Queen’s Speech

Baroness Watkins of Tavistock Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, before I commence, I should draw attention to my registered interests and remind the House that I am a mental health nurse and a lifelong member of the Royal College of Nursing.

I have welcomed in this House initiatives to widen participation in healthcare higher education, such as higher apprenticeships, the regulation and standards for nursing associates and accelerated postgraduate programmes targeted at mental health and learning disability nursing. To meet the Government’s commitment to increase healthcare student numbers by 10,000, we must continue to focus on monitoring what is happening in the higher education sector, and government must support sustainability and growth.

Following the changes to the funding of higher education in nursing, midwifery and allied health professions in England, we have experienced an average 23% reduction in student applications, although it is fair to say that in some areas the reduction is much higher. Universities are reporting a diverse picture across England, with some feeling confident that they are receiving better-quality applications from highly motivated and committed student applicants, while in other areas there are concerns about the viability of specific programmes such as learning disability and podiatry. Although the university sector has welcomed the funding reforms, it is clear that three areas that are fundamental to the success of higher education healthcare courses remain to be resolved.

First, universities need urgent clarification on the situation of placements in England. To enable growth and ensure student choice, the best model for this would be for placements to be linked to the student and for universities to be involved in the selection and quality of the placements, rather than serving the areas in the NHS where there might be care needs. But if students are paying for their placements, they will expect the right level of supervision.

Secondly, the success of education depends on the expertise of healthcare academic and practice staff. This is a wider UK issue, although the situation seems to have worsened in England recently. We must resolve the issue, with nearly 50% cuts to continuing professional development funding announced in March 2016 by Health Education England for each of its 13 local education and training boards across the country. As a result, some regions have faced cuts of more than 45% to CPD budgets, with further reductions expected this year. It is crucial that there is continued investment in building the clinical expertise of the nursing workforce to ensure that staff remain up to date with changes in healthcare, including technology. These cuts are an extremely short-sighted move, as it is only by equipping nurses in health and care environments with professional development, training and support that our existing workforce can help drive service transformation, particularly in mental health, including mental health in schools. Both the noble Baroness, Lady Cumberlege, and my noble friend Lady Masham have outlined the need to invest in mental health, especially in women’s intensive care. We know that recently patients from the south-west have had to travel more than 300 miles for in-patient mental health services. Clearly, we need to resolve these problems. Without continuing professional development, it will be particularly difficult.

Thirdly, nursing, midwifery and allied health professions are evidence and research-based professions. Research outcomes contribute to patient safety. With Brexit negotiations starting this month, we need to find a way to ensure that our universities across the UK continue to participate in EU research funding and networks, while we look at measures to increase research capacity in the healthcare disciplines. Researchers in these areas include less than 1% of the workforce—a figure that needs to improve dramatically.

Finally, since 2011 there has been a real-terms drop in earnings of up to 14% for NHS nursing staff. In May this year, RCN members voted overwhelmingly to take action on nursing pay. Over the summer, members will be protesting to scrap the cap. The cap forces good nursing staff out of the profession and leaves those who remain overstretched and undervalued. This has a profound and detrimental effect on the standards of care provided. While I am aware of the vote in the other House yesterday, I urge the Government to consider further over the summer whether removing the cap would be positive in retaining and attracting NHS staff, helping to resolve the workforce shortage so well outlined by others, and ensuring patient care. I also believe that this would reduce the need for nurses to join agencies to increase their salary and therefore increase the cost to the NHS.

It is estimated that there is currently a vacancy factor of about 11.1%—or 40,000 registered nurse vacancies in England. Under these circumstances, it is understandable that many nurses in the EU do not wish to come and work in Britain because of the extreme, increased workloads and the stress and fatigue that ultimately result from working in areas where there are insufficient staff to deliver high-quality care to patients. Without better pay and conditions, we will fail to secure the nursing and other healthcare workforce for the future. I urge the Minister to consider the issues raised, protect nursing education and enhance morale and recruitment. Even if this requires an increase in taxation, I believe that the majority of our citizens would support this idea.

