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Report on eIpnosis meeting with Marc Seale, CEO of the Health Professions Council, October 3rd 2008
At the end of August eIpnosis received a pair of messages that offered very contradictory views on the HPC's reputation. I emailed extracts of them to Marc Seale, his response was to invite me in for a meeting.
Marc met me in reception and led the way down to a basement room at HPC ‘s Kennington headquarters where we occupied two red settees. Tea was served, and Michael Guthrie, Director of Policy & Standards, joined us. Marc Seale is a genial, vigorous conversationalist and he began with an outline of the HPC’s current process.
Corporate governance changes in all the regulators such as the Council for Healthcare Regulatory Excellence [CHRE] are coming into place. The HPC council will be reduced from 27 to 20, the President will be called the Chair and will be appointed, not elected. The reduction in numbers means that there will not be a place on the Council for representatives of all the professions they regulate. Did I detect a hint in the Regulator’s tone that this was not a welcome development?
These changes are intended to be in place by July 2009. In response to my aside that a General Election might also be in that time frame, Marc said that they would be immune to a change of government.
Marc went on to speak about what was evidently their next big piece of business. The Department of Health [DoH] will shortly publish the ‘Psychologists’ Section 60 legislation coupled with the results of the ‘Psychologists Consultation’, ‘it is not meant to be at all controversial’ and unless it contains ‘errors’, will be rubber-stamped by Parliament’. It will then go for oversight to the House of Lords, and from there to the Privy Council to be signed off by the Queen. After this, when the stakeholders concerned have synchronized their diaries (and databases), the finalized legislation will then ‘Gazetted’, naming the day on which the Psychologist’s register will open.
And psychotherapy and counselling?
The DoH presently have a major preoccupation with the planned regulation of health care scientists. There are apparently lots of them too, in different flavours, varieties and titles, very complicated, more than the HPC can digest right away. They have been moved to later in the regulatory queue, to be dealt with ‘after the psychological therapies, the chocolate in the regulatory cake’.
On the regulation of psychotherapy and counseling, Marc and Michael said that they have finished the first phase of ‘scratching their heads on what to do’. They are now ‘looking for the (soon to be announced) Professional Liaison Group [PLG] to deliver a ‘package’’ i.e. how to regulate counseling and psychotherapy. This ‘package’ will be the result of the PLG following a ‘prescribed work plan’, informed by the results of the current HPC ‘Call for Ideas’.
The gatekeepers for the process choosing the members of this liaison group to define regulation of the psychological therapies are the HPC President and Di Waller, an avid regulatory enthusiast. My statement that this was unacceptable didn’t elicit a response and I went on to say that this formation of their decision-making process, coupled with having to follow a ‘prescribed work plan’ for guidance on ‘standards’, 𠆌ompetencies’ ‘education’ and ‘character’, meant that the PLG amounts to an endorsement process. ‘No, No’, Marc said in response to this, ‘the PLG could decide that statutory regulation isn’t appropriate’. And pigs might fly. Let’s see who makes it onto the PLG.
I had prepared several other issues that I wanted to raise and the meeting shifted to taking them in turn.
Why do I find SR and the HPC fundamentally problematic?
I argued that, in its unreflective deployment of a narrowly drawn healthcare model for working with the human condition, plus a structure based on audit and taxonomy, coupled with its freely expressed reliance on coercion and force, the HPC resembles an abusive practitioner. Exactly the toxic mix that is at the root of many, even perhaps most client complaints.
I extended this by reminding them that a majority, perhaps as many as 80% of psychological therapy practitioners, don’t work for the NHS and that many have decisively rejected a scientific/mental health/medical/healthcare model of human condition work. I made the reminder that The Health Professions Council regulatory regime is implicitly and explicitly medical-model based. And that this was experienced by many practitioners as oppressive, intolerable and unacceptable.
I also outlined my ‘procrustean’ take on the future of the field as perhaps the most fundamental objection to SR - that within a generation, as the field of psychotherapy and counseling distorts and shrinks itself to fit the HPC (and SfH) definitions of education, standards and competencies, this will eventually be all there is. At which point, following present plans for regulation, the state’s proxy, the HPC will be in control of the psychological therapies field, with the ability to insist, as with education, on making it do the state’s bidding.
I went on to raise a vigorous challenge about the way that an unlikely cabal of Lord Alderdice/Peter Fonagy/classical psychoanalysis/CBT seemed to have successfully captured the Skills for Health [SfH] National Occupational Standards process. Arguing that this imperious behaviour was ethically indefensible, I wondered if they appreciated that the classical psychoanalysts seemed to be reproducing the power plays of the 1980’s UKCP security council debacle and the subsequent 2001 Psychotherapy Bill. I underlined the extent to which the SfH process had been openly undemocratic, blatantly seeking to exclude or marginalize other therapy approaches such as Integrative and Humanistic forms of psychological therapy through the use of narrow criteria of medically derived evidence-based research, the validity of which in this field is highly contested. I invited them to consider my presumption that the HPC would necessarily be buying into the SfH definitions of the psychological therapies, after all they must have cost £200,000 to write. Adopting such an ethically indefensible, coercive and discriminatory developmental process as that generated by SfH, no matter how detailed the hundreds of pages of NOS competencies it produced, was a further very cogent reason for saying no to SR.
