Explore the vast range of titles available.

First of all, we can understand 'the true meaning of speech' as 'the unconscious meaning' that lies behind what you said. [...]this is an example of all three ideas. [...]Little intervened: \"Her life was in evident danger, either from the risk of suicide or from exhaustion; somehow I had to break through. The Labour Party has been revealed to be fuelling rather than starving anti-Semitic feeling; we now know that both Russia and wealthy businessmen were spending vast amounts of money in an effort to manipulate voters via social media shenanigans, since the referendum result was announced we have heard about the rising number of hate crimes, and we are currently experiencing a huge increase in knife crime in the capital.

This incisive study shows that \"regulation\", against which many have warned but which some psychotherapists still imagine to be a solution to all their ills, is actually already here. The author traces her way through this apparatus, and makes a compelling case for taking the HPC seriously as a machine that incarnates the very kind of unhealthy practice it pretends to set itself against.'- Professor Ian Parker, Manchester Metropolitan University'. If you want to know about the reality of state regulation, how it works in practice - as opposed to what people say about it - you should read this book. A shocking and unsettling account.'- Paul Gordon, author of The Hope of Therapy and former chair of the Philadelphia Association'. Do not let the simplicity of this lucid account of a difficult problem deceive you. 'This book investigates the claim that regulation by agencies of State is one of the prerequisites for improving professional practice. It displays how the underlying administrative interests of such bureaucracies are detrimental to the structure of professional communities.

