Yorkshire Cancer Network (YCN)
Criteria for Complementary Therapists
List of Complementary Therapy Disiplines Eligible onto the
Complementary and Natural Healthcare Council (CNHC)
*** VALID ON DATE OF PRINTING ONLY - all guidelines available at http://www.ycn.nhs.uk/ ***
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i Document Control
Title
YCN Criteria for Complementary Therapists
Author(s)
June Toovey, YCN Network Director
Owner
Yorkshire Cancer Network
Version Control
Version/ Draft
Date
Revision summary
1.0
April 2010
1.1
July 2010
Amendments to section 4.2.
1.2
June 2011
Amendments to section 4.2 and appendix 4
2.0
January 2012
Major Review
Contributors to current version
Contributor
Author/Editor
Section/Contribution
Individual
June Toovey
Full Guideline
Individual
Tracey Goldsbrough
Full Guideline
Individual
Janet Duerden
Full Guideline
Individual
Krystina Kozlowska
Full Guideline
Individual
Christine Skilton
Full Guideline
Individual
Denise Brown
Full Guideline
Individual
Janet Thogersen
Full Guideline
Individual
Nicola Rawstron
Full Guideline
Individual
Louise Fisher
Full Guideline
Individual
Sadie Smith
Full Guideline
Individual
Sue Cooke
Full Guideline
***VALID ON DATE OF PRINTING ONLY - all guidelines available at http://www.ycn.nhs.uk/ ***
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ii Information Reader Box
Title
YCN Criteria for Complementary Therapists
Author(s)
June Toovey, YCN Network Director
Publication date
March 2012
Review date
March 2014
Proposed Target
Audience for
Consultation / Final
Statement
All consultations and e-mail notification of updated guidelines will
be consulted to:
Proposed Circulation
List for Final
Statement
YCN Criteria for Complementary Therapists will be made available
electronically at http://www.ycn.nhs.uk/html/publications/
YCN Lead Nurses
The Contributors Listed Above
No hard copies will be circulated.
Yorkshire Cancer Network
21 Wetherby Road
Contact details
HARROGATE
HG2 7RY
tel: 01423 555705
email: info@ycn.nhs.uk
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iii Table of Contents
I DOCUMENT CONTROL ............................................................................................................ 2 II INFORMATION READER BOX ................................................................................................. 3 III TABLE OF CONTENTS ............................................................................................................. 4 IV AGREEMENT COVER SHEET .................................................................................................. 5 1 PURPOSE OF THE GUIDELINES............................................................................................. 6 2 INTRODUCTION ........................................................................................................................ 7 3 SCOPE OF THE YCN CRITERIA .............................................................................................. 8 4 NETWORK WIDE CRITERIA .................................................................................................... 9 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 5 CLEARANCE.............................................................................................................................. 9 QUALIFICATIONS, COMPETENCY & REGULATION OF COMPLEMENTARY THERAPIES....................... 9 WRITTEN INFORMATION FOR PATIENTS ..................................................................................... 14 INFORMED CONSENT ............................................................................................................... 15 NOTES ................................................................................................................................... 16 CONFIDENTIALITY ................................................................................................................... 16 PROTOCOLS ........................................................................................................................... 16 EQUIPMENT AND MATERIALS .................................................................................................... 17 CANCER LOCALITY GROUP REQUIREMENTS ................................................................... 18 5.1 5.2 LIST OF COMPLEMENTARY THERAPY PRACTITIONERS PRACTISING ON NHS PREMISES. ............... 18 LIST OF COMPLEMENTARY THERAPY PRACTITIONERS ENDORSED OR CITED IN PATIENT INFORMATION
BUT DO NOT PRACTICE ON NHS PREMISES ............................................................................... 19 6 CIRCULATION OF THE GUIDELINES (09-1A-302W) ........................................................... 20 7 APPENDICES .......................................................................................................................... 21 7.1 7.2 7.3 7.4 8 APPENDIX 1 ............................................................................................................................ 21 APPENDIX 2 – EXAMPLE COMPLEMENTARY CONSENT FORM ..................................................... 22 APPENDIX 3 - EXAMPLE OF A PROTOCOL FOR COMPLEMENTARY THERAPISTS FOR NHS
ORGANISATIONS ..................................................................................................................... 23 APPENDIX 4 - COMPLEMENTARY THERAPY ORGANISATIONS...................................................... 28 ACKNOWLEDGEMENTS ........................................................................................................ 30 ***VALID ON DATE OF PRINTING ONLY - all guidelines available at http://www.ycn.nhs.uk/ ***
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iv Agreement Cover Sheet
The Criteria has been agreed by:
Position
Chair of the YCN Management Board
Name
Mr S Duffy
Organisation
YCN
Date Agreed
31/01/2012
Position
Chair of the YCN Sub-Regional Palliative & End of
Life Care Group
Name
Ms L Vickerstaff
Organisation
North York and York PCT
Date Agreed
31/01/2012
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1 Purpose of the Guidelines
In October 2009, the Complementary Therapy (Safeguarding Practice) Quality Measures for
peer review were published. Although it is generally recommended that complementary
therapy is made available to patients, the actual range of and the levels of service provision
of such therapies are not subject to agreed boundaries; and NHS commissioners do not
have a mandatory requirement to provide them.
