Challenging misleading healthcare claims

PSA re-affirms official approval of the CNHC

Last year, we had concerns whether the Complementary and Natural Healthcare Council really had public protection at the heart of what they did. Despite failing to deal properly with our complaints, the Professional Standards Authority has just re-accredited them.

Note: this newsletter covers events that have taken place over the last 19 months and is necessarily long, detailed and involved. Even though this is a cut-down version, we believe it is important that the events are recorded and made public. But if all you need is a summary, jump to the end.

In May 2013, we said:

The CNHC recently applied to the Professional Standards Authority (PSA) to join their statutory Accredited Voluntary Register (AVR). With these revelations of the widespread and reckless claims being made by CNHC registrants, we suggest the PSA drop their application and have nothing further to do with them until the CNHC are able to fully demonstrate their ability to control their registrants and protect the public.

We had already begun testing the CNHC to see how they measured up to their own standards by submitting a sample batch of 100 complaints highlighting claims that our supporters were concerned about. We would like to thank all of those who helped us gather the details.

It was a long, slow process, but what was not ever clear was what that process actually was. One of the fundamentals of having a complaints procedure is that both the complainant and the complainee must know beforehand what process will be followed, how the complaint will be handled and how decisions will be reached. Transparency is everything if justice is to be done and seen to be done. We should expect no less from an organisation whose stated aim is to act in the public interest. There should be nothing done behind closed doors, out of the eye of public scrutiny lest there be accusations of favouritism, vested interests and putting members' interests before that of the public.

These are just the concerns that no doubt were in the minds of those drafting the Health and Social Care Act 2012 (HSCA) when they made provision for what was to be called the Accredited Voluntary Register. And no doubt there are worthy recipients of AVR accreditation. We do not believe, however, on the basis of past performance and on the way our current complaints have been handled, that the CNHC have met those expectations. Therefore we do not believe they deserve accreditation by a statutory regulator.

The OfQuack Paradox

The problem with organisations such as the CNHC is what has been called the OfQuack Paradox. OfQuack is the name many skeptics have given to the CNHC and — as we were told by Maggie Dunn, CEO of the CNHC over dinner several years ago — it is a moniker that has occasionally even been used by the CNHC themselves. There is also a parody Twitter account @OfQuack that claims to be the real regulator of quackery.

The OfQuack paradox goes something like this:

If a regulator of complementary/alternative/natural therapies were to do all they could to protect the public from misleading claims and treatments that had no good evidence base, their rules about what their members could claim or do would be so limited, no therapist would want to be a member, thus creating a perfect storm ending in their own demise.

There were signs that the CNHC were trying to do the job of a regulator properly when they wrote to Simon Perry five years ago. As Simon relates:

[Maggie Dunn, Chief Executive Officer] told me that as a regulator, the CNHC sees it as their duty to get in contact with alternative health course providers and authors. Given the nature of my original complaint, I expect this will enforce the view that claims must be justifiable.

What would a course on reflexology consisting only of justifiable claims cover exactly? How to spell reflexology?

This is so important, and so surprising I feel I need summarise in bullet points:

  • CNHC will tell practitioners to remove claims they cannot justify.
  • CNHC will conduct a review of evidence base for regulated therapies.
  • CNHC will contact all registrants to instruct them not to make claims without justification.
  • CNHC will contact complementary health course providers and authors to instruct them not to make claims without justification.

It is my view that adhering to the CNHC’s guidelines will make it impossible to practice complementary medicine.

It was clear to us that they had failed in this.

The only positive outcome of the external pressure that has been put on them has been the publishing of their 'Therapy Descriptors'. These are essentially information sheets about the various therapies they register and the claims the Advertising Standards Authority (ASA) would allow their members to make in their adverts. They are, because of the lack of good evidence for just about everything the CNHC's registrants do, somewhat bland.

However, as we found out when we asked our supporters to send us details of members' websites, these were being comprehensively ignored on a basis so widespread as to be endemic.

This is not the way an organisation purporting to uphold the requirements of the PSA's AVR standards should be acting, surely?

