Introduction
All of us who work in the field of counselling and psychotherapy, or who have an interest in it in any way, were called to respond to three documents posted on the Health Professions Council (HPC) website on 14th July 2009. The deadline for our responses was 16 October 2009, and the HPC was staggered to receive over 1000 replies. In July I wrote a report to guide some of the training organisations who were formulating their response. This coincided with an invitation to speak at the Psychology of Women Section Annual conference, where I was subsequently invited to submit a report on our HPC experiences for POWS Review. It seems useful to offer you that summer report. It offers an insight into some of the implications of HPC regulation for not only counselling and psychotherapy but for those professions, including practicing psychologist, who are already under HPC regulation.
Here follows the July 09 report …
… Few of us will know much about the background to this consultation but will probably be familiar with the catchphrase that this will ‘protect the public’. However, the lack of proper information, and the surfeit of spin provide an unsatisfactory background with which to approach it. So, it is vital that as many people and organisations in the general field of counselling and psychotherapy as possible respond to the call in order to protect the profession, and hence to protect the practice and the experience of the patient or client for many years to come.
The HPC documents appear straightforward, but are really quite difficult to understand – at times they are just plain baffling. Probably, many people who approach these documents for the first time will find them dull, confusing, and will want to walk away. Here’s an example of what awaits:
“Paragraph 2, Section 8, Education and training (p39): The HPC visits education and training providers to approve pre-registration education and training programmes against the standards of education and training. The standards of education and training are those standards necessary to ensure that someone who successfully completes that programme is able to meet the standards of proficiency for their part of the Register (the threshold standards for safe and effective practise).”
Some may hope they can take a short cut straight to the consultation document, but will find the questions assume an orientation that will need some thought to fully understand. For example, question 3 asks about structuring the register to include child psycho¬therapists as a separate title. This could easily be understood in exactly the opposite way to that supposed by the HPC and go on to produce negative unintended consequences. Most people might think: yes, you need special training to work with children. But this is not what is being asked. The relation between training and registration is not straightforward. The relation between regulation and practice is not straightforward. Nothing here is straightforward.
For the last two years I have been tracking the development of this process, and studying the sociological perspectives. This is a an important moment for the field, and everyone who cares about the tradition of psychoanalytic work needs to engage with it now, the deadline for the consultation is 16th October. There are some particular patches that might throw people off course, and I have tried to clarify these.
A potted history of the new statutory body
It is essential to grasp that this form of regulation is not the statutory regulation that much of the profession has been asking for over the years. That was a demand for power to be passed by statute to the existing professional body that would then administer business on behalf of its field of expertise. The current proposal is quite different and would more correctly be called state regulation. The difference needs to be appreciated when approaching the consultation exercise because the baseline assumptions behind the current proposals represent the complete opposite of what many will be expecting. The two approaches belong to different paradigms and don’t share common assumptions.
The Health Professions Council was created by the Health Professions Order, 2001, a piece of secondary legislation arising from the 1999 Health Act. The following year another piece of legislation (NHS Reform and Health Care Professional Act 2002) created a ‘supreme’ regulatory body, the Council for Regulating Health Professions (later renamed the Council for Health Regulatory Excellence, the CHRE), though the budget supporting it leaves it in quite a weak position. In any event, it is the HPC that receives the statutory powers delegated by Parliament to regulate the profession, not the profession itself. Here is a list of the organisations regulated by the CHRE, which shows the kind of practices regulated within this new regime.
1. General Chiropractic Council (GCC) regulates chiropractors.
2. General Dental Council (GDC) regulates dentists, dental nurses, dental technicians, dental hygienists, dental therapists, clinical dental technicians and orthodontic therapists
3. General Medical Council (GMC) regulates doctors
4. General Optical Council (GOC) regulates optometrists, dispensing opticians, student opticians and optical businesses
5. General Osteopathic Council (GOsC) regulates osteopaths
6. Health Professions Council (HPC) regulates the members of 14 health professions: arts therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists, dietitians, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, practitioner psycho¬logists, prosthetists/orthotists, radiographers, speech & language therapists
7. Nursing and Midwifery Council (NMC) regulates nurses and midwives
8. Pharmaceutical Society of Northern Ireland (PSNI) regulates pharmacists in Northern Ireland
9. Royal Pharmaceutical Society of Great Britain (RPSGB) regulates pharmacists in England, Wales and Scotland
From a Centralist Government point of view, the HPC sits alongside the GMC and GDC under the CHRE. This view tends to obscure the essential difference between the HPC and all those other bodies, and creates the appearance of equality across a set of practices.
HPC, like its overseer the CHRE, has no practical knowledge, expertise or experience, and this is an innovation introduced by academic lawyer Ian Kennedy through his chairmanship of the Bristol Royal Infirmary Inquiry (see also his Reith Lectures published by George Allen & Unwin in 1981 as The Unmasking of Medicine). The CHRE and the HPC are not guided by issues of knowledge or practice, but by the very vague mission given by government: ‘to protect the public’. They are answerable not to their membership, but to the State (incarnated in our time by Her Majesty the Queen Elizabeth II) via the Privy Council (a small team of 2 Lord and 2 MPs representing the Government, and whose membership changes from time to time). The relation between the HPC and its registrants is not one of knowledge, debate or democracy but of policing and control through the creation and application of standards. The HPC constructs standards general enough to apply across all the various professions within its domain, and perhaps this is why 75 of them seem to have been written for functionaries working in the NHS (e.g. ‘recognise the need to monitor and evaluate the quality of practice and the value of contributing to the generation of data for quality assurance and improvement programmes’ 2c.1.iii)
The kind of power that sustains the HPC is quite different from that which sustains the professional bodies. In the latter, the practical work itself forms the basis for organisation: to learn from experience, to transmit knowledge grounded in practice, to create structures of supervision and control of work, to guard access to that work, and to protect those who have chosen to follow the practice from the excess vagaries of life, and thus protect the practice. In this way, society can benefit from the knowledge, expertise, and experience of the profession in question. Some problems that arise in this form of organizing include the rise of cliques who might sometimes exert undue influence on groups, or the tendency towards sloth and greed that is said to accompany success and middle age! The laws of natural justice, of ordinary rivalry and competition, a sense of duty, ethics, and pride – and of course the influx of youth – have traditionally been relied on to hold these tendencies in check.
The HPC, on the other hand, is set up on the understanding that, having no interest in or experience or knowledge of the practice, it will not succumb to the pressures of self-interest, (and by the way, it currently appoints to its Director posts no-one middle aged …). This is supposed to reduce the threat of abuse by cliques, and to make it safe for government to delegate statutory power and responsibility over professions without further need of debate in parliament. Once this assumption is accepted, the Government can satisfy the demands of many professional groups wishing to gain access to statutory power without having to consider a separate Bill and Act for each one of them. This effectively circumvents the debate traditionally deemed necessary when forging a new law.
In practice, the Department of Health must still expend the same amount of work to draft legal documents (Section 60 orders, which refer to section 60 of the 1999 Health Act) for each professional group, but the government is spared the work of debating each one in the traditional manner that would normally turn a Bill into an Act. The debating process is, then, delegated to the HPC who in their turn transform the process by managing it through its Professional Liaison Groups. There are, of course, important differences between the two kinds of debate: notably the structure and space for criticism and dissension is removed in the HPC.
As a result of this historical development, the structure and assumptions of the HPC emerge in opposition to the work of psychotherapy and counselling, and there is reason to be concerned about the effect this will have on practice post regulation. Some training organisations believe that they will be able to reform themselves as ‘buffers’ to protect practitioners from the regulator, some practitioners think they can create their own personal defenses by simply ticking the right boxes, and getting on with things as before. Few people have given detailed consideration to the realities behind these ideas, little literature appears to exist on attempts made to date in this field (but see Michael Power’s work on the Audit Explosion, Max Travers on The New Bureaucracy, Marilyn Strathern and Hari Tsoukas on the Tyranny of Transparency, and of course, Andrew Sparkes’ innovative fictional approach to academia post RAE).
To really understand the grounds on which this consultation is made, it is very important to grasp the consequences that follow from the shift in power base away from practise and towards legal standards. As these standards come back at practitioners from the independent and more powerful organisation (HPC) practitioners will find it less and less easy to take their bearings from the truth of their work. The move towards the HPC is one that gives power to the artifice, and opposes this power to that which comes from the real work. As artificial power becomes more valuable, practitioners will be more concerned that their institutions are well placed in the new system to benefit from that power. This tends to amplify conflict in the field, and polarize positions: it can easily generate a vicious cycle.
The HPC consultation lists about 50 standards applicable to both counsellors and psychotherapists, with a further 3 specific to psychotherapy, and 2 specific to counselling. These latter appear on the last pages and give the HPC something with which to differentiate their register. It is worth noticing that in this context there is no need to protect each title separately, but to ask the practitioner concerned to decide which one they are fit to use. NB: If the HPC are to successfully protect the title of Counsellor they will have to amend the law (HPO, 2001) and specify the field as one pertaining to mental-health wellbeing.
Engaging with the consultation
If you have asked for the consultation document to be sent to you in the post, you will have a thick set of papers printed back to back and held together with a very large staple. If you have downloaded it from the website, you will have three separate documents that you can manipulate a bit more easily. The actual consultation (stapled at the front of the posted pack,) asks 20 highly configured questions and attempts to keep the consultation within the frame already decided. However, question 14 asks whether there are standards which should be added, amended or removed which does allow for something more unexpected to be said.
The longest document is Michael Guthrie’s report. Michael is the Acting Director of Policy and Standards, and in spite of the grand title (and enviable youth) is not experienced in any of the areas that he now has jurisdiction over. It has been Michael’s job to turn the process of regulation into a written record, to negotiate off- stage with the solicitor on questions of legal possibilities, and to make sure the capture takes place with as little fuss as possible. He has produced a rather confusing summary of the outcome of this work, which you could look at on page 3, but that I have edited here for simplicity.
The HPC propose that:
1. The register be structured to differentiate between psychotherapists and counsellors by making each one a protected title.
2. The criteria for transferring databases from existing registers be those laid out on page 29, section 5.3 paragraph 18: i.e. prospective registers need to be clear about criteria for entry onto their register; show how its people meet those criteria; have an obligatory code of ethics tied to a complaints process; demonstrate a well functioning complaints process; CPD; commitment to supervision consistent with theory;
3. The minimum national educational level for entry into the profession for Counsellors be 5 on the National Qualifications Framework, and 7 for Psychotherapists. (This does not mean that a counsellor with level 7 qualifications can enter as a psychotherapist, it only means they have more than the minimum required to enter.) Level 7 qualifications are at a level equivalent to Master's degrees, postgraduate certificates and postgraduate diplomas.
There are 8 numbered sections to the report, but the real business is found in section 4. Michael’s job is to produce an object (Psychotherapy and Counselling) that can be taken into the HPC database, bringing onto the Register as many people in as simple a way as possible. The data will be ‘cleaned up’ later, and the entry level to the database will be ‘gradually raised’ over time. Section 4 is where discussions begin about structuring the register and protecting the titles. Once this is settled – which is essentially a job of setting the shape of the database – the rest of the sections address themselves to the practical difficulties of bringing data across. This is why the proposal is to protect the titles counsellor and psychotherapist. They have rejected splitting the register into more specific areas (e.g. modalities) because the two proposed titles capture everyone concerned. The aim of the HPC is not to protect the various divisions within the field, but to hold a database of practitioners that can pay a fee and be held to account if a complaint is lodged against them. The practitioner has a duty to train specifically for any particular practise they are interested in. The database represents a minimum entry point, and to a large extent has in mind those freshly graduated from university. In fact, it is not really necessary to protect both titles. Once the section of the register is established (Psychotherapy and Counselling) registrants could be given responsibility to choose which title to use, when. This does not actually mean that anyone can be anything, because there is a demand that people only practice at the level to which they are qualified, it is here that the fault line of the HPC is probably most clearly exposed: on the one hand there is enormous reliance on people to do the right thing (which leaves the HPC open to the charge of being irrelevant, ineffective, and wooly), and on the other hand there is a very harsh and punitive public application of law for the minority of people (less than 0.5%) who are reported on, (which leaves the HPC open to the allegation of running show trials). If you want to argue for more specific titles, e.g. modality based, then you should bear in mind that the HPC is not designed to cope with this. To specify modes of practice implies constructing specific standards that allow a lawyer to argue effectively in a fitness to pratise hearing or at a Magistrates court (where use of title may be contested).
