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State Regulation

Here UKAHPP is posting regular updates on the move towards state regulation of psychotherapy and counselling, briefings on its potential impact on the profession and specific issues for humanistic practitioners, and information about opportunities to get involved.


The Department of Health plans to replace the current systems of voluntary self-regulation with a single mandatory system of state regulation by the Health Professions Council (HPC). The titles "psychotherapist" and "counsellor" will be legally restricted to practitioners who are HPC-registered. This state regulation is being developed by an HPC Professional Liaison Group assisted by a confusion of other government initiatives including Skills for Health (developing national occupational standards for each psychotherapy modality), Improving Access to Psychological Therapies (which has promoted CBT as a therapy of choice) and the National Council for Health and Clinical Excellence (NICE, promoting CBT for depression and cautioning that counselling or therapy are of uncertain effectiveness). The PLG's recommendations went back to the HPC Council on 12 December 2009 and - despite many problems revealed by the consultation - were forwarded to the Department of Health as "OK to go - legislate".

Assuming legislation is passed in 2011, transfer to HPC of the current voluntary registers (UKCP, UKAHPP, BACP etc) could start in 2012. After a 3-year grandparenting period, the earliest date that it is likely to become illegal to call oneself a 'counsellor' or 'psychotherapist' without being HPC registered is 2015. However, judicial review (see below) is likely to delay these estimated timetables.

The Board of UKAHPP has decided not to take a position exclusively for or against state regulation, and to support members taking either position, for or against.

If you want to have more background on state regulation of psychotherapy and counselling, have a look at these two summaries:
Statutory Regulation - (background from UKAHPP March 2008 newsletter)
State Regulation and Humanistic Psychology


Government Health Bill - good news?

The government Health Bill published on 26 January seemed to offer some hope to practitioners worried that the Health Professions Council would make it illegal for you to continue calling yourself a counsellor or psychotherapist unless you registered with HPC and took on board its legalistic & medical-model rules.  The Health Bill makes no reference to compulsory state regulation, and no reference to legal restriction on the titles counsellor and psychotherapist. 

The other good news is that the Health Bill mandates the Council for Regulatory Healthcare Excellence to set up a scheme for approval of the existing voluntary registers – like UKAHPP.  It also mandates HPC to do this, and mandates both organisations to set up their own registers if they choose to (but as voluntary not compulsory registers).  But be cautious – this is a government bill and may change before it becomes an act of parliament.  And it is both vague and complicated, so it is still difficult to be sure what will happen in a few years time.  Soon there will be a government White Paper that may make the detail clearer, or even change what is summarised above.  The HPC’s PLG meeting on 2 February gave some people the impression that the HPC still expects to be given monopoly-control of the titles counsellor and psychotherapist – see next article below.  At the AGM on 2 April we will have an expert speaker to update members on what is happening, & answer your questions – put this date in your diary now! – details available soon.

The Health Bill also proposes to change the name of the HPC to Health & Social Care Professions Council and of the CHRE to Professional Standards Authority for Health and Social Care.  The full name of this draft legislation is the Health and Social Care Bill.

HPC's last open PLG meeting
On 2 February the Health Professions Council held the last meeting of its Professional Liaison Group for counselling and psychotherapy.  The public can attend and observe (but speak at) PLG meetings.  So from now on the HPC will work even more behind closed doors in its planning for  the future of the counselling and psychotherapy professions.

The last PLG meeting deliberated on child psychotherapy, the distinction (if any) between counselling and psychotherapy, and ‘levels of entry’.   From a report by someone who attended this meeting, not much was clear except that the HPC seems determined to carry on regardless and what was previously discussed in public will now be decided by the HPC Council, in private. View this eIpnosis report here.  We will publish or summarise other reports of this PLG meeting, as & when received.

State Regulation - Judicial Review granted

On 10 December 2010 a judge granted permission for a legal challenge (Judicial Review) of the Health Professions Council's plans for compulsory state regulation of counsellors and psychotherapists. Remarkably, the HPC was also ordered to pay part of the costs of the six therapy organisations involved. For details, please see the Alliance for Counselling and Psychotherapy press release.

Critique of Health Professions Council Fitness to Practice system
At the heart of the Health Professions Council plans for the compulsory state regulation of counsellors and psychotherapists is the HPC’s complaints process – which it terms ‘Fitness to Practice’.  In contrast to the complaints processes of humanistic organisations like UKAHPP, which prioritise mediation, the HPC Fitness to Practice system is adversarial, public and legalistic.  A recent publication examines the nature of counselling and psychotherapy and shows how utterly unsuitable is the HPC FtP system.  One UKAHPP member, on reading this, described it as a “devastating critique.”  We encourage people to read this new document.

