Monday, 7 February 2011
The collapse of HPC procedure on capturing Counselling & Psychotherapy
Here's a link to a report of the final meeting of the Professional Liaison Group for Counselling and Psychotherapy. As we know, the process for capturing this field was originally supposed to end in October 2009. It failed. Instead of recognising its inappropriateness as regulator for this practice, the HPC scheduled another set of meetings, and relied on its power to shove things through regardless. The PLG was given another year to come up with the all important standards and entry requirements. It failed again. Instead of admitting defeat, the HPC still clings to its power and in a dazzling display of nincompoopery Di Waller and Marc Seale vowed 'this is not the end'. Annie Turner, true to form, reckoned the Council would settle it all with a vote. After all, it will be easier for them to decide on entry standards etc, not being cluttered up with any knowledge of, or responsibility for the practical problems and all. In fact this will even guarantee them a good supply of complaints from the field in future which can be counted as 'proof' of their indispensability! Click the heading to read the report.
Saturday, 29 January 2011
Correspondence between HPC and a Practitioner with real concerns for the future of the field.
On 20 September, 2010, Dr Douglas McFadzean (a Counsellor-Coordinator with the Stirling Locality Counselling Service, NHS Forth Valley) wrote, not for the first time, to the HPC. This generated a small exchange with the Director of Policy and Regulation, Mr Michael Guthrie. I have analysed this exchange in some detail in order to bring out the underlying problems that persist between practitioners who have questions both for and about the HPC and the dead-ends they find themselves in when a reply arrives. Between these four email exchanges we can see how the HPC appears to be making a fulsome reply but is not in fact addressing the points that have been raised. By studying the text in this detail, it is possible to uncover the ways in which the process fails, and it may predict the problems that lie in wait if nothing is done about it.
Dear HPC
Today I received an invitation (forwarded by COSCA on your behalf) to an information event to be held in Glasgow on 7 October 2010 as part of the process towards the potential regulation of psychotherapists and counsellors. Unfortunately, I (and several interested colleagues) find that the notice given is much too short - we shall find it exceedingly difficult to rearrange client appointments and other work to accommodate such an important event. I suspect the short notice will skew the attendance profile and make the meeting much less representative of the body of Scottish practitioners (particularly those working at the "coal face" with clients) than it might be. Given the continuing disquiet about the HPC regulatory route amongst many practitioners, the short notice of this event may well add to the disenfranchisement felt during the consultation process.
Perhaps you would be good enough to elucidate why such short notice has been given, and to consider whether the event should be delayed to ensure a good cross-section of practitioners can attend to share their views with the HPC.
Yours faithfully
Dr Douglas McFadzean
Douglas McFadzean asks specifically why short notice was given, and noted the effect this would have on attendance (ie skew it away from practitioners). From his point of view this is clearly a very important event that he wants to participate in, and furthermore, feels disenfranchised when HPC makes it difficult for him. His expectation is that the HPC will want to benefit from knowledge and experience like his, and will want him to know what their plans are too as they will affect him directly. Mr Michael Guthrie, the Director of Policy and Regulation at HPC replied on 6 October 2010 (7pm), the evening before the event in question and although apparently polite and friendly, his words reveal a very different stand point which is at odds with Dr McFadzean’s. I have inserted numbers into the text which link with the comments that follow in order to draw out some points for discussion.
Dear Dr McFadzean
Thank you for your email; my apologies for the delay in responding to your concerns.
The event in Glasgow is an information event and is part of four events we currently plan to hold, one in each of the four countries, (1) in order to provide information to psychotherapists and counsellors about the HPC and about our ongoing work. (2) We know that such a small number of events inevitably means that we will only reach a small fraction of practitioners, (3) but we plan to maximise the numbers who are able to attend each event.
I am sorry that you received an invite to the event at a late stage and therefore some colleagues were unable to attend. I note that you are due to attend the event yourself tomorrow. I think your email provides valuable feedback for us in relation to any future events we may arrange. The invite for the event initially went to voluntary sector and other psychotherapy / counselling organisations in Scotland, as it was felt that this would ensure (4) a sufficient number of attendees whilst avoiding a situation in which we would inevitably have to disappoint large numbers because of the fixed space available. We discovered, however, that we did have some available places and the invitation was kindly sent out by COSCA to its members.
I know that this was far from ideal in terms of notice and (5) I will ensure that we learn from this and that more notice is given for any events we hold. We do not plan any further events in Scotland at this stage, but, subject to a Government decision about whether regulation will proceed, it will be very important that we work with COSCA and other organisations in Scotland to keep practitioners informed.
In terms of the attendance at the event, I am confident that the profile of attendees is not (6) schewed [sic] in any way and we have a (7) good cross-section of practitioners across the psychotherapy and counselling field in Scotland and across different areas in practice, including practitioners from the NHS and the large voluntary sector in Scotland. (8) I understand from my colleagues that the event is now 'sold out'.
Thank you again for contacting us with your feedback.
Kind regards,
Michael Guthrie
Mr Guthrie’s letter presents the following information:
1) the meeting is to provide information to participants, not to glean information from them. This contradicts Dr McFadzean’s expectations. Certainly, the even was advertised on BACP’s website thus: “This is the first of several events the HPC will be holding in the four home countries, in order to consult more widely with counsellors and psychotherapists on the issue of regulation.” (emphasis added).
2) Reaching a small fraction of practitioners might be reasonable if this small fraction were carefully selected to represent the field. There is no evidence that this was done with any statistical elegance. The notice of the event was only channeled through particular organisations, and Mr Guthrie has still not adequately explained the short notice given of the event.
3) The stated aim of maximizing attendance is confounded by the HPC’s action: first it has limited the number of invitations, and then it issued invitations too late for practitioners to realistically re-arrange their work. In the event it was only about half full on day.
4) ‘sufficient’ contradicts the original aim of ‘maximising’, and raises a question about original intention (we already know it was only intended to talk to a small number of selected people). It also contradicts the idea of ‘inevitably disappointing large numbers’. These levels of ambivalence in Mr Guthrie’s reply raise questions about his integrity.
5) It is not clear what it is that Mr Guthrie will learn. The ambivalence about who would attend seemed to prevent him from realizing what he already must surely know (the HPC know the importance of forward planning, and spend a lot of attention on precisely this). It is not knowledge per se that was lacking, but rather a lack of clarity about the purpose of the meeting and thus the audience required.
6) ‘schewed’ means shunned, and appears to be a Freudian slip. The word Douglas McFadzean used was skewed.
7) ‘a good cross section’ implies a rational and thorough analysis of the field from which it might then be possible to draw a ‘cross section’. Dr McFadzean’s point was precisely this: the way that the HPC had gone about things would almost certainly skew the field away from practical knowledge per se. Mr Guthrie effectively deploys statistical jargon as a smoke screen to nullify the point.
8) Mr Guthrie thought the event was sold out, however, on the day, the event was only half filled.
Dr McFadzean wrote again on the evening of the event, and copied the letter to Brian Magee, Chair of COSCA (Counselling and Psychotherapy in Scotland)
Dear Michael
Thank you for your email explaining the circumstances of the short notice given for the Counsellors & Psychotherapists information event held in Glasgow today (Thursday, 7 October). As you noted, I did manage to attend the event myself, but unfortunately had to leave the panel session to travel before my points could be taken.
Perhaps you would be interested to hear my intended input in any case. I was going to express two main areas of concern:
1a) The lack of evidence base for the HPC route to regulation – for both the case for statutory regulation in the first place and for the case that the HPC approach will effectively achieve its aim to protect the public. (Surely a registration structure cannot be properly designed without substantive data and findings about the extent and nature of current malpractice, abuse, etc?)
1b) The lack of evidence base for much of the PLG's work in trying to set standards. (At least, Brian Magee was honest enough today to admit that COSCA’s initial approval for the differentiation of counsellors from psychotherapists was made "on pragmatic grounds", and not on any evidence base.)
2) The fundamental difficulty of trying to regulate effectively by title rather than by activity. The first questioner today hit the nail on the head - she was a CPN who did psychotherapy and counselling as part of her work activities. It is what practitioners do which harms clients, not their job title! It is almost inevitable that the most devious and dangerous practitioners will slip through the HPC regulatory net by simply modifying their title, whilst carrying on as before. In any case, a proper agreed definition of the activities of counselling and psychotherapy would seem essential, and cannot be naively assumed "as what counsellors and psychotherapists do".
These concerns were all discussed in detail earlier in my submission to the consultation about the PLG's recommendations, and I have since heard little to allay them. I would be most grateful if you could enlighten me on how these issues have been or can be properly addressed.
I hope you don't mind me sending a copy of this reply to Brian Magee as COSCA was involved in "passing on the message" about today's event and Brian is directly involved with the PLG.
With best regards
Dr Douglas McFadzean
In this letter Dr McFadzean raises directly the main problem that has been brought consistently to the attention of the HPC by many different people since the original ‘call for ideas’ in October 2008. In his point 1a), he clearly states that no rational ground has been given for changing the system of regulation for counselling and psychotherapy, and that (ipso facto) there is no evidence to guide future proposals. In parentheses he adds that that any intelligent man or woman would know that you cannot possibly design or propose a regulatory structure without a solid rational, logical ground, and without carefully collected evidence. He adds, in point 1b that the PLG also has no clear rational ground on which to do their work, nor any proper evidence with which to do their work. Point 2 draws attention to the way things are done now (a focus on function) before reminding Mr Guthrie that he should already be aware of these points having read them in the original call for ideas. He adds, however, that these points seem to have been ignored by the HPC. Finally, he asks how the HPC will address this vital issue now that it has been once more drawn to their attention.
Michael Guthrie replies on 12 October with a very long email indeed. There are many points to make about this email (about 30 individual points in all) beginning with the lack of a subject in the first sentence. In fact Mr Guthrie appears to be hiding behind a series of cut and paste pieces which serve only to obscure the fact that he has no clear reference points. For example, in Paragraph 2 (below) he presents the idea that the HPC is working on a problem about ‘how regulation for psychotherapists and counsellors might work’. For some reason Mr Guthrie has prefaced this point with ‘as you will know’, yet the subtlety of the point being made is something that hardly anyone seems to understand. It is this point, you see, (about how regulation might work – and it is important to note the conditional tense that is used here), that was the very point of contention brought so clearly to light in the hearing preliminary to the Judicial Review of HPC at the High Court in December 2010. There is a slipperiness in the language that requires us to be careful. The next sentence, for example, is very unclear. Is Guthrie saying that the Government asked the HPC to see how regulation might work? If so, his next point is just plain wrong. If the Government have asked how regulation might work, it is reasonable to assume that this will include a comparison with other regulatory schemes on offer (to compare how it does work elsewhere). Guthrie however, says this is not their remit, but offers no reasons to substantiate the statement. What explains the sloppy grammar, the lack of coherence? In fact the third sentence in the second paragraph sets off in one direction, then (as TS Eliot might say) makes a sudden leap, turns once about the house, and falls asleep. Guthrie says the Government has asked HPC to do something, which he then says the Government (or perhaps even Parliament) is responsible for doing itself. It is right here in this dodge that the HPC appears to duck out of any work that might be involved. Presumably, as an organisation created by statute, and with a CEO who claims publicly “The Health Professions Council also has a specific role in advising the Secretary of State of which new professions should become statutorily regulated, and that, I think, is vital in terms of protection of the public” (Confer Conference, 30 January 2010), there is a duty to the make sure that any advice given to the Secretary of State is based on proper research and consideration. This is precisely the point made by the QC in the High Court on 10 December 2010 and which the Judge found convincing.
Paragraph 3 is a vague reference to possible ‘public-friendly’ allies for the HPC’s equally vague position – padding.
In paragraph 4 a point emerges that is relatively new from the HPC. It is also contradictory, which is not new for the HPC. Much has been made of the fact that the HPC’s job is to ‘protect the public’. Here, however, is the admission that this great edifice has been erected to protect the public from ‘a very small minority’. This point completely ignores the other part of the HPC business – that of validating the educational systems around the country, of which we hear very little, but of which there is quite a lot. There is also no effort to rationalise the complicated system that is imposed for such a small minority, nor ‘how’ it ‘might’ actually achieve its ends (which is the question posed by McFadzean from the beginning).
Paragraph 5 is another frequently repeated phrase from the HPC repetoire, which is here used to avoid McFadzean’s specific request for supporting evidence.
Paragraph 6 sees for the first time Mr Guthrie’s own agency – he says ‘I think it is true to say’. What he thinks is true to say is that there is some report somewhere that probably makes it all alright. He cites no reference, and doesn’t even give the year of publication. This is shoddy work, and we are not even half way through the letter.
Dear Dr McFadzean
(P1) Thank you for your email. Very happy to answer the points you have raised.
(P2) 1(a) As you will know, the work the HPC is doing is about how regulation for psychotherapists and counsellors might work. This is in line with the White Paper in 2007 and its clear statement of Government policy. Therefore the work we are doing is not looking at the evidence for regulation or at alternative models of regulation as this is a consideration for the Government (and parliament) whose decision it is as to whether the policy contained within the White Paper should be implemented.
(3) Many charities in the mental health arena who have a consumer advocacy role support the statutory regulation of psychotherapists and counsellors because they consider that this will help to provide a more consistent and independent means of dealing with cases of malpractice. For example, the 'We Need to Talk' coalition of mental health charities called on the Government to introduce regulation a number of years ago, alongside calling for increased access to therapy for patients and clients.
(4) In our view, statutory regulation protects members of the public by setting standards, protecting commonly recognised professional titles and providing a way in which complaints can be dealt with fairly and appropriately. Statutory regulation means that the very small minority of practitioners who do not practice safely and effectively can be removed from the Register and prevented from continuing to practise and continuing to cause harm. I would argue that these important functions also increase public faith and confidence in the services provided by registered professionals.
(5) At the moment, a psychotherapist or counsellor who is removed from the membership of their professional body, for example, can simply continue in practice without any legal means for preventing continuing harm to members of the public.
(6) In terms of evidence of malpractice, I think it is true to say that the evidence for this is evolving. For example, the Council for Healthcare Regulatory Excellence (www.chre.org.uk) a few years ago (11) published findings from research which described the profound and long-lasting impact of boundary violations upon patients and clients.
(7) In our view, regulation is necessary to provide an independent means of dealing with the very small minority of practitioners who represent a danger to the public, and to provide the public and the profession with the assurance that the rest of the profession is signed up to standards for conduct and proficiency.
(8) However, I would emphasise that the final decision about regulation is a political one and in moving towards regulation the Department of Health is required to produce a full impact statement, looking at the reasons for and against introducing the policy and the impact or potential impact on all those affected.
(9)1(b) The work of the PLG in setting standards is certainly an iterative process. The reason why we establish PLGs is that whilst I and my colleagues will have experience of regulation, how it works, and our legislation, we are not psychotherapists or counsellors and therefore we need, and reply [sic] upon, the profession-specific expertise of the professional bodies and others with expertise in this area to help us in putting together standards of proficiency.
(10) The PLG has had many long and detailed discussions about the differentiation question which informs the standards, including taking into account the information and evidence gathered in responses to the Call for Ideas consultation in the summer of 2008 and the more recent consultation last year. In its discussion, the members of the PLG have often challenged each other to support their views with evidence. This is an area in which there are a wide variety of different views about the key interest groups with different groups taking very different views as to whether differentiation is necessary or feasible and on the standards that should be published. This seems to be a result of differences between organisations, differences in philosophy and differences in custom and practice.
(11) We have reconvened the PLG to try and resolve these issues. Neither I nor anyone at the HPC has any vested interest in whether there should be differentiation or not, but we want to try to work with the field to reach a solution which is workable, reflects reality, and meets the regulatory needs of the field. This includes and will continue to include scrutinising the evidence that is put forward for and against differentiation.
(12) You raise an important point. However, I do not personally believe that any approach to try and regulate by activity or 'function' would be successful or feasible, or considered to be so by the UK Government who would have to enshrine any such approach in legislation.
(13) In the UK professional regulation (and this includes groups such as nurses and chiropractors) has typically been by protection of titles. The Government tends to favour this approach as it ensures that commonly recognised professional titles are restricted to those who are qualified, whilst ensuring that regulation does not adversely affect those who it is not sought to regulate, or prevent service providers, employers and others in developing new job roles and new ways of working. There are a few examples of where activities or functions are protected in law but these are limited to discrete, physical acts that it is possible to define clearly to the required degree of specificity in legislation. For example, the fitting of contact lens is restricted to registered optometrists and dispensing opticians with necessary training, and the dispensing of hearing aids for retail sale or hire is restricted to registered hearing aid dispensers.
(14) Protection of function or activity is often used in the US where the scope of practice of each profession is often highly prescribed in legislation. The drawback from this approach is that it often acts to fetter the development of professions as a legislative amendment is necessary ever time a new technique or approach is developed or the profession wishes to develop into areas that in the past were typically carried out by other professionals. The UK Government typically tends to avoid protection of function because of such difficulties - it is necessary to define a discrete activity to a degree of precision, in legislation. It is often not possible to do this because of the nature of the practice of profession (e.g. interventions which are about communication rather than physical activities are a good example where this is much more difficult to achieve); because protecting a function would adversely affect another group that it is not sought to regulate; or because there is a lot of overlap between the practise of one profession and that of another (for example, in the medical arena nurses now undertake tasks that traditionally were undertaken by junior doctors).
(15) In terms of psychotherapy and counselling, my understanding is that there is no one agreed definition and each of the professional bodies has a slightly different emphasis. Indeed, arguably, this underlines the differences in perspective that we are attempting to work through in the PLG. In my view it would be very problematic indeed, if not impossible, to attempt to protect the activity or function of psychotherapy and counselling for the reasons outlined above. In particular, it would be necessary to differentiate the activities involved from other types of activity (e.g. debt counselling, advice, coaching); and differentiate it from the activities of other professionals who deliver so-called 'talking therapies' (e.g. psychiatrists, counselling psychologists, clinical psychologists).
(16) I think it is important to be honest about some the limitations of protection of title, but also honest about the benefits that protection of title would bring above the current situation in which no titles are protected. (See 1a) above).
(17) I hope the above is helpful and helps explain our perspectives on your questions. In relation to 1(b) this continues to be an ongoing process of debate and discussion within the PLG. I have copied Brian into this email.
Best wishes, Michael Guthrie
Paragraph 7 repeats the point about the work of the HPC being focused on a small minority of practitioners. Paragraph 8 repeats the wish of the HPC executive that the real work is being done by Department of Health. Paragraph 9 sees Mr Guthrie turn towards Dr McFadzean’s second point (1b). This reminds us that the previous 7 paragraphs (excluding the introductory remarks of the first paragraph) have all been, ostensibly, answering his point 1a. This was:
“1a) The lack of evidence base for the HPC route to regulation – for both the case for statutory regulation in the first place and for the case that the HPC approach will effectively achieve its aim to protect the public. (Surely a registration structure cannot be properly designed without substantive data and findings about the extent and nature of current malpractice, abuse, etc?).”
In the long detour presented by Mr Guthrie not one shred of evidence has turned up. There has been no apology for its lack, either. The next section turns towards Dr McFadzean’s second point:
1b) The lack of evidence base for much of the PLG's work in trying to set standards.”
In response to this point Mr Guthrie states that he and his colleagues know nothing about the practice they are proposing to regulate, but have to ask representatives to ‘help us’. This suggests that there is an endeavour on the part of the HPC to understand the area which they will then be empowered to regulate. The phrase in this paragraph (9) ‘an iterative process’ is a euphemism. It adds nothing, and pretends that something technical is going on. There isn’t. In paragraph 10 Mr Guthrie says that long and detailed discussions have taken place in the PLG. He says that members often challenge each other to provide evidence to back up their statement. This would suggest that the evidence Dr McFadzean asks for is ready to hand, yet Mr Guthrie produces none. This is not surprising, as the long and detailed discussions that I observed at the PLG produced nothing approaching the dignity of evidence but rather made the point that Dr McFadzean is making here – that the PLG has been put into an impossible position. Towards the end of this paragraph Mr Guthrie gives his synopsis of the PLG process. He says
‘This is an area in which there are a wide variety of different views about the key interest groups with different groups taking very different views as to whether differentiation is necessary or feasible and on the standards that should be published. This seems to be a result of differences between organisations, differences in philosophy and differences in custom and practice.’
Although he hasn’t offered a firm opinion (after the two years of studying this field), Mr Guthrie is willing to suggest that he thinks it is possible that there are a lot of differences in philosophy and custom and practice in the field. This does not bode well for the HPC’s intention to regulate the field. The HPO2001 requires each section of the register to contain a group who conform to a coherent body of knowledge.
Paragraph 11 takes us further into the bog. Mr Guthrie states that they have reconvened the PLG to overcome the difficulties stated. Yet this must surely be nonsense. Can you overcome the differences in philosophy, custom and practice of a field by selecting eight people and subjecting them to a process configured to achieve a different end? If you wanted to achieve a particular end, it would be sensible to construct a process conducive to that end. The process in use here is a ready made routine used to produce standards in an already unified and coherent field.
The reference to ‘scrutiny of evidence’ suggests (again) that there is some, (which could therefore be presented to Dr McFadzean), but this, again, is not forthcoming, adding to the growing conviction that there isn’t any.
Paragraph 12 again sees the emergence of Mr Guthrie’s personal opinion. He acknowledges the importance of the point made by Dr McFadzean and many others (notably the CPN at the meeting in Glasgow), that real regulation of this practice is done by attending to what actually happens in practice. Yes, it is an important point, but one that the HPC cannot accommodate because it regulates according to a different principle. Mr Guthrie frames this as a general point of regulation, but this completely ignores the fact that regulation takes different forms, and the regulation that is current in the field, at least of psychotherapy, is one that is based on function. Had the government maintained the tradition of passing statutory power to a professional group, this would have maintained the tradition of regulating according to function. Mr Guthrie, (a professed expert in regulation) appears not to know about this other kind of regulation. Even if we allow Mr Guthrie to remain within his own sphere of ignorance, or speciality, he still has to face the fact that the ‘good point’ made by Dr McFadzean and others is a serious spanner in the works, and this might constitute good grounds to advise the Secretary of State against passing statutory power to the HPC to regulate this field.
There are still five paragraphs left to comment on, but by now it seems clear that Mr Guthrie (consciously or otherwise) is weaving a web of waffle to stop Dr McFadzean in his tracks. What is completely absent here is any information about how the HPC’s form of regulation actually works, and how Mr Guthrie understands the costs and benefits of imposing this structure on a field which is actively and repeatedly telling him to take great care.
The most interesting thing in this exchange is what has not come to light. We know that Dr McFadzean specifically asked for the evidence upon which the HPC were acting, and Mr Guthrie was able to give him none. But in the 1,300 words of Mr Guthrie’s second reply neither was there any clear information about the nature of the relationship between the HPC as Regulator and the field itself. While the quantity of words suggests that Mr Guthrie genuinely wanted to respond to Dr McFadzean, it does seem rather clear that he has, unfortunately, nothing to say. He did explain that he and his HPC colleagues know nothing about the field, and that this was the reason they needed to convene the PLG, yet what has he learned from the two years’ work he has been engaged with? In spite of having read all the responses to the Call for Ideas (2008), and all the responses to the Public Consultation (2009), attended all the meetings, and so forth, he can only say that the field seems to be full of different philosophies and customs and practices. He makes no attempt anywhere to say how the regulatory function of the HPC has or will struggle with this. Judging from the reference to the ‘iterative’ work of the PLG it seems that the HPC are simply sending the professionals back to their homework until they have evacuated all the inconvenient signs of difference. He does not explicitly say that the HPC are trying to reduce the complexity to a singularity, yet this does seem to explain the otherwise mystifying ‘iterative’ process inflicted on the PLG.
At the Confer Conference practitioners were surprised to discover that the PLG membership had been selected by the HPC in a kind of job recruitment exercise. Practitioners had assumed that the field itself had exercised some control over who was to speak on its behalf. This recruitment process will be repeated if the field is captured, and the various people selected to scrutinise training and practice will be left to the judgement of the HPC. Mr Guthrie says nothing about the trouble that this might bring to his organisation given the range of philosophy and custom and practice that will still exist in practice (even if it has disappeared from the standards written by the PLG). He is supposed to be an expert in regulation, yet he says nothing about the practical problems that he and his colleagues will need to face if they succeed in capturing this complicated field. Why not?
We saw earlier that the QC at the High Court hearing concluded that the HPC had ducked the work they should have been doing to assess the regulatory needs of this field. This view seems to be supported by the evidence of the correspondence analysed here. This does not auger at all well for an organisation whose job will be to submit practitioners to its regulatory authority.
Dear HPC
Today I received an invitation (forwarded by COSCA on your behalf) to an information event to be held in Glasgow on 7 October 2010 as part of the process towards the potential regulation of psychotherapists and counsellors. Unfortunately, I (and several interested colleagues) find that the notice given is much too short - we shall find it exceedingly difficult to rearrange client appointments and other work to accommodate such an important event. I suspect the short notice will skew the attendance profile and make the meeting much less representative of the body of Scottish practitioners (particularly those working at the "coal face" with clients) than it might be. Given the continuing disquiet about the HPC regulatory route amongst many practitioners, the short notice of this event may well add to the disenfranchisement felt during the consultation process.
Perhaps you would be good enough to elucidate why such short notice has been given, and to consider whether the event should be delayed to ensure a good cross-section of practitioners can attend to share their views with the HPC.
Yours faithfully
Dr Douglas McFadzean
Douglas McFadzean asks specifically why short notice was given, and noted the effect this would have on attendance (ie skew it away from practitioners). From his point of view this is clearly a very important event that he wants to participate in, and furthermore, feels disenfranchised when HPC makes it difficult for him. His expectation is that the HPC will want to benefit from knowledge and experience like his, and will want him to know what their plans are too as they will affect him directly. Mr Michael Guthrie, the Director of Policy and Regulation at HPC replied on 6 October 2010 (7pm), the evening before the event in question and although apparently polite and friendly, his words reveal a very different stand point which is at odds with Dr McFadzean’s. I have inserted numbers into the text which link with the comments that follow in order to draw out some points for discussion.
Dear Dr McFadzean
Thank you for your email; my apologies for the delay in responding to your concerns.
The event in Glasgow is an information event and is part of four events we currently plan to hold, one in each of the four countries, (1) in order to provide information to psychotherapists and counsellors about the HPC and about our ongoing work. (2) We know that such a small number of events inevitably means that we will only reach a small fraction of practitioners, (3) but we plan to maximise the numbers who are able to attend each event.
I am sorry that you received an invite to the event at a late stage and therefore some colleagues were unable to attend. I note that you are due to attend the event yourself tomorrow. I think your email provides valuable feedback for us in relation to any future events we may arrange. The invite for the event initially went to voluntary sector and other psychotherapy / counselling organisations in Scotland, as it was felt that this would ensure (4) a sufficient number of attendees whilst avoiding a situation in which we would inevitably have to disappoint large numbers because of the fixed space available. We discovered, however, that we did have some available places and the invitation was kindly sent out by COSCA to its members.
I know that this was far from ideal in terms of notice and (5) I will ensure that we learn from this and that more notice is given for any events we hold. We do not plan any further events in Scotland at this stage, but, subject to a Government decision about whether regulation will proceed, it will be very important that we work with COSCA and other organisations in Scotland to keep practitioners informed.
In terms of the attendance at the event, I am confident that the profile of attendees is not (6) schewed [sic] in any way and we have a (7) good cross-section of practitioners across the psychotherapy and counselling field in Scotland and across different areas in practice, including practitioners from the NHS and the large voluntary sector in Scotland. (8) I understand from my colleagues that the event is now 'sold out'.
Thank you again for contacting us with your feedback.
Kind regards,
Michael Guthrie
Mr Guthrie’s letter presents the following information:
1) the meeting is to provide information to participants, not to glean information from them. This contradicts Dr McFadzean’s expectations. Certainly, the even was advertised on BACP’s website thus: “This is the first of several events the HPC will be holding in the four home countries, in order to consult more widely with counsellors and psychotherapists on the issue of regulation.” (emphasis added).
2) Reaching a small fraction of practitioners might be reasonable if this small fraction were carefully selected to represent the field. There is no evidence that this was done with any statistical elegance. The notice of the event was only channeled through particular organisations, and Mr Guthrie has still not adequately explained the short notice given of the event.
3) The stated aim of maximizing attendance is confounded by the HPC’s action: first it has limited the number of invitations, and then it issued invitations too late for practitioners to realistically re-arrange their work. In the event it was only about half full on day.
4) ‘sufficient’ contradicts the original aim of ‘maximising’, and raises a question about original intention (we already know it was only intended to talk to a small number of selected people). It also contradicts the idea of ‘inevitably disappointing large numbers’. These levels of ambivalence in Mr Guthrie’s reply raise questions about his integrity.
5) It is not clear what it is that Mr Guthrie will learn. The ambivalence about who would attend seemed to prevent him from realizing what he already must surely know (the HPC know the importance of forward planning, and spend a lot of attention on precisely this). It is not knowledge per se that was lacking, but rather a lack of clarity about the purpose of the meeting and thus the audience required.
6) ‘schewed’ means shunned, and appears to be a Freudian slip. The word Douglas McFadzean used was skewed.
7) ‘a good cross section’ implies a rational and thorough analysis of the field from which it might then be possible to draw a ‘cross section’. Dr McFadzean’s point was precisely this: the way that the HPC had gone about things would almost certainly skew the field away from practical knowledge per se. Mr Guthrie effectively deploys statistical jargon as a smoke screen to nullify the point.
8) Mr Guthrie thought the event was sold out, however, on the day, the event was only half filled.
Dr McFadzean wrote again on the evening of the event, and copied the letter to Brian Magee, Chair of COSCA (Counselling and Psychotherapy in Scotland)
Dear Michael
Thank you for your email explaining the circumstances of the short notice given for the Counsellors & Psychotherapists information event held in Glasgow today (Thursday, 7 October). As you noted, I did manage to attend the event myself, but unfortunately had to leave the panel session to travel before my points could be taken.
Perhaps you would be interested to hear my intended input in any case. I was going to express two main areas of concern:
1a) The lack of evidence base for the HPC route to regulation – for both the case for statutory regulation in the first place and for the case that the HPC approach will effectively achieve its aim to protect the public. (Surely a registration structure cannot be properly designed without substantive data and findings about the extent and nature of current malpractice, abuse, etc?)
1b) The lack of evidence base for much of the PLG's work in trying to set standards. (At least, Brian Magee was honest enough today to admit that COSCA’s initial approval for the differentiation of counsellors from psychotherapists was made "on pragmatic grounds", and not on any evidence base.)
2) The fundamental difficulty of trying to regulate effectively by title rather than by activity. The first questioner today hit the nail on the head - she was a CPN who did psychotherapy and counselling as part of her work activities. It is what practitioners do which harms clients, not their job title! It is almost inevitable that the most devious and dangerous practitioners will slip through the HPC regulatory net by simply modifying their title, whilst carrying on as before. In any case, a proper agreed definition of the activities of counselling and psychotherapy would seem essential, and cannot be naively assumed "as what counsellors and psychotherapists do".
These concerns were all discussed in detail earlier in my submission to the consultation about the PLG's recommendations, and I have since heard little to allay them. I would be most grateful if you could enlighten me on how these issues have been or can be properly addressed.
I hope you don't mind me sending a copy of this reply to Brian Magee as COSCA was involved in "passing on the message" about today's event and Brian is directly involved with the PLG.
With best regards
Dr Douglas McFadzean
In this letter Dr McFadzean raises directly the main problem that has been brought consistently to the attention of the HPC by many different people since the original ‘call for ideas’ in October 2008. In his point 1a), he clearly states that no rational ground has been given for changing the system of regulation for counselling and psychotherapy, and that (ipso facto) there is no evidence to guide future proposals. In parentheses he adds that that any intelligent man or woman would know that you cannot possibly design or propose a regulatory structure without a solid rational, logical ground, and without carefully collected evidence. He adds, in point 1b that the PLG also has no clear rational ground on which to do their work, nor any proper evidence with which to do their work. Point 2 draws attention to the way things are done now (a focus on function) before reminding Mr Guthrie that he should already be aware of these points having read them in the original call for ideas. He adds, however, that these points seem to have been ignored by the HPC. Finally, he asks how the HPC will address this vital issue now that it has been once more drawn to their attention.
Michael Guthrie replies on 12 October with a very long email indeed. There are many points to make about this email (about 30 individual points in all) beginning with the lack of a subject in the first sentence. In fact Mr Guthrie appears to be hiding behind a series of cut and paste pieces which serve only to obscure the fact that he has no clear reference points. For example, in Paragraph 2 (below) he presents the idea that the HPC is working on a problem about ‘how regulation for psychotherapists and counsellors might work’. For some reason Mr Guthrie has prefaced this point with ‘as you will know’, yet the subtlety of the point being made is something that hardly anyone seems to understand. It is this point, you see, (about how regulation might work – and it is important to note the conditional tense that is used here), that was the very point of contention brought so clearly to light in the hearing preliminary to the Judicial Review of HPC at the High Court in December 2010. There is a slipperiness in the language that requires us to be careful. The next sentence, for example, is very unclear. Is Guthrie saying that the Government asked the HPC to see how regulation might work? If so, his next point is just plain wrong. If the Government have asked how regulation might work, it is reasonable to assume that this will include a comparison with other regulatory schemes on offer (to compare how it does work elsewhere). Guthrie however, says this is not their remit, but offers no reasons to substantiate the statement. What explains the sloppy grammar, the lack of coherence? In fact the third sentence in the second paragraph sets off in one direction, then (as TS Eliot might say) makes a sudden leap, turns once about the house, and falls asleep. Guthrie says the Government has asked HPC to do something, which he then says the Government (or perhaps even Parliament) is responsible for doing itself. It is right here in this dodge that the HPC appears to duck out of any work that might be involved. Presumably, as an organisation created by statute, and with a CEO who claims publicly “The Health Professions Council also has a specific role in advising the Secretary of State of which new professions should become statutorily regulated, and that, I think, is vital in terms of protection of the public” (Confer Conference, 30 January 2010), there is a duty to the make sure that any advice given to the Secretary of State is based on proper research and consideration. This is precisely the point made by the QC in the High Court on 10 December 2010 and which the Judge found convincing.
Paragraph 3 is a vague reference to possible ‘public-friendly’ allies for the HPC’s equally vague position – padding.
In paragraph 4 a point emerges that is relatively new from the HPC. It is also contradictory, which is not new for the HPC. Much has been made of the fact that the HPC’s job is to ‘protect the public’. Here, however, is the admission that this great edifice has been erected to protect the public from ‘a very small minority’. This point completely ignores the other part of the HPC business – that of validating the educational systems around the country, of which we hear very little, but of which there is quite a lot. There is also no effort to rationalise the complicated system that is imposed for such a small minority, nor ‘how’ it ‘might’ actually achieve its ends (which is the question posed by McFadzean from the beginning).
Paragraph 5 is another frequently repeated phrase from the HPC repetoire, which is here used to avoid McFadzean’s specific request for supporting evidence.
Paragraph 6 sees for the first time Mr Guthrie’s own agency – he says ‘I think it is true to say’. What he thinks is true to say is that there is some report somewhere that probably makes it all alright. He cites no reference, and doesn’t even give the year of publication. This is shoddy work, and we are not even half way through the letter.
Dear Dr McFadzean
(P1) Thank you for your email. Very happy to answer the points you have raised.
(P2) 1(a) As you will know, the work the HPC is doing is about how regulation for psychotherapists and counsellors might work. This is in line with the White Paper in 2007 and its clear statement of Government policy. Therefore the work we are doing is not looking at the evidence for regulation or at alternative models of regulation as this is a consideration for the Government (and parliament) whose decision it is as to whether the policy contained within the White Paper should be implemented.
(3) Many charities in the mental health arena who have a consumer advocacy role support the statutory regulation of psychotherapists and counsellors because they consider that this will help to provide a more consistent and independent means of dealing with cases of malpractice. For example, the 'We Need to Talk' coalition of mental health charities called on the Government to introduce regulation a number of years ago, alongside calling for increased access to therapy for patients and clients.
(4) In our view, statutory regulation protects members of the public by setting standards, protecting commonly recognised professional titles and providing a way in which complaints can be dealt with fairly and appropriately. Statutory regulation means that the very small minority of practitioners who do not practice safely and effectively can be removed from the Register and prevented from continuing to practise and continuing to cause harm. I would argue that these important functions also increase public faith and confidence in the services provided by registered professionals.
(5) At the moment, a psychotherapist or counsellor who is removed from the membership of their professional body, for example, can simply continue in practice without any legal means for preventing continuing harm to members of the public.
(6) In terms of evidence of malpractice, I think it is true to say that the evidence for this is evolving. For example, the Council for Healthcare Regulatory Excellence (www.chre.org.uk) a few years ago (11) published findings from research which described the profound and long-lasting impact of boundary violations upon patients and clients.
(7) In our view, regulation is necessary to provide an independent means of dealing with the very small minority of practitioners who represent a danger to the public, and to provide the public and the profession with the assurance that the rest of the profession is signed up to standards for conduct and proficiency.
(8) However, I would emphasise that the final decision about regulation is a political one and in moving towards regulation the Department of Health is required to produce a full impact statement, looking at the reasons for and against introducing the policy and the impact or potential impact on all those affected.
(9)1(b) The work of the PLG in setting standards is certainly an iterative process. The reason why we establish PLGs is that whilst I and my colleagues will have experience of regulation, how it works, and our legislation, we are not psychotherapists or counsellors and therefore we need, and reply [sic] upon, the profession-specific expertise of the professional bodies and others with expertise in this area to help us in putting together standards of proficiency.
(10) The PLG has had many long and detailed discussions about the differentiation question which informs the standards, including taking into account the information and evidence gathered in responses to the Call for Ideas consultation in the summer of 2008 and the more recent consultation last year. In its discussion, the members of the PLG have often challenged each other to support their views with evidence. This is an area in which there are a wide variety of different views about the key interest groups with different groups taking very different views as to whether differentiation is necessary or feasible and on the standards that should be published. This seems to be a result of differences between organisations, differences in philosophy and differences in custom and practice.
(11) We have reconvened the PLG to try and resolve these issues. Neither I nor anyone at the HPC has any vested interest in whether there should be differentiation or not, but we want to try to work with the field to reach a solution which is workable, reflects reality, and meets the regulatory needs of the field. This includes and will continue to include scrutinising the evidence that is put forward for and against differentiation.
(12) You raise an important point. However, I do not personally believe that any approach to try and regulate by activity or 'function' would be successful or feasible, or considered to be so by the UK Government who would have to enshrine any such approach in legislation.
(13) In the UK professional regulation (and this includes groups such as nurses and chiropractors) has typically been by protection of titles. The Government tends to favour this approach as it ensures that commonly recognised professional titles are restricted to those who are qualified, whilst ensuring that regulation does not adversely affect those who it is not sought to regulate, or prevent service providers, employers and others in developing new job roles and new ways of working. There are a few examples of where activities or functions are protected in law but these are limited to discrete, physical acts that it is possible to define clearly to the required degree of specificity in legislation. For example, the fitting of contact lens is restricted to registered optometrists and dispensing opticians with necessary training, and the dispensing of hearing aids for retail sale or hire is restricted to registered hearing aid dispensers.
(14) Protection of function or activity is often used in the US where the scope of practice of each profession is often highly prescribed in legislation. The drawback from this approach is that it often acts to fetter the development of professions as a legislative amendment is necessary ever time a new technique or approach is developed or the profession wishes to develop into areas that in the past were typically carried out by other professionals. The UK Government typically tends to avoid protection of function because of such difficulties - it is necessary to define a discrete activity to a degree of precision, in legislation. It is often not possible to do this because of the nature of the practice of profession (e.g. interventions which are about communication rather than physical activities are a good example where this is much more difficult to achieve); because protecting a function would adversely affect another group that it is not sought to regulate; or because there is a lot of overlap between the practise of one profession and that of another (for example, in the medical arena nurses now undertake tasks that traditionally were undertaken by junior doctors).
(15) In terms of psychotherapy and counselling, my understanding is that there is no one agreed definition and each of the professional bodies has a slightly different emphasis. Indeed, arguably, this underlines the differences in perspective that we are attempting to work through in the PLG. In my view it would be very problematic indeed, if not impossible, to attempt to protect the activity or function of psychotherapy and counselling for the reasons outlined above. In particular, it would be necessary to differentiate the activities involved from other types of activity (e.g. debt counselling, advice, coaching); and differentiate it from the activities of other professionals who deliver so-called 'talking therapies' (e.g. psychiatrists, counselling psychologists, clinical psychologists).
(16) I think it is important to be honest about some the limitations of protection of title, but also honest about the benefits that protection of title would bring above the current situation in which no titles are protected. (See 1a) above).
(17) I hope the above is helpful and helps explain our perspectives on your questions. In relation to 1(b) this continues to be an ongoing process of debate and discussion within the PLG. I have copied Brian into this email.
Best wishes, Michael Guthrie
Paragraph 7 repeats the point about the work of the HPC being focused on a small minority of practitioners. Paragraph 8 repeats the wish of the HPC executive that the real work is being done by Department of Health. Paragraph 9 sees Mr Guthrie turn towards Dr McFadzean’s second point (1b). This reminds us that the previous 7 paragraphs (excluding the introductory remarks of the first paragraph) have all been, ostensibly, answering his point 1a. This was:
“1a) The lack of evidence base for the HPC route to regulation – for both the case for statutory regulation in the first place and for the case that the HPC approach will effectively achieve its aim to protect the public. (Surely a registration structure cannot be properly designed without substantive data and findings about the extent and nature of current malpractice, abuse, etc?).”
In the long detour presented by Mr Guthrie not one shred of evidence has turned up. There has been no apology for its lack, either. The next section turns towards Dr McFadzean’s second point:
1b) The lack of evidence base for much of the PLG's work in trying to set standards.”
In response to this point Mr Guthrie states that he and his colleagues know nothing about the practice they are proposing to regulate, but have to ask representatives to ‘help us’. This suggests that there is an endeavour on the part of the HPC to understand the area which they will then be empowered to regulate. The phrase in this paragraph (9) ‘an iterative process’ is a euphemism. It adds nothing, and pretends that something technical is going on. There isn’t. In paragraph 10 Mr Guthrie says that long and detailed discussions have taken place in the PLG. He says that members often challenge each other to provide evidence to back up their statement. This would suggest that the evidence Dr McFadzean asks for is ready to hand, yet Mr Guthrie produces none. This is not surprising, as the long and detailed discussions that I observed at the PLG produced nothing approaching the dignity of evidence but rather made the point that Dr McFadzean is making here – that the PLG has been put into an impossible position. Towards the end of this paragraph Mr Guthrie gives his synopsis of the PLG process. He says
‘This is an area in which there are a wide variety of different views about the key interest groups with different groups taking very different views as to whether differentiation is necessary or feasible and on the standards that should be published. This seems to be a result of differences between organisations, differences in philosophy and differences in custom and practice.’
Although he hasn’t offered a firm opinion (after the two years of studying this field), Mr Guthrie is willing to suggest that he thinks it is possible that there are a lot of differences in philosophy and custom and practice in the field. This does not bode well for the HPC’s intention to regulate the field. The HPO2001 requires each section of the register to contain a group who conform to a coherent body of knowledge.
Paragraph 11 takes us further into the bog. Mr Guthrie states that they have reconvened the PLG to overcome the difficulties stated. Yet this must surely be nonsense. Can you overcome the differences in philosophy, custom and practice of a field by selecting eight people and subjecting them to a process configured to achieve a different end? If you wanted to achieve a particular end, it would be sensible to construct a process conducive to that end. The process in use here is a ready made routine used to produce standards in an already unified and coherent field.
The reference to ‘scrutiny of evidence’ suggests (again) that there is some, (which could therefore be presented to Dr McFadzean), but this, again, is not forthcoming, adding to the growing conviction that there isn’t any.
Paragraph 12 again sees the emergence of Mr Guthrie’s personal opinion. He acknowledges the importance of the point made by Dr McFadzean and many others (notably the CPN at the meeting in Glasgow), that real regulation of this practice is done by attending to what actually happens in practice. Yes, it is an important point, but one that the HPC cannot accommodate because it regulates according to a different principle. Mr Guthrie frames this as a general point of regulation, but this completely ignores the fact that regulation takes different forms, and the regulation that is current in the field, at least of psychotherapy, is one that is based on function. Had the government maintained the tradition of passing statutory power to a professional group, this would have maintained the tradition of regulating according to function. Mr Guthrie, (a professed expert in regulation) appears not to know about this other kind of regulation. Even if we allow Mr Guthrie to remain within his own sphere of ignorance, or speciality, he still has to face the fact that the ‘good point’ made by Dr McFadzean and others is a serious spanner in the works, and this might constitute good grounds to advise the Secretary of State against passing statutory power to the HPC to regulate this field.
There are still five paragraphs left to comment on, but by now it seems clear that Mr Guthrie (consciously or otherwise) is weaving a web of waffle to stop Dr McFadzean in his tracks. What is completely absent here is any information about how the HPC’s form of regulation actually works, and how Mr Guthrie understands the costs and benefits of imposing this structure on a field which is actively and repeatedly telling him to take great care.
The most interesting thing in this exchange is what has not come to light. We know that Dr McFadzean specifically asked for the evidence upon which the HPC were acting, and Mr Guthrie was able to give him none. But in the 1,300 words of Mr Guthrie’s second reply neither was there any clear information about the nature of the relationship between the HPC as Regulator and the field itself. While the quantity of words suggests that Mr Guthrie genuinely wanted to respond to Dr McFadzean, it does seem rather clear that he has, unfortunately, nothing to say. He did explain that he and his HPC colleagues know nothing about the field, and that this was the reason they needed to convene the PLG, yet what has he learned from the two years’ work he has been engaged with? In spite of having read all the responses to the Call for Ideas (2008), and all the responses to the Public Consultation (2009), attended all the meetings, and so forth, he can only say that the field seems to be full of different philosophies and customs and practices. He makes no attempt anywhere to say how the regulatory function of the HPC has or will struggle with this. Judging from the reference to the ‘iterative’ work of the PLG it seems that the HPC are simply sending the professionals back to their homework until they have evacuated all the inconvenient signs of difference. He does not explicitly say that the HPC are trying to reduce the complexity to a singularity, yet this does seem to explain the otherwise mystifying ‘iterative’ process inflicted on the PLG.
At the Confer Conference practitioners were surprised to discover that the PLG membership had been selected by the HPC in a kind of job recruitment exercise. Practitioners had assumed that the field itself had exercised some control over who was to speak on its behalf. This recruitment process will be repeated if the field is captured, and the various people selected to scrutinise training and practice will be left to the judgement of the HPC. Mr Guthrie says nothing about the trouble that this might bring to his organisation given the range of philosophy and custom and practice that will still exist in practice (even if it has disappeared from the standards written by the PLG). He is supposed to be an expert in regulation, yet he says nothing about the practical problems that he and his colleagues will need to face if they succeed in capturing this complicated field. Why not?
We saw earlier that the QC at the High Court hearing concluded that the HPC had ducked the work they should have been doing to assess the regulatory needs of this field. This view seems to be supported by the evidence of the correspondence analysed here. This does not auger at all well for an organisation whose job will be to submit practitioners to its regulatory authority.
Tuesday, 28 December 2010
Some context to this HPC struggle - The state of British Higher Education
My thanks to colleagues who pass links on to me. This one was received last night (Simon Head, The Grim Threat To British Universities, January 2011), and is a grim reminder of the context of problems we are struggling with here. The HPC is one particular manifestation of an ideology set in motion decades ago and which has wide reaching and multiplying effects. Richard Gombrich's speech in Tokyo 2000 was one of the earliest accounts of the structural shifts playing a part in today's drama. The transcript of his talk has been mentioned here before, but is always worth a re-read, and can be found by following this link here.
Prof Gombrich was one of the dons referred to early in Head's article (click here for link to full article) who moved against giving Mrs Thatcher an honorary doctorate. Here is the paragraph from Head's NYRB article:
Simon Head's article, like that of Richard Gombrich, Conrad Russell (Academic Freedom, Routledge 1993), Max Travers (The New Bureaucracy, Policy Press 2007), Marilyn Strathern (Audit Cultures, Routledge 2000), and Michael Power (The Audit Explosion, Demos 1994), to name but a few, all point to the particular mode of administration that is used in this new wave, and the vacuum that it creates. The collapse of the system comes a few decades down the line by which time no-one is in any position to know what caused it. The creation of a muddle is one of proliferating the effects of the wave. It abandons the field of explanation to currents of less enlightened action. The HPC is modelled on just such a 'particular mode of administration' with signs of just such a vacuum in the making.
Prof Gombrich was one of the dons referred to early in Head's article (click here for link to full article) who moved against giving Mrs Thatcher an honorary doctorate. Here is the paragraph from Head's NYRB article:
"In the UK this system has been gathering strength for over twenty years, which helps explain why Oxford and Cambridge dons, and the British academy in general, have never taken a clear stand against it. Like much that is dysfunctional in contemporary Britain, the imposition of bureaucratic control on the academy goes back to the Thatcher era and its heroine. A memorable event in this melancholy history took place in Oxford on January 29, 1985, when the university’s Congregation, its governing parliament, denied Mrs. Thatcher an honorary Oxford degree by a vote of 738–319. It did so on the grounds that “Mrs. Thatcher’s Government has done deep and systematic damage to the whole public education system in Britain, from the provision for the youngest child up to the most advanced research programmes."Other recent articles on this theme include Stefan Collini's 'Browne's Gamble' in the London Review of Books Nov 2010 (click here), Terry Eagleton in the Guardian 17 Dec 2010: The Death of Universities, and Stanley Fish 'The Value of Higher Education made Literal" New York Times, 13 Dec 2010, which begins like this:
"A few weeks ago at a conference, I listened to a distinguished political philosopher tell those in attendance that he would not be speaking before them had he not been the beneficiary, as a working-class youth in England, of a government policy to provide a free university education to the children of British citizens. He walked into the university with little knowledge of the great texts that inform modern democracy and he walked out an expert in those very same texts."
Simon Head's article, like that of Richard Gombrich, Conrad Russell (Academic Freedom, Routledge 1993), Max Travers (The New Bureaucracy, Policy Press 2007), Marilyn Strathern (Audit Cultures, Routledge 2000), and Michael Power (The Audit Explosion, Demos 1994), to name but a few, all point to the particular mode of administration that is used in this new wave, and the vacuum that it creates. The collapse of the system comes a few decades down the line by which time no-one is in any position to know what caused it. The creation of a muddle is one of proliferating the effects of the wave. It abandons the field of explanation to currents of less enlightened action. The HPC is modelled on just such a 'particular mode of administration' with signs of just such a vacuum in the making.
Thursday, 23 December 2010
Letter from Bindmans to HPC Monday 20th Dec 2010
Dear Ms McIntyre,
Thank you for your confirmation of the arrangements for filing the draft Order.
I write on a related matter of considerable concern to my clients. It is that, following their agreement to your client’s proposal for an extension of time to enable a dialogue to take place about whether this claim might be settled, they became aware of a blog entry posted by Ms van de Gaag, the text of which is reproduced below.
The blog is objectionable on a number of levels. It presents the HPC’s arguments highly selectively; nothing is said of its contention that my clients’ case was unarguable, which was roundly rejected. It does not report the Judge’s actual decision on delay which was that there had been none and, in any event, that my client’s and others had been actively misled by the HPC about what was, and what was not, under consideration. It trivialises a case which the Judge described as “important” as a technical dispute about “points of law”. Fundamental questions about whether the HPC exceeded its legal powers are characterised as ephemera (“who did what and when and according to which process or guidance or directive”). It positively asserts that my clients’ complaints should be directed at the government, notwithstanding that very argument being rejected by the Judge. Last, it inaccurately describes progress in working relationships and development of standards, when the reality is that views on these matters remain polarized. One of the reasons for that is that the PLG has a narrow membership and has taken no meaningful steps to engage with those professionals who hold different views.
Had my clients been aware of the blog at the time they were considering your proposal for an extension of time, it is very unlikely they would have agreed to one. That is because, despite the nod to seeking common ground, the remainder of its contents suggest that the HPC’s position is entrenched and defiant (e.g. “[w]e can and probably will continue to argue”) rather than constructive and conciliatory.
My clients have no intention of responding in kind. They would like the blog removed from the HPC’s website immediately, however. When considering whether to not to agree to that request, your client should bear in mind the impact that refusing to agree to this reasonable request will have on the prospects for success in negotiations which, I remind you, it has sought.
I hope to receive confirmation the blog has been removed by close of business today.
Yours sincerely,
John Halford
Bindmans LLP
Thank you for your confirmation of the arrangements for filing the draft Order.
I write on a related matter of considerable concern to my clients. It is that, following their agreement to your client’s proposal for an extension of time to enable a dialogue to take place about whether this claim might be settled, they became aware of a blog entry posted by Ms van de Gaag, the text of which is reproduced below.
The blog is objectionable on a number of levels. It presents the HPC’s arguments highly selectively; nothing is said of its contention that my clients’ case was unarguable, which was roundly rejected. It does not report the Judge’s actual decision on delay which was that there had been none and, in any event, that my client’s and others had been actively misled by the HPC about what was, and what was not, under consideration. It trivialises a case which the Judge described as “important” as a technical dispute about “points of law”. Fundamental questions about whether the HPC exceeded its legal powers are characterised as ephemera (“who did what and when and according to which process or guidance or directive”). It positively asserts that my clients’ complaints should be directed at the government, notwithstanding that very argument being rejected by the Judge. Last, it inaccurately describes progress in working relationships and development of standards, when the reality is that views on these matters remain polarized. One of the reasons for that is that the PLG has a narrow membership and has taken no meaningful steps to engage with those professionals who hold different views.
Had my clients been aware of the blog at the time they were considering your proposal for an extension of time, it is very unlikely they would have agreed to one. That is because, despite the nod to seeking common ground, the remainder of its contents suggest that the HPC’s position is entrenched and defiant (e.g. “[w]e can and probably will continue to argue”) rather than constructive and conciliatory.
My clients have no intention of responding in kind. They would like the blog removed from the HPC’s website immediately, however. When considering whether to not to agree to that request, your client should bear in mind the impact that refusing to agree to this reasonable request will have on the prospects for success in negotiations which, I remind you, it has sought.
I hope to receive confirmation the blog has been removed by close of business today.
Yours sincerely,
John Halford
Bindmans LLP
UKCP Statement following Judicial Review Permission Hearing
Below I have reproduced a report that has been widely circulated both within and outside the UKCP. I have posted it here for information of those who might not get to see it via the usual channels. Also, if you click the title of this blog you will find it linked to a statement by UKCP Chair and CEO.
REPORT FROM LEGALLY QUALIFIED LAY TRUSTEE OF UKCP TO THE BOARD
Having just returned from the preliminary hearing, I would like to provide the Board with a brief report.
As you can imagine, there was a great deal of detailed discussion as to matters of fact and law but it boiled down to the following: the judge declared that the claimants (AGIP, AIP, Centre for Freudian Analysis and Research, College of Psychoanalysts – UK, Guild of Psychotherapists and The Philadelphia Association) were entitled to proceed with their application for judicial review of the conduct of HPC in making recommendations to the Secretary of State for Health regarding the regulation of psychotherapists and counsellors. This is what HPC were seeking to avert at today’s hearing.
Specifically, the judge rejected HPC’s arguments that the claimants were too late to lodge an action for judicial review and ruled that the claimants were entitled to proceed with their application for judicial review on all the grounds they had claimed. He suggested that there was some common ground and that the parties might meet.
There was considerable and detailed discussion about whether in acting as it did, HPC was simply conducting a feasibility study to assess its capacity to regulate psychotherapists and counsellors, as opposed to undertaking a broader exercise of making recommendations about statutory regulation of those professions. The judge concluded that the claimants were entitled to believe that it was the latter and not the former (despite HPC’s argument to the contrary) in view of the evidence presented to the court.
In a move I understand to be unusual in cases of this kind, the judge ruled that HPC must pay 1/3 of the claimants’ costs of today’s hearing.
From my observations of the hearing, the salient points were:
None of HPC’s arguments succeeded on the day;
Having heard the claimants’ submissions, the judge informed counsel for HPC that he was looking for some “knockout points”, which I took to mean he thought the claimants had made a convincing case. Having heard HPC’s case, he still ruled in favour of the claimants;
Unusually, a costs award was made in favour of the claimants so HPC is having to pick up some of the claimants’ costs.
REPORT FROM LEGALLY QUALIFIED LAY TRUSTEE OF UKCP TO THE BOARD
Having just returned from the preliminary hearing, I would like to provide the Board with a brief report.
As you can imagine, there was a great deal of detailed discussion as to matters of fact and law but it boiled down to the following: the judge declared that the claimants (AGIP, AIP, Centre for Freudian Analysis and Research, College of Psychoanalysts – UK, Guild of Psychotherapists and The Philadelphia Association) were entitled to proceed with their application for judicial review of the conduct of HPC in making recommendations to the Secretary of State for Health regarding the regulation of psychotherapists and counsellors. This is what HPC were seeking to avert at today’s hearing.
Specifically, the judge rejected HPC’s arguments that the claimants were too late to lodge an action for judicial review and ruled that the claimants were entitled to proceed with their application for judicial review on all the grounds they had claimed. He suggested that there was some common ground and that the parties might meet.
There was considerable and detailed discussion about whether in acting as it did, HPC was simply conducting a feasibility study to assess its capacity to regulate psychotherapists and counsellors, as opposed to undertaking a broader exercise of making recommendations about statutory regulation of those professions. The judge concluded that the claimants were entitled to believe that it was the latter and not the former (despite HPC’s argument to the contrary) in view of the evidence presented to the court.
In a move I understand to be unusual in cases of this kind, the judge ruled that HPC must pay 1/3 of the claimants’ costs of today’s hearing.
From my observations of the hearing, the salient points were:
None of HPC’s arguments succeeded on the day;
Having heard the claimants’ submissions, the judge informed counsel for HPC that he was looking for some “knockout points”, which I took to mean he thought the claimants had made a convincing case. Having heard HPC’s case, he still ruled in favour of the claimants;
Unusually, a costs award was made in favour of the claimants so HPC is having to pick up some of the claimants’ costs.
Tuesday, 14 December 2010
Press release from The Alliance on the HPC's misleading statements to Government and Stakeholders
On Friday 10th December 2010, a long awaited and crucial Judicial Review permission hearing found against the Health Professions Council (HPC). Six psychotherapy and psychoanalysis organisations have now won the right to take the HPC’s plans for the statutory regulation of counselling and psychotherapy to a full Judicial Review. The Judge criticised the misleading nature of HPC statements to both Government and stakeholders. The implications for the field are immense.
Background to the hearing
Legal action that has now culminated in the granting of a Judicial Review was initiated by a number of organisations who raised serious questions about the legality of the process followed by the Health Professions Council (HPC), a regulator created by Parliament, as it prepared to implement the Labour Government’s proposed regulation of counselling and psychotherapy. The organisations argued that, in an unwarranted extension of its legal remit, the HPC had proceeded as if its capability and suitability as the regulator for this field were foregone conclusions. Despite stating several times that it had not considered these questions, the HPC wrote to the Department of Health in December 2009 claiming that it had. Attempts to question this contradiction or even to have it acknowledged proved to be fruitless. Friday’s hearing finally recognised that the HPC were inconsistent and contradictory in their claims regarding their remit. As QC Dinah Rose put it, they had attempted to "rewrite history".
The papers lodged by Bindmans (solicitors for the six organisations) for the Judicial Review application documented these and other anomalies which indicated that the HPC has not acted in a rational or equitable way. For example, alternative models of regulation were not given proper consideration by the HPC, despite being repeatedly brought to their attention by many organisations and individuals. Key questions concerning the particular and distinctive nature of the talking therapies had been treated as if irrelevant. Indeed, most of HPC’s own criteria for regulating a profession, such as homogeneity of the knowledge base and common entry standards, were incompatible with this highly diverse field.
It appears that the Department of Health is already exploring alternative models of regulation and practitioner accountability. The result of the permission hearing seriously undermines the credibility of HPC's claim to be the right regulator for the field, given its admission to the court it has in fact done no research to support making such a claim.
Summary of the 10 December Permission Hearing Judgment
In his judgment at the permission hearing last Friday, Mr Justice Burton gave the six organisations permission to proceed with what he termed an ‘important’ Judicial Review challenging Health Professions Council proposals for regulating their field.
Representing the groups, barrister Dinah Rose QC maintained that the HPC had unlawfully failed to address critical questions about whether counselling and psychotherapy should be regulated by statute, and whether the HPC is the appropriate body to administer such regulation, given the fact that many practitioners explicitly eschew a ‘medical-model’ orientation.
Despite the HPC’s attempt to have the application ‘timed out’, Mr Justice Burton also ruled that the Judicial Review had been brought without delay and was ‘clearly arguable’. He also criticised the misleading nature of HPC statements. For example, practitioner groups had been led to believe that the HPC would fulfil its legal responsibility to report to the Department of Health on whether it had the requisite capability to regulate the field. This never happened, and HPC proceeded as if the requirement to report on the matter did not exist, despite acknowledging it in an early minuted meeting. Specifically, the judge questioned the HPC's reassuring communication to the Department in December 2009 that it had completed its exercise and was ready to accommodate the talking therapies. He invited the HPC to “reword or revise” that letter.
The HPC was also ordered to pay one-third of the therapy organisations’ costs, an unusual decision to be made at a permission hearing. The organisations understand it as a reflection of the strength of Dinah Rose’s arguments regarding the integrity of the HPC. The HPC will now have five weeks to file further evidence before the case is listed for a full hearing in the Spring of 2011. The judge also suggested a meeting between the parties to discuss the key questions that had emerged from the hearing.
After the hearing, Professor Darian Leader of the Centre for Freudian Analysis and Research, one of the six practitioner groups bringing the Judicial Review, said:
“It is very unfortunate that the HPC has chosen to use its existing registrants’ fees to fight this case to date. We are told by its solicitors that its legal costs already run to £47,000. This money could have been used to produce a meaningful report on how best to regulate the talking therapies. Instead it is being used to defend an empire-building decision that today’s ruling exposes as being legally questionable and, in our view, is perverse and unsustainable. The HPC was charged with investigating the regulatory needs of practitioner groups such as ours and deciding whether statutory regulation was appropriate at all and, if it was, whether it was the right regulator. It simply evaded those questions. We hope the HPC will now show itself to be appropriately sensitive to the indication given by the Court, withdraw its current proposals for regulation and step aside so a body that is actually capable of improving standards and protecting the public in this difficult field can be created.”
The Alliance position
The Alliance believes that its principled and long-standing critique of the HPC’s capability to regulate counselling and psychotherapy has been fully vindicated by this hearing. The HPC has been revealed in open court to be an organisation whose procedures and statements are substantially flawed, and it is now highly doubtful whether the HPC will ever be considered either competent or ethically suitable to regulate this complex and diverse field. Mutual trust, together with practitioners’ willing co-operation, are essential for the effective implementation of any new accountability framework, but following this hearing, practitioners can have little confidence in the HPC’s capacity to implement regulation fairly or appropriately. Many therapists have already been troubled by what they perceive to be the cavalier and often disrespectful approach that the HPC has taken prior to Justice Burton’s decision.
If some form of statutory regulation is eventually deemed to be inevitable – despite the fact that many in the field still believe that the case for it has not been made – then it would be essential that such regulation be sensitive to the particularities of therapeutic practice, the nature of which, for many practitioners and clients, is fundamentally different from other ‘professions’, not least ‘medical’ ones ancillary to healthcare.
The Alliance finds it encouraging that alternative regulatory options are currently under consideration at the Department of Health, including the ‘quality assurance’ model being developed by the Council for Healthcare Regulatory Excellence (CHRE), which might prove more compatible with the pluralistic regulatory system that currently exists in the field. The Alliance is keen to help find the most effective way forward, and we are hopeful that the Department of Health will now engage fully with both the Alliance and with the organisations bringing the Judicial Review, to carefully examine accountability and regulatory arrangements that have been successfully adopted in other countries, and which have proven satisfactory to Government, clients and service users, and to those who work in the field.
The Alliance for Counselling and Psychotherapy is a campaigning group with supporters from a wide range of approaches and interests within the field of the psychological therapies. The Alliance believes that regulation via the Health Professions Council is the wrong approach to addressing accountability and quality of practice in the field. It has previously convened a number of conferences and seminars, and has published widely on the shortcomings of the HPC’s proposed approach to regulating the field.
Sunday, 12 December 2010
Report of the Preliminary Hearing of request for Judicial Review of HPC, from The Alliance
Arrive at the Royal Courts of Justice, The Strand, London, Friday 10 December 2010, around 10.00am. There’s a gaggle of press outside waiting for the protagonists in the South Africa murder case. Pass them, and up the steps to the main front door, into the right-hand queue to pass bag through the X-ray scanner, and walk through the magnetic doorway. No need to give a name, or say where you’re going. Up the stairs and down the grand corridor, men and women flying past in billowing black gowns and curly wigs, piles of papers under their arms.
Room 7, on the right, has a little antechamber for your hats and coats; the hearing room within is wood panelled, with high ceiling and dangling dark chandeliers; the windows are all leaded lights. In the corner of the room, there is a door leading into a kind of enclosed balcony that juts out into the room – metal bars define its sides and extend completely over its top. There are rows of wooden pews sloping down to the little platform for the administrators, behind them the high wooden wall of the platform atop of which a line of green lamps stand ready to light the Judge’s volume of papers. The pews fill up. An earnest and affable young man in gold-rimmed glasses approaches to introduce himself - John Halford, solicitor - and the legal team that are representing us. Three other teams are there – there are four cases that make up the business of his Lordship Justice Burton today. Marc Seale, Anna van der Gaag and a handful of HPC administrators turn up and sit just in front of us. A rap on the door at the top of the room, and Mr Justice Burton bursts in with a huge lever-arch file of papers under his arm. ‘Court Rise’, says a voice, and we do. Then, bang – straight into the business.
Justice Burton dispatches the first case (a willing deportation) in less than fifteen minutes, telling the representative for the Home Secretary to rewrite his letter to the Saudi Arabian embassy and to ask for a reply within four weeks. In Saudi there is no Christmas delay, said the Judge, as the barrister tried to remonstrate about the shortness of time. There is a sigh of relief amongst our party, now crammed into the back rows of the pews – this man is practical, sensible, humorous, and efficient; there is hope for our case.
We learn that we are the main case of the day when Justice Burton apologises to the quiet, elderly gentleman sitting in the front row that his case won’t begin till 3.15pm. So many cases here are listed as little people versus big institutions. The judge invites the man to come back at 3.00pm, warning him that it would be boring to sit through the detail of the Health Professions Council. Mr Justice Burton checks himself with a wry smile, and looks at Dinah Rose, QC (representing the PsyReg group) and says ‘though it’s never boring when you are on, Dinah Rose’. Our hearts lift again – this might even be fun!
It was not yet 11am when Ms Rose stood up and she was still on her feet nearly two hours later. At lunch a colleague compared her performance to that of a dancer. She won the Lawyer Awards’ Barrister of the Year in 2009. She certainly had grace and dexterity, she had precision and energy, she was not clumsy or brash, and showed no sign of personal enjoyment in the points she was making, she nimbly stepped past all interruptions; and by the time she had finished, and she had put in place the basic principles and context within which the case against the HPC should be heard.
One question for exploration in this preliminary hearing was the relation between the HPC's activities and the mandate they had apparently been given by the 2007 White Paper – Trust, Assurance and Safety. This was at the heart of the HPC defence. It gave the HPC the task of regulating psychotherapy and counselling following the assessment both of the ‘regulatory needs’ of the talking therapies and whether ‘its system is capable of accommodating them’. A key issue was what ‘following’ meant: was it a contingent detail or, as the judge suggested, to be understood in the conditional sense of ‘provided that’? The HPC argued that they had simply told the Government that they were capable of accommodating the numbers, doing a kind of logistical, ‘mechanical’ exercise, without making any actual recommendation in their final letter to the Secretary of State in December 2009. The Judge summed this up as, ‘They had big buildings and enough photocopiers’. The HPC argued that it had not addressed the question of whether they had ‘the right standards and approach to regulate this field’ and therefore couldn’t be faulted on points of procedure or power. Dinah Rose repeatedly produced documents that proved the HPC were progressing as if they had done the prerequisite work on their capacity to regulate the field. The inherent duplicity of the HPC’s position was repeatedly exposed with written evidence, and, of course, succeeded in undermining the HPC argument. In the December 2009 letter, they actually stated that they had assessed the regulatory needs of the field and their capacity to accommodate those needs, while, in other correspondence, denying that they ever attempted this.
Rose quoted from the 1999 Health Act, the Health Professions Order 2001, the HPC’s own Guidance Documentation, the Government White Paper (Trust, Assurance and Safety, 2007), and from the Maresfield Report 2008, to build her case. A point made early in the proceedings was that the HPC often implies that those who disagree with them are seeking to avoid regulation for scurrilous reasons – the facts, she said, show quite clearly that the opposite is the case. Yes, echoed Mr Justice Burton, the opposite.
Rose stated that the HPC has no inherent power and cannot do what it likes, but has powers designated specifically to it via the legal statutes. By careful scrutiny of these statutes, she argued that they had been acting outside their powers, and that even if they weren’t acting outside these powers, then they were not following correct procedure. ‘The main purpose of this application’, she said more than once, ‘is to inform Government that when it makes its decision it should not listen to the HPC recommendations because, these are flawed’.
The HPC tried to argue that the Secretary of State for Health should have done the background work on whether the HPC was capable of actually regulating this group of practitioners. Dinah Rose countered this by saying it ‘cannot possibly have been the Government’s intention’, and produced letters (e.g. from the then Secretary of State, Ben Bradshaw, and from Mr Seale himself) and even reports (from the PLG) to show that this cannot have been true. All the evidence clearly showed that the HPC was ambivalent, at best, on the question of whether or not they were simply offering their hardware to help the government out, or whether they were seriously considering the reality of regulating this particular practice.
The second question which this hearing had been asked to consider was the point that the PsyReg group was too late to raise objections. Plenty of evidence (again, including letters from the HPC itself) was produced by Ms Rose to prove that they were not at all too late.
The HPC had been asked to consider how to regulate counselling and psychotherapy, and how it might be achieved. ‘Our submission’, said Rose, ‘is that they start off, decide it is too difficult and controversial, and duck the issue’. She points out that not only does the HPC know (as early as 2007) that this is a controversial question, and that many oppose it, but that this is even noted by Baroness Thornton (Labour & Co-op Peer) in Hansard in May 2009. She refers to the published minutes of the first PLG meeting which was already dealing with the tensions in the field, whereupon the Judge asked ‘Do you have people on the PLG?’ – ‘No’ she replied in a flash. ‘Hmmm’, said the judge.
Rose kept pushing her points that either the HPC didn’t have the power to say it could regulate C&P, and even if it did have that power, then it hadn’t followed the right procedure to accomplish it. There are two strands here, each one showing the HPC to be at odds with itself. They were shown to be acting inconsistently and, arguably, without integrity with respect to their own stated requirements. It was a letter from Bindmans that produced clear evidence of Marc Seale’s double-talk: in two separate letters written within a month of each other, Mr Seale claimed two conflicting and contradictory positions. ‘It is my submission’, said Dinah Rose, ‘that they’ve re-written history, taken different positions, used different reasons, are inconsistent’. She added, ‘It is not clear what their case is, they give mixed messages’. She concluded that ‘the purpose of this application is to make clear to the Government that no weight can be placed on recommendations of HPC: they have bypassed their statutory power, and their own guidance’.
When the HPC representative, Mr Fordham, stood up at 12.35pm, Mr Justice Burton looked him straight in the eye and said ‘I’m going to need a knockout point from you’, which we all took as a very good sign indeed. The QC began rather weakly, and wobbled his way forward for half an hour, managing only to muddle the various acronyms – before he sat down again we had an ‘LPG’ instead of a ‘PLG’, and an ‘HSPC’ instead of an ‘HPC’ – clearly confusing the name of his client with the name of his bank.
After lunch he came back in stronger voice, but his ‘knockout’ point still eluded him. After another half an hour, the Judge was ready to sum up. He began by saying ‘I propose to grant permission and will summarise’. A smile lit the faces in the back pews. He noted that the HPC claimed that it had not made any recommendations to the Government, yet this would be difficult to infer from their December letter. He invited HPC to rewrite or revise their December 2009 letter to the Secretary of State, to reflect the conclusions of today’s hearing. He pointed out that even if it were not decided to move to Judicial Review, the claimants would still have wrested an important statement from the HPC.
Nevertheless, Dinah Rose again pressed home the fact that the HPC was ignoring vital points, spinning others, and was happy to waste everyone’s time in order to try to save face. The Judge was persuaded, and awarded the JR permission to the claimants. Quick as a flash she stood up again and asked about the costs. In a move that seemed to be unusual at this stage of a case (i.e. costs are not normally awarded at a preliminary permission hearing), the Judge stated that the HPC must pay one third of the claimants’ costs. It was an elated group that stumbled out of the courtroom (the door of which had a hand-written note pinned to it stating ‘Court Full’) into the corridor. Their case, at last, had been genuinely heard.
Room 7, on the right, has a little antechamber for your hats and coats; the hearing room within is wood panelled, with high ceiling and dangling dark chandeliers; the windows are all leaded lights. In the corner of the room, there is a door leading into a kind of enclosed balcony that juts out into the room – metal bars define its sides and extend completely over its top. There are rows of wooden pews sloping down to the little platform for the administrators, behind them the high wooden wall of the platform atop of which a line of green lamps stand ready to light the Judge’s volume of papers. The pews fill up. An earnest and affable young man in gold-rimmed glasses approaches to introduce himself - John Halford, solicitor - and the legal team that are representing us. Three other teams are there – there are four cases that make up the business of his Lordship Justice Burton today. Marc Seale, Anna van der Gaag and a handful of HPC administrators turn up and sit just in front of us. A rap on the door at the top of the room, and Mr Justice Burton bursts in with a huge lever-arch file of papers under his arm. ‘Court Rise’, says a voice, and we do. Then, bang – straight into the business.
Justice Burton dispatches the first case (a willing deportation) in less than fifteen minutes, telling the representative for the Home Secretary to rewrite his letter to the Saudi Arabian embassy and to ask for a reply within four weeks. In Saudi there is no Christmas delay, said the Judge, as the barrister tried to remonstrate about the shortness of time. There is a sigh of relief amongst our party, now crammed into the back rows of the pews – this man is practical, sensible, humorous, and efficient; there is hope for our case.
We learn that we are the main case of the day when Justice Burton apologises to the quiet, elderly gentleman sitting in the front row that his case won’t begin till 3.15pm. So many cases here are listed as little people versus big institutions. The judge invites the man to come back at 3.00pm, warning him that it would be boring to sit through the detail of the Health Professions Council. Mr Justice Burton checks himself with a wry smile, and looks at Dinah Rose, QC (representing the PsyReg group) and says ‘though it’s never boring when you are on, Dinah Rose’. Our hearts lift again – this might even be fun!
It was not yet 11am when Ms Rose stood up and she was still on her feet nearly two hours later. At lunch a colleague compared her performance to that of a dancer. She won the Lawyer Awards’ Barrister of the Year in 2009. She certainly had grace and dexterity, she had precision and energy, she was not clumsy or brash, and showed no sign of personal enjoyment in the points she was making, she nimbly stepped past all interruptions; and by the time she had finished, and she had put in place the basic principles and context within which the case against the HPC should be heard.
One question for exploration in this preliminary hearing was the relation between the HPC's activities and the mandate they had apparently been given by the 2007 White Paper – Trust, Assurance and Safety. This was at the heart of the HPC defence. It gave the HPC the task of regulating psychotherapy and counselling following the assessment both of the ‘regulatory needs’ of the talking therapies and whether ‘its system is capable of accommodating them’. A key issue was what ‘following’ meant: was it a contingent detail or, as the judge suggested, to be understood in the conditional sense of ‘provided that’? The HPC argued that they had simply told the Government that they were capable of accommodating the numbers, doing a kind of logistical, ‘mechanical’ exercise, without making any actual recommendation in their final letter to the Secretary of State in December 2009. The Judge summed this up as, ‘They had big buildings and enough photocopiers’. The HPC argued that it had not addressed the question of whether they had ‘the right standards and approach to regulate this field’ and therefore couldn’t be faulted on points of procedure or power. Dinah Rose repeatedly produced documents that proved the HPC were progressing as if they had done the prerequisite work on their capacity to regulate the field. The inherent duplicity of the HPC’s position was repeatedly exposed with written evidence, and, of course, succeeded in undermining the HPC argument. In the December 2009 letter, they actually stated that they had assessed the regulatory needs of the field and their capacity to accommodate those needs, while, in other correspondence, denying that they ever attempted this.
Rose quoted from the 1999 Health Act, the Health Professions Order 2001, the HPC’s own Guidance Documentation, the Government White Paper (Trust, Assurance and Safety, 2007), and from the Maresfield Report 2008, to build her case. A point made early in the proceedings was that the HPC often implies that those who disagree with them are seeking to avoid regulation for scurrilous reasons – the facts, she said, show quite clearly that the opposite is the case. Yes, echoed Mr Justice Burton, the opposite.
Rose stated that the HPC has no inherent power and cannot do what it likes, but has powers designated specifically to it via the legal statutes. By careful scrutiny of these statutes, she argued that they had been acting outside their powers, and that even if they weren’t acting outside these powers, then they were not following correct procedure. ‘The main purpose of this application’, she said more than once, ‘is to inform Government that when it makes its decision it should not listen to the HPC recommendations because, these are flawed’.
The HPC tried to argue that the Secretary of State for Health should have done the background work on whether the HPC was capable of actually regulating this group of practitioners. Dinah Rose countered this by saying it ‘cannot possibly have been the Government’s intention’, and produced letters (e.g. from the then Secretary of State, Ben Bradshaw, and from Mr Seale himself) and even reports (from the PLG) to show that this cannot have been true. All the evidence clearly showed that the HPC was ambivalent, at best, on the question of whether or not they were simply offering their hardware to help the government out, or whether they were seriously considering the reality of regulating this particular practice.
The second question which this hearing had been asked to consider was the point that the PsyReg group was too late to raise objections. Plenty of evidence (again, including letters from the HPC itself) was produced by Ms Rose to prove that they were not at all too late.
The HPC had been asked to consider how to regulate counselling and psychotherapy, and how it might be achieved. ‘Our submission’, said Rose, ‘is that they start off, decide it is too difficult and controversial, and duck the issue’. She points out that not only does the HPC know (as early as 2007) that this is a controversial question, and that many oppose it, but that this is even noted by Baroness Thornton (Labour & Co-op Peer) in Hansard in May 2009. She refers to the published minutes of the first PLG meeting which was already dealing with the tensions in the field, whereupon the Judge asked ‘Do you have people on the PLG?’ – ‘No’ she replied in a flash. ‘Hmmm’, said the judge.
Rose kept pushing her points that either the HPC didn’t have the power to say it could regulate C&P, and even if it did have that power, then it hadn’t followed the right procedure to accomplish it. There are two strands here, each one showing the HPC to be at odds with itself. They were shown to be acting inconsistently and, arguably, without integrity with respect to their own stated requirements. It was a letter from Bindmans that produced clear evidence of Marc Seale’s double-talk: in two separate letters written within a month of each other, Mr Seale claimed two conflicting and contradictory positions. ‘It is my submission’, said Dinah Rose, ‘that they’ve re-written history, taken different positions, used different reasons, are inconsistent’. She added, ‘It is not clear what their case is, they give mixed messages’. She concluded that ‘the purpose of this application is to make clear to the Government that no weight can be placed on recommendations of HPC: they have bypassed their statutory power, and their own guidance’.
When the HPC representative, Mr Fordham, stood up at 12.35pm, Mr Justice Burton looked him straight in the eye and said ‘I’m going to need a knockout point from you’, which we all took as a very good sign indeed. The QC began rather weakly, and wobbled his way forward for half an hour, managing only to muddle the various acronyms – before he sat down again we had an ‘LPG’ instead of a ‘PLG’, and an ‘HSPC’ instead of an ‘HPC’ – clearly confusing the name of his client with the name of his bank.
After lunch he came back in stronger voice, but his ‘knockout’ point still eluded him. After another half an hour, the Judge was ready to sum up. He began by saying ‘I propose to grant permission and will summarise’. A smile lit the faces in the back pews. He noted that the HPC claimed that it had not made any recommendations to the Government, yet this would be difficult to infer from their December letter. He invited HPC to rewrite or revise their December 2009 letter to the Secretary of State, to reflect the conclusions of today’s hearing. He pointed out that even if it were not decided to move to Judicial Review, the claimants would still have wrested an important statement from the HPC.
Nevertheless, Dinah Rose again pressed home the fact that the HPC was ignoring vital points, spinning others, and was happy to waste everyone’s time in order to try to save face. The Judge was persuaded, and awarded the JR permission to the claimants. Quick as a flash she stood up again and asked about the costs. In a move that seemed to be unusual at this stage of a case (i.e. costs are not normally awarded at a preliminary permission hearing), the Judge stated that the HPC must pay one third of the claimants’ costs. It was an elated group that stumbled out of the courtroom (the door of which had a hand-written note pinned to it stating ‘Court Full’) into the corridor. Their case, at last, had been genuinely heard.
Saturday, 11 December 2010
Press release on JR from Bindmans LLP
Psychotherapists win the right to challenge Health Professions Council plans for statutory regulation
Mr Justice Burton has given six psychotherapy and psychoanalysis
practitioner groups permission to proceed with what he described as an
“important” judicial review challenge to proposals for their
regulation by the Health Professions Council (HPC).
The groups' barrister, Dinah Rose QC argued that the HPC had
unlawfully ducked critical questions about whether psychotherapy and
psychoanalysis should be regulated by statute and, more importantly,
whether the HPC is fit for purpose in this context given its focus on
the measurable outcomes of medical-style interventions. Their judicial
review was ruled to have been brought without delay and was “clearly
arguable” in the judge’s view. Giving a short oral judgement, Mr
Justice Burton went on to criticise the misleading nature of HPC
statements. Practitioner groups had been led to believe the HPC were
considering and would be reporting to the Department of Health on
whether it should be the regulator in circumstances where this was
apparently never planned or done.
During the course of the litigation the Department of Health has
maintained a neutral stance and put plans to introduce legislation on
hold to await the Court’s decision. The HPC will now have five weeks
to file further evidence before the case is listed for a full hearing
in the Spring.
Professor Darian Leader of the Centre for Freudian Analysis and
Research, one of the six practitioner groups, said today:
“It is very unfortunate that the HPC has chosen to use its existing
registrants’ fees to fight this case to date. We are told by its
solicitors that its legal costs already run to £47,000. This money
could be used to produce a meaningful report on how best to regulate
the talking therapies. Instead it is being used to defend an
empire-building decision that today’s ruling exposes as being legally
questionable and, in our view, is perverse and unsustainable. The HPC
was charged with investigating the regulatory needs of practitioner
groups such as ours and deciding whether statutory regulation was
appropriate at all and, if it was, whether it was the right regulator.
It simply evaded those questions. We hope the HPC will now show itself
to be appropriately sensitive to the indication given by the Court,
withdraw its current proposals for regulation and step aside so a body
that is actually capable of improving standards and protect the public
in this difficult field can be created.”
Notes
1 The claim was brought by the Association for Group And Individual
Psychotherapy, the Association of Independent Psychotherapists, the
Centre for Freudian Analysis and Research, the College of
Psychoanalysts-Uk, the Guild of Psychotherapists and the Philadelphia
Association.
2. The campaign has been supported by many well-known artists, writers
and philosophers, including Rosie Boycott, Tracey Emin, Brian Eno,
Sophie Fiennes, Bella Freud, Esther Freud, Antony Gormley, John Gray,
Oliver James, Anish Kapoor, Hanif Kureishi, Lee Hall, Susie Orbach,
Cornelia Parker, Adam Phillips, Will Self, Gavin Turk and Slavoj
Zizek.
Mr Justice Burton has given six psychotherapy and psychoanalysis
practitioner groups permission to proceed with what he described as an
“important” judicial review challenge to proposals for their
regulation by the Health Professions Council (HPC).
The groups' barrister, Dinah Rose QC argued that the HPC had
unlawfully ducked critical questions about whether psychotherapy and
psychoanalysis should be regulated by statute and, more importantly,
whether the HPC is fit for purpose in this context given its focus on
the measurable outcomes of medical-style interventions. Their judicial
review was ruled to have been brought without delay and was “clearly
arguable” in the judge’s view. Giving a short oral judgement, Mr
Justice Burton went on to criticise the misleading nature of HPC
statements. Practitioner groups had been led to believe the HPC were
considering and would be reporting to the Department of Health on
whether it should be the regulator in circumstances where this was
apparently never planned or done.
During the course of the litigation the Department of Health has
maintained a neutral stance and put plans to introduce legislation on
hold to await the Court’s decision. The HPC will now have five weeks
to file further evidence before the case is listed for a full hearing
in the Spring.
Professor Darian Leader of the Centre for Freudian Analysis and
Research, one of the six practitioner groups, said today:
“It is very unfortunate that the HPC has chosen to use its existing
registrants’ fees to fight this case to date. We are told by its
solicitors that its legal costs already run to £47,000. This money
could be used to produce a meaningful report on how best to regulate
the talking therapies. Instead it is being used to defend an
empire-building decision that today’s ruling exposes as being legally
questionable and, in our view, is perverse and unsustainable. The HPC
was charged with investigating the regulatory needs of practitioner
groups such as ours and deciding whether statutory regulation was
appropriate at all and, if it was, whether it was the right regulator.
It simply evaded those questions. We hope the HPC will now show itself
to be appropriately sensitive to the indication given by the Court,
withdraw its current proposals for regulation and step aside so a body
that is actually capable of improving standards and protect the public
in this difficult field can be created.”
Notes
1 The claim was brought by the Association for Group And Individual
Psychotherapy, the Association of Independent Psychotherapists, the
Centre for Freudian Analysis and Research, the College of
Psychoanalysts-Uk, the Guild of Psychotherapists and the Philadelphia
Association.
2. The campaign has been supported by many well-known artists, writers
and philosophers, including Rosie Boycott, Tracey Emin, Brian Eno,
Sophie Fiennes, Bella Freud, Esther Freud, Antony Gormley, John Gray,
Oliver James, Anish Kapoor, Hanif Kureishi, Lee Hall, Susie Orbach,
Cornelia Parker, Adam Phillips, Will Self, Gavin Turk and Slavoj
Zizek.
Friday, 10 December 2010
Judicial Review hearing goes against HPC
The judge agreed with the psyreg groups - there should be a judicial review of the HPC. More later
Thursday, 9 December 2010
Time and place of hearing re Judicial Review of HPC
COURT 7
Before MR JUSTICE BURTON
Friday 10 December, 2010
At half past 10
FOR HEARING
CO/11791/2010 Nursing And Midwifery Council v Beja
APPLICATION(s)
CO/12334/2010 The Queen on the application of Abdullah
v Secretary Of State For The Home Department
Applications for Permission
CO/4391/2010 The Queen on the application of Jallow-Halake
v Commissioner Of Police Of The Metropolis
CO/3229/2010 The Queen on the application of Association For Individual And Group Psychotherapy
v Health Professions Council
Ours being fourth on the list may mean that we don’t get started until midday or the afternoon.
See you there
Before MR JUSTICE BURTON
Friday 10 December, 2010
At half past 10
FOR HEARING
CO/11791/2010 Nursing And Midwifery Council v Beja
APPLICATION(s)
CO/12334/2010 The Queen on the application of Abdullah
v Secretary Of State For The Home Department
Applications for Permission
CO/4391/2010 The Queen on the application of Jallow-Halake
v Commissioner Of Police Of The Metropolis
CO/3229/2010 The Queen on the application of Association For Individual And Group Psychotherapy
v Health Professions Council
Ours being fourth on the list may mean that we don’t get started until midday or the afternoon.
See you there
Friday, 3 December 2010
What is the Health Professions Council (HPC)? Paper published in Self & Society
[You can get the full journal by emailing admin@ahpb.org.uk or go to the website.]
This is an important question that has yet to be adequately answered. The question is a logical one, not a political or rhetorical one. It is important to understand what a new ‘regulator’ is in terms of what it does on a daily basis, and how it organises its resources to accomplish its aims. Without a clear idea of the mechanisms at play it is not possible to predict the consequences of its actions, nor to hold it properly accountable for those consequences. If we only read the statements published by the HPC itself we won’t be any wiser. Statements like “We are the Health Professions Council (HPC). 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 professional skills and behaviour” are practically meaningless - we need to have some idea of how these statements are translated into practice, what grounds them in the truth. Much of the HPC publicity stresses the importance of Fitness to Practise hearings, and although these do take up a huge amount of time and money at the HPC, and a huge amount of PR space, in fact they account for a very tiny proportion of people on the register (see the Maresfield Report at maresfieldreport.com for a detailed analysis of this aspect of the HPC). Without knowing what the HPC think regulation really is or how it really works, it won’t be possible to know how to act in relation to it, nor how to judge whether it succeeds or fails.
One way to tackle the question is to approach the HPC as an organisation with everyday activities, committees, and budgets. From this point we can begin by saying that the HPC is an administrative centre which holds a database (known as The Register), which currently contains the details of 205,000 practitioners from 15 different occupations. Most of these occupations had previously been known as ‘professions supplementary to medicine’ and fell under the jurisdiction of the Council for Professions Supplementary to Medicine (an organisation created by the Conservative Government of 1960 in order to register those practitioners who worked in the NHS). The professions became known as Health Professions when the new Labour Government enacted the Health Professions Order 2001 (HPO 2001) in order to regulate these professions whether they worked for the NHS or not. The Order instituted key changes, and swept away the CPSM. Of course, many of the same people are still involved, and the organisation is still at the same address, but the new Order turned registration into regulation and centralised the power of the organisation by getting rid of the Professional Boards which had up until then guaranteed a place for each different practice in the organisation.
The Order states that the HPC must ‘set the standards necessary for safe and effective practice for each part of the register’, but it does not define what it means by standards, it does not define how to measure safe and effective practice, and it does not stipulate the necessity for generic over-arching standards. These are for the HPC to define, and in order to do this, it can consult practitioners – or as Chief Executive Officer, Marc Seale, put it at a conference in London (organised by Confer to put questions from Counsellors and Psychotherapists to HPC January 2010): ‘we invite them in to do a job, they do it, then we say good bye’.
There are three main areas of intervention where the HPC makes its presence felt as a regulator. Continuing Professional Development Audit and Fitness to Practise hearings each intervene at the level of individual registrant, Education and Training involves the validation of courses leading to professional qualification.
In each of these activities (CPD, FTP and E&T) the HPC recruits practitioners and lay people to help its Directors and staff to make decisions. The place of the practitioner in relation to these structures is new. Many of those who attended the Confer Conference were astonished to discover that the HPC recruit and select members to the Professional Liaison Group as if to a job vacancy. The assumption amongst practitioners had been that representatives from the various professional groups had been given a place on a forum, and had control over who attended. But this is one of the ideological changes introduced by the HPO2001. The HPC Council is appointed by the Government Appointments Commission; at Fitness to Practice Hearings lay people outnumber those with expertise or experience of the field in questions; in the new CPD audit, each registrant’s file is assessed by one lay-person and one person from the same part of the register. In brief, the HPC structure deliberately introduces a series of breaks between the knowledge of, and the regulation of, practice. This is problematic and contentious because it interrupts the flow of knowledge both in its development and in the natural regulation of practise, and obscures what actually happens by creating blind spots.
One member of the PLG responsible for distributing certificates of practise to people on courses across the country gave voice, privately, to his concerns that the expanding market for counselling courses was making it more and more difficult to be confident that certificates meant what they said. The changes introduced into the education system, making it more market driven, were weakening the processes of natural regulation and raising anxiety. Looked at from this point of view he quite liked the idea that the HPC would absolve his responsibility by offering a centralised system to punish people who transgressed. Great, if numbers is what interests you. Not great if knowledge and practice is important to you.
So, why are lay people so heavily relied upon in the HPC? If there are good reasons behind this innovation, they are not easy to find. More obvious, unfortunately, is the pernicious dimension overtly expressed in a variety of phrases (‘club culture’, ‘old boy networks’ ‘protectionism’ ‘self interest’). These invidious ideas found overt expression in the first major advertising campaign. It used photographs of people dressed up in white coats, but wearing false noses, eyebrows and glasses and invited the public to doubt the integrity of their practitioner. Four large posters from this campaign were proudly displayed as ‘art’ – framed and placed in the corridor at the HPC until only recently. What this extraordinary act seems to convey is that the organisation itself is not functioning as a thinking rational entity, but is animated by a rather simplistic idea. If there is good cause to mistrust local structures or practise and training then let us have the evidence and tackle the problem directly. What exists at the moment is a culture of insinuation and a rising level of fear – these do tend to push people away from rational thought and towards a knee-jerk call for ‘more power from above’ creating a vicious circle. The more centralised the system becomes, the less real information it has about what goes on in reality, and the more it gets tempted to blindly ‘crack down’ with its power.
The HPC claim to be able to ‘regulate’ through the application of standards, an idea borrowed from factory and quality management. There is ambiguity surrounding the real value of standards however, with some people openly saying they don’t matter in practice, and very little evidence that they mean much of an consistent value in the fitness to practice hearings. That there is a split between the standards and the reality is probably true. Where does this leave them as an instrument of regulation? If we follow the push to change the generic standards of proficiency we can get a better idea of the real meaning of the standards.
The push to change the current generic standards gathered momentum after the consultation closed on regulating psychology. On 2 December 2008 the Education & Training Committee agreed to “undertake a review” of the generic standards. This date marks the end of the overt process of consultation to take on the practising Psychologists to the HPC register and at the beginning of the overt process to capture counsellors and psychotherapists (this opened in summer 2008 with the Call for Ideas, the first meeting of the PLG for P&C took place on 4 December 2008). The Generic Standards had come in for criticism by the Psychologists, and would come in for more by the Counsellors and Psychotherapists when their turn came to comment on HPC proposals to take over their field.
When the HPC requested the Department of Health to write the legislation necessary to transfer power to regulate Psychologists to HPC under Section 60 of the Health Act 1999, the DH was also rewriting the constitution of the Council of the HPC. Until then each of the fourteen professions regulated by HPC had one member on the Council (plus an equal number of lay people, and the Council Chair), but, with the expanding number of professions coming into the HPC it was felt to be unfeasible to sustain this one to one relation, and membership of Council was fixed at nineteen which broke the connection between the Council and each group of practitioners. All current post holders lost their power, new advertisements went out, and the Appointments Commission chose the new Council ready for the July Council meeting where a Review Group (RG) was convened to continue the work on the replacement generic standards of proficiency. This introduces a further potential break between the knowledge and practice which can be better understood by following the way this group formed its ideas, and noting how it will implement them.
This RG comprised seven members, two of whom were newly appointed to HPC, two were not registrant members of HPC (hence, lay), and three were experienced HPC Council members. They met twice (28 September 2009 and again on 27/8 January 2010) before reporting to Council in March 2010. Their report was endorsed and their proposal went forward for public consultation between 28 July and 20 October 2010.
In October 2009 the public consultation on the regulation of Counselling and Psychotherapy closed with a record 1,100 responses in which criticism was levelled at the HPC as an inappropriate regulator for this field with the standards of proficiency widely cited as inappropriate. Although HPC presented an unperturbed face, and gave the go ahead to the DH to prepare to transfer power, the politics of the day held that this wouldn’t work unless something at least was done about the Generic Standards of Proficiency.
On Monday 26 July 2010, two days before the consultation on generic standards opened, the HPC announced their pleasure at being invited by the newly formed coalition Government to take over the regulation of Social Workers from the General Social Care Council. This coup must have been due to some skilful lobbying behind the scenes, and could not have been a complete surprise to the HPC executive and Council, but neither could it have been openly guiding the rewriting of the proposed new generic standards. This new government policy requires the HPC to change its name. This must also have an impact on the central generic standards for the foreseeable future. However, the process continues unchanged.
The Council Report (March 2010) notes that the RG was advised by HPC lawyers “not to make changes specifically in response to the feedback received through the psychotherapists and counsellors consultation as these professions are not currently regulated by the HPC”. The advice conveys the idea that standards of proficiency are intimately related to the work of specialists and must take this as the reference point, not the work of another group who may never join the register. Yet, the proposed new standards, as we will see, draw heavily on those already in use amongst many counselling and psychotherapy organisations.
When the RG reported to Council, it specifically noted that the ‘generic standards of proficiency should be retained as they recognised important commonalities shared by the professions regulated by the HPC’. Furthermore, ‘one of our strengths as a multi-profession regulator is our ability to have common processes that are applicable across all our professions’ (my emphasis). But the HPO 2001 only requires the HPC to establish standards of proficiency for different parts of the register, that is each different part that relates to a different kind of practice. There is no legal requirement for HPC to create over-arching generic standards. The reasons for having ‘generic standards’ are left vague and un-argued. They appear to have more to do with the needs of a new group of Council members to create an object to manage (a ‘mission statement’) than they do to the practice of any of the professions.
An added complication arose in September 2009, when HPC wrote to twenty professional bodies of groups already regulated asking them for feedback on the current generic standards of proficiency. Details of this survey were not made public, but the Review Group noted that seven of these twenty organisations responded to the survey: four said they had nothing to say, one commented on the introductory remarks, not on the standards themselves, and two commented in detail about eight of the twenty five main standards. The RG interpreted this to mean that most of the professional bodies covered by the HPC were satisfied with the current state of the standards. This rather odd conclusion allowed them to park the feedback on one side, and continue working towards its own agenda.
Attachment B of their Recommendations to the Council summarised the additional information made available to them and considered at their second meeting and showed that most of it came from the consultation on the regulation of counselling and psychotherapy, and the rest related to concerns raised by the psychologists. Furthermore, the implications of the new standards are spelled out in a time-table of work considered at the Council meeting which pointed out that it will take years before the psychologists can re-write their specific standards to take account of any changes at generic level. Here another problem is revealed: HPC explain that the timetable to rewrite the psychology standards is based on the three-year ‘grand-parenting’ period which will have to be allowed to play out under the current, agreed, standards. The logic here is that the standards are so central that people need to be sure of the standards they are judged by, it would be wrong to change them mid-stream. This logic, however, is not directing other work at the HPC. Psychologists with complaints against them prior to 1 July 2009, are being tried by HPC lawyers using HPC standards – which must be applied retrospectively. Nothing adds up.
There are many other anomalies all of which tend to suggest that there is little real thinking about the practical implications of ideas. The system seems to be built on the idea that centralised thoughts can be imposed, and this can be backed up with systems of punishment for local transgressors. The statement currently on the website says “The consultation follows a lengthy analysis of the standards where feedback was considered from a variety of stakeholders, including a number of comments from individuals and organisations. During the process the HPC set up a group of its Council members to review the generic standards and recommend whether any changes need to be made.” This implies the existence of an orderly, routine, well thought out process, but there is no evidence of a routine procedure to collect information about problems raised by the generic standards, and survey evidence seems to suggest that practitioners are not really thinking about this. At no point do the Review Group quote from any amassed wisdom generated from years of operating the previous standards. It rather looks, at best ad hoc, at least politically motivated, at worst simply business colonisation (‘with an eye to future opportunities for large-scale expansion and income generation’).
Reading through the minutes of Council and the report of the review group on generic standards, it seems that any question about the practical effect of the standards has been parked. In place of any proper impact study, we have a public consultation which, if previous consultations are any indication, bring in such a wide and varied response that it overwhelms the capacity of those delegated with the task of reading. Instead of thinking intelligently about the meaning and detail of responses, administrators are reduced to counting things, collapsing things, and pushing things together under generic headings. The machinery of the HPC almost seems to be designed to destroy actual knowledge and expertise. It certainly does not easily lend itself to an interpretation of enlightenment.
The standards that are in question are a complicated set of numbered points that try to differentiate between overarching and detailed generic standards. The box below renders the numbered points more or less into prose for ease of reading.
The current generic standards (interpreted, edited, and presented as prose)
“A professional must be able to demonstrate autonomy and accountability by practising within the legal and ethical boundaries of their work, in a non-discriminatory way, respecting confidentiality, and with the consent of the patient. He or she must exercise a professional duty of care and use good judgment, be able to manage workload and resources sensibly. These things must be ongoing.
Registrants must be able to work with other people, whoever they are, and to contribute to multi-disciplinary teams where necessary. Good communication skills across the board is expected.
Practitioners must be capable of investigating situations, gathering and analysing the right information and using the right techniques to carry out their work. They must be able to formulate and deliver treatment plans, draw on appropriate knowledge and skills and make professional judgements, all in a timely manner. They must be able to conduct the right procedures, treatments, and therapies etc safely and skilfully and maintain useful records.
Registrants must be able to evaluate the impact of their work both on any specific job and throughout their career. If necessary, they must comply with management audits.
Finally, registrants must know and understand the key concepts relevant to their particular practice. They must know how principles are expressed and translated into action and how to mediate specialist knowledge according to the context of their work. Finally, registrants must establish and maintain a safe practice environment.”
This reads like a general mission statement for a set of employees. The consultation document states that they ‘describe what registrants should know, understand, and be able to do at the time they apply to join the HPC Register’.
It goes on to give an explanation about why changes are needed: “We are aiming to make the new structure simpler than the current structure with less overarching standards. Some skills (eg communication) previously had more than one generic standards and we are proposing that they be combined into one broad standard”. No one explains how or why the old version was established, nor how it functioned over the intervening nine years, nor what problems actually occurred. Instead, a number of arguments are put forward for changing which read like post hoc rationalisations. ‘Language use’, for example was a problem that needed to be solved: ‘[now] we use language that can take into account changes in the law, technology or working practices which might take place over time’. How, exactly? Another problem is noted as “Not all generic standards apply to all professions regulated” – a contradiction in terms. In the report made to Council in March 2010, the Review Group revealed that Arts Therapists have never considered themselves covered and they have been part of the HPC since before it began. What a revelation! What is the real function, then, of these standards of proficiency? They seem to have very little to do with practice and everything to do with creating an appearance. Where does this leave the meaning of the word ‘regulation’?
The conclusion to section 3 boldly states that the generic standards of proficiency should be retained ‘as they recognise important commonalities shared by the professions regulated by HPC … [and] one of our strengths as a multi-profession regulator is our ability to have common processes applicable across all our professions’. If this were true, then the absence of generic standards would lead to the collapse of the HPC, it would imply the HPC remains nothing more than an empty idea held together by a law.
The penultimate bullet point of the conclusion states that ‘significant changes to both the structure and wording of the standards of proficiency are required to address the concerns that have been raised’, but no reference is made to the specific problems raised.
Section 4 contains the proposed standards themselves and Appendix C contains a table which organises the current standard alongside proposed changes together with the ‘reasoning’. This table is largely constructed out of a small number of ready-made statements which are inserted into boxes in a repetitive way, like bricks. In the column marked ‘reasoning’, where one might reasonably expect to find reasons, we find the repetition of a statement of belief. The final part of the table which contains the two new standards: the first is the old standard 1a.8 elevated to prime position: ‘We are proposing that it become an overarching generic standard as we feel that it is an important standard that is applicable across the whole register’ (emphasis added). And the second – “be aware of the impact of culture, equality and diversity on practice” - is ‘justified’ as follows: ‘We are proposing that this standard be added to reflect the importance of culture, equality, and diversity considerations for professionals and their practice. We believe that there is more to culture, equality and diversity consideration that just practicing in a non-discriminatory manner and that the additional standard is important’ (sic).
The Proposed Generic Standards of Proficiency
The Review Group met twice, ignored the legal advice, the survey responses, and all reference to technical practical work. They decided that generic standards were necessary, constructed a list of fifteen points headed generic standards of proficiency. Below these fifteen points are written out as plain text:
The proposed generic standards (interpreted, edited, and presented as prose)
“Registrants must be able to practice safely and effectively within their field of expertise, and especially within the legal and ethical boundaries of their work – and this is an ongoing requirement. They must be able to act alone and take responsibility for their judgement without becoming hostile to anyone. Personal and cultural prejudices, religious doctrines and sexual desires have no place in the work. A registrant must be sensitive to confidential matters, yet be able to communicate with others and maintain proper records. Practitioners should subject themselves to reflection and review of practice in order to assure the quality of their work. They must be able to draw on the right knowledge and skills in their work and understand the key concepts in their field. They are responsible for maintaining a safe and effective environment in which to practice their work.”
Conclusion
Little is what it is supposed to be, the dynamics of change seem much more clearly linked to political will and business opportunity than to practical or theoretical matters. There is much effort expended in presenting face, there are many patches of fog and confusion, and there is no evidence of any real, carefully thought through link between the centralised operations and the local application of practice. The suspicion that practitioners are fundamentally untrustworthiness lurks around in the fog, and occasionally comes out into the glaring light (even as a serious advertising campaign!), and this cannot bode well for the future of real work and real practice. What we have here is a smokescreen of conflicting and contradictory statements behind which business interests may quietly pursue policies of expansion and colonisation. Couple this together with the power of the law and what have you got? Apparently, the HPC.
Safe regulation of practice, on the other hand, comes from rational real knowledge and experience, and a willingness to be close to the action. It also requires local courage and clarity to speak up and act when something goes awry. Finally, successful regulation requires a realistic response to difficulties and a willingness to relinquish the petty pleasures that power inevitably brings.
Post Script.
In a series of letters pursing questions about a fitness to practise hearing, I asked Mr Seale, CEO, if he would use my formal title in correspondence. He replied that he thought it incorrect to address me as Dr, and referred me to Debretts to justify the snub. This came on a letter-head printed with the name of the HPC President: Dr Anna van der Gaag. Dr van der Gaag is a speech and language therapist and received her honorary doctorate from De Montfort University earlier this year. Coincidentally, the HPC recently agreed, after much resistance, to recognise PhD as one of the qualifications required for entry onto part of its register, and will therefore be responsible for validating courses leading to the title of Dr.
This is an important question that has yet to be adequately answered. The question is a logical one, not a political or rhetorical one. It is important to understand what a new ‘regulator’ is in terms of what it does on a daily basis, and how it organises its resources to accomplish its aims. Without a clear idea of the mechanisms at play it is not possible to predict the consequences of its actions, nor to hold it properly accountable for those consequences. If we only read the statements published by the HPC itself we won’t be any wiser. Statements like “We are the Health Professions Council (HPC). 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 professional skills and behaviour” are practically meaningless - we need to have some idea of how these statements are translated into practice, what grounds them in the truth. Much of the HPC publicity stresses the importance of Fitness to Practise hearings, and although these do take up a huge amount of time and money at the HPC, and a huge amount of PR space, in fact they account for a very tiny proportion of people on the register (see the Maresfield Report at maresfieldreport.com for a detailed analysis of this aspect of the HPC). Without knowing what the HPC think regulation really is or how it really works, it won’t be possible to know how to act in relation to it, nor how to judge whether it succeeds or fails.
One way to tackle the question is to approach the HPC as an organisation with everyday activities, committees, and budgets. From this point we can begin by saying that the HPC is an administrative centre which holds a database (known as The Register), which currently contains the details of 205,000 practitioners from 15 different occupations. Most of these occupations had previously been known as ‘professions supplementary to medicine’ and fell under the jurisdiction of the Council for Professions Supplementary to Medicine (an organisation created by the Conservative Government of 1960 in order to register those practitioners who worked in the NHS). The professions became known as Health Professions when the new Labour Government enacted the Health Professions Order 2001 (HPO 2001) in order to regulate these professions whether they worked for the NHS or not. The Order instituted key changes, and swept away the CPSM. Of course, many of the same people are still involved, and the organisation is still at the same address, but the new Order turned registration into regulation and centralised the power of the organisation by getting rid of the Professional Boards which had up until then guaranteed a place for each different practice in the organisation.
The Order states that the HPC must ‘set the standards necessary for safe and effective practice for each part of the register’, but it does not define what it means by standards, it does not define how to measure safe and effective practice, and it does not stipulate the necessity for generic over-arching standards. These are for the HPC to define, and in order to do this, it can consult practitioners – or as Chief Executive Officer, Marc Seale, put it at a conference in London (organised by Confer to put questions from Counsellors and Psychotherapists to HPC January 2010): ‘we invite them in to do a job, they do it, then we say good bye’.
