Statutory Registration Revisited

Dr. Gerry Mulhern, Managing Director of the Psychological Society of Ireland (PSI), in conversation with Edward Boyne

Edward: Gerry, you were Director of Professional Development of the PSI for several years and have been Managing Director since June 2014. You are also a former President of the British Psychological Society. The PSI has been engaged very closely with issues to do with statutory registration in recent years. Psychology was designated in the first tranche of professions to be regulated under the Health and Social Care Professions Act 2005. My questions for you today are connected with the PSI experience of statutory registration to date. As you know, the profession of psychotherapy has recently (March 2014) been designated by the Minister for Health for statutory registration.

Gerry: Yes that’s true, I’m aware of the designation of psychotherapy which has been a long time coming and is very welcome. Interestingly, to date the model of regulation in Ireland has followed the UK model closely. Regulation of psychotherapy in the way now envisaged is something of a departure from the process in the UK where there are no longer any plans to establish a register of psychotherapists.

The current situation in relation to the PSI has become clearer in recent weeks following some uncertainty over the timeline for registration. The most up-to-date information I have is that psychology will be among the remaining health and social care professions awaiting registration to begin the process of statutory registration in the first half of 2015.

Edward: What is your understanding of how the statutory registration process works when it is up and running?

Gerry: The 2005 Act sets out the processes that have to be enacted before full registration is up and running. For psychotherapists, the first step will be the appointment by the Minister for Health of a Psychotherapists’ Registration Board (PRB). This Board will have 13 members and will consist of a mixture of six psychotherapists and seven non-psychotherapists, that is ‘lay’ members. This key Board will be responsible for establishing and maintaining the Register of Psychotherapists, assessing and validating qualifications in psychotherapy obtained outside the State, setting the qualifying standard for entry to the profession, approving and monitoring all education and training programmes relevant for entry to the Register, setting the Code of Professional Conduct for Psychotherapists, and setting requirements for continuing professional development for psychotherapists. While it would be expected that the Board would wish to take into account the views of the existing professional bodies, it is not required to follow those views and will decide for itself about all of the requirements for registration. At this stage it is difficult to know what the PRB will do about the various matters I have listed. It’s fair to speculate that there will be some pressure politically for standards of education, training, conduct and CPD (continuing professional development) to be at least comparable with the other registered professions.

Approximately nine months following the appointment of the PRB, a ‘transitional’ Register will be established which will allow existing practitioners to be inducted onto the Register on the basis of transitional criteria. This is a very important element of statutory registration which is intended to cater for the likely significant diversity in qualifications and background among existing psychotherapists and to ensure that no-one currently earning a living lawfully through the practice of psychotherapy would risk being disenfranchised by the move to registration. I am not sure that the current provisions of the 2005 Act would be able to accommodate the grandparenting of psychotherapists, so I would expect that this would require a change in primary legislation. In any case, the requirements would almost certainly be a relevant degree or equivalent and the ability to demonstrate two years safe practice in the five years leading up to the opening of the Register.

The transitional Register will be open for exactly two years and existing practitioners are encouraged to join during this period, but are not required to do so. Anyone with ‘non-standard’ qualifications or other unorthodox circumstances would be strongly advised to join the Register comfortably ahead of the closing of the transitional period. Following the ending of the transitional period all eligible psychotherapists will be required to be on the Register. Following the transitional period, it will be illegal for any unregistered person to use the term ‘psychotherapist’.

Edward: I think we are all wondering what the transitional requirements will be. It sounds like the new Registration Board will hold a lot of statutory power. You mentioned that many of its members will be ‘lay people’ or non-psychotherapists. What is the Government thinking behind appointing such people as opposed to say appointing a Board consisting of elected members of psychotherapy professional bodies or indeed their staff or advisers? After all, they have the experience of operating a form of self-regulation to date. Surely the job of statutory regulation can safely be left to those with such experience?

Gerry: It’s interesting you should say that Edward, because this is the most commonly held view among practitioners undergoing regulation. However, the view that ‘professions know best’ and ‘we’ve always done it this way’ are the last things that the Regulator (CORU) wants to hear. From the outset, the Government has been absolutely clear that the central focus of statutory registration is the protection and confidence of the public and, in order to achieve this, Government has deemed that the process must be driven by the public and be independent of the professions being regulated. In operating the legislation CORU has been very clear about this imperative and has kept a healthy distance between itself and the relevant professional bodies. While acknowledging that it has much to learn from these bodies, CORU has sought to do so on its own terms, ensuring that professions do not overstep the mark. This also explains why the principle of a lay majority on the registration boards, and incidentally on CORU Council itself, is a central plank of the process.

