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.