HO 09
Memorandum submitted by the Northern Ireland Association of Homeopaths (NIAH)
1. Our submission is based on findings from the Northern Ireland
Integrated Medicine Pilot Programme 2007-2008[1].
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 (
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 (
· 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 [2]
4. We also proposed that
· health inequalities · deprived areas · effectiveness gaps in conventional medical treatments[3]
5. The Report confirms that
6. Comparison of NIAH briefing points and reported findings
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.[4]
· Patients receiving chiropractic and osteopathy treatment reported an average 38% improvement in their health and wellbeing.[5]
· Patients receiving homeopathic treatment reported an average 54% improvement in their health and wellbeing.[6]
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.[7]
11. Conclusions and recommendationsWe 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
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 (
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
18. The project was commissioned by the Department of Health, Social
Services and Public Safety with a view to exploring the potential for
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,
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 i.e. 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 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 (i.e. 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,
· 24% of patients who used other health services prior to treatment (e.g. 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
94% of patients would recommend
· 89% of patients expressed
an interest in continuing with (source, patient survey);
· Patients were supportive of
with a call for increased public awareness of the
potential of
· Patients identified a need
for held by some GPs towards
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
· 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 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
· 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 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 referring their patients to
· 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
22. Key Findings: The
· 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 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
· All
· CAM practitioners reported
a more positive attitude to
23. Recommendations
(i) Given the evidence of health gain documented by patients,
GPs and
(ii) This pilot project has clearly
demonstrated that
(iii) To further assist the process of
integrating
(iv) The project has highlighted a number of areas where the operation of a
(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 (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
(viii) The evaluation has documented the positive
impact of
(ix) Given that the evaluation outcomes are based on the perception of the various stakeholder groups (i.e. patients,
November 2009 [1]
Evaluation of a [2] Homeopathy - A Briefing for Healthcare Policymakers in [3] Kenneth Mayne, NIAH. Presentation to DHSSPSNI Primary Care Conference, 2006
[4] Measure Yourself Medical Outcome Profile (MYMOP) aggregate score decreased from before treatment 4.76 to 3.18 after treatment [5] Measure Yourself Medical Outcome Profile (MYMOP) aggregate score decreased from before treatment 4.28 to 2.66 after treatment [6] Measure Yourself Medical Outcome Profile (MYMOP) aggregate score decreased from before treatment 4.42 to 2.05 after treatment [7] NHS Cross-Regional SHA Social Value Commissioning Project Bulletin No1 July 2009 p4 |