blog (page 2), I called for CAM practitioner organisations to unite to form a CAM Lobby Group capable of proactively presenting the case for CAM at every opportunity by enabling their appointed expert representatives to respond swiftly, articulately and knowledgably to critics (particularly when appearing in the print or broadcast media) who, as Dr Michael Dixon opines in the record of an interview with him published in International Therapist Magazine (October 2011, pages 42-43), base their attack “far more on emotion than reason”.
Extending the above proposal, I suggest that businesses specialising in the production and supply of CAM remedies, equipment and other products, each nominate a representative to join the CAMLobby Groupand, if possible, to contribute to funding for its operation. I appreciate that this proposal might be open to challenge on the basis that some of these representatives might seek to use this initiative to obtain a commercial advantage for their organisation. Nevertheless, on balance, I would argue that this is very unlikely. Surely their representatives would have much to contribute as CAM lobbyists, not least by drawing on their commercial experience of the CAM sector?
Generally, it should be recognised that these business enterprises which manufacture and supply the remedies (e.g. essential oils, herbal, homeopathic, supplements and nutritional preparations) and equipment (e.g. specialist treatment couches/chairs and other treatment-room furniture, clinical tools, training programmes and practice management guidance – both print and online, the publication of specialist books, meditation audio packs, etc) are essential to many well-managed CAM practices (refer to my August 2017 blog: Adopting a business approach to practising CAM).
CAM business suppliers could and, in some cases, already do, aim to influence the development of health and social care policy and management and also the UK legislative process, for instance by making submissions to Parliamentary Select Committees. Their influence could be even more effective if delivered from within a CAM Lobby Group alongside expert practitioner representatives, some of whom might also be their customers.
credit to Sara Quintana, Yogahome Las Palmas and Tim Owen Jones
ANTICIPATED INCREASE IN PATIENTS’ DEMAND FOR CAM AS THE NHS AIMS TO SAVE FUNDS
It seems likely that CAM practitioners will be treating more patients in the future if, as proposed by NHS England (NHS England action to stop patients undergoing ineffective and risky treatments: 30.06.18), allegedly hundreds of thousands of them are denied NHS prescriptions and procedures. NHS England aims to save £200 million a year.
“It’s really important that patients and the public have a joint responsibility. The NHS is a really precarious resource for all of us”.
Potential targeted procedures include (among others) the following procedures that will be available only in exceptional circumstances: Dupuytren’s contracture, haemorrhoid surgery, hysterectomy for heavy menstrual bleeding, knee arthroscopies for arthritis and varicose vein surgery.
Other procedures, like injections for back pain, may be withdrawn completely. Treatments that might be withdrawn in the future include general anaesthetics for shoulder and hip operations and brain scans for patients who have migraines.
These proposals were prepared in consultation with the National Institute for Health and Care Excellence (NICE) and Medical Royal Colleges.
Of course, it is appropriate that NHS funds should be wisely spent but it is to be hoped that there will not be a ‘blanket ban’ and that the professional judgement of NHS GPs, Consultants and other clinicians who, after all, are medically and personally best qualified to know their patients and how to heal them, will be respected. They should not be compelled to comply with an inflexible interpretation of the NICE guidelines that is, in their professional judgement, contrary to the interests of their patients.
NHS England is consulting on the proposals from 4thJuly until 28th September 2018 with a view to implementing them for the 2019/20 financial year. The consultation documentation may be viewed here and here.
You may recall that, in an initiative launched on 20th December 2017, NHS England launched a public consultation to rein in prescriptions for some ‘over the counter’ products with the aim of “freeing up £136 million to expand other treatments for major conditions such as cancer and mental health problems”. The consultation closed on 14th March 2018.
Relevant to the above, readers may have seen the report on page 4 of the Times newspaper on 1st August 2018 (Cancer patients left in pain by NHS cuts) further to the letter (Pain relief concern) published that day in its letters column (page 22).
