The Joint Committee on Statutory Instruments now has an Order to consider which, if passed, will put 13,000 psychologists onto the register of the HPC in July. This order is called The Health Care and Associated Professions (Miscellaneous Amendments and Practitioner Psychologists) Order 2009. It is simultaneously laid before the Scottish Parliament.
The Order relates to the General Dental Council, the Health Professions Council, and the Royal Pharmaceutical Society of GB.
It includes governance changes which will effect the Council of the HPC. At the moment, HPC Council is made of members who are elected by the 13 professions already on the register plus 13 lay members who are appointed by Privy Council. This Order will remove the elected members and all will then be appointed by the Privy Council.
The power is moved (yet again) away from the people who practise, to a private group appointed by the Sovereign.
The explanatory memorandum puts it like this:
it is "to ensure that purely professional concerns are not thought to dominate its work"
"Regulators must be seen to be independent and impartial..."
"Doubts based on a perceived partiality have threatened to undermine .. trust"
"The regulators may be seen as partial ..."
"The composition is central to .. these perceptions"
"Regulators may be seen as partial to their professionals because [they] form the majority of their council or may be seen to be partial because their councils are thought to be elected to represent the particular interests of health professionals. Hence the moves to parity of membership and having independently appointed councils rather than professional members being elected by the profession." (Clause 7.1) [emphasis added]
There's a few things to note: these excerpts are all about manipulating an image rather than reflecting or establishing a system grounded in reality. It would be valuable to ask 'not thought by who?', 'perceived by who?' 'seen by who?', and 'on what occasion'? The vagueness does not encourage clear thinking. Second, the idea that purely professional objectives are a bad thing is odd. It sort of implies that the particular interests of health professionals are primarily against, and dangerously against, the interests of someone else. The vagueness leaves a nasty taste and encourages suspicion - abstract suspicion. Thirdly, the structure of the HPC is already predisposed towards destabilising the knowledge and practise of each of these groups of people, which makes it more likely that a group would to try to act in its own favour, to protect its boundaries, and to redefine its speciality - and all these things have already been insinuated as bad. An effective self fulfilling prophecy has been put in place which this new Order can only add to.
Couple this with the realisation that 13000 new people could be added to the register in summer, and that these people are working with other people's minds, and you have quite a prospect.
Quis custodiet ipsos custodes - who will guard the guardians of the psychologists? The question has an infinite regress, remedied here by ... the Queen.
Sunday, 15 March 2009
Sunday, 8 March 2009
Observer Front Page News: Victims of recession to get free therapy
Looking sideways at the problems of today:
Back in the 60s writers of the day were confidently anticipating that ours would be the Leisure Society: we would only have one day’s work each week because our technology and economic position in the world would be doing it all for us.
Few foresaw governments reluctant to let us enjoy our leisure. First they funnel us into never ending target led education, then they encourage us to audit each other by filling in more and more forms that make less and less sense, and now they plan to recruit half of us to therapize the other half and create a kind of smoke screen to conceal the real scene (Observer, 8th March).
Who will ask you how it feels to be all alone and without a home now that the bubble has burst? An army of newly recruited form filling government trained ‘therapists’ whose own good character will be policed and guaranteed by the hpc.
Back in the 60s writers of the day were confidently anticipating that ours would be the Leisure Society: we would only have one day’s work each week because our technology and economic position in the world would be doing it all for us.
Few foresaw governments reluctant to let us enjoy our leisure. First they funnel us into never ending target led education, then they encourage us to audit each other by filling in more and more forms that make less and less sense, and now they plan to recruit half of us to therapize the other half and create a kind of smoke screen to conceal the real scene (Observer, 8th March).
Who will ask you how it feels to be all alone and without a home now that the bubble has burst? An army of newly recruited form filling government trained ‘therapists’ whose own good character will be policed and guaranteed by the hpc.
Thursday, 5 March 2009
CHRE Conference 2009
A one day conference in London to which a large number of people were drawn from all over the UK for the launch of the new look CHRE. A new law (yes - another one) has been recently passed to reduce the Board of the CHRE down to six members plus a chair (removing the reps from the regulated bodies), all of whom are now new to the job. The strapline for this streamlined outfit is "Building Partnerships: from self regulation to shared regulation", which in itself is extremely ambiguous, if not downright misleading.
This is an emerging feature: something is being murdered - all reference to the previous incumbents of the Board is gone. The CHRE was invented by the HPO2001 to cure what was supposed as the problem of Self Regulation. What has happened to those intervening years?
In the morning's workshops there was a little bit of time to ask a question:
Question: what evidence is there that this kind of regulation increases levels of trust between professionals and their patients?
Dame Professor Professor Dr Dr Dr: What do you mean this kind of regulation?
The Dame in question is a perfectly lovely woman with 3 honorary doctorates, 2 honorary professorships, and fellowships etc at four prestigious national bodies. What, then, reduces such an accomplished lady to such a degree of blankness?
what evidence is there that the regulation practised by CHRE and its ilk reduces real risk and increases true trust? What ground is there for supposing that the new modus operandi is actually achieving its much trumpeted aim?
Onora O'Neill's 2002 Reith Lectures happened to be close to hand, so I quoted a little to situate my concerns: some arguments against performance auditing are that it creates a huge administrative burden that damages delivery of service; that professional work cannot be measured in the same way as the financial health of a company; and, worst of all, these kinds of measures are misleading and can create perverse incentives.
Dame: The world has moved on since that was written.
Well, yes, it is 2009, but Onora O'Neill's points might as easily be seen to have grown in significance and pertinence, rather than to have conveniently faded away. Here's another quote "Our revolution in accountability has not reduced attitudes of mistrust, but rather reinforced a culture of suspicion. Instead of working towards intelligent accountability based on good governance, independent inspection and careful reporting, we are galloping towards central planning by performance indicators, reinforced by obsessions with blame and compensation. This is pretty miserable both for those who feel suspicious and for those who are suspected of untrustworthy action - sometimes with little evidence." (click here for link to OU + BBC page)
Dame: I don't think I agree with the basis of your question.
OK - it is true that anyone asking for 'evidence' these days is usually on the attack (as Onora O'Neill predicted). Lets try a different angle: "O'Neill is especially known for her universalist and cosmopolitan standpoint. She believes that institution building can specify and allocate obligations to the needy. They are to specify who is obliged to fulfill economic rights. O'Neill firmly holds that the institutions have to be made accountable. This can be done through new technologies that are ideal for achieving transparency and openness. Justice, according to her, means finding the means for the vulnerable to express legitimate consent.finding the means for the vulnerable to express legitimate consent." [quoted from 4to40 website, click for link]
A major stumbling block that separated us in that room was the idea that there was any other kind of Regulation. 'What kind of regulation', seemed to produce a hole in the fabric that threatened to pull everybody in. Is there another way to speak, a way that doesn't produce such a terrifying void? I am fond of thinking etymologically:
Regulation: "Regular 'according to a rule' is the most instantly recognizable English descendant of Latin regula 'rule' ... It goes back ultimately to the same Indo-European base as produced Latin regere 'rule' (source of rector, regent, etc) and rex 'king' (source of English regal, royal, etc). From it was derived the late Latin verb regulare, which has given English regulate [17] and may also lie behind rile 'annoy' [19], ..." quoted from John Ayto's remarkable Dictionary of Word Origins (Bloomsbury, 1990, p437)
Governing is not reducible to a universal set of principles. We knew that. So where has this wisdom gone? I think it is being murdered, murdered by the way we speak.
This is an emerging feature: something is being murdered - all reference to the previous incumbents of the Board is gone. The CHRE was invented by the HPO2001 to cure what was supposed as the problem of Self Regulation. What has happened to those intervening years?
In the morning's workshops there was a little bit of time to ask a question:
Question: what evidence is there that this kind of regulation increases levels of trust between professionals and their patients?
Dame Professor Professor Dr Dr Dr: What do you mean this kind of regulation?
The Dame in question is a perfectly lovely woman with 3 honorary doctorates, 2 honorary professorships, and fellowships etc at four prestigious national bodies. What, then, reduces such an accomplished lady to such a degree of blankness?
what evidence is there that the regulation practised by CHRE and its ilk reduces real risk and increases true trust? What ground is there for supposing that the new modus operandi is actually achieving its much trumpeted aim?
Onora O'Neill's 2002 Reith Lectures happened to be close to hand, so I quoted a little to situate my concerns: some arguments against performance auditing are that it creates a huge administrative burden that damages delivery of service; that professional work cannot be measured in the same way as the financial health of a company; and, worst of all, these kinds of measures are misleading and can create perverse incentives.
Dame: The world has moved on since that was written.
Well, yes, it is 2009, but Onora O'Neill's points might as easily be seen to have grown in significance and pertinence, rather than to have conveniently faded away. Here's another quote "Our revolution in accountability has not reduced attitudes of mistrust, but rather reinforced a culture of suspicion. Instead of working towards intelligent accountability based on good governance, independent inspection and careful reporting, we are galloping towards central planning by performance indicators, reinforced by obsessions with blame and compensation. This is pretty miserable both for those who feel suspicious and for those who are suspected of untrustworthy action - sometimes with little evidence." (click here for link to OU + BBC page)
Dame: I don't think I agree with the basis of your question.
OK - it is true that anyone asking for 'evidence' these days is usually on the attack (as Onora O'Neill predicted). Lets try a different angle: "O'Neill is especially known for her universalist and cosmopolitan standpoint. She believes that institution building can specify and allocate obligations to the needy. They are to specify who is obliged to fulfill economic rights. O'Neill firmly holds that the institutions have to be made accountable. This can be done through new technologies that are ideal for achieving transparency and openness. Justice, according to her, means finding the means for the vulnerable to express legitimate consent.finding the means for the vulnerable to express legitimate consent." [quoted from 4to40 website, click for link]
A major stumbling block that separated us in that room was the idea that there was any other kind of Regulation. 'What kind of regulation', seemed to produce a hole in the fabric that threatened to pull everybody in. Is there another way to speak, a way that doesn't produce such a terrifying void? I am fond of thinking etymologically:
Regulation: "Regular 'according to a rule' is the most instantly recognizable English descendant of Latin regula 'rule' ... It goes back ultimately to the same Indo-European base as produced Latin regere 'rule' (source of rector, regent, etc) and rex 'king' (source of English regal, royal, etc). From it was derived the late Latin verb regulare, which has given English regulate [17] and may also lie behind rile 'annoy' [19], ..." quoted from John Ayto's remarkable Dictionary of Word Origins (Bloomsbury, 1990, p437)
Governing is not reducible to a universal set of principles. We knew that. So where has this wisdom gone? I think it is being murdered, murdered by the way we speak.
Wednesday, 4 March 2009
PLG C&P March 3rd meeting - day 2
What wasn't talked about yesterday: the threshold for entry onto the register. What wasn't talked about today: how to distinguish counsellors from psychotherapists.
What was talked about today was the number of voluntary registers that are known to exist (33 according to Sally Aldridge) and the traumatic effect this will have on the HPC. The Section 60 designates a legal date of transfer when a cd-rom is handed over, popped into a slot and dragged and dropped into a brand new folder. Usually there is one cd.
Here's a paragraph quoted from the web site of the Alliance for Counselling and Psychotherapy against State Regulation which introduces the problem:
"The therapeutic field is a rich and complex ecology, built up of many different approaches. This diversity is intrinsically valuable – since clients and their issues are equally varied – and is part of what we want to protect; however, from a regulatory point of view it is awkward and inconvenient, and needs to be ironed out. Good training helps the practitioner to develop their own unique style of work, rather than making them conform to a supposed ‘best practice’. The proposed regulation bids fair to flatten this rich ecology into a monoculture, with devastating consequences for the profession and for its clients."
The fact is that this profession is based on conversation, includes aspects of conversation that can't be put into words, and is a conversation that really must be made in private. You can see why the centralised planner might be uncomfortable with that.
Today someone suggested that the HPC would have to take this profession in 33 different registers. The room laughed, and Michael Guthrie spluttered, then said the Department of Health couldn't cope with that.
It occurred to me then that in swallowing this profession, the HPC might risk choking to death.
What was talked about today was the number of voluntary registers that are known to exist (33 according to Sally Aldridge) and the traumatic effect this will have on the HPC. The Section 60 designates a legal date of transfer when a cd-rom is handed over, popped into a slot and dragged and dropped into a brand new folder. Usually there is one cd.
Here's a paragraph quoted from the web site of the Alliance for Counselling and Psychotherapy against State Regulation which introduces the problem:
"The therapeutic field is a rich and complex ecology, built up of many different approaches. This diversity is intrinsically valuable – since clients and their issues are equally varied – and is part of what we want to protect; however, from a regulatory point of view it is awkward and inconvenient, and needs to be ironed out. Good training helps the practitioner to develop their own unique style of work, rather than making them conform to a supposed ‘best practice’. The proposed regulation bids fair to flatten this rich ecology into a monoculture, with devastating consequences for the profession and for its clients."
The fact is that this profession is based on conversation, includes aspects of conversation that can't be put into words, and is a conversation that really must be made in private. You can see why the centralised planner might be uncomfortable with that.
Today someone suggested that the HPC would have to take this profession in 33 different registers. The room laughed, and Michael Guthrie spluttered, then said the Department of Health couldn't cope with that.
It occurred to me then that in swallowing this profession, the HPC might risk choking to death.
More Regulation, Global Regulation
The news just now had poor old Gordon Brown wriggling on a hook about the economic collapse around the world. Gordon rightly said you need to diagnose the problem before you come up with the solution, then ignored his own advice by talking about robust regulation, strongest possible regulation, global regulation. He's right and also wrong. It all depends what you mean by regulation.
The idea of Popper's Nightmare is that this steady process of centralisation has been going on for years, the slow undermining of local practice and knowledge leads to a position where local knowledge and the structures that support it is destroyed. Technology plays a part in this, just as it plays a part in the re-animation. But, if you were the bloke in Central HQ facing an imminent election, and not terribly popular, you might not want to think about long term solutions to the crisis screaming in your face. BUT, a short term knee jerk increase in centralised power weilding (often what politicians mean by Robust Regulation, Strong Regulation, and Global Regulation) is going to make things worse. It keeps us locked into the nightmare.
Still, as this is likely to be the strategy, the rest of us need to think up some tactics. Humour, and humanity, theatre and maybe music, poetry perhaps. Antidotes to the boredom and lifelessness inflicted by the increasing administering of rules and their policing.
We should wish each other luck.
The idea of Popper's Nightmare is that this steady process of centralisation has been going on for years, the slow undermining of local practice and knowledge leads to a position where local knowledge and the structures that support it is destroyed. Technology plays a part in this, just as it plays a part in the re-animation. But, if you were the bloke in Central HQ facing an imminent election, and not terribly popular, you might not want to think about long term solutions to the crisis screaming in your face. BUT, a short term knee jerk increase in centralised power weilding (often what politicians mean by Robust Regulation, Strong Regulation, and Global Regulation) is going to make things worse. It keeps us locked into the nightmare.
Still, as this is likely to be the strategy, the rest of us need to think up some tactics. Humour, and humanity, theatre and maybe music, poetry perhaps. Antidotes to the boredom and lifelessness inflicted by the increasing administering of rules and their policing.
We should wish each other luck.
