Complementary and Alternative Health Care Services and the Services Directive Presentation to the EPHA Policy Seminar Brussels 24 June 2005 Stephen Gordon General Secretary European Council for Classical Homeopathy

CAM Services and the Services Directive Complementary & Alternative Medicine or non-conventional medicine/healthcare - a diverse range of health-care practices characterised by low-tech, low-risk,whole person, person-centred approaches to improving health as a means of treating and preventing disease. -treat a wide range of conditions not served well by conventional medical approaches -practised by a minority but increasing number of doctors who practise CAM inside or outside their nation al primary care systems a rising number of self-employed practitioners against direct financial consideration - direct provider to consumer relationship - included as part of public health care services of some MSs as part of an integrated healthcare agenda - new multi-million euro service sector offering jobs and economic benefit

CAM Services and the Services Directive CAM Services in the UK 30 years of ‘entrepreneurship, growth and job creation’ in a ‘competitive free market’ situation where there have been no ‘discriminatory or disproportionate requirements’ to restrict growth The service provision side has been underpinned by the UK common law situation where citizens can offer a service if there is no law to regulate it Emegence of a number of new haelth care professions Growth has been against the background of an NHS service where every patient has a GP provision is‘free at the point of delivery’

CAM Services and the Services Directive CAM Services in the UK Current situation –Multi-million pound industry of products and services –An estimated CAM service providers (cf UK GPs) –90% provided in the private sector –Health insurance companies increasingly fund it –1 in 5 UK citizens use CAM products and services annually –75 % want to see CAM services provided through the NHS –40% of GPs refer some patients for some CAM therapies –move towards an ‘integrated health’ agenda –CAM practitioners from other EU MSs can come to work on the UK

CAM Services and the Services Directive CAM Services in the UK Moves towards regulation –Voluntary self-regulation Majority of disciplines –Statutory self-regulation Osteopathy, chiropractic established Acupuncture and herbal Regulation of products Homeopathic and herbal medicines by EU directives Nutritional supplements by EU directive

CAM Services and the Services Directive CAM in Europe There has been a steady growth in the use and provision of CAM services across the EU over the past 3 decades. CAM is the second biggest growth industry in Europe CAM nutritional and medicinal products are already covered by EU directives - there are emerging health care professions, particularly in new MSs some are practised in all MSs, others in a few some are practised by MDs and practitioners CAM is poorly recognised and acknowledged at EU Level

CAM Services and the Services Directive CAM in Europe Council of Europe Policy Position 1999 alternative, complementary and non-conventional forms of medicine are growing in importance in Europe and throughout the world. The extent to which they are recognised and the legal status they enjoy vary greatly from one country to the next. Patients are increasingly calling for the use of different forms of treatment. This is a fact that cannot be ignored. The Assembly believes that the best guarantee for patients lies in a properly trained profession, which is recognises its limitations, has a system of ethics & self-regulation and is also subject to outside control. It would be unrealistic to wish to prevent the emergence of new professions in the health sector. The Assembly believes that in the future alternative or complementary forms of medicine could be practised by doctors of conventional medicine as well as by any well-trained practitioner of non-conventional medicine (a patient could consult one or the other, either upon referral by his or her family doctor or of his or her free will), should ethical principals prevail.

CAM Services and the Services Directive CAM in Europe European Parliament Lannoye/Collins Report Resolution on the status of non-conventional medicines calls on the Commission, to launch a process of recognising non-conventional medicine and, encourage the establishment of appropriate committees; to carry out a thorough study into the safety, effectiveness, area of application and the complementary or alternative nature of all non- conventional medicines and a comparative study of the various national legal models to which non-conventional medical practitioners are subject; to encourage the development of research programmes in the field of nonconventional medicines covering the individual and holistic approach, the preventive role and the specific characteristics of the non-conventional medical disciplines; undertakes to do likewise;

CAM Services and the Services Directive CAM in Europe The Regulatory Background is a heterogeneous one the regulatory situation for each discipline varies greatly from country to country some are legally restricted to MDs only in some MSs MDs are legally forbidden to practise them in a few MSs some disciplines are statutorily regulated in some MSs some professions are recognised but not regulated in many MSs there is a situation of neither regulation or recognition but one of legal neutrality or toleration CAM professions are not covered by MRPQ directive harmonisation in the area is a long way off

CAM Services and the Services Directive CAM in Europe : The potential impact of the services directive none due to all h/c services being excluded partial if public health care services excluded but private provision is implicated complete if all H/c services are included

CAM Services and the Services Directive: Impact Country of Origin Principle if applied as in the directive it could mean - provision of services in countries by practitioners otherwise forbidden to provide them - facilitate the spread of new services to the MSs and the opening up of new service sectors – Derogations: Host member state rules apply in the are of standards – prohibited practices in host states will be applied

CAM Services and the Services Directive: Impact Freedom of Establishment currently possible by nationals of some MSs moving to some other MSs but not for all due to national restrictions

CAM Services and the Services Directive: Impact Right of recipients to use the services of providers established in other Member States & Assumption of costs patients receiving CAM treatments through national healthcare provision Patients receiving CAM treatments privately cali from health insuarnce companies

CAM Services and the Services Directive: Conclusions Until the Dir on Services of General Interest is elaborated and its approach to HC services is clear private healthcare and CAM in particular should be included in the services directive to enable citizens to have true freedom of choice in their healthcare across the EU There is a strong element of control in public health systems where patient choice is limited by the third party’s economic interests and the views of established interests Minimal requirements for consumer safety need to be agreed for CAM professional providing services in MSs and across borders, Professional Indemnity Insurance Effective professional self-regulation through Membership of established professional associations or statutorily regulated professions