Under pressure

Philip Hunt

Phil Hunt on improving standards of nursing care in a squeezed NHS

Standards of nursing care are fundamental to the quality of the patient experience in the NHS. The last 20 years has seen nurses take on much greater responsibility as they have developed specialist skills and are looking after a much higher number of frail and vulnerable patients. 

Yet, this has happened in parallel to mounting concern about the neglect of basic standards of care including hygiene, the feeding of patients, and even face-to face contact. Ann Clywd MP’s moving and worrying description of her husband’s experience of the indifference of nurses in the final days of his life struck a chord with many. 

The problem is often blamed on Project 2000, which led to degree status for qualified nurses and the phasing out of enrolled nurses – the second tier of qualified nursing. It is often suggested that, as academic priorities have over-ridden practical training, nursing skills have been lost and that those with degrees have been apparently, too posh to wash.

The Lords has come back to this problem time and time again, and we will be having another go today when Baroness Emerton opens a debate on a recent Royal College of Nursing (RCN) report on the future of nurse education. Produced by a Commission chaired by Lord Willis of Knaresborough, the report makes a strong plea for enhancing the quality of education whilst emphasising the benefits of degree-level registration of all newly qualified nurses.

Ministers have to take this seriously and ensure that nurse education programmes give more practical training. A good start would be to give hospitals much more influence over the selection and training of nurses. 

Importantly, the RCN report also recommends the mandatory regulation of all staff who deliver patient care, including health care assistants. That must be right. These assistants play an increasingly important role in the NHS. But there is a real worry that they are sometimes forced to act beyond their competencies due to lack of trained nurses and supervision. There is now a compelling argument for statutory regulation to ensure proper training and standards. 

It would be wrong however, to simply put all responsibility for lapses in care and compassion at the hands of nurse education and lack of regulation of support workers. Nor should we ignore the huge challenge posed by the increasing number of frail elderly people in our hospitals, suffering from multiple chronic conditions. And it is also dishonest not to recognise that recent financial pressures have squeezed nurse patient ratios with an inevitable impact on the standards of care. The NHS has even started to see an actual reduction in the number they employ.

Only last week, the government was forced by the UK Statistics Authority to acknowledge that NHS spending had been cut. Little wonder that the highly respected King’s Fund has warned that the drive for financial stability could be at the expense of quality in patient care.

Undoubtedly, we need to focus on improving the standards of nursing. But we shouldn’t place nurses in an impossible position of treating more and more vulnerable patients without the appropriate staffing, support and training they need.

Lord Phil Hunt of Kings Heath is a Shadow Health Minister and Labour’s Deputy Leader in the Lords

Published 11th December 2012

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