§ Order for Second Reading read.
§ 11.6 a.m.
§ Mr. F. O. Roberts
I beg to move, That the Bill be now read a Second time."
A large number of private Members' Bills have made from time to time forceful appeals to all quarters of the House, but I venture to say that the Measure which I am privileged to submit to-day equals any in the purposes it sets out to achieve, in the good it can do if it is accepted and put into operation, and in the justice and strength of the cause with which it is associated. I hope that the sympathetic consideration it will receive and the support it will win may be equal to the worthiness of the cause it seeks to serve. If that be so, I can see it being unanimously accepted.
I am not a recent convert to this reform of nurses' and hospital workers' conditions, for, speaking on the Nurses Registration Bill in March, 1919, I said that I would have liked to have seen in that Bill definite provisions as to working conditions for nurses, especially those employed in institutions. I further said that, to put it mildly, some of them were working under conditions which could not be considered ideal, and f pleaded with the House on that occasion that nurses should be more generously remunerated and should have better working conditions. That was a long time ago; it is just one more illustration of how long a recognised reform takes to bring into operation. There is a general recognition that the working hours of nurses and allied services require drastic overhaul, and the urgency of the problem is rapidly becoming more apparent. The public mind is now made up that some important changes are bound to come about and are necessary. I am glad to note one very significant and hopeful sign, and that is that nurses and hospital workers are now more ready to try to protect themselves. They are beginning to know something of their own strength, 2422 and I believe they are seeing just a little of the beneficial results of union and unity.
There is no doubt that in some directions greatly improved conditions have been adopted, but those improvements can only be regarded as comparative; it is the general standard that matters for those who are engaged in hospital and institutional work. Everyone would wish to make sure that staffs are adequately trained and equipped in every way for the arduous work which they have to do, and there should be forthcoming a sufficient number to keep the hospitals properly manned. Under existing conditions recruitment for this purpose is not easy. There still remains the undoubted need for better conditions for staffs generally. The most real first step, in my judgment, would be to reduce and regularise the working hours. If that is done, those responsible for the control of hospital and institutional administration will undoubtedly find that many of their present difficulties will be solved. Success in administration of this kind is contributed to if staffs are reasonably treated and can carry out their duties free from elements which badly affect both body and mind. Unless a remedy can be found for the unsatisfactory state of affairs, the acute shortage of nurses must continue, the discontent now shown will spread, and the existing difficulties will increase enormously. Whatever approach has hitherto been made—and a good many have been made—to try to improve matters, nothing has been so effective as the standardisation and regularisation of working hours. This has always proved to be a major influence for good. Therefore, to bring about the most thorough and complete reform and settlement, I hold that speedy legislative action is bound to be the best way. No other can attain the desired end.
Can the Measure which I am introducing to-day be regarded as a move in the right direction? At any rate it is a very good commencement in an important undertaking, and, if it did nothing else, it would carry out the first principle we are urging, of standardising and regularising the hours. A long explanation of the Clauses of the Bill does not seem to me to be necessary to-day. I need only emphasise the plain and straightforward terms in which the principles have been declared. It is true that the Bill deals 2423 only with hospitals and institutions controlled by local authorities. It provides for a 48-hour working week for outdoor staffs, except in cases of emergency, where extended work may be permitted provided that overtime rates are paid for the hours worked in excess of 48. That is a principle dear to the heart of organised workers, and one which, applied to those who are doing this very vital work for the community, will certainly not be out of place. So far as indoor staffs are concerned, the Bill proposes to create what is called the 96-hour fortnight, again making provision that in cases of emergency extra hours may be permitted beyond the 96 hours provided that overtime is paid. This arrangement seems to be one eminently suitable and likely to meet the demands of all the circumstances which arise in connection with hospital work. One other important provision to which I should like to make particular reference is that which sets out to establish one weekly day of rest for all workers. This, again, is a principle which has been conceded in many cases over a great number of years to those workers who have been in some senses able to win it partially or wholly for themselves. It seems at any rate to be one that we ought not to delay putting into operation so far as all kinds of workers go, and this provision in the present Bill, if conceded and worked, will certainly meet a long-felt want. I think there can be no mistake as to the clarity of the declarations here made of the purpose which is behind the Bill.
I am not forgetting that there is a financial consideration which has to be borne in mind. I am more concerned to-day with advocating the acceptance of the general principle, but, whichever way we look at it, the cost of these reforms will have to be met. What the cost will be, except in general terms, I have not ascertained; but the information I have secured seems to indicate that it should not be such as to make this scheme prohibitive. It seems quite reasonable to suggest that, in this connection, some portion of the obligation, at any rate, if not all, should rest on the State. It may be that certain local authorities, pressed as they undoubtedly are, while anxious to meet a very just demand, would find the financial burden a little too heavy. In that event, is to too much to expect 2424 the State to come to their assistance financially? But financial considerations, while important, are not paramount. The Government could find a way to deal equitably with any situation of the kind indicated. Taxpayers would, in my judgment, be more ready to meet a bill for that purpose than some of the bills which have been presented.
Coming to a further consideration, can a 48-hour week be applied? I know there is criticism in certain directions, and that declarations have been made that, in connection with hospitals and institutions, it would be difficult, if not altogether impossible, to adopt generally a scheme of this kind; but I have certain examples in front of me which prove that, at any rate, a beginning has been made. The case is being tested, and the evidence which can be gathered seems to justify the conclusion that success is likely to attend the efforts of those who are now trying to provide better conditions of employment both for their nursing and other staffs in hospitals and institutions. I have a record here in the "Nursing Mirror" with regard to the Manchester Jewish Hospital, where a 48-hour working week is being introduced, and a schedule of hours has been arranged; and the matron says that the scheme is working well. At Swansea, a 48-hour week is being worked, together with a 96-hour fortnight for those sections of the staff for which it is necessary, and in this hospital other improvements have also been achieved.
I am informed that all London mental hospitals are now working on the 48-hour week basis, and that other London hospitals work on a 54-hour week basis. Leicester Mental Hospital, I am told, has been working a 48-hour week since 1935. The North Middlesex County Hospital instituted the eight-hour shift principle, and is working it for one year in the first instance; and I read that the experiment has been justified, that the nurses work better, are less tired, are more enthusiastic, their health is above the average and the schedules which have been arranged are overwhelmingly appreciated by the staff concerned. From the constituency which I have the honour to represent in this House, I have received a communication from the medical officer of health, in which he says that at Falloden House Hospital the nursing staff are now working 96 hours, that in 2425 the steward's and matron's department the same scheme has been applied and that porters and male attendants are working from 48 to 56 hours a week and are paid in accordance with the standard arranged by the Joint Industrial Council for such workers. They are some examples which seem to prove how good are the changes made, and how much they are appreciated by those coming within their scope.
Seeing how much is being done in that direction, the question may be asked, "After all, is there a need for this Bill?" A few extracts from letters which have reached me indicate the need for definite action, which is only possible by the will of this House. It stands out quite clearly that the chief factor in the disturbed state of workers in hospitals and institutions is the lengthy periods of duty. Even what is supposed to be rest or leisure time, I am informed, is often not left free, and my information is that hours vary from as low as 48 to as many as 80 per week. Apart from the fact that the imposition of these hours is exceedingly unfair to the individual, I think it is a fair contention that excessive hours are economically unsound, whether included in the recognised working week or paid for at overtime rates. The very nature of the work of these people makes long hours undesirable and, it may be, dangerous. By sticking to their duties too long at a time, the health of the workers is prejudiced, that alertness of body and mind which is essential to the proper discharge of their duties cannot be maintained, and it tends to destroy that keenness and that enthusiasm which are necessary. Long hours are not good for the individual workers, nor for the service generally.
Quite rightly, in this important work, efficiency is looked for; but we must be careful that we do not continue to impose conditions which militate against the best standards being attained. Such an attitude, in many quarters, has been evident up to the present; but, happily, we can now see signs of a change. One illustration of how long hours affect health is provided by figures gathered in the period following the last influenza epidemic. I am told that the general average of sickness among workers in hospitals during the epidemic was 30 per cent., but in a large hospital where the hours had been reduced, and it was 2426 possible to work under more reasonable conditions, the total number away from that hospital was only 10. That seems a fair indication of the good effect which will follow reduction of hours. May I now cite two illustrations taken from a number I have received to prove the contention that long hours are now being worked. One man writes to me from a big hospital in the north of England:The resident staff are often in a far worse position than the non-resident staff. Most of the latter at this institution work a 56-hour week. The resident staff work 83 and 67 hours, alternate weeks, the difference being accounted for by the Sunday on in one week and off the next.And the difference between the non-resident staff and the resident is that when the non-resident leave the institution they leave its atmosphere behind, which is all to the good.
I have another case here of a man who is a stoker in a hospital in the Midlands. He says that he works 72 hours per week regularly. He has no time off except his annual holiday; his pay is 42s. 6d. weekly, and out of this there is a deduction of 5s. a week for rent; and sometimes his hours are greatly in excess of the 72 which I have just quoted. In addition, he says that he has to pay for his own coal and light, and that nothing of that kind is found for him. Just one other example, and there I can leave it. I think that that side of the case is, at any rate, proved to a considerable extent when I have stated that the hours are up to 80 per week. This man says:I am employed at this Institution as assistant master and my hours per week total 78. My meal hours per week total 12½…which leaves me with not less than 65½ duty hours per week. In summer the hours are increased one half-hour per clay.These letters come from workers in large institutions in different parts of the country, and the statements made indicate a somewhat deplorable condition of affairs. The communications would seem to prove that there has been very grave remissness on the part of those responsible for the control of the administration. Everyone I know would wish to find conditions like these end as speedily as possible, but Parliamentary action, as outlined in the present Bill, is obviously the only way to bring the requisite authority to bear to clear away such mischievous conditions of employment.
2427 One cannot overlook the importance of other questions associated and allied with the limiting of hours of employment. Although these cannot be discussed in detail to-day, the points which occur to my mind and seem to warrant attention are those dealing with pay, pensions, holidays, study leave, food, recreation and leisure time. As the House is aware, a committee has been appointed, and in mentioning these matters one can conclude that, in some respects, inquiry may be justified, but with regard to the matter of hours, as proposed in the Bill, no inquiry is necessary. The facts are well known, and, in my judgment, they have been proved.
§ Sir Francis Fremantle
If the right hon. Member wants to do everything by a three-shift system—there are eight hours in every 24 and seven days in the week, which make a 56-hour week—how would he manage it on a 48-hour week?
§ Mr. Roberts
I do not want to depart from my advocacy of the general principle by going too much into details of the scheme, but if the hon. Gentleman will obtain a copy of the "Nursing Mirror," which I hold in my hand, he will find that there are schedules worked out in respect of the Manchester Hospital. The total number is here given, and, in addition, this journal has engaged expert advice in order to build up schedules which would comply with the exact terms and conditions of the Bill, and beyond that I do not need to trouble to go today. I was just saying that in my judgment—and, I believe, in the judgment of Members of the House generally, if they were free to express their views no inquiry is necessary to establish the need for the accptance of the proposals which are made in this Bill. The facts in connection with working conditions of nurses and hospital workers are well-known. If the Bill were to become operative, I do not see that it need interfere in the slightest degree with the work which the Government committee have been created to perform. Rather, the committee should welcome the Bill as giving them a very good send-off, and helping them to reach a better conclusion in the deliberations on the various points to which, apart from hours, they will be required to give their very special attention.
2428 I have found in all directions support forthcoming for the Bill, and I am informed by those who are in a position adequately to judge, that the Measure has the full support of the great majority of workers employed in and about hospitals controlled by local authorities. It is also supported by an organisation which is called the Nurses Advisory Council, a body which, I am told, speaks for all grades of nurses and other workers. In addition, under the auspices of the Guild of Nurses a delegate meeting was held last week attended by 500 nurses representing over 4,000 nurses employed in the London Hospitals, and this great meeting unanimously passed a resolution in favour of the Measure, and called upon the Government to find facilities for its passage. I have also received views which have been expressed by one or two matrons. Miss Dorothy Smith, of the Middlesex Hospital, says:I am definitely in favour of shortening working hours for both trained and untrained staff. Nurses need more leisure for both study and recreation, and should know well in advance when they are to be off duty.A very reasonable suggestion indeed. Miss Ashforth, the Matron in charge of the Hallam House Hospital, West Bromwich, particulars of whose working I have just quoted, says:the 96-hour fortnight is a good step. I am quite in favour of it.Another comment about working conditions which is not without significance and interest is one just made by Mr. Nathan Laski who holds a responsible position in connection with the Jewish Hospital at Manchester. He says:Nurses are miserably underpaid. Their hours are unduly long. The principle of collective bargaining is essential and security should be provided in old age.I would like to make one or two general observations and to urge that the staffs of hospitals and institutions should be regarded as responsible citizens. Their hours of employment should be such as to give them reasonable freedom and liberty. Irksome restrictions, which 'ire admittedly existent, should be avoided as far as is practicable and possible. I have here a quotation from a letter from a male attendant who suggests that the master of the public institution under whom he was working when he applied for a late pass, told him that one late pass in three months was all sufficient. This man is 27 years 2429 of age and is married, and it is not a very acceptable suggestion, to say the least of it that he should only be allowed a pass to be out after ten o'clock four times a year. That it not an attitude which is likely to attract the best men or women to the service. It will, probably rightly, be contended that this is not a general illustration or example, but it certainly proves that intolerance can prevail if there is no established protection.
It would be better for staffs if the living-out system could be developed inside other reforms. There are plenty of illustrations where authorities have made themselves responsible for erecting quite pleasant and comfortable hostels to replace the old accommodation which had been occupied up to recent times. Good work has been there done. If those two systems could work conjointly and in cooperation, a much better service would be secured, and the result would be seen in the greater benefits accruing. To show the advantage of the living-out system, information was given to me that one mental hospital in the North of England has not had to advertise for any staff for 14 years. The hospital, because of its conditions, has been its own recommendation. It has had the best kind of employment conditions, and 85 per cent. of the staff of the hospital have been permitted to live out.
These are indications of factors which have an important general bearing on the present position in relation to hospitals and institutions, and I come back to the main contention of the Bill that regulation of working hours is necessary to be authorised by Parliament before some of these reforms can come. Nurses and hospital workers make many sacrifices. They have made far too many for their devotion to be doubted in the slightest degree, but we have no right to put them in a position which takes them far beyond that by denying them the opportunity of sharing with others amenities of life which they have every right to enjoy.
I hold it to be the duty of the State to determine that those who are nursing the nation's sick and mentally depressed ought not to be compelled so to work that they run the avoidable risk of becoming patients themselves. This House could give a great lead to-day towards a big reform, and I am certain that the nation would wholly endorse the action which 2430 we might take in that direction. I am assured by Members of all parties in the House that they are in favour of the Bill and that they welcome its provisions, which they generally regard as fair and just. I, therefore, urge its acceptance by the House. If such be the happy result of my plea, it will be looked upon not only as a just recognition of the possibilities of sound and practical reform, but will also be regarded as a small appreciation of those who accept a task of devotion and self-sacrifice.
§ 11.39 a.m.
§ Mr. Marshall
I beg to second the Motion.
The Bill is a model of brevity and clarity, but we should make a mistake if we were to think that its brevity is the measure of ifs importance. If the principle underlying the Bill can be established, it will confer an inestimable boon on many thousands of people in this country who spend their lives in one of the noblest professions. My right hon. Friend has explained the object and provisions of the Bill with a profusion of facts and illustrations which relieves me of the necessity of covering the same ground. I should, however, like to make a few comments on the provisions of the Measure without unduly repeating what my right hon. Friend has said. The Bill deals with indoor and outdoor staff. The outdoor workers have of late years organised themselves into trade unions and have effected considerable improvement in their lot. The trade unions which cater for these outside workers have been very busy, and can certainly point to wonderful improvements as far as hours and conditions are concerned. I do not say that great improvements do not remain to be effected, but the need in their case is probably less than it is with respect to the indoor workers.
With regard to the indoor workers, I want to concentrate on the position of the nurses. There will be general sympathy with the object of the Bill in this respect. It may be that certain hon. Members have reservations on the subject. They may think that the Bill will put an intolerable burden upon local authorities, and that the difficulties of applying the main principle will be almost impossible. I do not entertain those ideas. I think that the local authorities will face the matter 2431 boldly and will realise that, Parliament having established the principle, it is their bounden duty to apply the principle of the 48-hour week or the 96-hour fortnight with regard to their outdoor and indoor staffs.
I have been a worker in the engineering industry and have spent a great deal of my life in great engineering works. When I first went there the hours were 53 or 54 a week. In the great steel industry they were 60 hours a week, dealing with continuous processes which, so far as the mechanical side was concerned, are quite as difficult as those involved in the question of nursing. Yet these various industries have overcome their difficulties and have applied the shorter working week. In the rolling mills and the great steel industry the hours are 48, and in the engineering industry 47. While these improvements have been going on in these national industries, we have been working our nurses anything up to 72 hours a week. The time is long overdue when we should do something in order to lessen the working hours of nurses. It is a strange commentary on our civilisation that in this wonderful service of healing we are working, for these incredibly long hours the people who minister to the sick and do all the necessary things for people when they are ill.
I do not deny that some improvements have taken place, and my right hon. Friend indicated where those improvements have been brought about. Some of the great cities have adopted the 48-hour week. With regard to my own city, I have a report from the medical officer of Sheffield dealing with a great and magnificent hospital which was taken over from the public assistance committee or the old Poor Law in 1930 and placed under the city council as a general hospital. I have here a recommendation in 1936 that the maximum of a 48-hour week be adopted; but the city council went much further than that. In a report which applies to all the hospitals under the city council, they recommended a maximum of 48 hours per week in all hospitals, an exception being made in the case of student and pupil nurses. I know that in Liverpool and in other great cities they have adopted a 48-hour week in some hospitals, but not in all. While 2432 we are grateful for what has been done, there still remains a great field in which this Bill would bring about immense improvement.
