Friday 4 October 2019

All things must pass

Mark Taylor, CEO of the Society of Homeopaths (SoH) has retired after five years in post. Over those five years, he has overseen all sorts of shenanigans, a marked decline in membership numbers as well as making a series of very odd statements. True to form, Taylor signed off with a strange blogpost.

 It is worth looking because it gives an opportunity to discuss some aspects of the SoH, particularly governance and its strategic direction. Taylor starts off with -
The Society’s current strategic plan contains the following vision: 
      To see homeopathy firmly established within British healthcare

I am standing down after nearly five years as Chief Executive and I have been asked what I think needs to happen for us to come close to this lofty aim. So, free from the constraints of corporate responsibility, here are my personal suggestions:
1. Let’s stop blaming the detractors
Detractors are not turning patients away. They are demoralising, irritating and they cause trouble for us with the authorities and in the press but there is no evidence that the millions of people favourably disposed to homeopathy are influenced by the lies and bile produced by the small number of detractors. Let’s just ignore them, depriving them of the oxygen of publicity.
Taylor is right in that the stated strategic goal is a "lofty aim". It isn't something that the SoH can do, even in cooperation with others. It might as set a strategic goal of holding a Homeopathy Awareness Week on Mars by 2025 run by British homeopaths. Failure is inevitable and automatic.

 One problem with believing your own propaganda is the cruel reality that the imagined support for your position is much less than you believe. Comparison with fringe political groups is appropriate. It is all very well for leaders of these groups to talk about "massive support" but how many people turn up to the meetings/marches? There have been pro-homeopathy demonstrations but they've had very low turnouts.

 The "millions of people favourably disposed to homeopathy" line and variations are often repeated but it is a matter of faith rather than a matter of fact. There isn't any decent information on the prevalence of pro-homeopathy beliefs in the UK but it is known that there has been a considerable decline in the number of homeopaths who belong to the various associations.

 Whatever spin Taylor et al want to put on it, from the perspective of the homeopathy associations, homeopathy is in decline. 

 Denying the "oxygen of publicity" to "detractors" is a curious notion. How would Taylor propose this is done? The SoH and the UK homeopathy community (the word is used advisedly) do not control access to the media or the public. 
2. Classical or not makes no difference
Two weeks into this job I found out there was not one sort of homeopathy but many. Most patients still have no idea and most don’t care. We can either accept that there is so much more that unites us than divides us or we can confuse our patients and delight our enemies by seeing how many homeopathic angels we can get to dance on the head of a pin.
Many older white males would disagree with Taylor. The history of homeopathy is littered with bitter disputes over homeopathic doctrine and who is "the true inheritor of Hahnemann". Hahnemann himself was scathing of homeopaths that he judged as doing things wrong. Although the SoH accepts members who practice all sorts of strange variations of homeopathy (not to mention other stranger therapies), there is still a perception that it favours classical homeopathy as opposed to, say, radionics.

 Taylor is right in that the public don't care about doctrinal differences. UK consumer awareness of the nature of homeopathy is low and if US research is anything to go by, the more they know, the less likely they are to use homeopathy (and by extension homeopaths).
3. The future of homeopathy is in the hands of homeopaths
History, evidence and millions of patients worldwide show that there is nothing wrong with homeopathy. Homeopaths are the best advocates. We must devote more time and resources to helping them build their practices and match their homeopathic knowledge with an equal understanding of marketing, administration, sales, networking, IT and advocacy.
Homeopaths are the best advocates? But they need to understand advocacy? There seems to be a contradictory there. However much the SoH try to empower homeopaths, if the market isn't there, it isn't there. 
4. Science and research are not the only answer
Let us be clear, evidence and research are very important and the more material we have to support homeopathy the better. But it is not the only way to defend homeopathy, indeed it is not the best way. There is no silver bullet; the establishment will never be convinced by the evidence. Use it by all means but the concept of patient choice is much stronger and resonates with a significantly wider group of people. How can it be right to persecute something that costs the state nothing, is non-toxic and is respected and utilised by millions of people?
It depends what the question is. Patient choice on the NHS is necessarily limited by financial constraints and there is a duty on NHS bodies to ensure that money is well spent. It's always been the case if you can afford, there is plenty of choice.