It was because of these endemic problems that we decided to bring them to the attention of the CNHC in the hope they would deal with them efficiently, swiftly, transparently and decisively in keeping with their aim of protecting the public.

We were to be disappointed.

We submitted our batch of 100 complaints on 28 May 2013.

CNHC Complaints Form

Example claims

To give just two examples, the claims we complained about included:

The Bowen Technique has been reported to help the following conditions: Back pain, sciatica and postural problems - Problems relating to the joints, including neck, hips, knee and shoulder - Asthma and hayfever - Frozen shoulder, tennis elbow - RSI, carpal tunnel syndrome -  Sports injuries - Arthritis - Headaches, migraines, anxiety, stress and insomnia - multiple Sclerosis and Parkinson's Disease - Respiratory problems - Digestive problems and IBS - Hormonal problems such as PMS and menopausal problems - Chronic fatigue, ME and low energy...

Craniosacral Therapy Can Also Help to Alleviate Arthritis, Asthma, Autism, Back Pain, Birth Trauma, Bronchitis, Cerebral Palsy, Colic, Depression, Digestive Problems, Drug Withdrawal, Dyslexia, Exhaustion, Effects of Cancer Treatment, Flatulence, Frozen Shoulder, Hormonal Imbalances, Hyperactivity, Immune System Disorders, Insomnia, Lethargy, Menstrual Pain, PMS, Migraine, Post-operative Problems, Post Traumatic Stress Disorder, Problems During and After Pregnancy, Reintegration After Accidents, Sciatica, Sinusitis, Spinal Curvature, Sports Injuries, Stress Related Illnesses, Tinnitus and Middle Ear Problems, TMJ (jaw) Disorders, Visual Disturbances, Whiplash Injuries. This is not an exhaustive list of conditions that may be helped by Craniosacral Therapy…

We thought all of these claims were questionable and certainly well outside the CNHC's Therapy Descriptors for Bowen Therapy and Craniosacral Therapy and the ASA's CAP Code.

More worrying were the claims about cancer.

Cancer claims

Amongst those 100 websites were six who were making claims about cancer. We decided the best way to resolve these and to discover how the CNHC would deal with them was to include them in our complaints.

The CNHC took swift action, contacting their members, requesting that they removed the claims and then passing the details on to their local Westminster Trading Standards to deal with as potential breaches of the Cancer Act 1939.

Yes, the CNHC reported six of their own members to Trading Standards.

We applaud them for that and for ensuring that the claims were removed as soon as possible. But they have not told us whether they preserved the evidence of the claims for cancer before they asked their members to remove them, so we don't know if Trading Standards had anything left to investigate.

Despite several requests, we have not been informed of the outcomes of any Trading Standards investigation, nor whether it resulted in any prosecutions.

The outcome of this was that the CNHC published new guidance on the Cancer Act to its members. It's a pity that their members needed to be reminded of their legal responsibilities.

But issuing guidance isn't enough unless there is a will to make sure it is adhered to.

Procedure? What procedure?

In dealing with the complaints, the CHNC's problems started with the fact that they had published two separate confusing and contradictory documents. The first was their Procedure for processing Complaints referred to the Complementary and Natural Healthcare Council (CNHC), dated December 2008 and 22 pages long. The second is titled Complaints Handling Process, also dated December 2008 but just four pages.

The much larger document contains detailed steps that are supposed to be taken at the various stages of a complaint and gives the procedures to be followed by the various committees when dealing with a complaint. The second document appears to be a brief summary of the main procedure.

We'll refer to the former as their detailed procedure document and the latter as their summary document below.

The problem is that the shorter one does not mirror the full procedure: it contradicts it in places and seems to describe a different process. A summary may well be a useful overview of how a complaint will be handled, but it is not — and cannot ever be — the definitive document, particularly when they don't actually agree. The longer, detailed document has to be the definitive one and the one any reasonable person would expect to be followed.

Does this matter? Well, yes it does. As I said above it is important that the procedure that is followed is the one that has been published for all to see so that both registrants and complaints know beforehand how a complaint will be dealt with. Chopping and changing rules and making them up as you go along don't fit in with the concept of natural justice. And we don't think it fulfils the requirements of the PSA's AVR Standard 11 a):

Provides clear information about its arrangements for handling complaints and concerns about a) its registrants and b) itself.

