Health and Care Professions Council: Registration Fees

Jim Cunningham Excerpts

Thursday 14th March 2019 Westminster Hall

[Mr Jim Cunningham (Coventry South) (Lab)]

I beg to move,

That this House has considered registration fees at the Health and Care Professions Council.

You and I have known each other a long time, Mr McCabe, but I think that this is the first time I have led a debate under your chairmanship. I hope you will show a bit of leniency, particularly to some of my hon. Friends. I thank Mr Speaker and the Chairman of Ways and Means for making provision for the debate. In actual fact, we were granted the debate at short notice; I think somebody else pulled out. Hon. Members will have to excuse me—I have a heavy cold, to say the least. I hope they can all hear me.

The debate follows on from early-day motion 2069, which I tabled last month and which condemned the Health and Care Professions Council’s unfair rise in registration fees. To date, that early-day motion has been signed by a truly cross-party group of 118 MPs, which shows the real concern across the House; it is very hard to get such a number. I hope that the debate leads to a rethink from the HCPC and the Government.

The HCPC exists to regulate health and care professionals. It sets standards, investigates complaints and keeps a register of workers in 16 different professions. Members might be interested to know what those professions are: arts therapist; biomedical scientist; chiropodist and podiatrist; clinical scientist; dietician; hearing aid dispenser; occupational therapist; operating department practitioner; orthoptist; paramedic; physiotherapist; practitioner psychologist; prosthetist and orthotist—I do not know what those are-radiographer; social worker, in England; and speech and language therapist. That covers quite a wide range, to say the least. Notably, social workers in England are still covered, despite plans to change that from 2019. Altogether, the HCPC regulates more than 360,000 professionals, 90,000 of whom are social workers.

To register, professionals have to pay an annual registration fee, which is currently £90. In autumn last year, the HCPC announced plans to raise its registration fees from £90 to £106 per year—an 18% rise. That follows a 5% rise in 2014 and a further 12.5% rise in 2015, so with the new rise fees will have risen by 40% since 2014. The HCPC argues that the rise is necessary in order to secure its financial health, giving five main reasons for the fee increase.

First, it plans to increase efforts to prevent problems before they occur. Secondly, it wants to use innovation and technology to modernise and improve services. Thirdly, it needs to address a caseload that is growing in number and complexity. Fourthly, it needs to address the impact of inflation since its last fee increase. Finally, it needs to pre-empt the transfer of social workers to a new regulatory body. While the HCPC has faced higher expenditure since 2015, these reasons cannot possibly support an 18% rise. Expenditure increased by £2.8 million in 2017-18, but £400,000 went on redundancy packages for management staff and £1.2 million went on refurbishing the HCPC head office.

The HCPC put its plans for a fee increase to its members over the winter. Responses to the consultation were damning, with 90% of respondents opposing the increase. Despite the findings of the consultation, the HCPC decided last month to impose the 18% increase. It has defended the rise by saying that its fees are lower than those of any other health and care regulator. However, other regulators are not comparable. Some cover very few members, reducing their economies of scale.

[Mike Hill (Hartlepool) (Lab)]

My hon. Friend is making an excellent speech. Of course, this issue affects not only the HCPC’s but other registrants, such as nurses, who have to register with the National Midwifery Council. Does he agree that, along with other things, such as car parking charges, low pay and no automatic incremental progression in a lot of health-related occupations—particularly for nurses—these kind of registration fee increases are just another tax on healthcare workers’ wages?

[Mr Cunningham]

In considering that, we have to remember that a lot of those workers’ salaries—for want of a better term—have in some instances been frozen since 2010, while in some instances they may have increased by 1% or 2%. With inflation at about 2% over that period, that is roughly an 18% cut in wages. Add the increased fee, and those workers are carrying a heavy burden that they should not have to carry. Adequate funding should be provided, rather than finding it by using hidden taxation methods. We all know that nurses and so forth in some of our hospitals have to pay car park charges. Given all those hidden costs, these workers are quite frankly bearing the brunt of the recession.

[John Howell (Henley) (Con)]

A lot of these organisations have always said that they want to keep their independence and do not want to be funded by other sources; they are pretty keen on making sure that that continues. Is the real issue not the amount of regulation that they have to deal with? That must be one reason why the funding level has increased.

[Mr Cunningham]

Organisations always argue that they want to be self-sufficient, but that should not come at the expense of the people whom they actually regulate. I am not an expert on the regulations that some of these bodies govern, but we should be very careful when thinking about changing regulations or reducing their amount. We would need to test that.

