National Health Service — Motion to Take Note

Part of the debate – in the House of Lords at 12:25 pm on 14th January 2016.

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Photo of Baroness Watkins of Tavistock Baroness Watkins of Tavistock Crossbench 12:25 pm, 14th January 2016

(Maiden Speech) My Lords, I thank the noble Lord, Lord Turnberg, for tabling this debate, in which it is a great honour as a Member of this House to make my maiden speech.

My career started in 1973 as a nursing student in close proximity to this House at Westminster hospital where, on a more personal note, I was fortunate to meet my husband, a surgeon. I thank him for his support and encouragement in embracing my appointment to this House. Although I do not mean to be controversial today, I can assure your Lordships that this is difficult for me, having extensively argued the merits of investment in nursing versus medicine, surgery versus mental health, and acute care versus community care throughout the 40 years’ experience I have as a nurse and regular practice with a surgeon at home. In turn, this led me to a deputy vice chancellor role at Plymouth University, with responsibility for student affairs, including a range of health programmes. I have more recently been involved in chairing academy schools, working as a non-executive director in the NHS and the Aster Housing Group. I also undertake charitable work in drug treatment centres and in the care of older people.

I thank noble Lords on all sides of the House for the warm welcome that has been extended to me since my arrival and all the staff of the House for the assistance they have given me. I also thank my two supporters—my noble friend Lady Emerton and the noble Lord, Lord Kestenbaum—and my mentor, my noble friend Lord Patel, who tells me that he is watching this from India.

The vision for the NHS is for a modern, efficient and sustainable NHS where care and compassion matter. It has been argued that an integrated approach could both improve the quality of care for patients and improve productivity. Numerous studies have shown that an increase in the number of registered nurses in hospital and community settings is associated with clear benefits for patient mortality rates and other key metrics. Patient outcomes are enhanced if care is co-ordinated and, where necessary, delivered by registered nurses. If hospital admissions are to be reduced, rapid assessment in patients’ own homes from a range of healthcare professionals is vital. Yet are we doing enough to ensure that we are training sufficient numbers of healthcare professionals to achieve and sustain integrated care as outlined in our strategy?

In the early 1980s, as a “nursing officer for change”, I worked in a large mental hospital where over 1,000 beds were closed and replaced with community-based services. The key to the largely successful project was that all clinical staff were provided with further education and development to prepare them for the changes in their role. Community care is now the norm for those who have mental health and learning disability challenges, and most care is successfully delivered in a range of health and social care settings. I would argue that we are not so successful in providing acute healthcare intervention in people’s own homes, as evidenced by increasing admission rates to hospital, yet other countries successfully provide more care in the community. We hardly have an ideal situation at the moment.

Key to successful community care for people with the most acute medical problems and long-term conditions is the number and kind of nurses that are available to work in a range of settings, yet we know that we have an international shortage of qualified nurses which is estimated to be at least 20,000 in the UK alone, resulting in increased agency staff costs and, perhaps more important, reduced continuity of care. Happily, the number of nursing places in universities is set to rise this year, but for the next three years we will have the lowest output of registered nurses because of previous short-term cuts. The noble Lord, Lord Willis of Knaresborough, has indicated that we need to put training at the very heart of the NHS agenda, and that lifelong learning is essential. If we want a thriving healthcare structure, we must ensure that we have a workforce that is provided by the voluntary, social enterprise and independent sectors as well as the NHS. We need to recruit, train and retain care assistants, who provide support for individuals in their homes working with registered nurses.

In a recent letter to the Times, the noble Lord, Lord Hunt of Kings Heath, concluded that the NHS is currently remarkably robust considering the level of investment. I agree, yet as others have said today, funding remains relatively stable in real terms and the only way to resource the future is to redesign our service to meet future challenges. Nursing is pivotal to this. In the current situation, the role and complexity of nursing is poorly understood, especially the role of the registered nurse with a degree. I can assure noble Lords that degree-level nurses are not too posh to wash, but can do so only if they have enough time to do it with care and compassion, as well as overseeing others who can deliver care well. The Guardian recently suggested that NHS leadership is ailing, but pointed to the Florence Nightingale leadership scholarships as an area of good practice. We must provide more opportunities for leadership development to ensure a supply of competent leaders who are able to respond to changing demand and lead the redesign of services for a sustainable NHS.

I have argued that registered nurses are pivotal to greater NHS productivity. This will require valuing and investing in the profession not only in terms of education and opportunity but by demonstrating for tomorrow’s care workers kindness and compassion in employment terms, so that this, in turn, is reflected in the care they give not only to us in this House but to society at large in the four countries of the United Kingdom.