Memorandum submitted by the Northern Ireland
Association of Homeopaths (NIAH) (HO 09)
1. Our submission is based on findings from
the Northern Ireland Integrated Medicine Pilot Programme 2007-08.[23]
The Pilot Programme was unique in that it was the first of its
kind in the United Kingdom to be commissioned by a Minister for
Health. It was not a clinical trial per se, but an evaluation
of a service in which GPs were able to refer patients for a range
of Complementary and Alternative Medical (CAM) treatments, including
homeopathic medical treatment.
THE NATURE
OF EVIDENCE
2. Evidence from observational studies is
highly appropriate for homeopathic medicine as the treatments
are individualised and therefore not fully amenable to analysis
by, for example, randomised controlled trials. We welcome the
acknowledgment by the Chair of the National Institute for Clinical
Excellence, Sir Michael Rawlins that greater weight should be
accorded to evidence from observational studies of this kind.
3. The findings and the recommendations
in the evaluation report (executive summary appended) bear out
the proposals made by the NIAH in the years prior to the announcement
of the Pilot Programme. Since 1999 we briefed successive
Ministers of Health and Department of Health officials that the
provision of Complementary and Alternative Medical (CAM) therapies
such as Homeopathy would produce benefits in:
— Reduction in drugs expenditure
— Alleviation of GP and hospital workload
— Savings accruing from reduced sick leave
— Increased creativity and productivity
— General well-being of society[24]
4. We also proposed that CAM therapies such
as Homeopathy would make a significant contribution toward solving
the intractable problems in Government healthcare priority areas
such as:
— effectiveness gaps in conventional medical
treatments[25]
5. The Report confirms that CAM treatments
including homeopathic treatment delivered significant health gains
and cost-efficiencies in all of the above circumstances. The evaluation
includes analyses across a range of indicators, all of which bear
out the case we presented in our briefings, as follows:
6. COMPARISON
OF NIAH BRIEFING
POINTS AND
REPORTED FINDINGS
| NIAH Briefing |
Reported findings |
Reduction in drugs
expenditure | — Half of GPs reported prescribing less medication and all reported that patients had indicated to them that they needed less
|
| — 62% of patients reported suffering from less pain
|
| — 55% reported using less painkillers following treatment
|
| — Patients using medication reduced from 75% before treatment to 61% after treatment
|
| — 44% of those taking medication before treatment had reduced their use afterwards
|
Alleviation of GP and
hospital doctor workload
| — 24% of patients who used health services prior to treatment (ie primary and secondary care, accident and emergency) reported using the services less after treatment
|
| — 65% of GPs reported seeing the patient less following the CAM referral
|
| — Half of GPs said the scheme had reduced their workload and 17% reported a financial saving for their practice
|
| — Half of GPs said their patients were using secondary care services less
|
Reduced sick leave
…increased productivity
…general wellbeing of
society
| — "Not only has this project documented significant health gains for patients, but it has also highlighted the potential economic savings likely to accrue from a reduction in patient use of primary and other health care services, a reduction in prescribing levels and reduced absenteeism from work due to ill health."
|
| |
7. HEALTH IMPROVEMENTS
BY THERAPY
Using the MYMOP protocol—a validated audit tool for
measuring
patient health gain in general practice:
— Patients receiving acupuncture treatment reported
an average 33% improvement in their health and wellbeing.[26]
— Patients receiving chiropractic and osteopathy treatment
reported an average 38% improvement in their health and wellbeing.[27]
— Patients receiving homeopathic treatment reported
an average 54% improvement in their health and wellbeing.[28]
The clinical assessments of the referring doctors concurred
with these figures.
8. VALUE FOR
MONEY AND
EFFICIENCY
We wish to draw the attention of the Committee to the amount
of detail in the evaluation report in respect of wider social
and economic context, which is more often than not omitted from
such studies. We submit that this provides not only evidence of
cost-effectiveness of healthcare investment, but extremely useful
information relating to the problems and management of healthcare
inequalities and the acknowledged effectiveness gaps in conventional
medical treatment, especially of chronic conditions endemic in
deprived areas.
