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In the minutes that remain to me, I want to bring to the House's attention the single most distasteful thing that I have experienced as the Member for Brent, North. Two days ago, I received an e-mail from a friend of mine, Panna Vekaria, who urged me to go on to a website and action a YouTube video, which was a promotional video for the Welsh British National party filmed in my constituency. It started with an image of Wembley football stadium. The camera was then driven through Wembley High street, focusing on people of African and of Indian descent, and on people whose
dress would indicate that they were Muslim or Hindu. It then stopped outside the mosque on Ealing road and focused on the sign of the Muslim welfare centre that stands there. All the time, the presenter, an individual from the British National party, was saying, "Look at that. That's not what Britain should be, that's not what Britain is like, that's not what Britain should have been allowed to become." I found this the single most revolting and disturbing thing in my life as a constituency MP. I issue this challenge to the British National party: "Come back to Brent, North and dare to stand against me at the next general election. Dare to put what you said on film to the whole of the British public. Dare to put it to the people of Brent, North. You claimed that those individuals your camera focused on were not British-well, I refute that." Those people are British. They are proud to be British and proud to be part of this society.
I am proud to represent the most multicultural borough in this country and, indeed, in Europe. More than 160 different first languages are spoken in our borough and more than 130 different first languages are spoken in our schools. We are proud of that. We are proud of the fact that in every single one of the schools in Brent, North, by the time those children reach the time to go to secondary school, they are achieving above the national average at key stage 2. These children are our future. I defy the British National party to come to Brent, North to stand at the next election. Of course, the BNP believes that these people are not even entitled to vote, but they are: they are here; they are British citizens. It is absolutely essential that the Queen's Speech that we will vote on in a few days' time includes an equality Bill. At the core of what we do in this place must be equality; it must form the essential heart of British public life and British politics.
When I spoke to a woman in my constituency who is second generation-her parents came from east Africa in the 1970s but the family was originally from India-she told me about a discussion that her family had had over the dinner table about the appearance on "Question Time" of the representative from the British National party. She told me how she and her husband tried to explain to their children that it was important that there should be free speech. They had been intellectualising how important it was that, in a democracy, people should, without fear, be able to express their views and state them clearly, and how important it was that other people should be able to argue with them rationally and defeat them in a rational debate.
However, what impressed me most was that her daughter, who was born here and who has been a British citizen her entire life, simply asked, "Why should they be allowed to go on television and question the fact that I am British?" All the intellectualising and all the fine words about freedom of speech and the importance of debate, were knocked to one side by that young girl and her sense of outrage that a fellow member of her own society and her own country could question her right to be what she was, and question what she was.
The British National party has, I believe, no basis in this society. It has defiled my constituency by coming into it in the way it did. I issue once again the challenge to the BNP: come-put up or shut up-but do not dare to speak about my constituents as you did on YouTube.
It is a privilege always to address the House. The last speaker following seven hours can speak at greater length than otherwise, and I am grateful for the opportunity that being last in the debate today has given me. I thank you, Mr. Speaker, and the House, for it.
Ordered, That the debate be now adjourned. -(David Wright.)
Debate to be resumed tomorrow.
Nurse Training
Motion made, and Question proposed, That this House do now adjourn. -(David Wright.)
9.58 pm
Siobhain McDonagh (Mitcham and Morden) (Lab): I am delighted to have secured this extremely timely debate. As a constituency MP, I am contacted by constituents who are dissatisfied with the service that they or their families receive in hospital, and the question of nurses' training often arises. Therefore, following the announcement that from 2013, entry to nursing will be at degree level, this is a good opportunity to highlight those concerns.
I want to make it clear that I do not agree with some of the more politically motivated criticisms of the Government's plans. I fully recognise the great strides made by our Government in restoring the NHS to full health. Since 1997, we have seen record spending on health, reversing years of Tory underinvestment. We need not take any lessons from the right about how to run our NHS. Our NHS has been not a 60-year mistake, but a 60-year success and triumph.
I also acknowledge that some critics of the Government's plans seem to be motivated by sexism. My hon. Friend the Under-Secretary of State for Health is concerned about that. The chief nursing officer for NHS England, Dame Christine Beasley, said:
"There is still an issue that because nursing has some of those feminine caring skills, people think anyone can do it. It's a very sad reflection of a male dominated media".
I oppose any criticism of the Government's plans that is based on sexism. My mother was a nurse in the first generation of NHS-trained nurses in 1948. Anyone who knows my family knows that it would take a very brave person to belittle in any way the role of women.
