The professional liaison group meeting for the proposed regulation of psychotherapists and counsellors on the 12th May 2010: An example of how not to dwell in un-knowing.
Bruce Scott, Philadelphia Association, London.
Introduction
The philosopher Ludwig Wittgenstein [1] subscribed to the idea that it is important to attend to the language one uses; the words that we habitually use and the contexts we use them in. Wittgenstein also recognised the inevitable coming up against the ineffability/ungraspability (in words) of our experience of life and language and famously wrote:
“What we cannot speak about we must pass over in silence.” [1, p 74]
Heaton [2] argues that the psychotherapist should do what Wittgenstein says the philosopher should do. The therapist must set limits between what can and cannot be said and thought by working out from what can be said (or thought). Thus the therapist lets the patient say and think everything he possibly can. This process thus hopefully helps the patient find the limits of thought and language. It is crucial that the patient (and therapist) experiences the limits of language as nobody can point this out to him. Only by wrestling with his own problems can he see the dissolving of his problems when he reaches his limits of his language (e.g., the futility of working out how can get happiness). The result of this is that he can never say how his problems were dissolved or how he was cured. This is why as Heaton argues, it is no good telling a patient when he comes to therapy that his problems will be solved when he reaches the limits of thought and language. This is because the limits cannot be put into words; they can only be reached through words and thoughts. Heaton admits that this formulation may sound mystical but this is a common facet of everyday experience. In other words, many people enjoy themselves, laugh, love etc but they cannot tell themselves or other people how to do these things (not even experts in CBT can do this). However, it was Wittgenstein’s intention to emphasis the mystical, to highlight it as a phenomenon and not to ignore it as some of his critiques have argued, because it cannot be put into words. There is a lesson here to be learned for the members of the PLG trying to work out how to go about implementing the regulation of psychotherapists and counsellors. It was a lesson the members of the PLG could have done to have been taught before the 12th May 2010. Maybe they don’t have to panic, create definitions of counselling and psychotherapy, set standards, get overly worried about public safety, pin down what psychotherapy is all about and regulate it (in the way they think it should be regulated). There could be another way. But this way has been forgotten and/or ignored by the PLG group and the HPC.
But let us go slowly. It may seem odd (to some members of the PLG) not to panic (and rest in silence) at the thought of non-HPC regulated therapists and counsellors at large in the country, but let me explain that in actuality, the panic should be put in its proper place; in the fact that panic is being deployed by the HPC and PLG, this is taking them further away from what is more important: Keats’ [3] notion of negative capability which Wittgenstein would have been proud to see them use. The poet Keats in a letter to his brother in 1817 wrote:
“I had not a dispute but a disquisition with Dilke, on various subjects; several things dovetailed in my mind, and at once it struck me, what quality went to form a man of achievement especially in literature and which Shakespeare possessed so enormously- I mean Negative Capability, that is when man is capable of being in uncertainties, Mysteries, doubts, without any irritable reaching after fact and reason…” [3, p40-41]
The lack of negative capability was shown in the panic, frustration and activity that were being utilized at the PLG meeting on the 12th May. The battle lines were being drawn, tactics were being assessed, and words were being used as weapons all in the fight to colonise the non-HPC regulated psychotherapists and counsellors in this country.
What I am trying to articulate by the wonderful philosophical insight of Wittgenstein [1] and Keats [3] is that the very act of the PLG group irritably and in a state of panic trying to find the words, concepts, and plans to regulate psychotherapists and counsellors is ignoring a fundamental mode of experience, that is both fundamental to psychotherapy, but also to how to live a good and happy life for those not necessarily in therapy. This mode of experience is not set out or recognised in the HPC’s standards of proficiency and conduct. Therefore, the PLG/HPC are ignoring their own dis-eased dialectic and use of words, which if attended to, as Wittgenstein advocated we should do, they would realise that they were ignoring the limits of what can and cannot be said but also what was right under their noses; their violent unconscious (or conscious?) intentions on those who don’t agree with HPC regulation and their own maltreatment of their own and others psyches by their refusal to dwell within the realm of unknowability and ungraspability (of their project to regulate the psychotherapies) that their dialectic in continually bringing them back to face.
The thing is, the PLG and HPC were trying (and it was painful to watch) to put a full-stop at the end of the psychotherapy and counselling debate and its regulation. But can psychotherapy or counselling be led to the full stop? To my mind no, and how can it be, for it would then no longer be what I and many others regard psychotherapy and counselling to be. The HPC want to bring us (those opposed to HPC regulation) into line and wipe out any uncertainty that rightfully has its place in a true psychotherapy; anything after the full stop wont exist (under HPC law) and will be regarded as chaos, criminal, quackery and all the rest of the bad names they can muster up in their defence of putting in the full stop in their text of what psychotherapy and counselling should be.
However, let me outline some of the narratives that occurred on the 12th May at the PLG meeting. It may serve us well and take Derrida’s [4] hint to do a close reading and listening to what went on during this meeting. I will outline what was said by some members of the PLG group accompanied by some of my thoughts from my field notes that I made during and after the PLG meeting (in italics).
The PLG meeting
Fiona Ballantine Dykes, in being invited to share her thoughts at the start of the meeting, questioned if the process (of trying to regulate psychotherapists) was really worthwhile, and questioned the nature of what being a regulator meant in the domain of psychotherapy and counselling. She also wanted a discussion of how the HPC regulation would be accepted by the field.
Jonathon Coe commented that energies were being sapped and that we (the HPC/PLG) had to attend to that.
One person mentioned (and echoed several times during the meeting by Anna van der Gaag, Chair of the HPC) that we had done a lot of good work and had made a lot of progress.
To my mind the futility and/or impossibility of the regulation and the “demand” to put a full stop on this whole regulation issue is apparent. Moral is low in the PLG. Their energy is low, and some of the PLG group are questioning the whole idea. Anna van der Gaag is the encouraging General, being positive in the shadow of a very difficult if not impossible task. The PLG/HPC are recognising the limits of language, but refusing to bow to these limits. They obviously see their goal as conquering and domination over the unregulated bad lands of psychotherapy and counselling.
One gentleman (perhaps Brian McGee, or maybe Peter Bell) was concerned about the regulation of volunteer counsellors and finding a way of least pain (yes pain) for them to be regulated.
Are the HPC trying to force a procedure upon people but trying to find a way to sooth them into a false sense of security so they just lie down and accept it? Like the promise of a lolly by the dentist to a child scared of going under the drill.
Sally Aldridge commented that we have to convince those who have opposition to HPC regulation that it is the best thing to do.
Why do those against the HPC regulation of psychotherapists and counsellors have to be convinced? Is it the best thing to do, to be regulated by the standards/format proposed by the HPC? Are there not other ways to address this whole issue? Many respectable people, including therapists, politicians, artists, and activists for example can see the dangers of HPC regulation not just for the practice of psychotherapy, but the effects this would have on human freedom and free creative space where individuals can express themselves [5].
Peter Fonagy said that one of the crucial bits of deal sold to the British Psychological Society to get the psychologists HPC regulated was that we agreed that the deal they (the psychologists) got would be open for review if they were unhappy with it. He also mentioned that the competence of the HPC has been questioned.
My mind goes back here to the well publicised HPC hearing of psychologist Dr Malcolm Cross, who to my mind was a prime example of mis-management and misconduct by the HPC themselves [6].
Fonagy also mentioned that a substantial sub-group of psychotherapists and counsellors have made it clear that they will never sign up for HPC regulation. Fonagy finds this problematic.
Why does he see it as problematic? Is diversity not applauded in this day and age? Surly diversity of psychotherapists and counsellors should be encouraged? If psychotherapists and counsellors were all the same, saying the same things, and acting in the same way, what kind of world would we live in? Diversity of people in life is what makes life interesting and fulfilling. It would be problematic if all psychotherapists and counsellors were the same and signed up to a regulatory system if they did not agree with it. Perhaps objection should be celebrated, and not condemned. It seems that freely objecting is frowned upon by the PLG/HPC. I find that worrying.
Carmen Ablack echoed Fonagy’s thoughts and said that there was an elephant on the table that is never talked about; the opposition to the HPC.
Well perhaps you should listen to them then. The opposition are quite contactable. But are they opposition? Are they not just different? See my comments directly above.
Anna van der Gaag, chipped in at this point (almost like rallying the demoralised troops) and said the “our” strongest weapon is dialogue and that the narratives going on externally (to the HPC/PLG) must not distract us from our job in hand; regulating the psychotherapists and counsellors. She continued. “Our” commitment must remain strong and I am sure we will get a good outcome.
This seems like military speak. Why must the narratives going on outside not distract you? Surely the narratives going on in the outside world are important. Perhaps the job in hand is to listen and acknowledge that other narratives exist that do not fit into the HPC narrative. To ignore them, or even silence them (what regulation is intent on doing) is barbaric. What would be the outcome of ignoring the external narratives? Victory over the opposition against HPC regulation? Would that be good? Good for whom?
Later, Mick Cooper talked about getting the views of user groups (or service users) to ask what they wanted from psychotherapy and counselling.
This might on the surface seem very logical, but is there not a potential (unsolvable) problem asking people what they want from therapy? Someone might say I want to be happier and be cured. This person goes to a therapist, does not get happier, is not cured, and blames the therapist. The person complains to the HPC, and the therapist may be suspended through a hearing, and/or re-educated in the ways of making people happier and curing them. He may even be struck off. Often a patient’s “demands” are the “problem”, as are their ideas/language of what is happiness and what is mental distress (e.g., depression). In other words it is just as valid to assert that there is no self, happiness is illusory, and there is no mental disease as such (in comparison to organic disease), to cure. To believe that you have a depression to be cured for example may be the problem; the belief and faith in a disease entity that causes depression that one has to get rid of.
Jonathon Coe asked the group what is the nature of protection and how do we protect. Peter Fonagy stated that the HPC has to protect people against human frailty.
Surely we do not need protected from human frailty, but recognise that we (human beings) are frail. To be protected from our frailty would be to take away what it is to be human; what educates us, what guides us, what makes us love and care for others. To feel depressed or to feel the angst of life may be life affirming. It may be a necessary political move to feel frail or feel like hell. The recent IAPT initiative of putting poorly trained psychology graduates in job centres to dish out CBT (note to HPC: which they are not really qualified to do) to get the jobless back to work smacks of ignoring human frailty. I am sure many jobless would want a job rather than some IAPT worker telling (patronising) them that the evidence for their negative beliefs are false. Government policies at times do not recognise human frailty, and act in full knowledge that people will be affected and hurt by them.
Sally Aldridge said that we should do research and the get the views of potential clients or patient and see what they want from psychotherapists and counsellors.
Again, well yes I can see the logic in this, but what if the patient’s “demands” are the problem? See comments above. But isn’t this the process of analysis itself; getting to grips with one’s destructive demands? Is psychotherapy not a conversation about a patient’s demands and why they come to see a therapist and pay for it.
One of the more thoughtful comments by the PLG group was by a woman called Linda Matthews. She asked the group, is regulation appropriate for psychotherapists and counsellors and is it Ok not to be regulated.
Is there doubt among the PLG troops?
Then there was whole debate about the differentiation of psychotherapy and counselling. I will not go into the details of this, suffice to say many people had different views about it, there was much disagreement, and an awful lot of confusion and grasping for ideas. Anna van der Gaag intervened and said that this discussion has opened a can of worms and now perhaps it is time to shut it. She did question how the problem affects the process of the regulation of psychotherapy and counselling.
I think it is important here to recognise the realm the PLG is now in; the land of ambiguity and uncertainty. But is this not one of the important things about psychotherapy; being committed to ambiguity and uncertainty? This reminds me of the late Peter Lomas’ [7] book, “Committed to uncertainty”. Perhaps uncertainty (which is certainly part of psychotherapy) should be laid on the table at the PLG and held up as “a reality” that will never go away. Perhaps the can of worms that is the difficulty of distinguishing psychotherapy and counselling should never be shut, it does not need to be shut, it is healthy that it remains forever open.
The topic of getting service user input was again brought up by Mick Cooper who enquired if there was any research money available for finding out about service user’s perspectives. There was some talk that this was possible. Anna van der Gaag asked it there was general agreement in the group that research into service users’ perspective should be sought. It generally was.
It looks like lots of other people’s money is now going to spent on research. Who will design the research study, what measures will they If this research is done in-house so to speak, how “scientific” and unbiased will the research be? Perhaps, Mick Cooper and Peter Fonagy will be enlisted to do this research? The big question is, why has these research proposals not been talked about already? This PLG group has been running for nearly two years and only now they come up with the idea of service user input; very worrying. It really felt the PLG group were desperately clutching at straws here.
Later on Brian Magee voiced his opinion that he thought we should find out how psychotherapy and counselling has been regulated, or not, overseas. Sally Aldridge replied that there is a lot of information readily available of how other countries “do it”. Fiona Ballantine Dykes replied, and opened that can of worms that earlier Anna van der Gaag asked to be shut, and said that all “these” other countries (I don’t know which countries she was referring to) differentiate between psychotherapists counsellors and if we did not do the same we would be doing something that was out of line.
But why would we (I take it with we she means the HPC/PLG or the UK) be out of line? If the HPC did not differentiate we would make another line, and other countries would be out of “our” line. Perhaps these other countries have got it wrong and need to join their (the HPC) or our countries potential regulatory policy?
There was then a whole lot of talk about setting educational standards for psychotherapists and counsellors. The response was to talk to education experts, get their opinion of what educational standards we should set. Fiona Ballantine Dykes responded to this with some degree of alarm. She said that psychotherapy is relational, and things get lost when you get stuck on just setting educational standards. Anna van der Gaag retorted that even with words things still get lost.
We are again getting back to the idea of uncertainty. The HPC don’t like this realm. It does not seem to want to go away. A bit like what psychotherapy is like, then. However, Anna van der Gaag is highlighting the limits of language that Wittgenstein [1] was on about. But as always, they (the HPC/PLG) shy away from this terrain.
Annie Turner continuing this theme asserted that the whole is greater than its parts; the therapist and the constituent parts of the therapist (i.e., training, personality, and school of thought). She argued that it was impossible to capture the nature of therapists on the basis of looking at the individual constituent parts. She insisted that getting caught up with entry levels and educational standards of psychotherapists and counsellors was a red herring.
Mmmm…getting back again to the realm of uncertainty.
Anna van der Gaag agreed that today we are not going to agree on educational standards for psychotherapists and counsellors.
Maybe there will never be agreement.
A little later, Sally Aldridge commented that we have never looked at the curriculum of psychotherapists and counsellors and that this might be a way forward.
Looks like that red herring that was mentioned before.
Julian Lousada said that we are going to get lost in too much information here and we should just battle out the key issues.
Did he mean getting lost in the fact there is no information to grasp onto? Does this
frighten the members of the PLG? Why can’t they withstand being lost? Surly they must recognise the need for potential lost-ness in the issue(s) they are talking about, that certainty can never be assured. Is not one of the key issues the uncertainty or the lost-ness inherent in the psychotherapeutic endeavour, and why should one battle with this?
The argument seemed to go back to the issue of opposition to HPC regulation and one gentleman said we must listen to our opponents. Fiona Ballantine Dykes replied to this and said that we should not ask what they object to, but how would they like it (regulation). Mick Cooper retorted and asked what is the point in that. Linda Matthews joined in and said that it is not “our” place to have a forum for opposition. Peter Fonagy said that we have to hear the objections. Fiona Ballantine Dykes had concerns that stakeholders views had been noted in the past but nothing had been done with them.
There is obviously a lot going on here. A mess … Chaos ... Struggle… Confusion.
At the close of the meeting, where nothing much had been agreed apart from getting service user input (costly research proposed) and getting an international perspective of how other countries regulate (or not) psychotherapists and counsellors (costly research proposed).
As a member of the public I resent money being spent at this late stage on research as a result of the grasping ramblings of a PLG group that frankly does not give me much confidence in the process they are painfully trying to conduct.
Anna van der Gaag sent her troops away and left her PLG troops with this message: Keep in radio contact.
The military metaphor, keep in radio contact is fitting. The PLG group and HPC see the issue of regulation as a colonisation of an invading army, forcing the frontline ever forward, ignoring the cries of mercy from the natives (psychotherapist and counsellors), believing they are correct, justified, and protecting the public. Sounds familiar? This was the cry from the righteous war-mongering governments of George Bush and Tony Blair when they tried to convince the world that they were protecting the West from terrorists and weapons of mass destruction. They also said they were protecting the people of the countries the US and UK armies invaded. Some protection!
In praise and honour of the paradox
The PLG group were, as I hope to illustrate, dipping in and out of what Kierkegaard [8] called the Paradox of Reason (or the impossibility of reason explaining away all uncertainty). Well let me correct myself, the PLG group were not so much dipping into the Paradox, they were often scrambling to get out of it. This is an important point, but it is never acknowledged by the PLG group. “It” is there, but it is not talked about. It lurks in the shadows but this paradox must play a part in the issue of the HPC regulatory issue of psychotherapists and counsellors. One example of this as discussed above, is the frantic issue of trying to pin down service users’ needs and expectations of what therapy can and should be like. A more obvious example of PLG/HPC anxiety and their running from the paradox is evident in their discussions of “capturing” the opposition to HPC regulation as if they are “right” and the opposition is wrong and misguided. Thus it seems the HPC/PLG think they have the monopoly on surety, reason, and correct judgment (or if they don’t are fighting to get it). Perhaps they could take a lesson from Kierkegaard.
Kierkegaard, in his chapter called “The absolute paradox: a metaphysical crochet” from his book “Philosophical Fragments”, says:
“The thinker without a paradox is like a lover without feeling: a paltry mediocrity.” [8, p46]
In other words, to live a human life without the mystery as described by Wittgenstein, this almost mystical unknown that the limits of language (and reason) brings us to, a mediocrity of existence. I realise that some highly educated intellectual fools in some ivory tower somewhere might baulk at this statement. However, Kierkegaard goes to on to describe how reason in actual fact seeks a collision (a realisation of the limits of reason). This is the supreme paradox; that all thought is the attempt to discover something that thought cannot think. What is this unknown that reason collides with? Kierkegaard called it the God, others call it the unconscious or the Real-we can never fully understand this. But Kierkegaard puts it like this; how should reason be able to understand what is absolutely different from itself. Reason mongers of the HPC and PLG have not grasped this, but taking Keats’ line, perhaps they should not even grasp.
Put another way, reason desires its own downfall because reason can never pin down everything, especially when it comes down to problems of the human soul, psyche, or how to live a good life. Kierkegaard called this the consciousness of sin, when one realises the paradox, that reason cannot solve everything. It is self-love, or vanity that thinks reason can be called upon to dominate the world. This self-love shrinks from the paradox; it is offended, because it perceives itself as passive. Self love is intent on concealing passivity. The offended consciousness or self love, Kierkegaard argues, can be taken as proof of the validity of the paradox. One truly learns when one is faced with the paradox, self-love dies, the absurdity of many things in life is realised, and one can move on from the stuck-ness that the vicious circle of reasoning has got one into. Many patients and psychotherapists know this place or experience (if one can call it a place or even experience). These are the moments of movement in psychotherapy, the Zen moments of realisation when one realises that the panic over the abyss of uncertainty is nothing really to worry about (but if there really is something to worry about, that is OK too, but one may not stop the forces of nature by thinking one’s way out of it). It is truly other, new, becoming (not pre-determined), playful, and cannot be scripted before hand. One has to take risks in getting there. As Laing [9] rightly said, one has to take one’s chances with the other in the consulting room; the therapist with the patient, the patient with the therapist, and also with oneself.
But as the HPC and PLG seem incapable of seeing, taking one’s chances with “another” human being and oneself is what is needed in therapy; but they want to erase all chance or risk taking. Offended consciousness in Kierkegaardian terms will occur in psychotherapy and counselling; with the therapist, with the patient, and between them. Not only that, the patient will be offended by the realisation of his offended consciousness, and may be offended that the therapist can do nothing about it. It may be the most natural thing, and helpful thing to let this offence play itself out in a natural therapeutic unfolding. It may mot be comfortable for both parties, but this is something that has to be realised (that can happen in therapy and everyday discourse) and play itself out. This is the basic fact of the impossibility of totalization through reason; there will always be a space or “in-between” that intersects our being in the world. The HPC want to erase this kind of experience from psychotherapy.
