Battle positions : Health and Social Care Bill January 19, 2011

by Julia Evans on February 1, 2011

The Government-defined battlefield of Wellbeing & (Mental) Health[1]

Against the Government: the position of regx2

From its principles [2],  regx2 is interested in those who consult practitioners of ‘Psychological therapies’ as well practitioners’ training, development and how these practices are held.  Thus, any relief at the Government’s apparent removal of centralised practitioner registration is tempered by the continued imposition of IAPT[3] & NIMHE[4] using SfH[5] competences, NICE clinical guidelines[6], evaluation against the Government’s library of standards[7] and so on.

Regx2 continues to act against.

The Government’s position:

The Government wants control of expenditure on NICE defined ‘depression’[8], ‘anxiety’[9] and other symptoms of dis-being or mental ill-health.  They are also committed to providing risk-free treatments which guarantee the outcome of wellbeing or good mental health with the imposition of cognitive-behavioural-therapy[10] (cbt) defined and evidence-based-practice defined, 10 sessions of cbt.  In order to achieve this GOOD for the population, they are shunting £70million into contracted-out services.  These services will be evaluated against the Government’s Library of Standards (see note 6) so that Government standard wellbeing or happiness or mental health is produced in the Government-standard human subjects so saving the Government millions of pounds in long-term sickness benefits.  Neat, ugh?

The Governments’ fawning collaborators:

A number of organisations have sniffed the £70million pounds – they are willing to sell any ethical position for a slice.  These include the Famous Five[11] with their  friends: BPS[12], academics with research departments hungry for Government funding, academics who are measured whether their students have got jobs (mainly within the Government’s high risk Mental Health Industry), and so on.  They cosy up to the Government and agree that, using centrally defined standards produces, without any doubt or error, centrally definable results: happiness, wellbeing, mental health by the use of systematic, risk-free, evidence-based treatments.  This collaboration will wipe out individual practices motored by relationships and based in trust.

The government’s emerging position:

The February 2011 emerging position following the publication of the  Health and Social Care Bill (This was due for circulation in January!!!) is:

Divide and Rule:

Those who wish to work in the Government’s contracted out high-risk-health-factories[13] producing wellbeing and mental health in compliance with Health Professions Order 2001 (Note 12), will be registered with a renamed HPC[14] as:  Approved Mental Health Practitioner [AMHP] This fits the HPC’s the Government’s exclusive use of the medical model ethos very well and one which, apart from psychologists[15], we may suppose will be the only ‘psychological therapy’ title over which the HPC will have control.

So the collaborators have it!  They have won! The Government, using Privy Council power, will control the standards, training, ethics, fitness to practice, entry criteria and so on, of all AMHP.  You will not be considered safe enough to practice in any of these Government-regulated areas unless you are HPC registered.  So anyone who recognises relationships as central to their practice will not qualify.  Relationships do not register in the Government’s central library of standards.   If one acquiesces, one becomes a standardised cog in the Government’s high-risk health industry.

Remember Patricia Hewitt MP[16], when Secretary of State for Health, stated:  The system rules OK – you do not need human BEINGS as the system has absolute knowledge.  The way the Government’s high-risk Mental Health Industry works, that is its principles, is also given in note 16.

So how many psychopractitioners are going to get AMHP status so they can pay the mortgage?

Many psychopractitioners do not consider they work within Mental Health.  But now the Government has extended the clinic to include Wellbeing (see HPO2001 – note 12) or Dis-being, are they part of the Government’s high-risk health industry?

And will they be able to continue, even within the Government’s descriptor of charlatan, working with any condition of dis-being?

Conclusion:

From Denis Postle‘s excellent notes on e-ipnosis: ‘The DoH’s Explanatory Notes for the Bill is no help with such questions. The Notes have nothing to say about either psychotherapy or counselling. However Wellbeing (sic) Boards and wellbeing ‘strategies’ merit 75 mentions in its 235 pages.’

My conclusion is that psychotherapy and counselling are being excluded from Government supported treatments for wellbeing in favour of the collaborator supported (Famous Five and academics – note 11) mental health practitioners who will be registered either with the HPC or the renewed CHRE.[17]

The Government’s & their Collaborators’ next move

Next level: Council for Healthcare Regulatory Excellence (CHRE) registration.