 Who is this "establishment"? It's obvious that the SoH craves the approval of this vague entity. And what is this persecution he speaks of?
5. Homeopaths together are stronger
If you wanted a structure guaranteed to be ineffective and weak in making the case for homeopathy, I suggest we stick to what we have. We need one body, one register, one vision and one voice. History and vested interests need to be cast aside.
History? Originally, there was just the one register - the Society of Homeopaths. The history of the various UK lay homeopathy associations (and other associations that accept homeopaths) is not well documented. There was an attempt back in the mid 2000s to set up a central register via something called the Council of Organisations Registering Homeopaths (CORH). Some money was provided by The Prince's Foundation for Integrated Health. A newletter can be found here. This ended in acrimony that seemed to be mostly between the SoH and the Alliance of Registered Homeopaths (ARH). Many of the same people involved are still around. Many of them don't play nicely with other children let alone each other.

 For practical reasons alone, creating a single register would be difficult and expensive. There are also questions as to what its role should be. Arguably, promotion of homeopathy should not be part of its role. 

 In reality, having certain homeopaths on your register is just asking for trouble. Not just because they represent reputational damage waiting to happen but also because some of them are divisive by nature.
6. 4Homeopathy is not enough
The thinking behind 4Homeopathy is great (though it would not be needed if 5 (above) was implemented but it is not enough. We need to be part of a much wider and influential CAM pressure group. Only then would we get the ear of Ministers and the attention of the press.
4Homeopathy is largely ineffective. It is distracted by non-UK issues. It becomes involved in very fringe issues and expends a lot of energy on them. That post mentions the "Release the First Report" business. That report was recently released and unsurprisingly it doesn't demonstrate that homeopathy works. Even less surprising is that the media were completely uninterested in what homeopaths had to say about it. To quote from NHMRC's CEO Anne Kelso - 
I am also aware and concerned that a significant amount of misinformation has built up about the content of this 2012 draft report. I am releasing the report now in an annotated form to address this misinformation.
4Homeopathy and Homeopathy Research Institute (HRI) must bear responsibility for much of that misinformation.

 Board minutes reveal attempts to link up with other CAM organisation but nothing seems to have come of them. Perhaps the involvement of Scientologist Martin Weightman was offputting? Or maybe Barry Tanner was a bit too much for them? Other CAM professions can are equally as riven by divisions as homeopathy - they have multiple associations that don't work together well, often with an acrimonious history.

 For various reasons, not all CAM associations are equal. Larger associations and those with larger financial resources would be likely to dominate any pressure group but some CAM therapies are more negatively perceived than others. Would the chiropractic associations want to share a platform with angelic therapists? 
7. Never lose the passion
All the above is not a plea for convention and orthodoxy, it is a plea for effectiveness and growth. We can do this without losing the range of unique characteristics that define and enhance homeopathy – sustainability, holism and inclusivity. But most of all, the passion.
Passion?
I do not imagine that everybody will agree with all my points but that is what it looks like from an outsider who has been, fascinated and energised by the homeopathy sector.
Very strange.

Taylor's Reign
Taylor stated with the SoH in February 2015. From that SoH news item -
Mark has extensive experience of not for profit organisations and joins the Society from VocalEyes a charity that helps to provide access to the arts for the blind and partially sighted people, where he was interim chief executive from August 2014. Prior to that Mark was director at the Museum Association (MA) for 24 years. 
He brings a knowledge and understanding of membership organisations including publishing, communications, training, event management and a range of membership services. He is widely experienced in lobbying, advocacy and campaigning on behalf of sectors and professions. 
Mark Taylor says “The Society is in good shape with a board focussed on the long term and a settled and talented set of staff. But, even in my preliminary discussions, I can see that membership services and the image of homeopathy are priorities.”
Taylor isn't a homeopath. In essence, he is a professional administrator. The SoH did experiment with a CEO role in the past but between 2010 and 2015 did not have one. Likely requirements of Professional Standards Authority (PSA) Accredited Registers scheme lead to the appointment of Taylor. Taylor was not involved in the initial accreditation. 

 To be fair to the SoH, it at least seems to be going through the motions of being a more professional organisation that it was prior to PSA accreditation and Taylor joining. It still has issues in coming to terms with external requirements but even there some small progress has been made. 

