Registration and Regulation – an attempt at an update and the Government’s Happiness/Wellbeing Factories reappear

by Julia Evans on May 19, 2011

Index of topics:

1) Power & control

2) Registration

3)  The use of regulation to produce Government standard Happiness –  Increased Access to Psychological Therapy  (IAPT) again

1)  Power & Control

An examination of the Government’s use of power and control is basic to any attempts at intervening in this area.  This is a movement to autocratic, top-down, rule-based, systematic, control which produces certainty  from that which exists currently which is based within a network of relationships of trust where the product cannot be defined.  There is no evidence that this profound change will produce anything other than abuse and that the current system of training and monitoring practice has failed.  The difference between the position of having and of being.

Now what is being attempted is the use of centralised systematic power and control into practices based in and motored by relationships.  By doing this, the Government grabs control of your practice, your training, defines supervision, defines your ethical standards, standardises clinical judgment in order to produce a measurable outcome.  This use of abusive power is also being attempted in the police, education, social workers, and so on.

Methods of intervening:  This use of abusive power gets its legitimacy from Parliament.  Most MPs have ceased to think and find a position – it is easier to protect your career position and become voting fodder.  It is very important that your constituency MP and other contacts within Parliament continue to be told that driving top down standards into practices based in relationships produces more risk not less.  And they also understand that there is no evidence that this change to centralised control of psychopractitioners will work or is needed.

2.  Registration:

Despite the Government being told by Lord Judge, the Lord Chief Justice of England and Wales that the use of Privy Council power (‘Lord Chief Justice on the Public Bodies Bill’  ) is not on, the Government is still enamoured by the image of controlling all these psychopractitioners by the Privy Council’s Health Professions Council.  There is no evidence of abuse but no worries, the Government must protect and be seen to protect.  Anne Milton MP, Parliamentary Under Secretary of State (Department of Health)  has recently, 4th May 2011, indicated that she is going ahead with centrally controlled registration through ‘voluntary’ registers.  These , of course, can handily be turned statutory when everyone is looking the other way.  Ms Milton’s reason is to “quality assure voluntary registers of unregulated health care professionals and workers in the UK and social care workers in England”.  So the Government cling to the delusion that the use of rules and regulations ensures the production of Mental Health.  The imposition of the Government’s central library of standards (see July 2010 White Paper: Equity and excellence: Liberating the NHS) rules ok.  Currently, two Government supported organisations are slugging it out:  CHRE (Council for Healthcare Regulatory Excellence ) and HPC (Health Professions Council)  See below for the latest position.

To be frank, either are very bad news.  They both work on this centralised, top-down use of power to produce uniformity and control – just like Tesco’s.

CHRE (Council for Healthcare Regulatory excellence)

In previous communications, I have exposed that the CHRE are on a charm offensive.  They have been meeting with representative of all the biggies:  United Kingdom Council for Psychotherapy – UKCP, British Association for Counselling and Psychotherapy – BACP, and so on.  Not only are these organisations committed to a standardising approach, it is the reason for their existence.  They not only think it is the way forward but it is not in their interest to put this basis up for question.  They favour a top-down centralised approach. At the moment, the CHRE are discussing draft proposals of how this is going to work with anyone the CHRE think is worth persuading.  Below is taken from their website.  The CHRE will drive standards centrally, run fitness to practice courts based on these standards, and more.  The CHRE also declares that it is possible to protect the public and promote the safety of the public from a central position.  The CHRE seems to be basing itself on the Inquisition which also protected the public from evil.  And it is treated seriously.  Both Houses of Parliament think this is a good idea and Anne Milton, Minister for Health, is forcing it through Committees as we look at screens.

From the CHRE web-site:  Healthcare regulation

Quote:  Healthcare across the UK is regulated by a range of different organisations working in a number of different ways. Some regulators check the quality and safety of services – for example the Care Quality Commission in England or the Regulation and Quality Improvement Agency in Northern Ireland. Others work on the quality and safety of medicines and medical devices – for example the Medicines and Healthcare products Regulatory Agency.

We oversee the organisations that regulate health professionals across the UK. The nine health professional regulatory bodies were set up to protect and promote the safety of the public.

They do this by

  • Setting the standards of behaviour, competence and education that health professionals must meet
  • Dealing with concerns from patients, the public and others about health professionals who are unfit to practise because of poor health, misconduct or poor performance
  • Keeping registers of health professionals who are fit to practise in the UK.
  • The regulators can remove professionals from their registers and prevent them from practising if they consider this to be in the best interests of the public.

CHRE:  Overseeing regulators

CHRE is responsible for overseeing the UK’s nine health professional regulatory bodies. Our oversight and scrutiny of the regulators is important for protecting patients and the public.

We review the performance of the regulators on an annual basis. We identify where things are being done well, and where improvements can be made. More information about our annual performance reviews is available.

Each regulator has a fitness to practise process for handling complaints made by patients, employers and others about health professionals. The most serious cases are referred to formal hearings in front of fitness to practise committees. We review all final decisions made by those fitness to practise committees. To learn more about our scrutiny of these decisions, information is available in the Final fitness to practise decisions section of our website.

We carry out an audit of the initial stages of regulators’ fitness to practise processes, looking at a sample of the decisions made by each regulator to close a case without referral to a formal hearing in front of a fitness to practise committee. We do this to ensure that the regulators’ decision-making processes are effective. We also assess whether the decisions taken protect the interests of patients and the public. More information is available in the Early FTP decisions section of our website.

