PLG: structure of the register - the call for ideas

The call for ideas - what is it? Part of the process of HPC-ification is to convene a Professional Liaison Group, who will discuss the issues and come up with a proposal. However, in order to avoid accusations of partisanship, there is a big effort to show how open to other ideas they are. The Call for Ideas is one way of presenting the image of openness. Another way is to hold the meeting in public. A third way is to hold a Stakeholders meeting to feed back to a wider group and even to take more comments (scheduled for March in Manchester). It reminds me of 'iteration' carried out by information system designers that I studied in the early 90s. High level policy makers made the decision to centralise knowledge and computerise processes, and engaged Anderson Consulting to help them to do it. A set of people called systems designers went out to discover how the work was being done, came back to the office to encode it into programmes, then sent the change management guys out to take the flak and find out what kinds of problems would need to be overcome when rolling out the new system.

Calling for ideas is a wonderful way of discovering the opposition. It is also a wonderful way of saying that you've consulted widely and listened carefully. But it is not a good way to conduct research, to make an analysis of the situation, and to think through unintended consequences.

The government has already decided that psychotherapists and counsellors constitute a threat to the public, but has not troubled to say how. It has already announced that they shall come under the regulation of the hpc. The government has also stipulated the structure and nature of the hpc in so far as it is able. It is a top down political decision that is enmeshed in a process of law. It is not an enquiry in the scientific spirit of enlightenment - it has no real interest in discovering how best to set things up so that the practice, the patient, the punter, the practitioner are operating in the best of conditions.

Right at the beginning of the meeting the Strathclyde Professor asked the sensible question: what is our role, what are we trying to do? The chair responded: to look at the arguments, to debate, to think, to say what we believe for reasons of public protection, to sketch things out, not hard and fast, but to give three main proposals for the structure. The HPC panel member representing physiotherapists added: it is not necessary to come up with a definitive decision, and the chair reiterated, 'yes, keep it vague, come up with a sketch'. Another HPC panel member, this one a lay member, added 'we aim to favour a model, but we know that it may change'. In the first meeting of the group it had been made plain that the role of the PLG was to recommend something to the HPC council who would propose it to the DH who have a team of writers to turn the proposition into law, should the government agree.

PLG: Day 1 structure of the register, protection of title

Wednesday 28 January 2009, Thought for the Day on Radio 4 was with the Right Reverend Tom Butler, Bishop of Southwark. As part of his job he is obliged to take up a seat in the House of Lords. His thought for the day was provoked by a 'cash for questions' allegation but led him to speak about the mundane details of the tedious work of a Lord: many hours of rather tedious examination of a bill, line by line. This, he went on, is 'the main contribution of the Lords to our democracy, not dramatic speeches to the gallery but meticulous revising of proposed legislation'.

Put this alongside the fact, now more and more openly acknowledged, that since 1997 the government has passed more laws than at any other time ever, and that many of those laws have been in the form of statutory instruments (which limit the possibility of debate severely), and it is perhaps not suprising that some Lords might be trying to regulate their work flow in the time honoured way of invoking an economic sanction.

No, it's not right and the individuals concerned should certainly be put into question. But there is also another way of looking at it, to wonder how the overall scenery could be contributing to a rash of unusual symptoms.

Tom Butler's thought ended with the words 'I see a House with mostly pretty dedicated and impressive characters working long and hard for the common good'. This was almost exactly the way a fellow member of the public gallery described what she saw at the HPC PLG for C&P later in the same day.

The first meeting of this group had been an unpleasant experience to observe. This was not all due to the inconvenient layout of the seats for sure (which had miraculously been rearranged in spite of letters to the contrary the day before). It was mostly about the implicit force with which the machinery was being applied with the result that debate, discussion, dispute were stifled. Today that was not so much the case.

Nevertheless, the thorny issue of centralised power imposing a state of affairs without a rational debate still has a part to play. But this is a part that has to remain concealed in order for the state to save face. And it is in everyone's interest, apparently, to maintain the mask in place.

There is the substance and there is the structure, and somehow the structure has been bent out of shape, which poisons the stuff of the substance. So, both of these things need to be addressed.

The business of the day took its lead from Michael Guthrie's summary of responses to a section of the call for ideas. But here again, it is impossible to go forward without first attending to the detail of the process. It will be the subject of the next blog.

Innocence or objectivity

There is an impossibility at the heart of the hpc. The impossibility is the assumption of innocence and the relation this has to the supposed position of objectivity. It is not a natural impossibility, like death, in the face of which one can labour heroically, but an unnatural impossibility which can render us at best foolish, at worse pernicious.

Ian Kennedy's Reith Lectures, delivered in 1980, led to a book which he gave the title: The Unmasking of Medicine (London George Allen & Unwin). In it he mounts a polemic against the profession of medicine, accusing medical practitioners of wielding the power over life and death. Kennedy ultimately wanted to know why it should be doctors who have that power, and why it couldn't be 'us' instead. He never elaborated what he meant be 'us', but Ian Kennedy was at that time an academic lawyer - a lecturer at the LSE. It never occurred to him that the profession of medicine ipso facto forced the practitioner into a position which ultimately must tangle itself up with death. In short, Kennedy's fallacy is that medics are inherently unsuitable to practise medicine, and 'we' would do it better, if only, like Austen's Lady Catherine, we had devoted ourselves to the practice. "If I had ever learnt I should have been a great proficient".

The assumption here, to spell it out, is that people fall into different categories. Them, and us: we are good, they are morally stained. It is the myth of the 'beautiful soul'. For surely, had Ian Kennedy chosen medicine, he would be confronted by the impossibilities of the practise himself.

When the Bristol Royal Infirmary row blew up in the national arena, the controversial labour peer Lord Levy phoned Ian Kennedy to invite him to chair the Inquiry. It is in the report of this inquiry that the explicit recommendations are made that the CHRE (see side panel for link) and the HPC be set up on the general principle that objectivity means knowing nothing about the practise. There is an assumption that objectivity can be achieved by obeying a set of rules, and limiting the subjective elements of life to the point of non-existence. It is a naive idea of objectivity, and open to abuse. It also flies in the face of recommendations by Dame Janet Smith, and written by the Right Hon Patricia Hewitt that the preservation of trust (that we have in people in general, including professionals in the medical field) has to be the starting point - that rules should not be written on the evidence of exceptions.

The recommendations of Kennedy's inquiry were taken up in the Health Professions Order 2001, and gave the basis upon which to create the CRHP (which now goes under the name CHRE) and the HPC. The HPO2001 was passed into law through Privy Council, thus making it one of very many pieces of legislation brought into existence without the usual full debate in the houses of parliament.

Laws, even well made laws, have to have careful attention when applying them in practice. And for this a whole other profession has grown up through the custom and practice of centuries: law. There is a common theme: how is the written rule brought to life in particular situations and applied to the life of a real human being. There are examples of bad application of law, with tragic consequences. There are examples of heroic bravery, sometimes also ending in tragedy. There is the letter of the law, and the spirit of the law. But the fact remains that some things, even tho written in books, still have to be carefully interpreted and weighed against the reality of the situation. Following the rules is not an adequate defense. No matter which way you look at it someone has to step in and bear the burden of reality. The rest of us can endeavour to create a society that won't scape-goat them, much less build an edifice upon that scape-goating, if hindsight gives a better solution.

We are back in the province of religion.

Conscientious Objection

Please bear in mind that these notes are written without recourse to a tape recorder and seated in place from which not everyone is visible. This was a particularly turbulent part of the meeting with some comments delivered in arch, barbed manner provoking several members to say 'we should not ridicule these people'. They are not strictly verbatim and the list is incomplete.

There was a part of the meeting today that focussed on Conscientious Objection, or Principled Non Compliance, p 37 of circulated document prepared by Michael Guthrie, Head of Policy and Standards.

The Strathclyde Prof asked HPC Head of Policy and Standards if the PNC suggestion was a practical option in his opinion. Guthrie replied that he could not foresee the government being able to accommodate it. [he spoke v quietly and quickly but this was the gist]

One lay member from the HPC said she had looked carefully at the arguments and chose one to dispute with here. The argument that the practise is entered into by consenting adults could not be supported because, as with dentists or estate agents, great harm could be done. She said 'it flies against the move'.

The HPC member representing Occ Therapy said You can't have your cake and eat it (you can't be on a register to be unregistered).

