HC Deb 01 April 1927 vol 204 cc1623-58

Order for Second Reading read.

Mrs. PHILIPSON

I beg to move, "That the Bill be now read a Second time."

I find myself in an unusually fortunate position, because the principle embodied in the Bill has already been approved by a Select Committee of this House. Hon. Members who have read the Report of the Select Committee, under the Chairmanship of the hon. Member for Fulham (Sir C. Cobb), will have seen that the issues involved were carefully explored and that evidence was taken from a representative body of witnesses. The Committee came to the conclusion that the existence of a genuine need for the registration and supervision of nursing homes was fully established. On arriving at this conclusion, they emphasised a number of facts which clearly emerged from the evidence placed before them. In the first place, the premises of many nursing homes are structurally defective and unsuitable for the purpose to which they are devoted. Secondly, the Committee were deeply impressed with the urgent need for registration and supervision, particularly in regard to that class of nursing home that caters for poor people and senile chronic cases. In the third place, they considered that in many nursing homes the accommodation for the nursing staff was seriously defective.

Having concluded that the case had been clearly established for the registration of nursing homes, the Select Committee gave careful attention to the problem of the machinery by which such registration could most appropriately be put into operation. The House will be aware that in the areas of certain progressive local authorities, such as London and Manchester, they have already in operation local Acts providing for the registration of maternity homes; and in 1926 Parliament passed a general Act which provided, inter alia, for the registration of maternity nurses. The Select Committee came definitely to the conclusion that the registration and supervision of maternity homes should be made a part of one comprehensive scheme covering all nursing homes. Following the principle adopted in the Midwives and Maternity Homes Act, 1926, the Select Committee recommended that the authorities to administer any system of registration should he the local authorities, namely, the county councils and the county borough councils under the general supervision of the Ministry of Health.

I will not weary the House with further details as to the specific recommendations of the Select Committee, but, to avoid repetition, I will now pass to a few observations about the Clauses in the Bill which substantially give effect to those recommendations. It I may depart from the strict numerical arrangement of the Clauses, I would like to ask the attention of hon. Members, in the first place, to Clause 8. This Clause defines the authorities which will administer the Bill. The local supervising authority will be the county council or the county borough council. This follows a recommendation by the Select Committee, and I think the House will agree that it avoids the danger, which we are all most anxious to avoid, of undue centralisation. Those persons carrying on nursing homes will be required to apply for registration. Clause 1 of the Bill makes it an offence for any person to carry on a nursing home without being registered in respect of it. I would particularly direct the attention of the House to the requirement in Subsection (3). The local authority will be entitled to refuse registration on the ground that the person applying is not a fit person or that the premises, whether in situation, construction, accommodation, equipment or staffing are unsuitable. Then, in paragraph (c), we come to those requirements which relate to the qualifications of persons managing nursing homes. Paragraph (c), which deals with nursing homes that come into existence after the passing of this Bill, aims at securing the ideal to which the Select Committee pointed, namely, that the person in charge of any nursing home and a certain proportion of the staff should be qualified nurses. Paragraph do makes the same provision on the lines recommended by the Select Committee in regard to existing nursing homes. Many of these are managed by persons who are not qualified nurses, and it was thought by some people that it would be an arbitrary and unfair thing for Parliament to deprive them of their livelihood merely because they have not a qualification which has only become general in the nursing profession in comparatively recent years. The Bill does not propose, in the case of nursing homes that are in existence at the commencement of the Act, to refuse registration if the person in charge is unqualified, but it does propose to insist that the person who is superintending the actual nursing of the patients shall be a qualified nurse. The House will see from paragraph (e) that, while maternity homes are brought into the scheme, a special provision is inserted because provision has to be. made for the special qualification of certified midwives who normally will be found in many of these establishments.

At this point, I might, perhaps, direct the attention of the House to the Schedule of the Bill which proposes to repeal Part II of the Midwives and Maternity Homes Act, 1926, thereby giving effect to the Select Committee's recommendation that maternity homes should be brought within the purview of this general Measure. Clause 3 makes detailed provision in the event of the local authority refusing to register or cancelling a registration. It will be seen that due notice has to be given of the intention of the authority to make any such order, and there is an appeal against them, first, to a Court of Summary Jurisdiction and then, if need be, to a Court of Quarter Sessions. Perhaps I might mention here that the Select Committee recommended that appeals should be made to a referee appointed by the Minister of Health, but I think the House will agree with me that there is much to be said for the principle embodied in this Clause, that such matters should be dealt with by the existing Courts rather than that the central authority should be called upon to appoint referees in these cases. Clauses 4 and 5 give the local authorities certain detailed powers for the execution of their duties under the Bill. The forth. Clause empowers them to make by-laws in regard to the records to be kept in nursing homes and in regard to certain notifications which must be made; and in Clause 5 will be found provision for inspection. Following the recommendation of the Select Committee, the duty of inspection is to be carried out by officers of the local authority, and it will be observed that the proviso is designed to secure that there shall not be any inquiry into the medical records of individual patients. This is a confidential matter, and the Select Committee considered that any inquiry by the local authority in regard to it would be resented, not only by the patient but by the medical advisers, and I am sure that the House will see the necessity for safeguarding that point.

In Clause 6 will be found provision for the temporary exemption of certain establishments of a charitable nature. This, again, is in accordance with the recommendation of the Committee and, in addi- tion, it provides for an appeal if any person is aggrieved by the refusal of a local authority to grant exemption. The next Clause to which I desire to draw the attention of the House is Clause 9, the definition Clause. It gives a definition of "Nursing home," which is designed to exclude certain establishments, mentioned in the Clause, which are maintained by public authorities, or constituted by special Act of Parliament, or incorporated by Royal Charter. This, again, follows the suggestion of the Select Committee, and is in accord with the corresponding provision in the Midwives and Maternity Homes Act. The definition also excludes any institution which is already liable to inspection under the Lunacy Act or the Mental Deficiency Act. This is obviously necessary, because such institutions are already subject to an inspection by the Board of Control, and there is no occasion to duplicate the machinery in such cases.

The definition of "Qualified nurse" in Clause 9 brings it into relation with the Nurses Registration Act, 1919, and I think that in some ways this Bill, providing for the registration of nursing homes, is the logical consequence of the Nurses Registration Act. That Act was a notable step forward in placing the nursing profession on a better recognised footing, and in improving the care and treatment of the sick. One of the important effects of this Bill will be to secure that proper qualifications on the part of the nursing staff shall be one of the conditions under which nursing homes may be registered. The last Clause to which I would draw the attention of the House is Clause 10, Sub-section (3) of which provides for proper safeguards for the repeal of local legislation. I think this rather carries out the underlying idea of the Select Committee when they recommended that nursing homes should be brought under one comprehensive scheme, and it is very desirable that this general Act should supersede such local Acts as are in operation in various parts of the country.

