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6th October 1999 text
Government Kills the Psychotherapy Bill

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In this extract from Hansard January 19th 2001 Lord Burlison outlines the government's position on the regulation of psychotherapy and related trades

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Lord Burlison:text
...we cannot accept that the Bill, well intentioned though it is, is the right approach at this time. There are two main reasons. First, as your Lordships are aware, the Government have given a high priority to improving service quality in general in the National Health Service and social care services, as well as in the private sector. A number of initiatives testify to that, including the development of a national service framework, the establishment of the National Institute for Clinical Excellence, the new framework of clinical governance and the proposals set out in the National Health Service Plan.

The noble Lord, Lord Hodgson of Astley Abbots, made an important point about the clinical effectiveness of psychotherapy. The Government are taking action to ensure that practice is evidence-based. We have established a national workforce action team to help us to ensure that the workforce is equipped to deal with mental health problems. It will focus on all members of the workforce in health and social care, including paying some attention to those delivering psychotherapy. We have also commissioned guidelines on treatment choice decisions in psychological therapies and counselling, which will help commissioners, employers and the public to know more about what works for whom in this complex field.

As your Lordships know, the Government believe that a requirement in law to register practitioners is among the strongest protections available to the public. That is why we have made it clear that we wish to work with the health professions to strengthen the system of professional self-regulation, using the order-making power in the Health Act. That is the approach that we propose for the introduction of statutory protection of title for professions, such as psychotherapists, that are not already regulated.

Our proposals for the new health professions council are eminently suitable for the group of psychotherapy professions that we are considering today. Our purpose is to establish universal independent standards of training, conduct and discipline for the protection of the public and to guide employers. Those standards are underpinned by the personal accountability of practitioners and by systems to deal with individuals whose continuing practice represents an unacceptable risk.

In designing the proposals, we have had to find a balance between three interests: the public--the patients and service users--who need effective, evidence-based treatments delivered by trained staff; the professional staff and therapists who provide care and treatment for those in need; and the health service, where the majority of the care and treatment is given.

We want to ensure that regulatory bodies are small enough and sufficiently fast-moving to be able to agree on necessary action and act quickly to respond to patients' needs. That means getting away from the long, tortuous legal procedures which currently are necessary in order to bring about rule changes to address issues in individual professional conduct cases.

We want to ensure that consumer organisations and patients' representative groups are present in force in the new regulatory bodies. We propose a membership ratio of approximately 50:50, with either a lay or professional president. We plan to continue with an approach based on professional self-regulation because the professions support us in upholding professional practice standards. They provide for cases of misconduct or deficient competence to be dealt with speedily. We need to be confident, as do the professionals, that there is sufficient involvement of those who alone have the knowledge to ensure that standards of training and conduct reflect the best professional practice and that those are being upheld.

I have referred to the important needs of the public and the patients. I have also spoken about the interests of the professionals who deliver treatment and care. All those matters must be addressed in a robust system for regulating professional practice. Some of them are addressed in the proposals put forward by the noble Lord, Lord Alderdice. However, what about the interests of the National Health Service and of the professionals and staff, including commissioners and the employers of those who deliver treatment and care? Concern for those interests brings me to the second reason why we do not support the proposals for a stand-alone psychotherapy council.

Psychotherapists are among a number of key professionals who provide psychotherapy services in the National Health Service and social care services, as well as in the private sector. Together with psychiatrists, psychologists, counsellors and others, they play an important part in the delivery of effective "talking treatment".

However, psychotherapists are not the only providers of psychotherapy in the NHS, where the main responsibility for the provision of treatment and care for the public lies. Most talking treatments in the NHS are provided by nurses, social workers, psychiatrists, psychologists and counsellors, some of whom deliver psychotherapy as the main component of their work within the NHS. What impact would the proposals, which concern psychotherapists alone, have upon them?

I cannot agree that an approach which addresses the needs of one group to the exclusion of the others is responsible, even though I readily acknowledge the importance of public protection in the private sector. Although protections are in place for members of the public who seek help through the use of psychological therapies in the National Health Service--for example, employers must be assured that practitioners are qualified for the tasks which they undertake and referrers must be confident that the treatment is right for the condition--we would not be reforming the legislation concerning regulation if we believed that those protections were sufficient.

