My Lords, when my noble friend Lord MacKenzie rose to speak, he said that he had had to tear up his original speech because of the speeches made by my noble friend Lady Wheeler and others, and I feel the same about mine. My noble friend made an excellent speech on the health service and on nursing in particular, and I should like to be fully and completely identified with what he said. However, there are a couple of things regarding this issue that I do not think were dealt with in that speech or in others, and I should like briefly to say something about them.
The first concerns nursing and nurses spending more time with patients and more time on the ward. My noble friend Lord MacKenzie implied that it was time to get nurses back to basics. It is part of the current ethos about the problem in the National Health Service that nurses are not spending enough time on the wards. Certainly, given the Francis report and other things, I can understand why that might be thought to be the case. At the same time, in my experience, it is crucial that we do not overlook the importance of high-quality nurse managers. Matrons and charge nurses are managers as well as nurses. Their clinical qualifications and expertise as clinicians are not always matched by their qualifications and expertise as managers and leaders.
Basically, hospitals work in teams. It is only teams that deliver. Anyone who has been a patient or worked in a hospital will understand that nurses do not work in isolation; they work in teams. Skills are needed to build and develop a team, to take it forward, to fill a gap, to look after an absence, and to deal with a crisis. All those important skills have to be learnt and developed by nurse managers. It is important that that is said.
In the past 10 years, developments have taken place in the commercial sector and some parts of the charity sector, and investment has been made in helping people to become high-quality managers and leaders. I am not sure that that same development has taken place in the National Health Service. We need to address that. I do not know whether the Minister would be kind enough to write to me about the ambitions in this respect. I do not expect chapter and verse, but I should like to know the direction of travel in making sure that we have world-class leadership among our nursing staff. It is worth using that word because in order to deal with the problems that we have seen in the Francis report we need that kind of ambition.
Secondly, on what I would call an holistic approach to patient care, again, the drum-beats at the moment are about patients left on trolleys and nurses not caring properly. However, the patient experience is about a lot more than a nurse and a doctor. It is about something much more fundamental and basic. If the first call to a general practitioner’s surgery is badly answered by an inattentive receptionist, it is the first step towards a bad patient experience. In the National Health Service, it is possible to have several bad patient experiences before you ever meet a clinician. It is very important that people who work in all professions—nursing, non-nursing and supporting professions—understand that the patient experience begins with them.
Everyone has responsibility for giving good patient care, including the GP who does not have time to listen properly to a patient, and the consultant who is too busy to explain exactly what the issues are and what might be done to help a patient’s situation. These skills are not taught in medical school or nursing school. I ask: are they taught or are they picked up? It is expected that these skills will be picked up and learnt on the journey from being a clinical practitioner to a manager and a leader. My opinion is that often those skills are not learnt and that they are badly lacking in a lot of health service experiences. We need to do something about that.
The skills required are those of listening, empathy and understanding. Sometimes they would be called soft skills, but they are crucial in the health service. Patients feel vulnerable, worried and anxious about what will happen to them, so it is very important that everyone who works in the health service understands that the patient experience begins with them and that they are responsible in just the same way as doctors and nurses. If it not too much trouble, I would not mind a note from the Minister about how that wider holistic approach to patient care, not just by clinical practitioners, doctors and nurses, is seen. I ask everyone in the health service to be aware of the importance of the patient experience.