Now it is the turn of the registrant at the centre of attention. Dr Cross is invited to take the witness seat, and is questioned first by his own lawyer, who establishes that he is who he says he is, and adds the qualifications he has, before launching into the detail. First, Mr Tyme establishes that Dr Cross made the restaurant reservation for the dinner on the night in question and then drew out the details of the accreditation process. In this way we learn that the relevant papers are received about twenty-eight days before the meeting, and web-based documents are consulted before attending the meeting. Was there anything special about this particular meeting? Yes, the accreditation was so close to the HPC takeover that it made sense to conduct the visit with this in mind. However, under the old scheme it was quite normal for conditions or recommendations to be made in the accreditation process, but under the new regime this would mean that the course would not be recognized as one which could pass students onto the HPC register, which would be disastrous for the students and for the university. It was therefore absolutely essential that the university avoid such a catastrophe—they had to pass first time. Dr Cross … So there was an onus upon us to not only bear this in mind, but to be on one level extra-rigorous so as not give the impression that we had not given it due consideration in order to help out in a collegiate sort of way. So there was an interesting situation of being hyper-vigilant in relation to issues and being absolutely satisfied there was nothing wrong. I think that responsibility had been passed down to the course, programme providers because the documentation was exceptional. The best I had ever seen. 102Then Mr Tyme established that Dr Cross had accomplished about twenty such visits in his career, and that he liked to conduct them in a developmental way, which is to say … never adversarial, always with a view to trying to assist a provider to deliver the best possible service to the students … it has very significant consequences, it is absolutely formal. I think there are two perspectives that one can take when one is interviewing or evaluating a particular product. Some people believe that you should put people under pressure to see how they perform under pressure. There is another camp, which I belong to, which is you should make people as relaxed as possible to get the best out of them. So my view is that I would try and put the accreditation team at as great an ease as possible so they could tell their best story. Now for the problematic question of alcohol: Mr Tyme Now, going back to the pre-meeting on 8 June, on your arrival at the hotel had you consumed any alcohol? Dr Cross Yes, I had. I had been to lunch. That was prior to setting off from London to Bristol. I recall very clearly having two glasses of wine at lunch with two colleagues who were both working half a day, and had arranged to finish work and have lunch. Then we all went our separate ways. Mr Tyme It has been said on your arrival you were drunk, references to slurred speech et cetera, what do you say to that? Dr Cross I do not believe that I was drunk. I know precisely how much I drank. It would be extraordinary to be drunk after two glasses of wine. 103Mr Tyme … Mr Hughes raised some concerns about a drink problem, an alcohol problem, are you able to comment on that? Dr Cross Yes. I find the accusation extraordinary. I find it extraordinary on a personal level, in that I do not believe I gave him any indication that was the case, and on a professional level I find it extraordinary that [he] could come to a diagnosis, which is in fact what it was, on the basis of a brief conversation. Mr Tyme How would you describe your relationship with Owen Hughes? Had you had much contact with him before the 8 June? Dr Cross I recall teaching him a very long time ago. I recall teaching him about ten to twelve years ago. He was a somewhat unremarkable student, but really no contact since his graduation from the university except where we may have sat in similar committees. But, again, quite large, so not really a relationship as such. Mr Tyme To paraphrase his evidence, if I was to describe him as your confidant, what would you say to that? Dr Cross I would not describe my relationship with him as being a confidant or someone whom I was close to, no. Mr Tyme But someone that you could tell very personal matters to? Dr Cross No, absolutely not. Mr Tyme Mr Hughes in his evidence said you told him about your personal relationship; do you recall that? Dr Cross I recall that evening very well, and, no, I did not discuss my personal relationship. I believe he is probably talking about my relationship with my partner and I certainly did not discuss my relationship with Mr Hughes. Mr Russen Was that challenged? Ms Kemp No. It was not challenged—he was not drunk either. (pause) Mr Russen He has presumably gone, has he? Ms Dwomoh-Bonsu Yes. The point disrupts the proceedings—could this have been ironed out in the preliminary process? Is it not the responsibility of the Investigating 104Committee to prove the case—that is, to know the strength of the evidence, the value of their witness? Surely someone would have asked what kind of evidence there was that the registrant was actually drunk and then cross-questioned their own witness? What about the Panel and the Legal Assessor—is this not a point at which they might notice that something may have been wrong with the process that led to the hearing? It is the responsibility of the HPC to prove their charge, yet Ms Kemp takes advantage of the situation and actually manages to present it as a problem for her, which rather goes against the idea that it is her responsibility to make a case. Ms Kemp My note does not refer to those matters including the fact that Dr Cross states he was not drunk. That certainly was not put to Mr Hughes. If I may say, it does present me with some difficulties where a witness’s evidence has not been challenged as it should be because I am now not in a position to recall Dr Hughes so that those matters can be put. I would certainly rely on my closing submissions on the fact that these matters have not been put to Mr Hughes and he has not had an opportunity to comment. That will be something that I would ask you to take into account. But in fairness to Dr Cross it is important that he has every opportunity to present his case and to put those matters to Mr Hughes if his evidence is directly challenged. So it is perhaps a matter for Dr Cross and his representative to consider the difficulty there is that Dr Cross is now giving evidence and should not in normal course speak to his representative either. Mr Tyme … to that extent even if I had put to Mr Hughes was he drunk, he is going to say presumably yes. You have heard from Molly Ross. She has given her account of his demeanour, slurred speech et cetera. I do not think we can take it much further … Dr Cross has said he was not, or he had two glasses of wine … Miss Reggiori I think the issue, and I am sure I will be corrected by both Ms Kemp and Mr Russen if I am wrong, is you appear to be putting in chief to Dr Cross matters which impact on Mr Hughes’s evidence which were not put to Mr Hughes in cross-examination, like, for example, 105whether or not Dr Cross confided in Mr Hughes about his personal relationship which I do not recall being put to [Mr Hughes] in cross-examination. Mr Tyme It may be the manner in which he came out with it. At that stage I would not have had any instruction on that specific point. It came out, he referred to issues of a personal nature. So the question I asked Dr Cross is whether or not he can be described as a confidant. Miss Reggiori Mr Russen, can you assist us with this. Mr Russen I am sorry, I instigated this interruption in Dr Cross’s evidence and one thing we should not do is throw Dr Cross off balance by interrupting the flow of his evidence. But there is a general expectation that where a witness against a party gives certain evidence which is not accepted by that party that the respects in which they do not accept it are put fairly clearly to the witness so they can deal with it because it is only in that way that the fact-deciding tribunal, namely the Panel here, can come to a view about it … to be perfectly blunt, it opens the door to Miss Kemp … Dr Cross Could I make a brief intervention, but just to say that I genuinely believe my opportunity to review what was said would be now and not to interrupt at that time. I apologise if I misconstrued. Ms Kemp It is not a matter that I think I can take any further. I think I have expressed my position. I will refer in the closing submissions. It is obviously a matter for both Dr Cross and Mr Tyme as to what they wish to do. Ms Reggiori I think the Panel will need to retire for a couple of minutes. Mr Russen Yes. Ordinarily, Dr Cross, once a witness starts giving their evidence they should not be communicating with their representative. That is the general rule because there is a rule for all witnesses, whether they are Registrants or any other as you probably heard Miss Reggiori say to the earlier witnesses, they should not be talking about the subject matter of the evidence. But I think that it has been accepted that for these purposes if you wish to speak to Mr Tyme about this nobody is going to object. 106(The Panel retired from 2.42 pm until 3.15 pm) I have edited out a lot of the repetition and verbiage to leave the essence, but even so it is clear that there is a great deal of agitation. It is also interesting to note that Mr Hughes has left without knowing the outcome, without hearing what Dr Cross had to say—this hearing is triggered by his letter, after all. Miss Reggiori I think unless anyone wants to raise anything [we will] just continue to hear Dr Cross’s evidence. Mr Tyme Yes. Mr Tyme now takes Dr Cross to the question o