Altogether, the HCPC has not given a strong reason for this huge increase, leaving affected workers frustrated and angry. In addition, the Government’s response to the fee change has been very disappointing: in answer to written questions, they have just repeated the HCPC’s weak defence of the fee rise. Ministers have argued that the registration fees remain the lowest of any health regulator, but that does not change the fact that the rise is disproportionate and unfair. The Government should be concerned over the threats to staff levels in the affected professions, but Ministers say they have made no assessment of the impact on staffing of this rise. That is a complete dereliction of duty, with staff openly talking of leaving due to the rise.

It is an irresponsible move by the Government to hide behind the HCPC’s independence. They must take steps to prevent fee rises from being the norm for the HCPC, and for all regulators, and help to build bridges between healthcare professionals and the HCPC, as trust is breaking down. HCPC members are understandably angry, believing that it is exploiting a stranglehold over their jobs. The rise amounts to nothing less than a tax on practising, and it has had little scrutiny or debate. I would like the HCPC to reverse the decision to increase registration fees by 18%. The Government and the HCPC must change the way fees are decided on, to prevent such a huge change happening in the future. The HCPC must operate in a fairer and more transparent way, and the Government must play a role in ensuring that that happens. It is time that the Government and the HCPC stopped taking advantage of those who take care of us all.

In response to the rise in fees, Unison conducted a survey of affected members and found that 99% of respondents did not back it. Importantly, it found that 76% did not see the current £90 fee as good value for money. Members feel that the HCPC offers no real benefit except for allowing them to practise. They are also critical of the justification given by the HCPC for the fee rise.

First, it must be pointed out that the 18% rise completely outstrips inflation. If the HCPC was genuinely concerned to cover inflation, it could implement smaller, year-on-year rises. I doubt whether the staff could afford those, frankly, but it is one way to look at it. Secondly, it is unfair for members of other professions to cover the costs of transferring social workers to a new regulator. The HCPC faces upheaval because of the change, but it is wrong for other professionals to pay the price.

Thirdly, the case for needing more funding after the transfer of social worker regulation is dubious. Social workers make up a quarter of members, which is a substantial number of registration fees. We all know what a difficult job they do. Often they are put in a situation where they cannot win, and they bear the brunt of some of the ills of society, to say the least of it. However, they also account for more than half of all fitness to practise cases. That is the HCPC’s largest area of expenditure. Despite a loss of income, the HCPC will face a sharper fall in costs at the same time. That fundamentally undermines the case for an 18% rise, and proves that it is unnecessary.

Unison also highlighted several changes that the HCPC should implement to reduce spending. First, it must take steps to make its complaints process more efficient. The Professional Standards Authority for Health and Social Care found in 2018 that the HCPC’s investigation committee refers cases too readily to the fitness to practise panel and that more than 20% of complaints are found at final hearings to be “not well founded”. Overall, members are funding a system that handles complaints against 0.64% of registrants and sanctions just 0.09%. No wonder so many members are left feeling that they gain nothing from their registration.

The fee rise comes on top of many years of wage freezes and below-inflation wage rises. Although £106 might not sound much to the Government or to some higher-earners in the health sector, the rise will be a real hit to part-time workers and those on lower wages. Professionals are left doubting their trust in the HCPC after being ignored in the consultation. The HCPC is facing growing unrest and resentment among its members. Many are now moving to non-regulated posts, and part-time working will become a lot less attractive, inevitably causing a fall in the number of workers in the sector.

--- Later in debate ---

[Mr Jim Cunningham]

I thank all Members who took part in the debate: my hon. Friends the Members for Heywood and Middleton (Liz McInnes), for York Central (Rachael Maskell) and for Blaydon (Liz Twist), the hon. Members for Strangford (Jim Shannon) and for Argyll and Bute (Brendan O'Hara), my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), and of course the Minister.

I welcome the undertakings that the Minister gave. I realise that some of the national health service issues that were raised are above his pay grade; the wages and conditions of employees are really an issue for the Secretary of State, so I would not expect any undertakings from the Minister about them.

I very much appreciated the contributions made by Front Benchers and Back Benchers alike, and I hope that listening to them enlightened the Minister. It certainly enlightened me, because I have never been involved in the national health service or anything like it; I have been involved more in the engineering side of life and in industry. It is always useful to hear from hon. Members about their experience. More importantly, I also thank the trade union for the invaluable background information that it provided. Some colleagues are probably aware of the situations that it has highlighted, but others may not be.

The Minister gave an undertaking to my hon. Friend the Member for Stroud (Dr Drew) that he would talk to the Professional Standards Authority; if he sent me a copy of that communication, I would be very interested. I come from an industrial trade union background. We were always taught, “Just because you get a knock-back, it doesn’t mean you should give in. Pick yourself up, dust yourself down and keep campaigning until you get justice.” Once again, I thank everybody who participated in the debate.

Question put and agreed to.

Resolved,

That this House has considered registration fees at the Health and Care Professions Council.