From time to time, we have been asked to conduct special reviews. These may relate to regulators in other sectors, or outside the UK. More information about our special reviews is available.

Also, information about handling complaints and our role in this is available for review.

End of Quote from CHRE web-site

Health Professions Council HPC

The Public Liaison Group (HPC PLG) met recently on May 12th.  I have elsewhere pointed out that only true believers in centralised control of the treatment of human distress are allowed on the PLG.  They are also the big players in making money from the registration game and they are even willing to promise impossibilities of protection from harm, as was the Inquisition’s main aim, to a gullible Government.  Yes, this is an instrument of state.  It answers to the Privy Council which answers to the Queen.  The full agenda and papers are available on the HPC’s website.

They are going into competition with CHRE, and the other big players: BACP ,  UKCP, British Psychoanalytic Council BPC   to be the regulator of choice – on a ‘voluntary’ basis of course.  The decision was postponed:  HPC Council decisions May 12th

Quote from HPC Council decisions May 12th:

Psychotherapists and Counsellors PLG

Council noted a paper relating to the Psychotherapists and Counsellors PLG. The paper outlined the conclusions previously reached by the Council in respect of the terms of reference of the PLG and the recommendations reached by the PLG over the course of its final meetings. The draft standards of proficiency considered at the final PLG meeting in February and the minutes of the final meeting (approved by the Chair following consultation with members) were also included within the paper.

End of Quote

So there is a war going on:  who can seduce the large training organisations, who are true believers in central control system and central library of standards and their ability to stop one human being from abusing another one.  Remember, there is in existence the criminal definition of abuse as in sexual abuse, physical abuse, financial abuse and so on.  So these organisations with Government backing believe there is a need to provide protection beyond tried and tested criminal and civil legal procedures.

And between them, centralised control may come into being.  This means that the Government, or its agencies, become guarantor of practice in place of the existing status quo: training organisations.  There is absolutely no evidence that this will be an improvement.

3.  The use of regulation to produce Government standard Happiness – Increased access to Psychological Therapies – IAPT  again

(Known as Wellbeing or Happiness Factories. Based on ‘High Risk Health Industry’ as in Lord Donaldson – the Chief Medical Officer – ‘Consultation analysis report: Good doctors, safer patients and The regulation of the non-medical healthcare professions‘ February 2007)

The Government’s use of standards in their contracting out process, has returned to my notice.  Contracting out is part of the Government’s privatisation process and integral to their Tesco-model of running Health care.  So you control the inputs (National Institute for Health & Clinical Excellence – NICE clinical guidelines), you control the transaction at the till (Government wellbeing operators), you control what is available (evidence-based practice) and you control results or outcomes.  So when the Government decides that care for Mental Health should transform into the Government’s Market in health care, then they retain top-down control bigtime.  The key outcome they require is Lord Layard’s economic happiness:

IAPT outcome framework and data collection:

Quote from IAPT web-site:


One of the key outputs of the Improving Access to Psychological Therapies (IAPT) Programme is to develop a routine outcome measuring tool to collate a set of data demonstrating whether or not the Pathfinder sites are successful in delivering psychological therapies to their target population, with the expected gain in mental health clinical outcomes, quality of life, patient experience and economic benefit.

The programme hypothesis described that the key benefits to people receiving the new service would be:

1.         Improved health and wellbeing

2.         Improved service user and carer experience and satisfaction

3.         Improved choice and access of clinically effective psychological therapy services

4.         Improved inclusion and employment status, including:

•           Maintaining people in work and involvement in activities of daily living •   Supporting people in returning to work and participating in activities of daily living

Consequently, the IAPT Routine Outcome Measuring Tool (Minimum Data Set) should ensure that these four domains are addressed appropriately as detailed in Section 6 of the IAPT Commissioner-led  Pathfinder Specification.  (Link to all referenced documentation) In addition to addressing the services needs of adults of working age, Pathfinder sites may choose to adopt a special interest group within their scope. Details of the tools to measure health and wellbeing outcomes will be developed as part of the consultation period.

End quote

The excellent King’s College study (September 2009) [ Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling Evidence from the Field by Dr Gerry McGivern, Dr Michael Fischer and Prof Ewan Ferlie, Department of Management, King’s College London, and Dr Mark Exworthy, School of Management, Royal Holloway, University of London] warned that Lord Layard’s combining the Government’s clinical judgment (NICE) together with its definition of skills or competences (Skills for Health) to produce economic happiness as defined in the Government’s contracting-out process, was not just of concern to those being treated.  Those giving the treatments defined by NICE Anxiety Guidelines , are used as if they were cogs in the production wheel of Happiness Factories.  Supervision becomes comparison with production or outcome measurements – the Government’s standard wellbeing for its standard recipients.  Employment contracts means acquiescence with passively implementing rather than responding as one human being to another. And you get paid by piece rate……….  And those awarded the Government contracts, even large charities, go laughing all the way to the bank, making money out of mental illness, both from sufferers and the enslavement of those who treat.

Does your MP understand this Government’s industrialisation of the treatment of Mental Health?


Circulated 19th May 2011


Note : If links to any required text do not work, check If a particular text or book remains absent, contact Julia Evans


Julia Evans

Practicing Lacanian Psychoanalyst, London


Further posts:

Some Lacanian history here

Lacanian Transmission here 

Of the clinic here 

Translation Working Group here 

 From LW working groups here

Use of power here 

By Sigmund Freud here 

Notes on texts by Sigmund Freud here 

By Jacques Lacan here     

Notes on texts by Jacques Lacan here

By Julia Evans here