Information, news and debate about psychoanalytic and psychodynamic psychotherapies
Process
The Health Professions Council (HPC) published a ‘call for ideas’ which ran from 23 July – 24 October 2008. This was sent to key stakeholders including professional bodies and education and training providers. The BPC submitted a detailed response.
The HPC established a Professional Liaison Group (PLG) to make recommendations on the following issues related to the future regulation of psychotherapy and counselling:
• Structure of the Register
• Protected title(s)
• Voluntary register transfer
• Grandparenting arrangements
• Standards of proficiency
• Standards of education and training.
The PLG has met over five meetings from December 2008 to May 2009. The recommendations were considered by the HPC Council on 6 July, and are now in consultation from July to October 2009.
The consultation along with the set of recommendations that went to the HPC Council meeting from the PLG is available to download from the the HPC’s website.
The PLG will reconvene on 18 and 19 November to further discuss standards of proficiency and the threshold entry level.
HPC Council will consider responses to the consultation and will finalise recommendations to the Secretary of State for Health and Ministers in the devolved administrations on 10 December 2009.
Information will be sought from voluntary registers in order to make recommendations about register transfers from January 2010.
There will be a further period during which the Department of Health (DH)’s Professional Regulation Branch will translate the HPC’s recommendations into the relevant secondary legislation. This will be an Order under Section 60 of the Health Act 1999 (equivalent of a medium-sized Act of Parliament). At a recent meeting between Gavin Larner, Director of Professional Standards, DH and the Psychological Professions Alliance Group (PPAG - BPC, BACP, UKCP, BABCP), he indicated that this process was likely to take up to two years. This would include a public consultation on the Section 60 Order.
It is not certain what impact a general election or change of government may have on this process. The view is that a new administration is unlikely to change the parameters of the current process although other priorities may affect the timetable.
It is therefore unlikely that statutory regulation will be implemented before 2012.
Recommendations
Structure of the Register
The PLG is recommending that the structure of the register differentiates between psychotherapists and counsellors. Practitioners would have access to the title of psychotherapist, or the title for counsellor, or both if they were dual registered.
Each part of the Register attracts a registration fee. Therefore, someone who would be registered as both a psychotherapist and a counsellor would pay two registration fees.
Standards of proficiency would therefore contain three elements:
• Generic standards of proficiency (applying across all of the professions of the HPC)
• Profession-specific standards common to both psychotherapists and counsellors
• Profession-specific standards for psychotherapists; and profession-specific standards for counsellors.
The possibility of modality-specific titles was discussed but rejected by the Group.
The Group also discussed whether the Register should differentiate between those qualified to work with children and young people and those qualified to work with adults. The Group was divided on this issue but adopted a working approach that did not make this differentiation. Therefore, the PLG did not draft standards of proficiency specific to working with children and young people. The PLG did not make any formal recommendations in this area and the HPC will ask a specific question around this as part of the consultation.
Protected titles
The HPC regulates by title, not by function. Only someone who is registered in the relevant part of the HPC register is able to use a protected title. The HPC’s powers to protect titles are contained within Article 6 (2) of the Health professions Order 2001 (‘the Order’). The parts of the Register and the protected titles are set out in a schedule to the Health Professions Council (Parts and entries in the Register) Order of Council 2003.
Article 39 of the Order sets out a number of offences relating to the misuse of protected titles. Article 39 (1) of the Order says:
Subject to paragraph (2), a person commits an offence if with intent to deceive (whether expressly or by implication) –
(a) he falsely represents himself to be registered in the register, or particular part of it or to be the subject to any entry in the register;
(b) he uses a title referred to in article 6 (2) to which he is not entitled;
(c) he falsely represents himself to possess qualifications in a relevant profession.
Article 39 (3) of the Order says:
A person commits an offence if –
(a) with intent that any person shall be deceived (whether expressly or by implication) he causes or permits another person to make any representation about himself which, if made by himself with intent to deceive, would be an offence under paragraph (1); or which
(i) is false to his own knowledge; and
(ii) if made by the other person would be an offence by him under paragraph (1).
