The following are some comments on the Health Professions’ Council’s ‘In Focus’ newsletter issue 8 December 2006 (.pdf)
Standards: In the footnote (i) is the Health Professions’ Council account of their consultation on standards. These standards are centrally determined by the HPC and then centrally enforced. This consultation is cosmetic it hides the central control processes which are actually in use. This form of what the HPC and DoH calls consultation has been used several times with the talking therapists. The latest example is the issuing of the competency document at the beginning of December with a reply date of February. A further example is the ignoring of responses from the talking therapies to the consultations.
These HPC standards apply to all situations there are no exceptions. In the Donaldson Report, the Health Industry is defined (on no evidence) as a high-risk industry. The examples of Alpha-Piper Disaster in the oil industry, Chernobyl in the nuclear industry and pilot error in the aircraft industry are used as a basis for action in the ‘health industry’. So processes used by health professionals in their interactions with other human beings the service users are being compared with processes used by machine operators yes an aircraft is a machine when correcting machine malfunctions. The subjectivity or individuality of the human beings involved is foreclosed both parties have to behave to machine-like rules which are defined by the HPC.
Listening Consultations: In footnote[ii] is advertised the HPC’s listening events. These are another form of cosmetic consultation. From colleagues who have attended these events, they are orchestrated to make you feel consulted. However, your feedback is gained by the use of forced-choice questions (When did you stop beating your wife?) where you are not allowed to question the underlying assumptions. The service users who were present felt patronised. They were there to legitimate the whole process and not either, to question the government’s view of how they should be treated or, put their individual view. This mechanism allows the government to state ‘we have consulted with x thousand people in z consultations who all agree with our approach....’.
The HPC’s response to Foster and Donaldson reports: In footnote[iii] is the text. Some matters arising:
- In the Health Professions Order 2001, the governance of all health professionals is laid out. Marc Seale merely agrees the tinkering by the DoH (with permission from the Privy Council) of the HPO in respect of the regulation of new groups, the appointment of Council members, and so on.
- Marc Seale emphasises, as does the report, the role of regulation in protecting the public. Safeguarding the public is in the HPO section 3 page 5. So the HPC, British Psychological Society, British Association of Counsellors and Psychotherapists and the United Kingdom Council of Psychotherapists all assert they can protect the public from murderers, rapists, gross incompetence, and human error (see Donaldson). Of course, the law is already clear on murder, rape, and promising services you can’t or won’t deliver. But the government, HPC, BPS, BACP, and UKCP are all omnipotent in their control and can prevent the above happening. I have, elsewhere, and on many occasions commented on ‘protection’ or ‘safeguarding’ as an aim. In particular, I wonder about a government who promises protection from terrorists, paedophiles, ill-health (see section 3 of HPO), fox-hunters, etc. Is safeguarding or protection an achievable aim? Should this lust for imposing certainty be part of governance processes in the UK?
- The practices witness protection and civil standards of proof are going to be applied to a relationship between a health practitioner and a service user. Why? To produce a standard way of regulating a machine-process-defined relationship between two human beings.
- ‘To further test the case for revalidation’: This means even those who are rushing to be regulated by the government through the HPO are going to have to prove to the HPC that they are up to the government’s standard even with years of successful practice.
- ‘To further test whether it could offer additional public protection’. I wonder what evidence is used to justify additional public protection.
- The HPC will be controlling all health professionals working outside the NHS. This enormous span of control has been commented on elsewhere especially the Ipnosis site.
- ‘The HPC emphasises the importance of consistent, targeted, UK-wide, risk based and proportionate healthcare regulation’. So to be consistent, the HPC will use the same risk-based targets for geriatrics, obstetrics, accidents, a sore throat, mental health, and so on inside or outside the NHS. It is interesting that the HPC thinks it can define risks in these situations in the same way that the much more predictable oil, nuclear and aircraft industries can.
‘Fitness-to-practice- hearings: The HPC publishes a list of miscreants with an introduction reproduced in the footnote[iv]. A huge, profitable complaints industry is being created. There are advertisements on public transports telling everyone of their ‘right’ to complain. The lawyers will not be far behind, as in the USA. One of the features of centralised control is that the control systems are never wrong. Thus, the blame for non-perfect human relationships must go to operators: the health professionals. The control system remains isolated from the processes between the two human beings as it is blind to human relationships. The system therefore starts to measure and control easy targets like note-taking and tick-evaluation sheets. The relationship between these measures and a relationship-based process is never established but the fitness-to-practice hearings are based on these measures.
‘Health and character as well as the necessary skills and knowledge’ The Doctors’ new standards mean that a doctor working in a pathology lab can loose their job for looking at pornography in their home even if the law has not been broken (see footnote [v]). And health (mental health?) and character are going to be judged by some civil servants sitting within the HPC.
‘We mean we can trust them to act legally.’ This is very scary. The HPC is able to prevent illegal acts occurring within their jurisdiction. Murders, rape, assaults, child abuse, and so on are prevented by the HPC’s systems of selection, training, supervision, appraisal and the HPC’s control of these systems. Thus the HPC are operating a private security system outside our normal methods of policing. This has echoes of policing methods in totalitarian regimes.
