In a small room beneath a Covent Garden Bookshop, a fluid group of 20 or so people meet monthly to divvy up parts and read Shakespeare’s plays aloud. Last week it was The Tempest. Prospero (banished from his Dukedom this 12 years) introduces his brother, now the Duke, to his daughter Miranda with these words: “Thy false uncle …
Being once perfected how to grant suits,
How to deny them, who t’advance, and who
To trash for overtopping, new created
The creatures that were mine, I say, or chang’d ‘em,
Or else new form’d ‘em; having both the key
Of officer and office, set all hearts I’ th’ state
To what tune pleas’d his ear, that now he was
The ivy which had hid my princely trunk,
And suck’d my verdure out on’t.
a little speech about the administrator gaining power over the Duke to gratify his envy and ambition…
At the Confer Conference, Dr Michael Fischer presented a summary of his work at KCL (Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling, 2009) and commented “there is a common perception in other fields, for example psychology, that an elite group has captured the regulatory process to further their own agenda.”
BPC Chair Julian Lousada (and member of the HPC PLG for C&P) had commented that he had seen no evidence that HPC regulation would change what went on in his consulting room.
This week at a major London Universtiy Psychology Deparment, this letter was sent round to the staff:
BPS and HPC accreditation visit Doctorate –
The Health Professions Council and the BPS are undertaking an accreditation visit to us. As a part of this visit they are keen to talk to supervisors and heads of service about their experience of the Course, of the trainees, and of training generally.
From past experience of these visits the HPC and BPS visitors will try to make this a fairly informal meeting, and the likely focus will be on the links between us (as a training provider) and the NHS (where the training is put into action).
We would like to invite you to attend this meeting [and] will reimburse travel costs, and provide some nice refreshments... etc
These are the points to situate what follows.
I went to the HPC this week to observe the Education and Training Committee Meeting that was billed as happening on Tuesday 2 February. The website was my guide, but no papers had been posted. I requested permission, and turned up in time for a supposed 10am start. A name tag was waiting for me at reception. After 20 minutes wait in the decompression chamber (you really have to go and discover this yourself) I asked Sonia what was up. It transpired that the meeting started at 10.30, and only one member had so far turned up. I asked if there was a pack of papers to read while waiting. She told me I should have downloaded them from the internet. I replied that the papers had not been posted, and asked if she might telephone the administrator to see if a pack were available. Slight tension. When she did, she again told me the papers were on the internet. “Not on my internet they weren’t” was the best I could do, with a smile.
The charming Steve, who had come to collect me (it is ridiculous to have to be shepherded like this – whose rule is this?) apologised for the lack of paper work – he had been off sick, but had asked someone to do this for him. They didn’t do it. As we drew near the committee room he asked if I had ever observed a panel before, and this brought me to a halt. Panel? I thought this was the committee meeting that was supposed to be discussing the applicability of the generic standards? No, this is a panel, where four ‘partners’ and three nameless administrators meet to discuss the “programmes in respect of which approval/ ongoing approval is recommended without conditions, or subject to conditions.”
This little panel was meeting to consider the reports written subsequent to visits around the country to where training is carried out by the ‘accrediting’ institutions.
Apparently, the HPC find it necessary to know each time the course leader is changed. Dr Jo-Anne Carlyle (a self employed Psychologist, Psychotherapist and Consultant) ventured a question. She said she was intrigued to discover that ‘programme leader change’ is considered a ‘major change’ and intrigued that HPC were interested in this.
Professor Diane Waller, the only member today who is also a member of the recently reduced HPC Council, said ‘it is a safe-guard for the staff’. Presumably a version of ‘protecting the public,’ in this case protecting the shrinking and frightened Programme Leaders employed in 21st century British Universities, from being forced to do something by the administrators and quality auditors at their college.
Helen Davis, Chair (Orthoptist, and, coincidentally Senior Lecturer at the University of Sheffield) added that ‘the profession finds it useful to keep a check on what is going on’.
There is a slippage between the HPC and the Profession. Here, Helen speaks of the profession as if it is coterminous with HPC. This ignores much in general, and everything that HPC says about itself – that it is independent of the professions and thus not subject to the tendency to close ranks against outsiders in order to protect itself. It also obscures the fact that it is the HPC who advertise, interview, select, train, and appraise the partners they use in this processes. Helen Davis does not represent the profession. Why does she not know this?
This week’s meeting was over in 22 minutes and the Chair said ‘we don’t get so much discussion as we did because the administrators are more involved. It is slightly more formulaic now, but more consistent.” Much of the work of the scrutinising panel is done at HQ where the administrators scrutinise the paperwork into a form that they can regulate. The administrators present at the meeting spoke almost entirely in the building block phrases of audit culture:
this is a major monitoring tool
It is subject to a major change
Scrutinise these changes by documentation
We have a 7 point programme
The committee is asked to approve
There is major impact on education providers
It is a well justified decision
An evidence based decision
It followed the logic process
We made a clear and reasoned decision.
Etc
The fourth Partner present at the panel was Mr Stephen Wordsworth (Head of School for Health and Social Care at Derby University – an operating department practitioner). At the end of the meeting, one of the administrators (surely in his early 20s) was delegated the task of guiding me back to the front door (for goodness sake). He gallantly offered to answer any of my questions. So I asked him which of the Partners was also a member of the full Council. He looked blank. No idea. What?
In the executive summary of the papers for the meeting is the statement: “The Health Professions Council (HPC) approve educational programmes in the UK which health professionals must complete before they can apply to be registered with us. The HPC is a health regulator and our main aim is to protect the public.” Etc.
There was a brief to and fro in the Panel meeting where Di Waller lamented the fact that ‘people just don’t understand’ that they can’t claim to be ‘state registered’ psychologists etc. This is an ongoing problem, apparently. People out there just don’t understand what the HPC really is. Di was surprised at the Confer Conference that people out there continue to think that the Standards of Practice and the Standards of Education and Training are being used to shape the curriculum of various training programmes. Like Julian Lousada, Di Waller seems to think that the job of the regulator has nothing whatsoever to do with the practice it seeks to regulate. Odd.
