A Physiotherapist (name and address supplied) wrote to the hpcwatchdog blog to tell of her shock at recent correspondence from HPC. Physiotherapists have been registered with HPC since its inception, and were with the CPSM (Council for Professions Supplementary to Medicine) before that. This year is the first time that they are being audited for Continuous Professional Development: “It has been made a condition for re-registration that we prove our CPD activity and how this activity has helped to improve our services”. How to improve your services! Esther is one of the 2.5% that have been randomly selected from the database to submit papers to ‘prove’ that the CPD she has undertaken during the year had a direct and positive impact on her practice. She followed the advice of her professional body (Chartered Society of Physiotherapists) when making her submission. Imagine her surprise, then, when the HPC wrote back and asked her for “more evidence as to how CPD has contributed to improving the quality of the service".
Apparently the HPC have realised that there is “no automatic link” between the CPD someone does and their competence as a practitioner, this has lead them to issue reminders to registrants that even if their CPD files are hunky-dory they might yet expect a letter from the fitness to practice committee. In case that doesn’t frighten them into improving, it invokes the law to back them up: “The Health Professions Order 2001 says that we can set standards for CPD and we can link these standards to renewing registration. We can also take registrants off our register if they have not met our standards."
This made the Alarm Bells ring and prompted contact with the hpcwatchdog: “I have followed the struggle of the Psychotherapists and Counsellors against control by the HPC and the posts on your HPC Watchdog website. I strongly feel that it is time to curb the powers of the HPC and I am very angry that health professionals should be treated like we cannot be trusted. I feel that all the health professionals under the umbrella of the HPC should get together and fight their corner. Unfortunately I get the feeling from our Chartered Society of Physiotherapists that they are all frightened of the powers of the HPC and even tend to take their side. It looks like they cannot be seen to take a stance against the powers of the HPC”.
She wants to widen the debate about the HPC and wrote to her local MP who just happens to be Nick Clegg, Deputy Prime Minister. His office replied almost straight away, noting her concerns and saying that a letter had been sent Andrew Lansley, MP, Secretary of State for Health to bring it to his attention.
In the meantime, I noticed at the recent Finance Committee that in spite of the £10m sloshing around in interest earning accounts, the HPC has been awarded a grant of £360,000 from the Department of Health in May 2009 to explore another new scheme to make sure practitioners know what they are doing. This is a ‘revalidation’ project.
Details are from a paper considered by the Health Professions Council on 10 December 2009.
The report says ‘the first task in our revalidation approach is to ensure that we understand the risk to the public posed by the professions that we regulate now and in the future. In particular we need more information about how different health care professionals (eg different professions, ages, genders, etc) expose service users to different levels of risks.” Risk by the way means ‘the potential to do harm’ (emphasis added). The unofficial hypothesis is that older men pose more risk.
Does this mean they don’t know what they are doing at the moment? The report boldly states “The HPC already has robust systems in place that reduce the risk to the public posed by our registrants by ensuring continuing fitness to practise processes, Continuing Professional Development (CPD) and the self certification that each registrant must complete when they renew their registration.”
A series of projects reveal more of the implicit assumptions of these centralist planners.
Project 1 wants to explore the link between conduct during training and subsequent FTP actions (can your student antics predict your grown-up malfeasance?) Discussions with Durham and Newcastle Universities are underway to appoint a researcher. The work will take a year, limited to studying one or two professions and will be quantitative. “The study should enable conclusions to be drawn about whether there is a link between poor conduct and performance during pre-registration education and training and subsequent FTP action. If a link is determined the study will also look at the areas of conduct which most commonly act as pre-indicators for subsequent FTP action… The outcomes from this study may indicate that the most effective way to increase public protection is to concentrate on pre-registration education and training, rather than introducing a post registration revalidation system.” The same team will undertake project 2.
Project 2 ‘piloting a pre-registration education and training ‘professionalism tool’. “By ‘professionalism tool’ we mean a method of teaching and promoting professionalism to students and emphasising the importance the HPC places on the conduct of our registrants.” p11. This is a five-year project tracking student progress and is hoped to “enable conclusions to be drawn about … identifying and resolving issues around professionalism during pre-registration ed & training, therefore reducing the number of FTP complaints regarding conduct.” Can we expect an edict to include this as part of the curriculum for our future training?
Project 3 will be an analysis of the HPC FTP data to identify trends regarding FTP across the register, analysing all data thus far collected since opening HPC register. The revalidation policy manager will work with a statistician for a year to explore the variation across profession, age, gender, route to registration, geographic location, types of practice, length of practice, NHS/Private, etc.
Project 4 an analysis of the CPD audit profiles to understand the impact of certain kinds of CPD on practice and misconduct, presumably. The study will analyse all available CPD profiles, assessor comments and assessment results. Two short-term contractors will do the work for a year, tho the CPD audit has only just begun and many professions are yet to be sampled. “The study should enable conclusions to be drawn about the following: if there are any trends regarding amount and type of CPD undertaken across the Register; trends regarding types of registrant that do not undertake appropriate or sufficient CPD, and effectiveness of [HPC] CPD processes in identifying registrants who are not continuing to practice safely and effectively. So, even if local practitioners manage to make their CPD files useful for their actual practice, the people with the statutory power intend to survey the data in your filing cabinet to predict your competence from a distance.
Project 5 and 6 are literature reviews of FTP process across the regulatory board. “For example if the data shows that concerns are most likely to arise either earlier or later in a registrant’s career, a revalidation process could be targeted [there]”.
BTW, I recently watched a video of old ladies at the Institute of Psychoanalysis could these be the targets of the new HPC CPD spot checks, or would there femininity predict their professionalism?
In the meantime, one man of a certain age is being put under close scrutiny by pro-HPC militants in the UKCP. A complaint was made to the charities commission that Chair Prof Samuels was breaching the regulations by fraternising with the Alliance for Counselling and Psychotherapy. The CC threw the complaint out. Statement by UKCP CEO David Pink on their website.
Yesterday’s HPC Council meeting (20 May 2010) considered the last Government’s last white paper ‘Building a National Care Service” which proposed that HPC license social care workers and healthcare support workers. This would have been a major step in creating a kind of ‘database state within a state’ of everyone remotely connected with the health or care of other people. It would have been a massive money-spinner for the ever-expanding HPC, but will it be scrapped by the new Government?
