Part 1: An in depth analysis of a fitness to practise case

On 1 July 2009, the UK Parliament delegated power to the Health Professions Council through a statutory instrument to take over the registers of practitioner psychologists from the British Psychological Society. Up until then the BPS had been opposed to regulation by the HPC, and had been working towards statutory regulation by a specialist psychological council. It is important to understand the difference. Instead of delegating power to an organisation that has been built up over time and proven itself trustworthy in terms of practice, administration, and knowledge, the Labour Government passed secondary legislation to create a new quasi-autonomous non-governmental organisation (QUANGO) and delegated the power to it. This organisation, the HPC, subsumed the role, staff and premises previously held by the Council for Professions Supplementary to Medicine (CPSM) but with new and changed powers.

The HPC is essentially an administrative centre which holds a database, divided into 15 sections each of which represents a separate type of practice (a full list is available on the HPC website). Before 1July 2010, the Council of the HPC was made up of 1 person from each of the regulated professions, plus the same number of laypeople (ie people not on the register). On July 1 2010, the Council was reduced in size. This effectively put paid to the idea that the Council required representatives from the different groups within it. It is important to realise that the HPC is not set up to work on any kind of democratic principles, the Council is not voted into position but is appointed by agents of the Privy Council - The Appointments Commission (this was established as the NHS Appointments Commission in 2001 to provide ‘an independent and transparent appointment process’ for public appointments, as an 'arms length body' of the Department of Health, https://www.appointments.org.uk/Home/AboutUs/Background 6 July 2010). The members do not ‘represent’ a constituency. The HPC was created by parliament and given powers to levy an annual fee on the members of its register, but there is no system in place whereby those who pay the fee can monitor or influence how it is actually spent. The HPC is accountable only to the Privy Council, a small group of MPs and Peers made up of members of the Government.

The most problematic aspects of the HPC are, therefore, the lack of a perceptible identity, the lack of practical mechanisms of accountability, and the split between administration and the practices it might otherwise serve. In fact, the administration has been set up as the new master in this relation, and it is the practitioners who are placed in a subservient position. They are essentially powerless, effectively disenfranchised.

I am going to characterise this as the problem of nothing. Wittingly or otherwise, the HPC has been set up on nothing. Nothing holds it together, nothing other determines its direction, nothing holds it fast to anything real. It should have been set up with the wisdom of zero, where zero ciphers something that is real. This ‘something real’ is what practitioners, in virtue of their work, are required to know something about, and to be able to work with effectively. This is what justifies their existence.

The problem with nothing is the difficulty it has in holding a position. This can create problems for the agents responsible for bringing the HPC to life, and might all too easily result in their looking for something more tangible to fill that place. This makes for slippery work: words will be proposed as anchor points, but without real meaning (ie nothing to grip onto, to hold them in place), then other words will find their way in, and it will seem as if people are making it up as they go along. This is where the HPC can all too easily become, wittingly or unwittingly, a pernicious, insidious and even destructive force.

As previously mentioned, on 1 July 2009, the UK Parliament delegated power to the HPC to take over the registers of practitioner psychologists. On that same day a new structure for Council was proposed and a new recruitment campaign was launched to fill the new positions. One of the new Council members happens to be a psychologist who, like most of the other Council members, is also an active academic. As soon as the power of the HPC was activated, a complaint was made about this registrant and was sent to the HPC. This is the story of that complaint.

The first time the public learn anything about this is about nine months later when notice of the hearing is posted on the HPC website about 4 weeks before the scheduled hearing date – auspiciously, it was the ides of March. The full allegation runs to seven numbered points. A psychology colleague spots it, I recognise the name of the new Council member, and the two of us decide to take time off work in order to observe the hearing.

The hearing room is a large bright modern room with tables arranged in a large oblong surrounding a big empty space. Around the table the actors sit (nine or ten people at any one time) with uniform nameplates in front of them. There is no visible cue as to the formal position each holds (except for the stenographer), no clue about how the power is distributed – the appearance puts them all on the level.

At one end of the room, near the door, two rows of chairs are set against the wall for members of the public and the press, which gives us some bearings. The stenographer sits in front of the public with her back to them, and she will transcribe onto her recording device all the words spoken. The chair next to her is empty until the first witness is called.

