March 3/4: PLG C&P 3rd meeting. Preparation

The Professional Liaison Group for Counselling and Psychotherapy is due to meet for the third time (3rd and 4th of March). There are 320 pages of reading in preparation for this meeting, all down-loadable from the HPC-uk.org website.

The (draft) minutes for the last meeting continue to refer repeatedly to The Group, and avoid being specific about what different people say at certain times (see blogs preparing for January meeting). The minutes give the overall impression of a set of people who are all of one mind, and who constantly agree with one another as they note this, receive that, and feel or discuss the other.

After the last meeting, I took the trouble to note down specifics that were said by particular people in a short spat that was unusually energetic. Eg, after coffee, before lunch, on day two, when the meeting considered the section of a report summarising responses to the call for ideas (in 7 lines of text) under the title point "3.2.2 Conscientious objection" (p37).

If you check the blog entry you will see several different responses to this question, which represented several different positions and some misunderstandings. You will also notice that a level of aggression was expressed which led some people to remind their colleagues to respect the positions of those who did not agree with them. These comments seem to have fallen onto the deaf ears of the minute taker (p5). Instead, he takes the opportunity to blandly restate the ideological position of the HPC before misrepresenting those with other opinions and then dismissing the point and throwing doubt on the intellectual ability of those oponents.

It was Annie Turner, Occupational Therapist Panel member of the HPC, and who said 'these people can't have their cake and eat it', which been translated by the minute taker into: the Group questioned why 'conscientious objectors' to statutory regulation [sic] would wish to be included on a list maintained by a statutory regulator and if the individuals concerned would be prepared to be subject to the HPC's processes and procedures.

One of the most persistent comments made by those with a different opinion to that of the HPC is that they are simply not heard (eg see the letter from IPN members, blogged on 10 Feb). The process of HPC-ification is not one of conversation, nor even that of debate. No doubt discussions at such a centralised level can tend to drift into vague generalisations - a few people have been asked to consider a lot of diversity in very little time. But why present a false front - what can be gained from this masquerade?

The HPC 'call for ideas' produced hundreds of pages of response. These were reduced to a 36 page document for consideration at the curtailed first meeting (enclosure 1, 4 Dec). One of these pages contained a bit more detail of the matter and clearly shows there was no intention of anyone to smuggle themslves onto the HPC register. Instead, it was suggested that another register would be drawn up. Bear in mind that the HPC notoriously state on their 'Road Map' to regulation Counselling and Pscyotherapy (Council Meeting, 13 Dec 2007, accessible if you click this link) that anyone not on the HPC register is a lesser human being:

"It should be noted that whilst there are many who will welcome [HPC regulation] there might be "a small but vocal minority of individuals and organisations who may want to avoid [HPC regulation] for a variety of reasons." which include: those who are unable to meet competence standards and ethical standards; or who are reluctant to pay the registration fees. The HPC has made a pre-emptive rhetorical strike by labelling those who don't agree with it as incompetent, unethical, and miserly.

This should help Annie Turner to understand why some people might want to construct a list outside the HPC - in order to dispell the negative image created by the HPC.

The people around the table do not all agree with one another, and some of them even made plain their own reservations about the outcome of the process (see Being Dragged Willingly, blog, 29 Jan). The thrust of the disagreement with HPC-ification is a genuine concern that the kind of regulation being proposed may well have long term catastrophic consequences. My observations at the FTP hearings already suggest that damage is being done and there is some good reason to pause and to engage in some genuine and critical thinking. Pretending that everything is easy and simple and nice isn't going to protect anyone. Who really believes that it does?

Sally Aldridge, BACP Head of Regulatory Policy. Therapy Today

In this month's BACP magazine "Therapy Today" Sally Aldridge writes:

"The decision to regulate counselors and psychotherapists through the HPC is a government one as laid out in the White Paper Trust, Assurance and Safety. "

She goes on to say that although other professional organisations have disputed whether the HPC is an appropriate regulator, the BACP is going along with it because the government has signalled its clear intention to go ahead with the process.

When the HPC first arrived on the scene it launched an advertising campaign which was insulting and not a little sinister. It depicted a variety of health professions (all of them were white, interestingly) each of whom looked like a bad joke, wearing a ridiculous mask. The strap lines were all about the way that people pretend to be other than what they are. The implication was clear enough: a lot of professionals lie. (Four of these adverts have been framed as large pictures and are displayed in the corridor at the HPC; I have commented on them in detail in 19th November blog "Struck Off".)

In the minutes of the Professional Liaison Group for Counselling and Psychotherapy at the HPC there is frequent mention of something called statutory regulation. Back in the late 1990s there was an attempt by Lord Alderdice to introduce statutory regulation for psychotherapy. It was his idea, his Bill, and he sought to bring it before parliament. This is an example of statutory regulation. It was thrown out.

State regulation, on the other hand, is when a government itself says that it must happen, and exerts its power on the nature and manner of that regulation.

It is pretty clear from Sally Aldridge's statement here that she believes that this current process is State Regulation: it is written in a Government's White Paper, a clear intention that the Government wants it done, she says.

Sally notes that other organisations dispute the appropriateness of the proposed regulation. I suppose she is aware that this country has a tradition of democracy, and that even if Government states its intention, it is not necessary (nor the custom) for the population to roll over and help them to carry it out, especially if it thinks this will create more problems than it hopes to solve. Good democratic systems rely on the thoughtful actions of its people.

What is at stake here is straightforward talking. You cannot both say that this is statutory regulation and that it has to be done because the Government insists. This recalls the phrase in the first PLG meeting when the Chair said 'if we don't do it to ourselves, the government will do it to us'. It is worth asking how the Government is forcing the BACP to do it to themselves - there is speculation about the benefits to be gained by the structures of institutional power, and a different set of questions related to who will be suffering from the consequences of such a manoeuvre. What is chilling is the lack of proper consideration to the different voices in this 'debate', and the way that those who may wield institutional power don't hesitate to use all kinds of blunt political manoeuvring to throw other people's arguments into bad light.

Surely if people think that something is wrong, and that there is a strong possibility that damage will ensue, then those people have a duty to stand up and say 'hang on a minute', even if they find it difficult simply to say NO.

At the end of Sally's statement she says that "Much of the opposition to statutory regulation [sic] in the HPC in letters to Therapy Today focuses on the nature of the process with terms such as ‘bureaucratic and statistically managed’, ‘cultures of surveillance’, ‘the stress of monitoring and assessment’, ‘role bound rather than ethical’."

She notices that there is a consistency in the concern voiced by people in relation to the proposed State Regulation. She goes on, however, to make the following interesting statement: "the HPC requirements of registration ... do not differ greatly from those of BACP"

This raises a series of questions the most obvious of which is, if the HPC system is not much different from the BACP then how will it improve things, exactly?

