Anne Millton meets miserable counsellors and therapists and tries to get them talking - Nov 2nd.

The Committee Room in Westminster Hall.

“Never have I been lobbied by so many people as I have on this subject”, said Anne Milton, (Conservative MP for Guildford, and Shadow Health Minister). She had called this three-hour meeting in the Grand Committee Room, Westminster Hall to get a constructive conversation going on the future of regulation for counselling and psychotherapy. Poor old Marc Seale (HPC CEO) was forced to sit up on the stage where 60 people could take careful aim and fire their questions at him throughout the afternoon. She said it had been hard work to persuade him to come, and she only withdrew her proposal to canvass the room on the question ‘HPC or Not” when another CEO present in the room let forth a loud and heartfelt NO!

Seale was there with his Chair, Anna van der Gaag because the mail-bags of MPs have been bursting with letters complaining about the HPC. However, the only other politician in the room was Earl Freddy Howe, the conservative spokesman for health in the Lords. He didn’t speak in the proceedings.

Seale’s opening talk asked ‘in whose interest’ it was to call this conversation, which made him seem like a nincompoop, and some people got quite angry.

I was more interested in Lynne Gabriel’s talk, which came next (Lynne is Chair of the BACP). She noted that the proposed recommendations would create a very different profession from the one that currently exists. This, of course, seems outrageous to her. However, throughout the entire process of the PLG this line has been openly pushed and repeated by HPC Council members, most ardently of all by Professor Annie Turner (Occupational Therapy) who said: ‘it was only when we [OT] realised that we had to stop thinking about what actually happens in practice, and invent an entirely new profession, that we made any progress with HPC regulation.” Could it be said much more clearly than that?

Colin Walker spoke on behalf of MIND, (now at the table due to the absence of Jonathan Coe, CEO from Witness; Coe has been present throughout not only the PLG meetings for Counselling & Psychotherapy, but also for those of Psychologists). He said that there was a shocking lack of evidence of abuse by practitioners in the UK – he meant there was no reliable research in to the reality of the situation which left everyone floundering around in anecdote and hearsay.

The third speaker began by pointing out that HPC opening address had slipped rather quickly into the idea that all regulation was HPC regulation, which then enabled them to spin the argument and imply that all those who opposed HPC were opposed to all statutory regulation. “This is simply not true”, said Darian Leader (College of Psychoanalysts-UK), whose second point touched on the question of human memory. There is a long and well-documented history of argument in favour of statutory regulation, and a long and well-documented history of objection to the HPC as regulator for this field. What is absent is an explanation why people had suddenly changed their minds when the HPC had not changed at all. History has been wiped out. They had forgotten their arguments when they saw ‘the train leaving without them’ - fear had lead them to let go of their beliefs in order to preserve their political position. “This process privileges politics over the best interests of our patients”, Prof Leader concluded.

Then came questions from the floor. There was a call for a convention on the future of counselling and psychotherapy; it was noted how the HPC process had itself been instrumental in producing more and more difference in the field; Marc Seale was told to ‘keep it real’ and to take a step back. Other comments included: there’s too much use of force, authority and coercion in the process; this approach to regulation suffocates practice; I don’t recognise my practice in these standards; every organisation should be consulted; ‘we should be responsible for what our future looks like, the HPC should not tell us or impose it onto us’. There was also frustration in another direction – ‘we’ve had our chance and blown it, so now we must accept the consequences’, and one organisation said wearily, “we are happy with it, regulate us, don’t let this lot hold us back”.

Anne invited the HPC to respond but then found herself giving them advice – don’t irritate people, she said, some of this is just silly, you really have to work harder to keep people with you. And when a PLG member said he didn’t recognise what outsiders were angry with, Anne Milton had to tell him: believe me, this question is real.

(For another account of this meeting, please email info@allianceforcandp.org and request the latest newsletter).

Is the HPC Legal? STOP AND THINK! says new EU report.

Is the HPC Legal? Stop and Think! says the new report issued by The National Council for Psychotherapy.

Italian Barrister Alessandro Amicarelli was commissioned to make a full analysis of the developments of work conducted towards proposed legislation on statutory regulation of psychological therapy practitioners in the UK via the HPC. What follows is a selection of information commentary and quotes from the first half of this important document. Go to the NCP website to download a pdf for yourself.

Richard Mark of the NCP will go to Westminster Hall on Monday and present Anne Milton with a bound copy of the report, together with a full pack of appendices.

Amicarelli’s 72 page report begins by reminding us that the UK does not have a tradition of State intervention in the liberal professions, and in fact is amongst the most liberal countries in the European Union with respect to regulation. Or at least we used to be. However, after reading this report we may well wonder whether we are about to wander off this noble liberal track and turn into something a lot less familiar.

The report clarifies the most perplexing questions and comes up with some surprises:

• Is this state or statutory regulation? It is statutory, but only because the state has abdicated its responsibility.

• Is HPC independent of or accountable to the Government? It is independent, but only because the state has abdicated its responsibility.

• Is there or is there not a link between HPC, SfH, NIMHE, IAPT etc. NO! But only because the State has not thought it through.

• Why have counselling and psychotherapy not been given their own regulatory body (like doctors, dentists, pharmacists etc)? Who can say? Nobody knows.

• Why is there a different approach to regulation of doctors, dentists, midwives and other related health professions? Who can say? Does anybody care?

• What are the similarities and differences between HPC and its predecessor CPSM? The CPSM allowed professionals to choose, the HPC removes choice.

Data transfer - data capture

A distinctive feature of discourse within the HPC is 'data capture'. The organisation is structured around a data-base, and 'data capture' is indeed part of computer-geek-speak. Thanks to the essential work of Max Weber, we don't have to be naive about this expansionist, aggressive, and powerful discourse.

To mistake the HPC for an entity without its own desire might have been Ian Kennedy's folly, but the rest of us don't need to be so daft - especially with the benefit of hindsight.

The HPC stands to gain at least £4m a year in registrant fees by taking on the counsellors and psychotherapists. Sometimes they estimate that this could even be double: £8m a year. No wonder it wants to 'capture' the data. It will allow HPC to send automated invoices, and to follow those invoices with automated legal threats to chuck you in the clink for non-payment and take away your livlihood.

Some of the existing professional organisations have already taken precautions and are restructuring their own membership registers to reflect the objections of those of their members who cannot in all good conscience sign up to the HPC. People must act now to avoid their data being transferred without their permission.

If no special action is taken, then the data is automatically transferred by power of law on the date specified in any future section 60 order. If the professional decides against taking up the possibility of HPC registration their data remains on the database at the HPC 'just in case'. See the letter from Michael Guthrie to Andrew Samuels below.

Power without responsibility, oooh, it is a terrible thing.

A round up of recent news

1. Shadow Health Minister Anne Milton calls 3-hour meeting in The Grand Committee Room, Westminster Hall on 2nd November for major stakeholders in the regulation debate for counselling and psychotherapy.

2. Videos are now online from The Alliance conference on 11 October. Independent reports can be downloaded by clicking here.

3. Andrew Samuels is standing for election as UKCP Chair – click here for videos and reports on the process, and click here for the on-line discussion on the UKCP web.

4. BACP rejects the HPC Proposals for regulating Counselling and Psychotherapy.

5. The Maresfield Report published: a thorough analysis of the statistics and expense of the HPC Fitness to Practise regime. Legal challenge to HPC via the well-known London law firm Bindmans. NCP publish 72 page report 'Is HPC Legal' by Italian Barrister A Amicarelli

6. The Kings College and Royal Holloway study, 'Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling' Funded by the General Medical Council and the Economic and Social Research Council – warn of over-regulation failing to provide the best model of patient care.

7. Compliance? Ambivalence? Rejection? A short book of responses to the HPC Consultation signed by 103 members of the Alliance Conference on 11 Oct was delivered to HPC on Monday 12th October, but no acknowledgement has been received.

8. A pamphlet by Arthur Musgrave containing ‘one half of a dialogue with enthusiasts for HPC regulation’ –a fascinating account of a serious attempt to enter a dialogue with those who are strongly in favour HPC of counsellors and psychotherapists.

9. Andrew Smith, Labour MP for Oxford East put a written question to the Department of Health (22 Oct) asking the Minister “If he will make a statement on the rejection by the British Association for Counselling & Psychotherapy of the Health Professions Council's proposed statutory regulation of psychotherapy and counselling.” The rather bland answer can be found by clicking here.

10. The House of Lords Select Committee on Merits of Statutory Instruments argues for less Government reliance on Regulations, in order to leave greater room for the professionalism of practitioners to deliver the objectives of improving learning.

11. 200 members now participate in the Alliance ning blog

12. AHPP (Humanistic Psychology Practitioners) advise members on strategies to avoid data transfer to HPC.

13. Regional groups continue to stage meetings to allow their members time and information to think with – a new meeting in Solent is currently being planned.

HPC answers some questions posed by Prof Andrew Samuels

"Dear Professor Samuels

Thank you for your recent emails. I have responded to each your questions in turn below.

1) How many people do you think will be registerable?

Estimates of numbers of psychotherapists and counsellors in the UK do vary by between around 40,000 (the approximate total of individuals on the larger professional bodies' registers / membership) up to around 100,000.

Reaching a more precise figure at this stage is difficult as it is hard to quantify the number of practitioners who may practise outside of the existing self-regulatory systems run by professional bodies and associations. In addition, at this stage it is also difficult to quantify how many practitioners are registered currently with more than one organisation.

I am sorry that I am not able to be more helpful in relation to this question.

2) How many voluntary registers do you think will be involved? How many are above 1,000?

We anticipate at the present time that the numbers of registers we will need to consider for transfer will number around the 30 to 40 mark. However, we may be contacted by other organisations who wish their membership lists to be considered for transfer and there may of course be further registers established or consolidation of registers prior to the opening of any statutory register, which would affect the overall figure.

I know that the registers / membership of the BACP, UKCP, BPC and BABCP all total over 1,000 members / registrants. However, we will know more once we begin the process of making recommendations about which registers should transfer early in the new year.

3) How do voluntary registers get transferred?

In order to introduce regulation for the first time, a Section 60 Order under the Health Act 1999 is required. This piece of secondary legislation has to be passed in Westminster and in Holyrood before the regulation becomes law.

The Section 60 Order specifies which registers will transfer to the statutory register and may indicate any arrangements that need to be entered into between the HPC and the holder of that register. This is a result of discussion between the Department of Health, the organisation and the HPC.

In terms of logistics, we would work with the organisation holding the register to establish the data they hold and compare it to the data we require for registration (name, address, data of birth, etc). The transfer of data would then normally occur electronically with security measures such as encryption put in place to protect data security.

Once the register transfer has taken place and the HPC register opened, we would normally write to everybody that has registered to welcome them to the Register. Approximately one month later the profession would go into ‘renewal’ – every profession renews its registration with us on a two-yearly cycle. Registrants would receive a renewal form and would be given three months in which to complete the form including reading and signing the declarations and returning this to us with payment. Registrants can choose to pay their fees for two years in full, or to pay via a 6 monthly direct debit. If we do not receive a completed form after two months we send a reminder; if a completed form and payment is not received by the end of the three month period, the registrant with lapse from the Register.

An organisation could potentially only send a proportion of names on their list(s); the registers that transfer is controlled by the detail included in the Section 60 Order. For example, when practitioner psychologists became regulated by us on the 1st July 2009, only those who held British Psychological Society practising certificates and who held or held in the past membership of one of the divisions relating to a relevant domain of practice transferred. This is fine detail that would need to be discussed between the Department of Health, the organisation concerned and us prior to the opening of the register. For example, as we register at the point of qualification and do not hold a student register, we would not want to transfer any data relating to students. In addition, we know that some registers differentiate between psychotherapists and counsellors, whilst others do not, and, depending on the final recommendations, we may need to enter into discussions about which parts or sections of registers transfer and to which ‘sub-section’ of the HPC register.

With regards whether someone can refuse their data to be transferred, this is something that an individual would need to take up with the organisation that holds their data (i.e. the holder of the voluntary register); this would also be something which might be covered during discussions with the Department of Health in specifying the registers that transfer in the section 60 order. Once the section 60 order comes into force, that gives the holder of the register the legal permission to transfer the register data.

4) What happens if someone whose data you hold after the transfer of a voluntary register does not re-register? Is it deleted, or held for the purposes of investigation of a protected title?

If someone transfers of the HPC register but does not renew their registration, they will no longer be registered and their name will no longer appear in the public-facing register.

In terms of the data we hold, if someone lapses from our register, their details would remain in our registration database (but no details would be publicly available). In many circumstances, someone may come off our register because they are taking a career break or are going on maternity leave but wish to re-register again in the future. Sometimes individuals also fail to renew their registration on time because of an oversight on their part and need to apply for readmission to the register so that they can begin to practise again. If someone has been previously registered with us, they have to complete an application form. If someone has previously been registered with us, we do not ask for proof of qualification but we ask instead for confirmation that they were previously registered. Subject to checks that the information we require has been received, they will be re-registered under their previous registration number – this avoids potentially creating duplicate entries in our register, ensuring the register remains as accurate as possible.

The information is not retained for the purposes of investigating protection of title offences. However, if we do receive a complaint about the potential misuse of a protected title, our first check is to ensure the person concerned isn’t already registered with us. Sometimes we receive complaints about the misuse of protected titles where the person is already registered with us, sometimes under their maiden rather than their married name or vice versa. In such circumstances we can normally advise the complainant and registrant as appropriate and close the case without the need for further investigation.

5) How do you know who their employer is? Why do you write to the employer?

When someone registers with us or renews their registration, we ask them to provide /update us with a home address and employer / practice address (if they have one). The employer / practice address is used in order to provide information on our online register which includes the approximate geographical area in which the registrant practises. For example, someone who worked in SE11 would have the location ‘London’ listed against their name in the online register. However, their full home or employer / practice address would not be publicly available. Listing a general area on the public-facing register means that a member of the public can easily identify a practitioner as this allows them to differentiate between registrants with the same or similar names.

