Society, April 2011

President's column
Contact Gerry Mulhern via the Society's Leicester office,
or e-mail: [email protected]

The league table season is well and truly under way; although, like supermarket asparagus and strawberries, fresh performance tables appear to have become an all-year-round offering. And it is a burgeoning industry. I have just received a second e-flyer inviting me to register for the 3rd Annual Symposium on University Rankings and Quality Assurance in Europe for a mere £295.

For primary and secondary schools, league tables are no longer published by the legislative bodies in Scotland, Wales and Northern Ireland, although the data are still collected, leaving just the Department for Education in England to rank schools on the basis of a weighted average of performance measures. But lest we in the regions start feeling smug, we should realise that newspapers have routinely obtained the performance data under the Freedom of Information Act and have constructed and published regional league tables.

Arguably, the unwelcome impact of league tables has been even greater in the university sector, due mainly to the slavish addiction to rank scores among university managers, a problem compounded by disturbing evidence of tabular illiteracy. As a numerate discipline, we have a responsibility to communicate the problems of the misuse such information. At the risk of stating the obvious, virtually all numerical scales are arbitrary and ordinal scaled data, such as university rankings, are more arbitrary than most.

One of the more influential tables, Times Higher Education's World University Rankings, illustrates the point perfectly. Referring to their rankings from 2004 to 2009, the WUR editor commented: 'As well as influencing student and staff choices, [the rankings] were used to help set university missions and even steer government strategies. But we felt that our previous methodology could no longer bear the weight that was being placed on it – it was too crude for the academy's wishes'. Hmmm, so university rankings based on a methodology acknowledged as 'too crude' had been published for six years and in that time had influenced stakeholder choices, driven university strategies and influenced government.

But all was not lost. Following massive investment, and in partnership with a leading research-data specialist, a new ranking system was developed for the 'new era of globalised higher education'. Introducing these all-new 2010 rankings, the THE's WUR editor observed: 'They are very different from those of 2009. Some institutions, and even whole countries, have not come out as well under the new system. Others look much better. But because of the methodological innovations, any movement up or down from 2009 cannot be seen as a change in the performance of any individual institution or country'.

The new 'robust, transparent and sophisticated' rankings were compiled using a weighted average of five broad categories and based on 13 different data types. However, weightings did not always reflect the relative importance of a particular metric: one of the five categories – research income from industry – although acknowledged as a significant indicator of quality, received a weighting of only 2.5 per cent because 'the figures provided by institutions for this indicator were patchy'. Of the remaining broad categories, some were made up of several metrics which appeared likely to be correlated with each other. Oh dear, hadn't they heard of bloated specifics, something any psychometrician worth their salt would seek to avoid like the plague? I rest my case.

In the end and, and regardless of the merits or otherwise of any methodology, the only thing that sticks is the rank score. The fact that a university ranked 6 scores 91.2 and that ranked 8 scores 91.1, or that an institution ranked 144 scores 51.9, and that ranked 156 scores 51.0, is so much less salacious.

The result has been a culture of managerialism and corporatism, distracting, even skewing, institutions away from the priorities on which they would be better advised to focus, encouraging institutions to be tactical rather than strategic, setting institution against institution, department against department and, most damagingly, academic against academic.

As psychologists, we are better placed than many to exercise insight into the limitations of quantitative exercises such as league table rankings and to communicate these to others. And we are certainly best placed to understand and seek to prevent some of the more unpleasant actions of individuals and institutions driven by such unsophisticated folly.

Registration matters – psychology and the Health Professions Council
Carole Allan (Chair, Professional Practice Board) and Sue Gardner (Vice President) 

The decade opened in January 2000 with the imprisonment of one of the most notorious doctors in history. Dr Harold Shipman murdered 250 of his patients between 1972 and 1998, usually with narcotic drugs he had stockpiled for this purpose under the guise of routine medical practice (Laurence, 2009). A series of inquiries into the Shipman murders led by Dame Janet Smith raised numerous concerns about the structure and function of the General Medical Council, the statutory regulator of doctors in the UK. This created a national debate about public safety and the role of regulation within the healthcare professions. Every profession, including our own, has examples of practitioners who are guilty of misconduct.

The Chief Medical Officer was asked to review the arrangements in place to protect the public from the harm from poorly performing doctors. His report Good Doctors, Safer Patients (Donaldson, 2006) was a wide-ranging review of medical regulation, drawing upon lessons from other high-risk industries, including the air industry, and making a series of 44 recommendations to remedy the situation.

