§ 2.30 p.m.
§ Mr. Tom Ellis (Wrexham)
I am grateful for the opportunity to raise the subject of homoeopathic medicine in the North-West and North Wales. I intend to deal specifically with matters that come under the control of the Liverpool Area Health Authority. Before doing that, it might be sensible for me to speak of homoeopathic medicine and how it fits into the general picture of medicine. By that means we shall be able to understand the problems and the attitudes of the various protagonists in Liverpool.
Homoeopathic medicine is an established branch of medicine, practised for over a century, particularly on the Continent, and by a minority of doctors in this country. It enjoys royal patronage here. The doctors who practise homoeopathic medicine are properly qualified medical practitioners who have received medical education and training supplemented by special training in homoeopathic medicine. There is no element of quackery about it although some members of the medical profession are prejudiced against it. I shall give examples of that prejudice and antipathy and I shall try to explain how it has arisen. I stress the word prejudice because attitudes are often based on blind prejudice, partly as a result of ignorance and partly because of professional jealousy.
The essential difference between homoeopathic medicine and the conventional medicine of the post-war years is that of philosophy. Homoeopathy is unashamedly a therapy, a treatment of the whole patient in physical and human 1457 terms as an organic entity. For that reason it demands for success more of the doctor in medical skills and human understanding than conventional medicine. The wisdom of conventional medicine regards the patient mechanistically, as a compendium of separate parts and separate bits of machinery, each part to be dealt with separately as the need arises by the specialist appropriate to that art.
Conventional practice, as seen today in our largest hospitals, has reached in a medical sense its clinical apogee through adopting the attitudes of mind of logical positivism. In that it has much in common with many other developments in our society during the past 100 years. The approach is mechanistic, dispassionately scientific—in the shalow sense of that term—coldly clinical and narrowly specialised and it is one that even a mildly sceptical man would immediately question as being supremely the ideal, let alone the sole approach, in so subjective and intensely personal a study as the ailments of mankind.
Many consequences of that attitude have become apparent in our Health Service. For example, the enormous size of some of our hospitals can be traced directly to it. If a consultant is appointed in a narrow speciality, the catchment area to provide him with an adequate work load has to be correspondingly large. Thus was sounded the death knell of the cottage hospital and the relegation of the work of the general practitioner to the work of rudimentary diagnosis accompanied by a great deal of medical hack work. It is with satisfaction that I see public disquiet with that development beginning to assert itself Proposals for new cotttage hospitals are now being put forward by the more far-seeing health authorities.
Another interesting consequence of the trend is that the consultant physician—the doctor accomplished in general medicine—has now become an almost extinct species in our hospitals, despite their size. We have consultant dermatologists or consultant specialists in pulmonary diseases and so on. There are few consultant physicians left.
I give another exmaple of the consequences of this mechanistic and logical positivism style of approach. It is one of which I have painful memories. I under- 1458 stand that the figure of 10 per cent. is generally accepted in the medical profession as representing the proportion of patients in hospital suffering not from their original compaint but from the deleterious side effects of drugs and their massive use, which is a feature of the scientific methodology. Some doctors put that figure higher.
It is not for me to argue from a purely medical point of view—taking the term "medical" in its broader sense—the merits of these two approaches to medicine. However, as an intelligent layman who has taken more than a passing interest in medical politics, where the term clinical freedom is so frequently abused, I can claim my legitimate right to insist that the two approaches should be complementary. Neither approach should be abandoned in the National Health Service because of the actions of some members of the medical profession when there are authoritative medical opinions supporting each approach and a public demand that justifies both.
I shall speak later about the rôle of the DHSS in retaining both forms of medicine and about some recent developments in Liverpool and elsewhere. But, first, to emphasise my legitimate right, I shall explain the demand for homoeopathic medicine. I need have no fear at present of an abandonment of conventional medical practice. I find it surprising that the Department of Health tells us on the one hand that there is little demand for homoeopathic medicine and on the other confesses that it has no evidence, statistical or otherwise, from which it can make a judgment.
