History of Regulation
History of the Regulation of
Complementary and Alternative Medicine in the United Kingdom
The Pyramid Structure
The first steps on the road to a robust regulatory process for complementary medicine were taken in 1987 with the formation of the British Complementary Medicine Association. This new association recognised the necessity for a ‘Therapy Council’ to act as a centralised knowledge base for each therapy with an overarching administrative process performing the regulatory role. This ground-breaking regulatory structure developed by Barry Tanner and Sir John Hopson was called the ‘Pyramid Structure’.
The Lannoye Report
In 1996 Paul Lannoye, a member of the European Parliament, presented a report on the status of non-conventional medicine to the European Parliament which recommended that complementary practitioners should be required to hold degree level qualification in Anatomy and that all ‘preparations’ used in non-conventional medicine should be subject to the same controls and test procedures used by conventional medicine. This would have resulted in their inclusion under the Medicines Act.
The Lannoye Report, or rather the vocal objection to the report content by some 40,000 practitioners served as a catalyst to reawaken government interest in the regulation of Complementary and Alternative Medicine.
Professional Organisation of Complementary and Alternative Medicine in the UK
In 1997 the Department of Health commissioned the Centre for Complementary Health Studies at Exeter University to conduct a study of the professional organisations representing Complementary and Alternative Medicine in the UK. The report stated that from the limited data available, the use of CAM was on the increase, a view supported by anecdotal evidence from the the NHS Alliance and the Department of Health. A further report was commissioned to establish the status of UK professional associations in the CAM field.
Integrated Healthcare, a Way Forward for the Next Five Years? A Discussion Document’ published in October 1997 by the Foundation for Integrated Medicine
In 1994 a group was set up at the suggestion of the Prince of Wales to consider the current position of orthodox, complementary and alternative medicine on the UK. The Foundation for Integrated Medicine (which then changed its name to The Prince’s Foundation for Integrated Health and is now called The Foundation for Integrated Health) was established. The report from this group simply endorsing the general line taken by the Exeter report.
The 1999 Health Act
The common law freedom to practise is curtailed by this act. Non-medical professionals may still practise in the healthcare sector, but the government can now require regulation of these professions. Freedom to practise without regulation is no longer protected in law. The 1999 Act confers “power to regulate any profession concerned (wholly or partly) with the physical or mental health of individuals…” Specifically, under Schedule 3, Part II, section 60 “ Her Majesty may by order in Council make provision — regulating any other profession which appears to Her [Majesty] to be concerned (wholly or partly) with the physical or mental health of individuals and to require regulation in pursuance of this section.”
Professional Organisation of Complementary and Alternative Medicine in the UK second report to the Department of Health by the University of Exeter.
This report set out recommendations for the pathway to self-regulation for CAM and was quickly followed by the Select Committee Report.
Report of the Select Committee on Science and Technology to the House of Lords
In view of the increasing use of complementary and alternative medicine, the Science and Technology Committee of the House of Lords prepared a report addressing issues of education, training and regulation and looking at the private sector as well as provision within the NHS.
The various CAM disciplines were divided by the Committee into three groups:
1. Therapies that claimed a diagnostic approach or represented a significant risk to the public. These were osteopathy and chiropractic which had already been regulated by Act of Parliament (statutory regulation) and acupuncture, herbal medicine and homeopathy.
2. Therapies where the practitioners did not claim to have diagnostic skills or were considered less of a risk to public health. These included the larger of the therapy groups, Reflexology, Aromatherapy, Massage, Reiki and Nutrition along with some of the less well supported therapies such as Naturopathy, Bowen Technique and Shiatsu. Alexander Technique were included in this group despite the therapy claim that they are ‘Teachers of a technique all
3. Therapies which claimed to offer diagnosis and treatment; favoured a philosophical approach and were indifferent to the scientific principles of orthodox medicine. These include Chinese Medicine and Kinesiology.
The House of Lords Report, HL Paper 123, Complementary and Alternative Medicine 2000 can be obtained from the The Stationery Office.
The Government Response to the Report.
The Government’s response to the Report accepted various recommendations.
