Third Standing Committee on Delegated Legislation
Wednesday 29 October 2003
[Mr. Peter Atkinson in the Chair]
Health Professions Council (Registration and Fees) Rules Order of Council 2003
Mr. Paul Burstow (Sutton and Cheam): I beg to move
That the Committee has considered the Health Professions Council (Registration and Fees) Rules Order of Council 2003 (S.I. 2003, No. 1572).
I am aware that other matters are causing our media to be agitated in the Corridor and that there may be reasons why others may want these rules disposed of reasonably quickly. I have just a few questions for the Minister.
There is no doubt that we all want robust registration and regulation of professions allied to medicine, and the Government should be applauded for introducing the legislation that established the new Health Professions Council.
The Minister of State, Department of Health (Mr. John Hutton): I am surprised that the hon. Gentleman welcomes that legislation, because I remember that he and his colleagues did not vote for it.
Mr. Burstow: The right hon. Gentleman is right, but I am dealing with the situation as it is now. If he would allow me, I would prefer to ask a few questions about how the Health Professions Council is working in practice. Given our previous position, it is perfectly legitimate to want to ask those questions.
We have had several representations, as we did during the passage of the legislation, expressing concerns about how the council is working in practice and how registrations are taking place. Concerns have been expressed about fees and some of the mechanisms that have been implemented, as well as about the pace of the enterprise.
Representations from several organisations within the professions allied to medicine have expressed concerns about how the council's registrar is dealing with the professional bodies. Will the Minister say a little about the communication strategy and the mechanisms for both formal, written consultation and ongoing dialogue between the professional bodies and the registrar? Written consultation is not enough and cannot adequately ensure genuine understanding and a consensus about how to put the processes in place.
Concern was expressed about the proposals originally made in the HPC's consultation about fee increases for the new function. The original proposal was for a charge of between £160 and £180 per annum, and many outside the House have welcomed the
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proposal to go for a charge of £120 over two years. The idea of a 50 per cent. discount for the first two years has been applauded.
However, a concern was expressed to us about how the charges for registration of professionals will be developed. It was put to us that the proposed increase represented an inordinate rise in costs for professionals. Even with the initial proposal of a £120 registration over two years, there are concerns about the burden that that places, in particular on low-paid and part-time staff. Will the Minister explain the Government's thinking about charges and increases in charges for registration in the long term? What would be an acceptable balance between the interests of the public, who want good registration and robust procedures, and ensuring that we do not create barriers to people who want to enter such important professions?
Will the Minister comment on the anger that has been expressed by some of the professions allied to medicine about the fees being charged, and the impact on low-paid and part-time staff? Also, will he say why the system could not have continued under the previous arrangements? One of the arguments for the fees has been that the council itself will now be able to claim subsistence and other payments for undertaking its duties as a member of the Health Professions Councils. Under the previous arrangements, that was done on a free and gratis and voluntary basis. Some have asked why that could not continue.
Has the Minister anticipated that the level of fees might provoke many existing registrants not to renew their registration? Has any assessment been made of the impact on participation of setting the price at too high a level? It would be useful to know whether such work has been undertaken.
A concern has been raised about the potential interaction of the Disability Discrimination Act 1995 with the order and the legislation that allowed it to be introduced. The point has also been made that new registrants are required to obtain a reference as to their physical and mental health, which must be provided by their doctor. Apparently, there is concernevidence is already emerging to confirm thisthat where a person has a disability some doctors are unwilling to sign off certificates. Is the Minister aware that, because of the new rule, there is a concern that some of the new professionals who have been offered posts in the NHS, and who are currently working in less well-paid support-worker roles, are being denied the ability to become registered? As a consequence, they cannot exercise the full rights and benefits that come with the new title. How long will that state of affairs last? Will there be a proper audit of the regulations governing the way in which the council registers people to ensure that it is fully compliant with the requirements of the 1995 Act?
Does the Minister know whether the Health Professions Council has in place the systems necessary to register overseas applicants? That has clearly been an issue for other parts of the national health service where, although we may not be reliant on overseas nurses and doctors, we find such a benefit very useful.
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On the issue of shortages, the professions allied to medicine would clearly benefit from such overseas recruitment, and some already do, but how will the registration system cope with that, and will it be able to deliver in future?
