HPC PLG C&P 12 May 2010

Here is a report edited from my verbatim notes of the first part of last week's meeting. This group has already 'worked' on the 'problem' for over a year, but nevertheless seems to be approaching something vague and anomalous almost for the first time. After a brief intro, the dialogue is presented to reveal the chaotic character of the meeting.

HPC President Anna van der Gaag closed the meeting at 2pm on the dot (as predicted in the plan) with the words:

“Thank you, we’ve got a huge amount from you today”

None of the members of the PLG seemed to notice, but one or two in the public seats repeated the words while looking completely stunned.

The last time we all met in this neutral venue (Avonmouth House) Chair Di Waller had opened the meeting with a small lecture to the effect that members of the PLG were not there to represent anyone other than themselves. They had been recruited as individuals. This message was deemed necessary in order to counter the mounting criticisms that the PLG did not represent ‘the field’.

Today, at 10.30am on the dot Gaag opened the meeting (Di Waller being unwell) by going round the table inviting reflections on progress to date. What follows is edited from my verbatim notes. My comment is at the end.

FBD: Fiona Ballantine Dykes (who happens to work for the CPCAB): the landscape is different on many levels, and it raises questions: for example, what does this group need to do carry the confidence of people we represent. There are still some fundamental questions about the function of regulation, and we need a discussion about how regulation under HPC will be acceptable to the field. The details are secondary to that.

JC: Jonathan Coe (coincidentally, CEO of Witness – whose charity status ceased to be recognised by the Charities Commission 10 Feb 2010): generally there has been a good degree of progress, and I share Fiona’s view that we need to get collective backing of decisions made by the group.

BM: Brian Magee (COSCA): The time it has taken! HPC need to keep the information flowing and keep people on board. The December Council meeting raised expectations that things would move faster than they have.

AT: Annie Turner (an occupational therapist on the HPC Council): Standards of Practice - a lot of work still needs to be done on these. But I’m pleased with the work HPC have done on Generic Standards, which will move us forward. It will move the whole thinking in HPC forward from past paradigms, it will keep professions thinking forward. Any disagreement is second to that. We have a mountain to climb, and must make a leap forward, and we must do the background work.

LM: Linda Matthews (BABCP): There have been lots of discussions, people have anxieties, some are indifferent, and some are looking forward to HPC regulation. There has been a lull, and we need the HPC to take us forward while we try to take our members with us. The time-table leading to Feb 2011 is daunting [pause] but we are hanging on in there. It’s a joint approach and we are happy to be part of that.

MC: Mick Cooper (a Counselling professor who works in Scotland): I was struck by the responses to the consultation; there were meaningful, clear responses in a number of areas, decisions where people are comfortable and happy. I feel optimistic about moving forward. The consultation was useful.

JM: Jean McMinn (a counselling teacher, who works in Northern Ireland): [very quiet] … whether we have got both titles and levels of entry right?

PB: Peter Bell: This looks different depending where you are, I’m with BASRT, Relate, and a practising counsellor. Relate is not a professional body but a deliverer of services. Each of these positions has a different view, because there are different consequences. But what about the external forces – they will have their influence, the change of government, for example, what will that mean?

SA: Sally Aldridge (the Director of Regulatory Policy at BACP): we still need to convince some people out there to trust the HPC. SoPs go some way to do that, and we’ve used this to define the profession. But we must remember to set standards to protect the public, and not to protect the profession.

PF: Peter Fonagy (Skills for Health, BPC, UCL): This has been an interesting process for me personally, and I’m extremely grateful to have been able to participate. It has taught me things I didn’t know before. In the meantime we’ve [DH] managed to determine the NOS for Psychoanalytic/ dynamic Psychotherapy and the world did not immediately cease to turn on its axis! Out of controversy we gained a consensus that people were able to sign up to. So, here, it is critical that questions are raised about the competence of the regulator. We need to see what criteria are used to judge whether HPC is actually working. This will only work if it is voluntary. Is this group representative? Are we checking back to see it has validity beyond the people here. It can only work if it is voluntary. A sub group is saying that it won’t play, so we need to address this, we need to actually listen, and produce documentation to show the HPC as willing and flexible… We can be the arbitrator between the profession and the HPC.

