Nursing

Lord Crisp Excerpts

Monday 14th May 2018 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what priority they will give to investing in nursing globally, in the light of the impact of such investment on improving health, promoting gender equality and strengthening local economies.

[Lord Crisp (CB)]

My Lords, it is a great pleasure to open this debate. I thank noble Lords who are taking part in it and hope that it has not disrupted too many dinner plans. I am going to address three matters in turn. First, I am going to talk about the background to the debate. Secondly, I am going to talk about why strengthening nursing globally is one of the most important things that we can do to improve health globally, and why it should be given a higher priority and greater investment. Thirdly, I shall conclude with some questions for the Government.

The background to this is that I co-chair the All-Party Parliamentary Group on Global Health, which undertook a review of nursing globally, with a review panel that I am delighted to say included the noble Baronesses, Lady Watkins and Lady Cox, and the noble Lords, Lord Ribeiro and Lord Willis, as well as Dan Poulter and Maria Caulfield, a doctor and nurse from the other place. Interestingly, nobody has done such a global review before. My focus is global, but what we are saying is also relevant to the UK, and I know that other noble Lords will mention nursing in the UK. I also say at the start that while our focus is nursing, a lot of it is also relevant to midwifery—and, of course, nurses work in teams.

As a review, we concluded three things. First, we will simply not achieve universal health coverage without strengthening nursing and the role played by the 20 million nurses and midwives globally—half the health workforce globally.

Secondly, nurses are too often undervalued and underutilised, unable to operate at the top of their licence. In other words, nurses are trained to a certain level, but then not in practice allowed or enabled to work to the level of their training. This is different in different countries but, interviewing nurses around the world, we found the same story everywhere. This is a huge waste of talent and resources.

Thirdly, the triple impact of strengthening nursing globally is that it will have an impact on three different sustainable development goals: improving health, promoting gender equity—nursing is clearly a route to women’s empowerment in Africa—and promoting a stronger economy.

These are important conclusions, but let me get to the heart of what I want to say and why I believe that now is the right moment to strengthen and develop nursing; why this is one of the most important things we can do to improve health globally; and why nurses will become even more important and influential in future. There are several reasons for this, but I want to talk about just three major ones.

The first is that diseases are changing. There is a global increase in non-communicable diseases—diabetes, heart disease, cancer and the like—and in co-morbidities in older people. As we all know, these diseases require holistic, patient-centred care, and this is at the very heart of nursing philosophy. Nurses address the whole person. They take not just a biomedical view but consider psychological, social and environmental aspects. We need a fundamental change of approach in how health services are delivered globally—new models of care—and nurses will be at the heart of that.

Here in the UK, we already have nurse-led and nurse-based services—for example, in diabetes and other long-term conditions. Those are increasing here in the UK, and there are now many similar services globally. We can see the impact of allowing nurses in South Africa to initiate treatment on anti-retrovirals, which has helped to turn around the epidemic of HIV, nurse prescribing in Botswana, the development of community services in Singapore and the strengthening of nursing in Uganda. These are all countries which understand the change which is happening. It is about improving access and quality and more cost-effective delivery of care. Nurses are very capable in all those areas.

The second big argument is that nurses are the health professionals closest to the community and, in many rural areas and slums are the first and often the only people who patients see. They are best able to help community health workers, the people in the most remote areas, to make them more effective and of higher quality.

Thirdly, this closeness to and being part of the local community also makes nurses the most effective health workers at promoting health, preventing disease, improving health literacy, early detection and tackling the social determinants of health.

I believe that those three aspects—holistic, person-centred care, reaching the most remote groups and promoting health and preventing diseases—are central to health policy in every country of the world. As I said, nurses are particularly fitted to handling it. It is for this reason that I believe that they will become even more important and influential in future.

I must say that our all-party review group thought that this was a no-brainer, but we were unable to persuade the UK Government or international bodies to act, so we started our own global campaign—Nursing Now. Here I pay tribute to my noble friend Lady Watkins, who has been with me on every step of this way, as well as offering invaluable advice as a nurse.

I do not have time to say anything about the campaign. We have a website, which I encourage people to visit. It is run in collaboration with the World Health Organization and the International Council of Nurses and supported, among others, by the Burdett Trust for Nursing, the Royal College of Nursing and THET. The Duchess of Cambridge, our patron, launched the campaign a little over two months ago, and there are now national groups in more than 40 countries, without us providing any financial support. It is clear that we have caught a tide. Our aim is to accelerate the changes that I think are under way around the world.

I turn to the Government and the question of improving the priority for developing nursing globally. I very much welcome the £5 million ring-fenced for the developing nursing within the health systems strengthening in partnership fund announced at the launch of our campaign. Here in the UK, I welcome the golden hellos to be offered to postgraduates starting in nursing in mental health, learning difficulties and district nursing. I hope that the Minister will be able to tell us about other things that the Government are doing to strengthen nursing.

However, none of these initiatives is truly strategic or embraces the need for a radical change in how we see nursing and its potential to make a major difference in the world. These are incidental, isolated issues, and they need to be brought together into a much larger programme. I am sure that we all understand and accept the importance of nursing, but do we understand how much bigger an impact it could have if it was enabled to do so? That is the crux of the matter.

I have many questions, but let me ask only a small selection. Four of them are about health. First, what are the Government doing to promote nurse-led services in countries where the Government are working with partners? Secondly, what are they doing to enable nurses to play a leading role in supporting community health workers, the people who reach into the furthest part of the African and other continents? What are they doing to support nurses to provide training, supervision and a point of referral so that the community health workers can operate to the highest level of quality, be more effective and therefore deliver universal health coverage in those countries?

Thirdly, what are the Government doing to strengthen nurses’ role in promotion, prevention, health literacy, early detection and tackling the social determinants of health? These are roles where nurses, who are close to and part of the community, could play an even greater role in future. Finally, what are the Government doing to ensure that nursing is at the forefront of the global strategies to promote universal health coverage and tackle non-communicable diseases? It is interesting to note that in those strategies, there is currently virtually no mention of the workforce, let alone nursing. The UK Government could play an important role in bringing the health workforce, and nursing in particular, up the agenda to tackle these important issues.

I have not talked about the gender aspects of nursing, but I hope that other noble Lords will. My question here is: what are the Government doing to engage and develop nursing as part of their strategy and action to promote gender equity? Surprisingly, nursing figures very little in all the strategies around the world for the development of women and gender. Similarly, I have not talked about the economic aspects. What are the Government doing to engage and develop nursing as part of their strategy and action to promote economic growth?

Strengthening nursing in the way I have described is a big and bold strategic idea. Is the Minister willing to arrange a top-level meeting for senior nurses to meet Ministers and officials from his department—or wider within government—to discuss the strategic impact of strengthening nursing globally and what the UK can do to take a lead on it?

In conclusion, I am convinced that strengthening nursing is one of the most important things we can do to improve health globally. Nursing is a profession whose time has come, and I very much hope that the Government will embrace these ideas wholeheartedly and increase their priority for investing in nursing.