Tuesday, 3 March 2009
PLG C&P March 3rd meeting
18 uniformed officers were waiting at the gate of the station tonight when I returned from the 1st day of this 3rd meeting of the HPC PLG for C&P. 18 uniformed officers to check the validity of our train tickets. Such a concentration of power for such a silly job is a rather stark example of how out of balance stuff is in the UK today. Perhaps they are protecting the public from leaving the station quickly. 18 uniformed officers (half of them wearing padded flack jackets over already portly tummies) rather choke the little underpass to the street.
Meanwhile in a bland office in a back street near Elephant & Castle 11 non-representatives of the counselling and psychotherapy world met together with about 20 other people in order to say nothing of importance from 10.30am till 3.30pm. They will meet again tomorrow, and I can only hope that they manage to muster the courage to utter a coherent and definitive sentence between them at least once in the meeting.
To be fair, two or three people did make valiant attempts to keep it real, but they were swimming against a tide of platitudes, point scoring and polite snipes.
The 11 non-representatives from the world of counselling and psychotherapy were selected by Diane Waller (an arts psychotherapist) in conversation with Anna van der Gaag (a speech and language therapist) and Michael Guthrie (an administrator). There had been 40 or so applications, some from individuals, some from organisations. A little list of criteria had been written down and Di, Anna and Michael made their longer list with this. Since then, they have been bombarded with emails and letters and visits about the non-representative nature of the 11 they selected. Today, at the opening of the meeting Diane Waller set out to make a statement. She wanted to set the record straight: the 11 non-hpc people round the table should know that they had not been selected to represent their particular group, but were simply there to ... err, to, well, the only specific thing I heard her say was to hold onto Wales as an idea (because not one amongst them was Welsh).
This is just one example of the mad rules that the group are supposed to abide by. How can Sally Aldridge not represent the BACP? She is their paid Director on precisely this question. They have several thousand members. If she has anything sensible to say, it would be from her experience in that job. Surely she should restrict herself to this, not exclude herself. She should inform the rest of the group about the real practical issues at stake in transferring this particular membership onto the HPC register - this is her specialist subject. What about Mick Cooper? He is a professor of counselling (a relatively new breed of professor, the evolution of which would be very interesting to track) from Strathclyde University. He does not represent the University. So he can speak from a different position, and people can hear him in his capacity of intellectual and scholar, or whatever indeed he is. Peter Fonagy? He is there under the auspice of the Skills for Health - he can restrict himself to talking about the National Operating Standards that are his responsibility to coordinate. Each member of the group has a specific position from which they can speak authoritatively, what's the problem? They have been chosen according to those criteria, haven't they? So why does Diane begin today's meeting by describing the rationality of their selection, then forbidding them to be precisely that? She ended her little lecture by strongly emphasising that those 11 non-representatives should Reinforce and Remind people of their non-representativeness, 'that would be helpful' she said.
Mad.
Difficult questions get parked, reparked and parked again. Topics are constantly left for another day. Another day? There are only 4 days left for this group of people to come up with something that is destined to be turned into law. LAW. Do we need any more laws in this country? There are already more laws than Parliament knows what to do with, and a handful of politicians at Saturday's Convention on Modern Liberty were even pledging to repeal dozens at a time. What is the point of turning this mess into a legal document? The field we know as counselling and psychotherapy is so diverse, so rooted in relationships and places, so firmly fixed amongst ordinary people that the wish to legislate it into a neat standardised package should rather be written into next DSM as a sectionable mental illness.
It is so difficult to sit silently watching this process. It feels like being forced to watch a child being drowned, and forbidden even from throwing a rope.
It is extremely difficult to report on anything of substance. Nothing of substance emerged. However, two things are worth passing on. In the moments before the meeting started this morning one of the HPC lay members on the PLG suddenly came over to show us a CHRE document. This was one of the documents that teach doctors not to have sex with their patients. This document was offered to us in answer to the question raised at the last meeting about the source of the data that Fonagy and Jon Coe were trumpeting that 5% of C&P practitioners constitute a real and present danger. Here is a great example of the real trouble that this group has. A group of eminent and intelligent people are unable to think clearly in this process. We were offered this document as the evidence that 5% of therapists and counsellors were dangerous. I thought she meant that the reference to the paper that produced the statistic would be in there. But no. What was there was the fact that some doctors have sex with or marry their patients. This is absolutely barmy. Well meant, but barmy.
The second notable moment came at lunch time: three of us 'public' were eating lunch together when one of the 11 non-representatives came and sat down beside us. She asked us for our advice - what would we say if it were us who had landed at that powerful table? This was a real live thinking human being and it was a massive relief to discover it. So what would we say? Keep it Real. And she did - after lunch she tried and tried and tried again to keep reality in the picture. I'm not talking about anecdotes - she was furnishing the meeting with real information about things that she knows about, that are actually happening out there. What a relief. I'm going to start a collection to raise a statue for her if she carries on like this.
Meanwhile in a bland office in a back street near Elephant & Castle 11 non-representatives of the counselling and psychotherapy world met together with about 20 other people in order to say nothing of importance from 10.30am till 3.30pm. They will meet again tomorrow, and I can only hope that they manage to muster the courage to utter a coherent and definitive sentence between them at least once in the meeting.
To be fair, two or three people did make valiant attempts to keep it real, but they were swimming against a tide of platitudes, point scoring and polite snipes.
The 11 non-representatives from the world of counselling and psychotherapy were selected by Diane Waller (an arts psychotherapist) in conversation with Anna van der Gaag (a speech and language therapist) and Michael Guthrie (an administrator). There had been 40 or so applications, some from individuals, some from organisations. A little list of criteria had been written down and Di, Anna and Michael made their longer list with this. Since then, they have been bombarded with emails and letters and visits about the non-representative nature of the 11 they selected. Today, at the opening of the meeting Diane Waller set out to make a statement. She wanted to set the record straight: the 11 non-hpc people round the table should know that they had not been selected to represent their particular group, but were simply there to ... err, to, well, the only specific thing I heard her say was to hold onto Wales as an idea (because not one amongst them was Welsh).
This is just one example of the mad rules that the group are supposed to abide by. How can Sally Aldridge not represent the BACP? She is their paid Director on precisely this question. They have several thousand members. If she has anything sensible to say, it would be from her experience in that job. Surely she should restrict herself to this, not exclude herself. She should inform the rest of the group about the real practical issues at stake in transferring this particular membership onto the HPC register - this is her specialist subject. What about Mick Cooper? He is a professor of counselling (a relatively new breed of professor, the evolution of which would be very interesting to track) from Strathclyde University. He does not represent the University. So he can speak from a different position, and people can hear him in his capacity of intellectual and scholar, or whatever indeed he is. Peter Fonagy? He is there under the auspice of the Skills for Health - he can restrict himself to talking about the National Operating Standards that are his responsibility to coordinate. Each member of the group has a specific position from which they can speak authoritatively, what's the problem? They have been chosen according to those criteria, haven't they? So why does Diane begin today's meeting by describing the rationality of their selection, then forbidding them to be precisely that? She ended her little lecture by strongly emphasising that those 11 non-representatives should Reinforce and Remind people of their non-representativeness, 'that would be helpful' she said.
Mad.
Difficult questions get parked, reparked and parked again. Topics are constantly left for another day. Another day? There are only 4 days left for this group of people to come up with something that is destined to be turned into law. LAW. Do we need any more laws in this country? There are already more laws than Parliament knows what to do with, and a handful of politicians at Saturday's Convention on Modern Liberty were even pledging to repeal dozens at a time. What is the point of turning this mess into a legal document? The field we know as counselling and psychotherapy is so diverse, so rooted in relationships and places, so firmly fixed amongst ordinary people that the wish to legislate it into a neat standardised package should rather be written into next DSM as a sectionable mental illness.
It is so difficult to sit silently watching this process. It feels like being forced to watch a child being drowned, and forbidden even from throwing a rope.
It is extremely difficult to report on anything of substance. Nothing of substance emerged. However, two things are worth passing on. In the moments before the meeting started this morning one of the HPC lay members on the PLG suddenly came over to show us a CHRE document. This was one of the documents that teach doctors not to have sex with their patients. This document was offered to us in answer to the question raised at the last meeting about the source of the data that Fonagy and Jon Coe were trumpeting that 5% of C&P practitioners constitute a real and present danger. Here is a great example of the real trouble that this group has. A group of eminent and intelligent people are unable to think clearly in this process. We were offered this document as the evidence that 5% of therapists and counsellors were dangerous. I thought she meant that the reference to the paper that produced the statistic would be in there. But no. What was there was the fact that some doctors have sex with or marry their patients. This is absolutely barmy. Well meant, but barmy.
The second notable moment came at lunch time: three of us 'public' were eating lunch together when one of the 11 non-representatives came and sat down beside us. She asked us for our advice - what would we say if it were us who had landed at that powerful table? This was a real live thinking human being and it was a massive relief to discover it. So what would we say? Keep it Real. And she did - after lunch she tried and tried and tried again to keep reality in the picture. I'm not talking about anecdotes - she was furnishing the meeting with real information about things that she knows about, that are actually happening out there. What a relief. I'm going to start a collection to raise a statue for her if she carries on like this.
Sunday, 1 March 2009
Recalling the Call for Ideas (October 2008): What do the British Want? not all
In the preparation period leading up to the sumbission of ideas to the HPC last autumn, this comment was made by Dr Richard Klein. It's a beautiful piece of writing: enigmatic, rhythmic, wise.
"The specular image of the mirror stage is the banal instrument that keeps us in the scene, that keeps us where we like to be, and that protects us from the world. The scene, of course, is imaginary - it is dominated by the image, and it introduces inertia into our mind.
"Politicians use it for electioneering purposes, or for moral goals. In psychoanalysis, we call this goal an ego ideal. Our political leaders embrace this ideal quite frequently - if not all the time. If you want to call a network of signifiers out of which come rules, regulations and laws - if you want to call that the symbolic, you would be following Lacan a little bit. The neo-labour politician speaks at the level of the ego ideal in order to shore up what he or she perceives to be unravelling and in order to ensure its citizens protection from all sorts of criminals.
"He promises from the point of the ideal to keep all “his people” (usually an American politician that uses this expression) safely in the scene, offering them protection from the world. For instance, Britishness is perceived to be unravelling. It has become an ego ideal that does not keep enough people in the scene anymore. We hear the signifier “British” uttered with increasing frequency and desperateness by our political leaders. It’s not only Europe that the British don’t want. The British don’t even want Britain. Freud’s famous question has never been answered. What does the woman want? Our politicians have to cope with a question that produces an even greater enigma that Freud’s: What do the British want?
"Life is difficult for a politician in this country. The ideal signifiers have weakened. Moreover, I am not too sure what the world is from which I need political protection. I think it is probably the atmosphere which is wearing out as an effect of whatever is falling out of the scene: storms, volcanoes, earthquakes, tsunamis, oceans, mountains, animal life, drains and sewers to catch what is falling out of the scene. None of this fits very well into the categories of the symbolic and the imaginary.
"But there is still one trick left to symbolise the world: we can’t have God without a plague of locusts. We can’t have the Father without real effects.
"These very politicians who do not know what the British want, now invite us to provide them with some ideas about what we want. "you tell us how we can protect everyone from the world. We are reasonable people. We will play with your ideas." this invitation is no more and no less an attempt to demonstrate to the world that our government runs on reason from the Scottish Enlightenment.
"What does the psychoanalyst want? Not all. That's what the psychoanalysts want. We must confront the government with that same enigma; the one that the woman confronts Freud with, and as it turns out, the one that the British do too. Not all."
"The specular image of the mirror stage is the banal instrument that keeps us in the scene, that keeps us where we like to be, and that protects us from the world. The scene, of course, is imaginary - it is dominated by the image, and it introduces inertia into our mind.
"Politicians use it for electioneering purposes, or for moral goals. In psychoanalysis, we call this goal an ego ideal. Our political leaders embrace this ideal quite frequently - if not all the time. If you want to call a network of signifiers out of which come rules, regulations and laws - if you want to call that the symbolic, you would be following Lacan a little bit. The neo-labour politician speaks at the level of the ego ideal in order to shore up what he or she perceives to be unravelling and in order to ensure its citizens protection from all sorts of criminals.
"He promises from the point of the ideal to keep all “his people” (usually an American politician that uses this expression) safely in the scene, offering them protection from the world. For instance, Britishness is perceived to be unravelling. It has become an ego ideal that does not keep enough people in the scene anymore. We hear the signifier “British” uttered with increasing frequency and desperateness by our political leaders. It’s not only Europe that the British don’t want. The British don’t even want Britain. Freud’s famous question has never been answered. What does the woman want? Our politicians have to cope with a question that produces an even greater enigma that Freud’s: What do the British want?
"Life is difficult for a politician in this country. The ideal signifiers have weakened. Moreover, I am not too sure what the world is from which I need political protection. I think it is probably the atmosphere which is wearing out as an effect of whatever is falling out of the scene: storms, volcanoes, earthquakes, tsunamis, oceans, mountains, animal life, drains and sewers to catch what is falling out of the scene. None of this fits very well into the categories of the symbolic and the imaginary.
"But there is still one trick left to symbolise the world: we can’t have God without a plague of locusts. We can’t have the Father without real effects.
"These very politicians who do not know what the British want, now invite us to provide them with some ideas about what we want. "you tell us how we can protect everyone from the world. We are reasonable people. We will play with your ideas." this invitation is no more and no less an attempt to demonstrate to the world that our government runs on reason from the Scottish Enlightenment.
"What does the psychoanalyst want? Not all. That's what the psychoanalysts want. We must confront the government with that same enigma; the one that the woman confronts Freud with, and as it turns out, the one that the British do too. Not all."
College of Psychoanalysts meet CE Marc Seale, Michael Guthrie and PLG chair Diane Waller
This interesting report is published on the website of the College of Psychoanalysts-uk. Click the heading to be redirected
The College of Psychoanalysts-UK meeting with HPC 27.2.08
Darian Leader and Andrew Hodgkiss met with Diane Waller, Michael Guthrie and Marc Seale.
We started by bringing up the claim made at the last PLG meeting that therapists pose a public threat, with their figure being 5%. Seale and Waller admitted that they had no hard data on this, and that their only statistics came from Witness and Fonagy, not based on any published studies, and that HPC had done no research themselves. So, we put it to them that this was anecdotal, reminding them that the Washington State discussion of therapy had insisted that claims about threatened public harm could not be based on tenuous argument or anecdotal evidence. Seale said that the "proof" was that all professions regulated by HPC showed 1.8-2% malpractice. This is the figure then to be expected from the therapies. We pointed out that this was circular and could be an artefact of the HPC framework itself. Social scientists, we suggested, could not take such an argument seriously. Seale said "I don't know what a social scientist is".
There was a discussion of the alleged threat of harmful practitioners, and we asked why, if public protection was the key variable for HPC, they were not pursuing protection of function rather than protection of title. What was the logic behind this? Seale indicated that in the place of protection of function there would be a campaign aiming at public education, presumably with the message that only HPC practitioners were to be trusted.
