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Royal London Hospital for Integrated Medicine

CoM Tags:

hospital, integrated medicine, College of Medicine

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An NHS centre for integrated medicine, part of University College NHS Foundation Trust

The Royal London Hospital for Integrated Medicine (RLHIM) is the largest and, as part of University College London Hospitals NHS Foundation Trust (UCLH), the most integrated public sector provider of Integrated Complementary Medicine (ICM) in Europe.

UCLH is one of the UK’s leading academic medical centres. Integrated care is offered in collaboration with several UCLH Hospitals and departments, including the University College Hospital Macmillan Cancer Centre, The National Hospital for Neurology and Neurosurgery, the Eastman Dental Hospital, the Elizabeth Garrett Anderson Hospital (women’s and children’s services), the gastroenterology and rheumatology departments of UCH. Models of integration vary according to patient need.

The RLHIM is an NHS centre, operating on the normal NHS terms and conditions, including that patients must be referred by their GP. All clinical staff are members of statutorily registered health professions with additional training and qualifications in ICM. Treatment options include (in alphabetical order) Autogenic Training, Acupuncture, CBT, Diet and Nutritional advice, Phytotherapy, Homeopathy, Medical and Clinical Hypnosis, Occupational therapy, Physiotherapy, Podiatry and Reflexology alongside conventional medicine.

We constantly strive to improve our services and have several programmes of service improvement and research to develop and improve services to our patients as well as providing information to both commissioners and patients. These are detailed below.

Shortlisted for our Innovations Award 2011.

Year established
Founded in 1849 as the London Homoeopathic Hospital, it received its ‘Royal’ status in 1948 becoming the Royal London Homoeopathic Hospital. The hospital was renamed the Royal London Hospital for Integrated Medicine in September 2010 to better reflect the services it offers.
Number of staff
Paid Staff (FT equivalent) 68, Volunteers 12
Number of users
25 -27,000 (patient appointments)
Is there a charge to users?
Standard NHS Charges and exemptions to patients. Course fees for students, some bursaries available via Blackie Foundation Library open access. Fees for full online access.
What makes your project sustainable?
Liaison & negotiation with NHS commissioners; information services; education and training; research.
Demographics
Our patients our NHS referrals from GPs – 80% from the London area. These cover a wide demographic of various age groups, gender, ethnicity, etc.
Innovation
The RLHIM has faced frequent funding challenges and has responded with innovation and by demonstrating patient benefit and satisfaction.The RLHIM has a strong and longstanding tradition of innovation. This includes the NHS’s first complementary cancer service (1960’s), acupuncture service (1977), musculoskeletal medicine service (1995), herbal medicine service (2008), integrated insomnia service (2010). In 2005 we launched the UK’s first course in integrated medicine for health professionals, other innovations include high volume acupuncture clinics, and integrated services for Antenatal, Allergy, Facial Pain.Integration is both ‘vertical’ (ie between the hospital, primary and self-care), and ‘horizontal’ (with other hospitals and departments within the Trust). A recent example of vertical integration is the introduction of the validated Sleepio online program for insomnia to complement the hospital based non-organic insomnia service. This won funding in a UCLH Trust innovation competition.

The RLHIM’s programme of research and service development aims to establish the hospital as delivering evidence based integrated medicine. All research emphasises the importance of patient experience; both in terms of understanding the treatment experience from the perspective of patients receiving treatment at the RLHIM, and evaluating treatments using methods which prioritise patient wellbeing and incorporate outcomes patients feel are important to them.

 

Patient-Centred, whole person preventative approach
All components of the RLHIM care emphasise the importance of patient experience and outcome. Self-care is an important element of our work which we are actively developing. Patients are consulted on the design of all research projects and service provision. Patient representative are included in all research teams. At the end of each study participating patients are provided with a copy of the findings, and comments invited.According to two separate surveys (Kings Fund/NHS Choices and Dr Foster) the RLHIM has some of the most positive patient feedback of any NHS Hospital. 
Evidence informed practice/audit and evaluation
Current research and service improvement initiatives
1. A large-scale pragmatic, multi-centre randomised controlled trial of a brief, nurse-delivered acupuncture treatment for patients suffering from a range of symptoms associated with cancer and its treatment. This project is being conducted at the UCH Macmillan Cancer Centre.The objective is to assess whether training nurses in acupuncture techniques at cancer centres will deliver improve patient experience and quality of life. Other outcomes are symptom control, cost-effectiveness and the views of the nurses providing the treatment and those of other stakeholders.This project has full Charitable funding.2. Non-statutory Patient Recorded Outcome Measures (PROMs) The RLHIM is the first NHS centre to attempt to gather comprehensive PROMs data: on all patients, conditions and all treatments provided by the RLHIM. We hope that this will become a UCLH Trust-wide initiative.

