Westminster Hall
Wednesday 24 May 2006
[Frank Cook in the Chair]
Nursing
Motion made, and Question proposed, That the sitting be now adjourned.—[Huw Irranca-Davies.]
9.30 am
Laura Moffatt (Crawley) (Lab): 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.
David Taylor (North-West Leicestershire) (Lab/Co-op): 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 the Member for Bury, South (Mr. Lewis) will announce something today that might improve that situation? We greatly admired the talents that he demonstrated in his previous post.
Laura Moffatt: 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.
Mr. Jim Devine (Livingston) (Lab): 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.
Laura Moffatt: 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 the Member for Brentford and Isleworth (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 the Member for Livingston (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.
Mr. David Drew (Stroud) (Lab/Co-op): 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?
Laura Moffatt: 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.
Mr. Andrew Smith (Oxford, East) (Lab): 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?
Laura Moffatt: 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.
Anne Moffat (East Lothian) (Lab): 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.
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