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Patient Choice and the threat to patient access to the RLHH
By Sato Liu Published: 29/01/2009
This is a national electronic referral service which aims to give patients the right to “choose any hospital in England funded by the NHS”, including some background information.
If a referral to a hospital specialty is required, the CAB scheme enables us to choose the hospital we want to go to. However, when a referral to the Royal London Homœopathic Hospital (RLHH) is requested, many patients are told that their PCT will not ‘fund homeopathy’.
Although homeopathy is available under the NHS a referral to the RLHH is not an automatic referral for homeopathic treatment. The hospital offers patients a wide range of integrated treatment options appropriate for the patient’s condition, both conventional and complementary and the clinical treatment is decided by the doctor in consultation with the patient. But our concern here is not about treatment; it is about patient choice and patient safety.
There are many reasons that patients want the integrated approach offered at the RLHH, including;
· cultural or lifestyle choice,
· their condition falls into a category that conventional treatment is unable to
help, known as an “effectiveness gap”,
· they have not benefited from the conventional treatment previously received
· they have experienced adverse effects from conventional treatment.
We know that some PCTs have written to GPs specifically informing them that they cannot refer to the RLHH under CAB, + whilst others allow it. This creates an unfair situation for patients living in the wrong ‘postcode’ areas.
A patient in the Haringey area who appealed against the decision not to allow him to attend the RLHH was told that he must ‘include both conclusive evidence of the effectiveness of the treatment and that conventional treatment had been unsuccessful’. We know of no other circumstance in which a patient would be asked to do this!
A patient in Kensington and Chelsea spent over a year fighting the decision not to allow her to attend the RLHH – despite her GPs request for an extra-contractual referral. Failing to secure approval, the GP referred her to a consultant in pain medicine at the National Hospital for Neurology & Neurosurgery, who subsequently reported back to the GP that it was ‘entirely appropriate’ for her to be referred to the RLHH’s Department of Musculoskeletal Medicine.
In a letter to the patient, the Chief Executive of K&C PCT explained the decision not to fund her referral to the RLHH citing lack of ‘valid research’ and the ‘natural risk of bias’ from consultants in the same NHS trust. Confusing for the patient and insulting to the integrity of the consultant.
There are many more examples where patients are not being allowed choice under the CAB Free Choice scheme. For people who are already suffering from poor health, it is inappropriate and unreasonable to place such a responsibility on them and is causing great distress.
Responding to a letter I sent to Rudi Vis, the Department of Health gave assurances of their commitment to improving patient choice, however, they state that ‘… NHS organisations have to take into account evidence for the safety and effectiveness of the treatment, and the availability of properly qualified and regulated practitioners. With the exception of chiropractic and osteopathy, all other professions which practice complementary and alternative medicine in the UK are unregulated.’
In fact, homeopathy is recognised by Act of Parliament (1950) and all practitioners at the RLHH are conventionally qualified and regulated healthcare professionals.
Regarding evidence-based medicine, in an article published in the BMJ’s Clinical Evidence, of 2,500 conventional treatments reviewed, 46% were shown to have ‘unknown effectiveness’ with only 13% rated as beneficial. Dr Roses of SmithKline Glaxo said that ‘90% of all our drugs only work in 30 - 50% of patients’. What other options are available then to help those who do NOT benefit?
In a letter to Glenda Jackson, the Department of Health state that ‘A referral by a GP still constitutes authority to treat … What the PCT is prepared to fund must be clear to all parties … but PCT commissioning arrangements will not restrict patients’ choice of where to be treated.’ But patient choice is being restricted with PCTs refusing to fund referrals to the RLHH.
As patients, we want to receive the best standard of care, delivered by regulated health professionals in a safe environment. The Government wants to develop an innovative, patient-centred national health service.
The RLHH fulfils both these objectives; it is a flagship for integrated medicine within the NHS, providing high quality medical care, delivered by fully qualified conventional medical doctors and claims a high level of patient satisfaction.
Part of the University College London Hospitals NHS Foundation Trust, the RLHH services are offered on the NHS and, under the Choose and Book Free Choice scheme, we are told we have the right to choose to be referred to it.
Referrals to the RLHH have been steadily declining since May 2006, when a lead article in The Times featured a letter sent to all NHS Trusts calling on them to decommission complementary medicine. This was timed to coincide with a speech on integrated healthcare given by the Prince of Wales to the World Health Assembly. Exactly one year later, a few of the original signatories revived their campaign with a letter to Directors of Commissioning - again leaked to The Times - calling for a boycott of homeopathy. The following day, a document which appeared to be an NHS official template for decommissioning of homeopathic services was sent to all PCTs in England.
In July 2007 Lord Palmer (Hansard 3 July 2007: Column 898) asked the Government whether the document Homeopathic Services was issued with the knowledge and approval of the Department of Health. Baroness Royall responded that ‘inquiries … indicate that the document was not issued with either the knowledge or the approval of the Department of Health.’
In October, the Department of Health website published a statement that ‘… the use of the National Health Service logo was inappropriate in this instance’. Too little, too late!
We believe that this document has been the primary cause of the decline in patient referrals to the RLHH - with at least eight PCTs having withdrawn their contracts and others subjecting patients who appeal to management panels, which on the whole appear to be unsympathetic to patient choice. Patients attending the RLHH have usually been through the NHS treatment options and have been referred to the RLHH as a last resort.
The hospital’s patient population is particularly diverse and many find the treatment options available to them are compatible with their cultural needs and preferences. If these services are removed from the NHS, albeit by default from lack of referral, their only option would be to attend as private patients.
However, the majority of patients attending the RLHH simply cannot afford to go privately. Those that can may end up consulting practitioners who, whilst they may be well qualified, are unregulated and in some cases, poorly qualified non-medical practitioners. This route is not in the best interests of patient or of public safety.
Although this paper has been produced on behalf of over 4,000 patients supporting the RLHH’s League of Friends campaign, there are several thousand more patients, and their GPs, around the country who wish to avail themselves of the hospital’s excellent services.