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Lord McColl of Dulwich: Although I believe that Amendment No. 1 is a real improvement to the Bill, I very much support the amendment moved by my noble friend Lord Caithness. He has put the case so clearly that, as a surgeon, I do not think I should muddy the waters any further. I support my noble friend.

Lord Hunt of Kings Heath: I congratulate the noble Lord, Lord McColl, on the brevity of his contribution.

Perhaps I may present the Government's view on the two amendments. I congratulate the noble Lord, Lord Alderdice, on his achievement so far in shaping the proposals for regulating the profession of psychotherapy. He has done immensely valuable work in addressing most of the concerns of the different branches, or modalities, of psychotherapy. His amendment is very much at the heart of that attention to the concerns of the professions and it demonstrates his commitment to the better development and regulation of psychotherapy in its many forms.

The noble Lord referred to 30 years of delay. I want to assure him and the Committee that the Government are in favour of better regulation of the psychotherapy profession. There is no doubt that that is needed. We are aware of cases of poor professional practice and also of cases involving the abuse of patients. Fortunately, such cases are rare, but we need to guard against them. I do support the principle of better regulation for psychotherapists.

However, we have to consider the matter in the context of the Government's position on regulation generally, which was stated in the NHS Plan. We want

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to make regulatory bodies smaller and more strategic to home in on essential issues of public safety. We want them to be faster to respond when things go wrong, to minimise the risk to patients from unsafe professional practice. We want them to develop meaningful accountability to the NHS, where that is appropriate, and to the public, who are the users of the services. We also want regulatory bodies to develop common approaches to common problems. It is unfair and confusing to the public that professional malpractice can be handled in such different ways by the current different regulatory bodies. We are setting up the United Kingdom Council of Health Regulators to promote collaboration and a common approach by health regulators and to spread good regulatory practice.

In that general context, I have to say that, well intentioned as the Bill is--it is very well intentioned--it is not the way that we would wish to go forward, in that it seeks to establish a free-standing statutory regulatory body for psychotherapists alone. We are committed to the regulation of psychotherapy but we do not think that a stand-alone Bill, even with this amendment, is the right way forward.

It is worth recalling that the Health Act 1999 contained special powers to provide for regulation by order under that Act. That was done so as to provide a fast, responsive way of regulating health professions so that concerns about patient safety can be addressed as quickly and as sensibly as possible. It is faster both to set up such a body and to make any subsequent changes to it by using an order rather than an Act in this way. But the order-making power still allows for discussion of the issues during and after extensive consultation, with wide input from all stakeholders. I was interested in the comments made earlier by the noble Lord when he stated that the modalities he had proposed should not be seen as a list that would be complete for all time. Part of the problem of regulation in the past has been that, when such regulation has been established by Parliament, it has been difficult to put into place any necessary changes and flexibilities. That was the reason why Section 60 was introduced into the Health Act 1999. It allows for that flexibility.

We need to discuss a second issue. Essentially, the Bill proposes to cover only a part of those engaged in this important area of healthcare provision. It is the intention of the Government to explore ways of regulating what has come to be known as all the "talking therapies", bringing them together under one body. I can assure noble Lords that it is our intention for officials of the Department of Health to discuss the concerns of psychotherapists, psychologists and counsellors over the coming months.

Lord Clinton-Davis: Before my noble friend moves on to his next point, what will happen if he is unsuccessful in his efforts to secure a rapprochement

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between the Jungians and the Freudians? I hope that the contrary will be the case, but if he is unsuccessful, then what will he do?

Lord Hunt of Kings Heath: I should like to make two points in response to that question. If rapprochement could not be secured, the impact would as great if we were talking about the Bill as proposed by the noble Lord or if we were progressing along the route favoured by the Government; namely, a Section 60 order. It is clear that what is necessary is that we must build on the enormously valuable work already undertaken by the noble Lord, Lord Alderdice, to try to build consensus among the various modalities.

Everything that we have learned over the past few years in the field of regulation demonstrates that, while the primary concern is the public interest--that must be our primary aim--equally, without ownership among the professions themselves, it is not going to work effectively.

Lord Wedderburn of Charlton: Before my noble friend moves on to his next point, could he clarify one matter? The point raised by my noble friend Lord Clinton-Davis surely ranges even wider? The interests of the public, which must come first, are surely primarily the interests of the patient. In that respect, we have today heard a plea for less action which pushes people into the same bed or onto the same couch and so forth. I addressed that point in my contribution on Second Reading, as did the noble Lord, Lord Alderdice. What benefit will be gained by insisting that counsellors be a part of this move, and what benefit would derive from presenting an order which cannot be amended in either House, given that it has been demonstrated, in the progress of this Bill, how much greater progress can be made in an area where delicacy and gentleness of approach are perhaps more important than tidiness?

Lord Hunt of Kings Heath: I shall respond by saying that, in relation to the desire to see the professions being regulated together, I believe that the NHS Plan sets out clearly why we need to break down barriers between different professions in the health field. Many advantages are to be derived from that. Examples are already in place in the draft order. A proposal has been put forward to establish the health professions council. That will be published as soon as possible. It is intended to bring together 12 professions, building on the professions already regulated under the Council for Professions Supplementary to Medicine. In an era when we wish to see consistency between the different professions, it is well worth considering whether the appropriate way forward here is to bring together psychotherapists, psychologists and counsellors.

