Template letter for your MP: News of Judicial Review of HPC

[Below is a text you might use to write to your MP, and perhaps the other election candidates, to let them know the issues. It has been prepared by the organisations connected to the JR process]

I think you will be interested to read this update on the judicial review of HPC's process regarding the proposed regulation of therapists and counsellors.

The judicial review of HPC is now in its first stage. Documents prepared by Dinah Rose QC and John Halford of Bindmans have been sent to the High Court which point to problems with the HPC's actions to date. It had been charged with assessing the regulatory needs of counselling and psychotherapy and whether its own system was capable of accommodating this field, yet proceeded as if this was a foregone conclusion. Despite stating several times unequivocally that it had not made any attempt to study these questions, HPC could then write to the Department of Health in December 2009 claiming that it had in fact done so. Attempts to query this contradiction proved fruitless.

The JR papers discuss and document this, as well as other major failures in the process, which indicate that the HPC did not approach its work in a rational or fair way. Alternative models of regulation were not given proper consideration despite being repeatedly brought to HPC's attention. Key questions about the nature of the talking therapies were ignored, and hardly any of the HPC's criteria for regulating professions, such as homogeneity of knowledge base or practice, are applicable to our highly diverse field.

The first set of documents will now be scrutinised by the courts. The instructing organisations are The Association for Group and Individual Psychotherapy, The Association of Independent Psychotherapists, The Centre for Freudian Analysis and Research, The College of Psychoanalysts-UK, The Guild of Psychotherapists and The Philadelphia Association. Funding of the review has been made possible by contributions from thousands of therapists and members of the public who feel strongly about the issue.

Significantly, the Department of Health has now said that it has "taken no view of the legality of the decision and recommendations [of HPC ] and will await the Administrative Court's decision on the claim. In the meantime the Department intends to continue work in relation to assessing the costs and benefits of different models of regulation for psychotherapists and counsellors". This is an important statement, as until now the DoH has simply repeated that it will regulate the talking therapies via HPC, and the HPC itself has refused to discuss different models of regulation. The fact that other models are being studied is real progress, and we hope that the DoH will work with our organisations and examine the models used in other countries, where regulatory arrangements have been arrived at that are satisfactory to both government and the field itself.



Problems with HPC


Since the 2007 White Paper '`Trust, Assurance and Saftey', the Department of Health has given the Health Professions Council the task of assessing the regulatory needs of the talking therapies and its own suitability to regulate them. This brief, however, was understood as an imperative to regulate, with a resultant neglect of representations from the field and no questioning of the suitability of its own regulatory framework.

The Health Professions Order states that any profession to be regulated by HPC “must cover a discrete area of activity displaying some homogeneity”. Counselling and psychotherapy constitute a diverse field and display little homogeneity. Many therapies do not consider themselves or advertise themselves as health professions. They focus on human relationships and not medical-style interventions with set outcomes or promises of cure. Unlike health professions, many therapies do not aim at removal of symptoms, but at an exploration of human life, understood in a variety of ways.

HPC has claimed recently that it is able to encompass relationship-based work, pointing to its apparently successful regulation of psychologists and arts therapists, yet there are very significant differences between these fields and our own, and there are many psychologists and arts therapists who feel that their work has already been compromised by HPC. Crucial to our work is the way in which elements from early life may be re-enacted in the therapy, and the long process of exploring this is generally not shared by these other fields.

The consultation process initiated by the Department of Health was intended to assess the feasibility and suitability of state regulation through dialogue with all of the professional field. However, the consultation process became monopolised by a small number of people with a narrow view of talking therapy. This reliance on a small number of people with a set agenda has created the illusion that counselling and psychotherapy are a homogenous field. It has also meant the wholesale exclusion of professional groups and user groups, despite initial inclusion in draft documents.

The key issue in the regulation debate has been protection of the public. Therapists accept that their clients need the highest possible form of protection from inadequate and unethical practitioners. No therapy organization or individual has argued against this principle. Indeed, therapists have consistently been open and active to strengthen the effectiveness of their current systems by all reasonable means. However, there is no research based evidence suggesting that the client-group here is in the degree of danger that would justify being forced into a type of regulation that, in many respects, is unsuitable and unworkable for current professional practices.

HPC complaints procedures are formal and adversarial. Most complaints in the field of the talking therapies are resolved by informal process and mediation. HPC gives no place to these processes, and thereby risks alienating potential complainants who do not wish to enter into such formal procedures, held in public with none of the confidentiality that a hearing may require. It also lacks the expertise to deal with the complexity of complaints in this field. Note that HPC reject more than 70% of complaints from the public as 'no case to answer' compared to around 10% in the main therapy organisations. As HPC states on its website, if they don't think a complaint will have a clear outcome, they won't hear the case, in contrast to the acceptance of complex complaints by therapy organisations.

HPC focus on two central issues regarding protection of the public: that any unscrupulous individual may set up a brass plate advertising their services as a therapist, and that, once struck off by a professional body, a therapist can simply continue to practise independently. Yet neither of these concerns is addressed by HPC regulation. HPC regulate professional titles not functions, so as long as the individual does not use a title protected by HPC, they can set up shop through use of any unprotected title: life coach, mentor, therapist, lifestyle consultant etc. Other models of regulation used abroad are much more effective, yet to date HPC have refused to examine them.

The HPC brings with it mechanisms that may be suitable for professions allied to medicine, but which threaten the survival of the very essence of psychotherapy. Therapy is forced into a one-size-fits-all model of healthcare intervention, with its focus on outcomes and protocol-based procedures. By marginalizing and even making illegal those forms of therapy which follow a different model, HPC regulation would deprive the public of their free choice of which therapists to consult.



The Regulation Debate



The field of counselling and psychotherapy in the UK is rich and diverse, with several hundred different schools and orientations. Approaches to therapy differ enormously: some therapies focus on symptom-relief, some specifically avoid this; some aim at insight into unconscious phantasies, some reject the very notion of an unconscious; some try to bolster a patient’s belief-system, some to undermine it; some encourage physical warmth, some proscribe this; some aim to get patients back to work, some do not. The range of practices is extraordinarily wide, and the public benefits from a choice as to this range of different approaches.

Since the early 1970s, the field has organized itself into a small number of umbrella organizations - UKCP, BACP, BPC - which have worked progressively on codes of ethics, practice and complaints procedures. There have been various attempts over the years to add a statutory framework to the field’s own set of procedures, yet these have been consistently ignored or rejected by government. Nearly every practitioner currently working in the UK belongs to a professional association with codes of ethics, practice and complaints procedures, which is inspected periodically by its umbrella organization. These codes were found by the UKCP-BACP mapping project, funded by the Department of Health, to fulfill or exceed HPC requirements.

This situation has not been especially controversial, yet calls for statutory regulation have been made by some therapists and lay people for the following reasons: there is nothing to stop any untrained person setting up a brass plate calling themselves a therapist; if a therapist is expelled from their professional organisation, there is nothing to stop them continuing to practice elsewhere; there are a small number of therapists who do not belong to any organisation and so are not subject to any agreed codes of ethics, practice and complaints procedures. These three factors are deemed to represent a significant risk to the public, which is the main reason given for statutory regulation.

The scare stories circulated to the media by HPC and by Witness, an advocacy group that the HPC has worked closely with and that is largely funded by the DoH, serve to inflate the risks involved and confuse the relevant issues. No therapy organization in the UK to date has shown any opposition to regulation. The question for them is whether HPC regulation is the best way to deal with these issues of protection of the public. HPC regulates professional titles, so if it regulated the title ‘psychotherapist’, it would be illegal for anyone to use this title without being HPC-registered. Likewise, being struck off the HPC register would make it illegal for someone to continue to offer services as a psychotherapist. This seems to solve the issue of public protection, yet HPC regulation in fact fails to do so since the practitioner may simply set up shop using another title not regulated by HPC: life coach, therapist, life skills advisor, mentor etc. It thus fails to deal with the brass plate argument or the practicing after expulsion issue.

Even if it were to close these loopholes by regulating functions and not simply titles, HPC regulation poses a number of very serious problems to the field of the talking therapies. It subscribes to outcome-based notions of health and wellbeing which are rejected by many schools of therapy, as well as redefining the actual concept of therapy itself. Therapy is defined as the correction of developmental and psychological dysfunction via the application of a set of techniques to the patient. Yet many schools of therapy see their work as totally opposed to this model based on the health/illness framework. For them, therapy is a joint work, a collaborative effort to explore human life, with no manifest aims to ‘correct’ dysfunction or promote health.

The very notions of health, wellbeing, normality and dysfunction are rejected by many schools of therapy. These schools of therapy have a tradition of social critique, and distance themselves from the contemporary industry of ‘wellbeing’. Terms like ‘health’ and ‘wellbeing’, they argue, often carry a political agenda in any given society, and the work of therapy has to go beyond them. Psychoanalysis, for example, has always aimed to subvert received forms of knowledge, and hence the current objection from most of the UK’s psychoanalytic groups to subsume analysis into a framework which is based on received forms of knowledge and power.

Given that the notions of health, wellbeing and illness run through HPC regulations, and influence its requirements regarding education and training, conduct, performance and the hearing of complaints, they naturally see HPC as unsuited to regulate their work. To construe therapy as a set of techniques to be applied to a patient, rather than as a relationship, an ongoing work between two people which can have no predictable outcomes or set goals, is to misunderstand its basic principles and ethics. HPC has redefined therapy though a medical lens which is not appropriate to the relationship-based paradigm of analysis and many therapies.

HPC uses a model of health professions as service industries: a client pays an expert for a service, which they deliver. But for many schools of therapy, the service is actually provided by the patient. Like an artist’s studio, the therapist provides a space where the patient can create something, following their own rhythm and logic. Therapy is thus not about the performance of any procedure. No outcome can be predicted in advance and so, contrary to the service industries, it is not self-evident what product the patient is paying for. This inherently risky work is clearly not served by pretending that its results and procedures are clear, predictable and transparent.

So where medical interventions may involve set outcomes which the patient could complain about if not achieved, many therapies are about the open-ended work done not by the therapist but by the patient. One could visit a therapist’s office for years and not actually be doing a therapy, in the sense of being authentically engaged in an activity of self-exploration. Therapy, for many schools, is about what the patient manages to invent and construct in their encounters with the therapist, who does not apply the kind of protocol-based procedure envisaged by HPC.

