HPC execute a summary of responses to their consultation

The HPC have published their summary of the 1,105 responses to their consultation on the regulation of counselling and psychotherapy. The Council will meet on 10 Dec (email Louise.Hart@hpc-uk.org to reserve a place to observe), and will be asked to agree the preliminary conclusions and to endorse the summary for public consumption.
Here are some noteworthy points from the executive summary and recommendations:
The HPC open with a clear reminder to the Government that it is only following their orders. Ultimate responsibility for the regulation of Counsellors and Psychotherapists is unambiguously laid at the feet of Government. This may indicate that the PLG will now be by-passed, with the debate returning to Parliament, or to the Dept of Health.

The HPC carefully present their position: “As the White Paper contained an unequivocal statement of policy by the Government that (subject to consultation and legislative approval) psychotherapists and counsellors would be regulated by the HPC, the task undertaken was limited to examining the practicalities of implementing that policy.” [emphasis added] (p2). This points to the particular ambiguity between State and statutory regulation as played out in this case. A few lines later this fudge is repeated: “it is important to note that the work was not intended to produce final drafts of either SOPs or SETs but was more in the nature of a feasibility study” [emphasis added] (p2).

The nature of this feasibility study was stretched over the course of a year, with 17 experts meeting five times to draw up recommendations, which were then circulated for consultation. So badly done was this, that it provoked an unprecedented 1105 responses of which 88% (968) were from individuals. 78% or the respondents disagreed with the first recommendation - that the register be structured to differentiate between counsellors and psychotherapists.

During this so-called ‘feasibility study’ the HPC have so far managed to identify “more than 40 organisations that represent the interests of Psychotherapists and Counsellors in some way, and it is likely that there may be others … not yet identified” (p3). After a year’s consideration the HPC have concluded that ‘the psychotherapy and counselling field does not appear to have a single or unified ‘professional voice” (p3) Extraordinary. The consultation showed the HPC that ‘there is a lack of consensus’ on the following 4 points: the need for statutory regulation, the structure of the register, the standards of proficiency, and the education and training requirements. Here are three of the four fundamental ‘building blocks’ of the HPC’s regulatory framework. The only brick that is un-contentious is that the titles Counsellor and Psychotherapist should be protected (around 80% agreement on this).
The HPC reminds its Council that it “should ensure that it takes into account that lack of consensus in reaching its conclusions” (p4).

Section 4 of the executive summary is devoted to the structure of the register. This is the core work of the HPC – it is, in essence, a database. If HPC do take on the ‘regulation’ of counselling and psychotherapy, it will be done by creating a new section in the database named Psychotherapists and Counsellors. This will become the 15th section of the register in which 14 other professional groups can also be found (eg Biomedical Scientists, Radiographers, and Paramedics). To enter any section of the register a candidate must pass a minimum level of standards that apply equally to all sections of the register. In addition, they must pass particular standards relating to their section of the register. Within that part of the register they will have access to one or more protected titles. Six of the sections have only one protected title, so no more standards to be met. However, the Psychologists have no less than 7 protected titles, each one of which is guarded by a different set of standards (3 other professions follow the same model, but with fewer titles). Four of the professions have more than one protected title but everyone can use either title. This last is called the ‘anti-avoidance’ provision.

So where does that leave Counselling and Psychotherapy? “In response to the consultation, the majority of respondents overall disagreed with the proposed differentiation and argued instead that the Register should be structured so that both titles were protected but could be used by any registrant registered in that part. This is similar to the chiropodists and podiatrists…” (p5).

Soul-wrights are similar to sole-wrights, yet different. So, what is the HPC to do? “The HPC considers that it is not possible at this stage to conclude whether the Register should differentiate between psychotherapists and counsellors without further work being undertaken on standards of proficiency” (p5).

The HPC concludes that “it is necessary to protect [both] titles” (p7) yet this produces problems where overlaps occur with professions completely outside its domain. “For example, if a nurse used counselling skills in their work but did not refer to themselves as a ‘counsellor” then, oddly enough, they would not need to register, so long as they didn’t call themselves a counsellor, but subsumed the skills within their nursing function.

Similarly, for someone in the RCP (psychiatry) or the GMC (both of whom are separate regulatory bodies and sit alongside the HPC ‘under’ the CHRE) the “HPC concludes that if it is clear to a member of the public that someone is a medical doctor … then it would not be necessary for them to become separately registered [with us]. This is an area that should be the subject of further discuss¬ion with the GMC and the RCP” (p7).
In all other professions (ie physiotherapy, arts psychotherapy, biomedical science, radiography) then dual registration is recommended. This creates, or rather supports, the traditional hierarchy that raises doctors and psychiatrists (and nurses) above all the other associated health care ‘professions’. The unresolved problem here is that an image of equality is floated by the new regulatory structure, which conceals the actual structure in play. Ambiguity & confusion follow on.

Section 7 of the executive summary considers which registers would be transferred by any future Section 60 legislation. On the one hand the HPC have got agreement on the criteria to make this judgement, but on the other they conclude “that deciding which registers will [be] … a matter for Government” (p9). To ease the practical difficulties, the HPC propose a longer, three stepped approach to data transfer.
They also recommend a longer grand-parenting period: 3 years, instead of the 2 the PLG agreed on.

The question of generic standards (ie the imperatives to control infection, submit to management and audit plans etc) brings further fog to the process. The executive summary notes that this was raised as a problem in the psycho¬logy consultation. Apparently this led the Education & Training Committee to agree (a year ago, on the 2 Dec 2008, 2 days before the first PLG for C&P) to “undertake a review”. After a year the HPC report that “some initial work has been undertaken … in the light of the feedback previously received”. They then conclude “the Council is requested to agree that any further consideration of draft Standards of Proficiency for psychotherapists and counsellors is deferred until such time as the Council has concluded the current review of its existing generic standards” (p11). So, before thinking about the criticisms of the Counsellors and Psychotherapists, they want to deliberate further on the criticisms of the Psychologists. Just how long is this supposed to take?
The majority of consultation responses disagreed with the proposed educational entry levels for counsellors (Level 5) (74% disagreed) and psychotherapists (Level 7) (65% disagreed). Further consultation will be necessary.

In spite of all this, the HPC concludes by stating that it has “not identified any specific issues that would prevent psychotherapists and counsellors from coming into the system of independent statutory regulation operated by the HPC”. Remarkable. Has anyone ever seen a feasibility study like this before?

Finally this document asks the Council to decide “whether the HPC systems are capable of accommodating and meeting the regulatory needs of psychotherapists and counsellors. Marc Seale (the Registrar) is supposed to inform Andy Burnham (the Secretary of State) of the conclusions (p13). In spite of all the logic, reason, and legal arguments put forward by more than 1000 people, the HPC continue to ignore anyone who gets in their way, choosing instead to press on with their advantage. The whole document pushes the Council to say Yes. Scandalous.