As we enter this hazardous age of 'Integration' (with a capital I) there's a great deal of ambivalence about what it might imply. We may be less alternative than we were, but wisely we remain unsure that we want to risk entangling with the complexity and stress of mainstream health care delivery! And perhaps these feelings also have to do with conventional medicine's explanatory power (scientists will turn CM – complementary medicine – into something else); with the conviction that getting too near 'orthodoxy' will mean being contaminated (CPs – complementary practitioners – will become reductionist clones); or that independence will be forfeit (CPs working in the 'system' will lose their autonomy and burn out like their conventional colleagues). Can CM integrate? Can there be collaboration (the word implies trafficking with the enemy) or will the Empire strike back and in some rearguard action achieve a medical takeover?

Or might it on the other hand turn out that the beautiful maps and languages of our medical systems will add new colour to bio-science's barren images? And might 'Integration' gradually bring about a quiet revolution in the way we understand the human condition and how to deal with it?

There you have it: the paranoia and the idealisation. Somewhere between the two lies the reality of docs, nurses and comps working alongside and learning from one another. The places where genuine collaboration happens are usually short of resources; teams at the sharp end where simply meeting the need for appointments and managing a growing waiting list takes up all the available energy. This is the reality of public sector healthcare.

These teams are stripped down to the basic essentials. They are too financially constrained to evaluate their work and generally reliant on the idealism of under-paid staff who want to see CM recognised inside the system. Unfortunately the people involved seldom have the knowledge and skills needed – and rarely the time – to collect the kind of data required to research outcomes and decide on best practice. Nor are meetings and professional development opportunities available where practitioners can explore each other's unspoken assumptions, alienating jargons and unstated expectations.

No surprise then that we are still a long way from understanding how best to use limited NHS resources to fund CM. And only the most blinkered optimist could believe things are going to get easier. In the 'new, modern dependable NHS' the cost effectiveness of any kind of healthcare (conventional or not) will be the acid test. Treatments which fail are unlikely to be bought by the commissioning groups whose task it will be after April 1st 1999 to determine local needs and decide what kind of health care to provide. So even though the 90s heralded bold experiments in NHS access to CM – largely because GP fund-holding encouraged innovation and diversity – the jury is now very much out on whether changes in GP funding will allow these ventures to continue. Lean and mean though public sector CM has been I am not alone in detecting a wind of change. At a recent seminar we held for the Foundation for Integrated Medicine many of the better-known 'integrated units' were represented, including Lewisham, Southampton, Glasgow, Marylebone, Liverpool. All were concerned that resources were increasingly difficult to find despite the research effort, media profile, public popularity and CM's growing reputation among medics, all of which have got us to this point. The idea that the battles are won and it is only a matter of time until the NHS fully embraces CM produces a very dangerous complacency.

Lewisham was delivering the goods. Its own research programme showed that. Yet despite having supporters at the highest level it was axed once the Hospital had to tighten its financial belt. The reason given was lack of evidence. NHS funding is fast being withdrawn from the Homoeopathic Hospitals on the same grounds even though Glasgow is festooned with research success and London Homoeopathic Hospital has published a convincing review of recent research illustrating the case for CM.

Serious research into integration requires a healthy academic network and enough public sector provision of CM to make it feasible. CM needs users and friends to stand up and be counted. Complacency, apathy and a lack of commitment to public sector healthcare is all it will take to pinch out the green shoots of integration. Cream rises, as they say, and since the name of the game is excellence, CM will have to earn its place as a University subject area just as it must win its spurs in the NHS.

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About Dr David Peters

Prof David Peters is Chair of the British Holistic Medical Association (BHMA.org), an open association for everyone concerned to develop medicine as if people matter. David is the Clinical Director and Professor of Integrated Healthcare at the University of Westminster (U of W), is on the Board of Directors of the U of W Institute of Health and Wellbeing, a transdisciplinary research and training group exploring biopsychosocial approaches to health creation and treatment. He may be contacted via petersd@westminster.ac.uk

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