The ‘Fat Controllers’ in the DoH dictate THE law with the agreement of both Houses of Parliament

by Julia Evans on August 13, 2012

The DoH’s response to Bruce Scott’s open letter sent to the CHRE’s CON-sultation. Available here Open Letter to the CHRE/PSA on Accreditation Standards  or here

Bruce Scott receives a reply, from within the DoH, to his submission to the CHRE consultation. See below for the full text of this response.  My comments follow.

THE QUESTION:

Is the following reply in any way an adequate response to Bruce Scott’s accusations or is it the naked imposition of power because Parliament has enabled their civil servants to control in this abusive way?

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The plot so far:

The CHRE (Council for Healthcare Regulatory Excellence) which will in the future be known as the PSA (Professional Standards Authority), announced a CON-sultation from 17th April to 10th July 2012, on Voluntary Registers or more particularly, ‘Accreditation standards for organisations that hold voluntary registers for health and social care occupations” for psychotherapists and counsellors.

Bruce Scott sent in his submission on the 7th July and emailed it within the Houses of Parliament on 23rd July. The list is at the bottom of the post, which also contains Bruce Scott’s letter at Open Letter to the CHRE/PSA on Accreditation Standards  or here

One of the recipient’s of this e-mail was the then, Minister of State (Care services), Mr Paul Burstow MP. (Paul Burstow lost this job in the September 2012 reshuffle. Norman Lamb MP appears to have replaced him.) This is the Department in direct control of all the shenanigans within the HPC (Health Professions Council), CHRE, the birth and promotion of IAPT, and much else.

Quotes from Bruce Scott’s letter:

Bruce’s second paragraph is as follows:

However, upon a closer, deeper and more thoughtful reading there are numerous discrepancies, mystifications, tautologies, lack of clarity and an apparent minimalist divulgence of specific information which makes for a very unconvincing and incomprehensible document. This consultation document, with its constant reference to standards for future regulation, does refer the reader to another document you have authored, “Right-touch regulation” (CHRE, 2010).  I presume to enable the reader garner more information of how the CHRE/PSA set standards and how you will regulate the field with them. However, on perusal of this document I felt I was led further down a rabbit warren of empty rhetoric, which actually made it no clearer what these “elusive” standards were and how an individual or organisation would be judged to meet these standards.

Quote from p2: My question in regards to the last point above is this: Will the CHRE/PSA structure be able to let the public, employers, or professionals, gauge whether they (counsellors and therapists) operate effectively and to high or common standards? I read no convincing formula as to how you would make sure this would occur. You also make no mention or quote any research evidence to show that standards amongst counsellors and psychotherapists are operating ineffectively or to low standards, and that existing systems are failing the public. Therefore, how can you assert what is written in 1.2 of your document?

Quote from p5: So am I right in concluding from this that the self-assessment tool is actually a pointless and worthless exercise as you will go to an organisation’s governing body and ask them if the organisation is lying and/or misguided? After consulting the results of the self-assessment of an organisation that is applying and then having consulted their governing body, will you then peruse your “standards” and decide if the organisation meets them? But surly the self-assessment will outline “your standards” and there will be a method to help show the organisation that is applying that they meet them the standards? I get the feeling from this Kafkaesque bureaucratic rhetoric that one never truly gets to know what the standards are and the decisions to what they might be and how organisations are accepted as meeting them is a process that is not transparent and even sinister.

I will leave you to further perusal of Bruce Scott’s document without my help.  I would describe Bruce Scott’s Open Letter as a devastating critique of the CHRE/PSA, their standards derived away from practice (probably in a room within Whitehall), their ‘Kafkaesque bureaucratic rhetoric’ within which world they work and so on.

The DoH’s response:

David Segar, the civil servant in charge of Ministerial Correspondence and Public Enquiries, Department of Health, fills the role of ‘Fat Controller’ and replies to Bruce Scott’s complete demolishment of the fig-leaf which legitimates the CHRE. This reply is available further down this post.

Second paragraph

This argues that the CHRE has been given the power to accredit voluntary registers, so they are going to force this through. No matter Bruce is arguing that this legislation does not produce safeguarding from rogue practitioners or understand the practices which have been developed over centuries. The CHRE, with DoH approval, rules OK because the Houses of Parliament have legitimised this use of power.  The result is asserted to be that the public will be reassured that ‘workers’ meet high standards.  There is no evidence that the public is upset and needs reassurance or that high standards are not already in place.  No matter, the ‘Fat Controller’ has decreed it should be so and Parliament has given him the power to make this decree.