In that letter, submitted and signed by one hundred and fourteen (114) consultants in pain medicine, it is claimed that there is a restriction on prescribing the demonstrably effective and, for some patients, “life-transforming” use of lidocaine plasters. These are a treatment for localised neuropathic pain that do not have the hazardous side-effects of oral analgesics.
The letter advises that, notwithstanding there are too few specialist pain consultants to prescribe the plasters for all the patients that need them, lidocaine plasters are nevertheless considered to be too expensive (at £52.00 for 30) for GPs to prescribe. This leads to unnecessary patient suffering even though the National Institute for Care Excellence (NICE) has stated that patients with pain should not have effective treatment discontinued. The Chief Executive of NHS Clinical Commissioners is quoted, in the above Times newspaper report, as saying that this does not mean there is a “blanket ban” as exceptional cases will be allowed after scrutiny.
So it is possible that patients who are denied such pain relieving prescriptions within the NHS will now turn to effective CAM treatments such as acupuncture, chiropractic or Reiki, to name only three.
COMPLEMENTARY TREATMENT OF VARICOSE VEINS: A RANDOMISED, PLACEBO-CONTROLLED, DOUBLE-BLIND TRIAL
This research article (E.Ernst, T.Saradeth, K.L.Resch: 01.09.90), an abstract of which may be viewed here, is published in Phlebology the leading scientific journal devoted entirely to venous disease that publishes on all aspects of diseases of the veins including the latest treatment procedures and patient outcomes. The results of the research suggested that oral treatment of primary varicosity using Poikiven®, a homeopathic medicine, is feasible.
This research may have even greater significance now than it did in 1990 in view of the NHS England consultation on the withdrawal of varicose vein surgery (and other treatments) as referred to above in the previous section.
SOME OF THE MOST IMPORTANT MECHANISTIC THEORIES THAT UNDERLIE HOMEOPATHY: CONFERENCE AT THE ROYAL SOCIETY OF MEDICINE, LONDON (14.07.18)
‘…This conference was organised by integrative medicine consultant Lord Kenneth Ward-Atherton alongside the British Homeopathic Association. One of its overarching aims was to explore where some of the brightest, relevant minds were at when it came to looking at the plausibility or otherwise of mechanisms explaining homeopathy’s claimed or proven clinical effects…’
Having introduced his review as above, eAlert of 18.07.18, Dr Robert Verkerk PhD, Founder, scientific & executive director of the Alliance for Natural Health International (ANH-Intl), continues as follows:
‘…Whatever the opponents of homeopathy argue, the clinical effect has been amply demonstrated. Could this new evidence from the science of water reveal a likely, albeit, complex mechanism – or possibly more likely – a series of parallel mechanisms? And could an understanding of these mechanisms provide the missing piece in the logic pathway required to shift the medical establishment’s perceptions about the usefulness of homeopathy for human or animal health?
This kind of sea change is urgently needed if we are to avert the extinction of homeopathy in the NHS, the veterinary sciences and beyond, caused by a lack of appetite among some for the ‘scientific truth’ – regardless of its consequences. And before you ask me to define ‘scientific truth’….I like the following definition: “a state of minimum discrepancy between theoretical prediction and observed reality.”
This conclusion, which ends the ANH-Intl Feature: Will homeopathy be saved – before it’s too late?, follows Dr Verkerk’s review of questions posed at the international seminar on the science of water (New Horizons in Water Science’ Evidence for Homeopathy?) held at the Royal Society of Medicine, London, on 14th July 2018.
In his review, Dr Verkerk further writes:
‘…All the presentations were filmed and we will be pointing our readers to them as soon as they become available, which we’re told by the organisers will be in the near future. In the meantime, we have distilled what appear to be some of the most important mechanistic theories that underlay homeopathy. We provide them for you in the chronological order in which they were presented, as follows:
· Professor Emeritus Brian Josephson (Theory of Condensed Matter, Cavendish Laboratory, University of Cambridge) was awarded his Nobel Prize in Physics at the age of 22 for his pioneering work on superconductivity and quantum tunnelling. Fifty six years on, he set the scene for the conference by suggesting that the current ‘matching’ theory for how two molecules (e.g. bioactive molecules and receptor molecules) communicate is incorrect. He argues that electromagnetic signals and quantum theory provide more likely or at least additional explanations.
