UPDATE: 09:00 February 25th
The Health and Social Care Bill January 19th 2011, and the later Command Paper February 16, 2011 demoted the HPC from its regulatory monopoly of counselling and psychotherapy titles in favour of a pluralistic quality assurance approach featuring voluntary registers; a decision that appeared to set an expanded CHRE in competition with the HPC. However, the HPC, in its February17th Position Statement on the Command Paper, confirms its understanding…
…that for currently unregulated groups, voluntary registration will in future be the Government's preferred option. However it also says the Government will consider statutory regulation where there is a compelling case on the basis of public safety risk and where assured voluntary registers are not considered sufficient to manage the risk. (eIpnosis emphasis)
Within a few weeks of the Command Paper, we heard from an eIpnosis correspondent that the HPC had commissioned research into the extent of abuse in the psychological therapies and later discovered this was likely to be presented to the HPC Council at the end of March. This research would have been commissioned during early/mid 2010. Is it unreasonable to speculate that it might have been commissioned at the time the HPC was served papers for the judicial review (for which permission to procede was given late in 2010) and is it also unreasonable to guess that the DoH would have let the HPC know last summer that they intended to uproot their regulatory monopoly.
In other words this research, carried out under the auspices of one of the members of the PLG who strongly favours state regulation, perhaps has another dimension, might it be a component in a fight-back by the HPC and its trainer/NHS allies to recover their lost SR status? The results of this research are used to show that counselling and psychotherapy do constitute a compelling public safety risk, one that does justifies statutory, i.e. compulsory, regulation of them, rather than the voluntary registration that the government has decided to adopt.
No doubt the HPC's contract for the study will have ensured that this research is ‘objective’, free of conflicts of interest, and all the possible biases listed in the eIpnosis video Validity in the Psychological Therapies Why Love Provides a Better Benchmark than Science have veen eliminated.
UPDATE: 14:00 February 18th
eIpnosis is closing coverage of the regulatory ferment with:
Enantiodromia: Government policy reverses
- from centralised control to pluralism
Other reactions to the Command Paper accumulate:
BACP not yet
UPDATE: 09:00 February 17th The Psychological Therapies - STATE REGULATION IS DEAD
February 16th The DoH releases a 'command paper' detailing its plans for the regulation of healthcare in the UK.
The DoH have listened to objections to the HPC's approach to regulation and have opted, at least for the term of this government, for a voluntary approach. The renamed CHRE will be entitled to administer voluntary registers from groups that meet their criteria.
The HPC policy for counselling and psychotherapy is in tatters, there will be no capture of titles, no right to capture, an unwilling professional group, as with the psychologists. The HPC, set to be held on a tighter rein by its regulator the CHRE, will be entitled to 'hold' voluntary registsers of practitoners who want their regime.
Look out for a more detailed review shortly.
UPDATE: 20:00 February 15th
Press release from the HPC spelling out a new softly softly approach to its fitnes to practice hearings. How curious that it appears the day before (see above) the release of the Command Paper spelling out in more detail
The Health Professions Council (HPC) has launched new information about its fitness to practice processes.
'This work was undertaken in response to research we commissioned to examine the views of the public, registrants, complainants and key stakeholders on their expectations of the HPC's fitness to practise process. The findings from the research have helped the HPC to provide more tailored information about its fitness to practise processes.
The new information provided on the website provides audience specific pages for those who have interaction with us. It contains information relevant to registrants, their representatives, complainants and witnesses.
A new audio-visual presentation has also been produced for anyone attending, or interested in, finding out about fitness to practise hearings. It provides an overview of how our hearings operate, including what to expect and the people who will be in attendance. It uses actors to describe the decision making process and possible sanctions that may be applied by a panel at a hearing. It is hoped the presentation will enable those who have to attend hearings to become more familiar with what to expect.'
The audio visual presentation can be found at www.hpc-uk.tv/
UPDATE: 10:00 February 6th
Chinese whispers strongly suggest that the Government White Paper which may finally spell out its plans for counselling and psychotherapy 'due before the end of the month', 'expected in mid- February', may appear on Thursday 10th February.