1. Each of the Group 2 therapies should organise themselves under a single professional body. These bodies should be well promoted, so the public are aware of them. Each should comply with core professional principles; relevant information should be made known to medical practitioners and healthcare professionals, so that there would be a single point of reference for standards, definition and education.
2. Training courses should become more standardised within a profession and be accredited by appropriate professional bodies.
3. Continuing professional development in practice should be a core requirement for members of professional associations.
4. Those therapies with a fragmented professional organisation should work with Healthwork UK (now Skills for Health) to develop National Occupational Standards (NOS), which should be supported by the Department of Health.
The Response also recommended that:
• Medical students learn more about CAM
• There should be more research into the field.
2002 – 2005
The Shipman Enquiry
This very large enquiry into the actions of Dr Harold Shipman delivered six reports over a five-year period and served to still further raise the government’s concern over the regulation of both orthodox and complementary medicine
The most significant sections of the report in regards to regulation are:
• Stage 4 – Monitoring and Disciplinary Systems and Complaints
• Generic Evidence > Regulations
The Stone Report
In 2005 a report by Professor Julie Stone, commissioned by the Foundation for Integrated Health, marked out the advantages of a profession-lead voluntary regulatory process with an overarching federal-style regulatory body. The structure suggested by Stone bares striking resemblance to the ‘Pyramid Structure’ originally proposed by Tanner and Hopson in 1987. Stone recommends that this structure also be adopted by statutory regulatory bodies. Stone argued strongly that voluntary systems need to develop in this way if they are to command government approval and public respect.
2006 – 2007
The Federal Working Group
In 2006 with a view to facilitating discussion between the therapies on the subject of a federal regulatory structure, The Princes Foundation consulted with the now established Lead Bodies for each therapy within Group 2 of the Governments Response to the Commons Select Committee (2001). Many of the Lead Bodies such as Shiatsu, Bowen Technique and Yoga, were not yet ready to be regulated in so far as they did not have in place many of the documents required to engage in a regulatory process but they agreed to send representatives to contribute to a Federal Working Group (FWG). The FWG met for the first of a scheduled twelve meetings early in 2007. The Lead Bodies for the four largest therapies, Aromatherapy, Reflexology, Massage and Reiki, between them representing 75% of the practitioners involved in FWG; were excluded from the process in July 2007 after expressing concerns as to the viability of the developing outcomes. A small group representing some 500 massage therapists later returned to the FWG process.
2007 Regulation Begins
The General Regulatory Council for Complementary Therapies
In September 2007 the therapies of Aromatherapy, Massage, Reflexology and Reiki launched a profession-lead voluntary federal regulator, The General Regulatory Council for Complementary Therapies (GRCCT). Operating in the original ’Pyramid Structure’ the GRCCT incorporated many recommendations of the Stone Report and is in accordance with the recommendations contained in the government white paper ‘Trust and Assurance, Regulation in the 21st Century’ published in Feb 2007.
In February 2008, the original four main therapies were joined by the Lead Body for Energy Therapies and later in the year by Neuroskeletal Re-alignment Therapy. Four further therapies are at different stages of admittance to National Registration.
The GRCCT currently regulates a sector of some 60,000 practitioners in the United Kingdom and is currently working with the government Sector Skills Council, Skills for Health on a review of National Occupational Standards (NOS) for Complementary and Alternative Medicine.
The fee for admission to the National Register is £30 + £5 for each additional therapy. i.e. a practitioner of Massage, Reflexology and Reiki would incur a registration fee of £45
The Complementary Health Professions Council
The small groups which had chosen to remain in the FWG developed an alternative regulatory structure based on a very much more complex model. Unique to any regulator in the UK this model proposes the use of an entirely lay governing board. In March 2008 the Complementary Health Professions Council, which had by then been renamed to The Complementary and Natural Healthcare Council (CNHC), held a launch event and announced that it would open a register for Massage Therapist and Nutritional Therapists in April 2008. The register failed to open.
In September 2008 the Chair of CNHC announced that the model developed by the FWG was not workable and was being redesigned by the lay team now administering CNHC.