NHS Resolution now covering claims against GPs: Possible benefits to patients
The professional standards for both UKCP and BACP members are having a revamp; are they clear, understandable and fit for purpose?
The UK Council for Psychotherapy (UKCP) has recently put a revised draft Code of Ethics out for consultation. This is the proposed new guidebook that will set the standards for UKCP members in their clinical work as well as in their personal lives. The consultation ends on 7 September 2018 and the new Code will likely come into force later this year, where after counsellor and psychotherapist members of the UKCP will need to know and comply with its terms. The revised Code warns that UKCP members “should be able to give an appropriately evidenced account of how they work with [the code] as part of their commitment to ethically-informed, ethically-aware practice”. Failure to comply will leave members vulnerable to complaints and to fitness to practise investigations with all the professional, reputational and personal consequences that often flow.
The British Association for Counselling Psychotherapists (BACP) is further down the road on its journey in preparing a new set of professional standards; its Ethical Framework for the Counselling Professions 2018 came into effect on 1 July this year. As with the Code of Ethics for UKCP members, the BACP Ethical Framework declares the standards applicable to BACP members and is the BACP’s main frame of reference when considering professional conduct complaints.
The standards have been updated to keep a pace with developments in the general law; in the UKCP Code, new sections have been added or beefed up on the duty of candour, consent, safeguarding, advertising, use of social media, conflict of interest and the acceptance of gifts. Similarly, changes to the BACP standards include a redefinition of the definition of candour, new sections on counselling skills, confidentiality and working in teams and updated sections in relation to gender identity, record keeping and consent in relation to children and young people. So far so good…
Both of these new rule books have fallen into the same trap: introducing a multi-layering of obligations of varying granularity and applicability, resulting in an over complicated set of rules, with insufficient clarity on the interplay between the different parts and how compliance might therefore be achieved.
Most regulatory or membership bodies, from the GMC for doctors, to the SRA for solicitors, produce a professional code applicable to the profession(s) it regulates. For some years now these codes have tended to follow a similar format: they set out the principles for members to observe, underpinned by more detailed standards, often in the form of a list of ‘do’s and don’ts’, to assist with the interpretation and practical application of the principles. By way of example, the GMC’s Good Medical Practice contains the high level principle that doctors should “show respect for patients”, and then sets out a detailed standard which sits under this Principle, explaining how the principle of respect is to be observed in practice, for example stating that doctors “must not use [their] professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them”. This approach, adopted by most regulators in across all sectors, enables practitioners to understand what is required of them and therefore be in the best position to uphold the high professional standards expected of them (and thereby avoid complaints).
Where a complaint is made against a regulated professional, the regulatory authority will consider whether the conduct complained of indicates that there may have been a breach of any of the principles and the standards set out in their code. Any allegation that is subsequently brought against a member usually mirrors the format of the code: alleging first that a practitioner has failed to comply with a principle and then going on to set out the particulars of the alleged misdemeanour by reference to the more granular standards that sit beneath the high-level principles.
Do the UKCP Code and BACP Frameworks follow this tried and tested model, thereby ensuring that their respective members know what is expected of them? Almost, but not quite.
The UKCP draft code gets off to a promising start, setting out the seven new overarching principles that it expects practitioners to honour and uphold, these being:
There is nothing particularly controversial about any these, although Human Rights and Social Justice sits a little uncomfortably in a list of (otherwise uncomplicated) desirable qualities. It is what follows that creates the real confusion. The Code goes on to list the detailed standards which members must comply with, all grouped under entirely different sub-headings to the principles listed above. These more specific, directory standards are described as Ethical Principles and include:
Under these various headings, there are 54 paragraphs of detailed requirements. Few of the standards are intrinsically controversial (although some are new – see above), but the failure to directly link the Principles to the standards makes the draft Code unnecessarily cumbersome. How is a practitioner to put into practise the principle of benevolence? Is being kind demonstrated by acting in the best interest of patients? Not always, consider the patient who needs to hear an unwelcome formulation: best interests would dictate providing this information to the client, benevolence might militate against it.
The layout and nomenclature of the BACP’s Ethical Framework is even more confusing. The Ethics section contains 11 values and six principles; the difference between them is far from clear. The Framework rather confusingly states that the values “inform principles” and that values “become more precisely defined and action-orientated when expressed as a principle”. Things might have become clearer were the principles in fact to have been more “precisely defined” than the values; quite simply, they are not and the interplay between them is impossible to divine.
To demonstrate the potential for confusion, look at the following statement and see if you can decide which statement is a value and which is a principle:
1. Autonomy. Respect the client’s right to be self-governing;
2. Facilitate a sense of self that is meaningful to the person(s) concerned within their personal and cultural context.
The answer: statement 1 is a principle and statement 2 is a value. Is it just me, or could it easily be the other way around?
To make matters worse, the BACP Framework then proceeds to set out 13 ‘personal moral qualities’. These seem to be yet another way of expressing the values and principles, albeit in a subtly different way. For example, whilst “commitment to being moral in dealings with others, including personal straightforwardness, honesty and coherence” is a personal moral quality, it looks an awful lot like “being trustworthy”, which is a principle.
Absolutely: for practitioners to be properly conversant with their professional standards, they must be able to read, understand and implement them. The BACP Framework and the UKCP Code are intrinsically difficult to follow; the interplay between the different layers of requirements is unclear and unnecessarily labyrinthine. Given that these are the standards against which a practitioner’s practice will be judged if a question arises about their conduct or competence, they should be expressed in plain English and, preferably, as a single list. Separating the standards into values, principles, qualities etc. inevitably leads to duplication and confusion.
It is just a shame that the sensible and commendable standards within these documents are somewhat lost in the confusing terminology and structure.
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