This last point leads me to Plato [10], who outlines, as I and many others believe, where mainstream thinking in relation to mental distress has gone wrong, and where the PLG and HPC are going astray in their thinking.
Chora is a philosophical term described by Plato in the Timaeus as a receptacle, a space or an interval. It is neither being nor non-being but an interval between in which the “forms” were originally held. Chora gives space; a very important idea in relation to psychotherapy and everyday living. Jacques Derrida [4] uses the concept of chora from Plato to name a radical otherness that gives a place for being. Derrida argues that chora defies attempts at naming an either/or logic. In other words, the chora is fully other, defies totalization, and I believe epitomizes what it is to be human; that logic cannot fully encompass this domain, and this is where “scientistic” thinking fails in relation to the human sciences and proliferation of theoretical abstractions of “mental health” and “treatment” fall foul. There is no getting away from chora, but you cannot get it either.
Derrida’s reading of Plato is like many commentators believe a correct reading of Plato, in comparison to the “logocentric” use/reading of Plato’s philosophy [11]. That is, readings of Plato which pick out the demonstrably true or false claims, making these the centre of the argument, while sending everything off to the periphery as mere rhetoric or ornamentation; letting logic lead the letter. Derrida argues that the result of a logocentric hegemony of Plato’s philosophy and logocentric scientistic viewing of the world is that any text (oral, written) is neutralized, numbed, inhibited, even though the these heterogeneous forces continue to stir in their inhibited form. The result is that a sanitised version of “reality” is constructed through the logocentric viewpoint, but something lies still stirring that defies the logocentricism. This is radical stuff, but a radicalism that is in great need of being acknowledged; the sanitized version of reality being constructed by the HPC and PLG with regards psychotherapy and counselling is being constructed by a logocentric reading of mental distress and psychotherapy and counselling. As Feyerabrand states:
“Proliferation of theories is beneficial for science, while uniformity impairs its critical power. Uniformity also endangers the free development of the individual.” [12, p24]
The above statement, like the visceral feeling of reading one of Plato’s dialogues is that of the sensation of the opening of the proverbial can of worms. One can feel the de-centering of the logocentric viewpoint. It also shows how uniformity, however well intentioned, banishes autonomy and critical thinking; there is no one truth, or even there is “no truth”. However, the person must dare to speak it, but he must question his truth-making as truth is no-thing; truthfulness is a way of being but always an unfinished business. We arrive here at a very interesting point, a point which is crucial to the idea of psychotherapy; if a prevailing logocentralism prevails the consulting room, what room for a different reading of the text is allowed. More importantly, if the “law” is handed down from say the Government or HPC via the PLG, of what one should do with people in mental distress, how many readings of “truth” are banished? This is a very serious question and is applicable to all parts of human living, not just with regards the practice of psychotherapy or the “treatment” of those deemed mentally ill.
The Chora of doing no good or doing harm: The statistical impossibility of doing away with risk in psychotherapy and counselling
Over lunch, at the PLG meeting, I listened to Peter Fonagy talk about the serious risk that unregulated therapists pose for society. He related the findings of a research study that found that 5% of psychotherapists do no good (patients do not get any benefit) or that they do harm of some kind (e.g., the patient gets worse or is traumatized by the therapist). Now, this might seem a statistic worthy of attention, but let me highlight something very thought provoking. Take a sample of 100 HPC regulated psychologists and the treatment they have administered (say CBT for depression) and also take 100 antidepressant treatments for depression and subject them to statistical analysis for efficacy and harm. In the distributions from the two samples (Psychologists’ CBT treatment and antidepressant treatments), there will always be some small percentage in both tails of scores (e.g., of efficacy) in the sample’s distribution where the treatment will show to have done nothing and/or done harm [13]. This is because the laws of probability and distributions in statistical analysis will always show small percentages (scores) in both tails of a distribution.
But, I hear a pro-HPC person say, psychologists are regulated and antidepressant drugs are regulated (for their use in depression). So if they are regulated, and they have done harm or have done nothing, they can (the psychologist or the drug) can be dealt with (the psychologist suspended, the drug taken off the shelves etc). However, it is not so simple. Before I explain why, SSRI antidepressant drugs have been shown to do harm for many years [14], but they are still used as treatment; obviously the risk attached to the use of them is deemed acceptable by those in power who sanction the drugs for the treatment of depression. If they do not sanction harm, why are these drugs still used? Those who advocate the use of the drugs may say that the small risk is worth it, but they still know someone will definitely be harmed.
But getting back to doing harm or no good, no matter how much regulation you apply to practitioners in the psychotherapies, and no matter how many therapists adhere to the standards of proficiency set by the HPC, every single research study conducted on efficacy and harm by therapists will show that some do nothing and some do harm. In other words you will always find that some percentage of therapists have either done nothing in regards treatment efficacy or even done what is regarded by some as harm (upset the patient, made them madder or made them worse, or offended them etc). No amount of regulation will ever change this. Some patients will just never get anything out of psychotherapy, and some patients will always feel that a therapist has traumatized them; the result of the pitfalls of therapy and transference. Moreover, sample distributions, as I have already said (in both tails of) will always yield a result where statistically a small percentage of therapists will still do either harm or no good. All you can do to ensure no risk or harm is outlaw all psychotherapy and psychology and while your at it, ban all drug treatment for depression, and all medical treatment for heart conditions (and many other conditions), because they all carry a statistical risk (via the laws of probability) of doing harm or no good [13].
So I put it to the HPC and PLG, if the banishment of risk and harm is not possible ever, what is the reasoning behind the proposed regulation of the psychotherapists and counsellors? Perhaps the HPC and PLG are coming up against the Paradox as Kierkegaard [8] talked about, are in the presence of Chora, and are offended, frightened and/or frustrated. Or perhaps there is a more sinister ploy; to attain a scientistic uniformity, which outlaws any other way of thinking. This would have benefits for those on the side of uniformity for sure (economic, status, power) , but would certainly be a terrible blow for freedom in a supposedly democratic country which values free speech. Free speech and free development would be repressed under an HPC led psychotherapy world; not only in its therapists but also its patients too. To witness the goings on at the PLG meeting on the 12th May 2010, was frightening. Do they not realise what they are doing to freedom? Perhaps they do, and are thinking of the benefits of that for themselves.
Coda into Chora
The dialectic of the PLG and HPC drips down notions and concepts into the hungry mouths of its members. Their irritability for the need to know, label and regulate is that they feel this approach will satisfy them. But there really is no real end to the irritability; there will always be another notion, idea, issue and problem to regulate; it will never be perfect. Why is it so difficult to get beyond this regulatory treadmill? What lies beyond this domain, beyond the irritable regulatory mind? The paradox is that the more you scratch or irritate this mind, the worse the irritability or itch gets.
The tragedy of HPC and similar “regulatory or classificatory systems” (i.e., DSM, NICE, IAPT, Skills for Health, CBT,) is that their “treatments” serve the itch or irritability they purport to get rid of. They start out on the root of uncertainty, celebrate their constructed certainty, re-create error (of false certainty), multiply error, reward error, and then realise that they cannot get rid of uncertainty. They then say things are getting worse; we need better treatments, more therapists, more research, and more funding; this is a capitalist obsession with production. And we all know about the problems of over-production as a result of capitalism. Capitalist time, as described by Deleuze and Guattari [15], has deemed productivity to be applicable to all domains of life, not just to economy and political sphere. Sleeping, eating, dieting, love-making and our mental health are all under this domain and are affected by its threat. There is always a “new” treatment to be followed, another media psychologist to tell us how to get better, slimmer, more productive, happier etc. It is this that makes life pathological and certainly not enjoyable or natural. The production of more and more information takes us away from the paradox, and attempts to hide the chora.
The sadness of our love-making, our love to each other, and of our experience is pent up also with the idea that if we don’t itch our itch or try to erase the irritability we will land in boredom. We do not want boredom I hear you yell! Yes for most people a world where there is no irritability to fix or an itch to scratch is a land of boredom. However, the pity is that we have not been properly educated as to what proper boredom is or what it feels like. Indeed, it might not even exist if one really looked into this problem. One might not need any external stimulation/action to deal with the painful irritability we like to scratch. But even so this alternative is not something that can be attached to a formulaic way of thinking-it can’t be. It would be a disaster if it was. This is because if we followed this way of dealing with our itch or irritability, of following a plan wilfully, piously, or stubbornly, we may tragically experience the itch-less path not how it is meant to be experienced. This is the world the HPC want to construct for psychotherapists, counsellors and patients.
Footnote
i Certain groups of therapists who join the HPC will have greater access to a livelihood of working as a therapist. Non-HPC regulated psychologists can no longer get work in the NHS for example. There is no room (or it was not taken up as an option) for principled non-compliance with HPC regulation.
References
1. Wittgenstein, L. (1961). Tractatus Logico-Philosophicus. Translated by G.E.M. Anscombe & B.F. McGuiness. London, Routledge and Kegan Paul.
2. Heaton, J.M. (1972). Symposium on saying and showing in Heidegger and Wittgenstein. Journal of the British Society for Phenomenology, Vol. 3, No1.
3. Keats, J. (1966). Selected Poems and Letters of Keats. Edited by R. Gittings. London, Heinmann Educational Books Ltd.
4. Derrida, J. (1997). Deconstruction in a nutshell: A conversation with Jacques Derrida. Edited by J.D. Caputo. New York, Forham University Press.
5. The Coalition Against Over-Regulation of Psychotherapy, www.coregp.org
6. Scott, B. (2010). A case of dialectical disease: A tale of a Health Professions Council hearing of a psychologist. Retrieved from www.hpcwatchdog.blogspot.com
7. Lomas, P. (1999). Committed to uncertainty: Essays in honour of Peter Lomas. Edited by L. King. London, Whurr Publishers Ltd.
8. Kierkegaard, S. (1985). Philosophical fragments/Johannes Climacus: Kirkegaard’s writings. Vol. 17. Edited by H.V & E.H. Hong. Princeton New Jersey, Princeton University Press.
9. Laing, R.D. (1972). Asylum. A film by Peter Robinson. Kino Video.
10. Plato: The Complete works. (1997) Edited by J.M. Cooper. Indianapolis, Hackett Publishing Company Inc.
11. Heidegger, M. (2001). Zollikon Seminars. Protocols-conversations-letters. M. Boss (Ed.). Translated by F. Mayer & R. Askay. USA: Northwestern University Press.
12. Feyerabrand, P. (1975). Against method. London, Verso.
13. Howell, D.C. (1995). Fundamental statistics for the behavioural sciences. Third Edition. Belmont California, Wadsworth Publishing Company.
14. Healy, D. (1997). The antidepressant era. Cambridge , MA, Harvard University Press
15. Deleuze, G., & Guattari, F. (2004). Anti-Oedipus: Capitalism and schizophrenia. London, Continuum.
Friday, 18 June 2010
A new template letter you can use to send to your MP
with thanks to the author, here is a helpful outline you can use to write to your new MP.
Dear ---
I am writing to you regarding the proposed regulation of the talking therapies by the Health Professions Council. At the time that the HPC was suggested as a potential regulator by the previous government, nearly all of the psychotherapeutic training organisations in the UK protested that the remit of HPC was too narrow to accommodate the breadth and diversity of the talking therapies. Detailed arguments were set out which explained why the talking therapies could not be reduced to health professions, yet the government at the time overruled these without any real process of consultation. We hope that now, with a new government in place, the time has come to recognize the shortcomings of the HPC model and to explore the best regulatory model for the field.
The consultation process itself has been highly controversial: representatives of training organisations and user groups initially included in draft lists of committee membership were excluded, and the original Department of Health requirement to include representation from the wide spectrum of professional groups was not followed. Instead a small number of people with their own highly specific political agenda gained control of the process and tried to force the talking therapies into a mould which quite simply won't fit. This is the mould of the medical health professional: that what a therapist does is to correct pathology.
Although there are certainly some therapists who use the medical model as a metaphor of their work the majority do not. For them, therapy is a conversation with the unconscious, an enquiry into an individual's history, a spiritual journey, an exploration of the human condition and the many other forms of enquiry which could be described under the heading: a life examined.
In the HPC's brief, following the 2001 Health Professions Order, it is stated that "The occupation [proposed for regulation] must cover a discrete area of activity displaying some homogeneity". With the talking therapies this is simply not the case: some therapies aim to remove people's symptoms, some do not; some involve the application of predetermined procedures, some do not; some offer a set outcome, some do not; some focus on an individual's history, some do not. The list goes on, but the key is the absolute heterogeneity of the field, a fact which those who have gained control of the consultation and regulatory process seek to obscure.
Regulatory consultations in many other countries have recognised this diversity of conceptions of therapy and appropriate regulation has then been proposed. This has happened in Australia and many parts of Canada and the US. The most robust model involves the statutory requirement that all therapists are registered with a list, administered by an independent professional body, giving full disclosure of training and qualifications, together with a public education programme to inform the public about the different varieties of therapy available.
Under HPC, the public will no longer have the freedom to choose the therapist they wish to consult. Therapists will have to fit the restricted definition of what therapy is set by HPC. Innovation in the field will be severely limited likewise by the parameters set by HPC on what constitutes best practice, a concept in itself rejected by many traditions in the therapy world. The richness and diversity of the field will be dramatically affected, with therapy trainings forced to satisfy requirements which are antithetical to their basic philosophies.
The issue of public protection is the main card HPC has played, yet the key point for thousands of therapists is not this, which everyone agrees is crucial, but rather the whole package that comes with it: therapy will become something different, shoe-horned into a vision of human life and relations that many traditions reject, offering instead critiques of received notions of ‘happiness’, ‘wellbeing’ and ‘health’.
It is understandable that HPC is lobbying harder than ever to become the regulator of the therapies, as its budgets are spiralling, with massive increases predicted for next year. Regulating therapists would provide the single largest cash injection the HPC has ever had. Yet alternative models of regulation, such as the Psychotherapy Bill proposed by Lord Alderdice or the models used in other countries, are far less expensive, and are for the most part entirely funded by registrants. Further detailed information on the regulation debate can be found in The Maresfield Report (www.maresfieldreport.com).
I hope that you will give these matters your consideration, and recognise the diversity of the field of the talking therapies and the risks involved in hasty regulation under HPC. I also hope that you will advocate an alternative model which does not reduce the therapies to outcome-based healthcare procedures but gives space for those many enquiries into the human condition which have flourished for the last 100 years.
Yours sincerely
Facts and Spin in the Regulation Debate
1) Current spin is that anyone opposed to HPC is opposed to regulation. In fact, everyone campaigning against HPC is in favour of regulation, just the appropriate kind. Therapy organizations have been in dialogue with government to seek appropriate regulation for nearly 40 years now.
2) When the Department of Health proposed HPC as regulator in 2006, nearly all groups in the field objected. Since then some groups have come to support HPC, less in terms of approving of its framework than of not wanting to ‘miss the boat’. It is believed by some that if HPC regulation happens, some individuals will become ‘Partners’, thus increasing their power and influence.
3) It is sometimes said that only a minority of practitioners object to HPC. In fact, in the only poll conduced to date, 48% were firmly opposed and only 22% in favour. The main organizations have refused to poll their members, and most therapists in the UK simply haven’t been given all the information about the process.
4) Public protection is the main card played by HPC. If a therapist abuses a patient they can, according to HPC, continue to practice under current arrangements. But in fact the HPC model allows precisely this. The practitioner can simply change their title, re-branding themselves as a ‘coach’ or any other kind of ‘therapist’. Regulatory schemes in other countries close this loophole.
5) HPC complaints procedures are public, formal and adversarial, and do not include mediation as a first step. HPC also deem more than 70% of complaints from members of the public ‘no case to answer’. In contrast, the main therapy organizations deem only around 10% of complaints ‘no case to answer’. In the field, more than 60% of complaints are successfully dealt with via mediation. HPC would thus discourage or disallow complaints, especially those which deal with sensitive issues requiring confidentiality.
6) The very rare cases of abuse that have come to light have nearly always involved a breach of current laws of the land. Little additional legislation would be required to prevent those convicted from practising again.
Dear ---
I am writing to you regarding the proposed regulation of the talking therapies by the Health Professions Council. At the time that the HPC was suggested as a potential regulator by the previous government, nearly all of the psychotherapeutic training organisations in the UK protested that the remit of HPC was too narrow to accommodate the breadth and diversity of the talking therapies. Detailed arguments were set out which explained why the talking therapies could not be reduced to health professions, yet the government at the time overruled these without any real process of consultation. We hope that now, with a new government in place, the time has come to recognize the shortcomings of the HPC model and to explore the best regulatory model for the field.
The consultation process itself has been highly controversial: representatives of training organisations and user groups initially included in draft lists of committee membership were excluded, and the original Department of Health requirement to include representation from the wide spectrum of professional groups was not followed. Instead a small number of people with their own highly specific political agenda gained control of the process and tried to force the talking therapies into a mould which quite simply won't fit. This is the mould of the medical health professional: that what a therapist does is to correct pathology.
Although there are certainly some therapists who use the medical model as a metaphor of their work the majority do not. For them, therapy is a conversation with the unconscious, an enquiry into an individual's history, a spiritual journey, an exploration of the human condition and the many other forms of enquiry which could be described under the heading: a life examined.
In the HPC's brief, following the 2001 Health Professions Order, it is stated that "The occupation [proposed for regulation] must cover a discrete area of activity displaying some homogeneity". With the talking therapies this is simply not the case: some therapies aim to remove people's symptoms, some do not; some involve the application of predetermined procedures, some do not; some offer a set outcome, some do not; some focus on an individual's history, some do not. The list goes on, but the key is the absolute heterogeneity of the field, a fact which those who have gained control of the consultation and regulatory process seek to obscure.
Regulatory consultations in many other countries have recognised this diversity of conceptions of therapy and appropriate regulation has then been proposed. This has happened in Australia and many parts of Canada and the US. The most robust model involves the statutory requirement that all therapists are registered with a list, administered by an independent professional body, giving full disclosure of training and qualifications, together with a public education programme to inform the public about the different varieties of therapy available.
Under HPC, the public will no longer have the freedom to choose the therapist they wish to consult. Therapists will have to fit the restricted definition of what therapy is set by HPC. Innovation in the field will be severely limited likewise by the parameters set by HPC on what constitutes best practice, a concept in itself rejected by many traditions in the therapy world. The richness and diversity of the field will be dramatically affected, with therapy trainings forced to satisfy requirements which are antithetical to their basic philosophies.
The issue of public protection is the main card HPC has played, yet the key point for thousands of therapists is not this, which everyone agrees is crucial, but rather the whole package that comes with it: therapy will become something different, shoe-horned into a vision of human life and relations that many traditions reject, offering instead critiques of received notions of ‘happiness’, ‘wellbeing’ and ‘health’.
It is understandable that HPC is lobbying harder than ever to become the regulator of the therapies, as its budgets are spiralling, with massive increases predicted for next year. Regulating therapists would provide the single largest cash injection the HPC has ever had. Yet alternative models of regulation, such as the Psychotherapy Bill proposed by Lord Alderdice or the models used in other countries, are far less expensive, and are for the most part entirely funded by registrants. Further detailed information on the regulation debate can be found in The Maresfield Report (www.maresfieldreport.com).
I hope that you will give these matters your consideration, and recognise the diversity of the field of the talking therapies and the risks involved in hasty regulation under HPC. I also hope that you will advocate an alternative model which does not reduce the therapies to outcome-based healthcare procedures but gives space for those many enquiries into the human condition which have flourished for the last 100 years.
Yours sincerely
Facts and Spin in the Regulation Debate
1) Current spin is that anyone opposed to HPC is opposed to regulation. In fact, everyone campaigning against HPC is in favour of regulation, just the appropriate kind. Therapy organizations have been in dialogue with government to seek appropriate regulation for nearly 40 years now.
2) When the Department of Health proposed HPC as regulator in 2006, nearly all groups in the field objected. Since then some groups have come to support HPC, less in terms of approving of its framework than of not wanting to ‘miss the boat’. It is believed by some that if HPC regulation happens, some individuals will become ‘Partners’, thus increasing their power and influence.