Nick Clegg’s speech robustly said that “it is time for a wholesale, big bang approach to political reform [blimey]… there will be no ID card scheme, no national identity register, no second generation biometric passports. They won’t hold your internet and email records. CCTV will be properly regulated. Ah! Is this within the remit of the HPC? Do cameras have an impact on the health and wellbeing of the nation? Yes - I think they do!
He also says the new government values debate and is unafraid of dissent, will remove limits on the rights to peaceful protest, propose to ‘tear through the statute book’, and ask us which laws we think should go.
Back at the HPC, the Education and Training Committee (10 March) agreed to recommend the working group recommendations for Generic Standards. However, with respect to the controversial SET 1 (see Annie Turner at last week’s PLG, and Eileen Thornton, previous PLGs) they noted that ‘the issue of generic standards was extremely complex because of the diversity of scopes of practise across the register’. They said nothing more in the minutes.
Here are the proposed new ‘over-arching’ generic standards:
1. Be able to practise safely and effectively within their scope of practice.
2. Be able to practise within the legal and ethical boundaries of their profession.
3. Understand the obligation to maintain fitness to practise
4. Be able to practise as an autonomous professional, exercising their own professional judgement
5. Be able to practise in a non-discriminatory manner
6. Be aware of culture, equality and diversity and their impact on practice
7. Be able to maintain confidentiality, while understanding the limits and potential ethical concerns that may arise
8. Be able to communicate effectively
9. Be able to work, where appropriate, with others.
10. Be able to maintain records appropriately, in accordance with applicable legislation, protocols and guidelines.
11. Be able to reflect on and review practice.
12. Be able to assure the quality of their practice.
13. Be able to draw on appropriate knowledge and skills to inform practice.
14. Understand the key concepts of the bodies of knowledge which are relevant to their profession.
15. Be able to establish and maintain a safe practice environment.
Notes
The phrase ‘you must be able to’ has been explained as necessary to accommodate brand new graduates as yet untested in practice (a group supposed to be more liable to turn up in the FTP machine).
Many if not most of the HPC Council are post-holders in Higher Education.
The general nature of these begs all kinds of questions in practice. I note for now that it is precisely the generality of standards of education and training that has led to ‘divisive’ practices noted more and more by members of the Education and Training Committee. This should not be surprising – the HPC structure removes any real grounds for judging actual work, pumps statutory law through vague standards, and appoints its own partners to police the system.
Surely a recipe for disaster.
Wednesday, 26 May 2010
Sunday, 16 May 2010
HPC PLG C&P 12 May 2010
Here is a report edited from my verbatim notes of the first part of last week's meeting. This group has already 'worked' on the 'problem' for over a year, but nevertheless seems to be approaching something vague and anomalous almost for the first time. After a brief intro, the dialogue is presented to reveal the chaotic character of the meeting.
HPC President Anna van der Gaag closed the meeting at 2pm on the dot (as predicted in the plan) with the words:
“Thank you, we’ve got a huge amount from you today”
None of the members of the PLG seemed to notice, but one or two in the public seats repeated the words while looking completely stunned.
The last time we all met in this neutral venue (Avonmouth House) Chair Di Waller had opened the meeting with a small lecture to the effect that members of the PLG were not there to represent anyone other than themselves. They had been recruited as individuals. This message was deemed necessary in order to counter the mounting criticisms that the PLG did not represent ‘the field’.
Today, at 10.30am on the dot Gaag opened the meeting (Di Waller being unwell) by going round the table inviting reflections on progress to date. What follows is edited from my verbatim notes. My comment is at the end.
FBD: Fiona Ballantine Dykes (who happens to work for the CPCAB): the landscape is different on many levels, and it raises questions: for example, what does this group need to do carry the confidence of people we represent. There are still some fundamental questions about the function of regulation, and we need a discussion about how regulation under HPC will be acceptable to the field. The details are secondary to that.
JC: Jonathan Coe (coincidentally, CEO of Witness – whose charity status ceased to be recognised by the Charities Commission 10 Feb 2010): generally there has been a good degree of progress, and I share Fiona’s view that we need to get collective backing of decisions made by the group.
BM: Brian Magee (COSCA): The time it has taken! HPC need to keep the information flowing and keep people on board. The December Council meeting raised expectations that things would move faster than they have.
AT: Annie Turner (an occupational therapist on the HPC Council): Standards of Practice - a lot of work still needs to be done on these. But I’m pleased with the work HPC have done on Generic Standards, which will move us forward. It will move the whole thinking in HPC forward from past paradigms, it will keep professions thinking forward. Any disagreement is second to that. We have a mountain to climb, and must make a leap forward, and we must do the background work.
LM: Linda Matthews (BABCP): There have been lots of discussions, people have anxieties, some are indifferent, and some are looking forward to HPC regulation. There has been a lull, and we need the HPC to take us forward while we try to take our members with us. The time-table leading to Feb 2011 is daunting [pause] but we are hanging on in there. It’s a joint approach and we are happy to be part of that.
MC: Mick Cooper (a Counselling professor who works in Scotland): I was struck by the responses to the consultation; there were meaningful, clear responses in a number of areas, decisions where people are comfortable and happy. I feel optimistic about moving forward. The consultation was useful.
JM: Jean McMinn (a counselling teacher, who works in Northern Ireland): [very quiet] … whether we have got both titles and levels of entry right?
PB: Peter Bell: This looks different depending where you are, I’m with BASRT, Relate, and a practising counsellor. Relate is not a professional body but a deliverer of services. Each of these positions has a different view, because there are different consequences. But what about the external forces – they will have their influence, the change of government, for example, what will that mean?
SA: Sally Aldridge (the Director of Regulatory Policy at BACP): we still need to convince some people out there to trust the HPC. SoPs go some way to do that, and we’ve used this to define the profession. But we must remember to set standards to protect the public, and not to protect the profession.