Third paragraph

The ‘Fat Controller’ declares that the CHRE will determine the accreditation process. So ‘Kafkaesque bureaucratic rhetoric’ becomes THE ONE law enforceable by Parliamentary decree.  You and your practice will probably have no place in this Government-controlled annointing of those who are going to be allowed in their Government-protected market in health care.  Your training organisation will be wiped out – the ‘Famous Five’ or the big boys – will win. No need for engagement with the process for yourself with a personal analysis, no need for clinical work to develop your practice, probably no need for supervision unless it is to ensure your standard is productive and cost effective enough. Remember the accreditation process is imposed, by decree, onto those organisations stupid or compliant enough to join in this power game.

 

In my 7 years of campaigning on this issue, my responses to all these CON-sultations have been treated the same: We have the power. We have the might. This is how it will work. We do not care how much you squeal because we are high on the amount of control handed to us on a plate by both Houses of Parliament.

 

Has anyone read ‘1984’? Has anyone been taught to think? Has anyone studied that the UK governance works by consent not enforcement?  It appears not.

 

Footnote:

I append Bruce Scott’s Summary in endnote  [i]  Here is his final paragraph and summary again:

The CHRE voluntary registers are a product of the desire of control; is this the desire mentioned in the consultation document and discussed above on page 2 of this letter. Control societies and systems operate on the basis of indefinite postponement; this is in relation to acquittal of the “accused” (see Fisher, 2009). The talking therapies are the accused within the proposed CHRE/PSA voluntary register scheme and because of their monitoring and vetting procedure, indefinite acquittal will be the modus operandi; nobody will be able to relax, because once we are in, we could be put out at anytime. The “education” needed to get on and stay on the registers like in control societies is lifelong; training (pointless CPD) that persists for as long as one’s working life continues. This leads to a situation where control and self-monitoring control becomes obsessive and ridiculous whereby we all become control addicts or obsessed with self-monitoring (on both sides). One just has to look at the Government’s Supporting People’s housing “standards” and their imaginary idealism of forever and infinite progress for its clients in terms of mental health (e.g., moving on, employment etc), despite the disastrous economic situation in the UK which will curtail any hope of  an individual’s idealism and mental well-being.  No amount of regulation within the talking therapies or “mental health” services will be able ever be able circumvent misery and poverty within a system where inequality of material resources and opportunities is supported by those who wield power and by those who want power.

Conclusion

The CHRE/PSA proposal for voluntary registers is an ill-thought out and inappropriate system that many counsellors and psychotherapists of all persuasions will view as a thoughtless conceptulisation of their work. I hope the CHRE/PSA will look again at its proposals and consider the implications of its master discourse, its false claims for promoting excellence, and its authoritarian claims of creating voluntary registers which will become “mandatory through choice”.

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THE QUESTION:

Is the following reply in any way an adequate response to Bruce Scott’s accusations or is it the naked imposition of power because Parliament has enabled them to abuse power in this way.

This text will be circulated widely within Parliament.  For the circulation list see endnote [ii]

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[i] Summary: Some thoughts on the philosophical and political position of the CHRE/PSA voluntary registers

What Foucault (see Foucault, 2008 for example) was afraid of in the reign of the norm (or I would say the normative and so-called normality, i.e., CHRE/PSA registers/standards) was that the norm becomes dictatorial and tyrannical. Subsequently people find it difficult to rebel against the average (or the so-called normality of CHRE standards), against the dictatorship of the norm. The CHRE/PSA have indicated that they will push for their standards to be seen as the mark of excellence and for employers to accept their mark as the mark of excellence. While organisations that opt out and/or feel that the CHRE/PSA standards are incompatible for them will be ruled out/excluded of earning an income based upon the CHRE/PSA push for dominance in the field of talking therapies.   Isolating this reference to the norm allows us to see that, even if it comes from CHRE/PSA dictatorial standards, deciding to conform to the norm (CHRE/PSA standards), to make the norm into the “law” (or pseudo-law; “mandatory through choice”) is a political choice. It seems to be the CHRE/PSA’s desire to making their standards “law” or the “the norm” for all, and banish all deviant or non-conforming ways of conceptualising counselling, psychotherapy and psychoanalysis. It is for this reason that I oppose the CHRE/PSA voluntary registers. Making the CHRE/PSA scheme the “kite mark” of excellence and pursuing/rejecting all the deviants from CHRE/PSA standards will be a factor of stagnation and curtailing of creativity and innovation within counselling, psychotherapy, and psychoanalysis; innovation which is so important to the freedom to be able to create one’s own discourse free from “the law” or “standard of an “Other”. In order to preserve innovation in a society, it is essential that the norm or standard should not be “law” from an over-bearing “Other”.  Much of psychotherapeutic and psychoanalytic discourse allows such innovation to flourish, which the CHRE/PSA registers/standards will stunt.

