The Minister of State, Department for International Development (Lord Bates) (Con)
My Lords, I, too, welcome this debate and join others in paying tribute to the noble Lord, Lord Crisp, for securing it and for the enormous personal contribution which he has made to raising the profile of nursing both here in the UK and around the world. The debate has drawn on the immense depth of expertise that resides on this subject in your Lordships’ House.
It is worth noting, for the record, as I found when I prepared for the debate, that contributions have come from two nurses—crucially, I start with them—but also from a former Permanent Secretary and a former chief executive of NHS England, a former Secretary of State and Minister of State for Health, as well as a fellow and an honorary vice-president of the Royal College of Nursing, a former president of the Royal College of Surgeons, a former president of the Royal College of Psychiatrists, a professor of nursing and a former hospital chairman.
Lord Bates
Swimmers, of course, are doing health promotion, and we pay tribute to the noble Lord’s work in this area.
This has been an excellent debate and I will respond to some of the points. The noble Lord, Lord Crisp, set the tone by reminding us of the critical role that nurses play in ensuring the delivery of holistic, patient-centred healthcare. The noble Baroness, Lady Bottomley, reminded us that nursing is the most trusted of professions. That carries wider benefits to health efforts. The noble Lord, Lord Willis, reminded us that nurses can be a catalyst for change in developing countries. The noble Baroness, Lady Masham, reminded us of the courage of our NHS volunteers who went out to tackle the outbreak of Ebola in Sierra Leone. The noble Baroness, Lady Cox, gave many powerful, practical examples of nursing achievement in delivering clinical care in remote and challenging situations. My noble friend Lord Ribeiro hit the nail on the head when he spoke about the role that nursing has in women’s empowerment, which is critical across so many areas.
The noble Baroness, Lady Hollins, talked about how nurses could be there in early intervention in mental health conditions. The noble Baroness, Lady Watkins, spoke about seeing nurses as a global resource in delivering the sustainable development goals relating to health. The noble Viscount, Lord Bridgeman, reminded us of the costs and administrative burdens faced by those coming to study nursing in this country. The noble Baroness, Lady Jolly, summed it up by saying that nursing delivers equality, prosperity and health. The noble Lord, Lord Collins, reminded us that, in these matters, the issues of health and disease know no national boundaries in the way they operate and therefore that they demand a different set of solutions.
I congratulate the noble Lord, Lord Crisp, and the noble Baroness, Lady Watkins, on their leadership on this issue since the launch of Nursing Now, which, the noble Lord, Lord Willis, reminded us, was attended by Her Royal Highness the Duchess of Cambridge and was a great success. I am delighted that my colleague, the Minister of State at the Department for International Development, Harriett Baldwin, attended and used that opportunity and platform to announce our support for nursing globally and for the campaign through our health partnership programme, starting in 2019. It is a £5 million programme that a number of noble Lords have welcomed. It will be allocated to focus on nurses and midwives. The programme is designed to address the priorities identified by countries and will focus on nurse leadership where it is part of a country’s health workforce strategy.
Through these partnerships we will work with countries to build comprehensive and effective healthcare systems, not just to deliver separate projects. The programme brings benefits to developing countries and to the UK health system from the increased skills and motivation that UK health workers acquire when working overseas. That is why this campaign recognises the vital role of nurses at the centre of every health system around the world. Nurses account for nearly 50% of the global health workforce. Their knowledge, skills and motivation are crucial in delivering health services to all, including to the poorest.
As the Triple Impact report and the Nursing Now campaign highlight, many countries are grappling with enormous challenges, including shortages, skills, gaps in leadership and challenges mentioned in particular by the noble Lord, Lord Crisp. In the UK, nurses are at the heart of our NHS. We want to keep these hard-working staff and build a workforce fit for the future. My noble friend Lord Ribeiro and the noble Lord, Lord Willis, among others referred to concerns they had about our capacity to train the nurses we need. We have announced 5,000 more nurse training places from 2018, alongside new routes into the profession and continuing measures to improve the work/life balance.
Globally, the World Health Organization and the World Bank estimate that countries will need to create around 40 million new health and social care jobs by 2030—a point raised by the noble Baroness, Lady Watkins. Low-resource countries, where these are needed most, face the greatest shortages of 18 million health workers. We must support them to train and deploy the health workers they need so they can access essential health services.
The noble Lord, Lord Ribeiro, spoke about the importance of the retention of trained staff in Ghana. The noble Baroness, Lady Jolly, spoke about her experiences at the conference and talked about the importance of the retention of staff in South Africa. The noble Baroness, Lady Watkins, rightly raised ethical questions about recruitment from some developing nations. That is why the UK Government support the World Health Organization’s Global Code of Practice on the International Recruitment of Health Personnel, which ensures that developing nations that are experiencing critical shortages of healthcare staff are not targeted for recruitment.
