BUSINESS PLAN FOR A COMPLEMENTARY CARE TRUST (SOCIAL ENTERPRISE ALTERNATIVE THERAPY COMPANY -SEATC)

Drafted by John Kapp, secretary Brighton and Hove SEATC group           13.12.09
22, Saxon Rd Hove BN3 4LE 01273 417997, johnkapp@btinternet.com.

John Kapp is a member of the Local Involvement Network (LINk) and an elected member of the steering group of the National Association of LINks Members (NALM) representing Sussex. He is a former consulting engineer economist and councillor who has been a patient representative since 2000. In 2002 he founded an alternative therapy centre opposite Hove town hall called Planet Janet, now called Revitalise. He wrote this business plan on behalf of the SEATC group, which is open to all to join as a committee member or observer. Comments by e mail or phone are welcome. The group has been holding monthly public meetings since July to develop this proposal at Revitalise café, opposite Hove town hall. The next meeting will be on Mon 4th Jan at 730-9pm at Revitalise.

PART 1 THE PROPOSAL– A PRESCRIPTION VOUCHER SCHEME TO PROVIDE FREE CAM ON THE NHS

Executive summary
This is a business plan of a proposal to deliver a 50% improvement in health in the city of Brighton and Hove with a 20% saving in 2009 cost by 2016. (£432 -345 mpa) We will do this by providing safe, effective complementary and alternative medicine (CAM) free on the NHS. We will do this by creating a ‘Complementary Care Trust’ like the old Primary Care Trust (PCT), which will be a new social enterprise company, which will be the sole provider of free CAM by contract with the NHS commissioners.

The company will issue £50 vouchers for CAM which General Practitioners (GPs) will give to patients who choose CAM. The patients will cash the vouchers at any of the existing 100 CAM centres in the city. By 2014, £100 mpa (22% of the present £456 million pounds per annum (mpa) health budget -– will be reallocated to prevention of illness, promotion of wellness, and getting people back to work.

We will start in 2011 and build up rapidly so that from 2014 we will supply 2 million CAM vouchers pa to patients who presently cannot afford CAM. We believe that this will transform their health and halve the present rate of alcoholism, drug taking, smoking, suicide, long term conditions, hospital admissions and GP visits. In turn this will reduce the cost of conventional treatment from £428 mpa to £237 mpa, and reduce the total cost of the National Health Service (NHS) in the city to £345 mpa, a saving of 20%. The effect on the budget of NHS Brighton and Hove is shown in the appendix. The target reduction in number of persons afflicted is shown in table 1.

TABLE 1 ANNUAL MONITORING TARGETS FOR 2016 FOR THE CITY

Target number	Statistical number of people pa affected in city	2009	2016 (50% of 2009)
1	Deaths from all causes pa	3,000n	3.000
2	Iatrogenis (doctor induced) deaths (note 1)	200n	100
3	Hospitalisation from iatrogenesis (a million people pa nationally)	5,000n	2,500
4	Deaths from suicide pa	36c	18
5	Drug users	2,250c	1,125
6	Alcoholics	50,000c	25,000
7	Obese	60,000c	30,000
8	Clinically depressed	15,000c	7,500
9	Smokers	50,000c	25,000
10	Long term conditions	40,000c	20,000
11	Teenage pregnancies	40,000c	20,000
12	On disability benefit (2.5m nationally)	12,500n	6250
13	Hospital admissions	100,000g	50,000
14	GP visits	100,000g	100,000
15	Deaths in preferred place (home)	750n	1500
16	No of patients dying with living wills	Hardly any	1500
17	Dementia patients killed by drugs (note 2)	9n	4
18	Staff off sick (note 3)	400n	200

The mainstay of the prevention program is the National Institute for Clinical Excellence (NICE) approved Mindfulness Based Cognitive Therapy (MBCT) 8 week course. 1500 courses will be provided from 2014 for 30,000 people each year. For details see paper ‘Improving Health by Ending the Prozac Nation’ number 9.28 of www.reginaldkapp.org.

Contents

Part 1 describes the essence of the proposal in 16 paragraphs and 14 pages.
Part 2 is the budget of estimated costs from 2009 to 2016 in 4 pages.
Part 3 is a draft constitution for the company in 2 pages.
Part 4 is an analysis of Strengths, Weaknesses, Opportunities and Threats (SWOT) of the proposal in 10 pages.
Part 5 is a list of the names, addresses and contact details of 130 existing CAM centres in the city, extracted from the Yellow Pages, in 7 pages.
The Appendix is a draft of what we would like to see in the forthcoming NHS Strategic Commissioning Plan for Brighton and Hove 2010-14.

Part 1 The proposal

1.1 Purpose of this business plan
This business plan is a proposal to provide free complementary and alternative medicine (CAM) at the point of use, paid for by taxation, in the city of Brighton and Hove. Its purpose is to transform the public health and social care services of the city by integrating complementary and alternative medicine (CAM) into those services. It provides the means to manifest Prince Charles’ vision of integrated healthcare in his keynote address to the Health Ministers of the world at the World Health Organisation (WHO) conference in May 2008.

We have published this plan as we hope that it will be copied in other towns, so that the whole of the UK will integrate CAM into their NHS. We also hope that other countries will integrate CAM into their state public health and social care provision, so that Prince Charles’ vision manifests throughout the whole world.

1.2 Meeting government policy objectives
Since the Darzi report of July 2008, it is now Department of Health (DoH) policy for the NHS to not only treat illness, but to prevent it, promote wellness, and empower people to take responsibility for their own health. This is a paradigm shift I and requires a massive reallocation of resources from treatment to prevention, particularly when the NHS is supposed to plan for 20% cuts by 2014.

Complementary and alternative medicine (CAM) has been delivering all these health benefits safely and effectively to those who do it regularly (say 3 hours per week). However, this costs £1,000-5,000 pa and only about 10% of the population are rich enough to do this. Denial of these benefits to 90% due to their inability to pay is a gross health inequality.

Polls show that 3 out of 4 patients want CAM to be provided free on the NHS. As the public pay for the NHS in their taxes, patients should be given the choice of free treatment of their choice (conventional medicine or CAM). Half of all GPs already refer patients for CAM, but the patient has to pay for the treatment themselves. CAM is already being provided in hospitals to keep the staff from burning out, and to the unemployed to help get them fit for work.

All healthcare providers will have to produce Quality Accounts over the next few years. These focus on safety, effectiveness, and patient experience. CAM has been delivering these outcomes for decades, but only to the well-off 10%. CAM is safe because it is harmless. There have never been any iatrogenic (doctor-induced) problems with CAM (unlike conventional medicine, where in the USA iatrogenesis has become the biggest killer, see para 4.1c, below)

Although CAM is not a quick fix, it is usually effective in curing conditions, (unlike drugs, which usually just mask the symptoms) Patient experience is highly rated with CAM, as proved by the growing market for it. (Unlike the NHS where patient dissatisfaction is indicated by the number of patients suing, and the corresponding high cost of professional indemnity insurance)

The government are consulting on the Welfare Reform bill which wants to reduce the £100 bnpa cost of working-age ill health, and the 2.6 million now on incapacity benefit 40% of whom (1 million) have mental health conditions. People on benefit are from the most disadvantaged communities, and is structural unemployment disguised as disability. Stress, anxiety and depression are a significant cause of work related problems, and non-work related sickness absence. The government’s solution is the commissioning of outside providers (consortia of private companies) to support these people back into the workplace, and this proposal to provide free CAM in the community could provide the means by which that could be done.

1.3 Healthcare in the city of Brighton and Hove
The commissioners of public healthcare in the city are the Brighton and Hove NHS (the former Primary Care Trust PCT) They are planning to spend £456 mpa next year (2010/11). This is £1.2 m per day, or £1,800 pa for every man woman and child in the city, or £50 (the value of 1 CAM voucher) per head per day.

This sum is presently spent paying around 8,000 healthcare staff providing conventional treatments, but hardly any on prevention (education leaflets, quit smoking clinics, etc). The money goes to a few big providers, namely the Royal Sussex County hospital and other hospitals for free secondary care (£180 mpa), the Sussex Partnership Trust for free mental health services (£45 mpa), the Southdowns Health Trust for free community care, (£51 mpa) about 47 GP surgeries for free primary care (£43 mpa), 56 dental practices for free dental care (£11 mpa), 23 opticians for free eye care, (£1.6 mpa) 60 pharmacies for free drugs (£41 mpa) and the ambulance service (£8 mpa). (There is £76mpa missing from this list)

There are about 2,000 CAM therapists working in about 100 CAM centres in the city, and perhaps a further 2,000 CAM therapists working from home. Not being publicly funded, they only treat clients who can pay. The going rate for CAM is about £40 per hour for one-to-one therapy, and about £40 for 6 hours of classes of an hour per week. There are dozens of different CAM treatments. Centres and therapists are fragmented, unlike conventional medicine.

Because of this fragmentation, it is administratively impossible for NHS commissioners to pay public money for CAM because it comes in millions of penny packets. This proposal solves this problem by creating a social enterprise company which would be a bulk provider of generic CAM therapies throughout the city. The company would be a consortium of those CAM centres who voluntarily decide to join the scheme, (hereafter called ‘registered centres’) which we hope will be all 100 of them. (a list of 140 is given in part 5) Joining the company would be free, as the costs of the company would be paid by the NHS.

1.4 A company providing free CAM on the NHS
This proposal would create a new ‘Complementary Care Trust’ like the old Primary Care Trust (PCT) to expand the accessibility of CAM from the present 10% well-off, to every patient who needs it in the opinion of their GP. This would meet the DoH’s objectives of making evidenced based, safe, effective treatments freely available to all patients that need them, irrespective of their ability to pay, thereby improving health and preventing long term conditions from developing. It would remove the health inequality, and help unemployed people on disability allowance back to work.

Like the existing medical providers, the company would contract with the NHS commissioners. Technically the company would be an ‘Alternative Provider of Medical Services’ (APMS) and sign a Service Level Agreement (SLA) to provide CAM at all registered centres. The company would be like a brokerage agency, matching supply of CAM at CAM centres to demand for it from patients. A simple example of a brokerage agency is a cab company (say telephone 202020) whose staff takes calls from fares, relays them by radio to drivers and the nearest cab picks them up.

The company would enable free CAM provision to follow the existing model of free primary care provision from GP surgeries, free dental care provision from dental practices, free eye care provision from opticians, free drug provision from pharmacists. The company would provide this brokerage service by issuing free CAM vouchers (for say £50 worth of CAM) to GP surgeries. The GP would give patients the choice of the conventional treatment (a prescription for drugs or an operation) or a voucher for CAM. If the patient chooses the vouchers they would trade them for CAM treatment of their choice to the value of the vouchers at any registered centre.

Payment to the centres and therapists for treatments rendered would be administered as follows. Every month the centres would invoice the company for the value of the vouchers traded, and the company would invoice the NHS commissioners. The commissioners would pay the company, who would pay the centres, who would pay the therapists who did the treatments. This would be similar to how GPs, dentists, opticians, pharmacists and their staff are now paid. The public money for CAM would follow the patient, as the government legislation in 2006 enacted.

The company’s office would be located at an accessible location in the city. It would include a CAM advice centre, where patients can get free advice in person, by telephone or e mail. The managers would be knowledgeable about CAM and provide a gatekeeper service to advise patients which CAM treatments would be best for them, and which centre could provide it. They would also publish a directory both on a website and in hard copy, which patients could access on line and keep at home for reference.

