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I wish to make two final points. There is an urgency about this issue. At other times we have been discussing the Mental Health Bill. The increased role envisaged in that Bill for psychologists and associated mental health professionals cannot but mean that there is going to be greater involvement of these sorts of professionals in the mental health world. There seems therefore to be an urgent need to make sure that there are standards and a quality of regulation to which they are not subject now.
It is a delight to see the Minister back at his old post. I hope that in the past six years he has not lost sight of my noble friends almost unique ability to group together people who do not agree on very much and get them to work together in ways that are quite extraordinarynot just in relation to this issue. I offer just one piece of advice to the Minister: if I were in his shoes and I had my noble friends offer to assist in moving to what I think will be a final resolution of this matter, I think I would bite his hand off.
Earl Howe: My Lords, there can surely be no one better qualified than the noble Lord, Lord Alderdice, to introduce a debate on this topic, nor indeed anyone more worthy of doing so, bearing in mind his staunch commitment to it over many years. It was entirely
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We start, as the noble Lord rightly said, from an agreed position of principle. We know that the Government, as much as the psychological professions themselves, are desirous of achieving a workable system of professional regulation. Indeed, we have known that for some years. It is, frankly, disappointing that six years after the noble Lord introduced his Private Members Bill, the expressions of commitment from the noble Lord, Lord Hunt, to help bring about that system of regulation have still not reached fruition. At that time we received a clear message from the Government that their preferred route for achieving regulation was to use the powers set down in the Health Act for a quick and flexible solution; namely, a Section 60 order.
It was not quite clear to me at the time whether they were suggesting that the psychological professions should be subsumed under the umbrella of what is now the Health Professions Council, or whether in their view there was a case for establishing by order a separate dedicated body for the talking therapies. Reading those debates again, I am inclined to think that they were deliberately leaving their options open on that point. Until the forthcoming White Paper is published we will not know for certain what the Governments final proposals are, but judging by the tenor of the Foster and Donaldson reports it seems clear to most of us which way the wind is blowing. That is why I believe this debate is timely.
Of course, in voicing my disappointment that no regulatory system has yet been put in place for the psychological professions, I do not mean that the last six years have been unproductive. The Foster and Donaldson reviews, whatever one thinks of their precise content, are evidence of the Governments wish to modernise medical regulation, in its broadest sense, across the piece. Equally, in the intervening time, the various branches of the psychological professions have shown commendable energy in trying to reach a consensus of views. What I think todays debate has shown is that that is by no means a straightforward matter. I am sure we will have time to debate Foster in the round at some future date, but one of the assertions he made that I find most unsatisfactory was the statement that,
That statement has the distinct ring about it of a prejudged conclusion. I have to say that the vagueness of the word probably in that sentence underscores my belief that there really is very little in the way of logical argument underpinning the recommendation. To argue that having one umbrella regulator is neater and tidier, which is what his position amounts to, is to adopt an a priori position that has nothing whatever
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If, as I fear, the Government are set on making the Health Professions Council responsible for regulating psychologists and psychotherapists, we are heading for real trouble. What unites those professions currently regulated by the HPC is that, as a generality, they work within a context of delivering healthcare on behalf of employers whose function it is to do that. The focus of the HPC is therefore on healthcare. As we have heard from my noble friend, only a minority of psychologists work in a healthcare environment. Many work in industry and commerce. Many do not provide one-to-one therapy as the main part of their job, or indeed at all. Many of them work independently and unsupervised. Certainly, there are important aspects of the work done by some psychologists that are related to peoples health and well-being, but it is for good reason that psychologists do not call themselves healthcare professionals.
To shoehorn psychologists, psychotherapists and counsellors, with all their very different modalities, into the Health Professions Council would be to blur the distinct and individual interests represented within those professions. That would not only do those professions an injustice; it would also be to the detriment of the clients whom they serve. It is very difficult to see how, under its present modus operandi, the HPC could accommodate and champion issues that may be very profession-specific and often very subtle. One person sitting on the council representing a multitude of disparate professional interests is a formula for poor regulation.
The British Psychological Society, in presenting its proposals for a free-standing psychological professions council, points to a whole host of considerations which, to my mind, confirm that fear: the relatively weak provisions within the HPC for revalidation; the near-impossibility of transposing that revalidation system on to work settings outside the NHS in a way that was consistent and fair; the lack of relevance to psychology and psychotherapy in much of what the HPC calls its standards of proficiency; its inability to accommodate the key standards expected of professionals within all those disciplines without a major change in the way the council operates; the huge difficulty of trying to set up a complaints system that would work fairly inside and outside the NHS; and the inability of the HPC to recognise trainees.
Why, therefore, resist the idea of a separate and dedicated regulatory body for the psychological professions? It would be quite possible, and indeed desirable, to replicate within such a body those features of professional regulation which are or should be universal. But it would also enable the distinct and important differences between the psychological professions on the one hand and most healthcare professions on the other to be captured.
