Using homeopathy in the NHS to benefit patients, improve treatment outcomes and reduce costs

The NHS budget for homeopathy is in the region of £4 million,[1] with resources allocated between three NHS homeopathic hospitals and a number of NHS homeopathic clinics. Some homeopathically trained doctors take NHS referrals and some 400 GPs integrate homeopathy into their day to day practice, treating around 200,000 patients per year.[2] In a recent consultation regarding the NHS Lanarkshire Centre for Integrative Care (formerly Glasgow Homeopathic Hospital), 80.6% of respondents supported referrals continuing.[3] With resources stretched and Clinical Commissioning Groups having to make strong cases for the allocation of funds,[4] what role does homeopathy have in the NHS?

As a user of homeopathy for nearly 25 years and a qualified practitioner for 15 of those, my personal and clinical experience is that homeopathy works. Additionally, having witnessed its efficacy in numerous babies and small children, and in animals, I have long since dismissed the idea that successful homeopathic treatment is simply the result of placebo effect.[5] The purpose of this article is not explain homeopathy as a treatment modality, nor to defend it against its critics,[6] but to illustrate, using two examples,[7] where its benefits lie for those patients who want access to the choice in medical treatment that the NHS itself advocates, and a democratic society expects; and to suggest that the integration of homeopathic and conventional medicine could improve treatment outcomes and facilitate more effective use of resources.[8]

Nine years ago my daughter, Annie (now 19), developed Henoch-Schönlein Purpura (HSP).[9] As the illness progressed, her joints became increasingly swollen and every movement was excruciating. The analgesics prescribed with the acknowledgement of the paediatrician that they could potentially exacerbate the vasculitis in her gut, were ineffectual. With the GP unable to offer other treatment and unwilling to visit, I phoned our homeopath, who came to see Annie and prescribed Bryonia – a remedy that closely matched her symptoms. The pain improved dramatically, and with continuing effect. We discontinued the analgesia. A week or so later the purpura erupted as large, painful dark purple bullae. Again, painkillers were ineffective. This time, the symptoms matched the remedy Lachesis – made from the venom of the bushmaster snake. After a dose of Lachesis 200 Annie fell asleep and slept soundly through the night for the first time in over 2 weeks.  Other remedies followed with equal success as her symptoms changed.

In all, Annie had two nights in hospital and a follow up visit to our GP.  Beyond diagnosis, monitoring for complications, hydration and limited pain relief, Annie’s treatment was homeopathic. Although various conventional treatment regimens have been described for HSP, there is no consensus on the protocols. Treatment with corticosteroids remains controversial.[10] In Annie’s case, analgesia was largely ineffective, while homeopathic treatment dramatically reduced pain, alleviated her symptoms and supported her convalescence. She seems to have fared better in terms of recovery time and subsequent health than other cases I’m aware of, for example regaining her mobility in a third of the time than did another family member, who had HSP resulting in long term renal problems, or the son of a GP friend who subsequently underwent a kidney transplant. She did not experience the recurrence of the illness that occurs in one in four patients.[11]

In situations where the suitability or efficacy of pharmaceuticals is limited (a scenario that is set to become more commonplace as anti-microbial resistance is on the increase),[12] homeopathy may offer more effective (and more cost-effective) treatment.[13] All conventional medicine could offer Annie when she had HSP (beyond the diagnosis, monitoring and reassurance that we were very grateful for) was analgesia that did not work. Homeopathic medicines, however, were effective. Additionally, Annie benefitted from the presence of a practitioner she knew and was comfortable with, who was able to contextualise his assessment of her acute state in his knowledge of her overall health, and who was able to visit her at home. As a family in distress dealing with a frighteningly unwell child and with hospital environments that can feel impersonal and disempowering, homeopathy gave us back some sense of control, as well as the relief that treatment was proving efficacious and was safe and free from side-effects.

Rarely accessing NHS services, families like ours who opt for alternative health care slip beneath the radar in terms of treatment outcomes and cost analysis. Annie’s burden on the NHS has been minimal. She has rarely seen a doctor, never taken antibiotics and has rarely taken analgesia. Her birth (at home with independent midwives) and childhood illnesses (chicken pox, whooping cough, mumps, coughs and colds and an ear infection) were managed homeopathically. This degree of self-reliance is unusual in today’s highly medicalised culture in which individuals consult GPs and frequent emergency departments for even minor ailments. It is not, however, uncommon among individuals and families who prefer complementary and alternative medicine (CAM) and whose practitioners encourage them to take responsibility for their own wellbeing. As my patients become confident with homeopathic treatment, they increasingly make homeopathy their first port of call, keeping the overburdened NHS for times when allopathic diagnostic tools or treatment are really required.