The User representative said 'What is the purpose of regulation - without statutory regulation people who are known to be harmful will continue to practise. People need to be prevented from practising. Either its the regulator or the law - and you can't have one law for one person and another for another.

Skills for Health quipped: they could always be taken [struck] off the non-register
another voice added "or sent off to Vermont"

The User representative continued: The evidence base [unsubstantiated] is clear that there is harm, the best outcome of these processes is that the vast majority will continue to practise in the way they've done before. Good practitioners will already be doing this. We have to come back again, and again, and again, to Public Protection. We are in the New World now, professional led self regulation is dead. The Health and Social Care Bill last year saw to that. There must now be equal numbers of lay people to professionals in the [regulation of the profession]

SfH said: Totally agree, these people constitute a harm. We must take a very firm view. Compared to other professions Psychotherapy is definitely harmful, potentially, 5% of practitioners cause harm [unsubstantiated]. The public is ill served by ineffective treatments with adverse effects. We hope it [the practise] will become more evidence based, with a little bit more notice of what is known, a general improvement in client care can happen. ...

BABCP said: We must not mock or ridicule these people, but the public needs protecting. The professionals need protection too. I think it [HPC] is a good move for the profession.

BPC: said We are the victim of our own rhetoric. Public Protection - we are part of the public too. We need protection, the clinical community needs protecting. Care providers are vulnerable. The public is at risk from us, but we are vulnerable to them.

HPC Physiotherapist said. Other aspirant groups have had this problem

The Chair: we have all been lobbied, the letter is philosophical. But they point to the confusion of State and Statutory Regulation, the question of totalitarianism. I've lived [or known someone who has lived] in [eastern bloc] for many years, I know what totalitarianism is, this is not that. It might look like it from the outside, but it doesn't feel like it inside the HPC. Also they talk of the medical model ...

CPCAB said The Petition had 1600 names at the beginning of the week, many of those are names of people I know and respect. I am not willingly a part of this but when I saw it couldn't be stopped I decided I had to join in to try to influence it.

HPC speaker said Public Protection also protects the registrant, it helps credibility, they have nothing to do but pay their fee, and gain status and credibility.

HPC Lay member said: HPC upholds public confidence in the profession, its a matter of pride to have been recognised by the HPC - its an external validation.

Amidst all this the COSCA member said: we might consider that there could be a number of registers springing up alongside the HPC one.

The chair suggested a ten minute break, and this discussion spilled into the adjacent room for coffee. On return they talked about the title Psychological Therapist. Then it was over as the HPC Lay member said 'if we think its right we'll do it, and ignore what goes on elsewhere.'

Being dragged willingly: experience of regulation by the state

During today's meeting of the PLG for C&P one of the group said that she had not wanted to be part of this process, but could see it was happening anyway and thought it was better to join in and to try to influence it, rather than be dragged unwillingly along.

Another member said there was no argument to avoid this process: times had changed, 'that' was history, 'this' is now, it is time for something new. This is new. That's all.

The HPC line is to reduce things to a shorthand: Professionals on the HPC register are safe, it is the others who are not. Then someone will say that professionals were a danger to the public before, and are only being brought under control by the introduction of lay people into their dominion. There is a lot to say here, a lot. But not much is being said in today's climate. There is a caste iron supposition that professionals are dangerous to society, and that lay people on boards and panels are the antidote to that. The force of this argument is quite frightening - it is used as a full stop to any further discussion. It has become a kind of magic bullet. This is the point on which I am focussed. How to uncover the process and mechanism that produces this kind of non-sensical thought. There is no magic bullet. I am more interested in the question: what needs to be done to allow ideas to be discussed and tested so that people can better understand the risks they are asking themselves or other people to take as a consequence.

The difficulty we are now faced with is how to minimise the damage that this twisted logic will cause. Only if we engage in thinking - and think not constrained by fear, nor compelled by brute force - can we hope to get out of this mess.

Names and naming

The PLG for C&P has been thinking about names that describe or label a practise, and I've been wondering about names that designate a person. I have been quite alarmed by the HPC habit of naming people as potentially unfit for practise before their case is heard. In effect this means that someone has their name exposed in some way for more than a year, and this is obviously a harm. I have wondered whether the HPC should apologise when the FTP panel decides there is no case to answer. When writing about these cases I have deliberately not used the registrant's name. The more cases I went to, tho, the more I began to wonder about the anonymity of the other people engaged in the process. To begin with it never occurred to me to include these people's names. But the more I observed, the more I thought about the meaning of a person's name and how that related to the professional nature of their work.

Being a professional, if you take it etymologically, can mean standing by what you say in public. There are other things to say here, but for now this is what I want to think about. The Fitness to Practise hearings are public spectacles. Board meetings are held in public. The PLG is held in public. The Fitness to Practise hearings are written down by a court stenographer who types up the notes and they become a testament to the process. People's names are used in these documents, and the HPC will send them to you if you request them. They are in the public domain. The people are named, and take responsibility for what they say. They are professionals. The lay members are professional in this respect too. Everyone is willing to act in their own name. No-one is 'just following orders'.

The professional liaison group is populated by people who are willing to speak, but some of these are speaking in their own name, others are speaking on behalf of organisations or associations of others. Should they be named in the notes? How should they be named in the notes? How should their contributions be attributed, and what is the responsibility of a blogger in this respect?

Well, I take responsibility for what I write, and I remind you that you can comment on it - this is the nature of a blog. You can also email me easily enough, and I can change what is written if necessary. The new technologies that have sprung up over the last few years give us new pause for thought. Join me in figuring out how to make this work in the spirit of long term public good. You are welcome.

What changes your mind?

The British Psychoanalytical Council is represented on the C&P PLG for the HPC by Julian Lousada. He made two memorable interventions in the first meeting of the PLG - they were made with gusto. First he expressed his discomfort at the amount of pseudo politeness going on in the group which created a pretense thateveryone was friends and all shared the same ideas. He made the very sensible point that this was not true, and the factual point that it was known that the issue that brought them together was itself rather contentious. He called for some straight talking, and to get the issues out on the table. Gusto or not it didn't work.

Later he made a direct reference to the poor excluded group of people who talk of Principled Non Compliance. He thought that this group were isolating themselves and in effect signing their own death warrant. He made a plea that something be done to leave the door open for these poor deluded fools so they would still be able to work after the PLG had done its business.

Judging from this google entry (below), I begin to understand the force of his point, and perhaps the reasons that he made it.

At a Freud Museum Conference in 1999, he delivered a polemic against the comodification of the psy field. Below is a quote from a review of the papers of that day.

THE FUTURE OF PSYCHOTHERAPY
Saturday 20 November 1999

Getting things done' was a theme of Julian Lousada's paper 'The State We're In' in which he pointed out that the government regulation of psychotherapy services may have a negative effect on the essential value of psychotherapy. Julian Lousada is the chair of the adult department at the Tavistock Clinic, London. In a sustained polemic he argued that the trend to turn patients into 'customers' and the service into a 'commodity' is the greatest present threat to psychotherapy. By fostering this 'business state of mind' psychotherapy becomes entirely concerned with instrumental objectives, without real emotional investment. These effects have come about through a change in the form of government intervention. Whereas government used to organise the 'means of production' or supply of services, it is now more concerned with specifying outcomes - "Where government was, now audit and regulation is". This affects not only service provision, but the training of therapists. Lousada pessimistically anticipated that the 'caring professions' may be veering towards a state of mind which itself is scared of forming relationships - the deathknell, surely, of psychotherapy as we know it"

PLG: structure of the register, protection of title

Tomorrow is the second time the PLG for counselling and psychotherapy meet. They have two days scheduled to discuss the 'structure of the register' and to figure out which titles shall be protected.

I shall be there in the 'public gallery' to observe this meeting. As part of my preparation I have been trying to get to know the members of the group, that is, to understand their position and aim in more detail.

To this end I have been looking at a powerpoint presentation given by the Director of Regulatory Policy for the BACP (dated 15 January 2009). This presentation repeats the mistake of the HPC minutes in calling this process statutory regulation. This process is in fact state regulation - as the chair of the PLG said at the last meeting (4 December), and I quote, "if we don't do it to ourselves, the government will do it to us".

The presentation appears to be a wonderful example of how the holistic planner thinks (see Popper's Nightmare - video clip in the sidebar). Of course, I don't know what was said on the day, and the speaker may well have been ironising the process and she went. But the slides are a sustained witness to the attempt of the holistic planner to create a cohesive picture with no cracks in it and make it easier for centralised power holders to make and impose their decisions. But as Karl Popper has forewarned us, it is only easy in theory, and will lead to a nightmare in practice.