With this brief review of the main provisions of the Bill, I recommend the Measure to the House as one designed to give effect to the principal recommendations of the Select Committee, in order to meet a long-standing need for the regulation of the position of nursing homes. If Parliament passes this Bill, it will be a safeguard against abuses, without unduly interfering with well-equipped and well-run establishments, and without impairing the privacy of treatment that patients and their medical advisers desire. The Bill fulfils its purpose through existing machinery, and it aims at raising the standard of the conditions under which the sick are nursed, and also the conditions under which the nursing profession perform their duties.

Mr. JOHNSTON

Before the hon. Member concludes, would she mind explaining why, in her very interesting survey of the terms of the Bill, existing maternity homes are excluded?

Mrs. PHILIPSON

I understand that the Seconder will deal with that point. I have, particularly, not dragged in any of the sordid cases that came before the Committee and individual members of the Committee, but, to stress my point, as I am so anxious to see this Bill placed on the Statute Book, I will tell the House of one individual case, where I know the relatives personally, and can vouch for the facts. It was at a nursing home in Leeds. There was a young married couple, and the wife went into the nursing home. They had very small means. It is true that the nursing home's terms were not very costly—they were only six guineas a week; but the cost was far heavier—it cost that woman her life. She died of septicæmia, and it was discovered afterwards that the woman in charge of the nursing home had no idea of and no qualifications for nursing whatever, and that, of the nurses there, although they were in uniform, not one had had the slightest experience or had the slightest conception of how to deal with maternity cases. That woman lost her life. I am sure I may make an appeal to hon. Members of all parties in the House. I know that the Bill can probably be improved, and I am hoping that Amendments will be put down in Committee by various hon. Members, including the hon. Member for Dundee (Mr. Johnston). I appeal to the House to give the Bill a Second Reading to-day, because it will not only be of great benefit to the nursing profession and to the medical profession, but, above all, to the public.

Mr. GERALD HURST

I beg to second the Motion.

I am very grateful to the hon. Lady for giving me the opportunity of seconding the Motion, because the subject of the registration of nursing homes is one that has appealed to me ever since it was first launched two years ago. In fact, in 1925 I myself brought forward a Bill based upon the principle which underlies this Measure. The movement which has culminated in the bringing forward of the Bill to-day did not originate through persons entirely outside the question of nursing homes. The movement for reform originated among the nurses themselves. The College of Nursing, which has done a great deal to secure better conditions for nurses and to improve their professional status, first raised the question some years ago because they were appalled by the fact, which is still a fact to-day, that there are up and down the country some hundreds of institutions which call themselves nursing homes, although there are not any qualified nurses on the staff, and although it is an absolute mockery to call such institutions homes. As the law stands at present, the words "nursing home" connote nothing. They have no legal significance at all. The result is that the public are persuaded again and again to enter into institutions which are in substance bogus nursing homes, because, although they make the pretence to be nursing homes, in fact there is no guarantee whatever that there is any qualification for treating the sick in those institutions. It was felt by the nurses who raised the question that the prevalence of institutions of this type was dragging through the mud the name of the noble calling which they pursue. That is the point of view of the nurses.

Of course from the public point of view the matter is at least as important. Those who at present go for treatment to a nursing home ought to know that it is a nursing home and not a bogus one, and at present, even in the case of homes that are owned by doctors or recommended by them, the doctors may themselves be quite ignorant as to the qualifications and characters of the nurses and the accommodation and the amenities of the home which they control or run. The result is that many members of the public pay very large fees to go into institutions which have no claim whatever to carry on the purpose which they profess to follow, and as the public has been protected in the past by legislation against quack dentists and doctors, it is considered high time that it should be protected against quack nursing homes. When this project was first brought forward, quite a number of reasonable people had their doubts as to the wisdom of legislating further for the registration and inspection of nursing homes. At present we are rightly jealous of interfering with the freedom of individuals to carry on their trade or business how they will, and it was felt, although there was a strong case, owing to the complaints which have been made particularly about maternity homes, there was considerable doubt as to the wisdom of interfering with nursing homes. The doubt was intensified in the mind of the Ministry of Health by the fact that very few complaints at that date had reached them with regard to homes other than maternity homes, so that, although encouragement was given to the Bill which is now styled, I believe, in honour of the hon. Member for St. Albans, Fremantle's Act, the Act that provides for registration of maternity homes, the question with regard to other nursing homes stood over until the Select Committee had reported. On that Select Committee there were a considerable number of doctors, whose opinions carry very great weight in this House, and the opinion of the Select Committee was unanimous on the question of the wisdom and propriety of introducing legislation for the registration and inspection of nursing homes. All who read the Report of the Committee will be particularly grateful to my hon. Friend the Member for Fulham (Sir C. Cobb), who was Chairman of the Committee, and whose industry and ability are reflected in the very interesting Report that Committee made to the House.

There are three outstanding features of that Report. First of all it represents a true picture of abuses which I think were not realised in the least by the ordinary public before the publication of the Report. Some of those abuses refer to inadequate and bad accommodation, the structure of the building, and the abominable way in which the staff were housed and accommodated in various places. But the main abuses, and those which I think will strike the imagination of the reading public most, are the abuses with regard to the neglect of the patient in a very large number of nursing homes. I should like to read a few sentences from the Report: Owing to insufficiency or lack of qualification in the staff, patients particularly of the senile chronic type, are stated to be left entirely to administer to their own wants although often quite incapable of doing so. That they frequently develop bed sores due to prolonged neglect. They are rarely washed. The bed linen is changed at very infrequent intervals, even when soiled. The rooms are verminous. No adequate protection is taken to prevent dissemination of contagious or infectious diseases, and frequently patients are unable to obtain any assistance when they require it. The food is scanty and often quite unsuitable, and has to be supplemented by the patients themselves or their friends. Elderly and senile patients, practically put away in a cheap home by relations who take little or no further interest in them suffer great indignities, are very unhappy and too frightened to make any complaint. That is only one passage from among many which are borne out by the evidence given before the Committee which shows how great those abuses are.

That is the first point they make in their Report. The second point is that they see no objection whatever to a system of registration and they regard registration as the only means by which the public can be protected against bogus and ill-managed homes. Thirdly, they see no objection at all, and in fact they recommend reasonable inspection. People very naturally boggle at the idea of inquisitorial methods. They do not like the idea, rightly, of a well-conducted nursing home being visited at all times of the day by unsuitable spies and inquisitors. But inspection is not necessarily inquisitorial. A reasonable in spection by qualified persons at reasonable times will, I am sure, be objected to by no one who carries on a reasonably conducted nursing home. There is in the Bill as now drafted, I think, a mistaken view put forward as to the person who should carry out the inspection. The Report of the Committee was that it should be carried out by the Medical Officer of Health assisted by his technical staff, that is to say, by a nurse qualified to go into matters of nursing and a sanitary officer to go into questions of sanitation as the case may be. In the Bill the word "inspector" is used. That is not what the Committee wanted. We want the inspecting officer to be, as in the case of maternity homes, the local medical officer of health assisted by a qualified nurse to deal with all questions of nursing and a sanitary officer to deal with all questions of sanitation. The view taken by the Committee was that inspection was desirable and necessary and was absolutely compatible with the absence of inquisitorial methods Those are the three dominating features of the Report, and a striking feature of the evidence given before that Committee was the entire absence of evidence hostile to the project of registration and inspection. Many witnesses volunteered to come forward but it was the most difficult thing in the world to find any witness who would say anything against the principle, at all events, of registration and inspection. I think the practical unanimity amongst expert opinion and non-professional opinion on this question is eloquent as to the need for this Bill.

