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"More than half of students on some nursing degree courses do not graduate because of the pressures of time, money and the academic standards demanded."
Although I do not get cases of students dropping out of college very often, most of the cases I deal with are students of nursing. Many colleges seem extremely tough; some students with legitimate personal troubles that have prevented them from doing well in exams are excluded because colleges will not take those troubles into account. Indeed, many who drop out do not have English as their first language, so perhaps the colleges have their own problems with communication and care, which need addressing.
"many nurses, armed with their new qualifications, will regard the basics of care as demeaning... Those who have spent three years at university and run up heavy debts will not take kindly to emptying bed pans or changing bed linen."
She sums up the fears of many of my constituents in the expression "too posh to wash". Of course, this is a simplistic expression, based on prejudice as much as fact, but the Government have a lot to do if they are to convince my constituents that we will not end up with a generation of nurses who are great at medical strategy, but no good at rolling up their sleeves.
"rejecting essential elements of bedside care because they feel it is not a worthwhile learning experience."
"I keep being asked to do things which won't help me learn-clear up poo, mop up blood, give patients tea and toast... I don't do those sort of things now."
I hope that my hon. Friend the Minister will view this debate as a positive contribution to how to improve the quality of care for our patients. I have not come here to attack the profession or to perpetuate a sexist portrayal of "angels". Nor have I come to be disloyal or disrespectful to a Government who have always aimed to do the best for our constituents. What I want is for nursing to be one of the country's top vocations and for nurses to be trained in full. As Brid Hehir says:
"Caring for sick people is a privilege and nurses need to be competent in providing it. When they are, their status will automatically improve."
The Minister of State, Department of Health (Phil Hope): I congratulate my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) on raising, as she put it, a timely and important issue, and thank her for doing so. She has spoken with characteristic passion for justice and equality, providing many examples this evening of circumstances where her constituents have not had a satisfactory experience in their hospitals, and my hon. Friend has taken up those cases-again, with her customary strength and commitment-with the local health service. She described cases that were, as she put it simply unacceptable-and I entirely agree with her. She is right to challenge such examples wherever and whenever they occur, and she is also right to emphasise the importance of training and the enduring values of nursing. I am pleased to have this opportunity of addressing directly the concerns that she has raised.
Nurses represent the largest staff group in the NHS. They work in a more diverse range of roles and settings than ever before. They are pivotal to the delivery of high-quality, safe care. There is hardly an intervention, treatment or health care programme in which they do not play a significant part.
As we all know, the environment in which all our health care professionals work, including our nurses, is changing. Society, the structures within which health care is provided and, indeed, health care delivery itself are changing. Some types of care that are currently provided in hospitals will be provided in the home or in communities. Technology is becoming more advanced; people are living longer, and therefore health needs are often more complex; and people's expectations are changing and growing. We have come a long way since the stereotypical days, if they ever really existed-my hon. Friend referred to them-when a nurse was expected simply to mop the fevered brow or provide a sympathetic ear. Nursing today requires an intricate interplay between fundamental care and high-level technical competence, biomedical knowledge, decision-making skills, and the ability to develop therapeutic relationships based on compassion as well as holistic and intelligent care.
It is in that context that we must examine the way in which we educate our new nurses, to ensure that they are equipped to deliver high-quality care now and in the future. No profession stands still, and nursing is no different. It has always adapted and responded to new demands. I think it right, in that context, that the Nursing and Midwifery Council has reviewed nurse education, and last week the Department of Health announced our timetable for implementing the resulting changes. It is in accordance with the recommendations of the council, the body that represents nurses, and it involves ensuring that by 2013 all nursing programmes are degree-level and meet the new knowledge, skills and assessment standards being developed by the council. Universities, working with health care employers, will need to revise their curriculums so that those standards, delivered at degree level, provide new nurses with the skills and knowledge that they need in the transformed NHS.
I want to use this opportunity to dispel a few myths-I think that my hon. Friend used the word "prejudices"-that have been bandied about in the last few days, many of which detract from the hard work, skills and dedication of nurses past, present and future. Nursing is not the
younger, less intelligent sister of medicine but a profession in its own right, with its own body of knowledge, its own evidence base and its own principles and values. Our nurses will always need to be compassionate and to care. They will still need to undertake care tasks that are an essential part of their role. That will not change with degree-level education. I can reassure my hon. Friend that students will still spend 50 per cent. of their time on the wards. Those students will be in the community working with patients and their families, learning on the job and being mentored by registered, practising nurses.
No profession has a monopoly on caring, but we should not be defensive about the fact that caring alone, vital as it is, is not enough to make a good nurse. Our nurses will still need to have the values-treating people with dignity, having empathy and demonstrating compassion-that we expect of a nurse. That is why we are working with the university sector and the national health service to strengthen the way in which we recruit our nursing students, the NHS's future lifeblood.