It is sometimes said that there is no evidence that CAM works, and that CAM practitioners are not professional, but this is not generally true. If CAM did not work, clients would not pay for it. Some CAM therapies are approved by the National Institute for Clinical Excellence (NICE) Demand for CAM is growing despite playing uphill against free conventional medicine. Most CAM therapists are professionally qualified with qualifying bodies. Physiotherapy, osteopathy, chiropractic are state registered professions, and acupuncture and 12 other CAM professions are in process of applying for state registration. Regulation of CAM is not as important as in conventional medicine because the risk of harm with CAM is negligible.

1.5 Forecast benefits for 2014 if this proposal is implemented.
The budget (see part 2) for the company shows that in 5 years time, (2014) the company would have a turnover of £10 mpa and employ 156 staff. The NHS would have re-allocated £100 mpa of public money (22% of its £456 mpa health budget) to prevention. This would provide 2 million CAM vouchers pa at £50 per voucher for CAM therapies which are safe, effective and prevent long term conditions from developing, instead of drugs which are harmful, ineffective, and create long term conditions. Each of the 100 registered CAM centres would be getting 60 NHS patients per day bringing in 60 vouchers per day, worth £3,000 per day or £1 mpa. This would provide full time employment for about 20 additional therapists in each centre, supported by an equal number of additional administrative staff totalling 40 additional staff per centre.

The total number of CAM therapists supported in the city by this re-allocation of public money would be 4,000 full time equivalent jobs. Each of them on average would receive a salary from the public purse of £20,000 pa. These jobs would be fulfilling because they would be contributing to the wellbeing of everybody in the community, including the CAM therapists themselves. This contrasts to the jobs in conventional medicine, which have a high staff sickness and burnout rate (5%) which is 50% more than the national average (3.3%) because they know the futility of their treatments which don’t work.

We estimate that by 2014 these 2 million vouchers issued pa would be going to about 100,000 poorest and sickest people, who would get on average 20 vouchers each pa, giving them £1,000 pa worth of safe, effective treatments and health advice. This would half the present high and increasing rates of alcoholism, drug taking, smoking, suicide, and long term chronic illness which presently afflicts 1 in 3. Mental and physical health would generally be improved throughout the population, reducing by half the number of hospital admissions and GP visits. This would halve the cost of conventional medicine from £400 mpa to £200 mpa. The total cost of the NHS would then be reduced from £400 mpa in 2009 to £300 mpa in 2014. This scheme would thus deliver a 50% improvement in health in the city with a 25% saving in cost.

1.6 improvement in public health targets by 50% for the city by 2014
The Strategic Commissioning Plan for Brighton and Hove dated March 2009 is published on the NHS/PCT website. (www.bhcpct.nhs.uk) It is titled ‘Improving Health and developing World Class Healthcare in Brighton and Hove 2009-14’ and is about 110 pages. Not surprisingly CAM is not mentioned. It is the source of most of the following figures for 2009, (designated c for city) Other figures (designated n for national) are deduced from national statistics divided by 200, as Brighton and Hove’s population (250,000) is about 1/200 the of the national population (50 million for England and Wales, 60 million including Scotland and N.Ireland). We will ask the director of public health (Tom Scanlon) to confirm or correct these 2009 figures. Figures designated g are guesses as no statistics were available at the time of writing.

TABLE 1 ANNUAL MONITORING TARGETS FOR 2016 FOR THE CITY

Target number	Statistical number of people pa affected in city	2009	2016 (50% of 2009)
1	Deaths from all causes pa	3,000n	3.000
2	Iatrogenis (doctor induced) deaths (note 1)	200n	100
3	Hospitalisation from iatrogenesis (a million people pa nationally)	5,000n	2,500
4	Deaths from suicide pa	36c	18
5	Drug users	2,250c	1,125
6	Alcoholics	50,000c	25,000
7	Obese	60,000c	30,000
8	Clinically depressed	15,000c	7,500
9	Smokers	50,000c	25,000
10	Long term conditions	40,000c	20,000
11	Teenage pregnancies	40,000c	20,000
12	On disability benefit (2.5m nationally)	12,500n	6250
13	Hospital admissions	100,000g	50,000
14	GP visits	100,000g	100,000
15	Deaths in preferred place (home)	750n	1500
16	No of patients dying with living wills	Hardly any	1500
17	Dementia patients killed by drugs (note 2)	9n	4
18	Staff off sick (note 3)	400n	200
Notes
1	‘40,000 deaths pa’ from TV programme Nov 2000 ‘Why doctors make mistakes’
2	‘1,800 dementia patients killed by anti-psychotic drugs’ News bulletin 1.12.09
3	5% staff sickness on 8,000 staff

1.7 What is the evidence that free CAM will deliver these benefits?
No study has been done on providing free CAM for a whole city before, so this proposal could be regarded as a pilot clinical trial of the efficacy of free CAM on the public health of Brighton and Hove over 10 years. Our belief that a 50% improvement in public health outcomes is possible is based on our personal experience of CAM in our own lives, and that of our clients. Not many clinical trials have been done on CAM to date, but those that have been done indicate that a dramatic improvement is possible, such as ‘the MBCT course halved the rate of relapse of depressed patients over 5 years.’ (see paragraph 1.6ei)

We cannot prove that a 50% improvement will happen if this project is implemented, any more than the PCT can prove what they claim will be the outcome of their strategic commissioning plan, which reads: ‘3.4.1 Impact on public health. Together they will transform the quality of care, and will be a major contributor towards reducing health inequalities and improving people’s life expectancy and quality of life’.

As the PCT’s plan only contains business as usual, there is no evidence that their plan will deliver this impact, and every likelihood that the public health of the city will go on getting worse. (as they have done since the start of the NHS) The PCT’s words are just wishful thinking. Conventional medicine cannot solve the problem of declining public health, because it is part of the problem. The solution lies in thinking outside the box, as previous pioneers of public health did, as described below.

1.8 Medicine for harm or good?
The book by Prof Edzard Ernst (chair of complementary medicine at Exeter University (with Simon Singh) ‘Trick or Treatment – Alternative Medicine on Trial’ is supposed to be an indictment of CAM. However, it is really a covert indictment of conventional medicine. (see reviews in section 9.26 of www.reginaldkapp.org) (Page numbers refer to the original text)

The book should be judged by its punchline at the end: ‘We argue that it is now time for the tricks to stop, and for the real treatments to take priority. In the name of honesty, progress, and good healthcare, we call for scientific standards, evaluation and regulation to be applied to all types of medicine, so that patients can be confident that they are receiving treatments that demonstrably generate more harm than good.’ (p248) Apart from the Freudian slip in switching ‘harm’ and ‘good’, every good-hearted citizen would support this conclusion. That slip is the only clue that indicates that the authors know that it is conventional, not alternative, medicine that needs to be exposed to the light of truth.

Quoting the authors again ‘One might argue that every individual has the right to spend money according to his or her own wishes, but if alternative practitioners are making unproven, disproven, or vastly exaggerated claims, and their treatments carry risks, then we are being swindled at the expense of our good health.’ (p240) This admirable statement should of course be applied to all practitioners. (conventional as well as alternative)

The shocking truth is that all people throughout the world are being forcibly swindled through their taxes to finance conventional therapies which do more harm than good and are killing them in large numbers. This is effectively publicly funded genocide to which all doctors, health authorities and governments are unwitting accomplices.

The culprit is Big Pharma. ‘This is the wealthiest institution in the world. The top 10 companies in Fortuna 500 are drug companies, and make profits exceeding all the other 490 companies put together. ($35 bnpa in 2002) It is primarily a marketing machine to sell drugs of dubious benefit. This industry uses its wealth to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centres, and the medical profession itself.’ Quote from Dr Maria Angell’s book ‘The Truth about the Drug Companies, - How they deceive us, and what to do about it.’ see www.wanttoknow.info/mediacoverup/health

1.9 Historical innovative solutions to public health problems
Ernst and Singh’s book gives an excellent historical resume of conventional cures over 4 centuries, and describes how the following five mavericks introduced innovative solutions in spite of opposition from the vested interests of the medical establishment.

a) The cure for scurvy (lemons and limes) had been documented in 1601. James Lind did a clinical trial in 1747 and confirmed its efficacy. However, the medical establishment was promoting all sorts of other remedies, and sailors continued to die of scurvy until 1795 (48 years later) when three quarters of an ounce of lemon juice was added to the standard diet of British sailors. (p19) (This is the reason why British sailors were called ‘limeys’ and why Britain won the battle of Trafalgar and ruled the seas throughout the 19th century, as British naval crews were the only ones not to be debilitated by scurvy)

b) Alexander Hamilton did a clinical trial in 1809 which showed that the death rate for patients treated with bloodletting was ten times greater than those who avoided it. Nevertheless bleeding continued to be a standard procedure. France imported 42 million leeches in 1833. As each decade passed rationality began to take hold amongst doctors, and dangerous and useless therapies such as bloodletting began to decline. (p23)

c) Dr John Snow cured the local cholera epidemic in Soho, London in 1854 by taking off the handle of the Broad Street water pump, thereby proving that its cause was contamination of that well. (p112)

d) Florence Nightingale was prioritizing hygiene in 1854 when everybody else was focussed on other things, such as surgery and pills. The officers and doctors felt that these changes were an insult to their professionalism, and fought her every step of the way, but she pushed ahead regardless. The death rate fell from 43% to 2%. (p27)

e) Hill and Doll showed in 1954 that smoking was a surprisingly deadly indulgence, and moreover produced data that stood up against the powerful interests of the cigarette industry. (p36) However, it took until 2007 (53 years later) for smoking to be banned in public buildings.

1.10 Doctors’ duty of care to staff and patients
GPs are risking their livelihood by being struck off the register if they refer their patients to CAM therapists at present because BMA Guidelines to GPs dated May 2009 state: ‘You must be satisfied that any healthcare professional to whom you refer a patient is accountable to a statutory body or employed within a managed environment. (my emphasis) If they are not, the transfer of care will be regarded as delegation, not referral. This means that you remain responsible for the overall management of the patient, and accountable for your decision to delegate.’ ….. ‘Referral’ means handing over (usually temporarily) some or all their responsibility for the patient. ‘Delegation’ means that they share responsibility for co-management of the patient.’

Dentists, opticians and pharmacists are employed within a managed environment’ which enables GPs to safely refer their patients to dentists for dental care, opticians for glasses, and pharmacists to cash their prescriptions. GPs are themselves employed in a managed environment by practices who are employed by the PCT.

The reason why GPs cannot refer patients for free CAM is because CAM therapists are not ‘employed within a managed environment’ This is what the proposed company will provide. CAM therapists will be employed by registered CAM centres, who in turn will be employed by the company. This managed environment will be statutorily regulated (as the PCT is now) so that the doctors can refer their patients with confidence without risking being sued or struck off the register.

1.11 Public expenditure on CAM treatments on staff and patients
The official NHS policy on CAM is that no public money may be spent on it. However University College Hospital in London has had a complementary therapy unit in its cancer centre since 1999 which now includes reflexologists, massage and aromatherapy as well as healers. (see http://www.fih.org.uk/integrated_health/integration_in_practice/nhs_healer.html Many other hospitals have done the same, including Guildford, Walsall, Southampton. Many doctors, managers and the Department for Work and Pensions are clandestinely breaching that policy because it works to cure the patients’ conditions, and health ministers are supporting them, as described below:

a) Many doctors are qualified as CAM therapists (such as homeopaths, acupuncturists, osteopaths) and use CAM in their consultations.

b) Under the Active Exercise programme GPs are giving free membership of gyms to patients to have supervised exercise, despite the fact that this is a referral or a delegation to unknown instructors.

c) For the last 3 years a charity called Active Lightworks have been sending CAM therapists into the Royal Sussex County Hospital to treat staff with aromatherapy massage to relieve stress for donations.

d) Unemployed people are being given free courses of holistic therapy of their choice to help them to get fit so that they can return to work and reduce the number of people on disability benefit (paid to 2.5 million people at present, which pro rata is 12,500 in the city)

e) Health Minister, Mike O'Brien said on 1.12.09 when being quizzed by the House of Commons Select Committee on Science and Technology: 'We take the view that it is not our job to stop clinicians prescribing these medications (CAM) if they feel they are appropriate……. NHS homeopathy is practised by trained doctors who have to take responsibility for what they do.’

