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24 Jan 2001 : Column 278WH

Complementary Medicine

11.0 am

Mr. David Tredinnick (Bosworth): I regard it as a great honour to be able to introduce this debate on the issues surrounding complementary and alternative medicine, based on the findings of the House of Lords Science and Technology Select Committee's recent report.

When I last addressed the subject, the Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), said that he admired the persistence and imagination with which I raised the issue at every turn; a compliment for which I was very grateful. I have been involved in the field of complementary and alternative medicine since my election in 1987, so it should be no surprise that I am again raising the issue.

If we were in Beijing or Hong Kong, we would have much to celebrate, as it is the Chinese new year today. Many across the world would say that this is a most auspicious day to debate this House of Lords report, paper no. 123. Soon after my election, I wrote a paper, as treasurer of the parliamentary group for alternative and complementary medicine, in which I argued that complementary and alternative medicine should be integrated into mainstream health care. At the time, that was thought to be a somewhat revolutionary approach.

Over the intervening years, such medicine has grown in people's estimation. The demand for it has increased dramatically in the United Kingdom; one in five people now use complementary and alternative medicine and the budget for treatments is approximately £350 million per annum.

Perhaps it is not so surprising that, recently, 160 Members of Parliament signed early-day motion 3 in my name, which broadly supported the findings of the Select Committee. When I was collecting the signatures, approximately a third of all colleagues said to me that they had direct experience of complementary and alternative medicine.

Therapies such as osteopathy and chiropractic, which were once treated with disdain by the orthodox medical profession, are now regulated by Acts of Parliament and considered almost mainstream by the orthodox profession.

Dr. Peter Brand (Isle of Wight): Does the hon. Gentleman accept that many Members signed the early-day motion because it urged the House to look at the House of Lords report, which is quite specific about some of the values--and, indeed, some of the non-proven aspects about alternative medicine? The hon. Gentleman must be very careful not to attribute motives to people supporting the motion. Members of Parliament signed to support the House of Lords report, and not necessarily the hon. Gentleman's views.

Mr. Tredinnick : I did say that the motion was broadly supportive of the report, and I did not go as far as to say that those who signed supported my views. The motion urged the Government to take notice of the report and it was supported across the House. I expect that the hon. Gentleman will expand on that later if he so desires.

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Last June, the Under-Secretary of State for Health said in Committee:

We should view the report in that context. Many disciplines hitherto not considered to be part of medicine at all have moved through the spectrum of complementary medicine and are now firmly integrated into the health service.

As the longstanding treasurer of the all-party group on complementary and alternative medicine, I support the findings of the Select Committee and I congratulate their Lordships on having worked so long and hard to produce this report. It marks the defining moment in the use of complementary health care in this country.

The report was commissioned largely on account of the huge increase in the use of complementary and alternative medicine not just in Britain but across the developed world. As the report states, it

such as whether regulations to protect the public are in place, how the evidence base has been accumulated and research conducted and whether the information sources on the subject and practitioners' training are adequate. The report also deals with the prospects for this form of medicine in the context of NHS provision of treatments.

The report makes five key recommendations, on: regulation; professional training and education; research; the information required by the public; and the delivery of complementary medicine in the national health service. The key objective of the Government, following the publication of the report, should be further integration of complementary and alternative medicine into the NHS.

The report provides a logical, safe and sensible way forward. Paragraph 4.37 says:

The report divides the therapies broadly viewed as complementary and alternative medicine into four groupings--groups 1, 2, 3a and 3b. We should examine each group, which attracted specific recommendations, in turn.

The first group is the so-called big five, which are already and increasingly provided on the national health service. These five--acupuncture, chiropractic, herbal medicine, homeopathy and osteopathy--are professionally organised disciplines with their own diagnostic approach and scientific evidence of effectiveness. Osteopathy and chiropractic are now regulated by Acts of Parliament and I was a member of the Committees--in previous Parliaments--that scrutinised the Bills concerned. Homeopathic doctors are regulated as doctors.

The report stated that regulation by statute might be appropriate for therapies such as acupuncture and herbal medicine and for the non-doctor homeopaths in the future. I would not disagree. For both, pre-existing voluntary regulation is in place and there is a credible

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evidence base. Following the inquiry, the Government should take action to make the big five widely available on the NHS to circumvent the patchy distribution of services, for which there can be no excuse.

The second group are, as the report puts it, the therapies most often used to complement conventional medicine. Some are already provided on the NHS, but more work is needed on regulatory structures and to increase confidence and provision. They are: the Alexander technique; aromatherapy; Bach flower remedies; bodywork therapies; counselling for stress; healing; hypnotherapy; maharishi ayurvedic medicine; meditation; nutritional medicine; reflexology; shiatsu; and yoga.

The challenge for the Government with regard to the second group is to determine regulatory structures and the proof of efficacy necessary for further integration in the health service.

I turn to the third group, which, as I have said, is really two groups. The report says:

--I would like colleagues to bear that last phrase in mind--

That is where I part company with their Lordships. Despite the length of the inquiry, perhaps it would have been better if they had waited until after Christmas and possibly given a little further consideration to those therapies listed in group 3. Most of those listed in group 3 should either be in groups 1 or 2. The group 3 listing of alternative disciplines, which offer diagnostic information as well as treatment but for which the Committee did not find convincing evidence of efficacy, include: Chinese herbal medicine, traditional Chinese medicine and ayurvedic medicine. That is hard to understand. I have been dealing with the Chinese medical institute and register in London, which is closely linked with Peking university and runs postgraduate courses for western medical doctors in collaboration with Peking university on Chinese medicine pharmacology. In fact, I will be speaking at the presentation of diplomas for doctors at the Chinese medical institute and register on 3 February.