Following the publication of this report a parallel review was commissioned to examine the regulation of other healthcare professionals. This recommended that all regulators should reform their processes and ensure that they met more robust and impartial requirements with a clear remit for public protection. To ensure that there was a coherent and consistent approach to regulation across all the healthcare professions, there was a further recommendation that there would be no new regulators in the future (Foster, 2006).

The National Framework for Regulation
The government's White Paper on the future of professional regulation Trust, Assurance and Safety: The Regulation of Health Professionals in the 21st Century (Department of Health, 2007) drew heavily on these recommendations and set out the national framework for health regulation reform, which was vigorously pursued.

Key points included the separation of the role of the professional body from that of the regulator, ensuring that regulatory council members were independently appointed and that there was parity of membership between professional and lay members, and that the regulator was more directly accountable to Parliament.

These reforms formed the background to the discussions and negotiations about the regulation of psychologists. The likelihood was that regulation would happen, with the Health Professions Council (HPC) as the probable regulator. The HPC governance framework was dictated by the White Paper.

Accordingly in July 2009, a legislative change gave the HPC the mandate to regulate 15,000 individual clinical, counselling, forensic, health, occupational and sports and exercise psychologists who offered services to the public. The details of those on the BPS register who were likely to be covered by statutory registration were transferred to the new regulator, and psychologists who wished to remain on the register were required to meet HPC regulatory standards. These are summarised in the adjacent box, which describes the main function of healthcare regulation – to safeguard the public by ensuring proper standards of healthcare practice. A number of these functions were previously undertaken by the Society, which no longer has the legitimacy to operate these processes.

Who are the regulators in health?
There are nine healthcare regulators. The largest is the Nursing and Midwifery Council with 665,599 members, followed by the General Medical Council, which has 231,232 members. Next is the HPC with 205,311 members. Over 1.4 million healthcare workers across 30 professions are now subject to statutory regulators of various kinds (Scott, 2010).

In addition, the Council for Healthcare Regulatory Excellence (CHRE) was set up in 2003 to oversee the work of the nine healthcare regulators. In particular it was given the power to audit and scrutinise the fitness to practise processes and can refer final fitness to practise decisions to the Courts if the decision is considered too lenient in the light of public protection (CHRE, 2010). It also ensures that good practice is shared and has published a series of high-profile reports; for example, guidance on promoting and maintaining clear sexual boundaries between patients and professionals (CHRE, 2008).

The Health Professions Council
The HPC is an independent, UK-wide health regulator set up by the Health Professions Order (2001). It has an explicit remit to regulate a range of professions (in contrast to, for example, the Nursing and Midwifery Council or the General Medical Council, which regulate single professions). Some other regulators also have a wide remit, such as the General Dental Council, which regulates both dentists and other dental professionals.
The HPC now regulates 15 separate and disparate groups. The largest groups are physiotherapists (42,600) and occupational therapists (30,000), with practitioner psychologists (15,000) midway in terms of numbers. There are proposals to incorporate further groups, and the government plans to abolish the General Social Care Council and to transfer the responsibility for the regulation of the social care workforce to the HPC (Department of Health, 2010).
The HPC is required to undertake its work according to the programme of reform set out in the White Paper Trust, Assurance and Safety. It must be independent of the professional bodies whose members it regulates. The HPC governing council has one member per profession regulated as well as lay input. This means that there is one practitioner psychologist providing input to the council.

There are approximately 120 office staff who undertake operational tasks. The HPC also appoint 600 Partners who work for a fee as agents of the HPC on a part-time basis. Partners undertake a variety of roles, such as CPD assessors, panel members, registration assessors and visitors who undertake approval visits to educational providers. They may be registered members of a particular profession, lay members or individuals appointed for their professional expertise, for example lawyers or doctors.

Positions are advertised on the HPC website, in a range of professional journals and in national publications. For example, the HPC advertised in April 2009 for Psychology Partners in advance of statutory regulation for psychologists to support the process. Appointments are made via an independent selection process and are not nominees of the relevant professional body.

The HPC, although independent of professional bodies like the BPS, has an active programme of engagement with the professions they regulate. For example, they have a presence at major professional events like the BPS Annual Conference. During summer 2010 the BPS hosted three events with the HPC to publicise their respective roles. More recently the HPC have undertaken a campaign to ensure that general practitioners are aware of the importance of referring their patients to registered health practitioners.

