All I have is a voice to undo the folded lie.
W.H. Auden

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

A Paper for Consultation
Closing date 24th March 2008

Pending production of a detailed review, eIpnosis has highlighted a few of what we regard as generically relevant elements of the government proposals. Be sure to also read Recipes for Ethical Bankruptcy Part #1 which has details of the changes to the constitution of the HPC

3. Statutory Regulation of Practitioner Psychologists²

Introduction

3.1. The Government has made known its intention of bringing those psychologists who provide psychological interventions to the public into statutory regulation since 2001. The reason for this is to set statutory standards of practice, training and conduct to ensure safe and effective practice, and to operate a statutory fitness to practise system to investigate and deal with cases of alleged impaired fitness to practise. This is so that the public can be confident that those practising in this profession and offering such services to the public are all competent and fit to do so. The proposal is that these psychologists should be regulated by the Health Professions Council, using the regulatory framework set out in the Health Professions Order 2001. (Health Professions Order 2001, SI 2002 No 254)

Definition

3.2. Those psychologists to be regulated means persons who as practitioners: use psychological expertise to offer services in advising, counselling, assessing* or intervening with* individuals, groups or organisations for the purposes of promoting, sustaining or improving their or others' psychological health, well-being or functioning, or who are wholly or mainly engaged in teaching at postgraduate level or managing persons who use or are seeking to acquire such expertise; and have expertise in one or more of the following domains of psychology: clinical psychology, counselling psychology, educational psychology, forensic psychology, health psychology, occupational psychology, or sport and exercise psychology. A full explanation of each domain is given at Annex A.

* The terms 'assessing' and 'intervening with' have been used to accommodate chiefly occupational psychologists, whose area of work is furthest removed from work with individual clients. Most of the other domains would fit a definition which replaced these terms with 'diagnosing and treating', which would more clearly exclude non-practitioners such as academic psychologists from the definition.

3.3. For the purposes of this consultation document the psychologists defined above, whom it is intended to regulate by means of the attached Order, are termed practitioner psychologists. This will not be a protected title but is used purely for ease of reference in this document.

Q1. Do you agree that practitioner psychologists should be statutorily regulated?

3.4. We do not propose that statutory regulation should cover teachers of psychology in schools or on undergraduate courses, nor all teachers on postgraduate programmes, or academic, research, or experimental psychologists (some of whom call themselves applied) who work exclusively in the furtherance of psychological knowledge. They do not offer psychological services as defined in 3.2 above. Some may collaborate with practitioner psychologists to teach on postgraduate courses or to carry out joint research which will inform and develop psychological practice delivered by practitioner psychologists and others, but they do not need to be statutorily regulated as practitioner psychologists in order to protect the public for the work they do. Instead, we consider that the standards they need to meet for that purpose relate to teaching or to ethical research. The only teachers whom we propose should be regulated are those teaching on postgraduate courses who move into such teaching from a practitioner background and who are instrumental in teaching others to become practitioners.

3.5. Similarly, the only managers we propose should be regulated by means of this Order are those practitioner psychologist managers who have moved into psychologist management from a practitioner background, and whose role requires them to have practitioner competence.

3.6. Any academic psychologists who do work additionally as practitioner psychologists will need to meet appropriate standards of proficiency and be regulated as practitioners.

Q2. Do you agree that psychologists and teachers working exclusively in the furtherance of psychological knowledge should not be statutorily regulated as practitioner psychologists?

3.7. We also do not propose to regulate by means of this Order other people engaged in delivering psychological therapies, such as psychotherapists, counsellors, associate psychologists and other roles in mental health. However, we will publish proposals in a future Order to bring them into statutory regulation, when standards of competence and training appropriate for their practice have been agreed.

Q3. Do you agree that others who deliver psychological therapies should not be dealt with in this Order but should be statutorily regulated in a future Order when standards appropriate to their roles have been agreed?

