FTP of a psychologist who was ordered to do CBT instead of psychotherapy

In April, colleague Bruce Scott noticed that a case on the Fitness to Practise listing on the HPC website had vanished. This was the case of a Psychology Practitioner whose allegation is particularly interesting to counsellors and psychotherapists (see points 3 and 4 especially):

“In the course of your employment as a forensic psychologist in training at R Hospital between 2001 and 2006 you:
1. failed to provide reports in a timely manner;
2. failed to keep accurate client files;
3. undertook psychodynamic work with clients which was outside your scope of practise;
4. continued to undertake psycho¬dynamic work with clients when directed not to do so by your supervisor;
5. submitted a court report which
a) was not counter-signed by your supervisor, and
b) referred to you as a forensic psychologist.
6. The matters set out in 1 – 5 above constitute misconduct.
7. By reason of that misconduct your fitness to practise is impaired.”

The case had been opened in the usual way, and was held in public at HPC HQ, in February this year. They had not managed to get through the proceedings in the two days allocated, so were waiting till June to complete the ordeal. Bruce made a note and planned to attend the final part of the hearing. Then he noticed its disappearance from the listings.

A couple of weeks ago I decided to dig around a bit and asked for the transcript of the hearing, and received four days’ worth of proceedings, amounting to nearly 90,000 words. The HPC clearly deem this case to be one wholly in the public domain, yet the second half, conducted in June, had not been publicly announced. Why?

Meanwhile, Bruce had also noticed that no cases for Practitioner Psychologists were appearing on the HPC website at all. What was going on?

The Chief Executive’s Report to Council last week (HPC Council meeting, 7 July 2010) contains statistics about cases broken down according to section of the register. For example, there are about 40-50 cases pending at the Investigating Panel stage (the first formal stage) for Practitioner Psychologists since the takeover last year (in fact, the Practitioner Psychologists come third most months, after Paramedics and Physiotherapists).

The figures for cases pending at the Competence and Conduct stage, the public hearing, are currently about 22 or so.

When asked why no cases were showing on the HPC website for psychologists, the clerk replied first that this question was being dealt with under the Freedom of Information Act, which seems a bit odd, and second that “The only practitioner psychologist hearings taking place in the next four weeks involve cases transferred from the British Psychological Society. Under the transfer arrangements, these individuals were not eligible for automatic transfer to the HPC register as there were outstanding fitness to practise matters at the time the register opened. The hearings are taking place before the Conduct and Competence Committee under the transitional arrangements to determine whether the person should be entered on the register. We are not publishing details of these cases on our website as these individuals are not currently on the HPC register.”

The decision to remove these cases from the website seems to have come shortly after Dr Cross’s case in March or April, and this appears to have created a bit of confusion in the HPC itself. The case whose allegation was quoted above was pronounced on the website in January in readiness of the February hearing date, but was not declared in May, four weeks before its final two days’ hearing in June. In the clerk’s email this week he specifically states that “The Council's policy is to publish the details of a hearing on the website four weeks in advance of the hearing date. Where a case is part heard or adjourned, the hearing will remain on the website with the new date.” This did not happen in this case. In the transcript of the case (which is freely available by emailing Ciara.O'Dwyer@hpc-uk.org and asking for it: PYL05183) the HPC solicitor clarifies the position as follows:

