As a nurse peer I have access to ministers - and they do listen
Baroness Watkins says she has influence not power, but that influence makes a difference. One of only five nurse peers in the House of Lords, she is using her public profile and access to government ministers to shape policy
Mary Watkins appointment to the House of Lords in 2015 did not come out of the blue and nor, she emphasises, did she simply wake up one day and decide she wanted to be a life peer. She had been urged to apply by a network of senior nurses who were determined to increase the professions representation in parliament.
One of the people who spoke to me was Sue Norman, the former Nursing and Midwifery Council head who had been a mentor to me. I said, I just...
Baroness Watkins says she has ‘influence not power’, but that influence makes a difference. One of only five nurse peers in the House of Lords, she is using her public profile and access to government ministers to shape policy
Mary Watkins’ appointment to the House of Lords in 2015 did not come out of the blue and nor, she emphasises, did she simply wake up one day and decide she wanted to be a life peer. She had been urged to apply by a network of senior nurses who were determined to increase the profession’s representation in parliament.
‘One of the people who spoke to me was Sue Norman, the former Nursing and Midwifery Council head who had been a mentor to me. I said, “I just don’t think I’m the right person” and she said unless we had several people giving it a go we weren’t going to get anyone in. One or two people had applied but they weren’t appointed.’
Baroness Watkins of Tavistock is one of five nurses to sit in the Lords but she points out that before her arrival only two had been appointed specifically for nursing, the long-serving Audrey Emerton, now in her eighties, and the late Jean McFarlane, who died in 2012.
She believes it was her non-nursing experience that appealed to the appointments commission. ‘They said we don’t want to talk to you about nursing, we want to talk about the things you have done in addition to nursing. I had been a senior vice-chancellor with a science and medical school reporting to me, and I had also done a lot of work with housing associations, so I had an interesting and eclectic portfolio.’
Mary Watkins – CV
- Qualified as a general nurse from Wolfson School of Nursing at Westminster Hospital in 1976
- Qualified as a mental health nurse from the South London and Maudsley Nursing School in 1979. Worked in community, in-patient mental health and acute settings, providing non-emergency and emergency healthcare
- Made a Nightingale scholar in 1985
- Appointed dean of the then Faculty of Health and Social Work at Plymouth University in 2003
- Appointed deputy vice-chancellor of the university in 2007
- Took early retirement in 2012 to care for her mother who had dementia, but retained close links to the Plymouth University Peninsula Schools of Medicine and Dentistry. Currently emeritus professor of healthcare leadership
- PhD graduate from the Florence Nightingale Faculty of Nursing and Midwifery, and returned to King’s College London as a visiting professor in 2016
- President of the Florence Nightingale Foundation
- Published widely on nursing education and leadership and was inaugural editor of the Journal of Clinical Nursing
- Represented the nursing profession on several Department of Health working parties and is nurse adviser to the BUPA Medical Advisory Panel
- Joined the House of Lords in November 2015 as a crossbench peer. As well as nursing and health services, her interests include housing and planning, and social services
Background in mental health
Lady Watkins, whose nursing background is in mental health, says that any nurse aiming for a seat in the Lords should bear in mind that the appointments commission is looking for well-rounded people who can contribute across a range of issues, not single-issue advocates.
She felt ‘an absolute novice’ in her early days in the Lords – ‘it did remind me of starting nursing’ – but was warmly supported by her fellow nurse peers, particularly Baroness Emerton. Crucially, she has received ‘generous’ assistance from nurse leaders outside parliament, who were rooting for her to succeed.
A common misconception about life peers is that they all receive their titles as an honour with nothing much expected in return. Lady Watkins is clear that as a working peer she has a job to do in scrutinising legislation and influencing government policy.
The long list of nurse leaders who help Lady Watkins contribute effectively, by giving her information and advice, includes Dame Jill Macleod Clark, who briefed her on the NMC’s new education standards at an early stage of their development, the RCN’s Janet Davies, Ruth May at NHS Improvement and the chief nursing officers of England, Scotland, Wales and Northern Ireland. ‘They have been willing to give me their opinions and listen to mine, often confidentially, so we can work out the best way forward for the profession.’
‘I’m learning it’s much more powerful in a debate to colour contributions with real-life examples’
Her speeches in the Lords, authoritative and detailed, show how well-briefed she has been. But more striking is how she draws on real-world experience, including from her own career, to bring policy issues and dry statistics to life.
