Wednesday, 27 January 2021

Consultation on the future shape of the Accredited Registers programme

 Below is my response to the Professional Standards Authority consultation. A future post will discuss the Accredited Registers scheme in more depth. It helps to read this first.


Question 1: Do you agree that a system of voluntary registration of health and social care practitioners can be effective in protecting the public?

For certain occupations, yes. It really depends on how committed occupations, individual registers and their members are to public protection. If (most) registrants are employed or contracted, the ethos of their employers can have a strong influence on the occupation and associated registers.

However, experience suggests that some registers, at best, pay lip service to public protection whilst some of their members undermine public health etc. Experience suggests that even when this is pointed, some registers fail to take concrete steps to address problems. In some cases, it may be due to the register itself, in other cases it has to do with the nature of the occupations they represent.

Question 2: How do you think the Authority should determine which occupations should be included within the scope of the programme? Is there anything further you would like us to consider in relation to assessing applications for new registers?

There is a need for more concrete definitions of what health and social care are. Legislation is somewhat vague and may need to be changed. There are arguments that some existing registers cover occupations that are not health care, even if registers and practitioners represent their occupation as such.

There can be problems with occupations that are vaguely defined and/or whose members practice adjunctive therapies yet see them as part of their occupation. Ideally, an occupation should have a clearly defined scope of practice or at least there should be a strong consensus within the occupation as to what it is.

Some Complementary and Alternative Medicine (CAM) occupations are particularly problematic in terms of vagueness; they use aphoristic and even metaphysical (vitalistic) language to describe themselves. Plain english it is not. This can also apply to some fringe psychological therapies.

Colonic hydrotherapy likely should not have been included for various reasons. Whilst enemas are used in clinical settings by clinicians, the clinical indicators are very clear and limited. However, non-medically qualified practitioners can not make the determination. Carried out by non-medically qualified practitioners, they are often associated with the discredited autointoxication theory. Klismaphilia is also a concern. In some jurisdictions, colonic hydrotherapy by non-medically qualified practitioners is prohibited. In others, the sale of equipment to them is prohibited.

That a therapy has a legitimate clinical use can not be the sole reason for it to be regarded as a health care occupation for non-medically qualified practitioners.

There are questions about massage therapy as well. Massage therapy can be used in a physiotherapy context, especially in rehabilitation, but it can also be used for pleasure/relaxation. It is understood that from the view of existing registers, admission is based on education and training.

Yoga therapy is questionable too. Structured exercise programmes are a core part of physiotherapy and there are physiotherapists who use yoga but they tend not to invoke “chakras” etc.

Some of the procedures used by non-medically qualified practitioners of non-surgical cosmetic treatments may be used by clinicians for justifiable medical reasons, although those reasons are often not cosmetic. For example, Botox injections can be used to control muscle spasticity.

The legality of supply of substances/devices used in some occupations is concerning. Whilst regulators like the MHRA may be indifferent to the supply of unlicensed medicines or the use of unapproved medical devices by non-medically qualified practitioners, they are concerned about the supply of prescription only medicines, medical devices of certain classes and the marketing of services involving such. Official tolerance of the legally questionable activities of some occupations should not be seen as providing a reason for recognition.

It is interesting to note that there are no Herbalism registers, nor are they accepted by either of the CAM umbrella registers.

Question 3: Do you think that moving from an annual to a longer cycle of renewal of accreditation, proportionate to risk, will enable the Authority to take a targeted, proportionate and agile approach to assessment? Do you think our proposals for new registers in terms of minimum requirements are reasonable?

A move to a longer cycle of renewal does make sense for certain well run ARs, as long as the Authority retains capacity to deal with any major developments that might occur with these registers.

Obviously, the Authority will maintain “in cycle” monitoring of such ARs. It may be sensible to require these ARs to supply some sort of annual update to the Authority. The “Share Your Experience” process may need to be changed.

There is a concern that it could lead to uneven income for the Authority. Uneven income could lead to an uneven approach to risk. This could be mitigated by a phased introduction and aligning renewal dates in such a way as to guarantee a regular income stream as well as potentially building reserves.

Minimum standards for new ARs are not unreasonable but there are concerns that some potential ARs might move very slowly and 12 months may be insufficient for them to potentially enact radical change. Of course, introducing pre-application assessment etc might mitigate some of that. Ideally, prospective ARs should think long and hard about applying for AR status and initiate a programme of change to align with Standards well before making a formal application. Unfortunately, not all registers have good strategic planning and direction.

Question 4: Do you think accreditation has been interpreted as implying endorsement of the occupations it registers? Is this problematic? If so, how might this be mitigated for the future?

It’s not even a question of “endorsement”. Accreditation is recognition of certain occupations as health and social care occupations. It is recognition of registers as being related to health and social care. For fringe occupations, the recognition that accreditation gives is a big deal. This is probably even more so for ARs that represent a single occupation and see promotion of the occupation as a major part of their role.

There is also the problem of recognition of an occupation being seen as recognising all the practices (bar adjunctive ones) carried out by that occupation even if they are questionable. Whilst the Authority may insist that (prospective) ARs prohibit such practices (CEASE therapy, anti-vaccination and gay conversion therapy are obvious examples), that will not be immediately apparent to the public.

Question 5: Do you think the Authority should take account of evidence of effectiveness of occupations in its accreditation decisions, and if so, what is the best way to achieve this?

This is a complex area. The criteria discussed in 4.11 could form a reasonable basis for accepting occupations without the need for copious evidence of effectiveness. However, two items are of concern -

d. The occupation or role is used independently by the public to support their health and wellbeing

If the occupation does not meet any of the other criteria, greater evidence of efficacy should be required. Again, CAM and certain fringe psychological therapies are the main source of worry.

f. Government and/or other public authorities support its inclusion in the programme.

On the face of it, this is not unreasonable. However, there are concerns that Government might ask the Authority to recognise an occupation that has no/little evidence of efficacy because it is seen as politically popular. Government might also view Accreditation as an alternative to legislation and statutory regulation when they might be warranted.

It is noted that the evidence of efficacy of occupations may vary considerable in its form. Social care is not amenable to RCTs and “placebo” social care would be unethical even if possible. But there is much academic literature, benchmarking of services and so on.

There can be a gap between claimed efficacy and evidence of efficacy. The bigger the gap, the greater the risks posed to the public.

Requiring some (prospective) ARs to submit a report outlining the evidence base for an occupation would be preferred over a “knowledge base”. It may prove a useful exercise for ARs anyway. There are concerns that some ARs lack the ability to understand let alone evaluate evidence. This can be seen in the cherry picking of favourable evidence (generally of poor quality) and the select ignoring of evidence of lack of efficacy.