There are two Amendments on the Order Paper to-day. One is that the Bill should be read this day six months. I cannot understand the mind of hon. Members who take that view. I can understand a man who says that further inquiry is necessary in this matter, but I shall be able to show hon. Members who take that view that very prolonged and adequate inquiry into the nursing profession has already been held. What is it that an inquiry would elicit? Do hon. Members want an inquiry to prove that there is a shortage in the nursing profession? That is admitted on all hands. Do they want it to prove that excessive hours are worked? I can prove that in a short time without any further inquiry. I have here the report of an inquiry held M 1930 covering many of the hospitals in Lancashire and Cheshire. It is the report of a committee set up by the Lancashire and Cheshire Whitley Council for non-trading services, a purely local authorities' committee. They agreed to set up a joint committee to inquire into the many anomalies which were operating among the workers in their institutions, and there is a very impressive list of the towns which were covered by that inquiry—Birkenhead, Bolton, Bootle, Liverpool, Manchester, Barrow-in-Furness, Oldham, Stockport, Salford, Warrington, Blackpool, Burnley, Bury, Rochdale, St. Helens, Southport and Wigan. They made various recommendations about hours. They say:At present very considerable divergence exists in the working hours, particularly of the nursing staffs. In some cases the working week consists of 47 hours, and in other cases so high a figure prevails as 72 hours. Generally the Joint Committee considers there is every justification for a reduction in working hours. It is realised that from the point of view of administration the problem of working hours is an important and difficult one, as any drastic alteration would disturb the smooth working of the hospitals, and would add very materially to the cost of administration. In all the circumstances and as a temporary measure it is recommended as follows:The working hours of nursing staffs he 56 per week, day and night work, and the working hours of the other classes be, as far as possible, reduced to 47 hours per week.2433 That was recommended as a temporary measure, not as a permanent figure, in order to tide over what may be called a transition period. This inquiry covered thousands and thousands of nurses. It is a very important report, and I cannot imagine that conditions have changed very much from that time up to the present.
§ Mr. Erskine Hill
Will the hon. Member tell me from what report he is quoting as I did not catch the name?
§ Mr. Marshall
It is the report of the Lancashire and Cheshire Intermediate Grade Joint Committee on the wages and working conditions of hospitals and institution employés. If further proof were needed I have here what is the most important inquiry ever undertaken into the question of nursing and its allied matters. I refer to the report of the "Lancet" Commission on Nursing, which was published in 1932. Their terms of reference were:To inquire into the reasons for the shortage of candidates, trained and untrained, for nursing the sick in general and special hospitals throughout the country, and to offer suggestions for making the service more attractive to women suitable for this necessary work.While this was not a Government inquiry, it was certainly a very important one. There were some very impressive names on the committee. The Earl of Crawford was the chairman, there was Professor Henry Clay, and Professor Fraser, and a long list of distinguished men and women in surgery, medicine and economics. Their report covers 256 pages, and deals with all aspects of the nursing profession. I believe there is a close connection between the long hours which are worked in the nursing profession and the shortage of nurses in our hospitals. The two things are connected, and cannot be separated. Let me quote a passage from this report which will bring home to hon. Members the seriousness of the position as it existed in 1932. Talking about the shortage of nurses they say:Hitherto patients have rarely been allowed to suffer. Deficiency in the quantity and quality of the candidates for nursing them has been met by imposing an increased strain on the members of the trained staff and on those who do come forward for training. But the time must come, and it has already come in some hospitals, when the patient has to wait for attention, or is so conscious of the overwork of the nurses that he hesitates to ask for it; when the doctor's orders are carried out 2434 with less promptness and skill than they should be; and when anxiety to get the necessary work done obsesses the minds of the senior nurses to such an extent as to lead them to spur juniors to get through their tasks quickly, while giving little teaching in the individual care of patients. In hospitals where acute shortage exists, new probationers may be flung into understaffed wards to take their part in the daily struggle against time.That is not a very rosy picture, but the amazing thing to me is that something was not done on that report. It may be that the slump which intervened at that time was responsible. The report goes on to deal with hours. I should say that a questionnaire was sent out to 1,000 hospitals throughout the country, and replies were received from 686. The inquiry covered no fewer than 44,000 nurses, so no one can say that it was not comprehensive or intensive enough. The report is certainly most amazing reading on the question of hours. I have extracted from it the hours worked in municipal hospitals, and hon. Members may be under no mistake that the hours worked in voluntary hospitals are very much worse. Taking the day span, it is stated in the report that 63 per cent. of the municipal hospitals, in London and the provinces, compel their nurses to be on duty from 13 to 13¼ hours, and that in 23 per cent. of them, the nurses have to be on duty from 13½ to 13¾ hours. In order to obtain the actual working hours, one has to deduct two hours off duty, and the time for meals. Nevertheless, the fact remains that the nurses have to be in the building practically from 13 to 13¾ hours during the day span. In the case of the night span, the report says that in 70 per cent. of the London and provincial municipal hospitals, the nurses have to be on duty from 11½ to 12¼ hours, and in 28 per cent. of them they have to be on duty from II to 11¼ hours. There is no free time at night, so that the net working time is much longer at night than during the day.
In making those statements, I do not wish to do an injustice to those hospitals which have made improvements since that time, and I know the splendid work the hospitals are doing; but if those conditions existed in 1930 and 1932, I think we are justified in saying that a very great deal of excessive work is being put in by the nurses in the hospitals concerned. I cannot imagine any hon. Member saying that the hours of work of nurses are not 2435 excessive. In face of those facts, and with all the avenues of employment which are open to-day to young women, it is no wonder that there is an acute shortage of probationers for the hospitals. The report states that the lack of eagerness on the part of girls from secondary schools to train as nurses shows that adjustments are necessary, unless the whole system is to break down. That is a very serious statement to make.
I think the House has a responsibility in this matter. I believe that this Bill is a very good one, and that the local authorities will face their responsibilities if the principle be established, I believe that the Bill, if passed, would have an influence in bringing the more backward authorities into line with the best ones in the country, which have already adopted the 48-hour week. The nursing profession is a necessary and a noble one. It ministers to the wants of humanity when humanity is at its lowest ebb. In doing its work it exercises a high degree of skill and shows wonderful devotion. We should be supremely grateful for the services which nurses give to humanity, and we should bring their hours down to reasonable limits, and not endeavour to cut them off from the social amenities of modern life. The House would do well to pass this Measure, and I believe that in passing it hon. Members would earn the gratitude of a great number of those devoted men and women.
§ 11.59 a.m.
§ Mr Erskine Hill
I beg to move, to leave out from the word, "That," to the end of the Question, and to add instead thereof:this House, in view of the setting up of an inter-departmental committee on the conditions affecting the nursing services, is of opinion that it is premature to proceed with this Bill and declines to give it a Second Reading.Before speaking on the Amendment I would like, on behalf of the House, to thank both the Mover and Seconder of the Motion for the very interesting and very sincere way in which they spoke about matters which concern the whole House. This is one of the most interesting subjects that could have been brought up, and I believe that all sides of the House are most sympathetic to the claim of the nursing profession. I will go further, and say that in dealing with the 2436 question of the hours of work of nurses, the House is dealing with one of the most vital questions that will have to be tackled before we get a solution of the whole problem, for it is commonsense that a tired nurse is a bad nurse.
It is essential that the nursing services should be brought up to date in every way. But this is a very difficult problem. It is not only a question of hours, but equally one of conditions of service; and it seems to me that one must regard this as one wide, comprehensive problem and deal with it in one Measure. It would not be in the best interests of the nursing profession to take one step without considering the whole matter, and I think that by means of a comprehensive Measure, we should deal not only with the hours of nurses but with nurses' welfare in general. It is true that the Bill deals with local government hospitals, but the House will agree that it would have repercussions on voluntary hospitals. Having had a great many years association with three large voluntary hospitals, I am perhaps entitled to give the House an idea of some of the difficulties that have to be faced in dealing with this problem. The Bill attempts only to solve one of the many questions, an important one, but by no means the most important one—
§ Mr. Erskine Hill
In this case I think it would be better to take them all together. But even assuming that the matter could be dealt with singly, I do not think that the Bill, in dealing with the maximum aggregate of hours, is tackling the problem from the proper angle. The management of the daily span of work is equally important. I may mention the report, from which the hon. Member for Brightside (Mr. Marshall), quoted, in support of what I say. That report deals with the span of work, and it advises that in the nurse's day of 13 hours work which is the normal at present in most places, those should be a free period of three hours, apart from the time for meals. That is a most important question. A Bill such as this should also include the amount of time necessary to give adequate time for meals, which was also recommended in the report to which I have referred. To meet the whole large problem, it is necessary, 2437 in the first place, to have a comprehensive Bill. Secondly, the Bill must be gradual in its operation, for the reason that in the case of hospitals, with their large and delicate organisation, a sudden change imposed and very often superimposed upon conditions which are difficult in themselves might lead to a situation of chaos.
I hope hon. Members opposite will realise that I do not mean to make that an excuse for doing nothing. In the case of one of the organisations with which I am connected, the normal hours of nurses used to be 57 per week. Now, I am glad to be able to say, the figure is 52 per week, and I am as anxious as possible that voluntary hospitals and other hospitals together should reduce the total hours of work. But I must point out that a great many provincial hospitals are in a very different position from the London hospitals, and that it is much more difficult for them to give these facilities. It stands to reason that if the Bill requires, as I am told it will require, a three-shift system, it will at once make a tremendous demand upon the supply of nurses, and although eventually better conditions in the nursing service will attract more people to that service, hon. Members must realise that, for the time being, it will produce a very difficult situation for the provincial hospitals. The effect might well be that some of those institutions, upon which local populations are dependent for health services, would not be able to provide adequate services. Viewing the matter from that aspect, I suggest to the House that there is a duty upon us not to pass too hasty legislation which might have the effect of impairing health services in the provinces, and even in London itself.
It seems to me that the great fault of the Bill is that it regards the question too much as a factory question. I sympathise with the hon. Members who regard it in that way and who want to reduce hours from that point of view. But they must realise that when we are dealing with a hospital we are dealing with something very different from a factory. In the case of the factory the humanitarian point of view has to be considered in relation to a worker working with a machine. When one is dealing with such a problem, one naturally and properly realises that the man who is 2438 working all day with a machine has to be considered. Solely in relation to the physical effects upon himself. But workers in a hospital are working with people as their medium, and before we attempt to alleviate their lot we must arrange to do so in such a way as to produce the best possible effects on the subjects of their work, namely, the patients. [HON. MEMBERS: "Why not vote for the Bill?"]. I hope to see ere long a Bill which will deal not only with conditions and hours but will tackle the whole question effectively from every angle. It is for that reason that I find myself counselling the House, however anxious hon. Members may be to proceed quickly, to pause a little not only in the interests of the patients, but also in the interests of the nurses.
The House is entitled to know from those who are anxious to proceed at once by way of this Bill, whether the local authorities have been consulted, and, if they have been consulted, what views they have expressed. It is clear that a Measure which will affect so many people throughout the country, ought to receive the fullest consideration from all who are immediately concerned. Not only should the local authorities have been consulted —and I am waiting to hear what has been done in that respect—but the voluntary hospitals ought to have been consulted also,, because, as I have tried to explain, this Bill has implications for them as well as for the other hospitals. If for no other reason than that, I would counsel a certain amount of caution in approaching this matter. We ought to have the fullest opinions upon it from every side. No one could fail to be impressed by the evidence which the Mover and Seconder of the Motion read to the House, in the form of letters and other documents from the nursing profession. But I do not believe the nursing profession is as unanimous as they would have us believe, and although I was impressed by the views which we heard, I think the House would be wrong to conclude that those were, necessarily, the views of more than a section of the profession, although, I have no doubt, 1.1 important section. To act upon the advice of one section of the profession, however important, without having regard to the difficulties of other sections of local authorities and voluntary hospitals would be a grave mistake.
2439 These considerations throw into relief the object of this Amendment. It proposes that we should await the result of the proceedings of a committee—not a committee which we are seeking to have appointed, but a committee which has already begun its sittings. I am sure that that committee will obtain all the evidence which is necessary to enable a wise decision to be taken and I submit that, in view of all the difficulties which I have mentioned, the reasonable attitude for us to adopt on this occasion is that of awaiting the report of the committee now sitting. Reference has already been made to the report of the "Lancet" Commission on Nursing, and in that connection I wish to point out that there are some matters which required considerations as well as the question of hours. With regard to probationers, for instance, a great many recommendations are made by that commission. They recommend such obvious things—things which we would all like to see as separate bedrooms, an adequate number of bathrooms, that common-rooms and dining-rooms should be airy and well-appointed, that well cooked diet should be provided and that an expert in domestic science should be appointed to undertake the housekeeping. I think hon. Members opposite in their desire—with which I do not agree—to see nurses living at home and away from the hospitals have overlooked the importance in any scheme for dealing with this question of regarding the hospital as a home. I must say a word about that, because it was suggested by the right hon. Gentleman who moved the Second Reading of the Bill that it was better in some ways for the nurses to live outside. Can that be so?
§ Mr. F. O. Roberts
I think the hon. and learned Member will recollect that in making that statement I referred not only to the need for development in the living-out system but also suggested that the two systems, living-out and living-in, might be co-ordinated and worked in cooperation, and I referred with gratification to the fact that better hospitals had been provided.
§ Mr. Erskine Hill
I am much obliged to the right hon. Gentleman for that explanation, and I hope that I did not do 2440 him an injustice; but it did seem to me that he was rather deprecating the living-in system, though it is true he said that the two systems should be co-ordinated. Let us consider for a moment how much better it is in many ways, both from the nurses' and the patients' point of view, that the nurses should live either in the hospital or in the annexe to the hospital. First of all you have the question of the nurse arriving at the hospital in the morning. If she lives outside she has to get up early, in many cases she has to prepare her own breakfast, she may have to strap-hang to get to her work and she may arrive at the hospital in a condition which is not nearly as good from her own point of view or that of her patient as the condition of the nurse who walks over from the nurses' home in which she lives. Certainly you must, where necessary, improve the condition of these homes. From the health point of view there is another matter which is of incalculable advantage. If a nurse is living by herself in rooms and she becomes ill she is not able to get that immediate attention which she would get if she lived in the nurses' home.
I mention these facts only because the right hon. Gentleman mentioned the benefits of living outside. It is fair to say that there are very many considerations which make it advisable for the nurse to live inside, but if one went into the question of all the reforms which would be beneficial to nurses, one would weary the House with the length of one's speech. It is for that reason that I say that the committee to which I have referred is the proper place in which to thrash out all these matters and to bring forward the evidence. If the Committee does not, according to some opinions, contain in every way the representation which seems to these opinions to be most suitable to have in mind one particular aspect of opinion, it can have brought before if the right sort of evidence by those who know the subject. The House ought to await the issue of the Committee's report. The all-important question raised by the Bill affects every Member of the House, because no one of us knows from one week to another when our lives may not depend upon having an efficient nurse to look after us in illness. We ought to remember that the essential need is for as prompt action as one can get, combined with efficiency. I ask the House 2441 to support the Amendment because I think it is best from the point of view of the patient, the hospitals and the nurses themselves.
§ 12.20 p.m.
§ Major Neven-Spence
I beg to second the Amendment.
My hon. and learned Friend, the Member for North Edinburgh (Mr. Erskine Hill), has spoken ably, comprehensively and persuasively. I wish to associate myself with all that he said by way of compliment to the right hon. Member for West Bromwich (Mr. F. O. Roberts), who moved the Second Reading of the Bill, and to those who are backing it. We all know perfectly well that a great: deal in the past history of employment in institutions it is perhaps better not to dwell upon, and that there still exists a need for reform in many directions. I hope that hon. Members opposite will give us on this side of the House credit for being just as sincerely anxious as they are to improve the lot of those whose lot needs improving. It may be that we differ in our views as to how to reach that end, but I think that we have a common aim. The right hon. Gentleman who moved the Second Reading is full of good intentions and I am only sorry that the Bill he has produced is such a thoroughly bad Bill. I shall explain why I think so. The Bill seeks primarily to produce some degree of uniformity in the hours of work in hospitals and institutions under the control of local authorities.
Let me, without offence, say that one of the most noticeable things about the policy of hon. Members opposite is their passion for uniformity, a passion that seems to govern so much of their outlook. Their desire is to level. I wish that the levelling was always a levelling up, and not, as I suspect, a process of levelling down in many cases. This passion has been amply displayed in the matter of hours of labour. Having sat here for two years I get more and more the impression that many hon. Members opposite regard work in itself as something undesirable and something to be reduced to the smallest possible compass. I do not agree with that view. I think that the average normal person does not look upon work as a bad thing. We look forward to our day's work, we do it to the best of our ability, and we go home at the end with a sense of satisfaction, unless one 2442 happens to be going home with a stillborn speech in one's pocket, when the sense is undoubtedly one of frustration.
I do not think that the primary consideration of the average working man is his hours of work. So far as my conversation with working men has gone, I have found that often they are much more concerned with wages, with the conditions under which they work, with the time spent in getting to and from their work and what it costs, and their home life and facilities for recreation and amusement. Many of these things weigh far more with them than the question whether nine, eight or seven hours day is best.
