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.