JL: Julian Lousada (Chair of BPC): I was wondering how the PLG thought it would acknowledge those opposed to its project. Some of us have tried to engage with them but it’s not easy – but we shouldn’t give up. How can we ensure as we proceed that the Professional Organisations see themselves as central to the process. HPC doesn’t exist in a vacuum, but in a vacuum that has a relationship with the organisations [sic]. The Profession will not be strengthened if there is a weakening of the organisations.

CA: Carmen Ablack (a body therapist with the UKCP): I’d like to name the small elephant in the room: Opposition. Out there are different levels of opposition and anxiety. There are those who oppose the idea that this is a HEALTH profession, those opposed to aspects of HPC operations in the past (which we can see change attempts). Those who need clarity and assurance. Different kinds of concern and opposition – it’s not all one thing. If Kathy were here she would stress the importance of the partnership with professional organisations. I guess we do need to name the reality of changes [Chair of UKCP? Government? Who knows, they weren’t named]. Also, it is important to note that the responses to the consultation took very different forms – we in UKCP asked our members to respond to us, then we made one response to HPC, this distorts the statistics of response kept by HPC as not all organisations did the same thing. The responses are not equal and can’t be represented as such.

PF: I’d also like to congratulate Michael [Guthrie] on the rigorous, robust, transparency of his documents, and to tell him I would be happy to offer him a job at UCL. Ha, ha, ha, ha, ha.

AvdG: In the words of Nelson Mandella, our strongest weapon is dialogue. We must not be distracted from the work we must do in this group. It’s a difficult balance, we must bring more voices in to the debate.

MC: Mick Cooper then got the discussion to focus on how to include more Users in the process: “this is a major omission,” he said. This passed the conch to Jonathan Coe who said: the purpose of Statutory Reg is public protection. What is the nature of protection here? We need to talk to people who’ve been harmed. There’s been a survey by Mind, and Witness has run Focus Groups. We need a range of different ways to sample this group, and we need to be sensitive to the information, which cannot be given in public [sic].

PF: We need to say what HPC FTP has to offer here that is better than what already exists.

AvdG: We offer Statutory Regulation.

PF: We need a detailed Qualitative Inquiry on the impact of the system; and we need to acknowledge that this is the project of protecting people against human frailty. P&C are different in terms of regulation - do the HPC mechanisms meet the needs of therapists or not? It can be tested.

CA: There’s a diversity of clients, we need to understand the impact of regulation on these different populations.

LM: Is regulation suitable for C&P – are the public getting what they need from us if we are not regulated.

AT: a question for Peter: you say that psychotherapy and counselling are different. Different from what, different to what? We all work with vulnerable people you know.

PF: to me, it is the relationship that is the service.

[MC, LM both vigorously disagree and SA says she doesn’t understand.]

FBD: You need service providers to buy into the service of the HPC.

AT: what difference does it make to us, that you are different? [as this is delivered as a rhetorical question it elicits no answer]

PB: People these days are being sent by social care, GPs, the courts, other elements of the statutory centre, they are not coming to us of their own accord, they come with a message from the other which says ‘fix me’, get me back to work, make me a better parent. It’s different today. We need to consider the different kinds of service user we treat these days.

MC: independent focus groups need to look at this.

JC: What is the nature of risk in this sector? Private practice?

AvdG: what can we do practically to resolve this [can of worms]?

FBD: What impact will this have on services?

SA: It’s a big project

LM: it’s a huge project

AT: We need to look at the public we aim to protect. Not everybody, obviously, but what do we want to learn from the people that we talk to? And we need to know how sufficiently representative they are.

JL: How can we say to users this is why we think HPC will be an improvement?

BMcG: What about the International perspective? What can we learn from Australia, Europe?

AT: Will the Bolognia protocol affect you? [Stunned silence]

PF: It will turn British Higher Ed upside down [Stunned silence]

FBD: The quality of relation cannot be captured in SoP.

MC: Shall we invite an educationalist to advise whether entry level will impact on Standards?