Likewise, some schools of analysis and therapy hold that patterns of thought and behaviour that produce suffering in the patient derive from childhood responses to what is unknown and unpredictable in their caregivers. The compulsion to please others, for example, may have its roots in interactions with an erratic and unpredictable parent. Therapy will play out this situation, so that the therapist may behave in an erratic and unpredictable way, allowing an access to the process by which the patient’ patterns of response were established. HPC’s emphasis on clarity of communication and behaviour may fit a small group of therapies, but cannot subsume this latter model.

Many clinicians who do not subscribe to the healthcare model see their work as an exploration of the human condition, a journey in the same sense that becoming a Buddhist monk involves a long process of questioning one's life, ideals and expectations. Like a Buddhist training, this long process of psychotherapy cannot be identified with a set of techniques or procedures to be applied to a human being, but forms rather a strange kind of relationship which operates in unpredictable and unexpected ways. One cannot know what will happen in advance, and change often takes place through surprise, bafflement, shock and disappointment. HPC regulates professions within a framework which explicitly aims to remove these variables, and so it cannot accommodate those therapies which give a valued and central place to risk, shock and disappointment, seen as tools of growth and development. With HPC, will therapists really continue to challenge their patients or, fearing complaint, will they little by little change the way that they work?

A further and critical reason for the unsuitability of HPC as regulator lies in the field of ethics. Psychotherapy has, for the last 100 years, offered the patient a system of values freed from the moral judgments of social authorities. This has indisputably been the central characteristic of psychotherapy and what set it aside from the mental hygiene movement and from techniques of social engineering. Therapy provides a space for challenging received wisdom, social imperatives and norms of all kinds. Yet HPC regulation, for many schools of therapy, would involve the wholesale application of such norms to the therapeutic encounter. The therapist would have to become a ‘health professional’, whose practice must adhere to a moralistic and normative framework. Failing this, the practitioner would be struck off.

This tension between psychotherapeutic ethics and social morals is a crucial issue, yet it must not be misunderstood to suggest that therapists see their work as somehow beyond the law. All therapy organisations agree that rigorous codes of ethics and conduct must be in place, as well as complaints procedures. In the event of any instance of sexual assault or financial fraud, the criminal justice system should be appealed to. In line with international practice, in other cases, mediation and informal resolution of complaints are the first step, rather than automatic escalation of a complaint to the level of litigation.

For some critics of traditional models of regulation, mediation and informal resolution are a profession’s way of avoiding responsibility for mistakes and misconduct. Yet escalation to the level of litigation and formal complaint may constitute barriers to real resolution of issues for those working within a non-healthcare model. For those therapies that are relationship-based, the parallel is less with HPC-regulated disciplines such as radiology or physiotherapy than with the introduction, encouraged by government, of mediation procedures as a first step when the divorce of a married couple is considered. Although this might seem surprising, it reflects more accurately the kind of problems some patients may experience in therapy - which, for many schools, is about re-living problematic relationships from the past – than the model of a failed medical intervention.

Yours sincerely

Guest post by Bruce Scott on the FTP hearing of Malcolm Cross

A case of dialectical disease: A tale of a Health Professions Council fitness to practice hearing of a psychologist.

Bruce Scott
Philadelphia Association, London

Whilst attending the Health Professionals Council fitness to practice hearing of Dr. Malcolm Cross on the 15th and 16th of March 2010, a conversation came to mind that took place between the playwright and poet Goethe and the philosopher Hegel in 1827. Their conversation highlighted the problem of “dialectical disease” of what this hearing, I felt, was suffering from. The conversation between Goethe and Hegel went as follows:

The discourse then turned upon the nature of dialectics. “They are in fact” said Hegel, “nothing more than the regulated, methodically-cultivated spirit of contradiction which is innate in all men, and which shows itself great as a talent in the distinction between the true and the false.”
“Let us only hope,” interposed Goethe, “that these intellectual arts and dexterities are not frequently misused, and employed to make the false true and the true false.”
“That certainly happens,” said Hegel; “but only with people who are mentally diseased.”
“I therefore congratulate myself,” said Goethe, “upon the study of nature which preserves me from such a disease……I am also certain that many a dialectic disease would find a wholesome remedy in the study of nature.”

It became clear during the course of the hearing that it was afflicted with this “dialectical disease” as they (i.e. lawyers, judging panel, complainants etc) were focussing upon and arguing about the notion of what amounts to “misconduct”. In effect they were trying to make the false true and the true false in their logical argumentations of what constitutes misconduct. As I sat in stunned silence, a fear came over me. I felt unsafe amongst these diseased dialecticians as the concerned parties , for what appeal to reason, or to nature as Goethe advocated, would or could be heard? Human nature had been left aside, human freedom had been forgotten, and common sense had been replaced by an authoritarian pseudo-psychological medico-empirical scientific dialectic pertaining to the notion of misconduct that was divorced from any “alternative” or freer way of looking at misconduct (if it could be called that). This lead to an abusive and violent hearing and sad conclusion to the hearing. Let me explain why.

The facts of the case have recently been circulating within various media (i.e., newspaper reports), but let me summarise . Dr Cross was the Chair of an accreditation team (4 in total) visiting a university to carry out its evaluation of a university counselling psychology course to see whether it was up to the job of being accredited with British Psychological Society (BPS) validation. The team met the night before at a hotel and had a brief discussion about the paperwork and any issues pertaining to the accreditation visit. Dr Cross felt (as Chair of this team) that there was very little to go over and that everything was in place for the visit the next day. Then team then went for dinner to a restaurant along with the wife of one of the team members. At dinner wine was drunk (4 bottles in total) and everybody was drinking. Dr Cross was not working as a psychologist at this dinner; neither were any other of the team in their respective roles. It was purely a social occasion. I will relate the facts of what happened during this meal in a moment, but suffice to say, Dr. Cross carried out his duties the next day as the head of the accreditation team perfectly well. Indeed, all the members of the team, which included the two complainants against him, described his performance the next day as “exemplary”. So one might ask what was the problem that occurred the evening before?
During the course of the dinner (and short informal meeting before dinner) Dr Cross was accused of:

1) Being drunk (at the dinner and when he arrived at the hotel for the informal accreditation discussion).
2) Being rude, lewd and condescending during the course of the evening.
3) Touching himself in a sexual manner.
4) Making sexual gestures to two of his colleagues: trying to kiss, express his love and offer oral sex to one colleague and touching the leg of another.

Some people may jump to the conclusion that these events are indeed misconduct and in need of judicial/HPC treatment. Such people might shout, “What! A psychologist drunk, rude, condescending and being sexually disinhibited! What scandal, strike him off, take him to the gallows!” Well obviously some people did, and it went through the laborious administrative process at the HPC and thence to hearing.

Here is an extract from a clinical psychology internet forum from a blogger after I had alerted their attention to the case of Dr Cross and the nature of HPC hearings . This blogger’s comments highlight the pervasiveness of diseased dialectical processes in the pro-HPC camp. It clearly does not see everything as it is in the clearing to quote Heidegger .

“….it would be highly concerning to me that such behaviour might have an impact on the people they work with, and beyond a certain threshold it would be appropriate to make a complaint. After all, a complaint is then investigated and a hearing is held, where parties can appoint solicitors, in which the person can challenge the allegations, and other witnesses can be called, and their peers can comment on their behaviour and what is outside of acceptable limits.”

Well, that makes it all ok then! Bring on the trial, justice will be done, the law will prevail – or does it?

The HPC lawyer cross-examining Dr Cross obviously believed in such a process. In her summing up of the case she brought the hearings attention to point 3 of “the Standards of conduct, performance and ethics” of an HPC registrant. This states:

“You must keep high standards of personal conduct, as well as professional conduct. You should be aware that poor conduct outside of your professional life may still affect someone’s confidence in you and the profession.”

Following on from this, point 4 on the Standards of conduct, performance and ethics states:

“You must tell us (and any other relevant regulators) if you have important information about your conduct or competence, or about any other registrants and health professionals you work with.”

The HPC lawyer then went on to argue that one has to consider the wider public policy (i.e., protection of the public). She argued that Dr. Cross’s behaviour was evidence of misconduct and was of interest to the confidence and safety of the public as he is a psychologist and treats vulnerable people. Concluding, she argued that the alleged misconduct of Dr Cross is evidence of his impairment of his fitness to practice. She referred to a case brought to the attention of the General Medical Council a few years ago where a Doctor had crossed the boundaries of the patient-doctor relationship (the Doctor had sex with his patient which was consensual). When I heard her mention this case I thought to myself what relevance is this to Dr Cross’ case.

These assertions of misconduct were bolstered earlier in the hearing by the fact that one the complainants (a psychologist) argued, whilst on the stand giving evidence, that Dr Cross’s behaviour was indicative of a potential serious problem that needed to be addressed. Don’t forget, this complainant had also been drinking on this evening. He confessed to drinking three glasses of wine. Perhaps it was more, maybe 4, or 5 perhaps. The second complainant (a British Psychological Society secretary whose role it was to takes minutes during the accreditation meeting the next day) was, according to the testimony of all others who gave evidence, texting, twittering, or emailing on her mobile or blackberry throughout the dinner. She accused Dr Cross of being rude to her and belittling her. She said he was nicer to everybody else compared to her. Dr. Cross had said to her that if she missed her friends that much, she should have stayed at home. Doesn’t the new DSM manual have a new disorder called something along the lines of “internet addiction” which leads to difficulty in social interactions and interpretation of social cues and interaction?

My mention of binge drinking and internet addiction is said with tongue in cheek. I was quite surprised that the HPC panel, the HPC lawyer, and Dr. Cross’s lawyer did not bring these facts up for any real discussion. However, the lay member of the panel did mention that she would find such “twittering” behaviour very rude.

Yes, Dr, Cross did admit to trying to kiss one of the accreditation team, told him he loved him and offered to give him oral sex. But he did say it was a joke, a bad joke perhaps, and not well received by one member of the team. The other male member of the team in his statement to the hearing (a paper submission) reported that he just laughed at Dr. Cross’ disinhibited sexual jokes and antics and did not think they were serious, and he was not offended by them in any way and neither was his wife who was also present.

