Yet another astonishing example of how the HPC mistakes Britain for a factory, and itself for the Factory Mananger.
The latest HPC hearing:
Date: Friday 9 October 2009
Name of Registrant: Xxxxx Xxxxxxx
Profession: Occupational therapist
Area of practise: Xxxxxxxxxx
Hearing Location: Park House, 184 Kennington Park Road,
Kennington, SE11 4BU, London
Committee: Conduct and Competence Committee
Allegation:
In the course of your employment as an Occupational Therapist by
xxxxxxxxxxxxxxxxxx between 2006-2008 you:
1. Failed to maintain accurate filing.
2. Failed to maintain adequate patient records and notes.
3. Failed to adequately manage your case load in particular that you did
not:
a) pick up referrals at a sufficient rate;
b) review cases within an adequate time frame;
c) close cases within an adequate time frame; and
d) submit two Disabled Facilities Grant applications, in a timely manner
in June 2006 and June 2007.
4. Failed to use I.T. systems as required.
5. Required support and guidance over and above that expected of a
qualified Occupational Therapist.
6. Failed to sufficiently meet the improvement targets as set by your
employers.
7. The matters set out in particulars 1-6 constitute misconduct and/or
lack of competence.
8. By reason of that misconduct and/or lack of competence, your fitness
to practise is impaired.’
Monday, 28 September 2009
Insidious creep of the 'protection' discourse.
At a party of artists on Saturday night, I spoke to a man who looked very glum. He is the head of department in a higher ed institute, one which is well regarded around the world for its artistic and talented craft-makers.
Before he even knew my particular interest he was telling me about a recent trip he had arranged to take a group of his mature students to Wales to exhibit their work. The health and safety administrator insisted that he discover the medication that each of his students were on and what time of day they should take it. He also had to nominate a student to ask him the time and the tablets he takes so that they could make sure each one didn't forget when they went on their weekend away.
Absolutely true. Right here, right now, in London.
I asked him why he didn't tell the administrator where to stick his stupid idea. He replied: there are so many fiddly petty fogging things to do these days, just to get the trip organised, that he didn't want to upset anyone who could prevent him even going.
I think he then felt embarrassed at his powerless position, because he added 'I wouldn't have minded but I had to design the form as well, myself!'
He should have minded, shouldn't he. The students aren't babies and can take their own tablets, and he certainly didn't want any of them intruding into his own body's failings. Just what was the administrator going to do with the information? Lord only knows!
How come nervous administrators wield such an amount of power?
Does this qualify one or both or all of them (the head of department, the health and safety administrator, the nominated student) as a Modern Health Professional?
Before he even knew my particular interest he was telling me about a recent trip he had arranged to take a group of his mature students to Wales to exhibit their work. The health and safety administrator insisted that he discover the medication that each of his students were on and what time of day they should take it. He also had to nominate a student to ask him the time and the tablets he takes so that they could make sure each one didn't forget when they went on their weekend away.
Absolutely true. Right here, right now, in London.
I asked him why he didn't tell the administrator where to stick his stupid idea. He replied: there are so many fiddly petty fogging things to do these days, just to get the trip organised, that he didn't want to upset anyone who could prevent him even going.
I think he then felt embarrassed at his powerless position, because he added 'I wouldn't have minded but I had to design the form as well, myself!'
He should have minded, shouldn't he. The students aren't babies and can take their own tablets, and he certainly didn't want any of them intruding into his own body's failings. Just what was the administrator going to do with the information? Lord only knows!
How come nervous administrators wield such an amount of power?
Does this qualify one or both or all of them (the head of department, the health and safety administrator, the nominated student) as a Modern Health Professional?
Sunday, 20 September 2009
HPC Council Meeting 10 9 09
The Council members sit round the table and have a 2" block of papers in front of them. Marc Seale laughed and apologised for the weight of paper they all faced at each meeting. He seemed to think the problem would be solved when he issued them each a laptop. Has he presumed that they don't read the papers? This is the real problem, surely.
From a mythical point of view, it might be said that the written word dominates the men and women. A friend of mine said 'it is speech that is under attack'.
The HPC staff speak very quickly, and in a kind of tone that makes it almost impossible for someone like me to follow. Someone not already practiced and versed in the language that is spoken here, someone who is interested in the meaning of what is being said.
This theme of speed and quantity is what catches my attention as the discussions progress through the enormously long and complicated agenda. What follows is drawn from the notes I jotted down as the meeting played out.
Annie Turner mentions that there are over 500 new programs to consider (post psychologist registration), and asks about the peak in complaints received in May.