There followed a long discussion about healthcare and why many practitioners could not situate themselves beneath this rubric. AH contrasted his work as an NHS psychiatrist with his work as an analyst. We tried to explain how many analysts and therapists do not buy into the ideology of health, happiness and well-being or the idea of expertise. Waller could not accept this, saying that there is a shared common view of health and well-being today, different from the old medical model. We went through parts of the HPC booklet 'Standards of Conduct, Performance and Ethics', pointing out how most of them were not compatible with analytic work and many forms of therapeutic work, and Waller seemed to recognise this. Examples included clear communication to a patient, contrasted with a traditional analyst's silence, and the obtaining of prior informed consent, when in analytic work and many forms of therapy the unknown outcomes make this problematic.
We explained the position of the practitioner as object of projections, with clinical examples and emphasised the open-ended nature and unpredictability of the work. Waller felt that anyone going for 'treatment' had to know what to expect - "They have to know the likely outcome", "You wouldn't enter into a relationship without knowing in advance what was going to happen" - but then admitted soon afterwards that "we don't know what's going to happen" in a therapy and that "the patient's expectations cannot be met".
We expressed concern that in the current HPC documentation re proposed generic standards for psychotherapy, there was frequent reference to evidence-based practice. The practitioner, according to HPC, must be aware of "what is known". We questioned the conceptual basis of this appeal to a given, and Waller admitted that the multiple orientations in the field left little room for consensus. Seale added that if a complaint were brought against, say a Kleinian, there would be at least one Kleinian on the panel hearing the complaint.
We discussed at length the HPC sanitised image of the practitioner and explained why this had little to do with the recognition of human weakness and failing involved in our work. We discussed clinical examples, and there was a slight tension and disagreement between Waller and Seale. We emphasised that we do not aim at 'good personal conduct', which seemed to surprise Seale, although these arguments had often been made in prior correspondence with HPC.
Waller was open to rational argument, and would concede points, but Seale appeared unable to. There was a moment in the meeting when it seemed finally we had got through and that they could see that many people just didn't offer healthcare with set outcomes. But Seale couldn't accept this. At one point he divulged that the current complementary medicine division between state registered and voluntary registered practitioners - which was mentioned in the discussion as being a possible structure for therapists - would be destroyed in three years, when a major public advertising campaign would begin to discredit those on the voluntary register. Later in the meeting, when the possibility of a separate list of non-HPC practitioners was returned to, he said that a couple of years after HPC regulation, they would launch a media campaign to discredit them too, with the message 'Don't use these people'. We observed that this would create a lot of protest, and Seale replied - with glee - that "We can afford a better advertising agency than them". When DL took up the 'Don't use these people' at the end of the meeting, he tried to avoid the issue.
At the end of the meeting, Seale came back to the question - what details would you want changed so you will go on the register? He is really anxious just to get on with it and close the case. We asked them 'Who would you trust - someone who is willing to be prosecuted for upholding the ethics of their work or someone who seeks primarily status and credibility?'. Waller of course indicated the former, while Seale said 'I don't understand the question'. We reminded them that the very first point of the 'HPC Guidance for Occupations Considering Applying for Regulation by the HPC' is that "The occupation must cover a discrete area of activity displaying some homogeneity' and this was clearly not the case. Seale now made it clear - probably despite himself - that if a practitioner receives money from a member of the public and does not offer a predictable healthcare outcome, they just shouldn't be allowed to practise. Such practices would presumably constitute exploitation. For him, even if he could recognise the difference between orientations, he seems firmly opposed to letting the forms of non-healthcare therapy continue in modern society. So, a far stronger position than that claimed up till now publicly by HPC.
The College of Psychoanalysts-UK meeting with HPC 27.2.08
Darian Leader and Andrew Hodgkiss met with Diane Waller, Michael Guthrie and Marc Seale.
We started by bringing up the claim made at the last PLG meeting that therapists pose a public threat, with their figure being 5%. Seale and Waller admitted that they had no hard data on this, and that their only statistics came from Witness and Fonagy, not based on any published studies, and that HPC had done no research themselves. So, we put it to them that this was anecdotal, reminding them that the Washington State discussion of therapy had insisted that claims about threatened public harm could not be based on tenuous argument or anecdotal evidence. Seale said that the "proof" was that all professions regulated by HPC showed 1.8-2% malpractice. This is the figure then to be expected from the therapies. We pointed out that this was circular and could be an artefact of the HPC framework itself. Social scientists, we suggested, could not take such an argument seriously. Seale said "I don't know what a social scientist is".
There was a discussion of the alleged threat of harmful practitioners, and we asked why, if public protection was the key variable for HPC, they were not pursuing protection of function rather than protection of title. What was the logic behind this? Seale indicated that in the place of protection of function there would be a campaign aiming at public education, presumably with the message that only HPC practitioners were to be trusted.
There followed a long discussion about healthcare and why many practitioners could not situate themselves beneath this rubric. AH contrasted his work as an NHS psychiatrist with his work as an analyst. We tried to explain how many analysts and therapists do not buy into the ideology of health, happiness and well-being or the idea of expertise. Waller could not accept this, saying that there is a shared common view of health and well-being today, different from the old medical model. We went through parts of the HPC booklet 'Standards of Conduct, Performance and Ethics', pointing out how most of them were not compatible with analytic work and many forms of therapeutic work, and Waller seemed to recognise this. Examples included clear communication to a patient, contrasted with a traditional analyst's silence, and the obtaining of prior informed consent, when in analytic work and many forms of therapy the unknown outcomes make this problematic.
We explained the position of the practitioner as object of projections, with clinical examples and emphasised the open-ended nature and unpredictability of the work. Waller felt that anyone going for 'treatment' had to know what to expect - "They have to know the likely outcome", "You wouldn't enter into a relationship without knowing in advance what was going to happen" - but then admitted soon afterwards that "we don't know what's going to happen" in a therapy and that "the patient's expectations cannot be met".
We expressed concern that in the current HPC documentation re proposed generic standards for psychotherapy, there was frequent reference to evidence-based practice. The practitioner, according to HPC, must be aware of "what is known". We questioned the conceptual basis of this appeal to a given, and Waller admitted that the multiple orientations in the field left little room for consensus. Seale added that if a complaint were brought against, say a Kleinian, there would be at least one Kleinian on the panel hearing the complaint.
We discussed at length the HPC sanitised image of the practitioner and explained why this had little to do with the recognition of human weakness and failing involved in our work. We discussed clinical examples, and there was a slight tension and disagreement between Waller and Seale. We emphasised that we do not aim at 'good personal conduct', which seemed to surprise Seale, although these arguments had often been made in prior correspondence with HPC.
Waller was open to rational argument, and would concede points, but Seale appeared unable to. There was a moment in the meeting when it seemed finally we had got through and that they could see that many people just didn't offer healthcare with set outcomes. But Seale couldn't accept this. At one point he divulged that the current complementary medicine division between state registered and voluntary registered practitioners - which was mentioned in the discussion as being a possible structure for therapists - would be destroyed in three years, when a major public advertising campaign would begin to discredit those on the voluntary register. Later in the meeting, when the possibility of a separate list of non-HPC practitioners was returned to, he said that a couple of years after HPC regulation, they would launch a media campaign to discredit them too, with the message 'Don't use these people'. We observed that this would create a lot of protest, and Seale replied - with glee - that "We can afford a better advertising agency than them". When DL took up the 'Don't use these people' at the end of the meeting, he tried to avoid the issue.
At the end of the meeting, Seale came back to the question - what details would you want changed so you will go on the register? He is really anxious just to get on with it and close the case. We asked them 'Who would you trust - someone who is willing to be prosecuted for upholding the ethics of their work or someone who seeks primarily status and credibility?'. Waller of course indicated the former, while Seale said 'I don't understand the question'. We reminded them that the very first point of the 'HPC Guidance for Occupations Considering Applying for Regulation by the HPC' is that "The occupation must cover a discrete area of activity displaying some homogeneity' and this was clearly not the case. Seale now made it clear - probably despite himself - that if a practitioner receives money from a member of the public and does not offer a predictable healthcare outcome, they just shouldn't be allowed to practise. Such practices would presumably constitute exploitation. For him, even if he could recognise the difference between orientations, he seems firmly opposed to letting the forms of non-healthcare therapy continue in modern society. So, a far stronger position than that claimed up till now publicly by HPC.
Philip Pullman and Fergal Sharkey at the Convention on Modern Liberty
Yesterday was the Convention on Modern Liberty - an extraordinary thing that happened in many cities in the UK and that brought together a very mixed bag of Brits. Lucky enough to live in London I was able to get a seat to see Philip Pullman deliver his 10 minutes worth of political poetry. He spoke from the heart - literally a voice of courage, speaking of courage: to act kindly, with good judgement, thinking of the long term, and not afraid of headlines in the Daily Mail. He said many memorable things:
"Joy does not flourish in the garden of anxiety."
"Acquiring modesty would give a proper sense of position in this world and remove the self-importance of politicians who think they are fighting an extensional war to defend western civilisation, when they are actually throwing their weight about behind the bike shed like playground bullies."
"When there came a threat from external nations a courageous nation would take a clear look at the danger and take realistic steps to avert it not take up a machine gun to defend itself against a wasp."
and most delightful of all:
"A modest Kingdom would have to think for a moment whether or not it was a republic, because its Royal family would be small and its members would be allowed to spend most their time in interesting careers as well as being Royal, their love affairs would remain their own business and people would always be glad to see them cycling past."
At the end of the day a small panel of writers and artists addressed those remaining. Fergal Sharkey was amongst the speakers, he is now Chief Exec of UK Music. He read out a clause from the Licensing Act 2003 which requires venues to fill in form 696 (or 57, or something) which insists on a risk assessment for any forthcoming performance of belly dancing, or live music etc. Two things stuck in my mind: first, the form required that names and addresses and other personal details of all of the performers be submitted to authorities two weeks in advance of the act. The second thing is that this law was passed into the practice of the majority of London Borough Councils seemingly without close scrutiny. Sharkey is now writing to various Councils asking them what on earth they think they are doing. His letters so far have received no reply.
I thought that his work exemplified the kind of courage Pullman calls for, once adored as a popular singer, he doesn't shirk from doing mundane work - reading through pages of legal documents, and following up the consequences and their preconditions. I think this way turns blunt acts of power into situated stories and re-introduces joy into a garden that might otherwise be overrun by anxiety. Inspiration, really.
"Joy does not flourish in the garden of anxiety."
"Acquiring modesty would give a proper sense of position in this world and remove the self-importance of politicians who think they are fighting an extensional war to defend western civilisation, when they are actually throwing their weight about behind the bike shed like playground bullies."
"When there came a threat from external nations a courageous nation would take a clear look at the danger and take realistic steps to avert it not take up a machine gun to defend itself against a wasp."
and most delightful of all:
"A modest Kingdom would have to think for a moment whether or not it was a republic, because its Royal family would be small and its members would be allowed to spend most their time in interesting careers as well as being Royal, their love affairs would remain their own business and people would always be glad to see them cycling past."
At the end of the day a small panel of writers and artists addressed those remaining. Fergal Sharkey was amongst the speakers, he is now Chief Exec of UK Music. He read out a clause from the Licensing Act 2003 which requires venues to fill in form 696 (or 57, or something) which insists on a risk assessment for any forthcoming performance of belly dancing, or live music etc. Two things stuck in my mind: first, the form required that names and addresses and other personal details of all of the performers be submitted to authorities two weeks in advance of the act. The second thing is that this law was passed into the practice of the majority of London Borough Councils seemingly without close scrutiny. Sharkey is now writing to various Councils asking them what on earth they think they are doing. His letters so far have received no reply.
I thought that his work exemplified the kind of courage Pullman calls for, once adored as a popular singer, he doesn't shirk from doing mundane work - reading through pages of legal documents, and following up the consequences and their preconditions. I think this way turns blunt acts of power into situated stories and re-introduces joy into a garden that might otherwise be overrun by anxiety. Inspiration, really.
Thursday, 26 February 2009
March 3/4: PLG C&P 3rd meeting. Preparation
The Professional Liaison Group for Counselling and Psychotherapy is due to meet for the third time (3rd and 4th of March). There are 320 pages of reading in preparation for this meeting, all down-loadable from the HPC-uk.org website.
The (draft) minutes for the last meeting continue to refer repeatedly to The Group, and avoid being specific about what different people say at certain times (see blogs preparing for January meeting). The minutes give the overall impression of a set of people who are all of one mind, and who constantly agree with one another as they note this, receive that, and feel or discuss the other.
After the last meeting, I took the trouble to note down specifics that were said by particular people in a short spat that was unusually energetic. Eg, after coffee, before lunch, on day two, when the meeting considered the section of a report summarising responses to the call for ideas (in 7 lines of text) under the title point "3.2.2 Conscientious objection" (p37).
If you check the blog entry you will see several different responses to this question, which represented several different positions and some misunderstandings. You will also notice that a level of aggression was expressed which led some people to remind their colleagues to respect the positions of those who did not agree with them. These comments seem to have fallen onto the deaf ears of the minute taker (p5). Instead, he takes the opportunity to blandly restate the ideological position of the HPC before misrepresenting those with other opinions and then dismissing the point and throwing doubt on the intellectual ability of those oponents.
It was Annie Turner, Occupational Therapist Panel member of the HPC, and who said 'these people can't have their cake and eat it', which been translated by the minute taker into: the Group questioned why 'conscientious objectors' to statutory regulation [sic] would wish to be included on a list maintained by a statutory regulator and if the individuals concerned would be prepared to be subject to the HPC's processes and procedures.
One of the most persistent comments made by those with a different opinion to that of the HPC is that they are simply not heard (eg see the letter from IPN members, blogged on 10 Feb). The process of HPC-ification is not one of conversation, nor even that of debate. No doubt discussions at such a centralised level can tend to drift into vague generalisations - a few people have been asked to consider a lot of diversity in very little time. But why present a false front - what can be gained from this masquerade?
The HPC 'call for ideas' produced hundreds of pages of response. These were reduced to a 36 page document for consideration at the curtailed first meeting (enclosure 1, 4 Dec). One of these pages contained a bit more detail of the matter and clearly shows there was no intention of anyone to smuggle themslves onto the HPC register. Instead, it was suggested that another register would be drawn up. Bear in mind that the HPC notoriously state on their 'Road Map' to regulation Counselling and Pscyotherapy (Council Meeting, 13 Dec 2007, accessible if you click this link) that anyone not on the HPC register is a lesser human being:
The (draft) minutes for the last meeting continue to refer repeatedly to The Group, and avoid being specific about what different people say at certain times (see blogs preparing for January meeting). The minutes give the overall impression of a set of people who are all of one mind, and who constantly agree with one another as they note this, receive that, and feel or discuss the other.
After the last meeting, I took the trouble to note down specifics that were said by particular people in a short spat that was unusually energetic. Eg, after coffee, before lunch, on day two, when the meeting considered the section of a report summarising responses to the call for ideas (in 7 lines of text) under the title point "3.2.2 Conscientious objection" (p37).
If you check the blog entry you will see several different responses to this question, which represented several different positions and some misunderstandings. You will also notice that a level of aggression was expressed which led some people to remind their colleagues to respect the positions of those who did not agree with them. These comments seem to have fallen onto the deaf ears of the minute taker (p5). Instead, he takes the opportunity to blandly restate the ideological position of the HPC before misrepresenting those with other opinions and then dismissing the point and throwing doubt on the intellectual ability of those oponents.
