CONTINUING THE PHILOSOPHY OF REGINALD O. KAPP

9.45 REMOVING THE OBSTACLES TO THE INTEGRATION OF COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) INTO HEALTH AND SOCIAL SERVICES


Paper for the Health and Overview Scrutiny Committee (HOSC)                               27.1.10

By John Kapp, Patient representative since 2000. Elected member of the National Association of LINk Members (NALM) representing Sussex. Former councillor 1995-9. Secretary of the Social Enterprise Complementary Therapy (SECT) committee


1. Motion to the Brighton and Hove HOSC
This committee approves in principle the proposal for integration of complementary therapy into the Health and Social Services of the City, and authorises the officers to engage with the SECT committee to develop the proposal and report back to the appropriate committees.

2. Historical background to the integration of CAM into the NHS
I have been campaigning for integration of CAM into the NHS for a decade, but others have been campaigning for much longer than me. A charity was formed in 1993 called the Foundation for Integrated Medicine, which changed its name a decade later to the Foundation for Integrated Health (1) It was patronised by Prince Charles, and has been quietly steering the government to clear away the obstacles on the road to integration nationally. This road clearance has taken 17 years. It was completed last week (20.1.10) with the coming into statute law of the NHS Constitution.

It is now up to local authorities (such as Brighton and Hove) to take advantage of this national road clearance to improve the health of their citizens by removing the local obstacles. This is what I am trying to do today.

I will look in detail at these obstacles in paragraph 4, but first we need to consider the Darzi/Boorman requirements of preventing sickness as well as treating it.

3. The Darzi / Boorman reforms require the NHS to provide both treatment and prevention functions
To the commissioners of the NHS, last year (2009) must have been an ‘annus horribilis’, as the government moved the goal posts in a big way, like never before. ‘Their’s not to reason why, their’s but to do or die’, as they are public servants whose salaries are paid by the public, who I represent both as a former councillor and as a patient representative.

At the beginning of last year the government gave the NHS the added function of promoting wellness and preventing illness, forcing it to live up to its name, and become a Health Service as well as a Sickness service to their 50 million patients. At the end of the year (end Nov 2009) they added the Boorman requirements of putting the prevention of illness of their 1.3 million staff at the heart of everything they do. The impact of this additional function is huge, as described in 4b) below.

To earn their crust, managers will now have to meet their new Boorman target of reducing the annual days lost through staff sickness by 3.5 million days, from 14.2 million to 10.7 million, which is 1% off their present nearly 5% rate. When this directive lands on the desk of conscientious managers it could give them a heart attack or stroke and cause their early retirement from burnout.

4. The obstacles to integration of CAM
There are three obstacles:

a) The myth about the lack of an evidence base for CAM
b) The confusion over whether the NHS’s function is treatment or prevention of illness
c) Prevention requires a different paradigm (holism) from conventional treatment (materialism, reductionism, mechanism.)

a) The evidence base for CAM
The idea that public money should not be spent on CAM because it has no proven evidence base. comes from drug company propaganda that only conventional medicine is evidenced based, and that CAM is quackery practiced by charlatans selling ‘snake oil’. They naturally want to keep their monopoly on NHS treatments and protect their vested interests.

That was the idea expressed in the e petition countering ours on the council website. It was put there by a clinician working for the NHS, (Ms Megan Earl-Gray) who appears to have posted it out of duty rather than conviction, as she is not here today to present it to you. The number of signatures that she got for it (21) shows that the public prefer our petition, which got 20 times more support. (445), as described in my paper (number 9.43) in your agenda papers ‘Proposal for free complementary therapy on the NHS. Report to council’ (2)

I have addressed this obstacle in my paper (number 9.44) titled: ‘Where is the evidence? Creating a level playing field for conventional and CAM’ (3) dated 26.1.10 which (like this paper) is on the table as a late addition to your agenda papers. I hope that I have removed this obstacle to integration by convincing you that this ‘no evidence’ idea is a myth without foundation, and that CAM has a stronger evidence base than drugs.

b) Confusion over the function of the NHS
Function is an obstacle to integration because the function of the NHS is very confused, again to the benefit of the drug companies. Until about a year ago the NHS just had one function, namely to treat sickness. The NHS was therefore a Sickness Service. Clinicians know this as it is embedded into their contracts of employment. (My sister, a psychiatrist, told me that 30 years ago)

The confusion in the public mind is caused by its name: NHS. ie ‘National Health Service’. The function of a health service is to promote health, but the NHS never used to do that: it just treated sickness. When I campaigned for CAM as a patient representative I always meet exactly the same reaction: ‘Not today thank you. CAM is not in the terms of reference of my department’. I have found that knee jerk reaction to apply from the bottom to the top of the NHS, namely from nurses through managers, officers on the Strategic Health Authority (SHA) in the Department of Health (DoH) through ministers, to the Secretary of State for health. Why is their reaction to CAM always ‘not today, thank you’?

The reason for this negative reaction is that CAM has a different function to that of the NHS. The function of CAM is to promote wellness and prevent illness. In other words, CAM is the true National Health Service. No wonder everyone is confused. Both the NHS and CAM are in disguise, wearing masks, like wolves in sheep’s clothing, or at the Venice Carnival.

