NHS and Social Care: Impact of Brexit

Baroness Emerton Excerpts

Thursday 21st July 2016 Lords Chamber

[Baroness Emerton (CB)]

My Lords, I congratulate and thank my noble friend Lady Watkins not only on securing this debate but on her excellent speech and setting the scene so ably this afternoon. I also thank the noble Viscount, Lord Bridgeman, for his tenacity of purpose. Ever since I joined the House, he has shown tenacity of purpose in regard to the English language and the statutory bodies.

I declare an interest as set out in the register. I am a retired registered nurse trying to keep up to date—and that is a job in itself. I will concentrate on the supply and delivery of quality care, not only in the National Health Service but in the private and charitable sectors.

In preparation for this debate, I gathered together the most recent headlines, which, I am afraid, do not make very happy reading. The Nursing Standard said:

“The United Kingdom is unprepared for nursing shortages”.

Health Service Journal stated:

“Reality bites as the NHS is told to face up to its failings”.

The BBC reports:

“Nurse shortage could last for years … 1 in 10 nurse posts in England unfilled … 29% of nurses are aged over 50 … 13% of nurses come from overseas”.

“Brexit may hit NHS nurse ‘pipeline’”,

says the chief executive of the NMC. The Nursing Times states:

“European nurses feel chill after Brexit vote”.

The Health Foundation report, Staffing Matters; Funding Counts refers to “pressure points” and associate nurses.

Like my noble friend Lady Watkins, I was filled with joy when I read the report from Simon Stevens. Like her, I had written my speech before I read his report. I will say more on that later.

I wish to take noble Lords back to the period before May 2010 when the Labour Government were in power and the noble Lord, Lord Darzi, the then Minister of Health, introduced care pathways and was seeking means of ensuring safe, high-quality delivery of care to the satisfaction of patients. Much progress was made on this but with the change of Government, the unmandated Health and Social Care Bill was introduced and proceeded through the next four years before completion. During those four years, I contributed at each stage of the Bill, along with other noble Lords, to establish safe staffing levels and either certification or regulation for support workers.

Since July 2014, much work has been attempted by various organisations to establish safe staffing levels comprising not just numbers but quality assurance by providing the appropriate level of competence of nurses and support workers. Without that assurance focused on the quality outcome, numbers alone will not take us forward. What we cannot afford is a further spate of inquires relating to unacceptable levels of low-quality care in view of the evidence of the dependency required by the patient, as occurred in the Mid Staffordshire inquiry.

The report by the noble Lord, Lord Carter, for example, relates to the number of workers and the number of hours per patient day required but gives no indication of the ratio of registered nurses and support workers. There is no regard to the spread. This presents a real dilemma: if the numbers required cannot be afforded as being both the right number with the right quality, then choices have to be made as to the level of service that can be provided, or alternative methods of funding have to be found. But what we cannot afford is further delays with the possibility of poor delivery of care because of the shortage of the right numbers of workers with the right qualifications in place. In short, we require a strategic plan that has explored options on numbers, quality outcomes, cost benefit, risk assessment and a timetable for implementation.

The regulation of support workers fell to Health Education England to initiate and the noble Lord, Lord Willis, produced the report Raising the Bar, which dealt with nursing associates. Work is now under way to pilot the introduction of the nursing associate and to build on the current support worker grade 2 and 3 to a level 4, extending the role to support the registered nurse, possibly with the academic requirement and aptitude to proceed to registered nurse training or to a degree.

While I applaud any possible move to develop further support for support workers and agree with the direction of travel, I find it difficult to accept the title “nursing associate”. This may sound pedantic but already there is confusion and many are referring in official documents to the “associate nurse”. The use of the word “nurse” is regulated by law, applying to those who have the required qualification and registration by the NMC. I am concerned that not only other professionals in the health service but—most of all—patients will be confused. To patients, quite rightly, a nurse is a qualified nurse. The fact that the person might not be a nurse at all would not enter their heads. If the title were, for example, “associate health carer”, it would indicate that they were not registered nurses but someone trained under the supervision of a registered nurse. This would help to prevent confusion—which could easily escalate—creeping into the title.

Evidence clearly shows that the previous state-enrolled nurses were abused and misused; they were exploited through being left in charge of wards with no appropriate support available. The likelihood of this happening must at all costs be eliminated. The advantage of the title “associate health carer” would be that the syllabus could include an introduction into social care aspects of the patient’s journey, which is especially necessary for care in the community, where we have the elderly, the mentally ill and some long-term dependent patients with learning disabilities who are cared for in the community but could be supported towards living a more independent life. This would provide excellent experience for those with the appropriate academic qualification. We need this opportunity for them to be trained and able to move forward, which would, we hope, break down some of the barriers between the organisations and the professions.

I suggest to the Minister that, while speed is of the essence to sort out the nursing associate, it would be preferable for health education to explore more fully the possible benefits that the role could have, for the benefit of not only the recipients of the care delivered but the nursing associate—or associate health carer—grade. The name is the key and it would be helpful if this could be examined. I look forward to hearing what the Minister has to say on that.

Safety and high-quality care cannot be ignored; we know the consequences of doing so are dire, as we witnessed in Mid Staffordshire, Winterbourne View and Southern Cross. We have to get rid of this idea of graduate nurses being “too posh to wash”. We urgently need to ensure the graduate nurses, on qualification, are responsible for the delivery of total assessment and care of the patient for whom they are responsible. Each patient is a unique individual who has a mind, body and spirit and it is the nurse who is responsible for assessing and addressing any issues that the patient may have, even if they are not immediately connected to the condition being treated. For example, a terminally ill patient may need to see a priest or the patient may be worried about a dependent relative who needs a social worker. The graduate nurse has the responsibility for the total holistic care of the patients allocated to him or her.

I also ask the Minister to address the question the noble Baroness, Lady Watkins, asked about the position of the nurse in the Department of Health. We are already in correspondence on this but it is a matter of great concern to the profession.