We (today’s audience) have been kept waiting in the small reception area at the other end of the building until the registrant, the lawyers, and the administrators have taken their places. We are met and invited to sit in the corner by the hearing’s officer, who seems to be anticipating a crowd of late arrivals. Two of us are wearing the yellow tags designating us as members of the public, and the other two are wearing the red tags reserved for the press. One of these is there on behalf of a press agency (his story of the event will be sold on to other newspapers without his authorship being recognised publicly), the other is from the Daily Mail.

Then the Panel enters. This is a highly symbolic act that transforms the room into a legal entity. The Panel is made up of three people, only one of whom is a registrant from the same practice as the accused; of the other two, one may be from another HPC regulated profession, and at least one (ie maybe two) will be a lay member (ie not a registrant). They always act as one, rising together, sitting together, entering and exiting the room together. They must come to a unanimous decision. They take up their seats – they always sit near the door, along the long right hand side of the oblong (from the audience’s point of view).

“Good morning everyone…”

This opens the event, and the stenographer begins her long day’s work.

“I am Clare Reggiori, the Panel Chair, and like my fellow Panel members, I am independent of the HPC.”

This statement is a little bit unusual. I have not heard a chair stress his or her independence before and although the panel members are obliged to reach an independent decision, they are in fact partners of the HPC: selected, trained, appraised, and paid by the HPC. As an example, at another panel (the hearing of a speech and language therapist) the Chair began like this:
“Good morning, ladies and gentlemen. I would like to open this Health Professions Council Conduct and Competence hearing by introducing the panel. On my right is Miss A B; a lay partner, on my left is Mr C D, a speech and language therapist and my name is John Smith. I am a lay partner with the HPC and I am chairing the hearing today. Perhaps we can go round the room and my colleagues can introduce themselves.”

Perhaps Miss Reggiori had been specially appointed from another regulatory body in recognition of the registrant’s membership of the HPC Council. It may also be that she simply felt it important on this occasion to remind everyone that the Panel were duty bound to make their decisions as independent subjects, something like a jury in a court, and without concern for the image or business of the organisation itself, without concern for the HPC. The gentleman to her left seemed puzzled by her statement, and said

“I am Richard Birkin. I am not quite independent; I am the Registrant Panel member.”

If Miss Reggiori meant she herself was not a registrant member of the HPC this was again not clear when the lady to her right said:

“I am Jillian Alderwick. I am the lay member of the Panel.” (emphasis added)
Although there are only about a dozen people in the room, the rules of procedure prohibit questions from the audience, and as no-one else asks for clarification, the anomaly remains unexplained. The Chair then invites the registrant, who is sitting opposite the Panel, to state his name. This is also a slight departure from the routine I’ve observed before, which typically simply goes anti-clockwise around the room thus ending with the Registrant – Dr Malcolm Cross. His representative, Mr Tyme, sitting to his left, is next, then comes the HPC Solicitor, Ms Kemp, who is sitting next to him. These three are seated along the other long side of the oblong, facing the panel, but the distribution of these three clearly reflects a different arrangement from those that they face. While the Panel is arranged evenly around the Chair, the prosecution and defense leave a space between them, so that the registrant and his lawyer are bunched at one end of the table, and the HPC is at the other.

Along the top (short side) of the oblong, the Hearings Officer, Akua Dwomoh-Bonsu, is next to say her name; next to her is the Legal Assessor, Mr Russen, who makes a short speech:

“I am Simon Russen. I am the Legal Assessor and I am afraid I have to be a bit longer than everybody else because I have to say what my job is and what my job is not.”

A lay-person would be forgiven for thinking that Mr Russen is the Judge of this court. In one way, he is, but in another he is not – as reflected in the manner in which he begins. In this new regulatory environment the function of the Judge appears to have been carved up and redistributed largely to the Panel. At times it is helpful to think of the Panel as the Jury, but in fact its role is more complicated and its composition is quite different. It is empowered to act as judge, jury, and also inquisitor (both for the prosecution and the defense). With the function of the Judge thus fractured, Mr Russen and the Panel must learn how to dance together without touching, or better, without being seen to be touching. When called to act in particularly legal ways, the Panel (essentially laymen in relation to the law) need to make use of his expertise, and there have been times when I have observed that this dependency can become extreme. But it is not for this reason that he has decided that he needs to say quite a lot about the nature of his role; his long intervention here is not typical. He goes on:

“First, I am not a member of the Panel, so that when it comes to decision-making, I do not participate in those decisions. All decisions are for the Panel and the Panel alone. I am a lawyer, and my primary job is to ensure that these proceedings are conducted properly in the sense that the correct procedure is followed and the right law applied.”

