Out Now! Regulation in Action. Paperback or Kindle

‘…if you feel that something is deeply wrong in the relationship between the state and civil society, and that there is too much interference in professional work, you will find this book both therapeutic and empowering.’ Max Travers, School of Sociology and Social Work, (foreword).

‘This book investigates the claim that regulation by agencies of State is one of the prerequisites for improving professional practice. It displays how the underlying administrative interests of such bureaucracies are detrimental to the structure of professional communities. The “quality indicators” produced by such regulatory bodies lead in general to the weakening of professional activity and research, and to the replacement of quality by its opposite. Janet Haney shows with some verve how this transformation was attempted in the field of psychoanalysis and psychotherapy.’ Bernard Burgoyne, Professor Emeritus of Psychoanalysis, Middlesex University.

‘This incisive study shows that “regulation”, against which many have warned but which some psychotherapists still imagine to be a solution to all their ills, is actually already here. Janet Haney traces her way through this apparatus, and makes a compelling case for taking the HPC seriously as a machine that incarnates the very kind of unhealthy practice it pretends to set itself against.’ Professor Ian Parker, Manchester Metropolitan University.

‘If you want to know about the reality of state regulation, how it works in practice – as opposed to what people say about it – you should read this book. A shocking and unsettling account.’ Paul Gordon, author of The Hope of Therapy and former chair of the Philadelphia Association.

‘Do not let the simplicity of this lucid account of a difficult problem deceive you. This is an important, readable, and informative account of applied regulation at the Health Professions Council.' Andrew Samuels, Professor of Analytical Psychology, University of Essex

New book out soon - Regulation in Action

O U T   S O O N

Regulation in Action - the Health Professions Council Fitness to Practise Hearing of Dr Malcolm Cross - Analysis, History and Comment by Janet Haney (nee Low). Published by Karnac, price £9.99.

Guest post from John Long Chiropodist - CPD and the HPC

The HPC publication from which this information was taken can be downloaded from here.....

http://www.hpc-uk.org/assets/documents/10001314CPD_and_your_registration.pdf

The particular reference to CPD, (Continuing Professional Development), and competency will be found on page 4 of the publication.

The text in italics is from the HPC publication shown above.

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There is no automatic link between your CPD and your competence.

That is a very clear statement from the HPC.

This is because it would be possible (although unlikely) for a competent professional not to undertake any CPD and yet still meet our standards for their skills and knowledge.

I think you need to read this again!

Why would it be unlikely?

If a competent professional does not undertake any CPD and still meets the HPC standards for skills and knowledge then surely, by definition, they are competent.

Equally, it would be possible for a registrant who was not competent to complete a lot of CPD activities but still not be fit to practise.

I totally agree.

There is no reason to believe that CPD will improve the fitness to practise, (FTP), of any individual.

We have a separate process (our fitness to practise procedures) for dealing with lack of competence, and this is not linked to our powers to make sure registrants undertake CPD.

OK, I now understand what CPD is not for. CPD is nothing to do with competence or fitness to practise, in fact there is not even a link between CPD and Competence/FTP. So why, exactly, does the HPC get involved with CPD?

The Health Professions Order 2001 says that we can set standards for CPD, and we can link these standards to renewing registration.

The Order says that the HPC can set standards for CPD and that they can link these standards to renewing registration. It does not say that they must do so.

There must be a compelling reason why the HPC does decide to get involved and, as the HPC has made clear, it is nothing to do with competency or fitness to practise.

We can also take registrants off our Register if they have not met our standards for CPD (although there is a right to appeal).

Hang on a minute. The HPC has stressed that CPD is nothing to do with competence or fitness to practise, therefore, CPD is nothing to do with public protection.

The HPC is keen to say that they have the “ powers to make sure registrants undertake CPD”. Note the use of that word “powers”.

Now I am not against CPD at all. In my long experience all professionals are constantly updating their skills and knowledge, that is in the nature of being a professional.

The difference now is that any such updating of skills and knowledge must be done to HPC standards regardless of the fact that those CPD standards are not linked in any way to competency or fitness to practise.

Being “struck off” is the most severe action the HPC can take against a registrant.

A registrant who is struck off is forbidden, by law, to use their professional title.

A registrant who is struck off will lose their job where that job requires a professional title.

A registrant can be struck off for not undertaking CPD to HPC standards regardless of the obvious fact that those standards do nothing to protect the public.

WHY?

Guest post: Ursula Arens, dietian. On CPD at HPC

This article was published in August 2010 in the Network Health Dietitians magazine, issue 57 (www.nhdmg.com), and is reproduced here with permission. It contains information and analysis on the process of CPD audit at HPC and raises questions about its purpose and unintended effects: what's it for, exactly? Is it for the good of the profession, or for the good of the HPC? JL

Learning about CPD,

By Ursula Arens

[A little over a year ago], about 170 dietitians were in a manic panic; they were amongst the first to have been randomly selected from the total list of about 7000 dietitian registrants, required to submit their continuing professional development (CPD) portfolios to the Health Professions Council (HPC) assessment panel. Bleak futures threatened those whose reflective ramblings were deemed inadequate; appeals could be made against assessment decisions, but the ultimate sanction could be removal from the professional register.

