Someone recently sent me an email following a series of Tweets I made requesting that Torbay and South Devon NHS Trust stop signposting to Palace Gate Counselling Service, an Exeter based counselling agency struck off by the BACP. The email contained the following words:

"Do you ever feel like it's an ongoing battle for an appreciation of the seriousness of what you and others endure? Without people like you persevering and getting the message out there publicly where would things be?"

Well yes. It absolutely feels like an ongoing battle. I first tried to ensure that the NHS stopped signposting patients to the Palace Gate Service over two years ago via my local Medical Committee as it had been brought to my attention that various NHS locations were continuing to signpost to Palace Gate Counselling. On their advice I sent the following email to the British Medical Association in October 2014:

Dear Sir or Madam

I am writing to you at the suggestion of Devon Local Medical Committee who felt unable to assist me. They were originally considering publishing an article for their newsletter after I raised concerned about local GP surgeries continuing to refer NHS patients to an Exeter based counselling agency who had BACP membership removed twice for unethical behaviour under two separate complaints. They decided that it was not the correct forum and suggested I try higher up.

I heard just a few weeks ago that ISCA Medical Practice in Exeter were still sending clients to the struck off agency. My own (GP) practice manager had no awareness of the issues. Yet Devon Primary Care Trust had sent this message to their Depression and Anxiety Service staff:

No further signposting or referrals to Palace Gate Counselling Services

We would like to inform all staff that counselling services run by Palace Gate Counselling have recently been investigated by the British Association of Counsellors and Psychotherapists (BACP) due to alleged improprieties.

The BACP Professional Conduct Committee found that the company were in breach of their ethical framework on thirty counts. This has resulted in their membership of the BACP being withdrawn.
The findings of the report can be found here.
This is a serious situation and as a result the Trust cannot support signposting or referral of people accessing our service to Palace Gate Counselling. This will cease with immediate effect.
Please note that this notice does not include CRUSE who are also based at Palace Gate.

Surely somebody is responsible for ensuring that GP's stop sending clients for therapy with therapists that have no accountability and have been removed from a professional register (twice)?

I have done pretty much everything in my power to try and highlight this situation. I am campaigning for the statutory regulation of counselling and psychotherapy which won't happen for years, if ever. In the meantime we have a situation where many NHS patients are seeking counselling outside of the NHS. The NHS choices page on counselling does not mention to patients that counselling is unregulated and that the onus is on them to check the credentials of their therapist. I believe that it is unethical to promote counselling as a treatment but not advise patients that they could end up seeing somebody who is unqualified and unregulated. I believe it to be irresponsible to have GPs refer patients to a service that has been proven to act unethically.(1)

I would very much appreciate somebody looking into this matter.

I received the following response:

As you may know, the BMA is a professional association and trade union for doctors in the UK. We are neither a clinical nor regulatory body, and as such we don't have a role in advising practices about local referral policies.
However you might like to contact NHS England for further advice - they could direct you to the relevant local Area Team. Similarly, the local Clinical Commissioning Group (CCG) would be another useful source of information regarding local referral policy in your area:

NHS England: Tel: 0300 311 22 33; Web: http://www.england.nhs.uk/

CCGs

NHS Northern, Eastern and Western Devon CCG: Tel: 01392 205 205; Web: http://www.newdevonccg.nhs.uk/

NHS South Devon And Torbay CCG: Tel: 01803 652500; Web: http://www.southdevonandtorbayccg.nhs.uk/Pages/default.aspx

Finally, you could raise your more general concerns about the way in which the counselling profession is regulated with the Government, and your local MP might be a good starting point for this.

While we are unable to advise directly, I hope this information is helpful.

As it happens I had already written the same email to NHS England who responded as follows:

Thank you for your email to NHS England.