Brexit: Nursing Staff

Baroness Watkins of Tavistock Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord O’Shaughnessy]

I thank the noble Baroness for giving us the opportunity to talk about the fact that we have increased the number of nurses and health visitors by nearly 5,000 since 2010. She is quite right to say that we need more of them; we have a growing and ageing population and higher expectations of what the NHS should be delivering. It is for that reason that we have a number of things in action: we have 52,000 nurses in training; we have a return to practice programme, which has already prepared 2,000 nurses to come back into the profession; and we are introducing nursing apprenticeships and nursing associates. We are not complacent about this issue—we know it is important—but there are a number of programmes in train to fill the gap that she has identified.

[Baroness Watkins of Tavistock]

My Lords, perhaps the Minister could consider that one of the reasons that people are not coming from the European Union is that they feel unwelcome; housing is almost impossible to get, particularly in some of the metropolitan areas; the reduction in the value of the pound against European currencies means that salaries have stagnated even more for some of these people; and, actually, morale is so poor in parts of the health service and social services that people would rather remain and work in their own countries.

[Lord O'Shaughnessy]

I reiterate the point that the Prime Minister made yesterday about the welcome, and indeed the offer of settled status, not just to nurses but to any other EU citizens and workers in the country. It is absolutely not the case that they are unwelcome—quite the opposite. They are as valued as much as any other person working in the health service. The noble Baroness mentioned housing, and she is right, of course, that housing is a huge issue for everybody. Indeed, one thing that I want to look at in the next few years is how we can take surplus land that sits within the NHS and make sure that some of it is used to provide the kind of key-worker housing that nurses, doctors and, indeed, other members of the public sector can use, so that they are able to come into the service and support our hospitals.

Education (Student Fees, Awards and Support)(Amendment) Regulations 2017

Baroness Watkins of Tavistock Excerpts

Thursday 27th April 2017 Lords Chamber

I believe that the Government’s approach is a high-risk one; when you have such a large shortage, there must be other ways to deal with it. Why can we not for a number of years lift the cap on universities and say, “Look, train as many as you possibly can.”? If the Government are not prepared to drop the scheme, why do they not say to nursing students who go on to spend a number of years working in the NHS, low paid as it is, that they will write off their tuition fees? That would be one way around it; it is belt and braces, I accept, but I do not believe we can risk what the Government are proposing. It is high-risk indeed, and that is why it should be debated, as it is now. It is interesting and important that we have a full debate on this issue.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register and I believe that this afternoon I am the only registered nurse in the House. Nursing is the largest profession in the UK, with some 500,000 people on the professional register. It is vital that the international shortage of nurses and allied health professionals is recognised and that more investment is given to meet the demands for healthcare in the future. I agree with the noble Lord, Lord Clark of Windermere, about the need to spend more on health and social care—but not necessarily with his solutions.

There is a need for at least three pathways to becoming a registered nurse. As a profession, we have supported the introduction of an associate nurse route, which should enable people to be paid while learning and working and to proceed ultimately, if they wish, to train for the register through a sophisticated apprenticeship-style route. We have the pilots in progress at the moment. The second important development in the NHS’s recent five-year plan is support in principle for a graduate entry route similar to Teach First, to be known as Nurse First. This is likely to be piloted in mental health and learning disability branches this autumn and would provide an alternative route into nursing.

The third route, which the majority of students follow, is a three-year university programme with clinical placements within both the NHS and other health care providers. The emphasis on hospital placements is not nearly as important at the moment as the need to ensure that students have experience in community settings and care homes—many of which are in the independent sector—because that is where a lot of people are cared for now, as well as at home. I therefore do not believe that we should reinstate the bursary, as we know that a lot of people applied to go to university because the bursary was there and we had a very high drop-out rate in year 1—I was a dean when that was happening, so I speak from experience. There were also some who completed the course but never had any intention of going into clinical nursing. They wanted to go into HR or to become an air stewardess—neither of which I think is a bad thing—but used the bursary structure to get their degree as an entry into those programmes rather than with the intention to spend a lifetime caring.

It would be preferable to invest in the three methods of education leading to registration and to seriously consider giving a bursary for the third year of training when—I agree with the noble Lord, Lord Clark—most students give a huge amount to the NHS and are often pretty indistinguishable in their final six months from a registered nurse. I also fully support consideration of the concept of forgivable student loans following a period of employment in the NHS on qualifying, rather like those granted to some nurses and medics sponsored by the forces during their education provision.

