Confer Conf (Part 3)

In a small room beneath a Covent Garden Bookshop, a fluid group of 20 or so people meet monthly to divvy up parts and read Shakespeare’s plays aloud. Last week it was The Tempest. Prospero (banished from his Dukedom this 12 years) introduces his brother, now the Duke, to his daughter Miranda with these words: “Thy false uncle …
Being once perfected how to grant suits,
How to deny them, who t’advance, and who
To trash for overtopping, new created
The creatures that were mine, I say, or chang’d ‘em,
Or else new form’d ‘em; having both the key
Of officer and office, set all hearts I’ th’ state
To what tune pleas’d his ear, that now he was
The ivy which had hid my princely trunk,
And suck’d my verdure out on’t.

a little speech about the administrator gaining power over the Duke to gratify his envy and ambition…


At the Confer Conference, Dr Michael Fischer presented a summary of his work at KCL (Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling, 2009) and commented “there is a common perception in other fields, for example psychology, that an elite group has captured the regulatory process to further their own agenda.”

BPC Chair Julian Lousada (and member of the HPC PLG for C&P) had commented that he had seen no evidence that HPC regulation would change what went on in his consulting room.
This week at a major London Universtiy Psychology Deparment, this letter was sent round to the staff:

BPS and HPC accreditation visit Doctorate –
The Health Professions Council and the BPS are undertaking an accreditation visit to us. As a part of this visit they are keen to talk to supervisors and heads of service about their experience of the Course, of the trainees, and of training generally.
From past experience of these visits the HPC and BPS visitors will try to make this a fairly informal meeting, and the likely focus will be on the links between us (as a training provider) and the NHS (where the training is put into action).
We would like to invite you to attend this meeting [and] will reimburse travel costs, and provide some nice refreshments... etc

These are the points to situate what follows.

I went to the HPC this week to observe the Education and Training Committee Meeting that was billed as happening on Tuesday 2 February. The website was my guide, but no papers had been posted. I requested permission, and turned up in time for a supposed 10am start. A name tag was waiting for me at reception. After 20 minutes wait in the decompression chamber (you really have to go and discover this yourself) I asked Sonia what was up. It transpired that the meeting started at 10.30, and only one member had so far turned up. I asked if there was a pack of papers to read while waiting. She told me I should have downloaded them from the internet. I replied that the papers had not been posted, and asked if she might telephone the administrator to see if a pack were available. Slight tension. When she did, she again told me the papers were on the internet. “Not on my internet they weren’t” was the best I could do, with a smile.
The charming Steve, who had come to collect me (it is ridiculous to have to be shepherded like this – whose rule is this?) apologised for the lack of paper work – he had been off sick, but had asked someone to do this for him. They didn’t do it. As we drew near the committee room he asked if I had ever observed a panel before, and this brought me to a halt. Panel? I thought this was the committee meeting that was supposed to be discussing the applicability of the generic standards? No, this is a panel, where four ‘partners’ and three nameless administrators meet to discuss the “programmes in respect of which approval/ ongoing approval is recommended without conditions, or subject to conditions.”

This little panel was meeting to consider the reports written subsequent to visits around the country to where training is carried out by the ‘accrediting’ institutions.
Apparently, the HPC find it necessary to know each time the course leader is changed. Dr Jo-Anne Carlyle (a self employed Psychologist, Psychotherapist and Consultant) ventured a question. She said she was intrigued to discover that ‘programme leader change’ is considered a ‘major change’ and intrigued that HPC were interested in this.
Professor Diane Waller, the only member today who is also a member of the recently reduced HPC Council, said ‘it is a safe-guard for the staff’. Presumably a version of ‘protecting the public,’ in this case protecting the shrinking and frightened Programme Leaders employed in 21st century British Universities, from being forced to do something by the administrators and quality auditors at their college.

Helen Davis, Chair (Orthoptist, and, coincidentally Senior Lecturer at the University of Sheffield) added that ‘the profession finds it useful to keep a check on what is going on’.

There is a slippage between the HPC and the Profession. Here, Helen speaks of the profession as if it is coterminous with HPC. This ignores much in general, and everything that HPC says about itself – that it is independent of the professions and thus not subject to the tendency to close ranks against outsiders in order to protect itself. It also obscures the fact that it is the HPC who advertise, interview, select, train, and appraise the partners they use in this processes. Helen Davis does not represent the profession. Why does she not know this?