Western doctors learn Chinese medicine and go on to treat using Chinese medicines. There is one such doctor in my constituency and I have met others practising in London. I cannot understand how it can be said that the evidence is not available. Professor Mei, the chairman of the Chinese medical institute and register, is trying to explain to the Medicines Control Agency how the safety mechanisms of Chinese medicine work. There is a fundamental problem of misunderstanding the classification of group 3. I suggest to the Minister that the evidence base exists, but that an interface with the western regulatory structure is required.

Another organisation in London, the Asante academy of Chinese medicine, is the first Chinese academy to be affiliated to a university in the U.K.--

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Middlesex university. The opening of the affiliated teaching and research centre, which I intend to attend, will be on 31 January. The evidence base is there, but it has not been understood. I have used traditional Chinese medicine and acupuncture on several occasions. Certainly, there are strong structures in place, including Peking university and now at Middlesex university, and we need to investigate how they can be extended into other groupings.

I referred to ayurvedic medicine and that is also in group 3a, despite the fact that maharishi ayurvedic is in group 2. Again, these should be in group 1. They should be available because the Indian system of ayurvedic medicine has been around for 3,000 years. At the time of Homer, the ancient Greeks travelled across land to India. I once said that they went round the Cape, but I am not sure that they were capable of doing that in those days. However, they certainly went to India and learned Chinese medicine. Eighty per cent. of the population of India and Sri Lanka use Chinese medicine, and recently the first ayurvedic hospital was opened in the United Kingdom. We cannot say that there is no evidence; the problem is that we are unable to interpret it.

It was said that for group 3b--other alternative disciplines--there was no evidence. That may be the case and it is another argument for Government help to obtain better evidence. All the therapies are valid; I have experience of them all. One of the first is listed as crystal therapy. Crystals seem to work crystal radio sets. If that energy can create a radio signal, it is likely to be able to do other things. It has long been held that crystals have energies that contribute to health and well being. Many therapists who massage use crystals under their massage beds. They may not tell their patients, but they believe that the crystals enhance the energies that they are using to help to repair the body.

There is also a British Dowsing Association; I have been with those involved in the west country and watched them at work. Dowsing can be used to find water. At Charing Cross station, there are illustrations of mediaeval woodcuts that illustrate dowsing. We should not dismiss it.

Iridology is a newer science involving looking into the eyes to discover medical problems. I recently attended an exhibition at which an iridologist, who was a qualified medical practitioner, asked 20 members of the audience to go up on stage. He looked into the eyes of each person and told them what their main medical complaints were. Seventy per cent. of them said that he had got it right. I went on to the stage and he got it broadly right for me; I have problems with muscles and tendons. I talked to him about his work. He said that the advantage of iridology was that he could look into someone's eyes and tell them which internal organs were not functioning properly. Not only that, he could tell them, for example, whether it was the right or left kidney. Why go for expensive endoscopies and goodness knows what else? If there is a failing in the modern health service, it is that we rely too much on expensive equipment. The Minister is trying to balance his budget. A little basic research on doctors who use iridology will show that they find a cheaper way to treat people.

Kinesiology has to do with muscle testing. If anyone holds something poisonous, such as carbolic, and then sees whether their arm has any strength, they will find that their muscles have little; if they hold an apple, which

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is harmonious with the body, the arm will have more strength. We have had demonstrations in the House, and it is a way of testing for allergies. Diets and allergies are an important part of health care in Britain today.

The final topic is so-called radionics, which is difficult for science to test using current conditions. In layman's terms, black box radionics involves the transmission of a signal that sends a healing process to someone remotely. I was talking to someone yesterday whose teenage children were in the far east; both had contracted a foot problem and had sores that would not heal. One child had nothing to do with radionics, while the other was given radionics treatment. The latter was healed, but the former had to go to Australia for treatment.

The Minister's mind should not be closed to such treatments. He should be aware that other treatments that are not the subject of the report are over the horizon, and are concerned with, for example, sick building syndrome. That is linked to the Chinese art of Feng Shui, which seeks to achieve well being through the modification of layout and orientation of workplaces. Feng Shui is concerned about "cutting Chi". I shall not talk about that today, but it is often used when a building is misplaced and is alleged to send bad energies that can cause problems in another building.

I referred to the Chinese new year. That is not set arbitrarily; the Chinese believe that, on a certain date, the energies in the sky above are very poisitve better. I was interested to find a report in a newspaper last month that stated that science has worked out that pregnancy, hangovers and visits to one's GP may be affected by the awesome power of the moon. The article stated:

and added that hospital units see 10 per cent. more patients and alcohol consumption rises. If science has discovered those facts, the Government will have to address them. If so, we may see the reunification of astronomy and astrology, which split in the 16th century. I do not suggest that the Minister needs to address the matters now, but if I were to make a speech at the end of the next Parliament, they might have come into the fold. I alert him to that.

I said that those in group 1--osteopaths, chiropractors, homeopaths, those who practise herbal medicine and acupuncturists--should immediately become more uniformly available throughout the United Kingdom. That is essential, and the Minister can achieve it right away. He needs to address the difficulties of efficacy with group 2 that are highlighted in the report. The problem is that too many organisations represent complementary and alternative medicine; there are about 150 in Britain.

When professional organisations within an individual therapy or profession join forces or work more closely together, quicker developments in self-regulatory structures, improved standards of training and greater recognition follow; that has happened for example, in acupuncture, aromatherapy, healing, herbal medicine and homeopathy. With not a lot of money, the Minister can help such groups to join together, especially aromatherapy and hypnotherapy, which have done well. There is great scope for the Government to intervene.

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The report also recommended that in order to protect the public, professions with more than one regulatory body should make a concerted effort to bring the various bodies together and to develop a clear professional structure. A minority in the complementary movement say that there should be one regulatory badge for all approved complementary practitioners. That is not the way forward. It would be more satisfactory for each discipline to develop its own regulatory structure. Nothing that encompasses every discipline will have the credibility that it needs.

