Nursing Quality and Compassion: The Future of Nursing Education

Earl Howe Excerpts

Tuesday 11th December 2012 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the noble Baroness, Lady Emerton, has been a tireless champion of the values and standards that underpin good nursing. This debate, on which I congratulate her, is therefore no surprise. Listening to her excellent speech reminds us once again of her long-standing expertise and wisdom in the field of nurse education and the regulation of the nursing profession.

My noble friend Lord Willis published his very comprehensive and helpful report into the future of nurse education in November. The report was the result of deliberations by his independent commission, which was established by the Royal College of Nursing under his consummate chairmanship. On publication, the report was handed to the chair of the RCN for her consideration. It was not a report to the Government and we will therefore not be formally responding to it. However, I recognise that its 29 wide-ranging recommendations are important and, as this debate has shown, need to be given due weight and consideration by leaders of the nursing profession.

As part of government changes, a new Secretary of State for Health was appointed this year. He has clearly stated that he has four priorities for his term in office: to improve the general quality of care, including nursing care; to rise to the challenge of caring for people with dementia; to improve the management of long-term conditions; and to reduce avoidable deaths from the major diseases. These priorities, importantly, impact on nursing care and nurse education and come as national nursing leaders have also changed significantly during the year. As part of the Health and Social Care Act, which passed through your Lordships’ House earlier this year, the NHS Commissioning Board was established, alongside the separate creation of Health Education England, both of which have prominent nurse leaders.

The noble Baroness, Lady Emerton, asked for some assurance that these bodies will take full account of the Willis report. Jane Cummings has been appointed chief nursing officer for England on the NHS Commissioning Board and Lisa Bayliss-Pratt is director of nursing for Health Education England. Both have significant leadership roles in the education and training of nurses, and I can tell the noble Baroness that they are looking at the Willis report in detail. Health Education England takes over the Secretary of State’s duties for ensuring an education and training system fit for purpose, and the chief nursing officer for England and the director of nursing for Health Education England will collaborate very closely in that regard.

My noble friend Lady Cumberlege asked what would make the report really live. It has a high degree of resonance across the profession already, with nurse leaders in the vanguard who will help ensure that it does not gather dust. Earlier this month, Compassion in Practice, a vision and strategy for nurses, midwives and care staff in the NHS, public health and social care, was published jointly by the chief nursing officer and the director of nursing in the Department of Health and lead nurse for Public Health England, Viv Bennett. Compassion in Practice articulates the values and behaviours expected of nurses, midwives and care staff. These values and behaviours are expressed as the “six Cs” of care, compassion, competence, communication, courage and commitment, each of which resonates with findings and recommendations of the Willis report.

This is not a vision without action. One area for specific action will be to ensure that the NHS, public health and social care services have the right staff with the right skills in the right place. This means that staff will be recruited for their values and behaviours as well as their capability to be lifelong learners. This point was made by a number of noble Lords. Importantly, the Willis report recognises how demanding and rewarding the practice of nursing is. It states very clearly that it found no evidence that revealed any major shortcomings in nursing education that could be held directly responsible for poor practice or the perceived decline in standards of care.

My noble friend and his commission are unequivocally supportive of degree-level registration for new nurses. This commitment by the Nursing and Midwifery Council will be fully implemented by September 2013. I am aware that the noble Baroness, Lady Emerton, too, is fully supportive of that. When it comes to achieving this change to nurse education, my noble friend Lord Willis rightly emphasised that educating nurses is a partnership between the NHS and universities. The noble Lord, Lord Hunt, was right to emphasise that. Student nurses cannot qualify and register if they have not satisfied both the university and, in practice settings, their NHS mentors, who formally assess them for their practical skills and knowledge as well as for their values, behaviours and ability to give care with compassion.

The compulsory state regulation of currently unregulated health and social care support workers in England is a topic that has arisen throughout the debate. It is a live issue in the nursing profession. We recognise the need to drive up standards among health and social care support workers, and have commissioned Skills for Health and Skills for Care to develop a code of conduct and national minimum training standards by January 2013. In addition, the Professional Standards Authority will have powers to accredit voluntary registers from this month. The Skills for Health and Skills for Care work will, for the first time, set clear national expectations about standards for these workers.