“As this was an investigation originally carried out by the British Psychological Society, it is probably right that I should explain the background and how the HPC comes to have jurisdiction just briefly. The background is that Ms D was registered with the British Psychological Society as a practitioner psychologist. And as you may be aware there has been a transfer of the voluntary register operated by the BPS into the statutory remit of the HPC. And ordinarily a person registered with the BPS would be then included in the relevant part of the register of the HPC. However an exception to that is where a person is subject to proceedings which could lead to their removal or suspension from the BPS register. And if that is the case, the HPC may determine that the person’s name is not to be entered into the relevant part of the HPC register, and dispose of the matter in such matters as it considers just. And that is according to Article 5(5), (6) of the Healthcare and Associated Professions (Miscellaneous Amendments and Practitioner Psychologist) Order 2009. I outline that in brief because Mr T [registrant’s solicitor] has kindly indicated to me this morning that there is no issue over jurisdiction. This matter has come straight to the Conduct and Competence Committee because of the stage that it had reached at the BPS. And so that explains why, in the notice of allegation, it is phrased in terms of whether she should be admitted to the Register, rather than the usual case where there has not been a transfer of this sort when you are considering someone who is already on the Register, and what if anything, should happen to that registration if you find the matters to be proved.”

So, there it is: this is one of those cases that the HPC is holding that has come from the BPS so the practitioner has not yet been granted access to the HPC Register (though she does have a registration number, and is apparently legally subject to the proceedings of the HPC conduct and competence committee). This is one of those hearings that I am now told is not being held in public, although, as you can see, I have received the transcript in full.

Apart from this anomaly, the case itself is fascinating. I commend it to you for leisure-time reading (I bet you could even register the time it takes to read it in your CPD file, if you indulge in such a thing). The lawyer, Mr T is wholeheartedly on the side of his client and goes at the HPC witnesses like a Rotweiler – “Yes, Mr S. I just want to start with something that is not in your witness statement. But is relevant to these proceedings. And that is the genesis of your complaint. Because, of course, this is a complaint which was not pursued or taken up by the Trust, the employer. This is a complaint that you personally had made with Dr B, isn’t it? … you, in fact, were never her supervisor for the purposes of the BPS chartership, were you? … In fact the Trust had previously taken the decision that you would not be her supervisor because she had already made a complaint about you and the way that you were conducting supervision.”

The defence sets out right from the get-go – this is a counter complaint made by two individuals, not supported by the Trust, and prompted by a grievance taken out by the defendant against both managers. As the case unfolds there are some interesting details about what does and does not count as psychodynamic work, what constitutes supervision, what is meant by ‘a vulnerable service user’ (in this case a man who, amongst other things, battered his girlfriend to death with a hammer), how NICE guidelines are used to justify imposing CBT and forbidding psychodynamic work, and finally, the sheer beauty of the evidence of the old psychiatrist (Dr K) who had been supervising the psychotherapeutic work of the defendant - it comes through as if from another planet.

The case rolled on, as already noted, for four whole days, costing about £8k excluding legal costs (say, another another £1k per day). The Panel took 4 hours to come to its decision, which took barely a page to record on the transcript. The decision was NOT well founded.

The latest FTP Annual Report from HPC reports a doubling in the proportion of registrants with complaints against them over the last five years: 0.19% in 2005-6, and 0.38% in 2009-10. There has been a huge increase in cases Not Well Found in the same period: 2% of all cases not well founded in 2005-6, and 30% not well found in 2009-10.

Kelly Johnson, Director of FTP notes in her report that the budget for the FTP department was approximately £6m last year, which is about 40% of the HPC’s operating costs, from money raised by registrant fees. There appears to be no effective mechanism for controlling the quality of work in the FTP department.

Thought Crime - an FTP case of a Biomedical Scientist

This is the story of a Biomedical scientist who was reported as saying of an absent colleague ‘I have an idea of what XX could do as her other job – a suicide bomber’. XX had suddenly handed in her notice with no other job to go to, and had thus become the subject of gossip for the colleagues who remained at work. At a leaving do for another member of staff a while later, the registrant’s comment caused a bit of unease, and somehow, later, seeped into the attention to one of the managers at work who hadn’t been at the party. In a series of convolutions that eventually led to the registrant being sacked, another manager actually phoned the woman who had left, and about whom the comment had been made, to tell her. Apparently he had wanted her to join in and give some kind of evidence of offense in a disciplinary process he was advancing against the registrant. She declined.

