Wednesday, 27 January 2021

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. 

No comments:

Post a comment