The HPC delivers an annual report and accounts to Parliament covering its reporting year 1 April to 31 March.

The fitness to practise process
The overriding obligation on the part of healthcare regulators is to ensure patient safety. This is the most high-profile area of the work for all regulators and regularly attracts press coverage. Analysis of fitness to practise data indicates that there are generally low levels of complaints and fitness to practise issues for the professions regulated by the HPC, although there is some variation.

There were a relatively large number of complaints against Practitioner Psychologists noted in the first year of registration (HPC, 2010), but the report says that this was due to the transfer of 44 cases from the BPS in a single batch in July 2009. The total figure represents complaints against 0.96 per cent Practitioner Psychology registrants, compared to a mean complaint rate of 0.38 per cent against all HPC registrants. It is too soon to say whether this level of complaint will be sustained in the longer term.

The regulator only considers complaints about impairment of fitness to practise and does not deal with minor work-related complaints or infringements of terms and conditions of service (HPC, 2009). Research conducted on behalf of the HPC shows that this aspect of regulation is poorly understood by the general public as well as registrants themselves (IPSOS Mori, 2010). For example there is confusion amongst the public about whether a national regulator can intervene in clinical care or resolve local disputes, although this is not within their remit.

In a detailed analysis of complaints data from 2006/7 for all professions, the majority (88 per cent) of complaints had a misconduct element, of which 13 per cent related to convictions or cautions; in addition 10 per cent of complaints were purely about competence (HPC, 2008). Examples of misconduct were convictions for drug offences, a conviction for possessing indecent images of children, convictions for assault and fraud. Examples of complaints about competence were failure to provide adequate patient care and failure to meet standards of proficiency. In the most recent Fitness to Practise Report (HPC, 2010), this trend has continued with most complaints being about misconduct (80 per cent).

Employers continue to be the largest single complaint group, making up 42 per cent of the complaints made in 2008/9, although this fell to 33 per cent in 2009/10. Complaints from the public make up almost one quarter of cases (23 per cent). The police made up 7 per cent of complaints. The HPC must be notified when a registrant is convicted or cautioned for an offence and also when the offence is disposed of via a conditional discharge.

Powers of investigation
When investigating a complaint, the HPC has powers to demand information and can require individuals or organisations to supply information or produce documents and has powers to override the provisions of the Data Protection Act. They can also require witnesses attend a hearing or produce documents. This is in contrast to a non-statutory regulator like a professional body, which has very limited powers of investigation.

Complaints that meet the HPC minimum information standards for an allegation go to an Investigatory Committee panel. The panel's role is to decide on the basis of documentary evidence whether there is a case to answer in terms of fitness to practise, and that there is a realistic prospect of proving the case. In 2009/10 the HPC received 499 allegations and the panels considered that in just over half of them (58 per cent) there was a case to answer.

The next stage involves a full hearing, details of which are posted on the HPC website four weeks in advance. Cases are heard by panels appointed by either the Conduct and Competence Committee or the Health Committee. Hearings of Health Committee panels may be held in private at the discretion of the HPC to protect the confidentiality of registrants suffering physical or mental ill health.

The full hearing must consider whether allegations against registrants are proven. Oral and documentary evidence is considered and tested. The HPC use the civil standard of proof, which means considering on the balance of probabilities whether an allegation is proven. This is in contrast to the more rigorous criminal standard, which requires proof beyond reasonable doubt. All nine regulators are now required to use the civil standard except in exceptional cases.

The total number of cases concluded at final hearing in 2009/10 was 256. Of these cases 76 (30 per cent) were considered as not well founded, and for three others no further action was taken. For the remainder a variety of sanctions were imposed, the most severe of which
is a striking-off order – 65 registrants were removed from the register. The process can be protracted and the average length of time for a case to conclude was 18 months, and 45 cases took over two years to conclude.

The cost of the fitness to practise process is substantial – £6 million in 2009/10, 40 per cent of the HPC's operating costs (HPC, 2010).

