Health and Care Professions Council: Registration Fees

– in Westminster Hall at 2:56 pm on 14th March 2019.

Alert me about debates like this

[Mr Steve McCabe in the Chair]

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South 3:00 pm, 14th March 2019

I beg to move,

That this House
has considered registration fees at the Health and Care Professions Council.

You and I have known each other a long time, Mr McCabe, but I think that this is the first time I have led a debate under your chairmanship. I hope you will show a bit of leniency, particularly to some of my hon. Friends. I thank Mr Speaker and the Chairman of Ways and Means for making provision for the debate. In actual fact, we were granted the debate at short notice; I think somebody else pulled out. Hon. Members will have to excuse me—I have a heavy cold, to say the least. I hope they can all hear me.

The debate follows on from early-day motion 2069, which I tabled last month and which condemned the Health and Care Professions Council’s unfair rise in registration fees. To date, that early-day motion has been signed by a truly cross-party group of 118 MPs, which shows the real concern across the House; it is very hard to get such a number. I hope that the debate leads to a rethink from the HCPC and the Government.

The HCPC exists to regulate health and care professionals. It sets standards, investigates complaints and keeps a register of workers in 16 different professions. Members might be interested to know what those professions are: arts therapist; biomedical scientist; chiropodist and podiatrist; clinical scientist; dietician; hearing aid dispenser; occupational therapist; operating department practitioner; orthoptist; paramedic; physiotherapist; practitioner psychologist; prosthetist and orthotist—I do not know what those are; radiographer; social worker, in England; and speech and language therapist. That covers quite a wide range, to say the least. Notably, social workers in England are still covered, despite plans to change that from 2019. Altogether, the HCPC regulates more than 360,000 professionals, 90,000 of whom are social workers.

To register, professionals have to pay an annual registration fee, which is currently £90. In autumn last year, the HCPC announced plans to raise its registration fees from £90 to £106 per year—an 18% rise. That follows a 5% rise in 2014 and a further 12.5% rise in 2015 so with the new rise, fees will have risen by 40% since 2014. The HCPC argues that the rise is necessary in order to secure its financial health, giving five main reasons for the fee increase.

First, it plans to increase efforts to prevent problems before they occur. Secondly, it wants to use innovation and technology to modernise and improve services. Thirdly, it needs to address a caseload that is growing in number and complexity. Fourthly, it needs to address the impact of inflation since its last fee increase. Finally, it needs to pre-empt the transfer of social workers to a new regulatory body. While the HCPC has faced higher expenditure since 2015, these reasons cannot possibly support an 18% rise. Expenditure increased by £2.8 million in 2017-18, but £400,000 went on redundancy packages for management staff and £1.2 million went on refurbishing the HCPC head office.

The HCPC put its plans for a fee increase to its members over the winter. Responses to the consultation were damning, with 90% of respondents opposing the increase. Despite the findings of the consultation, the HCPC decided last month to impose the 18% increase. It has defended the rise by saying that its fees are lower than those of any other health and care regulator. However, other regulators are not comparable. Some cover very few members, reducing their economies of scale.

Photo of Mike Hill Mike Hill Labour, Hartlepool

My hon. Friend is making an excellent speech. Of course, this issue affects not only the HCPC’s but other registrants, such as nurses, who have to register with the National Midwifery Council. Does he agree that, along with other things, such as car parking charges, low pay and no automatic incremental progression in a lot of health-related occupations—particularly for nurses—these kind of registration fee increases are just another tax on healthcare workers’ wages?

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

In considering that, we have to remember that a lot of those workers’ salaries—for want of a better term—have in some instances been frozen since 2010, while in some instances they may have increased by 1% or 2%. With inflation at about 2% over that period, that is roughly an 18% cut in wages. Add the increased fee, and those workers are carrying a heavy burden that they should not have to carry. Adequate funding should be provided, rather than finding it by using hidden taxation methods. We all know that nurses and so forth in some of our hospitals have to pay car park charges. Given all those hidden costs, these workers are quite frankly bearing the brunt of the recession.

Photo of John Howell John Howell Conservative, Henley

A lot of these organisations have always said that they want to keep their independence and do not want to be funded by other sources; they are pretty keen on making sure that that continues. Is the real issue not the amount of regulation that they have to deal with? That must be one reason why the funding level has increased.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

Organisations always argue that they want to be self-sufficient, but that should not come at the expense of the people whom they actually regulate. I am not an expert on the regulations that some of these bodies govern, but we should be very careful when thinking about changing regulations or reducing their amount. We would need to test that.

Altogether, the HCPC has not given a strong reason for this huge increase, leaving affected workers frustrated and angry. In addition, the Government’s response to the fee change has been very disappointing: in answer to written questions, they have just repeated the HCPC’s weak defence of the fee rise. Ministers have argued that the registration fees remain the lowest of any health regulator, but that does not change the fact that the rise is disproportionate and unfair. The Government should be concerned over the threats to staff levels in the affected professions, but Ministers say they have made no assessment of the impact on staffing of this rise. That is a complete dereliction of duty, with staff openly talking of leaving due to the rise.

It is an irresponsible move by the Government to hide behind the HCPC’s independence. They must take steps to prevent fee rises from being the norm for the HCPC, and for all regulators, and help to build bridges between healthcare professionals and the HCPC, as trust is breaking down. HCPC members are understandably angry, believing that it is exploiting a stranglehold over their jobs. The rise amounts to nothing less than a tax on practising, and it has had little scrutiny or debate. I would like the HCPC to reverse the decision to increase registration fees by 18%. The Government and the HCPC must change the way fees are decided on, to prevent such a huge change happening in the future. The HCPC must operate in a fairer and more transparent way, and the Government must play a role in ensuring that that happens. It is time that the Government and the HCPC stopped taking advantage of those who take care of us all.

In response to the rise in fees, Unison conducted a survey of affected members and found that 99% of respondents did not back it. Importantly, it found that 76% did not see the current £90 fee as good value for money. Members feel that the HCPC offers no real benefit except for allowing them to practise. They are also critical of the justification given by the HCPC for the fee rise.