 The composition of the SoH Board has changed over time - there are now more non-homeopath members. Compare the board from 2013 -
with as of September 2019 -
Homeopath directors are elected by members. Their term is 3 years. They can serve a maximum of two consecutive terms before having to step down. They must wait at least one year before seeking re-election. Independent directors are appointed by the Board but the same strictures about maximum of two consecutive terms apply. The SoH are going to appoint an additional two independent directors so that the balance is 50/50. Independent directors can vote in Board meetings.

In 2009, the SoH had 1483 members. In 2014, the SoH claimed to have "over 1200" members. It now has barely over 1000 members (and dipped under 1000 in 2018). The SoH has tried to boost numbers in a number of ways. It introduced reduced membership fees for new members for the first two years for new members. It made concerted efforts to attract back members who had left. It made the route for entry for those without qualifications from its recognised courses easier along with encouraging homeopaths from outside of the UK to join. It made increased efforts to recruit student members. And so on. At best, these have slowed the decline in membership. At worst they've cost money/reduced income for zero effect.

 Obviously numbers are dropping because the SoH is losing more members than it is recruiting. A very rough estimate of recruitment by year has been made. It looks as recruitment numbers peaked some time in the early 2000s (and possibly a bit before). The SoH was getting over 200 new members a year then. Since 2011, the numbers have hovered around the 50 mark. It is possible that the SoH suddenly became less successful at recruiting new members but if it did, the other homeopathy associations were also affected by the same issue. Joining any association would have had to become much less attractive. It's reasonable to assume that new number of newly qualified homeopaths has dropped considerably.

 Members are likely leaving the SoH for three reasons -
  • Retirement - quite simply, they have reached an age where they don't want to work anymore.
  • Business failure - whilst for some homeopathy is just a part time hobby and they have a secure income from other sources, this is not the case for others. The biographies of many homeopaths suggests they gave up a career to do homeopathy and they have the option of going back to that. Not everyone is cut out for self employment and the uncertainities that go along with it. 
  • Disatisfaction with the SoH - which could be various.
Obviously, the SoH can do nothing about the first. As for the second, the SoH can't magic up a market when none exists but it is doing things like this. It is known that some homeopaths are very upset with the SoH not standing up to officialdom etc. Some have left as a result and more may do so.

Like 4Homeopathy, the SoH has supported a number of homeopathy related campaigns presumably in guise of "promoting" homeopathy that are not UK related and certainly don't impact on their members. Changes to US enforcement policies re claims for over the counter homeopathic remedies have no impact on their members (unless they manufacture the products). Whether or not GPs are allowed to prescribe homeopathic remedies on the NHS doesn't impact on the vast majority of members or their clients. Indeed, they would represent competition.

There have been a number of media stories which not favourable to the SoH. There have also been a number of stories not directly connected to the SoH that they have commented on. Just reading a few of these should give a flavour.

New CEO Emily Buttrum
The role of a chief executive officer varies but in the case of the SoH the role is likely to involve day-to-day management as well as a bit of being the public face of the SoH. Emily Buttrum's appointment is unlikely to result in any changes in direction for the SoH - that is for the board to decide.

From what she says on her consultancy website, her last operational role was Commercial Director at South London and Maudsley NHS Foundation Trust. Typically, this kind of role involves a lot of writing of project funding bids and involvements with contracts.

 Buttrum officially started her role of 01/10/2019 although it would not be a surprise if she had informally attended key SoH meetings before then. On 03/03/2019, news broke of the Good Thinking Society (GTS)  succesful application for judicial review of the Professional Standards Authority (PSA) decision to accredit the SoH. This will be discussed at greater length in a future post but...

 The Plot Thickens
There are some key dates to consider. Permission was granted on 13/09/2019 which was a Friday. It is believed that the SoH isn't open on Mondays (although staff may read emails). The SoH would have been aware on 17/09/2019 at the latest.

 The SoH had a board meeting on 23/09/2019. It is very likely that the permission was discussed. The report of that meeting is unlikely to appear until November.

 The SoH may have believed that the media would not have been interested. Even if they did, it would have been foolish not to have some sort of plan in place. It is interesting to note that the SoH did not respond to media requests for interviews etc. This may represent a change in strategy. 

 At the time of writing, they have not made an statement on their website. To be fair, the SoH can take a little while to respond to events. They will need to offer some sort of reassurance to members soon if they haven't already (possibly by email or their online newsletter).



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