Progress (if you can call it that) towards regulation (if you can call it that) of psychotherapy in the UK continues to rumble on. I have been trying to discover more about the reality behind it.
The quango that looks like it will one day regulate psychotherapy here is the Health Professions Council (HPC). It currently regulates various other professions, so I had a look at one of its activities that affects regulated professionals directly — the hearing of complaints.
The HPC’s complaints hearings are reported online. I looked at the reports of twenty hearings at the end of last week to get an impression of what goes on. They were the most recent twenty on the site at that time — not a random sample, but not selected in any other way.
Half of the hearings I looked at were either for interim orders concerning complaints that have not yet been heard in full, or for reviews of complaints that were previously heard in full. These reports contained very little information, so I ignored them and read the reports of ten full hearings.
Six of the ten hearings concerned matters that had in fact been, or could have been, dealt with by a court of law, the police, or another authority. These comprised three cases of theft, two drug and alcohol offences, and one case of forgery.
Three of the ten hearings concerned matters that had in fact been, or could have been, dealt with by the employer. These comprised two cases in which professionals (a paramedic and a physiotherapist) did not do their jobs properly, and one in which a senior radiographer continued to do agency work while on sick leave from her main job. No patient was actually harmed in any of these three cases.
The remaining case concerned an administrative error by the HPC, which had led to someone being registered as an occupational therapist by mistake.
So the impression I get is that the HPC’s complaints process is thoroughly useless, mostly duplicating the work of the courts, the police and employers.
But it’s worse than merely the wasteful bureaucratic duplication that you would expect of a such a public body. Duplication like this undermines existing authorities.
In the case of the criminal law, the HPC undermines the police and the courts by creating double jeopardy for registered professionals who are accused of any crime.
Regardless of what action the police take, and regardless of the verdict of a court, the HPC can conduct a hearing of its own that is, in effect, a separate trial or a re-trial. The HPC is clearly sensitive to this, and repeatedly blusters along the lines of:
…the purpose of a sanction is not to punish. Rather, the purpose of a sanction is to protect the public and to maintain confidence in the registered profession and in the HPC’s regulatory function.
However, the sanctions that the HPC can impose can clearly have the effect of punishments. For example, people who are removed from the register not only lose their current jobs, they also lose the possibility of any other job in that profession.
In the case of employment, the HPC seems to undermine contracts and local procedures for resolving difficulties between professionals and managers. The temptation for employers must be to leave matters of professional standards entirely to the HPC.
In the two cases I read where professionals did not do their jobs properly, there was no indication that the employer, local management, or more senior professionals had ever tried to deal with the problems.
My impression is that the HPC’s role in these cases is to encourage the collapse of local accountability and professional support.
There must be some advantage to someone somewhere in having the HPC act in these apparently purposeless ways. What could it be?
HPC-regulated professions have in common that their members are mostly employed by the NHS. So it is realistic to see the HPC as, in effect, part of the NHS even though it also happens to affect some private practitioners.
The advantage for the NHS is precisely the collapse of local accountability and professional support that I mentioned above. The HPC allows the NHS to turn a blind eye to poor standards at the local level, while the HPC pursues a small number of scapegoat professionals at national level, giving the superficial impression that the public is ‘protected’.
A side-effect of the double-jeopardy threat to all regulated professionals is that any form of whistleblowing is severely discouraged. In ordinary circumstances, whistleblowers could reasonably expect to have to find a new job. The effect of the HPC is to make any disagreement with local management into an issue that could lead to loss of professional status — loss of any job in the profession, ever.
At a time when the NHS is massively increasing the provision of CBT, but doing so in ways that compromise the quality of the CBT that will be available, it is not surprising that psychotherapy is to be regulated by the HPC.
NHS trusts do not want to be accountable for the quality of the CBT they provide, and they want therapists who identify problems with the service to be discouraged from speaking out. The HPC’s role appears to be to make these things possible.
Over at DC’s Improbable Science there’s further reading on the HPC : Health Professions Council ignores its own rules: the result is nonsense