Health and Care Professions Council: Registration Fees

Mike Hill 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.

--- Later in debate ---

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under you in the Chair, Mr McCabe. I was also registered with the HCPC and the preceding bodies. Although I am no longer registered, I recognise the impact this issue has on NHS staff.

There are nine different regulators in the NHS, regulating 32 different professions. They provide a very important function: this is about protecting not only the public, but health professionals themselves in the course of their practice. The regulators are there to set, maintain and raise standards and to give confidence to the public, as well as to hold a register and protect the title of a profession, so that other people cannot set up a business pretending that they hold the professional qualifications, which people across the NHS work hard for.

Increasingly, regulators also ensure continuing professional development. The most advanced programme of professional development has been put in place by the Nursing and Midwifery Council in recent times. The regulations around that ensure that registrants are compliant with continuing professional development. The function of regulators is to ensure that professionals who fail to uphold professional standards and their duty of care are called to account, so that sanction is applied where necessary and recourse is taken.

We have already heard that—thankfully—a miniscule number of professionals are taken through disciplinary processes. That is a tribute to the great professionalism across the NHS. However, such cases do occur, and it is appropriate that rigorous processes are in place so that individuals can defend their position and have recourse to justice before appropriate action is taken. To have someone practising who is not fit for practice risks the whole profession, so it is vital that that is put in place.

However, the cost of that process has escalated substantially, as hon. Members have mentioned. When I first registered as a physio, I had to pay only £17. In 2015, the last year that I was registered, there was a huge increase—from £80 to £90. The suggested increase to £106 is, quite frankly, unacceptable, particularly given the background, as set out by hon. Members, of a decade of pay regression, pension cuts and student loan repayments. In my time we had grants, so things have changed significantly.

More and more burdens are being placed on health professionals. That means that more risk is placed on health professionals. When we had adequate staffing in the NHS, mistakes were less frequent and caseloads were safer. Unfortunately, in many professions people’s caseloads are now too big. The pressure on those individuals increases.

I was formerly head of health at Unite. We focused on organisations’ duty of care. Managers in particular must say no to the organisation and argue the case for more staff, rather than increase the pressure on health professionals by making their caseloads unsafe—that would mean that managers were failing in their duty of care, in breach of their standards of professional conduct.

[Mike Hill]

I am also a former Unison official. In view of that, does my hon. Friend agree that, as my hon. Friend the Member for Heywood and Middleton (Liz McInnes) rightly pointed out, the professional bodies cover not only full-time and part-time staff, but student social workers and student nurses? They are under the same constraints.

[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.