UPDATE 20:00 February 5th
On Wednesday February 2nd the Professional Liaison Group for counselling and psychotherapy [PLG] met for the last time.
The eIpnosis report on this meeting, Word .doc download, and .mp3 podcast are here.
Tasked with recommending how counselling and psychotherapy should be regulated, the PLG was unable to agree on two issues: whether there should be a separate register for Child Psychotherapy and whether or not counselling is the same or different from psychotherapy. Both decisions were referred to the HPC Council for a decision.
UPDATE 18:00 February 4th
CORRECTION 'Approved mental health practitioner' is not an upcoming category for the psychological therapies. Marc Seale HPC CEO tells us at the PLG meeting on February 2nd that 'Approved Mental Health Practitioner' is a specialty or sub-category of social work, around 2000 practitioners who have a role in 'sectioning' people if and when that is necesssary.
UPDATE 18:00 February 1st
The CHRE, soon to be PSAHSC, are on record today as claiming that:
under the new (regulatory) system, counsellors and psychotherapists will broadly have three options:
1:A voluntary register, held by a professional body and accredited by the CHRE/PSA.
2: A voluntary register, but held and/or administered by a statutory regulator such as the HPC.
3: The status quo as at present , i.e a voluntary register with no accreditation or links to a statutory regulator.
...'.the government has indicated that it is unlikely to proceed with statutory regulation for any new profession except herbal medicine, which is necessary to meet EU legislative requirements.
The new system of voluntary registration means that professions are free to choose whether to have their registers accredited by CHRE; and whether they wish to have their register held by a statutory regulator such as HPC or continue to manage them themselves'.
All of which makes tomorrow's meeting of the Professional Liaison Group at the HPC even more interesting.
The obscurity of the Health and Social Care Bill is partly due to it being devoted to altering previous legislation, however missing from its provisions seems to be any attempt to actually account for what it might mean in the light of day for anyone other than social workers.
For example a pertinent question might be:
'Reading the Bill, it seems HPC has two powers that are relevant to psychotherapists and counsellors. The first is that, after a risk assessment and consultation, the HPC could set up a voluntary register for individuals. The second is that they can accredit existing voluntary registers if they make application.'
Is this correct?
'Or more specifically, could an existing counselling or psychotherapy accrediting body, apply to the HPC and subject to due process as outlined below, have their voluntary register accredited?'
The DoH Explanatory Notes for the Bill is no help with such questions. The Notes have nothing to say about either psychotherapy and counselling. However Wellbeing (sic) Boards and well-being 'strategies' merit 75 mentions in its 235 pages.
If anyone looking in has any answer to the above questions do get in touch.
UPDATE 15:00 January 25th
Perhaps at least as indicative as anything else of the way things are heading, the Professional Liaison Group [PLG] is set to meet on February 2nd. The minutes and documents for the meeting are available here.
Minutes of the previous PLG meeting
The Judicial review
The Group noted that the Chair of Council had attended a hearing of the Administrative court on 10 December 2010. The hearing had considered an application for judicial review by six psychoanalytic and psychotherapeutic organisations of HPC’s recommendation to the Department of Health that it should regulate psychotherapists and counsellors.
The court had decided that the case should proceed to a full hearing, as the judge had ruled that the application for judicial review had not been ‘out of time’. The judge had decided that, although there was a great deal of common ground between the parties, there was not enough to conclude the case at this stage and therefore it should proceed to the next stage, namely a full hearing. It was expected that there would be a delay of up to six months before the hearing would be listed in the High Court. In the meantime, HPC was committed to the process of finding common ground as the judge had directed.
The Committee noted that the Group would continue its work pending the outcome of the judicial review and any decision by the government on whether the profession should be regulated by HPC (eIpnosis emphasis)
The PLG is particularly invited to consider the question of whether the first entry point for counsellors should be set at level 4 or level 5. Level 5 is used in the current working model and this has been the subject of discussion at previous meetings. The PLG is asked to make a formal decision.