Such might be expected from a judge, but he goes on:

“I can, of course, seek to help other people with those issues of procedural law if they wish me to do so.”

Thus he is there for the edification not only of the Panel, but of any of the actors at the table. This essentially establishes him as the master of the law, but this colossal skill (recognised in his fee) does not, in this setting, grant him any formal position of power. He must present himself as a servant. This produces an anomaly.

“As to how I go about doing my job, if the Panel are in this room then so too will be Dr Cross and Mr Tyme and they will hear what I am asked and how I reply to it and that ensures that the lady sitting over there makes a record of it and you have an opportunity to have a say about it.”

This information seems to be directed to the world at large, but might be meant specifically for Dr Cross designated by ‘you’ in the last few words. If this is the case, then perhaps Mr Russen is reassuring Dr Cross that the Legal Assessor is not biased in favour of the others, who also happen to be paid, like him, by the HPC. This, of course, raises questions about what happens when Mr Russen is required to speak to the Panel when they are deliberating in private. He addresses this point now:

“But the rules do allow Panels to ask for advice when they are in their private room. That is permitted. But if it happens in that way when we are next in here, I will [when back in the hearing room] summarise the request that has been made of me and summarise how I have replied to it, again, to ensure that it is recorded and you have an opportunity to comment on the advice I have given.”

He indicates that he is subject to a natural justice wherein the representative of the accused may challenge anything that seems prejudicial to his or her client. The function of the judge, then, seems to be distributed throughout several people in this kind of court, and creates an appearance of leveling. But we haven’t finished yet, he continues:

“And, finally, it is often the case that the Panel ask Legal Assessors to help them with the drafting of the decisions that they make along the way. That is permissible, but if it happens, two things; one, it is important that you should remember that it is only with the wording of the decision the Panel will already have arrived at, and, two, I will disclose the fact that I have had a hand in the drafting of it.”

This seems very pedantic, and it isn’t really clear why so much emphasis needs to be given. It rather suggests that the reality cannot be left to speak for itself, but must constantly be reminded of the place it is supposed to occupy.

For a comparison, here is the introductory statement made by the legal assessor in another case:

“ THE LEGAL ASSESSOR: My name is Angela Hughes and I am the legal assessor. My role is to advise the panel on law and procedure and to ensure that proceedings are conducted fairly and properly. I am independent of the panel and any advice I give to the panel will be placed on the record. I may be asked to assist the panel with the structuring of the decision. If I do so, I will only be asked to join the panel once it has reached its decision. I do not participate in the decision-making process itself.”

All the information is presented here in a much more simple, shorter, statement. What explains this slightly different tack?

Once Mr Russen has finished, the Panel Chair regains control. She addresses the accused directly and explains to him the procedure they are about to follow. She ends by giving the traditional assurance that:

“At the conclusion of the case, the Panel will have to consider whether the allegation is well founded. And that is all the Panel will consider at that stage. If the allegation is not well founded, then that is the end of the matter. If, however, the Panel find that the allegation is well founded, then we will move on to consider sanctions, but we only reach the sanction stage if we find the allegation against you is well founded.”

This is a version of another standard statement; here is one from another case for comparison:
“The panel will retire to decide whether or not the allegation is well founded. When we return, I will read out our decision and depending on what it is, at that point we may seek further submissions in relation to sanction. That is the process we are going to follow today. Is that clear?”

In today’s case the Chair stresses the phrase ‘case well founded’ – she repeats it four times in the course of four sentences; this raises a question about what might lie behind such an excess of emphasis.

The panel chair then asks that the allegation be put. The HPC solicitor intervenes with two preliminary matters. First is an administrative one, which concerns whether the bundles of paper in front of everyone contain the relevant pages. This is not uncommon, and reminds us of the administrative nightmare this formal procedure must be. Second is something called a Notice of Hearing:

“… I understand from Dr Cross’s representative he wishes to make a preliminary application before the allegations are put, so I will hand over to him to make that application.”

At this point the Mr Russen leaps in:

“Before the allegation is put?”

“Yes” says Mr Tyme

Mr Russen: “It would be unusual for the allegation to be put so the Panel would be able to focus on which bits of it are disputed.”