This book is quite particular and rather unusual. Most of it is a transcript of the fitness to practise case of a psychologist and HPC Council Member, Dr Malcolm Cross. I have chosen to present this transcription (made available under the law that created the Health Professions Council, henceforth the HPC) in order to allow people to grasp the reality of the new regulatory framework that now exists in this country. Very few people, even amongst those directly affected, seem to know what the framework is based on, nor how it arose. Much of the problem is that the new regulation is based on quite different assumptions from those we are accustomed to, and it is the arbitrary change in these underlying assumptions that make it difficult to grasp what’s going on. During the course of my research into this problem, Dr Cross’s fitness to practise case came forward. It occurred to me that the transcription of this case would provide the perfect material to reveal the nature of what is actually going on. The case itself reads rather like a soap opera, and has a curiously compelling character. It is quite fun to read. However, this is not the level at which the real information exists. The case is presented in order to show the mechanisms and procedures that are put into play in the name of “public protection”. Dr Cross himself is not the primary concern of this book, but 2a useful and unavoidable vehicle for it. I have topped and tailed the transcript with an introduction and conclusion. In Chapter One, I have brought together some threads that make up the backdrop to the case, and which help to make sense of what has happened. The concluding chapter also includes other information arising from my wider research into the HPC, which helps to show how the single case presented here is part of a wider pattern of chaos. I hope that it helps to frame the material and to prompt more people to act.

Dr Cross’s FTP case entered the public domain in February 2010, when a notice was posted on the HPC website four weeks in advance of the hearing. The allegation was set out in three points, the first of which was divided into seven separate instances amounting to the allegation of misconduct, leading, in turn, to the statement that “by reason of that misconduct your fitness to practise is impaired”. A colleague of mine spotted the case on the list of upcoming hearings and remarked on the strangeness of the allegation (Scott, 2009). I recognized the name of the registrant immediately—Dr Malcolm Cross, a recently appointed member of the new, redefined and reduced HPC Council. It was only seven months since the “practitioner psychologists” had entered the HPC register. Since HPC cases tend to take about 18 months to come to hearing, I calculated that the case must have originated quite some time ago or that it was being rushed through—probably because of the status of the defendant. Either way, to appoint someone to the new HPC Council only to then discover he was subject to a complaint raises some difficult questions.