For those individuals and families for whom private homeopathic treatment is not feasible financially, the NHS provides a valuable source of treatment that is sadly limited in availability and threatened by controversy[14] and funding cuts.  My second example describes the experience of a mother, incidentally from a medical family, who obtained a GP referral to the Bristol Homeopathic Hospital for her 8 year old daughter. Her account is as follows:

“The doctor had time to really figure out what our needs were. We felt included in the process. He asked my daughter about her interests and about her as a person. I liked the clarity and structure of the appointments, the fact that the treatment was integrated into the NHS and not marginal. He kept us informed, writing a detailed report to our GP and copying us in. The follow-up was good. Compared to our experience when we visit the GP where they (under a lot of time pressure) have only a small window to discuss the problem, we felt pleasantly surprised. He had time for us and there was a transparency about the process, which empowered us as patients.”

As these examples illustrate, many patients value compassion, transparency and accountability in their clinicians, prefer to operate from a position of informed choice, and place as much value on the quality of the consultation as on the treatment itself. In addition to offering patient-centred treatment, the nature of holistic medicine is that a significant portion of its evidence base is empirical and anecdotal – rooted in the lived experience of patients and the informed observations of the clinician. We must assess the patient’s recovery in relation to their own optimal health. The patient’s personal story is as valid – if not more so for that individual – as the findings in a clinical trial, and is sometimes the only data available.[15] Indeed, as NHS Choices acknowledges, ‘any medicine or treatment may work differently for different people’.[16] This is a fundamental principal in homeopathy in which the individual’s unique symptom picture and their responses to treatment are paramount as data on which to prescribe. Additionally, as happens in conventional medicine, homeopathic practitioners draw on their clinical training and experience, as well as available research, in their treatment decisions:

“Practitioners of conventional medicine strive to use treatments that are supported by clinical evidence showing they are safe and that they work. Still, the use of treatments in conventional medicine is not always based on scientific evidence. In these cases, use of treatment is based on the clinical experience and training of the health professionals – GPs, nurses, doctors – involved.”[17]

Sadly, homeopathic treatment is often sought after pharmaceutical and other interventions have failed and homeopaths often find themselves picking up the pieces.  The use of homeopathy as a frontline treatment would potentially reduce the need for more serious interventions (bypassing, for instance, the adverse effects associated with pharmaceuticals),[18] and (with the emphasis on supporting the patient’s constitution) improve the baseline health of patients.[19] Additionally, a more flexible and integrated approach to patient care would potentially benefit both those patients who want a joined-up health system that addresses all the physical, psychological and emotional aspects of their health in the same consultation and is not forced to compartmentalise them, and the NHS whose financial and time resources are constantly represented in the media as being at breaking point. The Faculty of Homeopathy states that ‘[t]he available evidence suggests that homeopathy has the potential to generate savings through reduced conventional prescribing and demand for other services.[20]

Many of my nursing colleagues support the use of homeopathy in conjunction with conventional treatment – and several of my homeopathy colleagues are also nurses. Support of Clinical Commissioning Groups for integrated homeopathic and conventional medicine, and the willingness of GPs to liaise with and refer patients to local homeopaths warrants further exploration and trial.   Clinical and cost outcomes may need to be monitored and assessed by observational studies and other research more suited to patient-centred treatment.



[3] NHS Lanarkshire Review of Homoeopathy Services – Report on the Public Consultation Exercise (2014) Section 3.1, table 1.

[5] See http://www.homeopathy-soh.org/research/evidence-base-homeopathy/placebo-effect/ accessed 5.10.14 for a discussion of placebo effect.

[6] See http://britishhomeopathic.c1055989.myzen.co.uk/wp-content/uploads/2013/05/evidencesummary.pdf  accessed 16.9.14 for a summary of the research evidence base for homeopathy.

[7] Both examples are used with permission.

[9] Clough, M. A Case of Henoch-Schönlein Purpura The Homeopath No. 26:1 2007: 11-13.