It is suggested that the Authority use an external panel of experts to evaluate the evidence base presented. Unless the Authority anticipates many new applications, developing in-house resources may be wasteful.

It is anticipated that if the Authority chooses to evaluate evidence of efficacy, regardless of how it chooses to do so, if ARs and their members do not like the results, there will be accusations of bias, mention of “Big Pharma” conspiracies and so on. Some CAM practitioners take the view that only practitioners understand the occupation and sometimes state that others are unqualified to make judgments about efficacy. This is a ludicrous assertion.

Evidence may also have a role to play in defining scope of practice. There is for example NICE guidance on the use of specific therapies for certain conditions. For example, Vega Machine (a “bioresonance” machine), Hair Mineral Analysis and Applied Kinesiology are all do not do for the diagnosis for allergies. Whilst NICE guidance is not mandatory, completely ignoring it should be viewed in a negative light.

Question 6: Do you think that changing the funding model to a ‘per-registrant’ fee is reasonable? Are there any other models you would like us to consider?

One problem with a per-registrant fee structure is that it does not reflect “work done” by the Authority in terms of dealing with an AR and it is known that some ARs necessarily create more work and cost than others. Larger/less problematic ARs would be, in effect, subsidising other ARs - but that would like apply to most other potential fee structures as well. A move to longer renewal cycles for less problematic ARs might mitigate that to an extent, if charged a renewal fee rather than an annual fee.

Any fee structure that the Authority implements must be transparent. Some ARs are very small and have limited budgets. A move to per-registrant fees would benefit them but even so, they likely still need to have a good idea of costs. A per-registrant fee might encourage some smaller registers to apply for accreditation.

It is noted that the Authority has mentioned pre-assessment fees that takes into account register size and number of professions covered.

A fee structure that was partly based on occupation sector could be justified if a particular sector, say CAM, generates more work for the Authority compared to others.

Question 7: Do you think that our proposals for the future vision would achieve greater use and recognition of the programme by patients, the public, and employers? Are there any further changes you would like us to consider? 

Possibly but it will take some time and unless there are changes to legislation, some elements of the vision can not be realised.

It may also be the case that some occupations currently included in the programme would have to undergo radical transformation or be excluded. The Authority may end up de-recognising the certain CAM occupations for example.

There is also the risk that Government may choose to statutory regulate counselling and psychotherapy.

Question 8: Do you agree that to protect the public, the Accredited Registers should be allowed to access information about relevant spent convictions?

This would require a change to legislation. There are concerns that some existing ARs are very amateur and may not have sufficient data protection measures in place.

Question 9: Are there any aspects of these proposals that you feel could result in differential treatment of, or impact on, groups or individuals with characteristics protected by the Equality Act 2010?

Not really. It is possible that some practitioners might feel that changes may impinge on their belief systems but those belief systems do not have the status of religious beliefs. Nor is there any occupation or AR that is tied to a particular religious belief. Membership of the UK Board of Healthcare Chaplaincy is open to all religions and even the non-religious. The Association of Christian Counsellors is non-denominational.

Very bad times for the Society of Homeopaths

Something very bad has happened to the Society of Homeopaths (SoH). The Professional Standards Authority (PSA) has suspended their Accredited Register status for twelve months and it is very unlikely it will ever get it back.

This has been coming for a while

Panel Decision

The decision may be written in temperate languagee but is hard hitting nonetheless.

The PSA suspended the SoH because a Panel judged that they had failed to meet two Conditions with a deadline of 21/10/2020. Those conditions were -

  • Condition One: The Society must ensure that its recruitment processes include appropriate due diligence checks to assure itself that applicants are, and have been, in compliance with the Society’s Code of Ethics and position statements, including those relating to the use of social media. This should apply to all paid and voluntary positions within the Society including Board and staff members. The Society should also ensure that it has processes in place to assure itself that officials of the Society remain in compliance after appointment. The Society must report to the Authority on the steps it has taken to comply with this condition within three months of the date of notification.
  • Condition Two: The Society must provide the Authority with its policy for the escalation of complaints against registrants, which are initially handled informally, into its formal processes and its procedures for handling persistent complainants. The Society must also provide a summary of complaints received since the publication of its new position statement on 10 June 2020 (including those handled through an informal route) and outcomes to the Authority. This should be completed within three months of the date of notification.

Condition 1 on the face of it should have been easy to meet, yet the SoH struggled. 

3.2 The SoH had provided updated recruitment policies and processes, and undertaken checks to assure itself of previous applicants’ compliance with its Code of Ethics and position statements. However, it was not clear how it intended to assure itself of compliance by staff and Board members on an ongoing basis which is particularly relevant as the SoH appoints practising homeopaths to these roles. Further, the ‘due diligence checks’ appeared to focus narrowly on social media. 

3.3 Given that the recruitment of the Professional Standards and Safeguarding Lead without appropriate checks was a serious oversight, this did not give sufficient confidence that the SoH would focus on public protection in its future recruitment and ongoing oversight of staff and Board members. 

The SoH has a history of interpreting things very narrowly and not considering broader issues. The PSA has criticised the leadership of the SoH before in terms of sticking to the literal word of instructions rather than the spirit of them. The SoH are not proactive in anticipating what the PSA might ask for next.

Condition 2 also looks fairly easy until you realise simply complying with the letter of the condition wasn't what this is about.

3.4 The SoH provided us with its policy for the escalation of complaints against registrants, which are initially handled informally. Although the policy had greater reference to social media, the Panel did not think that the policy made clear how concerns of a serious and/or complex nature would be handled with sufficient scrutiny and oversight. The SoH also provided its policy for handling Frivolous, Persistent and Vexatious complaints. The Panel was concerned that neither policy demonstrated how adequate focus could be assured on public protection above professional interests, and that this risked concerns not being handled in line with the Standards for Accredited Registers. 

3.5 The information provided by the SoH about its handling of complaints since June 2020 indicated that it did not fully recognise the risk to patients and the public from misinformation on registrants’ websites, and that it had not provided complainants who raised concerns of this nature with clear information about how they were being addressed. Also, while some steps had clearly been taken to contact registrants, and references to CEASE had been removed, the SoH’s response indicated that it found references to homeopathy treating autism as acceptable. 

3.6 Examples of registrants’ websites reviewed appeared to promote homeopathy as being able to treat conditions that require medical supervision, such as depression, autism, hyperthyroidism, and arthritis. The SoH’s evidence of monitoring indicated that these websites had been checked and determined to be compliant with its requirements. This raised a concern since the ASA’s guidance (which is set out as a requirement in the SoH’s Code of Ethics) clearly says that those practitioners who are not medically qualified should not refer to serious medical conditions.

