Unfit for practise because you don't hit your targets!

Yet another astonishing example of how the HPC mistakes Britain for a factory, and itself for the Factory Mananger.



The latest HPC hearing:

Date: Friday 9 October 2009

Name of Registrant: Xxxxx Xxxxxxx

Profession: Occupational therapist

Area of practise: Xxxxxxxxxx


Hearing Location: Park House, 184 Kennington Park Road,
Kennington, SE11 4BU, London

Committee: Conduct and Competence Committee

Allegation:

In the course of your employment as an Occupational Therapist by
xxxxxxxxxxxxxxxxxx between 2006-2008 you:
1. Failed to maintain accurate filing.

2. Failed to maintain adequate patient records and notes.


3. Failed to adequately manage your case load in particular that you did
not:
a) pick up referrals at a sufficient rate;
b) review cases within an adequate time frame;
c) close cases within an adequate time frame; and

d) submit two Disabled Facilities Grant applications, in a timely manner
in June 2006 and June 2007.

4. Failed to use I.T. systems as required.

5. Required support and guidance over and above that expected of a

qualified Occupational Therapist.

6. Failed to sufficiently meet the improvement targets as set by your
employers.

7. The matters set out in particulars 1-6 constitute misconduct and/or
lack of competence.


8. By reason of that misconduct and/or lack of competence, your fitness
to practise is impaired.’

Insidious creep of the 'protection' discourse.

At a party of artists on Saturday night, I spoke to a man who looked very glum. He is the head of department in a higher ed institute, one which is well regarded around the world for its artistic and talented craft-makers.

Before he even knew my particular interest he was telling me about a recent trip he had arranged to take a group of his mature students to Wales to exhibit their work. The health and safety administrator insisted that he discover the medication that each of his students were on and what time of day they should take it. He also had to nominate a student to ask him the time and the tablets he takes so that they could make sure each one didn't forget when they went on their weekend away.

Absolutely true. Right here, right now, in London.

I asked him why he didn't tell the administrator where to stick his stupid idea. He replied: there are so many fiddly petty fogging things to do these days, just to get the trip organised, that he didn't want to upset anyone who could prevent him even going.

I think he then felt embarrassed at his powerless position, because he added 'I wouldn't have minded but I had to design the form as well, myself!'

He should have minded, shouldn't he. The students aren't babies and can take their own tablets, and he certainly didn't want any of them intruding into his own body's failings. Just what was the administrator going to do with the information? Lord only knows!

How come nervous administrators wield such an amount of power?

Does this qualify one or both or all of them (the head of department, the health and safety administrator, the nominated student) as a Modern Health Professional?

HPC Council Meeting 10 9 09

The Council members sit round the table and have a 2" block of papers in front of them. Marc Seale laughed and apologised for the weight of paper they all faced at each meeting. He seemed to think the problem would be solved when he issued them each a laptop. Has he presumed that they don't read the papers? This is the real problem, surely.

From a mythical point of view, it might be said that the written word dominates the men and women. A friend of mine said 'it is speech that is under attack'.

The HPC staff speak very quickly, and in a kind of tone that makes it almost impossible for someone like me to follow. Someone not already practiced and versed in the language that is spoken here, someone who is interested in the meaning of what is being said.

This theme of speed and quantity is what catches my attention as the discussions progress through the enormously long and complicated agenda. What follows is drawn from the notes I jotted down as the meeting played out.

Annie Turner mentions that there are over 500 new programs to consider (post psychologist registration), and asks about the peak in complaints received in May.

These complaints are not about fitness to practice, but are complaints received from physiotherapy registrants trying to re-register themselves on time and proving too much for the administrators responsible for answering the phones.

Mary Clark Glass wondered whether the targets should be increased because the staff usually met them so easily.

Annie Turner mutters that the volume of work has risen hugely since the BPS programmes have been handed over for regulation.

Marc Seale said there had been a 'sea change in Fitness to Practice' that would require something new from the organisation. I wonder what he meant.

And someone else said that Michael Guthrie was building the evidence base of risk in connection with revalidation.

Anna van der Gaag - ah, someone who speaks slowly and clearly! - said, oh, I don't know what she said, perhaps it was she who mentioned Michael's evidence base of risk.

Mary Clark Glass wondered out loud how it could be possible to address behaviour through competencies, and Eileen Thornton said that 'we can't have a single model, but need a research base to base our decisions on." Jeff Lucas was happy that things were moving towards an evidence base, and said something about men of a certain age posing a risk group for the HPC.

Anna van der Gaag said that CPD was vital here, and Joy Tweed asked how long someone could be out of practice before 'they become a risk for us - we need research into this', then added 'how about patient feed back into CPD?' She wants to 'future proof' things, she said, adding that the professions were low risk right now, but 'we've 50 new professions in the pipeline'. FIFTY? Could I have possibly have heard that right? I think Joy who was still speaking as I wrote down: 'the longer you are in the profession, the greater risk you pose, so risk proofing would have to be done via supervision.'

Writing this now makes me chuckle and think about Karl Popper's central planner. The idea that the more experienced a professional is, the greater risk they pose to the HPC is hilarious from this perspective. The idea that the HPC will fight against such free thinking individualism by insisting on life-long supervision brings with it the spectre of a battle between the administrators backed by government legislation, vs the wit of wizened experience.

Back to the notes - Conduct. I've written it to emphasise the first syllable because each person who mentioned it stressed it like that as if trying to beat it into stone. The word seemed saturated with meaning, with something in excess of what could be articulated, something urgent trying to make itself heard. I've written down 'more fundamental revalidation, not just fitness to practice' to note the words of a Council member whose name I didn't catch. There was quite a concentrated piece of discussion here, which seemed to crystallise the interest of the whole group. Anna van der Gaag said 'there are people operating just below the level you would want, but they would not be subject to fitness to practise. How do we address that?" and Julia Drown said that revalidation methods should be compared with systems working around the world.

Marc Seale spoke of the struggle that the GMC were currently having, and said 'if we can crack it when no-one else has ... FTP ... CPD ... Self Correcting CPD... It is the Holy Grail," he said "can you come up with a system where a registrant self-corrects?"

Self corrects! I remember thinking of Prince Hal at that point, and turning towards the window. Anna van der Gaag's soothing voice brought me back into the room: "we are using well validated tools... it would be wrong to invent a scale ourselves that we thought would do the trick..." Eileen Turner was saying 'we know about this - lack of initiative, self direction, and motivation' and trailed off leaving Marc Seale free to say 'we are talking about a 4-5 year project - no-one has cracked it yet'.

Cracked what? How to tell if a student in university is going to commit a crime as he approaches middle age? I imagine that these things will have acquired the status of crime by then. The crime of not keeping neat and proper notes.

Apparently the Department of Health is funding some research that might relate to this. Somehow that does not bring me relief.

The business moved on to the CHRE review, and I came back into focus as Julia Drown is saying 'we don't want to be seen to protect the registrant, we are here to protect the public. It's about the message we send out to do that." I find myself smiling - she was a government spokesperson for health in her time as a Labour MP.

Marc Seale is saying something about the CHRE not having a comparison to judge good and bad practice, and Michael Guthrie said "we don't know what all the other regulators do" (goodness me, I think, you don't know what your own registrants do, perhaps you shouldn't you concentrate on that?)

Very often as I sit listening to these meetings I think about the reference points that people use. From my inquiry into the subject, it seems clear that they have no genuine point of reference. This is the natural consequence of Ian Kennedy's genius - to split the administration off from the practice, and then make the administrators responsible for the practice. This vacuum that they face is the logical consequence of Kennedy's prejudice. Tho, not just of Ian Kennedy.

My attention is brought back to the meeting by Anna van der Gaag's reassuring voice: "our school report is actually pretty good" she is saying "whatever we think of our head master, we actually have a good report."



Post Script: I've drawn a line in my notebook at that point, and probably left the room to get a glass of water. But when I returned they were talking about Sonographers, who I understand to be anyone who carries out those amazing technological tricks that reveal a tiny foetus sucking its thumb and wriggling around in the womb. Apparently, a sonographer is anyone who is using a sonograph, but not for long! A 200 page document was laid in front of the meeting from the Society and College of Sonographers who ask for HPC registration. Jeff Lucas said: "it appears to be a collective noun that not only overlaps different parts of the HPC register (ie lots of different professionals can use a sonograph, and even people who are not already in another profession), but is also shared across different regulators...'. But someone else, with an eye on expansion, said 'public protection' and blustered on: 'so a member of the public can know if someone is qualified to use the technology'. I nearly snorted, what a nice little earner the HPC are on. Every new piece of technology might inadvertently create a new profession for regulation. Now I understand how there could be another 50 in the queue already. Tell me, why would a member of the public need to know someone was qualified? Have we really reached the point when no-one trusts anyone in the NHS to know what they are doing? Maybe. Or, if not now, then probably sometime real soon.

Annual Meeting - 10 Sep 09

Thursday, 10th September 2009. The HPC annual meeting.

It is not immediately clear what status this meeting has - ie it is not the AGM of a charity, nor that of a registered company - there are no votes taken, and no body of people who have any power to bring to bear on the organisation. Formally, the HPC is answerable to Privy Council - and none of them was present, as far as I could tell.

In the absence of any legal framework within which to understand the meeting (in the absence of any statutes or formally written rules) we are left to deduce the meaning from the work that it does on the day, the way this enters the daily business, and of course, the way it describes itself on the website: "Our annual meeting is the Council's opportunity to reflect on the last year's business in a public setting... a short talk given by the President, followed by a question and answer session."

Two of us had submitted questions ahead of time, me and the woman from MIND. First, Chairwoman Anna van der Gaag made her brief reflections, then we were invited to pose our questions.