Person-centred group opposes HPC, but gets no help from BACP
BAPCA, the British Association for the Person-Centred Approach, surveyed its members and found 84% are against the state regulation by the Health Professions Council. At their 2010 AGM, BAPCA decided to "assertively oppose" HPC regulation, and to support the judicial review taken by some psychotherapy organisations to oppose HPC proposals.

BAPCA has links with BACP - the British Council for Counselling & Psychotherapy - because BAPCA requires its members to also belong to an organisation with ethical codes and complaints procedures. So many BAPCA members also belong to BACP. BAPCA sent BACP an Open Letter requesting BACP ensure that no members are transferred to HPC without their individual permission, and to develop alternatives to HPC including Alternative Professional Accountability. So far, BACP has failed to agree to this - and refused to publish BAPCA's Open Letter. CLICK HERE for the BAPCA Open Letter.

Of course, BAPCA members could vote with their feet - and join UKAHPP instead (we have ethical codes, charge less than BACP, and are committed to providing alternatives to HPC).

Report of the 2nd meeting on Alternative Professional Accountability
On 2 October several organisations including UKAHPP attended a meeting to discuss developments in the HPC and devise a form of professional accountability more suited to counselling and psychotherapy than the legalistic, adversarial and public system used by the HPC. CLICK HERE for a report of that meeting.

Judicial Review halts Department of Health plans
After the HPC informed the Department of Health that plans for state regulation of psychotherapists and counsellors could proceed, the DoH started to draft the necessary legislation. But this drafting has been halted, in view of the judicial review brought by five organisations opposed to the HPC plans. Please see the latest newsletter of the Alliance for Counselling and Psychotherapy Against State Regulation at www.allianceforcandp.org

Alliance Q&A on Principled Non-Compliance
The Alliance has provided an explanation in Question and Answer format of how principled non-compliance could work, providing practitioners with a legal and ethically-accountable alternative to state regulation. Click here to view.

One member's views on the HPC proposals
UKAHPP member Sue Lieberman and some of her colleagues have sent an interesting letter to The Guardian - CLICK HERE.

Report of Confer meeting on 23rd January

Health Professions Council letter
The Health Professions Council says that responses to its 2009 public consultation showed "unprecedented interest ... strongly articulated views." As a result, the HPC has had to delay meetings previously planned to finalise state regulation, in order now "to determine the most appropriate way forward".

But what will be "the most appropriate way forward"? HPC's letter of 9 November proposes to first ask the Department of Health for the legislation necessary to implement state regulation, and then continue discussing the details with the profession. But once HPC has the legislation, it will be under no obligation to really listen to the views which have already been expressed so strongly. And some of these views fundamentally questioned the suitability of the Health Professions Council as a regulator for psychotherapy and counselling. See HPC letter.

HPC "conclusions" from the public consultation
On 1 December 2009 the HPC website published two documents, a lengthy summary of the responses to the public consultation, and a shorter document on the conclusions it has drawn - the latter is the interesting, and astonishing, document.

It says that, because of the many "unprecedented... strongly articulated responses" to the public consultation, HPC has reached no conclusion and more discussion is needed on 7 of the main points on which it had intended to make recommendations to the Department of Health. The no-conclusion points are:-

- the structure of the Register (two aspects: differentiation btw counsellors & psychotherapists, differentiation btw adult & child practitioners; pp.5-6)
- how counsellor will be restricted for therapists but not others e.g. debt counsellors (p. 7)
- the Standards of Proficiency (p. 11), education & training requirements (p. 12)
- which voluntary registers should transfer (p. 9)
- and the threshold level of entry

Nevertheless, the HPC has asked the DoH for a Section 60 order asap and to sort these (basic) things out later. This seems wrong, because the government's White Paper required HPC to conduct a "rigorous process of assessing their (our) regulatory needs and ensuring its system is capable of accommodating them." The HPC itself describes the consultation as "limited to explaining the practicalities of implementing.." state regulation (p.2). Surely, if the HPC cannot reach conclusions on 7 of the main points it had intended to recommend to the DoH before a S60 order, it has either not done what the White Paper required or, indeed, it has shown that it is not a suitable regulator for these professions?

One further new development is that the HPC has decided to recommend a 3-year rather than 2-year period for grandparenting - which also means the Register will not open, & counsellors & psychotherapists will not have to be HPC-registered, until end 2012 earliest.