As someone who has only just found out that reflective writing did not mean holding a laptop against a mirror, I thought, what better way to demonstrate CPD, than to write a feature on CPD. Does feature writing count as reflective practice?

What, in a nutshell, do HPC want when they assess CPD? They want evidence and a description of the meeting of five standards that overall, promote reflective professional practice and a commitment to lifelong learning. The HPC concede that for some of the professions, the requirement to write in a reflective way about CPD activities was not well received, but regardless, HPC believe that over time the professions will be persuaded of the benefits of the reflective nature of the CPD standards that have been defined. The aims of the standards are to promote reflective practice and to foster greater emphasis on the outcomes of CPD activity rather than just a demonstration of hours-collection schemes.

Of the 14 professions that the HPC regulate, dietitians have come last into the audit requirement, so in many ways we have the benefits in being able to observe how things have gone for the forerunner professions. The first HPC CPD annual report was published in March 2010, and provides outcomes and discussion of the audits of the first four professions to be audited in 2008-9: chiropodists/podiatrists, operating department practitioners, orthoptists and paramedics.

In my view, the outcomes of the first audit cycle are astonishing. I am further concerned that the conclusions of the report do not ‘reflect’ the obvious issues that arise from the data. There has been one immediate change as an outcome of the first audit procedures: because some of the profiles submitted were strikingly similar, and investigations established that they had been produced on the individuals’ behalf by a third party, an amended wording was approved for standard 5. The previous version was, “present a written profile containing evidence of their CPD upon request.” The amended wording is now: “upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the standards of CPD.” The first cycle has also confirmed HPC’s decision to reduce the audit size from five per cent of registrants, to 2.5%.

Of the 650 chiropodists/podiatrists selected for audit, nearly 80% had their profiles accepted. Although none were removed from the register, about one in six of those selected for audit chose not to continue registration, against a reference of about one in thirteen typically expected not re-register every cycle. Of 650 chiropodists/podiatrists captured by audit snapshot, not one single individual was ‘assessed’ as unable to reach the defined five standards of the CPD hurdle, but 103 professionals, an excess of about 50 from the expected number, were lost to the services of foot health. Perhaps this ‘self-selection’ of lapsers has perfectly identified incompetent and incapable colleagues who should not be let near a corn or a bunion. This is far from proven by the HPC’s assessment, and another view could be that perhaps it represents a very unfortunate outcome of audits, resulting in an unnecessary loss to a profession, of experienced and capable colleagues. The nonchalant view expressed, that the twice-the-level expected of non re-registration indicates that this may have been influenced by selection for CPD audit, indicates little concern for further analysis of this leakage from the profession of foot healers, other than a comment that a larger number of lapsers were over the age of 50. The conclusion is not so simple, as the largest numbers of those selected for audit were in the age range 50-60 years, and the largest single age band of lapsers were 40-44 year-olds.

The due-to-audit lapser rates were lower in the other professions assessed, and lowest in the paramedics, where 3.4% did not re-register compared to expected levels of 2.7% - however numbers involved are too small to draw conclusions.

So of all the four professions audited, coming to a total of 1528 registrants, how many complied with the procedures to submit a portfolio, which was then assessed as inadequate? The answer is astonishing. Zero. Not one single submitted portfolio has been given an F-for-Fail. A few registrants have failed to meet the CPD standards, but in all cases, this is because they failed to submit a profile, not because what was submitted was considered insufficient to demonstrate professional reflection and learning. Can 1500+ health professionals really all be learning whiz kids, or could the whole CPD procedure not really be capturing what it was set up to? The very glib and non-reflective audit summary states that this “indicates that the guidance and communication provided by us [HPC] is enabling registrants to complete their CPD profiles in a way that demonstrates that they meet the CPD standards.” This self-congratulatory pat-on-the-back is undeserved, and a more critical analysis is really needed to address the leakage of perhaps competent professionals, and the contrast of the astonishing ‘100% pass rate’ of those who submit profiles.

Are there other ways to keep health professionals under a watchful and critical eye once they have escaped the nest of student hood? How, for example, are American registered dietitians channelled and assessed for quality learning and professional development?

The Commission on Dietetic Registration (CDR) is the independent credentialing agency for the American Dietetic Association (ADA). Their mission statement straddles their website (www.cdrnet.org): “protecting the nutritional health and welfare of the public through dietetic certification.” American dietitians have to pay $50 every year to be registered (less than half of the fee of £152 needed for the 2-year HPC registration). Dietitians need to obtain, over a five year recertification cycle, evidence of at least 75 hours of Continuous Professional Education (CPE), so about 15 hours per year. At the start of each cycle, dietitians need to define individual learning plans, which are verified and approved. Professional activities undertaken are then recorded, and can be logged online, into one (or several) of the predefined Learning Need Codes (see box). For example, attending a meeting presenting research on vegetarianism, would be recorded as LNC 4110. In addition to different themes and subjects, there is a requirement for different activity types of professional development; not all CPE can be gained from one kind of learning (see box for examples of CPE activity codes). For example, reading professional journals is CPE code 200 (such as Journal of the American Dietetic Association). However reading can only contribute a maximum of 15 CPE hours; this is extended up to 35 hours is one is the author of articles in peer-review journals or book chapters. Professional portfolios can be submitted for a mid-point review if it contains at least 30 hours, but required submission for all dietitians is within the five years period of the individual learning plan being set up. All American dietitians have their professional portfolios assessed every five years (but how many submissions fail?)