Background

3.8. In 2001, the Government declared its intention of bringing applied psychologists (those fitting the description in 3.2) into statutory regulation using the vehicle of the Health Act 1999. In 2002 the then Health Minister and the British Psychological Society made a joint public statement at the BPS's AGM that regulation would be via the Health Professions Council. From 2003, BPS collaborated with the Department of Health to inform Government proposals for legislation, which were issued for consultation in Health Care and Associated Professions (Miscellaneous Amendments) No 2 Order 14 'Applied Psychology: Enhancing public protection: Proposals for the statutory regulation of applied psychologists' in March 2005.

3.9. The result of the consultation was 55% against and 45% in support of the proposals, with disagreement focused on whether the Health Professions Council was suitable to regulate practitioners working outside healthcare settings, and whether it would have sufficient expertise to regulate a complex and highly qualified profession.

3.10. Talks between DH and BPS to examine BPS concerns took place in 2005. DH reviews of medical and non-medical regulation took place in 2005/6 (Good doctors, safer patients by the Chief Medical Officer for England, and The regulation of the non-medical health care professions by the Department of Health), were consulted on in 2006 and led to the publication of the Government's White Paper on regulation reform 'Trust, Assurance and Safety; The Regulation of health professionals in the 21st Century' in February 2007. A report on the consultation of the medical and non-medical review including an analysis of responses was published with the White Paper.

3.11. These reviews and consultation led to further dialogue between DH and BPS and other professional bodies and organisations representing both psychologists and others working in psychological therapies. A number of professional groups put forward alternative proposals for a Psychological Professions Council, but these were rejected by DH because they failed to meet some of the basic requirements for modern statutory regulation arising out of the reviews and the White Paper. The proposals in this document have taken account of further discussions with the BPS and others from the psychology profession, whilst adhering to the basic principles set out in the White Paper.

3.12. BPS has also been encouraged to engage directly with HPC to work through their concerns.

3.13. BPS and DH have considered four basic principles to apply to statutory regulation of psychologists providing psychological interventions to the public, listed below. DH and BPS are in broad agreement with the first three principles. The fourth principle reflects the Government's position based on statutory requirements. We are aware that BPS would prefer a single protected title, but we are concerned that it could lead to a significant reduction in current standards of practice, depending on the standards adopted, and would therefore reduce public protection. We think it is helpful to consider statutory regulation against these four principles and are grateful to the BPS for suggesting that we do so.

The four principles underpinning statutory regulation

1. All psychologists should be statutorily regulated who need to be, and no psychologist should be regulated who does not need to be.
2. There should be no reduction in protection of the public arising from the transition from voluntary regulation to statutory regulation.
3. There should be no reduction in standards of training arising from the transition from voluntary regulation to statutory regulation.
4. Titles restricted by law to registrants must reflect the competences required for safe and effective practice by registrants. These should be kept to a minimum to avoid confusion, but need to differentiate between practitioners who need different competences.

DISCUSSION OF THE FOUR PRINCIPLES

Definition of those psychologists to be regulated

3.14. Our definition in the whole of the two bullet points of paragraph 3.2 above is designed to capture those psychologists whom we think should be regulated and to leave out those whom we think should not. This means that all BPS Chartered Psychologists with practising certificates and an adjectival Divisional title will be automatically transferred to the HPC registered psychologist register on the day that it opens, unless there are outstanding fitness to practise proceedings relating to them.

3.15. The Association of Educational Psychologists keeps a membership list of educational psychologists with the same approved qualifications as BPS Chartered Educational Psychologists, supported by a Code of Practice and disciplinary and appeal procedures. Depending on the overall provision of their system it may be appropriate to transfer automatically those of their members who will meet HPC registration requirements. If automatic transfer is not possible there should be some scope for reducing the grandparenting scrutiny of AEP educational psychologists with approved qualifications.

