Panorama programmes have a reputation for shocking audiences. Last nights’s programme, ‘Undercover care’ was no exception. It told the story of systematic abuse in a residential care home for people with learning disabilities through graphic, disturbing footage, secretly filmed. Restraint of the ‘patients’ included a routine called ‘kissing the carpet’, in which vulnerable young disabled adults were pinned to the floor, sometimes under a chair, with their hands pinned under the feet of a support worker. The programme reported weeks when 24 such restraints took place – when one would have been shocking enough on its own. Professor Jim Mansell, one of the UK’s authorities on caring for people with learning disabilities and author of numerous reports and studies, was interviewed on the programme. He described the pattern of abuse as one he recognised - in which a senior long serving unqualified member of staff creates the model for others to follow, and no-one dares to challenge or report such abuse to the outside world.
I found this programme particularly shocking in part because I worked as a speech and language therapist with people with learning disabilities in the 1980s. At that time, institutional care was still common and stories of abuse were also widely reported in the press – although without the benefit of clever hidden cameras. I vigorously supported the campaign to close these long stay hospitals, many of which I had visited as part of a three year research study. Thankfully, almost all these large institutions had gone by the mid 1990s, replaced by smaller, more home-like residential facilities, closer to communities and families, more accessible to visitors, more transparent in their management.
But still the abuse continues. The Panorama programme has already led to a series of apologies, suspensions and soul searching. For me, it highlights yet again the importance of regulating individuals as well as institutions. On the spot inspections of care homes will only go so far in uncovering systematic abuse, because it can only ever be periodic inspection, whether unannounced or not. Castlebeck’s home had been inspected three times in the previous 2 years and there was ‘no evidence of systematic abuse’. We need to have regulation of all those employed in the care of vulnerable people, not just those whose qualifications give them more responsibility. We need a system which makes raising concerns about colleagues clear, simple and decisive and acceptable. We do not have a mandatory system of regulation for support workers in England. I look forward to the time when we do.
Anna van der Gaag
Chair
HPC
03 June 2011
12 April 2011
New Standards of Proficiency for social workers in England: Reflecting the complexity of social work practice
Many people will be aware that the Government has proposed to transfer responsibility for the regulation of social workers in England to the HPC. As part of the preparations for this transfer, we established a working group (known as a Professional Liaison Group) of experts in the field of social work to assist us with the drafting of new standards of proficiency for social workers in England. This group met for the last time this week, having met four times since November.
The purpose of the standards of proficiency is to establish threshold standards necessary for safe and effective practice. They must reflect existing requirements and training provision, and must be flexible enough to apply to the different environments in which social workers practise. Each profession regulated by HPC has developed standards, written as part of the overarching standards which apply to all. This is a legal requirement, and the standards are specified in the legislation, which is why they had to be developed in addition to existing frameworks and standards, such the Professional Capabilities Framework or the National Occupational Standards. The HPC standards of proficiency serve a particular purpose – they are threshold standards for safe and effective practise for social workers in England – and although they do relate to the existing frameworks they have to be created for each profession regulated by HPC.
The key challenge is to ensure that the standards reflect the values of social work, the complexity of practice and diversity of contexts and settings in which social workers find themselves.
The process of drafting standards requires individuals who are able to focus on the nuances of the meaning of a sentence whilst holding the big picture of what lies at the heart of social work practice. Over the years I have taken part in many PLG meetings at HPC. I have rarely seen a group work so well together so quickly on what is ahugely challenging task. The representatives from the social work community included social work managers, employers, academics, professional body, regulatory body and union representatives. The group was well chaired by Professor Jeff Lucas, a lay member of the HPC Council and included three Members of the HPC Council. The feedback from members on the process and the way it was conducted by the HPC Executive was positive and constructive.
The next step is to ensure that the standards are thoroughly reviewed by a wide range of stakeholders before being approved by the HPC’s Education and Training Committee and Council. Once published, the standards will be subject to ongoing reviews and updates to ensure that they continue to develop and change with the profession. There is more work to be done in ensuring that the standards are clearly situated within existing standards and frameworks for social workers in England, and that the relationships between these different standards and their particular purpose is clearly understood. I have no doubt that the collaborative spirit in which this first stage has been conducted will continue to influence the process as it unfolds, and I am grateful to all those who have taken the draft standards thus far. The beginning is always the hardest part.
Anna van der Gaag
Chair
HPC
The purpose of the standards of proficiency is to establish threshold standards necessary for safe and effective practice. They must reflect existing requirements and training provision, and must be flexible enough to apply to the different environments in which social workers practise. Each profession regulated by HPC has developed standards, written as part of the overarching standards which apply to all. This is a legal requirement, and the standards are specified in the legislation, which is why they had to be developed in addition to existing frameworks and standards, such the Professional Capabilities Framework or the National Occupational Standards. The HPC standards of proficiency serve a particular purpose – they are threshold standards for safe and effective practise for social workers in England – and although they do relate to the existing frameworks they have to be created for each profession regulated by HPC.
The key challenge is to ensure that the standards reflect the values of social work, the complexity of practice and diversity of contexts and settings in which social workers find themselves.
The process of drafting standards requires individuals who are able to focus on the nuances of the meaning of a sentence whilst holding the big picture of what lies at the heart of social work practice. Over the years I have taken part in many PLG meetings at HPC. I have rarely seen a group work so well together so quickly on what is ahugely challenging task. The representatives from the social work community included social work managers, employers, academics, professional body, regulatory body and union representatives. The group was well chaired by Professor Jeff Lucas, a lay member of the HPC Council and included three Members of the HPC Council. The feedback from members on the process and the way it was conducted by the HPC Executive was positive and constructive.