Section 5 wonders which existing databases should be transferred from the psychotherapy and counselling organisations already in existence. Section 6 considers how to structure the entry point for individual practitioners who are not already on those lists.
Section 7 is more problematic, and refers directly to Appendix 2. Here is where things can become very confusing unless you appreciate the function of the Standards of Proficiency (SoPs) from the HPC point of view. You will notice that most of the standards begin with the words ‘understand the need to’ rather than ‘be able to’. This is because the HPC see things very much from a mass educator point of view. The University sector is a major source of registrants for the other sections of the HPC register, and the HPC spend a lot of effort laying the tracks for students to roll straight onto the register when they graduate. The parts of the register, then, are not intended to create boundaries around specific sub-practices, as this would create a protected market for the practitioners concerned. From the HPC point of view, they want to make it possible for as many different practitioners to enter onto the database in as simple a way as possible. For our part of the register, this has a direct bearing on the question of working with children. The HPC doesn’t need a separate category for those who work with children. If a separate category is made, then specific SoPs have to be created. The slogan ‘to protect the public’ gets in the way here. The HPC is essentially a database that allows complaints to be made, lawyers to be engaged, and cases to be heard. The protection of the public is not achieved through prevention, nor by enlightenment and it is here that the real tension between ideologies begins to become clear.
Section 8 presents another set of problems. Here is where the HPC begins to exert a backward pressure onto the work of the various training institutions. Even though “The HPC only approves programmes that lead directly to an individual’s eligibility to register and gain access to the relevant protected title for their profession” (paragraph 4). The trainings are only interesting to the HPC in so far as they produce the right shape of data for easy entry onto the register. However, their interest, together with the power invested in them, has a distorting effect on the structure and delivery of training. Here is another potential stumbling block for practitioners. Unless the nature of the HPC is understood, power will be handed over to a body that will not be capable of wielding it wisely.
The list that appears under the title Standards of Proficiency has never really existed until now in our practise. There have been many attempts over the years to find a way to reduce what we do to a centrally applicable list, but the attempt always fail. That the list has now been created is not due to a sudden scientific breakthrough, but because the HPC need it in order to function and set a deadline for its production. It is an artifact of the HPC and has no practical relevance to practitioners nor to training institutions. It will acquire relevance in future in order to satisfy the HPC in their future demands. It is helpful to bear this in mind when reading the list of standards. Many of them have no obvious logic behind them – they were written by a committee under a deadline, and an imperative to appear united.
The Existing, and the Proposed Standards of Proficiency
The Standards of Proficiency have been divided into three numbered groups:
1. Professional Autonomy and Accountability;
2. Identification and assessment of health and social care needs; and
3. Knowledge, understanding and skills.
Each of these sections is split further and given letters, and many have yet a third and even a fourth level of division, giving the impression of structure and order yet it is almost impossible to distill any logic from the sections and the sub-sections. It makes more sense to read them as a managerial agenda.
A second dimension also exists, and has been depicted with three different inks. This distinction refers to the kind of professional implicated in the particular standard of proficiency. The three levels are:
1. All Professionals on the HPC register,
2. The specific section in the register relating to the single profession now known as Psychotherapy & Counselling, and finally
3 either (a) Counsellors or (b) Psychotherapists.
The generic standards will be going forward for review in a separate exercise, though these standards represent a central spine of the HPC. Any comments you wish to make about them will be held until the designated review, but if you want to comment on their impact on counselling or psychotherapy practise, or their relevance for such, then you should certainly make your views known now. Remember, any review of the generic standards will be subject to input from every other profession, and this set of standards are in a sense the back bone of the HPC. All the professions in the HPC are supposed to be equivalent on a certain level - “the Government believes that all professionals undertaking the same activity should be subject to the same standards of training and practice so that those who use their services can be assured that there is no difference in quality” (Trust Assurance and Safety, White Paper 2007, para 7.17).
References
Ian Kennedy (1981) The unmasking of medicine, LondonGeorge Allen & Unwin
Michael Power (1994) The audit explosion, London Demos
Michael Power (1994) The audit society, rituals of verification, Oxford: Oxford University Press.
Andrew Sparkes’ (2007) Embodiment, academics, and the audit culture; a story seeking consideration, Qualitative Research, 7, 581
Marilyn Strathern (2000) The tyranny of transparency, The British Educational Research Journal, V26N3
Max Travers (2007) The new bureaucracy; Quality assurance and its critics, Bristol, Policy Press
Hari Tsoukas (1997) The tyranny of light; temptations and paradoxes of the information society, Futures 29(9) 827-43
Saturday, 21 November 2009
Tuesday, 17 November 2009
Report 34, w/e 13 Nov 09. New UKCP Chair is Andrew Samuels
At 4pm on Monday 9th November the UKCP published its election results on the web. They had been expected at lunchtime.
UKCP election for Chair:
Total votes cast: 3,186
Total votes for Andrew Samuels: 2,108
Total votes for Carmen Joanne Ablack:1,074
Number of eligible voters: 6,714
Number of votes found to be invalid: 4
This was the first time that individual registrants have been eligible to vote in the elections for Chair of the UKCP and Tom Colling of the Electoral Reform Services (the independent charity commissioned to administer the voting) said: 'Turnout was very high when compared to that of other organisations. Fifty per cent is impressive”. This election marks the beginning of a new era for the organisation and is clearly a landslide with grassroots members showing their opposition to the organisational strategy to enter the HPC.
The election process, however, was plagued with bad feeling, bad behaviour and bad administration, and new Chief Executive Officer, David Pink, issued a statement on 4 November in which he said “With James [Antrican’s] support, I am asking the Board of UKCP for an independent, sober inquiry and review. I want inquiry and review, not a witch-hunt. UKCP has new lay trustees who are due to take office on 5 December; I will recommend that they are involved in the review. I think we will need to examine where things went wrong and what could have been handled better, but we need to do all this as part of a process that leads to healing and learning.”
On Saturday 7th November, at The Kings Fund, Cavendish Square, 7 UKCP Chairs, past and present, gathered to tell a story of the UKCP’s pathway toward statutory regulation. James Antrican conceived this idea as part of his final contribution as current Chair (which will be handed to Andrew Samuels on 5 December), and he used his presentation to speak of politics, controversy and power – ‘we are trying to bring psychotherapy into the world’.
The panel of speakers reflected the trajectory of history from Michael Pokorny’s optimistic days at the Rugby Conference with its dreams of independent statutory self-regulation, through to today’s ambivalent desperation about the prospect of the HPC. Michael Pokorny was clear that HPC was not right for this field, but the second speaker, Emmy van Deurzen (93-95), thought it a fantastic opportunity for the UKCP. In spite of her forthright enthusiasm she added that there was ‘a lot of rubbish’ to be cleared up before they entered, and in particular she named the ‘nonsense policy’ on criminal records, and the absurd lack of a mediation process.
Anne Casement’s presentation marked a turning point. It was during her time in the Chair (88-2001) that the Government axed all hopes of statutory self-regulation and announced its intention to impose the HPC. She resigned before the end of her term, and perhaps this would help explain why she used her UKCP talk to praise up the BPC.
Over wine and canapés at the end of the day news seeped out that the HPC had postponed the final PLG meeting, scheduled for 18 and 19 November. Both the Chair and Chief Executive of the HPC attended the afternoon meeting.
The formal notice of postponement was emailed at 1pm on Monday 9th:
• It spoke of ‘potential’ regulation yet proceeded with its intention to regulate.
• It admitted receiving an unprecedented 1000 responses to the consultation.
• It said that the Council meeting (10th December), would consider the analysis of these responses, and invited the PLG to observe.
• It anticipated “the PLG will be reconvened to undertake further work in revising the standards of proficiency”.
• Finally, it mentioned Anne Milton’s meeting from 2 November where: “participants felt that there needed to be more opportunities for discussion and debate both with HPC and within the field, about regulation.” However, any possibility of their exclusion as regulator is pre-empted by their intention “to hold a series of events next year to engage with the wider field”. These events, they say, will feed into the planned continuing work of the PLG.”
During this week some colleagues have been contacted by ‘call centre researchers’. One practitioner said “I've just had a telephone call from someone wanting to conduct a telephone interview on counselling and psychotherapy. She said she was from Skills for Health. When I asked her what it was in aid of, she told me it was something to do with the HPC but could not be more forthcoming. She said there ‘are a lot of counsellors out there who are not properly qualified'. I asked if she could send me the questions in writing but she refused, saying they were all 'on the computer' and the questionnaire could only be administered over the phone. I wondered if this was the start of the HPC/SFH's campaign to discredit anyone who opposes their regulation and/or to gather 'evidence' that there are indeed a lot of therapists 'out there' who are not 'properly qualified'.”
The BPC stage its third Savoy Conference on 26 and 27 November (£390). This series of conferences are run by The New Savoy Partnership, chaired by Jeremy Clarke, Chair of the Association for Psychoanalytic Practitioners in the NHS. Although the stated aim is to increase access for patients to a range of psychological therapies, the political distortion of these events make them seem more and more like a concerted campaign to increase the access of BPC members to jobs in the NHS and control over the training of others.
Any good intentions are buried beneath the more obvious power politics that is running roughshod over any genuine enlightened endeavour. The slogan ‘evidence based practice’ is announced in the very first paragraph of the blurb, and is swiftly followed by a statement that Andy Burnham (current Secretary of State for Health) will speak about the government’s New Horizons Framework. New Horizon takes over from the 10-year plan known as the Mental Health Framework, which saw the creation of a Mental Health Czar (Louis Appleby). It is “about driving up standards of mental health services, but also about promoting public mental health and wellbeing more widely. We want to prevent people getting depressed or mentally unwell in the first place.”
http://www.penninecare.nhs.uk/about/news/news-item/?doc=1421
BACP online Magazine Therapy Today carries letters and news relating to these concerns: The KCL Research: http://www.therapytoday.net/article/show/1427/)
The legal challenge (Bindman)
http://www.therapytoday.net/article/show/1420/
Letters: http://www.therapytoday.net/article/show/1437/
http://www.therapytoday.net/article/show/1439/
http://www.therapytoday.net/article/show/1440/
Against State Reg 2821 Against Over Reg 1711
Thanks to colleagues for their work in generating leads and information. Feedback welcome.
UKCP election for Chair:
Total votes cast: 3,186
Total votes for Andrew Samuels: 2,108
Total votes for Carmen Joanne Ablack:1,074
Number of eligible voters: 6,714
Number of votes found to be invalid: 4
This was the first time that individual registrants have been eligible to vote in the elections for Chair of the UKCP and Tom Colling of the Electoral Reform Services (the independent charity commissioned to administer the voting) said: 'Turnout was very high when compared to that of other organisations. Fifty per cent is impressive”. This election marks the beginning of a new era for the organisation and is clearly a landslide with grassroots members showing their opposition to the organisational strategy to enter the HPC.
The election process, however, was plagued with bad feeling, bad behaviour and bad administration, and new Chief Executive Officer, David Pink, issued a statement on 4 November in which he said “With James [Antrican’s] support, I am asking the Board of UKCP for an independent, sober inquiry and review. I want inquiry and review, not a witch-hunt. UKCP has new lay trustees who are due to take office on 5 December; I will recommend that they are involved in the review. I think we will need to examine where things went wrong and what could have been handled better, but we need to do all this as part of a process that leads to healing and learning.”
On Saturday 7th November, at The Kings Fund, Cavendish Square, 7 UKCP Chairs, past and present, gathered to tell a story of the UKCP’s pathway toward statutory regulation. James Antrican conceived this idea as part of his final contribution as current Chair (which will be handed to Andrew Samuels on 5 December), and he used his presentation to speak of politics, controversy and power – ‘we are trying to bring psychotherapy into the world’.
The panel of speakers reflected the trajectory of history from Michael Pokorny’s optimistic days at the Rugby Conference with its dreams of independent statutory self-regulation, through to today’s ambivalent desperation about the prospect of the HPC. Michael Pokorny was clear that HPC was not right for this field, but the second speaker, Emmy van Deurzen (93-95), thought it a fantastic opportunity for the UKCP. In spite of her forthright enthusiasm she added that there was ‘a lot of rubbish’ to be cleared up before they entered, and in particular she named the ‘nonsense policy’ on criminal records, and the absurd lack of a mediation process.