9. We are confident that if the homeopathic treatments
provided in the Pilot Programme were subjected to full Social
Return on Investment analysis, they would produce a high index
of return compared to many conventional treatments in the same
circumstances. Government wishes to see more proof of value for
money and return on future healthcare investment, as reported
by the NHS Cross-Regional Social Value Commissioning Project:
10. Value for money is concerned not just with unit
costs, but with what has been called the full value or public
benefit that a provider brings to delivering a service. This recognises
that every time the public sector spends money, it should do so
in a way that achieves as many of its objectives as possible.
That is, it is concerned with the value a provider creates
across a range of outcomes over the longer term with the resources
it is given. The draft NHS Constitution states that PCTs "will
use (their) resources for the benefit of the whole community".
This is where social value concepts have a vital role to play.
[29]
11. CONCLUSIONS AND
RECOMMENDATIONS
We respectfully suggest that:
12. In respect of the evidence for homeopathy the Committee
considers and accords appropriate weight to evaluations of observational
studies such as the Northern Ireland Integrated Medicine Pilot
Programme.
13.In evaluation of the effectiveness of medical treatments
the Committee takes into consideration the wider social and economic
contexts for the treatments and outcomes, particularly in respect
of social value and Social Return on Investment analysis.
14. DECLARATION OF
INTERESTS
The Northern Ireland Association of Homeopaths is a non-profit
group which represents professional homeopaths and homeopathic
medicine, and has had representation in the Northern Ireland Department
of Health CAM Advisory Group.
Appendix One
15. EXECUTIVE SUMMARY of the Independent Evaluation Report
on the Northern Ireland Integrated Medicine Pilot Programme.
16. This report presents the findings from an evaluation
of a pilot project which provided patients with access to a range
of Complementary and Alternative Medicine (CAM) through their
GP practice.
17. Overall 713 patients were referred to the project
by their GP. Patients presenting to their health centre with musculo-skeletal
and mental health conditions, were referred for a range of CAM
therapies including acupuncture, chiropractic, osteopathy, homeopathy,
reflexology, aromatherapy and massage.
18. The project was commissioned by the Department of
Health, Social Services and Public Safety with a view to exploring
the potential for CAM within existing primary care services in
Northern Ireland. The project was implemented by Get Well UK in
two primary care centres in Northern Ireland: Shantallow Health
Centre in Londonderry and The Arches Centre in Belfast.
19. The evaluation, conducted independently by Social
& Market Research (SMR), is based on an analysis of project
monitoring data provided by Get Well UK; and focus groups and
surveys of patients, CAM practitioners and GPs from the two participating
health centres.
20. KEY FINDINGS:
THE PATIENT
EXPERIENCE
Using the various data sources, the evaluation has found
a significant level of health gain for the vast majority of patients
who have received complementary and alternative medicine as part
of the pilot project. This is evidenced by the following:
— Analysis of MYMOP (Measure Yourself Medical Outcome
Profile) data, which was generated using a validated health instrument
used for measuring patient health gain in general practice, found
statistically significant improvements on each of the health outcome
indicators measured ie the severity of patient symptoms; the level
of patient activity associated with their symptoms; and, overall
patient wellbeing (source, MYMOP);
— The proportion of patients reporting that the severity
of their symptoms were "as bad as it could be", fell
from 31% prior to treatment to 5% following treatment (source,
MYMOP);
— 80% of patients recorded an improvement in the severity
of their main symptom, with 73% recording an improvement in their
level of activity associated with their main symptom (source,
MYMOP);
— 67% of patients recorded an improvement in their wellbeing
(source, MYMOP);
— 81% of patients said that their general health had
improved, with a similarly high proportion of patients (82%) reporting
to be less worried about their symptoms following treatment (source,
MYMOP);
— 81% of patients reported an improvement in their physical
health, with 79% reporting an improvement in their mental health
(source, patient survey);
— 84% of patients directly linked the CAM treatments
to an improvement in their overall wellbeing (source, patient
survey);
— 62% of patients were suffering less pain, with 60%
having more control over pain (source, patient survey);
— There was a 14 percentage point reduction in
the proportion of patients using medication between the pre and
post-treatment stages (ie down from 75% to 61%) (source, project
monitoring data);
— 44% of patients who were taking medication prior to
their treatment, had reduced their use of medication (source,
patient survey);
— Among patients using pain killers prior to treatment,
55% said that they use fewer pain killers following treatment
(source, patient survey);
— In the majority of patient cases, CAM practitioners
reported an improvement in: patient quality of life; relief of
presenting symptoms; relief of chronic conditions; increased mobility;
increased emotional stability; and, a reduction in patient worry
(source, project monitoring data);
