Issued: 8th February 2018 by BABCP Board

BABCP RESPONSE TO DEPARTMENT OF HEALTH AND SOCIAL CARE OPEN CONSULTATION: PROMOTING PROFESSIONALISM, REFORMING REGULATION

BABCP Response to Government Consultation on Statutory Regulation

The UK Government recently put out a document for consultation on regulation of healthcare professionals, entitled ‘Promoting Professionalism, Reforming Regulation’.

Statutory regulation of healthcare professionals is an important safeguard for the public. BABCP believes there is a gap in current provision of statutory healthcare regulation, with psychotherapy currently unregulated.

Psychotherapists of many different modalities undertake a very complex intervention with vulnerable patients and whilst some psychotherapy practitioners have additional regulation through a core professional body, many do not. BABCP conducted a member survey before responding to this consultation, and the majority of members who responded agreed that they were in support of regulation of psychotherapy. A working group of BABCP Trustee Directors, standing committee chairpersons and Board Advisors prepared an organisational response on behalf of BABCP to the government consultation.

BABCP has responded to the consultation paper stating their position as in favour of regulation of psychotherapy in order to protect the public and emphasising the importance of a quality-focussed regulatory system.

For more detail please see our responses to the individual consultation questions, given below.

The consultation document is available at: www.gov.uk: Regulatory_Reform_Consultation_Document.pdf

Q1: Do you agree that the PSA should take on the role of advising the UK governments on which groups of healthcare professionals should be regulated?

Yes. BABCP believes that this is reasonable.

Q2: What are your views on the criteria suggested by the PSA to assess the appropriate level of regulatory oversight required of various professional groups?

BABCP believes the criteria suggested by the PSA are reasonable if regulation remains effective.

One factor which BABCP believes is very important is the independence of regulatory bodies and the role this enables them to play in evaluating fitness to practice.

We believe there is a very important gap in current provision of healthcare regulation, with psychotherapy being unregulated. There is a long history of psychotherapy organisations, including BABCP, highlighting this to the Department of Health. Psychotherapists of many different modalities undertake a very complex intervention with vulnerable patients and whilst some psychotherapy practitioners have additional regulation through a core professional body, many do not.

Q3: Do you agree that the current statutorily regulated professions should be subject to a reassessment to determine the most appropriate level of statutory oversight?

Which groups should be reassessed as a priority and why?

We strongly believe the current statutorily regulated professions should be extended to include the professional practice of psychotherapy. This is an unregulated health practice currently being undertaken throughout the NHS with some practitioners who have additional regulation through a core profession but many who have none. This represents a risk to the public.

Of those professions already regulated, if some are to be reassessed in relation to level of statutory insight these should be the smaller ones in terms of checking that it makes sense for them to have a separate regulatory process.

However, we believe the focus of such a review should be patient safety and patient experience rather than solely economic drivers.

Q4: What are your views on the use of prohibition orders as an alternative to statutory regulation for some groups of professionals?

We believe these could be a viable alternative regarding fitness to practice or breaches to ethical codes. If published, this alternative would improve clarity for the public which we are in favour of.

Q5: Do you agree that there should be fewer regulatory bodies?

We believe that the focus should not be on the number of bodies but the function and extent to which they coordinate.

There should be a review of the coherence of the regulatory bodies that do exist before saying there should be fewer. This would enable commonalities and differences between professions to be explored, and could also widen the scope to include some professions that currently do not have regulation (e.g. psychotherapy). We believe this should not be solely a raw numbers-based economic exercise, but should be more nuanced than this. The review should then be presented as a basis to decide on numbers of regulatory bodies.

Q6: What do you think would be the advantages and disadvantages of having fewer professional regulators?

There is a clear economic case in terms of scale for having fewer but larger professional regulators.

However, we would like to emphasise that overly large regulatory organisations could become unwieldy and unhelpful, missing out important differences between professions which could put the public at risk. There are specific issues related to specific professions which regulatory bodies need to be aware of so they can safeguard the public, e.g. different types of risk arise with professions that treat patients behind closed doors as opposed to in a more public setting.

See additional response to Q14.

Q7: Do you have views on how the regulators could be configured if they are reduced in number?

We think that regulators should be configured according to the type of work and the type of risk involved in that work.

Q8: Do you agree that all regulatory bodies should be given a full range of powers for resolving fitness to practise cases?

We agree.

Q9: What are your views on the role of mediation in the fitness to practise process?

We recognise that the regulatory process is often long and drawn out for all parties but believe patient safety needs to be paramount.

We think mediation could be a potential gateway into the fitness to practise process if it was presented as an option that the complainant could opt for rather than an option which someone else decided was appropriate. It would be inappropriate for more serious complaints.

We want to be clear that this needs to have a clear audit trail and be reserved for situations where the complainant prefers it. Both parties can also choose to reject it as an option.

Concerns around this relate to the large power imbalance between therapists and their patients and a desire to protect patients from a mediation process where there is such a skewed power differential.

This should in no way be used as a more cost-effective option for that reason.

Q10: Do you agree that the PSA's standards should place less emphasis on the fitness to practise performance?

We do not agree. We believe the PSA’s standards should place most emphasis on fitness to practise. We do not want this emphasis to be diluted. It is of paramount importance to protect the public.

