Transformation of the Glasgow Homeopathic Hospital
The Inside story
by Dr. Bob Leckridge, MBChB FFHom.
28th November 2011
The Glasgow Homeopathic Hospital is much loved. It has been part of the West of Scotland’s health care for over a 100 years, and from the inception of the National Health Service, “the homeopathic” was taken into State ownership and management.
Uniquely in Scotland, it integrated a range of therapeutic approaches long before the terms “integrative” and “integrated” care became popular. For example, the hospital in 1000 Great Western Road had an operating theatre and the surgeons and homeopathic physicians worked together in the interests of their patients.
Money donated by the Scottish Public as far back as the 1930s was used to build the new premises in the grounds of Gartnavel Hospital which opened at the end of 1999 with signage on the front wall: “Centre for Integrative Care. Glasgow Homeopathic Hospital”.
It’s a long time since “the homeopathic” employed surgeons, and the emphasis these days is on “integrative care” - holistic, patient-centred, non-pharmacological and non-surgical interventions intended to increase resilience, well-being and coherence through empowering and enabling patients. Homeopathy both informs, and fits easily into this broad approach.
In recent months there has been an aggressive campaign of misinformation and insult against homeopathy in general, and the NHS Homeopathic Hospitals in particular. There’s no doubt this has produced deep distress in patients and staff alike.
In addition, the economic situation has created a hugely challenging time for the whole of the NHS, and doctors’ training and career pathways plus the Agenda for Change have produced enormous changes for NHS health care workers. Despite this almost perfect storm of pressures, the staff working with their NHS managers, have embraced change and engaged in a root and branch redesign of the service.
As we move into 2012, here is an inside end of year report.
The service will now be known as “The NHS Centre for Integrative Care. Glasgow Homeopathic Hospital” to better communicate the fact that this NHS facility offers a range of therapies and interventions all intended to be integrative in their effects and integrated within care pathways. The service has been redesigned to address the Scottish government’s Long Term Conditions agenda to best improve the care of patients with chronic illnesses.
We have reduced the number of inpatient beds, cut back from 7 day to Monday to Friday care, and developed a number of programmes for outpatients and day patients in groups and on a one to one basis. All with the intention of empowering patients and enabling them to learn ways to increase their energy levels, reduce their levels of pain, improve their well-being and reduce their needs for both pharmacological medicines and admissions to other hospitals.
The number of referrals to the hospital have remained steady throughout the whole of 2011. There has been no decline in demand.
The Scottish NHS is not structured the same way as the English and Welsh services, most notably with the central role of unitary Health Boards in Scotland which agree annual block contracts for referrals between themselves. There are no commissioners. Highland Health Board has decided it does not wish to pay for homeopathic medicines, but continues to support the referral of patients from their area to the NHS Centre for Integrative Care for holistic, integrative assessments and care programmes.
The Chronic Fatigue Service in the hospital was commissioned by NHS Greater Glasgow and Clyde, and is the only specialist NHS service for patients with this condition in the health board area.
NHS Greater Glasgow and Clyde at all levels of management have repeatedly stated clearly that there are no plans to close the NHS Centre for Integrative Care.
Two particular changes have been spun adversely by enemies of the hospital - the removal of a junior doctor post, and the closure of the hospital pharmacy.
The shift in emphasis towards greater outpatient care, with the parallel reduction in inpatient care, means that two “ward doctors” are not required. Historically, the ward doctor posts were filled by doctors nearing the end of their specialist training, but with “Modernising Medical Careers”, one of these posts was changed to a “Foundation Year” one - doctors in their earliest years of training. These doctors rotated through the hospital on 4 month programmes, where the previous doctors had 12 to 18 month contracts. They were also included in the Acute Medicine rota which resulted in their frequent time off from daily ward work to compensate for their out of hours work.
This all led to a higher demand on the other staff and at our request, the Postgraduate Dean withdrew the position, agreeing that it was not an appropriate post for a service specialising in the needs of patients with complex, chronic conditions. He had nothing but praise for the quality of training in consultation technique, communication skills and holistic assessment of those with chronic ailments which these young doctors received during their brief rotation with us.
Closing the pharmacy was a difficult decision, but it has normalised the relationship between this secondary care service and GPs. All other hospital specialists recommend treatments but don’t issue the prescriptions. It has also enabled us to contribute to the targeted budget savings required across the NHS without losing further posts (over 90% of the hospital’s budget is spent on people - staff salaries and costs).
We are currently working hard to build a secure future for this unique NHS service which serves the needs of patients largely with incurable conditions. It is hard to see where these particular patients would receive greater benefits at less costs within the NHS.