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Session 2008 - 09
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Public Bill Committee Debates

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 Government’s 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 Minister’s 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 titles—a restraint of trade issue—and 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 majority—60 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 on—it 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 her—an 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.

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