---

Health Care and Associated Professions (Miscellaneous Amendments and Practitioner Psychologists) Order 2009

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 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 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. 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. 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 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.