Nursing

Lord Collins of Highbury Excerpts

Monday 14th May 2018 Lords Chamber

[Lord Collins of Highbury (Lab)]

My Lords, I too thank the noble Lord, Lord Crisp, for initiating what has become a timely debate. Of course, it was not originally scheduled for now, but it has been incredibly timely, for all the reasons that noble Lords set out in the debate. I also thank the noble Lord, Lord Willis, for putting out a tweet earlier about trying to prompt a debate among nurses. At my early morning swim at 6.30 this morning I ran into a couple of nurses—it is true, I was there. I spoke to a nurse and he then subsequently tweeted about tonight’s debate and it generated quite a thread of comments, which I really appreciated. One thing I am certain about is that nurses certainly have a lot to say and are showing concern, not just about their own situation but about the global situation. The most common thing I heard was that health and disease know no boundaries. We have to address this and see it as a global issue.

A key goal of the UN’s 2030 development agenda is that everyone in the world should have access to healthcare—universal health coverage—and that nobody should be left behind. Today’s debate and the Nursing Now campaign make the case very strongly that this cannot possibly be achieved without strengthening nursing globally. This is partly about increasing the number of nurses. One thing we have heard in the debate, and certainly I read it on Twitter today, is that nurses have real concerns on staffing, inadequate facilities and resources, and the lack of effective support. All these things impact negatively on the ability of nurses to provide a safe and effective service. But strengthening nursing is also, as we have heard, about making sure their contribution is properly understood and enabling them to work to their full potential.

As the Global Health APPG report, in which noble Lords participated, said, strengthening nursing will have a triple impact in improving health, promoting gender equality and supporting economic growth. I shall return to that point later. To bring about the change we have heard we need, we really need to persuade politicians to work with the profession, addressing how nurses are perceived. Their potential is, sadly, overlooked because of strict hierarchies and engrained ideas about what nurses can and cannot do. I hope the Minister will take up the suggestion of the noble Lord, Lord Crisp, of a high-level meeting with the profession, so we can talk about these issues, not just in the context of the National Health Service but how DfID’s strategy is addressing these issues globally.

As the noble Baroness, Lady Masham, said, Ebola taught us that tackling that crisis required the strengthening of healthcare systems: growing the number of primary healthcare staff and their training; building scientific capacity in diagnostics and public health labs; and supporting public health messaging and outreach generally. Of course, this touches on education, which is such an important element of primary healthcare. Many countries have had insufficient investment in their health systems. Universal health coverage can make more countries resilient to health concerns, particularly about new diseases that may emerge, before they become widespread emergencies.

Another clear lesson from Ebola was the role of community engagement, which has all too often been regarded as a soft and relatively non-technical add-on to medical interventions. A good example, which I know I have raised in previous debates, was the DfID-funded social mobilisation action consortium in Sierra Leone, which brought together the local BBC Media Action group, the Centers for Disease Control and Prevention, Focus 1000 and Restless Development. Through their activity those NGOs, working with community and religious leaders, and partner radio stations covering every district in Sierra Leone, achieved tangible behavioural change around safe burials, early treatment and social acceptance of Ebola survivors. The stigma of disease is another issue that we have to address through education.

As noble Lords have said, the health professionals closest to the communities are the nurses, who are promoting good health and preventing disease as well as providing care at the community level. They are at the heart of most health teams. They support and supervise community health workers and link to more specialist care when needed.

The noble Lord, Lord Crisp, spoke about the £5 million which is certainly an extremely welcome grant from DfID. However, I want to hear from the Minister tonight just how DfID is translating the lessons that we have learned from the Ebola case, for example. How are we translating those lessons into specific action, particularly in Africa? We have heard about ageing populations and the rapid rise of diseases such as diabetes and heart disease, which are putting all health systems across the globe under strain. But in poorer regions, that comes on top of the burden of infectious diseases such as HIV/AIDS and malaria. The global shortage of health workers means that there simply are not enough to tackle these threats.

This debate has highlighted not only the importance of nursing but the work of our international development strategies. It has highlighted the fact that we do not deal with health simply in isolation. We must see these as global threats but also as having global solutions. It is not only that other countries can learn from us but more importantly, as the noble Lord, Lord Crisp, has said, that some of these innovations, particularly in Africa, are ones that we can learn from. That is why we should be focusing on this issue, and I welcome this debate.

[The Minister of State, Department for International Development (Lord Bates) (Con)]

My Lords, I, too, welcome this debate and join others in paying tribute to the noble Lord, Lord Crisp, for securing it and for the enormous personal contribution which he has made to raising the profile of nursing both here in the UK and around the world. The debate has drawn on the immense depth of expertise that resides on this subject in your Lordships’ House.