Odder still, however, is that the paperwork for this meeting, clearly states:
Introduction:
“The HPC visited the programme at the education provider to consider major changes proposed to the programme. The major change affected the following standards – curriculum and assessment. The programme was already approved by the HPC and this visit assessed whether the pro¬gramme continued to meet the standards of education and training (SETs) and continued to ensure that those who complete the pro¬gramme meet the standards of proficiency (SOPs) for their part of the Register.
Under ‘Sources of Evidence” a series of tick boxes ask:
‘Mapping document providing evidence of how the education provider has met the SETs’ and
‘Mapping document providing evidence of how the education provider has met the SOPs’.
Under the Recommended Outcome:
“To recommend a programme for ongoing approval, the visitors must be assured that the programme meets all of the standards of education and training (SETs) and that those who complete the programme meet our standards of proficiency (SOPs) for their part of the Register.” …
“The visitors agreed that 47 of the SETs have been met and that conditions should be set on the remaining 10 SETs.”
“Conditions are requirements that the education provider must meet before the programme can be recommended for ongoing approval. Conditions are set when certain standards of education and training have not been met or there is insufficient evidence of the standard being met.” …
Well, I suppose that solves the mystery of why on qualifying people advertise themselves as state registered, and also how the standards of training and proficiency work their way into the curriculum. One mystery still remains, however. Di was at pains to state that just because someone successfully completes an approved course, they are not automatically entitled to register at the HPC. Apparently people are asking why. Whether or no the why is answered, the fact remains: you have to apply to the HPC, who may turn you down, even with your new qualification from the approved course.
At the Confer conference Marc Seale kept saying that nothing was set in concrete, and that it was always possible to interpret. He also said that the HPC does not negotiate. At the time, these things seemed strange and meaningless. With a little time and attention a meaning emerges from the fog: nothing is set in concrete for Marc Seale for he is the new Duke; he and his acolytes can interpret the rules whichever way they like, and they don’t need to negotiate with anyone not in their clique. It is precisely this kind of thing amongst professional groups that is supposed to have provoked the need for the HPC in the first place (see Ian Kennedy’s Unmasking Medicine for a quick introduction to the argument).
The Shakespeare Readers Society is open to all. Info at
http://www.facebook.com/pages/London-Word-Festival/76602824994?ref=mf#!/event.php?eid=262356745978&ref=mf
Thursday, 11 February 2010
Tuesday, 2 February 2010
Confer Conf ( Part 2)
The Royal Court’s 2009 triumph, Jerusalem, opened at the Apollo theatre last night. The final drum beat called the audience to its feet: “come, you battalions. You fields of ghosts who walk these green plains still. Come, you giants.” And they came, stood, hollered, cheered, yelped, shouted and stamped and called the cast four times to take their curtain call.
Relatively speaking, something similar happened at the Confer Conference on Saturday last week. Paying roughly the same price for a ticket, this large audience of counsellors and psychotherapists was also moved to respond to the call that emanated from the stage. It was a long and hearty applause that met the interventions of Darian Leader (for the Alliance) and Andrew Samuels (for UKCP).
“The profit motive of corporations, the way the landscape is being made ever blander – these things are a horror to me. We’re facing difficult questions: how can the individual survive within these 'communities’ that are being worked into our society?”
Actually, these are actor Mark Rylance’s words in an interview about Jez Butterworth’s latest play just before it opened in Sloane Square last July (2009), but they could perhaps also be heard resonating around the room last Saturday.
Confer staged their play on the raised platform of the Ethical Society’s Conway Hall. Across the beam of the stage, carved deep into the stone, were the words UNTO THINE OWN SELF BE TRUE – the most famous advice of any counsellor, made famous by a play (Polonius to his son Laertes, in Shakespeare’s Hamlet). Under these words sat the line of speakers who had been selected by Confer, and given a few minutes to outline their positions before being subjected to a series of prearranged questions, constructed by the conference committee. This arrangement was not without its difficulties, but some important information emerged amongst the fraught exchanges, and some truth was achieved in the process. All in all, it was a pretty good show. To capture some of the spirit and information, I will present it as a kind of script taken from my notes written as the action unfolded. Often fragmented, it does coalesce into moments of surprising clarity. I have adopted the device of giving letters to indicate speakers simply. Here’s the key
A. Darian Leader (for the Alliance)
B. Julian Lousada (Chair of BPC),
C. Andrew Samuels (Chair of UKCP)
D. Marc Seale (Chief Exec of HPC)
E. Diane Waller (Chair of the Professional Liaison Group for Counselling and Psychotherapy for the HPC)
F. Michael Fischer (from Kings College London)
G. Lynne Gabriel (Chair BACP
Q. Questions
V. Voices from the floor.
A: we need to keep a space for different forms of practice.
B: members of the Institutions have been struggling with this job, but I, on the whole, am supportive of HPC. I ask myself, ‘would it interfere with the stance we take with our patients?’ I can’t find the evidence that it will.
[next to B is F, who is responsible for producing research evidence that strongly suggests that this form of regulation will adversely affect the stance professionals take with their patients. F maintains his composure, looking modestly at his papers, but the smallest tick flickers to life, just the once, under his right eye]
B: [continues] ‘Regulation’ is a toxic word. But we have to ask, are we adequately transparent? Are we adequately accountable? What I see here from you is an attack on the Nanny State. I happen to disa - [small pause, lips together, slight suggestion of ‘p’ before continuing almost seamlessly] - gree with that. We need the good container of the Nanny State.
C: we must reframe the division amongst us into a basis for constructing a solution.
D: I’m a boring bureaucrat in a grey suit. It’s my job. It’s what I do. We have a timetable towards statutory regulation, that’s it really.