The report also deals with training for health care professionals. It proposes better training for doctors in CAM disciplines and highlights the need for other statutorily regulated health care professionals to develop clear guidelines. That is important and I hope that the Minister will refer to it. Another issue is the availability of information about CAM. There is a clear need for more effective guidance for the public about what works and what is not safe in CAM. We need a central register of information and, as the report states, central resources should be directed either through the Government or in partnership with a neutral body.

Research and development is a major topic that is covered by the report. We need to create measures that effectively evaluate the benefits experienced by users of complementary therapies and consider different ways to test them. The normal method of double-blind trials is not necessarily the best way to check their effectiveness. As highlighted in the report, one thing is certain; there is not enough research. Time and time again, complementary therapists say, "We haven't got the time to produce trials. We are up against it making a living, so how can we offer the convincing proof that is required? We get on with our job: we teach people and heal them." The Government should set up proper trials, such as that which was set up recently at Glasgow university into the effectiveness of homeopathy in treating allergies. That scientific trial found that, on average, the homeopathic patients were 22 per cent. better and the placebo group were 2.5 per cent. better. The report refers to the need to distinguish between placebo effects and medicines, and this is a good example of how that can be done. It is the kind of research that we need.

The report also recommended a central mechanism for co-ordinating and advising on CAM research and for making available research and training opportunities with resourcing from the Government. The Minister may wish to respond. There is a recommendation that the NHS, the directorate and the Medicines Research Council should pump-prime this area with dedicated research funding to develop a few centres of excellence for conducting CAM research on appropriate disciplines.

Centres of excellence will make a huge difference; look at the science park at Cambridge, for example. If we put experts together, they will produce something very special. This will not cost the Government a lot of money; in fact, it is one of the best opportunities for any Government, as I argued with the last Government. It is such a cheap way of getting new health care into the system. If we can get the assurances of efficiency that we need in some of the other disciplines that are in

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group 2--not the mainstream ones such as acupuncture, herbal medicine and homeopathy, which are in group 1-- we can take things forward.

The last point that I want to cover is delivery in the national health service, which I have to say is patchy or non-existent. I spoke to Leicestershire health authority yesterday; it has a policy of not intervening, which, generally speaking, is the policy of the Department. I have been in three Parliaments and I have never found advisers to the Department of Health to be particularly sympathetic to complementary medicine. The Minister should look around and see who can advise him on creating a health service that does not discriminate in the provision of those disciplines in group one.

The primary care system has failed to expand the delivery of complementary and alternative medicine. Since GP fundholding was abolished, the amount of provision of complementary health care in the NHS has fallen and I have sent letters to the Department about the failings. I received a letter from the Anglo-European College of Chiropractic in August, saying that demand had fallen off due to the new primary care group arrangements. I received another letter, from Christchurch in Dorset, about the problems that those involved there are facing. The letter said:

Those are just two examples.

I would like to finish by giving an illustration of how complementary and alternatives medicine can work in practice and how people use complementary medicine to best effect. Recently, a constituent wrote:

I was asked what I, as a Member of Parliament, would do about it. I am not a physician, but I have had carpal tunnel syndrome myself--a condition where the cartilage round the wrist grips the nerve and, in my case, there is extreme pain in the second and third fingers. I went to see a doctor who at first did not pick up the problem. Subsequently, I saw the doctor's colleague who did pick it up but, in the intervening period, I visited an osteopath. That did not work, and so I went to a cranial osteopath, with limited success.

Then, I received the proper diagnosis and was told that I needed an operation, which would take a year on the NHS. I could go privately; anybody can if they have and want to spend the money. My constituent, who is on benefit, cannot afford to do so. I then went to my homeopathic doctor, who prescribed something that I think gave me relief. I have also used acupuncture, which stimulated the kidney and liver meridians to make sure that the flow of energy is better through the body to my hands. I have also used aromatherapy oils. I do not know which of those therapies has affected me; all I know is that I am better. I do not need an operation or to be a burden on the health service. I have done it all myself, and that is a good illustration of how complementary and alternative medicine works. Often, people like to move around therapies for treatment; some go to a healer, of whom there are around 20,000 in Britain.

To conclude, complementary and alternative medicine offers hope to people who have perhaps lost hope, sometimes when conventional doctors feel they

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have nothing else to offer. The House of Lords Select Committee report has drawn attention to many issues that need to be addressed if complementary medicine is to play its full role in the provision of health care in the UK. I urge the Government not only to take those recommendations on board but to act on them.

The therapies in group 2 meet the Lords' criteria for being suitable for the NHS. There are 50,000 complementary therapists in the UK, and perhaps 10,000 health care professionals. Thirty thousand of those 50,000 therapists fall into the category of being suitable for the NHS. The Government should act now to make greater use of those therapists, who are an under-utilised resource. The therapists could provide comfort and relief to millions of people and bring about considerable cost savings to the Government. I rest my case.


Dr. Peter Brand (Isle of Wight): I congratulate the hon. Member for Bosworth (Mr. Tredinnick) on securing the debate, and on highlighting the valuable contribution made by the House of Lords Select Committee on Science and Technology. As he pointed out, we may not be dealing with a mainstream medical activity, but we are certainly dealing with a mainstream commercial and patient activity; a turnover of some £350 million and 50,000 therapists are significant.

I supported the hon. Gentleman's early-day motion because the House of Lords clearly recognised that there was a need to evaluate what was going on within the market, and to draw up some criteria, if only for consumer protection. As a conventionally trained allopathic doctor, I am aware that there is a great deal of uncertainty in medicine. Many conventional therapies are first brought out on the basis of a theory. Hopefully, the evidence follows. Certainly within my clinical lifetime, effective drugs have been introduced. However, the theory of how drugs work has probably changed three or four times in 10 years. Therefore, one must not necessarily say that because we do not understand a process, it has no value.