3.7 As part of its own checks, the Authority asked the SoH about a concern which had been raised about the website of a practitioner listed as a SoH registrant. The SoH advised that the practitioner had been a former registrant but had resigned in 2017. The SoH corrected its register so they no longer appear as a registrant, and advised that it is carrying out checks to ensure that no similar issues remain. We would expect these issues to be fully resolved by the end of the period for suspension.

3.8 The response by the SoH to the complainant who had originally raised the concerns was brief and referred only to the Authority’s Conditions rather than actions it was taking to consider the concerns. Although the SoH highlighted that its procedures place it under no obligation to inform a complainant of an outcome, the Panel did not think its approach was transparent or would promote confidence in the occupation it registers.

The SoH's processes for dealing with concerns and complaints are complicated. The SoH gives itself many ways to reject concerns and complaints. Note the dates at which the various parts were updated - they changed during the period under consideration. Whilst it would be inappropriate to discuss details of concerns/complaints that might still be in process, it is known that some of them have nothing to do with claims made on websites. Some very serious issues about unethical practice and dishonesty have been raised with SoH but it fails on so many fronts to deal with what are fundamental issues. 

It's interesting to note that the SoH's auditing of member online content was a concern. It is known that when non-compliant content has been brought to the attention of the SoH, often nothing happens. Often it is unclear why but the above suggests that the SoH simply do not recognise (certain types of) non-compliance. Whether this is down to the individual(s) carrying out the audit or due to instruction from SoH leadership is unknown. The overall effect is that any trust the PSA might have had in the SoH to carry out audit itself is eroded.

To be very clear, the SoH have not treated the issue of member marketing having the potential to encourage clients to seek homeopathic treatment rather than medical treatment for certain conditions seriously. They have placed member interests before public health.

Standards

In looking at whether the SoH had met the conditions, the Panel found that the SoH did not meet six of the eleven Standards for Accredited Registers. Some of the Standards have sub-parts.

  • Standard 2: The organisation demonstrates that it is committed to protecting the public and promoting public confidence in the occupation it registers.
  • Standard 3a: Has a thorough understanding of the risks presented by their occupation(s) to service users and the public – and where appropriate, takes effective action to mitigate them.
  • Standard 3b: Is vigilant in identifying, monitoring, reviewing and acting upon risks associated with the practice of its registrants and actively uses this information in carrying out its voluntary register functions.
  • Standard 5: The organisation demonstrates that it has the capacity to inspire confidence in its ability to manage the register effectively.
  • Standard 7a: Ensures that the governance of its voluntary register functions is directed toward protecting the public and promoting public confidence in the occupation it registers.
  • Standard 8a: Sets, requires and promotes good standards of: − personal behaviour − technical competence, − business practice (including, as appropriate: financial practice, advertising, customer service, complaints handling, work premises / environment, management and administration).
  • Standard 11a: Provides clear information about its arrangements for handling complaints and concerns about a) its registrants and b) itself.
  • Standard 11b: Encourages early resolution of complaints including use of mediation where appropriate and it has adequate monitoring arrangements in place to identify matters that require disciplinary action.
  • Standard 11d: Focuses on protecting service users and the public where necessary and putting matters right where possible.
  • Standard 11e: Makes sound decisions that are fair, transparent, consistent and explained clearly.

It isn't clear if the Panel considered whether the SoH met other Standards.

Suspension

Current guidance says -

7.6 In cases of serious or ongoing concerns, a Panel may determine that accreditation of a register should be suspended. This is to allow the Register opportunity to address concerns, whilst ensuring transparency that a Register does not meet the Standards of Accreditation. In this situation, a Panel has determined that the concern is so serious that a Condition would not be sufficient to mitigate risk. Examples of this are: 

a. Where a Condition has been found by a Panel not to have been met, without sufficient justification, but where it is considered that the Register should be allowed a final opportunity to address the concern within a set timeframe to avoid accreditation being removed. This will include instances where concerns have been repeatedly raised by not addressed. 

b. Where there is an immediate patient safety risk or actions by a Register could bring the programme into disrepute. This could include failure to take action against registrants that are in contravention of its requirements, and/or where there are clear breaches of the law.

c. Instances of suspected malpractice or dishonesty by the Register where the Register has not provided adequate explanation. 

d. Where an organisation is unable to fulfil its core duties and requirements for eligibility as an Accredited Register, such as through organisation or financial issues which prevent its operation.

Certainly a and b apply to the SoH. 

Suspension is very much a last chance for the SoH. It probably doesn't warrant a last chance but some have suggested that removal might have triggered legal action, which neither party can afford. Some others have suggested that the PSA could have been subject to political pressure or at least be mindful of the potential. On the other hand, it resisted pressure from NHS England to remove accreditation back in 2019.

Whilst suspension is humiliating, it is unlikely to have much direct effect on the SoH and its members. It's not as if accreditation brings in business for members. As far as is known, it hasn't lead to increased numbers of referrals from GPs. Nor has it lead to clients chosing SoH members over other homeopaths - public awareness of the Accredited Registers scheme is very low.

It is worth pointing out that if serious concerns are raised about the SoH during the period of suspension, the PSA can consider removing accreditation. 

Conditions

The PSA have set out Conditions that the SoH must meet if they want to regain Accreditation.

4.6 The Panel agreed that the SoH would need to meet the following Conditions for suspension to be lifted:
1. Demonstrate that it has sought as far as reasonably possible to ensure compliance of its registrants with its Code of Ethics (including Advertising Standards Authority (ASA) requirements), and position statements over a period of at least six months. As part of this the SoH must demonstrate that it has taken action to identify and address instances of non-compliance, to the satisfaction of the Authority.
2. Ensure that it has appropriate separation in place between its functions of protecting the public and supporting professional interests. A clearer focus on public protection must be reflected and applied through its key functions, including:
a. Governance
b. Setting of standards
c. Complaints handling 
d. Provision of information by the SoH to the public.
3. Demonstrate through these arrangements and its decisions that it has a clear focus on public protection when considering matters related to the practice of homeopathy by its registrants.

4.7 Whilst we would expect the SoH to consider the points raised in this and earlier reports to satisfy these requirements, it should not limit itself to these. Fully addressing the points above will require the SoH to reflect on how it can demonstrate a focus on public protection, as required to meet the Standards for Accredited Registers and in doing so it might identify further actions.

Explicit mention of ASA guidelines is an escalation. Previously, the focus had been on member advertising complying with the SoH's position statements, which have a narrower focus on CEASE therapy and anti-vaccination misinformation. 