PF: Peter Fonagy (Skills for Health, BPC, UCL): This has been an interesting process for me personally, and I’m extremely grateful to have been able to participate. It has taught me things I didn’t know before. In the meantime we’ve [DH] managed to determine the NOS for Psychoanalytic/ dynamic Psychotherapy and the world did not immediately cease to turn on its axis! Out of controversy we gained a consensus that people were able to sign up to. So, here, it is critical that questions are raised about the competence of the regulator. We need to see what criteria are used to judge whether HPC is actually working. This will only work if it is voluntary. Is this group representative? Are we checking back to see it has validity beyond the people here. It can only work if it is voluntary. A sub group is saying that it won’t play, so we need to address this, we need to actually listen, and produce documentation to show the HPC as willing and flexible… We can be the arbitrator between the profession and the HPC.
JL: Julian Lousada (Chair of BPC): I was wondering how the PLG thought it would acknowledge those opposed to its project. Some of us have tried to engage with them but it’s not easy – but we shouldn’t give up. How can we ensure as we proceed that the Professional Organisations see themselves as central to the process. HPC doesn’t exist in a vacuum, but in a vacuum that has a relationship with the organisations [sic]. The Profession will not be strengthened if there is a weakening of the organisations.
CA: Carmen Ablack (a body therapist with the UKCP): I’d like to name the small elephant in the room: Opposition. Out there are different levels of opposition and anxiety. There are those who oppose the idea that this is a HEALTH profession, those opposed to aspects of HPC operations in the past (which we can see change attempts). Those who need clarity and assurance. Different kinds of concern and opposition – it’s not all one thing. If Kathy were here she would stress the importance of the partnership with professional organisations. I guess we do need to name the reality of changes [Chair of UKCP? Government? Who knows, they weren’t named]. Also, it is important to note that the responses to the consultation took very different forms – we in UKCP asked our members to respond to us, then we made one response to HPC, this distorts the statistics of response kept by HPC as not all organisations did the same thing. The responses are not equal and can’t be represented as such.
PF: I’d also like to congratulate Michael [Guthrie] on the rigorous, robust, transparency of his documents, and to tell him I would be happy to offer him a job at UCL. Ha, ha, ha, ha, ha.
AvdG: In the words of Nelson Mandella, our strongest weapon is dialogue. We must not be distracted from the work we must do in this group. It’s a difficult balance, we must bring more voices in to the debate.
MC: Mick Cooper then got the discussion to focus on how to include more Users in the process: “this is a major omission,” he said. This passed the conch to Jonathan Coe who said: the purpose of Statutory Reg is public protection. What is the nature of protection here? We need to talk to people who’ve been harmed. There’s been a survey by Mind, and Witness has run Focus Groups. We need a range of different ways to sample this group, and we need to be sensitive to the information, which cannot be given in public [sic].
PF: We need to say what HPC FTP has to offer here that is better than what already exists.
AvdG: We offer Statutory Regulation.
PF: We need a detailed Qualitative Inquiry on the impact of the system; and we need to acknowledge that this is the project of protecting people against human frailty. P&C are different in terms of regulation - do the HPC mechanisms meet the needs of therapists or not? It can be tested.
CA: There’s a diversity of clients, we need to understand the impact of regulation on these different populations.
LM: Is regulation suitable for C&P – are the public getting what they need from us if we are not regulated.
AT: a question for Peter: you say that psychotherapy and counselling are different. Different from what, different to what? We all work with vulnerable people you know.
PF: to me, it is the relationship that is the service.
[MC, LM both vigorously disagree and SA says she doesn’t understand.]
FBD: You need service providers to buy into the service of the HPC.
AT: what difference does it make to us, that you are different? [as this is delivered as a rhetorical question it elicits no answer]
PB: People these days are being sent by social care, GPs, the courts, other elements of the statutory centre, they are not coming to us of their own accord, they come with a message from the other which says ‘fix me’, get me back to work, make me a better parent. It’s different today. We need to consider the different kinds of service user we treat these days.
MC: independent focus groups need to look at this.
JC: What is the nature of risk in this sector? Private practice?
AvdG: what can we do practically to resolve this [can of worms]?
FBD: What impact will this have on services?
SA: It’s a big project
LM: it’s a huge project
AT: We need to look at the public we aim to protect. Not everybody, obviously, but what do we want to learn from the people that we talk to? And we need to know how sufficiently representative they are.
JL: How can we say to users this is why we think HPC will be an improvement?
BMcG: What about the International perspective? What can we learn from Australia, Europe?
AT: Will the Bolognia protocol affect you? [Stunned silence]
PF: It will turn British Higher Ed upside down [Stunned silence]
FBD: The quality of relation cannot be captured in SoP.
MC: Shall we invite an educationalist to advise whether entry level will impact on Standards?
AT: We should probably own that [sigh] well the usefulness of SET1 [pause], how it is used, [pause], well, if its used divisively in the profession then that is not good for public protection. This challenges council members. Considerable concern is coming to the Education and Training Committee. There is no wide consensus. We need more work to remove that Standard. [Brightens] It is almost a red herring, really, but [pause] what does it actually mean? [dipping again slightly] We’ve all been challenged by this.
FBD: The relationship is important.
PB: The relationship
AvdG: We are broader than health now, we can do it.
AT: I think this could be said for any practitioner.
AvdG: we won’t agree today, as we didn’t before, but we might in the future.
MC: No!
CA: I’ve witnessed the unfolding of issues over the last year, you’ve already done this. Lets name it.
SA: Should we look at the curriculum of all the training orgs? This will tell us what is going on out there.
AvdG: Who do we need at the table?
Voice: GOD
LM: Yes, I said that before too.
JL: So many presentations, its too much! We need to battle this out.
PB: what about employers? What about the opponents? [my neighbour asks me to note that it is now 12.10.]
MC: What for?
FBD: The HPC has proved itself open and willing to listen.
LM: They could give us stuff we are missing, though this is not a forum against HPC. We have emails from people with concerns about this, and we can help them through it.
PF: we need to hear the objections. We are the mediators between the field, and the HPC.
AvdG: Shall we have some lunch?
After lunch Gaag asked for outstanding questions. Julian Lousada tried to get the group to acknowledge the uniqueness of the relationship in this kind of work. He failed. Again, he tried. “How do we expose people to the clinical work?” he asked, before summoning the courage to add “do they have personal therapy?” then collapsed and added “Can we ask users whether they think they’ll get a better service if the practitioner they see has gone through their own therapy?” Sally Aldridge said “no matter how important it is, is it relevant here?” This, of course, is an excellent question, drawing attention to the fact that this meeting is about writing HPC documents which have no relevance to current practice except to sound its death knell. No-one indicated they heard, let alone understood what Sally said.