On 9th December 1975 I asked a number of Questions of the Minister of State about homoeopathic medicine. I asked in particular about the numbers of patients treated and about the numbers who had asked for homoeopathic treatment and failed to receive it. The broad reply to all my questions was that the information was not available. Yet, only a month later, when writing to an hon. Member who had complained about the lack of provision of homoeopathic treatment, the same Minister said,Clearly, in view of the small minority of patients interested in this form of treatment facilities are inevitably limited and tend to be concentrated at certain sites.I warn the Department that there is considerable evidence of a substantial 1459 demand that is usually unmet. The Minister must not stand on the sidelines, sheltering behind the medical profession's claim to clinical freedom to determine what should and what should not form the medical provision available through the National Health Service. That is especially important when the provision so determined would cast the service irrevocably into one particular mould, thereby jeopardising another legitimate, clinically well-established form of medical provision.
Another example of the increasing demand is the rapidly increasing numbers of newly qualified doctors attending courses in homoeopathic medicine. That is despite the fact that the Department does not go out of its way to help. For example, grants are not made available for that type of training.
The Minister could not stand on the sidelines on the grounds of clinical freedom if, for example, so tangible a form of treatment as orthopaedic surgery was threatened. The Minister should take the same attitude towards homoeopathic medicine. The principle of clinical freedom applies on both sides of the argument. The minority, the qualified and legitimate minority, is as entitled to its judgment as the majority is to its judgment.
It so happens, and here I come to the situation in Liverpool, that there have been persistent attempts over the years by some of the majority—eminent, well-established practitioners, for the most part, who dislike the philosophy of the minority, with its therapeutic approach to the whole patient as a human being—to whittle away at the provision of homoeopathic medicine in the Health Service.
Perhaps I may make a Socialist point in passing, which may appeal to my hon. Friend the Minister. It will be a sorry day of Aneurin Bevan's vision of a comprehensive National Health Service if homoeopathic treatment becomes available only privately.
Developments in Liverpool over recent years, now coming to a head, illustrate the issue well. I suspect that this applies to many other places as well, and in particular to London. There were six homoeopathic hospitals in Britain a few 1460 years ago, one of which was the Hahnemann Hospital in the centre of Liverpool. Some time ago, as part of a scheme of rationalising hospital resources, a proposal was made by the Liverpool Area Health Authority to close the hospital. The Faculty of Homoeopathy, based at the Royal London Homoeopathic Hospital, was consulted. I wish to quote from a letter sent by the Secretary of the Faculty to the Regional Administrator of the Mersey Regional Health Authority a few weeks ago. He said:At the time the Faculty was able to negotiate, not without problems, the setting up of a Department of Homoeopathic Medicine at the Liverpool Clinic as a replacement for the Hahnemann Hospital and the Department now occupies the top floor of the clinic. The Department is still centrally located and outpatients are seen there while in-patients have a ward at the Mossley Hill Hospital (which is well outside the centre of Liverpool).However, the Liverpool Clinic is itself due to be closed when the new Royal Liverpool Hospital is opened and the Area Health Authority gave an undertaking that the Department of Homoeopathic Medicine would move into this new hospital.This undertaking was given wide publicity in the local Press following the official opening of the Department on 1st July last year by the President of the Homoeopathic Trust for Research and Education.Since that time, however, it has slowly become evident that the original undertaking is not going to be kept. The Faculty of Homoeopathy has repeatedly asked for representation on the Commissioning Team planning the accommodation in the new Royal Liverpool Hospital but has always received evasive and non-committal replies.Now the Division of Medicine of the Health Authority has put out plans for accommodation and consulting rooms in the new Out-patients department and no space has been allocated for the Consultant Physician and Director of the Department of Homoeopathic medicine.If the Liverpool Clinic is closed, alternative facilities equal to those already enjoyed by the Department of Homoeopathy must be provided elsewhere. The loss of a hospital is serious enough but the provision of a Department of Medicine in its place went some way to meet this loss and its continuation is vital if Homoeopathic medicine is to survive in the North-West.It is not simply the North-West of England that is involved, but North Wales, which includes my constituency. For that reason, I am representing the interests of some of my constituents who are obliged to travel to Liverpool for homoeopathic treatment.
