– in Westminster Hall at 12:00 am on 24th May 2006.
Good morning,Mr. Cook. It is a pleasure to see you in the Chair today overseeing our proceedings.
I am delighted to have secured this debate on nursing. The NHS is made up of many people who have created the fantastic, modern NHS of today, but I want to concentrate on the role of nurses, their practice and nurse education. Nurses are to be found in all sorts of settings, but often they are stereotyped—certainlyI was during my 25 years as a nurse in the health service—as someone who wears a nice blue dress, has an upside-down watch and struts up and down like Hattie Jacques. Of course that is not true—although, to be honest, I was quite bossy. In fact, nurses are to be found in all parts of today's NHS. We have acute nurses working in our hospitals, and community nurses doing an excellent job in the outside world. There are those who help people with severe learning disabilities and those who care for people with mental health problems, and then there is the fantastic work done by occupational health nurses.
It would be great to tell the House of all the hideous and despicable things that I had to do as a nurse—not intentionally but in the course of my duties. I sometimes hear nurses say, "Oh, things are not like they were in my day," but I hope to demonstrate that nursing has developed into a serious professional career, with opportunities for development that were never thought of even 20 or 30 years ago. It is important to set the scene and to lay to rest the belief that everything was wonderful 30 years ago and that life for nurses is now a piece of cake. I firmly believe that that is not true. Life can be extremely difficult and nurses are doing an excellent job in a very busy NHS.
Since the time of Florence Nightingale, nurses have been at the forefront of development and improvements in health care. We need only look out of the window to see—if the blinds were open, we could see it better—the first school of nursing, founded by Florence Nightingale at St. Thomas' hospital. It is appropriate to debate nursing today because nurses have responded well to change. On the whole, they have been at the cutting edge of innovation and development in patient care.
Nursing has never been a job that anyone could do only for money. It has always been called a vocation, and that is how many speak of it, but I often thought that that was an excuse for paying nurses badly and for not respecting and understanding the work that they do. I am glad to say that nurses today are given the right resources and the money that they deserve, and that they have become part of a profession.
My hon. Friend is right to point out the real increases in nurses' pay since 1997, but we also need to offer proper financial support to nurses and midwives during training. There is a high attrition rate in midwifery training and larger bursaries are needed, partly because entrants may be more mature and have caring responsibilities. It can be a financial struggle to get to the end of the course. Does my hon. Friend think that the new Under-Secretary of State for Health, our hon. Friend Mr. Lewis will announce something today that might improve that situation? We greatly admired the talents that he demonstrated in his previous post.
I remember well being involved, with other hon. Members, in campaigning for a decent bursary for student nurses. I am well aware of the issues that affect nurses, certainly mature nurses. We want people of all ages to join the nursing profession, because that enhances the richness of the profession, which should not be a career choice only for those in their late teens. I understand that there are issues that particularly affect older people with families who are trying to develop their careers. I hope that the Minister will comment on that subject this morning.
Probably when my hon. Friend and I did our training, we not only received a salary but had employment protection. We had protection against unfair dismissal, for example, and women, who might have fallen pregnant during their training, also had the protection of maternity leave. Should we consider going back to those days instead of having a bursary? Students would still attend university, but would be associated with a local health board.
I completely understand my hon. Friend's point of view. He has a long history of campaigning on behalf of nurses. Having a salary was attractive, but it was very small and I suspect that, if it were set at the same rate, it would be completely inadequate for nurses today. In addition, we immediately became part of the work force as nurses, but had enormous difficulties in getting the classroom education that we so desperately needed. I believe that there is a middle way: we can properly reimburse student nurses for the work that they do, even if they are supernumerary to the nursing team on the ward, because they play a huge role. We need to respect and understand that.
Returning to why people become nurses, it is important to understand that nursing is a career of positive choice, with pathways of opportunity and clinical development. Nurses are no longer the handmaidens of consultants, doing as they are told. Life is very different for nurses today.
As I mentioned, my experience is very much hospital-based; I served 25 years in my local hospital on both day and night duty. I am pleased to see the hon. Members here, particularly my hon. Friend Ann Keen, who has enormous experience in the community. I hope that she will be able to catch your eye, Mr. Cook, so that we can hear more about community nursing. Many other Members present also take a great interest in the issues.
We must accept that things have changed for the better for nurses in respect of their stature and how they are regarded. However, we must also accept that life for today's nurses can be very hard. Their work load is much greater because we are treating people more successfully: thousands of people walking around today would probably not have survived 35 years ago. People are living longer, thank goodness, and many more are being treated through a whole range of interventions and treatments that were never seen before.
I first started nursing on a 25-bed ward. In those days, I could probably rely on 10 of those patients being relatively well, up and about and able to help with the tea trolley. It was not unusual for a patient to spend 10 days in hospital after a hernia operation. Now such patients would leave hospital the next day. We can only imagine the pressure that that puts on nursing staff to ensure that the bed is clean and fresh for the next patient. We accept that nursing is a different kettle of fish now from what it was years ago. Hospitals are no longer places where people convalesce.
I strongly support the aims of the White Paper "Our health, our care, our say: a new direction for community services". Recovering at home or in a setting other than hospital is by far the better option, but it must be well supported by good nursing staff and systems. That is why I am such a keen supporter of the proposals to broaden the opportunities for people to recover in their own home, where we know they do much better psychologically than if they were left in hospital. However, it means that today's 25-bed unit will contain 25 people needing intensive nursing and treatment.
Many of the changes that have taken place in the health service have been led by nurses. They understood that when a patient is recovering, being at home and being more active is the best option. We no longer condone patients being left in bed in hospital, waiting for the visiting hour when people can come to see them for a short while. Nurses have developed models of care to define nursing care in this century, and tremendous efforts have been made to ensure that nurse education leaves student nurses fit for practice.
To return to the intervention by my hon. Friend Mr. Devine, 30 years ago a nurse would spend six weeks in the school of nursing and then go straight on to a ward. Obviously, other nurses would provide support, but that was a very scary situation to be in and we should never condone that practice again. In the days when 10 of the 25 patients were relatively well, we could support such a practice, but today it would be dangerous.
