Nursing

Baroness Watkins of Tavistock Excerpts

Monday 14th May 2018 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, it is a real pleasure to follow my noble friend Lady Hollins. I draw attention to my interests as outlined in the register, and in particular as president of the Florence Nightingale Foundation.

I thank my noble friend Lord Crisp for securing this timely debate, because 12 May was International Nurses’ Day, which I spent at the RCN Congress with 4,000 other nurses in Belfast. Many of them came from countries outside the UK, including nurses who trained in the EU, the Commonwealth and from other parts of the globe, yet currently work in our four countries. This collective of nurses demonstrated that we need to think about the nursing workforce as a global resource, as opposed to manpower planning being thought of in a vacuum country by country. There is evidence that, it we think and plan strategically, nurses can be key to the achievement of the universal health coverage strategic development goal.

In the excellent Library briefing for this debate, we are reminded that there are an estimated 43.5 million health workers around the world and that just under half, 20.7 million, are nurses and midwives, yet Global Health Observatory data suggests that half the World Health Organization member states have fewer than three nurses and midwives per 100,000 head of population, and a quarter fewer than one. WHO estimates that a further 2.8 million nurses and midwives will be needed in Africa and 1.9 million in south-east Asia by 2030. Will the Minister indicate in his reply how the UK will contribute to increasing the global healthcare workforce over the next decade through targeted investment?

Investing in nursing makes economic sense. As the UN High-Level Commission on Health Employment and Economic Growth argues, there are three impacts from investing in and developing the healthcare workforce: improved health outcomes for populations; global health security, particularly through the reduction of transmittable diseases; and economic growth through job creation. The report further suggests that there should be a focus on reforming aid and accountability for health system strengthening, with a focus on skilled health workers, which, it suggests, could initiate a new era of international co-operation and action for economic and human security.

My noble friend Lord Crisp has already reminded us that investment in nursing will enhance women’s equal participation in the economy, which the UK mission to the UN has already emphasised is vital to the eventual gender equality of women globally. That is not to say that we should not increase the male population in nursing too. In turn, one would anticipate a reduction in violence towards women if they are in a position to be financially self-supporting through working as nurses or other healthcare workers, thus enabling them to leave abusive relationships where they were previously held in economic handcuffs, and to work with other women in their communities to prevent cycles of abuse. How can the Government promote partnership and mutual learning between the UK and other countries to bring shared benefits?

The UN high-level commission makes a number of recommendations for reform, including at least four enabling actions: mobilising leadership, enhancing investment, aligning accreditation across the globe— as the noble Lord, Lord Willis, has implied—and strengthening global learning. I would welcome the Minister’s opinion on how we will monitor our successes and challenges in relation to the enabling actions suggested within the five-year timeframe of 2016-21. Is now an appropriate time to take stock and set some clear, measurable goals for the UK’s investment in associated issues?

This must of course include developing our own workforce, as outlined by many other speakers in the debate, rather than continuing to rely on healthcare workers from overseas to staff our NHS and social services; depleting countries where there are already severe shortages in order to assist us is, to say the least, ethically questionable. However, overseas nurses are welcome here and opportunities for exchanges, strategic partnerships and alliances should always be promoted.

We know that nurses play a powerful and effective role in a range of healthcare settings and that many work in communities where they have lived for long periods. This makes them culturally sensitive and acceptable to the people they serve. The work that nurses have undertaken in Africa to reduce communicable diseases illustrates the effectiveness of their interventions. They continue to work to reduce the level of HIV and AIDS through health promotion. Similarly, nurses work with children and adults who have experienced extreme violence due to conflict and war, assisting them with mental health interventions as well as treating physical wounds.

Nursing Now, the global campaign to raise the status of the profession worldwide, involves more than 40 countries with the backing of their respective Governments. The campaign was instrumental in influencing the World Health Organization to appoint a chief nurse to its new leadership team. How long will it be before England has a chief nurse at the Department of Health and Social Care, part of whose remit should include an international dimension? Can the Minister tell us how the Government have invested to promote nursing globally to date, and whether they will increase that investment with associated clear objectives to ensure that the triple impact of such investment on improving health, gender equality and strengthening economies may be measured? One method has been clearly identified in the interim report by the noble Lord, Lord Darzi, reviewing healthcare in this country. It states:

“Governments must stop approaching the NHS and social care as a liability to be managed and instead look at it as an investment that delivers a return. Good health is an asset”.


How can we ensure that health is really perceived as a human right through investing in healthcare workers globally? Does the Minister agree that at least in part, we must do this by further investment in our own workforce in the UK and making the nursing profession a desirable choice for young people here at home in the future? In this way, we will also become less dependent on recruiting excellent nurses from overseas and enable middle and lower-income countries to train and retain nurses in their own communities.