Interview with Mind CEO Paul Farmer

INTERVIEW WITH PAUL FARMER, CEO MIND, FRIDAY OCTOBER 23, 2009. STRATFORD

Janet: So, my question is to do with centralization – regulation is a form of centralization, state regulation is a form of state centralization – and in this case is having a negative distorting effect. I’d like to start here, because Mind, of all places, is set-up on a grass roots principle and has traditionally argued against crass generalizations, insisting instead on specific local detail, and on ‘keeping things real’.

Paul: Yes, I’ll start by saying how our organisation works. The Mind network, as you correctly say, is what’s called a federated structure. In charity terms we’re like the Citizens Advice Bureau, Samaritans, or RSPCA. We have in effect a ‘parent’ or central body, and the local organisations (each a separate registered charity) affiliate to us (also a separate registered charity). They are all self-governing organisations with their own Trustees. Its a good model for meeting the needs of people who experience mental distress; owned, in the charity sense, by their local stakeholders, by local people, for local people.

We, here in the central office, are an enabler of a network. We bring together a network of people, so they can better understand their experiences, and we use that to help inform our national role. We also help them share their experiences with each other, so it’s not just an up down feed, but also a cross feed. A local association will contact us saying ‘we are setting something up, has anyone else done that?’ and we’ll say ‘yes, Glossop have done it, go talk to them’. Keeping people talking to each other.

JL: So, that involves you running around a lot?

PF: Yes, it’s a key part of what I think I should do, and we have a team of people in LMA (Local Mind Association) services. Not a very big team, but we allocate as much as we can to that network.

The second area is that of Quality. We have a Quality Standards Framework. If an organisation is to become associated, it has to fit this framework. The system is in its second generation. The first generation was begun 5 years ago for a three-year period. We are now in version 2.0 of that structure (laughs). The basic principles behind that framework is not to replicate other regulatory environments but to make sure our organisations are well managed and well governed and that they provide good quality services to people, to their service users.

JL: Did you initiate this?

PF: No I came in half way through phase one.

JL: I’m interested in the rise of what is called ‘audit culture’ and this sounds very much a part of that. Was there a struggle when it began?

PF: I don’t know very much about how people received it, but I do know, having come in at the end, that the general sense coming from local associations is that they found it a positive experience. There were of course some aspects that they found difficult but they found that the process was an enabling one and led to general improvements in the work they were able to do.

JL: What did they find difficult?

PF: Like any system you have to ensure that the areas we put in place, the themes we put in place for people, really match the needs of those organisations. There were some aspects of providing support for people which some local organisations found difficult but others didn’t. We have such a varied network, and different orgs would have found different aspects differently challenging. In a sense our clear ambition is not to prescribe a common offer but to be clear and confident that the services that are provided by local organisations, are provided by people who understand what their responsibilities are. You then have to set up a framework they want to join - given that affiliation is a voluntary act, we don’t ask people to affiliate to us, they ask to affiliate to us. So we are keen to see that they are providing the best possible support for people.

JL: I’m interested by the way the language shifts from what local organisations do and how the network supports them, to what the organisations must do in order to join.

PF: There are environments, and providing mental health services is one of those environments, where there is a requirement on people who provide those services, to have frameworks in place.

JL: Is Mind a mental health service provider?

PF: We share a view that the individual experiences are important, that a community based approach is a good way to go. We have a whole variety of different ways and networks for people to engage with us. We are lucky, we have that local engagement. Local Mind associations don’t solely provide contracted services. Many do because that’s part of the landscape, but many of them also run wholly voluntary support. They provide places for people to gather, opportunities for people to do things, and to share experiences. The relationship that those individuals have with us is very helpful, and very, very important to us and to our whole ethos. Our mission is that people who experience mental distress drive everything that we do. User involvement and participation is the DNA of the organisation, or the words through the stick of rock. Pretty much everything we do is informed by that. Over two thirds of our Trustees and over half our staff are users of mental health services. It is also part of what we do in our day-to-day work.

We have a formal structure called Mind link: a network of people with direct experience. There is a formal link where a rep sits on our Trustee Board, and an informal link - a place to consult and understand what people would like us to do. In our campaigning and policy work, we have people constantly coming to us on a much more informal basis (because people want to) telling us about their experiences. Our aim is to have a multi-layered multi-factorial kind of approach. I’m sure it isn’t perfect, but we are grounded in the here and now experiences and their understanding of things in the past and of what they would like to see in the future. We don’t claim to speak on behalf of everybody but we can promise to be informed by those experiences.

JL: So how did you end up in favour of HPC as regulator?

PF: We’re in favour of a regulatory framework. Yes. We don’t particularly want to get involved in a discussion about the rights and wrongs of the HPC. Our interest in this starts from the position that over many, many years people who have been in and out of mental health services and not in it all have told us that the only option they were given was an anti-depressant and they felt it wasn’t what they wanted. There’s a backdrop of concern about the efficacy and side effects. Mind has been prominent playing a role in that agenda, because people wanted a choice, an options menu was important. When we ask people ask what kind of choice they want, they say ‘some kind of talking therapy’.

Over many years we’ve advocated an increase in access to psychological therapies.

JL: people are asking to be heard as subjects, not treated as objects.

PF: I’d put it in terms of equity. What they want is a framework of recovery dialogue. People generally want to be seen as an equal partner in care. Sometimes that’s about choice of medication, choice of therapy, or support from people. What they were also saying was that people wanted to feel safe, and safety is an issue powerfully articulated in the journey of mental health service users over generations. Many people experienced very unsafe conditions in the asylums, many people still do, sadly, in in-patient units. And, in this context people have also told us about unsafe experiences in therapy, in the NHS. Given the nature of our experience over a very long period of time, we have been campaigning for a better deal for people with mental distress both in favour of greater choice and less institutional care. It was also important that we reflected the concerns that people have about safety, so our twin message around ‘psychological therapies’ (I know it is a contested term, but I hope you won’t mind if I use it, its difficult to know what to call it otherwise) is that we would want to encourage an expansion of the availability of psychological therapies, and an expansion to people who couldn’t afford it, so they become entitled to receive it in an NHS context.

Secondly, in that environment, people have to be confident that the experience and the situation are conducted in a safe and appropriate environment. Therefore, in that context when we were thinking about the issue of regulation, I think we felt that it was important that from perspective of safety there was a framework for people to receive protection of a statutory regulatory framework. That’s how we arrived at our position, informed by strong messages about safety and increasing availability.
JL: what kind of information do you have about the rotten experiences that people had outside of the NHS?

PF: are you saying they did not exist?

JL. No, I understand there to be two different kinds of problem. One is a general enlightenment problem, which would be solved when people better understand the dynamics of power and love, and the other is a problem of, lets call them predators. This requires a different kind of response. How can we make use of the testimonies to better understand the nature of the problem we are confronted with, so we actually solve the problem.

PF: I wouldn’t necessarily want to go into detail. We hear a lot of people talk very positively about their experiences in therapy, very positively indeed. For many people it is their life-line. That’s why we have consistently advocated an increase in access to therapy. If we didn’t think that people fundamentally thought it helpful we wouldn’t advocate it. These documents are driven primarily by a desire to make that more accessible to people. It’s a key part of our ethos. If there is an approach that people find helpful, it’s that.

So, yes, we know that lots of people are very supportive of this counselling and psychotherapy. But, because we are the network we are, we also hear of experiences of abuse. When you hear about those experiences, you know they are very painful, and that it is very difficult for the individual to speak about it. These are not frequent experiences. The vast majority, and we’ve said this publicly many times, the vast majority of therapists are doing a perfectly good job and they are absolutely understanding of the appropriate boundaries they should use. BUT there are some people whose experiences are telling us that this is not the case. If you’ve got your two categories those are - in your language - the predators. They are few and far between but it is not in the interests of therapists (though this is not our concern) and it is not in the interests of those who could benefit from therapy, particularly in the NHS environment: it is not safe. Something has to be done. There are not many of them. But in an environment where the very nature is intense and exclusive – private – it is really important that there is a mechanism that enables individuals to be able to pursue their concerns about individual therapists.

JL: Yes, predators are a pest. But, one of the most difficult things to bear in this press towards regulation, is the obfuscation of the facts. Do you have any sensible straightforward information about these predators?

PF: No. But there’s a slightly circular problem. It is the regulatory framework that will generate that data.

JL: There is already much reason to question that assumption. What is needed at this stage is to be able to ‘touch the source of information’, to gain confidence in it, to be at ease with it, before setting up a hugely expensive and elaborate bureaucratic machine that could as easily exacerbate the problem (this is a point made both by Ken Pope and Daniel B Hogan). What happens at the moment, in the absence of sensible data, is that a Bogey Man appears, reason is obliterated and the bureaucratic machinery gains speed – it is an effect of the discourse of security.

PF: The evidence gathered is testimony. But because there are so many therapists delivering so many different kinds of therapy, all differently linked to different organisations, it is difficult to see how that can be easily sewn up, sorry, joined up (laughs). But you know, the way we shape our decisions is based on individual testimony. We take a broad view about what research would be, but we do have a basic view that if one therapist oversteps the mark it is one too many . That should be the starting point. Inevitably, there are thousands of people practising a variety of different modalities, and I think that there is a chance that sometimes a very, very small number of people will be overstepping the line, and so there should be a system to address that.

JL: So, is there anything we can say about the volunteer sections in Mind?

PF: It’s an important point to make. We are a provider. Local associations are, I think, running about 60-70 services across the country. They are differently structured. There’s a wide range of approach. This is sometimes to do with the locality, the nature of commissioning, or the nature of service. But quite a lot of people run counselling services, which are staffed by people undertaking training. A lot of people who are currently active as therapists, have found that a very helpful and valuable experience in their training. It is actually very difficult to find environments to get this kind of experience, and its great then that people who qualify have had a good experience at a local level with us at Mind.

