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That is why the Nursing & Midwifery Council, following a review and consultation, announced the intention to raise the minimum academic level for registration as a nurse to a degree. The department, after considerable engagement with stakeholders, including strategic health authorities, announced in November 2009 that in England nursing programmes from 2013 will be degree level. Degree-level education will develop stronger analytical and problem-solving skills. It will preserve nurses' hands-on caring skills and build the skills needed to be increasingly independent and innovative. It will enable nurses to assess and apply effective evidence-based care, safely and confidently lead teams, and work across service boundaries. Nurses will be able to provide increasingly intelligent care with compassion. The change in the level of qualification, combined with revised competences on which the NMC is about to consult, will ensure that new nurses can further improve the quality of care and patient safety faster and more effectively.
Our existing nurses already operate in this environment and are effective at this. They have had the benefit of post-registration development and education. Many, often supported by their employers, will have upgraded, or are upgrading, their existing diplomas to degrees. The NMC has made it clear it will not require existing nurses to have degrees in order to remain registered. The NHS values all its existing nurses; they all have important contributions to make. But we cannot leave things to chance. If we are to improve quality, prevention and productivity, all new nurses need to have the skills and qualities to tackle the changes I have outlined much earlier in their careers. Degree-level registration
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Regarding costs, the cost of delivering a degree is substantially the same as for a diploma. Universities receive the same fee for both, and both programmes are three years long. New nurses, whether diploma or degree qualified, will continue to enter the NHS at the same pay band as now. We recognise that the change in qualification may make it harder to fill all pre-registration places once they are all degree level. We will attract a new cadre of students to nursing but will also need to actively attract talented people with the right values and develop new routes into nursing. We are exploring how we might better promote nursing careers.
We are also developing proposals with education colleagues to widen access to degree programmes-for example, through apprenticeships, NVQs and foundation degrees. These will construct routes into nursing for those without sufficient academic entry qualifications but who have the right attributes. It will also provide a clearer career pathway and support improved training for clinical support workers who are supervised by nurses and provide valuable care for patients. We are also exploring the potential for fast-tracking existing non-nursing degree-holders through nursing programmes. This builds on the NMC's proposals to increase the proportion of prior learning that can count towards a nursing qualification. More broadly, for professional education that the NHS commissions directly, we are encouraging fairer access by providing financial incentives for universities to improve their approach to equality, widening participation, and reducing attrition. Finally, we are also tackling the student financial support arrangements to make sure they are fairer.
The noble Baroness, Lady Gardner, brought home her anxiety about the black hole, which is key to her overall concerns. There is no evidence to suggest that the position on nursing numbers in terms of workforce planning is in a difficult position. The strategic health authorities developed local workforce plans based on service needs in current demographics. These are shared with the Department of Health. Indeed, the Department of Health is about to develop a Centre for Workforce Intelligence to support the process. The introduction of it is key. Subsequently, the department has worked with strategic health authorities to develop an assurance process to establish that plans are put in place to deliver change. This has looked, for example, at engagement with universities, risk assessment and project management. As the noble Baroness, Lady Finlay, pointed out, it has happened in Wales and we accept that there are lessons to be learnt.
The noble Baroness, Lady Gardner, also raised the issue of attrition. The department recognises that there are high attrition levels on some nursing programmes. We continuously work with strategic health authorities and universities to reduce attrition rates. However, the average attrition rate for degree nurses is 17 per cent while for diploma nursing students it is currently 21 per cent. The move to degree nursing may improve things
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The noble Baroness, Lady Gardner, raised six questions. I think that I have answered them all or in part. She raised an individual case. I shall not comment on that tonight or on any individual cases, but I acknowledge that maintaining the element of personal service and compassion in nursing is of central importance to us. As the noble Earl pointed out, considerable consultation is to be had with the NMC on setting up the structure of the new procedure. A high level of involvement is a key element of that, as is building these considerations carefully and solidly into the new structure.
The noble Baroness, Lady Finlay, talked about the lessons to be learnt from Wales. She cited a student who was not ready to progress on leaving school and said that people progress at different rates. I have much sympathy with that person. I think that we do not make enough of a commitment-dare I criticise my Government?-although I am sure that we make every possible effort. Lifelong learning should mean what it says. It should mean not only under-25 learning but "all the way through" learning. I learnt just as many skills in the latter part of my life as in the early part. I have listed the various channels that we are trying to progress so that people can come in at a junior level and move on.
Compassion and caring are central to our approach. Of course, we sometimes fail-and we apologise for that-but central to nursing must be compassion and safety. High standards of practical skills will be maintained. The essence of the Question before us is whether a degree will increase the total basket of skills without diminishing the practical skills. The Government feel that the answer is yes.
On the shape of training, the Nursing & Midwifery Council stipulates the hours in the preregistration process. Students currently undertake 4,600 hours of learning, 2,300 of which are in the practice environment; for example, in wards, clinics, outpatient departments, day units, nursing homes and community settings. This will continue to be the case when nursing moves to degree-only.