To agree in principle the threshold level or levels for entry to the Register (recognising that this will be subject to future consideration in light of the finalised standards and subject to a consultation held prior to the opening of any statutory register). In particular the following suggested levels (subject to discussion):
o ‘Level 5 counsellors’
o ‘Level 7 counsellors’ (whether differentiated from ‘Level 7 psychotherapists’ or not)
o ‘Level 7 psychotherapists’ (whether differentiated from ‘Level 7 counsellors’ or not)
UPDATE 12:00 January 25th
In the previous material I didn't include links to two essential documents, the first: Discussion Paper: Early thinking on CHRE’s potential role in operating a voluntary register scheme December 2010 amounts to a 'business plan', circulated privately to we might guess, the mainstream psychological therapies stakeholders and other related organisations but later freely available.
Secondly, following publication of the Health and Social Care Bill, a press release from the CHRE.
UPDATE 12:30 January 24th
Questions and some answers today from Marc Seale: HPC CEO Check out the item in red.
eIpnosis: Reading the Bill, it seems HPC has two powers that are relevant to psychotherapists and counsellors. The first is that, after a risk assessment and consultation, you could set up a voluntary register for individuals. The second is that you can accredit existing voluntary registers if they make application.
Have I got it right?
M.S.In answer to the first part of the question is yes if the Council decides to go down this route.
In relation to the second part of the question, which Article are you referring to?
Ipnosis:If so, do you anticipate doing either of these?
M.S.The Council will need to make a decision to decide to go down this route.
Ipnosis: And if you do, what would be the timescale?
M.S.The Bill/Act has to be approved by Parliament and then the HPC/HCPC will have to make Rules, possible issue Guidance and Standards and establish new processes. This process is unlikely to be completed before April 2012 at the earliest.
Ipnosis: A further question is, do you think the existing scheme for statutorily based registration is still likely to be pursued as the Government's policy?
M.S.We are expecting a White paper on this issue to be published sometime before March 2011
UPDATE 09:00 January 24th
A document came to light over the weekend that bring into sharper focus the regulatory possibilities: The Impact Assessment, 165 pages, details the expected financial and other effects that the Bill's provisions might produce.
There is very little in the Impact Assessment about the HPC, which suggests that its capacity for predatory behaviour is still in place, however the multiple opportunities for the enhanced CHRE to validate voluntary registers looks promising. They may provide a way for practitioners to sidestep capture by the HPC as an agency of the state.
Here are a few paragraphs that open out the CHRE options:eIpnosis emphasis in bold
E 3.17 : “no employer will be compelled to employ registered practitioners.”,
Page 123/4: ‘Rationalising the regulatory landscape’
E60. For some groups working in the health and social care sectors, statutory regulation may be a disproportionate response to the level of risk to the public. An assured system of voluntary registration would seek to enhance standards of professional and occupational competence and provide clear standards of expected conduct, but without the need for compulsory statutory regulation.
E61. The Department proposes to expand CHRE’s remit to enable it to set standards for and to quality assure systems of voluntary registration. It will be for CHRE to determine its quality assurance processes, but on the basis of discussions with CHRE, DH anticipate initial set-up costs of £100,000 in the first year, which will be funded by the DH. CHRE expects that the annual cost will continue to be around £100,000, which in subsequent years will be funded through fees from the voluntary registers it accredits. DH expects CHRE to reach full cost recovery within three years.
E62. Oversight of voluntary registers by CHRE may impose some costs on voluntary registers and their registrants. Voluntary registers will incur costs in preparing for scrutiny by CHRE, and this scrutiny may lead to more robust voluntary registration, increasing the costs of compliance for registrants. However, as registration will be voluntary, both registrants and the registering bodies will only participate where the benefit of doing so warrants the costs.
E63. Accredited voluntary registration should lead to improved standards of education, proficiency and conduct, improved dissemination of good practice, robust processes to improve public safety, and will improve the ability of employers and people who use services to distinguish between workers who have met nationally accredited standards and those who have not.
