New Book: Ruth E Jones - Foreshoring the Unconscious: Living Psychoanalytic Practice

Ruth E Jones - Foreshoring the Unconscious: Living Psychoanalytic Practice
http://www.psychoanalyticpractice.co.uk/

This short, readable, intelligent book, is one of a growing number of essays now being written in response to the threat posed by current regulatory thinking. As this kind of practice is threatened with extinction, Ruth Jones writes about what she does and why she does it. She is a psychoanalytic therapist who reminds us that working psychoanalytically is not without humour, not without a relation to science, and not the business of an elite. Drawing on her experience in quantum physics and the Medway foreshore Ruth makes use of images and metaphors to expose the essence of an encounter between two people, one of whom wants to know what is going wrong in their life, the other who is 'sitting back', 'holding open' and who is vitally alive to living. This short book answers the question 'what exactly is it that you do?' not only for someone thinking of finding a therapist, but also for anyone who is curious about the distinctiveness of contemporary psychoanalysis. It simply shows how the current fetish for centralised control either of data or of practitioners is essentially misguided, highly destructive, and extravagantly inefficient. Click here to buy it (£10 including P&P), then sit down and read it - it is an important part of the struggle. .

The UKCP meet the HPC day on September 24th 2010, or An education in misconduct. Guest post by Bruce Scott

Dr. Bruce Scott
Philadelphia Association, London.


The title in no way implies wrong doing on the part of the conference organisers, the United Kingdom Council for Psychotherapy (UKCP). It was a very well organised day where the two representatives from the Health Professionals Council (HPC) made very polished presentations and were very willing to talk about the HPC’s initiatives for regulating psychotherapists and counsellors and their training courses. The issue I have is that I feel that if I were to agree to the proposals offered so far by the HPC (and on the day in question) and sign up so to speak, I would, paradoxically be complicit in breaking the HPC’s standards of conduct, performance and ethics. Indeed, if any counsellor or psychotherapist did sign up to be regulated by the HPC (and also let their courses be regulated by the HPC), as the framework for the proposed regulation of counsellors and psychotherapists stands at the moment, then every one of the new registrants would be falling foul by breaching the HPC codes of conduct, performance and ethics. Let me explain why. Firstly, let me quote from the HPC’s website:

“We are a regulator, and we were set up to protect the public. To do this, we keep a register of health professionals who meet our standards for their training, professional skills, behaviour and health.”

Sounds fair enough at a glance; but all is not what it seems and worryingly a vast pro-HPC majority seem either unaware of their blind spots or have another agenda for signing up to the HPC. The fact as it stands is that the HPC have no evidence to back up their claim that they will and can protect the public. The HPC are not protecting the public, but are harming the public by trying to convince us (psychotherapists, counsellors, and the public) that they are.

At the conference during the afternoon session, delegates split up into different groups. I decided to go into a group which had as one of its members Michael Guthrie, the Director of Policy and Standards at the HPC, who would be responsible for setting educational standards of psychotherapy training courses if regulation went ahead. He is the person responsible for setting the educational standards which psychotherapy and counselling trainings will have to abide by if regulation goes ahead. Mr. Guthrie gave a polished presentation in the morning session, but I felt unconvinced as he had not produced any facts how the HPC’s policies would improve the psychotherapy world as it stands.
During the small group meeting I asked him if the HPC standards of education that will be imposed on psychotherapy trainings result in a better and improved education for trainees, and thus better psychotherapists, and therefore a world where the protection of the public is improved; better than what already exists and if there was any evidence to back up these actions and proposed plans.
To cut a long story short, he could not give me any evidence, scientific or anecdotal, and neither could any of the other delegates in the room, whom I felt were all pro-HPC. This was because, as I found out through the conversation we were having, there has been no research conducted to find out if the proposed regulation of psychotherapists and counsellors and their respective training courses will have any effect on improving training, psychotherapists and their conduct, fitness to practice, and would result in better protection for the public.

What was most disturbing was that there seemed to be some kind of unwillingness in my group amongst the delegates and Michael Guthrie to focus upon this important and troubling point (as the HPC’s primary remit is the protection of the public) that there was no evidence. On my asking of the question, Mr. Guthrie was silent, while another delegate broke the uncomfortable silence and protested that the world would be a better place with HPC regulation as her modality of practice would gain recognition within the NHS and thus achieve a more respectability in the world of psychotherapy and all what being in the NHS entails: more opportunities for earning income. Another delegate from the same modality agreed and gushed that she wished it (HPC regulation) would happen tomorrow, followed by another female delegate who lamented that the wait for regulation to happen is unsettling and she also wished it would just go ahead. A gentleman delegate explained how regulation would be good as it would give psychotherapists and counsellors a “seat” at the HPC table alongside the psychologists and would enable to stem the CBT /IAPT bias that is flooding the market and taking away jobs from psychotherapists and counselors form other modalities. He also stated that the psychotherapy and counselling’s image would be enhanced in the public eye if it was regulated by the HPC.

After these comments by my fellow delegates I felt as though my question was being swept under the carpet and I again intervened. I said that I understand what some people in the room were saying in relation to HPC regulation being good for jobs, or even that the image of psychotherapy and counselling might be improved, but that this was not what I had asked. I reiterated to the group that I had asked if there was any evidence for the HPC’s educational policies would result in a more risk free psychotherapy world as per their remit?

At this point I put on my academic psychologist’s hat (my previous life before I trained as a psychoanalytical psychotherapist was involved with studying the cognitive model of depression and the effects of antidepressants) and I said that as a psychological scientist I have to be convinced by evidence if I am to agree with a policy of action, but the HPC has provided no evidence. I then referred to what Peter Fonagy said at one previous PLG meeting during the lunch break ; he said that therapists have to be regulated as one study showed that 5% of therapists do either harm or no good. I then said to my fellow delegates this statistic may fit with remit of the HPC about protecting the public, but even if Fonagy’s statistic is true (I have never seen the paper) it is a deceptive statistic for several reasons. I explained to the group why. Firstly, in any distribution of therapists’ effectiveness, at either end of the distribution you will always have therapists who do not “cure” the patient, and at the other end therapists who do “harm”. I pointed out that it all depends of course what is meant by harm and doing no good or not “curing” a patient and thus we could get into a long discussion about what is harm and doing no good. Nevertheless, I said that regulation would never make this 5% of bad or harmful therapists disappear; you will always have patients who do not get “cured” and patients who feel they have been harmed. Regulation will not stop this statistic occurring so Fonagy’s argument does not hold any weight. Another example of how this is nonsense is when one thinks of antidepressant treatment. Most medical practitioners worth their salt know for a fact that some people will not get better taking antidepressants and some people will get a lot worse and be harmed. The same can be said for clinical psychologists giving CBT to people; some people will never get better and CBT might make them worse; CBT therapists know this fact well. As it stands, both these treatments are regulated as are the practitioners who apply them.

So I said to my delegates in my group that the HPC’s boastful idea that it is protecting the public by regulating psychotherapists is a delusion; a dangerous and futile grasping for a utopian world that can never be realised. The gentleman delegate agreed with my explanation, but reiterated that regulation was not about protection of the public and it never could be; it was about gaining the public’s confidence in psychotherapy. In other words the public will see HPC regulated psychotherapists and counsellors in a better light. Michael Guthrie spoke at this point and said it would be very difficult to do research and thus find evidence to see if the HPC’s regulatory policies for therapists and their training courses do protect the public. I retorted that this was debatable, but that it would be possible to ask the British public what they would think about psychotherapists and counsellors being unregulated by the HPC and regulated by the HPC. However, one would have to include the proviso and let the public be aware, that their safety would not be improved if therapists were regulated by the HPC as the HPC did not have any evidence that it would improve safety or improve protection of the public. What would the public think about this possibility?
What was quite amazing regarding this exchange was that nobody in the room, including Michael Guthrie defended or argued for the HPC’s remit that it was there to protect the public despite the HPC propaganda that this is what it is for. It seemed to not be an issue for anybody in the room that the whole HPC drive for regulation and the willingness of psychotherapists and counsellors wanting to sign up to the HPC may have nothing to do with safety of the public. I could not quite believe what I was hearing. On the one hand, being an anti-HPC regulation kind of guy, such an admission by the HPC representative and its supporters in that room was too good to be true, but on the other hand it is quite worrying that such deception and ambivalence on such an issue is alive and well in the HPC and its supporters. The minute taker who was writing down the questions and aspects of the discussion asked our group if their questions had been answered (by Michael Guthrie and other members) and she stated that she did not think that my question had been answered. I replied (just to double check that I had not been hallucinating) that it had. I said that it seems that the HPC have no evidence that its regulation policy for psychotherapists, counsellors, and training courses will improve public safety, and in fact the HPC and its proposal to regulate psychotherapists, counsellors, and their training courses has nothing to do with public safety. There was no noise of disagreement from the group or Michael Guthrie.

