20 July 2015

Who is publicising the PSAs Accredited Registers?

I recently published a post written by guest blogger Patrick Killeen on the Professional Standards Authority's Accredited Registers (ARs, previously known as Accredited Voluntary Registers/AVRs) the closest thing we have in the UK to the regulation and accountability of counsellors and psychotherapists. Patrick wrote a compelling argument about how the registers could effectively protect the public without the need for statutory regulation...if only the public knew of their existence... I highlighted the lack of awareness of the ARs in an article last year.

In light of Patrick's post and the few comments I received from other pro-regulation therapists on Twitter, I decided to ask the PSA what exactly they were doing to raise public awareness of the registers. As usual, they were very forthcoming with a prompt response:

The Authority works in partnership with each of the Accredited Registers to share information about the programme with a mixture of high level opinion formers in the health and care sector, and the general public. We each raise awareness through our stakeholder channels (including, for example, NHS England and NHS Employers) and the registers’ registrants do so directly with their patients and clients.

As the programme enters its third year, we are undertaking increasing amounts of work to raise awareness of its role in ensuring public protection.

One example of the work which we’ve done to increase awareness of the programme was our recent publication of Accredited Registers - Ensuring that health and care practitioners are competent and safe (this link no longer works and has been removed) which we sent to a wide range of stakeholders across national and local government, charities and the private sector. We are following up with meetings with key people. On 1 July we held a Round Table attended by around 40 representatives from all of those sectors, including National Voices, NHS Employers and the National Care Forum. This event generated a very positive discussion regarding ways in which all sectors could work in partnership to promote patient care through the use of accredited registers. Taking the suggestions from that meeting forwards, and building on the work already undertaken, we are drawing up a new communications plan for the forthcoming year.  We are also developing an information hub for commissioners and referrers and we will be sharing further information about this shortly.

My advice to fellow practitioners who are on an AR is to publicise this on your website, directory listings and in person to new clients. Explain what it means and help spread the word. I'll be relieved when the public at large start to wonder why a therapist or organisation is not on an Accredited Register.

Amanda Williamson Reg MBACP (Accred)

8 July 2015

The Regulation Debate; The PSA's Accredited Registers versus Protected Titles by Guest Blogger Patrick Killeen

(edited Jan 2024 as some of the links are now defunct; Google no-likey that)

I am honoured to be able to publish this guest post written by philosopher and trainee counsellor Patrick Killeen. I have come to know Patrick through his commenting on this blog as well as the unsafespaces.com blog hosted by Phil Dore. Patrick leaves very helpful, well thought out comments and is always very polite and respectful. We have had ongoing discussion about the regulation of counselling and psychotherapy. I recently published my ponderings following Patrick asking me what I would do if I had the power to regulate counselling and psychotherapy.

I invited Patrick to collate his thoughts on the regulation debate in a post for my blog. Here goes

In 2013 the Professional Standards Authority For Health and Social Care (the PSA) launched a new regulatory framework under which any group that maintains a register of health or social care professionals, and who can prove to the PSA that their register is run to protect the public and run well, can have their register accredited.  As a result there are now over 34,000 counsellors and psychotherapists working under professional regulations that are overseen by a statutory body [1].  However, it is still often said that "Counselling is unregulated because anyone can call themselves a 'Counsellor,'" and there are continuing calls to make "Counsellor" and "Psychotherapist" Protected Titles to stop unregulated practitioners posing a risk to the public.  This position is misguided, the practice of counselling would be no more regulated under Protected Titles than it is under Accredited Registers; when it comes to public protection there is nothing that could be achieved with Protected Titles that couldn't be done with existing laws.

The problem with regulated registers is that they only police registered professionals, so someone can sidestep them by simply not registering.  This limitation is obvious with Accredited Registers, which are explicitly voluntary, but it is also a feature of Protected Titles.  The Council for Healthcare Regulatory Excellence had this to say:

Protected titles create a boundary for professional practice, in that titles are reserved for registrants, and cannot legally be used by non-registrants. However, this does not stop people from practising in an unregulated way. There are examples of practitioners, including some who have been struck-off by a former regulator, who use non-protected titles. They may even state correctly that they are trained in a field of practice, and offer services to the public, without using a protected title. [2]

