Health and Care Professions Council: Registration Fees

Brendan O'Hara Excerpts

Thursday 14th March 2019 Westminster Hall

[Brendan O'Hara (Argyll and Bute) (SNP)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I, too, congratulate the hon. Member for Coventry South (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 the hon. Member for Strangford (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.

The hon. Member for Heywood and Middleton (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, the hon. Member for York Central (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 the hon. Member for Blaydon (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.

Budget Resolutions

Brendan O'Hara Excerpts

Tuesday 30th October 2018 Commons Chamber

[Brendan O'Hara (Argyll and Bute) (SNP)]

It is a pleasure to follow the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan), who, despite being on the wrong side of the line at the border, is always entertaining.

Despite the Chancellor’s rather dead-pan delivery of yesterday’s lengthy Budget, the simple truth is that not one of us can trust or believe a single word we heard. Whether on jobs, investment, tax cuts, austerity, extra funding for the NHS or universal credit, the truth is that the Budget is little more than a wish list cobbled together by someone seriously lacking in ambition. It is, none the less, a wish list of what the Chancellor would like if everything turns out the way he hopes it will in the Brexit negotiations. If those negotiations go pear-shaped—I reckon one would get pretty short odds on that being the case—he has admitted that we will all be back here in the spring for what he described, rather euphemistically, as a fiscal event.

In short, what we heard yesterday was, “This is what I’d like to do in an ideal world, but just don’t mortgage the farm on it happening because we have absolutely no idea how Brexit will turn out, and if it doesn’t go well, everything will be up in the air and we will have to do it all again before the clocks go forward.” The Chancellor basically admitted that his Budget will not be able to withstand Brexit. What a way to run a country. What a way to run an economy. Perhaps saddest of all, given that this was his best shot, what a paucity of ambition on the part of the Chancellor.

Anyone watching yesterday who had hoped for or expected the fulfilment of the Prime Minister’s promise of an end to austerity would have been left sorely disappointed. This Budget most certainly did not sound the death knell for austerity. Public sector workers, the low-paid, the disabled, the sick and those seeking employment will all still continue to bear an unfair share of the burden of austerity. Frances O’Grady, the general secretary of the TUC, was absolutely right when she said:

“This Budget does not undo the austerity that has devastated public services. And it lacks the investment needed to speed up wage growth after the longest pay squeeze in 200 years”.

Let no one be in any doubt that, 10 years on from the financial crash, austerity is far from over. The UK Government will continue to balance the books on the backs of the poorest, weakest and most vulnerable in our society.

[Luke Graham (Ochil and South Perthshire) (Con)]

The growth commission that was commissioned by the Scottish Government said that there would be 25 years of austerity if Scotland separated. How would Scotland balance the books then?

--- Later in debate ---

[Brendan O'Hara]

I refer the hon. Gentleman to the commission’s report and advise him to read it, rather than simply taking the crib sheet handed out by his party.

Much has been made of the Chancellor’s announcement that £20 billion of new funding would be made available to the NHS over the next five years. We are told that that funding will be transformational for the national health service, but let us put it into perspective. The new money, which we welcome, averages out at a 3.4% increase per annum for the next five years. That is actually still less than the average funding increases received by the NHS in the first 60 years of its existence. All the Chancellor announced is that NHS funding, having been squeezed mercilessly by the Tories in the past decade, is returning to a position that is a little below its historical average. The reality is that in releasing this money, the Chancellor has simply removed the Treasury’s heavy boot from the neck of the national health service. If the Chancellor had had the good manners to remain in the Chamber until my right hon. Friend the Member for Ross, Skye and Lochaber (Ian Blackford) had spoken yesterday, he would have heard him ask why the Scottish national health service is being short-changed in the Budget to the tune of £50 million a year, which makes a cumulative shortfall of £250 million over the five-year period. That £50 million is enough money to pay for 1,200 nurses in Scotland.

In his Budget, the Chancellor had the perfect opportunity to do the right thing: stop the roll-out of universal credit dead in its tracks until the well-publicised faults in the system, which are hurting the poorest and most vulnerable in our society, have been fixed properly, once and for all.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

Further to that point, is it not a scandal that the Highland Council has to fork out £2.5 million of its carefully hained resources to pay for the roll-out of universal credit? What might that £2.5 million have done for some of the poorest people in areas such as Argyllshire and my constituency?

