APPENDIX 9
Memorandum by The Society of Homeopaths
1. SUMMARY
1.1 Homeopathy is a safe, effectual and
cost-effective form of treatment for women in their child-bearing
years, which is increasingly being used by women both in pregnancy
and in child birth. Indeed, for many socially excluded groups
of women, such as certain communities of Asian women, homeopathy
is their treatment of choice. Yet, despite the growing demand
for homeopathic treatment by women and mothers, access remains
extremely limited for those who cannot pay and do not have access
to private medical insurance.
1.2 The Society of Homeopaths would support
increased choice for women in maternity services. We would particularly
encourage the Government to introduce measures to make homeopathy
more available to pregnant women and mothers on the NHS. In particular,
the Society calls on the Government to send a stronger signal
to primary care providers that complementary medicine is an accepted
part of the NHS and to give them permission to refer patients
to registered homeopaths for treatment.
2. SOCIETY OF
HOMEOPATHS
2.1 The Society of Homeopaths is the largest
and most representative body for professional homeopaths in the
UK. We have 900 members on our Register, all of whom have completed
recognised courses, at least one year's supervised clinical practice
and a six-month peer-reviewed registration process. Our Registered
Members are subject to a rigorous Code of Ethics and are insured
to £3 million professional indemnity.
2.2 In addition to Registered Members (RSHom's),
we also have 660 Licensed Members who have successfully completed
a course recognised by the Society and are fully clinically competent.
The Society's development as a professional organisation was commended
by the House of Lords Select Committee's report on complementary
and alternative medicine in 2000.
2.3 Our Registered Members increasingly
engage with health professionals such as midwives and health visitors
in providing complementary care in pregnancy and childbirth. In
addition, our members provide a service to a NHS Well-Woman Clinic
in the centre of Sheffield; this project is now in it's sixth
year. Where homeopathy is provided on the NHS (Wiltshire, Yorkshire,
Tyne and Wear, Highlands) patient opinion surveys consistently
reveal high satisfaction with the service.
3. HOMEOPATHY
IN MATERNITY/CHILDBIRTH
3.1 Homeopathy is ideal for women in their
childbearing years. It is a safe, gentle yet highly effective
system of medicine. Owing to the high dilutions used, homeopathy
is safe to use in pregnancy and childbirth, unlike many conventional
medicines which may cause unacceptable side-effects or an unacceptable
risk to the unborn child.
3.2 Anecdotal evidence has shown that homeopathy
can be a useful intervention in the treatment of common ailments
in pregnancy, labour and post-partum. In pregnancy homeopathy
is used to treat:
— threatened miscarriage;
— malpresentation of the baby;
— morning sickness and nausea;
— heartburn and indigestion;
— fainting and palpitations;
— emotional problems such as fear and
anxiety.
During and following the birth homeopathy is
used to treat:
— ineffectual contractions;
— after-pains post-partum;
— repair of damaged tissues eg Tears
and incisions; bruising and trauma;
— emotional instability eg fear and
anxiety; prevention of PND; and
— breastfeeding problems.
In many cases homeopathic medicines are taken
internally as well as applied topically as creams, ointments or
solutions for poultices.
3.3 If choosing homeopathic treatment as
part of their maternity care, it important that women consult
a registered homeopath and request their presence at the birth
of their baby. Prescribing during labour should be managed by
a Registered Homeopath in consultation with the midwife. In our
experience, midwives as a profession tend to have a high acceptability
of the use of CAM and respect patient choice in childbirth.
3.4 In addition to being a safe, effective,
and cheap method of treatment, homeopathy can also help the women
and partner feel that they are doing something constructive during
childbirth. This can give them a sense of having more control
over the birth.
3.5 Whilst there is overwhelming anecdotal
evidence to demonstrate the effectiveness of homeopathy in maternity
care, to date there has been little research undertaken. The Society
of Homeopaths would urge the Government to consider research in
this area a priority. We believe there would be a high degree
of compliance for such research from health professionals in the
field.
