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• ‘Counsellors and psychotherapists should have an ethical framework built into their very core, like Blackpool running through a stick of rock. The practitioner should know whether they are practising ethically.’
  
  So says BACP Chief Executive Laurie Clarke as he contemplates the task ahead to put into effect a wide-ranging reform of the BACP register. The changes will expand the register to include more BACP members and bring it under the aegis of a soon-to-be launched national regulatory body, the Professional Standards Authority for Health and Social Care (PSA).
  
  The PSA is the new title for the Council for Healthcare Regulatory Excellence (CHRE), the current super-regulator that sets standards and oversees all the existing statutory health and social care regulatory councils, such as the Nursing and Midwifery Council, the Health Professions Council and the General Medical Council.
  
  When the Coalition Government was elected it decided to explore a more flexible alternative to statutory regulation for health and social care professions and practitioners. The 2010 White Paper Enabling Excellence introduced a new world of healthcare regulation that would be light touch, where the key words would be ‘accountability’ and ‘autonomy’.
  
  Professional bodies would be invited to set up their own voluntary registers that would be approved by a national regulator to national standards. Importantly, professional organisations would still be able to decide their own ethical frameworks and standards for practice and education, within the overall requirements set by the regulator.
  
  BACP intends to be an ‘early adopter’ of this voluntary register scheme and has been working with the CHRE and other professional bodies to develop the standards for accreditation.
  
  Laurie Clarke says that the voluntary register is a better alternative to statutory regulation. ‘Once we saw where the wind of political change was heading, we started talking to the CHRE and discovered they had this alternative model on which they had already done a lot of work, and from that emerged this completely different philosophical and ideological view of regulation. The CHRE model is about evolution and development of the profession by the profession. The BACP Ethical Framework will remain the property of BACP and its members.’
  
  ‘Statutory regulation relies very much on the protection offered by the legally protected title. That system has been found to be flawed by many professions across the world,’  Clarke argues; the solution is for organisations representing healthcare professions to ensure their ethical and professional standards and frameworks meet the PSA’s over-arching standards but retain responsibility and accountability for themselves.
  
  ‘I would call it grown-up,’ says Sally Aldridge, BACP Director of Regulatory Policy and a key member of the BACP team that has been exploring and developing the new regulatory structure. ‘If we had gone with the Health Professions Council (HPC), we would have had to abide by their standards and codes of ethics and conduct procedures, which would make it harder for us to develop as a profession. This way, we keep ownership of the things we really value.’
  
  The PSA’s ‘light touch’ regulation will place the burden of accountability where it belongs: with the practitioner and their professional body. ‘The practitioner will have to really think about their own behaviour and standards of practice. That is the philosophy of the PSA and one much more in keeping with BACP’s own ethical framework,’ Aldridge says.
  
  Laurie Clarke acknowledges there are risks: not least that BACP members may not want to join the voluntary register. ‘That is their right. This is a voluntary register,’ he says. But he points to the potential benefits. Belonging to an approved register will, he hopes, open the doors to improved employment opportunities for counsellors and psychotherapists, in the NHS and in other sectors. The voluntary register, he says, is likely to be recognised formally by employers and agencies. The CHRE/PSA is currently negotiating with the Department of Health to ensure NHS employers require counsellors and psychotherapists employed through the Any Qualified Provider (AQP) system to be on a PSA-approved voluntary register, so that clinical commissioners and GPs can be confident that their patients are getting high quality care delivered by a practitioner trained to a nationally recognised standard.
  
  A kitemark of quality
  With the gradual expansion in NICE-approved therapies, employment of counsellors in NHS organisations is likely to increase significantly in the future. The other major employers – the education and voluntary sectors and Employee Assistance Programme (EAP) providers – are also likely to welcome a national register that carries the PSA’s seal of approval, Clarke believes.
  