It was Annie Turner, Occupational Therapist Panel member of the HPC, and who said 'these people can't have their cake and eat it', which been translated by the minute taker into: the Group questioned why 'conscientious objectors' to statutory regulation [sic] would wish to be included on a list maintained by a statutory regulator and if the individuals concerned would be prepared to be subject to the HPC's processes and procedures.
One of the most persistent comments made by those with a different opinion to that of the HPC is that they are simply not heard (eg see the letter from IPN members, blogged on 10 Feb). The process of HPC-ification is not one of conversation, nor even that of debate. No doubt discussions at such a centralised level can tend to drift into vague generalisations - a few people have been asked to consider a lot of diversity in very little time. But why present a false front - what can be gained from this masquerade?
The HPC 'call for ideas' produced hundreds of pages of response. These were reduced to a 36 page document for consideration at the curtailed first meeting (enclosure 1, 4 Dec). One of these pages contained a bit more detail of the matter and clearly shows there was no intention of anyone to smuggle themslves onto the HPC register. Instead, it was suggested that another register would be drawn up. Bear in mind that the HPC notoriously state on their 'Road Map' to regulation Counselling and Pscyotherapy (Council Meeting, 13 Dec 2007, accessible if you click this link) that anyone not on the HPC register is a lesser human being:
"It should be noted that whilst there are many who will welcome [HPC regulation] there might be "a small but vocal minority of individuals and organisations who may want to avoid [HPC regulation] for a variety of reasons." which include: those who are unable to meet competence standards and ethical standards; or who are reluctant to pay the registration fees. The HPC has made a pre-emptive rhetorical strike by labelling those who don't agree with it as incompetent, unethical, and miserly.
This should help Annie Turner to understand why some people might want to construct a list outside the HPC - in order to dispell the negative image created by the HPC.
Friday, 20 February 2009
Sally Aldridge, BACP Head of Regulatory Policy. Therapy Today
In this month's BACP magazine "Therapy Today" Sally Aldridge writes:
"The decision to regulate counselors and psychotherapists through the HPC is a government one as laid out in the White Paper Trust, Assurance and Safety. "
She goes on to say that although other professional organisations have disputed whether the HPC is an appropriate regulator, the BACP is going along with it because the government has signalled its clear intention to go ahead with the process.
When the HPC first arrived on the scene it launched an advertising campaign which was insulting and not a little sinister. It depicted a variety of health professions (all of them were white, interestingly) each of whom looked like a bad joke, wearing a ridiculous mask. The strap lines were all about the way that people pretend to be other than what they are. The implication was clear enough: a lot of professionals lie. (Four of these adverts have been framed as large pictures and are displayed in the corridor at the HPC; I have commented on them in detail in 19th November blog "Struck Off".)
In the minutes of the Professional Liaison Group for Counselling and Psychotherapy at the HPC there is frequent mention of something called statutory regulation. Back in the late 1990s there was an attempt by Lord Alderdice to introduce statutory regulation for psychotherapy. It was his idea, his Bill, and he sought to bring it before parliament. This is an example of statutory regulation. It was thrown out.
State regulation, on the other hand, is when a government itself says that it must happen, and exerts its power on the nature and manner of that regulation.
It is pretty clear from Sally Aldridge's statement here that she believes that this current process is State Regulation: it is written in a Government's White Paper, a clear intention that the Government wants it done, she says.
Sally notes that other organisations dispute the appropriateness of the proposed regulation. I suppose she is aware that this country has a tradition of democracy, and that even if Government states its intention, it is not necessary (nor the custom) for the population to roll over and help them to carry it out, especially if it thinks this will create more problems than it hopes to solve. Good democratic systems rely on the thoughtful actions of its people.
What is at stake here is straightforward talking. You cannot both say that this is statutory regulation and that it has to be done because the Government insists. This recalls the phrase in the first PLG meeting when the Chair said 'if we don't do it to ourselves, the government will do it to us'. It is worth asking how the Government is forcing the BACP to do it to themselves - there is speculation about the benefits to be gained by the structures of institutional power, and a different set of questions related to who will be suffering from the consequences of such a manoeuvre. What is chilling is the lack of proper consideration to the different voices in this 'debate', and the way that those who may wield institutional power don't hesitate to use all kinds of blunt political manoeuvring to throw other people's arguments into bad light.
Surely if people think that something is wrong, and that there is a strong possibility that damage will ensue, then those people have a duty to stand up and say 'hang on a minute', even if they find it difficult simply to say NO.
At the end of Sally's statement she says that "Much of the opposition to statutory regulation [sic] in the HPC in letters to Therapy Today focuses on the nature of the process with terms such as ‘bureaucratic and statistically managed’, ‘cultures of surveillance’, ‘the stress of monitoring and assessment’, ‘role bound rather than ethical’."
She notices that there is a consistency in the concern voiced by people in relation to the proposed State Regulation. She goes on, however, to make the following interesting statement: "the HPC requirements of registration ... do not differ greatly from those of BACP"
This raises a series of questions the most obvious of which is, if the HPC system is not much different from the BACP then how will it improve things, exactly?
But I don't want to get side tracked. The main point is this: saying that the HPC is almost the same as the BACP is a slippery rhetorical device. The HPC is not the same as the BACP, it is different in quite specific and deliberate ways. At this point someone might call for "Evidence?", and ask what frame of reference she is using.
What a lot of people are saying is that the basis of truth is slipping away, and politics and bureaucracy are creeping into its place. The usual conventions of knowledge and debate that allow one to know more or less what someone is saying have receded from the scene, and more and more we are faced with blunt wielding of power through banal and empty phrases. This is not something many of us are used to in this country. If we haven't found neat ways of conveying this to the satisfaction of Sally Aldridge, well sorry; if we sound alarmed, well we are right to be. When truth is under attack all speech and writing becomes subject to question. This is why those in positions of authority, ie those in bureaucratic systems of power, have even more of a responsibility to speak sensibly, carefully, and as far as they are able, truthfully. If they find that the subject is beyond their comprehension, they should pause and think, and get some good advice. If you were the Head of Regulatory Policy, this responsibility would fall on you.
"The decision to regulate counselors and psychotherapists through the HPC is a government one as laid out in the White Paper Trust, Assurance and Safety. "
She goes on to say that although other professional organisations have disputed whether the HPC is an appropriate regulator, the BACP is going along with it because the government has signalled its clear intention to go ahead with the process.
When the HPC first arrived on the scene it launched an advertising campaign which was insulting and not a little sinister. It depicted a variety of health professions (all of them were white, interestingly) each of whom looked like a bad joke, wearing a ridiculous mask. The strap lines were all about the way that people pretend to be other than what they are. The implication was clear enough: a lot of professionals lie. (Four of these adverts have been framed as large pictures and are displayed in the corridor at the HPC; I have commented on them in detail in 19th November blog "Struck Off".)
In the minutes of the Professional Liaison Group for Counselling and Psychotherapy at the HPC there is frequent mention of something called statutory regulation. Back in the late 1990s there was an attempt by Lord Alderdice to introduce statutory regulation for psychotherapy. It was his idea, his Bill, and he sought to bring it before parliament. This is an example of statutory regulation. It was thrown out.
State regulation, on the other hand, is when a government itself says that it must happen, and exerts its power on the nature and manner of that regulation.
It is pretty clear from Sally Aldridge's statement here that she believes that this current process is State Regulation: it is written in a Government's White Paper, a clear intention that the Government wants it done, she says.
Sally notes that other organisations dispute the appropriateness of the proposed regulation. I suppose she is aware that this country has a tradition of democracy, and that even if Government states its intention, it is not necessary (nor the custom) for the population to roll over and help them to carry it out, especially if it thinks this will create more problems than it hopes to solve. Good democratic systems rely on the thoughtful actions of its people.
What is at stake here is straightforward talking. You cannot both say that this is statutory regulation and that it has to be done because the Government insists. This recalls the phrase in the first PLG meeting when the Chair said 'if we don't do it to ourselves, the government will do it to us'. It is worth asking how the Government is forcing the BACP to do it to themselves - there is speculation about the benefits to be gained by the structures of institutional power, and a different set of questions related to who will be suffering from the consequences of such a manoeuvre. What is chilling is the lack of proper consideration to the different voices in this 'debate', and the way that those who may wield institutional power don't hesitate to use all kinds of blunt political manoeuvring to throw other people's arguments into bad light.
Surely if people think that something is wrong, and that there is a strong possibility that damage will ensue, then those people have a duty to stand up and say 'hang on a minute', even if they find it difficult simply to say NO.
At the end of Sally's statement she says that "Much of the opposition to statutory regulation [sic] in the HPC in letters to Therapy Today focuses on the nature of the process with terms such as ‘bureaucratic and statistically managed’, ‘cultures of surveillance’, ‘the stress of monitoring and assessment’, ‘role bound rather than ethical’."
She notices that there is a consistency in the concern voiced by people in relation to the proposed State Regulation. She goes on, however, to make the following interesting statement: "the HPC requirements of registration ... do not differ greatly from those of BACP"
This raises a series of questions the most obvious of which is, if the HPC system is not much different from the BACP then how will it improve things, exactly?
But I don't want to get side tracked. The main point is this: saying that the HPC is almost the same as the BACP is a slippery rhetorical device. The HPC is not the same as the BACP, it is different in quite specific and deliberate ways. At this point someone might call for "Evidence?", and ask what frame of reference she is using.
What a lot of people are saying is that the basis of truth is slipping away, and politics and bureaucracy are creeping into its place. The usual conventions of knowledge and debate that allow one to know more or less what someone is saying have receded from the scene, and more and more we are faced with blunt wielding of power through banal and empty phrases. This is not something many of us are used to in this country. If we haven't found neat ways of conveying this to the satisfaction of Sally Aldridge, well sorry; if we sound alarmed, well we are right to be. When truth is under attack all speech and writing becomes subject to question. This is why those in positions of authority, ie those in bureaucratic systems of power, have even more of a responsibility to speak sensibly, carefully, and as far as they are able, truthfully. If they find that the subject is beyond their comprehension, they should pause and think, and get some good advice. If you were the Head of Regulatory Policy, this responsibility would fall on you.
Wednesday, 18 February 2009
Dear Tessa Jowell, MP
Dear Tessa Jowell, MP
I came to West Norwood library towards the end of last year to see you, and spoke to one of your very helpful and friendly staff. The upshot of that meeting was that I would write you a follow up letter (in addition to the one I wrote earlier in that year). At last, this is that letter.
I have created a blog: HPCwatchdog.blogspot.com based on a whole series of visits I have been making to the HPC as a member of the public. If you read the case of Mr R (part 1, part 2, part 3), watch the video of Richard Gombrich explaining Popper's Nightmare, and consider the questions raised by Max Weber, this will give you a quick insight into my concerns and my orientation.
I am very worried indeed about the centralisation of power and the destruction of local knowledge that is the unintended consequence of the kind of regulation that is practiced by the HPC. From what I have seen it is already causing harm to ordinary decent people, and I truly believe that this harm has a pernicious quality that will be exponentially increased if the HPC draw the psychological practices within its domain.
Onora O'Neil has publicly voiced her concern about the destruction of trust that will follow the state regulation of psychological practices (especially of psychotherapy and counselling, but the psychologists are also very much in this domain). Michael Power has been writing about the way our audit culture ends up emptying the meaning out of words and practices, and leave us vulnerable to the collapse of the resulting empty shells, and Marilyn Strathern has also pointed to the hostile and aggressive undercurrents at play in moves under the banner of transparency. Aggressivity will increase where real meaning decreases – this is a lesson learned many times over throughout history.
Each of these great British scholars has been working away quietly revealing the otherwise hidden 'mechanisms' that hold our society together. None of them pretends to have the answer, nor the whole truth, but each of them is shedding very helpful light in very careful ways on things that we need to be very aware of.
I don't believe there is one answer to the situation we are currently in, but I am trying to find a way of approaching the questions without fueling aggressivity nor unduly increasing levels of anxiety. I suggest that a space be created which makes it possible to think. The rapid expansion of the HPC is not conducive to thinking. When I attended the Investigating Committee meeting last week (blogged on 12 Feb 2009) I was chilled to learn that the Kent Police had been invited in to train staff how to deal with escalating aggression. A much more sensible approach would be to ask why the aggression is escalating. From the hearings I have observed, and from comments I have received as a result of my blog, I can see a very strong argument that the orientation and mechanism of the hpc (the grounds on which it is empowered) actually fuels aggressivity - this creates a spiral which echoes Popper's nightmare and adds to the idea that this is what is being created.
It is difficult to know how to intervene, but I very strongly believe that we need to slow the process down, and give ourselves more time to think. How can I help to postpone the process of the Statutory Order that would pass the psychologists onto the HPC register? If you can advise me of this, I would be extremely grateful. If you would like me to explain my ideas in more detail - I am easily contactable. I would be happy to respond to a call and very receptive to any help you can give in shaping a parliamentary question on this issue.
Yours sincerely
I came to West Norwood library towards the end of last year to see you, and spoke to one of your very helpful and friendly staff. The upshot of that meeting was that I would write you a follow up letter (in addition to the one I wrote earlier in that year). At last, this is that letter.
I have created a blog: HPCwatchdog.blogspot.com based on a whole series of visits I have been making to the HPC as a member of the public. If you read the case of Mr R (part 1, part 2, part 3), watch the video of Richard Gombrich explaining Popper's Nightmare, and consider the questions raised by Max Weber, this will give you a quick insight into my concerns and my orientation.
I am very worried indeed about the centralisation of power and the destruction of local knowledge that is the unintended consequence of the kind of regulation that is practiced by the HPC. From what I have seen it is already causing harm to ordinary decent people, and I truly believe that this harm has a pernicious quality that will be exponentially increased if the HPC draw the psychological practices within its domain.
Onora O'Neil has publicly voiced her concern about the destruction of trust that will follow the state regulation of psychological practices (especially of psychotherapy and counselling, but the psychologists are also very much in this domain). Michael Power has been writing about the way our audit culture ends up emptying the meaning out of words and practices, and leave us vulnerable to the collapse of the resulting empty shells, and Marilyn Strathern has also pointed to the hostile and aggressive undercurrents at play in moves under the banner of transparency. Aggressivity will increase where real meaning decreases – this is a lesson learned many times over throughout history.
Each of these great British scholars has been working away quietly revealing the otherwise hidden 'mechanisms' that hold our society together. None of them pretends to have the answer, nor the whole truth, but each of them is shedding very helpful light in very careful ways on things that we need to be very aware of.
I don't believe there is one answer to the situation we are currently in, but I am trying to find a way of approaching the questions without fueling aggressivity nor unduly increasing levels of anxiety. I suggest that a space be created which makes it possible to think. The rapid expansion of the HPC is not conducive to thinking. When I attended the Investigating Committee meeting last week (blogged on 12 Feb 2009) I was chilled to learn that the Kent Police had been invited in to train staff how to deal with escalating aggression. A much more sensible approach would be to ask why the aggression is escalating. From the hearings I have observed, and from comments I have received as a result of my blog, I can see a very strong argument that the orientation and mechanism of the hpc (the grounds on which it is empowered) actually fuels aggressivity - this creates a spiral which echoes Popper's nightmare and adds to the idea that this is what is being created.
