Nursing

Baroness Jolly Excerpts

Monday 14th May 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I join noble Lords in congratulating the noble Lord, Lord Crisp, on calling the debate and on the APPG report. It has been an excellent debate, with informed contributions from noble Lords across the House.

We are here to talk about the all-encompassing importance of investing in nursing around the world. As serendipity would have it, a Minister’s response to a Written Question popped into my inbox this morning. This was the Question:

“To ask the Secretary of State for International Development, given the UK Government’s recent recommitment to defeating malaria, if her Department will increase investment in community-based primary healthcare programmes in remote, rural communities”.


This was the response from the Minister, Alistair Burt:

“DFID supports low income countries to make faster progress towards universal health coverage, with a particular focus on improving access to good quality primary care in poorer, very often remote areas. This support to strengthening health systems helps to ensure that countries are better able to prevent, detect and treat all causes of ill health”.


I am sure that noble Lords will agree that this came as quite a useful prologue to thinking about the debate.

Who better to deliver these changes than nurses? Nurses are an integral part of the global health workforce. Universal health coverage promotes the notion that, despite where one is in the world and the economic situation people find themselves in, each global citizen has the right to quality healthcare. As a country proud of its NHS and its irreplaceable facilities, this notion is close and dear to our heart. Yet nurses around the world, including here in the UK, face 21st-century obstacles. Health systems remain fragmented and endure systemic troubles that impede the quality of care. Communities are experiencing disengagement from participating in elevating their own health. Funding is often mismanaged, misplaced or misguided. Our own health obstacles surrounding Brexit pose a challenge to staffing. Research into universal healthcare has brought to light issues that affect most, if not all, countries with a healthcare workforce: their training and education, staff shortages, problems with recruitment and retention and limited accessibility to proper resources. Some of those sound quite familiar to us here at home.

Of course, countries vary greatly from an economic, social and political perspective. That is why, to combat such issues and signal nurses’ irreplaceable status to the world, the All-Party Parliamentary Group on Global Health published a critical report on nursing’s unique Triple Impact. I congratulate the noble Lord, Lord Crisp, on again putting his finger on the pulse. The report claims that investing in nursing globally progresses gender equality, builds strong economies and improves the health of all. Equality, prosperity and health: three fundamental legs that nursing strengthens. As the noble Lord said, that is a no-brainer.

On fortifying the equality, wellness and wealth of not just our own country but countries around the world, the report sets out several detailed recommendations and the practical applicability of each: nurses as policymakers; nurses developing their own potential through the Workforce 2030 initiative of the World Health Organization; nurses as leaders; nurses driving research, and nurses being empowered and therefore empowering other women.

Let us not forget the “global” aspect of investing in nurses globally. The UK must be a willing, active and successful participant when working with, and learning from, leading global health organisations. The exchange of health knowledge only improves Britain’s soft diplomatic power with nations of the world.

The noble Lord, Lord Crisp, mentioned gender; the noble Baroness, Lady Bottomley, mentioned prescribing. I wonder whether the noble Baroness was a Minister or Secretary of State at the time, but I remember two key changes which transformed the dynamic among health professionals and improved healthcare in my home county of Cornwall. The first was the de-medicalisation of community hospitals in the 1990s, turning them into effective, nurse-led step up, step down units; and, a bit later, the establishment of effective minor injury units in those hospitals. With those two changes came the impact of nurse prescribing.

GPs, predominantly men, were suspicious of both innovations, but now, 20 years on, nurses, predominantly female, have proved that with appropriate training and support they can lead healthcare in a local setting. Thinking of a global parallel, I remember several years ago the noble Lord, Lord Ribeiro, and I joining a party to Zambia. We visited a hospital out in the bush. Much like our community hospitals in Cornwall, they were then nurse-led very effectively, with not a doctor in sight. Doctors are great, but we do not need them all the time.

I return to the global agenda. Next month, we celebrate 70 years of the NHS. Twenty years ago, I was at the NHS Confederation conference to celebrate 50 years of the NHS. One of the most impressive speakers was the Health Minister from South Africa, who implored us not to poach her nurses. That country invests a significantly higher proportion of its GDP than us in training nurses. She asked us to desist and let them develop their strengths and health services in country. That is as important 20 years on as it was then.

Sponsored by the World Health Organization and the International Council of Nurses, Nursing Now takes these recommendations and works towards creating a world community that offers nurses more acknowledgment, security and authority. Nursing Now reminds us that the great power nurses hold, especially in this dynamic and cautious time, is unmatched and has a long reach. I would be grateful if the Minister told us how DfID intends to engage in this way, and what might be the timescale and the short-term and long-term investment.