17 (Part I) Aromatherapy in the UK
Part I of this chapter shows how professional aromatherapy has developed (and is still developing) in the UK, from simple beginnings to being the model for many other countries to follow (see Ch. 18). It reports the current situation in the field of complementary medicine and aromatherapy in particular, giving details of the relevant associations that look after the interests of aromatherapy and the therapists who practise it, especially with respect to standards of education and legislation regarding the use of essential oils. Part II discusses issues relevant to most health professionals – physiotherapists, occupational therapists, those who work in mental health etc. – as well as aromatherapists. A model set of the policies and protocols set up for nurses could be proposed for the professional practice of aromatherapy in UK healthcare settings.
Since arriving in Britain in the late 1960s via the beauty therapy industry, aromatherapy has greatly expanded into health, both in and out of hospitals, doctors’ surgeries and complementary health centres. Two people well known throughout the world – and considered by many to be somewhat responsible for its advancement since the 1980s – are Robert Tisserand and Shirley Price, educators and authors of several textbooks on the subject. Both helped instigate the first association purely for aromatherapy in Britain, the International Federation of Aromatherapy (IFA).
By the 1990s, more and more physiotherapists, nurses and midwives were attending accredited courses, and other countries are still keen to follow the ‘British way’.
Educational standards have changed considerably over the last decade. The first set of National Occupational Standards (NOS) for Aromatherapy was published in 1998 and has since been revised twice, the latest in 2009. The Aromatherapy Council (AC), lead body for the UK aromatherapy profession, is consulted on revisions of the NOS and on qualifications when awarding bodies are writing professional qualifications. It is now imperative that an aromatherapist, whether in nursing or private practice, is trained to the NOS and AC Core Curriculum (see Education below).
Many aromatherapy associations have been launched over the last 25 years. Most of those that exist today work with the AC to maintain standards and promote and enhance the aromatherapy profession as a whole. Member associations can be viewed on the AC website: www.aromatherapycouncil.co.uk
Aromatherapists are now showing an interest in studying advanced clinical aromatherapy (aromatic medicine/aromatology), first introduced in 1990 by the editors and now offered at two aromatherapy schools in the UK. Although this involves the intensive application of essential oils to the skin and the use of hydrolats by mouth to fight bacterial and viral infections as well as chronic conditions, graduates of advanced clinical aromatherapy courses do not necessarily practise all methods on their clients. Such courses, however, do provide complete and full training in these methods, ensuring that essential oils and hydrolats are used safely and with understanding for intensive skin applications, gargles, pessaries and suppositories. The editors sincerely believe that aromatherapy schools already teaching to a high standard should move with the times, and include a separate course on aromatology in their syllabus (see Ch. 9). Nurses, however, will not be able to integrate these skills into NHS care.
Unlike some other European countries (e.g. France and Germany, see Ch. 18), non-medically qualified practitioners of complementary and alternative therapies in the UK are, at present, free to practise under common law, irrespective of their levels of training or clinical competence.
The UK adopted European Medicines Law in 1994 and in most European countries CAM (complementary and alternative medicine) practitioners are required to be medically qualified before they can practise. There is, however, some temporary easing of the regulations for Member States within Medicines Law, principally in Section 12(1) of the Medicines Act 1968. These regulations are unique to the UK and permit unlicensed herbal remedies to be supplied to individual patients under certain conditions (confirmed by the Medicines and Healthcare products Regulatory Agency [MHRA] to be applicable to aromatherapists). One such condition allows them to use essential oils only when a personal consultation has been undertaken with the client. However, there is currently no definition in law about who carries out the consultation. As this implies that anyone can carry out this procedure, Section 12(1) is currently undergoing reform by the MHRA and Health Ministers.
There are concerns that aromatherapists may then lose their right to practise under Section 12(1) and to use essential oils as medicines, including labelling a specifically formulated remedy with health claims – medicinal claims for unlicensed products are not permitted under any circumstances, including product names, advertising and promotional material, and particularly websites, which are regarded as exactly the same as any other advertising media. Details can be viewed on www.mrha.gov.uk.
The retail supply of aromatherapy products may be subject to the amended UK Cosmetic Products (Safety) Regulations 2008, the General Product (Safety) Regulations 2005 or other applicable legislation, such as the Biocides Directive. The Aromatherapy Trade Council (ATC) responds to all Government Consultation Documents that could affect the aromatherapy industry. Further information and guidelines can be found on their web-site: www.a-t-c.org.uk.
