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Psychotherapy Bill Hl

Volume 622: debated on Wednesday 21 February 2001

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5 p.m

My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, That the House do now resolve itself into Committee.—( Lord Alderdice.)

On Question, Motion agreed to.

House in Committee accordingly.

[THE DEPUTY CHAIRMAN OF COMMITTEES (Lord Skelmersdale) in the Chair.]

Clauses 1 to 10 agreed to.

Clause 11 [ The Education Committee]:

moved Amendment No. 1:

Page 9. line 27, at end insert—
("(5) The Education Committee shall establish sub-committees to give authoritative advice on the educational, training and continuing professional development requirements of the various modalities of psychotherapy.
(6) At the outset, sub-committees shall be established in the following modalities—
  • (a) Psychoanalytic Psychotherapy, Psychoanalysis and Analytical Psychology,
  • (b) Cognitive and Behavioural Psychotherapy,
  • (c) Family and Systemic Psychotherapy,
  • (d) Group Psychotherapy,
  • (e) Humanistic and Integrative Psychotherapy,
  • (f) Experiential Constructivist Psychotherapy,
  • (g) Hypno-psychotherapy, and other sub-committees may be established as the Council deems appropriate.
  • (7) The Education Committee may, with the agreement of the sub-committees, modify the system of sub-committees set out in subsection (6)(a) to (g) above.").

    The noble Lord said: At Second Reading we addressed, at some length, the principle of regulation of the profession of psychotherapy. There was a gratifying welcome in your Lordships' House for the principle of regulation of psychotherapy, but with regret and concern it was noted by a number of noble Lords that this process had failed to reach fruition some 30 years after the publication of the Foster report, which had been such a crucial early marker.

    One reason for the failure has been the diversity of therapeutic approaches that fall within the bailiwick of psychotherapy. During the past couple of years, much of my endeavour has been directed towards persuading the various psychotherapy organisation and representatives to accept a relatively limited but coherent list of modalities. Indeed, one of the reasons why the wording in this amendment was not included in the Bill when it was first presented to your Lordships' House is that discussions have continued up until the last week or two to try to reach an agreement.

    The amendment, which sets down a number of modalities, does not permit or require registration by modality. The notion of modality is imported by way of sub-committees into the area of education and training and the purpose is to recognise the different requirements of education, training and continuing professional development of the different approaches to psychological treatment. Here I have taken on board the valid concern raised at Second Reading by the noble Lord, Lord Hodgson of Astley Abbotts, that education is not the same as training and that continuing education is now a proper requirement of all professions. By inserting subsection (5) into Clause 11, the amendment emphasises those three important components of professional education, professional training and continuing professional development.

    The advice that the sub-committees would be required to give is described as "authoritative". While to a lawyer, like my noble friend Lord Wedderburn of Charlton, that description may appear something of a hostage to fortune, its purpose is to emphasise the view of professional groups that the advice tendered by their modality sub-committees should be taken seriously. I know it would be their wish that within the confines of their modality, the advice tendered should be regarded by the education committee and the council pretty much as the authoritative word.

    Returning to the main burden of the amendment—the setting down of modalities—I emphasise that, despite the amendment, registration would not be by modality. The Bill gives legal protection to the title "psychotherapist", and with the exception of those already registered with the GMC, would require those who wanted to used the title "psychotherapist" to register with the General Psychotherapy Council. However, I repeat, as there has been some misunderstanding about it, that the indicative registration, as the Bill stands—I cannot say what may happen in the future—is not for the different modalities but for the title "psychotherapist" itself.

    The modalities described in the amendment are psychoanalytic psychotherapy, psychoanalysis and analytical psychology; cognitive and behavioural psychotherapy; family and systemic psychotherapy; group psychotherapy; humanistic and integrative psychotherapy; experiential constructivist psychotherapy and hypno-psychotherapy.

    I want to make it clear that I do not regard that list as being complete for all time, nor as satisfying the wishes of all therapists. The amendment gives the committees a substantial position—in some ways a starting position—but it clearly leaves open the possibility of the merging or de-merging of the subcommittees and of adding others. I believe that the flexibility for the development of new ways of working is important indeed. This Bill is not intended to create stagnation or rigidity but to create regulation. However, even as matters stand, I fully admit that some problems remain. We shall come to Amendment No. 2 and I shall want to make some remarks about it.

    At Second Reading, a number of noble Lords expressed concerns about the position of analytical psychology. I advised the House that I was aware of the problem and that I would try to address it specifically. I have met and corresponded with a substantial number of representatives of that and other traditions and it seems clear that unions—that is, practitioners of analytical psychology—are somewhat divided on the question. Some want to be separated into a separate modality, as proposed in the amendment standing in the name of the noble Earl, Lord Caithness, and the noble Lord, Lord Clinton-Davis, but others do not want to be divided from their colleagues. At least, that appears to be the current position. Although what we have is not perfect, it may be the best that we can have at present. More work needs to be done in that regard, but we shall deal with it later.