Up to March 2010, 38 allegations against Practitioner Psychologists were considered by the Investigatory Committee. It was found that for the majority of these allegations there was no case to answer, with a further three requiring further information to make a decision. The remaining 11 cases progressed to a Conduct and Competence Committee. For the three outcomes reported, the Committee imposed a Condition of Practice Order in one case, and ruled that the other two cases were not well founded and no sanctions were imposed. Subsequent to the publication of the most recent Fitness to Practise Report, the first Practitioner Psychologist was struck off the register in September 2010 for misconduct.

The role of the BPS
The BPS, like a range of other professional bodies, no longer operates its voluntary regulatory procedures in respect of practice. This has opened up further opportunities to concentrate on the core business of promoting psychology and the delivery and development of psychological practice for the public good. The BPS, through members' voluntary activities and the input from staff, supports all aspects of psychology within the UK, covering research, education and professional training, development and practice as described in the box 'The role of the British Psychological Society'.

Psychology and psychological issues are promoted through the media centre, marketing and parliamentary activity and governmental consultations. Joint activities are undertaken with other learned societies and professional bodies, and increasingly psychological issues are being developed on an international basis. The member networks (e.g. Divisions, Sections, Special Groups, Branches) offer members a variety of focused services and collegial activity to support and develop practice. The last few years have seen significant developments in support for members at every stage of a psychology career.

The future
There is now emerging clarity between the role of the regulator and that of the professional body. As the HPC grows larger with the addition of more diverse groups of practitioners, it becomes clearer that professional identity can be fostered and developed through membership of the British Psychological Society.

We are in the first phase of being a regulated profession and it is important that we monitor our experience with the regulatory process and ensure that feedback on significant issues goes via our professional body. The HPC convenes an annual formal meeting with the BPS to examine regulatory processes and functioning. Recent issues raised have been the operation of the grandparenting process, which will close in 2012, and the lack of regulation for trainees.
If you have any comments or suggestions for further information on registration issues, please e-mail us at [email protected].

References
Council for Healthcare Regulatory Excellence (2007). Annual report and accounts 2006/2007. London: The Stationery Office.
Council for Healthcare Regulatory Excellence (2008). Clear sexual boundaries between healthcare professionals and patients. London: Author.
Council for Healthcare Regulatory Excellence (2010). Fitness to practice audit report. London: Author
Department of Health (2007). Trust, assurance and safety. London: The Stationery Office.
Department of Health (2010). Liberating the NHS: Report of the arm's-length bodies review. London: Author.
Donaldson, L. (2006). Good doctors, safer patients: A report by the Chief Medical Officer. England: Department of Health.
Foster, A. (2006). The regulation of the non-medical healthcare professions: A Review by the Department of Health. London: Department of Health.
Health Professions Council (2008). Continuing fitness to practise. London: Author.
Health Professions Council (2009). Fitness to practise annual report 2009. London: Author.
Health Professions Council (2010). Fitness to practice annual report 2010. London: Author.
IPSOS Mori (2010). Expectations of the fitness to practise complaints process. England: Health Professions Council.
Laurence, J. (2009). Health stories of the decade. British Medical Journal, 339, 1–4.
Scott, F. (2010). Independent review of the requirement to have insurance or indemnity as a condition of registration as a healthcare professional. London: Department of Health.

Box 1: the role of the Health Professions Council

The Health Professions Council maintains a public register of those 'fit to practice' and who are able to use a protected title. It takes action against those not 'fit to practice' or who use a protected title illegally. The HPC sets mandatory standards for all health professions on it register.

Conduct, performance and ethics
The HPC sets generic standards for the behaviour and conduct expected of all registrants.
 - The HPC is unable to provide advice on ethical issues, directs registrants to their professional body.

Proficiency
The HPC sets proficiency standards at a threshold level for safe and effective professional practice:
 - generic standards for all registrants
 - profession-specific standards for all seven groups of practitioner psychologists.

Education and training
The HPC sets generic standards that education providers must meet to ensure that those completing an approved programme meet the Standards of Proficiency
 - The HPC only approves programmes that lead directly to eligibility to register.

Continuing professional development
The HPC sets generic standards that must be met by all registrants. It links registrants' ongoing learning and development with their continued registration.
 - Registrants are required maintain an up-to-date CPD record.
 - Registrants must on request supply a written CPD profile.

Box 2: the role of the British Psychological Society

Ethical issues
The Society supports and advises members on ethical decision making by publishing ethical guidance in the 'Code of Ethics and Conduct'. It publishes a wide range of research and practice guidelines, and maintains an online ethics helpline.
 - Members must adhere to member conduct rules to retain membership of the BPS.
 - The Society is unable to determine fitness to practise complaints.