3) It is sometimes said that only a minority of practitioners object to HPC. In fact, in the only poll conduced to date, 48% were firmly opposed and only 22% in favour. The main organizations have refused to poll their members, and most therapists in the UK simply haven’t been given all the information about the process.
4) Public protection is the main card played by HPC. If a therapist abuses a patient they can, according to HPC, continue to practice under current arrangements. But in fact the HPC model allows precisely this. The practitioner can simply change their title, re-branding themselves as a ‘coach’ or any other kind of ‘therapist’. Regulatory schemes in other countries close this loophole.
5) HPC complaints procedures are public, formal and adversarial, and do not include mediation as a first step. HPC also deem more than 70% of complaints from members of the public ‘no case to answer’. In contrast, the main therapy organizations deem only around 10% of complaints ‘no case to answer’. In the field, more than 60% of complaints are successfully dealt with via mediation. HPC would thus discourage or disallow complaints, especially those which deal with sensitive issues requiring confidentiality.
6) The very rare cases of abuse that have come to light have nearly always involved a breach of current laws of the land. Little additional legislation would be required to prevent those convicted from practising again.
Saturday, 12 June 2010
HPC and the torture of language
The new government hopes to roll back the database state, but do they understand what generates it, or their own role in it?
I would point them to the problem of language and prescribe a dose of Lewis Carroll.
HPC agents often use language to mean whatever they want at any particular time. I have reported many examples from Di Waller’s chairing of the PLG for C&P. The HPC video on CPD is another great treasure trove of examples. But Chair Anna van der Gaag is also quite skilled at this game. She recently wrote an introduction to a new scoping report on existing research on complaints mechanisms commissioned by the HPC and called it a monograph. And this is odd, because, you know, the word has hitherto referred to a scholarly and original piece of work that contributes to a field of intellectual study and thus to the overall enlightenment of society – the Longman Dictionary defines it as ‘a learned treatise on a small area of learning, a written account of a single thing’. The report, no matter how well executed is not a monograph. The stuff in it, no matter how elegantly writ, hardly constitutes the ‘evidence base’ on whose back van der Gaag wishes to advance her expansionist cause.
Who benefits from finding out how to get more people to complain? The report is quite clear in its conclusions. People seem to complain for some unspecific reason that has more to do with standing up for a little bit of truth. Very few people actually want compensation, or to cause trouble, or to break trust. They seem simply to want to be heard.
Will these people be helped if the HPC makes it easier for them to complain? No. The complaint may well trigger a process, but this is an HPC ‘fitness to practice’ process applied to the standardised conduct of a specific individual. The scoping document gave no reason to believe that the information from existing complainants had much to do with this. Secondly, the vast majority of complaints received by HPC are received from employers or other professionals, not from members of the public.
‘I weep for you, the Walrus said, I deeply sympathise, through sobs and tears he sorted out those of the largest size, holding his pocket-handkerchief before his streaming eyes.’
The beneficiaries of this peculiar FTP process are the HPC which turn cases into statistics to prove to Privy Council that they are doing a job; the barristers who receive the fee for pushing the case through to its administrative conclusion; and employers, who avoid having to deal with the problems that arise in their own back yard. None of this has anything to do with increasing the country’s intellectual capital or adding to its programme of enlightenment.
I’m reminded of the monetisation mania preached by Mrs Thatcher and her minions.
Anyway, the report is not a monograph. It is, as it says on the cover, a scoping document that scopes a possible field of colonisation for the HPC. It is commissioned as a kind of market research. Come on.
The HPC newsletter ‘In Focus’ has been pinging into my mailbox for nearly two years now and is dull as ditchwater. It used to list the FTP cases and often provided a little case study of how practitioners were messing up. Since October 2009 however, (Issue 25), the FTP cases have disappeared, and since June (issue 23) the In Focus front page has been given over to the problem of cajoling people into making their renewal on time. Every single issue from 23 to the current issue (29) exhorts registrants to renew their membership on time. How interesting. Supplementary news items tend to report the rate of renewal achieved, and suggest that you encourage your colleagues to renew and put posters up in your consulting room. There is also a regular little line or two thanking the personnel managers and union reps that have helped to round up the registrants and corral them into the pen. Great stuff.
Also regularly featured over the last year are the ‘listening exercises’. Like me, you probably imagine that a listening exercise is where the HPC listen to the views of its various constituents – a kind of corrective to the lack of democratic procedures associated with this kind of organisation. WRONG! These events are for YOU to listen to the HPC. They are undertaken in order to tell you what you need to do to comply with their CPD and FTP procedures. It should come as no surprise that lots of people attend these events (all hopping through the frothy waves, and scrambling to the shore), for if they do not comply they will surely lose their livelihood.
For all its literary faults, the current issue of In Focus does, however, give another wonderful example of the insidious spread of the database state.
On 1 July this year the contentious vetting and barring scheme comes into force. This caused quite a splash when Philip Pullman and other authors objected to being treated as potential paedophiles. The objections were heard, but no one grasped that the scheme itself was where the problem lay. Politicians unwilling to admit they might be wrong simply reduced the volume surrounding the idea but didn’t change the record.
The vetting and barring scheme is designed ‘to ensure that everyone working or volunteering to work with children or vulnerable adults is suitable to do so by being checked and registered’. This law defines a vulnerable adult as any adult receiving healthcare. Health care. This word has been subject to so many twists and turns over the last year or so as the Health Professions Council seeks to define just about everything as health in order to incorporate it within its remit that we can see how the logic of this silly discourse will press everyone to sign up to this pernicious system. Instead of seeing the flaw in the system (a replication of agencies all trying to save the public from itself), the HPC views the VBS database as a potential competitor for the services it provides itself! I quote:
‘…the majority of HPC registrants will need to be registered with the V&B Scheme. … However registration with the VBS will not be a requirement of registration with HPC… Registration with the VBS does not replace HPC registration… The HPC will continue to set the standards for practising in one of the professions it regulates and you will still need to be registered with the HPC if you use one of the titles we protect.’
As the government continues to broadcast scare stories about how little money the country has, and how awful things are going to be, I suppose we cannot expect those employed to administer these various databases regimes to willingly acknowledge that the work they are doing is worse than a waste of time. The money they waste is not raised by direct taxation, but by a kind of stealth tax levied directly on their registrants (who have no right to vote on the way this money is then used). The accompanying discourse of security assumes the population is probably guilty, and punishes it by making it pay for the computers and offices and administrators in these little database states. Is this the kind of thing that politicians would ask seven maids with seven mops to spend half a year sweeping clear?
I doubt it, said the Carpenter, and shed a bitter tear.
Andrew Lansley replied to Esther Hague, the physiotherapist caught in the CPD trap. Basically he told her that the HPC is independent from the professions it regulates and from Government in order to function fairly and effectively, and he is therefore afraid that it is not possible for the Department of Health to intervene in this matter. He also said:
“Section 28 of the NHS Reform and Health Care Professions Act 2002 gives me as Secretary of State the power to make provisions in regulations for the Council for Healthcare Regulatory Excellence (CHRE) to investigate complaints about the way the nine health professions regulatory bodies have exercised any of their functions. However, Section 28 has not yet been enacted and the CHRE does not, therefore, currently have any statutory power to take action on the complaints it receives.
“The purpose of the CHRE is to promote good practice in regulation and consistency across the nine healthcare regulatory bodies. In the absence of formal powers under Section 28, the CHRE can work with the regulatory bodies only informally and consensually on the complaints they receive."
So, there you have it, says Esther. The powers of the HPC are totally unchecked. With regards to her concern about the linking of CPD with re-registration or a refusal to re-register if the arbitrary standards of the HPC are not met, Nick Clegg (her MP) has written to the CHRE to raise the concerns with the Chief Executive.
“So”, she says, “we go round in circles.” But she hopes that Nick Clegg is beginning to recognise the unchecked powers of the HPC and says she is determined to take it further with him “to get this culture of mistrust and excessive regulatory powers of the HPC brought out in the open and hope that the new government will see the negative effect this has on health professionals”. Way to go, Esther.
The union now known as Unite has set up a National Occupational Advisory Committee for counselling and psychotherapy. Meeting Wednesday, 29th September 2010. Vacancies still exist for: Wales region, North East/Yorkshire and the Humber, Ireland, Eastern, East Midlands. You can email me for more info.
I would point them to the problem of language and prescribe a dose of Lewis Carroll.
HPC agents often use language to mean whatever they want at any particular time. I have reported many examples from Di Waller’s chairing of the PLG for C&P. The HPC video on CPD is another great treasure trove of examples. But Chair Anna van der Gaag is also quite skilled at this game. She recently wrote an introduction to a new scoping report on existing research on complaints mechanisms commissioned by the HPC and called it a monograph. And this is odd, because, you know, the word has hitherto referred to a scholarly and original piece of work that contributes to a field of intellectual study and thus to the overall enlightenment of society – the Longman Dictionary defines it as ‘a learned treatise on a small area of learning, a written account of a single thing’. The report, no matter how well executed is not a monograph. The stuff in it, no matter how elegantly writ, hardly constitutes the ‘evidence base’ on whose back van der Gaag wishes to advance her expansionist cause.
Who benefits from finding out how to get more people to complain? The report is quite clear in its conclusions. People seem to complain for some unspecific reason that has more to do with standing up for a little bit of truth. Very few people actually want compensation, or to cause trouble, or to break trust. They seem simply to want to be heard.
Will these people be helped if the HPC makes it easier for them to complain? No. The complaint may well trigger a process, but this is an HPC ‘fitness to practice’ process applied to the standardised conduct of a specific individual. The scoping document gave no reason to believe that the information from existing complainants had much to do with this. Secondly, the vast majority of complaints received by HPC are received from employers or other professionals, not from members of the public.
‘I weep for you, the Walrus said, I deeply sympathise, through sobs and tears he sorted out those of the largest size, holding his pocket-handkerchief before his streaming eyes.’
The beneficiaries of this peculiar FTP process are the HPC which turn cases into statistics to prove to Privy Council that they are doing a job; the barristers who receive the fee for pushing the case through to its administrative conclusion; and employers, who avoid having to deal with the problems that arise in their own back yard. None of this has anything to do with increasing the country’s intellectual capital or adding to its programme of enlightenment.
I’m reminded of the monetisation mania preached by Mrs Thatcher and her minions.
Anyway, the report is not a monograph. It is, as it says on the cover, a scoping document that scopes a possible field of colonisation for the HPC. It is commissioned as a kind of market research. Come on.
The HPC newsletter ‘In Focus’ has been pinging into my mailbox for nearly two years now and is dull as ditchwater. It used to list the FTP cases and often provided a little case study of how practitioners were messing up. Since October 2009 however, (Issue 25), the FTP cases have disappeared, and since June (issue 23) the In Focus front page has been given over to the problem of cajoling people into making their renewal on time. Every single issue from 23 to the current issue (29) exhorts registrants to renew their membership on time. How interesting. Supplementary news items tend to report the rate of renewal achieved, and suggest that you encourage your colleagues to renew and put posters up in your consulting room. There is also a regular little line or two thanking the personnel managers and union reps that have helped to round up the registrants and corral them into the pen. Great stuff.
Also regularly featured over the last year are the ‘listening exercises’. Like me, you probably imagine that a listening exercise is where the HPC listen to the views of its various constituents – a kind of corrective to the lack of democratic procedures associated with this kind of organisation. WRONG! These events are for YOU to listen to the HPC. They are undertaken in order to tell you what you need to do to comply with their CPD and FTP procedures. It should come as no surprise that lots of people attend these events (all hopping through the frothy waves, and scrambling to the shore), for if they do not comply they will surely lose their livelihood.
For all its literary faults, the current issue of In Focus does, however, give another wonderful example of the insidious spread of the database state.
On 1 July this year the contentious vetting and barring scheme comes into force. This caused quite a splash when Philip Pullman and other authors objected to being treated as potential paedophiles. The objections were heard, but no one grasped that the scheme itself was where the problem lay. Politicians unwilling to admit they might be wrong simply reduced the volume surrounding the idea but didn’t change the record.
The vetting and barring scheme is designed ‘to ensure that everyone working or volunteering to work with children or vulnerable adults is suitable to do so by being checked and registered’. This law defines a vulnerable adult as any adult receiving healthcare. Health care. This word has been subject to so many twists and turns over the last year or so as the Health Professions Council seeks to define just about everything as health in order to incorporate it within its remit that we can see how the logic of this silly discourse will press everyone to sign up to this pernicious system. Instead of seeing the flaw in the system (a replication of agencies all trying to save the public from itself), the HPC views the VBS database as a potential competitor for the services it provides itself! I quote:
‘…the majority of HPC registrants will need to be registered with the V&B Scheme. … However registration with the VBS will not be a requirement of registration with HPC… Registration with the VBS does not replace HPC registration… The HPC will continue to set the standards for practising in one of the professions it regulates and you will still need to be registered with the HPC if you use one of the titles we protect.’
As the government continues to broadcast scare stories about how little money the country has, and how awful things are going to be, I suppose we cannot expect those employed to administer these various databases regimes to willingly acknowledge that the work they are doing is worse than a waste of time. The money they waste is not raised by direct taxation, but by a kind of stealth tax levied directly on their registrants (who have no right to vote on the way this money is then used). The accompanying discourse of security assumes the population is probably guilty, and punishes it by making it pay for the computers and offices and administrators in these little database states. Is this the kind of thing that politicians would ask seven maids with seven mops to spend half a year sweeping clear?
I doubt it, said the Carpenter, and shed a bitter tear.
Andrew Lansley replied to Esther Hague, the physiotherapist caught in the CPD trap. Basically he told her that the HPC is independent from the professions it regulates and from Government in order to function fairly and effectively, and he is therefore afraid that it is not possible for the Department of Health to intervene in this matter. He also said:
“Section 28 of the NHS Reform and Health Care Professions Act 2002 gives me as Secretary of State the power to make provisions in regulations for the Council for Healthcare Regulatory Excellence (CHRE) to investigate complaints about the way the nine health professions regulatory bodies have exercised any of their functions. However, Section 28 has not yet been enacted and the CHRE does not, therefore, currently have any statutory power to take action on the complaints it receives.
“The purpose of the CHRE is to promote good practice in regulation and consistency across the nine healthcare regulatory bodies. In the absence of formal powers under Section 28, the CHRE can work with the regulatory bodies only informally and consensually on the complaints they receive."
So, there you have it, says Esther. The powers of the HPC are totally unchecked. With regards to her concern about the linking of CPD with re-registration or a refusal to re-register if the arbitrary standards of the HPC are not met, Nick Clegg (her MP) has written to the CHRE to raise the concerns with the Chief Executive.
“So”, she says, “we go round in circles.” But she hopes that Nick Clegg is beginning to recognise the unchecked powers of the HPC and says she is determined to take it further with him “to get this culture of mistrust and excessive regulatory powers of the HPC brought out in the open and hope that the new government will see the negative effect this has on health professionals”. Way to go, Esther.
The union now known as Unite has set up a National Occupational Advisory Committee for counselling and psychotherapy. Meeting Wednesday, 29th September 2010. Vacancies still exist for: Wales region, North East/Yorkshire and the Humber, Ireland, Eastern, East Midlands. You can email me for more info.
Wednesday, 26 May 2010
The Centralists keep themselves busy by inventing new ways to torment the practitioners: CPD, Revalidation, etc
A Physiotherapist (name and address supplied) wrote to the hpcwatchdog blog to tell of her shock at recent correspondence from HPC. Physiotherapists have been registered with HPC since its inception, and were with the CPSM (Council for Professions Supplementary to Medicine) before that. This year is the first time that they are being audited for Continuous Professional Development: “It has been made a condition for re-registration that we prove our CPD activity and how this activity has helped to improve our services”. How to improve your services! Esther is one of the 2.5% that have been randomly selected from the database to submit papers to ‘prove’ that the CPD she has undertaken during the year had a direct and positive impact on her practice. She followed the advice of her professional body (Chartered Society of Physiotherapists) when making her submission. Imagine her surprise, then, when the HPC wrote back and asked her for “more evidence as to how CPD has contributed to improving the quality of the service".
Apparently the HPC have realised that there is “no automatic link” between the CPD someone does and their competence as a practitioner, this has lead them to issue reminders to registrants that even if their CPD files are hunky-dory they might yet expect a letter from the fitness to practice committee. In case that doesn’t frighten them into improving, it invokes the law to back them up: “The Health Professions Order 2001 says that we can set standards for CPD and we can link these standards to renewing registration. We can also take registrants off our register if they have not met our standards."
This made the Alarm Bells ring and prompted contact with the hpcwatchdog: “I have followed the struggle of the Psychotherapists and Counsellors against control by the HPC and the posts on your HPC Watchdog website. I strongly feel that it is time to curb the powers of the HPC and I am very angry that health professionals should be treated like we cannot be trusted. I feel that all the health professionals under the umbrella of the HPC should get together and fight their corner. Unfortunately I get the feeling from our Chartered Society of Physiotherapists that they are all frightened of the powers of the HPC and even tend to take their side. It looks like they cannot be seen to take a stance against the powers of the HPC”.
She wants to widen the debate about the HPC and wrote to her local MP who just happens to be Nick Clegg, Deputy Prime Minister. His office replied almost straight away, noting her concerns and saying that a letter had been sent Andrew Lansley, MP, Secretary of State for Health to bring it to his attention.
In the meantime, I noticed at the recent Finance Committee that in spite of the £10m sloshing around in interest earning accounts, the HPC has been awarded a grant of £360,000 from the Department of Health in May 2009 to explore another new scheme to make sure practitioners know what they are doing. This is a ‘revalidation’ project.
Details are from a paper considered by the Health Professions Council on 10 December 2009.
The report says ‘the first task in our revalidation approach is to ensure that we understand the risk to the public posed by the professions that we regulate now and in the future. In particular we need more information about how different health care professionals (eg different professions, ages, genders, etc) expose service users to different levels of risks.” Risk by the way means ‘the potential to do harm’ (emphasis added). The unofficial hypothesis is that older men pose more risk.
Does this mean they don’t know what they are doing at the moment? The report boldly states “The HPC already has robust systems in place that reduce the risk to the public posed by our registrants by ensuring continuing fitness to practise processes, Continuing Professional Development (CPD) and the self certification that each registrant must complete when they renew their registration.”
A series of projects reveal more of the implicit assumptions of these centralist planners.
Project 1 wants to explore the link between conduct during training and subsequent FTP actions (can your student antics predict your grown-up malfeasance?) Discussions with Durham and Newcastle Universities are underway to appoint a researcher. The work will take a year, limited to studying one or two professions and will be quantitative. “The study should enable conclusions to be drawn about whether there is a link between poor conduct and performance during pre-registration education and training and subsequent FTP action. If a link is determined the study will also look at the areas of conduct which most commonly act as pre-indicators for subsequent FTP action… The outcomes from this study may indicate that the most effective way to increase public protection is to concentrate on pre-registration education and training, rather than introducing a post registration revalidation system.” The same team will undertake project 2.
Project 2 ‘piloting a pre-registration education and training ‘professionalism tool’. “By ‘professionalism tool’ we mean a method of teaching and promoting professionalism to students and emphasising the importance the HPC places on the conduct of our registrants.” p11. This is a five-year project tracking student progress and is hoped to “enable conclusions to be drawn about … identifying and resolving issues around professionalism during pre-registration ed & training, therefore reducing the number of FTP complaints regarding conduct.” Can we expect an edict to include this as part of the curriculum for our future training?
Project 3 will be an analysis of the HPC FTP data to identify trends regarding FTP across the register, analysing all data thus far collected since opening HPC register. The revalidation policy manager will work with a statistician for a year to explore the variation across profession, age, gender, route to registration, geographic location, types of practice, length of practice, NHS/Private, etc.
Project 4 an analysis of the CPD audit profiles to understand the impact of certain kinds of CPD on practice and misconduct, presumably. The study will analyse all available CPD profiles, assessor comments and assessment results. Two short-term contractors will do the work for a year, tho the CPD audit has only just begun and many professions are yet to be sampled. “The study should enable conclusions to be drawn about the following: if there are any trends regarding amount and type of CPD undertaken across the Register; trends regarding types of registrant that do not undertake appropriate or sufficient CPD, and effectiveness of [HPC] CPD processes in identifying registrants who are not continuing to practice safely and effectively. So, even if local practitioners manage to make their CPD files useful for their actual practice, the people with the statutory power intend to survey the data in your filing cabinet to predict your competence from a distance.