The slides show four interlocking pieces of a jigsaw puzzle: State Regulation, HPC, Skills for Health, and IAPT. NICE appears as a bullet point under the heading of IAPT and reminds me how difficult it is to conceptualise reality in this way. The whole country is reduced to four government initiatives, no wonder we're all anxious and depressed.


"The holistic planner overlooks the fact that it is easy to centralise all power, but impossible to centralise all knowledge which is distributed over many individual minds, and whose centralisation would be necessary for the wise wielding of centralised power ... Unable to ascertain what is in the minds of many individuals, he must try to control and stereotype interests and beliefs by education and propaganda, but this attempt to control minds must destroy the last possibility of finding out what people really think. For it is clearly incompatible with the free expression of thought, especially of critical thought, and ultimately it must destroy knowledge. The greater the gain in power, the greater the loss of knowledge." quoted in the Editorial, Times Higher Ed Supp, 8 June 1984(!)

Trust Assurance Safety - the White Paper (Feb 2007)

The Rt Hon Patricia Hewitt, MP, and then Secretary of State for Health, wrote in her Foreword to this White Paper "patients in the UK rightly have great confidence in their health professionals... the preservation of that trust has to be the starting point [of any regulation]... it is all too easy to focus on the incompetent or malicious practice of individuals and seek to build a system from that, [but]... professionalism is an unquantifiable asset to our society which rules, regulations, and systems must support, not inhibit." p1

This document is important in this process as it is where the words are written that produce the justification for the HPC-fication of counselling and psychotherapy - the field that is currently under consideration for state regulation.

Preparing for the next PLG for C&P, 28/29 Jan 09: structure of register

The complexity of this is mind boggling. What is in a name? How can we pin it down? What relation does it have to the practise, to reality, to the real?

Part of this document attempts to summarise points from documents received by HPC in its 'Call for Ideas'. Leaving aside questions of method, science, and truth, it is sufficient to note that 31 named institutions are quoted in this text, including Skills for Health, 'The NHS', IAPT, and New Ways of Working for Psychological Therapists.

Some other institutions include The Tavistock Centre for Couple Relationships, The Association for Rational and Emotive Behaviour Therapy, The Cambridge Body Psychotherapy Centre, The Association of Counsellors and Psychotherapists in Primary Care, and the Stirling District Mental Health Association.

In the spirit of scientific endeavour it would be valid to note the huge variety of responders, including several people speaking in their own name. In fact, this might be the most important point to note. The practise that is currently in question (conjured up by the phrase 'counselling and psychotherapy) is enormously diverse. There are those who think this is the most valid characteristic of a dynamic, responsive field of work - it is close to the ground, answerable to the roots of its practise, known through its context and locality. There are others who think this is a horrible mess that does not convince The Public of its solid knowledge base. This latter group are the ones who work tirelessly to reduce the diversity to a singularity which will be more easily managed by faceless bureaucrats in a centralised institution. These would be the foot soldiers that knowingly or not form the army that populate Popper's Nightmare (see video link in the side panel).

Preparing for the next PLG for C&P, 28/29 Jan 09: minutes of 4th Dec 08

The pack of papers are ready for reading, downloadable from the website (linked to the heading of this entry). The minutes of the last meeting, 4th December 08 are amongst that pack.

Some features of these minutes (as yet uncomfirmed) are noteworthy. First, the meeting is not formally constituted as a committee, tho it has a chair, and a set of minutes. It is a Group. Perhaps for this reason the minute taker has not taken the trouble to associate comments with individual group members, except to note those who are late or not attending. The only person that is named in the whole of these minutes is Professor Peter Fonagy, the spokesman for Skills for Health.
. Naming him in this way suggests that he is a particular kind of member of the group.

Otherwise it is The Group as a whole that acts, and it acts in a limited number of ways. I count them:

The Group was welcomed (2) by President and Chair
The Group introduced itself (1)
The Group noted (28)
The Group approved (1) (the agenda)
The Group received (4) reports from DoH, HPC, a summary of responses from CfI (Call for Ideas), the future workplan.
The Group would report (1) to the HPC in July 2009
The Group was asked (1) to identify areas requiring further work.
The Group felt (1) that some responses to CfI were uninformed
The Group agreed (5)
The Group asked (2) to be kept informed on SfH NOS, how to publicise its work

Most of these actions are posed in the passive, but some of them suggest an active agency, 5 of them consisted of agreeing. Lets look at those 5:

1. The group agreed that it would be be useful for a future meeting of the Group to hear about the experience of a profession which had previously become subject to statutory regulation. (Minute 6.5)
2. the Group agreed that it would be useful to ensure that its work addressed the areas indicated in the [HPC administrative] new profession process. (6.10)
3. The Group agreed that its work should focus on making recommendations on statutory regulation, whilst listening to dissenting and sceptical views. (6.11)
4. The Group agreed that its work should aim to ensure that statutory regulation would protect the public. (6.11)
5. The Group agreed that its discussions should focus on issues which related to protection of the public. (6.11)

Agreeing to comply with all the rules already written down.

Points to note.
1. how is agreement reached by the group? It is not clear.
2. what are the reasons given to support agreement number 1?
3. How will the other profession be chosen, and how will its experience be surveyed and reported? How is this more valuable than attending to the reality of the current practise?
4. How do the administrative procedures of the HPC shape, or impact on, the substantive work of the Group?
5. What is at stake in naming this process 'statutory' regulation, when state regulation is a more truthful description of this work.
6. In what way will dissenting or sceptical views be heard (note 3)? The image conjured up here could easily be understood as a kind of handicap, or distraction to the real work; it pre-supposes an unspecified agreement and prejudges a disposition - a splitting mechanism.
7. How is the public being conceived, and what is the harm, how will it protect?

The phrase 'statutory regulation' is used erroneously throughout this document. The correct term is state regulation - it proceeds directly from the act of the government which itself proceeds from the report of the Bristol Royal Infirmary Inquiry.

The limits placed on this group raise serious questions about the trustworthiness of the process. The group itself is constructed entirely within the domain of the HPC. The chair is already an HPC member, attached via another label. The PLG was selected by this chair in order to minimise the chance of actual debate. The substance of the meeting that did begin to touch the real concerns about the negative effects of this process on the practise has been entirely screened out. Brian Magee, for example (who is attached to COSCA - a group in Scotland), asked the very serious question: would the group be able to conclude that the process of HPC-ification was itself against the best interests of the client/user. Kathi Murphy (attached to Metanoia, an organisational member of the UKCP) had to forcefully remind Peter Fonagy (spokesman for Skills for Health) and Mr Bell (substitute for Rose Mary Owen, from the Relate Institute) that she was not fillibustering when she spoke of the real concerns that she was bound to represent that exist within the UKCP.

The minutes make no reference to the reasons the Chair had for closing the meeting 2 hours ahead of schedule. This remains a fact for conjecture.

More on the meaning of a 'Public Gallery'

Dear Mr Seale

Thank you for your letter dated 21 January, which I received yesterday.

I am surprised and pleased to hear that I am the first to take the trouble to draw to your attention the strange seating arrangements of your rooms, and the first to spend time reflecting on the unintended or unexpected consequences of this. It is good to be of use and to bring something new to light. I wonder, though, why you decline to engage with me on the point. When I described the layout to a colleague, he was most surprised. He had thought that 'public gallery' meant what it said.

I had no idea you were also seated here during the course of that meeting, but am happy to hear you were not uncomfortable. However, I am surprised you are not aware that you and I are in different positions and that this has a bearing on my experience, also it seems necessary to say that though you weren't made uncomfortable this is not evidence that I was not uncomfortable. I do wonder why you are so quick to dismiss my point.

My suggestion that the coffee tables could easily give way to the comfort of the public remains true. It was a simple suggestion made in good will, which you have completely overlooked.

I have been unable to fathom the meaning of your third paragraph (that the public is not expected to participate in the actual meeting itself). In a court of law, a lecture room, or indeed an opera house the audience might not be expected to participate in the actual thing itself, but nevertheless has a role to play. Moreover, it must be rare for the audience to be confined to a corner, and obliged continually to look askance at the backs of many players’ heads.