If the voluntary register holds details on employer / practice address, this will normally be given to HPC as part of the Register transfer. However, this data will sometimes not be held on the voluntary register, or, in the case of a HPC registrant, this information may not have been provided or the registrant may not have kept their details up to date.

When someone lapses from the register, we will write to the employers details (if we have them) within a month to let them know that the individual has lapsed. If someone is not on our Register, then they are legally unable to continue using a protected title. We do not have powers to make any legal requirements of employers directly; it is an individual’s responsibility to renew their registration if they still wish to practise using a protected title.

We write to the known employer following feedback we received from employers who asked us to do this. They wanted to ensure that they met their obligations to ensure that their staff were registered when necessary. In particular, employers want to avoid problems that arise where a member of staff fails to renew their registration but does not advise their employer who is unaware until the next time they check the registration status of members of staff.

The letter we send to employers (if we have this information) advises them that a registrant has lapsed from the registrant and explains that they are legally unable to use the protected title for their profession until they have readmitted to the register.

This letter is only sent where we hold details and where someone has lapsed from the register because they have failed to renew their registration and pay the requisite fee by the renewal date. However, registrants may decide to come off our register at any time by voluntarily asking us to remove their name.

I hope the above is helpful and answers your questions; but please let me know should you have any additional questions or points of clarification.

Kind regards,

Michael Guthrie"

UKCP officer election prompts new thinking on HPC

Reproduced below is a message from Andrew Samuels who has agreed to stand for election as Chair in the UKCP and is using this to bring information and debate alive on the impact of HPC on psychotherapy practice [the highlighting is mine].

"There's a strange and paradoxical feel to this election. Just at the moment when who we are and what we do as psychotherapists is going to be determined by the state, we hold an election in which individual judgement and choice will be decisive in UKCP for the first time. The idea that the future is in our hands is abroad – and at the same time, we are seeing how hard it is for some to truly accept that.

Everyone running for office says they wish to be judged on the issues and I am no exception. But the way this election is shaping up is very worrying indeed. We have seen a number of statements issued by the leadership of some sections that basically instruct their registrants on how to vote. The tone of some of these statements is not what I, for one, would have expected to see in public, as opposed to private discourse.

Equally worrying is the possibility of UKCP Central being manipulated by interests who are palpably opposed to what I am standing for. You should have received your voting papers by now but they have not been sent out. It has been suggested that the reason for this has been to allow for horse-trading between the two candidates from one section so that one would withdraw to avoid splitting their vote. The political tactic is fair enough, but not if it involves voting papers going out after the formally announced date showing only two candidates and not three, as if it were all just business as usual. Anyway, perhaps now really is the moment to focus on the issues.

HPC is not the only problem facing us but it is the one with the pressing time frame. In my position statement, which is included in Item 2 of the three items that follow this message, you will see that I am not trying to make the election into a referendum on HPC. We have other problems to face, both out there in arenas such as NICE and IAPT, and, after the way the election has gone, some pretty dire internal problems as well. I have had something to say about the whole range of issues, not just HPC.

The problem with my candidacy is that it does seek to reverse policy and hence it is an uphill struggle for me. Not least because, quite understandably you could say, the leadership of UKCP and of the sections are deeply implicated in and committed to the HPC policy. Hence they are bound to feel personally affronted if criticised and to take drastic action to stabilise their positions. I respectfully suggest that you, as registrants, do not necessarily share in the back stories of your leaderships, and I am asking you, in the secret ballot, to do your bit to restore UKCP to a commitment to some form of regulation that is more fitting to our values and traditions as psychotherapists.

For, as you will have realised, I am not opposed to all regulation. It has to be the right kind of regulation. That is why I am calling for a Convention on the Future of Psychotherapy and Counselling. There are alternative models for psychotherapy regulation, some of them having been tested in other countries. Yet I have been amazed to find, in discussion with architects of UKCP's regulation policy, that they have never even read the material.

Two ideas are worth noting. The first would be a 'Talking Heads Council', an improved version of the Psychological Professions Council that, only a few years ago, it was UKCP's policy to fight for. The other model is called the Practitioner Full Disclosure List; without going into detail, such a List would definitely safeguard the interests of the public and has other interesting features that might make it more appropriate for our profession.

I have been discussing our future with politicians from all three parties in both the Commons and the Lords. They are, by now, nearly all convinced by the arguments that HPC is wrong for us, though they do differ on how easy it would be to bring about a change. (No-one I have spoken to says a change is impossible or out of the question. They all say that a change will have to be towards a better model of statutory regulation.) There does seem to be a new willingness in Westminster and Whitehall to think again. If we send a clear message via our election that this is what we want, then, given the fact that the politicians will be thinking for a while about their own election, there is a window of opportunity. Nothing legislative that affects us is going to happen before the General Election.

This is what I am going to do about HPC if I am elected. First, I would try to bring the BACP and the BPC on board. Whether that succeeds or not, I will go to HPC and ask them to ask Government for the suspension of the process towards state regulation. Whether that succeeds or not, I will then call upon the Department of Health (and the Shadow health teams in the other parties) to back the call for the Convention on the Future of Psychotherapy and Counselling.

If this all fails, then I will assuredly work as hard as I can to get the best possible deal for UKCP in terms of how the HPC operates its register, and what the standards of proficiency and the criteria for approval as a training organisation turn out to be. I will make sure that we are adequately protected against those claims by BACP that are not sustainable (but support them where they seem to have serious grounds for complaint about the HPC proposals). I will do my best to protect the positions of those who do not wish to register, provided they adhere strictly to the rather stringent conditions of Principled Non-Compliance which are outlined in Item 3 that follows this message. It will not be enough just to do nothing at all.

You will see from this serious and detailed thought that is plain wrong for the HIPS Political Group to claim that I shouldn't even be in the election at all. The statement from this faction of HIPS is causing consternation and protest within their own section due to its defamatory choice of language, misrepresentation of the historical and contemporary facts, and authoritarian tone. Sadly, from the point of view of integrity in our professional life, the statement was distributed far and wide. I am sure it has been damaging to my chances despite the retraction of some of the wilder claims. In Item 2 that follows this message you will see my Response to what the HIPS Political Group sent out. It includes a rebuttal of their statement by a member of the UKCP Board of Trustees. When you read what Paul Atkinson has written, ask yourselves whether the HIPS statement is a reliable guide to how you should vote.

There is an election on and so everyone, including me, will tend to overstate their case. Nevertheless, I must say that the notion circulated by the Family, Couple, Sexual and Systemic Therapies Section that a vote for me will lead to people losing their jobs represents election scaremongering at its best (or worst)! Think about it for a moment. If HPC goes ahead in spite of Samuels, then no jobs will be lost. If there is another system put in place, then everyone will be in exactly the same boat. Again, no jobs will be lost. Opposing HPC won't lead to any losses of jobs. What all this shows is how invested everyone at the top of the professional tree (could we call them our Ruling Class?) is in maintaining control. Hence 'Stop Andrew at All Costs'.

Not everything that has been written is so awful, though, and I am grateful for the measured tone emanating from the Hypno-Psychotherapy Section. My reply to their statement, which is Item 1 following this message, enables me to explain why the Alliance came into being, and to remind everyone that over 850 UKCP registrants have signed the petition against regulation via HPC. No-one knows what the balance of opinion in the profession really is. Even BACP doesn't know and is at present conducting a sort of emergency poll on the HPC proposals. In my Response to the HIPS Political Group, I say it is 'amazing' that we don't know. I think I was pretty moderate in my choice of language. Maybe even after this election we still won't really know, but I will make good on my pledge to hold ballots on all matters to do with regulation in the future.

I am sure that, if elected, I will be tempted to 'go native', and to enjoy meeting with the powerful (and with the interesting) a little too much. I could well get inflated. But I will do my best to be conscious of this. I will certainly try to put a stop to the growing tendency for UKCP Central to develop a life and interests of its own, expressed in a ceaseless stream of authoritarian memoranda. As the Chair of a Member Organisation, I quite naturally get to read all the papers. Hence I feel able to say that our leaderships have got mixed up with the aims and objectives of the bureaucratic approach to civic life that is so prevalent in Britain today. I was first amused and then concerned to see that the latest papers from UKCP Central include documentation presented on forms and using language and notation identical to that used by HPC.

Go interpret!

Returning to the other challenges that face us, I think it is reasonably well known that mine was the first voice to go public about the outrage of IAPT getting all the resources from the government for its watered down version of CBT (apparently not particularly effective, according to their own research). I took a terrible hammering for speaking my mind and, though UKCP notables told me privately to keep on trucking because they couldn't be as direct in the meetings they were attending, they did nothing in public to help. What you can draw from this, in terms of what kind of Chair you want, is that I am likely to be more effective than most (in settings like the IAPT committees) to get the injustices and absurdities redressed. I would also seriously question what we are doing in the Savoy Partnership. I wouldn't advocate our leaving it as yet but we have lost our distinctive voice therein.

Similarly, with NICE, there seems to be this strange reluctance on the part of UKCP to really stick up for the kind of work we do. Either it is that, or we have not yet really worked out a concerted political strategy.

I will conclude on a personal note. I know I can be a difficult person, self-centred and bombastic at times. I am a funny mixture to myself of tough and fragile. Truly, I really didn't want to stand for this job, which is why I say in my position statement (in Item 2 below) that I was 'surprised' to be standing. At 60 years old and enjoying my clinical, academic and political work, and my personal life, I didn't need to do this. But I just felt so damn passionately that something has gone fantastically 'off' in our little world of psychotherapy. So, against my own needs for pleasure and a quieter life, I responded to requests to stand. I do so as an underdog, without the resources that candidates backed by powerful sections have. Could I really win when I have been targeted in the way I have been? We shall see. I am certainly not a 'man in a white suit', no Martin Bell – but I really think I have argued my case that it is time for a rethink by UKCP concerning its policies and its style of doing things.

I was going to say you could stop reading here but then I realised how patronising it would be to assume that you wouldn't be interested when, as they say, the future is in your hands. Please take the time (the election lasts all of October) to read through the material ....

Andrew

And From Scotland - ministers and servants : democracy inaction [sic]

Below is a letter from Stuart Morgan-Ayrs who is replying to Robert Girvan, who you will see is from the Regulatory Unit of the Scottish Gov (his letter is reproduced below that of Stuart). I've put them in this reversed date order because Stuart's is the more vibrant, alive and interesting, of the two. Robert's is an important testasment to the kind of response many of us have been getting from government ministers and their servants, and it is easy to see the mark of the HPC itself in the reply (hence bringing us again to the question of QUANGOs and their independence from gov and vice versa).

Stuart replied on 24th October with the following:


Dear Robert

Many thanks for your most interesting response.

Sadly it would appear that either the Scottish Government is not staying up to date having ceded this to Westminster, or your colleagues in London are keeping you well and truly out of the loop.

The HPC regulation regarding BPS is proving a failure with a substantial proportion of psychologists refusing to register. A major reason for this is that considering the unregulated nature of the title "psychologist", practicing psychologists are objecting to paying a yearly fee, which gains them nothing, just to add a prefix onto the generic term! By dropping the prefix they do the same job, in the same way, for the same money, save the cash and do not have to sign up to this daft scheme!

If psychologists are doing this, who are mainly employed, how will self employed counsellors and psychotherapists behave? Why should I for example, with qualifications in all three disciplines pay over £70 per year to use the title "counsellor" or "psychotherapist", when I can simply and accurately use the generic term "psychologist", "therapist", "psychoanalyst", "life coach" or "complementary therapist" for free. For those of us with post graduate qualification and over 10 years of professional practice - we do not need silly titles verified by a government quango to sell our wares! It is only going to be the scared and freshly qualified therapists, and those people employed by the NHS that are going to bother registering! Senior therapists like myself will naturally remain professionally accountable and insured through our existing affiliations.

The BACP - one of the largest counselling and psychotherapy bodies, together with many more smaller bodies have rejected the HPC draft proposals. This is driven by the fact that the membership of these professional bodies neither meet the draft proposal requirements, nor agree with this move backwards for the profession. The profession have simply not been consulted, instead a stooge ridden practitioner liaison group was set up (later modified to get rid of dissenters!). For example taking the BACP: 80% roughly of their members (their figures) are not BACP "accredited" but are instead professionals in related industries who use counselling and are currently classed as counsellors, or volunteers. These people will be excluded or face abhorrent costs! Many therapists have already paid out many thousands of pounds for independent training (the usual standard until recently) for good training, which will now be disputed. My own initial training cost over £8,000 for nearly 5 years of training, which I was only accepted on to as a graduate, and which led to an NVQ Level 4 in Training and Development. Highly assessed - highly supervised - high standard - multiple schools of therapy, and soon to be completely ignored.

TWO legal challenges have already been initiated to question and prevent the legislation in it's current form.

A substantial university study and report has also just condemned the HPC proposals as flawed.

A publication of leading therapists in their fields has now been published explaining why the proposals are completely unacceptable. Typically these papers are scribed by professionals with far more credibility in their divisions and schools of thought than anyone consulted by the HPC!

As for the levels of qualification for counsellors and psychotherapists, this is again a bad joke. For years counselling has been accepted as a part of almost any therapy physical, mental or combined, and therefore counselling courses of a vocational nature have arisen, usually at levels 3-5 on the SQA / QCA. Most would not be considered acceptable by the HPC since they require specific content (still undefined) at a minimum level 5 level.

