Critique of proposal for a Psychological Professions Council submitted by nine professional bodies

Headline summary

The Government is unable to accept this proposal for the following broad reasons, which are expanded in detailed comments on each part of the proposal below. The proposal is judged to be:
•	Flawed in its understanding of regulatory processes
•	Internally inconsistent
•	Flawed in not consistently promoting public safety 
•	Based on largely unsubstantiated criticism of the Health Professions Council (HPC) system and a misunderstanding of the requirements of statutory regulation common to all regulated professions.

Background

1.	The Government is pleased to agree with the professional bodies submitting this proposal (henceforth referred to as the bodies) that there is no doubt about the need for nationally-recognised standards of practice, conduct and ethics and training for people offering psychological services to the general public. We agree also about the potential damage of psychology and psychological therapy badly done.

2.	The Government also agrees with the analysis of why previous proposals to regulate these professions have failed, including representation of vested interests, and enhancing the status of professional associations.  However the Government’s view is that elements of these flaws remain apparent in this proposal, as demonstrated below.

3.	The Government notes that the bodies regard the latest attempt to regulate as failing because it attempted to fit a diverse field into a pre-existing template. The Government’s view however is that the template’s confines are restricted to those common elements of statutory regulation which apply to all regulated professions regardless of their conceptual model or scope of practice, and that the flexibility required by a diversity of professions is in fact provided for in the Government’s proposed route of regulation by HPC.

4.	The Government notes with concern that despite offers of discussions with HPC to explore their system to understand how it might apply satisfactorily to the psychological professions, the bodies have not recently been willing to engage in this examination of the HPC system.

5.	All following references are to paragraph numbers in the bodies’ proposal. 

Section One 

1.3	The bodies state that due to these professions’ psychological knowledge base, a single specialist regulatory body is the only appropriate means.  No justification is given for this.  Given the history of failure to agree roles, competencies, standards, and interface between these professions, a single specialist regulator could be inappropriate because it could establish a system of roles and standards based on professional vested interests, not on service users' and providers' needs. This would not serve the public interest.

1.6	It is unclear to the Government why the bodies claim that regulation of these professions would represent a qualitative shift into a behavioural science approach for HPC.  This claim disregards 

	(a) that HPC system works well for arts therapists and other professions who deliver psychological therapy, already using a behavioural science approach

(b) that many HPC professions, and accordingly many of its registrants, do not work in health contexts entirely.  Many HPC registrants work in schools, prisons, industry and in private practice, like members of psychological professions. 

HPC’s experience in regulating professions working both in a behavioural science context and in non-health contexts renders this a spurious argument.  This has been pointed out to the bodies over some time but has never been acknowledged by them. Until the bodies are prepared to enter into discussions with HPC on these points there will be no possibility of determining whether there is any issue of detailed adjustment necessary or practicable to provide appropriate regulation of these professions by HPC.

1.8	The Government agrees with the bodies about the need for statutory regulation for these groups. There is no doubt that applied or practising psychologists, psychotherapists, and counsellors meet criteria based on risk and potential harm which indicate their need for statutory regulation. The Government has named them as priority groups for statutory regulation in Chapter 7 of the White Paper ‘Trust, Assurance and Safety’.
 
The proposal splits the regulator’s function of registration, linked only to professional misconduct, from 'proper training and qualification', which elsewhere in the proposal (1.14) is allocated to professional bodies to decide.  This apparently overlooks the fact that being fit to practise is an issue both as a requirement for registration and post-registration – and encompasses much more than simply issues of misconduct. Lack of competence is also, of course, a critical aspect of fitness to practise – which necessarily links into levels of training. The bodies appear to have confused the differing functions of professional leadership and statutory regulation, which is the point being made by Foster. The core functions of a statutory regulator are to decide who goes onto the register and who stays on the register: professional leadership is about other issues, including developing the future scope of practice. That leadership role is different from the role of the statutory regulator.  

1.9	The proposal lists the five key principles established by the Government’s Better Regulation Executive of proportionality, accountability, consistency, transparency, and targeting and then states without explanation in 1.11 that regulation by HPC will not meet these principles to a sufficient standard to protect the public. 