  Zubeida Ali, Professional Lead for Counselling in Lancashire Care NHS Foundation Trust (LCFT) and Deputy Chair of BACP Healthcare division, says that a voluntary register will give patients and GPs a kitemark of quality against which to measure counsellors’ standards of practice and qualifications, particularly if it becomes a requirement within AQP. ‘The Health and Social Care Bill has done us a favour in some ways because GPs are now going to have to be upfront about this with their patients. Patients will be able to question why they are being referred to a particular counsellor, and whether the counsellor is appropriately qualified. Counsellors in LCFT have for many years been employed on the basis of being BACP accredited and having a number of years’ experience post-qualification. The BACP accreditation process is systematic and sets a high standard. We need that standardised procedure by which the NHS employs people with the appropriate skills and qualifications. Counselling providers will also in turn be able to go to clinical commissioning groups (CCGs) and GPs and say “This is what quality looks like”.’
  
  Claire Maguire is Clinical Lead for Psychological Therapies at Pennine Care Foundation Trust, based in Manchester. She is also a commissioner with NHS Bury and the Greater Manchester cluster of clinical commissioning groups. She sees the voluntary register as ‘evolutionary’; it lacks the full legal powers of a statutory register. But it does make a statement to commissioners, employers and the public. ‘People who aren’t even signed up to a voluntary register would have less credibility with commissioners. As a provider, it is something I would also look for when recruiting. I deal with a lot of queries from service users and they say they don’t know if a health worker is any good and how would they know, and what safeguards do they have if the treatment doesn’t work well for them. If you’re in the NHS there is the whole NHS governance structure but in the independent sector, you can look on a website and see what the standards are and have a checklist against which to test the counsellor.’
  
  Psychologists have only recently acquired statutory registered status with the HPC and she says it doesn’t tick all the boxes. ‘The standards for continuing professional development required of psychologists by the HPC are less sophisticated than those required by the British Psychological Society.’ She says she still uses the CPD documentation provided by BPS, precisely because she finds it more relevant to her professional development needs. ‘It is unfortunate that some people feel they no longer need to be in a professional body like the BPS.’
  
  The British Acupuncture Council (BAcC) is also considering becoming an ‘early adopter’ of the PSA voluntary registration scheme. The BAcC is the largest professional body representing acupuncturists in the UK, with some 3,100 members. It was keen to pursue statutory registration, not least because it is a legal prerequisite if someone receiving acupuncture is to give blood. Also, some health insurers don’t pay out for acupuncture unless the practitioner is on a statutory register. Says BAcC Chief Executive Nick Pahl: ‘We assumed we would be like the osteopaths and chiropractors. We were promised statutory registration. It was very disappointing when it didn’t happen. Voluntary registration is the next best opportunity, although it doesn’t protect the title.’
  
  Pahl says he will be happy with voluntary registration if the Government ensures the legal requirements for blood donation are amended and if it is recognised by the health insurance industry. ‘Registration is a not insignificant part of the decision-making process for the client. They want to search out the best quality practitioner and look for a stamp of quality. They also like their medical practitioner’s nod of approval, and that may be more forthcoming if we are part of the PSA scheme. Whether it carries enough weight with the public and stakeholders will depend, however, on how well the PSA markets it,’ he believes. ‘The PSA has to make a strong case. It is also very important that the NHS recognises these voluntary registers. You should have to be on a voluntary register to bid for NHS work through Any Qualified Provider.’
  
  The Institute of Healthcare Management is also planning to set up a voluntary register with the PSA. Sue Hodgetts, IHM Chief Executive, says statutory registration is no longer a realistic hope. ‘Voluntary registration is the next stage. It will give us a set of standards and an ethical framework.’ There is, she says, a change in the political tide away from the emphasis on regulation towards greater self-regulation and accountability. She agrees with BACP’s analysis: ‘Statutory regulation can sometimes remove the responsibility from the organisation to hold its members to account. You have to strike a balance between organisational and individual responsibility.’
  