We believe we were correct in assuming and expecting the CNHC to follow their detailed, published complaints procedure.

They didn't.

Informally resolved

We submitted our 100 complaints in ten batches of ten, all clearly numbered and labelled, such as Group A-01-0001 <name> (<CNHC Registration number>).

After many emails back and forth where we tried to get the CNHC to tell us a) why they weren't following their detailed procedure document and b) what process they were following, they were adamant that they wanted to pursue all our complaints 'informally'. This meant that they were avoiding treating them as formal complaints despite the seriousness of many of the claims and simply wanted to sort things out quietly with their registrants without any fuss being made and, presumably, without having to say anything about it on their website.

Their detailed procedure made no mention of any process for informally resolving complaints nor any criteria by which it could be decided a complaint might be suitable of informal resolution.

But what it does say is:

PART III

COMPLAINTS

14 Procedure upon receipt of information about a Registrant

14.1 On receipt of information about a Registrant, the Council shall first consider whether such information is a Complaint.

14.2 Information shall only be considered to be a Complaint if such information:

a. relates to an identifiable Registrant; and

b. makes a specific allegation or allegations relating to the fitness to practice of a Registrant.

14.3 If the information is not considered to be a Complaint, the Council shall inform the provider of the information that no further action will be taken and that the matter will be closed.

14.4 In order to assist the Council in making a decision under 14.2 above, the Council may request further evidence from any relevant party.

14.5 If the information is considered to be a Complaint, the Council shall refer the case the Investigating Committee. The Complainant will be sent a copy of the Council’s guidance about making a Complaint and may also be informed of alternative methods of resolving disputes.

We believed we had fulfilled the requirements of 14.2 a) and b): these are the only two criteria stated that will be used to determine whether 'information about a Registrant' is to be considered a complaint or not a complaint. We were never told that we had not met those criteria.

Our arguments fell on deaf ears.

What we were told was:

CNHC’s view is that in the first instance it will attempt to seek to resolve these complaints through appropriate intervention and advice [though see (17) below in respect of clear breaches of the Cancer Act 1939].  Given the number of complaints you have made, consideration is being given to how best to achieve this.

and:

I re-iterate that in the first instance (in line with the general principle of proportionality) CNHC will seek informal resolution of the complaints.

The 'principle of proportionality' sound like a good idea, but it is not in their procedures and we believed the serious claims being made by their registrants merited a proportionally serious response by the CNHC. Having a quiet, off-the-record word with registrants doesn't do justice to the seriousness of the complaints.

Instead, they made it clear that they wanted to take a course of action other than that defined in their detailed complaints procedure.

But they did seem rather confused about their own procedures. We were told:

As I trust I made clear in my previous response, the published Complaints Procedure applies following a decision to refer a complaint to the Investigating Committee.  I also explained that in the first instance, in line with our published Complaints Handling Process, CNHC will be seeking to resolve your complaints through appropriate intervention and advice.  Your interpretation of my response, therefore, does seem to be somewhat of a misrepresentation.

Clearly, the published complaints procedure says no such thing: it defines how a decision to refer a complaint to the Investigating Committee (IC) is made and 14.5 states that a complaint meeting the two criteria will then and only then be referred to the IC. It is not — as the CNHC claimed — the procedure to be followed after a complaint has been referred. Indeed, if it was the case that the whole procedure applied only to IC referred complaints, in what other document are the criteria that define what invokes their detailed procedures?

The CNHC may well argue that their summary document does just that, but here, the CHNC simply get into deeper water. Their (summary) Complaints Handling Process document states:

How can a complaint be made?

Complaints referred to the CNHC will only be considered if the complaint is received on a CNHC completed complaints form addressed to the Registrar. Complaints received by the Registrar will be processed through an initial preliminary enquiry procedure to ensure that matters referred to the Council are within the remit of the CNHC.

Investigating Committee’s role

If the matter under consideration is within the remit of the CNHC it will be referred to an Investigating Committee (IC). The IC will initiate a screening process and examine all the evidence relating to the complaint.