ASA advice on homeopathy and Guidance for Advertisers of Homeopathic Services represent a much tougher line and the latter dates from 2011! Homeopaths have a long history of antipathy towards the ASA. The SoH has provided confusing guidance to members in the past. It also has online training modules about advertising but as the PSA noted, they haven't any great effect.

Conditions 2 and 3 are very, very hard. Asking for changes to processes and organisational structures is one thing but the PSA are asking the SoH to change its culture. 

Reaction

The SoH released a statement. This is odd.

Since July 2020 the Society has been working towards meeting a number of conditions laid down by the Authority following an In-Year review of its accreditation. Evidence of compliance with some of the conditions was due in February 2021 but as a result of an interim internal panel review of the Society’s progress on those due in October 2020, the PSA decided its accreditation should be suspended. The Society is disappointed it was not given the full term to February 2021 to meet the conditions as it was confident it could do so and frustrated that the Authority’s panel and report made no allowance for the additional and incredibly challenging circumstances that Covid-19 presented at the same time as dealing with the new conditions. The Society has now been given a 12-month window in which to meet the PSA requirements and have its accreditation reinstated.

If the SoH thought that they were going to struggle with October deadlines, they could have appealed the panel decision that imposed them. They did not. As for the other conditions, evidence suggests that the SoH were nowhere near meeting them. 

Curiously, there has been little obvious reaction from members and their supporters. It is possible that there is much wailing and nashing of teeth in private online spaces. It may be the case that members simply do not care. The few visible responses tend to reveal a lack of understanding of what the Accredited Registers scheme is about. For example, one homeopath suggested that the SoH hadn't fought hard enough against the PSA and should take them to court. It is noted that there has been a drop in SoH membership but it's difficult to determine why members have left. There is no obvious sign of members resigning because accreditation was been suspended.

The Good Thinking Society (GTS) issued a statement as well and there was also a piece in the online Skeptic magazine. Both are written by Michael Marshall. From the Skeptic piece -

The PSA’s review also looked at the SoH’s handling of complaints regarding their registrants, finding that the SoH did not recognise the risk to patients and the public from misinformation on their registrants’ websites. While some steps had been taken to contact registrants over their claims, and references to the bogus CEASE therapy had been removed, the SoH’s response indicated that they found no issues with homeopaths claiming that homeopathy could treat autism – even when those references were being made by the homeopaths who had previously claimed to be able to cure autism via CEASE therapy. In a particularly damning line, the PSA found that they were not confident that complaints would be handled in a way that prioritised protecting the public over protecting the professional interests of the homeopaths.

The SoH had been charged with actively monitoring their registrants’ websites to find and correct any misleading claims. In the evidence they submitted of their monitoring effectiveness, the PSA found examples where homeopaths continued to promote homeopathy to treat depression, autism, hyperthyroidism, and arthritis, even after the SoH’s intervention. The SoH had checked these websites, and had determined these claims were compliant, even though they breached Advertising Standards Authority guidance – guidance the SoH’s own Code of Ethics makes clear must be followed. Either the SoH were incapable of recognising claims that were in breach of advertising rules, or they were incapable of getting their registrants to correct them.

Critics of homeopathy responded to these pieces and universally saw suspension as a good thing but questions were also raised about why the PSA accredited the SoH in the first place. 

The SoH have dodged a bullet in terms of media coverage, so much is going on with COVID-19, Brexit and other things, that their suspension has beenly barely reported. There was a brief piece in the Daily Telegraph and also something on the BMJ website. The latter did excite some doctors though. Things could have been much worse.

What next?

The SoH will have to decide soon if they wish to try to regain Accreditation. They may be better off giving up on the idea.

They can appeal the suspension but only on the following grounds -

  • Acted outside or beyond its powers
  • Did not follow proper procedure
  • Acted irrationally

In reality, only the third is possible. The Appeal board can cause the review to be repeated, it can overturn the decision and impose a new one or vastly more likely, reject the appeal. At the moment, there is no sign of an appeal. Of course, if an appeal was rejected, the SoH could apply for judicial review. The likelihood of success is extremely low and it would be expensive. The SoH aren't in a brilliant financial situation.

It is now possible for third parties to make a complaint against panel decisions but for anything to happen such as a further review, new evidence would be required. That seems unlikely.

The SoH are running an election process to appoint a new member to the Board. The outcome of the election is not going to have any material effect. It should be noted that the six current homeopath members of the board have been in place for a while and must bear responsibility for the suspension of accreditation. Some of them have been implicated in spreading anti-vaccination propaganda, misleading their clients re their qualifications and other unpleasantness. They do not see these things as resigning matters. It is difficult to see how the SoH can change with (largely) the same board.

The SoH has replaced its three independent (ie non-homeopath) directors but this was due to happen anyway. Independent directors are appointed to the board by the board. They can serve for a maximum of six years. The previous independent directors had all reached that point. Given that they are outnumbered by homeopath directors, it is difficult to imagine them having much influence over the direction of the SoH.

The SoH still needs to recruit a permanent Chief Executive. With an organisation as small as the SoH, the CEO is very much a day-to-day hands on manager. It's the Board that sets strategy. The CEO is responsible for implementing strategy. Given past negative media coverage of the SoH, CEO of the SoH is hardly an attractive role. It's not well paid either.

From the Panel decision -

The SoH will have opportunity to submit evidence of progress at interim reviews. These will take place every three months during the 12 month suspension. The SoH will be asked to provide evidence of how it is addressing the outstanding Conditions on 11 April, 11 July and 11 October 2021. Final evidence will be due on 11 January 2022. If the SoH can demonstrate to the satisfaction of the Authority that the Conditions have been met, then the Authority may bring forward the assessment of how the SoH meets the Standards, so that suspension can be lifted earlier than the 12 months. 

Because of the work involved in compiling evidence, let alone actually trying to comply, the SoH will have to decide whether to proceed with accreditation well before 11/04/2021. Note that the PSA will publish the result of the interim reviews. Each of those interim review reports is a potential trigger for media coverage. It is unlikely to meet conditions by 11/04/2021 and will probably struggle to meet them by 11/07/2021. Sustaining compliance for six months is going to be very, very hard for the SoH given its propensity for backsliding.

Homeopathy Awareness Week starts on 10/04/2021. The 2021 SoH Conference is likely to be online this year but the SoH hasn't announced a date yet. It has to have its Annual General Meeting by end of June 2021. It doesn't have to have its AGM and Conference at the same time but historically it has. The SoH could find interaction with members difficult because of the suspension but as mentioned above, maybe members don't care enough to give the SoH leadership a hard time.