E: I’m a 1970’s arts student, and a sociology professor. I am an integrative practitioner with curiosity. I ask: why do people make art? I was trained in the analytical approach, but not solely. I am used to dealing with tension in my job at the University - the Quality Assurance, Teaching Quality, which is exceptionally bureaucratic. I am pioneering, entrepreneurial, and I want to bring the regulator into this world, not leave him in the 1950s.
D: We don’t negotiate. It’s all in the hands of the Government. When the Section 60 is issued to Parliament it cannot be amended – it either stands or falls. This has never happened [the fall] in over 35 years. If it stands then there will be Gazetting, the Privy Council, it will be Enacted, then we will fix the Standards of Practice, and we will consult on that.
E: The wording of the Standards of Practice is quite old fashioned. It suits some of the professions, not others.
C: The PLG process did not work for us. D should not have written to the Government in December saying it was good to go.
D: We will have to make a Temporary Register – we have identified 60 voluntary registers, and my IT people will have to go through these taking out the duplicates, and cleaning up the data, it will be quite a job.
A: But the Judicial Review questions the whole process.
D: My legal people have instructed me that this question is sub judice, and given me preaction protocols to follow, these are careful ways that we are expected to behave.
A: it is not sub judice, and it would be perfectly proper to speak about it.
Q: What processes are there for the HPC to follow in order to take into consideration the ongoing concerns?
E: well, there was a Call for Ideas, the Professional Liaison Group, the Consultation. Actually, I would really like to say, I hear people say it was ‘a done deal’. It was not. It was not a done deal. It’s insulting to hear that. Insulting to the PLG. The criticisms that are made of the HPC are disrespectful to other professions.
D: Our Standards are not set in concrete.
C: We all have problems with the idea of auto transfer.
G: We’re in favour of a convention.
B: BPC are struggling with the issues. There are differences in the membership. Our register is not made up of members, but of institutions. I suppose that many of those who don’t agree with HPC regulation will not sign up and will practice under a different title, presumably Psycho-Analyst. The question is, how do you create a community? The problem with C’s model is there are no losers. But we have to ask, are we a coherent or a fragmented community, because we have to present a coherent front.
A: Why would we want to present a coherent front if we are fragmented? Surely this is what we work on with people who come to see us, who are suffering because they are struggling to present a coherent front to the world when they are in fact fragmented. [applause]
D: The Combo is under way, the titles of Counselling and Psychotherapy, the 3-year Grand-Parenting period, and the Register Transfer. But listen, the HPC is flexible. Nothing is set in stone.
C: Look, in Section 7.16 of Trust Assurance and Safety it says “With the exception of the new arrangements for the regulation of pharmacy, the Government will not establish any new statutory regulators. Psychologists, psychotherapists and counsellors will be regulated by the Health Professions Council, following that Council’s rigorous process of assessing their regulatory needs and ensuring that its system is capable of accommodating them.” You’re right, it’s not written in stone - it is enshrined in White Paper! [laughter]
A: and in Article 3.5 of the HPO2001 it states there is a Duty to Liaise with All External bodies and publics affected.
F: There is a common perception in other fields, for example psychology, that an elite group has captured the regulatory process to further their own agenda.
E: we did consult all parties
V: you didn’t consult us
E: no-one was refused a place
V: you refused us!
B: Collaboration with the HPC is good. But, the Fitness to Practice process is corrosive, punitive, and persecutory. We cannot have a system that doesn’t have some thought for the clinicians and their other patients. I don’t feel secure with the HPC FTP protocol. The question is, do HPC know that there are problems? I think HPC [pause] are [pause] do know. We had quite a robust, informed discussion on this.
E: The Generic section of the standards, are formulaic, and HPC has started a process of review. The system is not appropriate, and it’s been recognised as inappropriate. But, look, the SoP is not a curriculum document. Everyone makes that mistake. It should not dictate curriculum.
A: A detailed critique of the standards of practice has been made and made public. Its in the Maresfield Report, copies of which are at the front desk and downloadable from the internet. There are four main difficulties with them. First is the ‘infection control’ problem – that many of the generic standards have nothing whatsoever to do with our practice. The second is that they construe therapy as something applied to a passive patient. Third is the ideology that makes the human a piece of faulty equipment that needs fixing and setting back to work. Fourth, is the notion of audit and health. Many of the other HPC practices are contained and confined, not open ended, unpredictable and risky. For us, the patient is a potential, not a broken economic unit. [loud and long applause]
G: the Draft Standards of Practice are utterly unworkable.
C: Consultation needs to be real.
D: We don’t employ professionals directly, we set up a PLG. We advertise slots, people
apply, they do excellent work. I see no reason to change the PLG make up. The Standards of Practice are the very heart of regulation. I think our consultations are very thorough.
B: I’m perplexed by the enthusiasm, expressed by the audience in the length of their applause, to A and C. I don’t think we should pay too much attention to it.
V: Please don’t try to regulate my clapping [much laughter, and clapping].
E: I want to remind everyone that the Standards everyone are so upset were about actually written by the professions, I didn’t write them.
A: And I want to remind you that, according to the 2004 Doc, it is a requirement that any profession coming under HPC regulation be homogenous
D: it is not a requirement.
A: it is.
D: It isn’t. Look, we’ve just taken on seven different types of psychologists! Anyway, what’s written in the document is one thing, how we interpret it is another. Nothing is set in stone.
V: It seems to me that that real problem here is that the regulator seeks to replace real judgment with bureaucratic standards.
D: Standards go to the heart of regulation. If these are wrong, it won’t work.
V: It doesn’t work.
B: Standards are tragically low. What we need to ask is which organisations are the guardians of quality practice? It is not the HPC. We all share a common set of [pause], look we are the guardians of quality practice.
A: But do have a set of common skills? We might share one mode of practice – one that relies on the presence and place of the individual. Many might even agree that the single most important part of a training is someone’s personal therapy. But you can’t regulate someone’s personal therapy.