  Relate has been discussing with BACP whether to join its register as a sub-section or establish their own with the PSA. Nick Turner, Director of the Relate Institute, says the voluntary register at least avoids a re-opening of the ‘almost irreconcilable divisions’ that emerged within the counselling and psychotherapy community when a statutory register with the HPC was proposed. ‘The PSA is a regulation system for registers. Individual organisations need only to demonstrate that they have robust quality assurance systems in place to manage their own registers. I think the PSA system is much more respectful of the worth and value of the professional bodies themselves.
  
  ‘But at the end of the day the system must be focused on the best interests and welfare of clients and users. That is what the CHRE says is one of its stated aims and they will need to be held to account to ensure that happens.’

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  If you are close to applying for accreditation and would like further information, you can contact the BACP Professional Standards team on 01455 883300. BACP staff will also be available to answer members’ questions at the BACP Making Connections events. The next Making Connections is in Belfast on 15 June.

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  Reforming the BACP register
  Adoption of the voluntary register does mean some changes for BACP members. Some details of the new processes are still to be confirmed.
  
  The UK Register of Counsellors and Psychotherapists (UKRCP) will be retitled the BACP Register of Counsellors and Psychotherapists.
  
  BACP will also revise the entry standards to the register, to meet the higher PSA standards, and put in place a new assessment process to enable all its members to apply to join it. All accredited BACP members will stay on the retitled register, if they wish to do so. All graduates of BACP-accredited courses will also be eligible to join the register. Other BACP members will be able to take a short Certificate of Proficiency test – a two-hour, electronic assessment to test their knowledge and understanding of ethical practice.
  
  BACP intends that members who do not wish to be on the register will be able to remain simply as members (MBACP), and that registered members will be designated ‘Registered MBACP’ or ‘Registered MBACP Acc’.
  
  BACP is also changing its internal structures to meet the PSA requirement for a clearer separation between its professional and regulatory functions. The current BACP ethics, legal and regulatory functions will be brought together to form the Register, which will be separated from the rest of the BACP by a ‘firewall with doors’, as Laurie Clarke describes it. The Register will be accountable to a lay Advisory Board chaired by Professor Ed Sallis OBE, Vice Chair and Non-Executive Director of the Institute for Learning. The ‘doors’ in the firewall will ensure that the ethical framework and standards evolve in response to developments in professional knowledge and practice.
  
  ‘By holding the regulatory function on one side of the firewall and the professional body on the other, BACP will then be able to support members who are complained against. That has always been a real rubbing point: it gives members more confidence that they will be supported by their professional body, and gives complainants confidence that their complaint will be heard by a genuinely independent body. That has to be win-win on both sides,’ Sally Aldridge explains.
  
  The Certificate of Proficiency comprises a series of case studies presenting a range of ethical and professional dilemmas. Candidates click on different options to demonstrate their understanding of the issues raised and how they would respond to the situation.
  
  BACP will be setting up a national network of centres where members can take the test. Candidates will have an opportunity to practise on a sample test first, to familiarise themselves with the computer system.
  
  BACP member Helen Weighell has taken the Certificate in one of the pilots conducted by BACP to test its usability. ‘I was surprised. I went in feeling very skeptical about how it would work. I didn’t see how you could assess someone’s knowledge from a list of questions on a screen when so much of what we do is about rapport and the relationship between the client and the therapist. But I found it more taxing and that it made me think more than I expected. I really had to consider how I was going to answer the questions. That made it more interesting to do, but I also felt it was an effective assessment.
  
  ‘The computer shouldn’t be a major problem for people, even if they aren’t used to them. It’s user-friendly. You can’t break it.’
  
  BACP will be writing over the summer to all accredited members and members who have completed a BACP accredited course to explain the arrangements for transfer to the BACP register. Other BACP members will be written to over the next 18 months with information about the Certificate of Proficiency.

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  ‘This is shared regulation’
  Harry Cayton, Chief Executive of the CHRE, says the voluntary registration system will be fair, transparent and accountable...
  
