Annex 3
COMPLEMENTARY MEDICINE
1. For some years any scope for complementary
and alternative medicine (CAM) to help cancer patients was overshadowed
by claims that certain therapies could successfully treat cancer.
Such claims are less common now, although a few lesser-known CAM
treatments have been associated with remission by several well-publicised
cancer patients. However, evidence of the efficacy of these therapies
to successfully treat cancer is still very limited. Last-ditch
efforts by terminally ill patients to try any supposed alternative
cure for cancer, while understandable, leave them vulnerable to
exploitation by charlatans.
2. With the development of palliative care,
however, there has come a growing recognition that CAM therapies
can play a useful role in alleviating distress and helping cancer
patients cope with their condition.
3. In 1999, The Guild of Health Writers
ran a competition to award good practice in integrated healthcare.
One of the finalists was a team operating in Hammersmith and Charing
Cross Hospitals to provide massage, aromatherapy, reflexology,
relaxation and art therapy as part of a multidisciplinary approach
to palliative care for cancer patients. The team has since given
training and advice to nurses who aspired to provide a similar
service elsewhere.
4. The voluntary and commercial sectors
have developed a similar range of services. One example is Macmillan
Cancer Relief, which offers advice on using CAM therapies, and
can identify local self-help groups, many of which offer access
to certain therapies. Some Macmillan nurses are also trained to
administer certain therapies. Another example is the Bristol Cancer
Help Centre, which offers private counselling and the use of certain
therapies to support cancer patients. And the Haven Trust in London
is an example of a small charitable organisation that offers a
variety of therapies to support recovering breast cancer patients.
5. In 2001, two doctors who had suffered
breast cancer established an organisation called DIPEx whose website
(www.dipex.org) allows patients to share their experiences of
major illnesses, including cancer. The website is supported by
the National Electronic Library for Health and Macmillan Cancer
Relief. A section on complementary therapies includes patients'
experiences of using aromatherapy, reflexology, yoga, hypnotherapy,
relaxation, meditation, and dietary approaches to help cope with
breast cancer. All the accounts are supportive.
6. The National Institute for Clinical Excellence
is preparing guidelines on supportive and palliative care. Amongst
other things, the guidelines are expected to acknowledge the use
of CAM therapies in supportive and palliative care. To complement
the NICE guidelines, in June 2003 the Prince of Wales's Foundation
for Integrated Health and the National Council for Hospice and
Specialist Palliative Care Services jointly published guidelines
for the use of CAM therapies in supportive and palliative care.
The guidelines define the standards that all responsible CAM practitioners
should meet, including ethical and professional issues relevant
to cancer patients, and offers advice on selecting suitable therapies.
The Department of Health endorses the guidelines.
SPIRITUAL SUPPORT
SERVICES
7. In November 2003 the Department of Health
issued "Meeting the Religious and Spiritual Needs of Patients
and Staff" to the NHS.
— The modern NHS should be capable
of responding sensitively to the diverse nature of communities
it serves. Multi-faith support to patients and staff, via chaplaincy-spiritual
care givers is recognised as a significant contribution to the
patient experience in today's multi-cultural society.
— The new Department of Health guidance
is aimed primarily at the NHS; however, the potential for "crossover"
of applicability to organisations providing hospice and palliative
care is acknowledged and key stakeholders from the hospice community
have contributed to the Department of Health guidance.
— The Association of Hospice and Palliative
Care Chaplains has separately produced a "package" of
documents, aimed specifically at developing and delivering a range
of standards for hospice and palliative care chaplaincy.
— The Association's own standards,
(published spring 2003), recognise chaplaincy-spiritual care services
within hospices as a specialist function and the standards aim
to enhance quality of local delivery.
— The South Yorkshire Workforce Development
Confederation (WDC) leads on human resourcing and workforce issues
on behalf of the NHS. The WDC has its own links with hospice and
specialist palliative care services.
SUPPORT SERVICES,
INCLUDING DOMICILIARY
SUPPORT AND
PERSONAL CARE
8. Patients who receive palliative care
should meet local criteria for fully funded NHS continuing care,
in which case their personal care will be the responsibility of
the NHS. Guidance on fully funded NHS continuing care, published
in June 2001, makes it clear that "Patients who require palliative
care and whose prognosis is that they are likely to die in the
near future should be able to choose to remain in NHS funded accommodation
(including a nursing home) or return home with appropriate support.
Patients may also require episodes of palliative care to deal
with complex situations (including respite care)." It is
the level of need for care, not the condition or prognosis, which
is the criteria for NHS responsibility for care. Where the need
for care does not meet criteria for full NHS responsibility, or
additional support services beyond care of the individual are
needed in the home, these may be provided by local authority social
services.
9. The range of services, which may be commissioned
by local authority social services, includes:
— Practical help inside and outside
the home, such as cleaning and shopping;
— Help with personal care, such as
bathing and dressing;
— Help to care for children and other
dependants;
— Assistance with the practical and
emotional support of relatives or other informal carers caring
for the person with palliative care needs;
— Ensuring a safe living environment,
through adaptations, if necessary. Local housing services may
also play a part in this.
10. In addition, councils may offer a variety
of social work support and advice, occupational therapy, and other
social care services. Respite and day care, assisted transport,
volunteer visitors, and bereavement care may be provided by local
authority, NHS, or voluntary organisations. Practical aids such
as wheelchairs and other equipment should be provided through
a single integrated community equipment service by April 2004.
11. Support, information, and advice to
secure financial support, such as benefits, may be provided through
local authorities, voluntary groups, or other agencies, including
the Department for Work and Pensions and the Pension Service.
12. The Government has created freedoms
and flexibilities through the Health Act 1999 to allow greater
integration between health and social care services—and,
increasingly, other council services such as housing. The same
Act established a duty of partnership for NHS bodies and local
councils. Councils are expected to meet targets for the assessment
and receipt of social care services and the Community Care (Delayed
Discharges) Act 2003 requires social services to provide services
within a specified time limit (see Annex 7).
13. Assessment of need should be integrated
and cover the individual's needs as a whole. Department of Health
guidance for the single assessment process for older people, which
is to be implemented by April 2004, asks that assessments are
person-centred and focus on the needs and issues of most importance
to older people. In carrying out assessments where individuals
require intensive support, professionals are advised to explore
health conditions including life-threatening illnesses, pain,
reactions to loss and bereavement, and mental health and emotional
matters. Cultural and spiritual concerns and beliefs should also
be taken into account as and when appropriate. Through such assessments,
individuals with terminal illnesses and/or approaching the end
of their lives, can be assured that important needs will be identified
and addressed, and that their wishes will be respected as far
as possible.
14. Department of Health guidance on eligibility
for adult social care, issued to councils in May 2002 and implemented
from April 2003, requires that adults with actual or potential
life-threatening health conditions are given the highest priority
by councils if their needs call for social care services in addition
to any health support. This guidance requires that the same discipline
of assessment outlined in the single assessment process is applied
to adults of all ages.
15. The provision of personal care as part
of local authority commissioned domiciliary care is of growing
importance. The introduction from April 2003 of a regulatory framework
for personal care provided as part of domiciliary care is vital,
in particular:
— The requirement for care workers
providing personal care to receive training and appraisal appropriate
to their work (regulation 15(2) of the Domiciliary Care Agencies
Regulations 2002);
— The expectation in National Minimum
Standards for Domiciliary Care that newly appointed care workers
providing personal care will be required to demonstrate their
competence by registering for and completing within three years
the relevant NVQ care award.
|