We want 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
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I say Hear, hear to that. Nothing in that statement by the Minister points towards any sort of artificial homogenisation of professional regulation. There is reference to smaller and more strategic, not large and unwieldy; the Minister spoke of meaningful accountability to the NHS where that is appropriate, and not, by extension, where it is inappropriate. He spoke of common approaches to common problems, certainly, but not so as to prevent individual approaches to individual problems.
Artificial homogeneity is to be avoided for the simple reason that it dilutes public protection. Alongside the noble Lord, Lord Alderdice, I urge the Government, even at this late stage, to leave open the possibility of an independent statutory regulator for psychologists, psychotherapists and counsellors when they publish their White Paper. That is the formula most likely to produce a sense of ownership among the professions. We may have waited many years to reach a resolution of these very difficult issues, but whatever resolution is reached has to work.
The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, this has been a very good if short debate. Like other noble Lords, I thank the noble Lord, Lord Alderdice, for allowing us to discuss these important issues. I pay my own tribute to him for the tremendous work that he has done over the past few years in bringing the professions together. That is very much appreciated. I say to the noble Baroness, Lady Barker, that I am prepared to eat my hand off. I hope that we can continue to call on the noble Lords services. He is in a unique position and I look forward to further discussions with him.
It is wonderful to have what I said six years ago quoted back to me. I suppose that I should get used to that. Noble Lords will know that I had no doubt then and I have no doubt now of the importance and requirement for statutory regulation of psychotherapists and psychologists. The protection of patients requires it. Many of those patients are vulnerable people who need the certainty of protection from malpractice or abuse. I also believe, as other noble Lords have suggested, that it is good for the profession. The more confidence the public have in it, the more likely people are to turn to these professions for help in the future. We have what could be a virtuous circle of agreement. This is the best form of regulation where ownership by the profession goes hand-in-hand with the public interest. That is what we must seek.
In response to the noble Earl, Lord Howe, six years does seem a long time and it is a great pity that further progress has not been made, but it has not been for the want of trying of many peoplethe noble Lord, Lord Alderdice, the professions and officials in my department. I want to pay tribute to all
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As my noble friend Lady Pitkeathley pointed out, we are due to publish a White Paper shortly. That inevitably precludes me from responding in some detail to one or two of the more contentious points made in tonights debate, but no doubt there will be a time when we can debate these matters in the future. I also say to the noble Lord, Lord Alderdice, that he is right to point out the risks to the public of a variable quality in the performance of people who come under the titles that we have been talking about. On the other hand, I echo the remarks of my noble friend Lady Pitkeathley in saying that many of the people concerned have given huge benefit to the people who have come to them. I count myself as one of those people. Just as we are clearly agreed that we wish to have statutory regulation and want to outlaw people who should not be in a position to offer poor and sometimes dangerous services to individuals, let us pay tribute to the great majority of people within the umbrella of the talking therapies who have done so much to help people.
I was very interested in the remarks of the noble Baroness, Lady Bottomley, about the benefits of talking therapies. She referred to the work done by the noble Lord, Lord Layard, on cognitive behavioural therapy. Wearing my old hat at the DWP we were very interested in that work. She is right to refer to the number of people on incapacity benefit. The fact is that their life outcomes are very poor and the longer you are on IB the harder it is to get off. If you have been on it for two years, you are more likely to die or retire than ever to get back into work. Discussions are going on in the Government in relation to that report and to the benefits of cognitive behavioural therapy.
I now come to the divisions that have been referred to by the noble Baroness, Lady Barker, and other noble Lords. The noble Lord, Lord Alderdice, referred to the discussions that have taken place being long term, difficult and frustrating. But as the noble Baroness, Lady Bottomley, indicated, there are very legitimate reasons why these should be difficult and perhaps frustrating discussions. I want noble Lords to understand that I am sympathetic to some of the difficult issues that a number of the therapies face in talking about regulation. I pay tribute to the work that they have undertaken over the past six years.
It is important to state what the Government understand by statutory regulation. It exists to protect the public from poorly performing practitioners and does this essentially in three ways: first, by setting standards of practice, training and conduct; secondly, by registering those who have trained and are competent and can demonstrate that they are of good health and character; and thirdly, by operating a system to investigate and impose sanctions against registrants who are found to be unfit to practise. Limiting regulation to a system which addresses conduct and health issues alone will not protect the public from practitioners who are not
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Many professional bodies active in the field of psychotherapy and counselling have developed different theoretical models, as we have heard. My officials have worked with those bodies since 2001. It is noticeable that many of these bodies have very different ideas about what constitutes good practice. Therefore, it is very difficult to get any acceptance of leadership from within the field, on the grounds either of lack of knowledge or appreciation of each others approach.
In 2004 my department funded two umbrella organisations, the British Association for Counselling and Psychotherapy (BACP) and the UK Council for Psychotherapy (UKCP), to map training courses and the standards applied to them as a way of identifying training for different roles. This was unsuccessful in identifying the content of courses or scope of practice of roles although it provided valuable information on the number and classification of training courses. Many organisations in the field were unwilling to share details of their training with each other. We engaged Skills for Health to co-ordinate a competence framework. It launched its competence framework consultation in December last year and it is due to end on 23 February.
