Dinner Break Debate in the House of Lords, 5 May 09

On Tuesday 5th May, at 7.30pm, seven nobles took the trouble to attend the Dinner Break Debate at the House of Lords. This is a regular time-slot in the Lords’ programme where an hour is reserved for short debates on particular subjects. ‘These debates help to shape public policy’ says the glossy booklet available to all who enter the Strangers Gallery to observe. They also give the Lords a chance to go have something to eat before resuming the main business of the day. In this case it was the Marine & Coastal Access Bill that was slowly chugging through a very long list of amendments and would resume at 8.30pm to pick up where Lord Hunt finished them off at 7.28pm with amendment 63.
In that last half hour leading to the Break a little joke was made at the expense of a then absent Lord, the noble Lord John Alderdice. Lord Hunt looked over the woolsack to where he might find that familiar figure, thinking he may have arrived early for the debate on the Practitioner Psychologists.
Philip Hunt was raised to the peerage as Baron Hunt of Kings Heath, of Birmingham in the County of West Midlands 1997. John Alderdice pipped him by a year, being raised to the peerage as Baron Alderdice, of Knock in the City of Belfast 1996. Hunt sits centre left as you look down from the Stranger’s gallery (the Government benches, close to the despatch box), or on the right if you happen to be on the Woolsack, which is at the foot of the Throne. Alderdice sits on the right, near the woolsack, on the Liberal Democrat benches.
These two noble Lords had crossed swords before, when Hunt closed down Alderdice’s Psychotherapy Bill in 2000 – an early attempt to regulate the psys. (See Denis Postle’s very useful book Regulating the Psychological Therapies, From Taxonomy to Taxidermy, PCCS Books 2007).
By 7.28pm Alderdice had arrived, but Hunt and the others were off for their supper. This left seven noble members to debate the Health Care and Associated Professions (Miscellaneous Amendments and Practitioner Psychologists) Order 2009. In the Strangers Gallery sat at least three interested and several disinterested tourists. On the other side of the Hall the gallery held several key figures from the HPC.
This debate had not been expected. A rubber stamp was all inked up and ready to do its duty, but the Merits of Statutory Instruments Committee 11th report quietly caused a stir:
“[this Order] introduces, for the first time, statutory regulation of practitioner psychologists throughout the UK … The Committee has received correspondence from a number of psychotherapists and those practising similar disciplines: while many of the concerns expressed relate to a possible future Order, some of the issues mentioned, such as potential distortion of the market as a result of only regulating part of it, might arise as a result of the current instrument. A number of those currently practising in this field argue that the ‘one size fits all’ approach to the regulation of the health professions will cause significant damage to their profession. They are asking that the DH provide stronger evidence of the need to move away from voluntary regulation and how the policy proposed will increase the protection of the public. In debate, the House may wish to explore these issues further.”
Access to this report plus the full report of the debate in Hansards click here.
As the hall emptied Baroness Thornton opened the debate on behalf of the Government. Glenys Thornton was raised to the peerage as Baroness Thornton, of Manningham in the County of West Yorkshire 1998, and is a member of the Cooperative Party. She was chair of the Greater London Labour Party between 1986 and 1991.
“My Lords, the reforms set out in this draft order aim to enhance public confidence in the ability of the healthcare regulatory bodies to protect the public and deal with poor professional standards. The order continues the process of implementing the Government’s programme to improve patient safety through the reform and modernisation of the regulation of the healthcare professions, as set out in the White Paper, Trust, Assurance and Safety.”
I am aware that there has been a lot of interest in the build-up to this debate both in support of and against the provisions… At the moment, the only regulated group is psychiatrists, who are regulated as doctors by the GMC. As doctors they can also prescribe drugs to patients. The next highest qualified providers of talking therapies are practitioner psychologists, who are now being regulated for the first time. They must all have postgraduate qualifications.
Consideration is also being given to the regulation of psychotherapists and counsellors who have descending levels of professional qualification. The Health Professions Council has been working with bodies representing these groups to develop proposals but we are not there yet. Those discussions are continuing but no formal decisions have been made although we understand that the working group is hoping to report to the council of the HPC later this year. Any proposals to regulate psycho¬therapists and counsellors will be subject to further consultation before legislation is brought before the House. Given the weight of interventions on this matter by psychotherapists, we anticipate robust discussion and consultation.” [emphasis added]
Earl Howe who followed and spoke on behalf of the opposition repeated this reference to the number of letters received:
“My Lords, the House will be grateful to the Minister for introducing the order which, as some of us know, is the product of many years of discussion between the psychology profession and the Department of Health, as well as extensive discussion within the profession itself. I should like to be able to welcome it wholeheartedly on that account as being the settled view of all the parties involved, but, unfortunately, I cannot quite bring myself to do that because I am aware, as, I am sure, is the Minister, that there is great disquiet among members of the profession about what this order will mean for them and their patients and clients, and the precedent that it is likely to set as regards the related disciplines of psycho¬therapy and counselling in particular. My mailbag has been full to bursting with letters from psychologists and psycho¬therapists expressing total anguish about what the order contains and about the consultation that preceded it, which they see as having been stage-managed. It has not been particularly easy to tell those correspondents that by longstanding convention this House does not vote down secondary legislation. What we have in front of us, at least the part of it that relates to the regulation of psychologists, cannot, unfortunately, be described as a settled view or one that is universally welcomed.” [emphasis added]
Earl Howe had indeed been diligent in his replies to those who had written in expressing their concerns. He had told many people of this ‘longstanding convention’ whereby the Lords do not scupper a piece of secondary legislation. This is a point worth thinking on. Longstanding tradition is fine and dandy, but has to be seen in the light of more recent events. It is now well known that in the 10 years since Tony Blair took up his position as PM more laws were passed in UK than at any other time ever. This massive increase in legislation was a major topic of concern at the Convention on Modern Liberty on 28th February (http://www.modernliberty.net/), and the subject of the popular 2006 film by Chris Atkins: Taking Liberties (Revolver Films) http://www.imdb.com/title/tt0977667/.
