Unit 37:Complementary therapies in healthcare practice

Unit 37: Complementary Therapies in Healthcare Practice

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 Topic: Complementary and alternative medicine

Complementary or alternative medicine (CAM) defines healthcare practices that use methods alternative to pharmaceuticals to teat illness and injury. This kind of practice focuses on prevention and an individual’s holistic health, wellbeing and treatments are tailored specifically to meet each and every individual’s requirements. Alternative medicine practitioners are not licenced and regulated in the UK by healthcare partitioning bodies. “The US National Center for Complementary and Integrative Health (NCCIH) uses this distinction:

• When a non-mainstream practice is used together with conventional medicine, it's considered "complementary".
• When a non-mainstream practice is used instead of conventional medicine, it's considered "alternative". (NHS, 2018)

In this blog I will be discussing the history and purpose of CAM, the competence of practitioners administering CAM and the effectiveness of legislative requirements in regulating CAM.

CAM involves the use of natural products such as essential oils for aromatherapy and physical therapies like acupuncture, yoga, reflexology, diet and massages to treat a range of issues from, back and body pain, stress, anxiety, ADHD, insomnia and heart disease. “Most frequently used to treat more minor issues, CAM is often utilized for neck, back, or joint pains. It is also common in treatment of anxiety, depression, or symptom relief in other diseases.”(Nijs, 2013). The initiative is a popular option where pharmaceuticals fail or to alleviate the symptoms of medicines. Although there is lack of research on the matter; CAM is still on a rise.

It is said that the oldest forms of alternative medicine came from china and India, where they adopted a holistic social medical approach to medicine and used various herbs, acupuncture, oils, yoga and diet to restore a person to good health. The 17^th &18th centuries saw the beginnings of the common use of essential oils, acupuncture and aromatics for health. “During the great plague of Toulouse...... The next few centuries saw the medicinal properties and applications of essential oils analysed and recorded. These included such oils as cedar, cinnamon, frankincense, juniper, rose, rosemary, lavender, sage, Artemisia, cajeput, chervil, orange flower, valerian and pine.”( A brief history of aromatheraphy,2019). In the ancient times the Chinese would burn incense for balance and harmony. The Egyptians would use cedar oil for mummifications and oil distilleries have been found in India. During this same era acupuncture was brought to Europe, an article from the national centre for biotechnology states “One result of this was the development of the Western hypodermic needle from Chinese acupuncture needles. Sporadic clinical reports in Europe discussed the use of acupuncture to relieve pain”(ncbi, 2013).

After which came the revolution of technical chemistry evolution of science. During this time there were some test run on essential oils which provided factual evidence for herbal practitioners on the antibacterial properties of essential oils however, western medicines were focused on isolating the active ingredients of the oils and using them for the pharmaceutical industry. “Use of CAM declined with the appearance of antibiotics in the early 1900s and then regained popularity in the 1970s.2 The World Health Organization3 has noted that various forms of CAM have served as the primary health practice in developing countries for years and are expanding worldwide in countries where more conventional medicine is predominant.” (Kramlich, 2014). “In 1972, the first 2 cases using acupuncture anesthesia/analgesia for surgical operations were performed in the United States”(ncbi, 2013). Further to this “As acupuncture slowly proved effective, studies were conducted proving its efficacy in pain management, nausea relief, and headache dissipation, among other things. Subsequently, a 1997 National Institutes of Health (NIH) consensus conference reported that there was positive evidence for acupuncture's effectiveness.”(ncbi, 2014)

Today aromatherapy is widely used in the beauty, holistic well- being practices and in complementary therapies. “Few medical doctors offer aromatic medicine at this time, but capsules for IBS and relaxation are available with a prescription. More hospitals are including essential oil training in wellness staff education.”  ( A brief history of aromatheraphy,2019). And acupuncture is becoming increasingly popular and more acceptable in the medical profession “Many doctors in developed countries recommend acupuncture for treating pain.... The largest study supporting the use of acupuncture for chronic pain used individual patient data from 20,827 patients. This study showed a moderate benefit for acupuncture compared with usual care, and smaller effects were found for sham acupuncture.”(NHS, 2018) further to this “Case studies in the report demonstrate how complementary practice is already being integrated into NHS primary care services in some areas and is rated highly by patients. The authors are therefore right to suggest that NICE should consider how people are equally able to access services both geographically and in relation to individual therapies” (Kings Fund, 2005 in Complementary medicine roundup, 2017).