First, it must be pointed out that the 18% rise completely outstrips inflation. If the HCPC was genuinely concerned to cover inflation, it could implement smaller, year-on-year rises. I doubt whether the staff could afford those, frankly, but it is one way to look at it. Secondly, it is unfair for members of other professions to cover the costs of transferring social workers to a new regulator. The HCPC faces upheaval because of the change, but it is wrong for other professionals to pay the price.

Thirdly, the case for needing more funding after the transfer of social worker regulation is dubious. Social workers make up a quarter of members, which is a substantial number of registration fees. We all know what a difficult job they do. Often they are put in a situation where they cannot win, and they bear the brunt of some of the ills of society, to say the least of it. However, they also account for more than half of all fitness to practise cases. That is the HCPC’s largest area of expenditure. Despite a loss of income, the HCPC will face a sharper fall in costs at the same time. That fundamentally undermines the case for an 18% rise, and proves that it is unnecessary.

Unison also highlighted several changes that the HCPC should implement to reduce spending. First, it must take steps to make its complaints process more efficient. The Professional Standards Authority for Health and Social Care found in 2018 that the HCPC’s investigation committee refers cases too readily to the fitness to practise panel and that more than 20% of complaints are found at final hearings to be “not well founded”. Overall, members are funding a system that handles complaints against 0.64% of registrants and sanctions just 0.09%. No wonder so many members are left feeling that they gain nothing from their registration.

The fee rise comes on top of many years of wage freezes and below-inflation wage rises. Although £106 might not sound much to the Government or to some higher-earners in the health sector, the rise will be a real hit to part-time workers and those on lower wages. Professionals are left doubting their trust in the HCPC after being ignored in the consultation. The HCPC is facing growing unrest and resentment among its members. Many are now moving to non-regulated posts, and part-time working will become a lot less attractive, inevitably causing a fall in the number of workers in the sector.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 3:14 pm, 14th March 2019

I am always surprised when I am called early, Mr McCabe, but it is always a pleasure to speak in such debates.

I thank Mr Cunningham, who is a friend as well as a colleague, for obtaining the debate. I, along with many others, signed the original early-day motion, as he mentioned. I have had the benefit of his knowledge in studying the background and making sure we were on the same page. When he told me the story, it resonated with me and I knew it would resonate with my constituents and with people back home who work in the caring services. It will therefore come as no surprise if my comments echo those of the hon. Gentleman.

I thank the hon. Gentleman for persevering with the matters he is interested in. He was a Member when I first came to the House, and the two of us made friends quickly and have worked together on many things. I would say that he has signed all my EDMs and I have probably signed all his, so we have a mutual understanding. That is not because we are friends, but because we are of the same mind on the issues and we work together on them. I am pleased to do it. I think I signed his Coventry City early-day motion, and I think he even signed mine on Leicester City, so there we are. We crossed that divide as well.

I, like many Members in this Chamber, have been a consistent advocate of a pay increase for NHS staff. I lobbied the Government for it when my party came into the confidence and supply arrangement, and we thank them for the increase that they gave in response. I am fighting to equalise nurses’ pay on the mainland and in Northern Ireland, because there is a differential and we must close the gap. I am endeavouring, with the Department of Health in Northern Ireland and the permanent secretary, to ensure that we move closer together. It is very simple to me: I see a group of civil servants working in conditions that are not acceptable and I know that what they should be paid is vastly more than what is there. It need to pay them what they should be paid. We appreciate them and all that they do, as the hon. Member for Coventry South said, and I thank them too.

I had occasion about two years ago to be cared for by nurses in hospital, so I know how much they do. I was there three times that year. The 1.5% rise does not seem like a huge amount, yet the staff felt that it was a gesture of appreciation. It was important that we made a move in that direction. The Government’s agreement was 3% over a five-year period. To accept, in the same breath, an 18% increase in the fee to practise is shocking and far outweighs any gesture we have made. Such an increase will mean a 40% rise in HCPC fees since 2014. How can that be acceptable? There is no fairness or sense of balance in the process.

I always relate my speeches in the House to what happens in Strangford, so that the people there know I am industrious on their behalf. The Strangford example I want to use today is of a district nurse who approached me a few weeks ago. She complained that those who have gone to the private sector to carry out personal independence payment assessments and the like not only get to work nine-to-five, have a company car and a higher wage, and are not run off their feet in an understaffed ward; they also have their registration fees paid. They get better conditions in the private sector, and their fees are paid, so we can understand how NHS professionals feel. My constituent said it is little wonder that wards are crying out for qualified nurses, while the assessors can find people left, right and centre. We have a dearth of nurses in Northern Ireland and are 1,500 short. The Minister knows I understand that that is not his responsibility; I say it just to show the situation we are in. We simply cannot compete with the private sector, but why are we competing against ourselves with the PIP assessments, which are carried out with public money? We are robbing Peter to pay Paul, and that needs to end.

We need to take the opportunity to assure paramedics, occupational therapists, operating department practitioners, physiotherapists, radiographers, dieticians, chiropodists, podiatrists, orthoptists, clinical scientists and speech and language therapists that to ask them for a 40% increase in fees over five years is not acceptable. Yes, it may be only a pound a month, as some people have said, but the fact is that all bills, from gas to petrol to food, have risen. The issue is the combination of all those increases in bills. They all contribute to the lowering of income. We should want to encourage NHS practitioners—those in the health and care professions—to stay there and work in their vocation of choice.

I firmly believe that a message must be sent today from this place that we support health and care professionals in their fight for fairness and equality, and that we oppose the rise or will pay the fees on behalf of those who work full time in our NHS as part of our thank you to them. That would be an endorsement of their commitment to us as their patients. It is not even £9 a month per staff member, so can the Government not look after this and ensure that it is paid for NHS staff? Why are we asking them to pay it while those who work privately have theirs paid for? The issue is the imbalance. Those who work privately have this paid for, but that does not happen in the NHS. That is not the right message to send to dedicated NHS workers, and we must do better.

Photo of Liz McInnes Liz McInnes Shadow Minister (Foreign and Commonwealth Affairs) 3:21 pm, 14th March 2019

It is a pleasure to serve under your chairmanship, Mr McCabe. I am grateful to my hon. Friend Mr Cunningham for securing this important debate. I, too, had requested a debate on this subject but was unsuccessful, so I am pleased that he has been able to bring this important issue to the attention of the House.

