HPC Council meeting, 31 March 2011.

I had two reasons for attending this meeting: to hear concluding business relating to the new Generic Standards (which will be reported elsewhere) and to listen to the discussion concerning the possibility that HPC would introduce Voluntary Registers. While I was there, a third reason popped up under the heading of ‘Any Other Business’: deliberations regarding the future involvement of the HPC in regulating counselling and psychotherapy. This turned out to be the most interesting part of the meeting, but its true import, in my opinion, can be revealed only by viewing it through the prism of what was said during the rest of the meeting. In this way it becomes possible to grasp the manner in which language and meaning are dissociated at the HPC. Slogans emerged and were repeated as participants struggled to build sentences out of a small number of phrases that had no reference point outside the group. In fact, they appeared to function in order to constitute the group. Which essentially makes the HPC an organisation best characterised as both self-referential and self-seeking.

The Council members had been invited by the HPC to attend a morning meeting to catch up on the implications of various new government publications (the change of status and name, the regulation of Chinese medicine and herbalists, the Command Paper). This may help explain why so many Council members (Malcolm Cross, Deep Sagar, Eileen Thornton, Arun Midha and a couple of others) did not attend the afternoon’s Council meeting. There is also a process of appointment and re-appointment going on, but it’s not clear how this would have affected attendance.

Michael Guthrie, the Director of Policy and Regulation (in this context, by the way, I think that label ‘director’ is highly misleading), submitted a report for discussion on voluntary regulation. Jeff Lucas (Professor of Health Studies and Deputy Vice-Chancellor at the University of Bradford) asked whether anyone knew what ‘assured’ voluntary registration meant before recommending, assuredly, that ‘we need to use this word more’. He might also have asked what ‘voluntary registration’ meant, since no one at the table seemed to have much of an idea on the subject. Julia Drown (a Labour MP from 1997 to 2005) observed that it would mean more money for the HPC. At the same time, she also pointed out that voluntary registration would probably command a lower fee, especially for the social care workers, who are amongst the lowest-paid people in the country. But this, she urged, should not divert attention away from the grave danger posed by such people, who often had the most intimate relations with those they cared for. No evidence was presented of any specific danger posed by social care workers and no one asked for clarification or chose to dispute her claim.

Penny Renwick, Associate Dean of Health, Psychology and Social Care at Manchester Metropolitan University, appeared to want to inject some common sense into the proceedings when she replied that the ‘poor old public’ would be hugely confused and wouldn’t understand the ‘various levels of protection’ offered by the different registers. She even said that a voluntary register might be a ‘chocolate fireguard’ and wondered how the HPC would measure its effectiveness. Then, as if someone had nudged her under the table, she said ‘but I do recognise that this is the direction of travel’ and that ‘potentially there will be higher levels of public protection’. Anna van der Gaag had recently encouraged the education and training committee (which contained many of the people present at the meeting) to embark on a journey without knowing the destination, and John Donaghy (Paramedic, Principal Lecturer at The University of Hertfordshire) had asked that they ‘put the boat in the water before we find the evidence’. They were then talking about standards for ‘user involvement’ in education courses, but the phrase has no doubt gained some currency and was used here by Penny to show that she was ‘in the same boat’.

Joy Tweed (a part-time lecturer at the University of Westminster), who was sitting next to her, was quick to correct her: ‘The challenge to us, then,’ she said, ‘is to communicate to the public. We need to make sure that voluntary registers do what they set out to do.’ She didn’t elaborate on what, exactly, that might be, or on how such registers might be distinguished from the HPC’s statutory registers. The problem here, it seems to me, is nothing if not considerable. For the past ten years, the HPC has depended upon being able to exclude someone from the register to convince the public that it is being protected. Now, however, a rewriting of history seems imminent if the HPC is to maintain what little organisational and philosophical coherence it possesses while also controlling voluntary registers.

Perhaps this was what Annie Turner (Professor of Occupational Therapy at the University of Northampton) had in mind when she offered what I think is a new phrase. She began in the traditional way, referencing the need to ‘capture the risk’, but when she specified the practitioners constituting the cause of the risk, she named them, interestingly, as those who ‘care not’ to be on the register. This manages to imply that those who do not choose the HPC are ‘care-less’. It also, it seems to me, commits the crime of stealing credibility from the altogether different and delightful character of Herman Melville’s Bartleby, who manages his lowly position through the beautiful phrase ‘I prefer not’.