    There are those who would suggest that the semi-federal nature of my model would be directed better if it were described in the form of a collegiate structure rather than a modality arrangement. I have no doctrinal difficulty with that. I adopted a modality approach because of the substantial problem of using the current organisations as a basis for a collegiate structure. Many of the current organisations compete and overlap with each other and, try as I might, I have yet to see a model of how a collegiate structure might be put into a workable form.

    More difficult still, I have yet to understand how it can be constructed in a way which does not conflict with the European Convention on Human Rights because there are smaller organisations—some of which are established on the principle that they do not like organisation and are particularly opposed to regulation—which yet might well be able to claim coverage under the European convention.

    For those reasons, I have focused on the registration of individuals rather than the recognition of organisations or of colleges. But I remain, as I trust the Minister does, open minded about which model might work. If propositions are put which are workable and reasonable, and which conform to the proper legal regard, I shall happily embrace them. Neither the instrument of legislation nor the model for regulation is one to which I have a doctrinal attachment. I simply want something which will work and be proper.

    In summary, the amendment comes out of my discussions with the various organisations. To some outsiders, the disputes and divisions within the psychological world may appear as esoteric and quaint as do the procedures of your Lordships' House to the uninitiated, but they are all based on matters of substance—sometimes of history and relationships, broken or otherwise, and sometimes of genuine intellectual debate. Overcoming them is no easy matter and this amendment does not claim to be a perfect instrument. However, it is the best I have been able to achieve to date and at this point is substantially better than the alternatives. I beg to move.

    moved, as an amendment to Amendment No. 1, Amendment No. 2:

    Line 8, leave out ("and Analytical Psychology") and insert—
    ("() Analytical Psychology.").

    The noble Earl said: Sadly, I was unable to take part in the Second Reading debate so I shall take this opportunity to congratulate the noble Lord, Lord Alderdice, on bringing forward the Bill. When one is trying to help and to do good, it is always difficult to be buffeted around on all sides. I apologise to him for that but I am one of those people who are trying to make the Bill a little better. I certainly do not want to deter the noble Lord from pursuing the Bill in his discussions.

    It gives me particular pleasure to have my amendment supported by the noble Lord, Lord Clinton-Davis. For years, we were on opposite sides of the Dispatch Box hammering away at each other and it makes a pleasant change to be on the same side for once.

    I turn first to Amendment No. 1 which is a welcome step forward and a significant improvement to the Bill as it was at Second Reading. However, I believe that the amendment can be improved upon. My amendment seeks to make a separate modality for analytical psychologists who are the followers of Jung. We now start to enter what may be a very difficult and complicated area, and I shall try to keep it simple. Although I may err, I believe that it will be simpler for everybody to understand.

    It is common knowledge that Freud and Jung parted acrimoniously in 1913 and went their separate ways to form completely different theoretical bases for their approaches to analytical work. Jung moved away from Freud's biological determinism, as did Adler and Rank. But Jung transcended the theory of these biological forces and that led him to consider other forms of energy, apart from the sexual energy on which Freud focused, including power, nutrition and other forces. He looked at many metaphysical concepts and studied many cultures. His views accepted and embraced the complexity of human behaviour but not in the limited way that he believed Freud saw it. He also moved dream analysis into a different league. Perhaps a summary of his goals is best seen in the autobiographical Memories, Dreams and Reflections. Jung is not alone but his contribution is fundamental and unique.

    It is quite natural that out of the two different theories of Freud and Jung have evolved different techniques and institutions worldwide. At Second Reading the noble Lord, Lord Burlison, when talking about analytical psychology, said:

    "That is a branch of psychotherapy with a distinct and different training".—[Official Report, 19/1/01; col. 1354.]

    To force the followers of Freud and Jung some 80 years later to cohabit in the same modality is, I believe, unworkable and a recipe for disaster. If we look at the UK alone, the BCP and UKCP voluntarily split in 1992, only some nine years ago. I also say to the noble Lord, Lord Alderdice, that to lump them together in the same modality will create confusion in the mind of the public, who increasingly see analytical psychology and psychoanalysis as two discrete modalities, and that confusion will militate against the Bill's aim to protect and educate the public.

    I move away from the UK and look at the international scene for a moment. There are two international bodies: the International Psychoanalytical Association and the International Association for Analytical Psychology. To support my contention that these should be split in the UK, I quote the current International Journal of Psychoanalysis:

    "For the International Psychoanalytical Association: the term 'psychoanalysis' refers to a theory of personality structure and function and to a specific psychotherapeutic technique … based on and derived from … Sigmund Freud".