All I can conclude for this is that protection of the public may be a smokescreen for a “jobs for the boys” or a “seat at the table” attitude that fuels the pro-HPC psychotherapists and counsellors motives.

Two other important things that Michael Guthrie explained to the group were related to fitness to practice hearings and a proposed name change for the HPC that was discussed recently at a HPC meeting. I said to Mr. Guthrie and to the group that I was very concerned with the fitness to practice hearings that the HPC run. I told the group that I had been to one and I thought it was horrendous, barbaric, and de-humanizing process and that being there and witnessing the hearing was very upsetting. I asked if the HPC had any plans to have alternative ways of handling complaints made against registrants. Mr. Guthrie replied they there was indeed discussions about alternatives (e.g., mediation) going on within the HPC and that the Fitness to Practice Committee will meet on the 21st October at the HPC’s office in London and that I was welcome to go along to this meeting. I also asked about the possible name change of the HPC to the Care Professions Council and if this was still an option. Note that this would be one way to appease some people who did not like being called or identified as a health professional. Mr. Guthrie was quite sure that such name change plans had been shelved and he was sure that they would not be re-visited.

Now back to my education in misconduct. I feel it might pertinent to visit the HPC’s generic Standard of conduct, performance and ethics which all registrants have to abide by. If a registrant does not meet these standards, to quote the HPC from their website:

“The HPC will take action against health professionals who do not meet these standards…”

Actions taken by the HPC could include being struck off and not being allowed to practice, suspended, or conditions of practice being applied to the registrant. But let us look more closely at the individual standards in light of what I have talked about in this article. I will first outline the standards which I feel the HPC has not met itself and a budding registrant who if he or she signed up today would not meet the standards by the act of signing up, and then I will go on to explain why. I will do this sequentially for each standard I quote. This is not a comprehensive analysis; it just a snap shot and much more could be written about this. From the HPC’s booklet, Standard of conduct, performance and ethics that all registrants own and must live up to:

1. You must act in the best interest of service users.

It goes on to describe:

You are personally responsible for making sure that you promote and protect the best interests of your service users…..You must treat service users with respect and dignity…..You must not do anything, or allow someone else to do anything that you have good reason to believe will put the health or safety of service user in danger. This includes both your actions and those of other people.

From what I learned at this conference, the public are not being treated with respect and dignity. The HPC are deceiving the public with a false message of protecting the public. The HPC therefore are allowing themselves and potential psychotherapists and counsellor registrants (and currently with practitioner psychologists I might add) to put the mental health of members of the public in danger due to this deception. The HPC are also deceiving psychotherapists and counsellors with this deception of standing for the protection of the public. Further, if psychotherapists and counsellors willingly sign up to HPC regulation (as the HPC plans stand) if it goes ahead, then by being part of the HPC organisation, they will be in effect breaking standards by being a member; they will be complicit with the deception if they know that the HPC’s so-called remit for protection of the public is false. If they (prospective registrants) do not know that the public’s best interests are being protected, then it is a duty of the prospective to find out; in other words question the HPC and their false propaganda about protecting the public. Both allowing the HPC to operate in this way (not really being about public safety and having no evidence that their regulatory policies work), and the HPC allowing prospective psychotherapist and counsellor registrants to act in this way (sign up to a hollow and deceiving organisation) is not meeting this standard. For the HPC and prospective psychotherapist and counsellor registrants, fitness to practice is therefore impaired.

3. You must keep high standards of personal conduct.

This standard is described as:

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

Surly deception is poor professional conduct. The HPC’s professional conduct is tarnished due to the fact that they have no evidence that their regulatory policies they want to put onto psychotherapist and counsellors will work or protect the public. Surly it is duty of registrants and prospective registrants to be aware (and/or to find out by questioning the false propaganda of the HPC) that such conduct is un-professional and this knowledge would affect the confidence of the public in the HPC and its registrants. The HPC have not met this standard themselves, and if one signed up to the HPC one would be conducting oneself in a very unprofessional manner. Again fitness to practice impaired for both the HPC and prospective registrants.

4) You must provide (to us and any other relevant regulators) any important information about your conduct and competence.

This entails:

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

With such a standard the HPC must let the public and Centre for Healthcare Regulatory Excellence (the HPC’s regulator) that it is not fit for purpose. Its conduct is unprofessional due to the deception that continues regarding the lack of evidence that it has of its efficacy and also that it is deceiving the public that its function it to protect the public. This information must be made known for this standard to be met. Thus to sign up to the HPC is in effect a sign of a lack of competence and misconduct.

6) You must act within the limits of your knowledge, skills, and experience and, if necessary, refer the matter to another practitioner.

The HPC do not know if what they are doing or what they want to do (regulate psychotherapists and counsellors) will be or is presently effective (i.e., with practitioner psychologists). They do know, as discussed earlier that there is no evidence that what they do or want to do is not backed up with evidence. The HPC are not acting within their limits of knowledge, they are going beyond it. The HPC have not met this standard; their fitness to practice is impaired. Many prospective and willing psychotherapists and counsellors who sign up to HPC regulation must, if they are to meet this standard, refer the matter of their regulation to somebody else seek help and question their act of signing up to the HPC. This is because a prospective registrant does not know if they are signing up to a “safe” organisation. The HPC have not provided the prospective registrant with information and evidence as to what they do is reliable and the prospective registrant does not have the evidence that being regulated by the HPC will make them more effective and safer practitioners. The prospective registrant by signing up is going beyond the limits of their knowledge and thus would not meet this standard and therefore their fitness to practice would be impaired.

7) You must communicate properly and effectively with service users and other practitioners.

My points above are self-explanatory. The public (service users) are being deceived, and prospective registrants are being deceived by the HPC. Both prospective registrants and the HPC do not meet this standard; fitness to practice is impaired.

14) You must make sure that any advertising you do is accurate.

It explains further:

Any advertising you do in relation to your professional activities must be accurate. Advertisements must not be misleading, false, unfair, or exaggerated. In particular, you should not claim your personal skills, equipment, or facilities are better than anyone else’s, unless you can prove this is true…..Any potential financial reward should not play a part in the advice or recommendations or products and services you give.

This is a biggie! The HPC advertise that (from the HPC website and quoted at the start of this article):

“We are a regulator, and we were set up to protect the public. To do this, we keep a register of health professionals who meet our standards for their training, professional skills, behaviour and health.”

As discussed in this paper, the HPC have no evidence that what they do does protect the public. Is this not gross misleading advertisement from their website? This deception makes the HPC fail this standard; their fitness to practice is impaired. The budding registrant would be complicit in this deception if they signed up to the HPC knowing full well the HPC’s false propaganda about protecting the public. The willing registrants at the UKCP meet the HPC day that were in my group all talked about how it would be good for getting jobs/work/income etc and were well aware that the public safety remit of the HPC was not true (they did not disagree with me). Does this not amount to a potential registrant saying “I have the HPC stamp of approval and I can provide you with “better and safer services”, whilst they know full well that they would be part of an organisation that is deceiving the public regarding the remit of protecting the public as they have no evidence? Such behaviour (i.e., signing up to the HPC), if one knows the facts about the HPC (i.e., false public protection claim), is not accurate professional conduct; fitness to practice would therefore be impaired.

Then at the end of the booklet it defines fitness to practice.


When we say someone is “fit to practice”, we mean that they have the skills, knowledge, character and health to practice their profession safely and effectively.

The HPC are not fit to practice. They do not have the skills or knowledge; they have no evidence that what they do and intend to do with the talking therapies will be effective in protecting the public or make better therapists; thus they do not have adequate knowledge to practice safely in their regulatory function. Likewise, a budding registrant does not have the knowledge that HPC regulation will help them practice their profession safely and effectively. Indeed, by signing up without such knowledge, it may put the profession in grave danger, considering what I already talked about.
What I witnessed and listened to on the 24th of September 2010 at the UKCP meet the HPC day was an education for me; an education in how to fall into the traps of misconduct. How could I sign up to such an organization knowing what I know now? If I signed up as the HPC stands today and what I learned on that fateful Friday in September, I would have to go straight into a fitness to practice hearing. What a thought!


1 Cognitive behavioural therapy

2 Government initiative entitled “Improved Access to Psychological Therapies”. This initiative is mostly based on providing CBT and short term psychotherapy for as low a cost as possible. This initiative takes away work and income from trained counsellors and psychotherapists who do longer-term work and work which is not informed from a logical-positivist and evidence based practice standpoint. One result is that IAPT workers with very little training are employed simply to dish out CBT like a medicine to fix peoples’ negative cognitions (i.e., unemployed people in job centres). The political, social, and moral implications of such an initiative are obvious but beyond the remit of this article. See http://www.iapt-cbt.info/ for articles and critiques of IAPT and CBT/evidence based practice in the psychotherapies.

