regulating ethics and conduct at the council for · the past: with the cpsm and earlier still. this...

Research report

Regulating ethicsand conduct at theCouncil forProfessionsSupplementaryto Medicine– 1960 to 2002

Foreword 2

Acknowledgements 3

1 Introduction: the origins ofregulation 4

1.1 The Board of Registration ofMedical Auxiliaries 4

1.2 The development of statutoryregistration: the CPSM 4

2 Why regulate allied healthprofessionals’ conductand how? 7

2.1 The foundations 7

2.2 The three fundamental principles 7

2.3 Regulating allied healthprofessionals 8

2.4 Possible models of professionalregulation 9

2.5 The British model of professionalregulation 11

3 The CPSM structure and thedisciplinary function 12

3.1 The statutory foundations of theCPSM and boards 12

3.2 The purpose of the legislation 13

3.3 Justice, reasonableness and theright to a fair hearing 15

3.4 The Investigating and DisciplinaryCommittees 16

3.5 Infamous conduct 17

3.6 The investigating anddisciplinary ‘rules’ 18

3.7 Protected titles 19

3.8 Professional conduct andadmission to the Register 19

4 The disciplinary processat the CPSM 21

4.1 Allegations 21

4.2 The preliminary investigation 22

4.3 The effects of low publicknowledge of the CPSM 23

4.4 The disciplinary hearings 23

4.5 The hearing process 24

4.6 The Council 25

B

Contents

1

5 The boards’ standards ofconduct 27

5.1 The Statements of Conduct 27

5.2 The Statements of Conduct andregistrants 28

5.3 Queries and advice 28

5.4 1975 to 2002 – a period ofradical change 29

6 Individual issues relating tostandards of conduct 31

6.1 Advertising 31

6.2 Professional nameplates 33

6.3 Promoting products 34

6.4 Professional scope of practice 35

6.5 The ‘supplementary’ status of theprofessions 37

6.6 Delegation to assistants 40

6.7 Registrants’ responsibilities duringindustrial disputes 40

6.8 Duty of care owned to patients,clients and the public 41

6.9 Confidentiality and recordkeeping 44

6.10 Professional indemnityinsurance 45

6.11 Inappropriate association 46

7 Cases and hearings 48

7.1 The very small number of cases 48

7.2 Outcome of hearings 49

7.3 Competence cases 50

7.4 Health cases 50

8 The CPSM and professionalconduct, a final word 52

8.1 A great step forward in 1960 52

8.2 Internal reform and modernisationat the CPSM 52

8.3 The need for statutory change 53

Glossary 54

Relevant documents 56

Appendix 1 – The healthprofessions covered by the CPSMand the registrars 57

Appendix 2 – The disciplinarysections of the ProfessionsSupplementary to MedicineAct 1960 58

Appendix 3 – Convention for theProtection of Human Rights andFundamental Freedoms: Articles6, 10 and 11 62

Appendix 4 – The basic structureof the CPSM 63

Appendix 5 – Statistical charts 65

Foreword

In the area of conduct, as in all other areas ofprofessional regulation, there has beenconsiderable and significant developmentsince the Health Professions Council (HPC)began in 2002. However, the period ofregulation covered by the Council forProfessions Supplementary to Medicine(CPSM) and its respective boards was also atime of great significance, and saw equallyimportant development. It is now several yearssince the Health Professions Council replacedthe old boards. As such it is possible to takean objective look back at the efforts of theboards and their conduct committees, to dealwith the disciplinary side of regulation, and tomap any changes.

Professional conduct and ethics is increasinglytopical, and the source of growing discussion,controversy and research. To inform thedebate, it is important to be aware that theroots of regulating professional behaviour lie inthe past: with the CPSM and earlier still. Thisreport will therefore look at how the CPSMboards and their conduct committeesdeveloped their standards of conduct andethics and accompanying conduct processes,and how they dealt with some of the basicissues of the day.

This account is from the perspective of thehistory of the CPSM and boards. It does notconsider the HPC’s own processes, practicesand arrangements. It is an historical documentonly and so does not reflect the policy or viewsof the current HPC. Although, necessarily,it does on a number of occasions refer tolegal issues.

In looking at this period, it is important torecognise that ideas, principles and standardschange and develop, and will always do so.Much has changed in the world of all thehealth professions and wider society sinceregulation began. As a general observation,it would be unreasonable to expect today thatthose who set up and worked their systems ina quite different era would have always abidedby our own standards, judgments andprocesses. Indeed, the professionals and theirregulators fifty years hence will be looking attoday’s HPC in the same way that this reportlooks at the CPSM.

Regulating ethics and conduct at the Council for Professions Supplementary to Medicine – 1960 to 20022

This research report was prepared by TomBerrie, Information Service Manager at theHPC. Tom joined the Council for ProfessionsSupplementary to Medicine (CPSM) in 1984and was involved in the setting up of the HPCfrom its shadow form. The responsibilities ofhis current role include producing historicalmaterial and items relating to the foundationand development of the CPSM. This report istherefore a product of that work.

The author would like to thank the followingpeople / organisations for their support,suggestions and insight, all of which havecontributed to this review: Donald Lorimer,Dr Sandy Yule, The Society of Chiropodistsand Podiatrists, The Society of Radiographersand The College of Occupational Therapists.

Views expressed in this report are those of theauthor and not the HPC.

Regulating ethics and conduct at the Council for Professions Supplementary to Medicine – 1960 to 2002 3

Acknowledgements

1 Introduction: the origins of regulation

1.1 The Board of Registration ofMedical Auxiliaries

Regulating and registration of non-medicalhealth professions goes back many decades.Between 1960 and 2002 the Council andboards ‘Supplementary to Medicine’ carriedout this function for most of these professions.Before the early 1960s there had been avoluntary register for a few of them, which theBoard of Registration of Medical Auxiliaries(the BRMA) had run since 1937. The BritishMedical Association (BMA) had set up theBRMA in 1935, as a non-profit makingcompany. It published its first register on26 May 1937. Each profession that itregistered had its own committee. There werecommittees for chiropodists, dietitians,orthoptists, physiotherapists1, radiographers,speech and language therapists (then simply‘speech therapists’) and dispensing opticians.Each registrant paid a yearly fee of ‘half aguinea’ (10 shillings and sixpence inpredecimal money; a guinea was 21 shillings,£1.05) and received a registration certificate.

The BRMA carried on into the early 1960s,when the Council for ProfessionsSupplementary to Medicine (CPSM) andboards replaced it, although the CPSM didnot take on dispensing opticians, which wentto the General Optical Council (GOC), and didnot take on speech and language therapistsuntil 2000. The respective professional bodies,such as the then Society of Chiropodists andthe Society of Radiographers were much moredirectly involved in the BRMA than they were inthe subsequent CPSM. They appointed theprofessional representatives on theprofessional committees. The committeeshad no professional conduct functions,relying on the respective professionalbodies to deal with allegations.

Therefore, removal from the register onconduct grounds was problematical. Strictlyspeaking, the BRMA had no ‘powers’ atall, as it had no statutory basis. As well as theprofessional bodies, it was very much underthe control of medical practitioners and theirprofessional body, the BMA, which subsidisedits staff and accommodation. As the article inthe British Medical Journal in 19822, whichalthough unreferenced was probably written byBrian Donald, stated:

“The Board was effectively under the wingof the BMA, which not only subsidised itsstaff and accommodation but also kept afatherly eye on the various groups and triedto help improve their conditions, status,and pay.”

1.2 The development of statutoryregistration: The CPSM

The BRMA’s effectiveness was very limited dueto the fact that it lacked statutory backing to itsprocesses and, as stated above, had no role inprofessional conduct, which was left entirely tothe participating professional bodies. For thisreason, and because it was dominated by themedical profession, during the 1950s therewas considerable discussion withingovernment, the professions, and someconsultation with interested parties includingvarious professional bodies, on makingregistration ‘statutory’ (giving it legal backingthrough an Act of Parliament). People werenow using ‘professions supplementary tomedicine’ rather than ‘medical auxiliary’,as they were now professions in their ownright. The result was the ProfessionsSupplementary to Medicine Act 1960 (the Act).


1 However, the physiotherapists dropped out after a few years.

2 ‘Briefing: Professions supplementary to medicine’, The British Medical Journal, 284 (27 February 1982), pp 680–681.



The Act set up a supervisory Council, andboards for chiropodists, dietitians, biomedicalscientists (then called medical laboratorytechnicians), occupational therapists,physiotherapists, radiographers and remedialgymnasts (who were similar tophysiotherapists and merged with themin 1986).

Originally, there were to be eight professionalboards. But before Parliament passed theProfessions Supplementary to Medicine Bill,the speech therapy profession, which had untilthen intended to seek inclusion, decidedagainst doing so. It did not come within theterms of the Act until 2000. The OrthoptistsBoard came into being in 1967. Forconvenience, people usually called the wholestructure, collectively, the CPSM, although thiswas strictly speaking inaccurate, because theinitials only referred to the Council.3

Each board had its own register and two kindsof member; the majority being members of theprofession. The boards’ registrants elected themajority of members by a postal ballot.The Council appointed the rest afternomination by outside bodies. The medicalprofession in its various branches retained amajor role regarding the professions in theearly days. For example, the first Chairman ofthe Dietitians Board was not a dietitian but amedical practitioner, Dr R. J. Allen andcontinued in this post until the mid-1970s.The Chairman of its Education Committeecontinued to be a medical practitioner, Dr J. D.Baird, until the mid-1980s. This dominance ofthe medical profession changed during the lastperiod of CPSM’s history, as medicalpractitioners gradually became less involved inthe boards’ day-to-day work and activities.

Compared with the previous BRMA system,effective professional conduct powers were akey part of the CPSM system which theProfessions Supplementary to Medicine Act1960 set up. The Act did this through theboards’ Investigating and DisciplinaryCommittees, and the standards that the latterissued through their ‘Statements of Conduct’.State registration assured patients, the publicand employers that registered members of theprofession were appropriately qualified andcompetent to practise. It was a standard thatpeople could recognise throughout the UnitedKingdom and beyond. It provided significantpublic protection from unprofessional orunethical behaviour. An important reason forthis was that there was a formal, statutorydisciplinary process which began to set somebasic standards, and could deal withallegations against members of the professionand remove people from the register wherenecessary. Nonetheless, the Act was rooted inthe 1950s and there were significant limitationsto the existing powers.

During the last decade or so of their existence,the Council and boards began to deal with thechanging, and increasingly complex issues thatwere beginning to arise. They did so aseffectively as they could within the limitations oftheir powers. They and the staff had alsobegun to address and change anorganisational culture which was rooted in thepast. In particular, for a number of reasons, theincreasingly outdated legislation restricted andlimited the effectiveness of the powers that theboards had in relation to professional conduct.

3 Whilst acknowledging the importance within the whole structure of the autonomy of the Boards and their conductcommittees, we therefore continue this use of CPSM throughout the report.


Two of the most serious limitations were thelack of legal protection of the common titles ofeach of the professions and the very limitedsanctions that the boards’ DisciplinaryCommittees had. The government set up theHealth Professions Council (the HPC),amongst other things, to remedy these, byprotecting basic common titles and introducingfull ‘fitness to practise’ standards, rules,processes and sanctions, and standardising allof these for all its professions.

The title ‘professions supplementary tomedicine’ was in 1960 a great advance on‘medical auxiliaries’ and reflected themovement towards their increasingprofessional autonomy. However, as theprofessions developed further, the term itselfbecame outdated. Most of the partiesinvolved, including most of the professionsthemselves, the NHS institutions andgovernment departments, began instead touse the term ‘allied health profession’ and‘allied health professional’ throughout much ofthis period. Although its use in practice varied,this report uses this term throughout to coverthe professions within the CPSM, shortened toAHP, rather than the term ‘supplementary’.



2 Why regulate allied healthprofessionals’ conduct and how?

2.1 The foundations

Professional regulation has developed overseveral centuries and in our society it isarguably now regarded as normal. As a part ofthis, the CPSM professions have had formalregulation since 1960. Before looking at thedevelopment of CPSM’s regulation ofprofessional conduct, it is important to look atwhy regulation of their conduct, includingeducation and training, came about and thebasic principles involved.

2.2 The three fundamentalprinciples

British society has arguably long recognisedthat it cannot control all professional characterand behaviour, nor prescribe every detail ofbehaviour and practice. This would be highlyimpractical. Nor would it want to do so,because this would be contrary to our Westernconcept of the liberal professions andprofessionalism, which has long asserted thatit can and should leave professional,day-to-day practice to the individualprofessional’s own judgment. It has largelyleft the professional to ‘get on with the job inhand’. However, it recognises that someregulation is necessary, because of theresponsibilities that all health professionals,including AHPs, have regarding their patientsand the public in general. We can see threeprinciples which underlie such professionalregulation, and are of much more widerapplication, and existed well before the UKgovernment in the 1950s and early 1960s waspreparing and enacting the CPSM and itslegislation.

2.2.1Autonomy

Our society arguably encourages humanautonomy, ensuring that all can realise theirhuman potential. Individuals and groups areentitled to live as they believe is appropriate,and to free speech and expression.

People are therefore entitled to earn their livingand pursue their ambitions, including the rightto pursue the career and profession of theirchoice, and develop professional groups andassociations. Citizens are also free to consultprofessionals as they see fit.

2.2.2 The common good

The state must protect its public and ensuretheir safety, and protect them fromunprofessional, dangerous or incompetentpractice by establishing and enforcing basicprofessional standards, because it has longbelieved that it must protect and develop the‘common good’. The wellbeing of each personnecessarily relates to the good of everyone.Everyone should do good and avoid harm,and so must control, plan and regulate theirbehaviour, by following certain basicstandards. Society therefore expects healthprofessionals to benefit the public, tocontribute to the public or common good,and not to act against it.

2.2.3 Justice and equity

Our society wishes to maintain justice andequity and thus balance autonomy and thecommon good. This is particularly relevantto professional practice, where healthprofessionals have traditionally sought to earntheir living and further their legitimate careers,by serving others and society in general.So, the state must both respect professionalautonomy and protect the public, dealing witheach individual and group fairly. Justice andequity demand that all be consistent and fair,avoid unfair discrimination and arbitrarydirectives and decisions. Maintainingstandards and treating all fairly have long beena fundamental part of ‘being a healthprofessional’, whatever the specialism.Therefore, professionals and their institutionsmust establish good, sound reasons for theirpractice, actions and standards, related to theempirical evidence and real world.

2 Why regulate allied health professionals’ conduct and how?

2.3 Regulating allied healthprofessionals

Historically, within the United Kingdom, allthree principles have been equally important inregulating AHPs. They have for fifty years beenentitled to real, though certainly not unlimited,professional autonomy. This includes freedomto organise their profession collectively,through associations and groups. The degreeof autonomy has developed over time.Professions exist to provide a source ofincome, satisfaction and personaldevelopment for their members, and to servethe public good, and the public is entitled to agood and safe professional service from them.This is why the state started to regulate at leastsome of the AHPs through the CPSM in 1960,and sought to ensure that they were fit topractise. The public, the AHPs themselves andtheir employers are entitled to know thestandards that the professions are expected tomeet and by which they are to be assessed. Ithas long been accepted that these standardsmust be reasonable and founded uponcoherent principles and an evidence base; thatthe AHPs themselves must have someinvolvement in their creation and development;and that within the system, an AHP andprofession could expect fair andequitable treatment.

Although essential, statutory regulation hasnever been the only part of setting andmaintaining standards of conduct and ethics.There have always been other significantdimensions, which are essential for effectivecontrol and regulation. The regulators havealways needed to take into account the muchwider dimension within which standards ariseand are enforced, and work with them(something that is now often called‘metaregulation’). These are the common

values, customs, ideologies, traditions, history,institutions and life of the society within whichthe professions and regulators have emerged,worked and developed. AHPs themselves intheir associations and groups, both informaland formal, have long played a significant role,each with their own history, ethos andcommon purpose. The origins of the CPSMprofessions are very varied4. Each developeddifferently, in different contexts, within theirdiffering specialisms. Some are oldprofessions; for example, chiropody.Chiropodists first developed, a century or morebefore the foundation of the ChiropodistsBoard, within the context of independent,private practice. The radiography and dieteticprofessions developed within a technical andlargely hospital context, decades before theestablishment of their respective boards.The biomedical and clinical scientistsdeveloped within a scientific context.Occupational therapy and speech andlanguage therapy developed within a moreone-to-one, person-centred context, in avariety of types of organisation. The paramedicprofession is, on the other hand, very new andhas developed as ‘responders toemergencies’. Each therefore brought analready well-established ‘history’ upon beinggiven a board, which continued to form theirprofessional values, attitudes and conductthroughout the history of that board. This helpsexplain the boards’ and DisciplinaryCommittees’ choices of the standards whichthey highlighted and developed, those thatthey did not, and their attitudes to individualissues and cases.

Other professionals in the working environmenthave also played their part. The workingenvironment encompasses government policyand the media, employers and the users of the


4 For an early history of these professions see: G. Larkin, Occupational Monopoly and Modern Medicine, (TavistockPublications, London and New York, 1983). Several professional bodies have also produced their own histories fortheir professions.



service that they provide. All AHPs use theirprofession as a source of work and theirprofessional practice has an importanteconomic dimension. Their employers andemploying organisations, particularly but notexclusively the NHS, and market forces,particularly for the self-employed professional,have always influenced their ethicsand conduct.

Education providers have also always beenvital in forming all the CPSM professionals incompetent and ethical practice. Thiscontribution included practical training andacademic institutions, curriculum frameworks,minimum standards, entry requirements,systems of assessment, examination andvalidation. Setting and enforcing standards ofprofessional conduct has always been closelylinked to setting standards of professionaleducation and training. During this period,there were very considerable changes in thesetting and context of professional educationand training of AHPs, which have all had amajor impact on the standards of conduct.

2.4 Possible models ofprofessional regulation

Historically, the United Kingdom has usuallyincorporated regulation of professionalconduct within one single structure, which hasalso included professional education andtraining, and has chosen one particular way ofregulating professions. This was the structureused for the CPSM professions. However,Parliament could have, in theory, chosen otherways to regulate them. Before setting out theway that the government in 1959–60 chose forthe CPSM professions, below are the mainpossible alternatives.

2.4.1 Using the professional body

It could have given the task to the respectiveprofessional body. For example, at the timegovernment was considering regulating theCPSM professions, a professional body (the

Royal Pharmaceutical Society of Great Britainand the Pharmaceutical Society of NorthernIreland) regulated pharmacy. In the case of theCPSM professions, the Society ofRadiographers, for example, would haveregulated radiographers as well as representedtheir interests. In fact, many of the professionalbodies (including the Society of Radiographers)were (and continue to be) involved in theirmembers’ professional conduct, includingsetting standards and removing membershipdue to misconduct. However, this did not, initself, have statutory backing. Governmentshave used this method of regulation fornon-health professions, such as engineersand accountants (and continue to do so),by granting a royal charter to a particularprofessional body. This is a very oldlegal process, much older than that ofstate registration, and gives the body‘charter’ powers.

However, the extensive discussion throughoutthe 1950s produced a consensus that thismodel was likely to confuse the legitimate roleof the professional body as advocate of theprofession, with the quite different andpotentially conflicting role of protecting thepublic; this is particularly important to keepseparate in the case of professional conduct.Further (though this is less true in many casesnow), the respective professional bodies in the1950s were small and in some cases tiny (somehad almost no paid staff at all); in practice mostof them were not capable of fulfilling a regulatoryrole, particularly one which involved consideringobjectively and fairly disciplinary issues. Finally,regulation by professional body is, essentially,profession-specific and does not provide anyopportunity for interprofessional regulation andcommon standards. Even in the late 1950s and1960, government considered that a degree ofinterprofessional regulation and commonality ofstandards was desirable. These are the mainreasons why government, ministers andParliament did not choose this model in1959–60.