These complaints are not about fitness to practice, but are complaints received from physiotherapy registrants trying to re-register themselves on time and proving too much for the administrators responsible for answering the phones.
Mary Clark Glass wondered whether the targets should be increased because the staff usually met them so easily.
Annie Turner mutters that the volume of work has risen hugely since the BPS programmes have been handed over for regulation.
Marc Seale said there had been a 'sea change in Fitness to Practice' that would require something new from the organisation. I wonder what he meant.
And someone else said that Michael Guthrie was building the evidence base of risk in connection with revalidation.
Anna van der Gaag - ah, someone who speaks slowly and clearly! - said, oh, I don't know what she said, perhaps it was she who mentioned Michael's evidence base of risk.
Mary Clark Glass wondered out loud how it could be possible to address behaviour through competencies, and Eileen Thornton said that 'we can't have a single model, but need a research base to base our decisions on." Jeff Lucas was happy that things were moving towards an evidence base, and said something about men of a certain age posing a risk group for the HPC.
Anna van der Gaag said that CPD was vital here, and Joy Tweed asked how long someone could be out of practice before 'they become a risk for us - we need research into this', then added 'how about patient feed back into CPD?' She wants to 'future proof' things, she said, adding that the professions were low risk right now, but 'we've 50 new professions in the pipeline'. FIFTY? Could I have possibly have heard that right? I think Joy who was still speaking as I wrote down: 'the longer you are in the profession, the greater risk you pose, so risk proofing would have to be done via supervision.'
Writing this now makes me chuckle and think about Karl Popper's central planner. The idea that the more experienced a professional is, the greater risk they pose to the HPC is hilarious from this perspective. The idea that the HPC will fight against such free thinking individualism by insisting on life-long supervision brings with it the spectre of a battle between the administrators backed by government legislation, vs the wit of wizened experience.
Back to the notes - Conduct. I've written it to emphasise the first syllable because each person who mentioned it stressed it like that as if trying to beat it into stone. The word seemed saturated with meaning, with something in excess of what could be articulated, something urgent trying to make itself heard. I've written down 'more fundamental revalidation, not just fitness to practice' to note the words of a Council member whose name I didn't catch. There was quite a concentrated piece of discussion here, which seemed to crystallise the interest of the whole group. Anna van der Gaag said 'there are people operating just below the level you would want, but they would not be subject to fitness to practise. How do we address that?" and Julia Drown said that revalidation methods should be compared with systems working around the world.
Marc Seale spoke of the struggle that the GMC were currently having, and said 'if we can crack it when no-one else has ... FTP ... CPD ... Self Correcting CPD... It is the Holy Grail," he said "can you come up with a system where a registrant self-corrects?"
Self corrects! I remember thinking of Prince Hal at that point, and turning towards the window. Anna van der Gaag's soothing voice brought me back into the room: "we are using well validated tools... it would be wrong to invent a scale ourselves that we thought would do the trick..." Eileen Turner was saying 'we know about this - lack of initiative, self direction, and motivation' and trailed off leaving Marc Seale free to say 'we are talking about a 4-5 year project - no-one has cracked it yet'.
Cracked what? How to tell if a student in university is going to commit a crime as he approaches middle age? I imagine that these things will have acquired the status of crime by then. The crime of not keeping neat and proper notes.
Apparently the Department of Health is funding some research that might relate to this. Somehow that does not bring me relief.
The business moved on to the CHRE review, and I came back into focus as Julia Drown is saying 'we don't want to be seen to protect the registrant, we are here to protect the public. It's about the message we send out to do that." I find myself smiling - she was a government spokesperson for health in her time as a Labour MP.
Marc Seale is saying something about the CHRE not having a comparison to judge good and bad practice, and Michael Guthrie said "we don't know what all the other regulators do" (goodness me, I think, you don't know what your own registrants do, perhaps you shouldn't you concentrate on that?)
Very often as I sit listening to these meetings I think about the reference points that people use. From my inquiry into the subject, it seems clear that they have no genuine point of reference. This is the natural consequence of Ian Kennedy's genius - to split the administration off from the practice, and then make the administrators responsible for the practice. This vacuum that they face is the logical consequence of Kennedy's prejudice. Tho, not just of Ian Kennedy.
My attention is brought back to the meeting by Anna van der Gaag's reassuring voice: "our school report is actually pretty good" she is saying "whatever we think of our head master, we actually have a good report."