[10] Deng, F. et al. Henoch-Schönlein purpura in childhood: treatment and prognosis. Analysis of 425 cases over a 5-year period. Clin Rheumatol. 2010 April 29(4): 369-74.

[12] WHO (2014) ‘Antimicrobial Resistance: Global Report on Surveillance’ available at http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf, accessed 16.9.14.

[13] http://britishhomeopathic.c1055989.myzen.co.uk/wp-content/uploads/2013/05/evidencesummary.pdf states that ‘[i]ntegration of homeopathy with conventional treatment is associated with better clinical

outcomes for similar or lower costs’, and see http://www.britishhomeopathic.org/safety-and-cost-benefit/ accessed 16.9.14.

[14] The NHS Choices website presents a negative and discouraging view of homeopathy and CAM, despite the fact that these treatment modalities are offered by the NHS. See http://www.nhs.uk/conditions/homeopathy/Pages/Introduction.aspx accessed 16.9.14.

[15] A study at Bristol Homeopathic Hospital recorded the outcome of homeopathic treatment in over 6,500 patients with over 23,000 attendances over a 6 year period. At follow-up, 70% of patients reported an improvement in their health, including 50% who reported ‘major improvement’. Spence D.S., Thompson E.A. and Barron S.J. Homeopathic treatment for chronic disease: A 6-Year, university-hospital outpatient observational study. J Altern Complement Med 2005; 5: 793-8; A 500-patient survey at the Royal London Homeopathic Hospital showed that many patients were able to reduce or stop conventional medication following homeopathic treatment. Sharples F., van Haselen R., Fisher P. NHS patients’ perspective on complementary medicine. Complementary Therapies in Medicine, 2003; 11: 243–248.

[18] E.g. see Roberts, M. ‘Dementia ‘linked’ to common over-the-counter drugs’ available at http://www.bbc.co.uk/news/health-30988643 accessed 27 January 2015; and Marra, F. et al. ‘Antibiotic use in children is associated with increased risk of asthma’. Vol. 123, No. 3 March 1 2009 available at http://pediatrics.aappublications.org/content/123/3/1003.short accessed 5.10.14.

[19] E.g. homeopathic treatment of ear infections can reduce the use of antibiotics and avert the need for grommet insertion – an observation is based on my clinical experience. See also Frei H., Thurneysen A. Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution? British Homeopathic Journal 2001; 90: 180–2, 2013 revision available at http://static.squarespace.com/static/520f6c38e4b01b013b22f419/t/52bf22a0e4b0410823c26e41/1388257952343/AcuteOtitisMediaBHJ.pdf accessed 5.10.14; Jacobs J., Springer D.A., Crothers D. Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial. Pediatr Infect Dis J 2001; 20: 177-83, http://www.ncbi.nlm.nih.gov/pubmed/11224838 accessed 5.10.14; Friese K-H., et al. Homeopathic treatment of otitis media in children: comparisons with conventional therapy. Int J Clin Pharmacol Ther, 1997; 35: 296-301. http://www.ncbi.nlm.nih.gov/pubmed?term=9247843 accessed 5.10.14.

[20] ‘In France, where homeopathy is an integral part of the healthcare system, a government report showed that the total cost of care per patient receiving homeopathic treatment was 15% less than the cost of treatment provided by conventional physicians.’ http://www.facultyofhomeopathy.org/research/safety-and-cost-effectiveness/ accessed 5.10.14.

© Miryam Clough 2015

Shame and creativity

Shame is a potent inhibitor of identity, agency and creativity. It originates in our earliest relationships with the adults we depend on for survival. The way we manage shame later in life is directly influenced by our early attachment needs and the way these are or are not met; by the way our interest and engagement with the world around us is managed by our caregivers. If our attachment relationships are secure we learn to regulate the shame we experience as a normal, healthy part of our development and socialisation. This kind of manageable shame helps us to stay congruent to our deepest values. If this is not the case, if our primary caregivers are unpredictable, absent or terrifying in their emotional responses to us, we will have developed an archive of shame scripts that we struggle to manage and that come into play with subsequent shaming episodes. We’ll struggle to regulate our emotions, to trust and value ourselves, and to keep a perspective on shame.