There is a very brief pause while the Mr Tyme consults quietly with the Mr Russen, before capitulating.

Mr Tyme: “You can put the allegation”

Why did he abandon his original plan, which we know was discussed with the HPC solicitor? It is a question we can hold onto, even though we cannot ask either of the actors involved. It is possible that they don’t even know.

So, the Hearings Officer then reads out the allegation, which has been posted on the website for the last four weeks:

1. On the evening of 8 June 2009 in the course of a briefing meeting and dinner prior to a BPS accreditation visit the next day to the University of West of England of which you were convenor:
(1) you were drunk.
(2) because of your drunkenness you were incapable of chairing the briefing meeting.
(3) you were rude, condescending and aggressive towards a British Psychological Society employee (MR).
(4) you touched yourself inappropriately
(5) you threatened to expose yourself.
(6) you attempted to touch OH and SP inappropriately
(7) you made lewd suggestions to OH.
2. The matters set out in Paragraph 1(1) to (7) constitute misconduct.
3. By reason of that misconduct your fitness to practise is impaired.

Now that we have the allegation in front of us, there are a few things to notice. First the date of the activities in question are nine months before the hearing. This is half the usual time it takes. Second, the occasion of the allegation is non-clinical. In fact it is not even academic. The occasion is an informal meeting out of working hours, a private dinner, a social occasion for a few colleagues. This presents a contradiction which is disturbing: on one hand there are signs that this is a case rushed to hearing which could imply that there is a higher degree of danger to be dealt with than in other cases; on the other hand it seems that we have a non-starter – there is no practice, no patient and no public; this scene is, at the very least, a semi-private, social occasion. In order to resolve the contradiction, we might begin to assume that the conduct at the social event was very bad indeed, yet not so bad as to fall within the purview of the regular law (assault, drunk and disorderly, etc) – our interest is naturally piqued at this level; we want to know what is going on. At the same time, though, we know that this is really none of our business.

So, what interests us here? My argument is that the HPC is set up on a false premise, and a false promise – there is nothing of substance at its heart, and this makes it liable to do no good. This case is extremely useful for showing many aspects where the HPC errs, and this is, in my view, necessary to put a limit to this damage.

Mr Russen continues: “Now, I wonder if I could just explain this. It is usual to ask a Registrant ... if they wish to respond to that allegation, but it is my practice to proffer some explanation before that opportunity is taken up, if it is. And it is this, that there are three distinct elements included there. And they are the three elements reflected in every HPC allegation, and they are as follows: one, the facts, and they are the facts that are alleged in the first paragraph as subparagraphs (1) to (7) inclusive. Two, whether the facts amount to misconduct, that is to say HPC-relevant misconduct, and finally, if the facts did historically amount to misconduct, whether they are currently impairing the Registrant’s fitness to practise.”

So here again we are invited to think about three basic building blocks of HPC hearings, which simultaneously asks us to accept that it is right to consider this case, and which encourages us once again to bring the as yet unfounded allegations into the frame. He continues:

“Now, it can be very helpful for a Registrant to respond to the factual element of the allegation because that is something which, typically, a Registrant knows about. But a Registrant might wish to respond to the issues of misconduct and current impairment to fitness to practise. But even if there is a response to that the advice I would be giving to the Panel is it is a matter for them to form their judgment about in any event.”

The LA seems to be saying nothing. But he is not yet finished:

“So it is now, I think, Mr Cross’s [sic] opportunity to respond to the allegation which, of course, you do [through] Mr Tyme, but it is worth focusing on the fact there are those distinct elements of the facts, whether the facts were misconduct, and if there was misconduct, whether there is a current impairment of fitness to practise.”

This statement is very difficult to grasp – the grammar is slipping away from Mr Russen’s control. However, what comes over is that he is simply elucidating the formal and standardised process: those three steps already mentioned that will help to discover whether (1) the man here is guilty of the facts, (2) the facts amount to an offense, and (3) that it matters. But what function does this repetition have in today’s process? Judging by what happens immediately afterwards, it seems to have been done in order to confuse and disorient Mr Tyme. He might have known what he wanted to say before the allegation was put, but now he seems to have almost completely lost the plot:

Mr Tyme: “I have indicated to Miss Kemp. She is aware of the proposed application. It is simply this, if I can indicate and take you to the evidence of Owen Hughes and Sally Ross in the form of the statements, documentation disclosed in the bundle. For present purposes, and for present purposes only, I have to assume that the facts are as presented for the purpose of this application only.”