There are many ways to try to assess professional competency post qualification, but the ultimate aim has to be to support public confidence, and that of other professional colleagues, in the ‘brand’ of the profession. The CDR cites Mark Frankel, an American ethicist: “no longer does any profession enjoy the luxury of uncritical admiration or implicit trust from what is now an increasingly restive public.” Hence, what is not in dispute is the need for Continuing Professional Development.

Examples of Learning Need Codes

1000 Professional Skills

1140 Written communication, publishing

4110 Vegetarianism

5370 Obesity management

7200 Team building

8110 School meal service

9070 Research instruments and techniques

Examples of CPE Activity Codes

110 Case presentations

130 Exhibits

160 Journal Clubs

170 Lectures, Seminars

200 Professional reading

Information Sources

www.cdrnet.org

HPC. Continuing professional development annual report (CPDreport10) published March 2010

More discussion arising from Panorama

On the HPC website there is a page which details the requirements looked for when considering a new group for regulation. Following the change in government policy calling a halt to this regulatory process, the page now includes the sentence "The new professions/aspirant groups process is now closed and we are no longer considering applications." Nevertheless, we can still read the criteria the HPC claim to use when considering a new group for its register. This set of criteria was constructed after a process which included public consultation, some years ago, in 2002 I believe.

"The criteria we applied when we considered applications is as follows:

* Cover a discrete area of activity displaying some homogeneity
* Apply a defined body of knowledge
* Practise based on evidence of efficacy
* Have at least one established professional body which accounts for a significant proportion of that occupational group
* Operate a voluntary register
* Have defined routes of entry to the profession
* Have independently assessed entry qualifications
* Have standards in relation to conduct, performance and ethics
* Have Fitness to Practise procedures to enforce those standards
* Be committed to continuous professional development (CPD)"


Now, on June 3rd, 2011, Dr Anna van der Gaag, HPC President, wrote (in what the HPC solicitors refer to as her 'private' blog, yet apparently hosted by the HPC website) "We do not have a mandatory system of regulation for support workers in England. I look forward to the time when we do." The HPC is no longer receiving new applications for regulation, but it is still looking for opportunities to expand operations.

The blog entry is in response to the Panorama programme of 31 May (see also my previous blog entry below). You will remember that the abuses exposed by this programme were perpetrated by the unqualified care staff whose annual salary amounts to about £16,000. There is no discrete area of activity, no defined body of knowledge, no 'evidence base' for the practice, no professional body covering this section of the workforce... in fact not one of the criteria written above applies to this group of workers. The wish to regulate this sector of the work force has nothing to do with professional statutory regulation. It has a lot in common with the ideology of 'data-base state' solutions, so popular amongst those in power in the previous government.

In her blog, Dr van der Gaag writes "I worked as a speech and language therapist with people with learning disabilities in the 1980s. At that time, institutional care was still common and stories of abuse were also widely reported in the press – although without the benefit of clever hidden cameras. I vigorously supported the campaign to close these long stay hospitals, many of which I had visited as part of a three year research study. Thankfully, almost all these large institutions had gone by the mid 1990s, replaced by smaller, more home-like residential facilities, closer to communities and families, more accessible to visitors, more transparent in their management." There are three key points to explore here.

First: 'institutional care was still common' - this phrase is very vague and needs to clarified. The abuse reported on Panorama was also perpetrated within an organisational structure, and many of the residents seem to have been placed into that particular hospital by someone like a social worker or a member of a medical team (this wasn't made clear on the programme, but they did say of Simone that she was 'forcibly' taken into care). The money that funds the 'care' (£3,000 per month) comes from the common purse which is maintained via institutional mechanisms whose agents are absolutely invisible to us in this case. I mentioned in my previous blog that I had wished the Panorama programme had gone into this more carefully - perhaps there will be another programme going into this kind of detail soon.

If you remember (and you can still watch this programme on iPlayer), we did learn that the company had brought in a new manager - Lee Reed, the CE of Castlebeck, appointed January 2011. He was credible and articulate yet he functioned as an absolute block to any questions about the role played not only by the company's systems and style. To be fair, he would have seemed to have been making excuses, yet these issues must be explored against their institutional back drop. Castelbeck's web statement says that 'the international consultancy firm PricewaterhouseCoopers (PwC) [have been asked] to undertake a thorough independent review of the company, including its culture, medical protocols and communications systems.' Its difficult not to see this as an expensive show (paid for from the fees from the public purse I suppose) which bears little relation to the actual problem at hand. It might even be expected that one of the Big Five consultancy firms speaks the regulators language - they are not unattached to this ideology (see Max Travers' interesting study of the rise of The New Bureaucracies and Quality Control). The question still remains, why weren't Terry Ryan's words heeded and respected? It looks very much like another attack on local grown professionals while the big institutional players clean up.