2.4.2 Direct regulation by governmentdepartment and decree

Instead, governments have usually set uparrangements for regulating their AHPs that areindependent of the profession itself and itsprofessional associations. A significant andwidespread alternative to the British method isthe European continental tradition of directregulation within their own legal traditions,for example, through the relevant minister anddepartment, by decree and legal code.Government departments, nationally orregionally, directly control professionaleducation and practice (although they usuallydo this with the cooperation of, or eventhrough, the relevant professional body).Those who have attended an approvedinstitution and obtained the diplomasanctioned by the relevant governmentdepartment (in the case of AHPs, the HealthMinistry or Department) have the right topractise the profession. Only those so qualifiedare eligible to practise. They work within thescope of practice and codes of behaviourprescribed by legal decree. This decree is anintegral part of the whole legal code. Thosewho do not are breaking the law and can beprosecuted in the courts. This provides directaccountability of the professions to Parliamentor another democratically elected assembly.The decree and code directly enforceprofessional conduct and ethical standards,and have the full force of law.

However, in the United Kingdom, the HealthMinistry or Department has been the ultimateemployer of AHPs within the National HealthService as well as the strategic planner forhealth at the national level, since itsestablishment in 1948. Those involved in theconsultations and in preparing legislationconcluded that it would potentially confuse itsrole and functions if the Ministry of Health alsohad the quite different, and, potentiallyconflicting, function of detailed regulation of theprofessions. Other ministries or departments

would be unlikely to have the appropriateknowledge and expertise to carry out thefunction. Further, although a legal code givesthe profession full legal standing andprotection, it is likely to require a change in thelaw every time a change is needed. This couldslow down that natural progress anddevelopment which even in the 1950s wasregarded as important to any profession.Finally, it is clear from the reports and debatesduring the 1950s, that the UK governmentwished to allow the professions a degree ofinvolvement in their own regulation, whichwould be more difficult in the case of directregulation by government department. Theseare the reasons, among others, that in theUnited Kingdom, governments have notchosen, at least so far, this model of regulationfor full professionals, including for the CPSM in1960 and other subsequent regulatory bodies.

2.4.3 Licensing boards

Another alternative was the licensing boardsystem which is found, for example, in variousforms in the United States of America. It is,superficially, similar to the British system,in that a legally autonomous ‘board’regulates its designated profession.

The board is directly accountable to thegovernor or to the state legislature. Boardsissue their own codes of ethics, which theyenforce by various legal means. Many of theseboards are ‘profession-specific’ like the CPSMboards (except, unlike the CPSM they areoften entirely so, there being no overarchingCouncil). Unlike the British tradition however,boards offer a ‘licence’ rather than ‘entry on aregister’. The professional therefore has anactual ‘licence’ which they can place upontheir wall. In some cases this ‘licence’ is also atrue ‘licence to practise’, ie it grants functionalclosure to the professions, where only thosewith a licence can practise the profession.In 1960, almost none of the professions hadfunctional closure in the United Kingdom (to




this day, only midwifery, hearing aid dispensingand dentistry in the health area have this) andso far, governments have been very unwilling,to impose functional closure. In the late 1950sthis was out of the question for professions stillconsidered ‘supplementary’ to medicine, wheneven the medical profession did not have it.

2.5 The British model ofprofessional regulation

The British model for a long time has been the‘statutory registration’ model, where theregulatory body holds a register of those whomeet its standards, usually accompanied bysome form of protection of title for thosewhose names are on the register (seesection 3). This model has developeddifferently from those outlined above, andcountries greatly influenced by Britain also useit. In it, statutory bodies carry out regulationentirely separately from either professionalbodies or government departments, and areaccountable ultimately to Parliament, not theprofession or government.

In the 1950s, the relevant ministries and theirministers, most bodies consulted andParliament all agreed that this ‘registration’model was the most appropriate one forregulation of what they then called the‘professions supplementary to medicine’.They considered that it was the arrangementwhich best reflected the need to balancelegitimate professional autonomy with publicprotection. When Parliament set up the CPSM,the model had been well established for over ahundred years by the General Medical Council(originally the General Council of MedicalEducation and Registration). Therefore, thegovernment of the day set up the CPSMsquarely in that British tradition of regulation,which had also produced the General DentalCouncil, the General Optical Council and theother subsequent regulators of healthprofessions, as well as non-health registrationbodies such as the Architects Registration

Board. These statutory bodies have beenindependent of government from the start, buthave the legal powers to enforce theirstandards, including standards of conduct.However, the constitutions of these statutorybodies at that time allowed for participation bythe professionals themselves in their ownregulation. For example, each of the CPSMboards and their conduct committees (but notthe Council) had a majority of one of memberswho were directly elected by the registrantsthemselves. The purpose of this was to allowfor a direct participation by members of theregulated profession that was independent oftheir professional body.

3 The CPSM structure and thedisciplinary function

3.1 The statutory foundations ofthe CPSM and boards

3.1.1 The Council

The early consultation documents aboutregulation on the professions then called‘auxiliary to medicine’ acknowledged thatprofessional conduct and an effectivedisciplinary process was a key feature of anyfuture regulatory body, although they did notexplore this in any detail. The report of theWorking Party on the Statutory Registration ofMedical Auxiliaries in November 1954: thePater Report, prepared the way for stateregistration. It, in respect of professionalconduct, stated that the “functions which theregistration body should be designed toperform” should include the ability “[t]o removefrom the register persons who have shownthemselves unworthy of retention.”

The report advised that the proposedregistration boards have this function.The ‘Coordinating Council’ would hear anddetermine appeals by people removed fromthe register against the board’s decision.Professional discipline would be theresponsibility of each professional board, notthat of the coordinating council. Thegovernment adopted this policy in thesubsequent Professions Supplementary toMedicine Act 1960 (the Act).

The Act set up a Council, and boards forchiropodists, dietitians, biomedicalscientists (whose title was then medicallaboratory technicians5), occupationaltherapists, physiotherapists, radiographersand remedial gymnasts. Remedial gymnastswere similar to physiotherapists and merged

with the latter in 1986. The Council and boardswere legally accountable, not officially to thegovernment or Ministry of Health, but the ‘PrivyCouncil’, an ancient constitutional arrangementgoing back to medieval times. The PrivyCouncil retained certain rights to determineappeals, make certain appointments tostatutory bodies and to make legislation,known as ‘Orders in Council’ and ‘Orders ofCouncil’. All of these it exercised in respect ofthe CPSM and boards. In reality this meant therelevant Government Minister or Secretary ofState who was a member of the Privy Council.The Council of CPSM appointed the Registrar,who was the chief executive, although the term‘Chief Executive and Registrar’ did not appearuntil the very end of the CPSM. It employedthe other staff, collected registration fees,controlled the finances, supervised and co-ordinated matters of common interest, andorganised the elections to the boards.However, people began calling the Council,boards and staff, all, together, the CPSM, andnormally continued to do so until the end.People did not start to use the term ‘fitness topractise’ until very late in this period. Theprofessions at that time widely used the term‘discipline’, as in ‘professional discipline’ untilthe 1990s. At CPSM, people used terms like‘disciplinary procedure’, and the committeeswhich assessed and decided upon allegationswere ‘Disciplinary Committees’.

3.1.2 The boards

Each board was legally autonomous and hadits own disciplinary powers. It had two kinds ofmember. The majority of its members wereelected from its own registrants. The Councilinvited nominations from the registrants of that


5 The Act listed each profession specifically. Not long after, this profession renamed itself ‘medical laboratory scientificofficers’. However, to change the title of the Board would have required a change in the Act itself, so formally itremained the ‘Medical Laboratory Technicians Board’ until the end of the CPSM – the whole point of them being‘professions supplementary to medicine’ was that they were ‘professionals’, not ‘technicians’. However, the Boardused ‘medical laboratory scientific officers’ in everything but legal documents.


3 The CPSM structure and the disciplinary function

board, who elected from the nominations aprescribed number by a postal ballot.Registrants voted for elected members inpairs: there was the main member and an‘alternate’ member who had the right to attendand act on behalf of the main member if theywere not attending the meeting. The Councilappointed the rest of the Board members,after nomination by outside bodies named inthe legislation. The majority of these appointedmembers were from the medical profession.There would also be someone who was anexpert in education. At first they would usuallybe a college principal, then from about 1990,deans of faculties and professors. Each boardhad an Investigating Committee andDisciplinary Committee. All members of aboard had to be a member of one or the other,but could never be both. The Board Chairmanwas automatically the Chairman of theDisciplinary Committee. The board alsoappointed the Investigating CommitteeChairman from amongst the membership ofthat Committee. In some, but by no means allinstances, this would, by convention, be theVice-Chairman of the Board. However, thelegislation restricted membership of bothcommittees to board members only andneither could co-opt outsiders.

3.2 The purpose of the legislation

Section 1(2) of the Act stated that each board“shall have the general function of promotinghigh standards of professional education andprofessional conduct among members of therelevant professions”.

This subsection set out the ‘function’ of theboards and therefore, by implication, theCouncil, but it did not specify the ultimatepurpose of registration, ie what it was for,precisely why it was to promote high standardsand what they were. One should also note thatthe word ‘promoting’ is slightly less proactive,

than the later ‘establishing’ as, for example, inthe Health Professions Order 2001.Presumably it was up to the board todetermine what ‘high’ meant in particularcircumstances. In those days, unlike in modernlegislation, regulatory legislation usually did notactually set out what the ultimate purpose ofregistration was. The Act was no exception.We have to deduce its purpose from thelegislation itself, and its background andcontext. However, it is clear from thebackground papers leading to and from theAct, and the debates in Parliament on thepreceding Professions Supplementary Bill,that ‘state registration’ was about promotingstandards, with the ultimate purpose ofprotecting the public. Rod Pickis, in his paperCPSM and Professional Education,Registration, and Regulation6, quoted theMinister of Health of 1960, in describing thebenefits of state registration.

“Identification of trained and qualifiedpersons with high ethical standards, notonly for the purposes of the NHS, or evenof other public services, but also in theeyes of the public generally.”

Employers and the public needed safepractitioners, but also to have confidence inthe professions themselves. Certainly, all theboards and their Disciplinary Committeesunderstood their main purpose was to protectthe public. The introductions to all of theStatements of Conduct (see section 5), fromthe late 1960s, stated that “[t]he purpose ofthe statement is to enable the Board to fulfil itsstatutory function of promoting high standardsof professional practice. These standards arerequired, not solely, or even principally for thebenefit of the profession, but for the protectionof the public.”

6 See ‘Relevant Documents – Other Documents’, below.


The Minister in 1960 went on to say elsewherethat the legislation gave the professions a “[f]ulland proper measure of self government andconferred status through the association withthe Privy Council.”7

Following on from this, we can derive thelegislation’s ultimate purpose from thosefoundational principles which are at the veryheart of public life and legislation in the UnitedKingdom, and has already been covered insection 2 above: maintaining the liberty, bothindividual and collective to pursue theprofession of one’s choice and for the public toconsult that professional; the need to protectand develop the welfare of all, and thus thepatient and public; and ensuring justice andequity in dealing with all parties and settingbasic, consistent standards.

It is clear from the background of debates,discussion and reports of the time that thelegislation’s purpose was also to set theboundary between the medical professionsand what were then the ‘professionssupplementary to medicine’, between theprofessions and each other, and between theregulated and unregulated sectors. Thelegislation’s authors and framers clearly sawthat, as well as setting and enforcing standardsof conduct, the boards’ disciplinary functionsof the Investigating and DisciplinaryCommittees, hearings, and the issuing of theStatements of Conduct were intended to playan important part in this delineating ofboundaries. At the time, they were declaringand illustrating that the CPSM professions,were in a broad sense ‘medical’ in the broadersense, but supplementary to medicine itself.Rod Pickis, in his paper, quoted the Editor ofthe Lancet in 1960, Sir Theodore Fox, assaying that these professions were part of the

‘greater medical family’, with the medicalprofession clearly implied as the ‘head’ of thefamily. This is not the way people would see itlater. Nevertheless, they arguably continued(and continue to this day) to think of all healthprofessions as forming parts of the wholehealthcare team and recognised the need toset some sort of professional boundaries (seesection 6.4).

Finally, the previous background to the framingand passing of the Act implies that its purposewas also to provide a standard foremployment, including giving employers andpotential employers a degree of guarantee ofcompetence and good ethical behaviour. RodPickis stated that:

“The final standard is that of the standardfor employment. It should be emphasisedthat state registration is an independentstatutory standard of excellence, ofprofessionalism, of ethical behaviour and oftrue medical activity. It is also, at present,by separate statutory provision[subsequent to the PSM Act], the criterionfor employment in the relevant professionalcapacity in the NHS, in NHS Trusts and inLocal Authority Social ServicesDepartments.”8

This standard was (and is) applicable to anycontext in which the professional worked, asnot all of them worked or work for the NHSand a number work for themselves or theprivate sector.


7 Quoted in Rod Pickis’ paper ‘Relevant Documents – Other documents’, below.

8 Quoted in Rod Pickis’ paper ‘Relevant Documents – Other documents’, below



3.3 Justice, reasonableness andthe right to a fair hearing

The boards’ conduct powers reflected thealready well-established legislation of olderregulators of health professions. As statutorybodies, all the Committees and boards alsohad to obey the fundamental principles ofnatural justice. They could only act within thepowers given to them by Parliament, ie theycould not act ‘ultra vires’ and make decisionsor act outside the powers that its legislationhad given to it. So for example, a DisciplinaryCommittee could only use the sanctionsavailable to it within the legislation (striking offor not striking off), and could not make upentirely new ones.

Further, a Committee or Board could notmisuse its powers by acting ‘unreasonably’.The concept of ‘reasonableness’ is foundedupon a substantial body of case law built upover a considerable time. The committees andtheir officials had to act reasonably, fairly and ingood faith throughout all proceedings, and inall of its decisions, directions and actions.This principle goes back a long way andreflects the third fundamental principle inChapter 2 section 2.2, maintaining justice andequity. It included the duty that all partiesinvolved received a fair hearing, a central partof the CPSM investigating and disciplinaryprocesses. The important case, Dimes vGrand Junction Canal [1852], set out thefoundational definition of a fair hearing as theprinciple that “justice must not only be done,but must be seen to be done” and stated that“the maxim that no man is to be a judge in hisown cause should be held sacred.”

Therefore, the PSM Act, its subsidiarylegislation and the processes deriving fromthem, sought to ensure that the processes andhearings treated all sides fairly and equitably.During the processes, all parties had a right toa fair and impartial hearing of their case, toadequate notice of when the case was to beheard, to consider and challenge the evidence

presented, and reasonable time to preparetheir case thoroughly. The persons adjudicatingthe allegation had to be a disinterested partyand therefore not one of the parties in thecase.

When someone made an allegation, theregistrant whom they were accusing had theright to be fully informed of the accusation orallegation, and be given a fair opportunity torespond. The members of the InvestigatingCommittee and the Disciplinary Committee hadto be wholly impartial and unbiased. Therefore,a member of the Disciplinary Committee as setup by the Act, could not also be a member ofthe Investigating Committee and vice-versa, toensure that entirely different individualsconsidered the case at each stage, andboth were separate from the Council.Both committees were independent of theregistrant, their employer, their professionalbody, the police, the Courts or the personmaking the allegation. If a member of theCommittee was an interested party, they wererequired to declare this and could not take partin the proceedings. The principle in those dayswas that they were being ‘judged by theirpeers’, although both committees would alsohave medical practitioners, educationalists andothers from outside the profession. Registrantshad the opportunity to be represented duringthe process, although this was not compulsory.They were entitled to appear at the hearing ofthe Disciplinary Committee to present theircase, but this was not obligatory.

The Human Rights Act 1998, whichincorporated the Articles and Protocols of theConvention for the Protection of Human Rightsand Fundamental Freedoms, came into effectjust before the CPSM ended. The onlydifference that it made to the boards’ conductprocedures was that both the Investigating andDisciplinary Committees were now explicitlyrequired to set out the reasons for theirdecisions. Before, committees had in fact doneso, as this was seen as required by naturaljustice.


The reasonableness rule does not just includethe right to a fair hearing, but is more general,and includes any requirements, standards anddirections that the statutory body may make.For example, an item in a DisciplinaryCommittee’s Statement of Conduct (seesection 3.5) had to be reasonable and fair,and could not be arbitrary, whimsical orbiased. In fact, as is set out in section 6, it wasin this area, rather than that of allegations andhearings, where boards and committeesoccasionally laid themselves open toaccusations of unreasonableness andunfairness, for example, in relation toadvertising and publicising one’s services, and‘inappropriate association’.

3.4 The Investigating andDisciplinary Committees

The relevant sections of the PSM Act are setout in Appendix 2. Section 9 stated that theInvestigating Committee’s functions would beas follows.

“[T]he investigating committee shall becharged with the duty of conducting apreliminary investigation into any casewhere it is alleged that a person registeredby the Board is liable to have his nameremoved from the register, and of decidingwhether the case should be referred to thedisciplinary committee.”

Section 9 of the Act stated that:

“where

(a) a person who is registered by a board isconvicted by any court in the UnitedKingdom of a criminal offence which, in theopinion of the disciplinary committee set upby the board, renders him unfit to beregistered; or

(b) such a person is judged by thedisciplinary committee to be guilty ofinfamous conduct in any professionalrespect; or

(c) the disciplinary committee is satisfiedthat the name of such a person has beenfraudulently entered on the registermaintained by the board,

the committee may, if it thinks fit, direct thatthe person’s name shall be removed fromthe register.”

It also stated that:

“It shall be the duty of each disciplinarycommittee to prepare and from time to timerevise, in consultation with its board andthe Council, a statement as to the kind ofconduct which the committee considers tobe infamous conduct in a professionalrespect…but the fact that any matters arenot mentioned in such a statement shall notpreclude the disciplinary committee fromjudging a person to be guilty of infamousconduct in a professional respect byreference to such matters.”

These statements were therefore called‘Statements of Conduct’ (covered in sections 5and 6). Allegations under (a) came to be called,for convenience, ‘conviction cases’ and under(b), ‘conduct cases’, although all involvedprofessional conduct. In the late 1990s,committees included formal cautions as beingin the category of ‘conviction’. The relationshipbetween the two subsections was not entirelyclear. In assessing allegations in the conductcategory and giving advice to registrants onmatters of conduct, committees and hearingscould use the Statement of Conduct, althoughin the early years they were so short andunsystematic they were likely to be of limitedpractical value. Although they would refer tothe Statement, a hearing did not have anyspecific equivalent Statement or guidance onconviction cases.




3.5 Infamous conduct

The Act specifically refers to the concept of‘infamous conduct’, showing that it wasfundamental to all the boards’ standards ofprofessional conduct. The Act required that allthe Statements of Conduct set out the kind ofbehaviour which the Disciplinary Committeethought was ‘infamous conduct’. Infamousconduct was (and is) conduct that makes theregistrant unfit to stay on the Register. Theconcept of ‘infamous conduct’ is foundedupon a substantial body of case law. The termand concept goes back at least to the very firstMedical Act of 1858, which states that:

“If any registered MedicalPractitioner…shall after due Inquiry bejudged by the General Council to have beenguilty of infamous Conduct in anyprofessional respect, the General Councilmay, if they see fit, direct the Registrar toerase the name of such a MedicalPractitioner from the Register.”

Two significant Court cases contain the twoclassic definitions of infamous conduct.

– Alinson v the General Council of MedicalEducation and Registration (thepredecessor to the General MedicalCouncil) 1894 where the court defined itas if a professional “in the pursuit of hisprofession has done something withregard to it which would reasonably beregarded as disgraceful anddishonourable by his professionalbrethren of good repute andcompetency” and

– Felix v The General Dental Council 1960,where the judge said that the phraseremained as terms “denoting conductdeserving of the strongest reprobationand indeed, so heinous as to merit,when proved, the extreme professionalpenalty of striking off”.

‘Infamous conduct’ is therefore not just‘misconduct’. It is behaviour that brings theprofession into disrepute, and / or seriouslyendangers or adversely affects apatient / client, and / or seriously abusesthe registrant’s relationship with their patient /client. This was occasionally a problem for thecommittees, because there were examples ofmisconduct by registrants with which theywanted to engage, but could not do sobecause the actions were not ‘infamous’ andbecause the only remedy was the very seriousone of striking off.

