Covid-19: International Response

Viscount Bridgeman Excerpts

Monday 18th May 2020 Lords Chamber

[Viscount Bridgeman (Con)]

My Lords, surely one of the few good outcomes of this dreadful virus is the emergence of unprecedented co-operation among health authorities worldwide in fighting it, of which the highest profile is of course the work towards the development of a vaccine. I am grateful to the Minister for telling us the contribution of the United Kingdom. Sadly, all this is of course without the proper leadership that we could have expected from the United States.

The devotion and courage of health workers on the front line and indeed of their support teams in this country are beyond praise, but the organisation and management of the NHS is in need of review, a problem dodged by successive Governments. This is a once-in-a-lifetime opportunity—at least I hope so—for Her Majesty’s Government to take advantage of this global identity of mission to appoint a royal commission to compare in unprecedented depth the workings of our National Health Service, with all its brilliant achievements but with its shortcomings too, with those of other national health services worldwide, particularly those adopting a high profile in the current crisis, and recommend from whatever source the adoption of the best practices that the commission can identify.

Back in the 2000s, my noble friend Lord Hague, then leader of the Opposition, mandated my now right honourable friend Liam Fox, who was then shadow Health Minister, to familiarise himself with other health services in the EEA. His firm conclusion was that, for patients and clinicians, Germany was the place to be. I have checked this with Liam Fox, and his current view is that Switzerland now wins by a short head, but this is simply two centres of excellence in comparison with one another. All this would be for the royal commission for find out for itself. These are just two of the examples that we can take from some of our nearest neighbours.

Nursing

Viscount Bridgeman Excerpts

Monday 14th May 2018 Lords Chamber

[Viscount Bridgeman (Con)]

My Lords, the House will be very grateful to the noble Lord, Lord Crisp, for instituting this debate and I crave the indulgence of noble Lords for speaking in the gap. I must also ask for a further indulgence because this speech is not totally global in character. I speak as the former chairman of a central London independent hospital. Our experience, like that of many other hospitals and indeed of many patients, is of the excellence of nurses coming particularly from Australia, New Zealand and Canada. They have many attributes. On the whole they are very well trained in the British tradition. They have a reputation for being particularly good with patients, and of course they have the language. The attraction for them of coming to the UK is to work hard and save up for touring Europe, and certainly it has been the experience at our hospital that the limited stay is worth it for the service these nurses give during that period.

There is a distinct possibility that following Brexit, the number of nurses from the European Union will fall, and this has been highlighted in a rather depressing King’s Fund report published last October which many noble Lords will have received. This will obviously lead to an increase in demand for well-trained nurses from elsewhere. Incidentally, from that list of Australia, New Zealand and Canada, I deliberately omitted South Africa, because nurses are urgently needed in southern Africa, as highlighted by my noble friend Lord Ribeiro and the noble Baroness, Lady Watkins of Tavistock.

Currently, the expenses for nurses coming from outside the European Union and taking up work in this country are very considerable. We cannot do anything about geography but the fact is that nurses coming from the European Union at the moment have virtually no expenses, except possibly those of getting their English up to speed. I highlight the work done by my noble friend Lord Howe three years ago in getting the European Union to correct that anomaly. I ask Her Majesty’s Government, when they are formulating immigration policy following Brexit, to pay particular attention to minimising costly red tape and encouraging the valuable source of nursing excellence for the betterment of healthcare in this country.

EU: Healthcare

Viscount Bridgeman Excerpts

Wednesday 11th January 2012 Lords Chamber

[Viscount Bridgeman]

My Lords, I join other noble Lords in congratulating the Lord, Lord Kakkar, on his masterly overview of the subject.

In the short time available, I have to record cautiously encouraging news. Your Lordships will recall a debate on 8 September in which attention was drawn to the problems with language testing of health professionals from the EEA. My noble friend Lord Howe gave an encouraging reply at the time and, following a constructive Green Paper issued by the Commission, a draft directive was issued in December which includes three significant proposals.