3 An article I wrote entitled: The professional liaison group meeting for the proposed regulation of psychotherapists and counsellors on the 12th May 2010: An example of how not to dwell in un-knowing. This can be accessed at: http://hpcwatchdog.blogspot.com/2010/06/guest-post-by-bruce-scott-on-plg.html

4 An article I wrote entitled: A case of dialectical disease: A tale of a Health Professions Council fitness to practice hearing of a psychologist. This can be accessed here: http://hpcwatchdog.blogspot.com/2010/03/guest-post-by-bruce-scott-on-ftp.html

Sponsored Run - raising funds for the Judicial Review of HPC

The sponsored trot from Highgate to Hampstead was successfully undertaken on Saturday, and a huddle of shrinks and their friends shuffled away from the Waterlow Cafe at about 3.20pm as the grey clouds parted and let in the light from a beautiful big low autumn sun. The Heath was sparkling with october colours and many hearts were singing, if not from the exertion, then at the sight of London from the top of the hill. Whew. The ponds looked very inviting, tho no-one was swimming just then. Hot tea and amazing brazilian sweets made by the amazing Brazilian Suzana greeted us at Freud's House, where Auden's poem bubbled up out of the blue - In Memory Of Sigmund Freud. It was a delightul afternoon.

Thank you to all those who sponsored me and the others. There's still time - if you would like to recognise this action, please follow the link and donate to one of the trotters whose names still appear on the web (some are already removed, but some will be there for another few weeks).

On being snubbed by the HPC, and the creative responses to it

One of the really unpleasant things about HPC-ification is the insult that is implied in the DNA of the organisation (witness those amazing adverts that implied that health professionals were liars cheats and idiots - written about here in November 2008).

However, this institutional problem can be masqued somewhat by the ordinary common decency of the various charming people connected to it. However, I have to say that the tension is always very close to the surface, and it doesn't take much to break it. When decency does suddenly give way to personal prejudice (as it can do in any organisational setting), the institutional prejudice that provides the backdrop combines with the personal rubbish and is very unpleasant indeed.

I have included reference to some of this here during the course of my observations. For example, the women from IPN who went to visit the CEO in January 2009, were so disturbed by what they experienced that they wrote him a letter, which they kindly agreed to let me publish here on 10 Feb 2009. Also, the delegation from the College of Psychoanalysts UK (Andrew Hodgkiss and Darian Leader) reported their dismay after meeting with HPC (27th Feb 2009) where Mr Seale (CEO) boasted that his advertising budget was bigger than theirs and could blast any opposition out of the water. A report of the meeting can be found on their website by clicking here.

Knowing all this (and I too have had my share of unpleasant encounters at the HPC, and I'm only a visiting member of the public) I was still shocked to see this little video. Nonetheless, having watched it a few times and spoken about it to people who are totally unconnected to the topic, I find that I am deeply impressed. To speak openly about the insult is shocking and feels subversive - after all this is an institution backed by the British constitution, it is at the heart of our society, and has been entrusted with legal powers emanating from parliament. But because it is shocking it is absolutely essential to speak, sing, act, create art, about it. I don't know who made the video, but I'm very glad they did. You can watch it by following this link.

Full speech: The new Care Professions Council shows the way to return to reality

Just imagine ... The new Care Professions Council, a return to trust and reality.

Taken from the new website, the section reproduced below refers directly to the possible prospects for counselling and psychotherapy:

2. CPC and the psychological therapies - a new ethos: connection, relationship and authenticity.

The task of persuading the public that the HPC offers effective protection from trained registered practitioners whom they might suppose could be trusted remains incomplete. Finding ways to reassure potential registrants of the benefits of state regulation of the psychological therapies, and to move forward with current regulatory intentions, has been difficult.

There has been steady support for the HPC's efforts from the business interests in the field; however responses to its Call for Ideas and last year’s Consultation included sustained opposition. The new CPC ethos outlined here is an acknowledgment of the validity of some of this opposition.

In its relations with the psychological therapies the CPC recognises that:

• While it is confident that the HPC has been a reasonable organisation to relate to, it accepts that its approach to the subtleties and sophistication of the psychological therapies has been alienated and technocratic;
  
  
• This alienating approach, and its basis in regulatory duress that the HPC has hitherto deployed, repeats many of the difficulties that clients bring to therapy and will be eliminated from the processes of the new CPC;
  
  
• It is intolerable that at present abusive practice is primarily detected and confronted by clients, leading to subsequent investigation and sanctions. The CPC will work strenuously, beginning with the psychological therapies community itself, to move to a pro-active practitioner accountability culture in which, through improved education and training, and peer scrutiny, abuse of clients approaches zero;
  
  
• Clients expect to be able to trust their practitioners. The CPC appreciates that many psychological practitioners do not have a level of trust in its processes that matches the trust they are expected to deliver for clients. Redressing this deficit is an urgent CPC priority.
  
  
• We now concede that ‘regulation’ as it has been proposed, or even ‘self-regulation’, is fundamentally mistaken. The CPC appreciates that previously claimed 'client protection' is undeliverable for psychological therapy clients. Gradated forms of ‘accountability’ that reflect domains of practice, practice populations, full- or part-time employment and levels of practitioner capability are more appropriate and realisable;
  
  
• The existing stringent, externally generated HPC regulatory framework, based on a ‘skills’ or ‘standards’ perspective, promotes false compliance in practitioners who disagree with them, or who find them problematic;
  
  
• Legally binding commitment to such externally generated practitioner protocols that are subject to legalistic fitness to practise protocols invites litigation and defensive practice and this will be ended; they will be replaced via ongoing experiential research that will identify qualities that are more relevant to clients, such as ‘practitioner presence’ and ‘practitioner capability’;
  
  
• Through existing processes of accreditation, supervision and re-accreditation, almost all psychological therapy practitioners are embedded in forms of accountability;
  
  
• Since a considerable proportion of psychological therapy practitioners have been long-term clients, they are highly aware and respectful of how clients experience practitioners;
  
  
• For at least a ‘good enough’ client experience, practitioners need to be embedded in local cultures of accountability that provide proactive, values-congruent scrutiny of practitioner capability and its potential deficits, and that are able to reflect the diversity of the psy field.
  
  
• With appropriate support, an educated person can be enabled to self-assess the quality and extent of their own and their colleagues’ capabilities and presence, and how this plays out in their work with clients. Trainings that do not support an ability to deliver this capability will be deprecated.

Now that's more like it. How might we bring this about?

Sponsored Run - raising funds for the Judicial Review of HPC

I haven't run for nearly thirty years, but this review of HPC procedures is important. It has become overwhelmingly obvious that the only way to get the HPC to listen, and more important, to hear, is to get beyond the administrators and the council of professionals and engage the people who really hold the power - the lawyers. Expensive, 0f course. Hence the need to raise funds, hence I've decided to learn to run.

The PsyReg page gives the background. The latest news is that the Judge in charge has called a meeting (December 10) to put questions to HPC and to those who have raised the Review.

It's important to support the process. I've been getting up early and padding around the backstreets where I live to get in shape. The sponsored run is 5km from Waterlow Park (near Highgate Cemetery) through Hampstead Heath and ends at the Freud Museum (London) on 16th October. I started my regime a few weeks ago by walking for 70 paces, then running 30, and so on, gradually increasing the pace. Some days are better than others. Recently I dug out my faux-fur designer dalmation doggy spot dress that I made for a laugh 20 years ago, and thought I might trot as the HPC Watchdog - the dalmation dog Perdita from 101 dalmations! As the time draws nearer, however, I must admit that I'm probably not going to be able to run the whole thing, but will have to alternate running and walking. And the dress will almost certainly still not fit me on the day. BUT I'm going to give it my best, and last week I went out and bought a new pair of trainers...

If you have found these pages valuable, please click through to the My Charity page and sponsor me, or go to my profile page in the side bar and email me for more details.

Thank you very much.

Janet

Ethical dilemma?

This month's BACP magazine Therapy Today includes the regular feature 'ethical dilemma' which puts a topical question in practical terms and invites practitioners to think about it. Andy Rogers, a Person Centred counsellor working in Further/Higher Education has submitted this thoughtful and poignant response:

This month’s TT dilemma: "Suzanne has worked in a primary care counselling agency for four years and has become good friends with a colleague there, Michelle. Michelle is a highly respected and well-liked member of the team. Suzanne discovered recently that Michelle has been drinking heavily, and for some time. While she appears to be sober at work, Suzanne is fearful for Michelle’s clients and her capacity to work professionally. Michelle became distressed when asked about this and begged Suzanne not to say anything to her manager – she would ‘lose [her] job and become unemployable’. Suzanne feels torn between trying to support her friend to turn things around personally, and the wellbeing of her clients, which increasingly seems to be compromised."