On the second day of the hearing not much new is presented, but it is a full day before the verdict is announced, the Panel having taken five hours to reach their decision. The routine requires us to sit through the summing up by the solicitors. Ms Kemp returns to the three categories (1. Facts; 2. Misconduct; and 3. Impairment) and reminds the Panel that there is a conflict of evidence on several counts, and that they will have to make a decision on what amounts to the facts. She does not remind them that it is up to her to present strong evidence and not up to Dr Cross to disprove her. Dr Cross, she notes, says he was neither drunk nor incapable of chairing the pre-meeting. He says he did not rub his crotch, and that he was making a joke when he offered to kiss and expose himself to Owen Hughes. The questions surrounding Simon Parritt are inconclusive in terms of “fact”, but it is, she notes, certain that Simon Parritt was not offended by Dr Cross and that he made no complaint. The only additional point she makes here is that no “truth statement” accompanies Mr Parritt’s statement, a position on her part that manages to insinuate that Parritt could be deceitful. She does note that the question of exposure was not something that Mr Hughes mentioned at all in his evidence but was mentioned by Molly Ross, who acknowledged that she was unable to be explicit about it. Given that it 124is the responsibility of the HPC to make the case against Dr Cross, the case sounds rather weak even if one accepts its underlying premise. In respect of the particular of allegation 1(5), namely, that Dr Cross threatened to expose himself, the Council must accept that this was not something which was mentioned by Mr Hughes himself, and that the majority of the inappropriate behaviour in terms of sexual references or touching was aimed at Mr Hughes and it was not something that he mentioned. This was evidence that you heard from Ms Ross and she could not be specific about it. She simply referred to the fact that it seemed as if this was what he was suggesting. So I think the Council must accept that it was not something mentioned by Mr Hughes, and that it was something that Ms Ross only had a more limited view of given her position at the table and her own evidence that this is what she thought was happening. Moving on then to the particular 1(6), this is that Dr Cross attempted to touch Owen Hughes and Mr Parritt inappropriately. In relation to Mr Hughes, Dr Cross accepts that he leaned over the table in an attempt to kiss Mr Hughes. He stated to you in his evidence that this was a mock situation and that he was being silly. Mr Hughes said when cross-examined that he had no doubt about the seriousness of this situation, in effect, that Dr Cross was being serious. And he said in his evidence “it was the way he put it”. Again, in cross-examination when Mr Hughes was asked, “could you have misinterpreted what was said”, Mr Hughes said, “it was not a bad joke”. His clear response was, no, he could not have mis-interpreted it. It was not a joke. What Ms Kemp says next (which I have edited out) is, in essence, that two people say it wasn’t a joke, whereas Dr Cross says it was. She continues: You also have to consider motivation in this type of situation. Why would Mr Hughes or Ms Ross come to the Council and state things that they did not believe had happened? They themselves putting themselves through the process of giving evidence in public, knowing that there are ramifications of doing so. I would invite you to consider that. I do not propose to say anything more in relation to the facts. 125Ms Kemp poses an important question and pretends the answer is obvious. She places it as if it were rhetorical—but is it? Why would Mr Hughes or Ms Ross come to the Council and give such flimsy evidence knowing that there are ramifications of doing so? Dr Hughes tried to explain his motivation, though in a muddled and contradictory way (to help a colleague he was apparently in league against). But the intention of Molly Ross seems a little like spite, though it would have to be quite strong to explain the trouble she seems willing to go to. It seems likely that there is in fact another actor who is hidden here, but whose motives should really be questioned. Perhaps this actor can be glimpsed by the reference to Ms Johnson—part of the directorate of the HPC itself—left behind the scenes but apparently manipulating things for their own unstated ends. But I will briefly then move on to say something about misconduct. Misconduct is not defined as you know in any of the Health Professions Council’s orders or rules, or even Practice Notes. It is really a matter for your professional judgement notwithstanding that Dr Cross said that he considered his behaviour was below the professional standards that he would normally keep. It is still a matter for you to determine that. And in a sense you should do that relying on your own experience of what you consider to be proper conduct, bearing in mind what is expected of Registrants of the HPC and I have already referred you to the standard at paragraph 3 of the standards of conduct, performance and ethics. There is a sense here that Ms Kemp, in spite of her experience at the HPC, is making it up as she goes along. Misconduct is not defined—this in itself is a problem that needs to be addressed and sensible limits set. She says that it is up to the Panel to define it. These three people, appointed by the HPC, only one of whom has gone through the procedures and experiences necessary to qualify as a practitioner, have been granted the power to decide what counts as proper conduct for a fellow human being. What logic underpins this? In relation to impairment of fitness to practise, again, the notion of impairment is not defined, but in my submission you can consider it to be a negative, subsisting impact on the registration of a professional who is a member of the HPC. 126There are two elements to fitness to practise, there is the capability element and the suitability element, and the suitability element requires you to consider the wider public policy interests which were referred to the case of Cohen which are referred to in your practice notes, namely, the need to reaffirm clear standards of professional conduct, and to maintain public confidence in a practitioner. Those are the specific purposes or factors that you are considering in relation to impairment. Again, if we refer back to the practice note, we will see that it contains no details whatsoever of the actual case that gave rise to it. The generalized principle that is drawn from it is therefore ungrounded and left to the whim or wit of the HPC lawyer. It is not a strong argument. When considering impairment I would invite you to take into account three factors; firstly, the incident itself, it is accepted that it is a single incident that you are considering. Secondly, I would invite you to consider any insight that you consider has been displayed. And, thirdly, I would invite you to consider the Practice Note of the HPC which sets out some of the considerations which you should take into account when considering impairment. I do not propose to repeat those now, but I should add I was handed the case of Yeong v General Medical Council by the learned Legal Assessor. I understand Mr Tyme was also handed a copy. It is worth mentioning Paragraph 48 of this judgment. This Dr Yeong had been found to have crossed the patient doctor boundary by entering into a sexual relationship with a patient. At paragraph 48 of that judgment, I am not going to read all of it, but I read the second half of it. It says: “Where a [Fitness to Practise Panel] considers that the case is one where the misconduct consists of violating such a fundamental rule of the professional relationship between medical practitioner and patient and thereby undermining public confidence in the medical profession, a finding of impairment of fitness to practise may be justified on the grounds that it is necessary to reaffirm clear standards of professional conduct so as to maintain public confidence in the practitioner and in the profession. In such a case, the efforts made by the medical practitioner in question to address his behaviour for the future may carry very much less weight than in a case where the misconduct consists of clinical errors or incompetence.” 127The text that is being referred to here says: “In July 2002, whilst Dr Yeong was working as a consultant at the Kedang Kerbaul Hospital, a lady (referred to as ‘GN’) made an appointment to see him in respect of medical complaints. She saw him for consultations again in February and in March 2003. Shortly thereafter, Dr Yeong met GN for lunch. On Dr Yeong’s account, set out in a written plea of mitigation to the Singapore Medical Council (SMC) which was also before the FTPP, during this lunch meeting GN propositioned Dr Yeong and suggested they should go to a hotel room together. Soon afterwards they began a sexual relationship. In the course of that relationship, GN insisted that Dr Yeong pay substantial sums of money into her bank account. Dr Yeong paid her 4,000 Singaporean Dollars (approximately £2,000) per month over the course of the relationship, which was continued over about two years, resulting in a total payment to her of approximately £44,000. He also provided her with gifts. GN threatened to expose their relationship to his wife if he did not …” Yeong v General Medical Council, Court of Appeal—Administrative Court, 28 July 2009, [2009] EWHC 1923 (Admin).