Committees recognised that ‘infamousconduct’ has several aspects to it. It, forexample, includes endangering patient safety.Brian Donald’s revised introduction, commonto all boards, stated that:

“The Committee will have regard to…theduty on a member of the profession to haveproper regard to the welfare of a patient sothat the health or safety of the patient is notendangered.”

They also recognised that infamous conductincluded ‘bringing the profession intodisrepute’. Brian Donald’s revised introductionalso stated that:

“The adoption of such a code of disciplinewhich involves establishing ethical rulesand restriction beyond those required ofthe ordinary citizen by law, sometimes tothe personal disadvantage of theprofessional person, is designed toestablish the probity and competence ofthe profession in the eyes of the public.”

During the CPSM period, the followingjudgment by the Court of Appeal in Bolton vLaw Society (1994) supported this view. It held:


“the Solicitors Disciplinary Tribunal’s orderswere not primarily directed to punishmentbut to the maintenance of a well-foundedpublic confidence in the trustworthiness ofall member of the profession and thedischarge of any professional duty with lessthan complete integrity would attractsevere sanctions… A profession’s mostvaluable asset is its collective reputationand the confidence which thatinspires…The reputation of the professionis more important than the fortunes of anyindividual member… Membership of aprofession brings many benefits, but that ispart of the price.”

At that time, the Judicial Committee of thePrivy Council was the highest court of appealin respect of the conduct processes of mostthe regulatory bodies, including the CPSM.The Judicial Committee confirmed this inrespect of health professionals in a number ofnon-CPSM, appeal cases. As a result, theRegistrar of the CPSM wrote in early 2000 toall Board members and alternate membersreminding them that in dealing with cases theymust have consideration of not only:

“protection of the public [but also]…thewider one of public interest including amongother things:

1. Preserving public trust in theprofession.

2. Registering disapproval ofunprofessional conduct.

3. Maintaining high standards ofconduct.”

3.6 The investigating anddisciplinary ‘rules’

As soon as the boards began, the Registrar,John Tapsfield, who was a solicitor, draftedtheir subordinate legislation himself, includingthe rules for the Investigating Committees andDisciplinary Committees, and the Investigating

Committees’ standing orders.

Within the Professions Supplementary toMedicine Act there were sections and clauseswhich gave the CPSM Council powers to‘make rules’. The term ‘rules’ here has aformal, legal meaning, not just as in ‘rules andregulations’ (see Glossary), and they need tobe submitted to Parliament. In this case, theyprescribed the legal details for disciplinaryprocedure which were not in the original Actbut were outlined there. The CPSM andboards, being corporate bodies, had powersalso to set out formal processes andprocedures which had a legal status but didnot need approval of Parliament. These werethe ‘Standing Orders’ (see also the Glossary).

Each board had its own subordinatelegislation. Most of the legislation concernedthe Disciplinary Committees, not theInvestigating Committees. The InvestigatingCommittees did have their own rules, eg thePhysiotherapists Board (InvestigatingCommittee) Rules 1964, but these rules wereless detailed than those of the DisciplinaryCommittees. They simply set out theirconstitutions and did not cover procedures.The Investigating Committees laid these downin their standing orders, which barely changedbetween the start of CPSM and its end in2002. A registrant had the right to appeal adecision to the Judicial Committee of the PrivyCouncil. There was no corresponding specificand formal mechanism for the person makingthe allegation or a body acting on its behalf toappeal a decision as too lenient. However, theCouncil could challenge a decision under itsgeneral supervisory powers in Section 1(3).This rarely happened. Specific powers tochallenge decisions on grounds of excessiveleniency did not come until the Governmentcreated the Council for Healthcare RegulatoryExcellence (CHRE), after the end of the CPSM.




3.7 Protected titles

The Act did not protect the common titles ofthe professions, but there was some, limitedprotection of title. Anyone could legally use thecommon title, ‘dietitian’, etc without beingregistered. However, they could not callthemselves ‘state registered’, ‘registered’ and‘state’ dietitian, etc. It also sought to preventpeople, by their use of language ‘making out tobe’ or implying that they were registered whenthey were not. Later on the Council arrangedfor a number of successful prosecutionsagainst people using the above when theywere not registered, and publicised the boards’powers in this area and threatened withprosecution. Under separate legislativepowers, only people on the boards’ registerscould be employed in or contracted to theNational Health Service or local social services.The original separate regulations had beenintroduced making registration compulsory forthese categories of employees in 1964, forEngland and Wales, Scotland and NorthernIreland. This was closure of function in theareas where the majority of registrants worked.It did not, however, cover other areas of worksuch as private practice.

Protection of title was relevant to professionaldiscipline in two ways. First, the respectiveBoard, by definition, only covered the membersof its profession who were on its register, notthose who were not. This meant that the latterwere not subject to any statutory regulation; theBoard had no control over members of theprofession who were not registered, yet theycould still bring the profession into disrepute.So, for example, an allegation may have indeedbeen against a physiotherapist, but not allphysiotherapists were on the PhysiotherapistsBoard’s Register. Second, a registrant who wasstruck off could continue to practise, providedthey did not claim to be registered or try to workin the NHS or local social services. Both weremajor defects of the Act throughout itsexistence and why, amongst other things, theHealth Professions Order replaced it.

3.8 Professional conduct andadmission to the Register

The disciplinary powers only applied afterregistration. A board could not therefore refuseto register or reregister someone who wasunsuitable because of serious misconduct orill-health. They could not take into account anyconvictions or cautions before they actuallyentered the Register. Provided they had theright qualifications, the Board had to registerthem. For most of this period, the boards alsodid not take into account conduct orconvictions during periods when formerregistrants were off the Register. If they hadbeen registered before, the boardsautomatically reregistered them. Surprisingly, inrespect of the latter, until Mike Hall, Registrarshad never put into effect paragraph 13(ii) of thegeneral registration Rules which gave theRegistrar powers to require a former registrantwishing to return to the Register after five yearsor more to establish “to the satisfaction of theBoard his identity and good character”.

It is not now clear why they did not do so, asthis clause provided an important contribution tothe boards’ responsibilities for public and patientprotection. Mike Hall put this clause into effect inearly 1998, and from then on until the demise ofthe CPSM legislation, all former registrantswishing to return to the Register after anabsence of five years or more had to provideproper evidence of identity and good characterto the Registrar on the Board’s behalf.

The Council’s Working Party on the Future, inits document “Future Requirements andOpportunities” addressed the issue of conductbefore application as early as 1980. It wantedto introduce character requirements forapplicants for registration. The Councilaccepted this recommendation as a part of allthe Working Party’s recommendations. In1984, it included the recommendation in its listof recommended amendments to the Act:


“To ensure applicants for first registrationand subsequent restoration are free fromconvictions which would lead to erasurewere they registered at the time ofconviction.”

When it was clear that a review andreplacement of the Act was going to takesome time, the Registrar, Council and boardsagreed to take remedial action until amendinglegislation. They used their educational ratherthan disciplinary or registration powers.In 1998, all boards agreed to inform all ofthe educational centres which they approved,of the following:

“To protect vulnerable members of thepublic, the Board requires of academicinstitutions that all prospective radiographystudents submit to the institution criminalconviction certificates obtained under theData Protection Act 1984, Subject Access,(information which every citizen has theright to know), to ensure that there are noconvictions and / or cautions resulting fromcrimes of sufficient seriousness whichcould bar them from obtaining employmentin the National Health Service or itscontractors, or obtaining state registration.The production of this certificate will be acondition of acceptance on courses forwhich they have applied.”

Subsequently, a working party ofrepresentatives of all the boards, with theRegistrar, produced a document givingeducation providers advice on dealing withpotential students or students on approvedcourses who had criminal records.

All of this became an actual case in 1999,when an individual with a serious criminalconviction applied for registration with one ofthe boards. They had been convicted andserved a prison term for abuse of elderlypatients whilst a nurse. Although the Act didnot give the Registrar or boards specificpowers to refuse such an application, the

Registrar upon consultation, had, nonetheless,refused the application. He believed that theextreme seriousness of the criminal acts whichhad a direct bearing on the practice of an AHP,precluded him from accepting the application.He argued that the underlying purpose of allthe CPSM legislation was to protect the publicand patients, and he believed that he would befailing in his duty to the public if he had allowedthe individual to register. He thereforeinstructed the Registration Department not toregister this individual.



4 The disciplinary process at the CPSM

4.1 Allegations

A person made an allegation against aregistrant by contacting the Registrar in writing.Telephone and (towards the end) email wasinsufficient. The Registrar first arranged for theRegistration Department to check whether theperson complained against, called the‘respondent’, was actually on the Register ofthe relevant board. This was not always thecase. Out of ignorance, people would quiteoften send allegations against professionswhich were not within the CPSM. Some wouldbe on the registers of other regulators, such asnurses or optometrists (confusing them withorthoptists); others would not be regulated atall. Presuming the person was a registrant, theRegistrar then sent the allegation to theChairman of the Investigating Committee, who‘screened’ the allegation (‘screened’ is a moremodern term which the boards’ process didnot use, but it reflects the basic process whichwent on).

Although all cases related to professionalconduct, because of the way the legislationwas set out, cases were divided into two typesof case.

4.1.1 Conduct cases

There were two ways of making an allegationwithin this category. The first was forsomebody who was acting ‘in a publiccapacity’, which the Standing Orders definedas “an officer of a government department orof a local or public authority, acting as such, orany person holding judicial office or any officerattached to a court.”

At first, the Investigating Committees andRegistrars interpreted this quite strictly. Muchlater they interpreted this more broadly toinclude, for example, the registrant’s manager,the personnel manager or someone else inauthority in the organisation. This personacting in a public capacity wrote directly to theRegistrar setting out their case.

If somebody was a member of the public, itwas much more difficult to make an allegation.They could only submit an allegation bymaking a ‘statutory declaration’ in thepresence of a solicitor and sending it to theRegistrar setting out their case. TheInvestigating Committees’ standing ordersstated very specifically:

“provided that, except where the complaintor information relates solely to an allegationthat a criminal offence has beencommitted, or has been made by a personacting in a public capacity, the matter shallnot proceed further until one or morestatutory declarations has been furnishedin support thereof, stating the address anddescription of the declarant and thegrounds for his belief in the truth of anyfact declared which is not within hispersonal knowledge.”

The solicitor concerned would normally chargethem a fee for making such a declaration.There were, therefore, obstacles to a memberof the public making an allegation which werenot there for an employer or the police.Registrars and Investigating CommitteeChairmen interpreted this requirement verystrictly. If there was no statutory declarationand the individual was not somebody who wasacting ‘in a public capacity’, the allegationwould not proceed. The justification at the timewas that it deterred ‘frivolous and vexatious’allegations. However, it clearly gave a biasagainst the public and acted as a barrierto members of the public makinglegitimate allegations.

4 The disciplinary process at CPSM

4.1.2 Criminal cases

The Committees would also consider criminalcases, where a registrant had been foundguilty by a court. The Registrar would presentthese to the Investigating Committeestraightaway, without the need for a statutorydeclaration or submission by somebody actingin a public capacity. Registrants of all theboards were specifically excluded from theRehabilitation of Offenders Act 1974.Therefore, in respect of their professionalpractice, no conviction or accepted policecaution was ever ‘spent’. For many years therewas no formal procedure for finding out aboutcriminal cases against registrants. In 1997,the Home Office agreed to notify Registrar,Mike Hall of all convictions and police cautionsinvolving registrants. The Police CentralComputer was updated to enable this to takeplace. This covered England and Wales. It ispossible that a number of criminal convictionsagainst registrants went unnoticed by theCPSM until then. Even after this arrangement,the process would miss a registrant who didnot declare their profession to the police orcourt correctly. As with other allegations, theRegistrar would check whether the convictedperson was on the specific Register. Again,this was often not the case.

4.2 The preliminary investigation

The Chairman of the Investigating Committee,as ‘screener’, decided whether or not theallegation should proceed further. There were,in the Standing Orders and Rules, noguidelines or guidance whatsoever forChairmen on this judgment on whether or notto proceed. Much later, the solicitors which theCouncil and boards used for the wholedisciplinary process – Kingsley Napley –produced such guidance notes in successiveversions. Once the Chairman had agreed thatthe allegation would proceed, the StandingOrders required that the Registrar write to theregistrant with full details, including a copy of

any material which the complainant hadsubmitted, inviting them to submit anyexplanation or observations. The members ofboth the Investigating Committee andDisciplinary Committee themselves acted asthe panel to consider cases. The InvestigatingCommittee always met in private.The investigation was a preliminary one only.The Committee simply considered whether,with the evidence in front of it, there was acase to answer.

As a part of the question ‘is there a case toanswer?’, Committees considered, first whetherthe allegation related to infamous conduct in aprofessional respect, or would in any way bringthe profession into disrepute. If the answer wasyes, the Disciplinary Committee would examinethe case in more detail. Although apparentlystraight-forward, it was not always easy foreither committee to decide this. Even in thecase of convictions by a court, it was not alwaysobvious whether or not the crime affected theregistrant’s suitability to remain on the Register.Was this ‘infamous conduct’ in the committee’sspecific terms? Take the example of an offenceon which a number of the committees hadactually to deliberate,drink-driving. Committee’s held that, by andlarge, outside work hours during a registrant’snon-working life, such a conviction would notnormally affect their registration. A drink-drivingoffence, on the other hand, when the registrantwas driving between hospitals or on domiciliaryvisits, they considered was a quite differentmatter. There might also be circumstanceswhen an employer disciplined a registrant for aparticular action, but the Disciplinary Committeedid not strike them off. There could also becircumstances when a registrant was notsanctioned by the court but struck off by theDisciplinary Committee. On the other hand, avery serious crime would not necessarily havebeen committed in relation to a registrant’sprofessional practice at all, but was so seriousthat a Committee could not help but take it intoaccount. Examples would be grievous bodily




harm, sexual abuse of minors or abuse ofvulnerable adults.

In all conviction cases, both the Investigatingand Disciplinary Committee presumed that thecase had been found and crime proved. Inconduct cases, the case had to be proved.According to the standing orders of eachInvestigating Committee, the Committee couldask for further investigations or get advice fromits lawyers, but could not interview theregistrant. No reason for this is immediatelyobvious. However, it may be that the Counciland boards did not want InvestigatingCommittees to be tempted to start to assessthe case itself, which attendance of theregistrant could well encourage. On the otherhand, as a part of the further investigationsand advice, the Committee could ask thesolicitor to interview the registrant, but also thecomplainant and witnesses from both sides.

4.3 The effects of low publicknowledge of the CPSM

When the CPSM and boards first began in theearly 1960s, there was a statutory disciplinarysystem to deal with issues of professionalconduct, and administrative and internalarrangements derived from it, which there hadnot been before. This was a substantial andsignificant improvement. Nonetheless, it hadshortcomings which became more apparentas the century progressed. The general publicknew little, if anything about the Council andboards, even at the end in 2002. Indeed, untilabout 1990, there was very little publicity oftheir existence or work. At the beginning of theCPSM, the Council had sought advice onpublicising its work amongst the general publicfrom public relations consultants. This initiativedoes not appear to have lasted or have beenrepeated. By-and-large, the only contactswhich the Council, boards and Registrarfostered were with professional bodies andgovernment departments.

After 1990 the Council, Registrars and boardsbegan to put this right, but it required a majorand continuous effort, starting almost fromscratch. People did not know that the CPSMand boards existed, and therefore did notknow to whom they needed to complain if theywere dissatisfied with a CPSM registrant interms of their behaviour. There were alsoobstacles when they did want to make anallegation. They had to go to the trouble andexpense of getting a statutory declaration.They, too, had to have sufficient knowledgeand education to be able to submit their case,or resources to employ a solicitor to do so ontheir behalf. It is likely that legitimate casesnever appeared, by default, because the publicwere largely unaware of the CPSM’s existenceand many would have been put off anyway bythe obstacles in their path. Furthermore, theCPSM or boards or Registrar could not initiatecases themselves, but always had to wait untilthey received an allegation from elsewhere.Even if they knew of a major cause forcomplaint against a registrant, they could, inthemselves, do nothing about it.

4.4 The disciplinary hearings

The Professions Supplementary to Medicine(Disciplinary Committee)(Procedure) Rulescovered the proceedings of the committees.Each board’s Disciplinary Committee had itsown Rules, for example, the Dietitians Board(Disciplinary Committee) Rules 1964. TheseRules set up the committees. The Rulesrequired that:

“Not less than seven clear days before thedate fixed for a meeting of the Committee,the Registrar shall send to each member ofthe Committee a notice in writing of thedate, time and place of the meeting, and aprogramme of business for the meeting,which shall include the particulars of theallegations against registered in everydisciplinary case to be considered atthe meeting.”


At a formal hearing the Disciplinary Committeeused court-like procedures, as it was acting ina quasi-judicial capacity, very like a court oflaw. Hearings were open to the public.This was an exception for the CPSM, whereeven Council and Board meetings were held inprivate and were never open to the public,except for the Council at the very end of itsexistence. The Committee had to decidewhether, from the evidence presented to it,the conduct of which the registrant had beenaccused took place and, if it did, whether itrendered him / her unfit to be registered. Thebasic principles and procedures were thesame as used in a court. Both sides weregiven an equal and fair opportunity to presenttheir case. Once the Investigating Committeehad decided that there was a case to answer,the Council’s solicitor, rather than the personmaking the allegation, took over and presentedthe case in the hearing. In the hearing theDisciplinary Committee itself acted as thepanel (though this term was not used),over which the Committee Chairman presided.There was a legal assessor to advise theCommittee but also ensure that the hearingwas legal and fair.

The CPSM never employed its own solicitor fordisciplinary purposes, although the firstRegistrar, John Tapsfield, was a solicitor.Once the boards had set up their professionalconduct committees and processes, theCouncil engaged the firm of solicitors KingsleyNapley to carry out the legal aspects of thework. This involved presenting the caseagainst the registrant, advising the Committeesand advising the Registrars. The CPSM, unlikeother large regulators such as the GeneralMedical Council (GMC), never had aprofessional conduct department. Until the late1990s the Registrar and Registrar’s secretaryserviced all Disciplinary Committee hearingsthemselves. The Board secretaries servicedthe Disciplinary Committees when meeting ascommittees rather than hearings and, until theearly 1990s, they serviced all the Investigating

Committee meetings. This was only possiblebecause of the very small number of casesinvolved each year. Neither employees (noteven the Registrar), nor Board membersinvolved in the disciplinary processes receivedany training in this area until towards the end ofCPSM. They relied entirely on the professionaladvice of the Council’s solicitors.

4.5 The hearing process

All the Disciplinary Committees over the yearsdevised ways of trying to work the systemeffectively. The hearing process was fully‘accusatorial’. Both the person presenting theallegation and the respondent (the registrantbeing complained about) had an equal and fairopportunity to present their case. TheDisciplinary Committee had to decide whetherto find the registrant either ‘guilty’ or ‘not guilty’of ‘infamous conduct in a professional respect’(see section 3.5) or it could defer a decision.A registrant found ‘guilty’ could have her or hisname removed or ‘struck off’ from theRegister, which was their only sanction.The Committee would alternatively issue awarning or caution. The legislation did notspecifically give the Committee such powers,but it was taken as a reasonable and justimplication from the explicit powers it had.A hearing could decide that a particular actwas infamous conduct, but that there weremitigating circumstances. Therefore, andparticularly where a registrant had expressedregret and a determination that it would nothappen again, it was considered reasonableand in accordance with common justice, thatthey be given a warning that, should theycome before the Committee again, they wouldbe struck off, rather than be struck off thereand then. Thirdly, it would remove his or hername, but indicate that it would considerreadmission to the Register after a set period,provided proof of good conduct were received.




Again, the legislation did not specifically givethe Committee such powers, but it was takenas a reasonable implication in accordance withcommon justice.