The first paragraph defines a criterion that a complaint must be within the remit of the CNHC. To be expected, of course, but it requires no more than that.

The second paragraph clearly states that a complaint, if adjudged to be within the CNHC's remit will be passed to the IC who will then examine the evidence relating to the complaint.

None of our complaints ever reached the Investigating Committee.

One by one

The CNHC started to 'informally resolve' the complaints and told us about the first of them in August 2013, but they didn't complete them all until 31 January 2014, nearly 11 months after we submitted our complaints.

(We were told that three registrants had let their registration lapse prior to complaints about their websites being resolved, leaving 97.)

Each time, we were told:

I attach herewith copies of a further xx complaints that have been resolved informally ie either the wording complained of has been removed from the relevant website or has been amended in line with advice that the registrant has sought from the Committee of Advertising Practice Copy Advice Team.

At least all these websites had been checked, claims removed or amended on according to advice from the ASA.

A good job (eventually) well done.

Except…

A few months later, we decided to look at a small sample of the supposedly amended websites to see what they now said. 

Guess what we found?

This, from just two websites:

Abscess, Acne, Alcoholism, Anaemia, Angina, Anxiety, Arthritis, Asthma, Bloated Stomach / Wind, Breast Pain / Cysts, Blood Sugar Imbalance, Blood Pressure, Bruises, Candidiasis, Fungal Infections & Yeast, Cellulite, Cholesterol, Circulation, Coeliac Disease, Cold Sores, Colds & Flu, Colitis , Constipation, Crohn's, Cystitis, Dandruff, Diabetes Mellitus, Diarrhoea, Depression, Diverticulitis, Exhaustion / Fatigue/Tiredness, Endometriosis, Eczema, Electromagnetic Sensitivity, Gallstones, Glue Ear, Gout, Halitosis, Hayfever, Hot Flushes, Herpes Simplex, Heart & Arteries, Headache, Hypoglycaemia, IBS, Impotence, Immunity, Insomnia, Lymphatic Congestion or Lymphoedema, Libido, Lyme Disease, ME - Chronic Fatigue Syndrome, Mood Swings, Migraine, Menopause, Memory / Concentration Loss, Muscle Pain, Nausea, Osteoporosis / Porous Bones, Overweight, Parasites, Prostate, Polycystic Ovaries (PCOS), Premenstrual Tension - PMT, Periods, Psoriasis, Sinusitis, Stress, Thyroid - Hypothyroidism - Underactive Thyroid, Thyroid Unexplained Weight Gain, Toxin Elimination.

Asthma, Asthma revisit, Babies, Back Pain, Bear Grylls' battle with back pain, Bell's Palsy, Birth Traumas, Born Survivor, Bowen , Integration and Wholeness, Bowen and Health Care, Bowen Technique, an effective complement, Braces and loss of wellbeing, Cerebral Palsy, Children and anxiety, Drug and alcohol abuse help, Eczema, Engaging the immune system, Exercise induced tachycardia, Fibromyalgia, Giving the Right Signals, Healing Power of Gentle Touch, Hydrocephalus and hemiplegia, Knee and ankle study, Lingering symptoms, Lump in the throat, Lymphatic drainage, Lymphoedema, Ménière’s disease, Migraine help, Migraines, Mind-body integration, Mothers and Babies, Motor Neurone disease, Neck pain becomes history, Pain and Anxiety, Pain Control, Parkinson’s Disease, Pelvic area treatment, Peripheral Neuropathy, Post head-injury problems, Respiratory treatment with Bowen, Rheumatoid arthritis, Seasonal Allergic Rhinitis, Sinus – chronic problems, Sleep problems, Slipped discs, Sound Learning Centre, Sport and Bowen, Tinnitus, TMJ Syndrome, Veterans – help with recovery.

These are serious claims and we expected complaints about these to be treated seriously, particularly since we had already pointed these out to the CNHC and was assured everything had been sorted.