Anne Casement’s presentation marked a turning point. It was during her time in the Chair (88-2001) that the Government axed all hopes of statutory self-regulation and announced its intention to impose the HPC. She resigned before the end of her term, and perhaps this would help explain why she used her UKCP talk to praise up the BPC.
Over wine and canapés at the end of the day news seeped out that the HPC had postponed the final PLG meeting, scheduled for 18 and 19 November. Both the Chair and Chief Executive of the HPC attended the afternoon meeting.
The formal notice of postponement was emailed at 1pm on Monday 9th:
• It spoke of ‘potential’ regulation yet proceeded with its intention to regulate.
• It admitted receiving an unprecedented 1000 responses to the consultation.
• It said that the Council meeting (10th December), would consider the analysis of these responses, and invited the PLG to observe.
• It anticipated “the PLG will be reconvened to undertake further work in revising the standards of proficiency”.
• Finally, it mentioned Anne Milton’s meeting from 2 November where: “participants felt that there needed to be more opportunities for discussion and debate both with HPC and within the field, about regulation.” However, any possibility of their exclusion as regulator is pre-empted by their intention “to hold a series of events next year to engage with the wider field”. These events, they say, will feed into the planned continuing work of the PLG.”
During this week some colleagues have been contacted by ‘call centre researchers’. One practitioner said “I've just had a telephone call from someone wanting to conduct a telephone interview on counselling and psychotherapy. She said she was from Skills for Health. When I asked her what it was in aid of, she told me it was something to do with the HPC but could not be more forthcoming. She said there ‘are a lot of counsellors out there who are not properly qualified'. I asked if she could send me the questions in writing but she refused, saying they were all 'on the computer' and the questionnaire could only be administered over the phone. I wondered if this was the start of the HPC/SFH's campaign to discredit anyone who opposes their regulation and/or to gather 'evidence' that there are indeed a lot of therapists 'out there' who are not 'properly qualified'.”
The BPC stage its third Savoy Conference on 26 and 27 November (£390). This series of conferences are run by The New Savoy Partnership, chaired by Jeremy Clarke, Chair of the Association for Psychoanalytic Practitioners in the NHS. Although the stated aim is to increase access for patients to a range of psychological therapies, the political distortion of these events make them seem more and more like a concerted campaign to increase the access of BPC members to jobs in the NHS and control over the training of others.
Any good intentions are buried beneath the more obvious power politics that is running roughshod over any genuine enlightened endeavour. The slogan ‘evidence based practice’ is announced in the very first paragraph of the blurb, and is swiftly followed by a statement that Andy Burnham (current Secretary of State for Health) will speak about the government’s New Horizons Framework. New Horizon takes over from the 10-year plan known as the Mental Health Framework, which saw the creation of a Mental Health Czar (Louis Appleby). It is “about driving up standards of mental health services, but also about promoting public mental health and wellbeing more widely. We want to prevent people getting depressed or mentally unwell in the first place.”
http://www.penninecare.nhs.uk/about/news/news-item/?doc=1421
BACP online Magazine Therapy Today carries letters and news relating to these concerns: The KCL Research: http://www.therapytoday.net/article/show/1427/)
The legal challenge (Bindman)
http://www.therapytoday.net/article/show/1420/
Letters: http://www.therapytoday.net/article/show/1437/
http://www.therapytoday.net/article/show/1439/
http://www.therapytoday.net/article/show/1440/
Against State Reg 2821 Against Over Reg 1711
Thanks to colleagues for their work in generating leads and information. Feedback welcome.
Tuesday, 3 November 2009
Anne Millton meets miserable counsellors and therapists and tries to get them talking - Nov 2nd.
The Committee Room in Westminster Hall.
“Never have I been lobbied by so many people as I have on this subject”, said Anne Milton, (Conservative MP for Guildford, and Shadow Health Minister). She had called this three-hour meeting in the Grand Committee Room, Westminster Hall to get a constructive conversation going on the future of regulation for counselling and psychotherapy. Poor old Marc Seale (HPC CEO) was forced to sit up on the stage where 60 people could take careful aim and fire their questions at him throughout the afternoon. She said it had been hard work to persuade him to come, and she only withdrew her proposal to canvass the room on the question ‘HPC or Not” when another CEO present in the room let forth a loud and heartfelt NO!
Seale was there with his Chair, Anna van der Gaag because the mail-bags of MPs have been bursting with letters complaining about the HPC. However, the only other politician in the room was Earl Freddy Howe, the conservative spokesman for health in the Lords. He didn’t speak in the proceedings.
Seale’s opening talk asked ‘in whose interest’ it was to call this conversation, which made him seem like a nincompoop, and some people got quite angry.
I was more interested in Lynne Gabriel’s talk, which came next (Lynne is Chair of the BACP). She noted that the proposed recommendations would create a very different profession from the one that currently exists. This, of course, seems outrageous to her. However, throughout the entire process of the PLG this line has been openly pushed and repeated by HPC Council members, most ardently of all by Professor Annie Turner (Occupational Therapy) who said: ‘it was only when we [OT] realised that we had to stop thinking about what actually happens in practice, and invent an entirely new profession, that we made any progress with HPC regulation.” Could it be said much more clearly than that?
Colin Walker spoke on behalf of MIND, (now at the table due to the absence of Jonathan Coe, CEO from Witness; Coe has been present throughout not only the PLG meetings for Counselling & Psychotherapy, but also for those of Psychologists). He said that there was a shocking lack of evidence of abuse by practitioners in the UK – he meant there was no reliable research in to the reality of the situation which left everyone floundering around in anecdote and hearsay.
The third speaker began by pointing out that HPC opening address had slipped rather quickly into the idea that all regulation was HPC regulation, which then enabled them to spin the argument and imply that all those who opposed HPC were opposed to all statutory regulation. “This is simply not true”, said Darian Leader (College of Psychoanalysts-UK), whose second point touched on the question of human memory. There is a long and well-documented history of argument in favour of statutory regulation, and a long and well-documented history of objection to the HPC as regulator for this field. What is absent is an explanation why people had suddenly changed their minds when the HPC had not changed at all. History has been wiped out. They had forgotten their arguments when they saw ‘the train leaving without them’ - fear had lead them to let go of their beliefs in order to preserve their political position. “This process privileges politics over the best interests of our patients”, Prof Leader concluded.
Then came questions from the floor. There was a call for a convention on the future of counselling and psychotherapy; it was noted how the HPC process had itself been instrumental in producing more and more difference in the field; Marc Seale was told to ‘keep it real’ and to take a step back. Other comments included: there’s too much use of force, authority and coercion in the process; this approach to regulation suffocates practice; I don’t recognise my practice in these standards; every organisation should be consulted; ‘we should be responsible for what our future looks like, the HPC should not tell us or impose it onto us’. There was also frustration in another direction – ‘we’ve had our chance and blown it, so now we must accept the consequences’, and one organisation said wearily, “we are happy with it, regulate us, don’t let this lot hold us back”.
Anne invited the HPC to respond but then found herself giving them advice – don’t irritate people, she said, some of this is just silly, you really have to work harder to keep people with you. And when a PLG member said he didn’t recognise what outsiders were angry with, Anne Milton had to tell him: believe me, this question is real.
(For another account of this meeting, please email info@allianceforcandp.org and request the latest newsletter).
“Never have I been lobbied by so many people as I have on this subject”, said Anne Milton, (Conservative MP for Guildford, and Shadow Health Minister). She had called this three-hour meeting in the Grand Committee Room, Westminster Hall to get a constructive conversation going on the future of regulation for counselling and psychotherapy. Poor old Marc Seale (HPC CEO) was forced to sit up on the stage where 60 people could take careful aim and fire their questions at him throughout the afternoon. She said it had been hard work to persuade him to come, and she only withdrew her proposal to canvass the room on the question ‘HPC or Not” when another CEO present in the room let forth a loud and heartfelt NO!
Seale was there with his Chair, Anna van der Gaag because the mail-bags of MPs have been bursting with letters complaining about the HPC. However, the only other politician in the room was Earl Freddy Howe, the conservative spokesman for health in the Lords. He didn’t speak in the proceedings.
Seale’s opening talk asked ‘in whose interest’ it was to call this conversation, which made him seem like a nincompoop, and some people got quite angry.
I was more interested in Lynne Gabriel’s talk, which came next (Lynne is Chair of the BACP). She noted that the proposed recommendations would create a very different profession from the one that currently exists. This, of course, seems outrageous to her. However, throughout the entire process of the PLG this line has been openly pushed and repeated by HPC Council members, most ardently of all by Professor Annie Turner (Occupational Therapy) who said: ‘it was only when we [OT] realised that we had to stop thinking about what actually happens in practice, and invent an entirely new profession, that we made any progress with HPC regulation.” Could it be said much more clearly than that?
Colin Walker spoke on behalf of MIND, (now at the table due to the absence of Jonathan Coe, CEO from Witness; Coe has been present throughout not only the PLG meetings for Counselling & Psychotherapy, but also for those of Psychologists). He said that there was a shocking lack of evidence of abuse by practitioners in the UK – he meant there was no reliable research in to the reality of the situation which left everyone floundering around in anecdote and hearsay.
The third speaker began by pointing out that HPC opening address had slipped rather quickly into the idea that all regulation was HPC regulation, which then enabled them to spin the argument and imply that all those who opposed HPC were opposed to all statutory regulation. “This is simply not true”, said Darian Leader (College of Psychoanalysts-UK), whose second point touched on the question of human memory. There is a long and well-documented history of argument in favour of statutory regulation, and a long and well-documented history of objection to the HPC as regulator for this field. What is absent is an explanation why people had suddenly changed their minds when the HPC had not changed at all. History has been wiped out. They had forgotten their arguments when they saw ‘the train leaving without them’ - fear had lead them to let go of their beliefs in order to preserve their political position. “This process privileges politics over the best interests of our patients”, Prof Leader concluded.
Then came questions from the floor. There was a call for a convention on the future of counselling and psychotherapy; it was noted how the HPC process had itself been instrumental in producing more and more difference in the field; Marc Seale was told to ‘keep it real’ and to take a step back. Other comments included: there’s too much use of force, authority and coercion in the process; this approach to regulation suffocates practice; I don’t recognise my practice in these standards; every organisation should be consulted; ‘we should be responsible for what our future looks like, the HPC should not tell us or impose it onto us’. There was also frustration in another direction – ‘we’ve had our chance and blown it, so now we must accept the consequences’, and one organisation said wearily, “we are happy with it, regulate us, don’t let this lot hold us back”.
Anne invited the HPC to respond but then found herself giving them advice – don’t irritate people, she said, some of this is just silly, you really have to work harder to keep people with you. And when a PLG member said he didn’t recognise what outsiders were angry with, Anne Milton had to tell him: believe me, this question is real.
(For another account of this meeting, please email info@allianceforcandp.org and request the latest newsletter).
Sunday, 1 November 2009
Is the HPC Legal? STOP AND THINK! says new EU report.
Is the HPC Legal? Stop and Think! says the new report issued by The National Council for Psychotherapy.
Italian Barrister Alessandro Amicarelli was commissioned to make a full analysis of the developments of work conducted towards proposed legislation on statutory regulation of psychological therapy practitioners in the UK via the HPC. What follows is a selection of information commentary and quotes from the first half of this important document. Go to the NCP website to download a pdf for yourself.
Richard Mark of the NCP will go to Westminster Hall on Monday and present Anne Milton with a bound copy of the report, together with a full pack of appendices.
Amicarelli’s 72 page report begins by reminding us that the UK does not have a tradition of State intervention in the liberal professions, and in fact is amongst the most liberal countries in the European Union with respect to regulation. Or at least we used to be. However, after reading this report we may well wonder whether we are about to wander off this noble liberal track and turn into something a lot less familiar.
The report clarifies the most perplexing questions and comes up with some surprises:
• Is this state or statutory regulation? It is statutory, but only because the state has abdicated its responsibility.
• Is HPC independent of or accountable to the Government? It is independent, but only because the state has abdicated its responsibility.
• Is there or is there not a link between HPC, SfH, NIMHE, IAPT etc. NO! But only because the State has not thought it through.
• Why have counselling and psychotherapy not been given their own regulatory body (like doctors, dentists, pharmacists etc)? Who can say? Nobody knows.
• Why is there a different approach to regulation of doctors, dentists, midwives and other related health professions? Who can say? Does anybody care?
• What are the similarities and differences between HPC and its predecessor CPSM? The CPSM allowed professionals to choose, the HPC removes choice.
