Public Services Management: Unconventional cure for NHS: Paul Gosling reports on the growth of complementary treatment and its increased acceptance by the medical profession

THE PUBLIC is increasingly demanding osteopathy, homeopathy, acupuncture and other 'alternative' treatments. The medical profession, however, is split on whether the public should get what the public wants, at least on the NHS.

Many GPs are sympathetic. Some fundholders are responding to demands from patients. Meanwhile there is a call to bring over-the- counter 'natural' treatments under control, and within the framework of the NHS, to reduce the risks of ill health and possible death from unprescribed use.

A Which? poll last year found that a quarter of its readers visited alternative practitioners each year, almost twice as many as six years previously. 80 per cent of the people surveyed felt themselves to be cured or helped, and 75 per cent would use the treatment again. The most popular alternative treatments were osteopathy, chiropractic, homeopathy, acupuncture, aromatherapy, reflexology and herbalism.

A British Medical Association report, published in June, marked a turning point towards alternative treatment by the medical establishment, and was particularly sympathetic to manipulative therapies. A survey conducted by the BMA found that 80 per cent of GPs wanted to train in non-conventional treatment. The BMA added that practising therapists should be controlled by professional organisations, and be covered by indemnity insurance.

Professor Tom Meade, director of the Medical Research Centre's Epidemiology and Medical Care Unit, was a member of the BMA's working party. 'Manipulative therapies practised by people who are properly qualified have a lot to offer,' Professor Meade says.

A report published three years ago by the Medical Research Council, written by Professor Meade, found chiropractic to be more effective than conventional treatment for back pain. Among other research that has been conducted was a three year study for the MRC and the Research Council for Complementary Medicine, which looked at the different approaches taken by orthodox and alternative treatments.

The researcher, Dr David Reilly, now leads a post-graduate course in alternative treatment. The course is attracting an exponential growth in health professional students, he says. Dr Reilly is also consultant physician at Glasgow's Homeopathic Hospital, which accepts 220 NHS referrals a month. 'For three years demand has been outstripping supply by 50 per cent; every month the waiting list has grown.'

Dr Reilly's greatest concern is that the marginalisation of alternative treatments forces patients to lose an integrated service. Patients are now likely to be treated by multiple individual therapists, Dr Reilly says. This is less of a problem where an alternative therapist has a discrete role, as in osteopathy or chiropractic, but can lead to conflict where a homeopath or acupuncturist is seeking to treat the whole body.

Alternative treatments are available on the NHS for many patients; for many more they are not. It is dependent on a number of factors, not least the attitude of the GP, and whether a patient is registered with a fundholding practice. At least 250 GPs are also homeopathic practitioners. The Department of Health says that it is up to individual GPs to decide whether alternative treatments are appropriate, but that the GP remains accountable for the treatment.

The Royal London Homeopathic Hospital is one of four homeopathic hospitals within the NHS. The Royal London was established in 1850, and on creation of the NHS was integrated into it. A year ago the Royal London became an NHS trust, and is currently mailing price lists to all GP fundholders in London to encourage referrals. Consultants are qualified doctors who also prescribe conventional medication or surgery.

The provision of alternative treatments raises not only financial and practical questions, but also ethical ones. As such, in the opinion of Grampian Health Board, the answers must come, at least in part, from the public themselves.

Grampian has just embarked on a public consultation, asking its residents to describe their experience with alternative treatments, and whether they believe they should be available on the NHS. Consultation includes a freephone number and meetings with community groups. A forum on 2 November will give health professionals the opportunity to debate the way forward.

The authority stresses that even if the local population and health professionals all agree that alternative treatment should be generally provided it does not mean that they will be. Resource implications have to be dealt with.

One thing that continues to stand out is the difference in approach taken internationally, although Britain could yet be in the forefront of developments through an initiative from Exeter University, funded by a pounds 1.5m private donation. Edzard Ernst this month became Europe's first professor of complementary medicine. Among his responsibilities will be research into all types of alternative treatment, and to recommend its assimilation into orthodox medical practice and training. It could be a difficult job.

(Photograph omitted)