As for psychotherapy - post graduate sounds very nice - but the majority of courses are not university accredited! Therefore at a stroke the multitude of excellent courses, often vocational in nature will be consigned to scrap, because of a figure on the qualification scale pulled out of a closed discussion group! Why for example should a psychotherapist with say 20 years experience and existing diplomas have to retrain? Why should someone with for example a MSc in Psychology ALSO need a MSc in Psychotherapy? Why should a counsellor with level 3 accreditation and years of experience need to jump another 2 levels? And since most of the work is intuitive, why the silly emphasis on academic study anyway? What about persons with dyslexia and other learning restrictions either class, ethnic social or environmental? Counselling is a conversation, not a paper exercise and currently is a suitable career for them. It will not be if you need a university degree though! Why the discrimination against them and in favour of white middle class academic kids? And what about all the styles of psychotherapy and psychology and counselling that have no accredited university courses available? Are you going to criminalise providing these just because the courses have not yet been developed, or simply may never been available? I use Morita and other Eastern forms of psychology in my practice - university level courses are simply not available in these in the UK. Should therapists using these go and study an "approved" method like person centred (with half the history and development) and lose these methods for the public?

It would appear that your department is blindly following a course of action which is also being questioned in Westminster, and that is fundamentally flawed, not least because the HPC failed to adhere to the legal requirements of it's own mandate when (not) identifying whether this form of regulation was appropriate.

There now exist a raft of practical, ethical, philosophical, financial and legal reasons why the proposed HPC regulation is likely to fail or else do substantial damage to the industry.

Incidentally it is surely your responsibility to consult with the voluntary agencies of Scotland who employ counsellors and canvass their opinion? Are you aware that the effect of proposed measures will cause chaos and termination of services across Scotland the rest of the UK? Or are you planning to pay all the registration, grand-parenting, qualification and supervision fees on behalf of all the voluntary counsellors in the whole of Scotland? You might want to consider the bill per volunteer of registration, grand-parenting fee, any training required at undergraduate or post-graduate level to make the grade, and then reassessment! The figures we have seen include over £400 for grand-parenting and university fees can be easily into the thousands!

All that was ever required was an enforced requirement to be professionally registered with an adequate professional body, have full indemnity insurance and adhere to a nationally agreed code of conduct and ethics, with all names held centrally to ensure no jumping between associations in event of dismissal! The associations could easily be required to register all names within one register. Not exactly rocket science!

All the current proposals mean is that many of us are going to re-brand with a different job title rather than compromise our philosophical and ethical integrity if the HPC proposals go ahead. Since the numbers of us declaring this are in the thousands, PLUS the rejection of whole associations like the BACP - all the HPC is possibly going to achieve is causing us all to rename our job titles! What a waste of time, effort and tax-payer's money!

More information on this complete farce that you are signed up to!

http://www.psyreg.co.uk/

http://ipnosis.postle.net/

http://hpcwatchdog.blogspot.com/

http://www.allianceforcandp.org/pages/


Kind regards


Stuart


This is what he replied to:

ROBERT GIRVAN, Regulatory Unit
Scottish Government, Robert.Girvan@scotland.gsi.gov.uk


Dear Professor Morgan-Ayrs


Thank you for your e-mail of 21 September regarding the regulation of psychotherapists and counsellors. I have been asked to reply on behalf of the First Minister, Alex Salmond.


The regulation of these groups is a matter devolved in Scotland to the Scottish Parliament. However, the Scottish Government is currently committed to UK-wide regulation of the health professions, sensitive to Scotland’s needs. This is in the interests of the cross-border flow of staff and consistency in the application of standards across the four countries, as well as public understanding.


The White Paper Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century stated Government plans to introduce statutory regulation for psychotherapists and counsellors as a matter of priority, as what they do carries significant risk to patients and the public. The Health Professions Council (HPC) was the recommended regulator as it was designed to regulate new professional groups and had the most expertise in bringing new professions into statutory regulation and also in regulating a wide range of professions within a common system.


The final report of the Department of Health Extending Professional Regulation Working Group (EPRWG) was published on 16 July. This Group was set up as part of the implementation of the White Paper Trust, Assurance and Safety to take forward work on the scope of professional regulation. The Scottish representative on the Group ensured that our own Extending Professional Regulation Group fed in to the DH Group and vice-versa.


Given the risks presented by these groups, the EPRWG report supports the commitment to regulate psychotherapists and counsellors and recommends that the ongoing work to implement statutory regulation by the HPC should continue. The report can be viewed at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_102824

The HPC regulates by protection of title. Each of the professions regulated has at least one title which is protected in law. We are confident that the statutory regulation of psychotherapists and counsellors will promote protection of the public by restricting the use of protected titles to those who have demonstrated that they are fit to practise, and have the relevant skills, knowledge and aptitudes. Under statutory arrangements, the public will have the choice of whether or not to use a statutorily regulated, registered professional whose standards are explicit.

We are aware that there are a wide range of psychological and knowledge bases from which these psychological therapies have derived. As was the case with the introduction of statutory regulation for practitioner psychologists, for those practitioners who do not qualify for automatic transfer onto the HPC register the HPC will also provide for an interim assessment process known as ‘grandparenting’, which will allow applicants to register with them based on a more individualised assessment of their qualifications and experience.

All four constituent parts of the UK are still in the early stages of work on a regulatory system for psychotherapists and counsellors. As you note, the HPC sought the views of stakeholders with a call for ideas from 23 July 2008 to 24 October 2008. The responses informed the work of the HPC Psychotherapists and Counsellors Professional Liaison Group (PLG) set up to consider issues relevant to the statutory regulation of psychotherapists and counsellors.

The Group consisted of 17 members including representatives from professional bodies, education providers and service users. Their report has now been published and the HPC have completed a further three month consultation. The key issues they consulted on were the titles to be protected, the standards for safe and effective practice and the threshold level of qualification for entry to the HPC register. The outcome of the consultation will help inform the HPC’s recommendations to the Secretary of State and to Ministers in the devolved administrations on the regulation of this group. The consultation closed on 16 October and I hope that you submitted your views to it. The Scottish Government has also submitted a response to the consultation informed by key stakeholders.

There is still a considerable amount of work to be undertaken before statutory regulation can be implemented across the UK. We welcome the views of stakeholders as we move towards regulation, including during the further period of consultation that there will be on the eventual draft Order under section 60 of the Health Act 1999 which will put regulation in place for psychotherapists and counsellors across the UK.

I hope this clarifies the current position.


Yours sincerely


ROBERT GIRVAN

Playlet: PLG considers the serious questions raised by those who are concerned about the possible negative effects of regulation by the HPC

At the second meeting on the PLG (Professional Liaison Group) for Counselling & Psychotherapy, 28 and 29 January 2009, members were asked to consider the questions raised in the Call for Ideas (Oct 08) which were gathered together under the heading "Conscientious Objection". The arguments and concerns were condensed by administrator Michael Guthrie to a few lines, reproduced below.

Coincidentally, members of the PLG had also recently received a lobbying letter from the College of Psychoanalysts-uk, and a member of the public had placed copies of the Statement of Intent on the table from the Alliance for Counselling and Psychotherapy against State Regulation.

There were, then, a considerable number of objections, each laid out with substantial argument, presented to the PLG to consider. What follows is a small playlet, written from my notes made at the time (I was a silent observer at the back of the room), which presents the way these serious concerns were handled by the meeting:

First, the section from Michael Guthrie’s Summary of Responses to the Call for Ideas, Oct 08
3.2.2 (p37) relating to Conscientious objection.

Summary.
- The Register should be structured to provide for a list of 'conscientious objectors'. A list of 'non-licensed', 'non-certified' psychotherapists exists in the US State of Vermont.
More Information/points for discussion
- The PLG may wish to consider whether such an approach would be meaningful to either members of the public or the profession and achieve the public protection aims of statutory regulation. No known arrangement similar to that in Vermont exists in professional regulation in the UK


MICK: Is Principled Non Compliance a practical option in your opinion?

MICHAEL: I cannot foresee the government being able to accommodate it.

BRIAN: There is a possibility of several different registers springing up all simultaneously with HPC - have you thought of that?

MICHAEL: [nonplussed]

MARY: I’ve looked carefully at the arguments - that people choose willingly to go private and so on. But that’s the same with dentists, and they can do a lot of damage, or estate agents - they can rob you blind. If you are in a position where someone comes to you and you can do harm, then, well, I’m afraid I cannot support it.

ANNIE: Why are they asking the regulator to hold their names on the register if they don’t want to register and be regulated? You can’t have your cake and eat it too you know.

NICK: Are they the registered non-registered?

JONATHON: What is the purpose of regulation? Without statutory regulation people who are known to be harmful will continue to practice. People need to be prevented from practicing. Either it is the regulator or the law, and the law can’t be different for one person than another.

PETER: They could get taken off the Non Register

NICK: Or sent to Vermont

JULIAN: We must not ridicule them - they hold their position seriously, and hold it well.

JONATHON :Not ridicule, but put the facts. The evidence base is clear that there is harm. Best outcome of this process is the vast majority will continue to practice in the way they’ve done before, but bad practitioners will be removed. We have to come back again and again and again to the public protection issues. We are in a New World now. Professional led self-regulation is dead. The Health & Social Care Bill last year said there must be an equal number of lay people on the board as professionals.

PETER: I totally agree. These people - we should take a very firm view. Compared to other professions, psychotherapy is definitely potentially harmful. Five per cent of practitioners cause damage.
[voices off: says who - where's this published? what is the source the paper? what is the evidence? what grounds do you have for that? etc]
… The public is ill-served, the present situation is in-effective. We hope it will become more Evidence Based. A little bit more notice of what is known in general will lead to an improvement in client care. Registration is not new. The medical profession was against regulation. It is an urgent issue for public protection.

LINDA: We should not mock or ridicule these people. But, the public needs protection and therefore we need regulation. Professionals need protection too. I think it is a good move for the profession.

JULIAN: We are a victim of our own rhetoric. Public Protection - we are part of the public, the clinical community is part of the public. Care providers are vulnerable. The public is at risk from us, yes, but we are vulnerable to them too!

CARMEN: It is a philosophical position that these people are taking. It’s not about a ‘them’, there are several different groups. I would not choose the HPC if I had any choice.

JEFF: Other aspirant groups have had this problem.

DI (Chair): We have all been lobbied, lets be frank, but the letter is philosophical. They point to the confusion between State and Statutory Regulation, and raise the question of totalitarianism. [sigh] Look, I've lived in an eastern bloc country, oh, for many years, I know what totalitarianism is, and this is not that. It might look like it from the outside, but it doesn't feel like it inside the HPC. Also they talk of the medical model... No, no [shakes her head slowly from side to side] oh dear...

FIONA: We must take this seriously. They have a petition, and it had 1600 names on it at the beginning of the week, a lot of names on it that I respect. I’m not willingly part of this process. Perhaps I am willingly dragged into it, but only because I believe I decided I had to join in order to try to influence it.

VOICE: The HPC gives public protection. It protects the registrant. It helps with credibility. There is really nothing to do but pay the fee and gain status and credibility.

MARY: And upholding public confidence. It’s a matter of pride to have been recognised by the HPC, to get external validation.

DI: Oo, things are getting a little bit heated. Shall we take a short ten minute break and come back to finish it off?
....... [fade out… and back ]

DI: Right, now, we need to move on.

MICHAEL: Which protected titles do you want to have. We protect titles, rather than function, but we have to police mis-use of title, and we do that through the ‘intention to deceive’. If people don’t register, we won’t have public protection.

CARMEN: Registered counsellor, ok, but what about a registered life coach? I’m quite frightened by that. We need to look after, preserve, make clear, how to deal with the widespread use of the word.

MARY: If we think its right, we’ll do it, and ignore what goes on elsewhere.

CARMEN: If they are not doing it well enough, and they are using my professional title, well...!

MARY: [vehemently] We’ll get them on ‘if you go beyond your skills and competence’. [recovering herself] Prevention is the better protection of the public.

JULIAN: We’ve parked a difficult issue.

DI: But we can be seen to have done justice to the question.

A note on centrism (aka centralisation, and utopian holistic planning)

As you know, my interest in the 'new style auditing' (boosted here in the UK in the 1980s, with the Thatcher/Heseltine innovations in 'new public management') is the way it feeds into a more and more centralised system, giving more and more power to the utopian holistic planner and taking it away from the local folks who not only know what's going on in detail, but who are better placed to do something about a problem in a properly measured way.

So, yesterday's news story about the way that prison inspections led local prison managers to do the unthinkable (move prisoners around in order to second guess the inspectors, and secure a good result in the audit) is shocking but comes as no surprise. The excess of power in the centralist hand produces a contortion at the local level.

What is perhaps more disappointing is the way that those holding the centralised power absolve themselves of the responsibility. Dame Anne Owers was on the BBC saying that the moved would have had no effect on the inspection. Centralist utopian planners are as easily hoodwinked by the system they enjoy, as those who are subjected to it.

To parody it: the centralist thinks that the resulting perversion of duty amongst the local managers is a confirmation of their own prejudice - these guys need tough inspections to make sure they don't step out of line. A rather stupid but effective vicious circle is set up, exactly like the one that informs the HPC: 'those local practitioners need to be watched, in order to protect the public' is soon followed by, 'ooh, look what they are doing, I told you they had to be watched'.

As long as the centralist refuses to subject him or herself to even a little bit of self reflection, the system can carry on ad infinitum, and produce more and more horrendous results. A self fulfilling prophecy, and the destruction of a once pretty decent country.

Psychotherapy Organisations Poised to Challenge Health Professions Council in the Courts

This press release was sent out from psychoanalytic organisations yesterday from The College of Psychoanalysts-UK, Association for Group and Individual Psychotherapy, Association of Independent Psychotherapists, Centre for Freudian Analysis and Research, The Guild of Psychotherapists, The Philadelphia Association

The Government’s plans to regulate counselling and psychotherapy under the Health Professions Council faces a further setback this week with the threat of legal challenge by six leading psychotherapy organisations (Association for Group and Individual Psychotherapy, Association of Independent Psychotherapists, Centre for Freudian Analysis and Research, The College of Psychoanalysts-UK, The Guild of Psychotherapists, The Philadelphia Association) and the publication of a report from Kings College London and Royal Holloway, University of London, which questions the suitability of HPC as regulator. Only a week ago the publication of 'The Maresfield Report on the Regulation of Psychotherapy in the UK' showed serious problems with the Government project and with the HPC's attempts to impose itself as regulator.

