Nursing Quality and Compassion: The Future of Nursing Education

Baroness Emerton Excerpts

Tuesday 11th December 2012 Grand Committee

Tabled by

[Baroness Emerton]

To ask Her Majesty’s Government what is their response to the recommendations of the report of the Commission established by the Royal College of Nursing Quality and Compassion: the future of nursing education.

[Baroness Emerton]

My Lords, I am grateful to have this opportunity to seek the Government’s response to the commission looking at quality with compassion in the future of nursing education. First, I pay tribute to the Royal College of Nursing for commissioning this independent commission at such a critical time in the life of the nursing profession and congratulate the noble Lord, Lord Willis, as chairman, and his team of commissioners. I also thank those who gave the evidence that resulted in such a clear, comprehensive report with 30 recommendations, all pointing to urgent action being required of the profession it if it is going to be equipped to deliver high-quality care with compassion. It is so desperately needed today and will be very much needed in the future with growing demographic trends and the increase in the elderly population with increasing healthcare needs and, at the same time, rising costs of treatment. Within the last week, we have had the example of an MP describing the terrible treatment her dying husband received from nurses. At the other end of the spectrum, the NHS Commissioning Board’s chief nursing officer, Jane Cummings, introduced her vision of nursing with a culture of care, compassion, courage, commitment and competence for the future.

I declare an interest, as recorded in the register, but in particular as someone who has been closely involved in developing the profession’s move into higher education, and the introduction of Project 2000, as a chair of the regulatory body, the UKCC. The Willis report clearly sets out the time taken since the Briggs report to reach the point we are at 41 years later, on the eve of a graduate programme being fully implemented in September 2013. When introduced, Project 2000 produced many adverse comments, as the report says, due to inadequate preparation of all concerned, in the universities and the providers. By not working together, we are experiencing adverse comments as to whether it is necessary for graduate training to give compassionate care. This report demonstrates that registered nurses, educated at degree level, are more than equipped to deliver high-quality compassionate care. It says:

“The public needs to know what it can expect of registered nurses educated at degree level. Stakeholders should scale up recruitment campaigns and other measures, including dialogue with the media, to promote better understanding of contemporary nursing and nursing education and dispel the myth that better educated nurses are less caring”.

Perhaps I and colleagues have not had the courage to stand up and be counted to ensure that the 41-year gap did not exist. The document goes on to identify the urgent need to supply an academic nursing workforce and guarantee its future quality. The NHS Commissioning Board, the CCGs, Health Education England and the local education boards hold the responsibility for commissioning the right number of students to fill the right number of places to deliver the patient care pathways for well-being, public health, hospital care, and community care through the health and social care services, not forgetting the voluntary services.

The mandate to the NHS from the Secretary of State does not include Health Education England. This is funded directly by the Secretary of State but there does not appear to be a mandate, only an outcome measurement. This is but one of the 30 recommendations. My question to the Minister is: how will the Government ensure that what is necessary will be provided to enable the responsible bodies to adopt the recommendations of the report? We cannot afford a further delay in implementing these recommendations, as has been the history of Project 2000 and graduate training. We should not forget that the initial graduate registration is not the end; there must be provision for professional development and postgraduate development, with investment in research to allow evidence-based practice and innovation.

I have listened to a number of recent briefings and the evidence to date is that the medical professions—I exclude the medical professionals present—have little or no recognition of other professions’ contributions to delivery of care, research or innovations. Again, this is probably the professions’ fault for not speaking loudly enough to be heard and included or providing the evidence to support their case. It may also be a reflection of the status of the nursing profession as viewed by other members of the health teams which is now beginning to erode the public’s view. The answer surely must rest in the hands of the members of the professions.

The serious current economic situation presents many challenges. However, the evidence to date is that the delivery of high-quality care is cost effective in reducing complications, early discharge and reduced mortality—in other words, high-quality care is not only cost effective but safe and acceptable to the public. The recommendation relating to workforce planning describes the need to address skill mix. It states that there is an urgent need to revisit the workforce policy and skill mix and suggests:

“A planned programme of regulation should begin with the mandatory registration of all staff who deliver patient care”.

This, of course, includes support workers. It is a false economy not to follow this recommendation. Although the Skills for Care and Skills for Health bodies are due to report in January, it is a requirement of the Act to have a voluntary register.

The report recommends that there should be mandatory training and registration for support workers. Can the noble Earl please give an assurance that this issue will be revisited? At Third Reading of the Health and Social Care Bill it was said that the costs would be too high. Is it possible for a more recent up-to-date analysis of the cost to be carried out, as the one quoted was taken from a 2009 cost of a housekeeping scheme which does not equate to the work of the healthcare support workers? There is a growing awareness within the profession and among the public that there are insufficient registered nurses in some parts of the health service, more especially on wards for the elderly. However, there is a higher ratio of registered support workers where most in-patients have multiple conditions and require the skills of registered nurses. Action is required to produce a more accurate and sensitive workforce plan.

Time does not allow me to explore more of the report and its recommendations, but it is essential to note that, despite all the recent bad press and the criticism of the nursing profession, there is evidence of excellent care being given by dedicated, caring and compassionate nurses and support workers. It is also encouraging that the students interviewed showed great enthusiasm for the profession they had chosen, and were determined to hold high the traditions. Where this is obvious, it reflects good leadership of the profession and an organisational culture that fosters high-quality, compassionate care within the framework of the NHS constitution. I hope that Her Majesty’s Government will take on board the recommendations so ably set out in the commission’s report.