The relation between the process and the appearance of the process: the MHTP

The question of whether Counsellor could be a protected title raised barely a mutter at the meeting, and will be dealt with by solicitor Jonathan Bracken at some future date.

It is such a general word that it seems very likely that capturing it will cause a catastrophe. There are around 30,000 counsellors on the BACP books for example. It would be amazing if the HPC took these 30,000 counsellors into its care yet this seems to be the image that BACP wants to create.

I wonder what is actually happening at these meetings. The process seems specifically designed to addle the mind. Much that is said seems irrelevant - the Chair often openly contradicts herself, many issues are parked for future debate, put into a pot, or just 'left there' for a moment but no-one is holding a list. The agenda seems to hover over the content, the minutes don't name anyone in particular. With so much vagueness and lack of direction the PLG process appears to float over something that is moving according to its own will.

The meeting generally stops around about 3.30 but there was still no mention of the discussion expected on protecting the title of 'child psychotherapist. So it was a big surprise when at about 3pm Diane Waller invited Jonathan Coe to put forward some unexpected business. He wanted to know, for no particular reason, and a very angelic smile, whether the group might wish to consider whether or no to protect the title Psychoanalyst. What was that about?

BPC and Skills for Health slapped the suggestion down. BPC vaguely implied that to practise as a psychoanalyst one would first have to enter the register as a psychotherapist - "these are the minimum standards" he said "you are free to go higher if you wish". And SfH sort of backed this up.

At 3.15 or thereabouts the PLG finally came back to the question of whether to protect the title of Child Psychotherapist (an idea thrown out several times over this six month process). Eileen Thornton for the HPC said she could see nothing convincing in the paperwork submitted to support the demand. BPC and SfH both piped up again and began bellowing. The most incoherent stream of nonsense issued forth from the SfH foghorn about the physical nature of a child's brain, and BPC said that because he personally wasn't competent to practise as a child psychotherapist the title must be protected (from him we must suppose).

At 3.29 the doormouse woke up and declared some dates for the next PLG - 17th and 18th November. Nothing seemed to be settled. And, just when they thought it was all over two more days are pulled out of the hat.

In the meantime, Anna van der Gaag has been recruiting her new HPC Board, due to meet on July 6 to consider the PLG's recommendations. Only 3 of the original Council will be reappointed, so Diane Waller, Jeff Lucas, Mary Clark Glass, Annie Taylor, Eileen Thornton, and Graham Smith are unlikely to be around for the November PLG. The original programme of consultation and review has been muddled, but the Draft Standards of Proficiency (SOP) are going to be circulated for another round of consultation - after the new Council has heard the 'group's recommendations'. Will there be a second set of recommendations to Council and a second consultation? Not if the HPC want to rush this through parliament before the next general election.

The UKCP member (Kathi Murphy) specifically said that she was unhappy with the definitions distinguishing Counselling from Psychotherapy (cooked up in half an hour over yesterday's lunch by Mick Cooper and Peter Fonagy - an idea from Julian Lousada which was eagerly put into play by Di Waller, who over-rode the loud protestations from Kathi Murphy), but would accept them for now knowing that they had to go for consultation. Lousada later said he could accept the phrase 'mental health well being' as a definition for counselling, but would then want to give up the will to live - thus evidencing the hypothesis that depression follows moral cowardice.

There is a barely spoken knowledge that everyone involved in this process will have to fudge and force things to fit in order not to lose face. I heard the Counselling Professor (Cooper) mutter his amazement over tea that the UKCP had not contested the definition of Psychotherapy in the meeting. I heard myself wonder why no-one screamed when someone said that the DSM IV was the therapist's bible. Another member of the silent gallery confessed her great discomfort at having to remain mute at this process. I wonder why we all obey the rules. I remember those films and plays and books where someone finally stands up says 'look here, this is all nonsense'. You will ask me why I didn't say it myself.

Look here this is all nonsense.

Fit to practise?

The College of Psychoanalysts-UK is staging a conference on 6th June at Birkbeck College in London. One of the speakers is Mary Clark-Glass, HPC Council member, and member of the Professional Liaison Group for Counselling & Psychotherapy. Mary was bewildered at the recent HPC Fitness to Practise Forum when she realised that more than a third of the HPC total budget is spent on FTP processes. According to the Management Accounts of March 2009, that amounted to £4,652,779.

HPC income is made up of the fees paid by registrants. In 2009 New fees amounted to £751,055; Renewal Fees: £11,318,583; Readmission fees £203,592, sundry others to make up a TOTAL of: £13,505,960.

In his talk to the aspiring group of Hearing Aid Dispensers, Marc Seale, HPC CEO said ‘we are not a charity, we are self financing’. This ‘self financing’ is achieved through force of law: once a title is protected (eg Arts Therapist) a practitioner is compelled under threat of legal action to sign up to the HPC and pay the fee, (which is set by an act of parliament) or be prevented from practising. Mr Seale is responsible to HPC Council, who from July are all appointed by as well as answerable to Parliament through the Privy Council.

By the by, some people who have recently written challenging or critical letters to Mr Seale have received replies with this allusive paragraph: “In conclusion, I would like to raise a particular question. It is as follows. On the assumption that statutory regulation of psychotherapy commences within the next few years, will you apply to join the register, or will you stop practising as a psychotherapist? I look forward to your response with interest.” Could it be that instead of engaging thoughtfully with questions and criticisms about the ability of HPC to regulate psychotherapy Mr Seale is simply awaiting the opportunity to exercise the law?

We saw below (blog 8 May) that If you are late with your fees because you didn’t get the invoice, you can expect trouble.

