With permission of Betty Bertrand:
The true nature, or rather the true endeavour, of the HPC has finally been revealed in what initially I would have called a moment of grace. They want to invent a new profession.
During the debate on the standards of proficiency, Jeff Lucas, after much heavy silence, expressed his reservation regarding the relevance of the statutory regulation for Psychotherapists and Counsellors, at which point a whoop and applause broke out in the gallery and three people were warned against being thrown out.
The task of regulating the field of Counselling and Psychotherapy is indeed an impossible one, and the PLG had admitted it! But instead of holding on to this and facing up to the truth, the group carried on as if in the grip of obscure forces, and CREATED a new one! One that they thought they could regulate!
This new one has a vocabulary that fits perfectly with the 100 legal words allowed by the HPC solicitor. One member of the PLG said "we are creating a benchmark for the future, defining what counselling and psychotherapy is".
I am scared. I recognise myself neither as practitioner nor analysand in the standards created by this group. This Frankensteinian process will undoubtedly have serious consequences beyond even practice and ethics. The group, many of whose members' views I may respect individually, has themselves spawned a monster.
Sorry, but I did not share Annie Turner's enthusiasm when she said "until we [Occupational Therapists] laid down the Standards of Proficiency, we were unable to define ourselves as a profession".
I am sure that we do not need the HPC and/or friends of the government to tell us who we are – and not only because we constantly evolve. That is the nature of the work we do, of people, and their impact on the practice.
Day 2: and for the first time the muffled attendees sitting in the gallery were given colour handouts of the Standards of Proficiency. I wonder why. Was it some kind of gift? We were even thanked at the end by Diane Waller, apparently relieved that all the messy profession has been "tidied up" and ignoring for the moment the untidy fact that two more days in November had been scheduled.
The picture is not at all rosy - far from it. The past two days are only the beginning. The drafted papers will be circulating for wider consultation and everybody - in the profession OR NOT - should read the proposal and comment widely. Be warned - it is tedious and sickening. Meetings must take place, practical resistance should be organised. A moment of truth must be faced...
The new PLG (half of the members are liable to be replaced in the forthcoming Council appointments) will meet for two more days in November. Until then, we have some work to do.
By Betty Bertrand-Godfrey
Friday, 29 May 2009
Thursday, 28 May 2009
The relation between the process and the appearance of the process: the MHTP
The question of whether Counsellor could be a protected title raised barely a mutter at the meeting, and will be dealt with by solicitor Jonathan Bracken at some future date.
It is such a general word that it seems very likely that capturing it will cause a catastrophe. There are around 30,000 counsellors on the BACP books for example. It would be amazing if the HPC took these 30,000 counsellors into its care yet this seems to be the image that BACP wants to create.
I wonder what is actually happening at these meetings. The process seems specifically designed to addle the mind. Much that is said seems irrelevant - the Chair often openly contradicts herself, many issues are parked for future debate, put into a pot, or just 'left there' for a moment but no-one is holding a list. The agenda seems to hover over the content, the minutes don't name anyone in particular. With so much vagueness and lack of direction the PLG process appears to float over something that is moving according to its own will.
The meeting generally stops around about 3.30 but there was still no mention of the discussion expected on protecting the title of 'child psychotherapist. So it was a big surprise when at about 3pm Diane Waller invited Jonathan Coe to put forward some unexpected business. He wanted to know, for no particular reason, and a very angelic smile, whether the group might wish to consider whether or no to protect the title Psychoanalyst. What was that about?
BPC and Skills for Health slapped the suggestion down. BPC vaguely implied that to practise as a psychoanalyst one would first have to enter the register as a psychotherapist - "these are the minimum standards" he said "you are free to go higher if you wish". And SfH sort of backed this up.
At 3.15 or thereabouts the PLG finally came back to the question of whether to protect the title of Child Psychotherapist (an idea thrown out several times over this six month process). Eileen Thornton for the HPC said she could see nothing convincing in the paperwork submitted to support the demand. BPC and SfH both piped up again and began bellowing. The most incoherent stream of nonsense issued forth from the SfH foghorn about the physical nature of a child's brain, and BPC said that because he personally wasn't competent to practise as a child psychotherapist the title must be protected (from him we must suppose).
At 3.29 the doormouse woke up and declared some dates for the next PLG - 17th and 18th November. Nothing seemed to be settled. And, just when they thought it was all over two more days are pulled out of the hat.
In the meantime, Anna van der Gaag has been recruiting her new HPC Board, due to meet on July 6 to consider the PLG's recommendations. Only 3 of the original Council will be reappointed, so Diane Waller, Jeff Lucas, Mary Clark Glass, Annie Taylor, Eileen Thornton, and Graham Smith are unlikely to be around for the November PLG. The original programme of consultation and review has been muddled, but the Draft Standards of Proficiency (SOP) are going to be circulated for another round of consultation - after the new Council has heard the 'group's recommendations'. Will there be a second set of recommendations to Council and a second consultation? Not if the HPC want to rush this through parliament before the next general election.
The UKCP member (Kathi Murphy) specifically said that she was unhappy with the definitions distinguishing Counselling from Psychotherapy (cooked up in half an hour over yesterday's lunch by Mick Cooper and Peter Fonagy - an idea from Julian Lousada which was eagerly put into play by Di Waller, who over-rode the loud protestations from Kathi Murphy), but would accept them for now knowing that they had to go for consultation. Lousada later said he could accept the phrase 'mental health well being' as a definition for counselling, but would then want to give up the will to live - thus evidencing the hypothesis that depression follows moral cowardice.
