The
Committee consisted of the following
Members:
Chairman:
Mr.
David
Amess
Ancram,
Mr. Michael
(Devizes)
(Con)
Bradshaw,
Mr. Ben
(Minister of State, Department of
Health)
Brown,
Mr. Russell
(Dumfries and Galloway)
(Lab)
Burgon,
Colin
(Elmet) (Lab)
Cooper,
Rosie
(West Lancashire)
(Lab)
Gardiner,
Barry
(Brent, North)
(Lab)
Gummer,
Mr. John
(Suffolk, Coastal)
(Con)
Ingram,
Mr. Adam
(East Kilbride, Strathaven and Lesmahagow)
(Lab)
Jenkin,
Mr. Bernard
(North Essex)
(Con)
Johnson,
Ms Diana R.
(Kingston upon Hull, North)
(Lab)
Joyce,
Mr. Eric
(Falkirk)
(Lab)
Lamb,
Norman
(North Norfolk)
(LD)
Milton,
Anne
(Guildford)
(Con)
Mulholland,
Greg
(Leeds, North-West)
(LD)
Twigg,
Derek
(Halton) (Lab)
Wilson,
Mr. Rob
(Reading, East)
(Con)
Liam Laurence Smyth,
Committee Clerk
attended
the Committee
Second
Delegated Legislation
Committee
Tuesday 31
March
2009
[Mr.
David Amess in the
Chair]
Draft
Health Care and Associated Professions (Miscellaneous Amendments
and Practitioner Psychologists) Order
2009
10.30
am
The
Minister of State, Department of Health (Mr. Ben
Bradshaw): I
beg to move,
That the
Committee has considered the draft Health Care and Associated
Professions (Miscellaneous Amendments and Practitioner Psychologists)
Order
2009.
The
order continues the Governments programme to improve patient
safety by modernising the regulation of the health care professions, as
set out in our 2007 White Paper, Trust, Assurance and
Safety. The reforms aim to enhance public confidence in the
ability of the health care regulatory bodies to protect the public and
deal with poor professional standards. Several high-profile cases, such
as that of Dr. Harold Shipman, highlighted public concern and doubt
about the partiality of the regulatory bodies. If left unaddressed,
those doubts threaten to undermine trust in our system of professional
regulation.
The order
makes various amendments to the framework legislation for the
regulation of dentists, dental care professionals, pharmacists,
pharmacy technicians and those professions regulated by the Health
Professions Council. Some Members might recall the debates that we had
last year on similar orders and on the Health and Social Care Act 2008.
Changes to the governance arrangements of the General Dental Council
and the Health Professions Council include moving each of those bodies
from a partially elected to a fully and independently appointed
council. That will ensure that professional interests do not dominate
council deliberations.
The order
also brings practitioner psychologists under statutory regulation for
the first time, extends the regulation of pharmacy technicians to
Scotland and contains a number of other miscellaneous amendments. All
the measures in the order are supported by each of the regulatory
bodies covered by it, and I commend it to the
Committee.
10.32
am
Anne
Milton (Guildford) (Con): May I say what a pleasure it is,
as always, to serve under your chairmanship, Mr.
Amess?
I
broadly support the regulation of practitioner psychologists, but
significant concerns have been raised about the detail of this and
other orders. I draw the Ministers attention to some of the
other issues raised by counsellors and psychotherapists, because we
have a bit of a muddle over the detail. On the other side there are the
physiologists, who cannot wait for regulation and yet feel that the
Government are seriously dragging their feet, broadly with regard to
patient safety and the
protection of the public. Indeed, among some of the professions
regulation is a good thing, but the devil is most definitely in the
detail.
Let us take
psychoanalysts as an example. By its nature, psychoanalysis is a long
process that may take 10 to 15 years, and during that time a
therapeutic relationship might well require considerable anger to be
displaced on to the therapist. If at that point the client approaches
the HPC, will it have the skills to recognise whether there is a
problem with the psychoanalyst, or whether the anger, and therefore the
complaint, is part of the process of psychoanalysis itself? Although
psychoanalysts are not dealt with in the order, that is a good example
of where attention to detail and full understanding from the Department
and the HPC is necessary.
There is
concern about the 2,000-odd chartered psychologists, whom I understand
will not be deemed to be safe to practise by the HPC, because the
legislation, as drafted, will not allow automatic entry to its
register. They will therefore have to go through potentially costly
grandparenting scrutiny with the HPC. I quote from a letter that I
received from the British Psychological
Society:
The
effect of this exclusion is that these individuals may be disbarred
from professional practice using one of the proposed protected
titlesa restraint of trade issueand they may
potentially have to pay an extra fee to the HPC to be assessed to gain
entry to the Register via one of the grand parenting
routes.