The longer document summarising the responses says HPC received 1,105 responses - 968 from individuals and 137 from organisations. Of course, if the numbers of members represented by these organisations were added in, the responses received probably represent about 50,000 practitioners. From the list of 137 organisations sending responses, it seems that only a few UKCP member organisations (including UKAHPP) sent responses to this consultation.

Meeting with Anne Milton, shadow health minister, 2 November, House of Commons
Four reports on this well-attended 3-hour meeting give different accounts.

UKAHPP member John Gloster-Smith's report includes Anne Milton's comment that "the HPC had not be any means succeeded in bringing everybody in the therapy community on board with the regulation project", commenting with an exclamation "Recognise the anger - it's huge!"

BACP reports that it told Anne Milton the current HPC proposals were "not fit for purpose" and reported that "There was general agreement" about this at the meeting.

Janet Low from PsyPraxis reports that "although the HPC was given a grilling, it was clear that there still exists an underlying wish to smooth out the irritating bits and get back on track with the process".

Tom Warnecke, UKCP's vice-chair, reports mainly his own opinions that: "it doesn't make that much difference under whatever name we may be regulated and we may as well get on with what is on the table"; "User groups such as MIND push very strongly for independent statutory regulation and against any delays and their arguments will win any public debate"; "representatives from the 'Alliance against state regulation' ... appeared isolated in their perspectives". These opinions are now incompatible with all the UKCP registrants who gave Andrew Samuels a sweeping election victory as new UKCP chair, on the platform of negotiating strongly with government for a form of regulation much better suited to counselling and psychotherapy.

See all four reports on meeting with Anne Milton, shadow health minister

Challenges to HPC
The HPC consultation ended on 16 October 2009, with HPC planning to send its final recommendations to the Department of Health in November. But several new developments now put the HPC plans and its urgent timetable in doubt:

  • BACP has rejected the HPC proposals, reversing its previous position due to the outcry from members: "... having consulted widely with membership, it rejects the proposals because they lack any evidence base and because of feedback received from members". (Editorial, Therapy Today, October 2009)
  • UKCP has sent acceptance of HPC proposals 'in principle' with some serious reservations and call for further negotiation. Some UKCP sections (such as the analytical/Jungian section) are highly critical of the HPC proposals. Within the humanistic section UKAHPP (and others?) have criticised both the consultation process and HPC's substantive proposals, withholding acceptance pro tem (although a small group within HIPS has expressed complete acceptance). Many UKAHPP members have individually sent HPC feedback ranging from reservations on some specifics to fundamental criticism of HPC. UKAHPP Response to HPC
  • Lord Alderdice told UKAHPP members in an informal meeting that it was wrong to assume HPC regulation is a 'done deal' - opposition to the HPC plans on both pragmatic and principled grounds is strong; HPC is not the right type of regulating body for psychotherapy and counselling.
  • 'The Maresfield Report', was published on 7 October. This report commissioned and published by several therapy organisations, "delivers a devastating critique of the Government's flagship Health Professions Council. HPC are vaunted as the most efficient, robust route to protection of the public in the health sector, yet the report finds persistent failings in public protection, excessive and wasteful expenditure, and evidence of a policy of privileging employer complaints over complaints from members of the public". (extract from press release). Maresfield Report.
  • Five therapy organisations sought legal advice, and Bindmans (solicitors) sent HPC a 15-page challenge on basic procedural points on 16 October; this included the threat of judicial review unless HPC suspends its timetable for introducing compulsory state regulation. Bindman's legal response to HPC
  • Kings College London and Royal Holloway, University of London researched the effects of statutory regulation on doctors, psychologists, therapists and counsellors, finding that "Many therapists we spoke to were suspicious of what they saw as an elite group of senior psychologists steering wider assemblages in their own interests. ...undermining the nature of psychotherapy and counselling overall. ... interpersonal processes within clinical supervision, rather than distant quasi-legal regulation, are the key to protecting the public and ensuring the safety and efficacy of practice." The report of their research, which was funded by the General Medical Council and the Economic and Social Research Council, was published in October. 'Statutory Regulation and the Future of Professional Practice in Psychotherapy & Counselling'

Health Professions Council final consultation on state regulation (deadline 16 October).
The consultation period ended on 16 October 2009. For UKAHPP members we have kept a summary of the lengthy HPC documents in the members area of this website. For others, see the HPC website.