Project 5 and 6 are literature reviews of FTP process across the regulatory board. “For example if the data shows that concerns are most likely to arise either earlier or later in a registrant’s career, a revalidation process could be targeted [there]”.
BTW, I recently watched a video of old ladies at the Institute of Psychoanalysis could these be the targets of the new HPC CPD spot checks, or would there femininity predict their professionalism?
In the meantime, one man of a certain age is being put under close scrutiny by pro-HPC militants in the UKCP. A complaint was made to the charities commission that Chair Prof Samuels was breaching the regulations by fraternising with the Alliance for Counselling and Psychotherapy. The CC threw the complaint out. Statement by UKCP CEO David Pink on their website.
Yesterday’s HPC Council meeting (20 May 2010) considered the last Government’s last white paper ‘Building a National Care Service” which proposed that HPC license social care workers and healthcare support workers. This would have been a major step in creating a kind of ‘database state within a state’ of everyone remotely connected with the health or care of other people. It would have been a massive money-spinner for the ever-expanding HPC, but will it be scrapped by the new Government?
Nick Clegg’s speech robustly said that “it is time for a wholesale, big bang approach to political reform [blimey]… there will be no ID card scheme, no national identity register, no second generation biometric passports. They won’t hold your internet and email records. CCTV will be properly regulated. Ah! Is this within the remit of the HPC? Do cameras have an impact on the health and wellbeing of the nation? Yes - I think they do!
He also says the new government values debate and is unafraid of dissent, will remove limits on the rights to peaceful protest, propose to ‘tear through the statute book’, and ask us which laws we think should go.
Back at the HPC, the Education and Training Committee (10 March) agreed to recommend the working group recommendations for Generic Standards. However, with respect to the controversial SET 1 (see Annie Turner at last week’s PLG, and Eileen Thornton, previous PLGs) they noted that ‘the issue of generic standards was extremely complex because of the diversity of scopes of practise across the register’. They said nothing more in the minutes.
Here are the proposed new ‘over-arching’ generic standards:
1. Be able to practise safely and effectively within their scope of practice.
2. Be able to practise within the legal and ethical boundaries of their profession.
3. Understand the obligation to maintain fitness to practise
4. Be able to practise as an autonomous professional, exercising their own professional judgement
5. Be able to practise in a non-discriminatory manner
6. Be aware of culture, equality and diversity and their impact on practice
7. Be able to maintain confidentiality, while understanding the limits and potential ethical concerns that may arise
8. Be able to communicate effectively
9. Be able to work, where appropriate, with others.
10. Be able to maintain records appropriately, in accordance with applicable legislation, protocols and guidelines.
11. Be able to reflect on and review practice.
12. Be able to assure the quality of their practice.
13. Be able to draw on appropriate knowledge and skills to inform practice.
14. Understand the key concepts of the bodies of knowledge which are relevant to their profession.
15. Be able to establish and maintain a safe practice environment.
Notes
The phrase ‘you must be able to’ has been explained as necessary to accommodate brand new graduates as yet untested in practice (a group supposed to be more liable to turn up in the FTP machine).
Many if not most of the HPC Council are post-holders in Higher Education.
The general nature of these begs all kinds of questions in practice. I note for now that it is precisely the generality of standards of education and training that has led to ‘divisive’ practices noted more and more by members of the Education and Training Committee. This should not be surprising – the HPC structure removes any real grounds for judging actual work, pumps statutory law through vague standards, and appoints its own partners to police the system.
Surely a recipe for disaster.
Apparently the HPC have realised that there is “no automatic link” between the CPD someone does and their competence as a practitioner, this has lead them to issue reminders to registrants that even if their CPD files are hunky-dory they might yet expect a letter from the fitness to practice committee. In case that doesn’t frighten them into improving, it invokes the law to back them up: “The Health Professions Order 2001 says that we can set standards for CPD and we can link these standards to renewing registration. We can also take registrants off our register if they have not met our standards."
This made the Alarm Bells ring and prompted contact with the hpcwatchdog: “I have followed the struggle of the Psychotherapists and Counsellors against control by the HPC and the posts on your HPC Watchdog website. I strongly feel that it is time to curb the powers of the HPC and I am very angry that health professionals should be treated like we cannot be trusted. I feel that all the health professionals under the umbrella of the HPC should get together and fight their corner. Unfortunately I get the feeling from our Chartered Society of Physiotherapists that they are all frightened of the powers of the HPC and even tend to take their side. It looks like they cannot be seen to take a stance against the powers of the HPC”.
She wants to widen the debate about the HPC and wrote to her local MP who just happens to be Nick Clegg, Deputy Prime Minister. His office replied almost straight away, noting her concerns and saying that a letter had been sent Andrew Lansley, MP, Secretary of State for Health to bring it to his attention.
In the meantime, I noticed at the recent Finance Committee that in spite of the £10m sloshing around in interest earning accounts, the HPC has been awarded a grant of £360,000 from the Department of Health in May 2009 to explore another new scheme to make sure practitioners know what they are doing. This is a ‘revalidation’ project.
Details are from a paper considered by the Health Professions Council on 10 December 2009.
The report says ‘the first task in our revalidation approach is to ensure that we understand the risk to the public posed by the professions that we regulate now and in the future. In particular we need more information about how different health care professionals (eg different professions, ages, genders, etc) expose service users to different levels of risks.” Risk by the way means ‘the potential to do harm’ (emphasis added). The unofficial hypothesis is that older men pose more risk.
Does this mean they don’t know what they are doing at the moment? The report boldly states “The HPC already has robust systems in place that reduce the risk to the public posed by our registrants by ensuring continuing fitness to practise processes, Continuing Professional Development (CPD) and the self certification that each registrant must complete when they renew their registration.”
A series of projects reveal more of the implicit assumptions of these centralist planners.
Project 1 wants to explore the link between conduct during training and subsequent FTP actions (can your student antics predict your grown-up malfeasance?) Discussions with Durham and Newcastle Universities are underway to appoint a researcher. The work will take a year, limited to studying one or two professions and will be quantitative. “The study should enable conclusions to be drawn about whether there is a link between poor conduct and performance during pre-registration education and training and subsequent FTP action. If a link is determined the study will also look at the areas of conduct which most commonly act as pre-indicators for subsequent FTP action… The outcomes from this study may indicate that the most effective way to increase public protection is to concentrate on pre-registration education and training, rather than introducing a post registration revalidation system.” The same team will undertake project 2.
Project 2 ‘piloting a pre-registration education and training ‘professionalism tool’. “By ‘professionalism tool’ we mean a method of teaching and promoting professionalism to students and emphasising the importance the HPC places on the conduct of our registrants.” p11. This is a five-year project tracking student progress and is hoped to “enable conclusions to be drawn about … identifying and resolving issues around professionalism during pre-registration ed & training, therefore reducing the number of FTP complaints regarding conduct.” Can we expect an edict to include this as part of the curriculum for our future training?
Project 3 will be an analysis of the HPC FTP data to identify trends regarding FTP across the register, analysing all data thus far collected since opening HPC register. The revalidation policy manager will work with a statistician for a year to explore the variation across profession, age, gender, route to registration, geographic location, types of practice, length of practice, NHS/Private, etc.
Project 4 an analysis of the CPD audit profiles to understand the impact of certain kinds of CPD on practice and misconduct, presumably. The study will analyse all available CPD profiles, assessor comments and assessment results. Two short-term contractors will do the work for a year, tho the CPD audit has only just begun and many professions are yet to be sampled. “The study should enable conclusions to be drawn about the following: if there are any trends regarding amount and type of CPD undertaken across the Register; trends regarding types of registrant that do not undertake appropriate or sufficient CPD, and effectiveness of [HPC] CPD processes in identifying registrants who are not continuing to practice safely and effectively. So, even if local practitioners manage to make their CPD files useful for their actual practice, the people with the statutory power intend to survey the data in your filing cabinet to predict your competence from a distance.
Project 5 and 6 are literature reviews of FTP process across the regulatory board. “For example if the data shows that concerns are most likely to arise either earlier or later in a registrant’s career, a revalidation process could be targeted [there]”.
BTW, I recently watched a video of old ladies at the Institute of Psychoanalysis could these be the targets of the new HPC CPD spot checks, or would there femininity predict their professionalism?
In the meantime, one man of a certain age is being put under close scrutiny by pro-HPC militants in the UKCP. A complaint was made to the charities commission that Chair Prof Samuels was breaching the regulations by fraternising with the Alliance for Counselling and Psychotherapy. The CC threw the complaint out. Statement by UKCP CEO David Pink on their website.
Yesterday’s HPC Council meeting (20 May 2010) considered the last Government’s last white paper ‘Building a National Care Service” which proposed that HPC license social care workers and healthcare support workers. This would have been a major step in creating a kind of ‘database state within a state’ of everyone remotely connected with the health or care of other people. It would have been a massive money-spinner for the ever-expanding HPC, but will it be scrapped by the new Government?
Nick Clegg’s speech robustly said that “it is time for a wholesale, big bang approach to political reform [blimey]… there will be no ID card scheme, no national identity register, no second generation biometric passports. They won’t hold your internet and email records. CCTV will be properly regulated. Ah! Is this within the remit of the HPC? Do cameras have an impact on the health and wellbeing of the nation? Yes - I think they do!
He also says the new government values debate and is unafraid of dissent, will remove limits on the rights to peaceful protest, propose to ‘tear through the statute book’, and ask us which laws we think should go.
Back at the HPC, the Education and Training Committee (10 March) agreed to recommend the working group recommendations for Generic Standards. However, with respect to the controversial SET 1 (see Annie Turner at last week’s PLG, and Eileen Thornton, previous PLGs) they noted that ‘the issue of generic standards was extremely complex because of the diversity of scopes of practise across the register’. They said nothing more in the minutes.
Here are the proposed new ‘over-arching’ generic standards:
1. Be able to practise safely and effectively within their scope of practice.
2. Be able to practise within the legal and ethical boundaries of their profession.
3. Understand the obligation to maintain fitness to practise
4. Be able to practise as an autonomous professional, exercising their own professional judgement
5. Be able to practise in a non-discriminatory manner
6. Be aware of culture, equality and diversity and their impact on practice
7. Be able to maintain confidentiality, while understanding the limits and potential ethical concerns that may arise
8. Be able to communicate effectively
9. Be able to work, where appropriate, with others.
10. Be able to maintain records appropriately, in accordance with applicable legislation, protocols and guidelines.
11. Be able to reflect on and review practice.
12. Be able to assure the quality of their practice.
13. Be able to draw on appropriate knowledge and skills to inform practice.
14. Understand the key concepts of the bodies of knowledge which are relevant to their profession.
15. Be able to establish and maintain a safe practice environment.
Notes
The phrase ‘you must be able to’ has been explained as necessary to accommodate brand new graduates as yet untested in practice (a group supposed to be more liable to turn up in the FTP machine).
Many if not most of the HPC Council are post-holders in Higher Education.
The general nature of these begs all kinds of questions in practice. I note for now that it is precisely the generality of standards of education and training that has led to ‘divisive’ practices noted more and more by members of the Education and Training Committee. This should not be surprising – the HPC structure removes any real grounds for judging actual work, pumps statutory law through vague standards, and appoints its own partners to police the system.
Surely a recipe for disaster.
Sunday, 16 May 2010
HPC PLG C&P 12 May 2010
Here is a report edited from my verbatim notes of the first part of last week's meeting. This group has already 'worked' on the 'problem' for over a year, but nevertheless seems to be approaching something vague and anomalous almost for the first time. After a brief intro, the dialogue is presented to reveal the chaotic character of the meeting.
HPC President Anna van der Gaag closed the meeting at 2pm on the dot (as predicted in the plan) with the words:
“Thank you, we’ve got a huge amount from you today”
None of the members of the PLG seemed to notice, but one or two in the public seats repeated the words while looking completely stunned.
The last time we all met in this neutral venue (Avonmouth House) Chair Di Waller had opened the meeting with a small lecture to the effect that members of the PLG were not there to represent anyone other than themselves. They had been recruited as individuals. This message was deemed necessary in order to counter the mounting criticisms that the PLG did not represent ‘the field’.
Today, at 10.30am on the dot Gaag opened the meeting (Di Waller being unwell) by going round the table inviting reflections on progress to date. What follows is edited from my verbatim notes. My comment is at the end.
FBD: Fiona Ballantine Dykes (who happens to work for the CPCAB): the landscape is different on many levels, and it raises questions: for example, what does this group need to do carry the confidence of people we represent. There are still some fundamental questions about the function of regulation, and we need a discussion about how regulation under HPC will be acceptable to the field. The details are secondary to that.
JC: Jonathan Coe (coincidentally, CEO of Witness – whose charity status ceased to be recognised by the Charities Commission 10 Feb 2010): generally there has been a good degree of progress, and I share Fiona’s view that we need to get collective backing of decisions made by the group.
BM: Brian Magee (COSCA): The time it has taken! HPC need to keep the information flowing and keep people on board. The December Council meeting raised expectations that things would move faster than they have.
AT: Annie Turner (an occupational therapist on the HPC Council): Standards of Practice - a lot of work still needs to be done on these. But I’m pleased with the work HPC have done on Generic Standards, which will move us forward. It will move the whole thinking in HPC forward from past paradigms, it will keep professions thinking forward. Any disagreement is second to that. We have a mountain to climb, and must make a leap forward, and we must do the background work.
LM: Linda Matthews (BABCP): There have been lots of discussions, people have anxieties, some are indifferent, and some are looking forward to HPC regulation. There has been a lull, and we need the HPC to take us forward while we try to take our members with us. The time-table leading to Feb 2011 is daunting [pause] but we are hanging on in there. It’s a joint approach and we are happy to be part of that.
MC: Mick Cooper (a Counselling professor who works in Scotland): I was struck by the responses to the consultation; there were meaningful, clear responses in a number of areas, decisions where people are comfortable and happy. I feel optimistic about moving forward. The consultation was useful.
JM: Jean McMinn (a counselling teacher, who works in Northern Ireland): [very quiet] … whether we have got both titles and levels of entry right?
PB: Peter Bell: This looks different depending where you are, I’m with BASRT, Relate, and a practising counsellor. Relate is not a professional body but a deliverer of services. Each of these positions has a different view, because there are different consequences. But what about the external forces – they will have their influence, the change of government, for example, what will that mean?
SA: Sally Aldridge (the Director of Regulatory Policy at BACP): we still need to convince some people out there to trust the HPC. SoPs go some way to do that, and we’ve used this to define the profession. But we must remember to set standards to protect the public, and not to protect the profession.
PF: Peter Fonagy (Skills for Health, BPC, UCL): This has been an interesting process for me personally, and I’m extremely grateful to have been able to participate. It has taught me things I didn’t know before. In the meantime we’ve [DH] managed to determine the NOS for Psychoanalytic/ dynamic Psychotherapy and the world did not immediately cease to turn on its axis! Out of controversy we gained a consensus that people were able to sign up to. So, here, it is critical that questions are raised about the competence of the regulator. We need to see what criteria are used to judge whether HPC is actually working. This will only work if it is voluntary. Is this group representative? Are we checking back to see it has validity beyond the people here. It can only work if it is voluntary. A sub group is saying that it won’t play, so we need to address this, we need to actually listen, and produce documentation to show the HPC as willing and flexible… We can be the arbitrator between the profession and the HPC.
JL: Julian Lousada (Chair of BPC): I was wondering how the PLG thought it would acknowledge those opposed to its project. Some of us have tried to engage with them but it’s not easy – but we shouldn’t give up. How can we ensure as we proceed that the Professional Organisations see themselves as central to the process. HPC doesn’t exist in a vacuum, but in a vacuum that has a relationship with the organisations [sic]. The Profession will not be strengthened if there is a weakening of the organisations.
CA: Carmen Ablack (a body therapist with the UKCP): I’d like to name the small elephant in the room: Opposition. Out there are different levels of opposition and anxiety. There are those who oppose the idea that this is a HEALTH profession, those opposed to aspects of HPC operations in the past (which we can see change attempts). Those who need clarity and assurance. Different kinds of concern and opposition – it’s not all one thing. If Kathy were here she would stress the importance of the partnership with professional organisations. I guess we do need to name the reality of changes [Chair of UKCP? Government? Who knows, they weren’t named]. Also, it is important to note that the responses to the consultation took very different forms – we in UKCP asked our members to respond to us, then we made one response to HPC, this distorts the statistics of response kept by HPC as not all organisations did the same thing. The responses are not equal and can’t be represented as such.
PF: I’d also like to congratulate Michael [Guthrie] on the rigorous, robust, transparency of his documents, and to tell him I would be happy to offer him a job at UCL. Ha, ha, ha, ha, ha.
AvdG: In the words of Nelson Mandella, our strongest weapon is dialogue. We must not be distracted from the work we must do in this group. It’s a difficult balance, we must bring more voices in to the debate.
MC: Mick Cooper then got the discussion to focus on how to include more Users in the process: “this is a major omission,” he said. This passed the conch to Jonathan Coe who said: the purpose of Statutory Reg is public protection. What is the nature of protection here? We need to talk to people who’ve been harmed. There’s been a survey by Mind, and Witness has run Focus Groups. We need a range of different ways to sample this group, and we need to be sensitive to the information, which cannot be given in public [sic].
PF: We need to say what HPC FTP has to offer here that is better than what already exists.
AvdG: We offer Statutory Regulation.
PF: We need a detailed Qualitative Inquiry on the impact of the system; and we need to acknowledge that this is the project of protecting people against human frailty. P&C are different in terms of regulation - do the HPC mechanisms meet the needs of therapists or not? It can be tested.
CA: There’s a diversity of clients, we need to understand the impact of regulation on these different populations.
LM: Is regulation suitable for C&P – are the public getting what they need from us if we are not regulated.
AT: a question for Peter: you say that psychotherapy and counselling are different. Different from what, different to what? We all work with vulnerable people you know.
PF: to me, it is the relationship that is the service.
[MC, LM both vigorously disagree and SA says she doesn’t understand.]
FBD: You need service providers to buy into the service of the HPC.
AT: what difference does it make to us, that you are different? [as this is delivered as a rhetorical question it elicits no answer]
PB: People these days are being sent by social care, GPs, the courts, other elements of the statutory centre, they are not coming to us of their own accord, they come with a message from the other which says ‘fix me’, get me back to work, make me a better parent. It’s different today. We need to consider the different kinds of service user we treat these days.
MC: independent focus groups need to look at this.
JC: What is the nature of risk in this sector? Private practice?
AvdG: what can we do practically to resolve this [can of worms]?
FBD: What impact will this have on services?
SA: It’s a big project
LM: it’s a huge project
AT: We need to look at the public we aim to protect. Not everybody, obviously, but what do we want to learn from the people that we talk to? And we need to know how sufficiently representative they are.
JL: How can we say to users this is why we think HPC will be an improvement?
BMcG: What about the International perspective? What can we learn from Australia, Europe?
AT: Will the Bolognia protocol affect you? [Stunned silence]
PF: It will turn British Higher Ed upside down [Stunned silence]
FBD: The quality of relation cannot be captured in SoP.
MC: Shall we invite an educationalist to advise whether entry level will impact on Standards?
AT: We should probably own that [sigh] well the usefulness of SET1 [pause], how it is used, [pause], well, if its used divisively in the profession then that is not good for public protection. This challenges council members. Considerable concern is coming to the Education and Training Committee. There is no wide consensus. We need more work to remove that Standard. [Brightens] It is almost a red herring, really, but [pause] what does it actually mean? [dipping again slightly] We’ve all been challenged by this.
FBD: The relationship is important.
PB: The relationship
AvdG: We are broader than health now, we can do it.
AT: I think this could be said for any practitioner.
AvdG: we won’t agree today, as we didn’t before, but we might in the future.
MC: No!
CA: I’ve witnessed the unfolding of issues over the last year, you’ve already done this. Lets name it.
SA: Should we look at the curriculum of all the training orgs? This will tell us what is going on out there.
AvdG: Who do we need at the table?
Voice: GOD
LM: Yes, I said that before too.
