Nurses and Midwives: Fees

Debate between Grahame Morris and Alan Meale

Monday 23rd March 2015 Westminster Hall

[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.

[Sir Alan Meale]

I am here today because my sister is a midwife and has been a nurse all her adult life. This is not just about times of restraint and restrictions on pay; there has also been a thorough re-grading of the whole nursing and midwifery system throughout the UK, which has already re-graded many nurses to lower grades than previously. They are experiencing a double whammy, and this is the third time they have been hit with a fee rise. We should not approve it.

[Grahame M. Morris]

I am grateful for my hon. Friend’s intervention. That is another excellent point, well made. Pressures are being placed on the NMC, including increases in its costs, that are placing a greater strain and burden on nurses and midwives. The Government have to recognise that. I know that my hon. Friend the Member for Blaydon has reservations about whether the Government supporting the NMC with one-off grants would impact on its impartiality. I do not think that should necessarily follow. We should recognise the considerable pressures being placed on it financially, not least those arising out of public concerns and the recommendations of the Francis report. We want the public to be confident that the profession is properly regulated and that the fitness-to-practise procedures are operating properly and effectively. However, I agree with my hon. Friend. There was a ministerial statement last Thursday regarding untoward practices highlighted in a report, including bullying of staff and so on, in a hospital in east London—I think it was the Barts Health Trust. If fitness-to-practise referrals are being used by employers in that way, it is reprehensible and is adding to the strains and pressures on the NMC.

The latest fee increases are being imposed on nurses and midwives who were extensively consulted about them. My hon. Friend mentioned the overwhelming numbers: 96%—many of us would be over the moon to have that as a vote of confidence in the general election—voted against those recommendations. However, it seems that the consultation served little purpose, other than to antagonise nurses and midwives, because the Nursing and Midwifery Council has, apparently, taken little or no regard of the views of NHS staff and has pressed ahead with the fee increase.

The Nursing and Midwifery Council has also failed to provide any assurances that the latest increase will not be followed up by further increases in coming years. As my hon. Friend the Member for Mansfield (Sir Alan Meale) mentioned earlier, if we are to encourage people to come back into the profession, they have to know that the regulator has a reasonable, cost-effective process in place. The Nursing and Midwifery Council stated in evidence to the Health Committee last year that it had introduced an

“annual formal review of the fee level”,

so it is not necessarily an ongoing commitment. However, we have to ask: why has there been such a huge increase, of more than 50%, in a relatively short period?

Clearly the Nursing and Midwifery Council must meet its statutory obligations. We would expect that as Members of Parliament—and the public would certainly expect that—for maintaining professional standards. Certainly more needs to be done to remove the constraints it faces through the fitness-to-practise process—a number of hon. Members have highlighted that—which is too costly. Seventy-seven per cent of the Nursing and Midwifery Council’s income of more than £70 million is being spent investigating less than 1% of the nurses and midwives on the register. That is an incredible sum of money, and I find it difficult to comprehend how that can be an efficient use of resources.

The Nursing and Midwifery Council is making progress—I recognise that, and certainly the Committee recognised it, although it said it thought the progress was “fragile”. The NMC recognises past failures—not least in IT systems—and is seeking to overcome some of them, but it is clear that further improvement is required. An assessment by the Professional Standards Authority for Health and Social Care—the organisation that oversees all the professional regulators—has found that the Nursing and Midwifery Council is failing to meet seven of the 24 standards of good regulation. By any measure, I would suggest that there is still a long way to go in bringing it up to standard. Of those seven failures, two relate to fitness to practise.

While it is important that improvements continue to be made, it is wrong to expect nurses and midwives to bear the burden of the costs by themselves, particularly when we have seen the value of their pay fall in real terms over the life of this Parliament. The Government cannot sit idly by and allow continual increases in fees without taking action or giving some guidance. We hear Ministers time and again praising the hard work and dedication of nurses, and I hope the Minister will do that at the conclusion of the debate. Nurses do an amazing job in the most difficult circumstances, but when it comes to pay, pensions or professional fees, the kind words of Ministers seem to be rarely followed up by practical action that would help NHS staff.

In conclusion, I hope the Minister will say what steps he is taking to support the Nursing and Midwifery Council to ensure that it can continue to drive through the improvements we all want to see without having to increase the fees and the cost of employment for nurses and midwives. I also hope that he will address the points made by my hon. and right hon. Friends on the need to speedily bring forward the law commissioners’ sensible and well thought out proposals on the NMC. I would be interested if he could explain why they have not been brought forward before now.