It is worth noting, for the record, as I found when I prepared for the debate, that contributions have come from two nurses—crucially, I start with them—but also from a former Permanent Secretary and a former chief executive of NHS England, a former Secretary of State and Minister of State for Health, as well as a fellow and an honorary vice-president of the Royal College of Nursing, a former president of the Royal College of Surgeons, a former president of the Royal College of Psychiatrists, a professor of nursing and a former hospital chairman.

[Lord Collins of Highbury]

I do not know what category I fit into.

[Lord Bates]

Swimmers, of course, are doing health promotion, and we pay tribute to the noble Lord’s work in this area.

This has been an excellent debate and I will respond to some of the points. The noble Lord, Lord Crisp, set the tone by reminding us of the critical role that nurses play in ensuring the delivery of holistic, patient-centred healthcare. The noble Baroness, Lady Bottomley, reminded us that nursing is the most trusted of professions. That carries wider benefits to health efforts. The noble Lord, Lord Willis, reminded us that nurses can be a catalyst for change in developing countries. The noble Baroness, Lady Masham, reminded us of the courage of our NHS volunteers who went out to tackle the outbreak of Ebola in Sierra Leone. The noble Baroness, Lady Cox, gave many powerful, practical examples of nursing achievement in delivering clinical care in remote and challenging situations. My noble friend Lord Ribeiro hit the nail on the head when he spoke about the role that nursing has in women’s empowerment, which is critical across so many areas.

The noble Baroness, Lady Hollins, talked about how nurses could be there in early intervention in mental health conditions. The noble Baroness, Lady Watkins, spoke about seeing nurses as a global resource in delivering the sustainable development goals relating to health. The noble Viscount, Lord Bridgeman, reminded us of the costs and administrative burdens faced by those coming to study nursing in this country. The noble Baroness, Lady Jolly, summed it up by saying that nursing delivers equality, prosperity and health. The noble Lord, Lord Collins, reminded us that, in these matters, the issues of health and disease know no national boundaries in the way they operate and therefore that they demand a different set of solutions.

I congratulate the noble Lord, Lord Crisp, and the noble Baroness, Lady Watkins, on their leadership on this issue since the launch of Nursing Now, which, the noble Lord, Lord Willis, reminded us, was attended by Her Royal Highness the Duchess of Cambridge and was a great success. I am delighted that my colleague, the Minister of State at the Department for International Development, Harriett Baldwin, attended and used that opportunity and platform to announce our support for nursing globally and for the campaign through our health partnership programme, starting in 2019. It is a £5 million programme that a number of noble Lords have welcomed. It will be allocated to focus on nurses and midwives. The programme is designed to address the priorities identified by countries and will focus on nurse leadership where it is part of a country’s health workforce strategy.

Through these partnerships we will work with countries to build comprehensive and effective healthcare systems, not just to deliver separate projects. The programme brings benefits to developing countries and to the UK health system from the increased skills and motivation that UK health workers acquire when working overseas. That is why this campaign recognises the vital role of nurses at the centre of every health system around the world. Nurses account for nearly 50% of the global health workforce. Their knowledge, skills and motivation are crucial in delivering health services to all, including to the poorest.

As the Triple Impact report and the Nursing Now campaign highlight, many countries are grappling with enormous challenges, including shortages, skills, gaps in leadership and challenges mentioned in particular by the noble Lord, Lord Crisp. In the UK, nurses are at the heart of our NHS. We want to keep these hard-working staff and build a workforce fit for the future. My noble friend Lord Ribeiro and the noble Lord, Lord Willis, among others referred to concerns they had about our capacity to train the nurses we need. We have announced 5,000 more nurse training places from 2018, alongside new routes into the profession and continuing measures to improve the work/life balance.

Globally, the World Health Organization and the World Bank estimate that countries will need to create around 40 million new health and social care jobs by 2030—a point raised by the noble Baroness, Lady Watkins. Low-resource countries, where these are needed most, face the greatest shortages of 18 million health workers. We must support them to train and deploy the health workers they need so they can access essential health services.

The noble Lord, Lord Ribeiro, spoke about the importance of the retention of trained staff in Ghana. The noble Baroness, Lady Jolly, spoke about her experiences at the conference and talked about the importance of the retention of staff in South Africa. The noble Baroness, Lady Watkins, rightly raised ethical questions about recruitment from some developing nations. That is why the UK Government support the World Health Organization’s Global Code of Practice on the International Recruitment of Health Personnel, which ensures that developing nations that are experiencing critical shortages of healthcare staff are not targeted for recruitment.