There is a barely spoken knowledge that everyone involved in this process will have to fudge and force things to fit in order not to lose face. I heard the Counselling Professor (Cooper) mutter his amazement over tea that the UKCP had not contested the definition of Psychotherapy in the meeting. I heard myself wonder why no-one screamed when someone said that the DSM IV was the therapist's bible. Another member of the silent gallery confessed her great discomfort at having to remain mute at this process. I wonder why we all obey the rules. I remember those films and plays and books where someone finally stands up says 'look here, this is all nonsense'. You will ask me why I didn't say it myself.
Look here this is all nonsense.
Protecting the public from the intellectuals
In each PLG meeting the BACP Director of Regulatory Policy has cast aspersions on some other training organisation. For the most part she has been content to leave the accusation vague and nameless and just convey that 'those people out there are doing bad things and we need to police them, and to know what they are up to'. Yesterday however, she actually named one. She named Middlesex University. Middlesex University run a Masters in Psychoanalysis which has no clinical component - 'and we don't know what these people go on to do once they've been given their certificate' she said, with her eyebrows shooting high on her head. The implication was clear.
We don't know what these people go on to do? Well, I suppose they go to Mornington Crescent.
In this month's BACP magazine, Therapy Today, Sally Aldridge responds point by point to the Statement of the Alliance for Counselling and Psychotherapy against State Regulation. One of these points is that the HPC is a symptom of a suspicious state that increasingly grants itself privileges to intrude into its citizens' lives. Sally's response there in writing, was, yes, we do live in suspicious times, and yes we do need to know what these people are up to. "Quis custodiet ipsos custodies?", as they say on the MA at Middlesex University.
We don't know what these people go on to do? Well, I suppose they go to Mornington Crescent.
In this month's BACP magazine, Therapy Today, Sally Aldridge responds point by point to the Statement of the Alliance for Counselling and Psychotherapy against State Regulation. One of these points is that the HPC is a symptom of a suspicious state that increasingly grants itself privileges to intrude into its citizens' lives. Sally's response there in writing, was, yes, we do live in suspicious times, and yes we do need to know what these people are up to. "Quis custodiet ipsos custodies?", as they say on the MA at Middlesex University.
Wednesday, 27 May 2009
Mornington Crescent
Up to a year ago, it was quite common to hear people say that all this state regulation was to prevent another Harold Shipman. There is practically nothing you can say to this because it is beyond reason. Straight forward nonsense. It has been a relief over the last year to notice that his name has been dropped off the register. Another empty phrase came to circulate as justification for all these new jobs, these plush offices, these new procedures ... they are for 'public protection'. But, today, at the HPC PLG for C&P, over the finger buffet lunch, the Ghost of Shipman reappeared.
I was asking why the HPC board was being replaced. I was told: because of Harold Shipman.
There is a long running radio-show the game called Mornington Crescent which has people screaming with laughter for no apparent reason but that the phrase and game is engaged in so seriously, and yet is totally meaningless.
I was asking why the HPC board was being replaced. I was told: because of Harold Shipman.
There is a long running radio-show the game called Mornington Crescent which has people screaming with laughter for no apparent reason but that the phrase and game is engaged in so seriously, and yet is totally meaningless.
Regulating counselling and psychotherapy via HPC
At yesterday's PLG meeting at the HPC a very frosty silence opened up the day. Soon there were red faces and blustering interventions, and it seemed clear that something had happened outside the meeting. Suspicion and resentment bubbled up as it became more open that the 'big boys' had been cutting deals and manoeuvring for position to get the best deal in this power-sharing mess.
This group of practitioners - Counsellors and Psychotherapists - did not approach the HPC and ask to be regulated. The field has not organised itself into a centralised unified body that could be readily transferred across. So the HPC is going to have to force it to fit, with a force powered by an act in Parliament.
Professor Jeff Lucas ('lay member' of the HPC Council, and University VC many of whose graduates will end up on the HPC register), had showed himself capable of breaking through the 'group atmosphere' in January's meeting to point out the inconvenient truth that this field will involve taking on something like 40 different registers rather than the usual One. In yesterday's meeting he managed to say that this so-called field of counselling and psychotherapy was a mess and that it would be impossible for the HPC to regulate it.
Yes. The only possible outcome of forcing this impossible profession to fit is to destroy it and invent something new. Only then will you get a government sanctioned efficient programme of orderly, obedient, therapists.
This group of practitioners - Counsellors and Psychotherapists - did not approach the HPC and ask to be regulated. The field has not organised itself into a centralised unified body that could be readily transferred across. So the HPC is going to have to force it to fit, with a force powered by an act in Parliament.
Professor Jeff Lucas ('lay member' of the HPC Council, and University VC many of whose graduates will end up on the HPC register), had showed himself capable of breaking through the 'group atmosphere' in January's meeting to point out the inconvenient truth that this field will involve taking on something like 40 different registers rather than the usual One. In yesterday's meeting he managed to say that this so-called field of counselling and psychotherapy was a mess and that it would be impossible for the HPC to regulate it.
Yes. The only possible outcome of forcing this impossible profession to fit is to destroy it and invent something new. Only then will you get a government sanctioned efficient programme of orderly, obedient, therapists.
Friday, 15 May 2009
Fit to practise?
The College of Psychoanalysts-UK is staging a conference on 6th June at Birkbeck College in London. One of the speakers is Mary Clark-Glass, HPC Council member, and member of the Professional Liaison Group for Counselling & Psychotherapy. Mary was bewildered at the recent HPC Fitness to Practise Forum when she realised that more than a third of the HPC total budget is spent on FTP processes. According to the Management Accounts of March 2009, that amounted to £4,652,779.
HPC income is made up of the fees paid by registrants. In 2009 New fees amounted to £751,055; Renewal Fees: £11,318,583; Readmission fees £203,592, sundry others to make up a TOTAL of: £13,505,960.
