Queen’s Speech

Baroness Emerton Excerpts

Wednesday 3rd June 2015 Lords Chamber

[Baroness Emerton (CB)]

Seven lines and one word in the gracious Speech summarise the programme to be undertaken by the Government, behind which lies a tremendous amount of work, as set out in the forward view programme for the NHS. It sets a formidable number of changes to be effected by many currently in post, requiring tenacity of purpose in the management of change, which is set out clearly. Again, there is no mention of where the money will be found.

The public want the NHS to succeed. It is very precious to everyone. That is recognised by the Government, who included it in their manifesto and in their five-year forward view programme. But the plans to create a first-class NHS are facing many difficulties. Having been involved in the NHS since 1953, I can recall similar agency nursing problems, staffing issues and winter pressures, to name but a few, but the NHS has survived—and survival is what is required now.

Survival is dependent on professionals pulling together, and on every single employer and employee in the health service. Breaking down professional and organisational boundaries under good leadership will provide the public with the evidence-based care that is safe and of the highest possible quality. This requires investment in leadership preparation for front-line practitioners from the top management roles to first-line management—right the way through the organisation—as well as investment in research, revisiting the NHS constitution, the nurturing of staff, and the establishment of a culture of care values so that everyone appreciates the care being given.

How can I talk about investing when so many cutbacks are being planned? I believe that vast sums of money can be saved if we look at the various ways forward, particularly in the area of waste in the NHS of food, drugs and equipment.

I wish briefly to raise three things on behalf of the nursing and midwifery workforce. The first is safe staffing levels, which remain an issue and were of concern during the previous Government, although much progress has been made. However, there is remaining uncertainty that requires more work in order to provide guidance that will ensure the highest-quality patient care that is funded to agreed levels. This will involve accurate workforce planning so that rates of admission to training are sufficient to meet needs.

The cuts in intake over the past three years have resulted in the lowest level of qualified nurses entering the profession for the past 10 years. Interestingly, the drop in intake seen over the past three years and today’s entry to the professions equate to the escalation of agency fees in the past three years. This, of course, presents financial problems, and perhaps the funding of nurse education should be revisited with regard to NHS grants and a possible change to the loan system, as for all other students in higher education. This idea caused considerable controversy in the professions when people began entering nursing graduate training professions, but the grants system continued.

We need to overcome the very high rate of employment of agency nurses and midwives, which is not only expensive but uneconomical. There is lack of continuity of care and in many cases a consequent delay in the discharge of patients. Radical action must be taken in order for workforce plans to equate with patient demand. This work must be done by Health Education England, NICE, the financial bodies, NHS England and the Nursing and Midwifery Council in consultation with the professional bodies, staff organisations and employer organisations.

The functioning of the regulatory body for nurse midwives and health visitors has been the subject of criticism over the time it has been taking for the fitness-to-practise system to consider cases from start to finish. There is great disappointment that the Law Commission Bill that was expected this Session has not been included. This is causing considerable problems. The changes would allow for a faster and more efficient process and save money for the overstretched NMC budget, as well as the part met by nurses’ fees. For too long, the NMC has suffered the criticisms of the fitness-to-practise system, and now there has been criticism of the supervision of midwives. These issues need to be addressed as soon as possible through legislation so that the NMC can reduce the time for the fitness-to-practise systems to be worked through and allow the NHS to address the supervision of midwives.

Two important pieces of work are being carried out: one, under the chairmanship of the noble Lord, Lord Willis, is to look at the shape and future of care reviewing, and the other, by the noble Baroness, Lady Cumberlege, is to look at midwifery. One report is out for consultation and both look to the future. I hope that the Minister will be able to take account of this. Where there is a will there is a way, and I believe that NHS staff have the will to do the care that is required, provided that resources are made available.