"Andy Rogers, counsellor in HE/FE replies: "
Many potential assumptions are piled on top of each other in this scenario and we should scrutinise them. What constitutes ‘drinking heavily’ and how has this been ‘discovered’? Is Suzanne also ‘highly respected and liked’, or not? What light or shade does this cast on her account? In what sense might the ‘wellbeing’ of Michelle’s clients be ‘compromised’? If Michelle appears sober at work, why is Suzanne fearful? What are Suzanne’s attitudes to alcohol and – more broadly – what values does she hold about how therapists should conduct themselves in their personal lives? At the crux of this dilemma is the question of what it means to ‘work professionally’ and whether our behaviour outside work can compromise our role as practitioners, even if there is no evidence of it being detrimental to our clients. What conduct, then, is unacceptable, and why? What values lie behind these judgments? Must counsellors and psychotherapists behave ‘better’? Better than whom? Must our personal lives be healthy? What does ‘health’ mean here and is it being conflated with goodness, morality and virtue? Is that desirable? Does Michelle really need to ‘turn things around personally’? Are counsellors not fallible human beings, too? Might not such imperfection be an acknowledgement of our shared existential reality and an aid to ordinary empathic engagement? 

Perhaps, when asked about her drinking, Michelle’s distress and concerns about future employment are not hints that her clients could be at risk – as Suzanne appears to take them – but rather expressions of a thoroughly realistic appraisal of the operation of power and interest in both this encounter and its organisational, professional and cultural contexts. Perhaps Michelle knows that complaints in professional organisations and in our wannabe regulator – whose aims doubtless already mould our professional discourse – are brought more often by colleagues and employers than by service users, and that many motivations will be submerged beneath the claim of ‘client protection’. Maybe she is acutely aware that the culture of her profession is becoming dominated by tendencies towards risk aversion and blame, and that fear and careerism drive these more than client interests. Perhaps she read recently of the psychologist hauled before a Health Professions Council (HPC) Fitness to Practise hearing for being drunk at a social occasion with colleagues. He was cleared of misconduct but only after the charges against him were publicised on HPC’s website and in the national media. Perhaps Michelle realises too, in the very moment Suzanne confronts her, that events are already spiralling out of her control; that sometimes organisations move against individuals, and that while her colleagues will follow procedure with (we hope) good intentions, the system nonetheless has a powerful current of its own – the energy of unacknowledged self-interest – which completes the circuit of professionalised mistrust we increasingly find buzzing around the intimate conversations of therapy. Before Suzanne does anything further, she might want to reflect in depth upon such questions. Her friend’s dilemma, after all, is as potent as her own."

“We set the standards ‘you’ must meet.” The HPC new generic standards. Pt 1

The HPC’s latest In Focus magazine (Issue 30) contains an article preparing the ground for their five yearly review of standards. The chief concern of HPC in this project is to produce an ‘overarching’ set of standards to apply to everyone that might come under their control. These new standards will be analysed in more depth shortly. Analysing the text of this one page introductory article from In Focus reveals a number of important points – the title of this blog is one of them that rather speaks for itself. The rest are fragments from the text with a short discussion of each:

1. “There are separate standards of proficiency for each profession we regulate.” It is interesting to note that the HPC deem it necessary to include this statement rather than leaving it as read. It suggests they find it remarkable that it is still the case. The article here is concerned with a new set of standards that will be the ‘overarching’ standards which the 15 different professional standards will have to subordinate themselves to. This is a fabulous example of top down control and ignores the particulars of practice and implicitly over-rides any appeal to science or even common sense. The standards of the HPC do not flow from the actual work, they flow from a centralised committee and an amorphous public consultation. The HPC has been set up on the understanding that it can regulate without needing to know anything about the practice under its control. Each new profession captured by the HPC will make it even more difficult to attend to the diversity amongst practitioners, and cannot help but set up a pressure to reduce these distinctions to make it easier to manage. This pressure will force standards further and further away from actual practice, and closer and closer to moral or political requirements – the less interested the Regulator is in real work, the more interested it will become in its own thoughts and ideas.

2. “Your practice will develop over time, and you may find that you no longer meet all the standards of proficiency for your profession. This is not a problem.” This is from paragraph 2. Let me just quote from paragraph one: “We set standards which ‘you’ must meet, both to gain entry to the Register and to stay on the Register.” How are these two sentences to be reconciled? There is a loophole here through which different degrees of power can easily enter surreptitiously.

3. “Your service users will expect you to meet high standards of personal conduct”. This is a curious statement and seems more interested in creating a class above the rest. Why would you expect, say, an art’s therapist to have higher standards of personal conduct than yourself or, say, your postman? Also, how does the HPC know what ‘service users’ expect? There is no reference to any research which might be consulted. And of course, let us not forget that the phrase ‘service user’ is a politically correct euphemism for ‘patient’, and is incredibly unspecific (one HPC document says it refers to anyone who might know someone who comes under the care of someone on the register) a phrase which has gained currency over the last decade and which perpetuates a misunderstanding of the basic properties of language - there is no implicit moral order in the word patient which, etymologically at least, designates someone who is suffering. HPC standard setting seems to be more interested in ideology than practice. This makes it more a tool for cultural change placed in the hands of bureaucrats.

4. CPD. This requirement was brought in with Patricia Hewitt’s White Paper (Trust, Assurance, and Safety, 2007). Continuing Professional Development is a phrase that belongs to the audit culture ideology and provides the basis for commodifying knowledge and selling training courses for which certificates of attendance are now routinely produced only to be inserted into CPD files and shown to people at the HPC (and their ilk). The HPC boldly state that ‘CPD is the way you continue to learn and develop throughout your career so that you keep your skills and knowledge up to date and are able to work safely, legally, and effectively’. This, however, is a belief, not a fact. In order to substantiate the belief the government have enacted a law which has led the HPC to construct an elaborate ritual where 2.5% of registrants in a particular profession are ordered, at pain of being removed from the register, to fill in a form which proves that their CPD has done what the HPC say it does. HPC have appointed and trained Assessors (‘at least one of whom will be from the same profession as you’ proclaims the booklet), to read these forms and reject any that don’t prove the hypothesis. One physiotherapist was told that one lay-person and one physio looked at her return. She had been assured that the CPD she undertook was her business, as a professional. However, when she filled in the forms and sent them in she was surprised to receive a further communication from the HPC asking her to prove that her CPD was benefiting the service user: “The Standards could be met if the registrant can show links as to how her CPD activities within the registration period have improved her work and benefited the service user." We don’t know whether these are the comments of the lay-person or the professional, but we can find the idea written into the document that accompanies this process (downloadable, of course, from the website). It appears in between two ‘standards’ which have been created by a committee and a consultation process. One standard says ‘a registrant must seek to ensure that their CPD has contributed to the quality of their practice and service delivery’. Another says ‘a registrant must seek to ensure that their CPD benefits the service user’. The reference point has become one from business and has broken away from the rational basis of thought. This is no doubt a result of distributing ‘thinking’ over a disparate group of people none of whom can be held accountable for the consequences of their thoughts. The law of the land then pulses through this mish mash and gets imposed on real people who were otherwise busy getting on with their work. This particular physiotherapist is now very worried that the HPC might remove her from the register, and render her practise illegal, because she cannot prove that her CPD has improved the quality of her service to users! It makes her sound like a poorly functioning factory unit.

Incidentally, the administrator at the HPC is called The Customer Service Manager. Who is the customer here? Apparently the HPC think it is the registrant. However, the registrant, as we all know, is compelled through force of law to pay money to the HPC. There is no service supplied in return. They pay for the right to practice their trade (which was their right before the invention of the HPC). It would not be unreasonable to see them as a tax-payer except that this would require you to understand the HPC as a small state, and to acknowledge that in this mini-state there is taxation without representation.

And what would a lay-person have to offer to the process of assessing the CPD return of a practitioner about which they know nothing? The only thing that seems possible is that a lay person might have the kind of common sense that sometimes goes missing amongst people who know too much about something, and might therefore be helpful to ground a conversation. But the process hasn’t been set up as a conversation, and the situation has not been rescued – it is profoundly un-grounded. The lay-person, rather than one person amongst a group of professionals, is one half of the team that assesses the forms returned by the professional. If this example is typical, then apparently the comments of the assessors aren’t mediated by anyone in contact with reality, but are simply returned to the registrant with the implicit threat that they will lose their right to work. The reasoning, if such it be, behind putting lay people into this process can be traced to the lack of trust the politicians have in the professions who do the work. Remember that peurile advertising campaign that launched the HPC? It encouraged the public to doubt the veracity of the professionals' word. Pernicious stuff.