Before I was elected to this place, I was registered with the Health and Care Professions Council, because I worked as a clinical scientist in the NHS. As we have heard, registration with the HCPC is an essential part of the job: without professional registration, scientists and allied health professionals in the NHS are not allowed to practise. I am no longer registered with the HCPC. Having worked for the NHS for 33 years and had a career change late in my working life, I have called time on my NHS career, so there is no conflict of interest.

The HCPC charging above-inflation fee increases is nothing new, but it is scandalous that its latest proposal is to raise fees for already hard-pressed healthcare professionals by an enormous inflating-busting 18%. If that increase is imposed, HCPC fees will have risen by 40% since 2014, outstripping inflation and going hugely above any pay rises that NHS staff have had.

I remember from my days in the NHS that the HCPC used to impose above-inflation fee increases during the years of the George Osborne 1% public sector pay cap. Any representations that the staff and trade unions made to the HCPC, at a time when many staff had had no pay rise at all, fell on deaf ears and were simply ignored. It appears that that has emboldened the HCPC to ask for more and more from its members, with no discernible improvement in the performance of the HCPC or an increase in the services that it provides to its registrants.

NHS staff are already struggling, their pay having been suppressed for many years since 2010, but more and more financial demands are made on them in order to stay in work. NHS staff in England have to pay to park at their workplace; NHS staff are paying more towards their pensions; any member of staff with any sense will be paying trade union subscriptions; many are repaying student loans; and now, they appear to be expected to finance the HCPC’s excessive, unreasonable and unjustified fee demands.

The staff are just not being listened to. My trade union, Unite, submitted a 38,000-signature petition against the fee increase to the chief executive of the HCPC before the decision was made on 14 February this year to increase its mandatory fees by 18%. It appears that the HCPC is quite happy to blithely ignore the voices of 38,000 of its members. Additionally, the HCPC consulted on increasing its fees from £90 to £106 a year and 90% of those who responded disagreed, yet that seems to have had no impact on the decision made on 14 February.

Photo of David Drew David Drew Shadow Minister (Environment, Food and Rural Affairs)

Does my hon. Friend agree with me—she is making this case anyway—about how unaccountable this body is? I have dealt with individuals who have fallen foul of it and I have written to it on their behalf, but it appears to take no notice at all of what an individual MP or constituent has to say.

Photo of Liz McInnes Liz McInnes Shadow Minister (Foreign and Commonwealth Affairs)

I do agree, and I thank my hon. Friend for that intervention. I should add that while I worked for the NHS, I was a trade union rep for Unite the union and had many encounters with the HCPC. I found it to be opaque in its dealings and difficult to deal with.

I want to mention the effect of the fee increase on part-time workers, because scandalously there is no difference in fees between full-time and part-time workers, so it will have a disproportionate effect on part-time workers, who in the NHS are predominantly female.

If we look at what the HCPC actually does, we find, from its 2018 annual report, that it dealt with complaints against only 0.64% of registrants and that it sanctioned only 0.09%. Many members comment that they receive no benefit or professional services at all from their registration. As we have just discussed, the HCPC operates in a very opaque manner. Trade unions are not recognised within its own workforce, so there is no collective pay bargaining for its own employees and so we do not even know what the HCPC pays its staff.

The HCPC says that it needs this increase so that it can deliver smarter regulation, improve services and mitigate the impact of the transfer of the regulation of social workers to Social Work England. However, I have already talked about how few fitness-to-practise cases the HCPC deals with as a proportion of the total membership. When social worker regulation moves to a new regulator later this year, that should lead to a reduction in fitness-to-practise expenditure, given that 59% of that expenditure currently goes on social work cases. The HCPC’s costs should decrease, not increase, which makes this demand on registrants even more unjustified.

This is Healthcare Science Week and I pay tribute to all the scientists working across our NHS. Their work quite often goes unrecognised, but is an essential component of the diagnosis and treatment of disease. Healthcare scientists and allied health professionals are a vital part of our NHS team.

In conclusion, I call on the HCPC to pause, to delay any decision to increase fees and instead to explore alternative ways to reduce costs and to fully assess the impact of the transfer of social workers.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Transport) 3:29 pm, 14th March 2019

It is a pleasure to serve under you in the Chair, Mr McCabe. I was also registered with the HCPC and the preceding bodies. Although I am no longer registered, I recognise the impact this issue has on NHS staff.

There are nine different regulators in the NHS, regulating 32 different professions. They provide a very important function: this is about protecting not only the public, but health professionals themselves in the course of their practice. The regulators are there to set, maintain and raise standards and to give confidence to the public, as well as to hold a register and protect the title of a profession, so that other people cannot set up a business pretending that they hold the professional qualifications, which people across the NHS work hard for.

Increasingly, regulators also ensure continuing professional development. The most advanced programme of professional development has been put in place by the Nursing and Midwifery Council in recent times. The regulations around that ensure that registrants are compliant with continuing professional development. The function of regulators is to ensure that professionals who fail to uphold professional standards and their duty of care are called to account, so that sanction is applied where necessary and recourse is taken.

We have already heard that—thankfully—a miniscule number of professionals are taken through disciplinary processes. That is a tribute to the great professionalism across the NHS. However, such cases do occur, and it is appropriate that rigorous processes are in place so that individuals can defend their position and have recourse to justice before appropriate action is taken. To have someone practising who is not fit for practice risks the whole profession, so it is vital that that is put in place.

However, the cost of that process has escalated substantially, as hon. Members have mentioned. When I first registered as a physio, I had to pay only £17. In 2015, the last year that I was registered, there was a huge increase—from £80 to £90. The suggested increase to £106 is, quite frankly, unacceptable, particularly given the background, as set out by hon. Members, of a decade of pay regression, pension cuts and student loan repayments. In my time we had grants, so things have changed significantly.

More and more burdens are being placed on health professionals. That means that more risk is placed on health professionals. When we had adequate staffing in the NHS, mistakes were less frequent and caseloads were safer. Unfortunately, in many professions people’s caseloads are now too big. The pressure on those individuals increases.