One has to protect people and be rigorous in the evaluation of the process, potential side-effects and outcomes in so far as one can. I have problems with the hon. Member for Bosworth's claim that the evidence is there, but we do not understand it. Scientific evaluation is exactly the same whether we are talking about the effects of food, aromatherapy or anti-cancer medication. We look at what we do to someone and the outcome, test that against another group of people who are not having that intervention and look at the results to see whether one group fairs better than another.

Mr. Tredinnick : I was thinking mainly of traditional Chinese medicine, which, after all, treats between a quarter and a third of the world's population.

There are so many universities in China that it seems strange that anyone should say that there is no evidence that those therapies work. I feel that that is due to a misunderstanding.

Dr. Brand : I did not say that there was no evidence; I merely objected to the contention that the evidence was not understood. Simply because something has been

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done for a few thousand years does not mean that it is useful. The health outcomes in China are not especially good; nor are those in India. That type of medicine may be the only resource available to those populations, but their morbidity and mortality rates are far worse than they are in this country.

I have a problem, too, with the description of iridology as a new science; it is a new practice, but it cannot be called a science until it has been evaluated. One does not want to pick holes, but I also have problems with kinesiology and the idea that holding carbolic does something to one's muscles. I will have to change my soap, as I did not realise that carbolic could have such a dangerous effect on my well being.

The issue is serious, however. The House of Lords has done us a great service in considering the various complementary therapies and making an attempt to classify those that, although we may not understand them, are shown to be of value and--more important--not to do harm, and those about which we are uncertain. It is important that the consumer and patient are protected in this bewildering market. I have a problem with the enthusiastic proponents of alternative medicine because they seem to turn it into a quasi-religion. One has to accept a belief system and an entire philosophy before accepting treatment from a particular regime. That puts tremendous pressure on vulnerable people whose symptoms have not been relieved by traditional medical intervention.

I am not saying that we should never treat people because we cannot find an origin for their pain or misery, or that we should use only treatments that have gone through the double-blind trial procedures. One can often improve the patient's sense of well being through alternative methods, which has a tremendous effect on the disease process. Dr. Balint showed clearly that the placebo effect could be important, and every doctor would recognise that a doctor--in him or herself--has a placebo effect that may be powerful, either positively or negatively.

We should not close our minds to the opportunities presented by alternative medicine, but we should temper that with a degree of science. Scepticism is the wrong word; I believe that we should temper it with a degree of care for patients and consumers, for whom the Government and Members of Parliament have a responsibility.

Research is important. I do not accept that alternative practitioners can use the excuse that they are too busy to evaluate what they do. If one sets oneself up as a professional in a therapeutic regime, one has a professional duty to evaluate what one does and consider the outcomes. It cannot be acceptable to claim that one is too busy to do that. There should be a mechanism by which those evaluations are supported and published, so that a peer review can take place and they can be tested.

When a new drug comes out, one is always told that it is the best thing since sliced bread. A doctor can examine the clinical trials, but his experience with the first six patients on whom he uses the drug will determine whether he will continue to use it. We are all a bit like that. We need the science base, under the research base, to inform our gut feeling, because we

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cannot run a health service on gut feeling alone. I am sure that the Minister would agree with that because, at the end of the day, it is his money that is being spent.

I want to refer briefly to the problems of access to these therapies through the national health service. The hon. Member for Bosworth said that fundholding had reduced access to complementary therapies. That is not my experience.

Mr. Tredinnick : I had intended to say that primary care groups had seen a reduction of complementary provision, but that GP fundholding had helped.

Dr. Brand : I am glad that I have given the hon. Gentleman an opportunity to correct what he said by misadventure.

In my experience, fundholding created a blossoming of access to alternative medicine, for three reasons. First, the interventions on the whole were not harmful. Doctors are always minded that their first duty is not to do harm. Secondly, patients liked being referred to alternative practitioners. Thirdly, the interventions were, on the whole, very cheap. That may be a cynical point, but it is certainly advantageous to make significant savings on a prescribing budget by sending patients to a homeopathic practitioner or an acupuncturist, provided that one is not denying those patients more appropriate treatment.

Some of the more ideologically motivated complementary practitioners deliberately stand in the way of conventional medicine and significant treatment, believing that people must commit themselves to their philosophy of medical care. That is dangerous. Faith healers can also be dangerous in that way. There was a vicar in my village who did not believe in medicine; according to him, all cancers were caused by lack of faith, and church attendance was the solution to everyone's problems. When he tried to stop his mother-in-law taking her heart medication, I felt that I had to intervene. I was not sure whether he had done that because he did not like his mother-in-law, but I thought that his faith was being pushed on to a third individual, which was totally inappropriate. One sometimes sees instances of that; it shows that there is a need to protect the public from undue enthusiasts for such therapies.

Will the Minister do some work on the availability of complementary medicine since the establishment of primary care groups and trusts? In my own primary care group, we have reduced the access to complementary therapy. In my practice, we had access to an excellent acupuncturist and a homoeopathist, and found it valuable. The audits that we did on their interventions showed that they were helpful in about 30 per cent. of cases and extremely helpful in the 5 per cent. of cases that had not been helped by anything else. As I said, it was safe and cost-effective.

Our fundholding practice worked as a multi-fund, rather than an individual practice making individual decisions. We developed a menu from which individual fundholders could pick what they thought was most appropriate for their patients. Some patient groups therefore had access to alternative therapies; others did not because some doctors and patients were more

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enthusiastic than others about alternative medicine. That is appropriate; it is not for a central organisation to determine what is best for an individual patient within a locality.

Largely as a result of Government pressure, primary care groups now follow the doctrine of giving everyone equal access to every intervention, which has resulted in some people--depending on the membership of the groups making commissioning decisions--saying that the majority of GPs do not believe that therapies such as acupuncture or homeopathy have a place and that it would be inequitable for anyone to have access to them. That is not a positive way forward. It is more reasonable to have a fairly wide menu of interventions and then allow individual practitioners, in discussion with patients, to decide what is best for a particular patient within a particular practice.