By pretending that abuse is a feature of the 'bad old days of the NHS' van der Gaag is playing with words. You might think that this is sloppy, or, bearing in mind that she is a 'speech and language therapist', you might even consider it unethical, or unprofessional. No matter what you might think of her personal behaviour (and this is her 'personal blog', according to HPC solicitors) it would be naive to forget that she is also speaking from of her position as President of a large, multi-million pound concern, where Privy Council holds, in principle at least, the mechanism of accountability and control.

Second: "stories of abuse were also widely reported in the press". I have carefully read van der Gaag's blog, and nowhere does she mention any first hand evidence of the scale or nature of abuse in 1980s NHS institutions. Nor does she explain the link between the 'old' institution and the individual abusers in question. Nor does she quote a single instance of those that were 'widely reported' in the press. Broad brush statements are all very well, but here they simply serve to obscure the view, and cast aspersions over the whole of the 'old' NHS in one stroke.

Third: "I vigorously supported the campaign to close these long stay hospitals." I wonder what she though she was closing down? What, exactly, was the problem that was supposed to be solved by these changes? If we stick close to Anna van der Gaag, we are always too far away to know what is really going on in the world. How are today's institutions better than those which preceded them? Van der Gaag expands her point - the 'old' was to be "replaced by smaller, more home-like residential facilities, closer to communities and families, more accessible to visitors, more transparent in their management" These words might easily describe Winterbourne View, but they didn't help the people being pinned to the floor. There is quite a gap between the words and the reality - and no-one wanted to hear about it when Terry Ryan said it out loud.

Dr van der Gaag mentions that a lot of soul searching has followed from the Panorama programme, and this, she suggests, has led her to conclude that "For me, it highlights yet again the importance of regulating individuals as well as institutions."

One can only marvel at the soul searching that produced this nugget. Here we have the President of a large regulatory institution whose gravy train has recently been derailed by a new government and that is actively looking to diversify its business concluding that the only solution to this tragedy is to regulate not only the institutions and the professionals, but also the unqualified staff, uncle Tom Cobley and all. It rather starkly exposes the way that institutional pressures (and the institution in this case is the HPC) play on the weaknesses of their agents (in this case the President) and reduces them to puppets of an ideology, brushing the real problem firmly back under the carpet.

The only way that institutional power can be prevented from crushing some poor person's nose into the carpet, is the wise wielding of that power by the people who have been put into post. Presidents and CEOs are no exception to this rule, nor should they imagine for one moment that they are exempt from responsibility when things in their organisation go wrong.

Panorama exposé: Winterbourne View and its implication for the Neo Regulators

A couple of weeks ago Panorama shocked us all with a fly on the wall expose of chaos and tyranny in the Winterbourne View Hospital near Bristol (BBC1, 31 May, 9pm: Undercover Care, the Abuse Exposed; Paul Kenyon and Joe Casey). Residents (whose 'care' costs about £3k per month, paid for through our taxation, and implicating us in the result) were being subjected to regular and nasty bullying by a handful of staff at the lowest level of the hierarchy who seemed to have the run of the show even though qualified nursing staff and a management structure appeared to be in place. The next day on BBC Radio 4 World at One reporters remarking on the programme had been unable to get a minister to speak to them on air, so turned to Unison to provide them with a speaker at the last minute. Perhaps the short notice helps to explain why Christina McAnea (Head of Health) said that what was needed was higher levels of medical intervention and statutory regulation of the care workers. The residents at Winterbourne View Hospital are not sick, but are categorised as having 'learning difficulties'. What they need is something to do, and decent people to do it with. The undercover reporter noted that there was no regime of any specialist medication. The question of why these people were in hospital is an important one to ask, yet no-one asked it.

McAnea's second point, that the care workers should all be statutorily regulated, is one that has been made at the HPC (reported on here recently when Julia Drown raised it at a recent committee meeting). Perhaps McAnea was thinking about how to increase her power base in future negotiations with the government. Perhaps, because she can't possibly be thinking about the reality of the situation presented on the TV the night before. What was happening in the care home was against the law of the land. It wasn't a matter of incompetent professional malpractice. For the last ten years statutory regulation has pretended to be about professionalisation, but the thinly veiled attitude has always been an attack on the status of the professional - here the veil is ripped away and we can see quite clearly the aggression behind the call to statutorily regulate.

One criticism of this highly important programme was that it dwelt too long on the violence (the point was very well made and convincing in the first half of the programme), and so did not spend much time opening up the question of what had happened to the back-cloth of local networks that should have been there to support the qualified staff (Terry Bryan) in his attempt to do something about it. The chief thug on the ward had been there for over three years. This raises a massive set of questions about the structures of reason and control that most of us expect to be in place, (it was there, say, ooo, ten years ago) which could have dealt with the problem before it took hold. The glimpses we got of the senior nursing staff in the programme should at least make us ask what had happened to the structure of support that would have given them the power to act against the thugs. It is this, otherwise invisible, aspect of structure that we really need to pay attention to.