So, the panel adjourned on the second day at around 11.15am to see if Dr Cross’s behaviour amounted to misconduct of an HPC registered psychologist and if it amounted to an impairment of his fitness to practice. I had to wait for 6 hours to be called back for the result.

Luckily for Dr Cross, although the panel thought that he was drunk, lewd, and rude, it was not proven if he touched himself in a sexual manner (evidence submitted showed that the complainants could not see this occur as he was sitting in such a way that he was obscured). It was also not proven that Dr Cross was serious in his gestures of love and affection to people at this social occasion. The panel ruled that his behaviour did not amount to misconduct and thus the allegation of misconduct was not well founded. “Justice was done!” the pro-regulation brigade might shout at such a result. “You see,” they might say, “it is a good process, everything was done above board, witnesses were called, and he was cleared.”

Was he cleared? Is Dr Cross in the clear? Not according to the newspapers. He was written about as though he was guilty. The story was sensationalised with all the lewd bits highlighted to the omission of more balancing facts; that two other people were present at the dinner and they thought Dr. Cross’s behaviour was fine; disinhibited, joking, and fun yes, misconduct, no. It was not reported that nobody left the dinner and walked out in disgust; everybody enjoyed a two-course dinner with wine. It was not reported that everybody was drinking, and that no restaurant staff or diners made a complaint about Dr Cross. It was not reported that the BPS, who had been initially consulted about this incident by one of the complainants, wanted to deal with the incident in house. But this complainant was not satisfied with this; it was subsequently taken to the HPC. A grudge perhaps? More importantly, it was never reported in any of the newspaper reports that Cross was not on duty as a psychologist at the time, and also that he carried out his duties in an exemplary fashion (to everybody’s testimonies given) the next day.

What was most upsetting to me just when the HPC panel finished delivering their verdict, Dr Cross broke down into tears, and rushed out of the hearing room. Nobody flinched. I was almost brought to tears myself witnessing this. It was terrible. Dr Cross had been brought to trial, and I call it trial because it had all the hallmarks of a legal trial, and his reputation has been “sullied” by the press and his colleagues and the HPC process in a most disgusting way. This will no doubt affect his working life and livelihood and perhaps even his personal life and relationships. But never mind, justice was done, he was cleared. Of course, I am being ironic in this last statement.

I think at this juncture it might helpful to again look at this idea of “misconduct”. Dictionary definitions of misconduct pertain to: behaviour not conforming to prevailing standards of law, bad management by persons entrusted or engaged on another’s behalf, and deliberate wrongdoing, especially by government officials or military officials. The thesaurus, just for interest, gives some unsurprising results: to behave oneself improperly, rude behaviour, horseplay, and naughtiness.

There are also legal definitions of misconduct. These pertain to ideas of wrongful, improper or unlawful conduct motivated by premeditated or intentional purpose or by obstinate indifference to the consequences of one’s acts.

There are many other definitions of misconduct, but to draw the reader’s attention to these most common and helpful one’s presented here and re-direct the reader above to the HPC standards of conduct, performance and ethics (points 3 and 4), it is clear there is a huge scope for the application of misconduct that the HPC can pursue. Therefore it is clear from this that the HPC has become a dangerous monster. It is quite clear, that in their use of their idea of what constitutes misconduct, the HPC have in effect committed misconduct (mismanaged) themselves in the case of Dr Cross.

Why do I charge the HPC with misconduct in the case of Dr Cross and in general of becoming a dangerous institutional monster? Taking into consideration the scope of what misconduct can cover, and also how the HPC standards of conduct, performance and ethics are laid out, their system is open to abuse, as has occurred in the case of Dr Cross, by the HPC, registrants and patients or the general public. Points 3 and 4 of this document covers personal conduct but also the proviso that a “registrant must tell us (and any other regulators) if you have important information about your conduct or competence, or about other registrants and health professionals you work with.”

This framework encourages denouncements by colleagues and negates the possibility of talking to colleagues about problems, encourages defensive personal and professional conduct, and promotes a lack of trust in oneself or the possibility of efficient self-reflection. I think this is what Michel Foucault calls the panoptic society whereby, we overly self-govern ourselves out of fear of being caught out by the surveillance of the institution that makes the rules.

The HPC has however has wildly distorted any ordinary self-governance so that people denounce their colleagues to those who pretend to be the guardians of the public. In other words, we cannot act freely because the “Big Other” as Zizek explains, is always in the background, haunting our being, and robbing us of our ontological freedom. The HPC mistake themselves for the “Big Other”, in a Big Brother Orwellian way. Others are watching our behaviour for any flaws and will report this, not to us, but to the HPC. But we even have to watch out for our own flaws, and must report ourselves to the HPC if we notice any in ourselves. Has the HPC panoptic machine not gone too far?

It is clear from the HPC’s framework, that anybody who is offended by somebody’s (e.g., a psychologist) conduct such as swearing, smoking too much, not sleeping properly, being unfaithful, driving too fast, being late for work, eating unhealthy foods, spending too much time shopping or watching too much television, could make a complaint to the HPC. The examples I list could all be classed as misconduct. But please note, it also depends on who is offended. Some might be offended by such behaviour, others not. This is what occurred in the case of Dr Cross; some people were offended, or perhaps frightened by their duty to the HPC panoptic machine. Or was it because that they felt he didn’t like them as much as they thought or wanted him to like them?

What I am trying to say is this; was there not a better way to do things in the case of Dr. Cross and does the HPC not realise (maybe it does) that their dialectic concerning misconduct has reached monstrous proportions? I put it to the HPC that they have breached their own codes of what amounts to misconduct. They have badly mismanaged their position; protection of the public, and brought a case to hearing that had already been dealt with by the British Psychological Society. This case could have been dealt with (by the BPS for example) in a much more humane, civil, and satisfactory manner). Instead, they have infantilised a profession (psychologists) by encouraging them to snitch on colleagues for matters that previously could be dealt with face-to-face or in-house at work. In the past one could actually talk to a colleague or have word with your manager if someone offends you or if you are concerned about someone’s behaviour. But it seems that such simple gestures seem to be regarded by pro-HPC persons and bodies as obsolete and unreliable; we cannot be trusted anymore! God forbid the HPC cry, stop people from negotiating personal and professional relationships by talking to each other. Dr Cross has been dragged through the papers and his reputation sullied by offending two people. Dr Cross is a member of the public and has not been protected by this shambolic process. The HPC’s fitness to practice is impaired as they have damaged a psychologist’s career and livelihood (and perhaps eroded what it means to be human and the freedom of what this entails) whilst disregarding their ridiculous standards of conduct, performance and ethics of how they deal with misconduct.

We do unfortunately live in world where we will at some point offend someone. We will get up peoples noses and have disagreements. We will all also live lives and engage in behaviours that others will feel are unhealthy, dangerous, and in need of change; we all will. So the sorry state of affairs we all have to accept is that all psychologists, psychotherapists, and counsellors will at some point break the HPC standards of conduct, performance and ethics, and so will the HPC. Let’s all hand ourselves in and get it over and done with! The rock solid idealism of the HPC and how an HPC registrant should be is a fairytale and represents a quite frightening delusional fantasy of what the world should be like. The way the HPC lawyer and two complainants spoke about misconduct painted a picture of reality where no risk, fallibility, or pain (psychic) should enter human life or behaviour. This is dialectical disease.

We live in a world where there are unjust wars being waged (by our own and other governments), there is the banking crisis which exacerbates the greed and deceit by the bankers, politicians are fiddling their expenses and engaging in dodgy lobbying for private companies which affects government policy. The gap between rich and poor is bigger than ever, and there are thousands of homeless people roaming the streets of our country who do not have a warm bed to sleep in or hot plate of food to eat. Thus, I ask, why is it that health professionals (and psychotherapists and counsellors) are being targeted by such a massive projection or demand for “safety” (by the HPC and society in general). I feel we should take Lacan’s lead and seriously look into this demand and see what it has to say. I think underlying this demand may be something quite sinister or at least, fraught with dis-ease. However, I think we have right to feel ill at ease in today’s times, but I feel it is a cheap shot to target health professionals (and psychotherapists and counsellors) . The last thing we need, considering the state of the world today, is a panoptic state breathing down our necks accompanied by a diseased dialectic of what it means to be human or a psychologist (in his or her personal life). The HPC and similar constrictive institutions seem to want to impose a world view where no risk ever takes place, where human beings conduct themselves like robots and are rewarded for perfect behaviour, but severely punished for straying from the (ur) model.

I wonder what Goethe would have thought if he had witnessed the HPC hearing of Dr Malcolm Cross? I am certain that he would have felt that HPC’s dialectical disease would find a wholesome remedy in the study of the nature of the situation, instead of a dialectical process of trying to make the true false, and the false true, which is what occurred on the 15th and 16th of March 2010 in Kennington, London.


Footnotes
i Conversations of Goethe, with Johann Peter Eckerman. Da Capo Press (1998). Extract taken from page 244.
ii The HPC lawyer, Dr. Cross’s lawyer, the “independent judging panel, and witnesses including Dr. Cross.
iii There is no record of the case or the result of Dr. Cross on the HPC website for the public to consult. I have been in touch with the fitness to practice hearing department at the HPC and they told me that as this case was “not well founded” it automatically becomes deleted from the past hearings list. However, if Dr. Cross wished his hearing details and result to be left on the list (for whatever reason), it would be left on. However, other similar cases’ details and results have been left on the list. It remains to be seen if the HPC have “erased” the case of Dr Cross Orwellian style, for fear of what this terrible, abusive, and highly mismanaged case might signify to a public critical of the HPC regulation of psychologists, psychotherapists, and counsellors.
iv www.clinpsy.org.uk
v Martin Heidegger. Zollicon seminars: Protocols-conversations-letters. Published by Northwestern University Press in 2001.
vi Michel Foucault. Psychiatric power: Lectures at the College de France, 1973-1974. Published by Palgrave Macmillan in 2006.
vii Slavoj Zizek. How to read Lacan. Published by Granata Publications in 2006.
viii Jacques Lacan. Ecrits. A selection. Published by WW. Norton & Company in 2002.
ix I do not subscribe to the view that psychotherapists or counsellors are health professionals.