Down to ten

We gave the CNHC a list of just ten websites and asked them to confirm whether they were confident all the pages of these websites were now compliant with their Code of Conduct, Performance and Ethics, their advertising and Cancer Act guidance and Therapy Descriptors.

After consulting their Board, we were eventually told:

…the Board can assure you that at the time when your complaints against 100 CNHC registrants were resolved informally, it is confident that the identified websites complied with the Cancer Act 1939 and the Committee of Advertising Practice (CAP) Code

That answered a question we didn't ask; we wanted to know whether the CNHC believed they were complaint now, not six months to a year ago.

We think a responsible regulator would at least have looked at the websites we gave them and taken action on anything it found; it should certainly not have to wait for a member of the public to complain. We do not know whether the CNHC even looked at the websites.

Since it seemed the CNHC didn't want to do anything with the information we gave them, we felt we needed to make these complaints formal, even though we considered them to be a continuation of the original complaint that had not been properly dealt with.

The CNHC wanted the complaints on their special form and a 'hard or scanned copy of the website pages' we were complaining about. Neither of these requirements are specified in their detailed complaints procedure and we hadn't provided any hard copies of web pages in the original complaints.

However…

We supplied the complaints on their special form, including a list of the urls of the specific pages we had concerns about.

The CNHC wanted us to identify the specific wording on each page we were complaining about.

We argued that the words needed to be seen in the context of each page and that we were therefore concerned about all the wording on the pages we listed.

The CNHC still wanted the 'specific wording' that was the subject of our complaint.

We supplied a large file that contained screenshots of the webpages with specific wording identified with a yellow highlight on each page, but we reiterated that we were concerned about all the wording on those pages.

The CNHC seemed surprised at the number of screenshots we provided; we don't know why, since it corresponded to the number of pages whose urls we had already supplied to them. There were a lot of pages and a lot of highlighted text because these were the claims being made by their registrants! There is not — nor should there be — a word limit on the number of misleading claims being complained about.

Some of the text we highlighted was single words or phrases; sometimes paragraphs and sometimes complete pages:

Highlighted text

Click image to enlarge

As you can see, context is everything and it would have been trying to extract any few words out of any of these. In all these files, we had highlighted some text on every page, but, given the nature of some of the pages and documents, the claims being made and the context in which they were being made, some pages had most of the text highlighted. We were not comfortable picking out any specific words and felt that it was not our responsibility to isolate concerns about just a few specific words and expected the CNHC to have taken responsibility for doing that as part of their formal process.

If we had isolated some words, we believed that the CNHC would look only at those few words themselves, ignoring the rest. We had been given an assurance that claims would be looked at in context, but we had no confidence that this would be done such it covered all the areas we were concerned about. We were therefore left with no option but to try to insist that the CNHC accept our complaints as we had submitted them without weakening them by cutting back on the words we were concerned about.

As we understood the complaints process, it was the responsibility of the CNHC’s Investigating Committee to take the complaint information, examine the evidence provided and identify any potential breaches of their Code and, from that, determine if there was a case to answer and to then derive Formal Allegations to be presented to their Conduct and Competence Panel.

The onus cannot be placed on a complainant to identify and formulate specific and detailed allegations; all that a complainant should be required to do is to present information to the CNHC and for them to decide whether or not, after due investigation and consideration, that information was sufficient evidence with which to proceed with a complaint and that there was a case to answer.

Think of a customer who was not satisfied with the treatment received. It might have been possible for her to have formulated her complaint such that it isolated the very specific concerns she had and to detail how the Code of Conduct, Performance and Ethics had been breached, but it is entirely right, reasonable and appropriate for the CNHC, with their knowledge and expertise, to make all efforts to understand the issues and to help her formulate a complaint that highlighted those issues.

In our case, the CNHC seemed to expect us to isolate specific words that breached their Code, to the possible detriment of ignoring everything else.

Vexatious?

The CNHC still maintained that we had 'to identify in each case the specific wording that is the subject of your complaint'.

We believed we had already done that and pointed this out yet again to the CNHC.

