Bringing new health to the NHS

'Integrated' is the buzzword in medicine now. But will the NHS really swallow alternative therapies?

Peter Whitfield is entertaining his t'ai chi class with a demonstration. "If you're standing at 45 degrees, you're stable. More than 45 degrees..." and he suddenly lurches forward, causing the small group of mostly older women to dissolve into laughter. The setting is St Cecilia's community centre, Sheffield, in one of the most deprived areas in the whole of the country. And what is taking place is part of one of the country's most enlightened approaches to health care.

Peter is working with the team at Foxhill Medical Centre, an NHS practice which integrates orthodox medical treatment with CAM (complementary and alternative medicine). It covers an area of north Sheffield designated as one of "acute poverty", with 45 per cent of residents unemployed and high levels of debt. The practice team includes six conventionally trained GPs - one of whom is also a qualified acupuncturist - a herbalist, a massage worker and, recent arrivals, a yoga teacher and Peter with his t'ai chi expertise.

People who come to the Foxhill Medical Centre may choose to see either a doctor or CAM practitioner or may be referred from one to the other. Treatment is free, although there is talk of introducing a token charge for some CAM therapies where the person can afford to pay.

"The idea that there is a big battleground between the stuffy old doctors and the wacky alternative therapists is just not true," says Dr Tom Heller, a Foxhill GP who works part-time with The Open University developing health-related courses. "A recent survey found that 50 per cent of GPs either practise, or refer their patients to, complementary medicine."

The Foxhill practice, though, has gone a lot further than most. The CAM practitioners work on an equal footing with the GPs, says Dr Heller, and are fully involved in meetings to discuss individual cases or issues of clinical practice. And in informal meetings too. "If I am having a problem, I might just go along the way and talk to one of my CAM colleagues," he says.

The buzzword for this synergy of orthodox and complementary is an "integrated practice", and Foxhill is one of a small, but growing, number of examples. Dr Heller, an orthodox practitioner, is a firm advocate. "It became obvious that there is a range of conditions which orthodox medicine could not deal with," he says.

Conditions such as irritable bowel syndrome, which can be influenced by many factors including diet, lifestyle and exercise, may respond better to CAM than to the drugs prescribed by conventional treatment, he points out. "Orthodox medicine has chemicals which may take away the bowel spasms, but are not going to cure the underlying problem. This will only come about by adjusting the body's balance and reducing the stress."

Even where modern medical science has an effective treatment there may also be a role for CAM - t'ai chi, for example, with its emphasis on slow, relaxed movement, has been shown in trials to aid cardiac patients' recovery. Each of the CAM therapies introduced is evaluated by the Foxhill practice over an initial two-year period.

Dr Heller's experience made him the ideal choice to write part of The Open University's new course on Complementary and Alternative Medicine - a course aimed at anyone, qualified or not, who wants to know more about CAM, including how its effectiveness - or otherwise - is evaluated. It is, he believes, the first UK course at university level to provide an academic and sociological overview of the world of CAM.

Bendle is a herbalist who works two days each week for Foxhill. He treats conditions ranging from gut problems to menopausal symptoms, as well as offering palliative care for terminal illness. He makes his own medicines from a variety of plants, which if possible he gathers or grows himself. The local chemist also stocks herbal preparations and can dispense his prescriptions.

Patients who come to see Bendle get an initial 20-minute consultation followed by a series of longer sessions if their condition warrants it. "A lot of the problems with Western scientific medicine," he says "are the constraints in the system within which it operates. It is being submerged in an audit culture with more and more time spent on paperwork and less on chatting to patients."

Helen Taylor is a massage therapist who is also a qualified nurse. She sees Foxhill patients with a variety of physical and mental health conditions, which, she says, cannot always be separated out from one another. "They have a lot of problems in their lives which are causing stress."

A few, usually male, patients are sceptical initially, but won over when they feel the effects, she says. "People are very appreciative. A lot of people get great relief from pain and stiffness that they have had for years." The vast majority of the Foxhill patients she sees would never be able to afford private massage treatment.

According to Helen, Foxhill is unusual in the level of integration between orthodox and complementary treatments: "They use complementary medicine and respect it. In other places they have a different attitude towards us." She recalls a practice which had an aromatherapist attached, but not part of the team. "They came in to do their job, and went away."

Foxhill is expanding - the recent increase in its range of therapies heralds a move to a purpose-built healthy living centre, which will bring all its activities under one roof. Foxhill's success could point the way forward to a more holistic, people-centred National Health Service of the future. But it doesn't.

Politics and economics play as much of a role as science in determining what kind of health care is available. Despite the growing acceptance of CAM by orthodox practitioners, the chances of doctors' surgeries up and down the country modelling themselves on Foxhill are probably more remote than they were a few years ago. Foxhill's expansion is being funded, not by the NHS, but through a National Lottery grant. It is hard to find money for health in a health service which is "all about illness", Dr Heller says. "The NHS budgets now are pretty much taken up. It is difficult to see where money for new ideas will come from."

For those who want to explore the issues surrounding CAM, whether from the standpoint of a consumer, carer, health practitioner or just out of general interest, The Open University has a new course: Perspectives on Complementary and Alternative Medicine (course code K221), which begins next February. No medical expertise is necessary. For further details see www.open.ac.uk or ring 0845 300 6090 or e-mail general-enquiries@open.ac.uk.

You can also find out more in a new OU/ BBC Radio 4 series, The Other Medicine, presented by Anna Ford, who was an Open University tutor before becoming a broadcaster. The series looks at why people are turning to alternative medicine, whether there is evidence that it works and whether it can (or should) be more available on the NHS. The six-part series starts on Tuesday 21 September at 9pm.