My hon. and learned Friend referred to the factory outlook. You cannot lay down uniform hours of work for all industries. What may be an unreasonable day's work in mining may be a perfectly reasonable day in some other industry. It is impossible to lay down any hard-and-fast rule as to what is the optimum number of hours that anyone should work. I have been listening carefully to find out what hon. Members opposite are driving at. They seem to me to fix a certain number of hours and then to ask for a smaller number. Are we to aim ultimately at one universal holiday for everybody? If that were to happen, it would be a very dull world indeed. In any case, whatever may be the ideal number of hours that ought to be worked, I am certain that a compulsory reduction such as is proposed in this Bill is not the best way to achieve it. I think it is far better for hospitals and institutions that the arrangements should be arrived at between the institutions and the organisations representative of the people who are employed in them. This question must he approached with very great caution if harm is not to be done. It undoubtedly is the case—I freely admit it—that the hours worked in some institutions are far too long and ought to be reduced, but I am concerned with what is the more practical and sane way of effecting that reduction, and I am convinced in my own mind that compulsory legislation is not the way to go about it.
You have not only the staff to consider in this matter; you have to consider the primary person concerned, and that is the patient, and if you were to effect any sudden reduction to a common level in the hours of work in instutitions, there 2443 might be very unpleasant repercussions for the inmates. It is exceedingly important in the nursing profession and in institutions where nurses are employed to preserve a certain ratio between your probationer staff and your trained staff. Every matron and everybody in the nursing profession with any experience at all must know that, and any hon. Members who have had anything to do with the government of local authorities' institutions or of voluntary organisations know that this is a very important point indeed, and that if you suddenly increase the number of probationers as compared with the trained staff, you will have considerable difficulties to contend with. I believe that a sudden reaction in the hours of work, such as is proposed in this Bill, would in some cases result in chaos.
The hon. Member for Brightside (Mr. Marshall), who seconded the Motion for the Second Reading of the Bill, mentioned the shortage of recruits for the nursing profession. Does the right hon. Gentleman who moved the Second Reading or does his Seconder really think that if you pass this Bill, there will immediately be forthcoming a tremendous surge of recruits into the nursing profession? [HON. MEMBERS: "Yes!"] There would not. It is not the question of the hours of work that is responsible for the shortage of nurses.
§ Mr. Messer
Is the hon. and gallant Gentleman aware of the very large number of nurses who are employed by private associations and who refuse to go into the service of public authorities because of the lack of freedom and the number of hours of work?
§ Major Neven-Spence
I have no special knowledge on that point, but I think I am correct in my general statement, that if you were to pass a law reducing the number of hours of work, you would not immediately get a rush of candidates for the profession. There are too many other things attracting young women at the present time. Let me remind hon. Members opposite also that nurses are trained and not born. It takes a considerable time before a woman is a really efficient nurse, and I think, therefore, there is an overwhelming argument against a sudden change such as is proposed in this Bill. It is not a case of the inevitability of 2444 gradualness but of the absolute necessity of gradualness if you are not going to create chaos in some of these institutions.
Scotland will not easily be accused of suffering from an inferiority complex. We usually like to feel that we are one step ahead of England in most things, and I think I am correct in saying that some institutions in Scotland adopted the 48-hour week before any institution in England did so. My only reason for mentioning that is to refer to the reaction of the staff. They were not pleased at the reduction. and many of them murmured and preferred the system under which they were working before, with a 54-hour week.
§ Major Neven-Spence
The point is that there was a temporary objection—it was only temporary, I admit—on the part of the staff, and it occurred in asylums which were in the country, where the nurses found themselves with rather more leisure on their hands than they knew how to deal with. No doubt with improved facilities of transport, the development of motor transport and other things, these people are able to get more easily into the towns. In any case it is only a trivial objection, and it disappeared. I am not arguing against the reduction to 48 hours, which has my entire approval, but it shows that you can sometimes seek to do good by stealth and find that it is not altogether popular when you have done it.
There is the question of the outdoor staff to be considered, and I really do not think the right hon. Gentleman who introduced the Bill has altogether comprehended what that term includes, because many of these institutions are asylums, and they very often have farms, sometimes very big farms and more than one, attached to them. If the term "outdoor staff" were to be held to include those employed on the farms by local authorities, you simply could not work on a system such as this. No farm could be run under a system on which no person was allowedto work more than 48 hours in any one calendar week, except in cases of emergency.There is a very large number of outdoor employés in connection with public institutions. No doubt the painters. plumbers, 2445 and so on are all working under trade union arrangements, and if any Measure of this kind were ever introduced, you would have to make arrangements to leave the hours of the outdoor staff employed on the farms to be governed by the agricultural regulations already in existence.
Another point about this Bill is that the Title of it rather suggests that the local authorities are the backward people. I am sure the right hon. Gentleman did not mean to cast any slur on them in particular, but I cannot understand, when you produce a Bill dealing with a subject such as this, why you should confine your efforts entirely to hospitals and institutions under the control of local authorities. Surely, if you are going to tackle this problem at all, you should tackle all institutions dealing with the sick or with the mentally deficient, whether they are run by local authorities, by voluntary organisations, or otherwise. If you were to tackle only institutions run by local authorities, you would introduce diversity, which might be very harmful. If the Bill is necessary at all, let it be a comprehensive Bill embracing the whole of the institutions in which nurses are employed.
§ Dr. Haden Guest
Does the hon. and gallant Member object to diversity being introduced by the Labour party when he previously objected to uniformity?
It was not so much the uniformity as the levelling down to which I was referring, but we will let that pass. I am pointing out that it is desirable to deal with the question on a comprehensive basis instead of dealing with one particular section of it. I can see no reason for it. One gathers the impression from what has been said that conditions have not been improved. Anybody who knows anything about hospitals and institutions, however, knows that without any compulsory legislation enormous improvements have been made and are in process of being made. I do not wish to be merely destructive. I am entirely sympathetic with the aim of hon. Members opposite. I know that there are cases in which reductions of working hours will have to be brought about somehow or other. My only hope is that they can be brought about by persuasive means rather than by the use of the big 2446 stick such as this Bill. I believe that the end which hon. Members opposite have in view can much better be achieved by some system of inspection on the analogy of the Board of Control in regard to asylums. We know how rapid the improvement was after the Board was started, and it would be an enormous benefit if there were some form of inspection by which people visited different institutions, compared what they found there, and gradually eliminated black spots and raised the whole standard.
§ 12.38 p.m.
§ Mr. Lansbury
I should not have intervened in this Debate but for the fact that for a considerable number of years I have been associated with the administration of local government hospitals and Poor Law institutions, and because I am convinced that unless something is done to ameliorate the conditions of the nursing profession, we shall arrive at a condition of things when there will not be a sufficient number of young women willing to undertake this work. When any reform of this kind is undertaken it is usually started through the local authorities or through Government agencies and it then spreads out to the whole of the profession. The hon. Members who have spoken to the Amendment have asked why we want Parliament to compel local authorities to have a statutory working week for certain of their employés. There is ample precedent for that in the fact that the House lays down that in Government contracts and Government work trade union conditions shall operate. In the Debates on that question it will be found that the same argument which the hon. Members have put forward to-day in regard to this Bill were put forward against the proposition that the Government should set an example to other employers as to hours of labour, rates of pay and conditions generally. No one in the House would now ask for the repeal of that provision. Nobody on a local authority would ask that it should be repealed. We are acting entirely in line with that modern procedure when we bring forward this Bill.
§ Mr. Donner
Can the right hon. Gentleman tell us why the London County Council, which has a Socialist majority, has not taken any steps such as are required in this Bill? I can see no evidence of the presence to-day of the right 2447 hon. Gentleman the Member for South Hackney (Mr. H. Morrison).
§ Mr. Lansbury
I am the Member for Bow and Bromley and also a member of the Poplar Borough Council. Until the board of guardians was abolished, I had been a member since 1892. All I can say is that my colleagues, when they had the power, practised what they preached. Therefore, as I am not on the London County Council, I cannot answer for what that authority does. That is an argument why we should pass this Bill, in order to compel them to do it. When we bring in a Bill we do not usually ask that certain authorities should be exempted, and therefore the London County Council would come under the operation of this Measure, and they would not find the proposal impracticable. Everything is possible if you have the will to do it. When there is not the will and some power like this House says, "We will give you the will", it is done.
Although the Mover of the Amendment was downright in his support of the principle of shorter hours, I do not know where the Seconder stood. I am inclined to say that, everybody in the House, except the seconder, is wholeheartedly in favour of this proposition. His preliminary remarks seemed to imply that the only thing a manual labourer desired was to work as many hours as possible and to get as little recreation as possible. We on this side, and many on the other side, are standing examples—or sitting examples—of men who, when they had the opportunity, got away from manual labour at the earliest possible moment. I make no bones about that. I went away from shovelling coals as early as I could. I do not stand here and say that work is a blessed thing. It was invented as a curse and mankind has been running away from it ever since, until it reaches a position with labour-saving machinery, in which, as the late Lord Leverhulme said, we could work for a couple of hours a day and have the rest of the day for ourselves if we had the intelligence to do it. In those circumstances no one can object to an 8-hour day.
The Seconder of the Amendment said that nurses might not like it—he hedged a little afterwards; but last Friday I presided over a large meeting of nurses, and out of 1,800 who were present I think 2448 there were 13 who voted against a motion asking everybody in this House to give this Bill a Second Reading. I wish the speeches which were made at that meeting by nurses and others could be made in this House to-day, because they put forward an unanswerable case, which neither of the hon. Members supporting the Amendment has attempted to meet, a case which rested on the fact that they were not able to give as much attention to their patients as they would like, that their health was injured, and so on. On the question of living out, there was overwhelming evidence that the nurses wished to be treated like ordinary people and not put under a sort of discipline, having to be in at a certain hour, and being reported if they were late, a condition of things which, I think, no grown people regard as desirable in these days.
As to the question of their arriving tired at the hospital in the morning, perhaps some Members do not realise that sometimes the homes for nurses are quite a distance from the hospital, and to that extent they do live out, hut when it is said they would have to get up at home and "scramble their ham," I think the hon. Member said—I suppose he meant their ham and eggs— [Interruption]—Oh, it was "strap-hang on the way to work." I suppose the hon. Member was thinking that a nurse would have to get up and prepare her own breakfast and that she would be dead tired, but she does that now, very often, and I think that is a far-fetched argument against nurses living out.
§ Mr. Lansbury
It was not the hon. and learned Member to whom I was referring. No one could possibly misunderstand him. I understood his position quite clearly. I do not want to go further into the question of living out, except to say that I am certain that will become the practice in regard to nurses, and all that class of persons generally. Then we have had the argument that everybody—except the last hon. and gallant Member who spoke—is in favour of this reform only that we should not do it now; we should wait for some time. I have already dealt with the point that local authorities ought to start this reform, just as they have begun many other reforms. I would emphasise the point that, in my judgment, we shall get 2449 all the young women who are needed once we make the nursing profession something more than what it so very often is, a life of downright drudgery.
I owe a great deal to nursing and to the medical profession. I am able to get about and to work a good many hours—but not at one particular job. I should have been dead long ago if I had had to stick at one dead, monotonous job day in and day out. It is variety of occupation which enables people to do a very large amount of work. When ill I have often been ashamed to call a nurse. Once I was in a very helpless position and for 10 weeks every little movement I made caused pain—unless I could be moved instead of trying to move myself—but often I would not ring the bell or flash I he lamp because I knew what a trouble it was, and what work the girls had to do. I felt then that if ever I got the opportunity to do anything to ameliorate the conditions of nurses I would do it, and I have always tried to put in a word for them.
It is a false sort of attitude to take up to say that we must not undertake the reform asked for in this Bill because of the voluntary hospitals. I help voluntary hospitals and speak for them. We have not yet got a sufficient number of municipal hospitals anywhere in the country and many of the voluntary hospitals do magnificent work; and we ought to be grateful to them, but if this Measure is necessary—and no one has put up a serious argument against it—the country must choose whether it will subsidise the voluntary hospitals or establish a national medical service throughout the country. We have no right to put on to the nurses and the outside staffs of hospitals a burden which ought to be borne by society as a whole. If this reform is right, and I do not think anyone will deny that it is, we ought to find the ways arid means by which it can be carried out. We are discussing a very human thing, and that is, Ought we to expect young women—or young girls really—from 18 to 25 years of age to work the deadly hours which many of these nurses have to work?
In my judgment, broken time ought to be wiped off the slate altogether. If it is necessary to have three shifts of eight hours, and I do not think it is for the whole staff, we ought to agree to it. I was in a hospital for nearly a year, and 2450 I could see that when the nurses went off duty for an hour or two, or perhaps for two hours or for four hours, that the break brought no real rest at all. I beg hon. Members not to consider this question from the point of view of whether the voluntary hospitals can live up to the reform or not. We have set a standard for employers in competitive industries by raising the conditions for Government and local government employés. Nobody in the House would object—I am sure we, the Socialists, would not object—to subsidising the voluntary hospitals for the time being until something better could be done if that were necessary to enable them to put this reform into operation.
The final thing I have to say is that none of us has any right to expect a better service from these nurses than we expect of ourselves. Ministers of religion and doctors expect to rise higher in their professions and get more money and better conditions, and they are serving the community in one way or the other. Why should we think that a nurse regards her profession as so fine and noble a one that she must submit to conditions which none of us would voluntarily submit to, or which members of the medical profession or the Church would accept? As my hon. Friend said, nursing is a noble profession, whether it is a mother nursing her child, a daughter her mother or anything of the kind. Do not let us take advantage of that fact however, but let us say that we will pass the Bill. We can amend it, and I have no doubt that its promoters would be in favour of amending it, probably in respect of the date so that there might be a little more time to get over the difficulties—which, I think, are largely imaginary. Do not let us reject the Bill because we think a 48-hour week is impossible. It is possible if we have the will to do it.
§ 12.56 p.m.
§ Sir F. Fremantle
I think the whole House will join me in thanking the right hon. Gentleman who introduced the Bill, and the Seconder, for their useful, helpful and delightful speeches, and for the main line of their argument. These have already been considerably discussed, and I do not wish to repeat what has already been said. Perhaps I might be allowed to make a caveat for my speech, inasmuch as I am a Member, I think the only Member here present, of the new departmental 2451 committee on the nursing services, which held its first meeting yesterday. I, therefore, cannot, and should not be entitled to speak for the committee as a whole; all we have done so far is to have a preliminary meeting on procedure. I feel certain from my knowledge, and from personal acquaintance with many of those who are upon the committee, that there will be a large measure of agreement among them with the main principles of the Bill, and certainly with its ultimate general object—I might say complete agreement, with certain exceptions on details. Many of the general objects of the Bill would be generally approved by those with whom I have worked in the medical and nursing services, particularly in regard to the 98-hour fortnight.
If we are working towards that end, it should be clear to everyone that you cannot establish a 48-hour week in the nursing and medical services as easily as you can in the factory world. You can make up odds and ends of time in factories by employing people for the extra work that is required, whereas in hospitals, patients need attention morning, afternoon and night, and every minute during the 24 hours. You, therefore, must have nursing services available for every minute of the eight-hour shift which, reckoning seven days a week, makes a 56-hour week. This matter is dealt with easily enough in factories. You damp down the boiler at night, but you cannot damp down the boilers of your patients —or rather, Nature damps down the boilers of the patients and they require extra attention. You cannot take the principles of factory organisation into hospital life in trying to establish an eight-hour day, because it must be recognised that it means a 56-hour week, with such adjustments as may be made, or a 112-hour fortnight.
§ Mr. Messer
Is the hon. Member aware that North Middlesex Hospital is now operating an eight-hour day successfully?
§ Sir F. Fremantle
Yes, and the way they are doing it is by having more than a three-shift system, and extra nurses to fill in the extra requirements of the patient. That is obviously what you have to do unless you work the three-shift system based upon the 56-hour week. If you work less than 56 hours a week you 2452 increase the demand for nurses, but at the present time there is a shortage of nurses, and there will be an increased shortage in the near future. I will not argue that point any further, because it should be obvious. We want to find the way to attract young girls of the right quality into the nursing service.
I am rather surprised that a right hon. Gentleman like the Member for Bow and Bromley (Mr. Lansbury) should consider that it would be sufficient to pass the Bill, recognising that the obvious result would be that municipalities everywhere would be bound promptly to increase their staffs and to take nurses away from the voluntary hospitals throughout the country, including the cottage hospitals and so on, which would go absolutely phut and be spoilt. [HON. MEMBERS: "No !"] Oh, yes; you cannot suddenly attract a large number of girls to these places without some such result. The right hon. Gentleman said that this change might have to be done gradually; that is the whole state of the case from this side. It has to be done gradually and with the voluntary hospitals in mind. The Bill professes to have nothing to do with them in the ordinary way. Therefore there is a need for the departmental committee. Nobody on the committee would wish one small part of the problem to be legally decided now, in advance, because it would spoil the balance of the system which has to be dealt with, but which is now sub judice.
Reference was made to the "Lancet" Commission by the hon. Member for Brightside (Mr. Marshall) who seconded the Motion, and I am glad he did so. He did not refer to it in detail. The conclusion of the "Lancet" Commiission was that the span of work should not exceed 13 hours. After all this wonderful inquiry which the hon. Member rightly said was comprehensive and impartial, and looked thoroughly into the subject, it was recommended that on one or two days a week the span should not exceed 14½ hours, and that the extra time should be compensated for by extra hours off duty. If that is the most up-to-date and comprehensive inquiry that has been made, it is obviously necessary for the departmental committee to go rather thoroughly into the matter before recommending a maximum of eight hours. It is true that some authorities have, with great advantage, made definite regulations upon rigid hours of work. The hon. Member 2453 opposite who interrupted me has done excellent and admirable work as chairman, I think, of the public health committee of the Middlesex County Council. I understand that some of their institutions have gone far in this direction, and have had no difficulty in recruiting their hospitals. That does not affect the general situation. If one authority among so many gives these advantages, which we are all so keen on getting if possible for the whole nursing profession, that draws in recruits from all the rest of the nursing services. [HON. MEMBERS: Hear, hear "] That is agreed, and, therefore, it reduces the supply of nurses throughout the other hospitals, for which the position is thus made more difficult by the charitable and excellent action of the Middlesex County Council. The London County Council, which is perhaps as far ahead in municipal services as any authority in the world could be, and deals with no fewer than r,000 nurses, has managed to reduce the hours of employment to an average regular system of a 58-hour week, and in the mental hospitals 48 hours. But I hope it will be realised—
§ Sir F. Fremantle
I beg pardon; it is 54 and 48 hours. But that difference is insignificant. Mental hospital nursing is far more wearing and tearing to the nurses, male or female, than even ordinary sick nursing, and naturally the London County Council at first paid attention to the hours of duty in their mental hospitals. Even so, they could only manage a 48-hour week for their mental hospitals, and the others still have a 54-hour week. The London County Council can do that, of course, because they have the rates behind them. The voluntary hospitals have not that power. Therefore we must be quite clear as to whether we want to extinguish the voluntary hospitals and have a complete municipal system. I see an hon. Member of the Liberal Opposition nodding his head, as if he were of that opinion. It is not the old Liberal doctrine, and I hope it will never be the doctrine of any Members of this House. I do not think that even the right hon. Gentleman the Member for Bow and Bromley has succumbed to that yet.