MIND wanted to know whether there had been any problems arising from the regulation of the psychologists (1 July), and in particular whether anyone had made use of Principled Non-Compliance to reject the HPC.

The question was an informed and an intelligent one, and opened a welcome window onto the real world for the HPC. There is a tendency for things to get caught up in political (and Political) rhetoric so this question from the grass roots campaigning mental health user network was a great opportunity for the HPC spokesman Marc Seale (CEO) to make some real political capital.

I'm not really sure what he said, however. There were a lot of words, and he was smiling a great deal - this is what I wrote down at the time: "when you talk to professionals who are regulated, they are very proud, and embarrassingly positive ..." Chairwoman Anna van der Gaag (an expert in speech and language therapy) later summarised the answer: "it is too soon yet for any of us to know".

The question that I had sent in was on behalf of a colleague: "If a therapist is registered with the HPC, how does this affect the use of other unregulated therapies within their practice? For example an HPC registered psychotherapist using life coaching, hypnotherapy or other styles of therapy with their client."

This question has often been asked by those turning their attention for the first time to the HPC - I hear it asking: if I submit to your power, register my name, and pay the annual fee, will I be able to carry on practicing in the way I always have? If it were just a tax raised to fund the fitness to practice machinery, then the answer would be yes. It is not just a tax, however, but a whole new system of belief.

What did Marc Seale say? "This is a question about scope of practice. If you are regulated, and a complaint is made against you in one of your unregulated practices, we would still deal with that."

In her opening reflections, Anna van der Gaag mentioned that some of the professionals joining the HPC could rejoice in a reduction of fee from £667 to £76pa. With this, Anna let slip that, for her, the HPC is an alternative to registration with the existing practice based organisations - it is a rival to the existing professional bodies, and one that ultimately wants to replace professional bodies. She went on to say that the HPC represented a new kind of regulatory body, specifically 'a change from the paternalistic method' which she fleshed out with a quote from Don Berwick's John Hunt Lecture 2008 (entitled: Epitaph of a Profession !):

"we professionals are not our patient's partners. We are guests in their lives. We are not hosts. We are not priests in the cathedral of technology."

Well, leaving aside the irony that she must refer to a great man, speaking in the name of another great man in order to undermine a system based on great men, and forgetting for the moment the limitations of the metaphor of guest, what Anna seems to be arguing for is a change in attitude, conduct, and behaviour. She is calling, I think, for humbleness, whilst claiming that the HPC knows how to bring everyone to their knees.

Open letter to practitioners in the field of counselling and psychotherapy, from the psychoanalytic consortium

Reproduced here is an letter from 8 psychoanalytic institutions, openly addressed to anyone who considers themselves a colleague. It is one of three docs they have written in response to the HPC consultation on regulating counselling and psychotherapy. The other two docs can be accessed through the web-link embedded in the title of this blog and downloaded (HPC response to PLG and HPC Response to SoP). Taken together - or indeed separately - they are a tremendous rebuttal of the ideas put forward by the HPC. It remains to be seen whether the HPC is capable of tackling the points raised, or whether it will simply rely on the governmental power to ignore the opposition and carry on regardless.

Dear Colleague,

The Health Professions Council have now published their Draft Standards of Proficiency for Psychotherapy and Counselling. Although they have been working on the proposed regulation of the talking therapies for the last three years, the Standards will surprise many therapists and counsellors. They apply more to medical processes than to therapies, and will be unrecognisable to many practitioners. Indeed, they seem to apply more to a surgical team preparing a patient for an operation than to the open-ended relationship-based work of a talking therapy. The Standards dictate that practitioners should:

- know how to operate equipment and minimise the risk of infection.
- know how to select appropriate hazard control and risk management, reduction or elimination techniques.
- have a knowledge of health, disease, disorder and dysfunction.
- be able to evaluate and implement intervention plans using recognised outcome measures.
- know how to use protective equipment.
- know how to formulate and deliver plans and strategies for meeting health and social care needs.
- understand the principles of quality control and quality assurance and conduct audits correspondingly.
- maintain an effective audit trail, participate in audit procedures and work towards continued improvement.
- be able to formulate specific and appropriate management plans including the setting of timescales.
- demonstrate a logical and systematic approach to problem solving and be able to initiate problem solving techniques.
- observe and record client's responses.
-be able to demonstrate effective and appropriate skills in communicating information, advice and instruction.
- understand the need to engage service users and carers in planning and evaluating the diagnostics, treatment and interventions to meet their needs and goals.
- understand the importance of maintaining their own health.
- know how to meet the needs of the client.

A detailed critique of the Standards is [downloadable from the resource page linked to the heading of this blog: Response to HPC], together with a response to the HPC Professional Liaison Group's Report on the proposed regulation of psychotherapy and counselling [click header to download both docs]. Accepting the HPC Standards threatens the talking therapies with the same fate that has met other professions: practice simply becomes a technique of risk management, with the prime concern less the work undertaken with the client than the avoidance of litigation or complaint. Complaints, indeed, would be much more likely given the definition given by HPC of a 'service user': this no longer simply refers to the client, but to "anyone who is affected by the services of a registrant", including a client's relatives or spouse, thus encouraging third party complaints.

Therapists, on the HPC model, would be obliged to act in exactly the ways they may be encouraging their clients to escape from: submission to rather than questioning of internalised authority, and a conformity to socially-agreed expectations, rather then the fostering of creativity and uniqueness that therapies have traditionally aimed at. Whereas the system of values that the talking therapies have always offered was freed from the moral judgements of social authorities, it is now made to conform to exactly these moral judgements. It will no longer be psychotherapy as we know it.

All trainings in the field will, according to HPC, be obliged to meet the Standards of Proficiency, and the hearing of complaints and fitness to practice cases will use the Standards as a benchmark. Aside from the obvious problem of medicalising the talking therapies, the therapists of the future, in such a climate, may feel they are perpetually under a judgmental gaze, the private space of the therapy becoming the stage for an internalised judge or examiner. The consequences of this on therapeutic practice cannot be underestimated, and there is an irony here that many traditional descriptions of psychotherapy define it as the effort to find freedom from the internalised observer-judge that may be at the root of the client’s unhappiness.

While we unreservedly support codes of ethics and practice that ensure the practitioner's accountability, we do not believe that HPC's approach is suited to our field and so urge you, should HPC regulation take place, to adopt with us a position of principled non-compliance. If enough therapists and counsellors do not register with HPC, Government will realise the enormous mistake it is making, and our field may not face such a grim future.

Arbours Association
Association for Group and Individual Psychotherapy
Association of Independent Psychotherapists
Centre for Freudian Analysis and Research
The College of Psychoanalysts-UK
The Guild of Psychotherapists
Philadelphia Association
The Site for Contemporary Psychoanalysis

Counselling and Depression as remedies to FTP

From another case recently posted up on the HPC web, of a paramedic :

"you were referred to an independent counsellor by the Occupational Health Department. You told the Panel that the period of counselling has had a significant effect on your health, that your depression is well controlled and your relationship with your wife is now stable."

Well, three things stand out. First, in what way is it useful for the HPC to post this information up on the public domain? It smacks of 1984.

Second, the counselling is presented as a remedy prescribed by Occupational Health which rather begins to beg the question about another profession that might be regulated by the HPC.
Later in the announcement we find a letter from the GP validating the fact that the counselling has contained the depression. This effectively turns it into a medical condition under control, ultimately, of the GP. This is the third point, and is contentious, to say the least. The HPC and its staff operate within an unenlightened medical paradigm which brings 'counselling' into the frame as a solution, like a drug, to inefficient or ineffective workforce issues.

It is the legal frame, the centralised operation of the HPC, and the close proximity of a government agenda, that distorts the general human condition into a specific public spectacle. Even if this is an unintended consequence, it appears highly normal to those within the frame.

I think it is something that many people will be amazed to see blossoming in the UK today.

Learning from our mistakes

"it is difficult enough to be critical of our own mistakes, but it must be nearly impossible for us to persist in a critical attitude towards those of our actions which involve the lives of many men and women. To put it differently, it is very hard to learn from very big mistakes." Karl Popper, 1944 (Piecemeal Social Engineering)

The longer the HPC is allowed to continue with its large scale utopianist experiment, the less likely it is to learn from it. It has recently been noted that the ambulance drivers are disproportionately victimised by the FTP process - they are turning up far more than any other group on the HPC register. Also, more men are pushed into the process, even tho the majority of people on the register are in fact women. The HPC has commissioned some 'research' to discover whether the former fact is significant (I don't think they are worried about the second fact yet). I wonder what the outcome will be of that piece of work.

The point that Popper makes here is that there are two reasons for the difficulty to learn. The first is that, because of "the scale of a utopianist experiment, it is impossible to say which particular measure is responsible for any of the results.... Even the greatest efforts to secure a well-informed, independent and critical statement of these results are unlikely to prove successful. But the chances" he goes on to say "that such efforts will be made are negligible; on the contrary, there is every likelihood that free discussion about the holistic plan and its consequences will not be tolerated."

The passage from which I draw these words gets more and more interesting. Written in 1944 - before the end of the second world war, a whole lifetime ago - it seems amazingly relevant to the question before us today:

It will not be tolerated, because: "every attempt at planning on a very large scale is an undertaking which must cause considerable inconvenience to many people (to put it mildly) and over a considerable span of time. Accordingly there will always be a tendency to oppose the plan, and to complain about it. To may of these complaints the Utopian engineer will have to turn a deaf ear if he wishes to get anywhere at all; in fact, it will be part of his business to suppress unreasonable objections. But with them he must invariably suppress reasonable criticism too. And the mere fact that expressions of dissatisfaction will have to be curbed reduces even the most enthusiastic expression of satisfaction to insignificance. Thus it will be difficult to ascertain the facts, ie, the repercussions of the plan on the individual citizen; and without these facts scientific criticism is impossible.'