New Play - THERAPY, by Josh Appignanesi (Fund raiser for the Judicial Review of HPC)

9 April, 3pm - a rehearsed reading of the new play about the clash between the values of psychotherapy and those of the Health Professions Council.

'Therapy' is written by Josh Appignanesi (whose new film 'The Infidel' opens in April) and directed by Matthew Lloyd, whose recent production of 'Duet for One' at the Almeida was highly acclaimed.

A hilarious satire, drawing on a detailed knowledge of the current debates while at the same time being accessible to those from outside our field. Richard Schiff from 'The West Wing' will play the anti-HPC therapist, and the rest of the casting is being done now.

Expect terrific actors, and reserve your seats as soon as possible. The reading will take place at the Vaudeville Theatre, 404 The Strand, London, and the proceeds will go towards the JR Fighting Fund.

Tickets are £20 and can be reserved by phoning 0845 838 0829

I just had occasion to revisit this letter, sent to my MP last year. Plus ca change...


18 February 2009


Rt. Hon. Tessa Jowell MP
House of Commons
Westminster
London
SW1A 0AA

Dear Tessa Jowell

I came to West Norwood library towards the end of last year to see you, and spoke to one of your very helpful and friendly staff. The upshot of that meeting was that I would write you a follow up letter (in addition to the one I wrote earlier in that year). At last, this is that letter.

I have created a blog: HPCwatchdog.blogspot.com based on a whole series of visits I have been making to the HPC as a member of the public. If you read the case of Mr R (part 1, part 2, part 3), watch the video of Richard Gombrich explaining Popper's Nightmare, and consider the questions raised by Max Weber, this will give you a quick insight into my concerns and my orientation.

I am very worried indeed about the centralisation of power and the destruction of local knowledge that is the unintended consequence of the kind of regulation that is practiced by the HPC. From what I have seen it is already causing harm to ordinary decent people, and I truly believe that this harm has a pernicious quality that will be exponentially increased if the HPC draw the psychological practices within its domain.

Onora O'Neil has publicly voiced her concern about the destruction of trust that will follow the state regulation of psychological practices (especially of psychotherapy and counselling, but the psychologists are also very much in this domain). Michael Power has been writing about the way our audit culture ends up emptying the meaning out of words and practices, and leave us vulnerable to the collapse of the resulting empty shells, and Marilyn Strathern has also pointed to the hostile and aggressive undercurrents at play in moves under the banner of transparency. Aggressivity will increase where real meaning decreases – this is a lesson learned many times over throughout history.

Each of these great British scholars has been working away quietly revealing the otherwise hidden 'mechanisms' that hold our society together. None of them pretends to have the answer, nor the whole truth, but each of them is shedding very helpful light in very careful ways on things that we need to be very aware of.

I don't believe there is one answer to the situation we are currently in, but I am trying to find a way of approaching the questions without fueling aggressivity nor unduly increasing levels of anxiety. I suggest that a space be created which makes it possible to think. The rapid expansion of the HPC is not conducive to thinking. When I attended the Investigating Committee meeting last week (blogged on 12 Feb 2009) I was chilled to learn that the Kent Police had been invited in to train staff how to deal with escalating aggression. A much more sensible approach would be to ask why the aggression is escalating. From the hearings I have observed, and from comments I have received as a result of my blog, I can see a very strong argument that the orientation and mechanism of the hpc (the grounds on which it is empowered) actually fuels aggressivity - this creates a spiral which echoes Popper's nightmare and adds to the idea that this is what is being created.

It is difficult to know how to intervene, but I very strongly believe that we need to slow the process down, and give ourselves more time to think. How can I help to postpone the process of the Statutory Order that would pass the psychologists onto the HPC register? If you can advise me of this, I would be extremely grateful. If you would like me to explain my ideas in more detail - I am easily contactable. I would be happy to respond to a call and very receptive to any help you can give in shaping a parliamentary question on this issue.

Yours sincerely



Janet Low, MA PhD

Template letter you can use to send to your MP

Template letter which can be filled in and sent to your MP.


Dear ,
I thought that you may be interested in an update on the judicial review of HPC's process regarding the proposed regulation of therapists and counsellors, and an important bit of news from the DoH.

The judicial review of HPC is now in its first stage. Documents prepared by Dinah Rose QC and John Halford of Bindmans have been sent to the High Court which point to problems with the HPC's actions to date. It had been charged with assessing the regulatory needs of counselling and psychotherapy and whether its own system was capable of accommodating this field, yet proceeded as if this was a foregone conclusion. Despite stating several times unequivocally that it had not made any attempt to study these questions, HPC could then write to the Department of Health in December 2009 claiming that it had in fact done so. Attempts to query this contradiction proved fruitless.

The JR papers discuss and document this, as well as other major failures in the process, which indicate that the HPC did not approach its work in a rational or fair way. Alternative models of regulation were not given proper consideration despite being repeatedly brought to HPC's attention. Key questions about the nature of the talking therapies were ignored, and hardly any of the HPC's criteria for regulating professions, such as homogeneity of knowledge base or practice, are applicable to our highly diverse field.

The first set of documents will now be scrutinised by the courts. The instructing organisations are The Association for Group and Individual Psychotherapy, The Association of Independent Psychotherapists, The Centre for Freudian Analysis and Research, The College of Psychoanalysts-UK, The Guild of Psychotherapists and The Philadelphia Association. Funding of the review has been made possible by contributions from thousands of therapists and members of the public who feel strongly about the issue.

Significantly, the Department of Health has now said that it will await the outcome of the judicial review before acting on the HPC's recommendations and that it is exploring alternative models of regulation. This is an important decision, as until now the DoH has simply stated that it will regulate the talking therapies via HPC, and the HPC itself has refused to discuss alternative models of regulation. The fact that other models will now be studied is real progress, and we hope that the DoH will work with our organisations and examine the models used in other countries, where regulatory arrangements have been arrived at that are satisfactory to both government and the field itself.

Power without responsibility spells disaster for people in HPC FTP case

On Monday this week (15 March) I attended the Fitness to Practise Hearing of Council member Malcolm Cross. It has been a few months since I last attended an FTP meeting, and I was surprised to be asked to leave the room shortly after the proceedings began when the panel members left to deliberate in private. I asked the Hearings Officer to tell me the reason for this new and petty inconvenience. She was unable to. She promised to discover the reason and let me know (she did not take a note of my name or contact details, and I have heard nothing since). While I was in conversation with her the legal assessor of the case, Simon Russen (a freelance Barrister), came into the room and addressed me directly, cutting through my conversation with the clerk. He demanded to know if I was refusing to leave. Stunned, I told him I wanted to know the reason for being asked, as I am reluctant to obey rules that have no clear and rational basis. I had been asked to sit in the corner on arrival, but had failed to do that too. He left the room immediately. To my utter amazement, when the panel returned shortly afterwards Mr Russen interrupted the Panel Chair to say ‘I don’t know who that woman is in the brown jacket (pointing at me), but she refused to leave the room when the Panel left, and you might want to exclude her from the proceedings either now or in the future.’ The Panel Chair looked surprised, ignored him, and continued with her business.

Is this not way outside Mr Russen’s jurisdiction? He certainly didn’t bother to avail himself of the facts before throwing his weight around. I experienced it as an intense use of power with no other purpose than of frightening and humiliating me. It was very Kafkaesque.

The hearing’s officer had fetched the adjudications officer to explain that I must leave the (large and empty) room in case the lawyers wanted to have a private word. This is a very weak argument – lawyers are capable of having quiet words, if they really need them, without putting the public to any particular inconvenience – but I agreed to her request to prove that I was civil. As soon as I had crossed the threshold I was invited in again as the hearing was about to restart. So, this was a ritual designed to exercise power to show who had it and who didn’t. It was blunt and unnecessary. It was rude and disrespectful. It is outside the field of reason and rationality. It suggests the HPC does not understand the power it holds –that it is incompetent; or, worse, that it does understand and likes to play around. Either way, it undermines trust in the HPC.

This, however, is but a local instance. The real travesty is demonstrated by the treatment of the registrant in question. As you know, I have written about Fitness to Practise cases I’ve observed before. The highly centralised nature of the process is fundamentally at odds with the aim of dealing justly with a case. The premise upon which the process has been built is profoundly un-British – it presumes guilt of the professional as a starting point. Not only does this ensure a never ending supply of work for the FTP lawyers, administrators and panel members, but it also allows unproven allegations to be posted in public, which in turn attract (perhaps even bring forth) the salacious appetite of the media, who then publish details from the witness statements before the process is complete. This damages the reputation of the registrant, the profession, and indeed the country as a whole. The harm is done, multiplied and distributed through the networks of national (indeed global) media – it cannot be undone. The next day the independent Panel (after 6 hours of private deliberation) held that the HPC case was not well made: the Registrant had No Case To Answer.

How is the HPC held to account for its unwise allegation? I cannot see how this is to be done.
The politics of the case help to bring into view the fault at the heart of the HPC: who counts as ‘we’ in any particular moment and who holds them to account? On the one hand, the HPC is independent of the professionals – here ‘we’, as CEO Marc Seale has said, are the men in grey suits, the boring bureaucrats, the administrators that service the computers and meetings and that carry out government policy. ‘We’ are the people who receive complaints, shuffle the papers, avoid making decisions, hire the lawyers, and proceed as if we are protecting the public. However, at other times, the ‘we’ presents a face that includes some professionals: those appointed by the HPC to sit on the various committees, panels, and to visit the universtities on the ambiguous edge of the power. In this mode, from a certain point of view, it appears as if the HPC is in fact a professional organisation – which is not, really, the case.

At the FTP of Dr Cross, then, it was the HPC who brought the case against him. It was the HPC who believed he had a case to answer. The Panel, independent of the HPC, ruled this an error of judgement.

The committees that assess the complaints and decide whether a case should go forward or not – who exactly are they? Are they part of the HPC or not? Where is the inside and where is the outside of the HPC?