1461 The Secretary of the Faculty also said:The Faculty of Homoeopathy is under an obligation by Act of Parliament to do everything in its power to advance the principles and extend the practice of homoeopathy and the Minister of Health has given assurances that under the National Health Service Act homoeopathic institutions will be enabled to provide their own form of treatment and that the continuity of the characteristics of those institutions will be maintained.For the sake of brevity, I shall not quote a great deal of what Aneurin Bevan said in 1946, when he was engaged on establishing the National Health Service, but he gave various categorical assurances. On 23rd November 1946 he said:If they"—homoeopathic hospitals—are to be brought in it must be the obligation of the Regional Boards in establishing their Management Committee to see that these Management Committees are of a character which maintains the continuity of the characteristics of those institutions. I think that I can give that absolute guarantee, because otherwise it would be an emotional mutilation which nobody could possibly defend.I am afraid that that guarantee has become less than absolute over the years, and I indict the Department of Health and Social Security for that.
Why do we have the crisis in Liverpool? Why is the health authority now seemingly intent on reneging on its pledges? I have here a copy of the minutes of a meeting of the Medicine Division of the Liverpool Area Health Authority, Central/Southern District, held a few weeks ago. Minute No. 236 is a remarkable piece of work. It is to do with the allocation of rooms, consulting suites and so on, in the new hospital. When it reaches the matter of homoeopathic medicine, it says that the Consultant Physician and Director of the Department of Homoeopathy was asked to withdraw from the meeting. The minute goes on:There then followed a discussion about possible accommodation for homoeopathy in the Royal Liverpool Hospital. The following minute was unanimously passed by the Division:'The Division was horrified to learn that a Homoeopathy Clinic was suggested for the Royal Liverpool Hospital. They understand that this arose because of the takeover of the Hahnemann Hospital. However, since beds for homoeopathy were provided at Mossley Hill Hospital, Out-patient accommodation (including the necessary Pharmacy) should be provided there.1462They insisted unanimously that undergraduates should not be exposed to any unorthodox medicine before qualification, that the very existence of such a clinic in the hospital's prospectus would cause alarm to many doctors and patients, and that the Pharmacy should not be asked to attempt to supply expensive and unusual remedies.Finally, they knew that under no circumstances would the Departments of Medicine or Clinical Pharmacology allow any undergraduates to attend any such clinics and would not accept a Homoeopathist as a teaching hospital professional colleague'.For sheer blind prejudice and bigotry, crass ignorance and highly questionable ethical behaviour, it would be hard to find a better example, even from the minutes of the Wapping Bargees Mutual Benefit Society, let alone a body of professional men.
I could answer each of the criticisms made by the doctors. I do not think that patients would be alarmed. I do not know what happens to the patients at Mossley Hill. They must be more robust. Many people in my constituency are alarmed at the failure to make provision rather than about its being made. There are no unusual and expensive remedies provided by pharmacists for homoeopathy. It uses less expensive and incomparably less massive dosages of drugs than does conventional medicine, with its indiscriminate poisoning of many patients. I want to give my hon. Friend time to reply, so I shall not deal now with the other criticisms.
I wish to finish by quoting from a speech I made in 1971. It is rather pleasant to quote my own speeches, which are often far-sighted and wise. When we were debating the reorganisation of the National Health Service in Wales I said—and I beg my hon. Friend to ponder on this:There has been no opportunity to pare away to the core of the problem. I have in mind the supreme need to restore to the patient a measure of that dignity and importance, as an individual, which he now clearly lacks …I suspect that the general reaction of most ordinary people who are sufficiently fortunate to have only occasional contacts with the hospital service, and to a lesser extent with the general practitioner service, is one of resentful frustration, despite the often extremely high quality of medical treatment. This is frustration at what might be called the veterinary approach—the undoubted insensitivity to the needs of individuals as individuals—which has manifested itself so often in the Service and which has evoked the most persistent and 1463 continuous inception criticism of the N.H.S. since its inception.That sort of insensitivity is typically characteristic of agencies in which the dominant managerial voice is that of men skilled in expertise for which the organisational framework acts as a support, and who gradually manipulate the structure of the organisation to the service of the expertise as an end in itself. I suspect that the N.H.S. has fallen into this error in respect of the expertise of the medical profession."—[Official Report, Welsh Grand Committee, 28th July 1971; c. 36]The Minister has a glorious opportunity to begin correcting these fundamental failing of the Health Service. I beg him to intervene in Liverpool, to see what is happening there, and to ensure that the practice of homoeopathy continues for many years to come.