The proposed company would provide a vehicle to regularise these precedents and integrate them into the normal functioning of the NHS.

1.12 Reducing staff sickness in NHS
NHS staff sickness levels are appallingly high at 5%, which is 50% worse than the national average of 3.3%. If the NHS cannot keep its staff healthy, what chance have its patients got of keeping healthy? The Boorman report on staff sickness was accepted by the government on 1.12.09. It requires the NHS to bring their staff sickness rate down by 1% to 4% and save 3.5 million days lost pa.

The problem is that the NHS do not know how to do this. This new government target will stress staff even more, as it will be interpreted that they are now not allowed to go sick, precipitating burnout. This risks cascade failure of whole departments as the remaining staff try to keep going short-handed. Conventional medicine cannot solve the problem of staff sickness because it is the problem. The solution lies in thinking outside the box, to CAM.

The first principle of health dating from the ancient Greeks, Asclepius and Hippocrates is ‘physician heal thyself’. The proposed company will provide a managed environment for CAM therapists to be openly paid for by the NHS as part of the national health service, but who should the company treat first?.

The healthcare staff themselves are the highest priority because they are responsible for the health of the rest of the community and sick staff are a bad advertisements for the NHS. Furthermore, this transformation of public healthcare has to start with the commissioners. To be effective in life, everyone needs to walk their talk. Commissioners need to experience first hand the benefits of CAM to speak and write with conviction to influence providers to provide CAM through the company.

The commissioners number about 200, located in Prestamex house, 171, Preston Rd Brighton. We are willing to organise a mini pilot scheme for them at spare rooms at that site, putting on such CAM treatments as aromatherapy, reflexology, reiki, meditation. They can then feel the effectiveness of this, before deciding to put it into their commissioning plan for the city.

Assuming that they do, there are about 7,800 other NHS healthcare staff in the city, of which about 5,000 work at the Royal Sussex County hospital. If each member of staff was given 1 CAM voucher every week, this would require 8,000 vouchers per week, or 80 per week per CAM centre, 15 per day. 0.4 million pa. This is 50% more than the figure in the budget for year 5 (10 vouchers per day in 2015)

1.13 Who should the company treat next?
If free CAM works as we believe it will, many other classes of people will be clamouring for vouchers. There are many thousands of other public service staff who are near burnout in the ambulance service, local government, police, teachers, postmen. There are 12,500 unemployed on disability benefit who cannot work because of sickness. There are 40,000 with long term conditions. Sorting out the priorities for treatment is a decision for government, but the highest priority is the healthcare staff. Only when the Boorman target is met should the CAM service be expanded to treat the rest.

There are about 12,500 on disability benefit, who if given 1 voucher per week would require the entire budgeted output of year 6 (2016) of 20 vouchers per centre per day. There are a similar number of other public sector staff (local government officers, police, teachers). They also should be offered free CAM on the NHS.

The early drafts of this business plan diverted 25% of the health budget to prevention by CAM by 2020, but if this proposal works the public will not want to wait that long. There will be great public pressure on the company to accelerate the programme, so we have brought that forward to 2014. We would recommend at least 50% being diverted by 2020, but the rate of expansion should be an issue for public debate as the scheme develops.

1.14 How would the scheme work?
About half the GPs already provide free exercise classes under the Active Life Exercise Referral Scheme. This would be an extension of that scheme.

a) The GP sees a patient, and both agree that the patient’s care plan should include CAM. There is no need to specify which type of CAM or where. It is part of the therapy that patients (or their carers) take responsibility for themselves in choose the therapy, the centre and the therapist, rather than just being passive recipients, like children. The patient must believe in the treatment and the ability of their therapist for it to work. (placebo effect)

b) The GP gives the patient one or more £50 vouchers stapled together in a book and writes the patient’s name on each voucher, preferably by printing a label on his computer and sticking it on to the vouchers.

c) The patient can contact a manager (gatekeeper) in the Company for free advice on which complementary therapy would be best for them, and which centre could best provide it.

d) The patient contacts the receptionist at the centre of their choice, and discusses which treatment, which therapist, and their availability.

e) The patient books the session(s) and tenders the voucher to the receptionist as payment in advance. If the voucher value does not exactly equal the cost, the patient may make up any shortfall in value in cash, but may not exchange the voucher for cash, nor be refunded for any overpayment in value.

f) The receptionist writes the appointment and the therapist’s name on the voucher, files it, and enters it on the centre’s computer. On a set day of the month as determined by the company (to stagger the workload of the company staff), the receptionist fills in a proforma invoice claiming the value of all vouchers received, and e mails it to the company. Patients that do not attend, (‘no shows’) count as sessions taken and have to be paid for, as in other NHS providers.

g) The company staff process the proformas, and invoice the PCT monthly according to the agreed tariff, say £55 per voucher of £50 face value’s worth of complementary therapy, including a 10% handling fee of £5.

h) The company staff keep the administration fee (of £5 per voucher) and pay the remainder (£50) to the centre’s bank account by bank transfer.

i) The centre manager keeps the room hire and administration part (say £12) and pays the remainder (say £38) to the therapists who did the treatments, with the objective of therapists being paid within 2 months of doing the treatment.

j) Sufficient numbers of managers will be employed to handle the enquiries, and sufficient numbers of clerks will be employed to process the vouchers.

1.15 Draft Voucher
Vouchers would be printed like lottery tickets with numbers to prevent forgery. Each voucher would have a nominal face value of say £50, which can buy approximately 1 hour of one to one therapy or 6 hours of class or group therapy, at typical going rates at centres. The GP would issue vouchers singly if he thinks that the patient should do a class (say a yoga course), or in books of say 6, if he thinks that 6 sessions of one to one therapy are indicated (say of physiotherapy) Further books could be obtained if needed, like repeat prescriptions.

COMPLEMENTARY THERAPY VOUCHER FOR £50 This voucher entitles Mr/Mrs/Ms………………………………………….Of………………………………….. …………………………………………………………………………………………….. Contact telephone…………………………..E mail…………………………………….. To have £50 worth of complementary therapy sessions with any centre registered with the Company, as listed on the reverse side of this voucher The Company’s registered address is 22, Saxon Rd Hove BN3 4LE, 01273 417997, e mail johnkapp@btinternet.com, website www.reginaldkapp.org. Voucher issued by GP practice……………………………..on………………….. date Voucher cashed at ………………………………..centre on ………………………..date With …………………………………………….therapist for …………………..therapy

1.16 Entry criteria for centre registration
The prospective entry requirements for registration with the company would be approximately as follows as a draft. They are subject to discussion, and may be amended and agreed by meetings of the centres registering from time to time. The PCT commissioners will probably have clinical governance criteria that they wish to be incorporated into the Service Level Agreement contract, which may augment these criteria that the company decides (see part 4.4a, SWOT below).

The registered centre shall:

a) Offer a health service to the whole community. The model for this is the old family GP or dental practice, but it does not have to be the expensive modern versions of these.

b) Have an address in Brighton and Hove where clients shall be treated.

c) Be open for business for at least 40 hours per week, including some evening openings until at least 8pm.

d) Be appropriately equipped for the treatments offered, and be subject to spot inspection by the company, the commissioners’ staff and others.

e) Employ a receptionist on the premises throughout the opening hours who shall take bookings from potential patients in person, on the phone and by e mail.

f) Employ a business manager who shall deal efficiently with the company’s administration staff, mostly by e mail, phone and bank.

1.17 What CAM therapies would be offered by the company?
To help patients to choose what CAM therapies are available, the company would publish a directory of their registered centres and the therapies they offer in hard copy and on a website. The following is a guide to what could be in it:

a) One to one therapies
The most popular CAM therapies presently offered are physiotherapy, osteopathy, chiropractic, acupuncture, cranio-sacral therapy, colonic hydrotherapy. psychotherapy, hypnotherapy, NLP, counselling, psycho kinesiology, nutritional therapy, herbalism, homeopathy, reflexology, aromatherapy, shiatsu, Alexander Technique, Emotional Freedom Technique, (EFT) Eye Movement Desensitisation Reprogramming, reiki, astrology, rebirthing.

b) Groups
The most popular group classes are exercise classes, keep fit, weight watchers, yoga, pilates, tai chi, chi gung, meditation (Buddhist, Brahma Kumaris, Transcendental, Osho)

c) Educational Classes
The availability of public funding would encourage the provision of educational classes in self-help (such as diet and nutrition, lightning process, family constellation, vortex healing, astrology) and self-help groups for long term conditions, such as asthma, diabetes, cancer, heart disease, ME/Chronic Fatigue Syndrome.

d) Other therapies, groups and classes
The above lists are not exhaustive, and the Company would not exclude any CAM therapy or class that a registered centre might wish to offer. CAM therapies and classes are developing all the time, and registered centres would be encouraged to offer the latest treatments available.

e) NICE approved treatments.
Under clause 4.12 of the NHS constitution, patients have a statutory right to free treatments which have been approved by the National Institute for Clinical Excellence (NICE) provided that their GP confirms that it is appropriate for them. NICE approved CAM treatments would therefore have a star rating in the company’s literature. The commissioners are constitutionally required to provide these treatments free at the point of use.

Under extended rights presently being consulted (see 4.3g below) they may also have to provide them by a stated maximum waiting time, such as 18 weeks. The following CAM treatments are NICE approved, so should be offered free to patients as a constitutional right. Under the present administrative arrangements the NHS cannot meet this constitutional right of patients. However if this proposal is adopted they can do so. The following CAM treatments are NICE approved:

i) The 8 week Mindfulness Based Cognitive Therapy (MBCT) course for depressed patients as an alternative to antidepressant drugs.(see f) below)

ii) Hypnotherapy for Irritable Bowel Syndrome (IBS)

iii) Alexander Technique for back pain (since 2009)

iv) Acupuncture for pain relief

1.18 Mental health service
The mental health ‘service’ is presently a mis-nomer, as the service is not worthy of the name. Drug treatments have been discredited (The Secretary of State for Health, Patricia Hewitt MP announced in May 2006 ‘the end of the Prozac nation, see 4.3a) Although 10,000 extra CBT therapists have been recruited the waiting list for talking therapies is still over a year, and CBT is not suitable for every patient.

As mentioned in 1.17 e) above, the 8 week MBCT course is NICE approved so patients have a statutory right to it free. Mental health services would be transformed if the MBCT course was provided wholesale to everyone who wanted it. This proposal enables it to be offered as widely as facilitators are available to provide courses. It is immediately available in the city to those who can pay the going prices (about £190, reduced to £ 80 for concessions) The number of facilitators offering courses is estimated to be about 20, and the estimated number of course participants is about 200 per year.

A mental health service worthy of the name could be created if every CAM centre put on 15 MBCT courses pa for 20 patients per course, totalling 300 participants pa per centre. The 100 centres in the city would treat 30,000 participants pa. Some patients might need to repeat the course annually. New facilitators could be recruited by sending meditation leaders on the one week teacher training for this course. For further details of this, together with a business plan, see paper ‘Improving Health by Ending the Prozac Nation’ published as section 9.28 on website www.reginaldkapp.org.