    That is not what the followers of Jung believe, and that is why they deserve and should have independent recognition. The noble Lord, Lord Alderdice, himself recognised that at Second Reading. He acknowledged at col. 1334 that the two disciplines were a divided profession. Referring to analytical psychology, at col. 1356 he said he appreciated that,

    "it would not help matters for it to be 'muddled in' with other things".

    I believe that there is a very strong case for keeping these two specialist modalities separate. They are different and should remain so. Given the huge differences in philosophy, education, training and therapy, surely what the followers of Jung and Freud have put asunder the noble Lord, Lord Alderdice, should not join together. I beg to move.

    5.15 p.m.

    I am delighted to speak in support of the amendment moved by the noble Earl, Lord Caithness. He is right that we have not always agreed I welcome him to the cause of progress—but I am genuinely delighted to be on the same side today. Although we have a difference with the noble Lord, Lord Alderdice, that does not mean that we do not want to come to a rapprochement with him; of course we do. The noble Lord has given me an assurance—I believe that the same applies to the noble Earl, Lord Caithness—that between now and the enactment, we hope, of a Bill such as this, he will enter into further dialogue with everyone concerned with this difficult matter.

    It is true that all the therapeutic modalities under the proposed umbrella see themselves as members of a healing profession and have its integrity and the interests of their patients at heart. With that, I suppose, there will be no dissent whatsoever.

    The Bill encompasses many diverse means towards the aim of mental and emotional healing. It is extremely important that they are all recognised and acknowledged in their own right. The proposed amendment seeks to do exactly that. It acknowledges and supports the wish of the practitioners of analytical psychology—the Jungians—to be a separate entity and not to be subsumed into a grouping together with the psychoanalysts and the psychoanalytic psychotherapists, whose theory, practice and training differs fundamentally from their own.

    The analytical psychologists are smaller in number, albeit world-wide. They do not feel that their interests or those of their patients would be best served in cohabitation with much larger numbers of practitioners who are not on the same wavelength.

    I make no value judgments in supporting the amendment; neither does my noble friend, on this occasion, Lord Caithness. I merely uphold the right of an important branch of the profession who perceive themselves to be different and who have a very different approach from psychoanalytic practitioners, to be recognised as such in the mind of the public—their potential clients—by according them an independent identity within a modality in their own right.

    I hope that the further discussions which the noble Lord, Lord Alderdice, has described will prove to be constructive and that the outcome will be helpful, because a rapprochement between the different sectors in this particular field is of the utmost importance. If it does not occur, the Government will tell the noble Lord, Lord Alderdice, where he can get off. Of course they will. I want to see the Bill, or something like it, eventually enacted, as does my noble friend, on this occasion, Lord Caithness.

    Although I believe that Amendment No. I is a real improvement to the Bill. I very much support the amendment moved by my noble friend Lord Caithness. He has put the case so clearly that, as a surgeon, I do not think I should muddy the waters any further. I support my noble friend.

    I congratulate the noble Lord, Lord McColl, on the brevity of his contribution.

    Perhaps I may present the Government's view on the two amendments. I congratulate the noble Lord, Lord Alderdice, on his achievement so far in shaping the proposals for regulating the profession of psychotherapy. He has done immensely valuable work in addressing most of the concerns of the different branches, or modalities, of psychotherapy. His amendment is very much at the heart of that attention to the concerns of the professions and it demonstrates his commitment to the better development and regulation of psychotherapy in its many forms.

    The noble Lord referred to 30 years of delay. I want to assure him and the Committee that the Government are in favour of better regulation of the psychotherapy profession. There is no doubt that that is needed. We are aware of cases of poor professional practice and also of cases involving the abuse of patients. Fortunately, such cases are rare, but we need to guard against them. I do support the principle of better regulation for psychotherapists.

    However, we have to consider the matter in the context of the Government's position on regulation generally, which was stated in the NHS Plan. We want to make regulatory bodies smaller and more strategic to home in on essential issues of public safety. We want them to be faster to respond when things go wrong, to minimise the risk to patients from unsafe professional practice. We want them to develop meaningful accountability to the NHS, where that is appropriate, and to the public, who are the users of the services. We also want regulatory bodies to develop common approaches to common problems. It is unfair and confusing to the public that professional malpractice can be handled in such different ways by the current different regulatory bodies. We are setting up the United Kingdom Council of Health Regulators to promote collaboration and a common approach by health regulators and to spread good regulatory practice.

    In that general context, I have to say that, well intentioned as the Bill is—it is very well intentioned—it is not the way that we would wish to go forward, in that it seeks to establish a free-standing statutory regulatory body for psychotherapists alone. We are committed to the regulation of psychotherapy but we do not think that a stand-alone Bill, even with this amendment, is the right way forward.