Ms Kemp: “… You are considering an allegation in accordance with article 27(3)I of the HPO2001. You are considering an allegation made against Dr Cross which has been made under article 22(1)(a)i. That allegation, as you have heard, which was read out to you by the Hearings Officer, is that Dr Cross’s fitness to practise is impaired by reason of misconduct. And the overarching allegation is based upon particulars 1(7) of the Notice of Allegation dated 10 November 2009. That appears at page 6. You have heard already this morning from your Learned Assessor and also Mr Tyme that you consider the allegation in three stages. Firstly, is the factual element well founded, that is, proved on the balance of probabilities, and the Health Professions Council bears the burden of proof. Secondly, you then go on to consider whether those facts, if you find them to be proved, amount to misconduct. That is a matter for your professional judgement. Thirdly, if you do find that those facts amount to misconduct you consider whether fitness to practise is impaired as a result of today’s date”.

The main part of this book is the (slightly truncated) transcript of Dr Malcolm Cross’s FTP hearing at the HPC. It is examined in order to think about what the HPC form of regulation means, not because the actions of the man himself are particularly interesting; they are not. The main aim of the work is not to know anything in particular about Dr Cross, although this proves unavoidable—he has been thrust to the front of the picture and hides the real object of our analysis. Nevertheless our purpose is to understand how the HPC realizes its mandate of regulation. By reading this transcript with that aim in mind, it is possible to see behind the man in the dock and to ignore the details of the case and instead to focus on the people, ideas and structures that make up the context of the case, and that turn this into a case, in fact.

In this chapter, we are going to hear the evidence of the quality assurance officer from the BPS. As Ms Ross is a witness on behalf of the HPC, she is questioned first by Ms Kemp. Having established a few administrative details, Ms Kemp opens by quoting from the statement, in which Molly has said: I have always had a good professional relationship with Malcolm Cross and felt that his behaviour on the evening in question was entirely out of character. This is similar to the testimony of Mr Hughes, who also suggests he has a long-term knowledge of Dr Cross against which to judge Dr Cross’s behaviour on the evening in question as unusual.

Voltage- and calcium-dependent BK channels regulate calcium-dependent cellular events such as neurotransmitter release by limiting calcium influx. Their plasma membrane abundance is an important factor in determining BK current and thus regulation of calcium-dependent events. In C. elegans, we show that ERG-28, an endoplasmic reticulum (ER) membrane protein, promotes the trafficking of SLO-1 BK channels from the ER to the plasma membrane by shielding them from premature degradation. In the absence of ERG-28, SLO-1 channels undergo aspartic protease DDI-1-dependent degradation, resulting in markedly reduced expression at presynaptic terminals. Loss of erg-28 suppressed phenotypic defects of slo-1 gain-of-function mutants in locomotion, neurotransmitter release, and calcium-mediated asymmetric differentiation of the AWC olfactory neuron pair, and conferred significant ethanol-resistant locomotory behavior, resembling slo-1 loss-of-function mutants, albeit to a lesser extent. Our study thus indicates that the control of BK channel trafficking is a critical regulatory mechanism for synaptic transmission and neural function.