The discussion was degenerating by the minute and ended up discussing whether to meet in large or small groups, whether to have 5 minute or 50 minute presentations, and finally whether to meet at 10am or even 9.30 in order to get through the huge amount of work implied by their discussion. Gaag resisted all of this and said that 10.30 was fine and then concluded in a very calm voice, saying: “Engaging with those who oppose is very much about providing public meetings in all four countries to discuss all aspects of regulatory framework. Each aspect of regulatory practice will be presented and there will be lots of opportunity for Q&A, and within that there will be those who express strongly held views.”
I think it was Brian Magee who said – “and what will happen then? This is what happened in Manchester, and we were never given the opportunity to discuss it afterwards.”
Gaag smiled pleasantly and drew the meeting to a close. “Thank you, we’ve got a huge amount from you today”
COMMENT: The opening hour of the PLG let the members voice their concerns that the HPC process does not meet the needs of C&P. The rest of the meeting saw Gaag slowly override those comments and return to her business, ie to get what she needs to do in order to present the HPC as one that has ‘consulted’ with the appropriate people, ie 'users' . This idea comes 18 months after the HPC process began.
In the workplan (hardly discussed in the meeting), the business of constructing SETs and SOPs is scheduled for after the S60 is written. The DH is not interested in these, so HPC doesn't need to show that work is progressing - DH trust them to know what they are doing! However, as the HPC is staffed by administrators who know nothing of the practice they want to regulate, they delegate this work to a few people in the profession who in turn need the HPC to tell them how to do it because, as Annie Turner frequently says: they do not reflect current practice, but must invent something totally new.
If the HPC doesn’t properly define the profession (one of the major problems for this PLG is to maintain the impression that they are all from the same practice) and then does not allow the right Professionals sufficient time and resources to do the job then it can only succeed in laying the ground for imposing a set divisive and stupid standards. They are now no longer able to maintain ignorance on this: Annie Turner mentioned the growing concern in the Ed & Training Committee, where the Standards of Ed & Training are already showing signs of producing divisive fighting in the field it is supposed to regulate.
Group members raised some interesting points in their discussion, but the implications of their questions, had they followed any one of them through to its conclusion, would have upset the HPC if only because they would recognise the real time and work implied. Hence no meaningful discussion was allowed to establish itself - this is typical of these PLG meetings.
HPC President Anna van der Gaag closed the meeting at 2pm on the dot (as predicted in the plan) with the words:
“Thank you, we’ve got a huge amount from you today”
None of the members of the PLG seemed to notice, but one or two in the public seats repeated the words while looking completely stunned.
The last time we all met in this neutral venue (Avonmouth House) Chair Di Waller had opened the meeting with a small lecture to the effect that members of the PLG were not there to represent anyone other than themselves. They had been recruited as individuals. This message was deemed necessary in order to counter the mounting criticisms that the PLG did not represent ‘the field’.
Today, at 10.30am on the dot Gaag opened the meeting (Di Waller being unwell) by going round the table inviting reflections on progress to date. What follows is edited from my verbatim notes. My comment is at the end.
FBD: Fiona Ballantine Dykes (who happens to work for the CPCAB): the landscape is different on many levels, and it raises questions: for example, what does this group need to do carry the confidence of people we represent. There are still some fundamental questions about the function of regulation, and we need a discussion about how regulation under HPC will be acceptable to the field. The details are secondary to that.
JC: Jonathan Coe (coincidentally, CEO of Witness – whose charity status ceased to be recognised by the Charities Commission 10 Feb 2010): generally there has been a good degree of progress, and I share Fiona’s view that we need to get collective backing of decisions made by the group.
BM: Brian Magee (COSCA): The time it has taken! HPC need to keep the information flowing and keep people on board. The December Council meeting raised expectations that things would move faster than they have.
AT: Annie Turner (an occupational therapist on the HPC Council): Standards of Practice - a lot of work still needs to be done on these. But I’m pleased with the work HPC have done on Generic Standards, which will move us forward. It will move the whole thinking in HPC forward from past paradigms, it will keep professions thinking forward. Any disagreement is second to that. We have a mountain to climb, and must make a leap forward, and we must do the background work.
LM: Linda Matthews (BABCP): There have been lots of discussions, people have anxieties, some are indifferent, and some are looking forward to HPC regulation. There has been a lull, and we need the HPC to take us forward while we try to take our members with us. The time-table leading to Feb 2011 is daunting [pause] but we are hanging on in there. It’s a joint approach and we are happy to be part of that.
MC: Mick Cooper (a Counselling professor who works in Scotland): I was struck by the responses to the consultation; there were meaningful, clear responses in a number of areas, decisions where people are comfortable and happy. I feel optimistic about moving forward. The consultation was useful.
JM: Jean McMinn (a counselling teacher, who works in Northern Ireland): [very quiet] … whether we have got both titles and levels of entry right?
PB: Peter Bell: This looks different depending where you are, I’m with BASRT, Relate, and a practising counsellor. Relate is not a professional body but a deliverer of services. Each of these positions has a different view, because there are different consequences. But what about the external forces – they will have their influence, the change of government, for example, what will that mean?
SA: Sally Aldridge (the Director of Regulatory Policy at BACP): we still need to convince some people out there to trust the HPC. SoPs go some way to do that, and we’ve used this to define the profession. But we must remember to set standards to protect the public, and not to protect the profession.
PF: Peter Fonagy (Skills for Health, BPC, UCL): This has been an interesting process for me personally, and I’m extremely grateful to have been able to participate. It has taught me things I didn’t know before. In the meantime we’ve [DH] managed to determine the NOS for Psychoanalytic/ dynamic Psychotherapy and the world did not immediately cease to turn on its axis! Out of controversy we gained a consensus that people were able to sign up to. So, here, it is critical that questions are raised about the competence of the regulator. We need to see what criteria are used to judge whether HPC is actually working. This will only work if it is voluntary. Is this group representative? Are we checking back to see it has validity beyond the people here. It can only work if it is voluntary. A sub group is saying that it won’t play, so we need to address this, we need to actually listen, and produce documentation to show the HPC as willing and flexible… We can be the arbitrator between the profession and the HPC.