Because no sensible discussion is had of what has happened to local networks of management, the door is left wide open to the opportunistic thuggery of institutionalised power. For example, Minister Paul Burstow (a lib dem in name if not in action) ordered the Care Quality Commission to up its game. A highly centralised arms length government agent is given the order to do more spot checks. Great. This completely overlooks the point that the CQC is not only structurally unable to do anything about the problem we watched on the television (a point made tangentially in the World at One programme), but might even be part of the problem itself. The more the government pushes this style of regulation the more it attacks the thing that might actually make a difference. We are creating a self fulfilling prophecy. Has anyone got the courage to say it out loud?

On Friday 3rd June the HPC published a statement commenting on the Panorama programme. President Anna van der Gaag and her CEO Marc Seale said "We welcome any initiative that will increase the inspection of care services and improve standards. However, this will only happen if it is supported by an appropriate level of regulation of all the individuals working in care homes." They go on to lay the ground work for all care workers to be put under their control. This is presented as self evident fact yet there is absolutely no evidence whatsoever to support the statement. It remains a blatant act of institutionalised self interest with no regard for the real lives of the people - the residents and their families - that matter.

Why did the local network of reason and control fail? What is preventing decent people like Terry Bryan from being able to do his job? It is not the absence of a data base with everyone's name and address on it. Of that much we can be sure.

A good enough regulator? The controversy continues.

There is a group within the UKCP (United Kingdom Council for Psychotherapy) that cannot give up its wish for Statutory Regulation and clings to the HPC as the route to salvation in spite of everything that has happened. The misinformation produced by the spokeswomen of the group is incomprehensible to anyone who is interested in real information and wary of rhetoric. In a series of exchanges in the journal Self & Society, I recently had this letter published which contains some new information and some summaries of cases remarked upon earlier in this blog. I think it is worth posting it here too. For copies of the journal please go to The Association for Humanistic Psychology in Britain

Thank you very much for the renewed opportunity to join this debate about HPC regulation of the counselling and psychotherapy field, and for showing me Tricia Scott’s letter, also published in this issue, so that I may respond.

The degree of misunderstanding and confusion seems rather high. I think probably the best way forward here is simply for me to present some more information from my ongoing research into the HPC to allow your readers to make up their own minds.

I shall focus on the problem of Fitness to Practice hearings, and their relation to mediation procedures. In her article ‘A Fork in the Road for the Psychological Therapies?’ (Self and Society, Winter 2010), under the heading ‘Misinformation is rife’, Tricia Scott said that ‘There has always been the possibility of mediation within the system prior to a formal complaint being lodged’ and adds the HPC website address as confirmation. I responded to this point in my letter (published in the Spring 2011 edition) by reporting from an HPC meeting where Council members themselves showed their own lack of awareness of the real state of affairs in the organisation for which they are not only legally responsible but answerable to the Privy Council. The mediation available at the HPC comes not before, but after, FTP hearings – which explains why it has never been used. In her letter (this issue), Tricia Scott now states that ‘a regulator will always be the court-of-last resort’.

To judge the truth of the situation I have chosen to present summaries of three hearings, two of which I attended in full. I have read all the transcripts (NB: Readers are legally entitled to request transcripts of HPC fitness to practice hearings. I have supplied the relevant FTP numbers to Self and Society should anyone want to pursue the opportunity to request and read a transcript.) I believe that by paying attention to the way that HPC-regulation is realised in action, rather than listening to people describing what they hope might happen, gives us a better chance to understand what is really at stake.