Popper uses the word 'scientific' to mean critical thinking, and speaks often of its many different forms. Not for him the unified 'gold standard' that we find ourselves bogged down with under the 'evidence based' experiment of today.

The Utopianist planner must make man fit society

I'm reading Karl Popper's 1944 essay 'Piecemeal Social Engineering' in which he constantly compares the piecemeal social engineer with the utopianist holistic planner. One of the many distinctions he makes is that the PSE tries, bit by bit, to make society fit the real men and women who happen to live there, but the UHP tries to make his fellow men and women fit the society he dreams of.

By way of a break, I clicked over to the hpc website and had a look at some of the FTP allegations coming up in the next few months, and straight away found this one:

1. In the course of your employment as an Occupational Therapist by Super-Duper Hospital NHS Trust, between 19 March 2007 and 14 June 2007, you undertook work elsewhere whilst on long term sick leave and whilst receiving statutory sick pay.

2. The matter set out in Paragraph 1 constitutes misconduct.

3. By reason of that misconduct, your fitness to practice is impaired.

It's not that I think that someone who works for money whilst receiving stat sick pay should go un-remarked, but I do think that it is silly to say that it means, ipso facto, they are not morally fit for the work they are qualified to do. It's clumsy, brutal, and out of proportion with reality - Utopian, in a cold, harsh, petty, nasty sort of way.

Three no shows in a row:

Here's another case reported on today's press releases. Another registrant who didn't turn up, which might suggest that the registrant has no confidence in being given a fair hearing.

Points of interest

1. this is a manager that is being judged, which raises a series of questions about the difference between a manager and a practitioner, and so who is the judge of the proficiency.
2. Given the managerial function, this raises the question of the organisational context that gives the scene its local meaning.
3. Who raised the complaint - what attempts were made to resolve this at the local level, why did they fail.

In all these cases it is important to ask 'what is the evidence' used by HPC. It would be wrong to conclude that they had carried out objective in depth research. Often cases are launched on hearsay. All cases begin with the assumption that the professional is probably guilty. They are all are investigated at a distance, with paperwork as the main method. Committees are the primary vehicle, followed by solicitor who prepares the allegation (that is to say, the solicitor's research is not objective, but is conducted in order to win).

Final point, much is made of the phrase 'balance of probabilities' which borrows the power of statistics. No statistics are used, however, and the phrase is simply a metaphor.

Quoted from HPC website:"Mismanagement results in human error and lack of concentration in cellular pathology unit. Biomedical scientist, Mr x has been suspended from the HPC Register for misconduct after a HPC Conduct and Competence Committee found his current fitness to practise impaired whilst working at the Y Hospitals NHS Trust.

The panel heard how Mr X’s lack of competence as a senior staff member had resulted in over 600 products of conception (POC) that were not disposed of, swapped breast biopsies and a wrongly prepared rectal tissue sample.

The Panel also heard that the registrant failed to accept ownership and accountability for the incidents, and that he had not taken any remedial steps to address the short comings.

Panel Chair, Raymond Pattison, commented:“The registrant knowingly allowed an inordinate and substantial amount of POCs to accumulate”

“The registrants failure, in his managerial position, to exercise sound judgment, particularly to the sensitive issue of POC disposals constitutes a serious lapse from the standards to be expected of a health professional of his seniority.

”The panel decided the most appropriate action was to suspend Mr X from the Register for a period of one year with immediate effect.

Mr X was neither present nor represented at the hearing

Telling tales to the HPC - another failure to take responsibility locally.

And, here's another.
Points of note: a senior position, not simply that of practitioner - suggests that an appointments panel thought she was competent for the job.
Would seem to be a matter better dealt with by someone with a bit of life in them at a local level, rather than reported to an anonymous committee in some central office elsewhere.
The phone calls and internet seem very petty misdemeanours, and not obviously harmful to patients. Again, something that should be dealt with at a local level. Yet she was struck off! I'm not condoning slovenly work in the NHS, but trying to keep a perpsective, and to remember that once in many lifetimes, love can make a fool of even the best of us.
What about this woman's actual work - the thing that she does with a patient, there is absolutely no mention of this whatsoever. Odd.


quoted from HPC web:
Occupational therapist, Ms X has been struck off from the HPC Register for personal misconduct and failing to carry out adequate clinical occupational therapy input to patient care whilst working at the Y Primary Care Trust.

A panel of the HPC Conduct and Competence Committee heard how Ms X had failed to provide regular supervision and appraisals to the members of staff for whom she was responsible, failed to correctly assess patients and failed to organise cover for holiday and sickness leave.

The Panel also heard that Ms X had made personal calls to the value of £32 on her work telephone, used the Trust’s internet resources during working hours to contact dating agencies, took colleagues shopping during work hours and made excessive reference to personal issues in discussions with colleagues.“Ms X must have known that her failings were likely to place patients’ welfare at risk and that these were not proper uses of the Trust’s resources.”

The panel decided the most appropriate action was to strike Ms X from the Register with immediate effect.Ms X was neither present nor represented at the hearing.

Management vs HPC Police

What ever has happened to the staff of the NHS that they can't handle tensions at work? And why has note keeping become fetishised in this way?

Below, taken from today's HPC website, is someone who is described as experienced, yet is suspended for not filling in her notes. From the report here, it seems that there was a bit of a fight between colleagues at work. Everything is ok with the patients, no problems emerge from there, but when this woman goes on holiday, her colleagues appear to snitch on her! What is going on here? I wonder whether a new compturised system is getting in the way - something that assumes work should be done differently from the way it has been done throughout this woman's experience.

And as for the phrase 'I probably made it up' - what on earth is that supposed to refer to? the HPC are notorious for thinking that their registrants might fib (ref their advertising campaign which portrayed professionals as liars), and this quote is so out of context that it is meaningless.

quoted from HPC web:

Physiotherapist, Ms X, has been suspended from the HPC Register for failing to keep accurate patient records whilst employed by Y District Primary Care Trust.

A panel of the HPC Conduct and Competence Committee heard that whilst Ms X was on leave her colleagues were alerted to cases where she had failed to keep accurate records and failed to create action plans for appropriate treatment of patients.

Ms X was an experienced physiotherapist and had been counselled previously in relation to her inadequate record keeping. The Panel heard that when Ms X was confronted about the incidents she admitted ‘she had probably made it up.’

Panel Chair, Mr Gordon Sutehall, commented:

“We are satisfied that there were deficiencies in the registrant’s practice to record keeping and despite supervision and training the registrant did not consistently meet the required standard of record keeping”

“The allegation involves an element of dishonesty and is therefore a serious one.”

The panel decided the most appropriate action was to suspend Ms X from the Register for a period of six months with immediate effect.

Giving the lie to the HPC stats on how well they protect the public

A colleague from Scotland has done some hard work on the statistics of the HPC and has offered them for circulation. He asks that if you want to reproduce them, please do so in full to avoid misrepresenation:

For the period 2007-2008:
• The HPC’s operating expenditure was £11.58m, of which payroll costs amounted to £4.08m (35.3%), legal expenses £2.27m (19.6%), facilities management £1.13m (9.8%) and “partners” (assessors and other professionals) £1.11m (9.6%).
• The HPC employed 105 full time equivalent staff, costing £2.82m in wages and salaries, representing an average salary of £26,770.
• Considering allegations about the fitness to practise of registrants cost £3.76m (32.5% of overall expenditure).
• Of the 424 total allegations made against registrants, 108 (25.5%) came from the public, compared with 171 (40.3%) from employers and 63 (14.9%) from the HPC itself.
• 299 allegations (70.5%) of the total were considered, taking an average of 32 weeks before a case was heard by an Investigating Panel.
• 63 (58.3%) of the allegations from the public were heard, and only 18 (28.6%) of these allegations were found to have a case to answer.
• Each allegation with a case to answer which came from the public represented an HPC expenditure of £643k.

Paris, 16th May 09: Protecting the public from the State

Fifteen people met in Paris on Saturday 16th May, to sit together in a room and begin a new conversation. English speakers from London, Belgium, Bordeaux, Rouen, and of course Paris gathered at the University of Chicago on rue Thomas Mann to listen to five people speak about the British Experience of state regulation of the psys. All of us practise in some form or another – about half of us were psychoanalytically inspired, many were also psychologists, one a psychiatrist, one or two had done their training in the UK, and there was even a member of the UKCP present. Many work independently running their own private practices, and most were also linked in some way to state or voluntary projects. One was new to the field, nearly finished training, and wanted to know how the regulatory revolution was going to affect her future work.
There is something very precious about speaking in another country – shifting through subtle changes of culture and a different way of life often brings a change of perspective. So, first, I would like to thank Victoria for the invitation, and to thank the people who gave up a Saturday afternoon to hear about the British experience. The event was an initiative of the Simply Speaking section of a small group of English Speaking practitioners called Healthwise, Paris. - a group that knows how difficult it can be to navigate through the twists and turns of another culture’s systems.

The afternoon session was divided into 5 short presentations – Victoria opened up by reminding everyone of the events in France. Bernard Accoyer, a medical doctor and member of the Union for a Popular Movement, the conservative Party of which Jacques Chirac is a member, introduced legislation to restrict the practice of psychotherapy to psychiatrists and clinical psychologists. Although the bill was passed without debate, and apparently without objection in the Assembly (it was business done in the middle of the night!) there has been a mixed but on the whole vociferous public response since which has reversed many of the restrictions he tried to impose. [see The Pathology of Democracy edited by Jacques-Alain Miller with Bernard Burgoyne and Russell Grigg, Karnac 2005)

Victoria drew attention to the subtleties of language that become more obvious to non-native speakers living in another’s land and was able to maintain a pun through much of the afternoon’s discussion. What is the difference between a hole and a whole? This was a theme that Jean-Pierre Klotz later elaborated. She thought that Accoyer had made a fundamental mistake by drawing the public’s attention to what he called a hole in the law, and that this had boosted a move towards creating the state system as whole. Her underlying point was the rise of State Intervention in the most private aspects of life: who is responsible for who we speak to, she wanted to know.

