Complementary Healthcare Integration

These are some of my ponderings:

More and more over the past decade I  have seen more calls by holistic practitioners to be integrated into the National Health Service.  Imagine if you could go and see your GP and be prescribed massage therapy or reflexology or aromatherapy as part of your healthcare coverage. It seems like a great idea and yet I know that somehow if we do this we may well lose the ‘holistic’ aspect of complementary healthcare.

Most of the mainstream healthcare professionals I know, whether nurses or GPs or other specialised fields are stressed out.  What they practice is not holistic and they know it.  Stress levels are rising in the NHS (https://www.bmj.com/content/360/bmj.k1074) .  “Stress is believed to account for over 30 per cent of sickness absence in the NHS, costing the service £300-400 million per year. The latest NHS annual survey found that over 38 per cent (36 per cent in 2016) of NHS staff reported that they had suffered from work-related stress.”  (https://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/health-and-wellbeing/protecting-staff-and-preventing-ill-health/taking-a-targeted-approach/stress-and-its-impact-on-the-workplace).

So are we as holistic practitioners in wanting to join the NHS going to benefit from this?  Personally I feel no.  I think, to use Greta Thunberg’s quote on “cathedral thinking”, we need to reverse the process and integrate the NHS into a holistic wellbeing model.

Years ago I started studying medical herbalism before it became a degree course.  I had a passion for herbs and holistic health since childhood. I did a couple of certificates and then it was required to study for a degree with the notion from the medical herbalists that a degree would make it more legitimate and also protect the herbs from being forced out of use by legislation.  Years later, the NHS still barely recognises medical herbalists and legislation by the EU has seen many herbs prevented from being used or herb growers can’t justify the cost of growing certain herbs to pharmaceutical grade. Plus we still suffer with issues with contamination with growing and harvesting practices.

I studied for the first year of an osteopathy degree a few years back.  The main reason osteopathy kept pushing for more and more professionalism ironically was due to the Profumo spy scandal whereby the person who introduced John Profumo to Christine Keeler (a ‘callgirl’) was Stephen Ward, an osteopath who mixed in high society.  Before osteopathy was a degree in the UK it was a diploma with many of the earlier practitioners either studying it as a medicine qualification in the USA or here through mentorship and correspondence. Indeed many of my amazing tutors who had studied before it was a degree were highly skilled and knowledgeable yet they didn’t have degrees or at least not ones in the field of osteopathy; they had diplomas though and were perfectly capable of delivering effective treatments.  The push for ‘professionalism’ has largely been guided by trying to ditch the bad publicity of the one osteopath who was viewed as a pimp by the media of the time.

Whilst I agree that both medical herbalism and osteopathy need to have in person teaching plus recognised proper diplomas and certifications, I remain unconvinced that teaching them to degree level was necessary in terms of cost nor structure and still neither are recognised fully by the NHS which was one of the main reasons that the professional associations representing both disciplines wanted them to become degrees.  Both these courses have a high level of practical and vocational requirements and that does not necessarily lend itself well to the way degrees are structured.  It is important to understand research in terms of reading it, understanding it and also to generate studies.  However, most university departments in complementary studies tend to have limited ability to invest in research so what is done is very narrow in scope and terms of useability to “convince” the mainstream. When I was first introduced to complementary therapies some of the best practitioners were old school and did not have degrees.  What they had was a passion and they walked their talk with a holistic lifestyle.  More and more associated healthcare professionals are losing their enjoyment as the pressure mounts for ever increasing standards.  I’m not saying there should be no standards but if the cost is a lack of holism within these healing modalities and also a loss of some herbs and techniques then this unacceptable.