1. 344894. This radiographer works within the NHS, taking referrals from various doctors in the NHS. One particular patient became disturbed after a ‘trans-vaginal examination’, so much so that she lodged a complaint with the NHS Trust, the Care Quality Commission, and the Health Professions Council. Each of these three organisations undertook an investigation in its own manner, one by one. Each organisation, one by one, found that there was no case to answer. The HPC was indeed the last organisation to consider this case and had the benefit of knowing that both the NHS Trust and the Care Quality Commission had not upheld the patient’s complaint, and of using evidence that had been generated by the extremely thorough work of the NHS Trust. Nevertheless, the HPC chose to advance seven counts of misconduct, none of which was found to be supportable by the Panel when the case was heard (November 2009). The transcript bears witness to the great stress experienced by the registrant, and we may suppose that the patient also experienced a high level of distress that was not reduced by the process (her evidence was held in private, and the transcript is not available). It is not at all clear what benefit was gained by anyone, unless one takes into account the fees paid to the official members of the hearing. It would, however, be important to take into account the expense incurred by the NHS Trust both in terms of sick pay for the registrant (whose experience of the process was clearly unbearable) and the demands on the time of those members of its staff who undertook the in-depth investigations into the allegations.
2. 01053. An altruistic Speech and Language Therapist with ambitions not only to do good but also to advance the work of his profession left his position at the local PCT to take advantage of an opportunity to work, on sabbatical, in a deprived part of the world. A hitch in the technology prevented him from closing the case notes on all his clients before leaving. His replacement, who arrived after he had left and who had never met him, decided to visit one of these cases to make her own assessment about whether to close it or not. The patient was a young married man with Down Syndrome who lived with his parents. The parents were fulsome in their praise of the previous speech therapist, whom they had persuaded to treat their son beyond the prescribed six sessions allowed by the NHS. The new therapist pricked up her ears – are you telling me this man treated your son privately? The parents were shocked and clammed up. This was taken as damning evidence that the predecessor had exploited the family for personal gain. She duly reported him to the HPC, which listed the allegation as ‘you provided private speech and language therapy treatment to client x whilst also treating them on your NHS caseload’. The hearing established that the Registrant had attended a few times, made great progress, and had reluctantly accepted a few pounds from the parents to avoid offending them – the symbolic exchange was paramount. The registrant thought it important to say that the family shared a cultural background (Hindi) spoke the same language (the patient and the Registrant spoke English, Gujarati, and Hindi), and were connected to him via a local charity where he also worked. The case against him was built on the idea that he had a duty to ‘take steps to protect [himself] from suspicion of unethical conduct’. He stated that he would certainly never undertake such work again. The panel concluded that there was no case to answer.
3. 07913. As far as I have been able to establish, this final example was generated not by a complaint to the HPC per se but by the HPC trawling through the records of NHS investigations, which is something the HPC says it does as part of a proactive campaign to ‘protect the public’. The evidence against the registrant was in the form of videotape from a security camera (just vision, no sound). This is what we learned: a paramedic ambulance driver was bringing a pregnant woman into the local hospital one Saturday morning; the baby was in the breech position. As the ambulance driver pulled into the car park (which was almost empty and very quiet), he passed a car that was manoeuvring in a parking bay. The car driver was incensed when the ambulance did not give way to him. He leapt from his own car – leaving the engine running, the door open, and the windscreen wipers still going – and ran after the ambulance, shouting and gesticulating. He thumped on the driver’s window and yelled at him. The driver got out and propelled the man back to his car. This was a slow process and, by and by, a uniformed security guard lent his presence by standing next to the registrant and accompanying him as he backed the man towards his car. The NHS Trust suspended the paramedic for five weeks while it undertook an investigation, then sent him on a ‘conflict management’ course before allowing him to return to work. The HPC thought this unacceptable, and argued that the videotape provided clear evidence that the registrant was unfit for practice. The Panel listened to the registrant, who convinced them of his contrition, and went on to declare the case not well found.

Those in favour of HPC regulation often misrepresent those who are not in favour as being ‘anti regulation’. This, of course, flies in face of the facts. My argument, which is grounded in the information produced by my ongoing research (which commenced in 2008 and has involved my attendance at numerous HPC meetings and hearings), and which is situated in sociological and anthropological traditions of organisational research (from Max Weber through to the more recent studies of audit culture by Michael Power, Marilyn Strathern, Andrew Cooper, and Max Travers), is that regulation by the HPC is highly likely to seriously damage the structures necessary for safe and enlightened practice. It will not lead to better protection of the public; on the contrary, it is likely, at least, to mislead the public into a false sense of security.

The HPC Fitness to Practice annual report (2009-2010) notes a steep rise – from 2 per cent in 2005 to 30 per cent in 2010 – of cases not well found. What this tells us is that cases presented by the HPC are 15 times more likely to be wrong now than they were five years ago. In real numbers, this means that 76 cases out of the 256 that were heard (out of the 772 cases registered in the whole process) in 2009-2010 were not well founded. Which, in turn, resulted in only 0.09 per cent of HPC registrants being found to be either incompetent or guilty of misconduct in that period. While attending the case of the speech and language therapist (summarised above), I exchanged a few words with the FTP Panel Chair at lunchtime. He thought that of the cases heard at the HPC about 5 per cent were really necessary, which suggests that 95 per cent of them, in his experience, don’t require this kind of approach. Five per cent of 256 cases accounts for 13 people. To track down and drive out 13 people from (then) 205,311 registrants in 14 different practices (now 210,000 in 15 professions), the HPC spent approximately £6 million (40 per cent of its expenditure) on FTP hearings, and by implication, subjected many more to an overblown, adversarial, expensive, time consuming process. It is an example of bureaucracy displacing rational thought, like a juggernaut with no-one in the driving seat.

In the process of eliminating a few predators and rogues, a lot of money is spent on making reliable and diligent practitioners, and members of the public, very miserable indeed. Each of the cases mentioned here was eventually found to be unnecessary (not well found). Nevertheless, each of the registrants found themselves and their practice to be in serious question for about 18 months to two years (the waiting time for a case to be heard), without their being able to do a thing about it. This was clearly very unpleasant indeed, and a waste of resources. The last period of waiting is put on public display (allegations are displayed on the HPC website four weeks before the hearing), and the press are often encouraged to attend hearings and report on the allegations before the Panel actually comes to a decision as to whether or not a case is well found. For an example of the way the press can get drawn into this pernicious web, see http://www.telegraph.co.uk/health/healthnews/7449822/Psychologist-tried-to-kiss-male-colleague-in-front-of-wife.html, where the story remains on the internet one year after it was thrown out as ‘not well found’ by the HPC Panel. This case, by the way (which I report on in a forthcoming publication), actually proceeded after an apology was both made and accepted. The HPC has not been set up to resolve disputes, but to ‘protect the public’ by excluding unfit practitioners from their register. The organisational structures and practices follow from this. The difficulty of changing an organisation when it is in full swing are well known and widely documented. Shape shifting can be more easily achieved in speeches and even in documentation, but not so easily in practical reality. This needs to be borne carefully in mind when listening to the HPC rhetoric.