In the context of a new framework, the local Mind associations, in the main, are quite used to operating in a regulatory framework. In fact they are used to operating in several regulatory frameworks [laughs]. If you’re in housing environment or other services, eg, dementia, they each have a set of frameworks, so for a local association the prospect of a regulatory framework is something that they are reasonably used to. So, I think they will respond to that and work with it. I do think, and this is the only thing I’m prepared to say about the HPC and their proposed regulatory framework, I do think that there is a need to ensure that the framework is not overly bureaucratic.
JL: In Mind’s experience of providing counselling, have you had difficulties to deal with between client and counsellor?

PF: the structure that we have is that local associations administer a complaints procedure, and we are a third party that might intervene in certain circumstances. I am not aware that we have intervened in a particular case. I’m not saying no-one ever complained about our service, but I’ve certainly seen evidence, testimony, about problems in other places.

JL: Thank you very much for your time.


Foot Notes

1 We Need to Talk, a report commissioned by 5 leading mental health charities to make the cause for greater access to psychological therapies on the NHS. ISBN 9781903645918
While We Are Waiting, experiences of waiting for and receiving psychological therapies in the NHS, by Emily Wooster, MIND July 2008

2 When I sent the transcript in for approval I mentioned that the structure of this argument, ‘if one x does something wrong, then all x must be controlled” is something that Mind usually has to struggle against (“if one schizophrenic abuses someone, then all schizophrenics must be put on a register and controlled more carefully”). The logic of the argument is pernicious, and trades on an impossible idealisation which effectively brings a sub-class into existence.

An appeal for the Fighting Fund from the organisers

Make 2010 the Year that Psychotherapists and Counsellors Reclaim their Profession

Fighting Fund for the Talking Therapies

As you may know, the Government plans to introduce statutory regulation for psychotherapists and counsellors via the Health Professions Council (HPC). The initial consultation concluded that HPC was the wrong regulator, as it applies medical-style models of healthcare management to a field which, for a large part, does not subscribe to these models and values.

The talking therapies have always offered a system of values that is independent of those of the State, and if the current proposals are pushed through by government, it will no longer be possible to practice psychotherapy and psychoanalysis in the way they have been practised for the last 100 years. HPC regulations would effectively destroy psychotherapeutic practice and deprive each individual of their free choice as to which therapist they could consult.

If you’d like to know more about what’s going on, please look at The Maresfield Report which is available at www.psyreg.co.uk and also have a look at the websites www.coregp.org or www.allianceforcandp.org.

We are fighting here for the heart and soul of our profession and for the ability to offer a wide variety of approaches tailored to the individual, rather than imposing mechanistic ‘treatments’ applied to passive recipients, with false promises of public protection. Psychotherapy and counselling involve relationships between people and cannot be reduced to the model of a business transaction or a medical intervention like the prescription of a drug.

We have been lobbying now against HPC for more than a year and several groups have decided to take this further via legal action. We’re organising a fighting fund to instruct a top constitutional law firm with a leading QC to fight these plans. HPC were required to assess the 'regulatory needs' of the field and its own suitability as a regulator, yet they have neglected both of these tasks. Legal challenge will hopefully make a proper consultation on these issues necessary, which would include all stakeholders. While nothing is guaranteed, at the very least we would hope to achieve delay, rethinking and proposals more suited to our profession. The best case scenario is that we can make the Government – especially the NEXT Government – think again about taking forward proposals which have unprecedented levels of objection and opposition from our field.

We are seeking to raise money for this fund from individuals and organisations in our field. If you care about the talking therapies and want to help, please ACT NOW. Any donation, however small, will help. We already have many pledges towards the £200,000 we may need to raise. You can pay by instalments or give us a single sum.

Here are the details:

Transfer is the best method of payment: please send to:

JR Fighting Fund, Lloyds Bank
Sort Code 30-00-04, Account 02101964

or send cheques made out to:

‘JR Fighting Fund’
to Pine Cottage, Thornden Wood Road,
Herne Bay, Kent CT6 7NZ.

Hoping that you’ll be able to support our campaign.

With thanks and best wishes

Christopher Bollas, Julia Carne, Anouchka Grose, Dorothy Hamilton, David Henderson, Darian Leader, Haya Oakley, Susie Orbach, Adam Phillips, Werner Prall, Andrew Samuels (personal capacity), Joe Suart, Jason Wright .

Two characters in search of an author - the tragedy of anxiety and depression

The National Audit for Psychological Therapies for Anxiety and Depression is tucked under the wing of … The Royal College of Psychiatry (tag line: ‘let wisdom guide’) and is launched with a video podcast from the comedian Stephen Fry who “explains why the National Audit of Psychological Therapies is so important”. Of course he does.

“Hello there, it’s Stephen Fry, I’m sorry I can’t be at the launch of this fantastic new initiative, but I just wanted to show my support for it.

“It seems rather odd that an audit should be important in the world of psychotherapy and mental health, but actually of course without the knowledge that these audits give it’s very, very difficult to formulate proper policy and to get the treatment to where it’s most needed. So, any inequalities in service, and any problems that people have, and any needs that they foresee, or imagine, in the field need to be pulled together, and the Royal College of Psychiatrists, of which I have the honour to be an honorary fellow, is putting this together with its usual expertise and commitment. So I hope everyone can support this.

“Mental Health, as I’m sure you all know, is one of the biggest problems facing Britain at the moment. You can’t have general health without mental health, and without general health you can’t have any kind of prosperity.

"So, em, thank you very much indeed [vigorous nod of the head] for helping to support this great initiative, and I’m proud to be doing the same myself. Many thanks.”

Within the Royal College of Psychiatrists is something called the CC QI – a centre for quality improvement – the which has been carrying out national audits for … yes, the last 10 years.

The flimsy ground for this trivial pursuit is covered up by the names of no less than 15 corporate bodies, which lend their credibility to the project. But, the list also shows signs of self-replication in so far as at least one of them (The New Savoy Partnership) is itself a corporation made up of almost all of the others already on the list. In what precise practical ways the BACP, the UKCP and the BPC are partners in developing this particular audit is left unremarked. But it is worth noting that the first Savoy Partnership conference (Nov 2007) saw Prof David Clark unveiling his dream of data collection with the new IAPT (increasing access to psychological therapies) scheme. This plan involved questionnaires at the beginning and end of every session whereby what he called ‘evidence’ could be collected and entered onto a national database whence a cunning algorithm would ascertain where people were achieving their government’s quality targets for happiness

Perhaps there is a quotient of intelligence lying behind the choice of Stephen Fry to launch this project. Writing about his own QI show Fry says “There’s not been anything quite like it before. The questions are designed to be impossible to answer, so points are awarded for interesting answers rather than correct ones and points are taken away for dull or obvious blather …”

What points would the psychiatrists and economists win or lose? Their CCQI proudly displays its political correctness and thus the central characteristic of its programme – it is reaching all demographic areas, rich and poor, black and white, old and young, etc. This is not about the specifics of anguish, nor the dynamics of humour, but about the mental hygiene of the general population.

But what are psychological therapies? Although Fry mentions Psychotherapy in his podcast, this word is completely absent in the rest of the blurb. Instead we have inter alia computerised CBT, IAPT (which is a government spending programme, not a practice), Art Therapy, and group therapy, all lumped together as ‘services’ which have been ‘invited’ to participate in this audit.

IAPT is not a bright new idea of a hardworking practitioner, but a political expedient fed by centralised planners. Here's what they say: “People referred to psychological therapies for depression and anxiety should be assessed and treated promptly by a therapist, who delivers appropriate therapies in an acceptable manner and achieves an outcome that compares favourably with those of other comparable therapists”. The process is depicted in the literature as a never ending circle: establish standards, collect data on practice, compare this to the pre-written standards, plan necessary change, implement change and then … re-audit!

The questionnaires that are being administered reveal what is thought necessary to inform the national policy makers, on this vital work:

1 Thinking about your current treatment, how long approximately did you have to wait for your talking treatment to start? (ie referred by your GP)
2 I feel the waiting time for my treatment to start was reasonable. Y/N
3 I was given an option about different days/times available when scheduling my appointment. Y/N
4 I was able to get to my appointment location without too much difficulty. Y/N
5 I received enough information about my talking treatment before it began. Y/N

The second questionnaire asks

Thinking about today’s meeting, please circle your answer to each statement.
1 This talking treatment helps me to understand my problem. Y/N
2 I feel that I am getting the right kind of help. Y/N
3 If I have similar difficulties in the future, I would take up this talking treatment again. Y/N
4 I believe this talking treatment helps me to cope with my problem. Y/N

A third questionnaire asks practitioners to give details of their professional background and their qualifications – thus by-passing the role of local management, and ignoring the importance of experienced supervision.

There are also fourth, fifth, and sixth questionnaires but …

In case anyone would accuse the questionnaire designers of bias, carelessness, or anything at all, they declare quite openly that they didn’t actually design them themselves but used focus groups – of course they did – to come up with these ‘rigorous analytic tools’.

There is a confusion between admin and, well, science. What is the thinking behind offering these new ‘talking therapies’ as a cure? Reading these questionnaires the idea seems to be that punctuality, promptness and neat data entry is a cure for anxiety and depression. A bonus point from Stephen Fry and the QI team?

The politicians have not noticed they are perpetrating a joke. Lord Layard does not realise that he has been cast as the jester. We need to return to his 2006 Depression Report and read it with this new insight; we need to see if that's the way to relieve some of these symptoms.

If all the word were a stage, and all the men and women merely players, then Lord Layard and Prof Clark must be two characters in search of a half way decent author…

The Regulator's infinite multiplication: PP 39

“There’s a crack, a crack in everything. That’s how the light gets in” L Cohen.