On 17 July 2014, the CNHC told us:

You state you have provided “...just one file per url”. I have made a quick check and in one instance the file provides individual links to 75 pages. In total there appear to be links to 180 or so pages. Bearing in mind this and your reiterated statement that all of the text on all the pages specified are the subject of your complaint, I will be asking the CNHC Board to consider whether your complaints should be categorised as vexatious, on the following grounds

• you have failed to specify precisely what you are complaining about

• you are seeking to make unreasonable demands on CNHC resources

The next meeting of the Board is scheduled for 6 August and I will be in touch with you again after that.

We were at a loss to understand what it was going to take to get the CNHC to take complaints about their registrants making the claims such as the ones above seriously and act in the public interest?

In one final attempt, we reiterated many of the claims we had found on those websites and that the ASA's guidance on Health Therapies and Evidence QA (Sept 2011) states:

Marketers should be mindful that merely listing medical conditions could imply their treatment or therapy is effective.

We didn't know how to make this any clearer. We had given them 'information about a registrant' as required by their complaints procedure; we had provided the complaints of their own forms; we had listed the website pages; we had specified what wording concerned us; we had provided screenshots of those pages.

What does it take to get a regulator to consider serious complaints about serious issues of public protection?

The final six

The CNHC informed us that four more registrants had let their membership lapse: we were now down to just six complaints.

We had fully expected the CNHC to rule our six complaints vexatious and to dismiss them, but they surprised us on 12 August by giving us one last chance to identify the specific wording (even though we had already done so).

Oh, and they created a new document, dated 08 August 2014: Policy for dealing with Vexatious Complaints and Abusive Complainants.

Meanwhile…

A few weeks before we submitted our initial 100 complaints in March 2013, the CNHC applied to the statutory Professional Standards Authority for Health and Social Care for accreditation for their Accredited Voluntary Register scheme that was set up under the Health and Social Care Act 2012 (HSCA).

This seeks to ensure the public are protected by ensuring accredited organisations meet certain standards in relation to their operation. They say they make no judgement on the efficacy of any treatment provided by any organisation who is accredited, but the implication is there that an organisation backed by a statutory body — and the same one that oversees the GMC, GDC, etc — must be of high quality and provide good treatments.

We did not believe then that the CNHC could meet the required standards and that accrediting them would do no more than give members of the public a misleading and false impression that the CNHC would deal effectively in the best interests of the public.

We responded to the PSA's Call for information on the CNHC's application, giving our reasons.

One of our main objections was that the AVR was intended to cover ''health and/or social care occupations’. We analysed what the HSCA actually said in its convoluted way and argued that occupations that had no good evidence of any healthcare benefit (as the vast majority of the occupations that the CNHC register) could not meet the requirement of being a 'health and/or social care occupations’ and therefore could not be accredited.

The PSA disagreed but never really rebutted our objections; overall, they did not agree with our recommendation that the CNHC not be accredited.

However, we know from their Panel Decision report that the CNHC did not have an easy time of it, partly due to our response and partly to what others told the PSA about their concerns — it took the PSA six months to consider the application. They gave several recommendations:

Recommendation 1: Quality Assurance Project – participation of verifying organisations (VOs) in the quality assurance project is essential and should therefore be mandatory. CNHC should provide a plan highlighting when it will receive and review evidence submitted by all VOs.

Recommendation 2: Integrity of the Register – CNHC should have a mechanism in place to ensure that all its registrants comply with its education and training standards, particularly those who had been practising for four years or less at the time of initial registration with CNHC.

The Panel considered two scenarios: a) the evidence submitted through the quality assurance project may demonstrate that a specific verifying organisation might not have appropriately applied the standards required for CNHC registration (non-compliant case); b) some verifying organisations are not engaged in the quality assurance project so CNHC is unable to assure that its criteria are being applied appropriately (non-engaged case). In both cases, CNHC should have a mechanism in place to assure itself that registrants verified by non-compliant and non-engaged verifying organisations still meet its education and training requirements.

Recommendation 3: Enforcing and Promoting standards – CNHC should have a plan in place that demonstrates how it will proactively promote and enforce its Code of Conduct amongst registrants, particularly, sections related to misleading advertisement. The plan should include active promotion of its advertising guidelines and other relevant codes/advice from the Committee of Advertising Practice and Advertising Standards Authority.