Concerns about HPC

1.12	The proposal repeats the following concerns:
	a1)	The psychological professions are predominantly non health-related so should not be regulated by a Health Professions Council. However most of the current HPC professions work in the same non-health settings as psychological professionals.  The Government recognises the bodies’ concern but consider this is misconceived, since HPC is already regulating registrants working in the same non-health settings as psychological professionals, and must already therefore show both awareness of and ability to deal with the issues raised by practice in different non-health contexts.
 
	a2) Also many psychological professionals do work in health settings. The bodies’ persistent refusal to recognise this means that their proposal would establish a regulatory system for them that was as inappropriate for psychologists working in health settings as the bodies claim the HPC’s system is for those working in non-health settings. What is needed is a system which can regulate these professions wherever they work, as the HPC provides for its regulated professions. The Government is not confident that the PPC as proposed here could do that.  

a3) The bodies suggest sometimes that the PPC should include regulation of academics and researchers (1.12, 6.23) but at other times exclude these (2.8). This is an internal inconsistency which damages the proposal – see comments on 2.8. The Government’s position has always been that academics and researchers who do not offer psychological services to members of the public with psychological needs do not need statutory regulation. This would not be proportionate as the risk to individual service users entailed in their work is not great enough to justify regulation in this way and is sufficiently covered differently by the application of ethical standards relating to academic and research work.  The BPS current system does allow academics and researchers to be chartered (the BPS voluntary regulation system).  This opens up a loophole whereby those not trained and not necessarily competent to treat those with psychological needs appear eligible to do so and access activity statutorily restricted in order to protect the public from untrained practitioners. This is against the public interest.

	b)	The HPC would need to be sensitive to the subtle nuances between different kinds of psychological specialisms. In fact bringing in diverse and wide-ranging professional specialist expertise is a key feature of HPC’s system, allowing for an unlimited input from within the regulated professions to provide appropriate specialists to undertake fitness to practise procedures, education and training accreditation and individual registrant assessment. 

1.13     All the professions regulated by HPC are distinctive in their own way, and not all operate in a primarily medical context. It follows that HPC already has evolved mechanisms for ensuring that the specific contexts in which each of its regulated professions operate are taken fully into account. It does this by involving professional input from each of the regulated professions. It would do the same for psychological professions.   

1.14	The Government feels that the split here between the roles of the regulator and the professional body amount to a fundamental misunderstanding of statutory regulation. The regulator must set realistic standards of competence to reflect current practice as the basis for registration and as one benchmark for use in considering registrants’ fitness to practise. The professional body may develop aspirational standards as part of the professional leadership and development role, which may feed into revised regulatory standards as they become mainstream. It is not in the public interest for professional bodies to set standards which may be based on protecting professional status and commercial interests. These may be unnecessarily restrictive and may prevent the practice of some competent practitioners, leading to a restricted workforce and inadequate service provision.   

Chapter Two

2.5	The proposed categories of registrants are very widely drawn, including those who claim competence in the professions but are not necessarily practising. It is hard to see how they will meet registration requirements such as continuing professional development or securing indemnity insurance. There is an inherent internal inconsistency in a system which could require registration of people who cannot meet its requirements.  

2.7	The Government has made clear that it is not possible to restrict in law the title ‘Psychologist’ to one subset only of all those who legitimately claim and use that title. This proposal demonstrates no understanding that the protected title is linked to registration on the basis of meeting competence standards linked to that title.  To protect the generic title psychologist means either setting standards too low to protect public from poor performance by practising psychologists, since the practising competences would need to be left out so that research and academic psychologists could meet them. Alternatively, protection of this title would unfairly criminalise both the latter groups, if they tried to use a title associated with standards which they could not meet, and others who have a legitimate claim to the title “psychologist” because of their qualifications but who are not practising or engaged in academic work or research.

2.8	This paragraph compounds the problem exposed in relation to 2.7 above by excluding teachers and researchers from registration. This does not fit with the statement later in the proposal (6.23) that there will be an academic route to registration. This paragraph also misses the point that there may be some applied or practising psychologists who carry out research (and who teach and manage services) with and for those clients with psychological treatment needs. These are people whose careers in teaching, management and research may derive from and depend on their initial qualification as practising psychologists, including for instance some of those leading or teaching on postgraduate programmes aimed at training applied psychologists offering psychological services. They should be statutorily regulated since they need to meet competences for psychology practice relevant to their scope of practice in teaching, managing or researching for others in this practice. This is no different from other regulated professions. This appears to be presented as a continuation of the existing BPS system which allows academics untrained in practising  psychology access to work restricted to trained applied or practising psychologists, which may be to the detriment of the public.

2.9  This paragraph attempts to prevent the majority of psychologists from using the title which this proposal restricts to practising psychologists only. This problem will not arise if statutory regulation is restricted to applied or practising psychologists only, as the Government proposes.