Reflexology is documented to originate from Egypt around the 12^th century, by the late 14^th century it was being practiced in Europe under another name (zone therapy). “Father of modern reflexology, Dr. William Fitzgerald (1872–1942) has discovered that zone therapy has been used by Aboriginal American.” (ncbi, 2015). The practice has also been tacked to China and Australia. Since then a lot of work has been done to help people understand reflexology. Dr. William Fitzgerald greatly facilitated the movement in the 1900’s along with Eunice Ingham where they theorised that the human body can be divided into 10 parts and with the application of pressure on certain areas pain can be alleviated in the same area. The theory was proven correct when Dr. William Fitzgerald preformed minor surgeries using this approach. From their work evolved the foot mapping and reflexology charts we use today.

Today reflexology is recognized as a respected and effective complementary therapy by medical professionals, it is practiced by therapists who are recognized by a professional body. It is used in today’s society mostly to relieve stress and relax. It is also prescribed on the NHS but, resources are thin and waiting times long so most people pay to go private. Further to this, the International Institute of Reflexology provides courses in the UK to allow individuals to gain a level 3 in reflexology. In some countries like the United States it is used in replacement of anesthesia to alleviate post operative pain and anxiety.

Skills needed for CAM practitioners.

As CAM focuses on a person holistic health and wellbeing, taking a socieo-medical perspective on health, together with the fact that practitioner do not nessacary need any experience or qualifications to practice, means that practitioners will need to be competent in a range of skills and have a certain level of people and leadership skills to be the most effective practitioner.

Like all health and social care practices effective communication (verbal and written) needs to be built into the foundation of the practice as well as being conscious to give informed consent. As practitioners need to be relatively hands on with clients and would need a range of general and personal information’s for the care planning and assessment process; good English,  listening and the skill to communicate with people of all ages are all beneficial. Further to this they may have to work alongside other holistic or medical professionals and with the client and their families therefore, teamwork and problem solving skills are also necessary. The ability to be caring, reassuring and understanding of different people’s wants and needs is another great quality, together with the ability to advocate for individuals. Lastly it is important that CAM professionals are able to cope with emotional situations, build trusting relationships and be able to articulate and support the use of conventional therapies and alternative medicine; along with knowledge of healthcare ethics/ moral.

CAM is on the rise and society is beginning to accept and integrate CAM into the healthcare field. With the demand for CAM on a rise and more people seeking out alternative treatments therefore, it is imperative that CAM professionals effectively self regulate to guarantee the professional’s deliver a high standard of service to achieve the best results and ensure the services they deliver are satisfactory. Therefore it is important that alternative medicine practitioners carry themselves to the same standard as general healthcare practitioners. And consider codes of conduct and healthcare legislation and guidance’s in their practice to make sure services are safe and effective. Registering with a professional body will “show to the public that you uphold high standards of practice in your work.  Being registered builds trust with your clients, health providers and the public by demonstrating that you “Stand up for Standards.”(CNHC, 2019). “The increasing availability of CAM training within higher educational institutions is an encouraging development, as it provides externally validated educational achievements. However there is some concern that even courses within universities, designed to train students to practise, are often not accredited by a professional regulatory body of the therapy being studied.” (parliament uk, 2000)

Professional practice requirements for administering CAM.

As CAM practitioners are not generally recognised as healthcare professionals; some can be licensed professionals who decided to practice conventional medicine. Others are volunteers, individuals who have benefited from the practice in the past or those who want to heal people without the use of pharmaceuticals.  It is not mandatory for alternative medicine practitioners to need experience or qualifications to become a practitioner. “However savvy practitioners also want to gain a recognised qualification that will enable them to enhance their practice, enable them to join an appropriate professional register and include the new skills in their insurance portfolio.” (CPH, 2015).  The lack of awareness, regulations and attention/resources put into this area means that this sector is vulnerable to malpractices. More effort needs to be put into this area to avoid complaints and incidents and as precautionary safeguarding matters.

Who are the regulators of complementary and alternative medicine?

The UK provides Herbal medicine degrees and courses in alternative medicine which are accredited by a professional body. Also “Complementary therapies are provided by suitably trained practitioners. Therapists will be members of their industry accreditation or regulatory body, which will have a specific code of conduct.” (NHS, 2018). Specific training courses are also available for individuals wishing to practice, teach or advice on alternative medicine. The Federation of holistic Therapists (FHT) are the professional association for CAM therapists; they provide support, advice, training, information and resources for both practitioners and people seeking treatment. Individual practitioners can also choose to register with the complementary and natural healthcare council (CNHC), who the government body responsible for regulating complementary healthcare practitioners. However, Osteopathy and chiropractic are regulated in the same way as conventional medicine and have their own registry councils.