My other question related to designating the speakers with names and positions - both seating and substantial. Your reply addresses only 2 of my 4 points. You supplied a list of names and organisational associations, but I also asked for their position statements and where they were seated. Even the minimum would have been a welcome addition to the day - my neighbours also spent many minutes looking for such a list on and about the chairs. I understand that you are not obliged, and that we might have brought our own copy, etc but be assured a few of us at least had expected it as a courtesy.

There is little courtesy here, in fact, and I am indeed surprised. Your reply is rather mechanical and lacks a human touch. This gives me cause for concern.

One final point – I should like you to know that I have been writing a blog called ‘hpcwatchdog’ for a few months now, and that I would like to record this correspondence there. May I suppose that you will let me know if you don't agree to this act?

Yours sincerely

creative strategies of resistance to nutty demands and ideas

This is edited from an email comment received from a dedicated shrink:

"I was reminded upon reading your recent posting of the current crop of HPC adverts, in which their key strapline, before everything else, asserts their primary role as "the protection of the public" (presumably, the public is being protected from us). This does seem to imply the existence of some embedded beliefs, prejudices, at work in the HPC that might inhibit full and open debate with such a body.

... In my work I am being audited four times between now and September by various agencies, or parts of agencies (I suppose this is an extension of the same logic, the auditors are there to protect the people I work with from me).

.... I thought of applying for one of the HPC jobs currently advertised in order to sabotage it (but then I thought about ..... life!)"

The responsibility and respect of the public

Dear Dr Anna van der Gaag (President of the HPC)

You were kind enough to welcome us as members of the public, to the first meeting of the PLG for Counselling and Psychotherapy (4 December). In now occurs to me that you might be the person to ask for something quite mundane yet vital in preparation for the next two day ordeal (28 and 29 January).

I found it very uncomfortable at the last meeting partly on account of the strange arrangement of the seating. I had expected to be seated in a 'public gallery' which would afford me the opportunity to view the proceedings and aid my listening and understanding. As it turned out, we were crammed into a corner, and forced to look at the backs of several heads. It was often difficult to know who was speaking as the name tags were not at all visible, this made it difficult for me to follow the discussion at times.

I am rather dreading the repeat of this experience, especially as it will be spread over two days. I have raised this with Messrs Bendall and Seale, but have yet to receive a reply.

But the discomfort of the public gallery was also caused by the substance of the meeting. For example, there were two members of the HPC panel present in this meeting who took up a lot of valuable time apparently reassuring the new professional representatives that in spite of widespread objections from the profession, resistance was going to be futile. This might have been amusing had it been said succinctly, but it was said more than once and at length, which suggests that humour was not the intention. This was odd - what can have been their meaning? Resistance is futile. Wasn't this what the Borg were famous for saying? I should very much have liked to have asked.

A second occasion arose when the spokesman for Skills for Health said there was evidence that 5% of therapists were a serious threat to the public. Can this really be true? Shocking! The HPC say that only 0.23% of other professions represent such a menace. No-one on the committee challenged him. Someone should have. I did wonder whether we had a duty in the public gallery to shout out at that point. What would happen if a voice of conscience were to emit from the back of the room?

It is difficult to know where to post one's questions in all this, and this is why I have finally come up with the idea to write to you. There was more than one moment in the proceedings when our quiet cramped corner was shuffling and muttering under its breath as some committee member or other talked rot. Perhaps there could be a way for the meeting to tolerate or even benefit from some of this frustration. After all, any theatre, even a court of law, can benefit from the feedback of the audience if the performance is outstanding in any way. I hope that the Chairman of the Group is capable of tolerating a groan, a guffaw, or a gasp at least issuing from the back of the room, tho I am sure this would be altogether better managed if we were first accorded the dignity of a properly constructed space.

I do hope you are able to respond.

Yours sincerely

habeas corpus - the case of missing Mr TH

Another missing man at the centre of this pernicious process. When I arrived this morning the waiting room was full of giggling women. It was as if they were out for a day's pleasure. The line manager, the line manager's line manager, and finally, the line manager's line manger's line manager (yes, another case from the NHS). Three women lining up to nail the coffin down of occupational therapist Mr TH.

The third in this happy parade was the one who submitted the complaint to the hpc. She did this about one or two years after Mr TH had left the employ of her team. Why? "he was a threat to public safety."

She spoke so quietly that I had to strain forward to hear her, so I stood up and moved forward to hear the rest of her statement. In the nano second it took for me to settle in the seat in front she was standing up and leaving. That was it! She had been called in order to recite this empty phrase! Bang, the final nail in the coffin.

At no point in this morning's proceedings did anyone mention what it was that he was doing with his patients that was such a threat. The entire discussion revolved around his note taking. The context of this is the computerisation of notes in the NHS - something which other occupational therapists are fed up about.

Why is it a threat to patient safety for Mr TH to not write notes according to the computer developers protocol? 'in case he doesn't come in and someone else has to take over his work'. (We're talking about occupational therapy remember.) Is there an example of the danger that ensued when he did not turn up for work (he went off sick, then resigned a few months after this witch hunt began). No, no examples. No examples at all in fact, all we had were vague generalisations and examples of his administrative skills: did he make a phone call, did he write a note. His work as an occupational therapist was absolutely absent from the case.

The line of questions that were presented to the witnesses got nowhere near uncovering any kind of truth. The three women were vague, one was verbose, and all were well versed in newspeak: 'got to get up to speed', 'golden rule is to keep accurate and up to date records', 'I did an audit of notes', 'a random selection of his files', 'there was insufficient detail', 'notes were vague'. No substantive content whatsoever in any of the three womens allegations. No sign of any patient in trouble, no whisper of any complaint from any of the people he worked with. None. Repeat: NONE.

Yet another case of people occupying positions of power in the New NHS who are blatantly unworthy of the responsibility on their shoulders. No gravitas, no experience, no compassion, no speech of their own, nothing to say except to mouth empty phrases that knock around like bricks doing random damage, no idea except to cover their backs. Not professional.

I wonder what the Panel will decide. Decision so far not posted.

Preparing for the next PLG for C&P, 28/29 Jan 09

[email sent 19th January]
Dear Mr Seale

Looking forward to the HPC PLG for C&P meeting next week, 28 and 29 January, I have written to Mr Bendall to ask if it is possible to organise the room differently so that the public gallery is accorded more respect. I understand that Mr Bendall is not in today, and I suspect he may not be the correct person to whom to address this request, so I have taken the liberty of writing to you.

The problem I refer to is the way the furniture is organised. We are rather pushed into the corner and forced to look at the back of people's heads. This makes it uncomfortable but also very difficult to ascertain who is speaking, and thereby to understand the position from which to make sense of their words.

I think it is common practice for rooms to be organised along the lines of a theatre when the public is allowed to observe. This would be a very welcome innovation not only in the PLG, but also for the fitness to practice hearings and, of course, all other events at which the public is included.

At the very least, if you are unable to innovate in time for next week, may I suggest that you remove the coffee table to another room and allow the seats to occupy the whole of the back wall. Also, it would be enormously helpful to provide a list of the names of the people on the PLG, their affiliation, their position statement, and the seating plan. This would go a long way to relieving the situation.

Yours sincerely




Name and address supplied

Disguising the truth

Mr Marc Seale is the Chief Executive of the HPC. The HPC is a QUANGO - a quasi autonomous non governmental agency. The Longman dictionary definition of this is as follows: set up by a government and having statutory powers in a specific field (eg the race relations board). In this case set up by the Health Professions Order 2001 - HPO2001 - and passed into law by Parliament in early 2002, responsible to, and administered by the Privy Council. Wikipedia adds 'the acronym can carry with it an implication of poor management and lack of accountability.'

At the BSHAA's congress, 18 April 08, Kenilworth, Mr Seale introduced the HPC as 'not a charity'. I wasn't there, but the powerpoint presentation is available on the web to download. One of the slides in his powerpoint show states: Not a charity. The HPC is not a charity. I wonder who might have thought that it was? Perhaps it was a joke, but I wonder why Mr Seale did not take the time given to him by the BSHAA to explain exactly what the HPC was? Perhaps he did in his talk, while his powerpoint projection continued to emit the empty information in large print on the screen that might have dominated the room.

Freud is famous for pointing out that when an analysand says 'it was not my mother' that we are indeed in the domain of the mother. So, is Marc Seale cunningly deploying a trick to subliminally implant the idea into the minds of this potential new source of income that the HPC is indeed a charity? I think we should be told.