If a GP has strong feelings that no one should be referred outside the conventional envelope, patients may still have access to the alternatives if they feel strongly that that is what they want. Will the Minister reflect on whether his laudable attempt to make access to medical intervention equitable around the country will stifle some of the more imaginative approaches that were taken in the past?

Some complementary medicines play a similar role to counselling and psychotherapy; they are a supportive mechanism, and if they make people feel better and are not disproportionately expensive, that is excellent. It is ridiculous that we have had to sack our acupuncturist, but can still obtain acupuncture by sending people to a consultant anaesthetist in a pain clinic--which is considerably more expensive than treatment from an in-house practitioner who was popular with our patient group.

The report is helpful and shows a way forward. The box system is extremely helpful. It is for those who think that they have been placed in the wrong group to make the case to become more part of the mainstream. I am also glad that recommendations have been made on professional accountability and insurance. I began practising medicine at a time when one could be struck off for referring someone to a non-medically qualified practitioner, on the grounds that we should not dabble with such people as osteopaths and chiropractors but should refer patients only to what were seen as subsidiary disciplines such as physiotherapy. I am very glad that that attitude has disappeared and that we now recognise professional expertise outside the strictly medical circle. We have an approach of teamwork, centred around the patient.

It is important to set up a system that enables alternative practitioners who want to join that team to take responsibility and to accept liability for their actions. The disciplines in group 1 have taken that on board, which is why the House of Lords found them much easier to deal with than those in group 3, who rely more on faith than on evidence.

11.50 am

Mrs. Caroline Spelman (Meriden): I congratulate my hon. Friend the Member for Bosworth (Mr. Tredinnick) on securing the debate. It is good to have an opportunity to debate the House of Lords Select Committee on Science and Technology report on complementary and alternative medicine.

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I pay tribute to the Select Committee's work; the report is comprehensive and most informative to those of us who are not familiar with the range of alternative and complementary therapies. I cannot comment on the efficacy of the diverse range of therapies and I would not attempt to do so. The Select Committee was the best forum in which to attempt the difficult task of categorising the different therapies.

The question that was paramount in the Select Committee's work was how best to protect the public. Anyone who visits a complementary therapist places himself or herself in a position of trust, in the same way as someone who visits a conventional practitioner does. It is a one-to-one relationship in which the patient's problem is discussed in privacy and with a degree of confidentiality, which people expect the therapist to respect. Recommendations are made and a solution may be suggested or treatment practised during that therapy session. We must seriously consider whether more protection should be afforded to people visiting the blossoming range of alternative therapists.

It is interesting that 40 per cent. of general practitioners refer their patients to practitioners of alternative and complementary therapies. I am not surprised by the statistic given by my hon. Friend that one third of Members of Parliament have direct, personal experience of alternative and complementary medicines. The public are prepared to pay individually to receive treatments in the belief that they will address their problems. Alternative and complementary medicine is expanding and playing a more important role, as the hon. Member for Isle of Wight (Dr. Brand) explained, and conventional practitioners are having to get their heads round the way in which these different medicines may work together with conventional medicine.

What can be done to protect the public is a topical question. Last night, there was a debate on the Floor of the House about the dreadful events that led to the murders of the patients of Dr. Shipman. God forbid that there should be a repetition of a Shipman situation, even on a minor scale, in alternative and complementary medicine. Some safeguards must be put in place.

We made an attempt to afford the public better protection during proceedings on the Care Standards Act 2000. My hon. Friends and I tabled a new clause, which would have enabled the Care Standards Commission to regulate complementary medicine by requiring it to maintain a register of alternative therapists. It would have given the Secretary of State important powers to protect the public in respect of the description of services, claims made in respect of services, and techniques that might be employed. Our constructive proposal was rebuffed on the grounds that, as the Select Committee was undertaking an inquiry, it was not an appropriate moment to seize the legislation and make such a provision. We were told that we should wait to find out what came out of that inquiry and react accordingly.

We have all now read the Select Committee's report, which contains several recommendations. Do the Government accept that regulation of complementary and alternative medicine is necessary? If so, which of the two routes that the Select Committee considered under the Health Act 1999--a single body representing the entire profession applying for statutory regulation by

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order in the Privy Council, or a new health professions council--do the Government believe would be better? Will they say now, as they were not able to say when the Select Committee was taking evidence, what the advantages and disadvantages would be of those alternative routes to regulation?

The reason given for not responding at the time to the Select Committee's questions on that point was that one of the two options--the new health professions council--was subject to consultation. The consultation is now over, and the Department will have received all responses by the beginning of November at the latest. Did those responses raise questions about incorporating alternative and complementary medicine under the umbrella of the new health professions council, and if so, what is the Minister's view of those questions?

The Select Committee report also recommends that national studies should be commissioned to obtain more detailed quantitative information about the extent of complementary and alternative medicine in use in the United Kingdom. Our debate has revealed that, as legislators, we are operating in the dark on the matter. We are not sure how many practitioners are involved and where they are. The Government have a responsibility to keep tabs on developments in the blossoming field of alternative medicine. I should be interested to know whether they accept the recommendation that such studies should be undertaken.

We do not yet know the outcome of the consultation, but one of my anxieties about the Government's proposal to create a new health professions council relates to the slightly untidy arrangements that will result. Some of the professions allied to medicine are already regulated by statutory arrangements; indeed, osteopaths have their own Act. That has led to not a little local jealousy from some of the other professions, which are worried that, as they will not have a similar legislative basis for their regulation, they will suffer as a result of inferior regulatory arrangements. That problem is difficult to avoid, as the existing legislation is already in place. A problem might arise if one of the routes recommended by the Select Committee were taken. A range of alternative and complementary therapies are available. Will some be regulated by statutory order while others come under the umbrella of the health professions council? That presents some difficulty, and I should be genuinely interested to hear how the Minister suggests that we proceed, given those diverse arrangements.