Post Script: I've drawn a line in my notebook at that point, and probably left the room to get a glass of water. But when I returned they were talking about Sonographers, who I understand to be anyone who carries out those amazing technological tricks that reveal a tiny foetus sucking its thumb and wriggling around in the womb. Apparently, a sonographer is anyone who is using a sonograph, but not for long! A 200 page document was laid in front of the meeting from the Society and College of Sonographers who ask for HPC registration. Jeff Lucas said: "it appears to be a collective noun that not only overlaps different parts of the HPC register (ie lots of different professionals can use a sonograph, and even people who are not already in another profession), but is also shared across different regulators...'. But someone else, with an eye on expansion, said 'public protection' and blustered on: 'so a member of the public can know if someone is qualified to use the technology'. I nearly snorted, what a nice little earner the HPC are on. Every new piece of technology might inadvertently create a new profession for regulation. Now I understand how there could be another 50 in the queue already. Tell me, why would a member of the public need to know someone was qualified? Have we really reached the point when no-one trusts anyone in the NHS to know what they are doing? Maybe. Or, if not now, then probably sometime real soon.
From a mythical point of view, it might be said that the written word dominates the men and women. A friend of mine said 'it is speech that is under attack'.
The HPC staff speak very quickly, and in a kind of tone that makes it almost impossible for someone like me to follow. Someone not already practiced and versed in the language that is spoken here, someone who is interested in the meaning of what is being said.
This theme of speed and quantity is what catches my attention as the discussions progress through the enormously long and complicated agenda. What follows is drawn from the notes I jotted down as the meeting played out.
Annie Turner mentions that there are over 500 new programs to consider (post psychologist registration), and asks about the peak in complaints received in May.
These complaints are not about fitness to practice, but are complaints received from physiotherapy registrants trying to re-register themselves on time and proving too much for the administrators responsible for answering the phones.
Mary Clark Glass wondered whether the targets should be increased because the staff usually met them so easily.
Annie Turner mutters that the volume of work has risen hugely since the BPS programmes have been handed over for regulation.
Marc Seale said there had been a 'sea change in Fitness to Practice' that would require something new from the organisation. I wonder what he meant.
And someone else said that Michael Guthrie was building the evidence base of risk in connection with revalidation.
Anna van der Gaag - ah, someone who speaks slowly and clearly! - said, oh, I don't know what she said, perhaps it was she who mentioned Michael's evidence base of risk.
Mary Clark Glass wondered out loud how it could be possible to address behaviour through competencies, and Eileen Thornton said that 'we can't have a single model, but need a research base to base our decisions on." Jeff Lucas was happy that things were moving towards an evidence base, and said something about men of a certain age posing a risk group for the HPC.
Anna van der Gaag said that CPD was vital here, and Joy Tweed asked how long someone could be out of practice before 'they become a risk for us - we need research into this', then added 'how about patient feed back into CPD?' She wants to 'future proof' things, she said, adding that the professions were low risk right now, but 'we've 50 new professions in the pipeline'. FIFTY? Could I have possibly have heard that right? I think Joy who was still speaking as I wrote down: 'the longer you are in the profession, the greater risk you pose, so risk proofing would have to be done via supervision.'
Writing this now makes me chuckle and think about Karl Popper's central planner. The idea that the more experienced a professional is, the greater risk they pose to the HPC is hilarious from this perspective. The idea that the HPC will fight against such free thinking individualism by insisting on life-long supervision brings with it the spectre of a battle between the administrators backed by government legislation, vs the wit of wizened experience.
Back to the notes - Conduct. I've written it to emphasise the first syllable because each person who mentioned it stressed it like that as if trying to beat it into stone. The word seemed saturated with meaning, with something in excess of what could be articulated, something urgent trying to make itself heard. I've written down 'more fundamental revalidation, not just fitness to practice' to note the words of a Council member whose name I didn't catch. There was quite a concentrated piece of discussion here, which seemed to crystallise the interest of the whole group. Anna van der Gaag said 'there are people operating just below the level you would want, but they would not be subject to fitness to practise. How do we address that?" and Julia Drown said that revalidation methods should be compared with systems working around the world.
Marc Seale spoke of the struggle that the GMC were currently having, and said 'if we can crack it when no-one else has ... FTP ... CPD ... Self Correcting CPD... It is the Holy Grail," he said "can you come up with a system where a registrant self-corrects?"
Self corrects! I remember thinking of Prince Hal at that point, and turning towards the window. Anna van der Gaag's soothing voice brought me back into the room: "we are using well validated tools... it would be wrong to invent a scale ourselves that we thought would do the trick..." Eileen Turner was saying 'we know about this - lack of initiative, self direction, and motivation' and trailed off leaving Marc Seale free to say 'we are talking about a 4-5 year project - no-one has cracked it yet'.