In one speech she highlighted the need for investment in district nursing by recalling how she once discovered why a patient’s leg wound wasn’t healing by paying an unscheduled visit. She found the woman in a cold house, huddled over a heater, in effect baking the bandage on her leg and preventing healing. The woman explained she had only put the central heating on when she knew the nurse was coming round. Lady Watkins’ point was that while she had the time to investigate why her patient wasn’t recovering, and intervene to prevent her becoming housebound, today’s overstretched nurses often do not.
The extent to which having an impact politically is about making an emotional connection with your audience has surprised her. ‘Sometimes you are much more powerful in a debate by saying an “I” statement. I’m learning to colour contributions with real-life examples, but it wasn’t easy to do it at the beginning.’
Valuable political access
Lady Watkins says a peer has 'influence but not power' – but the influence does make a difference. ‘You have access to people and they listen to you. You can speak to ministers privately. And one of the things about being a peer is if you write them a letter they have to answer. You can also put a written question down and that is helpful. It can make them stop and think.’
‘My next mission is getting more mental health and learning disability nurses’
She is ‘thrilled’ that her efforts on behalf of district nursing – greatly assisted by Queen’s Nursing Institute chief executive Crystal Oldman who worked ‘incredibly hard’ to provide her with the information to build a case – have helped secure funding for up to 500 new training places. ‘The government have woken up,’ she says. On this issue, she told a minister, she was a ‘nagging tooth’.
‘My next mission is how do we get more mental health and learning disability nurses?’ The answer, she explains, is once again, carefully deployed ‘influence’. Rather than berating the government over decisions that have contributed to the workforce crisis, such as scrapping the student bursary, she will try to show ministers that the government’s own objectives in healthcare are being put at risk by nursing shortages. ‘You say “your strategy is brilliant, but you won’t achieve it unless you do something here”.’
Sometimes though, a less conciliatory approach is required. Lady Watkins relishes the freedom that comes with not being attached to any political party. ‘As a crossbencher you can really stand up and say this isn’t good enough.’
Progress on pay deal
Last July she was one of a group of crossbench, Labour and Liberal Democrat peers who signed a letter to The Times, calling on the government to scrap the 1% NHS pay cap. The move was widely reported and she believes it did have an impact. When the recent staged pay deal of between 6.5% and 29% was announced she ‘made a point’ of congratulating the government in the House of Lords. The pay offer may not be enough, she says, ‘but it is a great improvement and it’s important to acknowledge that’.
‘Pay is only one part of what nurses need to feel better – they need to feel they have done a good job’
After she made her comments, she worried slightly that she might have ‘over-egged the thanks’. Certainly, the response on social media to the deal was far from congratulatory, with many nurses scathing about the government’s offer and the unions’ recommendation to accept. ‘I’m not surprised,’ she says. For experienced nurses at the top of their grade, the deal is ‘not brilliant news. But if you are young there is a clear structure to increase your pay more quickly than you could in the past’.
That the best pay offer nurses have had in years should attract so much ire is a sign of a discontent that goes beyond pay, suggests Lady Watkins. ‘Part of the reason people aren’t thrilled about it is that the NHS is not receiving sufficient funds to deliver what society expects and what nurses want to do. Pay is only one part of what nurses need to feel better. They need to feel at the end of the day that they have done a good job and have managed to do 90% of what they would have liked to.’
The lack of follow-up health and social care in the community, which traps older people in hospital beds they are ready to leave, is particularly demoralising for nurses, she says. ‘If you see someone losing their independence while waiting for discharge that is very difficult.’
Seamless transition from acute to community
Lady Watkins has argued in the House of Lords for a ‘total systems approach’ to health and social care, with acute trusts providing community support for six weeks following discharge. ‘There are some simple solutions that could make things better – and the government is getting interested.’
She has also called for spending to be targeted on improving care in care homes and in people’s own homes, as well as on increasing nursing numbers.
What really worries her is that the consequences of chronic underfunding, such as cancelled operations and delayed discharges, are making younger people disillusioned with a health service that doesn’t seem able to deliver for them or their grandparents. ‘We have to fund the NHS better so that society keeps on wanting it. And that will also make working in the NHS more attractive again.’
She wants not just an increase in health and social care spending, but a funding model that will secure an agreed income for services for the next ten years. ‘The NHS will be 70 this year, it is right that we think about the next decade.