— 24% of patients who used other health services prior
to treatment (eg other primary care services, secondary care services
and Accident and Emergency), said they now use these services
less often (source, patient survey);
— 64% of patients in employment said that following
treatment they now take less time off work. Among patients not
in employment, 16% said that having the CAM treatments had encouraged
them to think about going back into employment (source, patient
survey);
— 94% of patients would recommend CAM to other patients
with similar health conditions (source, patient survey);
— 89% of patients expressed an interest in continuing
with CAM, with just 30% saying they would be able to afford to
continue with CAM treatments (source, patient survey);
— Patients were supportive of CAM being integrated into
primary health care, with a call for increased public awareness
of the potential of CAM for health gain (source, patient focus
groups);
— Patients identified a need for CAM to be promoted
among GPs in Northern Ireland, and for initiatives to be taken
to help reduce the level of scepticism held by some GPs towards
CAM (source, patient focus groups);
21. KEY FINDINGS:
THE GP EXPERIENCE
— In 65% of patient cases, GPs documented a health improvement,
with a high degree of correlation between GP and patient assessment
of health improvement (source, project monitoring data);
— In 65% of patient cases, GPs said they had seen the
patient less often following the patient's referral to CAM (source,
project monitoring data);
— Improving patient health was found to be the main
motivation for GPs getting involved in the pilot project (source,
GP survey and focus groups);
— Most GPs said that their understanding and knowledge
of CAM had improved by participating in the pilot project, with
most conceding that their knowledge was limited at the initial
stages. Some GPs had experienced difficulty initially in matching
their patients with appropriate therapies, with most of the GPs
supporting the need for further educational interventions such
as seminars, talks with practitioners and having more written
information on CAM (source, GP survey and focus groups);
— Half of GPs reported prescribing less medication for
chronic or acute patients (source, GP survey);
— Half of GPs reported that the option to refer their
patients to CAM had reduced their workload, with two GPs pointing
to a financial saving for their practice. All but one of the GPs
had seen the project as a positive development for their practice,
with all agreeing that it provided them with more referral options
(source, GP survey);
— Most GPs reported that their patients were using Allied
Health Professionals less often, with half saying that their patients
were using secondary care services less often (source, GP survey);
— Ten out of the 12 GPs surveyed had a more positive
view of the potential for CAM within primary care, with all wishing
to continue with the option of referring their patients to CAM
(source, GP survey);
— In 99% of patient cases, the GP said that they would
be willing to refer the same patient, or another patient, to the
Get Well UK service. Also in 98% of patient cases, the GP said
they would be willing to recommend the service to another GP (source,
project monitoring data);
22. KEY FINDINGS:
THE CAM PRACTITIONER
EXPERIENCE
— CAM practitioners reported a health improvement in
77% of their patients on average, with health gains including:
pain relief; improved quality of life;
— improved mobility, stress relief and improved emotional
wellbeing (source, practitioner survey);
— CAM practitioners identified a need for a series of
educational interventions targeted at GPs to improve their understanding
of CAM and to better support them with matching health conditions
with appropriate therapies (source, practitioner survey and focus
groups);
— CAM practitioners called for GPs to supply more information
on patient medical condition as part of the referral process (source,
practitioner survey and focus groups);
— CAM practitioners identified a tendency for GPs to
refer patients with chronic medical conditions to the project,
with practitioners concerned that the therapies may not be as
responsive to this type of patient compared to, for example, patients
with acute medical conditions (source, practitioner survey and
focus groups);
— Affordability was identified as the main barrier for
patients wishing to continue with CAM (source, practitioner survey
and focus groups);
— All CAM practitioners supported the integration of
CAM within primary health care, with patient health gain cited
as the key benefit (source, practitioner survey and focus groups);
— CAM practitioners reported a more positive attitude
to CAM among GPs who had participated in the project, with ongoing
contact and communication between GPs and CAM practitioners identified
as a key requisite if CAM is to be rolled out more extensively
across Northern Ireland (source, practitioner survey and focus
groups);
23. RECOMMENDATIONS
(i) Given the evidence of health gain documented by patients,
GPs and CAM practitioners, it is recommended that DHSSPS and the
project partners explore the potential for making CAM more widely
available to patients across Northern Ireland. Not only has this
project documented significant health gains for patients, but
it has also highlighted the potential economic savings likely
to accrue from a reduction in patient use of primary and other
health care services, a reduction in prescribing levels and reduced
absenteeism from work due to ill health.