Remember the regx2 circulation about regulatory capture?  This is when the big organisations use their power to divert the authority from regulating anything.  It happened in banking and the railway industry.  Well, CHRE is in regulatory capture before it has begun to perform its function – whatever that is.  It has sent a confidential CON-sultation out to the big-players:  the famous Five:  UKCP, BACP, BPC, CBT-ers, those who devise training standards with the Open University, (See notes 16 & 17) Academic Institutions who gain money if their graduates have jobs (AMHP) to go to and so on.  Thus, the CHRE ensures it is fully compliant with their Collaborators’ demands, before it sets up shop.  Under this Bill, the big players are fighting to get this form of Government recognition so they can be big players in the Government-protected high-risk mental health industry.

Does this matter?  We can all slink into our holes and continue practicing whilst pretending to be nothing to do with health or wellbeing.

Do you really wish to practice from this marginalised position?  Remember the big collaborators will be able to claim Government-approved status & providing risk-free treatments:  ‘You are safe with us – here is the Government-approved kite-mark’.  They will be able to mount advertising campaigns to back their claims.

Treatments for those who the Government-supported NICE guidelines define as having mental health issues, such as Anxiety, will be government regulated under this bill.

Originally circulated to regx2 on 1 February 2011 17:27:00 GMT


[1] This was devised following my reading of Denis Postle’s helpful researches reported on e-ipnosis:   ‘Health and Social Care Bill, Regulation of Psychological Therapies,  The  Plot Thickens, First impressions of the new regulatory landscape.’ Web-link: Health and Social Care Bill January 19, 2011

[2] Regx2 principles of action

regx2 works in relationships with others to:

Enable sufferers from symptoms of psychic or mental distress to choose the treatment or practice which works for them rather than the One prescribed by the government.

Resist the top-down imposition by the law of the One Standard driving practitioners’ training, development, practice, ethics, complaints procedure, etc that produces unhealthy uniformity.  N.B.  The DoH Scoping Project (July 2005) found 571 training organisations.  This strategy seeks to support this healthy diversity rather than protect or prioritise one or a section of its variants.

[3] IAPT is Increased Access to Psychological Therapy.

[4] NIMHE is National Institute for Mental Health in England.  The New Ways of Working for Psychological Therapists (NWW)  project for psychological therapists is now underway. NWW is a part of the National Institute for Mental Health in England (NIHME)’s National Workforce programme and has a close relationship to the IAPT programme, especially around work force issues.

[5] S4H or SfH is Skills for Health.

[6] NICE is National Institute for Clinical Excellence.

[7] The Department of Health’s (DoH) 2010 ‘White Paper: Equity and excellence: Liberating the NHS’  Published date:

12 July 2010   trumpets the Government’s centralised library of standards. 

[8] NICE clinical guidelines for depression are available here.

[9] NICE clinical guidelines for Anxiety are here.

[10] cbt is cognitive behavioural therapy.  Here is the NHS’s standard definition

[11] Famous Five (after Enid Blyton’s heroes) refers to those collaborators who are helping to define the Health Professions Council’s (HPC’s) competences.  They act to protect their interests: supporting the enshrinement of practice in standards which are driven down using top-down control.  They are:

UKCP United Kingdom Council of Psychotherapy,

BACP British Association for Counselling and Psychotherapy,

BPC British Psychoanalytic Council,

CPCAB Counselling & Psychotherapy Central Awarding Body is a UK awarding body that is managed by professional counsellors, trainers and supervisors. Now in their 16th year of operation, they are the only awarding body in Europe to specialise in the field of counselling. They are one of the largest awarding bodies in this field, with about 130 Recognised training centres across the UK (with some centres in other countries) and around 11,000 candidates registered with them annually.  All CPCAB qualifications have been updated and revised in 2010 to reflect the most recent research findings on the effectiveness of counselling and to anticipate the proposed requirements of statutory regulation.       and

BABCP   British Association for Behavioural & Cognitive Psychotherapies is the lead organisation for cbt, the Government’s treatment of choice, in the UK.