The Department of Health plays an important role in signalling to the conventional medical community the areas in which research should be conducted. The Government send signals to research councils about areas of prioritisation that they would like to see pursued. Should the Department of Health send similar signals to research councils about promoting more of a research culture in complementary and alternative medicine?

What plans do the Government have for regulating the professions allied to medicine, either by statutory means or by the health professions council route? Does the Minister accept that regulating areas of conventional medicine would help to lay an important pathway for the recognition of qualifications and training in the new therapies? That would also enhance

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the standing of the new professions in complementary medicine. When we debated the new clause during the proceedings on the Care Standards Bill, it received a positive reaction from representatives from the complementary medicine professions, who saw in it an opportunity to establish received pathways to recognition as a qualified practitioner. Does the Minister accept that that would benefit the practitioners and their customers? Were we to place ourselves in the hands of an alternative therapist, we would receive some reassurance from knowing that that therapist had a recognised qualification for the skill that he was practising.

The Select Committee report on complementary and alternative medicine focused on the diversity of therapists and their skills and how they might be regulated, but it did not touch on the products used, which are an important part of the therapy. A homeopath might make use of very different products from those prescribed by the hon. Member for Isle of Wight, with his depth of experience. That is an important area.

The Minister is sure to be aware that the United Kingdom is currently in a difficult position. A new European directive to control products used by alternative and complementary therapists regards some of the well-established products sold in health food shops, such as vitamins and herbal remedies, as medicines. Practitioners are concerned that remedies hitherto widely used by the public might be restricted if subject to the kind of directives envisaged at a European level. Medicines should be vigorously tested--I am sure that we would all agree that the public should not be placed at risk because of a medicine that had been inadequately tested--but many remedies have been in use for many years.

Testing is an expensive process, and new, novel medicines often fall at the first fence because a company has insufficient resources to have them tested. The position of a number of established remedies may be precarious if they are caught in a rigorous new medicines directive. I know that a number of practitioners of complementary and alternative medicines would be interested to hear the Government's view on the proposed new directive.

12.4 pm

The Minister of State, Department of Health (Mr. John Hutton) : I start by warmly congratulating the hon. Member for Bosworth (Mr. Tredinnick) on raising the subject of alternative and complementary medicines today. I congratulate him also on the depth of his knowledge of the subject, which is probably unrivalled in the House. My hon. Friend the Minister of State, Department of Health, the Member for Southampton, Itchen (Mr. Denham) has rightly praised the hon. Gentleman for his tireless devotion to those subjects. I should also like to pay tribute to his commitment to his cause.

The hon. Gentleman made an interesting reference to the impact that the full moon can sometimes have on our lives. I have no idea whether there is a full moon today or whether it has had any influence on our debate,

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but he certainly made some intriguing remarks about that, which gave everyone who heard them pause for thought.

I compliment also the hon. Member for Isle of Wight (Dr. Brand) on his thoughtful comments. He posed the issue in terms of public safety. I do not think that this is just about public safety; it goes much wider than that. I agree that public safety issues are important, but there is another issue to which he rightly referred. NHS doctors and patients must have the widest possible choice of available remedies. We must also ensure that NHS resources are used effectively. We must not just balance important issues of public safety; we must do all those things simultaneously. That is a difficult balancing act, as I am sure that the hon. Member for Bosworth would be the first to concede.

We are quite clear about the priorities on which we should focus at the moment. When we came into office, the NHS was under-doctored and under-nursed. Too many health care services were being delivered in Victorian buildings. Those are our priorities, in addition to dealing with the top clinical priorities that the NHS faces; the big killers such as cancer and coronary heart disease, where our survival rates are simply not acceptable and where more work has to be done to improve services.

A difficult set of choices has to be made by Governments of whatever party. We have tried to set out through the NHS plan and all our other work the key priorities behind our commitment to modernise and reform the NHS and to increase its capacity to meet the needs of our complex society in the 21st century. I want to refer to how alternative and complementary medicine can play a part in that in my response to the hon. Member for Bosworth's detailed and thought-provoking comments.

The hon. Member for Isle of Wight expressed his support for the Government's efforts to promote greater consistency of NHS provision across England. That is an important focus for our work, but he is wrong to conclude from his example that GPs were being required to fit themselves into a straitjacket of policy that would narrow the options available to them. That is not what we are doing.

Dr. Brand : I do not think that that is the perception of some of the primary care groups and primary care trusts on the ground. There is a risk of losing diversity of choice for the sake of equity of access.

Mr. Hutton : I strongly believe that we can avoid, and have avoided, making that trade-off. We have always made it clear in relation to the reforms that we made to primary care that we want to level up the provision of services. The hon. Gentleman gave an example from his own practice. He said that access to complementary medicine had been narrowed down. I do not dispute that for a second, but that is a choice that he and his colleagues made locally--[Interruption.] The hon. Gentleman may want to correct me, but we believe that our reforms to primary care will improve the delivery of services. Our reforms will end--I must tell the hon. Member for Bosworth--the totally unacceptable state of affairs created by GP fundholding. Far from increasing choice, it effectively narrowed it for many patients. We are determined to put right that wholly unacceptable change to the NHS.

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The hon. Member for Meriden (Mrs. Spelman) asked about professional regulation and research and asked what signal the Department would send to the complementary alternative sector about the importance of research. I have a simple message; research is very important. A strong, research-based culture would be beneficial to complementary and alternative medicine, and we would welcome it; as would, I am sure, the hon. Member for Bosworth.

Debate has rightly focused on the House of Lords report into complementary and alternative medicines. The report represents the first-ever comprehensive inquiry into complementary medicine in the United Kingdom by any parliamentary Select Committee. Written evidence was submitted by 180 individuals and organisations, 46 of whom were subsequently called to give oral evidence. That testifies to the thoroughness with which the Committee approached its task. My hon. Friend the Minister for Public Health also appeared before the Committee towards the end of its deliberations.

