More discussion arising from Panorama

On the HPC website there is a page which details the requirements looked for when considering a new group for regulation. Following the change in government policy calling a halt to this regulatory process, the page now includes the sentence "The new professions/aspirant groups process is now closed and we are no longer considering applications." Nevertheless, we can still read the criteria the HPC claim to use when considering a new group for its register. This set of criteria was constructed after a process which included public consultation, some years ago, in 2002 I believe.

"The criteria we applied when we considered applications is as follows:

* Cover a discrete area of activity displaying some homogeneity
* Apply a defined body of knowledge
* Practise based on evidence of efficacy
* Have at least one established professional body which accounts for a significant proportion of that occupational group
* Operate a voluntary register
* Have defined routes of entry to the profession
* Have independently assessed entry qualifications
* Have standards in relation to conduct, performance and ethics
* Have Fitness to Practise procedures to enforce those standards
* Be committed to continuous professional development (CPD)"


Now, on June 3rd, 2011, Dr Anna van der Gaag, HPC President, wrote (in what the HPC solicitors refer to as her 'private' blog, yet apparently hosted by the HPC website) "We do not have a mandatory system of regulation for support workers in England. I look forward to the time when we do." The HPC is no longer receiving new applications for regulation, but it is still looking for opportunities to expand operations.

The blog entry is in response to the Panorama programme of 31 May (see also my previous blog entry below). You will remember that the abuses exposed by this programme were perpetrated by the unqualified care staff whose annual salary amounts to about £16,000. There is no discrete area of activity, no defined body of knowledge, no 'evidence base' for the practice, no professional body covering this section of the workforce... in fact not one of the criteria written above applies to this group of workers. The wish to regulate this sector of the work force has nothing to do with professional statutory regulation. It has a lot in common with the ideology of 'data-base state' solutions, so popular amongst those in power in the previous government.

In her blog, Dr van der Gaag writes "I worked as a speech and language therapist with people with learning disabilities in the 1980s. At that time, institutional care was still common and stories of abuse were also widely reported in the press – although without the benefit of clever hidden cameras. I vigorously supported the campaign to close these long stay hospitals, many of which I had visited as part of a three year research study. Thankfully, almost all these large institutions had gone by the mid 1990s, replaced by smaller, more home-like residential facilities, closer to communities and families, more accessible to visitors, more transparent in their management." There are three key points to explore here.

First: 'institutional care was still common' - this phrase is very vague and needs to clarified. The abuse reported on Panorama was also perpetrated within an organisational structure, and many of the residents seem to have been placed into that particular hospital by someone like a social worker or a member of a medical team (this wasn't made clear on the programme, but they did say of Simone that she was 'forcibly' taken into care). The money that funds the 'care' (£3,000 per month) comes from the common purse which is maintained via institutional mechanisms whose agents are absolutely invisible to us in this case. I mentioned in my previous blog that I had wished the Panorama programme had gone into this more carefully - perhaps there will be another programme going into this kind of detail soon.

If you remember (and you can still watch this programme on iPlayer), we did learn that the company had brought in a new manager - Lee Reed, the CE of Castlebeck, appointed January 2011. He was credible and articulate yet he functioned as an absolute block to any questions about the role played not only by the company's systems and style. To be fair, he would have seemed to have been making excuses, yet these issues must be explored against their institutional back drop. Castelbeck's web statement says that 'the international consultancy firm PricewaterhouseCoopers (PwC) [have been asked] to undertake a thorough independent review of the company, including its culture, medical protocols and communications systems.' Its difficult not to see this as an expensive show (paid for from the fees from the public purse I suppose) which bears little relation to the actual problem at hand. It might even be expected that one of the Big Five consultancy firms speaks the regulators language - they are not unattached to this ideology (see Max Travers' interesting study of the rise of The New Bureaucracies and Quality Control). The question still remains, why weren't Terry Ryan's words heeded and respected? It looks very much like another attack on local grown professionals while the big institutional players clean up.

By pretending that abuse is a feature of the 'bad old days of the NHS' van der Gaag is playing with words. You might think that this is sloppy, or, bearing in mind that she is a 'speech and language therapist', you might even consider it unethical, or unprofessional. No matter what you might think of her personal behaviour (and this is her 'personal blog', according to HPC solicitors) it would be naive to forget that she is also speaking from of her position as President of a large, multi-million pound concern, where Privy Council holds, in principle at least, the mechanism of accountability and control.

Second: "stories of abuse were also widely reported in the press". I have carefully read van der Gaag's blog, and nowhere does she mention any first hand evidence of the scale or nature of abuse in 1980s NHS institutions. Nor does she explain the link between the 'old' institution and the individual abusers in question. Nor does she quote a single instance of those that were 'widely reported' in the press. Broad brush statements are all very well, but here they simply serve to obscure the view, and cast aspersions over the whole of the 'old' NHS in one stroke.

Third: "I vigorously supported the campaign to close these long stay hospitals." I wonder what she though she was closing down? What, exactly, was the problem that was supposed to be solved by these changes? If we stick close to Anna van der Gaag, we are always too far away to know what is really going on in the world. How are today's institutions better than those which preceded them? Van der Gaag expands her point - the 'old' was to be "replaced by smaller, more home-like residential facilities, closer to communities and families, more accessible to visitors, more transparent in their management" These words might easily describe Winterbourne View, but they didn't help the people being pinned to the floor. There is quite a gap between the words and the reality - and no-one wanted to hear about it when Terry Ryan said it out loud.

Dr van der Gaag mentions that a lot of soul searching has followed from the Panorama programme, and this, she suggests, has led her to conclude that "For me, it highlights yet again the importance of regulating individuals as well as institutions."

One can only marvel at the soul searching that produced this nugget. Here we have the President of a large regulatory institution whose gravy train has recently been derailed by a new government and that is actively looking to diversify its business concluding that the only solution to this tragedy is to regulate not only the institutions and the professionals, but also the unqualified staff, uncle Tom Cobley and all. It rather starkly exposes the way that institutional pressures (and the institution in this case is the HPC) play on the weaknesses of their agents (in this case the President) and reduces them to puppets of an ideology, brushing the real problem firmly back under the carpet.

The only way that institutional power can be prevented from crushing some poor person's nose into the carpet, is the wise wielding of that power by the people who have been put into post. Presidents and CEOs are no exception to this rule, nor should they imagine for one moment that they are exempt from responsibility when things in their organisation go wrong.