I advise that NHS counselling services are not commissioned by NHS England, rather they are commissioned by local Clinical Commissioning Groups (CCGs). If you wanted to raise a concern about counselling services commissioned by the NHS in your local area, I would recommend that you contact your local CCG NHS Northern, Eastern and Western Devon CCG.

However, I also understand that you are concerned about GPs in your area referring patients for private counselling services that both you and the BACP have considered to be substandard. I have highlighted your concerns with the Primary Care Commissioning team at your local NHS England Area Team, as they are responsible for commissioning GP services in your local area.

Regarding professional regulation, you may find this document (now broken link Jan 24) produced by the Law Commission useful. I would recommend that you discuss any suggestions regarding changes to health and social care legislation with the Department of Health, or highlight your concerns with the Professional Standards Authority.

I hope that this information is useful to you.

I followed the advice within and sent the same details to my local Clinical Commissioning Group who responded thus:

Thank you for your email, as GP’s within Devon are commissioning by NHS England I have forwarded your email to their Local Area Team and they should be in contact with you directly.

I didn't hear anything following this. Fast forward some 20 months to June 2016 and it is brought to my attention by a journalist that NHS Torbay and South Devon Trust have continued to signpost patients to Palace Gate Counselling Service via an online document which was updated only a month before. So I sent a further email to my local Clinical Commissioning Group:

You sent me this message around 18 months ago and I have still not been contacted by anyone regarding this matter. I have today been notified by a journalist that a Devon NHS trust is still advertising the services of the counselling agency on an online resource updated just a few months ago. Basically, the NHS is endorsing a proven unsafe counselling agency. I am not prepared to let this go on.

And guess what? I received no response. Which is why I eventually Tweeted as Tweeting does seem to be an effective way of getting organisations to listen. Lo and behold, my Tweet led to the following email being sent to me by the department at NHS Torbay and South Devon Trust responsible for the leaflet in question the day after they saw my Tweet:

One of my colleagues has forwarded me your message on Twitter regarding Palace Gate Counselling Service. As BACP have found the service guilty of serious professional misconduct we have now removed details about it from our information. We weren’t unfortunately aware of this before, otherwise we would have removed the details earlier.

So finally, I have managed to get yet another source of referrals to this struck off agency removed. I have also had to contact the Citizens Advice Bureau and a local Church to ask them to stop referring, even though they had both received a statement from a large group of local counsellors.

And yet despite all this the organisation continues to operate. The counsellors working there receive their supervision from the two directors who's behaviour got the agency struck off. Clapham and Talbott carry on practising. They can continue to sing their own praises and attract clients via the Palace Gate Counselling Service Twitter and Facebook pages. This is totally legal.

Why do I have to work so hard at making sure that the NHS are not signposting patients to this struck off service? Why do I bother? I bother because I have a duty of care. I bother because I receive messages from alarmed people who see me as a point of contact, as the person who will alert the appropriate organisations. On occasion I have become quite resentful that people don't seem to be prepared to do it themselves but would rather send me an email and leave it with me to sort out. What about other people's duty of care? What about the NHS' duty of care? Why do I feel like I am shouting into the void much of the time?

Even after all this and Tweets being sent direct to Exeter Sessional GPs they continue to list Palace Gate Counselling Service in their online resource pack.

Should I give up? Is it a waste of time? And let's not forget that I have received various legal threats from the directors of Palace Gate Counselling that I will be sued if I go public with the complaints.

And so we return to the words sent to me recently:

Without people like me nothing would change and many more people would be at risk of the abusive behaviour that I and others have challenged. Sometimes I really want to give up. Except I take the safety of clients in therapy very seriously.

(1) I am pleased to say that the NHS web page on counselling does now mention the Professional Standards Authority Accredited Registers. I do have huge doubts about the efficacy of the AR's as a way of protecting clients/patients but it is a step in the right direction.

Amanda Williamson Coaching and Counselling Service in Exeter, Devon

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22 August 2016

The Ongoing Battle of Protecting Clients from Struck off Therapists

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