The first two are essentially technical ones to do with how the CNHC rely on VOs to check potential registrants are 'properly' trained. This could be the subject of a future newsletter.

But the third demands that the CNHC has a plan to 'proactively promote and enforce its Code of Conduct amongst registrants, particularly, sections related to misleading advertisements'.

They also imposed the following conditions:

Condition 1: CNHC must have a single complaints procedure where the criteria for handling and recording of these complaints both informally or formally are explicitly clear to the public and explain the types of complaints for which informal resolution is not suitable (e.g. dishonesty, fraud, repeated complaints and so forth). Its criteria and process for escalating complaints from informal to formal procedures must also be clear to the public.

Condition 2: The 110 complaints discussed in the resubmitted application must be assessed according to procedure and either resolved informally where appropriate or escalated to formal resolution, i.e. sent to the Investigating Committee. The AVR team should be notified when all complaints have been resolved or escalated to formal resolution. A plan for resolution of all complaints should be provided with notification.

CNHC had until the 31st of October 2013 to comply with conditions.

CNHC-AVR logoThe first is an attempt to clear up the confusion of having different complaints documents saying different things — just as we have described above.

The second condition of accreditation was that they should have a plan to deal with our then 100 complaints. Disappointingly, it seems to accept that the CNHC can informally resolve complaints, despite this not being part of their published complaints process document.

As a result, the CNHC amended their documents.

AVR accreditation permits members of the organisation to use the AVR logo as a sign of respectability; any CNHC member can display their combined logo.

However, the accreditation has to be renewed every year and the annual call for information for their first renewal was announced on 04 July 2014. Their accreditation ended on 23 September, but is maintained while the annual re-appraisal is being undertaken if it has not finished before the previous accreditation expires.

Re-accreditation

We, of course, responded to the PSA's call for information, taking the opportunity to bring the PSA up to date on how the CNHC had still not dealt with our complaints and how — as far as we could see — none of the claims we had highlighted to the CNHC had been removed from websites of their registrants and why we still had serious concerns about claims being made on some of their members' websites. We included in that a complete record of our correspondence with the CNHC, amounting to some 30 pages, so they could see how the CNHC had dealt with our complaints.

That re-appraisal process has been completed and the PSA have now published their AVR Panel decision stating that the CNHC's accreditation is being renewed for another year.

PSA Accredited Register logoAt this point, it should be noted that the PSA have changed the name of their Accredited Voluntary Register. For reasons best known to them, they recently changed the name to Accredited Register, dropping the word 'Voluntary'. It is not clear why this could be seen as a step in the right direction at all; it simply hides that these registers are voluntary. It is possible that a member of the public will now see these registers as having the equivalent standing to the PSA's statutory registers it oversees such as the GMC, GDC, etc.

There are several interesting points to be made about the PSA's re-accreditation report, but we'll confine ourselves to what they say about our complaints here. The relevant section states:

The Panel then discussed the concerns related to six registrants’ websites allegedly in breach of advertising standards, CNHC’s Code and therapy descriptors. The Panel was informed that CNHC had asked for more specific information about the exact wording that was the cause of the complaint for each of the websites in line with their complaints procedure. The Panel was told that the complainant had submitted electronic links to CNHC (182 files in total) where sometimes whole paragraphs were highlighted as causing the complainant concern. The panel was also told that the complainant stated that their concern related to all the text on all the specified pages. CNHC Board had decided that in the interest of fairness and reasonableness it was right that registrants knew precisely what was being complained of. The Board had asked the Registrar to give the complainant another opportunity to specify the words they were complaining about otherwise the complaints would be classified as vexatious under CNHC’s recently published ‘Policy for dealing with vexatious Complaints and Abusive Complainants’. At the time of the panel meeting CNHC informed the Authority that it had contacted the complainant to inform them of the Board’s decision above.