The next step is to ensure that the standards are thoroughly reviewed by a wide range of stakeholders before being approved by the HPC’s Education and Training Committee and Council. Once published, the standards will be subject to ongoing reviews and updates to ensure that they continue to develop and change with the profession. There is more work to be done in ensuring that the standards are clearly situated within existing standards and frameworks for social workers in England, and that the relationships between these different standards and their particular purpose is clearly understood. I have no doubt that the collaborative spirit in which this first stage has been conducted will continue to influence the process as it unfolds, and I am grateful to all those who have taken the draft standards thus far. The beginning is always the hardest part.
Anna van der Gaag
Chair
HPC
09 February 2011
BLOG update: Counsellors and psychotherapists working group meets for the last time
Last week, the tenth and final meeting of the HPC professional liaison group on counsellors and psychotherapists took place before a packed public gallery of observers.
Since the meeting in December last year, the counsellor and psychotherapy members of the group have held meetings to undertake further reviews of the draft standards of proficiency.
There were three substantive items on the agenda – consideration of a new draft set of standards for psychotherapists working with children and young people, the draft standards of education and training, and the revised draft standards of proficiency for counsellors and psychotherapists, aligned with the new version of the generic standards of proficiency.
The Group had already made an in principle decision that the profession specific standards of proficiency should be drafted for counsellors at Level 5 and Level 7, and Level 7 for psychotherapists, effectively creating two level of entry points for counsellors, and one for psychotherapists. This meeting provided an opportunity for the whole group to review these draft standards with a view to making recommendations to the HPC Council in due course.
As ever there was a wide ranging discussion on almost all of these issues, and at several points the group felt it was important to take an indicative vote amongst those from the counselling and psychotherapy professions around the table. The outcome of this voting was as follows
• There was agreement (one abstention) that the first entry point for counsellors should be set at Level 5.
• There was agreement (one abstention) that there should be different entry points for counsellors – one at Level 5 and the other at level 7
These outcomes represent significant progress in the work to describe different levels of practise.
On the other two substantive points, - creating a separate set of standards of proficiency for child psychotherapists and holding two separate sets of standards of proficiency for counsellors and psychotherapists at Level 7 - the group did not reach a consensus. . These matters were therefore referred to the HPC Council for further deliberation.
There were passionate views round the table, not least over the importance of the language of the standards, and a clear feeling that there were differences in identity, philosophy and semantics between counsellors and psychotherapists. There were also differences in practise, which some felt could be more clearly articulated in the draft standards at Level 7. However, the opposite view was that that differentiation at entry level 7 was not supported by evidence from the field – there were currently counsellors and psychotherapists who use the title interchangeably, applying theory and practise from both fields, depending on the context.
The disparity continues to centre around describing differentiation – and specifically how and what differentiates a counsellor and a psychotherapist trained to Level 7 when they qualify from a training programme. For me, the debate is a philosophical and ideological one – tied up closely with identity. I did not hear anyone say that there was no difference between the two – only disparate views on how and what distinguishes them at the point of entry to practise.
Since the outset of the work of the PLG, references have been made to the ‘building blocks’ of regulation – standards, levels of entry to the Register and the structure of the Register being examples of these. It struck me after the meeting that the standards could also be described using the analogy of a climbing wall. The standards are something like the footholds and hand-grips on a climbing wall. If the wall is ‘professional practise’, and the climbers are practitioners – there are an almost unlimited number of ways that the wall can be climbed. For counsellors and psychotherapists, we may not yet have agreement on where the foothold and hand grips should be placed on the wall, but we are significantly closer now than we were a year ago.
This debate will therefore continue well beyond the ending of the PLG. I very much believe that this further work will bring us to a pragmatic solution that is acceptable to the majority. Members of the PLG have been tenacious in their commitment to this work, and have created new milestones, new agreements, new clarity. Without clear standards, there can be no robust regulation. On behalf of the Council, I would like to thank them for their personal investment and considered contribution to this important work.
Anna van der Gaag
Chair
HPC
Since the meeting in December last year, the counsellor and psychotherapy members of the group have held meetings to undertake further reviews of the draft standards of proficiency.
There were three substantive items on the agenda – consideration of a new draft set of standards for psychotherapists working with children and young people, the draft standards of education and training, and the revised draft standards of proficiency for counsellors and psychotherapists, aligned with the new version of the generic standards of proficiency.
The Group had already made an in principle decision that the profession specific standards of proficiency should be drafted for counsellors at Level 5 and Level 7, and Level 7 for psychotherapists, effectively creating two level of entry points for counsellors, and one for psychotherapists. This meeting provided an opportunity for the whole group to review these draft standards with a view to making recommendations to the HPC Council in due course.
As ever there was a wide ranging discussion on almost all of these issues, and at several points the group felt it was important to take an indicative vote amongst those from the counselling and psychotherapy professions around the table. The outcome of this voting was as follows
• There was agreement (one abstention) that the first entry point for counsellors should be set at Level 5.
• There was agreement (one abstention) that there should be different entry points for counsellors – one at Level 5 and the other at level 7
These outcomes represent significant progress in the work to describe different levels of practise.