To get an idea of the limits of Protected Titles it's worth looking at the case of chiropodists and physiotherapists.  When the Health and Care Professionals Council (HCPC) was set up in 2003 "Chiropodist" (along with "Podiatrist") and "Physiotherapist" were made Protected Titles.  In 2007 the HCPC commissioned market research which found that the public were unaware of the difference between someone operating under unprotected titles like "Foot Health Practitioner" and "Sports Injury Therapist" and someone using the Protected Titles "Chiropodists" and "Physiotherapist"; some practitioners even complained that the titles used by unregistered individuals were more attractive to potential clients than the protected ones.  [3]

All that protecting the titles had changed was the words needed to describe the problem of unregulated practitioners.  In 2002 you might have said "Not all chiropodists are suitably trained and regulated so make sure you see a State Registered Chiropodist", while in 2007 you would have said "Not everyone offering foot health care is suitably trained and regulated so make sure you see a Chiropodist or Podiatrist"; both statements refer to the same people doing the same things with the same levels of regulation.

The thing that can give professional regulations real teeth isn't their power over registered professionals, rather it is the extent to which they curtail the activities of everyone else.  For example, anyone can call themselves a "Gas Engineer" just as anyone can call themselves a "Counsellor", but if you are aren't on the Gas Safe Register you are forbidden from working on mains gas appliances [4].  It's the fact that unregistered individuals are banned from working with mains gas that protects us from incompetent gas engineers, without that ban the regulation of registered engineers would be ineffectual.

If you tried to enact a similar ban for counselling then you would hit an immediate problem, there is no well-defined activity that unqualified individuals should be banned from doing.  Physically what a counsellor does is listen and talk; but it would be absurd to say that no-one is allowed to listen and talk with anyone else unless if they weren't a registered counsellor.   Try to finish the following sentence: If you are not Gas Safe Registered you must not even attempt to fit or repair gas appliances, and if you are not a qualified counsellor you must not even attempt to…  

As things stand, if you are not on a PSA Accredited Register of counsellors then legally you must not claim to be on a PSA Accredited Register of counsellors; but seeing as most people have no idea what Accredited Registers are it wouldn't stop you counselling.  If "Counsellor" was made a Protected Title then we would have a situation where if you are not on the statutory register of counsellors you must not use the word "Counsellor" to describe yourself; it wouldn't stop you from counselling, it would just force you to be more creative in your marketing (e.g. "Person-Centred Practitioner" or "Psychodynamic Therapist"). On their own Accredited Registers are completely toothless and Protected Titles would have one useless tooth.

Fortunately the statute books are not the whole story.  The more that people and organisations who engage or recommend counsellors look for Accredited Registers the greater the limitations will be on unregistered practitioners; not in the form of things that you mustn't do by law, but in the forms of things that you can't do because others insist on dealing with registered practitioners.  If Accredited Registers become widely understood and respected, to the point that potential clients are put off if a counsellor isn't on an Accredited Register, then they will become effective tool of professional regulation (the same would be true of Protected Titles).  The PSA's assessment is that  "awareness of the programme is at an early stage. Considerable ongoing promotion is needed to increase its public profile and bring it to the attention of the people best placed to spread the word about its existence or make referrals, such as GPs and social workers." [1] If they manage to make Accredited Registers a household name then the practice of counselling really will be regulated.

So, if you are outraged at the fact that counsellors and psychotherapists can continue to practice after being struck off, quitting their regulatory body, or flatly refusing to be regulated, then I urge you not to press for Protected Titles, the statutory battle has already been won with the introduction of Accredited Registers.  Instead, use your energy to get behind the PSAs and Accredited Registers: tell people how they can use Accredited Registers to protect themselves; complain to the PSA when complaints are mishandled by governing bodies; respond to their calls for information; scrutinise their decisions; and if they drag their heels shove them forward as hard as you can.  Accredited Registers are a promising start, let's do what we can to get them to fulfil their promise. 

[1] Professional Standards Authority for Health and Social Care, March 2015, "Accredited Registers: Ensuring that health and care practitioners are competent and safe." 

[2] Council for Healthcare Regulatory Excellence , February 2010, "Protecting the public from unregistered practitioners: Tackling misuse of protected title."

[3] Health and Care Professionals Council, July 2007, "Evaluating public awareness concepts."

[4] The Gas Safe Register. http://www.gassaferegister.co.uk

For more posts about regulation please see below:

Regulation - a client and therapist friendly way forward? (November 2014)

The problems with a voluntary regulatory scheme (Sept 2014)

Spreading the word on AVRs - the Professional Standards Authority responds (Sept 2014)

The Regulation of Counselling and Psychotherapy - What the Public Want (June 2013)

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