IPNOSIS: a journal for the Independent Practitioners Network

Health Care and Associated Professions (Miscellaneous Amendments) No 2 Order 2008

A Paper for Consultation
Closing date 24th March 2008

Recipes for Ethical Bankruptcy? #1#2
Regulating the 'Regulator'
IPNOSIS EDITORIAL

On December 21st The Department of Health posted details of a 'Consultation' on an untidy variety of proposals that range from re-fitting the HPC and tidying dentistry and pharmacology, to taking psychologists into Health Professions Council custody¹.

eIpnosis sieved the DoH Consultation for details of the chartered psychologists capitulation to the embrace of the state, with gleanings which you can find here. We then realised that the changes to the HPC outlined in the Consultation document were generically more important than who was going to be first to sup from the poisoned chalice of SR (after all the BPS asked for it!).

The ethically challenged professions of yesteryear have conjured a genii out of the DoH bottle that is a recipe for ethical bankruptcy. The evidence?

Let's start at the end of the Consultation. When eIpnosis looked closely at the draft legislation text, we found that 'he' is required to act or comply 13 times and 'his' interests or concerns are addressed 95 times 'Her' Majesty and 'Her' Privy Council appear twice and 'she', female practitioners, doesn't appear at all. This despite the likelihood that the gender balance in the 'professions' being regulated is if anything weighted towards women.

And this is the legal instrument for defining ethical standards and competencies that will protect the public?

No doubt people will say 'don't get so excited, legislation has traditionally been written in this way'. Oh yes, but this is psychological therapy not cement manufacture. How for example, would the 800+ BPS counselling psychologists respond to a client who is being bullied by her male boss at work? Would they say, 'don't get so excited, men traditionally behave this way?

Ethical bankruptcy.

When we turn to the Consultation document in paragraph 6.2. there is the claim that the:

'main purpose of statutory regulation is to protect the health, safety and well-being of people using or needing the services of registered professionals. ...one of the reasons for statutory regulation is to ensure proper standards that are necessary for the safe and effective practice of a particular profession.

We see the assertion but what about the delivery? For a taste of ethical bankruptcy in action, what clients actually experience as a result of HPC civic accountability, see Health Professions Council Special #3

However, as though responding to the evidence in that report, the ethical deficiencies of the HPC are recognised in para 6.5

'it is intended to emphasise its importance as the main focus of regulation and to steer it further towards public interest overriding that of registrants'.

But nothing in the consultation text promises to deal with the iatrogenic harm the HPC constitution propogates. For example through a paper-based appeal-free complaint system overwhelming likely to alienate vunerable, distressed clients. Again, see Health Professions Council Special #3

The HPC seeks to deny it, but as an institution it acts from a very technocratic version of the medical model of human functioning. Perhaps out of awareness of this, the authors felt that they had better do a bit of window dressing. How about 'well-being', paragraph 6.6? Wouldn't that be a promising prospect for re-branding?

'Including "well-being" of the public in this objective, which the HPC has always had [...] is a reflection of the change in focus of health care generally from cure to prevention and health promotion.

To convince us of the authenticity of this paradigm shift and, if emphasis were needed, to further underline the deeply compromised ethical quality of the civic accountability that the HPC exists to deliver, councils will generally:

'have, as a minimum, parity of membership between lay and professional members, to ensure that purely professional concerns are not thought to dominate their work' (eIpnosis emphasis)

If the civic accountability that HPC provides was adequate, why would this be an issue? Why would the public need to be protected from practitioner bias, ie from regulated practitioners? Or would there be un-regulated practitioners on the Council?

There is more, and note here the use of the word 'independently':

To dispel the perception that Councils are overly sympathetic to the professionals they regulate, council members will be independently appointed;

The problem as eIpnosis sees it is not that the rubber-stamp, blame-absorption role of council members is problematic but that the constitution of the HPC is hopelessly biased. It discriminates against people of disability, people who are poor, inarticulate, who don't use the internet, or who have difficulty writing letters. Again see Health Professions Council Special #3

But we must move on. As time passes, and pigs are seen to fly, the 'independent' appointments arrangements (on which, more below) will no doubt ensure that there is no drift towards reinforcing government control of the psychological therapies.

But in fact there was no need for us to hold our breath, no need to wait to see how this 'independence' will play out. Amendments in the draft Order:

will allow the Privy Council to provide by Order for the numbers of lay and registrant members on the Health Professions Council, their terms of office, arrangements for appointing a chair, and provisions with respect to the suspension or removal of members.

And if this were not enough, further on, paragraph 6.42. there is the announcement that:

In future, all members of the Council will be appointed by the Privy Council (in practice, through Directions by the Appointments Commission)².

And if this were not enough #2.

Presently there are elections for 13 members of the HPC. Elections are held each year for 1 quarter of the registrant members. In line with their total confidence in the value of the HPC's 'fitness to practise' style civic accountability of its practitioners, in future, paragraph 6.49:

Amendments elsewhere in this order will change this system so that all members of the Council are appointed by the Privy Council, thus removing the need for registrant members to be elected.

The consultation document lays out the future evolution of regulation of the psychological therapies with admirable clarity.

As might be expected, this elegant work of alienated, intellectual grandeur evokes the subjectivity it denies. It is a document that stirs in eIpnosis feelings of sadness bordering on disgust. An echo of existing deep sadness that the psychological therapies could be so unaware of the political dimensions of psychopractice as to fail to notice that the embrace of the state will be toxic.

That these experts on the human condition could so entranced by such obvious hypnotic inductions as: state regulation will 'protect the public' and that: state regulation was 'inevitable', will entail tragic consequences. Look out for very constricted practice boundaries, congealed creativity, soul-death, and continuing iatrogenia.

The people in the eIpnosis report Health Professions Council Special #3 experienced HPC state regulation not as protection or caring but as harmful.