Part 2 Budget for the company

2.1 Summary of benefits of this scheme in 2020
The benefits of this scheme are summarised in paragraph 1.6 above, which show that by 2014 the scheme could reduce by half the present high and increasing rates of alcoholism, drug taking, smoking, suicide, and long term chronic illness which presently afflicts 1 in 3. Mental and physical health would generally be improved, reducing hospitalisation and GP visits to half the present rate.

2.2 How will demand rise for free CAM on the NHS?
The CAM profession is not organised, so figures are not available for demand for CAM. However the House of Lords Select Committee report on CAM published in 2000 estimated that £1.6 billion pa was spent on CAM in UK at the time of writing. If this was spent by 10% of the population who can afford it, (6 million people) the average spent on CAM was then £270 per person pa. After allowing for inflation this is about £400pa, or about £1 per person per day. The government want the NHS to prevent illness, so it would seem reasonable to budget £1 per head per day of public money to prevention of long term chronic conditions in later life. If this sum was provided to all the 250,000 people in Brighton and Hove, it would cost the NHS commissioners £100 mpa. This is the value of 2 million vouchers pa at £50 per voucher. This amount is called the ‘target CAM demand’.

The target CAM demand of £100 mpa or 2 million vouchers pa will take time for everyone to adjust to this new integration of CAM into the NHS. We originally created the forecast to reach this target in ten years time, in 2020, but subsequently accelerated the programme to reach that in 5 years time by 2014.

We assume that this proposed scheme will start in 2011 with a low demand at 2 vouchers per centre per day. This is just a ‘nice little earner’, raising £33,000 pa for each centre, and £330,000 pa for the company. Thereafter, demand is assumed to quadruple each year for 4 years, to reach the ultimate CAM demand figure of 60 vouchers per centre per day in 2014. This would raise £1 mpa for each centre, and £10 mpa for the company. The assumed growth in demand each year is shown in table 2 below, with previous annual figures for the slower growth left in as intermediate figures.

TABLE 2 ASSUMED RISE IN DEMAND FOR CAM VOUCHERS

PER CENTRE					WHOLE COMPANY
Year and Calendar year	Number of vouchers per centre per day Vpd	Value of vouchers per centre per day £pd	Number of vouchers per centre pa Vpa	Value of vouchers per centre pa £kpa	Number of vouchers thousands pa kVpa	Value of vouchers @£50 per voucher £mpa	Value of admin. fees @£5 per voucher £mpa
1     2011	2	100	660	33	66	3.3	0.33
	4	200	1,320	66	132	6.6	0.66
2     2012	8	400	2,660	132	264	13.2	1.32
	10	500	3,300	165	330	16.5	1.65
3     2013	20	1000	6,600	330	660	33	3.3
	30	1500	10,000	500	1000	50	5.0
	40	2000	13,200	660	1,320	66	6.6
	50	2500	16,500	825	1.650	82.5	8.25
4     2014	60	3000	20,000	1000	2,000	100	10

2.3 Budget assumptions about the first year of operation, calendar year 2011

a) Abbreviations: V= number of vouchers. K= kilo, thousands, m=mega, millions.
b) The number of registered centres will be 100.
c) The company staff will comprise two managers at £40kpa and 4 clerks at £25kpa (total staff 6, cost £180kpa) Overheads of office rental, services, business rates, etc are assumed to equal the costs of staff. Total company cost for 6 staff is £360kpa for first 2 years.
d) Each centre receives on average: 1 voucher per day, 6 per week, 330 pa. e) Total vouchers managed by the company: 100 per day, 600 per week, 33kpa, of face value £1.65 million pa
f) Tariff price to the NHS for each £50 voucher is £55, which is paid by the PCT to the company, who distribute it as follows:
g) The company pays the centre £50, keeping £5 as administration fee.
h) The centre distributes the £50 as they see fit, but it would seem reasonable to keep a room hire and administration fee of say £12 and pay the therapist £38 which is a reasonable take-home going rate per hour for CAM therapists.
i) Turnover of company for 33,000 vouchers pa @ £55 per voucher = £1.65 mpa
j) Total administration fees for 33,000 vouchers pa @£5 = £165kpa
k) Revenue £165k minus costs £360k = loss of £195kpa.
l) Staff work 1,700 hours pa. Average staff time for 4 clerks to process each voucher @ 33kVpa over 6,600 hours pa is 12 minutes per voucher in the first year, and 6 minutes in every succeeding year.(The details of this are given in 2.4 below)
m) Centres are open for 330 days pa.

2.4 Number of staff required
The first year demand is 200 vouchers per day (66,000 pa) We assume that 2 managers, (one a deputy to the other), will be required to handle the enquiries from patients. If every voucher gave rise to an enquiry, (as it may do in the first year) each manager could give 4 minutes to each enquiry. We assume that 4 clerks will be required to process the vouchers, taking 6 minutes per voucher per clerk.

In every subsequent year, we increase the number of managers and clerks in proportion to the increase in number of vouchers handled. This assumes the same enquiry time of 4 minutes per voucher per manager, and an administration time of 6 minutes per voucher per clerk. However, the number of enquiries per voucher will decrease as the public become used to the system.

2.5 Company Budget
The budget is appropriate to the scale of the services demanded. Figures are in £ thousands pa (£kpa) . The word ‘staff’ includes the manager and assistant managers at a ratio of 2 clerks per manager, averaging £30kpa per member of staff employed.

TABLE 3 BUDGET COSTS, REVENUES AND SURPLUSES FOR FIRST 6 YEARS

Year number & calendar Year	No of vouchers per centre per day from table 1	Staff number on payroll	Staff cost £kpa	Overheads £kpa	Total company costs £kpa	Revenue @£5 per voucher from table 1 £kpa	Surplus (deficit) £kpa
1     2011	2	6	180	180	360	330	(30)
	4	11	330	330	660	660	0
2     2012	8	21	630	630	1,260	1,320	60
	10	26	780	780	1,560	1,650	90
3     2013	20	52	1,560	1,560	3,120	3,300	180
	30	78	2,340	2,340	4,680	5,000	320
	40	104	3,120	3,120	6,240	6,600	360
	50	130	3,900	3,900	7,800	8,250	450
4     2014	60	156	4,680	4,680	9,360	10,000	640
5     2015	60	156	4,680	4,680	9,360	10,000	640
6     2016	60	156	4,680	4,680	9,360	10,000	640

2.6 NHS budget
The effect on the NHS budget will be a cut in total expenditure of 20%, by halving the cost of conventional treatment and allocating £100 mpa to prevention, as shown in the appendix at the end of this document

2.7 What should the administration fee be?
It is difficult to estimate how much advice patients will need from managers, and how much time clerks will need to process the vouchers. The staffing levels depend on the amount of staff time allocated to this. The above estimate of 8 minutes per enquiry per manager, and 6 minutes per voucher per clerk in the second and subsequent years may be inadequate in the early years before people get used to the new treatments.

If staff time to handle enquiries and vouchers were doubled to 16 minutes and 12 minutes respectively, the number of staff would need to be doubled throughout the whole forecast. To pay for the doubled costs, the administration fee would need to be doubled to 20% or £10 per voucher.

For simplicity the above budget assumes a constant administration fee of £5 per voucher (10% of its face value) throughout the 6 years of the forecast. In practice, if this scheme is implemented, it would be prudent to start the scheme at an administration fee of 20%, £10 per voucher, which allows for twice as many staff at the beginning. It is better to have too many staff than too few, because if the company is understaffed the patients will not have a good experience, prejudicing the sustainability of the scheme. As patients and staff get used to free CAM, economies of scale will probably occur and staff would get more efficient in giving advice and handling the vouchers. Less staff would then be needed, and the administration fee could then be reduced in increments to 10% or £5 per voucher.

2.8 Start-up costs
To start up this company the SEATC committee will need hire well qualified people, (who could be management consultants) to do the following tasks: set up the company, register it with the authorities, find a suitable office premises, negotiate and sign the SLA contract with the NHS commissioners, negotiate with and register the CAM centres, print the vouchers, appoint the directors, advertise for staff, interview and appoint them. We estimate that this will require the services of 2 experienced people (a manager at £40,000 pa and an assistant manager at £30,000 pa) for 9 months at a cost of £50,000 for salaries and accommodated in an office, £100,000 for overheads, total £150,000.

We have been advised that start up grants for innovation projects such as this one are available from:

a) The Social Enterprise Investment Fund (who have £100 million to disperse over two years) We are advised to apply for this through Future Builders.
b) The Regional Innovation Fund, from our South East Coast Strategic Health Authority, who has £2 million to invest each year.

We intend to apply for a start-up grant for this scheme soon.

2.9 Proposed timetable
The following dates are the most optimistic possibilities for the actions of the SEATC group committee:

a) In Jan 2010 we will apply for a grant for this start-up sum of £150,000.
b) in Feb 2010 on its receipt we will recruit the start-up manager and deputy manager (perhaps through recruiting management consultants).
c) In April 2010, the start-up manager and deputy will start the work outlined above in 2.7.
d) In January 2011 the company will open its doors and start trading.

Part 3 Draft Constitution of the SEAT Company (Memorandum and Articles, Terms of Reference)

3.1 Name
The name of the company shall be the Brighton and Hove Social Enterprise Alternative Therapy (SEAT) Company, hereafter abbreviated to SEATC or ‘the company’. Another name may later be decided as the proposal develops, such as: the Brighton and Hove Social Enterprise Complementary Therapy Company (SECTC) or Brighton and Hove Complementary Care Trust (CTC)

3.2 Purpose
The purpose of the company shall be to promote wellness and prevent illness to the citizens of the city of Brighton and Hove, hereafter abbreviated to ‘the city’. (As the government want to integrate health and social services, the purpose could include ‘reduce unemployment’.)

3.3 Aim
The aim of the company shall be to contract with the city NHS commissioners under a Service Level Agreement (SLA) to provide complementary and alternative medicine (CAM) including one to one therapy, group therapy and educational classes, free at the point of use, at registered centres of the company in the city.

3.4 Objectives
a) To provide free CAM for NHS patients at all registered centres.
b) To invite all CAM centres in the city to become registered centres of the company.
c) To supply vouchers for CAM to all GP surgeries and other gatekeepers to issue to patients, which may be exchanged for free CAM at any registered centre.
e) To create an administration to pay CAM centres and therapists in arrears for the CAM treatments provided, preferably within 2 months.
f) To promote free classes and groups at registered centres to educate patients in self-help techniques.
g) To publish a directory of registered CAM centres and therapies in a website and in hard copy to publicise what is available.

3.5 Powers of the company
a) To contract with the city NHS commissioners as an agency on behalf of all registered centres.
b) To hire an office, advice centre, open a bank account, and employ staff.
c) To take such other powers as are necessary to fulfil the above purpose, aims and objectives.

3.6 Organisation of the board of the company
a) The Company shall be run by a board of 12 directors, 6 of whom shall be appointed by the SEATC Group committee, and 6 by the NHS commissioners, annually at an Annual General Meeting (AGM)
b) All meetings of the board shall be held in public. The proceedings shall be transparent and open, and the minutes shall be published.
c) Members of the public may submit written questions to the board at every board meeting, which shall be answered publicly.
d) The board shall engage and employ a chief executive officer (CEO) who shall manage the company.
e) The CEO shall engage and employ such deputy managers and staff as he/she shall from time to time require to efficiently provide the services for which the company is contracted.