I was formerly head of health at Unite. We focused on organisations’ duty of care. Managers in particular must say no to the organisation and argue the case for more staff, rather than increase the pressure on health professionals by making their caseloads unsafe—that would mean that managers were failing in their duty of care, in breach of their standards of professional conduct.

Photo of Mike Hill Mike Hill Labour, Hartlepool

I am also a former Unison official. In view of that, does my hon. Friend agree that, as my hon. Friend Liz McInnes rightly pointed out, the professional bodies cover not only full-time and part-time staff, but student social workers and student nurses? They are under the same constraints.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Transport)

Students do have responsibility, but the registered health professional is responsible for ensuring that they are safe under their practice while they are training in their profession. Training the future workforce is an incredibly important additional function of health professionals.

The Law Commission came forward with a set of recommendations for registrant bodies in 2012. In 2019, we still have not seen the implementation of those recommendations in full. I would like the Minister to explain why that is the case. Implementing a substantial piece of work about ensuring patient safety should surely be at the forefront of the Minister’s agenda. I am interested to hear the reasons for the delay, and what plans there are to put those recommendations in place. Training programmes for health professionals need to focus on the ethics, behaviour and conduct of health professionals, if we want to see a reduction in the number of cases. Managing that risk is really important.

I want to raise a number of points to move this case forward. First, as we have heard, 38,000 people signed a petition to register their discontent with the fee rise. That cannot be ignored. These are valuable NHS workers. Their call must be heard and reflected on. However, the HCPC hardly seems to have taken that into consideration. As my hon. Friend Liz McInnes said, the number of fitness-to-practise cases being taken forward—currently, 59% of them involve social workers—will disappear. Therefore, surely the registrant body’s costs will decrease. We want to hear how that will benefit health professionals.

This is a tax on professionals. Will the Minister consider funding that regulation fee through the NHS? It does not make sense for nurses, physios and speech therapists, for example, to pay a different amount. That is a tax on professionals who have put in the training and the hours, and go over and above the hours. Why can the Government not pay the amount for each health professional? More than a gesture, it is a responsibility of the NHS to ensure that its registrants, including part-time workers, have that support. I completely concur with the suggestion made by my hon. Friend the Member for Heywood and Middleton that there should be a part-time rate.

Photo of David Drew David Drew Shadow Minister (Environment, Food and Rural Affairs)

Forgive me if I am being simple, but do we know where the extra money is going and what the HCPC is doing with it? Can it explain that? Are the Government holding it accountable? Can my hon. Friend throw some light on that?

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Transport)

My hon. Friend makes such a good point. I wish I could explain that, but to me it seems to be more money and less work. I am as baffled as he is about why health sector workers have to pay into this institution to do less work. I worked as a part-timer when I was head of health at Unite. Although I worked at weekends, I had to pay the full fee, so I certainly understand the frustration. Of course, that mainly affects women, who are more likely to work part time.

Finally, I ask that an expansion of the number of registered health professionals should be considered—after all, this is about keeping the public safe. We should know that the title under which the professional acts is secure and represents them. Certainly psychological services, such as psychotherapists, have requested to be registered, as have community nursery nurses. It is perplexing that the registration of nursing associates on a register—not this one—has been accelerated, but the registration of community nursery nurses, who have long asked for that, has not happened.

I would go further and say that, as we are looking at the future of the social care workforce across the country, we should also look at individuals who are singlehandedly going into people’s homes but who do not have the protection of being on a professional register. Ultimately, that is about keeping the public and our health professionals safe and secure. What steps is the Minister taking to ensure that a greater number of professionals are protected under the existing regulatory regimes?

Photo of Liz Twist Liz Twist Labour, Blaydon 3:40 pm, 14th March 2019

It is a pleasure to serve under your chairmanship, Mr McCabe. I thank my hon. Friend Mr Cunningham for securing this important debate, which I am glad to have the opportunity to speak in. For many years, it was my privilege to work with many healthcare professionals, so I take a keen interest in this subject. I was happy to add my signature to the letter to the HCPC to oppose the, at the time, 18% proposed increase in fees.

It is right that healthcare professions should be regulated and that those bodies should be independent of the Government, which means that fees must be attached to the registration. Having set fees, however, those bodies must have a view to the people and the professions that they regulate. Many people covered by the Health and Care Professions Council are not big earners, despite playing an incredibly important part in our healthcare system, and they are often missed out when we talk about healthcare workers.

We talk about doctors and nurses, but we rarely talk about all the other NHS staff who are integral to our healthcare system. I have worked with paramedics, occupational therapists, dieticians and many others, who are an important part of that healthcare team. In the last 18 months, I have had personal experience in my family of the great work they do—on stroke rehabilitation, for example. It is important work, but the pay is not great. Typically, people are paid at band 5, which starts at £23,000 a year, so we are not talking big bucks.

Photo of Mary Glindon Mary Glindon Shadow Minister (Environment, Food and Rural Affairs) (Farming and Rural Communities)

My hon. Friend is making a good argument about the different levels of pay. Does she agree that one of the most unfair arguments for raising the fees is that they are lower than for other professional bodies? Dentists and doctors get paid much more money, so there is no fairness in that comparison.

Photo of Liz Twist Liz Twist Labour, Blaydon

I agree with my hon. Friend and I will come on to that point later.

Although we in this House talk about how valuable healthcare workers are in all kinds of debates, the fact is that their pay has not kept in line with the real cost of living, so an 18% increase in registration fees is huge and out of all proportion with the pay increases that they have had in recent years. Most of them do not have a choice about whether to register; they must be registered to be able to work. The increase will bring the total increase in registration fees to 40% since 2014, which is incredible.

As hon. Members know, one issue that the NHS is facing is staff shortages in certain areas. It cannot be ignored that something such as this increase can only be a disincentive to staff looking to do those important jobs. As other hon. Members have said, another key issue is the impact of social workers. They are currently covered by the HCPC, but they are about to go off to their own regulatory body. The significance of that should not be lost. While it will mean a reduction in income, of course, it will also mean a significant decrease in the number of fitness-to-practise cases, which are inevitably expensive to prepare. Currently, 25% of HCPC registrants are social workers, but more than 50% of fitness-to-practise cases are in the social work field. That significant factor should be taken into account when the HCPC considers its fees.