· Professor Luc Montagnier was co-awarded a Nobel prize in Physiology or Medicine in 2008 for the discovery of HIV. He argues that electromagnetic signals can be transduced in highly diluted aqueous solutions originally containing some bacterial or viral DNA. Montagnier has found that agitation of preparations during their dilution (= succession in homeopathy) was found to be essential for this transduction.
· Professor Jerry Pollack (Pollack Laboratory, University of Washington, Seattle) showed that water within living systems largely exists not as H2O, but as structured matrices composed of H3O2 molecules (‘exclusion zone water’ or ‘EZ water’, for more information, see separate article) ‘EZ water’: the water that makes us and all other life . This structured water is negatively charged and acts like a battery that can do work within the body. Along with ethanol that can also form exclusion zones, EZ water also has a great capacity to retain information; this could potentially be exploited and could surpass the data storage capacity of today’s silicon ‘chips’.
· Professor Vladimir Voeikov (Chair of Bioorganic Chemistry, Faculty of Biology, Lomonosov Moscow State University) and his lab have shown how signatures could be left by biologically active substances as high-energy, reactive oxygen species (ROS). These bioenergetic signals may represent what homeopaths or herbalists refer to as ‘vital force’ and may contribute to the observed property of ‘memory’ in water.
· Professor Voeikov also discussed the work of his colleague, Professor Alexander Konovalov (Russian Academy of Sciences). The work suggests that memory could be retained by nano-sized assemblies of water molecules (referred to as ‘nanoassociates’) created around bioactive molecules long after their removal.
· Adding to the debate, head of the Department of Chemical Engineering, Indian Institute of Technology, Professor Jayesh Bellare explained that his team are able to detect nanoparticles of the starting materials or their aggregates in even the most diluted homeopathic products (manufactured according to the Homoeopathic Materia Medica). He attributes some of the effects (even if they were electromagnetic or quantum in action) to these nanoparticles…’
Dr Verkerk has since commented (19.07.18):
‘…We need unified hypotheses that can be tested, along the lines of this: orderliness can be imprinted at the quantum level into water, ethanol or other substances and this provides a persistent energetic (e.g. electromagnetic) signal that mediates observed effects. Homeopathy is interesting because it forces society to address the issue in ways that are non-linear and not reductionist, compartmentalised or over-simplistic…’
My thanks to Dr Verkerk and to the ANH-Intl for their permission to copy and quote from the above review. Also, see the post (25.07.18) by the 4Homeopathy Group titled New Horizons in Water Science – Conference a major success.
BRITISH HOMEOPATHIC ASSOCIATION (BHA): JUDICIAL REVIEW CLAIM REJECTED BY THE HIGH COURT (05.06.18)
In his Judgement [Case Number: CO/4843/2017; Neutral Citation Number:  EWHC 1359 (Admin)] following a hearing in the High Court during the 1st to the 4th May 2018, The Hon. Mr Justice Supperstone confirmed (paragraph 61) that the court was not concerned with passing judgement on the legitimacy or otherwise of the view that homeopathy works.
He recorded that, although NHS England (NHSE) accepted that there is a body of opinion, to which some practicing clinicians adhere, that homeopathy works (and that there is evidence to that effect), what NHSE was consulting on was its provisional view that there was no robust evidence that homeopathy actually works.
To summarise, the BHA application for judicial review was based on claims of unfairness, failure to properly consult and alleged breaches of statutory duty.