In his talk to the aspiring group of Hearing Aid Dispensers, Marc Seale, HPC CEO said ‘we are not a charity, we are self financing’. This ‘self financing’ is achieved through force of law: once a title is protected (eg Arts Therapist) a practitioner is compelled under threat of legal action to sign up to the HPC and pay the fee, (which is set by an act of parliament) or be prevented from practising. Mr Seale is responsible to HPC Council, who from July are all appointed by as well as answerable to Parliament through the Privy Council.
By the by, some people who have recently written challenging or critical letters to Mr Seale have received replies with this allusive paragraph: “In conclusion, I would like to raise a particular question. It is as follows. On the assumption that statutory regulation of psychotherapy commences within the next few years, will you apply to join the register, or will you stop practising as a psychotherapist? I look forward to your response with interest.” Could it be that instead of engaging thoughtfully with questions and criticisms about the ability of HPC to regulate psychotherapy Mr Seale is simply awaiting the opportunity to exercise the law?
We saw below (blog 8 May) that If you are late with your fees because you didn’t get the invoice, you can expect trouble.
Perhaps, with an annual income of thirteen and a half million pounds, we could expect HPC to put some of that cash to work on a more effective, not to say more polite, process of fee collection. Perhaps, with an annual income of thirteen and a half million pounds, and only a few hundred allegations to think about, the HPC could be able to spend time, money and effort on other more productive and important matters.
Allegations received:
70 for the y/e 2002,
172 y/e 2004, and
424 y/e 2008 (0.24% of total registrants in 08).
That is, 30% of income is spent on investigating 0.24% of the register against whom allegations are made.
I have not been able to find any reference in the accounts to money spent on improving education, nor disseminating information, ideas or findings arising from the work of the 185,000 practitioners on the HPC books. The amount recorded in the account as spent on the Welcome Pack for registrants was: £0. That’s Nought. Zip, Zilch, Zero. I wonder why they reported it.
The FTP annual report for year-end 2009 is not yet published but the report for y/e 2008 can be downloaded from here
For this period there were 178,289 people on the HPC register, and most of the allegations received were about people who live and work in England (as opposed to those in Wales, Northern Ireland or Scotland).
The majority of complaints are made against men. The vast majority of registrants (76%), however, are women.
Of the 299 allegations that were considered, only 186 were referred for a full hearing of which a decreasing number are held to be well founded. Probably 139.
The HPC appoint a law firm, Kingsley Napley Solicitors to present cases on their behalf. Needless to say, the HPC then have to ‘continually strive’ to manage these costs and have had to introduce a ‘capped hours’ arrangement.
The 09 y/e Management Accounts record a figure of £2,516,642 paid in legal expenses of one kind or another.
In answer to questions whilst observing hearings at the HPC I have been told that it is the solicitor who must do the ‘research’ to build the case against the registrant in question.
Although the number of cases being considered by FTP panels is increasing the number of allegations where the outcome was not well founded has also increased. Solicitors are paid whether they win the case or not, which suggests that there is no tension in the system to insist upon a proper investigation.
Employees of the HPC are not involved in the FTP decision-making process. This is trumpeted as a virtue and is supposed to ensure that all decisions are made independently, and are free from any appearance of bias. Being free from bias, and being free from any appearance of bias are, of course, two different things. Being hands off might indicate objectivity, but it may also indicate abdication of responsibility. Furthermore, being ignorant of something could be either a sign of naivety, or of stupidity.
A recurring and disappointing aspect of the HPC is the frequency with which rhetoric replaces reason. For example, at the end of her executive summary, Kelly Johnson (Director of Fitness to Practise) writes ‘the process is not about punishing a registrant, it is designed to ensure that action is only taken when it is necessary to protect the public.’ This is an empty phrase which could surely only be made by someone with little or no experience of the real world. A registrant against whom an allegation is raised deserves to believe - to know - that the investigation into the allegation is going to be fair and impartial. Only in this way could the process approach something akin to justice.
Who makes the complaints? The biggest group of complainers are … employers. 171 in the year 2006-7, which accounted for 40% of allegations. This suggests that when an employer is unhappy with a member of staff they can shunt the responsibility for dealing with it over to the HPC who in turn shunt the cost of it onto the … employees. Also, as the majority of defendants are men, one begins to wonder about the attributes of the complainer, details of whom are not exposed in the annual report. What do the Unions say about this?
A second group of complaints come automatically from the police (35 in 2007/8). The Home Office Circular 6/2006 provides that the HPC must be informed if a registered health professional is convicted or cautioned for an offence (tho only in England and Wales). This is a legacy of Ian Huntley and the tragedy of Soham in 2003.
At the HPC FTP Forum on Friday 24 April, Council members asked why such an adversarial and expensive method was favoured over mediation, even where the latter might be more effective. The law governing HPC regulation only allows mediation to be mentioned at the end of the process, by which time registrant and complainant are well entrenched in conflict, and mediation is no longer viable.
Jonathan Bracken, HPC Solicitor and Parliamentary Agent, is responsible for writing the operating procedures for the HPC, and is engaged to train people to follow these rules.
A Kingsley Napley press release tells us: The Hearing Aid Council is pleased to announce that it has appointed Jonathan Bracken as its new legal director plus Kingsley Napley as its new Disciplinary Committee solicitors and case handlers.
There is no tension in this system where those who are engaged can call each other to account. This appears to be fostering a situation where Kingsley Napley and their colleague Jonathan Bracken are taking up the slack. This all feeds back into the self fulfilling prophecy - that professionals are greedy unethical ne'er do wells, and need to be placed into the hands of the administrators.
Personal ethics more than ever are going to be required until this stupid system is dismantled or reassembled on rational, ethical, reasonable grounds.
HPC income is made up of the fees paid by registrants. In 2009 New fees amounted to £751,055; Renewal Fees: £11,318,583; Readmission fees £203,592, sundry others to make up a TOTAL of: £13,505,960.
