Baroness Thornton: Response to issues raised in Lords CBT debate
For ease of reference, three items are compiled within this one posting:
The first, the link for the House of Lords “CBT Debate” which took place on 18 March 09:
Health: Cognitive Therapy
Question for Short Debate
Tabled By Baroness Tonge:
To ask Her Majesty’s Government what steps they are taking to implement cognitive psychotherapy in the National Health Service.
The full debate can be read here on Hansard:
The Countess of Mar’s contribution starts in column 317; Baroness Thornton’s reply to the debate starts in column 323.
The second item, from the ME Association, a commentary on “ME/CFS AND THE INSURANCE INDUSTRY”, includes reference to the Countess of Mar’s raising the issue of NICE and insurance companies during this Lords “CBT Debate” plus a copy of the ME Association’s report on the debate.
The third, a letter from Baroness Thornton, Minister in the Government Whips Office, Government Spokesperson for the Department of Health, to the Countess of Mar, dated 2 April 2009.
From the ME Association:
ME/CFS AND THE INSURANCE INDUSTRY
PHI/INCOME PROTECTION POLICIES
The ME Association has become increasingly concerned about feedback from our members regarding the way in which some insurance companies are behaving when it comes to claims for private sickness/disability related benefits – PHI (income protection/replacement) policies in particular.
We do not believe that the NICE guideline on ME/CFS is helping matters, especially the way in which one insurance website has interpreted the outcome of the NICE guideline judicial review to mean that ME/CFS is now classified as a psychiatric illness rather than a physical illness. As a result, it is claimed that insurance companies can opt of making payments to people with ME/CFS where there is a psychiatric illness exclusion clause in the contract. See also our report on the Countess of Mar raising this issue during a House of Lords debate: http://www.meassociation.org.uk/content/view/826
We have therefore arranged a meeting with representatives from the Association of British Insurers (ABI) to discuss these and other insurance-related concerns. The meeting will take place on Wednesday 8 April.
Whilst we cannot undertake to deal with individual insurance related problems at this meeting, we are keen to hear from anyone who has any important general points which ought to be raised at this meeting. The agenda for the meeting will be based on the concerns noted above about the NICE guideline and the various problems that are discussed in the new MEA information leaflet on PHI policies.
We are also about to start updating our database on insurance companies that are either helpful or unhelpful when it comes to offering travel insurance policies to people with ME/CFS. If you have any 2009 information on helpful/unhelpful travel insurers please let us know the basic details.
MEA iterature can e obtained using the pdf ORDER FORM on the MEA website:
Countess of Mar slates NICE and the health insurance industry
The NICE Guideline on ME/CFS, and the attitude of many health insurers towards people with the illness, came under withering fire from the Countess of Mar in a debate in the House of Lords yesterday (March 18).
The Countess said the Guideline was published amid “a barrage of criticism” from the ME community because the only two treatments it recommended – on the basis of very limited and strongly criticised scientific evidence – were Cognitive Behaviour Therapy (CBT) and Graded Exercise (GET).
The recent judicial review did not test the scientific validity of NICE’s recommendations. The Countess said the assertion made by Professor Peter Littlejohns, NICE clinical and public health director, after the legal challenge was rejected – he said this “means that the NICE guideline is the gold standard for best practice in managing ME/CFS” – was not accurate.
Speaking in a debate opened by Baroness Tonge on the cognitive therapy programme launched by the NHS. the Countess said: “People with ME already bear a great burden of disbelief about the reality of their illness from their closest relatives, their friends, the medical profession and other care professionals they encounter, as well as the community at large.
“There has been a preponderance of articles on “yuppie flu” in the press and broadcast media; research funding, other than that provided by the ME charities, has been exclusively weighted in favour of the psychosocial as opposed to the biomedical aspects of the illness; and ME patients seem to have to go through a great many more hoops, including CBT, to obtain and retain social security benefits and social care packets, as well private health insurance.”
But the Countess, who chairs a strategic ME planning group called ‘Forward ME’ comprising the heads of several national ME charities and voluntary groups, reserved her most intense criticism for the health insurance industry for their misinterpretation of the illness as a psychiatric condition.
“I have a quotation from Health Insurance News UK dated 22 February 2009. Under the heading,
“Medical Insurance May Not Cover Chronic Fatigue”,
“it gives a condensed description of ME. It then states:
“This sounds like a physical problem, doesn’t it? However, the NICE guidelines suggest that it is a psychiatric condition rather than a physical one.”.
