Nursing Quality and Compassion: The Future of Nursing Education

Lord Willis of Knaresborough Excerpts

Tuesday 11th December 2012 Grand Committee

[Lord Willis of Knaresborough]

My Lords, I congratulate the noble Baroness, Lady Emerton, on securing this debate and I echo the comments made by the noble Baroness, Lady Cumberlege, about her efforts in the House. The fact that only four out of 788 Peers have a nursing background is a sad reflection on how important this profession is and how little it is regarded in terms of our debates and our work. I also thank the noble Baroness, Lady Cumberlege, for her very kind comments, particularly referring to district nurses—my mother was a district nurse and I remember only too well sniffing her bag.

The appalling events at Winterbourne View, which we discussed last night, and the disturbing revelations by Ann Clwyd about her husband are graphic reminders that care by nurses, or indeed other healthcare professionals, is not always what it should be. That has to be a starting point, rather than believing that everything in the garden is absolutely rosy.

This short debate does not allow us to look at the complex reasons why sometimes care breaks down but, no matter how difficult it is, I share the view of the general secretary of the RCN that poor practice has to be exposed. It has to be understood why it has happened, it has to be rectified and there should never be an excuse to patients or their carers about a lack of compassion.

I was privileged to be asked by the RCN to lead the independent review, which was about pre-registration nursing in the wake of changes to the Nursing and Midwifery Council standards and indeed to the growing media criticism that nurses were “too posh to wash” and “too clever to care”. Those descriptions were absolutely appalling to apply to any professional. Such comments were predicated on the assumption that the move to an all-graduate education programme for nurses would result in the recruitment of less caring and less compassionate students.

Today the vast majority of nurses are not graduates. If poor care is occurring today, it is not because we have graduates. In fact it will not be until 2013 in England that all entrants as registered nurses will be graduates. Making the bland assumption that by expecting higher educational attainment from nurses means you will get less care and compassion is absolute nonsense.

More than 100 organisations gave evidence to us, from every strand of opinion. We interviewed 29 witnesses, from the RCN to Health Education England; from charities to the NMC; from the Council of Deans to patient groups. I went over to Belfast and to Dundee, Cardiff, Oxford and Huddersfield to interview patients and to look at what was happening. Not one produced a shred of evidence to support the idea that raising academic standards would lower care and compassion, so we need to knock that on the head. We want the brightest and best of our young people, and indeed our mature entrants, to come into the profession. We want them to include care and compassion as part of those qualities.

Central to our report was the belief that patients must be at the centre of the education of tomorrow’s nurses. Universities must also do far more to ensure that patients and their representatives are central to recruitment and to programmes. If nursing is not about patients, quite frankly it is not about anything. We too often get tied into structures and to organisation rather than the root causes of what we are trying to do. I make a plea, too, for research to be placed right at the heart of training. I met students who saw the research component as an addition. You tick that box to become a graduate. I argued that that was not what graduateness is about. Graduateness is about developing critical thinking. It is about leadership. It is about challenge and if you are not building research right into the heart of it for nurses to ask: “Why am I doing this? Is there a better way of doing it? Can I be involved in a project to look at doing things better?”, then I think we are missing a trick.

I will finish, because of time, with the issue of healthcare support workers. The vast majority of patients I met did not understand the difference between a nurse and a healthcare support worker. Having a chart at the front of the hospital, showing people wearing fancy uniforms of different colours, really does not tick the box; when you are brought into an emergency ward, the last thing you want to do is say, “Stop, can I just have a look at the chart to see who everybody is?”. It is an absolute nonsense. I share the view of the noble Lord, Lord MacKenzie, that the vast majority of these people are hard-working, diligent and want to do a very good job. However, there is not a single care home in the United Kingdom that does not rely virtually entirely on this brilliant and dedicated workforce, which often performs tasks, including dispensing medicines, without any training or background and without there being any way of registering or regulating its members.

How can it be—I say this to the noble Earl, who I know is the most caring of Ministers—that the most vulnerable patients in the United Kingdom, often in their own homes and at the latter stages of life, are cared for by an underqualified and unregulated workforce? How can we allow that? We recognised, as a commission, how difficult it will be to move to a regulated and fully trained workforce. It cannot be done overnight, and to pretend that it can is fanciful. However, we should be making a start, which is what the commission recommended.

The idea of a voluntary register is perfectly okay for good providers—but they do not need a voluntary register, because they do it already. A voluntary register would not have made the slightest difference to Winterbourne View. I make a plea to the Minister that I would like to see all 29 of our recommendations referred to by the Minister in a proper report back. Ultimately, I am enormously grateful for having this opportunity to place the report before this Committee.