The measures set out the clinical governance requirements for the Network to exercise over
such complementary therapy as might be provided. They deal with the case of practitioners
offering therapy or consultations on the Network's NHS premises and also the case where
practitioners or organisations are endorsed and cited in the patient information of the
Network's MDTs, chemotherapy services, radiotherapy departments and information services
and centres. (Throughout this document when the term patient information is cited it is
referring to the definition above.) The measures intentionally focus on those clinical
governance issues which are directly relevant to the welfare of patients rather than those
dealing with the professional development of staff providing complementary therapy. The
guidelines aim to ensure a consistent approach and safe practice to patients.
The criteria are confined to adult cancer services. Measures are currently being developed
that specifically address the provision of services for children and young adults with cancer.
These guidelines meet the requirements for the YCN Board (Measures 09-1A-301 and
302w), which is required to produce and distribute criteria which should be agreed Networkwide and which should be met by practitioners in the Network or those cited in the Network's
patient information.
Following agreement by the YCN Board, these criteria will be circulated to the Cancer
Locality Group Chairs to:
•
•
•
document agreement of the criteria (09-1D-101w),
produce a list, updated annually, of the complementary therapy practitioners offering their
therapy or consulting with patients on the NHS premises of the locality (09-1D-102w) and
ensure those listed meet the relevant Network complementary therapy criteria (09-1D103w).
produce a list, updated annually, of those practitioners of complementary therapy (or
organisations providing practitioners) who are endorsed or cited in the patient
information, used by the locality, but who do not practise on the NHS premises of the
locality (09-1D-104w) and meet the agreed criteria (09-1D-104w)
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2 Introduction
These guidelines set out the clinical governance requirements for therapists or organisations
that provide complementary therapy for adults with cancer and are either:
• employed by the NHS
• self employed and hold an NHS honorary contract
• employed by another organisation
• work in a voluntary capacity
• endorsed and cited in the patient information.
All practitioners offering complementary therapies on NHS premises or cited/endorsed in the
patient information must adhere to these guidelines as a pre-requirement to practice on NHS
premises whether they are paid by the NHS or other agencies for their services or where the
therapies are provided on a volunteer basis. Therapists who cannot meet the criteria as set
out in this guidance must not be permitted to practice complementary therapies in NHS
settings and will not be endorsed/cited in patient information.
These guidelines will be distributed to all the YCN Cancer Locality Groups, Trust CEOs,
voluntary / independent sector providers of palliative care and any other organisations
providing complementary therapy to patients with cancer in the geographical area of the
YCN.
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3 Scope of the YCN Criteria
For the purpose of this document, ‘Complementary Therapy’ is used to cover a range of
specific therapies which are offered to patients with cancer as having potential benefit, but
which are not offered as an alternative tumour reduction (cancer reduction, tumour ablation
or removal) method to any of the conventional treatments offered by the Network (surgery,
radiotherapy, chemotherapy, endocrine therapy or biological therapy). Hence the term used
here is ‘complementary’ not ‘alternative’.
The definition of complementary therapy is:‘Complementary therapies are used alongside orthodox treatments with the aim of providing
psychological and emotional support through the relief of symptoms’
NICE Supportive and Palliative Care Improving Outcomes Guidance (2004)
The main purpose in the use of these therapies is to help:
•
•
•
•
promote relaxation
reduce anxiety
ease symptoms
help the patient find coping mechanisms and strategies
The complementary therapies cited in the peer review measures are as follows:
Acupuncture, acupressure, aromatherapy, healing, homeopathy, hypnotherapy, massage,
reflexology, relaxation & visualisation, shiatsu, reiki and bowen therapy
This is not a comprehensive list and other therapies may be offered, however, it is
anticipated the list will cover the majority of complementary therapies endorsed by or
provided on YCN NHS premises
For complementary therapies not listed above or included in the, Complementary & Natural
Healthcare Council (CNHC) register (see regulation section 4ii below) the YCN will work with
the Clinical Governance Committees of the NHS organisations to review and consider their
inclusion in the YCN Complementary Therapy agreed criteria. This will include agreeing the
necessary governance arrangements (e.g. relevant qualifications) that would need to be in
place.
It is recognised that volunteers provide hand and foot massage in NHS premises across the
Network. Although these services are not specifically covered within these criteria, it is
recommended that these volunteers are trained in this practice and have a certificate to
demonstrate their competence. An example of an organisation providing this training is the
Red Cross.
Other services which have therapeutic value to patients, but are not strictly considered to be
complementary therapies may be delivered across the Network, e.g. colour therapy and
Cancer Locality Groups are responsible for deciding the appropriate qualifications required
where these are provided.
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4 Network Wide Criteria
4.1 Clearance
If working on NHS premises, the therapist should be:
•
An NHS employee
•
Self employed with an NHS honorary contract
•
Employed by an organisation with an employment policy which covers at least the
following:¾ Occupational Health Clearance
¾ Clearance for working with vulnerable adults (or children if relevant)
¾ Criminal Records Bureau clearance
¾ Written agreement to adhere to Trust policies and procedures (including
health and safety, patient confidentially, equal opportunities etc)
¾ In possession of relevant indemnity insurance which should be checked
annually to ensure that it is current. A photocopy of the insurance document
should be taken and placed on the therapist’s personnel file.
•
If the therapists are volunteers they should have gained the above clearances as per the
locality policy applicable to volunteers.
Localities will be responsible for ensuring that the complementary therapists practicing on
NHS premises are adequately insured either via the relevant indemnity insurance or covered
by the Trusts vicarious liability.
