Letter to Chair of the Nursing and Midwifery Council on Government commitments to nursing career progression
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Ron Barclay-Smith
Chair of the Nursing and Midwifery Council
23 Portland Place
London
W1B 1PZ
Adrian Ramsay MP
House of Commons
London
SW1A 0AA
09.02.26
Dear Mr Barclay-Smith,
I am writing to you regarding the proposed increase in registration fees for registrants with the
Nursing and Midwifery Council. I am concerned about the potential impact of these changes
on nurses, midwives and nursing associates across the country.
The proposed 19% increase in the main registration fee comes at a time of acute cost of living
pressures, alongside sustained real terms pay erosion.
I appreciate that professional regulators are reliant on their funding from registrants, but I am
concerned that this increase is disproportionate to the current rate of inflation and could
negatively affect recruitment, retention and workforce morale.
At a time when the NHS continues to struggle with staff shortages in many areas, we should
be doing all we can to ensure nurses, midwives and nursing associates remain in their roles
and encourage new people to join these professions.
This proposed increase is also likely to serve as a particular disincentive to the many part-time
workers in the health service or those considering reducing their hours before or after
retirement who must pay the full fee despite not receiving a full-time salary.
I recently heard from UNISON who highlighted concerns about the impact of the proposed
increase on registrants. UNISON represents over 1.3 million members across public services,
and a substantial proportion of their membership is made up of those professions regulated
by the NMC. A recent survey carried out by the union found that there is widespread opposition
to the fee increase, with only 10% of respondents considering it affordable.
I am aware of the NMC’s ongoing work to improve fitness to practice, promote equality,
diversity and inclusion and foster a positive organisational culture. However, forcing already
stretched nurses, midwives and nursing associates to pay significantly higher fees is not the
solution to address these challenges and could further damage trust in their regulator.
I therefore urge the NMC to reconsider your current proposals to increase registration fees
and to look at other options to increase your funding such as further targeted work to increase
the number of decisions made at the screening stage and reduce unnecessary referrals from
employers and members of the public.
I look forward to your considered response.
Adrian Ramsay MP
Waveney Valley
A Letter on the Urgent Need for Targeted Prostate Cancer Screening
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Adrian Ramsay MP co-signed this cross-party letter initiated by Prostate Cancer Research
Dear Secretary of State,
We write united by a belief that no man should die because of his postcode, ethnicity, or GP access.
Prostate cancer is now the most common cancer in UK men, with over 63,000 diagnoses and 12,000 deaths annually.i Today, the UK National Screening Committee (UK NSC) meets to decide on prostate cancer screening. This is a defining moment for men’s health. The Government must be ready to act so that those at highest risk – men aged 45–69 who are Black, have a family history of prostate, breast or ovarian cancer, or carry BRCA1/BRCA2 variants, all of whom face at least twice the average risk of developing prostate cancer – are no longer left behind.ii
1) A growing inequity
The latest National Prostate Cancer Audit (2025) shows inequalities are deepening. Men in deprived areas are more likely to present with advanced disease and more likely to die.iii Our current opportunistic PSA testing system is unstructured, inefficient and unfair – a postcode lottery where some men succeed because they know to ask or can pay privately, while others are turned away despite repeated requests.
Yet the data hide what cannot be modelled: eroded trust among communities who feel abandoned. Black men, already at higher risk, often believe the system fails them. Families bear devastating emotional and financial burdens from late-stage disease – costs absent from formal modelling but among the most compelling reasons to act.
2) The evidence is now clear
The evidence shows screening saves lives. The 23-year follow-up of the European Randomised Study of Screening for Prostate Cancer demonstrated a 13% mortality reduction – comparable to breast and bowel screening, with the numbers needed to screen and treat to prevent a death in line with those for existing programmes.v
Modern diagnostic pathways have transformed safety. Prostate Cancer UK’s 2024 analysis found harms reduced by 79% thanks to MRI and improved biopsy techniques.vi The Göteborg-2 trial confirmed pre-biopsy MRI halves overdiagnosis.vii
Today, the pathway is entirely different to when the UK NSC last evaluated screening: men have an MRI before any biopsy is considered; biopsies are carried out using safer transperineal methods; and low-grade cancers are far less likely to be detected – and, when they are, they are managed with active surveillance rather than treatment. Harms that once justified inaction have largely been engineered out.