[Brendan O’Hara]

I could not agree more. The hon. Gentleman is absolutely right to highlight the cost to councils and individuals of the appalling roll-out of universal credit. The Government know that it is wrong, but they are pigheadedly determined to see it roll out. The Budget was the Chancellor’s perfect opportunity to stop it, but he refused. For reasons best known to himself, he decided instead to tinker around at the edges, with the promised money coming nowhere close to meeting the shortfall that was created by his predecessor. The Chancellor has decided to do almost nothing for those who are currently on universal credit and are struggling under the work allowance, the two-child cap and the benefit freeze.

As Gillian McInnes, the manager of the citizens advice bureau in my Argyll and Bute constituency, said:

“The Government has still not done enough to address the real problems of universal credit, which are causing serious hardship for many families. Without further support for families, many parents and children will be left in a desperate situation, with many”—

indeed, many more—

“forced into using food banks.”

This was the Chancellor’s opportunity to end austerity—he chose not to. This was his opportunity to stop and fix universal credit—he chose not to. Instead, he and the UK Government chose to hand out tax cuts to the wealthy while continuing to try to balance the country’s books on the backs of the poorest in our society. Heaven help us all if this was the Chancellor’s “good guy Budget”—the one that was based on the Government securing a half-decent Brexit deal. One shudders to think what he has up his sleeve when we are all forced to reconvene in this place early next year for his fiscal event, if and when the Brexit negotiations go totally pear-shaped.

Surgical Mesh Implants

Brendan O'Hara Excerpts

Wednesday 18th October 2017 Westminster Hall

[Emma Hardy]

Absolutely; I will talk about that later. One of the women who wrote to me this week explained that her surgeon was worried about trying to remove a small piece of mesh from the heart of her vital organs, near her bowel and bladder, which he could not actually see by visual examination, ultrasound or X-ray. She explained that, since having the mesh fitted five and a half years ago, it has prevented her body from healing, causing ongoing problems ever since.

This is not an effort to scaremonger. For most, the surgery is successful, but we have estimates from the Medicines and Healthcare Products Regulatory Agency that about 1% to 3% of women suffer complications. A recent report in the scientific journal Nature showed evidence of about 10% of women suffering complications after surgery, and another research study estimates that the figure could be 15% to 20% or even higher.

[Brendan O’Hara (Argyll and Bute) (SNP)]

I thank the hon. Lady for calling this incredibly important debate. My constituent Nancy contacted me recently. She had a mesh implant fitted seven years ago, and her life and that of her family have been turned upside down. She is in constant, crippling pain. She needs tramadol, and when the tramadol has not worked, she has been in hospital for four days on morphine. Does the hon. Lady agree that this devastation for women and their families is absolutely intolerable and must never be allowed to happen again?

[Emma Hardy]

I completely agree. Sadly, that example is reflected across the whole UK. The Department of Health says that in the past 10 years 136,000 women in England were treated with mesh implants for urinary incontinence and organ prolapse, but it is only recently that NHS England has brought in guidelines that require surgeons to inform patients of the possible risks, and even now we do not have accurate information about just how many women are suffering complications after mesh implants. We know that mesh is the subject of international scrutiny, with legal cases in countries around the world, including Australia, Belgium, Canada, Israel, Italy, the Netherlands, the USA and Venezuela.

World Autism Awareness Week

Brendan O'Hara Excerpts

Thursday 28th April 2016 Commons Chamber

[Brendan O'Hara (Argyll and Bute) (SNP)]

I pass on my sincere thanks to the Chair for indulging me by calling me so early in the debate. I have to return home to attend to urgent constituency business this afternoon. I also congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan) on securing this very important debate.

As we have heard, autism is a spectrum condition, meaning that no two autistic people display the same characteristics. Some people with autism live relatively independent lives, while others, at the other end of the spectrum, might need a lifetime of specialist care and support. That demands that every single person living with autism be treated as an individual and that society affords each individual the respect and dignity they deserve. I have no doubt that we, as a society, aim to do that, but the question is: do we actually do it?

I recently met the National Autistic Society at the launch of its “Too Much Information” campaign, designed to help people recognise autistic behaviour and better understand how they should respond to it. It is an excellent report. It sometimes makes for uncomfortable reading, but I commend it to all Members. In it, the society published figures from a wide-ranging survey it had commissioned to look at public attitudes towards those living with autism. Its findings suggest that we, as a society, have a long way to go in affording people living with autism the respect and dignity they deserve.