The NHS organisation must keep an up to date register of therapists who meet these criteria
and who are working on the premises/ endorsed in the patient information literature.
4.2 Qualifications, Competency & Regulation of Complementary
Therapies.
The Complementary Therapy Practitioner must be eligible for registration with a recognised
professional body pertaining to their therapy.
Health Care Professionals wishing to incorporate complementary therapies into their work
are required to check with their professional body regarding eligibility to use therapies as part
of their professional practice.
Complementary therapy covers a wide range of different practices and there are a plethora
of Professional Associations that practitioners can belong to. This makes it very challenging
for the NHS to have robust assurance processes in place without an agreed national list of
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recognised professional bodies or a compulsory regulation system. To give as much
assurance as currently feasible the YCN recommends that when ever possible the
Complementary & Natural Healthcare Council (CNHC) is used as the quality assurance
benchmark.
For complementary therapies not listed in the peer review measures or included in the CNHC
register. Localities will be required to work with their Clinical Governance Committees to
review and consider the practice being delivered on NHS premises or endorsed/cited in
patient information produced by the locality ensuring that there is robust assurance of the
governance of individual practitioner’s competency.
Complementary & Natural Healthcare Council
The CNHC has been set up as a national voluntary regulator in complementary therapies
and is endorsed by the Department of Health and within the Peer Review Measures,
The Department of Health in November 2009 stated: "CNHC is the only voluntary regulatory
body for complementary healthcare which has official government backing. No other
organisation has the same exacting criteria or focus on safety and quality.”
The CNHC is in the process of including new therapies into its framework but does not, as
yet, regulate all therapies. It is anticipated that within the next two years the CNHC will cover
the majority of complementary therapies. Updates of new therapies included in the CNHC
framework can be found on their website http://www.cnhc.org.uk.
It is recognised that the CNHC as a regulatory body does not provide any continuing
professional development opportunities it is therefore seen as good practice for therapists to
belong to an appropriate professional association.
It is recognised that a period of transition will be required to ensure that the CNHC cover the
relevant complementary therapies and to allow practitioners the time to register with them
Within the next year (i.e. before the peer review validation August 2012) any
complementary therapy practitioner working on YCN NHS premises or cited/endorsed
in the patient information, MUST have:
•
•
A qualification relevant to their therapy
Current registration with the CNHC (it is advised best practice for practitioners to also
belong to an apporiate professional association)
The therapist’s certificate of qualification and CHNC registration,, should be checked
and a photocopy of the documents kept in the therapist’s personnel file.
In the interim period for those therapies not included on the CHNC register
Any complementary therapy practitioner working on YCN NHS premises or
cited/endorsed in patient information MUST have:
•
•
A qualification relevant to their therapy
Current registration with a relevant Professional Association (It is the responsibility
of localities to assure themselves of individuals competency) )
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The therapist’s certificate of qualification and Professional Association should be
checked and a photocopy of the documents kept in the therapist’s personnel file.
Complementary Therapies on the CNHC register
The complementary therapy disciplines that are currently eligible for entry to the CNHC
Register are:•
•
•
•
•
•
•
•
•
•
•
•
•
Alexander Technique teaching
Aromatherapy
Bowen Therapy
Healing
Hypnotherapy
Massage Therapy
Microsystems Acupuncture
Naturotherapy
Nutritional therapy
Reflexology
Shiatsu
Sports and Remedial Therapy
Yoga Therapy
The CNHC states that for these complementary therapies, the following professional
associations or training institutions have been approved for verifying that their members meet
the CNHC standards for registration.
Alexander Technique teaching only
Society of Teachers of the Alexander Technique (STAT)
Interactive Teaching Method Teaching Association (ITM)
Professional Association of Alexander Teachers (PAAT)
Alexander Technique International (ATI)
Federation of Holistic Therapists (FHT)
Aromatherapy
International Federation of Professional Aromatherapists
(IFPA)
Aromatherapy & Allied Practitioners Association (AAPA)
Association of Physical & Natural Therapists (APNT)
Complementary Therapists' Association (CThA)
Federation of Holistic Therapists (FHT)
International Federation of Aromatherapists (IFA)
Bowen Therapy
Bowen Therapy Professional Association (BTPA)
Federation of Holistic Therapists (FHT)
Bowen Association UK (BAuk)
Healing
British Alliance Of Healing Associations (BAHA)
British Association of Therapeutic Touch (BATT)
Federation of Holistic Therapists (FHT)
The College of Psychic Studies (CPS)
www.stat.org.uk
www.alexandertechnique.itm.org
www.paat.org.uk
www.ati-net.com
www.fht.org.uk
www.ifparoma.org
www.aromatherapyuk.net
www.apnt.org
www.complementary.assoc.org.uk
www.fht.org.uk
www.ifaroma.org
www.bowen-therapy.co/Bowen/btpa-cnhc.asp
www.fht.org.uk
www.bowen-technique.co.uk
www.britishalliancehealingassociations.com