The Kings College and Royal Holloway study, 'Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling', http://www.kcl.ac.uk/content/1/c6/06/35/90/StatutoryRegulation1.pdf, funded by the General Medical Council and the Economic and Social Research Council, warns of over-regulation failing to provide the best model of patient care. A focus on high-profile 'media spectacles' creates a regulatory climate 'obsessed with blame', leading to regulatory practices which fail both clinicians and patients. The HPC is criticised for its failure to address political forces at work in its consultation process, with certain stakeholders battling for 'position and influence'. It concludes that HPC-style regulation may well be less effective at public protection than a profession-based mandatory regulation, with an emphasis on mediation and interpersonal processes such as supervision. Current regulatory proposals fail to recognise the complexity and subtlety of the therapist-patient relationship.

These conclusions echo those of The Maresfield Report, http://www.psychoanalysis-cpuk.org/PDF/MaresfieldReport.pdf, which also highlights HPC's expensive and adversarial system of complaints, with a growing backlog of unheard complaints and a exceptionally high rate of dismissing complaints from members of the public as 'no case to answer' (more than 70% compared to 10% in therapy organisations' existing procedures). Complainants may be required under HPC to disclose medical history and hearings take place in front of a public gallery, undermining basic principles of confidentiality. The Report also finds that although there have been several European projects to introduce statutory registration of therapists, Britain is the only European country to propose regulation for the actual content of therapy sessions.

Many of the organisations which published The Maresfield Report have also threatened a legal challenge to HPC this week via the well-known London law firm Bindmans. HPC were given the brief to assess the 'regulatory needs' of the field and to explore its own suitability as a regulator, yet proceeded as if there was simply no question that the field required regulation and that they, in fact, would be the regulator. There is concern that one motivation here may be financial: HPC budgets are growing each year, and the registration fees of counsellors and therapists would be the single largest source of income the HPC would receive from one profession.

HPC's failure to make a proper evidence-based case for regulation, ask itself critical questions as required by the statutory regime and conduct proper consultation means that its actions are open to challenge in a judicial review claim. The psychotherapy organisations involved will decide whether to issue one in the next few weeks, depending on the HPC's response to Bindmans' submission. The new reports and the legal challenge will be a major embarrassment to HPC at a time when it has begun actively lobbying both Conservative and Lib-Dem policy makers, anticipating a change of government before the proposed legislation can be introduced. It will be particularly embarrassing to HPC’s CEO Marc Seale, who is trying to push through this controversial regulation while many politicians are becoming critical of the once received wisdom of the project.

My response to the HPC Consultation on the regulation of Counselling & Psychotherapy

Submission to the HPC Consultation on the State Regulation of Counselling & Psychotherapy. Oct 2009.

Janet Low, MA PhD. Clinical Associate (CFAR), MBACP. Visiting Honorary Fellow at Manchester Metropolitan University.

Author: HPCwatchdog.blogspot.com

When Professor Richard Gombrich spoke at the Rally of the Impossible Professions (September 2008) he quoted from Karl Popper’s 1940s essay, Piecemeal Social Engineering. Since then, I have found myself dipping into this old essay and finding much of interest and use for understanding the predicament we face today. I have decided to kick off this submission with a quote from that essay, in which he considers the virtues of the piecemeal social engineer as opposed to the recklessness of the idealistic holistic planner. I hope that his words might find an echo in the soul of the person delegated to read my submission, and that some of the Popper’s wisdom and experience might help to redirect us back onto a more practical path.

“while the piecemeal engineer can attack his problem with an open mind as to the scope of the reform, the holist cannot do this; for he has decided beforehand that a complete reconstruction is possible and necessary. This fact has far-reaching consequences. It prejudices the Utopianist against certain sociological hypotheses mentioned which state limits to institutional control… For example expressing uncertainty due to the personal element, the ‘human factor’. By a rejection a priori of such hypothesis, the Utopian approach violates the principles of scientific method. On the other hand, problems connected with the uncertainty of the human factors must force the Utopianist, whether he likes it or not, to try to control the human factor by institutional means, and to extend his programme so as to embrace not only the transformation of society, according to plan, but also the transform­ation of man. ‘The political problem, therefore, is to organise human impulses in such a way that they will direct their energy to the right strategic points, and steer the total process of development in the desired direction."

It seems to escape the well-meaning Utopianist that this programme implies an admission of failure, even before he launches it. For it substitutes for his demand that we build a new society, fit for men and women to live in, the demand that we ‘mould’ these men and women to fit into his new society. For those who do not like living in it only admit thereby that they are not yet fit to live in it; that their ‘human impulses’ need further ‘organising’. But without the possibility of tests, any claim that a ‘scientific’ method is being employed evaporates. The holistic approach is incompatible with a truly scientific attitude.” p311 of A Pocket Popper, edited by David Miller, andpublished by Fontana in 1983

Responses to the consultation questions:

1. Do you agree that the Register should be structured to differentiate between psychotherapists and counsellors? If not, why not?

No. The HPC has not grasped the difference between counselling and psychotherapy and it would be irresponsible to blunder in and impose the distinction without an intelligent and realistic explanation as to why. There are many differences, not only between counselling and psychotherapy but amongst those that would go under each name. Without an appreciation of the reality of the work, the effect of HPC regulation will almost certainly distort and obfuscate the situation which will in turn actively not protect the public. It is possible that the men and women charged with putting the system to work in the real world may succeed in overcoming this tendency to distort, but this would be a strange thing to expect people to do, and unrealistic to expect them to do it for long.

2. Do you agree that the Register should not differentiate between different modalities? If not, why not?

Q2 Yes. The complexity of reality will be damaged and should not be contemplated by the HPC, who have no obligation to understand the reality or experience of the field.

3. Do you think that the Register should differentiate between practitioners qualified to work with children and young people and those qualified to work with adults? If yes, why? If not, why not?

No. To attempt this is to fundamentally misunderstand the nature of regulation as practiced by the HPC. The request to split the register in this way will simply result in a false segmentation in the market for training.

4. Do you agree that ‘psychotherapist’ should become a protected title? If not, why not?

No, the prospect of state, statutory, and HPC regulation on this field has already distorted it to the point where the words psychotherapy and counselling have been and continue to be detached from any meaningful subject. A mixture of entrepreneurial politics, and a failure to really address the meanings and uses of the titles has led some members of the field to fudge the labels and use them as marketing tools with an eye to possible pay differentials in a post regulation world. This is a good example of the distortion that can happen when statutory regulation looms large on the horizon. Unless and until sensible, level headed, cool and calm thinking is allowed to happen around this question, the title should not be protected. The confusion cannot foster an enlightened public, and will leave members quite vulnerable to misunderstanding. Daniel P Hogan’s work (1978) concludes that unless there is a well defined body of knowledge to define a practise, statutory regulation should be avoided.

5. Do you agree that ‘counsellor’ should become a protected title? If not, why not?

No. The generality and normality of the word is the value of the word. To bring it within the jurisdiction of the HPC or statutory power will set up all kinds of unexpected difficulties in unexpected places. It has already been noted by the HPC that changes in law will be necessary to make it possible to protect the title. This is a good example of the way labyrinths of bureaucratic structures become necessary when the centralised planner does not recognise the truth of reality. In extreme cases this can lead to the application of force, as the powerful structures try to force reality to fit, rather than admit defeat. A point made succinctly by Popper, in the quote that preceding this response.

6. Do you agree with the approach to dual registration outlined in the report? If not, why not?

No. Dual registration threatens to get out of hand (as the recent Council discussion on Sonography testifies). The power of good regulation emanates from the fact that the practice in question can be clearly defined and known. The idea of a profession is that of something a person dedicates their life to. Whereas this is true for some who engage in counselling and psychotherapy, it is also true that many do so alongside other occupations (and don’t forget, many people work voluntarily). The life experience, and the open mindedness of this is itself a valuable resource, which prevents counselling and psychotherapy from mistaking themselves for discrete and immutable objects. There is little indication that the HPC process will be able to distinguish well enough between the various practices to know whether or not someone is doing one thing or another. Arts Therapy and Counselling Psychology are good examples of this. They are currently used to justify the inclusion of psychotherapy and counselling in the HPC register, yet this argument holds within it a logical contradiction. There may also be difficulties arising from the practice of body psychotherapy and some other parts of the register. Border disputes might be another unintended consequence of the process. The beauty of the wide field of counselling and psychotherapy is that it draws from such a diversity of experience in society. The fact that almost anyone can in principle speak and listen is a reason for not regulating it via the HPC. The practice is distinct in this way, and poses special problems for HPC regulation. The true nature and extent of trouble caused by this state of affairs is not known in any useful way. For those who are particularly animated by this, may I recommend some level headed and objective research be done into the literature before a careful and sensitive inquiry be opened up in the actual time and place that presents the most concern.

NB. On several occasions during the course of the PLG I heard members of the HPC advise their new colleagues to ‘forget what happens in practice at the moment, and invent a totally new profession’ (Prof Annie Turner was the most consistent proponent of this view). This advice is wrong and puts in question the whole direction of HPC regulation for the field. A similar line was also articulated by Jonathan Bracken at the HPC Council meeting when the groups within the Psychologists were arguing for PhD entry level criteria. Bracken reminded Council members that they had decided upon the correct standards for practice and should not give in to ‘what currently happens in reality’. This is highly questionable, and throws serious doubt on the ability of the HPC to regulate any practitioners. It appears to belie an underlying cynicism which would predict perverse consequences. I shall return to this in due course.

7. How appropriate are the draft criteria for voluntary register transfers?

Inappropriate – it is the way that an organisation puts them into practise that is the most valuable criteria, and this can vary over time. The system in use by the HPC does not afford the time or skill to forge the kind of relations that are necessary to make a judgment on the quality of the various registers.

8. Do you have any comments on the outline process for identifying which registers should transfer?

The very large number of registers being considered by the HPC is cause for much concern. HPC cannot make a relationship with each register, and is therefore in a very difficult position to trust and judge. If the HPC must rely on answers from a questionnaire such as this, we should all be very worried about the quality of data entering the system.

9. What evidence might an organisation holding a voluntary register provide in order to support their submission?

Unfortunately, over the last 10 years or so, the word ‘evidence’ has been distorted to such a degree that in many contexts it has become almost meaningless (there are of course exceptions to this, but in general, unless the discursive space is carefully protected, the word tends to becomes a political weapon rather than a valuable way of transmitting information). This is, to put it mildly, a pity. However, it does furnish us with another good opportunity to observe the way that political power can twist and pervert the ordinary course of things (the phrase Evidence Based Medicine was invented as a political slogan by Archibold Cochrane back in the 70’s, it only became popular after the new Labour Government promoted it as a policy for ‘modernising’ the NHS, and for solving the BSE/CJD problem.).

In the ‘old days’, before the capture of ‘evidence’ by politics, it would be possible to think that your question included an idea of a real human being looking for a variety of information from a number of sources and weighing up reality in order to make a judgment. Here we can also draw on the parallel field of law, where evidence takes part in a complex system of investigation, prosecution, defense, cross examination, review and assessment by jury, and, finally judgment. In other words, evidence must always be weighed up in relation to the social arrangements that are made around it. In answering this question, then, I must make an assumption about the way that the ‘evidence’ will be used – ie, what is the context in which information will be turned into evidence, and what is the quality of the personnel that will interpret the information and form judgments. I think there is rather a high chance that the computerized context of the HPC will favour an automatic reading of evidence which will reduce information to little more than ticks in boxes. In other words, I strongly recommend you reflect seriously on what you are asking for here.

10. Do you agree that the grand-parenting period for psychotherapists and counsellors should be set at two years in length?

If the HPC cannot avoid becoming the regulator of this field, the grand-parenting period should surely approach infinity to allow conscientious and serious practitioners to remain safe from the threat of the distorting effects of its power until a proper solution is found. Even those who are actively seeking HPC regulation know that there are very many problems indeed to be sorted out before regulation will be functioning effectively. It is sensible to leave a very large margin in order to reduce what is likely to be inadvertent damage, and thus to increase the possibility of protecting the public. In doing this, the HPC would also gain a realistic view of the opinions of those in practise as to the quality of the regulation it proposes. At present the HPC cannot hope to gauge a measure of success as the regulation already comes with the force of law. At this year’s Annual Meeting I heard Mr Seale laugh cheerfully and say that many professionals are embarrassingly positive about being regulated by the HPC – this ‘evidence’ could be interpreted in a number of ways, not all of which would be flattering to the HPC. The presence of statutory power can easily distort the context in which information is produced. To be embarrassingly cheerful could as easily parody a highly distorted relation not unlike that between a cheerful slave and its cruel or stupid master.

11. Do you think that the standards support the recommendation to differentiate between psychotherapists and counsellors?

No.

12. Do you think the standards are set at the threshold level for safe and effective practice? If not, why not?

No. The vast majority of the standards are completely irrelevant (the generic standards), and are almost certainly going to set up a distortion in this particular field of work. This will actively not protect the public – ie, will make the public less safe. Secondly, those standards which have been written specifically for counselling and psycho­therapy were cobbled together from a variety of other aborted attempts, and are only here presented as a finished item to fit in with an arbitrary time table. There has been no testing out in pratise of these standards, and no attempt has been made to think through the possible negative consequences in the various practices and modes of training that exist up and down the country.

There is something crucial to say at this point. Those who have been engaged in this process have revealed a lot of different motives and justifications for their participation. For one, it is to prevent certain specific others from practicing (a personal motive), for another it is to make sure that they have some say in whatever happens, the better to make a buffer to protect their members from the worst effects of the new system. A third says openly that these standards will have no effect whatsoever on practice, so for him they are a façade to be erected behind which ‘business can carry on as usual’. Several of those PLG members drawn from the counselling and psychotherapy field have also openly said that they would not chose the HPC as the regulator, but were participating in a process they didn’t agree with, because they had no choice. One even said she was dragged to the table, though she conceded she had been willing to be dragged but only in order to influence things from inside the system.

