Nursing Quality and Compassion: The Future of Nursing Education

Baroness Cumberlege Excerpts

Tuesday 11th December 2012 Grand Committee

[Baroness Cumberlege]

My Lords, this House is impoverished; we do not do ourselves justice. We have a paucity of Peers who are nurses. We have some splendid surgeons, physicians and Fellows of the Royal Society but, of course, we have the noble Baroness, Lady Emerton. Noble Lords will know that she is not only a very remarkable person but an extremely distinguished and highly respected nurse. However, it is unfair to expect her to carry the burden of the profession on her own. Therefore, my first question to my noble friend—I suspect that I know the answer—is: will he do all he can to influence those who make the decisions on membership of this House? Yet again, we are very indebted to the noble Baroness not only for securing this debate but for her knowledge, expertise—and courage, because she has left her sickbed to come here today. She exemplifies so much that we know is superb in nursing.

If the noble Baroness, Lady Emerton, is the heroine of the hour, the noble Lord, Lord Willis, is the hero. The noble Lord has written one of the best clear, concise, informative, authoritative and action-packed reports that I have read. It is a model for others to follow. I pay tribute also to the RCN and to Peter Carter, who commissioned this report and who exercised a self-denying ordinance not to interfere. It must have been tempting. The fear that we all have is that, like other excellent reports, this will sit on a shelf and there will be insufficient political will to implement it. Therefore, my second question to my noble friend is: what can he do to ensure that the report lives?

The noble Lord, Lord Willis, pulls no punches in destroying the irrational idea that kindness and intelligence are incompatible with an all-graduate nursing profession. He states that this is not simply desirable but essential—and I so agree. The concept that a nurse must be a professional among equals, a leader of teams and, in some cases, the head of a very large organisation, is not new. However, those in positions of great authority have been appointed against enormous odds.

A good education is never wasted. It brings with it not only knowledge but the confidence to hold one’s own in vigorous debate and argument. The debate is all about maintaining and improving compassionate care. That care has to be underpinned by professionalism, which depends on values, behaviours and relationships that can be inculcated at an early stage. They can be taught but in practice, with restricted budgets, they have to be defended, cherished and fought for. A well educated, confident nurse leader is essential to maintaining staff and improving the quality of care.

District nursing has always been the unloved cousin who is forgotten, does not receive presents and does not even qualify in this context for any specialist community training. I declare an interest as a fellow of the Queen’s Nursing Institute and of the Royal College of Nursing, and I am a patron of the Association for Nurse Prescribing; all my interests are in the Register of Lords’ Interests. The Queen’s Nursing Institute is one of the few champions of district nursing. Commenting on the Willis report, the QNI made the point that there is currently no requirement for district nurses to have any specialist community training. They do not even have to have experience of working outside of hospitals, despite recognition that care provided for patients in their own homes is unique; it is different. Universities are reducing, and in some cases, have ceased altogether to run courses.

I know that the commission was tasked with looking at pre-qualification training, but our policy is to keep people at home, which is where they want to be. That depends on ensuring that there are enough nurses with the right qualification and training. My third question to my noble friend is, would he consider a further report, akin to the Willis report, to look at post-registration training.

The number of community nurses, particularly district nurses, is falling. In 2009, we saw, for the first time, the number of qualified district nurses in England fall to below 10,000, which represents a 23% reduction in the past 10 years. The most recent figures available, for the year up to September 2011, shows another fall of almost 10%. Furthermore, the community nursing workforce tends to be older, and some figures claim as much as 59% of current community nurses plan to retire in the next decade. I believe that this is a crisis in the making, and it will thwart the Government’s current plans to see fewer patients admitted to hospital. However, the Government are to be congratulated on their recent focus on the recruitment of health visitors. They have a clear plan, complete with measurable targets; they have provided a useful, recent example of a concentrated recruitment effort. My fourth question to my noble friend is, therefore: will he explore a similar commitment to district nursing?

I want to address the subject of healthcare assistants, but I appreciate that I am running out of time, and I have not got time to do that. However, I must say to the noble Baroness—and I regret having to say this—that I am not yet truly convinced that registration is the answer for healthcare assistants. Ultimately the employers must be accountable for the training, competence, supervision and performance of their own staff.

With the report of my noble friend Lord Willis, and the powerful strategy launched last week, referred to by the noble Baroness, Lady Emerton, we can see a real change for the better, a brighter future for nursing and a comprehensive return to compassionate patient care, which is, after all, what we all want.