Queen’s Speech

Lord MacKenzie of Culkein Excerpts

Tuesday 14th May 2013 Lords Chamber

[Lord MacKenzie of Culkein]

My Lords, I had intended to speak on the draft care and support Bill and to deal with some of the positives in it, as well as some of the issues in the interface between health and social services. I had also intended to deal with the crisis in A&E departments and, inter alia, to be critical of the absence of Bills on important public health issues such as tobacco and the minimum pricing of alcohol. However, my noble friends Lord Hunt of Kings Heath and Lady Wheeler, as well as the noble Lord, Lord Patel, said all I wished to say on that, so I will not take up the time of the House by repeating it, save to say that I agreed with every word.

I will spend a little time on the issue of nurses and nursing. The image of the profession has taken something of a battering in the past few months. As a nurse I am saddened by the adverse publicity arising from Winterbourne View and Mid Staffs, among other places. There have been some shocking, inexcusable examples of bad nursing. I have no time for it; such staff should not be caring for the sick and vulnerable. They have no place in the health and caring services. However, the whole profession should not be made to carry the guilt for a few bad eggs. The opprobrium is not deserved because the vast majority are working their socks off every shift in increasingly difficult circumstances.

The Minister rightly said that,

“what went wrong at Mid Staffs was not typical of our NHS and … the vast majority of doctors and nurses give excellent care day in, day out. We must make sure that the system does not crush the innate sense of decency and compassion that drives people to give their lives to the NHS”.—[Official Report, 26/3/13; col. 968.]

I could not agree more with these sentiments. My hope is that his words will resonate throughout the boardrooms of the service because it is clear that it is all too easy to slip into the sad state of affairs that was clearly evident at Mid Staffordshire.

It is clear from the Francis report that there are issues for nursing. The noble Lord, Lord Willis, said in the introduction to his report, Quality and Compassion: The Future of Nurse Education, that,

“there has been insufficient political or professional will to implement past recommendations”.

However, the big announcement from government was to propose something not recommended in the Francis report: having potential nurses working as healthcare assistants for a year before entering formal education. I cannot see where that idea came from, because there was no criticism of nurse education in Francis. Yet the Government ignored recommendations in the report that a registered specialist status should be created for the nursing care of older people, and ignored the recommendation that HCAs should have compulsory registration. Trusts are to be free to decide whether to have ward sisters spending more time on the ward and nurses more time at the bedside.

Recommendation 209 in the report, on a registration system for healthcare assistants, could not have been stronger. It is supported by most HCAs and is meat and drink to me because it reflects almost exactly the policy of my old union at the time of Project 2000. In supporting the move of nursing education into academia and the ending of the old enrolled nurse training, as it then was, we wanted a new second-level nurse and a fully qualified, accountable service for patients.

That did not happen, but wheels turn full circle and the same debate that we led then is now being rerun. There was an interesting letter to the Times on 24 April from Dr Anthony Carr, a distinguished former Chief Nursing Officer, fellow of the Royal College of Nursing and member of the Cumberlege committee that produce the excellent report, Neighbourhood Nursing, in the 1980s. Dr Carr’s letter chimes with much of our old policy. He first asked a question that deserves to be asked: how many patients today realise that their main nursing care is given by people with little or no training whatever? For HCAs he goes on to propose the solution of a year’s training and practice under the supervision of clinical teachers. He proposes that, if satisfactory, this should lead to a licence to practise, which should be overseen by the Nursing and Midwifery Council. That would give accountability, regulation and a national standard of training.

Piloting such an idea for HCAs would fit far better with the ethos of the Francis report than the fence-sitting, “we have not ruled out regulation and registration” approach taken by the Government. The Camilla Cavendish report is unlikely to go along with regulation and registration because that was not included in her terms of reference. However, I hope that she will still support the idea. She used to write pieces supporting registration, unless my memory is playing tricks.

I go back to the Government’s proposals that aspirant student nurses work for a year as HCAs, and to their spat with the Royal College of Nursing. The college does not need me to defend it. I have never been a member. When I started my nurse training, the college did not admit men into membership, so I joined another union and ended up as its general-secretary many years later. However, much more united these rival organisations for nurses than ever divided us. It is a bit thin, unpleasant and lacking in resonance for the Secretary of State to attack the college in the way that he did because it dared to disagree with the proposal that student nurses should first work as HCAs for a year.

The Secretary of State seeks to use the Francis recommendation about the RCN as a fig leaf. Staff organisations are entitled to give a considered response and to advocate on any proposals made by Governments that will have an effect on nurses and nursing, particularly when they have not been consulted in the first place. For the Department of Health to suggest that the RCN or anyone else who opposes such an idea lacks credibility is nonsense, not least because it appears that the idea of a year as an HCA before entering nurse education is the sort of policy that might have been thought up in front of the metaphorical shaving mirror.

It is not easy to separate professional issues from what might be referred to as pay and rations. It is right that the Royal College and UNISON should ask questions about where the funding will come from for this idea; where the supervision and mentorship are going to come from; where the vacancies are, if any; and whether these people will come within the Agenda for Change pay structure. They are right to point out the risk that they will pick up bad habits and, as we used to put it, the risk of “learning with Nellie”. They are right to ask whether the idea will work at all and whether it will lead to a better nurse than would be the case if the Francis recommendations were taken up instead. Above all, nursing organisations need to be consulted and involved before such announcements are considered or made. Enhancing the status of the profession and looking after pay and conditions can sometimes be separated and sometimes not. As General Secretary of my old union, I set up a professional department for precisely that reason.

I repeat that it cannot be right that the thrust of the problems facing the NHS is laid at the door of the nursing profession. Let us have a proper look at mandatory staffing ratios. Let us get ward sisters back on the ward, taking clinical charge. Let us get student nurses doing what Francis recommended, and find a way to ensure that there is hands-on practice during the three years of university education.

The Government have said some of the right things, post-Francis, on tightening up accountability, duty of candour for providers—although, as many others say, that needs to go further—and introducing the concept of a chief inspector for hospitals. I would like to see that post being held by a nurse, and to see the Government follow through as rapidly as possible in cutting the paperwork burden that nurses endure at the moment. I want to see nurse leaders in trusts responsible and accountable for the delivery of nursing care. They should not have several other portfolios added to their role. And yes—the nursing profession needs to challenge, perhaps more that it has ever done, and to stand on its professional feet. But there has to be a cultural change in the service as well, and Governments, managers and boards have to listen.

In conclusion, I hope that the Government listen and engage with nursing organisations on all these challenges that face the NHS, and in particular that of delivering consistent quality care.