The Professions Supplementary to MedicineAct used the terms ‘guilty’ or ‘not guilty’,terminology which people now regard asinappropriate. Although they were acting in aquasi-judicial capacity, the DisciplinaryCommittees were not dealing with criminal law,to which the term ‘guilty’ applies, butconsidering the question as to whether or nota person should be on the Board’s Register.The standard of proof which hearings usedwas, essentially, that used in civil cases.A hearing sought to balance the probabilities,the standard of proof being higher the moreserious the circumstances. A registrant’slivelihood, and professional and personal goodname were at stake. On the whole therefore,the standard of proof would be slightly higherthan the average civil case in a court oflaw, and, as R Pickis stated in hisunpublished paper9 :

“It should be borne in mind here that thatthe precedents relating to theestablishment of sufficient proof ofinfamous conduct also come into play. Inrough lay terms, it is understood that thelevel of proof in civil cases is that a judgemust be satisfied that a case is made onthe balance of probabilities. The criminallevel of proof is that the case is establishedbeyond reasonable doubt. The level ofproof in CPSM cases lie (sic) somewherebetween the two. The standard ofproof being higher the more seriousthe circumstances.”

4.6 The Council

Professional conduct was a Board not aCouncil responsibility, through theirInvestigating and Disciplinary Committees,except that the Council made the relevantRules, and employed the staff who organisedthe hearings and serviced the committees,the legal assessors and the solicitors topresent the cases. However, it had quiteextensive general supervisory powers. Section1(3) stated that:

“The Council shall perform its generalfunction of co-ordinating and supervisingthe activities of the boards

(a) by making to each board, or inviting theboard to make to the Council, proposals asto the activities to be carried on by theboard or other boards;

(b) by recommending a board to carry onsuch activities, or to limit its activities insuch manner, as the Council considersappropriate after consultation with theboard on the proposals aforesaid;

(c) by concerning itself with mattersappearing to it to be of special interest toany two or more of the boards, and bygiving the boards such advice andassistance as it thinks fit with respect tosuch matters;

(d) by exercising its powers under thefollowing provisions of this Act in suchmanner as the Council considers mostconducive to the satisfactory performanceby each board of the board’s functionsunder this Act.”

9 Quoted in Rod Pickis’ paper ‘Relevant Documents – Other documents’, below.


In the event that the Council did not use thesepowers proactively in respect of ethical andconduct matters until the 1980s. Until then, byand large, it left the boards and theirDisciplinary Committees to their own devices.However, as covered in section 6, a number ofgeneral ethical and conduct issues began toarise which applied to all the professions. Itmade sense that the Council co-ordinate thediscussion and consideration of these issues,and proactively introduce them whenappropriate. Examples of this are confidentialityof patient data, infection control and‘whistleblowing’. In some instances, aDisciplinary Committee and its Board wouldconsider an issue and then recommend thatthe Council invite all boards to do so.Examples are registrants’ responsibilitiesduring an industrial dispute and forclinical records.



5 The boards’ standards of conduct

5.1 The Statements of Conduct

The Act required that each DisciplinaryCommittee produce its own standards ofconduct: the Statement of Conduct. TheCommittee had to consult its own board andthe Council in doing so, but it did not requireany other consultation. From the beginning,each statement had an introduction. Theintroduction explained the purpose of thestatement, the powers under which theCommittee had produced it and howregistrants should interpret it. Most of thecommittees changed their introductions fourtimes. The first Registrar wrote the introductionto the very first statements, which wascommon to all professions and the subsequentone. Dr Brian Donald revised it in consultationwith the Council’s solicitor in the early 1980s.Both wrote before the Plain English Campaignbegan influencing organisations and theirliterature and documents. As was then thenorm, the language that the introductions andthe statements themselves used deriveddirectly from the legislation, from purely legaland administrative perspectives. Generalattitudes to this changed in the 1980s andearly 90s. Therefore, in the late 1990s,following the example of the OccupationalTherapists Disciplinary Committee, whichrewrote its Introduction in 1995–6, mostcommittees rewrote the Introductions entirelyto make them more readable and usable.Some of the committees at that timealso rewrote their statements in moreuser-friendly language.

In the first fifteen years or so, the number ofthese written standards was very small.Hearings did not need to confine theirconsiderations to the statements whenconsidering allegations. In practice, most‘standards’ they used were unwritten andassumed, and provided the committees couldbroadly demonstrate reasonableness, theywere not acting ‘ultra vires’.

The committees did not produce their writtenstandards as a result of specific engagementwith the ethical issues and principles involved,nor as a coherent whole. It would not haveoccurred to them to do either because thiswas not needed in that period of theirexistence. They were ad-hoc and almostentirely intuitive. Later, although thecommittees amended them more frequently,largely reactive rather than proactive.They were reactive to issues which disciplinaryhearings brought up in individual cases, andsubsequently also to general issues whichcame up in the broader health world or widersociety, such as confidentiality of patient dataor responsibilities of registrants during anindustrial dispute.

Section 9 of the Act stated that:

“but the fact that any matters are notmentioned in such a statement shall notpreclude the disciplinary committee fromjudging a person to be guilty of infamousconduct in a professional respect byreference to such matters.”

All the versions of the introductions to thestatements reminded registrants of this. So itwas never expected that the statement wouldset out in detail every possible example ofinfamous conduct. Nonetheless, principlessuch as that set out by the Law Lords in 1993in their judgment in the Tony Bland case(described in greater detail in section 6) thatany decision about patient care should “carryconviction with the ordinary person as beingbased not merely on legal precedent but alsoupon acceptable ethical values”, beganincreasingly by the early 1990s to influence allregulators, at least indirectly, including those atCPSM. The Council, boards and committeesincreasingly recognised that these valuesneeded in future to be more explicit andarticulated, and thus be of use as guidance tothe average registrant, the overwhelmingmajority of whom would never have anallegation made against them.


5.2 The Statements of Conductand registrants

At first, the statements had little impact on theprofessions, even less on the wider healthworld. Each board included a copy of thecurrent statement with each application formand required that an applicant sign that theyhad “read the Board’s statement relating toInfamous Conduct”. The Act required eachboard to: “send by post to each registeredmember of the relevant profession, at hisaddress on the register, a copy of thestatement for the time being revised.”

In the early days, committees almost neverchanged their statements (for example theDietitians Statement did not change between1966 when the Dietitians DisciplinaryCommittee issued its first one and 1985 whenit issued a second version; in contrast, it thenchanged six times between 1985 and 2001).Each board included a copy in the front of itsannual register, but few people actually boughtthese. Therefore, the large majority ofregistrants would never see or refer to a copyof its board’s statement once they had appliedfor registration. So they were not things whichthe average practitioner would have had tohand in their day-to-day practice, which in theearly days was, by and large, not consideredto be their purpose. Much later, the DisciplinaryCommittees and their boards began using theirstatements as a means of setting andpublicising their standards of conductand ethics.

Most of the professional bodies had their ownstatements of professional ethics and conductprocedures. Their statements were often moredetailed than the Statements of Conduct.Some of the areas which the professionalstatements covered were not relevant to theboards, for example scales of fees charged byprivate practitioners. For most of the CPSMperiod, there was little, if any, interactionbetween the boards’ Statements of Conduct

and the professional bodies’ ethicalstatements. However, towards the end thischanged. In assessing allegations and cases,and in giving advice to registrants theCommittees and Investigating CommitteeChairmen were increasingly using theprofessional bodies’ ethical statements toclarify points. Some of the DisciplinaryCommittees therefore added to theIntroduction to the Statement of Conductwording such as that used in theRadiographers Statement from 1999.

“When considering such cases in the lightof the Statement, the Committee may takeinto account the current “Code ofProfessional Conduct” of the Society ofRadiographers.”

5.3 Queries and advice

The statements were a little more widelypublicised through the process by whichregistrants could send in queries relating toconduct and ethics. Registrants would write tothe Registrar asking for advice on a particularmatter relating to professional conduct. In theearly days the queries related to issues like theuse of a particular word or phrase in their‘announcement of practice’ or name plates.Much later they related to issues such asdelegation to assistants, record keeping,sterilisation of equipment and control ofinfection, additional professional responsibilitiesand post-registration training. The Registrarused the Statements of Conduct as a basis forhis advice to give to registrants. They alsoreceived requests for advice from employersand the occasional member of the public.

At first this facility was of little importance andthere were very few of these enquiries, evenfrom registrants. During the 1980s theyincreased considerably and became animportant part of the professional conductfunction. Professions, such as the orthoptists,whose Investigating Committees had almostno cases during the whole of their existence,




nonetheless did receive a number of queriesrelating to conduct and ethics. Someprofessions received a regular number fromtheir registrants each year. Originally, theRegistrar by himself had responded, as andwhen appropriate. When the numbersincreased, Brian Donald, the second Registrar,with the Council’s solicitors, developed aformal process for handling and responding tothese queries. Under this more formal process,the Registrar would receive a query from aregistrant about some matter of professionalconduct. For example, they would set out aproposal that they would delegate a particulartask to an assistant and ask whether this wasacceptable. The Registrar would then seek theadvice of the relevant Investigating CommitteeChairman and, where necessary, the Council’ssolicitor, as well as previous responses tosimilar queries. The registrant who wasenquiring was here asking for practical adviceon specific issues, which they could use intheir day-to-day practice. The Registrartherefore had to consider and word the advicecarefully, and make sure that his advice wasconsistent. Sometimes registrants wanted adefinitive ruling read off a detailed code. Thiswas never possible because, there were neversuch detailed codes. The advice always had toremind the registrant that the DisciplinaryCommittee and Board would always allow andexpect them to use their professionaljudgment, and took the circumstances of eachindividual case into account. Over the years,the Registrars built up a body of precedentin respect of advice given, but would alsoneed to amend advice appropriately inresponse to changing circumstances,disciplinary cases and statements.

Occasionally, if a number of queries on thesame topic arose and there was no clearanswer which the Registrar and InvestigatingCommittee Chairman could give, the Registraror Investigating Committee Chairman or Board

would ask the respective DisciplinaryCommittee to see if it needed to change itsStatement.

5.4 1975 to 2002 – a period ofradical change

In the first fifteen years, the boardsconcentrated their efforts first on setting uptheir processes and assessing those who hadpractised the professions before 1963, but hadnot undergone the approved qualifications,(known then as ‘grandfathering’), and later, onestablishing and developing their educationalpowers. They did very little in the area of ethicsand conduct. Some had no cases for manyyears. In a report on likely future developmentsto Council in October 1974, the then Registrar,John Tapsfield commented as follows:

“In the field of professional conduct, theboards have, with few exceptions, beenrequired to do little beyond publishingstatements relating to infamous conduct ina professional respect.”

Later in the report, he even suggested thattheir professional conduct power could beremoved and implied that all such issues couldbe left to the professional bodies, because “theboards have had little part to play in it.”

This was a decidedly premature judgment andvery definitely not the case subsequently;indeed, this began to change not long after hemade this comment and suggestion.

In the 1950s and 1960s unwritten codes ofbehaviour and attitudes which came from amuch earlier age were still common. In thiscontext, it could be argued that the CPSMprofessionals did not need much guidance orarticulated standards. The large majority ofhealth professions still looked up to themedical profession, which for many was theideal, as were the other establishedprofessions such as lawyer, accountant andarchitect. This all radically changed in the1970s and by the end of CPSM, professional


conduct and the setting of standards ofconduct had become increasingly important tothe boards and their professions. This periodsaw major change and development in all theprofessions, as well as radical changes inwider society. There were some forms ofconduct which in the 1960’s society and theprofessions in particular had considered were‘infamous conduct’, but no longer consideredthem to be so by the late 1990’s or at thebeginning of the new millennium. By way of ageneral example, until 1967, homosexual actsbetween men in England were a crime (and thelaw didn’t change in Scotland and NorthernIreland until the early 1980s). Therefore, anopenly gay lifestyle was potentially a matterthat could have been subject to disciplinarysanctions by a regulator (although at theCPSM there were, actually, no such cases).Since then attitudes have changed, so thatlater in the CPSM period, AHPs were free tobe openly gay and form gay relationships.

However, all of the Disciplinary Committeesresisted the opposite temptation of trying tocover every eventuality and eliminate allpossible risk by turning their Statements ofConduct into highly detailed ‘codes ofconduct’ which tried to cover every eventuality.Indeed, by and large, they all tried to avoidusing the term ‘code’. The statements wereindicative statements and most remained fairlygeneral throughout. This allowed practitionersthe freedom to make their own professionaljudgments in accordance with theircircumstances and their patients’ orclients’ needs.

The next sections describes this period ofradical change in more detail, by usingexamples of individual issues and principleswith which the Disciplinary Committees andtheir boards had to deal in relation to theirStatements of Conduct.



6 Individual issues relating tostandards of conduct

6.1 Advertising

6.1.1 Advertising as infamous conduct

A good example of the radical change inattitudes over the decades is over advertising.In the 1960s, all boards considered that anyadvertising whatsoever was ‘infamousconduct’. In fact, the very first allegationagainst a physiotherapist in 1967 was that he:

“advertised for the purpose of promotinghis own professional advantage (a) by asign attracting attention to his professionalskill and services; and (b) by publicationof an advertisement in the BristolEvening Post.”

The Physiotherapists Statement of Conductstated as follows.

“Physiotherapists should not (a) directly orindirectly canvas for patients; (b) advertise,whether directly or indirectly for thepurpose of obtaining patients or promotingtheir own professional advantage, norshould they, for such purpose, procure,sanction, or acquiesce in the publication ofnotices commending or directing attentionto their professional skill, knowledge,services or qualifications or deprecating theprofessional skill, knowledge, services orqualifications of others. The Committee,however, would not regard it as a breach ofthis requirement for a physiotherapist towrite to registered medical or dentalpractitioners in order to draw attention tohis name, address and qualifications, andto the fact that his services as aphysiotherapist are available.”

The Disciplinary Committee found him “guiltyof infamous conduct in a professional respect”.However, he was not struck off. The ban on‘advertising’ at the beginning did not just cover‘inappropriate’ advertising as it did in the laterCPSM period. The boards’ and theircommittees’ interpretation of ‘advertising’was at first very strict indeed.

They considered that you were ‘advertising’even if you simply told an interviewer in anewspaper or programme that you were ‘stateregistered’ and allowed that to be published orbroadcast. In 1971, the third-ever hearingagainst a physiotherapist found aphysiotherapist guilty of infamous conduct(although he was not struck off in this case) onthe grounds that he had:

“Indirectly advertised for the purpose ofpromoting his professional advantage andfor the purpose of his professionaladvantage acquiesced in the publicationof an article in the Sussex Express”.

In the fourth-ever hearing against aphysiotherapist as late as 1982, the hearingfound her guilty of ‘infamous conduct’ for thesame reason. Again, she was not struck offbecause, according to the Committee:

“On the evidence we have heard we areuncertain that it was [her] deliberateintention to promote her own professionaladvantage in allowing the publication of thearticle referred to. Nevertheless, the articledirected attention to her skills, knowledge,service and qualifications and we aregreatly concerned that a person of herexperience was not more circumspect inthe conduct of the interview. We regardher as being negligent in not following upthe article”.

The Chiropodists Statement of Conduct wasslightly more liberal. It stated that:

“No chiropodist should advertise or canvas,directly or indirectly, for the purpose ofobtaining patients or promoting his ownprofessional advantage, but it would not beregarded as a breach of this provision for achiropodist i) to send professional cards orletters to patients who have been attendedby him, as a principal, giving notice of achange of address, ii) to notify registeredmedical practitioners and to put up to four[later 12] announcements under the

6 Individual issues relating to standards of conduct

heading of ‘professional’, ‘medical’ or‘personal’ all appearing within a period offour weeks [later six months] in twonewspapers circulating in a district where itis proposed to set up a new practice or totake over an existing practice.”

By the 1980s, items in the Yellow Pages oftelephone directory became very important toprivate practitioners. The ChiropodistsDisciplinary Committee therefore added afurther section to its item on advertising.

“It is considered that a registrant whosename appears in classified telephone orother local directories will not be guilty ofmisconduct, provided that (i) an individualentry in the general listing does not appearin distinctive type or setting and (ii) an entryin a group announcement carries thedesignation ‘State Registered…’ and thatall registrants in the directory have beenoffered an opportunity to participate.”

The Committee recognised that its registrantsneeded to advertise in this new medium,because unregistered chiropodists werealready doing so and because the public hada right to know that such services wereavailable. This section of the item onadvertising did not last long as a result of thepressure from the Office of Fair Tradingdescribed below. All that survived was theattempt to require all its registrants to put‘State Registered’ at the top:

“all such advertisements must be headed‘State Registered Chiropodist’; no othermaterial in the announcement may belarger in size or more prominently displayedthan the heading.”

It lasted until the end of the Board’s existence,but it is, with hindsight, highly unlikely thatthe Committee would have been able toenforce this.

6.1.2 Pressure from outside

All Disciplinary Committees changed this strictinterpretation, after discussion andconsultation with the Office of Fair Trading inthe mid-1980s provoked all the Committeesand boards to rethink their positions.The Office regarded such an absolute ban onadvertising as an unfair restriction on trade. Itthreatened to take up the matter further withMinisters under restrictive practice legislation ifthe Disciplinary Committees did not relaxthem. Committees and boards began toappreciate that it was particularly unfair toregistrants in private practice, as this restrictioncould not bind the unregistered members ofthe professions, who could, and did, advertisehowever they liked. The prime purpose of allthe boards was to protect the public, not theprofessions. The boards and committeesdiscussed and at times agonised over anumber of questions. What was wrong instating to a journalist or interviewer that youwere a state registered member of yourprofession? Indeed, it could be seen as freepublicity for the Board and CPSM. Is thereanything inherently wrong in promoting yourpractice for your own professional advantage,provided you do so ethically, fairly and legally?Does the public need protection fromregistrants publicising themselves oradvertising their services? On the contrary,they increasingly recognised that the publicand potential users of their services wouldbenefit from the increased access toinformation on practitioners that would resultand also that they may benefit from a degreeof competition. On the other hand, theyrecognised that the public does needprotecting from being misled or lied to, andregistrants must act fairly in terms of theiradvertising in respect of the public, but alsotheir fellow professionals. The Office of FairTrading also accepted this fact. Thecommittees therefore removed any ban onadvertising itself, but retained a ban onmisleading, false, unfair or exaggerated




advertising. An absolute ban on advertisingcould well have been challenged, particularlyby then, as unreasonable, and subsequently,had it not been changed, as contraveningArticle 10 ‘Freedom of expression’ of theEuropean Convention on Human Rights(see Appendix 3), whose purpose is to ensurelegitimate freedom of expression. The UKsigned the Convention in 1951 and so itapplied when the boards were beginning in theearly 1960s; since the Human Rights Act cameinto force in 2000, giving the Convention effectin domestic law, such restrictions would havebeen unsustainable.

6.2 Professional nameplates

In the early decades, the Physiotherapist andChiropodist Statements were also very stricton the professional nameplates whichregistrants put up outside their clinics.This was particularly relevant to these twoboards, which registered a large number ofprivate practitioners. Nameplates were veryimportant in the days before Yellow Pages,the internet and websites. Because registrantswere not allowed to advertise, apart fromword-of-mouth or referral by a medicalpractitioner, a nameplate outside their clinicwas the only way a member of the publiccould know that a registrant’s practice existed.The Physiotherapist Statement’s wordingwas that:

“Professional signs should be dignified andrestrained in character, and limited to suchas are, in position, size and wording nomore than are reasonably required toindicate to persons seeking them the exactlocation of, and entrance to the premiseswhere practice is carried on.”

The Chiropodists wording added ‘plates’ and‘stationery’ to the above:

“Practitioners may describe themselves asState Registered Chiropodists, and mayuse only their names, decorations, andqualifications for the time being recognisedby the Board for inclusion in the Register,their telephone number and hours ofattendance. They should not use any othertitles or qualifications, and in particular,should not use expressions such as‘Foot Clinic’.”