3.16. During previous consultations concerns were expressed by some domains of practitioner psychologists that they should not be statutorily regulated by the Health Professions Council. The complaint was that the HPC was seen as operating a medical model of regulation with no understanding of a behavioural science approach, and no experience of regulating a profession working across many contexts and settings including those outside health and social care. We have taken note of this complaint but consider that the HPC does regulate many other professions with members who do not work in health or social care. These professions recognize however that the general principles underpinning HPC regulation apply to all their members and have accepted a versatile and inclusive system of regulation which combines comprehensive common processes and requirements where appropriate, and the flexibility of profession and domain specific requirements informed by the professions and domains themselves. The behavioural science approach is already used by some of HPC's regulated professions, although BPS assert that only practitioner psychologists are full behavioural scientists. HPC's ability to regulate such groups will be further enhanced by the acquisition of input from practitioner psychologists.

3.17. BPS itself has remained insistent that all domains of practitioner psychologists should be regulated together. The definition of practitioner psychologists is therefore drawn widely enough to include all the seven domains to whose members BPS currently give practising certificates, and must include all those who fit within the definition in 3.2. It goes without saying that if all practitioner psychologists are to be regulated together, a single regulator who can regulate across the whole range of contexts and settings in Health Care and Associated Professions (Miscellaneous Amendments) No 2 Order 16 which they practise, including health and social care as well as non-health settings, is needed.

3.18. Occupational psychologists, including business psychologists, have raised objections to being regulated by a regulator whom they feel has no apparent understanding of their scope of practice or the context in which they work. Similar concerns have been raised by some educational psychologists, expressed less as a point of principle than as a need for more understanding about how such regulation would work in practice.

3.19. The Government's view is that a case can be made that all seven domains fit within the definition for practitioner psychologists in 3.2, and, most importantly, should be statutorily regulated for the protection of the public to whom or on whose behalf they provide psychological services based on psychological need. There may however be a case for those who work primarily with organisations rather than with individuals or groups to be omitted from statutory regulation. If occupational and business psychologists were omitted, it would be possible to adjust the wording of the definition in 3.2 to make clearer the distinction between academic psychologists, whom we do not intend to regulate, and practitioner psychologists, whom we do.

Q4. Do you agree that all seven domains should be statutorily regulated by HPC? If not, which domains should not?

Q5. Do you agree with the descriptions of the seven domains in Annex A? If not, what alterations would you recommend?

Grandparenting proposals

3.20. BPS currently give practising certificates to some psychologists who are not registered within the seven domains covered by their Divisional accreditation, the Divisions corresponding to the seven domains. Some 1,600 would be eligible for Divisional accreditation, and if BPS identify and accredit them with the appropriate Division before the HPC register opens they would be automatically transferred to it.

3.21. Grandparenting is a transitional provision to allow competent current practitioners without approved qualifications, who would therefore not be eligible for automatic registration, to continue to practise where appropriate. There will be a proposed grandparenting period of three years to allow time for these practitioners to demonstrate that they meet the standards for registration, including undertaking any additional training which may be necessary. Once the grandparenting period is over the only route to registration and practice will be by meeting fully HPC registration standards for all UK and overseas-trained applicants, as specified in legislation such as the Health Professions Order as amended.

3.22. In addition, BPS currently give practising certificates to another 1,400 Chartered psychologists who do not fully meet the standards of any one of the Divisions. These include:

Psychologists who are Chartered by means of their academic training sometimes supplemented by supervised practice or experience, which does not meet the full range of competences required for one of the seven domains.
o Of these, some may offer advice as consultants in their academic areas of expertise. We propose that these should make clear that they are not qualified to offer services as a practitioner psychologist and if necessary either curtail their consultancy activities or undergo training to become competent to practise fully;

o others may offer a full psychological service as defined in 3.2 above but in their narrow area of academic expertise only. We propose that the latter group seek to achieve HPC registration under grandparenting.

Some, but not all, psychologists trained overseas in part only of a full domain of practising psychology. This includes some neuropsychologists whose training does not cover the full range of competences for a clinical or educational psychologist, which in the UK is the prerequisite for the post-registration neuropsychology training.