www.ttouch.org.uk
www.fht.org.uk
www.collegeofpsychicstudies.co.uk
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The Guild of Professional Healers
The Healing Trust
Hypnotherapy
Federation of Holistic Therapists (FHT)
The association for Professional Hypnosis & Psychotherapy
(APHP)
The British Association of Hypnotherapy (BIH)
The British Association of Therapeutical Hypnotherapists
(BAThH)
The British Scociety of clinical Hypnosis (BSCH)
The Corporation of Advanced Hypnotherapy (CAH)
The General Hypnotherapy Register (GHR)
The Hypnotherapy Association
The Hypnotherapy Society (Hs)
The National Association of Counsellers, Hypnotherapists &
Psychotherapists (NACHP)
The National Council of Hypnotherapy (NCH)
The National Council of Psychotherapists (NCP)
The NC Student and Alumni Guild
The national Register of Advanced Hypnotherapists (NRAH)
The national Society of Professional Hypnotherapists
(NSPH)
The Society of Stress Managers (SSM)
The World Federation of Hypnotherapists
Massage
London & Country Society of Physiologists (LCSP)
Massage Training Institute (MTI)
National Association of Massage & Manipulative Therapies
(NAMMT)
Scottish Massage Therapists Organisation (SMTO)
Aromatherapy & Allied Practitioners Association (AAPA)
Association of Holistic Biodynamic Massage Therapists
(AHBMT)
Association of Physical & Natural Therapists (APNT)
Complementary Therapists' Association (CThA)
Federation of Holistic Therapists (FHT)
Institute of Sport & Remedial Massage (ISRM)
Sports Therapy Organisation (STO)
Sports Massage Association (SMA)
Oxford Natural Therapists Association (ONTA)
Scottish Massage Therapists Organisation (SMTO)
www.guildofprofessionalhealers.org.uk
www.thehealingtrust.org.uk
www.fht.org.uk
www.aphp.co.uk/index.php
www.britishinstituteofhypnotherapy-nlp.com
www.bathh.co.uk
www.bsch.org.uk
www.advanced-hypnotherapy-register.com
www.general-hypnotherapyregister.com/CNHC%20details.htm
www.thehypnotherapyassociation.co.uk
www.hypnotherapysociety.com
www.nachp.org
www.hypnotherapists.org.uk
www.ncphq.co.uk
www.hypnotherapy.net/accreditation.htm
www.nrah.co.uk/membership/introduction.htm
www.nsph-hypnotherapy.co.uk
www.manageyourstress.co.uk
www.w-fh.co.uk
www.lcsp.uk.com
www.massagetraining.co.uk
www.nammt.co.uk
www.scotmass.co.uk
www.aromatherapyuk.net
www.ahbmt.org
www.apnt.org
www.complementary.assoc.org.uk
www.fht.org.uk
www.theisrm.com
www.uksportstherapy.org.uk
www.thesma.org
www.oxfordschoolofmassage.com
www.scotmass.co.uk
Microsystems Acupuncture
Acupuncture-acutherapy Council
Ear Acupuncture Register
Federation of Holistic Therapists (FHT)
The Acupuncture Society
The College of Auricular Acupuncturists
The Society of Auricular Acupuncturists
www.ukorientalmedicine.com
www.yuantmc.co.uk/ear/earmenu.htm
www.fht.org.uk
www.acupuncturesociety.org.uk
www.auricularacupuncturecollege.com/index.php
www.auricularacupuncturecollege.com/saac
Naturopathy
Federation of Holistic Therapists (FHT)
Association and Register of Colon Hydrotherapists (ARCH)
www.fht.org.uk
www.colonic-association.org/index.html
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General Council and Register of Natropaths (GCRN)
Incorporated Society of Regitered Naturopathy (ISRN)
London College of Naturopathic Medicine and Health
Science (LCNMA)
Nutritional therapy
British association for Applied Nutrition and Nutritional
Therapy (BANT)
Federation of Holistic Therapists (FHT)
Wholistic Nutritional Medicine Society (WNMS)
www.naturopathy.org.uk
www.naturecuresociety.org
www.lcnm.co.uk
www.bant.org.uk
www.fht.org.uk
www.wnms.org.uk
Reflexology
Association of Reflexologists (AoR)
British Reflexology Association (BRA)
Aromatherapy & Allied Practitioners Association (AAPA)
Complementary Therapists' Association (CThA)
Federation of Holistic Therapists (FHT)
Association of Physical & Natural Therapists (APNT)
Professional Reflexology
www.aor.org.uk
www.britreflex.co.uk
www.aromatherapyuk.net
www.complementary.assoc.org.uk
www.fht.org.uk
www.apnt.org
www.professionalreflexology.org/cnhc
Shiatsu
Federation of Holistic Therapists (FHT)
Zen Shiatsu Society (ZSS)
The Shiatsu Society (SS)
Shiatsu International (SI)
www.fht.org.uk
www.zen-shiatsu-society.co.uk
www.shiatsusociety.org
www.shiatsu-international.com
Sports & Remedial Therapy
Complementary Therapists' Association (CThA)
Federation of Holistic Therapists (FHT)
National Association of Massage & Manipulative Therapists
(NAMMT)
Institute of Sport & Remedial Massage (ISRM)
Scottish Massage Therapists Organisation (SMTO)
Sports Therapy Organisation (STO)
Yoga Therapy
Krishnamacharya Healing and Yoga Foundation (KHYF)
Yoga Therapy and training Centre (YTTC)
Centre of Yoga Studies (CS)
Friends of Yoga Society (FRYOG)
Dru Yoga (UK)
Yoga Biomedical Trust
Birthlight
British Wheel of Yoga (BWY)
Federation of Holistic Therapists (FHT)
Ivengar Yoga Association (IYA)
www.complementary.assoc.org.uk
www.fht.org.uk
www.nammt.co.uk/cpd.php
www.theisrm.com
www.scotmass.co.uk
www.uksportstherapy.org.uk
www.khyf.net
www.yogaireland.com
www.yogastudies.org
www.friendsofyoga.co.uk
www.druworldwide.com
www.yogatherapy.org
www.birthlight.com
www.bwy.org.uk
www.fht.org.uk
Please note the information in the above table was accurate when this criteria was produced in June 2011
During 2011 the Register will open to more disciplines, as they become ready and wish to
register. Those in this category which are relevant to these criteria are:•
•
Cranial Sacral therapy
Reiki
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As these complementary therapies come on line, the CHNC website will list details of the
professional associations or training institutions that have been approved for verifying that
their members meet the CNHC standards for registration.