Although almost every person in the United Kingdom had heard of, or was aware of, autism, only a fraction actually recognised what it meant. There is a chasm between public awareness and public understanding of autism. It is this lack of public understanding that causes great distress for those living with the condition and their families. The right hon. Lady has given us some of the findings, but they are worth repeating: 87% of parents had experienced people stopping and staring at their children while they were displaying autistic behaviour and 74% had experienced public expressions of disapproval at their children displaying autistic behaviour. Importantly, the NAS also spoke to people living with autism, and what it discovered was pretty depressing: 84% of people living with autism felt they were judged by the rest of society as being “strange”.

[Jo Churchill (Bury St Edmunds) (Con)]

Would the hon. Gentleman agree that that reaction to people in our society with autism and their families leads to a fear of going out, as my constituent Maureen said, which, particularly for autistic children transitioning into adulthood, can in turn lead to social isolation for them and often their primary carer, which is not adequately recognised across the piece?

[Brendan O'Hara]

The hon. Lady is absolutely correct, and it is something I will touch on in a moment.

Nearly 70% of people living with autism believe that the public see them as antisocial and almost one third have been asked to leave a public place for displaying behaviour associated with their condition. As a result, as the hon. Lady just alluded to, four in every five people living with autism in the UK feel isolated from society and half do not go out for fear of how people will react to their condition. As I said, those statistics make for pretty depressing reading and should force us all to look at our behaviour and question what we are doing, as a community, to our fellow citizens that makes them prefer social isolation to the way they are treated by the public, ourselves included.

It is not all bad news, however, as the NAS report also contains some good news. Its research shows that with greater knowledge and better understanding, the general public will behave with much greater empathy towards autistic people.

[Roger Mullin (Kirkcaldy and Cowdenbeath) (SNP)]

One piece of good news is that many areas of Scotland are blessed with specialist speech and language therapists who well understand the condition and give particular support in schools, for example, to those with communication challenges.

[Brendan O'Hara]

I thank my hon. Friend, who is a specialist in this area, for his intervention, and I commend the great work done throughout Scotland—and, I assume and hope, the UK—in that field.

As I say, there is much to look forward to and to be hopeful about. We have to get the key messages out to the public, and those key messages are: people with autism might need extra time to process information and respond to people; people with autism can become anxious in social situations; people with autism can become anxious when faced with unexpected changes or unscheduled events; people with autism can often be hyper-sensitive to noise, light, smell or colour; and, you know what, when things get too much, people with autism can have a meltdown. Deal with it!

To conclude, I will quote from the Scottish Government’s autism strategy. Their vision is

“that individuals on the autism spectrum are respected, accepted and valued by their communities and have confidence in services to treat them fairly so that they are able to have meaningful and satisfying lives.”

That is something around which the entire House can unite.

Contaminated Blood

Brendan O'Hara Excerpts

Tuesday 12th April 2016 Commons Chamber

[Dr Paul Monaghan (Caithness, Sutherland and Easter Ross) (SNP)]

One of my first actions, following my election to this place, was to highlight the plight of those infected with contaminated blood in the 1970s and 1980s. I did this by writing to the Department of Health, following discussions with Julie, a constituent of mine. In July 2015, I also tabled early-day motion 334 to recognise

“the ongoing hardship and challenges faced by those infected with contaminated blood”

and to encourage

“the Prime Minister to implement promised arrangements to distribute an additional £25 million to those affected as soon as is practicable.”

Infected blood is one of the most terrible chapters in the history of the NHS. Many people have died or suffered long-term disability and hardship as a result of infection. Relatives have had to sacrifice careers to provide care and support, and in some cases partners and loved ones have become infected. Patients, families and carers have dealt with those difficulties with immense and enduring courage. My constituent Julie was born with a rare genetic condition known as Ehlers-Danlos syndrome, which requires treatment, including blood transfusions. She was infected with contaminated blood in 1974—42 years ago—while a young woman with her whole life ahead of her. Following a transfusion that September, she quickly developed symptoms of hepatitis and suffers today from a range of chronic and debilitating health conditions that have rendered her unable to remain upright for longer than 10 minutes at a time without becoming fatigued, owing to liver and lung damage arising directly from the transfusions.

Although now living in Scotland, Julie was infected in England. The liability for the current ex gratia schemes is based on where the individual was infected, rather than residency. This means that the English schemes and the consultation recently launched by the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), are responsible for supporting Julie and delivering the financial support she will require.