On the other two substantive points, - creating a separate set of standards of proficiency for child psychotherapists and holding two separate sets of standards of proficiency for counsellors and psychotherapists at Level 7 - the group did not reach a consensus. . These matters were therefore referred to the HPC Council for further deliberation.
There were passionate views round the table, not least over the importance of the language of the standards, and a clear feeling that there were differences in identity, philosophy and semantics between counsellors and psychotherapists. There were also differences in practise, which some felt could be more clearly articulated in the draft standards at Level 7. However, the opposite view was that that differentiation at entry level 7 was not supported by evidence from the field – there were currently counsellors and psychotherapists who use the title interchangeably, applying theory and practise from both fields, depending on the context.
The disparity continues to centre around describing differentiation – and specifically how and what differentiates a counsellor and a psychotherapist trained to Level 7 when they qualify from a training programme. For me, the debate is a philosophical and ideological one – tied up closely with identity. I did not hear anyone say that there was no difference between the two – only disparate views on how and what distinguishes them at the point of entry to practise.
Since the outset of the work of the PLG, references have been made to the ‘building blocks’ of regulation – standards, levels of entry to the Register and the structure of the Register being examples of these. It struck me after the meeting that the standards could also be described using the analogy of a climbing wall. The standards are something like the footholds and hand-grips on a climbing wall. If the wall is ‘professional practise’, and the climbers are practitioners – there are an almost unlimited number of ways that the wall can be climbed. For counsellors and psychotherapists, we may not yet have agreement on where the foothold and hand grips should be placed on the wall, but we are significantly closer now than we were a year ago.
This debate will therefore continue well beyond the ending of the PLG. I very much believe that this further work will bring us to a pragmatic solution that is acceptable to the majority. Members of the PLG have been tenacious in their commitment to this work, and have created new milestones, new agreements, new clarity. Without clear standards, there can be no robust regulation. On behalf of the Council, I would like to thank them for their personal investment and considered contribution to this important work.
Anna van der Gaag
Chair
HPC
17 December 2010
A day in court
On Friday, I attended a hearing in the Administrative court to address the question of whether the case brought by six psychotherapy and psychoanalysis practitioner groups should proceed to a full judicial hearing. HPC argued that the claimants were ‘out of time’ in legal speak, in other words they had not lodged their complaint within the timeframe for a judicial review. The Judge decided that, although as he put it “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. We can expect a delay of about four to six months before this hearing will be listed in the High Court. In the meantime, the HPC is committed to the process of finding ‘the common ground’ as Justice Burton directed.
What struck me about the exchange in court was that the claimant’s real argument is with the government, and not the HPC. We can and probably will continue to argue on points of law, about who did what and when and according to which process or guidance or directive, but the decision over statutory regulation is not and never has been a decision for the HPC. It is a decision for government. The frustration is that we are now involved in an expensive process which will not, in the end, solve this.
Since this work on regulation began, there has been significant progress both in working relationships and in the practical development of standards. In September, the UKCP invited the HPC to an education event for its members, something which would not have been possible earlier this year. There have been many other initiatives which suggest to me that the level of disquiet about HPC is subsiding, and the level of mutual respect and shared aspiration is increasing.
Anna van der Gaag
Chair HPC
What struck me about the exchange in court was that the claimant’s real argument is with the government, and not the HPC. We can and probably will continue to argue on points of law, about who did what and when and according to which process or guidance or directive, but the decision over statutory regulation is not and never has been a decision for the HPC. It is a decision for government. The frustration is that we are now involved in an expensive process which will not, in the end, solve this.
Since this work on regulation began, there has been significant progress both in working relationships and in the practical development of standards. In September, the UKCP invited the HPC to an education event for its members, something which would not have been possible earlier this year. There have been many other initiatives which suggest to me that the level of disquiet about HPC is subsiding, and the level of mutual respect and shared aspiration is increasing.
Anna van der Gaag
Chair HPC
26 October 2010
A meeting of minds
On the 7th October, HPC held an information event for counsellors and psychotherapists in Glasgow. It was well attended. We began with a presentation on the purpose of regulation, and moved on to an update of the work of the Professional Liaison Group for psychotherapists and counsellors and a description of the HPC’s Fitness to Practise process. This was followed by an hour long Question and answer session with a panel. Brain McGee, Chief Executive of COSCA (Counselling in Scotland) and member of the HPC’s PLG, joined us on the panel.
The audience raised a wide range of issues about the proposals for statutory regulation. First, there were concerns about the potential financial impact of regulation on voluntary sector organisations and their volunteers. In Scotland there is a strong and well established infrastructure of volunteers who provide counselling services, perhaps more so than in other parts of the UK, and the issue of funding the fee could become a breaking point. There was discussion around whether the Scottish government could or would offer a subsidy, given the widespread use of volunteer counselling services in Scotland.
Some representatives from the voluntary sector organisations also asked about the timescale for the implementation of statutory regulation, and expressed frustration at the continuing delay. As well as the desire to fully address the complexity of some of the issues about regulating psychotherapists and counsellors the uncertainly around the current governments position in this regard was also noted by the audience.
There was discussion about some of the unresolved issues still being considered by the PLG, such as the criteria for selecting voluntary registers for transfer, differentiation between counselling and psychotherapy, and what individuals would call themselves post regulation. There was some feeling expressed that the result of the consultation exercise showing that 78% of individuals did not favour differentiation should be taken as a clear sign of the views of counsellors and psychotherapists. However, the HPC noted that these figures might not convey the full picture as a number of the current voluntary registers had asked individuals to respond directly to them and had collated views.
