The Review of Clinical Policies for Lancashire and South Cumbria Clinical Commissioning Groups (CCGs) – Frequently Asked Questions (FAQs)
What are complementary and alternative therapies?
Complementary and alternative therapies are a wide range of healthcare services that are usually regarded as being outside the scope of conventional medical practice. They are often used alongside or instead of standard treatments and often take an holistic approach to the patient.
The therapies referred to in the policy include homeopathy, acupuncture, aromatherapy, reflexology, osteopathy and hypnotherapy but its principles may be applied to other therapies with similar characteristics that are considered ‘alternative’ or ‘complementary’ to standard treatments. Practitioners involved in delivering these therapies are often concerned with the general equilibrium and overall wellbeing of the patient, which is laudable but not necessarily appropriate to NHS commissioning.
What changes have been made to the draft updated and revised policy on complementary and alternative therapies?
The existing policy allows, in certain circumstances, for a number of these therapies to be provided outside the conventional treatment pathway or for therapy practitioners, such as osteopaths, to be referred to by NHS providers. The updated policy no longer supports this approach and only allows the use of complementary and alternative therapies within the NHS care pathway by NHS contracted providers of care. This is because the clinical evidence to support the use of these therapies is extremely limited and cannot sustain broader commissioning by the CCGs, especially in the current environment.
I’ve been to a chiropractor-reflexologist-osteopath and it worked for me – why should they be restricted or excluded services?
A number of these alternative therapies and treatments may well make a patient feel better and aid their general wellbeing but there is little clinical evidence that these therapies are beneficial in tackling specific health problems or ailments. For example, there is good evidence that osteopathy is effective in treating persistent or recurrent lower back pain but little evidence it is effective for neck, shoulder or lower limb ailments. In addition, the manipulative techniques used by osteopaths are similar to those used by physiotherapists when treating lower back pain so the gain in using the alternative osteopathy is limited compared to the more conventional physiotherapy. Where there is benefit, the complementary therapies will be undertaken by suitably qualified practitioners within the NHS provider process.
You funded some of these complementary and alternative therapies before – why can’t this continue? What has changed?
Yes, some complementary and alternative therapies were funded previously, in certain circumstances. Some will continue to be funded, but in more limited circumstances and only through the NHS care pathway.
There was limited clinical evidence to support the commissioning of these complementary and alternative therapies previously. This situation has not changed and there continues to be limited clinical evidence. What has changed is that your local NHS can no longer afford to support procedures and therapies where there is little or no evidence of their effectiveness when demand for treatments and therapies which have been proven to work are so high and rising. A combination therefore, of current clinical evidence and cost means your local NHS is taking a different approach to the funding of these alternative and complementary therapies.
Why do we need a new policy for rehabilitation after damage to the facial nerve?
Rehabilitation treatments following damage to the facial nerve are not routinely funded by the NHS and have been subject to a number of individual funding requests. When applications for individual funding requests begin to escalate for any particular treatments and are no longer confined to a handful of cases a year, CCGs must decide whether to introduce a service development, which if agreed would mean that treatment will be routinely funded, or whether to introduce a clinical policy which will identify the criteria that must be met for the treatment to be provided.
Introducing a service development is not based simply on the number of treatments now taking place but takes into account other factors such as the nature of the treatment, its effectiveness, the health gain achieved, value for money and its priority in relation to other treatments, new or existing. It was determined that the rising level of treatments for rehabilitation after damage to the facial nerve would be met most appropriately by introducing a new clinical policy.
How many cases for rehabilitation after damage to the facial nerve do CCGs have?
Damage to the facial nerve has a number of causes but overall there are over 300 cases a year across the CCGs in Lancashire. However, of these cases less than a third requires treatment. For the remainder the damage is temporary or the damage is limited and does not affect functions damaged by more serious cases, such as taste, eating and swallowing, eye closure, tear production and paralysis of the face.
I’ve heard of facial nerve palsy – is this a different problem?
No, facial nerve palsy is a condition resulting from damage to the facial nerve and is therefore, covered by the new draft policy. Facial nerve palsy refers to the partial or complete weakness of the facial muscles and can result in paralysis. Bell’s palsy is one of the main causes of facial nerve palsy. A large proportion of damage to the facial nerve cases relate to facial nerve palsy.
When will these policies be adopted by the CCGs?
A firm date for the adoption of these policies has not been determined as there are still a number of processes to go through before the CCGs can approve and adopt these policies. Public engagement will take place over an 8 week period following which there may be changes made to the policies. The policies will then need to be considered by the Commissioning Policy Development and Implementation Working Group, which is overseeing the policy review process, before final consideration by the CCGs. It is anticipated however, that the policies will be adopted and implemented by February 2018.