	It is important however that agreement is reached by all members of the psychology profession on which titles denote the following roles:
•	Those psychologists with 3 years’ or equivalent postgraduate training in the practice of psychology who are competent to offer psychological services to persons or groups who need them (these will be statutorily regulated)
•	Those psychologists trained as above who move into research, teaching or management of such services (these will be statutorily regulated)
•	Those psychologists who work in research, experimental psychology or other academic psychology posts engaged in the furtherance of psychological knowledge, who do not offer psychological services to people or groups, but some may collaborate in research with or teach on applied or practising psychology training programmes led by those in category 2 above (these will not be statutorily regulated)
•	Those psychologists with one year or equivalent postgraduate training in offering psychological services to people  or groups (these will be statutorily regulated in due course when their role, scope of practice and training has been finalised). 

2.10	This  element of the proposal allows one offence, that of using a protected title unless registered. The HPC system includes other offences (falsely claiming registration, and falsely claiming possession of qualifications) which together provide a stronger framework for public protection than this proposal. 

2.12	The Government does not accept that the HPC Standards of Proficiency and Code of Conduct, Performance and Ethics could not be altered in order to address profession-specific requirements of the psychological professions: indeed this is part of HPC’s practice in admitting a new profession. For instance the term ‘professional’ could replace 'clinical' to make the Code relevant and necessary for occupational psychologists. The HPC has recently decided to make this change during its own review of standards. The inclusion of infection control has a wider importance for general health and should not be lightly dismissed for any professional practitioner. Also the additions and alterations for psychological professionals could be seen as less relevant for other professions, but these may be of sufficient overall value to enhance the Code for all. 

2.13, 14 & 15 The issue of how to protect the public from the performance of students while in training will be given wider consideration in the wake of the White Paper ‘Trust, Assurance and Safety’.  Registration may not be the only or most efficient way of achieving this aim. The HPC currently uses a system of accreditation of training providers which holds them responsible for the performance of their students. 
	
	The Government would in any case disagree with the use of the term ‘conditional registration’ in this context since that term applies to registrants subject to a fitness to practise conditions of practice order.

2.16	The Government does not accept the assumption made in this paragraph that the emerging roles described here will all necessarily be support workers. Different psychological roles will be qualified for different scopes of practice, some of which are likely to meet criteria for statutory regulation. It will be important to consider such roles in the wider workforce, service need and regulatory context and to treat them consistently with other new roles whether at support worker level or not.

2.19	The Government notes that the criteria for readiness for regulation put forward in this proposal mirror some of those developed by HPC, but with some potentially dangerous omissions relating to a voluntary register entailing commitments to continuing professional development and fitness to practise, and also relating to externally verified education and training. These omissions make the transfer to statutory regulation practically very difficult and seriously undermine public safety.

Chapter Three

3.6	The Government’s view is that this paragraph demonstrates a misunderstanding of the role and purpose of regulation. It does not give consideration of a public open appointment system. Government appointments would not be desirable for an independent body. There is little consideration of necessary or desirable qualities, skills, knowledge or experience for lay members, such as for instance those involved in education and training and service provision.  Representation of professions is not what is needed: registrant members should bring a professional perspective to the work or the regulator, rather than representing the profession’s interests, which belongs to the remit of the professional bodies. 

3.7 &3.8	The Government’s view is that appointment by public open competition of regulatory body members is the best way to ensure Council members who are fit for purpose and for this reason is preferable to electing registrant members. This is part of the change being brought in following ‘Trust, Assurance and Safety’, which will also alter the structure of the regulators.

3.9	This paragraph demonstrates a continuing misunderstanding on the part of the bodies of the way in which HPC operates. In the main profession-specific issues are not raised at Council level, since the Council itself is concerned with regulatory strategy and policy. Profession-specific issues are dealt with at lower, concrete functional levels in committees, mechanisms for approving education, assessing applicants for registration, fitness to practise procedures, and through professional liaison groups. These are the areas which need professional expert input, which HPC gets by the appointment of partners from within the regulated professions, although not necessarily from the professional bodies themselves to avoid any conflict of interest.

3.10	This paragraph demonstrates an outdated and inaccurate view of how HPC operates. As mentioned above it is not the Council itself which controls the design of curricula and professional standards of its professions, although it has the ultimate responsibility for consulting on and ratifying standards developed through its mechanisms described above. This approach used by HPC is very similar to that employed by the bodies in their voluntary systems, where these exist.

3.11	This paragraph appears to contradict the statement in paragraph 1.14 which allocates the setting of professional standards to the professional bodies. This is not acceptable for the reasons given in relation to 1.14 above.

