NHS: Standards of Care and Commissioning

Lord Rooker Excerpts

Thursday 31st March 2011 Lords Chamber

[Lord Rooker]

My Lords, there is widespread concern among nurses, patients and relatives about the many incidents of poor nursing highlighted in recent years. There are of course many fine examples of high-quality nursing practice, and I can testify to that from my own family experiences. But action now needs to be taken to improve the state of nurse training and management. Over the past five years, a nurse friend of mine, Sheila Try, has been contacting successive Health Ministers, Select Committees and others with these concerns, as well as the Chief Nursing Officer, all to no avail. They have all failed to see that there is a fundamental flaw in the training and management of nurses and that the image of nursing has been damaged. The Chief Nursing Officer commented to Sheila that these,

“concerns resonate very well with nurse leaders who I have met around the country and with the wide range of people who explain their experiences to the Prime Minister’s Commission, ‘Frontline Care’”.

That is a clear admission of the points that Sheila and other experienced nurses are making.

Sheila Try is a qualified nurse and a health visitor to BSc standard, and a former senior manager and a reviewer for the Commission for Health Improvement. She is not someone who wants to turn the clock back, but she is concerned with the basic essentials of nursing. Last week, she met over 70 third-year degree nursing students at a local university who are due to qualify in August. They stated that they,

“do not feel confident or competent to work as staff nurses as the training has failed to give them the knowledge and skills they need, with clinical placements being too short. There are inconsistencies in clinical practice and Health Care Assistants are doing nursing tasks, including wound dressings, while they as students are doing Health Care Assistant roles (handing out drinks) when they should be being trained in nursing tasks”.

The students are concerned that their competencies are usually decided on just one observation of the skill required, such as catheterisation or wound care. They would prefer a more rigorous check in order for them to feel competent and confident. On learning to drive with an instructor, you do not do a three-point turn only once.

One of the issues lies in the ratio of academic to clinical practice. The time spent in contact with patients is only 15 weeks in each of the first two years over two placements and 21 weeks over two placements in the final year. That is not enough. This is not resulting in well trained nurses capable of giving good, consistent quality care at the point of qualification.

Image and esteem are important. These have been damaged by the practice of not using the title of “nurse” and the poor national uniform that was introduced some years ago. After working for three years to become a nurse, people are told not to use the title, but to tell patients their first name, which is unprofessional. The sign above the bed says, “Your nurse is Susan” or “Mark”, but not “Nurse Jones” or even “Nurse Susan”. That is ridiculous because it is unprofessional and breeds a familiarity that can cause problems.

The uniforms that nurses wear in most hospitals are not very professional, with qualified nurses wearing the same uniform with no difference in design to identify their status. The uniforms are often of poor quality. Nurses have said that they are more like a cleaner’s overalls—that is not to degrade cleaners. This affects not only the image that the uniforms portray to patients and relatives but also how nurses feel about themselves.

One major hospital in the Midlands has recently changed its uniform policy, bringing in colours to identify a nurse’s grade and with the grade embroidered on the uniform. Patients and relatives can now distinguish between a staff nurse and the sister in charge. It has massively lifted morale, because the nurses feel valued. The ward management points that Sheila has asked me to make are exactly the same, word for word, as those made by the noble Lord, Lord Turnberg. The solution, she thinks, is simple: tackle the way in which nurses are trained, with more time spent with patients and less in the classroom.

Nursing needs to be up to date with technology and the changing face of disease and management, but essential care is vital to ensure patients’ safety. A better balance between academia and professional placements, needs to be found. And, yes, Nurse Try would welcome an opportunity to put the case to the Minister direct.