Page 134 (Key risks and sensitivities)
E119. The Department has considered non-legislative approaches for delivering the objectives outlined in paragraph E21 (i.e. streamlining ALB sector, reducing duplication and central bureaucracy.) Such non-legislative approaches include voluntary regulation or self-regulation, and as far as it is feasible to do so, they have been included. Fundamentally, primary legislation will be needed to change the structure of the ALB landscape and therefore these objectives cannot be delivered without the need for primary legislation.
E120. Where there are additional burdens placed on the private sector DH has attempted to quantify these as far as possible. Preliminary estimates for this burden are approximately £2.3m annually using Equivalent Annual Costing techniques. This is to be counterbalanced by benefits that the private sector would enjoy through these proposals, for instance through the expansion of NICE guidance and accredited voluntary registers. This has been provisionally quantified as around £0.6m annually, using the same Equivalent Annual Cost method. With this in mind, DH must consider the policies outlined in this impact assessment to comprise an IN in the One In One Out framework.
Page 140/141 (Competition Assessment)
E3.7. For the CHRE, the compulsory levy on the regulators is likely to result in a very small increase in the registration fee paid by registrants. This is very unlikely to have any effect on the number or range of registered professionals.
E3.8. Quality assurance of voluntary registers by CHRE may have an indirect effect on the number and range of health and social care practitioners. Members of a quality assured voluntary register will meet specified standards of training and competence, and their registration status means that this will be easily verifiable by employers and the public. Therefore, being registered is likely to be an advantage when seeking employment. Not being registered may, over time, result in a rise in the threshold for entry to certain occupations, which would be expected to raise standards of practice.
3) Would the policy limit the ability of suppliers to compete?
E3.9. There is currently no competition between suppliers since many of the ALBs are created to deliver a certain function. The policy does not have the intended effect of providing or changing competition, so this policy will not limit supplier’s ability to compete.
E3.10. In terms of indirect effects, the Department does not believe this policy will limit the ability of the health sector to compete. Quality assurance of voluntary registers by CHRE places no limits on the ability of practitioners to compete in the labour market. Practitioners are free to choose whether to join a quality assured voluntary register.
Page 141 Small Firms Impact Test
E3.12. The Small Firms Impact Test (SFIT) considers any impacts on small businesses or their customers as a result of government policy. Specifically, the SFIT asks whether “the proposal affect[s] small business, their customers or competitors118” where a small business is defined as a business with a headcount of less than 50. DH envisages impacts on small firms for the changes to the GSCC and CHRE.
E3.16. For the CHRE, the compulsory levy on the regulators is likely to result in a very small increase in the registration fee paid by registrants. This is very unlikely to have any effect on registered professionals or their employers, even in the case of sole traders, the self-employed, or those who work for small businesses.
E3.17. Quality assurance of voluntary registers may have some impact on small firms and their customers. It is anticipated that the prospect of quality assurance by CHRE may encourage professional and occupational groups to enter into voluntary registration. The registration fees that these groups would pay may contribute to upward pressure on wages. Although this may have a disproportionate effect on small employers, no employer will be compelled to employ registered practitioners. Similarly, where small businesses choose to pass the cost of registration on to their customers through higher prices, those customers will be free to go elsewhere. Therefore, although quality assurance of voluntary registration will create new costs, because registration is voluntary, these costs will only be incurred where practitioners, their employers and customers judge that the benefit warrants the cost.
UPDATE 14:30 6 January 22nd
In characteristic fashion neither the CHRE or the HPC spell out what the Health Bill legislation is likely to mean for the psychological therapies. However in the absence of more concrete information here is what it begins to look like:
Two routes open up for civic accountability for psycho-practitioners (not only counsellors and psychotherapists).
1. The HPC are licensed to create a register for practitioners who work in mental health ie the NHS, and register(s) see below for 'unlicensed professionals'.