May I say a few words about the Bill itself? First of all, in answer to the question of the hon. Member opposite, until the Bill is passed there is no need at all to deal with the registration of maternity homes now in being, and the reason why this Bill deals only with future maternity homes is that existing nursing homes are effectually and completely covered by the Act passed last year. There is one point with regard to paragraph (c) of Clause 1 (3). The distinction between paragraphs (c) and (d) is that (c) deals with conditions precedent to the registration of homes in the future and (d) deals with conditions precedent to the registration of homes now in being. With regard to (c,) future homos, the condition to be met before registration is granted is that the home must be under the charge either of a doctor or a qualified nurse, and then the Bill ought to read, in my view, "in either case there should be a proper proportion of qualified nurses on the staff." The word "or" is used, but it is not meant as an alternative, because it would be ridiculous to make a condition that existing homes must have a qualified nurse on the staff and not to make at least an equally strong condition with regard to future homes. I think that is a mistake in drafting and the real intention is that with regard to the registration of future homes there must either be a doctor in charge or a qualified nurse and that in either case there must be a proper proportion of qualified nurses on the staff. Some hon. Members may say, if that is the idea why do you make a more moderate provision with regard to homes that are now in being? The answer to that is that under the existing law a great many persons have put their money into nursing homes and have been conducting them to the best of their ability and according to their lights, and although they are not in any way skilled persons you do not want to deprive people of their livelihood by sudden legislation. It is thought, rightly, that it is best to temper the wind to the shorn lamb and not to impose the same drastic conditions upon already existing homes. But a condition is made that in existing homes it is not asking too much to urge that, whoever the proprietor may be and whatever the staff may otherwise consist of, the actual superintendence of the nursing should be vested in a qualified nurse resident in the home. After all, according to the evidence submitted to the Committee, it costs no more to employ a qualified nurse than an unqualified nurse, as unfortunately at present the remuneration given to qualified nurses is so low that I imagine, having regard to the ordinary range of nursing homes, it is not imposing too heavy an obligation upon existing homes to ask that the superintendent matron should be at any rate a qualified nurse.

The only other point about the actual terms of the Bill, most of which are non-controversial, is with regard to Clause 5. As at present drafted it says: An officer duly authorised by the local supervising authority. That is not adequate. We do not want to have very important duties put upon some minor official, possibly some inexpert young lady doctor. We want to have it in the hands of the medical officer of health of the district assisted, in the case of nursing, by a qualified nurse and in the case of sanitary matters by a qualified sanitary officer as the case may be. There is one thing about homes run or owned by doctors. The suggestion has been made that it is unfair to impose any conditions on homes owned or run by doctors with regard to the nurses employed by them in such homes. The evidence given before the Committee satisfied all the members, including the medical members, that these abuses were rife in homes owned by doctors as well as in homes run by unprofessional persons. I am not reflecting on the main body of the medical profession, but the fact was established that homes owned by doctors are not necessarily immune from the abuses to which other nursing homes are liable. No doctor of any status would object to having his home registered. Registration conveys no stigma: it confers a status rather than a stigma.

In the definition of a qualified nurse it may be asked, and I know that certain of the enthusiasts in the nursing profession do raise the point: "Why do you admit into the definition of a qualified nurse, any nurse beyond a State registered nurse?" The answer is that we have to bear in mind vested interests, and that many women of long experience and some ability are nursing who have not, unfortunately, taken the very wise step of registering themselves upon the State nursing register. With a view to meeting these hard cases, so far as existing institutions are concerned, and all nurses who are now practising, the definition of a qualified nurse has been enlarged so as to include not merely the State registered nurses, but those who before the commencement of this Act have completed a three years' course, such as is defined in the Section. I believe it may be possible to enlarge that definition, and I know that the hon. Member for Derby (Sir R. Luce) has several points to bring forward in regard to that matter; but they are Committee points. So far as the general principle of the Bill is concerned, I do not think that anyone who knows anything about the question and who has read the Report or is in touch with the best opinion among doctors, nurses or patients will have any hesitation whatever in voting for the Second Reading of the Bill.

Mr. A. V. ALEXANDER

As the hon. and learned Member has legal knowledge, I would like to ask him a question with regard to Clause 9. Can he tell me what is the interpretation of a nursing home?

In his view as a lawyer, does the term "nursing home" include a convalescent home? Some of us are very much interested in a number of convalescent homes dealing with the workers.

Mr. HURST

If in a convalescent home nursing is given, it will certainly come within the definition. It is a pure question of fact, and if in a convalescent home nursing is, in fact, given it would come within the definition. In order to be a nursing home there must be a reception and a provision of nursing. If a convalescent home only receives but does not provide nursing, it would not come within the definition, but if it receives and provides nursing it would come within the definition.

Sir DOUGLAS NEWTON

I beg to move to leave out the word "now," and, at the end of the Question, to add the words "upon this day six months."

In moving this Amendment I desire to assure the House that it is not done through any feeling of hostility to the aims and objects of the Bill. Some of us feel that even if we had had prejudices against the Bill, which personally I did not have, the able, and, if I may be permitted to say so, the pleasant way in which the Bill Was introduced by the hon. Member for Berwick-on-Tweed (Mrs. Philipson) would have gone a long way towards removing any preconceptions. The purpose of the Amendment is mainly directed to calling attention to Clause 8, which I regard as a serious blot in the Bill. The Mover of the Second Beading stated that she did not consider that the Bill made for undue centralisation. I am afraid that I must challenge that statement because I feel that the Bill does give undue and unnecessary centralisation. The authorities who will be responsible for administering this Bill under Clause 8 will be the council of every county and the council of every county borough, and nobody else. That, ipso facto, keeps out the whole of the non-county boroughs.

We realise that nursing homes in the country are increasing, and that they are doing very valuable work. Many of them are well equipped and many of them are well conducted, but there are some oases which leave something to be desired; hence the justification for this Bill. We do think that non-county boroughs should not be shut out. The Association of Municipal Corporations feel that the Bill would be more effective and more useful and that it would be possible to administer its provisions with less friction and less expense if it were made possible for non-county boroughs to carry out its provisions. One suggestion which I would submit to the Mover and Seconder of the Bill and those responsible for the Bill is, that a non-county borough which is an education authority and also the authority under the Maternity and Child Welfare Act, 1918, should be empowered to administer this Bill when it becomes the law of the land. Three Bills have been before the House recently, namely, the Maternity and Child Welfare Act, 1918, the Mid-wives and Maternity Homes Bill, 1926, and now we have this Bill.

The Maternity and Child Welfare Act, 1918, is administered by county borough councils, by county councils and by non-county borough councils in cases where non-county boroughs are able to prove to the satisfaction of the Ministry of Health that they are capable and competent to administer the Act. The result of the working of the Act during the last two or three years has been satisfactory and has shown that that provision has worked with considerable success. The medical officers and the health visitors who were established under that Act have done a most admirable work. They have performed the functions with which they were charged most efficiently, and the evidence of the good work which has been discharged by these medical officers and health visitors will be seen even more in the future than it is at the present time. These officers also help to link up the work as far as health service is concerned with the educational work undertaken by the local authorities.