In relation to the order-making power, perhaps I may say to my noble friend that I believe distinct advantages may be gained because of the flexibility such an order-making power would give us to respond to changes that will take place over the years in professions and in public perceptions and expectations. The process of laying an order is

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extensive. In relation to the health professions council, which is a model, we have engaged, first, in extensive consultation with the stakeholders; there has then been public consultation. Following that, a draft order will be published for consultation. Only following that will an order, which has to be approved by affirmative legislation, be laid. I believe that that is an acceptable process. It allows for considerable debate and, at the end, it will allow your Lordships and another place to come to a view.

So far as concerns the noble Lord's proposals to establish an education committee for each of the seven groups of modalities for psychotherapy, I fully support what one might describe as a "federated" approach which allows specific professional input where it matters into training and education issues. As we have heard, the modalities proposed by the noble Lord do not have the support of all the relevant groups. However, I believe that the approach he has taken is the right one. Certainly, the Government will want to build on that approach when we come to make more specific proposals in relation to regulation.

Amendment No. 2, which has been brought forward by the noble Earl, Lord Caithness, and is supported by my noble friend Lord Clinton-Davis, meets the concerns of many analytical psychologists who wish to have their modality recognised separately from that of psychoanalytic psychotherapists, although my understanding is that some analytical psychologists would prefer to remain closely linked with psychoanalysts, as reflected in the amendment of the noble Lord, Lord Alderdice.

In relation to this point, I hope that, as a result of this debate today and the discussions which will undoubtedly take place, it will be possible for the different groups to come together and to agree an appropriate way forward. Certainly so far as the Government are concerned, it would be our intention over the next few months to hold discussions with all of the appropriate professional groups to take forward the enormously valuable work that has already been undertaken.

Lord Alderdice: Perhaps I may pick up on two elements. First, as regards Amendment No. 2, I indicated that I would say something further when the noble Earl, Lord Caithness, and the noble Lord, Lord Clinton-Davis, had spoken. The example that they have given shows something of the complexity of dealing with such historical professional matters.

Perhaps I may explain the picture as I understand it. There are those analytical psychologists--Jungians, as they are described after the name of their founder--who want a separate modality; they want, as it were, to paddle their own canoe. That view has been represented to me by a number of their organisations, in particular the Association of Jungian Analysts, the Independent Group of Analytical Psychologists, the Confederation of Analytical Psychologists and the analytical psychology section of the United Kingdom Council for Psychotherapy. In total those groups represent, by their own account, some 185 therapists.

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Then there are those analytical psychologist organisations which are associated with the British Confederation of Psychotherapists--that is, the Society for Analytical Psychology and the union division of the BAP. At the moment, they appear to be much less sure that they want to separate from their colleagues in psychoanalysis and psychoanalytic psychotherapy. They claim a membership of some 240 therapists. On those figures, they would appear to represent a majority in the union community.

I am not interested in whether it is a question of majorities or minorities--that is not important--but it is clear that there is a division within the union community. It may be a division that can be resolved among themselves in time--it may not even be a long time; I do not know--but I did not enter into this legislation to create further divisions; there are more than enough already. The purpose was to try to bring people together. If Amendment No. 2 were to be accepted, whatever the numbers game, the effect would certainly be, not to reach agreement all round, but simply to have a different set of somewhat disappointed analytical psychologists.

I fully accept that what we have proposed does not solve the problem. I am grateful to the noble Earl for his kind words in relation to the Bill as a whole, as I am to the noble Lord, Lord Clinton-Davis. However, I say to them that I have been in discussions, and I wish to continue those discussions, with the representatives of the different elements of analytical psychology and with the other groups to try to see whether we can reach some further understanding that will take us beyond this problem.

I hope that on that basis the noble Earl may feel able to withdraw the amendment, because there are further implications to pressing that view. For example, the noble Lord, Lord Clinton-Davis, mentioned the position of psychoanalysis. It is not an entirely unified body. Freud is certainly the father; but most families have divisions in them even when they recognise the same father. The Kleinians take a different line from the Lacanians; and even among the Freudians there are divisions between the more classical approach and the more modern approach. So there are dilemmas.

I may be wrong, but I do not really doubt that if the analytical psychologists had a modality of their own, psychoanalysts would then say, "In truth, we ought to have one, because psychoanalysis is something rather different from psychoanalytical psychotherapy". Then, one would quickly find that among the other modalities where some degree of compromise has been reached in bringing together different streams, they themselves would begin to say that what is sauce for the goose ought to be sauce for the gander, and that they, too, ought to have two, three or more modalities. All the work that we have been trying to do to bring together this somewhat fissiparous profession would begin to unstitch.

I fully acknowledge the proper concerns that are pointed up by the amendment. But I appeal to the noble Lords to withdraw it, on the basis that we continue to work on the matter. I do not see my

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amendment as being the end of the story. I see it simply as a basis from which we can work. But it would be unhelpful simply to find ourselves unstitching all that has thus far been put together. We need to continue to work on it.

Perhaps I may briefly respond to some elements of what the Minister said and perhaps respond more fully to it in relation to one of the other amendments. I am grateful to the Minister for his recognition that this is a piece of work that needs to be done and upon which we must build. I am encouraged that he talks about building on it over the next few months. Time passes, and other matters become priorities. I shall want to hold the Minister and his colleagues to the commitment that the work should be done over a relatively short period of time.

I also welcome the Minister's comments about trying to build on the modality approach. We may want to return to this matter. I find it difficult to see how we can find another way of working. If we do, that is wonderful. But at least we have something on which we can begin to work and build.

I welcome the responses and the considerable interest in these proposals and the constructive response of the Minister to date, although I want to pick that up a little further. I appeal to the noble Earl to withdraw the amendment at this point and we can continue to work together on the matter.

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