The other thing I want to draw the House’s attention to is that there are 500,000 nurses in the four countries that make up the United Kingdom and that we have invested very little in return-to-nursing programmes and in encouraging them back to work. That action might be the fastest route to getting more registered nurses back into practice.

Finally, I support the concept that the noble Lord has just addressed. Public sector salaries have been significantly tightened in the last few years and there is a definite case that initial starting salaries in the NHS for nurses and allied health professionals should be increased to recognise that they will be expected to repay their student loans from 2020. As a woman, I get very fed up with hearing both in this House and the other House that very few nurses will have to pay back much of their loan because they do not earn very much. That is not the right approach.

I urge any future Government to invest further in health and social care in order to recruit and retain healthcare professionals. Currently, the ratio of women to men in nursing is nine to one and has remained unchanged for many years. We spend significant time and money on recruiting female engineers; perhaps we should do similarly to encourage more men into nursing and the allied health professions—but I accept that this will be possible only if there is fair remuneration for nurses’ work and funding for continued professional development, as currently happens in medicine. I believe that what I have outlined would be a more strategic approach to the challenges that we face than the straightforward reintroduction of bursaries in the first two years of university programmes leading to registration.

Social Care in England: Older People

Baroness Watkins of Tavistock Excerpts

Monday 20th March 2017 Lords Chamber

[Lord O'Shaughnessy]

On care homes, it is true that some care providers are exiting the system. However, there is the same number of beds and, indeed, there are more nursing homes. So there is churn in the system and there are more home care agencies than there were in 2010. I say that only to point out that it is a changing picture. On carers, she is quite right: this is a long overdue strategy and it will be published shortly.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister explain why the number of mental health and community nurses in England fell between 2010-11 and 2015-16 by 13% to 33,000, as is clearly outlined in the Age UK report? Further, could he explain the recent significant cut in funding at HEE for post-qualifying nurse education, which includes the preparation of district nurses and advanced mental health nurse practitioners? If more people are to be cared for at home, the false separation between social and health care must be acknowledged, particularly if you want to achieve some of what is outlined in the STPs, which we are going to talk about later.

[Lord O'Shaughnessy]

Changes are going on in the nursing workforce and the noble Baroness is right about the cases she points out. It is also worth pointing out that there has been an increase in the number of nurses with general qualifications who are able to work across both health and care, which is important for integration. She will know that there have been changes in the way nursing training has been funded, both in the way she said and in bursaries. However, we are committed to increasing the number of training places available for nurses.

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.

Nurses: Training

Baroness Watkins of Tavistock Excerpts

Tuesday 22nd November 2016 Lords Chamber

[Lord Willis of Knaresborough (LD)]

My Lords—

[Baroness Watkins of Tavistock (CB)]

My Lords—

[Noble Lords]

Cross Bench!

[Baroness Watkins of Tavistock]

My Lords, can the Minister comment on the ratio between nurses retiring from the service and those coming in? I too welcome the potential development of the nursing associate—although we need to get it right—and graduate-entry nursing, but we still need a system to rapidly increase the number of registered nurses over the next five years. I do not believe that the figures illustrate that we will be replacing like with like in terms of numbers.

[Lord Prior of Brampton]

My Lords, the best estimate of Health Education England is that, making reasonable assumptions about the attrition rate of students and the retention of existing nurses, by 2020 we will have 40,000 more registered nurses working in the NHS than we do today.

NHS and Social Care: Impact of Brexit

Baroness Watkins of Tavistock Excerpts

Thursday 21st July 2016 Lords Chamber

Moved by

[Baroness Watkins of Tavistock]

That this House takes note of the implications of the European Union referendum result for government policies on ensuring safe staffing levels in the National Health Service and social care services.

[Baroness Watkins of Tavistock (CB)]

My Lords, we have spoken at length about the uncertainty following the decision to leave the EU. While negotiations take place in the coming months and years, we must not forget that business continues as usual in the health and social care services, where staff care for our loved ones 24 hours a day, seven days a week. Two big stories appeared in the papers at the beginning of the week. The first was about nurses and plagiarism in universities and the second, much more cheerful one, was an opinion piece in the Daily Telegraph by Simon Stevens, the chief executive of NHS England, with which I broadly agree. However, I want noble Lords to know that I had written this speech before I read his piece, so it is not plagiarism.