The CHRE/PSA discourse seems so benign with its discourse of normalism, but it is couched within a faltering rhetoric of certainty guided by a master discourse (i.e., “mandatory through choice” and encouraging employers to favour people on their books). The CHRE/PSA is also mystifying; it holds up its hand of fairness (i.e., self-assessment), but ultimately takes it away in a Kafkaesque mode (i.e., inviting random comments from unnamed “interested parties” and conducting investigations into the validity of comments from interested parties).

The CHRE/PSA is encouraging the collectives of counsellors, psychotherapists, and psychoanalysts, to be its subjects and a step in this direction is self-evaluation against an unknown or veiled bench-mark. This is a subtle management of our “population”. As Foucault (2008) discussed the management of populations structurally implies a rejection of difference in terms of individual singularity. It reabsorbs difference into a divergence in relation to the norm defined by the average in terms of behavior. In other words, difference is not allowed to flourish.

As Brousse (2007) argues, difference in the psychoanalytic sense (difference apprehended outside of all comparative references) is not relative in within the realm of CHRE/PSA. On the contrary it is hated; the CHRE/PSA will publicise on their website those who they hate. It is hate because it carries with it in the CHRE/PSA eyes the law of failure (to be incorporated into their fold). Brousse describes how from the psychoanalytic perspective this ideal (in other words CHRE/PSA regulation) is in the realm of the imaginary, the semblable, or from Baudrillard’s (1981) position, the nightmare of the simulacra; the CHRE/PSA voluntary registers masquerading as “real” whilst excluding the reality of its faulty symbolic (i.e., claims to its  excellence).

Roch (2007) describes the psychoanalytic act as interrupting the forced mode (i.e., the A, B, C or normalization, of the cure, of audited perfection or perfected audit); it introduces inconsistency. This hole, this edge disturbs the defense, or the semblance (the CHRE/PSA structure). The analytic act makes the semblance/simulacra tremble; its gets rid of knowledge’s misunderstanding or the idea that there is certainty of understanding; i.e., in the case of the CHRE/PSA, the certainty that its registers are the best, the ideal, the mark of excellence.

The CHRE voluntary registers are a product of the desire of control; is this the desire mentioned in the consultation document and discussed above on page 2 of this letter. Control societies and systems operate on the basis of indefinite postponement; this is in relation to acquittal of the “accused” (see Fisher, 2009). The talking therapies are the accused within the proposed CHRE/PSA voluntary register scheme and because of their monitoring and vetting procedure, indefinite acquittal will be the modus operandi; nobody will be able to relax, because once we are in, we could be put out at anytime. The “education” needed to get on and stay on the registers like in control societies is lifelong; training (pointless CPD) that persists for as long as one’s working life continues. This leads to a situation where control and self-monitoring control becomes obsessive and ridiculous whereby we all become control addicts or obsessed with self-monitoring (on both sides). One just has to look at the Government’s Supporting People’s housing “standards” and their imaginary idealism of forever and infinite progress for its clients in terms of mental health (e.g., moving on, employment etc), despite the disastrous economic situation in the UK which will curtail any hope of  an individual’s idealism and mental well-being.  No amount of regulation within the talking therapies or “mental health” services will be able ever be able circumvent misery and poverty within a system where inequality of material resources and opportunities is supported by those who wield power and by those who want power.

Conclusion

The CHRE/PSA proposal for voluntary registers is an ill-thought out and inappropriate system that many counsellors and psychotherapists of all persuasions will view as a thoughtless conceptulisation of their work. I hope the CHRE/PSA will look again at its proposals and consider the implications of its master discourse, its false claims for promoting excellence, and its authoritarian claims of creating voluntary registers which will become “mandatory through choice”.

 

Yours sincerely

Dr Bruce Scott

Psychoanalytic Psychotherapist

(In my capacity as an independent practitioner).

References.

Baugrillard, J. (1981). For a critique of the political economy of the sign. Candor NY, Telos Press Ltd.

Brousse, M. H. (2007). Love of the sinthome against a hatred of difference. Psychoanalytical Notebooks. The London Society of the New Lacanian School: Regulation and evaluation, 16, 161-166.

