Report on the HPC Council meeting Dec 10th 09

Behind the rhetoric of transparency business goes on as usual.

The executive of The Health Professions Council were in the gallery at the House of Lords on Wednesday night, waiting for the nod to pass the Audiologists onto their database.

At 7.45 pm the Health Professions (Hearing Aid Dispensers) Order was moved by Baroness Thornton (Labour Co-op Peer), and after interventions by opposition spokesman Earl Howe, Lib Dem Baroness Barker, and CHRE Chair Baroness Pitkeathley, by 8.05pm it was done. In that 20 minutes several things were said that are worth taking note of. Click here for a link to the full debate.


1. Modernisation. “I am sure noble Lords will join me in thanking the Hearing Aid Council for the work it has done in regulating the private hearing aid profession for over 40 years, but now is the time for change… To deliver high-quality services, change is needed and modernisation will prevent gaps in patient safety from occurring”.

2. Money. “The transfer of the register of private hearing aid dispensers to the Health Professions Council will deliver real benefits for everyone concerned. Private hearing aid dispensers will benefit from a considerable reduction in their annual registration fee, from £695 to £76.”

3. Big is beautiful “The Health Professions Council has significant economies of scale, with over 200,000 registrants, compared with only 1,700 on the Hearing Aid Council's register.”

4. Centralised is beautiful. “The abolition of the Hearing Aid Council will also achieve the Hampton report's aim of reducing the overall number of regulators.

5. Pre-emptive Punishment. “At present, the Hearing Aid Council can take action against a practitioner only once harm has actually occurred. However, the Health Professions Council will have the power to remove a practitioner from the register before any harm takes place, on the grounds that a person is likely to present a risk to the public.”

6. Criminal offense: “it creates a new offense relating to the dispensing of hearing aids by unregistered persons”

7. Extending power: “The Health Professions Council will, for the first time, protect function as well as title … in future, any person not registered with the Health Professions Council who performs the functions of a hearing aid dispenser will also commit an offense.”

8. Old Guard: This legislation also makes way for the abolition of the current Hearing Aid Council. Baroness Barker (LibDem) said “It is commend¬able that a body should work so assiduously towards its own demise; that is very generous of it.

9. New Control: Baroness Pitkeathley said: “It is important that the HPC committees have the full range of sanctions available to deal with the case appropriately and are not bound to follow the HAC's decisions. … I think we are talking about a principle here – [Government] expects the HPC to exercise its judgment in reviewing whether sanctions imposed by the Hearing Aid Council on an individual are adequate for public protection”

...

Six psychoanalytic groups wrote a letter appealing to members of the Health Professions Council to recognise the scale of the problem it faced in attempting to regulate counselling and psychotherapy (click here for text of letter). Nevertheless, in Kennington on Thursday morning, it was barely mentioned, and the HPC Council nodded through the executive’s recommendations to carry on regardless.

There were more people in the public gallery than sitting round the table, including one young woman with two laptops typing furiously throughout the proceedings. The seating arrangements for observing are irritatingly inconvenient – the front two rows are always reserved for HPC staff, which means that genuine observers have several obstacles obscuring their view. Nevertheless this young woman squished on her seat with her technology and a set of papers never let up her tapping. She had the names and photographs of all council members next to her, which is the only way to know who said what. The Council is run following the ‘cabinet model’ which means that no remarks are ever attributed to individuals in the minutes and all decisions are assumed to be unanimous – everything goes through on a nod.

CEO report to Council one or two members expressed some alarm at the increase in numbers of Fitness to Practise hearings. Marc Seale smiled and chivvied things along but was picked up by new Council member Deep Sagar, a management consultant who has extensive experience of governance and management across various sectors, who said that a 10-15% increase was indeed something to be explained. In his characteristic fashion, Seale laughed and said ‘if you put a magnifying glass to the paper, then yes, you can see an increase’ and it was not until Mary Clark-Glass suggested that they might need to take on more staff that he let his mask slip. He referred to the catastrophe at the General Social Care Council (see PP36), which revealed the gap between the executive and the council through which the council then fell. With this rather sobering thought, he went on to admit that cases do seem to be taking longer which he thought the result of more complex cases coming to light. This he explained as the result of the ‘public’ cottoning on to the facility of the HPC. Sagar didn’t remark that NHS employers report the majority of cases.

Michael Guthrie presented his report of the responses to the public consultation on counselling and psychotherapy. He remarked that aside from the original consultation setting up HPC, and the consultation to raise fees, this was the largest response the HPC had ever received. He had struggled to make a quantitative analysis of the replies because people had often strayed away from the strict letter of the question. He had done his best, then, to make what he called 'a qualitative analysis' of the data.

Guthrie’s job is to set up the parameters of the database, and ensure that future FTP hearings can make use of the standards of education and training and of proficiency to efficiently prosecute their cases. He is, therefore, acutely interested in the threshold educational level for entry onto the register. The consultation responses to these questions are where he focuses attention.

Mary Clark Glass was the first to speak in the discussion. She said “I find great interest in the disputing stances” before invoking the shibboleth of “Public Protection”.

Eileen Thornton said the report was ‘balanced and objective’ and she ‘would not mind putting her name to it’.

Deep Sagar asked “would it be fair to assume that the question was not asked ‘are you in favour of regulation?’ as distinct from ‘are you in favour of HPC regulation?’” Guthrie said, yes, the question had not been asked, because the terms of reference from the White Paper and the building block blah blah, ‘so we didn’t analyse the answers in that way, and indeed it would be hard to’.