Local authorities which are non-county boroughs already pay for the nursing of women in these homes under the Maternity Acts. They already have to inspect these institutions and see that they are properly equipped and conducted- At the present time there are 861 boroughs, urban and district councils which administer such schemes, and those 261 authorities are entirely separate from the county councils. Only five county councils are administering maternity Acts for the whole of their areas. In Wales, in the County of Glamorganshire there are 24 boroughs, urban and rural district councils which administer schemes under the Maternity Acts, while in the Metropolis there are 28 borough councils. May I refer to my own constituency of Cambridge, where we have a population of over 60,000. That city is an authority under the 1918 Act for maternity and child welfare. Although it is an authority under the Maternity and Child Welfare Act, approved by the Ministry of Health to conduct the services which arise out of the Act, yet under this Bill it will be unable to inspect the nursing homes which are situated in the town. Although the administration of this Bill will rest with the county council there is not a single nursing home in the county. The only nursing homes are in the area of the town, and I have no doubt that what applies in this case applies equally in the case of other boroughs. We consider it to be a most unsatisfactory position for the county council to be the supervising body in cases of this kind. Non-county boroughs situated like this, with fully qualified medical and other officers, are in every way competent to deal with any situation which may arise under this Bill.

But this Bill deals not only with existing homes. Its provisions extend to new homes to be built in the future, and I would point out that, under the Bill as drafted, if a new building is contemplated or required, if structural alterations are needed, the plans will have to go not only to the county council, which is the supervising authority under the Bill but also to the non-county borough council. Under this Bill both sets of officials will have to be consulted, the officials of the county council, and the officials of the non-county borough. If I might give a case in point to illustrate what I mean, the case of the town of Sutton Coldfield in Warwickshire. It happens, so I am told, to be one of the healthiest places in the Kingdom, and perhaps for that reason it is full of nursing homes. Sutton Coldfield is some 25 miles from the county town, Warwick. Under this Bill, when an application is made for the registration of a nursing home in Sutton Coldfield the county medical officer of health will have to proceed from Warwick, 25 miles out and 25 miles back, to inspect that home. If any structural alterations are required, the county architect will have to go 25 miles out and 25 miles back, and when he is there, he will also have to get into touch with the architect the officials and the sanitary officers of the borough of Sutton Coldfield. There you have the awkward position of those in charge of the nursing home not knowing whether they have to apply to the county council and its officers 25 miles away, or whether they have to deal with the officers of the local borough council. It will duplicate and perhaps quadruple control, it will add to the delay, increase expense, and causes irritation and annoyance, and it is not in the beet interests of the patients in the home.

Under Clause 1 the application for registration is not going to be merely a formal matter. It is not going to be easily done. May I direct the attention of hon. Members to the provision, and they will see that before registration is given, a whole series of provisos have to be met. Under proviso (a) the applicant is to be a fit person; under (b) the situation, construction, and accommodation, and staffing and equipment, are all to be in accordance with the needs of the situation; under (c) there is to be a proper proportion of qualified nurses engaged. All these and other conditions as well will have to be complied with, and I submit that the authority which is best able to determine all these many local and sometimes rather delicate and difficult points is the local authority on the spot rather than the county council whose headquarters may be situated many miles away from the borough. Under Clause 3 the question of appeals is dealt with. Applicants who may feel aggrieved in any way have a right of appeal. Presumably they will have to travel many miles in order to state their case. Under Clause 4 records have to be kept and inspected, and there again we claim that the local authority on the spot is the best qualified to deal with these records.

In these days there is a constant and clamorous call for economy, and if this Bill is to be put into the hands of the county council and they are not to be allowed to delegate their powers, it will undoubtedly mean that they will have to increase their staffs, and their travelling expenses will be added to. When the Bill dealing with the housing of rural workers was before this House, the county council was made the local authority to deal with the provisions of that Act, and it was only after a considerable struggle that powers were given in that Bill by which the county council could delegate its functions to other local authorities. By a strange chance, I received to-day a letter from a county council who are desirous of delegating these powers, and the argument they use for asking the small local authorities to take over these powers is that they have no housing staff, no housing inspectors, to inspect the buildings that are erected, and that the local authorities have more intimate knowledge of local conditions and by-laws. I think the powers which were given under that Act should certainly be extended to this Bill, as the same arguments are pertinent and relevant to this subject. The non-county boroughs strongly objected during the passage of the Midwives and Maternity Homes Act to the supervising authority being the county council. Under this Bill the Midwives and Maternity Homes Act, Part II, is to be repealed. Now, when the field is going to be greatly widened and registration and regulation is going to be extended to the much wider field of nursing homes, we feel that the case of the non-county borough is much stronger than it was even at that time.

If I might give a precedent for the suggestion I am submitting, I would draw the attention of the promoters of the Bill to the position in respect of the Widows', Orphans' and Old Age Pensions Act, 1925. There the House decided that Where the council of any non-county borough or urban district is both a local education authority and an authority for the purposes of the Maternity and Child Welfare Act, 1918, that council shall be the local authority for the purposes of this Act. I suggest that that is an absolute precedent for the change we are discussing, and the House would be well advised to see if they cannot grant the same powers in respect of this new Bill.

I noticed that there are one or two omissions from this Bill. One is that no provision has been made for the State inspection of nursing homes by qualified nurses. I notice, too, that the necessity for stating whether or not qualified nurses are employed at nursing homes run by doctors or other people for profit is not imposed. I hope that both of these points will receive the attention of the promoters. In moving the Motion which stands in my name, I would again like to say that I am in full sympathy with the aims and objects of the Bill, because I believe it makes a valuable contribution towards much-needed. legislation in the interests of the sick. At the same time, I regard this question as to who is or is not to be the authority for administering its provisions as a most important point and one which ought to have consideration.

Mr. HARRISON

I beg to second the Amendment.

In doing so, I would like to emphasise to the Movers and supporters of the Bill that I am in entire sympathy with its principles. If it goes through, there will be a great addition to the safeguards which we already have for increasing the welfare and health of the people in general. The Mover of the Amendment for the rejection has gone through the main points of his objections in detail. I would only like to reinforce the case —and it is a very strong case—of the non-county boroughs, who are going to be left out in this Bill. It does seem to me that, where you have authorities who are to-day local education authorities and authorities under the Maternity and Child Welfare Act, 1918, and who have all the officials, the medical officers of health, the sanitary inspectors, the nursing staff, to supervise and carry out this Bill, they should be allowed to do it, as they have a complete staff to administer the Bill more efficiently in many cases than county councils can possibly do it. As the Mover pointed out, there are only five county councils in the whole of England and Wales that are administrative authorities over the whole of their county for the Child Welfare Act, but there are 261 boroughs and urban district councils who are administering this Act. It would be in the interests of economy and would save any chance of overlapping with this machinery on the spot if the precedent, which was followed in the Widows', Orphans' and Old Age Pensions Contributory Act, could now be followed. After all, it is the boroughs and borough councils who are responsible for carrying out Public Health Acts. They would be the authority to deal with an outbreak of contagious disease. It would not be the county council, but the local borough councils whose officials would be called upon. Many Committee points could be raised to show how local administration is far the most adequate to deal with cases arising under this Bill.