Sheila Drayton (a consultant in professional and organisational development) said the voluntary register had fewer benefits since there was no protection of title. She also warned her colleagues of the dangers posed by care home managers. ‘No group,’ she added, ‘posed less risks than any others.’ She gave no reference to support this statement but appeared not to notice that, within normal protocols of meaning, she was also advancing the proposal that management consultants, Roman Catholics, blue-eyed boys, writers, poets, hairdressers, Uncle Tom Cobley and all would also need, one day, to be captured.

Mary Clark-Glass (a founder member of Northern Ireland’s Women’s Rights Movement) referred vaguely to her dreadful experience with voluntary registers in the fields of dry cleaning and estate agency in order to underline the need to ‘capture the risks’ involved. Mary has been a Council member since it began and might perhaps be expected to know that the HPC has never actually identified any specific risk or attempted to assess its own capacity to have an impact on any such risk.

Someone then asked what happened with voluntary registers in other countries, and a murmur of answers rippled around the table: ‘it doesn’t happen elsewhere,’ the UK ‘is unique in the world’. I eagerly await the research on registration in the solar system, the Milky Way, and the cosmos in its entirety.

Anna van der Gaag summed up: ‘we are gathering evidence, staying flexible – what we are looking for today is agreement in principle’. She clearly felt she had got it, though to the inexperienced eye, it only looked like she had done nothing other than move the agenda on.

The next topic proved controversial and generated some heat. The particular history, customs and practices of social work have led to the situation where students are also registered (at a nominal £10 per head). As the HPC has been given the responsibility for taking over this register, it has to figure out what this means within its context, the logic of which excludes students. Julia Drown, ever mindful of the great risk that people pose to each other, asked how the vetting and barring scheme operated in relation to students. I don’t know what relevance this had, and no one else seemed interested. Mary Clark-Glass seemed quite indignant and stated that the CHRE was ‘against student registration’. She even wanted to know what evidence there was that student registration ‘worked’. Then, really letting go, she asked, ‘Do we just do what a Minister tells us to do?’ The Council attempted to sidestep this outburst with a quiet and polite laugh. Meanwhile, Prof Lucas doggedly listed four reasons against student registration before demanding to know ‘what intended benefits are claimed for statutorily registering students?’ Di Waller (arts psychotherapist) agreed in principle, though I’m not completely sure what that principle was because she also said (and here it’s important to note the twist to the logic) that she wanted to ‘safeguard students on placement’. There is, I believe, a double trap here. She seemed to be agreeing with Council but at the same time disagreeing with them and agreeing with the Government proposal (which others had spoken against). Then she used the idea of regulation and registration as a method of protecting the practitioner – even though regulation and registration are actually supposed to protect the public from the practitioner (cf Julia Drown and Sheila Drayton). But even Di admitted it would be useful to see ‘the evidence’.

It is interesting to notice what provokes the Council to ask for evidence. Here, it seems they ask in the hope that it will help to protect them from the will of the Minister. Yet throughout the past three years psychotherapists and counsellors have been asking for evidence that regulation by the HPC would actually improve the level of public protection and have been consistently ignored by the HPC. Probably it is just a ploy, which won’t actually lead the executive to actually respond to the request; the HPC has never been interested in evidence and has not set up any processes to generate real evidence, preferring, as QC Dinah Rose said (when she represented the PsyReg group at the Royal Courts if Justice in December, in pursuit of a Judicial Review) to duck the hard work and pretend.

Richard Kennett (a chartered accountant) was, of course, worried by the £10 fee and concluded that ‘it must be subsidised by full registrants’, though he didn’t say what, exactly, ‘it’ was.

After all this hot air Mr Seale (CEO) told, or perhaps, reminded the Council that ‘the Transfer Order of 2nd April will give us the students’, and added that the HPC were looking for a grant from the DH to cover the costs. One wonders what the purpose was of the discussion, in the light of this timing and context. The process to register the Social Workers has in fact been ongoing for some time now.

The agenda imposed the image of order and cut the discussion off. Then, when the Council was being apprised of the fate of the anaesthetists (a group which had asked to be regulated by the HPC before the Government announced a halt to statutory regulation), Julia Drown piped up again and opened up the real problem for the group. She said she felt it was premature to say that statutory regulation is not available for any new professions. She seemed not to care – or maybe even to realise – that this view is in flat contradiction to the present Government’s Command paper, which clearly states an end to the process begun by the previous Government (of which she was a part, at least until 2005). She was neither supported nor contradicted in this section of the meeting, but the topic returned with a vengeance under ‘Any Other Business’.