But I don't want to get side tracked. The main point is this: saying that the HPC is almost the same as the BACP is a slippery rhetorical device. The HPC is not the same as the BACP, it is different in quite specific and deliberate ways. At this point someone might call for "Evidence?", and ask what frame of reference she is using.

What a lot of people are saying is that the basis of truth is slipping away, and politics and bureaucracy are creeping into its place. The usual conventions of knowledge and debate that allow one to know more or less what someone is saying have receded from the scene, and more and more we are faced with blunt wielding of power through banal and empty phrases. This is not something many of us are used to in this country. If we haven't found neat ways of conveying this to the satisfaction of Sally Aldridge, well sorry; if we sound alarmed, well we are right to be. When truth is under attack all speech and writing becomes subject to question. This is why those in positions of authority, ie those in bureaucratic systems of power, have even more of a responsibility to speak sensibly, carefully, and as far as they are able, truthfully. If they find that the subject is beyond their comprehension, they should pause and think, and get some good advice. If you were the Head of Regulatory Policy, this responsibility would fall on you.

Dear Tessa Jowell, MP

Dear Tessa Jowell, MP

I came to West Norwood library towards the end of last year to see you, and spoke to one of your very helpful and friendly staff. The upshot of that meeting was that I would write you a follow up letter (in addition to the one I wrote earlier in that year). At last, this is that letter.

I have created a blog: HPCwatchdog.blogspot.com based on a whole series of visits I have been making to the HPC as a member of the public. If you read the case of Mr R (part 1, part 2, part 3), watch the video of Richard Gombrich explaining Popper's Nightmare, and consider the questions raised by Max Weber, this will give you a quick insight into my concerns and my orientation.

I am very worried indeed about the centralisation of power and the destruction of local knowledge that is the unintended consequence of the kind of regulation that is practiced by the HPC. From what I have seen it is already causing harm to ordinary decent people, and I truly believe that this harm has a pernicious quality that will be exponentially increased if the HPC draw the psychological practices within its domain.

Onora O'Neil has publicly voiced her concern about the destruction of trust that will follow the state regulation of psychological practices (especially of psychotherapy and counselling, but the psychologists are also very much in this domain). Michael Power has been writing about the way our audit culture ends up emptying the meaning out of words and practices, and leave us vulnerable to the collapse of the resulting empty shells, and Marilyn Strathern has also pointed to the hostile and aggressive undercurrents at play in moves under the banner of transparency. Aggressivity will increase where real meaning decreases – this is a lesson learned many times over throughout history.

Each of these great British scholars has been working away quietly revealing the otherwise hidden 'mechanisms' that hold our society together. None of them pretends to have the answer, nor the whole truth, but each of them is shedding very helpful light in very careful ways on things that we need to be very aware of.

I don't believe there is one answer to the situation we are currently in, but I am trying to find a way of approaching the questions without fueling aggressivity nor unduly increasing levels of anxiety. I suggest that a space be created which makes it possible to think. The rapid expansion of the HPC is not conducive to thinking. When I attended the Investigating Committee meeting last week (blogged on 12 Feb 2009) I was chilled to learn that the Kent Police had been invited in to train staff how to deal with escalating aggression. A much more sensible approach would be to ask why the aggression is escalating. From the hearings I have observed, and from comments I have received as a result of my blog, I can see a very strong argument that the orientation and mechanism of the hpc (the grounds on which it is empowered) actually fuels aggressivity - this creates a spiral which echoes Popper's nightmare and adds to the idea that this is what is being created.

It is difficult to know how to intervene, but I very strongly believe that we need to slow the process down, and give ourselves more time to think. How can I help to postpone the process of the Statutory Order that would pass the psychologists onto the HPC register? If you can advise me of this, I would be extremely grateful. If you would like me to explain my ideas in more detail - I am easily contactable. I would be happy to respond to a call and very receptive to any help you can give in shaping a parliamentary question on this issue.

Yours sincerely

Master Signifers, Aggression, and Truth.

Developments in linguistics and in anthropology brought this idea into use in the early parts of the last century. I shall not lecture you on it but invite you to cut to the chase.

There are words or phrases frequently uttered that have great power but very little meaning - they appear unattached to other elements either in a sentence or in the world. They point to nothing. The vagueness of this can raise anxiety, especially when uttered by people occupying positions of institutional and legal power. Lets call them 'master signifiers' - they have power 'because I or We say so'.

I should add that they are not always necessarily bad. They are a part of language and life and can be extremely useful and put to the good with care. They are a necessary feature of language, in fact, because when we speak we are usually trying to speak about something beyond speech, something that our speech aims to invoke. I think this might be particularly difficult for native English speakers to grasp, because we are so seldom required to face the foreigness of our mother tongue. If we forget this nature of language, however, we can easily forget how important it is to attend to the invention and deployment of master signifiers. Lets keep this practical.

Three of the major master signifiers that organise the discourse around the hpc are: Evidence, Public Protection, and Regulation. I have been trying to turn Public Protection into a meaningful phrase by attaching it to specific examples and paying particular attention to its use (which section of the public is being protected, from what particular harm, and on which specific occasion?). In this way the signifier is introduced to other signifiers with which it is revealed to have an otherwise hidden relation. The concealed relations leave them unquestionable, and we have seen in the case studies particularly, that this can be seriously unhelpful.

When the relations are left in the dark, the phrase can get wielded rather aggressively - intentionally or not - by someone who happens to be occupying a position of power. If used by someone not in any kind of position of power you can safely ignore them as a babbling fool. Unfortunately, these phrases are very often heard coming out of the mouths of people in positions of power - journalists, politicians, members of panels, committee members, for example. To call these people babbling fools might be true in that particular moment, and there have been times in this country when it has been perfectly acceptable to say so, even if you are no-one in particular yourself. But - and its a big but, and one that needs to be acknowledged and understood - at the moment because these people are supported by society and given positions of power, calling them such without great tact seems likely to provoke much more than their own personal wrath. It is as if the whole edifice will crumble away with them, as if they personally are the power. To speak out seems to risk bringing the power of the institution right down on your head.

So, master signifiers are instruments of power: they are cut off from meaning and draw attention to the power of the person that speaks; and they are used to cut off meaning in other conversations, to disempower other speakers - this is a double whammy.

Law

The bloke who runs the local heel bar in West Norwood used also to run a dry cleaning service out the back. He had to shut it down because some distant law or other now declares his machines to be dangerous. He might shut down his shop, leaving yet another empty space in this benighted high street.

In the ten years that Tony Blair took up the PM post the UK government passed more laws than at any other time ever. The Magna Carta is in shreds. So many laws were passed that the people in the House couldn't actually read them all. Eventually someone had the idea to turn Acts into Orders which reduced the amount of time officially needed to scrutinise them.