Under these powers, the HPC can prosecute individuals who use a protected title whilst not registered, if they do so with ‘intent to deceive’. A person found guilty can be liable to a fine on level 5 of the standard scale (up to £5,000).
This means that in any proceedings brought by the HPC, the HPC has to prove that the title was used with the intention of misleading members of the public. The intention to deceive can be both express and implied. This means that the HPC is able to deal with cases where the title may not be used, but its use is implied in other ways. An example would be where an individual does not use the term ‘psychotherapist’ but says that one of the services they offer is ‘psychotherapy’.
Voluntary register transfers
The section of the Register for psychotherapists and counsellors will be established through the incorporation of a number of existing voluntary registers operated by various professional bodies. It will need to be decided which voluntary registers will be incorporated and how such a decision will be made. The registers which transfer are specified in the Section 60 Order. Anybody whose name appeared on the voluntary registers on the day before regulation was introduced would transfer to the HPC Register. Shortly afterwards, the HPC would write to all those who transferred asking them to renew their registration by signing a form and paying the registration fee.
Discussion within the PLG has indicated that there may be 30 or more voluntary registers which will need to be considered for transfer. It is important that only registers which identify practitioners who are practising autonomously, making professional and independent judgements and taking full responsibility for their actions should transfer. This means that registers must distinguish between those in training and individuals who are in practice. Those in training would not be eligible to be considered for transfer.
Differentiation between psychotherapists and counsellors means that any voluntary register which transferred to the HPC would also have to clearly differentiate between psychotherapists and counsellors. This would rely on accurate information about the register and the individuals on the register.
Organisations will be asked to identify whether their register is a register of psychotherapists, counsellors or both.
The HPC will approve all those education and training programmes, historic and current, that led or lead to registration with one of the voluntary registers that transfers. This would mean that someone who was part way through their education and training when the Register opens, or who had allowed their voluntary registration to lapse, for example, would be able to apply for registration by virtue of having completed an approved qualification.
The PLG have recommended the following criteria for voluntary register transfers for further consultation:
• The voluntary register must demonstrate clear definitions and expectations of the required qualification(s) and/or experience necessary to register
• The voluntary register must demonstrate processes for assuring that applicants meet the required standards of entry which may include accreditation of educational programmes
• The voluntary register must demonstrate evidence that members are required to adhere to code of conduct and ethics (or equivalent), which informs the register’s complaints process
• The voluntary register must demonstrate evidence of robust, open and transparent procedures for dealing with complaints about practitioners, including evidence that the procedures are followed where complaints have been made
• The voluntary register must demonstrate evidence that members are expected to demonstrate a commitment to CPD
• The voluntary register must demonstrate evidence that members are expected to demonstrate a commitment to supervision consistent with their own theoretical model.
The HPC Executive anticipates that the process of inviting organisations to submit evidence to show how they meet the criteria could begin in early 2010. The process is likely to be:
• Organisations are contacted and offered a timeframe to submit documents to the HPC to demonstrate how the voluntary register meets the criteria
• Organisations will be asked to identify whether the Register is of psychotherapists, counsellors or both
• Information supplied by organisations will be scrutinised by a member of the HPC Executive
• If further information is required, organisations will be contacted and asked to submit additional information
• Once all the information has been received, it will be considered by the HPC against the set criteria. The decisions could be made by a panel of the HPC’s Education and Training Committee set up to advise the HPC’s Council
• If the register meets the criteria, the HPC will recommend it to the department of Health.
Grandparenting
During the grandparenting period, individuals who have not been members of one of the voluntary registers, and who do not hold an approved qualification which meant they could have been registered, but who have been in practice before the opening date of the Register, can apply for registration.
There are two grandparenting ‘routes’ outlined in Article 13 (2) of the Health professions Order 2001:
Route A: Applicants can apply via this route if they can demonstrate that they have been in practice for three out of five years before the opening of the register (or its equivalent on a part time basis). An applicant has to demonstrate that they practise safely, lawfully and effectively within the scope of their practice.