The consequence of this massive increase in business means that many laws are being passed without full discussion (Kate Hoey, Lab MP for Vauxhall, made this point at the Convention). That this particular order was discussed at all must be recognised as a major achievement caused by those therapists who for the first time in their lives, no doubt, wrote a letter to a Lord or Lady.
Although much of Howe’s speech was highly critical of the current Order, (eg possibility of creating state sponsored rigidity; the lowering of standards; the distinctiveness of psychology from healthcare) he did take the time to state his position on statutory legislation, which he agrees with in principle. “With no disrespect to the individuals involved, I have been looking too long at these issues to be able to endorse that point of view. In the 21st century, with a need for full professional accountability, professional standards of practice, transparency and protection of the public, it is difficult to argue that statutory regulation in any form whatever is unnecessary.”
Lord Alderdice (a consultant psychiatrist in psychotherapy who runs the Centre for Psychotherapy in Belfast, a National Health Service facility, and who is a member of the BPC) was next to take the floor. Much of his speech was concerned with resurrecting his proposals for an alternative psychological professions council, which would at least have the advantage of knowing something of the thing it tried to regulate, unlike the HPC which he implied was ‘not fit for purpose’. He also pointed out that the current Order would ‘split the profession’ by registering practitioners and not those engaged in teaching and research. This is a very interesting point when considered alongside the list of competencies which implies an insistence that practitioners subordinate themselves to ‘evidence based research’.
At 8pm Baroness Pitkeathley piped up from the back of the Government benches. Another one raised to a peerage in 1997, Jill Pitkeathley is also the newly appointed Chair at the CHRE (the regulator of the HPC). Ironically, in spite of this recent appointment, Jill managed to keep a straight face when she argued that Regulators should be independent of the Government and the professions that they regulate, so that they can make and be seen to make—that is very important—appropriate decisions in the public interest. This was a point made in recognition of part of the Order which authorises changes to the structure of the HPC Council – removing elected professionals and replac¬ing them with appointments by Privy Council.
Next up was Viscount Eccles. John Dawson Eccles is an elected hereditary peer and sits on the conservative benches. He is also a member of the Merits of Statutory Instruments Committee. I am not as sanguine as my noble friend Lord Howe is about the benefits of statutory regulation and would like to emphasise what the noble Baroness, Lady Pitkeathley, said about independence. The great problem with all systems of statutory regulation that I have been involved with is that it is very difficult to believe that you have the independence that you were promised. I have debated the independence of public bodies a number of times in this House and usually I have been disappointed.
He also argued that no evidence had been provided to support the blank statements made by the Government about the need to regulate, and predicted a rise in imaginative accusations for the Fitness to Practise process given the nebulous nature of psychology: “What results from this state-controlled mechanical agenda is an increase from 134 HPC malpractice allegations in 2003–04 to three times that number in 2007–08, against a 30 per cent—less than one-third—increase in practitioners regulated under the 13 present headings. Psychologists will take the HPC on to new ground: matters of the mind. The attempt to codify and define will open the door to a rapid rise in imaginative allegations. One needs only to look at the prescriptive detail that the HPC thinks is appropriate for psychological qualification. Does the Minister really believe that a rising tide of allegations is, or ever will be, a good indicator of patient safety or public confidence?
He pointed out that the work of so-called consultations and the Government’s attempt to brush conflict under the carpet did not amount to evidence of agreement, and he was the third to mention the influx of well-reasoned letters to Westminster which constituted plenty of evidence of contro¬versy should anyone want to recog¬nise it. He finished up by saying that although we “are probably stuck with the order, or at least the psychological part of it, it should be the last with “psy” in the title.
This left the floor to Baroness Thornton to close on behalf of the Government. One thing worth quoting from these closing remarks is the question she posed in relation to psychotherapists and counsellors? “As I said in my opening remarks, there will be a statutory period of consultation before any further orders are laid. Legislation is not inevitable—although we currently agree with noble Lords that it is desirable.”
The voice from the Woolsack then asked if everyone ‘was content’. There being no-one willing to break tradition and admit to being not content, the Order was passed, and with it the Psychologists on to the register of the HPC in July 2009.