In his talk to the aspiring group of Hearing Aid Dispensers, Marc Seale, HPC CEO said ‘we are not a charity, we are self financing’. This ‘self financing’ is achieved through force of law: once a title is protected (eg Arts Therapist) a practitioner is compelled under threat of legal action to sign up to the HPC and pay the fee, (which is set by an act of parliament) or be prevented from practising. Mr Seale is responsible to HPC Council, who from July are all appointed by as well as answerable to Parliament through the Privy Council.
By the by, some people who have recently written challenging or critical letters to Mr Seale have received replies with this allusive paragraph: “In conclusion, I would like to raise a particular question. It is as follows. On the assumption that statutory regulation of psychotherapy commences within the next few years, will you apply to join the register, or will you stop practising as a psychotherapist? I look forward to your response with interest.” Could it be that instead of engaging thoughtfully with questions and criticisms about the ability of HPC to regulate psychotherapy Mr Seale is simply awaiting the opportunity to exercise the law?
We saw below (blog 8 May) that If you are late with your fees because you didn’t get the invoice, you can expect trouble.
Perhaps, with an annual income of thirteen and a half million pounds, we could expect HPC to put some of that cash to work on a more effective, not to say more polite, process of fee collection. Perhaps, with an annual income of thirteen and a half million pounds, and only a few hundred allegations to think about, the HPC could be able to spend time, money and effort on other more productive and important matters.
Allegations received:
70 for the y/e 2002,
172 y/e 2004, and
424 y/e 2008 (0.24% of total registrants in 08).
That is, 30% of income is spent on investigating 0.24% of the register against whom allegations are made.
I have not been able to find any reference in the accounts to money spent on improving education, nor disseminating information, ideas or findings arising from the work of the 185,000 practitioners on the HPC books. The amount recorded in the account as spent on the Welcome Pack for registrants was: £0. That’s Nought. Zip, Zilch, Zero. I wonder why they reported it.
The FTP annual report for year-end 2009 is not yet published but the report for y/e 2008 can be downloaded from here
For this period there were 178,289 people on the HPC register, and most of the allegations received were about people who live and work in England (as opposed to those in Wales, Northern Ireland or Scotland).
The majority of complaints are made against men. The vast majority of registrants (76%), however, are women.
Of the 299 allegations that were considered, only 186 were referred for a full hearing of which a decreasing number are held to be well founded. Probably 139.
The HPC appoint a law firm, Kingsley Napley Solicitors to present cases on their behalf. Needless to say, the HPC then have to ‘continually strive’ to manage these costs and have had to introduce a ‘capped hours’ arrangement.
The 09 y/e Management Accounts record a figure of £2,516,642 paid in legal expenses of one kind or another.
In answer to questions whilst observing hearings at the HPC I have been told that it is the solicitor who must do the ‘research’ to build the case against the registrant in question.
Although the number of cases being considered by FTP panels is increasing the number of allegations where the outcome was not well founded has also increased. Solicitors are paid whether they win the case or not, which suggests that there is no tension in the system to insist upon a proper investigation.
Employees of the HPC are not involved in the FTP decision-making process. This is trumpeted as a virtue and is supposed to ensure that all decisions are made independently, and are free from any appearance of bias. Being free from bias, and being free from any appearance of bias are, of course, two different things. Being hands off might indicate objectivity, but it may also indicate abdication of responsibility. Furthermore, being ignorant of something could be either a sign of naivety, or of stupidity.
A recurring and disappointing aspect of the HPC is the frequency with which rhetoric replaces reason. For example, at the end of her executive summary, Kelly Johnson (Director of Fitness to Practise) writes ‘the process is not about punishing a registrant, it is designed to ensure that action is only taken when it is necessary to protect the public.’ This is an empty phrase which could surely only be made by someone with little or no experience of the real world. A registrant against whom an allegation is raised deserves to believe - to know - that the investigation into the allegation is going to be fair and impartial. Only in this way could the process approach something akin to justice.
Who makes the complaints? The biggest group of complainers are … employers. 171 in the year 2006-7, which accounted for 40% of allegations. This suggests that when an employer is unhappy with a member of staff they can shunt the responsibility for dealing with it over to the HPC who in turn shunt the cost of it onto the … employees. Also, as the majority of defendants are men, one begins to wonder about the attributes of the complainer, details of whom are not exposed in the annual report. What do the Unions say about this?
A second group of complaints come automatically from the police (35 in 2007/8). The Home Office Circular 6/2006 provides that the HPC must be informed if a registered health professional is convicted or cautioned for an offence (tho only in England and Wales). This is a legacy of Ian Huntley and the tragedy of Soham in 2003.
At the HPC FTP Forum on Friday 24 April, Council members asked why such an adversarial and expensive method was favoured over mediation, even where the latter might be more effective. The law governing HPC regulation only allows mediation to be mentioned at the end of the process, by which time registrant and complainant are well entrenched in conflict, and mediation is no longer viable.
Jonathan Bracken, HPC Solicitor and Parliamentary Agent, is responsible for writing the operating procedures for the HPC, and is engaged to train people to follow these rules.
A Kingsley Napley press release tells us: The Hearing Aid Council is pleased to announce that it has appointed Jonathan Bracken as its new legal director plus Kingsley Napley as its new Disciplinary Committee solicitors and case handlers.
There is no tension in this system where those who are engaged can call each other to account. This appears to be fostering a situation where Kingsley Napley and their colleague Jonathan Bracken are taking up the slack. This all feeds back into the self fulfilling prophecy - that professionals are greedy unethical ne'er do wells, and need to be placed into the hands of the administrators.
Personal ethics more than ever are going to be required until this stupid system is dismantled or reassembled on rational, ethical, reasonable grounds.
Saturday, 9 May 2009
British Psychological Society dismayed
The day after the Lords bowed to tradition (see previous post) the President of the BPS wrote to members expressing her dismay.