Medicine has transformed what happens in the NHS. We no longer have generalist surgeons or medics and there are no generalist nurses, either. Nurses soon specialise in a particular area and deliver specialised care. I remember well the days when, for example, over-65s who had had a heart attack would see a consultant physician, who would say, "Well, old chap, you've had a heart attack, so I'll ask you to go home and rest and we'll see how you are in a couple of weeks." Today's NHS would never treat anyone of that relatively young age in such a way; it ensures that all that can be offered is offered. I am glad to say that there has been a tremendous fall in the number of people dying of coronary heart disease, because of the specialist intervention. However, none of that can happen without nursing staff supporting innovations, ensuring that people have the intervention that they need and get the care and support that they need when they get home.
Today's nurse education is very different from what it was years ago. Nurses are empowered through education, and not only to deliver excellent care. They are also encouraged to challenge what is offered to patients, to think of new ways of delivering care, to respond to patients' needs and to act as an advocate on their behalf. The Council of Deans and Heads of UK University Faculties for Nursing and Health Professions has been doing tremendous work to ensure that nurse education is of the highest standard. A recent statement on nurse education from the council said:
"Education programmes should seek to ensure that students have the knowledge, skills and expertise to practise in a culturally diverse environment and develop lifelong learning skills".
The statement refers to skills such as flexibility, scholarship, questioning, analysis, critique and the use of evidence. I was not taught to challenge or use critique—the very idea would have been frowned on when I did my nurse training.
My hon. Friend is in touch with the midwives at the Stroud maternity unit, which is threatened with closure. Yesterday, I received a letter from the university of the West of England saying that it was important to keep such facilities open so that they could provide training for midwives. Does my hon. Friend agree that nurses and midwives will not have proper training facilities for nurses and midwives if we contract NHS facilities?
As chair of the all-party group on maternity, I am very aware of the issues facing the Stroud birthing unit. I also know that my hon. Friend is a keen supporter of the nurses there and that he is keen to ensure that that excellent unit survives. He is right about nurse education and continuing education, and when trusts face difficulties—I shall speak a little more about this—they should be wary of cutting budgets in ways that result in their not training as many of those entering the profession or continuing their education afterwards. That would be a false economy, and none of the innovations that I described would have happened without a well educated, empowered work force. I thank my hon. Friend for raising the subject.
I have talked about how different training has become. Today's nurse education includes increased practice-based learning, which we called for very strongly. We felt that in the Nursing 2000 initiative there was an overemphasis on classroom activity and not enough emphasis on practice-based activity, and the change has been warmly welcomed.
My hon. Friend mentioned training, and I want to put the issue to the Minister in the hope that we can have an ongoing dialogue to ensure that training budgets are secure and ring-fenced. That would give acute trusts and primary care trusts the ability to continue investing in their most precious commodity—their staff.
Nurses who are in practice now are having a very different time from their predecessors, and I look with envy at some of the activities and innovations that are taking place. I like to keep in touch with what is happening and I have assisted in the Royal College of Nursing leadership programmes for modern matrons, which has helped me to understand some of the issues that those people face.
Nurses continue to press for greater autonomy, and nurse organisations across the board, including trade unions, such as Unison, and the RCN, continue to ensure that nurses introduce new ways of practising. Talk of evidence-based practice is now typical in every nurse setting, as nurses ensure that they continue to deliver the best care to patients.
Nurses who have been through nurse education have a responsibility to other team members. I am delighted that more than 80,000 more nurses are working in the NHS, but there has also been a huge increase in health care assistants, and nurses have a responsibility to ensure that those assistants receive the best training so that they can assist in care giving. No one is better placed than nurses to ensure that health care assistants receive the training, education and continuing development that they desperately need.
I endorse what my hon. Friend says about the important role that health care assistants play. Does she agree that secondment, which offers health care assistants a route into qualified nursing, is enormously important? I read the accounts in the very helpful debate pack that the Library prepared for the debate, and it was alarming to find that getting a secondment place seems to be something of a lottery. Does my hon. Friend agree that it would be helpful if the Minister addressed those points?
I am deeply grateful to my right hon. Friend for that intervention, because I wanted to go on to talk about securing finance to ensure that workplace development goes on. The secondment programmes are excellent, and as he says, places are hard fought for, but there are other ways to get into practice. I congratulate Unison on its work with the Open university in helping people, including mature people, in the workplace who cannot afford to give up their jobs and start training for a completely new career. It encourages them through high-quality training, in partnership with the Open university, to develop their skills. An excellent programme was recently launched for social workers working in a care setting who choose to go on and develop their skills. There are routes other than secondment, and we should use those methods to make sure that people have an opportunity to develop. After all, what is better than someone who understands the profession becoming a health care assistant and then deciding to go on to become a registered nurse? The only way that we can truly guarantee quality of care is to secure the budgets and, once again, I ask the Minister to say a little about that.
There have been fantastic innovations in nurse education, and I am particularly taken with the role of modern matrons. They have provided highly visible and accessible leaders for nurses and have given nurses the sense that there are tremendous career paths open to them, which will ensure that they stay in the profession. That has always been a problem—the health service used to lose many good nurses into management, because they felt that there was no reason to remain in practice as there was no sensible career path for them. It is different today.
Modern matrons are there to drive up clinical standards and to empower nurses to take on a greater range of clinical tasks to improve care. Recently, the matrons charter, which was designed as an action plan for cleaner hospitals, has been warmly welcomed. Such nurse-led initiatives are beginning to make our hospitals a much better, nicer environment. In fact, Beverley Malone of the Royal College of Nursing has said:
"we are pleased to see such a clear government understanding of how important it is to empower matrons."
Another fine initiative is the role of nurse consultant. It was first referred to in 1999 in the strategy document, "Making a Difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare". Those nurses came into being in January 2000.
I have examples of both a modern matron and a nurse consultant making a huge difference in their setting. Lynne Phair, a nurse consultant for older people in Crawley primary care trust, is doing tremendous work in ensuring that there is better care for older people when they leave hospital and go into the community. In addition, she is working in partnership with Crawley borough council to deliver education to groups including Age Concern, health care assistants or friends and family visiting older people at home, to ensure that older people do not become ill if there is a heat wave—although I am slightly worried that the weather will never warm up.
There were many headlines in 2003 about how many people in France died as a result of the prolonged hot weather; estimates range up to 15,000, I believe. We should not forget that 2,000 older people are estimated to have died in the UK from heatstroke and heat exhaustion because they were not given the right equipment or treated as they should have been to reduce the threat of heatstroke. Lynne Phair is working in partnership with the borough to ensure that everybody understands what to do and what advice to give; she is producing really good information and certificates to get that message across—and it is getting across to many people. That is just another example of how the role of nurses has changed.