3.6 Whilst we would encourage more research
into the efficacy of homeopathy, particularly in maternity care,
it is imperative that such research are designed with the principles
of homeopathy in mind. Research into our modality to date has
relied on inappropriately designed trials and has not included
a genuine test of whether homeopathy works. Real-life clinical
trials and in-practice pilots offer suitable models to explore
the role homeopathy can play in pregnancy and childbirth. Research
currently being carried out by Dr. Weatherly-Jones RSHom (University
of Sheffield) to develop relevant research models for homeopathic
treatment will be important in helping to inform the design of
future trials. We therefore welcome the Department of Health's
recent decision to award Dr Weatherly-Jones a grant to carry out
this important three-year programme of research.
4. CHOICE IN
HEALTHCARE
4.1 In the NHS Plan the Government set out
a new vision for the National Health Service—a health service
designed around the patient. Significant investment and measures
to modernise the NHS will be crucial in helping the NHS to move
towards this goal. However, it is only by giving patients a greater
voice in what kind of treatment they receive, as well as when,
where and how they receive it, that the Government's vision can
actually achieved.
4.2 As the former Secretary of State for
Health acknowledged in his speech to the Social Market Foundation
in April this year, patient choice has historically been the reserve
of the wealthy. As Alan Milburn stated, "For too long choice
in health care has only ever been available to those with the
means to pay for it. Those with more money have been able to exercise
more choice. That is the real two-tier health care in our country."[8]
This is true not only of conventional medicine, where patients
are able to jump queues to access faster treatment, but also in
complementary medicine, which remains to a large extent the reserve
of those able to pay for it. Currently the vast majority of women
who want to use homeopathy in maternity care have to pay privately
for treatment. A private course of treatment costs anything between
£50 and £150, plus attendance at the birth.
4.3 Demand for homeopathy in maternity care
is, however, increasing amongst those who have the option. It
is estimated that 470,700 adults use homeopathy annually, spending
over £30 million per year[9].
This growing market for homeopathy is being recognised by the
private sector. Private Medical Insurance companies, for example,
increasingly allow referrals and self-referral to Registered Members
of the Society of Homeopaths. Royal Sun Alliance, The Hospital
Saturday Association, Prime Health, Health Shield, Healthsure,
Anglia Healthcare, as well as Civil Service and Employees Health
Insurance schemes, all cover such referrals. Private hospitals
are also increasingly offering their patients the choice of complementary
therapies. The private hospital St John and St Elizabeth in London,
for example, women are encouraged to be in control of their labour
through such techniques as visualisation and hypnotherapy, as
well as treatments such as homeopathy and reflexology.
4.4 Over recent years the Government has
endeavoured to strengthen choice for patients in some parts of
the NHS. Since July 2002, for example, patients waiting for a
cardiac operation for more than six months have been given a choice
about where and when they are treated—whether in the NHS,
the private or voluntary sectors. However, this formalisation
of choice remains confined to a small range of easily diagnosable
conditions and to patients who have been waiting for a significant
length of time for treatment (and who the NHS has arguably already
failed). The scheme has not been extended to maternity services,
where women continue to have to rely on a "one size fits
all" system.
4.5 Having access to complementary and alternative
medicines is particularly important for some of the most socially
excluded women in the community. Some ethnic minorities, and Asian
women in particular, consider homeopathy their family medicine
of choice. Evidence for this comes from homeopaths working in
voluntary and social settings within these communities, where
trust of the homeopath is greater than trust for the general practitioner.
5. BARRIERS TO
CHOICE OF
HOMEOPATHIC TREATMENT
5.1 In December 2001 the Secretary of State
for Health announced that complementary therapies that can demonstrate
proof of effectiveness will be made available on the NHS[10].
Yet, in our members' experience women are still finding it difficult
to access homeopathy on the NHS. PCTs in particular are still
not referring patients to registered homeopaths even where evidence
exists. The Society believes that there remain some significant
barriers that are preventing women from being able to exercise
a greater choice in their maternity care.
5.2 "Permission": The reluctance
of GPs in particular to refer patients to a registered homeopath
does not appear to be a consequence of personal beliefs in the
effectiveness or not of the treatment. Rather, our members have
found that the key issues are simply that they do not have a history
of doing so and are not being encouraged to by the PCTs. Despite
the announcement by the Secretary of State that complementary
medicine should be available to those who want it, many GPs appear
to be under the impression that their own PCT would not allow
it.
5.3 The Society is therefore calling on
the Government to send a stronger signal to primary care providers
that referring patients to registered homeopaths is "permitted"
within the NHS.
