The parliamentary Science and Technology Committee completed its report into homeopathy in February 2010, concluding that it should not be provided on the NHS.
This was on the basis that there was no evidence that homeopathic treatments have any benefit beyond the placebo effect, and policies were not based on sound evidence.
Among the experts called to give evidence was NHS West Kent, which had conducted a review of commissioning homeopathic treatments in 2007-9 and concluded that these treatments did not represent a priority for NHS funding.
The committee’s report said of NHS West Kent’s review: “We were impressed with NHS West Kent’s review of the commissioning of homeopathy and consider that it provides a good model for other commissioning organisations, particularly those that fund homeopathic hospitals. We recommend that the Department of Health circulate NHS West Kent’s review of the commissioning of homeopathy to those PCTs with homeopathic hospitals within their areas. It should recommend that they also conduct reviews as a matter of urgency, to determine whether spending money on homeopathy is cost effective in the context of competing priorities.”
NHS West Kent’s decision created a great deal of controversy, not least because the decision to decommission homeopathy effectively led to the closure of the Tunbridge Wells Homeopathic Hospital. The decision was challenged through judicial review, and a local campaign was supported by the local MP.
The committee’s findings have been accepted by NHS West Kent not just as vindication of its decision, but as confirmation that that PCTs across the UK can and should learn from its experience to allow better use of limited NHS resources.
NHS West Kent looked at commissioning data and the evidence base for homeopathy. The PCT’s professional executive committee commissioned an independent review of studies into homeopathy that met the criteria for evidence-based medicine. The review found no clear evidence to support commissioning homeopathy.
Meanwhile, a review of commissioning data revealed that while a high number of GP practices had referred patients for homeopathic treatment, these patients represented less than 1 per cent of the population covered by those surgeries. In addition, it appeared that most of these patients had asked to be referred. All GPs were audited about their experience of referral to homeopathic services.
There was no available data that allowed the PCT to quantify the benefit to patients for every pound spent on homeopathy. Nor was it possible to conclude that those patients could not have experienced greater health gains through other treatments. However, Tunbridge Wells Homeopathic Hospital’s own audit, combined with personal anecdotes, suggested that homeopathy may have helped individuals in circumstances where conventional medicine was perceived to have failed or created unacceptable side effects. Worryingly, the high number of follow-up visits seemed to suggest that there was a degree of dependency in some patients to these services.
To inform the PCT’s decision, a public consultation was held between April and July 2007. To ensure full engagement from all relevant parties, an advisory group was set up to oversee the consultation process. This consisted of representatives of the local NHS, the homeopathic hospital and patient representative groups.
The consultation paper was available to anyone who requested it, and was sent to 1,000 randomly selected members of the public. Public meetings were held. The strength of feeling around this subject led to a judicial review, but this established that the consultation was sound. However, the PCT withdrew the decision to decommission until it had completed an equality impact assessment on the decision, which took place between December and June 2008.
The full assessment found that while homeopathy has no proven clinical effectiveness there may be an impact on a small cohort of patients with complex long-term conditions and/or life-limiting illness who no longer find relief in conventional medicines and who perceive benefit from their experience of homeopathy.
The PCT therefore put in place measures to deal with the small numbers of patients who find no relief in conventional medicines and perceive strong benefits from homeopathy. These were:
- introducing an individual case review system for those patients
- agreeing exceptional criteria for use by the individual funding request panel when deciding on requests for homeopathy treatment
- conducting a review of services available for people with complex multiple long-term conditions where conventional medicines are no longer effective, including self-care support.
When giving evidence to the Science and Technology Committee, NHS West Kent’s medical director Dr James Thallon summed up the arguments by saying: “Clearly if the business of PCTs is about prioritisation, then the treatment which scientific opinion says is of virtually no effectiveness we would prioritise at a far lower level than other treatments we wish to commission.”