Nursing

Lord Willis of Knaresborough Excerpts

Monday 14th May 2018 Lords Chamber

[Lord Willis of Knaresborough (LD)]

My Lords, as always it is a pleasure to follow the noble Baroness, Lady Bottomley. In particular, I congratulate the noble Lord, Lord Crisp, on securing this debate and thank the noble Baroness, Lady Watkins, for the enormous contribution that she has made to the Nursing Now initiative launched just a few weeks ago by the Duchess of Cambridge.

I must confess that, little did I know, when the noble Lord, Lord Crisp, sent me an email to join his review board, that we would produce a report, the Triple Impact report in 2016, which would have such an impact. Propelling UK nursing to the fore of the challenge to achieve universal health coverage globally within a realistic timescale seemed an impossible task—but he is well on the way to achieving the impossible.

As the report emphasised, nurses are the largest single component of a global health workforce, and their skills and values make them ideally placed to lead healthcare initiatives in a variety of settings. For me, the crucial challenge of the report is to make the nurse a catalyst for change, using healthcare to build stronger local economies and improve the lives of women.

What part can or will the UK play in accepting and delivering the challenges of the Triple Impact report? I have no doubt that many UK nurses and midwives have knowledge, skills and leadership qualities to take up the challenge, despite all too often being thwarted by the pressures of daily activity and outdated clinical hierarchies. However, a cadre of newly qualified nurses is emerging, particularly those who will be trained to the new NMC standards following the inspirational work of Dame Jill Clark—and, I might say, Jackie Smith, who has just announced today that she will be leaving as chief executive of the Nursing and Midwifery Council. She is a remarkable woman who has done so much to change the face of regulation as it interfaces with nursing.

These new nurses will be particularly well suited to the global challenge, as the emphasis on leadership, independent working and problem solving becomes more prevalent. There is also a sharper focus in the work of the HEIs, as the challenge of a graduate nursing profession has become embedded in both practical and theoretical pedagogies. This point was brought home by the publication of the latest QS league tables for the world’s best nursing schools, where Manchester, King’s and Southampton are in the top 10.

The desire to search for excellence has resulted in Nottingham University Hospital Trust and Oxford University Hospital Trust being on the cusp of gaining Magnet status for nursing excellence—a prospect which I was told was totally unrealistic and impossible just a few years ago. Equally, the emergence of Health Education England’s draft workforce strategy with a full section on “the global healthcare workforce”, demonstrates tentative but welcome steps away from viewing non-UK staff as a commodity to fill vacancies and more as an opportunity to enhance care by investing in a global healthcare team. The “earn, learn and return” initiative is welcome; the global nursing partnership with Jamaica and the recent agreement with India will result in far stronger reciprocal arrangements that can be repeated around the globe.

However, the emphasis of the Government remains far too restrictive and the words in the strategy of recruiting staff,

“in a way that is consistent with wider Government policy on reducing net migration”,

is a chilling factor, particularly on the 41,962—that is the figure today—non-EEA nurses and midwives who are currently NMC registered and who hail from 73 different countries, from India and the Philippines, with the largest numbers, to Nigeria and Zimbabwe, to Belarus and Myanmar. There is somebody on the NMC register from every country in the world. Imagine what results we would get if we invested in these colleagues as part of our global campaign.

Unless we make global nursing an academic priority in our universities, we will not take advantage of our nursing heritage. It is our traditions, our excellence of teaching, and our innovative and outstanding care settings that give the UK a platform for leading the global nursing challenge—but research must be a priority and not an add-on. In 2010, the Lancet commission on education of health professionals, of which the noble Lord, Lord Crisp, was a member, recognised the need for a,

“robust, competent and professionally capable workforce”.

Professionalism and leadership were regarded as essential qualities—the very reason they are so prominent in the new nursing standards. However, nurses must be allowed to apply these qualities in challenging settings, and there is nothing more challenging that doing so alongside colleagues in developing countries or in remote areas where the nurse, more than any other healthcare professional, is the one whom people will see.

To build an infrastructure that can sustain such programmes requires resources from the Department of Health and from DfID, but also from BEIS, to allow postgraduate nurses and other health professionals to research the effectiveness of global nursing in a developing world. It is not good enough to do that research purely through a clinical lens. If they are to act globally, nurses must think and research globally. In the US, a host of leading universities not only have centres for global health but encourage nursing graduates to carry out research in the field alongside other disciplines. Johns Hopkins, through its Center for Global Initiatives, promotes nurses on international placements, links them to schools of nursing around the world and encourages interdisciplinary research promoting broader health and welfare. The University of Washington, at its Center for Global Health Nursing, disseminates and promotes global health nursing, creates strategic partnerships internationally, and promotes nursing students’ involvement in global health policy. With its collaborative global research programmes, New York University—which I know well—has established nursing centres in Rwanda, Liberia, Ghana, Tanzania and China, as well as offering its degree courses in Abu Dhabi, Shanghai and Vietnam.

The vision for global healthcare and the future of nursing looks beyond these shores and the narrow confines of where nursing has been in the past, and sees our nurses, who are the best in the world, going out and spreading their gospel around the world.