More than 670,000 Nursing and Midwifery Council (NMC) members currently pay £76 for their annual registration, generating £53m for the organisation.
In 2011/12, the NMC experienced a 48% increase in fitness to practise referrals compared to the number made in 2009/10.
The rise resulted in total NMC expenditure of £61m against income of £53m for the same year.
In order to afford the increased workload, the NMC funded the £8m deficit from its financial reserves.
However, the NMC believes that fitness to practise referrals will continue to increase in number and complexity, and so will the length and cost of Conduct and Competence Committee hearings.
The NMC does not believe it will be able to continue to comply with its regulatory responsibilities with its current income levels.
It forecast that for 2012/13, the increase in fitness to practise referrals will result in investigatory costs of £43m. This, combined with the NMC's other regulatory and support functions, is expected to result in total NMC expenditure of £73m for 2012/13.
NMC interim chair Professor Judith Ellis MBE has said: "The NMC exists to protect the public, setting standards for education and practice, maintaining a register of nurses and midwives and taking action when an individual's fitness to practise is called into question".
The NMC's aim is to ensure the health and wellbeing of the public.
This poses a dilemma. If the NMC is to continue to manage its current caseload efficiently, and is to comply with its aims and statutory functions, particularly concerning the protection of the public, it would appear that there is an immediate need either to significantly increase the cost of yearly registration or for the government to assist the NMC's financial burden.
In answer to this dilemma, the NMC proposes to raise registration fees from £76 to £120-per-year; a 63% increase for every individual wishing to practise as a nurse or midwife in the UK.
Aim of the fee increase
The income generated through registration fees must cover all NMC regulatory and investigatory activity, in order that the statutory body can ensure the protection of the public.
This activity includes:
- quality assurance of education
- maintenance of the register
- development of standards
- statutory supervision of midwives
- processing of fitness to practise investigations and Conduct and Competence Committee hearings
Additionally, the NMC has a duty to ensure its own financial stability.
It argues that if it does not increase registration fees, it will have to 'scale back' its fitness to practise investigations and Conduct and Competence Committee hearings, which, by definition, will mean that protection of the public will not be fulfilled as effectively.
Prof Ellis said: "If our income were to remain at the current level we would have no choice but to scale back our fitness to practise activity.This would, however, mean that we would be failing in our duty to protect the public."
The NMC believes that increasing the registration fee to £120-per-annum-per-registrant will enable it to deliver its regulatory and investigatory functions to a standard that will ensure the protection of the public, and enable it to:
- meet the unpredictable demands of increasing numbers of fitness to practise referrals
- comply with fitness to practise key performance indicators
- eliminate the historic caseload by summer 2014
- deliver an appropriate model of revalidation
- invest in IT systems to ensure it can support the increase in regulatory need
- ensure correct levels of reserves to cover unforeseen events
The NMC's current caseload is around 4,500 at any one time. It says a fee increase in line with its proposals will enable it to manage an 8% increase in referrals.
Article 47(3) of the Nursing and Midwifery Order 2001 states that before any new rules are made, the NMC will 'consult representatives of any group of persons who appear likely to be affected by the proposed rules and these may include such persons as appear to it to be representative of:
(a) registrants or classes of registrant
(b) employers of registrants
(c) users of the services of registrants
(d) persons providing, assessing or funding education and training for registrants and prospective registrants'
On 1 June 2012, the NMC began a 12-week consultation process, seeking the views of those set out in Article 47(3) (a) - (d), in relation to the proposed increase in annual registration fees, and about whether or not future fees should be linked to inflation.
A recent petition against the NMC's fee proposals attracted an unprecedented 80,000 signatures from registrants. To put this into context, a recent petition in response to NHS pension proposals secured only 30,000 NMC registrant signatures.
The RCN and UNISON published the views of their respective members on 24 August 2012, the day the consultation ended. The key facts and figures from these responses are as follows:
- 99.3% of RCN members and 98.1% of UNISON respondents opposed the proposed fee increase
- 87% of RCN members and 55% of UNISON members thought the government should contribute to the running of the NMC
- RCN members believe that the NMC should conduct a full independent financial audit, backed by Health Secretary, Andrew Lansley, in order that the NMC fully investigates how it has lost control of its finances
- 80%of RCN members did not think that the NMC should be expected to pay over £800,000 towards the running of the Council for Healthcare Regulatory Excellence
- 55.6% of UNISON members wanted to maintain a separate regulator for nurses and midwives; but
- Only 13.3% of UNISON members stated that they had confidence in the NMC as a regulator
Unrepresented registrants and increased costs
More nurses and midwives facing NMC fitness to practise investigations and Conduct and Competence Committee hearings without legal representation - either where they are not union members or where their union membership benefits do not extend to the ongoing investigation - adds to NMC's workload and costs.
The logical conclusion is that the costs increase will be passed onto registrants through the proposed fee rise, because if registrants are not legally represented, NMC investigations and hearings are longer, more complex and more costly.
This is because, throughout an investigation, registrants have to deal with the NMC case office and legal team directly, prepare for the hearing without the benefit of legal advice, conduct their own advocacy, and have legal complexities explained to them in detail.
Whilst it is clear the NMC must comply with its statutory functions and ensure the protection of the public, it must also consider the views of its registrants and take them seriously.
It must take into consideration that any fee increase may be viewed as unfair by those nurses and midwives with unblemished records, who might believe they are paying for those registrants who do not uphold NMC standards. In fact, the RCN's response to the proposed increase in registration fees shows "very clearly" that nurses and midwives do not think it is for them to "bail out" the NMC.
Finally, whether the NMC obtains the funds it needs to enable it to carry out its investigatory and statutory functions to a sufficiently high standard to protect the public through increased registration fees or through government backing, all registrants have the right to a fair hearing, and unrepresented registrants should seek legal advice at the earliest opportunity.
It remains to be seen whether the NMC's proposed fee increase will go ahead.
If you are an NMC registrant with questions about the reasons for the proposed increase, or have questions about a fitness to practise investigation or a Conduct and Competence Committee hearing, please contact us on 03700 865722 or at:
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