---

As regards practitioner psychologists, after much discussion and consultation we have identified 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 or well-being, and as such carry the greatest potential for causing harm to their patients. These groups are clinical psychologists, health psychologists, counselling psychologists, forensic psychologists, educational psychologists, occupational psychologists and sport and exercise psychologists. We do not want to regulate all psychologists as this would capture significant numbers of psychologists who do not work with clients or patients and who form no risk to the health and well-being of individuals; for example, those psychologists working in the area of pure academic research, teachers and other psychology graduates who we do not wish statutorily to regulate. Nor do we want to protect the title “psychologist” for the exclusive use of those we are regulating as that would prevent these other groups who we do not wish to regulate but who have a legitimate claim to that title, from using it.

I am aware that there are a number of chartered psychologists with practising certificates who the British Psychological Society consider should have their names automatically transferred to the new HPC register, along with those who are members of the seven divisions of the BPC, whose members will transfer automatically. However, it is not clear whether these chartered psychologists are entitled to membership of those seven divisions. If they are not, they are not at present allowed by the BPS to use the titles associated with membership of those divisions—for example, clinical psychologist—and as the BPS has not granted them the right to use those titles we are not prepared to provide for their automatic transfer to the new register, which would give them that right. However, we are asking the BPS to work with us to resolve these situations. I should emphasise that a cornerstone of statutory regulation is restricting the use of titles associated with a profession to those who should properly be entitled to use them. This means that the public can be reassured that a person who calls himself, for example, a clinical psychologist, is fully qualified and able to treat them as such.

As a consequence of all this those BPS members with practising certificates who are not allowed by the BPS to use the basic protected titles will need, if they wish to use any of those protected titles, to apply to the HPC for registration once the statutory register opens. The HPC has indicated that it will recognise all existing qualifications that would have led to chartered psychologist status. If a BPS member holds one of these qualifications, they will be able to apply for registration in the same way as newly qualified psychologists. Any current practitioners who do not have recognised qualifications will be able to go through a process known as “grandparenting”—an assessment process under which each application is assessed

5 May 2009 : Column 512

individually before the applicant can be admitted to the statutory register. Under this process some applicants may be required to take a test of competence before registration is granted.

The remainder of 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. It also extends the statutory regulation of pharmacy technicians to Scotland. Some Members present may recall the interesting debates last year on similar orders and the Health and Social Care Act.

Changes to the governance arrangements of the General Dental Council and the Health Professions Council include moving each of these bodies from a partially elected to a fully and independently appointed council to ensure that professional interests should not unduly influence council deliberations. In the past year five other health professions regulators have already made this move: the General Medical Council; the General Chiropractic Council; the General Osteopathic Council; the General Optical Council and the Nursing and Midwifery Council.

Other miscellaneous amendments include: the standardisation of the statutory duties to ensure that regulators consider the interests of stakeholders in their deliberations; new arrangements for accountability to Parliament, including a new requirement for each regulator to report on its arrangements for ensuring that it adheres to good practice in relation to equality and diversity; a new requirement for the GDC and HPC to publish a strategic plan; and new arrangements for the constitutions of statutory committees of the GDC and HPC.

Amendments are made to the Safeguarding Vulnerable Groups Act 2006 and the Protection of Vulnerable Groups (Scotland) Act 2007 and to a range of fitness to practise rules for each of the regulatory bodies. These amendments will make it easier for regulators to strike off registrants who are barred from working with children or vulnerable adults when the new Independent Safeguarding Authority is established.

Provisions in relation to emergencies such as pandemic flu will allow the registrar of the RPSGB to register anyone he considers suitably experienced as a pharmacist, such as recently retired pharmacists, during a public health emergency and to give enhanced prescribing rights to more of its registrants.

I should perhaps also point out that in the debates elsewhere on this order, in both the House of Commons and the Scottish Parliament, the regulation of clinical physiologists and other scientist groups has been raised. Noble Lords may be aware that the role of clinical physiologists is being considered as part of the modernising scientific careers programme, about which the Department of Health recently consulted. Officials are considering the responses to that consultation before developing proposals for regulation. All the measures are supported by each of the regulatory bodies covered by this order. I commend it to the House.

Earl Howe: My Lords, the House will be grateful to the Minister for introducing the order which, as some of us know, is the product of many years of discussion

5 May 2009 : Column 513

between the psychology profession and the Department of Health, as well as extensive discussion within the profession itself. I should like to be able to welcome it wholeheartedly on that account as being the settled view of all the parties involved, but, unfortunately, I cannot quite bring myself to do that because I am aware, as, I am sure, is the Minister, that there is great disquiet among members of the profession about what this order will mean for them and their patients and clients, and the precedent that it is likely to set as regards the related disciplines of psychotherapy and counselling in particular. My mailbag has been full to bursting with letters from psychologists and psychotherapists expressing total anguish about what the order contains and about the consultation that preceded it, which they see as having been stage managed. It has not been particularly easy to tell those correspondents that by longstanding convention this House does not vote down secondary legislation. What we have in front of us, at least the part of it that relates to the regulation of psychologists, cannot, unfortunately, be described as a settled view or one that is universally welcomed.