From those PLG members who were there from other parts of the HPC, two thought they should persuade the counsellors and psychotherapists to actually invent a brand new profession so that the HPC would be able to regulate it! Another thought that the variety and diversity in the field of counselling and psychotherapy was a ‘mess’ and intended to use HPC mechanisms ‘to tidy it up’. A third, or rather, fourth, was preoccupied with bringing professionals into fitness to practise procedures in order that the HPC triumph over it’s rival the GMC in an imaginary competition of ‘show trials’. Yet another member of the PLG held up proceedings for almost half an hour to consider how to prevent people from practising who had ‘a boy scouts badge in counselling’ thus insulting the institute of boy scouts!

The list of examples goes on. The process was not set up in such a way to ‘bring out the best’ from its constituents. The chairing of the meeting was insipid, un-inspiring, not rigorous, and became famous for a set of phrases: ‘we’ll park that for the moment’, ‘put that in the pot’, ‘we’ll come back to it later’. Each of those phrases might be put to good use in such a context, but here they signified stalling, avoiding, postponing and almost completely succeeded in preventing any serious sensible discussion from taking place at all.

This, however, was no ordinary incompetence and even seems possible to signify an underlying cynicism. From the beginning of the process the chair and other practitioner members of the HPC Council emphasized that the meeting was not one in which decisions should be made, but that it should be thought of as a place to ‘keep it vague, and make a sketch’. This somewhat extraordinary aim was made especially clear when the Chair brought the meeting to a ‘false close’ at the end of a very short first meeting, and again in the second meeting after a short and largely sneering discussion on the question of ‘conscientious objections’. She said: ‘we can be seen to have done justice to the question’ presumably because a small amount of time could be recorded in the minutes. Being seen to do something, here, sounds remarkably like ‘pretending to do something’ and in fact this latter would be a better description in this case.

This is a strong claim, and one not to be made lightly. However, the constant prevarication also meant that at the 11^th hour the PLG had to resort to the extraordinary measure of asking Peter Fonagy and Mick Cooper to ‘get together over lunch’ to come up with a differential to settle the tricky question of distinguishing counselling from psychotherapy. Kathi Murphy objected strongly but was pretty much ignored as Diane Waller eagerly took up the suggestion (made by Julian Lousada). This meant that, for those of us watching from the back of the room, the complexities of the matter were being taken out of the hands of those who had knowledge of the realities of this distinction and were given to two individuals. That is, Mick Cooper was there as Professor of Counselling, and to Peter Fonagy whose place on the PLG has been obscured and left ambiguous.

It is important now to say something of this. Peter Fonagy has very many titles, but probably it is an important aspect of many of these that he is, or at least has been, a training analyst in the British Psycho-Analytical Society, now known as the BPC. Julian Lousada is openly attributed as a member of the BPC and this is further confirmed when his absence draws forth a substitute, the BPC CEO Malcolm Allen. This leaves Peter Fonagy as the ‘representative’ of Skills for Health. The Chair of the PLG therefore took advice from the BPC (Julian Lousada) to allow another member of the BPC to define psychotherapy, and overruled objections from the UKCP (UKCP rep Kathi Murphy later said she would not dispute the definition at the meeting because she knew that this would go out to public consultation). The history of psychotherapy in the UK makes this move an extremely controversial one, and exposes Diane Waller as, at best, extremely naïve.

A second reading of the same scenario is also left wide open – that the chair of the PLG delegated the defining of psychotherapy to Skills for Health. This is the official line, given the official designation of Fonagy to that organisation in all the HPC paperwork. This is an extraordinary thing to do in any case, but is made worse but the frequent plaintive cries of the HPC (Waller and Guthrie for example at the Manchester Stakeholder Event) that the SfH has no influence on the HPC.

It is not unreasonable, of course, to invite someone from one place (is Fonagy an employee of SfH?) and to make use of his wide-ranging skills while he is there, but in the interests of transparency, an effort must be made to explain the logic, reasons, rationalities of such a decision. What is clear in all this is that complex and difficult issues were rushed, squashed, collapsed and condensed, and their consequences were not given much consideration.

13. Are the draft standards applicable across modalities and applicable to work with different client groups?

No.

14. Do you think there are any standards which should be added, amended or removed? To begin, all of the generic standards should be removed. To follow, all of the specific standards are contentious, disputable and highly partial. None of them has been tested out in practice, or at least no attention has been given to any knowledge or experience of this.

15. Do you agree that the level of English language proficiency should be set at level 7.0 of the International English Language Testing System (IELTS) with no element below 6.5 or equivalent? (Standard 1b.3)

No.

16. Do you agree that the threshold educational level for entry to the Register for counsellors should be set at level 5 on the National Qualifications Framework? If not, why not?

No. The NQF is not appropriate to this field. It is the mix of people that is important, rather than creating a homogenized ‘army’ of workers. The revolution in education in the UK at present is a further problem here. This was discussed many times at the PLG without coming to any useful conclusion. Again we have the dispiriting situation where people working in the real world are having to stretch the truth extremely thin in order to make the centralist planners dream appear to come true.

17. Do you agree that the threshold educational level for entry to the Register for psychotherapists should be set at level 7 on the National Qualifications Framework? If not, why not?

No. See above.

18. Do you have any comments about the potential impact of the PLG’s recommendations and the potential impact of statutory regulation?

There is good reason to believe that HPC regulation of this field will produce - has already produced - perverse unintended consequences which will not only destroy important knowledge and experience within the field, create divisions and conflicts, and damage the experience of those who wish to consult someone in order to overcome their difficulties, but will create an illusion of public protection which indeed then constitutes a clear and imminent danger to the public.

19. Do you have any comments about the potential implications of this work on the future regulation of other groups delivering psychological therapies?

There is good reason to think there will be many negative implications of HPC regulation within the field as well as beyond it. There are good reasons to be very cautious indeed when approaching the regulation of talking and listening.

20. Do you have any further comments?.

The HPC stands to gain at least £4m a year in fees by regulating this field and is hardly disinterested. The HPC is not answerable to its constituents: it is undemocratic. The HPC has repeatedly ignored difficult questions which threaten to contradict its belief system. The HPC has allowed itself to be used as an agent of aggression against those who question it (eg by circulating the letter of Jonathan Coe after the Manchester Stakeholder Meeting in March 09, and not then circulating the responses to that letter). The HPC has shown no evidence that it engages in serious self reflection, but conducts itself on the belief that it alone knows what is best for the good of society. I recommend a rereading of Karl Popper’s interesting and pertinent essay: piecemeal social engineering. Those more up to date and are already able to take on ideas from further a-field, might wish to turn directly to the work of Michel Foucault.

Post Script

Having closely observed the proceedings of the HPC over the course of the last year, I have very little reason to believe that my work here will be given proper consideration. Since the Call for Ideas (Oct 2008) I have been repeatedly dismayed at the way the HPC and its agents have waived aside ideas and arguments that don’t coincide with their own. It is true that I have been given the opportunity to sit silently at the back of the room and watch all the proceedings, thank you for that, but I have seen much to make me doubt the wisdom of placing my trust in the organisation.

My investigations into the history and workings of this organisation have shown how the flawed logic of the HPO2001 coupled with the lack of proper debate caused by a government’s reliance on secondary legislation has produced a thoughtless apparatus in which even minor amounts of self interest and blind prejudice are easily magnified and go on, inevitably, to cause harm.

I am very concerned by the cavalier use of the political slogan ‘to protect the public’ which without due consideration amounts to little more than scaremongering and goes on to produce cynicism.

During the course of my observations I have seen a Council member punch the air in joy to hear the ‘good news’ that registrants will be subject to higher costs if they appeal decisions of the HPC. I have heard a HPC Solicitor maliciously interpret a practitioner, and by implication, all those who have worked along side him, as long time liars who have got away with sloppy practise for twenty or more years (FTP of Paul Manktelow, Registration Number: PA08359, Allegation Number: FTP01149). I have myself been subject to ridicule in front of the Annual Meeting when the CEO Marc Seale laughed at the idea that my writing on the HPC might be useful or interesting to the organisation.

None of this can be dismissed as one off chance events when seen in the context of the advertising campaign used to launch the organisation a few years ago: the picture of ‘stupid white people’ dressed up in false noses, joke moustaches and villainous eyebrows revealed the disrespectful attitude that makes up a fundamental part of this organisations culture. Incidentally, I was pleased to see the relics of this removed from the walls of HPC HQ in the summer (where they had been displayed ‘proudly’ as art works, framed and displayed on a busy corridor), but when I asked the HPC for copies of the art work from that campaign, I was stonewalled by the administrators.

I have traced the thread of this idea (‘that behind the mask lies a charlartan’) to Ian Kennedy’s 1980 Reith Lectures. The book produced as a result appeared a year later as The Unmasking of Medicine, and the cover carried the picture of a medical man who was indeed wearing a mask. The simplistic idea of Kennedy was that the mask worn by the medic was not so much done for the good of the work and the safety of all those involved, but to disguise the truly villainous nature of the man behind it. Although Kennedy said this was not his thesis, it is not difficult to read it on every page of the book. We all know that Kennedy went on to be invited by Lord Levy (on the strength of this Reith lecture work), to chair the Bristol Royal Infirmary Inquiry whose conclusions led directly to the creation of the HPC.

This is not to say that an ‘evil conniving’ man is responsible for this mess, but that a man’s prejudice has entered unchecked and has left an indelible mark. I have already mentioned the lack of proper debate surrounding the invention of the HPC (I refer to the process that allows secondary legislation to be passed that constitutes the structure of this organisation). The continual lack of proper space to think and talk through the issues is leading us towards a disaster. This is why I have chosen to bring Karl Popper into the picture.

Such a centralisation of power cannot but make fools of all of us. Anyone who gallantly enters the process and tries to make it work better, almost qualifies as a modern Sisyphus. There is, however, at least one important difference. Though Sisyphus was destined to watch his work constantly be undone, those engaged in the HPC have no such friendly enemy! The work they do is mangled, yes, but that then goes forward to become law. It then could easily then go on to be used to distort and even destroy the work of all those who are then obliged to sign up to it. Professor Micheal Power has been documenting an aspect of this process (dubbed Audit Culture) since 1994.

One important and possible good thing to come out of all of this is that those of us actively thinking about all this may learn first hand just how easy it is to turn a good thing bad. The mundane mechanisms and bland rhetoric that supports the process of HPC regulation of counselling and psychotherapy can easily pervert the good intentions or ordinary people and end up manufacturing foul deeds.

I’ll end this response by recounting something I witnessed at the final PLG meeting. One well educated and experienced professional was forced to agree to something that went against his wisdom, experience, and intellect. He said ‘ok I’ll accept it, but I may give up the will to live” (Julian Lousada on the PLG for C&P).

It does not augur well.

The Maresfield Report

The College of Psychoanalyts UK publish damning report of state endorsed regulatory processes: Here is the press release accompanying the Maresfield report, issued on October 7 2009

The Maresfield Report on the Regulation of Psychotherapy in the UK

"A new report [published 09 Oct] delivers a devastating critique of the Government’s flagship Health Professions Council. HPC are vaunted as the most efficient and robust route to protection of the public in the health sector, yet the report finds persistent failings in public protection, excessive and wasteful expenditure, and evidence of a policy of privileging employer complaints over complaints from members of the public.

The Maresfield Report, which focuses on the proposed HPC regulation of counselling and psychotherapy, finds that:

* Since 2006, around 30% of complaints made to HPC each year have not been processed, creating a growing backlog and placing undue stress on all parties involved.

* Although its complaints expenditure is the largest part of HPC’s budget, with £4.66m spent in 2008-9, only 17 complaints from the public heard by HPC were deemed to have a case to answer.

* Of all complaints to the HPC from the public, more than 70% are deemed ‘no case to answer’ by HPC, compared with only 10% deemed ‘no case to answer’ by the UK’s largest psychotherapy umbrella organisation UKCP.

* Employer complaints about employees constitute the largest part of HPC complaints hearings, yet these are financed by registrants of the individual health professions that HPC regulates. Registrants are thus effectively financing employment tribunals that ought to be funded by NHS Trusts and other employers.

* In 2008-9, more than 80% of complaints from employers were deemed ‘case to answer’, compared with only 22% from members of the public.

* All HPC hearings take place in front of a public gallery, depriving complainants of the confidentiality that the details of psychotherapy cases may require. The formal and adversarial parameters of HPC hearings will discourage potential complaints.

* HPC does not offer any mediation or informal processes of complaint resolution, in contrast to the psychotherapy organisations which resolve more than 60% of cases via mediation.

* Most forms of psychotherapy do not fit the criteria of health professions set out by HPC and cannot be made to fit them without changing the very definition of psychotherapy itself.

* Although there have been several projects to ensure that therapists are registered and subject to complaints procedures, Britain is the only European country to propose regulation for the actual content of therapy sessions.

The report will be a major embarrassment to HPC at a time when it has begun actively lobbying both Conservative and Lib-Dem policy makers, anticipating a change of government before the proposed legislation can be introduced. It will be particularly embarrassing to HPC’s CEO Marc Seale, who is trying to push through this controversial regulation while many politicians are becoming critical of the once received wisdom of the project.

You can read the Maresfield Report in full on www.psychoanalysis-cpuk.org"

duplicity, politics and the destruction of knowledge & ethics

Overheard on the grapevine.

"there has not been one defender of the principle of State Regulation, who does not smile sheepishly and admit that those within the field who have sought regulation have done so for reasons of power, prestige and presumed financial gain; client protection is a ruse to legitimise their position."

"Some come up with anecdotes of so and so practicing down the road, and calling themselves a Psy/Counsellor and that with State Regulation, they can be made to stop.