The next bullet point on the show said 'the HPC is self financing'. Not a charity, but self financing. This rather suggests that it is competing in the free market and people are freely choosing to purchase its services because they think they are worthwhile. Not at all. Not only is it not a charity, but it is not a regular business, competing alongside a variety of others, either.

The HPC has the power to prosecute people for practising without paying their fee to the HPC. It is underwritten by law to compel money into its coffers through the use of statutory power. Without HPC registration, practitioners cannot use government 'protected' titles. The NHS and its contractors, are obliged to employ HPC-registrants thus creating a Government or Statutorily regulated market.

Why mask the truth in this way?

The right decision but the wrong reason

Mr W's panel agreed that the allegation against Mr R did not amount to a damnation of his fitness to practice. If you want to read their decision you will have to email the HPC because it won't be published on the website.

Why not? Because Mr R wants his name removed from any further damaging publicity. Fair enough.

I wonder, tho, whether the HPC would consider publishing an apology.

This seems only right. For it was they who thought that Ms B had uncovered a serious case of misconduct that amounted to a significant threat to the public's safety; and it was they who have made Mr R's life extremely unpleasant during the time it takes for the allegation to actually come to trial; and it was they who hired the legal counsel (Ms T) to attack Mr R on their behalf in public on January 5th, 2009. Yes, I would say she attacked and have asked for the full transcript so that I can describe it on a future blog where you may judge for yourself. From my seat in the public gallery it seemed almost obscene to allow her to hammer away for so long when the case was so obvious a non-starter. The law lost its position of objectivity and Ms T went out for her own satisfaction to get a positive result. Not professional, not competent. And Ms B? What might we think of her fitness to practise, judged on her actions in this case?

But the reason that the panel gave for coming to its conclusion continues to miss the point. To be charitable, I shall say that the HPC has been set up on a twisted logic which makes it very difficult for anyone to do a decent job there. The twist is of course difficult to reveal - it is concealed behind a facade which effectively corrupts the truth (hence my reference to George Smiley in the twitter bar) and it will be the subject of several more blog entries, I'm sure. But for now I need to focus on the point of the unfortunate Mr R's Kafkaesque experience.

If you remember, Mr R is a speech and language therapist. This work is not renowned for is life threatening qualities, unlike, say heart surgery, or administering morphine. Nor is it clear why only an NHS employee in office hours may administer a treatment. What is the evidence that giving extra sessions outside the jurisdiction of the NHS will present a danger to the public? Absolutely none in this case.

The taken for granted assumption behind the HPC's action against Mr R can be deduced: that professionals are greedy, money grabbing creatures who will deceive the public if they are not subject to close scrutiny by their colleagues and managers in the NHS together with the weight of authority of the HPC. Puerile.

Mr R is innocent even if he charges the going rate for extra sessions. In fact, by charging the going rate he enters into a relation where both he and his clients are protected. The financial arrangement between people is in itself a form of regulation. The HPC and the NHS here seem to think that money is a filthy contaminator which must be treated like excrement that only they have the expertise to manage. They have invented a new harm - money - against which the public must be protected. This idea is juvenile and has no place in an institution underwritten by the laws of this land.

Continuity and Change

On leaving the building yesterday lunchtime, I chanced on the Chair of the Panel. John W's opened the channel for a conversation and we sketched our different positions. He had previous experience as a panel member listening to child protection cases - his background is in social work. He has been a Chair at the HPC since the FTP hearings first began (2004). He assured me he was totally independent of the HPC and that occasionally there were even big rows. The kind of independence interests me. I had seen an advert for a panel chair in the last HPC Newsletter, they advertise, recruit, pay the fee, run the appraisals.

John was pleased that a member of the public was taking an interest in the work of the HPC - they should. Good. He said that everyone in the room is monitoring and scrutinising each other all the time, and that Angela H, today's HPC Legal Advisor, was really the one who made sure that justice was done. It was already very noticeable how the panel leans on the knowledge of this person, but so far I have mostly only heard them recite pre-formulated speeches about the balance of probabilities, their impartiality, and the panel's ultimate responsibilty for judgement. At the last hearing I attended I had been interested that the Legal Advisor loaned his laptop to the Panel to read their speech out from. What is of note is that the Panel Chair looks very much to that function to take his bearings in terms of justice, fairness, and due process - and to phraseology too. It has been very difficult so far for me to appreciate in what way the panel is independent, they seem very much tied up, and actually often they seem timid and sometimes even out of their depth.

In the room yesterday there was the Hearing Officer (Jonathan Dillon), the Legal Advisor (Angela H), the shorthand writer, the Presenting Officer (Elizabeth Tahari from the Kingsley Napley law practice), the Professional (Mr R) and his legal representative, the panel: Chair (J Williams), the lay member (Lesley Hawksworth) and the Speech and Language Therapist member (Martin Duckworth). In the audience: me and another case manager (understudying the role which was today filled by the tenacious and determined Elizabeth Tahari), and, when the witness (Ms Betts) took the stand, a man who might have been her father sat for a while with us.

There are many accounts of the HPC - what it is, why its there, what it does. Marc Seale, Chief Executive, stresses its independence and innovative nature. John Williams, Panel Chair, stresses its similarity to the other current regulatory bodies (especially the GMC), and its place in the sequence of history (taking over both the building and the work of a previous incumbant: the Council for Professions Supplementary to Medicine). The case manager at the back of the room is more familiar with registration hearings - something that I can only guess at by overhearing conversations in the reception (people from Australia and Italy who want to register for work in the UK). Yesterday's registrant at the hearing (Mr R) knows that it has the power to wreck his livlihood and seriously disrupt his life for a year or so before. For his patient and the parents of his patient and others like them? I wonder whether they feel protected from an incompetent or miscreant professional by the actions of the Council. It seems rather unlikely, on the balance of all probabilities.

Money, charity, the NHS and the case of Mr R

There was snow on the ground, and big flakes in the air this morning as I boarded the bus to Kennington. It is the 11th day of Christmas, and the first day back at work for many people in the country. There are quite a few cases beginning today in the Fitness to Practice rooms, so many indeed that the HPC was renting some from its neighbour the Evangelical Alliance. As I walked through the doors I was greeted by a flat screen tv display telling me 'Kind words are like honey, sweet to the taste and good for your health'. Proverbs 16 24

Kind words can cost you your reputation as an HPC health professional, or at least, a kind act can if today's case is a typical example.

The allegation in this case is a short one: "that Mr R provided private speech and language therapy treatment to [a client] whilst also treating them on NHS caseload at [a PCT]". When I popped my head round the door to see if the business had begun the Chair was quizzing the Barrister on the use of the word 'them'.

The writer of the allegation had been at pains to avoid bringing the patient into view. For this reason she had avoided the word 'him' and used 'them' in its place. This switch from single to plural had created the impression that Mr R was in the habit of taking his patients into his private practice. The point clarified that only one patient was in question, and that language might be used for other purposes than simply stating facts.

There was only one witness in today's case: Ms B. She had been employed to replace Mr R when he resigned at the end of Sabbatical. They had never met. Mr R had seen his patient for the standard 5 sessions and was closing the case. However, he had not filled in the last form before going off on leave. So, when Ms B turned up she acquired a case that was all but closed, needing only one final act to make it so. She visited the patient at home to make her assessment, and agreed to close the case.

In this morning's part of the hearing a lot of context and detail was revealed. For example, it turns out that the patient is a young man, probably in his twenties. He is married, but still lives at home with his mum and dad whose culture and religion happens to be the same as Mr R. They all speak the same two home languages as well as English. In the detail of the discussions this morning, I understood that mum and dad were doing their best to 'normalise' their Down Syndrome son, and had high hopes that the 'articulation process' of the speech and language therapy would make him just like anyone else. In the meantime dad often spoke on his behalf, jumping in to answer questions and give opinions instead of leaving a space for his son to struggle in. Mr R put it like this - he said there was a lot of energy in the room when the parents were present. In fact, as the case unfolded, Mr R said that his own intervention was less to do with administering the standard procedure and more focused on working with the family to create space in which the young man could find his own way to communicate.

By all accounts the work was successful but the STAP [the South Tyneside Assessment of Phonology] showed that further standardised treatment was unlikely to match target outcomes. The patient and his parents all wanted to carry on with the work, and all agreed that Mr R was the man to do it. The parents were particularly keen, and asked Mr R several times if he would carry on - never mind the rule about 5 sessions, they would pay they were so pleased with the results.

