Whenever asked about the use of Complementary and Alternative Medicine (CAM) in the Scottish NHS, the Scottish Government quote the ‘Guidance HDL (2005) 37’, issued to NHS Boards in August 2005. This document was issued as a consequence of my meetings with Andy Kerr, the Scottish Health Secretary at that time.
In essence the ‘Guidance’ states that:
- The Executive recognises that CAM may offer relief to some people suffering from a wide variety of conditions
- There is no legislative bar to prevent practitioners from offering their services
- a GP or hospital clinician may refer a patient for alternative treatment
- The GP or hospital clinician would require to be satisfied of the value of the treatment and the competence of the practitioner, and would remain responsible for the patient’s medical care
- If an NHS Board sees a need for the provision of a particular type of CAM in its area it is open to that Board to provide that therapy, at the Board’s discretion
- There was a consensus of opinion that there should be a single regulatory council for both disciplines [acupuncture and herbal medicine], and strong support for the proposition that there should be a single UK council
- The Executive will work with the UK Government and the other devolved administrations to introduce legislation to establish such a council
- Complementary and Alternative Medicine is an area in which there is increasing public interest. Chief Executives are asked to take this into account in the planning of services
This is great on paper but there is absolutely nothing in place to support the statements above and offer patients the chance to use Complementary And Alternative Medicines (CAM) if they chose to.
In February 2012, I submitted the following questions to the Directorate for Health and Healthcare Improvement – long Term Conditions Unit:
The Government has often quoted the Guidance issued to NHS Boards in August 2005 which makes clear that, “if they choose to refer a patient for alternative treatment, the GP or hospital clinician would require to be satisfied of the value of the treatment and the competence of the practitioner, and would remain responsible for the patient’s care” (Shona Robison to Andy Kerr, Nicola Sturgeon to Mary Scanlon both in March 2011 and others).
QUESTION 1: Assuming that all conditions above are met and a GP would like to refer a patient for alternative or complementary therapy today, how is payment made i.e. who pays for the patient’s alternative therapy treatment and what is the payment process? Answer 1: “Clinicians in NHS Scotland can only refer a patient for complementary therapy where their NHS Board agrees to the referral. In such instances the treatment is provided free of charge”. So, basically, only patients who can afford drug-free therapies can use them. Other patients will have to use either physiotherapy (not effective for ALL types of pain), psychology (to help COPE with pain or medication (which can have extreme adverse effects, some times leading to death).
QUESTION 2: What mechanisms are there in place to allow a GP to be satisfied with the competence of any given practitioner? Answer 2: “I can confirm that there are no mechanisms in place to implement the statements of the Guidance.”
QUESTION 3: What is the referral pathway for such referral? Answer 3: “It is up to the Boards to establish the appropriate referral pathways”. So, the answer is ‘No’, there is no referral pathway
Similar questions have also been asked by Mary Scanlon MSP and Jackie Baillie MSP
So, the question remains – why isn’t the Government doing more to put their statements into practice?
Chronic Pain in Scotland 
I have only ever been offered drugs on the NHS. Once I asked for physiotherapy and was refused. In pain and completely at the end of my tether, I managed to leave the City and that Doctor, and 10 years later we have some progress – it is now possible to self-refer for physiotherapy. Whoever made that change, ‘Thank-you’ .. I did the excersises and they worked….but only up until my next bout of debilitating anxiety and sleep deprivation. With common problems such as Sciatica, Fybromyalgia, Arthritis, Cramps, Lack of circulation causing dread diseases of the heart and kidneys, premature aging and infirmity stemming from long periods of stress or periods of recuperation following accident (such as experienced by my son who has Haemophilia) – why is massage STILL not available on the NHS? How, with about 4,000+ years of history, can the case for this not be proved?
Is it because GP’s and drug companies back up the notion that masge and touch therapies are ‘kinky’, or not effective as as a minstream treatment for pain..done correctly, how wrong they are! Touch deprivation itself causes brain damage in infants and depression in teenagers – all well documented – and we have been here before! When I trained for my Diploma back in ’94, there was talk of general practitioners surgeries having massage rooms. Co-incidentally, when working as an actor, I was even employed to go to London to record a marvellous interactive voiceover for an ‘expo’ on ‘Care Led NHS’, in which the idea of CAM was touted.. but supposedly, there is not yet the demand for it.. . That was 19 years ago, (my twin boys are now 18 years old) and during this time, I have managed to ‘keep my hand in’. It hlped me over come chroinc pain and I wanted to share that and I love to practise something I really beleive in! Simply to make it more acccessible, I want to treat people at far LESS than the ‘going rate’ which other therapists ’round about me locally are charging – but at the same time I do not wish to undercut these clinics…For someone in chronic pain that ‘going rate’ of £35-55 is far too much, especially when they need it every week or every month. Being in chronic pain really affects your ability to do certain jobs, frequently curtailing earnings – it’s obvious – we need to offer this service on the NHS, and make it a normal choice for people in musculo-skeletal nerve, and connective tissue disorders.
I do know people who have had bad experiences of massage, but on questioning, this was invairiably because the massage was performed badly and without enough knowledge of the patient. The massuer or masseuse hadn’t taken the subject seriously enough to train properly, and was not really ‘tuned in’ to what the client really needed. massage cannot be forced either – a willingness to relax is very important, and with some people that has to be taught as a starting point to addressing their illness.
In this day and age, when the empahais should be well into PREVENTION rather than CURE BY DYING, or by living on courses of manufactured compounds with deeply worrying side effects (such as I was prescribed for labrynthitis recently) , or last ditch hospitalisation after a person is found to be seriously ill – which Dear BMA, NHS Boards and Scottish Executive – strangely enough, it has been noted most frequntly occurs following a prolongued period of STRESS – at the first sign of pain which is not related to cancer, heart diease, head injury; thrombosis; internal bleeding etc. (all basic contraindications for any self respecting massage therapist or GP) – a course of good, well thought-out massage can really help…. Early intervention with massage and self-management of pain ought to be taught and if this were available on the NHS it would reduce the overal NHS costs of maintaining ill people in clinisc and hospital beds.
GP’s should be encouraged to train in touch therapy too. Since the profession started relying on machines to detect problems instaead of palapation and close observation, they have lost many of the necessary skills to be good physicians – full stop. Many of them have their prescription pads out before one has even told them the matter. Massage on prescription would make all the difference. There is a massive wealth of dedicated professionals currently’waiting in the wings’, hoping to make a difference to the Nations Health. Why not LET THEM DO JUST THAT?
Here, here Julia, couldn’t agree more. A wealth of experience, knowledge and assistance well beyond the understanding of most medical folk, which is terribly sad. Thank goodness many people are waking up to the fact that drugs etc are not the be all and end all and are seeking things which are far more compatible with the human body 🙂