While doing research for today's debate, I learned of dissatisfaction among some within the community of professions allied to medicine at the fact that the registrar and the HPC are showing real unwillingness to confirm the continued and equal participation of professional bodies in course approval and reapproval processes. For the professions, being involved in the process of determining the courses themselves is important. To feel that they have not yet had clarity from the registrar on whether they will have a part to play in that in future sows a sense of uncertainty and dissatisfaction that could so easily be overcome if there was a proper dialogue. There is a dialogue, but it could improve, and that would reassure organisations that their concerns will be addressed.
Can the Minister give us the assurance that the course approval system will continue to respect the rights of professional bodies to determine fitness? Will that be effectively ceded to the HPC, or will professional bodies still have some part to play?
These statutory instruments Committees play a valuable part in scrutinising the minutiae of Government regulations, and we hope that the Minister can give us some answers that will, if not allay our fears, allay those of many in the community of professions allied to medicine.
Mr. Hutton: The hon. Gentleman raised a number of concerns about these rules, and I intend to deal with them briefly.
I am not aware that any of the disability bodies or the Disability Rights Commission have raised concerns with the Health Professions Council about the terms of the original order. All our legislation has to comply with the standards that we have set for disabilityand especially for the principle of non-discrimination. If any question arose as to whether the orders complied with primary legislation in that regard, that would be a matter ultimately for the courts. The hon. Gentleman doubtless knows that it has never been our intention to introduce anything into these rulesor into the original Health Professions Order 2001that discriminates against disability; that is not, and never has been, part of the thinking behind this legislation. Indeed, I made that clear to his colleague, the hon. Member for Oxford, West and Abingdon (Dr. Harris). I am unaware of anything that has changed to give me, or anyone else, cause for concern in that regard.
The hon. Member for Sutton and Cheam (Mr. Burstow) asked whether the current arrangements for registering overseas applicants are sufficient, and I can assure him that they are. A full range of procedures for registering and recognising the qualifications of overseas applicants from the European Economic Area and further afield is available to the Health Professions Council.
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The hon. Gentleman raised a number of concerns at the beginning and the end of his speech about the way in which the HPC is going about the job of course validation. As he is doubtless aware, that matter is not covered by these rules, which are about registration and setting the level of fees. He might want to discuss course validation with me later, or to raise the matter with the HPC directly because, as he knows, I have no power to direct the HPC to do anything. That is only right, because these are matters of professional self-regulation. Indeed, it was the decision of this Housealthough not, at the time, of the Liberal Democratsto support this legislation, and these are the boundaries that we set.
The hon. Gentleman's principal concern was fees. I shall say something about them in a moment as he asked me several questions about them, but I shall first describe briefly what the rules are about. They lie at the heart of the new regulatory system agreed by this House when it approved the Health Professions Order 2001. The HPC has much wider powers and sanctions than its predecessors, as well as a much broader range of functions. They are all designed to strengthen protection of those members of the public who use the services of health care professionals. The public have a natural right to expect that those who treat them are competent to do so safely and effectively. That should always be the principal aim of statutory health regulation.
It is also essential that the system work fairly for the professionals who are being subjected to that regulation. The 2001 order makes it a criminal offence for professionals to practise in such professions unless they are registered with the HPC. As so much is at stake for them, it is important that the system of regulation be applied properly, and in accordance with rules that are fair and effective. I would argue strongly that these rules are fair and effective.
This order is one of a series of statutory instruments that implements the provisions of the 2001 order. The rules provide the means by which the HPC operates its register of those professionals who meet its standards, and they set the level of fees that registrants will be required to pay to the HPC. Those fees fund the work of the HPC in discharging its statutory dutiesthis House has required it to discharge themand they do no more than that.
In particular, the rules cover the following: information to be kept on the register, some of which may be published; the procedure for making applications for registration, or for renewal of registration, including the requirements to be met and the information to be submitted in support of applications; periods within which a qualification must have been awarded; and provisions on lapsed registration and voluntary removals from the register. In praying against this statutory instrument, the hon. Member for Sutton and Cheam did not raise any concerns about those aspects, so I take it that heand other members of the Committeeare not concerned about them. Given that, for the one Conservative Member who is present, a rival attraction is going on in Committee Room 14, it might be better if I limit the
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rest of my remarks. In fact, you will also be taking a keen interest in what is going on in that Room, Mr. Atkinson.