This week’s meeting was over in 22 minutes and the Chair said ‘we don’t get so much discussion as we did because the administrators are more involved. It is slightly more formulaic now, but more consistent.” Much of the work of the scrutinising panel is done at HQ where the administrators scrutinise the paperwork into a form that they can regulate. The administrators present at the meeting spoke almost entirely in the building block phrases of audit culture:

this is a major monitoring tool
It is subject to a major change
Scrutinise these changes by documentation
We have a 7 point programme
The committee is asked to approve
There is major impact on education providers
It is a well justified decision
An evidence based decision
It followed the logic process
We made a clear and reasoned decision.
Etc

The fourth Partner present at the panel was Mr Stephen Wordsworth (Head of School for Health and Social Care at Derby University – an operating department practitioner). At the end of the meeting, one of the administrators (surely in his early 20s) was delegated the task of guiding me back to the front door (for goodness sake). He gallantly offered to answer any of my questions. So I asked him which of the Partners was also a member of the full Council. He looked blank. No idea. What?

In the executive summary of the papers for the meeting is the statement: “The Health Professions Council (HPC) approve educational programmes in the UK which health professionals must complete before they can apply to be registered with us. The HPC is a health regulator and our main aim is to protect the public.” Etc.

There was a brief to and fro in the Panel meeting where Di Waller lamented the fact that ‘people just don’t understand’ that they can’t claim to be ‘state registered’ psychologists etc. This is an ongoing problem, apparently. People out there just don’t understand what the HPC really is. Di was surprised at the Confer Conference that people out there continue to think that the Standards of Practice and the Standards of Education and Training are being used to shape the curriculum of various training programmes. Like Julian Lousada, Di Waller seems to think that the job of the regulator has nothing whatsoever to do with the practice it seeks to regulate. Odd.

Odder still, however, is that the paperwork for this meeting, clearly states:

Introduction:
“The HPC visited the programme at the education provider to consider major changes proposed to the programme. The major change affected the following standards – curriculum and assessment. The programme was already approved by the HPC and this visit assessed whether the pro¬gramme continued to meet the standards of education and training (SETs) and continued to ensure that those who complete the pro¬gramme meet the standards of proficiency (SOPs) for their part of the Register.
Under ‘Sources of Evidence” a series of tick boxes ask:
‘Mapping document providing evidence of how the education provider has met the SETs’ and
‘Mapping document providing evidence of how the education provider has met the SOPs’.
Under the Recommended Outcome:
“To recommend a programme for ongoing approval, the visitors must be assured that the programme meets all of the standards of education and training (SETs) and that those who complete the programme meet our standards of proficiency (SOPs) for their part of the Register.” …
“The visitors agreed that 47 of the SETs have been met and that conditions should be set on the remaining 10 SETs.”
“Conditions are requirements that the education provider must meet before the programme can be recommended for ongoing approval. Conditions are set when certain standards of education and training have not been met or there is insufficient evidence of the standard being met.” …
Well, I suppose that solves the mystery of why on qualifying people advertise themselves as state registered, and also how the standards of training and proficiency work their way into the curriculum. One mystery still remains, however. Di was at pains to state that just because someone successfully completes an approved course, they are not automatically entitled to register at the HPC. Apparently people are asking why. Whether or no the why is answered, the fact remains: you have to apply to the HPC, who may turn you down, even with your new qualification from the approved course.

At the Confer conference Marc Seale kept saying that nothing was set in concrete, and that it was always possible to interpret. He also said that the HPC does not negotiate. At the time, these things seemed strange and meaningless. With a little time and attention a meaning emerges from the fog: nothing is set in concrete for Marc Seale for he is the new Duke; he and his acolytes can interpret the rules whichever way they like, and they don’t need to negotiate with anyone not in their clique. It is precisely this kind of thing amongst professional groups that is supposed to have provoked the need for the HPC in the first place (see Ian Kennedy’s Unmasking Medicine for a quick introduction to the argument).

The Shakespeare Readers Society is open to all. Info at
http://www.facebook.com/pages/London-Word-Festival/76602824994?ref=mf#!/event.php?eid=262356745978&ref=mf