Nurses and Midwives: Fees

Debate between George Freeman and Philip Hollobone

Monday 23rd March 2015 Westminster Hall

[George Freeman]

The hon. Gentleman makes a really good point; I was trying to make a similar point myself. We have encouraged the NMC and made it easier to speed up its processes. Anecdotally, I know from speaking to nurses and midwives that there is a lot of frustration about the slow pace of basic procedures, such as getting registration and coming back to the profession.

My hon. Friend the Member for Congleton (Fiona Bruce) cogently and clearly told the story of one of her constituents, a nurse, and spoke about the bureaucratic and clumsy registration processes. There is a common message for the NMC: it has a £70 million budget, so it ought to be able to run a less inefficient, quicker organisation and direct resources away from bureaucracy and towards dealing with fitness to practise, in which there is likely to be a growing public interest. It is good that the public want to drive up standards and be clear about patient safety across the professions.

On the issue of revalidation, we believe that nurses and midwives have some of the most important jobs in the NHS. They care for patients every day, so it is crucial to ensure that they are up to speed with the standards that the public and patients expect. We support the NMC in its drive to introduce revalidation, which will improve safety and the quality of care. It will reassure patients that nurses remain fit to carry out their vital work.

The challenges of the serious debt and structural deficit inheritance that we as a society are confronting mean that everyone in our public services has to deliver more for less within the current financial constraints and to ensure that standards continue to improve. Across our public services—indeed, across our general economy—there are extraordinary levels of productivity gain day in, day out. The general economy runs at 2% to 3% productivity growth every year with its eyes shut. The challenge is to create in the public sector the right climate and leadership conditions so that our great public servants can deliver similar productivity.

That said, we recognise the importance of the level of the NMC registration fee to all its registrants, which is why the Government have assisted the NMC to introduce rules that will allow registrants to pay their registration fee in instalments. Those rules came into effect on 9 March, and they enable the front-line nurses and midwives who have to pay the £3 extra fee to schedule payment of the total £120 annual fee across the whole year.

To maintain the NMC’s independence from the Government, its registration fee must cover the full costs of its regulatory activity. I am sure that nobody in any corner of the House believes that we should downscale or curtail the quality of that regulatory work merely on the basis of members’ unwillingness to pay. The principle is that health care professionals should fund the regulation of their profession to maintain the confidence of the public and patients. However, it is for the NMC to decide how to meet its statutory functions and protect patients and the public, which is our paramount consideration. The NMC recognises that it needs to do more to maintain the confidence of registrants, patients and the public in its performance, and to continue to improve its operation, effectiveness and efficiency.

I am grateful for the chance to correct the record and clarify that the Government are prioritising the lowest-paid workers in the NHS; we applaud and support their commitment. I want to take this opportunity to reaffirm the Government’s gratitude, thanks and support for their work. Despite the difficult funding constraints, in this Parliament we have consistently supported the lowest-paid workers in the NHS, rather than the best-paid, and we have reflected that in the latest pay settlement.

At the heart of this measure are some important points that need to be reiterated. There is a long-standing convention that health care professionals pay their own professional registration fees. The reform will increase the registration fee paid by nurses and midwives, whose average salary is £31,000, by £3, against their annual registration fee of £120. The Government have given the NMC a £20 million grant to help to offset those costs. The NMC has made it clear that it is able to pay for a substantial element of the increases through its ongoing efficiency programmes. The principal driver of cost is the growing public interest in fitness to practise and the cost of handling such cases. We are helping the NMC, not least by helping it to deal with those cases much more quickly, as the hon. Member for Easington highlighted.

We should not hold back the public’s interest in fitness to practise. It is part of a new culture of transparency and accountability across the system, post the Francis report, and the Secretary of State and many others want to encourage it in the modern NHS. The NMC is an independent statutory body that is accountable to Parliament, not Ministers.

I welcome the chance to inform the debate, particularly for NMC workers and for the many nurses and midwives who have taken the time to sign the Government’s e-petition form and, through the Backbench Business Committee and Members in the Chamber, to bring this issue to the Floor of the House. We as Ministers are very aware of the needs of the lowest-paid NHS workers, who do an extraordinary job for us. That is why, in the latest pay deal, we reflected that, with a 5.6% increase for the lowest earners and a 1% pay rise, which equates to £300 in the pockets of the nurses and midwives we are talking about.

The measures in the Budget and the Chancellor’s wider tax reforms, such as raising the tax threshold for the lowest-paid workers, will take more than 4 million of the lowest-paid workers out of tax altogether. The lowest-paid nurses and midwives are now £900 a year better off as a result of the increase of the personal allowance to £11,000. That is a substantial sum, compared with the £3 fee increment. The hon. Members for Denton and Reddish (Andrew Gwynne) and for Blaydon are eloquent and persuasive men, but even they cannot suggest that a £3 fee on health care professionals earning £31,000 represents a crisis in the NHS. They rightly said that it is important that the NMC quickly develops its efficiency and upgrades its internal mechanisms, and they made a number of interesting points about how that can be done to maximise fairness for the lowest-paid workers. I want to take the opportunity to repeat that the Government are absolutely on the side of those workers.

[Mr Philip Hollobone (in the Chair)]

It was a real treat for me to have been in the Chair to hear the Minister’s response, but a great misfortune not to have been in the Chair to have heard the introductory remarks of the hon. Member for Blaydon (Mr Anderson). As recompense, he now has two or three minutes to pithily sum up the debate, largely for my benefit.