On fitness-to-practise cases, I well remember from representing people how devastating it is for any health professional to face a complaint or a fitness-to-practise case, but many people are being held in limbo waiting for their case to be heard, or even awaiting a decision that the case should not be pursued. A 2018 report by the Professional Standards Authority for Health and Social Care was critical of the HCPC and suggested that cases were being referred to the fitness-to-practise panel by its investigation committee too readily. The report stated:

“In our review of its performance this year, we set out our concerns about how the HCPC approaches the discontinuance of cases. Our view was that the approval of discontinuance decisions by the HCPC (with no additional information or evidence being presented since the decision of the Investigation Committee to refer the case) may indicate that the Investigation Committee is failing to identify when there is no case to answer.”

Clearly, that has a significant impact on the professional under investigation and on the operation of the HCPC, and is a factor in costs.

As other hon. Members have mentioned, the proposed 18% increase will have a disproportionate impact on part-time workers, who are predominantly women and mostly in the NHS, because it is a flat-rate fee. That does not seem reasonable.

We hope that the Health and Care Professions Council will listen to the comments made in the debate. Unison has also made some suggestions that the HCPC should consider. First, there should be a pause in implementing the decision to increase fees until the impact of social workers moving away can be assessed. It will clearly be a significant factor in the future, so it seems appropriate that the full impact should be known before an important decision to increase by 18% is made. Secondly, I am told that the Health and Care Professions Council has £18 million of cash reserves, which should be used to allow the impact of the move of social workers to be considered before fees are raised. Thirdly, there should be a more stringent look at other means of raising revenue, rather than just increasing fees.

The Health and Care Professions Council carried out a consultation on the fee increase. By its own admission there were 2,398 responses, many of which opposed the proposed increase. The HCPC has written to explain its position to those of us who signed the letter that we wrote before it made the decision. In that letter, it compared its fees with those of other healthcare regulators. Frankly, that comparison is not valid, as my hon. Friend Mary Glindon has already said. A comparison with the fees paid by dentists, which are £890 a year, or doctors, which are £390 a year, is completely misleading. Typically, HCPC registrants will be paid vastly smaller salaries, so it is not just apples and pears, but apples and strawberries. There is a real mismatch and disparity in the comparisons being made, so they are not valid.

As other hon. Members have, I call on the Health and Care Professions Council to reconsider its position and to agree to Unison’s suggestions as a way to avoid the 18% increase in fees.

Photo of Brendan O'Hara Brendan O'Hara Shadow SNP Spokesperson (Inclusive Society) 3:49 pm, 14th March 2019

It is a pleasure to serve under your chairmanship, Mr McCabe. I, too, congratulate Mr Cunningham on securing this important debate and highlighting the issue. If it were not for him and one or two other hon. Members, the change might have gone largely unnoticed, except by those adversely affected by it. I sincerely hope that it now gets the attention that it so deserves.

As hon. Members will know, the overwhelming majority of health and care matters involving Scotland are devolved to the Scottish Parliament. However, most of the system of regulation of health and care professionals still operates at a UK-wide level. That is because in 2010 the Calman Commission on Scottish Devolution felt that those bodies that dealt with professional regulation of practitioners would best operate at a UK level. The commission’s rationale was that that would provide clarity and assurance to patients that there was a common approach and a common set of standards right across the UK, and that it would also help to facilitate the mobility of professionals who chose to move between the nations of the United Kingdom.

The one exception to that was, of course, social work; Scotland, Wales and Northern Ireland had their own professional bodies in place alongside the Health and Care Professionals Council, which represented social workers in England. Together, those bodies worked on a four-council basis across the UK, and had a memorandum of understanding that set out a framework for close working. As I understand it, part of the problem is that the HCPC is about to lose around 90,000 social workers in England to a new professional body—an issue to which I will return shortly.

Professional registration fees for social workers is a devolved matter; it was devolved in 2003, and the fees remained static until 2016. It goes without saying that the Scottish Government would welcome further devolution of such powers to Scotland, so that we can ensure that any planned changes to that regime are better tailored to the needs of health and care practitioners in Scotland.

As for the issue before us, the Scottish Government are on record as saying that they are more than a little surprised and confused as to why an 18% hike in fees was deemed necessary or appropriate. They seek clarification from the HCPC on how such a substantial jump, which is so out of line with inflation, could possibly be justified. In addition, they are seeking reassurances from the HCPC that it is not simply attempting to make up any projected loss in revenue as a result of the departure of social workers in England by hiking up membership registration fees.

As the hon. Member for Coventry South said, being a member of the HCPC is not an optional extra; people cannot opt out of it and still practise their profession. As the HCPC has a captive market, any price increase must be seen as fair and proportionate, and the practitioners who pay that increased fee must know why they are being forced to pay it, and what benefits it will bring to them and to the profession as a whole. As I understand it, the Scottish Government have contacted, or will contact, the HCPC to get a clearer understanding of its motivation, both in the short and the long term.

As has been pointed out by just about every speaker, this 18% rise in fees hugely outstrips inflation. Given the real-terms cuts that many health and care staff have experienced in recent years, that is another financial blow that they could do without.

In addition, as the HCPC insists on charging a flat rate, if the rise in fees goes ahead as planned, it will of course have a disproportionate effect on part-time workers, who are mainly women, and those workers who are considering reducing, or want to reduce, their working hours. I repeat the Scottish Government’s call for all workers to be paid the real living wage, which better reflects the cost of living and inflation. I am proud that Scotland has the highest proportion of employees earning the real living wage of any nation of the UK.

The contributions to this excellent debate have had a common theme. Regarding Jim Shannon, it beggars belief that anyone in his constituency could be unaware of how hard he works. I used to wonder how he did so much in this place, and I have concluded that he is one of triplets. His valuable contribution today, which compared the pay rise for NHS workers with the rise in professional fees being asked by the HCPC, was very telling.

Liz McInnes brought a much-needed voice from the shop floor or the coalface to this debate, and I am very grateful to her for sharing her experience. It is that experience, and her credibility, that demand that she be listened to by the people making this decision.