This question nicely framed Roger Litten’s presentation. Roger works as a counselling psychologist in the British NHS and is well placed to comment on the massive changes in the context of the various ‘psy’ practises sparked by Government policies over the last decade. Not only is there the IAPT (Increased Access to Psychological Therapy) programme which promises computerised CBT in every local Doctor’s surgery, but also the Evidence Based Approaches of NICE (the central planning agency – National Institute of Clinical Excellence) which require psychotherapists to greet new clients with the words – this has no evidence to support its efficacy! Then there is the attempt to codify and equalise NHS jobs via Skills for Health (A Department of Health initiative that collaborates with Business ideology to create a skilled workforce rather than an educated population), and finally the HPC – a giant database that purports to regulate the character and behaviour of all the new ‘skilled’ health professionals.
Elizabeth Gurnicki (Clinical psychologist, with a Freudian Field DEA) posed the question: why do our European governments want to regulate and monitor the practice of psychotherapy – surely not for the sake of the economy. She reflected that national identities and ideologies were less attractive since the totalitarian catastrophe of the 1940-45 war, and that since the fall of the Berlin wall choice in approach to the economy was now effectively redundant. This leaves those of us in the rich world with little more to do than develop more riches, to manage mass consumption, and to control the population flow. This was interesting, as it puts politicians more in the role of managers and makes governing more a question of governance. Couple this with the developments in cybernetics and management-information-systems, and we have a strong move towards Big Brother.

This helped to situate the topic I had chosen to speak about: the Fitness to Practise (FTP) process as played out in the Health Professions Council. The HPC is a new invention and a flag-ship of New Public Management in Britain. It is staffed entirely by administrators, with a handful of professionals invited on to the periphery to deal with tricky problems of practice as and when they arise. My observations of some FTP hearings had easily discovered the anomalies that such an approach throws up. The lack of sensible experience and attention to the realities of practice tend to mean that FTP hearings resemble the figments of Kafka’s imagination (see HPCWatchdog.blogspot.com).

Bordeaux psychoanalyst and psychiatrist Jean Pierre Klotz carefully sketched the important differences between British and French culture, and reminded us of the tendency of centralised politics and generalisations to ride rough shod of these essential details of everyday life. He argued that the French revolution gave them an experience that makes it more difficult to forget why the State and the Citizen should be held as separate entities. The French culture pays attention to the space between the two which effectively protects the citizen from the overbearing power of the state. The French state is created and upheld by law, and the individual is protected from it by human rights. This essential space is precisely what is being removed by the British reliance on regulation. Regulation does not function in the same way as the law. It is, in a funny way, the inverse of the law.

Victoria summed up with a question about the way that Europe as an idea was changing the context for us all. It is providing some people with an opportunity to quietly invent what they call 'European standards' from which to establish themselves as the reference point to control. See project europsy for a glimpse of that new venture.

Bristol Alliance, 13th May 09

First, a personal view of the day from Arthur: We had day long meeting, to which over 30 people turned up - and a number of people who are known to sympathise were unable to come. The morning focused on NICE gudelines, IAPT and the impact of PCT recommisioning in three different local PCTs. The afternoon was devoted to the impact of regulation and the choice we as counsellors and psychotherapists face about how we respond.

People were undoubtedly stirred up and energised. We were able to suggest that people who want to get further involved don't reinvent the wheel but plug into the wider Alliance network. There was considerable interest in further meeting(s). Professional Full Disclosure (PFD) received some very favourable comments from experienced practitioners, who hadn't yet heard of the work that the local group has been doing on this.

Something that is becoming apparent to me is that many practitioners only gradually take on board the importance of taking a stand on the issue of regulation. We are in a consciousness raising period and have to keep working at people within our local networks.


Els: I agree - I find that many practitioners are working very hard to earn a crust and do not necessarily have a lot of spare time and energy to engage with what is happening. Often people assume that it has nothing to do with them (or that it is inevitable) - I think this view is particularly prevalent amongst those in private practice, However, when people's awareness is raised and they become aware of the fact that HPC regulation will affect them too - they become energised. I feel in Bristol we now have a base from which to launch further events.

Sussex Alliance, 9 May 09

Congratulations! "Sussex Alliance" was born this afternoon (9 May 09) after a successful mini-conference over 4 hours this Sat pm.

Richard, Guy, myself and Andy spoke to a gathering of 25 with Tim also in attendance holding a strong admin side.

A few individuals would like to plug in to Alliance subgroups.

Suffice to say at this stage, there was a powerful sense of concern for the issues, a very healthy discussion and exploration and hopefully the beginnings of a local snowballing effect.

Thanks for the good wishes to those who sent
Best
Kevin B

Andy: Yes, it was a good afternoon and I'm now convinced this coal face work with practitioners is vital. Many coming from knowing nothing (some not having heard of the Alliance...) asking us why they haven't been consulted or why BACP isn't representing them etc. Lot of fear, exasperation and negativity but group moved towards activism by the end. They want to plan more events I think with groups they are connected to. Got a few signatories for the BACP letter as well.

Cheers to Richard, Guy, Kevin and Tim - I think we did well. I was chuffed with the responses to my first public speech on regulation. Might brave it again sometime.

Nicky: I just wanted to thank you all for Saturday so far we have had great feed back. Also some reasons why people did not attend, mostly people who believe regulation will not impact on their work at all. I would like to pass this on to Alliance as it would be good to be able to back up my concerns with them. So Again Thank You All very much

Someone at the event said: I have found reading the Janet’s accounts of HPC proceedings, whilst potentially depressing, incredibly helpful in being better able to articulate why it is that regulation does *not* serve to protect the public. The reality of regulation means having to draw up standards, which leads, precisely, to standardisation, which means that only those qualities which can be measured can be considered; the higher qualities of human care, consideration and love cannot be included. We might wish that regulation meant something different; the reality is that it can only harm people; and that includes everyone – both practitioners and their clients. If this is already true for doctors, nurses and hospital workers, then it must be doubly true for counsellors and psychotherapists.

Alliance in Liverpool, July 11th: lessons from a beekeeper

"This kind of bees - little brown furry bears - are much less aggressive than most other types" said Mark as he handed me the all-in-one veil and suit so that I could help him tend to the hives. "If you take care of the smoker (a little can of smouldering leaves to give the impression of a nearby forest fire, and encourage the bees to crawl deep within the hive), I want to see if I can introduce some new frames". If you don't keep the frames in place the bees tend to build honey-combs that are unsupported, and which fall off when you try to take the honey. This was a totally unexpected pleasure for the weekend I spent in Liverpool, where I had been invited to speak to a group of counsellors and psychotherapists in a fine Edwardian town house close to the centre of the city.

Organising a bee-hive is a matter of making sure the conditions are right, and letting the bees get on with it. If you want to have a drop of their honey too, there's a bit more work to do. But generally speaking you don't have to interfere too much - they know their business better than you.

Mark had invited two of us to speak to the group on Saturday morning. Pat is a local counsellor, who began this line of work in 1993 with a 4-year diploma. She began practising with 5 years of voluntary work and has worked with people in all kinds of difficulties, some of the people she met get categorised as suffering from Severe Enduring Mental Illness - a recent management category invented to help governments decide how to divvy up funding.

After her initial training Pat had moved from voluntary to paid work mainly through short-term schemes like the EAP. She describes her approach as humanistic. Then the 'powers that be' withdrew the funding, and she was back to voluntary work once again.

Having set up a private practise, and allowed it to wane as her EAP work took off, Pat is now faced with having to start up all over again. Part of the backdrop is the fiasco of IAPT in the NHS which is forcing CBT into the frame as Managers are exercising more power. When the local PCT's switched their funding in favour of an IAPT provider not only did local voluntary/charitiable agencies lose funding and jobs, but large sections of the local NHS psychotherapy service had to be decommissioned. This had been a service that offered group analysis, CAT, individual psychodymanic therapy, drama therapy as well as behavioural therapy and CBT. Pat was clearly fed up to see her training and experience being destroyed, and watching the great diversity of pratice being reduced to a very poor version of a new fashion that the funding managers favoured. She could feel herself become cynical as she read documents claiming to 'retain choice' for patients and clients at the same time that she was being forced onto a CBT course to save her job. "I'm feeling a bit of a dinosaur" she said " There's no dialogue - the manager is only conscious of his own job". She was on the point of giving up.

This struck a chord, and Mark expressed his concern at the new computerised system for 'delivering' IAPT. IAPTUS - "If you get into to their comprehensive patient data set, as well as standard patient information it can be set to record marriage status, single or cohabiting, whether on benefits - if so what sort of benefits you are on. In addition IAPTUS can ask patients about the ethnic and national origins ...... it also can enquire whether you are gay, heterosexual, or other!!!" A database can capture loads of information - the power of its scale can be mesmerising: why not get it all now, as you never know when it might come in handy. In the ordinary course of events, this kind of nonsense would be overcome pretty quickly. But, we are not in ordinary times.

Mark drew on his long experience as a psychoanalytic therapist within the NHS to ask: 'how long will this fad last - we've seen the Defeat Depression campaign, and don't forget CAT (cognitive analytic therapy) - these were things that got everyone excited and attracted the funding in their day. Isn't this CBT just one in a line of Miracle Cures that sweep through the NHS from time to time, only to be discarded a little while later?"

