Open letter by John Kapp
22, Saxon Rd, Hove BN3 4LE, East Sussex
    Tel 01273 417997 31
to Cllr Garry Pelzer-Dunn
Chairman, Health Overview and Scrutiny Committee (HOSC), Brighton and Hove City Council

31st January 2010

Dear Garry

1 Recommendation.
Please append this letter to the minutes of the HOSC meeting so that it becomes a public document and enables this matter to be considered again at the next meeting of the HOSC.

2 ‘Briefing note on CAM’
A 2 page document titled: ‘Briefing Note on CAM’ was included in the tabled papers at the HOSC meeting on 27.1.10. It was presumably put there by the NHS staff to inform councillors on the current NHS policy on CAM pertaining to agenda item 50, the noting of my e-petition: ‘Proposal for free CAM on the NHS.’ The information in that document was misleadingly out of date.

This letter seeks to put the record straight by setting out the up to date facts about CAM. These facts not only allow the NHS to commission the NICE-approved CAM therapies, but mandate them to do so in order to prevent sickness and improve the health of their staff (as the Boorman report requires) and their patients (as the Darzi report requires) in accordance with the NHS constitution which became law on 20.1.10. I hope that councillors and NHS officers will put in hand this integration of CAM for the benefit of all, as called for in my paper tabled at the meeting titled: ‘Removing the obstacles to the integration of CAM’ dated 27.1.10 (1).

3 What does the ‘Briefing note on CAM’ say?
I have extracted parts from paragraphs 5 and 9 of the document as a summary (italicized):

‘Should any CAM treatment prove as effective as conventional medicine then it would be supported by PCTs….In summary then, CAM is currently little used by the NHS, although many complementary treatments could potentially be employed by the medical establishment. When CAM is used it tends to be employed in instances where there are no particularly effective conventional treatments available – eg for controlling moderate back pain. If CAM were to be more extensively employed it would be in this type of area – for the many conditions and ailments for which there is no particularly effective conventional treatment, and where an unproven (but not unsafe) alternative approach is unlikely to lead to worse outcomes, even if there is little or no evidence that it will produce better ones.’

The document was not dated, and the author was not quoted, but I have read similar statements before from Prof Edzard Ernst, who holds the chair of complementary medicine at Exeter University. I believe that he wrote this document many years ago, certainly before the PCT changed its name to the NHS in 2009, and probably also before the National Institute for Clinical Excellence (NICE) was issuing guidelines in 2005, as he does not mention NICE. He is well known for damning CAM with faint praise (as he does in this document) or rubbishing it as he did in his book: Trick or Treatment – Alternative Medicine on Trial. Published in 2008, which I have reviewed (2)

4 What the briefing paper should have said
The current situation regarding CAM is as follows. I have rewritten the briefing paper for councilors showing how the NHS should have stated it, again in italics:

Some CAM therapies have been approved by NICE, showing that they have not only passed clinical trials showing that they work, but also that they are cost-effective, justifying the expenditure of public money on them. NICE approval is the gold standard of evidence based treatments. NICE-approved treatments are endorsed in the NHS constitution which became law on 20.1.10 and gives every citizen the statutory right to all NICE-approved treatments provided that their doctor says it is appropriate for them, free at the point of use. The following CAM treatments became NICE-approved on the date shown in brackets:

a) For lower back pain (LBP) physiotherapy, osteopathy, chiropractic, acupuncture and Alexander Technique (2009)

b) For depression (Mindfulness Based Cognitive Therapy course.(2004)

These two conditions (LBP and depression) are the commonest cause of staff sickness in the NHS as stated in the Boorman report, which was accepted by the government in Nov 2009. This also applies to the general population, and over half of all GP consultations are taken up with these two conditions. The NHS is now required to prevent illness as well as treat it in both our own staff, and also our patients. The only way that we can meet these requirements is by commissioning and providing those two NICE-approved CAM treatments in sufficient bulk to meet the demand for them within an 18 week wait. We are working on a plan to do this which we will put into our Strategic Commissioning Plan 2010-14.

5 Demand for the MBCT course
I have estimated the demand in the city for the MBCT course to be 30,000 participants pa (1 in 6 of the population) which could be provided by running 1,500 courses pa at 20 participants per course at £300 per participant, costing £9 million pa. The basis for this is given in paper section 9.39 ‘Business plan of proposal for free CAM on NHS’ (3)

6 Question for the Board of the NHS Brighton and Hove
I confirm having asked a public question of the NHS Board at their meeting on 2.2.10:

What measures are you including in your Strategic Commissioning Plan 2010-14 to meet the Darzi/Boorman requirements of preventing sickness in patients and reducing your staff sickness rate?

I have copied this letter to senior staff of the NHS so that they can action the integration of CAM, which would enable you to meet the requirements of the CQUIN paper coming up as item 6/10 on the agenda of the Board meeting on 2.2.10, as per the extract given below in the appendix.

With best wishes,

Yours sincerely

John Kapp
Former councillor, and elected member for Sussex of the National Association of LINK Members (NALM)

cc Alan McCarthy, Chairman NHS Brighton and Hove
Darren Grayson, Chief Executive NHS Brighton and Hove
Amanda Fadero Deputy Chief Executive Brighton and Hove
Geraldine Hoban Director of Commissioning Brighton and Hove
Nick Carter-Meadows Deputy Director Quality and Engagement Brighton and Hove
Richard Ford Commercial Director, Sussex Partnership Foundation Trust
Brighton and Hove LINk
National Association of LINk Members
Committee SECT

1 Paper ‘Removing the obstacles to the integration of CAM’ by John Kapp dated 27.1.10 section 9.45 of
2 Reviews of book ‘‘Trick or Treatment – Alternative Medicine on Trial.’ Published in 2008, section 9.26 of
3 ‘Business plan of proposal for free CAM on NHS’ section 9.39 of

Commissioning for Quality and Innovation (CQUIN) (46 pages)
Paper by Nick Carter-Meadows, Deputy Director Quality and Engagement for 2.2.10

3.8 From 2010/11 the programme will be a significant component of the local approach towards Commissioning for Quality and Innovation (CQUIN).
The vision for the programme is that patients will have access to the same standards of high quality care regardless of where they live, who their GP is or where their local hospital or community provider is located in South East Coast, and aims to:

save lives and improve care;
improve the quality of life for patients;
provide world class health services;
establish a quality improvement process focused on world class results for patient;
improve the patients experience of healthcare.

The programme scope will include importing good practice and embedding a rolling set of indicators, clarifying the quality standards that commissioners want providers to meet using the best evidence available. The development of Community and Primary Care Pathways is seen as critical to providing consistent and reliable treatment for patients in the initial five focus areas.

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