§ Mr. Lansbury
May I say that all my life, since I have been able to think, I have been in favour of a national medical, nursing and surgical service, and, whenever a Bill can be brought in for that, I shall vote for it whole-heartedly. Until it does come in, I shall help the voluntary hospitals to do the job that has to be done.
§ Sir F. Fremantle
If we were able to decide that question by further discussion between the right hon. Gentleman and myself, I should like to ask what he means by a national service. If he means a system that is nation-wide, all co-operating together, I should be with him; but if it is to be put under local authorities popularly elected and disciplined by the regular rules of ordinary local government, I should be hotly against him, and so would the medical and nursing profession as a whole, until times change. But that is another question.
We must recognise at the back of our minds that the spirit of service comes into the nursing profession. That spirit of service, which is so ardently required and necessary for the actual carrying out of the work, has undoubtedly been liable to be abused by local authorities in the past, to the detriment of the nurses, and, through them, of the patients. That is agreed on both sides. One of the most noted medical men of recent times, in an address to medical students, said to them: "Remember that you are entering a service, not a trade. You must not seek rewards for yourselves, but sufficient means and conditions for yourselves." That is the principle at which we ought to aim.
Do not let us disregard the history of this service. It dates from the old monastic times when women devoted themselves to it. The monasteries were the basis of the voluntary hospitals and of the whole medical and nursing service. Women gave themselves up to that service entirely, with the enormous advantages which everyone recognises who has had anything to do with this work. That spirit of the monastic principle continues on the Continent, where women still live absolutely for their patients and with no regard to themselves except for what is necessary. I am glad to say that many medical men at the present day, I should like to think the majority, look upon their service in the same light, and 2455 that, surely, is what we all want to encourage. The kind of scheme that this Bill proposes would be absolutely cut-and-dried legislation, as if it were a mere trade, providing for the rights of the individuals by simply parcelling out their hours and duties regardless of the spirit of service. The drastic discipline of the old monastic days is now impossible, but let us see if we cannot retain something of the spirit.
As to the question of time off and time out of hospital, we all know how essential it is for anyone bearing responsibility to get out from their surroundings and be absolutely clear, if possible, of their responsibilities as well as their surroundings and conditions. Therefore, we all want to get better terms than are available now for ordinary nurses with regard to getting real time off. But let us remember that the ideal still is that the girl or the medical student comes into the hospital and makes it his or her home for the time being. It is not simply a workshop to which they come, downing tools at four o'clock or eight o'clock regardless of the patients. They look on that institution as a home in which they live and move and have their whole main being for the time. I speak from experience. When I came down from Oxford and went into a hospital, I did the same thing, as did many others with me. So intense is the responsibility and the interest of this medical life in hospitals that you concentrate entirely, and shut out the outside world. It is a finer life for those taking part in it, whether doctors or nurses, and an infinitely finer service for the patients. But under this Bill all that is to be left to look after itself.[Interruption.] I do not say that that is the intention of the Bill, but it is the basis of the ordinary trade union system in factory life. I do not quarrel with it, but, indeed, support it in general as being the ideal in the circumstances.
§ Sir F. Fremantle
Because I am expressing myself passionately on the lines 2456 of the principle that must actuate the whole of that Committee and the whole of this House. I have tried to avoid matters of detail that will have to be decided later. Anyhow, I have not gone further than the hon. Members who introduced the Bill, and this House has a right to have the matter considered from every point of view. I am entirely in the hands of those who are concerned to say whether I have gone beyond what is right as a member of a Departmental Committee. Certainly, I will avoid anything with regard to particular details. We have got this clash of the old historical principle of service and the modern idea of regularisation and systematisation. It would be perfectly absurd for anyone to think that a nursing service can be provided without recognising that when boys and girls go into a profession, at the age of 18, they are looking at the rival advantages and disadvantages. There are many of these points into which we have to go on the Committee, in order to achieve the object, which we all have in mind, of making very considerable improvements in the nursing system.
The question must arise whether we believe in getting this improvement by dictatorial legislation—that is the object of hon. Members on the opposite side, and of many enthusiasts who are not politicians at all, because it appears necessary in order to get improvements made—or do we believe that it is better that we should work, not by dictatorial legislation, but through conviction, that is, by voluntary principles, enforced by public opinion. At present, public opinion is not sufficiently defined on the subject. It has not seen the need for this. It may be strengthened by the impression created by this Debate, and, further, by the inquiry of the Departmental Committee. It is the same problem arising in regard to these conditions, which can be systematised, as we are meeting in the domestic service problem, where the old, long-established, intimate family relationships are now face to face with this tremendous competition from outside.
We must, in regard to nursing, meet modern needs; but we should be sacrificing an enormous asset, in trying to draw girls of the highest kind into the nursing service, if we were to sacrifice the spirit of service that comes down from 2457 the days of the religious houses, and from more recent times, up to the present, of the great voluntary hospitals. We must concede our improvements on properly planned lines, and it will then be up to us who so strongly support the voluntary hospitals system, as well as the municipal hospitals system, to recognise that we have to take strong action in order to carry out what is necessary. The voluntary hospital is on trial for its life, and so is the basis of one of the noblest occupations open to men and women, and that demands the rejection of this Bill.
§ 1.20 p.m.
§ Mr. Messer
I have to confess to a feeling of genuine amazement at the speech to which we have just listened. I want to make no allusion which will be personal, but if I stood in the position of the hon. Member who has just spoken I should be compelled to withdraw from that committee. I can hardly conceive of the possibility of a committee which is to inquire, receive evidence, and, it is assumed, deal impartially with the situation, being able to do it when there sits on it a member who has already made up his mind in the way that the hon. Member has done.
§ Sir F. Fremantle
Will the hon. Member mention any point on which I have made up, or expressed, my mind on details?
§ Mr. Messer
I honour the hon. Member for his convictions. I honour anybody who opposes me with a depth of feeling on a principle, but my admiration is tinged with deep regret when anybody who holds that feeling takes an office where strict impartiality is demanded. If may deal with one or two other points raised this morning, I do not know that I have ever heard such inconsistences. It is urged that we should not pass the Bill, because it is only dealing with one aspect of the problem, and that we should wait 2458 until we have a comprehensive Bill dealing with every aspect—conditions of work, food and leisure. Is it really sensible for us to believe that those bad conditions are more bearable when the nurses are working 80 hours a week than they would be if the nurses were working 48 hours a week? It does not bear examination.
But let us look at the actual effects of a reduced working week. Everybody agrees that this service is the most important social service that we have at present. We are proud of the doctors, and proud of the surgeons who are capable of performing such wonderful operations. When the surgeons leave a patient in the hands of a nurse, much of the service he has performed can be rendered either more or less effective, according to the type of nursing that the patient has. I have had experience of voluntary hospitals, and I am proud of the position I hold as chairman of the Board of the North Middlesex County Institution. We found, when we held our examination for efficiency, that every one of our nurses passed. One gained a gold medal and three gained silver medals. Efficiency has been improved because of the reduction of hours, which has given them an opportunity for study and, perhaps more important than anything else, an opportunity for recreation, which nurses need, perhaps, more than anybody else. We are working an eight-hour shift and a 48-hour week. The hon. Member says it cannot be done. He reminds me of the old lady who went to the Zoo, and when she saw a giraffe said, "There is no such thing." Every one of our nurses is working an eight-hour shift and a 48-hour week.
What is the result on the nurses themselves? Every month at our meeting we have had for years a chart containing the names of nurses who are off duty sick. We have a smaller incidence of sickness among the nursing staff now than ever we had before. That is not only true of North Middlesex, but it is operating over the great county of Middlesex, not only in one institution, but in all the institutions which come under the control of the Middlesex County Council. Is it fair? Here we have a great machine doing the most important work, for, after all, the wealth of a nation is in the health of its people. There is nothing that can compensate for lack of health. You 2459 may be possesesd of any material advantage you like, but without the capacity to enjoy it because of failing health, it is of very little use. The value of the nursing profession then, raises nurses far above the level of those who are engaged in other aspects of that work. Yet we give to our carpenters and joiners and building trade workers a 44-hour week in the winter, and a 48-hour in the Summer. We give to our clerks a 37-hour week, with complete freedom, and it is urged that what you should do is to allow the free play of circumstances to determine the hours of our nurses, as they at present exist in some parts of the country, to anything up to 80 hours a week. Is it believed that you are going to get the best type of service? The argument of the hon. Member for St. Albans (Sir F. Fremantle) was, let the nursing profession realise how noble it is, and then nurses will be prepared to work longer for it. But the truth is that they do not. He must know, in his position, perhaps even better than I do, that the diminution in the source of supply is assuming alarming proportions. The reduction in the recruitment of nurses is assuming ing dimensions which are serious. What is the reason? Is it because nurses are not working long enough, as the hon. Member suggests, and that what we ought to do is to give them longer hours?
§ Mr. Messer
Let us analyse it. If we treat nurses like we treat any ordinary human beings, and we give them a regular period of work just like that given to the ordinary artisan, the purity of their spirit revolts against it. What we have to do is to inspire them with the nobility of the service which they are rendering, and then they will come into the service and work, on the assumption of the hon. Member, any hours that may be determined by the free play of circumstances. That appears to me to be the logic of that argument, and if it is, surely, it is not borne out by the facts, because we are not getting the 2460 nurses. Is it suggested that we should not treat these nurses like ordinary human beings?
Two main arguments have been used against this Bill. First of all, that of finance. Set off against the increased cost will be a reduction in the amount you are paying in respect of sick leave, and the greater efficiency of the nurses. Whatever may be said for the things which you can purchase with money, there is no value, no test and no standard that can be applied to the services rendered by a nurse in reference to your health. She is part of the great remedial and curative system, just as the doctor is part of it. He is an indispensable part of it. She may be less indispensable, but she is a necessary part of it. The doctor can say, "You have a most serious condition, but I have measured the length of your purse, and I will remove your appendix for zoo guineas." The nurse has not that opportunity. She is part of that great system, but she is not treated as though she were. She is treated just as a unit who cannot be considered on the same lines as any other member of the human family engaged in it.
The argument, then, is one of finance. When people are ill they are prepared to pay anything in order to get well, and they have a right to pay for the nurse, not in accordance with the estimation of the ability to pay, but in accordance with the estimation of the value of the service which is rendered. It is going to cost more, but it is money which is going to a quarter where it ought to have gone a long time ago. The very importance of the work that she does has rendered her incapable of taking the steps to improve her position which can be taken by others. It is unthinkable that you should have a strike in the nursing profession. The nurses cannot down tools because of the very things about which the hon. Member spoke; it is such a human and important thing. You are taking advantage of the nobility of character that refuses to down tools by saying that their condition should not be improved. If they were able by the force of organisation to compel it, you would give it; you would find the money then. If it were a question of not having nursing services, because nurses would come only on their own terms, you would pay their terms. Why cannot we do from motives of decency what we 2461 would do if we were compelled? Why cannot we do it on the merits of the case? The financial aspect, I agree, has to be met. There is nothing that can be said to be of greater value than health, and, therefore, you ought to be prepared to pay for it.
The second argument is the want of accommodation. A great hospital like the North Middlesex Hospital, with 1,100 beds, makes the test a very good one. You get an enormous hospital like that able to make the change, and when the change was made, I do not think that there was any of the chaos of which the hon. Gentleman was afraid. I did not see any confusion. I did not realise to any great extent a reluctance on the part of the nurses to work the new conditions. I did not hear from any quarter that the system was not wanted, that the nursing profession itself was against it, arid that as a consequence of that decision it would not work. The medical superintendent took a secret ballot without anybody knowing and over 30 nurses decided in favour of it, and only one nurse was against it, in this case, because the incidence of the particular shift was rather awkward. If I were to speak here for far longer than I intend, I could not state the case in the way that it has been stated in a letter which reached me yesterday morning. In my Division there is a very big isolation hospital, and I received a letter signed by a sister and 60 nurses. The letter says:Dear Sir,We the undersigned staff of the North Eastern Hospital, St. Ann's Road, South Tottenham, venture to ask if you would kindly give us your wholehearted support when the charter for a 96-hour-fortnight for nurses is being introduced into the House of Commons on Friday, the 3rd December. Shorter working hours are urgently needed—and nobody ought to know that better than those who are doing it.and would be very much appreciated by all of us, and also be a great aid to recruitment.The hon. and gallant Member says just the oppositeas there is a steady decline in applications for the posts of probationary nurses. Should this Bill be passed In e would like to assure all Members of Parliament supporting it that they will be doing great service to the nursing profession, upon whose care so largely depends the health of the nation. In the event of any national emergency arising we would like to 2462 think that the nursing profession is not going to he depleted of its numbers, but that it will find us an A.1 army of volunteers ready to answer the call of duty, as a great many of us did during 1914–18.That letter comes straight from those who are affected. Is it not time to ask the opinions of those who are affected? I know that in hospital service the first consideration is the patient. Where can it he shown that the patient is going to be placed at a disadvantage by reducing the hours of the nurses? The hon. Member for St. Albans says that nurses are not engaged in production, at any rate only as maternity nurses. He says that they are not engaged in factory life, that they are engaged in dealing with human beings, and therefore you cannot get nurses to do their work in the same stereotype way as those engaged in production. Those of us who are interested in hospital work know that there are certain peak hours of work. It is not true to say that you have the same amount of work during the whole day. There is the same need for attention to duties, but there are certain peak hours. In a full complement ward, that is a ward with four nurses, we have three starting, say, at 7 o'clock in the morning and one starting at 8.30. As a consequence of that arrangement we do not get one shift finishing at a certain hour and another shift starting at that hour, but we get a complete consecutive circle right through the whole of the 24 hours. There has been no chaos or confusion. There has been proper attention to the reports from the sister on duty to the sister coming on duty, and there has been shown a greater efficiency in the work, greater care of the patients and an improvement all round.
It is a good thing when we are dealing with a question of this sort that we should pay attention to what has taken place and what can be done. What we ought to say is that we will not have the anomaly of one section being able to attract applicants from other sections, to their detriment, but that we will make the conditions general. That is the real answer to the hon. and gallant Member opposite. He is strongly supporting the voluntary system, and that is why he is afraid. The real opposition to the Bill comes from those who support the voluntary system. That cannot be because they think the principle of the Bill will do harm to the nurses.
§ Sir F. Fremantle
It would be equally impossible for the municipal hospitals to carry out this proposal at the present time, even if it were introduced.
§ Mr. Messer
The hon. Member did not prove that. I have proved that one great municipality can do it. Why cannot others?
§ Major Neven-Spence
Can the hon. Member prove that they could all do it at once? That is the whole point.
§ Mr. Messer
There is no reason why we should assume that it would be done all at once. Before a Bill of this description passes through its Committee stage such inquiries would have been made as would show what reservoir of service we have. We should then be able to tell what are the sources of supply. An enormous number of nurses go through our training schools and gain experience of midwifery and general nursing and become registered nurses, and then pass out of municipal and voluntary hospital life. An enormous number in this way are able to get that freedom of life to which they are entitled, and are able to get a higher rate of pay than they would get in municipal or voluntary hospital service. They are engaged by private nursing associations. Is it not remarkable that we may pay a nurse £100 a year and yet find difficulty in getting a supply? We may, therefore, have to go to a co-operative association, only co-operative in name, and pay that co-operative association three guineas per week for the nurses we take from them. We are compelled to pay more for the nurses we draw from the private associations than we pay to the nurses we have in our regular employment, because each of those nurses is a free agent. She is not subject to the same restrictions and has not to obey the discipline, sometimes a very harsh discipline, of a matron who has been trained in a very hard school.
There is another objection to the Bill—it has not been made this morning, but it exists—and that is the question of accommodation. There are some institutions that will need one-third additional staff if this Bill comes into operation. What are they going to do? Our nurses' home at the present time is filled to capacity. The tight hon. Member for Bow and Bromley (Mr. Lansbury) was right when he said, 2464 let' them live out. We do that. In the North Middlesex Hospital many of our nurses live out. They do not strap-hang. I do not know whether they cook their breakfast before they come, but they are entitled to a meal immediately they arrive, so that that does not matter very much. The hon. and gallant Member opposite referred to his own experience as a doctor, coming from Oxford to a hospital; but he knew that he would only stay at the hospital a comparatively short time, whereas the nurse has to live her life in the institution.
§ Sir F. Fremantle rose —
§ Mr. Deputy-Speaker (Captain Bourne)
I would point out that a considerable number of hon. Members wish to take part in the Debate, and every time there is an interruption it curtails the opportunities for hon. Members.
