Strikes (Minimum Service Levels) Bill

Debate between Baroness Watkins of Tavistock and Lord Kakkar

Committee stage
Thursday 9th March 2023 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I support Amendment 18 in the name of my noble friend Lord Patel. I remind noble Lords of my registered interests; in particular, that I am a practising clinician. The amendment, and my noble friend’s introduction to it, clearly lay out an important point about the consequences with regard to practice on non-strike days if a minimum level of staffing is defined for clinical areas on strike days. It is possible that, on non-strike days, staffing levels will fall below the minimum defined for a strike day. Under those circumstances, would it be appropriate for the healthcare organisation in question to continue to deliver service in that clinical area where the minimum service or staffing level defined for a strike day has been breached?

What would be the consequences for a clinician—a regulated healthcare professional—offering to work and participate in the delivery of clinical care in a clinical environment whose staffing would, on a strike day, be considered to have fallen below a safe level? What would be the consequence for a regulated healthcare organisation of continuing to promote the delivery of care, on a non-strike day, in an area that it would consider unsafe on a strike day if the staffing level were below that defined? For instance, what view have the professional and system regulators taken of this potential situation?

Would there then be a greater risk for potential litigation associated with the delivery of care in a clinical area that had failed to provide, on a non-strike day, staffing levels that were considered the minimum level to be provided on a strike day? Would that have a chilling effect on the capacity or willingness of clinicians and healthcare professionals to participate in the delivery of care under those circumstances? These are important issues that need to be explored in some detail to ensure that they are not unintended consequences of proceeding with an approach that secures patient safety on strike days but, unfortunately, fails to have determined that appropriate protection of patient safety on non-strike days.

[Baroness Watkins of Tavistock (CB)]

My Lords, I support the amendment in the names of my noble friends Lord Patel and Lord Kakkar, and I agree with everything they said. I return to the issue of life and limb. We need to recognise that we have people in hospitals and care homes who, if they did not receive compassionate care, would be left in unclean beds, would not be fed and would not receive what we think of as ordinary, everyday care. Therefore, the whole issue of what minimum levels should be needs to be thought about really carefully. It needs to be thought about outside the opportunities of strikes and in terms of ordinary, everyday care.

I am worried that, without the amendment proposed, it is possible that we would have safer, or better, care on strike days than on non-strike days. I am also worried that, unless we tackle the workforce shortage, which has driven staff to their current level of discontent in health and care, we will continue to have problems. This is not just about people striking for an increase in salary; it is about people’s real concern about being unable to deliver the service they wish to deliver.

Health and Care Bill

Debate between Baroness Watkins of Tavistock and Lord Kakkar

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, it is a pleasure to follow the noble Lord, Lord Patel, on the term “nurse”, which is protected in law at the moment only for those who are a “registered nurse”. This means that anyone can describe themselves as a nurse, as the noble Baroness, Lady Wheeler, outlined. They can even describe themselves as a nurse if they have no qualifications or experience—or, perhaps more seriously, have just been struck off the register. As somebody who was a member of the forerunner to the Nursing and Midwifery Council, I can say that we do not strike people off the register lightly, so the risks of such people being at large and describing themselves as nurses are serious. For this reason, a petition was created calling for the title “nurse” to be protected further in UK law.

In the initial response by the Government to the petition, recognition was given that the protection of professional titles

“provides assurance to the public that someone using that title is competent and safe to practise.”

The response references a consultation by the Department of Health and Social Care on professional regulation, Regulating Healthcare Professionals, Protecting the Public. In the Nursing and Midwifery Council response to this consultation, the nursing regulator recognised issues around the limitations of “nurse” not being a protected title and said it did not think that its current powers are sufficient,

“given that they are primarily based around titles that are not widely understood by the public or used by the professions.”

This amendment is designed to ensure that there are sufficient regulatory levers to be able to protect the public in the future.

Nurses on the NMC register find it difficult to understand why the Government are reluctant to protect the title. As part of the statutory regulations of the Health and Social Care Act 2012, it was mandated that registered nurses would be part of the clinical commissioning group governing body. In Regulation 11 of the National Health Service (Clinical Commissioning Groups) Regulations 2012, the CCG governing body is required to include at least one registered nurse within its membership. This created a statutory commissioning role for nursing leaders in England that will be lost should this not be required within integrated care boards’ executive membership. Please can the Minister explain whether guidance will include a recommendation that there should be a registered nurse as part of the executive team on integrated care boards?

[Lord Kakkar (CB)]

My Lords, I support Amendment 264, in the name of the noble Lord, Lord Hunt of Kings Heath, to which I have added my name. In so doing, I remind noble Lords of my own interests, particularly as a fellow of the Royal College of Surgeons of England, a fellow of the Royal College of Physicians of London and an honorary fellow of the Royal College of Surgeons of Edinburgh.

This is a critical amendment, as the noble Lord, Lord Hunt of Kings Heath, indicated, strongly supported by my noble friend Lord Patel. Currently, the National Health Service (Appointment of Consultants) Regulations 1996, with additional guidance provided by the department in 2005, restricts membership of advisory appointments committees for consultants to certain royal colleges, as we have heard with the appointment of surgeons by the Royal College of Surgeons of England alone—and, indeed, for physicians by the Royal College of Physicians of London. This is an anomaly. The medical royal colleges across the United Kingdom are recognised in terms of the postgraduate training that they are able to supervise, the continuing professional development they are able to provide and, indeed, collaborate with regard to postgraduate examination which is required for provision of the certificate for the completion of specialist training. However, when it comes to the question of consultant appointment, there is this restriction.

Noble Lords might ask why it is important that this matter be dealt with. The provision by a medical royal college of a professional member to serve as part of the appointment process for a new consultant is critical. Those representatives provide expertise and insight with regard to the nature of the job description, the requirements for the individual post, and the assessment of individual candidates as part of the selection process on the day.