The hidden and unwritten assumptions behindthis wording reflect values and attitudes of theearly period, and show the shift in socialattitudes and values since then. It is, forexample, not obvious to us now why the term‘foot clinic’ was unacceptable. For some time, ithas been normal and acceptable both in theNHS and private practice for chiropodists orpodiatrists to describe their place of work as a‘foot clinic’, ‘chiropody clinic’ or ‘podiatry clinic’.Indeed, examination of the minutes of theSociety of Chiropodists’ Council confirms thatthis objection to the term ‘clinic’, and especially‘foot clinic’, was taken very seriously and goesback a long way (before the Board began). Itappears that the profession in its early daystook its cue on such matters from the usage ofthe medical profession, which had ‘practices’and ‘surgeries’, but for some reason regardedthe term ‘clinic’ as inappropriate or evenunacceptable. This ban on the term ‘foot clinic’or similar terms was still in the 1987 Statement.

However, by 1989 it had been removed andincorporated the item on nameplates into theone on advertising, and simply stated that“[p]rofessional signs should be dignified andprofessionally restrained.”


6.3 Promoting products

Boards did not approve of their registrantspromoting products for gain. Most Statementsof Conduct had items on this. Some werestricter than others. Most simply banned allsuch promotion. For example, the OrthoptistsStatement stated as follows.

“No registered orthoptist should acceptcommission on the sale of goods or inrespect of any action arising out of thepractice of his/her profession.”

The Physiotherapists Statement allowed thesupply of dressings and appliances inconnection with the treatment given, as follows.

“Physiotherapists should not eitherpersonally or as agents or employees ofany person, firm or corporate body, sell oraccept commission on the sale of goods tothe public in connection with occupation asphysiotherapist, nor should they in any waydirectly or indirectly be associated with thesale of such goods. This would notpreclude them from supplying dressingsand appliances in connection with thetreatment of a particular condition for whichthey have been consulted.”

The Chiropodists Statement had the samewording. Whether or not the registrant wasallowed to sell these items is unclear.Presumably they were allowed to do so tocover their cost. The Dietitians Statement wasnot so strict. The first version gave as anexample of infamous conduct:

“improperly promoting the sale of anyproduct in connection with her profession asdietitian or for her own personal advantage”

This was somewhat unclear. Dietitians,particularly those who work for commercialcompanies, have always to some extent beeninvolved in the promotion of products, by thevery nature of their professional practice. TheDietitians Disciplinary Committee laterexpanded and clarified the item as follows.

“A state registered dietitian must not 4 a)make or support unjustifiable statementsrelating to particular products, b) use asingle brand name as the sole descriptionof a product when giving therapeuticadvice to individuals or groups. It isimportant that a range of products isdescribed. 5) be involved in the promotionof dietary products in other than aprofessionally restrained manner. Whenworking for commercial organisations,whether employed or contracted, dietitiansshould not be personally identified inproduct advertising material and mustensure that their scientific knowledge andclinical skills are used in an accurate andprofessionally responsible manner in anypromotional activity.”

Even the new boards included an item on this.The Prosthetists and Orthotists Statement said:

“No prosthetist-orthotist shall compromisehis/her professional judgment in theprosthetic-orthotic management of apatient/user for the purposes ofcommercial gain, either personally, or as anagent, or employee of any person, firm orcorporate body.”

Both the Paramedics and Arts TherapistsStatements had strict bans on promotionalactivity for gain. Undoubtedly, in the early days,some of this reflected older attitudes to being a‘professional’. However, when they reviewedthis ban later on, committees appreciated thatthere was (and still is) an important publicprotection aspect to the question ofpromotional activity. This is why the newboards created in 2000 retained an item on it.The committees recognised that a registrantmust not abuse their reputation as aprofessional and their superior knowledge andexpertise. A member of the public could easilybe misled into believing that a particularproduct is superior on the recommendation ofa health professional, who, in fact may bedoing so simply because they are being paid




to do so and not from any intrinsic merit.Registrants therefore had and have a duty toensure that any recommendations orpromotions are made disinterestedly.

6.4 Professional scope ofpractice

6.4.1 The significance of professionalscope of practice

One of the purposes of the boards’ disciplinaryfunction was, jointly with their educationalfunction, to help boards determine what theirregistrants could and could not doprofessionally. As explained in Section 3.2,an implied requirement of the Act and thestatements was that they protect the boundarybetween the medical profession and the‘professions supplementary to medicine’,between the professions themselves, andbetween the regulated and unregulatedsectors. This is the complex area of scope ofpractice, ie what a professional can andcannot do; it is the area or areas of theirprofession in which they have the knowledge,skills and experience to practise lawfully, safelyand effectively. Although there was no formaldefinition as such at that time, this was what‘scope of practice’ was in the CPSM period.

6.4.2 Scope of practice, competenceand proficiency

Scope of practice is a subject in its own rightand too complex to discuss here in detail. It isworthy of a separate study of its own.

However, it does relate closely to professionalconduct and discipline, and did so at theCPSM. Although all boards had Statements ofConduct, not all developed formal standards ofeducation and training. None specificallydeveloped the equivalent of the HPC’sstandards of proficiency. Some, such as the

Radiographers Board, were very reluctant todo so, because they wished to avoid rigidity,be as flexible and non-prescriptive as possiblein their approach, and to encourageinnovation. Until the degree programmesreplaced the old diplomas, the large majority ofboards simply approved the core-curriculum oftheir respective professional body as being the‘benchmark’ of proficiency and competence.These were in effect the standards ofproficiency, although none actually used thatterm. So, one determined each profession’sscope of practice almost entirely by drawingfrom other organisations’ documents, byimplication and by unwritten consensus andagreement, rather than by formal definition.When most of the CPSM professionsdeveloped preregistration degree programmes,boards were involved in the Quality AssuranceAgency’s development of benchmarks for eachprofession and used them as points ofreference. In effect, the scope of practice of allthe professions expanded considerablybetween 1960 and 2002.

6.4.3 The Chiropodists Board andDisciplinary Committee and scopeof practice

With one or two exceptions, Statements ofConduct in this respect set out what aregistrant could not do, rather than what theycould do. Only the Chiropodists Statementclearly laid down what the scope of practicefor the ‘chiropodist’ actually was:

“Chiropody comprises the maintenance ofthe feet in health condition, and thetreatment of their disabilities by recognisedchiropodial10 methods in which thepractitioner has been trained. Chiropodistsshould confine themselves to this field ofwork.”

10 Strictly speaking chiropody is a noun and therefore the Board often used the term ‘chiropodial’ as anappropriate adjective.


In the 1980s there was considerable debateand controversy over chiropodists carrying outfoot surgery, both within the profession andwith the medical profession. A number ofchiropodists were expanding into foot surgeryand aroused the suspicions of members of themedical profession, particularly orthopaedicsurgeons. Some of this related to protection ofthe public issues and some to simpledemarcation issues, partly relating to the‘supplementary’ status of all CPSMprofessions (covered in section 6.5). The Boardand its Disciplinary Committee were, for aperiod, caught between a small but vocal‘avant-garde’ of the profession, who werepushing the professional boundaries, and theorthopaedic surgeons who were deeplysuspicious of any change to the status-quoand had several representatives on theChiropodists Board. There was particularpressure on the Board from two specialistchiropody associations The PodiatryAssociation and The British College ofPodiatry11 to permit the use of designatoryletters in its Register indicating that theregistrant had obtained qualifications in ‘footsurgery’. This, by implication, meant that theywanted the Board and its committees to give,at least tacit, acceptance to expansion by itsregistrants in to the area of foot surgery.

These specialists were also pressing for theacceptance of the term ‘podiatrist’ to mean achiropodist who had gained postregistrationtraining and qualifications in foot surgery, whichfurther complicated matters. In the event theyfailed in this and the term became, and now is,simply an alternative to chiropodist. However,on the question of chiropodists practising footsurgery, all agreed that, whatever the Board

and Disciplinary Committee accepted, tacitly orotherwise, its registrants would always need tokeep their practice within the competence theyhad gained in their education and training,either pre- or postregistration. The DisciplinaryCommittee therefore made no addition to itsitem in the Statement on scope of practice,but added a footnote to it.

“Ambulatory foot surgery, which isbecoming an established procedure inchiropodial12 practice, is surgery performedby Chiropodists at a level sufficiently minoras to be carried out on a day-case basisand which would not normally warrant in-patient admission, the patient beingambulant with or without assistanceimmediately after surgery. It should besubject to the limitations of the operator’sskills and training, and the facilitiesavailable.”

6.4.4 The other boards

The Physiotherapists Statement simply said“A physiotherapist should confine himself13 totreatment in those fields of physiotherapy inwhich he has been trained.”

It made no attempt to define whatphysiotherapy actually was. The otherstatements had similar items.

This reluctance to define formally and legally aprofession’s scope of practice was deliberate.The committees and boards increasinglyrecognised that, whilst professionals needmuch more than just vague implications andunwritten assumptions, strict definitions willtend to make change and developmentdifficult. In the modern world, all professionsare continually growing and developing, and


11 Both these associations later merged with the Society of Chiropodists and Podiatrists.

12 See footnote 10.

13 Statements often followed the contemporary practice of using ‘he’ to mean ‘he or she’, even though most of theirrespective professions were female.



need to do so. The view that the boards andcommittees by and large took was that it is theregulator’s role to watch and guide thisdevelopment, not to dictate to its professionshow and whether or not they should so grow.

6.5 The ‘supplementary’ status ofthe professions

6.5.1 Professions ‘supplementary tomedicine‘

In the early days, apart from chiropodists, thetwo things the professions could definitely notdo were either ‘diagnose’ or receive individualswithout first getting a ‘referral’ from a medicalpractitioner. In later years, these twoprohibitions were more and more difficult todefine and enforce, and in most caseseventually disappeared. Both prohibitionsreflected that in 1960 the professions were‘supplementary’ to medicine, by legal definitionand provide good examples of this status.However, what exactly did it mean?‘Supplementary’ was clearly more than‘auxiliary’ (the former term) and ‘subordinate’,but was not ‘equal to’.

6.5.2 Diagnosis

In the early years of CPSM, the terms‘diagnose’ and ‘diagnosis’ or ‘clinicaldiagnosis’ had, throughout the medical world,specific and restricted meanings. The issue ofwhether or not an AHP could ‘diagnose’ wasan important part of this relationship betweenthe professional and the medical practitioner,and the status and exact meaning of‘supplementary’. For many years only aregistered medical practitioner (and dentist)‘diagnosed’. If appropriate, he14 then passedan aspect of this diagnosis to a professionalsupplementary to medicine to act upon withintheir own expertise. Professions

supplementary to medicine only ‘assisted’ themedical practitioner or, at most, ‘treated underhis supervision’.

For most of the CPSM professions at thebeginning and for about two decadesafterwards this was presumed and assumedwithin the requirement for ‘referral’, see below.However, for two professions, their Statementspelt it out in a separate item. The firstexample is the Radiographers Statementwhich stated in the first Statement in 1964 that“No registered radiographer should: Holdhimself out as a person who by training andexperience is professionally qualified todiagnose or treat injury or disease.”

Although the Disciplinary Committee graduallyadded and developed exceptions to this, thiswas more relevant to diagnostic radiography;therapeutic radiographers had been involved inthe treatment of patients from the beginning.Presumably, in the case of therapeuticradiographers, it meant that they were not toclaim that they could treat someone bythemselves, but only under medicalsupervision. Relating to diagnosis, theparticular issue with diagnostic radiographerswas whether they could ‘report’ on a medicalimage which they had produced such as anX-ray, ie interpret what they saw.

For many years this was seen as ‘diagnosis’and therefore forbidden. They merely producedthe image and gave it to the medicalpractitioner (usually but not always aradiologists) to interpret. Gradually, asradiography education and training developed,the statements allowed for greater involvementof the radiographer in interpreting andcommenting upon the images which they hadthemselves produced, particularly inemergencies. This reflected the changingarrangements and formal working procedures,

14 In most cases in the early days it was a ‘he’.


and relationships between radiographers andradiologists ‘on the ground’ in individualhospital departments, especially since manyradiographers were (and are) working inaccident and emergency departments, wherea radiologist may not be immediately on hand.

Similarly, the Medical Laboratory ScientificOfficers Statement stated, too, that:

“No registered medical laboratory scientificofficers should: Hold himself out as aperson who, by training and experience, isprofessionally qualified to diagnose or treatdisease in man or animal,”

But it gave no exceptions.

Over the years, the CPSM registrants becamebetter trained and took greater responsibilityfor their patients’ treatment; and, unlike insome other countries, there was often ashortage of medical practitioners, andcontinual restriction on funds to train and paythem. Therefore, what the medical practitionerdid and what the other AHPs did becameincreasingly blurred. And what exactly was a‘diagnosis’ and why was what the medicalpractitioner did ‘diagnosis’ and not the CPSMprofessional? As professionals, the CPSMprofessions were moving from ‘supplementaryto medicine’ to ‘allied to medicine’. The laterchanges to the Statements of Conductreflect this.

6.5.3 Referral from a medicalpractitioner

A part of this change in status was the gradualrelaxing and then final removal of therequirement that a registrant could only adviseand treat a patient or client if they had firstbeen referred to them by a medicalpractitioner. Until the late 1980s, boards andtheir Disciplinary Committees took thisrequirement very seriously in their Statementsof Conduct. With the exception of thechiropodists, no registrant could advise or treata patient if they simply arrived at their clinic or

place of work. The patient had to haveconsulted a medical practitioner (or dentist butthe number of dentists referring to CPSMprofessional must have been very small) first,who then formally ‘referred’ them to aregistrant with a diagnosis and instruction as towhat was required. If a member of the publicsimply turned up, the registrant (apart from achiropodist) would have to send them to theirgeneral practitioner or another medicalpractitioner for a diagnosis and referral beforethey could do anything. For example, the 1966Occupational Therapists Statement of Conductstated that:

“No registered Occupational Therapistshould: Undertake the treatment of anypatient, unless that patient has beenreferred to him for treatment by a registeredmedical practitioner.”

The 1967 Physiotherapists Statement ofConduct added “except in emergency or forsome other exceptional reason.”

The Dietitians Statement was less strict. Fromthe beginning, the item stated that theCommittee would consider “[h]abitually treatingany patient therapeutically without regard toinstructions given by a registered medical ordental practitioner” as infamous conduct; it didnot define what “habitually” meant. In 1986 itadded “[t]he Committee would not regard thegiving of general nutritional and dietary adviceto groups as a breach of this provision.”

However, the 1988 Dietitians Statement wasapparently more restrictive, stating that:

“No registered dietitian should: advise apatient therapeutically unless that patienthas been referred to her/him by aregistered medical or dental practitionerexcept in emergency or for some otherexceptional reason or unless she/heconsults with the patient’s doctor aboutsuch advice”.




Although it did have a footnote which statedthat “the giving of general nutritional anddietary advice would not be regarded as abreach of this provision”

Times have now changed, but in the earlydecades of CPSM, registrants were very much‘supplementary’ to medicine and only aregistered medical practitioner would knowenough about the patient and his / her overallhealth, and the breadth of medical conditions.A registrant only knew their own specialistarea. In the early days, their qualifications werenot at degree level. Some were considerablybelow degree level. For example, the earlyform of the Diploma of the College ofRadiographers was only two years long.However, by the late 1980s this was no longertrue and by the mid-1990s, almost all of theprofession were graduate entry, and somewere developing Masters degrees within theirown professional expertise and a fewobtaining doctorates.

In the 1950s and 60s, the medical professionhad dominated all health professions and thehealth service, and were heavily representedon the Council and boards. Undoubtedly, in anumber of instances they were resistant togreater professional autonomy for theprofessions. Most medical practitioners andthe medical professions wanted to maintaincontrol over these professions, for a variety ofreasons, some of them out of self-interest.

Further still, most CPSM registrants werewomen and most medical practitioners thenwere men, which is likely to have influencedtheir view at first, that is, until later in the CPSMperiod, when some of the medical appointeeson the boards and Council itself werethemselves women.

6.5.4 Removal of dependency

Some boards and their DisciplinaryCommittees changed what was, in effect, a‘dependency’ requirement and therefore their‘supplementary’ status more quickly thanothers. In reality, although still legally‘supplementary’, by the end of CPSM, all theprofessions were in practice better describedas ‘allied’ to medicine, as professions in theirown right. The Physiotherapists Board andDisciplinary Committee began debating thisissue in the mid-1980s. By the late 1980s, the1989 Physiotherapists Statement of Conductsimply stated that:

“A physiotherapist shall communicate andco-operate with registered medical ordental practitioners in the managementof patients.”

By the end of all the boards’ existence, all thewording was the same in essence to that ofthe Physiotherapists Statement.

Almost all of this was at the general level. Inpractice, if one looks at the outcomes of all theCPSM disciplinary hearings for all boards,there was only ever one case in the area ofreferrals. This was against a biomedicalscientist in 1990. He was found guilty ofinfamous conduct for requesting an item “forthe purpose of diagnosis knowing that requestwas not by a Registered Medical Practitioner”.He was not struck off, but the Committeestated that it the Committee “continues to holda serious view of the circumstances that led tothis charge of which he was faulty on hisown admission”.

In fact, as the graph in Appendix 5(14) shows,even in the more general area of ‘practisingoutside of scope of practice’ (which would alsoinclude allegations that a registrant carried outa treatment for which they were not properlyqualified), only four per cent of cases could beclassified as such.


6.6 Delegation to assistants

In the other direction, a number of the CPSMprofessions were, by the 1980s, increasinglydelegating relatively simple tasks to assistantsand helpers who were directly responsible tothem. By the end of CPSM, most of theprofessions had helper / assistant gradesworking to them. At that time, the Council, andsome boards and committees were very awarethat their registrants were often under pressurewithin the NHS and from other employers tocut costs by delegating tasks to personnelwho were not trained for them. It must beadmitted that not everyone outside theprofessions themselves was able to distinguishbetween professional protectionism (whichcertainly could be a factor at times) andlegitimate protection of the public fromunqualified or underqualified individualscarrying out practices and techniques beyondtheir competence. Some people, particularly inthe late 1980s and 1990s, presumed, oftenwrongly, that professional staff, whenexpressing their concerns regardinginappropriate delegation, were simplyprotecting and serving their own interests,when there were also important publicprotection issues. Like some of the otherprofessions (for example the physiotherapists,radiographers and occupational therapists),the chiropody profession developed andbegun to train footcare assistants during thisperiod. The Chiropodists Statement thereforeincluded an item on this in its Statement(although it is very likely that most of the otherswould soon also have included similar items ifthey had continued). In it the Committee wasacknowledging that delegation of simple taskswas necessary and even desirable, but wantedto avoid inappropriate delegation to footcareand other such assistants, which it recognisedwas not to the benefit of the patient.Employers who forced registrants to delegate

tasks and treatment to individuals who werenot properly trained for them, could endangerthese patients. If things went wrong, it was theregistrant who would, at least in part, receivethe blame. The Statement stated as follows:

“A state registered chiropodist whoimproperly delegates to a person who isnot a state registered chiropodist duties orfunctions requiring the knowledge and skillof such a chiropodist is liable to disciplinaryproceedings. This statement is notintended to restrict the proper training ofchiropody and other health students or theuse of other registered health staff whohave been trained to perform specialisedfunctions or to carry out treatment ofprocedures falling within the proper scopeof other registered professions.”

6.7 Registrants’ responsibilitiesduring industrial disputes

The major socio-economic and culturalchanges which began in the 1960s and 1970s,which included the changes in employmentpatterns of professional workers and the largeincrease in the size of almost all of the CPSMprofessions (see Appendix 4(1)), had a majorimpact on professional practice, ethics andbehaviour. Increasingly, the professions drewfrom a much wider social background, onewhich had not been brought up or formed inthe traditional ethics of the old professions.Many younger members of the healthprofessions saw themselves as ‘workers’ and‘employees’, certainly not ‘professional men’,and became increasingly unionised (forexample, the Society and College ofRadiographers has been a member of theTrades Union Congress for a long time).

