Health and Social Care

Baroness Watkins of Tavistock Excerpts

Thursday 24th November 2016 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank my noble friend Lady Finlay of Llandaff for securing this debate, which follows a similar one in my name held in July, referred to by the noble Lord, Lord Colwyn. I will not repeat a lot of what I said in July; instead, I shall focus on the challenges that have begun to emerge over the last three months in relation to nursing and the allied health professionals workforce.

Others have already said that it is vital that we continue to value our EU colleagues who work in the health and social care sectors. The Chief Nursing Officer, Jane Cummings, has joined others in stating the value that we place on these workers. At the moment, we can to some extent continue to recruit from the EU. However, as an example, on a recent visit to Spain it was made very clear to me by some nurses that they no longer seek an opportunity to come and work in the UK because they fear that the very high number of Spanish nurses who are here now will seek to return, and they may then not have jobs if they, in turn, go back to Spain after a short period here. So, as well as what we know from meta-analysis, we are, anecdotally, very clear that things are changing.

Another important point is that we must not over-recruit from countries where there is already a significant shortage of healthcare workers. The report of the noble Lord, Lord Crisp, which looks particularly at the triple impact of nursing internationally, argues that we must be very careful not to do that.

Amid the concerns and possible doom and gloom, this week the Royal College of Nursing celebrated its centenary and I attended part of its conference. A really positive note was the developments in nursing across the four countries of the UK and the absolute commitment to continuing to improve care and support for our communities, working with healthcare staff from a range of backgrounds and countries in the EU.

The UK Government have told us that they want to ensure that the health and social care needs of our population are not negatively impacted by the UK’s exit from the EU. A sound supply of staff is essential, not only for the NHS but for the voluntary and independent sectors. It is estimated, for example, that the independent health sector generates in excess of £2 billion a year for the London economy, with associated tax revenues for the Treasury. As indicated yesterday in the Autumn Statement, we need to keep this kind of business in the UK, and, to get those benefits, we need to provide the staff to deliver them.

Our relationship with the EU has had a substantial direct and indirect impact on the delivery of health and social care in the UK. It has developed really good patient safety standards and improved the quality of care. The staff we have now are central to the successful delivery of care in the future. Because so many others have talked about this today, I do not intend to dwell for long on the incredible support for older people that is provided by staff from the EU, However, it is essential that we develop more home-grown staff.

We need to develop a long-term, coherent workforce strategy and implement plans that maintain and grow the domestic health and social care workforce. The noble Lord, Lord Warner, talked very clearly about the fact that we have failed to do that in the past. There is a terrible fear of over-recruitment. Certainly we need a whole new set of doctors and nurses, but we also need nursing and medical academics to support the rapid increase in such programmes, so it is not quite as simple as it seems. We must ensure appropriate educational and professional regulatory frameworks, including for nurses, nurse associates and social workers trained in the UK, to create a proper professional pathway for young people.

Others have referred to the fact that a lot of the law from Europe has resulted in safeguarding decent working conditions for staff. It is imperative that as we go through the great repeal Bill, we do not undermine some of those advances, such as TUPE and other good standards for those employed.

I turn to the relatively severe concern of funding for the ongoing training of nurses, midwives and allied health professionals, which has been stripped out again this year. Therefore, we have people qualifying who would like to develop their career, but who cannot afford to because of the post-qualifying costs of further and higher education.

We have not seen any campaigns to successfully promote nursing as a career such as those we have recently seen for teaching. Of course, I finished writing my speech last night and then read the Metro on the way in this morning, in which there is a fantastic advert for nurses to return to practice in London—there are always exceptions to the rule. However, we need to fundamentally encourage people to come into nursing and the allied health professions, particularly as they will be starting to pay their own fees. We cannot do this too soon.

There are steps we can take that will protect against nurse shortages. Noble Lords will know that I have consistently argued that postgraduate pre-registration courses that supply nurses for the NHS need protection. I am delighted that the Government have committed to continue funding these in 2017-18, but that needs to continue until at least 2020.

My noble friend Lady Finlay described the numbers and challenges we will face if our EU friends decide to move. However, all the figures on NHS-funded nurses fail to take into account the shortage in specialties in mental health, largely because most of the child and adolescent mental health services are provided by private companies contracted by the NHS. There is already concern that recruiting to mental health and learning disability nursing programmes next year may prove difficult. We need to keep a watchful eye on this and ensure that we can retain and recruit in those areas.

Common EU standards for training and recognition of qualifications have enabled mobility, raised educational standards and improved health. Other activity, including research collaboration, has developed nursing practice. I trust that the Minister will give careful consideration to some of the challenges we have raised, particularly how we will staff mental health and learning disability services in the future.