Health and Social Care Bill

Lord Cotter Excerpts

Tuesday 25th October 2011 Lords Chamber

[The Earl of Listowel]

My Lords, I am reminded by this debate of my experience 10 years ago when visiting a hostel for young drug abusers in Kings Cross and speaking with the mental health nurse there. She said, “I was placed here nine months ago with three other mental health nurses. We were given no support and I am the last mental health nurse working with these very needy young men”. She was doing an immensely important and demanding job. I do not know if she was not getting her line supervision from the NHS, although I imagine she should have been. I know that there is a concern that when health professionals are placed away from the mainstream of the NHS, they do not necessarily get the support they need. One issue that I would like some clarification on, perhaps in a letter, is that of continuing professional development and the supervision of professionals even when they are working in outreach services. When they are away from the mainstream health service, they should still be getting the proper supervision and support they need.

I said at Second Reading that one cannot legislate for the NHS to care for patients, but what one can do is nurture the people who work in the health service—the doctors, nurses and physiotherapists. One can give them the best training and the best ongoing support so that they are capable of caring and being considerate. What was happening with the mental health nurse I mentioned was that she was caring in the most adverse circumstances. She had everything stacked against her. She said, “We just did not get the support. It was not thought that we needed support to do this important work”.

Concerns have been raised about future pressures on the training and development of healthcare professionals. There is also the Nicholson challenge: a lot of money has to be shaved in a short time. There is concern about fragmentation. As my noble friend Lord Kakkar said, training is an expensive process and costs professionals’ time. It might be helpful to consider for a moment what has happened in the social work arena over the past 20 years or so. One has seen a lowering of the thresholds of entry into the social work profession and a diminution in quality. Many good people are working extremely hard, but it is widely recognised that there has been a diminution in quality. I am thinking particularly of child and family social workers. They have to assess a family and decide whether a child stays in the family or is removed, a decision that will quite probably have consequences for the rest of that child’s life. But the thresholds have been lowered so far that, until recently, one could get on to a social work course with two Ds at A-level. Current social workers talk about “old school social workers” who knew the law and were methodical in their approach, and how they regret their passing.

I am grateful that this amendment has been tabled and it is right that it has been given such priority. There must be no diminution. Indeed, we must strive to improve training and support for the development of our care professionals. A particular area of concern has been that of psychiatry. We have had difficulty recruiting sufficient psychiatrists, and I understand that nowadays most psychiatrists do not have English as their first language, which is a matter of concern. I would cite the area of child mental health professionals as well. I know that the Royal College of Psychiatrists has been working hard on this, but I wanted to light this up as an area of concern.

Finally, I recently visited midwives working in a hospital in central London. I was advised that they received only one supervision session per annum. That seems an extremely poor amount of supervision. Normally in the health service it is provided every one to two months. Supervision sessions provide an opportunity to discuss, among other things, the continuing professional development needs of practitioners. I may have misunderstood the position and there may be some other context for midwives, but I would be grateful if the Minister could write to me with a bit more information about how midwives are given the continuing professional development they need.

I look forward to the Minister’s response. This is a tremendously important debate that is key to ensuring that, in the future, patients in the NHS get the quality of care they deserve.

[Lord Cotter]

My Lords, like others, I should declare an interest. My father was a GP and my wife an occupational therapist. I have taken an interest in the NHS for the past 12 years in Parliament, but I feel more intimidated than the noble Lord, Lord Mawhinney, for good reason. However, I see great merit in Amendment 2 and the other amendments in the group. As many colleagues have said in their speeches, there is a big issue here that needs to be addressed in a specific way. To be specific, at Second Reading I raised the issue of healthcare assistants. A concern has been expressed to me by others—and I read in the newspapers—that a voluntary code for healthcare assistants may just not be enough.

This morning I was speaking to a nurse and she made a very clear point. She said: “We are directing healthcare assistants in nursing and we give them the jobs to do but I do have a concern that if they do not have sufficient training they may carry out the job I have given them not particularly well and that is a responsibility which goes back upon my shoulders.”. To quote from the papers,

“It is amazing that healthcare assistants, caring for patients in uniforms indistinguishable from nurses, are completely unregistered”—

That may not be quite correct, I do not know—

“and can start work with as little as an hour’s training”.

I have highlighted this issue for later in the Bill. I hope the Minister will consider this and have time to look at it at a later stage.

[Earl Howe]

My noble friend will be aware that we have had two Oral Questions recently that have covered this point. I want to correct one point he made—our proposals are for a voluntary register, not a voluntary code. He was talking about a voluntary code. If under our proposals a healthcare assistant were to register under the voluntary system there would be a set of standards that went with that registration. The code would not be voluntary in that sense. I look forward to the later stages of our Committee debates to discuss these very important issues. We will have that opportunity.

[Lord Cotter]

I thank the Minister very much. As usual he was addressing the issues. I hope that by highlighting them again we will ensure that training is going to be really adequate for them to meet the requirements.

[Lord Mackay of Clashfern]

My Lords, I support the view that this is an extremely important issue. It is also extremely difficult and there is a lot to be done to get this right. I am an honorary fellow of two Scottish medical colleges. The contribution of Scotland to the training of doctors and nurses has to be kept in mind, and many other parts of the world also contribute to our NHS training, particularly at the graduate stage. It makes it extremely difficult to know how to cater for all the possibilities and I wish my noble friend every success in coping with this problem.