3.23. Our proposal is that all current BPS practising psychologists who do not meet the full range of competences for a Division and domain should be required to undergo assessment and if necessary training including a further period of supervised practice to meet HPC registration standards, during the proposed grandparenting period of three years after the HPC register is opened.

Q6: Do you agree that holders of BPS practising certificates who do not meet the full range of competences for one of the seven domains of psychology practice should be eligible for HPC registration and continuing practice only if they demonstrate they meet HPC standards for safe and effective practice, including undergoing additional training if necessary?

Standards and levels for protection of the public

3.24 In our proposals, statutory regulation requires the setting of standards of conduct, performance and ethics, and also of proficiency such as the regulator considers necessary for the safe and effective practice of psychology as defined above. This means that the regulator must set standards of competence and must approve education and training to deliver those competences, at a threshold level which delivers safe and effective practice by all registrants within that profession. Most will go on to develop additional specialist expertise after registration, but none should fall below it at the point of registration.

3.25 The regulator is not compelled to approve education and training only at the threshold level, but may approve courses and qualifications at a higher level. BPS have advised Health Care and Associated Professions (Miscellaneous Amendments) No 2 Order 18 us that the competencies required for entry onto the BPS voluntary register as a practising Chartered Psychologist have been benchmarked at level 12/Doctoral level. This level of education and training can be achieved either through a professional doctoral programme in a University or by undertaking the BPS's own qualifications. BPS have told us that these may supplement a Master's level qualification. Whichever route is taken and whatever the academic award title, BPS say that the level of competency required is equivalent and leads to Chartered status. BPS state that this is the level for all current BPS practitioners, although it is not clear to us and is disputed by some members of the profession that the level equates in all domains to Doctoral level. If there is a difference in the level of competence between different domains, it may be worth considering setting different threshold levels of qualification for different domains.

3.26 In our proposals, it will be for HPC to set standards of proficiency and standards of education and training, including the threshold level of qualification for entry to the register. They will do this only after full public consultation with all stakeholders, planned for November 2007 to January 2008.

3.27 Practitioner psychologists must all meet the standards required in one or more of the seven domains of psychology listed above. These are expected to require at least three years' undergraduate education in psychology accredited by the BPS for the Graduate Basis for Registration and three years' or equivalent postgraduate education and training in psychological practice. Only registrants who meet them will be allowed to register. Not being on the register will not, in itself, prevent someone from practising, but it will prevent him or her from using one of the protected titles associated with practitioner psychologists if they do. In time, we anticipate that, in particular, public bodies commissioning services from practitioner psychologists will only commission services from those who are registered.

3.28 Some business psychologists, who operate within the occupational psychologist domain, have raised the question of whether they should be required to have a first degree in psychology before undergoing postgraduate training, since some current practitioners undertake postgraduate education and training in business psychology following a first degree in a different discipline. If they were to continue to practise as occupational psychologists they would need to have their overall training, education and experience assessed against HPC standards of proficiency and might need additional training to achieve registration via grandparenting.

Q7. Do you agree that standards to protect the public should cover conduct, competences and education and training?

Q8. Do you agree that practitioner psychologists should need to have at least three years' undergraduate education in psychology accredited by the BPS for the Graduate Basis for Registration plus three years or equivalent postgraduate education and training?

3.29 There will be an opportunity in a future Order to regulate others working in psychology with different patterns and levels of training, such as psychology graduates with a one-year post graduate training. These will not have the same competencies as full clinical psychologists. The clear distinction between the two levels of education, training and practice for these two different roles (the first with three years' or equivalent postgraduate education and training in psychological practice, and the second with one year's postgraduate education and training in psychological practice) will be maintained.