The HPC has allowed, created and promoted the opportunity for the reputation of a registrant, of a Council Member, and arguably of a whole profession, to be publicly displayed falsely. Dr Cross would find his picture and his name published in the Daily Telegraph next to a range of spurious allegations. The procedure of the HPC had manufactured a set of facts that the journalists were invited to report. Does this not make the HPC responsible for defamation – defamation of Dr Cross, of the Psychology Profession and ultimately, perversely itself!
The twisted logic that lies at the heart of the law that established the HPC makes the HPC really rather dangerous. It behoves those who manipulate HPC power to actively understand it, and to understand their position within it. It is certainly not the remit of a boring bureaucrat in a grey suit. This job demands someone wise.

As things stand the administrators are given the power to proceed with cases against registrants (and to hire lawyers) without ever having to think about, much less face up to, the consequences of their actions.

The fault in the law can be traced to the thoughtlessness of Professor Ian Kennedy whose political promotion to the chair of the BRII led directly to the invention of the HPC. It appears that Kennedy’s idea played directly into political beliefs that neither the professionals nor those closely associated with them could be trusted to manage themselves, so a QUANGO that knows nothing about either of these things was created as their ruler. In effect Kennedy’s recommendation insists that the HPC remains stupid, as any sign of wisdom renders it liable to the pernicious accusation of being professional. This is clearly rubbish.

Wisdom is required to make sensible assessments in disputes and conflicts around work. Wisdom and information. Although the people delegated to do this work on behalf of the HPC may indeed have these capacities, the structures and channels in which they work clearly undermine, and even destroy, this valuable resource.

Classic and modern - power play remains the same no matter what the date is

Do you remember the excitement of watching the milometer clicking over from 9999 to 10000? Do you remember the excitement of the supposed millennium-bug ten short years ago? Did you read those interesting books that came out then to teach us what we’d forgotten about zero? Georges Ifrah – The Universal History of Numbers; John D Barrow – The Book of Nothing; Robert Kaplan – The Nothing that Is; Brian Rotman – Signifying Nothing; and Charles Seife – Zero: The biography of a dangerous idea. They all reminded us that zero was an invention very tricky to grasp rationally. The first Civilisation that grappled with it, used to sacrifice members of their underclass when zero clicked over on their clock.

We’ve come a long way since then, yet there remains a certain madness that feeds off the notion of newness.

In today’s copy [Issue 2, Spring 2010] of the BPC’s (British Psycho-analytic Council) publication New Associations we find Julian Lousada (Chair of the BPC, hitherto the BCP) is quoted in bold as saying ‘in this day and age, self regulation is a dirty word’ and proceeding as if the slander is a fact. This is part of a three-page transcription of a discus-sion between Lynne Gabriel (Chair, BACP), Andrew Samuels (Chair, UKCP) and himself on the current state of HPC-play.

Lynne is quoted as saying, quite openly, that she is “challenged by [the UKCP’s] multifaceted position on regulation.” She can’t grasp the UKCP’s multi track position which recognises members who are pro-HPC and also builds a position for those who are opposed. If a future law forces people to sign up to HPC it will be even more important to establish positions of objectivity and rationality from which people can play the power implied by the new arrangement. The power that is circulating in the HPC has nothing whatsoever to do with that drawn from real work. It has even less to do with Hippocrates or Hephaestus – of which more will be said later. There is no genuine work to help hold it on course. Nor are there mechanisms by which people can call it to account. Those who pay the tax levied by the HPC are not entitled to vote. Ever. There is even less possibility of using the power of reason or argument on an ordinary everyday basis. The power in a practitioner-based organisation at least has the virtue of being linked to the rationality of knowledge and reality of praxis, as well as to a membership that can put forward arguments, call for information, and, indeed, vote. Lynne, are you saying that if a more powerful body threatens you, you must discreetly pretend otherwise, and do your best to not speak out against it?

This position finds a slightly different expression in Julian Lousada who invokes an image of a ‘good citizenship’ in order to thwart opposition (“The problem is that PNC [principled non compliance] is not a strategy of citizenship, it’s a strategy of individualism.” p3). Under what conditions does a man of such education, experience and position, seek to short-circuit a debate? Earlier in the piece he presented a slightly more ambiguous position which saw some value in a dissenting citizen: “My sense is that a combination of robust opposition (to the HPC as regulator) and the sustained discussions that we’ve been having with them on the same issues have together resulted in their [HPC] acknowledgement that there will have to be a substantial rewrite (of the generic standards of proficiency) in order to accommodate us. Perhaps wrongly, I trust that they are going to do that…” I’d like to ask Julian: on what grounds do you place your trust – it looks very much like an identification? And from the slippage in your position you have already answered who you think should be sacrificed – those who robustly challenge the HPC.

Dr Gabriel states openly that she is (and others are) pursuing HPC regulation to gain status, respectability, and money (p3). It would be a relief to hear this acknowledged more widely as the reason, and to ask how it fits in with the more usual rhetoric about ‘protecting the public’. Throughout the conversation Lynne talks about what the HPC will do, is going to do, has promised to do. She ignores the fact that the process, according to the HPC (and which her organisation has been an active participant in for at least the last 18 months) should by now be over!

I think it worth noting in passing that the word ‘modern’ is supposed to denote NOW, something happening in the moment, not the future, and much less in the conditional, and to remark that the only reason the HPC is still making promises (the proposed new generic standards, the proposed new FTP process, the proposed new changes to GP statements re health etc, etc, etc) is because active individual subjects took the time, trouble, and inconvenience, to remind everyone of the necessity to think.

There are two other articles in this BPC paper that I’m going to mention. The first is written in a very strange style and is placed (on page 9) in opposition to an essay by Andrew Samuels (which is entitled Regulation: do we have a choice? and appears on p8). It has no attributed author, but is presented under an Orwellian pseudonym: INGEGRITY. This turns out to be the cover for a group calling itself Integrating Social Responsibility into Psychological Therapies (ISRPT), which is described as “a number of practitioners [who] have recently come together to form a new group called Integrity that supports statutory regulation under the Health Professions Council”. We are not told who these people are. The mystification grows ever thicker as the text takes up the style of journalistic objectivity: ‘Integrity is a new body promoting statutory regulation … It came from a group of practitioners who were [sic] interested in working constructively with the government … Integrity say they want to gather voices… They want to harness our profession’s vision … The group says that regulation will free up access to funding… They want us … They believe that an independent regulator is vital in the 21st century… The group point to several facts… They claim that … ” Etc, etc, etc. It is only in the final paragraph that the author appears to acknowledge his or her relation with ISRPT, tho there is still some room for doubt: “It is the belief of INTEGRITY that if we enter into an effective partnership with HPC, they [the HPC] will become fit for purpose”. If the author is in fact not INTEGRITY, then INTEGRITY appears in the text like a kind of all knowing, all powerful presence: “It is the belief of INTEGRITY that if we enter into…” What on earth is going on here, and why does the BPC, in the voice of Malcolm Allen,‘welcome’ (p1)?

Finally, CEO Malcolm Allen (whose evident love of the classics does not stop him from using of a less sophisticated kind of power) writes the front-page news. Although he book ends his piece with two classical references (a quote from Hippocrates, and a reference to Hephaestus) the bulk of the text simply pushes the reader to buckle under the HPC. Malcolm, do you really think that Hephaestus would have earned his reputation in history if, seeking power, money and status, he had buckled under such a regime?

Trust, Humbleness, Wakefulness - 3 virtues for a hale and hearty society

At last year’s Convention on Modern Liberty author Philip Pullman stepped up to the podium and invoked courage, humble-ness, and wakefulness as essential virtues for a nation. The text has just been reprinted (an anniversary debate held at the British Museum gave the occasion) in a Guardian pamphlet, which can be consulted on the website. “A nation whose laws express fear and suspicion and hostility cannot sustain delight for very long” he said, and for my money, comes closest to indicating what is wrong with HPC-State Regulation, and why we need to pay attention.

Last month, a general news item reported that an “NHS chief executive has been sacked for swearing too much at work”. He was sacked seven months after that Trust's chairman resigned (he said he was being put under pressure to meet targets). The implic-ation is that the swearing was just an excuse to get rid of someone no longer liked. It was implied in the report that his fall from grace came when he voiced the opinion that meeting government targets would put patients at risk. For full article see Guardian, Wednesday, 10 February 2010

Pullman himself shows what happens when you become ensnared in the modern ‘protection’ racket. Thinking back to July last year (2009) the Guardian reported the launch of yet another data-base ‘solution’ masquerading as protection for the public. The ISA (Independent Safeguard¬ing Authority) was proposed as a register for anyone coming into contact with children in schools. The idea was that bureaucrats could vet entries to the database and exclude all potential paedophiles, thus preventing them from access to children at school. Pullman was reduced to outrage: "When you go into a school as an author or an illustrator you talk to a class at a time or else to the whole school. How on earth – how on earth – how in the world is anybody going to rape or assault a child in those circumstances? It's preposterous”. The discourse already presumes that someone is going to rape a child, the work then becomes trying to defend oneself against the implicit accusation. The loud public protest against this led the Government to climb down, but rather than chuck out the faulty logic, they have ‘watered down’ the requirements (The checks will now involve only those working with the same children once a week, not once a month, for example.)

Meanwhile, I am grateful for the diligent work of Bruce Scott from the PA who has drawn attention to an interesting case due to be heard in the Fitness to Practise panel at HPC on 15th March. A counselling psychologist has been accused of drunk and lewd behaviour at a BPS dinner, which the HPC Panel deem prima facie evidence of potential danger to the public.

But this psychologist is not an ordinary case, he holds a position on the HPC Council. How did the HPC appoint someone to the Council when there was a FTP allegation against him? Perhaps the allegation came after the fact, in which case we can marvel at the speed with which it is actually being heard (it is more typical to wait at least 18 months, according to the HPC documenta¬tion, but here only 8 months will have passed by). But another question emerges: is the public appointment itself implicated in the allegation? The logic of the HPC, like that of the ISA, already skews the case.
The allegation is printed on the HPC website in the usual way, and it will be up to the players on the day to bring information to light to enable the panel (one lay, one other profession, one from the ‘same’ profession) to come to a sound conclusion. It is tempting to conjecture and analyse the allegation before the hearing, but this simply spreads the allegation farther and wider before the case has had a chance to be heard. Any damage done cannot then be undone. All questions must be answered at the time of the hearing (15th March). The underlying logic presumes the professional is probably guilty.