Professional issues
The Society supports and advises members on professional practice and academic issues through membership of:
 - Divisions – which focus on training and practice and aim to develop psychology as a profession and as a body of knowledge and skills
 - Sections – which further members' specialised scientific interests, promoting psychological research and exchange of ideas
 - Special Groups – which provide a forum for members working in a particular field
 - Branches – groups for meeting and exchanging ideas within a geographical area
 - Support groups – for undergraduates, postgraduates, training, practitioner and fellowship level.

Education and training
The Society supports higher education programmes and professional training with:
 - an accreditation through partnership scheme which aims to focus on improvement and quality enhancement for educational programmes
 - Society qualifications leading to HPC registration.

Continuing professional development
The Society supports CPD through its Learning Centre training and development portal, which:
 - provides information and guidance on professional development.
 - provides workshops, e-learning packages and approved training
 - incorporates CPD online planning and recording that is compliant with the needs of the HPC and BPS recommendations.
 

Get engaged
The Society's 2011 public engagement grant scheme launches in April. Dr Graham Powell, Chair of the Publications and Communications Board, said: 'We recognise our role in supporting our members who are communicating psychology and delivering psychological services to the public. We're delighted that for 2011 we have substantially increased the funding available for our scheme at a time when many other organisations are cutting back. We have £40,000 available either for one project or to be shared amongst several smaller projects.'The grants aim to help members promote the relevance of evidence-based psychology to wider audiences, either through direct work or by organising interesting and relevant communications activities. Applications from those working with sport and exercise psychology projects throughout the UK, in the final run-up to the London Olympics in 2012, are particularly welcome. Go to www.bps.org.uk/grants for more details.

The closing date for completed applications forms is 1 July. The Society will aim to notify applicants of outcomes by 31 August.

Men's Health
The final seminar in a Society-funded series devoted to psychological issues in men's health will be held at Glasgow Caledonian University on 31 May.

Professor Brendan Gough, leading the series, said: 'Men's health is said to be in crisis, a situation popularly linked to "masculinity", yet we know relatively little about men's perspectives and practices related to health, lifestyle and embodiment. This third seminar brings together specialist researchers and has a focus
on how men understand and cope with serious illness.'
Speakers are Professor Kate Hunt (Social and Public Health Sciences Unit, Glasgow) on 'Experiences of illness and identity among men who have breast cancer'; Dr Sarah Seymour-Smith (Nottingham Trent University) on 'Men's accounts concerning prosthetic testicles in the context of testicular cancer'; Professor Paul Flowers (Glasgow Caledonian University) on 'Gay men, HIV and sexual conduct'; and Dr Steve Robertson (Leeds Metropolitan University) on 'Men and embodiment during cardiac rehabilitation'.

Places are limited so please e-mail Sheilah Han ([email protected]) to book a place as soon as possible.

Postgraduate students wishing to present a poster should send a 200-word abstract by e-mail to Professor Brendan Gough by 29 April ([email protected]). A travel bursary of £75 will be awarded to the best abstract (judged by the organising committee).

Going green in the workplace
The Going Green Working Group, part of the Division of Occupational Psychology, has published a report into the psychology of sustainability in the workplace. Drawing together a range of research and case studies that were originally presented at the Division's Going Green Symposium held in London in 2010, its aim is to provide an illustration of the important contribution that the field of work and organisational psychology can make to understanding and promoting green behaviour at work. The report contains a range of useful material for 'people specialists' in organisations, including a number of vignettes and case studies particularly aimed at practitioners.

Professor Dean Bartlett (London Metropolitan University) said: 'Highlights include some fascinating research from the BRE Building Design Consultancy, which shows how individuals will adapt and even sabotage technology aimed at greening the operations of an organisation to suit their needs. There's also a revealing account of how an organisation consisting largely of environmental specialists – the Environment Agency – has improved its own environmental performance. Finally, a snapshot of findings from a survey of UK organisations conducted by City University outlines the different approaches that organisations are taking to encourage pro-environmental behaviour among employees.'

Other contributions focus on the application of a number of well-established psychological theories to the green organisational imperative and the difficulties that can be encountered in engaging staff in green initiatives.

Copies of the report are available for download from www.bps.org.uk/goinggreen