Complementary Therapy Professional Associations included in the national Cancer patient
Information
There are some therapies that are not currently eligible for entry to the CHNC register but are
included in the National Cancer Patient Information Pathways, which give details of the
organisations that can help identify the professional registration recommended to identify a
suitably qualified therapist. The organisations quoted in the pathways with the website
address are listed below.
Acupuncture
BacC – British Acupuncture Council
BMAS – British Medical Acupuncture Society
www.acupuncture.org.uk
020 8735 0400
www.medical-acupuncture.co.uk
01606 786782
Healing
National Federation of Spiritual Healers (now The
Healing Trust)
UK Healers
www.thehealingtrust.org.uk
Homeopathy
British Homeopathic Association and Faculty of
Homeopathy
The Society of Homeopaths
www.trusthomeopathy.org
www.ukhealers.info/hh.htm
www.homeopathy-soh.org
Relaxation and Visualisation
These therapies are most usually offered by those
therapists who are qualified in other disciplines such as
counselling or hypnotherapy and so those qualifications
and professional registrations must apply.
Currently there are two complementary therapy disciplines listed in the Peer Review
measures (Acupressure and Reiki) which do not have CHNC registration or, any
recommended professional bodies listed in the information on the National Cancer Patient
Information Pathways. There may also be other complementary therapies being practiced
across the Network that are not included in the above tables.
The Network is not in a position to endorse qualifications or registration standards for
complementary therapies independently, however, a list of additional complementary therapy
organisations can be found in appendix 4 for information
The list of therapies included in the Network criteria will be reviewed in 2012 and new
therapies added that have received CHNC registration.
4.3 Written Information for patients
Patients should be provided with written information for the therapies offered. This can either
be prepared by the Trust e.g. in a leaflet which explains a number of therapies offered or in
individual leaflets prepared by the therapists. Any information provided by the practitioner to
patients must be agreed by the chair of the Cancer Locality Group. It is useful to offer written
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information about the therapy prior to a session so that the patient can read it before and
after.
The information should cover the following:•
A statement to the effect that the therapy is not an alternative method of tumour reduction
to the conventional therapies (surgery, radiotherapy, chemotherapy, endocrine or
biological therapy).
•
The leaflet should not promise any cure or particular benefit.
•
Patients should know what they are being offered, what they can expect, how long the
sessions will last, what they may feel after a session and what to do if they feel worse
after a session.
•
The leaflet should state the therapist’s (network agreed) qualification.
•
It is recommended that information is available in languages and formats understandable
by all including ethnic minorities and people with disabilities.
•
The leaflet should not be used by the therapist to advertise their own private practice.
Patients wanting to make arrangements with the complementary therapist privately for
treatment in their own homes or on non NHS premises must be entitled to do this without
pressure from the complementary therapist to continue treatment and incur costs. Where
the patient wishes to engage in an arrangement with the complementary therapist outside
the NHS setting then this is a matter for the patient and the complementary therapist
separate to this guidance. The therapist should make the patient aware of the fees that
will be incurred in any private arrangements prior to the patient booking an appointment.
•
It is recommended that patients inform a member of the Multi-Disciplinary Team if they
are considering having complementary therapy, so they can assist the patient in making
an informed decision about whether that type of complementary therapy is right for them
4.4 Informed consent
Informed consent can be said to have been given based upon a clear appreciation and
understanding of the facts, implications, and future consequences of an action.
For those unable to give informed consent unaided through, for example, language or
understanding difficulties, the NHS organisation should follow local policies already in place
for gaining consent.
For the consent to be valid the patient must:
•
•
•
Be competent to take the particular decision.
Have received sufficient information make the decision
Not be acting under duress
A written consent form should be provided by the Trust in a standard format (example
attached in Appendix 2). Written consent must be gained from each patient prior to the start
of each therapy.
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It should be made clear that declining a therapy will in no way adversely affect a patient’s
care. Regard should be given to patient choice and it is important to note that some patients
may not wish to engage in complementary therapies.
Therapies are not to be given in the following circumstances:
•
Where patients do not wish to use complementary therapies
•
Where patients are under the care of a psychiatrist or are diagnosed with clinical
depression and the therapist providing psychological based complementary therapies
has not received prior agreement from the patient’s Consultant/GP
•
Where a health assessment undertaken prior to therapy identifies a contra-indicating
factor to that therapy
•
Where a language common to both does not exist between the complementary therapist
and the patient and when hypnotherapy or psychological based treatments are to be
offered.
•
Complementary therapists should be aware and sensitive to the fact that some patients
may prefer to be given therapy by a therapist of the same gender.
