Integrated Health Care

Anne Milton Excerpts

Wednesday 2nd June 2010 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I congratulate my hon. Friend the Member for Bosworth (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.

[David Tredinnick]

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.”

[Anne Milton]

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.

[Mr Stephen Dorrell (Charnwood) (Con)]

Quite right.

[Anne Milton]

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.