There was a discussion around the relationship between professional bodies and the regulator – with concerns expressed that regulation would diminish the role of the professional bodies. Clearly, HPC could not replace the services and support offered by these bodies. The panel responded by referring to previous experiences from other professions where the role of the professional body as the body focused on promotion of the standards and the reputation of the profession was enhanced once the disciplinary function was transferred.
Fitness to practise processes were also raised, in particular concerns about how the HPC supported those individuals for whom there was no case to answer. What was the duty of care to them? Kelly Johnson, Director of Fitness to Practise described the processes that had been put in place to support individuals and outlined the work being done exploring the role of mediation in a regulatory context. She acknowledged again the significant stress arising from any scrutiny of an individual’s practise.
I personally was heartened to hear that at least one individual who had attended one of our previous stakeholder events held in Manchester in 2009, said she felt this event showed that the HPC was listening to the views of practitioners and was more constructive in the dialogue. There has been the need for some culture shifts/changes in approach for us as an organisation in thinking about the regulation of psychotherapists and counsellors. I hope that such listening will continue on both sides.. The whole event did feel like a conversation that was illuminating for both listeners and speakers, and I was pleased to be part of it.
Anna van der Gaag
Chair HPC
The audience raised a wide range of issues about the proposals for statutory regulation. First, there were concerns about the potential financial impact of regulation on voluntary sector organisations and their volunteers. In Scotland there is a strong and well established infrastructure of volunteers who provide counselling services, perhaps more so than in other parts of the UK, and the issue of funding the fee could become a breaking point. There was discussion around whether the Scottish government could or would offer a subsidy, given the widespread use of volunteer counselling services in Scotland.
Some representatives from the voluntary sector organisations also asked about the timescale for the implementation of statutory regulation, and expressed frustration at the continuing delay. As well as the desire to fully address the complexity of some of the issues about regulating psychotherapists and counsellors the uncertainly around the current governments position in this regard was also noted by the audience.
There was discussion about some of the unresolved issues still being considered by the PLG, such as the criteria for selecting voluntary registers for transfer, differentiation between counselling and psychotherapy, and what individuals would call themselves post regulation. There was some feeling expressed that the result of the consultation exercise showing that 78% of individuals did not favour differentiation should be taken as a clear sign of the views of counsellors and psychotherapists. However, the HPC noted that these figures might not convey the full picture as a number of the current voluntary registers had asked individuals to respond directly to them and had collated views.
There was a discussion around the relationship between professional bodies and the regulator – with concerns expressed that regulation would diminish the role of the professional bodies. Clearly, HPC could not replace the services and support offered by these bodies. The panel responded by referring to previous experiences from other professions where the role of the professional body as the body focused on promotion of the standards and the reputation of the profession was enhanced once the disciplinary function was transferred.
Fitness to practise processes were also raised, in particular concerns about how the HPC supported those individuals for whom there was no case to answer. What was the duty of care to them? Kelly Johnson, Director of Fitness to Practise described the processes that had been put in place to support individuals and outlined the work being done exploring the role of mediation in a regulatory context. She acknowledged again the significant stress arising from any scrutiny of an individual’s practise.
I personally was heartened to hear that at least one individual who had attended one of our previous stakeholder events held in Manchester in 2009, said she felt this event showed that the HPC was listening to the views of practitioners and was more constructive in the dialogue. There has been the need for some culture shifts/changes in approach for us as an organisation in thinking about the regulation of psychotherapists and counsellors. I hope that such listening will continue on both sides.. The whole event did feel like a conversation that was illuminating for both listeners and speakers, and I was pleased to be part of it.
Anna van der Gaag
Chair HPC
18 May 2010
Counsellors and psychotherapists working group meets again
Anna van der Gaag, Chair of HPC writes:
On the 12 May 2010, the sixth meeting of the HPC’s working group (called the professional liaison group) on counsellors and psychotherapists took place in London. The purpose of the meeting was to review progress and to discuss the plan of activities over the coming months.
There was a consensus round the table that progress had been made over the past year. Areas where further work was necessary were now more clearly in focus. The HPC’s initiatives on reviewing the generic standards of proficiency, and the Council’s recognition that the generic standards needed to become more over arching and less orientated towards the language of ‘health’ were seen as a key to accommodating counsellors and psychotherapists within the existing structures. There was also an acknowledgement that HPC’s ongoing engagement with the professional associations was important to making progress on all the outstanding issues – differentiation between counsellors and psychotherapists, child and adult work, as well as consensus building on the standards of proficiency and the standards on education and training. Third, members of the group spent time discussing the wider debates taking place about regulation, and the need for ongoing engagement with those who currently oppose regulation. There was an acknowledgement of the range of reasons behind opposition to HPC as a regulator. Several members felt it would be helpful to know more of the detail behind the proposals for the alternative form of regulation being proposed.
The planned activities over the coming months will centre around the PLG’s further engagement with a range of stakeholders as well as further deliberations by the group on the outstanding issues outlined above. There was agreement that the group wished to invite service users to present their perspectives on these issues, as their voice had been under represented. Careful consideration would need to be given to how best to hear more from users on their experiences of counselling and psychotherapy and views on regulation. Other suggestions included employers and those with expertise in working with children, some additional perspectives on regulation of the profession across the world, and possibly additional input from educationalists when giving further consideration to standards from education and training.