Few, including Mark, seemed convinced by this. Not only are there more government initiatives - eg IAPT, CBT, NICE, SfH, HPC, etc - all bubbling away at the same time, but the underlying assumption seems to have changed.

The work I've done tracing the factors contributing to this shift was what I had gone to speak about. I was very pleased, then, when a few days later, Pat emailed me to say "your explanation was immensely helpful - now I know why I felt so confused for so long and so isolated". The frames of reference for counselling and psychotherapy are changing fundamentally. It is becoming very difficult for people to maintain a productive orientation to their work as their horizon is swept out of view. Unless we get real information out to existing practitioners, and reframe this as a struggle for survival, there is a good chance that an established, trusted, network of practice could lose its way for ever.

Alliance at the West Midlands Institute of Psychotherapy, 15th June 09

Here's a news note by Guy Gladstone, who accepted the invitation to speak in Birmingham last month on behalf of the Alliance for Counselling and Psychotherapy against State Regulation.

15 members of the West Midlands Institute of Psychotherapy, including most of their council, showed up for their hour and a half Monday evening in-house event to be better informed on SR, for and against. I spoke for half an hour deconstructing the arguments for SR and outlining alternative accountability measures, then invited them in pairs to voice their fears and anxieties in connection with SR before moving to question and answer mode in a seated circle.It emerged that none were explicitly pro SR, some were resigned in the inevitability trance and others found the prospect of not calling themselves psychotherapists inconceivable. Everyone was given a new copy of the Alliance Statement with details of the October Conference, I plugged the petitions and signposted to the Conference to get up to speed with what PNC might entail and some were fired up to investigate further. One turned up with a download of CPJA's rejection of Skills for Health expressing outrage against SfH. Questions generally revealed little prior knowledge re HPC but hearing more about it elicited dismay. Overall a worthwhile visit, a positive reception for the Alliance case, oaktrees grow from acorns ...

e-petition against over-regulation of psychotherapy

Manchester Stake Holders - re-match

On June 22nd, I was at the Manchester Metropolitan University talking to a group of counsellors and psychotherapists about the history and context of state regulation under the HPC. They was much interest in the history and context of State Regulation and Audit Culture, and exasperation about the lack of genuine engagement of those involved in rolling out the legislative plan with those who were worried about the implications. At the end of the meeting, the group decided to re-stage the "Manchester Stakeholders Meeting" and invite the HPC to come along to it in the hope of actually getting the message across. (See earlier blogs about the HPC Meeting held on 31 March 09).

Here is a letter from Ian Parker to the HPC Chair, Anna van der Gaag. It invites her, her Council, her PLG and those of her staff to come along for a real conversation about the issues involved.



Ian Parker BA PhD AFBPsS CPsychol FRSA Professor of Psychology

13 July 2009 OPEN LETTER

Anna Van der Gaag
Chair, Health Professions Council, UK
Park House, 184 Kennington Park Road,
London, SE11 4BU

Dear Anna van der Gaag,

I have been discussing with a number of colleagues in the field of counselling and psychotherapy the HPC Stakeholder meeting you held in Manchester earlier this year. As you know, many of those who were able to attend the meeting were disappointed by the presentations, and are concerned that the follow-up to the discussion that took place has not been arranged by the HPC. A letter was circulated to those who attended from Jonathan Coe, one of the speakers, but apart from that there has been no opportunity to take forward the discussion and to involve more counsellors, psychotherapists and clients.

We have taken it upon ourselves to organise an event to reflect on these issues, and this will take place on Saturday 3 October 2.00-5.00 at the Friends Meeting House, 5 Mount Street, Manchester M2 5NS. So now we would like to invite you, the members of the PLG, and any of the members of the New Council that would like to get a more accurate picture of the debate that is taking place in the profession about the proposed regulation, together with Michael Guthrie, Kelly Johnson, Charlotte Urwin and any other of your staff as you think necessary to attend as our guests. Please do let us know who will be coming, so we can be sure to reserve some seats for you all.

We will be happy to involve you in the discussions that afternoon, and intend the meeting to serve as a model for consultation around state regulation of counselling and psychotherapy.

Yours sincerely



Ian Parker
Manchester Alliance (Alliance for Counselling and Psychotherapy against State Regulation: www.allianceforcandp.org

The First HPC 'Smaller Board-Like' Council Meeting, July 09

I've just got back (a bit blustered and slightly damp - flighty July weather) from this morning's new 'Board-Like' HPC Council Meeting. It set me to thinking about reference points. What does a new 'board-like' council do? It is now newly constituted as 19 people, half of whom are 'lay'. From what I heard this morning, Lay largely refers either to NHS managers or University employees.

The Health Professionals Council isn't really a Council of Health Professionals, at least not if today's rather vague comments are anything to go by. It is a Council of professionals who have something to do with health. And if that's still a bit too specific, then 'well being' is what they are really interested in. The Council for Protecting the Public's Well Being from the Proliferation of people who like to think of themselves as Professionals. There, that should just about cover it.

What has caused this little bit of creativity with the title? I suppose it is because the Health Professions Council has just taken 15,000 psychologists under its wing. Psychology - is that really a health profession? Really? No. Not unless you stretch the idea of health to incorporate the psyche, in which case you may as well prepare to regulate the church, hairdressers, mediums, actors, poets, parents, best friends, musicians, and uncle Tom Cobbley and all. The lack of proper bearings allow things to slide all over the place.

Reference points - from what does the Health Professions Council take its bearings? When Michael Guthrie took the hot seat to present his report on the work of the Professional Liaison Group for Counsellors and Psychotherapists he mentioned the Government White Paper (Trust Assurance and Safety) 7 times in the first 3 minutes. This is a major reference point. There was no logic, reason, rationale given other than that, and the white paper does not go to any trouble to justify its decision either. So, one small phrase in this government document is supposed to give the grounds for HPC to take 40,000 counsellors and psychotherapists onto its books.

Michael Guthrie is a young man, perhaps 30, maybe more, who seems a very competent administrator. He can assimilate a lot of information and write a report that includes all the points, presenting conflicting ideas side by side and making it bland enough for nobody to notice what is really going on. I suppose he is also ambitious. This is probably his first time in the driving seat - his predecessor went off on maternity and was not given her job back when she asked to return part time. To get the counsellors and psychotherapists on to the HPC register will be a nice feather in his cap. Fair enough, but not as a major reason for pushing something through as contentious and difficult as this.

Between a rock and a hard place - West Wales Counsellors find out about the hpc

Now that the HPC PLG for C&P is at the end of its life, I am off on a series of 'road shows'. I've just returned from West Wales where I addressed a room full of counsellors and psychotherapists in Rhosygilwen Mansion, one of those beautiful old conference centres amid amazing rolling green countryside and a herd of light brown cows.

I was the guest of Janet Garner, owner of West Wales Counselling and Psychology Services (www.wwcps.co.uk), a home-grown provider of EAPs for local organisations. She had been glad to see a debate at last in Therapy Today about the pros and cons of HPC registration and welcomed the chance to get some information flowing around the real implications this will have for practice.

I suggested that she ask one of the PLG members to come along too, and named someone who had impressed me with her ability to stay sensible and say sane things in spite of a very vexing situation – Fiona Ballantine Dykes of the Counselling and Psychotherapy Central Awarding Body (CPCAB)

A local trainer and practitioner made up the third and she would speak about changes in institutional education and how they impact on local counselling. The day's programme was well put together and attractive enough to entice 20 or so practitioners to sign up, tho none would come from the NHS.

West Wales is a very long way away - and not only from London; so we were both offered a room for the night. "Is that ok?" Janet G asked diplomatically, "or are you two at daggers drawn?" It was ok - I was looking forward to actually meeting Fiona in the real world and to have some time for a chat. So, a four-hour whoosh from Paddington and a four-hour wriggle through beautiful country lanes in a car brought the two of us together at a very generous table late last Friday night.

What a delight! Films, books, poetry, all turned out to be fruitful conversations. The three of us chatted about our own trajectories into the therapy world and about dogs, cats, horses, children, tragedy and love. So I was startled and amused the next day as we pulled into the conference centre car park: Fiona switched off the engine, turned slowly toward me, and mischievously said - it was nice knowing you, may the best woman win. We wryly acknowledged that we were, in important ways, on different sides of a fence.

I'd asked for the first slot of the day to avoid being positioned as an 'anti'. The last thing I wanted was to repeat the pattern laid down by the HPC which is to polarise the discussion and put me into a hopeless opposition. My strategy was to give a history and context to the rise of audit culture, and situate the HPC firmly within it. From a sociological point of view it is clear that the HPC is part of an ideology which is antagonistic to the paradigm of most of the talking therapies. I wanted to talk to Fiona as well as to the others, to give some coordinates and context with which to make sense of something that has been described as ‘being crushed by a thundering juggernaut’.

Just before the event began, Fiona leaned towards me to ask a very important question: the Chief Executive of the CPCAB had spotted the rise in regulatory bodies and the changes in counselling trainings and had figured that people who held the work dear could act as a buffer between the real world in the consultation room and the idealised life of the regulators and thus help to keep things working. However, as the regulators grow in strength and number and impose more and more guidelines and standards, it could become more difficult to hold the two worlds apart. What, she wanted to know, would I do, in such a position as this.

Good question. It reminds me of a film I saw recently - Sleep Furiously by Gideon Koppel. It was set very close to where we had our meeting, close to where Dylan Thomas used to write and live. The film became the subject of a few conversations that weekend, and when I recited a line from it - "It is only when I sense the end of things,/ that I find the courage to speak/ the courage, but not the words" - several people responded by reciting some Thomas poetry:

Do not go gentle into that good night. Rage, rage against the dying of the light.