Route B: This route is open to applicants who do not satisfy the time in practice for Route A, but who have been in practice before the opening of the register. An applicant has to demonstrate that the combination of their education, training and experience meets the standard of proficiency for the profession.
The PLG’s recommendation is that the grandparenting period should be two years in length.
Standards of proficiency
HPC’s standards of proficiency for each of its regulated professions are the ‘necessary’, ‘threshold’ or ‘minimum’ standards considered to be essential for safe and effective practice.
Education and training programmes are approved against the standards of education and training to ensure that someone who successfully completes an approved programme meets the standards of proficiency.
The standards of proficiency are divided into generic standards, which apply to all HPC registered professions and profession-specific standards which apply to each specific profession. The HPC plans to separately review the generic standards during 2009/10 to make sure that they are appropriate to the range of professions it regulates and may regulate in the future.
The PLG agreed that the standards of proficiency should contain four elements:
• Generic standards
• Profession-specific standards which would be common to both psychotherapists and counsellors
• Profession-specific standards for psychotherapists
• Profession-specific standards for counsellors.
It should be said that some members of the PLG did not support the view that there should be differentiation between psychotherapists and counsellors (this was and remains the view of, for example, the BACP). No doubt, this view will continue to be argued during the consultancy period.
The draft standards of proficiency recommended by the PLG can be downloaded here.
Education and training
The standards of education and training are those standards necessary to ensure that someone who successfully completes that programme is able to meet the standards of proficiency for their part of the Register (the threshold standards for safe and effective practice). The HPC approves programmes delivered by Higher Education Institutions (HEIs), professional bodies and private providers. There is no requirement for an approved programme to be delivered or validated by a HEI. The HPC only approves those programmes that lead directly to an individual’s eligibility to register and gain access to the relevant protected title(s) for their profession.
If a programme is approved (having met any conditions if applicable), it is granted open ended approval subject to ongoing checks that the programme continues to meet the requisite standards via the annual monitoring and major change processes. The HPC does not undertake cyclical re-visits of programmes (i.e. every five years). However, if information from the annual monitoring or major change processes indicates that further investigation is necessary to decide whether the standards continue to be met, it may re-visit a programme.
The Health Professions Order 2001 does not provide the HPC with a power to set the qualifications required for entry, but enables it to approve qualifications which meet the standards it has set for entry to the Register. The HPC’s obligation is to set threshold standards of entry to its Register, the minimum standards of proficiency which a newly qualified applicant needs to meet in order to be able to practise safely and effectively. The HPC may then approve a qualification which delivers those standards, but it cannot insist that only a specified form of academic award will do so.
Standard one of the standards of education and training (‘SET 1’) sets out the threshold level of qualification for entry to the Register. SET 1 provides the threshold levels of qualification “normally” expected to meet the remainder of the standards of education and training (and thus the standards of proficiency). The term “normally” is included in SET 1 as a safeguard against the unlawful fettering of the HPC’s discretion. Given the terms of the Health Professions Order 2001, it would be an improper exercise of its powers for the HPC to refuse to approve a programme which delivered the standards of proficiency and the remainder of the standards of education and training solely on the basis that it did not lead to the award of a qualification specified in SET 1.
The PLG is recommending that the ‘normal’ threshold level of qualification for entry to the Register should be set as follow:
• For counsellors, level 5 on the National Qualifications Framework / Intermediate level on the Framework for Higher education Qualifications / level 8/9 on the Scottish Credit and Qualifications Framework
• For psychotherapists, level 7 on the National Qualifications Framework / M level on the Framework for Higher education Qualifications / level 11 on the Scottish Credit and Qualifications Framework
On the day the Register opens, the HPC will approve all those programmes, historic and current, that led or lead to membership of one of the voluntary registers that transfers. The HPC will then need to develop operational arrangements for visiting those programmes to approve them against its standards. There is therefore likely be a further ‘lead in period’ before programmes are visited and reapproved against the HPC’s standards.
13 July 2009