The design is an innovative, using iPads and encouraging patients to enter long term follow up data online, even after they have been discharged from the hospital.

The project will gather essential information and every patient referred for 3 years. It will evaluate patient improvement, cost effectiveness of the treatment and patient experience of treatment using the EQ-5D-5L measure of health related quality of life at specific time points. This will be used to calculate Quality Adjusted Life Years (QALYs).

A nested qualitative study with a sub-sample of patie
nts will additionally explore patients’ experiences of receiving treatment at RLHIM. This project has received full Charitable funding.

3. A pragmatic observational cohort study of integrated treatment for musculoskeletal disorders This project is under way, it uses a mixed methods approach to assess the impact of ICM treatment as offered at the RLHIM for patients with a variety of musculoskeletal disorders over one year. The Research Fellow is a PhD candidate at London South Bank University, co-supervised at the RLHIM

4. Exploring patients’ perceptions of self-care: The daily practice of RLHIM clinicians promotes pateint self-care. However, advice and support on self-car ids formalised and generally not included in information provided to patients and commissioners, nor in leaflets or on the website. The project aims and develop the RLHIM’s self-help and self-care approaches, informed by patient perceptions and views.

A qualitative study will be undertaken with patients to explore their perceptions of self-care. Once analysed, the results will influence RLHIM self-care policy and service provision. This project has received some Charitable funding.

5. A feasibility study evaluating a course of Tai Chi training, in conjunction with standard care, for patients with Parkinson’s disease (PD).

This study, a collaboration with the National Hospital for Neurology and Neurosurgery will provide preliminary data on effectiveness in terms of function and mood of Tai Chi training It will inform the design of a subsequent randomised controlled trial.

6. A pragmatic observational study on the clinical effectiveness of rosehip capsules for patients with chronic knee pain. All participating patients will receive a 3 month course of rosehip capsules.

Outcome measures will be completed at baseline and 3 months. All patients will also participate in a nested qualitative study to explore their experiences of this treatment for chronic knee pain.

7. A service evaluation study of self-acupuncture for patients with tension-type headaches. This is a service evaluation of a newly-introduced treatment. All patients will receive an administered course of acupuncture congruent with NICE guidelines. Subsequently they will be offered training in self-acupuncture. The study will evaluate the effectiveness of the self-acupuncture, compared to no additional treatment. Patients will also participate in a nested qualitative study to explore their experience of self-acupuncture.

8. RLHIM is supervising or co-supervising several health professionals undertaking higher degrees in ICM, including

• A Professional Doctorate in Clinical Psychology for a qualitative study exploring fibromyalgia patients’ experiences of receiving Autogenic Training
• A Professional Doctorate in Health Psychology. The research is a pilot study evaluating the impact of mode of delivery of Cognitive Behavioural Therapy (CBT) for Insomnia.
• An MSc research project exploring the effect on patients with fibromyalgia and their ability to cope with on-going pain, when cognitively processing their key metaphorical pain-related cognitions using CBT-based techniques.

 

Multi-disciplinary collaboration, and professional communication
All members of clinical staff are members of one of 4 multidisciplinary clinical teams. Our research projects include multi-disciplinary collaboration with leading international experts within relevant fields.Institutes collaborating on RLHIM research projects include, several hospitals and departments of UCLH NHS Trust, Macmillan Cancer Care, British Medical Acupuncture Society, University College London, University of Southampton, London South Bank University, and Manchester University.The RLHIM was redeveloped, reopening in 2005. Patient feedback frequently refers to the healing atmosphere of the hospital.
Contact details
60 Great Ormond St
t: 020 7391 8880
w: www.uclh.nhs.uk/rlhim
e: Peter.fisher@uclh.nhs.uk