"... There are still many details about the arrangements that are not yet resolved. For instance the Standards of Proficiency, and the Threshold Entry level remain to be debated and agreed by the Educational and Training Committee, and the Council of the HPC, this is scheduled for 20 May. Also the detail of the HPC grandparenting criteria remain to be agreed by the HPC and again it is expected that the decision will be made on 20 May.
As we are now ending an era for the Society as a regulator and entering a new phase of our organisation’s life I would like to take this opportunity to thank everyone who has been involved in the statutory regulation process – we haven’t always seen eye-to-eye, although I think we can all agree that the final form of regulation as proposed by the Government and agreed by the parliaments is less than ideal." [emphasis added]
The British continue to grin and bear the stupidity of those in positions of power.
Why?
Perhaps some dream of the chance to be 'raised to the peerage' themselves where they might act out their revenge. Possibly it's the dubious flattery of being held the second best in the hierarchy of the psys. Or maybe it's just the promise of pay rises and power over the new army of mental health workers in the 'Agenda for Change NHS'.
Or perhaps it is just our destiny, our national character, something hardwired into our genes.
"... There are still many details about the arrangements that are not yet resolved. For instance the Standards of Proficiency, and the Threshold Entry level remain to be debated and agreed by the Educational and Training Committee, and the Council of the HPC, this is scheduled for 20 May. Also the detail of the HPC grandparenting criteria remain to be agreed by the HPC and again it is expected that the decision will be made on 20 May.
As we are now ending an era for the Society as a regulator and entering a new phase of our organisation’s life I would like to take this opportunity to thank everyone who has been involved in the statutory regulation process – we haven’t always seen eye-to-eye, although I think we can all agree that the final form of regulation as proposed by the Government and agreed by the parliaments is less than ideal." [emphasis added]
The British continue to grin and bear the stupidity of those in positions of power.
Why?
Perhaps some dream of the chance to be 'raised to the peerage' themselves where they might act out their revenge. Possibly it's the dubious flattery of being held the second best in the hierarchy of the psys. Or maybe it's just the promise of pay rises and power over the new army of mental health workers in the 'Agenda for Change NHS'.
Or perhaps it is just our destiny, our national character, something hardwired into our genes.
Dinner Break Debate in the House of Lords, 5 May 09
On Tuesday 5th May, at 7.30pm, seven nobles took the trouble to attend the Dinner Break Debate at the House of Lords. This is a regular time-slot in the Lords’ programme where an hour is reserved for short debates on particular subjects. ‘These debates help to shape public policy’ says the glossy booklet available to all who enter the Strangers Gallery to observe. They also give the Lords a chance to go have something to eat before resuming the main business of the day. In this case it was the Marine & Coastal Access Bill that was slowly chugging through a very long list of amendments and would resume at 8.30pm to pick up where Lord Hunt finished them off at 7.28pm with amendment 63.
In that last half hour leading to the Break a little joke was made at the expense of a then absent Lord, the noble Lord John Alderdice. Lord Hunt looked over the woolsack to where he might find that familiar figure, thinking he may have arrived early for the debate on the Practitioner Psychologists.
Philip Hunt was raised to the peerage as Baron Hunt of Kings Heath, of Birmingham in the County of West Midlands 1997. John Alderdice pipped him by a year, being raised to the peerage as Baron Alderdice, of Knock in the City of Belfast 1996. Hunt sits centre left as you look down from the Stranger’s gallery (the Government benches, close to the despatch box), or on the right if you happen to be on the Woolsack, which is at the foot of the Throne. Alderdice sits on the right, near the woolsack, on the Liberal Democrat benches.
These two noble Lords had crossed swords before, when Hunt closed down Alderdice’s Psychotherapy Bill in 2000 – an early attempt to regulate the psys. (See Denis Postle’s very useful book Regulating the Psychological Therapies, From Taxonomy to Taxidermy, PCCS Books 2007).
By 7.28pm Alderdice had arrived, but Hunt and the others were off for their supper. This left seven noble members to debate the Health Care and Associated Professions (Miscellaneous Amendments and Practitioner Psychologists) Order 2009. In the Strangers Gallery sat at least three interested and several disinterested tourists. On the other side of the Hall the gallery held several key figures from the HPC.
This debate had not been expected. A rubber stamp was all inked up and ready to do its duty, but the Merits of Statutory Instruments Committee 11th report quietly caused a stir:
“[this Order] introduces, for the first time, statutory regulation of practitioner psychologists throughout the UK … The Committee has received correspondence from a number of psychotherapists and those practising similar disciplines: while many of the concerns expressed relate to a possible future Order, some of the issues mentioned, such as potential distortion of the market as a result of only regulating part of it, might arise as a result of the current instrument. A number of those currently practising in this field argue that the ‘one size fits all’ approach to the regulation of the health professions will cause significant damage to their profession. They are asking that the DH provide stronger evidence of the need to move away from voluntary regulation and how the policy proposed will increase the protection of the public. In debate, the House may wish to explore these issues further.”
Access to this report plus the full report of the debate in Hansards click here.
As the hall emptied Baroness Thornton opened the debate on behalf of the Government. Glenys Thornton was raised to the peerage as Baroness Thornton, of Manningham in the County of West Yorkshire 1998, and is a member of the Cooperative Party. She was chair of the Greater London Labour Party between 1986 and 1991.
“My Lords, the reforms set out in this draft order aim to enhance public confidence in the ability of the healthcare regulatory bodies to protect the public and deal with poor professional standards. The order continues the process of implementing the Government’s programme to improve patient safety through the reform and modernisation of the regulation of the healthcare professions, as set out in the White Paper, Trust, Assurance and Safety.”
I am aware that there has been a lot of interest in the build-up to this debate both in support of and against the provisions… At the moment, the only regulated group is psychiatrists, who are regulated as doctors by the GMC. As doctors they can also prescribe drugs to patients. The next highest qualified providers of talking therapies are practitioner psychologists, who are now being regulated for the first time. They must all have postgraduate qualifications.