The work of the PLG in gathering more expertise and hearing from a wider range of stakeholders will run in parallel with four public meetings across the UK. These public meetings will provide opportunities for further dialogue with the profession. Each meeting will include presentations from HPC on its work, a question and answer session and workshops.
My own observation was that there were several threads running through today’s discussions – one was the ongoing need for the PLG members and the HPC to engage with the profession. The second was the centrality of the relational element in counselling and psychotherapy – which was common across all modalities - and should be clearly recognised and articulated in the current debate. The meeting was, as ever, populated by a wide ranging and constructive dialogue and a desire to make further progress towards statutory regulation.
Anna van der Gaag
Chair
HPC
On the 12 May 2010, the sixth meeting of the HPC’s working group (called the professional liaison group) on counsellors and psychotherapists took place in London. The purpose of the meeting was to review progress and to discuss the plan of activities over the coming months.
There was a consensus round the table that progress had been made over the past year. Areas where further work was necessary were now more clearly in focus. The HPC’s initiatives on reviewing the generic standards of proficiency, and the Council’s recognition that the generic standards needed to become more over arching and less orientated towards the language of ‘health’ were seen as a key to accommodating counsellors and psychotherapists within the existing structures. There was also an acknowledgement that HPC’s ongoing engagement with the professional associations was important to making progress on all the outstanding issues – differentiation between counsellors and psychotherapists, child and adult work, as well as consensus building on the standards of proficiency and the standards on education and training. Third, members of the group spent time discussing the wider debates taking place about regulation, and the need for ongoing engagement with those who currently oppose regulation. There was an acknowledgement of the range of reasons behind opposition to HPC as a regulator. Several members felt it would be helpful to know more of the detail behind the proposals for the alternative form of regulation being proposed.
The planned activities over the coming months will centre around the PLG’s further engagement with a range of stakeholders as well as further deliberations by the group on the outstanding issues outlined above. There was agreement that the group wished to invite service users to present their perspectives on these issues, as their voice had been under represented. Careful consideration would need to be given to how best to hear more from users on their experiences of counselling and psychotherapy and views on regulation. Other suggestions included employers and those with expertise in working with children, some additional perspectives on regulation of the profession across the world, and possibly additional input from educationalists when giving further consideration to standards from education and training.
The work of the PLG in gathering more expertise and hearing from a wider range of stakeholders will run in parallel with four public meetings across the UK. These public meetings will provide opportunities for further dialogue with the profession. Each meeting will include presentations from HPC on its work, a question and answer session and workshops.
My own observation was that there were several threads running through today’s discussions – one was the ongoing need for the PLG members and the HPC to engage with the profession. The second was the centrality of the relational element in counselling and psychotherapy – which was common across all modalities - and should be clearly recognised and articulated in the current debate. The meeting was, as ever, populated by a wide ranging and constructive dialogue and a desire to make further progress towards statutory regulation.
Anna van der Gaag
Chair
HPC
30 April 2010
The proposed regulation of counsellors and psychotherapists: reflections from the Chair
Anna van der Gaag, Chair of HPC writes:
In recent months I have benefited greatly from conversations with members of the profession, who have discussed the government’s proposals for statutory regulation. Several have asked me to write a brief statement, which may help to explain some facts to those unfamiliar with the HPC and in particular, to describe our underlying principles as well as practices.
When was the HPC set up?
The HPC was established in 2001, as the UK wide statutory regulator for 12 professions working in NHS, education and social care settings as well as private practitioners. From the start, it was given a remit to advise the government on the statutory regulation of additional professions and by 2010, it had assumed responsibility for regulating three further professions, including psychologists.
How do professions become regulated by HPC?
There are two ways in which a profession can be recommended for regulation by the HPC.
Firstly, the HPC itself has the legal power to make recommendations to the Secretary of State for Health and to Scottish Ministers on the regulation of a profession. To help us in exercising this power we have a ‘new professions process’ through which professional bodies representing professions seeking regulation can apply and demonstrate that they meet 10 criteria for regulation. To date we have received unsolicited applications via this route from 11 professions, including dance movement therapists, and have made recommendations for their regulation to government.
Secondly, the government can make a decision to regulate a profession itself, normally via a White Paper. In 2007, this was the route chosen by the government for the regulation of several professions, including psychologists, counsellors and psychotherapists. Direct reference is made to the government’s desire to regulate these professions in the White Paper entitled ‘Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ .
What do we do?
The four key functions of a statutory professional regulator are to
• Set and monitor standards for the professions regulated by them, including standards on continuing professional development
• Keep a register of those who meet the standards
• Monitor and approve education programmes
• Run a fitness to practise process
Underlying principles
There are several key principles underpinning our work. First, many of our standards are ‘generic’, that is they are designed to apply to all the professions that we regulate. This recognises the similarities between many professions, and allows for greater consistency and clarity from the public’s perspective. Second, our legislation is compliant with Human Rights principles and law, and is designed to protect the public and not to ‘punish’ practitioners. This compliance underpins all our processes – from the way in which standards are agreed and set, to the organisation, language and delivery of fitness to practise processes. For example, there is no reference in the fitness to practise process to ‘punishment’ or ‘guilt’ ‘ ‘defendant’ or ‘charges.’ The emphasis is on establishing whether the person’s ‘fitness to practise’ is ‘impaired’ and whether public protection is ‘required’ in relation to that individual.