The first is that a warning system is to be introduced so that regulatory bodies must warn each other if, for example, a doctor or nurse has been struck off or suspended from a register and attempts to register in another member state. The second is that there will be updated minimum training requirements for doctors, dentists, pharmacists, nurses and midwives to reflect the evolution of those professions and of education in those fields. That is particularly important with some of the newer accession states, where there is a very different culture and practice. The third is the right for regulatory bodies to check the language skills of health professionals—something for which UK health organisations have been pressing. On that point, does the department’s reading of Article 38 of the directive, especially its second paragraph, give a blanket power for a competent authority routinely to examine all applicant health professionals for knowledge of the language, which I understand to be a common aim among those authorities?

Those three proposals will have a major impact in remedying the shortcomings affecting health professions which were thrown up by the original directive. I remind your Lordships that the healthcare regulatory organisations in England, and those covering devolved Administrations where they have responsibility, played a major role in discussion on the Green Paper. Finally, I pay tribute to the Minister and his department for working with the Commission to achieve what I am confident will be a favourable and constructive development.

Health Professionals: EEA and Non-EEA Citizens

Viscount Bridgeman Excerpts

Thursday 8th September 2011 Lords Chamber

Moved By

[Viscount Bridgeman]

To call attention to the disparity in the authorisation procedures for European economic area (EEA) and non-EEA citizens who are seeking to practise as health professionals in the United Kingdom; and to move for Papers.

[Viscount Bridgeman]

My Lords, I am very grateful for the opportunity to initiate this debate and particularly grateful to those noble Lords who will speak, as notice only came last Thursday because of the Recess.

I call attention to the disparity of treatment of health professionals trained within the EEA and outside it. It is particularly marked in the case of nurses, but applies to a greater or lesser degree to all healthcare professionals. I am deliberately omitting mentioning doctors in great depth as I know distinguished doctors taking part in the debate will speak with authority on this subject. The Nursing and Midwifery Council—the NMC—is responsible for the registration of and setting standards for all nurses throughout the United Kingdom and the islands. There is no better way of viewing this disparity than through the eyes of the NMC and I make no apology for taking that route myself.

Let me summarise the main differences. Nurses from outside the EEA have to take the overseas nursing programme as part of registering. This is a comprehensive 20-day course invoking professional competency and, where applicable, a period of supervised practice of between three and six months in length. All applicants have to undergo the International English Language Testing System. The NMC is therefore in a position to exercise total control over the registration of these non-EEA applicants. Contrast this with healthcare professionals trained within the EEA, who are subject to the Commission’s mutual recognition of professional qualifications directive of 2005. Under this directive, healthcare professionals seeking to register and practise in another EEA member state have the right to do so provided that their qualifications meet the minimum standards as laid out in the directive. If these standards are met, the member states’ competent authorities—I shall refer to them as regulators, as it is rather easier—must automatically recognise the qualification and register those professionals as fit to practise in their countries. They have no option. Regulators are not allowed to undertake further competency checks, including checking whether practice competencies had been kept up to date or the applicant has basic communications skills in English.

Thus the directive does not require a migrating EEA nurse or midwife to demonstrate that they have kept their practice up to date since obtaining their training qualification. At the same time the NMC has no option but to register automatically EEA nurses and midwives, even those who may not have practised for, say, 20 years. Indeed, I am advised by the NMC that over the past year it had applications from over 1,400 EEA-trained nurses and midwives who have not practised for at least four years. Another proposal by the Commission—it is part of the revision of the directive, about which I will talk later—that causes concern is the principle of partial access. The Commission, in an otherwise well thought-out document, has suggested that professionals who have shortfalls in training that cannot be compensated by an adaption period should be registered with limits to their practice. This is simply not practicable in the case of nurses and midwives, who in the case of A&E nurses, for example, must often make ranges of critical clinical decision quickly and in pressured situations. I urge the Government to strongly resist this proposal.

I wish to cite a number of examples where, in the case of EEA applicants, the directive causes the registration process to be inadequate. First, member states’ training standards can vary greatly. For example, different countries put different emphasis on the importance of record-keeping. In inquiries that I made, I was amazed to find that several advanced countries did not have a tradition of patient notes such as we have in this country. While training in a large number is comparable to that in the UK, this is not the case with some of the newer accession countries. EEA standards for general nursing and midwifery date back three decades and do not account for fundamental changes in the professions over this time. Those changes include the use of new technologies and evidence basis, the shift from acute to community nursing and the move in some countries to a degree-level standard of training.