It is very difficult to grasp what he is saying – but on second reading I understand that he is drawing attention to the written word, those contained in the bundles and which have a special attribute in the proceedings.

“However, if I can draw your attention to, firstly, the evidence of Owen Hughes, and you will find at P3 of his statement, and if I can be as neutral as possible in summarizing, Mr Hughes attended the pre-meeting on 8 June. There was some discussion, there was a social element, a large social element of the evening. There was a meal and there was drink had. And it is alleged that Mr Cross was inebriated, drunk.”

He seems embarrassed and ill at ease: he had wanted to avoid any of these words entering into the frame today, yet he finds that he cannot avoid them coming out of his own mouth. He is caught in a trap even as he tries to avoid the trap. This trap was sprung in the quiet word that Mr Russen had with him just before the Hearings Officer read out the allegation. We have noted that the conversation he had with the HPC lawyer had led him to believe he would be able to carry out his original plan. We might expect that as a paid representative, probably a lawyer, he would have understood the law of the process. [Footnote: a few weeks later at another hearing, I was chatting to the news agency journalist, who has listened to a lot of these hearings. He stressed the importance for a Registrant to get a really good lawyer, which, he added, was one with experience of working in the HPC.] He stumbles on:

“At paragraph 3 you will see the final sentence where Mr Mattews said: “The format of the visit was to include a pre-accreditation meeting [of the BPS], a social [meeting] and, the following day, the formal accreditation meeting with members of the university.”

“So in essence, what you have is a pre-meet, those who were attending the accreditation met in advance to ensure that all the participants were present and ready to attend the accreditation on the following morning.”

The point he is driving at is that this was a private, social occasion, and is not relevant to the HPC. But he does not come out and say this. If this is indeed the point he is trying to make, then it makes sense to say it before the allegation is read, for once the allegation is in public, some damage to his client’s reputation is already done. This raises the question of what someone can do to remove the allegation from the website if they think the HPC investigating committee is doing shoddy work. But there is still some way to go with this intervention:

“You will see, if I may then direct you to page 24 which is, you will see it is the letter which was referred to signed by Sally Ross dated 17 September 2009. It is the third paragraph before the end and it begins “if I may”. Ms Ross describes the behaviour that she complains of and goes on to say importantly: “However, whilst it is my job to attend such events, and each minute of my time spent on an accreditation visit is classed as work time, for colleagues acting as accreditation team members, it is a voluntary commitment and one which falls outside of their normal work commitments. It should also be noted that the pre-meeting was held at a time which is outside normal working hours to the volunteers. Further Dr Cross’s behaviour on the day of the accreditation visit cannot be faulted and could only be described as exemplary.”

It seems quite clear now that Mr Tyme is trying to put into question the very idea that there is any case to answer; more, he is questioning the HPC’s assumption that there is actually anything on which to erect a case. This would be sufficient to make him go right round the houses – to challenge the very process that is sanctioned by law itself is to shake your fist at God. This is something Shakespeare spent most of his plays telling us was a very dangerous thing indeed. We still have more than half a page of transcript to go. Perhaps it is not surprising, now we understand the pickle he finds himself in, that he goes on to shoot if not himself, then his client, in the foot:

“… So, therefore, in my submission, with reference to the three limb test which has quite correctly been pointed out, I query, in my submission, make submission that there is not sufficient evidence of impairment in this conduct. Misconduct maybe.”

Misconduct maybe? What leads him to suggest that the case is a non-starter, and then immediately imply, strongly, that his client has probably misbehaved? But even now he has not yet finished:

“And I would invite this Panel to consider whether or not, based on the evidence as it stands, and this is the totality of the evidence before you today in relation to the specific points, of his capabilities and the manner in which he performed, whether or not that is sufficient to amount to an impairment of his fitness to practise. That is my submission.”