One more thing is worth noting before we get to that part of the meeting. Kelly Johnson, Director of Fitness to Practice (again, I would caution against assuming you know what the word ‘director’ means in this context), remarked that in one of her reports ‘there is some language that has crept in’. An interesting phrase, I thought to myself. She was, in fact, referring to her use of the word ‘patient’ in relation to the audiologists, who apparently prefer the phrase ‘service user’. She didn’t say ‘I’m sorry, I made a mistake’ – she simply said ‘some language has crept in’. Poor old language! Reduced to creeping around at the HPC and promptly blamed when staffers stumble under the burden of so much linguistic legerdemain. George Orwell must be spinning in his grave.

Anyway, under the heading of ‘Any Other Business’, the Council finally turned its attention to the problem of capturing counsellors and psychotherapists. As is well known, the Command Paper issued by the Government in March made it clear that no new professions would be statutorily regulated, including counselling and psychotherapy (this latter point was set out in a footnote). The HPC wrote to Anne Milton (Under Secretary of State, DH) on 18 February to ascertain if this meant that there would be no statutory regulation for counselling and psychotherapy. Anne Milton wrote back confirming that there would be no statutory regulation for counselling and psychotherapy.

Here are two paragraphs from her letter: ‘As you have noted, the Command Paper Enabling Excellence makes clear that for the overwhelming majority of occupational and professional groups which are not currently subject to statutory regulation, including those groups recommended by the Health Professions Council for statutory regulation in the past, the assumption will be that assured voluntary registration would be the preferred option.’ She adds: ‘I can therefore confirm that it is not currently our intention to proceed with statutory regulation of psychotherapist and counsellors. However, we will keep this under review in the light of the experience of assured voluntary registration.’

If the HPC were a rational organisation, it might have conducted research into the prospects involved in a new product or line of work, considered the evidence thus collected and finally come to a decision. It might decide that the proposed venture was not viable, and that the costs already invested were ‘sunk costs’. ‘Sunk costs’ is a phrase from the language of accountancy and was no doubt invented to help get over precisely this problem: the organisation needs to find the time and method to mourn the loss of the hoped-for new venture and then to move on. If the HPC were not a rational organisation, individual members might mistake their place and promote their personal interest over and above that of the organisation, and then be unable to drop their objective. As someone from the onlookers said later, in place of mourning, melancholia might set in.

Jeff Lucas (a member of the Professional Liaison Group for Counselling and Psychotherapy) remarked that Anne Milton was merely reflecting the ‘politics of the day’. He said he would be ‘uneasy if we decide to abandon’ the capture of Counselling and Psychotherapy, adding ‘on the principle of public protection’ as if this actually meant something.

Let us pause for a moment to remember that at no point in the process (a protracted one that began in the summer of 2008) have the HPC looked for or produced one shred of evidence that the public will be better or worse protected through HPC statutory regulation. This was precisely the point on which Mr Justice Burton allowed the PsyReg group to proceed with their petition for a Judicial Review of the HPC procedures on 10 December 2010. The HPC agreed to write a letter of apology to the Secretary of State for Health for misleading him into thinking that the HPC had done the work necessary before it recommended itself as capable of regulating this field. It is to no one’s credit that the HPC Council, responsible to the Privy Council, continue to pretend that what happens in the High Court has no bearing on them.

Lucas stumbled on, bolting together ready-made phrases that, although still incomprehensible, nevertheless do reveal his personal investment in this matter and his reluctance to give up the prize: ‘…ignore the playing field... Statutory Regulation is not politics… public protection is still an option open to us... I would be reluctant to abandon, and would want to be active for assured voluntary registration.’

Mary Clark-Glass (another member of the PLG for C&P) joined in in the same way: ‘There is a compelling risk, and that, to me, tells me that the matter is still within our power and grasp. If we can show that patient safety is at stake, this will overrule the political wish. Otherwise it will be seen as closing the door, which is certainly not the case.’ She did not elaborate on the nature of the ‘compelling risk’ or on the source of the evidence that there was one. My best guess is that she is hoping to find a Dr Shipman lurking amongst the ranks of counsellors and psychotherapists which will trump logic, reason and politics and allow the HPC to romp home with their prize. It is worth recalling the warning Mr Seale gave to the College of Psychoanalysts when they visited him on 27 March 2009: the HPC would, he said, launch a media campaign to discredit them, using the message ‘Don’t use these people’. When it was pointed out to him that this would create a lot of protest, Seale replied – with glee – that ‘We can afford a better advertising agency than them’ (http://www.psychoanalysis-cpuk.org/HTML/HPCMeeting0209.htm).