If, as very young children, we are encouraged and allowed to be ourselves, we will have the confidence to explore and the courage to create. If, on the other hand, we have learned to reign ourselves in to ensure that our physical and attachment needs are met, to ensure that we are cared for, we are likely to struggle with exploring our environment freely and with expressing ourselves creatively. We are likely to be hampered by shame.

Creativity by its nature demands that we are original; it requires original ideas and ways of expressing them. Being creative is about putting ourselves on the page, on the canvas, in the notes in our composition, in the design of the fabric or the architecture of the building, the layout of the garden, the format of the workshop we are leading, in the clothes we are wearing, in the colour we paint our window frames.

Sharing the fruits of our creativity necessitates self-exposure. Immediately we put ourselves out there we are under surveillance, subject to the gaze of others. Often that surveillance is wary, the gaze is critical. While we hope for appreciation, affirmation and delight, we also open ourselves up to the possibility of dislike, disapproval and even ridicule. Exposure is also one of the key attributes or characteristics of shame. When we experience shame, we feel exposed and want to hide. We want the ground to swallow us up.

A relationship with exposure is common to both shame and creativity, suggesting that they have a core baseline or root. This root is in identity. Shame and creativity are both intrinsic to a sense of self. If I am secure in myself, know and trust my identity and feel valued, shame is moderate and I can manage it. I am able to risk exposure because I trust myself and my ability to bounce back, and I feel supported by others around me. If on the other hand I have a global sense of myself as bad or inadequate, if I depend on the approval of others to feel good about myself, I may struggle to reveal my creativity, to put myself on the page, to expose myself to the possibility of criticism. Some people would rather die than risk shame.

To live with a burning desire to create that cannot be fulfilled is a death, or at least a sickness, of the soul. Gershen Kaufman (1996) describes shame as a sickness of the soul that must be healed in order for the self to be whole. One of the first ways both to heal shame and to find safety to express ourselves creatively is to find community. To surround ourselves with people who care for us, who are supportive, whom we can trust, and to explore our creativity in that context. It is to seek out and nurture those aspects of our identity that were not allowed to flourish in childhood, and which we know in our hearts are still present, waiting to be liberated. And above all, it is to approach ourselves with compassion.

© Miryam Clough 2012

Delivering dignity and restoring pride – nursing older people

The NHS Confederation’s ‘Delivering Dignity’ report is encouraging. It highlights the prevalence of ageism in British society, rightly asserts the fundamental needs and rights of older people, and recognises the problems induced by command and control leadership, and low status, task orientated care provision.

The first of the report’s key recommendations to care homes advises the establishment of a Care Quality Forum  ‘to look at all aspects of care home staffing, including issues of status and pay, qualifications, recruitment, retention, development, monitoring and regulation.’ This recommendation points up issues that are key to nursing care across settings, from community and residential care to hospital wards. In order to understand why addressing these issues is crucial to the provision of high quality and respectful care, it is helpful to consider the effects of shame, an emotion that although seldom acknowledged, is ubiquitous in human interaction.

Shame involves a negative evaluation of the self as bad or not good enough. It pulls us back from engagement with the things that interest and motivate us. It can lead to a loss of moral agency and professional integrity. In the grip of shame, we can lose interest in our work, and at times our values. We may feel powerless to change our situation or to challenge a situation that we know is wrong. Shame has a ripple effect outwards from the individual or organisation experiencing it, to those within their sphere of influence. We need to recognise that nursing/care staff who do not themselves feel respected and valued may find it difficult to respond respectfully and compassionately to the elderly people in their care (‘Delivering Dignity’ p.15).

The relevance of shame to the current state of elderly care in the UK lies (in part) in the lack of social capital associated both with unqualified nursing care – reflected in low pay and poor status, and with a branch of nursing that is not hi-tech and therefore lacks glamour. It is compounded by an under-resourced and inflexible provision that is desk-led and task/target orientated (this culture has given rise to the term ‘bed blockers’), that fails to trust the judgement of those in the front line and consequently does not allow nursing staff to adequately meet the needs of their patients. This is fundamentally shaming and demoralising to the majority of staff who would prefer to do their jobs well, and who struggle to manage the tension between responding gently, sensitively and patiently to older people, who may be struggling to communicate their needs, and the pressure to meet practical deadlines – often with limited staffing.