Keith Ross remarked on the constant feedback during the process, and thought the huge response highlighted the value of consultation. He acknowledged that HPC had to do some more work - ‘it seems to hinge on the differentiation, or not, between counselling and psychotherapy’.

Julia Drown said ‘we need to do further work on what is meant by the clear messages we have got’.

Jeff Lucas said ‘it is a balanced report, I share Keith’s issue that the biggest question is on differentiation.” But added that ‘the principle of differentiation is reasonably well made, though it is quite difficult to understand the number of different positions. I accept that we have more work to do on this.”

Annie Turner said ‘it is a balanced report’ and added her observations: these concerns are not new for any profession coming onto the register, and they usually soon disappear.

Sheila Drayton , however, said there were marked differences here, especially in relation to children.

Anna van der Gaag invited them to agree the text of Michael’s report for publication on the website, before inviting Marc to lead them through the decisions laid out in the executive summary.

Seale began by explaining the process of a Section 60 order. It involves a joint consultation between England Scotland, Wales and Northern Ireland, 3 month’s public consultation, debate in Commons, Lords, Commons, Lords and finally Privy Council and Scottish Parliament before the power is ‘switched on’.

It was here that he noted the new pharmacy regulator had ‘failed to get through parliament’ (as proposed in the white paper, 2007) and nodded once more to last night’s triumph in the Lords by the HPC.

The next part of the meeting was a lesson in bureaucratic politics. The Executive summary had been arranged in careful sections, each one leading to a decision requested from the council. They took them one by one.

Julia Drown wanted to know details of the timetable, and a ripple of laughter ran through the gallery when Seale said a Section 60 was uncontroversial. In his opinion, the PLG would have more work to do now than it did over the last year. Jeff Lucas blamed the ‘advanced practitioners’ who couldn’t or wouldn’t grasp the concept of threshold level entry. Mary Clark Glass said they had struggled, but clearly not enough. Julia Drown began to see the complexity but was sure that ‘we can do it’. So, Anna van der Gaag concluded ‘I think that I am hearing from you that you see the need for further work. You see the need for the PLG to help us make the right decision to take the work forward. We do want the PLG to continue”

Eileen Thornton said ‘if we are going ahead with the PLG, what about the membership? We need to reflect the disturbances that have been raised.”

“Yes, absolutely” said Anna. And so the first set of proposals were deemed agreed and the discussion moved on to the next.

Proposals for Dual Regulation were accepted, tho Sheila Drayton wanted to know why the GMC had been singled out for special treatment here. There was no clear answer given, and she let it go.

Marc Seale talked about the problems faced with multiple register transfer. From an IT point of view the data was very dirty, and time would certainly be needed to clean it all up before opening the register. “I think there is an algorithm followed by a manual process” said Michael Guthrie, when they noticed that the IT expert had chosen that moment to leave the room.

Seale said that the grand-parenting period should be extended from two to three years ‘because a lot of people leave it to the lat moment’. Julia Drown was very quick to remonstrate – this is not the right reason! Seale slithered his way out, and the Council agreed to 3 years.

This left short time for a discussion about the controversial generic standards. Eileen Thornton said that the PLG process had made quite significant changes to the wording and that the amended document was now with the original 12 bodies. Anna van der Gaag corrected her to say that they had made quite significant positive impact, and Di Waller wearily said that the other professions had not been very happy with the language of these standards for quite a while, and was pleased that they were now being ‘positively impacted’.

This is certainly a can of worms, and Eileen Thornton (chair of education and training committee) concluded by saying they were revisiting the SET 1 where problems were constantly arising, and were expected to continue to do so as the HPC ‘spread out to different kinds of registrant’.

Anna concluded by saying “I think that what I’ve heard is that you recommend … further work, further consultation, and further discussion. You wish to involve the PLG in that ongoing work, and you have not identified any specific issues to prevent us from regulating psychotherapy and counselling.

Jonathan Bracken (solicitor and parliamentary consultant to HPC) grinned widely and said ‘you are making a clear decision that you are capable, but further work needs to be done’.

Meanwhile, a collection is underway to fund a Judicial Review of the HPC (see press release quoted on 19th October on the hpcwatchdog.blogspot.com, and reported in PP31). Pledges for over £50,000 have already been received. This review will go step by step, and focus on the discrepancy between what HPC were required to do, and claimed to be starting in Dec 2007, and what they actually did (ie ignore the 'whether' and 'why' questions regarding regulation). With the prospect of a JR, the HPC will not be able to rush a Section 60 into existence - there has been talk of getting this done, and ironing out the details after, as indeed happened with the Psychologists transfer.
To contribute to this initiative you can transfer funds to JR Fighting Fund, Lloyds Bank Sort Code 30-00-04, Account 02101964, or send cheques made out to JR Fighting Fund to Pine Cottage, Thornden Wood Road, Herne Bay, Kent CT6 7NZ.

Organisers suggest £100 contributions which can be paid in installments. Andrew Samuels writes: “in 37 years in the profession, I have never seen anything like this. With the money, we can continue to instruct Bindmans, who are a leading firm of constitutional lawyers, and they have instructed one of the country's top QC barristers specialising in administrative law. She was very impressive when we met her the other day. She has agreed to work for greatly reduced fees, as have Bindmans, and neither of them is in need of our money so they will definitely not let us do anything rash. If the fundraising goes well, we will use some of the money for the campaign, placing info in national newspapers as a way of combating the spin from HPC. A fundraising committee made up of individuals from different organisations will make sure that the fund is properly administered and the money used responsibly.”