4.5 Notes
Each therapist must keep clear and concise records of their therapeutic sessions. NHS
organisations employing complementary therapists or making use of volunteer
complementary therapists should ensure that a clear policy is in place in relation to the
recording and storage of notes from complementary therapists.
Hospital computerised records are covered by the Data Protection Act. Any therapist holding
patients’ records/notes on their personal computer, outside the hospital must be registered
with the Data Protection Service.
4.6 Confidentiality
Complementary therapists are bound by both the Code of Ethics of their relevant
professional bodies and also by the guidance of the establishment in which they provide
therapy.
Confidential information should only be shared with the patient’s permission or only when
necessary for the patient’s welfare.
Therapists are subject to the same complaints procedures as all other employees of the
establishment in which they work.
4.7 Protocols
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NHS organisations should be mindful that complementary therapists may not have specific
experience working within an NHS environment and so guidance should be given to aid them
to provide therapies within a clinical environment.
It is considered good practice for each cancer locality to have protocols for all therapies that
are offered on the NHS premises. An example protocol is included in Appendix 3.
For practitioners who are endorsed/cited in the patient information but who do not practice on
NHS premises, items (i) to (vii) apply and in addition the following applies.
4.8 Equipment and materials
•
Materials
Therapists must adhere to any guidance on toxicity of substances contra indicated for
patients with cancer advised by their code of professional conduct and professional
indemnity insurance.
•
Equipment
Complementary therapists who use their own equipment (e.g. massage tables) must ensure
their equipment meets European CE standards. The equipment must be maintained in
accordance with the manufacturer’s recommendations.
Equipment must be cleaned using disinfectant wipes and dried thoroughly between patients
or the equipment must be protected with disposable covers, which is changed between
patients. Most equipment for usage with patients has manufacturers’ recommended cleaning
methods and these must be adhered to.
NB. Complementary Therapists working in organisations inspected by the Care Quality
Commission are exempt from (viii).
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5 Cancer Locality Group Requirements
The Cancer Locality Group should agree the Network criteria for complementary therapy as
a pre-condition for practitioners practising on the NHS premises of the locality or being
endorsed or cited in the written patient information encompassed by the locality.
5.1 List of complementary therapy practitioners practising on NHS
premises.
Each Cancer Locality Group should produce a list annually of the complementary therapy
practitioners offering their therapy or consulting with their patients on the NHS premises of
the locality.
The list should record the following information:
•
Name of the complementary therapist
•
Complementary therapy offered
•
Qualification of the complementary therapist
•
NHS Premises at which the complementary therapist offer therapies
•
Confirmation that the complementary therapist has complied annually with securing
professional indemnity assurance and membership of the CNHC (where applicable)
•
The consent form used at each organisation
•
The employment status of the complementary therapist i.e. employed by the NHS,
volunteer etc.
In order to be compliant The Cancer Locality Group must annually for each practitioner:•
See documentation that they are an NHS employee or that their employing or volunteer
recruitment organisation’s clearance policies are agreed by the chair of the Cancer
Locality Group.
•
Check that the practitioner holds a professional qualification that is listed within this
Network criteria.
•
Check that each practitioner has written information for patients which demonstrates the
items shown in (iii) above.
•
Check the consent and check that this demonstrates the requirements in (iv) above.
For the compliance of the Cancer Locality Group, all of the practitioners on the list should
meet the criteria.
This information should be verified annually by the Cancer locality Group (CAG). An example
check list is provided in Appendix 1.
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5.2 List of complementary therapy practitioners endorsed or cited in
patient information but do not practice on NHS premises
The Cancer Locality Group should produce a list updated annually of those practitioners of
complementary therapy (or organisations providing practitioners) who are endorsed or cited
in the patient information of the MDTs, chemotherapy services and radiotherapy
departments, encompassed by the locality, but who do not practice on the NHS premises of
the locality confirming that those practitioners or organisations meet the criteria described in
sections (i) – (viii).
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6 Circulation of the Guidelines (09-1A-302w)
Following agreement from the YCN Management Board and the Chair of the YCN SubRegional End of Life Care Group, these guidelines will be circulated to Cancer Locality
Group Chairs, Trust CEOs voluntary/independent sector providers of palliative care and any
other organisation providing complementary therapy in the geographical area covered by the
Network. The criteria will be made available to clinicians, managers, patients and the public
on the YCN website.
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7 Appendices
7.1 Appendix 1
Checklist for Trusts / other NHS organisations in employing Complementary
Therapists or making use of volunteer complementary therapists.
The following is a checklist of the criteria to be adhered to before a complementary therapist
commences work on an NHS premises.
•
Occupational health clearance
•
Clearance for working with vulnerable adults
•
CRB check
•
Written agreement to adhere to the trusts policies and procedures
•
Up to date professional indemnity insurance (photocopy taken by the NHS organisation
and kept on file. This must be checked annually)
•
Relevant qualifications (certificated provided and a photocopy taken by the NHS
organisation and kept on file)
•
Suitable written information for the patient (NHS organisations may decided to provide
this for all the complementary therapies offered)
•
Consent form available(should be provide by the NHS organisation in a standard format
and distributed to all therapists)
•
The complementary therapist must be aware of how to record notes from sessions
offered.
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7.2 Appendix 2 – Example Complementary Consent Form
NAME OF TRUST / NHS ORGANISATION ……………………………………………………………………………
PATIENT CONSENT FORM FOR COMPLEMENTARY THERAPY
Name of Complementary Therapist
……………………………………………........................