The Traditional Herbal Medicinal Products Directive (THMPD) was implemented in the UK in 2005 and states that all herbal products must have a continuous traditional medicinal use of 30 years, including at least 15 years within the European Community. Details are available on the MHRA’s website at www.mhra.gov.uk. The MHRA has assured the ATC that any product not classified as a medicine should not be affected by the Directive, and that essential oils and aromatherapy products can continue to be sold under the current regulatory regimes for cosmetics and general products.
Cosmetics legislation requires all cosmetic products to be safety assessed by a suitably qualified person, such as a doctor, chartered biologist or chartered chemist, before being placed on the market. This includes a ban on animal testing as from March 2009, and was extended to include 26 chemical substances identified by the EC as an important cause of contact-allergy reactions; 16 of these occur naturally in essential oils commonly used in aromatherapy. As from 11 March 2005, if a product contains one of the 26 named fragrance chemicals in excess of 0.01% (wash-off) or 0.001% (leave-on), that chemical must be included in the list of ingredients on the label, together with a sell-by date.
The UK Cosmetic Products (Safety) Regulations 2008 can be downloaded from the OPSI Office of Public Sector Information) web site www.opsi.gov.uk/si/si2008/uksi_20081284_en_1, or by simply putting the regulations into Google.
Professional training in aromatherapy can be delivered via colleges of further education, adult education colleges, universities and private academies. Not all of these courses offer a qualification that gives the student the possibility of practising afterwards, but those that do have to comply with NOS and the AC core curriculum. The awarding body qualifications are available for funding on the National Qualifications Framework and therefore are most likely to be found in further education or adult education colleges. Some colleges may also have sought accreditation from one of the professional associations to enhance their standing, as have many of the universities. All awarding bodies have to seek approval from the AC prior to submission to Ofqual, the new regulator of qualifications and examinations in England, in order to uphold standards.
A copy of the AC Core Curriculum can be downloaded from their website at www.aromatherapycouncil.co.uk, along with information on training and approved courses. From April 2010, the AC has a new school’s accreditation scheme where schools can be individually vetted, then entered on a list, ensuring that prospective students receive adequate training, which should include the following:
• anatomy, physiology and pathology
• applied aromatherapy (aromatherapy massage routine and completion of 60 case studies)
• theory and safety aspects of essential oils and hydrolats (including basic botany and chemistry/toxicity) and their possible effects on the human organism
• business studies, professional studies
• understanding of research, reflective practice and therapeutic relationship skills.
Although standards are now set to cover the basics necessary for all complementary medicine approved courses (Skills for Health made this a priority in 2009 when revising the NOS for CAM), it would be helpful for students wishing to study several CAM therapies if more colleges offered the basics, such as anatomy, physiology and pathology; fundamentals of orthodox diagnosis; patient referral guidelines; professional ethics; codes of practice; counselling and organizational skills (including record keeping) to be studied separately, enabling further CAM therapies to be offered and studied without unnecessary repetition – and unwanted expense.
It is unfortunate that herbal medicine and aromatherapy cannot be combined into one subject for a degree course, as the practice of aromatic medicine would then become possible for all aromatherapists. The difficulty may be mainly due to the large percentage of massage content in aromatherapy training, which is not needed by a medical herbalist. However, it seems strange that medical herbalists can legally administer essential oils by mouth when their training in essential oils is less in-depth than that of an aromatherapist. Fortunately, aromatherapists who go on to study aromatic medicine/aromatology are at least able to increase the scope of treatments they can offer clients, by intensive application (see Ch 9).
Aromatherapy and reflexology were the first complementary therapies to have Government-endorsed educational standards, published in 1998. Skills for Health – a government agency – is responsible for NOS, but works with the various lead bodies for complementary therapies to write the content.
The purpose of developing the NOS for healthcare was to continually improve services for all those who receive care. NOS are competence based, covering the practice of aromatherapy and other elements common to all complementary health practitioners. NOS are not qualifications, but are baseline standards – i.e. the minimum requirements needed in order to qualify as an aromatherapist. The core curriculum developed by the Aromatherapy Council is the bridge between NOS and a syllabus, and the two are inextricably linked. Individual schools and professional associations are not limited to the NOS and core curriculum, and are therefore able to include more depth, cover more essential oils, and include other elements of interest relevant to an aromatherapist. Those wishing to undertake a more in-depth training course should send for the syllabus and check the extras against the AC core curriculum.
