Draft Nursing and Midwifery (Amendment) Order 2018

Justin Madders Excerpts

Wednesday 20th June 2018 General Committees

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Evans. As the Minister said, the draft order amends the Nursing and Midwifery Order 2001 to provide the Nursing and Midwifery Council with the necessary legal powers to regulate the nursing associate profession. Committee members will be relieved to hear that the Opposition do not oppose the draft order. We understand the importance of bringing nursing associates under the auspices of the NMC as soon as possible.

As we heard, the nursing associate role was create in response to the “Shape of Caring” review in 2015 as a defined care role to act as a bridge between unregulated healthcare assistants and the registered nursing workforce. Now that the role has been created, we agree with the Royal College of Nursing, which stated in its response to the Government’s consultation on these provisions that

“there must be absolute clarity that the nursing associate…is not a separate profession, but a new role within the nursing family that works under the delegation of the Registered Nurse”.

It went on to ask for “urgent guidance” to be published on “the precise relationship between” nurse associates and registered nurses

“in terms of delegation and accountability”.

Although bringing both roles under the same regulatory umbrella is a step in the right direction, will the Minister confirm whether we can expect such guidance to be issued? It is particularly important to try to achieve clarity and consistency given the varied roles that associates are taking during the implementation phase, not least for their benefit and for patient safety.

Let me turn to the amendments to the 2001 order, in particular the appointment of nursing associates to relevant panels. It is worth noting that the discretion afforded to the NMC for practitioners is slightly wider than it is currently for nurses and midwives. I presume that is to take account of the initial paucity of nursing associates with relevant experience to sit on panels. The NMC hopes that sufficient associates will emerge in due course to take a more active role in the process. Does the Minister intend to keep an eye on that, to ensure that in time these roles will always be judged by relevant peers?

The Opposition support the proposed approach to education and training for nursing associates. However, as my hon. Friend the Member for Easington said, there are concerns about continuing professional development across the board. As we heard, Health Education England’s budget for workforce development has been slashed by 60% over the last two years, from £205 million to £83.49 million in 2017-18. We had an announcement about increased spending in the NHS this week, but I understand that there was nothing specifically for training. I know this is slightly outside the scope of the order, but I would be grateful for some clarity from the Minister on that.

There is also a worrying shortage of qualified registered nurses to supervise the training of nursing associates. We are certainly in favour of the approach but urge the Minister to step up the availability of continuing professional development to ensure adequate supervision and training.

[Mr Sheerman]

My hon. Friend pushed the Minister early in his remarks on whether the Royal College of Nursing was fully consulted and on board. What is his interpretation—is it on board and in favour of all this?

[Justin Madders]

It is fair to say it is on board the train. On whether it is fully behind this, it is a question of ensuring that it is done in the right way. I will go on to outline where its main concerns lie.

As the Minister will know, there is a question about substitution. I commend his ingenuity in claiming that the vacancy rate in the nursing profession is only 1%, which must be a record for the public sector. I am sure he will be talking to his ministerial colleagues about how he has managed to achieve that. There is clearly an issue with the level of money spent on agency and bank nurses in the NHS, so we must remind ourselves that the real figure is much higher.

As my hon. Friend the Member for Huddersfield said, there is anxiety about substitution, particularly in the context of the high vacancy rate we believe there is. The fact is, more nurses are leaving the profession than joining it, and there is also a demographic challenge in that one in three nurses are due to retire in the next decade. In that context, there is well-founded anxiety that nursing associates could be used as a substitute for registered nurses.

I appreciate what the Minister said about providing a bridge or a ladder between particular roles, but there may be concerns, as some trusts have acted in, shall we say, a quite remarkable or coincidental way. The Warrington hospital trust agreed to reduce the number of full-time equivalent nurses on its wards by 23.58, and at the same time created 24 new nursing associate roles. That seems quite a remarkable coincidence and shows why there will be legitimate questions about whether the order will continue to be fit for purpose if it turns out that nursing associates are taking on more of the nursing role.

[Grahame Morris]

My hon. Friend makes an important point. If nursing associates are going to be used to replace registered nurses, that is a huge concern. Everything that we have learned about some of the terrible things that have happened—including the announcement in today’s statement—shows that numbers are important, but so is the right skill mix. We have to ensure that we have an appropriately skilled nurse workforce to ensure that we deliver high standards of care in hospitals and social care settings.

[Justin Madders]

My hon. Friend is absolutely right. We need to keep a close eye on that. It is not fair on the professionals involved, and it is certainly not fair on patients, if people are asked to do things beyond their capacity or competence. The order would be a fool’s errand if we found that that became commonplace.