I am grateful to Dr Jay Watts, CPsychol AFBPsS, for the following report:
“I have some knowledge of the effects of HPC regulation on Clinical Psychology as a lead psychologist in the NHS who recruits clinicians, and someone involved in doctoral training programmes. Marc Seale (CEO HPC) has often said that psychologists have gone into the HPC with no complaint. This is not true. I am one of many people who have formally written to the HPC objecting to them as the regulators. Further, there has been substantial discord within the profession about being allied to a health/illness opposition to which many of us fundamentally disagree. Though the critical sections within psychology have been less active in opposition to the HPC than psychotherapists, this partly results from an exhaustion following the mock consultations associated with the Mental Health Act (and especially the process of the Bill) in the early years of millenium (when we literally took to the streets).

“Some speakers at the recent ‘Confer’ conference gave the impression that psychotherapists would have a choice about whether to have their data transferred to the HPC or not. Our experiences with data protection were far murkier than that. All chartered psychologists registered with the BPS were automatically transferred to the HPC. Those of us who then chose not to register were chased for our fees as we were deemed to have “forgotten” to re-register (as opposed to having opted-out in the first place). The HPC then wrote not only to the psychologist but also to their employing organisation (NHS, voluntary organisations) to say the psychologist must have “forgotten” to pay and to remind them and their employing organisation to do so immediately for the “protection of the public”. A risk adverse NHS reacts jumpily to that, as you can imagine.

“Furthermore, national job descriptions have changed for psychology: HPC registration is already an 'essential' criteria for both NHS and clinical academic posts. Already, trainees in clinical and counselling psychology now have to receive their clinical supervision and personal therapy from HPC registered psychologists. The delights of modern computer applications (whereby one can't start writing an application form until one has ticked 'yes' to the essential criteria) make it very difficult if not impossible for organisations to even short-list psychologists who support principled non-compliance. At best, this produces a two-tier system where the NHS and many voluntary organisations keeps the more conventional psychologists whilst those opposed to increased governmentality find themselves restricted to private practice. This is unacceptable given that the majority of the poorest, most marginalised potential patients have reduced to centrally controlled treatment approaches. However, there are still many practitioners in the NHS and other organisations (such as Mind) that offer therapeutic spaces that are not about mental hygiene or the seeking of mature object relations. Whilst we all support a proper system of regulation for the psy-professions, state regulation by the HPC is already having a constraining effect on clinical psychology practice and training in the NHS. The structural changes which occur so quickly when HPC enters the scene make it naïve to believe some psychotherapists will be able to opt out of HPC. If something is precious, then it is worth fighting to protect it even if one makes some enemies on the way.”

Thanks, as ever, to colleagues for bringing news to my attention.

Confer Conf (Part 3)

In a small room beneath a Covent Garden Bookshop, a fluid group of 20 or so people meet monthly to divvy up parts and read Shakespeare’s plays aloud. Last week it was The Tempest. Prospero (banished from his Dukedom this 12 years) introduces his brother, now the Duke, to his daughter Miranda with these words: “Thy false uncle …
Being once perfected how to grant suits,
How to deny them, who t’advance, and who
To trash for overtopping, new created
The creatures that were mine, I say, or chang’d ‘em,
Or else new form’d ‘em; having both the key
Of officer and office, set all hearts I’ th’ state
To what tune pleas’d his ear, that now he was
The ivy which had hid my princely trunk,
And suck’d my verdure out on’t.

a little speech about the administrator gaining power over the Duke to gratify his envy and ambition…


At the Confer Conference, Dr Michael Fischer presented a summary of his work at KCL (Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling, 2009) and commented “there is a common perception in other fields, for example psychology, that an elite group has captured the regulatory process to further their own agenda.”

BPC Chair Julian Lousada (and member of the HPC PLG for C&P) had commented that he had seen no evidence that HPC regulation would change what went on in his consulting room.
This week at a major London Universtiy Psychology Deparment, this letter was sent round to the staff:

BPS and HPC accreditation visit Doctorate –
The Health Professions Council and the BPS are undertaking an accreditation visit to us. As a part of this visit they are keen to talk to supervisors and heads of service about their experience of the Course, of the trainees, and of training generally.
From past experience of these visits the HPC and BPS visitors will try to make this a fairly informal meeting, and the likely focus will be on the links between us (as a training provider) and the NHS (where the training is put into action).
We would like to invite you to attend this meeting [and] will reimburse travel costs, and provide some nice refreshments... etc

These are the points to situate what follows.

I went to the HPC this week to observe the Education and Training Committee Meeting that was billed as happening on Tuesday 2 February. The website was my guide, but no papers had been posted. I requested permission, and turned up in time for a supposed 10am start. A name tag was waiting for me at reception. After 20 minutes wait in the decompression chamber (you really have to go and discover this yourself) I asked Sonia what was up. It transpired that the meeting started at 10.30, and only one member had so far turned up. I asked if there was a pack of papers to read while waiting. She told me I should have downloaded them from the internet. I replied that the papers had not been posted, and asked if she might telephone the administrator to see if a pack were available. Slight tension. When she did, she again told me the papers were on the internet. “Not on my internet they weren’t” was the best I could do, with a smile.
The charming Steve, who had come to collect me (it is ridiculous to have to be shepherded like this – whose rule is this?) apologised for the lack of paper work – he had been off sick, but had asked someone to do this for him. They didn’t do it. As we drew near the committee room he asked if I had ever observed a panel before, and this brought me to a halt. Panel? I thought this was the committee meeting that was supposed to be discussing the applicability of the generic standards? No, this is a panel, where four ‘partners’ and three nameless administrators meet to discuss the “programmes in respect of which approval/ ongoing approval is recommended without conditions, or subject to conditions.”

This little panel was meeting to consider the reports written subsequent to visits around the country to where training is carried out by the ‘accrediting’ institutions.
Apparently, the HPC find it necessary to know each time the course leader is changed. Dr Jo-Anne Carlyle (a self employed Psychologist, Psychotherapist and Consultant) ventured a question. She said she was intrigued to discover that ‘programme leader change’ is considered a ‘major change’ and intrigued that HPC were interested in this.
Professor Diane Waller, the only member today who is also a member of the recently reduced HPC Council, said ‘it is a safe-guard for the staff’. Presumably a version of ‘protecting the public,’ in this case protecting the shrinking and frightened Programme Leaders employed in 21st century British Universities, from being forced to do something by the administrators and quality auditors at their college.

Helen Davis, Chair (Orthoptist, and, coincidentally Senior Lecturer at the University of Sheffield) added that ‘the profession finds it useful to keep a check on what is going on’.

There is a slippage between the HPC and the Profession. Here, Helen speaks of the profession as if it is coterminous with HPC. This ignores much in general, and everything that HPC says about itself – that it is independent of the professions and thus not subject to the tendency to close ranks against outsiders in order to protect itself. It also obscures the fact that it is the HPC who advertise, interview, select, train, and appraise the partners they use in this processes. Helen Davis does not represent the profession. Why does she not know this?

This week’s meeting was over in 22 minutes and the Chair said ‘we don’t get so much discussion as we did because the administrators are more involved. It is slightly more formulaic now, but more consistent.” Much of the work of the scrutinising panel is done at HQ where the administrators scrutinise the paperwork into a form that they can regulate. The administrators present at the meeting spoke almost entirely in the building block phrases of audit culture:

this is a major monitoring tool
It is subject to a major change
Scrutinise these changes by documentation
We have a 7 point programme
The committee is asked to approve
There is major impact on education providers
It is a well justified decision
An evidence based decision
It followed the logic process
We made a clear and reasoned decision.
Etc

The fourth Partner present at the panel was Mr Stephen Wordsworth (Head of School for Health and Social Care at Derby University – an operating department practitioner). At the end of the meeting, one of the administrators (surely in his early 20s) was delegated the task of guiding me back to the front door (for goodness sake). He gallantly offered to answer any of my questions. So I asked him which of the Partners was also a member of the full Council. He looked blank. No idea. What?

In the executive summary of the papers for the meeting is the statement: “The Health Professions Council (HPC) approve educational programmes in the UK which health professionals must complete before they can apply to be registered with us. The HPC is a health regulator and our main aim is to protect the public.” Etc.

There was a brief to and fro in the Panel meeting where Di Waller lamented the fact that ‘people just don’t understand’ that they can’t claim to be ‘state registered’ psychologists etc. This is an ongoing problem, apparently. People out there just don’t understand what the HPC really is. Di was surprised at the Confer Conference that people out there continue to think that the Standards of Practice and the Standards of Education and Training are being used to shape the curriculum of various training programmes. Like Julian Lousada, Di Waller seems to think that the job of the regulator has nothing whatsoever to do with the practice it seeks to regulate. Odd.

Odder still, however, is that the paperwork for this meeting, clearly states:

Introduction:
“The HPC visited the programme at the education provider to consider major changes proposed to the programme. The major change affected the following standards – curriculum and assessment. The programme was already approved by the HPC and this visit assessed whether the pro¬gramme continued to meet the standards of education and training (SETs) and continued to ensure that those who complete the pro¬gramme meet the standards of proficiency (SOPs) for their part of the Register.
Under ‘Sources of Evidence” a series of tick boxes ask:
‘Mapping document providing evidence of how the education provider has met the SETs’ and
‘Mapping document providing evidence of how the education provider has met the SOPs’.
Under the Recommended Outcome:
“To recommend a programme for ongoing approval, the visitors must be assured that the programme meets all of the standards of education and training (SETs) and that those who complete the programme meet our standards of proficiency (SOPs) for their part of the Register.” …
“The visitors agreed that 47 of the SETs have been met and that conditions should be set on the remaining 10 SETs.”
“Conditions are requirements that the education provider must meet before the programme can be recommended for ongoing approval. Conditions are set when certain standards of education and training have not been met or there is insufficient evidence of the standard being met.” …
Well, I suppose that solves the mystery of why on qualifying people advertise themselves as state registered, and also how the standards of training and proficiency work their way into the curriculum. One mystery still remains, however. Di was at pains to state that just because someone successfully completes an approved course, they are not automatically entitled to register at the HPC. Apparently people are asking why. Whether or no the why is answered, the fact remains: you have to apply to the HPC, who may turn you down, even with your new qualification from the approved course.