Consideration is also being given to the regulation of psychotherapists and counsellors who have descending levels of professional qualification. The Health Professions Council has been working with bodies representing these groups to develop proposals but we are not there yet. Those discussions are continuing but no formal decisions have been made although we understand that the working group is hoping to report to the council of the HPC later this year. Any proposals to regulate psycho¬therapists and counsellors will be subject to further consultation before legislation is brought before the House. Given the weight of interventions on this matter by psychotherapists, we anticipate robust discussion and consultation.” [emphasis added]
Earl Howe who followed and spoke on behalf of the opposition repeated this reference to the number of letters received:
“My Lords, the House will be grateful to the Minister for introducing the order which, as some of us know, is the product of many years of discussion between the psychology profession and the Department of Health, as well as extensive discussion within the profession itself. I should like to be able to welcome it wholeheartedly on that account as being the settled view of all the parties involved, but, unfortunately, I cannot quite bring myself to do that because I am aware, as, I am sure, is the Minister, that there is great disquiet among members of the profession about what this order will mean for them and their patients and clients, and the precedent that it is likely to set as regards the related disciplines of psycho¬therapy and counselling in particular. My mailbag has been full to bursting with letters from psychologists and psycho¬therapists expressing total anguish about what the order contains and about the consultation that preceded it, which they see as having been stage-managed. It has not been particularly easy to tell those correspondents that by longstanding convention this House does not vote down secondary legislation. What we have in front of us, at least the part of it that relates to the regulation of psychologists, cannot, unfortunately, be described as a settled view or one that is universally welcomed.” [emphasis added]
Earl Howe had indeed been diligent in his replies to those who had written in expressing their concerns. He had told many people of this ‘longstanding convention’ whereby the Lords do not scupper a piece of secondary legislation. This is a point worth thinking on. Longstanding tradition is fine and dandy, but has to be seen in the light of more recent events. It is now well known that in the 10 years since Tony Blair took up his position as PM more laws were passed in UK than at any other time ever. This massive increase in legislation was a major topic of concern at the Convention on Modern Liberty on 28th February (http://www.modernliberty.net/), and the subject of the popular 2006 film by Chris Atkins: Taking Liberties (Revolver Films) http://www.imdb.com/title/tt0977667/.
The consequence of this massive increase in business means that many laws are being passed without full discussion (Kate Hoey, Lab MP for Vauxhall, made this point at the Convention). That this particular order was discussed at all must be recognised as a major achievement caused by those therapists who for the first time in their lives, no doubt, wrote a letter to a Lord or Lady.
Although much of Howe’s speech was highly critical of the current Order, (eg possibility of creating state sponsored rigidity; the lowering of standards; the distinctiveness of psychology from healthcare) he did take the time to state his position on statutory legislation, which he agrees with in principle. “With no disrespect to the individuals involved, I have been looking too long at these issues to be able to endorse that point of view. In the 21st century, with a need for full professional accountability, professional standards of practice, transparency and protection of the public, it is difficult to argue that statutory regulation in any form whatever is unnecessary.”
Lord Alderdice (a consultant psychiatrist in psychotherapy who runs the Centre for Psychotherapy in Belfast, a National Health Service facility, and who is a member of the BPC) was next to take the floor. Much of his speech was concerned with resurrecting his proposals for an alternative psychological professions council, which would at least have the advantage of knowing something of the thing it tried to regulate, unlike the HPC which he implied was ‘not fit for purpose’. He also pointed out that the current Order would ‘split the profession’ by registering practitioners and not those engaged in teaching and research. This is a very interesting point when considered alongside the list of competencies which implies an insistence that practitioners subordinate themselves to ‘evidence based research’.
At 8pm Baroness Pitkeathley piped up from the back of the Government benches. Another one raised to a peerage in 1997, Jill Pitkeathley is also the newly appointed Chair at the CHRE (the regulator of the HPC). Ironically, in spite of this recent appointment, Jill managed to keep a straight face when she argued that Regulators should be independent of the Government and the professions that they regulate, so that they can make and be seen to make—that is very important—appropriate decisions in the public interest. This was a point made in recognition of part of the Order which authorises changes to the structure of the HPC Council – removing elected professionals and replac¬ing them with appointments by Privy Council.
Next up was Viscount Eccles. John Dawson Eccles is an elected hereditary peer and sits on the conservative benches. He is also a member of the Merits of Statutory Instruments Committee. I am not as sanguine as my noble friend Lord Howe is about the benefits of statutory regulation and would like to emphasise what the noble Baroness, Lady Pitkeathley, said about independence. The great problem with all systems of statutory regulation that I have been involved with is that it is very difficult to believe that you have the independence that you were promised. I have debated the independence of public bodies a number of times in this House and usually I have been disappointed.
He also argued that no evidence had been provided to support the blank statements made by the Government about the need to regulate, and predicted a rise in imaginative accusations for the Fitness to Practise process given the nebulous nature of psychology: “What results from this state-controlled mechanical agenda is an increase from 134 HPC malpractice allegations in 2003–04 to three times that number in 2007–08, against a 30 per cent—less than one-third—increase in practitioners regulated under the 13 present headings. Psychologists will take the HPC on to new ground: matters of the mind. The attempt to codify and define will open the door to a rapid rise in imaginative allegations. One needs only to look at the prescriptive detail that the HPC thinks is appropriate for psychological qualification. Does the Minister really believe that a rising tide of allegations is, or ever will be, a good indicator of patient safety or public confidence?
He pointed out that the work of so-called consultations and the Government’s attempt to brush conflict under the carpet did not amount to evidence of agreement, and he was the third to mention the influx of well-reasoned letters to Westminster which constituted plenty of evidence of contro¬versy should anyone want to recog¬nise it. He finished up by saying that although we “are probably stuck with the order, or at least the psychological part of it, it should be the last with “psy” in the title.