Julie is currently classed as Skipton stage 1 and has received an ex gratia payment of £20,000 but receives no annual award. Her medical condition means that she has great difficulty meeting the qualifying criteria for stage 2, which would increase her ex gratia payment and provide approximately £15,000 per annum in badly needed support. I have reviewed her correspondence with the Skipton Fund on the reassessment and have found it unhelpful, perhaps even deliberately obtuse.

[Brendan O’Hara (Argyll and Bute) (SNP)]

I thank my hon. Friend for giving me the opportunity to raise the case of my constituent Susan Webster who lost her partner, Charlie, almost five years ago, after he contracted hepatitis C as a result of contaminated blood, leaving her and their now 14-year-old daughter without any financial support. Since Charlie’s death, Susan and her daughter have received little or no Government help and have had to approach the Skipton Fund themselves. Today, they remain in a state of limbo while the Government dither over the future of the UK scheme. Does he agree that the Government, having dragged their heels for years, must now act to support the survivors of this scandal without any further delay?

[Dr Monaghan]

I absolutely agree with my hon. Friend. It is a tragic case that he outlines, and I will come to his specific point shortly.

On 21 January 2016, the Health Minister stated that the UK Government wanted to increase the amount of money on offer for victims of infected blood by £100 million, in addition to the £25 million announced in March 2015 by the Prime Minister. This takes the total to £225 million over the five years to 2020. As we know, there is a 12-week consultation on these proposals that closes this week, on 15 April. However, the proposed payment schemes have been heavily criticised by many of those affected for being outdated and confused in structure. That is my experience of them too. They also appear unfair.

The UK Government have estimated that the Department will spend a further £570 million over the projected lifetime of the reformed scheme, but analysis shows that the Department wants to cap annual payments for victims in England at £15,000 and that these will no longer be index linked and so will not increase with the cost of living. The UK Government also want to remove regular discretionary payments, including the winter fuel allowance and the £1,200 per child annual payment.

Dementia and Alzheimer’s Disease

Brendan O'Hara Excerpts

Tuesday 12th April 2016 Westminster Hall

[Brendan O'Hara (Argyll and Bute) (SNP)]

I congratulate my ever-industrious friend who secured this important debate, the hon. Member for Strangford (Jim Shannon).

Regardless of where any of us live in these islands, I am sure we agree that, from the point of diagnosis until the end of life, every person living with dementia deserves nothing less than the best care society can provide. In Scotland approximately 90,000 people are living with dementia, about 2,000 of whom live in my constituency. There is barely a family who have not been affected by that awful disease. Indeed, there is probably not a person in the Chamber who has not been affected by the illness. Yet all too often those who suffer from dementia are stigmatised and discriminated against, because their symptoms are sometimes difficult to handle, so they are sometimes treated with less respect and dignity than other members of society. That is unacceptable and must change.

I am delighted that the Scottish Government have made tackling dementia a national priority and that since 2008 they have funded the Scottish dementia clinical research network, which has brought together academics, clinicians, carers and people living with dementia, with the aim of turning scientific discoveries into safe and effective treatments. That collaborative approach is to be commended. Since coming to power, the SNP Government in Holyrood have put those living with dementia, and those who care for them, at the heart of their policy making. In 2011 they published the standards of care for dementia in Scotland, which gave people suffering from dementia guaranteed rights—the right to a diagnosis; the right to access to a range of treatments, care and support; the right to be regarded as a unique individual and treated with dignity and respect; the right to be as independent as possible and to be included in the community; the right to have carers who are well supported and educated about dementia; and the right to end-of-life care that respects the wishes of the person concerned.

I applaud the Scottish Government for the great work they are doing, but it is important to recognise that it would not all be possible without an army of people committed to caring, and to making and implementing policies. Scotland is blessed with a volunteer corps and carers who make that possible. In Argyll and Bute 2,000 people are living with dementia. A couple of months ago I was privileged to be invited to open, in my home town of Helensburgh, the brand new Alzheimer Scotland dementia resource centre, which has taken dementia care—figuratively and literally—from the back and side streets on to our high street. Our community now has a central hub, where people trained to provide support and education are constantly available. There is a drop-in centre, a performance area and a café, as well as space for individual and group therapy. It is a wonderful resource and I congratulate Alzheimer Scotland and its staff on achieving so much and making that happen—particularly Susan Russell, the service manager, and Jean Armitage, the policy and engagement manager. We know that dementia is a growing problem and that we have to tackle it; but let us not forget that there are already wonderful people making things happen in the community.