AT: We should probably own that [sigh] well the usefulness of SET1 [pause], how it is used, [pause], well, if its used divisively in the profession then that is not good for public protection. This challenges council members. Considerable concern is coming to the Education and Training Committee. There is no wide consensus. We need more work to remove that Standard. [Brightens] It is almost a red herring, really, but [pause] what does it actually mean? [dipping again slightly] We’ve all been challenged by this.

FBD: The relationship is important.

PB: The relationship

AvdG: We are broader than health now, we can do it.

AT: I think this could be said for any practitioner.

AvdG: we won’t agree today, as we didn’t before, but we might in the future.

MC: No!

CA: I’ve witnessed the unfolding of issues over the last year, you’ve already done this. Lets name it.

SA: Should we look at the curriculum of all the training orgs? This will tell us what is going on out there.

AvdG: Who do we need at the table?

Voice: GOD

LM: Yes, I said that before too.

JL: So many presentations, its too much! We need to battle this out.

PB: what about employers? What about the opponents? [my neighbour asks me to note that it is now 12.10.]

MC: What for?

FBD: The HPC has proved itself open and willing to listen.

LM: They could give us stuff we are missing, though this is not a forum against HPC. We have emails from people with concerns about this, and we can help them through it.

PF: we need to hear the objections. We are the mediators between the field, and the HPC.

AvdG: Shall we have some lunch?

After lunch Gaag asked for outstanding questions. Julian Lousada tried to get the group to acknowledge the uniqueness of the relationship in this kind of work. He failed. Again, he tried. “How do we expose people to the clinical work?” he asked, before summoning the courage to add “do they have personal therapy?” then collapsed and added “Can we ask users whether they think they’ll get a better service if the practitioner they see has gone through their own therapy?” Sally Aldridge said “no matter how important it is, is it relevant here?” This, of course, is an excellent question, drawing attention to the fact that this meeting is about writing HPC documents which have no relevance to current practice except to sound its death knell. No-one indicated they heard, let alone understood what Sally said.

The discussion was degenerating by the minute and ended up discussing whether to meet in large or small groups, whether to have 5 minute or 50 minute presentations, and finally whether to meet at 10am or even 9.30 in order to get through the huge amount of work implied by their discussion. Gaag resisted all of this and said that 10.30 was fine and then concluded in a very calm voice, saying: “Engaging with those who oppose is very much about providing public meetings in all four countries to discuss all aspects of regulatory framework. Each aspect of regulatory practice will be presented and there will be lots of opportunity for Q&A, and within that there will be those who express strongly held views.”

I think it was Brian Magee who said – “and what will happen then? This is what happened in Manchester, and we were never given the opportunity to discuss it afterwards.”

Gaag smiled pleasantly and drew the meeting to a close. “Thank you, we’ve got a huge amount from you today”

COMMENT: The opening hour of the PLG let the members voice their concerns that the HPC process does not meet the needs of C&P. The rest of the meeting saw Gaag slowly override those comments and return to her business, ie to get what she needs to do in order to present the HPC as one that has ‘consulted’ with the appropriate people, ie 'users' . This idea comes 18 months after the HPC process began.

In the workplan (hardly discussed in the meeting), the business of constructing SETs and SOPs is scheduled for after the S60 is written. The DH is not interested in these, so HPC doesn't need to show that work is progressing - DH trust them to know what they are doing! However, as the HPC is staffed by administrators who know nothing of the practice they want to regulate, they delegate this work to a few people in the profession who in turn need the HPC to tell them how to do it because, as Annie Turner frequently says: they do not reflect current practice, but must invent something totally new.

If the HPC doesn’t properly define the profession (one of the major problems for this PLG is to maintain the impression that they are all from the same practice) and then does not allow the right Professionals sufficient time and resources to do the job then it can only succeed in laying the ground for imposing a set divisive and stupid standards. They are now no longer able to maintain ignorance on this: Annie Turner mentioned the growing concern in the Ed & Training Committee, where the Standards of Ed & Training are already showing signs of producing divisive fighting in the field it is supposed to regulate.

Group members raised some interesting points in their discussion, but the implications of their questions, had they followed any one of them through to its conclusion, would have upset the HPC if only because they would recognise the real time and work implied. Hence no meaningful discussion was allowed to establish itself - this is typical of these PLG meetings.