In paragraphs 36 and 37 of his Judgement, the Judge described the grounds of the BHA challenge as follows, that the:
1. NHSE has failed to consult fairly by failing to provide consultees with sufficient information to enable them to give a meaningful response to the consultation and failing fairly to summarise the homeopathy issues the consultation was considering and/or NHSE misled consultees and/or failed to consult on alternatives;
2. NHSE failed to consult at a time when proposals were still at a formative stage and/or there was a substantial risk that it had pre-determined its decision to withdraw support for homeopathy;
3. NHSE has breached the public sector equality duty contrary to s.149 of the [Equality]Act 2010; and
4. NHSE has no power to issue the Guidance, as it purported to do, under s.14Z10 of the [National Health Service] Act 2006.
[Note: text of Judgement slightly summarised and italicised]
The Judgement concluded that, although arguable, the above grounds were not made out. Accordingly, the BHA claim was dismissed.
The following are responses to the Judgement by a selection of organisations:
British Homeopathic Association (BHA);
Society of Homeopaths;
Faculty of Homeopathy;
DAZ (online) an independent pharmaceutical journal for science and practice (Dr Helga Blasius)[Note: a translation is available]
For a brief law firm review search here.
To quote Karin Mont MARH, Chair of the Alliance of Registered Homeopaths, in her excellent article Threescore years and ten published in Homeopathy in Practice Journal (Spring/Summer 2018, pages 4 & 5):
‘…contrary to some media reportage, this is NOT yet another blow for homeopathy; this is a ruling based very specifically on points of law…’
HOMEOPATHY: UPDATE ON EVENTS IN AUSTRALIA
First, some good news: Consumers win fight to keep natural medicines on pharmacy shelves. The Your Health Your Choice website, managed by The Australian Homeopathic Association, has posted the following announcement on its website:
‘…Popular natural treatments used to manage hay fever, stress, insomnia, joint aches, teething, and other medical conditions will continue to be sold on pharmacy shelves after a landmark win for consumers.
In June last year a report to the Federal Government recommended natural medicine and treatments, including homeopathic products, be banned or restricted from sale in pharmacies.
Tens of thousands of consumers protested with nearly 80,000 people joining the Your Health Your Choice campaign to call on the Government to protect their right of choice to access natural medicines…Petrina Reichman of Your Health Your Choice said consumers were relieved Health Minister Greg Hunt had listened to community concern and decided to protect natural medicines and keep them on pharmacy shelves… “Two in three Australians use some of complementary medicine and the people who use it will tell you it is effective for them and their families,” she said.
“The World Health Organisation supports natural medicine as an important part of the healthcare system and there is a growing body of good quality clinical research studies around the world to show efficacy and effectiveness.”…’
Meanwhile, the controversy surrounding action by The Australian National Health & Medical Research Council (NHMRC) continues. The NHMRC allegedly failed to disclose to the public a first report suspected as being supportive of homeopathy before publishing what is claimed to be a biased and flawed second report “declaring homeopathy to be ineffective for any condition”.
A complaint has been made to the Commonwealth Ombudsman. The outcome of this challenge is awaited. For more information, search The Homeopathy Research Institute website here and here and, if you wish to support the campaign, you can sign the petition calling for the release of the first report here.
An article by Gerry Dendrinos published, in two parts, by SIMILIA The Australian Journal of Homeopathic Medicine reviewing the ethics of the NHMRC focus on homeopathy may be read here (Part 1, December 2016 – Volume 28 Number 2) and here (Part 2, June 2017– Volume 29 Number 1).
ROYAL COLLEGE OF GENERAL PRACTITIONERS (RCGP) CALLS ON GOVERNMENT TO FACILITATE ‘SOCIAL PRESCRIBING’ FOR ALL PRACTICES: PRACTICES AND UK HEALTH AND SOCIAL CARE LEGISLATION AND POLICY SHOULD ACKNOWLEDGE THE ROLE OF CAM IN SOCIAL PRESCRIBING
In my December 2017 blog, I refer to Social Prescribing as being developed by the Social Prescribing Network (co-chaired by Dr Michael Dixon, the National Clinical Social Prescribing Champion for NHS England and Chairman of The College of Medicine).