The issue of risk aversion and nurses not making positive decisions was raised. If we get the graduate course right-and we do need to consult on it-it will improve the ability of individual nurses to make decisions in those critical-judgment areas.
The noble Baroness, Lady Gardner, and others spoke about two levels of nursing and said that there is a need for the practical nurse. We do not see it that way, but, nevertheless, there will be staff involved in patient care. The NMC register has one part for registered nurses; there is no intention to create a second level for assistant nurses. However, it is recognised that there needs to be some form of regulation for some support staff. It is an ongoing area of consideration.
The noble Baroness, Lady Masham, said that we need more specialists, but that we also need compassionate individuals. We agree. The need for maintaining the
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The noble Earl, Lord Howe, in many ways made the case for the degree nurse. I agree with most of what he said: it should be led not by status but by competencies which improve their performance, make them work more safely and deliver better healthcare. We commit that compassion and people skills will continue to be part of that training and part of their future.
8.34 pm
Equality Bill
Committee (3rd Day) (Continued)
8.36 pm
Clause 77: Discussions with colleagues
81A: Clause 77, page 49, line 33, at end insert-
"( ) A term of a person's work that purports to prevent or restrict the person (P) from seeking disclosure of information from a colleague about the terms of the colleague's work is unenforceable against P in so far as P seeks a relevant pay disclosure from the colleague; and "colleague" includes a former colleague in relation to the work in question."
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall): If Amendment 81B is agreed to, I cannot call Amendment 82 by reason of pre-emption.
81B: Clause 77, page 49, line 34, leave out from "A" to "whether" in line 36 and insert "disclosure is a relevant pay disclosure if made for the purpose of enabling the person who makes it, or the person to whom it is made, to find out"
The Deputy Chairman of Committees: If Amendment 82A is agreed to, I cannot call Amendments 83, 84 and 85.
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82A: Clause 77, page 49, line 39, leave out subsections (3) and (4) and insert-
"( ) The following are to be treated as protected acts for the purposes of the relevant victimisation provision-
(a) seeking a disclosure that would be a relevant pay disclosure;
(b) making or seeking to make a relevant pay disclosure;
(c) receiving information disclosed in a relevant pay disclosure."
Amendments 83 to 85 not moved.
Clause 77, as amended, agreed.
87: After Clause 77, insert the following new Clause-
"Equal pay audit following contravention by employer
(1) In the event that a court or employment tribunal finds that an employer has contravened the provisions of this Act relating to equal pay, the employer shall be required to undertake an audit, to be known as an equal pay audit, and to make the results of the audit available in the prescribed manner.
(2) In this section "prescribed" means prescribed in regulations made by the Secretary of State."
Baroness Morris of Bolton: My Lords, I speak to Amendment 87 and the other amendments in my name and the name of my noble friend Lady Warsi. Our amendments would have the effect of easing an unnecessary bureaucratic burden on companies without, we believe, weakening the effect of the Bill on equal pay.
We regard equal pay as a matter of social justice and believe that the plight of women working in firms of all sizes should not be ignored. I introduced a Private Member's Bill on this subject a year ago this week and remain firmly committed to the issue and its importance. I said then that pay inequality is not acceptable whatever the economic times. We must ensure a culture of equality and fairness in the workplace to motivate women, who will play a crucial part as the economy recovers. I reiterate that in the knowledge that noble Lords around the Chamber will share my dismay that in the 21st century women are still paid on average almost 13 per cent less than men, with the figure rising substantially for part-time work. I remind your Lordships that 45 per cent of women who work in the UK do so on a part-time basis.
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These women deserve to be treated fairly and protected by the law, yet we have seen the pay gap widen in some areas. That is why I brought legislation before your Lordships' House. I did not pursue it last January because I genuinely believed, as so many of us did, that we would have seen the Equality Bill in your Lordships' House long before now. However, as I and my noble friend Lady Warsi explained at Second Reading, we are not convinced that the Bill's intention to impose compulsory pay audits is the right way in which to proceed. We believe that requiring all companies to carry out this exercise would be costly and time-consuming and would not necessarily be effective.
Surely the emphasis and resources should be directed at problem employers and how we deter unfair practices. The more sensible solution would be to require an audit in all companies in which an employee has brought a successful case on these grounds. That would greatly strengthen the current position by providing meaningful sanctions against unfair employers while not burdening the majority of fair employers with a new administrative burden. I recognise that business organisations are not too keen on the Government's amendments but have concerns with our proposals as well, mainly because they have worries over the tribunal service. We understand those worries and would like to carry out a review of the service if possible.
As noble Lords will see from our proposal that Clause 78 should not stand part, we have serious concerns with the means of achieving a shared desire. Just before Second Reading, there were hints in what appeared to be well informed media that the Government might be looking to row back on company pay audits. The Minister denied that when we raised it at Second Reading, but there is still time for her to reconsider.
