In November 2015 we carried out a formal consultation which led to our decision to decommission homeopathy services in Liverpool.
What's Homeopathy and who uses the service?
Homeopathy is “the system of medicine which is based on the principle that you can treat ‘like with like’, that is, a substance which causes symptoms when taken in large doses, can be used in small amounts to treat similar symptoms” (The Society of Homeopaths, 2015). Creating homeopathic medicines usually involves treating a person with highly diluted substances, given mainly in tablet form, with the aim of triggering the body’s natural system of healing.
At present NHS Liverpool Clinical Commissioning Group commissions homeopathy services up to the value of £30,000 a year. A small number of patients in the city choose to use this service. Patients are referred into the service directly by their GP and are offered an initial assessment with a homeopath for the referred condition(s) and the opportunity to have up to four further follow up appointments.
Between April 2014 and April 2015, the homeopathy service saw 121 new patients and held 447 follow up appointments with existing patients.
Patient surveys and MYMOPs scores (Measure Yourself Medical Outcome Profile) submitted by the Liverpool Homeopathic Service in 2013/14 showed positive responses, many patients referring to the advice they were given in the consultation resulting in lifestyle benefits including improved diet, increased exercise and improvement in mood.
Who provides the service and what does it do?
Liverpool homeopathy service is provided via a contract with The Liverpool Medical Homeopathy Service CIC, hosted at Old Swan Health Centre. The service treats the following conditions:-
The main reasons people sought treatment from the homeopathy service from December 2013 - August 2015 were pain, anxiety and depression, bowel complaints, skin diseases; and gynaecological problems.
Why is a change to the service being considered?
To improve health in Liverpool, we continuously review the services we commission in order to create a health care system that is person-centred, supports people to stay well and provides the very best in care as well as value.
National guidance by the National Institute for Health and Care Excellence (NICE) does not recommend the use of homeopathy in its guidance on complementary and alternative treatments.
In 2014 a policy review and public consultation were carried out for Merseyside CCGs regarding a range of treatments considered to be of low clinical priority, including homeopathy. There were a handful of comments regarding complementary therapies, nothing specifically regarding homeopathy from members of the public. There was one GP comment and they stated a preference for funding to be stopped.
The revised Policy recommended that complementary therapies should not be routinely commissioned unless recommended by NICE guidance. At the time NHS Liverpool CCG decided to continue with the funding and revisit the issue at a later date. NHS Liverpool CCG is now reviewing the service and to seek patient and public opinion as to whether the service should continue to be commissioned.
NHS Liverpool CCG has also received a challenge to its decision to continue to fund the service.
What evidence is there about homeopathy as a treatment?
“A 2010 House of Commons Science and Technology Committee report on homeopathy said that homeopathic remedies perform no better than placebos, and that the principles on which homeopathy is based are "scientifically implausible". This is also the view of the Chief Medical Officer, Professor Dame Sally Davies.”
The report by the Government Science and Technology Committee reviewed evidence for and against homoeopathy and concluded that the NHS should cease funding homeopathy. It also concluded that the Medicines and Healthcare Products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. As they are not medicines, homeopathic products should no longer be licensed by the MHRA. The indications being that any beneficial outcomes of homoeopathy treatment are due to a placebo effect. The full report can be found at:
The Government responded as follows:
“We agree with many of the Committee’s conclusions and recommendations. However, our continued position on the use of homeopathy within the NHS is that the local NHS and clinicians, rather than Whitehall, are best placed to make decisions on what treatment is appropriate for their patients - including complementary or alternative treatments such as homeopathy - and provide accordingly for those treatments.
“There naturally will be an assumption that if the NHS is offering homeopathic treatments then they will be efficacious, whereas the overriding reason for NHS provision is that homeopathy is available to provide patient choice. The Government Chief Scientific Advisor’s position remains that the evidence of efficacy and the scientific basis of homeopathy is highly questionable.”
The full Government response to the paper can be found at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216053/dh_117811.pdf
NHS Choices Website further comments on several individual pages that homeopathy is not recommended. Further evidence is available in the document downloads on this page.
NICE Guidance does not state anywhere that homeopathy is a recommended treatment. There is little reference to homeopathy in NICE Guidance other than:
What options have been considered?
NHS Liverpool CCG has considered 5 options relating to the future of NHS Liverpool homeopathy services. The options considered are described below.
There is a lack of evidence about the patient benefits of homeopathy and we are committed to achieving the best health gain from the money we spend on services. NHS Liverpool CCG’s governing body has stated a preference for Option 5, to stop funding the service.
We would like to know which of these options you think is best.
The CCG continues to fund homeopathy services at the current level which is 100 first appointments, 400 follow ups (£29,000 per year).
The CCG funds homeopathy services with no maximum spending limit. This option could increase spending on this service. Agreement would need to be reached with the current provider of the service as to whether this was feasible or if additional providers would need to be sought.
The CCG continues to fund homeopathy services but reduces the maximum spending limit. This option could result in some patients not being seen as there would be insufficient funds available.
The CCG continues to fund the service only on an exceptional basis i.e. via Individual Funding Requests. This means the GP referring a patient would have to prove exceptional circumstances, meaning
“The patient has a clinical picture that is significantly different to the general population of patients with that condition and as a result of that difference; the patient is likely to derive greater benefit from the intervention than might normally be expected for patients with that condition.”
This option could result in an additional financial burden on the CCG which funds these cases.
The CCG stops funding the homeopathy service. The current contract to provide the service requires 1 month notice of termination.
The Governing Body meeting in November decided Option 5, to end the contract was the CCG's preferred option and that a public consultation would be carried out about this. This forms that consultation exercise.
What are the aims of this consultation?
The aim is to:-
a) understand people’s views regarding the commissioning of homeopathy services
The objectives are as follows:-
a) Understand Liverpool people’s attitudes to homeopathy as an NHS service
b) Seek views regarding the demand for homeopathy services among the Liverpool population
c) Seek views regarding the benefits / value perceived from homeopathy services in the Liverpool population
d) Seek views regarding the costs of providing a homeopathy service in the Liverpool population
e) Produce an engagement report to inform future decision making relating to commissioning homeopathy services
Who can contribute to this discussion?
During this consultation we would like to hear from :-
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