Beauty therapy qualifications include some basic study of aromatherapy, although these usually use pre-blended oils and there is no study of botany or chemistry, blending or safety data of individual essential oils. The resulting qualifications are not recognized by the AC or the new regulatory body, the Complementary and Natural Healthcare Council (CNHC); beauty therapists are therefore not deemed to be aromatherapists without also obtaining an approved aromatherapy qualification. To register with the CNHC or to work within the NHS, graduation from an AC accredited course is essential.
As more research is done it becomes even more important that aromatherapists understand the chemistry behind essential oils and the relationship (if any) between these and their effects on the body and mind. In addition, holism (the theory that a complex entity, system etc. is more than merely the sum of its parts) has still to play a major part in aromatherapy treatments for the scientific application to be truly successful.
There is no excuse for anyone to undertake a course not accredited by the AC, as all the information is available on the AC website. It is up to the student to question the course provider and check the AC website.
The number of training options creates a minefield for potential students, and many schools and institutions still offer substandard training; the AC website allows prospective students to check these out. If a course cannot be accessed via the AC website it is probably not worth the money, unless it is for personal interest only. If the intention is to train as a professional aromatherapist in the UK, the course should be thoroughly checked first. Courses must be at least over one academic year (9 months), with a minimum of 250 hours in class; 60 case studies must be included – those from a previous massage course cannot be counted. Fast-track courses or distance learning courses where attendance is not required will not be recognized.
In November 2000 the House of Lords Select Committee on Science and Technology published a report on complementary and alternative therapies which called for more evidence-based research, tighter regulation of therapies and practitioners and more reliable information, so that the public could make informed choices regarding their healthcare. The training and qualification of therapists is a key issue in policy development and the House of Lords report identified the need for all complementary therapies to develop a sound system of regulation and accreditation.
In response to this, the government urged the representative bodies for each therapy to unite to form a single body for regulating their profession (DoH 2001) in the best interests of patients and the wider public (Tavares 2003). It also urged CAM regulatory bodies to put in place codes of practice to limit claims made by practitioners, and to ensure that their members recognize and follow them.
One of the principal requirements of modern healthcare provision can be summed up by the term ‘evidence based’. It is no longer sufficient for any therapeutic approach simply to rely on a long history of use, or popularity, or widespread availability, to justify its continued acceptance. Evidence of both safety and efficacy of all forms of therapeutic intervention is now required (Field 2003).
The report classified therapies according to their evidence base and level of professional organization in relation to regulation (see Part II and Table 17.1).
Table 17.1 Therapies classified according to their evidence base and level of professional organization in relation to regulation
| Group 1 Professionally organized alternative therapies | Group 2 Complementary therapies | Group 3 Alternative disciplines |
|---|---|---|
| Acupuncture Chiropractic Herbal medicine Homoeopathy Osteopathy |
Alexander technique Aromatherapy Bach and other flower remedies Massage Reflexology Healing, including Reiki Hypnotherapy Shiatsu |
3a Long-established and traditional systems of healthcare Ayurvedic medicine Anthroposophical medicine Chinese herbal medicine Traditional Chinese medicine |
| 3b Other alternative disciplines Crystal therapy Dowsing Iridology Kinesiology Radionics |
Categories of CAM disciplines (House of Lords Report 2000).
It has been difficult for a member of the public to have a central point where they can go to obtain information on therapists who have trained to the required standard and are competent, fit to practise and insured. This is because, owing to the popularity of CAM – particularly aromatherapy – over the last 20 years, many new associations and organizations sprang up purporting to represent the profession. Each individual association holds its own register of members, but there is no external check on whether or not they hold an appropriate aromatherapy qualification.
Following the House of Lords Report in 2000 and the government’s response in 2001, the Prince of Wales’s Foundation of Integrated Health (formed in 1993), was given a grant by the Department of Health to help bring therapies together under one lead body and help them to write standards and policies to enable each therapy to regulate itself (the FIH was closed in April 2010).