Instead of a god shaped hole in our social fabric, we've stuffed it full of laws laws laws. Good for no-one except, well, no, not even for lawyers.

But does this help to explain the existence of the hpc? I look, I search, I want to know what has happened to this country that it brings a thing like this into being. Answers on a postcard, please.

Right now a piece of legislation is waiting in the wings to be tabled in the House of Lords. It goes under the name of a statutory instrument - a Health Care and Associated Professions (Miscellaneous Amendments) (no 2) Order 2008. It is laid before parliament under Section 62(10) of the Health Care Act 1999 for approval of each house and of Scottish Parliament. If passed it will transfer a set of psychologists into the domain of the HPC. It is done under the familiar phrase 'in order to protect the public'.

The administrators at the HPC will receive a huge list of names to write onto their register. The HPC will then become the administrators of applications to join this register, remain on this register, or be removed from this register. In order to know how best to exercise this centralised power, they will have to grapple with the problem of knowledge, never mind the infinite variety of practice. Here we are again in Popper's Nightmare (see previous blogs and side panel for succint explanation).

The folly that produced the hpc would have us believe that it is because they know nothing about a practice that they are the best people to manage those practices. Grasping the real truth of this point is akin to grasping the idea of zero. There is all the difference in the world between zero and nothing.

Do you remember when Gordon Brown took up the PM post - shortly after this he was out and about consulting Citizen's Councils. The idea was that the political machinery would gather together groups to advise politicians, and the qualification to be a member of the group was to have no idea at all about the subject in question. The implicit belief behind this is that everyone has the potential to say something sensible, be useful, be a valuable citizen. But alongside this another kind of implicit belief is at play - that those who had achieved positions of power and status on particular topics were not to be trusted with the truth. That they would be more interested in maintaining their position than of applying the truth that had led them there. There is a little bit of truth in both positions, an no-one needs me to tell them.

So what is it that leaves us in such a lurch as we are in? One hypothesis that I have been advancing is that Popper's Nightmare has been long time in the making, and this has gradually weakened the knowledge base across the country at grass roots level. This is one strand. Another hypothesis comes from Max Weber, whose discourse on institutional power has been helpful in reminding me that these questions are not new but have always to be grappled with. A third strand relates to the way that we are dominated by empty phrases which get weilded as aggressive objects rather than as parts of a meaningful discourse between subjects. It is this that I shall now try to talk about using a word from linguistics: signifiers.

FTP or management failing?

Today's case at the HPC is that of a physiotherapist. It is another case where the management structure of the NHS has clearly failed to take timely action on a minor question, and which has allowed the machinery of the HPC to blunder in. It is difficult to justify this as a serious misdemeanour from which the public needs protecting. It is more easily understood as petty malice on someone's behalf. Copied below is the allegation as printed on the HPC website. In the next financial year. The FTP budget for next financial year is estimated in the region £5.6million.

Your fitness to practise as a registered health professional is impaired by reason of your misconduct and/or lack of competence in that:

1. At all material times you were employed as a Physiotherapist by East Elmbridge and Mid Surrey Primary Care Trust.

2. On 1st August 2005 you took unauthorised absence from work whilst on duty.

3. On 6th February 2006 you took unauthorised absence from work whilst on duty.

4. Between March 2005 and February 2006 whilst on duty:
(a) you made excessive personal telephone calls on the Trust’s telephone and;
(b) this was contrary to Trust policy.

5. Following an audit of your patient treatment notes it was found that:
(a) there were discrepancies between the activity recorded on your statistics sheets and the activity documented in your patient notes;
(b) you failed to keep adequate patient notes.

6. During your employment at the Trust:
(a) on 6th March 2006 you did not assess a patient, Mr A pre-operatively.

Redefining 'Professional' & Frightening the Public: more on Mr R

From the transcript of the case of Mr R. [I have used the name Freddy in place of his real name, to reflect the familiar diminutive that was used at the hearing.]

Ms B, the witness said: "A family member, the father, said that this was the work that Freddy had given his son to do privately. When I questioned him and said "was it the case that Freddy also saw your son privately?" the answer was "Yes". The family felt very anxious and asked me whether I was in touch with Freddy. I explained that I had never met Mr R and that it was not good practice or approved practice to work with somebody privately whilst on their NHS case load. The family were anxious. They really liked Freddy and they had built up a very good rapport."

When Ms B was asked to explain why it was not good practice for someone to work in private with someone also on the NHS case load, she replied:

Ms B: "Firstly it is in our professional guidelines that we are not allowed to manage a case where we are already seeing that particular individual on an NHS case load. Also for me, personally, it is unethical to be seeing somebody and then at another time to be taking money from them."

Is it just about money? Ms B said Mr V should also belong to the association for private practice. Then she mentioned note taking and liaison with other professionals involved. This allowed HPC Council to ask the purpose of note taking, which brought forth this revealing answer:

HPC Q: Why would you be taking clinical Notes?
Ms B: Just as a record really otherwise you will be leaving yourself open to be vulnerable.

When questioned by Council for Mr R, Ms B explained more clearly: 'it is recommended to protect you from suspicion.'

Ms B had not made her allegation against Mr R because his professional work was in question, but because she thought he was open to suspicion. What kind of suspicion, and from who? This brings us back to defining the idea of 'protection of the public'.

Protection of the Public. Who represents the public in this case? The family is implicitly ruled out as the case unfolds - they are described in ways that throw them into question, and which excludes their point of view. They become the group that tempt the professional off the straight and narrow. The public that is being protected here seems to be one that might be shocked to hear that someone employed by the NHS is not completely under control, and this would imply that they are being protected from that shock. This is clearly irrational, and cannot be the intention of anyone involved, but the accumulation of evidence does seem to point to this interpretation.

Ms B is not throwing doubt on the professional practice of her colleague. The family is pleased with the work, the young man in question is happy with the work. In fact Ms B went on to say "I think Mr R did a really good job".

When Ms B was questioned by the Panel, the lay member, Ms Lesley Hawksworth, brought her back to the point of how she interpreted the rules.

Ms Hawksworth: "You have already been referred to the guidelines on page 34. In paragraph 4 it says: "Therapists who have any current health service involvement may not normally undertake private therapy with that client." It does not say must never. "
Ms B: "Can you say that again?"
Ms H: "The sentence does not say 'must never' undertake private practice'
Ms B: I would have to clarify that with the independent practice to clarify exactly what that means.
There then followed a confusion between the panel members which brought to light two different versions of rules. Mr Duckworth (the panel member representing the Speech and Language Therapy profession) had a more recent version:

Mr D: "The statement from the Communicating Quality latest edition, would seem, from the text here that I have just read out, that the suggestion is, if you are treating the NHS client, you may not undertake private management of that case. Is that your understanding?
Ms B: "Yes, it is".

