|Having read my recent book Regulating the Psychological Therapies 'from cover to cover' as he put it in a letter to the publisher, Marc Seale, CEO and Registrar of the Health Professions Council [HPC] invited me to come in for a meeting. As you can imagine this was not an opportunity to miss and I showed up with a couple of other books from the same dissenting tradition to give him, with the promise of two more that I didn't have to hand.
I'd wondered what the meeting would be about and voices had cautioned me to still my polemical tendencies, I anticipated that, with Marc having read 256 pages from me, it would be a time to listen to him. And so it proved.
Marc Seale [MS] and Rachel Tripp, Director of Policy and Standards, [RT] took me through a five point outline of HPC functions extracted from its Strategic Intent 2006-2009 document (p8). We discussed HPC priorities and its relations with other entities such as the Department of Health [DoH] and Skills for Health [SfH]
After this we moved on to discuss some of the imponderables of regulating psychopractice.
The mantra throughout was 'standards', the HPC universe rotates around the notion of 'standards' and the considerable consequences of failing to attain, or sustain them. To fill out this outline, I'll add a separate critical review of a three HPC documents that touch on what this means for anyone who chooses to register with the HPC.
A few headlines from our meeting:
HPC is not a quango, it really is independent of government. MS gave an example of a government attempt to persuade them to down-size certain standards to aid recruiting that the HPC had outright refused.
MS confirmed my impression that in signing up to the HPC, practitioners would enter a 'one-to-many-relationship' very like that we have with the Inland Revenue, with similar random 'controls' and legal sanctions for non-compliance.
The HPC has no professionals on its staff, i.e. everyone is from outside the occupations being regulated. They are not civil servants, and both MS and RT had been irked at being described as 'parasitical bureaucrats'. As the labyrinthine premises testified (much larger than the facade would suggest) regulation involves a lot of administration, with presently 180,000+ individual accounts. There are however 400 'partners', paid sub-contractors who advise and assist and serve as Panel chairs, Panel members, Registration assessors, and Visitors.
'The recent White Paper (Trust, Assurance and Safety - The Regulation of Health Professionals in the 21st Century) recommends that in the future, all Council members should be appointed rather than elected, we expect that in the future, our professional members will also be appointed by the Appointments Commission'. RT
HPC regulation appears to be entirely a paper based process, after signup there is no ongoing face-to-face contact. The DoH has apparently been making noises about eventual re-accreditation but this seemed to be a distant prospect.
HPC meetings are intended to be open and transparent; apparently anyone can attend council and disciplinary hearings.
MS and RT acknowledged the possibility of massive non-compliance with regulation of psychotherapy and counselling if and when it is introduced; a 20% take up would count as a major failure.
Regulation of psychopractice through the HPC requires considerable commitment to cooperation by stakeholders i.e. 'Regulation by the council is, to a large extent, dependent on participation by members of the regulated profession in a number of roles'. (Section 15 Application for Regulation of a New Profession
) The move towards appointed 'professionals' seems likely to reduce this burden.
When I raised the objection that I and others feel about the 'Health' Profession title and its implicit assumption of a medical model of human functioning, MS and RT smilingly groaned at yet another complaint about the 'medical model', as though it might indeed be an albatross around their regulatory necks. In a later email RT responded that:
'Regulation by us does not require a profession to commit to the medical model. Indeed, many of the professions we currently regulate would, I imagine, have very similar problems with the medical model to those of you and your colleagues.'
'Similarly, many of the individuals we currently regulate do not work in the NHS, and some of them indeed would not necessarily consider themselves to be 'health professionals'. Our registrants work in research, management, education, private practice, prisons, schools, industry, and any other environment where they may apply their professionals skills safely and effectively. '
Ros Mead's November 2005 Next Steps presentation appeared to outline a dependent chain of events with the DoH hiring SfH, and ENTO to, in my favoured phrase, map and measure, counselling and psychotherapy. Once their competencies and roles had been taxonomized they were supposed to be ready for capture by the HPC. This dependency does not now appear to run.
The HPC did not seem all that interested in, or convinced of the value of the SfH trawl of psychotherapeutic competencies and their analysis into roles. They may or may not adopt their 'standards' but are not obligated to do so. Indeed the HPC appears to be as independent of DoH perspectives on regulation as they are of government. An apparent consequence of this, is that the HPC could be open to out of the box suggestions about how to do psychopractice regulation, though I guess they would have to 'compatible' with the 2001 legislation.