This is only a small glimpse of some of the problems that can be uncovered by observing the HPC in practice and thinking about what it means. There are other examples from the FTP process which indicate other kinds of problems, some of which have been discussed on the hpcwatchdog.blogspot.com. There are also questions around the way that Council and committees conduct their discussion, make decisions, and construct strategy (see my report on Council meeting 31 March 2011). There are also signs of fundamental problems connected with the invention and application of Standards (eg in Council Committee documentation the art therapists claimed that for nine years the generic standards never applied to them – reported in my article in Self & Society, winter 2010). The process of educational assessment also shows signs of distress between administrators, council members, and educational establishments (Education and Training Committee meeting, 10 March 2011). Each of these areas is problematic (both from a theoretical and a practical point of view) and there are very few signs that HPC agents are even trying to find realistic and practical solutions. No doubt there are some problems within some training organisations in the counselling and psychotherapy field, but this does not mean that there are no problems outside the field, or that those other problems are less important or less problematic. The question, surely, is how to resolve real problems in a realistic way that is true to our experience, knowledge, and theories.

Before the 2007 White Paper, all the major organisations in the field publicly stated their opposition to the HPC as regulator of this field – it was widely deemed to be inappropriate. This proved to be true. Even with government support, the HPC was forced to go to double time with the Professional Liaison Group, and even then failed to find the definitions and material they claimed to need to ‘set the standards’. One member of that PLG group, Annie Turner (Occupational Therapy member of Council) repeatedly advised the group to ignore the way the field actually practiced, and tried to persuade them to invent standards that would fit the HPC mode! This sign of an active split between methods of regulation and practical reality is very troubling. There are very many reasons indeed to hesitate before recommending the HPC as any kind of regulator (statutory or voluntary) for our field.

Yours faithfully

Janet Low

Job Description – Chief Executive & Registrar

One extra note - I originally asked the personnel department to send me the descriptions of these executive jobs (FTP, Case Management and Policy and Standards), but they were diverted to another function and sent to me under the banner of 'freedom of information'. My hypothesis at the time was that this anomaly was a manifestation of employee (or 'executive') angst and muffled resentment. The more recent job description (for Director or Education) was accomplished without invoking the machinery of the law.

Main Purpose of Job

• To lead and manage employees and be responsible for the day to day management of HPC.

Position in Organisation

• Reports to the President on a day to day basis.

• Leads the Executive Management Team.

• Liaison with Council and Committees.

• External liaison with relevant external stakeholders which include (but are not limited to) consumer and employer groups, governments, other professional regulators, politicians, professional bodies and trade unions.

• Liaises with employees at all levels within the organisation.

Scope of Job

• The Chief Executive & Registrar shall have such functions as the Council may direct.

• The Chief Executive and Registrar shall be responsible for all operational matters as set out in the HPC’s Scheme of Delegation.

Dimensions and Limits of Authority

• Oversees the HPC budget and operates within the budgetary limits of the organisation and in accordance with HPC Financial Policies.

• Manages financial affairs and functions as the Accountable Officer for the HPC.

Skills, Knowledge and Abilities

Essential

• Relevant post-graduate qualification or equivalent experience.

• Significant experience at a non-executive Board level.

• Experience of leading and directing a team or several teams which have included a diverse range of functions and positions.

• A recently held position or equivalent at Board level in a public, private, voluntary or community sector organisation.

• Proven track record of effective leadership in driving major organisational and cultural change.

• Proven ability to address multiple and complex problems and develop solutions in the light of challenging and sensitive circumstances, and in the face of conflicting pressures.

• Excellent oral and written communication skills.

• Knowledge and understanding of communications and experience of working with the media.

• Sound judgement and ability to reach conclusions which are principled and workable.

• Experience of working collaboratively with a Chairman and a Board and having a thorough understanding of corporate financial issues.

• A thorough understanding of the role of healthcare professionals and their representative bodies and the system of statutory regulation and Government’s wider plans for the modernisation of health and social services.

• A proven ability to engage with a wide range of stakeholders.

• Willingness to travel on a regular basis throughout the UK and internationally, including overnight stays as required.

Duties and Key Responsibilities

Your principal duties and key responsibilities will be those set out below. In addition to those duties, HPC reserves the right to require you to undertake additional or other duties within your capacity as may from time to time be reasonably required and necessary to meet the needs of the HPC.

• To lead and manage employees and be responsible for the day to day running of HPC.

• In collaboration with the Council, develop the vision and strategy for the HPC and oversee their implementation.

• To develop and implement an annual business plan in collaboration with Council and Committees.

• To inspire confidence in the Council, its employees and stakeholders.

• To manage financial affairs and function as the Accountable Officer for the HPC.

