Transcript SEXUAL HEALTH ADVISING – HEALTH PROMOTION …

COUNSELLING WITHIN
SEXUAL HEALTH ADVISING ETHICAL CONSIDERATIONS
Ian Boss
Sexual Health Adviser
September 2009
MY CONCERN
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In the rush towards professionalism and
statutory regulation for Sexual Health Advisers
are we ignoring the ethical boundaries for good
counselling practice and patient care within
health advising?
AIMS
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In light of the requirements for statutory regulation for
healthcare professionals. The main aims are:
1). Check that the standards for offering counselling
within Health Advising meet the national
recommendations set out by the BACP for counselling
within the NHS.
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This was done by an audit of the counselling elements within
job descriptions that were advertised throughout 2008.
Comparing these against the standards for offering
counselling within the NHS.
Also reviewing these against the standards set down by the
SSHA National Job Description.
AIMS
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2). To review the standards set out by the NMC
for SCPHN in sexual health and SSHA
“Developing the workforce” that they are fit for
purpose.
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This was done by reviewing the SSHA & NMC
competencies for Health Advising.
Conclusion & recommendations.
STATUTORY REGULATION
Professional regulation becomes statutory regulation at a point
where the State regards it as so important for public safety that it
legislates for a ban on either using the professional title or doing
certain things unless your name appears in the register. This
protects the patients from the harm caused by people practising
a profession which they are not fit to. It engenders public
confidence by allowing members of the public and the
employers of professionals to check on a person’s registration
status, knowing that the information they find will be correct and
up to date.
The Department of Health (July 2006).
The regulation of the non-medical healthcare professionals.
London DH
AUDIT OF H. A. JOB DESCRIPTIONS &
PERSON SPECIFICATIONS - 2008
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Job descriptions were collected for one year:
January 2008 to January 2009
www.jobs.nhs.uk (search ‘health adviser’)
Number of Job Descriptions reviewed: n = 65
Aim to look at the counselling qualifications
required to provide the counselling tasks.
To check these against BACP/FHCP standards
for offering counselling within the NHS.
CODES FOR DATA COLLECTION
Job Descriptions: Tasks
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OC = Ongoing Counselling.
HV = Giving HIV positive results with
ongoing/ or counselling.
RR = Familiar with health promotion strategies,
motivational change and counselling
models.
CODES FOR DATA COLLECTION
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OT = Other Crisis Counselling Interventions
Initial crisis intervention, assessment and counselling
e.g.: TOP, depression, sexual identity, sexual assault,
substance misuse, sexual dysfunction.
 or = Assess psychological / emotional distress,
provide containment and / or referral (assess
immediate suicide risk).
 or = Respond to frequent situations which can be
highly emotive, distressing and unpredictable.
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BREAKDOWN OF THE DATA
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Number of job descriptions reviewed: n=65.
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‘Ongoing counselling’: OC = 34 (52.4%).
Post HIV positive counselling: HV = 55 (84.6%).
Crisis counselling interventions: OT = 56 (86.2%).
Risk Reduction: RR = 8 (12.3%).
Psychological / Counselling support, includes all
and/or any of the above: = 64 (98.5%).
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QUALIFICATIONS SUMMARY
TABLE 1
QUALIFICATIONS SUMMARY
TABLE 1
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A): 14 (21.5%) of clinics were not asking for any
counselling qualification.
B): Counselling Training / Counselling Qualification,
did not indicate the level.
C): Only one clinic asked for a diploma in counselling.
(This is consistent with BACP/FHCP & UKCP/CPC
guidelines for offering counselling within the NHS).
D): With the MSc Counselling; this was optional with
other either/or qualifications.
Nine ‘person specifications’ asked for two or more
counselling qualifications.
EXPERIENCE SUMMARY
TABLE 2
EXPERIENCE SUMMARY
TABLE 2
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A): 24 (36.95%) of clinics were not asking for
any counselling experience
B): Request that the HA has ‘counselling skills
or 1:1 counselling experience’. (Counselling
comes across as something that is picked-up on
the job rather than an academic qualification).
