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24 May 2006 : Column 462WH

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.

Laura Moffatt: 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.

Mr. John Baron (Billericay) (Con): 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.

Laura Moffatt: 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.

Mr. Devine: 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
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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.

Laura Moffatt: 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.

Several hon. Members rose—

Frank Cook (in the Chair): 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.

10.7 am

Mr. Andrew Smith (Oxford, East) (Lab): I congratulate my hon. Friend the Member for Crawley (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
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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.

Mr. Baron: 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.

Mr. Smith: 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
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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.

Ann Keen (Brentford and Isleworth) (Lab): 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.

Mr. Smith: 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
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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.

Dr. John Pugh (Southport) (LD): 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?

Mr. Smith: 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.

10.19 am

Ann Keen (Brentford and Isleworth) (Lab): 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 the Member for Crawley (Laura Moffatt) and myself. We were followed in 2001 by my hon. Friend the Member for East Lothian (Anne Moffat), and more recently by my hon. Friend the Member for Livingston (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
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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
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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:

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.

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