    It is worth recalling that the Health Act 1999 contained special powers to provide for regulation by order under that Act. That was done so as to provide a fast, responsive way of regulating health professions so that concerns about patient safety can be addressed as quickly and as sensibly as possible. It is faster both to set up such a body and to make any subsequent changes to it by using an order rather than an Act in this way. But the order-making power still allows for discussion of the issues during and after extensive consultation, with wide input from all stakeholders. I was interested in the comments made earlier by the noble Lord when he stated that the modalities he had proposed should not be seen as a list that would be complete for all time. Part of the problem of regulation in the past has been that, when such regulation has been established by Parliament, it has been difficult to put into place any necessary changes and flexibilities. That was the reason why Section 60 was introduced into the Health Act 1999. It allows for that flexibility.

    We need to discuss a second issue. Essentially, the Bill proposes to cover only a part of those engaged in this important area of healthcare provision. It is the intention of the Government to explore ways of regulating what has come to be known as all the "talking therapies", bringing them together under one body. I can assure noble Lords that it is our intention for officials of the Department of Health to discuss the concerns of psychotherapists, psychologists and counsellors over the coming months.

    Before my noble friend moves on to his next point, what will happen if he is unsuccessful in his efforts to secure a rapprochement between the Jungians and the Freudians? I hope that the contrary will be the case, but if he is unsuccessful, then what will be do?

    I should like to make two points in response to that question. If rapprochement could not be secured, the impact would as great if we were talking about the Bill as proposed by the noble Lord or if we were progressing along the route favoured by the Government; namely, a Section 60 order. It is clear that what is necessary is that we must build on the enormously valuable work already undertaken by the noble Lord, Lord Alderdice, to try to build consensus among the various modalities.

    Everything that we have learned over the past few years in the field of regulation demonstrates that, while the primary concern is the public interest—that must be our primary aim—equally, without ownership among the professions themselves, it is not going to work effectively.

    Before my noble friend moves on to his next point, could he clarify one matter? The point raised by my noble friend Lord Clinton-Davis surely ranges even wider? The interests of the public, which must come first, are surely primarily the interests of the patient. In that respect, we have today heard a plea for less action which pushes people into the same bed or onto the same couch and so forth. I addressed that point in my contribution on Second Reading, as did the noble Lord, Lord Alderdice. What benefit will be gained by insisting that counsellors be a part of this move, and what benefit would derive from presenting an order which cannot be amended in either House, given that it has been demonstrated, in the progress of this Bill, how much greater progress can be made in an area where delicacy and gentleness of approach are perhaps more important than tidiness?

    I shall respond by saying that, in relation to the desire to see the professions being regulated together, I believe that the NHS Plan sets out clearly why we need to break down barriers between different professions in the health field. Many advantages are to be derived from that. Examples are already in place in the draft order. A proposal has been put forward to establish the health professions council. That will be published as soon as possible. It is intended to bring together 12 professions, building on the professions already regulated under the Council for Professions Supplementary to Medicine. In an era when we wish to see consistency between the different professions, it is well worth considering whether the appropriate way forward here is to bring together psychotherapists, psychologists and counsellors.

    In relation to the order-making power, perhaps I may say to my noble friend that I believe distinct advantages may be gained because of the flexibility such an order-making power would give us to respond to changes that will take place over the years in professions and in public perceptions and expectations. The process of laying an order is extensive. In relation to the health professions council, which is a model, we have engaged, first, in extensive consultation with the stakeholders; there has then been public consultation. Following that, a draft order will be published for consultation. Only following that will an order, which has to be approved by affirmative legislation, be laid. I believe that that is an acceptable process. It allows for considerable debate and, at the end, it will allow your Lordships and another place to come to a view.

    So far as concerns the noble Lord's proposals to establish an education committee for each of the seven groups of modalities for psychotherapy, I fully support what one might describe as a "federated" approach which allows specific professional input where it matters into training and education issues. As we have heard, the modalities proposed by the noble Lord do not have the support of all the relevant groups. However, I believe that the approach he has taken is the right one. Certainly, the Government will want to build on that approach when we come to make more specific proposals in relation to regulation.

    Amendment No. 2, which has been brought forward by the noble Earl, Lord Caithness, and is supported by my noble friend Lord Clinton-Davis, meets the concerns of many analytical psychologists who wish to have their modality recognised separately from that of psychoanalytic psychotherapists, although my understanding is that some analytical psychologists would prefer to remain closely linked with psychoanalysts, as reflected in the amendment of the noble Lord, Lord Alderdice.

    In relation to this point, I hope that, as a result of this debate today and the discussions which will undoubtedly take place, it will be possible for the different groups to come together and to agree an appropriate way forward. Certainly so far as the Government are concerned, it would be our intention over the next few months to hold discussions with all of the appropriate professional groups to take forward the enormously valuable work that has already been undertaken.