V: In the Liaison Group the impression is given that there is a free and fair exchange of views aiming at some kind of agreement. But some papers I have seen, got from the website, suggest that in fact the agenda is set by the HPC, answering questions that are of interest to them. This is not real liaison, more a mystifying exercise in domination by the HPC. Who did set the agenda of the PLG?"
E: [throat clearing, rambling and mumbling finally giving way to:] me, me and Michael Guthrie [administrator at the HPC].
V: Why is it only now that some people are arguing against HPC?
A: This has been going on for years!
D: The process is time consuming, frustrating, irritating. Some of these professions have developed over centuries, so when the regulator turns up and says ‘thank you, I’ll have that’, well, it’s understandable that some are unhappy. Look, I’m only doing my job, I’m a really boring guy, and nothing is set in stone, we are always able to interpret...
Here is the list of questions prepared by the organisers, and the timetable they hoped to adhere to:
10.05 What structures exist for further negotiations by members of the professional community with the Health Professions Council on areas that continue to be contested?
10.15 What capacity does the HPC have to address the ongoing concerns expressed by the professional community?
10.25 What would the consequences be of not joining the HPC register? Will the practitioners have their membership of their current umbrella organisation withdrawn?
10.35 What scope remains for amendments to the government’s decision to regulate psychotherapy and counselling via the HPC?
10.45 A summary of the findings of the Kings College research into the experience of being registered by the HPC – presentation by Dr Michael Fischer
10.55 How do the panellists believe the tension between the needs of the therapist and the patients/clients is best handled in our society? By an external government agency or an independent statutory regulator?
11.05 The HPC Standards of Proficiency are raising concerns because they are formulaic. How would the HPC ensure that these do not restrict good practice that is process-based and that will take into account ruptures in the practitioner-patient relationship that are often part of the therapeutic process?
11.15 How does the HPC intend to influence and regulate psychotherapy and counselling training curricula in the long term?
11.25 What would be the role of independent training organisations in a post- regulation culture?
Frustration from the audience forced the chair to abandon these questions and the timetable and brought questions in from the floor. There was a struggle.
Over lunch it became clear that members of the Professional Liaison Group (of whom only a very few were present today) were as much in the dark as the rest of us about the intentions of the HPC in the next few months.
Marc Seale’s remarks in the morning gradually began to make sense in retrospect. The December Council meeting (2009) saw him gain support from his Council to write to the Department Health saying ‘lets go’. That meeting also said it would reconvene a larger and more representative PLG to consider all the problems. This now seems to have fallen by the by. Seale said (Saturday) that he saw no reason to do things differently. He has written to the DH to signal the start of the drafting (of the Section 60 Legislation), waiving aside the inconvenience of 1,100 replies to the public consultation.
There is due to be a meeting of the Education and Training Committee of the HPC on Tuesday (2nd Feb) though the papers have not yet been posted (as at 3.30pm Friday 29th Jan). It is supposed to discuss the much maligned generic standards that apply across all the various different professions.
Meanwhile Seale seems to believe it will be possible (for him and those close to him) to ‘interpret’ things around the legislation, and put up with the few years of misery (of those a little removed from him) that will follow. He said ‘all professions are upset at first, but settle down after a few years’… !
In the afternoon the confer auditorium was organised into a ‘coffee house conversation’ and everyone got to have a say. In both groups I was in (which were very different from each other – two people were hostile to HPC, two were hostile to those opposing the HPC, one was just plain confused, and another was fulminating against the bureaucracy sweeping through the NHS and suspected the HPC of same) there was a common question asked: Who elected the member of the Professional Liaison Group? Stunned silence greeted the news that the PLG had been appointed by Diane Waller and the HPC.
Jerusalem is at the Apollo (Shaftesbury Ave) until 24th April.
Relatively speaking, something similar happened at the Confer Conference on Saturday last week. Paying roughly the same price for a ticket, this large audience of counsellors and psychotherapists was also moved to respond to the call that emanated from the stage. It was a long and hearty applause that met the interventions of Darian Leader (for the Alliance) and Andrew Samuels (for UKCP).
“The profit motive of corporations, the way the landscape is being made ever blander – these things are a horror to me. We’re facing difficult questions: how can the individual survive within these 'communities’ that are being worked into our society?”
Actually, these are actor Mark Rylance’s words in an interview about Jez Butterworth’s latest play just before it opened in Sloane Square last July (2009), but they could perhaps also be heard resonating around the room last Saturday.
Confer staged their play on the raised platform of the Ethical Society’s Conway Hall. Across the beam of the stage, carved deep into the stone, were the words UNTO THINE OWN SELF BE TRUE – the most famous advice of any counsellor, made famous by a play (Polonius to his son Laertes, in Shakespeare’s Hamlet). Under these words sat the line of speakers who had been selected by Confer, and given a few minutes to outline their positions before being subjected to a series of prearranged questions, constructed by the conference committee. This arrangement was not without its difficulties, but some important information emerged amongst the fraught exchanges, and some truth was achieved in the process. All in all, it was a pretty good show. To capture some of the spirit and information, I will present it as a kind of script taken from my notes written as the action unfolded. Often fragmented, it does coalesce into moments of surprising clarity. I have adopted the device of giving letters to indicate speakers simply. Here’s the key
A. Darian Leader (for the Alliance)
B. Julian Lousada (Chair of BPC),
C. Andrew Samuels (Chair of UKCP)
D. Marc Seale (Chief Exec of HPC)
E. Diane Waller (Chair of the Professional Liaison Group for Counselling and Psychotherapy for the HPC)
F. Michael Fischer (from Kings College London)
G. Lynne Gabriel (Chair BACP
Q. Questions
V. Voices from the floor.
A: we need to keep a space for different forms of practice.
B: members of the Institutions have been struggling with this job, but I, on the whole, am supportive of HPC. I ask myself, ‘would it interfere with the stance we take with our patients?’ I can’t find the evidence that it will.