The
society considers
that
the
Department of Health have taken a narrow view to only recognise and
therefore regulate those of our Chartered Psychologists who are members
of one of our seven profession Divisions, whilst we have argued that
many of the excluded 2,000 work in areas that cross
professional boundaries or in specialist subsets of professional
practice, but who are nonetheless safe and independent
practitioners.
It
argues
that the
proposed Statutory Instrument would not achieve its purpose of fully
protecting the public from the full range of existing qualified
practitioner psychologists; it may disbar existing Chartered
Psychologists from future employment; and it may force some 2,000
existing Chartered Psychologists to go through potentially
costly...scrutiny.
The
explanatory memorandum
states:
Statutory
regulation...enables the setting of statutory standards of
practice to ensure safe and effective conduct, and provides for the
operation of statutory fitness to practise procedures to investigate
and deal with cases of alleged impaired fitness to practise. As a
consequence, the public can have greater confidence that individuals
practising the profession are competent and fit to do
so.
Any
statutory instrument of this nature must have the confidence of the
public and the professions that work within the regulatory regime. That
flies in the face of my previous quote from the BPS which suggests that
the order would not achieve its purpose of fully protecting the
public.
The measure
has been broadly welcomed by the Association of Educational
Psychologists, which welcomes and endorses the order, referring only to
a regret about how long it has taken. That amplifies my point about
this being a bit of a muddle. The detail is unclear and does not have
the full confidence of the professions.
The results
of the consultation document were interesting to read. The Minister did
not refer to this, but 120 responses were received, and 15
additional responses were received by letter. Will the Minister tell us
how many people were
invited to respond? There was not overwhelming support for the
provision. If we run through the consultation document, we see that
there is no doubt about the general support for the statutory
regulation of general practitioner psychologists. However, question 3
reads:
Do
you agree that others who deliver psychological therapies should be
statutorily regulated in a future
Order...?
Although
47 per cent. of respondents agreed, 40 per cent. did not, and 13 per
cent. were unsure. Therefore, over half of those asked were not certain
that those who deliver psychological therapies should be statutorily
regulated in a future order when standards appropriate to their roles
have been agreed.
Let us look
at question
4:
Do
you agree that all seven domains should be statutorily regulated by
HPC?
Although
a majority60 per cent.of those who expressed a view
supported that, 31 per cent. did not, and 9 per cent. were unsure.
Therefore, 40 per cent. of people were not behind that
measure.
I will not go
through all the questions, but question 5
asks:
Do
you agree with the descriptions of the seven domains in Annex A? If
not, what alterations would you recommend?
The domains have been
of particular concern. Only 39 per cent. of respondents
agreed with the descriptions; 34 per cent. did not; and 27 per cent.
were unsure. Therefore, 61 per cent. of people were not entirely happy
with the descriptions of the seven domains. I could go onit is
important that a consultation of this nature is not dismissed out of
hand.
I stress that
there is support for the provision, but there are some issues regarding
the details. Therefore, I cannot honestly agree with the comments made
and the conclusion that the response was positive. I think that the
response was mixed and that the conclusion does not reflect the truth
of the consultation.
The
respondents expressed considerable concerns. Generally, however, there
are no concerns about the regulation of pharmacy technicians or changes
to the constitution of the General Dental Council, and there are no
doubts about the powers given to the Royal Pharmaceutical Society to
register additional pharmacies in an emergency.
I would like
the Minister to address the issues that I have raised about the
consultation and conclusions. We also need to know what harm has been
caused by lack of regulation of psychologists and what harm will be
prevented by the introduction of this order.
Although I am
broadly in agreement with this statutory instrument, I have a lot of
concerns about the detail. It would be useful if the Minister would be
prepared to revisit those matters when the order comes into effect.
Some of the concerns might be allayed, and some might be dealt with. It
is important for the professions that will come under the regulation to
know that there will be an opportunity to come back to the Minister and
the Department to iron out some of the problems, particularly that of
the 2,000 practitioner psychologists who are not
covered.
10.40
am
Greg
Mulholland (Leeds, North-West) (LD): As the Minister
knows, we have supported the order all along. I just want to reiterate
that support and to say that it is an important measure. I have no
further comment.
10.41
am
Mr.
Rob Wilson (Reading, East) (Con): My hon. Friend the
Member for Windsor (Adam Afriyie) has asked me to express some concerns
on behalf of his constituent, Mr. Marc Adams, who feels
strongly that public protection is being compromised by the order. As
the Committee knows, the order introduces the statutory registration
and regulation of psychologists. That includes protecting certain job
titles from use by those other than appropriately qualified
psychologists. However, Marc Adams believes that the order takes a
narrow approach to protecting job titles and does not cover the use of
the term psychologist. For example, while the title
clinical psychologist will be protected under the
order, consulting psychologist will
not.