Mr D has re-established Ms B as a sensible woman, but only if you don't ask any questions about the validity of the text itself. There followed a brief confusion about the dates of the different versions of this text, as well as the authority which published them. It is published after the date Mr R's practice was called into question. It seems likely that the rule is written as a diplomatic matter between the Royal College and the Independent Practitioner bodies that each try to represent the Speech and Language therapists. Fair enough, they are carving out their respective territory of jurisdiction; but should this not be taken into account when interpreting the text? The lay member is right to pose her question here on the side of sense and reason rather than of management and trade. But she seems to have been side-lined quite quickly.

more to follow shortly,

Investigating Committee, Feb 09

There are 555 food days arising from Fitness to Practise activity.
And £300,000 is spent each year on hiring the shorthand writers.

I am now attending various committee meetings at the HPC to find out what is talked about at strategic level.

Most people have not really thought about the implications 0f the HPC - why would they, when there are so many other things to do in life? Those people who are forced to think about the HPC tend to leave it in the abstract realm of a TLA and at most associate it with the figure of the CE, Marc Seale. Well, the HPC in practice is a very different thing. I know of people who make appointments to visit Marc Seale in the belief that they will speak to a man and persuade him with reason. None have yet succeeded. There is little reason to think that they would. First of all Mr Seale is placed in a highly particular position. This organisation did not come into existence through the desire of a man, not the demand of the market nor of local people, nor from the exigencies of practice - it came into existence through a highly particular, and alarmingly flawed, political will. Discussing things with this CE is not going to work, because, in effect, he has been set up in a highly constrained position and given the power, in effect, to print money.

There is a second thread to take into account: the organisation is large, has a history, and is stitched into the fabric of life in many different ways. There are sandwich makers and stenographers makers who depend upon it for their living, for example.

By going along and observing I have two different aims. One is to allow readers to realise that this organisation supports the living and the careers of a lot of real people (and won't disappear overnight, nor give up its wish to make money). Second is to gradually reveal what the day to day business of the place really is. I have been an ethnographer in my time, and it is this that is giving me an orientation.

In the meeting there were some familiar faces around the committee table, and a nod of recognition from Anna van der Gaag. I sat behind another familiar figure - Diane Waller, chair of the C&P PLG - and was surprised that she said nothing at all throughout the whole of this meeting. I recognised the new Secretary, and was pleased to see Kelly Johnson, head of FTP, who I had read about at the Tribunal. I was surprised at how young and inexperienced she looked.

The committee meeting itself is, of course, based on a large number of documents which are numbered more than named, eg: 100026AC20090205Investigating-enclosure7-complaintsliterature, and 100026AA20090205Investigating-enclosure5-workplan2009-10. Teams of people are employed full time to compile and take care of these documents. Panel members are probably paid a fee to read them and to come to London to discuss them. Little by little, I shall find a way through too, and try to reveal something which renders them accessible and perhaps gives a fresh view.

Where to begin? I'll take two points of humour.

There's an HPC CPD DVD, and will be an HPC FTP DVD, several people laughed quietly at this, perhaps enjoying the poetry in the letters.

The second thing that made members laugh was the idea that the figure for costs invoked by a High Court Appeal had been increased, which means that someone failing to win an appeal against an HPC decision would be obliged to give up several thousand pounds. One panel member punched the air with joy and Kelly Johnson giggled.

A little less funny is the fact that by the end of the month the Kent Police will have delivered their special 'escalation procedure' training programme which is aimed to help the FTP employees in their business of conflict management.

So let's turn to something more comforting. Sylvia works on reception, and has done so for more than 13 years. She has seen many refurbishments in her time, as well as the re-naming of the organisation and changes in its relation to the public. She told me that her desk has been moved around the building. First she sat in the basement, then in the heart of the building, now she sits at this nice little number in a double locked chamber right next to the glass front door. Before, visitors and public were trusted to come in and find their way through the corridors. Now they are forced to obey magnetic locks, wear large name tags, and wait to be escorted wherever they want to go.

There are other important things to say about the meeting, and relate to the planning, forecasting, and expansion that formed a bulky and central document. I'll have leave it here for the moment, and return to the task later on.

The actual HPC Council meeting, Feb 2009

The 30 minute meeting was extraordinary for the lack of debate and discussion. Not all of the papers had been ready before the meeting and a couple of them were handed out, one in particular was presented to the group and 5 minutes were designated for reading. This paper had been written by the Department of Health who are apparently all of a frenzy these days, and hadn't got there act together. The Council Members duly bent their heads to consider this important document. A lacklustre attempt to comment followed, and was met by a robust rebuttal from the resident lawyer.

This lawyer turns out to be none other than Jonathan Bracken, a partner at Bircham Dyson Bell. This is the man credited with writing the documents that brought the HPC to life (see blog below headed 'The Information Commissioner'): the Father of the organisation. He was in fine form, probably the only member of the meeting who hadn't just spent 5 hours in brainstorming future strategy and expansion. His joke related to another new short document, on which the increases in fees were written. This must pass through parliament. He informed the meeting that altho the document was just being handed round, in fact nothing on it had changed since their view of its draft. This of course was good, he quipped, except he might have liked to have seen the figures increase. He laughed "hahaha".

HPC Council meeting, Feb 2009

Yesterday I went to observe the full Council meeting at the HPC. I had set aside the whole day for the occasion, but as most of the day was given over to a strategy work shop and an expansion work shop, the actual business of the group was restricted to 30 minutes at the end of the afternoon. This was the 30 minutes to which the public were admitted. There was one other public obliged to wait in the reception area until the Council were ready to display themselves and we had a few minutes conversation before we were ushered into the only two empty chairs in a very full room, where once more I discovered myself crammed into the corner looking at the back of a row of heads. I was luckier than my colleague - his seat had been soaked by a leak in the air conditioning...

This other member of the public was a young man - an Oxford graduate. Why on earth was he there? I had asked. He works for the CHRE - the official watchdog of the HPC. As part of their remit they like to drop in on the various regulatory bodies under their auspice to see how they are getting on. He asked me why I was there - I had to concede that I was the unofficial watchdog, and as he didn't immediately laugh out loud I launched my manifesto.

I told him I was very worried about the unintended consequences of such a strange invention as the HPC, and indeed the CHRE, come to mention it. He looked amazed. I talked about the centralisation of power and the centralisation of knowledge and the catastrophic consequences this has on the local practice of any profession. He let me continue. I spoke of the collapse of the banking system and pointed to the system of regulation they had been subject to. I drew the comparisons and predicted a similar collapse in the professions subject to it here, due to the inevitable destruction of local knowledge that such a move sets in train. He seemed to be interested, so I risked Popper's Nightmare. Of course he had heard of Karl Popper, but he had not studied his nightmare, so I referred him to the you-tube clip of Richard Gombrich, which is linked to the side-bar of this blog. I seemed to be on firm ground, so I followed it up with encouragement towards Marilyn Strathern and Michael Power, then pressed my advantage by mentioning Mark Neocleous.

