- Email: [email protected]
A noble vision and a flawed outcome
176
News update and forthcoming events / Complementary Therapies in Clinical Practice 16 (2010) 174e179
Pioneering new courses in CAM at the University of Westminster B. Isbell* School of Life Sciences, University of Westminster, 115 New Cavendish Street, London W1W 6UW, United Kingdom
Over the past 15 years five complementary medicine BSc (Hons) degrees have been developed at the University of Westminster. The multidisciplinary, innovative and internationally renowned Polyclinic, where the students complete their clinical practice, under the close supervision of experienced practitioners, reinforces collaborative working. Placement opportunities enable students to extend their expertise in inter-professional working. Following the successful validation in April 2010, the Scheme has been extended to 14 courses. The new Integrated Masters and MSc courses are in response to demands for highly skilled CAM practitioners. The Integrated Masters (IM) planned to commence in September 2010, are in Acupuncture, Herbal Medicine, Nutritional Therapy and Complementary Medicine (with pathways in Naturopathy or Therapeutic Massage, Aromatherapy and Shiatsu). IM courses are identical to BSc (Hons) courses for the first three years
of a full time course. The IM route may be particularly suitable for those with previous learning at degree level, but it is available to all applicants. The fourth year, full time IM, develops individual scholar practice by developing therapy skills, supervision, research skills and clinical governance. The MSc courses include Acupuncture, Herbal Medicine, Nutritional Therapy and Complementary Medicine for practitioners of other CAM professions. Two-year part time MSc courses will be offered from September 2011 and one-year FT from September 2012. Both the IM and MSc courses consist of short learning bursts of three days incorporating tutor, peer support and virtual learning environments. MSc courses also contain a research methods module and a dissertation contributing to the evidence base of CAM therapies. This course can assist students wishing to progress onto MPhil/PhD or Professional Doctorate programmes also available in the School of Life Sciences.
* Contact Professor Brian Isbell, School of Life Sciences, University of Westminster, 115 New Cavendish Street, London W1W 6UW, United Kingdom. Tel.: þ44 20 7911 5036; fax: þ44 20 7911 5028. E-mail address: [email protected] doi:10.1016/j.ctcp.2010.05.005
A noble vision and a flawed outcome Roger James*, Mij Ferrett, Vivien Ray Secretary, Vice-chair & Chair of the Craniosacral Therapy Association, Monomark House, 27 Old Gloucester Street, London WC1N 3XX, United Kingdom
The Complementary and Natural Healthcare Council (CNHC) has been established with the aim of having one single independent, reliable regulator of complementary and alternative medicine (CAM). A key role in its formation was played by Prof Julie Stone, now of the Peninsula College of Medicine at Truro. She wrote a report published in 2005 for the Prince’s Foundation for Integrated Health on a possible federal regulator for complementary medicine.1 The eventual outcome of this carefully researched and very thorough report was the formation of the CNHC. In her guest editorial for the February 2010 issue of the journal Complementary Therapies in Clinical Practice, Prof Stone laments the poor take-up rate of complementary and alternative medicine therapists registering with the CNHC and says that the failure of the organisation to become the single recognised regulator in the field will be to the disadvantage of CAM professions in general. Prof Stone’s reasoning is as elegant as ever, but in our view there are flaws in it. This becomes more evident when one compares the 2005 report with the guest editorial. In the editorial she says that ‘a stumbling block for sector-wide sign-up seems to be coming from the professional associations, who have concerns that if practitioners become registered with the CNHC, their own membership numbers will fall’. That may be true of some opponents of CNHC from within the professions, but it is not why we, the writers of this
letter, have opposed this model of regulation from the time it was proposed. The crucial reasons for our opposition are that we believe this is an inappropriate model and it runs the risk of being imposed upon certain professions without adequate discussion or the consent of a majority of their members. Why inappropriate or flawed? That can be answered in the words of Prof Stone herself who said in her 2005 report, “A [federal CAM regulator] would be owned by the professions it regulated.” (ibid 29) She makes a similar point elsewhere: Because this is voluntary regulation, professionals have to buy into the proposals. A new voluntary system can’t be imposed on practitioners, because they will have the responsibility of setting up and running the scheme. A system won’t be successful unless professionals support it. (ibid p 30, our emphasis) If one compares the structure of the wholly voluntary CNHC with that of the nearest comparable organisation, the Health Professions Council (HPC), the most striking difference is that the HPC council is composed of equal or nearly equal numbers of lay and practitioner members. This is the current pattern in all statutorily regulated health professions. The CNHC in contrast, is run by a main board composed entirely of lay people.2 Instead of health
News update and forthcoming events / Complementary Therapies in Clinical Practice 16 (2010) 174e179