    Perhaps I may pick up on two elements. First, as regards Amendment No. 2, I indicated that I would say something further when the noble Earl, Lord Caithness, and the noble Lord, Lord Clinton-Davis, had spoken. The example that they have given shows something of the complexity of dealing with such historical professional matters.

    Perhaps I may explain the picture as I understand it. There are those analytical psychologists—Jungians, as they are described after the name of their founder—who want a separate modality; they want, as it were, to paddle their own canoe. That view has been represented to me by a number of their organisations, in particular the Association of Jungian Analysts, the Independent Group of Analytical Psychologists, the Confederation of Analytical Psychologists and the analytical psychology section of the United Kingdom Council for Psychotherapy. In total those groups represent, by their own account, some 185 therapists.

    Then there are those analytical psychologist organisations which are associated with the British Confederation of Psychotherapists—that is, the Society for Analytical Psychology and the union division of the BAP. At the moment, they appear to be much less sure that they want to separate from their colleagues in psychoanalysis and psychoanalytic psychotherapy. They claim a membership of some 240 therapists. On those figures, they would appear to represent a majority in the union community.

    I am not interested in whether it is a question of majorities or minorities—that is not important—but it is clear that there is a division within the union community. It may be a division that can be resolved among themselves in time—it may not even be a long time; I do not know—but I did not enter into this legislation to create further divisions: there are more than enough already. The purpose was to try to bring people together. If Amendment No. 2 were to be accepted, whatever the numbers game, the effect would certainly be, not to reach agreement all round, but simply to have a different set of somewhat disappointed analytical psychologists.

    I fully accept that what we have proposed does not solve the problem. I am grateful to the noble Earl for his kind words in relation to the Bill as a whole, as I am to the noble Lord, Lord Clinton-Davis. However, I say to them that I have been in discussions, and l wish to continue those discussions, with the representatives of the different elements of analytical psychology and with the other groups to try to see whether we can reach some further understanding that will take us beyond this problem.

    I hope that on that basis the noble Earl may feel able to withdraw the amendment, because there are further implications to pressing that view. For example, the noble Lord, Lord Clinton-Davis, mentioned the position of psychoanalysis. It is not an entirely unified body. Freud is certainly the father; but most families have divisions in them even when they recognise the same father. The Kleinians take a different line from the Lacanians; and even among the Freudians there are divisions between the more classical approach and the more modern approach. So there are dilemmas.

    I may be wrong, but I do not really doubt that if the analytical psychologists had a modality of their own, psychoanalysts would then say, "In truth, we ought to have one, because psychoanalysis is something rather different from psychoanalytical psychotherapy". Then, one would quickly find that among the other modalities where some degree of compromise has been reached in bringing together different streams, they themselves would begin to say that what is sauce for the goose ought to be sauce for the gander, and that they, too, ought to have two, three or more modalities. All the work that we have been trying to do to bring together this somewhat fissiparous profession would begin to unstitch.

    I fully acknowledge the proper concerns that are pointed up by the amendment. But I appeal to the noble Lords to withdraw it, on the basis that we continue to work on the matter. I do not see my amendment as being the end of the story. I see it simply as a basis from which we can work. But it would be unhelpful simply to find ourselves unstitching all that has thus far been put together. We need to continue to work on it.

    Perhaps I may briefly respond to some elements of what the Minister said and perhaps respond more fully to it in relation to one of the other amendments. I am grateful to the Minister for his recognition that this is a piece of work that needs to be done and upon which we must build. I am encouraged that he talks about building on it over the next few months. Time passes, and other matters become priorities. I shall want to hold the Minister and his colleagues to the commitment that the work should be done over a relatively short period of time.

    I also welcome the Minister's comments about trying to build on the modality approach. We may want to return to this matter. I find it difficult to see how we can find another way of working. If we do, that is wonderful. But at least we have something on which we can begin to work and build.

    I welcome the responses and the considerable interest in these proposals and the constructive response of the Minister to date, although I want to pick that up a little further. I appeal to the noble Earl to withdraw the amendment at this point and we can continue to work together on the matter.

    I am grateful to the noble Lord, Lord Clinton-Davis, and to my noble friend Lord McColl of Dulwich for their able support for my amendment. Having heard the Minister's remarks, I must congratulate the noble Lord, Lord Alderdice, even more strongly than I did to begin with. The noble Lord, Lord Wedderburn of Charlton, put his finger on the pulse: if the Minister intends to use Section 60 of the 1999 Act, we do not have a hope of having a discussion anything like we have had this afternoon in this kind of atmosphere, constructively trying to get some agreement. We shall be presented with an affirmative resolution, which we either take or leave. We cannot amend it; and we shall not have any sort of sensible discussion on these issues. Indeed, what the Government decide will be forced upon us.

