Gobbledegook & Tautology: The Establishment G&T

As so often in my life, it was a patient that provided the enlightenment. I had been working as a locum in Worcester just after the Millennium and the NHS was embarking on another round of what management termed euphemistically as “service rationalisation”, which those at the sharp end of clinical delivery understood to be another term for discharging patients from long-term palliative care.

Historically, the NHS used to provide “chiropody” to people who fulfilled certain criteria – pensioners, pregnant women, school-children and those with an underlying medical condition, such as diabetes, poor circulation, arthritis or those with an incapacity like blindness or what we now call learning difficulties; the mentally handicapped. Over the last sixty years, as the podiatry profession developed its scope of practice, other patients were routinely included in NHS care. Adults with acute conditions like ingrown toenails and gait disorders could be referred by their doctors and by the time I qualified in 1983, some podiatrists had undertaken training in surgical practise – initially in the USA – for routine and complex foot and ankle bone surgery, normally the domain of the orthopaedic surgeon. But these advances in clinical provision – as welcome as they are for any discipline, also stimulate demand – and that brings us back to the perennial problem of cost and funding of NHS services.

Since the introduction of general management principles in the NHS following Roy Griffiths’ Report in the 1980’s, care has been prioritised in line with funding. As new treatments have emerged, the demand for services and its impact on NHS budgets have increased exponentially, and as always when bean-counters and bureaucrats are in charge, something had to give. In NHS podiatry clinics during the 1990’s onwards, what ‘gave’ was the care provided to millions of people up and down the breadth of the UK, who suddenly found themselves on the wrong side of an administrative line that specified new criteria for access to services, which precluded a subtle shift away from clinical ‘need’ – to clinical ‘risk’.

Now, I don’t really have an issue with that – nor do most clinicians who have worked in the NHS. If someone is in urgent need of care, then of course they should be prioritised; that is simple common-sense, but unless funding increases at the same rate as clinical demand, there will always be a shortfall and some people will lose out. Such are the times we live in.

A few months before I came to Worcester, I was working in a fairly remote clinic in the middle of the North York Moors and had turned up for my first clinic near Helmsley and was met by the Service Manager, who explained they had contracted me for four weeks to help “re-educate” the patients who made up the bulk of the service caseload in rural and remote clinics. Patients (or service users, as they were now labelled) were to be encouraged to look after themselves and their own foot problems. Nail files and callous rasps were provided and I was supposed to encourage the recipient that it would be much better if they looked after their own feet or that of their partner. It was called “empowerment”.

I only lasted a week in that post and found the whole approach distasteful and quite dangerous. No provision had been made for those people to have their treatment provided elsewhere – and it was quickly apparent the new criteria was iniquitous, if not, dangerous.

The “at-risk” criteria included those people with diabetes, thus in some NHS trusts, a twenty-something insulin dependent diabetic could have regular chiropody care – even though their “need” was minimal – but a ninety-six year-old with painful age-related conditions, but no qualifying medical criteria, could not.

In Worcester, the Trust had provided a letter that could be handed to patients to help them understand the new conditions for access. In typical NHS management-speak, it presented a warm, fuzzy illusion of giving everything whilst taking more besides away. My patient that day read the letter with a smile… “How lovely. Just as Mr Blair predicted!” he said, and I thought he was talking about the current Prime Minister before he explained what and who he really meant.

“It’s ‘doublespeak’”, he announced. “Haven’t you read 1984? Rationalisation, prioritisation, empowerment! Monkeys could do better any day…” and he would know, being an authority on primates as well as many other subjects….

My patient that day became a good friend and mentor over the years. Sarel Eimerl was in his mid eighties and lived in a Quaker house near the cathedral, when we first met. He was a literary authority; from the classics to the life of Giotto, but he is better known as the editor of Time-Life Books – and as you might expect, he was nobody’s fool. In an earlier life he served in the diplomatic corps in Mesopotamia (Iraq) and the conversation returned to political events at the time. “This is almost as bad as the dossier the other Mr Blair has just written,” he said waving the letter at me; “why can’t people just tell the truth?”

Why, indeed?