At the Confer conference Marc Seale kept saying that nothing was set in concrete, and that it was always possible to interpret. He also said that the HPC does not negotiate. At the time, these things seemed strange and meaningless. With a little time and attention a meaning emerges from the fog: nothing is set in concrete for Marc Seale for he is the new Duke; he and his acolytes can interpret the rules whichever way they like, and they don’t need to negotiate with anyone not in their clique. It is precisely this kind of thing amongst professional groups that is supposed to have provoked the need for the HPC in the first place (see Ian Kennedy’s Unmasking Medicine for a quick introduction to the argument).

The Shakespeare Readers Society is open to all. Info at
http://www.facebook.com/pages/London-Word-Festival/76602824994?ref=mf#!/event.php?eid=262356745978&ref=mf

Confer Conf ( Part 2)

The Royal Court’s 2009 triumph, Jerusalem, opened at the Apollo theatre last night. The final drum beat called the audience to its feet: “come, you battalions. You fields of ghosts who walk these green plains still. Come, you giants.” And they came, stood, hollered, cheered, yelped, shouted and stamped and called the cast four times to take their curtain call.

Relatively speaking, something similar happened at the Confer Conference on Saturday last week. Paying roughly the same price for a ticket, this large audience of counsellors and psychotherapists was also moved to respond to the call that emanated from the stage. It was a long and hearty applause that met the interventions of Darian Leader (for the Alliance) and Andrew Samuels (for UKCP).

“The profit motive of corporations, the way the landscape is being made ever blander – these things are a horror to me. We’re facing difficult questions: how can the individual survive within these 'communities’ that are being worked into our society?”
Actually, these are actor Mark Rylance’s words in an interview about Jez Butterworth’s latest play just before it opened in Sloane Square last July (2009), but they could perhaps also be heard resonating around the room last Saturday.

Confer staged their play on the raised platform of the Ethical Society’s Conway Hall. Across the beam of the stage, carved deep into the stone, were the words UNTO THINE OWN SELF BE TRUE – the most famous advice of any counsellor, made famous by a play (Polonius to his son Laertes, in Shakespeare’s Hamlet). Under these words sat the line of speakers who had been selected by Confer, and given a few minutes to outline their positions before being subjected to a series of prearranged questions, constructed by the conference committee. This arrangement was not without its difficulties, but some important information emerged amongst the fraught exchanges, and some truth was achieved in the process. All in all, it was a pretty good show. To capture some of the spirit and information, I will present it as a kind of script taken from my notes written as the action unfolded. Often fragmented, it does coalesce into moments of surprising clarity. I have adopted the device of giving letters to indicate speakers simply. Here’s the key

A. Darian Leader (for the Alliance)
B. Julian Lousada (Chair of BPC),
C. Andrew Samuels (Chair of UKCP)
D. Marc Seale (Chief Exec of HPC)
E. Diane Waller (Chair of the Professional Liaison Group for Counselling and Psychotherapy for the HPC)
F. Michael Fischer (from Kings College London)
G. Lynne Gabriel (Chair BACP
Q. Questions
V. Voices from the floor.

A: we need to keep a space for different forms of practice.

B: members of the Institutions have been struggling with this job, but I, on the whole, am supportive of HPC. I ask myself, ‘would it interfere with the stance we take with our patients?’ I can’t find the evidence that it will.

[next to B is F, who is responsible for producing research evidence that strongly suggests that this form of regulation will adversely affect the stance professionals take with their patients. F maintains his composure, looking modestly at his papers, but the smallest tick flickers to life, just the once, under his right eye]

B: [continues] ‘Regulation’ is a toxic word. But we have to ask, are we adequately transparent? Are we adequately accountable? What I see here from you is an attack on the Nanny State. I happen to disa - [small pause, lips together, slight suggestion of ‘p’ before continuing almost seamlessly] - gree with that. We need the good container of the Nanny State.

C: we must reframe the division amongst us into a basis for constructing a solution.

D: I’m a boring bureaucrat in a grey suit. It’s my job. It’s what I do. We have a timetable towards statutory regulation, that’s it really.

E: I’m a 1970’s arts student, and a sociology professor. I am an integrative practitioner with curiosity. I ask: why do people make art? I was trained in the analytical approach, but not solely. I am used to dealing with tension in my job at the University - the Quality Assurance, Teaching Quality, which is exceptionally bureaucratic. I am pioneering, entrepreneurial, and I want to bring the regulator into this world, not leave him in the 1950s.

D: We don’t negotiate. It’s all in the hands of the Government. When the Section 60 is issued to Parliament it cannot be amended – it either stands or falls. This has never happened [the fall] in over 35 years. If it stands then there will be Gazetting, the Privy Council, it will be Enacted, then we will fix the Standards of Practice, and we will consult on that.

E: The wording of the Standards of Practice is quite old fashioned. It suits some of the professions, not others.

C: The PLG process did not work for us. D should not have written to the Government in December saying it was good to go.

D: We will have to make a Temporary Register – we have identified 60 voluntary registers, and my IT people will have to go through these taking out the duplicates, and cleaning up the data, it will be quite a job.

A: But the Judicial Review questions the whole process.

D: My legal people have instructed me that this question is sub judice, and given me preaction protocols to follow, these are careful ways that we are expected to behave.

A: it is not sub judice, and it would be perfectly proper to speak about it.

Q: What processes are there for the HPC to follow in order to take into consideration the ongoing concerns?

E: well, there was a Call for Ideas, the Professional Liaison Group, the Consultation. Actually, I would really like to say, I hear people say it was ‘a done deal’. It was not. It was not a done deal. It’s insulting to hear that. Insulting to the PLG. The criticisms that are made of the HPC are disrespectful to other professions.

D: Our Standards are not set in concrete.

C: We all have problems with the idea of auto transfer.

G: We’re in favour of a convention.

B: BPC are struggling with the issues. There are differences in the membership. Our register is not made up of members, but of institutions. I suppose that many of those who don’t agree with HPC regulation will not sign up and will practice under a different title, presumably Psycho-Analyst. The question is, how do you create a community? The problem with C’s model is there are no losers. But we have to ask, are we a coherent or a fragmented community, because we have to present a coherent front.

A: Why would we want to present a coherent front if we are fragmented? Surely this is what we work on with people who come to see us, who are suffering because they are struggling to present a coherent front to the world when they are in fact fragmented. [applause]

D: The Combo is under way, the titles of Counselling and Psychotherapy, the 3-year Grand-Parenting period, and the Register Transfer. But listen, the HPC is flexible. Nothing is set in stone.

C: Look, in Section 7.16 of Trust Assurance and Safety it says “With the exception of the new arrangements for the regulation of pharmacy, the Government will not establish any new statutory regulators. Psychologists, psychotherapists and counsellors will be regulated by the Health Professions Council, following that Council’s rigorous process of assessing their regulatory needs and ensuring that its system is capable of accommodating them.” You’re right, it’s not written in stone - it is enshrined in White Paper! [laughter]

A: and in Article 3.5 of the HPO2001 it states there is a Duty to Liaise with All External bodies and publics affected.

F: There is a common perception in other fields, for example psychology, that an elite group has captured the regulatory process to further their own agenda.

E: we did consult all parties

V: you didn’t consult us

E: no-one was refused a place

V: you refused us!

B: Collaboration with the HPC is good. But, the Fitness to Practice process is corrosive, punitive, and persecutory. We cannot have a system that doesn’t have some thought for the clinicians and their other patients. I don’t feel secure with the HPC FTP protocol. The question is, do HPC know that there are problems? I think HPC [pause] are [pause] do know. We had quite a robust, informed discussion on this.

E: The Generic section of the standards, are formulaic, and HPC has started a process of review. The system is not appropriate, and it’s been recognised as inappropriate. But, look, the SoP is not a curriculum document. Everyone makes that mistake. It should not dictate curriculum.

A: A detailed critique of the standards of practice has been made and made public. Its in the Maresfield Report, copies of which are at the front desk and downloadable from the internet. There are four main difficulties with them. First is the ‘infection control’ problem – that many of the generic standards have nothing whatsoever to do with our practice. The second is that they construe therapy as something applied to a passive patient. Third is the ideology that makes the human a piece of faulty equipment that needs fixing and setting back to work. Fourth, is the notion of audit and health. Many of the other HPC practices are contained and confined, not open ended, unpredictable and risky. For us, the patient is a potential, not a broken economic unit. [loud and long applause]

G: the Draft Standards of Practice are utterly unworkable.

C: Consultation needs to be real.

D: We don’t employ professionals directly, we set up a PLG. We advertise slots, people
apply, they do excellent work. I see no reason to change the PLG make up. The Standards of Practice are the very heart of regulation. I think our consultations are very thorough.

B: I’m perplexed by the enthusiasm, expressed by the audience in the length of their applause, to A and C. I don’t think we should pay too much attention to it.

V: Please don’t try to regulate my clapping [much laughter, and clapping].

E: I want to remind everyone that the Standards everyone are so upset were about actually written by the professions, I didn’t write them.

A: And I want to remind you that, according to the 2004 Doc, it is a requirement that any profession coming under HPC regulation be homogenous

D: it is not a requirement.

A: it is.

D: It isn’t. Look, we’ve just taken on seven different types of psychologists! Anyway, what’s written in the document is one thing, how we interpret it is another. Nothing is set in stone.

V: It seems to me that that real problem here is that the regulator seeks to replace real judgment with bureaucratic standards.

D: Standards go to the heart of regulation. If these are wrong, it won’t work.

V: It doesn’t work.

B: Standards are tragically low. What we need to ask is which organisations are the guardians of quality practice? It is not the HPC. We all share a common set of [pause], look we are the guardians of quality practice.

A: But do have a set of common skills? We might share one mode of practice – one that relies on the presence and place of the individual. Many might even agree that the single most important part of a training is someone’s personal therapy. But you can’t regulate someone’s personal therapy.