Before tackling the detail, perhaps I may briefly comment on the part of the order that gives rise to little or no controversy. I can certainly give a welcome to the section dealing with the General Dental Council. The arrangements will bring the GDC into line with the GMC and other regulators, as the Minister said, regarding the composition of their council, and puts other aspects of its governance arrangements on to a more up-to-date footing. I can also express my support of the provisions that cover the pharmacy profession. The legislation relating to the statutory regulation of pharmacy technicians in England and Wales has not yet been brought into force, so it is welcome that with the order we are considering, there is the immediate prospect of having regulation of pharmacy technicians across Great Britain as a whole. I am also glad that in line with the nursing and medical professions, provisions have been included that will enable the Royal Pharmaceutical Society of Great Britain to register individuals as practising pharmacists on an emergency basis for a temporary period.

Those are the uncontroversial elements of the order: I return to the more difficult ones. One of the points that people have made when writing to me—I am talking about practising psychologists—is that they see no practical need for statutory regulation of the profession and maintain that the case for it has not been made. With no disrespect to the individuals involved, I have been looking too long at these issues to be able to endorse that point of view. In the 21st century, with a need for full professional accountability, professional standards of practice, transparency and protection of the public, it is difficult to argue that statutory regulation in any form whatever is unnecessary. Some have argued that there is already voluntary regulation through the British Psychological Society and other professional bodies, so why do we need to make it statutory?

There are several answers. One is that the present system does not protect the key professional titles. Anyone can call himself a clinical or health psychologist without any recognised professional basis for doing so. That cannot be right from the point of view of

5 May 2009 : Column 514

public protection. Another reason is that although the professional bodies are made up of fair minded and conscientious individuals, they are accountable in the end to no one but themselves. Through the order comes the link to Parliament and the Council for Healthcare Regulatory Excellence. I believe that to be a positive, not a negative, step.

Many of the fears expressed to me have related more to psychotherapists and counsellors than practitioner psychologists. The reason why those fears have been voiced so loudly is that the order is viewed as the forerunner to an inevitable sequel that will impose statutory regulation on those other disciplines. That is what people are fearful of. I will quote from one letter that I have received, which is representative of many:

“If registration of psychologists, counsellors and psychotherapists goes ahead, it will lead to the standardisation of knowledge and training and stifle the diversity of thought and practice among the talking therapies. This diversity is a source of strength and creativity, reflecting the diversity of human experience ... Standardisation is also potentially discriminatory, as it would be based on the dominant forms of subjectivity, which marginalise many [minority groups] ... In the long run it would reduce the choice of therapies available in the independent sector, as training courses not approved by the state would find it difficult to fill places”.

I am troubled by those criticisms, because while one would not want to encourage wild and dangerous experimental practice, I can see that being able to branch out into new territory and not having a totally homogenised and inflexible set of standards is highly desirable. No professional discipline can be set in aspic. The basic charge is that regulation under the HPC will create a narrow and restrictive definition of the field within which psychologists operate and thereby deprive the public of a wide range of therapies; in other words, state-sponsored rigidity. What does the Minister have to say?

An equally difficult issue that some have raised with me is that practitioner psychologists see their work as more of an art than a science. What that means is that effective outcomes rest largely on the personal qualities of the practitioner, such as empathy and intuition, qualities that are not quantifiable and thus not amenable to regulation. Equally, because each client is unique, what counts as successful professional activity cannot be captured by a set of defined competencies. Individual well-being cannot be captured as a standard because each individual is different, with a different view of what well-being means for him or her.

7.45 pm

I wonder whether the Minister can give me her reaction to this point. Unlike the noble Lord, Lord Alderdice, I am not able to form a professional view of it, but one problem is that if good professional practice is wholly incapable of being defined, as is suggested, the same has to be true of poor professional practice and there would be no need to train anyone. That cannot possibly be correct. If it were, it seems that we would not be able to call psychology a profession at all. Nevertheless, there is a kernel of genuine concern about the nature of outcomes in psychology, which are seen as being different in kind and substance from outcomes in, say, medicine, which can be measured and objectively defined.