Was the Minister aware of the issue in Warrington, and has he made inquiries about any risks or trends in substitution? Does he intend to put safeguards in place to prevent it from becoming commonplace?

[Mr Sheerman]

Today of all days, with the vote that we will all be involved in shortly, someone should put on record the question of how far the order, which I have read carefully, applies to nursing associates coming from Spain. My chief executive at the Calderdale and Huddersfield trust said that at one stage, the hospital could not have been run without young Spanish nurses, although they are much diminished in quantity now. Under the present visa regulations, could those Spanish nurses come in as nursing associates to train here?

[Justin Madders]

I think my hon. Friend’s question is directed at the Minister, rather than me.

[Mr Sheerman]

I think I was being naughty.

[Justin Madders]

I repeat the question that my hon. Friend has posed. There is provision in the order to take account of European economic area nursing associates, I think, but my understanding is that there is not a uniform description or role that fits the narrative across the board. We are still developing that, so comparisons are not necessarily easy to make. I urge the Minister to look carefully at the guidance on delegation and accountability for both roles, so that the scope of practice reduces any risk that staff are carrying out activities and duties beyond their professional remit.

We do not oppose the order or what it seeks to achieve, but I would welcome some reassurance from the Minister on the issues that have been ventilated. The nursing associate role has the potential to make an important contribution to the NHS, but—this needs to be reinforced—it can never be a substitute for the role of a registered nurse. I appreciate what my hon. Friend the Member for Huddersfield has said, because the role will allow people to enter the profession or the nursing world without being saddled with the debts that the Government’s current policy commits them to. Of course, the Opposition are committed to reinstating the nursing bursary, which I hope will reverse the trend we have seen in the past couple of years of a downward trajectory in the number of applications and a narrowing of the groups that have applied, but I do not see that as inconsistent with what the Government are trying to achieve today.

--- Later in debate ---

[Stephen Barclay]

From memory, the fee is the same as for a nurse in the NMC, which is £120, although I am sure that my colleagues will correct me if my memory is misplaced on that. That is a flat rate applied by the NMC across the board.

The hon. Member for Huddersfield and the Opposition Front Bencher also raised the issue of overseas staff. This will be a new role, and the Prime Minister’s announcement on tier 2 visas applies to existing roles, such as doctors and nurses, whereas this role is not currently in place. However, the opening of the nursing associate part of the register will provide a new registration route for overseas nursing staff whose competence and qualifications fall short of those of a registered nurse, providing that they can demonstrate that they meet the same high standards expected of a nursing associate trained in England. Again, just as it is a ladder for his constituents, it is a pathway through which European staff could potentially enter the NHS. [Interruption.] My memory was correct: the NMC has consulted on applying a fee of £120.

The hon. Member for Ellesmere Port and Neston mentioned the guidance. The Department is working with arm’s length bodies, NHS Employers, healthcare environment inspectorates and the regulators—the NMC and the CQC—to develop guidance. That will obviously need to be in place before the first tranche of nursing associates come out of their training in January ’19. I also note his point on panels. It is a perfectly fair observation, and I take it on board.

[Justin Madders]

I think the fee is still out for consultation.

[Stephen Barclay]

It is.

--- Later in debate ---

[Justin Madders]

The figure is proposed to be set at the same rate as for a nurse. I understand that, once the NMC sets up this process, the costs will be broadly similar to those for a nurse, but the fact is that this role is designated to be on “Agenda for Change” band 4, whereas nurses are in band 5. Does the Minister agree that there is possibly an argument that the proposed fee should be slightly lower to reflect that?

[Stephen Barclay]

I see exactly the point that the hon. Gentleman raises. The NMC is consulting on that, and I think that consultation should be allowed to run its course, but I am sure that his points will have been heard by those undertaking it.

Agency spend was raised. Again, that is an area of considerable focus within the Department. It is part of the transformation that the Prime Minister signalled with the investment announced on Monday, and there is a lot of work on, for example, e-rostering and how to give staff greater predictability and flexibility, and how we can use technology to facilitate that, because that also has an impact on retention rates.

I hope I have addressed the hon. Gentleman’s points. I am grateful for his and the Opposition’s support for the new role. It is important that we increase the number of people able to access roles in the NHS, and this is a valuable pathway to enable that. I commend the draft order to the Committee.

Question put and agreed to.

Resolved,

That the Committee has considered the draft Nursing and Midwifery (Amendment) Order 2018.