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.
Tuesday, 17 February 2009
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.
(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,
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,
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