5.4 Understanding of homeopathy amongst
NHS practitioners: If patients are to exercise their choice, they
need to be made fully aware of all of the options available to
them. Yet, too few doctors, nurses and midwives themselves are
familiar with how complementary medicines can benefit pregnant
women and women in childbirth. The House of Lords Select Committee,
in its report on Complementary and Alternative Medicine, expressed
concern about this lack of awareness, stating: "We were concerned
to hear that, unlike the medical schools, there seems to be little
or no evidence of a trend within nursing schools to ensure that
student nurses come into contact with the main issues connected
to the practice of CAM therapies. This is despite the fact that
nurses are probably the most likely of all conventional health
practitioners to use CAM techniques in their day-to-day practice."
(6.97)
5.5 The Society of Homeopaths is working
with the Nursing and Midwifery Council (NMC) to increase the level
of awareness amongst its members. We have produced an "Advice
Note", accessed from the NMC website, which outlines homeopathic
treatment. A Society Director is represented on the Royal College
of Nursing Complementary Medicines Forum for Nurses and is making
a presentation to the RCN at their autumn conference 2003. We
would, however, support further measures by the Government to
improve understanding of complementary therapies amongst NHS professionals.
5.6 Financial Resources: In our members'
experience, NHS managers sometimes claim that they simply do not
have the resources to fund complementary medicines as well as
conventional. However, research undertaken in a number of pilot
projects indicates that referring patients to registered homeopaths
can help to alleviate the burdens on GPs, including the financial
pressures. Case studies produced as part of a study in Bradford-on-Avon,
for example, show that the cost differences between treating a
patient with conventional medicine and homeopathic therapies can
be significant for a GPs' practice.
5.7 In order to assess the cost implications
of giving patients access to complementary medicine in more detail,
the Society calls on the Government to fund a number of pilot
projects across the country, incorporating general medical practices,
as well as NHS maternity units.
5.8 Regulation: A further reason given by
NHS managers refusing to refer patients to complementary medicine
therapists is that they believe that the quality control and regulation
of the sector is insufficient. The Society of Homeopaths is working
hard to raise the standards of professionalism in homeopathy and
the complementary medicine sector. The Society is a key player
in the Council of Organisations Registering Homeopaths (CORH),
working to establish a single register for the profession. This
will enable all patients who require homeopathic treatment, as
well as GPs and midwives who refer their patients to a Registered
homeopath, to be sure of the professional standards, competency
and accountability of the homeopaths they employ. We believe that
it is essential that the new single register sets the highest
possible standards for professional homeopaths and we will be
supporting the most rigorous options for the development of this
register.
6. ABOUT THE
SOCIETY OF
HOMEOPATHS
6.1 Professional Registration—The
Society of Homeopaths is the largest and most representative body
of professional homeopaths in the UK and sets high level indicators
of professionalism and practice, thereby ensuring public confidence
about the safety and competence of RSHom's.
6.2 Competence—all Registered homeopaths
have undergone a peer review of their clinical and administrative
practice standards in order to conform to the required Registration
Standards of the Society regarding their competence to practice.
6.3 Recognition—the recent House of
Lords Select Committee on Science and Technology Report into Complementary
Medicine (Nov. 2000) praised the leadership of the Society of
Homeopaths in continually raising standards within the profession.
6.4 Malpractice Insurance—all Registered
members have professional indemnity and public liability insurance
arranged through the Society of Homeopaths.
6.5 Accountability—all registered
members' professional behaviour and practice is governed by the
Society's Codes of Ethics, Conduct and Practice. The Society has
an established complaints procedure with appropriate sanctions.
6.6 Reflective Supervision—all Registered
members are expected to participate regular reflective clinical
mentorship programmes.
6.7 CPD—all Registered members are
expected and encouraged to participate in improving their practice
through programmes of continuing professional development.
6.8 National Occupational Standards—The
recent NOS for Homeopathy provide valuable criteria to assess
professional performance along with the Society's own Core Assessment
Criteria.
June 2003
8 Speech by Alan Milburn to the Social Market Foundation,
30 April 2003. Back
9
University of Sheffield 2001. Back
10
Speech by Alan Milburn, December 2001. Back
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