JL: Julian Lousada (Chair of BPC): I was wondering how the PLG thought it would acknowledge those opposed to its project. Some of us have tried to engage with them but it’s not easy – but we shouldn’t give up. How can we ensure as we proceed that the Professional Organisations see themselves as central to the process. HPC doesn’t exist in a vacuum, but in a vacuum that has a relationship with the organisations [sic]. The Profession will not be strengthened if there is a weakening of the organisations.
CA: Carmen Ablack (a body therapist with the UKCP): I’d like to name the small elephant in the room: Opposition. Out there are different levels of opposition and anxiety. There are those who oppose the idea that this is a HEALTH profession, those opposed to aspects of HPC operations in the past (which we can see change attempts). Those who need clarity and assurance. Different kinds of concern and opposition – it’s not all one thing. If Kathy were here she would stress the importance of the partnership with professional organisations. I guess we do need to name the reality of changes [Chair of UKCP? Government? Who knows, they weren’t named]. Also, it is important to note that the responses to the consultation took very different forms – we in UKCP asked our members to respond to us, then we made one response to HPC, this distorts the statistics of response kept by HPC as not all organisations did the same thing. The responses are not equal and can’t be represented as such.
PF: I’d also like to congratulate Michael [Guthrie] on the rigorous, robust, transparency of his documents, and to tell him I would be happy to offer him a job at UCL. Ha, ha, ha, ha, ha.
AvdG: In the words of Nelson Mandella, our strongest weapon is dialogue. We must not be distracted from the work we must do in this group. It’s a difficult balance, we must bring more voices in to the debate.
MC: Mick Cooper then got the discussion to focus on how to include more Users in the process: “this is a major omission,” he said. This passed the conch to Jonathan Coe who said: the purpose of Statutory Reg is public protection. What is the nature of protection here? We need to talk to people who’ve been harmed. There’s been a survey by Mind, and Witness has run Focus Groups. We need a range of different ways to sample this group, and we need to be sensitive to the information, which cannot be given in public [sic].
PF: We need to say what HPC FTP has to offer here that is better than what already exists.
AvdG: We offer Statutory Regulation.
PF: We need a detailed Qualitative Inquiry on the impact of the system; and we need to acknowledge that this is the project of protecting people against human frailty. P&C are different in terms of regulation - do the HPC mechanisms meet the needs of therapists or not? It can be tested.
CA: There’s a diversity of clients, we need to understand the impact of regulation on these different populations.
LM: Is regulation suitable for C&P – are the public getting what they need from us if we are not regulated.
AT: a question for Peter: you say that psychotherapy and counselling are different. Different from what, different to what? We all work with vulnerable people you know.
PF: to me, it is the relationship that is the service.
[MC, LM both vigorously disagree and SA says she doesn’t understand.]
FBD: You need service providers to buy into the service of the HPC.
AT: what difference does it make to us, that you are different? [as this is delivered as a rhetorical question it elicits no answer]
PB: People these days are being sent by social care, GPs, the courts, other elements of the statutory centre, they are not coming to us of their own accord, they come with a message from the other which says ‘fix me’, get me back to work, make me a better parent. It’s different today. We need to consider the different kinds of service user we treat these days.
MC: independent focus groups need to look at this.
JC: What is the nature of risk in this sector? Private practice?
AvdG: what can we do practically to resolve this [can of worms]?
FBD: What impact will this have on services?
SA: It’s a big project
LM: it’s a huge project
AT: We need to look at the public we aim to protect. Not everybody, obviously, but what do we want to learn from the people that we talk to? And we need to know how sufficiently representative they are.
JL: How can we say to users this is why we think HPC will be an improvement?
BMcG: What about the International perspective? What can we learn from Australia, Europe?
AT: Will the Bolognia protocol affect you? [Stunned silence]
PF: It will turn British Higher Ed upside down [Stunned silence]
FBD: The quality of relation cannot be captured in SoP.
MC: Shall we invite an educationalist to advise whether entry level will impact on Standards?
AT: We should probably own that [sigh] well the usefulness of SET1 [pause], how it is used, [pause], well, if its used divisively in the profession then that is not good for public protection. This challenges council members. Considerable concern is coming to the Education and Training Committee. There is no wide consensus. We need more work to remove that Standard. [Brightens] It is almost a red herring, really, but [pause] what does it actually mean? [dipping again slightly] We’ve all been challenged by this.
FBD: The relationship is important.
PB: The relationship
AvdG: We are broader than health now, we can do it.
AT: I think this could be said for any practitioner.
AvdG: we won’t agree today, as we didn’t before, but we might in the future.
MC: No!
CA: I’ve witnessed the unfolding of issues over the last year, you’ve already done this. Lets name it.
SA: Should we look at the curriculum of all the training orgs? This will tell us what is going on out there.
AvdG: Who do we need at the table?
Voice: GOD
LM: Yes, I said that before too.
JL: So many presentations, its too much! We need to battle this out.
PB: what about employers? What about the opponents? [my neighbour asks me to note that it is now 12.10.]
MC: What for?
FBD: The HPC has proved itself open and willing to listen.
LM: They could give us stuff we are missing, though this is not a forum against HPC. We have emails from people with concerns about this, and we can help them through it.
PF: we need to hear the objections. We are the mediators between the field, and the HPC.
AvdG: Shall we have some lunch?
After lunch Gaag asked for outstanding questions. Julian Lousada tried to get the group to acknowledge the uniqueness of the relationship in this kind of work. He failed. Again, he tried. “How do we expose people to the clinical work?” he asked, before summoning the courage to add “do they have personal therapy?” then collapsed and added “Can we ask users whether they think they’ll get a better service if the practitioner they see has gone through their own therapy?” Sally Aldridge said “no matter how important it is, is it relevant here?” This, of course, is an excellent question, drawing attention to the fact that this meeting is about writing HPC documents which have no relevance to current practice except to sound its death knell. No-one indicated they heard, let alone understood what Sally said.
