NHS: Long-term Sustainability

Baroness Chisholm of Owlpen Excerpts

Thursday 18th April 2024 Lords Chamber

[Baroness Chisholm of Owlpen (Non-Afl)]

I congratulate the noble Baroness, Lady Ramsey, on a very moving and brilliant speech. I also thank my noble friend Lord Patel for bringing this timely debate to us today. As he mentioned, community will play a vital role in the future sustainability of the NHS. I will speak briefly on community nurses, who deliver, along with the help of care assistants and families, bespoke care to individuals in their homes and the community. It is not unusual for these professionals to live in the area where they carry out their work, leading to—I feel this is a key point—them having the added advantage of often being aware of the families’ circumstances, bringing the continuation of information, relationships and management. They foster an organic connection for patients and their families—care that is delivered to the community from birth to death.

We all know that primary prevention avoids the manifestation of disease, improving health through information and lifestyle behaviour, which includes dietary and nutrition interventions along with vaccinations, strategies to promote sexual reproductive health, family planning and mental health well-being. If this healthcare can be provided in the community in family hubs, schools, the workplace, medical centres and homes, it obviously frees up hospital beds and unnecessary GP appointments.

However, from what I have read, 4,000 district nurses are providing care for a population of around 55.8 million. That is one nurse per 14,000 people, whereas there is one GP per 1,600 people. The fall since 2010 equates to almost half of NHS community matrons and district nurses, and 29% of health visitors. Health equality is achieved when everyone has a fair and just opportunity to be as healthy as possible. Community-based nurses are well positioned to play an important role in addressing the underlying causes of poor health.

We are all well aware that it is vital that we move from concentrating solely on treatment and management of disease to prevention and social needs. Embedded within the community, community professionals are well positioned to build trust. They see first-hand the limitations associated with those they are involved with, be it in housing, family, mobility, transportation or dietary issues, to mention just a few. They connect and engage with partners from across social, health and other services. That is the ideal, but without the professional numbers required to carry out this vital work and giving them time with their clients, along with time to report back to the multidisciplinary team, none of the above can be achieved.

It is an attractive career that provides flexible working and a diversity of roles as an autonomous and independent practitioner. With the use of modern technology, there should be more productive time with clients and less paperwork. But a survey done by The Queen’s Nursing Institute in 2022 found that, in practice, the application of digital technology is poor. The survey pointed out that poor user experience appeared to be around design and function rather than a lack of computer literacy or enthusiasm. It went on to highlight problems with unsuitable hardware and software, lack of integration and repetition of data entry, as well as a lack of compatibility between different computer systems. That is disappointing. Can the Minister tell us what has been done in this regard and what is being done to raise the level of community nurses and encourage nurses to go into this genre of nursing?

In conclusion, over the past few weeks we have had a record fallout of the workforce due to long-term illness. Community nursing enables patients to remain independent in their homes with bespoke care, which is obviously beneficial to their health, economically beneficial to the NHS and beneficial to the productivity of the country. I have rather rattled through this, but as with sustainability of the NHS, time is of the essence, and it is the same in this Chamber.