[next to B is F, who is responsible for producing research evidence that strongly suggests that this form of regulation will adversely affect the stance professionals take with their patients. F maintains his composure, looking modestly at his papers, but the smallest tick flickers to life, just the once, under his right eye]
B: [continues] ‘Regulation’ is a toxic word. But we have to ask, are we adequately transparent? Are we adequately accountable? What I see here from you is an attack on the Nanny State. I happen to disa - [small pause, lips together, slight suggestion of ‘p’ before continuing almost seamlessly] - gree with that. We need the good container of the Nanny State.
C: we must reframe the division amongst us into a basis for constructing a solution.
D: I’m a boring bureaucrat in a grey suit. It’s my job. It’s what I do. We have a timetable towards statutory regulation, that’s it really.
E: I’m a 1970’s arts student, and a sociology professor. I am an integrative practitioner with curiosity. I ask: why do people make art? I was trained in the analytical approach, but not solely. I am used to dealing with tension in my job at the University - the Quality Assurance, Teaching Quality, which is exceptionally bureaucratic. I am pioneering, entrepreneurial, and I want to bring the regulator into this world, not leave him in the 1950s.
D: We don’t negotiate. It’s all in the hands of the Government. When the Section 60 is issued to Parliament it cannot be amended – it either stands or falls. This has never happened [the fall] in over 35 years. If it stands then there will be Gazetting, the Privy Council, it will be Enacted, then we will fix the Standards of Practice, and we will consult on that.
E: The wording of the Standards of Practice is quite old fashioned. It suits some of the professions, not others.
C: The PLG process did not work for us. D should not have written to the Government in December saying it was good to go.
D: We will have to make a Temporary Register – we have identified 60 voluntary registers, and my IT people will have to go through these taking out the duplicates, and cleaning up the data, it will be quite a job.
A: But the Judicial Review questions the whole process.
D: My legal people have instructed me that this question is sub judice, and given me preaction protocols to follow, these are careful ways that we are expected to behave.
A: it is not sub judice, and it would be perfectly proper to speak about it.
Q: What processes are there for the HPC to follow in order to take into consideration the ongoing concerns?
E: well, there was a Call for Ideas, the Professional Liaison Group, the Consultation. Actually, I would really like to say, I hear people say it was ‘a done deal’. It was not. It was not a done deal. It’s insulting to hear that. Insulting to the PLG. The criticisms that are made of the HPC are disrespectful to other professions.
D: Our Standards are not set in concrete.
C: We all have problems with the idea of auto transfer.
G: We’re in favour of a convention.
B: BPC are struggling with the issues. There are differences in the membership. Our register is not made up of members, but of institutions. I suppose that many of those who don’t agree with HPC regulation will not sign up and will practice under a different title, presumably Psycho-Analyst. The question is, how do you create a community? The problem with C’s model is there are no losers. But we have to ask, are we a coherent or a fragmented community, because we have to present a coherent front.
A: Why would we want to present a coherent front if we are fragmented? Surely this is what we work on with people who come to see us, who are suffering because they are struggling to present a coherent front to the world when they are in fact fragmented. [applause]
D: The Combo is under way, the titles of Counselling and Psychotherapy, the 3-year Grand-Parenting period, and the Register Transfer. But listen, the HPC is flexible. Nothing is set in stone.
C: Look, in Section 7.16 of Trust Assurance and Safety it says “With the exception of the new arrangements for the regulation of pharmacy, the Government will not establish any new statutory regulators. Psychologists, psychotherapists and counsellors will be regulated by the Health Professions Council, following that Council’s rigorous process of assessing their regulatory needs and ensuring that its system is capable of accommodating them.” You’re right, it’s not written in stone - it is enshrined in White Paper! [laughter]
A: and in Article 3.5 of the HPO2001 it states there is a Duty to Liaise with All External bodies and publics affected.
F: There is a common perception in other fields, for example psychology, that an elite group has captured the regulatory process to further their own agenda.
E: we did consult all parties
V: you didn’t consult us
E: no-one was refused a place
V: you refused us!
B: Collaboration with the HPC is good. But, the Fitness to Practice process is corrosive, punitive, and persecutory. We cannot have a system that doesn’t have some thought for the clinicians and their other patients. I don’t feel secure with the HPC FTP protocol. The question is, do HPC know that there are problems? I think HPC [pause] are [pause] do know. We had quite a robust, informed discussion on this.
E: The Generic section of the standards, are formulaic, and HPC has started a process of review. The system is not appropriate, and it’s been recognised as inappropriate. But, look, the SoP is not a curriculum document. Everyone makes that mistake. It should not dictate curriculum.
A: A detailed critique of the standards of practice has been made and made public. Its in the Maresfield Report, copies of which are at the front desk and downloadable from the internet. There are four main difficulties with them. First is the ‘infection control’ problem – that many of the generic standards have nothing whatsoever to do with our practice. The second is that they construe therapy as something applied to a passive patient. Third is the ideology that makes the human a piece of faulty equipment that needs fixing and setting back to work. Fourth, is the notion of audit and health. Many of the other HPC practices are contained and confined, not open ended, unpredictable and risky. For us, the patient is a potential, not a broken economic unit. [loud and long applause]
G: the Draft Standards of Practice are utterly unworkable.
C: Consultation needs to be real.
D: We don’t employ professionals directly, we set up a PLG. We advertise slots, people
apply, they do excellent work. I see no reason to change the PLG make up. The Standards of Practice are the very heart of regulation. I think our consultations are very thorough.
B: I’m perplexed by the enthusiasm, expressed by the audience in the length of their applause, to A and C. I don’t think we should pay too much attention to it.
V: Please don’t try to regulate my clapping [much laughter, and clapping].
E: I want to remind everyone that the Standards everyone are so upset were about actually written by the professions, I didn’t write them.
A: And I want to remind you that, according to the 2004 Doc, it is a requirement that any profession coming under HPC regulation be homogenous
D: it is not a requirement.
A: it is.
D: It isn’t. Look, we’ve just taken on seven different types of psychologists! Anyway, what’s written in the document is one thing, how we interpret it is another. Nothing is set in stone.