"Whatever happened to going and speaking to someone whose practice you find so objectionable...? Whatever happened to taking a stand in one's community, and to risk being sued, if necessary... Even writing a letter to the local papers, speaking about the practice, if not the person, and warning people not to fall for scams (if scams they be)"

"This SR route favours a world of scoundrels and cheap cowards"

The consultation nears its deadline, much begins to happen

This just received via email from a colleague: This month’s Therapy Today contains the news that BACP is rejecting the HPC proposals on the grounds of amongst other things “the implicit medical model of the HPC’s generic and proposed psychotherapy SOP’s”, “the integrity of the process; there appears to be an underlying assumption of difference and hierarchy in the HPC and PLG”, “lack of evidence” in a number of areas, “HPC’s anomalous position with regard to setting academic threshold levels”, “lack of any consideration of the impact on the delivery of services”, and my favourite, creating: “a division in the therapeutic field that does not exist in the workplace. BACP believes this is in the interests of power and status rather than the public good”. Ouch. They also openly question the PLG chair’s capability to be unbiased given that she is already an HPC registered art therapist (see page 56).

I read the message just as I was leaving the house to cycle up to Kennington with a little package from the Alliance for Counselling and Psychotherapy against State regulation. I had been designated Hermes for the mission: to get the new book (Compliance? Ambivalence? Rejection?) into the consultation process before Friday’s deadline. The TT news put the wind in my wheels.

As I arrived at HPC HQ, I saw a DHL biker fiddling with his panniers on the pavement, and I wondered if he had just delivered the amazing Maresfield Report.

The young woman on the desk actually opened the door before I reached the top of the stairs, and (this really did surprise me) gave me a welcoming smile. (I have to admit that over the months she and I have rarely hit it off.)

I said that I had a gift for the Policy and Standards department, and could she call someone down to receive it from me.

She jumped to her feet and ran to the inner door, and yelled "Grace! Can you come back! There's another one!"

Grace duly returned, and took me into the little cubby-hole, recessed in reception, and I offered her my hand.

She had to remove the little blue rubber finger-stall that was stuck on the end of her finger, before greeting me in the accustomed way.

I told her I had a gift from my tribe to hers, and asked her if she was able to receive it with the dignity it deserved.

Just for a moment she dissolved into giggles before rallying to say she would try.

The letter enclosed in the envelope, and wrapped around the book said:

Enclosed please find our book containing essays and responses to your consultation request. Many of these submissions have also been sent individually. We hope that you recognise that this work represents a sustained and serious effort by a few who have drawn on the support of many un-named others. Those who signed the book represent many of those others.

It is a symbolic act that we make in giving you this gift, which we trust you to treat with the respect that it deserves.

The 103 signatures were collected at a conference in London yesterday, which was organised to consider taking up the position of principled non-compliance with the regulation as proposed by your process.

The conference drew around 220 people, about 90 of who are registrants with the UKCP and 130 with BACP (as well as those from other organisations).


The Alliance for Counselling & Psychotherapy against State Regulation.

info@allianceforcandp.org
www.allianceforcandp.org

Report on the Manchester 'HPC Recall Meeting'

Department of Psychology
Manchester Metropolitan University Elizabeth Gaskell Campus
Hathersage Road Manchester M13 OJA UK

Tel 0161 247 2573 Fax 0161 247 6364 Email I.A.Parker@mmu.ac.uk

Ian Parker BA PhD AFBPsS CPsychol FRSA Professor of Psychology

5 October 2009 OPEN LETTER

Anna Van der Gaag
Chair, Health Professions Council, UK
Park House, 184 Kennington Park Road,
London, SE11 4BU

Dear Anna van der Gaag,

On Saturday 3rd October 2009 in Manchester the ‘HPC Recall Meeting’ took place and discussed where counsellors and psychotherapists are up to with the government plans to have them regulated by the Health Professions Council (HPC). The HPC now already includes professions that are not actually ‘Health Professions’, and many psychologists (who were brought into the HPC in July 2009) have made it clear that it is inappropriate to include them under that heading). This 3rd October recall meeting was organised after the failure of the HPC itself to follow up a ‘stakeholder’ consultation meeting it held in Manchester in March earlier in the year. At this stakeholder meeting, probably to the surprise of the HPC, there was a good deal of opposition to their idea of what regulation is and the work so far of their ‘Professional Liaison Group’ (PLG). There was no report and discussion of the issues raised at the stakeholder meeting at the following PLG, and the HPC has not either organised any further open consultative meetings or engaged with the questions raised in March. HPC staff and PLG members were invited to the Recall meeting but declined to attend, adding insult to injury by suggesting that it would be possible to meet privately after the current consultation period is over.

At our meeting we noted the absence of the HPC and the PLG, and then reviewed progress, or lack of it, so far. We noted that the division between counselling and psychotherapy is quite artificial, and that there is an impossible paradox at work when we expect counsellors not to engage in (what the PLG recently termed) ‘mental disorder’ (as many counsellors working for MIND have to do, for example) or psychotherapists not to be concerned in their practice with ‘mental health and well-being’. This paradox highlights the absurdity of the attempt to press those in different modalities to conform to standard covering definitions of ‘counselling’ and ‘psychotherapy’. There is, of course, a deeper problem at work in the pressing of all involved into standardised models and procedures (those favoured, it is clear, by those leading this process in the PLG). There is a particular threat to ‘patients’ (clients, service users) in that the HPC regulation will give an illusion of security in which those who have been obedient and conform to the HPC register will then have even more licence to abuse their power, and this regulative process will close down one of the few spaces in culture in which people can attempt to speak freely and reflect on what they have said.

We noted that high-profile cases in disciplinary procedures will still actually be able to practice, and that ‘protection’ of the public would be better served by recourse to the law (and resources that are being put into the HPC be put instead into good legal advice and support for those who are often, for good reason, shy of approaching lawyers for help). HPC regulation will also lead to defensive practice by counsellors and psychotherapists anxious that they are going beyond the remit of work defined by their place on the register, refusing to take on ‘difficult’ clients perhaps, and so access to counselling and psychotherapy will actually be severely reduced. We noted that there is no place for mediation in disputes (until after a hearing is over), and that the HPC PLG has chosen to ignore a large body of evidence on this kind of process as an alternative approach. We spent some time discussing threats to practice, but it should be clear so far that the meeting also explored practical alternatives.

We appreciate that the HPC has a difficult if not impossible task, and now would be the time, already late but not too late, to conclude that they are not the organisation to undertake regulation of counselling and psychotherapy, and to tell the government this. In the meantime it was clear at the 3rd October Recall meeting that many counsellors and psychotherapists will refuse to join the HPC register – not because they are against regulation as such but against this state regulation – and Principled Non-Compliance is an option some of us can pursue to defend our practice against the HPC process which threatens to destroy it.

Yours sincerely



Ian Parker
Manchester Alliance (Alliance for Counselling and Psychotherapy against State Regulation: www.allianceforcandp.org

Unfit for practise because you don't hit your targets!

Yet another astonishing example of how the HPC mistakes Britain for a factory, and itself for the Factory Mananger.



The latest HPC hearing:

Date: Friday 9 October 2009

Name of Registrant: Xxxxx Xxxxxxx

Profession: Occupational therapist

Area of practise: Xxxxxxxxxx


Hearing Location: Park House, 184 Kennington Park Road,
Kennington, SE11 4BU, London

Committee: Conduct and Competence Committee

Allegation:

In the course of your employment as an Occupational Therapist by
xxxxxxxxxxxxxxxxxx between 2006-2008 you:
1. Failed to maintain accurate filing.

2. Failed to maintain adequate patient records and notes.


3. Failed to adequately manage your case load in particular that you did
not:
a) pick up referrals at a sufficient rate;
b) review cases within an adequate time frame;
c) close cases within an adequate time frame; and

d) submit two Disabled Facilities Grant applications, in a timely manner
in June 2006 and June 2007.

4. Failed to use I.T. systems as required.

5. Required support and guidance over and above that expected of a

qualified Occupational Therapist.

6. Failed to sufficiently meet the improvement targets as set by your
employers.

7. The matters set out in particulars 1-6 constitute misconduct and/or
lack of competence.


8. By reason of that misconduct and/or lack of competence, your fitness
to practise is impaired.’

Insidious creep of the 'protection' discourse.

At a party of artists on Saturday night, I spoke to a man who looked very glum. He is the head of department in a higher ed institute, one which is well regarded around the world for its artistic and talented craft-makers.

Before he even knew my particular interest he was telling me about a recent trip he had arranged to take a group of his mature students to Wales to exhibit their work. The health and safety administrator insisted that he discover the medication that each of his students were on and what time of day they should take it. He also had to nominate a student to ask him the time and the tablets he takes so that they could make sure each one didn't forget when they went on their weekend away.

Absolutely true. Right here, right now, in London.

I asked him why he didn't tell the administrator where to stick his stupid idea. He replied: there are so many fiddly petty fogging things to do these days, just to get the trip organised, that he didn't want to upset anyone who could prevent him even going.

I think he then felt embarrassed at his powerless position, because he added 'I wouldn't have minded but I had to design the form as well, myself!'

He should have minded, shouldn't he. The students aren't babies and can take their own tablets, and he certainly didn't want any of them intruding into his own body's failings. Just what was the administrator going to do with the information? Lord only knows!

How come nervous administrators wield such an amount of power?

Does this qualify one or both or all of them (the head of department, the health and safety administrator, the nominated student) as a Modern Health Professional?

HPC Council Meeting 10 9 09

The Council members sit round the table and have a 2" block of papers in front of them. Marc Seale laughed and apologised for the weight of paper they all faced at each meeting. He seemed to think the problem would be solved when he issued them each a laptop. Has he presumed that they don't read the papers? This is the real problem, surely.

From a mythical point of view, it might be said that the written word dominates the men and women. A friend of mine said 'it is speech that is under attack'.

The HPC staff speak very quickly, and in a kind of tone that makes it almost impossible for someone like me to follow. Someone not already practiced and versed in the language that is spoken here, someone who is interested in the meaning of what is being said.

This theme of speed and quantity is what catches my attention as the discussions progress through the enormously long and complicated agenda. What follows is drawn from the notes I jotted down as the meeting played out.

Annie Turner mentions that there are over 500 new programs to consider (post psychologist registration), and asks about the peak in complaints received in May.

These complaints are not about fitness to practice, but are complaints received from physiotherapy registrants trying to re-register themselves on time and proving too much for the administrators responsible for answering the phones.

Mary Clark Glass wondered whether the targets should be increased because the staff usually met them so easily.

Annie Turner mutters that the volume of work has risen hugely since the BPS programmes have been handed over for regulation.

Marc Seale said there had been a 'sea change in Fitness to Practice' that would require something new from the organisation. I wonder what he meant.

And someone else said that Michael Guthrie was building the evidence base of risk in connection with revalidation.

Anna van der Gaag - ah, someone who speaks slowly and clearly! - said, oh, I don't know what she said, perhaps it was she who mentioned Michael's evidence base of risk.

Mary Clark Glass wondered out loud how it could be possible to address behaviour through competencies, and Eileen Thornton said that 'we can't have a single model, but need a research base to base our decisions on." Jeff Lucas was happy that things were moving towards an evidence base, and said something about men of a certain age posing a risk group for the HPC.

Anna van der Gaag said that CPD was vital here, and Joy Tweed asked how long someone could be out of practice before 'they become a risk for us - we need research into this', then added 'how about patient feed back into CPD?' She wants to 'future proof' things, she said, adding that the professions were low risk right now, but 'we've 50 new professions in the pipeline'. FIFTY? Could I have possibly have heard that right? I think Joy who was still speaking as I wrote down: 'the longer you are in the profession, the greater risk you pose, so risk proofing would have to be done via supervision.'

Writing this now makes me chuckle and think about Karl Popper's central planner. The idea that the more experienced a professional is, the greater risk they pose to the HPC is hilarious from this perspective. The idea that the HPC will fight against such free thinking individualism by insisting on life-long supervision brings with it the spectre of a battle between the administrators backed by government legislation, vs the wit of wizened experience.

Back to the notes - Conduct. I've written it to emphasise the first syllable because each person who mentioned it stressed it like that as if trying to beat it into stone. The word seemed saturated with meaning, with something in excess of what could be articulated, something urgent trying to make itself heard. I've written down 'more fundamental revalidation, not just fitness to practice' to note the words of a Council member whose name I didn't catch. There was quite a concentrated piece of discussion here, which seemed to crystallise the interest of the whole group. Anna van der Gaag said 'there are people operating just below the level you would want, but they would not be subject to fitness to practise. How do we address that?" and Julia Drown said that revalidation methods should be compared with systems working around the world.

Marc Seale spoke of the struggle that the GMC were currently having, and said 'if we can crack it when no-one else has ... FTP ... CPD ... Self Correcting CPD... It is the Holy Grail," he said "can you come up with a system where a registrant self-corrects?"

Self corrects! I remember thinking of Prince Hal at that point, and turning towards the window. Anna van der Gaag's soothing voice brought me back into the room: "we are using well validated tools... it would be wrong to invent a scale ourselves that we thought would do the trick..." Eileen Turner was saying 'we know about this - lack of initiative, self direction, and motivation' and trailed off leaving Marc Seale free to say 'we are talking about a 4-5 year project - no-one has cracked it yet'.

Cracked what? How to tell if a student in university is going to commit a crime as he approaches middle age? I imagine that these things will have acquired the status of crime by then. The crime of not keeping neat and proper notes.

Apparently the Department of Health is funding some research that might relate to this. Somehow that does not bring me relief.

The business moved on to the CHRE review, and I came back into focus as Julia Drown is saying 'we don't want to be seen to protect the registrant, we are here to protect the public. It's about the message we send out to do that." I find myself smiling - she was a government spokesperson for health in her time as a Labour MP.

Marc Seale is saying something about the CHRE not having a comparison to judge good and bad practice, and Michael Guthrie said "we don't know what all the other regulators do" (goodness me, I think, you don't know what your own registrants do, perhaps you shouldn't you concentrate on that?)

Very often as I sit listening to these meetings I think about the reference points that people use. From my inquiry into the subject, it seems clear that they have no genuine point of reference. This is the natural consequence of Ian Kennedy's genius - to split the administration off from the practice, and then make the administrators responsible for the practice. This vacuum that they face is the logical consequence of Kennedy's prejudice. Tho, not just of Ian Kennedy.