There are other points with which I would like to deal. The Seconder of the Bill pointed out how important it was that the inspection of these nursing homes should be done thoroughly. If there is to be inspection at all, it should be a proper one, as he rightly pointed out. The medical officer of health, qualified nurses, the sanitary inspectors, and probably an architect would be required to see that the conditions at any nursing home were proper. That is most desirable, but if you are to bring these officials from a county town, perhaps 20 miles away, to carry out the inspection, you have not only got to pay their travelling expenses, but it would be the men on the spot that they would have to ask for their information. This duplication is highly undesirable. In conclusion, I would stress to the promoters of the Bill how very desirable it is that the existing authority, such as we have suggested, should be allowed to come in and administer the Bill.

3.0p.m.

Dr. DRUMMOND SHIELS

I am happy to be able to congratulate the hon. Lady who brought, in this Bill on her realisation of the importance of the subject and to express the hope that the Bill will have a smooth passage through the House. I should also like to pay a tribute to the Seconder, the hon. and learned Member for Moss Side (Mr. Hurst) for his efforts in bringing about this legislation. I am very glad that he does not carry all his political principles into the realm of health. I do not think that the general public or the ordinary Members of the House realise the need for this legislation. I am sure that the Members of the Select Committee—-I speak for myself at any rate—had no idea that the matter was so serious and that a Bill of this kind was so much required. We have found it was not a matter entirely of the status of the home. We discovered that some homes where large fees were charged were unsatisfactory, but I think, as the hon. and learned Member for Moss Side said, what we were most impressed with was the number of cases of chronic and poor patients who were kept under deplorable conditions.

The hon. Member quoted a reference from the Report of the Select Committee. I would emphasise what was said there. We had evidence from a vicar of the Church of England, who had been in the habit of visiting some homes at Wimbledon. He had been doing that for seven years, and knew these places intimately. He spoke about the crowded nature of the accommodation, of one particular home which was run by a man and his wife and one small maid-of-all-work, who did the nursing and the housework as well, and attended to 15 or 20 people, practically all of whom were bedridden and could not attend to themselves. The house was filthy, the bed linen was not changed for weeks, the patients and their surroundings were verminous, and the matron and her husband, either separately or together, were frequently under the influence of drink.

To picture any section of the community living under these conditions is almost unbelievable. I would almost have said that it would be impossible in our country at this time of day for that to go on, but we have very reliable evidence that this is often the state of things. We believe that Regulations should be introduced to prevent homes of this kind existing at all. The great problem, of course, in this as in many other matters, is poverty. These people were paying 15s. to 25s. a week. We know that it is quite impossible to get even adequate food and housing for that sum, apart altogether from nursing. Therefore we consider that if that is all these people are able to pay they ought to be in a public institution. We believe in that connection, that the increasing use of Poor Law hospitals, with the removal of the stigma, would be a very great help to the solution of this problem, and we are looking forward to the alteration of the Poor Law as a means towards the greater utilisation of these hospitals which now in many cases are not used to their full capacity. I know that in Scotland, and I believe in certain places in England, these hospitals are being used without the stigma of the Poor Law being emphasised, and in many cases they are well staffed and equipped. It is far better that these unfortunate people should be taken care of by a public authority and get decent treatment than that they should be at the mercy of people running a home simply for profit, and with no training.

Then the hon. Member who moved the Second Reading spoke about the nurses. I do think that the whole community owes to nurses a debt which it has never yet discharged. Unfortunately, we still have in the nursing profession a sort of Florence Nightingale tradition, that it is a vocation, that it is love of humanity and all that sort of thing, and that money is a sordid consideration. So it is, but it is a very essential one, as we all know, and the trouble is that, while everyone speaks well of nurses and admires their work, there is very little attention paid to their material condition and housing and conditions of labour. The Bill does not touch all of these things, but an attempt will be made to see that nurses are properly housed. We had very bad evidence in regard to even good homes, which had public rooms and patients' rooms all right, while the nurses were shoved up in a garret and day and night nurses slept in a sort of Box and Cox way. We hope that this sort of thing will be abolished; also that there will be a quota of fully trained nurses in each home. Most of us would wish that all nursing homes should be completely staffed by fully trained nurses, but we realise that this is not possible at the present time. At least, there will be some proportion, which will have to be roughly fixed, of qualified nurses on the staff. In that way we hope that the status of nurses will be improved and their general standard of life increased.

There are various details of the Bill that I would like to see amended. The last speaker referred to the non-county boroughs. That is a very difficult subject, and one which requires a lot of consideration. There is a good deal to be said for what the hon. Member has put forward, but it has to be considered at the same time that co-ordination of all legislation acting in the same way is very desirable, and it is just a question of the relative importance of the different aspects of the question. I am sure we all have sympathy with the proposal, and that we shall be glad to consider it in Committee. There are many other points to be considered. For instance, the reasons given for refusal to register are-too many and too complicated, and they seem to overlap. It will be understood that, as I believe the Bill is a good one, I want it to be applied to Scotland. I do not see why my country should be left out. Only slight alterations would be necessary to make the Bill perfectly suitable to Scotland. Therefore, I want to warn hon. Members of this House, especially Southern hon. Members, that I shall seek to include my country in the benefits, and I hope we shall have a unanimous feeling in this matter. This is one of the Bills, in which we in this House can take the greatest pleasure, where there is no-party controversy and where we are all united in an equal determination to see that, whatever happens to people who-are well and strong, those who are ill and suffering should at least get the very finest of medical and nursing skill, so-far as it is possible for that to be decreed by this House.

Major-General Sir RICHARD LUCE

As a Member of the Select Committee which considered this question, and as one who has had in the past considerable experience of nursing homes, fortunately not as a patient, I should like to say a few words to recommend the Second Heading of this Bill. When the Committe began to sit, I came to the question with a very considerably open mind. In my previous experience, in days gone by, I had found homes in which I had to work that were not as satisfactory as one would have liked, but perhaps in the natural course of the development of things, because that experience lasted over a considerable number of years, I had not in recent years at any rate come to the conclusion that there were any very great scandals going on in such nursing homes as were brought to my notice. But when we came to receive evidence, my views were very rapidly changed, and I very soon came to the conclusion that there was a very real need for the regis- tration of these homes. Indications have already been given as to the kind of evidence that was submitted. The trouble was mostly not in the regular surgical nursing homes or medical nursing homes, but more in those that were the sort of odd places that took in a poor class of patients for small fees, and also certain other places which took in a class of patient that did not require generally much nursing, but homes which in certain cases did not hesitate to take in cases that came to them of a much more serious nature, for which they were totally unfitted to do the nursing, and the evidence which came to us made it quite clear, to my mind, that a Bill of this kind was needed.