3.30 Standards of proficiency will be set by the Health Professions Council. In developing them, they are working with members of the profession of practitioner psychologists and members of the public to ensure that standards are necessary; adequate; and comprehensive. The starting point for development of the HPC standards is the standard currently used by practitioner psychologists. The standards will include specific competences for practice in different domains where necessary as well as generic competences required for safe practice by all practitioner psychologists. The generic standards of proficiency for all HPC registrants will also be included, and there will be scope to consider modifying these to accommodate practitioner psychologists' practice and the contexts in which they work, while ensuring that relevant standards for all registrants are preserved.

3.31 Statutory regulation will increase the protection of the public by bringing into regulation those not adequately covered by voluntary regulation.

Q9. Do you agree that partnership working between HPC, the profession and the public is the right way to design standards of proficiency for this profession?

Education and training standards and accreditation

3.32 In our proposals, the standards of training for entry to the register must be set so that the standards of proficiency necessary for safe and effective practice are met.

3.33 Such standards must take account of matters such as the outcomes to be achieved by such education and training. They are therefore derived from competences rather than level of academic award. Standards must be applicable across the UK.

3.34 Standards of both proficiency and education and training are developed with input from members of the professions and are subject to full consultation before adoption. The regulator makes the final decision on standards.

3.35 Education quality assurance for both pre- and post-registration education and training including Continuing Professional Development is the responsibility of the regulator who has the non-delegable duty of both setting such standards and satisfying itself that they are met. In doing so, it may arrange with others, including members of the profession, to approve courses, qualifications and institutions in accordance with criteria which it must set. Pre-registration education and training means practitioner psychologist education and training only, that is, at postgraduate level. Undergraduate psychology programmes are not within the remit of the statutory regulator.

3.36 Academic quality assurance operated through the HEI system designed to ensure that academic programmes are fit for award will continue as now. This proposal relates to an additional requirement for the statutory regulator to operate quality assurance to ensure that vocational education and training programmes deliver fitness to practise. These systems will overlap to some extent and there will be scope for some co-operation to avoid unnecessary duplication of information provision on the universities concerned. 3.37 The Government has considered calls from many professional bodies from a number of professions for a statutory prescribed role for them to take part in professional education and training accreditation. While the Government acknowledges that professional expertise and input, amongst others, is essential for appropriate accreditation, its position is that it is not right to dictate to the statutory regulator how it should obtain this input, as this could hamper both its impartiality and its efficiency. The statutory regulator is required to take into account the views of a wide range of stakeholders in performing its functions. In the case of the Health Professions Council, its duty to co-operate will be amended so that it has the new standard duty of all health care regulators, which includes a duty to co-operate, in so far as it is appropriate and reasonably practicable, with bodies concerned with the education or training of registrants.

Q10. Do you agree that standards of proficiency, education and training should be derived from competences necessary for safe and effective practice?

Q11. Do you agree that the regulator should have discretion as to how it obtains professional expertise to carry out professional education accreditation?

Protected titles

3.38 The restriction of legally protected titles to those who are registered carries with it the possibility of criminal offences being committed, punishable by fines, if individuals:

Use a title they are not entitled to

Falsely represent themselves to be registered

Falsely claim to possess professional qualifications

3.39 A single protected title may not protect the public. Because titles are integrally linked to standards of competence necessary for safe and effective practice, a single title would need to be associated with competences that all registrants using the title could meet. Current standards used by BPS show that there are domain-specific competences in addition to generic practitioner psychologist competences which all can meet. If the domain-specific ones are lost, registrants in those domains may be allowed to meet lower standards than they do now, and public protection will be reduced.

3.40 BPS have proposed that the single title of 'Psychologist' or, failing that, 'Registered Psychologist' should be protected and should be linked to generic practitioner psychologist competences.

3.41 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. To protect the generic title "psychologist" means either setting standards too low to protect the public from poor performance by practitioner psychologists, since the practising competences would need to be left out so that research and academic psychologists, as well as others who can legitimately describe themselves as psychologists, could meet them. Alternatively, protection of this title would unfairly criminalise these groups if they tried to use a title to which they have historically been entitled but which has become associated with standards which they could not, and do not need to, meet.

