Positive Health Online

This article examines the following issues which are of relevance to the practice of Complementary and Alternative medicine (CAM) in the future:

1. The relaxation of constitutional and economic restrictions and the reform of funding options relating to voluntary sector charitable organisations and the implications of this for CAM practitioners;
2. Anticipated and existing public sector policies aimed at increasing the role of the voluntary sector in the provision of public sector health services;
3. What action CAM practitioners could take to ensure that their practices both accommodate and benefit from these changes.

Many charities which operate in the voluntary sector would welcome the opportunity to spend money on the purchase of CAM services for the treatment of their beneficiaries and staff. It is likely that this will be the case increasingly in the future.

The Role of the Charities

Charities form a substantial part of the voluntary sector. Their potential spending power should not be underestimated. Recent information1 states that, for the year ending 2002, there are a total of 186,175 charities listed on the Charities Commission register together receiving a yearly income of £30 billion. 

Medical Research is one of the chief beneficiaries of charitable donations.2 Furthermore, the Home Secretary, Mr David Blunkett, has recently published a Report titled Charities And Not-For-Profits: A Modern Legal Framework3 aimed at enhancing the principle of public benefit and widening the definition of a charity to include, amongst other things, the charitable activity of advancement of health.

When speaking at a ‘Third Way’ conference in London on 11 July 2003, The Prime Minister, Tony Blair, announced4 that the government would be publishing plans to extend choice in healthcare:
“With the supply of care opened up to a range of providers – public, private and voluntary.”

On 27 December last year Mr John Reid, the Health Secretary, announced:
“We are working towards an NHS where every patient has a choice of when, where and how they are treated. Working with our partners in healthcare, including the voluntary sector, is fundamental to achieving this vision.”

The Prime Minister’s statement, the Home Secretary’s report and the Health Secretary’s announcement acknowledge the need for the Voluntary Sector and its constituent charities to play an increasing role in the provision of health care. By the time this Article is published a joint committee of both Houses of Parliament should be scrutinising a draft Charities Bill acknowledging, amongst other things, charitable relief for those in need of healthcare.

Health and the Voluntary Sector

An example of where the transfer of health services from the public service to the voluntary sector has produced positive results is in the case of the Royal National Institute for Deaf People (RNID). In his letter to The Times newspaper on 29 July 2003 (“Charity Reforms”), Mr John Low, the Chief Executive of RNID, describes how his charitable organisation received a remit from the Department of Health to manage the first phase of modernizing NHS hearing aid services. He commented:
“The partnership between RNID and the Department of Health proves that by utilizing the specialist expertise, energy and drive of a highly focused charity it is possible to deliver rapid reform of Public Services.”

Those working in the voluntary sector already make a substantial contribution to health and social care provision. This takes the form of hands-on activities by both individuals and groups and also by organizations combining to form voluntary action heath and social care forums promoting the provision of voluntary services and the support of users.

Such locally-based voluntary action initiatives are actively encouraged by Primary Care Trusts (PCTs) which, in accord with their community-based healthcare programmes, are committed to developing locally sensitive health services. PCTs consider it essential that the voluntary sector is involved in the planning and delivery of innovative and flexible health care services.

Primary Care Trust involvement in holistic integrated healthcare initiatives include the folowing:

1. Bristol South and West Primary Care Trust managed the Hartcliffe and Withywood Complementary Therapies Project which received a total of £183,354 including £129,000 from the Single Regeneration Budget (SRB5). This funded a three-year project (2000-2003) exploring the demand for complementary medicine services in the project area. Therapies involved included acupuncture, aromatherapy, homoeopathy, jinshin jyutsu, massage, Indian head massage, osteopathy, reflexology and shiatsu;
2. The Newcastle Primary Care Trust Integrated Healthcare Pilot was instrumental in progressing a research report carried out by Stella Rose Carmichael (e-mail:  stellarose@blueyonder.co.uk) published by Tyne and Wear Health Action Zone (TWHAZ) and entitled Promoting Positive Mental Health and Well-being: Is There a Role for Complementary Medicine?. This research involved aromatherapy, chiropractic, homoeopathy, osteopathy and, initially, shiatsu and concluded that “the fundamental approach and philosophy of complementary medicine had a positive impact”. Research funding was provided by the TWHAZ;
3. The Waltham Forest Primary Care Trust Community Health Project (www.communityhealthproject.org.uk telephone 020-8928 2244) provides holistic integrated accessible healthcare to the most disadvantaged groups in its community. The Project provides, amongst other things, aromatherapy, homoeopathy, counselling, acupuncture, osteopathy and massage. It receives funding from the Primary Care Trust, the Single Regeneration Budget and the National Lottery New Opportunities Fund.