Another fine example of a modern matron is Faye Butler, from the dermatology department of the Newcastle group of hospitals. People with dermatological problems face massive waiting times and it is extremely distressing if a patient suffering from a skin problem has to wait weeks to see someone. Thanks to Faye Butler's leadership and the work of the rest of the team, those waiting times have been hugely reduced. In fact, people are referred straight away to see the dermatologist and to get treatment that week. That is a huge change, which was made through nurses taking a lead.
There are other innovations, such as nurse prescribing. We were just talking about it when I was leaving the profession in 1997, but now there has been a huge expansion in how nurses can prescribe drugs. We would like to see more, but that was a difficult argument fought in the face of a medical profession that was uncomfortable with it. I think the profession now accepts that it was the right innovation and that we are able to treat more people more quickly and fulfil our pledge to ensure that people have the care thatthey need.
Many of us see the way in which cancer care has been transformed in our communities. The two-week waiting time is not achieved merely by a consultant, of course. The nursing staff are there to ensure that patients, mostly women in breast cancer cases, can attend the clinic and have a day there, get a diagnosis and either leave the department skipping and laughing or get the extra care that a breast care nurse can offer, and to provide that continuing care through treatment. Nurses are prepared to put that innovation into action and to ensure that we respond properly.
The same applies to efforts to tackle methicillin-resistant Staphylococcus aureus. Every nurse knows that the problem is not just the result of high bed occupancy. Anybody who does any serious work into health care-acquired infections knows that they are very complex. I was pleased to see the trade unions and the Royal College of Nursing come together with the Department of Health to develop an action plan to reduce the incidence of MRSA, which is proving extremely successful. It is dishonest to say that MRSA is caused just because hospitals are over-busy. That is not the whole picture and I hope that the Minister will be able to say a few words on that.
As I have said, we have seen massive changes in the health service thanks to the nurses who have ensured that it can change. The number of qualified nurses working in the NHS has increased by 23.4 per cent. Recently, there have been concerns and many headlines about redundancies in the nursing profession. Distressing though it is to those affected by such redundancies, we should set that against the backdrop of more than 85,000 more nurses. None of us would support the loss of nurses just because of money issues, but we must accept that many more people are working in the NHS.
That is why I was completely bemused to see what looked like a staged event when the Secretary of State was greeted at the Royal College of Nursing conference. I was nursing at a time when the trust that I worked for suffered real-terms cuts: it did not merely have a standstill budget, but its allocation of money was cut. Yet whenever we saw on the news the Secretary of State at the time being greeted by the Royal College of Nursing, we never saw such events. I wonder whether we need to be a little more sensible about our campaigning.
I apologise to my hon. Friend for being able to be here for only part of the debate, and I congratulate her on securing it.
As a former nurse and a former president of Unison, I wonder whether she shares my concern about the way in which the Royal College of Nursing treated the Secretary of State for Health. During the debate, I have heard about the innovations and good things that are happening in health and nursing as a result of mature dialogue between the unions and the Government. It was appalling of the RCN to treat the Secretary of State like that. I suffered similarly when I was president of Unison, but that came from a Trotty militant element—[Laughter.] Unison had problems along those lines. I attended a congress as president and the shouting and heckling was a distressing experience that I did not deserve. The Secretary of State certainly did not deserve to be treated like that, and the RCN should be ashamed of itself.
I am deeply grateful to my hon. Friend and delighted that she is able to be with us for a short time. I know that she wanted to take part in the debate, but faced time pressures.
I agree that there is a time and a place for campaigning, and there is a role for nursing organisations, including Unison and the RCN. However, it is easy to lose the support of the House with negative campaigning. I have been reading in Hansard the criticism from hon. Members on both sides of the House about the way in which that campaigning was undertaken. It was damaging to nursing, particularly as the RCN in its evidence to the Health Committee seemed to say something different. We should bear that in mind.
May I suggest that perhaps the frustration shown at the conference was about not just job losses but a range of other issues, such as vacancy freezes, graduate skills going to waste and a growing disillusionment in the profession following the RCN's survey, which suggested that many nurses are planning to leave the NHS? I do not think it was only about job losses; I think it was about wider issues also.
I do not know the rationale for that staged event. I do not understand it and refuse to accept that it was beneficial. When I started my nursing training in 1972, I was told that nurses' morale was at the lowest ebb ever. In 1980, I was again told that their morale was at the lowest ebb ever. That has continued for many years. There has clearly been enormous investment, but we are still hearing that nurses' morale is at the lowest ebb ever. There is an issue and we must try to understand it because my understanding, certainly from Unison's work with nurse members, is that they are feeling much better about the profession, although recent events have made them feel more uncomfortable. We must get a grip on the budgets.
I was a senior trade union official when the Conservative party was in power and we had real-terms cuts. Frankly, I do not understand why, with the increased budgets, there are redundancies in any hospital. In Scotland, we wanted to keep nationalpay bargaining. Turnover in Scottish hospitals is about 7 per cent., but turnover in some hospitals south of the border is 34 per cent. a year. Perhaps the Minister will enlighten us on whether we should bring in chief executives, directors of human resources and finance directors before any announcements are made on redundancies and cuts. Questions should be asked about how the budgets are managed.
I completely agree with my hon. Friend. The Surrey and Sussex Healthcare NHS Trust, which serves my constituency, has one of the highest deficits in the country. I expect it to work with the turnaround team, which has greatly benefited the work of the trust, to examine areas where there is overspending. We need to keep the front-line staff in place to make sure that they continue to provide the care that is so desperately needed. Other ways of managing need to be considered. The turnaround team is doing innovative work and examining back office work rather than staff, so I agree with my hon. Friend.
As an old nurse who has left the profession, I do not view the nursing of the past through rose-coloured spectacles. I firmly believe that nurses today are better qualified and much better able to respond to today's NHS. They work extremely hard. I salute every single one of them and hope that they continue to work in this fantastic NHS.
Order. It is advisable for me to draw to the attention of all right hon. and hon. Members a three-minute discrepancy between the electronic time display and the time on the annunciator. We must go by the annunciator, which shows the time throughout the House.