18 ‘person specifications’ asked for more than
two elements for counselling experience.
14 CLINICS THAT DID NOT ASK FOR
COUNSELLING QUALIFICATIONS
TABLE 3
14 CLINICS THAT DID NOT ASK FOR
COUNSELLING QUALIFICATION
TABLE 3
14 (21.5%) of clinics were not asking for any
counselling qualification.
Equates to: 9 (13.9%) carrying out ‘ongoing
counselling’ without counselling qualifications.
 5 (7.7%) were carrying out high level counselling with
either none or little experience of having previously
used counselling.
NB: All these clinics are in breach of SSHA, BACP &
UKCP guidelines for offering counselling within the
NHS.
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OVERALL ASSESSMENT OF THE
DATA
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1). Generally fair to say that all clinics carry out
some form of counselling support or ‘ongoing
counselling’.
2). Primarily in the area of giving HIV positive
results and crisis work.
EVALUATION OF THE JOB
DESCRIPTIONS (1)
‘Nursing’ Within The Job Descriptions
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RGN as an essential qualification was in all the
job descriptions.
58% of the ‘job descriptions’ did not have any
nursing task within them.
14% only had PDGs as the only nursing task.
EVALUATION OF THE JOB DESCRIPTIONS (2)
Two ‘job description’ from the same clinic demonstrate how
the essential qualifications in general are becoming more
nursing orientated. In both cases the ‘job descriptions’
remained the same. There was also very little in both of them
that required you to be a nurse.
TO:
FROM:
 Sexual Health Adviser /
 Nurse Practitioner /
Nurse Practitioner
Health Adviser
 Qualifications
 Registered Nurse 1st
 Qualifications
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level/CQSW/Diploma Social
Work or relevant degree e.g.
psychology (E)
Counselling Qualification (D)
Skills
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Counselling skills (E)
Special Knowledge: To have
knowledge and understanding of
clinical and psychological aspects
of STI’s and related sexual health
issues (E).
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Registered Nurse 1st level (E)
Counselling Qualification (D)
EVALUATION OF THE JOB
DESCRIPTIONS (3)
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Only one job description mentioned the BACP
as a professional body and was asking for BACP
Accreditation.
COUNSELLING STANDARDS
WITHIN THE NHS (1)
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SSHA Manual for Sexual Health Advisers
recommend:
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For contract based counselling – to work within
BACP Ethical Framework for Good Practice in
Counselling & Psychotherapy.
COUNSELLING STANDARDS
WITHIN THE NHS (2)
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BACP/FHCP & UKCP/CPC recommendations
for qualifications for counselling with in the
NHS:
‘qualification to diploma level or equivalent,
which comprises a minimum of 450 hours
of, taught theory and skills’.
A4C Band 6 or above ‘to be accredited in
counselling or psychotherapy recognised by
a professional body’.
COUNSELLING STANDARDS
WITHIN THE NHS (3)
Guidance for best practice: the employment of counsellors and
psychotherapist in the NHS. BACP 2004.
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A ‘counselling skills’ course: “do not result in a
professional qualification……as counselling competency
is not tested at this level and that course tutors may not
be qualified counselling practitioners”.
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A ‘certificate in counselling’: “may combine both
practical and theoretical components….. successful
completion of this programme usually enables the student
to access the diploma in counselling”.
COUNSELLING STANDARDS
WITHIN THE NHS (4)
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These are only guidelines for best practice as
legally there are no statuary requirements.
Statutory regulation takes place in 2 – 3 years for
the BACP through the HPC.
REVIEW OF SSHA NATIONAL
JOB DESCRIPTION
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Next two slides show the national SSHA ‘job description’
The counselling aspects are highlighted in ‘yellow’
A ‘counselling certificate’ is the only essential counselling
qualification. (This would be prior to A4C and is against
both SSHA & the BACP guideline for offering counselling
within the NHS).
The MSc in Counselling is optional, along with other
masters qualifications.
The Job Summary / Main Responsibilities both state
‘ongoing counselling’.
There are no nursing elements within this job description.
This is a ‘health promotion / counselling’ Job Description
and has nothing to do with nursing.