After discussing the provided information the Panel decided to call CNHC’s Registrar during the meeting in line with AVR process to ask whether or not CNHC could assure itself and the Authority that the concerns raised did not identify any risk to public protection. The Registrar clarified that CNHC did not consider the concerns raised to be complaints as yet because they have not received the specific information they need in order to inform the registrant what was being complained about. The Panel agreed that in fair process registrants had a right to know what was being complained about and that CNHC was following their documented complaints procedure. Having considered the information provided by the Registrar the Panel decided that, not withstanding whether or not the concerns raised with them constituted formal complaints, the CNHC should satisfy themselves and the Authority that there were no issues with the websites that raised any risks to public protection and issued the Instruction set out above. CNHC was asked to provide an update to the Authority in three months from the date of the outcome letter.

There are two main points to be made here:

  1. The CNHC did not consider the concerns raised to be complaints as yet because they have not received the specific information they need in order to inform the registrant what was being complained about.
  2. The CNHC should satisfy themselves and the Authority that there were no issues with the websites that raised any risks to public protection.

Firstly, it beggars belief that the CNHC do not, as yet, consider our six complaints as complaints — despite having complied with what their detailed procedure document states — and that they won't do so until they have received what they deem to be the 'specific information'. In fact, we don't really even see them as new complaints at all, but as examples of the first 100 that have not yet been resolved.

Secondly, it also beggars belief that the CNHC — despite being made aware of the specific concerns we had last March — could not assure the PSA that that there were no issues with the websites that raised any risks to public protection and have to be given a further three month in which to do so.

It's difficult to fathom why claims such as those we have highlighted above could not be a serious cause for concern to any organisation that had one iota of concern for public protection. In what world does making claims for asthma, Diabetes Mellitus, depression, autism screening, ME, cerebral palsy, Ménière’s disease, Parkinson’s Disease, hydrocephalus and hemiplegia and post head-injury problems not raise concerns for public protection?

Serious questions

Remembering the OfQuack Paradox, we can perhaps expect this kind of behaviour from the CNHC, but what — and this is perhaps the more serious question — will it take for the PSA to stop giving legitimacy to such an organisation? How serious do claims have to be before they are beyond the pale even for the PSA?

In one of their FAQs, the PSA states:

Does accreditation mean that a particular therapy is better than others?

No. Accreditation does not validate the efficacy of a particular therapy. This means that the Authority will not test whether or not a particular therapy has better results than other therapies.

…or whether any therapy has any good evidence of efficacy at all.

This is a direct consequence of the HSCA because it has no explicit requirement that any therapies of accredited registers be evidence-based — or even reality-based.

But the PSA does have the power to act when an accredited regulator fails to follow its agreed procedures and fails to protect the public, yet it seems it won't act when serious concerns are raised and ignored by an accredited organisation.

So what would it take? Would they only act after someone has been harmed by misleading advice given out by a member of one of their accredited organisations. We just don't know.

However, although we have been at an impasse, we have now provided the CNHC with a spreadsheet containing the 'specific wording' they have asked for and we hope they will now properly deal with our complaints.

We will, of course, keep you informed.

TL;DNR

The Too Long; Did Not Read version…

  • We were concerned about claims being made by CNHC registrants that might mislead the public.
  • With the help of our supporters, we gathered details of claims being made and submitted complaints about 100 registrants to the CNHC.
  • The CNHC told us they wanted to resolve them 'informally, even though their published procedure didn't allow for this.
  • We were (eventually) told they had all been resolved.
  • We checked ten websites and were concerned at the claims still being made.
  • We tried to get the CNHC to deal with six of these complaints and they were on the verge of declaring them 'vexatious'.
  • Meanwhile, the statutory Professional Standards Authority (PSA) accredited the CNHC to their Accredited Voluntary Register, despite being made aware of serious concerns.
  • As part of their first annual re-accreditation process, we submitted our account of the way the CNHC had handled our complaints and our concerns over this, maintaining that the CNHC had breached the AVR Standards.
  • The PSA re-affirmed the CNHC's accreditation regardless.
  • We have now cut down the words we were concerned about and sent them to the CNHC.
  • We await the final acceptance of our serious concerns as complaints and to them being dealt with properly in a manner we expect of an organisation purporting to act in the public interest — and of one given the imprimatur of a statutory regulator.

07 December 2014


 

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