All nurses will still be trained to undertake the essential nursing activities that underpin good patient care and promote health. Keeping patients clean and comfortable, and ensuring they are fed and have enough to drink, will still be an essential part of the nursing role. I hope I have given my hon. Friend and her constituents sufficient assurance that such tasks will be a key element of the work of nurses of our national health service.
However, nurses will also be educated to complete a detailed assessment and analysis of people's health care needs, be they physical, mental or social, and to diagnose, refer, prescribe care or, indeed, intervene themselves as appropriate. Many of our nurses already do this. All nurses continually develop their practice, and many operate well above the level of their original qualifications while still providing the basics of care.
It is worth remembering that more than 30 per cent. of our nurses have degrees already, and we should recognise their significant contribution. Many have obtained them as part-time students, often while working full time over a number of years. Nurses often say that they did not realise the positive impact having a degree would have on their nursing practice, and how much they have improved services for patients as a result. Therefore, the move to degree-level education is in some regards a recognition of the fact that many nurses already operate at this level, and of their professional contribution and status.
Some critics have rightly identified that making nursing degree-level will present a challenge to those who do not have traditional academic qualifications or cannot afford to do degrees. The Department starts from the position that nurses must receive the right education, of both content and level, to equip them to provide high-quality care. We must only recruit those who have the ambition and talent to become excellent nurses. With this principle in mind, we must also ensure that we support and promote wide access to degree places for those who may come late to nursing, for those who may need a bit of extra support and for those who have already developed health care-related skills and knowledge in the workplace, such as health care support workers. Therefore, we are building on good existing practice at national level, and developing with the further and higher education sectors and employers new access routes through, for example, apprenticeships, national
vocational qualifications and foundation degrees. In addition, the NMC is looking to increase the amount of previous academic and practice learning that can be recognised from the current one third maximum up to one half, and hence shorten a programme. That will provide more opportunities for those with relevant, valid experience without their having to go back to square one. We are also tackling the student support arrangements, to make sure that they are fair and do not present any barrier to people who wish to train in nursing or the other health care professions. To support the changes I have outlined, we are also putting in place action to promote nursing as a career. We must attract more nursing applications from people who will make the best nurses and stay in the profession.
We have also published a preceptorship framework to help ensure that our newly qualified nurses have protected time and expert support to help quickly develop the confidence to make the transition to effective practitioner. We have provided the service with an extra £20 million to support preceptorship provision.
In addition, we have published a framework for post-registration nursing careers, mapped against patient pathways, to support a more flexible and competent workforce and equip nurses with the skills and capabilities they require for the future. The framework can be used to demonstrate the wide range of career opportunities in nursing and support the promotion of nursing careers. Together, these developments provide the right direction of travel if we are to fulfil our ambition to provide higher quality care for all. I want to ensure that the intended benefits of changes to pre-registration nurse education are fully realised. Our patients and the public deserve nothing less. Therefore, officials in the Department are working with the national health service, the trade unions, universities, strategic health authorities and the regulator to develop a national implementation plan. All of this links to a wider vision for the profession and for what needs to be done collectively to carry it forward into the future.
Since the launch of the Prime Minister's commission on the future of nursing and midwifery in England, the Department has been engaging with, and listening to, the public, nurses, midwives and professionals. We asked what people wanted from the nurses and midwives of
the future, what skills and competencies they should have and what barriers they may face. We have received an overwhelming response-there have been more than 2,500 individual and organisational responses. The commission has reflected on the responses and developed a vision for the future, identifying some hot topics areas where it wanted further debate to take place. Since the beginning of October we have been debating this vision statement and listening to people's views in response to the hot topics at a series of events across the country and via a range of channels to ensure that the final result resonates with nurses, midwives and other health workers, as well as with the public.
Our vision of nursing and midwifery set out the future that the commission wants to see. Our ultimate goal is that all nursing and midwifery staff fulfil their potential to help service users, families and communities to achieve the best possible health and well-being. We also foresee a future in which nurses and midwives will take centre stage in all aspects of health care and in which nursing and midwifery practice will continue to be rooted in compassion and dignity. Among the hot topic debates, we have been debating how to ensure that the transition to degree-level registration is successfully implemented to enable the nurses of the future to deliver the care that patients want and deserve. The commission will include that important issue in detail in its report.
We value our existing nurses for their contribution now and in the future. We require them to undertake continuing professional development, and we know that many of them have the skills and knowledge to work above the level of their original qualification. We must also recruit nursing students who have the ambition and talent to be excellent nurses. We must maintain a wide access to education programmes for those who may have traditional qualifications and have come to nursing late. I believe we owe that to not only the nurses, but the patients and their families who rely on our national health service to deliver the excellent quality of care that we require for ourselves and for the whole community.