V: In the Liaison Group the impression is given that there is a free and fair exchange of views aiming at some kind of agreement. But some papers I have seen, got from the website, suggest that in fact the agenda is set by the HPC, answering questions that are of interest to them. This is not real liaison, more a mystifying exercise in domination by the HPC. Who did set the agenda of the PLG?"

E: [throat clearing, rambling and mumbling finally giving way to:] me, me and Michael Guthrie [administrator at the HPC].

V: Why is it only now that some people are arguing against HPC?

A: This has been going on for years!

D: The process is time consuming, frustrating, irritating. Some of these professions have developed over centuries, so when the regulator turns up and says ‘thank you, I’ll have that’, well, it’s understandable that some are unhappy. Look, I’m only doing my job, I’m a really boring guy, and nothing is set in stone, we are always able to interpret...

Here is the list of questions prepared by the organisers, and the timetable they hoped to adhere to:
10.05 What structures exist for further negotiations by members of the professional community with the Health Professions Council on areas that continue to be contested?
10.15 What capacity does the HPC have to address the ongoing concerns expressed by the professional community?
10.25 What would the consequences be of not joining the HPC register? Will the practitioners have their membership of their current umbrella organisation withdrawn?
10.35 What scope remains for amendments to the government’s decision to regulate psychotherapy and counselling via the HPC?
10.45 A summary of the findings of the Kings College research into the experience of being registered by the HPC – presentation by Dr Michael Fischer
10.55 How do the panellists believe the tension between the needs of the therapist and the patients/clients is best handled in our society? By an external government agency or an independent statutory regulator?
11.05 The HPC Standards of Proficiency are raising concerns because they are formulaic. How would the HPC ensure that these do not restrict good practice that is process-based and that will take into account ruptures in the practitioner-patient relationship that are often part of the therapeutic process?
11.15 How does the HPC intend to influence and regulate psychotherapy and counselling training curricula in the long term?
11.25 What would be the role of independent training organisations in a post- regulation culture?

Frustration from the audience forced the chair to abandon these questions and the timetable and brought questions in from the floor. There was a struggle.
Over lunch it became clear that members of the Professional Liaison Group (of whom only a very few were present today) were as much in the dark as the rest of us about the intentions of the HPC in the next few months.

Marc Seale’s remarks in the morning gradually began to make sense in retrospect. The December Council meeting (2009) saw him gain support from his Council to write to the Department Health saying ‘lets go’. That meeting also said it would reconvene a larger and more representative PLG to consider all the problems. This now seems to have fallen by the by. Seale said (Saturday) that he saw no reason to do things differently. He has written to the DH to signal the start of the drafting (of the Section 60 Legislation), waiving aside the inconvenience of 1,100 replies to the public consultation.
There is due to be a meeting of the Education and Training Committee of the HPC on Tuesday (2nd Feb) though the papers have not yet been posted (as at 3.30pm Friday 29th Jan). It is supposed to discuss the much maligned generic standards that apply across all the various different professions.

Meanwhile Seale seems to believe it will be possible (for him and those close to him) to ‘interpret’ things around the legislation, and put up with the few years of misery (of those a little removed from him) that will follow. He said ‘all professions are upset at first, but settle down after a few years’… !

In the afternoon the confer auditorium was organised into a ‘coffee house conversation’ and everyone got to have a say. In both groups I was in (which were very different from each other – two people were hostile to HPC, two were hostile to those opposing the HPC, one was just plain confused, and another was fulminating against the bureaucracy sweeping through the NHS and suspected the HPC of same) there was a common question asked: Who elected the member of the Professional Liaison Group? Stunned silence greeted the news that the PLG had been appointed by Diane Waller and the HPC.

Jerusalem is at the Apollo (Shaftesbury Ave) until 24th April.

Confer Conference, Saturday 23rd Jan 2010 (Part 1)

Saturday’s Confer Conference on HPC State Regulation brought together the figureheads of key clans active in the UK psy field today.

As we know, clan HPC is not a native psy organisation, but seeks to take control of the practice in order, as it says, ‘to protect the public’. This clan draws its power not from practice or philosophy, nor even from any pressure group or union, but from the Government. It holds a veil over this relationship.

Ultimately, the relation HPC seeks to build is with the individual members of the 50 or so clans in the psy field, yet initial negotiations take place with the leaders of a few of the more powerful tribes. It is with the individual members that the long-term interest of the HPC lies. This is where the tax will be levied, this is where the new rituals of engagement will be played out, this is where the power will be applied. HPC estimate it will ‘capture’ anything between 50,000 and 100,000 members in this new arrangement.

The money raised from the annual levy will pay for the offices, the salaries, the equipment etc etc etc, of the HPC clan, which retains almost absolute control over decisions how to spend it.

There are virtually no mechanisms whereby the members, or registrants as they are known, can call or hold this regulator to account.

As we have already discussed, and as Italian Barrister and Psychotherapist Alex Amicarelli has exposed, the HPC has been put into a position of power by the Government, but without any obvious mechanisms to call forth its responsibility. Like Shakespeare's Measure for Measure, the Duke carelessly hands power to the rectitudinal Angelo then clears off out of the public eye. This fudge makes it possible for the HPC and its supporters to say whatever they like, depending on what is needed to win the argument at any particular moment. The position it holds is the symbolic key that guarantees its immunity.

It is helpful to think in these terms when reading the extraordinary document that the Conference organisers encourage conference participants to read in preparation for the meeting. In Marc Seale’s statement, for instance, we find just two short paragraphs (presented, by the way, for no apparent reason in quote marks). These reveal the sophistication that is necessary to deploy from a man in such a position. In the first paragraph Marc states that Statutory Regulation will make Psychotherapy and Counselling safer. And in the second paragraph he states that HPC regulation has no negative effects.

The position statement issued by the British Psychoanalytical Council, is a little longer (5 pages), but bears a similar declamatory tone. For example, on NICE: “We consider that the establishment of the National Institute of Clinical and Health Excellence (NICE) that carefully weighs the evidence for the effectiveness (and cost effectiveness) of treatments in the UK is an immense social gain.” But goes on to offer the contradictory information that “there is an issue around whether an overwhelming and over-simplistic primacy has been given to randomised controlled trials (RCTs)”. There is no attempt to analyse the conflict.

The BPC Statement pledges support for each area of Government policy – IAPT, NICE, SfH & NOS, and the HPC. It adds that it is also working with NIMHE and its new project NWW. Anyone who wants to know what these acronyms mean is obviously suffering from 20th century syndrome, and should report immediately to their nearest government re-programming centre, or download the do-it-yourself software (perhaps the link will soon be available on the BPC website).

The statements of Darian Leader (speaking on behalf of the Alliance for Counselling and Psychotherapy against State Regulation) and of Andrew Samuels (appearing in his capacity as Chair of UKCP) have yet to be posted to the website. Instead, you can re-read the original Alliance Statement of Intent, or plough your way through the UKCP’s response to the public consultation on the report of the Professional Liaison Group for Psychotherapy and Counselling produced for the HPC.

Also posted for your edification are the BACP response, the HPC Draft Standards of Proficiency, Michael Guthrie’s (HPC Director of Policy and Standards) assimilation of all 1,100 responses to the consultation, and the Government’s White Paper (Trust, Assurance and Safety). There is no mention of the Maresfield Report, nor a link to the Kings College report

For those who still have room for more reading you may be interested in the following background information, taken from evidence submitted to the Select Committee on Health in 2006. These excerpts come from evidence given on 15th June, 2006, by Marc Seale (CEO of HPC), Sarah Thewlis (Chief Executive of the Royal college of Nursing and Midwifery), and Finlay Scott (CEO of GMC). It is included here because it shows a couple of interesting features. First, the real pathway of accountability of the HPC, and second the way this emphasises the fundamental objectives of the government’s regulatory machine in the regulators mind.

The Chair of the committee (who himself happened to be a lay member of the GMC), kicked off by asking: “How are regulators helping to develop a workforce that is fit for purpose for the 21st century, as opposed to just developing more of the same?”
Sarah answered: “…by seeing regulation in its broadest context and not just seeing it dealing with unfitness to practise issues… but I think very much when you are working at workforce planning it is about making sure that people that come on to the register are competent… [and] we have worked very hard with employers about making sure that we can provide a flexible workforce”. [emphasis added]

Scott answered in exactly the same way: we have four functions, not just dealing with impaired doctors, but also “Standards, Ethics, Education and Registration, [which] all help us to contribute to the shaping of the workforce through influencing not only undergraduate medical education and training, but also the attitudes, the ethics and principles that doctors take to their work day by day and, as with the Nursing and Midwifery Council and other regulators, the very direct control over who joins our register from outside the UK and the EEA… we are ensuring that we fully involve representatives of the public, employers, and of course representatives of the profession, to try to ensure that the public's expectations of doctors can be reflected in the way that the doctors of today are educated.”

And Seale said: “The Health Professions Council also has a specific role in advising the Secretary of State of which new professions should become statutorily regulated, and that, I think, is vital in terms of protection of the public. I think the last thing is that all three of us have participated in the Foster and Donaldson Review and we are eagerly awaiting the outcome of that because I think that will that enable the regulators to be fit for purpose as we move forward into the existing century.”
When you look at the place from which the CEO is held accountable, and observe the methods of those who are actually empowered to challenge him, then you might begin to understand how the process gets so badly distorted.

Marc Seale had the last word in that particular sitting of the Committee. It is a little difficult to grasp, but revealing nevertheless. Here is what he said:
Mr Seale: “It might be useful to link this debate back to workforce planning. What is going on—and it is beginning to accelerate this change—is the traditional model of doctors, nurses and physiotherapists is beginning not to work, because I think what is happening is that new skills, new technology, new drugs, et cetera, start off in a very small group of individuals who are skilled in doing that and gradually that skill goes down through the workforce. At the same time you can actually now come into the workforce at a particular level with that new set of skills and what the regulators have to do is to capture those new individuals with the new skills as it trickles down through the system. Currently it is not quite working correctly but I think all the regulators want to see it work effectively. That will mean that as demands are put on the workforce those skills could then flow through the individuals.” [emph added]

Measure for Measure is at the Almeida from Feb 12th, to April 10th.
“To whom should I complain? Did I tell this, who would believe me?”