JL: So many presentations, its too much! We need to battle this out.
PB: what about employers? What about the opponents? [my neighbour asks me to note that it is now 12.10.]
MC: What for?
FBD: The HPC has proved itself open and willing to listen.
LM: They could give us stuff we are missing, though this is not a forum against HPC. We have emails from people with concerns about this, and we can help them through it.
PF: we need to hear the objections. We are the mediators between the field, and the HPC.
AvdG: Shall we have some lunch?
After lunch Gaag asked for outstanding questions. Julian Lousada tried to get the group to acknowledge the uniqueness of the relationship in this kind of work. He failed. Again, he tried. “How do we expose people to the clinical work?” he asked, before summoning the courage to add “do they have personal therapy?” then collapsed and added “Can we ask users whether they think they’ll get a better service if the practitioner they see has gone through their own therapy?” Sally Aldridge said “no matter how important it is, is it relevant here?” This, of course, is an excellent question, drawing attention to the fact that this meeting is about writing HPC documents which have no relevance to current practice except to sound its death knell. No-one indicated they heard, let alone understood what Sally said.
The discussion was degenerating by the minute and ended up discussing whether to meet in large or small groups, whether to have 5 minute or 50 minute presentations, and finally whether to meet at 10am or even 9.30 in order to get through the huge amount of work implied by their discussion. Gaag resisted all of this and said that 10.30 was fine and then concluded in a very calm voice, saying: “Engaging with those who oppose is very much about providing public meetings in all four countries to discuss all aspects of regulatory framework. Each aspect of regulatory practice will be presented and there will be lots of opportunity for Q&A, and within that there will be those who express strongly held views.”
I think it was Brian Magee who said – “and what will happen then? This is what happened in Manchester, and we were never given the opportunity to discuss it afterwards.”
Gaag smiled pleasantly and drew the meeting to a close. “Thank you, we’ve got a huge amount from you today”
COMMENT: The opening hour of the PLG let the members voice their concerns that the HPC process does not meet the needs of C&P. The rest of the meeting saw Gaag slowly override those comments and return to her business, ie to get what she needs to do in order to present the HPC as one that has ‘consulted’ with the appropriate people, ie 'users' . This idea comes 18 months after the HPC process began.
In the workplan (hardly discussed in the meeting), the business of constructing SETs and SOPs is scheduled for after the S60 is written. The DH is not interested in these, so HPC doesn't need to show that work is progressing - DH trust them to know what they are doing! However, as the HPC is staffed by administrators who know nothing of the practice they want to regulate, they delegate this work to a few people in the profession who in turn need the HPC to tell them how to do it because, as Annie Turner frequently says: they do not reflect current practice, but must invent something totally new.
If the HPC doesn’t properly define the profession (one of the major problems for this PLG is to maintain the impression that they are all from the same practice) and then does not allow the right Professionals sufficient time and resources to do the job then it can only succeed in laying the ground for imposing a set divisive and stupid standards. They are now no longer able to maintain ignorance on this: Annie Turner mentioned the growing concern in the Ed & Training Committee, where the Standards of Ed & Training are already showing signs of producing divisive fighting in the field it is supposed to regulate.
Group members raised some interesting points in their discussion, but the implications of their questions, had they followed any one of them through to its conclusion, would have upset the HPC if only because they would recognise the real time and work implied. Hence no meaningful discussion was allowed to establish itself - this is typical of these PLG meetings.
HPC President Anna van der Gaag closed the meeting at 2pm on the dot (as predicted in the plan) with the words:
“Thank you, we’ve got a huge amount from you today”
None of the members of the PLG seemed to notice, but one or two in the public seats repeated the words while looking completely stunned.
The last time we all met in this neutral venue (Avonmouth House) Chair Di Waller had opened the meeting with a small lecture to the effect that members of the PLG were not there to represent anyone other than themselves. They had been recruited as individuals. This message was deemed necessary in order to counter the mounting criticisms that the PLG did not represent ‘the field’.
Today, at 10.30am on the dot Gaag opened the meeting (Di Waller being unwell) by going round the table inviting reflections on progress to date. What follows is edited from my verbatim notes. My comment is at the end.
FBD: Fiona Ballantine Dykes (who happens to work for the CPCAB): the landscape is different on many levels, and it raises questions: for example, what does this group need to do carry the confidence of people we represent. There are still some fundamental questions about the function of regulation, and we need a discussion about how regulation under HPC will be acceptable to the field. The details are secondary to that.
JC: Jonathan Coe (coincidentally, CEO of Witness – whose charity status ceased to be recognised by the Charities Commission 10 Feb 2010): generally there has been a good degree of progress, and I share Fiona’s view that we need to get collective backing of decisions made by the group.
BM: Brian Magee (COSCA): The time it has taken! HPC need to keep the information flowing and keep people on board. The December Council meeting raised expectations that things would move faster than they have.
AT: Annie Turner (an occupational therapist on the HPC Council): Standards of Practice - a lot of work still needs to be done on these. But I’m pleased with the work HPC have done on Generic Standards, which will move us forward. It will move the whole thinking in HPC forward from past paradigms, it will keep professions thinking forward. Any disagreement is second to that. We have a mountain to climb, and must make a leap forward, and we must do the background work.
LM: Linda Matthews (BABCP): There have been lots of discussions, people have anxieties, some are indifferent, and some are looking forward to HPC regulation. There has been a lull, and we need the HPC to take us forward while we try to take our members with us. The time-table leading to Feb 2011 is daunting [pause] but we are hanging on in there. It’s a joint approach and we are happy to be part of that.
MC: Mick Cooper (a Counselling professor who works in Scotland): I was struck by the responses to the consultation; there were meaningful, clear responses in a number of areas, decisions where people are comfortable and happy. I feel optimistic about moving forward. The consultation was useful.
JM: Jean McMinn (a counselling teacher, who works in Northern Ireland): [very quiet] … whether we have got both titles and levels of entry right?
PB: Peter Bell: This looks different depending where you are, I’m with BASRT, Relate, and a practising counsellor. Relate is not a professional body but a deliverer of services. Each of these positions has a different view, because there are different consequences. But what about the external forces – they will have their influence, the change of government, for example, what will that mean?
SA: Sally Aldridge (the Director of Regulatory Policy at BACP): we still need to convince some people out there to trust the HPC. SoPs go some way to do that, and we’ve used this to define the profession. But we must remember to set standards to protect the public, and not to protect the profession.
PF: Peter Fonagy (Skills for Health, BPC, UCL): This has been an interesting process for me personally, and I’m extremely grateful to have been able to participate. It has taught me things I didn’t know before. In the meantime we’ve [DH] managed to determine the NOS for Psychoanalytic/ dynamic Psychotherapy and the world did not immediately cease to turn on its axis! Out of controversy we gained a consensus that people were able to sign up to. So, here, it is critical that questions are raised about the competence of the regulator. We need to see what criteria are used to judge whether HPC is actually working. This will only work if it is voluntary. Is this group representative? Are we checking back to see it has validity beyond the people here. It can only work if it is voluntary. A sub group is saying that it won’t play, so we need to address this, we need to actually listen, and produce documentation to show the HPC as willing and flexible… We can be the arbitrator between the profession and the HPC.
JL: Julian Lousada (Chair of BPC): I was wondering how the PLG thought it would acknowledge those opposed to its project. Some of us have tried to engage with them but it’s not easy – but we shouldn’t give up. How can we ensure as we proceed that the Professional Organisations see themselves as central to the process. HPC doesn’t exist in a vacuum, but in a vacuum that has a relationship with the organisations [sic]. The Profession will not be strengthened if there is a weakening of the organisations.
CA: Carmen Ablack (a body therapist with the UKCP): I’d like to name the small elephant in the room: Opposition. Out there are different levels of opposition and anxiety. There are those who oppose the idea that this is a HEALTH profession, those opposed to aspects of HPC operations in the past (which we can see change attempts). Those who need clarity and assurance. Different kinds of concern and opposition – it’s not all one thing. If Kathy were here she would stress the importance of the partnership with professional organisations. I guess we do need to name the reality of changes [Chair of UKCP? Government? Who knows, they weren’t named]. Also, it is important to note that the responses to the consultation took very different forms – we in UKCP asked our members to respond to us, then we made one response to HPC, this distorts the statistics of response kept by HPC as not all organisations did the same thing. The responses are not equal and can’t be represented as such.
PF: I’d also like to congratulate Michael [Guthrie] on the rigorous, robust, transparency of his documents, and to tell him I would be happy to offer him a job at UCL. Ha, ha, ha, ha, ha.
AvdG: In the words of Nelson Mandella, our strongest weapon is dialogue. We must not be distracted from the work we must do in this group. It’s a difficult balance, we must bring more voices in to the debate.
MC: Mick Cooper then got the discussion to focus on how to include more Users in the process: “this is a major omission,” he said. This passed the conch to Jonathan Coe who said: the purpose of Statutory Reg is public protection. What is the nature of protection here? We need to talk to people who’ve been harmed. There’s been a survey by Mind, and Witness has run Focus Groups. We need a range of different ways to sample this group, and we need to be sensitive to the information, which cannot be given in public [sic].
PF: We need to say what HPC FTP has to offer here that is better than what already exists.
AvdG: We offer Statutory Regulation.
PF: We need a detailed Qualitative Inquiry on the impact of the system; and we need to acknowledge that this is the project of protecting people against human frailty. P&C are different in terms of regulation - do the HPC mechanisms meet the needs of therapists or not? It can be tested.
CA: There’s a diversity of clients, we need to understand the impact of regulation on these different populations.
LM: Is regulation suitable for C&P – are the public getting what they need from us if we are not regulated.
AT: a question for Peter: you say that psychotherapy and counselling are different. Different from what, different to what? We all work with vulnerable people you know.
PF: to me, it is the relationship that is the service.
[MC, LM both vigorously disagree and SA says she doesn’t understand.]
FBD: You need service providers to buy into the service of the HPC.
AT: what difference does it make to us, that you are different? [as this is delivered as a rhetorical question it elicits no answer]
PB: People these days are being sent by social care, GPs, the courts, other elements of the statutory centre, they are not coming to us of their own accord, they come with a message from the other which says ‘fix me’, get me back to work, make me a better parent. It’s different today. We need to consider the different kinds of service user we treat these days.
MC: independent focus groups need to look at this.
JC: What is the nature of risk in this sector? Private practice?
AvdG: what can we do practically to resolve this [can of worms]?
FBD: What impact will this have on services?
SA: It’s a big project
LM: it’s a huge project
AT: We need to look at the public we aim to protect. Not everybody, obviously, but what do we want to learn from the people that we talk to? And we need to know how sufficiently representative they are.
JL: How can we say to users this is why we think HPC will be an improvement?
BMcG: What about the International perspective? What can we learn from Australia, Europe?
AT: Will the Bolognia protocol affect you? [Stunned silence]
PF: It will turn British Higher Ed upside down [Stunned silence]
FBD: The quality of relation cannot be captured in SoP.
MC: Shall we invite an educationalist to advise whether entry level will impact on Standards?
AT: We should probably own that [sigh] well the usefulness of SET1 [pause], how it is used, [pause], well, if its used divisively in the profession then that is not good for public protection. This challenges council members. Considerable concern is coming to the Education and Training Committee. There is no wide consensus. We need more work to remove that Standard. [Brightens] It is almost a red herring, really, but [pause] what does it actually mean? [dipping again slightly] We’ve all been challenged by this.
FBD: The relationship is important.
PB: The relationship
AvdG: We are broader than health now, we can do it.
AT: I think this could be said for any practitioner.
AvdG: we won’t agree today, as we didn’t before, but we might in the future.
MC: No!
CA: I’ve witnessed the unfolding of issues over the last year, you’ve already done this. Lets name it.
SA: Should we look at the curriculum of all the training orgs? This will tell us what is going on out there.
AvdG: Who do we need at the table?
Voice: GOD
LM: Yes, I said that before too.
JL: So many presentations, its too much! We need to battle this out.
PB: what about employers? What about the opponents? [my neighbour asks me to note that it is now 12.10.]
MC: What for?
FBD: The HPC has proved itself open and willing to listen.
LM: They could give us stuff we are missing, though this is not a forum against HPC. We have emails from people with concerns about this, and we can help them through it.
PF: we need to hear the objections. We are the mediators between the field, and the HPC.
AvdG: Shall we have some lunch?
After lunch Gaag asked for outstanding questions. Julian Lousada tried to get the group to acknowledge the uniqueness of the relationship in this kind of work. He failed. Again, he tried. “How do we expose people to the clinical work?” he asked, before summoning the courage to add “do they have personal therapy?” then collapsed and added “Can we ask users whether they think they’ll get a better service if the practitioner they see has gone through their own therapy?” Sally Aldridge said “no matter how important it is, is it relevant here?” This, of course, is an excellent question, drawing attention to the fact that this meeting is about writing HPC documents which have no relevance to current practice except to sound its death knell. No-one indicated they heard, let alone understood what Sally said.
The discussion was degenerating by the minute and ended up discussing whether to meet in large or small groups, whether to have 5 minute or 50 minute presentations, and finally whether to meet at 10am or even 9.30 in order to get through the huge amount of work implied by their discussion. Gaag resisted all of this and said that 10.30 was fine and then concluded in a very calm voice, saying: “Engaging with those who oppose is very much about providing public meetings in all four countries to discuss all aspects of regulatory framework. Each aspect of regulatory practice will be presented and there will be lots of opportunity for Q&A, and within that there will be those who express strongly held views.”
I think it was Brian Magee who said – “and what will happen then? This is what happened in Manchester, and we were never given the opportunity to discuss it afterwards.”
Gaag smiled pleasantly and drew the meeting to a close. “Thank you, we’ve got a huge amount from you today”
COMMENT: The opening hour of the PLG let the members voice their concerns that the HPC process does not meet the needs of C&P. The rest of the meeting saw Gaag slowly override those comments and return to her business, ie to get what she needs to do in order to present the HPC as one that has ‘consulted’ with the appropriate people, ie 'users' . This idea comes 18 months after the HPC process began.
In the workplan (hardly discussed in the meeting), the business of constructing SETs and SOPs is scheduled for after the S60 is written. The DH is not interested in these, so HPC doesn't need to show that work is progressing - DH trust them to know what they are doing! However, as the HPC is staffed by administrators who know nothing of the practice they want to regulate, they delegate this work to a few people in the profession who in turn need the HPC to tell them how to do it because, as Annie Turner frequently says: they do not reflect current practice, but must invent something totally new.
If the HPC doesn’t properly define the profession (one of the major problems for this PLG is to maintain the impression that they are all from the same practice) and then does not allow the right Professionals sufficient time and resources to do the job then it can only succeed in laying the ground for imposing a set divisive and stupid standards. They are now no longer able to maintain ignorance on this: Annie Turner mentioned the growing concern in the Ed & Training Committee, where the Standards of Ed & Training are already showing signs of producing divisive fighting in the field it is supposed to regulate.
Group members raised some interesting points in their discussion, but the implications of their questions, had they followed any one of them through to its conclusion, would have upset the HPC if only because they would recognise the real time and work implied. Hence no meaningful discussion was allowed to establish itself - this is typical of these PLG meetings.
Wednesday, 12 May 2010
Elite pro-hpc lobby press to raise morale as PLG reconvenes
"The Times Newspaper ran a special feature last week (Friday 7 May) Should Psychotherapy be State Regulated. Mind put the Pros - “For Mind, it’s not about who regulates but about how it is done — as long as regulation is statutory and independent, then we have no preference who does the job.” The No voice came from the College of Psychoanalysts - “The HPC’s fitness for practice codes make this freedom impossible and therapists risk being struck off for conduct which no court would consider criminal. A rigid moralism reminiscent of McCarthyism lies at the core of its procedures, as witnessed in the recent “trial” of a psychologist for making sexual jokes at a private dinner”. And the Maybe from UKCP – “we are also calling for the new government immediately to organise a convention to discuss alternative futures for the profession. Because many of our members seem likely to refuse to register with HPC, we are developing an alternative approach to professional regulation”.
The Guardian ran a piece on Bank Holiday Monday (3 May) Psychotherapy Rebels consider Rebranding to Avoid State Regulation.
Malcolm Allen (BPC chief exec) has a little opinion piece in yesterday's Guardian (11 May)
And on Sunday there was also an article in the Observer
You might wonder why the regulation debate is suddenly all over the papers again. The articles contain the same old arguments and examples that appeared a year ago when the psychologists were approaching their regulatory deadline. There is no new scandal, no new news at all. But today (Wed 12 May) the Professional Liaison Group for Psychotherapy and Counselling will meet again for the first time since the public consultation overwhelmingly rejected their proposals. It seems that a little group of four or five people eager for HPC regulation have got together to lobby the health and society editors to run pro-HPC pieces.
The PLG membership remains exactly the same in spite of promises at the Dec 2009 Council meeting to expand it. I wonder how they feel to get together again after the 1,000 responses to their dreadful attempt to come up with a plan last summer. Di Waller, titular chair of the group, famously blamed (at the Confer Conference in March this year) the professionals in this group for failing to come up something that would have been less controversial. She and the Director of Policy and Standards (Michael Guthrie) have been given the power to identify new stakeholders to provide additional expertise and avoid any future embarrassment. No doubt Di will be blaming them for failing her in due course.
Sunday, 2 May 2010
Finance, Fashion, Security, and the death of philosophy
I popped into the HPC yesterday to catch the first hour of the Finance Committee Meeting. As I walked up the stairs to the front door I noticed a really pretty circle of shiny steel within which a bright blue light changed to lime green as I was let in. There was another by the internal door that serves as the entrance to the main part of the building. I remarked on them to the receptionist, and noted more and more of them as I was escorted down the corridor to the bright and airy council chamber in which the Finance Committee had already commenced its business. There, Brian Walker had taken the guest seat at the square table, around which the committee and its servants sat, and was talking about the falling value of the building. Around the table, the Council members were sitting with their new sleek, metallic light-weight lap-tops. Those with thick spiral bound sets of paper were probably the staff. Everyone in the back row (except me) has one of these spiral booklets balanced on his pin-striped knee.
Mr Walker was talking of the effect the recession was having on the value of the building. He said several times that it was the best quality office building in the area and I remembered hearing exactly this talk at another Finance meeting perhaps a year ago. He said the market was ‘bumping along the bottom’, and he ‘did not foresee an improvement’ next year, ‘the market place is what has to drive us’ he said, and ‘this is where we stand’, etc. Julia Drown asked ‘should we sell up and cash in?’ He replied that that Freeholds weren’t selling at the moment, because no-one’s got any money. There was a short detour about the number of millions it was now possible to raise compared to the squillions that were the norm more recently. Nevertheless, he reassured the Council that their ‘covenant’ was clearly very strong, because it was effectively Government backed.
“Should we sell the building and lease it back?” The council member asked. “Should you occupy a freehold?” repeated a startled Mr Walker, “it’s relatively unfashionable, because it is so cheap to lease”. No, then, I suppose.
Malcolm Cross asked if he could ask a naïve question. He was assured he could. “Is it possible, if the organisation grows organically, and colonises different spaces around the neighbourhood, to reconsolidate later?” “Yes” said Mr Walker who was then free to leave.
This made room at the table for Jonathan Bracken, the Legal Adviser, and a young woman who seemed to be making her debut at the meeting – Kathryn Neuberger, the Partner Manager of the HPC. She tentatively read the document relating to Item 11 of the agenda: Partner Code of Conduct and my notebook filled up with legal phrases: Code of Conduct, Contracts Compliance, Specific Conduct, Revised Code. Partner Code of Conduct. Someone asked what had provoked this revision, “had there been a spate of complaints about the Partners?” “No. We only get about 2 complaints a year”. “Oh, who from? Other partners perhaps, or from HEIs?” Kathryn didn’t know, so it probably wasn’t the reason for revising the contracts and codes. We didn’t learn what was, nor why it was here in the Finance meeting. Jonathan Bracken added some serious sounding stuff the only part of which I could understand was “making sure people keep up with training requirements”.
Malcolm Cross apologised for wanting to ask ‘another probably stupid question’, and was again assured it was ok. He was puzzled about the complaints procedure, and was unsure what was meant by the contractual obligation to act in ‘good faith’. This prompted a breeze of laughter after which Jonathan Bracken recovered himself and affably said it was “one of those things one instinctively knows but cannot be put into words”. Business done he then bustled out of the room with a huge grin on his face.