§ Mr. Messer
If I have misrepresented anything that the hon. and gallant Member said, I apologise. If there is a difficulty in regard to accommodation, surely it is the wise thing to let the nurses live out, providing that it is done under certain safeguards that will ensure their being able to get to duty in time. With that provision at our hospital we have found that the nurses have been able to enjoy ordinary normal life rather than the life of someone living in an institution, and there has been improvement in the service. I hope the House will give the Bill a Second Reading. The Committee points that have been used against it are not sufficiently worthy to justify our refusal of a Second Reading. There are points that can be made against the Bill, but we can improve it in Committee, and I ask the House to give it its chance by giving it a Second Reading.
§ 1.44 p.m.
§ Captain Cunningham-Reid
The last speaker has criticised my hon. Friend the Member for St. Albans (Sir F. Fremantle) because he has expressed certain views, and because he is a member of the Departmental Committee which is considering the whole question of the conditions under which nurses have to work. The hon. Member for St. Albans is going to express his views on that committee and I fail to see why he should not express the same views in this House, given this opportunity. I can see nothing improper in that. I think it 2465 is very much to his credit that he is prepared to come here and show that he has the strength of his convictions. I should have thought that those who criticise the hon. Member for St. Albans would have been only too pleased that he has expressed his views in this House, because they now know what his views are, and will have an opportunity of button-holing him in the Lobby and getting him to change them—an opportunity they would not have had in the ordinary course of events.
I should like to make it quite clear at the outset that I do not challenge the general principle of the Bill, and by the general principle I mean the 48-hour week for outside workers in hospitals and the 96-hour fortnight for indoor workers. I have every reason to believe that many of, if not all, the great voluntary hospitals as well as the hospitals and institutions which come directly under the jurisdiction of local authorities, have also the same end in view. I do not criticise the Bill because of its general principle. The reason I am opposing it is because it is impracticable and untimely. The Bill is singularly ill-timed. It endeavours to deal with only a small portion of the problems which the nursing profession has to face to-day. It has been pointed out already that a Departmental Committee is going into the whole of this sphere. it has a very comprehensive agenda and many more matters than those dealt with by the Bill are to be considered by it. The hon. Member for South Tottenham (Mr. Messer) overlooked the fact that many of the grievances he brought forward are to be dealt with by this Departmental Committee. It may be confidently assumed that the report of such a committee will be followed by the necessary Government legislation in this House. Yet in face of this sweeping Government inquiry and consequent legislation, the right hon. Member who has moved the Second Reading of the Bill and the seconder have thought fit to bring it forward although it deals with only a fringe of the problem. I should have thought, having been so fortunate as to get a place in the ballot, that they could have occupied their time far better in bringing forward legislation which does not overlap impending Government legislation.
§ Captain Cunningham-Reid
I think it stands to reason that if a Government Departmental Committee makes an inquiry legislation will follow. [HON. MEMBERS: "No !"] No doubt the Parliamentary Secretary to the Ministry of Health is in a better position to give an answer, but I certainly assume that such will be the case; anyhow, I am giving reasons why I consider the Bill is ill-timed. I should like to add, in parenthesis, that, although a Government Departmental Committee is investigating this problem, and such investigation is very welcome, nevertheless I regret that on the committee there are no women who are representative of the nursing organisations. There are four women on the committee, and I agree that two of them are very distinguished ladies, one the Chairman of the General Nursing Council and the other the Matron of the Middlesex Hospital, but there is not one woman on the committee who is directly representative of the various nursing organisations; and I think they should be considered. There is quite a number of such organisations, and, in fact, I believe one has a membership of over 30,000 State-registered nurses. I would ask the Parliamentary Secretary to make a note of this suggestion and ask the Minister even at this late hour whether such representation could not still be incorporated on the committee.
I have said that the Bill is impracticable as well as ill-timed. May I give the House reasons why I consider the Bill impracticable. I hope hon. Members will forgive me if I remind them that I represent the Harley Street district as well as many of the larger hospitals in London. Therefore, I have an opportunity of getting first-hand and reliable information on the subject. According to the estimates I have received, it appears that the immediate statutory enforcement of the 96-hour fortnight contemplated in the Bill must call for an in-unediate staff increase, and I understand that this increase would amount to anything up to 20 per cent. The hon. Member for Tottenham South, put it as high as one-third. But in the case of hospitals which come under the jurisdiction of local authorities we may assume that the question of cost is not of such importance as it is to voluntary hospitals. The cost in their case can be reflected in the rates, and I agree that hon. Members above the Gang- 2467 way are not always very concerned as to what the rates may be. But I would point out that the promoters of the Bill cannot overlook the immediate and insoluble problems of accommodation which would at once arise if the Bill became law.
The hon. Member for Tottenham South said that this difficulty could easily be dealt with, because it would mean that the nursing staff would live out. Let me point out two facts. First that with an increase of staff by one-third it would be very difficult to find sufficient and suitable accommodation outside the hospitals in the short space of time which is allowed under the Bill. The Bill, in fact, allows for no period of grace during which the unfortunate hospitals concerned would be. permitted to build the necessary 20 or 30 per cent. increase in their accommodation or to find the necessary accommodation elsewhere. If hon. Members will read Clause 1 they will see this provision:On and after the passing of this Act, no person employed on an outdoor staff of a hospital or institution under the control of a local authority, shall he required to work more than forty-eight hours in any one calendar week, except in cases of emergency. No person employed upon the indoor staff of a hospital or institution under the control of a local authority (other than a person employed in the capacity of a chief administrative officer) shall be required to work more than ninety-six hours in any fortnight, except in cases of emergency.Then there are penalties set out in Clause 4 which can amount to a maximum of £100 for each offence. The logic of the Measure certainly seems to imply that those responsible for the infliction of penalties must accept the existence of a semi-permanent state of emergency until the hospitals are in a position to provide or find the necessary accommodation, otherwise the whole of the Bill will look ludicrous. Hon. Members will under-stand that it would be impossible for the hospitals to immediately make provision for the necessary accommodation, or to find the necessary fines stipulated under the Bill. It is all they can do at the present time to find sufficient funds to run their own affairs. Therefore, I feel that this is one of the insoluble problems which directly arise from the Bill, and that makes it impossible for me to believe that the promoters have realised the full implications of the Bill.
2468 I repeat that the principle of the 40-hour week or the 96-hour fortnight is generally accepted, and I think it is a reform that is bound to come sooner or later. The principle is certainly accepted by me, but I feel that the reform should be brought about gradually, so as to give the hospitals a chance of providing for the necessary accommodation and also of providing for the necessary costs, which must be considered. An inquiry has been set up which at this time is going carefully into a far wider field than was touched upon by the Mover and Seconder of the Bill. Consequently, I feel that we should wait and see what is the result of that inquiry. I believe that the Bill introduced at this moment is not only ill-conceived, but that in the way it has been introduced it is also indigestible.
§ 1.57 p.m.
§ Mr. R. Acland
I wish to deal seriously with the question whether the hon. Member for St. Albans (Sir F. Fremantle) ought not to resign from the Committee. I do not wish to put the matter strongly, although I feel strongly on it. I wish to put it quite moderately and in a way which I think will appeal to the hon. Member. The usefulness of the report of the Committee will depend upon the committee receiving the confidence of the public which reads the report. I am well aware that it is possible for people, even when they hold strong views, as the hon. Member does on this question and as I do on, say, the Government's foreign policy, to divest themselves of their prejudices when they want to do so; but would the hon. Member have any confidence whatever in the report of a committee to investigate the Government's foreign policy which was presided over by me? Of course he would not, because he knows what are my views.
I think I could make myself quite impartial, and I am sure that the hon. Member thinks that he could make himself quite impartial, and I am prepared to believe that; but if he will consider what his feeling would be if I were on a committee examining the Government's foreign policy, I am sure he will see that after the speech which he has made, although he believes he can divest himself of his prejudice, there can be no public confidence in the report of the committee, of which he is, no doubt, a very active member. Anybody who reads the 2469 hon. Member's speech, and who does not know the power of the hon. Member to put away his preconceived ideas, will say that he is a man who will judge every single question by the one criterion, "Can the voluntary hospital afford it?".
§ Sir F. Fremantle indicated dissent.
§ Mr. Acland
It is not the only one. I wish now to comment briefly upon two matters arising out of the hon. Member's speech. He spoke of public opinion compelling the adoption of right standards. How many decades after 1840 should we have had to wait until public opinion got women out of the coal mines? It had to be done by an Act of Parliament. We hear the same old argument brought up over and over again. There was another point to which the hon. Member directed attention. While the hon. Member was speaking, I was asking myself the question whether voluntary hospitals should be abolished or not, and I was asking myself whether his speech was not a very strong argument against voluntary hospitals. I am sorry to say that my head was nodding affirmatively in reply to the question that I asked myself, for the whole of his speech was showing that the voluntary hospitals are preventing the introduction of what my hon. Friends want.
Let me now deal with the Amendment. It says that an inquiry is sitting, and that that must prevent our taking a decision, and that the inquiry may recommend all sorts of things. I am sorry that the hon. Member told us that the Committee is to investigate only the details. I think that is a great pity. He said that he had not made up his mind on the details, as though it were only the details that were to come before the committee. If the committee is to do its job and is to issue a report that will be the foundation for the system of hospital management and the terms of service for nurses, if it is to accomplish what everybody wants to accomplish, namely to attract young entrants of the best type into the hospitals, is it not certain that it must recommend, among other things, a 48-hour week or a 96-hour fortnight, and would not the House reject its recommendations 2470 if it recommended anything else? Therefore, if we passed this Bill, with Amendments such as would be suggested in the Committee stage, we should be doing something which could not run contrary to the departmental committee.
I have been impressed by the argument from hon. Members opposite to the effect that the sudden application of this reform would be accompanied by very grave inconveniences and possibly by prejudices to the services of the hospitals. For that reason, they say that there ought to be a delay. I have been impressed by that argument, but I should have been more impressed if I had not heard the same argument used over and over again from the benches opposite, so that I have almost come to believe that the argument is used for the sake of getting a delay. I feel that the more because I happened by chance to come across an interesting document of which I had read one-third before I knew what it was. Then, although I knew it was an indiscretion, I could not restrain myself from reading the whole of it. The document that was in my hands for a few moments was none other than the rubber stamp document which the Government Whips keep in their office and hand to hon. Members opposite, with various blanks in it which have to be filled in, so as to make it appropriate for use as an Amendment to any and every private Member's Bill moved from this side of the House. I had not got it in my possession long enough to commit it thoroughly to memory, so that there may be mistakes in the version which I am about to read. It is as follows:That this House, while deeply sympathetic to the needs of… thanks the Government for its policy directed towards the increase of… and is of opinion that this matter is best left to direct negotiations between the employers and employés concerned, that pending the report of the commission now investigating the whole question of…is of opinion that it would be premature for this House to consider compulsory legislation dealing with. …We have had that Amendment to private Members' Motions and Bills so often that I am beginning to doubt its sincerity.
§ Mr. Acland
I was not in the House then. Therefore, I question the complete sincerity of hon. Members opposite who 2471 ask for delay, and I make a suggestion, which was also made by the right hon. Gentleman the Member for Bow and Bromley (Mr. Lansbury). I have not consulted those who are responsible for the Bill, but I suggest that, on the terms that the Bill receives a Second Reading to-day, they should agree to postponing its operations until 1939 or 1940 or even 1941. That is a Committee point. If the promotors of the Bill agree that it should not be put into effect until a date such as 1940, will hon. Members opposite vote for the Bill? [HON. MEMBERS: "No."] Is not that an exposure of the hollowness of their professions this morning? They say that they are only too anxious to get on with this great reform. They say that they want to institute a 40-hour week but, they add, "Give us time." My reply to them is "Pass this Bill now and then take whatever time you want." If the Bill is passed now the matter will still be in the hands of the party opposite. Hon. Members on this side will not be able to force on hon. Members opposite the date 1940 for the coming into operation of the Bill, if 1941 is the practicable date.
Surely, the course which I suggest would avoid the dilemma suggested by hon. Members opposite. They all appear to agree that it would be a very nice thing to get these improved conditions in the nursing service but, they say there are not enough nurses. Then we are told that there are not enough nurses because there are not improved condition. What, then, do we propose to do about that? Are we to do nothing? Are we to say every time it is proposed to improve conditions: "Unfortunately the conditions are so bad, that we have not enough nurses to enable us to improve the conditions"? Is not my suggestion an effective way out of the difficulty, namely, to give nurses and potential recruits to the nursing profession, a Parliamentary guarantee that conditions will be improved in 1940 or 1941, whichever year is considered practicable, and then to set out on a recruiting campaign? I support the Second Reading of the Bill.
§ 2.9 p.m.
§ Commander Sir Archibald Southby
Owing to a mistake on the part of the Clerks at the Table my name appeared 2472 attached to the Amendment which has been moved from this side of the House. All hon. Members will agree with me that it is very seldom that our friends the Clerks at the Table make a mistake but on this particular occasion I put in an Amendment in relation to another Bill, and by mistake it was transferred to this Bill. [HON. MEMBERS: "Write more plainly."] It was not due to my handwriting, because it was in typescript. I find myself in general agreement with the provisions of the Bill and certainly with the objects of the Bill, but I would prefer a Government Measure which dealt comprehensively with the whole nursing profession. I believe that profession requires complete reorganisation not only as regards hours and salaries, but also as regards other matters. Nursing is not so much a profession as a calling, and we ought to do everything we can to lighten the labours of those who have taken up that arduous, difficult and trying calling, which is nowhere more arduous, difficult and trying than in the great hospitals where the mentally unsound are treated.
I regard all piecemeal legislation as bad, and I do not believe that this Bill goes far enough. The whole question of the present position of the nursing service requires investigation. The conditions of service, not only in hospitals and institutions conducted by public authorities, but in those which are maintained by voluntary subscription, ought to he enquired into. If there was not at the present time a committee sitting to inquire into these matters, I should he inclined to vote for the Second Reading of this Bill although there are points in it which, as the right hon. Gentleman the Member for Bow and Bromley (Mr. Lansbury) has said, call for amendment in Committee. But if the whole question is under consideration by a committee of inquiry, I cannot think that it is right to pass piecemeal legislation of this kind lest its passage should in some way prejudice the work of the committee. In passing, may I say that I regret the fact that there are not more members of the great nursing profession itself on that committee?
§ Sir Edward Campbell
May I be allowed to inform my hon. and gallant Friend that they can appear as witnesses before the committee and in that way 2473 they can press their views, perhaps even more readily than if they were members of the committee?
§ Sir A. Southby
I agree that they can appear as witnesses, but I do not think that meets the case. When the committee is inquiring into the disabilities which we all know to exist in the profession, I think, in fairness, the profession itself should have had more representatives on the committee. I appeal to the promotors to withdraw this Bill so that a comprehensive Measure which would have the support of every Member of the House can be introduced. This Debate has conclusively proved that there is not a Member on either side who it not anxious to improve the salaries, hours and general conditions of nurses and make the profession attractive. While there is much in the Bill that I would like to support, I feel that I cannot vote for it, but I do not intend to vote against it.
§ 2.13 p.m.
§ Mr. Short
I was impressed by the arguments of the Mover and Seconder of the Motion and the clarity with which they were presented to the House. But I was revolted by the lack of argument and the failure to present a case evident in the speeches of the Mover and Seconder of the Amendment. They produced no argurnent whatever against the case in favour of the Bill. I certainly came to the conclusion when listening to the Seconder of the Amendment that had we introduced a Bill for levelling up the hours to 80 per week instead of reducing them to 48 per week, we should have had his support. But the most astonishing, scandalous and outrageous speech delivered was that of the hon. Member for St. Albans (Sir F. Fremantle). I am sorry that he is no longer in his place, because it is desirable, and indeed essential, that we should make clear to him, having regard to the trend of his utterance to-day, the arguments which he advanced and the case which he presented, that we have no confidence in him as a member of the Departmental Committee, and as long as he sits on that committee the Opposition will have no regard for the report of the committee. In my judgment the hon. Member has offended all Ole canons of decency as a member of a Departmental Committee which has held only one meeting, and if he has not the wisdom and the sense to resign, I say without hesitation that we 2474 shall look to the Minister of Health, who appointed this Departmental Committee, to take the requisite action.
I speak with some strength upon the matter, but I am echoing the sentiments of Members of my party, and I hope those sentiments will be noted. This Bill is so good, as I have learned during this Debate, that if the principles of it were adopted there would be no nurses for voluntary hospitals; they would leave the voluntary hospitals. I am not surprised that that would be the case, because the conditions prevailing in the voluntary hospitals are very bad indeed, particularly from the point of view of hours. The hon. Member for St. Albans referred to the wonderful and magnificent spirit and the nobility of character of the nurses. That spirit has been traded on all through their lives; their willingness to serve and their self-sacrifice have been exploited in every direction. The hon. Member also referred to the undesirability of dictatorial action. What are we here for? What is the policy, what is the attitude of Parliament? Are we not every day interfering, passing legislation, compelling people to do something which they will not do of their own accord in the social interests of the community?