Similarly, Rachael Maskell, another former healthcare professional, gave a personal account of paying £17—I think that is what she said—at the beginning of her career, and compared that with the £106 fee being proposed. That really gave this debate context.

I thank Liz Twist for sharing the personal experiences of her family, who have been supported by a dedicated professional. I guarantee that that dedicated professional will not earn a great deal; for them, this increase will be a significant amount of money. I thank all the hon. Members who have spoken for their contributions this afternoon.

If this proposed 18% increase goes ahead, HCPC fees will have risen by 40% since 2014. That is a remarkable figure by any standard, and it is easy to see why the unions and others view it as excessive, unreasonable and unjustified. I put on the record my thanks to Unison for its enormous help in briefing Members of Parliament. I cannot think why the HCPC did not take advantage of this opportunity to brief Members as well; it seems to be entrenched somewhere and does not wish to engage. It had an opportunity to put its case and let Members understand in greater detail its rationale for this increase.

I cannot help but think that at a time when the NHS is struggling with staff shortages in many areas, this decision could have a negative impact on key parts of its workforce. The arbitrary way in which this increase seems to have been arrived at, and the lack of any adequate mechanism to prevent such an arbitrary rise, is seriously problematic.

A consultation opened in September last year. The consultation document put out by the HCPC referred to: improving capacity and services around fitness to practise; keeping pace with inflation, although perhaps the HCPC is talking about Venezuelan inflation, because this increase seems wildly out of line with inflation here; and the costs associated with the impending transfer of social workers in England to their own professional regulatory body. I think that last part is the key to this situation. There is an overwhelming sense that the HCPC is chasing money that it fears it will lose as a result of this reorganisation.

I am not naive; I understand that folk do not normally vote for price rises. However, the fact that 90% of respondents were opposed to the rise should cause concern, yet the HCPC is pressing ahead regardless with its decision to implement this rise in fees. When Unison asked about the increase, 99% of respondents opposed it, and 76% said that they did not believe that they were getting good value for money as things were, which shows that the HCPC has a problem.

As we have heard many times—indeed, I have referred to this myself—the change in the regulation of social workers in England is the key to this situation. However, I call on the HCPC to pause before implementing this decision to increase fees. It should seriously consider why its members are so implacably opposed to it. Can it seriously justify asking its remaining members to pick up the slack resulting from the loss of social workers in England to a new professional body? I do not think it can. During that pause, perhaps it could examine further ways of increasing its revenue, rather than continuing on the road that it is on.

I finish by once again thanking the hon. Member for Coventry South for bringing this matter to our attention, and for securing this ever so important debate.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care), Shadow Minister (Business, Energy and Industrial Strategy) (Labour) 3:59 pm, 14th March 2019

It is a pleasure to serve under your chairmanship, Mr McCabe.

As have many other hon. Members, I congratulate my hon. Friend Mr Cunningham on securing this important debate and on the way in which he has led the campaign. As he rightly pointed out, 114 Members have signed an early-day motion on this topic, which shows the level of concern about the proposals across the House.

My hon. Friend set out the five main reasons why the HCPC argues that the increase is justified. However, as he correctly pointed out, it cannot be justified, particularly in the context of what he referred to as excessive redundancy packages and refurbishment costs within the organisation. He was right that it is irresponsible of the Government to hide behind the HCPC. Recent events may give us cause to believe that the Government are completely powerless in everything and unable to govern, but surely there is something they can do about this; it is a question of political will.

As always, it was a pleasure to hear from Jim Shannon. He put it aptly when he described the increases as having no sense of fairness or balance, and he is right that increases in the cost of everyday items make it difficult to find any justification for these fee increases.

My hon. Friend Liz McInnes brought her experience to the debate, as she often does. I am sorry to hear that she has called time on her NHS career, but the NHS’s loss is no doubt her constituents’ gain. She was right to remark on the correlation between public sector pay restraint and increased fees, and she highlighted what I would characterise as the opaque way in which the HCPC operates. It does not recognise trade unions, we do not know what its pay rates are and, as she said, many registrants do not see any value in what it does. I join my hon. Friend in paying tribute to the healthcare scientists and allied health professionals who work in the NHS, and agree with her that they provide a vital part of the service.

We heard from another former NHS professional, my hon. Friend Rachael Maskell. She brought her own frontline experience to the debate and highlighted the importance of maintaining the integrity of the register, to protect both the professions and the public. She rightly pointed out that the number of those whose professional standards are brought into question is minuscule, and made the pertinent point that the risk for professionals is probably greater now than in the past, due to the continual challenges with workforce numbers.

We also heard from my hon. Friend Liz Twist, who made the point—as did many others—that although the staff we are concerned with today are not the typical NHS staff we spend a lot of our time talking about, they are just as important as every other member of the NHS family. She was right that this fee increase is out of proportion, and that such fees can only be seen by staff as a disincentive to stay in the professions. She also made the perfectly reasonable point that cash reserves could be used to prevent a fee increase this year and to make time for a more open and detailed examination of how such eye-watering increases can be avoided in future.

Professional regulation plays a vital role in setting and enforcing the standards of professional behaviour, competence and ethics that underpin the day-to-day interactions between patients and health and social care services in the UK. There are nine regulators in the UK, which regulate 32 professions and are independent of Government under the law. Their roles, functions and powers vary, but all set standards of competence, conduct and ethics that professionals must abide by. Professionals must register with them to practise. They monitor the quality of all education and training courses, maintain a public register of professionals, investigate complaints, and make decisions about whether registered professionals should be allowed to continue to practise. In short, they play a vital role in upholding public trust and confidence in the professions.

The HCPC currently regulates 15 health and care professions across the UK, as well as social workers in England, although as we have heard, social workers are due to move to a new regulator later this year. At the moment, that represents 366,000 health and social care professionals, including paramedics, occupational therapists, biomedical scientists, chiropodists, dieticians, physiotherapists, radiographers, prosthetists, orthotists, speech therapists and social workers—Members will be glad that they were not the only ones to struggle with some of those names. All those professionals are vital to the day-to-day running of the national health service. Registrants have to pay a fee to join the register and must then pay a yearly retention fee to remain on it and be able to practise.