    By bringing forward the Bill and allowing for such discussion, the noble Lord, Lord Alderdice, has not only done this House and Parliament a huge service; he has also done the whole of the psychotherapy world a bigger service than I expected. I hope that the Minister will not kill the Bill too prematurely. I believe that this sort of discussion is extremely beneficial. It will also benefit the Minister's negotiations with the bodies concerned. They will be mightily confused because, after having talked to the noble Lord, Lord Alderdice, for so long, they will now have to face the challenge of having to talk to the Minister's civil servants.

    The reason for my amendment was confirmed by what the noble Lord, Lord Alderdice, said at the beginning of his remarks. He said that the results of the discussion of the sub-committee would be an authoritative word on the subject. When you have two bodies of the Freudian and the Jungian sets, if I may so describe them, that are divided—my division is more 50:50 compared with that of the noble Lord, Lord Alderdice; but that is immaterial—by such a longstanding philosophical split, I think that such a subcommittee offering the authoritative word will lead to many problems.

    In view of what the Minister said, I believe it would be quite wrong for me to press my amendment at this stage. The more discussion that can take place between now and a later stage—indeed, even at a later stage—the greater the benefit will be. I am so glad to note that we are all on the same side as regards trying to get a sensible solution to the problem. I wish the noble Lord, Lord Alderdice, well in his discussions before we reach the next stage. I beg leave to withdraw my amendment.

    Amendment No. 2, as an amendment to Amendment No. 1, by leave, withdrawn.

    On Question, Amendment No. 1 agreed to.

    moved Amendment No. 3:

    Page 9. line 27, at end insert—
    ("() The Education Committee may, where it deems fit, establish Advisory Committees in respect of particular patient groups or settings.
    () The Education Committee shall in the first instance give consideration to the establishment of Advisory Committees for—
  • (a) psychotherapy with children,
  • (b) psychotherapy within the National Health Service, and
  • (c) psychotherapy within the criminal justice system.").
  • The noble Lord said: My Lords, aside from the differences occasioned by different psychological theories and by the range of skills and procedures that may be brought to bear on psychological disorders and on their sufferers—we have already discussed something of the range involved—there are also differences occasioned by the varying settings and patient groups.

    As someone who has worked both inside and outside the NHS, I am aware of the special and more onerous responsibilities usually borne by NHS facilities and practitioners. This was a matter mentioned by the noble Lord, Lord Burlison, on Second Reading. Forensic psychotherapy is also practised in a setting—namely, the criminal justice system—which has very particular problems and requirements. Moreover, working with children is much more than just working with small adults. Indeed, working with young people is a specialism that is quite separate from that of working with children or with adults.

    Those reasons have led me to propose Amendment No. 3, which would open up the possibility of advisory committees dealing with particular groups, or settings. That would include psychotherapy with children, psychotherapy within the NHS and psychotherapy within the criminal justice system. These are not intended to be separate modalities with separate theories, and so on. In a sense, they are cross-cutting issues that bring together therapists from different backgrounds and modalities who might, nevertheless, be working with the same group of young people, people in the criminal justice system, or whatever.

    On Second Reading, the noble Earl, Lord Listowel, mentioned his own extensive experience in working with young people. I believe that both he and others in that field will be aware that those who work with young people do not necessarily do so in all the same modalities. There are some who come with group-work background; there are some who come with a humanistic background; and there some who come from a more psychoanalytical background. The proposal for advisory committees is an effort to try to help bring these cross-cutting issues together. They are not separate modalities but they constitute no less important differences. That is why I have opened up this new way of addressing them in the structure of the Bill. I beg to move.

    5.45 p.m.

    I speak in support of the amendment. It was my privilege some time ago to visit Bully House, Centrepoint's facility for homeless young people with high support needs; for instance, young people who self-harm or who have previously drifted from hostel to street to hostel. For several years a psychotherapist working with the staff as a group helped them to make sense of the troubling behaviour of their residents and the sometimes disturbing feelings that behaviour called up in the staff. Before and after my visit I heard from several practitioners in the field—workers with young homeless people—about how very good Buffy House was at preventing troubled young people returning to the street. I have met on several occasions one resident who was in the habit of harming herself. She still has crises but she is sufficiently recovered to exhibit and obtain commissions for her art work. The staff of Buffy House were recorded as taking the least sick leave of any within the whole Centrepoint organisation. They worked with its most challenging clients.

    I welcome the amendment because it provides the flexibility to include within this legislation innovative practice in different settings of the kind I have described.

    I, too, support the amendment which is a very constructive one.