Also, I remind right hon. and hon. Members that I am required to call the first of the three Front-Bench speakers at 10.30, so we have only 24 minutes left. Only two hon. Members are seeking to catch my eye in that time. I ask them to bear what I have said in mind when making their speeches and when accepting or responding to interventions.
I congratulate my hon. Friend Laura Moffatt on securing this important debate, and on the eloquence, personal experience and knowledge that informed her excellent opening contribution. I am very proud to have in my constituency Oxford Brookes university, where there is a vibrant school of health and social care, which I had a hand in initiating many years ago when I chaired the university board. That school trains 2,000 students and its training facilities have been consolidated into a new centre with state-of-the-art teaching facilities including a professional and clinical skills centre, which does excellent work.
My hon. Friend eloquently described the crucial roles that are involved in modern nursing skills, and which contribute to the work of a health team. She described from personal experience the difference between the present arrangements and those of many years ago. Hon. Members and the public are full of praise for the contribution of nurses and other health professionals. The progress and tangible difference that they make can be seen every day. I am sure that other hon. Members receive, as I do, positive feedback about people's personal experience of the national health service, based on the care that they are given.
As my hon. Friend said, nurses are at the cutting edge of innovation in health care and have been driving many of the improvements in hospitals and other health facilities. She also pointed out that people do not go into nursing for the money; but it is a good thing—and I am very proud that the Labour Government are responsible—that nurses' pay has been significantly increased and that the number of nurses has been increased by 87,000. Opposition Members who fasten on difficulties in the health service would do well to remember that if they had had their way in voting against the extra money going to the NHS, we should not have had those extra nurses, and the pressures and difficulties would be greater.
As a point of fact, Conservatives agree with the Government's Budget, which has been set to 2008, so peddling the line that we continually vote for cuts does not take account of the context. Neither the Government nor the Opposition parties have been able to predict beyond 2008, as it is simply not possible to do so.
I do not want to get into partisan fights on the matter. I simply made a passing reference to the fact—it is a fact—that the principal Opposition party did not vote for the resources that were necessaryto increase health funding in the way that the Government have increased it. Therefore, it is true that the position would have been worse, not better, if they had had their way. The change is to be welcomed.
As I said, I wish to raise three key issues in this contribution. The first was touched on earlier when my hon. Friend discussed pathways into nursing and the importance of professional development. I wish to stress the point and invite my hon. Friend the Minister to respond on the question of health care assistants and opportunities to qualify, whether through secondment or the other routes to which my hon. Friend the Member for Crawley referred.
The point is worth stressing because health care assistants are an enormously important part of the modern health care team. They bring experience and a set of life skills that can be invaluable in nursing.For many of them, especially those with family responsibilities, the secondment route is financially the most viable way into nursing. It is a great loss to the profession if people have that potential and want to qualify as nurses but are held back because they are unable to get a secondment place. That is why I invite my hon. Friend the Minister to set out the Government's thinking on how we can maintain and, where possible, expand that important route. Such opportunities are crucial to making the most of those individuals' potential.
Those opportunities are also important in confronting nursing shortages, as we have done on many occasions in the past. Especially in areas of high-cost accommodation such as Oxford, the challenge for the future must be not simply to fill gaps by recruiting nurses from overseas, although they have made an invaluable contribution, or by increasing training for the future, although that is important, but to do more to retain the staff whom we have and to ensure that people who already live in an area and who have the potential to become qualified nurses have a route into nursing. Such people already have accommodation in the area, so they do not face the burden of high prices and rents. That is particularly important in constituencies such as mine.
The second key area is the impact of current financial deficits. It is a coincidence that as we meet here today, staff at the John Radcliffe hospital in Oxford will be briefed on the likely implications for them of correcting the local deficit. Last week, headline leaked reports stated that as many as 600 posts might go, so staff are understandably apprehensive. I have met RCN representatives, Unison and others to discuss that difficult situation.
The crucial thing is that patient care must be safeguarded. The nurses whom I met have undertaken to alert me if there is any threat to patient care so that I can raise it at the highest level, but it is unfortunate indeed that people are being subjected to anxiety. The situation is terrible for people who face losing their job. I believe that that apprehension informed some of the anger voiced at the RCN conference. Certainly the nurses who came to see me in the recent lobby said that that was the reason for it, although I echo what others have said about the impact that it had and how it came across.
The other dimension to the deficits, to which my hon. Friend the Member for Crawley referred, was covered in the excellent briefings from the Councilof Deans, which warn that the biggest cuts in commissioning of nurses going into training appear to be in those strategic health authority areas where the deficits are largest. In some areas, cuts of up to 30 or40 per cent. in the current financial year are being spoken about. After all that has been done to improve nurse training and recruitment, it would be an utter tragedy if we returned to the bad old pattern of feast and famine by allowing those short-term financial pressures to cut recruitment for the future.
In fact, the Council of Deans has made it clear that the problem that we faced in the '90s, when the reduction was made in student numbers, was what we inherited as a Government in 1997 and beyond. We must not make those mistakes again. The Department must take the Council of Deans's remarks seriously, and I hope that the Minister will address that.
My hon. Friend is absolutely right. The problems that we faced in the past were the product of sharp cuts in nurse training intakes in earlier years. We must not go back to that situation, because it would mean that we would not have sufficient nurses in 2009, 2010 and 2011, which will be necessary both to staff the expanded services and to meet the important demographic challenge, as a substantial proportion of the existing nursing staff approaches retirement.
I invite the Minister to acknowledge the important point that reductions in nurse training to meet short-term financial pressures do not necessarily bear any relationship to longer-term staffing needs. I would be grateful for an assurance that the Government will review overall nurse commissioning numbers to ensure that proper weight is attached to the medium and long-term requirement for nurses, taking account not only of the expansion in services, but of the demographics, as nurses come up for retirement. It is not clear to me that a strategic health authority basis for commissioning will necessarily achieve the total aggregate number of nurses that we need for the future.
As we have all been saying, the health service has been improving enormously, thanks to the extra resources that have gone in, the extra staff who have been recruited, the professional development that has been undertaken, and the hard work and dedication of teams of health care professionals. Just as it is a tragedy wherever that progress is damaged by financial deficits, which we must deal with, so it would be tragic indeed if we faced future nurse shortages because of short-term considerations.
Does the right hon. Gentleman favour a fairly rigid form of ring-fencing of training budgets to SHAs in order to address the problems that he has outlined?