When the original Bill was mooted some two years ago, there was a good deal of objection from the medical profession on certain grounds. I think they had not realised the real seriousness of the question, and though there was no general body of objection to registration, the body of the medical profession did lay down certain rules which they would consider necessary in regard to registration. They were very anxious that there should be a delegating body to be the responsible body for granting registration and that there should be representation of medical men and also of nurses. One of the other great points that were made was that there should be that sanctity of professional secrecy between patient and doctor, which I think has been fairly well met by the provision in Clause 5 in regard to no interference. Then there was a great demand on the part of the medical profession that homes under the charge of medical practitioners might be exempted, if not from registration, at least from inspection, and it will be within the memory of the House that that exemption was permitted in the Mid-wives and Maternity Homes Act, which was passed last year. The Section which allowed that exemption, Clause 11 of the Bill, was inserted in another place and agreed to by this House, but it was not originally in the Bill.

That Midwives and Maternity Homes Act was passed before the great body of evidence which we obtained before the Select Committee was received, and I think that with that evidence before us, which proved conclusively that certain doctors' homes were not above suspicion, that view has been considerably modified by the medical profession, and that they would no longer demand the inclusion of such a Clause for exemption. Personally, I think it would be a great mistake to think of putting in any exemptions for homes run by medical men. I think it would be a bad thing, not only for the nursing homes, but for the medical profession, to ask for such an exemption, in view of what has been shown in the evidence that was brought before the Select Committee. Therefore, as the Bill stands at present, I see no objection to it from the medical point of view, as far as I am concerned, at any rate.

I think that if the Bill is carried out in the proper spirit, there will be four great things gained. We shall have gained a co-ordination of the two kinds of homes which were previously separated. There is no great difference between a maternity home and a nursing home, and many homes cater for both classes of case, and quite rightly. Of course, the ideal thing is that a maternity home should, perhaps, be given up entirely to midwifery cases, but in small places that is often impossible, and it is often quite advisable, where you have a really good home, that both classes of case should be taken, and there is no real objection to it. By bringing the two classes of nursing home, the maternity and the general nursing homes, under registration, we shall be bringing about a co-ordination which is necessary and reasonable. Then, if this Bill becomes law, we shall have obtained the fact that nursing homes will have suitable buildings and that they will be properly equipped for the nursing profession according to the class of case that they take in.

There will also be guaranteed a reasonable standard of nursing. It is quite impossible, as has been stated, for every patient to be treated entirely and absolutely by completely qualified nurses. There are not enough in the country to provide for that purpose, and there must also be a certain number of people who are under training or passing up to the stage of training. In general hospitals, there is only a small proportion of qualified nurses, and there is always a large number of pupil nurses who are undergoing training, who do a great deal of the work of nursing the sick in hospitals, and there is no reason why a similar sort of arrangement should not be allowed in nursing homes, as long as the requisite standard of nursing is maintained and as long as the patients realise that that is the fact. Of course, to make out that a nurse was a qualified nurse when she was not would not be fair, and it is always right that patients should know, if they really want to know, whether the nurse looking after them is qualified or not. At the same time, it is impossible that all the nurses in all the homes should be fully qualified.

Then we think, also, there will be con-silerable gain in the matter of the care of the nurses themselves. It is laid down that one of the grounds for refusing to register a nursing home shall be that the accommodation for the nurses is insufficient. In my view, that is a very valuable point. Of course, in a Bill like this it is not possible, perhaps, to get everything that many people would like. One of the complaints we hear about nursing homes is that they are extortionate, that they demand enormous fees for very inadequate services. But it is impossible, I think, that any Bill or any inspection could deal with the financial side of the bargain between the patients and the institution. That is one of those things which must be left to ordinary bargaining between those concerned. Although this Bill will help nurses, it cannot be expected to do quite all that the nursing profession demand from it, that is to say, that it should protect the interests of those who are fully qualified against those who are not fully qualified. From that point of view the criterion must be, it seems to me, the good of the patient rather than the good of the nurse.

As to the question of the supervising authority, in the Committee we had to consider this very fully. There was a very considerable body of evidence from the proprietors of nursing homes, and from others as well as doctors, that it was essential the supervising authority should be an entirely independent body. A large number gave evidence that they considered the only suitable people to supervise should be the Ministry of Health, someone entirely outside all local influence, but the Committee came to the conclusion that that would be costly and too bureaucratic. At the same time, we felt it was necessary that the authority should be a very wide one, one with a whole-time person to do the inspection, provided with sufficient staff already under him, such as a staff of suitable nurses to help him with the inspection and other suitable inspectors, sanitary and so on, and that at the same time he should be a person of great responsibility, and the authority to which he was responsible should be a high one. Although, of course, such a borough as Cambridge is only a few thousands below the number which would make it a county borough, and from our point of view there could be no objection, we did feel it was not wise in the ordinary way that the supervising authority should be a small one. At any rate, it ought to be a borough of very considerable size with a whole-time medical officer of health and complete staff.

There are one or two points of criticism, really Committee points, which struck me in the Bill. Clause 1, Sub-section (3) (e) does not, as far as I can make out, allow of the patients in maternity cases being attended by a doctor. It says in the Bill that registration may be refused if the person superintending the nursing of the patients is not either a qualified nurse or a certified midwife; apparently there is no mention of doctor, and in those circumstances she employment of a doctor might be cause for the rejection of a nursing home. It is a minor point, but I think it will have to be considered. In Clause 4, Sub-section (1) (b) one of the by-laws which a supervising authority may pass may require notification to be given of any death occurring in a nursing home together with a statement of the cause thereof. There may be difficulties about a nursing home certifying the cause of death of a patient. It is no business of a nursing home even to have any knowledge of the cause of death, under certain circumstances. One can realise that it may be necessary in maternity homes where a considerable number of septic cases are occurring and when it is known that septicæmia is prevalent in the home; but that is a question of notification rather than of letting them know the cause of death.

In the Bill passed last year dealing with the registration of births and deaths it was laid down that it was the duty of the doctor to send the certificate as a confidential document to the registrar. Therefore, it is not within the rights of a nursing home to have any knowledge of the cause of death of a patient who has died in the home. It might be a matter of very considerable importance in many cases that the cause of death should not get out even to the nursing staff. A patient may be suffering from some disease which is due to alcohol. Cirrhosis of the liver is usually caused by a person having taken too much stimulant. It is not right that that cause of death should be given out to everybody far and wide, because it would hurt the feelings of the relations. It is a thing which is more or less confidential to a patient and his close relations. Therefore, it is not part of the duty of a nursing home to give the cause of death to anybody. The doctor's certificate is to give the cause of death to the registrar, and to him alone.

As suggested by the Seconder, I think there is some little doubt over the question of the qualified nurse. The definition Clause lays it down that she must be a person registered in the general part of the register of nurses. It may not be necessary for a nurse attending certain classes of cases to be registered in the general part of the register. Suppose it were a nursing home dealing only with children. A nurse with the qualifications for nursing children comes under the special part of the register which deals with children. The same applies in the case of a mental home where it might not be necessary to have fully-qualified nurses, providing they were fully qualified in regard to mental work. Of course I am aware that those are points which may be considered in Committee. With these few remarks I wish to help on this Bill through its Second Reading, and I think it will be a most valuable Act when it has been passed into law.