Cracked what? How to tell if a student in university is going to commit a crime as he approaches middle age? I imagine that these things will have acquired the status of crime by then. The crime of not keeping neat and proper notes.
Apparently the Department of Health is funding some research that might relate to this. Somehow that does not bring me relief.
The business moved on to the CHRE review, and I came back into focus as Julia Drown is saying 'we don't want to be seen to protect the registrant, we are here to protect the public. It's about the message we send out to do that." I find myself smiling - she was a government spokesperson for health in her time as a Labour MP.
Marc Seale is saying something about the CHRE not having a comparison to judge good and bad practice, and Michael Guthrie said "we don't know what all the other regulators do" (goodness me, I think, you don't know what your own registrants do, perhaps you shouldn't you concentrate on that?)
Very often as I sit listening to these meetings I think about the reference points that people use. From my inquiry into the subject, it seems clear that they have no genuine point of reference. This is the natural consequence of Ian Kennedy's genius - to split the administration off from the practice, and then make the administrators responsible for the practice. This vacuum that they face is the logical consequence of Kennedy's prejudice. Tho, not just of Ian Kennedy.
My attention is brought back to the meeting by Anna van der Gaag's reassuring voice: "our school report is actually pretty good" she is saying "whatever we think of our head master, we actually have a good report."
Post Script: I've drawn a line in my notebook at that point, and probably left the room to get a glass of water. But when I returned they were talking about Sonographers, who I understand to be anyone who carries out those amazing technological tricks that reveal a tiny foetus sucking its thumb and wriggling around in the womb. Apparently, a sonographer is anyone who is using a sonograph, but not for long! A 200 page document was laid in front of the meeting from the Society and College of Sonographers who ask for HPC registration. Jeff Lucas said: "it appears to be a collective noun that not only overlaps different parts of the HPC register (ie lots of different professionals can use a sonograph, and even people who are not already in another profession), but is also shared across different regulators...'. But someone else, with an eye on expansion, said 'public protection' and blustered on: 'so a member of the public can know if someone is qualified to use the technology'. I nearly snorted, what a nice little earner the HPC are on. Every new piece of technology might inadvertently create a new profession for regulation. Now I understand how there could be another 50 in the queue already. Tell me, why would a member of the public need to know someone was qualified? Have we really reached the point when no-one trusts anyone in the NHS to know what they are doing? Maybe. Or, if not now, then probably sometime real soon.
Sunday, 13 September 2009
Annual Meeting - 10 Sep 09
Thursday, 10th September 2009. The HPC annual meeting.
It is not immediately clear what status this meeting has - ie it is not the AGM of a charity, nor that of a registered company - there are no votes taken, and no body of people who have any power to bring to bear on the organisation. Formally, the HPC is answerable to Privy Council - and none of them was present, as far as I could tell.
In the absence of any legal framework within which to understand the meeting (in the absence of any statutes or formally written rules) we are left to deduce the meaning from the work that it does on the day, the way this enters the daily business, and of course, the way it describes itself on the website: "Our annual meeting is the Council's opportunity to reflect on the last year's business in a public setting... a short talk given by the President, followed by a question and answer session."
Two of us had submitted questions ahead of time, me and the woman from MIND. First, Chairwoman Anna van der Gaag made her brief reflections, then we were invited to pose our questions.
MIND wanted to know whether there had been any problems arising from the regulation of the psychologists (1 July), and in particular whether anyone had made use of Principled Non-Compliance to reject the HPC.
The question was an informed and an intelligent one, and opened a welcome window onto the real world for the HPC. There is a tendency for things to get caught up in political (and Political) rhetoric so this question from the grass roots campaigning mental health user network was a great opportunity for the HPC spokesman Marc Seale (CEO) to make some real political capital.
I'm not really sure what he said, however. There were a lot of words, and he was smiling a great deal - this is what I wrote down at the time: "when you talk to professionals who are regulated, they are very proud, and embarrassingly positive ..." Chairwoman Anna van der Gaag (an expert in speech and language therapy) later summarised the answer: "it is too soon yet for any of us to know".
The question that I had sent in was on behalf of a colleague: "If a therapist is registered with the HPC, how does this affect the use of other unregulated therapies within their practice? For example an HPC registered psychotherapist using life coaching, hypnotherapy or other styles of therapy with their client."