It is difficult to know how to intervene, but I very strongly believe that we need to slow the process down, and give ourselves more time to think. How can I help to postpone the process of the Statutory Order that would pass the psychologists onto the HPC register? If you can advise me of this, I would be extremely grateful. If you would like me to explain my ideas in more detail - I am easily contactable. I would be happy to respond to a call and very receptive to any help you can give in shaping a parliamentary question on this issue.
Yours sincerely
Master Signifers, Aggression, and Truth.
Developments in linguistics and in anthropology brought this idea into use in the early parts of the last century. I shall not lecture you on it but invite you to cut to the chase.
There are words or phrases frequently uttered that have great power but very little meaning - they appear unattached to other elements either in a sentence or in the world. They point to nothing. The vagueness of this can raise anxiety, especially when uttered by people occupying positions of institutional and legal power. Lets call them 'master signifiers' - they have power 'because I or We say so'.
I should add that they are not always necessarily bad. They are a part of language and life and can be extremely useful and put to the good with care. They are a necessary feature of language, in fact, because when we speak we are usually trying to speak about something beyond speech, something that our speech aims to invoke. I think this might be particularly difficult for native English speakers to grasp, because we are so seldom required to face the foreigness of our mother tongue. If we forget this nature of language, however, we can easily forget how important it is to attend to the invention and deployment of master signifiers. Lets keep this practical.
Three of the major master signifiers that organise the discourse around the hpc are: Evidence, Public Protection, and Regulation. I have been trying to turn Public Protection into a meaningful phrase by attaching it to specific examples and paying particular attention to its use (which section of the public is being protected, from what particular harm, and on which specific occasion?). In this way the signifier is introduced to other signifiers with which it is revealed to have an otherwise hidden relation. The concealed relations leave them unquestionable, and we have seen in the case studies particularly, that this can be seriously unhelpful.
When the relations are left in the dark, the phrase can get wielded rather aggressively - intentionally or not - by someone who happens to be occupying a position of power. If used by someone not in any kind of position of power you can safely ignore them as a babbling fool. Unfortunately, these phrases are very often heard coming out of the mouths of people in positions of power - journalists, politicians, members of panels, committee members, for example. To call these people babbling fools might be true in that particular moment, and there have been times in this country when it has been perfectly acceptable to say so, even if you are no-one in particular yourself. But - and its a big but, and one that needs to be acknowledged and understood - at the moment because these people are supported by society and given positions of power, calling them such without great tact seems likely to provoke much more than their own personal wrath. It is as if the whole edifice will crumble away with them, as if they personally are the power. To speak out seems to risk bringing the power of the institution right down on your head.
So, master signifiers are instruments of power: they are cut off from meaning and draw attention to the power of the person that speaks; and they are used to cut off meaning in other conversations, to disempower other speakers - this is a double whammy.
There are words or phrases frequently uttered that have great power but very little meaning - they appear unattached to other elements either in a sentence or in the world. They point to nothing. The vagueness of this can raise anxiety, especially when uttered by people occupying positions of institutional and legal power. Lets call them 'master signifiers' - they have power 'because I or We say so'.
I should add that they are not always necessarily bad. They are a part of language and life and can be extremely useful and put to the good with care. They are a necessary feature of language, in fact, because when we speak we are usually trying to speak about something beyond speech, something that our speech aims to invoke. I think this might be particularly difficult for native English speakers to grasp, because we are so seldom required to face the foreigness of our mother tongue. If we forget this nature of language, however, we can easily forget how important it is to attend to the invention and deployment of master signifiers. Lets keep this practical.
Three of the major master signifiers that organise the discourse around the hpc are: Evidence, Public Protection, and Regulation. I have been trying to turn Public Protection into a meaningful phrase by attaching it to specific examples and paying particular attention to its use (which section of the public is being protected, from what particular harm, and on which specific occasion?). In this way the signifier is introduced to other signifiers with which it is revealed to have an otherwise hidden relation. The concealed relations leave them unquestionable, and we have seen in the case studies particularly, that this can be seriously unhelpful.
When the relations are left in the dark, the phrase can get wielded rather aggressively - intentionally or not - by someone who happens to be occupying a position of power. If used by someone not in any kind of position of power you can safely ignore them as a babbling fool. Unfortunately, these phrases are very often heard coming out of the mouths of people in positions of power - journalists, politicians, members of panels, committee members, for example. To call these people babbling fools might be true in that particular moment, and there have been times in this country when it has been perfectly acceptable to say so, even if you are no-one in particular yourself. But - and its a big but, and one that needs to be acknowledged and understood - at the moment because these people are supported by society and given positions of power, calling them such without great tact seems likely to provoke much more than their own personal wrath. It is as if the whole edifice will crumble away with them, as if they personally are the power. To speak out seems to risk bringing the power of the institution right down on your head.
So, master signifiers are instruments of power: they are cut off from meaning and draw attention to the power of the person that speaks; and they are used to cut off meaning in other conversations, to disempower other speakers - this is a double whammy.
Tuesday, 17 February 2009
Law
The bloke who runs the local heel bar in West Norwood used also to run a dry cleaning service out the back. He had to shut it down because some distant law or other now declares his machines to be dangerous. He might shut down his shop, leaving yet another empty space in this benighted high street.
In the ten years that Tony Blair took up the PM post the UK government passed more laws than at any other time ever. The Magna Carta is in shreds. So many laws were passed that the people in the House couldn't actually read them all. Eventually someone had the idea to turn Acts into Orders which reduced the amount of time officially needed to scrutinise them.
Instead of a god shaped hole in our social fabric, we've stuffed it full of laws laws laws. Good for no-one except, well, no, not even for lawyers.
But does this help to explain the existence of the hpc? I look, I search, I want to know what has happened to this country that it brings a thing like this into being. Answers on a postcard, please.
Right now a piece of legislation is waiting in the wings to be tabled in the House of Lords. It goes under the name of a statutory instrument - a Health Care and Associated Professions (Miscellaneous Amendments) (no 2) Order 2008. It is laid before parliament under Section 62(10) of the Health Care Act 1999 for approval of each house and of Scottish Parliament. If passed it will transfer a set of psychologists into the domain of the HPC. It is done under the familiar phrase 'in order to protect the public'.
The administrators at the HPC will receive a huge list of names to write onto their register. The HPC will then become the administrators of applications to join this register, remain on this register, or be removed from this register. In order to know how best to exercise this centralised power, they will have to grapple with the problem of knowledge, never mind the infinite variety of practice. Here we are again in Popper's Nightmare (see previous blogs and side panel for succint explanation).
The folly that produced the hpc would have us believe that it is because they know nothing about a practice that they are the best people to manage those practices. Grasping the real truth of this point is akin to grasping the idea of zero. There is all the difference in the world between zero and nothing.
Do you remember when Gordon Brown took up the PM post - shortly after this he was out and about consulting Citizen's Councils. The idea was that the political machinery would gather together groups to advise politicians, and the qualification to be a member of the group was to have no idea at all about the subject in question. The implicit belief behind this is that everyone has the potential to say something sensible, be useful, be a valuable citizen. But alongside this another kind of implicit belief is at play - that those who had achieved positions of power and status on particular topics were not to be trusted with the truth. That they would be more interested in maintaining their position than of applying the truth that had led them there. There is a little bit of truth in both positions, an no-one needs me to tell them.
So what is it that leaves us in such a lurch as we are in? One hypothesis that I have been advancing is that Popper's Nightmare has been long time in the making, and this has gradually weakened the knowledge base across the country at grass roots level. This is one strand. Another hypothesis comes from Max Weber, whose discourse on institutional power has been helpful in reminding me that these questions are not new but have always to be grappled with. A third strand relates to the way that we are dominated by empty phrases which get weilded as aggressive objects rather than as parts of a meaningful discourse between subjects. It is this that I shall now try to talk about using a word from linguistics: signifiers.
In the ten years that Tony Blair took up the PM post the UK government passed more laws than at any other time ever. The Magna Carta is in shreds. So many laws were passed that the people in the House couldn't actually read them all. Eventually someone had the idea to turn Acts into Orders which reduced the amount of time officially needed to scrutinise them.
Instead of a god shaped hole in our social fabric, we've stuffed it full of laws laws laws. Good for no-one except, well, no, not even for lawyers.
But does this help to explain the existence of the hpc? I look, I search, I want to know what has happened to this country that it brings a thing like this into being. Answers on a postcard, please.
Right now a piece of legislation is waiting in the wings to be tabled in the House of Lords. It goes under the name of a statutory instrument - a Health Care and Associated Professions (Miscellaneous Amendments) (no 2) Order 2008. It is laid before parliament under Section 62(10) of the Health Care Act 1999 for approval of each house and of Scottish Parliament. If passed it will transfer a set of psychologists into the domain of the HPC. It is done under the familiar phrase 'in order to protect the public'.
The administrators at the HPC will receive a huge list of names to write onto their register. The HPC will then become the administrators of applications to join this register, remain on this register, or be removed from this register. In order to know how best to exercise this centralised power, they will have to grapple with the problem of knowledge, never mind the infinite variety of practice. Here we are again in Popper's Nightmare (see previous blogs and side panel for succint explanation).
The folly that produced the hpc would have us believe that it is because they know nothing about a practice that they are the best people to manage those practices. Grasping the real truth of this point is akin to grasping the idea of zero. There is all the difference in the world between zero and nothing.
Do you remember when Gordon Brown took up the PM post - shortly after this he was out and about consulting Citizen's Councils. The idea was that the political machinery would gather together groups to advise politicians, and the qualification to be a member of the group was to have no idea at all about the subject in question. The implicit belief behind this is that everyone has the potential to say something sensible, be useful, be a valuable citizen. But alongside this another kind of implicit belief is at play - that those who had achieved positions of power and status on particular topics were not to be trusted with the truth. That they would be more interested in maintaining their position than of applying the truth that had led them there. There is a little bit of truth in both positions, an no-one needs me to tell them.
So what is it that leaves us in such a lurch as we are in? One hypothesis that I have been advancing is that Popper's Nightmare has been long time in the making, and this has gradually weakened the knowledge base across the country at grass roots level. This is one strand. Another hypothesis comes from Max Weber, whose discourse on institutional power has been helpful in reminding me that these questions are not new but have always to be grappled with. A third strand relates to the way that we are dominated by empty phrases which get weilded as aggressive objects rather than as parts of a meaningful discourse between subjects. It is this that I shall now try to talk about using a word from linguistics: signifiers.
FTP or management failing?
Today's case at the HPC is that of a physiotherapist. It is another case where the management structure of the NHS has clearly failed to take timely action on a minor question, and which has allowed the machinery of the HPC to blunder in. It is difficult to justify this as a serious misdemeanour from which the public needs protecting. It is more easily understood as petty malice on someone's behalf. Copied below is the allegation as printed on the HPC website. In the next financial year. The FTP budget for next financial year is estimated in the region £5.6million.
Your fitness to practise as a registered health professional is impaired by reason of your misconduct and/or lack of competence in that:
1. At all material times you were employed as a Physiotherapist by East Elmbridge and Mid Surrey Primary Care Trust.
2. On 1st August 2005 you took unauthorised absence from work whilst on duty.
3. On 6th February 2006 you took unauthorised absence from work whilst on duty.
4. Between March 2005 and February 2006 whilst on duty:
(a) you made excessive personal telephone calls on the Trust’s telephone and;
(b) this was contrary to Trust policy.
5. Following an audit of your patient treatment notes it was found that:
(a) there were discrepancies between the activity recorded on your statistics sheets and the activity documented in your patient notes;
(b) you failed to keep adequate patient notes.
(a) on 6th March 2006 you did not assess a patient, Mr A pre-operatively.
Redefining 'Professional' & Frightening the Public: more on Mr R
From the transcript of the case of Mr R. [I have used the name Freddy in place of his real name, to reflect the familiar diminutive that was used at the hearing.]
Ms B, the witness said: "A family member, the father, said that this was the work that Freddy had given his son to do privately. When I questioned him and said "was it the case that Freddy also saw your son privately?" the answer was "Yes". The family felt very anxious and asked me whether I was in touch with Freddy. I explained that I had never met Mr R and that it was not good practice or approved practice to work with somebody privately whilst on their NHS case load. The family were anxious. They really liked Freddy and they had built up a very good rapport."
When Ms B was asked to explain why it was not good practice for someone to work in private with someone also on the NHS case load, she replied:
Ms B: "Firstly it is in our professional guidelines that we are not allowed to manage a case where we are already seeing that particular individual on an NHS case load. Also for me, personally, it is unethical to be seeing somebody and then at another time to be taking money from them."
Is it just about money? Ms B said Mr V should also belong to the association for private practice. Then she mentioned note taking and liaison with other professionals involved. This allowed HPC Council to ask the purpose of note taking, which brought forth this revealing answer:
HPC Q: Why would you be taking clinical Notes?
Ms B: Just as a record really otherwise you will be leaving yourself open to be vulnerable.
When questioned by Council for Mr R, Ms B explained more clearly: 'it is recommended to protect you from suspicion.'
Ms B had not made her allegation against Mr R because his professional work was in question, but because she thought he was open to suspicion. What kind of suspicion, and from who? This brings us back to defining the idea of 'protection of the public'.
Protection of the Public. Who represents the public in this case? The family is implicitly ruled out as the case unfolds - they are described in ways that throw them into question, and which excludes their point of view. They become the group that tempt the professional off the straight and narrow. The public that is being protected here seems to be one that might be shocked to hear that someone employed by the NHS is not completely under control, and this would imply that they are being protected from that shock. This is clearly irrational, and cannot be the intention of anyone involved, but the accumulation of evidence does seem to point to this interpretation.
Ms B is not throwing doubt on the professional practice of her colleague. The family is pleased with the work, the young man in question is happy with the work. In fact Ms B went on to say "I think Mr R did a really good job".
When Ms B was questioned by the Panel, the lay member, Ms Lesley Hawksworth, brought her back to the point of how she interpreted the rules.
Ms Hawksworth: "You have already been referred to the guidelines on page 34. In paragraph 4 it says: "Therapists who have any current health service involvement may not normally undertake private therapy with that client." It does not say must never. "
Ms B: "Can you say that again?"
Ms H: "The sentence does not say 'must never' undertake private practice'
Ms B: I would have to clarify that with the independent practice to clarify exactly what that means.
There then followed a confusion between the panel members which brought to light two different versions of rules. Mr Duckworth (the panel member representing the Speech and Language Therapy profession) had a more recent version:
Mr D: "The statement from the Communicating Quality latest edition, would seem, from the text here that I have just read out, that the suggestion is, if you are treating the NHS client, you may not undertake private management of that case. Is that your understanding?
Ms B: "Yes, it is".
Mr D has re-established Ms B as a sensible woman, but only if you don't ask any questions about the validity of the text itself. There followed a brief confusion about the dates of the different versions of this text, as well as the authority which published them. It is published after the date Mr R's practice was called into question. It seems likely that the rule is written as a diplomatic matter between the Royal College and the Independent Practitioner bodies that each try to represent the Speech and Language therapists. Fair enough, they are carving out their respective territory of jurisdiction; but should this not be taken into account when interpreting the text? The lay member is right to pose her question here on the side of sense and reason rather than of management and trade. But she seems to have been side-lined quite quickly.
more to follow shortly,
Ms B, the witness said: "A family member, the father, said that this was the work that Freddy had given his son to do privately. When I questioned him and said "was it the case that Freddy also saw your son privately?" the answer was "Yes". The family felt very anxious and asked me whether I was in touch with Freddy. I explained that I had never met Mr R and that it was not good practice or approved practice to work with somebody privately whilst on their NHS case load. The family were anxious. They really liked Freddy and they had built up a very good rapport."