A massive 18% increase in the registration fee is due to take effect from October 2019, taking the fee to £106, although that increase is subject to parliamentary approval. It comes on the back of above-inflation increases in 2014 and 2015, the second of which occurred despite the HCPC reassuring registrants that their fees would not be reviewed again for a period of two years. If the proposed increase is imposed, HCPC fees will have increased by 40% since 2014, which not only outstrips inflation—which, according to the Office for National Statistics, has averaged about 2.5% over the past few years—but is well above the pay rises that our hard-working NHS staff have received over that period. Let us not forget that the modest pay award that those staff recently secured came only after many years of campaigning, during which time their wages consistently fell behind the cost of living.

I can understand why, in that context, an 18% increase seems disproportionately high. Would the Minister care to comment on whether, in the context of the years of pay restraint that we have talked about, such an unprecedented increase in fees is indeed indefensible, and whether it is right that pay rises will not keep up with the increases in fees?

I appreciate the concern expressed by some Members that there is no real mechanism to stop the HCPC imposing fees at whatever level it sees fit. As my hon. Friend the Member for Heywood and Middleton has said, and as we all regularly hear from staff-side union members, modest pay rises are being eroded by a series of other costs, including increased pension contributions, student loan repayments and increasing car parking charges. Another increase, at a time when pay is not keeping up with the cost of living, will only reduce the disposable income of those staff. The Government must acknowledge the crisis in recruitment and retention, and that all those factors are conspiring against any improvement in the serious staff shortages the NHS faces.

The need to retain staff has never been greater; we should be doing all we can to attract new people, and to encourage those who already work in the NHS to stay. As we have heard, that is a particular concern for part-time staff. Over the years, the HCPC has declined to consider introducing a pro rata structure. Unison has expressed concern that some registrants might be pushed to move into non-regulated posts, work in posts where there is no requirement to renew their registration or decide not to continue to practise, even on reduced hours. Again, that might have a negative effect. Will the Minister comment on that disparity between part-time and full-time staff, and make representations to the HCPC about it? Does he agree that it creates a disincentive for people who might not want to work full-time, but could still play a valuable role in the NHS?

Some 90% of respondents to the consultation argued against the fee rise, but the HCPC are going to press ahead with it. When Unison carried out a survey of its registered members at the end of last year, 99% did not support an increase in registration fees. Those large fee increases raise concerns about whether the HCPC is operating as efficiently as it could be, so when he responds, will the Minister comment on whether the HCPC represents value for money?

The HCPC has given a number of reasons for the proposed increase, including improving capacity and service in the area of fitness to practise, keeping pace with inflation, and costs associated with the impending transfer of the regulation of social workers to Social Work England this year. The HCPC became the regulator for social workers in 2012, and has had to invest in additional staff and accommodation to fulfil that role. The reasons why, four years later, the Government announced that they would be transferring the regulation of social workers to a new regulator are not clear to me, but it is unacceptable that HCPC registrants should effectively be paying the price for a political decision. Several Members mentioned that 73% of HCPC resources are spent on fitness-to-practise cases, and social worker cases account for 59% of that amount, so it seems reasonable to conclude that costs ought to decrease this year. In that context, it is incumbent on the Minister to see whether any justification can be put forward for the fee increase.

As my hon. Friend the Member for York Central mentioned, the Law Commission made recommendations back in 2012 that would have enabled regulators to become more agile, to modernise and to reduce the costs associated with fitness to practise. I recall the Conservative party signalling its intention to reform in its 2017 general election manifesto. As we know, the Queen’s Speech following that election did not include any reference to that legislation. Will the Minister indicate whether that reform will now see the light of day?

Does the Minister agree that the Government should accept responsibility for the lack of action on reforming healthcare regulation and for their decisions on social work regulation, which have had a negative impact on the HCPC? Will he do what he can to ensure that registrants do not pay the price for that failure? Our dedicated and hard-working NHS staff deserve better than that.

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care) 4:10 pm, 14th March 2019

It is a pleasure to serve under your chairmanship, Mr McCabe. Like everyone else, I congratulate Mr Cunningham on securing this debate. He made an impassioned speech that aired his campaign, which he has led with style and impact. The Health and Care Professions Council is one of nine UK-wide regulators. It performs an important role in the health and care sectors across all four countries of the UK, acting in patients’ and service users’ interest to ensure the professional standards we need to guarantee safety and quality.

Right at the start of my speech, I pay tribute to all the dedicated professionals who work in the professions governed by the HCPC. It is also right to respond to the Opposition spokesman, Justin Madders. He said, if I heard him correctly, that it was irresponsible of the Government not to intervene. There is an important point of principle here: the HCPC is independent of the Government. It is funded by registrants’ fees on a cost-recovery basis. It is therefore not the Government’s role to tell the HCPC what its fees should be. It is not a question of hiding or a lack of political will; it is a matter of law. As the hon. Gentleman knows, there is a mechanism for oversight of the HCPC, which is the Professional Standards Authority. It oversees the HCPC and its setting of fees.

It has been an excellent debate with lots of useful and informed contributions. I have been in a number of debates with Jim Shannon, and he spoke with his usual passion not only on behalf of the people of Strangford, but in the wider context as well. I want to pick up on what Liz McInnes said; I was listening carefully to her contribution. She is right that the vast majority of registrants have very little contact with the regulator between renewals of their registration. That may be a frustration and not seen as value for money, but from the other point of view, the HCPC’s largest expenditure is on delivering the fitness-to-practise function. It is therefore inevitable that it concentrates on the very small number of registrants whose performance or conduct has fallen below the expected level.

The key thing is the need for regulatory reform, which the hon. Member for Ellesmere Port and Neston was challenging me on a moment ago. We have recognised that regulators have inherited a complex and restrictive registration practice that is often bureaucratic and administratively burdensome. As he rightly pointed out, the four UK Governments consulted on proposals for reforming the legislative structure of professional regulation. That consultation finished last year.

The reforms that we are looking to make, and are still committed to, will shift the balance in professional regulation, freeing up the regulators to concentrate more on prevention and to work directly with registrants, rather than just on fitness to practise. I assure the hon. Gentleman that it is not our intention to hide that. We intend to bring it forward, and we will do so in the near future.