How does the Fitness to Practise process work?
Anyone can make an allegation against any practitioner on our register. We decide whether the allegation meets our standard of acceptance for an allegation and if it does, we start a process to assess whether or not the practitioner does, or does not meet our standards. We do recognise that any examination of a professional’s work is going to be stressful and will have an impact on all those involved.
The process involves a number of stages, and we make sure that we communicate with the individuals concerned so that they know what is happening at each stage. It may involve a full public hearing at which all sides have an opportunity to have their views heard by a panel. There are certain circumstances in which hearings are heard or part heard in private, for example, when panels are required to consider details of a professional’s physical or mental health, or where the identity of witnesses need to be protected. However we adhere to the ‘open justice principle’ used throughout the United Kingdom, which means that in general our hearings are held in public.
The panels are made up of professional and lay people. They will always include a person who is from the same profession as the practitioner, and where appropriate there will be experts from the field who are invited to give their views at the hearing. The HPC has well over 400 Partners, many drawn from the professions themselves, who undertake the work of inspecting education programmes, assessing applications to join the register, as well as sitting as panel members at fitness to practise hearings. There are also many ‘lay’ Partners, who come from a wide variety of public service and independent sector backgrounds, and are all given training in HPC’s principles and processes. If we were to regulate counsellors and psychotherapists, we would recruit new Partners from the various counselling and psychotherapy modalities and disciplines to undertake this work.
Onora O’Neill, in her book ‘A Question of Trust’, talks about the importance of having ‘individuals with knowledge’ responsible for making judgements. HPC is wholly committed to ensuring that this is the case in all its day to day decisions – whether about education standards or ethical standards or standards of competence or – ‘proficiency’ as it is called in law – for a particular profession.
Where panels identify that a registrant’s fitness to practise is impaired, they must determine what degree of public protection (if any) is required. Panels should approach this in a proportionate manner and as so far as possible, registrants should be allowed to remain in practice subject to any necessary restrictions if that is consistent with public protection.
HPC’s approach to justice, para 9.0, 2010.
When determining what action to take, the panel have a range of sanctions which it can apply to practitioners, including placing conditions on practise, or requiring a period of supervised practise, or suspending the person from work until such time as they are ready to return to work.
The approach to justice at HPC is, in this sense, restorative, not retributive in nature (see illustration below showing the justice continuum). The panels of the HPC are not there to punish individuals, although a small minority of individuals (currently 0.03%) are taken of the register and are not able to continue practising. These individuals have in most instances been identified as posing a serious risk to the public by an independent panel with representation from the profession itself.
We know from independent sources (Borys and Pope, 1989, Pope, 1991, Sarkar, 2004) that there is evidence that a minority of practitioners do present a risk to the public but it is only a tiny minority.
Recognising what is different about counsellors and psychotherapists
Many psychotherapists and counsellors have discussed with me the complex nature of their work with individuals. Depending on their ideology and discipline, they explain this in different language, but one of the common themes that comes across is that therapy can be a risky business – and we know that some argue that any kind of ‘talking’ therapy is inherently risky. People who come for therapy can be ‘damaged’ by events and circumstances, vulnerable, abused, and angry as well as searching for greater levels of insight and understanding. The risk therefore of misinterpretation, retaliation, or disappointment is often high, and the therapist enters into therapy with a degree of awareness that the client may, or may not derive benefit, and may or may not find the experience of therapy to be a positive one. Indeed, many will undergo therapy which becomes difficult, painful, confusing and challenging, though in the majority of cases the outcome will leave the person feeling that therapy has been a rewarding and strengthening experience.
If one introduced a system of statutory regulation into this therapeutic environment, then the concern is that there will be therapists who are ‘blamed’ by their clients for disappointment or disorder in their lives which may have nothing to do with the therapist’s behaviour or competence. It is the relational element in counselling and psychotherapy, common across all modalities and central to the therapeutic process itself, that gives rise to great complexity and therefore greater potential for misrepresentation.
HPC is aware that theses are some of the concerns amongst practitioners. However, I believe that the system of regulation delivered by HPC is able to accommodate this, whilst still offering the level of public re-assurance and protection. I believe this for a number of reasons:
Firstly, our fitness to practise process is about deciding whether a professional remains fit to practise. Sometimes a client might be unhappy about their therapy or their therapist, for example, they are unhappy because they didn’t find their therapy helped them. We have to consider the complaints we receive individually but we only need to take action where a practitioner’s fitness to practise might be impaired and where we might need to take action to protect other members of the public.
The HPC cannot address all complaints, and nor does it wish to. It is concerned only with investigating impairment in practise which has consequences for public protection. For example, the fitness to practise of a therapist who borrows money from their client or who engages in sexual activity with a client during therapy sessions is very likely to be impaired.
In these examples most members of the public and indeed fellow therapists would reasonably conclude that this was unacceptable behaviour. These are the kinds of issues of impairment that have consequences for public protection.
Secondly, we have experience in regulating arts psychotherapists, a group of therapists with whom there is certainly some commonality with counsellors and psychotherapists. From this experience we know that the number of allegations against these professions has been very small. For example, between 2005 and 2007, there were four allegations against arts therapists. The assertion that the HPC is receiving many dozens of complaints against talking therapists is unfounded.