When Ms B was asked to explain why it was not good practice for someone to work in private with someone also on the NHS case load, she replied:
Ms B: "Firstly it is in our professional guidelines that we are not allowed to manage a case where we are already seeing that particular individual on an NHS case load. Also for me, personally, it is unethical to be seeing somebody and then at another time to be taking money from them."
Is it just about money? Ms B said Mr V should also belong to the association for private practice. Then she mentioned note taking and liaison with other professionals involved. This allowed HPC Council to ask the purpose of note taking, which brought forth this revealing answer:
HPC Q: Why would you be taking clinical Notes?
Ms B: Just as a record really otherwise you will be leaving yourself open to be vulnerable.
When questioned by Council for Mr R, Ms B explained more clearly: 'it is recommended to protect you from suspicion.'
Ms B had not made her allegation against Mr R because his professional work was in question, but because she thought he was open to suspicion. What kind of suspicion, and from who? This brings us back to defining the idea of 'protection of the public'.
Protection of the Public. Who represents the public in this case? The family is implicitly ruled out as the case unfolds - they are described in ways that throw them into question, and which excludes their point of view. They become the group that tempt the professional off the straight and narrow. The public that is being protected here seems to be one that might be shocked to hear that someone employed by the NHS is not completely under control, and this would imply that they are being protected from that shock. This is clearly irrational, and cannot be the intention of anyone involved, but the accumulation of evidence does seem to point to this interpretation.
Ms B is not throwing doubt on the professional practice of her colleague. The family is pleased with the work, the young man in question is happy with the work. In fact Ms B went on to say "I think Mr R did a really good job".
When Ms B was questioned by the Panel, the lay member, Ms Lesley Hawksworth, brought her back to the point of how she interpreted the rules.
Ms Hawksworth: "You have already been referred to the guidelines on page 34. In paragraph 4 it says: "Therapists who have any current health service involvement may not normally undertake private therapy with that client." It does not say must never. "
Ms B: "Can you say that again?"
Ms H: "The sentence does not say 'must never' undertake private practice'
Ms B: I would have to clarify that with the independent practice to clarify exactly what that means.
There then followed a confusion between the panel members which brought to light two different versions of rules. Mr Duckworth (the panel member representing the Speech and Language Therapy profession) had a more recent version:
Mr D: "The statement from the Communicating Quality latest edition, would seem, from the text here that I have just read out, that the suggestion is, if you are treating the NHS client, you may not undertake private management of that case. Is that your understanding?
Ms B: "Yes, it is".
Mr D has re-established Ms B as a sensible woman, but only if you don't ask any questions about the validity of the text itself. There followed a brief confusion about the dates of the different versions of this text, as well as the authority which published them. It is published after the date Mr R's practice was called into question. It seems likely that the rule is written as a diplomatic matter between the Royal College and the Independent Practitioner bodies that each try to represent the Speech and Language therapists. Fair enough, they are carving out their respective territory of jurisdiction; but should this not be taken into account when interpreting the text? The lay member is right to pose her question here on the side of sense and reason rather than of management and trade. But she seems to have been side-lined quite quickly.
more to follow shortly,
Thursday, 12 February 2009
Investigating Committee, Feb 09
There are 555 food days arising from Fitness to Practise activity.
And £300,000 is spent each year on hiring the shorthand writers.
I am now attending various committee meetings at the HPC to find out what is talked about at strategic level.
Most people have not really thought about the implications 0f the HPC - why would they, when there are so many other things to do in life? Those people who are forced to think about the HPC tend to leave it in the abstract realm of a TLA and at most associate it with the figure of the CE, Marc Seale. Well, the HPC in practice is a very different thing. I know of people who make appointments to visit Marc Seale in the belief that they will speak to a man and persuade him with reason. None have yet succeeded. There is little reason to think that they would. First of all Mr Seale is placed in a highly particular position. This organisation did not come into existence through the desire of a man, not the demand of the market nor of local people, nor from the exigencies of practice - it came into existence through a highly particular, and alarmingly flawed, political will. Discussing things with this CE is not going to work, because, in effect, he has been set up in a highly constrained position and given the power, in effect, to print money.
There is a second thread to take into account: the organisation is large, has a history, and is stitched into the fabric of life in many different ways. There are sandwich makers and stenographers makers who depend upon it for their living, for example.
By going along and observing I have two different aims. One is to allow readers to realise that this organisation supports the living and the careers of a lot of real people (and won't disappear overnight, nor give up its wish to make money). Second is to gradually reveal what the day to day business of the place really is. I have been an ethnographer in my time, and it is this that is giving me an orientation.
In the meeting there were some familiar faces around the committee table, and a nod of recognition from Anna van der Gaag. I sat behind another familiar figure - Diane Waller, chair of the C&P PLG - and was surprised that she said nothing at all throughout the whole of this meeting. I recognised the new Secretary, and was pleased to see Kelly Johnson, head of FTP, who I had read about at the Tribunal. I was surprised at how young and inexperienced she looked.
The committee meeting itself is, of course, based on a large number of documents which are numbered more than named, eg: 100026AC20090205Investigating-enclosure7-complaintsliterature, and 100026AA20090205Investigating-enclosure5-workplan2009-10. Teams of people are employed full time to compile and take care of these documents. Panel members are probably paid a fee to read them and to come to London to discuss them. Little by little, I shall find a way through too, and try to reveal something which renders them accessible and perhaps gives a fresh view.
Where to begin? I'll take two points of humour.
There's an HPC CPD DVD, and will be an HPC FTP DVD, several people laughed quietly at this, perhaps enjoying the poetry in the letters.
The second thing that made members laugh was the idea that the figure for costs invoked by a High Court Appeal had been increased, which means that someone failing to win an appeal against an HPC decision would be obliged to give up several thousand pounds. One panel member punched the air with joy and Kelly Johnson giggled.
A little less funny is the fact that by the end of the month the Kent Police will have delivered their special 'escalation procedure' training programme which is aimed to help the FTP employees in their business of conflict management.
So let's turn to something more comforting. Sylvia works on reception, and has done so for more than 13 years. She has seen many refurbishments in her time, as well as the re-naming of the organisation and changes in its relation to the public. She told me that her desk has been moved around the building. First she sat in the basement, then in the heart of the building, now she sits at this nice little number in a double locked chamber right next to the glass front door. Before, visitors and public were trusted to come in and find their way through the corridors. Now they are forced to obey magnetic locks, wear large name tags, and wait to be escorted wherever they want to go.
There are other important things to say about the meeting, and relate to the planning, forecasting, and expansion that formed a bulky and central document. I'll have leave it here for the moment, and return to the task later on.
And £300,000 is spent each year on hiring the shorthand writers.
I am now attending various committee meetings at the HPC to find out what is talked about at strategic level.
Most people have not really thought about the implications 0f the HPC - why would they, when there are so many other things to do in life? Those people who are forced to think about the HPC tend to leave it in the abstract realm of a TLA and at most associate it with the figure of the CE, Marc Seale. Well, the HPC in practice is a very different thing. I know of people who make appointments to visit Marc Seale in the belief that they will speak to a man and persuade him with reason. None have yet succeeded. There is little reason to think that they would. First of all Mr Seale is placed in a highly particular position. This organisation did not come into existence through the desire of a man, not the demand of the market nor of local people, nor from the exigencies of practice - it came into existence through a highly particular, and alarmingly flawed, political will. Discussing things with this CE is not going to work, because, in effect, he has been set up in a highly constrained position and given the power, in effect, to print money.
There is a second thread to take into account: the organisation is large, has a history, and is stitched into the fabric of life in many different ways. There are sandwich makers and stenographers makers who depend upon it for their living, for example.
By going along and observing I have two different aims. One is to allow readers to realise that this organisation supports the living and the careers of a lot of real people (and won't disappear overnight, nor give up its wish to make money). Second is to gradually reveal what the day to day business of the place really is. I have been an ethnographer in my time, and it is this that is giving me an orientation.
In the meeting there were some familiar faces around the committee table, and a nod of recognition from Anna van der Gaag. I sat behind another familiar figure - Diane Waller, chair of the C&P PLG - and was surprised that she said nothing at all throughout the whole of this meeting. I recognised the new Secretary, and was pleased to see Kelly Johnson, head of FTP, who I had read about at the Tribunal. I was surprised at how young and inexperienced she looked.
The committee meeting itself is, of course, based on a large number of documents which are numbered more than named, eg: 100026AC20090205Investigating-enclosure7-complaintsliterature, and 100026AA20090205Investigating-enclosure5-workplan2009-10. Teams of people are employed full time to compile and take care of these documents. Panel members are probably paid a fee to read them and to come to London to discuss them. Little by little, I shall find a way through too, and try to reveal something which renders them accessible and perhaps gives a fresh view.
Where to begin? I'll take two points of humour.
There's an HPC CPD DVD, and will be an HPC FTP DVD, several people laughed quietly at this, perhaps enjoying the poetry in the letters.
The second thing that made members laugh was the idea that the figure for costs invoked by a High Court Appeal had been increased, which means that someone failing to win an appeal against an HPC decision would be obliged to give up several thousand pounds. One panel member punched the air with joy and Kelly Johnson giggled.
A little less funny is the fact that by the end of the month the Kent Police will have delivered their special 'escalation procedure' training programme which is aimed to help the FTP employees in their business of conflict management.
So let's turn to something more comforting. Sylvia works on reception, and has done so for more than 13 years. She has seen many refurbishments in her time, as well as the re-naming of the organisation and changes in its relation to the public. She told me that her desk has been moved around the building. First she sat in the basement, then in the heart of the building, now she sits at this nice little number in a double locked chamber right next to the glass front door. Before, visitors and public were trusted to come in and find their way through the corridors. Now they are forced to obey magnetic locks, wear large name tags, and wait to be escorted wherever they want to go.
There are other important things to say about the meeting, and relate to the planning, forecasting, and expansion that formed a bulky and central document. I'll have leave it here for the moment, and return to the task later on.
Wednesday, 11 February 2009
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".
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".
HPC Council meeting, Feb 2009
Yesterday I went to observe the full Council meeting at the HPC. I had set aside the whole day for the occasion, but as most of the day was given over to a strategy work shop and an expansion work shop, the actual business of the group was restricted to 30 minutes at the end of the afternoon. This was the 30 minutes to which the public were admitted. There was one other public obliged to wait in the reception area until the Council were ready to display themselves and we had a few minutes conversation before we were ushered into the only two empty chairs in a very full room, where once more I discovered myself crammed into the corner looking at the back of a row of heads. I was luckier than my colleague - his seat had been soaked by a leak in the air conditioning...
This other member of the public was a young man - an Oxford graduate. Why on earth was he there? I had asked. He works for the CHRE - the official watchdog of the HPC. As part of their remit they like to drop in on the various regulatory bodies under their auspice to see how they are getting on. He asked me why I was there - I had to concede that I was the unofficial watchdog, and as he didn't immediately laugh out loud I launched my manifesto.
I told him I was very worried about the unintended consequences of such a strange invention as the HPC, and indeed the CHRE, come to mention it. He looked amazed. I talked about the centralisation of power and the centralisation of knowledge and the catastrophic consequences this has on the local practice of any profession. He let me continue. I spoke of the collapse of the banking system and pointed to the system of regulation they had been subject to. I drew the comparisons and predicted a similar collapse in the professions subject to it here, due to the inevitable destruction of local knowledge that such a move sets in train. He seemed to be interested, so I risked Popper's Nightmare. Of course he had heard of Karl Popper, but he had not studied his nightmare, so I referred him to the you-tube clip of Richard Gombrich, which is linked to the side-bar of this blog. I seemed to be on firm ground, so I followed it up with encouragement towards Marilyn Strathern and Michael Power, then pressed my advantage by mentioning Mark Neocleous.
Here he rallied and began putting counter arguments.
- Professionals must be regulated - the public think they are already.
- They are, I quickly replied.
- Self regulation? He countered, with a rye smile.
- Yes, of course, said I.
- But that is hardly reliable, the professionals only look after themselves.
- But such a cynical argument also applies to yourself.
- How so?
- The HPC, the CHRE must also look after themselves, attend to their public persona, safeguard their jobs and their future employment, this is just part of life.
- But surely standards of knowledge and performance are necessary to protect the public.
- Yes but how are they produced and policed - we are back at Popper's Nightmare.
- But people need these rules for practice
- Which rules? There are rules generated in the process of practice and discussion within the communities that work on these things, and then there are rules made by centralised committees and constructed by political processes. Then there are rules for practice, questions of ethics, and rules of law. The context is complex, but not so complex that those who work and practice can't attend to them. It is more difficult for people who don't work in the practice to come up with a good set of rules. This question touches on science and politics. Which rules do you mean?
Enter Colin Bendall whose job it is to usher us into the performance.
This other member of the public was a young man - an Oxford graduate. Why on earth was he there? I had asked. He works for the CHRE - the official watchdog of the HPC. As part of their remit they like to drop in on the various regulatory bodies under their auspice to see how they are getting on. He asked me why I was there - I had to concede that I was the unofficial watchdog, and as he didn't immediately laugh out loud I launched my manifesto.
I told him I was very worried about the unintended consequences of such a strange invention as the HPC, and indeed the CHRE, come to mention it. He looked amazed. I talked about the centralisation of power and the centralisation of knowledge and the catastrophic consequences this has on the local practice of any profession. He let me continue. I spoke of the collapse of the banking system and pointed to the system of regulation they had been subject to. I drew the comparisons and predicted a similar collapse in the professions subject to it here, due to the inevitable destruction of local knowledge that such a move sets in train. He seemed to be interested, so I risked Popper's Nightmare. Of course he had heard of Karl Popper, but he had not studied his nightmare, so I referred him to the you-tube clip of Richard Gombrich, which is linked to the side-bar of this blog. I seemed to be on firm ground, so I followed it up with encouragement towards Marilyn Strathern and Michael Power, then pressed my advantage by mentioning Mark Neocleous.
Here he rallied and began putting counter arguments.
- Professionals must be regulated - the public think they are already.
- They are, I quickly replied.
- Self regulation? He countered, with a rye smile.
- Yes, of course, said I.
- But that is hardly reliable, the professionals only look after themselves.
- But such a cynical argument also applies to yourself.
- How so?
- The HPC, the CHRE must also look after themselves, attend to their public persona, safeguard their jobs and their future employment, this is just part of life.
- But surely standards of knowledge and performance are necessary to protect the public.
- Yes but how are they produced and policed - we are back at Popper's Nightmare.
- But people need these rules for practice
- Which rules? There are rules generated in the process of practice and discussion within the communities that work on these things, and then there are rules made by centralised committees and constructed by political processes. Then there are rules for practice, questions of ethics, and rules of law. The context is complex, but not so complex that those who work and practice can't attend to them. It is more difficult for people who don't work in the practice to come up with a good set of rules. This question touches on science and politics. Which rules do you mean?
Enter Colin Bendall whose job it is to usher us into the performance.