As the noble Lord, Lord Crisp, has argued, this is not just about health services. Investments in the health workforce go beyond improving health. The health sector offers employment opportunities for women and strengthens local economies. The UN High-Level Commission on Health Employment and Economic Growth, which the noble Baroness, Lady Watkins, referred to, found that in 123 countries women make up 67% of workers in health and social sectors. The noble Baroness, Lady Bottomley, and the noble Lord, Lord Crisp, referred to this as well. The commission has estimated that women would take between 59% and 70% of additional jobs created in education, health and social services. These opportunities will be even more important in low-income countries, where women are often excluded from formal employment.

To promote these opportunities in the health sector, a DfID programme in Bangladesh, for example, is aiming to ensure that 4,300 licensed midwives are employed. Some 30% of these will be in remote areas, providing opportunities to young women where other formal employment opportunities are scarce. To deliver and sustain this triple impact, the Government remain committed to working in partnership with countries to strengthen their health systems by improving their health workforces, including addressing the global shortage of nurses and midwives, to ensure that no one is left behind. DfID improves access to and the quality of health services by supporting training, mentorship and supervision for health workers; for example, in Kenya we have trained 7,000 nurses and midwives in emergency obstetric and newborn care. This has already resulted in a 10% reduction in maternal deaths.

Our programmes also invest in nurse leadership, which the noble Baroness, Lady Bottomley, referred to. Through a UK partnership, 20 nurses in Uganda have been trained by UK volunteers in nurse leadership for palliative care. I think the noble Lord, Lord Crisp, referred to this programme. These nurses have supported the training of 154 other health workers and empowered them to take on care traditionally delivered by doctors and to broaden access to palliative care.

In the time available I will turn to some of the questions that were raised. If I do not cover them all, I will of course write. The noble Baroness, Lady Masham, and my noble friend Lord Bridgeman asked about EU nurses leaving after the referendum. Overall, there are 3,600 more EU staff working in the NHS since the referendum. We have seen a small reduction in the number of EU nurses working in the NHS over the period. However, this is due mainly to the introduction of new language tests by the Nursing and Midwifery Council.

The noble Baroness, Lady Cox, asked about healthcare in challenging conflict situations. The UK Emergency Medical Team, including nurses, spent over six weeks training more than 3,000 Rohingya people, with local Bangladeshi nurses working alongside them, learning vital infection prevention and control skills. The local nurses are now tackling diphtheria in the Cox’s Bazar camps.

The noble Lord, Lord Willis, was right to pay tribute to Jackie Smith, the Nursing and Midwifery Council chief executive, who has announced that she is retiring. We join the noble Lord in paying tribute to her leadership of the NMC over the past six years and wish her every success for the future.

The noble Baroness, Lady Watkins, wondered, after the World Health Organization’s appointment, how long it would be before there was a chief nurse at the Department of Health. The Chief Nursing Officer for England, Jane Cummings, advises the Government on nursing workforce issues. We are delighted that her office is working with the noble Lord, Lord Crisp, and the noble Baroness, Lady Watkins, on the Nursing Now campaign.

The noble Baroness, Lady Bottomley, spoke about the Commonwealth connection. I am pleased to confirm that Nursing Now representatives took part in a recent Commonwealth summit event through the Commonwealth Nurses and Midwives Conference.

The noble Lord, Lord Crisp, asked whether nurses were at the forefront of health strategies. The UK recognises the critical role played by nurses. Our bilateral programmes, our support for the World Health Organization’s leadership and our investments in strengthening health systems all promote this essential role.

The noble Baroness, Lady Hollins, asked about mental health and specialist nurses. We recognise that nurses deliver specialist services. The UK funds a research programme called PRIME and a programme in Ghana, improving the care of patients with mental health issues. The disability summit in July this year will highlight the need for services to be inclusive and cater for all needs so that no one is left behind.

There is a wealth of expertise in this area in this House which has been demonstrated in this Chamber today. We remain open to other ideas on how we can build on our commitment to support nurses and midwives through health partnerships.

The noble Lord asked me a specific question on the round table. I will take that back and talk with my ministerial colleagues about it. It seems a sensible way forward and I know that the Ministers Burt, Baldwin and others have appreciated their engagement with him on the Nursing Now campaign. Through DfID and other departments we are committed to playing a part in enhancing the vital contribution of nurses and midwives in healthcare and prevention for all, especially for the poorest people in developing countries.