professionals being on the main board there is an advisory panel (profession specific board) for each therapy which includes some practitioners, who can make recommendations to the main board. We believe this is a clumsy structure which is likely to be expensive and CAM professionals will have no say in the main board proceedings and subsequent regulatory decisions emerging from the CNHC. Recommendations from a peripheral committee will not carry the same weight as having members of the regulated professions on the board. In the proposals for setting up the CNHC there was the rather odd provision for three representatives of the professions to be allowed to attend main board meetings e but as observers only. This has been quietly dropped. The decision to have a lay-only structure of the CNHC main board may be based on the opinion that CAM professions would be unable to come to mutual agreements regarding overarching guidelines encompassing disparate therapeutic groups. There is no evidence to suggest that CAM professionals are incapable of working together. So how did we get from the passage we have quoted from the 2005 report to the current structure of the CNHC where the professions do anything but own the federal regulator? The responsibility must lie with those, including representatives of the CAM professions, who drew up the initial proposals when establishing the CNHC prior to its inception in 2008. It could be that lack of support for the new regulator is related to the speed with which it was set up which allowed no time to settle difficult issues. Prof Stone made the critical observation in 2005 that establishing a federal regulator was a process that could not be rushed. She called this a ‘significant task’ (ibid p 36) e in less academic language one might translate this as a mammoth job e and that it would take years rather than months. In a subsequent assessment of the feasibility of the formation of a CAM federal regulator carried out by Maggy Wallace for the Prince’s Foundation for Integrated Health in 2006, she wrote that any profession wishing to be involved ‘must wish to participate in the establishment of a federal approach for complementary healthcare and must demonstrate its commitment to the concept.’3 Our observations from within our own profession and what we have learned through contacts with other CAM professional associations are that the consent and commitment of a majority in each profession have in some cases not been secured, with the result that numbers registered with the CNHC are very small in relation to potential registrants e even in those professions where the CNHC register has been open for over a year. The feeling that is created suggests many CAM practitioners are being dragged kicking and screaming into something their professions may not have been properly consulted about, still less approved. There is also widespread concern among complementary practioners about the methods the CNHC is employing to verify the qualifications of applicants to its register. The regulator is using professional associations to carry out this task 4 One can see a reason for this e these associations may be considered capable of knowing how well qualified their own members are. However, the
* Corresponding author. Tel.: þ44 01342 810112. E-mail address: [email protected] (R. James). doi:10.1016/j.ctcp.2010.05.012
177
question arises as to why the CNHC does not do its own checking of qualifications, and standards. In certain circumstances CNHC verification can be done by an association to which the applicant does not belong.4 This is not likely to lead to confidence in the integrity of the CNHC or the credentials of its members. One can understand that the management of a hospice or some other institution, within the NHS or outside, would be glad to know that they could refer to one central register to see if someone wanting to work for them was a fit and proper person. While this may be a laudable aspiration, we do not believe the CNHC looks in the least likely to be able to be able to provide the authoritative and inclusive listing of competent therapists which is its raison d’etre. Large numbers of CAM therapists have registered with a rival organisation, the General Regulatory Council for Complementary Therapies. Many more have decided to keep their trust in the already existing tried and trusted professional organisations. The likelihood is that the CNHC model is not going to work in its present form. It needs to ensure that it listens to the needs of health professionals in order to meet these needs and gain the trust of practitioners and the public. CAM practitioners have years of experience and knowledge related to regulation and should be integral to the structural development of the CNHC or equivalent organisations. Prof Stone says that the Government has ‘thrown its weight fully’ behind the creation of the CNHC. It is unclear what the new Government’s view will be, now that the CNHC has been in operation for over a year. Taxpayers’ money has been put in to get it started and we would be surprised if the Department of Health were not having some misgivings by now. Without large additional finance, the CNHC will not be able to finance its operations from registrants’ fees for some time to come e possibly some years. Supporters of the CNHC talk as though self-regulation by CAM professions was unknown until the federal regulator appeared. CAM practitioners are regulated by a variety of professional associations which commonly utilise rigorous schemes of self-regulation, appropriate to the level of potential risks involved, and a match for anything in the CNHC. The question and concern here is whether the regulatory practices and roles of professional associations can be safely and effectively left to one body. Professional CAM associations are far more zealous for the safety of their clients and the good name of their profession than any federal regulator is likely to be.
References 1. Stone J. Development of proposals for a future voluntary regulatory structure for complementary health care professions. The Prince of Wales’s Foundation for Integrated Health; 2005. 2. Website of Complementary and Natural Healthcare Council, http://www.cnhc. org.uk/pages/index.cfm?page_id¼60. The Prince of Wales’s Foundation for Integrated Health [2008] A Federal Approach to Professionally-Led Voluntary Regulation for Complementary Healthcare p. 6. 3. Wallace M. PFIH feasibility/implementation study; 2006. p. 25. 4. CNHC website, http://www.cnhc.org.uk/pages/index.cfm?page_id¼22.