Gideon Koppel may not have found the words but he made a beautiful and intelligent film - much of it is in Welsh with English subtitles. In one scene, the camera focuses on the mobile library as a woman steps in to browse. The librarian and the borrower babble away in Welsh, then when he moves forward to drop a little barrier into place at the door, she turns round and laughs, and the words "Health and Safety" break into their conversation in English. The audience in the cinema laughed in sympathy.

I can't make movies, nor am I a poet but I'm not too proud to take my bearings from these two great artists. I don't know what Fiona should do, except perhaps more of what she does already: not to go gentle into the soporific false promise of safety peddled by the HPC, but rage, rage against the nonsense of bureaucracy and try to stop it putting out the light.

The HPC ETC on the question of psychologists

The list of agenda items for the Education and Training Committee this week was very long indeed. It would turn your soul to stone if you actually read that stuff. Some of the papers were read out by some of the admin staff present. Their style of speaking turns your soul to stone. Punctuated by regular staccatos 'er' 'er' 'er' and delivered in a monotone - this is not about transmitting information. It reminds me of a child rushing through its prayers, hurrying it out of the way. Or a bland repetition of a ritual where the meaning has been long lost.

Most of the meeting was about massaging the Psychologists onto the register. A question about PhDs was causing great concern. A couple of kinds of psychologists have managed to make PhD the entry level of their register. None of the other groups on HPC lists requires a PhD. The Psychologists want to maintain their tradition, however. So, Diane Waller and Jeff Lucas both made long interventions which appealed to the group for support. Lucas managed to string together a whole series of Newspeak Phrases which made me wish I had a tape recorder. It reminds me of a christmas party game where people ina circle each contribute a new phrase to a sentence which must be repeated by the next person in the line, who adds a phrase of thier own. The outcome is a very long sentence which makes no sense at all, but honours each player in the circle.

Flexibility was the word that captured the hearts of enough of the members present. This was Di Waller's earnest attempt to overturn Mr Bracken's constant advice. He said - don't pay attention to the reality of the practise, remember the ideals you have set in the standards. She said, yes, but we probably could be flexible. The HPC must be seen to be flexible. And so it was that against all the odds that the Psychologists made their point.

One more thing - a little bit of business was done towards the end of a long and tedious meeting. Some small course in South Africa which has been training ambulance drivers to HPC UK standards had cropped up on a list as an anomaly. The committee spoke about it as if it were a foregone conclusion that this course was a freebie of some kind for somebody somewhere. They didn't know much about it, and didn't really care. In just a few brief moments they agreed to disenfranchise it. Boom. Someome's livlihood - vanished into thin air.

A moment of truth - the PLG from a 'users' perspective

With permission of Betty Bertrand:

The true nature, or rather the true endeavour, of the HPC has finally been revealed in what initially I would have called a moment of grace. They want to invent a new profession.

During the debate on the standards of proficiency, Jeff Lucas, after much heavy silence, expressed his reservation regarding the relevance of the statutory regulation for Psychotherapists and Counsellors, at which point a whoop and applause broke out in the gallery and three people were warned against being thrown out.

The task of regulating the field of Counselling and Psychotherapy is indeed an impossible one, and the PLG had admitted it! But instead of holding on to this and facing up to the truth, the group carried on as if in the grip of obscure forces, and CREATED a new one! One that they thought they could regulate!

This new one has a vocabulary that fits perfectly with the 100 legal words allowed by the HPC solicitor. One member of the PLG said "we are creating a benchmark for the future, defining what counselling and psychotherapy is".

I am scared. I recognise myself neither as practitioner nor analysand in the standards created by this group. This Frankensteinian process will undoubtedly have serious consequences beyond even practice and ethics. The group, many of whose members' views I may respect individually, has themselves spawned a monster.

Sorry, but I did not share Annie Turner's enthusiasm when she said "until we [Occupational Therapists] laid down the Standards of Proficiency, we were unable to define ourselves as a profession".

I am sure that we do not need the HPC and/or friends of the government to tell us who we are – and not only because we constantly evolve. That is the nature of the work we do, of people, and their impact on the practice.

Day 2: and for the first time the muffled attendees sitting in the gallery were given colour handouts of the Standards of Proficiency. I wonder why. Was it some kind of gift? We were even thanked at the end by Diane Waller, apparently relieved that all the messy profession has been "tidied up" and ignoring for the moment the untidy fact that two more days in November had been scheduled.

The picture is not at all rosy - far from it. The past two days are only the beginning. The drafted papers will be circulating for wider consultation and everybody - in the profession OR NOT - should read the proposal and comment widely. Be warned - it is tedious and sickening. Meetings must take place, practical resistance should be organised. A moment of truth must be faced...

The new PLG (half of the members are liable to be replaced in the forthcoming Council appointments) will meet for two more days in November. Until then, we have some work to do.

By Betty Bertrand-Godfrey

The relation between the process and the appearance of the process: the MHTP

The question of whether Counsellor could be a protected title raised barely a mutter at the meeting, and will be dealt with by solicitor Jonathan Bracken at some future date.

It is such a general word that it seems very likely that capturing it will cause a catastrophe. There are around 30,000 counsellors on the BACP books for example. It would be amazing if the HPC took these 30,000 counsellors into its care yet this seems to be the image that BACP wants to create.

I wonder what is actually happening at these meetings. The process seems specifically designed to addle the mind. Much that is said seems irrelevant - the Chair often openly contradicts herself, many issues are parked for future debate, put into a pot, or just 'left there' for a moment but no-one is holding a list. The agenda seems to hover over the content, the minutes don't name anyone in particular. With so much vagueness and lack of direction the PLG process appears to float over something that is moving according to its own will.

The meeting generally stops around about 3.30 but there was still no mention of the discussion expected on protecting the title of 'child psychotherapist. So it was a big surprise when at about 3pm Diane Waller invited Jonathan Coe to put forward some unexpected business. He wanted to know, for no particular reason, and a very angelic smile, whether the group might wish to consider whether or no to protect the title Psychoanalyst. What was that about?

BPC and Skills for Health slapped the suggestion down. BPC vaguely implied that to practise as a psychoanalyst one would first have to enter the register as a psychotherapist - "these are the minimum standards" he said "you are free to go higher if you wish". And SfH sort of backed this up.

At 3.15 or thereabouts the PLG finally came back to the question of whether to protect the title of Child Psychotherapist (an idea thrown out several times over this six month process). Eileen Thornton for the HPC said she could see nothing convincing in the paperwork submitted to support the demand. BPC and SfH both piped up again and began bellowing. The most incoherent stream of nonsense issued forth from the SfH foghorn about the physical nature of a child's brain, and BPC said that because he personally wasn't competent to practise as a child psychotherapist the title must be protected (from him we must suppose).

At 3.29 the doormouse woke up and declared some dates for the next PLG - 17th and 18th November. Nothing seemed to be settled. And, just when they thought it was all over two more days are pulled out of the hat.

In the meantime, Anna van der Gaag has been recruiting her new HPC Board, due to meet on July 6 to consider the PLG's recommendations. Only 3 of the original Council will be reappointed, so Diane Waller, Jeff Lucas, Mary Clark Glass, Annie Taylor, Eileen Thornton, and Graham Smith are unlikely to be around for the November PLG. The original programme of consultation and review has been muddled, but the Draft Standards of Proficiency (SOP) are going to be circulated for another round of consultation - after the new Council has heard the 'group's recommendations'. Will there be a second set of recommendations to Council and a second consultation? Not if the HPC want to rush this through parliament before the next general election.

The UKCP member (Kathi Murphy) specifically said that she was unhappy with the definitions distinguishing Counselling from Psychotherapy (cooked up in half an hour over yesterday's lunch by Mick Cooper and Peter Fonagy - an idea from Julian Lousada which was eagerly put into play by Di Waller, who over-rode the loud protestations from Kathi Murphy), but would accept them for now knowing that they had to go for consultation. Lousada later said he could accept the phrase 'mental health well being' as a definition for counselling, but would then want to give up the will to live - thus evidencing the hypothesis that depression follows moral cowardice.

There is a barely spoken knowledge that everyone involved in this process will have to fudge and force things to fit in order not to lose face. I heard the Counselling Professor (Cooper) mutter his amazement over tea that the UKCP had not contested the definition of Psychotherapy in the meeting. I heard myself wonder why no-one screamed when someone said that the DSM IV was the therapist's bible. Another member of the silent gallery confessed her great discomfort at having to remain mute at this process. I wonder why we all obey the rules. I remember those films and plays and books where someone finally stands up says 'look here, this is all nonsense'. You will ask me why I didn't say it myself.

Look here this is all nonsense.

Protecting the public from the intellectuals

In each PLG meeting the BACP Director of Regulatory Policy has cast aspersions on some other training organisation. For the most part she has been content to leave the accusation vague and nameless and just convey that 'those people out there are doing bad things and we need to police them, and to know what they are up to'. Yesterday however, she actually named one. She named Middlesex University. Middlesex University run a Masters in Psychoanalysis which has no clinical component - 'and we don't know what these people go on to do once they've been given their certificate' she said, with her eyebrows shooting high on her head. The implication was clear.

We don't know what these people go on to do? Well, I suppose they go to Mornington Crescent.

In this month's BACP magazine, Therapy Today, Sally Aldridge responds point by point to the Statement of the Alliance for Counselling and Psychotherapy against State Regulation. One of these points is that the HPC is a symptom of a suspicious state that increasingly grants itself privileges to intrude into its citizens' lives. Sally's response there in writing, was, yes, we do live in suspicious times, and yes we do need to know what these people are up to. "Quis custodiet ipsos custodies?", as they say on the MA at Middlesex University.