Aromatherapy was originally governed by the Aromatherapy Organizations Council (AOC), launched in 1991. Prior to the House of Lords report, the AOC was already discussing statutory regulation of aromatherapy with the Department of Health, but after the report the government preferred voluntary self-regulation for complementary therapies, so in 2001 the AOC set up a regulation working party.
In 2003 the AOC was dissolved and the Aromatherapy Consortium was born, working towards voluntary self-regulation of the aromatherapy profession. The Consortium worked closely with the Prince of Wales’s Foundation, and the new voluntary self-regulatory body for aromatherapy was launched on schedule in December 2006 at a special reception in the House of Commons under the new name ‘Aromatherapy Council’.
Around the same time, Professor Julie Stone published a report via the Prince’s Foundation showing the benefits of having one regulatory body for all complementary therapies, rather than an individual body for each therapy. The AOC had presented a similar document to the Foundation in 2000, but at that time it was not thought to be relevant. The aromatherapy profession supported the idea, as the majority of them also practise other therapies and it would be to their advantage not to pay individual regulators. Equally, it would also benefit members of the public, making the finding of a suitable therapist much simpler.
In January 2007, the Federal Working Group (FWG) had its first meeting, hosted by the Foundation as a result of a further government grant. This meeting brought together 12 complementary therapy disciplines hoping to find agreement on the structure of a single regulator to represent all the therapies. The last meeting took place in July 2007, at which time there was not total agreement; this included the Aromatherapy Council, at that time a regulator itself.
Fortunately, the Foundation passed responsibility to a new body, the CNHC, to carry on the work and the AC has collaborated with them to iron out discrepancies (the CNHC aromatherapy regulatory register was launched in May 2009). The AC has selected four Profession Specific Board (PSB) members to advise the CNHC of any aromatherapy issues, and has supplied a list of qualifications which are acceptable for registration. It is likely in the future that any aromatherapist wishing to work in the NHS will need to be CNHC registered, and the Department of Health supports the CNHC.
As long ago as 1997 a survey by the University of Exeter revealed that, of the number of members from complementary therapy associations working in the NHS, up to 50% were from aromatherapy, healing and reflexology associations. ‘Aromatherapy and reflexology are popular with nurses and this is likely to account for much of their involvement’ (University of Exeter 1997 p. 60). This percentage has no doubt increased greatly since then.
Almost 20 years ago Barker (1994) believed himself to be just that, saying he was a trained professional aromatherapist, despite being a nurse. ‘It does aromatherapy a great disservice by tagging it on to another discipline to give it credibility when it is already a valid system of medicine. We should be proud of our profession in the use of essential oils and not need to use another profession as a crutch.’ Nowadays complementary therapists practise a range of disciplines, professions quite separate from nursing or any other, albeit still allied to medicine, and so aromatherapists can call themselves healthcare professionals in the same way as nurses. In the past, many hospitals have funded nurses on aromatherapy courses, many of these being run specifically for the nursing profession and consultants. A major breakthrough occurred in 1993, when GPs were empowered to refer patients to complementary therapists for treatment on the NHS, provided that the GP concerned remained clinically accountable for the patient. As a result, since the mid-1990s GPs have a much more sympathetic and cooperative attitude towards aromatherapy than when the editors came into the profession in the early 1970s. The medical profession are now more willing to listen seriously to claims of the positive and sometimes dramatic effects that essential oils can have on people’s overall health and many private therapists now work in conjunction with their local GP on minor health problems that can be helped by essential oils.
There have been many clinical successes in hospitals where essential oils have been used, and the results of projects and trials (albeit not of rigorous research standard – very difficult in the case of essential oils) have led to a greater willingness to listen and to use aromatherapy in hospitals and community care.
The NHS and Community Care Act Self-Governing Status for NHS hospitals – NHS Trusts – was created in 1990, set up to manage hospitals and other NHS services. This change in status may have been a contributory factor in the increase in complementary therapies being practised in health care.
Aromatherapy has many professional associations, most of which are multidisciplinary. Most associations are paid members of the lead body, the Aromatherapy Council, where they work together in the interest of the profession as a whole. The Aromatherapy Council advises the CNHC (whose main concern is public safety) on specific aromatherapy matters. The professional associations are more like a trade body, looking after the interest of the therapists who are members. They provide insurance, conferences, magazines/newsletters, continuing professional development (CPD) opportunities and support their members in the event of a complaint. We see similar structures in other professions, such as in nursing, where one of the professional associations is the Royal College of Nursing and the regulatory body is the Nursing and Midwifery Council. The difference in the aromatherapy profession is that there are many professional associations; these are listed below in alphabetical order, those dedicated purely to aromatherapy being at the top. All but the first are Members of the Aromatherapy Council, which is the lead body.
