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Posted by Richard Lawton, Feb 23 2011 9:59AM

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CThA response needed to Command Paper 'Enabling Excellence'?

I practice as a body psychotherapist, so was horrified when the last Labour government proposed state regulation of counselling and psychotherapy, as it became clear that a purely medical model was going to be used. Fortunately a lot of counsellors and psychotherapists started fighting the proposals, and a few days ago the Coalition government dropped the proposals. The Command Paper on the health professions ('Enabling Excellence') stated

"in recent decades compulsory blanket statutory regulation of the health and social care workforce in England has too often been seen as the first resort, rather than the last, in deciding how best to assure safe, effective and respectful care. Where regulation has been extended, there has not always been a robust and transparent case made based on the level of presenting risk.”

It went on to add:

"In many cases, the risk to service users and the general public posed by groups of unregulated health and social care workers is not considered to be such that regulation of individual workers is necessary."

So the present government is against compulsory regulation unless there is a demonstrable risk to the public. A very commonsense attitude!

To me, this suggests that the CNHC is now dead in the water. I would like to hear from the CThA on how they intend to respond to the Command Paper and what they now see as the role (if any) of the CNHC.
Rodney Stuart Robinson
Mar 3 2011 6:18PM
I am with you all the way Richard. It has occurred to me that doctors in general practice are not very accountable for their work in terms of producing outcomes or patient satisfaction statistics. Maybe new legislation is required to help general practitioners to “enable excellence”.

As a complementary therapist I hear many stories of what I feel to be bad conventional management of some conditions. To be more specific, I mean stories of cases where the prescribed treatment made the original problem worse or produced new problems, often due to due side effects of the prescribed medication. Now my point is that in all cases that I have seen, that is where the situation is left as far as the GP is concerned. The patient may eventually seek my (alternative) help but before this stage there comes a point where they lose faith in the GP and don't return to him/her feeling that there is “no point”. In this way we have general practitioners unaware of the dissatisfaction the patient feels with their treatment as very few people make formal complaints about their GP.

Secondly we have the unsatisfactory situation of the public being completely unaware of which practices produce good/bad/ugly results and for what type of conditions. Schools and hospitals have league tables but what information is available for a patient regarding quality of service provided by GP surgeries? What about doctors who are rude or show arrogance toward their patients? There should be a clear system whereby complaints satisfaction, dissatisfaction can be fed back and reported on both to the GP practice and to the department of health. I suggest we write and ask the Secretary of State for Health to consider what can be done.

Now I happen to know that under the last Labour government, general practitioners salaries rose at an unprecedented rate without any requirement for additional work or improved outcomes. I feel this is wrong. I believe that with additional benefits and perks a GP can earn £200,000 a year.

I as a self employed complementary practitioner mainly practising homoeopathy, I earn a small fraction of this amount but if I don't obtain results my clients stop attending and I am without my income. The same pressures don't exist for GP's.

I'm not saying all GP's are bad as I'm sure there are many good GP's out there but how do we know? What measures are in place? And how is the patient experience evaluated if at all?

The 'spotlight' has been on complementary therapy recently but I believe the same if not greater scrutiny should be on general practice because greater harm is possible due the toxicity of medications and the invasive nature of most conventional treatments.

I wonder if you think as I do that the spotlight of scrutiny should shine more brightly on some corners of conventional medicine?
Richard Lawton
Mar 4 2011 1:34PM
A recent report (http://news.bbc.co.uk/1/hi/health/8584600.stm) found that in 25 of the NHS trusts a total of 4,600 more patients had died at those trusts in 2007-08 than would be expected. Even if some of those numbers are explainable, many more cases will not have been considered (these were hospital deaths only, so not including GP patients). This maybe gives a rough idea of how many people are killed by conventional medical care each year.

If any CAM therapy killed even 1% of those numbers it would be banned instantly. (Less than that, actually. Chinese herbal medicine came under scrutiny after a couple of deaths in the late 90s, and has now been severely restricted and regulated. I'm not aware of any other fatalities caused by CAM treatments.)

Yet there has been this big push against CAM by academia & pharma interests, particularly against 'unscientific' treatments like homeopathy. Given the NHS fatalities, this seems a bit like insisting on a Health & Safety risk assessment for a replacement lightbulb while your house is actually on fire...

But nothing will change, because there are too many vested interests.



Rodney Stuart Robinson
Mar 4 2011 3:41PM
Thank you Andrew for that clear and informative post. I couldn't agree more with the points you raise, its just good to know there's someone out there who shares my views of the CAM/conventional medical world. A lot of CAM therapists seem to be missing the point with this misguided rush to register with whatever body presents itself. They seem to be under the misguided understanding that this will increase acceptability of CAM by conventional medicine. I have written to Andrew Lansley, Secretary of State for Health, today along the lines of your post, if for nothing else, then to make me feel better. Maybe there's a few others out there who will join me.

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