The discussion was degenerating by the minute and ended up discussing whether to meet in large or small groups, whether to have 5 minute or 50 minute presentations, and finally whether to meet at 10am or even 9.30 in order to get through the huge amount of work implied by their discussion. Gaag resisted all of this and said that 10.30 was fine and then concluded in a very calm voice, saying: “Engaging with those who oppose is very much about providing public meetings in all four countries to discuss all aspects of regulatory framework. Each aspect of regulatory practice will be presented and there will be lots of opportunity for Q&A, and within that there will be those who express strongly held views.”
I think it was Brian Magee who said – “and what will happen then? This is what happened in Manchester, and we were never given the opportunity to discuss it afterwards.”
Gaag smiled pleasantly and drew the meeting to a close. “Thank you, we’ve got a huge amount from you today”
COMMENT: The opening hour of the PLG let the members voice their concerns that the HPC process does not meet the needs of C&P. The rest of the meeting saw Gaag slowly override those comments and return to her business, ie to get what she needs to do in order to present the HPC as one that has ‘consulted’ with the appropriate people, ie 'users' . This idea comes 18 months after the HPC process began.
In the workplan (hardly discussed in the meeting), the business of constructing SETs and SOPs is scheduled for after the S60 is written. The DH is not interested in these, so HPC doesn't need to show that work is progressing - DH trust them to know what they are doing! However, as the HPC is staffed by administrators who know nothing of the practice they want to regulate, they delegate this work to a few people in the profession who in turn need the HPC to tell them how to do it because, as Annie Turner frequently says: they do not reflect current practice, but must invent something totally new.
If the HPC doesn’t properly define the profession (one of the major problems for this PLG is to maintain the impression that they are all from the same practice) and then does not allow the right Professionals sufficient time and resources to do the job then it can only succeed in laying the ground for imposing a set divisive and stupid standards. They are now no longer able to maintain ignorance on this: Annie Turner mentioned the growing concern in the Ed & Training Committee, where the Standards of Ed & Training are already showing signs of producing divisive fighting in the field it is supposed to regulate.
Group members raised some interesting points in their discussion, but the implications of their questions, had they followed any one of them through to its conclusion, would have upset the HPC if only because they would recognise the real time and work implied. Hence no meaningful discussion was allowed to establish itself - this is typical of these PLG meetings.
Wednesday, 12 May 2010
Elite pro-hpc lobby press to raise morale as PLG reconvenes
"The Times Newspaper ran a special feature last week (Friday 7 May) Should Psychotherapy be State Regulated. Mind put the Pros - “For Mind, it’s not about who regulates but about how it is done — as long as regulation is statutory and independent, then we have no preference who does the job.” The No voice came from the College of Psychoanalysts - “The HPC’s fitness for practice codes make this freedom impossible and therapists risk being struck off for conduct which no court would consider criminal. A rigid moralism reminiscent of McCarthyism lies at the core of its procedures, as witnessed in the recent “trial” of a psychologist for making sexual jokes at a private dinner”. And the Maybe from UKCP – “we are also calling for the new government immediately to organise a convention to discuss alternative futures for the profession. Because many of our members seem likely to refuse to register with HPC, we are developing an alternative approach to professional regulation”.
The Guardian ran a piece on Bank Holiday Monday (3 May) Psychotherapy Rebels consider Rebranding to Avoid State Regulation.
Malcolm Allen (BPC chief exec) has a little opinion piece in yesterday's Guardian (11 May)
And on Sunday there was also an article in the Observer
You might wonder why the regulation debate is suddenly all over the papers again. The articles contain the same old arguments and examples that appeared a year ago when the psychologists were approaching their regulatory deadline. There is no new scandal, no new news at all. But today (Wed 12 May) the Professional Liaison Group for Psychotherapy and Counselling will meet again for the first time since the public consultation overwhelmingly rejected their proposals. It seems that a little group of four or five people eager for HPC regulation have got together to lobby the health and society editors to run pro-HPC pieces.
The PLG membership remains exactly the same in spite of promises at the Dec 2009 Council meeting to expand it. I wonder how they feel to get together again after the 1,000 responses to their dreadful attempt to come up with a plan last summer. Di Waller, titular chair of the group, famously blamed (at the Confer Conference in March this year) the professionals in this group for failing to come up something that would have been less controversial. She and the Director of Policy and Standards (Michael Guthrie) have been given the power to identify new stakeholders to provide additional expertise and avoid any future embarrassment. No doubt Di will be blaming them for failing her in due course.
Sunday, 2 May 2010
Finance, Fashion, Security, and the death of philosophy
I popped into the HPC yesterday to catch the first hour of the Finance Committee Meeting. As I walked up the stairs to the front door I noticed a really pretty circle of shiny steel within which a bright blue light changed to lime green as I was let in. There was another by the internal door that serves as the entrance to the main part of the building. I remarked on them to the receptionist, and noted more and more of them as I was escorted down the corridor to the bright and airy council chamber in which the Finance Committee had already commenced its business. There, Brian Walker had taken the guest seat at the square table, around which the committee and its servants sat, and was talking about the falling value of the building. Around the table, the Council members were sitting with their new sleek, metallic light-weight lap-tops. Those with thick spiral bound sets of paper were probably the staff. Everyone in the back row (except me) has one of these spiral booklets balanced on his pin-striped knee.
Mr Walker was talking of the effect the recession was having on the value of the building. He said several times that it was the best quality office building in the area and I remembered hearing exactly this talk at another Finance meeting perhaps a year ago. He said the market was ‘bumping along the bottom’, and he ‘did not foresee an improvement’ next year, ‘the market place is what has to drive us’ he said, and ‘this is where we stand’, etc. Julia Drown asked ‘should we sell up and cash in?’ He replied that that Freeholds weren’t selling at the moment, because no-one’s got any money. There was a short detour about the number of millions it was now possible to raise compared to the squillions that were the norm more recently. Nevertheless, he reassured the Council that their ‘covenant’ was clearly very strong, because it was effectively Government backed.
“Should we sell the building and lease it back?” The council member asked. “Should you occupy a freehold?” repeated a startled Mr Walker, “it’s relatively unfashionable, because it is so cheap to lease”. No, then, I suppose.
