"The method is not one of remedy; it is one of constructive education."
(From John Dewey's Introduction to Constructive Conscious Control of the Individual, by F.M. Alexander, p xxxii).
The Lannoye Report
In 1996 Paul Lannoye, a member of the European Parliament, presented a report on the status of non-conventional medicine to the European Parliament which recommended that only complementary practitioners with a university degree or diploma should be allowed professional autonomy and the right to diagnose, i.e. that training of such practitioners should be as rigorous as for those practising mainstream western medicine.
It was clear that many disciplines would be affected if the European Parliament accepted this report. Though the Alexander Technique could be said to be concerned with health in the broadest sense and could be described as ‘alternative’, it is not medicine nor is it therapy, and first and foremost it is an educational technique. There was concern among many in the Alexander profession about the implications of the report and how the Alexander Technique would be viewed.
Professional Organisation of Complementary and Alternative Medicine in the UK 1997 - a report by the University of Exeter.
In 1997 the Department of Health commissioned the Centre for Complementary Health Studies at Exeter University to conduct a study of the professional organizations representing Complementary and Alternative Medicine (CAM) in the UK. The study included various kinds of CAM from herbal medicine to osteopathy and reported that from the limited data available, the use of CAM was on the increase, a view supported by anecdotal evidence from the Foundation for Integrated Health, the NHS Alliance and the Department of Health. The Alexander Technique was included in the report on page 13 and referred to as “a distinctive form of healthcare”. “AT professionals consider themselves as teachers rather than healthcare practitioners (and their clients as ‘students’)".
A further report was commissioned to establish the status of UK professional associations in the CAM field.
‘Integrated Healthcare, a Way Forward for the Next Five Years? A Discussion Document’ published in October 1997 by the Foundation for Integrated Medicine
In the early 1990s a steering committee was set up at the suggestion of the Prince of Wales to consider the current position of orthodox, complementary and alternative medicine on the UK. The Foundation for Integrated Medicine (now known as the Prince's Foundation for Integrated Health or PFIH) was established. Their report includes recommendations endorsing the general line taken by the Exeter report.
Since the inception of PFIH, members of the AT professional bodies have attended their meetings and seminars in order to gain information about regulation and to continue to increase the awareness of administrators involved in regulation about the educational nature of the AT.
The 1999 Health Act
The common law freedom to practise remains, it has not been revoked, but the freedom has been curtailed. Non-medical professionals may still practise in the healthcare sector, but the government can now require regulation of these professions, including ours. Freedom to practise without regulation is no longer protected in law. Today the 1999 Act confers “power to regulate any profession concerned (wholly or partly) with the physical or mental health of individuals...” Specifically, under Schedule 3, Part II, section 60 “ Her Majesty may by order in Council make provision --- regulating any other profession which appears to Her [Majesty] to be concerned (wholly or partly) with the physical or mental health of individuals and to require regulation in pursuance of this section.”
Professional Organisation of Complementary and Alternative Medicine in the UK 2000, a second report to the Department of Health by the University of Exeter.
This report set out recommendations for the pathway to self-regulation for CAM, among which it included the Alexander Technique, again recognizing that Alexander Technique professionals consider themselves teachers and not healthcare practitioners. This report included the results of surveys collected from Alexander Technique organizations. Some AT organizations objected to aspects of the report which appeared prescriptive and related more to other CAM disciplines than to the AT. Correspondence received from a member of the Exeter team in March 1999 and addressed to a STAT ‘think-tank’, included the statement “we realize that the AT is recognized as an educative technique for the patient to learn and then practice for themselves---.”
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Report of the Select Committee on Science and Technology to the House of Lords, 2000
In view of the increasing use of complementary and alternative medicine, the Science and Technology Committee of the House of Lords prepared a report addressing issues of education, training and regulation and looking at the private sector as well as provision within the NHS. Some AT organizations expressed concerns about the inclusion of the AT. The Select Committee presented its recommendations to the UK Government in 2000 and included the Alexander Technique within the area of CAM.
The various CAM disciplines under discussion were divided into three groups:
- Those that claimed a diagnostic approach. These were osteopathy and chiropractic which had already been regulated by Act of Parliament (statutory regulation) and acupuncture, herbal medicine and homeopathy.
- Disciplines where the practitioners did not claim to have diagnostic skills. The Alexander Technique was included here, along with counseling, meditation, healing and so on.
- Other disciplines which claimed to offer diagnosis and treatment, favoured a philosophical approach and were indifferent to the scientific principles of conventional medicine, both traditions such as Chinese Medicine and disciplines which ‘lacked a credible evidence base’ such as crystal therapy, kinesiology.
The report at least recognized that the Alexander Technique is a taught technique, not a therapy, and that Alexander Technique professionals see themselves as teachers and not healthcare professionals.
The House of Lords Report, HL Paper 123, Complementary and Alternative Medicine 2000 can be obtained from the The Stationery Office.
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The Government Response to the Report, 2001
The Government’s response to the Report accepted various recommendations. The most significant of these for the Alexander Technique were:
- Each of the Group 2 disciplines should organize themselves under a single professional body. These bodies should be well promoted, so the public are aware of them. Each should comply with core professional principles, relevant healthcare information should be made known to medical practitioners and healthcare professionals, so that there would be a single point of reference for standards, protection against poorly-trained practitioners and redress for poor service.