§ 2.50 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)
I am grateful to my hon. Friend for raising the subject of homoeopathic medicine in the North-West and Wales in today's debate. I know that he has for a long time been concerned about the future of homoeopathic medicine in general, and in particular about its provision in Liverpool. I hope that he will find at least a measure of reassurance in my reply to this debate today, assuming that I can fit it into the 10 minutes that I have.
My hon. Friend has frequently sought confirmation, as he has today, that the provision of homoeopathic treatment under the National Health Service would be guaranteed. He has referred to the undertaking given by Aneurin Bevan when the National Health Service was started—and we have ourselves always adhered to that guarantee. I shall speak later of the responsibility for providing facilities for homoeopathic treatment and the issues of clinical freedom that are raised, but we have consistently held that homoeopathic treatment should be available under the National Health Service as long as there are practitioners who are willing to provide it and patients who wish to receive it.
My hon. Friend has often stated, in his campaign for homoeopathic treatment to be more generally available, that homoeopathy is a legitimate form of medical practice. Of course it is—otherwise it would not be justifiable to allow its provision under the National Health Service 1464 in the way that I have described. One must for this reason, if for no other, draw a contrast here between homoeopathic treatment and the various branches of so-called "fringe medicine" to which it is often compared but which are not available under the National Health Service. I readily acknowledge that the principles that underline homoeopathy have a long and honourable tradition, going far further back in the history of thought than Samuel Hahnemann, who developed the system of homoeopathy as it is known today.
But the fact that homoeopathy is a respectable form of medicine does not in itself mean that it commands universal acceptance. Indeed, it is inevitable that the majority of doctors, who practice conventional or "orthodox" medicine, will generally prefer the correspondingly conventional remedies to the homoeopathic treatments; these latter tend to use small quantities of substances that accentuate the symptoms of the ailment for which they are prescribed, so hoping to stimulate the body's own defence mechanisms to fight the illness. And it is of course for individual doctors to decide what action to take, including prescribing, in treating any patient. This is the very essence of clinical freedom.
It is for this reason that, while any doctor is free to prescribe homoeopathic treatment under the National Health Service, very few in fact choose to do so. And for the reasons that I have just mentioned it would be wholly wrong to seek to influence doctors in any way where their clinical judgment is concerned. I cannot, therefore, hold out any hope to my hon. Friend of homoeopathic treatment from doctors becoming more widely available, and he must acknowledge that, even if, as he suggests, more people are turning to homoeopathy—and he talked of a substantial demand—the number of patients seeking homoeopathic treatment can only be a very small fraction of the total who go to their doctors for treatment.
This means that the provision of homoeopathic medicine under the National Health Service is necessarily patchy, depending on where particular doctors with an interest in homoeopathy happen to practise. My hon. Friend was critical of the Department's attitude. We 1465 acknowledge that homoeopathy is respectable, but it is also, in the quite literal sense, "alternative medicine", and as such it cannot have the same claim for universal accessibility as, say, one of the obviously necessary acute specialties in medicine. Essentially, then, it is for the individual clinician, and not for my Department, to determine whether or not he wishes to treat his patients homoeopathically.
A similar argument applies to the provision of hospital facilities for homoeopathic treatment. It is open to consultants, as to other doctors, to provide such treatment, but the availability of hospital facilities is, and must remain, a matter for the responsible area health authority to determine, just as it must decide on hospital provision in general to meet local needs and priorities. Again, I admit that this has resulted in a distinctly patchy pattern of provision—hospital facilities for homoeopathy are provided in England, in London, Bristol and Tunbridge Wells—and, of course, in Liverpool. I also admit that this may result in long journeys for some patients who wish to receive homoeopathic treatment in hospital, but my hon. Friend will gather from what I have said that I regard the claims of homoeopathy as rather different from those of other branches of medicine, quite apart from the fact that it is not for my Department to intervene in health authorities' arrangements for hospital provision.
My hon. Friend has expressed his particular concern this afternoon about the provision of homoeopathic facilities in Liverpool. I know of the long-standing interest that he has taken in the Hahnemann Hospital, and I pay tribute to his concern to see that his constituents and their neighbours who wished for homoeopathic treatment should still be able to receive it. But the history of the closure of the Hahnemann Hospital and the continuation of its work is long and complex, and it would be wrong to consider it in isolation from the wider question of hospital services in South and Central Liverpool, of which it was a part.
