Health and Care Professions Council: Registration Fees

David Drew Excerpts

Thursday 14th March 2019 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I am grateful to my hon. Friend the Member for Coventry South (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.

[Dr David Drew (Stroud) (Lab/Co-op)]

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.

[Liz McInnes]

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.

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[Rachael Maskell]

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 the Member for Heywood and Middleton (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.

[Dr Drew]

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?

[Rachael Maskell]

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?

--- Later in debate ---

[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Mr McCabe. Like everyone else, I congratulate the hon. Member for Coventry South (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, the hon. Member for Ellesmere Port and Neston (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 the hon. Member for Strangford (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 the hon. Member for Heywood and Middleton (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 the hon. Member for York Central (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 the hon. Member for Blaydon (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.

[Dr Drew]

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?

[Stephen Hammond]

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.