In view of the Government’s statements above, it is likely that PCTs will be making increased demands of the voluntary sector in the future. This being the case, those working in the voluntary sector will themselves require healthcare support.

Certainly, the current demand for such support is not in doubt. For instance, recently reported5 research in the Proceedings of the National Academy of Sciences (July 2003) revealed that overworked carers have high levels of interleukin-6, which is associated with increased risk of cardio-vascular disease and cancer. The research found that, in a study of 117 carers, each of whom was caring for a spouse with Alzheimer’s, the stress endured by the carers caused their immune systems to age prematurely.

CAM and Community Based Healthcare

CAM is ideally suited to the community-based healthcare provision now being actively encouraged by the Government and PCTs. Its holistic ethos addresses clinical and lifestyle issues including the concept that patients should take responsibility for their own health care. CAM has long been providing patient-centred treatments in response to patient choice, both of which are healthcare objectives now being actively pursued through policies adopted by the Government and PCTs.

How, then, might CAM practitioners contribute to and benefit from these changes in healthcare strategy?
Practitioners could pursue four initiatives without delay, namely:

1. Practitioners could prepare their practices for a future where CAM will become accepted and funded as being more integrated with conventional medicine. My earlier article6 attempts to deal with some of the practice management implications of such integration;
2. Practitioners could approach their local Voluntary Action Health and Social Care Forum proposing that it conducts a survey of its membership with the aim of obtaining evidence of need for CAM. Such evidence could then be used to engage a local PCT, Hospital Trust and/or another health provider organization in negotiations for funding to pay for CAM services, benefiting both the voluntary sector and others in need. A sample survey form can be found at the end of this article;
3. Practitioners could approach those voluntary organizations which participated in the survey proposing that they respectively apply to funding organizations for funds which they could then use to purchase CAM services for their beneficiaries’ use. For example, a local ‘Care for Carers’ group could apply for funds to set up a programme of CAM treatments for its overworked carers.
   An example of regeneration funding involvement is the recent case of two doctors’ surgeries in Cornwall receiving a £40,000.00 grant from the Neighbourhood Renewal Fund enabling them to refer patients on low incomes for complementary medicine treatments in acupuncture, art therapy and homeopathy. The CAM practitioners work alongside the GPs in Penzance and Newlyn.
   Practitioners may find a reluctance on the part of some charitable organizations to purchase CAM services from what is essentially a private sector business, namely a practitioner working in private practice. In response to this, a practitioner could comment that it is surely a proper and ethical use of charitable funds to purchase CAM healthcare services for beneficiaries and staff who are in need of them. Indeed, by doing so, the purchasing organization might be said to be enhancing the health and safety at work environment of its staff;
4. A practitioner could initiate the formation of a private company limited by guarantee for charitable purposes through which CAM services could be provided to the voluntary sector and to others in need. Whilst this corporate charitable status would encourage charities to purchase CAM services from the company, this initiative may not be attractive to many practitioners. This is because a company of this type would be controlled by volunteer trustees/ directors acting independently of the practitioner who would rely on them for treatment assignments and payment of fees. In addition, there would be the administrative duties and expense involved in running the company. Furthermore, finding Trustees/ Directors may prove an obstacle since, by law, they are not entitled to receive any benefit or remuneration from the company.