Q11: Do you agree that the PSA should retain its powers to appeal regulators' fitness to practise decisions to the relevant court, where it is considered the original decision is not adequate to protect the public?

We agree.

Q12: Do you think the regulators have a role in supporting professionalism and if so how can regulators better support registrants to meet and retain professional standards?

We think regulators should keep their role to a purely regulatory function and that separate and specific professional bodies, like the BPS, GMC and ourselves (BABCP) should work to support people to meet and retain professional standards.

Q13: Do you agree that the regulators should work more closely together? Why?

We think some degree of independence is helpful but we would welcome more and clearer communication on shared issues for the purpose of consistency of standards and greater public understanding.

Q14: Do you think the areas suggested above are the right ones to encourage joint working? How would those contribute to improve patient protection? Are there any other areas where joint working would be beneficial?

We believe there is a hybrid needed: whilst we would welcome a move towards a single set of shared generic standards e.g. relating to consent to treat and confidentiality, we also think there is a need for profession-specific standards. Different specific considerations will be important for a psychologist as compared to a chiropodist and it is important to recognise these differences as well as the overlapping areas of best practice.

Q15: Do you agree that data sharing between healthcare regulators including systems regulators could help identify potential harm earlier?

Yes, in theory, but we believe it is important to be careful about the implications of this for data protection. We suggest exploring the implications in greater detail before making a change.

Q16: Do you agree that the regulatory bodies should be given greater flexibility to set their own operating procedures?

We would agree only within appropriate ethical and legal constraints, not with complete freedom.

Q17: Do you agree that the regulatory bodies should be more accountable to the Scottish Parliament, the National Assembly for Wales and the Northern Irish Assembly, in addition to the UK Parliament?

We would support this if the outcomes generated were generalizable across all four nations rather than overly localized or resulting in restriction to ability to train and practice NHS-wide.

Q18: Do you agree that the councils of the regulatory bodies should be changed so that they comprise of both non-executive and executive members?

We agree but think the balance should favour non-executives.

Q19: Do you think that the views of employers should be better reflected on the councils of the regulatory bodies, and how might this be achieved?

No. We believe employers may have some conflicting interests. Therefore, the councils of regulatory bodies should be solely related to ultimately promoting good patient care and experience. Involving employers more would likely risk over-complication and possible prioritization of cost effectiveness.

Q20: Should each regulatory body be asked to set out proposals about how they will ensure they produce and sustain fit to practise and fit for purpose professionals?

This is reasonable and we understand that regulatory bodies already do this. The key question then is how to decide if these proposals are adequate. We think there should be an independent arbiter of this and believe the issue of how this is decided is important and needs independent adjudication.

Q21: Should potential savings generated through the reforms be passed back as fee reductions, be invested upstream to support professionalism, or both? Are there other areas where potential savings should be reinvested?

We would recommend that any savings go on fee reduction.

Q22: How will the proposed changes affect the costs or benefits for your organisation or those you represent?

  • an increase
  • a decrease
  • stay the same

Please explain your answer and provide an estimate of impact if possible.

The proposed changes as outlined in this consultation will not affect costs or benefits for our organisation. The extra change we have proposed in our support for introducing regulation for psychotherapists would be likely to have a negative cost implication for our organisation but we nonetheless believe it to be very important for the public interest.

Q23: How will the proposed changes contribute to improved public protection and patient safety (health benefits) and how could this be measured?

Improvements to consistency would enhance public protection and ensure standards are evenly applied across professions.

Improved consistency would aid public understanding of standards and fitness to practise processes.

Our additional suggestion of regulating psychotherapy could have a huge impact on public safety. Psychotherapy is not always benign. It has the potential to make hugely positive changes to someone’s mental health but also has the potential to harm. Psychotherapists are also not all benign and it is vital to protect the public against poor practice.

Better regulation could enhance the public perception and credibility of psychotherapy whilst decreasing stigma attached to those with mental health issues therefore potentially increasing access to care by those in need.

Q24: Do you think that any of the proposals would help achieve any of the following aims:

  • Eliminating discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010 and Section 75(1) and (2) of the Northern Ireland Act 1998?
  • Advancing equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it?
  • Fostering good relations between persons who share a relevant protected characteristic and persons who do not share it?

If yes, could the proposals be changed so that they are more effective?

If not, please explain what effect you think the proposals will have and whether you think the proposals should be changed so that they would help achieve those aims

It is difficult to comment on this without a clear understanding of how the current system is underpinned by these aims and how much the current system is flawed in meeting these aims. We would suggest that a review of this is undertaken.

We can say that having consistent general standards as well as profession-specific standards, and including regulation of psychotherapy, would help prevent unethical practices such as conversion therapy, which is ongoing to this day. Conversion therapy involves some psychotherapists offering to “cure” homosexuality. BABCP are opposed to this as stated in our Memorandum of Understanding v2 signed this year by ourselves and multiple other psychotherapy organisations. Since psychotherapy is currently unregulated there is no way of formally investigating these individuals’ fitness to practice. This would be an area where inclusion of psychotherapy in regulation would help to achieve the aim of eliminating discrimination and advancing equality.

Promoting professionalism reforming regulation.pdf