The PSA have indicated that the lifting of suspension is not only dependent on meeting the conditions. They will look at whether the SoH meets all of the Standards. Not only that, but the Standards may have changed due to the consultation that is currently going on. It is possible that the SoH could go to a lot of trouble only to find accreditation removed because homeopathy has no real evidence of efficacy. 

Right now, there aren't any clear indications of which way the SoH is going to jump. It doesn't seem to be taking any decisive action. 

Friday, 4 December 2020

Cliff edge

What is going on with the Society of Homeopaths (SoH) and the Professional Standards Authority (PSA) has become a little clearer. Things have moved on since the last blog postThe SoH recently told the PSA that they do want to renew Accredited Register (AR) status.

But the SoH has a number of hurdles to overcome before the PSA will consider their application.

Conditions
The PSA have imposed various Conditions on the SoH. One Condition was imposed by the last Annual Review, three by an in year review in July 2020. 

The decision as to whether the SoH have met those Conditions will be made by an Accreditation Panel (composed of three senior PSA staff). If they haven't, Accreditation may be removed. If that happens, the SoH's application may be dead in the water.

Two were due on 21/10/2020. At the time of writing, the Panel was still yet to meet.
Condition 1: The Society must ensure that its recruitment processes include appropriate due diligence checks to assure itself that applicants are, and have been, in compliance with the Society’s Code of Ethics and position statements, including those relating to the use of social media. This should apply to all paid and voluntary positions within the Society including Board and staff members. The Society should also ensure that it has processes in place to assure itself that officials of the Society remain in compliance after appointment. The Society must report to the Authority on the steps it has taken to comply with this condition within three months of the date of this letter. (Deadline 21 October 2020)
It isn't known exactly what the SoH's policies are on social media (not visible to the public). Even so, this should not be too difficult to meet. Recently advertised positions mention compliance as a pre-condition for application and that the SoH will send a copy of the policy to the applicant. The more cynical might think that this would present an applicant with an opportunity to delete any problem content - although if the applicant is a member of the SoH they should already be compliant.
Condition 2: The Society must provide the Authority with its policy for the escalation of complaints against registrants, which are initially handled informally, into its formal processes and its procedures for handling persistent complainants. The Society must also provide a summary of complaints received since the publication of its new position statement on 10 June 2020 (including those handled through an informal route) and outcomes to the Authority. This should be completed within three months of the date of this letter. (Deadline 21 October 2020)

This is trickier. Historically, the SoH were averse to dealing with complaints/concerns from critics. This has not served them well in recent times as frustration with the SoH has lead to critics raising concerns with the PSA about the SoH's complaint/concern handling. Providing the PSA with a policy and procedures is one thing but the PSA want to see if that they are being applied.

The PSA have indicated that the Accreditation panel may take into account any issues that have raised in those concerns/complaints. Whilst none are likely to result in the Accreditation panel removing Accreditation, they could result in the imposition of further Conditions. On the other hand, given that renewal is getting closer, they may defer consideration of such matters until then.

Condition 3: The Society must: 

a) monitor its registrants’ use of social media to ensure that they are complying with its position statements. The Society should provide quarterly reports to the Authority. 

b) review and if necessary, update its social media policy for registrants, ensuring consistency of guidance to registrants on the content of their own websites, and their statements and actions on others’ websites and other social media. This should be completed within six months of the date of this letter. (Deadline 21 January 2021)

a) in effect broadens the scope of Condition c) discussed below. That deadline is getting very close and although some SoH problem members have amended social media content, more have done absolutely nothing. The SoH really needs to pick up the pace of getting members to comply if it intends to meet that condition.

b) potentially sets up a requirement for the SoH to look at all online activity by members. 

It's clear from some PSA reports that they have concerns about the tone of guidance that the SoH has produced in the past. They felt that the SoH has not taken public protection seriously. It looks as if the SoH issued some sort of social media guidance in April 2020 but there is no obvious sign of it being updated. It is impossible to know if it has been reviewed. There may be a gap between what the SoH thinks compliance looks like and what the PSA thinks. 

Some non-compliance is certainly down to intrasigence on the part of more difficult members. It is known that the SoH have spoken to some members about their social media yet they show no sign of amending it. The most clearly worded guidance would be unlikely to have any effect on them. Expulsion may be the only option. 

Also, there is a Condition set in February 2020 by the previous Annual Review. For convenience, this will be refered to as Condition 0.

a) Make its position statements clear that registrants must not practise or advertise adjunctive therapies that are incompatible with Society registration. Specific reference must be made to the Society’s position forbidding the 2 practice of CEASE, and dietary/nutritional supplements. This must be submitted to the Authority for review and published within three months. - met

b) Make its position statements clear that registrants’ scope of practice does not allow registrants, whether acting in a professional or public capacity, to provide advice on vaccination or offer or provide homeopathy as an alternative to vaccination for the prevention of serious infectious diseases. Registrants should direct service users to NHS and other public health sources, for example, their GP or public health departments. Revised statements must be submitted to the Authority for review and published within three months. - met

c) Provide quarterly reports of its monitoring to ensure that within the following 12 months all registrant websites comply with its updated position statements (as referred to in part a above) - deadline 13 February 2021

d) Complete and make available to the public its guidance on adjunctive/supplementary therapies and inform the Authority how it will promote compliance with that guidance - deadline 9 January 2021

c) is very tough. In short, all member websites must comply with the Position Statements by the deadline. If members do not voluntarily comply, the SoH will have to at the very least suspend them if not expel them. The SoH looks to have expelled one member over anti-vaccination content on their website. Kate Diamantopolou is very obviously anti-vaccination. Compared to some ARs, the SoH provide very little information on specific allegations but there is the hint of more than just her website being non-compliant.

It may be able to meet this Condition but there could be problems with the interpretation with the Position Statements. Given that there will be four reports in total, the PSA will know if progress is being made. It is known that the PSA will be doing their own checking.

d) has the potential to upset a lot of members. Many members use "therapies" other than homeopathy. If the SoH declares some of them incomptaible with membership, they could lose members. It doesn't set a deadline for compliance but there is the potential for the PSA to impose a Condition.

This is a problem that affects other Accredited Registers as well. Their attitudes vary. It is known that the PSA expects them to cooperate over some of the more problematic therapies that are offered.

Member consultation
The SoH ran a member consultation February 2020 to September/October 2020 regarding AR status. The results of the consultation are not available to the public nor is qualitative analysis that seems to have been carried out.

What it told members during the consultation is unknown but historically, the SoH has played up the supposed benefits of Accreditation most of which have not materialised and never mentioned the downsides. There is no indication of whether the SoH communicated to members that the price of retaining Accreditation is ever escalating restrictions on what they do and what they say. Nor is there any indication of communicating that the SoH would have to actually start to enforce restrictions at some point. It is doubted that the SoH would have been as blunt as telling members that support for Accreditation is support for expelling members who refuse to comply with standards.