I declare my interests as listed in the register, in particular as a registered nurse in both the adult and mental health domains, a member of the Royal College of Nursing, emeritus professor of nursing at Plymouth University and the chair of the peninsula CLAHRC in the south-west. I am delighted to congratulate our current Minister, who is to continue in his role representing health in this House. I will use nursing as a lens through which to articulate my questions, but I believe that the majority of the issues raised affect all those working in our NHS and social care services, and of course the clinical research community.

The decision to leave the EU leaves us with serious uncertainty on the current and future supply of the lifeblood of our NHS, the private, voluntary and social care sectors—namely, the workforce. That decision, together with what I had written was a proposed move to a loans system for nursing and other healthcare students, could pose a dangerous threat to the quality of patient care. This morning the Government announced that they will move to that loans system, and I will return to that later in my remarks.

In March 2016, the HSCIC figures for England showed a headcount of nearly 320,000 nurses and health visitors, 26,000 midwives, nearly 20,000 ambulance staff and almost 150,000 scientific, therapeutic and technical staff. At the same time in Scotland the headcount was approximately 60,000 nurses and midwives. Out of those numbers it is estimated that between 5% and 10% of the staff working in these roles are from other EU countries, clearly with variations by professional group. There are currently more than 33,000 nurses who trained in the EU registered to work in the UK and in 2015-16 alone there was an increase of 9,000 EU-qualified nurses on the NMC register. The latest GMC figures show that more than 30,000 doctors are working in the UK whose primary qualification is from another EU or European Economic Area country.

EU nationals play an integral role in delivering safe, high-quality care now more than ever, and our NHS is particularly dependent on these crucial staff. Yet EU nationals already working in these services are worried about what their future holds and whether they will be able to continue to make a valuable contribution to our society. Likewise, patients and users of our NHS have the same questions. Let me be clear: these professionals are highly valued and we simply cannot do without them.

Noble Lords may have heard of incidents since the referendum in which some health professionals from outside the UK have been subjected to racial abuse while caring for patients. No member of staff should have to tolerate abuse in the workplace at any time. Ambiguity around the immigration status of health professionals is not helping matters, and I ask the Minister to look at how quickly we can reassure them. Staffing levels, recruitment and the retention of nurses in the NHS continue to lag behind the number of staff we need to guarantee the highest levels of safe care for people using the NHS. In Wales, and soon in Scotland, staffing levels are enshrined in law. I urge the Government in England to look at this option carefully for public protection in the post-Brexit era.

Following the Francis inquiry into standards of care in Mid Staffordshire, the public were assured that financial considerations would not be put above the need to provide high-quality care and maintain good standards, which of course are dependent on the number of staff employed. The relationship between the staffing ratio of nurses to patient outcomes is well evidenced through international research: the higher the number of nurses, the better patient outcomes are, including patient readmissions after discharge. Yet mental health services in particular suffer from chronic understaffing and the number of specialist mental health nurses has fallen by 10% over the past five years. There are strong arguments for adequate nurse-to-service-user ratios to ensure the proper development of therapeutic relationships in mental health services. It is also clear that the higher the number of experienced registered nurses on duty, the less restraint and seclusion are used, which I argue is an indicator of quality care. While the introduction of the new nursing associate role in England is widely supported, current research suggests that the role will be no substitute for registered nurses, but a supplement to care delivery.

Many people who voted to leave the EU did so because they believed that extra resources would be allocated to the NHS as a result of savings in EU contributions. I argue that further funds should be found to train, develop and retain professional staff in the NHS and social services. In this context, I return briefly to what was the Government’s proposal but is now going to happen: the replacement of NHS bursaries by student loans for nurses and other health professionals. This idea began before the result of the referendum was known. It is an increasingly risky move during this period of turbulence through all the changes with the EU. But now that it has been announced, we must make the best of it. Nurses are struggling to make ends meet as it is. We have heard of some student nurses using food banks. Any reforms to the student bursary structures need to ensure that tomorrow’s workforce is not saddled with a lifetime’s debt, which the Government have already acknowledged is unlikely to be fully repaid given the average nurse’s lifetime earnings.