The IAM is not a member of the AOC as it is an umbrella group for both aromatherapists and those who practise intensive application of essential oils and/or use essential oils and hydrolats orally. The range of competence covered is unique to the UK, as it has three levels of membership: Associate membership, Membership, Licenciate membership and Fellowship (FIAM), UK Master’s degree level. It offers comprehensive insurance, support and advice to all members and associates.
The IFA was launched in 1985 and is an aromatherapy association that has spread worldwide. Members receive quarterly editions of the Aromatherapy Times magazine, have access to a block insurance scheme, and receive discounts on IFA conferences, offers on CPD courses and exemption from London Borough licensing.
The IFPA was launched in 2002 following a merger of the International Society of Professional Aromatherapists (ISPA), originally formed in 1990 by Shirley Price, and the Register of Qualified Aromatherapists (RQA), originally formed in 1991 by Gabriel Mojay. It is the largest aromatherapy-only association in the UK. It offers an insurance scheme, reduced prices at national aromatherapy conferences, a quarterly aromatherapy journal – In Essence – CPD opportunities and exemption from London Borough licensing.
This AAPA was established in 1994 and is a member of the lead body for massage therapy, the General Council for Massage Therapy (GCMT). It covers all therapies, seeing aromatherapy and massage as its main concern, and offers an insurance scheme, low-cost or free CPD and a regular newsletter. The helpline is staffed by qualified therapists. Members enjoy exemption from London Borough licensing.
The APNT was established in 1986 with the aim of representing practitioners of complementary medicine who have reached the required standards of training and education. It is also a member of the GCMT and the British Complementary Medicine Association (BCMA). It offers an insurance scheme and CPD opportunities.
This register is part of the Institute for Complementary and Natural Medicine (ICNM). It was formed in 1989 and offers low-cost insurance, CPD opportunities, a regular journal, advertising opportunities, and members enjoy exemption from London Borough licensing.
This large multidisciplinary association was a merger between the Guild for Complementary Practitioners (GCP) and the International Therapies Examination Council (ITEC) in 2001. Members receive a free copy of the Embody magazine, low-cost insurance, CPD opportunities, advertising opportunities, local therapy clubs and exemption from London Borough licensing. Most members are graduates of ITEC, one of the awarding bodies that are invited to AC meetings.
FHT is a large multidisciplinary association that was established in 1965. Membership includes free membership of the International Therapist magazine and offers local support groups, a helpline, membership of all lead bodies, seminars and workshops for CPD, low-cost insurance and exemption from London Borough licensing.
This UK trade association is for the aromatherapy essential oil industry. Founded in 1993, its mission is to promote responsible marketing of genuine aromatherapy products and safe usage of essential oils by consumers. To this end, it has established a code of practice for product labelling and packaging and publishes guidelines on the regulation, labelling, advertising and promotion of aromatherapy products to assist those setting up in business, e.g. it will review labels and promotional material prior to printing to ensure they comply with the complexities of the law. It has a policy for the random testing of its members’ oils.
The ATC represents the interests of manufacturers and suppliers in the trade at legislative forums where decisions are made which affect the industry; it advises its membership and the public alike on ever-changing legislation and its likely effects on the industry.
The ATC works closely with the Aromatherapy Council and other organizations to ensure the needs of the profession are served appropriately by the aromatherapy trade.
Research in the UK can be viewed on the links page of the AC website; The Essential Oil Resource website, which provides scientific information about essential oils, is fully searchable and available online by subscription (see Useful addresses, p. 528).
This part of Chapter 17 has given an overall picture of how aromatherapy developed in the UK and how it stands at the time of writing. Legal requirements regarding the practice of aromatherapy and the sale of products containing essential oils have been covered, with a full discussion on the standards of education required and the importance of thorough training. It shows the growth of essential oil use in hospitals over the last decade, and how both aromatherapists and nurses are professionals in their own right. The most respected associations are listed to help qualifying aromatherapists select one suitable for them.