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What future is there for counselling in the NHS

I n 2002, I wrote an article for Healthcare Counselling and Psychotherapy Journal (Proctor, 2002a) as though it was 2015 and I was tracing the (at that point) fictional history of the NHS from 1985 to 2015. This was based on my experiences in 2002 with the healthcare system in the US; the discourses that were current in the UK at the time seemed to prefigure a move to an insurance-based healthcare system provided by the private sector. In this article, I reflect on the extent to which my predictions from 2002 were accurate and predict again the possible changes to come in counselling services. In my original piece, I described the ‘efficiency’ and ‘accountability’ discourses, which were becoming increasingly prominent at the time. The ‘efficiency’ discourse was used to argue that better management of existing resources would improve healthcare, rather than increasing resources. This justified the split between ‘purchasers’ and ‘providers’, which led to the ‘commissioners’ and ‘providers’ division of today. The ‘accountability’ discourse was used to scare the public about ‘rogue practitioners’ doing their own thing and justified the transfer of power from healthcare professionals to managers, with professionals needing to prove that their practice was ‘evidence-based’. This approach supported an industry of regulating bodies, such as the National Institute for Health and Care Excellence (NICE), in deciding what would count as evidence, and in increasing the power of approaches within mental health that fitted nicely within a technological, scientific model, such as cognitive behavioural therapy (CBT), moving mental healthcare further away from the idea of relationships, and professionals further away from the idea that who and how we are as people matters. These discourses perpetuate the myth of standardising mental healthcare, as though any human relating can be done in a uniform way. As part of this approach, the notion of performance-related pay was already being mooted in 2002, which I predicted would be introduced across the board, Public payment and private provision