It is time that the excessive hours of labour of nurses were dealt with. They are no credit to us or to the medical profession, and they are a discredit to the attitude of the public at large. In some cases nurses are working 80 hours a week. I ask how any woman or girl, never mind what her skill or training may be, can render efficient service and possess the alertness of mind necessary for the performance of her duty, if she is working as much as 80 hours per week? It is suggested that the nurses do not desire this reform. I have here a statement made by the Matron of the Doncaster Infirmary, a woman competent to express an opinnion upon a matter of this kind. It is reported in the "Yorkshire Post" of 1st December; so it is quite recent and up to date:Miss Duesbury, the Matron at Doncaster Infirmary, said she wanted better conditions for the nurses, including a day off every week. In view of what Mr. Hanson had said she felt she must tell her side of the story. The T.U.C. were trying to get nurses to join a union to obtain a 96 hours fortnight. Nurses have their own professional organisation in the College of Nursing, which was equal to 2475 the Medical Association. This organisation fully realised that the conditions of service were appalling.Miss Duesbury said that her night nurses worked 77 hours a week, and day nurses 63 hours. She had been trying to get these hours reduced for two or three years. If some hospitals could do it, others could. Nurses wanted shorter hours and less work. It would mean extra expense and extra buildings. Why should they work six-and-a-half days out of seven? No one else did it. Even the night porter had a night off a week, yet night nurses had only one night off a month.That statement, in itself, convinces me of the need for a Bill of this kind. If we establish by Statute a 48-hours week for the outdoor staff and a 96-hours fortnight for the indoor staff, that will have a splendid moral effect in the country. Voluntary hospitals will have to review the conditions under which they live and maintain themselves. They will be compelled to bring their conditions of labour into conformity with the statutory provisions of this Bill, which will prevail in the case of local authorities. There will be a corresponding improvement in the health and welfare of the nurses. Patients will have better and more consistent attention, and we shall be free from the odium and criticism that the nurses are working deplorably long hours.
§ 2.23 p.m.
§ Mr. Storey
The whole House, particularly those of us who have spent a long time working for voluntary hospitals, will agree with hon. and right hon. Gentlemen opposite regarding the objects of this Bill and the wish to improve the lot of the nurses. We have to admit that in the past conditions have not been satisfactory. The work has been hard, the hours long and the pay low, and little provision has been made for old age. But we have also to admit that in the last few years much has been done to shorten the hours, to provide decent hostels for nurses to live in, and to provide superannuation for old age. But a great deal more has still to be done if we are to establish nursing as a profession with good conditions. The only thing between me and the hon. Gentlemen opposite is as to the method by which we shall proceed, whether we shall proceed by legislation or by reform from within. Personally, I prefer the latter method, for I feel that if we are to enforce better conditions by legislation, we shall be emphasising the personal rights of the 2476 staff and getting away from that vocational ideal of nursing, which is to place the patient first.
Great credit, I think, is due to the College of Nursing in that they do so much to stress the vocational ideal of nursing and to encourage their members to put the patient always first. But if we are to encourage such an ideal, it places very great responsibility upon the managements of the hospitals and calls for their active co-operation in reforms. If a nurse is to regard her work as a vocation, she must be given that feeling of security that will enable her to apply her whole mind to the work, knowing that she can rely on adequate periods of rest, adequate conditions under which to live, and adequate provision for her old age. If she has no such security, the vocational ideal will fail. and personal rights and hours will be put first. If such were to happen, I think nursing would lose much of that spirit of service, and, in losing that, would lose the very special position which it holds among the people of this country. That view is held by the College of Nursing. The hon. Member for Doncaster (Mr. Short) spoke well of the College of Nursing and said that they held that conditions were appalling, but he did not go on to tell us that the College of Nursing oppose such legislation as is proposed to-day.
§ Mr. Storey
I am sorry if I misunderstood the hon. Gentleman. I think I am right in saying that the College of Nursing, who after all represent some 29,000 generally trained nurses, do look upon such legislation as this as harmful to their profession. The College was formed for securing better educational and economic conditions for nurses. They are strongly in favour of a reduction of hours, yet they have placed it on record that in their opinion it is in the interests neither of the nurses nor of the patients to compel standard hours of work by legislation. They state that experience has proved that such questions are best discussed between their professional organisations and those responsible for the welfare of the sick. Particularly do they condemn the proposal in the Bill that 2477 there shall be extra pay for extra time, because they submit that it tends to lower the standards of nursing and the tradition which has been the pride of British nursing in the past.
When such an authoritative body holds such opinions as these, I think this House may well hesitate to step in, particularly if we feel that progress is being made with reforms, and I submit that progress is being made. The right hon. Gentleman, in moving the Second Reading of the Bill, admitted that progress was being made in many ways in reforming the lot of nurses. Hours have been shortened, better homes and hostels are being provided, and superannuation is becoming more general. But difficulties do exist. There will have to be provision for extra nurses, there will have to be accommodation for them, and surely, when these difficulties are considered, there is all the snore reason for encouraging reforms from within instead of trying to impose rigid hours upon the nursing profession by legislation. The hon. Member who seconded the Motion for the Second Reading told us that if adjustment was not made soon, the whole system would break down, but surely if we hasten to impose rigid conditions by legislation the system is much more likely to break clown under the strain.
I am aware that this Bill applies only to local authorities' hospitals, but much has been said about how it will affect the voluntary hospitals. In fact, the hon. Member for South Tottenham (Mr. Messer) suggested that the main opposition came from the voluntary hospitals. That is not the case. The voluntary hospitals are definite in their support of the College of Nursing in improving conditions, they are giving active support to the College in their work for betterment, and they are determined to proceed as quickly as possible, considering all the practical difficulties, with the reduction of hours. For example, at Bradford a new nurses' hostel is being built, so that the staff can be increased and the hours of the nurses reduced; at my own hospital, the hospital in which I am interested, we are shortly to start building a large nurses' home, with the help of the Commissioner for the Special Areas, which will again enable us to increase our staff and to reduce hours; the Herefordshire and Gloucestershire Regional Committee report that hospitals are making every effort in their area to 2478 reduce hours, both day and night; the West Kent Regional Council recommend all hospitals to reduce hours without delay and to adopt the 96 hours a fortnight for which this Bill calls; and the Eastern Regional District have agreed to the principle of the 96-hours fortnight and declared their intention gradually to introduce such measures.
When such reports come from the various regions where voluntary hospital work is carried out, I think we can claim that the voluntary hospitals are alive to this problem and ready to do their share. I therefore hope the House will not pass legislation which is bound to cause dislocation but will rather encourage the hospitals and the professional organisations to co-operate in order to raise the nurses' status on the basis of service to the patient coupled with security to the nursing profession.
§ 2.32 p.m.
§ Mr. McEntee
I should like to ask the hon. Member for Sunderland (Mr. Storey), who it was who passed the resolution to which he made reference? Was it a resolution passed by a governing body or an executive body, or was it a resolution passed by the branches or the ordinary meetings of the 29,000 nurses to whom he made reference? I cannot believe that the 29,000 nurses who are associated with the College of Nursing or indeed that any majority of them would be prepared to say that they would object to this House passing this Bill. I do not believe it.
§ Mr. Storey
The hon. Member has asked me a question. I have in my hand a letter from the Secretary of the College of Nursing, which states:While appreciating the good intentions of the sponsors of the Bill, which seeks to attain such ends through legislation, the Council of the College considers it neither in the interests of the nursing profession nor of the British public to compel a standard of hours of duty by rigid legislation
§ Mr. McEntee
The Council of the College. I thought so, but I venture to say that the members of the College of Nursing would not agree to that. I am quite sure they would not, and I think the members of the College, when they have read this Debate to-day, will have something to say with regard to the state ment which has been made. I am very glad to see the hon. Member for St. Albans (Sir F. Fremantle) back in his 2479 place, because I am going to make a suggestion to him that I think will meet with the approval of many of the Members who have spoken, on both sides of the House. It has been suggested that the Departmental Committee which is to make this inquiry ought to have more working nurses on it. That view seems to have fairly general approval in the House. The Government might take note of that expression of opinion, and, in view of the very prejudiced statements that have been made by the hon. Member for St. Albans, he would be doing a service to the committee and to the nurses if he were to resign his position on the committee so as to enable at least one more working nurse to serve. The hon. Member talked as if an eight-hour day were part of the Bill. He has evidently not taken the trouble to read the Bill which he so freely criticises. There is nothing in it that limits the day to eight hours. It lays down a 48-hour week or a 96-hour fortnight, and that if these hours are exceeded the people should be paid for it. The number of hours recommended in the report from which the hon. Gentleman quoted was not exceeding 56 hours, and the logic of that is that if they worked 13¼ hours one day they would work fewer hours on another day, so that the total hours for one week did not exceed 56.
§ Sir. F. Fremantle
The actual proposal was that the night work should not exceed 13 hours. For day duty there was no amount laid down, but for night duty the report says the hours should not exceed 56 in any week. That is the Commission's report which the hon. Member for Brightside (Mr. Marshall) said was the most up-to-date and comprehensive report.
§ Mr. McEntee
I am not really very much concerned with what they said. prefer to look at the question from the point of view of ordinary common decency, and would any Member say that on night duty, except on rare occasions, any man or woman should work 13¾ hours? It is wrong, and everybody 2480 knows it to be wrong. Will anyone say that 48 hours is not a reasonable week for women in the nursing profession? If anything, it is too long. We are merely asking that they should have a standard 48-hour week and that if they are compelled by emergency to work longer hours, they should be paid extra. No one has said that that is unreasonable. What are the arguments put against it? I listened carefully to the hon. and learned Member for North Edinburgh (Mr. Erskine Hill), and his case was that a measure ought to be comprehensive and ought to be gradual in its operation. Is it not true that the legislation passed in this House is always partial and progressive rather than comprehensive? We know that this Bill is partial and does not cover the whole field of nursing. Is it to be said that because we cannot do at once all that we believe to be necessary for the wellbeing of the nursing profession, we should do nothing? That appears to be the logic of the hon. Member's argument.
§ Mr. Erskine Hill
The argument I endeavoured to make was that we wanted something done as soon as possible, but that nothing effective could be done without this further inquiry.
§ Mr. McEntee
The other point made by the hon. Member was that it should be gradual. The question is how gradual should it be. Nurses have been waiting for years for this improvement, and we say the time has arrived when Parliament should step in and do something humane for them. It must be remembered that nurses have study to do in addition to their long hours of work. A person who is working long hours is not in a fit mental condition to study and from that point of view shorter hours are necessary and ought to be put into operation as soon as possible.
The only argument that has appealed to me is that the Bill should be deferred for a reasonable time because, if it were put into operation immediately, it might create unsatisfactory conditions in the management of hospitals. It is for the Committee of the House to say that, because of the effect the passing of the Bill might have, it should not be put into operation at once. The longest period for which it ought to be deferred is the period which will be necessary for the 2481 training of the new entrants who would come into the profession as a consequence of the passing of the Bill. If that is the view of the House, it could be embodied in the Bill on the Committee stage. Everybody agrees that a nurse or anybody else who works excessive hours deteriorates in efficiency. As the seconder of the Amendment said, the primary consideration is the patient. Is it not necessary, therefore, that the nurse who looks after the patient should be in a fit and proficient state? Can a nurse be in a fit state and proficient if she has to work the excessive hours that prevail to-clay? All the arguments are in favour of the shortening of the hours as early as possible.
One argument I have not heard is that based on national necessity and defence. We have heard a good deal about national Defence and the preparations to be made to defend us in time of war. Is there anything more necessary than a full and an efficient staff of nurses? All the evidence to-day goes to show that our nursing staff is not as proficient as it ought to be—I do not say that it is generally inefficient, but it is not as efficient as it might be—and that numerically it is not as strong as it ought to be. It has been admitted by pratically every speaker that the reason for the falling-off in the numbers of those who go into the nursing profession is the long hours they have to work and the lack of opportunities for recreation and for leisure. From every point of view a case has been made out for the immediate passing of a Bill such as this, even if it has to be amended as regards the time at which it shall come into operation.
The local authority on which I serve have two hospitals under their control. They are not at the present time operating the 48-hour week wholly but are endeavouring to bring it into operation. They found themselves up against the difficulties which some Members have spoken of as being pretty general, and have found it necessary to operate the system gradually, but all the maids and the general body of others who look after the cleanliness of the hospitals have the 48-hour week, and some of the nurses too, and within a short time I hope all of them will have the shorter week. If hon. Members opposite are genuine in their statements that they are in favour of the shorter working week for nurses 2482 let them give this Bill a Second Reading, and if the necessity for introducing this reform gradually is the only reasonable objection which they have to the Bill then let gradualness be considered in Committee and let the Bill be amended so that it will not come into operation until it can operate with effect.
§ 2.48 p.m.
§ Mr. Lipson
I rise to support the Bill, and I hope that the fact that I sit on this side of the House will not make my support less welcome to hon. Members opposite. If they think it a good thing that a Member on one side of the House should be able to exercise impartial and fair judgment upon proposals which emanate from the opposite side I hope that when reasonable and just proposals are put forward from this side, as they very often are, hon. Members opposite will act likewise. I speak with some experience of hospital administration. For over 10 years I have been chairman of the committee of visitors of two mental hospitals with more than 1,300 patients, and in that and other capacities I am quite prepared to face the obligations which this Bill would impose upon the committees of which I am a member. I want to associate myself with what has been said from various quarters of the House in praise of the speech of the right hon. Member who introduced this Bill. I think he would be the first to admit that while he has found powerful support in the speeches of those who favour the Bill, perhaps some of the best arguments in its favour have come from those who have opposed it, and I should like to deal with one or two of those.
The hon. and learned Member who moved the Amendment had this complaint against the Bill: that it did not go far enough, that it was not sufficiently comprehensive, that it did not deal with all the grievances from which workers in hospitals suffer. It is a strange argument to be used by a Member on this side of the House, that a Bill does not deal with everything and that it does not go far enough. At the same time he suggested that the result of passing this Bill would be to produce chaos. Apparently he would support a Bill which went very much further, and I imagine that his Bill would produce confusion worse confounded.
§ Mr. Erskine Hill
I did try to point out that, although this Bill would produce chaos, when the matter had been fully considered a Bill could be brought in which would be more gradual in its processes, and obviously would avoid the chaos which the hon. Member charges me with saying would be likely to take place.
§ Mr. Lipson
I think the criticism of the hon. and learned Member that the Bill would be too sudden in its action has been met by Members who have said that they would support in Committee Amendments to delay for a reasonable period the application of this Bill. I think that is a sufficient answer. We are also told that we ought to oppose this Bill because it does not apply to those who serve in voluntary hospitals. We all know why the voluntary hospitals have been left out of the Bill. It is not because we do not want the conditions of those who serve there to be improved at the same time, but we realise that those hospitals are not in a position at present to meet financially the obligations which the Bill would impose upon them. If the Bill were applied in the first case to the hospitals under local authorities there would be the opportunity of seeing how the system worked there, and the voluntary hospitals would have time in which to make arrangements.
It has been suggested that this might entail some form of Government subsidy to enable voluntary hospitals to be ready for the time when they also would come under the terms of the Bill. So far as the expense to hospitals is concerned, it is not an impossible burden which we are proposing to impose upon them, and in any case I believe that some part of the burden might easily be met if the Minister of Agriculture and the Minister of Health would arrange between them that milk should be supplied to hospitals at least as cheaply as it is supplied to manufacturers. That would go a very long way towards meeting the expense of this reform. The truth is that there is no case against this Bill except a bad case. We were told by the hon. and learned Member who moved the Amendment that a tired nurse is a bad nurse. Could there be a better argument in favour of this Bill? We were told that it is not in the best interests of the nurses that this Bill should be passed. Why is it not in their best interests? We 2484 who support the Bill maintain that it is not only in the interests of the nurses that it should be passed, but also in the interests of the patients, because we realise that if we continue to impose an impossible burden on nurses we make it more difficult for them to carry out their important functions. It is in the interests of the nurses and the patients that we ask for this Bill. In moving the Amendment, the hon. and learned Gentleman said that he would support another Bill ere long. When I hear arguments of that kind I am reminded of the words in "Alice in Wonderland":Jam to-morrow and jam yesterday—but never jam to-day.If the proposals of the Bill are reasonable, I suggest strongly that we should not be deterred by the difficulties, largely imaginary, which have been advanced by the opponents of the Bill, but that we should give to the nurses in our hospitals the reasonable working hours which they deserve, and for which they have been waiting so long.
Another argument against the Bill is that it applies to the hospitals the standard of the factory. Is it suggested that you should have a better standard of conditions in a factory than in the great hospital services? I remind opponents of the Bill that a human being is a human being, whether working in a factory or in a hospital. If you set up a reasonable standard for a factory it is right that you should apply that standard to a hospital. There is nothing sudden or revolutionary in the proposal; it simply follows the traditional practice of English custom and legislation in other matters. Some hospitals have already led the way, and the suggestion of the Bill is that you should compel backward hospitals to apply the principle which more advanced hospitals have found practicable and possible. Difficult as the problem is for voluntary hospitals, I am glad to know that one has led the way in this matter, and, as a Jew, I am particularly proud that that hospital should be the Jewish Hospital in Manchester. If the world is not yet ready for the law to come forth from Zion, I hope, at any rate, that this law will go forth from Manchester.
The only objection that can be raised against the Bill is on the ground of cost. I submit that the amount of money involved is comparatively trifling. Let us 2485 realise that as long as this urgent and necessary reform is delayed somebody is paying the price for it, and that the price is being paid by the nurses. I would remind hon. Members, also that the hours of nurses are not limited to those spent in the hospitals; examinations have to be passed, and a good deal of time is spent upon them. I support the Bill as an urgent and necessary' measure of reform. We have been told by its opponents that they have every sympathy with its principles. My answer is that sympathy is not enough. What is required is action, and action is promised in the Bill. I, therefore, ask hon. Members to pass the Bill.
§ 2.59 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Bernays)
I intervene for a few moments, not to attempt to wind up the Debate but, for the convenience of the House, to indicate the attitude of the Government towards the Bill. We should all like to congratulate the right hon. Gentleman the Member for West Bromwich (Mr. F. O. Roberts) upon his success in the Ballot and the magnificent use to which he has put that success to-day. With the main object of the Bill every Member of the House is in sympathy. I do not think there was any particular reason for my hon. Friend the Member for Cheltenham (Mr. Lipson) to remind us that a nurse is a human being. Every speech from every part of the House has indicated our desire to do all that we can to help the nursing profession. We all realise the immense services rendered to the community by nurses, and all desire that those services shall be performed in the best possible conditions.