I also want to make it clear that I do not raise this issue out of any impulse to attack the Government. Loyalty to the Labour party is another trait that is in my genes. In 12 years I have never voted against the Government, and have no intention of doing so.
10 pm
Motion lapsed (Standing Order No. 9(3)).
Motion made, and Question proposed, That this House do now adjourn.- (David Wright.)
Siobhain McDonagh: However, I do think that it is the role of constituency MPs to inform the Government of grass roots feelings in order to enable Ministers to make the best decisions. Since 1997, the status and pay of nurses has risen, and thousands more nurses have been employed. This has gone hand in hand with a massive growth in health spending. When I think back to the 1990s under the Tories, when patients died on trolleys in corridors at my local hospital because there were not enough beds, I know how good it is that today's debate is about how to give people the best possible care, rather than about whether we can give them any care at all. Nobody has to wait 18 months for an operation. But with such massive investment also comes great responsibility. Particularly in times like these, it is vital that we get as much as we can out of the public purse.
Residents in parts of my constituency have a life expectancy eight years lower than those in neighbouring constituencies. More babies are born with low birth
weights there, and morbidity is high. Life for many people is hard. Given the chaotic lives of some of my constituents, the care that they receive from nurses can make a vital difference to their life expectancy. That is why any changes in the way that nurses are recruited and trained cause such anxiety. Nursing is not just a medical job. It involves interpersonal, communication and care skills. However, despite all the investment in training in recent years, the complaints that I receive are rarely about nurses' top-end medical skills. They are nearly always about care.
Sadly, one of my most supportive Labour party activists, Alf Jones, died last year. He was a popular man with my stuffers-a group of older Labour party members who help me fill envelopes and fold newsletters. After visits to see him on Barrington Brooke ward at St. Helier hospital, the stuffers complained repeatedly to me about the care standards that they saw there. They described an elderly man left at night with faeces on his nightshirt for everyone on the ward to see; patients not washed; full urine bottles left lying around; dirt on the beds, stairs and landings; patients ignored despite screaming and crying; a lack of privacy; the frequent loss of false teeth; and patients who could not walk being expected to use a zimmer frame.
The stuffers were so shocked that they asked me to arrange a meeting with the hospital's chief executive, which I did. As a result, a member of staff was removed, and increased training and supervision was given to the ward team. The stuffers are now regularly invited on to the ward to see for themselves that standards are being maintained.
Mr. A is another Labour party stalwart, who has devoted most of his life to the care of vulnerable people. Now in his 80s, he was admitted to St. Helier with an infection. While in accident and emergency he became incontinent and was mortified that he was not given the appropriate privacy. Then, when he was admitted, he had nightly battles with his nurse. Every night she would want to take off his cardigan, which kept him warm, and his hearing aid, but without his earpiece he suffered from unbearable tinnitus. He became so scared of the nurse that he asked to leave.
Mrs. H contacted me about her 92-year old mother. While she was in St. Helier, they would not let her go to the toilet, even though she could walk a little, and could manage fine once she had been wheeled to the door. She was forced either to go in her bed, or be put up in a hoist and dangled over a bedpan, with two members of staff standing by to cheer her on, shouting, "Come on, push!" or, "Clever girl." While she was in accident and emergency, one nurse inserted a cannula so badly that her wrists and arms were covered with bruises. Mrs. H also said that while she was visiting another ward she spotted a golf ball-sized piece of faeces. Despite pointing this out to staff at Sunday lunchtime, she noticed that it was still there on Monday evening. Apparently, it was finally cleared at 11am on Tuesday.
Mrs. H wrote a very moving letter to me. She said:
"Maybe the 'walk a mile in my shoes' philosophy should be drummed into all medical students at the beginning of their training, and underlined throughout to prevent this very sad downward trend in care".
"Today it is 3 years in University, and once qualified they are let loose on the wards, and if the computer cannot tell the nurses what to do it is not done. Today we seem to have nursing by machine. Machines cannot talk to patients; patients cannot talk to the machines. The intermediary has to be the nursing staff, and....the nursing staff were sadly lacking in their experience with coping with older people."
In August the Patients Association published its report "Patients not Numbers, People not Statistics", which detailed a further 16 cases of neglect and poor care, including catheter bags not being changed, cold patients in wet beds who had been forced to wet their beds because they had not been taken to the toilet, and elderly, confused patients being shouted at by staff. The association's president, Claire Rayner, is well known as a nurse. She describes herself as being
"from a generation of nurses who were trained at the bedside and in whom the core values of nursing were deeply inculcated."