When Ms Betts turned up to make her assessment, the patient's parents let slip that Mr R had done some work with their son outside the domain of the NHS. As soon as they had said this they realised they had dumped their man in trouble and clammed up. But Ms B was not to be deflected. She wanted to know how often this had happened and how much he had been paid. The more she asked the less they said, the message had been instantly transmitted! Something unspeakable had happened, and now the family began to worry that they had caused Mr R to be sacked.

In a way they were right. They had not reckoned on Ms B clinging so tenaciously to the rule book, nor indeed that such a rule book had in fact been written, and they certainly never imagined anything like the HPC who would use such a book to purge the profession of any imaginary stain.

As it turned out Mr R did see this family about four more times outside the NHS protocol. He accepted about £6 from them to avoid the embarrassment that was created through his refusal to accept a proper fee. Today, 2 or 3 years later he says he would definitely never do that again.

Quite right; if he does work in private, he should participate directly in the symbolic exchange that regulates it. He might negotiate a proper price for himself, refer the case to a colleague in private practice, or perhaps he could channel the money to a charity.

No! None of these ideas were considered. Mr R now knows not to accept private work because it would catch him in this dreadful process that might ultimately prevent him from working. For if he is struck off (and that is the HPCs intention - 'a clear case of misconduct'), then he will be legally prevented from practice. In future, he will not try to help a family in need, he will attend only to the requirements of his cv.

From where I sat in this proceeding, I would say there's a very strong possibility that money is a tabu topic in the NHS and forecloses any sensible discussion about working effectively with patients. It certainly muddied the discussion at the HPC. (Was he accused because he took money - sub-text because was greedy? Or because he gave charity - sub-text that he was naive? The prosecuting agent didn't mind which, so long as she nailed him with one.) What was quite clear from this morning's discussion was that the family made direct and repeated demands for treatment that the NHS protocol ruled out. Mr R however, could see that something less rigid and more responsive could and would have a good effect. For goodness sake! What on earth is wrong with that? That Mr R will never do that again is, well, it's a shame. And if The Public conjured up colludes with this ruse then we are in bigger trouble than I had thought.

It was said several times by Ms B that a professional must act ethically to protect himself from suspicion. This puts a curious twist on the question "who is being protected by the HPC, and from what?" Listening to Ms B it seems that 'the public' that is protected is the one that belongs to a profession. What the HPC is protecting this public from is the accusation from an ill-informed mob who might otherwise point the finger of suspicion. There are two kinds of public here. One is being protected from the truth, the other is being protected from any possible accusation of suspicion.

Poor show. Doubly so, for in another time or another place it would be quite normal to deal with this question in an ordinary conversation between people (supervision? seminar? collegiate conversation? quiet personal reflection?), or even just getting on with the job and accepting a fee for it. What we have instead is an elaborate construction of something approaching a kangaroo court dressed up as respectable profession.

the public, and who it is protected from

The phrase 'to protect the public' gets bandied around a lot, but even with only a small pause one is confronted with a number of problems. What is it - this thing so readily and easily called the public? What must it be protected it from - what is the threat that is imagined?

In the fitness to practice hearing for the absent Mr S (see blog below), I had occasion to ask Mr W how the HPC understood what they meant by 'protecting the public'. Although he had no ready answer for this he did me the courtesy of improvising. 'We don't survey the public to discover a meaning, it's a kind of ideal I suppose; we have lay members, that's what they are for, and everyone is also, of course, a member of the public'. Everyone is also a member of the public. Yes.

More than once I have had the impression that I am in the presence of the invention of some kind of a new religion. Conjuring up an idea of 'what the public will think if they saw this' is rather like "what would god think if he saw me do this?" There are important differences, of course, but the functioning of an Ideal in order to govern behaviour is a very large part of the work of these FTP panels.

The act, and the responsibility for the act.

When the panel returned its verdict on the absent Mr S this week Mr W jumped in very sharply to press the panel to enact the suspension immediately in order to 'protect the public'. The panel retired to consider this, and took Mr P with them for advice. In the lull I asked Mr W in what way he was responsible for his work, and whether he could say why he had decided to ask for this measure to be brought into play so swiftly. Mr W assured me that it was not his decision, but a general policy, made by a committee.

Mundane details

On this bright winter's morning the action in the HPC FTP rooms was slow. The only hearing in progress was that of Mr S (paramedic) whose case had come to the HPC from the police. There had been a traffic accident, a breathaliser, an admission of alcoholism. This had led to a conviction. Mr S was not present at the HPC hearing, which begun today and was over by lunch time. The Panel's verdict was flying from the web-site by the middle of the afternoon. No witnesses were involved, and no legal representation had been engaged from outside to present or defend the case. It seemed to be a straight forward regurgitation of a case already held. The only people on stage when I entered the room were the court stenographer, the HPC case presenter (Mr W), the HPC Hearing Officer (Mr S), and the legal adviser (Mr P). They were discussing their luck in the office secret santa.

After a short while the chairman of the Panel popped his head round the door to ask the legal adviser to come and give his legal advice in the little room round the corner where the panel are able to discuss things in private.

In the wait I was able to address a few questions to Mr W who had been good enough to introduce himself. He recognised my name from a series of email exchanges over the previous weeks.

Mr W is one of 12 officers employed at the HPC in this function. They are drawn from a range of different backgrounds, many of them from other regulatory bodies (Financial Services, Border Control, some ex-police, and so on). Some of them also have legal training but Mr W does not. This confused me. I have been impressed by the highly stylised way this role had been filled in the other cases I had observed, and had become quite sure this function was brought in from the outside. One of the registrant's representatives had told me this as a matter of self-evident fact, in fact. But no.

Mr W said that when a case came through from the Police there was seldom any need for the HPC to engage a solicitor as they could rely on the evidence that had been produced through this other legal procedure. This also confused me, and in fact I understood him to tell me the exact opposite. I had assumed that a case coming from the courts would need a professional law person to understand the translation necessary to bring something from one domain of law into another. As it turns out, the administrators at the HPC appear to simply be picking up a case and repeating it: a sort of empty echo, but one with serious consequences for the person in question.

I asked if he was also a kind of researcher, someone who must go out and discover the facts of a case and find the witnesses who would come and speak. Not really. This was more likely delegated to a solicitor who would be instructed to act on behalf of the HPC. It was less 'research', and more 'investigation', of course. The kinds of facts that are produced through this process are not on the side of knowledge and truth as we know them in science and practice. They are a different quality of knowledge, and will ultimately be written with the weight of State law, not with the weight of the real - something that interests me a lot.

After the panel had presented its conclusions (click the heading of this blog to read them for yourself) they withdrew once more to consider the sanction. Before they left the room they were reminded that a new set of sanctions had been issued by the HPC and had come into force today. The new sanctions had been created by the Conduct and Competence Panel (made up of all kinds of professions and lay people), and written in the Indicative Sanctions Policy, both of which (no doubt) can be consulted on the web.


Post script. When the Panel exited they stopped and said hello. They were returning at 1.30pm to be the Panel for the next hearing of the day. This gave the Chairman of the Panel the chance to say a little about themselves. He was a Chairman. He would be Chairman again this afternoon.The Lay Member would also be returning. The other gentleman was the Paramedic Panel Member, so he won't be returning. They would slot in the relevant Panel member to represent the next registrant. So, out of the 7 people present (8 including me), only one has any idea of the realities and practicalities of the registrants actual real work.

Mr H & facts 1, 2, 3(a), (b), (c), (d), (e), 4(a), (b), and (c) etc

Poor Mr H. I hope he has a sense of humour. A dyslexic man, qualified by some regulated and audited educational body to work as a physiotherapist, faced with a panel of people who prove facts 1, 2, 3, etc and write that "the HPC Standards of proficiency were breached, viz: Standards 1a 4, 1a 5, 1b, 1 1b4, 1b5, 2a.1, 2a.2, 2a.3, 2a.4, 2b.1, 2b.2, 2b.3, 2b.4, 2b.5, 2c.1, and 2c.2."

Sitting in the crammed up seats in a cold draft near the door, (which might well appear - misleadingly - in the minutes of this meeting as the 'public gallery') I would say that there are good grounds to suppose that the educational body that granted Mr H the qualification might be unfit for practice. Furthermore, I think that the NHS Trust who employed Mr H also has a little case to answer. The permanent shortage of staff, which is well known to be worse over the Christmas and New Year period, is the context in which Mr H was first offered the job which he had refused. He recognised that he would be in difficulties in such a particular context as this (it was a 'respiratory' rotation, and Mr H knew he had no expertise in this). The job was offered to him again later as no-one else had been found for it, and this time he accepted it. Perhaps he thought he was helping out, and that this spirit of charity on his part would be met with by staff around him.