See below some responses to the HPC from:-

Skills for Health National Occupational Standards
Efforts by some within the Humanistic and Integrative Psychotherapy Section (HIPS) of UKCP to downgrade the humanistic tradition and to promote the section as primarily "integrative" seem to have failed. These efforts were factional, were not representative of the interests of all HIPS members, but have been persistent over the last year - including private meetings with Lord Alderdice and others in charge of developing state regulation. Had these efforts succeeded they would have lessened the chances of humanistic practice being recognised in the Skills for Health National Occupational Standards. The Association's HIPS rep Derek Lawton has devoted a great deal of time to resisting these moves, assisted by our Board members Seamus Nash and Mike Wilson. This good news is reported in Derek's unofficial report HIPS Delegates Meeting of 29 May. We hope the official HIPS minutes accord with this.
But much time and energy has been wasted on this unnecessary split over the last year, resources which would have been better spent on addressing the real concerns about how state regulation of psychotherapy and counselling is being developed. UKAHPP member, Tricia Scott, has been involved in the Skills for Health Working Group (in a personal capacity) throughout the development of the humanistic National Occupational Standards. Tricia's report to the 20 July meeting of the UKCP's Humanistic and Integrative Psychotherapy Section detailing the work and giving her view of it is available here.

Health Professions Council plans for state regulation
The NOS developed by Skills for Health are said to be optional, rather than mandatory. But some see these two, simultaneous initiatives as inevitably linked, including some who have engaged fully in discussions with these government bodies. Psychoanalytical / psychodynamic organisations in the UKCP have come to the position of rejecting both the NOS resulting from lengthy consulation and the consultation process itself - and view the NOS as part of the HPC state regulation. What the organisations report is lengthy but well worth reading, as the reluctant conclusion of psychotherapists who have so far engaged fully in efforts to develop state regulation.
The psychoanalytica l/ psychodynamic organisations protested that "We, and all psychotherapy organisations of which we are aware, have been actively committed to regulation for many years ... (but) the proposed process of HPC regulation will narrow the broad practice of psychotherapy, making much of what currently takes place in reputable psychotherapy consulting rooms illegal in the near future." For more, see CPJA and CP-UK rejection of proposed standards.

Alliance for Counselling and Psychotherapy Against State Regulation
The Alliance was formed by practitioners disturbed and unconvinced by current proposals for state regulation through the Health Professions Council (HPC). "Our political, professional and personal conscience compels us to become guardians of the diversity and independence of psychotherapy and counselling, and to speak out on behalf of our own right to practice ethically and according to our best judgement; of the rich traditions of the discipline and of future generations of practitioners; and also of the clients who might seek to use our services now and in the future - their right of choice and their autonomy and responsibility."
See www.allianceforcandp.org and sign up for their newsletter.

Government's 2008'Call for Ideas' on state regulation
UKAHPP sent a response to the 'Call for Ideas', after consulting with members - see UKAHPP response to HPC Call for Ideas 2008.
Related UKAHPP documents you may want to read are:
Some pros and cons of State Regulation (UKAHPP document)
One UKAHPP member's response

The UKCP sent two responses to the 'Call for Ideas' in September and October which are now on their website - see www.psychotherapy.org.uk

What UKAHPP is doing
UKAHPP is attending many of the HIPS and UKCP meetings on this subject. We have argued strongly for the retention of the humanistic title and recognition of the humanistic tradition. The UKAHPP consulted with members - see UKAHPP Members' views - from which followed a letter from the Chair of UKAHPP Board to HIPS calling for stronger action, a Letter to HIPS organisations and Briefing to HIPS organisations. See also an account by Derek Lawton, UKAHPP rep to UKCP.
Tricia Scott, UKAHPP member emeritus, is on the Political Group of HIPS negotiating on state regulation. In the Spring 2008 issue of Transformations journal she argued strongly for the recognition of the humanistic tradition and Guy Gladstone, another UKAHPP member, argued against state regulation.

More on the threat to 'humanistic'
This Counselling & Psychotherapy Central Awarding Body briefing outlines the mismatch between this diverse profession and the proposed state regulation.
The Humanistic & Integrative Psychotherapy Section (HIPS) of UKCP briefing identifies inequities which are marginalising and excluding humanistic practitioners.

Action you can take
sign a petition calling upon the Government to halt the state regulation process and think again - and please include AHPP as your organisation.
write directly to your MP to ensure the humanistic tradition is recognised and included using the template letter provided here. Some UKAHPP members have already done this and several MPs have said they will raise the matter with the Department of Health. Find out who your MP is by clicking on www.upmystreet.com/commons/l/

Other links and information
For more on State Regulation, see Self & Society July-August 2008 at www.ahpb.org.uk
UKCP - www.psychotherapy.org.uk
BACP - www.bacp.co.uk
Health Professions Council - www.hpc-uk.org
Independent Practitioners Network - www.ipnosis.postle.net