    I welcome the amendment of the noble Lord, Lord Alderdice. The suggestion that advisory committees be established is a sensible one. However, in specifying the areas where committees should be established, is there not a danger of being inflexible and over-constraining the work of what in the end will be a self-regulatory body?

    I respond to the comments of the noble Earl, Lord Caithness, on the Section 60 process. At the moment I am examining Section 60 processes in relation to the Health Professions Council which includes professions such as physiotherapists and chiropodists. Great care is being taken to talk with the professions and to take them and consumer interests with us in this matter. I am sure that the process of having a draft order before an order is eventually laid allows for a great deal of discussion and for picking up some of the issues in relation to how much is put on the face of any proposal and how much is left to the self-regulatory body.

    I am grateful to the Minister for giving way. I do not dispute what he says. I well remember undertaking those consultations myself. However, when the measure comes to the Chamber, there is nothing we can do about it. Therefore, our discussion is limited. We have to accept what the Government have produced for us or else reject the whole order.

    I am not sure whether my noble friend has finally sat down. I address a specific point in his remarks. Words matter and this debate matters a great deal to the forward march of the proposals among those who are perhaps by custom prone to disagree. He said that the measure is too inflexible. I ask the following question which deserves an answer. How would the order be more inflexible than setting up advisory committees in regard to groups and settings? How would he be more flexible than that?

    I think that there is a great argument for flexibility in the arrangements, certainly as far as any Section 60 proposal is concerned. One might take the view that it should be left to the regulatory body itself to decide in the first instance which advisory group should be set up. That was simply my point.

    An interesting question has been raised both by the Bill and by the Minister's response in terms of the use of Orders in Council and, indeed, by the comments of the noble Lord, Lord Wedderburn of Charlton.

    In another setting, I have a measure of responsibility for legislation going through a unicameral assembly. That is also the case now in Scotland. We have increased the number of scrutiny opportunities, which were somewhat limited under the original Act. I suspect that we shall follow the good example being set by our colleagues in Scotland who have moved to pre-legislative scrutiny. It almost appears that a Private Member's Bill gives the opportunity for pre-legislative scrutiny of a possible Order in Council. What goes round comes round, as they say. I still want to hold the Minister to his promise that some measure will be brought forward.

    Perhaps I may press the amendment. The noble Lord, Lord Wedderburn, made this point. My amendment states that,
    "The Education Committee shall in the first instance give consideration".
    It does not state that such committees shall be formed but simply that the committee "shall give consideration". Why? It is perhaps a sad reflection on our society that only a small number of therapists work with children. Anxiety has been expressed on many occasions that in the hurly-burly of the psychotherapeutic world the interests and concerns of those who work specifically with children might have relatively little weight. Therefore the Bill requires that someone who has a qualification in child psychotherapy shall be on the education committee. That is to reassure the relatively small minority who work with children that they will have their say.

    The same argument applies to those who work in psychotherapy in the criminal justice system. Psychiatry in the criminal justice system is in a small minority. In Northern Ireland, during a period of serious civil trouble, there was no forensic psychiatrist let alone a psychotherapist. There is reasonable concern among those who work in relatively small specialisms. These provisions address that concern.

    Whereas in most health professions the overwhelming majority of practitioners are employed within the NHS and only a small number are employed outside, in psychotherapy the overwhelming majority of practitioners work in the private, community and voluntary sectors. Only a small minority of those who call themselves psychotherapists are employed within the NHS. Many others—doctors, nurses, psychologists and social workers—practise psychotherapy within the NHS. But most of those who fall within the remit of the Bill and who wish to describe themselves as psychotherapists work outside the NHS. The NHS is the specific responsibility of the Government and Parliament. That is why the concern needs to be addressed, although in the most permissive way that I could devise.

    I am grateful to noble Lords for their thoughts and responses. I commend the amendment.

    On Question, amendment agreed to.

    Clause 11, as amended, agreed to.

    Clauses 12 to 43 agreed to.

    In the schedule:

    moved Amendment No. 4:

    Page 31, line 14, at end insert—
    ("() One of the persons appointed by the Privy Council under sub-paragraph (1)(b) above shall be a trained counsellor in good standing.").

    The noble Lord said: In moving the amendment, I speak also to Amendment No. 5. At this late hour of the evening, perhaps we can group the two amendments together, particularly since Amendment No. 5 is relatively technical. At Second Reading, the issue of whether psychotherapy should best be regulated by itself or in conjunction with other professions was raised. The Minister has directed himself to that issue today.

    On Second Reading, the noble Lord, Lord Burlison, seemed to suggest that bunching psychotherapy in with the new health professions council might be the best way to address the problem. I have read and reread the noble Lord's comments. He referred to effectiveness of treatment, which is a separate issue that has nothing to do with regulation. He also referred to the practice of psychotherapy by a range of other professionals. Again, that is not a matter to which the Bill refers. He also expressed the view that at certain levels there is no difference between counselling and psychotherapy, which will attract the bristles of psychotherapists and counsellors at various levels. As a professional, I felt some confusion about that response. I have listened with some interest to what the noble Lord, Lord Hunt of Kings Heath, has said.