I was reminded of Sarel last Thursday at the conclusion of the proceedings in the Crown Court Appeal with the HCPC in Preston. Sarel had offered countless examples of doublespeak that I should have been familiar with. Simple deception and lies to complex propaganda designed to induce mass deception. Within a few simple sentences he explained what was really behind the Iraq conflict and the rise of Islamic fundamentalism; a view that still holds primacy today. But I never expected the most devious and deceitful examples of this duplicitous practice from a government health regulator and its legal representatives – nor indeed did any other of my colleagues in podiatry or any other of the health professions.

Having given evidence last Thursday and as there are no reporting restrictions, I can now offer a more detailed commentary on this curious and worrying business – and I will do so over the coming weeks.

Those that have the capacity to remember these things will recall I pled guilty to an offence just over two years ago for using a professional title without being registered with an appropriate authority – a medical regulator. It wasn’t an oversight – I had deliberately withheld my registration fee (£74) – and for good reason – but the offence I thought I was pleading guilty to, actually didn’t exist and it turns out, I wasn’t doing anything illegal in the first place. I feel rather uncomfortable writing that as it amply illustrates what a fool I have been, but I do take some comfort in the knowledge that my ignorance was shared with just about everyone else in the health professions and most of the public too!

We have been blatantly lied to – or deceived – if you prefer, by a medical regulator and government who have a different agenda altogether than the one stamped on the regulatory and public-safety tin. In law, this is called fraudulent misrepresentation. Plus ça change!

And nobody was any the wiser.

I was in the witness box for just over five hours and only managed to make Mr Holland lose the plot on two or three occasions, but it was good fun all the same. I’m going to look forward to his explanation of the difference between “unlawful” and “illegal” one of these days, perhaps when I’m adjusting the rope tension when he starts that airy and exposed traverse on Crowberry Ridge. If I can persuade him it might be in his best interests – and providing he’s fully tuned into the dialect, it should be one of life’s more captivating moments. But Thursday was certainly an illuminating and enlightening experience. I’m also looking forward to the day when he can unearth the piece of paper from his client telling me I could write unregistered and still win the lottery. Who would’ve known? Certainly not me…but who did provides the answer to the question; “who is responsible for this prosecution?” Can you guess yet?

Unfortunately, we haven’t finished. I should never have tempted fate by suggesting there might be a prologue, but the Judge had a prior appointment in London and had to scoot away sharpish for the train and we finished at 3.30pm and with another few witnesses to call, she adjourned matters until 26 February next year. For the final time. Hopefully. At this rate, Mr Holland will be able to buy Lochgelly or Cowdenbeath on the fees he’s earned in this case alone and he doesn’t even know what it’s all about yet. Isn’t life funny indeed?

And the 26th February is, coincidentally, the same date as the last successful appeal at the Old Bailey two years ago. Would you believe it?

As I have written elsewhere, I am fast running out of currency – if not monetary then in gratitude – and it was fantastic to see so many colleagues and friends in the public gallery. It is during these occasions that you discover who really matter in your life – and that is never a bad thing. Thank you again for all that made the effort – it was hugely appreciated.

Mass deception is not a new concept – humanity, individually and collectively, has been constantly manipulated, deceived and brainwashed throughout history; it is a curious condition that undermines our perceived status as this planet’s most intelligent beings. If only we could see just what really stands before us. Or maybe blissful ignorance is a trait that reigns supreme…

UPDATE: I was informed at 6pm 14/12/15 that Mr Holland is unavailable on the 26th and a new date is yet to be set. Merry Christmas.

Seating Arrangements on the Titanic


Oh dear. Quite a few people mistakenly call the Registrar at the HCPC, Mr Searle. It’s a common mistake and one that I’ve made myself, but it’s actually Mr Seale. Even Mr Holland tripped up a couple of times in October and he gets all the cheques! The memory isn’t quite what it was these days, but I usually find it’s helpful if you just remember ‘slippery’ – which turns out to be quite apt. Twelve years is an awfully long time….

Because we go from this:

“From July 9th, 2003, the titles below are protected by law. Anyone using one of these titles must be registered with the Health Professions Council, or they may be subject to prosecution and a fine of up to £5,000.”

To this….





….and in our professional journal this month, they tried again….

Questions from the Society of Chiropodists and Podiatrists for the HCPC

Jonathan Jones, Stakeholder Communications Manager at the Health and Care Professions Council, answers your questions about the misuse of protected titles and the action the HCPC takes against those who imply they are HCPC registered when not registered.