Renewal Process
The renewal process guidance has changed. It is a lot clearer, especially in terms of timings. It may take a while for the timings to be achieved though. The PSA has had a backlog of Accreditation renewals which it is working its way through. Also, Conditions placed on ARs before prior to the new guidance was in place may have deadlines that don't align with the new timeline. For example, the guidance talks about the Accreditation decision being made four weeks before the renewal date but some Conditions have the renewal date as their deadline. This seems to be the case for some of the Conditions on the SoH and the decision of whether they have been met will be part of the renewal decision rather than seperately considered.

Fees guidance states - 

Once payment has been received and confirmed by the Authority’s Finance team, the Accreditation team will start their review.  

Fees are non-refundable. 

Warning signs
As well as consideration of the Conditions that have a deadline around the renewal date, the PSA stated in the August in year review - 

4.9 However, the Panel confirmed that there are clear public health reasons why it is wrong for practitioners to endorse the practice of CEASE, anti-vaccination messages or otherwise suggest that homeopathy should be used as an alternative to recognised medical interventions. The Authority expects all Accredited Registers to take a proactive leadership role in ensuring that its registrants are meeting its standards and considered that, if the Society does decide to continue to seek to be part of the register, it needs to demonstrate that its leadership fully supports both the spirit and the letter of its statements. The Authority can look at this question again as part of the next reaccreditation round.

This is strong stuff. One criticism of the SoH is that in the past it has done the minimum possible to satisfy the letter of Conditions, Recommendations, etc. For example, it only looked at websites of members and didn't look at Facebook accounts that were being used as websites. 

What the SoH should expect, if they manage to retain Accreditation, is another raft of Conditions and Recommendations (which as the in year reviews have demonstrated can turn into Conditions). It should also expect complaints to be raised.

At the moment it looks as if the SoH will fail to meet Condition 3. If the SoH fails to retain Accreditation as a result, it may appeal, likely on the grounds that the time scales were unreasonably short. The most that could achieve is re-Accreditation with an extended deadline of the Condition hanging over it.

It could try to argue that restrictions on members' personal social media are unreasonable but there are precedents for members of certain professions being sanctioned by their regulator over personal social media. If the SoH pursued that line would be effectively admitting a lesser status for its members than "professional". 

Complaint
Prior to the change in the renewal process, the only way for third parties to challenge an Accreditation decision was via judicial review. Now, third parties can complain about decisions. This is not the same as an appeal in that it can't overturn an Accreditation decision but one potential outcome is that the PSA could mount an in year review.

In theory, the PSA were always able to do this but never have until the SoH had their problems. 

In year review
The PSA suggests as reasons for in year review - 

a. Information that indicates a Standard has been breached.
b. Information that suggests the Accredited Register has not been transparent in a previous renewal of accreditation.
c. Information that suggests a previously met Condition may have been breached.
d. Events that have potential to bring the programme into disrepute.

A complaint about the renewal of the SoH's Accreditation would likely have to present new evidence that the PSA had not seen to trigger an in year review. It is known that the SoH has given incorrect/incomplete information in the past although the reasons are unknown.

Can the Society of Homeopaths retain Accreditation?
Possibly, if it can meet Conditions 0.c and 3.a. It should become clearer whether they stand any chance of this closer to the respective deadlines.

However, getting past the renewal stage is one thing. Something like the Sue Pilkington fiasco could happen again and trigger an in year review. Renewal is bound to come with Conditions and depending on deadlines, failure to meet them could result in removal of Accreditation before the next renewal.

There is also the strategic review of the AR programme. It will not deliver anything in time for this renewal but it certain will for the next and that could involves changes to the Standards that the SoH might be hard pressed to meet.







Monday, 31 August 2020

Game over for the Society of Homeopaths?

The in-year review of the Society of Homeopaths (SoH) Accreditation by the Professional Standards Authority (PSA) has completed. The PSA did not remove Accreditation. Instead it imposed addition Conditions on the SoH.

Whilst this may fall short of what some critics of the SoH were hoping for, it does not mean the SoH are out of the woods yet. It would be very difficult for them to meet the Conditions. They may choose to withdraw from the Accredited Registers scheme.

Parts
There is a news item.
It links to a Accreditation Panel report from July 2020. This was not published immediately.
Because of concerns raised, a further report was produced in August 2020. This was published a week after the Accreditation Panel met for the second time.
On the page about the SoH, there is a link to Q&A about the in-year review as well as the August report, as well as re-stating of the Conditions.


Background
Regular readers will be well aware of the multiple ongoing concerns about the SoH and its members. An in-year review can occur outside of the usual annual cycle if serious concerns are brought to the attention of the PSA.

It's clear that the appointment of Sue Pilkington initially triggered the in-year review. To quote from the July report.
3. Investigation of concerns raised in June 2020 
3.1 On 11 June 2020, the Authority received information through its Share Your Experience process that the recently appointed Safeguarding Lead of the Society (who is also a registrant) had apparently published social media posts that might contravene the Society’s position statements, and its wider standards and Code of Ethics. 
3.2 The Authority raised the concerns with the Society and began an investigation on 12 June 2020. The Authority undertook a social media audit and found material on the Safeguarding Lead’s social media, and the Society’s own social media accounts, which appeared to contravene its Code of Ethics and recently published position statements, and the Cancer Act 1939. Some of the posts were within the past six months and included material that could be considered anti-vaccination and promoting treatments for specified conditions, including cancer and Covid-19. In accordance with its processes, the Authority asked a Moderator to consider the evidence and decide whether further investigation or other action was warranted.
The Moderator believed that there were sufficient concerns for a Panel to consider the matter. The Panel were concerned by Pilkington's appointment.
4.3 The Panel expressed its serious concerns that, very soon after the Society’s accreditation had been renewed with conditions designed to ensure registrants’ compliance with core requirements of practice, the Society had appointed to a critical position a person who had recently published statements at clear variance with those requirements. This inevitably called into question the Society’s ability to comply with the Standards for accreditation.
The July 2020 report was not published but it would have been seen by the SoH. The SoH were well aware of concerns and Conditions before the public were.