3.12, 3.13 &3.15	The committee structure proposed has several potential shortcomings.  There appears to be a large professional majority with apparently a token lay member as Chair, drawn from the main Council. This will not instil public confidence in the impartiality of the regulator. The link between the Council and the committees is not very dissimilar from HPC in terms of the strategic function. It is however very dissimilar from modern regulatory practice in including casework undertaken by the committees. This appears to be outdated, potentially professionally protectionist and in contravention of good practice developed since the Human Rights Act to maintain a strict segregation between policy makers and casework adjudicators.
	
	The Government does not accept the statement in 3.15 that the bodies’ proposal would allow full representation on statutory committees of what is described as an appropriate level of professional input to all parts of the decision-making process, without making the committees very large, expensive and inefficient to operate, given the range of modalities, specialisms and roles within the professions. The HPC’s method of recruiting an unlimited pool of professional partners who act as required in specific functions reporting to the committees is efficient and effective.

Chapter Four

4.5	The Government cannot accept the concept of full registration for some classes of registrants and some unspecified lower level of registration for others, described as support workers. The applicability of generic standards supplemented by additional standards for some registrants but not others may be sensible to reflect different regulated roles, but this does not lead to different levels of regulation. This paragraph appears to confuse a career framework approach to career development with registration.  There must be standards for full registration for each regulated role within applied or practising psychology, including both those with one year’s and those with three years’ or equivalent postgraduate training. It may be the professional aspiration that all should reach the highest level of practice and training, but that view may not be shared by service users, service providers, education providers or commissioners, whose views must inform the decisions of the regulator.
The Government does not agree that standards of proficiency should be unduly linked to levels of academic award, rather that they should be competence-based reflecting the competences needed to perform the role safely and effectively. Setting award-based standards may serve the profession’s interest more than that of the public.
4.6	The Government does not accept the bodies’ proposal here about “conditional” registration, which appears to contradict the proposal in 2.15 which introduces it.  If the bodies see no need for standards for "conditional" registration (students), why register them, and in any case on what basis?  If, as the bodies state here, supervision during training does away with the need for standards, it also does away with the need - and basis - for registration.

4.8	The Government’s view is that the proportion between generic and specific standards attributed to HPC professions may not be accurate and would welcome HPC’s comments. However a comparison of the HPC standards with those contained in the Quality Assurance Agency’s benchmark statement for clinical psychology shows very considerable congruence between the two. A collaborative comparison between the bodies and HPC would be very helpful. The Department of Health asked the Presidential team at the British Psychological Society to look at specific standards to supplement generic ones for practising psychologists in November 2005. It is not clear whether this has been done.

4.9	The example given here to demonstrate the unsuitability of HPC generic standards is surprising. Reflection on clinical practice could be replaced by reflection on professional practice. The Government would not agree that reflective practice is itself unsuitable for psychological professions. 

4.10	Many of the HPC generic standards apply to all regulated professionals, not just those in health related fields, and will be missed if not included for psychological professions, leaving gaps in their professional standards which could reduce public safety.  Again it is simply wrong to claim that HPC professions work only in health.  The reference to different levels of registration here suggests the possibility that the bodies intend different academic levels as the basis for registration. This may be more relevant to protecting professional status than to protecting public safety, as discussed above in 4.5

4.11	The regulator must own the standards it sets and must take account not only of professional bodies’ views but also those of service providers, users and funders.  The Government sees the lack of recognition of all stakeholders’ views as a serious flaw in this proposal.  The bodies also support the use of National Occupational Standards or QAA benchmark statements as the basis for regulatory standards. This is what HPC use to inform their standards. In the Government’s view it would be helpful if the bodies recognised that and entered into collaboration with HPC to produce regulatory standards for their professions.
 
4.12	The Government is pleased to acknowledge the bodies’ recognition of the need for the regulator’s review of standards in conjunction with professional bodies, whose input here is welcomed, and also with service users and with other stakeholders, as described above.

Chapter Five

5.3	The Government agrees that consistent application of standards and of educational quality assurance, externally verified so as to provide objective assessment of consistency, is important for public protection. In its view this is best achieved by a single system operated by the regulator itself, since setting standards of practice and training is a core regulatory function that cannot be delegated. 

5.4	The Government notes the bodies’ recognition of the different aims of regulator and professional body.  The Government reiterates the point made in 1.14. It is important that standards are not set at a level to support professional development which may be higher than necessary for threshold registration standards, particularly if this is done to  protect the interests of a small, higher qualified subset within the profession. This could be against service user and delivery interests if it restricts the potential workforce unnecessarily.