Mornington Crescent

Up to a year ago, it was quite common to hear people say that all this state regulation was to prevent another Harold Shipman. There is practically nothing you can say to this because it is beyond reason. Straight forward nonsense. It has been a relief over the last year to notice that his name has been dropped off the register. Another empty phrase came to circulate as justification for all these new jobs, these plush offices, these new procedures ... they are for 'public protection'. But, today, at the HPC PLG for C&P, over the finger buffet lunch, the Ghost of Shipman reappeared.

I was asking why the HPC board was being replaced. I was told: because of Harold Shipman.

There is a long running radio-show the game called Mornington Crescent which has people screaming with laughter for no apparent reason but that the phrase and game is engaged in so seriously, and yet is totally meaningless.

Regulating counselling and psychotherapy via HPC

At yesterday's PLG meeting at the HPC a very frosty silence opened up the day. Soon there were red faces and blustering interventions, and it seemed clear that something had happened outside the meeting. Suspicion and resentment bubbled up as it became more open that the 'big boys' had been cutting deals and manoeuvring for position to get the best deal in this power-sharing mess.

This group of practitioners - Counsellors and Psychotherapists - did not approach the HPC and ask to be regulated. The field has not organised itself into a centralised unified body that could be readily transferred across. So the HPC is going to have to force it to fit, with a force powered by an act in Parliament.

Professor Jeff Lucas ('lay member' of the HPC Council, and University VC many of whose graduates will end up on the HPC register), had showed himself capable of breaking through the 'group atmosphere' in January's meeting to point out the inconvenient truth that this field will involve taking on something like 40 different registers rather than the usual One. In yesterday's meeting he managed to say that this so-called field of counselling and psychotherapy was a mess and that it would be impossible for the HPC to regulate it.

Yes. The only possible outcome of forcing this impossible profession to fit is to destroy it and invent something new. Only then will you get a government sanctioned efficient programme of orderly, obedient, therapists.

Fit to practise?

The College of Psychoanalysts-UK is staging a conference on 6th June at Birkbeck College in London. One of the speakers is Mary Clark-Glass, HPC Council member, and member of the Professional Liaison Group for Counselling & Psychotherapy. Mary was bewildered at the recent HPC Fitness to Practise Forum when she realised that more than a third of the HPC total budget is spent on FTP processes. According to the Management Accounts of March 2009, that amounted to £4,652,779.

HPC income is made up of the fees paid by registrants. In 2009 New fees amounted to £751,055; Renewal Fees: £11,318,583; Readmission fees £203,592, sundry others to make up a TOTAL of: £13,505,960.

In his talk to the aspiring group of Hearing Aid Dispensers, Marc Seale, HPC CEO said ‘we are not a charity, we are self financing’. This ‘self financing’ is achieved through force of law: once a title is protected (eg Arts Therapist) a practitioner is compelled under threat of legal action to sign up to the HPC and pay the fee, (which is set by an act of parliament) or be prevented from practising. Mr Seale is responsible to HPC Council, who from July are all appointed by as well as answerable to Parliament through the Privy Council.

By the by, some people who have recently written challenging or critical letters to Mr Seale have received replies with this allusive paragraph: “In conclusion, I would like to raise a particular question. It is as follows. On the assumption that statutory regulation of psychotherapy commences within the next few years, will you apply to join the register, or will you stop practising as a psychotherapist? I look forward to your response with interest.” Could it be that instead of engaging thoughtfully with questions and criticisms about the ability of HPC to regulate psychotherapy Mr Seale is simply awaiting the opportunity to exercise the law?

We saw below (blog 8 May) that If you are late with your fees because you didn’t get the invoice, you can expect trouble.

Perhaps, with an annual income of thirteen and a half million pounds, we could expect HPC to put some of that cash to work on a more effective, not to say more polite, process of fee collection. Perhaps, with an annual income of thirteen and a half million pounds, and only a few hundred allegations to think about, the HPC could be able to spend time, money and effort on other more productive and important matters.

Allegations received:
70 for the y/e 2002,
172 y/e 2004, and
424 y/e 2008 (0.24% of total registrants in 08).

That is, 30% of income is spent on investigating 0.24% of the register against whom allegations are made.

I have not been able to find any reference in the accounts to money spent on improving education, nor disseminating information, ideas or findings arising from the work of the 185,000 practitioners on the HPC books. The amount recorded in the account as spent on the Welcome Pack for registrants was: £0. That’s Nought. Zip, Zilch, Zero. I wonder why they reported it.

The FTP annual report for year-end 2009 is not yet published but the report for y/e 2008 can be downloaded from here

For this period there were 178,289 people on the HPC register, and most of the allegations received were about people who live and work in England (as opposed to those in Wales, Northern Ireland or Scotland).

The majority of complaints are made against men. The vast majority of registrants (76%), however, are women.

Of the 299 allegations that were considered, only 186 were referred for a full hearing of which a decreasing number are held to be well founded. Probably 139.

The HPC appoint a law firm, Kingsley Napley Solicitors to present cases on their behalf. Needless to say, the HPC then have to ‘continually strive’ to manage these costs and have had to introduce a ‘capped hours’ arrangement.

The 09 y/e Management Accounts record a figure of £2,516,642 paid in legal expenses of one kind or another.

In answer to questions whilst observing hearings at the HPC I have been told that it is the solicitor who must do the ‘research’ to build the case against the registrant in question.
Although the number of cases being considered by FTP panels is increasing the number of allegations where the outcome was not well founded has also increased. Solicitors are paid whether they win the case or not, which suggests that there is no tension in the system to insist upon a proper investigation.

Employees of the HPC are not involved in the FTP decision-making process. This is trumpeted as a virtue and is supposed to ensure that all decisions are made independently, and are free from any appearance of bias. Being free from bias, and being free from any appearance of bias are, of course, two different things. Being hands off might indicate objectivity, but it may also indicate abdication of responsibility. Furthermore, being ignorant of something could be either a sign of naivety, or of stupidity.

A recurring and disappointing aspect of the HPC is the frequency with which rhetoric replaces reason. For example, at the end of her executive summary, Kelly Johnson (Director of Fitness to Practise) writes ‘the process is not about punishing a registrant, it is designed to ensure that action is only taken when it is necessary to protect the public.’ This is an empty phrase which could surely only be made by someone with little or no experience of the real world. A registrant against whom an allegation is raised deserves to believe - to know - that the investigation into the allegation is going to be fair and impartial. Only in this way could the process approach something akin to justice.

Who makes the complaints? The biggest group of complainers are … employers. 171 in the year 2006-7, which accounted for 40% of allegations. This suggests that when an employer is unhappy with a member of staff they can shunt the responsibility for dealing with it over to the HPC who in turn shunt the cost of it onto the … employees. Also, as the majority of defendants are men, one begins to wonder about the attributes of the complainer, details of whom are not exposed in the annual report. What do the Unions say about this?

A second group of complaints come automatically from the police (35 in 2007/8). The Home Office Circular 6/2006 provides that the HPC must be informed if a registered health professional is convicted or cautioned for an offence (tho only in England and Wales). This is a legacy of Ian Huntley and the tragedy of Soham in 2003.

At the HPC FTP Forum on Friday 24 April, Council members asked why such an adversarial and expensive method was favoured over mediation, even where the latter might be more effective. The law governing HPC regulation only allows mediation to be mentioned at the end of the process, by which time registrant and complainant are well entrenched in conflict, and mediation is no longer viable.

Jonathan Bracken, HPC Solicitor and Parliamentary Agent, is responsible for writing the operating procedures for the HPC, and is engaged to train people to follow these rules.
A Kingsley Napley press release tells us: The Hearing Aid Council is pleased to announce that it has appointed Jonathan Bracken as its new legal director plus Kingsley Napley as its new Disciplinary Committee solicitors and case handlers.

There is no tension in this system where those who are engaged can call each other to account. This appears to be fostering a situation where Kingsley Napley and their colleague Jonathan Bracken are taking up the slack. This all feeds back into the self fulfilling prophecy - that professionals are greedy unethical ne'er do wells, and need to be placed into the hands of the administrators.

Personal ethics more than ever are going to be required until this stupid system is dismantled or reassembled on rational, ethical, reasonable grounds.

British Psychological Society dismayed

The day after the Lords bowed to tradition (see previous post) the President of the BPS wrote to members expressing her dismay.

"... There are still many details about the arrangements that are not yet resolved. For instance the Standards of Proficiency, and the Threshold Entry level remain to be debated and agreed by the Educational and Training Committee, and the Council of the HPC, this is scheduled for 20 May. Also the detail of the HPC grandparenting criteria remain to be agreed by the HPC and again it is expected that the decision will be made on 20 May.
As we are now ending an era for the Society as a regulator and entering a new phase of our organisation’s life I would like to take this opportunity to thank everyone who has been involved in the statutory regulation process – we haven’t always seen eye-to-eye, although I think we can all agree that the final form of regulation as proposed by the Government and agreed by the parliaments is less than ideal." [emphasis added]

The British continue to grin and bear the stupidity of those in positions of power.

Why?

Perhaps some dream of the chance to be 'raised to the peerage' themselves where they might act out their revenge. Possibly it's the dubious flattery of being held the second best in the hierarchy of the psys. Or maybe it's just the promise of pay rises and power over the new army of mental health workers in the 'Agenda for Change NHS'.

Or perhaps it is just our destiny, our national character, something hardwired into our genes.