During the late 1970s the industrial disputescharacteristic of those years spread into thehealth service. A number of key health




personnel went on strike or took otherindustrial action. This was largely a newphenomenon, one which people associatedwith miners and car workers, not ‘professionalmen’. However, in practice, their pay andworking conditions were now essentiallythe same as other organised workers.This nonetheless raised some major issues ofprinciple. On the one hand, members of aunion, whatever their work, would maintain aloyalty to that union and their fellow members.On the other, for workers who were AHPs,such loyalty could never be absolute, becauseeach also had responsibilities to their patients’care and safety. Ethically, registrants could notuse engagement in a legitimate and officialindustrial dispute as a reason for abandoningor endangering their patients, and thus couldnot automatically absolve themselves fromallegations of infamous conduct.

The Medical Laboratory Technicians Board andDisciplinary Committee began the debate onthis in 1980, after the events of 1978 andthe ‘Winter of Discontent’ of 1978–79.In particular, a medical member of the Boardhad reported that as a part of an industrialdispute, medical laboratory scientific officers inthe laboratory in which he also worked, hadwithdrawn from emergency duty rosters.The Council took the initiative to urge all theother boards and their committees to discussthis, and took legal advice. The Councilconsulted more widely than was normal for thetime and sought the views of trade unions aswell as the professional bodies and employers’representatives. The Council and all the boardsand their Disciplinary Committees came tobasically the same conclusion. The area wasextremely sensitive. Committees had toexercise a great deal of caution and diplomacy.On the one hand, all agreed that some sort ofreference to this would need to be included inthe boards’ statements. They did not wish the

public or employers to think that they wereautomatically condoning any action carried outduring a dispute. On the other hand, after theWinter of Discontent and the election ofMargaret Thatcher’s government in 1979,circumstances and industrial relations werehighly charged emotionally and partiessignificantly divided. Boards and the Councildid not therefore want the parties to potentialdisputes to think they were taking sides. Afterthey sought and received Counsel’s opinion,the committees did not add an item to theirstatements themselves, but added afootnote to the Introduction to eachStatement, as follows:

“The question of the relationship betweenthe requirements of the statement andaction taken in an industrial dispute hasbeen raised on a number of occasions. Itwould not be proper for a DisciplinaryCommittee to be involved in the merits ofany industrial dispute concerningregistrants and their employers and theparticipation by registrants in industrialaction would not be regarded as within thestatement of conduct. The statement ofconduct is concerned only with infamousconduct in a professional respect; theprinciples of conduct against which that willbe judged are set out in the introduction toand the contents of the statement. TheDisciplinary Committee will consider anyallegations referred to them irrespective ofwhether or not the conduct complained ofhas arisen in the course of industrial action,or in any other circumstances.”

6.8 Duty of care owed to patients,clients and the public

6.8.1 Safe and effective practice

The complex issue of where a registrant’sresponsibilities lay in an industrial dispute


opened up the whole issue of the duty ofcare that they had to their patients.

Health practitioners have always recognisedthat they have a responsibility in relation totheir patients, but until this period it had notbeen considered necessary to specify or codifythis. The political and industrial climatechanged again in the late 1980s and 1990s,and the emphasis was more on safe andeffective practice in general, rather than themore specific issue of the consequences of anindustrial dispute (one which had become lesstopical by then). A number of DisciplinaryCommittees added the warning that theirregistrants must not exploit or abuse theirrelationship with their patients or clients.

During the 1990s there were several high-profile cases where medical practitioners hadcovered up serious incompetence andmistakes by their colleagues, and otherpractices which endangered the health andsafety of patients, and where individuals whohad reported them had been ostracised anddiscriminated against. The latter came to beknown as ‘whistle-blowers’. The CPSMInvestigating and Disciplinary Committees hadnot received any such cases, but certain otherregulators had been criticised, rightly orwrongly, for either ignoring ‘whistleblowers’ orbeing ineffective in such situations. They hadalso been accused, again, whether or not thiswas actually justified, for appearing to ‘protecttheir own’, and for acting as if their role were todefend their registrants and their interests,rather than protect the public. In response,a number of other regulators, including, forexample, the General Dental Council, nowrequired that their registrants report to theappropriate authority a colleague’s conduct orbehaviour or condition which threatened thewell-being of their patients or clients. A CPSMregistrant could also conceivably findthemselves in a similar predicament. At theCPSM Council’s recommendation, in 2001 all

the Disciplinary Committees, after discussionwith their respective boards, inserted similaritems into their statements of conduct.The items not only laid down this obligation,but asserted that the safety of patients orclients must come first at all times and shouldoverride personal or professional loyalties.

6.8.2 Registrants’ responsibilities inrelation to withdrawal of treatmentand care

In 1992 and 1993, dietitians became involvedin a challenging ethical question which lies atthe point where duty of patient care meets theexact moment of death, and still provokesmuch thought and discussion today. This isthe issue of a ‘persistent vegetative state’.The Law Lords on 4 February 1993 had issueda legal ruling in relation to the Tony Bland case.He had been in a coma since being deprivedof oxygen during the tragedy in 1989 at theHillsborough football stadium. The judges inthe Court of Appeal in early December 1992had upheld the previous decision to allow themedical staff to end the artificial feeding ofTony Bland. The Law Lords had also upheldthis decision. They had recommended that infuture, cases of patients like him should eachbe referred to the High Court. They describedsuch patients as ‘insensate with no hope ofrecovery’. They raised a number of majorethical issues surrounding patients in this state,which they believed needed clarifying byParliament. They believed that the diagnosiswas a medical matter, but that any legaldecision about their care should “carryconviction with the ordinary person as beingbased not merely on legal precedent but alsoupon acceptable ethical values.”

The particular issue in this case was whetherthe health team, which included and stillincludes dietitians, could legally and morallystop parenteral and tube feeding, and thusallow the patient to die. Formerly, asprofessions supplementary to medicine,




dietitians would likely have relied upon anddeferred to the decisions of medicalpractitioners. However, the Dietitians Boardbelieved that, as they were fully professionalsin their own right, a dietitian had their ownprofessional contribution, and:

“should not in any way abrogateresponsibility towards her/his patient. TheBoard emphasised that it was not theresponsibility of the dietitian to carry out alldiscussion her/himself, but it would be wisefor her/him to assure her/himself thatadequate discussions had occurred beforeher/himself concurring with an intention tocease feeding such a patient.”

The case had initiated a lively and at timesheated debate nationally. One of the crucialquestions was at what point in practice could ateam declare that a patient was ‘insensate withno hope of recovery’ and was this actuallydeath? In the case of Tony Bland, his brain wasirreparably damaged. However, in other, albeitrare, cases people in a persistent coma have,nonetheless, come out of it, sometimes yearslater. Another question was whether tubefeeding could be classed as treatment orfeeding. A third was, whether or not it wasfeeding or treating, was this in anywaybenefiting a patient whose brain could even bedescribed as hardly existing. As it was acomplex issue where it was difficult to lay downhard-and-fast rules, the Disciplinary Committeedid not include an item in its Statement ofConduct, but the Board itself producedguidelines for all of its registrants. The DietitiansBoard looked at a consultative document whichthe British Medical Association had previouslyproduced in September 1992, “Discussionpaper on treatment of patients in persistentvegetative state”, and produced its ownguidelines, in consultation with the BritishDietetic Association. Overall, this particularissue is a very good example of how CPSMregistrants were developing increasingprofessional responsibilities.

6.8.3 Control of infection

A growing concern during the 1980s and 90swas the danger of cross-infection duringtreatment. Because chiropodists frequently useinstruments such as scalpels which cut theskin, the Chiropodists Board and itsDisciplinary Committee began considering thisin the mid-1980s. Until then, the professionhad believed that cold sterilization using strongdisinfectant was sufficient. However, the Boardnow believed, after considering expertevidence which it had sought, that this was notsufficient to ensure that instruments were trulysterile, and therefore took the view that onlyheat sterilization via autoclave providedadequate prevention of cross-infection.The Board had therefore issued therequirement that all schools of chiropodyprovide heat sterilization of all instruments.However, the Disciplinary Committee did notmake this requirement of all the board’sregistrants through its Statement ofConduct, which it considered would havebeen too specific.

For the other boards, the issue was largelyfirst raised in relation to AIDS / HIV. This initself caused concern with some boards.They observed that, during the 1980s andearly 90s there was growing public and mediaattention regarding AIDS, in some cases, theybelieved, disproportionate to other infectionissues. The Department of Health producedguidance in the early 1990s, with coveringinstructions about the requirement forhealthcare staff to disclose details to theiremployers on whether they were HIV positiveor if their life-style might put them at risk.The boards were asked to consider if this hadimplications for them. Having received andconsidered copies of the guidance from theDepartment of Health on this, all boardsproduced their own advice. However, severalboards and their Disciplinary Committeesexpressed concern that the advice only dealtwith only one aspect of the whole issue of

infection control – one usually associated in thepublic’s mind with a particular minority group –and that it had partly arisen only because themedia had drawn attention to it. TheOccupational Therapists Board, for example:

“expressed concern that such guidanceconcentrated on only one, well publicizedaspect of cross infection, commenting thatthere were other, more likely sources ofcross infection which were wholly ignoredby the guidance documents and were inpractice of much greater danger topatients/client.”

The Disciplinary Committees did not addan item to their Statements of Conduct,but, rather, the boards produced advicethemselves. Some committees refused evento attach this advice to the Statement ofConduct. From the beginning, the ChiropodistsBoard entitled its advice on this ‘CrossInfection’ and worded it accordingly. Withhindsight, we can see that the boards’ andcommittees’ concerns had validity. If they hadincorporated an item exclusively on AID / HIVinto their formal Statements, boards and theirDisciplinary Committees would have beendrawing attention to only one aspect of amajor, much broader issue. Subsequently themuch broader nature of the issues involvedrelating to cross infection became clear.

6.9 Confidentiality andrecord keeping

6.9.1 Confidentiality

Just as some issues, such as advertising andreferral, declined in importance between 1960and 2002, so other issues arose which had notbeen significant at the beginning. Some ofthese arose from the fact that registrants’professional responsibility and therefore theexpectations of employers and the public hadgrown. Some arose from the wider changes insociety, professional behaviour and the health

service and provision. One of the mostimportant issues which reflected both was thedevelopment of data protection andconfidentiality law and requirementsbetween the mid 1980s and the 2000s.Health practitioners have always needed torespect their patients’ confidentiality and data.However, until the 1980s, nothing in most ofthe statements specifically set out or clarifiedwhat this meant in practice. Because of thenature of their practice, both theRadiographers and Medical LaboratoryScientific Officers Statements of Conductwere exceptions to this. Both had an item onconfidentiality from the beginning.Both statements said that registrantsshould not knowingly:

“disclose to any patient, or to any otherunauthorised person, the result of anyinvestigation or any other information of apersonal or confidential nature gained inthe course of practice in his profession.”

The first data protection legislation was in themid-1980s and covered the, by then extensive,use of computerised records. Upon the adviceof the then Department of Health and SocialSecurity, all Disciplinary Committees added anitem to their statements of conduct which saidthat a registrant should not:

“in the course of professional work seek,keep or store and disclose healthinformation about a patient other thansolely for the purpose of that patient’scontinuing care.”

They thus extended the requirement to allrecords rather than just computerised ones.The Data Protection Act 1998 replaced theprevious legislation, in response to theEuropean Directive on data protection, andcame into force in 2000. The committeesmodified their statements accordingly, toinclude reference to obtaining patients’ orclients’ consent.





6.9.2 Record keeping

Record keeping is a closely related toconfidentiality. Considering how importantkeeping good clinical notes and records is toany professional, it is perhaps surprising thatnone of the statements referred to itthroughout the history of the CPSM. However,two boards did address the question, theDietitians Board and the new Prosthetists andOrthotists Board. The Dietitians DisciplinaryCommittee considered two cases in 1995 and1998 respectively, relating to allegations ofinadequate clinical record-keeping. In bothinstances the Committee hearing declared thatthe case was well-founded and in the secondcase the registrant was struck-off. Partly as aresult of this, the Board produced a jointguidance document on record keeping withthe British Dietetic Association.

Arising from a recent query to its InvestigatingCommittee Chairman and general discussionwithin the profession, the Prosthetists andOrthotists Board also began discussing clinicalnote-keeping in 1999. The Board in October1999 agreed formally, as a matter of principle,that failure by a registrant to keep clinical noteson patients treated would be likely to beconsidered infamous conduct in a professionalrespect and so informed the DisciplinaryCommittee. The Disciplinary Committee thenbegan to consider how to take this intoaccount in its Statement and anypossible hearings.

At the board’s suggestion, its Chairmanrecommended at the next Council meetingthat the boards and Council consider jointly thequestion of clinical note keeping by allregistrants. Other boards (for example theRadiographers Board) recognised that this wasan important item which needed furtherdiscussion. However, none of them were ableto progress this much further before the HPCreplaced them. In the meantime, theProsthetists and Orthotists Board produced

some draft guidelines, and consulted theBritish Association of Prosthetists andOrthotists and other interested parties on this.Unusually for then, it also sent a consultationletter and the draft guidelines to all of itsregistrants. A number of registrants replied andthe Board Chairman, Colin Peacock, analysedthem. The replies supported the proposal, butstated that, for notekeeping to be effective,employers would need to give practitionersenough time to complete the notes. However,the Board was unable to finish thisconsultation before the HPC replaced it in April2002. The Disciplinary Committee would havealmost certainly included an item in itsStatement referring to the guidelines if it hadcontinued, as would, undoubtedly, othercommittees. Nonetheless, the ShadowConduct and Competence Committee tookthe Board’s draft guidelines into account whendiscussing and drafting an item on recordkeeping in the Standards of Conduct,Performance and Ethics.

6.10 Professional indemnityinsurance

Some regulators (for example the GMC,General Optical Council (GOC) and GeneralDental Council (GDC)) require their registrantsto take out professional indemnity insurance.At the CPSM, only the Chiropodists Statementreferred to professional indemnity insuranceand only in a footnote, which it introduced in1986. By and large, boards and theircommittees did not believe that it wasappropriate for them to lay down requirementsregarding insurance cover and left such thingsto the professional bodies, who oftenincorporated insurance cover in theirmembership fees. However, because manychiropodists worked in private practice, aloneor in partnership, the Disciplinary Committeebelieved it appropriate at least to mention it.The Statement included it as a generalfootnote, as follows:


“It would not be proper for a DisciplinaryCommittee to be involved in questions ofprofessional negligence and the adequacyof registrants’ insurance cover under whichpatients could be paid for damagessuffered. However, other aspects of thepractitioner’s relationship with patientsmight become the subject of complaintand the fact that a professional relationshipremains impaired because a practitionerhas failed to pay damages for want ofadequate insurance cover might betaken into account when other mattersare considered.”

6.11 Inappropriate association

Throughout the Chiropodists Board’s existencethere was a category of ‘infamous conduct’which was peculiar to that Board, called‘inappropriate association’. It arose because,unlike most of the other CPSM professions,there were two distinct sectors within theprofession, the registered and unregistered.The Chiropodists Board and its DisciplinaryCommittee wanted to stop its registrants fromassociating with chiropody institutions which‘were not recognised by the Board’:

“Chiropodists should not teach or take partin the conduct of examinations inchiropodial15 subjects, or be in any wayassociated with any school or institutionwhich has not been recognised bythe Board.”

The early version added “unless they havepermission from the Board to do so,” whichthe Committee dropped somewhat later, butadded exemptions for training students ofother health professionals, post-registrationtraining of chiropodists (presumably registeredones) or foot-care assistants.

Many chiropodists were not registered with theBoard and, if they were in private practice, didnot need to be. There were several educationaland training institutions which trainedchiropodists, but were not approved by theBoard. Those who successfully completedtheir courses could not register with the Board,but could work in private practice.

The physiotherapy profession also had verydistinct registered and unregistered sectors,but did not attempt to include such arestriction. The Chiropodists Board was tryingto avoid a blurring of the distinction betweenthe two sectors. It wanted to stop registrantsfrom giving even an occasional lecture or talkto an unapproved school of chiropody. It wasnot an idle threat. During the history of theChiropodists Board, the DisciplinaryCommittee found two registrants guilty ofinfamous conduct for associating “with aninstitution… which has not been recognized bythe Board without the permission of the Boardto do so,” the second being as late as 1989. In1983, the Committee struck the first registrantoff the register, the second it did not.

This was a significant example of theconsequences of unprotected titles. However,since 2005 legal protection of the titleschiropodists and podiatrist, the two formersectors of registered and unregistered havemerged through the grandparenting process.This issue is therefore no longer relevant. Inretrospect, could the Board’s DisciplinaryCommittee have enforced such a restriction,even before the Human Rights Act 1998 cameinto force? On the common law grounds aloneof fairness and reasonableness, was itseriously unethical behaviour? Was it unethicalat all? If the two individuals above had pressedthe matter further and taken the Committee tothe Judicial Committee of the Privy Council or


15 See footnote 10.



judicial review, would the former or a courthave upheld the view that such behaviour was‘infamous conduct in a professional respect’?This is perhaps unlikely, particularly as thelanguage which the item in the Statement usedwas ambiguous. The PSM Act nowhere usedthe term ‘school’ or ‘recognised’, so whatexactly did they mean? It did use the word‘institution’, but this could also mean any formof institution. Article 11 of the EuropeanConvention on Human Rights, ‘Freedom ofassembly and association’16 protects the rightsof all to join and be associated with lawful andpeaceful associations. Since 2000, it is veryunlikely that the Committee could havedefended this item successfully in the light ofthis Article.

16 See Appendix 3.

7 Cases and hearings

7.1 The very small numberof cases

The graph in Appendix 5(2) compares the totalnumber of registrants with the number ofcases reaching the Disciplinary Committees.As we can see, this stayed very small indeedthroughout the time they existed. In someyears, there were no cases at all, ie in 1975–6,1976–7 and 1985–6. The graph in Appendix5(3) shows the proportion of cases per 1,000registrants, for all registrants. In fact, thehighest proportion was right at the beginning in1965–66. Professions varied slightly. TheOrthoptists Disciplinary Committee never had acase to consider. The new boards, ie thoseformed from 1997 onwards, did not last longenough to produce enough cases to indicatesignificant patterns. The graph in Appendix5(4) shows that the Chiropodists Board’sDisciplinary Committee considered casesthroughout its existence, but even here therewere very few. The appendices show, by wayof example, a profession which had very fewcases (dietitians), through to those which had anumber of cases throughout, (chiropodists). Asthe graphs in Appendix 5(6) and 5(7) highlight,the Dietitians Disciplinary Committee did notconsider a case until 1991–92. The CPSM didnot collect data on gender of registrantsagainst whom an allegation was made or whohad been through the disciplinary process.Indeed, it did not collect gender data at all, butit was nonetheless clear that during much ifnot all of its history the majority of registrantswere women. However, from an examination ofthe outcomes of the very small number ofhearings held, the majority of registrants whowent through a hearing were men.

Why were there so few cases? From theminutes of the Investigating Committees, thereis no evidence that these Committees werereceiving large numbers of cases and not

referring them. For example, the OccupationalTherapists Board’s Investigating Committee(see Appendix 5(12) did not receive a case until1976–7, which it referred to the DisciplinaryCommittee. For many of the years betweenthen and 2002, it again did not receive anycases. Apart from 1999–00, when it receivedseven cases, of which it referred only one,when it did receive cases, it received 1, 2 or 3.Another example, the Medical LaboratoryTechnicians Board follows basically the samepattern. In accordance with normal procedurein terms of confidential personal data, theCPSM (and its successor the HPC) has notkept copies of allegations received during theCPSM days and which did not proceed to theInvestigating Committees, nor is there anextant record of what or how many theRegistrars received, but there is no evidence,either, that large numbers of people weremaking allegations which the Registrars orInvestigating Committee Chairmen werescreening out.

There are several reasons for this tiny number ofcases for every profession. Until the last fewyears of the CPSM, very few people, whetheremployers or the public, knew that the boardsor their disciplinary processes existed; and, untilthe mid 1990s convictions involving registrantsrarely reached the CPSM. Even if the publicknew they existed, they knew little if anythingabout what they did. The requirement thatmembers of the public always had to make astatutory declaration was an obstacle, too.