5. “We use the standards we set whenever we make a decision about [‘you’]”. This statement is nothing more than an alibi. The standards are so vague (we will come to them in due course) that they can be used in wide variety of ways (as we have seen in some of the fitness to practice cases). The HPC are using the Standards as a pseudo objective written document to justify the power they have to stop someone from working. But because the standards are so far removed from actual practice, there is nothing real to help to ground the process of judgement, which leaves the whole thing open to politics and ideology or whim. This will feel like ‘bullying’ by anyone who is unfortunate enough to be in the way. There is no reason or rationality that can be appealed to in order to ameliorate the experience of the power.

6. “As an autonomous and accountable professional, you are responsible for the decisions that you make and must be able to explain them [to us].” There is a contradiction in this that expresses an impossible wish – like that of the child who wants to know something without the having to expend the time and effort it takes to learn. A responsible professional can be expected to account for him or herself to someone who works in the field, who understands the work; an excellent teacher could explain the work to someone who actually wants to know something about it. But why should all registrants now be expected to be excellent teachers, especially when the relationship of teacher pupil is totally inverted through the misapplication of institutional power? Furthermore, by insisting that knowledge be reduced to easily digestible chunks the HPC adds to the commodification of knowledge and interrupts the natural process of transmission and acquisition that traditionally supports a community of practitioners. If that weren’t bad enough, this highly centralised system cannot possibly benefit from the knowledge it produces, anything of value is simply discarded as the process transforms into a method of judging the quality of product in an imaginary factory. The practitioner is transformed into the product.

7. “[Our] Flexible standards give you the opportunity to grow and develop within your scope of practice”. Says who? The willingness of the HPC to say whatever it wants is truly breathtaking. There are no checks and balances.

8. “[Our Flexible Standards] also allow you the opportunity to make your own decisions based on circumstances”. The wording of these statements clearly communicate that the HPC is the overlord by whose grace you, the professional, are granted permission to work. Without this permission you would not have the opportunity to make your own decisions. The HPC, remember, knows nothing about the practice, and delegates big decisions to a few hand picked professionals held in a centralised system, and (in the annual consultation jamboree) to the public at large, over whom no quality control is exercised.

9. The following statement is another great example of the way the HPC insinuate that there is a danger lurking out there that they can protect you from: “You may be placed in a situation where you are worried that something you have been asked to do, or a policy you have been asked to follow, may mean you cannot meet our standards. You may also worry that this will affect your registration. We cannot give guarantees about the outcome of every situation. However, if you make informed, reasonable, and professional judgements about your practice, in the best interests of your service users, and you can explain the decisions that you made if asked to, it is very unlikely that you would not meet our standards or that your registration would be affected.” This does nothing to reassure but is vague and suggestive, it insinuates that you can’t cope in the world without them. It is infantalising.

10. “We would welcome any comments you may have about this article of any suggestions of topics for the future”. There is no promise that thought will be given to any comments that criticise the article - the CEO (Mr Seale) has said he will 'just take on the chin' any criticisms that come his way. Judging from the way that previous comments have been dealt with by his staff it is to be expected that only comments in support of the HPC’s self image will be given any credence.

11. “Next time we will look at whistleblowing and raising concerns.” Unfortunately, nothing productive will be done with any concerns, they will simply be turned into grist for the mill in this 'ecological' disaster.

Empty speech: Mr Seale on the regulation of counsellors and psychotherapists

Last year, April 2009, an interview with Marc Seale was published on epolitix.com, the first question had two parts. It was a very clear and direct question:

Question: Why has the government decided to bring in statutory regulation for the so-called 'talking therapies'? Does the HPC believe that regulation is necessary in this field?

The response given by CEO Mr Marc Seale is vague and evasive and says almost nothing; lets take it line by line to find something more substantial to say: "The purpose of regulation is to protect members of the public"

This line has never been substantiated - there was no research of any kind - good bad or indifferent - to establish the level or nature of danger that existing practices represented. This major lack leaves us all staring at the repetition of a political statement which we are supposed to swallow whole. The lack of any kind of objective or realistic benchmarks also mean that no proper judgement will every be able to be made about improvements effected by HPC regulation. We will be left in the domain of politics. At the last meeting of the HPC Professional Liaison Group for Counselling and Psychotherapy (12 May 2010) one of the professional members said it would be necessary to offer something more tangible to critics about the way that HPC is able to give better protection to the public. He implied that very few people would be satisfied with a bland repetition of the party line. The reply came quickly from HPC Chair Dr Anna van der Gaag who said: "we offer statutory regulation". For her, the mere presence of parliamentary power is sufficient guarantee of public protection. This is simplistic twaddle at best, and there can be few who believe it, even if there are few who are prepared to say so.

Mr Seale's next sentence is: "The government has indicated that it wishes to bring in statutory regulation for a number of the 'talking therapies' including psychologists, psychotherapists and counsellors"

Yes, we can find this wish written into the White Paper (Trust Assurance and Safety, 2007), but we can find no reason or rationale written alongside it. From the context of the White Paper the common knowledge is that politicking behind the scenes by the economist Lord Layard and his allies (who came together as the 'Savoy Conference') persuaded the then government to invest £170m in some kind of 'talking cure' provision in the NHS in order to save spending on Incapacity Benefits. That Government swallowed the maths, but could not justify giving money to people who were outside its control. Hence the intention to put Counsellors and Psychotherapists under the HPC (the great irony is, however, that the people actually employed to bring about this miracle cure were all outside this established field of expertise! The only winners seem to have been those few who won the training contracts...) Until that point all the major professional groups in the field were adamant in their rejection of HPC as their regulator. With the promise of nice jobs in the NHS they capitulated. Some people might call this bribery.

Mr Seale continues: "These professions account for a large number of practitioners and there is currently no compulsory requirement for registration."

The joke is that since the 1970s psychotherapists have been traipsing along to government offices asking for statutory power to be given to them, in order regulate the field. No government has ever agreed because the field is so diverse. If one pays attention to reality and to history we can see that, yes, there are a lot of people practising in this field, and no, there is no compulsory requirement for state registration. Further, we can understand that, until now, this has never been sufficient reason to hand over statutory power. What is not said here is that almost all the practitioners in the field belong to organisations that perform a regulatory function. Most people want to belong to a community that supports their work. Mr Seale seems to imply that without some kind of external force, practitioners would skulk around in the semi shadows doing things that weren't quite right.

He goes on: "Statutory regulation means that practitioners have to be registered in order to practise, demonstrating that they meet clear standards for their conduct and competence."

There it is, without the HPC, practitioners would not meet clear standards. Now, setting standards against which to judge the competent and incompetent has been the major difficulty of the professional liaison group at the HPC. As I have mentioned many times on this blog, HPC Council Member and Occupation Therapist Annie Turner repeatedly advised the counsellors and psychotherapists on the PLG to forget what actually happens in practice, and invent new standards to fit the HPC regulatory framework. She said that her own profession struggled for a long time before it realised that the Standards used by HPC were nothing to do with the actual practise they would police. The sentence from Mr Seale, above, suggests that the public will be better protected because now there are clear standards of conduct and competence. The advice of Professor Turner is that the actual technical competence of the practitioner is something that HPC is powerless to regulate. What standards, then, is Mr Seale talking about, and how will these standards help to protect the public? What kind of danger does he imagine he will be able to combat with the kind of standards that are invented to fit into his organisational framework? I have never heard or read Mr Seale give any kind of detailed response to these important and serious questions. He certainly doesn't give it here, in this EPolitix interview:

He goes on: "It also means that effective action can be taken in the event of a complaint." This is played like a trump card. Mr Seale’s organisation is, effectively, a fitness to practise factory, the raw material is the pool of registrants that legislation puts into the HPC database. More than one third of the annual income taken from registration fees is spent on the fitness to practise department, yet the proportion of registrants it processes is less than 1% of the register. 499 cases were considered by panels of the Investigating Committee in 2009-10. The number of registrants within the domain of HPC for this period was 205,000. That is 0.24% of all registrants presented a problem. Leaving aside for the moment the kind of problem these registrants pose, we are still left with the rather dismal statistic that of those 499 cases 30% were found unproven by the final hearing. So, out of 499 possible cases from which the public, apparently, needed protection, only 352 were found to be in some way problematic. So, this organisation, with its annual income of £16m managed to ‘protect the public’ from 352 practitioners last year. These figures simply don't support the claims Mr Seale is mouthing.

