It is true that NG206 essentially specifies certain therapist roles (s1.11.8 "Refer people ME/CFS to a physiotherapist or occupational therapist working in an ME/CFS specialist team if they. . ."), but it's not at all clear to me that just because that's in the guideline that charities & other patient organisations should be asking for it. We should be asking only for what's in our interests.
The 2002 CMO report was, I understand, widely considered a favourable milestone. It also recommended the setting up of local services including CBT & GET; we got the CBT & GET, and not the medical care and the nursing & personal care it also specifies. But in recommending that this type of clinic was set up it contributed to the loss of interest by physicians, and the effective ceding of ME/CFS to psychologists and physiotherapists.
If the plan were very much a radical departure from current practice, RCPsych & many others would be howling, demanding that it be brought to an immediate end, in the same way that they did for NICE.
Also, with NG206 we had some idea of what would be in it: there was a draft version & comments made by organisations on the draft were published and responded to publicly; this process, by contrast, is almost completely opaque. There's no draft. The names of those involved are not made public. We have no way of knowing if it's brilliant, mediocre or dreadful.
with with no funding, it can't be anything other than dreadful. the lives of m.e have been too wasted for them to keep taking time for reports that exclude patients and then fail in some way. It was never justified for the MRC / UKRI which, lets remember for long covid, went straight in with two funding calls to set up a research portfolio and clinical trials, to put everything on pause for m.e , when they have been meeting with our charities several times a year since 2007 and acting as if they needed further meetings to work out how to stimulate the field
. Re. The 2002 chief medical officers report report , CBT/ get was still In it’s hay day and influence powerful until about 2011 - Even the m.e APPG nhs report of 2010 was I think citing Esther Crawley as A key witness and get and CBT as the most evidence based treatments. But it still was better in some ways than the NICE guidelines & what looks to be in the DHSC delivery plan. The Gibson Report of 2006 made the point that there had been no consensus at all that m.e , even from people they'd interviewed on a behavioural angle, was a purely behavioural condition and therefore why was all the funding going exclusively to that and the same could be said of services. Certainly regarding severe me, there was never evidence at all for behaviour treatment as sole intervention or even as fairly effective intervention and there was no ethical support for just abandoning severe m,e to untrained, disinterested and powerless GP's , which is what happened
I'm not able to read documents cover to cover but I’ve skimmed the CMo report, I think it was blighted the sensible recommendations for severe me being put under the heading of "patient recommendations" (and who listens to those) and the general recommendations at the end were less good /specific regarding severe m.e. This might reflect all that could be agreed on because the psychiatrists were still influential and some of them walked out because they felt that it was too biomedical.
Also my understanding of the CM0 report was that in it, the referral services were supposed to be, like most secondary care, for those with more severe and complex needs , whereas NHS turned it turned them into cheap, minimal services which excluded severe me and became abc fatigue management
[/QUOTE]General Practitioners should usually be able to manage most cases in the community setting, but must be able to refer patients for specialist opinion and advice where appropriate (e.g. because of complexity in diagnosis and treatment)…..
…
Sufficient tertiary level specialists in CFS/ME should be available to advise and support colleagues in primary and secondary care.
Health service planning
Service networks should be established to support patients in the primary care and community setting, to access when necessary the skills, experience, and resources of secondary and tertiary centres, incorporating the principles of stepped care. ….
……..
• Health service commissioning through primary care organisations, supported by health authorities or wider consortia, must ensure that local provision for these patients is explicitly planned and properly resourced, and that health professionals are aware of the structure and locale of provision. Health commissioners should be requested to take immediate steps to identify the current level of service provision for CFS/ME patients within their locality.
• Each Strategic Health Authority should make provision for secondary and tertiary care for people with CFS/ME, based on an estimated annual prevalence rate of approximately 4,000 cases per million population in the absence of more refined data.
• People who are so severely affected that their disability renders them housebound or bed-bound have particular constraints in regard to their access to care.
These specific needs must be met through appropriate domiciliary services.[/QUOTE]
