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.

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". 

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.

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