5.5	(1) this is the HPC model
	(2) this is the previous CPSM and collapsed QAA model
	(3) This model is not preferred by Government. Educational and professional standard setting is a core regulatory function which cannot be delegated without risking inconsistent application and possible equal treatment infringement. While it is possible to engage with other bodies to assist for instance in information gathering to assist in quality assurance decision making, the delegation of the function entirely and the potential for delegatees to usurp or distort standard setting can cause problems. More than one statutory regulator has had difficulties with this model in the past and it is not one the Government would wish to replicate. 

5.6	This paragraph does not explain how the cost of educational accreditation would be met. Other partners might not be able to support the costs themselves so might claim costs from the regulator, in which case there would be no saving. The point has been made to the Department of Health that higher education institutions prefer a single approval system which reduces unnecessary burdens on them, and that if there is a regulator with the statutory duty to approve their programmes that is the preferred method.

5.8	This paragraph shows that the approval team seems disproportionally weighted in favour of professional members. Lay members with the perspective of other stakeholders such as service users and providers can also play a valuable part.

5.9	It is not clear that the current voluntary systems run by some of the bodies provide standardisation now. Ownership of the decision on applicable standards within the regulator, underpinned by robust and consistent QA, is what ensures proper standardisation of training and professional competence..

5.12	The Government understands that this paragraph does not reflect accurately the HPC system which does not limit professional membership of an approval team to one. The HPC system currently consists of approvals visits carried out by two members of the profession with appropriate experience plus a member of the executive, and visitors’ reports are further scrutinised by an education and training panel with both professional and lay membership.  However this proposal does not make a case to support having more than one professional member; it simply assumes that is worthwhile, without apparently considering benefits or costs.

5.13	This paragraph demonstrates an inaccurate misunderstanding of HPC’s current operation. HPC already sets and monitors postgraduate education and training standards for a number of its professions whose pre-registration training is at these levels. The Government has no concerns about HPC’s ability to assess such programmes. In doing this work it appoints partners from the regulated professions to draw on their expertise, and it will do this for the psychological professions also.

5.14	HPC does not engage in joint approval activities for the reasons given above in 5.5 and 5.6. The only approval necessary for programmes leading to registrable qualifications is that given by the regulator who has that statutory duty. Additional review visits by professional bodies may add to the burdens of training providers but are not strictly necessary once statutory regulation is in place. However HPC standards of education and training recognise the important role of professional bodies in often providing detailed guidance about curricula, which assists education providers in developing their curricula (see SET 4.2). This approach reduces the burdens on education providers because it is less prescriptive and supports innovation - the standards can be met in a variety of different ways. Operationally, HPC often share approvals visits with professional bodies and other regulators, where appropriate, thereby lessening the burden on education providers. Where there is a statutory regulator most professional bodies no longer accredit pre-registration training.

Chapter Six

6.4	The Government wishes to reinforce the point that the statutory regulator must own standards for entry to the register. It is necessary and important to consult all relevant stakeholders on them.  The Government also notes that the current voluntary system operated by some of the bodies does not necessarily set consistent standards, or can even demonstrate what standards are used as the basis for registration, since accreditation and registration is sometimes delegated to member organisations. This does not give confidence that this proposal would be able to deliver what is described here as desirable. The project which the Government has funded for Skills for Health to develop National Occupational Standards in psychological therapy, including psychotherapy and counselling, should help to identify different roles, competences and standards as a basis for registration in a statutory system. 

6.5	The HPC register is designed to differentiate between specialisms within a profession at the point of first registration, where this is necessary. It is important to recognise that statutory regulation of a profession requires registration of those who meet threshold standards at the point of first qualification. Post-registration specialist qualifications may also be recognised but should not be confused with initial registration.
 
6.7	It is unclear what the relevance is of setting guidance on timescales: whether this is time since qualifying in which a qualification remains current for registration, or time taken to qualify, and whether if the latter this has relevance to meeting competence standards.

6.8	This largely mirrors  the HPC process, and it is unclear what extra benefit this would provide.

6.9	The bodies provide no attempt to justify the benefit or additional expense of using at least five assessors for each applicant for registration.

6.11	The grandparenting process should focus on measuring the competences, not purely the experience and education and training, of applicants without approved training. Otherwise this proposal could prevent the practice of people who are competent. This would be against the public interest in unnecessarily restricting the entry to the workforce, and could also contravene applicants’ human rights.

6.13	This proposal appears to be potentially discriminatory by making no provision for part-timers. The usual provision is to recognise safe, effective and lawful practice for three out of the previous five years. The bodies do not explain or justify why they are seeking a longer period of practice as evidence of safe practice, and therefore a heavier than usual burden on applicants.
 
6.14	The bodies here dismiss the HPC system as providing a minimal level of scrutiny but they disregard the effect of the overall HPC system, including limited initial scope of practice, adherence to the code of conduct, and compulsory continuing professional development.   Also the bodies produce no evidence that the HPC system results in unfit registrants.  