She laments any reduction in those values. Although the association admits that only 2 per cent. of patients rated their care as poor, it points out that that represents more than 1 million cases of what Ms Rayner calls the
"dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment"
that some elderly people have experienced.
The problem is well articulated in the report by Julie Bailey, whose mother Bella had an appalling experience. She said:
"When we complained about all this to the Trust they told us that they had a new initiative that would provide guidance on standards of care regarding communication, nutrition, privacy, dignity and record keeping. Surely after three years of training, nurses should be aware of these basic needs and how to set their own standards?"
My constituents want more rolling up of sleeves and delivering of common-sense caring. This was brought home to me by another Mrs. H and her daughter, who happens to be a practising nurse. They came to see me about Mrs. H's mother, who was a patient at St. George's hospital. They had found her mother in soiled clothing, with other night clothing covered in faeces hidden away in her locker. She was in dirty and unhygienic conditions, and it was clear that she was being neglected. Her colostomy bag was not changed when required, and documentation about her fluid and food intake was not kept up to date. When Mrs. H and her daughter complained to the ward sister, they found that a nurse had tried to alter the drug chart. On another occasion, a nurse confronted Mrs. H and her daughter, addressing her in south London terms as "Girlfriend", which I do not think any of us would regard as acceptable.
"I have concerns about the organisation of the staff...and the lack of care and skills with patients. Staff should not have to be retrained in how to record notes, how to speak to patients and their relatives. Staff should have that knowledge already."
Mrs. H did have one good thing to say, however. She said:
"There was one genuinely friendly person on that ward. She was a nursing assistant called Sharon who always took the time to speak to the patients and their relatives. I feel that it doesn't take much to show humanity."
That is the crux of people's concerns about the Government's proposals. They want nurses who speak to them and who show humanity. They do not want
compassion and humanity to come second to classroom-based teaching, and they do not want anyone who has those qualities to be put off the nursing profession.
In an article in "Spiked Online", the head of engagement and patient involvement, a sessional nurse in NHS London, Brid Hehir, argues that
"the most fundamental aspect of nursing-caring-has been degraded and devalued. Bedside care has been devolved to health care assistants. It's as if bedside care is no longer the remit of nurses."
She accepts that in previous decades nursing was undervalued, but she is not convinced that the solution is more academic training. She goes on to say:
"Prior to 1992...nurses spent only a quarter of their training in the classroom and three quarters on the wards...They are now expected to learn through supervised participation-observing but not participating."
"many nurses qualify with nothing like enough skills, knowledge, clinical and practical experience."
"The problem can only get worse if university-based training becomes the norm because the emphasis will shift further to theoretical aspects of caring as opposed to its practical application."
This relates closely to the concerns of my constituents.
The person who bathes a patient needs to have enough medical knowledge to spot physiological problems. For instance, a nurse might find that a patient is gaining or losing weight. They might find dry skin, which is a sign of dehydration. They might find bed sores, or other wounds such as bruising. Of course, a porter or a health care assistant could just as easily bathe a patient, but would they have the medical understanding to appreciate what these signs mean?
Even nurses themselves are divided. On the Nursing Times website, there are more than 100 readers' comments about the article entitled "All new nurses must have degrees". Most think that the degrees will not improve the profession. It is true that some believe that this will raise standards and that if a few would-be nurses do not qualify, so be it. However, I have to say that that is not a sentiment that I-or, it seems, most Nursing Times readers-share. My mother was not a graduate, but she was an excellent and conscientious nurse, able to care and read someone's medical records.
As one nurse in a similar position says:
"I don't think I am capable of degree-level learning on any course...I simply don't learn effectively by writing thousands of essays. If this decision was made a year ago, I would not be able to gain a nursing qualification."
"I work with nurses who have two degrees but do not even know what is normal body temperature. They have excellent computer skills but lack oral communication skills or simple people skills."
"Obviously, the people with influence don't read any of the comments on here by 'real' nurses, otherwise I doubt they would go ahead with the plans for degrees only nurses. Most of us have said that fundamental basic skills that underpin nurses are 'hands on' and need to be learned at the bedside, not in the classroom."
I hope this reassures her that some people do read her comments. I am not sure whether I am a person "with influence", but I hope that this helps.
"I studied for 2 years at Diploma...and then transferred to Degree. This lowered my bursary considerably and upped my academic responsibilities. No change in my ward responsibilities...The stress of this extra workload nearly made me, and several colleagues, give the course up. I made my choice to transfer to degree as I was led to believe promotion was more likely with it. However, this does not seem to be the case in practice."
I think we need to be careful about nurses becoming disillusioned.
That comment brings me to the high risk of drop-out rates. According to today's Times:
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