In fact one of the witnesses, the Band 6, said she had a good working relationship with Mr H, and had been happy to spend time teaching him on the job. So what changed her mind?

The Band 7, another young woman, and responsible for quite a lot (it seemed to me) in this NHS Trust, spoke in a way that did not inspire much confidence. She seemed to reproach Mr H, and to resent his presence - I don't think she can have been part of the process to recruit him to her team. He seemed to represent a threat to her reputation, and to require more from her than she was able to give.

Now, this could mean that she was not fit for purpose, not capable of dealing with the perennial staff shortages, not capable of coping with the level of qualifications produced by contemporary educational bodies, not capable of accommodating the differences amongst the people she is required to work with. Not capable of holding her ground in the face of potential allegations of failure that might be aimed at her.

Or is there another way of thinking about this? As it happens, I studied business 30 years ago. This was when the function 'Personnel' still enjoyed a position. At that time there was much excitement at the new phrase 'Human Resources Management' and the academics in the business schools at the time wondered what effect such a shift in terms signified. Tony Watson (now Prof at Nottingham Trent University) taught me that 'personnel' derived from the French duality born of war-fare: personnel/material. It indicated a human being as opposed to an object. The term Human Resource, however, rather put the person on the same side as an object. Essays and exams were written by hundreds at the time on the question of possible future consequences.

That was a very different context. It was not so unusual to consider it rather dishonest to scape-goat an individual for the failings of the group.

Now it seems that we, the British, think it a virtue to single someone out for a public show trial.

No patient was harmed as a consequence of Mr H's employment.

So what is going on in our name, and from what are we being protected?

Is it not knowledge, or better yet, truth that we are being shielded from? The truth not only of the complexity of reality constructed by us and by government policies over the last 30 years, but also of the truth of human subjectivity and the impossibility to actually turn us all into a fantastically efficient machine.

Physiotherapists and their notes: Mr H's FTP hearing

Today's Fitness to Practice Hearing focused mainly on the question: can Mr H write notes according to the rule book. His chosen practice is Physiotherapy.

The case opened this morning, and is expected to unfold over three days. I stayed for four hours and listened to the cross examination of two witnesses, who seemed to be the whistle blowers in this case. They had been his Band 6 and Band 7 supervisors in a rotation he (Band 5) undertook a year ago.

There was no word of a problem with his actual practice, but a lot of trouble with his ability to recite the rules, and especially with writing them down in the case notes. This is how the two women want to invest their trust in him - can he write notes the way they can?

He is not like them. He is dyslexic, and he has a different relation to the written world.

One witness coughed her way through her performance, and sprinkled it with so many generalisations and ready made phrases that I wondered whether she might inadvertently prove herself unfit for practice.

She and her colleague were effectively questioning the man's qualification, which had been awarded by some other body. This opens up a can of worms. Clearly something had shaken their trust and he had become the object of their fear. So much so indeed that they had decided he must be excluded not just from their work environment, but from their profession and his chosen trade. They had, however, a great deal of difficulty making their case clear.

A lot of the talk and cross-questioning concerned the grading of the jobs, the level of staffing, the role of a crisis team, bits of specialist equipment, and other NHS organisational details. This gave a glimpse context within which this drama was taking place, and opens up another can of worms.

Times have indeed changed, and the structural context of both universities and hospitals have been transformed radically by successive government policies. One upshot of this is that today we can watch witch hunts and construct scape goats rather than think about the process, the system, the context or the way people end up scrapping when they feel under threat themselves. This may not be the intention, but it requires a lot of effort to subvert that 'natural' effect. The arena in which our assembly are obliged to meet is structured in such a way to exclude any other kind of outcome. It was a relief, then, to hear the Panel ask for details of the context that threw some real light on situation in question.

The much respected GP George Freeman (trainer, teacher, and practitioner) told me earlier this year that now, for the first time in his long experience, the British Government was supporting a glut of students in the medical profession. He said that many more were going through medical school than there were jobs in hospitals, and in rotations etc. This is a kind of State induced over-production which is often justified by reference to a false kind of 'natural selection'. You don't need me to spell out the kind of benefits that arise for the Government, and the inconvenience to the students that this nonsense implies. (click here to find the full text of that conversation).

It is the kind of competition that Chris Woodhead and Margaret Thatcher enjoyed provoking. It is based on the mistaken belief that you bring out the best in people by artificially undermining the basis of their trust and then injecting fear.

The way the two women spoke in this case revealed lots of inconsistencies and incoherences that left me thinking that they simply didn't understand the way Mr H worked, and couldn't appreciate the value he was providing. He is just not like them.

For example, one of the 'cases' they brought against him was an incident with a patient who was, as it turned out, about to die. It seems that Mr H had read the situation quickly and correctly from the social relations in the room - the family were assembled around the bed of the patient - so when he entered, he let them tell him what had happened (a stroke), listened to the patient's chest through his stethoscope (perhaps to give comfort, it was suggested) before leaving without conducting the planned physiotherapy treatment.

His supervisors complained that he didn't read the information from the file but got it from the relatives, furthermore he should have collected all the 'objective and subjective data' and he should have talked to the medics involved in the case. This was indeed the course of action then taken by the Grade 5 (a woman who knows what is required) after which she arrived at the same conclusion - that today's regime of physiotherapy would be completely out of place.

State Imposition and Statutory Regulation

The British Psychological Society web-site says: "Statutory regulation of psychologists is a stronger form of regulation than the current voluntary system and is therefore potentially a better means of protecting the public. The Society has argued for a long time that a statutory system is necessary to protect the public from charlatans and poor practice."

Statutory regulation, as it is implied here, is strong because it has the force of law pulsing through its veins. To be very clear, tho, this law may be local (pertaining to rules of the organisation itself) if the statutes are those of the organisation. Or it may be State Law, the law of the land, if the statutes are then written into the books of the Houses of Parliament.

What is happening currently, however, is State Regulation of psychological profession, and this is another thing again. State Regulation is imposed by the Government onto the professional organisation.

What protects the public from poorly functioning professionals, however, is not the enforcement of centralised rules (which is an excellent method of producing rule bound functionaries, and people too timid to use their own common sense). On the contrary, what is needed is strong networks of knowledge producing communities who maintain a clear emphasis on the realities of practice.

Here we have the two elements that make up Popper's nightmare. First, how can we make a system that supports the vibrant creation of practical knowledge, distributed as it is, in the minds of the may people that make up the community? Second, how does this relate to the FW Taylor's principle of efficiency, or to the legal notion of the nation state.

In the case of Statutory regulation, it can happen that a profession underwrites the structures of its organisation by getting them written into the Statute books of parliament, thus creating a powerful closed shop.

In the case of State regulation, it is the Government that imposes a system of regulation on a profession. This puts the professionals into a position of either having to pretend it was their idea in the first place, or risk themselves by opposing the law of the land. In 2001 suddenly the Labour Government decided this would be its course of action.

This means that in the current scenario relating to the so-called health professions, things are muddied precisely on this point.

The Government decided to impose State regulation on a whole range of professions. To do this, it first created two new bodies with the Health Professions Order 2001: The CHRE and the HPC. This followed the advice of the report of the Bristol Royal Infirmary Inquiry. It was imagined that these bodies would be able to operate independently of Government and of professionals, and would take over the management of a whole range of practitioner bodies. Once in this position, the HPC would itself apply to the Government to turn the newly written 'statutes' into Statutory Law. In this way, the Government would avoid the accusation of imposing State Regulation on an unwilling body of practitioners. That is, the HPC would be able to claim that it was involved in a process of statutory regulation.

This, however, is stretching the truth exceeding thin.

Psychotherapy & Counselling, 1st meeting of the Professional Liaison Group .

At the Professional Liaison Group for Psychotherapy and Counselling held on Thursday 4th December the central difficulty - resolving the tensions between imposing government policy from the top down and listening to bottom up, democratically expressed opposition - was raised and then avoided before calling the meeting to an unexpected early end: 2 hours before schedule.