[12] BPS is the British Psychological Society.   The BPS is a founder member of the Psychological Professions Alliance Group (PPAG) members not currently registered with the HPC are: British Psychoanalytic Council, United Kingdom Council for Psychotherapy, British Association for Counselling and Psychotherapy, British Association for Behavioural and Cognitive Psychotherapies. Members of the British Psychological Society are already regulated by the HPC. This group forms the dominant part of any CON-sultative group to S4H, IAPT, HPC, etc  They hold in common with the Government that it is possible to “safeguard health and wellbeing”  (See Health Professions Order 2001 – HPO2001)  An example of their key role in ensuring jobs for their members which also safeguards their future:

Minutes from the Health Professions Council (HPC)’s Psychotherapists and Counsellors Professional Liaison Group (PLG), 19 October 2010:

‘HPC information for the Psychological Professions Alliance Group (PPAG)

Executive summary and recommendations

Introduction

At previous meetings, the group was informed that a group of professional bodies (‘The Psychological Professions Alliance Group’) had been undertaking work in an attempt to resolve the outstanding issues around the potential statutory regulation of psychotherapists and counsellors. A number of those professional bodies are represented at the PLG and therefore will be able to provide a more up-to-date picture of the genesis and outcomes of those discussions at the meeting.’

This I take to be clear evidence that they see themselves controlling all transmission and development of the talking therapies.  By their actions, anyone who wants to work for the NHS or organisations contracted to it, will have to pay them to be registered and will have to comply with their centrally imposed standards.

[13] ‘high risk health industry’ is what Lord Donaldson, former Chief Medical Officer, names anywhere where human distress is treated.  See the Donaldson Report Good doctors, safer patients: Proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients, 14 July 2006 where he compares the Government’s high risk health industry with prospecting for oil (Alpha-Piper disaster), the nuclear industry (Chernobyl) and pilots dropping aircraft out of the skies.  This is driving the Government’s industrial approach – of course there is no evidence that working within relationships of trust to care for and treat fellow human beings has anything in common with Lord Donaldson, then Chief Medical Officer’s, examples of high risk industries.

[14] HPC is Health Professions Council and is answerable to the Privy Council.  See the Health Professions Order 2001 which sets up and governs the HPC.

[15] The psychologists capitulated was officially rubber-stamped in May 2009.  See the Merits of Statutory Instruments Committee, House of Lords, comments in their Eleventh Report 2008/09 page 3.  They referred the capitulation to a full House of Lords vote as they were not very happy with being asked to rubber-stamp it.

[16] The Government’s underlying logic of the following statements has never been questioned.  Both Houses of Parliament were seduced and did not critique or debate them.  These assumptions still drive Government action.

The Government’s logic, derived from Lord Donaldson’s ‘high risk health industry’ (Report 2006)  Note 13

An analysis of the Foreward to the ‘White Paper: Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century‘ Presented to Parliament by the Secretary of State for Health, The Rt Hon. Patricia Hewitt, MP, by Command of Her Majesty February 2007’ follows :

Conjunctions – unrelated concepts which have been added together to produce:

*  Professional regulation + the framework it creates = the preservation of trust

*  Professional regulation + the framework it creates =                                                                                                                                                                 the justified confidence of patients

JE wonders what unjustified confidence is based in – a relationship of trust & love?

*  Professional regulation + the framework it creates = the bedrock of safe and effective clinical practice

*  Professional regulation + the framework it creates = the foundation for effective relationships between patients and health professionals

*  Professionalism = an unquantifiable asset – JE:  where is the evidence that it is an asset?  Surely this is the Government’s opinion repeated as fact.

*(JE:Is the following assertion possible?) professionalism to be supported by rules, regulations and systems.

The Government has a question: how to deal with the small number of professionals

who, at some time in their working lives, provide poor quality care to patients,

and who cause concerns for patients, their families and professional colleagues,

while (JE: the Government supports) supporting the overwhelming majority in their commitment to better clinical care and higher professional standards?