Here he rallied and began putting counter arguments.
- Professionals must be regulated - the public think they are already.
- They are, I quickly replied.
- Self regulation? He countered, with a rye smile.
- Yes, of course, said I.
- But that is hardly reliable, the professionals only look after themselves.
- But such a cynical argument also applies to yourself.
- How so?
- The HPC, the CHRE must also look after themselves, attend to their public persona, safeguard their jobs and their future employment, this is just part of life.
- But surely standards of knowledge and performance are necessary to protect the public.
- Yes but how are they produced and policed - we are back at Popper's Nightmare.
- But people need these rules for practice
- Which rules? There are rules generated in the process of practice and discussion within the communities that work on these things, and then there are rules made by centralised committees and constructed by political processes. Then there are rules for practice, questions of ethics, and rules of law. The context is complex, but not so complex that those who work and practice can't attend to them. It is more difficult for people who don't work in the practice to come up with a good set of rules. This question touches on science and politics. Which rules do you mean?

Enter Colin Bendall whose job it is to usher us into the performance.

IPN women's delegation to Marc Seale, CE, HPC

This letter is brought to my attention:

Marc Seale
Chief Executive and Registrar
Health Professions Council

8 February 2009

An Open Letter to Marc Seale:
First of all we really appreciate your taking the time to meet with us on 27th January and would like to thank you for that. We should say though that we were rather surprised to also meet with Diane Waller, as that had not been part of our agreement. However, the meeting was instructive as it helped to clarify our thoughts and feelings about statutory regulation, although probably not quite in the way you intended.

As you may remember, your invitation came about as a result of your meeting with Denis Postle, when you said you would like to meet with other members of the Independent Practitioners Net-work. We trusted therefore you would be interested in our views on the proposed statutory regula-tion of the psychological therapies. Perhaps naively we assumed that you would first want to hear our reasons for not welcoming this proposal and then, having listened to us, counter our arguments point by point. This might have allowed for an interesting debate, but sadly this was not what hap-pened.

You did agree with our suggestion that we could perhaps all take a few minutes to expand on who we were, what had brought us to the table, what we would like from the meeting and perhaps even what we felt passionate about. After that, however, instead of listening to our views, in which you ap-peared to have no interest, you did your best to dominate the meeting with your views. You then said ‘I don’t understand your argument!’, which surprised us, as we had not had a chance to inform you of what our argument might be! It was hard for us to break into your or Diane’s monologues and when we tried, we ended up feeling talked over. At the end of the meeting you did not ask what it had been like for us, but told us that it had been ‘useful’. Really? We left your office feeling disap-pointed and very frustrated with a clear sense that you really did not want to hear anything that might be anti regulation.

You left us with only one hope: that if not enough counsellors and psychotherapists wish to find a safe home ‘under your tent’, then, by your own admission, being regulated by the HPC would not work. If we may be so bold as to make that assumption, where would you and everyone else go from there?

To conclude, did you happen to see the article in the education section of the Guardian of 27th
January, 2009, the date of our meeting, regarding Universities and red tape entitled “Regulation, regulation, regulation”? Steven Egan, HEFCE’s deputy chief executive is quoted as saying:

“…Our sector is still over-regulated proportionate to the risks that arise from it. As a general proposition, the country will gain more value from us if we devote our resources to doing rather than measuring?”

Could this not also apply to the psychological therapies?

Yours Sincerely,


Irene Galant, Barbara Hacking, Jenny Nicholson, Els van Ooijen

Jucial Review, appealing against the HPC decisions

Someone had been advised by the HPC that the only means of redress open to them after a decision had been made by the HPC was via a judicial review. They duly set one in process, and hired a solicitor. Only then did they discover that they were not in a position to put such a process into play.

This case involved an NHS manager who had been sacked. The HPC tend to trawl these cases and bring them into their own net to re-play the scene and ring out the surplus value. The upshot of this is that the HPC then becomes the complainant in the HPC Process. People who had been involved in the original case might be forgiven for thinking that they still had a part in this second playing of the scene, but in fact they don't. The HPC take over the show - in this way they act on behalf of an imaginary public and take a local sacking into a national misdemeanour.

There are two threads - one is the way a local event is passed to a central court (local difficulties acquire national status), the other is the question of self interest. The original professions were attacked on the grounds that they couldn't be trusted to keep their house in order as they were likely to be biased in their own favour. This inconvenient truth, however, also applies to any new body set up to keep order, it is part of life and must be dealt with by each of us as we act. The idea was that the HPC would always be objective because it has no interest in the professions it manages. However, this completely ignores the interest it has in maintaining itself - it is a naive, puerile view. The HPC is left with no other purpose than to maintain a register and police it - it is administrator, law enforcer, law interpreter, law maker. In the case of the original professions they were also interested in the work itself, and the knowledge pertaining to the work. In fact they were more interested in the work itself for without it they would cease to exist. In the case of the HPC their work - their trade, their profession so to speak - is administrative and legal. They are not interested in the actual work of the people over whom they have such far reaching legal powers. Their business is collecting names onto registers (and money associated), arranging the lists, creating sets of abstract standards of character and practise at a distance, and of enforcing these standards. That's it. It is a false profession, based on nothing. They are under the jurisdiction of another such body (the CHRE) and each of these is under the jurisdiction of the Privy Council, as far as I can see.

My contention is that the HPC is an artificial creation based on a false assumption. This is very shaky ground which sets up a need for a strong policing in order to make it work - an artificial force takes the place of any possible natural order. This sets up an absolute system and places far too much power in the hands of a small set of people. It is a very tricky situation, and one which is out of balance with the requirements of the situation.

It has been very common to explain the creation of the HPC and the CHRE through reference to Harold Shipman. The fear that is created by this move is two fold. There is the fear invoked through reference to a serial killer, and there is fear invoked by the irrationality of the reference to the subject in question. That is, there is no rational link between this murderer, and the creation of a large list, a centralised knowledge base, and an aggressive police force. The link has more in common with a paranoid idea than it does with reason, experience, and rationality.

The Information Commissioner & HPC's FTP

You can go to www.informationtribunal.gov.uk and get copies of cases, I have one whose decision was promulgated on 14 March 2008. According to my dictionary of word origins, promulgate is linked to the idea 'to milk', that is to cause to emerge. This promulgation was set in motion by a series of events which culminated in a Freedom of Information (FOI) request by Ms Z who had referred a case to the HPC. The HPC refused to give the information which led to the Information Commissioner being called onto the scene. He then issued an Information notice requesting sight of the disputed information and the HPC appealed this notice under section 57(2) of the FOI Act.