Italian Barrister Alessandro Amicarelli was commissioned to make a full analysis of the developments of work conducted towards proposed legislation on statutory regulation of psychological therapy practitioners in the UK via the HPC. What follows is a selection of information commentary and quotes from the first half of this important document. Go to the NCP website to download a pdf for yourself.
Richard Mark of the NCP will go to Westminster Hall on Monday and present Anne Milton with a bound copy of the report, together with a full pack of appendices.
Amicarelli’s 72 page report begins by reminding us that the UK does not have a tradition of State intervention in the liberal professions, and in fact is amongst the most liberal countries in the European Union with respect to regulation. Or at least we used to be. However, after reading this report we may well wonder whether we are about to wander off this noble liberal track and turn into something a lot less familiar.
The report clarifies the most perplexing questions and comes up with some surprises:
• Is this state or statutory regulation? It is statutory, but only because the state has abdicated its responsibility.
• Is HPC independent of or accountable to the Government? It is independent, but only because the state has abdicated its responsibility.
• Is there or is there not a link between HPC, SfH, NIMHE, IAPT etc. NO! But only because the State has not thought it through.
• Why have counselling and psychotherapy not been given their own regulatory body (like doctors, dentists, pharmacists etc)? Who can say? Nobody knows.
• Why is there a different approach to regulation of doctors, dentists, midwives and other related health professions? Who can say? Does anybody care?
• What are the similarities and differences between HPC and its predecessor CPSM? The CPSM allowed professionals to choose, the HPC removes choice.
Data transfer - data capture
A distinctive feature of discourse within the HPC is 'data capture'. The organisation is structured around a data-base, and 'data capture' is indeed part of computer-geek-speak. Thanks to the essential work of Max Weber, we don't have to be naive about this expansionist, aggressive, and powerful discourse.
To mistake the HPC for an entity without its own desire might have been Ian Kennedy's folly, but the rest of us don't need to be so daft - especially with the benefit of hindsight.
The HPC stands to gain at least £4m a year in registrant fees by taking on the counsellors and psychotherapists. Sometimes they estimate that this could even be double: £8m a year. No wonder it wants to 'capture' the data. It will allow HPC to send automated invoices, and to follow those invoices with automated legal threats to chuck you in the clink for non-payment and take away your livlihood.
Some of the existing professional organisations have already taken precautions and are restructuring their own membership registers to reflect the objections of those of their members who cannot in all good conscience sign up to the HPC. People must act now to avoid their data being transferred without their permission.
If no special action is taken, then the data is automatically transferred by power of law on the date specified in any future section 60 order. If the professional decides against taking up the possibility of HPC registration their data remains on the database at the HPC 'just in case'. See the letter from Michael Guthrie to Andrew Samuels below.
Power without responsibility, oooh, it is a terrible thing.
To mistake the HPC for an entity without its own desire might have been Ian Kennedy's folly, but the rest of us don't need to be so daft - especially with the benefit of hindsight.
The HPC stands to gain at least £4m a year in registrant fees by taking on the counsellors and psychotherapists. Sometimes they estimate that this could even be double: £8m a year. No wonder it wants to 'capture' the data. It will allow HPC to send automated invoices, and to follow those invoices with automated legal threats to chuck you in the clink for non-payment and take away your livlihood.
Some of the existing professional organisations have already taken precautions and are restructuring their own membership registers to reflect the objections of those of their members who cannot in all good conscience sign up to the HPC. People must act now to avoid their data being transferred without their permission.
If no special action is taken, then the data is automatically transferred by power of law on the date specified in any future section 60 order. If the professional decides against taking up the possibility of HPC registration their data remains on the database at the HPC 'just in case'. See the letter from Michael Guthrie to Andrew Samuels below.
Power without responsibility, oooh, it is a terrible thing.
Monday, 26 October 2009
A round up of recent news
1. Shadow Health Minister Anne Milton calls 3-hour meeting in The Grand Committee Room, Westminster Hall on 2nd November for major stakeholders in the regulation debate for counselling and psychotherapy.
2. Videos are now online from The Alliance conference on 11 October. Independent reports can be downloaded by clicking here.
3. Andrew Samuels is standing for election as UKCP Chair – click here for videos and reports on the process, and click here for the on-line discussion on the UKCP web.
4. BACP rejects the HPC Proposals for regulating Counselling and Psychotherapy.
5. The Maresfield Report published: a thorough analysis of the statistics and expense of the HPC Fitness to Practise regime. Legal challenge to HPC via the well-known London law firm Bindmans. NCP publish 72 page report 'Is HPC Legal' by Italian Barrister A Amicarelli
6. The Kings College and Royal Holloway study, 'Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling' Funded by the General Medical Council and the Economic and Social Research Council – warn of over-regulation failing to provide the best model of patient care.
7. Compliance? Ambivalence? Rejection? A short book of responses to the HPC Consultation signed by 103 members of the Alliance Conference on 11 Oct was delivered to HPC on Monday 12th October, but no acknowledgement has been received.
8. A pamphlet by Arthur Musgrave containing ‘one half of a dialogue with enthusiasts for HPC regulation’ –a fascinating account of a serious attempt to enter a dialogue with those who are strongly in favour HPC of counsellors and psychotherapists.
9. Andrew Smith, Labour MP for Oxford East put a written question to the Department of Health (22 Oct) asking the Minister “If he will make a statement on the rejection by the British Association for Counselling & Psychotherapy of the Health Professions Council's proposed statutory regulation of psychotherapy and counselling.” The rather bland answer can be found by clicking here.
10. The House of Lords Select Committee on Merits of Statutory Instruments argues for less Government reliance on Regulations, in order to leave greater room for the professionalism of practitioners to deliver the objectives of improving learning.
11. 200 members now participate in the Alliance ning blog
12. AHPP (Humanistic Psychology Practitioners) advise members on strategies to avoid data transfer to HPC.
13. Regional groups continue to stage meetings to allow their members time and information to think with – a new meeting in Solent is currently being planned.
2. Videos are now online from The Alliance conference on 11 October. Independent reports can be downloaded by clicking here.
3. Andrew Samuels is standing for election as UKCP Chair – click here for videos and reports on the process, and click here for the on-line discussion on the UKCP web.
4. BACP rejects the HPC Proposals for regulating Counselling and Psychotherapy.
5. The Maresfield Report published: a thorough analysis of the statistics and expense of the HPC Fitness to Practise regime. Legal challenge to HPC via the well-known London law firm Bindmans. NCP publish 72 page report 'Is HPC Legal' by Italian Barrister A Amicarelli
6. The Kings College and Royal Holloway study, 'Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling' Funded by the General Medical Council and the Economic and Social Research Council – warn of over-regulation failing to provide the best model of patient care.
7. Compliance? Ambivalence? Rejection? A short book of responses to the HPC Consultation signed by 103 members of the Alliance Conference on 11 Oct was delivered to HPC on Monday 12th October, but no acknowledgement has been received.
8. A pamphlet by Arthur Musgrave containing ‘one half of a dialogue with enthusiasts for HPC regulation’ –a fascinating account of a serious attempt to enter a dialogue with those who are strongly in favour HPC of counsellors and psychotherapists.
9. Andrew Smith, Labour MP for Oxford East put a written question to the Department of Health (22 Oct) asking the Minister “If he will make a statement on the rejection by the British Association for Counselling & Psychotherapy of the Health Professions Council's proposed statutory regulation of psychotherapy and counselling.” The rather bland answer can be found by clicking here.
10. The House of Lords Select Committee on Merits of Statutory Instruments argues for less Government reliance on Regulations, in order to leave greater room for the professionalism of practitioners to deliver the objectives of improving learning.
11. 200 members now participate in the Alliance ning blog
12. AHPP (Humanistic Psychology Practitioners) advise members on strategies to avoid data transfer to HPC.
13. Regional groups continue to stage meetings to allow their members time and information to think with – a new meeting in Solent is currently being planned.
HPC answers some questions posed by Prof Andrew Samuels
"Dear Professor Samuels
Thank you for your recent emails. I have responded to each your questions in turn below.
1) How many people do you think will be registerable?
Estimates of numbers of psychotherapists and counsellors in the UK do vary by between around 40,000 (the approximate total of individuals on the larger professional bodies' registers / membership) up to around 100,000.
Reaching a more precise figure at this stage is difficult as it is hard to quantify the number of practitioners who may practise outside of the existing self-regulatory systems run by professional bodies and associations. In addition, at this stage it is also difficult to quantify how many practitioners are registered currently with more than one organisation.
I am sorry that I am not able to be more helpful in relation to this question.
2) How many voluntary registers do you think will be involved? How many are above 1,000?
We anticipate at the present time that the numbers of registers we will need to consider for transfer will number around the 30 to 40 mark. However, we may be contacted by other organisations who wish their membership lists to be considered for transfer and there may of course be further registers established or consolidation of registers prior to the opening of any statutory register, which would affect the overall figure.
I know that the registers / membership of the BACP, UKCP, BPC and BABCP all total over 1,000 members / registrants. However, we will know more once we begin the process of making recommendations about which registers should transfer early in the new year.
3) How do voluntary registers get transferred?
In order to introduce regulation for the first time, a Section 60 Order under the Health Act 1999 is required. This piece of secondary legislation has to be passed in Westminster and in Holyrood before the regulation becomes law.
The Section 60 Order specifies which registers will transfer to the statutory register and may indicate any arrangements that need to be entered into between the HPC and the holder of that register. This is a result of discussion between the Department of Health, the organisation and the HPC.
In terms of logistics, we would work with the organisation holding the register to establish the data they hold and compare it to the data we require for registration (name, address, data of birth, etc). The transfer of data would then normally occur electronically with security measures such as encryption put in place to protect data security.
Once the register transfer has taken place and the HPC register opened, we would normally write to everybody that has registered to welcome them to the Register. Approximately one month later the profession would go into ‘renewal’ – every profession renews its registration with us on a two-yearly cycle. Registrants would receive a renewal form and would be given three months in which to complete the form including reading and signing the declarations and returning this to us with payment. Registrants can choose to pay their fees for two years in full, or to pay via a 6 monthly direct debit. If we do not receive a completed form after two months we send a reminder; if a completed form and payment is not received by the end of the three month period, the registrant with lapse from the Register.
An organisation could potentially only send a proportion of names on their list(s); the registers that transfer is controlled by the detail included in the Section 60 Order. For example, when practitioner psychologists became regulated by us on the 1st July 2009, only those who held British Psychological Society practising certificates and who held or held in the past membership of one of the divisions relating to a relevant domain of practice transferred. This is fine detail that would need to be discussed between the Department of Health, the organisation concerned and us prior to the opening of the register. For example, as we register at the point of qualification and do not hold a student register, we would not want to transfer any data relating to students. In addition, we know that some registers differentiate between psychotherapists and counsellors, whilst others do not, and, depending on the final recommendations, we may need to enter into discussions about which parts or sections of registers transfer and to which ‘sub-section’ of the HPC register.
With regards whether someone can refuse their data to be transferred, this is something that an individual would need to take up with the organisation that holds their data (i.e. the holder of the voluntary register); this would also be something which might be covered during discussions with the Department of Health in specifying the registers that transfer in the section 60 order. Once the section 60 order comes into force, that gives the holder of the register the legal permission to transfer the register data.
4) What happens if someone whose data you hold after the transfer of a voluntary register does not re-register? Is it deleted, or held for the purposes of investigation of a protected title?
If someone transfers of the HPC register but does not renew their registration, they will no longer be registered and their name will no longer appear in the public-facing register.
In terms of the data we hold, if someone lapses from our register, their details would remain in our registration database (but no details would be publicly available). In many circumstances, someone may come off our register because they are taking a career break or are going on maternity leave but wish to re-register again in the future. Sometimes individuals also fail to renew their registration on time because of an oversight on their part and need to apply for readmission to the register so that they can begin to practise again. If someone has been previously registered with us, they have to complete an application form. If someone has previously been registered with us, we do not ask for proof of qualification but we ask instead for confirmation that they were previously registered. Subject to checks that the information we require has been received, they will be re-registered under their previous registration number – this avoids potentially creating duplicate entries in our register, ensuring the register remains as accurate as possible.
The information is not retained for the purposes of investigating protection of title offences. However, if we do receive a complaint about the potential misuse of a protected title, our first check is to ensure the person concerned isn’t already registered with us. Sometimes we receive complaints about the misuse of protected titles where the person is already registered with us, sometimes under their maiden rather than their married name or vice versa. In such circumstances we can normally advise the complainant and registrant as appropriate and close the case without the need for further investigation.