The tables. In the Inquisition, one of the methods of punishing those who refused to comply was to hold them up to public ridicule in dunce’s hats. I am no historian and it is my understanding we had abolished public stocks some centuries ago....
Julia Evans December 2006
[i] Standards of proficiency consultation
In the August edition of In Focus we reported that we had been reviewing the standards of proficiency for the first 12 professions we regulated. These standards are the threshold standards we consider necessary for the safe and effective practise of professionals we register. They play a central role in how someone becomes and remains registered with us.
We reviewed the standards of proficiency from October 2005 to make sure that they were working, and that they continued to reflect current practice as experienced by registrants, employers, educators and others. We are now consulting on draft standards for the first 12 professions we regulated and would welcome your comments. In particular:
1. Do you think the introduction clearly explains the role and purpose of the standards?
2. Do you agree with the changes we have made to the existing standards?
3. Do you think any additional standards are necessary?
4. Do you think any standards are redundant?
5. Do you think there are any standards which might be reworded?
6. Following discussion about the use of terminology in the standards, we decided to replace the phrase ‘patients, clients and users’ with ‘service users’. We would welcome your comments and suggestions on this change.
You can download a copy of the consultation document by visiting our website:
Please e-mail your details to firstname.lastname@example.org if you would like us to send you a hard copy.
If you would like to respond to this consultation, please send your response to the address opposite.
The consultation will run until Friday 12 January 2007. We will update youwith the outcome of the consultation in the future editions of In focus.
[ii] Upcoming Listening Events have your say!
The HPC hosts a number of Listening Events around the UK to ensure regular contact with key stakeholder groups and to keep in touch with their views and requirements. These events are open to anyone who is interested in our work.
Two identical meetings are held on each day, running from 2-4pm and 6-8pm. Each meeting includes a presentation on HPC and is followed by a Q&A session where attendees can put comments and questions to a panel of Council members.
Our next Listening Events will be held in Aberystwyth on Tuesday 13 and Worcester on Thursday 15 February 2007. For further details please see the ‘Events’ section of our website: www.hpcuk.
[iii] HPC responds to Government plans for UK healthcare regulation. The HPC has now submitted its response to the Department of Health's review of non-medical regulation, and the Chief Medical Officer's report, 'Good Doctors, Safer Patients'.
HPC Chief Executive, Marc Seale explained, “We welcome the opportunity to respond to the Department of Health’s review and agree with many of the recommendations, particularly those around the regulation of new groups, the
appointment of Council members, and the emphasis the report has placed on the role of regulation in protecting the public.”
“We see many of the proposals in the report as an endorsement of our current practices, particularly the areas of lay representation, accountability to Parliament, our approach to witness protection and the adoption of civil standards of proof.”
The HPC’s response to the consultation is wide ranging, but emphasises the need to further test the case for revalidation, particularly the potential cost to health professionals, whether it could offer additional public protection, and the need for healthcare regulation to take account of the significant number of health professionals working outside the NHS. In addition, the HPC is recommending that statutory regulation would be useful for other groups of healthcare support workers, including for example emergency medical technicians and assistant practitioners.
The HPC’s response further highlights that health professionals are increasingly working in multi-disciplinary teams and emphasises the importance of consistent, targeted, UK-wide, risk based and proportionate healthcare regulation. An approach which the HPC believes would be welcomed by employers, members of the public and professionals themselves.
Marc Seale continued, “We believe we are leading the way in delivering an effective model of healthcare regulation and will continue to work closely with the Department of Health and other stakeholders to ensure that our role in protecting the public continues to be strengthened and recognised.”
To view HPC’s full response, please see our website at: www.hpc-uk.org/publications/
[iv] Fitness to practise hearings: September November 2006
Our Fitness to Practise Department is responsible for handling complaints, known as ‘allegations’, about the fitness to practise of professionals we register. When we say that a health professional is fit to practise we mean that he or she has the health and character, as well as the necessary skills and knowledge to do their job safely and effectively. We also mean that we trust them to act legally.
Our main responsibility is to protect the public, maintaining public confidence in the professions and professionals we regulate. We will consider every complaint we receive about a health professional on a case by case basis and take action in light of the individual circumstances.
The table below provides basic details of hearings held since the production of October’s In Focus.
For further information on these and all other fitness to practise hearings, please click on the following link:
All hearings begin at 10.30am and are open to the press and public, unless otherwise stated. If you wish to attend a
hearing held by the HPC, please contact Victoria Nash on 020 7840 9784 or email: email@example.com
Date of Hearing
Profession Notice of Allegation
27 Sept James Sheehan PA5249 Paramedic Conduct and/or Competence
5 Oct Clare Groom PA6441 Paramedic Conduct and/or Competence
12 Oct Joe Osmond SL5914 Speech & language therapist
[v] See Tougher ethical code imposed on doctors Misbehaviour at home could mean loss of licence New guidance follows inquiry into abuse cases Sarah Boseley, health editor Tuesday October 24, 2006 The Guardian