Are you following all this?

I'm new to all this too, but little by little I intend to try to discover something about the particularity of the time we live in, the institutions we invent, the context in which bits of our lives get lived.

From the promulgated decision I learn things that I already knew: "The HPC is established under the Health Professions Order 2001 (the 2001 Order)" and subtle differences from things that I thought I knew: ... "It's main functions are set out at article 3(2) of the 2001 Order as "...to establish from time to time [my emphasis] standards of education, training, conduct, and performance for members of the relevant professions and to ensure the maintenance of those standards." The main objective in exercising its functions is "to safeguard the health and well being of persons using the services of registrants." This is written in The Order. But there is room for interpretation in practise and it is this that is in question at the Tribunal Service.

"The HPC's functions include the maintenance of a register of health professionals and a mechanism, called the Fitness to Practise process (the Process) whereby the conduct and performance of registrants may be investigated and called to account. An adverse adjudication on a registrant's fitness to practise may lead to, amongst other things, a registrant being removed from the register (such that they could not work in their chosen profession) or conditions being attached to the performance of their profession. Members of the public, employers etc, may make allegations to the HPC with regard to the fitness to practise of particular registrants. Such cases are investigated by the HPC and as a preliminary step in the Process a decision will be taken by a Panel of the Investigating Committee whether there is a case to answer. [If not, the Process ends. If so, a new Committee is called for a full hearing." (Quoted from the Tribunal's introduction.)

In the case in question the initial Committee decided there was no case, so Ms Z made her FOIA request to see on what basis this decision had been made. This was refused by the HPC on the grounds that certain exemptions applied, namely sections 30, 40, and 41... So Ms Z made an application under section 50 of the FOIA for a decision by the Information commissioner as to whether her request had been dealt with in accordance with law. After a lot of argy bargy the HPC filed a Notification of Appeal against the Information Commissioner's Information Notice and so triggered this appeal to tribunal.

It's quite Dickensian - we are in the field of law, very particular human relations, and, by the by, a professional practise.

The Tribunal heard evidence from Mr Jonathan Bracken from Bircham Dysen Bell, who were solicitors for the HPC. Mr Bracken had been involved in the setting up of the HPC and had advised on many of its processes, he had drafted most of its rules. He explained to the Tribunal that the HPC had 'moved away' from a punitive disciplinary scheme, and had put in its place the Fitness to Practise regime. It is a process in two stages. These stages were put into question at the Tribunal and Mr Bracken was revealed as lacking (he had to admit that some of his documents 'perhaps were not as well worded as might be') .

The next in the dock was Ms Kelly Johnson, the HPC's Director of Fitness to Practise. She was obliged to say that 'the practise and procedure guidance were living documents and in certain respects in need of revision'. In the course of her evidence she revealed that the information gained in the Process at the early stage could be shared with the competent authorities of the other European Union states, and in addition, circumstances could arise in which the HPC gave the police a registrant's information prior to a 'no case to answer' determination. Registrants are not warned of these possible disclosures.

To cut a long story short, the Tribunal concluded that 'registrants were unaware of the fact that HPC on occasion made disclosures in the public interest... The reality was that the 'aura' of confidence (as Counsel for the HPC had put it) attached to the information provided by registrants, was not as clear or as bright as contended." [my emphasis] Furthermore, the Tribunal added "this case came nowhere near the mark". Their decision in favour of the Information Commissioner had indeed been unanimous.

A public point of view: Paola

Paola commented recently that: From where I am standing, the HPC has been protecting the professional against ACCOUNTABILITY. This has not helped her either: learning of the dire consequences of her many misguided actions and inappropriate interferences would have given her valuable feedback and helped her in her professional development and in her personal growth: the HPC has failed her too...

She continues:

"I always felt that there would be much more value for us in an apology and in a constructive use of the damage done to my son and myself as an opportunity for education and training, awareness and growth. The HPC does not do these things. In fact, and with reference to my previous post, the HPC does not do apologies either. The HPC does not do feelings and emotions and real people full stop..."

Paola's experience reveals more of the nature of this particular bureaucracy. It has been set up not as a pre-packaged or natural object without history, values, or character. It is a kind of living thing that can be assessed as a creature in its own right. In a previous blog I reported that Mr Williamson (one of the FTP panel chairmen) had pointed out that the HPC was similar to the GMC and that had inherited something from its predecessor (housed in the same building, and perhaps employing some of the same administrators and support staff) the Council for Professions Supplementary to Medicine. There is every reason to procede with an enquiry into the nature of this new thing, and not to assume that an organisation has no character nor that such is irrelevant. It is a necessary discipline to consider the character of the HPC and its conduct and to ask if it is fit for purpose.

There are also the unintended consequences. Paola raises this other point. "It seems to me that there may well be another worrying outcome of HPC regulation, a danger inherent in their structure and procedures: that the academic and professional standing of registrants under investigation will have a bearing on the outcome. In other words, that there will be a hierarchy of vulnerability to sanctions ..."

From my random attendance of FTP hearings I could not help but be struck by the absence of genuine cases raised by bona fide patients. So far there has been an angry and aggressive man shouting at an ambulance driver, a frightened colleague wishing to avoid another hearing about his own conduct, a training manager who thought he would be held responsible for an amblance drivers decisions, and a new recruit anxious not to be contaminated by any kind of accusation that she rules had not been obeyed.

The HPC has a particular nature, which has an effect on those it brings within its domain.

HPC PLG C&P day 2, pm

Towards the end of the HPC PLG for C&P last week the group started thinking about their next meetings. According to the work plan written down by Mr Guthrie, most of these meetings will be taken up with the question of Education and Training/standards of proficiency.

As the group approached this they revived something that Diane Waller had mentioned and parked a bit earlier. It was the question of 'life coaches' and people using other titles but doing similar work. Mr Guthrie had reminded the group that the process was about Protecting Titles, not function. This left the difficult question of figuring out how the HPC could guarantee anyone on its register without recourse to training and validation of practise. There is also the question of what they would do if people simply invented a new title for their work.

This is the way the nightmare works. Having invented a name, they now have to invent a new practise that fits the name and that they can police, otherwise they have no power whatsoever. It is a where the twist in the law is most obvious. The mistake Ian Kennedy and his followers made was to imagine a group of people who were the exception to the rule. The rule was that professionals were not to be trusted, the exception to this rule could alone solve this problem. The exception to this rule is the HPC. When Ian Kennedy said so casually 'why should they [the medics] have the power over life and death' he implicitly also said 'it should be us, who are better'. Which is, of course, nonsense.