Perhaps, with an annual income of thirteen and a half million pounds, we could expect HPC to put some of that cash to work on a more effective, not to say more polite, process of fee collection. Perhaps, with an annual income of thirteen and a half million pounds, and only a few hundred allegations to think about, the HPC could be able to spend time, money and effort on other more productive and important matters.

Allegations received:
70 for the y/e 2002,
172 y/e 2004, and
424 y/e 2008 (0.24% of total registrants in 08).

That is, 30% of income is spent on investigating 0.24% of the register against whom allegations are made.

I have not been able to find any reference in the accounts to money spent on improving education, nor disseminating information, ideas or findings arising from the work of the 185,000 practitioners on the HPC books. The amount recorded in the account as spent on the Welcome Pack for registrants was: £0. That’s Nought. Zip, Zilch, Zero. I wonder why they reported it.

The FTP annual report for year-end 2009 is not yet published but the report for y/e 2008 can be downloaded from here

For this period there were 178,289 people on the HPC register, and most of the allegations received were about people who live and work in England (as opposed to those in Wales, Northern Ireland or Scotland).

The majority of complaints are made against men. The vast majority of registrants (76%), however, are women.

Of the 299 allegations that were considered, only 186 were referred for a full hearing of which a decreasing number are held to be well founded. Probably 139.

The HPC appoint a law firm, Kingsley Napley Solicitors to present cases on their behalf. Needless to say, the HPC then have to ‘continually strive’ to manage these costs and have had to introduce a ‘capped hours’ arrangement.

The 09 y/e Management Accounts record a figure of £2,516,642 paid in legal expenses of one kind or another.

In answer to questions whilst observing hearings at the HPC I have been told that it is the solicitor who must do the ‘research’ to build the case against the registrant in question.
Although the number of cases being considered by FTP panels is increasing the number of allegations where the outcome was not well founded has also increased. Solicitors are paid whether they win the case or not, which suggests that there is no tension in the system to insist upon a proper investigation.

Employees of the HPC are not involved in the FTP decision-making process. This is trumpeted as a virtue and is supposed to ensure that all decisions are made independently, and are free from any appearance of bias. Being free from bias, and being free from any appearance of bias are, of course, two different things. Being hands off might indicate objectivity, but it may also indicate abdication of responsibility. Furthermore, being ignorant of something could be either a sign of naivety, or of stupidity.

A recurring and disappointing aspect of the HPC is the frequency with which rhetoric replaces reason. For example, at the end of her executive summary, Kelly Johnson (Director of Fitness to Practise) writes ‘the process is not about punishing a registrant, it is designed to ensure that action is only taken when it is necessary to protect the public.’ This is an empty phrase which could surely only be made by someone with little or no experience of the real world. A registrant against whom an allegation is raised deserves to believe - to know - that the investigation into the allegation is going to be fair and impartial. Only in this way could the process approach something akin to justice.

Who makes the complaints? The biggest group of complainers are … employers. 171 in the year 2006-7, which accounted for 40% of allegations. This suggests that when an employer is unhappy with a member of staff they can shunt the responsibility for dealing with it over to the HPC who in turn shunt the cost of it onto the … employees. Also, as the majority of defendants are men, one begins to wonder about the attributes of the complainer, details of whom are not exposed in the annual report. What do the Unions say about this?

A second group of complaints come automatically from the police (35 in 2007/8). The Home Office Circular 6/2006 provides that the HPC must be informed if a registered health professional is convicted or cautioned for an offence (tho only in England and Wales). This is a legacy of Ian Huntley and the tragedy of Soham in 2003.

At the HPC FTP Forum on Friday 24 April, Council members asked why such an adversarial and expensive method was favoured over mediation, even where the latter might be more effective. The law governing HPC regulation only allows mediation to be mentioned at the end of the process, by which time registrant and complainant are well entrenched in conflict, and mediation is no longer viable.

Jonathan Bracken, HPC Solicitor and Parliamentary Agent, is responsible for writing the operating procedures for the HPC, and is engaged to train people to follow these rules.
A Kingsley Napley press release tells us: The Hearing Aid Council is pleased to announce that it has appointed Jonathan Bracken as its new legal director plus Kingsley Napley as its new Disciplinary Committee solicitors and case handlers.

There is no tension in this system where those who are engaged can call each other to account. This appears to be fostering a situation where Kingsley Napley and their colleague Jonathan Bracken are taking up the slack. This all feeds back into the self fulfilling prophecy - that professionals are greedy unethical ne'er do wells, and need to be placed into the hands of the administrators.

Personal ethics more than ever are going to be required until this stupid system is dismantled or reassembled on rational, ethical, reasonable grounds.

The actual HPC Council meeting, Feb 2009

The 30 minute meeting was extraordinary for the lack of debate and discussion. Not all of the papers had been ready before the meeting and a couple of them were handed out, one in particular was presented to the group and 5 minutes were designated for reading. This paper had been written by the Department of Health who are apparently all of a frenzy these days, and hadn't got there act together. The Council Members duly bent their heads to consider this important document. A lacklustre attempt to comment followed, and was met by a robust rebuttal from the resident lawyer.

This lawyer turns out to be none other than Jonathan Bracken, a partner at Bircham Dyson Bell. This is the man credited with writing the documents that brought the HPC to life (see blog below headed 'The Information Commissioner'): the Father of the organisation. He was in fine form, probably the only member of the meeting who hadn't just spent 5 hours in brainstorming future strategy and expansion. His joke related to another new short document, on which the increases in fees were written. This must pass through parliament. He informed the meeting that altho the document was just being handed round, in fact nothing on it had changed since their view of its draft. This of course was good, he quipped, except he might have liked to have seen the figures increase. He laughed "hahaha".