Dinner Break Debate in the House of Lords, 5 May 09

On Tuesday 5th May, at 7.30pm, seven nobles took the trouble to attend the Dinner Break Debate at the House of Lords. This is a regular time-slot in the Lords’ programme where an hour is reserved for short debates on particular subjects. ‘These debates help to shape public policy’ says the glossy booklet available to all who enter the Strangers Gallery to observe. They also give the Lords a chance to go have something to eat before resuming the main business of the day. In this case it was the Marine & Coastal Access Bill that was slowly chugging through a very long list of amendments and would resume at 8.30pm to pick up where Lord Hunt finished them off at 7.28pm with amendment 63.
In that last half hour leading to the Break a little joke was made at the expense of a then absent Lord, the noble Lord John Alderdice. Lord Hunt looked over the woolsack to where he might find that familiar figure, thinking he may have arrived early for the debate on the Practitioner Psychologists.
Philip Hunt was raised to the peerage as Baron Hunt of Kings Heath, of Birmingham in the County of West Midlands 1997. John Alderdice pipped him by a year, being raised to the peerage as Baron Alderdice, of Knock in the City of Belfast 1996. Hunt sits centre left as you look down from the Stranger’s gallery (the Government benches, close to the despatch box), or on the right if you happen to be on the Woolsack, which is at the foot of the Throne. Alderdice sits on the right, near the woolsack, on the Liberal Democrat benches.
These two noble Lords had crossed swords before, when Hunt closed down Alderdice’s Psychotherapy Bill in 2000 – an early attempt to regulate the psys. (See Denis Postle’s very useful book Regulating the Psychological Therapies, From Taxonomy to Taxidermy, PCCS Books 2007).
By 7.28pm Alderdice had arrived, but Hunt and the others were off for their supper. This left seven noble members to debate the Health Care and Associated Professions (Miscellaneous Amendments and Practitioner Psychologists) Order 2009. In the Strangers Gallery sat at least three interested and several disinterested tourists. On the other side of the Hall the gallery held several key figures from the HPC.
This debate had not been expected. A rubber stamp was all inked up and ready to do its duty, but the Merits of Statutory Instruments Committee 11th report quietly caused a stir:
“[this Order] introduces, for the first time, statutory regulation of practitioner psychologists throughout the UK … The Committee has received correspondence from a number of psychotherapists and those practising similar disciplines: while many of the concerns expressed relate to a possible future Order, some of the issues mentioned, such as potential distortion of the market as a result of only regulating part of it, might arise as a result of the current instrument. A number of those currently practising in this field argue that the ‘one size fits all’ approach to the regulation of the health professions will cause significant damage to their profession. They are asking that the DH provide stronger evidence of the need to move away from voluntary regulation and how the policy proposed will increase the protection of the public. In debate, the House may wish to explore these issues further.”
Access to this report plus the full report of the debate in Hansards click here.
As the hall emptied Baroness Thornton opened the debate on behalf of the Government. Glenys Thornton was raised to the peerage as Baroness Thornton, of Manningham in the County of West Yorkshire 1998, and is a member of the Cooperative Party. She was chair of the Greater London Labour Party between 1986 and 1991.
“My Lords, the reforms set out in this draft order aim to enhance public confidence in the ability of the healthcare regulatory bodies to protect the public and deal with poor professional standards. The order continues the process of implementing the Government’s programme to improve patient safety through the reform and modernisation of the regulation of the healthcare professions, as set out in the White Paper, Trust, Assurance and Safety.”
I am aware that there has been a lot of interest in the build-up to this debate both in support of and against the provisions… At the moment, the only regulated group is psychiatrists, who are regulated as doctors by the GMC. As doctors they can also prescribe drugs to patients. The next highest qualified providers of talking therapies are practitioner psychologists, who are now being regulated for the first time. They must all have postgraduate qualifications.
Consideration is also being given to the regulation of psychotherapists and counsellors who have descending levels of professional qualification. The Health Professions Council has been working with bodies representing these groups to develop proposals but we are not there yet. Those discussions are continuing but no formal decisions have been made although we understand that the working group is hoping to report to the council of the HPC later this year. Any proposals to regulate psycho¬therapists and counsellors will be subject to further consultation before legislation is brought before the House. Given the weight of interventions on this matter by psychotherapists, we anticipate robust discussion and consultation.” [emphasis added]
Earl Howe who followed and spoke on behalf of the opposition repeated this reference to the number of letters received:
“My Lords, the House will be grateful to the Minister for introducing the order which, as some of us know, is the product of many years of discussion between the psychology profession and the Department of Health, as well as extensive discussion within the profession itself. I should like to be able to welcome it wholeheartedly on that account as being the settled view of all the parties involved, but, unfortunately, I cannot quite bring myself to do that because I am aware, as, I am sure, is the Minister, that there is great disquiet among members of the profession about what this order will mean for them and their patients and clients, and the precedent that it is likely to set as regards the related disciplines of psycho¬therapy and counselling in particular. My mailbag has been full to bursting with letters from psychologists and psycho¬therapists expressing total anguish about what the order contains and about the consultation that preceded it, which they see as having been stage-managed. It has not been particularly easy to tell those correspondents that by longstanding convention this House does not vote down secondary legislation. What we have in front of us, at least the part of it that relates to the regulation of psychologists, cannot, unfortunately, be described as a settled view or one that is universally welcomed.” [emphasis added]
Earl Howe had indeed been diligent in his replies to those who had written in expressing their concerns. He had told many people of this ‘longstanding convention’ whereby the Lords do not scupper a piece of secondary legislation. This is a point worth thinking on. Longstanding tradition is fine and dandy, but has to be seen in the light of more recent events. It is now well known that in the 10 years since Tony Blair took up his position as PM more laws were passed in UK than at any other time ever. This massive increase in legislation was a major topic of concern at the Convention on Modern Liberty on 28th February (http://www.modernliberty.net/), and the subject of the popular 2006 film by Chris Atkins: Taking Liberties (Revolver Films) http://www.imdb.com/title/tt0977667/.
The consequence of this massive increase in business means that many laws are being passed without full discussion (Kate Hoey, Lab MP for Vauxhall, made this point at the Convention). That this particular order was discussed at all must be recognised as a major achievement caused by those therapists who for the first time in their lives, no doubt, wrote a letter to a Lord or Lady.
Although much of Howe’s speech was highly critical of the current Order, (eg possibility of creating state sponsored rigidity; the lowering of standards; the distinctiveness of psychology from healthcare) he did take the time to state his position on statutory legislation, which he agrees with in principle. “With no disrespect to the individuals involved, I have been looking too long at these issues to be able to endorse that point of view. In the 21st century, with a need for full professional accountability, professional standards of practice, transparency and protection of the public, it is difficult to argue that statutory regulation in any form whatever is unnecessary.”
Lord Alderdice (a consultant psychiatrist in psychotherapy who runs the Centre for Psychotherapy in Belfast, a National Health Service facility, and who is a member of the BPC) was next to take the floor. Much of his speech was concerned with resurrecting his proposals for an alternative psychological professions council, which would at least have the advantage of knowing something of the thing it tried to regulate, unlike the HPC which he implied was ‘not fit for purpose’. He also pointed out that the current Order would ‘split the profession’ by registering practitioners and not those engaged in teaching and research. This is a very interesting point when considered alongside the list of competencies which implies an insistence that practitioners subordinate themselves to ‘evidence based research’.
At 8pm Baroness Pitkeathley piped up from the back of the Government benches. Another one raised to a peerage in 1997, Jill Pitkeathley is also the newly appointed Chair at the CHRE (the regulator of the HPC). Ironically, in spite of this recent appointment, Jill managed to keep a straight face when she argued that Regulators should be independent of the Government and the professions that they regulate, so that they can make and be seen to make—that is very important—appropriate decisions in the public interest. This was a point made in recognition of part of the Order which authorises changes to the structure of the HPC Council – removing elected professionals and replac¬ing them with appointments by Privy Council.
Next up was Viscount Eccles. John Dawson Eccles is an elected hereditary peer and sits on the conservative benches. He is also a member of the Merits of Statutory Instruments Committee. I am not as sanguine as my noble friend Lord Howe is about the benefits of statutory regulation and would like to emphasise what the noble Baroness, Lady Pitkeathley, said about independence. The great problem with all systems of statutory regulation that I have been involved with is that it is very difficult to believe that you have the independence that you were promised. I have debated the independence of public bodies a number of times in this House and usually I have been disappointed.
He also argued that no evidence had been provided to support the blank statements made by the Government about the need to regulate, and predicted a rise in imaginative accusations for the Fitness to Practise process given the nebulous nature of psychology: “What results from this state-controlled mechanical agenda is an increase from 134 HPC malpractice allegations in 2003–04 to three times that number in 2007–08, against a 30 per cent—less than one-third—increase in practitioners regulated under the 13 present headings. Psychologists will take the HPC on to new ground: matters of the mind. The attempt to codify and define will open the door to a rapid rise in imaginative allegations. One needs only to look at the prescriptive detail that the HPC thinks is appropriate for psychological qualification. Does the Minister really believe that a rising tide of allegations is, or ever will be, a good indicator of patient safety or public confidence?
He pointed out that the work of so-called consultations and the Government’s attempt to brush conflict under the carpet did not amount to evidence of agreement, and he was the third to mention the influx of well-reasoned letters to Westminster which constituted plenty of evidence of contro¬versy should anyone want to recog¬nise it. He finished up by saying that although we “are probably stuck with the order, or at least the psychological part of it, it should be the last with “psy” in the title.
This left the floor to Baroness Thornton to close on behalf of the Government. One thing worth quoting from these closing remarks is the question she posed in relation to psychotherapists and counsellors? “As I said in my opening remarks, there will be a statutory period of consultation before any further orders are laid. Legislation is not inevitable—although we currently agree with noble Lords that it is desirable.”
The voice from the Woolsack then asked if everyone ‘was content’. There being no-one willing to break tradition and admit to being not content, the Order was passed, and with it the Psychologists on to the register of the HPC in July 2009.