The UNDER-SECRETARY of STATE for SCOTLAND (Major Elliot)

Perhaps it will be convenient at this stage to state the opinion of the Government in regard to the Bill now before the House. In the first place, I wish to apologise for the absence of the Minister of Health, whose absence is accounted for because he has to attend an important function in his own constituency. Taking the Measure as a whole it seems quite reasonable that the House should give it a Second Reading, and that it should have a place on the Statute Book. It is a mere coincidence that I found myself some two years ago dealing with this subject, and at that time we set up a Select Committee upon whose Report this Bill is based. I think in the Report brought forward the case has been made out as far as the country to which this Measure applies is concerned.

I was somewhat astonished to hear the hon. Member for East Edinburgh (Dr. Shiels) suggest that at a later stage of the Bill it might be advisable to bring the kingdom of Scotland within the scope of the operation of this Measure. I see from the third page of the Report that the Select Committee held 14 meetings, and examined 36 witnesses, including representatives of the Ministry of Health, but I failed to notice that they examined any representative of the Scottish Board of Health, and I cannot imagine the hon. Member opposite suggesting that a Bill of this kind should be passed into law and applied to Scotland without hearing the representatives of the Government of his own country. After all, differences exist in regard to this question in England and Scotland, and it is only reasonable that those differences should be recognised in separate legislation. As regards the principle of inspection and registration, it is not a new principle, and it is thoroughly agreed to on all sides of the House. Of course the machinery by which it is proposed to carry out this inspection and registration is a matter of controversy, but most of the associations and local authorities concerned are agreed that this inspection should be carried out.

I think the Mover and Seconder of the Amendment for the rejection of this Bill made out a strong case in favour of the non-county boroughs being considered in this matter. That question was fully considered by the Select Committee, but all wisdom is not summed up in the minds of a Select Committee, and it is quite reasonable that a Committee of the House of Commons should further consider this matter. That a Committee of the House of Commons may not agree with the view of the Select Committee on this point is something that has been known to happen before, and I should be very glad if the Mover of the Bill would give an assurance, as I understand she is willing to do, that this matter will be fully considered with an open mind in Committee, and that the statements of the Select Committee will not be taken as prejudging the case one way or the other.

Mrs. PHILIPSON

indicated assent.

Major ELLIOT

The number of homes concerned is perhaps larger than the House realises. The Registrar-General, in his returns, mentions that there are over 2,000 convalescent and nursing homes in England and Wales, and, in fact, the number might run as high as 3,000. It is quite possible that with such a large number of these institutions, abuses may have crept in. If we pass this Bill, we shall be able to see whether the beneficial results which have been found in places like London and Manchester, where the local authorities in the past have had power to inspect maternity homes—whether the improvement in the treatment given in those homes—will be paralleled in the case of nursing homes under the inspection provided by this Bill. I do not think there is any need for me to say more, except to say that we are in favour of this Bill, and hope that it will get a Second Reading. We believe that the points in dispute are Committee points, and we see every reason to hope that the Measure may find its place on the Statute Book.

Mr. JOHNSTON

I am sorry to hear from the Under-Secretary of State for Scotland that this Bill, which he describes as a good Bill, does not apply to the country for which he has some responsibility. Unless it be on the assumption that this Bill should be "tried on the dog" before it is made applicable to Scotland, I cannot see why Scotland should be exempt from its provisions. I for one agree with the main contention put forward by the Mover of the Amendment that the tendency to centralisation and bureaucracy in these matters is to be deplored, and I cannot see why a municipal authority presently efficient, with its own Medical Officers of Health, should not maintain the supervision of all health matters inside its own areas as now, and not have another medical authority superimposed upon it, with perhaps two medical authorities disagreeing. I am perfectly certain that there is a large measure of support in the House for retaining as direct municipal control as we possibly can in these matters.

The one point—and it is a Committee point—that I rose about this afternoon was this question of maternity homes. When the hon. Member for Berwick-upon-Tweed was speaking, I ventured to ask her why existing maternity homes are to be excluded from the purview of the Bill, and she answered that the point would be met by the hon. and learned Member for Moss Side (Mr. Hurst) who was to second the Bill. In his speech, he simply declared that the matter so far as existing maternity homes were concerned was already settled by the Midwives and Maternity Homes Act of 1926. I was surprised at that in view of certain communications which I have received, and I have turned up the Midwives and Maternity Homes Act of 1926, and I find that there is no compulsory provision for having any qualified nurses on the premises of existing maternity homes. I still think that the promoters of the Bill should explain to the House why existing maternity homes—after all, we are dealing with existing maternity homes, and it is in them that the trouble arises—were deliberately excluded from the purview of the Bill. That is the only point I wish to make, except to say that I trust that as many of these maternity and nursing homes as possible will be municipalised, because that is the real solution of the problem. So long as we have not municipally-owned nursing and maternity homes all over the country, it is obvious that steps must be taken to protect poor men and children who are taken into nursing homes, and poor women who are taken into maternity homes as much as possible. I still hope that in Committee the Under-Secretary for Scotland will not set his mind lightly against giving the women and children of Scotland the same advantages and protection that are proposed for those in England.

Major ELLIOT

Of course, we have moved a considerable distance in that direction, especially as far as women and children are concerned, in the Midwives Bill now before the House.

Mr. JOHNSTON

That is true, but no one knows better than the hon. and gallant Gentleman that the Midwives Bill does not at all bring the advantages to the people of Scotland that this Bill, prima facie, is to bring to the people of England. I trust in Committee he will assist rather than hamper us in bringing the women and children of his native land within the advantages and benefits of this Measure.

Sir CYRIL COBB

I wish to say a word about a point of criticism made by the hon. Member for Cambridge (Sir D. Newton). We had a certain amount of evidence before us in the Select Committee, but I do not think we had anything like all the considerations the hon. Gentleman laid before the House just now. We were looking at it much more from the point of view of the people who are running nursing homes, doctors and so forth, as to how far they would like the small local authorities to be the registering and inspecting authority and we were very anxious, in coming to a decision, to steer quite clear between too great centralisation on the one side and too great de-centralisation on the other. That is why we said county councils and county boroughs. Certainly the hon. Member for Cambridge brought forward considerations which were certainly not before the Committee and I am sure it will be the wish of every Member of the Select Committee who happens to find himself on the Committee on this Bill, to be very willing to discuss any questions that may arise in regard to non-county boroughs. I think it will not be possible to include all non-county boroughs as registering and inspecting authorities. I think we shall have to say large non-county boroughs, perhaps like Cambridge or Chesterfield or some large towns of that kind which have maternity and child welfare matters to look after in their own area and which have competent and full-time medical officers, might very well be included in those authorities which might have the administration of the licensing and inspecting of nursing homes. With regard to convalescent homes, inasmuch as there are a certain number which are not run for gain or profit, they would very likely come under Clause (3, which provides that a local supervising authority may grant exemption from the operation of the Act in respect of any hospital or institution not carried on for profit.