He says: "We believe that independent statutory regulation of psychologists, psychotherapists and counsellors is essential in order to protect members of the public." He doesn't say why, or how. For Mr Seale, it is sufficient to repeat the party line. At a conference in London on 23 January 2010 organised by Confer (and reported on this blog), Mr Seale was invited to speak to counsellors and psychotherapists about his proposals for regulation the field. His line throughout this meeting was that, "I am only a boring bureaucrat" "I'm just a man in a grey suit" "I just carry out the orders of the government". He consistently sidestepped his responsibility (valued at £180,000 per annum plus expenses according to the figures) claiming to be nothing other than an obedient servant of politicians. Mr Seale's job, however is as Chief Executive Officer and Registrar of an organisation with an income (levied through legislation) of £16m and increasing (but what is a registrar, what does he actually do?).

In the news last week (reported in the previous blog – HPC to capture Social Workers), the new Government seems to believe that Mr Seale is independent of government. How can we square these two things? If Mr Seale is only the obedient servant of the politicians, why don't the politicians know? Without someone taking responsibility here we are left with an organisation with statutory power to levy money from practitioners to stage show trials on behalf of employers (the highest proportion of 'complaints' come from managers in the NHS).

A second question posed by EPolitix last year was:

Question: There are parties who believe that the HPC is not an appropriate regulator for the psychology, psychotherapy and counselling professions, as your current models of regulation can not successfully be applied to non-medical therapies. How would you respond to that?

Mr Seale replies: "We are confident that our model of regulation works and is sufficiently flexible to allow us to regulate these professions. We are a multi-professional regulator and we currently regulate the members of 13 different professions including physiotherapists, paramedics and art therapists."

Again, Mr Seale avoids giving a proper answer to the question and simply states his belief.

He goes on: "Our registrants work in a variety of different contexts and many of our registrants do not work within the NHS for example, working instead in areas such as the prison service, education and industry. The professions we currently regulate also practice in very different ways and to different models, not just the medical model."

Mr Seale is trying to parry the arguments made against his organisation, but he does not engage with the issues (ie the problems associated with regulating such a generalised field). It is as if none of the words have any real meaning, but are simply the ones he has been given to string together into sentences in order to get by. It is as if he knows that he doesn’t really have to bother to think about things, as he has already been given the power.

Finally: "Strong professional input is vital to our model of regulation and we ensure good professional input through the use of 'partners'. Partners are members of the professions we regulate (and lay people) who provide the expertise and advice on matters of professional practise that we need for good decision making. For example, partners may be panel members who sit on fitness to practise panels that consider complaints about registrants, others may be registration assessors or visitors to education providers."

At the Confer meeting in January the counsellors and psychotherapists that I sat with in the afternoon's discussion groups were astonished to discover that the HPC chose and appointed the people from the profession who they wanted to work with. They had assumed that the profession itself would be better placed to know the best people for the job. Of course they are, but this is not what interests the HPC. The bias produced in the field by HPC policy is very troubling and has already caused much conflict and friction. It distorts the field in ways that have nothing whatsoever to do with knowledge and practice, and everything to do with the politics and power of the HPC. What Mr Seale means when he says 'good' and 'strong', then, depends on his own idea of what is good and true, it is a political argument, not a practical one where what counts as Good and True is defined by Mr Seale. The people that the HPC chose to work with were all people who consented to HPC regulation. Those who had strong reservations about the validity of HPC-style regulation were excluded from the process. Only when the HPC process was defeated (the 'public consultation' on HPC proposals last October provoked an unprecedented 1,000 responses and prevented the HPC from moving towards legislation before the collapse of the Labour Government) did any of those Good Strong people on the PLG start talking about taking the opposition seriously. HPC still don't think that would be necessary, however. Judging from Dr van der Gaag's chairing of the last PLG meeting (12 May 2010) HPC will continue their strategy of scare tactics by collecting together cases of complaints to insinuate that the field is full of sexual predators. This tends to close the gates on rational discussion very quickly indeed, and produces a push for punitive top down control.

Mr Seale has nothing to say for himself. He doesn't understand the work he is authorised to regulate, and won't accept responsibility for that gap in his understanding. There is a vacuum. Without an active thoughtful agent willing to engage with the void, he leaves it open to opportunistic and unpredictable forces. Such forces might have little to do with goodness, truth, or with protecting the public. Really, anyone would know that to make something valuable and worthwhile you have to make an effort, even (or especially) when power is handed to you on a plate.

HPC to capture social workers and change its name

On Tuesday 26 July the Department of Health announced that the General Social Care Council would go and the Social Workers currently under its regulatory authority would be passed to the HPC. The name of the HPC will be changed to reflect the new direction. Primary legislation will be required to achieve these aims.

This surprise was announced by the DH with the publication of a new document called Liberating the NHS: Report of the Arms Length Bodies Review.

Traditionally, social workers do not come under the auspice of the NHS, they come under social services which is a local authority concern. It's not clear how this move will liberate the NHS.

The DH press release says: “The General Social Care Council is an Executive Non-Departmental Public Body responsible for the regulation of social workers and social work students in England. It is anomalous as the only professional regulator answerable directly to the Secretary of State for Health.

The HPC is supposed to be answerable to the Privy Council, or perhaps to the Council for Regulatory Health Excellence. Neither of these bodies, though, seem to actually have any power over HPC. The social workers are being handed over to a body that is answerable to no-one.

“We see no compelling reason why the General Social Care Council should remain as an Executive Non-Departmental Public Body in the arm’s-length bodies sector, and we see potentially significant benefits from putting the regulation of social workers on a similar footing to the regulation of health professions. This involves the regulator being funded through registration fees charged to those registered, set at a level to cover the regulatory functions. In this way members of a regulated profession buy into their professional standards, which are set independently of government, and have an incentive to ensure these are upheld throughout the profession. …"

The potentially significant benefits will accrue to the HPC in the form of the registration fee. In effect this is a tax on the social workers. The fee paid to their own professional body is usually justified in terms of benefits accruing. Aside from the right to work, it is not clear what benefits the HPC offer in return for the fee. There are no voting mechanisms by which professionals who pay the registration fee are able to have any say whatsoever over how that money is spent. Income from fees next year is budgetted at £17m. The single most important item on the list of calls on this money is the fitness to practise department, who are due to spend £7m next year (next highest spenders are communications, IT and registration admin, each around £1m-£1.5m). The FTP department reported that 30% of its cases this year fell as not proven at hearing. All cases account for less than 1% of the total number of people registered. The production of standards by which to regulate the practice is, unfortunately, a daydream. During my observations of the Professional Liaison Group for Counselling and Psychotherapy, I heard Professor Annie Turner say more than once that the only way any profession could come up with standards suitable for the HPC was to forget what happens in practice, and invent something to fit the regime. This, sadly, does not bode well for the future of social workers, let alone the people who depend on them.

“The abolition of the General Social Care Council, the transfer of functions in relation to the regulation of the social worker workforce and related changes will require primary legislation. The timing of these changes is dependent on discussion with the Health Professions Council and the General Social Care Council to ensure an orderly transition.” Department of Health Liberating the NHS: Report of the Arms Length Bodies Review.

http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_117844

This news came out of the blue for The British Association of Social Workers. Thinking fast they announced that the new entity must strongly recognise social work in its title and its focus. Ruth Cartwright (joint manager of BASW) said the new body could be called the ‘Health and Care Profession Commission’, while the BASW Chief Exec (Hilton Dawson) thought “the Health Professions and Social Work Council” would be better. There is, of course, much concern that this sudden announcement by the DH comes without any consultation with Social Workers. Who did they consult with? Presumably the President and CEO of the HPC, whose programme of expansion is well known to anyone who cares to read the reports and listen to the meetings.

The GSCC was created in October 2001, one month before the Health Professions Order 2001 was put before the Houses of Parliament for debate. Last year the CHRE (created in 2002 by the NHS Reform and Health Care Professional Act 2002) was commissioned to review the GSCC after the senior management team collapsed. The inquisition found a huge backlog of fitness to practise hearings, and concluded that more robust paperwork systems were needed in order to deliver public protection. The Guardian reported (21 July 2009) that the Chief Exec of the GSCC had been suspended and sent home. The GSCC had been struggling to cope with the growing number of referrals since the Baby P case.

This sudden announcement in favour of HPC seems to be linked less to current government thinking than to the trajectory set up by the last Government, who published a White Paper just a few weeks before calling the General Election - ‘Building the National Care Service’ which had already nominated HPC to help push this through. The HPC had welcomed that white paper and the Government’s approach to piloting the licensing of social care workers and healthcare support workers. HPC PR said of that initiative:

“We look forward in due course to working with other stakeholders on the licensing model of regulation. We are committed to widening regulation to maximise public protection whilst not placing disproportionate burdens on the workforce.

