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External auditors have reviewed NMC fee rise

The Nursing and Midwifery Council has bought in external auditors to examine the business case for its proposed fee rise, Nursing Times has learnt.

Council members will consider the audit report from KPMG at their next meeting this week, before voting on whether to press ahead with the planned 58% hike in the registration fee.

They will also decide at the meeting whether to accept the government’s offer of a one-off £20m grant, which was announced by ministers last week. But even if the council accepts the grant, some level of fee increase would still be needed to balance the NMC’s books.

The regulator had previously insisted the business case for the fee rise was sound and refused to bring in external auditors, despite two written requests to do so from former health secretary Andrew Lansley and repeated calls from unions.

An NMC spokeswoman insisted the decision to bring in the auditors after all was not a “U-turn”. She said: “KPMG have reviewed our assumptions on which the business case for fees was made.

“The independent reviews should give assurance to council as to the robustness and appropriateness of the activity and financial projections upon which they are being asked to make a decision.”

The NMC claims the fee rise is needed to cope with a 47% increase in fitness to practise referrals since 2009-10, and a predicted further spike in referrals when the public inquiry into care failings at Mid Staffordshire Foundation Trust reports next year.

Royal College of Nursing head of policy Howard Catton welcomed the decision to carry out the audit. He said: “This is something we have been calling for. Registrants need to be reassured and have confidence that if there is a fee rise, it’s based on expert advice.”

The regulator’s original refusal to carry out the audit was seen as an attempt to assert its independence from government.

In July the council expressed “grave concern” when the government intervened in the recruitment of a new NMC chair. Ministers advised the Privy Council to appoint experienced civil servant Mark Addison, rather than allow the regulator to continue its own recruitment process.

KPMG also carried out audit at the NMC in March, which focused on its financial position. The audit report, obtained by Nursing Times under the Freedom of Information Act, questioned a number of assumptions about the cost and length of hearings on which the 2012-13 budget was based.

It found an assumption that it would be cheaper to bring investigations back in house was not based on a “substantive cost-benefit analysis” and discovered the NMC had budgeted for only 310 investigations between April and June this year, when it would in fact need to carry out 650.

Appearing before the Commons health select committee last week, Mr Addison told MPs that he did not expect it the results of the new review to contradict the NMC’s fitness to practise assumptions.

Asked whether the NMC would accept the government’s grant, he said it was decision for the council.

He added the regulator would “want a clear set of time limited outcomes to be judged against in return for the £20m”, so that the government’s involvement had a clear end point.

“We do not want to find ourselves in hock to the government,” he said.

Visit on Thursday for breaking news from the NMC’s council meeting.

Readers' comments (18)

  • why can't all costs involved in further referrals following the mid staff public enquiry be paid for by the trust. They employed and trained the staff, they were responsible for ensuring standards were monitored, not us.

    in 'no case to answer' referrals who pays the costs? - are the referrers charged money for inappropriate referrals?

    where there has been a clear systematic failing, breakdown in communication, staffing issues, skill-mix issues, lack of training etc. which results in a nurse error who is held responsible and do they pay for any referral costs?

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  • Stop being fools! Just refuse to pay it!

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  • How much has the NMC had to pay KPMG to do this external audit?

    A vote of no confidence in the NMC by the profession should stop them in their tracks!

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  • Anonymous | 23-Oct-2012 12:11 pm


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  • I agree that a vote of no confidence in the NMC should be put forward by the unions on our behalf.

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  • I agree with those calling for a vote of 'no confidence' in the NMC. It is about time a halt was called to their unaccountable and unwarranted 'ivory tower' mindset. Let's have an elected body with some real accountability to lead us. I know of no-one in the profession who regards the NMC with anything other than bewilderment and contempt. Time to call a halt.

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  • Its all very well saying don't pay it but then when registration lapses you cannot work!

    Its sad to say but we are in a no win situation unless the government steps in and orders the NMC to freeze/reduce the rise.

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  • Perhaps there's a case for mass refusals to pay an ineffective organisation?

    They couldn't remove us all from the register en masse. Imagine the effect on employers!

    I think unions and professional bodies could do a decent job by organising a large scale refusals and ensuring that there was a legal framework in place to support such a campaign of civil disobedience.

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  • I agree. A vote of no confidence in the NMC should be put forward. This opinion should be pretty well apparent from the recent comments from nurses displayed on these pages and in the press.

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  • I Feel a vote of no confidence is the only way forward. I do, however, worry that there will be a large percentage of nurses who will be apathetic to this.

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  • I will vote for the no confidence.

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  • How much more will this audit cost?
    I agree that trusts and other referrers should be charged for hearings + investigations if not resolved satisfactorily internally, as well as inappropriate referrals. If its complaints or concerns these should be raised via trust's complaints procedures, if appropriate escalated at public expense (as we're all members of the public).
    If all nurses won't pay renewal / joining fee after the rise and technically not being able to work as registered nurses: are employers going to say you cant work, or let them carry on working (like HCAs) as they still have skills + experience, possibily pay nurses try fees (unlikely). Some ppl will prob carry on paying, others waiting for subs to lapse, but eventually when employers reach a critical number of non-payers, services may not function if they don't keep enough staff on (after-all employees do not all have to be in a union or a professional body, so why be in the nmc ;) which don't do much to help registrants ). I think school teachers in England are no longer in the General Teaching Council for England (GTCE), after it wound up a couple years ago. I don't hear teachers loosing their jobs, getting worse or suddenly can't teach anymore. Teaching standards are still there to be maintained or they will be disciplined / investigated / sacked.

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  • I will vote for no confidence in NMC too if it came up.

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  • Anonymous | 23-Oct-2012 6:58 pm even if they did try to remove us all from the register, most nurses would probably have retired by the time they got round to the backlog!

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  • anon 1.57 - or dead from old age!

    If people refuse to pay then the NMC will use that as another excuse to put fees up for those who will pay and play us off against each other.

    How do we go about starting the vote of no confidence?

    We have NQs who have to work as HCAs for weeks as their PIN number isn't through even though they paid their fee, presumably if you don't have a PIN then you work as an HCA.

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  • The NMC is not doing an effective job.
    We are living in difficult times when Leaders must be strong and good so we can survive and grow.
    Nursing has fallen.
    Is there a leader for nurses out there?

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  • A vote of "No Confidence" is the only way forward, but do the unions do anything about it, do you not think they keep hiking their fees up and then dont do what nurses want anyway. Sorry but we are stuffed either way, if you want to work as a nurse you have to pay your registration fee, regardless of how much it costs, and yet we allow the unions to do nothing about it.We still continue to pay to both organizations and get nothing in return, but then again we only have ourselves to blame as we have always allowed everyone to walk all over us, dont think it will change in my life time, just glad i,m at the end of my career and not just starting out, feel very sorry for the young newly qualified nurses, do they really know what they have let themselves in for. My niece qualifies this september, and yes I did try to persuade her not to come into nursing as I hate the thought of all the dissallusion she has let herself in for,but saying all of this, there is,nt an other profession I would rather have done, for the biggest majority of my career I have loved the priveledge of caring for patients and hope that my niece and all future nurses can get the same satisfaction from their jobs.

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  • tinkerbell

    Bill Rollings | 24-Oct-2012 9:29 am

    why ever would you think that:)

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