The modern idea of regulation sets off from a dream of perfection and sets up an infinite regress. There is a regulator (you under the discipline of your practice and its theoretical apparatus), a regulator of the regulator (the HPC), and a regulator of the regulator of the regulator (CHRE). Now there is a regulator of the regulator of the regulator of the regulator. Welcome to the brand new OHPA – the Office of Health Professions Adjudicator.

The OHPA was set up by statutory instrument number 2722 (yes, SI number 2,722 in the year 2009), the Health Care and Associated Professions, using powers from Section 161(3) and (4) and paragraphs 5 and 7 of Schedule 6 to the Health and Social Care Act 2008 (a). The Chairman of this new Quango is Walter Merricks, CBE, fresh from his resignation from his last regulatory post as head of the UK Financial Ombudsman Service (FOS). Walter is qualified to regulate the regulators in the health care professions field because, a) he lives in the UK, b) he has never been prosecuted for lying, and c) he knows nothing whatsoever about any of the practices that come or may yet come within his jurisdiction. These are all stipulated requirements written not only in his job description but inscribed in the statutory instrument which I cannot find in the minutes of any recent Privy Council, but that nevertheless came to life on 1 Nov 2009.

Now Walter is looking for a chief executive officer (salary circa £150k pa) to help him deal with problematic cases referred from fitness to practice systems of the General Medical Council (these will be expanded to include the General Optical Council and in due course all other health profession regulators). “The OHPA’s creation is a key part of the Government’s wider reform programme, aimed at enhancing the confidence of practitioners and the public in professional regulation: our organisation will ensure that the decision-making process in fitness to practise cases is independent from those investigating and presenting the case.”

Because neither the chair nor his chief executive are supposed to know anything (because this is supposed to guarantee their impartiality), the qualities stipulated for the job are all about strength, rigour, and transparency, naturally.

“Early priorities will be working to decide the shape and structure of our organisation, and implementing strong governance arrangements to ensure we operate openly, transparently and with both rigour and integrity. You will need strong skills in setting vision and managing performance and sensitivity to the values of fairness in judicial decision making. In return, this role presents an unrivalled opportunity to take the lead and be both accountable and recognised for the establishment of an exemplar organisation.” Accountable to Privy Council, that is.

“The creation of OHPA follows an extensive review of the regulation of doctors by Dame Janet Smith, following the Shipman Inquiry. Its aim is to present a single, independent body to handle fitness to practise cases across a broad cross-section of healthcare professionals.” Earlier this year Dame Janet told the BBC "I really was shocked to find how totally our system of death certification is dependent upon the honesty and integrity of a single doctor," Although justice minister Bridget Prentice rejected the criticism, saying she was confident the "possibility of something as horrific as Shipman will have very, very little chance of happening again" nevertheless the regulatory juggernaut thunders along. (Could Shipman Happen Again? broadcast on BBC Radio 4 at 8pm on 12 Feb 2009).

“It will be a compact organisation, but with the capability to influence well beyond those who come into contact with doctors and opticians and who wish to raise complaints. OHPA will work closely with the professional regulatory bodies and a wide range of other stakeholders.” [quoted from the Applicant’s Information Pack which can be accessed via GatenbySanderson].

Earlier this week (13 Dec, 21.00) Lord Filkin (Labour life peer since 1999) was interviewed on BBC Radio News Channel, The Westminster Hour. His committee (the Merits of Statutory Instruments Committee) has been looking at whether secondary legislation actually has the effect it sets out to enact. “If [government] don’t know if [its] policy objectives have been achieved you are clearly in a dangerous area”. He gave several examples of ‘rather simplistic legislation’ that ‘is not a very effective way of controlling’ things, and asked ‘do they really know what’s happening in practice?’ He also drew attention to the tradition of the Lords to not normally dispute secondary legislation. “The key words are not normally, or not routinely”, he said. “It doesn’t mean Never”. When the Lords do register a dispute, it makes everyone wake up. The defeated department will probably bring the legislation back 3 weeks later, but the symbolic power of such an action cannot easily be rubbed out.



Meanwhile, at the LSE, Professor Sally Lloyd Bostock has been applying her interdisciplinary interests in psychology and law to analyse the question of risk and regulation as they unfold for the GMC. Her current area of interest is in “Regulation and Compensation Culture, in particular medical regulation by the GMC. In a recent paper “Risk-based approaches and professional regulation by the General Medical Council” (published in Risk and Public Services, LSE, 2009) Professor Bostock lays out the background and questions currently faced by GMC, which help us to understand how regulation may affect our field if things continue unchecked along their current trajectory. There follows some basic information of interest taken directly from this paper:

The GMC was originally created pursuant to the Medical Act 1858, primarily to enable the public to distinguish suitably qualified doctors from ‘quacks. It is still funded entirely by doctors’ subscriptions, and has statutory authority under the Medical Act 1983. Its duties include maintaining up-to-date registers of qualified doctors, dealing with doctors whose fitness-to-practise is in doubt, and fostering good medical practice and promoting high standards of medical education. GMC summarises its purpose as ‘protect, promote and maintain the health and safety of the community by ensuring proper standards in the practice of medicine.

…Against a background of changing culture and uncertainty about its future, the GMC has been open to new risk based approaches, but ambivalence and sometimes serious reservations are also found. “Some reservations relate to the inherently moral nature of risk-based decisions”.

Organisational complexity is growing as new bodies concerned with standards and excellence in healthcare are created, and the GMC’s remit alters as responsibilities are added, removed, or redefined, obscuring where the work of the GMC begins and ends. Changing NHS work practices, changing conceptualisation of the causes of medical error which embrace organisational factors and growing emphasis on supporting rather than sanctioning unsafe doctors, all have an impact on the definition of the GMC’s role.
Ambiguity over which risks various bodies ought to regulate gives rise to possibilities for blame transference and blame avoidance, creating further risks to the GMC.

The heavy information demands of risk-based approaches are a serious impediment to their implementation in medical regulation. Information sources related to patient safety and performance of doctors have proliferated, and information gathered for one purpose is often ill-fitted to serve other purposes.

Complaints and referrals are entangled with social processes of assigning responsibility. They are very unlikely to be representative of risks to patients, or even of patient dissatisfaction.

The CHRE came under criticism from within the medical profession for agreeing that maintenance of public confidence should be one of the criteria for determining ‘undue leniency’ of decisions referred to the High Court under s29 of the 2002 Act.

The article concludes: “The spread of risk-based approaches has changed the GMC’s environment, but it is questionable how appropriate they are to the tasks and public sector values of the GMC itself. Risk-based tools can stimulate systematic thinking and expose questions about priorities, but they can also become instruments in blaming strategies. Their use is often costly, limited by the information available, and involves inescapably normative decisions.”

Lucy Bannerman’s article in the Times newspaper 7th December, sparked a series of letters on psychotherapy regulation eg from Richard House, Andrew Samuels, Marc Seale. Each letter also spawned a string of comments in which more furious debate ensued.

Dates for your diary, 2010

Sunday 10th January, New Lacanian School Becoming an analyst: between regulation and formation. 11am til 5pm in the Bloomsbury Suite, ULU (free).

Saturday, January 23. 9.30am till 5pm in the Conway Hall, Red Lion Square, London. Confer Conference: State Regulation: The Issues. (£50) Speakers -Dr Lynne Gabriel, Chair, British Association of Counselling and Psychotherapy. Professor Darian Leader,. Julian Lousada, Chair, BPC. Professor Andrew Samuels, Chair, UKCP. Marc Seale, Chief Executive and Registrar, HPC. Professor Diana Waller, Chair, Counsellors and Psychotherapists PLG of the HPC. Dr Michael Fischer, Research Fellow in Healthcare Management, Kings College London

March 16th, 6.30pm - 9.30pm Brighton. Sussex Counselling The Big Debate, at the Brighthelm Centre, with Diane Waller (chair of HPC PLG for C&P), David Pink (CEO of UKCP), Janet Low, HPC reps, etc. contact Sussex Conselling

Judicial Review of the HPC (see 19th October post hpcwatchdog.blogspot.com).
To contribute to this initiative you can transfer funds to JR Fighting Fund, Lloyds Bank Sort Code 30-00-04, Account 02101964, or send cheques made out to JR Fighting Fund to Pine Cottage, Thornden Wood Road, Herne Bay, Kent CT6 7NZ.

Academics against bean counters 520
Against State Reg 2851 Against Over Reg 1719

Special thanks this week go to Andreas Ginkell, Denis Postle, Richard House and Roger Litten for information and links to material that is reported here. All feedback welcome.

Merry Xmas, and Happy New Year everyone. Reports resume on 8th January, 2010.

News of the fighting fund for the campaign against the HPC

text of blurb to raise money, from the organisers:

THE FIGHTING FUND FOR THE CAMPAIGN AGAINST THE HPC


As you may know, a number of organisations in our field have sought legal advice from the law firm Bindmans regarding the HPC juggernaut. HPC continue to ignore rational argument and refuse to recognise their unsuitability as regulator for our field. In a crucial meeting today, they made the decision to ignore the many critiques they have received and to advise Government that they should regulate the talking therapies.

It is now time to fight back at a legal level via the administrative court procedure known as Judicial Review (JR). If successful, a JR would force the HPC and also the Government to go back to the drawing board regarding statutory regulation. They would have to undertake the serious research and consultation that they have failed to carry out. Of course, it could still lead back to HPC - but many individuals and organisations think it is an option worth pursuing.

The snag, as ever, is money. In an ideal world, we would need to have between £100,000 and £200,000 in hand to be safe. This sounds impossible until we remember that a lot of relatively small donations could raise a very large sum. If 2,000 people each gave £50, we would have £100,000. If the sum was £100, we would have £200,000. Donations could be made in instalments - four monthly payments of £25 would work. By way of comparison, over 2000 people voted for Andrew Samuels in the UKCP election.