Patient Name ……………………………………………
Therapy Offered ………………………………………..
Date of Birth ……………………………………………
Leaflet/Literature
Provided to the Patient …………………… (YES / NO)
I sign to confirm that:• I have received the information
TICK
provided by the therapist

• I have understood that the therapy is not an
alternative to conventional cancer treatment 
• I consent to the therapy

Signed ………………………
(Patient)
Date ………………….
Signed …………………………..
(Complementary Therapist)
Date ……………..
Please ensure that this document is placed in the patient’s notes in accordance with the policy of the NHS organisation in which the
therapy is provided
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7.3 Appendix 3 - Example of a Protocol for Complementary Therapists
for NHS Organisations
Local Protocol
1. All prospective practitioners will be screened by the Voluntary Services Department in
line with current departmental practices.
2. Therapists will be responsible for observing all the guidelines in line with normal
volunteering policy, including equal opportunities, safe handling, health and safety, and
hygiene.
3. All practitioners will agree with and sign a declaration of patient confidentiality.
4. Therapists must hold an appropriate professional insurance policy for their approved
therapy.
5. Permission for a session must come from the patient themselves; although staff may
suggest a session or help a patient select one which is appropriate to their needs.
6. Sessions will only be given after the therapist has met with, and discussed the therapy
with the patient. Patient’s medical and nursing notes should be made available to the
therapist.
7. Details of each treatment will be documented by the therapist(s) within the patient’s notes
and will then be dated and signed by the therapist.
8. All therapists will uphold the dignity of the patient at all times and strictly observe the
ethical code of their professional body.
9. Before offering complementary therapies to patients the complementary therapist must
inform the person in charge of the ward/ out patient area that therapies are to be offered /
given to ensure that complementary therapies are not offered / provided to patients for
which these are not suitable.
10. Regular communication between the therapist and nursing staff and other healthcare
professionals is encouraged. Therapist’s concerns regarding changes in the patient’s
condition should be discussed immediately with the nurse in charge, and documented in
the patient’s record.
11. All therapists are expected to be committed to continuing personal development and will
be supported and encouraged to develop their knowledge and skills in specialist areas.
12. All patients will be offered an evaluation form to record their comments regarding the
therapies they receive which includes asking how good the therapist is about giving
appropriate information, how the patient has felt about the session, and any other
relevant comments they may wish to make.
13. The location of the sessions will vary according to the patient’s needs and environment,
but the wishes of the patient regarding privacy should be respected at all times.
14. All sessions given by practitioners from the Voluntary Services Department are free of
charge, and no charges or donations are to be sought by therapists.
Treatment Guidelines
Therapists must adhere to any guidance on toxicity of substances contra indicated for
patients with cancer advised by their code of professional conduct and professional
indemnity insurance.
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Massage
Generally, gentle, non-invasive massage techniques should be employed so as not to overstimulate the patient’s system. Kneading, pummelling and deep massage are not
recommended.
Clinical Checklist/Contraindications
1. Body Temperature
Do not treat patients with a high temperature.
Very hot areas can indicate an infection, inflammation or intense cellular activity. In oncology
patients, cancerous sites are often hot. Therapists should check with staff first to establish
appropriateness of treatment.
2. Fluid Retention/Swelling/Lymphoedema
Avoid the area. Never massage a swollen limb/trunk, unless you have been specifically
trained in appropriate drainage techniques, or have been shown a particular technique by the
patient’s specialist care giver (e.g. physiotherapist).
3. Undiagnosed Lumps or Areas of Inflammation
AVOID THE AREA – report this finding.
(It may indicate a recent growth in cancer patients which has not yet been diagnosed.)
4. Skin Problems/Rashes
These could be circulatory problems or reaction to medication/diet. AVOID THE AREA OF
ANY RASHES – report this finding.
5. Pinprick Bruising
These are indicators of a very low blood count. Check with nursing staff or medical staff
before treating.
Massage very gently with careful light strokes to help the body feel warmer. It may be
suitable to massage hands and feet only in order to avoid affected areas.
6. Radiotherapy
Radiotherapy treatment entry and exit sites should be avoided for up to six weeks following
treatment.
Use very gentle strokes following radiotherapy as the skin remains vulnerable to damage.
7. Stoma Sites, Dressings and Catheters
AVOID THESE. Massage elsewhere, i.e.: hands and feet.
8. Scar Tissue/Broken Skin/Lesions/Recent operation sites or wounds
Avoid areas of recent scar tissue/broken skin or lesions.
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9. Tumour Site
Do not massage over the tumour site, near the tumour site or adjacent or affected lymph
glands.
10. Deep Vein Thrombosis (DVT)
Do not massage feet or legs if the patient has a diagnosed or suspected deep vein
thrombosis in the legs, or arm/hand if a thrombosis is suspected in the arm.
11. Areas of Infection
Avoid all areas of external infection. Employ appropriate infection control techniques.
12. Injury and Bone Metastases (secondaries)
Avoid areas of injury or bone metastases.
13. Phlebitis (hot/inflamed veins)
Avoid areas of phlebitis. Work above the area affected.
14. Hot or inflamed Joints
Avoid hot or inflamed joints, except to apply cooling oils where appropriate.
15. Angina, Hypertension, Hypotension
Exercise caution with patients with these conditions, using gentle massage strokes and
balancing oils. Check with the nursing or medical staff as patients may need to be treated in
an upright/sitting position.