1. What action does the HCPC take when you receive information that that a foot health practitioner is claiming to be a chiropodist / podiatrist?

The aim of the HCPC is to ensure ongoing compliance with the law. If the HCPC receives information that a protected title is potentially being misused, its first step is to contact the person or organisation concerned, explain the law, and inform them that they should not use the title unless they are entitled to do so.

Where there is evidence to show that an offence is being committed, the HCPC will send out a ‘cease and desist’ notice, which sets out what action it will take if the person or organisation continues to break the law. In most cases, people do comply at this stage.

If anyone continues to misuse a protected title, the HCPC’s Chief Executive or Director of Fitness to Practise can authorise a prosecution. Some cases close on receipt of this notice of prosecution. If not, the case goes to court and if convicted, individuals are liable to a fine of up to £5,000.

2. Equally, what action does the HCPC when you receive information that a non-HCPC registered (degree qualified) podiatrist is calling themselves a chiropodist / podiatrist?

It is a criminal offence to imply that you are registered with the HCPC when you are not. We would therefore take the same action as outlined above. {Eh?}

3. What about anyone who calls themselves a ‘formerly registered podiatrist’ and actively makes sure that all their patients are aware they are not registered with the HCPC?

It is important to bear in mind that we must treat every situation on a case-by-case basis. The key consideration when determining whether someone has misused a protected title and be liable for prosecution is if there was an intention to deceive (whether expressly or by implication). The HCPC is unlikely to pursue cases where there is clearly no intention to deceive. On a related note, quite understandably many professions are proud to be part of their profession after retirement so they may choose to use a term like “Retired Podiatrist” or “Former Podiatrist”. Similar qualifying adjectives are also acceptable which do not intend to imply registration such as “Student Occupational Therapist” or “Equine Physiotherapist”.

4. If someone is offering chiropody or podiatry services but not using the title chiropodist or podiatrist will the HCPC still take action?

Yes. As outlined above, it is an offence to either misuse a protected title or to imply that you offer chiropody or podiatry services. Therefore, if someone who described themselves, for example, as a “Foot Health Practitioner” and said that they offered chiropody or podiatry services we would take action.

9. At what point does misrepresentation become a criminal act?

If someone states or implies that they are registered and they are not, or uses a protected titled which they are not entitled to use, they are liable to prosecution and if convicted could face a fine of up to £5,000. The ultimate decision as to whether a crime has been committed rests with the court / judge.

10. What are the penalties for ‘holding out’, and do you think they are a sufficient deterrent?

If an individual ‘holds out’, or in other words pretends to be registered when they are not, then we can take action, as outlined above. In most cases individuals comply having received a ‘cease and desist’ notice, or even before this once we have made our initial contact with them explaining the law. For the period 2013–14 the HCPC received 325 new protection of title referrals, 101 of which related to chiropody / podiatry. Of these cases, 94 were remedied prior to a ‘cease and desist’ notice being sent out.

If the individual fails to comply and the HCPC authorises a prosecution, some cases close on receipt of this notice of prosecution. If not, the case goes to court and if convicted, individuals are liable to a fine of up to £5,000. The fact that most cases close before they reach this stage suggests that the initial letter explaining the law, the cease and desist notice, the notice of prosecution, and the potential fine, all act as deterrents to the misuse of protected titles.

11. Do you think that the current legal framework is robust enough to protect the public?

Yes. The system of regulation that our legislation allows us to operate is based on the protection of titles, not functions. This approach means that the public are protected by using professionals who meet our statutory standards and can easily check registration. Not protecting specific functions has clear benefits for the professions. It means that roles can change and develop over time with minimum intervention from the regulator. We review our standards on an ongoing basis with involvement of the professions as well as service users, employers, unions and others to ensure that they continue to be fit for purpose. Our processes are robust and are regularly audited both internally and externally

Oh what a wicked web we weave….

You know, I can’t find the words “protected titles” in that thick bundle of pages of the legislation that they sent with the summons nearly three years ago now.  It was only loosely tied up when it arrived and I think a few pages must’ve dropped out. Oh dear!

I wonder if he’ll show face? He’s probably busy contemplating an internal audit, but maybe I should call into Lanigan’s on the way through, just in case….

The evidence suggests that some people just never learn.