There is a great deal of fundraising starting today, not only in our groups but across the whole network of counselling and therapy organisations. We need to get the first stage of JR going within the next ten days, following the HPC meeting today. It is a step by step process, so we will be able to consider our options at the different stages of the review process. But we need to ask everyone to start sending the money now!

You can use the information below to pay in instalments but maybe we should say that the end of April is the cut off for instalment payments. If people gave four instalments of £25 in January, February, March and April, that would be great. But we'll have to rely on you to remember to send the other instalments. We are thinking of £100 as a target figure but we realise some will give more and some less and all of it is very welcome.

AS (personal capacity) writes: in 37 years in the profession, I have never seen anything like this. With the money, we can continue to instruct Bindmans, who are a leading firm of constitutional lawyers, and they have instructed one of the country's top QC barristers specialising in administrative law. She was very impressive when we met her the other day. She has agreed to work for greatly reduced fees, as have Bindmans, and neither of them is in need of our money so they will definitely not let us do anything rash. If the fundraising goes well, we will use some of the money for the campaign, placing info in national newspapers as a way of combating the spin from HPC. A fundraising committee made up of individuals from different organisations will make sure that the fund is properly administered and the money used responsibly.

Transfer is the best method of payment. Please send to:

JR Fighting Fund, Lloyds Bank
Sort Code 30-00-04, Account 02101964,
or send cheques made out to:
‘JR Fighting Fund’
to Pine Cottage, Thornden Wood Road,
Herne Bay, Kent CT6 7NZ.


With best wishes

Andrew Samuels (personal capacity) and Darian Leader

Report on the HPC Council meeting Dec 10th 09

Behind the rhetoric of transparency business goes on as usual.

The executive of The Health Professions Council were in the gallery at the House of Lords on Wednesday night, waiting for the nod to pass the Audiologists onto their database.

At 7.45 pm the Health Professions (Hearing Aid Dispensers) Order was moved by Baroness Thornton (Labour Co-op Peer), and after interventions by opposition spokesman Earl Howe, Lib Dem Baroness Barker, and CHRE Chair Baroness Pitkeathley, by 8.05pm it was done. In that 20 minutes several things were said that are worth taking note of. Click here for a link to the full debate.


1. Modernisation. “I am sure noble Lords will join me in thanking the Hearing Aid Council for the work it has done in regulating the private hearing aid profession for over 40 years, but now is the time for change… To deliver high-quality services, change is needed and modernisation will prevent gaps in patient safety from occurring”.

2. Money. “The transfer of the register of private hearing aid dispensers to the Health Professions Council will deliver real benefits for everyone concerned. Private hearing aid dispensers will benefit from a considerable reduction in their annual registration fee, from £695 to £76.”

3. Big is beautiful “The Health Professions Council has significant economies of scale, with over 200,000 registrants, compared with only 1,700 on the Hearing Aid Council's register.”

4. Centralised is beautiful. “The abolition of the Hearing Aid Council will also achieve the Hampton report's aim of reducing the overall number of regulators.

5. Pre-emptive Punishment. “At present, the Hearing Aid Council can take action against a practitioner only once harm has actually occurred. However, the Health Professions Council will have the power to remove a practitioner from the register before any harm takes place, on the grounds that a person is likely to present a risk to the public.”

6. Criminal offense: “it creates a new offense relating to the dispensing of hearing aids by unregistered persons”

7. Extending power: “The Health Professions Council will, for the first time, protect function as well as title … in future, any person not registered with the Health Professions Council who performs the functions of a hearing aid dispenser will also commit an offense.”

8. Old Guard: This legislation also makes way for the abolition of the current Hearing Aid Council. Baroness Barker (LibDem) said “It is commend¬able that a body should work so assiduously towards its own demise; that is very generous of it.

9. New Control: Baroness Pitkeathley said: “It is important that the HPC committees have the full range of sanctions available to deal with the case appropriately and are not bound to follow the HAC's decisions. … I think we are talking about a principle here – [Government] expects the HPC to exercise its judgment in reviewing whether sanctions imposed by the Hearing Aid Council on an individual are adequate for public protection”

...

Six psychoanalytic groups wrote a letter appealing to members of the Health Professions Council to recognise the scale of the problem it faced in attempting to regulate counselling and psychotherapy (click here for text of letter). Nevertheless, in Kennington on Thursday morning, it was barely mentioned, and the HPC Council nodded through the executive’s recommendations to carry on regardless.

There were more people in the public gallery than sitting round the table, including one young woman with two laptops typing furiously throughout the proceedings. The seating arrangements for observing are irritatingly inconvenient – the front two rows are always reserved for HPC staff, which means that genuine observers have several obstacles obscuring their view. Nevertheless this young woman squished on her seat with her technology and a set of papers never let up her tapping. She had the names and photographs of all council members next to her, which is the only way to know who said what. The Council is run following the ‘cabinet model’ which means that no remarks are ever attributed to individuals in the minutes and all decisions are assumed to be unanimous – everything goes through on a nod.

CEO report to Council one or two members expressed some alarm at the increase in numbers of Fitness to Practise hearings. Marc Seale smiled and chivvied things along but was picked up by new Council member Deep Sagar, a management consultant who has extensive experience of governance and management across various sectors, who said that a 10-15% increase was indeed something to be explained. In his characteristic fashion, Seale laughed and said ‘if you put a magnifying glass to the paper, then yes, you can see an increase’ and it was not until Mary Clark-Glass suggested that they might need to take on more staff that he let his mask slip. He referred to the catastrophe at the General Social Care Council (see PP36), which revealed the gap between the executive and the council through which the council then fell. With this rather sobering thought, he went on to admit that cases do seem to be taking longer which he thought the result of more complex cases coming to light. This he explained as the result of the ‘public’ cottoning on to the facility of the HPC. Sagar didn’t remark that NHS employers report the majority of cases.

Michael Guthrie presented his report of the responses to the public consultation on counselling and psychotherapy. He remarked that aside from the original consultation setting up HPC, and the consultation to raise fees, this was the largest response the HPC had ever received. He had struggled to make a quantitative analysis of the replies because people had often strayed away from the strict letter of the question. He had done his best, then, to make what he called 'a qualitative analysis' of the data.

Guthrie’s job is to set up the parameters of the database, and ensure that future FTP hearings can make use of the standards of education and training and of proficiency to efficiently prosecute their cases. He is, therefore, acutely interested in the threshold educational level for entry onto the register. The consultation responses to these questions are where he focuses attention.

Mary Clark Glass was the first to speak in the discussion. She said “I find great interest in the disputing stances” before invoking the shibboleth of “Public Protection”.

Eileen Thornton said the report was ‘balanced and objective’ and she ‘would not mind putting her name to it’.

Deep Sagar asked “would it be fair to assume that the question was not asked ‘are you in favour of regulation?’ as distinct from ‘are you in favour of HPC regulation?’” Guthrie said, yes, the question had not been asked, because the terms of reference from the White Paper and the building block blah blah, ‘so we didn’t analyse the answers in that way, and indeed it would be hard to’.

Keith Ross remarked on the constant feedback during the process, and thought the huge response highlighted the value of consultation. He acknowledged that HPC had to do some more work - ‘it seems to hinge on the differentiation, or not, between counselling and psychotherapy’.

Julia Drown said ‘we need to do further work on what is meant by the clear messages we have got’.

Jeff Lucas said ‘it is a balanced report, I share Keith’s issue that the biggest question is on differentiation.” But added that ‘the principle of differentiation is reasonably well made, though it is quite difficult to understand the number of different positions. I accept that we have more work to do on this.”

Annie Turner said ‘it is a balanced report’ and added her observations: these concerns are not new for any profession coming onto the register, and they usually soon disappear.

Sheila Drayton , however, said there were marked differences here, especially in relation to children.

Anna van der Gaag invited them to agree the text of Michael’s report for publication on the website, before inviting Marc to lead them through the decisions laid out in the executive summary.

Seale began by explaining the process of a Section 60 order. It involves a joint consultation between England Scotland, Wales and Northern Ireland, 3 month’s public consultation, debate in Commons, Lords, Commons, Lords and finally Privy Council and Scottish Parliament before the power is ‘switched on’.

It was here that he noted the new pharmacy regulator had ‘failed to get through parliament’ (as proposed in the white paper, 2007) and nodded once more to last night’s triumph in the Lords by the HPC.

The next part of the meeting was a lesson in bureaucratic politics. The Executive summary had been arranged in careful sections, each one leading to a decision requested from the council. They took them one by one.

Julia Drown wanted to know details of the timetable, and a ripple of laughter ran through the gallery when Seale said a Section 60 was uncontroversial. In his opinion, the PLG would have more work to do now than it did over the last year. Jeff Lucas blamed the ‘advanced practitioners’ who couldn’t or wouldn’t grasp the concept of threshold level entry. Mary Clark Glass said they had struggled, but clearly not enough. Julia Drown began to see the complexity but was sure that ‘we can do it’. So, Anna van der Gaag concluded ‘I think that I am hearing from you that you see the need for further work. You see the need for the PLG to help us make the right decision to take the work forward. We do want the PLG to continue”

Eileen Thornton said ‘if we are going ahead with the PLG, what about the membership? We need to reflect the disturbances that have been raised.”

“Yes, absolutely” said Anna. And so the first set of proposals were deemed agreed and the discussion moved on to the next.

Proposals for Dual Regulation were accepted, tho Sheila Drayton wanted to know why the GMC had been singled out for special treatment here. There was no clear answer given, and she let it go.