V: It seems to me that that real problem here is that the regulator seeks to replace real judgment with bureaucratic standards.
D: Standards go to the heart of regulation. If these are wrong, it won’t work.
V: It doesn’t work.
B: Standards are tragically low. What we need to ask is which organisations are the guardians of quality practice? It is not the HPC. We all share a common set of [pause], look we are the guardians of quality practice.
A: But do have a set of common skills? We might share one mode of practice – one that relies on the presence and place of the individual. Many might even agree that the single most important part of a training is someone’s personal therapy. But you can’t regulate someone’s personal therapy.
V: In the Liaison Group the impression is given that there is a free and fair exchange of views aiming at some kind of agreement. But some papers I have seen, got from the website, suggest that in fact the agenda is set by the HPC, answering questions that are of interest to them. This is not real liaison, more a mystifying exercise in domination by the HPC. Who did set the agenda of the PLG?"
E: [throat clearing, rambling and mumbling finally giving way to:] me, me and Michael Guthrie [administrator at the HPC].
V: Why is it only now that some people are arguing against HPC?
A: This has been going on for years!
D: The process is time consuming, frustrating, irritating. Some of these professions have developed over centuries, so when the regulator turns up and says ‘thank you, I’ll have that’, well, it’s understandable that some are unhappy. Look, I’m only doing my job, I’m a really boring guy, and nothing is set in stone, we are always able to interpret...
Here is the list of questions prepared by the organisers, and the timetable they hoped to adhere to:
10.05 What structures exist for further negotiations by members of the professional community with the Health Professions Council on areas that continue to be contested?
10.15 What capacity does the HPC have to address the ongoing concerns expressed by the professional community?
10.25 What would the consequences be of not joining the HPC register? Will the practitioners have their membership of their current umbrella organisation withdrawn?
10.35 What scope remains for amendments to the government’s decision to regulate psychotherapy and counselling via the HPC?
10.45 A summary of the findings of the Kings College research into the experience of being registered by the HPC – presentation by Dr Michael Fischer
10.55 How do the panellists believe the tension between the needs of the therapist and the patients/clients is best handled in our society? By an external government agency or an independent statutory regulator?
11.05 The HPC Standards of Proficiency are raising concerns because they are formulaic. How would the HPC ensure that these do not restrict good practice that is process-based and that will take into account ruptures in the practitioner-patient relationship that are often part of the therapeutic process?
11.15 How does the HPC intend to influence and regulate psychotherapy and counselling training curricula in the long term?
11.25 What would be the role of independent training organisations in a post- regulation culture?
Frustration from the audience forced the chair to abandon these questions and the timetable and brought questions in from the floor. There was a struggle.
Over lunch it became clear that members of the Professional Liaison Group (of whom only a very few were present today) were as much in the dark as the rest of us about the intentions of the HPC in the next few months.
Marc Seale’s remarks in the morning gradually began to make sense in retrospect. The December Council meeting (2009) saw him gain support from his Council to write to the Department Health saying ‘lets go’. That meeting also said it would reconvene a larger and more representative PLG to consider all the problems. This now seems to have fallen by the by. Seale said (Saturday) that he saw no reason to do things differently. He has written to the DH to signal the start of the drafting (of the Section 60 Legislation), waiving aside the inconvenience of 1,100 replies to the public consultation.
There is due to be a meeting of the Education and Training Committee of the HPC on Tuesday (2nd Feb) though the papers have not yet been posted (as at 3.30pm Friday 29th Jan). It is supposed to discuss the much maligned generic standards that apply across all the various different professions.
Meanwhile Seale seems to believe it will be possible (for him and those close to him) to ‘interpret’ things around the legislation, and put up with the few years of misery (of those a little removed from him) that will follow. He said ‘all professions are upset at first, but settle down after a few years’… !
In the afternoon the confer auditorium was organised into a ‘coffee house conversation’ and everyone got to have a say. In both groups I was in (which were very different from each other – two people were hostile to HPC, two were hostile to those opposing the HPC, one was just plain confused, and another was fulminating against the bureaucracy sweeping through the NHS and suspected the HPC of same) there was a common question asked: Who elected the member of the Professional Liaison Group? Stunned silence greeted the news that the PLG had been appointed by Diane Waller and the HPC.
Jerusalem is at the Apollo (Shaftesbury Ave) until 24th April.
Thursday, 28 January 2010
Confer Conference, Saturday 23rd Jan 2010 (Part 1)
Saturday’s Confer Conference on HPC State Regulation brought together the figureheads of key clans active in the UK psy field today.
As we know, clan HPC is not a native psy organisation, but seeks to take control of the practice in order, as it says, ‘to protect the public’. This clan draws its power not from practice or philosophy, nor even from any pressure group or union, but from the Government. It holds a veil over this relationship.
Ultimately, the relation HPC seeks to build is with the individual members of the 50 or so clans in the psy field, yet initial negotiations take place with the leaders of a few of the more powerful tribes. It is with the individual members that the long-term interest of the HPC lies. This is where the tax will be levied, this is where the new rituals of engagement will be played out, this is where the power will be applied. HPC estimate it will ‘capture’ anything between 50,000 and 100,000 members in this new arrangement.
The money raised from the annual levy will pay for the offices, the salaries, the equipment etc etc etc, of the HPC clan, which retains almost absolute control over decisions how to spend it.
There are virtually no mechanisms whereby the members, or registrants as they are known, can call or hold this regulator to account.
As we have already discussed, and as Italian Barrister and Psychotherapist Alex Amicarelli has exposed, the HPC has been put into a position of power by the Government, but without any obvious mechanisms to call forth its responsibility. Like Shakespeare's Measure for Measure, the Duke carelessly hands power to the rectitudinal Angelo then clears off out of the public eye. This fudge makes it possible for the HPC and its supporters to say whatever they like, depending on what is needed to win the argument at any particular moment. The position it holds is the symbolic key that guarantees its immunity.