As I said, the evidence from the Council of Deans is that the reductions in commissioning appear to be most severe in the areas where the deficits are highest. That rather suggests that the financial pressures are being allowed to distort the pattern of recruitment. Ring-fencing is therefore an option that the Government ought to explore seriously; otherwise, they should assure us that the total number of nurses going into training will be adequate to meet future need.
I started my speech by referring to the education and training in my constituency. It is also crucial to have stability in our important training institutions, so that they do not face very sharp shifts in numbers, because that would destabilise an important part of the infrastructure that, at the end of the day, supports the national health service. I look forward to the Minister's response.
I am pleased to have the opportunity to contribute to this debate on nursing.
May 1997 saw an historic event: the election of the first two nurses to join the House of Commons—my hon. Friend Laura Moffatt and myself. We were followed in 2001 by my hon. Friend Anne Moffat, and more recently by my hon. Friend Mr. Devine. Why did it take so long? I think that we had an image problem. People asked what nurses did and knew, and how they could become Members of Parliament when all they did was take temperatures and make beds. They said, "Nurses are not very knowledgeable, so how can they possibly become MPs?" Jane Salvage, who used to edit Nursing Times, wrote the book "The Politics of Nursing", in which she expanded on many theories in relation to outbreaks of feminism in the nurse's home; there was certainly one in my nurse's home. I am proud and pleased that the electorate of Brentford and Isleworth put their trust in me. "Trust me, I'm a nurse," was my slogan, and, of course, they did—and they still do.
With regard to moving nurse education into higher education, my hon. Friend the Member for Crawley mentioned her training. The training used to be like preparing for war most of the time, because nurses never knew what they were going to face on the ward. On night duty, first-year student nurses were left on their own with patients coming back from theatre. That was unsafe and dangerous practice, but such practice did not happen under a Labour Government. Opposition Members should reflect on some aspects of the past.
Academic snobbery about what a nurse's qualifications were worth was conveyed to me whenwe moved into higher education. I was told by one academic, who was in charge of the geography department, that my registered nurse qualification was not really worth one A-level. I suggested that if he was going to have a heart attack he should have it while I was around, because he would then probably welcome the fact that I was a cardiac nurse and would be unlikely to send for the professor of history to assist him. That measure of academic snobbery is still in existence. There are people who still say, "Why do nurses need diplomas or degrees?", and ask what was wrong with the old-fashioned type of preparation—preparation for duty, vocation, obedience and tolerating aspects of health care that should never have been accepted. I am proud of today's nurses andtheir nurse educators, who prepare them for practice in a totally different way. Midwifery has always had a different tradition; midwives have been accepted as practitioners in their own right. We might secure a debate on midwifery for another time.
The issues I am discussing are probably to do with the fact that nursing is a predominantly female profession, although I acknowledge that my hon. Friend the Member for Livingston bucked that trend and has made an impressive contribution to nursing. However, nurses are ideal MPs because we are good listeners and communicators, and problem solvers. We are all the things that an honourable Member of Parliament should be. I should say again in this context that we are trusted.
Nurses are also crucial for the future of health in our country. My right hon. Friend the Chancellor commissioned the first report—the Derek Wanless report—on the future trends and needs of health care in our country. Much of that is to do with chronic conditions and a growing population of frail older people who are experiencing such conditions. It is the nursing work force who are taking on that challenge in respect of cancer, chronic diseases, cardiovascular conditions, trauma and paediatrics.
We want to acknowledge the clinical excellence demonstrated by nurses. West Middlesex university hospital is in my constituency; I worked in it for many years, and I would like to thank Yvonne Franks, the director of nursing and midwifery, for helping me to prepare for this debate. Unfortunately, I cannot use all the material that she offered me. I could have taken up the whole morning in explaining the work that many of the leading nurse specialists in my trust are participating in, but I feel that I ought to mention a couple of examples.
We are all familiar with the changing clinical work in relation to heart disease, and rightly so. My hon. Friend the Member for Crawley mentioned the differences of some years ago, such as being told to go home and rest. That is certainly not the case now. I pay tribute to Phillip Eardley, acute coronary syndrome charge nurse, who works in association with Cas Shotter, a cardiology nurse specialist, in the accident and emergency department, leading the management of patients with chest pain. Those nurses prescribe diagnostic tests, implement treatments and deal with the transfer of patients. They decide whether patients are transferred to the Hammersmith hospital for primary angioplasty, and they also teach junior medical staff. That is the job of the advanced practitioner. I pay tribute to them, and apologise that, because of time restraints, I am unable to give examples of other nurses.
The advanced practitioner in the UK is well advanced. We are a model for other countries. Other nursing schools and universities come to the UK to look at how we are practising in that advanced way. However, the advanced practitioner needs continuing education and training. We need to evaluate the real contribution that nurses make. We have made an investment in them which must be looked after. They now have the opportunity for child care provision that they never had in the past, and flexible working and proper rota systems have been put in place. In West Middlesex university hospital, Yvonne Franks is doing pioneering work into matching the appropriate skill of nurses to particular patient need. That seems obvious, but sadly, it is not taking place in all areas of health care.
We have evidence of a better educated work force. The challenge is evaluating the payback from the investment. Professor Anne Marie Rafferty whom I know as a nurse, heads the Florence Nightingale school of nursing and midwifery at King's college, London. I cannot end on a better note than quoting her words:
"Educated and well trained health workers save lives."
That is what the nursing profession in our health service is doing. They are on duty 365 days a year, 24 hours a day, giving care. I know that the House supports them, and I hope that we always demonstrate that with all-party support, and that we continue to recognise the work of people in the nursing profession and the quality of care that they give.
I congratulate Laura Moffatt on her opening speech in this important debate, to which she contributed a good deal of expertise. I marvel at her commitment—there is hardly a health meeting that I go to in this building to which she does not show up and make a valuable contribution.
I am not an expert, like the hon. Lady, but I have something in my CV that is vaguely relevant. In a gap year, when I was a student, I worked as a nursing assistant in an old-fashioned mental hospital in Maidstone, Kent called Oakwood hospital. I started there with not a day's training and no secondment. I was simply given a white coat and set off, and I ended up on refractory and block wards. There must be few other MPs who have shown people into padded cells, administered electroconvulsive therapy and seen a straitjacket used.