Marc Seale talked about the problems faced with multiple register transfer. From an IT point of view the data was very dirty, and time would certainly be needed to clean it all up before opening the register. “I think there is an algorithm followed by a manual process” said Michael Guthrie, when they noticed that the IT expert had chosen that moment to leave the room.

Seale said that the grand-parenting period should be extended from two to three years ‘because a lot of people leave it to the lat moment’. Julia Drown was very quick to remonstrate – this is not the right reason! Seale slithered his way out, and the Council agreed to 3 years.

This left short time for a discussion about the controversial generic standards. Eileen Thornton said that the PLG process had made quite significant changes to the wording and that the amended document was now with the original 12 bodies. Anna van der Gaag corrected her to say that they had made quite significant positive impact, and Di Waller wearily said that the other professions had not been very happy with the language of these standards for quite a while, and was pleased that they were now being ‘positively impacted’.

This is certainly a can of worms, and Eileen Thornton (chair of education and training committee) concluded by saying they were revisiting the SET 1 where problems were constantly arising, and were expected to continue to do so as the HPC ‘spread out to different kinds of registrant’.

Anna concluded by saying “I think that what I’ve heard is that you recommend … further work, further consultation, and further discussion. You wish to involve the PLG in that ongoing work, and you have not identified any specific issues to prevent us from regulating psychotherapy and counselling.

Jonathan Bracken (solicitor and parliamentary consultant to HPC) grinned widely and said ‘you are making a clear decision that you are capable, but further work needs to be done’.

Meanwhile, a collection is underway to fund a Judicial Review of the HPC (see press release quoted on 19th October on the hpcwatchdog.blogspot.com, and reported in PP31). Pledges for over £50,000 have already been received. This review will go step by step, and focus on the discrepancy between what HPC were required to do, and claimed to be starting in Dec 2007, and what they actually did (ie ignore the 'whether' and 'why' questions regarding regulation). With the prospect of a JR, the HPC will not be able to rush a Section 60 into existence - there has been talk of getting this done, and ironing out the details after, as indeed happened with the Psychologists transfer.
To contribute to this initiative you can transfer funds to JR Fighting Fund, Lloyds Bank Sort Code 30-00-04, Account 02101964, or send cheques made out to JR Fighting Fund to Pine Cottage, Thornden Wood Road, Herne Bay, Kent CT6 7NZ.

Organisers suggest £100 contributions which can be paid in installments. Andrew Samuels writes: “in 37 years in the profession, I have never seen anything like this. With the money, we can continue to instruct Bindmans, who are a leading firm of constitutional lawyers, and they have instructed one of the country's top QC barristers specialising in administrative law. She was very impressive when we met her the other day. She has agreed to work for greatly reduced fees, as have Bindmans, and neither of them is in need of our money so they will definitely not let us do anything rash. If the fundraising goes well, we will use some of the money for the campaign, placing info in national newspapers as a way of combating the spin from HPC. A fundraising committee made up of individuals from different organisations will make sure that the fund is properly administered and the money used responsibly.”

an appeal to the HPC Council

Response to HPC ‘Conclusions on the Proposed Statutory Regulation
of Psychotherapists and Counsellors’, December 2009.

From

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
The Philadelphia Association

We are writing to respond to the Council Paper regarding the proposed statutory regulation of psychotherapists and counsellors. This draft paper indicates both the failure of HPC to carry out the requirements set out in the Government's 2007 White Paper, ‘Trust, Assurance and Safety’ as well as a failure to reach broad agreement on the crucial regulatory ‘building blocks’: professional titles to be protected, standards of proficiency, and standards of education and training. It is rather surreal that this draft set of recommendations is thus based on a lack of agreement around the fundamental issues, as if the process must continue despite its lack of rigorous foundations.

As the Council Paper reminds us, the 2007 White Paper stated that ‘... psychotherapists and counsellors will be regulated by the Health Professions Council following that Council’s rigorous process of assessing their regulatory needs and ensuring its system is capable of accommodating them’. HPC to date has acted as if there is no question of having to assess the ‘regulatory needs of the field’ or whether its system is indeed suited to accommodate them. These important and necessary tasks have not been carried out. The Council Paper states that there was an agreement of the HPC Council on 13 December 2007 to consider the questions of whether the HPC’s regulatory building blocks could be used to meet the regulation of the field and whether this could be done within the existing regulatory structure, yet a few lines later we read that for HPC, ‘the task undertaken was limited to the practicalities of implementing [the government’s] policy' re regulation of psychotherapists and counsellors. In other words, the question of regulatory needs and of the HPC’s suitability as regulator have not been addressed. As the Council no doubt knows, a legal challenge has now begun which focuses on this failure of HPC to carry out the task set out in the White Paper in a rational and responsible way.

The Paper contains further significant contradictions and omissions. The section on 'Methodology' on page 3 states that the Council invited relevant stakeholders to contribute via a 'Call for Ideas'. A Professional Liaison Group was set up to ‘explore the building blocks of regulation and its discussion was informed by the responses received to the Call for Ideas’. This description is incorrect and distorts the actual process. The central arguments against the suitability of HPC as regulator were made repeatedly to HPC during the course of 2008 yet the PLG consistently failed to enter into any serious or sustained discussion of these objections. This fact is well known in the field and has been documented systematically.

The Council Paper then tells us that ‘a stakeholder event attended by around 50 people was also held in Manchester in March 2009 to further discuss the potential future regulation of psychotherapists and counsellors’. In fact, at the meeting the initial presentations simply set out road maps for HPC regulation as if this were a given and the presentations specifically avoided any discussion of the questions of regulatory needs and of whether the HPC was the appropriate regulator. Numerous participants objected and during the course of the day stakeholders were able to shift the discussions to the basic issues of the rationality of the proposed regulation under HPC. However, these debates failed to have any effect on the subsequent PLG consultation, and indeed, when a further event was organised by stakeholders in Manchester to continue the discussion, HPC declined to attend. Objections and critiques from stakeholder groups have been documented by HPC in a cosmetic fashion, just to suggest that the voices from the field have been ‘listened to’. However, there has been no sustained, serious discussion within the PLG of the central issues at stake.

This effort to foreclose rational debate on the key issues is reflected in the accompanying document ‘Psychotherapists and Counsellors – Consultation Responses’. Most of the basic points about the principle of HPC regulation here are simply relegated to the final section of the report ‘Further Comments’ as if they were contingent details which did not have a bearing on the central questions. We have to wait until page 54 under 12.1.15 to read that ‘Some respondents questioned the purpose, validity and integrity of the consultation process. In particular, some said that the HPC had failed to consult on its suitability as a regulator of this field, or the relative suitability of other organisations or regulatory approaches’. They said that the HPC had failed to demonstrate the appropriateness of its system’. Stakeholder groups have repeatedly pointed out these are the central questions, and that they merit proper and serious consideration.

In the next section of the Council Paper 'Representative Organisations’, there is an acknowledgment that ‘the psychotherapy and counselling field does not appear to have a single or unified “professional voice”’. In fact, this is because the field is not unified in any sense and is not based on a single or unified body of knowledge or set of practices. Regulation under HPC requires that any field to be regulated display a homogeneity in its knowledge base and set of practices, yet this is not the case for the field of the talking therapies. This fact has been repeatedly pointed out to HPC yet its consequences have not been taken seriously.

Although there are many different perspectives on the question of regulation currently in the field, HPC continues to misrepresent the debate by suggesting that all those individuals and organisations who oppose HPC regulation are opposed to statutory regulation as such. Yet they know very well that no one really questions the principle of statutory regulation: it is just the question of who should be the regulator. This fact was made clear at the November 2nd meeting held at Westminster convened by Anne Milton MP, at which Marc Seale perpetuated this spin and was corrected in the discussion by the MP and by stakeholder groups.

There is also the question of the involvement of service users in the consultation process. HPC documents have repeatedly referred to the involvement of service users, yet in fact this has meant the involvement of advocacy groups claiming to represent the interests of users. In fact, the user groups which have specifically asked HPC to be represented on the PLG were denied representation. There has thus been a wholesale exclusion of real user groups. The HPC has instead chosen the advocacy groups it knows will support its own recommendations. There are two further questions here. Firstly, it is well known that one of the largest client groups of psychotherapists are psychotherapists. Psychotherapists are thus service users. Indeed at the November 2nd meeting at Westminster, the ‘service user’ that MIND brought with them was in fact a qualified psychotherapist. The second question here regards the political manipulation of service users. Those in therapy may be in favour of statutory regulation yet to suggest this must mean HPC regulation without making all the other models of statutory regulation available to service users for their consideration is surely an abusive process which is using the voices of ‘service users’ for political ends.

If we turn now to the question of 'building blocks', identified by HPC as central to its whole consultation process, there has been no agreement concerning the differentiation between psychotherapists and counsellors; there has been no agreement regarding the question of the draft standards of proficiency; and there has been no agreement re the question of standards of education and training. The proposals put forward so far by HPC have been deemed inadequate and confused, yet given this disarray the Council Paper proceeds as if the HPC’s recommendations should simply be accepted, with the absurd proviso that most of these recommendations have in fact yet to be made. The paper 'Conclusions on the Proposed Statutory Regulation of Psychotherapists and Counsellors' actually concludes with the statement on page 12 that ‘no conclusion’ can be drawn regarding education and training and standards of proficiency.

It is surely time for the HPC Council to recognise the complexity of the field it is dealing with and to have the honesty and courage to reassess the HPC’s suitability as regulator in the interests of both public protection and the protection of the ethics and vitality of the field of the talking therapies.