16. Jaundice
Exercise caution with patients with these conditions. Check with the nursing or medical staff
before proceeding.
17. Low platelet counts
This will contra-indicate the use of massage using pressure techniques as there is a greater
likelihood of bruising.
Reflexology
Contraindications:
As with usual practice.
General
Gentle touch.
Thrombosis/Embolism
Do not treat until the condition has been managed medically, or after you have liaised with
appropriate medical personnel.
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Precautions
Lymphomas and leukaemias – very gentle sessions.
In the case of stem cell transplants avoid the use of reflexology whilst the immune system is
suppressed.
Radiotherapy And Chemotherapy
Gentle treatments bearing in mind any vulnerable areas connected with side effects of
treatment.
Other Therapies
Whatever the therapy, the following general considerations should be regarded:
•
•
•
•
the patient’s physical and emotional state
treatment programme
side effects of treatment
physical problems related to the patient’s condition.
Therapy should be gentle with the main aim of relaxation and relief of stress and stress
related symptoms. Therapists should, where possible, liaise with the person’s medical or
nursing team where treatment is imminent, ongoing or recently completed.
General Guidance When Giving A Session
Hands must be washed immediately before and after treatments are given, and alcohol gel
should be used in accordance with ward policy.
No jewellery or watches should be worn on hands or lower arms.
Adherence to the dress code should be carefully observed.
Aprons should always be worn when working with any immune compromised patient.
For in patients all treatments for patients are to be given on the patient’s own bed, or at their
bedside.
All therapists should establish a working pressure that is comfortable for the patient at all
times.
The length of each session will be in agreement with the patient and in recognition of their
specific needs at the time of the session. However, an average of 20-30 minutes is
recommended, unless the patient is able to tolerate more without being over tired.
Always check with the nursing staff before treating a patient who is being barrier
nursed, or has MRSA, so that cross-infection is avoided.
Training
Training is offered on the management of patients with cancer.
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Evaluation
Information on complementary therapies should be collected regarding:
Number of sessions given
Length of time spent in each therapy session
Type of treatment given
Oils used during session (where relevant)
Supervision
Supervision is not a mandatory requirement but is recommended in the interests of safe best
practice. Many therapists feel that their work is best supervised by someone with in-depth
knowledge of their subject and as such seek outside professional supervision. Supervision
engaged in outside of the hospital is at the sole discretion the individual therapist and at their
personal cost.
Private Practice
The Trust recognises that volunteers also practice privately in their own time. However,
volunteers should make it clear to all their clients that their volunteering within the NHS is
totally unrelated to their private practice as a therapist.
Volunteers may not seek to deliberately recruit patients during their volunteering for the
Trust, but may in the course of discussions give information about their private practice.
Any requests for treatment from visitors, relatives or friends of patients, or hospital staff must
be treated as private work, and no treatments may be given on site unless agreed by
Voluntary Services and senior ward staff.
(This protocol is provided with kind permission of the Volunteer Department of
University College Hospital London on which this is based)
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7.4 Appendix 4 - Complementary Therapy Organisations
Acupuncture
•
•
•
ACCP – Acupuncture Association of Chartered Physiotherapists
http://www.aacp.org.uk 01733 390006
BAWA – British Academy of Western Medical Acupuncture
http://www.bawma.co.uk/british-medical-acupuncture 0151 3439168
BAAB – British Acupuncture Accreditation Board
http://www.baab.co.uk 020 8735 0466
Aromatherapy
•
•
•
•
•
•
•
•
•
•
•
•
•
Aromatherapy Consortium info@aromatherapy-regulation.org.uk
0870 7743477
Aromatherapy Council http://www.aromatherapycouncil.co.uk
Aromatherapists Society
http://www.thearomatherapistssociety.net
01903 694435
AMA – Association of Medical Aromatherapists
0141 332 4924
ANM – Association of Natural Medicine
01376 502762
http://www.associationnaturalmedicine.co.uk
City & Guilds http://www.cityandguilds.com
Embody http://www.embodyforyou.com
0845 202 2941
IHHT – Institute of Health and Holistic Therapies
ICM – Institute of Complementary Medicine
0207 922 7980 http://www.i-c-m.org.uk/education
IPTI – Independent Professional Therapists International
01777 700383 mailto:iptiuk@aol.com
ITEC Professionals
http://www.itecworld.co.uk
020 8994 4141
Tisserand Institute http://www.tisserand.com
01273 224084
VTCT http://www.vtct.org.uk
02380 684500
Healing & Energy Based Therapies
•
•
•
NFSH – National Association of Spiritual Healers
01604 603247 (there are numerous professional organisations related to healing;
standards of training may need to be verified) http://www.nfsh.org.uk
Reiki Association http://www.reikiassociation.org.uk
UK Reiki Federation http://www.reikifed.co.uk
01264 791441
‘M’ Technique
•
Approved Instructor ‘M’ Technique ® course http://www.mtechnique.co.uk
Manual Lymphatic Drainage
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•
MLD UK http://www.mlduk.org.uk 0844 800 1988
(trained in: Vodder, Asdonk, Casely-Smith, Földi or Leduc)
This list is adopted from the Essex Cancer Network complementary therapy
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8 Acknowledgements
With thanks to the Sussex and Essex Cancer Networks for sharing their complementary
therapy documents, which have been used and adapted in the development of these
guidelines.
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