This left the floor to Baroness Thornton to close on behalf of the Government. One thing worth quoting from these closing remarks is the question she posed in relation to psychotherapists and counsellors? “As I said in my opening remarks, there will be a statutory period of consultation before any further orders are laid. Legislation is not inevitable—although we currently agree with noble Lords that it is desirable.”
The voice from the Woolsack then asked if everyone ‘was content’. There being no-one willing to break tradition and admit to being not content, the Order was passed, and with it the Psychologists on to the register of the HPC in July 2009.
In that last half hour leading to the Break a little joke was made at the expense of a then absent Lord, the noble Lord John Alderdice. Lord Hunt looked over the woolsack to where he might find that familiar figure, thinking he may have arrived early for the debate on the Practitioner Psychologists.
Philip Hunt was raised to the peerage as Baron Hunt of Kings Heath, of Birmingham in the County of West Midlands 1997. John Alderdice pipped him by a year, being raised to the peerage as Baron Alderdice, of Knock in the City of Belfast 1996. Hunt sits centre left as you look down from the Stranger’s gallery (the Government benches, close to the despatch box), or on the right if you happen to be on the Woolsack, which is at the foot of the Throne. Alderdice sits on the right, near the woolsack, on the Liberal Democrat benches.
These two noble Lords had crossed swords before, when Hunt closed down Alderdice’s Psychotherapy Bill in 2000 – an early attempt to regulate the psys. (See Denis Postle’s very useful book Regulating the Psychological Therapies, From Taxonomy to Taxidermy, PCCS Books 2007).
By 7.28pm Alderdice had arrived, but Hunt and the others were off for their supper. This left seven noble members to debate the Health Care and Associated Professions (Miscellaneous Amendments and Practitioner Psychologists) Order 2009. In the Strangers Gallery sat at least three interested and several disinterested tourists. On the other side of the Hall the gallery held several key figures from the HPC.
This debate had not been expected. A rubber stamp was all inked up and ready to do its duty, but the Merits of Statutory Instruments Committee 11th report quietly caused a stir:
“[this Order] introduces, for the first time, statutory regulation of practitioner psychologists throughout the UK … The Committee has received correspondence from a number of psychotherapists and those practising similar disciplines: while many of the concerns expressed relate to a possible future Order, some of the issues mentioned, such as potential distortion of the market as a result of only regulating part of it, might arise as a result of the current instrument. A number of those currently practising in this field argue that the ‘one size fits all’ approach to the regulation of the health professions will cause significant damage to their profession. They are asking that the DH provide stronger evidence of the need to move away from voluntary regulation and how the policy proposed will increase the protection of the public. In debate, the House may wish to explore these issues further.”
Access to this report plus the full report of the debate in Hansards click here.
As the hall emptied Baroness Thornton opened the debate on behalf of the Government. Glenys Thornton was raised to the peerage as Baroness Thornton, of Manningham in the County of West Yorkshire 1998, and is a member of the Cooperative Party. She was chair of the Greater London Labour Party between 1986 and 1991.
“My Lords, the reforms set out in this draft order aim to enhance public confidence in the ability of the healthcare regulatory bodies to protect the public and deal with poor professional standards. The order continues the process of implementing the Government’s programme to improve patient safety through the reform and modernisation of the regulation of the healthcare professions, as set out in the White Paper, Trust, Assurance and Safety.”
I am aware that there has been a lot of interest in the build-up to this debate both in support of and against the provisions… At the moment, the only regulated group is psychiatrists, who are regulated as doctors by the GMC. As doctors they can also prescribe drugs to patients. The next highest qualified providers of talking therapies are practitioner psychologists, who are now being regulated for the first time. They must all have postgraduate qualifications.
Consideration is also being given to the regulation of psychotherapists and counsellors who have descending levels of professional qualification. The Health Professions Council has been working with bodies representing these groups to develop proposals but we are not there yet. Those discussions are continuing but no formal decisions have been made although we understand that the working group is hoping to report to the council of the HPC later this year. Any proposals to regulate psycho¬therapists and counsellors will be subject to further consultation before legislation is brought before the House. Given the weight of interventions on this matter by psychotherapists, we anticipate robust discussion and consultation.” [emphasis added]
Earl Howe who followed and spoke on behalf of the opposition repeated this reference to the number of letters received:
“My Lords, the House will be grateful to the Minister for introducing the order which, as some of us know, is the product of many years of discussion between the psychology profession and the Department of Health, as well as extensive discussion within the profession itself. I should like to be able to welcome it wholeheartedly on that account as being the settled view of all the parties involved, but, unfortunately, I cannot quite bring myself to do that because I am aware, as, I am sure, is the Minister, that there is great disquiet among members of the profession about what this order will mean for them and their patients and clients, and the precedent that it is likely to set as regards the related disciplines of psycho¬therapy and counselling in particular. My mailbag has been full to bursting with letters from psychologists and psycho¬therapists expressing total anguish about what the order contains and about the consultation that preceded it, which they see as having been stage-managed. It has not been particularly easy to tell those correspondents that by longstanding convention this House does not vote down secondary legislation. What we have in front of us, at least the part of it that relates to the regulation of psychologists, cannot, unfortunately, be described as a settled view or one that is universally welcomed.” [emphasis added]
Earl Howe had indeed been diligent in his replies to those who had written in expressing their concerns. He had told many people of this ‘longstanding convention’ whereby the Lords do not scupper a piece of secondary legislation. This is a point worth thinking on. Longstanding tradition is fine and dandy, but has to be seen in the light of more recent events. It is now well known that in the 10 years since Tony Blair took up his position as PM more laws were passed in UK than at any other time ever. This massive increase in legislation was a major topic of concern at the Convention on Modern Liberty on 28th February (http://www.modernliberty.net/), and the subject of the popular 2006 film by Chris Atkins: Taking Liberties (Revolver Films) http://www.imdb.com/title/tt0977667/.