In 2019, with degrees costing £9,250 a year, gone are the days where someone who has a love of learning could study a number of different disciplines and integrate them.  You only get one shot at a student loan so once you’ve used it then you have to find 3 or 4 x £9,250 to do further studies out of your own savings (does anyone have a spare £30k in their savings to study). This is severely limiting.  When I studied reflexology 10 years ago it was a two year course, two or three days a week at Level 3 (equivalent to A level) and just about affordable at around £1,200 per annum.  We did lots of case studies, tutor and peer reviewed feedback sessions, exams and also covered reflexology techniques plus did anatomy & physiology, pathology and business studies plus a whole unit on Health & Safety. We received lectures on nutrition, implementing a healthy lifestyle and it was part of an overall complementary therapy diploma that included massage and aromatherapy plus optional units in crystal therapy and Indian Head Massage.  We worked to the National Occupational Standards and yet now 10 years later most reflexology courses are Level 5 which means taking out a student loan if you don’t already have a degree or if you do having to find thousands of pounds to fund it.

I don’t have data to back this but most of the people I know who practice complementary therapies don’t earn very much (most less than £20k) unless they go into teaching or are prepared to work in the spa industry for minimum wage and 60 hours a week (whereby they soon burnout and get work-related injuries).  And as most are self-employed it can be a struggle if you need to take a break for health reasons or otherwise.  Another factor is many are women so most of us get into complementary therapies as we want to create a lifestyle that is holistic and that fits around children but with the gender paygap our income is lower.  As more and more professional bodies push towards more ‘professionalism’ I do wonder how many are missing the point that the NHS’s version of professional is not at all holistic.  It does not allow for a work/life balance for neither patients nor the practitioners and is all about shift work and pushing people beyond what we know is healthy with sleep deprivation and high stress environments being the norm.  Lifestyle and nutrition choices are largely ignored as being important to wellbeing.

I am not saying that professional complementary therapists can’t study to degree level nor do I want to stop this.  However, I do question why so much has to be at degree level in terms of the costs.  Degrees themselves are a bizarre model that date back to a time whereby only the wealthy could afford the time to study in a leisurely way over several years.  As universities opened up opportunities to more and more and degree education became affordable it was logical to use this to integrate complementary therapies into this model of learning. When degrees didn’t cost as much it was easy to study fulltime and either have a part time income to fund living costs and books or study part time at weekends and work fulltime alongside etc.  You could study and know that you would recover the costs once you had your degree and were working by having a higher income and if you wanted to study another subject it was easier to save up to do so.  Now a degree does not guarantee a higher income at all and although the loan doesn’t have to be paid back until you earn over £25,000 (at 9%), it does mean most people are trapped into one path as further years of study are prohibitive unless you earn six figures.  Again government has not used a holistic model for degree funding; it’s based on income and financial return rather than also including a love of learning, passion, enjoyment, raising standards within society and giving people freedom.

Also I question whether there is wisdom in seeking to integrate into the NHS when the NHS has so many issues created by a non holistic healthcare model.  If we join what do we stand to lose?  If our professional associations lose sight of what a holistic lifestyle is then this will be a disaster.  So many of us who have sought to leave the mainstream traditional career rat race.  When I was in traditional work roles I spent my days with migraines, headaches, stomach ache and RSI issues because I had no idea how to take proper care of myself nor did I know how to address my employers.  I do not want to go back to that by being ‘professional’.  I don’t want to wear a uniform every day; I want to buck the trend and deliver hope to my clients. I want them to feel better but also think better.  I want people to know what, in the words of Greta Thunberg, “cathedral thinking” is where we upgrade and change things for the better rather than repeatedly doing the same things over and over that make us dysfunctional and cause more harm than good.

The NHS is amazing in that overall the benefits of having free-at-source universal healthcare is so important.  However, I feel the NHS could learn a lot from complementary therapies.  Our consultations are longer, we ask questions that are not just one issue based but we look on things as a whole and go deep, we emphasise movement and food choices, we look at posture habits and we help with distress through de-stressing and relaxation.  As practitioners we do our utmost to increase our own wellbeing so that we can be good models for our clients and also know of other healthy options to refer our clients to such as yoga or Pilates.

In Canada, the healthcare model there allows for integration of various therapies such as osteopathy, naturopathy and massage therapy. However, the pressure on professionalism means that many practitioners are working more hours than is healthy, lose work/life balance and are having to spend vast amounts on CPD at the cost of having a living wage.  I hope that here in the UK before integrating with the NHS we realise what we may lose.

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