“We believe a licensing model can achieve this balance for support workers, and we look forward to the opportunity to pilot the scheme.”

While it is not clear how Social Workers, Psychotherapists and Care Workers relate to each other as subjects for HPC regulation (let alone how they relate to paramedics, physiotherapists, and biomedical scientists), it is clear that the HPC is keen to pursue its expansion as planned, and to reduce the differences amongst practitioners to maximise economies of scale (see eIpnosis for a further analysis of this move). The new government has apparently been convinced by the argument, although this cannot be without problems within its ranks.

To understand the current news in relation to the ideas stated and published in the run up to the election, have a look at the Conservative Party’s ‘Blue Blog’ November 2009, where John Penrose (currently conservative MP for Weston-super-Mare, ex Bank Trading FloorRisk Manager, management consultant, and Commercial Director of an Academic Books Division) wrote “…As anyone who reads this blog frequently will know, I’ve been working on policies to get rid of red tape, bureaucracy and quangos. After a fair amount of hard work with the big brains in the Conservative Party, I’ve now consolidated these into a comprehensive series of reforms under the rather unsnappy title of ‘Regulation in the Post-Bureaucratic Age’, which we launched in October at the Conservative Party’s conference in Manchester."

It might be more than interesting to notice the trouble this accomplished man had in coming up with a snappy title for his work. He is probably trying to force too much into too tiny a space. This can't be comfortably for a risk manager.

“... The reforms are designed to cut at the very heart of the Government’s regulation culture and free British businesses from the regulatory millstone around their necks. We’re aiming to improve the quality and effectiveness of new regulations, and to start a culture change in Westminster and Whitehall so we can sweep away Labour’s ‘regulation for regulation’s sake’ attitude and replacing it with a less burdensome and intrusive approach."

It is noticeable and questionable that he is focussing on business rather than seeing the problem in terms of anyone who is trying to do a job of work.

“And about time too. Regulation has been snowballing out of control. It now costs businesses an extra £76 billion to keep the Government’s bureaucrats happy. That’s why it’s vital that we get this policy right. If these new listening events are anything like the one we held earlier this year, then I should have a lot to think about afterwards. I hope that everyone who attends will feel we’ve struck the spark that lights the bonfire of red tape.”

The logic that leads him to say that businesses should be allowed to save money must surely be the same logic that assumes that businesses would be better off wisely investing their money, and paying attention to their trade. But this is precisely the same logic that could be applied to anyone plying any kind of trade, even a poet. Penrose, however, does realise the pernicious way that the regulatory ideology eats away at social responsibility and has found its way into many different kinds of practice: the executive summary of the post regulation report states:

“Since 1997, the Labour Government has introduced an unprecedented number of new regulations, which have undermined social responsibility and reduced the UK’s economic competitiveness. The exponential increase in regulation has not only hit businesses (particularly small businesses), but it has also increased the bureaucratic burden on individuals, charities, public bodies and social enterprises. This has hindered innovation and social action and has also led to a rapid increase in government spending on administration and inspection regimes. Unfortunately, as we have seen with the failed system of tripartite financial regulation, Labour’s bureaucratic approach has not only impacted negatively on businesses, social enterprises, charities and public bodies; it has also been largely ineffective."

This is an important point. By asking people to pay money and attention to the regulatory ritual, not only does it stop people doing valuable things with their time and money, but it actually eats away at the normal checks and balances that people have built up in their work and which allow them to govern themselves and those around them in a more ordinary, and effective way. The regulatory ideology has nothing to ground itself with, but can only expand, spread fear, and rush on in the hope that no-one has time to ask questions.

“A different way is possible. We need to sweep away Labour's ineffective system of bureaucracy and replace it with a post-bureaucratic approach to regulation that makes use of new technologies and insights from social psychology and behavioural economics to achieve our policy goals in a less burdensome and intrusive way."

It is here that the rhetoric lets Penrose down so badly. Is it post-bureaucratic regulation he wants, or post regulatory bureaucracy. What do these words actually mean?

“Achieving this innovative and post-bureaucratic approach to regulation across government will not happen overnight. It will require a fundamental culture shift amongst policymakers in Whitehall and beyond, which will only be made possible through significant structural reforms."

Probably it is more important that people begin to really think about words and what they mean when they speak, than it is to make any innovative, post-wotnot, culture change, fundamental or otherwise.

“These structural reforms fall into two major categories. First, institutional changes that will curb the volume of new regulations, and remove existing regulations that are shown to be ineffective or overly burdensome. Second, policy changes to improve the quality and effectiveness of any new regulations, and ensure that they are genuinely post-bureaucratic and reflect the latest insights from academic research."

How can anything show itself to be genuinely post-bureaucratic unless we know what the phrase means? Without some genuine post-bullshit talking, we are going to lose some truly valuable knowledge, practices, and, probably, some absolutely essential qualities like trust, truth, and justice.

So, let's stick with the particular against this background of generalities - why has the Government suddenly decided that the Health Professions Council is a good candidate to regulate the Social Workers? It didn’t ask the social workers, so who did it ask? In the absence of any information, it seems quite likely that this sudden announcement is a result of politicking behind the scenes by the HPC who need to secure increased income to cover its expanding inefficiencies. The lack of any rationale for swapping the social workers into the Health Professions Council is very worrying. If it is possible to change the Health Professions Council into the Social Work and Health Professions Council just like that, then it looks like the HPC is the puppet of ... politicans, who themselves seem to be the puppet of ... the HPC. Is anyone taking real responsibility here? Does anyone understand what's going on?

There appears to be no idea behind the move, and no idea to behind the HPC. It might be time to turn to an article recently published in the New Statesmen by a former diplomat, and Conservative MP for Buckingham 1983-97, George Walden. The article is a bold analysis of the character, or lack of it, of the prime minister. “Nowhere Man”, is published online at the New Statesman on 28 June 2010

FTP of a psychologist who was ordered to do CBT instead of psychotherapy

In April, colleague Bruce Scott noticed that a case on the Fitness to Practise listing on the HPC website had vanished. This was the case of a Psychology Practitioner whose allegation is particularly interesting to counsellors and psychotherapists (see points 3 and 4 especially):

“In the course of your employment as a forensic psychologist in training at R Hospital between 2001 and 2006 you:
1. failed to provide reports in a timely manner;
2. failed to keep accurate client files;
3. undertook psychodynamic work with clients which was outside your scope of practise;
4. continued to undertake psycho¬dynamic work with clients when directed not to do so by your supervisor;
5. submitted a court report which
a) was not counter-signed by your supervisor, and
b) referred to you as a forensic psychologist.
6. The matters set out in 1 – 5 above constitute misconduct.
7. By reason of that misconduct your fitness to practise is impaired.”

The case had been opened in the usual way, and was held in public at HPC HQ, in February this year. They had not managed to get through the proceedings in the two days allocated, so were waiting till June to complete the ordeal. Bruce made a note and planned to attend the final part of the hearing. Then he noticed its disappearance from the listings.

A couple of weeks ago I decided to dig around a bit and asked for the transcript of the hearing, and received four days’ worth of proceedings, amounting to nearly 90,000 words. The HPC clearly deem this case to be one wholly in the public domain, yet the second half, conducted in June, had not been publicly announced. Why?

Meanwhile, Bruce had also noticed that no cases for Practitioner Psychologists were appearing on the HPC website at all. What was going on?

The Chief Executive’s Report to Council last week (HPC Council meeting, 7 July 2010) contains statistics about cases broken down according to section of the register. For example, there are about 40-50 cases pending at the Investigating Panel stage (the first formal stage) for Practitioner Psychologists since the takeover last year (in fact, the Practitioner Psychologists come third most months, after Paramedics and Physiotherapists).

The figures for cases pending at the Competence and Conduct stage, the public hearing, are currently about 22 or so.

When asked why no cases were showing on the HPC website for psychologists, the clerk replied first that this question was being dealt with under the Freedom of Information Act, which seems a bit odd, and second that “The only practitioner psychologist hearings taking place in the next four weeks involve cases transferred from the British Psychological Society. Under the transfer arrangements, these individuals were not eligible for automatic transfer to the HPC register as there were outstanding fitness to practise matters at the time the register opened. The hearings are taking place before the Conduct and Competence Committee under the transitional arrangements to determine whether the person should be entered on the register. We are not publishing details of these cases on our website as these individuals are not currently on the HPC register.”