6.18	It appears to the Government that the bodies are proposing that applicants for registration trained overseas are to be assessed against higher standards than those applied to UK trained practitioners. This appears unfair and in contravention of European law governing the assessment of EEA migrants wishing to work in other member states. The bodies give no justification as to why the HPC system, which assesses such migrants against threshold standards for UK new qualifiers, is seen to be not sufficiently robust. This higher requirement also seems at variance with the requirement proposed in paragraph 6.24.

6.19	In designating a competent authority the Government must be satisfied that it will comply with the requirements of relevant European Directives. The competent authority is usually the statutory regulator where one exists. It follows that the statutory regulator must also demonstrate its willingness and ability to comply with European law.

6.20	This paragraph appears to suggest that assessment of EEA migrants takes place through an adaptation period. The relevant EU Directive allows migrants to choose between an adaptation period or an aptitude test, but they must not be required to do both. 

6.21	The Government acknowledges that English language proficiency at IELTS Level 8 may be necessary for people working in the psychological professions because of their need to appreciation the nuances of communication and the expression of deep and complex feelings and experiences. However, it is a matter that requires further consideration and would be a matter for discussion with HPC, which does require IELTS Level 8 proficiency for one of its existing professions but for a different reason.

6.23	This paragraph creates a potentially dangerous loophole. The Government cannot allow registration of people with no practical training in a register designed to set standards for people delivering psychological services to those with psychological needs, requiring practical training in such work.  This paragraph appears to equate research and academic skills with practical skills.  The latter are essential for public protection so registering people without them is a serious flaw. This appears to stem from the confusion over different parts of the psychology profession noted in 1.12 above. It may be linked to concerns voiced by some members of the psychology profession that research psychologists need to be statutorily regulated in order to access research funding. This is a misunderstanding about the purpose of statutory regulation of those offering psychological services. It is not designed to apply to those engaged in the furtherance of psychological knowledge, for whom other safeguards through research ethics committee requirements are in place. Also this proposal contradicts paragraph 2.8, so is internally inconsistent. 

6.24	The system described here exactly mirrors that of the HPC, although it is unclear what other non-standard applicants there may be. But unlike in 6.18 the bodies here propose to use the standards for first entry to register of the UK newly qualified practitioner. 

6.25	The bodies here give no evidence at all as to why or how their proposal will be most thorough or robust.  The use of a higher number of assessors could result in fewer decisions in favour of applicants if it is harder for them to reach a consensus. This could reduce the number of recruits to the workforce, which might not be in the public interest.  The bodies do not show how their proposal would be fair, transparent and non-discriminatory.

6.26	The term conditional registration refers to those registrants with conditions attached to their practice following a fitness to practise process.  The bodies’ use of it in the context of registering students before they have reached the competences required for registration shows a misunderstanding of the full statutory process.

6.27	This paragraph appears to impose unrealistic expectations on the regulator. The statutory regulator has the duty to approve training arrangements including ensuring that training providers take responsibility for the quality of their students' practice during training under supervision, since trainers and supervisors are far better placed than the regulator to undertake ongoing and timely quality control of their students’ work. The training providers’  commitment to quality of training and supervision of students may diminish if they are not responsible for the quality of their students’ practice. The HPC has a duty to set standards of education and training which must be met by all training providers whom it approves to offer training leading to a registrable qualification. It appears from this paragraph that the bodies do not see this duty as an integral part of the role of the PPC.

6.28	The bodies do not attempt to justify their assertion that a time limit to the student process is beneficial. Nor do they demonstrate what steps they would take to avoid discrimination in applying the limit. 

6.29	Presumably 'completing' should read 'undertaking' in this paragraph since it is about registration of students during, not after, training. HPC does of course have conditional registration for those who complete training and become registered - if they need it following a fitness to practise procedure. Student registration may not be necessary if there are found to be more effective ways of achieving the same result of protecting the public against poorly performing students in training.  It is not clear what the basis of registration would be for admission to the student register - would it be practicable and not a disproportionate burden?  Further problems with student registration are identified below in 7.10.
			
Chapter Seven

7.6	The bodies here recommend one system of revalidation for all registrants but then contradict this in 7.10, by ruling out revalidation for students.

7.8	The requirement for health and character references could be disproportionate and different from what is required by other regulators, some of whom have tried and discontinued this practice.  The bodies do not make clear what they intend by their definition of evidence to demonstrate competence. HPC takes a wide range of employment contexts into account in setting CPD requirements for its existing professions, and takes account of CPD schemes operated by the professional bodies relating to those professions.

