Queen's Speech

Baroness Emerton Excerpts

Thursday 3rd June 2010 Lords Chamber

[Baroness Emerton]

My Lords, I, too, welcome the noble Earl, Lord Howe, to the government Front Bench and offer him my congratulations on his appointment as Minister for Health. I am sure that his experience, knowledge and wisdom will be invaluable in taking forward the five priorities set out by the Secretary of State for Health and the long list of proposals within the health section of the coalition programme for Government. I also congratulate the noble Lord, Lord Hill, on his appointment and his mastery of the subject in his opening and maiden speech. I welcome my noble friend Lord Kakkar to the Cross Benches and congratulate him on his maiden speech. I am sure that his expertise in the area of medicine will be of great benefit to the deliberations of this House.

As I read the coalition Government priorities in the health section, I could not resist casting my mind back to 1953 when I started as a student nurse. At that time the ward sister reigned supreme and the matron was to be obeyed not only by the nurses but also by doctors and administrators alike. In my time, I have experienced six major reorganisations of the NHS, all of which had good points. I agree with my noble friend Lady Murphy that changes of organisational structures are sometimes good, but there are also things which are not so good. The one that stands out and disappoints me is the lessening of authority and accountability of the ward sister and the community sisters through to the director of nursing, both in hospitals and in the community. Therefore, I am delighted to read that:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care. We are committed to reducing duplication and the resources spent on administration … We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line … Doctors and nurses need to be able to use their professional judgment about what is right for patients, and we will support this by giving front-line staff more control on the working environment”.

It important for us to note that professional judgment and working with more autonomy and higher levels of the critical thinking and problem-solving skills are core elements at the heart of the Nursing and Midwifery Council’s review for pre-registration education and the move to the degree, under which the Nursing and Midwifery Council register will from 2013 require all registrants to have a degree. All those standards have a clear synergy with the Government's vision of the role of the future professionals in the NHS. The proposals all echo the recent recommendations of the Burdett Trust for Nursing in Leadership and the Business of Caring, the RCN’s recent work on strengthening the role of the ward sister and the most recent recommendations of the Commission on the Future of Nursing and Midwifery Professions.

I very much hope that the coalition Government will grasp this opportunity to develop and enact those policy statements with the benefit of improving the quality of patient and client care; ensuring that there are clear lines of accountability and authority well-defined and understood from the patient, the client and the public level through to the board level, including enhancing the role of the nursing voice at board level; and being knowledgeable of the wider context of the NHS, conversant with modern nursing practice and measuring clinical outcomes both in hospital and in the community.

It is also important to note that the announced cuts in finance will not exempt the multi-professional education and training budgets and that the current £4.8 billion will be reduced by 10 per cent, most affecting undergraduate and postgraduate education in medicine and dentistry. The £0.8 billion which is used for continuous professional education and national innovations is the most vulnerable. That raises concerns about the Government's ambition to raise quality of care standards and the future shape of the workforce. Balancing the necessary cuts to meet the overall deficits will require the highest quality of medical and nursing professional management skills to ensure a workforce that will protect the safety and well-being of patients, together with the priority to raise the profile of public health, which will require knowledge and expertise so that clinical outcomes of patient experience and safety are met, as well as meaningful health promotion and prevention of disease being developed further.

I refer to two other important issues. The Government have said that they will seek to stop foreign health professionals working in the NHS unless they pass robust language and competency tests—a crucial policy requiring action to change the current interpretation of the EU legislation, the professional qualification directive 2005/36. This prevents regulators from assessing the language competence of EEA professionals before admitting them to the registers. Currently, assessment is left to employers, not the regulators, and ignores the fact that many health and social care professionals are independent practitioners who practise outside the NHS and formal management assessments. The Nursing and Midwifery Council exists to safeguard the health and well-being of the public, and all nurses and midwives on the register should be safe and effective in practice, but the regulator is not permitted systematically to language-test trained applicants, therefore undermining the integrity of the register and presenting a risk to the public. The situation is also confusing to employers, applicants and the public, leading to a potential risk to the health and well-being of the public.

I ask the noble Earl to ensure that the 2012 review of directive 2005/36/EC on the recognition of professional qualifications reflects these concerns. Health and social care professions from outside the UK make a significant contribution to healthcare in this country, but patient safety must always take priority over free movement of labour.

While I share the concern of my noble friend Lord Sutherland about the delay in the introduction of long-term care and the suggestion of a commission, I hope that the Government will quickly take forward the commission and bring forth a sustainable structure of funding for long-term care. The part played by nurses and social care workers will be crucial in establishing the three Ps: prevention, personal and partnership. I should like to add the three Cs: care, compassion and communication, which are all essential ingredients that the public are looking for, especially in the light of the recent inquiry about Mid Staffordshire that demonstrated so clearly unacceptable levels of care. It pointed to the need for a highly competent workforce, high levels of supervision and management within a culture conducive to demonstrating compassion and communication with the flexibility to cross boundaries from health to social service and other partners. There is no doubt that there is a formidable list of proposed policies and I wish the Government well in taking them forward.