Malcolm Cross asked if he could ask a naïve question. He was assured he could. “Is it possible, if the organisation grows organically, and colonises different spaces around the neighbourhood, to reconsolidate later?” “Yes” said Mr Walker who was then free to leave.
This made room at the table for Jonathan Bracken, the Legal Adviser, and a young woman who seemed to be making her debut at the meeting – Kathryn Neuberger, the Partner Manager of the HPC. She tentatively read the document relating to Item 11 of the agenda: Partner Code of Conduct and my notebook filled up with legal phrases: Code of Conduct, Contracts Compliance, Specific Conduct, Revised Code. Partner Code of Conduct. Someone asked what had provoked this revision, “had there been a spate of complaints about the Partners?” “No. We only get about 2 complaints a year”. “Oh, who from? Other partners perhaps, or from HEIs?” Kathryn didn’t know, so it probably wasn’t the reason for revising the contracts and codes. We didn’t learn what was, nor why it was here in the Finance meeting. Jonathan Bracken added some serious sounding stuff the only part of which I could understand was “making sure people keep up with training requirements”.
Malcolm Cross apologised for wanting to ask ‘another probably stupid question’, and was again assured it was ok. He was puzzled about the complaints procedure, and was unsure what was meant by the contractual obligation to act in ‘good faith’. This prompted a breeze of laughter after which Jonathan Bracken recovered himself and affably said it was “one of those things one instinctively knows but cannot be put into words”. Business done he then bustled out of the room with a huge grin on his face.
Everyone turned to the pages full of figures – The Finance Department Report, the first page of which details funds under management of £6,100,000 plus 2 investment portfolios amounting to £4,010,000. That’s over ten million pounds of money tied up in investment accounts earning various rates of interest.
Revenue of nearly £15 million is received through registration, but was slightly exceeded by expenses. There are two notes of particular interest offered as explanation for the overspend:
1. Professional Fees. “The unfavourable variance of £238k is mainly due to an unfavourable variance of £60k for legal advice due to additional advice in relation to new professions, an unfavourable variance of £62k for other legal costs due to a [sic] increase in high court appeals, and unfavourable variance of £58k for transcript writers due to the increase in the number of hearings and an unfavourable variance of £49k for legal expenses due to an increase in disbursements and costs relating to Psychologist Hearings.” (Note I p 4,).
2. Fitness to Practise. “The unfavourable variance of £612k was due to an increase in the number of allegations being received and the increase in the length of hearings. This included unfavourable variances on room hire (£65k), panels (£394k) and transcript writers (£58k). There was also an unfavourable variance of £62k in other legal costs due to the increase in high court appeals.” (Note 7 p 6.)
A couple of other small amounts turned out to be equally as interesting. A figure of £90,000 revealed a point of fear and trembling for the HPC. Once upon a time, the HPC had bought a licence for its Microsoft Software, but the piece of paper that accompanied this act has long since been lost. The HPC is worried at this lack of proof of their virtue. If Microsoft ever comes knocking on the door to demand to see the licence, it will have nothing but a word of honour to offer. The finance team didn’t think Microsoft would believe them. So, they have been salting away a few thousand a year against the day of judgment. Finally they decided to go out and buy fresh licences and be done with it. So, there does exist a body capable of frightening the HPC. Very Old Testament, I must say, in a 21st Century kind of way.
The second interesting figure is £360,000, concealed in the cash flow accounts where it appears as an exceptional expense, written in brackets to signify that in fact it is an income (September 2008). It is a payment from the Department of Health. I am currently trying to discover what this signifies.
Just before I had to leave, Marc Seale was explaining that he was expecting ten times as many Fitness to Practise cases on the books when they took on Psychotherapists and Counsellors. This was, he said, because there are about 40 or 50 organisations out there, most of whom lack proper fitness to practise processes, so it’s a major issue which he is currently negotiating with Government – the extra costs he foresaw pertaining to P&C FTP shouldn’t be passed on to the existing registrants and another source must be found.
NB Paramedics are disproportionately represented in FTP, though no similar logic is applied there. Perhaps the HPC are making the DH pay for the inconvenience they are experiencing with this ‘New Profession’.
It was much later that I remembered one more point while watching the premier of the film Erasing David (to be televised on More 4, 10pm Tuesday 4th May). The film, sponsored by the Joseph Rowntree Reform Trust (who launched last year’s Convention on Modern Liberty), is an experiment designed to reveal the amount and kind of personal information held on databases. It is also a study in creeping fear, and a reminder of the role played by the rhetoric of security which justified so much legislation, including that which created the HPC. One scene in the film jogged my memory back there. It was a scene in modern school which used finger-print technology to take the daily register. A beautiful shiny metal oval contains a blue light on which each pupil presses their finger on entrance to the class. It reminded me that Malcolm Cross had raised a very tentative question, for which he apologised profusely, about the figure for Access Control on Additional Doors (Budgeted at £9,400, Actual, three times that: £27,757). Marc Seale had, in his customary way, rattled off the security rationale for this, and moved on. Apparently there had been a break-in, so they had decided to increase the security to make sure everyone was safe inside the building. Dr Cross ventured to ask again “and I suppose a proper discussion was had at the time?” Oh yes, said Mr Seale, and this time closed the conversation stone dead.
Thanks to Ian Parker (CFAR) and Simona Revelli (The Guild) who have both brought the bad news that Middlesex University’s renowned Department of Philosophy has suddenly been closed down. Article Guardian online here:
and petition against the closure here:
Link to Richard Gombrich’s prophetic article from 2000 British Higher Education Policy in the last Twenty Years: The Murder of A Profession. Here:
And Paul Verhaeghe’s keynote paper Chronicle of a Death Foretold – the end of Psychotherapy, can be googled and downloaded from the Dublin City University Health4Life Conference 2007.
Mr Walker was talking of the effect the recession was having on the value of the building. He said several times that it was the best quality office building in the area and I remembered hearing exactly this talk at another Finance meeting perhaps a year ago. He said the market was ‘bumping along the bottom’, and he ‘did not foresee an improvement’ next year, ‘the market place is what has to drive us’ he said, and ‘this is where we stand’, etc. Julia Drown asked ‘should we sell up and cash in?’ He replied that that Freeholds weren’t selling at the moment, because no-one’s got any money. There was a short detour about the number of millions it was now possible to raise compared to the squillions that were the norm more recently. Nevertheless, he reassured the Council that their ‘covenant’ was clearly very strong, because it was effectively Government backed.