Part 4 Strengths, Weaknesses, Opportunities, Threats. (SWOT) of CAM and this company voucher scheme if this project were implemented

4.1 Strengths of this proposal
a) Meeting government policy objectives

i) Relocation
The white paper of 2006 called for the relocation of healthcare from hospitals to community health centres. This project would provide healthcare in the 100 CAM health centres in Brighton and Hove.

ii) Removing health inequalities.
Government want to remove health inequalities, particularly from people on benefit and those from the most disadvantaged communities. CAM is a popular and growing alternative health service, but at present it is restricted to those with ability to pay. (about 10% of the population) This proposal will remove health inequalities by opening up CAM centres to everybody in the community, irrespective of their ability to pay.

iii) Patient choice
The keynote statement from ‘Choice at referral – guidance framework for 2006/7, dated 27.4.06, is ‘Choice is not alien, but an intrinsic part of the discussions that GPs have with patients to find the most appropriate care’. This proposal delivers to patients the most important choice of all – choice of treatment

iv) Prevention
The Darzi report of July 2008 called for the NHS to prevent illness and promote wellness. This project would meet this objective by integrating CAM, which prevents disease by relieving stress, (the cause of dis-ease) before it becomes disease.

v) More healthcare staff
The Wannless report called for a third more doctors and two thirds more nurses by 2020 to end the NHS staffing crisis. By 2020 this project will add about 50% to the city’s healthcare staff by adding 4,000 CAM staff to the present 8,000 conventional staff.

vi) Quality
The DoH is presently consulting (closing on the 10.12.09) on their new requirement for NHS providers to produce Quality Accounts from April 2010 and April 2011, which focus on safety, effectiveness, and patient experience. This project meets these objectives as follows:

vii) Patient Safety
This is a subject which is high on the political agenda. CAM treatments are safe because they are gentle and non-invasive. There have never been any iatrogeninc (doctor induced) deaths or maimings from any CAM intervention. (unlike conventional medicine, see 4.1c) below). Recommendation 8 of a recent DoH directive states:

"Accountability for patient safety rests with the Chair and Board of each NHS organisation. Each Board should therefore be expected to outline how it intends to discharge this responsibility. Importantly, each Board should also make clear how it intends to ensure that patients and carers play an integral part in all initiatives to introduce a patient safety culture change within the NHS." The writer of this business plan has been a patient representative for the last 10 years.

viii) Effectiveness
Effective treatments are those which cure the condition. CAM is effective in curing patients (unlike conventional medicine) because it addresses the cause of their disease. This is stress between the ambitions of their mind (as manifest in their lifestyle) and the ability of their body to cope with that lifestyle. CAM delivers effectiveness through its active ingredient - meditation (an altered state of consciousness) in which patients become aware of why they are making themselves ill through stress, change their belief, attitude and lifestyle to relieve the stress, which allows their body to self-heal.

ix) Patient experience.
CAM gives good patient experience by empowering patients to take responsibility for their own health. CAM therapists have empathy with their clients because they have previously suffered similar symptoms, have discovered how to cure themselves, and became a CAM therapist to share their understanding of their experience.

x) Welfare to work
The Department of Work and Pensions (DWP) are also consulting at present on the welfare reform bill, which aims to reduce the £100 bnpa cost of working-age ill health, and the 2.6 million now on incapacity benefit, 40% of whom (1 million) have mental health conditions. This is thought to be structural unemployment disguised as disability, which is rightly thought to be curable. Stress, anxiety and depression are a significant cause of work related problems, and non-work related sickness absence. The government’s solution is the commissioning of outside providers (consortia of private companies) to support these people back into the workplace. Our proposal is just what the government wants. Our proposed company is a consortium of existing private companies which can help to cure stress, anxiety and depression, and hence help people back to work. Dr Steve Feast of DWP is speaking about this at the Future of Welfare to Work conference on 1.12.09.

xi) Avoiding privatisation.
This proposal is not privatisation of the NHS because social enterprise companies have to plough back their profits, and are transparent and accountable, so cannot pay out big bonuses.

xii) NHS engagement with Local Involvement Networks (LINks)
The DH is issuing a call for health and care professionals to proactively engage with their LINk, as they are having a positive effect on services including reducing waiting times, improving standards and increasing accessibility. (Gateway reference number: 13208) 10.12.09 see www.nhs.uk/links Action: PCT chief executives will wish to review their understanding of the role of their LINk and contribution they can make in improving services and facilitating communication between the PCT and the local community. The SEATC secretary writing this (John Kapp) is an active member of LINks, and represents Sussex on the National Association of LINk Members (NALM)

b) Integration of CAM into conventional medicine
This is the aim of the Prince of Wales charity ‘Foundation for Integrated Health’ (www.fih.org.uk) which has been campaigning for more than a decade. Despite excellent arguments, this aim has not been realised because no-one has solved the administrative problem of paying public money for CAM. This proposal solves that problem, and puts CAM on an equal footing with primary and secondary care, dentistry, opticians and pharmacies. Prince Charles gave the keynote speech to the World Health Organisation in May 2008, attended by all the health ministers of the world. He called for the integration of CAM into conventional medicine. This has given rise to integrated health departments, chairs and degrees (such as those given by the Universities of Westminster and Buckingham) now replicated all over the world.

c) SHA support for innovative schemes to improve the NHS
The inspiration for this proposal occurred to the writer at the DoH innovation exhibition 18-19th June 2009, as described in his paper ‘Integration of CAM into the NHS via Social Enterprise Alternative Treatment Companies’ published on section 9.38 of www.reginaldkapp.org. We have already received advice from Dr Alan Kennedy and Mr Joop Tanis of the Strategic Health Authority (SHA) who are engaged to support innovative schemes like this one through their gestation and teething problems.

d) The public prefer CAM to drugs
The public prefer CAM because it empowers them to create health and prevent illness, (unlike drugs which usually just suppress symptoms) CAM is based on the holistic paradigm of treating the whole person in body, mind, spirit and environment. It gives patients a healing environment in which they can take responsibility to heal themselves by addressing and removing the cause of their illness, which is stress in their mind.

Conventional medicine is based on the materialistic, reductionist, mechanistic paradigm which treats only the body by cutting, burning or poisoning. It does not address the cause of their disease, which is in the mind. By suppressing the symptoms, drugs prevent self-healing, and have side effects which can seriously damage your health and even kill you. Iatrogenic (doctor-induced) illness has become the biggest single killer in the USA (mostly from adverse drug reactions) with 800,000 iatrogenic deaths pa, compared to 700,000 deaths pa from heart disease and 590,000 deaths pa from cancer (www.garynull.com/articles ‘Death by Medicine’)

e) CAM has the soundest evidence base, and some have NICE approval
Contrary to drug company propaganda, many CAM treatments (such as meditation and touch therapies) have an evidence base going back thousands of years, whereas the oldest drug (aspirin) is only about 110 years old. The proof that CAM treatments work is that the public continue to pay for them in increasing quantity, in spite of playing uphill against free drugs. Some CAM therapies are NICE approved, such as Mindfulness Based Cognitive Therapy (MBCT) as an alternative to anti-depressant drugs such as Prozac, (see 1.6e above) acupuncture, cranial osteopathy, Alexander Technique for back pain. Many CAM therapies are being researched, with prospect of more becoming NICE approved. Under the NHS constitution, patients are entitled to free NICE approved treatments provided their GP says it is appropriate. This proposal will make it possible for patients to have NICE approved treatments paid for by the NHS in accordance with the constitution.

f) The public like vouchers
Luncheon vouchers were big business in the 1970s. The rise of the Transition town movement has recently given prominence to voucher schemes, such as the ‘Totnes pound’.(see www.transitiontowns.org/totnes) and LETs schemes. The innovative idea in this proposal is to use vouchers to enable the NHS to pay for CAM in the community as a practical solution to the problem of breaking bulk in a fragmented CAM market.

4.2 Weaknesses of this proposal
a) CAM’s holistic paradigm is not recognised by conventional science
Doctors used to be taught at medical school that CAM is quackery practiced by charlatans. This attitude was acquired during the reforms leading to the creation of the General Medical Council in 1853 which is maintained out of habit. The old guard of doctors are therefore prejudiced against CAM which blinds them so that they cannot see the evidence. For example, Prof Edzard Ernst (chair of complementary therapy at Exeter University) wrote a book in 2008: ‘Trick or Treatment – Alternative Therapy on Trial’, which he claims to ‘deliver the ultimate verdict with clarity, scientific rigour and absolute authority. …Most UK doctors consider it (CAM) to be little more than superstition and a waste of money…..Our mission is to reveal the truth’. He rubbishes CAM, and even says that ‘there is no evidence whatsoever for the existence of innate intelligence or its role in health’ (p147) or for ‘a vital force’.(p104) (My review of this book is published in section 9.26 of www.reginaldkapp.org)

Who is out of step? Conventional medicine is based on conventional science which is based on the materialist, reductionist, mechanist paradigm (underlying belief system) Materialists believe that only the body is real, and that it is a machine. Spirit, soul, mind, intelligence, and even life are illusions or delusions. It is therefore not surprising that conventional medicine cannot accept CAM which is based on the holistic belief that spirit creates life, which creates mind, which creates body. A dis-eased mind created a diseased body. A healthy body requires a mind which is at ease with itself. Healing means dropping negative beliefs and attitudes, which can only be done by going beyond the mind in meditation, allowing the body to cure itself.

The old guard’s Victorian attitude to CAM is no longer scientific, because the new sciences of psycho-neuro-immunolgy and neuro-physiology confirm that the body’s physiology depends on what the mind believes and thinks each moment. There is now a huge literature and evidence base for this mind/body view, including books by many eminent doctors such as Dr Deepak Chopra and Dr Bernie Siegel.

Recent experiments in quantum physics now proves the existence of another world outside physical space time, known as ‘non-locality’, and ‘entanglement’ of particles. The mechanism by which CAM works in unblocking the flow of the life force is well explained by quantum physicist Prof Amit Goswami’s book ‘God Is Not Dead’ (2008) using Dr Rupert Sheldrake’s concepts of telepathy by morphic fields, published in ‘A New Science of Life’, (1981 revised 2009) They believe that spiritual and mental energy is waves which collapse into particles of matter when observed by consciousness. (A review of these books by me will be published in Scientific and Medical Network Review in Dec 09)

b) Some CAM lacks regulation and clinical governance
CAM comprises dozens of different types of treatment. Some of these have professional qualifying bodies and learned societies to regulate them, such as physiotherapy, osteopathy, chiropractic, and acupuncture. A further 12 CAM professions are presently negotiating with the government to become state registered and recognised. Some CAM therapies (such as reflexologists, homeopathy, reiki, meditation) have several rival professional bodies competing for members. The government want competing regulatory bodies to amalgamate into a single body to represent the whole profession, but some members are resistant to that, remaining loyal to their old institution. There is British Register of Complementary Practitioners.

There are some CAM therapies which have recently been adopted in the west which do not yet have recognised qualifying bodies, such as Bert Hellinger’s family constellation therapy developed from shamanism. It has been found effective in healing individuals, families and societal wounds, such as holocaust, slave trade, apparteid. This is sweeping Germany, Spain, South Africa and elsewhere. The innovative process for developing this healing modality could not have happened if it had been regulated.