These advances mean we now have the tools to deliver screening safely and effectively, yet the system is frozen waiting for next-generation trial data. Comments in The Times (3 October) suggest results from the upcoming TRANSFORM trial may take over a decade.viii Waiting would entrench inequality and allow preventable deaths. Evidence is strong enough to act now.Perfection must not be the enemy of progress.
3) Practical, affordable and efficient
Targeted screening is practical and affordable. Prostate Cancer Research’s 2025 report, Prostate Cancer Screening: The Impact on the NHS, with modelling by Carnall Farrar, shows additional annual costs would be around £25m – just 0.01% of the NHS budget – with modest workforce uplift and costs per screen comparable to existing programmes.ix Recent data also show a simplified MRI, taking 10 minutes, is as effective as current scans, opening the path to increased capacity within existing resources.x
The socio-economic benefits are substantial. Deloitte UK modelling found a five-year targeted programme would deliver a net benefit of £54m through earlier diagnosis, reduced treatment costs, and quality-of-life gains.xi Late-stage treatment averages £127,000 per patient vs. £13,000 for early-stage.xii Every delay costs lives and money.
Public support is overwhelmingly behind action: a nationally representative Healthwatch England poll of 3,575 men found 79% would attend screening if invited.xiii Tens of thousands have called on Parliament to act. We have a duty to listen, and to act.
4) Learning from the world
The UK can lead but risks falling behind. Sweden’s Organised Prostate Testing (OPT) programme shows that structured, equitable testing is achievable even without a formal programme, laying the groundwork for a future national rollout.xiv Across Europe, the EU is implementing its prostate cancer screening recommendation, and Australia is preparing to endorse risk-adapted testing for high-risk men.xv xvi
Introducing targeted screening would be a legacy-defining advance for men’s health, aligned with the ambitions of the Men’s Health Strategy and the National Cancer Plan.
Yours sincerely,
Adrian Ramsay MP co-signed this cross-party letter initiated by Prostate Cancer Research.
i prostatecanceruk.org/for-health-professionals/data-and-evidence
ii James ND, Tannock I, N'Dow J et al. The Lancet Commission on prostate cancer: planning for the surge in cases. Lancet.
2024 Apr 27;403(10437):1683-1722. doi: 10.1016/S0140-6736(24)00651-2. Epub 2024 Apr 4. Erratum in: Lancet. 2024 Apr
27;403(10437):1634. doi: 10.1016/S0140-6736(24)00748-7
iii National Prostate Cancer Audit (NPCA) State of the Nation Report 2025. London: National Cancer Audit Collaborating
Centre, Royal College of Surgeons of England, 2025. natcan.org.uk/reports/npca-state-of-the-nation-report-2025/
iv Roobol MJ, de Vos II, Månsson M, et al. European Study of Prostate Cancer Screening - 23-Year Follow-up. N Engl J Med.
2025 Oct 30;393(17):1669-1680. doi: 10.1056/NEJMoa2503223
v Vickers A. Early Detection of Prostate Cancer - Time to Fish or Cut Bait. N Engl J Med. 2025 Oct 30;393(17):1742-1743. doi:
10.1056/NEJMe2509793
vi Norori N, Burns-Cox L, Blaney N et al. Using real world data to bridge the evidence gap left by prostate cancer screening
trials, ESMO Real World Data and Digital Oncology, Volume 6, 2024, 100073, ISSN 2949-8201, doi:
10.1016/j.esmorw.2024.100073
vii Hugosson J, Månsson M, Wallström J et al. Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only.