7.10	Arrangements for revalidation will be considered by working parties set up in the wake of the White Paper ‘Trust, Assurance and Safety’, and arrangements for members of the psychological professions will be expected to be consistent with those for other associated professions. An annual revalidation check may prove to be disproportionate and may not be good value for money. 

7.11	The Government would prefer to use distinct terms to distinguish between different reasons for coming off the register, relating to lapse in practice or striking off as a result of a fitness to practise procedure. This confusion of terms is repeated in 7.14.

7.15	The bodies do not offer an explanation of their assertion that the HPC system of CPD requirement is disappointing or inadequate. It is however the case that this was not intended to be a form of revalidation. The Government understands that HPC has recently decided to set up a working group to look at the issues around assuring continuing fitness to practise which will feed in to the work of the non-medical revalidation wirking group set up by the Government following the White Paper “Trust, Assurance and Safety”.

7.16	The bodies’ criticism of the HPC current system does not fully take account of HPC’s risk profile-based sampling and flexibility.

Chapter Eight

8.1	The Government does not accept the bodies’ assertion that the HPC fails to include sufficient profession specific input in fitness to practise procedures. This assertion shows either ignorance or misunderstanding of the HPC system which both the Department of Health and HPC have tried to dispel by offering the bodies accurate information on the way HPC operates.

8.3 	The Government points out that a code of conduct and ethics is not enough to  form the basis of a fitness to practise system, which must also include standards of competence, health and character. The regulator’s code of conduct complements these essential requirements but does not substitute for them. The Government sees this as a serious omission in this proposal.

8.8	Working parties set up in the wake of the White Paper ‘Trust, Assurance and Safety’ will consider local and national mechanisms for the investigation and adjudication of allegations of unfitness to practise and how to link these to local wider complaints procedures. These mechanisms will need to operate in a wide range of employment settings. It will be important that any system aimed at the psychological professions is consistent with whatever is developed for other associated professions.

8.10	This paragraph does not take account of the fact that many allegations may not involve profession-specific issues. It is not clear whether lay panellists are intended to engage on an equal basis with professional panellists.

8.11	The Government points out that HPC is not necessarily limited to one professional panellist member if there is a need for more, but the bodies’ assumption that more are needed – without an attempt at explanation or justification – disregards the fact that one may be enough in many cases where the allegation is not based on a profession-specific issue. The automatic inclusion of more members than are needed could result in a process which is over-slow, cautious, costly and burdensome.

8.13	The restriction of one professional panellist in adjudication hearings contradicts the need expressed by the bodies in 8.11 for more to take part in investigation hearings. It may similarly be the case in some complex cases hinging on profession-specific issues that one panel member may not be enough in the case of a specialism. The Government considers that a flexible system is likely to be most efficient and fair.

8.14	The issue of fitness to practise reform across all health professional regulators will be addressed in the wake of the White Paper ‘Trust, Assurance and Safety’. The Government wishes to point out however that the statistics regularly published by HPC about its fitness to practise operations do not bear out an allegation that there is a professional bias to their process, and indeed such an allegation is misleading. HPC panels consist of a chair, a registrant member from the profession concerned and a lay person. Panel chairs are recruited on merit, and are mostly lay, so the vast majority of cases panels have a lay majority. There can be no more than a registrant majority of one. Provisions for medical assessors, expert witnesses and for registered medical practitioners to join the panel mean that expertise can be added to a panel when necessary. 

8.15-16	The bodies’ proposal here mirrors the HPC system.

8.18	The bodies propose here a statutory committee with a lay majority, unlike the decision-making panels to hear the cases themselves.  It is unlikely that this split would instil public confidence in the impartiality of the system. There is no attempt proposed for mediation or consensual disposal to avoid cases reaching full hearings, and no specific links made with policy and training standards, which the Government finds a curious omission.

Chapter Nine

9.3	It is not clear if the proposal in this paragraph relates to the re-registration or restoration of former registrants, following a lapse or striking off the register as part of a fitness to practise process.  The proposal is not explicit about specified minimum competence requirements. The Government does not accept that applicants for re-registration should apply without being informed of the requirements they would need to meet.

9.5	This paragraph does not make clear who is responsible for the decision to re-register – the fitness to practise panel or the overseeing Board.  If the former has already set a conditions of practice order it would be unfair for the latter to set further conditions as well.  The involvement of a statutory Council in individual casework and in professional assessment interviews would contravene best practice in ensuring distance between policy setters and casework deciders. 