“It goes on to say:
“Because of the NICE guidelines private health insurance companies are within their right to refuse cover if an applicant’s policy does not include psychiatric cover”.
“I cannot find any confirmation for the extraordinary suggestion that ME is a psychiatric condition in the NICE guidelines. Will the Minister ensure that this misinformation is rapidly withdrawn?”
“I have been dealing with ME sufferers for 17 years and I have never encountered a group of patients who are so maligned. The last straw for them is the requirement that they undertake a course of CBT and/or GET in order to qualify for benefits and private insurance payments.
“I accept that, in some cases, CBT alone may be beneficial. I suspect that in the old days it would have been called “grin and bear it”. However, CBT is rarely offered without GET and ME patients know only too well-and their views are supported by some 4,000 papers on scientific and clinical research-that GET makes their symptoms worse.
“The NICE guidelines lay great stress on the importance of shared decision making, working in partnership with the patient and the need for specialist expertise. Unfortunately, because this is a “Cinderella” condition, there are few specialists. Indeed, some of the specialist centres set up following the CMO report in 2002 have had to close because of a lack of funding and expertise. For this reason, “referral out of area” and “choose and book” should be available to all sufferers.
“The Department of Health and the World Health Organisation acknowledge that this is not a psychiatric condition. What action is the Minister’s department taking to ensure that people with ME are as respected as people with other medical conditions and that they are not forced to accept, as a condition for receipt of benefits and social care, “treatments” such as CBT and GET that, at best, provide no beneficial effects and, at worst, are positively harmful?”
Replying to the debate for the Government, Baroness Thornton said:
“The noble Countess, Lady Mar, made a very interesting and well informed speech about CFS/ME, whose sufferers she has championed for many years. I will be pleased to investigate the issues that she has raised about CFS/ME treatment, recommended by NICE. It is important to restate the value which the Government place on the independence of NICE’s evaluation process, but I undertake to follow up the disturbing point she made and see whether I can provide her with clarification.”
To read the full debate in Hansard, please click here:
The Countess of Mar’s contribution starts in column 317 and Baroness Thornton’s full reply to the debate starts in column 323.
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Countess of Mar slates NICE & Health Insurance
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Minister in the Government Whips Office
Government Spokesperson for the Department
The Countess of Mar
House of Lords
Cognitive Behavioural Therapy
I write in response to the issues you raised on 18 March 2009, in our debate about cognitive behavioural therapy in the NHS.
You spoke eloquently about the difficulties facing people with CFS/ME and I appreciate the points you make. However, it would be inappropriate for me to comment on the quality of the evidence that NICE used to develop the guideline as it is an independent body.
At the same time, I think it is important to emphasise that NICE clinical guidelines are just that – guidelines for healthcare professionals. The guideline recognises there is no one form of treatment to suit every patient and it does not force patients into treatments they do not want. In fact, the guideline emphasises a collaborative relationship between clinician and patient, and recognises that treatment and care should take into account personal needs and preferences. lt goes so far as to say that healthcare professionals should recognise that the person with CFS/ME is in charge of the aims of the treatment programme.
Professionals are therefore free to use their clinical judgement and, in consultation with the patient, decide on the most appropriate treatment options on an individual basis, taking into account individual clinical factors and the preferences of each patient.
As you know, CBT is a rehabilitative approach designed to offer patients practical steps to help them manage their physical symptoms. ln common with other illnesses and conditions such as chronic pain, cancer, heart disease and diabetes where it has been successfully used to this end, its use does not imply that the cause of the illness is psychological.
It is not helpful to differentiate between biomedical and psychosocial treatment as, based on the currently available clinical evidence, patients are best served by a holistic approach.
Like you, I cannot understand why Health lnsurance News UK should interpret the NICE guideline as suggesting CFS/ME is a psychiatric condition rather than a physical one when, as you so rightly point out, NICE specifically states that CBT is “an evidence-based psychological therapy that is a collaborative treatment approach. When it is used for CFS/ME, the aim of CBT is to reduce symptoms, disability and distress associated with the condition. The use of CBT does not assume that the symptoms are psychological or ‘made up’.”
I should let you know that I will copy this letter to everyone who took part in the debate and I thank you once again for your valued contribution to it.
House of Lords, London SW1A 0PW.
Telephone 020 7219 8502