It is natural that the length of time during which nurses are, in some cases, on duty should give cause for anxiety, and produce the demand that the working time should be revised. It is indisputable that the working conditions of many nurses are not satisfactory. What is the situation with regard to hours? It is clear that the practice is unequal. Some local authorities have adopted a three-shift system for nurses and, in some, for example, Middlesex, a 48-hour week is actually working. The majority have been unable to tie their hands, and are working longer hours generally, and on night duty much longer. The "Lancet" 2486 Commission reported that in 50 per cent. of the hospitals the hours were from 55 to 60 per week, and in 7 per cent. the hours of work were more than 65 per week. That is a situation which clearly calls for serious and searching examination.
How does the right hon. Gentleman propose to deal with it in his Bill? The Bill provides for a 48-hour week or a 96-hour fortnight for employés of local authorities engaged in or about hospitals and mental institutions, except in case of emergency; such emergency overtime is to be paid for at special rates; there is to be a weekly day of rest, and there are penalties for contravention. Everyone concerned in and about these institutions, indoor and outdoor, is covered, but the Bill does not apply to voluntary institutions. The hon. Member for Everton (Mr. Kirby) explained, when a similar Bill was promoted last Session:We realise the difficulties that a Bill of this sort might bring to those organisations." —[OFFICIAL. REPORT, 14th April, 1937; col. 1014, Vol. 322.]The House must make up its mind how it is to vote on the Bill, and my task is only to indicate the attitude of the Government. Questions were put by my hon. and learned Friend the Member for North Edinburgh (Mr. Erskine Hill) very important questions, but we had not yet had answers from the party opposite. The first of them is: Have local authorities been consulted upon the Bill?
Though the Bill deals with local authority institutions, the associations of local authorities have not been consulted, nor have they considered the provisions of the Bill. In the mind of the Government that is an important objection to the Bill. The London County Council employs, I am informed, as many as 11,000 nurses, but the London County Council has not been asked for its views. All these bodies are known to have been interesting themselves in the general question of recruitment and maintenance of satisfactory nursing staffs.
§ Sir Henry Fildes
Why did not the hon. Gentleman's Department inquire of the London County Council when this Bill was known to be going forward?
§ Mr. Bernays
The Government are not responsible for the Bill, and it was not for us to make inquiries but for those who are promoting the Bill. I am stating 2487 the attitude of the Ministry of Health on this whole question.
§ Mr. F. O. Roberts
May I ask whether the hon. Gentleman has seen any objections from those authorities? We have had none, and, consequently, we accept that as approval.
§ Mr. Bernays
Yes. I will deal with that later. The problem with which the local authorities are faced at the present time, in staffing their hospitals with nurses, is principally that of remedying the shortage of recruits. The immediate imposition of a 48-hour week, as it is phrased in the Bill:On and after the passing of this Act,could not but increase that shortage at the moment. I think that that is obvious. The hon. Member for South Tottenham (Mr. Messer) said, I think, that one-third as many nurses again would be required—
§ Mr. Messer
That was in the case of those hospitals which already worked their nurses up to 80 hours a week. Obviously, it would not need as many as one-third for the more reasonable ones. If I may quote the instance of the Middlesex County Council, less than 15 per cent. were required.
§ Mr. Bernays
At any rate, a substantial number would be required, and it appears that the immediate effect must be a substantial accentuation of the existing shortage. I think it is obvious, too, that the adjustment of supply to demand must be a gradual one. To ensure the supply we have not merely to consider the question of hours, but other means of making the profession as attractive as possible, including training and education. Hence the Committee of Inquiry that has recently been set up. My right hon. Friend has set up a very strong Committee of Inquiry, which includes representatives of every party, and its terms of reference are as wide as they could be made. They are:To inquire into the arrangements at present in operation with regard to the recruitment, training, registration, and terms 2488 and conditions of service of persons engaged in nursing the sick, and to report whether any changes in those arrangements or any other measures are expedient for the purpose of maintaining an adequate service, both for institutional and for domiciliary nursing.Those are very wide terms of reference. I was asked by the right hon. Gentleman the Member for West Bromwich, by the hon. Member for South Tottenham, and by other hon. Members, why is such an inquiry needed. I think the answer is a simple one. The nurses themselves wanted this inquiry. They did not, when they came as a deputation to my right hon. Friend, I think in 1935, propose immediate legislation, and the decision to institute this inquiry followed strong expressions of opinion from the College of Nursing and other bodies that such an inquiry was urgently needed.
The need for this inquiry arose primarily out of the increasing difficulty experienced by hospital authorities in securing an adequate number of recruits for their nursing staffs. The position as regards the shortage of nurses has recently grown more acute. The "Lancet" report has been quoted, but, since that report was published, owing to the rapid development of hospital services by local authorities in many part of the country, the difficulty has become still greater. Moreover, that Commission was limited by its terms of reference to the consideration of the existing shortage, but the terms of reference of the new Committee are on a broader basis, and will enable a review to be made of the probable developments and requirements of the nursing service in the future. The committee are also charged with the important duty, which fell outside the findings of the "Lancet" Commission, to inquire into the many other fundamental questions, besides hours of labour, which militate against the adequate recruitment of nurses. The terms of reference of this Committee cover all the points at issue in the Bill, and more as well; and I suggest that it would be stultifying ourselves and embarrassing to the committee in the full consideration of the questions at issue if the present Bill were proceeded with. I would further point out that it is not a question of the Government proposing to set up a committee. The committee has already been set up; and it had its first meeting, I think, yesterday. A point was raised with regard to the constitution 2489 of the committee, and it was argued that there were no representatives on this committee of the associations of nurses. There are two answers to that: first, that the associations of nurses will have the fullest opportunity of giving evidence, and, secondly, that the committee does, in fact, include a lady who is a working nurse.
This procedure, of inquiry first and legislation afterwards, is, after all, very familiar to the House. It is constantly being employed in the Ministry of Health in regard to legislation. A committee on rural housing has resulted in the decision that legislation will be introduced next Spring. We have had a committee on the superannuation of local government officers, and legislation was introduced and passed last summer. Every Rent Restriction Bill has been preceded by a committee. And that is the procedure we are proposing to adopt in regard to the problem of nurses. I believe that that procedure is adopted by every party —investigation first and action afterwards. I believe that if hon. and right hon. Gentlemen opposite were sitting on these Benches today their spokesman would be making a similar speech to that which I am trying to make in a similar situation.
When I ask the House to reject the Bill, it is not because the Government are not in sympathy with the objects the promoters have in mind, but because the Government feel that they are adopting a more practical way of achieving those objects. We want to do the best we can for the nursing profession, which has, in a high degree, as its inspiration, service and not self. Every branch of the health services, whether concerned with infant welfare or with health visiting or with the patient expert labours in the wards of our great hospitals, depends in a high degree for its success on the skill, discipline, courage, and consecrated commonsense of the people engaged in it. I suggest that it is in the interests of the profession itself and the people for whom it ministers that there should be no question of party politics, if it can possibly be avoided, in any Measure brought forward to improve the condition of nurses. They serve the community irrespective of party, and the House of Commons, as a Council of State and not a battleground of party, must see that they receive justice.
2490 It was with that idea that my right hon. Friend appointed this committee. When this committee has reported and we consider the facts laid before it, it is earnestly to be hoped that the legislation which may be introduced to deal with the situation will likewise have all-party support.
§ 3.15 p.m.
Mr. David Adams
The Parliamentary Secretary and the Seconder of the Amendment very naturally played upon the fact that there is an inter-departmental committee studying the conditions affecting nursing services. We have heard of these committees before, and we noticed that there was no guarantee given by the Parliamentary Secretary that the necessary legislation would be promoted by the Government. Being perhaps more practical, we feel that the opportunity which the Ballot has placed in our hands of bringing forward this Bill at the present time ought not to be wasted. It is an extraordinary request that we should allow the present conditions, which are admittedly bad in the nursing profession particularly, to continue for, it may be, many months ahead, as though the appointment of a committee or commission was the solution of the difficulties which are under consideration. The appointment of a commission has often been quite synonymous with no action. We have a commission sitting upon safety in mines, but are we to hold up measures for providing for greater safety and protection of those who work at our collieries in consequence? We have the location of industry under consideration, and are industries not to be located because at some remote time there may be legislation? There is also a commission sitting considering the question of oil from coal, and, therefore, are we, as a nation, to recommend our industrialists who are interested in that problem to hold their hands pending the result of that inquiry and possible legislation that may ensue?
The hon. Member for North Edinburgh (Mr. Erskine Hill) and his colleagues have stated that some chaos would ensue in the event of the passing of this Bill, but is it not the fact that the position would be almost immediately remedied by the attraction of numbers to the nursing profession because of improved conditions which the legislation would admittedly bring about? My experience of municipal 2491 life for more than 45 years has convinced me—and there have been no exceptions to it—that in any department in which labour of any sort is required, either skilled or unskilled, technical or otherwise, from the lowest to the highest, you can always obtain the addition of numbers provided you raise the standard of remuneration and improve the conditions. Where there is difficulty in obtaining young women to enter the nursing profession, it is a difficulty similar to the difficulties experienced by municipalities in getting persons to enter the child welfare service, inspectors and others, but that has been remedied by an improvement in the conditions of service.
One need not pay too much attention to the arguments of the Mover and Seconder of the Amendment, because they admittedly cancelled each other out. The Mover of the Amendment contemplated the possibility of legislation at some remote time, but the Seconder made it perfectly clear that he was utterly opposed to anything in the nature of such action. Apparently, he would rely on voluntary action to the end. It was clear that he is not living in a real practical age, because he quoted cases of nurses who object to having reduced hours. The hon. Member for St. Albans (Sir F. Fremantle) spoke of the difficulty of 48 hours being adopted, although we know that the 48 hours system is in use in a large number of hospitals. That fact, however, did not deter him from using that argument. He gave us a very delightful homily, which ought to be written in verse and sent to the hospitals, in favour of sacrifice on the part of nurses; not sacrifice on the part of the male staff but on the part of the nurses. Apparently, many of them ought to engage in the highest form of sacrifice by working for no remuneration.
What is the position in the City of Newcastle? In the City Mental hospital there is a system of 48 hours for all grades. In the Newcastle General Hospital the male staff work 48 hours and the female staff 52 hours in the daytime and 54 hours at night. In the City Hospital the male staff work 48 hours and the female staff 53 hours in the daytime and 59 at night, while the domestic staff work an average of 56 hours.
Yes. These are municipal hospitals. It is clear from these figures that the men are better organised than the women and that through their trade union they have used the requisite amount of pressure, but the women are incapable of so doing. The main support of nurses is supposed to be the College of Nursing, which has sent a circular to Members of Parliament, in which they deprecate a number of things. Apparently, they would not have legislation which would reduce hours. They think that any improvement should be obtained voluntarily. They say:It is common knowledge that Bills have been brought before Parliament which aim at reducing the working hours of the indoor employés to 48 per week, and to enforce overtime pay for overtime work. Whilst appreciating the good intentions of the sponsors of Bills, who seek to attain such ends through legislation, the Council of the College consider it neither in the interest of the nursing profession nor of the sick public to compel a standard of hours of duty by rigid legislation.All legislative control is rigid, but it does not follow that there would not be elasticity in the 96 hours during the fortnight. Any body or council which makes a statement of that character ought to be removed in the general interests of the College and nurses. And they proceed in this way—I really have never listened to more arrant nonsense:The introduction of extra pay for extra time would tend to lower the standards of work which for so long have been the tradition as well as the pride of British nurses.Is the nursing profession remunerated by such high salaries that its members can afford to go without pay for the additional hours they may work? Would they be demoralised by having an increase of salary, as is suggested in this marvellous document? it has been my privilege as Chairman of the Health and Hospitals Committee for a number of years to sign the indentures of many probationers to this profession, and of course to deliver a short homily as to their duty to their patients. and to the hospitals. It seems to me that if I have to do this in hospitals where nurses are worked 80 hours a week it would be a complete mockery to suggest that they should be cheerful on every occasion, 2493 if necessary humorous, and should respond to the dignity of a profession which by these long hours was sapping their spirits and health and which was merely a sweated occupation.
I had the privilege recently to visit one or two of the great municipal hospitals in the United States of America. At Los Angeles there is one of the largest in the United States. It cost £2,200,000 in money and has bedding accommodation for 3,300. That hospital is run most efficiently on a 40-hour week and a five day week, and in certain of the hospitals it was suggested that a further reduction of hours would be in the general interests of the whole community. The managing director and the executive committee of this hospital in Los Angeles informed me that these shorter hours had been the means of improving the health standards of the whole staff and that they were relatively free from sickness. Neither the patients nor the executive committee nor the nurses and the staff concerned would dream of going back to the old hours, which were substantially more than 40 hours per week.
A great national movement is going on in this country for a reduction of the hours of labour. The financial burdens which have been referred to must be subordinated to a reasonable treatment of the servants of the municipalities. The scarcity of nurses would undoubtedly be remedied if there were improved conditions, and that would also apply to the voluntary hospitals. Already, due to the wisdom of the Ministry of Health, there have been set up joint hospital boards, in which the voluntary hospitals consult with the municipal hospitals, and vice versa. on various matters. There is no question that the joint hospital boards throughout the country, as far as the voluntary hospitals are concerned, would respond to the changed conditions and reduce the hours of work of their nurses on the same lines as the municipal hospitals. It might take a long period to do so, but, if the Bill were given a Second Reading it would be possible, on the Committee stage, to make Amendments to meet that situation. In the interests of the House, in the interests of the patients, in the interests of the family life of the nursing profession, and in the interests of national fitness, hon. Members ought to give the Bill a Second Reading.
§ 3.32 p.m.
§ Sir H. Fildes
I listened with interest to the speech of the Parliamentary Secretary. If the hon. Gentleman could give us an indication that, following the report of the committee of inquiry, his Department would introduce legislation, as soon as possible, to deal with this matter, I feel that that would satisfy the very strong opinion which exists in the House. Hon. Members will agree that this principle is very widely accepted, but anyone who has had experience of such matters knows that it sometimes takes a long while for an accepted principle to be put into operation. The situation is a serious one. I have heard of young nurses who have completely broken down in health as a result of their having had to associate for long unbroken periods with people in various stages of insanity. The Parliamentary Secretary referred to the great shortage of nurses. It is obvious that that shortage will continue as long as the present conditions exist. I know that I am addressing these remarks to converted people. I think the House as a whole will agree that the Minister of Health has been very active in trying to solve the problems confronting his Department, and on his record alone we should be prepared to accept an undertaking that at as early a date as possible he would bring in legislation to deal with this matter. I hope we shall be told that the Minister can do something within a reasonable period to solve this pressing problem.
§ 3.34 p.m.
§ Mr. Lunn
I think every hon. Member who listened to the speech of the Parliamentary Secretary must have been very disappointed by the tone of that speech. Parliamentary Secretaries are compelled to do all sorts of things, and those who have listened to speeches of the Minister of Health in Debates dealing with the development of the health services, will have felt sorry for the Parliamentary Secretary who, this- afternoon, had to face all the arguments made by almost every speaker in favour of this principle and this Bill. The hon. Member who spoke last said he would like to vote for this Bill because he knows that if we have to wait for what was suggested by the Parliamentary Secretary to be carried into effect, we shall not get legislation in the interests of the nurses 2495 for a very long time. Everyone agrees that this is a very necessary and useful service. Why then, have this procrastination? There may be other things necessary to make the position of the nurses better, besides the shortening of hours, but that reform would be a great contribution to their welfare.
My right hon. Friend who moved the Motion and my hon. Friend who seconded it both showed that they have gone fully into this question and were well acquainted with the facts, and they spoke almost as gently as one would expect nurses to speak. The hon. and learned Member who moved the Amendment followed their example in that respect, but the Seconder of the Amendment endeavoured to be as bitter as he could against anything that was in the interests of the nurses or in the interests of change. I cannot allow this occasion to pass without mentioning the speech of the hon. Member for St. Albans (Sir F. Fremantle). A great deal has been said to-day about the Departmental Committee which is inquiring into all these matters concerning nurses. Yet the Member of the House who has made the most passionate speech heard in the Debate to-day, against anything for the welfare of the nurses, against anything in the way of change and betterment, is a member of that Departmental Committee. I cannot imagine that the Government who were responsible for the appointment of that committee to act as judges and to decide impartially upon the evidence, will allow a Member to continue to act upon it who has expressed himself as the hon. Member for St. Albans did to-day. I admire the passion with which the hon. Member spoke, but I disagree entirely with his views, and I say that he ought to have kept his seat during this Debate in view of what his position is to be in regard to the matters now being considered by the Departmental Committee. I agree with the observation made from this side that it might be advisable to have upon that committee some practical young nurses who have some life and vitality and some experience as well, and who would see to it that the committee gave full consideration to all the points mentioned in the terms of reference.
I have been a Member of this House for nearly 20 years. I remember the 2496 passing of the Nurses Registration Act. in March, 1919. Many Members of this House know very well that since the War. women have had the vote and that women's rights, neglected for generations, have had to be recognised. In almost everything that is done we have to consider the fact that there are 2,000,000 more women voters than men voters. One could hear an echo of that in the speeches of those Members who are going to vote against this Bill. They are very anxious that it should be known that they are in favour of the principle of shorter hours, although they intend to vote against legislation. I believe that this House is the proper body to deal with a matter of this sort.
I believe this House ought not to hesitate to vote for a Bill of this kind. Since I was a boy I have always worked for voluntary hospitals and have been on their committees, but I have never hesitated to say, on the platform or elsewhere, that I favour national and municipal hospitals and nursing services in preference to voluntary services. We have to-day a position that ought to make most of us take that line. Since 1930 many of our Poor Law Hospitals have become municipal hospitals. They are doing wonderfully well. In fact they are not in any way behind the best of the voluntary hospitals. There is not a city or a county that is not endeavouring to see that its hospitals outclass the voluntary hospitals. In many cases that is being done. Nurses will become more plentiful for the municipal hospitals because the conditions in them are somewhat improved.
