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).
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: