Transcript of a presentation given to the London Regional Gathering of the Independent Practitioners Network. October13th 2001

Regulation - the shape of things to come
Anne Richardson
Deputy Branch Head Mental Health Services
Department of Health

[Anne Richardson introduces herself]

A little bit about me. I'm a clinical psychologist by background originally. I qualified back in 1977, and worked in the health service for, I guess almost 20 years and partly at University college in an academic job, jointly running the clinical psychologist training program there before moving to the DOH in 1995. So I've been there for 6 years or so. I'm not always full-time. I started out working half-time at UCL and carried on working half-time and I still do some clinical work now and my orientation developed over the years as I guess is true for many of you as well. I've recently been doing a training in IPT, Inter-Personal Therapy, a brief, focused, time-limited treatment mainly researched for depression, based on the 'object relations' school which finds a good personal fit for me because my original background was in CBT as you might imagine suitable for a clinical psychologist and I've moved through a spell of personal therapy towards a more interpersonal focused approach for my own work. So I still do that at the Chelsea and Westminster once a week. I say that to you because I want to say to you that I'm not coming exclusively from a civil servant background. So my perspective is a perspective that has some knowledge of the issues of working with people and all that that involves.

Right now another bit of introduction or background... 

I'll say this several times as I go through the presentation but it is very important that people don't run away with the idea that this is going to be a quick or easy process or even that it will certainly, this initiative, that it will certainly lead to regulation and registration of psychotherapists. It may or it may not but I'll explain where the government is coming from in relation to that.

The first slide is an attempt to put the issues about legal matters into some context.
This overhead summarises the government's quality framework...

Diagram in here.

If you have connections with the NHS you may well have heard about the Performance Assessment Framework, PAFF... this is the PAFF diagram that we all use. What it does is to help connect up the various different initiatives that are concerned with improvements in service quality.

In that top bubble you've got National Service Frameworks. We've published a national service framework for mental health in 1999. We had a national service framework for older people's services in 2000/2001. We've got an NSF for children's services coming out in 2002, and there are NSF's for diabetes, Renal disease, Coronary heart disease and so on, already in the system.
I say this because it is important to put legal methods of doing something about quality into context.

Laws are very... are only... one way and they are perhaps an over-simple way, of doing something about quality. The way you influence quality is by a variety of different means and NSFs we believe, is one aspect of that quality framework. 
 
So for mental health, NSF sets out standards for the delivery of effective mental health services. Some of you will be familiar with what the NSF says... this is really important for us in mental health services. Although I know many of you will be involved in aspects of care that are more clearly 8. centered on education or personal growth rather than health per se I would imagine most of your clients are nonetheless distressed coming with anxiety-related problems and so on so it is relevant for you too. 

 Now in that middle section you've got a set of processes really

 Professional self regulation which is all the action being taken to strength the provision of codes of conduct, guideline on ethical practice, the support that for example the government is giving to the GMC, the General Medical Council, or to the UKCC, the group that regulates nurses and others. So work there to strengthen what professional bodies currently do. There is the framework of clinical governance as well, which is a system within clinical services. Within which practitioners are held to account through a system of feedback for the work that they do. And there is in each patch a clinical governance lead who takes responsibility for service audit, making sure that, where appropriate, routine good practice is followed. 

And then there is action on life-long-learning. Which is again for NHS employees making it plain that regardless of your professional background, even if you are not one of the professionally affiliated staff, it is still appropriate that you should have continuing education and development as a means of enhancing the quality of what you do. There's been more money delivered to the social care services and more coming along next year to strengthen education and training and make it possible for people to get decent CPD. I imagine a lot of you do all that off your own bat. But if you look at services in primary care in particular, it is really hard for primary care teams and staff to actually get access to budgets for Continuing Professional Development. Most of the money currently goes to specialized services.

And then at the bottom there, you've got the way the feedback loop is joined up and there is a new National Performance Framework, new bodies and organizations like the Commission For Health Improvement which you've heard about and the National Survey Of Service Users and carers views. It's called a national Patient Survey because this is led by the non-medical health bit of the department, we tend to use service users and carers as a term rather than patients but anyway that's what it's called. 

So you set clear standards, you have processes to help you deliver them and then you monitor those standards... but like I say, there is one message to take from it... and that is that the law is only one way that you might improve quality, there are lots of other ways too...

10 You will have heard about the order making power in the Health Act 1999, the order-making power is at section 60 of the act. It's been called the Henry VIII clause in the Act, the reason for that is because the last time it was used... it gives the secretary of state very powerful powers to amend legislation... the time is was used before the Health Act 1999 was to help Henry VIII get rid of some wives.

Our Secretary of State doesn't need to do that but nonetheless the section 60 Order is a bit of the Health Act which enables ministers to make changes which are required by the professions and it enables changes to be made to existing legislation. So for instance it was the section 60 power that was used to amend the GMC regulations when the Shipman enquiry first blew up. And the first time the section 60 act order was used was in order to make it a requirement that doctors should be suspended from practice once they were under investigation. That was prompted by ... the Shipman events.

It's also been used to modernise the system of professional self-regulation which the GMC does for doctors. Medicine was the first group to be tackled in this way and it is also being used to develop the legislation to enable the Professions Supplementary to Medicine Act to be replaced. The PSM Act is the statute that registers speech and language therapist dietitians, orthoptists and so on, I think there are 12 or 13 professions, I always forget whether its 12 or 13, somebody might know, different professions, that are currently registered under the PSM Act. And the Health Professions Council which is going to replace the PSM act really strengthens the ability of the law to insist on things like CPD. So that practitioners that are registered under the Act can't continue to be registered unless they have demonstrated, or continue to demonstrate, that they do participate in CPD.
........

Now the Health Act Order-making power which is what's used to set up the Health Professions Council or HPC, as I said before, has also been used to reform some of these systems. So it's been used for the nursing and midwifery council. These were all changes that that profession wanted to make. And the order-making power is... as I said... the order-making power is...I said it's powerful but it's good because it's quick. There have been bits of proposal waiting in the wings for years and years and years, especially around the GMC, which simply there hasn't been Parliamentary time to do. But this order-making power enables you to do things relatively quickly once you've decided what you want, which is a key feature. It was also used to set up the General Social Care Council Its been used for Pharmacy Act reform. It's been used to make changes to the dentists' regulation and changes to opticians' regulation.

Now there are lots of new groups waiting in the wings who want registration... and these are some of them...

Operating department practitioners. Well they are not a very big group but this is one of those areas where size doesn't matter because they are a small group but they could be quite dangerous. What do they do? They work in surgical wards, in surgery and they assist, so if they haven't had training it matters really.

Clinical perfusionists. I'm terribly sorry you'll have to forgive me for not being able to tell you what one of those is. Does anybody know?

Support workers well they're another group who are seeking some sort of regulation and registration.
 
Complementary and alternative medicines. Well you may have seen the house of Lords debate on complementary and alternative medicines and seen the government response you can read more about on the web site if you want to. But there a very strong argument was made in the debate that for example acupuncture and other complementary and alternative practitioners should be regulated because of the risks unprofessional practice poses, or because of the risks that practice delivered by untrained people presents to the public and of course psychotherapists, psychologists and counsellors are potentially waiting in the wings. 

The psychologists in particular have a long history of interest in statutory registration. Their arguments go back some 20/25 years now and over time they've got quite close to it, then pulled back. And relatively recently, it is said this, is just rumour mind you, I don't know if it is true, but it's said that they had two peers in the House of Lords quite keen to take forward a Private Members Bill on their behalf And of course they drafted their own Bill, there was there a lot of support for the idea from the government, from other departments and from the Privy Council and other professional bodies, and from the public and from practitioners and so on. But the proposers stepped back because the Health Act was there and because the Health Act offers the opportunity to do it, to do registration for a number of people, and to do it in an economic way... 

So they are close to being ready. 

Psychotherapists... well you can tell me. I've been talking with representatives and interested individuals and professional bodies and organisations and really anybody who wants to have... has something to say... about this issue for psychotherapists and counsellors. It's my impression is that counsellors are reasonably keen to pursue statutory registration. My sense is that... we haven't done a formal consultation... this is all part and parcel of just gathering views at this stage... my sense is that the psychotherapists are bit more mixed.

But as I say we can talk about this... you can tell me. 

Let me outline some general principles behind the development of statutory registration for such groups. The first and most important driver for this so far as the government is concerned is public safety.

I don't think that civil servants any longer need any convincing that psychotherapy can be dangerous.

I receive a number of letters on a regular basis from people who have been what I can only call victims of unprofessional practice...and sometimes it's worse than unprofessional practice, sometimes it's abuse, and that might be financial abuse, it might be sexual abuse, it might be child abuse, and those people and families write to government, write to ministers... bravely in many cases to outline what they've been through. And we also hear from groups like POPAN who collect information on a slightly more systematic basis than that about the numbers of people who have been victims in that way. I think that whereas once upon a time some time ago it wouldn't have been too surprising to hear somebody say... oh well psychotherapy... why would you want to register that? Psychotherapists can't do any harm. It is clearly not true and it is not a view that is held by anybody dealing with this issue now.

I think it's also clear that when you follow those individual's stories it's common that they can't get redress. It's common that a professional body doesn't actually even have a clear... I mean some of them do... some of them do very, very well and they have proper, robust, open, transparent disciplinary procedures and procedures for investigating complaints. But actually a lot of them don't and to be fair, some of them are... appear to be more interested in protecting their members rather than they are in protecting members of the public who have been on the receiving end.

So it's not untypical for a service user, for a psychotherapy patient to have felt that there was a cause for complaint... to take that complaint to a professional body and not to have any information about what happens next... their letter goes into a black hole and months and months go by... So somebody might take up... if they know about POPAN... might go to POPAN and Popan do a really good job in providing advocacy and information for people who are wanting to take up complaints.

But even the structure of some of the committees are not balanced... precisely the individuals who are on the committees making judgments about the practitioners who are guilty, perhaps allegedly, of unprofessional practice are those individuals, or are connected to those individuals who have been practicing... they are not independent... is what I'm trying to say.

We know that the systems aren't great...professionals can also be victimised and they also need their interests to be guarded. You also as therapists need to find ways within your structures to make sure that you are not unreasonably criticized, or unfairly criticised and that matters just as much, but that balance of interests hasn't always been right. It has been much more in favour of the therapist up to now.

So the balance of interest between the patient the therapist and the employer ....it's certainly true within the NHS that NHS managers and employers need to know more about what to expect from a competent psychotherapist... what does it mean to fund, support, supervision or continuing professional development.

One of the things that has been set out in the statutes, or in the arrangements that follow on from the statutes, is that those expectation are clear.

That there are standards that are open and obvious.

This initiative is driven by the needs of service users but it does have professional ownership
The reason I say that is that Ministers and civil servants do recognise that the only people who are best qualified to judge whether someone is qualified to practice is somebody who has that qualification...

Although the committees on the health professions Council...have a majority of only one... in terms of profession's representation... all the rest are lay members... it is nonetheless true that things like the training committees and the committees that deal with standards of education and who should be registered and who shouldn't be... are mainly made up of those people who you would expect to know what a good qualification looks like.

Development of the statutes are driven by a wish to make procedures more simple to make them targeted and fairer more transparent and to operate much more quickly. And I guess the best example of this that we have to look at right now are the procedures used by the GMC which were incredibly complicated and weren't very targeted... didn't always look very fair. And certainly weren't transparent…It was extremely difficult… I mean I've had occasion where I've had a letter from a member of the public complaining about a practitioner of psychotherapy who also had medical training and I'd ring up the GMC and I'd say 'can you tell me whether this person is under investigation?' and it appears I couldn't be told. I understand why but it would be good to know a bit more about what the procedures are, so these things are part of what the drive is. 

So general principles... to be compatible with the needs of the NHS, because the NHS is still in fact I think... we don't have good data held centrally on this... is the biggest provider across the UK, of talking treatments... Now some people hate that expression so I apologise to you if you do but it's a quick shorthand for me to summarise all the different approaches that get offered that are not drug... that might include psychotherapy, IPT, CBT whatever, whatever. 

Most talking treatments are delivered within the NHS... which is not to say that most specialised psychotherapy is provided there...There is a lot of specialised psychotherapy provided in the private sector, a lot of counselling provided in the private sector but adding up all of it... lots is in the NHS. 
And therefore it is appropriate that the NHS is one of the stakeholders, one of the interests here, and we need to think about that... so one aspect of the work involves trying to encourage psychotherapists psychologists and counsellors to develop procedures and practices that are consistent with what is going on in the NHS, for example around clinical governance, or for example, around supervision and support. 

Obviously it has to be compatible with Human rights and EU requirements. And the government believes strongly that the system of statutory registration such as it might be for any group needs to be accountable to government... sorry I should have said parliament... But accountable to Parliament. So that the public has a right to be involved as it were.
 
Sorry this is so NHSsy but you know you'd expect that from somebody from the Department of Health I guess but it [the NHS] is a big driver.

The NHS plan that was published last year also argued that regulatory bodies should be much smaller than they are. That they should have much greater patient and public membership. As I said before they should have fast, transparent procedures, they should be accountable and actually what the NHSD plan did was to propose a new... an over-arching... we jokingly call it OFFREG which is a UK Council of Health Regulators... which would coordinate the work of the professional registration councils...and make sure they were all operating to equivalent standards. Now in fact that UK council of health regulators won't be called that because since this was published we've had the Kennedy report, the report of the enquiry...the Bristol enquiry which is called the Kennedy report and that document proposed something very similar... and it's called something else.. I think its called the Council of Health Regulators CHR. The principle is the same they are proposing an over-arching regulator of regulators. 

Now I'm going to say a bit about the Council for the Regulation of Health Professionals, HPC The one that replaces the Professions Supplementary to Medicine Act. I'm going to talk a little bit about it for two reasons 

One, because it offers the best example out there at the moment for you to look at if you are interested to see what a model might look like that would register psychotherapists. That's one reason. So the shape of the HPC is the best example... if you are trying to invent a machine that will fly... we have got one aeroplane just about to take off over there which is worth your while looking at in order to give you an idea of what shape it is, how fast it goes, and whether it is likely to fall down.

There's a second reason for why I want to mention the HPC ...and it is because it also leaves open the possibility that new groups... beyond speech and language therapists could join the HPC if they wanted to and if they were ready.

The HPC actually offers one model to register psychotherapists, counsellors and psychologists. I'm not saying it is the best model... there are some things that it might not do that you might want but anyway... 

Within HPC, patients' interests come first, there is an emphasis on open and transparent procedures, I've said all this before, the intention is to be responsive to change needed by the professionals.

What would make a group eligible? Assuming you wanted to be eligible for registration?

Well... size is important but it's not the only issue because as I've said, operating department practitioners are quite a small group but they are potentially quite dangerous... the degree of risk is also a factor... so size plus a clear case of public protection... Well on both those counts psychotherapists, counsellors and psychologists fit the bill... there are enough to make it a concern... there is sufficient of a case on public protection to make ministers concerned about practice.

There would need to be understanding on the part of all those practitioners who would be affected... of what was going on... so people would need to understand what it meant. Now that's why as I said at the beginning this isn't going to be quick... because it is going to take us a really long time to scope the issues, to talk to people, to get information out there about what the issues really are. And there is no way at all that the government will be running away with an order, or a piece of legislation to enforce registration on a group of professionals that don't want it. It's as ??????? simple as that. ..........but part of my job is to make sure that... to contribute to the issues actually involve what this actually means. 

So people need to know, and I think of the letters I get from psychotherapists... I think it is difficult for you in the private sector or the independent sector because you know maybe the communications aren't always as clear... maybe that's not a fair remark... but it strikes me as quite commonly there... the needs for disseminating information aren't always as easy... certainly not as easy for me to get to... If I were wanting to put information out I'm never quite sure for practitioners how I do that...

But I get a lot of letters, not a lot, but quite a few, mostly what they have in common that they don't fully understand what this is all about and so I'm really conscious of the need to get information out there about what is going on, and more importantly, what isn't. 

So in addition to understanding the issues, it's important that the group if it is a group... which is another question... that there is unanimity... that there is agreement about the right way forward... and that isn't easy.... I think that's very unlikely.... it's impossible right now... completely impossible right now but maybe in the future it won't be.

In order to be eligible for statutory regulation, a group has to have agreed standards for selection. Who should get in to the profession? Who should qualify and be registered? Who should actually get into training? And here you'd ask yourselves... well do you have any kind of agreement as a group, or as a collection of groups, or as a federation, about who is unsuitable to train as a psychotherapist. I mean are there people you'd exclude from training?

Don't know? 

Maybe it's something to talk about... 

Standards for selection do matter. You have to agree what the content of training was. Now, you only have to think about the difference between a training in say...psychoanalytic psychotherapy, or psychoanalysis and CBT, or some trainings in counselling, to see that this is like the difference between well... the difference between those is vast. This doesn't perhaps matter too much provided that all the groups who call themselves counsellor agree that about what it is that constitutes a training to be a counsellor, and if it is different from what constitutes a training to be a psychotherapist that's fine, it doesn't matter as long as the counsellors and the psychotherapists agree.

For example the psychologists have got quite well defined standards for selection, they've got clear standards for training, they have a national system of accreditation with a single professional body that approves 24 courses across the country that work to a similar level. it doesn't mean there isn't variation but they do at least have those standards set there.

For psychotherapy... well different approaches wouldn't even agree about the appropriateness of personal therapy as part of a training. Do 350 hours of supervised practice matter? Or should it be 50? Should you learn theories of mental ill-health? Should you learn research methods? Audit methods? Should you be explicitly taught communication skills? I know quite a lot of psychotherapy and counseling trainings that don't do that... staggeringly enough.

So there has to be some agreement on what has to go into training for the different groups and then there has to be agreement about what should constitute continuing professional development.

We'd probably all of us sign up to a notion that it is important to professionally update your skills, it is important to seek supervision for the work you do. We'd probably all agree to that. But how much? What type? How do you check that it has happened?........You know that the doctors are moving towards professional re-validation, so they are going to be developing a sort of portfolio of continuing medical education which will be vetted by the professional body. So that is how they're doing it.

What about us?

Then you have to agree what the register looks like, for example should it register only those people who are fully qualified? Which is what the HPC does...you have to complete your training as a speech and language therapist before you can join the register but the medical register offers an opportunity for provisional registration. Because there are doctors who do their basic medical qualification and then they go on to specialize, to learn psychiatry. So they have a conditional registration and then do an MRCPsych. The membership of the Royal College of Psychiatrists exam. Is that appropriate is that a sensible model for psychotherapists? Because there are lots of people like psychologists for instance who would do a basic training but wouldn't necessarily see themselves qualified to offer psychotherapy. They then go on to do some sort of more specialized talking treatment training. Which arguably would then enable them to enter a psychotherapy register.

So... all this is to be thought about

You need agreed standards on practice. Again its easy to say, it trips off the tongue but actually it is complicated to do that because think for example about the differences between approaches to teaching practice that are used by some of the psychotherapy and counselling training organisations.
I talked with the British Association of Behavioural and Cognitive Psychotherapy a few months ago and as part of their standard practice they use video and audio tapes of sessions. I've been doing the IPT training as I said, and I've been, with the client's permission and with the appropriate safeguards in place, and with lots of opportunities to say no, and indeed some people do say no, and it's quite right too... I've been then sending the tapes off with any names oblated to North America to have them listened to by an IPT specialist, who then you know, sends them back and I've had these long phone conversations... I have a supervisor in London and I tell you it was a scary business going back to doing that after a few years but really, really good.
 
Now taping your sessions is anathema to some practitioners some practitioners will tell you that, as somebody in UKCP said to me when we were at a meeting with them, she drew in her breath and she said 'tapes!' I said yeh. Well obviously that interferes terribly with the transference and isn't an appropriate thing for them to do it's not what they would permit and yet it is part of standard teaching and training practice being observed, having someone else in the room using a one way screen, typical in family therapy with all the safe guards but for some groups it is simply not on.

So how do we deal with that? We would have to have some agreement about what was appropriate practice for teaching. Ideally it would need to be evidence-based rather than based on faith you know, it needs to based on what we know about what's effective and what we know about what's risky. Rather than just automatically just assuming that we should continue to do it in the way we've always done it.

Not very much psychotherapy practice is actually hands-on, it doesn't really involve physical contact with the patient. But some alternative approaches do and although my main focus is the psychotherapy, psychology and counselling and there are some semi-complementary approaches which do involve touching patients and if so, then it is appropriate that there should be clear standards or guidelines, or whatever you want to call it, set out about how that is delivered.

Last but not least, we would need to agree what we meant or what we should do when somebody complained. Maybe this one is slightly easier because I think that for the most part, although we wouldn't always agree what did constitute a breach of professional practice, in some of the minute details of training, we probably would agree, all of us about the things that are wrong.
I think across all the psychologies, psychotherapy, counseling you don't have sex with your patients, you don't abuse them financially, you don't mislead them, etc We'd probably all be able to sign up to some common ground there. 

And that actually is the major driver for this legislation anyway... public safety.

So what you can do is write into the legislation some of those things that everybody does agree and then set up sub-committees and advisory committees to help you develop the rest.

Let me say something about some of the constraints that there are. 
I've mentioned some. I've mentioned the most important ones which concern where people are up to. There are also these constraints on timing 

Parliamentary time-table. it is incredibly busy... it's a real constraint. It is incredibly busy. 
You know that the plans for setting up the Health Professions Council which were a twinkle in the eye back in 1999, or before because the Professions Supplementary to Medicine Act long since needed reform... that particular statute isn't going to be on the books until 2002. So it won't actually have its enabling legislation until next summer... so...although a shadow council has been setup now and it is learning how to operate, it won't actually start working until next summer properly.

The establishment of that over-arching OFFREG, I called it, the new UCHR, whatever it is to be called in the end, that won't even... that will possibly .be debated in the house this... the initial debate will be held this autumn in November, next month. But that would be very unlikely that couldn't possibly be on the statute book either for another couple of years because that's just how long it takes. So the parliamentary timetable is a real constraint.

Minister's priorities. We've had a Labour government since... come in for a second term and that's meant that this interest in service quality... which is not to say that an alternative government wouldn't also be interested in service quality... but it does mean that this agenda on the Health Act and on developing the means to strengthen professional self regulation... has had a longer go than it otherwise might have done but you know there will be another election, ministers may change... they may change their minds... Although this government has given a commitment to taking action in due course on statutory registration for psychotherapists, psychologists and counsellors, very wisely there's been no commitment about when that would be done or how that will be done and the only undertaking at the moment is to talk it through.

If an order were to be developed then there are protections even on the face of the Act which have to be thought about. An order has to be published three months before it is laid before parliament. It has to be debated in both Houses... and what else...? It can't be amended in the House but it can be voted out.

So what that means is that there has to be absolutely full consultation in advance of any order. You have to have a pretty certain run for a thing before you even write an order. And that is an important safeguard for those of you that opposed in principle to statutory registration...a view which I respect... but that's an important safeguard for you because it means that there would be an opportunity to debate the philosophical issues. And the issues of principle that underpin the question of whether a law is the right way to do it, or whether some of those other ways are more important to do first. Which I think we'd all agree, these other ways are also important and we should be getting with them now. So... minister's priorities.

Resources are an issue as well. I'm the only person at the department who has a particular background in this area of psychology, psychotherapy, and I work closely with Ros Meade who is the head of non-medical regulation and she has her hands very full at the moment with the HPC and with the nursing groups, we're also amending the statutes concerning them. So that's another reason why this isn't going to happen fast.

And as I say we need agreement on those things.

There are a number of possible structures though that we might be thinking about in due course and one is these are based on what is there in the HPC right now We could be looking at a small strategic council that's set out broad principles for the talking therapies, maybe something, a council that would register psychologists, counsellors and psychotherapists, or perhaps for some of the groups we could be looking to the Health Professions Council in due course... there might be some groups that would want to attach themselves to the cluster being regulated/registered through the HPC.

I'm absolutely neutral about this personally, as long as those other conditions are met and everybody knows what they are doing and is clear, I think you design the vehicle that's going to get you where everyone wants to go. There's no drive to take you in one direction rather than another in terms of the structure.

What is clear is that whatever the structure, whether it's a structure that connects counselling psychotherapy, psychology, it would have statutory committees for the common ground. So it would have a statutory committee on education, conduct, health and fitness to practice. Those are the standard ones that you always have.

You then have separate uni-professional or uni-modality advisory committees for specific issues
Let's say... I mean... that you favoured something like Lord Alderdice proposed at the 11th hour when he proposed his Private Member's Bill to register psychotherapists back in the last parliamentary session. He identified 8 different areas within which it would be possible to register as a psychotherapist. I call them areas because in fact it was a mixture of modalities and settings. So that for instance... I don't have the list in my head... but there was a child and family section and a there was systemic child and family section and I thought, well if you were a systemic therapist offering work to adults, where would you go? And there was a psychoanalytic section proposed which upset the Kleinian analysts who didn't feel that they should be in the same group as the Freudian analysts....

end of tape side one
 begin side two 

.......You do have these statutory committees for the common ground and that's what they there for. But you know arguably you might want to have separate groups for some things... but that's up for debate.

You then have, well within the HPC anyway... these hearings panels for uni-professional and uni-modality input, so that where a group comes along and says look we're different from them for the following reasons... you have these thing built into the structures to make it possible for them to be heard, which is a protection for those rather, perhaps more esoteric groups, or groups who are very thin in number.

So if you want to take thinking about this further forward, then you certainly should have a look at the HPC, its on the web... but I actually think to be honest you'd be much better, instead of doing that to forget the structures actually, your time is much better spent talking and communicating with each other and talking and communicating with the various other professional bodies in this field. And professional organisations who do different things for their members, some of them are more union-like, some of them are more like publishers, some of them are more like proper professional bodies. I mean there is a spread. But your time is well spent talking to those groups to get a sense of where they are coming from and to get a sense of what the common ground is and to see if the profession, as profession I believe it to be, can move forward on these important matters... say of public protection... that's what really counts

This is what we have to resolve later.
What type of council?
Which professions? 
Which modalities? 
Which trainings? 
I've said all this... these are all the things to be talking about before you even start thinking about the law, let's look at what at what the people actually feel they want....

[request to read the list on the slide]

Issues to resolve
What type of council?
Which professions should included? You'll be familiar about the debate that there was at the time about hypno-psychotherapists or hypnotherapists. Some people believe that hypno-psychotherapy isn't a distinct professional group. They believe instead, that hypnotic techniques might be used as an adjunct to psychological therapy, to a talking therapy but it's not something that is a stand-alone approach. There are a mixture of views about that. Some people wouldn't want to be registered alongside hypno-therapists anyway. And that's a factor, it's which people would you be happy to be in a room with.
 
That poses, prompts the question... of which modalities... or should it be settings rather than modalities? 

Well who knows?

The question about training standards, which is perhaps the most important one... and a metaphor that I've sometimes used in talking about this which might ring bells for those of you that are interested in bird watching. 

I think this is a bit like speciation in birds. You know when you are trying to... if you don't know anything about birds at all and you see these things flying around a bit like you see a psychotherapist... oh there goes one... that's a bird... If you are an expert you don't see a bird you see a finch, or a sparrow or a pigeon, and what you know about the finch and the sparrow and the pigeon is that they don't sing the same songs, they don't mate, they don't speak to each other, they don't live in the same areas, and they certainly don't live together. So that's what psychotherapy is like, you have these rather different species, despite the fact that actually some flying lessons wouldn't be a bad idea for some. I mean maybe I'm extending the metaphor beyond it's appropriateness but ...it's a question of deciding where you draw the line before you get into the really difficult bits of differentiating between the groups.

Accreditation criteria 
Well that's an issue to resolve. That's basically about who should be on the register and how do you decide what methods to use to accredit the training courses that do exist because there are a great many out there. You only have to look in the back of Time Out or any newspaper and you'll find courses offering therapy training... which at the moment it's possible at the moment for anybody to take, and then anybody can call himself or herself a therapist, a psychotherapist and offer services to the public. And that is essentially what this is all about it's all about...trying to do something about that.

Codes of conduct well there would be agreement I think that we could all reach about... common codes of conduct.

Discipline and appeals procedures. Well that has to be resolved. What should happen when someone has a complaint.

Fitness to practice now this is an important one ...because we are not exempt from psychological problems ourselves, we're not exempt from mental ill-health ourselves. None of us I suspect as a psychotherapist or as a therapist of any kind would argue that it's appropriate to be delivering practice if you yourself aren't functioning as you should be. Either if you are physically ill, or if you are mentally ill. It's normal to stop working if you are physically ill, how normal is it to stop working if you are feeling anxious, stressed, depressed? Should you be counseling people going through a divorce if that's what just happened to you? Maybe it makes you better at it. That's an open question... 

...There are moments when it’s appropriate to ask a question about whether someone is fit to practice. And if that's the case and they are not fit to practice then action needs to be taken. And not just maybe to remove somebody from the register, or to desist from practice for a bit, but a mature profession will actually look to support it's members in such a way that that's not the end of the story... you know... that that would lead to a period say of re-training, or treatment, or help and support and supervision, or whatever was appropriate for that person, so that they could re-enter the profession if that's what was appropriate. Or not, if it wasn't.

And that's really what CPD, continuing professional development and re-validation is also all about because it is about ensuring that people... because I don't know if its true that most mistakes, that many mistakes that happen in psychotherapy practice happen not because of ill will perhaps, though some mistakes get made for that reason... mistakes get made because people don't have good enough training... or because they've not... or an issue has not been highlighted for them. Therefore a mature profession does something to make sure that those issues are made clear to people.

Let's move on.

What would success look like?
I do think it's a long way away (and I'm nearly finished so now please be reassured...)
It would mean clearer identities for the talking therapists. I think it would mean a clearer distinction than perhaps exists now between the use of therapeutic technique and the professional practice. Or use of that technique in the service of the public, or in a job. So I'm not saying that we are, or should be, in the business of registering people who deliver counseling skills. If I go to my GP I expect my GP to be a good communicator. I expect him or her to be able to use effective communication skills in relating to me. That is not the same as being a counsellor. If I go to a priest, I expect him, I guess it would be a him, if its a priest, certainly given my background it would be. I would expect someone with that background to have effective communication skills. The delivery of their practice might well be helped if they had done a counselling course. No problem. They still wouldn't register as a counsellor, and we wouldn't be interested in regulating their practice as counsellors or as psychotherapists because they are not calling themselves counsellors, or psychotherapists... they are delivering something else. A GP is delivering medicine and so on.

So it would make it clear...that there was a distinction between the professional offering of therapy and the use of those skills.

It would mean better professional support for practitioners, because at the moment, certainly within the NHS, there isn't clarity about what people are entitled to by way of CPD. It's not accepted that all people need supervision and support at some time. But if we could be clearer about what that meant for psychotherapists we would have a much better chance of getting it.

It would mean wider acceptance of codes of conduct, of standards for training, and wider acceptance of what was ethical practice.

It would mean a stronger partnership for those people who were employed within the NHS to manage poor performance and again it might not be so interesting to you this, if you work mostly in the independent sector, but at the moment if someone is guilty of poor professional practice... and let's use a psychologist as an example, where there is a single national body, if they get struck off the register, albeit the voluntary register, there's no automatic feedback loop to their employer. So the employer wouldn't necessarily know that that had happened. And apart from entry to a job as a psychologist in the NHS where you have to eligible for registration... you don't have to register... so there's no ongoing check. Now within medicine that does happen... you know, if somebody is struck of the register it's automatic, it has an impact on their employment but that's not how it is for us. So there would be a closer connection. There would be early identification of problems. It would help if you had those structures to identify problems where they occur and to act on them. It would mean obviously that complaints from members of the public could be handled much more quickly because there'd be a clear structure for doing it and systems in place that were funded... to do this.

Just as an aside here, some of you may know osteopaths or the general osteopathic council that was actually set up by a private members bill some years ago was an example of an approach that was a sort of stand-alone approach, they took a Private Members Bill just for osteopaths, which contrasts with the approach which is more federal for the professions under the HPC. The costs to osteopaths of registering are really high. I think they are in the region of £7-900 a year. Quite a lot of money. Taking this approach is cheap. Because it is supported by government. It's.... a system that... the more you have in the group, the lower the costs are kept.

You get more objective performance assessment because you have systems in place, as I said for supervision and support and CPD and so on, you can target your CPD more appropriately.
Ok, so that's pretty much what in due course success might look like. 

I'll leave a reading list with you so that you can.... circulate it...

OK now that is it.
list of web resources.

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