As regards language testing, as I said, under the directive EEA nurses and midwives applying for registration cannot be systematically tested for language competency. This is in stark contrast to the IELTS for non-EEA applicants, which includes even those from English-speaking countries. I consider that this is illogical and inefficient. Your Lordships will be aware that the directive places the onus of measuring language competency on employers rather than regulators. This has a number of practical defects, the first and crucial one being the lack of uniformity. For instance, hospital B may refuse an applicant on the ground of language competency, but that applicant may have come from hospital A where there was no problem. Not all hospital personnel departments are experienced in spotting language deficiency. A significant number of cases certainly slip through the net. The case of Dr Daniel Ubani is well known. In that case a patient died through an incorrect drugs dosage which was traced to the doctor’s inadequate command of English. Too much should not be made of this case as it was, after all, one isolated incident. However, for the reasons that I have just outlined, I suggest that there is another disaster waiting to happen. I know of one hospital where a number of consultant surgeons have refused to perform operations unless every member of the theatre team has English as his or her first language.

Here I come to the blunt instrument which will be familiar to those experienced in these matters. Until recently, the NMC required all applicants, including those from the EEA, to demonstrate at least 450 hours of practice in the three years prior to their application. However, over the past two years the Government have had no option but to request the NMC to drop this requirement as it affects nurses coming from the EEA on the ground that it is incompatible with the directive. I am told by the NMC that it has reluctantly had to comply.

On a more encouraging note, the Commission, the Department of Health and BIS are well aware of the urgency of the language and other competency risks I have discussed. Many of the risks to which I have referred could be mitigated through changes to the existing directive. A review of the directive is under way and is due to be completed by 2012. The NMC is leading a group of 25 European nurse regulators to co-ordinate their responses through the review process. As part of the review the European Commission released a Green Paper in June exploring changes to the directive. The Green Paper suggestions have gone some way to addressing concerns but they are still not clear enough. It is worth summarising what the NMC wishes to see in nurses from within the EEA registered in the United Kingdom. This is taken from its submission to Sub-Committee G—I am very pleased to see the noble Baroness, Lady Young of Hornsey, in her place—and is an excellent summary of what is expected from a nurse or midwife from the EEA seeking to practise in the UK. They should be trained to a level equivalent to that of training in the UK. They should be fit to practise within the scope of practice of the professions in the UK and they should be able to communicate effectively in English.

In the light of this the NMC has a “shopping list” which I respectfully bring to the Minister’s attention. First, minimum training requirements should be modernised to reflect the changing roles of nurses and midwives, potentially to a degree-level standard. I am talking about other EEA members here. Secondly, all EU regulators in the Community should be required to implement continuous professional development to ensure that competencies are kept up to date. Thirdly, the principle of partial access must not be applied to the healthcare professions. Finally, and most importantly—this is at the heart of this debate—regulators must be allowed to satisfy themselves of language competence at the point of registration, and employers should be allowed to undertake competency checks.

BIS, supported by the Department of Health, has recognised throughout the review process the unique position of healthcare professionals and supports many of the changes proposed by the NMC. I think that it also appreciates the urgency of the situation. The Government are to be commended for their recent efforts to strengthen a local-level system of language competency checks to be put in place at an early stage and operate until a full-scale revision of the directive is completed, which will take a number of years. I urge BIS to continue to reflect the concerns of the nursing profession in its submission to the Green Paper consultation, which closes on 21 September. I also urge the Government to continue this support when draft legislative changes to the directive are made later this year for consideration by the European Parliament and in due course by the Council of Ministers.

I hope that a feature of this debate will be patient safety. I hope that the Minister will be able to assure the House that he and his colleagues in BIS will keep up the pressure on the Commission not only to set up an interim regulatory system but to ensure that the directive as revised emerges as helping to maintain the traditionally high standards of nursing in the United Kingdom rather than acting as a hindrance, which it sadly does at present. As with any measures taken to prevent or minimise accidents, tomorrow may be too late. I beg to move for Papers.

[Baroness Northover]

My Lords, I remind noble Lords that this is a strictly time-limited debate and that therefore when the clock reaches four, noble Lords will have had their time. To go further will take either from the time of other noble Lords or of the Minister responding at the end.