When a registrant is sacked or demoted the employer is obliged to tell the HPC, who then consider making their own case against the registrant. This case was first heard by the Conduct and Competence Committee on 29 March 2010 and was concluded on 15 June when the panel found the HPC had made a good case and decided to issue a caution for three years against the registrant. The first part of the hearing was conducted in public. The transcript is available to the public (email ftp@hpc-uk.org and ask for Allegation Number FTP02357) The second part of the hearing was held in private, but the decision is published in full on the HPC website

In order to build a case the HPC lawyer refers to Standard 3 “You must keep high standards of personal conduct” and Standard 12, “You must behave with honesty and integrity and make sure that your behaviour does not damage the public confidence in you or your profession.” Indeed, in the decision, the Panel make use of these standards to justify their action: “The Panel note that misconduct can encompass inappropriate behaviour which occurs out with the course of professional practise itself but compromises the reputation of the profession concerned. The Panel find that the remarks were inappropriate and focused on a professional colleague’s ethnicity. The Panel find that the following HPC Standards of Conduct, Performance and Ethics were breached:
3 – You must keep high standards of personal conduct.
13 – You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.
The Panel find misconduct.” No attention is made in the hearing to say what kind of public would lose which sort of confidence in what kind of profession. Nor is there is any effort made to put this to any kind of test. It remains vague.

It is unclear how this comment constitutes a danger to the public. It is also unclear how this comment constitutes a case for dismissal in the NHS. That it has moved both organisations to such a level of activity, resulting in a dismissal (after 30 years of work in which no complaint was ever made about the employee) raises general questions about the direction of British social policy, and specific questions about the quality of local management and leadership in each of these places.

The case was reported in the Daily Telegraph on Friday 16th July, on page 11, under the headline: “Scientist ‘said junior could be a bomber’” the article opens by remarking that the registrant ‘has been allowed to remain in the profession.’ The first hand report of the case would most probably have come from a news agency, rather than a DT reporter on site. Neither, however, ask why this constitutes a case.

In 1995, the JM Consulting Company was commissioned by the Department of Health to make a report into the regulation of health professions. This was an inquiry into the Professions Supplementary to Medicine Act (1960) with recommendations for new legislation. The report notes that amongst the principle areas of concern raised about the then CPSM (Council for Professions Supplementary to Medicine) was ‘archaic and inflexible procedures for discipline’ which meant that misconduct falling short of the ‘infamous’ was not addressed. In essence, the 1960 Act protected the public “by providing a (last resort) mechanism for disqualifying professionals shown to be guilty of exceptional examples of misconduct.” (p18). A lot changed with the passing of the Health Professions Order 2001, but nowhere can I find it written that thought crime, wise-cracks or jokes should become part of the remit of the Conduct and Competence Committee. This particular case must raise questions not simply about the general nature of the secondary legislation behind the HPC, but about the specific management and personal style of those who are responsible for its day-to-day work.

Meanwhile, on Nick Clegg’s Your Freedom Site, HPC regristrants from other professions continue to post their own comments about the bizarre procedures of HPC: eg, this one posted by galileo July 09, 2010 at 21:16:

“This spring I have received 6 letters and 2 printed booklets from HPC. And, if you can believe it, all were to tell me how to fill in my renewal form, which was no more than a recto-verso tick box form. Does it really take a 20-page booklet to tell a professional, trained and recognised as senior in my work, with almost 20 years professional background and clinical experience, how to confirm that my name and address haven't changed? Not only did they write to me, but they also invented a manager that they imagined I must have and who they wrote to, asking them to prompt me to send back my form. Now let me be clear, all this was simply to renew my registration and continue to pay HPC. Nothing to do with providing me with any relevant information about improving my practice, protecting the public, and neither did it provide the public with any meaningful information about me. And all of this was months before the deadline for renewal... Why not use the funds instead to provide public education so that people know what questions to ask and how to access the most suitable one of the multiple treatment choices available to best meet their needs?”

Now, that’s a good idea.