N Engl J Med. 2022 Dec 8;387(23):2126-2137. doi: 10.1056/NEJMoa2209454
ix Prostate Cancer Research. Prostate Cancer Screening: Impact on the NHS; 2025
x Ng ABCD, Asif A, Agarwal R et al. Biparametric vs Multiparametric MRI for Prostate Cancer Diagnosis: The PRIME Diagnostic
Clinical Trial. JAMA. 2025 Oct 7;334(13):1170-1179. doi: 10.1001/jama.2025.13722
xi Prostate Cancer Research. Socio-Economic Impact of Prostate Cancer Screening; 2024
xii Prostate Cancer Research, ibid
xiii healthwatch.co.uk/blog/2025-10-08/men-would-come-forward-prostate-cancer-screening
xiv Bratt O, Godtman RA, Jiborn T et al. Population-based Organised Prostate Cancer Testing: Results from the First Invitation
of 50-year-old Men. Eur Urol. 2024 Mar;85(3):207-214. doi: 10.1016/j.eururo.2023.11.013
xv EU Council Recommendation 2022/2381 and Beating Cancer Plan updates (2024). consilium.europa.eu/en/press/press-
releases/2022/12/09/council-updates-its-recommendation-to-screen-for-cancer/
xvi Prostate Cancer Foundation of Australia, Public Consultation: Draft 2025 Clinical Guidelines for the Early Detection of
Prostate Cancer. pcfa.org.au/public-consultation/
The Government has finally acknowledged the NHS dentistry crisis. Now it must take action.
8th of August 2025
When I stood for election a little over a year ago, the one issue that came up time and time again was the near-complete collapse in access to NHS dental care locally. It was raised by parents who couldn’t get appointments for their children, and by people sometimes travelling hours just to be seen. I’ve even spoken to people in so much pain that they resorted to pulling out their teeth. This cannot be right.
I’ve long believed that dentistry is the forgotten sibling of the NHS. A vital service that has been chronically underfunded for decades.
From day one in Parliament, I made it a priority to press the Government on this issue. I’ve repeatedly raised it on the floor of the House, submitted questions, and met with the British Dental Association (BDA) and the campaign group Toothless in England multiple times to hear directly from those on the front lines. Their message has been consistent: the current system is broken.
Dentists are willing and able to help, but many are leaving NHS work because the contract model is unworkable, and the funding is not there. That is why I have sought to work with the BDA to secure a new workable contract - one that serves dentists, patients, and the NHS.
The Government’s response until now has been lacklustre to say the least. They have promised reforms that never materialised and continued to allocate funding that, infuriatingly, went unspent. In fact, despite the Government’s initial action and announcements and schemes that were supposed to fix things, the proportion of dentists working in the NHS in Norfolk and Waveney continues to drop.
I took the opportunity in Parliament last month to ask the Minister of State for Care whether the recently announced additional funding for the Department of Health and Social Care would lead to substantial investment in NHS dentistry. I asked a simple, direct question. Will the Government ensure that the extra funding that has been put into the Department is actually reflected in extra funding for NHS dentistry?
This time, the Minister gave a clear and welcome commitment. He said, and I quote, “Every penny that is allocated to NHS dentistry must be spent on NHS dentistry.” He also acknowledged how outrageous it is that we have seen underspending in dentistry budgets at a time of rising demand. Crucially, he recognised that areas like East Anglia, which have been underserved for years, must be prioritised.
As someone who has worked consistently on this issue, both inside and outside Parliament, I am pleased that the Government is finally starting to recognise the scale of the problem. But let’s be clear. Words are not enough. Promises mean little unless they are followed by action. What we need is for this Government to live up to its commitment to spend every penny allocated to NHS dentistry, and to follow through as soon as possible with the contract reforms so we can stop – and then reverse – the exodus of dentists from the NHS.
For people in Waveney Valley and across East Anglia, this needs to result in more NHS dentists on the ground. It needs to mean appointments that are available when needed. Patients must not be forced into private treatment or left waiting for months or longer for basic care.
There is also a broader question here about how we view dentistry as part of our health system. For too long, dental care has been treated as a separate or second-tier service. That must change. Oral health is not an optional extra, it’s a vital part of our overall health. Until the Government sees this, we are going to get nowhere in improving our overall wellbeing.
Untreated dental problems can lead to severe pain, serious infections, and, in some cases, leave people unable to eat. Tooth decay is the number one reason for hospital admission for children – a total scandal. The idea that this essential part of healthcare is now out of reach for so many people is not just unfair. It is a public health failure.
The Government may have come to its senses on NHS dentistry, but this must now be a turning point, not just a passing gesture. In the months ahead, I will continue to work with the BDA and Toothless in England to push for tangible action, not just words.
No one should be in pain because they cannot afford to see a dentist. No child should be denied basic healthcare because of where they live. It’s time the Government made good on its promise and delivered NHS dentistry that works for the people who need it most.
I will not let this issue drop. I will continue to fight for a system that works, for patients, for dentists, and communities like ours.