The Royal College of Nursing found that 40% of London’s nurses expect to leave the city by 2021 because housing costs are so high. The additional costs of even small monthly student loan repayments for nurses will make life harder for them despite working full-time. Tomorrow’s nurses serve as a good example of the very people our new Prime Minister wishes to consider when making future policy decisions. I, really more than anybody else, hope that the introduction of the loan does not prove to be a mistake. Any new model of funding should have been piloted before we ran it right across England, to ensure that it would result in an increase in the number of nurses taking up training places.

However, as a pause is not feasible, which many noble Lords know I would have liked, there remains a critical need to ensure the security of the future workforce supply—a task that I believe has become more difficult since 24 June. In that light, I shall touch briefly on three areas of risk on which there is widespread consensus from all organisations in the nursing world.

First, will the Government commit to protecting the postgraduate pre-registration courses that are so valued by employers and enable some of our best and brightest graduates to fulfil specialist careers in the NHS? Perhaps we should develop something similar to Police Now or Teach First. Secondly, will the Government commit to measures to support students who might otherwise be deterred from joining courses, ensuring that childcare grants do not disadvantage single parents, and recognise the particular challenges facing some professions in areas of nursing where student recruitment is still not buoyant, such as podiatry and learning disability nursing?

Thirdly, will the Government recognise the extra costs that healthcare students incur from essential aspects of their courses, in particular the travel and accommodation expenses associated with placements, particularly in rural areas, occupational health and uniform requirements? Linked to this, will they fund universities directly to purchase high-quality placements for students, so that the placement money follows the student and does not get incorporated into core hospital budgets?

As we continue the transition to the new healthcare education funding system in England, we need to look beyond the immediate implementation of these reforms to the longer term. The retention of staff within the NHS is a far greater challenge than recruiting students to join undergraduate programmes. There is a clear case for the Government to consider “forgivable loans” for students who go on to work in the NHS for, say, three to five years—a cost, of course, but one that could well be outweighed by savings on agency staff and recruiting from overseas.

For all the debate on pre-registration education, which is entirely appropriate, perhaps a deeper concern for the future lies in an area where very little has been said: that of professional development funding—a silence that we must break if the future of the NHS and its workforce is to be safeguarded through the momentous changes ahead. Central to the implicit covenant we make with NHS staff is that we will support and train them in their jobs. This will become more important than ever as we ask them to deliver the extraordinary challenges that rapid shifts in technology, the genome project, changing patient needs and increased financial pressures demand.

Yet despite this, NHS England’s centrally distributed budget for ongoing training for more than three-quarters of the health professional workforce has been cut by 45% this year. There is no doubt that the cuts are affecting those professions that are predominantly female. Failing to fund in the areas that we need most in the future, such as return-to-nursing programmes, cognitive behaviour therapy skill development and district nursing, could have serious consequences, and we need to think about care delivery outside the NHS hospital box.

How can we expect our staff to deliver the NHS five-year forward view and the care our population needs if we do not support their continued professional development necessary to do their jobs? The simple truth is that the national strategic priorities of the NHS, on which there is widespread consensus, and the funding decisions on education and training do not add up. We all understand the financial pressures on the NHS but education and training must no longer be a soft target. We need to ensure strategic leadership so that short-term financial savings do not result in us not having an adequate workforce in the future. I seek assurances from the Minister that the Government will work with and not against the healthcare professions in such a review of looking at how to tackle this subject in the longer term.

I now turn briefly to one related topic. Since 24 June the need for a senior nurse in the Department of Health as well as a chief nursing officer at NHS England has become even more important. We must have a nurse leader to advise Ministers and others at government level, to represent the UK on the world stage and steer us through the challenges ahead during EU negotiations. Nursing is the backbone of our health and care system. Department of Health-based nurse leadership will make a vital contribution to the challenges that we have to face. One example will be to review the EU professional qualifications directive 2013/55.

Finally, I recognise that enormous questions need to be addressed following the EU vote. That is why I believe that healthcare professionals should be involved in any discussions affecting our health and social care services. It is only by working together that we will be able to chart a path of success through this new and rapidly changing landscape. The Government must act now to develop a coherent and sustainable workforce strategy for the future, and recognise the essential contribution of overseas staff alongside the pressing need to educate, recruit and retain a workforce from within the UK.