Lastly, the standards we use are ‘enabling’ standards, not prescriptive standards. We do not and would not prescribe what should happen during each therapy session, for example, and we recognise that professionals on our register might meet our standards in a variety of different ways, depending upon, for example, their professional background, their personal preference, and the needs of individual clients.
In a recent article published in the spring edition of ‘New Associations’, Val Huet, group psychotherapist and Chief Executive of the British Association of Art Therapists, told New Associations, the new publication from the British Psychoanalytic Council ,
‘Nobody from HPC is going to stand at your elbow and say you must do this or that. Their concern is public protection.”
Furthermore we are in the process of reviewing our standards to make them more overarching and to remove the language of health and disease which has caused concern.
HPC’s plans for Mediation research
There are some disputes between therapist and client that may be more amenable to different means of resolution, such as mediation. Such alternatives will be more appropriate in some circumstances than others, and will depend upon factors such as the nature and severity of the allegation and whether or not both parties agree to such an approach. They can reduce the impact of the experience of bringing an allegation for both parties and provide a way of resolving conflict. We are looking at how and when such approaches are applied in other fields of work, and will then make a decision as to whether or how they might be piloted by HPC. We will be working closely with the professions on this, and there will be further updates on the progress of this work later in the year.
References
Department of Health (2007)
Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ .
HPC Fitness to Practise Annual Report 2009
www.hpc-uk.org/publications
HPC’s Approach to Justice and Impairment
Council papers, March 25 2010, Enclosure 9.
New Associations – News analysis and opinion from the psychoanalytic community. ‘Forging as modern profession’, Spring Issue 2010, p6-7.
O’neill, O. (2002) A Question of Trust. Reith Lectures 2002
In recent months I have benefited greatly from conversations with members of the profession, who have discussed the government’s proposals for statutory regulation. Several have asked me to write a brief statement, which may help to explain some facts to those unfamiliar with the HPC and in particular, to describe our underlying principles as well as practices.
When was the HPC set up?
The HPC was established in 2001, as the UK wide statutory regulator for 12 professions working in NHS, education and social care settings as well as private practitioners. From the start, it was given a remit to advise the government on the statutory regulation of additional professions and by 2010, it had assumed responsibility for regulating three further professions, including psychologists.
How do professions become regulated by HPC?
There are two ways in which a profession can be recommended for regulation by the HPC.
Firstly, the HPC itself has the legal power to make recommendations to the Secretary of State for Health and to Scottish Ministers on the regulation of a profession. To help us in exercising this power we have a ‘new professions process’ through which professional bodies representing professions seeking regulation can apply and demonstrate that they meet 10 criteria for regulation. To date we have received unsolicited applications via this route from 11 professions, including dance movement therapists, and have made recommendations for their regulation to government.
Secondly, the government can make a decision to regulate a profession itself, normally via a White Paper. In 2007, this was the route chosen by the government for the regulation of several professions, including psychologists, counsellors and psychotherapists. Direct reference is made to the government’s desire to regulate these professions in the White Paper entitled ‘Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ .
What do we do?
The four key functions of a statutory professional regulator are to
• Set and monitor standards for the professions regulated by them, including standards on continuing professional development
• Keep a register of those who meet the standards
• Monitor and approve education programmes
• Run a fitness to practise process
Underlying principles
There are several key principles underpinning our work. First, many of our standards are ‘generic’, that is they are designed to apply to all the professions that we regulate. This recognises the similarities between many professions, and allows for greater consistency and clarity from the public’s perspective. Second, our legislation is compliant with Human Rights principles and law, and is designed to protect the public and not to ‘punish’ practitioners. This compliance underpins all our processes – from the way in which standards are agreed and set, to the organisation, language and delivery of fitness to practise processes. For example, there is no reference in the fitness to practise process to ‘punishment’ or ‘guilt’ ‘ ‘defendant’ or ‘charges.’ The emphasis is on establishing whether the person’s ‘fitness to practise’ is ‘impaired’ and whether public protection is ‘required’ in relation to that individual.
How does the Fitness to Practise process work?
Anyone can make an allegation against any practitioner on our register. We decide whether the allegation meets our standard of acceptance for an allegation and if it does, we start a process to assess whether or not the practitioner does, or does not meet our standards. We do recognise that any examination of a professional’s work is going to be stressful and will have an impact on all those involved.
The process involves a number of stages, and we make sure that we communicate with the individuals concerned so that they know what is happening at each stage. It may involve a full public hearing at which all sides have an opportunity to have their views heard by a panel. There are certain circumstances in which hearings are heard or part heard in private, for example, when panels are required to consider details of a professional’s physical or mental health, or where the identity of witnesses need to be protected. However we adhere to the ‘open justice principle’ used throughout the United Kingdom, which means that in general our hearings are held in public.
The panels are made up of professional and lay people. They will always include a person who is from the same profession as the practitioner, and where appropriate there will be experts from the field who are invited to give their views at the hearing. The HPC has well over 400 Partners, many drawn from the professions themselves, who undertake the work of inspecting education programmes, assessing applications to join the register, as well as sitting as panel members at fitness to practise hearings. There are also many ‘lay’ Partners, who come from a wide variety of public service and independent sector backgrounds, and are all given training in HPC’s principles and processes. If we were to regulate counsellors and psychotherapists, we would recruit new Partners from the various counselling and psychotherapy modalities and disciplines to undertake this work.
Onora O’Neill, in her book ‘A Question of Trust’, talks about the importance of having ‘individuals with knowledge’ responsible for making judgements. HPC is wholly committed to ensuring that this is the case in all its day to day decisions – whether about education standards or ethical standards or standards of competence or – ‘proficiency’ as it is called in law – for a particular profession.