--- Later in debate ---

[Viscount Bridgeman]

My Lords, I am most grateful to noble Lords who have taken part in this debate. I am slightly disappointed by the Minister. I understand that he is hamstrung by the requirements for the language testing. However, I draw the attention of your Lordships to the Green Paper where a number of quite constructive options are set out. I hope that, with tremendous support, the Government will pursue these with great vigour. I am particularly grateful for the Minister’s reassurance on the question of partial access. I think noble Lords will be reassured on that.

Turning to my noble friend Lady Hussein-Ece’s point, it is essential that the free movement of all health professionals is not impeded. I am confident that in due course satisfactory checks as to suitability and language will emerge. I should also like to thank the noble Baroness, Lady Young, for her kind words of welcome and I very much look forward to serving on that committee with my noble friend Lord Hunt. I have seen the submissions, which are of very high quality. We can expect some very interesting results. I beg leave to withdraw the Motion.

Motion withdrawn.

Health: Cancer

Viscount Bridgeman Excerpts

Thursday 11th November 2010 Lords Chamber

[Viscount Bridgeman]

My Lords, the whole House will be grateful to the noble Baroness, Lady Finlay of Llandaff, for securing this important debate. In her speech she once again reminded us of the leadership that she continues to give in this field, which is of continuing urgency. I declare an interest as a former chairman of St John’s Hospice in St John’s Wood, central London.

I will speak briefly on care at home in the context of cancer sufferers. A joint report by Healthcare at Home and Dr Foster estimates that delivering end-of-life care services at home could save the NHS £160 million, yet only a quarter of patients are able to die at home. It is worth talking through what a well organised hospice—and I am happy to say that there is a gratifyingly large number of them—is able to achieve with Hospice at Home.

The totem words are “hospital avoidance”. The core of the home service is a close relationship with community nurses and GPs. However, the important point is that there is also a team of carers without formal qualifications who are given basic training at the hospice. They will look after the patient's basic needs such as washing, bed-making and shopping. Often, they become effective counsellors, which is particularly important to long-term cancer survivors as it can restore their confidence to get back into the world around them. These carers not only provide a valuable human resources augmentation, but they can at any time call on the community support team of trained professionals and on the resources of the hospice. It has been said to me that the fact that the patient can be cared for at home is in itself one of the most valuable and effective palliative treatments. So it is, if one can use the term respectably in this context, a win-win situation. The patient, often very confused and terrified of any form of hospitalisation, has all the familiarity of home surroundings; at the same time, hospice and hospital beds are freed up and, significantly, Hospice at Home is a cost saving for the health service.

I have referred to long-term cancer sufferers, for an increasing number of whom life expectancy has been prolonged thanks to new and effective drugs. The noble Baroness referred to clinical developments in palliative care which are assisting this extension of life, which is of course pertinent to the subject of this debate. This extended life expectancy will provide additional demands on community and palliative care nurses.

The Government’s commitment to 24/7 community nursing is to be welcomed. More of concern, however, was the announcement in the comprehensive spending review that the Department of Health will no longer financially support the previous Government’s commitment, given by the then Prime Minister personally in a speech to the King’s Fund on 8 February, to provide one-to-one nursing services for every cancer patient. That said, however, I was encouraged by the remarks of my honourable friend Paul Burstow, the Minister for care services, in another place on the debate on rarer cancers on 27 October. He said that the Government are re-examining the question of one-to-one support. I shall very much welcome any further reassurance that the Minister can give on the current position and on one other small point. Can any initiative provide for the requirement that, wherever possible, a terminally ill patient’s preferred place of death is recorded? I do not need to point out how useful this information is in planning the care of cancer patients.

Women in Society

Viscount Bridgeman Excerpts

Wednesday 21st July 2010 Lords Chamber

[Viscount Bridgeman]

My Lords, we have had six sensitive maiden speeches of remarkable quality, and we look forward with anticipation to that of the noble Baroness, Lady Smith. I am not quite sure what the collective for seven maiden speakers—unprecedented in this House—is, but I am sure that my noble friend Lord Black and my noble friend Lord Deben, who is not in his place, will forgive me if I suggest a collective of “merry maidens”.