This ‘call to arms’ by the RCGP is a welcome endorsement of the scheme to which CAM practitioners will no doubt contribute their services, often unpaid and from within the voluntary and charitable sectors.
In its Newsfeed dated 04.05.18, the RCGP includes the following:
‘…According to a recent RCGP survey, 59% of family doctors think that social prescribing can help reduce workload. An evidence review, from the University of Westminster, found that studies report an average drop of 28% in demand on GP services following a referral to a social prescribing service. This has led to the College’s call for every practice to be equipped with access to a dedicated social prescriber to help patients find the right care…’
If the NHS primary care sector, through some of its GP services, is prepared to refer patients to CAM practitioners operating within the social prescribing scheme (e.g. for aromatherapy or reflexology), albeit as a referral described as for ‘non-medical care’, then why is it that other (see page one of my June 2018 blog) GP services are reluctant to recommend the same therapy as part of an integrated healthcare treatment plan (combining the best of conventional medicine and CAM) to their patients? Is it logical to draw this distinction?
Social prescribing was the subject of a press report and, at page 29, a leading article in the Times newspaper on 08.05.18. In the former, Dr Michael Dixon, who is reported as having been responsible for Social Prescribing at NHS England, and Professor Helen Stokes-Lampard, chairwoman of the RCGP’s, are both quoted at length as supporters of the scheme.
Dr Dixon is also joint-author of the publication Getting Started: prospects for health and well-being boards, published by The Smith Institute in September 2012, about which more information may be viewed here and here.
The College of Medicine, in collaboration with The Kings Fund, The University of Westminster, Elemental and The Conservation Volunteers, will be following-up the sell-out success of its 2017 Conference with a 2018 Conference titled Social Prescribing: Coming of Age to be held at The King’s Fund on 06.11.18.
The event will examine the ways in which social prescribing models can be embedded and implemented, looking at how it can be measured and the impact it is already having on patient outcomes. It will hear from local areas around the country that have implemented social prescribing models which can report on their learning and outcomes and provide practical resources.
This conference is open to all people interested in social prescribing local or international. More information and booking facilities for the Conference may be found here.
COLLEGE OF MEDICINE’S WRITTEN EVIDENCE (22.06.18) TO THE HOUSE OF COMMONS HEALTH AND SOCIAL CARE COMMITTEE: ANTIMICROBIAL RESISTANCE INQUIRY
Further written evidence, which may also be viewed on the Inquiry website here, was also submitted by the following CAM organisations and individuals:
The Society of Homeopaths;
David Tredinnick MP;
Dr Yubraj Sharma;
Alliance of Registered Homeopaths (ARH);
Interestingly, written submissions from the CAM sector were mainly concerned with homeopathy.
A NATIONAL CENTRE FOR ARTS AND HEALTH
Art therapists, including members of the British Association of Arts Therapists (BAAT), will be interested in the recent (18.07.18) King’s Fund post titled Planning for a national centre for arts and health, some ten years on from the call by former Health Secretary Alan Johnson for participatory arts to be part of the mainstream in health and social care.
The proposal for “a new national strategic centre to support the advance of arts and health” was a key recommendation of the report Creative Health: the arts for health and wellbeing, described as “an encyclopaedic summary of arts and health activity across the UK” subsequent to an inquiry by the All Party Parliamentary Group on Arts, Health and Wellbeing.
To investigate the evidence-base for arts in health, search here.
Refer to The College of Medicine ‘news and blog’ webpage post Two thirds of GPs think engaging with the arts can help to prevent ill health (24.07.18).
THE COLLEGE OF MEDICINE SUPPORTS THE INTEGRATIVE HEALTH CONVENTION 2018
The Convention will be held on the 13th and 14th October at Park Plaza, Victoria, London. To find out more and to book your place search here.