Despite British Psychological Society objections to the HPC regime (they have apparently written to every MP saying so) Applied Psychologists are poised to enter the HPC system, 2008 was mentioned. Next on the horizonpsychopractice, with psychotherapy apparently in the HPC foreground, and counselling a more distant, and as it appeared, distinct and more problematic prospect. Neither MS nor RT mentioned psychoanalysis. And regulation of all three occupations looked to be a long way off, with 'ten years' hinted at in an aside, 'and' they joked, that personally 'we'd probably have moved on by then'. From this I picked up a sense of considerable and understandable trepidation on their part at what would be involved in bringing psychotherapy and counselling into regulation
If we leave aside for the moment the generic objections many of us have to the HPC model of regulation, MS and RT do see the HPC as intentionally seeking not to restrict psychopractice but to be a 'frame' within which whatever works is OK. While admitting SR will have a downside, HPC is clearly very concerned, that SR doesn't diminish or harm practice. Overall MS and RT gave as much emphasis to this point as they did to the centrality of 'standards'.
In a later email listing 'urban myths' about the HPC RT wrote:
'The way that we regulate professions can take account of a diverse profession, provided that standards are established by a process of consultation. A profession regulated by us may encompass different specialisms or modalities, different professional bodies, different theoretical approaches, or any combination of the above.'
'We set threshold standards for the practice of a profession, recognising that many if not most registrants will practise at a level above this. Likewise, we do not dictate the content of curricula for approved courses, beyond requiring that in order to be approved by us, a course must ensure that those who complete the course can meet our threshold standards for their professional skills and knowledge (the 'Standards of Proficiency' for the profession). Regulation doesn't therefore restrict the profession, and doesn't prevent individuals from developing new ways of practising, provided that they can do so safely and effectively.'
As someone from a technical, commercial background Marc Seale may have been astonished at the, albeit partial, history of the group dynamics of UK regulationism in Regulating the Psychological Therapies. My guess is that the amount of dissent around regulation that it embodies was new to him.
In unequivocally refusing to bystand the incongruities and spurious ethical claims of the mainstream accrediting and training bodies in the UK, Regulating the Psychological Therapies may have conveyed to the HPC the extent to which, in contemplating the regulation of psychopractice, the HPC is entering a clash of culture, even civilizations.
It begins to look like a contest between Technocracy and The Cults.
Technocracya worldview rooted in positivist, scientistic, rationality where feeling, emotion and intuition are sidelined or suppressed in favour of technical and managerial expertise, a perspective that seems strongly expressed in the HPC. Cults I'd define, not necessarily pejoratively, as groups of people who intensely adhere to a worldview that in their local experience is authentic and effective e.g. the myriad styles and methods of psychopractice work with the human condition.
In an indication of the technocratic orientation of the HPC, MS had never heard of participative research, Cooperative Inquiry, Action Research or Appreciative Inquiry, ways of doing research with people and the chapter of my book that gave him the most difficulty ('impenetrable') was the one (Ch26) that describes a cooperative inquiry into flourishing.
The upside of a HPC route to regulation is that it may succeed in demolishing the spurious claims to ethical virtue and exclusivity of the mainstream accrediting and training bodies in favour of a democratization of therapy and giving easier access to such services e.g. the DoH policy of Improving Access to Psychological Therapies [IAPT]. The downside, of which more anon, is that the HPC appears to have a structure that copes poorly or not at all with the contradictions or ambiguities of psychopractice and that its ethos, being input and complaint based, is diametrically opposed to best practice accountability. In other words, as it stands, it is not fit for purpose.
What I didn't get to discuss was the education dimension of the HPC, their capacity to determine, fairly tightly I imagine, the curricula and agenda of trainings. How far this would extend past the mainstream offerings is open to question since there is every chance that the 'partners' and council members who would get to decide such matters will be drawn from the universities and mainstream accrediting bodies. If you were planning to set up an HPC accredited course in say equestrian-assisted psychotherapy, or soul contract reading psychotherapy, delete it from the business plan right away.
From the meeting with MS and RT Ipnosis learned one very important thing it can really matter to distinguish between institutions that are open, transparent, well intentioned but mistaken (HPC), and groupings of organizations BACP, BCP, BPS, UKCP, that are closed, ethically challenged, exclusive, self-serving and also mistaken but which really ought to know better than to actively seek endorsement of their expertise by the state.
Finally, we could all do with remembering that the HPC appears to be just as uninformed about psychopractice, its values and ethos as most psychopractitioners are about how the legislative politics of regulation may change their working lives.