• To drive and maintain the organisation’s performance and service delivery.

• Direct line management responsibility for the Executive Management Team.

• Provide leadership and motivation for all HPC employees.

• Establish and maintain strong working relationships with key HPC stakeholders.

• To present and promote HPC’s operational aims, objectives and achievements to external organisations as required.

• To liaise with the President and keep the President informed of developments.

• To provide such information to the Council as the Council and President require in order for the Council to assess the performance of the business and the achievement of the agreed strategy and budget.

• To carry out the responsibilities of the post with due regard to the HPC's Diversity Policy and to treat colleagues and other HPC stakeholders with respect and dignity at all times.

Job Description - Head of Case Management

Fitness to Practise Department

Main Purpose of Job

• Manage the operation of HPC’s Fitness to Practise directorate case work function.

• Design, develop and implement processes to support the work of the department.

• To assist in the implementation of the organisations fitness to practise strategy

Position in Organisation

· Reports directly to the Director of Fitness to Practise

· Provides guidance and support to Fitness to Practise Department employees.

· HPC liaison with Council and relevant Committees which include (but are not limited to) the 3 Statutory Fitness to Practice Committees.

· External liaison with relevant external stakeholders which include (but are not limited to) professional bodies, other regulators, government departments and MP’s, consumer and employer groups, police forces, court services, lawyers and employers of registrants.

· Use of statutory powers as delegated by Committees and Council

· Liaises with the Head of Adjudication regarding the management of the fitness to practise process

· Investigates Fitness to Practise allegations, including use of Statutory Powers delegated by Committees and Council

Scope of Job

• Management of case management and administration function within the fitness to practise directorate

• To assist in the delivery and development of the fitness to practise strategy and be aware of developments in regulation that affect fitness to practise.

Dimensions and Limits of Authority

· Provides support and guidance to the Fitness to Practise employees as directed by the Director of Fitness to Practise

· Line Management of Lead Case Managers of Case Team and Administration Manager.

· Budgetary approval ability and able to order good or services from existing suppliers to a value defined by the Director of Fitness to Practise and HPC Financial Policy.

· Act as HPC’s spokesperson on Fitness to Practise matters as required

· Monitor application of Part V and Part VI of the Health Professions Order

· Monitor application of Article 39 of the Health Professions Order

Skills, Knowledge and Abilities

Essential

• Educated to degree level and/or relevant knowledge and understanding

• Demonstrated ability and knowledge to manage, support and lead a team, and to motivate employees

• Demonstrated ability to manage highly complex cases

• Sound knowledge of instructing lawyers and providing appropriate instruction in relation to cases and of stakeholder management

• Ability to apply and interpret procedures and law as it relates to HPC’s case work.

• A high level of written English and oral communications skills, including the ability to communicate professionally with customers from all backgrounds, including people who may be vulnerable

• Proven ability to work and communicate with all employees, including at a senior management level, including the ability to advise senior managers on HPC’s case management function

• Highly efficient and organised team player.

• Excellent presentation skills.

• Sound working knowledge of window based software packages, including word processing, spreadsheets, databases, electronic mail, and the internet

Duties and Key Responsibilities

Your principal duties and key responsibilities will be those set out below. In addition to those duties, HPC reserves the right to require you to undertake additional or other duties within your capacity as may from time to time be reasonably required and necessary to meet the needs of the HPC.

Operational Responsibilities

· Deliver and develop fitness to practise strategy.

· Thorough awareness of all cases.

· Assist in the drafting of particulars and sign off on these before posting.

· Develop, monitor and implement processes for tracking cases.

· Develop, monitor and implement and review process for analysing trends in the fitness to practise department.

· Assist in the development of FTP’s equality and diversity scheme – including making complaints accessible.

· Produce monthly fitness to practise statistics and raise and analyse any anomalies with the Director of Fitness to Practise.

· Identify and lead policy developments in the fitness to practise department.

· Lead in the production of the Fitness to Practise Annual report.

· Maintain a relationship with external lawyers instructed by the Fitness to Practise Department.

· Risk assessment of fitness to practise cases

· Lead (with the Head of Adjucation) in the design, delivery and implementation of partner training

· Lead organisation wide projects relevant to the Fitness to practise function

Employee Management

· Manage the day to day functions of the employees within the Case Management function, briefing the Director of Fitness to Practise on any significant issues.

· Monitoring the workload of the team, ensuring that targets and standards of performance are achieved.

· Being a point of contact and referral for queries about complex issues by team members.

· Liaising with the Director on any relevant Human Resources matters as required.

· Leading and supporting other team members where appropriate – including the development of induction programs.

Publications

· Write and produce future HPC Fitness to Practise publications where appropriate.

Other

· Deputise for Director of Fitness to Practise where required in the Director’s absence.

· Help maintain service standards and external benchmark standards acquired by the organisation.

· Aid in the budget management and planning of the Fitness to Practise budget (including resource management and forecasting)

· To support the operation of HPC’s Council and Committees by preparing papers as required.

· To carry out the responsibilities of the post with due regard to the HPC's Diversity Policy and to treat colleagues and other HPC stakeholders with respect and dignity at all times.