Tuesday, 10 February 2009
IPN women's delegation to Marc Seale, CE, HPC
This letter is brought to my attention:
Marc Seale
Chief Executive and Registrar
Health Professions Council
8 February 2009
An Open Letter to Marc Seale:
First of all we really appreciate your taking the time to meet with us on 27th January and would like to thank you for that. We should say though that we were rather surprised to also meet with Diane Waller, as that had not been part of our agreement. However, the meeting was instructive as it helped to clarify our thoughts and feelings about statutory regulation, although probably not quite in the way you intended.
As you may remember, your invitation came about as a result of your meeting with Denis Postle, when you said you would like to meet with other members of the Independent Practitioners Net-work. We trusted therefore you would be interested in our views on the proposed statutory regula-tion of the psychological therapies. Perhaps naively we assumed that you would first want to hear our reasons for not welcoming this proposal and then, having listened to us, counter our arguments point by point. This might have allowed for an interesting debate, but sadly this was not what hap-pened.
You did agree with our suggestion that we could perhaps all take a few minutes to expand on who we were, what had brought us to the table, what we would like from the meeting and perhaps even what we felt passionate about. After that, however, instead of listening to our views, in which you ap-peared to have no interest, you did your best to dominate the meeting with your views. You then said ‘I don’t understand your argument!’, which surprised us, as we had not had a chance to inform you of what our argument might be! It was hard for us to break into your or Diane’s monologues and when we tried, we ended up feeling talked over. At the end of the meeting you did not ask what it had been like for us, but told us that it had been ‘useful’. Really? We left your office feeling disap-pointed and very frustrated with a clear sense that you really did not want to hear anything that might be anti regulation.
You left us with only one hope: that if not enough counsellors and psychotherapists wish to find a safe home ‘under your tent’, then, by your own admission, being regulated by the HPC would not work. If we may be so bold as to make that assumption, where would you and everyone else go from there?
To conclude, did you happen to see the article in the education section of the Guardian of 27th
January, 2009, the date of our meeting, regarding Universities and red tape entitled “Regulation, regulation, regulation”? Steven Egan, HEFCE’s deputy chief executive is quoted as saying:
“…Our sector is still over-regulated proportionate to the risks that arise from it. As a general proposition, the country will gain more value from us if we devote our resources to doing rather than measuring?”
Could this not also apply to the psychological therapies?
Yours Sincerely,
Irene Galant, Barbara Hacking, Jenny Nicholson, Els van Ooijen
Marc Seale
Chief Executive and Registrar
Health Professions Council
8 February 2009
An Open Letter to Marc Seale:
First of all we really appreciate your taking the time to meet with us on 27th January and would like to thank you for that. We should say though that we were rather surprised to also meet with Diane Waller, as that had not been part of our agreement. However, the meeting was instructive as it helped to clarify our thoughts and feelings about statutory regulation, although probably not quite in the way you intended.
As you may remember, your invitation came about as a result of your meeting with Denis Postle, when you said you would like to meet with other members of the Independent Practitioners Net-work. We trusted therefore you would be interested in our views on the proposed statutory regula-tion of the psychological therapies. Perhaps naively we assumed that you would first want to hear our reasons for not welcoming this proposal and then, having listened to us, counter our arguments point by point. This might have allowed for an interesting debate, but sadly this was not what hap-pened.
You did agree with our suggestion that we could perhaps all take a few minutes to expand on who we were, what had brought us to the table, what we would like from the meeting and perhaps even what we felt passionate about. After that, however, instead of listening to our views, in which you ap-peared to have no interest, you did your best to dominate the meeting with your views. You then said ‘I don’t understand your argument!’, which surprised us, as we had not had a chance to inform you of what our argument might be! It was hard for us to break into your or Diane’s monologues and when we tried, we ended up feeling talked over. At the end of the meeting you did not ask what it had been like for us, but told us that it had been ‘useful’. Really? We left your office feeling disap-pointed and very frustrated with a clear sense that you really did not want to hear anything that might be anti regulation.
You left us with only one hope: that if not enough counsellors and psychotherapists wish to find a safe home ‘under your tent’, then, by your own admission, being regulated by the HPC would not work. If we may be so bold as to make that assumption, where would you and everyone else go from there?
To conclude, did you happen to see the article in the education section of the Guardian of 27th
January, 2009, the date of our meeting, regarding Universities and red tape entitled “Regulation, regulation, regulation”? Steven Egan, HEFCE’s deputy chief executive is quoted as saying:
“…Our sector is still over-regulated proportionate to the risks that arise from it. As a general proposition, the country will gain more value from us if we devote our resources to doing rather than measuring?”
Could this not also apply to the psychological therapies?
Yours Sincerely,
Irene Galant, Barbara Hacking, Jenny Nicholson, Els van Ooijen
Thursday, 5 February 2009
Jucial Review, appealing against the HPC decisions
Someone had been advised by the HPC that the only means of redress open to them after a decision had been made by the HPC was via a judicial review. They duly set one in process, and hired a solicitor. Only then did they discover that they were not in a position to put such a process into play.
This case involved an NHS manager who had been sacked. The HPC tend to trawl these cases and bring them into their own net to re-play the scene and ring out the surplus value. The upshot of this is that the HPC then becomes the complainant in the HPC Process. People who had been involved in the original case might be forgiven for thinking that they still had a part in this second playing of the scene, but in fact they don't. The HPC take over the show - in this way they act on behalf of an imaginary public and take a local sacking into a national misdemeanour.
There are two threads - one is the way a local event is passed to a central court (local difficulties acquire national status), the other is the question of self interest. The original professions were attacked on the grounds that they couldn't be trusted to keep their house in order as they were likely to be biased in their own favour. This inconvenient truth, however, also applies to any new body set up to keep order, it is part of life and must be dealt with by each of us as we act. The idea was that the HPC would always be objective because it has no interest in the professions it manages. However, this completely ignores the interest it has in maintaining itself - it is a naive, puerile view. The HPC is left with no other purpose than to maintain a register and police it - it is administrator, law enforcer, law interpreter, law maker. In the case of the original professions they were also interested in the work itself, and the knowledge pertaining to the work. In fact they were more interested in the work itself for without it they would cease to exist. In the case of the HPC their work - their trade, their profession so to speak - is administrative and legal. They are not interested in the actual work of the people over whom they have such far reaching legal powers. Their business is collecting names onto registers (and money associated), arranging the lists, creating sets of abstract standards of character and practise at a distance, and of enforcing these standards. That's it. It is a false profession, based on nothing. They are under the jurisdiction of another such body (the CHRE) and each of these is under the jurisdiction of the Privy Council, as far as I can see.
My contention is that the HPC is an artificial creation based on a false assumption. This is very shaky ground which sets up a need for a strong policing in order to make it work - an artificial force takes the place of any possible natural order. This sets up an absolute system and places far too much power in the hands of a small set of people. It is a very tricky situation, and one which is out of balance with the requirements of the situation.
It has been very common to explain the creation of the HPC and the CHRE through reference to Harold Shipman. The fear that is created by this move is two fold. There is the fear invoked through reference to a serial killer, and there is fear invoked by the irrationality of the reference to the subject in question. That is, there is no rational link between this murderer, and the creation of a large list, a centralised knowledge base, and an aggressive police force. The link has more in common with a paranoid idea than it does with reason, experience, and rationality.
This case involved an NHS manager who had been sacked. The HPC tend to trawl these cases and bring them into their own net to re-play the scene and ring out the surplus value. The upshot of this is that the HPC then becomes the complainant in the HPC Process. People who had been involved in the original case might be forgiven for thinking that they still had a part in this second playing of the scene, but in fact they don't. The HPC take over the show - in this way they act on behalf of an imaginary public and take a local sacking into a national misdemeanour.
There are two threads - one is the way a local event is passed to a central court (local difficulties acquire national status), the other is the question of self interest. The original professions were attacked on the grounds that they couldn't be trusted to keep their house in order as they were likely to be biased in their own favour. This inconvenient truth, however, also applies to any new body set up to keep order, it is part of life and must be dealt with by each of us as we act. The idea was that the HPC would always be objective because it has no interest in the professions it manages. However, this completely ignores the interest it has in maintaining itself - it is a naive, puerile view. The HPC is left with no other purpose than to maintain a register and police it - it is administrator, law enforcer, law interpreter, law maker. In the case of the original professions they were also interested in the work itself, and the knowledge pertaining to the work. In fact they were more interested in the work itself for without it they would cease to exist. In the case of the HPC their work - their trade, their profession so to speak - is administrative and legal. They are not interested in the actual work of the people over whom they have such far reaching legal powers. Their business is collecting names onto registers (and money associated), arranging the lists, creating sets of abstract standards of character and practise at a distance, and of enforcing these standards. That's it. It is a false profession, based on nothing. They are under the jurisdiction of another such body (the CHRE) and each of these is under the jurisdiction of the Privy Council, as far as I can see.
My contention is that the HPC is an artificial creation based on a false assumption. This is very shaky ground which sets up a need for a strong policing in order to make it work - an artificial force takes the place of any possible natural order. This sets up an absolute system and places far too much power in the hands of a small set of people. It is a very tricky situation, and one which is out of balance with the requirements of the situation.
It has been very common to explain the creation of the HPC and the CHRE through reference to Harold Shipman. The fear that is created by this move is two fold. There is the fear invoked through reference to a serial killer, and there is fear invoked by the irrationality of the reference to the subject in question. That is, there is no rational link between this murderer, and the creation of a large list, a centralised knowledge base, and an aggressive police force. The link has more in common with a paranoid idea than it does with reason, experience, and rationality.
The Information Commissioner & HPC's FTP
You can go to www.informationtribunal.gov.uk and get copies of cases, I have one whose decision was promulgated on 14 March 2008. According to my dictionary of word origins, promulgate is linked to the idea 'to milk', that is to cause to emerge. This promulgation was set in motion by a series of events which culminated in a Freedom of Information (FOI) request by Ms Z who had referred a case to the HPC. The HPC refused to give the information which led to the Information Commissioner being called onto the scene. He then issued an Information notice requesting sight of the disputed information and the HPC appealed this notice under section 57(2) of the FOI Act.
Are you following all this?
I'm new to all this too, but little by little I intend to try to discover something about the particularity of the time we live in, the institutions we invent, the context in which bits of our lives get lived.
From the promulgated decision I learn things that I already knew: "The HPC is established under the Health Professions Order 2001 (the 2001 Order)" and subtle differences from things that I thought I knew: ... "It's main functions are set out at article 3(2) of the 2001 Order as "...to establish from time to time [my emphasis] standards of education, training, conduct, and performance for members of the relevant professions and to ensure the maintenance of those standards." The main objective in exercising its functions is "to safeguard the health and well being of persons using the services of registrants." This is written in The Order. But there is room for interpretation in practise and it is this that is in question at the Tribunal Service.
"The HPC's functions include the maintenance of a register of health professionals and a mechanism, called the Fitness to Practise process (the Process) whereby the conduct and performance of registrants may be investigated and called to account. An adverse adjudication on a registrant's fitness to practise may lead to, amongst other things, a registrant being removed from the register (such that they could not work in their chosen profession) or conditions being attached to the performance of their profession. Members of the public, employers etc, may make allegations to the HPC with regard to the fitness to practise of particular registrants. Such cases are investigated by the HPC and as a preliminary step in the Process a decision will be taken by a Panel of the Investigating Committee whether there is a case to answer. [If not, the Process ends. If so, a new Committee is called for a full hearing." (Quoted from the Tribunal's introduction.)
In the case in question the initial Committee decided there was no case, so Ms Z made her FOIA request to see on what basis this decision had been made. This was refused by the HPC on the grounds that certain exemptions applied, namely sections 30, 40, and 41... So Ms Z made an application under section 50 of the FOIA for a decision by the Information commissioner as to whether her request had been dealt with in accordance with law. After a lot of argy bargy the HPC filed a Notification of Appeal against the Information Commissioner's Information Notice and so triggered this appeal to tribunal.
It's quite Dickensian - we are in the field of law, very particular human relations, and, by the by, a professional practise.
The Tribunal heard evidence from Mr Jonathan Bracken from Bircham Dysen Bell, who were solicitors for the HPC. Mr Bracken had been involved in the setting up of the HPC and had advised on many of its processes, he had drafted most of its rules. He explained to the Tribunal that the HPC had 'moved away' from a punitive disciplinary scheme, and had put in its place the Fitness to Practise regime. It is a process in two stages. These stages were put into question at the Tribunal and Mr Bracken was revealed as lacking (he had to admit that some of his documents 'perhaps were not as well worded as might be') .
The next in the dock was Ms Kelly Johnson, the HPC's Director of Fitness to Practise. She was obliged to say that 'the practise and procedure guidance were living documents and in certain respects in need of revision'. In the course of her evidence she revealed that the information gained in the Process at the early stage could be shared with the competent authorities of the other European Union states, and in addition, circumstances could arise in which the HPC gave the police a registrant's information prior to a 'no case to answer' determination. Registrants are not warned of these possible disclosures.
To cut a long story short, the Tribunal concluded that 'registrants were unaware of the fact that HPC on occasion made disclosures in the public interest... The reality was that the 'aura' of confidence (as Counsel for the HPC had put it) attached to the information provided by registrants, was not as clear or as bright as contended." [my emphasis] Furthermore, the Tribunal added "this case came nowhere near the mark". Their decision in favour of the Information Commissioner had indeed been unanimous.
Are you following all this?
I'm new to all this too, but little by little I intend to try to discover something about the particularity of the time we live in, the institutions we invent, the context in which bits of our lives get lived.
From the promulgated decision I learn things that I already knew: "The HPC is established under the Health Professions Order 2001 (the 2001 Order)" and subtle differences from things that I thought I knew: ... "It's main functions are set out at article 3(2) of the 2001 Order as "...to establish from time to time [my emphasis] standards of education, training, conduct, and performance for members of the relevant professions and to ensure the maintenance of those standards." The main objective in exercising its functions is "to safeguard the health and well being of persons using the services of registrants." This is written in The Order. But there is room for interpretation in practise and it is this that is in question at the Tribunal Service.
"The HPC's functions include the maintenance of a register of health professionals and a mechanism, called the Fitness to Practise process (the Process) whereby the conduct and performance of registrants may be investigated and called to account. An adverse adjudication on a registrant's fitness to practise may lead to, amongst other things, a registrant being removed from the register (such that they could not work in their chosen profession) or conditions being attached to the performance of their profession. Members of the public, employers etc, may make allegations to the HPC with regard to the fitness to practise of particular registrants. Such cases are investigated by the HPC and as a preliminary step in the Process a decision will be taken by a Panel of the Investigating Committee whether there is a case to answer. [If not, the Process ends. If so, a new Committee is called for a full hearing." (Quoted from the Tribunal's introduction.)
In the case in question the initial Committee decided there was no case, so Ms Z made her FOIA request to see on what basis this decision had been made. This was refused by the HPC on the grounds that certain exemptions applied, namely sections 30, 40, and 41... So Ms Z made an application under section 50 of the FOIA for a decision by the Information commissioner as to whether her request had been dealt with in accordance with law. After a lot of argy bargy the HPC filed a Notification of Appeal against the Information Commissioner's Information Notice and so triggered this appeal to tribunal.
It's quite Dickensian - we are in the field of law, very particular human relations, and, by the by, a professional practise.