News update and forthcoming events / Complementary Therapies in Clinical Practice 16 (2010) 174e179
Pioneering new courses in CAM at the University of Westminster B. Isbell* School of Life Sciences, University of Westminster, 115 New Cavendish Street, London W1W 6UW, United Kingdom
Over the past 15 years five complementary medicine BSc (Hons) degrees have been developed at the University of Westminster. The multidisciplinary, innovative and internationally renowned Polyclinic, where the students complete their clinical practice, under the close supervision of experienced practitioners, reinforces collaborative working. Placement opportunities enable students to extend their expertise in inter-professional working. Following the successful validation in April 2010, the Scheme has been extended to 14 courses. The new Integrated Masters and MSc courses are in response to demands for highly skilled CAM practitioners. The Integrated Masters (IM) planned to commence in September 2010, are in Acupuncture, Herbal Medicine, Nutritional Therapy and Complementary Medicine (with pathways in Naturopathy or Therapeutic Massage, Aromatherapy and Shiatsu). IM courses are identical to BSc (Hons) courses for the first three years
of a full time course. The IM route may be particularly suitable for those with previous learning at degree level, but it is available to all applicants. The fourth year, full time IM, develops individual scholar practice by developing therapy skills, supervision, research skills and clinical governance. The MSc courses include Acupuncture, Herbal Medicine, Nutritional Therapy and Complementary Medicine for practitioners of other CAM professions. Two-year part time MSc courses will be offered from September 2011 and one-year FT from September 2012. Both the IM and MSc courses consist of short learning bursts of three days incorporating tutor, peer support and virtual learning environments. MSc courses also contain a research methods module and a dissertation contributing to the evidence base of CAM therapies. This course can assist students wishing to progress onto MPhil/PhD or Professional Doctorate programmes also available in the School of Life Sciences.
* Contact Professor Brian Isbell, School of Life Sciences, University of Westminster, 115 New Cavendish Street, London W1W 6UW, United Kingdom. Tel.: þ44 20 7911 5036; fax: þ44 20 7911 5028. E-mail address: [email protected] doi:10.1016/j.ctcp.2010.05.005
A noble vision and a flawed outcome Roger James*, Mij Ferrett, Vivien Ray Secretary, Vice-chair & Chair of the Craniosacral Therapy Association, Monomark House, 27 Old Gloucester Street, London WC1N 3XX, United Kingdom
The Complementary and Natural Healthcare Council (CNHC) has been established with the aim of having one single independent, reliable regulator of complementary and alternative medicine (CAM). A key role in its formation was played by Prof Julie Stone, now of the Peninsula College of Medicine at Truro. She wrote a report published in 2005 for the Prince’s Foundation for Integrated Health on a possible federal regulator for complementary medicine.1 The eventual outcome of this carefully researched and very thorough report was the formation of the CNHC. In her guest editorial for the February 2010 issue of the journal Complementary Therapies in Clinical Practice, Prof Stone laments the poor take-up rate of complementary and alternative medicine therapists registering with the CNHC and says that the failure of the organisation to become the single recognised regulator in the field will be to the disadvantage of CAM professions in general. Prof Stone’s reasoning is as elegant as ever, but in our view there are flaws in it. This becomes more evident when one compares the 2005 report with the guest editorial. In the editorial she says that ‘a stumbling block for sector-wide sign-up seems to be coming from the professional associations, who have concerns that if practitioners become registered with the CNHC, their own membership numbers will fall’. That may be true of some opponents of CNHC from within the professions, but it is not why we, the writers of this
letter, have opposed this model of regulation from the time it was proposed. The crucial reasons for our opposition are that we believe this is an inappropriate model and it runs the risk of being imposed upon certain professions without adequate discussion or the consent of a majority of their members. Why inappropriate or flawed? That can be answered in the words of Prof Stone herself who said in her 2005 report, “A [federal CAM regulator] would be owned by the professions it regulated.” (ibid 29) She makes a similar point elsewhere: Because this is voluntary regulation, professionals have to buy into the proposals. A new voluntary system can’t be imposed on practitioners, because they will have the responsibility of setting up and running the scheme. A system won’t be successful unless professionals support it. (ibid p 30, our emphasis) If one compares the structure of the wholly voluntary CNHC with that of the nearest comparable organisation, the Health Professions Council (HPC), the most striking difference is that the HPC council is composed of equal or nearly equal numbers of lay and practitioner members. This is the current pattern in all statutorily regulated health professions. The CNHC in contrast, is run by a main board composed entirely of lay people.2 Instead of health
News update and forthcoming events / Complementary Therapies in Clinical Practice 16 (2010) 174e179