We are debating the issue today before the Government have published our response to their Lordships' report. The hon. Member for Bosworth will accept that I cannot anticipate the Government's full response here, although it will be published in the near future. The response will, of course, be published and presented to Parliament as a command paper. In the normal run of events, there would be a debate in the Lords, but that is a matter for the Committee itself to determine.

In recent years, we have seen increased public interest in and use of complementary medicine. It is a thriving feature of the private health care sector. Some forms of complementary medicine are also provided in the NHS on the basis of clinical need, usually as an adjunct to orthodox treatment and sometimes practised by members of the orthodox health professions. The Government are aware that many people have found complementary medicine helpful and that it has some powerful advocates, including some from the world of orthodox medicine.

Today's debate has touched on the main themes in the report--regulation, training, research, information and NHS use. Reference has also been made to how the report has introduced some structure to the world of complementary and alternative medicine by classifying therapies into three primary groups.

The first group embraces what the Committee refers to as the "principal disciplines"; osteopathy, chiropractic, acupuncture, herbal medicine and homeopathy. The second contains the therapies most often used to complement conventional medicine, such as aromatherapy, massage and reflexology. The third consists of disciplines that, in the view of the Committee, adopt a philosophical approach very different to the scientific principles of conventional medicine. Some of these are long-established, traditional forms of health care, such as traditional Chinese and ayurvedic medicine. Others are therapies that the Committee viewed as lacking a credible evidence base, such as crystal therapy and iridology--both mentioned by the hon. Member for Bosworth.

I recognise the difficulty of generalising about such a diverse range of therapies, but it is important that we begin to introduce more structure into the

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complementary medicine world, not least to help patients and the general public better understand what they are dealing with. Not every therapy will fit exactly into the wide definitions suggested in the report, but I recognise the potential value of adopting sensible working definitions as a foundation for making real progress in future.

Among other things, the structure and definitions in the report provide a useful template for developing the regulation of complementary and alternative medicine therapies. As the report has suggested, some therapies have reached the stage where they ought seriously to consider preparing for regulation on a statutory basis. Other therapies need to progress to the point where they have their own recognisable voluntary regulatory bodies. In time, some of them may also become suitable candidates for some form of statutory regulation. One thing is sure. If complementary and alternative medicine is to be recognised as a respected member of the caring professions, it must put in place a proper regulatory framework that will raise standards and protect patients.

In giving evidence to the Committee in October, my hon. Friend the Minister for Public Health said that effective regulation of complementary and alternative medicine practitioners was important to ensure proper protection and support for patients. She also made clear the Government's view that without effective regulation, it was hard to promote greater uptake of complementary medicine in the NHS.

The Chief Medical Officer, Professor Liam Donaldson, who also gave evidence to the Committee, made it clear that he thought it important that as professions formed themselves into recognisable professional bodies, they were brought forward into the right statutory framework.

In this respect, Department of Health officials have already held exploratory meetings with representatives of the two professions that the Committee considered could be early candidates for statutory regulation; herbalism and acupuncture. These discussions have focused on the steps that each profession needs to take in preparation for statutory regulations.

The scope and nature of any future statutory regulation of these professions needs to be discussed more widely and there will need to be full consultation. Among other things, consultation could explore the feasibility of including aspects of the practice of traditional Chinese medicine, ayurveda and other forms of traditional medicine based on herbs in the arrangements made to regulate herbalists as a whole. This could offer a way forward to some of the disciplines, which the Committee has chosen to categorise as group 3 therapies.

In relation to other professions, we have stated our support for the work being done by the Foundation for Integrated Medicine to help establish and improve voluntary, regulatory schemes. The foundation will be holding a conference next week, to which it has invited a wide range of regulatory and professional bodies from complementary medicine. The aim of this conference is to encourage constructive debate about taking forward the recommendations in the report. An open forum of this sort will give the various professional groups an

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ideal opportunity to discuss what the Committee has recommended in relation to regulation and professional standards and to consider how they will respond.

We do not, of course, view complementary and alternative medicine in isolation. We are currently working hard to raise standards across the NHS and the private sector in patient-centred care, in better equipped, better trained and better regulated professions. The higher standards that we are setting for the NHS will provide a yardstick against which complementary and alternative medicine should be measuring itself, whether it is practised in the private sector or the NHS and whether it is provided by doctors and nurses or by complementary medicine therapists.

Regulation of products is important and the hon. Member for Meriden referred to this. Following extensive consultation with UK interest groups, we are now working with our partners in Europe on proposals for a directive in traditional medicines. The aim is to provide a framework for the effective regulation of traditional herbal remedies, balancing public safety and consumer choice. The hon. Lady will be aware that the Commission has produced a first draft of that directive and the Medicines Control Agency has produced some initial responses. I am very happy to let the hon. Lady see the response of the Medicines Control Agency; it may be in the Library.

There is significant concern in the UK at the moment about the way in which these issues are being dealt with. There are about 500 licensed herbal medicines available on the UK market and many more are sold under section 12 exemptions. The difficulty with the existing arrangements is that whereas the normal licensing arrangement provides strong protection for the public, they have been perceived by some as limiting public choice. The section 12 herbal exemptions offer the public greater choice, but do not always provide adequate protection. There is every opportunity that this work can be taken forward successfully with our colleagues in Europe and that is the best place for this type of work to be done.

An important function of professional regulation is setting standards for training and education. I accept that there is a lot of work to be done in this area in training health care practitioners who aspire to practise complementary medicine and providing more undergraduate doctors and nurses with some familiarisation with complementary medicine. The important thing will be for the professional bodies involved to set clear standards and to work closely together in doing so.