The Tribunal heard evidence from Mr Jonathan Bracken from Bircham Dysen Bell, who were solicitors for the HPC. Mr Bracken had been involved in the setting up of the HPC and had advised on many of its processes, he had drafted most of its rules. He explained to the Tribunal that the HPC had 'moved away' from a punitive disciplinary scheme, and had put in its place the Fitness to Practise regime. It is a process in two stages. These stages were put into question at the Tribunal and Mr Bracken was revealed as lacking (he had to admit that some of his documents 'perhaps were not as well worded as might be') .
The next in the dock was Ms Kelly Johnson, the HPC's Director of Fitness to Practise. She was obliged to say that 'the practise and procedure guidance were living documents and in certain respects in need of revision'. In the course of her evidence she revealed that the information gained in the Process at the early stage could be shared with the competent authorities of the other European Union states, and in addition, circumstances could arise in which the HPC gave the police a registrant's information prior to a 'no case to answer' determination. Registrants are not warned of these possible disclosures.
To cut a long story short, the Tribunal concluded that 'registrants were unaware of the fact that HPC on occasion made disclosures in the public interest... The reality was that the 'aura' of confidence (as Counsel for the HPC had put it) attached to the information provided by registrants, was not as clear or as bright as contended." [my emphasis] Furthermore, the Tribunal added "this case came nowhere near the mark". Their decision in favour of the Information Commissioner had indeed been unanimous.
A public point of view: Paola
Paola commented recently that: From where I am standing, the HPC has been protecting the professional against ACCOUNTABILITY. This has not helped her either: learning of the dire consequences of her many misguided actions and inappropriate interferences would have given her valuable feedback and helped her in her professional development and in her personal growth: the HPC has failed her too...
She continues:
"I always felt that there would be much more value for us in an apology and in a constructive use of the damage done to my son and myself as an opportunity for education and training, awareness and growth. The HPC does not do these things. In fact, and with reference to my previous post, the HPC does not do apologies either. The HPC does not do feelings and emotions and real people full stop..."
Paola's experience reveals more of the nature of this particular bureaucracy. It has been set up not as a pre-packaged or natural object without history, values, or character. It is a kind of living thing that can be assessed as a creature in its own right. In a previous blog I reported that Mr Williamson (one of the FTP panel chairmen) had pointed out that the HPC was similar to the GMC and that had inherited something from its predecessor (housed in the same building, and perhaps employing some of the same administrators and support staff) the Council for Professions Supplementary to Medicine. There is every reason to procede with an enquiry into the nature of this new thing, and not to assume that an organisation has no character nor that such is irrelevant. It is a necessary discipline to consider the character of the HPC and its conduct and to ask if it is fit for purpose.
There are also the unintended consequences. Paola raises this other point. "It seems to me that there may well be another worrying outcome of HPC regulation, a danger inherent in their structure and procedures: that the academic and professional standing of registrants under investigation will have a bearing on the outcome. In other words, that there will be a hierarchy of vulnerability to sanctions ..."
From my random attendance of FTP hearings I could not help but be struck by the absence of genuine cases raised by bona fide patients. So far there has been an angry and aggressive man shouting at an ambulance driver, a frightened colleague wishing to avoid another hearing about his own conduct, a training manager who thought he would be held responsible for an amblance drivers decisions, and a new recruit anxious not to be contaminated by any kind of accusation that she rules had not been obeyed.
The HPC has a particular nature, which has an effect on those it brings within its domain.
She continues:
"I always felt that there would be much more value for us in an apology and in a constructive use of the damage done to my son and myself as an opportunity for education and training, awareness and growth. The HPC does not do these things. In fact, and with reference to my previous post, the HPC does not do apologies either. The HPC does not do feelings and emotions and real people full stop..."
Paola's experience reveals more of the nature of this particular bureaucracy. It has been set up not as a pre-packaged or natural object without history, values, or character. It is a kind of living thing that can be assessed as a creature in its own right. In a previous blog I reported that Mr Williamson (one of the FTP panel chairmen) had pointed out that the HPC was similar to the GMC and that had inherited something from its predecessor (housed in the same building, and perhaps employing some of the same administrators and support staff) the Council for Professions Supplementary to Medicine. There is every reason to procede with an enquiry into the nature of this new thing, and not to assume that an organisation has no character nor that such is irrelevant. It is a necessary discipline to consider the character of the HPC and its conduct and to ask if it is fit for purpose.
There are also the unintended consequences. Paola raises this other point. "It seems to me that there may well be another worrying outcome of HPC regulation, a danger inherent in their structure and procedures: that the academic and professional standing of registrants under investigation will have a bearing on the outcome. In other words, that there will be a hierarchy of vulnerability to sanctions ..."
From my random attendance of FTP hearings I could not help but be struck by the absence of genuine cases raised by bona fide patients. So far there has been an angry and aggressive man shouting at an ambulance driver, a frightened colleague wishing to avoid another hearing about his own conduct, a training manager who thought he would be held responsible for an amblance drivers decisions, and a new recruit anxious not to be contaminated by any kind of accusation that she rules had not been obeyed.
The HPC has a particular nature, which has an effect on those it brings within its domain.
HPC PLG C&P day 2, pm
Towards the end of the HPC PLG for C&P last week the group started thinking about their next meetings. According to the work plan written down by Mr Guthrie, most of these meetings will be taken up with the question of Education and Training/standards of proficiency.
As the group approached this they revived something that Diane Waller had mentioned and parked a bit earlier. It was the question of 'life coaches' and people using other titles but doing similar work. Mr Guthrie had reminded the group that the process was about Protecting Titles, not function. This left the difficult question of figuring out how the HPC could guarantee anyone on its register without recourse to training and validation of practise. There is also the question of what they would do if people simply invented a new title for their work.
This is the way the nightmare works. Having invented a name, they now have to invent a new practise that fits the name and that they can police, otherwise they have no power whatsoever. It is a where the twist in the law is most obvious. The mistake Ian Kennedy and his followers made was to imagine a group of people who were the exception to the rule. The rule was that professionals were not to be trusted, the exception to this rule could alone solve this problem. The exception to this rule is the HPC. When Ian Kennedy said so casually 'why should they [the medics] have the power over life and death' he implicitly also said 'it should be us, who are better'. Which is, of course, nonsense.
What follows is a compact and incomplete account of some of the discussion. I've given it like this as an antidote to the anodyne minutes which reduce all the differences in the group to a single unanimous voice. I have also included their names so that anyone reading this blog might decide to engage in a conversation with any of these people (simple to figure out how through google) on some of the points that they make.
Jonathan Coe (Witness CE) said "The need for standards in professional training is what will protect the public."
Graham Smith (HPC Panel, Physio) linked this to the 'intention to deceive'.
Karen Ablack (UKCP standing in for Kathi Murphy) remarked that 'if people are not doing it [therapy] well enough and they are using my professional title then ...' she left it to her body language to indicate what she would do (flush them down the loo, I guess, she seemed to
indicate poo).
Mary Clark Glass (HPC Panel lay member) said 'we'll get them on it - if you go beyond your skills and competence, you will be called to account'.
Someone said "Prevention is the better protection of the public"
Finally Julian Lousada (BCP) remarked 'we've parked a difficult issue' to which
Diane Waller (chair) replied 'we can be seen to have done justice to the question'.
Sally Aldridge (BACP) then offered to exhume a dead and buried report done by the big 5 some years ago [UKCP, BACP, BPS, BCP, BABCP I think] which had tried and failed to synthesise competencies across the board. Someone else offered another similar dead and buried document, and Peter Fonagy (SfH) offered his NOS. All were eagerly accepted as fodder for the next few meetings.
In this way the work done in these other places by these other people for those other purposes are going to emerge into this tight schedule and could easily be taken up for want of the time to make something more suitable. This is how bad laws get made, and its other people who are going to suffer the consequences without any idea how it happened to them. That's why I'm writing this blog.
As the group approached this they revived something that Diane Waller had mentioned and parked a bit earlier. It was the question of 'life coaches' and people using other titles but doing similar work. Mr Guthrie had reminded the group that the process was about Protecting Titles, not function. This left the difficult question of figuring out how the HPC could guarantee anyone on its register without recourse to training and validation of practise. There is also the question of what they would do if people simply invented a new title for their work.
This is the way the nightmare works. Having invented a name, they now have to invent a new practise that fits the name and that they can police, otherwise they have no power whatsoever. It is a where the twist in the law is most obvious. The mistake Ian Kennedy and his followers made was to imagine a group of people who were the exception to the rule. The rule was that professionals were not to be trusted, the exception to this rule could alone solve this problem. The exception to this rule is the HPC. When Ian Kennedy said so casually 'why should they [the medics] have the power over life and death' he implicitly also said 'it should be us, who are better'. Which is, of course, nonsense.
What follows is a compact and incomplete account of some of the discussion. I've given it like this as an antidote to the anodyne minutes which reduce all the differences in the group to a single unanimous voice. I have also included their names so that anyone reading this blog might decide to engage in a conversation with any of these people (simple to figure out how through google) on some of the points that they make.
Jonathan Coe (Witness CE) said "The need for standards in professional training is what will protect the public."
Graham Smith (HPC Panel, Physio) linked this to the 'intention to deceive'.
Karen Ablack (UKCP standing in for Kathi Murphy) remarked that 'if people are not doing it [therapy] well enough and they are using my professional title then ...' she left it to her body language to indicate what she would do (flush them down the loo, I guess, she seemed to
indicate poo).
Mary Clark Glass (HPC Panel lay member) said 'we'll get them on it - if you go beyond your skills and competence, you will be called to account'.
Someone said "Prevention is the better protection of the public"
Finally Julian Lousada (BCP) remarked 'we've parked a difficult issue' to which
Diane Waller (chair) replied 'we can be seen to have done justice to the question'.
Sally Aldridge (BACP) then offered to exhume a dead and buried report done by the big 5 some years ago [UKCP, BACP, BPS, BCP, BABCP I think] which had tried and failed to synthesise competencies across the board. Someone else offered another similar dead and buried document, and Peter Fonagy (SfH) offered his NOS. All were eagerly accepted as fodder for the next few meetings.
In this way the work done in these other places by these other people for those other purposes are going to emerge into this tight schedule and could easily be taken up for want of the time to make something more suitable. This is how bad laws get made, and its other people who are going to suffer the consequences without any idea how it happened to them. That's why I'm writing this blog.
Max Weber on Structures of Power
"All political structures use force, but they differ in the manner in which and the extent to which they use or threaten to use it against other political organisations." This is the opening sentence of an essay first published in 1921 but written between 1910 and 1914. He is careful to distinguish the differences in the ways different states make use of their structures of power, as he goes on "Not all political structures are equally 'expansive'. They do not all strive for an outward expansion of their power". He speaks of the jealousy of neighbouring states, of the vulnerability of those in possession of colonies to that jealousy, and of the way that proximity and shape might expose some states to invasion from their neighbours. In the opening paragraph he sketches the usual way a structure might acquire domination over another: "by incorporating [others] or making them dependent."
All this can be read in the collection by HH Gerth and C Wright Mills that I have borrowed from my local Lambeth Library, and which I note (not without interest) was first published in 1948.
He goes on to sketch two broad attitudes that political structures tend to have towards those outside their immediate control. They can be more 'isolationist' or they can be more 'expansive', and of course they can change their mind about this along the way. 'On the basis of this power the members may pretend to a special 'prestige' and their pretensions may influence the external conduct of the structure.. Experience teaches us that claims to prestige have always played into the origins of war... Feudal lords, like modern officers or bureaucrats, are the natural and primary exponents of this desire for power-oriented prestige... power for the political community means power for themselves as well as prestige based upon this power."
"For the bureaucrat and the officer, an expansion of power, however, means more office positions, more sinecures, and better opportunities for promotion (even in a lost war)."
After a short excursion into some moments in history describing states favouring isolationist policies (including Roman, Britian, and Spartan) he returns to the question of fear. "The Spartan aristocrats, so far as they were able, quite deliberately limited their political expansion for the sake of isolation. They restricted themselves to the smashing of all other political strucures than endangered their power and prestige. They favoured the particularism of city states. Usually, in such cases, and in many similar ones, the ruling groups of notables (the Roman nobility of office, the English and other liberal notables, the Spartan overlords) harbor more or less distinct fears lest an Imperator, that is, a charismatic war lord, emerge. A tendency towards centralisation of power goes very readily with a chronically conquering 'imperialism' and the war lord might gain the ascendancy at the expense of the power of the ruling notables."
Weber concludes this opening section by returning to the question of money: "Like the Romans, the British, after a short time, were forced out of their policy of self-restraint and pressed into political expansion. This occured, in part, through capitalist interests in expansion."
In order to try to understand the nature of the hpc it is necessary to understand the context which brought it into existence. I've gone back to Weber as a kind of touch stone. I particularly like the way that he sets off without forgetting that human beings are subject to fear, jealousy, aggressivity, and greed. He doesn't emphasise this unduly, he doesn't do it like Ian Kennedy, and he doesn't pretend it isn't part of the scene. It is the sensibility of a novelist in the service of a sort of science, not the raging of a beautiful soul against the sins of the others.
All this can be read in the collection by HH Gerth and C Wright Mills that I have borrowed from my local Lambeth Library, and which I note (not without interest) was first published in 1948.
He goes on to sketch two broad attitudes that political structures tend to have towards those outside their immediate control. They can be more 'isolationist' or they can be more 'expansive', and of course they can change their mind about this along the way. 'On the basis of this power the members may pretend to a special 'prestige' and their pretensions may influence the external conduct of the structure.. Experience teaches us that claims to prestige have always played into the origins of war... Feudal lords, like modern officers or bureaucrats, are the natural and primary exponents of this desire for power-oriented prestige... power for the political community means power for themselves as well as prestige based upon this power."
"For the bureaucrat and the officer, an expansion of power, however, means more office positions, more sinecures, and better opportunities for promotion (even in a lost war)."
After a short excursion into some moments in history describing states favouring isolationist policies (including Roman, Britian, and Spartan) he returns to the question of fear. "The Spartan aristocrats, so far as they were able, quite deliberately limited their political expansion for the sake of isolation. They restricted themselves to the smashing of all other political strucures than endangered their power and prestige. They favoured the particularism of city states. Usually, in such cases, and in many similar ones, the ruling groups of notables (the Roman nobility of office, the English and other liberal notables, the Spartan overlords) harbor more or less distinct fears lest an Imperator, that is, a charismatic war lord, emerge. A tendency towards centralisation of power goes very readily with a chronically conquering 'imperialism' and the war lord might gain the ascendancy at the expense of the power of the ruling notables."
Weber concludes this opening section by returning to the question of money: "Like the Romans, the British, after a short time, were forced out of their policy of self-restraint and pressed into political expansion. This occured, in part, through capitalist interests in expansion."
In order to try to understand the nature of the hpc it is necessary to understand the context which brought it into existence. I've gone back to Weber as a kind of touch stone. I particularly like the way that he sets off without forgetting that human beings are subject to fear, jealousy, aggressivity, and greed. He doesn't emphasise this unduly, he doesn't do it like Ian Kennedy, and he doesn't pretend it isn't part of the scene. It is the sensibility of a novelist in the service of a sort of science, not the raging of a beautiful soul against the sins of the others.
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