professionals being on the main board there is an advisory panel (profession specific board) for each therapy which includes some practitioners, who can make recommendations to the main board. We believe this is a clumsy structure which is likely to be expensive and CAM professionals will have no say in the main board proceedings and subsequent regulatory decisions emerging from the CNHC. Recommendations from a peripheral committee will not carry the same weight as having members of the regulated professions on the board. In the proposals for setting up the CNHC there was the rather odd provision for three representatives of the professions to be allowed to attend main board meetings e but as observers only. This has been quietly dropped. The decision to have a lay-only structure of the CNHC main board may be based on the opinion that CAM professions would be unable to come to mutual agreements regarding overarching guidelines encompassing disparate therapeutic groups. There is no evidence to suggest that CAM professionals are incapable of working together. So how did we get from the passage we have quoted from the 2005 report to the current structure of the CNHC where the professions do anything but own the federal regulator? The responsibility must lie with those, including representatives of the CAM professions, who drew up the initial proposals when establishing the CNHC prior to its inception in 2008. It could be that lack of support for the new regulator is related to the speed with which it was set up which allowed no time to settle difficult issues. Prof Stone made the critical observation in 2005 that establishing a federal regulator was a process that could not be rushed. She called this a ‘significant task’ (ibid p 36) e in less academic language one might translate this as a mammoth job e and that it would take years rather than months. In a subsequent assessment of the feasibility of the formation of a CAM federal regulator carried out by Maggy Wallace for the Prince’s Foundation for Integrated Health in 2006, she wrote that any profession wishing to be involved ‘must wish to participate in the establishment of a federal approach for complementary healthcare and must demonstrate its commitment to the concept.’3 Our observations from within our own profession and what we have learned through contacts with other CAM professional associations are that the consent and commitment of a majority in each profession have in some cases not been secured, with the result that numbers registered with the CNHC are very small in relation to potential registrants e even in those professions where the CNHC register has been open for over a year. The feeling that is created suggests many CAM practitioners are being dragged kicking and screaming into something their professions may not have been properly consulted about, still less approved. There is also widespread concern among complementary practioners about the methods the CNHC is employing to verify the qualifications of applicants to its register. The regulator is using professional associations to carry out this task 4 One can see a reason for this e these associations may be considered capable of knowing how well qualified their own members are. However, the
* Corresponding author. Tel.: þ44 01342 810112. E-mail address: [email protected] (R. James). doi:10.1016/j.ctcp.2010.05.012
177
question arises as to why the CNHC does not do its own checking of qualifications, and standards. In certain circumstances CNHC verification can be done by an association to which the applicant does not belong.4 This is not likely to lead to confidence in the integrity of the CNHC or the credentials of its members. One can understand that the management of a hospice or some other institution, within the NHS or outside, would be glad to know that they could refer to one central register to see if someone wanting to work for them was a fit and proper person. While this may be a laudable aspiration, we do not believe the CNHC looks in the least likely to be able to be able to provide the authoritative and inclusive listing of competent therapists which is its raison d’etre. Large numbers of CAM therapists have registered with a rival organisation, the General Regulatory Council for Complementary Therapies. Many more have decided to keep their trust in the already existing tried and trusted professional organisations. The likelihood is that the CNHC model is not going to work in its present form. It needs to ensure that it listens to the needs of health professionals in order to meet these needs and gain the trust of practitioners and the public. CAM practitioners have years of experience and knowledge related to regulation and should be integral to the structural development of the CNHC or equivalent organisations. Prof Stone says that the Government has ‘thrown its weight fully’ behind the creation of the CNHC. It is unclear what the new Government’s view will be, now that the CNHC has been in operation for over a year. Taxpayers’ money has been put in to get it started and we would be surprised if the Department of Health were not having some misgivings by now. Without large additional finance, the CNHC will not be able to finance its operations from registrants’ fees for some time to come e possibly some years. Supporters of the CNHC talk as though self-regulation by CAM professions was unknown until the federal regulator appeared. CAM practitioners are regulated by a variety of professional associations which commonly utilise rigorous schemes of self-regulation, appropriate to the level of potential risks involved, and a match for anything in the CNHC. The question and concern here is whether the regulatory practices and roles of professional associations can be safely and effectively left to one body. Professional CAM associations are far more zealous for the safety of their clients and the good name of their profession than any federal regulator is likely to be.
References 1. Stone J. Development of proposals for a future voluntary regulatory structure for complementary health care professions. The Prince of Wales’s Foundation for Integrated Health; 2005. 2. Website of Complementary and Natural Healthcare Council, http://www.cnhc. org.uk/pages/index.cfm?page_id¼60. The Prince of Wales’s Foundation for Integrated Health [2008] A Federal Approach to Professionally-Led Voluntary Regulation for Complementary Healthcare p. 6. 3. Wallace M. PFIH feasibility/implementation study; 2006. p. 25. 4. CNHC website, http://www.cnhc.org.uk/pages/index.cfm?page_id¼22.