Other concerns were raised which caused the Panel to consider things again.
3 Concerns raised July 2020  
3.1 On 30 July 2020 the Society reported to the Authority that its interim Chief Executive Officer (CEO) had resigned. The Authority was concerned that the fact that two senior posts were vacant might mean that the Society was unable to take the actions that would enable it to meet the new Conditions. 
3.2 In addition, the Authority became aware that a particular registrant appeared to still be advertising and practising CEASE, despite us bringing this registrant to the attention of Society in February 2020. On further investigation, we discovered that 32 Society registrants were listed as CEASE practitioners (around a third of the total listed for the UK) on the cease-therapy.com website. Although this website is not run by the Society or any of its members directly, the inclusion of Society registrants on the website raised concerns about the effectiveness of the actions being taken by the Society to ensure its registrants comply with its position statements. The Accreditation team looked at the websites of those individuals and noted concerns about the content of six of them.
Emily Buttrum was appointed CEO in October 2019. By March 2020, she had gone. Richard O'Quinn was interim CEO up until 30/07/2020. Apparently, the SoH have a new interim CEO but their identity is unknown. The SoH website still shows O'Quinn as interim CEO. There is a question about O'Quinn's involvement in the appointment of Pilkington.

There are a small number of SoH members who still mention CEASE on their websites despite the SoH's prohibition. These members have been known to both the PSA and SoH since the end of 2017. There are questions about the ability of the SoH to monitor and enforce member compliance.

Conditions
As the various documents make clear, the PSA think that the problems with the SoH can be dealt with by existing and new Conditions, rather than removing Accreditation, assuming the SoH are minded to implement the Conditions.

There are two Conditions from the Annual Review that still need to be fulfilled -
c) provide quarterly reports of its monitoring to ensure that within the following 12 months all registrant websites comply with its updated position statements (deadline 13 February 2021).
Monitoring is time consuming but achieving total compliance is more about persuasion and if it comes to it, expelling members.
d) complete and make available to the public its guidance on adjunctive/supplementary therapies and inform the Authority how it will promote compliance with that guidance. 
The PSA is asking the SoH come up with a policy on adjunctive therapies. It's not asking for compliance yet. It wants to know how the SoH will ensure compliance. As discussed here, the use of adjunctive therapies seems to be very prevalent. If the sampling is representative, more members other therapies in addition to homeopathy than don't. 

The new Conditions are -
Condition 1 – recruitment policies  
4.7 The Panel considered the Society’s proposals to change its recruitment policies. The Panel considered that it was essential that members of the Society’s staff team and its Board demonstrably uphold the Society’s standards. It is important that the Society undertakes due diligence about this through checks conducted during its recruitment processes and also on an ongoing basis to ensure that compliance is maintained. 
4.8 The Panel decided to issue Condition 1: The Society must ensure that its recruitment processes include appropriate due diligence checks to assure itself that applicants are, and have been, in compliance with the Society’s Code of Ethics and position statements, including those relating to the use of social media. This should apply to all paid and voluntary positions within the Society including Board and staff members. The Society should also ensure that it has processes in place to assure itself that officials of the Society remain in compliance after appointment. The Society must report to the Authority on the steps it has taken to comply with this condition within three months of the date of this letter. (Deadline 21 October 2020)
Appointing Pilkington was an unmitigated disaster for the SoH. This Condition is hardly surprising. On the face of it, it looks easy to comply with but it would effectively exclude a considerable proportion of SoH members from holding paid or voluntary positions with the SoH. It would exclude anti-vaccinationists for standing for Board elections and so. Not only that, but the SoH would have to continuously monitor appointees' activities. There are questions about the monitoring abilities of the SoH.
Condition 2 – complaints handling 
4.9 The Panel considered the Society’s processes for handling complaints about its registrants’ websites and social media content. The Panel noted that the Society had received twenty-one complaints about its registrants’ compliance with its new position statements. The Panel noted that it was not for the Panel to comment on how individual complaints were being handled as these cases were ongoing and it is the Authority’s policy not to get involved in ongoing complaints.
4.10 The Panel noted comments from the Society during verbal evidence that it was the Society’s policy to deal with such concerns in an informal way by, for example, contacting a registrant regarding advertising that is in breach of its Codes and working with them to put it right, before initiating its formal complaints procedures or referring to Trading Standards. The Society has previously stated that it will accept concerns from any source, all concerns are acknowledged and acted on, but outcomes are not provided to the party raising the concern if it has been handled through an informal process. It was unclear to the Panel, however, how the Society escalated concerns from an informal route to a formal route where that was justified, or how it handled persistent complainants. 
4.11 The Panel decided to issue Condition 2: The Society must provide the Authority with its policy for the escalation of complaints against registrants, which are initially handled informally, into its formal processes and its procedures for handling persistent complainants. The Society must also provide a summary of complaints received since the publication of its new position statement on 10 June 2020 (including those handled through an informal route) and outcomes to the Authority. This should be completed within three months of the date of this letter. (Deadline 21 October 2020)
This requires some explanation. Whilst the PSA may not want to comment on individual complaints/concerns, they do want to know what the SoH are doing about them. The PSA is not confident that the SoH is dealing effectively with them. There have long been concerns about how the SoH deals with concerns. Historically, it has tended to brush off public health concerns.