The Government despotically answers its own question:  We (JE: the royal we, of course) need a system that understands the pressures and strains under which all professionals operate.  (JE:  And Parliament swallowed that a system has a better understanding of a human being under pressure and strain than a fellow human being.  And I am not making this up.  And my anger is starting to erupt.)

A system that shows understanding, compassion and support where these are appropriate.

(JE:  Honestly, this was what was written – check for yourself –  and what, at the behest of Parliament, is being implemented.  Am I alone in my concern about the Government’s inability to tell a human relationship from that driven or regulated by a system?  Where are the Government’s real living examples of systems which show the human qualities of understanding, compassion and support?)

It also means a system that is better able to identify people early on who are struggling – perhaps with personal problems of mental health or addiction.

(JE:  So the system is infallible whereas human beings, for example, Dr Shipman’s colleagues (Dame Janet Smith’s The Shipman Enquiry :  makes interesting reading) or Baby P’s social workers.)

It also means a system that is better able to show the same care to them, people who are struggling, that they have shown to their patients, so that they have a fair chance to improve and return to practice, if that is possible.

(JE: Wow!  1)  So systems are able to show the same care that human beings can show one another.  News to me!  2)  Care by systems gives a fair chance!  Now what does that mean?  I presume it is the Government’s opinion that Systematic care is neutral as it is free of contaminating relationships.  It is only under these sterile relationship-free conditions that fairness emerges.  What grounds does the Government have for this astonishing statement?

It means a system that is better able to detect and act against those very rare malicious individuals who risk undermining public and professional confidence.

(JE:  So THE system is more able to detect and act against malicious individuals than are the Police or colleagues?  So THE system is more powerful (and given more powers via the Privy Council), than the Police.  The Government is setting up its own private, overseer.  Its own fiefdom where the Government rules absolutely – no Judiciary to interfere.  And no voice is raised in Parliament to question this.)

Quotes from the ‘Foreword’  written by The Rt Hon. Patricia Hewitt, MP,  Secretary of State for Health

2.  For any consideration of the regulation of health professionals, the preservation

of that trust has to be the starting point. Professional regulation must create a

framework that maintains the justified confidence of patients in those who

care for them as the bedrock of safe and effective clinical practice and the

foundation for effective relationships between patients and health

professionals.

3.  That professionalism is an unquantifiable asset to our society, which rules, regulations and systems must support, not

inhibit.

4. The question is therefore how to deal with the small number of professionals

who, at some time in their working lives, provide poor quality care to patients,

and who cause concerns for patients, their families and professional colleagues,

while supporting the overwhelming majority in their commitment to better

clinical care and higher professional standards. We need a system that

understands the pressures and strains under which all professionals operate

and shows understanding, compassion and support where these are

appropriate. It also means a system that is better able to identify people early

on who are struggling – perhaps with personal problems of mental health or

addiction – and supporting them, showing the same care to them that they

have shown to their patients, so that they have a fair chance to improve and

return to practice, if that is possible. It means a system that is better able to

detect and act against those very rare malicious individuals who risk

undermining public and professional confidence.

5. Professional regulation is about fairness to both sides of the

partnership between patients and professionals.

Principles underpinning statutory professional regulation:

For that to be the case, there are a number of key principles that should underpin statutory professional regulation.

• First, its overriding interest should be the safety and quality of the care that patients receive from health professionals.

• Second, professional regulation needs to sustain the confidence of both the public and the professions through demonstrable impartiality. Regulators need to be independent of government, the professionals themselves, employers, educators and all the other interest groups involved in healthcare.

• Third, professional regulation should be as much about sustaining, improving and assuring the professional standards of the overwhelming majority of health professionals as it is about identifying and addressing poor practice or bad behaviour.

• Fourth, professional regulation should not create unnecessary burdens, but be proportionate to the risk it addresses and the benefit it brings.

• Finally, we need a system that ensures the strength and integrity of health professionals within the United Kingdom, but is sufficiently flexible to work effectively for the different health needs and healthcare approaches within and outwith the NHS in England, Scotland, Wales and Northern Ireland and to adapt to future changes.

Please note:  a more detailed comparison of the Governments principles with principles derived from a relationship-base will follow.

[17] CHRE is Council for Healthcare Regulatory Excellence