5) How do you know who their employer is? Why do you write to the employer?
When someone registers with us or renews their registration, we ask them to provide /update us with a home address and employer / practice address (if they have one). The employer / practice address is used in order to provide information on our online register which includes the approximate geographical area in which the registrant practises. For example, someone who worked in SE11 would have the location ‘London’ listed against their name in the online register. However, their full home or employer / practice address would not be publicly available. Listing a general area on the public-facing register means that a member of the public can easily identify a practitioner as this allows them to differentiate between registrants with the same or similar names.
If the voluntary register holds details on employer / practice address, this will normally be given to HPC as part of the Register transfer. However, this data will sometimes not be held on the voluntary register, or, in the case of a HPC registrant, this information may not have been provided or the registrant may not have kept their details up to date.
When someone lapses from the register, we will write to the employers details (if we have them) within a month to let them know that the individual has lapsed. If someone is not on our Register, then they are legally unable to continue using a protected title. We do not have powers to make any legal requirements of employers directly; it is an individual’s responsibility to renew their registration if they still wish to practise using a protected title.
We write to the known employer following feedback we received from employers who asked us to do this. They wanted to ensure that they met their obligations to ensure that their staff were registered when necessary. In particular, employers want to avoid problems that arise where a member of staff fails to renew their registration but does not advise their employer who is unaware until the next time they check the registration status of members of staff.
The letter we send to employers (if we have this information) advises them that a registrant has lapsed from the registrant and explains that they are legally unable to use the protected title for their profession until they have readmitted to the register.
This letter is only sent where we hold details and where someone has lapsed from the register because they have failed to renew their registration and pay the requisite fee by the renewal date. However, registrants may decide to come off our register at any time by voluntarily asking us to remove their name.
I hope the above is helpful and answers your questions; but please let me know should you have any additional questions or points of clarification.
Kind regards,
Michael Guthrie"
Thank you for your recent emails. I have responded to each your questions in turn below.
1) How many people do you think will be registerable?
Estimates of numbers of psychotherapists and counsellors in the UK do vary by between around 40,000 (the approximate total of individuals on the larger professional bodies' registers / membership) up to around 100,000.
Reaching a more precise figure at this stage is difficult as it is hard to quantify the number of practitioners who may practise outside of the existing self-regulatory systems run by professional bodies and associations. In addition, at this stage it is also difficult to quantify how many practitioners are registered currently with more than one organisation.
I am sorry that I am not able to be more helpful in relation to this question.
2) How many voluntary registers do you think will be involved? How many are above 1,000?
We anticipate at the present time that the numbers of registers we will need to consider for transfer will number around the 30 to 40 mark. However, we may be contacted by other organisations who wish their membership lists to be considered for transfer and there may of course be further registers established or consolidation of registers prior to the opening of any statutory register, which would affect the overall figure.
I know that the registers / membership of the BACP, UKCP, BPC and BABCP all total over 1,000 members / registrants. However, we will know more once we begin the process of making recommendations about which registers should transfer early in the new year.
3) How do voluntary registers get transferred?
In order to introduce regulation for the first time, a Section 60 Order under the Health Act 1999 is required. This piece of secondary legislation has to be passed in Westminster and in Holyrood before the regulation becomes law.
The Section 60 Order specifies which registers will transfer to the statutory register and may indicate any arrangements that need to be entered into between the HPC and the holder of that register. This is a result of discussion between the Department of Health, the organisation and the HPC.
In terms of logistics, we would work with the organisation holding the register to establish the data they hold and compare it to the data we require for registration (name, address, data of birth, etc). The transfer of data would then normally occur electronically with security measures such as encryption put in place to protect data security.
Once the register transfer has taken place and the HPC register opened, we would normally write to everybody that has registered to welcome them to the Register. Approximately one month later the profession would go into ‘renewal’ – every profession renews its registration with us on a two-yearly cycle. Registrants would receive a renewal form and would be given three months in which to complete the form including reading and signing the declarations and returning this to us with payment. Registrants can choose to pay their fees for two years in full, or to pay via a 6 monthly direct debit. If we do not receive a completed form after two months we send a reminder; if a completed form and payment is not received by the end of the three month period, the registrant with lapse from the Register.
An organisation could potentially only send a proportion of names on their list(s); the registers that transfer is controlled by the detail included in the Section 60 Order. For example, when practitioner psychologists became regulated by us on the 1st July 2009, only those who held British Psychological Society practising certificates and who held or held in the past membership of one of the divisions relating to a relevant domain of practice transferred. This is fine detail that would need to be discussed between the Department of Health, the organisation concerned and us prior to the opening of the register. For example, as we register at the point of qualification and do not hold a student register, we would not want to transfer any data relating to students. In addition, we know that some registers differentiate between psychotherapists and counsellors, whilst others do not, and, depending on the final recommendations, we may need to enter into discussions about which parts or sections of registers transfer and to which ‘sub-section’ of the HPC register.
With regards whether someone can refuse their data to be transferred, this is something that an individual would need to take up with the organisation that holds their data (i.e. the holder of the voluntary register); this would also be something which might be covered during discussions with the Department of Health in specifying the registers that transfer in the section 60 order. Once the section 60 order comes into force, that gives the holder of the register the legal permission to transfer the register data.
4) What happens if someone whose data you hold after the transfer of a voluntary register does not re-register? Is it deleted, or held for the purposes of investigation of a protected title?
If someone transfers of the HPC register but does not renew their registration, they will no longer be registered and their name will no longer appear in the public-facing register.
In terms of the data we hold, if someone lapses from our register, their details would remain in our registration database (but no details would be publicly available). In many circumstances, someone may come off our register because they are taking a career break or are going on maternity leave but wish to re-register again in the future. Sometimes individuals also fail to renew their registration on time because of an oversight on their part and need to apply for readmission to the register so that they can begin to practise again. If someone has been previously registered with us, they have to complete an application form. If someone has previously been registered with us, we do not ask for proof of qualification but we ask instead for confirmation that they were previously registered. Subject to checks that the information we require has been received, they will be re-registered under their previous registration number – this avoids potentially creating duplicate entries in our register, ensuring the register remains as accurate as possible.
The information is not retained for the purposes of investigating protection of title offences. However, if we do receive a complaint about the potential misuse of a protected title, our first check is to ensure the person concerned isn’t already registered with us. Sometimes we receive complaints about the misuse of protected titles where the person is already registered with us, sometimes under their maiden rather than their married name or vice versa. In such circumstances we can normally advise the complainant and registrant as appropriate and close the case without the need for further investigation.
5) How do you know who their employer is? Why do you write to the employer?
When someone registers with us or renews their registration, we ask them to provide /update us with a home address and employer / practice address (if they have one). The employer / practice address is used in order to provide information on our online register which includes the approximate geographical area in which the registrant practises. For example, someone who worked in SE11 would have the location ‘London’ listed against their name in the online register. However, their full home or employer / practice address would not be publicly available. Listing a general area on the public-facing register means that a member of the public can easily identify a practitioner as this allows them to differentiate between registrants with the same or similar names.
If the voluntary register holds details on employer / practice address, this will normally be given to HPC as part of the Register transfer. However, this data will sometimes not be held on the voluntary register, or, in the case of a HPC registrant, this information may not have been provided or the registrant may not have kept their details up to date.
When someone lapses from the register, we will write to the employers details (if we have them) within a month to let them know that the individual has lapsed. If someone is not on our Register, then they are legally unable to continue using a protected title. We do not have powers to make any legal requirements of employers directly; it is an individual’s responsibility to renew their registration if they still wish to practise using a protected title.
We write to the known employer following feedback we received from employers who asked us to do this. They wanted to ensure that they met their obligations to ensure that their staff were registered when necessary. In particular, employers want to avoid problems that arise where a member of staff fails to renew their registration but does not advise their employer who is unaware until the next time they check the registration status of members of staff.
The letter we send to employers (if we have this information) advises them that a registrant has lapsed from the registrant and explains that they are legally unable to use the protected title for their profession until they have readmitted to the register.
This letter is only sent where we hold details and where someone has lapsed from the register because they have failed to renew their registration and pay the requisite fee by the renewal date. However, registrants may decide to come off our register at any time by voluntarily asking us to remove their name.
I hope the above is helpful and answers your questions; but please let me know should you have any additional questions or points of clarification.
Kind regards,
Michael Guthrie"
UKCP officer election prompts new thinking on HPC
Reproduced below is a message from Andrew Samuels who has agreed to stand for election as Chair in the UKCP and is using this to bring information and debate alive on the impact of HPC on psychotherapy practice [the highlighting is mine].
"There's a strange and paradoxical feel to this election. Just at the moment when who we are and what we do as psychotherapists is going to be determined by the state, we hold an election in which individual judgement and choice will be decisive in UKCP for the first time. The idea that the future is in our hands is abroad – and at the same time, we are seeing how hard it is for some to truly accept that.
Everyone running for office says they wish to be judged on the issues and I am no exception. But the way this election is shaping up is very worrying indeed. We have seen a number of statements issued by the leadership of some sections that basically instruct their registrants on how to vote. The tone of some of these statements is not what I, for one, would have expected to see in public, as opposed to private discourse.
Equally worrying is the possibility of UKCP Central being manipulated by interests who are palpably opposed to what I am standing for. You should have received your voting papers by now but they have not been sent out. It has been suggested that the reason for this has been to allow for horse-trading between the two candidates from one section so that one would withdraw to avoid splitting their vote. The political tactic is fair enough, but not if it involves voting papers going out after the formally announced date showing only two candidates and not three, as if it were all just business as usual. Anyway, perhaps now really is the moment to focus on the issues.
HPC is not the only problem facing us but it is the one with the pressing time frame. In my position statement, which is included in Item 2 of the three items that follow this message, you will see that I am not trying to make the election into a referendum on HPC. We have other problems to face, both out there in arenas such as NICE and IAPT, and, after the way the election has gone, some pretty dire internal problems as well. I have had something to say about the whole range of issues, not just HPC.
The problem with my candidacy is that it does seek to reverse policy and hence it is an uphill struggle for me. Not least because, quite understandably you could say, the leadership of UKCP and of the sections are deeply implicated in and committed to the HPC policy. Hence they are bound to feel personally affronted if criticised and to take drastic action to stabilise their positions. I respectfully suggest that you, as registrants, do not necessarily share in the back stories of your leaderships, and I am asking you, in the secret ballot, to do your bit to restore UKCP to a commitment to some form of regulation that is more fitting to our values and traditions as psychotherapists.
For, as you will have realised, I am not opposed to all regulation. It has to be the right kind of regulation. That is why I am calling for a Convention on the Future of Psychotherapy and Counselling. There are alternative models for psychotherapy regulation, some of them having been tested in other countries. Yet I have been amazed to find, in discussion with architects of UKCP's regulation policy, that they have never even read the material.
Two ideas are worth noting. The first would be a 'Talking Heads Council', an improved version of the Psychological Professions Council that, only a few years ago, it was UKCP's policy to fight for. The other model is called the Practitioner Full Disclosure List; without going into detail, such a List would definitely safeguard the interests of the public and has other interesting features that might make it more appropriate for our profession.
I have been discussing our future with politicians from all three parties in both the Commons and the Lords. They are, by now, nearly all convinced by the arguments that HPC is wrong for us, though they do differ on how easy it would be to bring about a change. (No-one I have spoken to says a change is impossible or out of the question. They all say that a change will have to be towards a better model of statutory regulation.) There does seem to be a new willingness in Westminster and Whitehall to think again. If we send a clear message via our election that this is what we want, then, given the fact that the politicians will be thinking for a while about their own election, there is a window of opportunity. Nothing legislative that affects us is going to happen before the General Election.
This is what I am going to do about HPC if I am elected. First, I would try to bring the BACP and the BPC on board. Whether that succeeds or not, I will go to HPC and ask them to ask Government for the suspension of the process towards state regulation. Whether that succeeds or not, I will then call upon the Department of Health (and the Shadow health teams in the other parties) to back the call for the Convention on the Future of Psychotherapy and Counselling.
If this all fails, then I will assuredly work as hard as I can to get the best possible deal for UKCP in terms of how the HPC operates its register, and what the standards of proficiency and the criteria for approval as a training organisation turn out to be. I will make sure that we are adequately protected against those claims by BACP that are not sustainable (but support them where they seem to have serious grounds for complaint about the HPC proposals). I will do my best to protect the positions of those who do not wish to register, provided they adhere strictly to the rather stringent conditions of Principled Non-Compliance which are outlined in Item 3 that follows this message. It will not be enough just to do nothing at all.