‘I think we have to sign up to the next ten years and accept that it is going to cost more to deliver care to our population.’
She is encouraged by the health and social care secretary Jeremy Hunt’s comments on the need for long-term financial planning. Is it a matter of pushing on an open door? ‘I think at the moment, yes. When the time is right you have to act, and I think the time is right now.’
Lady Watkins has no truck with the idea that the Conservative government wants to dismantle the NHS. ‘I think politically Theresa May believes in the health service, which is great, and she knows the government has to show its commitment. One part of that is doing something about pay, and the other part is making sure the health service can change – that will not come about without investment in training so that people can work differently.’
The government may want to invest in and improve the health and social care system but does it have the money or the energy to embark on such major work? There are concerns that the domestic agenda is bound to suffer as all political bandwidth is consumed by Brexit. Lady Watkins, however, sees the government’s workload as an opportunity, not a barrier. ‘It is why we should strike now, because if a simple path is shown and it is not exorbitant it will be accepted in a way it wouldn’t be if they had time to crawl over it 20 times.’
‘I want to empower senior nurses over CPD funding’
One of the most pressing priorities is securing improved funding for nurses’ continuing professional development. At the chief nursing officer for England’s summit in March, Lady Watkins drew attention to the underinvestment in nursing with this much-reported quip: ‘I have had the pleasure and challenge of being married to a surgeon for nearly 40 years. All his post-qualifying education was paid for. Mine wasn’t. Think about that.’ It went down a storm.
‘I didn’t know I was going to say that,’ she laughs. Her aim at the summit was to ‘empower the most senior nurses in England’ to go back to their organisations and push for change. All healthcare staff, not just nurses, need to have their CPD funded so they can meet the changing needs of the NHS, she says. ‘If it is about learning a skill the employer needs, it should be funded.’
‘It is difficult to sell the profession to a 16 year old because you can’t describe how you would get somewhere’
Another topic she feels strongly about is the need for a career structure that will show nurses in their thirties a clear path up to board level, with access to support and development opportunities, such as placements, along the way. A clearer career structure (similar to the route to chartered status for engineers) would also, she suggests, make nursing more attractive to school-leavers and, importantly, men. ‘It is difficult to sell the profession to a 16 year old because you can’t describe how you would get somewhere. And still only one in ten nurses are men – it is partly because the career structure is less clear.’
A gender-balanced profession
She is ‘absolutely certain’ that greater gender balance would be good for the profession. ‘Men would be challenging about some of our practices and add value by making us more diverse. And who wouldn’t want to make any profession more diverse?’
Having more men would also, she suspects, raise the status and increase the influence of the profession, a key objective of the global Nursing Now campaign. Lady Watkins is the alternate chair of the campaign, which, by empowering nurses, is attempting to deliver World Health Organization objectives for universal healthcare and improve the position of women. The WHO’s objectives for healthcare won’t be met, she says, unless governments train more nurses and enable them to practise to the full extent of their licence. It is not only nurses in developing nations who are prevented from being as effective as they could be, she points out.
‘There are advanced nurse practitioners who have not been able to take on their full roles and some nurses who qualified as prescribers who have not been able to prescribe. It is also clear that we have people like nurse endoscopists who are allowed to work at the level they trained at in one hospital but have difficulties if they move to another hospital.’ A more structured approach, with recognition of advanced skills and standards, is needed, ‘so if you move around you don’t have to go back to the drawing board’.
She would also welcome a little more structure – an end point – in the careers of working peers, which would increase turnover in the Lords. ‘I would vote for legislation that you should [normally] retire after 15 years and serve a maximum of 20 years.’
At 63, Lady Watkins is clearly enjoying her role in the Lords but it is a huge commitment. ‘When the House is sitting, I spend four days a week on Lords’ business.’ The travel alone, from her home in a village 40 minutes from Plymouth, is tiring.
Seeing her in her kitchen, gamely cooperating with the instructions of Nursing Standard’s photographer, after I’ve already taken up a good part of her afternoon with this interview, it is hard to imagine her slowing down. But she has no intention of going on forever. ‘I couldn’t keep up this pace at 80.’
She believes the number of nursing and healthcare peers needs to double or treble, to ten or 15, and hopes nurse leaders will increasingly see the Lords as a place where they can make a difference. ‘It is living up to what I hoped a working peer could and should do. It is a huge privilege to represent the profession at this level.’
Thelma Agnew is commissioning editor, Nursing Standard
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