Everyone turned to the pages full of figures – The Finance Department Report, the first page of which details funds under management of £6,100,000 plus 2 investment portfolios amounting to £4,010,000. That’s over ten million pounds of money tied up in investment accounts earning various rates of interest.
Revenue of nearly £15 million is received through registration, but was slightly exceeded by expenses. There are two notes of particular interest offered as explanation for the overspend:
1. Professional Fees. “The unfavourable variance of £238k is mainly due to an unfavourable variance of £60k for legal advice due to additional advice in relation to new professions, an unfavourable variance of £62k for other legal costs due to a [sic] increase in high court appeals, and unfavourable variance of £58k for transcript writers due to the increase in the number of hearings and an unfavourable variance of £49k for legal expenses due to an increase in disbursements and costs relating to Psychologist Hearings.” (Note I p 4,).
2. Fitness to Practise. “The unfavourable variance of £612k was due to an increase in the number of allegations being received and the increase in the length of hearings. This included unfavourable variances on room hire (£65k), panels (£394k) and transcript writers (£58k). There was also an unfavourable variance of £62k in other legal costs due to the increase in high court appeals.” (Note 7 p 6.)
A couple of other small amounts turned out to be equally as interesting. A figure of £90,000 revealed a point of fear and trembling for the HPC. Once upon a time, the HPC had bought a licence for its Microsoft Software, but the piece of paper that accompanied this act has long since been lost. The HPC is worried at this lack of proof of their virtue. If Microsoft ever comes knocking on the door to demand to see the licence, it will have nothing but a word of honour to offer. The finance team didn’t think Microsoft would believe them. So, they have been salting away a few thousand a year against the day of judgment. Finally they decided to go out and buy fresh licences and be done with it. So, there does exist a body capable of frightening the HPC. Very Old Testament, I must say, in a 21st Century kind of way.
The second interesting figure is £360,000, concealed in the cash flow accounts where it appears as an exceptional expense, written in brackets to signify that in fact it is an income (September 2008). It is a payment from the Department of Health. I am currently trying to discover what this signifies.
Just before I had to leave, Marc Seale was explaining that he was expecting ten times as many Fitness to Practise cases on the books when they took on Psychotherapists and Counsellors. This was, he said, because there are about 40 or 50 organisations out there, most of whom lack proper fitness to practise processes, so it’s a major issue which he is currently negotiating with Government – the extra costs he foresaw pertaining to P&C FTP shouldn’t be passed on to the existing registrants and another source must be found.
NB Paramedics are disproportionately represented in FTP, though no similar logic is applied there. Perhaps the HPC are making the DH pay for the inconvenience they are experiencing with this ‘New Profession’.
It was much later that I remembered one more point while watching the premier of the film Erasing David (to be televised on More 4, 10pm Tuesday 4th May). The film, sponsored by the Joseph Rowntree Reform Trust (who launched last year’s Convention on Modern Liberty), is an experiment designed to reveal the amount and kind of personal information held on databases. It is also a study in creeping fear, and a reminder of the role played by the rhetoric of security which justified so much legislation, including that which created the HPC. One scene in the film jogged my memory back there. It was a scene in modern school which used finger-print technology to take the daily register. A beautiful shiny metal oval contains a blue light on which each pupil presses their finger on entrance to the class. It reminded me that Malcolm Cross had raised a very tentative question, for which he apologised profusely, about the figure for Access Control on Additional Doors (Budgeted at £9,400, Actual, three times that: £27,757). Marc Seale had, in his customary way, rattled off the security rationale for this, and moved on. Apparently there had been a break-in, so they had decided to increase the security to make sure everyone was safe inside the building. Dr Cross ventured to ask again “and I suppose a proper discussion was had at the time?” Oh yes, said Mr Seale, and this time closed the conversation stone dead.
Thanks to Ian Parker (CFAR) and Simona Revelli (The Guild) who have both brought the bad news that Middlesex University’s renowned Department of Philosophy has suddenly been closed down. Article Guardian online here:
and petition against the closure here:
Link to Richard Gombrich’s prophetic article from 2000 British Higher Education Policy in the last Twenty Years: The Murder of A Profession. Here:
And Paul Verhaeghe’s keynote paper Chronicle of a Death Foretold – the end of Psychotherapy, can be googled and downloaded from the Dublin City University Health4Life Conference 2007.
Mr Walker was talking of the effect the recession was having on the value of the building. He said several times that it was the best quality office building in the area and I remembered hearing exactly this talk at another Finance meeting perhaps a year ago. He said the market was ‘bumping along the bottom’, and he ‘did not foresee an improvement’ next year, ‘the market place is what has to drive us’ he said, and ‘this is where we stand’, etc. Julia Drown asked ‘should we sell up and cash in?’ He replied that that Freeholds weren’t selling at the moment, because no-one’s got any money. There was a short detour about the number of millions it was now possible to raise compared to the squillions that were the norm more recently. Nevertheless, he reassured the Council that their ‘covenant’ was clearly very strong, because it was effectively Government backed.
“Should we sell the building and lease it back?” The council member asked. “Should you occupy a freehold?” repeated a startled Mr Walker, “it’s relatively unfashionable, because it is so cheap to lease”. No, then, I suppose.
Malcolm Cross asked if he could ask a naïve question. He was assured he could. “Is it possible, if the organisation grows organically, and colonises different spaces around the neighbourhood, to reconsolidate later?” “Yes” said Mr Walker who was then free to leave.
This made room at the table for Jonathan Bracken, the Legal Adviser, and a young woman who seemed to be making her debut at the meeting – Kathryn Neuberger, the Partner Manager of the HPC. She tentatively read the document relating to Item 11 of the agenda: Partner Code of Conduct and my notebook filled up with legal phrases: Code of Conduct, Contracts Compliance, Specific Conduct, Revised Code. Partner Code of Conduct. Someone asked what had provoked this revision, “had there been a spate of complaints about the Partners?” “No. We only get about 2 complaints a year”. “Oh, who from? Other partners perhaps, or from HEIs?” Kathryn didn’t know, so it probably wasn’t the reason for revising the contracts and codes. We didn’t learn what was, nor why it was here in the Finance meeting. Jonathan Bracken added some serious sounding stuff the only part of which I could understand was “making sure people keep up with training requirements”.
Malcolm Cross apologised for wanting to ask ‘another probably stupid question’, and was again assured it was ok. He was puzzled about the complaints procedure, and was unsure what was meant by the contractual obligation to act in ‘good faith’. This prompted a breeze of laughter after which Jonathan Bracken recovered himself and affably said it was “one of those things one instinctively knows but cannot be put into words”. Business done he then bustled out of the room with a huge grin on his face.
Everyone turned to the pages full of figures – The Finance Department Report, the first page of which details funds under management of £6,100,000 plus 2 investment portfolios amounting to £4,010,000. That’s over ten million pounds of money tied up in investment accounts earning various rates of interest.
Revenue of nearly £15 million is received through registration, but was slightly exceeded by expenses. There are two notes of particular interest offered as explanation for the overspend:
1. Professional Fees. “The unfavourable variance of £238k is mainly due to an unfavourable variance of £60k for legal advice due to additional advice in relation to new professions, an unfavourable variance of £62k for other legal costs due to a [sic] increase in high court appeals, and unfavourable variance of £58k for transcript writers due to the increase in the number of hearings and an unfavourable variance of £49k for legal expenses due to an increase in disbursements and costs relating to Psychologist Hearings.” (Note I p 4,).
2. Fitness to Practise. “The unfavourable variance of £612k was due to an increase in the number of allegations being received and the increase in the length of hearings. This included unfavourable variances on room hire (£65k), panels (£394k) and transcript writers (£58k). There was also an unfavourable variance of £62k in other legal costs due to the increase in high court appeals.” (Note 7 p 6.)
A couple of other small amounts turned out to be equally as interesting. A figure of £90,000 revealed a point of fear and trembling for the HPC. Once upon a time, the HPC had bought a licence for its Microsoft Software, but the piece of paper that accompanied this act has long since been lost. The HPC is worried at this lack of proof of their virtue. If Microsoft ever comes knocking on the door to demand to see the licence, it will have nothing but a word of honour to offer. The finance team didn’t think Microsoft would believe them. So, they have been salting away a few thousand a year against the day of judgment. Finally they decided to go out and buy fresh licences and be done with it. So, there does exist a body capable of frightening the HPC. Very Old Testament, I must say, in a 21st Century kind of way.
The second interesting figure is £360,000, concealed in the cash flow accounts where it appears as an exceptional expense, written in brackets to signify that in fact it is an income (September 2008). It is a payment from the Department of Health. I am currently trying to discover what this signifies.
Just before I had to leave, Marc Seale was explaining that he was expecting ten times as many Fitness to Practise cases on the books when they took on Psychotherapists and Counsellors. This was, he said, because there are about 40 or 50 organisations out there, most of whom lack proper fitness to practise processes, so it’s a major issue which he is currently negotiating with Government – the extra costs he foresaw pertaining to P&C FTP shouldn’t be passed on to the existing registrants and another source must be found.
NB Paramedics are disproportionately represented in FTP, though no similar logic is applied there. Perhaps the HPC are making the DH pay for the inconvenience they are experiencing with this ‘New Profession’.
It was much later that I remembered one more point while watching the premier of the film Erasing David (to be televised on More 4, 10pm Tuesday 4th May). The film, sponsored by the Joseph Rowntree Reform Trust (who launched last year’s Convention on Modern Liberty), is an experiment designed to reveal the amount and kind of personal information held on databases. It is also a study in creeping fear, and a reminder of the role played by the rhetoric of security which justified so much legislation, including that which created the HPC. One scene in the film jogged my memory back there. It was a scene in modern school which used finger-print technology to take the daily register. A beautiful shiny metal oval contains a blue light on which each pupil presses their finger on entrance to the class. It reminded me that Malcolm Cross had raised a very tentative question, for which he apologised profusely, about the figure for Access Control on Additional Doors (Budgeted at £9,400, Actual, three times that: £27,757). Marc Seale had, in his customary way, rattled off the security rationale for this, and moved on. Apparently there had been a break-in, so they had decided to increase the security to make sure everyone was safe inside the building. Dr Cross ventured to ask again “and I suppose a proper discussion was had at the time?” Oh yes, said Mr Seale, and this time closed the conversation stone dead.
Thanks to Ian Parker (CFAR) and Simona Revelli (The Guild) who have both brought the bad news that Middlesex University’s renowned Department of Philosophy has suddenly been closed down. Article Guardian online here:
and petition against the closure here:
Link to Richard Gombrich’s prophetic article from 2000 British Higher Education Policy in the last Twenty Years: The Murder of A Profession. Here:
And Paul Verhaeghe’s keynote paper Chronicle of a Death Foretold – the end of Psychotherapy, can be googled and downloaded from the Dublin City University Health4Life Conference 2007.
Monday, 26 April 2010
Art, literature, and bureaucracy
Picking up the Archbishop’s thread from Easter Bank Holiday Monday – can literature defeat bureaucracy? – I’m sorry to report that there was a clear win for bureaucracy at last weeks International PEN meeting ‘Free the Word’ at London’s South Bank. Internationally celebrated writer Donato Ndongo-Bidyogo (a political refugee currently living in Spain, exiled from his home in Equatorial Guinea) was denied entry into the UK to take the stage on Saturday because the beleaguered bureaucrat got tangled up in the red tape of the new border control agencies (UKBA, formed in April 2008). Donato had applied to enter as a ‘business visitor’, but the poor fuddled civil servant got hopelessly lost in the labyrinth of rules and ended up quoting chapter and verse from the wrong page of the book. Donato was rejected without hope of appeal and thus prevented from entering good old bastion of liberty, free speaking Britain.
The Labour Party Manifesto links this new agency with crime reduction policy in chapter 5 entitled Crime and Immigration. “Our borders are stronger than ever” it declares, though it may simply be that piles and piles of red tape are simply in the way. This “new Border Agency has police-level powers and thousand more immigration officers, 100 per cent of visas are now biometric, and new electronic border controls will be counting people in and out by the end of the year… Genuine refugees will continue to receive protection.” Or not…
In the absence of Donato Ndongo-Bidyogo’s bodily presence, someone read a passage from his book: Shadows of your Black Memory (Swan Isle Press, 2007), around about page 84. Told in the voice of a boy this piece describes him watching with glee as his Uncle, the leader of the tribe, sparred and jibed with the visiting Catholic Priest whose mission was to impose his superior culture on these poor guys who were evidently stuck in the dark and dismal past. The Uncle’s work was to constantly subvert the Priest’s mission by reminding him to practice what he preached. But the Priest was deaf to his witty reminders and carried on obliviously. The justifications for the Priest’s unwelcome rescue package were uncannily familiar and reminded me, of all things, of the HPC. A man convinced he is right, and employed in a state backed institution excuses himself the effort to think and takes pleasure from telling the other how to live.
Which reminds me, I received a letter from Marc Seale today, replying to the letter I sent following Malcolm Cross’s hearing in which I asked a series of questions about the way the HPC conducts itself. Mr Seale quotes chapter and verse from his big book of rules to prove that I am wrong to raise these questions, and invites me in for re-educating.
Last night at the National Theatre, Alan Bennett’s play, The Habit of Art, (in which, by the way, Alex Jennings, who read the part of the CBT therapist in Josh Appignanesi’s play Therapy! plays the Benjamin Britten) was filmed and broadcast live across the world to thousands and thousands of people. Fabulously rich, layered, funny, thought provoking, intelligent, and mysteriously moving this play sent me off to discover Auden on You Tube reading his poem In Memory of Freud in which so many lines are worth quoting but these especially:
If he succeeded, why, the Generalised Life
Would become impossible, the monolith
Of State be broken and prevented
The co-operation of avengers.
Other lines also reminded me of Therapy! whose most moving scenes come in the analytic session when, between them, analyst and analysand managed to find the truth that Auden puts like this: “to be free is often to be lonely”. And,
But he would have us remember most of all
To be enthusiastic over the night
Not only for the sense of wonder
It alone has to offer, but also
Because it needs our love…
Literature alone doesn’t solve it, of course. Bennett’s play was very different from that of Mark Haddon currently playing at the Donmar – Polar Bears. This one tries hard to look directly at Bi-polar living with the help of philosophy, post-mortem anatomy, and post-modern style. Although engaging in parts, the cut up nature of the play gives everyone the chance to avoid asking themselves what the hell they thought they were doing. It gave a glimpse of the world in which Sigmund Freud’s work was already long forgotten.
In Auden’s poem, written in 1939, he could say of Freud
To us he is no more a person
Now but a whole climate of opinion.
Climate Change, apparently, has evaporated his wisdom.
Only Hate was happy, hoping to augment
his practice now, and his shabby clientele
At the Dulwich Village yoga class on Tuesday evening two women talked enthusiastically about what they’d learned on the Radio 4 programme “Between Ourselves” earlier that morning (9.am, 20th April) in a discussion between Oliver James and Laverne Antrobus. If a baby doesn’t receive the right amount of love, they said, then the brain does not develop, and there’s nothing more to be done. They went on to explain that this was the reason for Jamie Bulger’s murder. Listening again (on iPlayer) Oliver James (who I learned is the son of two psychoanalysts) didn’t exactly say this, but the general drift of his interventions take us directly into this difficult water and look very much like the current climate of opinion.
Back in the Manifesto, in a section of chapter 5 (Crime and Immigration) entitled Early Intervention and Preventing Crime, the Labour Party boldly state: “We need to do more and act earlier to stop children going down the wrong path. So we will expand Family Nurse Partnerships to all vulnerable young mothers, reducing future crime and behavioural problems. For the 50,000 most dysfunctional families who cause misery to their neighbours, we will provide Family Intervention Projects – proven to tackle anti-social behaviour – a no-nonsense regime of one-to-one support with tough sanctions for non-compliance’. All three major Party Political Manifestos contain a line or two about mental health. Labour promise to provide ‘access to psychological therapy for those who need it’. The Liberal Democrats say they will ‘improve access to counselling for people with mental health problems, by continuing to roll out cognitive and behavioural therapies’. The Tories will ‘increase access to effective ‘talking’ therapies.’ The question remains in all cases, however, how these policies relate to the State. In particular, who defines mental illness, who defines the talking therapy, the behavioural adaptation, the cognitive modification, and how the practitioner who delivers this policy is going to be policed.
The Institute of Group Analysis, in the 7th edition of their newsletter Dialogue (March 2010) illustrates how the insipid creep of the modern British State infiltrates even (!) analysed minds. At their conference (Can Group Therapy Survive NICE: Examining the Evidence) Glenys Parry and Chris Blackmore presented their findings from what is known in these circles as ‘a systematic review’. They were searching for ‘evidence’ of the ‘effectiveness’ of psychodynamic group therapy and group analysis, something they described as ‘difficult’ in the ‘deluge of articles picked up by their search terms’. Nevertheless, they were able to conclude that there was, indeed, broad and consistent evidence for the aforesaid therapies, tho ‘insufficient to distinguish between the various group therapies, and, get this, ‘insufficient randomised controlled trials’.
And thus they can conclude, this puts them ‘in the position of not being able to make a case for inclusion in NICE guidelines apart from in a combined treatment for personality disorder.’
What do do? Chris Mace ‘usefully’ suggested that they do a Cost Benefit Analysis on their Group Analysis! Apparently the Powerpoint presentations can be accessed from the IGA website.
Perhaps you too have had experience of doing a systematic review. You will know that it is made possible by the powerful computerised search engines ploughing mindlessly through databases to pick up keywords across disparate fields. The quantity of papers that line up to be read is literally mind-blowing. Each paper, once a pearl of wisdom situated in an agonistic field, is plucked from its context and thrust into a such a heap that difference, meaning and value are reduced, mashed and beaten to a pulp and any goodness is utterly destroyed.
Perhaps you too have had experience of learning a poem off by heart, or of learning a part in a play. You will know that it is only possible by constantly going over one text. Could there be two more different approaches?
Auden, again, on Freud:
He wasn’t clever at all: he merely told
The unhappy Present to recite the Past
Like a poetry lesson till sooner
Or later it faltered at the line where
Long ago the accusations had begun,
And suddenly knew by whom it had been judged
How rich life had been and how silly
And was life-forgiven and more humble.
The whole poem is well worth a longer look - published by Faber and Faber in the collection Another Time.
The Labour Party Manifesto links this new agency with crime reduction policy in chapter 5 entitled Crime and Immigration. “Our borders are stronger than ever” it declares, though it may simply be that piles and piles of red tape are simply in the way. This “new Border Agency has police-level powers and thousand more immigration officers, 100 per cent of visas are now biometric, and new electronic border controls will be counting people in and out by the end of the year… Genuine refugees will continue to receive protection.” Or not…
In the absence of Donato Ndongo-Bidyogo’s bodily presence, someone read a passage from his book: Shadows of your Black Memory (Swan Isle Press, 2007), around about page 84. Told in the voice of a boy this piece describes him watching with glee as his Uncle, the leader of the tribe, sparred and jibed with the visiting Catholic Priest whose mission was to impose his superior culture on these poor guys who were evidently stuck in the dark and dismal past. The Uncle’s work was to constantly subvert the Priest’s mission by reminding him to practice what he preached. But the Priest was deaf to his witty reminders and carried on obliviously. The justifications for the Priest’s unwelcome rescue package were uncannily familiar and reminded me, of all things, of the HPC. A man convinced he is right, and employed in a state backed institution excuses himself the effort to think and takes pleasure from telling the other how to live.
Which reminds me, I received a letter from Marc Seale today, replying to the letter I sent following Malcolm Cross’s hearing in which I asked a series of questions about the way the HPC conducts itself. Mr Seale quotes chapter and verse from his big book of rules to prove that I am wrong to raise these questions, and invites me in for re-educating.
Last night at the National Theatre, Alan Bennett’s play, The Habit of Art, (in which, by the way, Alex Jennings, who read the part of the CBT therapist in Josh Appignanesi’s play Therapy! plays the Benjamin Britten) was filmed and broadcast live across the world to thousands and thousands of people. Fabulously rich, layered, funny, thought provoking, intelligent, and mysteriously moving this play sent me off to discover Auden on You Tube reading his poem In Memory of Freud in which so many lines are worth quoting but these especially:
If he succeeded, why, the Generalised Life
Would become impossible, the monolith
Of State be broken and prevented
The co-operation of avengers.