The NHS pretends to be a Health service, but is really a Sickness service. CAM is really a Health service, but is disguised as CAM. This is a derogatory name, demeaning CAM as being inferior to Conventional Medicine, which is the Real McCoy Medicine. CAM is at best regarded as ‘ complementary’ to the Real Medicine, and at worst ‘alternative’ to it, which implies that is some obscure therapy that ‘dare not speak its name’.

c) Prevention needs a different paradigm to conventional treatment
The NHS is stuck in the antiquated paradigm of Conventional medicinen namely materialism, reductionism, and mechanism. It sees people like cars, and sick people like crashed cars. Until a year ago the NHS function was just to treat sickness, in other words to fix crashed people.

The old guard of clinicians are like Tates’ garage mechanics, whose function is fixing crashed cars. If Tates mechanics were asked to prevent accidents they would say ‘that is not our function or business. We have not been trained to prevent accidents, and we are not qualified to provide that service.’ The same applies to all NHS clinical staff. They have not been trained in prevention of illness, and are not qualified to provide that service.

Neither I nor the government is asking the old guard of clinicians to change what they do. They can go on treating sickness as they did before, within the commissioning budget as decided by the commissioners. All that I ask (and the government expect) is that the old guard is not allowed to obstruct the commissioners from commissioning CAM treatments in the interests of patients, rather than doctors or drug companies. This includes commissioners of the Social Services and unemployed budget. The model of prevention provision that I am advocating is shown in table 1 below.

TABLE 1 HOW THE 2 FUNCTIONS OF TREATMENT AND PREVENTION SHOULD BE COMMISSIONED TO BE PROVIDED

No

Function to be provided

Provider

1

Treating sickness in patients and staff

Health care outsourced to:

1 Primary care by GPs
2 Secondary care by hospitals
3 Dental care by dentists
4 Optical care by opticians
5 Pharmaceutical care by chemists

Social care outsourced to providers:

1 care homes
2 educational charities
3 etc

2

Preventing sickness in patients and staff

Complementary Care Trust, outsourcing complementary care to:

Social Enterprise Complementary Therapy (SECT) Company,
which issues CAM vouchers tradable for CAM at 100 CAM centres in the city.

I don’t want any commissioners to have a heart attack, which is why I have provided them with the lifeboat of this proposal. I say to them: ‘Don’t worry about the new Darzi/Boorman requirements of prevention. Leave the whole lot of it to us by delegating it to the 4,000 CAM therapists in the city administered by the SECT company. All you have to do is engage with us on the SECT committee to outsource prevention, lock, stock and barrel to us. The details of how this would work is described in my paper: ‘Business Plan of Proposal for Free Complementary Therapy on the NHS’ (4) It won’t cost you a penny, as we have applied for a government grant to set up the company.

You will have to find the courage to stand up to the old guard of clinicians who say to you: ‘over my dead body will you engage with those snake oil merchants’. Let them rant and rave and have the heart attack, not you. They do not hold the budget. You do. They are on tap, and you are on top. We, the public who pay you, rely on you to act in our interests, not theirs or the drug companies.

6 Has anything like this happened before?
Yes, in the recycling of waste. Until about a decade ago, the function of refuse collection used to be just the tipping of everything to landfill. As landfill sites became full, and tipping fees went up, the government required councils to take on the second function of recycling glass, paper etc. This required a paradigm shift of attitude towards waste from useless to useful.

The charity organisation ‘Magpie’ has always believed that waste is useful. It has provided a kerbside box recycling scheme for several decades to residents who pay for their service. About 5 years ago the council were forced by the government to copy their scheme and provide a free service which is the present black box recycling scheme, in addition to the green wheely bin collection of waste to landfill. The two functions require different collection vehicles with different crews, and management with different ethos, as shown in table 2

TABLE 2. HOW ARE THE 2 FUNCTIONS OF REFUSE AND RECYCLING PROVIDED?

No

Function provided - collection of:

Provider - council:

1

Refuse in green wheely bins

Refuse crews

2

Recycling in black boxes

Recycling crews

Today I am asking the council to do the same sort of institutional change as they did about 5 years ago for recycling. I am asking them and the NHS to create the institutional arrangements shown in table 1 above.

7 Conclusion – please adopt this motion
I urge you to approve this motion, which would again make our city a pioneer. We would then be the first municipality in the country (and maybe in the world) to provide for our citizens an integrated health and social care system which both treats and prevents illness which would double their health and halve their sickness by 2016.

Brighton already has the honour of being the first municipality in the world to have an electric train in 1884, namely the Volks railway, which is still running, And we nearly had the first public electricity supply in the world in 1885, being pipped to the post by 3 months by Godalming. Please make history again today by passing this motion:

‘This committee approves in principle the proposal for integration of complementary therapy into the Health and Social Services of the City, and authorises the officers to engage with the SECT committee to develop the proposal and report back to the appropriate committees.’

8 References
1 Foundation for Integrated Health www.fih.org.uk
2 Paper: ‘Proposal for free complementary therapy on the NHS. Report to council’ section 9.43 of www.reginaldkapp.org
3 Paper: ‘Where is the evidence? – Creating a level playing field for public funding of conventional and complementary therapy.’ Section 9.44 of www.reginaldkapp.org
4 Paper: ‘Business Plan of Proposal for Free Complementary Therapy on the NHS’ by SECT committee, section 9.39 of www.reginaldkapp.org

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