In those days, I was familiar with the division between state-enrolled nurses and state registered nurses—one could tell them apart by their varying epaulettes and colour-coding—and the further division between them and the lower grade of nursing assistant, which I was. As such, I was completely unqualified and untrained, and I muddled through as best I could. We were aware that SRNs were the crème de la crème, who were going somewhere. They would become the charge nurses and, for those who were very fortunate, the matrons. However, my impression was that the training then was not anything like as intensive as it now is and that monitoring of performance was somewhat weak. I was aware at only one stage in my work of being inspected, and that was when the boards of hospital visitors, or whoever they were, trooped through from time to time and took more interest in the state of the floors than in the condition and happiness of the patients. That seemed to be their major and fundamental preoccupation.
In those days, one was aware of the clear demarcation between the nurses, who saw the patients very often, knew a great deal about them and could do much for them, and the doctors, who were of course the experts without whom nobody could move, who none the less saw patients relatively infrequently.
My brief experience of nursing before going off to study philosophy at university was intensely interesting and enjoyable. It was also a good preparation for other career moves. I say that because someone recently described this place as the last Victorian asylum. That may be a little unfair, but this place is full of people talking out loud to no one in particular.
Things have changed radically in nursing. I start on a good note by saying that the Government and the profession are to be congratulated. We have an increased supply of nurses—more than ever before—and we depend less on foreign staff, who ought to be working and providing health services in their own countries. We have increased salaries and improved career paths for nurses and others in the nursing profession. We also have improvements in the quality and variety of nursing education, and the link with higher education is an important boost in status, which the hon. Lady said was much needed and which is firmly to be welcomed. Nursing training also encourages career development and builds on nurses' skills.
I warm to the concepts of nurse practitioners and of nurses being able to prescribe. Those long overdue and necessary reforms will break down the strict divisions that hitherto existed between nurses and doctors and their relevant areas of expertise. If we are to have decent medical care in the community, we need greater qualifications among the nursing profession. If we are to take pressure off the accident and emergency departments by having more minor injury units, we shall need nurses who can deal with a variety of unexpected conditions. If we are to advance the healthy living agenda and have flexible and effective care we will need expert and skilled nurses, and we are getting them stage by stage.
The Government's strategy is essentially correct. I doubt whether anyone would speak against it. The strategy is correct and the profession is to be congratulated on endorsing it. However, it is a long-term strategy, as evidenced by the comments that we remember hearing when we remember our own experiences, and my concern is that it will be blown off course by short-term financial needs, or that it will be cross-grained with other initiatives. I think specifically of payment by results, and the drive to turn every NHS unit, whatever it be, into a financially autonomous, solvent, trading and entrepreneurial unit almost overnight.
The system cannot bear that sort of stress, because it effectively asks organisations to wipe out in one year deficits that have been built up over many years. That is what led to Mr. Smith talking about feast and famine in nursing training in relation to recent resource cuts. It was also referred to as stop-go in a briefing that we all received. They are all phrases that will be familiar to the Minister after his Treasury experience. Boom and bust is another. I assume that he is agin it.
It is clear that SHA training budgets are often raided, that they are sometimes underspent, and that they are only notionally ring-fenced. They can therefore become a source of brokerage, top-slicing or centre-saving. Whatever one calls it, the money just goes—especially in those areas that have the biggest problems. It is in those areas with larger deficits that existing staff are most fearful, job security is declining and additional training prospects are worsening. To cite a personal example, the acute trust in my constituency has a substantial deficit. It has announced 200 redundancies, but it has said that nurses will not be made redundant, which is welcome. I should declare an interest. My son's partner, who has trained as a children's nurse, cannot gain employment and is looking for a job outside nursing that will use her considerable talents.
Setting that against the general complaint of the royal colleges and the strategic liaison group about the lack of clinical academic pathways, one can begin to see a problem emerging. They complain about the difficulty of combining the service and the education roles. That can only bring about a reduction in effective mentoring. People's experiences cannot easily be traded in both areas as effectively as they might. They also complained—this point, too, was made by the right hon. Gentleman—about a lack of work force planning and the fact that we have not linked training places to needs, as has happened for the medical profession.
What is happening is not something that could be dressed up in tabloid headlines as a meltdown, collapse or crisis in nursing; however, it is a genuine and serious problem, which can and should be tackled, and which calls into question the coherence of what the Government are doing and the haste with which they are acting. Hon. Members have spoken warmly about the Government's support of the nursing profession and nurse training, but they are in danger, on this issue in particular, of snatching defeat from the jaws of victory.
What is required is a broad view, consistency and sensible pragmatism—all of which I associate with the Minister and elements of the ministerial team. The strategy can be right, and we agree that it is, but if the tactics are wrong we end up with a bit of a mess.
I, too, congratulate Laura Moffatt on securing this important debate, and I welcome the Minister to his new post.
As we all know—we have all mentioned it—nurses perform an invaluable role. The NHS could not run without the hard work and dedication of its work force. Nurses more than anyone else are on the front line of patient care. However, I suggest to the Minister that there is growing frustration in the nursing profession. That was particularly brought home at the recent rally and lobby of Parliament. Many nurses are questioning what is happening. We all accept that extra money has been put into the NHS and welcome it, but not enough has reached front-line services and nurses increasingly point to the administrative burdens that they must undertake and the fact that the number of managers in trusts has grown faster than nurses' numbers.
One cannot dispute that the number of nurses has increased, and we welcome it, but nurses make the point that not enough of the new money reaches front-line services. They feel they labour under an increasing burden of bureaucracy and political interference from a Government who insist on micro-managing the NHS through targets and red tape. I suggest that a fair number of the current frustrations and concerns are inevitably linked to NHS deficits. I ask the Minister not just to dismiss that point as party political, but to take on board those concerns expressed by nurses, and deal with them in the debate.
Nursing training has been mentioned a few times in the debate so far. The concern is that places on courses are being cut and that clinical placements are being cancelled.
Does the hon. Gentleman agree that in the 1990s nurse training was dramatically reduced, which caused the shortage that we inherited in the late 1990s? Will he at least acknowledge that that is what happened?
Yes, there were cutbacks at times. There is no doubt about it. Yet what seems not to be accepted is that over the entirety of that period there were real-terms inflation-beating increases in the budget of the NHS.
By way of illustration of that, and to deal with one of the points that the hon. Member for Crawley made about improvements in cancer provision, the improvements that have been made since 1997 have not, despite all the extra money that has been put into the NHS, broken the trend of decreasing mortality rates that goes back to the early 1980s. Yes, improvement has continued, but despite all the money, there has been no marked improvement on decreasing cancer mortality rates. That is one example of how the money has indeed been provided, but not enough has reached front-line services, because much has been soaked up by the bureaucracy that has been created in the NHS.