“Should we sell the building and lease it back?” The council member asked. “Should you occupy a freehold?” repeated a startled Mr Walker, “it’s relatively unfashionable, because it is so cheap to lease”. No, then, I suppose.
Malcolm Cross asked if he could ask a naïve question. He was assured he could. “Is it possible, if the organisation grows organically, and colonises different spaces around the neighbourhood, to reconsolidate later?” “Yes” said Mr Walker who was then free to leave.
This made room at the table for Jonathan Bracken, the Legal Adviser, and a young woman who seemed to be making her debut at the meeting – Kathryn Neuberger, the Partner Manager of the HPC. She tentatively read the document relating to Item 11 of the agenda: Partner Code of Conduct and my notebook filled up with legal phrases: Code of Conduct, Contracts Compliance, Specific Conduct, Revised Code. Partner Code of Conduct. Someone asked what had provoked this revision, “had there been a spate of complaints about the Partners?” “No. We only get about 2 complaints a year”. “Oh, who from? Other partners perhaps, or from HEIs?” Kathryn didn’t know, so it probably wasn’t the reason for revising the contracts and codes. We didn’t learn what was, nor why it was here in the Finance meeting. Jonathan Bracken added some serious sounding stuff the only part of which I could understand was “making sure people keep up with training requirements”.
Malcolm Cross apologised for wanting to ask ‘another probably stupid question’, and was again assured it was ok. He was puzzled about the complaints procedure, and was unsure what was meant by the contractual obligation to act in ‘good faith’. This prompted a breeze of laughter after which Jonathan Bracken recovered himself and affably said it was “one of those things one instinctively knows but cannot be put into words”. Business done he then bustled out of the room with a huge grin on his face.
Everyone turned to the pages full of figures – The Finance Department Report, the first page of which details funds under management of £6,100,000 plus 2 investment portfolios amounting to £4,010,000. That’s over ten million pounds of money tied up in investment accounts earning various rates of interest.
Revenue of nearly £15 million is received through registration, but was slightly exceeded by expenses. There are two notes of particular interest offered as explanation for the overspend:
1. Professional Fees. “The unfavourable variance of £238k is mainly due to an unfavourable variance of £60k for legal advice due to additional advice in relation to new professions, an unfavourable variance of £62k for other legal costs due to a [sic] increase in high court appeals, and unfavourable variance of £58k for transcript writers due to the increase in the number of hearings and an unfavourable variance of £49k for legal expenses due to an increase in disbursements and costs relating to Psychologist Hearings.” (Note I p 4,).
2. Fitness to Practise. “The unfavourable variance of £612k was due to an increase in the number of allegations being received and the increase in the length of hearings. This included unfavourable variances on room hire (£65k), panels (£394k) and transcript writers (£58k). There was also an unfavourable variance of £62k in other legal costs due to the increase in high court appeals.” (Note 7 p 6.)
A couple of other small amounts turned out to be equally as interesting. A figure of £90,000 revealed a point of fear and trembling for the HPC. Once upon a time, the HPC had bought a licence for its Microsoft Software, but the piece of paper that accompanied this act has long since been lost. The HPC is worried at this lack of proof of their virtue. If Microsoft ever comes knocking on the door to demand to see the licence, it will have nothing but a word of honour to offer. The finance team didn’t think Microsoft would believe them. So, they have been salting away a few thousand a year against the day of judgment. Finally they decided to go out and buy fresh licences and be done with it. So, there does exist a body capable of frightening the HPC. Very Old Testament, I must say, in a 21st Century kind of way.
The second interesting figure is £360,000, concealed in the cash flow accounts where it appears as an exceptional expense, written in brackets to signify that in fact it is an income (September 2008). It is a payment from the Department of Health. I am currently trying to discover what this signifies.
Just before I had to leave, Marc Seale was explaining that he was expecting ten times as many Fitness to Practise cases on the books when they took on Psychotherapists and Counsellors. This was, he said, because there are about 40 or 50 organisations out there, most of whom lack proper fitness to practise processes, so it’s a major issue which he is currently negotiating with Government – the extra costs he foresaw pertaining to P&C FTP shouldn’t be passed on to the existing registrants and another source must be found.
NB Paramedics are disproportionately represented in FTP, though no similar logic is applied there. Perhaps the HPC are making the DH pay for the inconvenience they are experiencing with this ‘New Profession’.
It was much later that I remembered one more point while watching the premier of the film Erasing David (to be televised on More 4, 10pm Tuesday 4th May). The film, sponsored by the Joseph Rowntree Reform Trust (who launched last year’s Convention on Modern Liberty), is an experiment designed to reveal the amount and kind of personal information held on databases. It is also a study in creeping fear, and a reminder of the role played by the rhetoric of security which justified so much legislation, including that which created the HPC. One scene in the film jogged my memory back there. It was a scene in modern school which used finger-print technology to take the daily register. A beautiful shiny metal oval contains a blue light on which each pupil presses their finger on entrance to the class. It reminded me that Malcolm Cross had raised a very tentative question, for which he apologised profusely, about the figure for Access Control on Additional Doors (Budgeted at £9,400, Actual, three times that: £27,757). Marc Seale had, in his customary way, rattled off the security rationale for this, and moved on. Apparently there had been a break-in, so they had decided to increase the security to make sure everyone was safe inside the building. Dr Cross ventured to ask again “and I suppose a proper discussion was had at the time?” Oh yes, said Mr Seale, and this time closed the conversation stone dead.
Thanks to Ian Parker (CFAR) and Simona Revelli (The Guild) who have both brought the bad news that Middlesex University’s renowned Department of Philosophy has suddenly been closed down. Article Guardian online here:
and petition against the closure here:
Link to Richard Gombrich’s prophetic article from 2000 British Higher Education Policy in the last Twenty Years: The Murder of A Profession. Here:
And Paul Verhaeghe’s keynote paper Chronicle of a Death Foretold – the end of Psychotherapy, can be googled and downloaded from the Dublin City University Health4Life Conference 2007.
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