Nurses and Midwives: Fees

Mark Durkan Excerpts

Monday 23rd March 2015 Westminster Hall

[Mark Durkan (Foyle) (SDLP)]

As other Members have said, it is a pleasure to serve under your chairmanship, Mr Havard. I commend the hon. Member for Blaydon (Mr Anderson) on securing this debate. I suppose he is a gamekeeper turned poacher on the Backbench Business Committee. He ensured that the e-petition, which gathered a significant number of signatures, would be debated before the close of this Parliament.

It is a pleasure to follow not only the opening speech from the hon. Gentleman, but also the insights from the hon. Member for Easington (Grahame M. Morris). His teasing out of where some of these issues could go are reinforced by his experience as a member of the Health Committee. It was also a pleasure to hear from the hon. Member for Congleton (Fiona Bruce), who talked about a particular constituency case that has given strong, more than anecdotal evidence that corroborates some of the issues raised by other Members on how the NMC is having to work, because of the position it is in. It is important that we consider issues relating not only to how the NMC works and whether its cost burdens should be alleviated in different ways or apportioned, but to the Professional Standards Authority, the funding source and scheme of which seems to be fundamental to the inequities we are discussing.

Many people wonder what Parliament’s role is in all this. They think Parliament is meant to oversee the health service and strong public service ethics, but it appears to wring its hands when these changes come along but everyone seems powerless to do anything. I tabled a prayer of annulment against the order that has brought about the increase in fees—early-day motion 697 if any Members want to scrabble in and sign it before Dissolution. However, it is only a prayer of annulment. As the hon. Member for Easington said, many people have written to MPs in all parts of the UK, but they are left bemused by the responses they receive. At least now we are having this debate, courtesy of the hon. Member for Blaydon. I look forward to hearing the Minister respond to it.

The point has been made that those who have to register with the NMC have faced pay restraint for a number of years. They are locked into pay freezes, and many are coping with the perverse and inequitable outcomes of the “Agenda for Change”. That has been the case for many professionals in my constituency in Northern Ireland, who have not only questioned where they are in relation to particular bands and how their responsibilities have been correlated with others, but found themselves at odds with what has been decided in neighbouring health trusts.

If people are already facing so many frustrations relating to their pay and conditions, they are particularly aggrieved when they are hit with what is essentially a vocational tax. They are being told that because their vocation is so important and sensitive and is subject to a registration process that is open to fitness-to-practise procedures, they have to pay more for the privilege of continuing to work. They are not being paid any more—they are actually being paid less—but they are having to pay more to register to turn up to work. Surely that is unfair and inequitable.

The fees have gone up from £76 to £100, and now to £120. That is just shy of a 60% increase in a small number of years, and people are rightly aggrieved. If that has been the form over a couple of years, they will ask whether it will be sustained—will it project into the future? There is a proper question for us to ask in Parliament and for Ministers to answer. It is not enough simply to say, “Well, this is the process we have. The NMC has to make the decisions and there is nothing we can do about it.” A couple of years ago, because of the pressure of the number of fitness-to-practise cases, the Government saw fit to use a £20 million subvention to help to relieve the situation, so why could not a further subvention be used? That would at least provide cover while other changes were introduced.

There are questions about the PSA’s funding being sourced on a per-registrant basis, which seems to line up the NMC for a particularly undue hit in terms of its source funding to the PSA. I will not go through it all again, but hon. Members asked about the cost burden that will arise and the procedural length of fitness-to-practise cases. Other hon. Members asked whether there might now be impressionistic evidence that health service management is using fitness-to-practise cases as a crude management tool. Perhaps they allow management to abscond from some of its more subtle and intelligent responsibilities by transferring crude enforcement to someone else. The cost in such cases is clearly giving rise to what seems to be a completely disproportionate working burden on the NMC.

[Mr Anderson]

I related to what a trade union representative told me about taking people through a fitness-to-practise hearing that lasted 10 days and cost £30,000. Employers may well be trying to prevent exactly that sort of thing from happening and tying up their HR staff—all the witnesses and people they have to suspend. Instead of taking responsibility, employers are parking such issues with the NMC, which has hugely increased its work load and the related costs.

[Mark Durkan]

I thank the hon. Gentleman for making that point and for giving colour to the concerns we feel when we look at the number of cases, the cost burden, the wider impact on the NMC and the costs faced by those who have to register with the NMC. We must remember that the NMC does not only work to service its members’ professional standing. It is there to safeguard not only professional standards but public assurance and the wider public interest.

There is a case for asking whether anything can be done to alleviate and re-profile the NMC’s costs and whether those costs can be better shared so that they do not fall only on nurses and midwives but are spread more widely among all of us who rely on the work and good standing of the regulators of such services.

A number of hon. Members mentioned the proposals in the offing that might allow some of these issues to be addressed. It is not a case of some of us just screaming against a fee increase and saying, “Something should be done about it”—there have been opportunities. Reference has been made to the Law Commission’s draft Bill on the regulation of the health and social care professions. It is disappointing that that has not been taken forward in this Parliament, but it should be soon, because it would provide a context for addressing some of the structural and operational questions about the NMC, as well as other issues of fairness and standards.

When the hon. Member for Easington referred to some of the issues arising from the Francis report, the hon. Member for Blaydon got sensitive about that, but we should recognise that as something else that is affecting nurses’ and midwives’ morale. As well as facing pay restraint and bigger fees, they are facing the wider issue of morale relating to their professional reputation, what with some of the headlines that have come out of the Francis report. No doubt the Minister will pay great tribute to the work of nurses and midwives, but we must listen to their concerns and worries. That is why so many people—not just nurses and midwives—signed the e-petition. They want to hear Parliament speak on this issue, which is why this debate is so welcome. I look forward to hearing the Minister’s response.