A further matter for practitioners to consider is whether or not to make a charge for treatments.

Traditionally, services provided to the voluntary sector have usually been given free of professional charges. However, perhaps to coincide with the new ‘Third Way’ government initiative, this state of affairs may be about to change. Recent reports8 have suggested that voluntary organizations should be properly paid for the services they provide, at least where such services are commissioned by the public sector.

If this were the case then a voluntary organization could incorporate into its application for funding a request for sufficient funds to enable it to purchase on a full cost basis CAM services for its beneficiaries, staff and for others as appropriate (e.g. for carers and for those being cared for).

Funding and the Voluntary Sector

As the voluntary sector is going to be asked to take on additional public healthcare responsibilities, it is only fair and necessary that it adopts a less traditional and more commercial approach to its funding sources.

This appears to be strongly supported by Stuart Etherington, Chief Executive of the National Council for Voluntary Organizations (NCVO). He was recently reported9 as saying:

“Voluntary Organizations should not take on contracts on the terms that local authorities offer. They should say: ‘This is the price of the added value that we have to offer – you can take it or leave it’.”

Mr Stephen Bubb, Chief Executive of the Association of Chief Executives of Voluntary Organisations (ACEVO), has called for an end to short-term voluntary sector contracts with the state, he says: “We want long-term, 25-year contracts not short-term year-on-year negotiating.”10

The Chief Executive of the Work Foundation, Mr Will Hutton, believes that the voluntary sector is well placed to deliver public services in view of its attributes of: “entrepreneurship, local accountability and autonomy.”11

Central government also recognizes the need for a more realistic approach to funding. Accordingly, it is encouraging voluntary organizations to increase their capacity and to become more independent. The Treasury’s £125 million Future Builders Fund marks a movement away from traditional grant aid funding of core costs to a longer-term investment strategy including loans and other funding options.

Such options will need to be expanded if the voluntary sector is to accommodate the anticipated increase in the health service demands made of it.

CAM practitioners should be ready to take advantage of this proposed less restrictive and more opportunistic voluntary sector environment in which complementary and alternative medicine should play its part.

There is much hard work, discussion and investment now taking place12 aimed at enabling CAM practitioners to integrate their specialist, holistic, caring and clinical skills into the proposed more community-based national healthcare service. It is, of course, the activities and the level of commitment contributed by individual CAM practitioners which will determine the success or otherwise of such integration.

The conclusion must be that CAM practitioners should prepare now for a future of new and exciting professional opportunities. In preparing, they should take particular care to preserve their professional autonomy and the holistic nature of their practice in what, inevitably, will become a more competitive practising environment.

References

1.    Accountancy Age (July 17th, 2003) and as reported in The Times newspaper 22nd July 2003. Public Agenda p3. Multibillion Industry that takes from us all.
2.    Inside Research commissioned by the Charities Aid Foundation and the National Council for Voluntary Organizations (NCVO), www.cafonline.org
3.    Charity Commission report:  www.Charitycommission.gov.uk and Home Office Report: www.homeoffice.gov.uk
4.    The Independent newspaper. 12th July 2003 p10. PM hints that middle class may have to “pay own way”.
5.    The Times newspaper 8th July 2003. Public Agenda p6. New Medical Research.
6.    Richard Eaton. Complementary Medicine – Prepare for the future. Positive Health. Issue 93. October 2003. VOLUME?
7.    CAM Magazine. September 2003. 3: Issue 2. Page 5 and BBC News online, August 4th. 2003.
8, 9.    The Times newspaper. 13th May 2003. Public Agenda. Stop treating us like a charity.
10, 11    Third Sector. September 24th 2003 and as reported in The Times newspaper 30th September 2003. Public Agenda. Page 7. Charities place trust in PFI.  www.acevo.org.uk
12.    The Prince of Wales’s Foundation for Integrated Health. Setting the Agenda for the future. ISBN 00-95-39453-32. May 2003. and National Guidelines for the use of complementary therapies in supportive and palliative care. ISBN 0-95-39453-59. May 2003.