2. existing accrediting bodies can apply to have their (presumably upgraded) accreditation processs bar-coded/kitemarked by the CHRE.
Seems we are going to have two competing forms of registration/regulation/accreditation.
Will they be equal under the law and in the eyes of the NHS managers?
And, but, possibly, conceivably and other kinds of tentativeness... all this could be taken to imply that there will be no HPC regulation of title.
And... considering the amount of face-saving involved... it is likely to be a long way down the road.
UPDATE 16:00 January 21st
eIpnosis contacted Marc Seale HPC CEO:
The statement today about future HCPC responsibilities under the Health and Social Care Bill was welcome.
Does the provision...
· that HCPC may keep voluntary registers for unregulated professionals.
...mean that HPC would be able to hold a register of 'unlicensed psychotherapists' as I suggested at our very first meeting, what I think of as the 'Vermont' model of regulation? Or does it refer only to people involved in some aspect of social care?
The powers are in Article 212 of the Health and Social Care Bill.
UPDATE 11:14 January 21st
In among various already well known items about regulation of the social workers is the following:
· that HCPC may keep voluntary registers for unregulated professionals.
(eIpnosis emphasis) this appears to refer to social workers but a wider interpretation of their remit would put them it competition with the renamed CHRE.
The Health Bill published Jan 19 not only deranges the NHS in general but also, it would seem, long afoot plans to regulate counselling and psychotherapy.
Here is a probably premature and even erroneous take on the new landscape of the psychological therapies. (if you know better please get in touch, denis AT postle.net) In the interests of short term sanity I'll preserve the original names of the key institutions.
The CHRE are now licensed to quality assure voluntary registers for a fee, so we can assume that significant psychological therapy organizations will negotiate with them to provide a validated voluntary register for their members, e.g. It is easy to imagine the BACP successfully negotiating to hold a CHRE endorsed voluntary register of counsellors and if they can afford the fees, others will follow.
So far so good.
However the HPC hasn't evaporated, though some aspects of its fate remain uncertain.
The CHRE's new capacity undercuts the terminal dispute which the HPC has been presiding over - the two titles 'counselling' and 'psychotherapy - and whether they are the same, overlap or are different. A new category has emerged. Approved Mental Health Practitioner[AMHP] This fits the HPC's medical model ethos very well and one which apart from psychologist, we may suppose will be the only therapy title over which the HPC will have control.
Marc Seale HPC CEO tells us at the PLG meeting on February 2nd that 'Approved Mental Health Practitioner' is a specialty or sub-category of social work, around 2000 practitioners who have a role in 'sectioning' people if and when that is necesssary.
Following the February 2nd PLG meeting, it looks as if we can now expect a two tier form of psychological therapies practitioner accreditation/accountability; some form of HPC 'voluntary register' ('voluntary' but try to work in the NHS without it) and a second which administered by the CHRE which will suit practitioners who don't see their work as in any way involved with mental health.
We might guess that the training market will move to offering two tier trainings: one route gets you onto a CHRE validated voluntary register, a second, or extra training layer, provides HPC status.
And what will this mean apart from being acceptable to the NHS? It is unclear at the moment but here is a guess - if you opt for HPC, in addition to being able to describe yourself as a 'counsellor' or 'psychotherapist' you will be liable for 'fitness to practice' disciplinaries administered by the HPC.
If you opt for only the CHRE voluntary register you will be subject to that register's protocols.
'Counsellor'/'Psychotherapist' title capture by the HPC appears to have gone. (but the PLG will still meet on February 2)
Massive loss of face by the HPC due to determined opposition to its approach to regulation of the psychological therapies. This seems likely to shape some of the detailed outcomes we have yet to see.
What has united the opposition to the robotic automaton of HPC regulation has been the desire to hold a space open for forms of accountability that can remain reflexive of themselves as institutions and the increasingly corporate state in which we inhabit and which inhabits us.
Looks like this opposition has been a qualified success.
Suggestions, comment, new information etc would be welcome. I'll post them here.
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First Impressions of the new regulatory landscape