Niall McDermott, Head of Policy & Standards from the Dept of Health, presented the legal frame of the group, explaining the role and process of Section 60 of the Health Act 1999. The work of the PLG will result in recommendations that go to the HPC Council, from where it goes to his team of lawyers to be turned into law. He also spoke of the links between the various governmental bodies, saying that he saw no reason why Skills for Health shouldn't inform HPC - the correct steps had been taken to make that 'read across' work.

Micheal Guthrie, Head of Policy and Standards at HPC said 'there's a clear policy direction from the Government, full stop' and ended his presentation by pointing to the not inconsiderable benefits to the professional bodies who join this process. He added that the PLG were faced with a very difficult and ambitious process, and that they would be 'asked to make pragmatic decisions' in order to 'move things forward'.

Jonathan Coe, CE of Witness supported this line and said 'opposition to the process is a misperception - our job is to move away from left field views' and implement the government's policy. This line was repeated by other HPC Council members on the group (notably Annie Turner representing Occupatonal Therapy and Eileen Thornton for the Physiotherapists) who made long and frequent interventions to reassure those representing the new profession of psychotherapy that there is always dissension to the process, but it would all get suppressed in the end: someone said 'we have a task to do, we have to manage the task'. This was more clearly stated later by another HPC representative, this one appointed as chair of this committee, arts therapist Diane Waller; she said: 'this is the HPC's task: the Government has made a decision, if we don't do it to ourselves, it will be done to us.'

Kathi Murphy (UKCP rep and psychotherapist with Metanoia) had to remind the group that she was not filibustering (a political point set up by the Skills For Health spokesman, and knocked home by the representative for Relate) but was in fact raising important arguments thoughtfully made by large groups she was there to represent. This was the most clear statement that the meeting actually had some work to do to take on board the different positions within the profession.

Sally Aldridge, Head of Regulatory Policy for the BACP, quietly asked how they would resolve the difficulties of dual registration. This deceptively simple question conceals not only the fight for status that might wreck the work of this committee, but also the unwelcome news that there is no way of stipulating when the work of this profession is simply one thing or the other. Brian Magee, representing counselling and psychotherapy for Scotland gave voice to another small question that cuts right across this one, but from a very different starting point. He asked whether the group was entitled to decide that regulation was not in service users’ interests. This question triggered the chair to stop the meeting for lunch. It was a little after 12 midday.

Popper's Nightmare

At the Rally of Impossible Professions, held in London on 20 September, Richard Gombrich had occasion to remind us all of the pertinance of Popper's Nightmare. Click the link for a short snippet of this on you-tube

“The holistic planner overlooks the fact that it is easy to centralize power but impossible to centralize all knowledge which is distributed over many individual minds, and whose centralisation would be necessary for the wise wielding of centralised power. But this fact has far-reaching consequences. Unable to ascertain what is in the minds of many individuals, he must try to control and stereotype interests and beliefs by education and propaganda. But this attempt to exercise power over minds must destroy the last possibility of finding out what people really think, for it is clearly incompatible with the free expression of thought, especially of critical thought. Ultimately it must destroy knowledge; and the greater the gain in power, the greater will be the loss of knowledge.” Karl Popper

Newshounds and the public's right to know

My trip today to the HPC revealed some very different knowledge. The Fitness to Practice Hearing was for an Art Therapist who works with children. The practitioner is alleged to have said things about children, sex and death. This counts sufficiently as a story for the Daily Mail to send a reporter, and for two Agency journalists to turn up too. They, however, took off for Great Ormond Street as soon as the news broke about baby Hope's death after the operation to separate her from her twin sister Faith. This left the unfortunate Daily Mail hound to wait, and wait, and wait... and pass the time with me.

I learned a lot from her.

For a start, in a regular court, there is no need to hang around in the reception waiting to be called. You can just march right on in and watch what goes on while waiting for the real action to start. Second, if someone asks you to leave because a witness prefers to speak in private, you can sit tight - after all, what the witness says is not private. Third, well the third point requires a bit more background.

This morning's case alleges that the therapist tried to make jokes to a colleague about children in relation to sex and death. His case is now heard in the week where the news is all about the aftermath of the tragedy of Baby P. So, Mr D's representative moved to remove the press and the public from the gallery, and petitioned for the case to be heard in private.

So I learned another detail: first, the appeal was made to section 10, 1, a. This is written in Statutory Instrument 2003 No 1575, The Health Professions Council (Conduct and Competence Committee) (Procedure) Rules Order of Council 2003. Here it is:

"(a) the proceedings shall be held in public unless the Committee is satisfied that, in the interests of justice or for the protection of the private life of the health professional, the complainant, any person giving evidence or of any patient or client, the public should be excluded from all or part of the hearing"

What the Daily Mail reporter then wanted to know was under what power she could challenge this. For her our exclusion was an outrageous breach of civil liberties, and might be a contravention of the Human Rights Act.

I stuck close by as she refused to be ushered back to the dullness of the reception, and while she phoned around to see if she could muscle her way back into the room,I noticed the coming and going in the corridor. Three middle aged men in grey walked by and back again, two in their outdoor macs. The indoor man was pointing out the hearing in this room, and the other one in that, and seemed to boast that they always had two or three going on at the same time. As he brought them back down the corridor he said, 'we shall have much more in a few months, maybe 20 or so at the same time, when the psychologists come onto our books. They tend to have better insurance, so the cases will go on for longer'. Never had the place felt more like a factory where registrants are dumped by colleagues and bosses into the mill for the pleasure of the legal profession and the administrators.

The HPC staff don't get involved at all in the nasty business. It is central part of the process that a false objectivity is constructed, and it is here that we can see most clearly the mechanism for producing proliferating unintended unheeded consequences. The 'court gimp' as the hack called him, just trawls through paperwork to collect complaints, then organises the paperwork and room bookings. An IPC is convened (independence practitioners) and it is up to them to gather evidence and find witnesses. The administrator can shrug, and smile, and go home with a clear conscience. These details are spelled out in the Health Professions Order 2001, the legal instrument passed by an elite group, the Privy Council, late in the year 2001.

The journalist was on a 'steep learning curve' trying to figure out her place in the law at the HPC. I am giving myself - and you, if you are there - a more gentle, longer slope to get the hang of the thing, for there is a twist in the logic of it which is pernicious, and which I believe is already producing unitended consequences of a kind that must be stopped.

One more thing: the law that this process is set up on is no ordinary kind of law. It is apparently called 'regulatory law' and has it's own kind of logic.

Bit by bit, in this ordinary way, I am trying to learn and to pass on the peculiar nature of the thing that is taking over as 'task master' for an extraordinary and diverse range of practitioners. I believe it to be the public's duty to join in. Especially as all this is done in our name.

Newsworthiness and children.

A shock expose was trumpeted on Radio 4's pm last night (Tuesday 2 December). The reporting was all indignant self-righteousness and puffed up pride: Radio 4 PM had played a vital role in ... well, from the tone, it must have been tracking down a seriously criminal and saving the lives of at least a dozen children. An undercover reporter had got himself a job in a private ambulance firm and found himself on a shift with a loud bragging bore. He captured this on tape and took it back to base like a hunter in a tribe released into the wild as part of an initiation into man-hood. The bore bragged that he had once had a criminal record. The conclusion that the BBC jumped to was that this man was in close proximity with sick children ... err, and, well what? What the story lacked in facts and reason, the presenter made up with huff and puff.

Reading the small print it turns out that this man is an excellent employee, and the conviction was seven years ago. But, well, this is news in a week of children stories.

As the hospital manager began speaking the journalist suddenly jumped in and urgently and excitedly stated 'and you didn't know about it until the BBC brought it to your attention, is that correct'. For goodness sake. The news and the agitation here is all produced by an over zealous BBC anxious to claim its place among the 'winners' who
save the life of an innocent child. For shame.

In amongst the story a Unison Union rep gives an opinion. It turns out that the ambulance firm is subcontracted to a contractor 'outside' the NHS. This frames his statement as: private company bad, NHS good. He adds "We are seeing the growth of an uncontrolled and unregulated industry." These two lines serve as shorthand for bringing everyone back under the tight control of the State.

Yet, wait, what's this: a small fact emerges. Private ambulance operators are used throughout England, but they are not used at all in Wales and only rarely in Scotland and Northern Ireland. So what, then, is happening in England?

Let's hold off with the sensationalism and short cuts shall we, and take things a bit more slowly and carefully. Its crucial now for us to think and to see what's really going on.