Nursing Quality and Compassion: The Future of Nursing Education

Lord Hunt of Kings Heath Excerpts

Tuesday 11th December 2012 Grand Committee

[Lord Hunt of Kings Heath]

My Lords, I, too, must declare a number of health interests that are on the register—principally as chair of the Heart of England NHS Foundation Trust. I also thank the noble Baroness, Lady Emerton, for initiating this debate. In fact, only two weeks ago she presented badges to some of our nurses who had passed the trust’s intensive internal examinations. I am particularly indebted to her for doing so. I am also glad that my noble friend Lord MacKenzie, the other nurse speaking in this debate, spoke so eloquently and provided a background to some of the issues that laid the foundation for some of the concerns about the quality of nurse education.

In discussing the concerns, I hope that we acknowledge the tremendous strides the profession has made in the past 20 years. Nurses have taken on a lot of specialist skills and are looking after a much higher proportion of frail elderly patients with comorbidities. They have taken on other responsibilities as well. The noble Baroness, Lady Cumberlege, was very much responsible for that. I think of the work that she has done as regards childbirth and nurse prescribing. However, as the noble Lord, Lord Kakkar, suggested, we have this irony that at the same time as we have seen the huge potential of nurses there is concern about neglect of basic standards of care. We have all heard Ann Clwyd MP’s moving and distressing description of her husband’s last days and what he described as the indifference of some nurses.

The noble Baroness, Lady Emerton, referred to Project 2000, at which many point the finger of blame. However, I am glad that in his excellent report the noble Lord, Lord Willis, endorsed the ambition of a graduate nursing profession. I am sure that that is important, but I hope that the Minister will reflect on problems regarding the education of nurses within our universities. Clearly something is wrong. I believe that the monitoring of the curriculum has been left in the main to HR people in the health service and to the universities themselves, and that that has often led to major problems. HR people do not know about standards of nursing care—they are not in a good position to make decisions about these commissions—and universities are concerned with academic issues. They are not concerned with practical nursing standards on the ward. I believe that the answer—I am biased—is to allow the NHS to have much more involvement in the training and selection of nurses in the future. I am not suggesting that we go back to the old hospital nurse training schools, but NHS trusts need to be much more involved in future. My own trust is in discussions with the university hospital in Birmingham and the University of Birmingham about a tripartite approach to nurse training. That must be the way forward. I hope that the new regional structures will not get in the way of that.

My understanding is that the Nursing and Midwifery Council intends to deal with revalidation in about 2015, after clearing up the problems that it has. I very much welcome its approach. I also welcome the current leadership of the NMC, who show every sign of getting to grips with the many problems that they have inherited. I hope that the noble Earl agrees with the comments made on research. It is so important that we give more emphasis to nursing research.

My noble friend Lord MacKenzie spoke about the importance of supernumerary status. I agree, but I say to him that there is an issue of resources—I need to come back to that—and of being able to afford it. The noble Lord, Lord Patel, spoke about workforce planning. I urge the Government not to not leave it to local people to decide the number of commissions. We know that that will be a failure. I remember appearing before the Health Select Committee about five years ago to explain why education commissions had been reduced. I endured two not very happy hours doing so. I assure the noble Earl that his ministerial team will have the same problem. I gather that doctor commissions are also being reduced. This will prove to be a major mistake which the NHS will pay for one way or another in about five to 10 years’ time.

I will not repeat what other noble Lords have said about healthcare assistant regulation. The Government have been wholly unconvincing on this as, frankly, has the central health regulatory authority. We have to have the regulation of healthcare assistants; patient safety demands it. There is a clear consensus, and the only people opposed to it are the central regulator, which for some bizarre reason seems to cling on to this idea that you can do it through voluntary accreditation, and the Government. The intellectual argument against regulation seems very weak indeed.

Finally, before we put all responsibility for lapses in care in the hands of nurse education and the lack of regulation of support workers and of nurses themselves, we cannot ignore the huge nursing challenge posed by the increasing number of frail elderly people in our hospitals who are suffering from multiple chronic conditions. It is also grossly unfair not to recognise the financial pressure on the NHS at the moment. Nurse to patient ratios are being squeezed, and the reduction of the number of nurses in employment is an indicator of that. The Government must own up to the fact that they themselves are creating some of the pressures that are making it harder for nurses to do the job they want to do. I believe that we will come back constantly to these issues until we are able to resolve nurse education training, sort out the regulation of healthcare assistants and create the conditions in which nursing care can thrive.