However, it is the speech of my noble friend Lord Black of Brentwood of which I am privileged to speak in appreciation. My noble friend brings to this House a long experience of the media, and his intention to contribute to discussions on the future of the newspaper industry will be of great benefit to this House. I am sure that your Lordships will wish him to convey to his colleagues in the industry the message that in their coverage of their Lordships’ proceedings there is always room for improvement.

Noble Lords will recall with admiration—and, I think, gratitude—the work that he did with my noble friend Lord Wakeham on the Press Complaints Commission at a particularly sensitive time. With his interest in museums and music, he will indeed have much to contribute to the workings of this House, and to this we look forward with much anticipation. His speech today on the role of older women was delivered with a passion and commitment which was truly impressive, addressing as it did the core of this most important debate. We are very grateful.

I now wish to speak about a very different aspect of the role of women from that raised by my noble friend in this important debate—and we are all very grateful to my noble friend Lady Verma for her outstanding leadership in initiating it. I refer to the increasingly important role of African women in the life of Africa. Women form 70 per cent of the workforce in Africa as a whole. However, despite major initiatives by the United Nations and the major donor countries—and the United Kingdom can hold its head high, particularly with the recent commitment by the coalition Government to ring-fence funding for overseas development—together with high-powered conferences, little progress has, disappointingly, been made in advancing the rights and welfare of women in Africa. The curse of malnutrition, insufficient medical aid, particularly maternity care, and of course the universal curse of HIV/AIDS, together with the custom which stretches back centuries of requiring of women both hard labour and the procreation of large families, have all placed enormous obstacles in the path of the advancement of women. We were shocked by the story which the noble Baroness, Lady O’Loan, told us about the stoning of the Somali woman; it was particularly pertinent in the African context.

Among the majority of rural and low-income urban dwellers, women perform all domestic tasks, while for many farming and trade are also included. They are responsible for the care of children, the sick and the elderly in addition to performing essential social functions within the community. Their struggle for survival often results in environmental damage, a simple example being the collection of firewood, which contributes so much to soil erosion in many parts of Africa. In many cases, women are subject to abuse, such as female genital mutilation, and they are especially vulnerable to AIDS because of their lack of power over their sexuality and reproductive functions. As an illustration, about 50 per cent of women in Africa are married by the age of 18, and one in three women is in a polygamous marriage.

Although many countries have ratified UN agreements such as the Convention on the Elimination of Discrimination Against Women, at the same time many countries have taken very few steps in translating this into better living and working conditions. The simple fact is that in many ways Africa’s development is substantially held back by excluding the perspectives, skills and dynamism of half the population. Examples of initiatives by African women that can be seen in many countries are women-only mutual aid societies, benevolent groups in churches, co-operatives and market women’s groups.

That leads me to the main point that I want to make. Several noble Lords in this debate have spoken about the importance of education, mainly in the United Kingdom context, but in Africa it is absolutely seminal. It is all too common to find that what limited educational facilities are available are still hampered by gender discrimination and unimaginative curricula that do not take into account that the majority of girls will not go beyond primary education, and they are not geared to helping girls to obtain basic life skills. Of course, there is always the temptation for parents to give priority to their sons’ education. The noble Lord, Lord Desai, who is not in his place, mentioned this in the slightly different context of India. Mothers have many complications with their daughters—adolescent pregnancy, early marriage and the burden on girls to shoulder household labour, and, sadly, in many cases their daughters are forced into prostitution for simple economic reasons. However, there are shining exceptions. In Lesotho, for example, largely due to out-migration by the men, females account for 75 per cent of students, even in higher education.

As was put so succinctly by CamFed, an America-based charity in Africa, when you educate a girl in Africa, everything changes. She will be three times less likely to get HIV/AIDS; she will earn 25 per cent more income; and she will have a smaller, healthier family. I am talking not about the giveaway of sacks of flour, which can be siphoned off along the supply chain, but about a tangible permanent investment which can go to the next generation. An educated mother with a small family is in a much better position to fulfil her ambitions for the advancement of her children. In the challenging and often depressing problem of population in Africa, education, as was so well articulated by that charity, leads to a win-win situation.