5 May 2009 : Column 515

Two main concerns have been raised with me by the British Psychological Society and I ask the Minister to comment on them. The first is about the threshold entry level for safe and effective practice. The Minister of State in another place took issue with the BPS’s long-standing position on this, which is that the threshold entry is at doctorate level or level 12. That is the level at which all existing qualifications and training are set for all existing chartered psychologists. Therefore, what the Minister said flatly contradicts the assurance which the BPS received, which was that quality standards would not be lowered by the transition from the voluntary to the statutory register. It is also, incidentally, somewhat presumptuous. How can any Minister pre-empt a decision about professional standards that the HPC itself will need to make?

The second issue raised by the society was helpfully covered in the Minister’s remarks; it relates to the chartered psychologists whom this order will exclude from registration. According to the BPS there are about 2,000 of them. I was grateful for the Minister’s remarks, but the BPS has pointed out to me that all those people are considered by the society to be suitably qualified and fit to practise and some of them have been on the register for many years. The charge against the Department of Health is that Ministers have taken a decision on an unjustifiably narrow basis to recognise only those chartered psychologists who happen to be members of one of seven professional divisions. Not only will this order leave the public unprotected from this large number of independent practitioners; but it will also disbar those individuals from professional practice using a protected title. This amounts to a distortion of the market and a restraint of trade. That is a serious charge and I should be grateful if the Minister could respond to it.

A number of correspondents have asked a very simple question, which is, “What makes the Government think that the HPC is capable of protecting the public reliably and effectively in this particular field?” That question brings us back to the debate we held in this Chamber just over two years ago when the noble Lord, Lord Alderdice, and I argued strongly for the setting up of an independent statutory regulator for psychologists, psychotherapists and counsellors. The Government have instead chosen to go down the HPC route, apparently because they have set their face against creating yet another independent regulator. But the worries remain, because up to now the focus of the HPC has been very much directed towards professions related to healthcare. Psychology is seen as being quite distinct from healthcare. Large numbers of psychologists work completely outside a healthcare environment and cannot sensibly be subject to the same sorts of standards of assessment. It is the same concern as that which I mentioned earlier. People are afraid that, because the HPC does not understand psychology, it will serve only to homogenise professional regulation in ways that take no account of the individuality and diversity that creative practical psychology should encourage. In other words, it will force psychologists into a regulatory mould in which they do not fit.

By contrast, a dedicated, professionally-led regulatory body would by definition have been able to accommodate

5 May 2009 : Column 516

such individuality and diversity. It would be helpful to hear from the Minister why, in the end, the Government rejected this option. Had they accepted it, I have little doubt that it would have commanded much wider acceptance among members of the individual professions than, sadly, this statutory instrument has been able to do.

Lord Alderdice: My Lords, I declare an interest in the parliamentary sense as a consultant psychiatrist in psychotherapy, and I run the Centre for Psychotherapy in Belfast, which is a National Health Service facility.

I am grateful to the Minister for introducing the order. As the noble Earl, Lord Howe, said, she helpfully outlined some of the issues that come to the fore. There are a number of elements of the order to which I wish to draw attention. Like the noble Earl, I entirely welcome the emergency provisions and the safeguarding of vulnerable groups provisions that are put in place. Like him, I find these uncontentious. I understand that, with regard to the professional bodies, no particular objections have been lodged—for example, by the General Dental Council—to the changes that are proposed in the order, effectively to remove the possibility of professionals electing from among their own professional colleagues a number who would exert professional oversight.

I am less sanguine about this development than many of those involved. The appointment of all members would mean that there is no real independent professional voice, for all effectively will be government appointees. The Government are an interested party in this matter, since in many of these professions they are an almost monopoly employer through the NHS. In the case of dentists, one of the problems is that a degree of disenchantment has meant that a very large number have left the NHS. I would have thought that that in itself was an interesting marker to which the Government and the General Dental Council might have paid attention. However, I do not wish to major on this, because it seems that the professionals in those areas are content to go with it.

On the subject of regulatory peculiarities, I am used to inconsistencies between different orders. For example, as the noble Earl pointed out, I proposed about 10 years ago the establishment of a council for psychotherapy, and I shall return to that later. The Government insisted that they would not support such a proposal, because they were absolutely not going to have any further separate professional bodies; everything would be subsumed within the Health Professions Council. Then they promptly decided to create the General Pharmaceutical Council, referring to a much smaller number of professionals than would have been the case in psychotherapy, never mind within psychological therapies as a whole. So I am familiar with this kind of inconsistency between orders.