HPC execute a summary of responses to their consultation

The HPC have published their summary of the 1,105 responses to their consultation on the regulation of counselling and psychotherapy. The Council will meet on 10 Dec (email Louise.Hart@hpc-uk.org to reserve a place to observe), and will be asked to agree the preliminary conclusions and to endorse the summary for public consumption.
Here are some noteworthy points from the executive summary and recommendations:
The HPC open with a clear reminder to the Government that it is only following their orders. Ultimate responsibility for the regulation of Counsellors and Psychotherapists is unambiguously laid at the feet of Government. This may indicate that the PLG will now be by-passed, with the debate returning to Parliament, or to the Dept of Health.

The HPC carefully present their position: “As the White Paper contained an unequivocal statement of policy by the Government that (subject to consultation and legislative approval) psychotherapists and counsellors would be regulated by the HPC, the task undertaken was limited to examining the practicalities of implementing that policy.” [emphasis added] (p2). This points to the particular ambiguity between State and statutory regulation as played out in this case. A few lines later this fudge is repeated: “it is important to note that the work was not intended to produce final drafts of either SOPs or SETs but was more in the nature of a feasibility study” [emphasis added] (p2).

The nature of this feasibility study was stretched over the course of a year, with 17 experts meeting five times to draw up recommendations, which were then circulated for consultation. So badly done was this, that it provoked an unprecedented 1105 responses of which 88% (968) were from individuals. 78% or the respondents disagreed with the first recommendation - that the register be structured to differentiate between counsellors and psychotherapists.

During this so-called ‘feasibility study’ the HPC have so far managed to identify “more than 40 organisations that represent the interests of Psychotherapists and Counsellors in some way, and it is likely that there may be others … not yet identified” (p3). After a year’s consideration the HPC have concluded that ‘the psychotherapy and counselling field does not appear to have a single or unified ‘professional voice” (p3) Extraordinary. The consultation showed the HPC that ‘there is a lack of consensus’ on the following 4 points: the need for statutory regulation, the structure of the register, the standards of proficiency, and the education and training requirements. Here are three of the four fundamental ‘building blocks’ of the HPC’s regulatory framework. The only brick that is un-contentious is that the titles Counsellor and Psychotherapist should be protected (around 80% agreement on this).
The HPC reminds its Council that it “should ensure that it takes into account that lack of consensus in reaching its conclusions” (p4).

Section 4 of the executive summary is devoted to the structure of the register. This is the core work of the HPC – it is, in essence, a database. If HPC do take on the ‘regulation’ of counselling and psychotherapy, it will be done by creating a new section in the database named Psychotherapists and Counsellors. This will become the 15th section of the register in which 14 other professional groups can also be found (eg Biomedical Scientists, Radiographers, and Paramedics). To enter any section of the register a candidate must pass a minimum level of standards that apply equally to all sections of the register. In addition, they must pass particular standards relating to their section of the register. Within that part of the register they will have access to one or more protected titles. Six of the sections have only one protected title, so no more standards to be met. However, the Psychologists have no less than 7 protected titles, each one of which is guarded by a different set of standards (3 other professions follow the same model, but with fewer titles). Four of the professions have more than one protected title but everyone can use either title. This last is called the ‘anti-avoidance’ provision.

So where does that leave Counselling and Psychotherapy? “In response to the consultation, the majority of respondents overall disagreed with the proposed differentiation and argued instead that the Register should be structured so that both titles were protected but could be used by any registrant registered in that part. This is similar to the chiropodists and podiatrists…” (p5).

Soul-wrights are similar to sole-wrights, yet different. So, what is the HPC to do? “The HPC considers that it is not possible at this stage to conclude whether the Register should differentiate between psychotherapists and counsellors without further work being undertaken on standards of proficiency” (p5).

The HPC concludes that “it is necessary to protect [both] titles” (p7) yet this produces problems where overlaps occur with professions completely outside its domain. “For example, if a nurse used counselling skills in their work but did not refer to themselves as a ‘counsellor” then, oddly enough, they would not need to register, so long as they didn’t call themselves a counsellor, but subsumed the skills within their nursing function.

Similarly, for someone in the RCP (psychiatry) or the GMC (both of whom are separate regulatory bodies and sit alongside the HPC ‘under’ the CHRE) the “HPC concludes that if it is clear to a member of the public that someone is a medical doctor … then it would not be necessary for them to become separately registered [with us]. This is an area that should be the subject of further discuss¬ion with the GMC and the RCP” (p7).
In all other professions (ie physiotherapy, arts psychotherapy, biomedical science, radiography) then dual registration is recommended. This creates, or rather supports, the traditional hierarchy that raises doctors and psychiatrists (and nurses) above all the other associated health care ‘professions’. The unresolved problem here is that an image of equality is floated by the new regulatory structure, which conceals the actual structure in play. Ambiguity & confusion follow on.

Section 7 of the executive summary considers which registers would be transferred by any future Section 60 legislation. On the one hand the HPC have got agreement on the criteria to make this judgement, but on the other they conclude “that deciding which registers will [be] … a matter for Government” (p9). To ease the practical difficulties, the HPC propose a longer, three stepped approach to data transfer.
They also recommend a longer grand-parenting period: 3 years, instead of the 2 the PLG agreed on.

The question of generic standards (ie the imperatives to control infection, submit to management and audit plans etc) brings further fog to the process. The executive summary notes that this was raised as a problem in the psycho¬logy consultation. Apparently this led the Education & Training Committee to agree (a year ago, on the 2 Dec 2008, 2 days before the first PLG for C&P) to “undertake a review”. After a year the HPC report that “some initial work has been undertaken … in the light of the feedback previously received”. They then conclude “the Council is requested to agree that any further consideration of draft Standards of Proficiency for psychotherapists and counsellors is deferred until such time as the Council has concluded the current review of its existing generic standards” (p11). So, before thinking about the criticisms of the Counsellors and Psychotherapists, they want to deliberate further on the criticisms of the Psychologists. Just how long is this supposed to take?
The majority of consultation responses disagreed with the proposed educational entry levels for counsellors (Level 5) (74% disagreed) and psychotherapists (Level 7) (65% disagreed). Further consultation will be necessary.

In spite of all this, the HPC concludes by stating that it has “not identified any specific issues that would prevent psychotherapists and counsellors from coming into the system of independent statutory regulation operated by the HPC”. Remarkable. Has anyone ever seen a feasibility study like this before?

Finally this document asks the Council to decide “whether the HPC systems are capable of accommodating and meeting the regulatory needs of psychotherapists and counsellors. Marc Seale (the Registrar) is supposed to inform Andy Burnham (the Secretary of State) of the conclusions (p13). In spite of all the logic, reason, and legal arguments put forward by more than 1000 people, the HPC continue to ignore anyone who gets in their way, choosing instead to press on with their advantage. The whole document pushes the Council to say Yes. Scandalous.

The problem with HPC regulation

Introduction
All of us who work in the field of counselling and psychotherapy, or who have an interest in it in any way, were called to respond to three documents posted on the Health Professions Council (HPC) website on 14th July 2009. The deadline for our responses was 16 October 2009, and the HPC was staggered to receive over 1000 replies. In July I wrote a report to guide some of the training organisations who were formulating their response. This coincided with an invitation to speak at the Psychology of Women Section Annual conference, where I was subsequently invited to submit a report on our HPC experiences for POWS Review. It seems useful to offer you that summer report. It offers an insight into some of the implications of HPC regulation for not only counselling and psychotherapy but for those professions, including practicing psychologist, who are already under HPC regulation.

Here follows the July 09 report …
… Few of us will know much about the background to this consultation but will probably be familiar with the catchphrase that this will ‘protect the public’. However, the lack of proper information, and the surfeit of spin provide an unsatisfactory background with which to approach it. So, it is vital that as many people and organisations in the general field of counselling and psychotherapy as possible respond to the call in order to protect the profession, and hence to protect the practice and the experience of the patient or client for many years to come.

The HPC documents appear straightforward, but are really quite difficult to understand – at times they are just plain baffling. Probably, many people who approach these documents for the first time will find them dull, confusing, and will want to walk away. Here’s an example of what awaits:
“Paragraph 2, Section 8, Education and training (p39): The HPC visits education and training providers to approve pre-registration education and training programmes against the standards of education and training. The standards of education and training are those standards necessary to ensure that someone who successfully completes that programme is able to meet the standards of proficiency for their part of the Register (the threshold standards for safe and effective practise).”
Some may hope they can take a short cut straight to the consultation document, but will find the questions assume an orientation that will need some thought to fully understand. For example, question 3 asks about structuring the register to include child psycho¬therapists as a separate title. This could easily be understood in exactly the opposite way to that supposed by the HPC and go on to produce negative unintended consequences. Most people might think: yes, you need special training to work with children. But this is not what is being asked. The relation between training and registration is not straightforward. The relation between regulation and practice is not straightforward. Nothing here is straightforward.

For the last two years I have been tracking the development of this process, and studying the sociological perspectives. This is a an important moment for the field, and everyone who cares about the tradition of psychoanalytic work needs to engage with it now, the deadline for the consultation is 16th October. There are some particular patches that might throw people off course, and I have tried to clarify these.

