Nurses and Midwives: Fees

Baroness Ritchie of Downpatrick Excerpts

Monday 23rd March 2015 Westminster Hall

[Mr David Anderson (Blaydon) (Lab)]

I beg to move,

That this House has considered the e-petition relating to proposed increase in fees for nurses and midwives.

It is a great privilege to serve under your chairmanship today, Mr Havard. I thank hon. Members for coming to this serious debate, and I thank my colleagues on the Backbench Business Committee for agreeing to it. I also thank the various trade unions and representative organisations in the national health service that have provided support and given me background material for the debate.

I start by reading out the petition and thanking Mr Stephen Iwasyk and the other 113,795 people who signed it, demonstrating their interest and concern about this vital issue. The petition states:

“We would like the Government to Review the Nursing and Midwifery Council (NMC) with regard to the fees charged to registered nurses and midwives, and the processes through which those fees are decided. The Nursing and Midwifery Council (NMC) recently discussed a further increase in registration fees for Nurses and Midwives from £100 to £120. The fees were increased 2 years ago from 76 to 100 following a consultation that was overwhelmingly against the rise. The NMC are, of course, obliged to consult before any further rise. However 96%+ of individuals voted against the rise last time. The Health Committee in their report earlier that year said ‘We would urge the NMC to avoid further fee rises and to consider fee reductions for new entrants to the register.’ Approximately 670,000+ Nurses and Midwives contribute £67+ Million annually to the NMC. Please sign the petition to encourage a review of the NMC and the charging of annual fees to Nurses and Midwives.”

I am grateful for the opportunity to debate an important issue that faces many of our constituents who are nurses and midwives. The petition, which had reached 113,796 signatures by the time it closed in February, relates to the proposal of the Nursing and Midwifery Council to increase registration fees for all 670,000 nurses and midwives by almost 60% in two years. The e-petition opposed the proposed fee increase and called for a general review of the NMC, and a review of the charging of annual fees to nurses and midwives.

[Ms Margaret Ritchie (South Down) (SDLP)]

I congratulate my hon. Friend on securing the debate. Does he agree that there is an urgent need for the Government to enter discussions with the Nursing and Midwifery Council with a view to reducing fees, in order to sustain the profession and keep people in it?

[Mr Anderson]

That is absolutely what the debate is about. I will point out some glaring worries that have been described to me about the capability and the effectiveness of the NMC. It is not that people do not want to pay a subscription fee; people are forced to pay a fee to be registered, and if they do not pay it, they cannot work. If they cannot work, obviously, they will not make money. The question is whether they get value for money. I am pleased that my hon. Friend the Member for Easington (Grahame M. Morris) is here, and I hope that he will talk about the findings of the Select Committee on Health, which published a report a couple of years ago that was—to put it mildly—quite critical of the NMC.

I will provide some background about what the NMC stands for, what its objectives are and why it proposed a fee increase. I will explain why the NMC fee increase was so strongly opposed by the overwhelming majority of nurses and midwives. The reasons for that opposition included the NMC’s historically poor financial oversight and management, which was highlighted in a damning report by the Council for Healthcare Regulatory Excellence in July 2012. The council criticised the NMC’s lack of focus on preventive measures to reduce fitness-to-practise referrals, the real-terms pay cut imposed by the coalition Government on hard-working nurses and midwives and the catastrophic impact that a fee increase would have on workplace planning. Finally, I will talk about the impact of future fee increases on nurses and midwives and on the care that patients will receive.

Despite heavy opposition from professional bodies and trade unions representing registrants’ views, the NMC chose to increase fees, effective from the end of last month. I want to talk about how fees could be reduced, which comes back to the point made by the hon. Member for South Down (Ms Ritchie).

--- Later in debate ---

[Mr Anderson]

My hon. Friend makes a valid point, which again comes back to what the review can look into: whether members are getting value for money. That is what we are talking about here. The NMC might think, “If we need more money, we can get it because they have got no option other than to pay.” It can hold people to ransom and, unfortunately, that is what it is surely doing. That is clear, because it has ignored the legitimate claims of those who have said, “Please, give us some relief here.” It appears that those people were told, “We’re going to ignore you, anyway.”