The lack of scientific and medical recognition of CAM has hampered the development of effective regulation to protect the public against cowboys. The more that public money becomes available for CAM, (such as by the implementation of this proposal) the easier it will be to get CAM therapies better regulated. However, the need for public protection is not as necessary as in conventional medicine, for reasons given in 4.4a) below.

c) Not all CAM therapists are professional
Being professional costs money, and making a living as a CAM therapist is not easy. Some CAM therapists see only a few clients a week, so make hardly enough money to live on. Some cannot afford to rent a room in a centre, so treat clients in their home. The centres listed below are small businesses, usually converted homes with a few therapy rooms hired out to other CAM practitioners, who work freelance, renting a room as and when a client books them. Some CAM therapists do not belong to a professional body. Some do not keep up to date with continual professional development (CPD)

d) The problem of playing uphill against a free NHS
The reason why it is not easy to make a living either as a CAM therapist or a CAM centre proprietor is that the free NHS has devalued the currency of health. People are used to free treatment, so consider £30 for an hour of CAM treatment as too expensive, whereas they readily spend that on a meal out for two, or £200 per hour on a solicitor.

e) Competition between CAM therapists and centres
Difficulty in getting clients (now worse in the credit crunch) has created a competitive attitude among CAM therapists and CAM centres. This makes them see others as rivals. They seldom see them as colleagues with whom they should co-operate for the common good of their profession. Few see CAM as a profession in its own right. There have been schemes to get the NHS to pay for CAM before. For example, about 3 years ago the physiotherapists tried to get the NHS to pay for physiotherapy. We do not know why it was not implemented.

4.3 Opportunities for this proposal
a) The lack of public trust for drugs and paradigm shift to holism.
Repeated doctor and drug bashing in the media for decades has eroded public trust in the safety and efficacy of conventional medicine, eg report by MPs shows that 300,000 are at risk of hospital-acquired infections (Nov 09) Public consultation meetings held by the NHS shows that the public do not generally believe NHS spokesmen. The drug companies rightly see CAM as their principal rival, and have been using their power in the media to rubbish CAM by saying that CAM has no evidence base of efficacy in randomised clinical trials. Although this is true, it is irrelevant as trials are not the only test of efficacy.

The media spotlight has now turned on the evidence base for drugs, which is unravelling. Repeated scandals in news bulletins show that drug trials have been fudged, resulting in the forced withdrawls: Thalidomide c1970 after children were born deformed, Vioxx in 2004 after 300,000 deaths from heart attacks, Seroxat for children in 2007 after many suicides. Report: ‘Prozac doesn’t work’ (Feb2008) despite 16 million prescriptions pa written for it in UK and 40 million pa worldwide. ‘Pfitzer fined $1.5 billion for deception’. (Sept 09) The drug companies have also been publicly criticised for the lavish way that they promote drugs to doctors with free holidays abroad, and paying doctors to ghost write reports on trials for which they have not seen all the data. (Sept 09) 1,800 deaths pa from anti-psychotic drugs ‘chemical cosh’ which benefit only 1 in 5 dementia patients (12 Nov 09)

Books such as ‘Food is better medicine than drugs’ by Dr Jerome and ‘The Great Cholesterol Con’ by Dr Richard Kendrick, expose the problems of drugs. Health service reform is the big issue the USA, from where news bulletins show people at public meetings shouting at each other. There is a battle of belief systems (paradigm) going on - materialist v holist. The vested interests (medical profession and drug companies) are ranged against the public, who are winning the battle of ideas. A paradigm shift is under way which will eventually give CAM the opportunity to take its rightful place as the safest and most cost-effective healing modality, but it will be a long, hard struggle.

b) Opportunity for a marriage between conventional medicine and CAM
A marriage by integration of CAM into the NHS is needed to heal both the NHS, which has been in staffing crisis for decades, and society, which is getting increasingly sicker. The more that a nation spends on public healthcare, the sicker it gets, due to the poison in conventional treatments. In UK we spend 10% of GDP, which politicians of all parties now warn that the nation can no longer afford. In the USA they spend 15%, and as mentioned in 4.1c) above, iatrogenesis (mostly from adverse drug reactions) is now the biggest killer, killing 800,000 Americans pa. A report published in the diamond jubilee of the NHS (2008) showed that the healthiest year in the 20th century for the British people was 1944. There was no NHS, and all available healthcare went to the war-wounded. When doctors went on strike (in other countries) people’s health improved.

Conventional medicine is male dominated, and needs the female sensitivity and wisdom of CAM to moderate it. The time has come for the overwhelmed male conventional therapists and the underwhelmed female CAM therapists to stop shouting at each other like neighbours from hell, get married, co-operate and live happily ever after. Integration of CAM therapists into the NHS will increase the number of public healthcare staff by half as many again, as called for in the Wannless report. Integration of cost effective CAM interventions into the NHS will also solve the NHS funding crisis. The public benefits of this proposal are so great that NHS managers will eventually be forced to take this proposal seriously.

c) Opportunity for collaboration with welfare reform companies
Welfare reform companies (such as A4E, Workdirection, Reedinpartnership) are working towards the government’s objective to get unemployed people into work. Their objectives and ours overlap concerning the 2.6 million nationally who are on incapacity benefit because of sickness. We are contacting these companies to work with them.

d) Real accountability: guidance on the NHS duty to report on consultation
New legislation will come into force in April 2010. The NHS duty to report on consultations will require all PCTs and SHAs that commission services to explain how they have acted upon feedback from patients and the public. ‘Real Accountability’ aims to help the NHS get ready for the legislation. The guidance explains the legal obligations and provides practical help and advice in terms of preparing and publishing reports. This will make it more difficult to consult and ignore.

e) Revolution or evolution: the challenges of conceptualizing patient and public involvement in a consumerist world
This is from the abstract of a new report by Prof Jonathan Q. Tritter, which indicates a change in the paternal attitude of public health services throughout the world giving opportunity for patients to have a say in public health matters.
‘Background Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service user's experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice. Objective This article proposes a conceptual framework for patient and public involvement (PPI) and goes on to explore the different justifications for involvement and the implications of a rights-based rather than a regulatory approach. These issues are highlighted through exploring the particular evolution of English health policy in relation to PPI on the one hand and patient choice on the other before turning to similar patterns apparent in the United States and more broadly.

f) Patient designed services could save the NHS billions
This paper from the National Endowment for Science, Technology and the Arts (NESTA), argues that savings in the NHS could be achieved through radical patient-centred service redesign and more effective approaches to public behaviour change. Allowing doctors and patients to design healthcare services could save the NHS £20bn by 2014. (see www.nesta.org.uk/thehumanfactor)

g) Consultation on the NHS Constitution
This DoH consultation proposes new patient rights to treatment within a maximum of 18 weeks from a GP referral and to be seen by a cancer specialist within 2 weeks from a GP referral, or where this is not possible, for the NHS to take reasonable steps to offer a range of alternative providers; and NHS Health Checks for those aged 40 to 74 to assess their risk of heart disease, stroke, diabetes and kidney disease.
It also welcomes views on areas where the Department of Health believes they will soon be able to offer rights, such as dentistry, evening and weekend access to GPs, personal health budgets, the ability to choose to die at home and rapid access to diagnostic tests.

Following the commitment in Building Britain's Future to strengthen advocacy and redress systems, the consultation also seeks views on the proposed role of the Constitution Champion. Go to the Department of health web site to respond to the consultation by 10th Feb at:
www.dh.gov.uk/en/Consultations/Liveconsultations/DH_108012

4.4 Threats against this proposal
a) Doctors’ prejudice against CAM.
As mentioned in 4.2a) above, the medical profession are prejudiced against CAM. Under their materialist paradigm the only valid intervention is what is done to the body. Mind, spirit, holism are not in their vocabulary. Doctors are the most conservative members of society, so they are the last people to voluntarily accept a paradigm shift to holism, which underlies CAM. (However, this might change in 2011 when the DoH will require doctors to be revalidated.)

It is not managers who run hospitals but doctors. This was the conclusion of Gerry Robinson in the TV series on ‘Fixing the NHS’ in Nov 2007 and ‘One Year After’ in Nov 2008. This proposal can therefore expect opposition from the prejudice of the old guard of doctors, backed up by the vested interests of the drug companies for patients to ‘keep taking the pills’, to maintain their profits.

The biggest threat to this project is that the old guard will pressurise the commissioners (who are managers, but without power over the treatments they commission) to refuse to contract with the company that we create. The NHS commissioners have a monopoly over the spending of public money. Without a contract the company can do nothing. The trump card of the old guard of doctors is: ‘contract for CAM over my dead body’ which can kill this proposal stone dead in its tracks.

b) Refusal to sign a contract for CAM
This threat has already materialised. We received a letter dated 5.10.09 from Darren Grayson, the chief executive of Brighton and Hove NHS stating: ‘we are not intending to commission practice based generic alternative therapy provision at this point in time’. He confirmed on the phone that this letter is intended to shut the door on this proposal for the next 5 years. However, we regard it as a test of our resolve. It has galvanised us into redrafting this business plan in a more robust way and recruiting potential allies to our cause.

We intend to put pressure on Darren to change his mind and come to the negotiating table. His team is required to publish their strategic commissioning plan for the next 3-5 years soon (the present target date is 25th Nov) They then have to consult the public on it. We will then challenge him to justify the absence of generic CAM in it.

We are therefore publicising our scheme in the media and to people who may have an overlapping interest, such as the SHA, DoH. DWP, and companies such as A4e Workdirection, Reedinpartnership. Even if Brighton and Hove NHS do not take up this scheme as a pilot, some other PCT might do so.

We also intend to test public support by a petition as follows:
‘Free complementary therapy on the NHS’,
‘ We, the undersigned, support the proposal for a social enterprise company to contract with the NHS commissioners to provide free complementary and alternative medicine (CAM) vouchers for use in the existing CAM centres in the city, section 9.39www.reginaldkapp.org see Brighton and Hove Council are launching an online petition service on 21.11.09. on ‘Get Involved Day’, when we hope to launch it.

c) Throttling registering centres with red tape and unnecessary expense
As and when the Brighton and Hove commissioners change their mind and come to the negotiating table, new threats will arise. The next threat will be that the old guard will try to kill the viability of this scheme by burdening the registered centres with un-necessary red tape and expense. For example, they may put into the contract the same clinical governance arrangements as prevail in conventional medicine, such as all therapists have to have membership of a state registered professional body, and have expensive professional indemnity insurance.

This is required in conventional medicine because patients’ health is often damaged by their invasive treatments, known as iatrogenesis, - doctor-induced illness, described above. If that happens, patients or their relatives can sue for damages. The risks of being sued are now so high that professional indemnity insurance can cost tens of thousands of pounds pa for doctors.

CAM treatments are gentle and have no side effects or adverse reactions. We have never heard of any iatrogenic death or serious injury from a CAM intervention, nor of any CAM therapist being sued by a client. The worst outcome of CAM is a nil effect. The company will prevent unreasonable clinical governance demands being imposed on registered centres and CAM therapists.

d) CAM centres declining to register with the company
As mentioned in paragraph 2e) above, CAM professions are not used to working together. They may have an attitude of‘ territorial rivalry, such as the osteopaths not wanting to join a body that includes chiropractors or physiotherapists. For the scheme to provide CAM as a community service there need to be at least as many registered CAM centres as GP surgeries (47) If the company does not get enough, it will not be viable. We believe that the prospect of receiving £1 mpa per centre of public money by 2020 will concentrate proprietors’ minds so that all who have suitable premises will register. We assume in the above budget that this is 100.

