Nursing

Lord Ribeiro Excerpts

Monday 14th May 2018 Lords Chamber

[Lord Ribeiro (Con)]

My Lords, it is a real pleasure to follow the noble Baroness, Lady Cox, in this debate. She is a renowned globetrotter when it comes to humanitarian missions in Africa and other lower and middle-income countries. It was also a privilege to succeed her as president of my old school, Dean Close.

The noble Lord, Lord Crisp, to whom we owe this debate, in his book Turning the World Upside Down, referred to by the noble Baroness, Lady Bottomley, records meeting the founder of the Bangladesh Rural Action Committee in his headquarters within sight of the slums of Bangladesh. He asked him how the world could make faster progress in reducing death in childbirth. His reply was, “Empower the women”. That single statement is what this debate is all about, for a high proportion of nurses globally are still women.

A hundred years since women got the vote in the UK, they have scaled unimaginable heights, with many in the top echelons of the NHS, in management as chief executives of hospitals, in the Department of Health or as consultant nurses. That is not so in many lower and middle-income countries. Here, I declare an interest as a member of the All-Party Parliamentary Group on Global Health, which in 2016 took evidence on the future development of nursing globally. The most telling comment in our report was that nurses,

“are frequently not permitted to practise to the full extent of their competence; are unable to share their learning; and have too few opportunities to develop leadership, occupy leadership roles and influence wider policy”.

A commonly held term that has long been rejected in the UK was that, in not being able to utilise their skills, nurses were essentially “handmaidens” for doctors and had no scope for development. There are of course cultural and social barriers within developing countries which reinforce this stereotypical view, and it is time it was challenged. More must be done to empower women, who represent 90% of the nursing and midwifery workforce.

Another aspect of the Triple Impact report by the APPG on Global Health was the highlighting of workforce issues and the impact of migration. As noble Lords will know, I come from Ghana, which after 60 years of independence has faced many challenges in healthcare. I had worked there for a year in 1973, so can attest to the improvements nationally since that time. However, this evidence from Janet Kwansah on incentives for rural service among nurses in Ghana is worthy of note. She said:

“Like many countries in sub-Saharan Africa, Ghana is faced with the simultaneous challenges of increasing its health workforce, retaining them in country and promoting a rational distribution of staff in remote or deprived areas of the country. Recent increases in both public-sector doctor and nurse salaries have contributed to a decline in international out-migration, but problems of geographic mal-distribution remain”.


Brexit will have a significant impact on the UK, as Europe currently supplies the highest proportion of overseas nurses, at 29%. Brexit will see many European nurses leave, and the UK will have to resist the temptation to recruit nurses from lower and middle-income countries, as it has done in the past. The dilemma will be how to induce European nurses to stay, while avoiding the targeting of countries with nursing shortages. I ask my noble friend the Minister what strategies the Government have in mind to overcome this problem and the concern that I am sharing with the House.

Finally, I want to mention a new initiative funded by the National Institute for Health Research—the global surgery unit. I declare an interest as chairman of the independent advisory board of that group. Its purpose is to undertake surgical research to improve health outcomes in lower and middle-income countries through developing pathways for surgical innovation. The aim is to deliver sustainable changes in surgical practice in operating theatres in three continents, supported by a consortium of three UK universities: Birmingham, Edinburgh and Warwick. It will deliver the project through five overseas limbs in central America, west Africa, southern and eastern Africa, and south Asia, and will involve 40 lower and middle-income hospitals. We hope that this will not only have an impact on front-line surgeons but encourage nurses to participate, raising their profile and encouraging others to consider a career in nursing, as nurses are seen as part of the extended team and not merely as the handmaidens of doctors.

When I was president of the college and subsequently, I was privileged to undertake various visits to east Africa—to Ethiopia, Malawi and other countries—taking surgical teams to train local surgeons in surgical procedures. One thing we always did was take a nurse with us—Judy Mewburn. She was a great asset because, while we were teaching the doctors how to carry out surgical procedures, she would take the nurses aside and show them how to set up the trolleys in a sterile way. It is that collaborative approach of doctors and nurses working together that I believe will make a big difference. We see the benefits and effects of teamworking in the UK, with nurses being much more involved in the work of doctors. I hope we will be able to take some of those messages overseas and, by doing so, empower women to take up nursing and to provide the best possible care for their patients.