However, even in the case of the GMC, whichalways had a much higher profile than theCPSM, the number of allegations received isvery small compared to registrant numbers,albeit larger than for CPSM. The GMC figuresfor allegations and enquiries received for thesame period as the last five years of CPSM areas follows17.

Year GMC allegations and fitness topractise enquiries

1998 1,503

1999 2,687

2000 4,470

2001 4,504

2002 3,937

According to the GMC’s Annual Report of2003 “by the end of 2002 over 200,000doctors held provisional, full and limitedregistration”18. 3,937 registrants involved in anallegation / enquiry out of 200,000 registrantsis under two per cent.

There is no evidence to suggest a conspiracyby all regulators to avoid looking into and tocover up most allegations against registrants.Instead one can legitimately come to theconclusion that there continue to be so fewallegations largely because the vast majority ofregistrants are committed to their job andvocation to help others and contribute to theirwell-being as AHP, and therefore maintain theircompetence, continue to developprofessionally and do not misbehave.

7.2 Outcome of hearings

As we can see from the graphs in Appendix5(13), very few registrants indeed were everstruck off during the whole CPSM period.From all the cases where committees foundthat a registrant was ‘guilty of infamousconduct’ (see graph in Appendix 5(14)), thereasons fall into the following categories:

– standards of conduct

– theft / fraud

– drug abuse

– alcohol abuse

– violence

– verbal abuse

– sexual misconduct

– bringing the profession into disrepute

– record-keeping issues

– confidentiality issues

– scope of practice issues

– practising outside of scope ofpractice

– referral issues

– acting against patients’ best interests

– health and safety of patients

– incompetence

– advertising issues

– inappropriate advertising

– inappropriate promotion ofproducts

– sterilization issues

– supervision and delegation issues

– fraudulent entry to the register

17 From GMC annual reviews.

18 See page 4 of the GMC Annual Report of 2003.


Some reasons for imposing sanctions weremore common than others and someprofessions were more susceptible to somekinds of misconduct than others. For example,chiropodists19 were apparently susceptible totheft and radiographers 20, alcohol abuse.However, the figures are so small that we canin no way see them as representative of theprofession.

7.3 Competence cases

Although strictly speaking Committees couldnot take competence into account, in practicethey could do so partially by classifying it asacting against the patient’s best interest. If aregistrant acted incompetently, this is clearlyacting against the patient’s best interest.However, because the only category was‘infamous conduct’ and ‘bringing theprofession into disrepute’, and the onlysanction was striking off, this could onlycover very serious or ‘gross’ incompetence.The Council and boards for some time, from atleast since 1980, had wanted to extend therange of sanctions, and take into accounthealth and competence issues. There was noway of dealing with practitioners who, althoughnot grossly incompetent, regularly fell short ofminimum standards of competence. For these,striking off is usually not the most appropriatesanction, because it means that theprofessional drops out of the system.Rather, committees wanted to bring theirpractice up to an acceptable standard so thatthey can continue to make a contribution as ahealth profession.

7.4 Health cases

The CPSM Disciplinary Committees also couldnot take into account health issues as such.Again, they, where possible, used thecategories which were open to them,particularly ‘acting in the patient’s best interest’or not doing so. A registrant whose ill-healthseriously impaired their competence andpractice, and endangered the health andsafety of patients should not remain on theRegister. However, this was rather stretchingthe plain meaning of ‘infamous conduct’ andonly covered serious ill-health. Furthermore, aswith normal incompetence, striking off wasusually not the appropriate remedy.

Committees, boards and the Councilincreasingly recognised that ‘impairment ofcompetence due to ill-health’ is quite differentfrom something like theft, violence or sexualabuse. Indeed, informing the world thatsomeone is ‘guilty of infamous conduct’ underthese circumstances would give an entirelywrong impression and could make theircondition even worse. In one particularinstance, a registrant, who was anoccupational therapist had, as a result of aserious episode of mental illness, set fire toher place of work on two occasions.The Occupational Therapists DisciplinaryCommittee realised that for the moment shewas a danger to the public and should not beallowed to practise whilst still seriously mentallyill. Setting fire to her place of work on twooccasions was, objectively ‘infamous conduct’.They were, nonetheless very aware that shehad acted purely as a direct consequence ofher illness, not with malice, and whilst not fullyresponsible for her actions. Simply striking heroff and declaring her “guilty of infamousconduct” would give a false impression of hermotives and impair her full recovery.


19 Appendix 5 (15).

20 Appendix 5 (16).



Nonetheless, they could only use thelegal powers currently available.The Committee therefore formally declared:The Committee had:

“heard the facts of the casesympathetically. They would have wished tobe in a position to consider a conditionalsuspension whilst she received appropriatetreatment but they were not empowered todo so. Therefore in respect of the mattersto which the charges relate the respondent[registrant against whom the allegation hasbeen made] is guilty of infamous conduct ina professional respect and her name shouldbe removed from the Register. However theCommittee hope that she will considerapplying for restoration of her name at asuitable time in the future when she canproduce appropriate evidence to supporther application. The Committee feel that itis in her best interests to be relieved of theresponsibility of practising in the presentcircumstances.”

Given the serious limitations, the Committee inthis instance dealt with this particular registrantin as sympathetic a way as was possible.

Partly as a result of this case and more generaldiscussion, the Council’s Working Party on theFuture, in its report ‘Future Requirements andOpportunities’ in 1980, considered thequestion of allegations involving physical andmental health rather than conduct. During itsconsultation, it had found that the majority ofthose responding to its discussion document,were in favour of the Working Party’s proposal.

The Working Party favoured a joint healthcommittee to deal with this, as, even then, itrecognised that the number of such cases waslikely to be small. It therefore recommendedthat the Council support a change in thelegislation allowing a ‘joint Council / boardsmedical cases committee be set up with apower to suspend registration and / or restrictpractice’, which would involve members who

would be specialist medical practitioners. TheCouncil included in its list of recommendedlegislative changes, which would it produced in1984, as follows:

“To provide Boards with powers andorganisation to suspend the registration ofor impose restrictions upon the practice ofa registrant whose health may impair hiscompetence or affect his conduct. Thesame powers of suspension and restrictionshould also be available to DisciplinaryCommittee for us in conviction andmisconduct cases.”

All reference to a joint committee has beendropped as this was an idea that was arguablynot politically opportune at the time.

8 The CPSM and professionalconduct, a final word

8.1 A great step forward in 1960

The CPSM, boards and their committees wereproducts of the 1950s and early 1960s (as theHPC is a product of the early 2000s).The boards set themselves up and developedtheir disciplinary powers and standards in theirearly years within the ethos of that era, onewhich was, in many respects, very differentfrom what came later. The world in which theyhanded over to HPC had in many senseschanged very considerably since theirbeginnings and, although legally the sameentities, they themselves were, actually, inmany senses quite different.

Inevitably, how the boards, their Investigatingand Disciplinary Committees and the CPSMexecutive exercised these powers varied fromtime to time and from board to board.Nonetheless, the statutory registration whichthe Professions Supplementary Act achievedwas a great step forward in 1960.An important contribution to this was that itincluded what were, for the time, real andeffective powers relating to professionalconduct. It provided a ‘kitemark’ analogous tothat used by the British Standards Institutesince 1903, showing that registrants (and thecourses and institutions which educated andtrained them) met a certain standard ofpractice and behaviour for the protection of thepublic. This in turn provided a real and effectivestandard for employment.

8.2 Internal reform andmodernisation at the CPSM

All the professions within the CPSM grewconsiderably over the period it existed. In 1965the number of registrants was 25,950, in 2002it was 137,014. In the 1960s, apart for theposition of Registrar, the first of whom was alawyer and the Assistant Registrar who carriedout some accounting and administrativefunctions, the only staff which CPSM neededwere a small number of clerical and

administrative staff; (see Appendix 4 for adiagram setting out the staff structure until1984). A registration department, with amanager, known as the Registration Officer,and registration clerks, carried out theregistration function itself. Two administrativeassistants ran all the boards and the Councilas committee clerks, entirely unaided.Apart from the actual registration function itselfand the Disciplinary Committee hearings, theydid everything relating to regulatedprofessions: preparing and sending outagendas; minuting meetings; dealing with allmatters arising from the meetings; advisingboards on professional, educational and othermatters; liaising and communicating withoutside bodies; running each board’s approvaland monitoring, overseas application andgrandparenting schemes. The Councilappointed an additional administrativeassistant in 1984, but all three worked unaideduntil the early 1990s. There was almost nospecialisation of tasks. Individual members ofstaff provided what input there was in all areasin which the Council, boards, Investigating andDisciplinary Committees were involved, on anad-hoc basis. For example, until the mid-90s,the Registrar’s secretary provided theadministration of disciplinary cases.

When it computerised the registers, theCouncil had greatly helped modernise theregistration process, but the otheradministrative processes and arrangementsdid not change until the early 1990’s. In 1989,the organisation fundamentally remained thesame as in the early 1960s in its ethos; yet itwas facing radical changes within theprofessions and professional practice, healthservice, educational world and general socialchange. Upon his appointment as Registrar in1989, Roderic Pickis began tackling the largebacklog of urgent internal change needed thathad built up over more than two and a halfdecades, and of bringing the internaladministration, management and ethos fromthe early 1960s into the 1990s, including the



8 The CPSM and professional conduct, a final word

processing of professional conduct matters.Michael Hall, his successor, continued this untilthe HPC took over (see Appendix 4 for adiagram setting out the staff structure in 2001).

8.3 The need for statutory change

For some time the Council and boards hadrecognised the legal shortcomings of the PSMAct, as did many outside CPSM. Several ofthese shortcomings related to theirprofessional conduct powers. Section 6.3 setsout why this was the case: as well as generalconcerns, the lack of protection of commontitle was relevant to professional conduct. Assection 7 highlights, the disciplinary powersand sanctions which were available to theDisciplinary Committees were very crude. Theirpowers only related to ‘infamous conduct in aprofessional respect’ and could not take intoaccount ordinary misconduct, or competenceand health issues, and the only sanction wasstriking off, when a more subtle andappropriate sanction was often required.

Further, there was the fact that each board hadits own professional conduct committees. Inthe CPSM’s Working Party on the Future, in1980 its report ‘Future Requirements andOpportunities’, had floated the idea of a jointdisciplinary committee of the Council ratherthan one for each board. This would haverequired a change in legislation. The WorkingParty’s discussion document had commented:

“For such little use, in some professionsrobbing the Board of any experience of theoperation of the disciplinary powerswhatsoever, the provision of eight separatearrangements seems inept andcumbersome. The merging of committeesin a Council disciplinary committee to bejoined by, say, three assessors from eachBoard, seems a practical alternative.”

This had aroused some vehement oppositionin some quarters, particularly those whowished to retain professional differences andwere jealous of professional autonomy.In respect of existing powers which related toconduct and conviction cases, the WorkingParty had subsequently recommended that theCouncil leave well-alone. Nonetheless, therewas also support for this proposal and it couldbe argued that, by the end, twelve separateInvestigating and Disciplinary Committees wasnot only administratively inefficient, but couldencourage excessive bias towards theprofession and individual professional,reinforced by the fact that none of thecommittees could legally open its membershipto outsiders, including lay members.

The fact that CPSM or boards or Registrar hadno powers to initiate cases at all themselves,but always had to wait until they received anallegation from elsewhere meant that casesmay well have got missed (although there is noactual statistical evidence for this). Even if theyknew of a major cause for complaint against aregistrant, they could, in themselves, donothing about it.

Any significant changes required changes tothe Act itself. In 1980 the Council began todraw up a list of changes which it and theboards wanted implemented. It was not until1995 that the government began to preparefor a major review of the PSM Act, whichultimately resulted in its replacement by theHealth Professions Order 2001.

Nonetheless, despite all the limitations of thelegislation, on balance the boards and theirInvestigating and Disciplinary Committeesaccomplished a great deal, particularly in twoperiods: in their first two or three years whenthey were setting themselves and theirprocesses up; and within the last ten to twelveyears of CPSM.

Glossary

AHP Allied health profession or allied health professional, a term commonly usedduring this period for those previously called ‘profession supplementary tomedicine’

Applicant A person applying to join the Register

BRMA Board of Registration of Medical Auxiliaries

CPSM Council for Professions Supplementary to Medicine

DHSS (former) Department of Health and Social Security, subsequently separatedinto the Department of Health and Department of Social Security

Discipline / Term used for the formal powers relating to professional conduct exerciseddisciplinary by the CPSM boards (and certain other regulators)

Fees The fees payable by registrants for admission to the Register, orre-admission or renewal of registration; fees were the CPSM’s, and are theHPC’s, main source of income

GDC General Dental Council, one of the UK statutory regulators of healthcareprofessionals, which regulates dental professionals (dentists, dental nurses,dental technicians, dental hygienists, etc)

GMC General Medical Council, one of the UK statutory regulators of healthcareprofessionals, which regulates medical practitioners

GOC General Optical Council, one of the UK statutory regulators of healthcareprofessionals which regulates optometrists, dispensing opticians, studentopticians and optical businesses

Grandparenting Process by which people without approved qualifications apply forregistration if they practised before the opening of the Register, both for theCPSM boards and HPC, previously called ‘grandfathering’

HPC Health Professions Council

Health Professions The Health Professions Order 2001 which set up the HealthOrder Professions Council

Member Member of Council or a Board, either appointed or elected

NHS National Health Service

Professional body Organisation which aims to further a particular profession and the interestsof professionals such as registrants.

PSM Act Professions Supplementary to Medicine Act 1960 which set up the CPSMand boards

Protected title Professional titles which a regulator protects by law (eg occupationaltherapist, paramedic, physiotherapist, radiographer)



Glossary

Register The record of professionals who meet the standards

Registrant An individual whose name is currently on the Register

Registrar A person appointed by the Council under the PSM Act, thenHealth Professions Order 2001, who has certain functions as directedby the Council

Regulator In this context, any organisation which is responsible for regulatingprofessional workers and their professions

Rules Legal documents which prescribe in more detail how the organisation willrun, and set out procedures for statutory committees, work in relation toprofessional conduct, procedures for registration and the level of fees

Sanction Decision reached as a result of a disciplinary hearing; for CPSM this waswhether or not to strike off

Scope of practice Procedures and processes undertaken by a registrant, which includeswhat they actually do, what they can do and what they are entitled to do

Standing orders Document which sets out the formal procedures for running Council,Board and committee meetings; they dictate how the members andofficers, including the chairman and vice-chairman, will act and behave

Statutory Set up, required or enforced by the authority of an Act of Parliament

Statutory committee A committee which the legislation requires be established to carry outcertain statutory functions

Statutory Instrument Secondary legislation which is made under the authority of Acts ofParliament (primary legislation)

Statutory regulation Regulation of a profession in accordance with a piece of legislation

Striking off One of the possible sanctions in a disciplinary case, for the CPSM the onlyone; the registrant’s name will be removed from the Register

UKCC United Kingdom Central Council for Nursing, Midwifery and Health Visiting(the predecessor of the NMC)

Relevant documents

The sources for this report include the minutesof the relevant meetings of boards andcommittees, reports to meetings, standardsdocuments, government reports andCouncil reports.

Reports

Z. Cope, ‘Cope Report’, Reports of theCommittees on Medial Auxiliaries,1951.

J. E. Pater, ‘Pater Report’, The Working Partyon the Statutory Registration of MedicalAuxiliaries report, 1954.

‘The report of the Council’s Higher and FurtherEducation Working Party’, The Next Decade,1979.

‘The report of the Council’s Working Party onthe Future’, Future Requirements andOpportunities, 1980.

K. Melvin, A. Richardson, ‘A Report to theCouncil for Professions Supplementary toMedicine’, Revising the ProfessionsSupplementary to Medicine Act 1960, NuffieldInstitute for Health, 1995.

‘Report of JM Consulting Ltd to theDepartment of Health on the future of theProfessions Supplementary to Medicine Act1960’,1996.

Other documents

The Professions Supplementary to MedicineAct 1960 and relevant subsidiary legislation (allnow repealed)

The Statements of Conducts in their variouseditions of all former boards

The minutes of the CPSM boards and theirDisciplinary Committees

European Convention for the Protection ofHuman Rights and Fundamental Freedoms

Papers for the Professions Supplementary toMedicine Bill and Act, then in the Departmentof Health Archive at the Elephant and Castle.

R. Pickis, as Registrar 1989–95, unpublishedpaper ‘CPSM and Professional Education,Registration, and Regulation’, explains thepurpose of registration, and the boards’educational and professional conductfunctions, and sets out the background,foundational principles theses.

G. Larkin, Occupational Monopoly andModern Medicine, Tavistock Publications,London and New York, 1983.

A Wilcock, Occupation for Health: A Journeyfrom Self-Health to Prescription Volumes 1 and2, British Association of Occupational Therapy/ College of Occupational Therapists, 2001.

J. Barclay, In Good Hands: The History of theChartered Society of Physiotherapy 1894-1994, Butterworth-Heinemann Ltd, Oxford,1994.

I. Moodie, The Society of Radiographers 50Years of History, Society of Radiographers,London, undated.

‘Briefing’, British Medical Journal, 284,(27 February 1982), pp. 680–81.



Appendix 1: The health professionscovered by the CPSM and the registrars

The professions which the CPSM coveredwere as follows, in date order.

From the beginning

Biomedical scientists (formerly medicallaboratory technicians then medical laboratoryscientific officers)

Chiropodists (since 2005 also calledpodiatrists)

Dietitians

Occupational therapists

Physiotherapists

Radiographers

Remedial gymnasts (merged withphysiotherapists in 1986)

From 1967

Orthoptists

From 1997

Prosthetists and orthotists

From 1998

Art, music and drama therapists (collectivelyarts therapists)

From 2000

Clinical scientists

Paramedics

Speech and language therapists (formerlyspeech therapists)

CPSM Registrars

John Tapsfield 1960 – 1976

Brian Donald 1976 – 1985

Frank Whitehill 1985 – 1989

Roderic Pickis 1989 – 1995

Michael Hall 1995 – 2002

Appendix 2: The disciplinary provisionsof the Professions Supplementary toMedicine 1960Disciplinary provisions

Investigating and Disciplinarycommittees

8.–(1) Each board shall set up two committees,to be known as the investigating committeeand the disciplinary committee respectively, ofwhich –

(a) the investigating committee shall becharged with the duty of conducting apreliminary investigation into any casewhere it is alleged that a personregistered by the board is liable ofdeciding whether the case should bereferred to the disciplinary committee;and

(b) the disciplinary committee shall becharged with the duty of considering anddetermining any case referred to it by theinvestigating committee and any othercase of which the disciplinary committeehas cognisance under subsection (5) ofthe next following section.

(2) The provisions of Part 1 of the SecondSchedule to this Act shall have effect withrespect to the constitution of investigating anddisciplinary committees, and provisions of PartII of that Schedule shall have effect withrespect to the procedure of disciplinarycommittees.

Removal of names from register forcrime, infamous conduct, etc

9.–(1) Where –

(a) a person who is registered by a board isconvicted by any court in the UnitedKingdom of a criminal offence which, inthe opinion of the disciplinary committeeset up by the board, renders him unfit tobe registered; or

(b) such a person is judged by thedisciplinary committee to be guilty ofinfamous conduct in any professionalrespect; or

(c) the disciplinary committee is satisfiedthat the name of such a person hasbeen fraudulently entered on the registermaintained by the board,

the committee may, if it thinks fit, direct thatthe person’s name be removed fromthe register.

(2) When the disciplinary committee directsthat a person’s name shall be removed fromthe register, the committee shall cause a noticeof the direction to be served on that register.

(3) The person to whom such a directionrelates may, at any time within twenty-eightdays from the date of service on him of thenotice of the direction, appeal against thedirection to Her Majesty in Council inaccordance with such rules as Her Majesty inCouncil may by Order prescribe for thepurposes of this subsection; and the boardconcerned may appear as respondent on anysuch appeal and, for the purpose of enablingdirections to be given as to the costs of theappeal, shall be deemed to be a party theretowhether or not it appears on the hearing ofthe appeal.