The Convention comprises 36 different hour-long talks on Conventional and Complementary Healthcare with an emphasis on integrated health. The topics discussed range from Acupuncture to Ayurveda, Breathwork to Yoga, TCM to Hypnosis, NLP to EFT, Massage to Energy Work: All led by many leaders in their fields. It will cater to Doctors, Conventional and Complementary Therapists, and the Public.
THE FEDERATION OF HOLISTIC THERAPISTS (FHT): APPOINTS A NEW PRESIDENT AND PRESENTS ITS 2018 CONFERENCE “SUPPORTING THE INTEGRATED HEALTHCARE AGENDA”
The FHT has elected a new president, Christopher Byrne. He initially trained in Swedish and sports massage before going on to complete an MSc degree in Acupuncture and Traditional Chinese Medicine. This was closely followed by gaining experience at the Hepingli Hospital and Beijing Academy in China. Today, Christopher runs a busy therapy practice and training school.
The FHT was established more than 50 years ago and is the largest and leading professional association for therapists in the UK and Ireland. Its independently Accredited Register lists more than 10,000 complementary therapists offering one or more of the following therapies: Alexander Technique, aromatherapy, body massage, Bowen technique, cranio-sacral therapy, healing, homeopathy, hypnotherapy, kinesiology, Microsystems acupuncture, naturopathy, nutritional therapy, reflexology, reiki, shiatsu, sports massage and yoga therapy.
On 29th November, the FHT will hold its 2018 Conference at the King’s Fund in the heart of London’s West End where talks will be presented by leading experts, including Dr Michael Dixon (Chair of the College of Medicine), in research, education and integrated healthcare. They will look at some of the many ways professional therapists can support both the public and the medical workforce – from helping patients to make positive lifestyle changes and manage their own health and symptoms, to addressing ‘effectiveness gaps’ and creating cost and time efficiencies within the NHS.
Also, the winners of the 2018 FHT Excellence Awards will be announced at the Conference.
THE RESEARCH COUNCIL FOR COMPLEMENTARY MEDICINE (RCCM): CAMSTRAND CONFERENCE 2018
The RCCM, soon to have a new website, is looking for Trustees to join its Board.
The Summer 2018 CAMRN newsletter covered the events and awards presented at the 2018 CAMSTRAND Conference held at Manchester University on the 26th and 27th June.
The winner of the George Lewith CAMSTRAND Bursary was Lucy Field, of Liverpool John Moores University for her oral presentation ‘Building Resilience Through Heart Rate Variability Biofeedback Training’.
The Dr Janine Leach Research Award was won by Dr Nicola Brough who received the prize of £2000 to continue the validation work for her wellbeing questionnaire developed as part of her PhD whilst at the University of Warwick: “The development and validation of the Warwick Holistic Health Questionnaire (WHHQ) a patient reported outcome measure for assessing changes in health and wellbeing in users of Craniosacral Therapy”.
Congratulations to the award winners and also thanks to the RCCM Board and staff for their commitment to CAM.
Visit the RCCM website to sign up as a Member or to receive its Newsletter.
THE CHARITY COMMISSION’S CONSULTATION ON CAM
As I write, the outcome of the Charity Commission’s Consultation, expected in Autumn 2017, is still awaited. By the time you read this the outcome of the consultation may be known in which case I will refer to it in more detail in my next blog. In the meantime, please refer to my August 2017 blog for more information.
And finally, the:
ANH-INTL BLUEPRINT FOR HEALTH SYSTEM SUSTAINABILITY: A WELCOME INITIATIVE
Some salient points covered by this blueprint: The existing system is broken, Co-creation and consensus are key, Bottom-up not down, Creating a common language, A sustainable system is built around the individual, not the provider…and more.
Read and understand more about this very welcome and exciting initiative here and here. The launch of the completed, post-consultation, widely endorsed sustainability blueprint is expected in October.