Prince Charles, now apparently in tune with the zeitgeist, has been back to the BMA promoting integrated medicine.The NHS is catching up fast, reports Alison Moore

When Prince Charles argued the case for complementary and alternative medicine in front of the British Medical Association 18 long years ago his speech was seen by some as further proof of his eccentricity.

Orthodox medicine was in the ascendancy, doctors were assured of their position in society and patients were, on the whole, the grateful recipients of treatment.

Complementary medicine was very much on the fringe, ignored by the vast majority of medical doctors and seen as the province of sandal-wearing cranks.

Last week the prince repeated his call for more integrated medicine and the rediscovery of the 'healing relationship' between health professionals and patients.

But he was speaking in a very different world, in which many doctors still appear chastened and shocked by the seismic shifts of the last decade.

Although the Millennium Festival of Medicine conference - organised by the BMA - took as its theme celebrating the past and shaping the future, the emphasis of many speakers was very much the future and its uncertainty.

The prince paid tribute to doctors and other health professionals, acknowledging the pressures of rising expectations, demand and technological change. But his focus was on the human side of medicine: 'As important as these extraordinary scientific and technological advances, I believe, will be the rediscovery of the healing relationships with the deeply felt need for better support systems to enable healthcare professionals to maintain and nurture their capacity to communicate and care, ' he said.

'I fervently hope that the human skills and intuitive abilities that are possessed by new medical students will be valued and nurtured by the latest training programmes.'

He also repeated his call for 'the potentially powerful role of complementary therapies' to be increasingly recognised and included into individuals' healthcare.

But the issues he identified around this were very different from those of 18 years ago.

Research into efficacy, regulation and educating doctors to respond to the increased demand for therapies almost presuppose a general acceptance that complementary medicines have a part to play.

The changing face of medicine continued to be the theme of the first day of the week-long conference, with sessions looking at the development of medical education and practice, and the growing role of primary care.

But changing practices can be a challenge. Nigel Offen, a former trust chief executive and now head of clinical quality at Eastern region, outlined a joint-working scheme he had pioneered in 1996-97 aimed at reducing bedblocking.

This had delivered significant savings for both hospital and social services involved - and had then been widely publicised. But few other trusts had taken up the scheme, despite the obvious benefits it offered. One example of successful change is at South Tees Acute Hospitals trust where senior doctors have been involved in ground-breaking work looking at their skills and what will be needed in the future.

'There is a great deal of mythology around the Neanderthal nature of the doctor, ' said medical director Professor Ian Haslock. 'Consultant medical staff do want management development.

'They do participate enthusiastically. They do embrace new methods - and they do put their development into practice.'

But the mood of the conference was caught by Dr Alastair Scotland, director of medical education and research at the Chelsea and Westminster Healthcare trust, who spoke of the need to demonstrate that doctors are listening to what the public wants of them: 'I think some of the discomfort we are feeling is that maybe we have lost the ability to listen to the general public, to society.

'At the start of a new century we need to negotiate a new agreement with society.'