We will continue to encourage complementary medicine regulatory bodies to set clear and consistent professional standards for their registrants and to work with education and training institutions to ensure that these institutions offer qualifications that meet these standards. As I said, there is much work to be done. Officials from the Department have discussed the report's recommendations with the Department of Education and Employment, the Qualifications and Curriculum Authority and the Quality Assurance

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Agency. Once the Government's response to the report has been published, I am sure that wider consultation is likely to follow.

Mr. Tredinnick : The Minister said earlier that there would be a Government response in the very near future. Does that mean this month or next month? It would be reassuring to hear that it did. I have not yet heard him say anything about the issuing of guidance to health authorities on complementary and alternative medicine, so perhaps he could address that point. Does he intend to set up a register of practitioners?

Mr. Hutton : The hon. Gentleman need not worry; I will deal with all his points.

Hon. Members have talked about the need for more research into complementary and alternative medicine. Complementary medicine needs better research, not just more research. The most popular therapies, at least, need to be underpinned by more definitive, high-quality research evidence. Everyone recognises that it will take time to produce such evidence, but opportunities exist for researchers to train in the techniques that they will require and the academic expertise is beginning to come together to help to co-ordinate research efforts. My Department welcomes applications to fund complementary medicine research projects, provided that they offer a clear link to one of the NHS priority areas.

In the meantime, I fully accept that information on complementary and alternative medicine, such as it is, needs to be carefully synthesised and made available in a much more user-friendly way both to the wider public and to health professionals. The provision of better information for patients is a key feature of the NHS plan, and work is in hand to include complementary medicine in the information that will be made available more widely to the public.

Better information on complementary medicine will be in patients' interests twice over. First, it will help them to decide which therapies could be appropriate for them and where to go for treatment. Secondly, it will inform them of the professional standards to expect. When the public expect and demand high standards of complementary medicine practitioners, the complementary medicine professions will have even more incentive to put high standards in place and to live up to them.

We have given the Foundation for Integrated Medicine a grant to create a database of information, which will enable it to advise anyone who wants more information on regulatory bodies and the codes of conduct that they follow. Regulatory bodies must be the repository of more detailed information about registered practitioners, the appropriateness of their treatments, likely costs and complaints procedures. Information on the nature of treatments is also available from a wide range of other reputable sources. NHS Direct will be able to expand the information that it provides when authoritative evidence of safety and effectiveness becomes available and proper regulatory systems are in place.

It is important for both complementary and orthodox medical practitioners to share information with one another about their treatments. In fact, there is

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considerable scope for the two sides of medicine to work together more collaboratively. I am not sure whether the hon. Member for Bosworth saw the leading article in last week's British Medical Journal that argued for much greater integration of complementary and orthodox medicine. He referred to that approach, and I strongly believe that there is much to commend it.

The hon. Gentleman was anxious for me to talk about NHS provision. Complementary medicine can, and often does, play a part in treating NHS patients. An informal survey carried out on behalf of the Department of Health a year ago found that 58 per cent. of primary care groups were providing patients with access to some form of complementary medicine. We continue to keep a watchful eye on the extent to which primary care groups make complementary medicine services available.

As part of an on-going work programme, we have commissioned Sheffield university's medical care research unit to undertake a detailed study into the impact that primary care groups have had on access to complementary medicine through NHS primary care. The study will be completed at the end of 2001 and will help to inform our future policy.

We have collaborated with others to produce a basic information pack for primary care groups on complementary medicine. The pack was built on the results of the informal survey previously carried out for the Department of Health and focused on the therapies that that study had shown to be most commonly encountered in primary care; chiropractic, osteopathy, acupuncture, homeopathy and aromatherapy. As well as offering information about the nature of each therapy and the conditions that were most likely to benefit from them, the pack discussed the regulatory status of practitioners and provided sources of further information. Several examples were included of how those therapies had been adopted in primary care.

We circulated that pack to primary care groups and sent a shorter companion booklet to all GPs in England in July. The feedback that we received suggested that many people found it helpful. As my hon. Friend the Minister for Public Health mentioned to the House of Lords Select Committee, we hope to produce a new version of the pack for patients.

Mrs. Spelman : We obviously need to be careful with the use of public money for the provision of health care.

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Could he assure me that what is provided for the NHS is based on evidence, and not just on popularity? There needs to be a proper evidence base behind the provision of complementary and alternative medicine on the NHS; the fact that a therapy has been made available because it is popular is not quite the same thing.

Mr. Hutton : I agree with the hon. Lady, and that was the point made by my hon. Friend the Minister for Public Health in her evidence to the Committee; popularity is never enough, and there has to be an evidence base of effectiveness. Towards the end of this year, the National Institute for Clinical Excellence will be publishing evidence-based guidance to the NHS on supportive and palliative care for cancer patients. The guidance will aim to improve patients' experience of cancer care and, in doing so, improve the quality of life for all those affected by cancer.

The hon. Member for Bosworth might be interested to know that one of the issues that NICE is considering, as it prepares its guidance, is the potential benefit that cancer patients derive from complementary services. As I said earlier, if complementary medicine aspires to be equal with other forms of NHS treatment, it must meet the same standards. It must be clear and realistic about the contributions that it can make, and it should work in an integrated way with other forms of treatment. Effective regulation of practitioners is important, as is an appropriate evidence base for the treatments that they offer.

The report sets an authoritative agenda for change. Some of the complementary and alternative medicine professions have begun making the improvements that they need to secure a more lasting place in public affections. They must now drive forward these changes more decisively, and the professions that have still to put those changes in hand must do so more urgently.

Mr. Tredinnick : Before he finishes, will the Minister state what "in the very near future" means in terms of the Government response?

Mr. Hutton : I am glad that the hon. Gentleman reminded me of that. I think that it will be published in the next few weeks, although I cannot go much further than that, other than to say that the Government certainly welcome the report and will be setting out a full response in the near future.

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