Edward: So it sounds like the current leaders of the psychotherapy profession, elected or otherwise, as with other professions such as psychologists, will be expected to more or less stand aside and allow a ‘neutral’ entity, i.e., the Registration Board, to take complete control. I imagine this has been and will be difficult for some of those hard- working leaders to take on board. It’s also the prospect of fairly dramatic change and a substantial drop in income as the accreditation function in all its aspects (including financial) is taken over by a statutory body.

How do you see the future for professional bodies? What about your own body, the PSI? What will be their role, if any, in the medium term?

Gerry: You are absolutely right Edward. All professions undergoing regulation have had sleepless nights about the risk of an implosion in their membership numbers and I have a hunch that one or two professional bodies may not survive in the long run. Within PSI many of our members have asked why they should remain members after statutory registration. The answer for all professional bodies is to be clear about what they do on behalf of their membership and to seek to enhance and expand services to members.

In PSI, we have considered various scenarios around the impact on member recruitment and retention and I think we have developed an approach which will ensure that we remain relevant. Part of the answer is to focus on respective roles of the Regulator (CORU) and the professional body and to remind members that the former focuses solely on public safety and on minimum standards to ensure public protection. Professional bodies on the other hand are concerned with enhancing professional esteem and identity, the highest standards of professional practice and services to members. The challenge for the professional body is to demonstrate this in practice rather than merely asserting that this is ‘what we do’.

Edward: We hear a lot about ‘fitness to practise’ issues under statutory registration. Can you comment on this?

Gerry: one of the first tasks of the PRB following its appointment will be to take CORU’s generic Framework Code of Conduct and Ethics and adapt it for the profession of psychotherapy. The resulting document, likely named the Code of Professional Ethics and Conduct for Psychotherapists, will consist of the generic standards as well as those developed for the profession as a whole and others that apply to specific specialisms. The fitness to practise of any registered psychotherapist will be judged in terms of their compliance with the Code as well as their maintenance of CPD as required by CORU.

Part Six of the 2005 Act deals with fitness to practise. For psychotherapists, as for other professionals, this will cover complaints from any member of the public, employer, colleague or anyone else who is unhappy with the service provided by a registered psychotherapist. CORU is obliged to investigate all such complaints through a tiered process involving preliminary screening through to professional conduct hearings where deemed appropriate.

Edward: The other issue many practitioners raise is in relation to the ‘assessment of professional practice’. In cases where practitioners don’t meet the educational or training standards for statutory registration they must undergo an ‘assessment of professional practice’ by the Registration Board. Can you shed any light on what this assessment might involve?

Gerry: The methodology for assessment of professional practice will be a matter entirely for the Registration Board and would be likely to involve paper-based assessment of knowledge and practical assessment of skills, whether through interview or observation. Such assessment is intended to judge the extent to which an individual’s knowledge and skills are comparable to those embodied in current approved education and training. In many cases there is unlikely to be a need for assessment during the transitional phase of the Register, hence my earlier advice that existing practitioners should ensure that they seek to join the Register during this period. I would also reassure practitioners that the ethos of regulation is not to disenfranchise safe and effective practitioners who have been lawfully earning their living as psychotherapists. But it is intended to weed out unsafe and unqualified practitioners, which I’m sure all would agree is a good thing.

Edward: At the present time, professional training courses in psychotherapy are enrolling new students. The trainers don’t and can’t possibly know what the standards for training are to be or even what courses will be accepted by the new statutory registration regime. Given the powers of the Registration Board, recognition by a professional body of a training course might be seen as of somewhat limited value. new students today cannot count on any form of grandparenting or transitional arrangements from a ‘professional body register’ to a statutory register. As someone closely involved in psychotherapy training I am acutely aware of the ethical obligations we have to new students in terms of advising and guiding them for their future careers. Do you have any words of wisdom to offer on these ‘transitional’ problems?

Gerry: In spite of my earlier comments about the desire of the Regulator to keep a healthy distance from professional bodies, I believe that the new Psychotherapists’ Registration Board will want to draw upon currently accepted standards of education and training in the profession. Despite the lay majority on the PRB, there will also be a healthy number of psychotherapists, at least two of whom must be involved in psychotherapy education. They will undoubtedly be influential in setting the standards of approved qualifications for entry to the profession and those standards should reflect current good practice. The PRB’s future criteria should reflect those elements of best educational provision that currently exist when they set about doing their work. I would reassure all who are concerned that the intention of regulation is not to wrong-foot or undermine those engaged in current good practice, whether as educators or practitioners Ñ rather, the intention is to embed these high standards into Statute.

Edward: Many thanks for agreeing to this conversation Gerry and for your helpful remarks.