What follows is a compact and incomplete account of some of the discussion. I've given it like this as an antidote to the anodyne minutes which reduce all the differences in the group to a single unanimous voice. I have also included their names so that anyone reading this blog might decide to engage in a conversation with any of these people (simple to figure out how through google) on some of the points that they make.

Jonathan Coe (Witness CE) said "The need for standards in professional training is what will protect the public."

Graham Smith (HPC Panel, Physio) linked this to the 'intention to deceive'.

Karen Ablack (UKCP standing in for Kathi Murphy) remarked that 'if people are not doing it [therapy] well enough and they are using my professional title then ...' she left it to her body language to indicate what she would do (flush them down the loo, I guess, she seemed to
indicate poo).

Mary Clark Glass (HPC Panel lay member) said 'we'll get them on it - if you go beyond your skills and competence, you will be called to account'.

Someone said "Prevention is the better protection of the public"

Finally Julian Lousada (BCP) remarked 'we've parked a difficult issue' to which

Diane Waller (chair) replied 'we can be seen to have done justice to the question'.

Sally Aldridge (BACP) then offered to exhume a dead and buried report done by the big 5 some years ago [UKCP, BACP, BPS, BCP, BABCP I think] which had tried and failed to synthesise competencies across the board. Someone else offered another similar dead and buried document, and Peter Fonagy (SfH) offered his NOS. All were eagerly accepted as fodder for the next few meetings.

In this way the work done in these other places by these other people for those other purposes are going to emerge into this tight schedule and could easily be taken up for want of the time to make something more suitable. This is how bad laws get made, and its other people who are going to suffer the consequences without any idea how it happened to them. That's why I'm writing this blog.

Max Weber on Structures of Power

"All political structures use force, but they differ in the manner in which and the extent to which they use or threaten to use it against other political organisations." This is the opening sentence of an essay first published in 1921 but written between 1910 and 1914. He is careful to distinguish the differences in the ways different states make use of their structures of power, as he goes on "Not all political structures are equally 'expansive'. They do not all strive for an outward expansion of their power". He speaks of the jealousy of neighbouring states, of the vulnerability of those in possession of colonies to that jealousy, and of the way that proximity and shape might expose some states to invasion from their neighbours. In the opening paragraph he sketches the usual way a structure might acquire domination over another: "by incorporating [others] or making them dependent."

All this can be read in the collection by HH Gerth and C Wright Mills that I have borrowed from my local Lambeth Library, and which I note (not without interest) was first published in 1948.

He goes on to sketch two broad attitudes that political structures tend to have towards those outside their immediate control. They can be more 'isolationist' or they can be more 'expansive', and of course they can change their mind about this along the way. 'On the basis of this power the members may pretend to a special 'prestige' and their pretensions may influence the external conduct of the structure.. Experience teaches us that claims to prestige have always played into the origins of war... Feudal lords, like modern officers or bureaucrats, are the natural and primary exponents of this desire for power-oriented prestige... power for the political community means power for themselves as well as prestige based upon this power."

"For the bureaucrat and the officer, an expansion of power, however, means more office positions, more sinecures, and better opportunities for promotion (even in a lost war)."

After a short excursion into some moments in history describing states favouring isolationist policies (including Roman, Britian, and Spartan) he returns to the question of fear. "The Spartan aristocrats, so far as they were able, quite deliberately limited their political expansion for the sake of isolation. They restricted themselves to the smashing of all other political strucures than endangered their power and prestige. They favoured the particularism of city states. Usually, in such cases, and in many similar ones, the ruling groups of notables (the Roman nobility of office, the English and other liberal notables, the Spartan overlords) harbor more or less distinct fears lest an Imperator, that is, a charismatic war lord, emerge. A tendency towards centralisation of power goes very readily with a chronically conquering 'imperialism' and the war lord might gain the ascendancy at the expense of the power of the ruling notables."

Weber concludes this opening section by returning to the question of money: "Like the Romans, the British, after a short time, were forced out of their policy of self-restraint and pressed into political expansion. This occured, in part, through capitalist interests in expansion."

In order to try to understand the nature of the hpc it is necessary to understand the context which brought it into existence. I've gone back to Weber as a kind of touch stone. I particularly like the way that he sets off without forgetting that human beings are subject to fear, jealousy, aggressivity, and greed. He doesn't emphasise this unduly, he doesn't do it like Ian Kennedy, and he doesn't pretend it isn't part of the scene. It is the sensibility of a novelist in the service of a sort of science, not the raging of a beautiful soul against the sins of the others.

Local practise, central rhetoric.

The issue that continues to get lost in all this public protection and regulation type talk is the real local problem of the difficulty that people get into when they try to work together. What can be done when someone disagrees strongly with the way their practitioner is operating, or if they think they have been harmed by it in some way? On a comment to a previous blog Paola has talked of the change in relation between her and her son when he began working with a music therapist. The music therapist is registered with the HPC so Paola took her complaint there. Judging from her comments she found the process very unsatisfactory, and instead of reducing her disquiet it has given her more to complain about. From her point of view the HPC is protecting the practitioner against her right to complain.

Jonathan Coe is the chief executive of Witness, a charity set up to help people give voice to their complaints against practitioners. He is on the PLG for C&P at the HPC. At the last meeting (Jan 09) he said that the evidence base was clear that there is harm done by practitioners in the field of counselling and psychotherapy and that something must be done about it. He was particularly concerned to know how to stop someone practising after it had been decided they should be struck off the register. But what, Jonathan, what shall be done? I can see  no good reason to believe that the HPC will make things any better, with it's huge computerised list of names, its random spot checks on Continuing  Professional Development, and the centralised policing of educational standards across the hundreds and hundreds of colleges up and down the country. I can see plenty of reason to believe that it will make things worse.

When it comes down to it, the problem is  how to create conditions for safe practise, for informed and thoughtful practitioners and publics, and for safe and productive forums of debate and disputation. 

At the recent Rally of Impossible Professions, in London (September 2008) a university counsellor gave a little example in the morning of the way that safe spaces were being eroded by the encroaching audit culture. Where once there was a group of practitioners who created a space in which it was possible to discuss the issues and deal with the anxiety arising from some of the work, now the manager closes down difficult topics and imposes brute control.

In an afternoon session at the Rally, Mark Neocleous outlined  the steady rise in the discourse of security and shows how, paradoxically, it creates the conditions conducive to hostility. The repetition of empty phrases like 'we must protect the public', or 'regulation is the only way', or '5% of practitioners are a danger to society' contribute to a rising unease because there is no way to understand what they mean.