We must also consider the issues which arise from the delivery of treatments by unregistered practitioners in a number of professional groups; for example, unregistered counsellors deliver treatments in perhaps as many as half our general medical practices, and psychologists are not registered either.

This is an important issue. I cannot accept that where counselling is offered by a trained practitioner to the high standards set by the leading professional bodies it is distinguishable from psychotherapy in anything but name. I cannot accept that the practice of clinical psychologists trained to deliver cognitive behaviour therapy or family therapy, known as psychotherapy, should be outlawed. Therefore, we should not, in all conscience, exclude those providers from our regulatory framework.

Therefore, if we pursue this route to registration, our proposals for the new health professions council will contain significant advantages for those who deliver psychotherapy. First, the proposals contain scope to accommodate the range of modalities for psychotherapy. Secondly, they accommodate the different approaches to psychotherapy and contain scope to accommodate the range of different professionals and responsibilities in this area. Thirdly, they give psychotherapists the benefit of consistency with a much larger group of health professionals, with all that that means in terms of access to good regulatory practice developed over time.

My noble friend Lord Clinton-Davis made a point about analytical psychology. That is a branch of psychotherapy with a distinct and different training. We know that different training standards matter. We can accommodate that. However, what matters about different approaches when it comes to regulation is that they can join others in a common approach in the action to take when a member of the public seeks redress because of poor, unprofessional practice.

We propose to bring together a large number of diverse professions and provide consistent policy and handling of education, training and professional conduct standards by means of statutory joint committees. Those committees will be able to draw on advice from uni-professional advisory panels which will cover the specific concerns and requirements of each profession or each different modality. The council itself will be required to take account of the different needs of each profession or group of professions

That will, we hope, satisfy the need for consistency across the board where it is necessary, and will also provide the need for sensitivity to professional differences. It will give psychotherapists themselves the reassurance that their own specific clinical training, practice and standards will be based on what only they themselves can know. It will also provide reassurance for the public that any problems which might arise from poor practice or conduct by a psychotherapist will be dealt with according to the same rules applying to any other health profession regulated by the new council.

The noble Lord, Lord Alderdice, proposes to protect the title of the psychotherapist so that only those registered as such may use that title. He recognises that members of other professions already regulated elsewhere, for instance by the GMC, practise psychotherapy. The proposals for the health professions council will provide for protection of title and will recognise the need to safeguard members of other professions so that they can continue to practice psychotherapy.

The noble Lord, Lord Hodgson of Astley Abbotts, mentioned "grandfathering"--the process by which existing practitioners might seek registration by virtue of length of practice rather than by meeting professional standards. I hope that that will be covered under our proposals for the health professions council. Our approach will enable professional staff to take pride in ownership of their professional standards and to work with lay people to ensure that those standards are consistently applied.

My noble friend Lord Wedderburn made a point in respect of the view suggesting that the Government's approach would not have the support of the relevant professions and other stakeholders. It is an approach based on the proposals contained in the Bill on professional self-regulation but it offers significant additional benefits.

I know that psychotherapy has much to offer modern mental health and social care. However, we know also that it is a field beset by divisions and differences in training, practice, organisation, commissioning and self-delivery. I want to say therefore how impressed I am with the work of the noble Lord, Lord Alderdice, in bringing together so many different psychotherapy practitioners to discuss those issues. He progressed the debate in a significant

I have listened carefully to the case the noble Lord made and to the points made by other noble Lords in the course of the debate. I have no doubt that the case for registration of psychotherapists is a strong one. But while I want to reassure your Lordships about that, I must emphasise that we are convinced that using the powers of the health Acts is the most appropriate way to proceed. It cannot be appropriate to address but one section of the field in a manner which separates it from the approach we propose for the rest.

We believe that the Health Act is the right vehicle for the registration of psychotherapists, counsellors, psychologists and other related groups. We intend to scope the requirements, building on the excellent work started by the noble Lord, and assess the other important factors such as the professionals' readiness for registration and the availability of parliamentary time with a view to positive and early action.

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edited, maintained and © Denis Postle 1999