There is no mandatory regulation for CAM practitioners however; there are voluntary organisation that practitioners can register with. One of the main regulators of CAM is the complementary and natural healthcare council who have been approved by the Professional Standards Authority for Health and Social Care. With government funding and support they regulate the voluntary sector and provide information on many therapies and publish a public register for practitioners who have joined. The main purpose of this government body is to hold CAM practitioners accountable for their practices. Even though “statutory regulation has not happened and remains voluntary for most forms of CAM, other than osteopathy and chiropractic. Osteopathy is regulated by the General Osteopathic Council. Chiropractic is regulated by the General Chiropractic Council.” (Harding, 2016). Further to this there are also professional associations for specific therapies where practitioners can also register. This body will regulate persons who practice aroma therapy and acupuncture who register.

The health and care professionals’ council (HCPC), who are a regulator of healthcare professionals, have been pushing for the agenda of regulating CAM professionals to make it mandatory for them to meet certain standards in order to safeguard the public from unsafe practices however, “In 2011 government announced that it intended to introduce statutory regulation for this group. However, after convening a working group they agreed that there was insufficient evidence to justify statutory regulation.”(HCPC, 2018). Although they do recommend “The Professional Standards Authority (PSA) holds a list of accredited voluntary registers which they have independently assessed against their own standards. They cover professions that are not regulated by law, with professionals working within and outside the NHS.” (HCPC, 2018). “the British Acupuncture Council, the National Institute of Medical Herbalists) broadly supported the recommendation and were for a period of time collaborating with the HCPC to develop more detailed plans on how statutory regulation might be introduced. This included addressing issues such as language competence and standards of education and training”(HCPC, 2015).

The Medicines Health Regulatory Authority (MHRA) on CAM state “Many herbal remedies used in the UK are not mass produced, but made up on an individual basis, and these are currently exempt from the need for a licence.” (MHRA, 2008) Due to this “Medicines Health Regulatory Authority {who} was already responsible for approving certain herbal medicines in common use, and had experience in dealing with poor practise” (MRHA, 2008). To combat this they do publish the details of and herbal product that may contain harmful ingredients or any ingredients that interact with conventional medicines on their website. They also introduced the yellow card scheme which is a website that provides information and a platform to report any incidents or concerns with both conventional and alternative medicine.

Additionally the national occupational standards (NOS) who are approved by UK government regulators and their performance standards relate to almost every role in every sector in the UK including CAM professionals. The general regulatory council for complementary therapies (GRCCT) state “Our purpose is to protect the public by promoting and enforcing high standards of education, performance and conduct amongst practitioners of Complementary and Alternative Medicine” (GRCCT, 2019). They are another regulator where professionals can register and access support within their profession.

The push for more CAM integrated care

Even though there are an abundance of registers and regulator services for CAM, as it is not considered a medical profession they are not regulated, audited or expected to uphold the same standard as medical care professionals, nor are accessible services available on the NHS. “The availability of CAMs on the NHS is limited, and in most cases the NHS will not offer such treatments. The National Institute for Health and Care Excellence (NICE) provides guidance to the NHS on effective treatments that are value for money. NICE has recommended the use of CAMs in a limited number of circumstances.” (NHS, 2017). These include; homeopathy, acupuncture, reflexology, aromatherapy and body manipulation services.

With the increasing number of people seeking out alternative medicine together with the fact that the CAM profession is for the most part voluntary and alternative medicine is a part of the healthcare system whether the government takes it seriously or not, there is a huge need for the CAM sector to be researched, legitimised and legally regulated/ audited and that CAM professionals are required by law to follow all the relevance guidance’s. Although the NHS use of CAMs is limited if they were to integrate more of these services it would be more cost-effective and honouring the sociomedical model of health which is focused on prevention, the environment and an individual’s holistic well being. This would also mean that the CAM services would be regulated to the same standard as the NHS and increase its credibility as more research and funding would then be conducted within that sector to increase its sustainability.

Currently even though there are therapies out there, courses, training and services that are being regulated as well as a complaint platform, I feel the government need to start taking CAM services seriously and integrating CAM practice fully into society educating people and professionals on the benefits and risks of CAM as it would be upholding regulations relating to giving individuals more informed choices over their care. And will allow for individuals wishing to practice CAM to undergo relevant mandatory training to ensure all services are safe and effective and practitioners are competent. Lastly, CAM practitioners often work with venerable individuals therefore safeguarding checks such as the DBS are extremely necessary and are currently not required.

Having some CAM therapies in the NHS is a starting point but there definitely needs to be a huge turn around so that Practices are safe and Practitioners understand their responsibility to the public. “CAM does appeal to the public; many feel it is more natural; some feel the holistic approach benefits them; others may turn to it when they feel conventional medicine has let them down. We have a duty to help our patients make informed decisions about their healthcare. We should provide them with the evidence about CAM to aid their empowerment and decision-making process. High-quality evidence is often lacking and a UK study (looking at the impact of CAM on health outcomes) called for those evaluating impact, to use standardised tools to improve the overall quality of the studies”. (Harding, 2016).