It is helpful to think in these terms when reading the extraordinary document that the Conference organisers encourage conference participants to read in preparation for the meeting. In Marc Seale’s statement, for instance, we find just two short paragraphs (presented, by the way, for no apparent reason in quote marks). These reveal the sophistication that is necessary to deploy from a man in such a position. In the first paragraph Marc states that Statutory Regulation will make Psychotherapy and Counselling safer. And in the second paragraph he states that HPC regulation has no negative effects.
The position statement issued by the British Psychoanalytical Council, is a little longer (5 pages), but bears a similar declamatory tone. For example, on NICE: “We consider that the establishment of the National Institute of Clinical and Health Excellence (NICE) that carefully weighs the evidence for the effectiveness (and cost effectiveness) of treatments in the UK is an immense social gain.” But goes on to offer the contradictory information that “there is an issue around whether an overwhelming and over-simplistic primacy has been given to randomised controlled trials (RCTs)”. There is no attempt to analyse the conflict.
The BPC Statement pledges support for each area of Government policy – IAPT, NICE, SfH & NOS, and the HPC. It adds that it is also working with NIMHE and its new project NWW. Anyone who wants to know what these acronyms mean is obviously suffering from 20th century syndrome, and should report immediately to their nearest government re-programming centre, or download the do-it-yourself software (perhaps the link will soon be available on the BPC website).
The statements of Darian Leader (speaking on behalf of the Alliance for Counselling and Psychotherapy against State Regulation) and of Andrew Samuels (appearing in his capacity as Chair of UKCP) have yet to be posted to the website. Instead, you can re-read the original Alliance Statement of Intent, or plough your way through the UKCP’s response to the public consultation on the report of the Professional Liaison Group for Psychotherapy and Counselling produced for the HPC.
Also posted for your edification are the BACP response, the HPC Draft Standards of Proficiency, Michael Guthrie’s (HPC Director of Policy and Standards) assimilation of all 1,100 responses to the consultation, and the Government’s White Paper (Trust, Assurance and Safety). There is no mention of the Maresfield Report, nor a link to the Kings College report
For those who still have room for more reading you may be interested in the following background information, taken from evidence submitted to the Select Committee on Health in 2006. These excerpts come from evidence given on 15th June, 2006, by Marc Seale (CEO of HPC), Sarah Thewlis (Chief Executive of the Royal college of Nursing and Midwifery), and Finlay Scott (CEO of GMC). It is included here because it shows a couple of interesting features. First, the real pathway of accountability of the HPC, and second the way this emphasises the fundamental objectives of the government’s regulatory machine in the regulators mind.
The Chair of the committee (who himself happened to be a lay member of the GMC), kicked off by asking: “How are regulators helping to develop a workforce that is fit for purpose for the 21st century, as opposed to just developing more of the same?”
Sarah answered: “…by seeing regulation in its broadest context and not just seeing it dealing with unfitness to practise issues… but I think very much when you are working at workforce planning it is about making sure that people that come on to the register are competent… [and] we have worked very hard with employers about making sure that we can provide a flexible workforce”. [emphasis added]
Scott answered in exactly the same way: we have four functions, not just dealing with impaired doctors, but also “Standards, Ethics, Education and Registration, [which] all help us to contribute to the shaping of the workforce through influencing not only undergraduate medical education and training, but also the attitudes, the ethics and principles that doctors take to their work day by day and, as with the Nursing and Midwifery Council and other regulators, the very direct control over who joins our register from outside the UK and the EEA… we are ensuring that we fully involve representatives of the public, employers, and of course representatives of the profession, to try to ensure that the public's expectations of doctors can be reflected in the way that the doctors of today are educated.”
And Seale said: “The Health Professions Council also has a specific role in advising the Secretary of State of which new professions should become statutorily regulated, and that, I think, is vital in terms of protection of the public. I think the last thing is that all three of us have participated in the Foster and Donaldson Review and we are eagerly awaiting the outcome of that because I think that will that enable the regulators to be fit for purpose as we move forward into the existing century.”
When you look at the place from which the CEO is held accountable, and observe the methods of those who are actually empowered to challenge him, then you might begin to understand how the process gets so badly distorted.
Marc Seale had the last word in that particular sitting of the Committee. It is a little difficult to grasp, but revealing nevertheless. Here is what he said:
Mr Seale: “It might be useful to link this debate back to workforce planning. What is going on—and it is beginning to accelerate this change—is the traditional model of doctors, nurses and physiotherapists is beginning not to work, because I think what is happening is that new skills, new technology, new drugs, et cetera, start off in a very small group of individuals who are skilled in doing that and gradually that skill goes down through the workforce. At the same time you can actually now come into the workforce at a particular level with that new set of skills and what the regulators have to do is to capture those new individuals with the new skills as it trickles down through the system. Currently it is not quite working correctly but I think all the regulators want to see it work effectively. That will mean that as demands are put on the workforce those skills could then flow through the individuals.” [emph added]
Measure for Measure is at the Almeida from Feb 12th, to April 10th.
“To whom should I complain? Did I tell this, who would believe me?”
As we know, clan HPC is not a native psy organisation, but seeks to take control of the practice in order, as it says, ‘to protect the public’. This clan draws its power not from practice or philosophy, nor even from any pressure group or union, but from the Government. It holds a veil over this relationship.
Ultimately, the relation HPC seeks to build is with the individual members of the 50 or so clans in the psy field, yet initial negotiations take place with the leaders of a few of the more powerful tribes. It is with the individual members that the long-term interest of the HPC lies. This is where the tax will be levied, this is where the new rituals of engagement will be played out, this is where the power will be applied. HPC estimate it will ‘capture’ anything between 50,000 and 100,000 members in this new arrangement.
The money raised from the annual levy will pay for the offices, the salaries, the equipment etc etc etc, of the HPC clan, which retains almost absolute control over decisions how to spend it.