All Ministers of Health are anxious to improve our health services, and none more so than the present Minister, who takes pride in the fact that our public health services to-day are better than they have ever been, with improved nursing, with health visitors, child welfare, better hospitals and a midwife service. In every way things are being made better so that the health of the people may be considered. It is a striking fact that while we are doing that we are also doing our best to create a war which will wipe out the whole of us, if it comes about. I cannot understand any man giving his vote against a Bill like this, which will do a great deal if it will not do all that we wish.
2497 What is worse than a tired, overworked, underpaid nurse? She becomes irritable, indifferent; and who has to pay the penalty? The patient.
I have had a long communication regarding this Bill from the West Riding County Council, pointing out certain difficulties in their case. But we have had a speech to-day from the hon. Member for South Tottenham (Mr. Messer), perhaps the most wonderful speech ever heard in this House on this subject, certainly the most wonderful speech I have heard since I came to the House. He has shown us that difficulties can be easily overcome if we have a will to overcome them. He has given us his experience, real, practical, every-day experience, as chairman of a hospital which is bigger than many that we have in the provinces, a hospital with 1,100 beds. In many of the great hospitals in the county of Middlesex the difficulties have been overcome.
§ Mr. Bernays
I do not think I made it quite plain in my speech that the Association of Municipal Corporations are opposed to the Bill.
§ Mr. Bernays
I should be glad to show to the hon. Member the letter from the Association of Municipal Corporations to the Ministry, stating that they oppose the Bill.
§ Mr. Lunn
It is not altogether regarded as a rule that Members who introduce a Private Bill may take the opportunity of going to these associations and ascertaining their attitude before a Bill is considered. The Parliamentary Secretary was asked what was the attitude of the municipalities to the Bill. Only now have we got the answer. The Parliamentary Secretary has unearthed a revolution, or something of the kind.
§ Mr. Bernays
I said that the London County Council had indicated their views, and I think the hon. Member will see from my speech that when challenged I definitely said the local authorities were opposed to it.
§ Mr. Lunn
The hon. Member for Aberdare (Mr. G. Hall) put a question to the Parliamentary Secretary as to whether or not municipalities had said that they were opposed to the Bill, when he was saying 2498 that certain municipalities were not in favour of it, and until now we have had no statement with regard to it. Now, however, we get the statement that the municipal corporations have expressed themselves as against the Bill.
§ Mr. Lunn
I think it is unfortunate that the Minister did not use any argument in reply to my hon. Friend, but now that he has used this argument we must accept that as being the position. At the same time that does not in any way minimise the importance of the principle that we are considering. Practically every Member of this House has declared himself in favour of the principle of a shorter working day for nurses. This Bill is a very modest Bill. All that it asks is that we should institute a 48-hour week for those who work outdoors and a 96-hour fortnight for those who work indoors at hospitals. I should like to see something much shorter than an eight-hour day for all workers, and I think it is possible to have it. I admit that local rates are a burden on many localities, especially distressed areas, semi-distressed areas, and industrial areas, but wherever the questions of pain and suffering are concerned I do not think money ought to enter into the matter at all. If we can reduce or remove pain and suffering in any way, I have never felt that there ought to be any argument in regard to either rates or taxation.
Our hospital services to-day are wonderful, and they are improving year by year. We are getting a better type of nurse, and we are having nurses who are better qualified than ever before. Every local authority is wanting Queen's Nurses if it has to appoint a health visitor or a district nurse, and all that is for the well-being of the people at large, so that I hope that when we come to the vote on this Bill we shall take the step forward of passing it as one item among the points mentioned in the terms of reference which were dealt with by the Minister. I should say that it ought to be put into operation immediately, but if it is to be delayed at all or until the Committee has reported, 2499 I think we could be preparing the municipalities, the authorities, and the Ministry of Health for the time when it did come into operation, which would mean a good deal to thousands of nurses and would do a great deal to aid recruitment for the nursing profession, which is one of the most magnificent and necessary to the life of the people.
§ 3.49 p.m.
§ Mr. Grant-Ferris
I am grateful for this opportunity to make clear my position in regard to this Bill, because my name appears on the Paper as supporting the Motion for its rejection. I have listened with great care and attention to practically all the speeches this afternoon, and I, in common with everybody else in the House, agree with the principle of this Bill. I should like to say here and now that I am prepared to vote for the Bill, but in the circumstances I am not prepared to vote for it. The arguments against the passing of the Bill now are overwhelming. As far as I can see, there are two or three main arguments, namely, that the Bill touches only the fringe of the question, that the local authorities have not been consulted, and that a distinguished committee, containing three Members of the House, including the hon. Member for Anglesey (Miss Lloyd George), are to deliberate on this subject, and we shall have their findings, I hope, in the near future.
The main thing we have to consider is the nursing profession. The priesthood and the nursing service are the two great examples of the vocation system. In the older days the priesthood took care of the nursing services, but to-day they are separate from each other. Let us recognise the fact that nursing is, indeed, a vocation, and that it is our duty as people outside that profession to see that we do not impose upon the ladies who take up the vocation. I have discussed this matter with a great number of nurses. There is a large hospital in my constituency, and I should not like any member of the profession to think I am unsympathetic to their claims because I propose to vote against the Bill. Their great claims are that they should have better payment, shorter hours, and the option of living out. The hon. Gentleman, the Member for Barnstaple (Mr. Acland), in a fiery and somewhat ill-conceived speech, asked whether, if this Bill were withdrawn 2500 now, the Government would undertake to support it if it were brought forward again in 1941. That is the same as asking "Have you left off beating your wife?" because in 1941 I may not be here. The hon. Member for Barnstaple, I am sure, will not be here. It would be ill-advised at this moment to have anything to do with the Bill. I am convinced that everybody is at one in their desire to do something for the nurses, and they could have no better spokesman than the right hon. Member for West Bromwich (Mr. F. 0. Roberts), than whom no more respected man ever entered that town. We should not, however, at the present time, allow this Bill to pass.
§ 3.54 p.m.
§ Mrs. Hardie
It has been a delightful experience for me, having tried to organise women and to get better conditions for them, to see the men to-day tumbling over one another to secure better conditions for a section of women who deserve it and work very hard. I am in a peculiar position, because I am the only Member present who has ever done any nursing. I have never been a professional nurse, but I have had a great deal of amateur nursing to do. I have nursed parents, sisters, brothers, neighbours and friends, and I know what a mental and physical strain it is to nurse sick people. A great deal has been said about this noble vocation, and I realise that it is a noble vocation. In my own case those I have nursed have been people whom I loved and cared for, but let the House think of the sacrifice of the women who nurse patients who are nothing whatever to them and who do the most difficult and disagreeable jobs for other people when they are ill. I have never yet been in the position of needing to be nursed, but when I do come to that state I shall feel humble and grateful to the women who have to do for me what I have seen them do for others. If a nation so wealthy as we are cannot organise a hospital service to give nurses reasonable hours of labour and decent wages, we do not deserve to be nursed.
It has been an old game to talk to women about the nobility of our vocation and our duty to do this, that and the other, but the young women of to-day are not going to be so soft as we were in the past, and are going to demand decent conditions for themselves. They are not 2501 going to sacrifice their lives, as many of us did in the old days, when we believed that it was our duty to sacrifice ourselves to all the people around us. If we do not give decent conditions to-day, young women will not join the nursing profession. I used to tell women in the old days, "If you want a soft job try to get a man's job." Where women are competing with one another in any occupation we always find that the wages are low, the hours long and the conditions high, but if they get into an occupation in which men and women are employed the conditions are very much better, and women are now learning to force themselves into many professions and occupations.
I should like to stress the mental strain of being continually with sick persons. It is not only a physical strain but a mental strain. I have noticed that men want to get out of a sick room very quickly, because though they may feel all the sympathy in the world they find it is a great strain to be up against sickness and suffering. Nurses are not all callous women and despots, as many people think. They have to show a sort of hard feeling, or they could never get through with the work, and the better
§ the nurse and the more sympathetic nature she has the more she suffers when she is nursing sick people. It is a disgrace to the Government and to the body of men here if they cannot see their way to pass this Bill to enable women to get a reduction in hours, and they should go further and bring in a Bill to ensure for them better conditions.
§ 3.58 p.m.
§ Mr. F. O. Roberts rose in his place, and claimed to move, " That the Question be now put," but Mr. SPEAKER withheld his assent, and declined then to put that Question.
§ Mr. Williams
I should like to ask why it is that the right hon. Member for South Hackney (Mr. H. Morrison), who employs one-eighth of the nurses in this country, has not up to now, apparently, decided to afford them the terms of employment embodied in this Bill?
§ Question put, "That the words proposed to be left out stand part of the Question."
§ The House divided: Ayes, 111; Noes, 122.2503
|Division No. 39.]||AYES||[4.0 p.m.|
|Acland, R. T. D. (Barnstaple)||Hardie, Agnes||Pethick-Lawrence, Rt. Hon. F. W.|
|Adams, D. (Consett)||Harris, Sir P. A.||Price, M. P.|
|Adams, D. M. (Poplar, S.)||Harvey, T. E. (Eng. Univ's.)||Quibell, D. J. K.|
|Adamson, W. M.||Hayday, A.||Richards, R. (Wrexham)|
|Alexander, Rt. Hon. A. V. (H'Isbr.)||Henderson, A. (Kingswinford)||Ridley, G.|
|Ammon, C. G.||Henderson, J. (Ardwick)||Ritson, J.|
|Banfield, J. W.||Hicks, E. G.||Robinson, W. A. (St. Helens)|
|Barnes, A. J.||Hills, A. (Pontefract)||Salter, Or. A. (Bermondsey)|
|Batey, J.||Jagger, J.||Sanders, W. S.|
|Beaumont, Hon. R. E. B. (Portsm'h)||Jenkins, A. (Pontypool)||Seely, Sir H. M.|
|Bevan, A.||Johnston, Rt. Hon. T.||Sexton, T. M.|
|Buchanan, G.||Jones, A. C. (Shipley)||Shinwell, E.|
|Cape, T.||Jones, J. J. (Silvertown)||Short, A.|
|Charleton, H. C.||Kelly, W. T.||Silkin, L.|
|Chater, D.||Kennedy, Rt. Hon. T.||Silverman, S. S.|
|Cluse, W. S.||Lansbury, Rt. Hon. G.||Smith, Ben (Rotherhithe)|
|Clynes, Rt. Hon. J. R.||Lawson, J. J.||Smith, E. (Stoke)|
|Cripps, Hon. Sir Stafford||Leach, W.||Smith, Rt. Hon. H. B. Lees- (K'ly)|
|Daggar G.||Lee, F.||Smith, T. (Normanton)|
|Davidson, J. J. (Maryhill)||Lipson, D. L.||Sorensen, R. W.|
|Davies, C. (Montgomery)||Lunn, W.||Stewart, W. J. (H'ght'n-le-Sp'ng)|
|Davies, S. O. (Merthyr)||Macdonald G. (Ince)||Strauss, G. R. (Lambeth, N.)|
|Day, H.||McEntee, V. La T.||Taylor, R. J. (Morpeth)|
|Dabbie, W.||McGhee, H. G.||Thorne, W.|
|Dunn, E. (Rother Valley)||MacLaren, A.||Thurtle, E.|
|Ede, J. C.||MacMillan, M. (Western Isles)||Tinker, J. J.|
|Edwards, A. (Middlesbrough E.)||MacNeill, Weir, L.||Viant, S. P.|
|Edwards, Sir C. (Bedwellty)||Mainwaring, W. H.||Walker, J.|
|Evans, D. O. (Cardigan)||Maxton, J.||Watkins, F. C.|
|Evans, E. (Univ. of Wales)||Messer, F.||Whiteley, W. (Blaydon)|
|Fletcher, Lt.-Comdr. R. T. H.||Montague F.||Williams, E. J. (Ogmore)|
|Gallacher, W.||Morrison, R. C. (Tottenham, N.)||Williams, T. (Don Valley)|
|Gardner, B. W.||Nathan, colonel H. L.||Windsor, W. (Hull, C.)|
|Grenfell, D. R.||Naylor, T. E.||Woods, G. S. (Finsbury)|
|Griffith, F. Kingsley (M'ddl'sbro, W)||Oliver, G. H.||Young, Sir R. (Newton)|
|Groves, T. E.||Owen, Major G.|
|Hall, G. H. (Aberdare)||Paling, W.||TELLERS FOR THE AYES.—|
|Hall, J. H. (Whitechapel)||Parker, J.||Mr. F. O. Roberts and Mr.|
|Allen, Lt.-Col. Sir W. J. (Armagh)||Errington, E.||Procter, Major H. A.|
|Anderson, Sir A. Garrett (C. of Ldn.)||Fox, Sir G. W. G.||Raikes, H. V. A. M.|
|Baillie, Sir A. W. M.||Fremantle, Sir F E.||Ramsbotham, H.|
|Balfour, G. (Hampstead)||Ganzoni, Sir J.||Rathbone, J. R. (Bodmin)|
|Balfour, Capt. H. H. (Isle of Thanet)||Gilmour, Lt.-Col. Rt. Hon. Sir J.||Reed, A. C. (Exeter)|
|Barrie, Sir C. C.||Gluckstein, L. H.||Reid, Captain A. Cunningham|
|Baxter, A. Beverley||Grant-Ferris, R.||Reid, Sir D. D. (Down)|
|Beamish, Rear-Admiral T. P. H.||Grattan-Doyle, Sir N.||Reid, W. Allan (Derby)|
|Beauchamp, Sir B. C.||Grimston, R. V.||Robinson, J. R. (Blackpool)|
|Bernays, R. H.||Guest, Lieut.-Colonel H. (Drake)||Royds, Admiral P. M. R.|
|Bird, Sir R. B.||Hacking, Rt. Hon. D. H.||Russell, S. H. M. (Darwen)|
|Blair, Sir R.||Hartington, Marquess of||Samuel, M. R. A.|
|Boulton, W. W.||Harvey, Sir G||Sandeman, Sir N. S.|
|Bowater, Col. Sir T. Vansittart||Heilgers, Captain F. F. A.||Savery, Sir Servington|
|Boyce, H. Leslie||Hely-Hutchinson, M. R.||Scott, Lord William|
|Braithwaite, Major A. N.||Heneage, Lieut.-Colonel A. P||Smiles, Lieut.-Colonel Sir W. D.|
|Briscoe, Capt. R. G.||Herbert, Major J. A. (Monmouth)||Smith, Bracewell (Dulwich)|
|Brown, Col. D. C. (Hexham)||Holmes, J. S.||Somerville, A. A. (Windsor)|
|Brown, Brig.-Gen. H. C. (Newbury)||Hope, Captain Hon. A. O. J.||Spans, W. P.|
|Browne, A. C. (Belfast, W.)||Hudson, Capt. A. U. M. (Hack., N.)||Stanley, Rt. Hon. Oliver (W'm'Id)|
|Bull, B. B.||Hulbert, N. J.||Storey, S.|
|Bullock, Capt. M.||Hume, Sir G. H.||Strauss, E. A. (Southwark, N.)|
|Burgin, Rt. Hon. E. L.||Hutchinson, G. C.||Stuart, Hon. J. (Moray and Nairn)|
|Campbell, Sir E. T.||Kerr, Colonel C. I. (Montrose)||Sutcliffe, H.|
|Carver, Major W. H.||Lambert, Rt. Hon. G.||Tacker, Sir R. I.|
|Castlereagh, Viscount||Leighton, Major B. E. P.||Taylor, Vice-Adm. E. A. (Padd., S.)|
|Cayzer, Sir C. W. (City of Chester)||Levy, T.||Tryon, Major Rt. Hon. G. C.|
|Cazalet, Thelma (Islington, E.)||Loftus, P. C.||Tufnell, Lieut.-Commander R. L.|
|Colville, Lt.-Col. Rt. Hon. D. J.||McKie, J. H.||Ward, Lieut.-Col. Sir A. L. (Hull)|
|Cooke, J. D. (Hammersmith, S.)||Macsnamara, Capt. J. R. J.||Waterhouse, Captain C.|
|Courthope, Col. Rt. Hon. Sir G. L.||Macquisten, F. A.||Watt, Major G. S. Harvie|
|Cox, H. B. Trevor||Margesson, Capt. Rt. Hon. H. D. R.||Wayland, Sir W. A|
|Cranborne, Viscount||Marsden, Commander A.||Whiteley, Major J. P. (Buckingham)|
|Croft, Brig.-Gen. Sir H. Page||Maxwell, Hon. S. A.||Williams, H. G. (Croydon, S.)|
|Crooke, J. S.||Mayhew, Lt.-Col. J.||Windsor-Clive, Lieut.-Colonel G.|
|Cruddas, Col. B.||Mellor, Sir J. S. P. (Tamworth)||Winterton, Rt. Hon. Earl|
|Denman, Hon. R. D.||Mitchell. Sir W. Lane (Streatham)||Wise, A. R.|
|Dower, Major A. V. G.||Moore, Lieut.-Col. Sir T. C. R.||Withers, Sir J. J.|
|Duckworth, W. F. (Moss Side)||Morris-Jones, Sir Henry|
|Duggan, H. J.||O'Connor, Sir Terence J.||TELLERS FOR THE NOES.—|
|Edmondson, Major Sir J.||Palmer, G. E. H.||Mr. Erskine-Hill and Major|
|Ellis, Sir G.||Pownall, Lt.-Col. Sir Assheton||Neven-Spence.|
§ Question proposed, "That the posed words be there added."
§ Several hon. Members rose —
§ It being after Four of the Clock, the Debate stood adjourned.