As the noble Lord, Lord Crisp, has argued, this is not just about health services. Investments in the health workforce go beyond improving health. The health sector offers employment opportunities for women and strengthens local economies. The UN High-Level Commission on Health Employment and Economic Growth, which the noble Baroness, Lady Watkins, referred to, found that in 123 countries women make up 67% of workers in health and social sectors. The noble Baroness, Lady Bottomley, and the noble Lord, Lord Crisp, referred to this as well. The commission has estimated that women would take between 59% and 70% of additional jobs created in education, health and social services. These opportunities will be even more important in low-income countries, where women are often excluded from formal employment.
To promote these opportunities in the health sector, a DfID programme in Bangladesh, for example, is aiming to ensure that 4,300 licensed midwives are employed. Some 30% of these will be in remote areas, providing opportunities to young women where other formal employment opportunities are scarce. To deliver and sustain this triple impact, the Government remain committed to working in partnership with countries to strengthen their health systems by improving their health workforces, including addressing the global shortage of nurses and midwives, to ensure that no one is left behind. DfID improves access to and the quality of health services by supporting training, mentorship and supervision for health workers; for example, in Kenya we have trained 7,000 nurses and midwives in emergency obstetric and newborn care. This has already resulted in a 10% reduction in maternal deaths.
Our programmes also invest in nurse leadership, which the noble Baroness, Lady Bottomley, referred to. Through a UK partnership, 20 nurses in Uganda have been trained by UK volunteers in nurse leadership for palliative care. I think the noble Lord, Lord Crisp, referred to this programme. These nurses have supported the training of 154 other health workers and empowered them to take on care traditionally delivered by doctors and to broaden access to palliative care.
In the time available I will turn to some of the questions that were raised. If I do not cover them all, I will of course write. The noble Baroness, Lady Masham, and my noble friend Lord Bridgeman asked about EU nurses leaving after the referendum. Overall, there are 3,600 more EU staff working in the NHS since the referendum. We have seen a small reduction in the number of EU nurses working in the NHS over the period. However, this is due mainly to the introduction of new language tests by the Nursing and Midwifery Council.
The noble Baroness, Lady Cox, asked about healthcare in challenging conflict situations. The UK Emergency Medical Team, including nurses, spent over six weeks training more than 3,000 Rohingya people, with local Bangladeshi nurses working alongside them, learning vital infection prevention and control skills. The local nurses are now tackling diphtheria in the Cox’s Bazar camps.
The noble Lord, Lord Willis, was right to pay tribute to Jackie Smith, the Nursing and Midwifery Council chief executive, who has announced that she is retiring. We join the noble Lord in paying tribute to her leadership of the NMC over the past six years and wish her every success for the future.
The noble Baroness, Lady Watkins, wondered, after the World Health Organization’s appointment, how long it would be before there was a chief nurse at the Department of Health. The Chief Nursing Officer for England, Jane Cummings, advises the Government on nursing workforce issues. We are delighted that her office is working with the noble Lord, Lord Crisp, and the noble Baroness, Lady Watkins, on the Nursing Now campaign.
The noble Baroness, Lady Bottomley, spoke about the Commonwealth connection. I am pleased to confirm that Nursing Now representatives took part in a recent Commonwealth summit event through the Commonwealth Nurses and Midwives Conference.
The noble Lord, Lord Crisp, asked whether nurses were at the forefront of health strategies. The UK recognises the critical role played by nurses. Our bilateral programmes, our support for the World Health Organization’s leadership and our investments in strengthening health systems all promote this essential role.
The noble Baroness, Lady Hollins, asked about mental health and specialist nurses. We recognise that nurses deliver specialist services. The UK funds a research programme called PRIME and a programme in Ghana, improving the care of patients with mental health issues. The disability summit in July this year will highlight the need for services to be inclusive and cater for all needs so that no one is left behind.
There is a wealth of expertise in this area in this House which has been demonstrated in this Chamber today. We remain open to other ideas on how we can build on our commitment to support nurses and midwives through health partnerships.
The noble Lord asked me a specific question on the round table. I will take that back and talk with my ministerial colleagues about it. It seems a sensible way forward and I know that the Ministers Burt, Baldwin and others have appreciated their engagement with him on the Nursing Now campaign. Through DfID and other departments we are committed to playing a part in enhancing the vital contribution of nurses and midwives in healthcare and prevention for all, especially for the poorest people in developing countries.