However, here we have inconsistency within the order. There is now going to be a UK-wide application of a psychologist’s registration to all four parts of the United Kingdom, but Northern Ireland will be specifically excluded from statutory registration of pharmacy technicians. The order brings Scotland into line, but not Northern Ireland. I know that Northern Ireland is

5 May 2009 : Column 517

not easy to bring into line on a number of issues, but it seems to me particularly strange in this regard, for while there will be relatively few pharmacy technicians in Northern Ireland in numerical terms, and almost all of them will simply work within Northern Ireland, there are already a number of psychologists who operate across the border between Northern Ireland and the Republic of Ireland. It seems to me that there is something particularly strange here. I rather suspect—in fact, I am rather sure—that the Minister and her colleagues have been in consultation with the Northern Ireland Executive. I do not for a minute wish to hold her accountable for the decisions of the Northern Ireland Executive, if that were even possible. However, I would be interested to know whether any justification was requested on the differing decisions to have psychology as a UK-wide registration but to have Northern Ireland specifically excluded in respect of pharmacy technicians.

The main issue is the new statutory registration of practitioner psychologists and the potential implications for psychotherapists and counsellors. The House will be aware that the subject of statutory registration for psychologists, psychotherapists and counsellors is one that I have pursued through two Private Members’ Bills, a number of Parliamentary Questions, debates and other modalities. I make it very clear that I am supportive of statutory regulation and registration. Indeed, if Her Majesty’s Government had accepted some of my proposals in this place 10 years ago, they would have been operative for some time.

One argument at the time against my Bill was that it would take too long and that to pursue things through Section 60 of the then Health Bill would be much quicker and easier. At that time, I was conducting a number of discussions, which involved the BPS, UKCP, BCP, BACP, the Royal College of Psychiatrists, the Association of Child Psychotherapists and a number of other bodies. The department successfully wooed away the British Psychological Society with the promise that things would move much more quickly. The BPS had been pursuing the possibility of a Private Member’s Bill in another place bringing in registration. The department promised that things could move much more quickly if only the BPS would separate itself off from these difficult and contentious people in psychotherapy and counselling. Almost 10 years later, we find ourselves with an order for psychologists and with still nothing really in sight for psychotherapists and counsellors. I think that the concerns of the noble Baroness about the difficulties that there might be ahead are well informed.

The HPC is being used but, in a letter dated 26 September 2006, the president of the BPS said that the BPS opposed having the HPC as a regulator because it was,

“not fit for that purpose”.

That is why the BPS had engaged with other professional bodies and brought forward the proposal of a psychological professions council, which would, among other things, have brought all psychological therapies and professionals together. The Minister said that psychiatrists were the only ones that were currently regulated. This is almost the case, because it is also the case that arts psychotherapists are regulated through

5 May 2009 : Column 518

the Health Professions Council, so there is a little bit of experience there. A psychological professions council would bring all of them together, with a different understanding of things from that belonging to those working in the physical therapies and physical scientific approaches that are largely the base for the Health Professions Council.

It is also the case, as has been mentioned, that the order has effectively split the profession of psychology. Those psychologists who are working specifically in healthcare and in a number of other areas will be separated off from those who are—if one might say so—the pure science, research academic psychologists, who will not be required to register; in some ways, it would not be appropriate for them to do so, because they are not health professionals. Effectively, this divorces them, which is a problem that would not have arisen if a psychological professions council had been the modality that was taken forward.

I am puzzled as to why the Government have not proceeded with the psychological professions council. It is only a few minutes since the noble Lord, Lord Hunt of Kings Heath, was on the Front Bench making kind remarks about me. He was the Minister responsible in 2000 and 2001, when he indicated that there was a case for a separate council. In private, he endearingly called it a “talking heads council”, but perhaps the term “psychological professions council” would be more congenial. I think that he did not entirely let go of his belief, even some time later.

I would like the Minister to put on record why it has not been possible to create the new council. It cannot be a financial or an organisational question, because a much smaller number of practitioners is involved than with the General Pharmaceutical Council, yet it has been possible to establish that. Indeed—here I cast a sidelong glance at the noble Earl—it may not be long before a new Government are in place; they certainly will be before there are proposals for the regulation of psychotherapists and counsellors. I wonder whether that might be the time—for tonight does not appear to be the time—when we might rectify this misguided approach and establish a psychological professions council that would be the suitable home for psychologists, psychotherapists, counsellors, arts therapists and others, as such a council would understand more fully the complexities of the work and the difference between that work and what is appropriate for the Health Professions Council to regulate.

8 pm

Baroness Pitkeathley: My Lords, I speak as chair of the Council for Healthcare Regulatory Excellence, which has been mentioned. It is the body that regulates and reviews the performance of the nine bodies that are the regulators for the individual professions. I thank the Minister for explaining the order so succinctly. CHRE supports the measures and their positive impact on public protection. We very much welcome their introduction.

---