The exemptions from this clause are very interesting. Why would they not apply to government departments? Perhaps we are to believe that Her Majesty's Government have an unimpeachable record on equal pay. Sadly, that case does not look too convincing, given that two past Ministers for Women in another place have been appointed to do the job but not been given a salary to do it. If any part of the explanation is that this is superfluous or impractical in the cases to which the exemption applies, that should tell us all we need to know about this clause.
Together with our belief that this clause is over-bureaucratic and puts an undue burden on good employers, we object to it because it will apply only to women in companies of a certain size. The amendment proposed by the noble Lord, Lord Lester of Herne Hill, seeks to address this, but we remain of the firm belief that any equal pay legislation should be there for all women. However, if this clause remains, the metrics for gender pay gap reporting will be crucial.
A number of business organisations have been in touch with us regarding serious concerns about the EHRC report, which will supposedly contain the metrics for gender pay gap reporting. Harriet Harman charged the EHRC with delivering a voluntary reporting framework that would allow greater pay transparency to be measured. The publication was expected to coincide with the Second Reading of the Equality Bill in your Lordships' House on 11 December, but the deadline came and went. According to business groups,
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The way this has been organised means that we do not have the report today. Has it been published yet? It certainly had not been earlier. Have the Government found agreement? What were the parameters of the near agreement before Christmas, and why have the Government rowed back on this? Late amendments, late reports, late metrics-it makes you almost feel like saying, "We can't go on like this". I beg to move.
8.45 pm
Lord Lester of Herne Hill: My Lords, at this late hour I cannot muster sufficient disappointment and indignation, as I feel, about this part of the Bill, and I have already said some of what I feel at Second Reading. Using moderate language, it is in my view a complete betrayal of what I expected would be in the Bill on the principle of equal pay for men and women.
I can deal swiftly with the amendment that the noble Baroness, Lady Morris of Bolton, has just moved. I hope she will forgive me for saying this, but I find the position of Her Majesty's Opposition incoherent- Amendment 87, Amendment 89 and Clause 78 stand part attempt to water down the gender pay gap information clause. They seek to remove Clause 78 in its entirety and replace it with a clause that would only require an employer to publish a pay audit if a court or employment tribunal found that they had contravened the provisions of the Act relating to equal pay. In other words, the position of the Official Opposition as I understand it is that they do not like what the Government have put in, pathetic and weak though it is, and instead they want to treat an equal pay audit as a punishment-so that only if you were found, in an individual case, to have broken the law would you suddenly have an equal pay audit inflicted upon you. That is not sensible. For one thing, it is entirely arbitrary. We are dealing with a systemic problem that requires a systemic solution.
What is the systemic problem? The systemic problem is that the Equal Pay Act 1970-Barbara Castle's Act-has proved to be unworkable. I am afraid this is because its procedures, which were amended in Margaret Thatcher's time to comply with the European Court of Justice judgment, were deliberately intended to be unworkable. It is tortuous, and the judges have said
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The matter we were discussing before was technical: it was simply an attempt to state the equal pay law, as it is, in an accurate way in the Bill. Now we are talking about what can be done, more than a generation after the Equal Pay Act was first enacted, to close the pay gap in a really effective way.
When I introduced my own Private Member's Bill, based on Professor Sir Robert Hepple's report, we set up a working party which consisted of all the main government departments, the CBI and the TUC. Month after month we sat and negotiated the equal pay audit that was in my Bill. I remember the CBI representative Mr Cridland, for example, was entirely in favour of it. What has happened now is that I am afraid since their inception the present Government have always asked themselves, and answered, one question: what would the employers think about this? It is the wrong question. The right question is how can you achieve equal pay for women, given the history of non-compliance?
The reason an equal pay audit is required is not as a punishment. It is because employers in the private and public sectors need to review their pay systems to see whether there is any direct or indirect discrimination, and they need to do so voluntarily, not by way of punishment. Any good employer, I hope, already tends to do that. The question is: what encouragement can the law give?
The noble Baroness, Lady Gould, who I am delighted to see is in her place, knows this at least as well as I do, as does the noble Baroness, Lady Turner. At the moment, the law works by encouraging employers to carry out job evaluation schemes. If they carry out a job evaluation scheme measuring the work that men and women do throughout the labour force, and then apply it properly to pay, they can eliminate direct and indirect sex discrimination. The real question is: how can the law best assist in encouraging large and medium-sized employers to do what is needed, which is to eliminate sex discrimination in pay after all these years? I do not suggest that the reason for the pay gap is only sex discrimination-of course that is not the case. Part of the reason has to do with other social factors, which we all know about. There is undoubtedly still persistent and continuing sex discrimination.
It seems to have got into the head, not necessarily of the CBI but some of its members, that it is clever to leave the system as it is now. As I read its submissions, the CBI opposes the timid proposals in the Bill. Employers seem to be under the impression that the best thing they can do is leave the present antiquated, tortuous and unworkable system as it is, so that it can simply be soldered up year after year, leaving it to individual litigation.
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