As a result of the competence-based role identification, we may find that some practitioners who are currently called counsellors do the same job as psychotherapists and should be regulated as such. We may also find that there are roles at other levels, and some may work in managed and supported environments which may not need statutory regulation.
My officials began talks on a draft order with the British Psychological Society in 2003. The talks lasted two years and produced an order which was issued for consultation in March 2005. Noble Lords will know that the BPS rejected those proposals, first, because it wanted a separate psychology council and, secondly, because it rejected its previous position, which was that only those working in applied fields of psychology would be regulated. The Governments position is that we need regulate only those whose practice warrants it because of the risk to the public if their practice goes wrong. The BPS called for other types of academic and research psychologists with theoretical training only to be registered. Thirdly, the BPS wishes to protect the generic title psychologist and set generic standards which could not be met by those without practical training. However, if we legally restrict the title psychologist to those who can demonstrate practical and theoretical competence, we would unfairly criminalise many with a legitimate claim to use the title.
There is an analogy here with the legal profession. Many eminent academic lawyers have every right to call themselves lawyers but because they have not had vocational training they cannot call themselves
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We have carried out a major review in the past two years of the regulation of health professions. We will shortly be publishing a White Paper, which I cannot anticipate, but I hope it will pick up some of the issues that the noble Earl, Lord Howe, has raised, such as revalidation. In dealing with the talking therapies, we are dealing with professions outwith the National Health Service and healthcare. Clearly, in the whole future of health regulation, we have to address the diversity of provision that is developing in the health service and in the independent sector, which takes us back to some of our earlier debates. I cannot comment on the questions raised in relation to the Health Professions Council; to do so would anticipate the White Paper. However, I understand what noble Lords are saying to me tonight. I say to them that I do not think we should underestimate the very good work that the HPC has undertaken since its establishment; nor that it registers and regulates many professional people who practice outwith the National Health Service. I understand that there will be further debate in that area.
I cannot comment at this stage on what the noble Baroness, Lady Barker, said about lay people. I take it from her remarks that she is not against a sizeable proportion of lay people being involved in the regulation of professional people. I hope that the White Paper may have something to say to address the very interesting point that she raises on dual regulation.
In conclusion, this has been an excellent short debate. We are all agreed that regulation of the talking therapies is a very important matter; I regard it as very important indeed. There will be issues to discuss on what is in the White Paper. I understand the issue about the Health Professions Council and the desire of some to have a separate council. That will have to await further discussion. What is not in doubt is the departments willingness to engage with the professions as much as possible or our debt to the noble Lord, Lord Alderdice, for all the work that he has done in the past, and in anticipation of the work that I hope he will do in the future.
(1) A court before which an organisation or person is convicted under this Act may make an order that the organisation makes public in a manner and form to be decided by the court details of any or all of the following
The noble Baroness said: My Lords, in Grand Committee there was a full discussion on naming and shaming, as proposed in an amendment tabled by the noble Lord, Lord Hunt of Wirral, and in my amendment. The amendments sought to give power to the court to publicise a conviction. Our amendment spells out not only that there should be naming and shaming, but the steps that must be taken to try to ensure that there is no recurrence. We believe this to be extremely important. The public have a right to know, in a case in which a death has occurred, not only that those liable have been convicted and have paid the appropriate penalty, but that steps are being taken to ensure that a similar incident is unlikely to happen. The impression that I received on Report was that my noble friend the Minister was quite sympathetic to the points that we raised, and he said that he was considering carefully the suggestions that had come forward. I therefore await with interest his response to the amendment today. I beg to move.
Lord Wedderburn of Charlton: My Lords, I have added my name to the amendment, and I regard it as a very important matter. I very much hope that the Minister will be able to tell us that the Bill will be firmed up on the question of making it clear to the public who has failed in regard to these essential matters of safety at work. I support the amendment very strongly.
The Attorney-General (Lord Goldsmith): My Lords, I pay tribute to my noble friend because she has spoken persuasively in the past about the desirability of having a sanction of this sort. As a result of the arguments put forward by my noble friend and others, including in another place, we have been persuaded that adverse publicity orders would be a powerful addition to the package of sanctions in the Bill.
We have tabled Amendment No. 38 in the name of my noble friend Lady Scotland, and we shall come to it later. The noble Lord, Lord Hunt, has also tabled Amendment No. 29 but, as it happens, they are not grouped together. I shall speak in more detail about Amendment No. 38 when we reach it, but I hope that my noble friend will accept that we believe it achieves what she is looking for from her amendment. In that respect, I hope that it will also respond to what the noble Lord, Lord Wedderburn, has asked for. So, if my noble friend is content to be patient to that extent, I invite her to withdraw her amendment at this stage and we shall deal with the detail of the government amendment when we get to it.
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