Then Annie Turner (PLG member for C&P) picked up the theme: ‘The current climate appears to be through voluntary regulation, but we shouldn’t abandon what we have achieved. It would be a mistake. We have learned a lot, and we could use it to advance public protection. Let’s look at voluntary regulation. When we set it up, let’s look at standards, areas of risk, and assess whether voluntary regulation is appropriate. It would be foolhardy to abandon work we’ve done.’ What she can possibly mean by ‘we have learned a lot’ is anyone’s guess. Annie Turner constantly showed her inability to understand the issues at stake in regulating counselling and psychotherapy and consistently advised the PLG to invent standards that had nothing to do with current practice but that could, rather, fit the HPC. The PLG ended in disarray. Even after double time had been allowed, they failed to reach agreement on any of the basic questions – see the report by eIpnosis at http://ipnosis.postle.net/pages/LastPLGReportl.htm .

Of course, you won’t find this acknowledged at the HPC, and, as might have been expected, the chair of the PLG, Di Waller, said: ‘We have done what we have done for public protection, this has always been our remit, and I see no reason to abandon our principles right now…’ Mostly, what Di did at those PLG meetings was ‘park’ difficult issues, ‘put them in the pot’ until later, and postpone things.

While we are on the subject of principles, it might be worth remembering that the Arts Therapists recently wrote to the HPC saying that they had never considered the HPC Generic Standards as applying to them. Those standards are frequently cited as the method by which the HPC assures public protection. There is no evidence that they do, in fact, improve public protection, but this should not deflect us from the presence and acceptance of the cynical attitude here (reported in this blog on 3 Dec 2010, and published in Self & Society, vol 38, no 2, winter2010).

Then Mary Clark Glass, whose dander was still up, said: ‘We assess the risk, and we decide… We do not see this letter [from Anne Milton] as saying ‘no more statutory regulation’. To reflect a moment – it was at the first PLG meeting that a couple of observers in the ‘public gallery’ shouted ‘What is the source of your evidence?’ when two members in particular were playing fast and loose with statistics. At the second meeting, Mary Clark-Glass approached me with a pamphlet, and, riffling through its pages, stated that the evidence was ‘here’. I found none and was unable to persuade her to acknowledge this. She appeared confused and gestured vaguely at the pages before turning away altogether. It was one of many Kafkaesque moments I’ve experienced at the HPC. Exactly what she means by ‘we assess the risk’ is anyone’s guess. In the light of her radical rewriting of Anne Milton’s letter, we might expect it to mean ‘we do what we like’.

Three Council members with less personal involvement nevertheless echoed the tribal call: ‘we have a duty of care towards the public, we’ll do voluntary first, or statutory’… ‘step by step we’ll … proceed with assured voluntary regulation first, then …’ Finally Anna van der Gaag quietly assured the Council that they had concluded. She ‘summarised’ by saying ‘there is huge complexity, more work to be done, we have made an in-principle decision … our actions must be based on Public Protection, and that Statutory Regulation is still an option.’

On the steps outside the HPC, one attendee from the public gallery noted that the HPC were delusional in their misreading of Anne Milton’s letter. They had also managed to completely avoid any mention of the letter sent to Council members by the Alliance for Counselling and Psychotherapy, or from the Psychological Professions Alliance Group (PPAG), who wrote to say that ‘while we are exploring with CHRE the main option of a system based on the accreditation of existing voluntary registers, it would be helpful if HPC did not pursue for the moment the setting up of its own voluntary register. Such a move might serve to muddy the water of the dialogue we now need to have with CHRE’ (quoted from New Associations, Issue 5, Spring 2011, p2).

It is quite clear that the HPC has no interest at all in the real problems involved in the regulation of this group of practices, most of which depend on networks of knowledge and experience amongst its practitioners. In opposition to this, the HPC has declared itself willing to break the networks and has probably set in motion a process to seek a scandal to frighten the business into its nets.

In the meantime, the murder of language, the ongoing lack of rational discussion about the kind of regulation that is implied by the HPC and the absence of credible evidence in the decision-making process cry out to be addressed before any more business is passed its way.