During a time of continued pay restraint for hard-working nurses and midwives and ever-increasing costs of essentials such as child care, household bills and everyday items, the proposed fee increase left many registrants feeling that that was yet another attack on their standard of living.

[Ms Ritchie]

My hon. Friend is making a good point. By and large, the NMC’s members are women and some of them are in part-time employment. Does he agree that the disproportionate payment to the Professional Standards Authority for Health and Social Care will have an adverse impact on equality and could infringe equality regulations?

--- Later in debate ---

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Havard; regrettably, it may well be for the last time in this Parliament.

I congratulate my hon. Friend the Member for Blaydon (Mr Anderson) on securing this debate and the Backbench Business Committee on allocating the time. It is on an important issue, and the reason I wish to participate in it is because I serve on the Health Committee and we have looked at this issue on a number of occasions as part of our annual accountability hearings. Indeed, we produced a report, which my hon. Friend referred to; it was the fifth report of Session 2013-14, and the reference is HC 699. It is an excellent piece of work. The Committee went into some detail, covering many issues mentioned by my hon. Friend the Member for Blaydon and making recommendations about how best to proceed.

I do not want to repeat the arguments, but it might be useful to put into context the report and the concerns that have been raised. Constituents of mine who are nurses and midwives have written to me individually, quite apart from the petition. I think many hon. Members throughout the country have had similar representations.

There is an issue about fairness in respect of this considerable increase in fees, and about how the increases have come about. There is also an issue about whether those who are required, by the nature of their employment, to be registered should be placed into financial hardship, as has happened in some cases, particularly with women returners who are working limited, part-time hours. We all agree with registration, to maintain public confidence and trust in the nursing profession. However, there is an issue about whether some allowance should be made for them, in terms of a reduction in their fees.

As my hon. Friend indicated, the nursing and midwifery professions are among the oldest established and longest regulated professions in the United Kingdom, with regulation taking many forms over the last century. The current regulator, the Nursing and Midwifery Council, which has given evidence to the Health Committee, has been in operation since 2002. As we have heard, it is the statutory regulator for more than 670,000 nurses and midwives. The £67 million figure relating to its income is an old one, because it now receives more than £70 million.

In 2011, the Health Committee began holding annual accountability hearings in relation to the Nursing and Midwifery Council. Prior to that, our concentration was essentially on the regulation of the medical profession, with the General Medical Council. We have since widened the scope of the annual accountability hearings. In its report on the first annual accountability hearing with the Nursing and Midwifery Council, the Committee expressed concerns

“about the affordability of the registration fee”.

This has not just popped up: we have identified it as a trend since 2011. In that report, the Committee urged the Nursing and Midwifery Council

“to avoid further fee rises and to consider fee reductions for new entrants to the register”.

However, there have been fee rises since then. When I was first elected, the fees were £76 and they increased to £100 in February 2013. The further rise to £120 a year—that would probably account for the increase in revenue—would mean a 52% fee increase, at a time when nurses and midwives are experiencing severe and unsustainable pay restraint. These problems are further compounded by the decision of the Government and the Secretary of State for Health to veto the 1% NHS pay rise, denying a pay increase to 70% of nursing staff and ignoring the view of the independent pay review body. I want to place on record that the incredible work and effort of our nurses and midwives is of great value, and I want to say how much that is appreciated throughout the country.

[Ms Ritchie]

My hon. Friend is making a compelling case for the career position of nurses and midwives. Does he agree that the Nursing and Midwifery Council, as well as the Government, should be encouraging people into the profession, rather than providing disincentives, discouraging them from joining it and from training for such vital roles that will benefit all within the wider community?

[Grahame M. Morris]

I agree wholeheartedly. All across the country—certainly in my area—efforts are made, and have been made consistently, to recruit good quality staff. Often recruitment is done overseas, with adverts being placed in newspapers in countries that train good quality nurses and midwives, but have a surplus. It often strikes me as bizarre that although we have a reservoir of women returners, we not making it as easy as possible for them to return. Doing that would be in the interests of the service and of the country. It would be a false economy to continue doing what we are doing.