Health and Care Professions Council: Registration Fees

Liz Twist Excerpts

Thursday 14th March 2019 Westminster Hall

[Liz Twist (Blaydon) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I thank my hon. Friend the Member for Coventry South (Mr Cunningham) for securing this important debate, which I am glad to have the opportunity to speak in. For many years, it was my privilege to work with many healthcare professionals, so I take a keen interest in this subject. I was happy to add my signature to the letter to the HCPC to oppose the, at the time, 18% proposed increase in fees.

It is right that healthcare professions should be regulated and that those bodies should be independent of the Government, which means that fees must be attached to the registration. Having set fees, however, those bodies must have a view to the people and the professions that they regulate. Many people covered by the Health and Care Professions Council are not big earners, despite playing an incredibly important part in our healthcare system, and they are often missed out when we talk about healthcare workers.

We talk about doctors and nurses, but we rarely talk about all the other NHS staff who are integral to our healthcare system. I have worked with paramedics, occupational therapists, dieticians and many others, who are an important part of that healthcare team. In the last 18 months, I have had personal experience in my family of the great work they do—on stroke rehabilitation, for example. It is important work, but the pay is not great. Typically, people are paid at band 5, which starts at £23,000 a year, so we are not talking big bucks.

[Mary Glindon (North Tyneside) (Lab)]

My hon. Friend is making a good argument about the different levels of pay. Does she agree that one of the most unfair arguments for raising the fees is that they are lower than for other professional bodies? Dentists and doctors get paid much more money, so there is no fairness in that comparison.

[Liz Twist]

I agree with my hon. Friend and I will come on to that point later.

Although we in this House talk about how valuable healthcare workers are in all kinds of debates, the fact is that their pay has not kept in line with the real cost of living, so an 18% increase in registration fees is huge and out of all proportion with the pay increases that they have had in recent years. Most of them do not have a choice about whether to register; they must be registered to be able to work. The increase will bring the total increase in registration fees to 40% since 2014, which is incredible.

As hon. Members know, one issue that the NHS is facing is staff shortages in certain areas. It cannot be ignored that something such as this increase can only be a disincentive to staff looking to do those important jobs. As other hon. Members have said, another key issue is the impact of social workers. They are currently covered by the HCPC, but they are about to go off to their own regulatory body. The significance of that should not be lost. While it will mean a reduction in income, of course, it will also mean a significant decrease in the number of fitness-to-practise cases, which are inevitably expensive to prepare. Currently, 25% of HCPC registrants are social workers, but more than 50% of fitness-to-practise cases are in the social work field. That significant factor should be taken into account when the HCPC considers its fees.

On fitness-to-practise cases, I well remember from representing people how devastating it is for any health professional to face a complaint or a fitness-to-practise case, but many people are being held in limbo waiting for their case to be heard, or even awaiting a decision that the case should not be pursued. A 2018 report by the Professional Standards Authority for Health and Social Care was critical of the HCPC and suggested that cases were being referred to the fitness-to-practise panel by its investigation committee too readily. The report stated:

“In our review of its performance this year, we set out our concerns about how the HCPC approaches the discontinuance of cases. Our view was that the approval of discontinuance decisions by the HCPC (with no additional information or evidence being presented since the decision of the Investigation Committee to refer the case) may indicate that the Investigation Committee is failing to identify when there is no case to answer.”

Clearly, that has a significant impact on the professional under investigation and on the operation of the HCPC, and is a factor in costs.

As other hon. Members have mentioned, the proposed 18% increase will have a disproportionate impact on part-time workers, who are predominantly women and mostly in the NHS, because it is a flat-rate fee. That does not seem reasonable.

We hope that the Health and Care Professions Council will listen to the comments made in the debate. Unison has also made some suggestions that the HCPC should consider. First, there should be a pause in implementing the decision to increase fees until the impact of social workers moving away can be assessed. It will clearly be a significant factor in the future, so it seems appropriate that the full impact should be known before an important decision to increase by 18% is made. Secondly, I am told that the Health and Care Professions Council has £18 million of cash reserves, which should be used to allow the impact of the move of social workers to be considered before fees are raised. Thirdly, there should be a more stringent look at other means of raising revenue, rather than just increasing fees.

The Health and Care Professions Council carried out a consultation on the fee increase. By its own admission there were 2,398 responses, many of which opposed the proposed increase. The HCPC has written to explain its position to those of us who signed the letter that we wrote before it made the decision. In that letter, it compared its fees with those of other healthcare regulators. Frankly, that comparison is not valid, as my hon. Friend the Member for North Tyneside (Mary Glindon) has already said. A comparison with the fees paid by dentists, which are £890 a year, or doctors, which are £390 a year, is completely misleading. Typically, HCPC registrants will be paid vastly smaller salaries, so it is not just apples and pears, but apples and strawberries. There is a real mismatch and disparity in the comparisons being made, so they are not valid.

As other hon. Members have, I call on the Health and Care Professions Council to reconsider its position and to agree to Unison’s suggestions as a way to avoid the 18% increase in fees.