    After Second Reading, I was contacted by the Society of Chiropodists and Podiatrists, who understandably were not wholly taken with my reference to their work. They entirely agreed that a one-size-fits-all health professions council was not a practical proposition. I wonder whether one reason that we still do not have regulation after 30 years is that we have tried to put too many things together. I have been accused of that this evening, so I recognise that the Government face a difficult dilemma.

    I accept that there are shared borderlines and professional interests. Amendment No. 4 would ensure that counselling was represented on the general psychotherapy council. It is not a solution to the problem, but a demonstration of my recognition that the borderline between counselling and psychotherapy is difficult to define and that there is a real need to take into consideration the range of professions, as the Minister said. I do not turn aside from that.

    On Second Reading, the noble Lord, Lord Burlison, made much of the range of those involved in talking therapies and the relationship between them. I accept that. Amendment No. 5 is a tidying-up amendment consequential on the reference in paragraph 11(1)(a) of the schedule only to the Royal College of Psychiatrists and the Royal College of General Practitioners. That shows that the aim of the Bill is to bring people in, not to exclude them.

    I accept that a number of bodies outside those specific to psychotherapy have an interest in the issue. As the Minister has said, it may be that the need for regulation of psychotherapy can be addressed along with the need for regulation of psychology and ultimately of counselling, although I do not believe that counselling is yet ready for the regulation that psychotherapy and psychology now need. I hope that the Government will recognise that not all of that needs to be done at the same time. We may be able to capitalise on some progress, bank that and then build on it.

    I do not doubt the commitment of the Minister and the Government to regulation in psychotherapy, if for no other reason than that this Government have as great a leaning as any in recent times towards the regulation of most things. However, that does not mean that they will be successful or that they will do it in the best way possible. I am encouraged by the Minister's comments about consultation and commitment and by the fact that he envisages early movement, not a dilatory approach. I beg to move.

    6 p.m.

    I am grateful to the noble Lord for his comments. I confess to him that I am responsible for better regulation in the Department of Health, which is a process designed to see what regulations we can drop to reduce the burdens on industry. I await with great interest his comments on our record on regulation.

    I firmly believe that we should build on the noble Lord's valuable work. The regulation of psychotherapists is important and should be pursued. We also need to assess progress in relation to the other professions that the noble Lord mentioned. Discussions are needed about where and how it is best to regulate the professions, whether they should be brought together in one body and, if so, how. That is the next matter that needs to be discussed with the professions.

    We need to address the concern, which is common in the NHS, that the majority of effective psychotherapy may be provided by professionals who do not call themselves psychotherapists. The noble Lord rightly said that whatever mechanism is chosen, one has to accept that not every profession will march to the same timetable. Flexibility is needed to pick up professions when they are ready for regulation.

    My interpretation of the Bill and the composition of the general council is that six lay members will be appointed by the Privy Council, although one of those members will be a medical practitioner. The amendment would mean that a second professional, a counsellor, would be appointed. I understand and support the noble Lord's reasons for saying that it would be useful if a person such as a counsellor served at the general council. However, with regard to regulation more generally, we are seeking to have an overall majority of one among the lay membership. That approach has been adopted in relation to the Central Council for Nursing, Midwifery and Health Visiting and the health professions council. We shall need to deal with that matter in our more detailed discussions in the coming months.

    I welcome the Minister's response, and in particular his comments on everyone not having to move at the same speed and his commitment to the process of regulation. I fully accept his comments on the relative lack of lay representation in this regard. That point was made on Second Reading by the noble Lord, Lord Hodgson, and correctly so. I sought to address the problem but realised how many consequential amendments would have been required to fill out all of the numbers. Members of the Committee would not have thanked me at this hour on a Wednesday evening if I had brought forward all of the necessary consequential amendments. I accept I he Minister's comments and I do not doubt that they will be an important component in forthcoming discussions.

    I welcome the Government's response. I promise that my colleagues and I will hold the Minister and the Government to the relevant commitments. If there is a small way in which I can continue to assist in the regulation of the profession, which is in many ways a governmental rather than a parliamentary responsibility, I look forward to our continuing to work together. I beg to move.

    On Question, amendment agreed to.

    moved Amendment No. 5:

    Page 31, line 15, leave out first ("the") and insert ("a").

    On Question, amendment agreed to.

    Schedule, as amended, agreed to.

    House resumed: Bill reported with amendments.

    House adjourned at five minutes past six o'clock until Monday, 26th February.