Part 5 List of CAM centres in Brighton and Hove

No	Name	Address	Phone	Contact and Email
1	Revitalise	86 Church Rd, Hove BN3 2EB	738389	Mr & Mrs R. Brown richardandclare@sky.net
2	The Acupuncture Clinic	143 Portland Rd Hove BN3 5QJ	722422	Chris Dance info@acupuncture-clinic.org
3	Chiropractic Life	88 Portland Rd Hove BN3 5DL	208188	Dr Richard McMinn info@chiropracticlifehove.com
4	Evolution Arts	2 Sillwood Terrace Brighton	204204	Tessa Chisholm/Miranda info@evolutionarts.co.uk
5	Holistic Health Centre	53 Beaconsfield Rd Brighton BN1 4QH	696295	Sally Roberts, Ann Holistichealth2000@yahoo.co.uk
6	Wilbury Clinic	64 Wilbury Rd Hove BN3	324420	Julian Barker ptysan@clara.co.uk
7	Dolphin House Clinic	14, New Rd Brighton BN1 1UF	324790	Sara Plumb info@dolphiin-house.org.uk
8	Dyke Rd Clinic	274 Dyke Rd Brighton BN1 5AE	561845	Steve Guthrie/Mandy Majendie naturalhealth@dykeroadclinic.co.uk
9	Kemptown Osteopathic Clinic	34, Chesham Rd Brighton BN2 1NB	600023	Mark Andrews mark@brightonosteopathy.co.uk
10	Albion Clinic	1 Albion St Brighton BN2 9NE	628221	Jasmin Uddin admin@albionclinic.co.uk
11	Chinese Medicine	49 Queens Rd Brighton BN1 3XB	749977	Dr Sun Doctorsun88@yahoo.com
12	Avicenna Centre of Chinese Medicine	98 The Drive Hove BN3 6GP	776499	Mrs Al-Khafaji/Tracy Black reception@avicenna.co.uk
13	Chinese Herbal Health Centre	7 Trafalgar St Brighton BN1 4EQ	606224	Mark Cai Caisaw@hotmail.com
14	Andrew Kane Clinic	209 Preston Rd Brighton BN1 6SA	555111	Andrew Kane/Lester info@andrewkanecentre.co.uk
15	Anahata Health Clinic	119-120 Edward St Brighton BN2 0JL	698687	Deborah Wolf/Phillip Tucker info@anahatahealth.com
16	Adhara Natural Therapy Centre	11 Arundel House 22 The Drive, Hove BN3 £JD	777464	Sharron Martincramp sharronmc@talktalk.net
17	Brighton Acupuncture Clinic	22 Spring St Brighton BN1 3EF	326896	Susan Truce susantruce@hotmail.com
18	Brighton Bowen Clinic	32 Bates Rd Brighton BN1 6PG	885784	Kirsty Seaborne brightonbowen@yahoo.co.uk
19	Mind and Body Health Clinic	7 Portland Place Brighton BN	670960	Lis Morris lizmorris@live.co.uk
20	The Pathway Clinic of CM	28 Coombe Terrace Brighton BN2 4AD	693259	Tom Sydenham thepathwayclinic@yahoo.co.uk
21	Move Active Meditation Centre	20 Kirby Drive Peacehaven BN10 7DY	582747	Paul Collins paul@beyondgroup.co.uk
22	China Centre	44 Boundary Rd Hove BN3 4EF	422500	Frank tiewanggff@hotmail.com
23	The Rock Clinic	270 Eastern Rd Brighton BN2 5TA	621841	Melanie Withers office@rockclinic.ndo.co.uk
24	Hove Skin Clinc	13 New Church Rd Hove BN3 4AA	719834	Dr Russell Emerson info@hoveskinclinic.co.uk
25	Sussex Medical Chambers	126 New Church Rd	430022	Junia Bentley Junia.bentley@sussexmedicalchambers.co.uk
26	SAKS Beauty Salon	David Lloyd Centre Brighton Marina Brighton BN2 5UF	666426	Lisa Grebby l.grebby@btinternet.com
27	Fiveways Acupuncture Clinic	207 Ditchling Rd Brighton BN1 6JB	504488	Peter/Linda
28	Acupuncture and Herbs	112 St James St Brighton BN2 1TH	699852	Vivien Zhong v.zhong@hotmail.com
29	Marine Clinic	12 Marine Drive Rottingdean BN2 7HQ	307001	Anne Pether annepether@yahoo.co.uk
30	College of Clinical Massage	Unit 4, 20-26 Round Hill St Brighton BN2 3RG	562676	Michael and Elaine Gibbons megibbons@ntlworld.com
31	Herb Kingdom (Hove) Clinic	89 Church Rd Hove BN3 2BA	746484	Di Wu, wudi@sinolinx.co.uk herbkingdom@sinolinx.co.uk
32	Coast Chiropractic	198 Church Rd Hove BN3 2DU	321133	Dr Anne French/Debbie Brown Coast.chiropractic@yahoo.co.uk
33	Dragon Acupuncture	Upper Gardner St Brighton	07760492136	Nicki Ritchie Nicki_ritchie@hotmail.com
34	The Clinic	34 Dyke Rd Av Brighton BN1 5LB	560888	Dr Morton Westergaard mailtheclinic@aol.com
35	Back2Balance Chiropractic Clinic	35 Goldstone Villas Hove BN3 3RT	206868	Rebecca Nicholas / Barbara info@chiropractorsbrighton.co.uk
36	Browns Chiropractic Clinic	177 Preston Rd Brighton BN1 6AG	501146	Dr David Brown info@brightonchiro.co.uk
37	Sundial Clinic	111 Queens Rd Brighton BN1 3XF	774114	Mathew Bennett / Nathalie Nathalie@sundialclinics.co.uk
38	Sundial Clinic	52 St James St Brighton BN2 1QG	696414	Dr Richard Hollis Richard@sundialclinic.co.uk
39	SHS (herbal supplier)	Portslade Hall, 18 Station Rd Portslade BN41 1GB	07899 907045	Malcolm Simmonds Malcolm@shs100.com
40	Chiropractic First	82 Goldstone Villas Hove BN3 3RU	324466	Mark Yacoub Mark_yacoub@hotmail.com
41	Healing in Motion	LA Fitness, St Helier Av Hove BN3 3RE	724211	Judith Eaton/ Nicola Dow judy@eatonphysio.co.uk
42	Hove Chiropractic	2 West Way Hove BN3 8LD	7331177	Chris Pearcey chris@hovechiro.co.uk
43
44	Clinic on the Level	2 Ditchling Rd Brighton BN1 4SF	309060	John Lewis john@pod-iatry.co.uk
46	The Physioterapy Practice	105 Havelock Rd Brighton BN1 6GL	565212	Susan Foulds / Vicki
47	Wilbury Physiotherapy Ltd	40 Wilbury Rd Hove BN3 3JP	206206	Susan Carnaghan physio@wilbury-physio.co.uk
48	Esporta Health Club	Village Way Falmer	667826	Penny Lucy pennylucy@hotmail.co.uk
49	Soft Tissue Clinic	10 The Drove Brighton BN1 5NN		Amanda Oswald Amanda@softtissueclinic.co.uk
50	Natural Fertility Clinic	Unit 4, 20-26 Roundhill St Brighton BN2 3RG		Houri Alavi hourialavi@btinternet.com
51	Brighton Physiotherapy Clinic	56a Marine Parade Brighton BN2 1PN	621248	Sara Baxter info@brightonphysioclinic.co.uk
52	Palmeira Practice	62 Palmeira Ave Hove BN3	329557	David Bradley/Susan Sharman www.palmeiraphysio.co.uk
53	Turning Tide Pilates		07882576540	Tansy Blaik-Kelly turningtidepilates@googlemail.com
54	Evolution Arts	2 Sillwood Terrace Brighton BN1 1UR	204204	info@evolutionarts.org.uk
55	Brighton Buddhist Centre	17 Tichborne St Brighton BN1 1UR	772090	info@brightonbuddhistcentre.co.uk
56	Jasmine's Wellbeing Centre	10 Blatchington Rd Hove BN3	329271	Yangli Xu jasminewellbeing@hotmail.com
57	Pathways to Health	15 New Rd Brighton BN1 1 UF	720200	Jane Healey info@pathwaystohealth.org.uk
58	Kemptown Osteopathic Clinc	34 Chesham Rd Brighton BN2 1NB	600023	Mark Andrews mark@brightonosteopathy.co.uk
59	Fiveways Osteopathic Clinic	308 Ditchling Rd Brighton BN1 6JG	566172	Nicholas Mitchell nicmit@ntlworld.com
60	Withdean Osteopathic Clinic	5 Withdean Rd Brighton BN1 5BL	700218	Pat Maccarthy
61	Brighton Alexander Technique College	50 Grantham Rd Brighton BN1 6EF	562595	Carolyn Nicholls Carolynn.nicholls@btinternet.com
62	Seven Dials Osteopathic Clinic	71-75 Dyke Rd Brighton BN1 3JE	273005	Nick Webbe www.brighton-osteopath.co.uk
63	Sussex Back Pain Clinic	58 New Church Rd Hove BN3 4FL	725667	Steven Morris info@sussexbackpainclinic.co.uk
64	Hove Osteopathic Clinic	235 New Church Rd Hove BN3 4EE	208410	Tanya May, Richard Skudder www.hoveosteopathicclinic.co.uk
65	Pain Relief Clinic	77A Carlisle Rd Hove BN3 4FQ	739949	Stephanie Witts Stephanie.witts@googlemail.com
66	Charter Medical Centre	88 Davigdor Rd Hove BN3	552425	Meta Pike
67	Rex Brangwyn Associates	2 Wilbury Crescent Hove BN3 6FL	775559	Rex Brangwyn rexbrangwyn@mac.com
68	Cheetahs Gym	King Alfred Centre Kingsway, Hove BN3	206644	Mark Harper Cheetahs.gym@btinternet.com
69	Coral Health and Fitness Centre	Orchard Rd Hove BN3 7BG	731262	David Funnell healthclub@coral.co.uk
70	Korina Biggs	16 Leicester Villas Hove BN3 5SQ	420259	Korina Biggs korina@freeuk.com
71	Curves, Ladies only Fitness	353 Portland Rd Hove BN3 5SF	415905	Bev Baker curveshove@hotmail.com
72	LA Fitness Hove	St Helier Ave Hove BN3	724211	Ryan Tully hove@lafitness.co.uk
73	Falmer Sports Complex	Ridge Rd, Falmer Brighton BN1 9PL	877125	Simon Tunley s.ftunley@sussex.ac.uk
74	Fit for All	Unit 1 Portland Rd Ind Est Hve BN3 5NT	415515	Sera Bates sera@fitforall.co.uk
75	Fitness First Clubs	78-81 Queens Rd Brighton BN1 3XE	220931	Mary Sassi / Hannah brighton@fitnessfirst.com
76	Gymophobics (Brighton and Hove)	1st Floor, Blatchington Rd Hove BN3 3YH	733933	Janet Stokes
77	Healthy Vibes Fitness Studio	200 Church Rd Hove BN3 2DJ	710709	Sue Archer / Finnie info@healthyvibesfitness.co.uk
78	Hilton Metropole Living Well Club	106-121 Kings Rd Brighton BN1 2FU	715078	Carl Tudor Carl.tudor@hilton.com
79	LA Fitness Brighton	Tower Point, 44 North Rd, Brighton	685868	George Gordon brighton@lafitness.co.uk
80	Lanes Health Club	Queens Hotel, Kings Rd Brighton BN1 1NS	221618	Lee Willingham laneshealth@queenshotelbrighton.com
81	Portslade Sports Centre	Community College, Chalky Rd	411100	Graham Whittaker g.whittaker@pcc-web.com
82	Riptide Fitness Centre	150-153 Kings Rd Arches, Brighton BN1 1NB	725444	Matt Bartsch manager@riptide.co.uk
83	ZT Fitness	7 Hove Business Centre Fonthill Rd, Hove BN3 6HA	202226	Sol Gilbert sol@solgilbert.com
84	Brighton Natural Health Centre	Regent St Brighton	600513
86	Bikrams Yoga College	26-28 Franklin Rd Portslade BN44	420279	Carolyn Jikieni (CJ) info@bikramyoga.com
87	Dynamic Yoga	Unit 9, Business Centre Fonthill Rd, Hove BN3 6HA	707777	Stuart Tranter info@dynamicyoga.tv
88	HSP Holistic Energy Training Centre	79 Trafalgar St Brighton BN1 4EB	357559	Clare Gaudie info@hspholistic.com
89	Institute of Ivangar Yoga Sx	17 Langdale Gardens Hove BN3 4HJ	326205	Andy Roughton andy@hoveyoga.co.uk
90	Natural Bodies Yoga Centre	28-29 Bond St Brighton BN1 1RD	711414	Garry Carter info@naturalbodies.org.uk
91	Sun Power Yoga	18 Baxter St Brighton BN2 9XP	571595	Michelle Winter mlwinter@hotmail.com
92	Robert Bonner Chiropodist	25 Windlesham Close Portslade BN41	231547	Robert Bonner
93	Ardens Health and Wellbeing Clinic	26 Upper Hamilton Rd Brighton	554132	Sarah Arden, Jade Diable mail@lilywhitescrafts.co.uk
94	Regina Neming AT	1 Clarendon Villas Hove BN2	728001	Regina Neming rnuk02@btinternet.com
95	Claudia Weiss AT	75 Southover St	693202	Claudia Weiss claudiaweissftat@aol.com
96	Sole Sister Chiropody	136 Preston Drive Brighton BN1 6FJ	553863	Jane Faulkner
97	Withdean Foot Clinic	1 Valley Drive Brighton BN1 5FA	557501	Linda Antram Linda_antram2005@yahoo.co.uk
98	BE Pilates CoachingStudio	121 Eldred Av Brighton BN1 5EL	273074	Carla Armour Be.pilates-coach@ntlworld.com
99	Goodwood Court Medical Centre	52 Cromwell Rd Hove BN3 3DX	770822	Luke Hawkins surgery@goodwoodcourt.org
100	Breakthrough Therapies	15 Braybon Av Brighton BN1 8EA	500467	Jenny Jenner info@breakthroughtherapies.co.uk
101	Greg Sturges Drama	55 Rugby Place Brighton BN25JB	819239	Greg Sturges Greg.sturges@ntlworld.com
102	Herbalife	5b Third Ave Hove BN 3	723884	Julie julieherb@aol.com
103	European Shiatsu School	Brighton Natural Health Centre 27 Regent St Brighton BN1 1UL	747045	Markus Grasser essbrighton@btopenworld.com
104	Manos Chiropractor Clinic	34 Palmeira Sq Hove BN3 2JP	733469	Paul Harris brighton@manosclinics.com
105	North Laines Holistic Centre	1 Kemp St Brighton BN1 4AP	681794	Geraldine Coffey nlholistics@yahoo.co.uk
106	Alive Fitness and Health Centre	25 Castle St Brighton BN1	739606	Jose Munns sales@alivehealth.co.uk
107	Shenyang Herbal Centre	106A Western Rd Brighton BN1 2AA	730044	Kerry
108	Back to Health	3 Hove Park Villas Hove BN3	422009	Patricia Holden patriciarholden@yahoo.co.uk
109	Vitality Acupuncture	40 Coleridge St Hove BN3 5AD	776020	Penny Boyland info@vitalityacupuncture.net
110	Dyke Rd Natural Health Clinic	274 Dyke Rd Brighton BN1 5AE	561844	Trevor Gunn vaccines@trevorgunn.com
111	Phoenix Homeopathy	44 Rutland Rd Hove BN3 5FF	0845 166 8108	Sarah and Paulo Whitaker phoenixhomeopathy@gmail.com
112	Gillian Buck Osteopath Clinic	72 The Drive Hove	203820	Jeremy Buck
113	Creative Health Connections	18 Eaton Place Kemptown BN2 1EH	702847	Jocelyn Jones Jocelynjones49@googlemail.com
114	Miranda Holt Homepath	12 Queens Square Brighton BN1 3FD	721172	Miranda Holt info@healinghomeopathy.com
115	The Homeopathic House	35 Carlisle Rd Hove BN3 4FP	702070	Veronica Walton arnicaworks@hotmail.com
116	Purely Pilates	35 Church Rd Hove BN3 2BE	770900	Charlie Allerton Charlie_allerton@hotmail.com
117	Kemptown Homeopathy	18 Prince Regent's Close Brighton BN2 5JP	683246	Ione Powell ionepowell@postmaster.co.uk
118	Jane Dickinson Homeopath	11 Hollingbury Terrace Brighton BN1 7JE	556876	Jane Dickinson Jane.dickinson@yahoo.co.uk
119	Isis Centre	3 Dorset St Brighton BN2 1WA	626644	info@isiscentre.co.uk
119	The Spence Practice	22 Elizabeth Av Hove BN3 6WG	509793	Andrew Spence info@thespencecentre.co.uk
121	PJ Solutions Hypnotherapy	28A Ventnor Villas Hove BN3	07808141752	Paula Newman Pnewman1@hotmail.co.uk
122	Nikolov Nik	52 Walsingham Rd Hove BN3	889002	Nikilov Nik, Francesca Zannoni fzannoni@gmail.com
123	Lynne Somerville Hypnotherapy	39 Grange Rd Hove BN3	749080	Lynne Somerville
124	Sussex Hypnotherapy Practice	11 Thornhill Way Portslade BN41	07786962973	Dave Fowle fowledavid@yahoo.co.uk
125	Julie James Hypnotherapy	56 Berridale Ave Hove BN3 4JJ	202768	Julie James Julie@jjhypnotherapy.com
126	Robinson Cathy	36A Grange Rd	889096	Cathy Robinson
127	Smart Nutrition	47 Lansdowne Place Hove BN3	775480	Emma Wells emma@smartnutrition.co.uk
128	Ocean Wave Pilates	30 The Drive Hove BN3 3JD	724472	Jason Thomas info@oceanwavepilates.com
129	Brighton Shiatsu Centre	55A Grantham Rd Brighton BN1 6EF	07806944359
130	Brighton Shiatsu College			Debbie Collins brighton@shiatsucollege.co.uk
131	No Nonsense Nutrition	20 Lowther Rd Brighton BN1 6LF	2331251	Lindsey Krabbendam lindsey@nononsensenutrition.co.uk
132	Nutrition Diet and Weight Management	33-35 Beaconsfield Villas Brighton BN1	07921611260