This question has often been asked by those turning their attention for the first time to the HPC - I hear it asking: if I submit to your power, register my name, and pay the annual fee, will I be able to carry on practicing in the way I always have? If it were just a tax raised to fund the fitness to practice machinery, then the answer would be yes. It is not just a tax, however, but a whole new system of belief.
What did Marc Seale say? "This is a question about scope of practice. If you are regulated, and a complaint is made against you in one of your unregulated practices, we would still deal with that."
In her opening reflections, Anna van der Gaag mentioned that some of the professionals joining the HPC could rejoice in a reduction of fee from £667 to £76pa. With this, Anna let slip that, for her, the HPC is an alternative to registration with the existing practice based organisations - it is a rival to the existing professional bodies, and one that ultimately wants to replace professional bodies. She went on to say that the HPC represented a new kind of regulatory body, specifically 'a change from the paternalistic method' which she fleshed out with a quote from Don Berwick's John Hunt Lecture 2008 (entitled: Epitaph of a Profession !):
"we professionals are not our patient's partners. We are guests in their lives. We are not hosts. We are not priests in the cathedral of technology."
Well, leaving aside the irony that she must refer to a great man, speaking in the name of another great man in order to undermine a system based on great men, and forgetting for the moment the limitations of the metaphor of guest, what Anna seems to be arguing for is a change in attitude, conduct, and behaviour. She is calling, I think, for humbleness, whilst claiming that the HPC knows how to bring everyone to their knees.
It is not immediately clear what status this meeting has - ie it is not the AGM of a charity, nor that of a registered company - there are no votes taken, and no body of people who have any power to bring to bear on the organisation. Formally, the HPC is answerable to Privy Council - and none of them was present, as far as I could tell.
In the absence of any legal framework within which to understand the meeting (in the absence of any statutes or formally written rules) we are left to deduce the meaning from the work that it does on the day, the way this enters the daily business, and of course, the way it describes itself on the website: "Our annual meeting is the Council's opportunity to reflect on the last year's business in a public setting... a short talk given by the President, followed by a question and answer session."
Two of us had submitted questions ahead of time, me and the woman from MIND. First, Chairwoman Anna van der Gaag made her brief reflections, then we were invited to pose our questions.
MIND wanted to know whether there had been any problems arising from the regulation of the psychologists (1 July), and in particular whether anyone had made use of Principled Non-Compliance to reject the HPC.
The question was an informed and an intelligent one, and opened a welcome window onto the real world for the HPC. There is a tendency for things to get caught up in political (and Political) rhetoric so this question from the grass roots campaigning mental health user network was a great opportunity for the HPC spokesman Marc Seale (CEO) to make some real political capital.
I'm not really sure what he said, however. There were a lot of words, and he was smiling a great deal - this is what I wrote down at the time: "when you talk to professionals who are regulated, they are very proud, and embarrassingly positive ..." Chairwoman Anna van der Gaag (an expert in speech and language therapy) later summarised the answer: "it is too soon yet for any of us to know".
The question that I had sent in was on behalf of a colleague: "If a therapist is registered with the HPC, how does this affect the use of other unregulated therapies within their practice? For example an HPC registered psychotherapist using life coaching, hypnotherapy or other styles of therapy with their client."
This question has often been asked by those turning their attention for the first time to the HPC - I hear it asking: if I submit to your power, register my name, and pay the annual fee, will I be able to carry on practicing in the way I always have? If it were just a tax raised to fund the fitness to practice machinery, then the answer would be yes. It is not just a tax, however, but a whole new system of belief.
What did Marc Seale say? "This is a question about scope of practice. If you are regulated, and a complaint is made against you in one of your unregulated practices, we would still deal with that."
In her opening reflections, Anna van der Gaag mentioned that some of the professionals joining the HPC could rejoice in a reduction of fee from £667 to £76pa. With this, Anna let slip that, for her, the HPC is an alternative to registration with the existing practice based organisations - it is a rival to the existing professional bodies, and one that ultimately wants to replace professional bodies. She went on to say that the HPC represented a new kind of regulatory body, specifically 'a change from the paternalistic method' which she fleshed out with a quote from Don Berwick's John Hunt Lecture 2008 (entitled: Epitaph of a Profession !):
"we professionals are not our patient's partners. We are guests in their lives. We are not hosts. We are not priests in the cathedral of technology."
Well, leaving aside the irony that she must refer to a great man, speaking in the name of another great man in order to undermine a system based on great men, and forgetting for the moment the limitations of the metaphor of guest, what Anna seems to be arguing for is a change in attitude, conduct, and behaviour. She is calling, I think, for humbleness, whilst claiming that the HPC knows how to bring everyone to their knees.
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