I was listening carefully to Rachael Maskell. She made a point about the need for registration and also for the system to be updated. The Government are committed to that. I also listened carefully to Liz Twist. She spoke with knowledge and mentioned a number of the fitness-to-practise cases she has been involved with. She was right to point out that the vast majority of those have been social care cases over a number of years. That brings me to a key point. A number of Members raised the issue of the HCPC’s costs potentially going down as a result of social workers moving out of that regulatory process. I have not looked at that in great depth, but it is highly likely that variable costs will decline for the HCPC. As a number of Members have pointed out, social workers make up the vast majority of the professions that are regulated—more than 25%—so there is an element of fixed costs. They are being helped by the establishment of Social Care England, and the costs are being met by the Government.

The HCPC currently regulates 16 professions. The hon. Members for Coventry South and for Ellesmere Port and Neston read out the list of professions, so I will not rehearse them all over again, but I reiterate my point: these valued professionals are performing crucial roles across the NHS and the wider health and care system. It is important that the public have assurance that those professionals are regulated. If they are regulated by the HCPC, the public knows that they are appropriately trained and hold the relevant qualifications and that they meet the expected standards of conduct, performance and ethics. Where a professional falls below these standards, it is important that the HCPC is able to protect the interests of patients.

I take the point made by a number of hon. Members that the HCPC currently has the lowest registration fees of any UK-wide regulator in the health and care professions. It is clearly not right to look at that in comparison with some of the more highly paid professions, but it is true that the current annual registration is lower than that for a number of others, such as nurses and midwives. I also take the point that the proposal is for a large, one-off increase, but there has not been an increase for two years, and the registration fees are tax-deductible, so the increase will amount to about £1 a month.

A number of Members mentioned the disparity between the fees that are payable by part-time and full-time staff. I have listened carefully to that argument, and I will write to the HCPC to ask it to look at that more carefully. That seems to me to be a fair point.

A number of Members raised points about the consultation. The legislation that founded the HCPC required it to consult on any fee increase. Accordingly, it ran a public consultation, to which it received 2,396 responses. Some 95% of those responses were from professionals whom it regulates. It also engaged extensively with professional bodies, trade unions and other bodies ahead of and during its consultation. The draft response to the fees consultation was published with the HCPC’s council papers of 14 February. It is right that 90% of the respondents did not support a proposed fee rise.

However, it is fair to note that the majority of respondents also wanted HCPC to invest more in prevention and improved services, in increasing capacity, and in improving the quality and timeliness of the fitness-to-practise services that it delivers. Everybody accepts that no fee rise is popular, but the HCPC has been clear that the principal reason for this one is to allow it to deliver the services identified by registrants in the consultation.

Photo of David Drew David Drew Shadow Minister (Environment, Food and Rural Affairs)

The Minister will have heard my earlier intervention. Will he assure us that he will ask for complete transparency and accountability, so that we know what the additional costs will go towards?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

I listened to the hon. Gentleman, and I will make a promise to him. As I pointed out at the beginning of my speech, it is not the Government’s role to tell the regulator how to set its fees or what to set them for. However, I see no reason why the Professional Standards Authority should not ask the HCPC to give that reassurance and to publish that information. I will write to the hon. Gentleman when I have spoken to the PSA to ensure that it can do that within its remit. Given that it has oversight, I am sure that that will be possible.

Photo of Liz McInnes Liz McInnes Shadow Minister (Foreign and Commonwealth Affairs)

It is my understanding that the changes to the HCPC rules will be subject to parliamentary approval. The Minister says that the Government will not be able to have any influence, so by what mechanism will the rule change be approved by Parliament?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

On oversight of the fee change, there is effectively accountability to Parliament through an order of the Privy Council. The Government will need to introduce an order of the Privy Council, which will be subject to the negative resolution procedure. The financial oversight is done by the PSA. The Government have to lay the order, but the oversight is done via the Privy Council.

As I said, there has rightly been much discussion this afternoon about the reason for the proposed fee rise. The HCPC makes the point that it has not raised its fees since 2015. It also rightly makes the point that the vast bulk of the fee rise is for the services that its registrants want. I promised to write to Dr Drew about that.

I thank the hon. Member for Coventry South for raising this issue. The debate has highlighted his campaign. I have no doubt that the HCPC and the PSA will have listened, and will take regard of this afternoon’s debate. I hope that my remarks, the promise I made to the hon. Member for Stroud, and my commitment to write to the HCPC will help the campaign of the hon. Member for Coventry South. I am clear that registrants should continue to benefit from a regulator that provides value for money and services to its registrants; I know that the PSA will ensure that they do so.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South 4:23 pm, 14th March 2019

I thank all Members who took part in the debate: my hon. Friends the Members for Heywood and Middleton (Liz McInnes), for York Central (Rachael Maskell) and for Blaydon (Liz Twist), the hon. Members for Strangford (Jim Shannon) and for Argyll and Bute (Brendan O'Hara), my hon. Friend Justin Madders, and of course the Minister.

I welcome the undertakings that the Minister gave. I realise that some of the national health service issues that were raised are above his pay grade; the wages and conditions of employees are really an issue for the Secretary of State, so I would not expect any undertakings from the Minister about them.

I very much appreciated the contributions made by Front Benchers and Back Benchers alike, and I hope that listening to them enlightened the Minister. It certainly enlightened me, because I have never been involved in the national health service or anything like it; I have been involved more in the engineering side of life and in industry. It is always useful to hear from hon. Members about their experience. More importantly, I also thank the trade union for the invaluable background information that it provided. Some colleagues are probably aware of the situations that it has highlighted, but others may not be.

The Minister gave an undertaking to my hon. Friend Dr Drew that he would talk to the Professional Standards Authority; if he sent me a copy of that communication, I would be very interested. I come from an industrial trade union background. We were always taught, “Just because you get a knock-back, it doesn’t mean you should give in. Pick yourself up, dust yourself down and keep campaigning until you get justice.” Once again, I thank everybody who participated in the debate.

Question put and agreed to.

Resolved,

That this House
has considered registration fees at the Health and Care Professions Council.

Sitting adjourned.