There are three main areas of intervention where the HPC makes its presence felt as a regulator. Continuing Professional Development Audit and Fitness to Practise hearings each intervene at the level of individual registrant, Education and Training involves the validation of courses leading to professional qualification.
In each of these activities (CPD, FTP and E&T) the HPC recruits practitioners and lay people to help its Directors and staff to make decisions. The place of the practitioner in relation to these structures is new. Many of those who attended the Confer Conference were astonished to discover that the HPC recruit and select members to the Professional Liaison Group as if to a job vacancy. The assumption amongst practitioners had been that representatives from the various professional groups had been given a place on a forum, and had control over who attended. But this is one of the ideological changes introduced by the HPO2001. The HPC Council is appointed by the Government Appointments Commission; at Fitness to Practice Hearings lay people outnumber those with expertise or experience of the field in questions; in the new CPD audit, each registrant’s file is assessed by one lay-person and one person from the same part of the register. In brief, the HPC structure deliberately introduces a series of breaks between the knowledge of, and the regulation of, practice. This is problematic and contentious because it interrupts the flow of knowledge both in its development and in the natural regulation of practise, and obscures what actually happens by creating blind spots.
One member of the PLG responsible for distributing certificates of practise to people on courses across the country gave voice, privately, to his concerns that the expanding market for counselling courses was making it more and more difficult to be confident that certificates meant what they said. The changes introduced into the education system, making it more market driven, were weakening the processes of natural regulation and raising anxiety. Looked at from this point of view he quite liked the idea that the HPC would absolve his responsibility by offering a centralised system to punish people who transgressed. Great, if numbers is what interests you. Not great if knowledge and practice is important to you.
So, why are lay people so heavily relied upon in the HPC? If there are good reasons behind this innovation, they are not easy to find. More obvious, unfortunately, is the pernicious dimension overtly expressed in a variety of phrases (‘club culture’, ‘old boy networks’ ‘protectionism’ ‘self interest’). These invidious ideas found overt expression in the first major advertising campaign. It used photographs of people dressed up in white coats, but wearing false noses, eyebrows and glasses and invited the public to doubt the integrity of their practitioner. Four large posters from this campaign were proudly displayed as ‘art’ – framed and placed in the corridor at the HPC until only recently. What this extraordinary act seems to convey is that the organisation itself is not functioning as a thinking rational entity, but is animated by a rather simplistic idea. If there is good cause to mistrust local structures or practise and training then let us have the evidence and tackle the problem directly. What exists at the moment is a culture of insinuation and a rising level of fear – these do tend to push people away from rational thought and towards a knee-jerk call for ‘more power from above’ creating a vicious circle. The more centralised the system becomes, the less real information it has about what goes on in reality, and the more it gets tempted to blindly ‘crack down’ with its power.
The HPC claim to be able to ‘regulate’ through the application of standards, an idea borrowed from factory and quality management. There is ambiguity surrounding the real value of standards however, with some people openly saying they don’t matter in practice, and very little evidence that they mean much of an consistent value in the fitness to practice hearings. That there is a split between the standards and the reality is probably true. Where does this leave them as an instrument of regulation? If we follow the push to change the generic standards of proficiency we can get a better idea of the real meaning of the standards.
The push to change the current generic standards gathered momentum after the consultation closed on regulating psychology. On 2 December 2008 the Education & Training Committee agreed to “undertake a review” of the generic standards. This date marks the end of the overt process of consultation to take on the practising Psychologists to the HPC register and at the beginning of the overt process to capture counsellors and psychotherapists (this opened in summer 2008 with the Call for Ideas, the first meeting of the PLG for P&C took place on 4 December 2008). The Generic Standards had come in for criticism by the Psychologists, and would come in for more by the Counsellors and Psychotherapists when their turn came to comment on HPC proposals to take over their field.
When the HPC requested the Department of Health to write the legislation necessary to transfer power to regulate Psychologists to HPC under Section 60 of the Health Act 1999, the DH was also rewriting the constitution of the Council of the HPC. Until then each of the fourteen professions regulated by HPC had one member on the Council (plus an equal number of lay people, and the Council Chair), but, with the expanding number of professions coming into the HPC it was felt to be unfeasible to sustain this one to one relation, and membership of Council was fixed at nineteen which broke the connection between the Council and each group of practitioners. All current post holders lost their power, new advertisements went out, and the Appointments Commission chose the new Council ready for the July Council meeting where a Review Group (RG) was convened to continue the work on the replacement generic standards of proficiency. This introduces a further potential break between the knowledge and practice which can be better understood by following the way this group formed its ideas, and noting how it will implement them.
This RG comprised seven members, two of whom were newly appointed to HPC, two were not registrant members of HPC (hence, lay), and three were experienced HPC Council members. They met twice (28 September 2009 and again on 27/8 January 2010) before reporting to Council in March 2010. Their report was endorsed and their proposal went forward for public consultation between 28 July and 20 October 2010.
In October 2009 the public consultation on the regulation of Counselling and Psychotherapy closed with a record 1,100 responses in which criticism was levelled at the HPC as an inappropriate regulator for this field with the standards of proficiency widely cited as inappropriate. Although HPC presented an unperturbed face, and gave the go ahead to the DH to prepare to transfer power, the politics of the day held that this wouldn’t work unless something at least was done about the Generic Standards of Proficiency.
On Monday 26 July 2010, two days before the consultation on generic standards opened, the HPC announced their pleasure at being invited by the newly formed coalition Government to take over the regulation of Social Workers from the General Social Care Council. This coup must have been due to some skilful lobbying behind the scenes, and could not have been a complete surprise to the HPC executive and Council, but neither could it have been openly guiding the rewriting of the proposed new generic standards. This new government policy requires the HPC to change its name. This must also have an impact on the central generic standards for the foreseeable future. However, the process continues unchanged.
The Council Report (March 2010) notes that the RG was advised by HPC lawyers “not to make changes specifically in response to the feedback received through the psychotherapists and counsellors consultation as these professions are not currently regulated by the HPC”. The advice conveys the idea that standards of proficiency are intimately related to the work of specialists and must take this as the reference point, not the work of another group who may never join the register. Yet, the proposed new standards, as we will see, draw heavily on those already in use amongst many counselling and psychotherapy organisations.
When the RG reported to Council, it specifically noted that the ‘generic standards of proficiency should be retained as they recognised important commonalities shared by the professions regulated by the HPC’. Furthermore, ‘one of our strengths as a multi-profession regulator is our ability to have common processes that are applicable across all our professions’ (my emphasis). But the HPO 2001 only requires the HPC to establish standards of proficiency for different parts of the register, that is each different part that relates to a different kind of practice. There is no legal requirement for HPC to create over-arching generic standards. The reasons for having ‘generic standards’ are left vague and un-argued. They appear to have more to do with the needs of a new group of Council members to create an object to manage (a ‘mission statement’) than they do to the practice of any of the professions.
An added complication arose in September 2009, when HPC wrote to twenty professional bodies of groups already regulated asking them for feedback on the current generic standards of proficiency. Details of this survey were not made public, but the Review Group noted that seven of these twenty organisations responded to the survey: four said they had nothing to say, one commented on the introductory remarks, not on the standards themselves, and two commented in detail about eight of the twenty five main standards. The RG interpreted this to mean that most of the professional bodies covered by the HPC were satisfied with the current state of the standards. This rather odd conclusion allowed them to park the feedback on one side, and continue working towards its own agenda.
Attachment B of their Recommendations to the Council summarised the additional information made available to them and considered at their second meeting and showed that most of it came from the consultation on the regulation of counselling and psychotherapy, and the rest related to concerns raised by the psychologists. Furthermore, the implications of the new standards are spelled out in a time-table of work considered at the Council meeting which pointed out that it will take years before the psychologists can re-write their specific standards to take account of any changes at generic level. Here another problem is revealed: HPC explain that the timetable to rewrite the psychology standards is based on the three-year ‘grand-parenting’ period which will have to be allowed to play out under the current, agreed, standards. The logic here is that the standards are so central that people need to be sure of the standards they are judged by, it would be wrong to change them mid-stream. This logic, however, is not directing other work at the HPC. Psychologists with complaints against them prior to 1 July 2009, are being tried by HPC lawyers using HPC standards – which must be applied retrospectively. Nothing adds up.
There are many other anomalies all of which tend to suggest that there is little real thinking about the practical implications of ideas. The system seems to be built on the idea that centralised thoughts can be imposed, and this can be backed up with systems of punishment for local transgressors. The statement currently on the website says “The consultation follows a lengthy analysis of the standards where feedback was considered from a variety of stakeholders, including a number of comments from individuals and organisations. During the process the HPC set up a group of its Council members to review the generic standards and recommend whether any changes need to be made.” This implies the existence of an orderly, routine, well thought out process, but there is no evidence of a routine procedure to collect information about problems raised by the generic standards, and survey evidence seems to suggest that practitioners are not really thinking about this. At no point do the Review Group quote from any amassed wisdom generated from years of operating the previous standards. It rather looks, at best ad hoc, at least politically motivated, at worst simply business colonisation (‘with an eye to future opportunities for large-scale expansion and income generation’).
Reading through the minutes of Council and the report of the review group on generic standards, it seems that any question about the practical effect of the standards has been parked. In place of any proper impact study, we have a public consultation which, if previous consultations are any indication, bring in such a wide and varied response that it overwhelms the capacity of those delegated with the task of reading. Instead of thinking intelligently about the meaning and detail of responses, administrators are reduced to counting things, collapsing things, and pushing things together under generic headings. The machinery of the HPC almost seems to be designed to destroy actual knowledge and expertise. It certainly does not easily lend itself to an interpretation of enlightenment.
The standards that are in question are a complicated set of numbered points that try to differentiate between overarching and detailed generic standards. The box below renders the numbered points more or less into prose for ease of reading.
The current generic standards (interpreted, edited, and presented as prose)
“A professional must be able to demonstrate autonomy and accountability by practising within the legal and ethical boundaries of their work, in a non-discriminatory way, respecting confidentiality, and with the consent of the patient. He or she must exercise a professional duty of care and use good judgment, be able to manage workload and resources sensibly. These things must be ongoing.
Registrants must be able to work with other people, whoever they are, and to contribute to multi-disciplinary teams where necessary. Good communication skills across the board is expected.
Practitioners must be capable of investigating situations, gathering and analysing the right information and using the right techniques to carry out their work. They must be able to formulate and deliver treatment plans, draw on appropriate knowledge and skills and make professional judgements, all in a timely manner. They must be able to conduct the right procedures, treatments, and therapies etc safely and skilfully and maintain useful records.
Registrants must be able to evaluate the impact of their work both on any specific job and throughout their career. If necessary, they must comply with management audits.
Finally, registrants must know and understand the key concepts relevant to their particular practice. They must know how principles are expressed and translated into action and how to mediate specialist knowledge according to the context of their work. Finally, registrants must establish and maintain a safe practice environment.”
This reads like a general mission statement for a set of employees. The consultation document states that they ‘describe what registrants should know, understand, and be able to do at the time they apply to join the HPC Register’.
It goes on to give an explanation about why changes are needed: “We are aiming to make the new structure simpler than the current structure with less overarching standards. Some skills (eg communication) previously had more than one generic standards and we are proposing that they be combined into one broad standard”. No one explains how or why the old version was established, nor how it functioned over the intervening nine years, nor what problems actually occurred. Instead, a number of arguments are put forward for changing which read like post hoc rationalisations. ‘Language use’, for example was a problem that needed to be solved: ‘[now] we use language that can take into account changes in the law, technology or working practices which might take place over time’. How, exactly? Another problem is noted as “Not all generic standards apply to all professions regulated” – a contradiction in terms. In the report made to Council in March 2010, the Review Group revealed that Arts Therapists have never considered themselves covered and they have been part of the HPC since before it began. What a revelation! What is the real function, then, of these standards of proficiency? They seem to have very little to do with practice and everything to do with creating an appearance. Where does this leave the meaning of the word ‘regulation’?
The conclusion to section 3 boldly states that the generic standards of proficiency should be retained ‘as they recognise important commonalities shared by the professions regulated by HPC … [and] one of our strengths as a multi-profession regulator is our ability to have common processes applicable across all our professions’. If this were true, then the absence of generic standards would lead to the collapse of the HPC, it would imply the HPC remains nothing more than an empty idea held together by a law.
The penultimate bullet point of the conclusion states that ‘significant changes to both the structure and wording of the standards of proficiency are required to address the concerns that have been raised’, but no reference is made to the specific problems raised.
Section 4 contains the proposed standards themselves and Appendix C contains a table which organises the current standard alongside proposed changes together with the ‘reasoning’. This table is largely constructed out of a small number of ready-made statements which are inserted into boxes in a repetitive way, like bricks. In the column marked ‘reasoning’, where one might reasonably expect to find reasons, we find the repetition of a statement of belief. The final part of the table which contains the two new standards: the first is the old standard 1a.8 elevated to prime position: ‘We are proposing that it become an overarching generic standard as we feel that it is an important standard that is applicable across the whole register’ (emphasis added). And the second – “be aware of the impact of culture, equality and diversity on practice” - is ‘justified’ as follows: ‘We are proposing that this standard be added to reflect the importance of culture, equality, and diversity considerations for professionals and their practice. We believe that there is more to culture, equality and diversity consideration that just practicing in a non-discriminatory manner and that the additional standard is important’ (sic).
The Proposed Generic Standards of Proficiency
The Review Group met twice, ignored the legal advice, the survey responses, and all reference to technical practical work. They decided that generic standards were necessary, constructed a list of fifteen points headed generic standards of proficiency. Below these fifteen points are written out as plain text:
The proposed generic standards (interpreted, edited, and presented as prose)
“Registrants must be able to practice safely and effectively within their field of expertise, and especially within the legal and ethical boundaries of their work – and this is an ongoing requirement. They must be able to act alone and take responsibility for their judgement without becoming hostile to anyone. Personal and cultural prejudices, religious doctrines and sexual desires have no place in the work. A registrant must be sensitive to confidential matters, yet be able to communicate with others and maintain proper records. Practitioners should subject themselves to reflection and review of practice in order to assure the quality of their work. They must be able to draw on the right knowledge and skills in their work and understand the key concepts in their field. They are responsible for maintaining a safe and effective environment in which to practice their work.”
Conclusion
Little is what it is supposed to be, the dynamics of change seem much more clearly linked to political will and business opportunity than to practical or theoretical matters. There is much effort expended in presenting face, there are many patches of fog and confusion, and there is no evidence of any real, carefully thought through link between the centralised operations and the local application of practice. The suspicion that practitioners are fundamentally untrustworthiness lurks around in the fog, and occasionally comes out into the glaring light (even as a serious advertising campaign!), and this cannot bode well for the future of real work and real practice. What we have here is a smokescreen of conflicting and contradictory statements behind which business interests may quietly pursue policies of expansion and colonisation. Couple this together with the power of the law and what have you got? Apparently, the HPC.
Safe regulation of practice, on the other hand, comes from rational real knowledge and experience, and a willingness to be close to the action. It also requires local courage and clarity to speak up and act when something goes awry. Finally, successful regulation requires a realistic response to difficulties and a willingness to relinquish the petty pleasures that power inevitably brings.
Post Script.
In a series of letters pursing questions about a fitness to practise hearing, I asked Mr Seale, CEO, if he would use my formal title in correspondence. He replied that he thought it incorrect to address me as Dr, and referred me to Debretts to justify the snub. This came on a letter-head printed with the name of the HPC President: Dr Anna van der Gaag. Dr van der Gaag is a speech and language therapist and received her honorary doctorate from De Montfort University earlier this year. Coincidentally, the HPC recently agreed, after much resistance, to recognise PhD as one of the qualifications required for entry onto part of its register, and will therefore be responsible for validating courses leading to the title of Dr.
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