Other lines also reminded me of Therapy! whose most moving scenes come in the analytic session when, between them, analyst and analysand managed to find the truth that Auden puts like this: “to be free is often to be lonely”. And,
But he would have us remember most of all
To be enthusiastic over the night
Not only for the sense of wonder
It alone has to offer, but also
Because it needs our love…
Literature alone doesn’t solve it, of course. Bennett’s play was very different from that of Mark Haddon currently playing at the Donmar – Polar Bears. This one tries hard to look directly at Bi-polar living with the help of philosophy, post-mortem anatomy, and post-modern style. Although engaging in parts, the cut up nature of the play gives everyone the chance to avoid asking themselves what the hell they thought they were doing. It gave a glimpse of the world in which Sigmund Freud’s work was already long forgotten.
In Auden’s poem, written in 1939, he could say of Freud
To us he is no more a person
Now but a whole climate of opinion.
Climate Change, apparently, has evaporated his wisdom.
Only Hate was happy, hoping to augment
his practice now, and his shabby clientele
At the Dulwich Village yoga class on Tuesday evening two women talked enthusiastically about what they’d learned on the Radio 4 programme “Between Ourselves” earlier that morning (9.am, 20th April) in a discussion between Oliver James and Laverne Antrobus. If a baby doesn’t receive the right amount of love, they said, then the brain does not develop, and there’s nothing more to be done. They went on to explain that this was the reason for Jamie Bulger’s murder. Listening again (on iPlayer) Oliver James (who I learned is the son of two psychoanalysts) didn’t exactly say this, but the general drift of his interventions take us directly into this difficult water and look very much like the current climate of opinion.
Back in the Manifesto, in a section of chapter 5 (Crime and Immigration) entitled Early Intervention and Preventing Crime, the Labour Party boldly state: “We need to do more and act earlier to stop children going down the wrong path. So we will expand Family Nurse Partnerships to all vulnerable young mothers, reducing future crime and behavioural problems. For the 50,000 most dysfunctional families who cause misery to their neighbours, we will provide Family Intervention Projects – proven to tackle anti-social behaviour – a no-nonsense regime of one-to-one support with tough sanctions for non-compliance’. All three major Party Political Manifestos contain a line or two about mental health. Labour promise to provide ‘access to psychological therapy for those who need it’. The Liberal Democrats say they will ‘improve access to counselling for people with mental health problems, by continuing to roll out cognitive and behavioural therapies’. The Tories will ‘increase access to effective ‘talking’ therapies.’ The question remains in all cases, however, how these policies relate to the State. In particular, who defines mental illness, who defines the talking therapy, the behavioural adaptation, the cognitive modification, and how the practitioner who delivers this policy is going to be policed.
The Institute of Group Analysis, in the 7th edition of their newsletter Dialogue (March 2010) illustrates how the insipid creep of the modern British State infiltrates even (!) analysed minds. At their conference (Can Group Therapy Survive NICE: Examining the Evidence) Glenys Parry and Chris Blackmore presented their findings from what is known in these circles as ‘a systematic review’. They were searching for ‘evidence’ of the ‘effectiveness’ of psychodynamic group therapy and group analysis, something they described as ‘difficult’ in the ‘deluge of articles picked up by their search terms’. Nevertheless, they were able to conclude that there was, indeed, broad and consistent evidence for the aforesaid therapies, tho ‘insufficient to distinguish between the various group therapies, and, get this, ‘insufficient randomised controlled trials’.
And thus they can conclude, this puts them ‘in the position of not being able to make a case for inclusion in NICE guidelines apart from in a combined treatment for personality disorder.’
What do do? Chris Mace ‘usefully’ suggested that they do a Cost Benefit Analysis on their Group Analysis! Apparently the Powerpoint presentations can be accessed from the IGA website.
Perhaps you too have had experience of doing a systematic review. You will know that it is made possible by the powerful computerised search engines ploughing mindlessly through databases to pick up keywords across disparate fields. The quantity of papers that line up to be read is literally mind-blowing. Each paper, once a pearl of wisdom situated in an agonistic field, is plucked from its context and thrust into a such a heap that difference, meaning and value are reduced, mashed and beaten to a pulp and any goodness is utterly destroyed.
Perhaps you too have had experience of learning a poem off by heart, or of learning a part in a play. You will know that it is only possible by constantly going over one text. Could there be two more different approaches?
Auden, again, on Freud:
He wasn’t clever at all: he merely told
The unhappy Present to recite the Past
Like a poetry lesson till sooner
Or later it faltered at the line where
Long ago the accusations had begun,
And suddenly knew by whom it had been judged
How rich life had been and how silly
And was life-forgiven and more humble.
The whole poem is well worth a longer look - published by Faber and Faber in the collection Another Time.
Saturday, 17 April 2010
Constructing the proposed new generic standards
This is based on the HPC Council meeting of March 25th 2010 (attended by Bruce Scott, from the PA). The long list of dense documents pertaining to this meeting can be accessed here:
http://www.hpc-uk.org/aboutus/council/councilmeetings/index.asp?id=523)
A private meeting followed in the afternoon (public excluded), which dealt with the Judicial Review.
Marc Seale (CEO of HPC) opened: registrant fees would probably be increased to fund the rising volume of fitness to practice hearings. In the accompanying papers the fitness to practice budget for 2010/2011 is estimated at £7,145,823! “That’s a lot of lawyers” thought Bruce to himself.
Seale also talked about launching a media campaign to create/push for the professionalism of the guys at football matches with buckets and sponges who run on to the pitch when a player gets injured. The HPC only want “professional helpers” who will then have be HPC registered!
He also wants to capture golf coaches and sports psychologists/coaches, saying ‘we have got to get them because some are not trained psychologists or sports coaches’.
Will the insidious nature of HPC regulation make its way into the Sunday kick-about with the boys or girls? Will “coaches” have to be regulated? Bruce used to be a racing cyclist: “I had several “unqualified” coaches throughout my career - they did it for free because they loved the sport and wanted to give something to the community: they were ex-cyclists, boxers, or just keen on endurance sport. Under the proposed HPC system my coaches would be not be allowed to get involved in sport coaching at all.”
The volume of papers the Council is faced with is overwhelming. I shall focus on only one, The Generic Standards of Proficiency Review Group – Executive summary and recommendations, http://www.hpc-uk.org/assets/documents/10002CED20100325Council-enc06-genericSoPsreview.pdf
These standards are applicable to ALL registrants across the 15 professions already regulated. They were shown to be wholly inappropriate for counselling and psychotherapy in the recent public consultation.
In brief: the Group recommended:
1) The generic standards applicable to all registrants should be kept.
2) But they should be BROADENED.
The council agreed.
The Group comprised:
Eileen Thornton (Physiotherapist)
Joy Tweed (Lay, Lecturer Health & Social Care)
Di Waller (Arts therapist)
Arun Midha (Lay, MBA)
John Donaghy (Paramedic)
Annie Turner (Occupational Therapist)
Penny Renwick (Chiropodist).
They met twice: on 28 September (ie before the end of the consultation on C&P) and then on 27/8 January 2010, after a ‘survey’ of 20 professional bodies. They were specifically advised (presumably by the invisible Legal Adviser mentioned in the report last week): “not to make changes specifically in response to the feedback received through the psychotherapists and counsellors consultation as these professions are not currently regulated by the HPC.”
In September 2009, HPC wrote to TWENTY professional bodies asking for feedback on the generic standards of proficiency. SEVEN responded: FOUR said they had nothing to say, ONE commented on the intro, not the standards, and TWO commented in detail about eight of the 25 or so standards. The Group thought this might indicate that on the whole most of the professional bodies covered by the HPC were satisfied with the standards. It would be interesting to know which two bodies gave the detailed comments.
Why is the HPC reviewing them if none of the existing Groups is unhappy with them? Is it because they want to capture C&P? But they are advised not to consult C&P in the process of revision.
Attachment B of the Review Group’s Recommendations summarises the additional information available to the Group and considered at their second meeting. Most of this information came from the consultation on regulating counselling and psychotherapy, and the rest relates to concerns raised by the psychologists. Neither of these Groups are allowed to be involved in re-writing the generic standards. The legal implications of any new standards for the time-table of work means that it will take years before the psychologists can re-write their specific standards (because the grand-parenting period has to be allowed to play out under the current, agreed, standards). If the PLG for P&C begin writing their specific standards before the new ones are finalised (they are due to reconvene on 12th May 2010, the new generic standards are predicted for January 2011); they too will also have to wait at least three years before re-writing can begin.
It is not noted that the huge number of concerns coming from these two Groups indicates the inappropriateness of including them in the domain of the HPC. Everyone in this field expressed forthright opposition to regulation by the HPC before the White Paper (Trust, Assurance and Safety) was published in 2007, an inconvenient truth that HPC tends to bracket off and ignore.
The report is presented with numbered sections suggesting an orderly progression of logic. However, on close reading one is forced to conclude that the numbering exists mainly for reference, much like page numbering. Could it be also that the numbers function to separate sentences from each other in order to ignore the flow of meaning and logic that some of them might present.
For example in para 2.2 the Group “[agree] that standards 2a.1-2a.4 are examples of when rewording the standards would still not make them applicable for all professions” because they do not apply to Arts therapists. The inconvenient truth that Arts therapists have not met these standards for 8 year is isolated in a numbered paragraph and ignored.
Meanwhile, the Group reflect on the history of the generic standards in the HPC. These were introduced when the HPC was created in order to identify commonalities across the professions. That this was only achieved by ignoring the anomaly of the Arts therapists is not noted.
It is again ignored in Paragraph 2.4, where “the Group agreed that the principle of having a set of generic standards of proficiency is important as they recognise that the professions regulated by the HPC do have commonalities.” To make the professions conform is the single most important task of this Group. But, apparently incapable of referring to real aspects of the work involved in the professions, the Group relies on generalised moral guidelines apparently of their own invention.
First, it is worth noticing how the re-write is justified. To recap, the Group must retain something called generic standards in order to justify the existence of the HPC as the single entity capable of regulation. But they know that these must be substantially rewritten if they are to succeed in capturing C&P. The existing professions have never complained, and don’t see the need to change. But the Arts therapists have taken this opportunity to say that, after more than 8 years, have never complied with these generic standards. As the HPC likes to justify its competence to regulate C&P by reference to its success with Arts therapists, this constitutes a considerable weak point.
This is probably why the admission is made, separated in a numbered paragraph, and then simply ignored.
So how will seven people rewrite the generic standards applicable to more than 205,000 people in 15 different professions? First they acknowledge that they can’t simply reword the current standards, because “some concerns go beyond wording” (2.1, p2). But this means that all other standards will also have to be rewritten, as the generic standards function as section headings in the overall document of standards.
In order to justify this huge project, the Group present three possible options and then choose one. This is prefaced with:
“The Group therefore agreed that generic standards should be retained, but that they should be as CONCISE as possible and applicable to the increasing diversity of professions and professional philosophies regulated by the HPC.” [emphasis added]
Note the use of the word ‘therefore’, which implies a logical argument, where in fact there is none. This small Group of people, meeting on two separate occasions, interspersed by a failed ‘survey’ of 20 professional organisations, are of course unable to do the job they have been tasked with. But instead of saying so (as the generic standards indeed would command) they seem to be creating a smokescreen behind which they are improvising wildly.
Preceding the word ‘therefore’ are four numbered paragraphs bluntly restating the imperative that HPC must have generic standards. The 5th preceding paragraph was the one that said Arts therapists have never conformed to 4 of these.
The word CONCISE has no meaning in the text, but seems instead to signal the Group’s anxiety at the amount of work, time, money and effort that this project will entail. All but the Arts therapists, apparently, are happy with the current standards.
What about the words BROADEN and EXPAND in the next section – what might they mean? Having recommended CONCISE new standards, the Group set out three options.
1. To make concise the old standards – rejected.
2. BROADEN the consultation of old generic standards to include principles and STRUCTURE of standards - rejected.
3. EXPAND the review of generic standards to include STRUCTURE of standards – accepted
This option (3) was chosen ‘because’
1. It would allow the HPC to engage with those who have an interest in the generic standards;
2. The HPC would be seen to be listening and responding to external feedback.
3. It would ‘future proof’ standards for potential new Groups;
4. A BROADER review would stand up to public scrutiny;
5. The work already done can feed into the BROADER review. (P. 4)
The rationale is blatantly political – if there is any sign of any other logic in the text, I couldn’t find it.
The Group goes on to consider a few different options for structuring the new BROADER generic standards:
1. Remove the generic standards, and allow each profession to compile their own. Rejected!
2. Group the generic standards under BROAD headings (eg Psychological Therapies, Scientists and Allied Health Professionals). Rejected ‘because’ it would be ‘complex and superficial’!
3. Change the structure to OVERARCHING, BROAD standards. Accepted because: it would give a set of OVERARCHING standards applicable to all; it would provide headings under which each Profession could then write its own SUB-STANDARDS (sic); the standard ‘be able to select appropriate personal protective equipment and use it correctly’ is likely to be retained for biomedical scientists, but is less likely to be needed for Arts therapists.’ Well, well, well – what a pitiful state of affairs.
Paragraph 2.19 lists six bullet points in an attempt to justify why this option is the most appropriate. These points are an object lesson in how to rob words of any meaning and muddle and confuse the reader to force through the forgone conclusion. Here they are in condensed form:
1. Keep generic standards;
2. There are 14 [sic] diverse professions but there are some commonalities that the generic standards recognise;
3. The OVERARCHING generic standards can be interpreted by individuals;
4. It solves terminology problems allowing difference to be expressed within the professions, own standards; the new structure can be rolled out, beginning with the most problematic professions; new professions will fit.
This meaningless jumble of words leads directly to RECOMMENDATION 3: to adopt OVERARCHING generic standards with profession specific sub-standards underneath. Sub-standards?
The proposed 15 new overarching generic standards (yet to be tweaked by executive and legal advisor) can be winkled out of the HPC website here. http://www.hpc-uk.org/assets/documents/10002CED20100325Council-enc06-genericSoPsreview.pdf
Last Friday saw the first full read through of Josh Appignanesi’s new play Therapy! at London’s Vaudeville Theatre. Matthew Lloyd directed the cast
Richard Schiff – The Shrink
Alex Jennings – The CBT
Jessica Raine – The Analysand
Amanda Drew –Wife
Tom Goodman-Hill –Husband
Particularly impressive were Richard Schiff, instantly believable as the psychoanalyst, and Jessica Raine (the analysand trying to get the best of both worlds by also having CBT). Food provided the linking theme, and the action shifted between consulting rooms and dining room, presenting political points, sexual politics, problems of identity and rivalry, hilariously. It was a real privilege to watch five professionals turn our dilemma into a satirical workout for their talents. (Thanks to Julia Carne, CFAR, for contributing to this.)
http://www.hpc-uk.org/aboutus/council/councilmeetings/index.asp?id=523)
A private meeting followed in the afternoon (public excluded), which dealt with the Judicial Review.
Marc Seale (CEO of HPC) opened: registrant fees would probably be increased to fund the rising volume of fitness to practice hearings. In the accompanying papers the fitness to practice budget for 2010/2011 is estimated at £7,145,823! “That’s a lot of lawyers” thought Bruce to himself.
Seale also talked about launching a media campaign to create/push for the professionalism of the guys at football matches with buckets and sponges who run on to the pitch when a player gets injured. The HPC only want “professional helpers” who will then have be HPC registered!
He also wants to capture golf coaches and sports psychologists/coaches, saying ‘we have got to get them because some are not trained psychologists or sports coaches’.
Will the insidious nature of HPC regulation make its way into the Sunday kick-about with the boys or girls? Will “coaches” have to be regulated? Bruce used to be a racing cyclist: “I had several “unqualified” coaches throughout my career - they did it for free because they loved the sport and wanted to give something to the community: they were ex-cyclists, boxers, or just keen on endurance sport. Under the proposed HPC system my coaches would be not be allowed to get involved in sport coaching at all.”
The volume of papers the Council is faced with is overwhelming. I shall focus on only one, The Generic Standards of Proficiency Review Group – Executive summary and recommendations, http://www.hpc-uk.org/assets/documents/10002CED20100325Council-enc06-genericSoPsreview.pdf
These standards are applicable to ALL registrants across the 15 professions already regulated. They were shown to be wholly inappropriate for counselling and psychotherapy in the recent public consultation.
In brief: the Group recommended:
1) The generic standards applicable to all registrants should be kept.
2) But they should be BROADENED.
The council agreed.
The Group comprised:
Eileen Thornton (Physiotherapist)
Joy Tweed (Lay, Lecturer Health & Social Care)
Di Waller (Arts therapist)
Arun Midha (Lay, MBA)
John Donaghy (Paramedic)
Annie Turner (Occupational Therapist)
Penny Renwick (Chiropodist).
They met twice: on 28 September (ie before the end of the consultation on C&P) and then on 27/8 January 2010, after a ‘survey’ of 20 professional bodies. They were specifically advised (presumably by the invisible Legal Adviser mentioned in the report last week): “not to make changes specifically in response to the feedback received through the psychotherapists and counsellors consultation as these professions are not currently regulated by the HPC.”
In September 2009, HPC wrote to TWENTY professional bodies asking for feedback on the generic standards of proficiency. SEVEN responded: FOUR said they had nothing to say, ONE commented on the intro, not the standards, and TWO commented in detail about eight of the 25 or so standards. The Group thought this might indicate that on the whole most of the professional bodies covered by the HPC were satisfied with the standards. It would be interesting to know which two bodies gave the detailed comments.
Why is the HPC reviewing them if none of the existing Groups is unhappy with them? Is it because they want to capture C&P? But they are advised not to consult C&P in the process of revision.
Attachment B of the Review Group’s Recommendations summarises the additional information available to the Group and considered at their second meeting. Most of this information came from the consultation on regulating counselling and psychotherapy, and the rest relates to concerns raised by the psychologists. Neither of these Groups are allowed to be involved in re-writing the generic standards. The legal implications of any new standards for the time-table of work means that it will take years before the psychologists can re-write their specific standards (because the grand-parenting period has to be allowed to play out under the current, agreed, standards). If the PLG for P&C begin writing their specific standards before the new ones are finalised (they are due to reconvene on 12th May 2010, the new generic standards are predicted for January 2011); they too will also have to wait at least three years before re-writing can begin.
It is not noted that the huge number of concerns coming from these two Groups indicates the inappropriateness of including them in the domain of the HPC. Everyone in this field expressed forthright opposition to regulation by the HPC before the White Paper (Trust, Assurance and Safety) was published in 2007, an inconvenient truth that HPC tends to bracket off and ignore.
The report is presented with numbered sections suggesting an orderly progression of logic. However, on close reading one is forced to conclude that the numbering exists mainly for reference, much like page numbering. Could it be also that the numbers function to separate sentences from each other in order to ignore the flow of meaning and logic that some of them might present.
For example in para 2.2 the Group “[agree] that standards 2a.1-2a.4 are examples of when rewording the standards would still not make them applicable for all professions” because they do not apply to Arts therapists. The inconvenient truth that Arts therapists have not met these standards for 8 year is isolated in a numbered paragraph and ignored.
Meanwhile, the Group reflect on the history of the generic standards in the HPC. These were introduced when the HPC was created in order to identify commonalities across the professions. That this was only achieved by ignoring the anomaly of the Arts therapists is not noted.
It is again ignored in Paragraph 2.4, where “the Group agreed that the principle of having a set of generic standards of proficiency is important as they recognise that the professions regulated by the HPC do have commonalities.” To make the professions conform is the single most important task of this Group. But, apparently incapable of referring to real aspects of the work involved in the professions, the Group relies on generalised moral guidelines apparently of their own invention.
First, it is worth noticing how the re-write is justified. To recap, the Group must retain something called generic standards in order to justify the existence of the HPC as the single entity capable of regulation. But they know that these must be substantially rewritten if they are to succeed in capturing C&P. The existing professions have never complained, and don’t see the need to change. But the Arts therapists have taken this opportunity to say that, after more than 8 years, have never complied with these generic standards. As the HPC likes to justify its competence to regulate C&P by reference to its success with Arts therapists, this constitutes a considerable weak point.