The Judicial Committee Act. 1833, shall applyin relation to a disciplinary committee as itapplies to such courts as are mentioned insection three of that Act (which provides forthe reference to Judicial Committee of thePrivy Council of appeals to Her Majestyin Council).



Appendix 2: The disciplinary provisions of the Professions Supplementary to Medicine 1960

(4) A direction for the removal of a name fromthe register shall take effect–

(a) where no appeal under this section isbrought against the direction within thetime limited for the appeal, on theexpiration of that time;

(b) where such an appeal is brought and iswithdrawn or struck out for want ofprosecution, on the withdrawal orstriking out of the appeal;

(c) where such an appeal is brought and isnot withdrawn or struck out as aforesaid,if when the appeal is dismissed and nototherwise.

(5) A person whose name is removed from theregister in pursuance of a direction of adisciplinary committee under this section shallnot be entitled to be registered in that registeragain except in pursuance of a direction in thatbehalf given by the committee on theapplication of that person; and a directionunder this section for the removal of a person’sname from the register may prohibit anapplication under this subsection by thatperson until the expiration of such period fromthe date of the direction (and where he hasduly made such an application, from the dateof his last application) as may be specified inthe direction.

(6) It shall be the duty of each disciplinarycommittee to prepare and from time to timerevise, in consultation with its board and theCouncil, a statement as to the kind of conductwhich the committee considers to be infamousconduct in a professional respect, and theboard shall send by post to each registeredmember of the relevant profession, at hisaddress on the register, a copy of the statementas for the time being revised; but the fact thatany matters are not mentioned in such astatement shall not preclude the disciplinarycommittee from judging a person to be guilty ofinfamous conduct in a professional respect byreference to such matters.

Section 8.

Second Schedule

The Investigating and DisciplinaryCommittees

Part I

Constitution of the Committees

1.–(1) The board by which an investigatingcommittee and a disciplinary committee areset up shall, in consultation with the Council,make rules regulating the membership of eachof the committees, and the times and places ofthe meetings, quorum and mode ofsummoning members of the disciplinarycommittee; but subject to paragraph (b) below,a person shall not be eligible for membershipof either committee unless he is a member ofthe board.

(2) Such rules shall secure that–

(a) no person who acted as a member ofthe investigating committee with respectto any case shall act as a member of thedisciplinary committee with respect tothat case; and

(b) where a case against a person whoresides and practises the relevantprofession in Northern Ireland is beforeeither of the committees, at least onemember of that committee at anymeeting thereof shall be a member of theboard who resides and practises asaforesaid or (where no member of theboard satisfies that requirement or nomember who satisfies that requirement isavailable to act on the committee) aregistered member of the relevantprofession residing and practising asaforesaid and appointed by the board tobe a member of the committee for thepurposes of the case in question.


(3) Rules under this paragraph shall not comeinto force until approved by the Privy Council.

Part II

Procedure of Disciplinary Committees

2.–(1) For the purposes of any proceedingsbefore a disciplinary committee in England orWales or Northern Ireland the committee mayadminister oaths and any party to theproceedings may sue out writs of subpoena adtestificandum and duces tecum, but no personshall be compelled under any such writ toproduce any document which he could not becompelled to produce on the trial of an action.

(2) The provisions of section thirty-six of theSupreme Court Act 1981 shall apply in relationto any proceedings.

Schedule 5, Supreme Court Act 1981.

(3) For the purpose of any proceedings beforea disciplinary committee in Scotland, thecommittee may administer oaths and theCourt of Session shall on the application of anyparty to the proceedings have the like poweras in any action in that court to grant warrantfor the citation of witnesses and havers to giveevidence or to produce documents before thecommittee, and for the issue of letters ofsecond diligence against any witness or haverfailing to appear after due citation, to grantwarrant for the recovery of documents, and togrant commissions to persons to take theevidence of witnesses or to examine haversand receive their exhibits and productions.

3.–(1) Subject to the next following sub-paragraph, the Council shall make rules as tothe procedure to be followed and the rules ofevidence to be observed in proceedings beforedisciplinary committees, and in particular–

(a) for securing that notice that theproceedings are to be brought shall begiven, at such time and in such manneras may be specified by the rules, to theperson alleged to be liable to have hisname removed from the register;

(b) for determining who, in addition to theperson aforesaid, shall be a party tothe proceedings;

(c) for securing that any party to theproceedings shall, if he so requires, beentitled to be heard by the committee;

(d) for enabling any party to the proceedingsto be represented by counsel or solicitoror (if the rules so provide and the partyso elects) by a person of such otherdescription as may be specified bythe rules;

(e) for requiring proceedings before thecommittee to be held in public except sofar as may be provided by the rules;

(f) for requiring, in cases where it is allegedthat a person is guilty of infamousconduct in any professional respect, thatwhere the committee judges that theallegation has not been proved it shallrecord a finding that the person is notguilty of such conduct in respect of thematters to which the allegation relates.

(2) As respects proceedings for the registrationof a person whose name was previouslyremoved from the register by direction of adisciplinary committee, the Council shall havethe power to make rules with respect to all orany matters mentioned in the foregoing sub-paragraph, but shall not be required to do so;and separate rules under this paragraph maybe made as respects such proceedings.




(3) Before making rules under this paragraphthe Council shall consult the boards for thetime being established under this Act, andbefore entering into consultations with theCouncil under this subparagraph a board shallconsult such bodies representing members ofthe relevant profession as the board thinks fit.

(4) Rules under this paragraph shall not comeinto force until confirmed by order of the PrivyCouncil.

4.–(1) For the purpose of advising a disciplinarycommittee on questions of law arising inproceedings before it, there shall in all suchproceedings be an assessor to the committeewho shall be a barrister, advocate or solicitor ofnot less than ten years standing.

(2) The power or appointing an assessor for adisciplinary committee shall be exercisable bythe Council after consultation with the boardconcerned, but if no assessor appointed bythe Council is available to act in any particularproceedings the committee may itself appointan assessor qualified as aforesaid for thoseproceedings.

(3) The Lord Chancellor may, by statutoryinstrument, make rules as to the functions ofassessors appointed under this paragraph,and in particular such rules may containprovision for securing–

(a) that where an assessor advises adisciplinary committee on any questionsof law as to evidence, procedure or anyother matters specified by the rules, heshall do so in the presence of every partyor person representing a party to theproceedings who appears thereat or, ifthe advice is tendered while thecommittee is deliberating in private, thatevery such party or person as aforesaidshall be informed what advice theassessor has tendered;

(b) that every such party or person asaforesaid shall be informed if in any casethe committee does not accept theadvice of the assessor on such aquestion as aforesaid,

and may contain such incidental andsupplementary provisions as the LordChancellor considers expedient.

(4) Except in the case of an assessorappointed by the committee itself under sub-paragraph (2) above, an assessor may beappointed under this paragraph eithergenerally or for any particular proceedings orclass of proceedings, and shall hold andvacate office in accordance with the terms ofthe instrument under which he is appointed.

(5) The relevant board may pay to an assessorappointed under this paragraph remunerationat such rates as may be determined by theCouncil with the consent of the LordChancellor.

Appendix 3: Convention for theProtection of Human Rights andFundamental Freedoms (the EuropeanConvention on Human Rights)


Article 6. Right to a fair trial

1 In the determination of his civil rights andobligations or of any criminal charge againsthim, everyone is entitled to a fair and publichearing within a reasonable time by anindependent and impartial tribunal establishedby law. Judgment shall be pronounced publiclybut the press and public may be excludedfrom all or part of the trial in the interests ofmorals, public order or national security in ademocratic society, where the interests ofjuveniles or the protection of the private life ofthe parties so require, or to the extent strictlynecessary in the opinion of the court in specialcircumstances where publicity would prejudicethe interests of justice.

2 Everyone charged with a criminal offenceshall be presumed innocent until proved guiltyaccording to law.

3 Everyone charged with a criminal offence hasthe following minimum rights:

a) to be informed promptly, in a language whichhe understands and in detail, of the natureand cause of the accusation against him;

b) to have adequate time and facilities for thepreparation of his defence;

c) to defend himself in person or through legalassistance of his own choosing or, if he hasnot sufficient means to pay for legalassistance, to be given it free when theinterests of justice so require;

d) to examine or have examined witnessesagainst him and to obtain the attendanceand examination of witnesses on his behalfunder the same conditions as witnessesagainst him;

e) to have the free assistance of an interpreterif he cannot understand or speak thelanguage used in court.

Article 10. Freedom of expression

1 Everyone has the right to freedom ofexpression. This right shall include freedom tohold opinions and to receive and impartinformation and ideas without interference bypublic authority and regardless of frontiers.This article shall not prevent States fromrequiring the licensing of broadcasting,television or cinema enterprises.

2 The exercise of these freedoms, since it carrieswith it duties and responsibilities, may be subjectto such formalities, conditions, restrictions orpenalties as are prescribed by law and arenecessary in a democratic society, in the interestsof national security, territorial integrity or publicsafety, for the prevention of disorder or crime, forthe protection of health or morals, for theprotection of the reputation or rights of others, forpreventing the disclosure of information receivedin confidence, or for maintaining the authority andimpartiality of the judiciary.

Article 11. Freedom of assemblyand association

1 Everyone has the right to freedom ofpeaceful assembly and to freedom ofassociation with others, including the right toform and to join trade unions for the protectionof his interests.

2 No restrictions shall be placed on theexercise of these rights other than such as areprescribed by law and are necessary in ademocratic society in the interests of nationalsecurity or public safety, for the prevention ofdisorder or crime, for the protection of healthor morals or for the protection of the rights andfreedoms of others. This Article shall notprevent the imposition of lawful restrictions onthe exercise of these rights by members of thearmed forces, of the police or of theadministration of the State.

A typical Board with its committees before the late 1980s

For one or two boards, the title of the nonstatutory committees was different. Later, several boardsreplaced their education committees with joint committees with their respective professionalbodies.

Organisational structure before 1984


Appendix 4: The basic structure of theCPSM

Board

Statutory Committees

Disciplinary Committee Investigating Committee Registration Committee Education Committee

Secretary

Assistant RegistrarTwo Board

Administration Assistants

Registration Officer Cashier Janitor-Receptionist Two Typists

Registration Clerks(several)

Assistant

Nonstatutory Committees

Registrar

Appendix 4: The basic structure of CPSM

Organisationalstructure

in2001


Per

sona

lA

ssis

tant

Fina

ncia

lC

onsu

ltant

Chi

efEx

ecut

ive

and

Reg

istr

ar

Four

Ass

ista

ntR

egis

trar

s/

Boa

rdS

ecre

tarie

s

Dep

uty

Reg

istr

arA

dmin

and

Ove

rsea

sA

pplic

atio

ns

Reg

istr

atio

nO

ffice

r

Acc

ount

ant

Dep

uty

Reg

istr

arIn

terp

rofe

s-si

onal

affa

irs

Offi

cean

dLe

gal

Ser

vice

sM

anag

er

Ass

ista

ntR

egis

trar

/M

LTB

oard

Sec

reta

ry

Jani

tor

Rec

eptio

n-is

tC

ater

ing

Ass

ista

nt

Thre

eA

dmin

assi

stan

ts,

MLS

Ose

ctio

n

Five

Adm

inA

ssis

tant

s,ov

erse

asap

plic

atio

ns

Sys

tem

sM

anag

er/

Inte

rnal

Aud

itor

Typi

stD

ocum

ent

Man

age-

men

tCle

rk

Acc

ount

-an

tsA

ssis

tanc

e

Adm

inis

tra-

tive

Ass

ista

nt

Nin

eR

egis

trat

ion

cler

ks

Sys

tem

Sup

port

and

Web

site

Adm

inis

tra-

tor

Ass

ista

nt


Appendix 5: Some statistical charts

In the next few pages are some charts illustrating the work of the CPSM disciplinary process.

Appendix 5 (1) Total registrants 1964–5 to 2010–11

0

50,000

100,000

150,000

200,000

250,000

Total registrants

1964-651965-661966-671967-681968-691969-701970-711971-721972-731973-741974-751975-761976-771977-781978-791979-801980-811981-821982-831983-841984-851985-861986-871987-881988-891989-901990-911991-921992-931993-941994-951995-961996-971997-981998-991999-002000-012001-022002-032003-042004-052005-062006-072007-082008-092009-102010-11

Year


Appendix 5 (2) Total registrants and total cases 1965 to 2002


0 5 10 15 20

Totalcases

TotalregistrantsNumber of cases

Number of registrants

1964–65

1965–66

1966–67

1967–68

1968–69

1969–70

1970–71

1971–72

1972–73

1973–74

1974–75

1975–76

1976–77

1977–78

1978–79

1979–80

1980–81

1981–82

1982–83

1983–84

1984–85

1985–86

1986–87

1987–88

1988–89

1989–90

1990–91

1991–92

1992–93

1993–94

1994–95

1995–96

1996–97

1997–98

1998–99

1999–00

2000–01

2001–02

0 20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Year



Appendix 5 (3) All professions: cases per thousand registrants 1965 to 2002

0.00

0.05

0.10

0.15

0.20

Cases per 1,000 registrants

1964–65

1965–66

1966–67

1967–68

1968–69

1969–70

1970–71

1971–72

1972–73

1973–74

1974–75

1975–76

1976–77

1977–78

1978–79

1979–80

1980–81

1981–82

1982–83

1983–84

1984–85

1985–86

1986–87

1987–88

1988–89

1989–90

1990–91

1991–92

1992–93

1993–94

1994–95

1995–96

1996–97

1997–98

1998–99

1999–00

2000–01

2001–02

Year


Appendix 5 (4) Chiropodists: total registrants and total cases 1965 to 2002


0 1 2 3 4 5 6

Totalcases

Totalchiropodistsregistered

Number of cases

Number of registrants

1964–65

1965–66

1966–67

1967–68

1968–69

1969–70

1970–71

1971–72

1972–73

1973–74

1974–75

1975–76

1976–77

1977–78

1978–79

1979–80

1980–81

1981–82

1982–83

1983–84

1984–85

1985–86

1986–87

1987–88

1988–89

1989–90

1990–91

1991–92

1992–93

1993–94

1994–95

1995–96

1996–97

1997–98

1998–99

1999–00

2000–01

2001–02

Year

0 1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000



Appendix 5 (5) Chiropody cases per 1,000 registrants 1965 to 2002

0.0

0.2

0.4

0.6

0.8

1.0

1964–65

1965–66

1966–67

1967–68

1968–69

1969–70

1970–71

1971–72

1972–73

1973–74

1974–75

1975–76

1976–77

1977–78

1978–79

1979–80

1980–81

1981–82

1982–83

1983–84

1984–85

1985–86

1986–87

1987–88

1988–89

1989–90

1990–91

1991–92

1992–93

1993–94

1994–95

1995–96

1996–97

1997–98

1998–99

1999–00

2000–01

2001–02

Year

Cases per 1,000 registrants


Appendix 5 (6) Dietitians total registrants and total cases1992–3 to 2001–2 (no cases before 1992–93)

Appendix 5 (7) Dietetic cases per 1,000 registrants1992–3 to 2001–2 (no cases before 1992–93)


Total cases

Total registrants

Num

ber

ofca

ses

Num

berofregistrants

Year

0.0

0.5

1.0

1.5

2.0

0

1,000

2,000

3,000

4,000

5,000

6,000

2001–022000–011999–001998–991997–981996–971995–961994–951993–941992–93

Cas

espe

r1,

000

regi

stra

nts

0.0

0.1

0.2

0.3

0.4

0.5

0.6

2001–022000–011999–001998–991997–981996–971995–961994–951993–941992–93Year



Appendix 5 (8) Dietetic conviction and conduct casesthroughout the boards existence

Appendix 5 (9) Dietitians Investigating Committee referral of cases

Num

ber

0

2

4

6

8

10

ConductConviction

Total cases

Referred

Not referred

Num

ber

0.0

0.5

1.0

1.5

2.0

2001–022000–011999–001998–991997–981996–971995–961994–951993–941992–931991–92Year

Type of case


Appendix 5 (10) Dietetic cases: catergories of reasons for case found


0.0

0.5

1.0

1.5

2.0

Promotionof products

Patients’ bestinterests – incompetence

Practising outside of scope of practice

Record-keeping issues

Verbal abuse

Numberof cases

Reason for case



Appendix 5 (11) Occupational therapists total registrants and total cases1977–78 to 2001–2 (no cases before 1977–78)

0

1

2

3

4

Total cases

Total chiropodists registered

Num

ber

ofca

ses

Num

berofregistrants

0

5,000

10,000

15,000

20,000

25,000

2001–02

2000–01

1999–00

1998–99

1997–98

1996–97

1995–96

1994–95

1993–94

1992–93

1991–92

1990–91

1989–90

1988–89

1987–88

1986–87

1985–86

1984–85

1983–84

1982–83

1981–82

1980–81

1979–80

1978–79

1977–78

Year

Appendix 5 (12) Occupational therapy cases per 1,000 registrants1977–78 to 2001–2 (no cases before 1977–78)

0.0

0.1

0.2

0.3

0.4

Cas

epe

r1,

000

regi

stra

nts

2001–02

2000–01

1999–00

1998–99

1997–98

1996–97

1995–96

1994–95

1993–94

1992–93

1991–92

1990–91

1989–90

1988–89

1987–88

1986–87

1985–86

1984–85

1983–84

1982–83

1981–82

1980–81

1979–80

1978–79

1977–78

Year



Appendix 5 (13) Outcome of all cases 1964–65 to 2001–2

1964–65

1965–66

1966–67

1967–68

1968–69

1969–70

1970–71

1971–72

1972–73

1973–74

1974–75

1975–76

1976–77

1977–78

1978–79

1979–80

1980–81

1981–82

1982–83

1983–84

1984–85

1985–86

1986–87

1987–88

1988–89

1989–90

1990–91

1991–92

1992–93

1993–94

1994–95

1995–96

1996–97

1997–98

1998–99

1999–00

2000–01

2001–02

Year

Struck

off

Notguilty

No

furtheraction

Postponed

Restored

Number of cases

0 1 2 3 4 5 6 7 8

Appendix 5 (14) Categories of reasons for finding “guilty of infamousconduct” for all Boards for whole period 1964–2002

Appendix 5 (15) Chiropody categories of guilty findings from 1964–5 to 2002



Chiropody categories of guilty findings from 1964-5 to the end

Alcohol abuse (9%)

Violence (1%)Verbal abuse (1%)

Sexual misconduct (17%)

Bringing the profession into disrepute (4%)Record-keeping issues (7%)Confidentiality issues (2%)

Practising outside of scope of practice (4%)Referral issues (1%)

Health and safety of patients (2%)

Theft / fraud (31%)

Drug abuse (2%)Patients’ best interests – incompetence (14%)

Sterilization issues (1%)Supervision and delegation (1%)

Fraudulent entry (1%)

Inappropriate advertising (3%)Promotion of products (1%)

Theft / fraud (63%)

Sexual misconduct (14%)

Practising outside of scope of practice (2%)

Patients’ best interests – incompetence (5%)

Sterilization issues (2%)

Supervision and delegation (5%)

Fraudulent entry (2%)

Inappropriate association (5%)

Inappropriate advertising (2%)



Appendix 5 (16) Radiographers: reasons for guilty findings 1979–80 to 2002(no cases before 1979–80)

C

Alcohol abuse (29%)

Violence (7%)

Sexual misconduct (31%)Bringing the profession into disrepute (11%)

Record-keeping issues (4%)

Patients’ best interests – incompetence (14%)

Practising outside of scope of practice (4%)

This document is available in alternativeformats and Welsh on request.Call +44 (0)20 7840 9806or email [email protected]

Park House184 Kennington Park RoadLondon SE11 4BU

tel+44 (0)845 300 6184fax +44 (0)20 7820 9684www.hpc-uk.org

© Health Professions Council 2012Publication code: BERRIE12This publication is produced using trees from sustainable forests and recycled fibre.