3.42 In statutory regulation the term 'registered', for example in the expression 'registered psychologist', is not usually part of the protected title, as individuals would still be able to call themselves "psychologist", even if they are not a 'registered psychologist', without committing an offence. However in those professions where there is a need to distinguish between a specifically-competent set of practitioners and others in the profession without such competences, registration is limited to those with the competences and the term 'registered' is part of the protected title. In a health care context, the term 'registered' is currently only used for Registered Medical Practitioners and Registered Nurses, but would also be an appropriate descriptor for practitioner psychologists, particularly given the fact that the term 'chartered psychologist' already has common currency, which is in effect a description linked to voluntary registration. We recognise that this would be unique for a profession regulated by the Health Professions Council, but it would meet the particular circumstances of this one profession. The protected titles of the other professions regulated by HPC will remain unchanged by this proposal.

3.43 The Government's proposal is therefore to use the term 'registered psychologist' as the name of the part of the HPC register to refer to all registered psychologists within the different domains. However, the protected titles will reflect the competences needed for safe and effective practice in each practitioner psychologist domain. The protected titles will be:

Clinical psychologist

Counselling psychologist

Educational psychologist and child psychologist

Forensic psychologist

Health psychologist

Occupational psychologist

Sport and exercise psychologist

3.44 For educational psychologists we propose to protect two commonly used titles which are recognised as interchangeable and relate to the same competences.

3.45 Depending on the outcome of the HPC consultation on standards of proficiency for practitioner psychologists mentioned in 3.26 above, it may be that agreement can be reached on sufficiently robust generic standards which include domain-specific competences as well as generic practitioner competences. If so it may be possible to protect the one title of 'registered psychologist' instead of, or as well as, the seven domain specific ones. Views on this are particularly sought.

3.46 It has been suggested that some academic, research or experimental psychologists whose theoretical expertise lies in one of these areas should be allowed to use the title appropriate to them from this list, without committing an offence in law. Our proposal includes an exemption to the offence of using a title to which there is no entitlement for such academic psychologists. They must not however claim to be registered or qualified for practice as a registered psychologist: to do so will remain offences. It has also been suggested however that the existence of such an exemption could cause confusion, since some non-practitioner psychologists would be continuing to use titles which denote practitioner competences. We would welcome views on whether or not this exemption should be provided.

Q12. Do you agree that some academic and research psychologists should be allowed to use protected titles without committing an offence, as long as they do not practise as in the definition in 3.2?

3.47 The title chosen for the current group of practitioner psychologists (those with 3 years' postgraduate training or equivalent) proposed for statutory regulation must not fetter legislators by excluding other groups of psychologists who may evolve in the future and require statutory regulation. One such group is associate psychologists whose role and one-year or equivalent postgraduate training is currently being developed.

Q13. Do you agree with the proposed protected titles? If not, what others would you suggest?

OPTIONS FOR THE REGULATION OF PRACTITIONER PSYCHOLOGISTS

3.48 During discussion of the present proposals, it was suggested that the Department of Health should provide a synopsis of the options appraisal it had previously carried out to consider the most suitable regulator for the profession. This was to instil confidence that the proposed regulator would be able to deliver against key principles underpinning the need for proper public protection.

3.49 Options had been identified and appraised by DH in the original consultation in 2005 and had again been considered as part of the review of non-medical regulation in 2006 and in the White Paper 'Trust, Assurance and Safety' published in 2007, and also in the Department's critique of the proposals from the psychological professions for a Psychological Professions Council. We are grateful for the time and care given by these bodies in putting forward their suggestions which we have taken into account in arriving at the proposals presented in this document.

3.50 DH has during this overall process appraised the following four options:

Voluntary regulation by BPS

Statutory regulation by BPS

Statutory regulation by HPC

Statutory regulation by a separate Psychology Professions Council.

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

A Paper for Consultation
Closing date 24th March 2008