You will see from this serious and detailed thought that is plain wrong for the HIPS Political Group to claim that I shouldn't even be in the election at all. The statement from this faction of HIPS is causing consternation and protest within their own section due to its defamatory choice of language, misrepresentation of the historical and contemporary facts, and authoritarian tone. Sadly, from the point of view of integrity in our professional life, the statement was distributed far and wide. I am sure it has been damaging to my chances despite the retraction of some of the wilder claims. In Item 2 that follows this message you will see my Response to what the HIPS Political Group sent out. It includes a rebuttal of their statement by a member of the UKCP Board of Trustees. When you read what Paul Atkinson has written, ask yourselves whether the HIPS statement is a reliable guide to how you should vote.
There is an election on and so everyone, including me, will tend to overstate their case. Nevertheless, I must say that the notion circulated by the Family, Couple, Sexual and Systemic Therapies Section that a vote for me will lead to people losing their jobs represents election scaremongering at its best (or worst)! Think about it for a moment. If HPC goes ahead in spite of Samuels, then no jobs will be lost. If there is another system put in place, then everyone will be in exactly the same boat. Again, no jobs will be lost. Opposing HPC won't lead to any losses of jobs. What all this shows is how invested everyone at the top of the professional tree (could we call them our Ruling Class?) is in maintaining control. Hence 'Stop Andrew at All Costs'.
Not everything that has been written is so awful, though, and I am grateful for the measured tone emanating from the Hypno-Psychotherapy Section. My reply to their statement, which is Item 1 following this message, enables me to explain why the Alliance came into being, and to remind everyone that over 850 UKCP registrants have signed the petition against regulation via HPC. No-one knows what the balance of opinion in the profession really is. Even BACP doesn't know and is at present conducting a sort of emergency poll on the HPC proposals. In my Response to the HIPS Political Group, I say it is 'amazing' that we don't know. I think I was pretty moderate in my choice of language. Maybe even after this election we still won't really know, but I will make good on my pledge to hold ballots on all matters to do with regulation in the future.
I am sure that, if elected, I will be tempted to 'go native', and to enjoy meeting with the powerful (and with the interesting) a little too much. I could well get inflated. But I will do my best to be conscious of this. I will certainly try to put a stop to the growing tendency for UKCP Central to develop a life and interests of its own, expressed in a ceaseless stream of authoritarian memoranda. As the Chair of a Member Organisation, I quite naturally get to read all the papers. Hence I feel able to say that our leaderships have got mixed up with the aims and objectives of the bureaucratic approach to civic life that is so prevalent in Britain today. I was first amused and then concerned to see that the latest papers from UKCP Central include documentation presented on forms and using language and notation identical to that used by HPC.
Go interpret!
Returning to the other challenges that face us, I think it is reasonably well known that mine was the first voice to go public about the outrage of IAPT getting all the resources from the government for its watered down version of CBT (apparently not particularly effective, according to their own research). I took a terrible hammering for speaking my mind and, though UKCP notables told me privately to keep on trucking because they couldn't be as direct in the meetings they were attending, they did nothing in public to help. What you can draw from this, in terms of what kind of Chair you want, is that I am likely to be more effective than most (in settings like the IAPT committees) to get the injustices and absurdities redressed. I would also seriously question what we are doing in the Savoy Partnership. I wouldn't advocate our leaving it as yet but we have lost our distinctive voice therein.
Similarly, with NICE, there seems to be this strange reluctance on the part of UKCP to really stick up for the kind of work we do. Either it is that, or we have not yet really worked out a concerted political strategy.
I will conclude on a personal note. I know I can be a difficult person, self-centred and bombastic at times. I am a funny mixture to myself of tough and fragile. Truly, I really didn't want to stand for this job, which is why I say in my position statement (in Item 2 below) that I was 'surprised' to be standing. At 60 years old and enjoying my clinical, academic and political work, and my personal life, I didn't need to do this. But I just felt so damn passionately that something has gone fantastically 'off' in our little world of psychotherapy. So, against my own needs for pleasure and a quieter life, I responded to requests to stand. I do so as an underdog, without the resources that candidates backed by powerful sections have. Could I really win when I have been targeted in the way I have been? We shall see. I am certainly not a 'man in a white suit', no Martin Bell – but I really think I have argued my case that it is time for a rethink by UKCP concerning its policies and its style of doing things.
I was going to say you could stop reading here but then I realised how patronising it would be to assume that you wouldn't be interested when, as they say, the future is in your hands. Please take the time (the election lasts all of October) to read through the material ....
Andrew
Sunday, 25 October 2009
And From Scotland - ministers and servants : democracy inaction [sic]
Below is a letter from Stuart Morgan-Ayrs who is replying to Robert Girvan, who you will see is from the Regulatory Unit of the Scottish Gov (his letter is reproduced below that of Stuart). I've put them in this reversed date order because Stuart's is the more vibrant, alive and interesting, of the two. Robert's is an important testasment to the kind of response many of us have been getting from government ministers and their servants, and it is easy to see the mark of the HPC itself in the reply (hence bringing us again to the question of QUANGOs and their independence from gov and vice versa).
Stuart replied on 24th October with the following:
Dear Robert
Many thanks for your most interesting response.
Sadly it would appear that either the Scottish Government is not staying up to date having ceded this to Westminster, or your colleagues in London are keeping you well and truly out of the loop.
The HPC regulation regarding BPS is proving a failure with a substantial proportion of psychologists refusing to register. A major reason for this is that considering the unregulated nature of the title "psychologist", practicing psychologists are objecting to paying a yearly fee, which gains them nothing, just to add a prefix onto the generic term! By dropping the prefix they do the same job, in the same way, for the same money, save the cash and do not have to sign up to this daft scheme!
If psychologists are doing this, who are mainly employed, how will self employed counsellors and psychotherapists behave? Why should I for example, with qualifications in all three disciplines pay over £70 per year to use the title "counsellor" or "psychotherapist", when I can simply and accurately use the generic term "psychologist", "therapist", "psychoanalyst", "life coach" or "complementary therapist" for free. For those of us with post graduate qualification and over 10 years of professional practice - we do not need silly titles verified by a government quango to sell our wares! It is only going to be the scared and freshly qualified therapists, and those people employed by the NHS that are going to bother registering! Senior therapists like myself will naturally remain professionally accountable and insured through our existing affiliations.
The BACP - one of the largest counselling and psychotherapy bodies, together with many more smaller bodies have rejected the HPC draft proposals. This is driven by the fact that the membership of these professional bodies neither meet the draft proposal requirements, nor agree with this move backwards for the profession. The profession have simply not been consulted, instead a stooge ridden practitioner liaison group was set up (later modified to get rid of dissenters!). For example taking the BACP: 80% roughly of their members (their figures) are not BACP "accredited" but are instead professionals in related industries who use counselling and are currently classed as counsellors, or volunteers. These people will be excluded or face abhorrent costs! Many therapists have already paid out many thousands of pounds for independent training (the usual standard until recently) for good training, which will now be disputed. My own initial training cost over £8,000 for nearly 5 years of training, which I was only accepted on to as a graduate, and which led to an NVQ Level 4 in Training and Development. Highly assessed - highly supervised - high standard - multiple schools of therapy, and soon to be completely ignored.
TWO legal challenges have already been initiated to question and prevent the legislation in it's current form.
A substantial university study and report has also just condemned the HPC proposals as flawed.
A publication of leading therapists in their fields has now been published explaining why the proposals are completely unacceptable. Typically these papers are scribed by professionals with far more credibility in their divisions and schools of thought than anyone consulted by the HPC!
As for the levels of qualification for counsellors and psychotherapists, this is again a bad joke. For years counselling has been accepted as a part of almost any therapy physical, mental or combined, and therefore counselling courses of a vocational nature have arisen, usually at levels 3-5 on the SQA / QCA. Most would not be considered acceptable by the HPC since they require specific content (still undefined) at a minimum level 5 level.
As for psychotherapy - post graduate sounds very nice - but the majority of courses are not university accredited! Therefore at a stroke the multitude of excellent courses, often vocational in nature will be consigned to scrap, because of a figure on the qualification scale pulled out of a closed discussion group! Why for example should a psychotherapist with say 20 years experience and existing diplomas have to retrain? Why should someone with for example a MSc in Psychology ALSO need a MSc in Psychotherapy? Why should a counsellor with level 3 accreditation and years of experience need to jump another 2 levels? And since most of the work is intuitive, why the silly emphasis on academic study anyway? What about persons with dyslexia and other learning restrictions either class, ethnic social or environmental? Counselling is a conversation, not a paper exercise and currently is a suitable career for them. It will not be if you need a university degree though! Why the discrimination against them and in favour of white middle class academic kids? And what about all the styles of psychotherapy and psychology and counselling that have no accredited university courses available? Are you going to criminalise providing these just because the courses have not yet been developed, or simply may never been available? I use Morita and other Eastern forms of psychology in my practice - university level courses are simply not available in these in the UK. Should therapists using these go and study an "approved" method like person centred (with half the history and development) and lose these methods for the public?
It would appear that your department is blindly following a course of action which is also being questioned in Westminster, and that is fundamentally flawed, not least because the HPC failed to adhere to the legal requirements of it's own mandate when (not) identifying whether this form of regulation was appropriate.
There now exist a raft of practical, ethical, philosophical, financial and legal reasons why the proposed HPC regulation is likely to fail or else do substantial damage to the industry.
Incidentally it is surely your responsibility to consult with the voluntary agencies of Scotland who employ counsellors and canvass their opinion? Are you aware that the effect of proposed measures will cause chaos and termination of services across Scotland the rest of the UK? Or are you planning to pay all the registration, grand-parenting, qualification and supervision fees on behalf of all the voluntary counsellors in the whole of Scotland? You might want to consider the bill per volunteer of registration, grand-parenting fee, any training required at undergraduate or post-graduate level to make the grade, and then reassessment! The figures we have seen include over £400 for grand-parenting and university fees can be easily into the thousands!
All that was ever required was an enforced requirement to be professionally registered with an adequate professional body, have full indemnity insurance and adhere to a nationally agreed code of conduct and ethics, with all names held centrally to ensure no jumping between associations in event of dismissal! The associations could easily be required to register all names within one register. Not exactly rocket science!
All the current proposals mean is that many of us are going to re-brand with a different job title rather than compromise our philosophical and ethical integrity if the HPC proposals go ahead. Since the numbers of us declaring this are in the thousands, PLUS the rejection of whole associations like the BACP - all the HPC is possibly going to achieve is causing us all to rename our job titles! What a waste of time, effort and tax-payer's money!
More information on this complete farce that you are signed up to!
http://www.psyreg.co.uk/
http://ipnosis.postle.net/
http://hpcwatchdog.blogspot.com/
http://www.allianceforcandp.org/pages/
Kind regards
Stuart
This is what he replied to:
ROBERT GIRVAN, Regulatory Unit
Scottish Government, Robert.Girvan@scotland.gsi.gov.uk
Dear Professor Morgan-Ayrs
Thank you for your e-mail of 21 September regarding the regulation of psychotherapists and counsellors. I have been asked to reply on behalf of the First Minister, Alex Salmond.
The regulation of these groups is a matter devolved in Scotland to the Scottish Parliament. However, the Scottish Government is currently committed to UK-wide regulation of the health professions, sensitive to Scotland’s needs. This is in the interests of the cross-border flow of staff and consistency in the application of standards across the four countries, as well as public understanding.
The White Paper Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century stated Government plans to introduce statutory regulation for psychotherapists and counsellors as a matter of priority, as what they do carries significant risk to patients and the public. The Health Professions Council (HPC) was the recommended regulator as it was designed to regulate new professional groups and had the most expertise in bringing new professions into statutory regulation and also in regulating a wide range of professions within a common system.
The final report of the Department of Health Extending Professional Regulation Working Group (EPRWG) was published on 16 July. This Group was set up as part of the implementation of the White Paper Trust, Assurance and Safety to take forward work on the scope of professional regulation. The Scottish representative on the Group ensured that our own Extending Professional Regulation Group fed in to the DH Group and vice-versa.