This is probably why the admission is made, separated in a numbered paragraph, and then simply ignored.
So how will seven people rewrite the generic standards applicable to more than 205,000 people in 15 different professions? First they acknowledge that they can’t simply reword the current standards, because “some concerns go beyond wording” (2.1, p2). But this means that all other standards will also have to be rewritten, as the generic standards function as section headings in the overall document of standards.
In order to justify this huge project, the Group present three possible options and then choose one. This is prefaced with:
“The Group therefore agreed that generic standards should be retained, but that they should be as CONCISE as possible and applicable to the increasing diversity of professions and professional philosophies regulated by the HPC.” [emphasis added]
Note the use of the word ‘therefore’, which implies a logical argument, where in fact there is none. This small Group of people, meeting on two separate occasions, interspersed by a failed ‘survey’ of 20 professional organisations, are of course unable to do the job they have been tasked with. But instead of saying so (as the generic standards indeed would command) they seem to be creating a smokescreen behind which they are improvising wildly.
Preceding the word ‘therefore’ are four numbered paragraphs bluntly restating the imperative that HPC must have generic standards. The 5th preceding paragraph was the one that said Arts therapists have never conformed to 4 of these.
The word CONCISE has no meaning in the text, but seems instead to signal the Group’s anxiety at the amount of work, time, money and effort that this project will entail. All but the Arts therapists, apparently, are happy with the current standards.
What about the words BROADEN and EXPAND in the next section – what might they mean? Having recommended CONCISE new standards, the Group set out three options.
1. To make concise the old standards – rejected.
2. BROADEN the consultation of old generic standards to include principles and STRUCTURE of standards - rejected.
3. EXPAND the review of generic standards to include STRUCTURE of standards – accepted
This option (3) was chosen ‘because’
1. It would allow the HPC to engage with those who have an interest in the generic standards;
2. The HPC would be seen to be listening and responding to external feedback.
3. It would ‘future proof’ standards for potential new Groups;
4. A BROADER review would stand up to public scrutiny;
5. The work already done can feed into the BROADER review. (P. 4)
The rationale is blatantly political – if there is any sign of any other logic in the text, I couldn’t find it.
The Group goes on to consider a few different options for structuring the new BROADER generic standards:
1. Remove the generic standards, and allow each profession to compile their own. Rejected!
2. Group the generic standards under BROAD headings (eg Psychological Therapies, Scientists and Allied Health Professionals). Rejected ‘because’ it would be ‘complex and superficial’!
3. Change the structure to OVERARCHING, BROAD standards. Accepted because: it would give a set of OVERARCHING standards applicable to all; it would provide headings under which each Profession could then write its own SUB-STANDARDS (sic); the standard ‘be able to select appropriate personal protective equipment and use it correctly’ is likely to be retained for biomedical scientists, but is less likely to be needed for Arts therapists.’ Well, well, well – what a pitiful state of affairs.
Paragraph 2.19 lists six bullet points in an attempt to justify why this option is the most appropriate. These points are an object lesson in how to rob words of any meaning and muddle and confuse the reader to force through the forgone conclusion. Here they are in condensed form:
1. Keep generic standards;
2. There are 14 [sic] diverse professions but there are some commonalities that the generic standards recognise;
3. The OVERARCHING generic standards can be interpreted by individuals;
4. It solves terminology problems allowing difference to be expressed within the professions, own standards; the new structure can be rolled out, beginning with the most problematic professions; new professions will fit.
This meaningless jumble of words leads directly to RECOMMENDATION 3: to adopt OVERARCHING generic standards with profession specific sub-standards underneath. Sub-standards?
The proposed 15 new overarching generic standards (yet to be tweaked by executive and legal advisor) can be winkled out of the HPC website here. http://www.hpc-uk.org/assets/documents/10002CED20100325Council-enc06-genericSoPsreview.pdf
Last Friday saw the first full read through of Josh Appignanesi’s new play Therapy! at London’s Vaudeville Theatre. Matthew Lloyd directed the cast
Richard Schiff – The Shrink
Alex Jennings – The CBT
Jessica Raine – The Analysand
Amanda Drew –Wife
Tom Goodman-Hill –Husband
Particularly impressive were Richard Schiff, instantly believable as the psychoanalyst, and Jessica Raine (the analysand trying to get the best of both worlds by also having CBT). Food provided the linking theme, and the action shifted between consulting rooms and dining room, presenting political points, sexual politics, problems of identity and rivalry, hilariously. It was a real privilege to watch five professionals turn our dilemma into a satirical workout for their talents. (Thanks to Julia Carne, CFAR, for contributing to this.)
Monday, 12 April 2010
The Mystery of FTP. Andrew Marr, Archbishop of Canterbury, Philip Pullman, Mona Sidiqqui and David Baddiel help us to think about the HPC
The big idea written into the circuitry of the HPC is that professional organisations have vested interests which render them unfit to be given statutory power and to conduct their own regulation. Only an organisation free from vested interests is capable of dealing objectively with regulation says the One with the big idea.
This assumes that there are other kinds of organisations that do not have vested interests. Thus a central and longstanding problem is dismissed at a stroke. This blind spot at the heart of the HPC is identical to that which gives prejudice its energy. It gathers together a set of people and separates them from other people through the application of a negative characteristic. Written into the law is the idea that professionals are not to be trusted to regulate themselves, HPC functionaries are.
Before 2001 it was enough for politicians to say ‘we don’t think these professionals are ready to be handed statutory power’. A strong reason for this was the lack of a coherent body of knowledge to bind the field into one. Now it is said that we can make the field into one by defining it as a threat to the public, and then creating a new statutory body to police it.
The HPC appeared as the one organisation incapable of corruption. The benefactor of its virtue was The Public whose vigilance against sinful aspects of itself was needed to make the thing work.
The idea that the HPC is incapable of corruption is linked to the idea that it cannot think for itself but gets its instructions from something unnamable and powerful. This might explain why the professional links to the HPC are largely shrouded in mystery. There are three sacred tomes: Standards of Proficiency, Standards of Education and Training, and Standards of Conduct, Performance and Ethics.
Any problems associated with these three great questions are swept aside with a combination of strategies: consult legal advisors; appoint friendly panels of experts; set up bureaucratic procedures which are somehow not of their own invention nor subject to their influence.
Each of these routines can be seen at work in any of fitness to practise hearings. Today’s example is of a complaint that was prevented from entering the process. This is a part of the picture that rarely gets exposed, but it is nevertheless instructive in that it reveals once more revealing the way in which the HPC interprets its mission and reveals what it considers a sin.
It is worth holding in mind the recent case of psychologist and HPC Council member Malcolm Cross (an excellent report of which is posted on the HPC watchdog blog, written by Bruce Scott). The contrast reveals the working assumptions about the nature of the public the HPC feels it worth protecting, about the kind of sin that it needs to protect the public from, and also about the potential for vested interests to make themselves felt.
The setting, as usual, is the NHS. An employee suspects he is about to be downgraded when a manager re-writes his job description. There is a specific clause in the job contract forbidding unilateral changes, and he suspects the manager is trying to avoid a redundancy situation. He complains to a more senior manager who sits on the paperwork and does nothing about it. The employee (who does not belong to a trade union) engages a lawyer and complains to the Trust. He is vindicated and the managers are prevented from breaking the law. A few weeks later an incident arises at work and the two managers use it to effectively get rid of the thorn in their side. So the employee complains to the HPC that the two managers are acting unprofessionally – the main contention was their intention to break the law by rewriting the job description and failing to activate a grievance.
If Dr Cross’s dinnertime antics register as a possible harm to the public, why does this case not also make the HPC alarm ring?
Here is what the HPC said: “I … understand that both complaints were closed on the basis that the concerns you raised were not considered to relate to the registrants’ fitness to practise as registered professionals.”
The letter is signed by the head of case management who explains that someone else has given her to understand that, following due process, they have judged that the actions are nothing to worry about. She continues:
“Please be advised that your complaints were closed following legal advice from the HPC’s legal advisor. The complaints were not considered by a Panel of the Investigating Committee.”
There is something curious in the form of the letter. In a Humpty Dumpty way she writes: legal advice was gotten from the legal advisor. In repeating the phrase she avoids saying who is actually responsible here, and conjures up the mystery of He whose name cannot be spoken. The repetition effectively creates a screen behind which we may not go. We have to trust that this manager has the experience and wisdom to know that this ok, but we know nothing about her nor how she’s been put to the test. The legal advice also stops the complaint from entering the formal process – it does not go in front of the Panel of the Investigating Committee (populated by registrants and lay-people recruited and trained through the HPC).
She continues:
“I am of the view that the complaints you made against X and Y do not raise public protection issues …
The emplyee’s point was that x and y were trying to over-ride the law to implement their own, local, agenda, and might have used the power of the institution to damage his own less powerful position.
“I am satisfied that your complaints were investigated fully and dealt with appropriately …
Investigated fully? It was legal advice from the legal advisor, not Investigation by the Investigation Panel.
… “Should you remain dissatisfied with the HPC’s decision to close your complaint, it is open to you to make a complaint via the HPC complaints process.”
Such convolutions do not inspire confidence, and neither does the fact that the complaints manager is another HPC employee.
“You should address your complaint to: Mr Greg Ross-Sampson, Director of Operations, HPC…"
Presumably Mr Greg Ross-Sampson will go to the same legal advisor for legal advice and catch our complainant in the same infernal loop.
This complaint has many aspects, and the situation remains in dispute. One of the complications is that the complainant discovered that the manager he was complaining about was the chair of his professional organisation. He now suspects that the manager’s position in the hierarchy, coupled with his liaison with the HPC, has effectively scuppered his complaint. The promise of protection was offered, and this public was disappointed. No ameliorating mechanisms were put into play.
Andrew Marr nailed the problem within the first few minutes of Easter’s Start the Week (BBC R4, Monday, 4 April 2010). In conversation with the Archbishop of Canterbury, Marr said ‘It seems to me that the core of the problem is that of being an institution, because every institution wants to protect itself as an institution’. This, of course, is not news (Max Weber said much the same thing about a century ago), but perhaps more interesting is that Marr was talking not only to Rowan Williams but also to Philip Pullman whose new book (The Good Man Jesus and the Scoundrel Christ) novelises exactly this dilemma. “What we are talking about is the difference between the institution and the essence,” said Marr. Rowan Williams thought a central theme of Pullman’s books was the question of the ‘price you pay for transmitting, in institutional terms, the message’. Pullman thinks the price too high, Williams does not.
Prof Mona Siddiqui tried to elaborate on this difference by reminding everyone that these differences of opinion exist amongst many religious. For example, the Sunni and Shia sects of Islam have almost opposite relationships with bureaucratic structure. Unfortunately, her point was lost as soon as Marr asked: ‘Is it possible to have an effective religion without a huge bureaucracy? To which Williams replied: ‘You need some way of recognising from generation to generation that you are talking about the same mission’. The question became: ‘Does the religion, does the structure, have enough in it to rein the people back from less relevant ends?’
David Baddiel (whose new film The Infidel directed by Josh Appignanesi is out this week), said the urge to institutionalise, along with the tendency to split and form schisms can also be found among atheists.
Mona Siddiqui raised the question of love by distinguishing between institutional expressions of religion (which give context and reference points for people to make sense of it), and the creation and exploitation of sacred leaders. Again, the point was left when Pullman set off on a slightly different tack: ‘There is always an original visionary who speaks about a time that will be coming soon when heaven will be fulfilled and earth will be full of plenty. Of course it doesn’t happen, so an institution is set up in order to validate the vision’. He could have been speaking of politics.
Both Marr and Williams picked up the thread and talked about rules, codes, tick boxes, and the collection of scores to ‘prove’ the truth of the vision. Williams thought ‘this is one of the things that the gospels do try to undermine’, and a bizarre wager was made when the writer pessimistically bet on bureaucracy to always trumps literature, and the Archbishop (optimistically) backed literature to triumph over bureaucracy.
Baddiel thought that the function of bureaucracy was to inject the greater truth into the story and noted how some people could then cash in on the power. Williams thought that this was too instrumental a version, and that it gave people too much intentionality. It is not, he said, really the way a lot of these things start out. But he might have conceded it was the way that a many things proceeded, especially when cut off from the original plot.
But then a pearl of wisdom was dispensed. The Archbishop said: ‘Something happens that releases an explosion of puzzles, more than language can cope with, which leads to a very complicated period. This is when you begin to see the start of bureaucracy.’
He could have been speaking of a pregnancy, a terrorist attack, the triggering of a psychosis, or the conception of the HPC.
This assumes that there are other kinds of organisations that do not have vested interests. Thus a central and longstanding problem is dismissed at a stroke. This blind spot at the heart of the HPC is identical to that which gives prejudice its energy. It gathers together a set of people and separates them from other people through the application of a negative characteristic. Written into the law is the idea that professionals are not to be trusted to regulate themselves, HPC functionaries are.
Before 2001 it was enough for politicians to say ‘we don’t think these professionals are ready to be handed statutory power’. A strong reason for this was the lack of a coherent body of knowledge to bind the field into one. Now it is said that we can make the field into one by defining it as a threat to the public, and then creating a new statutory body to police it.
The HPC appeared as the one organisation incapable of corruption. The benefactor of its virtue was The Public whose vigilance against sinful aspects of itself was needed to make the thing work.
The idea that the HPC is incapable of corruption is linked to the idea that it cannot think for itself but gets its instructions from something unnamable and powerful. This might explain why the professional links to the HPC are largely shrouded in mystery. There are three sacred tomes: Standards of Proficiency, Standards of Education and Training, and Standards of Conduct, Performance and Ethics.
Any problems associated with these three great questions are swept aside with a combination of strategies: consult legal advisors; appoint friendly panels of experts; set up bureaucratic procedures which are somehow not of their own invention nor subject to their influence.
Each of these routines can be seen at work in any of fitness to practise hearings. Today’s example is of a complaint that was prevented from entering the process. This is a part of the picture that rarely gets exposed, but it is nevertheless instructive in that it reveals once more revealing the way in which the HPC interprets its mission and reveals what it considers a sin.
It is worth holding in mind the recent case of psychologist and HPC Council member Malcolm Cross (an excellent report of which is posted on the HPC watchdog blog, written by Bruce Scott). The contrast reveals the working assumptions about the nature of the public the HPC feels it worth protecting, about the kind of sin that it needs to protect the public from, and also about the potential for vested interests to make themselves felt.
The setting, as usual, is the NHS. An employee suspects he is about to be downgraded when a manager re-writes his job description. There is a specific clause in the job contract forbidding unilateral changes, and he suspects the manager is trying to avoid a redundancy situation. He complains to a more senior manager who sits on the paperwork and does nothing about it. The employee (who does not belong to a trade union) engages a lawyer and complains to the Trust. He is vindicated and the managers are prevented from breaking the law. A few weeks later an incident arises at work and the two managers use it to effectively get rid of the thorn in their side. So the employee complains to the HPC that the two managers are acting unprofessionally – the main contention was their intention to break the law by rewriting the job description and failing to activate a grievance.
If Dr Cross’s dinnertime antics register as a possible harm to the public, why does this case not also make the HPC alarm ring?
Here is what the HPC said: “I … understand that both complaints were closed on the basis that the concerns you raised were not considered to relate to the registrants’ fitness to practise as registered professionals.”
The letter is signed by the head of case management who explains that someone else has given her to understand that, following due process, they have judged that the actions are nothing to worry about. She continues:
“Please be advised that your complaints were closed following legal advice from the HPC’s legal advisor. The complaints were not considered by a Panel of the Investigating Committee.”
There is something curious in the form of the letter. In a Humpty Dumpty way she writes: legal advice was gotten from the legal advisor. In repeating the phrase she avoids saying who is actually responsible here, and conjures up the mystery of He whose name cannot be spoken. The repetition effectively creates a screen behind which we may not go. We have to trust that this manager has the experience and wisdom to know that this ok, but we know nothing about her nor how she’s been put to the test. The legal advice also stops the complaint from entering the formal process – it does not go in front of the Panel of the Investigating Committee (populated by registrants and lay-people recruited and trained through the HPC).
She continues:
“I am of the view that the complaints you made against X and Y do not raise public protection issues …
The emplyee’s point was that x and y were trying to over-ride the law to implement their own, local, agenda, and might have used the power of the institution to damage his own less powerful position.
“I am satisfied that your complaints were investigated fully and dealt with appropriately …
Investigated fully? It was legal advice from the legal advisor, not Investigation by the Investigation Panel.
… “Should you remain dissatisfied with the HPC’s decision to close your complaint, it is open to you to make a complaint via the HPC complaints process.”
Such convolutions do not inspire confidence, and neither does the fact that the complaints manager is another HPC employee.
“You should address your complaint to: Mr Greg Ross-Sampson, Director of Operations, HPC…"
Presumably Mr Greg Ross-Sampson will go to the same legal advisor for legal advice and catch our complainant in the same infernal loop.
This complaint has many aspects, and the situation remains in dispute. One of the complications is that the complainant discovered that the manager he was complaining about was the chair of his professional organisation. He now suspects that the manager’s position in the hierarchy, coupled with his liaison with the HPC, has effectively scuppered his complaint. The promise of protection was offered, and this public was disappointed. No ameliorating mechanisms were put into play.
Andrew Marr nailed the problem within the first few minutes of Easter’s Start the Week (BBC R4, Monday, 4 April 2010). In conversation with the Archbishop of Canterbury, Marr said ‘It seems to me that the core of the problem is that of being an institution, because every institution wants to protect itself as an institution’. This, of course, is not news (Max Weber said much the same thing about a century ago), but perhaps more interesting is that Marr was talking not only to Rowan Williams but also to Philip Pullman whose new book (The Good Man Jesus and the Scoundrel Christ) novelises exactly this dilemma. “What we are talking about is the difference between the institution and the essence,” said Marr. Rowan Williams thought a central theme of Pullman’s books was the question of the ‘price you pay for transmitting, in institutional terms, the message’. Pullman thinks the price too high, Williams does not.
Prof Mona Siddiqui tried to elaborate on this difference by reminding everyone that these differences of opinion exist amongst many religious. For example, the Sunni and Shia sects of Islam have almost opposite relationships with bureaucratic structure. Unfortunately, her point was lost as soon as Marr asked: ‘Is it possible to have an effective religion without a huge bureaucracy? To which Williams replied: ‘You need some way of recognising from generation to generation that you are talking about the same mission’. The question became: ‘Does the religion, does the structure, have enough in it to rein the people back from less relevant ends?’
David Baddiel (whose new film The Infidel directed by Josh Appignanesi is out this week), said the urge to institutionalise, along with the tendency to split and form schisms can also be found among atheists.
Mona Siddiqui raised the question of love by distinguishing between institutional expressions of religion (which give context and reference points for people to make sense of it), and the creation and exploitation of sacred leaders. Again, the point was left when Pullman set off on a slightly different tack: ‘There is always an original visionary who speaks about a time that will be coming soon when heaven will be fulfilled and earth will be full of plenty. Of course it doesn’t happen, so an institution is set up in order to validate the vision’. He could have been speaking of politics.
Both Marr and Williams picked up the thread and talked about rules, codes, tick boxes, and the collection of scores to ‘prove’ the truth of the vision. Williams thought ‘this is one of the things that the gospels do try to undermine’, and a bizarre wager was made when the writer pessimistically bet on bureaucracy to always trumps literature, and the Archbishop (optimistically) backed literature to triumph over bureaucracy.
Baddiel thought that the function of bureaucracy was to inject the greater truth into the story and noted how some people could then cash in on the power. Williams thought that this was too instrumental a version, and that it gave people too much intentionality. It is not, he said, really the way a lot of these things start out. But he might have conceded it was the way that a many things proceeded, especially when cut off from the original plot.
But then a pearl of wisdom was dispensed. The Archbishop said: ‘Something happens that releases an explosion of puzzles, more than language can cope with, which leads to a very complicated period. This is when you begin to see the start of bureaucracy.’
He could have been speaking of a pregnancy, a terrorist attack, the triggering of a psychosis, or the conception of the HPC.
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