Council for Healthcare Regulatory Excellence (2010). Right-touch regulation. Retrieved from: www.chre.org.uk

Council for Healthcare Regulatory Excellence (2011). Voluntary registers: Setting the bar. Retrieved from: www.chre.org.uk

Council for Healthcare Regulatory Excellence (2012). Accreditation standards for organisations that hold voluntary registers for health and social care occupations. Retrieved from: www.chre.org.uk

Fisher, M. (2009). Capitalist realism: Is there no alternative? Winchester UK, Zero Books.

Foucault, M. (2008). Psychiatric power: Lectures at the Collège de France, 1973-1974. New York, Palgrave Macmillan.

Health and Social Care Bill (2011). Retrieved from: www. dh.gov.uk

Nisbett, R.E., & Wilson, T.D. (1977). Telling more than we can know: Verbal reports on mental processes. Psychological Review, 84, 231-259.

Roch, M.H. (2007). The psychoanalytic act and its paradoxes. Psychoanalytical Notebooks. The London Society of the New Lacanian School: Regulation and evaluation, 16, 167-175.

Scott, B (2010). The professional liaison group meeting for the proposed regulation of psychotherapists and counsellors on the 12th May 2010: An example of how not to dwell in un-knowing. This can be accessed at: http://hpcwatchdog.blogspot.com/2010/06/guest-post-by-bruce-scott-on-plg.html or a reprint requested from the author at brucescott@gmx.co.uk

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[ii] Circulation list

Rt Hon Jeremy Hunt MP, Secretary of State for Health

Mr Norman Lamb MP, Minister of State for Health

Earl Howe  Parliamentary Under-Secretary of State for Quality in the Department of Health

Rt Hon Andy Burnham MP, Shadow Secretary of State for Health

Rt Hon Lord (Philip) Hunt of King’s Heath : Shadow Health Team

Lord Carlile of Berriew, Former Lib-Dem Spokesperson & member of the Joint Committee on the draft Mental Health Bill

Mr Paul Burstow MP, Former Minister of State for Health (Care Services) Replaced 09/2012

The Viscount Eccles – former member of the Merits of Statutory Instruments Committee

Rt Hon Dr Vince Cable MP – Julia Evans’ constituency MP

House of Commons Select Committee on Health

Government Members

Rt Hon Stephen Dorrell  (Chair)

Mr Andrew George MP (Lib Dem)

Dr Daniel Poulter (& Parliamentary Under Secretary of State at the Department of Health)

Mr Chris Skidmore MP

Mr David Tredinnick MP

Dr Sarah Wollaston MP

Opposition members

Ms Rosie Cooper MP

Ms Barbara Keeley MP

Mr Grahame M Morris MP (& Member of Mental Health All-Party Parliamentary Group)

Mr Virendra Sharma MP

Ms Valerie Vaz MP

Mental Health All-Party Parliamentary Group  Purpose:

To inform parliamentarians about all aspects of mental health.

Chair:  Mr Charles Walker  MP  Conservative

Vice-Chair: Ms Alison Seabeck MP, Labour

& Ms Nicky Morgan MP Conservative

Secretary: Baroness Murphy of Aldgate, Crossbench &

Mr James Morris MP – Conservative

Treasurer: Lord Alderdice, Lib Dem

Members:

Lord Hunt of the Wirral – Conservative

Sir Peter Bottomley MP – Conservative

Mr Chris Heaton-Harris MP – Conservative

Mr Damian Hinds MP – Conservative

Mr Guy Opperman MP – Conservative

Ms Penny Mordaunt MP – Conservative

Mr David Wright MP – Labour

Mr Grahame M Morris – Labour (also Mental Health Group)

Ms Kerry McCarthy MP – Labour

Mr Mike Gapes MP – Labour/Co-operative

Mr Jim Dobbin MP – Labour/Co-operative

Dame Anne Begg – Labour

Mr Russell Brown MP – Labour

Mr Jon Cruddas – Labour

Mr Hywel Williams – Plaid Cymru

Sponsors of the House of Commons debate ‘Mental Health’ on 14th June 2012 

Mr Charles Walker MP, (See Mental Health All-Party Parliamentary Group above)

Sir Peter Bottomley MP, (See Mental Health All-Party Parliamentary Group above)

Jon Cruddas MP, (See Mental Health All-Party Parliamentary Group above)

Mark Durkan MP, – Social Democratic and Labour Party

Dr Julian Lewis MP – Conservative

Nicky Morgan  (See Mental Health All-Party Parliamentary Group above)

James Morris  (See Mental Health All-Party Parliamentary Group above)