Like Peter Carter (Today Programme, BBC Radio 4, 29.2.12) I am reluctant to accept that neglect in elderly care is wilful. ‘Delivering Dignity’ recognises there is a lack of congruence between the varying and legitimate care needs older people and current provision. It also recognises that leadership, training and remuneration that demonstrate a genuine respect and value for nursing staff and for the individuals they care for, will foster pride and high self-esteem, providing a buffer to shame and allowing them to ‘do the right thing’ for patients (‘Delivering Dignity’ Key recommendations for hospitals: 3 & 4, p.5).

We are being presented with the opportunity to restore pride and social capital to elderly care. It is time for care providers across all settings to promote the vital importance of fundamental care tasks and to foster, through their mission statements, policies, recruitment, training, and budgets an authentic and above all empathic approach to caring for elderly and vulnerable human beings.

© Miryam Clough 2012

A shameful state of care?

The gravity of the Care Quality Commission’s finding that one in five NHS Hospitals are neglecting elderly patients to a criminal extent was compounded in November 2011 by the Equality and Human Rights Commission report, which reveals that thousands of elderly people in England receive care services at home that are so poor their human rights are being breached.

Denying that budget cuts have any bearing on these findings, Care Minister Paul Burstow side-stepped questions about care staff receiving the minimum wage and told the BBC that “this is what happens when you have people who feel they can switch off their basic humanity and compassion when they cross the threshold of someone’s home to provide what should be decent quality care…”[1].

Clearly we need to ask why, beyond an inevitable few bad apples (a recruitment issue), an alarming number of nursing and care staff fail to respond to patients and clients with empathy and diligence. Equally, we need to recognise that the practical shortcomings of poorly resourced, target driven care, which are very much in evidence in recent reports on care standards, may be having an insidious impact on staff motivation and professional integrity. A consideration of the effects of shame, an emotion that is ubiquitous in human interaction but rarely acknowledged, may help us understand current failings in provision, which the CQC attributes to ineffective leadership and poor staff attitude.

Those staff who feel that nursing the elderly is beneath them may be experiencing shame, exacerbated by a culture that places value on financial and time-driven targets at the expense of the physical and psychological wellbeing of patients and staff alike; that fails to trust staff to function competently, creatively and with initiative, and to reward them adequately.

Shame involves a negative evaluation of the self as bad or not good enough. It pulls us back from engagement with the things that interest and motivate us. It can lead to a loss of moral agency and professional integrity. In the grip of shame, we can lose interest in our work, and at times our values. We may feel powerless to change our situation or to challenge a situation that we know is wrong. This may in part explain why some care and nursing staff neglect to do their jobs well.

For instance, with budgets in some local authorities so restricted that carers are limited to 15 minute stints in an elderly person’s home, carers may be forced to meet externally determined deadlines at the expense of responding to the legitimate needs of clients. Laying the blame for neglect entirely on care staff fails to address the lack of congruence between the varying care needs of individuals and an under-resourced and inflexible provision. Such an approach is fundamentally shaming and demoralising to those staff who would prefer to do their jobs well.

In a society which expresses value through financial reward, paying care staff the minimum wage can only reinforce the lack of value placed on this work by government ministers and care providers. In part what it exposes is gender inequality, the legacy of a patriarchal culture in which caring for the elderly and vulnerable has traditionally been undertaken by women. There is no longer any excuse for this and we cannot afford to underestimate the correlation between low pay and poor self-esteem – a corollary of shame.

Additionally, shame leads to resentment and hostility. The less staff are valued and respected by their managers and community, the less they are likely to value and respect the vulnerable people in their care. Conversely, leadership, training and remuneration that demonstrate a genuine respect and value for staff and for the individuals they care for, will foster pride and high self-esteem, providing a buffer to shame.

It is too easy to lay the blame for neglect on carers rather than the budget and system inadequacies that make care work an occupation to feel ashamed of. Effective leadership is crucial to restore pride and social capital to care. Care providers need to promote the vital importance of fundamental care tasks and to foster, through their mission statements, policies, recruitment, training, and budgets an authentic and above all empathic approach to caring for elderly and vulnerable human beings.

© Miryam Clough 2012

 

 



[1] ‘Care minister Paul Burstow on Elderly care report’, BBC News 23.11.2011, http://www.bbc.co.uk/news/health-15854448, accessed 23.11.11