Generally on the Bill itself, we took a great deal of evidence of all kinds and I think the House will agree that we were justified in recommending registration and inspection for two main reasons, first of all I think in the interest of the individuals themselves, that is to say the individual sick person. How does it happen that people find themselves in nursing homes? I should say in 85 per cent. of the cases because in a sudden emergency the house itself is not suitable for the sick person to be properly looked after or because the doctor himself advised a nursing home, and without warning a member of the family has to be sent to a home. They probably know nothing about the homes in a neighbourhood and have to take such information as they can get second-hand and they have to take the nursing home practically on chance. I think that is all wrong for the individual sick person. In the second place as a general consideration I think it is a blot on the public health of the country that the sort of places where sick people are nursed, or supposed to be nursed, should exist. We have done a great deal in the last 12 or 15 years but that these nursing homes which are absolutely irresponsible to anyone should still exist and the terrible things that happen in them that were brought up in the evidence before the Committee is really a blot upon the public health of the country. For these two considerations alone apart from all the details of the Bill I hope the House will give it a Second Reading.

Mr. A. V. ALEXANDER

The hon. Member who has just sat down dealt with the point raised by the hon. Member for Cambridgeshire in regard to the local authorities who will have the power to administer the Bill. Hon. Members on this side are anxious that the principle of the Bill should be established, but if the interpretation put upon what Amendments may be made in Committee are in accordance with what the hon. Gentleman has said, I am afraid we must tell the promoters that we may have to oppose it at a later stage. It is as well to say on the Second Reading that if hon. Members on the Select Committee set their faces against certain Amend- ments, it will increase the difficulty of getting the Bill through. It seemed to me that the hon. Gentleman had London in his mind, with a view to getting any Amendments moved upstairs in conformity with what the London County Council might desire. The hon. Member for Cambridge (Sir D. Newton) made a very strong point when he asked for coordination in respect of this Bill with the powers under the Maternity and Child Welfare Act, 1918. That Act was based on a much earlier Act, the Act of 1907, dealing with the notification of births, and every local authority which had adopted the 1907 Act was deemed to be an authority which might work the 1918 Act. Clause 2 of the 1907 Act says: In this Act the expression ' local authority ' means the council of a borough including the council of a metropolitan borough and the mayor and aldermen of the City of London in common council and the council of an urban or rural district council and also the council of a county. I am not suggesting that we may want in connection with this Bill to include among the authorities who may work it every rural district council or every urban district council, but what is necessary is that, if they found it economical and efficient in certain areas to take over the two Acts already on the Statute Book, the Notification of Births Act, 1907, and the 1918 Act in connection with Maternity and Child Welfare, it would be only maintaining the best means of co-ordination to make this Bill work in exactly the same way. The hon. Member who has just spoken has, I am afraid, coloured his views because of his association with the London County Council. I hope it is not in his mind that he wants to shut out from the working of this Bill, when it becomes an Act, the Metropolitan Boroughs, because that is what appeared from his reference to the possible omission of such boroughs as Chesterfield, Cambridge and others. If he wants real co-ordination, he will have to see that this Bill is made possible to be worked in exactly the same way as the Notification of Births Act, 1907, and the Maternity and Child Welfare Act, 1918. I submit very strongly to the promoters of the Bill, who have stated their case with very great skill and moderation, that if they want to get the Bill through to its final stage they would do very well to consider sympathetically that point of view.

Another point is, that I am sorry that in the terms of the Bill there is no provision for dealing with the remuneration of nurses. The hon. and learned Member for Moss Side (Mr. Hurst) referred to the very low standards which are often adopted in regard to remuneration. I think the promoters will find that when the Bill goes to Committee it may be necessary to move a Clause in general terms, not laying down too rigid a basis, but suggesting that in return for the status which will be conferred upon these homes by registration and inspection they should see that there is a reasonable standard of remuneration given to the nurses employed in the homes. We shall not vote for the Amendment, which I hope will be withdrawn, but as we are entirely in support of the general principles of the Bill I hope the promoters will give careful attention to the points I have raised.

Dr. VERNON DAVIES

I should like to satisfy the hon. Member who has just spoken in regard to the intentions of the promoters of the Bill. They are particularly anxious that the Bill should get on to the Statute Book, because it will remove a very great scandal in this country. The method and administrative machinery could very well be left to the Committee, but I would point out to the hon. Members who have supported the Amendment that the question which they raised was gone into very carefully by the Select Committee and there were numerous objections brought before us in regard to non-county boroughs. However, that is a question which could very easily be gone over again in Committee.

The point we have to bear in mind is that this scandal which the Bill seeks to remove, it is nothing less than a scandal, must be dealt with as quickly as possible. It was a matter of great surprise to most members of the Committee to find that there was so little knowledge in this country of the abuses in some of these nursing homes. One of the greatest benefits from the Select Committee was that although the medical profession as a whole had no idea that inspection and registration of all nursing homes should be allowed, yet, after hearing and read- ing the evidence which was brought before the Select Committee, they recognised that the scandal was so grave that they had no grounds for objecting to legislation in regard to the inspection of medical men's own nursing homes. That is a great step in advance. I do not think the Bill goes quite as far as the members of the Select Committee would like. Certain Amendments may possibly be moved upstairs, but the principle of the Bill stands unchalleneged, and I think the hon. Lady, who so felicitiously moved the Second Reading, has every reason to be satisfied with the reception it has received.

There is one point to which hon. Members should give a little attention, and that is, that the demand for this Bill has come from the nursing profession as well as from the public. The nursing profession is a very noble one, and they are naturally anxious that its members should be fully trained and fully qualified; and it is important not only for the progress of nursing but also for the health of the community that the nursing of this country is in the hands of fully competent qualified nurses. The Bill does not go quite as far as I should like in safeguarding the interests of nurses, and quite possibly we may move Amendments in Committee which, I hope, will meet with the approval of the promoters. At the same time, we recognise that we must not interfere with those women who are not thoroughly trained nurses but who are doing exceedingly good work. We must be as lenient as we can with them. What we are aiming for is that the health of this country shall be looked after by fully competent trained people, medical men and nurses; that all abuses shall be done away with, and that nothing shall be hidden. We feel that in this Bill we shall have the hearty co-operation and support of all good nursing homes, all good doctors and all good nurses, because, having nothing to hide, they will not be afraid of inspection. The difficulties we have had have come from those second-class nursing homes who are afraid of inspection. When this Bill gets on the Statute Book this House will feel that it has passed legislation which was urgently required and which will be for the benefit of the community as a whole.

Miss BONDFIELD

We are not satisfied with the provisions regarding maternity home benefits, and we shall have to move Amendments in Committee on that subject.

Mr. ALBERY

I do not wish to detain the House now except to associate myself with the hon. Member for Cambridge (Sir D. Newton), who is not proposing to press his Amendment, after the assurance given by the promoters of the Bill that the question of non-county boroughs will be considered in Committee.

Question, "That the word ' now ' stand part of the Question," put, and agreed to.

Bill read a Second time, and committed to a Standing Committee.