Given the risks presented by these groups, the EPRWG report supports the commitment to regulate psychotherapists and counsellors and recommends that the ongoing work to implement statutory regulation by the HPC should continue. The report can be viewed at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_102824
The HPC regulates by protection of title. Each of the professions regulated has at least one title which is protected in law. We are confident that the statutory regulation of psychotherapists and counsellors will promote protection of the public by restricting the use of protected titles to those who have demonstrated that they are fit to practise, and have the relevant skills, knowledge and aptitudes. Under statutory arrangements, the public will have the choice of whether or not to use a statutorily regulated, registered professional whose standards are explicit.
We are aware that there are a wide range of psychological and knowledge bases from which these psychological therapies have derived. As was the case with the introduction of statutory regulation for practitioner psychologists, for those practitioners who do not qualify for automatic transfer onto the HPC register the HPC will also provide for an interim assessment process known as ‘grandparenting’, which will allow applicants to register with them based on a more individualised assessment of their qualifications and experience.
All four constituent parts of the UK are still in the early stages of work on a regulatory system for psychotherapists and counsellors. As you note, the HPC sought the views of stakeholders with a call for ideas from 23 July 2008 to 24 October 2008. The responses informed the work of the HPC Psychotherapists and Counsellors Professional Liaison Group (PLG) set up to consider issues relevant to the statutory regulation of psychotherapists and counsellors.
The Group consisted of 17 members including representatives from professional bodies, education providers and service users. Their report has now been published and the HPC have completed a further three month consultation. The key issues they consulted on were the titles to be protected, the standards for safe and effective practice and the threshold level of qualification for entry to the HPC register. The outcome of the consultation will help inform the HPC’s recommendations to the Secretary of State and to Ministers in the devolved administrations on the regulation of this group. The consultation closed on 16 October and I hope that you submitted your views to it. The Scottish Government has also submitted a response to the consultation informed by key stakeholders.
There is still a considerable amount of work to be undertaken before statutory regulation can be implemented across the UK. We welcome the views of stakeholders as we move towards regulation, including during the further period of consultation that there will be on the eventual draft Order under section 60 of the Health Act 1999 which will put regulation in place for psychotherapists and counsellors across the UK.
I hope this clarifies the current position.
Yours sincerely
ROBERT GIRVAN
Stuart replied on 24th October with the following:
Dear Robert
Many thanks for your most interesting response.
Sadly it would appear that either the Scottish Government is not staying up to date having ceded this to Westminster, or your colleagues in London are keeping you well and truly out of the loop.
The HPC regulation regarding BPS is proving a failure with a substantial proportion of psychologists refusing to register. A major reason for this is that considering the unregulated nature of the title "psychologist", practicing psychologists are objecting to paying a yearly fee, which gains them nothing, just to add a prefix onto the generic term! By dropping the prefix they do the same job, in the same way, for the same money, save the cash and do not have to sign up to this daft scheme!
If psychologists are doing this, who are mainly employed, how will self employed counsellors and psychotherapists behave? Why should I for example, with qualifications in all three disciplines pay over £70 per year to use the title "counsellor" or "psychotherapist", when I can simply and accurately use the generic term "psychologist", "therapist", "psychoanalyst", "life coach" or "complementary therapist" for free. For those of us with post graduate qualification and over 10 years of professional practice - we do not need silly titles verified by a government quango to sell our wares! It is only going to be the scared and freshly qualified therapists, and those people employed by the NHS that are going to bother registering! Senior therapists like myself will naturally remain professionally accountable and insured through our existing affiliations.
The BACP - one of the largest counselling and psychotherapy bodies, together with many more smaller bodies have rejected the HPC draft proposals. This is driven by the fact that the membership of these professional bodies neither meet the draft proposal requirements, nor agree with this move backwards for the profession. The profession have simply not been consulted, instead a stooge ridden practitioner liaison group was set up (later modified to get rid of dissenters!). For example taking the BACP: 80% roughly of their members (their figures) are not BACP "accredited" but are instead professionals in related industries who use counselling and are currently classed as counsellors, or volunteers. These people will be excluded or face abhorrent costs! Many therapists have already paid out many thousands of pounds for independent training (the usual standard until recently) for good training, which will now be disputed. My own initial training cost over £8,000 for nearly 5 years of training, which I was only accepted on to as a graduate, and which led to an NVQ Level 4 in Training and Development. Highly assessed - highly supervised - high standard - multiple schools of therapy, and soon to be completely ignored.
TWO legal challenges have already been initiated to question and prevent the legislation in it's current form.
A substantial university study and report has also just condemned the HPC proposals as flawed.
A publication of leading therapists in their fields has now been published explaining why the proposals are completely unacceptable. Typically these papers are scribed by professionals with far more credibility in their divisions and schools of thought than anyone consulted by the HPC!
As for the levels of qualification for counsellors and psychotherapists, this is again a bad joke. For years counselling has been accepted as a part of almost any therapy physical, mental or combined, and therefore counselling courses of a vocational nature have arisen, usually at levels 3-5 on the SQA / QCA. Most would not be considered acceptable by the HPC since they require specific content (still undefined) at a minimum level 5 level.
As for psychotherapy - post graduate sounds very nice - but the majority of courses are not university accredited! Therefore at a stroke the multitude of excellent courses, often vocational in nature will be consigned to scrap, because of a figure on the qualification scale pulled out of a closed discussion group! Why for example should a psychotherapist with say 20 years experience and existing diplomas have to retrain? Why should someone with for example a MSc in Psychology ALSO need a MSc in Psychotherapy? Why should a counsellor with level 3 accreditation and years of experience need to jump another 2 levels? And since most of the work is intuitive, why the silly emphasis on academic study anyway? What about persons with dyslexia and other learning restrictions either class, ethnic social or environmental? Counselling is a conversation, not a paper exercise and currently is a suitable career for them. It will not be if you need a university degree though! Why the discrimination against them and in favour of white middle class academic kids? And what about all the styles of psychotherapy and psychology and counselling that have no accredited university courses available? Are you going to criminalise providing these just because the courses have not yet been developed, or simply may never been available? I use Morita and other Eastern forms of psychology in my practice - university level courses are simply not available in these in the UK. Should therapists using these go and study an "approved" method like person centred (with half the history and development) and lose these methods for the public?
It would appear that your department is blindly following a course of action which is also being questioned in Westminster, and that is fundamentally flawed, not least because the HPC failed to adhere to the legal requirements of it's own mandate when (not) identifying whether this form of regulation was appropriate.
There now exist a raft of practical, ethical, philosophical, financial and legal reasons why the proposed HPC regulation is likely to fail or else do substantial damage to the industry.
Incidentally it is surely your responsibility to consult with the voluntary agencies of Scotland who employ counsellors and canvass their opinion? Are you aware that the effect of proposed measures will cause chaos and termination of services across Scotland the rest of the UK? Or are you planning to pay all the registration, grand-parenting, qualification and supervision fees on behalf of all the voluntary counsellors in the whole of Scotland? You might want to consider the bill per volunteer of registration, grand-parenting fee, any training required at undergraduate or post-graduate level to make the grade, and then reassessment! The figures we have seen include over £400 for grand-parenting and university fees can be easily into the thousands!
All that was ever required was an enforced requirement to be professionally registered with an adequate professional body, have full indemnity insurance and adhere to a nationally agreed code of conduct and ethics, with all names held centrally to ensure no jumping between associations in event of dismissal! The associations could easily be required to register all names within one register. Not exactly rocket science!
All the current proposals mean is that many of us are going to re-brand with a different job title rather than compromise our philosophical and ethical integrity if the HPC proposals go ahead. Since the numbers of us declaring this are in the thousands, PLUS the rejection of whole associations like the BACP - all the HPC is possibly going to achieve is causing us all to rename our job titles! What a waste of time, effort and tax-payer's money!
More information on this complete farce that you are signed up to!
http://www.psyreg.co.uk/
http://ipnosis.postle.net/
http://hpcwatchdog.blogspot.com/
http://www.allianceforcandp.org/pages/
Kind regards
Stuart
This is what he replied to:
ROBERT GIRVAN, Regulatory Unit
Scottish Government, Robert.Girvan@scotland.gsi.gov.uk
Dear Professor Morgan-Ayrs
Thank you for your e-mail of 21 September regarding the regulation of psychotherapists and counsellors. I have been asked to reply on behalf of the First Minister, Alex Salmond.
The regulation of these groups is a matter devolved in Scotland to the Scottish Parliament. However, the Scottish Government is currently committed to UK-wide regulation of the health professions, sensitive to Scotland’s needs. This is in the interests of the cross-border flow of staff and consistency in the application of standards across the four countries, as well as public understanding.
The White Paper Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century stated Government plans to introduce statutory regulation for psychotherapists and counsellors as a matter of priority, as what they do carries significant risk to patients and the public. The Health Professions Council (HPC) was the recommended regulator as it was designed to regulate new professional groups and had the most expertise in bringing new professions into statutory regulation and also in regulating a wide range of professions within a common system.
The final report of the Department of Health Extending Professional Regulation Working Group (EPRWG) was published on 16 July. This Group was set up as part of the implementation of the White Paper Trust, Assurance and Safety to take forward work on the scope of professional regulation. The Scottish representative on the Group ensured that our own Extending Professional Regulation Group fed in to the DH Group and vice-versa.
Given the risks presented by these groups, the EPRWG report supports the commitment to regulate psychotherapists and counsellors and recommends that the ongoing work to implement statutory regulation by the HPC should continue. The report can be viewed at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_102824
The HPC regulates by protection of title. Each of the professions regulated has at least one title which is protected in law. We are confident that the statutory regulation of psychotherapists and counsellors will promote protection of the public by restricting the use of protected titles to those who have demonstrated that they are fit to practise, and have the relevant skills, knowledge and aptitudes. Under statutory arrangements, the public will have the choice of whether or not to use a statutorily regulated, registered professional whose standards are explicit.
We are aware that there are a wide range of psychological and knowledge bases from which these psychological therapies have derived. As was the case with the introduction of statutory regulation for practitioner psychologists, for those practitioners who do not qualify for automatic transfer onto the HPC register the HPC will also provide for an interim assessment process known as ‘grandparenting’, which will allow applicants to register with them based on a more individualised assessment of their qualifications and experience.
All four constituent parts of the UK are still in the early stages of work on a regulatory system for psychotherapists and counsellors. As you note, the HPC sought the views of stakeholders with a call for ideas from 23 July 2008 to 24 October 2008. The responses informed the work of the HPC Psychotherapists and Counsellors Professional Liaison Group (PLG) set up to consider issues relevant to the statutory regulation of psychotherapists and counsellors.
The Group consisted of 17 members including representatives from professional bodies, education providers and service users. Their report has now been published and the HPC have completed a further three month consultation. The key issues they consulted on were the titles to be protected, the standards for safe and effective practice and the threshold level of qualification for entry to the HPC register. The outcome of the consultation will help inform the HPC’s recommendations to the Secretary of State and to Ministers in the devolved administrations on the regulation of this group. The consultation closed on 16 October and I hope that you submitted your views to it. The Scottish Government has also submitted a response to the consultation informed by key stakeholders.
There is still a considerable amount of work to be undertaken before statutory regulation can be implemented across the UK. We welcome the views of stakeholders as we move towards regulation, including during the further period of consultation that there will be on the eventual draft Order under section 60 of the Health Act 1999 which will put regulation in place for psychotherapists and counsellors across the UK.
I hope this clarifies the current position.
Yours sincerely
ROBERT GIRVAN
Thursday, 22 October 2009
Playlet: PLG considers the serious questions raised by those who are concerned about the possible negative effects of regulation by the HPC
At the second meeting on the PLG (Professional Liaison Group) for Counselling & Psychotherapy, 28 and 29 January 2009, members were asked to consider the questions raised in the Call for Ideas (Oct 08) which were gathered together under the heading "Conscientious Objection". The arguments and concerns were condensed by administrator Michael Guthrie to a few lines, reproduced below.
Coincidentally, members of the PLG had also recently received a lobbying letter from the College of Psychoanalysts-uk, and a member of the public had placed copies of the Statement of Intent on the table from the Alliance for Counselling and Psychotherapy against State Regulation.
There were, then, a considerable number of objections, each laid out with substantial argument, presented to the PLG to consider. What follows is a small playlet, written from my notes made at the time (I was a silent observer at the back of the room), which presents the way these serious concerns were handled by the meeting:
First, the section from Michael Guthrie’s Summary of Responses to the Call for Ideas, Oct 08
3.2.2 (p37) relating to Conscientious objection.