This list was compiled by going through the yellow pages. It is incomplete. Please check your entry and send any corrections to us by e mail at johnkapp@btinternet.com. If you know other CAM centres in the city which are not on the list and would like to be, please send us their details or tell them to get in touch with us.

Appendix

Draft Strategic Commissioning Plan for 2010-16

The following is what we would like NHS Brighton and Hove to put in their Plan, as requested in our letter to Dr Geraldine Hoban, Director of Commission dated 13.12.09.

Government directives
Much has happened since the last Strategic Commissioning Plan was written in March 2009. The Darzi reforms of July 2008 has forced the NHS into a paradigm shift by placing a statutory duty on us to prevent illness as well as to treat it. The NHS constitution has given patients new statutory rights, including having free NICE approved treatments which their doctor says is clinically appropriate for them. We now have to increase patient safety, improve effectiveness, improve patient experience, reduce our staff sickness by 20%, while planning cuts in spending of 20%, which reduces our present budget by £87 mpa from £432 mpa in 2009/10 to £345 mpa in 2014.

Prevention of illness and promotion of wellness
Accordingly we are planning a massive reallocation of resources from treatment to prevention. We will increase the budget spent on prevention from £4 mpa (1%) now to £104 mpa (30%) in 2014. The emphasis will be on courses which teach patients to take responsibility for their own health, and empower them with self-help techniques by which they can remain well and fit, such as the NICE approved Mindfulness Based Cognitive Therapy (MBCT) course, and the Expert Patient Programme, (EPP).

To fulfill our new statutory requirement to commission the prevention of illness and promotion of wellness we will create a new Trust called the ‘Complementary Care Trust (CCT) which will commission complementary and alternative medicine (CAM) in the same way as the Primary Care Trust (PCT) commissions primary care. The CCT will contract with a social enterprise company to be the sole provider of free CAM on the NHS. This will provide free CAM on the NHS by printing £50 vouchers for CAM which will be distributed to gatekeepers, such as GPs and other healthcare staff. Patients will be offered the choice of conventional treatment as usual or CAM vouchers which will be tradable at any of the 100 registered CAM centres in the city. The budget cost for these CAM vouchers is shown in the ‘prevention’ column of the table below in addition to what we already spend. The ‘treatment ‘ column is conventional treatment as before.

TABLE 1 NHS BRIGHTON AND HOVE BUDGET 2009-16

Year Cost £million pa		Treatment	Prevention                               %		Total Reduction on 2009
	2009	428	4	1%	432		0%
	2010	452	4	1%	456		+6%
1	2011	424	4 + 4=8	2%	432		0%
2	2012	390	4 + 14=18	4%	408		-6%
3	2013	343	4 + 33=37	10%	380		-12%
4	2014	241	4 + 100=104	29%	345		-20%
5	2015	241	4 + 100=104	29%	345		-20%
6	2016	237	8 + 100=108	30%	345		-20%

TABLE 2 ANNUAL MONITORING TARGETS FOR 2016 FOR THE CITY

Target number	Statistical number of people affected in city pa	2009	2016 (50% of 2009)
1	Deaths from all causes pa	3,000n	3,000
2	Iatrogenis (doctor induced) deaths note 1	200n	100
3	Hospitalisation from Iatrogenis (1 million people pa nationally)	5,000n	2,500
4	Deaths from suicide pa	36c	18
5	Drug users	2.250c	1,125
6	Alcoholics	50,000c	25,000
7	Obese	60,000c	30,000
8	Clinically depressed	15,000c	7,500
9	Smokers	50,000c	25,000
10	Long term conditions	40,000c	20,000
11	Teenage pregnancies	40,000c	20,000
12	On disability benefit (2.5m nationally)	12,500n	6,250
13	Hospital admissions	100,000g	50.000
14	GP visits	100,000g	100.000
15	Deaths in preferred place (home)	750n	1,500
16	No of patients dying with living wills	Hardly any	1,500
17	Dementia patients killed by drugs	9n	4
18	Staff off sick (note 3)	400nn	200
Notes
1	'40,000 deaths pa' from TV programme Nov 2000 'Why doctors make mistakes'
2	'1,800 dementia patients killed by anti-psychotic drugs' News bulletin 1.12.09'
3	5% staff sickness on 8,000

End of life care.
Polls show that 3 out of 4 patients want to die at home, so that intention will drive our commissioning. Acute hospitals are not designed for dying in, so we will assist GPs to make strenuous efforts to support their patients to die at home, by commissioning hospice at home services. We will also instigate an Advance Decision (living will) form (on the lines of that downloadable free from www.compassionindying.org.uk) to go prominently in the patient’s notes. This will empower terminally ill patients to specify interventions that they do not wish to have, such as resuscitation for loss of consciousness, antibiotic for chest infections, intravenous feeding, ventilation, hospitalization. It will also specify to whom they wish to give power of attorney to make decisions for them should they lose capacity. This will help staff and paramedics to take action on which the patient has previously made a conscious decision.

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