The Chair is obliged to ask the HPC solicitor to respond. She uses the opportunity to repeat the HPC position, that she is confident that there is a case to be answered. However, before she restates her main points, she does concede that the Panel could dismiss the case at this stage if they thought that the evidence before them was not sufficient to find the Registrant’s fitness to practise impaired. That is, if the Panel think that what someone does in private is irrelevant to their business, they may throw a case out. This, however, as the LA will soon say, would imply that they thought their colleagues in the Investigating Panel had done a shoddy job. It is not clear how the HPC solicitor is implicated in this charge; it is not clear to what extent the research thus far carried out by HPC has been done by her. Miss Kemp continues:

“However, it is my submission that there is evidence before you which you should consider in respect of the allegation that fitness to practise is impaired. This is because impairment of fitness to practise, albeit an undefined concept in the Health Professions Council’s legislation rules has been defined or considered in the High Court in a number of cases, and it is referred to in your Practice Note on finding of fitness to practise is impaired which is a Health Professions Council’s practice note. It is referred to in that Practice Note what a Panel should consider. I understand that the Panel has these practice notes. The Practice Note on page 3 refers to the case of Cohen v The General Medical Council and the reference is EWHC 581 (Admin).”

This is verbatim from the transcription, and is quite difficult to follow. She appears to say that fitness to practise is an undefined concept in the HPC’s legislation, but that one can deduce its meaning through High Court decisions on a number of previous cases. It seems that the wisdom of the High Court over the last eight years has been reduced to a practice note issued to the panel – a bureaucratic item. Yet she then goes on to quote one of the cases that informs this organisational rule, and we see it is from the General Medical Council. It is not clear why this is relevant here, nevertheless, she goes on to give her synopsis of that case, and no-one shouts ‘objection’:

“The High Court in Cohen said that the Panel is concerned with the issues of whether in the light of any misconduct proved the fitness of the health professional to practise had been impaired taking account of the critically important public policy issues. It goes on to say that those public policy issues are, the need to protect the individual patient and the collective need to maintain confidence in the profession, as well as declaring and upholding proper standards of conduct and behaviour which the public expect, and that the public interest includes, among other things, the protection of patients and maintenance of public confidence in the profession.”

Is the GMC case common currency amongst those present? To me it seemed a strange reference point and one that served only to remind everyone that a more powerful body is somehow on the side of the HPC – in short, a lawyer’s trick but no-one picks up on it. She goes on:

“Those public policy issues and those considerations can take two forms. They can take the form of a consideration of a Registrant’s capability in terms of their ability to practise. But also their suitability to practise. And suitability takes into account personal conduct. And this is a case that involves such conduct, and one of the aspects which Registrants of the HPC are required to consider which is set out in the Standards of Conduct, Performance and Ethics at Paragraph 3 is that Registrants must keep high standards of personal conduct. It says “You must keep high standards of personal conduct, as well as professional conduct. You should be aware that poor conduct outside your professional life may still affect someone’s confidence in you and your profession”.

“So whilst it is accepted that this incident involving Dr Cross occurred in, effectively, three stages. There was a pre-meeting in respect of the accreditation visit. Then, secondly, a social event. And then, thirdly, there was the accreditation visit itself. You can look at conduct which occurred in the social aspect of this case, but also in the pre-meeting which was in work context. So those aspects of conduct can be considered. In my submission, there is evidence which goes to personal conduct which falls to be considered [sic] and it would be better dealt with by the Panel in my submission if it were to hear the evidence before you today. So the evidence of Mr Hughes and Sally Ross, and [you will] also hear from Dr Cross and then come to your own determination whether you consider fitness to practise impaired.”

The registrant’s representative is given another chance to respond, but declines, this leaves it open to the LA who stokes himself up again, refers once more to those three building blocks:

“Well, I think the Panel has to be very clear about what it is being asked to do. And it is not being asked to form a judgment as to whether or not Dr Cross’s current fitness to practice is impaired.”

Before continuing with Mr Russen’s argument, it is important to look more carefully at the phrase ‘fitness to practice’. We have heard nothing whatsoever about the registrant’s practice as a counselling psychologist. We have heard that his competency at chairing a BPS accreditation visit in a University was exemplary. We begin to be aware of the scope of power the HPC assumes for itself. Not only does it easily assume an interest in the registrant’s academic work, but also in his private affairs. This is justified through a standard which asks its registrants not to bring the profession into disrepute. It is worth asking, which profession? It is not the profession of counselling psychologists, nor of psychologists, not even of scholars, but of the new and emerging profession that is being actively, if thoughtlessly, created by the HPC to fill the void – this is the Health Profession where Health has assumed the status of a Proper Noun, not the general adjective you might hitherto have assumed.