Summary.
- The Register should be structured to provide for a list of 'conscientious objectors'. A list of 'non-licensed', 'non-certified' psychotherapists exists in the US State of Vermont.
More Information/points for discussion
- The PLG may wish to consider whether such an approach would be meaningful to either members of the public or the profession and achieve the public protection aims of statutory regulation. No known arrangement similar to that in Vermont exists in professional regulation in the UK
MICK: Is Principled Non Compliance a practical option in your opinion?
MICHAEL: I cannot foresee the government being able to accommodate it.
BRIAN: There is a possibility of several different registers springing up all simultaneously with HPC - have you thought of that?
MICHAEL: [nonplussed]
MARY: I’ve looked carefully at the arguments - that people choose willingly to go private and so on. But that’s the same with dentists, and they can do a lot of damage, or estate agents - they can rob you blind. If you are in a position where someone comes to you and you can do harm, then, well, I’m afraid I cannot support it.
ANNIE: Why are they asking the regulator to hold their names on the register if they don’t want to register and be regulated? You can’t have your cake and eat it too you know.
NICK: Are they the registered non-registered?
JONATHON: What is the purpose of regulation? Without statutory regulation people who are known to be harmful will continue to practice. People need to be prevented from practicing. Either it is the regulator or the law, and the law can’t be different for one person than another.
PETER: They could get taken off the Non Register
NICK: Or sent to Vermont
JULIAN: We must not ridicule them - they hold their position seriously, and hold it well.
JONATHON :Not ridicule, but put the facts. The evidence base is clear that there is harm. Best outcome of this process is the vast majority will continue to practice in the way they’ve done before, but bad practitioners will be removed. We have to come back again and again and again to the public protection issues. We are in a New World now. Professional led self-regulation is dead. The Health & Social Care Bill last year said there must be an equal number of lay people on the board as professionals.
PETER: I totally agree. These people - we should take a very firm view. Compared to other professions, psychotherapy is definitely potentially harmful. Five per cent of practitioners cause damage.
[voices off: says who - where's this published? what is the source the paper? what is the evidence? what grounds do you have for that? etc]
… The public is ill-served, the present situation is in-effective. We hope it will become more Evidence Based. A little bit more notice of what is known in general will lead to an improvement in client care. Registration is not new. The medical profession was against regulation. It is an urgent issue for public protection.
LINDA: We should not mock or ridicule these people. But, the public needs protection and therefore we need regulation. Professionals need protection too. I think it is a good move for the profession.
JULIAN: We are a victim of our own rhetoric. Public Protection - we are part of the public, the clinical community is part of the public. Care providers are vulnerable. The public is at risk from us, yes, but we are vulnerable to them too!
CARMEN: It is a philosophical position that these people are taking. It’s not about a ‘them’, there are several different groups. I would not choose the HPC if I had any choice.
JEFF: Other aspirant groups have had this problem.
DI (Chair): We have all been lobbied, lets be frank, but the letter is philosophical. They point to the confusion between State and Statutory Regulation, and raise the question of totalitarianism. [sigh] Look, I've lived in an eastern bloc country, oh, for many years, I know what totalitarianism is, and this is not that. It might look like it from the outside, but it doesn't feel like it inside the HPC. Also they talk of the medical model... No, no [shakes her head slowly from side to side] oh dear...
FIONA: We must take this seriously. They have a petition, and it had 1600 names on it at the beginning of the week, a lot of names on it that I respect. I’m not willingly part of this process. Perhaps I am willingly dragged into it, but only because I believe I decided I had to join in order to try to influence it.
VOICE: The HPC gives public protection. It protects the registrant. It helps with credibility. There is really nothing to do but pay the fee and gain status and credibility.
MARY: And upholding public confidence. It’s a matter of pride to have been recognised by the HPC, to get external validation.
DI: Oo, things are getting a little bit heated. Shall we take a short ten minute break and come back to finish it off?
....... [fade out… and back ]
DI: Right, now, we need to move on.
MICHAEL: Which protected titles do you want to have. We protect titles, rather than function, but we have to police mis-use of title, and we do that through the ‘intention to deceive’. If people don’t register, we won’t have public protection.
CARMEN: Registered counsellor, ok, but what about a registered life coach? I’m quite frightened by that. We need to look after, preserve, make clear, how to deal with the widespread use of the word.
MARY: If we think its right, we’ll do it, and ignore what goes on elsewhere.
CARMEN: If they are not doing it well enough, and they are using my professional title, well...!
MARY: [vehemently] We’ll get them on ‘if you go beyond your skills and competence’. [recovering herself] Prevention is the better protection of the public.
JULIAN: We’ve parked a difficult issue.
DI: But we can be seen to have done justice to the question.
Coincidentally, members of the PLG had also recently received a lobbying letter from the College of Psychoanalysts-uk, and a member of the public had placed copies of the Statement of Intent on the table from the Alliance for Counselling and Psychotherapy against State Regulation.
There were, then, a considerable number of objections, each laid out with substantial argument, presented to the PLG to consider. What follows is a small playlet, written from my notes made at the time (I was a silent observer at the back of the room), which presents the way these serious concerns were handled by the meeting:
First, the section from Michael Guthrie’s Summary of Responses to the Call for Ideas, Oct 08
3.2.2 (p37) relating to Conscientious objection.
Summary.
- The Register should be structured to provide for a list of 'conscientious objectors'. A list of 'non-licensed', 'non-certified' psychotherapists exists in the US State of Vermont.
More Information/points for discussion
- The PLG may wish to consider whether such an approach would be meaningful to either members of the public or the profession and achieve the public protection aims of statutory regulation. No known arrangement similar to that in Vermont exists in professional regulation in the UK
MICK: Is Principled Non Compliance a practical option in your opinion?
MICHAEL: I cannot foresee the government being able to accommodate it.
BRIAN: There is a possibility of several different registers springing up all simultaneously with HPC - have you thought of that?
MICHAEL: [nonplussed]
MARY: I’ve looked carefully at the arguments - that people choose willingly to go private and so on. But that’s the same with dentists, and they can do a lot of damage, or estate agents - they can rob you blind. If you are in a position where someone comes to you and you can do harm, then, well, I’m afraid I cannot support it.
ANNIE: Why are they asking the regulator to hold their names on the register if they don’t want to register and be regulated? You can’t have your cake and eat it too you know.
NICK: Are they the registered non-registered?
JONATHON: What is the purpose of regulation? Without statutory regulation people who are known to be harmful will continue to practice. People need to be prevented from practicing. Either it is the regulator or the law, and the law can’t be different for one person than another.
PETER: They could get taken off the Non Register
NICK: Or sent to Vermont
JULIAN: We must not ridicule them - they hold their position seriously, and hold it well.
JONATHON :Not ridicule, but put the facts. The evidence base is clear that there is harm. Best outcome of this process is the vast majority will continue to practice in the way they’ve done before, but bad practitioners will be removed. We have to come back again and again and again to the public protection issues. We are in a New World now. Professional led self-regulation is dead. The Health & Social Care Bill last year said there must be an equal number of lay people on the board as professionals.
PETER: I totally agree. These people - we should take a very firm view. Compared to other professions, psychotherapy is definitely potentially harmful. Five per cent of practitioners cause damage.
[voices off: says who - where's this published? what is the source the paper? what is the evidence? what grounds do you have for that? etc]
… The public is ill-served, the present situation is in-effective. We hope it will become more Evidence Based. A little bit more notice of what is known in general will lead to an improvement in client care. Registration is not new. The medical profession was against regulation. It is an urgent issue for public protection.
LINDA: We should not mock or ridicule these people. But, the public needs protection and therefore we need regulation. Professionals need protection too. I think it is a good move for the profession.
JULIAN: We are a victim of our own rhetoric. Public Protection - we are part of the public, the clinical community is part of the public. Care providers are vulnerable. The public is at risk from us, yes, but we are vulnerable to them too!
CARMEN: It is a philosophical position that these people are taking. It’s not about a ‘them’, there are several different groups. I would not choose the HPC if I had any choice.
JEFF: Other aspirant groups have had this problem.
DI (Chair): We have all been lobbied, lets be frank, but the letter is philosophical. They point to the confusion between State and Statutory Regulation, and raise the question of totalitarianism. [sigh] Look, I've lived in an eastern bloc country, oh, for many years, I know what totalitarianism is, and this is not that. It might look like it from the outside, but it doesn't feel like it inside the HPC. Also they talk of the medical model... No, no [shakes her head slowly from side to side] oh dear...
FIONA: We must take this seriously. They have a petition, and it had 1600 names on it at the beginning of the week, a lot of names on it that I respect. I’m not willingly part of this process. Perhaps I am willingly dragged into it, but only because I believe I decided I had to join in order to try to influence it.
VOICE: The HPC gives public protection. It protects the registrant. It helps with credibility. There is really nothing to do but pay the fee and gain status and credibility.
MARY: And upholding public confidence. It’s a matter of pride to have been recognised by the HPC, to get external validation.
DI: Oo, things are getting a little bit heated. Shall we take a short ten minute break and come back to finish it off?
....... [fade out… and back ]
DI: Right, now, we need to move on.
MICHAEL: Which protected titles do you want to have. We protect titles, rather than function, but we have to police mis-use of title, and we do that through the ‘intention to deceive’. If people don’t register, we won’t have public protection.
CARMEN: Registered counsellor, ok, but what about a registered life coach? I’m quite frightened by that. We need to look after, preserve, make clear, how to deal with the widespread use of the word.
MARY: If we think its right, we’ll do it, and ignore what goes on elsewhere.
CARMEN: If they are not doing it well enough, and they are using my professional title, well...!
MARY: [vehemently] We’ll get them on ‘if you go beyond your skills and competence’. [recovering herself] Prevention is the better protection of the public.
JULIAN: We’ve parked a difficult issue.
DI: But we can be seen to have done justice to the question.
Wednesday, 21 October 2009
A note on centrism (aka centralisation, and utopian holistic planning)
As you know, my interest in the 'new style auditing' (boosted here in the UK in the 1980s, with the Thatcher/Heseltine innovations in 'new public management') is the way it feeds into a more and more centralised system, giving more and more power to the utopian holistic planner and taking it away from the local folks who not only know what's going on in detail, but who are better placed to do something about a problem in a properly measured way.
So, yesterday's news story about the way that prison inspections led local prison managers to do the unthinkable (move prisoners around in order to second guess the inspectors, and secure a good result in the audit) is shocking but comes as no surprise. The excess of power in the centralist hand produces a contortion at the local level.
What is perhaps more disappointing is the way that those holding the centralised power absolve themselves of the responsibility. Dame Anne Owers was on the BBC saying that the moved would have had no effect on the inspection. Centralist utopian planners are as easily hoodwinked by the system they enjoy, as those who are subjected to it.
To parody it: the centralist thinks that the resulting perversion of duty amongst the local managers is a confirmation of their own prejudice - these guys need tough inspections to make sure they don't step out of line. A rather stupid but effective vicious circle is set up, exactly like the one that informs the HPC: 'those local practitioners need to be watched, in order to protect the public' is soon followed by, 'ooh, look what they are doing, I told you they had to be watched'.
As long as the centralist refuses to subject him or herself to even a little bit of self reflection, the system can carry on ad infinitum, and produce more and more horrendous results. A self fulfilling prophecy, and the destruction of a once pretty decent country.
So, yesterday's news story about the way that prison inspections led local prison managers to do the unthinkable (move prisoners around in order to second guess the inspectors, and secure a good result in the audit) is shocking but comes as no surprise. The excess of power in the centralist hand produces a contortion at the local level.
What is perhaps more disappointing is the way that those holding the centralised power absolve themselves of the responsibility. Dame Anne Owers was on the BBC saying that the moved would have had no effect on the inspection. Centralist utopian planners are as easily hoodwinked by the system they enjoy, as those who are subjected to it.
To parody it: the centralist thinks that the resulting perversion of duty amongst the local managers is a confirmation of their own prejudice - these guys need tough inspections to make sure they don't step out of line. A rather stupid but effective vicious circle is set up, exactly like the one that informs the HPC: 'those local practitioners need to be watched, in order to protect the public' is soon followed by, 'ooh, look what they are doing, I told you they had to be watched'.
As long as the centralist refuses to subject him or herself to even a little bit of self reflection, the system can carry on ad infinitum, and produce more and more horrendous results. A self fulfilling prophecy, and the destruction of a once pretty decent country.
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