My attention is brought back to the meeting by Anna van der Gaag's reassuring voice: "our school report is actually pretty good" she is saying "whatever we think of our head master, we actually have a good report."



Post Script: I've drawn a line in my notebook at that point, and probably left the room to get a glass of water. But when I returned they were talking about Sonographers, who I understand to be anyone who carries out those amazing technological tricks that reveal a tiny foetus sucking its thumb and wriggling around in the womb. Apparently, a sonographer is anyone who is using a sonograph, but not for long! A 200 page document was laid in front of the meeting from the Society and College of Sonographers who ask for HPC registration. Jeff Lucas said: "it appears to be a collective noun that not only overlaps different parts of the HPC register (ie lots of different professionals can use a sonograph, and even people who are not already in another profession), but is also shared across different regulators...'. But someone else, with an eye on expansion, said 'public protection' and blustered on: 'so a member of the public can know if someone is qualified to use the technology'. I nearly snorted, what a nice little earner the HPC are on. Every new piece of technology might inadvertently create a new profession for regulation. Now I understand how there could be another 50 in the queue already. Tell me, why would a member of the public need to know someone was qualified? Have we really reached the point when no-one trusts anyone in the NHS to know what they are doing? Maybe. Or, if not now, then probably sometime real soon.

Annual Meeting - 10 Sep 09

Thursday, 10th September 2009. The HPC annual meeting.

It is not immediately clear what status this meeting has - ie it is not the AGM of a charity, nor that of a registered company - there are no votes taken, and no body of people who have any power to bring to bear on the organisation. Formally, the HPC is answerable to Privy Council - and none of them was present, as far as I could tell.

In the absence of any legal framework within which to understand the meeting (in the absence of any statutes or formally written rules) we are left to deduce the meaning from the work that it does on the day, the way this enters the daily business, and of course, the way it describes itself on the website: "Our annual meeting is the Council's opportunity to reflect on the last year's business in a public setting... a short talk given by the President, followed by a question and answer session."

Two of us had submitted questions ahead of time, me and the woman from MIND. First, Chairwoman Anna van der Gaag made her brief reflections, then we were invited to pose our questions.

MIND wanted to know whether there had been any problems arising from the regulation of the psychologists (1 July), and in particular whether anyone had made use of Principled Non-Compliance to reject the HPC.

The question was an informed and an intelligent one, and opened a welcome window onto the real world for the HPC. There is a tendency for things to get caught up in political (and Political) rhetoric so this question from the grass roots campaigning mental health user network was a great opportunity for the HPC spokesman Marc Seale (CEO) to make some real political capital.

I'm not really sure what he said, however. There were a lot of words, and he was smiling a great deal - this is what I wrote down at the time: "when you talk to professionals who are regulated, they are very proud, and embarrassingly positive ..." Chairwoman Anna van der Gaag (an expert in speech and language therapy) later summarised the answer: "it is too soon yet for any of us to know".

The question that I had sent in was on behalf of a colleague: "If a therapist is registered with the HPC, how does this affect the use of other unregulated therapies within their practice? For example an HPC registered psychotherapist using life coaching, hypnotherapy or other styles of therapy with their client."

This question has often been asked by those turning their attention for the first time to the HPC - I hear it asking: if I submit to your power, register my name, and pay the annual fee, will I be able to carry on practicing in the way I always have? If it were just a tax raised to fund the fitness to practice machinery, then the answer would be yes. It is not just a tax, however, but a whole new system of belief.

What did Marc Seale say? "This is a question about scope of practice. If you are regulated, and a complaint is made against you in one of your unregulated practices, we would still deal with that."

In her opening reflections, Anna van der Gaag mentioned that some of the professionals joining the HPC could rejoice in a reduction of fee from £667 to £76pa. With this, Anna let slip that, for her, the HPC is an alternative to registration with the existing practice based organisations - it is a rival to the existing professional bodies, and one that ultimately wants to replace professional bodies. She went on to say that the HPC represented a new kind of regulatory body, specifically 'a change from the paternalistic method' which she fleshed out with a quote from Don Berwick's John Hunt Lecture 2008 (entitled: Epitaph of a Profession !):

"we professionals are not our patient's partners. We are guests in their lives. We are not hosts. We are not priests in the cathedral of technology."

Well, leaving aside the irony that she must refer to a great man, speaking in the name of another great man in order to undermine a system based on great men, and forgetting for the moment the limitations of the metaphor of guest, what Anna seems to be arguing for is a change in attitude, conduct, and behaviour. She is calling, I think, for humbleness, whilst claiming that the HPC knows how to bring everyone to their knees.

Open letter to practitioners in the field of counselling and psychotherapy, from the psychoanalytic consortium

Reproduced here is an letter from 8 psychoanalytic institutions, openly addressed to anyone who considers themselves a colleague. It is one of three docs they have written in response to the HPC consultation on regulating counselling and psychotherapy. The other two docs can be accessed through the web-link embedded in the title of this blog and downloaded (HPC response to PLG and HPC Response to SoP). Taken together - or indeed separately - they are a tremendous rebuttal of the ideas put forward by the HPC. It remains to be seen whether the HPC is capable of tackling the points raised, or whether it will simply rely on the governmental power to ignore the opposition and carry on regardless.

Dear Colleague,

The Health Professions Council have now published their Draft Standards of Proficiency for Psychotherapy and Counselling. Although they have been working on the proposed regulation of the talking therapies for the last three years, the Standards will surprise many therapists and counsellors. They apply more to medical processes than to therapies, and will be unrecognisable to many practitioners. Indeed, they seem to apply more to a surgical team preparing a patient for an operation than to the open-ended relationship-based work of a talking therapy. The Standards dictate that practitioners should:

- know how to operate equipment and minimise the risk of infection.
- know how to select appropriate hazard control and risk management, reduction or elimination techniques.
- have a knowledge of health, disease, disorder and dysfunction.
- be able to evaluate and implement intervention plans using recognised outcome measures.
- know how to use protective equipment.
- know how to formulate and deliver plans and strategies for meeting health and social care needs.
- understand the principles of quality control and quality assurance and conduct audits correspondingly.
- maintain an effective audit trail, participate in audit procedures and work towards continued improvement.
- be able to formulate specific and appropriate management plans including the setting of timescales.
- demonstrate a logical and systematic approach to problem solving and be able to initiate problem solving techniques.
- observe and record client's responses.
-be able to demonstrate effective and appropriate skills in communicating information, advice and instruction.
- understand the need to engage service users and carers in planning and evaluating the diagnostics, treatment and interventions to meet their needs and goals.
- understand the importance of maintaining their own health.
- know how to meet the needs of the client.

A detailed critique of the Standards is [downloadable from the resource page linked to the heading of this blog: Response to HPC], together with a response to the HPC Professional Liaison Group's Report on the proposed regulation of psychotherapy and counselling [click header to download both docs]. Accepting the HPC Standards threatens the talking therapies with the same fate that has met other professions: practice simply becomes a technique of risk management, with the prime concern less the work undertaken with the client than the avoidance of litigation or complaint. Complaints, indeed, would be much more likely given the definition given by HPC of a 'service user': this no longer simply refers to the client, but to "anyone who is affected by the services of a registrant", including a client's relatives or spouse, thus encouraging third party complaints.

Therapists, on the HPC model, would be obliged to act in exactly the ways they may be encouraging their clients to escape from: submission to rather than questioning of internalised authority, and a conformity to socially-agreed expectations, rather then the fostering of creativity and uniqueness that therapies have traditionally aimed at. Whereas the system of values that the talking therapies have always offered was freed from the moral judgements of social authorities, it is now made to conform to exactly these moral judgements. It will no longer be psychotherapy as we know it.

All trainings in the field will, according to HPC, be obliged to meet the Standards of Proficiency, and the hearing of complaints and fitness to practice cases will use the Standards as a benchmark. Aside from the obvious problem of medicalising the talking therapies, the therapists of the future, in such a climate, may feel they are perpetually under a judgmental gaze, the private space of the therapy becoming the stage for an internalised judge or examiner. The consequences of this on therapeutic practice cannot be underestimated, and there is an irony here that many traditional descriptions of psychotherapy define it as the effort to find freedom from the internalised observer-judge that may be at the root of the client’s unhappiness.

While we unreservedly support codes of ethics and practice that ensure the practitioner's accountability, we do not believe that HPC's approach is suited to our field and so urge you, should HPC regulation take place, to adopt with us a position of principled non-compliance. If enough therapists and counsellors do not register with HPC, Government will realise the enormous mistake it is making, and our field may not face such a grim future.

Arbours Association
Association for Group and Individual Psychotherapy
Association of Independent Psychotherapists
Centre for Freudian Analysis and Research
The College of Psychoanalysts-UK
The Guild of Psychotherapists
Philadelphia Association
The Site for Contemporary Psychoanalysis

Counselling and Depression as remedies to FTP

From another case recently posted up on the HPC web, of a paramedic :

"you were referred to an independent counsellor by the Occupational Health Department. You told the Panel that the period of counselling has had a significant effect on your health, that your depression is well controlled and your relationship with your wife is now stable."

Well, three things stand out. First, in what way is it useful for the HPC to post this information up on the public domain? It smacks of 1984.

Second, the counselling is presented as a remedy prescribed by Occupational Health which rather begins to beg the question about another profession that might be regulated by the HPC.
Later in the announcement we find a letter from the GP validating the fact that the counselling has contained the depression. This effectively turns it into a medical condition under control, ultimately, of the GP. This is the third point, and is contentious, to say the least. The HPC and its staff operate within an unenlightened medical paradigm which brings 'counselling' into the frame as a solution, like a drug, to inefficient or ineffective workforce issues.

It is the legal frame, the centralised operation of the HPC, and the close proximity of a government agenda, that distorts the general human condition into a specific public spectacle. Even if this is an unintended consequence, it appears highly normal to those within the frame.

I think it is something that many people will be amazed to see blossoming in the UK today.

Learning from our mistakes

"it is difficult enough to be critical of our own mistakes, but it must be nearly impossible for us to persist in a critical attitude towards those of our actions which involve the lives of many men and women. To put it differently, it is very hard to learn from very big mistakes." Karl Popper, 1944 (Piecemeal Social Engineering)

The longer the HPC is allowed to continue with its large scale utopianist experiment, the less likely it is to learn from it. It has recently been noted that the ambulance drivers are disproportionately victimised by the FTP process - they are turning up far more than any other group on the HPC register. Also, more men are pushed into the process, even tho the majority of people on the register are in fact women. The HPC has commissioned some 'research' to discover whether the former fact is significant (I don't think they are worried about the second fact yet). I wonder what the outcome will be of that piece of work.

The point that Popper makes here is that there are two reasons for the difficulty to learn. The first is that, because of "the scale of a utopianist experiment, it is impossible to say which particular measure is responsible for any of the results.... Even the greatest efforts to secure a well-informed, independent and critical statement of these results are unlikely to prove successful. But the chances" he goes on to say "that such efforts will be made are negligible; on the contrary, there is every likelihood that free discussion about the holistic plan and its consequences will not be tolerated."

The passage from which I draw these words gets more and more interesting. Written in 1944 - before the end of the second world war, a whole lifetime ago - it seems amazingly relevant to the question before us today:

It will not be tolerated, because: "every attempt at planning on a very large scale is an undertaking which must cause considerable inconvenience to many people (to put it mildly) and over a considerable span of time. Accordingly there will always be a tendency to oppose the plan, and to complain about it. To may of these complaints the Utopian engineer will have to turn a deaf ear if he wishes to get anywhere at all; in fact, it will be part of his business to suppress unreasonable objections. But with them he must invariably suppress reasonable criticism too. And the mere fact that expressions of dissatisfaction will have to be curbed reduces even the most enthusiastic expression of satisfaction to insignificance. Thus it will be difficult to ascertain the facts, ie, the repercussions of the plan on the individual citizen; and without these facts scientific criticism is impossible.'

Popper uses the word 'scientific' to mean critical thinking, and speaks often of its many different forms. Not for him the unified 'gold standard' that we find ourselves bogged down with under the 'evidence based' experiment of today.

The Utopianist planner must make man fit society

I'm reading Karl Popper's 1944 essay 'Piecemeal Social Engineering' in which he constantly compares the piecemeal social engineer with the utopianist holistic planner. One of the many distinctions he makes is that the PSE tries, bit by bit, to make society fit the real men and women who happen to live there, but the UHP tries to make his fellow men and women fit the society he dreams of.

By way of a break, I clicked over to the hpc website and had a look at some of the FTP allegations coming up in the next few months, and straight away found this one:

1. In the course of your employment as an Occupational Therapist by Super-Duper Hospital NHS Trust, between 19 March 2007 and 14 June 2007, you undertook work elsewhere whilst on long term sick leave and whilst receiving statutory sick pay.

2. The matter set out in Paragraph 1 constitutes misconduct.

3. By reason of that misconduct, your fitness to practice is impaired.

It's not that I think that someone who works for money whilst receiving stat sick pay should go un-remarked, but I do think that it is silly to say that it means, ipso facto, they are not morally fit for the work they are qualified to do. It's clumsy, brutal, and out of proportion with reality - Utopian, in a cold, harsh, petty, nasty sort of way.

Three no shows in a row:

Here's another case reported on today's press releases. Another registrant who didn't turn up, which might suggest that the registrant has no confidence in being given a fair hearing.

Points of interest

1. this is a manager that is being judged, which raises a series of questions about the difference between a manager and a practitioner, and so who is the judge of the proficiency.
2. Given the managerial function, this raises the question of the organisational context that gives the scene its local meaning.
3. Who raised the complaint - what attempts were made to resolve this at the local level, why did they fail.