May I make some progress? The hon. Lady may want to intervene again later, although I want to leave the Minister some time to respond.
Let me give an example. According to Nursing Standard magazine, half of all the SHAs in England that responded to the survey admitted to cutting training posts, and the average reduction in England as a whole was 10 per cent. That must cause concern, because it means that fewer student nurses will get the practical experience that they need to qualify and the NHS will be poorer for not having fresh talent to replenish an increasingly ageing work force. That is a particular concern given that the RCN's own study has shown that about 100,000 nurses are due to retire in the next five to 10 years. Meanwhile, the Council of Deans and Heads has suggested that the reduction in the number of students who are being commissioned is greater in areas where SHAs report larger deficits, so there can be no dispute that deficits are having an impact on training places.
In addition to the cuts imposed by SHAs, there is already a high drop-out rate among trainee nurses, and about one in four students are thought not to be completing their courses. Perhaps the Minister will be kind enough to outline what studies, if any, have been done of nurses' reasons for walking away from training opportunities. I expect that inadequate access to bursaries has something to do with it, but the flexibility and family-friendliness of training hours are also important, because the average age of nursing students is about 29, and many of them have young children. Those problems must be addressed, although difficulties at the NHS student grants unit last year did not help matters.
However, the problems in nursing are not confined to students. Even when nurses do qualify, many find it difficult to get jobs, because NHS trusts are riddled with deficits, as we have heard. The Royal College of Nursing regional director recently claimed that, in the west midlands alone, about 4,000 student nurses who were due to graduate in the next two months will not have jobs to go to. That is symptomatic of the growing problem of graduate unemployment in the NHS as a whole, of which physiotherapists are another example. Indeed, the problem of vacancy freezes seems to be getting much worse. Given that it costs about £100,000 to train a nurse, it is a great waste of public money and a missed opportunity to enhance patient care if nurses do not find work in the NHS soon after graduating.
Vacancy freezes and graduate skills going to waste are one concern, but to return to a point made by the hon. Member for Crawley, it cannot be denied that the nurses who heckled the Secretary of State last month were also worried by the prospect of redundancies.The RCN has estimated that at least 13,000 posts are due to be lost as a result of the financial pressures on the NHS.
Does the hon. Gentleman agree that the language used is important? If someone is given compulsory redundancy, they know that they have been told that they are going, but I have looked at the figures and I do not see 13,000 redundancies—I see a freeze on vacancies, a reduction in the number of agency nurses and management of the financial problems.
The hon. Gentleman makes a valid point. The problem is that we do not know for sure what the number is. Locally, we are seeing job cuts and people being made redundant, but I agree with him about the validity of the 13,000 figure. I have not checked that figure, but have the Government come up with figures that reflect the true state of affairs? At the moment, nobody knows, and all we hear are headline figures for job cuts. Broadly speaking, therefore, I agree with the hon. Gentleman and I ask the Minister to give us a better estimate, rather than just relying on the RCN figure.
When the scale of the deficits crisis did become known—this is where I will take the Government to task—the Government argued that job losses in NHS trusts and acute hospital settings were broadly justified by the shift in emphasis towards care in the community. However, perhaps the Minister would care to explain how—taking the RCN figure—13,000 job losses can be made up when there 4,000 fewer full-time equivalent district nurses in the NHS than there were in 1997, with a 3 per cent. fall last year alone? Those weaknesses in primary care must be addressed before acute nursing posts are cut.
The Government White Paper "Our health, our care, our say" argues for transferring NHS activity from acute to primary care. There is much in the White Paper to be commended, but the Government will not be able to make good their pledge unless they develop capacity in the community, and at the moment that is not happening. Instead, the number of district nurses is decreasing; there is a shortage of school nurses; and birth centres and community hospitals are closing. Capacity is being shut down without any proper assessment of whether it is required. I suggest to the Minister that that could be storing up problems for the future and I would appreciate his response on that point.
Those problems illustrate nurses' concerns about the security and status of their profession within the NHS. The bottom line seems to be that many nurses are still leaving the profession because their expertise and hard work are not being respected. An RCN survey published last year showed that more than a quarter of nurses' time was spent on clerical or administrative duties. Half of all nurses who left the NHS in the previous year cited stress and the work load as reasons for changing job, and those problems are likely to become more acute as the work force contracts. Is it any wonder that 30 per cent. of all respondents to a recent RCN survey—up from 27 per cent. in 2003—said that they would leave their employer within the next two years? That is the RCN's own survey.
Conservative Members have long called for a different approach—one that would reverse the recent rapid growth in the number of managers and administrators and force politicians to withdraw from the day-to-day running of the health service. We would reduce the need for central control and leave hard-working nurses to get on with the job. In short, we would seek the re-emergence of nursing as a respected and largely autonomous health care profession.
Nurses deserve our support, but the crisis in NHS finances has placed burdens on staff. We can do a great deal to promote nursing in the medium and long term, but the immediate task is to assess the damage caused by the consequences of deficits and to address the concerns of nurses themselves.
It is always a pleasure to serve under your chairmanship, Mr. Cook. I congratulate my hon. Friend Laura Moffatt on securing this Adjournment debate and on the passionate and knowledgeable way in which she described the development of nursing over a relatively short period. She described experiences that she had when she was a front-line nurse in the national health service and some of the challenges and difficulties that nurses faced. She also described the sense of reward that she got from being a nurse and recognised how significantly things have changed in recent times.
It was good to hear it highlighted that it is the Labour party that, since 1997, has welcomed the election of not only my hon. Friend the Member for Crawley, but my hon. Friends the Members for Brentford and Isleworth (Ann Keen), for East Lothian (Anne Moffat) and for Livingston (Mr. Devine)—all serving nurses who have been elected to the House of Commons. That is a step forward for democracy. When my hon. Friends the Members for Crawley and for Brentford and Isleworth were elected, it was the first time in history that nurses had been elected to Parliament. I am very proud that all of them are Labour Members of Parliament. They are some of the best colleagues in the parliamentary Labour party, as I am sure everyone agrees.