The SoH has had multiple opportunities to deal with some concerns such as CEASE and anti-vaccination. Generally, it hasn't and when it has reluctantly acted it is because the PSA has put pressure on it. It rarely engages with those raising concerns, which sometimes results in the PSA getting involved.
Condition 3 – social media policy 
4.12 The Panel noted the Society’s proposals to update its social media policy to give it more of a public protection focus and noted that this had been issued as a Recommendation to the Society at its last annual review in February 2020. The Panel agreed that the concerns raised about the Safeguarding Lead and the Society’s handling of this process, could give rise to concerns about its ability to inspire public confidence in its management and governance of the register. This placed further importance on the need for clear guidelines to its registrants. 
The Panel decided to replace the previously issued Recommendation with a new Condition 3: The Society must: 
a) monitor its registrants’ use of social media to ensure that they are complying with its position statements. The Society should provide quarterly reports to the Authority. 
b) review and if necessary, update its social media policy for registrants, ensuring consistency of guidance to registrants on the content of their own websites, and their statements and actions on others’ websites and other social media. This should be completed within six months of the date of this letter. (Deadline 21 January 2021)
The PSA are being very clear here that the SoH's Position Statement applies to members' social media and marketing on third party websites. Formulating a social media policy was originally a Recommendation in the Annual Review -
5.15 The Authority had received concerns regarding a sample of registrants’ public social media posts, that appeared to discourage vaccination and drew this to the Society’s attention. The Authority considered an initial response from the Society which appeared to apply different standards between registrants’ professional, and personal behaviours on social media. The response suggested the possibility that outside of their homeopathic practice, registrants may act contrary to the Society’s standards without risk ofdisciplinary action. 
5.16 The Authority did not agree with the Society’s position that personal beliefs, stated in public spaces, could be distinguished from registrants’ professional practice. The Authority noted many practitioners were self-employed or otherwise represented their own practices on social media, and that promoting ‘anti-vaccination’ messages may conflict with the Society’s position statements. The Authority asked if the Society had considered issuing its policy on the use of social media (further to existing statements regarding treatment of cancer) in its position statements (or other guidance) or within its Code of Ethics. 
5.17 The Society, having further reviewed the social media pages provided, considered they were part of the registrants’ practice due to the content and nature of the materials ‘posted’. The Society stated it accepted that if registrants’ personal social media pages are publicly accessible, members of the public looking for information about homeopaths or homeopathy may be informed or influenced by what they read there. 
5.18 The Society affirmed that the use of social media blurred boundaries between registrants’ personal and professional lives. The Society stated it would develop guidance on the use of social media by registrants and its Board. The Society would draw from existing examples of best practice and engage its membership in development of the guidance. Once issued the Society would check registrants’ engagement with the guidance and include social media pages where possible within its regular audit of registrants. 
5.19 The Society advised that those registrants already highlighted to the Society would be prioritised under its audit schedule. Where necessary the Society would consider disciplinary procedures, applying relevant sections of its Code of Ethics, and its previous communication to registrants requiring them to review all social media pages, websites, and other material. 
5.20 The Authority noted the Society’s recognition that registrants’ social media may impact on their professional life and their compliance with the Society’s standards. The Authority also noted that the Society had confirmed it could take action regarding registrants’ use of social media and considered theSociety’s approach appeared proportionate. As part of the Condition issued under Standard 2, the Authority required the Society to provide a copy of its guidance to the Accreditation team and set out how it would monitor compliance with that guidance. (Recommendation 3)
If the SoH has a social media policy, it's not been made public. Even if it does exist, the SoH will likely have made a mess of it. There are concepts that homeopaths struggle with such as professional boundaries which would have to be addressed as part of such a policy.

Worse
From the August report -
1 Outcome 
1.1 The Panel met on 13 August 2020 to consider the information provided as part of an in-year review of the Society of Homeopaths (the Society). The Panel recognised the concerns raised, however felt that they could be addressed through the previously issued Conditions. The Panel decided that it would not be proportionate to take further action at this time. However, the Panel wished to make clear that the Authority expected that the Society had a leadership role in demonstrating whole-hearted endorsement of the Authority’s view that advertising or undertaking Completed Elimination of Autistic Spectrum Expression (CEASE) therapy or putting across anti-vaccination messages posed a risk to public health and were not compatible with membership of an Accredited Register. The Authority would be assessing the Society’s approach to this in the event that the Society sought reaccreditation.
 Before the Panel considered the matter -
3.6 The Moderator considered the messaging provided by the Society to its registrants about its new position statements and noted that there appeared to be inconsistencies between the messages the Society was giving to its members and the content of its position statements. This raised the question about whether the Society has made an effective distinction between professional and public interest, and properly prioritised the latter. The Authority expects public protection to be the main focus for its registers.  
3.7 There was concern that materials provided to members by the Society failed to adequately recognise the concerns raised about CEASE and anti-vaccination as valid risks to public protection. This, combined with a further change in leadership, could undermine confidence in the ability of the Society to ensure compliance with the position statements.
The putting members' interests first and failing to recognise CEASE and anti-vaccination as risks are long standing criticisms of the SoH. It's not known what was in that messaging that caused some much concern but the SoH saying one thing publicly and something else to members is nothing new. It maybe the case that the PSA had to ask to see the communications with members. 

Also -
4.8 The Panel noted the communications by the Society to its members. It was concerned that the tone of these communications may indicate that the Society did not see the issues raised as a significant as the Authority does. However, it also recognised that there were significant differences of opinion within the Society’s membership and that it was open to the Society to have a debate about whether it wished to be part of the Accredited Registers scheme or not. While the Panel was disappointed that the leadership of the Society was not more emphatic in endorsing the Conditions, it recognised that there was a spectrum of reasonable ways to put the message across and it did not consider that the Society’s communications went so far as to undermine its position statement. 
4.9 However, the Panel confirmed that there are clear public health reasons why it is wrong for practitioners to endorse the practice of CEASE, anti-vaccination messages or otherwise suggest that homeopathy should be used as an alternative to recognised medical interventions. The Authority expects all Accredited Registers to take a proactive leadership role in ensuring that its registrants are meeting its standards and considered that, if the Society does decide to continue to seek to be part of the register, it needs to demonstrate that its leadership fully supports both the spirit and the letter of its statements. The Authority can look at this question again as part of the next reaccreditation round.
The clear unambiguous message from the PSA is that anti-vaccination and CEASE therapy are incompatible with membership of an Accredited Register.

The criticism of the SoH's leadership is also very clear. There have long been concerns about its leadership but compared to what was said in Accreditation report back in February, either the PSA's position has hardened or the SoH have gone backwards. To quote -
5.21 The Authority noted the breadth of actions undertaken by the Society’s leadership in response to the issues highlighted, within the period of assessment and considered that these would inspire confidence in the Society’s ability to manage its register effectively. The Authority found that this Standard continued to be met, noting the link to the issues identified and Conditions set within Standard 2.

Whilst it is known that the SoH is/was consulting with members over PSA Accreditation, there is no indication of how far this has got, let alone any outcome.

Game over?
This blog has made the point that the SoH may be better off withdrawing from the Accredited Registers scheme. In short, the scheme has delivered no obvious benefits to SoH members and the increasing compliance requirements have lead to the loss of members.

Because of varying deadlines of the Conditions, there are several points at which the PSA could remove Accreditation. Even if they can get through those, the PSA have clearly signalled that they would long and hard at the SoH's leadership at the next Accreditation. There is also the possibility that events could trigger yet another in-year review if the SoH does something as spectacularly stupid as appoint Sue Pilkington.

The in-year review took a narrow focus. There are a number of issues that it did not deal with. For example, it did not consider the business of the effective re-branding of CEASE therapy as "Homeopathic Detox Therapy". Or the problem of certain members spreading COVID-19 misinformation and being against masks.

The PSA has started a consultation on the future of the Accredited Registers scheme. Whilst it is unlikely to result in any direct changes to Standards in the short term, responses may influence the PSA's interpretation of the current Standards and this would be in addition to the change in emphasis seen above.

It is not at all clear which way the SoH are leaning on Accreditation at the moment. It has made no real public mention of it since February 2020. Its members likewise have had nothing much to say since then, which suggests indifference.

It needs to decide very soon what it is going to do. Doing nothing is pretty much guaranteed to end in removal of Accreditation and extensive negative media coverage.