In all these cases it is important to ask 'what is the evidence' used by HPC. It would be wrong to conclude that they had carried out objective in depth research. Often cases are launched on hearsay. All cases begin with the assumption that the professional is probably guilty. They are all are investigated at a distance, with paperwork as the main method. Committees are the primary vehicle, followed by solicitor who prepares the allegation (that is to say, the solicitor's research is not objective, but is conducted in order to win).

Final point, much is made of the phrase 'balance of probabilities' which borrows the power of statistics. No statistics are used, however, and the phrase is simply a metaphor.

Quoted from HPC website:"Mismanagement results in human error and lack of concentration in cellular pathology unit. Biomedical scientist, Mr x has been suspended from the HPC Register for misconduct after a HPC Conduct and Competence Committee found his current fitness to practise impaired whilst working at the Y Hospitals NHS Trust.

The panel heard how Mr X’s lack of competence as a senior staff member had resulted in over 600 products of conception (POC) that were not disposed of, swapped breast biopsies and a wrongly prepared rectal tissue sample.

The Panel also heard that the registrant failed to accept ownership and accountability for the incidents, and that he had not taken any remedial steps to address the short comings.

Panel Chair, Raymond Pattison, commented:“The registrant knowingly allowed an inordinate and substantial amount of POCs to accumulate”

“The registrants failure, in his managerial position, to exercise sound judgment, particularly to the sensitive issue of POC disposals constitutes a serious lapse from the standards to be expected of a health professional of his seniority.

”The panel decided the most appropriate action was to suspend Mr X from the Register for a period of one year with immediate effect.

Mr X was neither present nor represented at the hearing

Telling tales to the HPC - another failure to take responsibility locally.

And, here's another.
Points of note: a senior position, not simply that of practitioner - suggests that an appointments panel thought she was competent for the job.
Would seem to be a matter better dealt with by someone with a bit of life in them at a local level, rather than reported to an anonymous committee in some central office elsewhere.
The phone calls and internet seem very petty misdemeanours, and not obviously harmful to patients. Again, something that should be dealt with at a local level. Yet she was struck off! I'm not condoning slovenly work in the NHS, but trying to keep a perpsective, and to remember that once in many lifetimes, love can make a fool of even the best of us.
What about this woman's actual work - the thing that she does with a patient, there is absolutely no mention of this whatsoever. Odd.


quoted from HPC web:
Occupational therapist, Ms X has been struck off from the HPC Register for personal misconduct and failing to carry out adequate clinical occupational therapy input to patient care whilst working at the Y Primary Care Trust.

A panel of the HPC Conduct and Competence Committee heard how Ms X had failed to provide regular supervision and appraisals to the members of staff for whom she was responsible, failed to correctly assess patients and failed to organise cover for holiday and sickness leave.

The Panel also heard that Ms X had made personal calls to the value of £32 on her work telephone, used the Trust’s internet resources during working hours to contact dating agencies, took colleagues shopping during work hours and made excessive reference to personal issues in discussions with colleagues.“Ms X must have known that her failings were likely to place patients’ welfare at risk and that these were not proper uses of the Trust’s resources.”

The panel decided the most appropriate action was to strike Ms X from the Register with immediate effect.Ms X was neither present nor represented at the hearing.

Management vs HPC Police

What ever has happened to the staff of the NHS that they can't handle tensions at work? And why has note keeping become fetishised in this way?

Below, taken from today's HPC website, is someone who is described as experienced, yet is suspended for not filling in her notes. From the report here, it seems that there was a bit of a fight between colleagues at work. Everything is ok with the patients, no problems emerge from there, but when this woman goes on holiday, her colleagues appear to snitch on her! What is going on here? I wonder whether a new compturised system is getting in the way - something that assumes work should be done differently from the way it has been done throughout this woman's experience.

And as for the phrase 'I probably made it up' - what on earth is that supposed to refer to? the HPC are notorious for thinking that their registrants might fib (ref their advertising campaign which portrayed professionals as liars), and this quote is so out of context that it is meaningless.

quoted from HPC web:

Physiotherapist, Ms X, has been suspended from the HPC Register for failing to keep accurate patient records whilst employed by Y District Primary Care Trust.

A panel of the HPC Conduct and Competence Committee heard that whilst Ms X was on leave her colleagues were alerted to cases where she had failed to keep accurate records and failed to create action plans for appropriate treatment of patients.

Ms X was an experienced physiotherapist and had been counselled previously in relation to her inadequate record keeping. The Panel heard that when Ms X was confronted about the incidents she admitted ‘she had probably made it up.’

Panel Chair, Mr Gordon Sutehall, commented:

“We are satisfied that there were deficiencies in the registrant’s practice to record keeping and despite supervision and training the registrant did not consistently meet the required standard of record keeping”

“The allegation involves an element of dishonesty and is therefore a serious one.”

The panel decided the most appropriate action was to suspend Ms X from the Register for a period of six months with immediate effect.

Giving the lie to the HPC stats on how well they protect the public

A colleague from Scotland has done some hard work on the statistics of the HPC and has offered them for circulation. He asks that if you want to reproduce them, please do so in full to avoid misrepresenation:

For the period 2007-2008:
• The HPC’s operating expenditure was £11.58m, of which payroll costs amounted to £4.08m (35.3%), legal expenses £2.27m (19.6%), facilities management £1.13m (9.8%) and “partners” (assessors and other professionals) £1.11m (9.6%).
• The HPC employed 105 full time equivalent staff, costing £2.82m in wages and salaries, representing an average salary of £26,770.
• Considering allegations about the fitness to practise of registrants cost £3.76m (32.5% of overall expenditure).
• Of the 424 total allegations made against registrants, 108 (25.5%) came from the public, compared with 171 (40.3%) from employers and 63 (14.9%) from the HPC itself.
• 299 allegations (70.5%) of the total were considered, taking an average of 32 weeks before a case was heard by an Investigating Panel.
• 63 (58.3%) of the allegations from the public were heard, and only 18 (28.6%) of these allegations were found to have a case to answer.
• Each allegation with a case to answer which came from the public represented an HPC expenditure of £643k.

Paris, 16th May 09: Protecting the public from the State

Fifteen people met in Paris on Saturday 16th May, to sit together in a room and begin a new conversation. English speakers from London, Belgium, Bordeaux, Rouen, and of course Paris gathered at the University of Chicago on rue Thomas Mann to listen to five people speak about the British Experience of state regulation of the psys. All of us practise in some form or another – about half of us were psychoanalytically inspired, many were also psychologists, one a psychiatrist, one or two had done their training in the UK, and there was even a member of the UKCP present. Many work independently running their own private practices, and most were also linked in some way to state or voluntary projects. One was new to the field, nearly finished training, and wanted to know how the regulatory revolution was going to affect her future work.
There is something very precious about speaking in another country – shifting through subtle changes of culture and a different way of life often brings a change of perspective. So, first, I would like to thank Victoria for the invitation, and to thank the people who gave up a Saturday afternoon to hear about the British experience. The event was an initiative of the Simply Speaking section of a small group of English Speaking practitioners called Healthwise, Paris. - a group that knows how difficult it can be to navigate through the twists and turns of another culture’s systems.

The afternoon session was divided into 5 short presentations – Victoria opened up by reminding everyone of the events in France. Bernard Accoyer, a medical doctor and member of the Union for a Popular Movement, the conservative Party of which Jacques Chirac is a member, introduced legislation to restrict the practice of psychotherapy to psychiatrists and clinical psychologists. Although the bill was passed without debate, and apparently without objection in the Assembly (it was business done in the middle of the night!) there has been a mixed but on the whole vociferous public response since which has reversed many of the restrictions he tried to impose. [see The Pathology of Democracy edited by Jacques-Alain Miller with Bernard Burgoyne and Russell Grigg, Karnac 2005)

Victoria drew attention to the subtleties of language that become more obvious to non-native speakers living in another’s land and was able to maintain a pun through much of the afternoon’s discussion. What is the difference between a hole and a whole? This was a theme that Jean-Pierre Klotz later elaborated. She thought that Accoyer had made a fundamental mistake by drawing the public’s attention to what he called a hole in the law, and that this had boosted a move towards creating the state system as whole. Her underlying point was the rise of State Intervention in the most private aspects of life: who is responsible for who we speak to, she wanted to know.

This question nicely framed Roger Litten’s presentation. Roger works as a counselling psychologist in the British NHS and is well placed to comment on the massive changes in the context of the various ‘psy’ practises sparked by Government policies over the last decade. Not only is there the IAPT (Increased Access to Psychological Therapy) programme which promises computerised CBT in every local Doctor’s surgery, but also the Evidence Based Approaches of NICE (the central planning agency – National Institute of Clinical Excellence) which require psychotherapists to greet new clients with the words – this has no evidence to support its efficacy! Then there is the attempt to codify and equalise NHS jobs via Skills for Health (A Department of Health initiative that collaborates with Business ideology to create a skilled workforce rather than an educated population), and finally the HPC – a giant database that purports to regulate the character and behaviour of all the new ‘skilled’ health professionals.
Elizabeth Gurnicki (Clinical psychologist, with a Freudian Field DEA) posed the question: why do our European governments want to regulate and monitor the practice of psychotherapy – surely not for the sake of the economy. She reflected that national identities and ideologies were less attractive since the totalitarian catastrophe of the 1940-45 war, and that since the fall of the Berlin wall choice in approach to the economy was now effectively redundant. This leaves those of us in the rich world with little more to do than develop more riches, to manage mass consumption, and to control the population flow. This was interesting, as it puts politicians more in the role of managers and makes governing more a question of governance. Couple this with the developments in cybernetics and management-information-systems, and we have a strong move towards Big Brother.

This helped to situate the topic I had chosen to speak about: the Fitness to Practise (FTP) process as played out in the Health Professions Council. The HPC is a new invention and a flag-ship of New Public Management in Britain. It is staffed entirely by administrators, with a handful of professionals invited on to the periphery to deal with tricky problems of practice as and when they arise. My observations of some FTP hearings had easily discovered the anomalies that such an approach throws up. The lack of sensible experience and attention to the realities of practice tend to mean that FTP hearings resemble the figments of Kafka’s imagination (see HPCWatchdog.blogspot.com).

Bordeaux psychoanalyst and psychiatrist Jean Pierre Klotz carefully sketched the important differences between British and French culture, and reminded us of the tendency of centralised politics and generalisations to ride rough shod of these essential details of everyday life. He argued that the French revolution gave them an experience that makes it more difficult to forget why the State and the Citizen should be held as separate entities. The French culture pays attention to the space between the two which effectively protects the citizen from the overbearing power of the state. The French state is created and upheld by law, and the individual is protected from it by human rights. This essential space is precisely what is being removed by the British reliance on regulation. Regulation does not function in the same way as the law. It is, in a funny way, the inverse of the law.

Victoria summed up with a question about the way that Europe as an idea was changing the context for us all. It is providing some people with an opportunity to quietly invent what they call 'European standards' from which to establish themselves as the reference point to control. See project europsy for a glimpse of that new venture.

Bristol Alliance, 13th May 09

First, a personal view of the day from Arthur: We had day long meeting, to which over 30 people turned up - and a number of people who are known to sympathise were unable to come. The morning focused on NICE gudelines, IAPT and the impact of PCT recommisioning in three different local PCTs. The afternoon was devoted to the impact of regulation and the choice we as counsellors and psychotherapists face about how we respond.

People were undoubtedly stirred up and energised. We were able to suggest that people who want to get further involved don't reinvent the wheel but plug into the wider Alliance network. There was considerable interest in further meeting(s). Professional Full Disclosure (PFD) received some very favourable comments from experienced practitioners, who hadn't yet heard of the work that the local group has been doing on this.

Something that is becoming apparent to me is that many practitioners only gradually take on board the importance of taking a stand on the issue of regulation. We are in a consciousness raising period and have to keep working at people within our local networks.


Els: I agree - I find that many practitioners are working very hard to earn a crust and do not necessarily have a lot of spare time and energy to engage with what is happening. Often people assume that it has nothing to do with them (or that it is inevitable) - I think this view is particularly prevalent amongst those in private practice, However, when people's awareness is raised and they become aware of the fact that HPC regulation will affect them too - they become energised. I feel in Bristol we now have a base from which to launch further events.

Sussex Alliance, 9 May 09

Congratulations! "Sussex Alliance" was born this afternoon (9 May 09) after a successful mini-conference over 4 hours this Sat pm.

Richard, Guy, myself and Andy spoke to a gathering of 25 with Tim also in attendance holding a strong admin side.

A few individuals would like to plug in to Alliance subgroups.

Suffice to say at this stage, there was a powerful sense of concern for the issues, a very healthy discussion and exploration and hopefully the beginnings of a local snowballing effect.

Thanks for the good wishes to those who sent
Best
Kevin B

Andy: Yes, it was a good afternoon and I'm now convinced this coal face work with practitioners is vital. Many coming from knowing nothing (some not having heard of the Alliance...) asking us why they haven't been consulted or why BACP isn't representing them etc. Lot of fear, exasperation and negativity but group moved towards activism by the end. They want to plan more events I think with groups they are connected to. Got a few signatories for the BACP letter as well.

Cheers to Richard, Guy, Kevin and Tim - I think we did well. I was chuffed with the responses to my first public speech on regulation. Might brave it again sometime.

Nicky: I just wanted to thank you all for Saturday so far we have had great feed back. Also some reasons why people did not attend, mostly people who believe regulation will not impact on their work at all. I would like to pass this on to Alliance as it would be good to be able to back up my concerns with them. So Again Thank You All very much

Someone at the event said: I have found reading the Janet’s accounts of HPC proceedings, whilst potentially depressing, incredibly helpful in being better able to articulate why it is that regulation does *not* serve to protect the public. The reality of regulation means having to draw up standards, which leads, precisely, to standardisation, which means that only those qualities which can be measured can be considered; the higher qualities of human care, consideration and love cannot be included. We might wish that regulation meant something different; the reality is that it can only harm people; and that includes everyone – both practitioners and their clients. If this is already true for doctors, nurses and hospital workers, then it must be doubly true for counsellors and psychotherapists.