The long-awaited report on NHS Lanarkshire's review of homeopathy services has finally been published
The report recommends that:
NHS Lanarkshire should cease new referrals of Lanarkshire residents to the CIC as of 31 March 2015 on the basis of the lack of clinical effectiveness evidence for homoeopathy, and other health interventions noted in this paper, delivered by the CIC.
It is expected that the Board will accept its recommendations this afternoon at their extraordinary meeting.
[Updated at 14:55] NHS Lanarkshire have just announced their Board's decision to accept the report's recommendation to stop all referrals to the Glasgow Homeopathic Hospital after next March.
Their Director of Public Health and Health Policy, Dr Harpreet Kohli, and his team (which included the homeopath and Lead Clinician at the GHH, Dr Bob Leckridge) conducted a thorough review:
In reaching a consensus on recommendations for the future of the homoeopathy service, the Group considered all the evidence gathered during the course of the review and also took account of A Healthier Future and NHS Scotland’s Strategy Ambitions.
Following full consideration and deliberation, the Group concluded that, whilst the subjective evidence from patients expressing benefit from and support for the service was strong, there was clear and unambiguous evidence that homoeopathy and associated services were lacking in terms of therapeutic benefit. In addition there was a strength of clinical opinion across the UK that homeopathic treatments should not be provided by the NHS. On that basis, the Group’s view was not to recommend referral to the CIC, which offers homoeopathy and associated services.
They conducted a literature review for the treatments provided by the GHH, concluding:
The literature reviewed in relation to homoeopathic care for various conditions including fibromyalgia (coping with pain and depression), prevention and treatment of influenza and influenza-like illness, therapy for preventing or treating the adverse effects of cancer treatment, attention deficit/hyperactivity disorder (ADHD) and insomnia, found insufficient or no evidence to support homoeopathy.
Mindfulness-based cognitive therapy
Reviews of MBCT for the treatment of various conditions including fibromyalgia, chronic diseases, stress reduction for breast cancer, chronic fatigue syndrome and anxiety and depression concluded that there is some evidence that MBCT improves psychological health in breast cancer patients and improves mental health and symptom management in patients with chronic disease.
No systematic reviews or meta-analyses were identified for HeartMath.
Mistletoe for cancer symptoms
Reviews of mistletoe extracts for cancer patients had differing results – a Cochrane Review concluded that there was insufficient evidence while two other studies concluded that mistletoe extract may be associated with better survival and that there was some evidence to support the effects on quality of life. Limitations of the studies were highlighted however and a caveat added to treat the findings with caution.
Music and movement therapy
Some reviews of music and movement therapy, while concluding that listening to music may help to reduce anxiety, reduce pain and respiratory rate and have a beneficial effect on the quality of life for people in end-of-life care, did not have strong evidence. The therapy appeared to have benefit for patients with Parkinson’s disease but concluded that future studies should include greater numbers of patients.
For homeopathy, their Homeopathy Review Group built on the work carried out by the House of Commons Science and Technology Select Committee in their Evidence Check on homeopathy, looking at appropriate evidence published since then, up to October 2014. They found that the report's conclusions were unaffected by any new evidence.
As well as surveying existing patients and GPs, and visiting the GHH and its outreach clinics in Coatbridge and Carluke, a public consultation was also carried out by NHS Lanarkshire — the results of that have also just been published. Nearly 6,000 responses were received with the majority in favour of continuing to refer to the GHH. Our response to the consultation can be read here.
However, the report notes that there had been a concerted campaign to 'Save the Glasgow Homeopathic Hospital', including an online petition, instigated by homeopath Louise Mclean of the Homeopathy Heals website. It also noted that an analysis showed most signers were from outwith Lanarkshire. We have been made aware that Mclean has called for supporters intending to demonstrate outside the building where this afternoon's meeting is being held and to write to MSPs and the Scottish Health Minister to complain.
Of the responses expressing support, the main themes were:
- Patient choice
- No side effects of remedies
- Not needing to go to hospital
- Homoeopathy works
- Cost effective
Of the responses expressing no support, the main themes were:
- No basis in science
- Waste of time and money
- Homoeopathy has never been proven to work
- Homoeopathy is useless
Despite the praise for the services (mostly from those not actually using them), we commend NHS Lanarkshire for going with the best evidence rather than popularity in deciding what treatments to provide.
Patients will not be left high and dry by this decision. New referrals will cease on 30 March 2015, but those currently attending the GHH or the two outreach clinics will continue to receive the treatments.
New patients from April will be able to receive a wide range of conventional, evidence-based, treatments such as those provided by psychosocial services, the addictions service and a number of condition-specific services already provided by NHS Lanarkshire.
Overall, this is a damning indictment of the services provided by the GHH. It can only be an embarrassment to NHS Greater Glasgow and Clyde to have a 'hospital' that is providing treatments for which their Lanarkshire colleagues have concluded there is no good evidence.
After the closure of its pharmacy in 2011, the withdrawal of referrals from NHS Highland in 2010 and from NHS Lothian in 2013 and the decline in outpatient attendances over the last ten years, this must surely be the final nail in the coffin of the Glasgow Homeopathic Hospital.
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