The consequence of this massive increase in business means that many laws are being passed without full discussion (Kate Hoey, Lab MP for Vauxhall, made this point at the Convention). That this particular order was discussed at all must be recognised as a major achievement caused by those therapists who for the first time in their lives, no doubt, wrote a letter to a Lord or Lady.
Although much of Howe’s speech was highly critical of the current Order, (eg possibility of creating state sponsored rigidity; the lowering of standards; the distinctiveness of psychology from healthcare) he did take the time to state his position on statutory legislation, which he agrees with in principle. “With no disrespect to the individuals involved, I have been looking too long at these issues to be able to endorse that point of view. In the 21st century, with a need for full professional accountability, professional standards of practice, transparency and protection of the public, it is difficult to argue that statutory regulation in any form whatever is unnecessary.”
Lord Alderdice (a consultant psychiatrist in psychotherapy who runs the Centre for Psychotherapy in Belfast, a National Health Service facility, and who is a member of the BPC) was next to take the floor. Much of his speech was concerned with resurrecting his proposals for an alternative psychological professions council, which would at least have the advantage of knowing something of the thing it tried to regulate, unlike the HPC which he implied was ‘not fit for purpose’. He also pointed out that the current Order would ‘split the profession’ by registering practitioners and not those engaged in teaching and research. This is a very interesting point when considered alongside the list of competencies which implies an insistence that practitioners subordinate themselves to ‘evidence based research’.
At 8pm Baroness Pitkeathley piped up from the back of the Government benches. Another one raised to a peerage in 1997, Jill Pitkeathley is also the newly appointed Chair at the CHRE (the regulator of the HPC). Ironically, in spite of this recent appointment, Jill managed to keep a straight face when she argued that Regulators should be independent of the Government and the professions that they regulate, so that they can make and be seen to make—that is very important—appropriate decisions in the public interest. This was a point made in recognition of part of the Order which authorises changes to the structure of the HPC Council – removing elected professionals and replac¬ing them with appointments by Privy Council.
Next up was Viscount Eccles. John Dawson Eccles is an elected hereditary peer and sits on the conservative benches. He is also a member of the Merits of Statutory Instruments Committee. I am not as sanguine as my noble friend Lord Howe is about the benefits of statutory regulation and would like to emphasise what the noble Baroness, Lady Pitkeathley, said about independence. The great problem with all systems of statutory regulation that I have been involved with is that it is very difficult to believe that you have the independence that you were promised. I have debated the independence of public bodies a number of times in this House and usually I have been disappointed.
He also argued that no evidence had been provided to support the blank statements made by the Government about the need to regulate, and predicted a rise in imaginative accusations for the Fitness to Practise process given the nebulous nature of psychology: “What results from this state-controlled mechanical agenda is an increase from 134 HPC malpractice allegations in 2003–04 to three times that number in 2007–08, against a 30 per cent—less than one-third—increase in practitioners regulated under the 13 present headings. Psychologists will take the HPC on to new ground: matters of the mind. The attempt to codify and define will open the door to a rapid rise in imaginative allegations. One needs only to look at the prescriptive detail that the HPC thinks is appropriate for psychological qualification. Does the Minister really believe that a rising tide of allegations is, or ever will be, a good indicator of patient safety or public confidence?
He pointed out that the work of so-called consultations and the Government’s attempt to brush conflict under the carpet did not amount to evidence of agreement, and he was the third to mention the influx of well-reasoned letters to Westminster which constituted plenty of evidence of contro¬versy should anyone want to recog¬nise it. He finished up by saying that although we “are probably stuck with the order, or at least the psychological part of it, it should be the last with “psy” in the title.
This left the floor to Baroness Thornton to close on behalf of the Government. One thing worth quoting from these closing remarks is the question she posed in relation to psychotherapists and counsellors? “As I said in my opening remarks, there will be a statutory period of consultation before any further orders are laid. Legislation is not inevitable—although we currently agree with noble Lords that it is desirable.”
The voice from the Woolsack then asked if everyone ‘was content’. There being no-one willing to break tradition and admit to being not content, the Order was passed, and with it the Psychologists on to the register of the HPC in July 2009.
Friday, 8 May 2009
The friendly face of the hpc... not
I am indebted to a colleague for digging out this gem. When a government gives an organisation lots of power and asks them to do an impossible job, you can expect them to resort to rudeness and force fairly quickly, I guess, especially when they have been set up on the assumption that professionals are not trustworthy. Unintended consequences of a poorly thought through law? Self fulfilling prophecy more like:
"....You will soon receive your [HPC] registration renewal form. Remember, if you do not, it is your responsibility to contact the HPC to request one. In 2005, the HPC deregistered over 900 SLTs; many because of problems with the registration process - some had not given the HPC their new address and some did not sign the form. If you are deregistered it can take up to a fortnight before you can get back on the HPC register. You will not be able to work as an SLT during this time. Consequently, you risk suspension from work or having to work as an assistant, on an assistant's pay, until you are back on the register...."
(Royal College of Speech and Language Therapists' Bulletin, May 09 - Issue 685; p7)
"....You will soon receive your [HPC] registration renewal form. Remember, if you do not, it is your responsibility to contact the HPC to request one. In 2005, the HPC deregistered over 900 SLTs; many because of problems with the registration process - some had not given the HPC their new address and some did not sign the form. If you are deregistered it can take up to a fortnight before you can get back on the HPC register. You will not be able to work as an SLT during this time. Consequently, you risk suspension from work or having to work as an assistant, on an assistant's pay, until you are back on the register...."
(Royal College of Speech and Language Therapists' Bulletin, May 09 - Issue 685; p7)
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