A potted history of the new statutory body
It is essential to grasp that this form of regulation is not the statutory regulation that much of the profession has been asking for over the years. That was a demand for power to be passed by statute to the existing professional body that would then administer business on behalf of its field of expertise. The current proposal is quite different and would more correctly be called state regulation. The difference needs to be appreciated when approaching the consultation exercise because the baseline assumptions behind the current proposals represent the complete opposite of what many will be expecting. The two approaches belong to different paradigms and don’t share common assumptions.
The Health Professions Council was created by the Health Professions Order, 2001, a piece of secondary legislation arising from the 1999 Health Act. The following year another piece of legislation (NHS Reform and Health Care Professional Act 2002) created a ‘supreme’ regulatory body, the Council for Regulating Health Professions (later renamed the Council for Health Regulatory Excellence, the CHRE), though the budget supporting it leaves it in quite a weak position. In any event, it is the HPC that receives the statutory powers delegated by Parliament to regulate the profession, not the profession itself. Here is a list of the organisations regulated by the CHRE, which shows the kind of practices regulated within this new regime.
1. General Chiropractic Council (GCC) regulates chiropractors.
2. General Dental Council (GDC) regulates dentists, dental nurses, dental technicians, dental hygienists, dental therapists, clinical dental technicians and orthodontic therapists
3. General Medical Council (GMC) regulates doctors
4. General Optical Council (GOC) regulates optometrists, dispensing opticians, student opticians and optical businesses
5. General Osteopathic Council (GOsC) regulates osteopaths
6. Health Professions Council (HPC) regulates the members of 14 health professions: arts therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists, dietitians, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, practitioner psycho¬logists, prosthetists/orthotists, radiographers, speech & language therapists
7. Nursing and Midwifery Council (NMC) regulates nurses and midwives
8. Pharmaceutical Society of Northern Ireland (PSNI) regulates pharmacists in Northern Ireland
9. Royal Pharmaceutical Society of Great Britain (RPSGB) regulates pharmacists in England, Wales and Scotland
From a Centralist Government point of view, the HPC sits alongside the GMC and GDC under the CHRE. This view tends to obscure the essential difference between the HPC and all those other bodies, and creates the appearance of equality across a set of practices.

HPC, like its overseer the CHRE, has no practical knowledge, expertise or experience, and this is an innovation introduced by academic lawyer Ian Kennedy through his chairmanship of the Bristol Royal Infirmary Inquiry (see also his Reith Lectures published by George Allen & Unwin in 1981 as The Unmasking of Medicine). The CHRE and the HPC are not guided by issues of knowledge or practice, but by the very vague mission given by government: ‘to protect the public’. They are answerable not to their membership, but to the State (incarnated in our time by Her Majesty the Queen Elizabeth II) via the Privy Council (a small team of 2 Lord and 2 MPs representing the Government, and whose membership changes from time to time). The relation between the HPC and its registrants is not one of knowledge, debate or democracy but of policing and control through the creation and application of standards. The HPC constructs standards general enough to apply across all the various professions within its domain, and perhaps this is why 75 of them seem to have been written for functionaries working in the NHS (e.g. ‘recognise the need to monitor and evaluate the quality of practice and the value of contributing to the generation of data for quality assurance and improvement programmes’ 2c.1.iii)

The kind of power that sustains the HPC is quite different from that which sustains the professional bodies. In the latter, the practical work itself forms the basis for organisation: to learn from experience, to transmit knowledge grounded in practice, to create structures of supervision and control of work, to guard access to that work, and to protect those who have chosen to follow the practice from the excess vagaries of life, and thus protect the practice. In this way, society can benefit from the knowledge, expertise, and experience of the profession in question. Some problems that arise in this form of organizing include the rise of cliques who might sometimes exert undue influence on groups, or the tendency towards sloth and greed that is said to accompany success and middle age! The laws of natural justice, of ordinary rivalry and competition, a sense of duty, ethics, and pride – and of course the influx of youth – have traditionally been relied on to hold these tendencies in check.

The HPC, on the other hand, is set up on the understanding that, having no interest in or experience or knowledge of the practice, it will not succumb to the pressures of self-interest, (and by the way, it currently appoints to its Director posts no-one middle aged …). This is supposed to reduce the threat of abuse by cliques, and to make it safe for government to delegate statutory power and responsibility over professions without further need of debate in parliament. Once this assumption is accepted, the Government can satisfy the demands of many professional groups wishing to gain access to statutory power without having to consider a separate Bill and Act for each one of them. This effectively circumvents the debate traditionally deemed necessary when forging a new law.

In practice, the Department of Health must still expend the same amount of work to draft legal documents (Section 60 orders, which refer to section 60 of the 1999 Health Act) for each professional group, but the government is spared the work of debating each one in the traditional manner that would normally turn a Bill into an Act. The debating process is, then, delegated to the HPC who in their turn transform the process by managing it through its Professional Liaison Groups. There are, of course, important differences between the two kinds of debate: notably the structure and space for criticism and dissension is removed in the HPC.

As a result of this historical development, the structure and assumptions of the HPC emerge in opposition to the work of psychotherapy and counselling, and there is reason to be concerned about the effect this will have on practice post regulation. Some training organisations believe that they will be able to reform themselves as ‘buffers’ to protect practitioners from the regulator, some practitioners think they can create their own personal defenses by simply ticking the right boxes, and getting on with things as before. Few people have given detailed consideration to the realities behind these ideas, little literature appears to exist on attempts made to date in this field (but see Michael Power’s work on the Audit Explosion, Max Travers on The New Bureaucracy, Marilyn Strathern and Hari Tsoukas on the Tyranny of Transparency, and of course, Andrew Sparkes’ innovative fictional approach to academia post RAE).

To really understand the grounds on which this consultation is made, it is very important to grasp the consequences that follow from the shift in power base away from practise and towards legal standards. As these standards come back at practitioners from the independent and more powerful organisation (HPC) practitioners will find it less and less easy to take their bearings from the truth of their work. The move towards the HPC is one that gives power to the artifice, and opposes this power to that which comes from the real work. As artificial power becomes more valuable, practitioners will be more concerned that their institutions are well placed in the new system to benefit from that power. This tends to amplify conflict in the field, and polarize positions: it can easily generate a vicious cycle.

The HPC consultation lists about 50 standards applicable to both counsellors and psychotherapists, with a further 3 specific to psychotherapy, and 2 specific to counselling. These latter appear on the last pages and give the HPC something with which to differentiate their register. It is worth noticing that in this context there is no need to protect each title separately, but to ask the practitioner concerned to decide which one they are fit to use. NB: If the HPC are to successfully protect the title of Counsellor they will have to amend the law (HPO, 2001) and specify the field as one pertaining to mental-health wellbeing.

Engaging with the consultation
If you have asked for the consultation document to be sent to you in the post, you will have a thick set of papers printed back to back and held together with a very large staple. If you have downloaded it from the website, you will have three separate documents that you can manipulate a bit more easily. The actual consultation (stapled at the front of the posted pack,) asks 20 highly configured questions and attempts to keep the consultation within the frame already decided. However, question 14 asks whether there are standards which should be added, amended or removed which does allow for something more unexpected to be said.

The longest document is Michael Guthrie’s report. Michael is the Acting Director of Policy and Standards, and in spite of the grand title (and enviable youth) is not experienced in any of the areas that he now has jurisdiction over. It has been Michael’s job to turn the process of regulation into a written record, to negotiate off- stage with the solicitor on questions of legal possibilities, and to make sure the capture takes place with as little fuss as possible. He has produced a rather confusing summary of the outcome of this work, which you could look at on page 3, but that I have edited here for simplicity.

The HPC propose that:
1. The register be structured to differentiate between psychotherapists and counsellors by making each one a protected title.
2. The criteria for transferring databases from existing registers be those laid out on page 29, section 5.3 paragraph 18: i.e. prospective registers need to be clear about criteria for entry onto their register; show how its people meet those criteria; have an obligatory code of ethics tied to a complaints process; demonstrate a well functioning complaints process; CPD; commitment to supervision consistent with theory;
3. The minimum national educational level for entry into the profession for Counsellors be 5 on the National Qualifications Framework, and 7 for Psychotherapists. (This does not mean that a counsellor with level 7 qualifications can enter as a psychotherapist, it only means they have more than the minimum required to enter.) Level 7 qualifications are at a level equivalent to Master's degrees, postgraduate certificates and postgraduate diplomas.

There are 8 numbered sections to the report, but the real business is found in section 4. Michael’s job is to produce an object (Psychotherapy and Counselling) that can be taken into the HPC database, bringing onto the Register as many people in as simple a way as possible. The data will be ‘cleaned up’ later, and the entry level to the database will be ‘gradually raised’ over time. Section 4 is where discussions begin about structuring the register and protecting the titles. Once this is settled – which is essentially a job of setting the shape of the database – the rest of the sections address themselves to the practical difficulties of bringing data across. This is why the proposal is to protect the titles counsellor and psychotherapist. They have rejected splitting the register into more specific areas (e.g. modalities) because the two proposed titles capture everyone concerned. The aim of the HPC is not to protect the various divisions within the field, but to hold a database of practitioners that can pay a fee and be held to account if a complaint is lodged against them. The practitioner has a duty to train specifically for any particular practise they are interested in. The database represents a minimum entry point, and to a large extent has in mind those freshly graduated from university. In fact, it is not really necessary to protect both titles. Once the section of the register is established (Psychotherapy and Counselling) registrants could be given responsibility to choose which title to use, when. This does not actually mean that anyone can be anything, because there is a demand that people only practice at the level to which they are qualified, it is here that the fault line of the HPC is probably most clearly exposed: on the one hand there is enormous reliance on people to do the right thing (which leaves the HPC open to the charge of being irrelevant, ineffective, and wooly), and on the other hand there is a very harsh and punitive public application of law for the minority of people (less than 0.5%) who are reported on, (which leaves the HPC open to the allegation of running show trials). If you want to argue for more specific titles, e.g. modality based, then you should bear in mind that the HPC is not designed to cope with this. To specify modes of practice implies constructing specific standards that allow a lawyer to argue effectively in a fitness to pratise hearing or at a Magistrates court (where use of title may be contested).

Section 5 wonders which existing databases should be transferred from the psychotherapy and counselling organisations already in existence. Section 6 considers how to structure the entry point for individual practitioners who are not already on those lists.