(ii) This pilot project has clearly demonstrated that CAM
fits well within a primary health care context, with patients
valuing the support and judgment of their GPs in accessing treatments.
It is recommended that DHSSPS and the project partners examine
ways of integrating CAM within primary care, taking on board the
need for a strategy to promote GP knowledge and understanding
of CAM to ensure that health conditions are matched appropriately
with CAM therapies. A strategy to promote awareness and understanding
of CAM among GPs, as well as the positive health gains for patients,
should also go some way to addressing issues around scepticism
held by some GPs.
(iii) To further assist the process of integrating CAM with
primary health care, it is recommended that consideration be given
to exploring the potential for sharing medical records with CAM
practitioners. Furthermore, consideration should be given to exploring
the potential for CAM practitioners to be involved in clinical
meetings and case conferences, which may provide patients, particularly
those with chronic health problems, with more treatment options.
This may also lead to significant cost savings for the health
service.
(iv) The project has highlighted a number of areas where the
operation of a CAM service can be further improved. In particular,
it is recommended that DHSSPS and the project partners explore
ways of ensuring that patients are provided with accurate and
up to date information at all points of the referral process,
as well as at the point of receiving treatments. In addition,
the evaluation has found that patients may benefit from a "triage"
system to ensure appropriate matching of health conditions and
CAM treatments;
(v) Given that the pilot project has raised expectations among
patients, DHSSPS and its partners should consider a mechanism
for ensuring that patients who presented with long-term illnesses,
and in particular those who experience pain, be offered booster
or maintenance sessions beyond the life of the project.
(vi) Given the limited number of CAM practitioners in Northern
Ireland, and the difficulties in identifying practitioners to
participate in the pilot project, it is recommended that DHSSPS
and the project partners consider ways of retaining this resource
within a model for wider service delivery.
(vii) Given that the health outcomes for patients have been
significant, it is recommended that DHSSPS and the project partners
consider the development of a public health information campaign
aimed at promoting the potential benefits of CAM. Allied to this
point, it is recommended that DHSSPS and its partners examine
the role of CAM in supporting health prevention and health promotion
strategies, given the evidence that patients are likely to adhere
strongly to the advice provided by CAM practitioners.
(viii) The evaluation has documented the positive impact of
CAM on patients who are economically active, particularly in the
context of helping people back into work following illness. It
is recommended that the outcomes from this project be shared with
colleagues in other departments (eg Department for Employment
and Learning), to allow them to examine the potential for CAM
within their own operational areas.,
(ix) Given that the evaluation outcomes are based on the perception
of the various stakeholder groups (ie patients, CAM practitioners
and GPs), it is recommended that DHSSPS and the project partners
give consideration to integrating other approaches to measuring
health impact (eg a formal case control study) on an ongoing basis.
November 2009
23
Evaluation of a CAM Pilot Project in Northern Ireland (2008) D
McDade2008 Back
24
Homeopathy-A Briefing for Healthcare Policymakers in Northern
Ireland, NIAH 2000, 2004 Back
25
Kenneth Mayne, NIAH. Presentation to DHSSPSNI Primary Care Conference,
2006 Back
26
Measure Yourself Medical Outcome Profile (MYMOP) aggregate score
decreased from before treatment 4.76 to 3.18 after treatment Back
27
Measure Yourself Medical Outcome Profile (MYMOP) aggregate score
decreased from before treatment 4.28 to 2.66 after treatment Back
28
Measure Yourself Medical Outcome Profile (MYMOP) aggregate score
decreased from before treatment 4.42 to 2.05 after treatment Back
29
NHS Cross-Regional SHA Social Value Commissioning Project Bulletin
No1 July 2009 p4 Back
|