- Training courses should become more standardized within a profession and be accredited and validated by appropriate professional bodies.
- Continuing professional development in practice should be a core requirement for members of professional associations.
- Those disciplines with a fragmented professional organization should work with Healthwork UK to develop National Occupational Standards (NOS), which should be supported by the Department of Health.
It was also recommended that medical students learn more about CAM and that there should be more research into the field.
Recently the term 'CAM' (Complementary and Alternative Medicine) has been changed to 'CAH' (Complementary and Alternative Healthcare).
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2005-2008 Developments in Regulation
The Stone Report 2005
In 2005 a report by Professor Julie Stone, commissioned by the Foundation for Integrated Health, marked a watershed in voluntary regulation by introducing new ideas being adopted in statutory regulation.
Professionally-led regulation
Developments in the field of statutory regulation, especially in the wake of various regulatory crises such as that leading to the Shipman Inquiry (2002-2005), and an important Department of Health report on the regulation of non-medical healthcare professions (Foster 2006), led to what Stone describes as a ‘substantive shift’ in policy – ‘away from self-regulation in which the profession is the sole arbiter of the standards it sets for itself’, to what is known as ‘professionally-led’ regulation. In this form of regulation ‘the professions work in partnership with other stakeholders who have a legitimate interest’ including the public, statutory authorities, educational institutions and others. Stone argued that voluntary systems need to develop in this way if they are to command government approval and public respect.
Federal-style regulation
Stone also noted the trend toward streamlining regulation through the creation of federal-style bodies for whole sectors. This model was seen to be particularly appropriate for the complementary healthcare sector, since the costs of regulating themselves to a standard reasonably comparable the statutory sector would be prohibitive for most of the individual complementary healthcare professions.
General structure of the CNHC - how will it work?
Since a large part of regulation is concerned with generic issues that are common to all healthcare professions, they can be dealt with by shared procedures and shared structure. CNHC, therefore, has a lay Federal Regulatory Council (FRC) with a small number of boards serving under it. A Profession Advisory Board (PAB) with representatives of each of the regulated professions will advise the council, although it will not be part of the regulatory authority as such.
In addition, each profession has its own Profession Specific Board (PSB) to administer profession-specific standards and review them periodically. In our case, the profession specific standards are being set initially by the ATVSRG and its working groups.
Changes in standards will take place only with full consultation with the profession. An independent mediation and arbitration process is available to help resolve any disagreement between the Regulator and the professions.
Designing a Federal Regulatory Council for Complementary Healthcare Professions
A Federal Working Group (FWG) was set up in early 2007 under the auspices of the Foundation for Integrated Health, with the task of designing the detailed structure of a suitable regulatory body along the general lines proposed by Professor Stone. One member of ATVSRG was appointed to the FWG to represent the interests of the AT teaching profession and contribute substantially to the design. The details were completed a year later and the Complementary and Natural Healthcare Council launched in April 2008.
The Complementary and Natural Healthcare Council - the new federal regulator
At present the new Council, the CNHC, is being set up and is expected to open for business in the autumn of 2008. When teachers have been consulted and they have debated the issues – and after some tasks that ATVSRG is currently working on have been completed – the CNHC is likely to consider us ready to join them some time next year if we wish to. Individual teachers can then choose whether or not they want to be included on the Council’s Register of Teachers of the AT.
Safety and competence
The chief purpose of Profession-led Federal Regulation is to assure the public that any Registered practitioner (or teacher) is both safe and competent, and recognised as such by members of their own profession and by representatives of the public interest. Moreover, Federal Regulation provides recourse to an independent complaints process external to the profession, but with professional input to it. This new form of regulation is expected to encourage professions to maintain high standards and to motivate trainees to ensure that they are well trained.
Regulation of Generic and Specific Standards
Generic standards are those applicable to a whole group. They apply to aspects of our work such as ethics, conduct, attitude, running a business and so forth that are common to all practitioners in the Complementary Healthcare sector. In our case, Specific standards apply to the teaching of the AT, to our knowledge, understanding and competence as teachers. The structure of the new Council prevents the possibility of any practitioner of another form of Complementary Healthcare from having any influence on matters affecting our specific standards, and vice versa.
A complaints process has been designed to be ‘light-touch’ with ample opportunities for conciliation before any judicial process is considered. No compensation will be awarded to complainants, even if successful. Only in extreme cases will a practitioner be removed from the Register.
Joining the Register
Practising teachers who belong to one of the organisations represented on the ATVSRG before the start date of the Register are automatically entitled to join the Register during an initial period of three years. This procedure is known as ‘grandparenting’. When the three years is over, those teachers who have not joined but wish to do so, will have to undergo an assessment process. Teachers who do not belong to the recognised organisations will also have to undergo assessment.
The registration fee is expected to be around £45.00 per annum.
What does 'voluntary' mean in practice?
It means that no profession entitled to join the Federal Regulator is obliged to. It also means that when a profession decides to join, the individual practitioners (teachers) can choose whether or not to join the Register.
Market forces may influence decisions, particularly if the Federal Regulator commands public respect and people prefer to go to a teacher or practitioner on its Register.
Because a voluntary system of regulation does not grant right of title, any teacher removed from the Register, or not admitted to it, will not be denied the right to practise.
View the Julie Stone Report>>
Read about the Federal Approach to regulation>>
In response, the ATVSRG has sent this letter>> to the PFIH.
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