The decision to remove these cases from the website seems to have come shortly after Dr Cross’s case in March or April, and this appears to have created a bit of confusion in the HPC itself. The case whose allegation was quoted above was pronounced on the website in January in readiness of the February hearing date, but was not declared in May, four weeks before its final two days’ hearing in June. In the clerk’s email this week he specifically states that “The Council's policy is to publish the details of a hearing on the website four weeks in advance of the hearing date. Where a case is part heard or adjourned, the hearing will remain on the website with the new date.” This did not happen in this case. In the transcript of the case (which is freely available by emailing Ciara.O'Dwyer@hpc-uk.org and asking for it: PYL05183) the HPC solicitor clarifies the position as follows:

“As this was an investigation originally carried out by the British Psychological Society, it is probably right that I should explain the background and how the HPC comes to have jurisdiction just briefly. The background is that Ms D was registered with the British Psychological Society as a practitioner psychologist. And as you may be aware there has been a transfer of the voluntary register operated by the BPS into the statutory remit of the HPC. And ordinarily a person registered with the BPS would be then included in the relevant part of the register of the HPC. However an exception to that is where a person is subject to proceedings which could lead to their removal or suspension from the BPS register. And if that is the case, the HPC may determine that the person’s name is not to be entered into the relevant part of the HPC register, and dispose of the matter in such matters as it considers just. And that is according to Article 5(5), (6) of the Healthcare and Associated Professions (Miscellaneous Amendments and Practitioner Psychologist) Order 2009. I outline that in brief because Mr T [registrant’s solicitor] has kindly indicated to me this morning that there is no issue over jurisdiction. This matter has come straight to the Conduct and Competence Committee because of the stage that it had reached at the BPS. And so that explains why, in the notice of allegation, it is phrased in terms of whether she should be admitted to the Register, rather than the usual case where there has not been a transfer of this sort when you are considering someone who is already on the Register, and what if anything, should happen to that registration if you find the matters to be proved.”

So, there it is: this is one of those cases that the HPC is holding that has come from the BPS so the practitioner has not yet been granted access to the HPC Register (though she does have a registration number, and is apparently legally subject to the proceedings of the HPC conduct and competence committee). This is one of those hearings that I am now told is not being held in public, although, as you can see, I have received the transcript in full.

Apart from this anomaly, the case itself is fascinating. I commend it to you for leisure-time reading (I bet you could even register the time it takes to read it in your CPD file, if you indulge in such a thing). The lawyer, Mr T is wholeheartedly on the side of his client and goes at the HPC witnesses like a Rotweiler – “Yes, Mr S. I just want to start with something that is not in your witness statement. But is relevant to these proceedings. And that is the genesis of your complaint. Because, of course, this is a complaint which was not pursued or taken up by the Trust, the employer. This is a complaint that you personally had made with Dr B, isn’t it? … you, in fact, were never her supervisor for the purposes of the BPS chartership, were you? … In fact the Trust had previously taken the decision that you would not be her supervisor because she had already made a complaint about you and the way that you were conducting supervision.”

The defence sets out right from the get-go – this is a counter complaint made by two individuals, not supported by the Trust, and prompted by a grievance taken out by the defendant against both managers. As the case unfolds there are some interesting details about what does and does not count as psychodynamic work, what constitutes supervision, what is meant by ‘a vulnerable service user’ (in this case a man who, amongst other things, battered his girlfriend to death with a hammer), how NICE guidelines are used to justify imposing CBT and forbidding psychodynamic work, and finally, the sheer beauty of the evidence of the old psychiatrist (Dr K) who had been supervising the psychotherapeutic work of the defendant - it comes through as if from another planet.

The case rolled on, as already noted, for four whole days, costing about £8k excluding legal costs (say, another another £1k per day). The Panel took 4 hours to come to its decision, which took barely a page to record on the transcript. The decision was NOT well founded.

The latest FTP Annual Report from HPC reports a doubling in the proportion of registrants with complaints against them over the last five years: 0.19% in 2005-6, and 0.38% in 2009-10. There has been a huge increase in cases Not Well Found in the same period: 2% of all cases not well founded in 2005-6, and 30% not well found in 2009-10.

Kelly Johnson, Director of FTP notes in her report that the budget for the FTP department was approximately £6m last year, which is about 40% of the HPC’s operating costs, from money raised by registrant fees. There appears to be no effective mechanism for controlling the quality of work in the FTP department.

Thought Crime - an FTP case of a Biomedical Scientist

This is the story of a Biomedical scientist who was reported as saying of an absent colleague ‘I have an idea of what XX could do as her other job – a suicide bomber’. XX had suddenly handed in her notice with no other job to go to, and had thus become the subject of gossip for the colleagues who remained at work. At a leaving do for another member of staff a while later, the registrant’s comment caused a bit of unease, and somehow, later, seeped into the attention to one of the managers at work who hadn’t been at the party. In a series of convolutions that eventually led to the registrant being sacked, another manager actually phoned the woman who had left, and about whom the comment had been made, to tell her. Apparently he had wanted her to join in and give some kind of evidence of offense in a disciplinary process he was advancing against the registrant. She declined.

When a registrant is sacked or demoted the employer is obliged to tell the HPC, who then consider making their own case against the registrant. This case was first heard by the Conduct and Competence Committee on 29 March 2010 and was concluded on 15 June when the panel found the HPC had made a good case and decided to issue a caution for three years against the registrant. The first part of the hearing was conducted in public. The transcript is available to the public (email ftp@hpc-uk.org and ask for Allegation Number FTP02357) The second part of the hearing was held in private, but the decision is published in full on the HPC website

In order to build a case the HPC lawyer refers to Standard 3 “You must keep high standards of personal conduct” and Standard 12, “You must behave with honesty and integrity and make sure that your behaviour does not damage the public confidence in you or your profession.” Indeed, in the decision, the Panel make use of these standards to justify their action: “The Panel note that misconduct can encompass inappropriate behaviour which occurs out with the course of professional practise itself but compromises the reputation of the profession concerned. The Panel find that the remarks were inappropriate and focused on a professional colleague’s ethnicity. The Panel find that the following HPC Standards of Conduct, Performance and Ethics were breached:
3 – You must keep high standards of personal conduct.
13 – You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.
The Panel find misconduct.” No attention is made in the hearing to say what kind of public would lose which sort of confidence in what kind of profession. Nor is there is any effort made to put this to any kind of test. It remains vague.

It is unclear how this comment constitutes a danger to the public. It is also unclear how this comment constitutes a case for dismissal in the NHS. That it has moved both organisations to such a level of activity, resulting in a dismissal (after 30 years of work in which no complaint was ever made about the employee) raises general questions about the direction of British social policy, and specific questions about the quality of local management and leadership in each of these places.

The case was reported in the Daily Telegraph on Friday 16th July, on page 11, under the headline: “Scientist ‘said junior could be a bomber’” the article opens by remarking that the registrant ‘has been allowed to remain in the profession.’ The first hand report of the case would most probably have come from a news agency, rather than a DT reporter on site. Neither, however, ask why this constitutes a case.

In 1995, the JM Consulting Company was commissioned by the Department of Health to make a report into the regulation of health professions. This was an inquiry into the Professions Supplementary to Medicine Act (1960) with recommendations for new legislation. The report notes that amongst the principle areas of concern raised about the then CPSM (Council for Professions Supplementary to Medicine) was ‘archaic and inflexible procedures for discipline’ which meant that misconduct falling short of the ‘infamous’ was not addressed. In essence, the 1960 Act protected the public “by providing a (last resort) mechanism for disqualifying professionals shown to be guilty of exceptional examples of misconduct.” (p18). A lot changed with the passing of the Health Professions Order 2001, but nowhere can I find it written that thought crime, wise-cracks or jokes should become part of the remit of the Conduct and Competence Committee. This particular case must raise questions not simply about the general nature of the secondary legislation behind the HPC, but about the specific management and personal style of those who are responsible for its day-to-day work.

Meanwhile, on Nick Clegg’s Your Freedom Site, HPC regristrants from other professions continue to post their own comments about the bizarre procedures of HPC: eg, this one posted by galileo July 09, 2010 at 21:16:

“This spring I have received 6 letters and 2 printed booklets from HPC. And, if you can believe it, all were to tell me how to fill in my renewal form, which was no more than a recto-verso tick box form. Does it really take a 20-page booklet to tell a professional, trained and recognised as senior in my work, with almost 20 years professional background and clinical experience, how to confirm that my name and address haven't changed? Not only did they write to me, but they also invented a manager that they imagined I must have and who they wrote to, asking them to prompt me to send back my form. Now let me be clear, all this was simply to renew my registration and continue to pay HPC. Nothing to do with providing me with any relevant information about improving my practice, protecting the public, and neither did it provide the public with any meaningful information about me. And all of this was months before the deadline for renewal... Why not use the funds instead to provide public education so that people know what questions to ask and how to access the most suitable one of the multiple treatment choices available to best meet their needs?”

Now, that’s a good idea.