There are virtually no mechanisms whereby the members, or registrants as they are known, can call or hold this regulator to account.
As we have already discussed, and as Italian Barrister and Psychotherapist Alex Amicarelli has exposed, the HPC has been put into a position of power by the Government, but without any obvious mechanisms to call forth its responsibility. Like Shakespeare's Measure for Measure, the Duke carelessly hands power to the rectitudinal Angelo then clears off out of the public eye. This fudge makes it possible for the HPC and its supporters to say whatever they like, depending on what is needed to win the argument at any particular moment. The position it holds is the symbolic key that guarantees its immunity.
It is helpful to think in these terms when reading the extraordinary document that the Conference organisers encourage conference participants to read in preparation for the meeting. In Marc Seale’s statement, for instance, we find just two short paragraphs (presented, by the way, for no apparent reason in quote marks). These reveal the sophistication that is necessary to deploy from a man in such a position. In the first paragraph Marc states that Statutory Regulation will make Psychotherapy and Counselling safer. And in the second paragraph he states that HPC regulation has no negative effects.
The position statement issued by the British Psychoanalytical Council, is a little longer (5 pages), but bears a similar declamatory tone. For example, on NICE: “We consider that the establishment of the National Institute of Clinical and Health Excellence (NICE) that carefully weighs the evidence for the effectiveness (and cost effectiveness) of treatments in the UK is an immense social gain.” But goes on to offer the contradictory information that “there is an issue around whether an overwhelming and over-simplistic primacy has been given to randomised controlled trials (RCTs)”. There is no attempt to analyse the conflict.
The BPC Statement pledges support for each area of Government policy – IAPT, NICE, SfH & NOS, and the HPC. It adds that it is also working with NIMHE and its new project NWW. Anyone who wants to know what these acronyms mean is obviously suffering from 20th century syndrome, and should report immediately to their nearest government re-programming centre, or download the do-it-yourself software (perhaps the link will soon be available on the BPC website).
The statements of Darian Leader (speaking on behalf of the Alliance for Counselling and Psychotherapy against State Regulation) and of Andrew Samuels (appearing in his capacity as Chair of UKCP) have yet to be posted to the website. Instead, you can re-read the original Alliance Statement of Intent, or plough your way through the UKCP’s response to the public consultation on the report of the Professional Liaison Group for Psychotherapy and Counselling produced for the HPC.
Also posted for your edification are the BACP response, the HPC Draft Standards of Proficiency, Michael Guthrie’s (HPC Director of Policy and Standards) assimilation of all 1,100 responses to the consultation, and the Government’s White Paper (Trust, Assurance and Safety). There is no mention of the Maresfield Report, nor a link to the Kings College report
For those who still have room for more reading you may be interested in the following background information, taken from evidence submitted to the Select Committee on Health in 2006. These excerpts come from evidence given on 15th June, 2006, by Marc Seale (CEO of HPC), Sarah Thewlis (Chief Executive of the Royal college of Nursing and Midwifery), and Finlay Scott (CEO of GMC). It is included here because it shows a couple of interesting features. First, the real pathway of accountability of the HPC, and second the way this emphasises the fundamental objectives of the government’s regulatory machine in the regulators mind.
The Chair of the committee (who himself happened to be a lay member of the GMC), kicked off by asking: “How are regulators helping to develop a workforce that is fit for purpose for the 21st century, as opposed to just developing more of the same?”
Sarah answered: “…by seeing regulation in its broadest context and not just seeing it dealing with unfitness to practise issues… but I think very much when you are working at workforce planning it is about making sure that people that come on to the register are competent… [and] we have worked very hard with employers about making sure that we can provide a flexible workforce”. [emphasis added]
Scott answered in exactly the same way: we have four functions, not just dealing with impaired doctors, but also “Standards, Ethics, Education and Registration, [which] all help us to contribute to the shaping of the workforce through influencing not only undergraduate medical education and training, but also the attitudes, the ethics and principles that doctors take to their work day by day and, as with the Nursing and Midwifery Council and other regulators, the very direct control over who joins our register from outside the UK and the EEA… we are ensuring that we fully involve representatives of the public, employers, and of course representatives of the profession, to try to ensure that the public's expectations of doctors can be reflected in the way that the doctors of today are educated.”
And Seale said: “The Health Professions Council also has a specific role in advising the Secretary of State of which new professions should become statutorily regulated, and that, I think, is vital in terms of protection of the public. I think the last thing is that all three of us have participated in the Foster and Donaldson Review and we are eagerly awaiting the outcome of that because I think that will that enable the regulators to be fit for purpose as we move forward into the existing century.”
When you look at the place from which the CEO is held accountable, and observe the methods of those who are actually empowered to challenge him, then you might begin to understand how the process gets so badly distorted.
Marc Seale had the last word in that particular sitting of the Committee. It is a little difficult to grasp, but revealing nevertheless. Here is what he said:
Mr Seale: “It might be useful to link this debate back to workforce planning. What is going on—and it is beginning to accelerate this change—is the traditional model of doctors, nurses and physiotherapists is beginning not to work, because I think what is happening is that new skills, new technology, new drugs, et cetera, start off in a very small group of individuals who are skilled in doing that and gradually that skill goes down through the workforce. At the same time you can actually now come into the workforce at a particular level with that new set of skills and what the regulators have to do is to capture those new individuals with the new skills as it trickles down through the system. Currently it is not quite working correctly but I think all the regulators want to see it work effectively. That will mean that as demands are put on the workforce those skills could then flow through the individuals.” [emph added]
Measure for Measure is at the Almeida from Feb 12th, to April 10th.
“To whom should I complain? Did I tell this, who would believe me?”
Wednesday, 20 January 2010
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.
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.
Friday, 15 January 2010
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 .
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 .
Tuesday, 12 January 2010
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.
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…
“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…
Friday, 18 December 2009
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.
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.
Saturday, 12 December 2009
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
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.”
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.”
Thursday, 10 December 2009
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.
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.
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