Section 7 is more problematic, and refers directly to Appendix 2. Here is where things can become very confusing unless you appreciate the function of the Standards of Proficiency (SoPs) from the HPC point of view. You will notice that most of the standards begin with the words ‘understand the need to’ rather than ‘be able to’. This is because the HPC see things very much from a mass educator point of view. The University sector is a major source of registrants for the other sections of the HPC register, and the HPC spend a lot of effort laying the tracks for students to roll straight onto the register when they graduate. The parts of the register, then, are not intended to create boundaries around specific sub-practices, as this would create a protected market for the practitioners concerned. From the HPC point of view, they want to make it possible for as many different practitioners to enter onto the database in as simple a way as possible. For our part of the register, this has a direct bearing on the question of working with children. The HPC doesn’t need a separate category for those who work with children. If a separate category is made, then specific SoPs have to be created. The slogan ‘to protect the public’ gets in the way here. The HPC is essentially a database that allows complaints to be made, lawyers to be engaged, and cases to be heard. The protection of the public is not achieved through prevention, nor by enlightenment and it is here that the real tension between ideologies begins to become clear.

Section 8 presents another set of problems. Here is where the HPC begins to exert a backward pressure onto the work of the various training institutions. Even though “The HPC only approves programmes that lead directly to an individual’s eligibility to register and gain access to the relevant protected title for their profession” (paragraph 4). The trainings are only interesting to the HPC in so far as they produce the right shape of data for easy entry onto the register. However, their interest, together with the power invested in them, has a distorting effect on the structure and delivery of training. Here is another potential stumbling block for practitioners. Unless the nature of the HPC is understood, power will be handed over to a body that will not be capable of wielding it wisely.

The list that appears under the title Standards of Proficiency has never really existed until now in our practise. There have been many attempts over the years to find a way to reduce what we do to a centrally applicable list, but the attempt always fail. That the list has now been created is not due to a sudden scientific breakthrough, but because the HPC need it in order to function and set a deadline for its production. It is an artifact of the HPC and has no practical relevance to practitioners nor to training institutions. It will acquire relevance in future in order to satisfy the HPC in their future demands. It is helpful to bear this in mind when reading the list of standards. Many of them have no obvious logic behind them – they were written by a committee under a deadline, and an imperative to appear united.

The Existing, and the Proposed Standards of Proficiency
The Standards of Proficiency have been divided into three numbered groups:
1. Professional Autonomy and Accountability;
2. Identification and assessment of health and social care needs; and
3. Knowledge, understanding and skills.
Each of these sections is split further and given letters, and many have yet a third and even a fourth level of division, giving the impression of structure and order yet it is almost impossible to distill any logic from the sections and the sub-sections. It makes more sense to read them as a managerial agenda.

A second dimension also exists, and has been depicted with three different inks. This distinction refers to the kind of professional implicated in the particular standard of proficiency. The three levels are:
1. All Professionals on the HPC register,
2. The specific section in the register relating to the single profession now known as Psychotherapy & Counselling, and finally
3 either (a) Counsellors or (b) Psychotherapists.

The generic standards will be going forward for review in a separate exercise, though these standards represent a central spine of the HPC. Any comments you wish to make about them will be held until the designated review, but if you want to comment on their impact on counselling or psychotherapy practise, or their relevance for such, then you should certainly make your views known now. Remember, any review of the generic standards will be subject to input from every other profession, and this set of standards are in a sense the back bone of the HPC. All the professions in the HPC are supposed to be equivalent on a certain level - “the Government believes that all professionals undertaking the same activity should be subject to the same standards of training and practice so that those who use their services can be assured that there is no difference in quality” (Trust Assurance and Safety, White Paper 2007, para 7.17).

References
Ian Kennedy (1981) The unmasking of medicine, LondonGeorge Allen & Unwin
Michael Power (1994) The audit explosion, London Demos
Michael Power (1994) The audit society, rituals of verification, Oxford: Oxford University Press.
Andrew Sparkes’ (2007) Embodiment, academics, and the audit culture; a story seeking consideration, Qualitative Research, 7, 581
Marilyn Strathern (2000) The tyranny of transparency, The British Educational Research Journal, V26N3
Max Travers (2007) The new bureaucracy; Quality assurance and its critics, Bristol, Policy Press
Hari Tsoukas (1997) The tyranny of light; temptations and paradoxes of the information society, Futures 29(9) 827-43

Report 34, w/e 13 Nov 09. New UKCP Chair is Andrew Samuels

At 4pm on Monday 9th November the UKCP published its election results on the web. They had been expected at lunchtime.
UKCP election for Chair:
Total votes cast: 3,186
Total votes for Andrew Samuels: 2,108
Total votes for Carmen Joanne Ablack:1,074
Number of eligible voters: 6,714
Number of votes found to be invalid: 4
This was the first time that individual registrants have been eligible to vote in the elections for Chair of the UKCP and Tom Colling of the Electoral Reform Services (the independent charity commissioned to administer the voting) said: 'Turnout was very high when compared to that of other organisations. Fifty per cent is impressive”. This election marks the beginning of a new era for the organisation and is clearly a landslide with grassroots members showing their opposition to the organisational strategy to enter the HPC.
The election process, however, was plagued with bad feeling, bad behaviour and bad administration, and new Chief Executive Officer, David Pink, issued a statement on 4 November in which he said “With James [Antrican’s] support, I am asking the Board of UKCP for an independent, sober inquiry and review. I want inquiry and review, not a witch-hunt. UKCP has new lay trustees who are due to take office on 5 December; I will recommend that they are involved in the review. I think we will need to examine where things went wrong and what could have been handled better, but we need to do all this as part of a process that leads to healing and learning.”

On Saturday 7th November, at The Kings Fund, Cavendish Square, 7 UKCP Chairs, past and present, gathered to tell a story of the UKCP’s pathway toward statutory regulation. James Antrican conceived this idea as part of his final contribution as current Chair (which will be handed to Andrew Samuels on 5 December), and he used his presentation to speak of politics, controversy and power – ‘we are trying to bring psychotherapy into the world’.
The panel of speakers reflected the trajectory of history from Michael Pokorny’s optimistic days at the Rugby Conference with its dreams of independent statutory self-regulation, through to today’s ambivalent desperation about the prospect of the HPC. Michael Pokorny was clear that HPC was not right for this field, but the second speaker, Emmy van Deurzen (93-95), thought it a fantastic opportunity for the UKCP. In spite of her forthright enthusiasm she added that there was ‘a lot of rubbish’ to be cleared up before they entered, and in particular she named the ‘nonsense policy’ on criminal records, and the absurd lack of a mediation process.
Anne Casement’s presentation marked a turning point. It was during her time in the Chair (88-2001) that the Government axed all hopes of statutory self-regulation and announced its intention to impose the HPC. She resigned before the end of her term, and perhaps this would help explain why she used her UKCP talk to praise up the BPC.
Over wine and canapés at the end of the day news seeped out that the HPC had postponed the final PLG meeting, scheduled for 18 and 19 November. Both the Chair and Chief Executive of the HPC attended the afternoon meeting.
The formal notice of postponement was emailed at 1pm on Monday 9th:
• It spoke of ‘potential’ regulation yet proceeded with its intention to regulate.
• It admitted receiving an unprecedented 1000 responses to the consultation.
• It said that the Council meeting (10th December), would consider the analysis of these responses, and invited the PLG to observe.
• It anticipated “the PLG will be reconvened to undertake further work in revising the standards of proficiency”.
• Finally, it mentioned Anne Milton’s meeting from 2 November where: “participants felt that there needed to be more opportunities for discussion and debate both with HPC and within the field, about regulation.” However, any possibility of their exclusion as regulator is pre-empted by their intention “to hold a series of events next year to engage with the wider field”. These events, they say, will feed into the planned continuing work of the PLG.”


During this week some colleagues have been contacted by ‘call centre researchers’. One practitioner said “I've just had a telephone call from someone wanting to conduct a telephone interview on counselling and psychotherapy. She said she was from Skills for Health. When I asked her what it was in aid of, she told me it was something to do with the HPC but could not be more forthcoming. She said there ‘are a lot of counsellors out there who are not properly qualified'. I asked if she could send me the questions in writing but she refused, saying they were all 'on the computer' and the questionnaire could only be administered over the phone. I wondered if this was the start of the HPC/SFH's campaign to discredit anyone who opposes their regulation and/or to gather 'evidence' that there are indeed a lot of therapists 'out there' who are not 'properly qualified'.”

The BPC stage its third Savoy Conference on 26 and 27 November (£390). This series of conferences are run by The New Savoy Partnership, chaired by Jeremy Clarke, Chair of the Association for Psychoanalytic Practitioners in the NHS. Although the stated aim is to increase access for patients to a range of psychological therapies, the political distortion of these events make them seem more and more like a concerted campaign to increase the access of BPC members to jobs in the NHS and control over the training of others.

Any good intentions are buried beneath the more obvious power politics that is running roughshod over any genuine enlightened endeavour. The slogan ‘evidence based practice’ is announced in the very first paragraph of the blurb, and is swiftly followed by a statement that Andy Burnham (current Secretary of State for Health) will speak about the government’s New Horizons Framework. New Horizon takes over from the 10-year plan known as the Mental Health Framework, which saw the creation of a Mental Health Czar (Louis Appleby). It is “about driving up standards of mental health services, but also about promoting public mental health and wellbeing more widely. We want to prevent people getting depressed or mentally unwell in the first place.”
http://www.penninecare.nhs.uk/about/news/news-item/?doc=1421

BACP online Magazine Therapy Today carries letters and news relating to these concerns: The KCL Research: http://www.therapytoday.net/article/show/1427/)
The legal challenge (Bindman)
http://www.therapytoday.net/article/show/1420/
Letters: http://www.therapytoday.net/article/show/1437/
http://www.therapytoday.net/article/show/1439/
http://www.therapytoday.net/article/show/1440/

Against State Reg 2821 Against Over Reg 1711

Thanks to colleagues for their work in generating leads and information. Feedback welcome.