National Health Service: Sustainability

Baroness Emerton Excerpts

Thursday 9th July 2015 Lords Chamber

[Baroness Emerton (CB)]

My Lords, I, too, congratulate my noble friend Lord Patel on securing this debate and on his timely contribution.

I refer back to the 1942 Beveridge report and the six years it took for the politicians to agree the NHS Bill and launch the NHS. I have been privileged to serve the NHS for 60 years, during which time many reports have been published proposing changes to meet the needs of the times.

I looked back to 1948—three years post-war—when ration books were still in use and young men were called up for national service. One thing was very apparent in 1948—the NHS would not have to deal with obesity. My thoughts wandered further and I wondered if the Minister might consider treating the national obesity problem by reintroducing rationing and national service—one way of improving the general health of the population, but I fear it would not be too popular.

Since the inception of the NHS, much progress has been made in diagnostics and the treatment of disease, alongside progress in the fields of medicine, nursing, midwifery and professions allied to medicine. There have been changes in the management of the services, usually heralded by the dreaded word “reorganisation”. Some of these have been for better, and some for worse. The nursing and midwifery professions have had their share of changes in regulation, education, practice and management; again, some for better, and some for worse. I believe the nursing and midwifery professions have in fact weathered the changes with positive outcomes. Nurses always rise to the occasion and many might describe them as unsung heroes or heroines because they always go the extra mile, not just because of the NHS constitution or their code of conduct, as important as those are, but because they really care about the delivery of care to patients. However, the two professions are generally poorly understood, as explained in the recently published book by Davina Allen, The Invisible Work of Nurses. She writes:

“There is a widely held view that all systems tend towards disorder and that energy is required to maintain order. Nurses are the source of this energy in healthcare. Formal organisations have a tendency to overestimate their orderliness and the degree to which their activities are governed by rational systems and processes. Yet in so far as healthcare exhibits any order, the findings of this study show, this must be understood as a nursing order”.

It is timely for me to pursue this a little further as there is a great risk, as Ministers and the Government make decisions quickly in order to deal with the current financial issues, in looking for quick ways to solve the problems. In the current situation, the role and complexity of the work of nurses and midwives is poorly understood, especially the role of the registered nurse. There is categorical evidence that degree-level education of nurses is associated with lower mortality rates in hospitals. Suggesting that another level of registered nurses might be the answer ignores all the previous research, which demonstrated that the state-enrolled nurse was “abused” and “misused”. This was to the detriment of safe care to patients and unfair to the enrolled nurses, who were placed in impossible positions, leading to many mistakes. The opportunity to develop further the roles of the current workforce would be more appropriate, in order that new models of care could be introduced to assist in developing new pathways of patient care—integrated care, for example. The support to the registered nurse is vital, as is the work currently being undertaken by the noble Lord, Lord Willis.

Planning the nursing and midwifery workforce in a time of national economic difficulty and ensuring the safety and delivery of high-quality care is not an easy task. But it is imperative that it is guided by a proven evidence base. If the outcome is unaffordable then difficult decisions have to be made as to the level of service that can be provided, or money found to meet the costs. These are hard decisions but it is better to be safe than sorry. Another Mid Staffordshire, Winterbourne View or Morecambe Bay cannot be afforded and it would be wrong to exploit the nursing and midwifery professions against an evidence base. The largest single workforce in the NHS cannot be expected to sacrifice its professionalism for a political expediency at a high risk to patients. The Chief Nursing Officer, who is leading this piece of work, needs the full support of the professions and the understanding of the politicians. Where would the NHS be without the seven-day service given by nurses and midwives now and in the future?