9.7	This paragraph appears to confuse the entry route for first registration with the scrutiny for re-registration following a period of de-registration, for which greater scrutiny may need to apply. It is possible that the HPC system may be enough proportionately, and that applied by some of the bodies in their voluntary systems too restrictive.

9.8	The Government points out that the flexibility of methods of demonstration and assessment which the bodies criticise is compliant with European legal requirements.  It is not clear that the system operated by some of the bodies at present is either consistent or legally compliant.

9.9	This paragraph perpetuates the confusion over terms already noted above.  Conditional registration in HPC means a fitness to practise sanction of requiring a registrant found unfit to practise to meet conditions which restrict his or her practice. It is not clear that the bodies  recognise the possibility of a wider range of sanctions than striking off, although 9.5 mentions conditions attached to registration.  The lack of a wide range of sanctions could make this proposal very restrictive and unfit for purpose.

Chapter Ten

10.3	The Government questions the need for a new code of ethics and conduct to be developed since there are many examples from both existing statutory regulators and from professional bodies. It is not clear why the bodies feel a need to include academics in the development of the code, since there is no intention to regulate academics who are already subject to ethics standards elsewhere. The Government draws the bodies’ attention to HPC’s current public consultation on a revised code of conduct, performance and ethics, produced following a revision exercise with the input and involvement of their  professional bodies. The Government understands that some of the bodies were involved in this exercise, and urges the bodies to respond to the formal consultation. 

10.4	It is unclear whether in this paragraph the bodies are confusing a variety of practice standards deriving from different modalities, or a variety of approaches to ethical issues such as confidentiality and consent, about which there will be a need for clarity as the basis for regulation.

10.5	The Government’s view is that the HPC code of conduct, performance and ethics goes further in some respects than those of the bodies’ own voluntary codes. It should be quite possible to consider both codes together instead of rejecting either one, since both could enhance a code applicable to practitioners in these professions and others. The HPC code sits above specific guidance produced by professional bodies and HPC panels can have reference to other standards and frameworks, such as Department of Health guidance on confidentiality in deciding whether HPC standards have been met.

10.7	The Government notes that much of the content of the European psychologists’ Meta Code reflects provisions within the HPC code and are entirely consistent with its principles. However there are some respects in which the Meta Code could usefully be expanded in the interests of public safety. For instance under competence there is the need to set the responsibility for registrants to keep within the limits of their own competence, not just function well within them. Also the Meta Code does not appear to set duties for registrants relating to health and conduct.

Chapter Eleven

11.4	The Government feels that it is not obvious within this proposal how the PPC is to function proportionately, consistently and transparently.

11.5	This paragraph again demonstrates a fundamental misunderstanding.  The statutory regulator must both set standards and apply them to police the profession. Being responsible for both activities is the best way of ensuring that it acts fairly, transparently and consistently.

11.6	This appears to mean cross-regulator work on common standards for multidisciplinary team members from different professions. The Government is expecting this issue to be explored in one of the working parties set up in the wake of the White Paper ‘Trust, Assurance and Safety’. There will need to be some clarification of how power would be shared across regulators responsible for regulating different professions using some of the same competences. This could be facilitated by use of the Skills for Health competence framework. 

11.7	This paragraph ignores the fact that the regulator of these professions will regulate some health care professionals - possibly the majority of its registrants will come into this category, counting psychotherapists and counsellors working in mental health.  Also the CHRE currently covers some non-health professionals, so this is a false distinction.

 Chapter Twelve

	The Government makes the general points that this proposal does not provide a fully costed analysis for the system described, which appears at several points outlined above to be expensive and disproportionate in terms of the benefits it may provide. 

12.2	The Government would be interesting to see figures to back up the bodies’ claim of 100,000 registrants in this field.

12.7	The Government suggests that 500 courses for approval seems to be an  underestimate.  In 2005 two of the bodies, BACP and UKCP, identified over 520 courses for psychotherapy and counselling alone.

12.9	This estimate of 15 full fitness to practise hearings per year seems likely to be an under-estimate. This operation could grow substantially once established.

12.10	The estimated cost and consequent registrant fee is set across a very wide range, with no workings to show the assumptions on which they are based, which does not give confidence in their validity. They could result in annual individual registrant’s fees of  £50-150, which could be double that of HPC.  How is this value for money?

12.11	The Government agrees that this is a very basic financial assessment. It appears  incomplete and is not a feasible basis for deciding the viability of the proposal.

Appendix B

	The Government notes that this comparison table contains some inaccuracies which present a misleading picture of the HPC system. For instance no mention is made of the HPC requirement that those struck off the register as unfit to practise may not apply for consideration for restoration to the register until five years have elapsed since their striking off.

Department of Health

25 July 2007