In response Marc Seale said that SfH ‘was the government, or was under contract to the government’ and that ‘the HPC were independent of government’. When I continued with my detailing of SfH’s intolerable processes, re-iterating that if adopted they alone would make an HPC regulatory regime widely unacceptable, Marc said he was going to send for a megaphone! He loudly insisted that ‘we are independent of employers, professions and government’. Interestingly, alongside this strongly underlined claim to be highly independent of these constituencies, Marc said without irony, that his antennae are constantly tuned for what he called ‘regulatory capture’, i.e. the HPC being captured by employers or professions! As I write this I recall, see the opening paragraph, that the government has unilaterally altered the composition and line of authority of the HPC. ‘Independent’ maybe but soon with an appointed, not elected Chair.
Marc and Michael argued that in taking on board the psychological therapies ‘they are looking to generate as much consensus as possible through engagement with the professions’ and are hoping that ‘we will all engage with the HPC to find a threshold for entry to the register that will take in as many practitioners as possible’. They are very concerned to strike a balance in the HPC standards between employers who want low thresholds and professions that set them too high. On my challenge that regulation will compromise diversity in the field and along with it innovation and creativity, he said that the HPC ‘wanted their strait jacket of regulation to have a huge degree of freedom’, he wanted ‘as big a tent as we can all live with’.
I was being heard but had anything I said get through?
When several times I raised the issue of HPC’s ‘reputation’ Marc sat back in a way that suggested a greater concern with what I was saying than with some of the rest of the conversation. I mentioned the shaping of reputation through the HPC’s punitive ‘naming and shaming’ complaints adjudication regime, seen by some of us as putting people in the stocks and throwing things at them. He claimed that ‘we don’t do punishment but we accept that the people judged would/should feel punished!’ A semantic marshmallow that. I pointed out that these people they had successfully separated from their mostly NHS employment had previously been accredited by the HPC registrant process. This contradiction of their quality assurance process did not seem to have occurred to them.
Marc Seale has a background in satellite communications and I went on to raise the challenge that the HPC’s Quality Assurance model was fundamentally archaic. This seemed to raise eye brows a little. I outlined the history of quality assurance in manufacturing that had until the 60’s relied on methods of quality control that involved inspection of production output and the subsequent binning of any rejects. This is basically how the HPC regulatory process works. Modern manufacturing long ago rejected this approach in favour of continuous process assurance, i.e. not making any rejects, the Independent Practitioners Network [IPN] model. Why did the HPC think that detecting and publicly binning practitioner rejects would be a good match for the subtleties of the psychological therapies let alone the practitioners they presently regulate? Discussion elicited the sense that Marc doesn’t understand the difference, see Hogan 2000, between input and output accreditation. He claimed that what they did was ‘output accreditation’. As though putting someone on a state register wasn’t a decisive input? There was lots more to say on this but did I really want to be educating the HPC to be more successfully oppressive?
As we moved on I asked them to consider what practitioners such as myself faced with the actual prospect of SR might do. What were the options? Quit? Sign up? (into false compliance) or disappear? I went on to argue for an accommodation with practitioners for whom SR is unacceptable, suggesting that the HPC establish a department that would acknowledge (even register!) dissenters i.e. a Department for Principled Non Compliance [PNC] or as I have lately moved to calling it, Conscientious Objection [CO]. This set them back a bit, ‘we can’t do that, it isn’t in the Act’. Marc came back a bit too quickly on this I felt, suggesting that perhaps there might yet be a hair crack in the granite block of the HPC’s legality. I pressed on, arguing that I believed they probably had lots of discretion if they chose to exercise it. ‘No’ Marc said, I’d find myself in court’. So much for accommodation, and having a big tent. The tent appears to be HP2001 in size and shape.
Marc said a time or two that ‘I should try to take a more positive view of their plans for regulation’. I re-iterated that if they want us to engage, to acknowledge the HPC regulatory process, then formal disengagement might be one of the acceptable options. Like a negotiated entry on to an HPC administered PNC/CO register. I said I thought they would hear more of Principled Non-Compliance/Conscientious Objection.
Footnote: Marc several times underlined the necessity of remembering that Scotland is now a very distinct legislative process from Northern Ireland, Wales and England. However this distinction didn’t seem to much affect the proposed regulatory processes for the psychological therapies i.e. the PLG promises to be both driver, dynamo and taxidermist.
Yesterday I received almost simultaneously two emails that carried the following assertions:
HPC press release:
'The HPC receives positive Performance Review from the health professions watchdog
The Health Professions Council (HPC) has been commended in a report published today by the Council for Healthcare Regulatory Excellence (CHRE) for being an effective and publicly accountable regulator.
The annual Performance Review undertaken for all of the nine UK regulators highlighted that the HPC is a well organised regulator that is clearly committed to constantly improving efficiency and performance'.
Email from an eIpnosis correspondent:
'As regards the CHRE, I attach their response: they mention "new powers", but essentially they can't do anything for us.
I continue to be outraged [...] that a registrant can cause harm, make an error and demonstrate incompetence over time and STILL the client would get no acknowledgement (i.e. no possibility of recovery from the trauma). I'd like to ask the CHRE how widespread this practice is in the other bodies they regulate, and then publicise it. [...]
I am terrified for the public at the prospect of the HPC's being given any other responsibilities, I really am. Seriously now.'
BTW To anyone who takes the trouble to show up at their meetings, CHRE oversight is a threadbare pretence. Take a look at Janet Low's eIpnosis video report on her visit to a CHRE board meeting.