I look forward to contributions from other noble Lords, who I thank in advance for staying for almost the final debate before the Recess. I hope that the Minister will provide reassurance on the issues raised this afternoon. I beg to move.

--- Later in debate ---

[Baroness Watkins of Tavistock]

I thank the Minister for his response and his recognition that some of these issues need to be returned to in future as a strategy develops in relation to the Brexit discussions. This country has always worked with staff from across the world, as I was reminded this morning when I went to the Nightingale Museum and saw the wonderful new Mary Seacole memorial. She was a Jamaican nurse who worked with Florence Nightingale. We must not take as long as we have taken to recognise her to reassure EU staff working with us, otherwise they will leave very quickly and, more importantly, new people will not come from the EU to work with us because of the uncertainty.

I recognise the need to negotiate about UK nationals who live in other EU countries. However, a swift assurance to all EU health and care workers in the UK would serve to reassure not only them but the vast majority of EU nationals who actually live in the four countries of Great Britain. I therefore urge that we do not take too long to reassure everyone about the need to continue to have this mixed workforce, to get a proper continuing strategy for health and education in future, and to ensure that we not only train new nurses and doctors but give them continued professional development so that they want to stay in this country and become a core part of our retained senior workforce.

Motion agreed.

NHS: Unsafe Hospital Discharges

Baroness Watkins of Tavistock Excerpts

Wednesday 15th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, this is a difficult issue. You can lead a horse to water but you cannot make it drink. To some extent you have to rely on local people working together, and it is behaviour and culture that determine long-term sustainable improvement. If we try to force the pace beyond that at which local people are prepared to go, in the long run we may not make as much progress. In the first instance we hope that the STP process, involving all local people and giving them a framework for working together, will deliver the results we need. If it does not, we will have to revisit it.

[Baroness Watkins of Tavistock (CB)]

My Lords, could the Minister ask why the NHS has not considered funding nursing home places for people who are ready to be discharged for two or three weeks, so that they can have 24-hour care funded by the NHS while they prepare to move back home? People who live alone, in particular, are just waiting for financial assessments while reducing other people’s access to acute hospital beds, including young people who are routinely having standard operations cancelled.

[Lord Prior of Brampton]

My Lords, looking back over 20 years, the reduction in the number of what you might call step-down facilities—community hospitals and the like—has been a huge mistake. We lack step-down facilities. In America they are called skilled nursing units. The fact is that an acute hospital is not a good place to be for anyone once they are medically fit to be discharged; all the evidence suggests that it is more expensive but, more importantly, less good for the patient. I agree entirely with the noble Baroness that we need to explore avenues of discharging people earlier to nursing homes, community hospitals or, better still, back home with the right community support.

NHS: Hospital Overcrowding

Baroness Watkins of Tavistock Excerpts

Tuesday 15th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the demand on the health service is rising for many reasons, of which the growing population is clearly one. However, without the extraordinary contribution made to the NHS by people who have emigrated here from other countries, we would not have an NHS at all.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister comment on how we might prevent people going into hospital through much better structuring of community teams led by nurses? Last week, I was told at the Secretary of State’s conference on patient safety that the mean age of patients on a medical ward at Oxford was 83. When I was a ward sister, it was around 50.

[Lord Prior of Brampton]

My Lords, clearly it must make more sense to provide better treatment for elderly people in their homes, away from hospitals, particularly for those with often multiple long-term conditions. One of the tragedies of government policy since 2000—this goes across both parties—is that, although the rhetoric has been about moving care out of hospitals into the community, it has been extremely difficult to do it.

National Health Service: Nurses

Baroness Watkins of Tavistock Excerpts

Tuesday 26th January 2016 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, what consideration have the Government given to enabling people who want to study nursing as a second degree to have loans in the way that they will allow for those studying some STEM subjects? We have traditionally had mature entrants who are already graduates.

[Lord Prior of Brampton]

My Lords, we are still consulting on the details of this scheme, but I assure the noble Baroness that the loan scheme will be available for mature students doing their second degree as it is for those doing their first degree.