Health and Care Professions Council: Registration Fees

Part of the debate – in Westminster Hall at 3:59 pm on 14th March 2019.

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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.