Where panels identify that a registrant’s fitness to practise is impaired, they must determine what degree of public protection (if any) is required. Panels should approach this in a proportionate manner and as so far as possible, registrants should be allowed to remain in practice subject to any necessary restrictions if that is consistent with public protection.
HPC’s approach to justice, para 9.0, 2010.
When determining what action to take, the panel have a range of sanctions which it can apply to practitioners, including placing conditions on practise, or requiring a period of supervised practise, or suspending the person from work until such time as they are ready to return to work.
The approach to justice at HPC is, in this sense, restorative, not retributive in nature (see illustration below showing the justice continuum). The panels of the HPC are not there to punish individuals, although a small minority of individuals (currently 0.03%) are taken of the register and are not able to continue practising. These individuals have in most instances been identified as posing a serious risk to the public by an independent panel with representation from the profession itself.
We know from independent sources (Borys and Pope, 1989, Pope, 1991, Sarkar, 2004) that there is evidence that a minority of practitioners do present a risk to the public but it is only a tiny minority.
Recognising what is different about counsellors and psychotherapists
Many psychotherapists and counsellors have discussed with me the complex nature of their work with individuals. Depending on their ideology and discipline, they explain this in different language, but one of the common themes that comes across is that therapy can be a risky business – and we know that some argue that any kind of ‘talking’ therapy is inherently risky. People who come for therapy can be ‘damaged’ by events and circumstances, vulnerable, abused, and angry as well as searching for greater levels of insight and understanding. The risk therefore of misinterpretation, retaliation, or disappointment is often high, and the therapist enters into therapy with a degree of awareness that the client may, or may not derive benefit, and may or may not find the experience of therapy to be a positive one. Indeed, many will undergo therapy which becomes difficult, painful, confusing and challenging, though in the majority of cases the outcome will leave the person feeling that therapy has been a rewarding and strengthening experience.
If one introduced a system of statutory regulation into this therapeutic environment, then the concern is that there will be therapists who are ‘blamed’ by their clients for disappointment or disorder in their lives which may have nothing to do with the therapist’s behaviour or competence. It is the relational element in counselling and psychotherapy, common across all modalities and central to the therapeutic process itself, that gives rise to great complexity and therefore greater potential for misrepresentation.
HPC is aware that theses are some of the concerns amongst practitioners. However, I believe that the system of regulation delivered by HPC is able to accommodate this, whilst still offering the level of public re-assurance and protection. I believe this for a number of reasons:
Firstly, our fitness to practise process is about deciding whether a professional remains fit to practise. Sometimes a client might be unhappy about their therapy or their therapist, for example, they are unhappy because they didn’t find their therapy helped them. We have to consider the complaints we receive individually but we only need to take action where a practitioner’s fitness to practise might be impaired and where we might need to take action to protect other members of the public.
The HPC cannot address all complaints, and nor does it wish to. It is concerned only with investigating impairment in practise which has consequences for public protection. For example, the fitness to practise of a therapist who borrows money from their client or who engages in sexual activity with a client during therapy sessions is very likely to be impaired.
In these examples most members of the public and indeed fellow therapists would reasonably conclude that this was unacceptable behaviour. These are the kinds of issues of impairment that have consequences for public protection.
Secondly, we have experience in regulating arts psychotherapists, a group of therapists with whom there is certainly some commonality with counsellors and psychotherapists. From this experience we know that the number of allegations against these professions has been very small. For example, between 2005 and 2007, there were four allegations against arts therapists. The assertion that the HPC is receiving many dozens of complaints against talking therapists is unfounded.
Lastly, the standards we use are ‘enabling’ standards, not prescriptive standards. We do not and would not prescribe what should happen during each therapy session, for example, and we recognise that professionals on our register might meet our standards in a variety of different ways, depending upon, for example, their professional background, their personal preference, and the needs of individual clients.
In a recent article published in the spring edition of ‘New Associations’, Val Huet, group psychotherapist and Chief Executive of the British Association of Art Therapists, told New Associations, the new publication from the British Psychoanalytic Council ,
‘Nobody from HPC is going to stand at your elbow and say you must do this or that. Their concern is public protection.”
Furthermore we are in the process of reviewing our standards to make them more overarching and to remove the language of health and disease which has caused concern.
HPC’s plans for Mediation research
There are some disputes between therapist and client that may be more amenable to different means of resolution, such as mediation. Such alternatives will be more appropriate in some circumstances than others, and will depend upon factors such as the nature and severity of the allegation and whether or not both parties agree to such an approach. They can reduce the impact of the experience of bringing an allegation for both parties and provide a way of resolving conflict. We are looking at how and when such approaches are applied in other fields of work, and will then make a decision as to whether or how they might be piloted by HPC. We will be working closely with the professions on this, and there will be further updates on the progress of this work later in the year.
References
Department of Health (2007)
Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ .
HPC Fitness to Practise Annual Report 2009
www.hpc-uk.org/publications
HPC’s Approach to Justice and Impairment
Council papers, March 25 2010, Enclosure 9.
New Associations – News analysis and opinion from the psychoanalytic community. ‘Forging as modern profession’, Spring Issue 2010, p6-7.
O’neill, O. (2002) A Question of Trust. Reith Lectures 2002
Subscribe to:
Posts (Atom)