NMC MIGRATION FOR SCPHN
IN SEXUAL HEALTH
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Application Pack 4: Migration To NMC Register as a
Specialist Community Public Health Nurse (SCPHN) in
Health Advising, Part 3 of the NMC Register.
The NMC have seemingly taken the ‘public health’
recommendations from the DoH documents, and have
created the Application Pack 4.
This now has become the gold standard adopted by
SSHA for Sexual Health Advising, (Develping The
Workforce).
These days nationally most HA jobs are excluding nonnurses from application.
MY CONCERNS ABOUT THE
NMC ‘APPLICATION PACK 4’
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It doesn’t adequately equip the nurse to deal with the more
complex patient issues.
It doesn’t ensure that the nurse is qualified to carry out the
counselling task, nor doesn’t it suggest any formal counselling
training for the nurse.
For example; Principle 3
1a) Critically analyse communication, teaching and counselling models
theories, and their application to sexual health advising practice.
1b) Develop self awareness and interpersonal skills to feel comfortable,
responding to sexual health need or referring appropriately.
2) Demonstrate skill in the application of motivational and behaviour
change theories to practice.
There is very little in this ‘Application Pack 4’ that requires you
to be a nurse. The only nurse specific task is for prescribing
medications under PGDs.
SEXUAL HEALTH ADVISING –
Developing The Workforce (London DH June 2008)
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This document presents as a fait accompli that the NMC set the
standards for health advising.
Nurses are the only professional group valued within this
document.
It does not mention counsellors, counselling or the BACP as a
professional body.
It is also negligent in failing to acknowledge the complexity of
patients presenting issues.
The competencies for nurses within this document are very good
for the ‘health promotion’ aspects of HAing, which could be for
all HAs and not just for the nurse HAs.
My concern is that by putting nurses into a job they are not
qualified or skilled enough to do, may compromise patient care,
inadvertently keeping the patient psychologically maladjusted and
within the ‘sick role’.
CONCLUSION /
RECOMMENDATIONS (1)
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1). Due to poor counselling standards within HAing over the
years, many clinics are in breach of BACP/FHCP and SSHA
guidelines for offering counselling within the NHS.
2). Over the past 18 months with the move by SSHA to align
HAing to the NMC, most clinics usually only want RGN (level
1) as the only essential qualification:
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New tasks are also being added which exclude non-nurses from
application.
Job description still expect HA to carry out complex counselling task
without any formal counselling qualifications.
The majority of job descriptions (58%) don’t have any nursing tasks
within them, yet some form of counselling was in 98.5% of them,
including ‘ongoing counselling’ in 52.4%.
CONCLUSION /
RECOMMENDATIONS (2)
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3). SSHAs ‘National Job Description’, does not have
any nursing tasks within it. This leaves questions as to
why SSHA is aligning HAing to the NMC for
standards.
4). With statutory regulation for counselling via BACP
with the HPC in 2011/2012. Many HAs and clinics that
offer counselling could be in breach of these guidelines
and open to prosecution, leaving the workforce
unsupported and vulnerable, including their patients.
CONCLUSION /
RECOMMENDATIONS (3)
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5). There needs to be uniformity of counselling
qualifications and standards for HAs across the UK.
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It needs to be in-line with BACP/FHCP recommendations
and A4C for counsellors and counselling within the NHS.
CONCLUSION /
RECOMMENDATIONS (4)
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6). SSHA has created a split amongst HAs by
not registering all HAs at the same time:
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I suggest they take this slit further and create two categories
of HA.
1). First being counselling HA, who are the prime HAs who
work in GUM clinics.
2). Second being SCPHN HAs who are the prime HAs in the
community.
NB: This would fit in with the recommendations
by the DoH and NICE documents.
TO ANSWER MY INITIAL
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Finally, to answer the question I posed at the start of
this presentation:
“In the rush towards professionalism and statutory regulation for
Sexual Health Advisers are we ignoring the ethical boundaries
for good counselling practice and patient care within Health
Advising?”
My answer is “YES”.
THANK-YOU FOR YOUR
TIME
I can be contacted via email:
[email protected]