  In what way is the voluntary registration system better than a statutory register for organisations like BACP?
  I don’t think we should talk about better or worse. It’s different. The scheme for voluntary registers provides a new kind of fully independent public assurance that the practitioner they choose is trained and qualified, committed to high standards, and that there is a fair complaints process if something goes wrong. An organisation like BACP already has a strong public identity but joining the assurance scheme and getting accredited will give the public and possible employers increased confidence.
  
  In what way does it offer better protection for clients and employers?
  The scheme will accredit BACP’s register as trustworthy. At the moment there are many different registers for many occupational groups. How does a member of the public or employer know who is reliable? They don’t. Some are honest and well-founded; others are little more than trade associations promoting businesses. Being accredited will mean that a register is properly run, consistent in its approach, fair to both public and registrants if something goes wrong, and both the public and registrants will be able to complain to the Professional Standards Authority if they think the organisation is not holding to the accreditation standards.
  
  We anticipate that employers will be much more inclined to employ counsellors from an accredited register than those who are not. Accreditation will provide assurance and increase confidence in the quality of the counsellor. We are working with the Department of Health to ensure that assured voluntary registers are recognised in the framework for Any Qualified Provider (AQP). The PSA will actively promote our accreditation scheme to employers and commissioners as a single, trusted source.
  
  Will the PSA respect the autonomy of member organisations – in particular, their professional standards/guidelines?
  We do not set the professional standards for the statutory regulators we oversee now and we won’t for voluntary registers. We will want to be sure that occupational standards are properly set and enforced but what those standards are is a matter for the organisation holding the register. Our scheme is also voluntary so organisations who don’t like our standards don’t need to join the scheme. The standards are out for consultation now (see web link below).
  
  There are very many different kinds of therapies. The PSA will not make a judgment on efficacy – that is a matter for the person who provides or uses the therapy. We can’t say if a therapy works or not, only if the register of persons providing it is properly run.
  
  There will be standards of education and training however and assessment of the quality of entrants to the register. We will have the power to decide if a particular therapeutic approach is legitimately defined as health or social care.
  
  How will PSA make voluntary registration accessible to smaller organisations representing counsellors and psychotherapists? Is there not a very clear risk that they will be left out of the system if they can’t afford the fees?
  We haven’t settled the fee. But the scheme has to be self-funding after three years. There will be certain fixed costs, such as the approval process, the annual check, promoting the scheme, the new website, dealing with enquiries and possibly complaints. We are very aware that the costs may be high for small organisations. Our idea is that they may form groups or come in under the umbrella of a larger organisation that has the strength to apply on its own account. The terms for them doing so would be a matter for the two organisations not for the PSA. However the PSA will expect all organisations to meet the same standards.
  
  So our aim is to run a value for money scheme that provides a new set of consumer protections and encourages the use of therapists and others in health and social care who are committed to good practice in their field. If we don’t provide value, we will fail. If we do, we will together improve quality and build public protection.
  
  Is self-regulation really the answer? Won’t BACP be in effect protecting its own? How can that be guarded against?
  I actually think we don’t have self-regulation any more. We have shared regulation. That is regulation shared between professionals and the public, in the interests of society as a whole. I see the voluntary registers scheme as a different way of looking at consumer protection. Just as voluntary registers are a partnership between people who work in a particular occupation to raise standards and protect service users, so the accredited registers scheme will be a partnership between the organisations and the PSA.
  
  There is a shared interest in improving. Good counsellors want to do well and to be on an accredited register, BACP needs to maintain its standing and continue to be accredited; the PSA’s credibility will be lost if we allow poor performance to exist.
  
  In the end, though, I’d be unwise to say we can ‘ensure’ anything. No regulator can do that. In the end it’s up to the person providing care and the person choosing that care. What the voluntary register scheme will do is give people standards to judge that by.

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  To respond to the CHRE consultation on the PSA accreditation standards, visit https://www.chre.org.uk/voluntaryregisters/468/