It is this that is the crux of the problem. The PLG at the HPC are happy to keep repeating the phrase 'we must protect the public', but are less interested to hear that they are perpetrating a problem that is producing a very real danger for a much bigger public by obliterating the conditions for safe practise and genuine enquiry.  The HPC is part of a very large and long process of centralisation in this country that is steadily tearing knowledge away from practise. Michael Power's ongoing work into the rise of the audit culture leaves the reader in little doubt as to the way that this is happening. Read the beginning of the argument  here and follow it up in his other books, they are very well written, cogently argued, and give an unbiased account of the nitty gritty  way that these things are happening. And they are happening here in the UK.

Centralisation

On this morning's Today programme a piece of news announced that Government Minister's were interested by Denmark's Social Workers' approach to looking after children. Government Ministers, mind.

Five years ago I was at a conference in Birmingham at which a few hundred people (medics, managers, policy makers) were discussing European Health Management issues. I think it may have been a man from Denmark who said with emphasis (that seemed to stun even him) that the British System was so very much more centralised than in all the rest of Europe.

Twenty five years ago, as a freshly minted business studies graduate, I was engaged on a project on the question of Centralisation at British Telecom. This was in the year of its privatisation. It was the first of the nationalised industries to come onto this new scene, and was Mrs Thatcher's innovative entry into creative accounting. At that time the rhetoric was all about decentralisation as the most effective business strategy, and it was used very much as a rationale for flogging the national asset and for dismantling the organisation. Everything was put into question as 'centralisation' was linked to the 'old ways of doing things' (and thus put into the moral bad box) and decentralisation was linked with the cut and thrust of commerce (hence morally good).

I am not interested here in the rights and wrongs of nationalisation and privatisation, but I am (and was) very interested that a centralist decision was being rolled out under the rhetoric of decentralisation and that there was a twist in the idea that seemed impossible to resist. A few years later I fetched up at Thames Water to do an ethnographic study of computer systems design. Here I was amazed to discover that privatisation was in preparation under the signifier centralisation! Thames Water, in virtue of the nature of its business, was very much tied to the ground. It's operations (water works, sewage treatment works) were very much linked to particular localities and had a strong association with people and their bodies. In spite of the obvious reasons for this, 'decentralisation' soon became associated with nationalisation, and hence part of the moral bad ground, and Centralisation became the name of the new strategy, associated with all that was good.

This new strategy at Thames Water was brought in at huge expense from Anderson Consulting. This was one of the Big Five consultancies who enjoyed great success around the world, and who employed the elite of the graduate crop each year. This organisation now goes under the name of Accenture - the name change came shortly after the Enron debacle, I'm sure you will recall. The bulk of the work that I witnessed at Thames Water was to do with the creation of a call centre in Swindon (one of the first of this new idea) which was to be supported by the creation of an immense set of computerised information systems. A significant, yet implicit, part of this new ideology was the belief that it was better to remove knowledge from local human beings, and place it in machines.

I think it would be easy to read this as an attempt to lay blame and seek retribution. I'm sure I am susceptible to that, at least as much as anyone else. But actually I think that this is precisely the problem. It is only just dawning on me, after all these years of study, analysis and consideration, that we as a country (at least) are well on the way to Popper's Nightmare in so far as a certain process of centralisation has been steadily ongoing in so many different areas of our life for at least 25 years - and is accompanied by the rise of a rather ridiculous morality .

The creation of the HPC is very much part of this process, and even with the best will in the world and the greatest minds in the Kingdom, it would be difficult for anyone to overcome the pressure that has been building up over decades which aims to produce intelligent centralised systems based on a pernicious idea, and at the expense of decentralised, real, local, loyal (at least they used to be) human subjects.

Small wonder it is Government Minister's who are so interested in Denmark's Social Workers, or that this counts at mainstream morning national news.

Snow

The last time there was snow like this was 1991. A huge cloud of snow on its way to Moscow dumped itself prematurely on south east England. I remember it well. The roof to our block of flats was removed in readiness for a new set of slates. Perfect timing. But more memorable was the fact that I was off to Moscow for the 33rd Annual Conference for the Young Historians and Philosophers of Science. Much excitement as everyone was saying it was colder in London than in Moscow. I had been offered the chance to go to this conference by Steve Woolgar, who was then the head of a research centre at Brunel University that hosted a number of projects looking at innovation, culture, and technology. I was engaged on an ethnographic study of computer systems designers at in a water company just before privatisation. It was this research that formed the basis of the paper I was to give to the young historians and philosophers in Moscow.

I count myself very lucky to have had the chance to go. There was one MacDonalds in the main square, a single bright blob of colour in a grey landscape with a huge long queue snaking out the door and down the road. Queues were not unusual, of course, and not particular to MacDonalds, they were a part of city life. Other bits of life were also open to me. I was given a room in an appartment of a lovely young woman and her husband for the duration of my stay. Their fridge and cupboards were stocked to the gills with merchandise of one form or another. Their phone rang almost constantly when we were at home, and this was the mechanism that triggered the exchange of money and goods for this family and their friends.

I also remember my amazement when standing at a bus stop with Natasha waiting to get home. We were there for just a few minutes when a car pulled up and we jumped inside. She explained that this was normal - she didn't know the driver, but in return for taciturn grunts she handed him a few coins when we got out. It was not a pleasant social experience, but it was extremely helpful on a cold winter's night.

I had intended to go to the HPC today to observe the Education and Training Committee Panel meeting, but apparently all the buses in London have been suspended, and I'm certainly not chancing my bike. Can you imagine our society developing a private taxi service along the lines that sprung up in Moscow? I wonder what we would do should it ever become necessary to innovate.

Little Dorrit - nobody's fault, everyone's in it

The recent serialisation of Dicken's Little Dorrit was remarkably well timed on the question of unexpected wealth followed by unexpected crash. In an earlier film version of the book, however, the subtitle is added to remind us of the subtle point that Dickens was making throughout the story: Nobody's Fault. This refrain runs through each of the intricate threads of the book and is especially interesting in relation to Arthur Clennam recently returned from 20 years in China. He imagined that his family must be responsible for Mr Dorrit's extended stay in the Marshalsea debtors' prison, and tried to assuage what he felt sure was his guilt in this other family's story, and in doing so unwittingly set up the conditions in which a greater tragedy was to play out.

In the meantime, Mr Merdle, man of the age, was held captive in his position of money maker. Few wanted the trouble of working out how to make their own money increase in value, rather they clamoured to press their cash into his bank in the irrational belief that Merdle could make it increase in value.

A third theme includes the Circumlocution Office where legal documentation and process are entirely submerged in arcane process and bureaucratic nightmare coupled with men who, robbed of any access to worthwhile work of their own, barely rise above the pettiness of obstruction and snobbery.

In the telling of the tale Dickens draws out the characters, and allows this to be the motor of the story. The overall 'fault' is the accumulation of faults of the players.