Health and social care assistants already work in environments that are subject to regulation by the Care Quality Commission. The Independent Safeguarding Authority can take action to bar them from working in regulated activity. Further, the work they do should be delegated to them and managed by staff—usually nurses—who are themselves subject to professional regulation and should not be asked to undertake a task for which they are not trained. The care given by health and social care support workers is at the heart of NHS-funded services. We plan to keep this under review in the light of the findings and recommendations in particular of the Francis inquiry, which is due to be published in the new year, to ensure that the system and process remain fit for purpose. I will repeat what I said yesterday at the Dispatch Box. The Government’s mind is open but we need to ensure that there is a good, evidence-based case before proceeding with mandatory regulation.

The noble Baroness, Lady Emerton, asked whether there had been a more recent cost analysis than the 2009 data of registering healthcare support workers. The answer is, not to my knowledge. Clearly, the cost of regulating 1.8 million health and social care support workers would be significant, but the basis of our decision not to regulate was not cost. Those who advocate regulation of support workers sometimes speak as if regulation were a panacea. I do not believe it is in any way a substitute for performance management. The duties of a support worker are always delegated from a responsible registrant, usually a nurse, as I have mentioned, and that fact could not, and should not, change.

If the concern is that we are somehow exposing patients to unacceptable risk by not regulating, then again, I do not think the assumption underlying that suggestion—that regulation would be the answer—is valid. It implies that support workers are inherently dangerous, which I do not accept at all. If a support worker were to be seen as a danger then, as I have mentioned, the Independent Safeguarding Authority has a vetting and barring scheme which can prevent unsuitable support workers being employed.

My noble friend Lord Willis asked about research as part of a nursing degree. I absolutely agree with what he said in that regard. It is already, in fact. Nurses, as undergraduate nurses, will be able to critically appraise research. Some will wish to become researchers and there are nationally funded clinical academic training schemes to support this.

A number of noble Lords, including the noble Lords, Lord Hunt and Lord MacKenzie, spoke about nurse education. Planning the number of nurses and the size and shape of the workforce has to be based on the needs of the people in our care. Services must be properly designed around the care and treatment that people need and these decisions could result in the need for nursing numbers to change, and very often they do.

At present, SHAs work with local employers to determine nurse training commissions. From April next year, Health Education England assumes national leadership for a new system of planning and developing the entire healthcare and public health workforce. HEE will ensure that the shape and skills of the future health and public health workforce evolve to sustain high-quality health outcomes in the face of demographic and technological change.

From 2013 all nurse education programmes will need to meet the new education standards set by the NMC and we support the NMC’s decision, as I have mentioned. It is the right direction of travel if we are to make all nursing degree level and if we are to fulfil our ambition to provide high-quality care for all.

Time is against me, so I will endeavour to cover just a few more questions but I will write to noble Lords with answers to other points.

The noble Lord, Lord Kakkar, asked me about preceptorship and I listened to his remarks with interest. Preceptorship is a development framework for newly qualified practitioners which, as he outlined, aims to ensure the smooth transition from student to qualified, accountable practitioner through a programme of bespoke support. It is predominantly administered through employment. We plan to develop the preceptorship framework further during 2012-13 within a clinical leadership framework. Work has commenced on that project and should be delivered by next April.

The noble Lord asked about deans of nursing schools signing off candidates after a period of preceptorship. That is an interesting idea which I do not believe has been fully discussed across the profession. I will ask officials to test the proposal with the Nursing and Midwifery Council and the Council of Deans of Health.

Will we support schemes for the fast-tracking of nurse leaders? That idea is most definitely supported and we have committed to £40 million in 2013-15 for leadership development that will assist aspiring and talented nurse leaders. Unfortunately, time prevents me from expanding on that, which I would like to have done.

The noble Lord, Lord Hunt, asked about monitoring standards of care by students. It is right that nurse education is a partnership between the NHS and universities, as I have mentioned, and it is true that the NHS must be more involved with the selection of students. Health Education England will work on that.

I think my time is now up. I thank noble Lords for a very rich and rewarding debate which, as I have mentioned, I will follow up in writing to all noble Lords who have spoken.