Consequently,
it will be almost impossible for members of the public to distinguish
between a qualified, regulated psychologist and someone who claims to
be a psychologist and who has little, if any, training. Should such an
unregulated psychologist abuse a client, that client would have no
protection and that psychologist would be free to deceive and abuse in
future. For those reasons, Marc Adams believes that the proposal
completely fails to protect vulnerable members of the public who use
psychologists. He would like to see a more detailed approach rather
than the piecemeal approach taken by the
order.
10.42
am
Mr.
Bradshaw: The hon. Member for Guildford asked several
questions that I shall endeavour to answer. If I do not succeed, I
shall write to heran alternative that I hope she will accept.
As for why we are dealing only with psychologists under the order, but
not psychotherapists and counsellors, she will be aware that a queue of
professions is waiting for professional
regulation.
Anne
Milton: Will the hon. Gentleman give
way?
Mr.
Bradshaw: Perhaps the hon. Lady will let me make a few
comments before I give way. Although she has not been a member of a
Committee that has discussed the regulation of medical professions, one
of her colleagues has and she will know that the order that we are
debating has been consulted on widely. Regulation is done on a risk
basis. Psychiatrists are the only regulated group, but that is because
they can prescribe drugs to patients. The next highest qualified
providers of talking therapies are practitioner psychologists, and we
are regulating them now. They have postgraduate qualifications. The BPS
has long argued that the profession should be limited to those with
doctorates. That is not accepted by our Department. Now, the HPC should
determine the appropriate level of qualification for entry into the
profession.
We
are considering the regulation of associate psychologists,
psychotherapists and counsellors, who have descending levels of
professional qualification. However, those professions are not subject
to the provisions of the draft order and any proposals to regulate them
would have to be subject to further consultation before any legislation
was laid before
Parliament.
Anne
Milton: I intervene to clarify the point. I completely
understand that there is an order to the regulation of the different
professions. To some extent, that may be what is causing the
problem. I raised the issue of
psychoanalysts, because it is a good example of where the Department
needs to be terribly aware of some intricate detail. Physiologists, who
I spoke of, cannot wait for that to happen, but the Minister appears
not to be willing to do
it.
Mr.
Bradshaw: Many professions are keen to be regulated,
partly because being statutorily regulated gives a profession kudos,
but the responsibility of the Government and the HPC is to make a
judgment about where the most risk lies to the patient and to deal with
the professions in that order of
risk.
The
hon. Lady asked what harm would be avoided by the draft order. As I am
sure she is aware, given her background, psychologists treat vulnerable
people. Examples of poor treatment in the past have led to results such
as inappropriate or incompetent treatment and unethical behaviour,
including financial and sexual abuse. Statutory regulation is a
sensible vehicle for addressing some of those
issues.
The
hon. Lady may be aware that physiologists are part of the modernising
scientific careers programme, about which officials recently consulted
for policy proposals. They are currently considering responses to that
consultation before preparing draft
legislation.
The
hon. Lady also asked why we are not regulating all psychologists and
protecting the generic title psychologist. It is
because we do not want to regulate for the sake of regulation. What we
are trying to do is in the interests of public protection. We have
identified the seven areas of practice within the overarching
discipline of psychology where the majority of those practising work
with individuals or groups on interventions to improve their health and
well-being. If we regulated all psychologists, that would capture a
significant number of psychologists who do not work with clients or
patients and who form no real risk to individuals; for example,
psychologists working in pure academic research, and teachers and
psychology graduates whom we do not wish statutorily to
regulate.
The hon. Lady
asked about chartered psychologists. We are aware that a number of them
have been issued with practising certificates by the BPS but are not
entitled to be full members of one of the seven divisions of the
society, whose members will automatically transfer to the HPC register.
It is not clear whether the psychologists will all need to be
registered. Our view is that if the BPS is unable to allow those people
to use the titles associated with full membership in its divisions, it
is difficult to justify giving them an automatic right to do so without
further consideration by the HPC.
We do not
want to breach the principle that practitioners without the normal
breadth of training should not be given an automatic right of transfer.
However, those neuropsychologists and other chartered psychologists who
are, or have been, registered within one of the seven divisions will
have their registration automatically transferred.
The hon. Lady
asked about the findings from the consultation. It found that 89 per
cent. supported statutory regulation of practitioner psychologists; 70
per cent. agreed that psychologists and teachers working exclusively in
the field of further psychological knowledge should not be regulated;
60 per cent. agreed that all seven domains should be statutorily
regulated by the HPC; and 60 per cent. agreed that the holders of BPS
practising certificates who do not meet the full range of competencies
for one of the seven domains should be eligible for registration only
if they demonstrate that they meet HPC standards for safe and effective
practice. In answer to her question about how we consulted, we did so
through emails; invitations were sent to all the key stakeholder
professional bodies, and the consultation was published on our
website.
I have tried
to address all the comments made by the hon. Lady.
Question
put and agreed to.
10.47
am
Committee
rose.