My hon. Friend will know that the hospital services in these parts of Liverpool had more hospital beds than any area outside London, and that the need to rationalise provision has long been recognised. This was why as long ago 1466 as 1972 detailed plans were submitted to the then Secretary of State jointly by the Liverpool Regional Hospital Board and the United Liverpool Hospitals to provide balanced, comprehensive and modern facilities for the city of Liverpool over a period of 15 years. These plans included the closure of a number of older and under-used hospitals to coincide with the opening of new ones, including Fazakerly and the new Liverpool Teaching Hospital, and improvements at others. The Hahnemann Hospital, where 27 out of 50 beds were used for homoeopathy, was among those approved for closure—and I should stress that its average occupancy over the years 1972–74 was around 50 per cent.—surely a vindication of the joint plan. I must also emphasise that approval of the plan was given only after extensive consultation with local bodies.
The concern that homoeopathic facilities should not be lost when the Hahnemann closed was understandable, and indeed was taken fully into account by those responsible for the plans and their implementation. Indeed, the Faculty of Homoeopathy was involved in frequent discussions and consultations by the responsible health authorities and their successor authority—to such an extent, in fact, that the planned closure of the Hahnemann did not take place until 31st May last year—long after the original date was envisaged.
Approval of the closure was given only on the understanding that homoeopathic in-and out-patient facilities would continue to be available. My hon. Friend will no doubt know of the difficulty which the Liverpool Area Health Authority (Teaching) and the Faculty of Homoeopathy had in their discussions in deciding the best place for relocation—possible travelling difficulties and other factors all had to be taken into account. In the event, it has been agreed that out-patient facilities for homoeopathy will be provided at the Liverpool Clinic with inpatient facilities at Mossley Hill Hospital. Pharmaceutical facilities are to be available at the Ear, Nose and Throat Infirmary, next door to the Liverpool Clinic and arrangements have been made to ensure that nursing and radiological services will fit in with homoeopathic requirements.
My hon. Friend may contend that splitting facilities in this way is less than 1467 ideal. I would reply that, given local difficulties in relocation, a compromise was perhaps to be expected and that this—which has been accepted by the Faculty of Homoeopathy and the consultant physician in homoeopathy—will ensure the continued availability of hospital facilities for homoeopathic treatment in Liverpool. Nevertheless, the offer of accommodation for all homoeopathic facilities at Mossley Hill, which is still open to the Faculty of Homoeopathy, would have the advantage of concentrating all services on one site, and I hope that the Faculty will give it further serious consideration.
Neither the Liverpool AHA(T) nor my Department is aware of the Faculty ever being promised a department of Homoeopathy in the new Liverpool Teaching Hospital; the number of clinical sessions would certainly not justify this, and no such department was ever planned. I understand, however, that if facilities are to be split, the AHA(T) has indicated that it will provide out-patient facilities appropriate to the number of homoeopathic patients at the teaching hospital when the Liverpool Clinic closes.
As for the provision of homoeopathic treatment in North Wales, the prescribing of treatment given to an individual patient is, as I have said, a matter for the individual doctor, but so far as I am aware there is no pressing demand for this type of treatment from any considerable number of patients and it is not provided in the hospital service in North Wales. Nor am I aware of any family doctor there providing this form of treatment to any appreciable extent, although I understand that an occasional prescription for a homoeopathic remedy is dispensed.
I am afraid it seems unlikely that the Clwyd AHA will feel able in the foreseeable future to earmark resources for the provision of homoeopathic facilities.
The independence of clinical judgment must mean that doctors are free to practice homoeopathic medicine or not, as they wish. Similarly, the right and duty of health authorities to plan hospital provision in accordance with the perceived needs and priorities of their areas must leave them free to decide whether or not to provide hospital facilities for homoeopathic medicine. If my hon. Friend is disheartened by the unevenness of homoeopathic facilities, I hope that at least he has drawn some encouragement 1468 from my reiteration of Aneurin Bevan's undertaking and from his knowledge that the continuation of both out-patient and in-patient facilities in Liverpool from the Hahnemann Hospital has been assured.