Nursing: Elderly and Vulnerable Patients

Earl Howe Excerpts

Wednesday 19th October 2011 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, it is the responsibility of the Nursing and Midwifery Council, the NMC, to set educational standards that higher education institutes’ educational programmes must abide by. The Nursing and Midwifery Professional Advisory Board, the PAB, brings together all relevant stakeholders, including representatives from the service, professions, NMC, Royal College of Nursing, Unison and the higher education institutes, and is well placed to advise the department on workforce education and training matters.

[Baroness Gardner of Parkes]

I thank the noble Earl for that reply. Does he agree that while we are all pleased to see graduate nurses achieving new heights, there is considerable concern, following the abolition of SENs, about the loss of those caring, practical nurses who did not require university entrance levels? Has he seen Sheila Try’s report, Why is Nursing Failing? A Student Centred Action Plan, and, if not, will he ask his department to look at that?

[Earl Howe]

My Lords, we do value the contributions that SENs provide, those who are still in practice. It is certainly the case that the NMC no longer approves programmes for nurses on part 2 of the register and there are no plans to reintroduce educational programmes to part 2 of the register. What we have done is to develop guidance on widening the entry gate to preregistration programmes for those individuals who show the necessary values and behaviours but who otherwise do not possess the traditional academic qualifications. I am aware of the report that my noble friend mentioned. Sheila Try has written to me and I have asked the department to consider the recommendations that she has made.

[Lord Rooker]

Does the Minister agree that it is a very valuable report? If I may remind him, on 31 March in this House when we had a debate on nursing care I asked him if he would meet Sheila Try. Following the question asked by the noble Baroness, I respectfully ask him to study the latest report by this trained nurse, who makes very valid points about what has gone wrong with the training of nurses in the last 25 years.

[Earl Howe]

My Lords, from my reading of the report —and I have looked through it—I think there is much there that we can pick up very usefully, so I agree.

[Baroness Masham of Ilton]

My Lords, does the noble Earl agree that district nurses do a very important job in keeping vulnerable, elderly and disabled people in the community? Is he aware that there is a shortage and that their training needs to be different because they go into other people’s homes?

[Earl Howe]

The noble Baroness, as ever, makes a very important point. It is one of the reasons we have a very ambitious programme of expanding the number of health visitors. She is right about tailoring the training to suit the environment. That is why there are local curricula as well as the core nursing curriculum that have approved standards from the NMC but are sensitive to local needs in individual areas.

[Lord Elton]

My Lords, when Florence Nightingale initiated the growth of modern hospitals, the most important thing she did was to insist that nurses should deliver what she called “tender, loving care”, which later became known as TLC, and remained so when I was in hospital in my middle age. Is it not time that the National Health Service assessed the personality of people seeking to embark on nursing careers to see whether it contained enough compassion?

[Earl Howe]

My noble friend is quite right and there is now a renewed emphasis on that very point, with initiatives to help the nursing workforce practise to the highest clinical standards. These include Essence of Care, which outlines quality provision of the fundamentals of care, and Confidence in Caring, which improves nurse interaction with patients. While national initiatives such as those can stimulate thinking and offer guidance on best practice, it is really the local nurse leaders, team leaders, ward sisters and matrons who are key to setting and maintaining standards for quality and safety in their own clinical areas.

[Baroness Emerton]

My Lords, state enrolled nurses’ training was discontinued on the mere fact that those nurses were being abused and misused, because they were being asked to do tasks that were above the level of their competence. We are in the same situation now with these healthcare support workers, who are not trained to a level where they can accept the tasks being delegated to them. I ask the Government to look at this, because we cannot continue to misuse those support workers in the way in which we are—by their being given tasks which they are not suited to.

[Earl Howe]

The noble Baroness, with her expertise, makes a powerful point. We fully agree that there is an issue over unregistered healthcare assistants; I think the debate is around what we should do about it. We believe that the case for statutory regulation has not been made, although we would not close our minds to it. The point that the noble Baroness makes relates much more to nursing supervision, appropriate levels of delegation on a ward or in a care home, and appropriate supervision and training. That is a matter not for regulation but for nurse leaders in hospitals and care homes.

[Baroness Thornton]

My Lords, this is yet another report to add to others highlighting these issues. I think that the Minister has gone some way to explaining what change is needed, so that elderly people get treated in hospitals with the respect and dignity they deserve. However, how does he suggest that the nursing community should resist dangerous cost-cutting exercises by trusts, which are placing patient safety at risk by replacing experienced clinical staff with more junior nurses and healthcare assistants?

[Earl Howe]

We believe that patient safety is paramount and that it is a matter not just for staff on a ward but for the board of an organisation as well, to assure itself that the highest standards are being maintained. That means having proper staff ratios—ratios of staff to patients, that is—and ratios of trained and untrained staff within a ward. These are messages that we are consistently putting out.