My hon. Friend David Taylor always turns up to make a contribution. However much he goes on about my talents as a Minister, I am not in a position to make announcements today on additional resources for midwifery bursaries, but I take on board the general concern that he expressed about retention of midwives, particularly on some courses. What are the obstacles getting in people's way and what issues do I need to address in my new role to deal with that?
My right hon. Friend Mr. Smith made a very important contribution to the debate. I think that the last time we both participated in a debate in Westminster Hall, we were discussing cash machines and access to cash. This is a slightly different subject—such is the nature of government. He referred to health care assistants and secondment programmes. As I understand it, that is very much left to local discretion, depending on the market and on supply and demand. However, I am willing to look into secondment programmes for health care assistants—that specific opportunity to get into nursing—and into what is happening and what we want to happen.
My right hon. Friend also drew attention to the important role that Oxford Brookes university plays. It is a centre of excellence for social and health care and has been for some time, offering significant training opportunities. He also referred to the sad news that some of his constituents will receive today at John Radcliffe hospital. Although I cannot comment on the specific circumstances, I am sure that he will be making very strong representations about the decisions made by the hospital management, particularly in the context of any impact on patient care, and that he will maintain a dialogue with members of the ministerial team on those issues.
My right hon. Friend and others talked about cuts in training in certain areas and asked what the pattern was. We should begin by saying that there has been a massive increase in the number of training places made available since the Labour Government came to power. As a consequence, there is a massive number of new entrants into nursing. Dr. Pugh was good enough to acknowledge that. However, in every public service there is a tendency to regard the training budget as the first to go—the soft target—and as former Minister with responsibility for skills, I am highly aware of that. We need to monitor the impact of decisions on training budgets, and we will do that, but it would be wrong to use words such as crisis and decline; we have to adopt a measured approach and should always look at the issues in context.
My hon. Friend the Member for Brentford and Isleworth talked from personal experience about the realities of nursing in the past. What she said about academic snobbery is absolutely true of the way that this country treats vocational education and training generally. Frankly, if we are to be successful in our public service ambitions and in the economic challenges that we face, we have to change that almost uniquely English snobbish approach to vocational education and training—I can feel myself making one of my speeches as a former Minister with responsibility for young people and adult skills. That is a real problem that is endemic in the culture of this country, and we have to attack it in every way that we can.
My hon. Friend also referred to the Chancellor's role in ensuring unprecedented levels of investment in the national health service, year on year. Frankly, it was an act of political leadership for him to tell people not long ago that increasing national insurance by 1 per cent. was merited and morally right if we wanted the kind of national health service that this country deserves. What was interesting about that decision and that leadership is that—if we remember the political climate at the time and the electoral consequences of that decision—people actually endorsed it. It was right to be honest and to say that to achieve the growth in NHS investment required, difficult decisions would be necessary. People in this country cherish and value the national health service and believe that there is nothing more important than investing in it and ensuring that it continues to be something that we can be proud of in any international context.
The Minister is multi-talented. He referred to his time at the Department for Education and Skills, so he will be aware of the need to ensure that training places fit the needs of industry and commerce. In nursing, there is a question whether the commissioning of places actually reflects hospital needs. That has not been touched on so far; will the Minister do so?
It is common sense to look into that and make sure that the content of training reflects the needs of the health service, not just now but in future. That links to the point that the hon. Gentleman made about primary and community care, which I shall address in a moment.
My hon. Friends the Members for Brentford and Isleworth and for Crawley talked about the heroes and heroines who work on the front line of our national health service every day, making a difference to the quality of people's lives, and indeed saving lives, and it is important to mention them in an abstract, general debate such as this. We cannot possibly mention them all today. However, for family reasons, I have recently experienced what they do, so I know that not only their expertise and specialist knowledge, but their sensitivity and compassion make a tremendous difference when a person has health difficulties. We are very fortunate with the quality and calibre of the people who nurse on the front line in this country.
The hon. Member for Southport described this place as the last Victorian asylum, and most of us would agree, although inmates—at least some of them—are allowed home at weekends. The hon. Gentleman was good enough to acknowledge the Government's and the profession's success in work force development in the context of nursing. He said that it would be disingenuous not to welcome the long-term strategy, but expressed concerns about what is happening now and how that might undermine it. I certainly regard one of my responsibilities as keeping a close eye on ensuring that the challenges that we face do not end up undermining that long-term strategy, which, as the hon. Gentleman said, enjoys a tremendous amount of consensus.
I thank Mr. Baron for welcoming me to my new position. That is probably where we part company; I do not think that we shall agree on much else. It is difficult for Labour Members to hear Conservative spokespeople talking about financial and resourcing difficulties in the national health service. It sticks in the throat a little, not because of naked, tribal party politics, but because of the real-life history of the national health service between 1979 and 1997.
There were real-terms cuts, a dramatic decline in morale and a belief that people who worked in public services were leaching the public purse rather than making a massive contribution to the well-being of this country. The criticisms and challenges from the Conservative party do not have the same credibility and legitimacy as genuine concerns expressed by trade unions, members of the professional bodies and Labour Members of Parliament. As a Government, we have been willing to match rhetoric, passion and a belief in the health service with hard, real additional resources—and reform and modernisation—to recognise the needs of patient care in the 21st century.
The hon. Gentleman talked about the Government's micro-managing the NHS and so on. Actually, under the NHS reforms, we have been devolving more and more responsibility and power to the front line. Equally, I do not believe that we should take politics entirely out of the national health service; in my view, it is one of the great dividing lines of British politics. No wonder the Conservative party wants to take politics out of the national health service.
I cannot give way, as I do not have enough time. The hon. Gentleman mentioned micro-managing the national health service. When we say to trusts and managers, "You have deficits, and it is about time you brought them under control. You have to make difficult decisions. We cannot allow the situation to go on because it destabilises the national health service," we get criticised. We leave people to make some of those difficult choices at a local level in local circumstances.
We shall take no lessons on the national health service from the Conservative party. I shall listen to constructive suggestions, comments and even criticisms. However, to pretend that the NHS is in some kind of meltdown or crisis is disingenuous and dishonest from a party that starved the service of resources and demoralised it.
The hon. Gentleman says that there has been a decrease in the number of primary care and community care nurses. I shall correct that for the record. The number of nurses in primary and community care in this country has increased by 37 per cent. since 1997.
The health service is in a good position. There are daily challenges; demography itself means that we face an ever-growing elderly population with acute health needs. However, we can be proud—