It is a great pleasure to introduce the first of the King's Fund President's lectures. It is fitting that the theme of tonight's event is Integrated Healthcare, a cause which the King's Fund has championed on behalf of the public for so long.
It was at another anniversary - celebrating 150 years of the BMA in 1982 - that I first expressed a hope that it might prove possible one day to bring complementary and orthodox medicine closer together. Since then there have been a number of significant developments, including the statutory registration of osteopaths and chiropractors (in which I took a particularly close interest); and the development of a number of centres where patients can receive a variety of treatments - orthodox and complementary - according to their needs. These changes have taken place during a period which has also seen evidence of a growing desire within orthodox medicine to place more emphasis on the personal needs of the individual and to widen the scope of treatments available. The BMA's Report 'Complementary Medicine: New Approaches to Good Practice' four years ago and the GMC's report in the same year 'Tomorrow's Doctors' are evidence of this changing approach.
For well over a decade, I have tried to encourage a more integrated provision of healthcare for the ultimate benefit of patients. I am personally convinced that many more people could benefit from complementary medicine as well as from a more personal and patient-centred approach in orthodox medicine. It is also clear from the enormous increase in the use of complementary therapies by the general public - largely paid for out of their own pockets - that I am not entirely alone in this belief. It seems to me that complementary medicine can sometimes bring a different approach and assist in unlocking the individual's inner resources to aid recovery or to help manage and live with chronic illnesses for which there is little prospect of cure.
So it would appear that we have reached a defining moment in our attitude towards healthcare in this country among both the public and health professionals.
In February 1996 I convened and chaired a seminar involving healthcare professionals from a wide variety of backgrounds, to review the current situation and to discuss what practical steps should be taken to further communication and cooperation between all concerned in the provision of healthcare services.
We agreed at that discussion to establish a number of Working Groups to examine the requirements for firstly, research and development, secondly, education and training, thirdly, regulation, and fourthly, the delivery of integrated care. I have been enormously encouraged by the positive and cooperative spirit in which the Working Groups and the Steering Committee have addressed the challenge and by their diligence and enthusiasm. I am extremely grateful to the Chairmen and Chairwomen, and to all the Members, for their hard work and dedication to this initiative over the past 18 months. I particularly want to acknowledge the support of the Foundation for Integrated Medicine in this most valuable work.
You will find that the fruits of the Working Groups' deliberations are in the document entitled 'Integrated Healthcare: A Way Forward for the Next Five Years?' which is being published today. But before I talk about that, perhaps it is worth just reminding ourselves what we are trying to do. Why, when all is said and done, does integration in healthcare matter?
I believe it matters because we cannot afford to overlook or waste any knowledge, experience or wisdom from different traditions that could be brought to bear in the cause of helping those who suffer. Over the past ten or 20 years tremendous advances have been made in biological and other scientific research, such that we now have the prospect of successfully treating conditions previously considered incurable. But clearly this alone is not fulfilling all our healthcare needs as large numbers of people are paying to seek help from complementary medical practitioners. We simply cannot ignore what is a very real social phenomenon. What is it saying about our current medical provision, our needs and our aspirations? These need to be better understood and the implications seriously considered. To do so we need to encourage debate, communication and partnership between those who provide healthcare and those who receive it.
Some complementary treatments do seem to be helpful in a significant number of areas where orthodox medical practice may have a limited amount to offer. We surely owe it to ourselves, as well as to patients, to explore the potential of such treatments to alleviate pain, suffering and disability. We need to create an environment in which patient-centred healthcare can flourish and individuals can be empowered to take greater control of their own well-being, health and healing.
Progress towards integration has, indeed, been made and complementary medical practices that might once have been regarded as on the margins of healthcare are now more widely accepted and respected. Osteopaths and chiropractors are now regulated by Act of Parliament and, together with practitioners of acupuncture, homoeopathy and other complementary therapies, are increasingly working in collaboration with General Practitioners within the National Health Service.
But there is still much more to be done. There is still a dearth of information and scientific research on the effectiveness of many complementary therapies and too little understanding - and, I suspect, considerable prejudice - about how they work. This lack of information is a barrier both to medical practitioners and to people in need of treatment.
Recent surveys show that, in the main, orthodox medical and nursing schools currently offer little by way of familiarisation with the range of complementary therapies, their possible benefits, limitations and risks. Conversely, training programmes for practitioners of some complementary therapies rarely provide information about the approaches of orthodox medical care to diagnosis and treatment. Sometimes it seems that the main problem lies in finding a common language, through which those educated in one tradition can communicate with those educated in another.
This brings me back to the work in hand. The document being published today, as I have said, is called 'Integrated Healthcare: A Way Forward for the Next Five Years?' The title ends with a question mark because our aim is to stimulate further debate and new ideas, and because I believe that the best way of taking these suggestions forward is by consultation and debate between all those who have a role to play. But the report is much more than just a starting point. In addition to the ideas and proposals of all those who participated in the Working Groups, it reflects responses to formal consultation with a wide range of individuals and organisations in both the orthodox and complementary healthcare fields, as well as providers and consumers. These included the royal colleges, leading researchers, professional organisations like the BMA, and some of the leading medical schools and bodies representing complementary medical practitioners. While there was a lively debate - as we had hoped - it was heartening to see an overwhelming endorsement from all concerned for the aims of the initiative and a broad measure of support for the means of achieving them.
It seems to me that we need to understand why so many people seek help from complementary therapies; we need to carry out more research into their effectiveness; to encourage better regulation to protect the public, better training and education to improve the skills and knowledge of all healthcare practitioners; and to provide better information - both for people who are seeking treatment and for GPs and other healthcare professionals to whom people turn for advice. Above all, we need to explore the potential of an integrated approach to healthcare where health is much more than simply the absence of disease and infirmity.
The document has many proposals on all these topics, which the following speakers will cover in more detail.
The proposals in the report now need to be discussed and the views of all those with an interest in healthcare, especially representatives of patients, need to be considered. I hope very much that we shall be able to take stock of progress and focus further discussion at a conference on this subject which is being planned for next year.
Meanwhile, I am sure you will find much (perhaps too much!) to stimulate your own ideas in what our speakers will say today. I can only urge you to read the document; to contribute to the debate and, above all, to help us in every way you can to carry the process forward and make Integrated Healthcare centred on the individual a reality for the next millennium."