HC Deb 07 April 1943 vol 388 cc641-8
Mr. Hutchinson (Ilford)

I beg to move, in page 1, line 9, to leave out "assistant nurses," and to insert "nursing assistants."

The object of this Amendment and the other Amendments which appear on the Paper in my name is to meet the apprehension which is felt by a number of State registered nurses that, if a new class of assistant nurse is introduced, some confusion will arise between the State registered nurse who has undergone the full period of training and has obtained the full qualification and the new assistant nurse who has reached only a preliminary stage in her training. What is apprehended is that, in the mind of the public, no very clear distinction will be drawn between those two classes, if both are permitted to use the expression "nurse" as part of their authorised description. At first sight the Committee may think that this is a distinction without a very real difference behind it but I hope to show that there is a very substantial difference indeed.

In the case of institutions, nothing very much turns upon the different description, because both classes will continue to be described colloquially as nurses. Nothing will prevent that. The difficulty arises with nurses sent out to fulfil private engagements. The magic of the description lies, of course, in the expression "nurse." There is a danger—the Committee may think it is a substantial danger—that confusion will arise in the public mind between the State registered nurse and the assistant nurse in cases where a "nurse" is offered for a private engagement. It is essential to find some description which will not lead to that confusion in the public mind which seems likely to be caused by the description "assistant nurse."

As far as I am aware, this is the only case in which a-person is able to obtain a recognised professional description before he or she has acquired the full pro- fessional qualifications. In this case a nurse, if she has completed two years' training and passed certain examinations, will be entitled to make use of the description "nurse." Having investigated the matter I have been able to find no other case in which the acquisition of the preliminary professional qualifications entitles the person concerned to make use of the professional description. The Committee will bear in mind that the important element in this description is the term "nurse." Under this and the other Amendments which I have placed on the Order Paper, the assistant nurse would become known by a description which will convey clearly to the public mind, not always very accurate in these matters, that the assistant nurse or "nursing assistant," as I propose to call her, has not yet acquired the full professional qualifications.

I do not desire to be drawn into a discussion of the qualifications of the assistant nurse. Everybody, I think, recognises that she is entitled to the special official status which she will get under the Bill. Everybody recognises the value of the services which she performs. It is true that she is capable of performing certain limited nursing services. Nobody disputes that. But I venture to submit to the Committee that the name which I suggest more accurately describes her qualifications than the name proposed in the Bill. It seems to me that the expression "nursing assistant" will convey to the public mind the fact that the person to whom it is applied possesses certain nursing qualifications, but not the full qualifications which are required to entitle her to State registration as a nurse, more clearly than the expression "assistant nurse."

I am aware—and no doubt my right hon. Friend in his reply will dwell upon it—that this is not a new matter. It was considered at some length by the Athlone Committee. The result of their consideration was that they recommended—and the Minister has followed their recommendation—that the new class of enrolled assistants should be described as "assistant nurses." That was not a unanimous recommendation. I notice that all the qualified nurses who were members of the Athlone Committee dissented from that recommendation. They presented a minority report, in which they recommended that any description including the expression "nurse" should be restricted to those nurses who had attained full qualifications. But the recommendations of the Committee did not follow those lines.

I have examined the reasons given by the Athlone Committee for their recommendation. I am bound to say that I am not impressed by them. They reached their conclusion by what seems to be a peculiarly inverted form of reasoning. They began by saying that whatever the various descriptions which might be applied, nurses would still colloquially be known as "nurses." That, of course, is true. The committee went on to say that they recognised that there might be a certain confusion in the public mind if the assistant nurse became entitled to a description which involved the use of the term "nurse." I should have thought that that would have been the best possible reason for recommending the use of some other description. But notwithstanding the fact that the Committee recognised that some confusion in the public mind was likely to arise, they still went on to recommend the adoption of the expression which they thought likely to give rise to such confusion.

Sir Francis Fremantle (St. Albans)

May I ask my hon. and learned Friend whether the ladies in question presented a minority report or made any definite alternative suggestion?

Mr. Hutchinson

I have already said that there was a minority report by four ladies who were, I think, the only four nurses on the committee. In that report they recommended that a description which included the term "nurse" should not be applied to assistant nurses, and they suggested another description.

Sir F. Fremantle

What was that suggestion?

Mr. Hutchinson

My hon. Friend knows that they suggested that the assistant nurse should be described as a "registered invalid attendant." I am not suggesting that description to the Committee. I think that the term "nursing assistant" which I propose describes more accurately the person concerned and the duties which she is qualified to perform.

I was pointing out before I was interrupted that the recommendation of the Athlone Committee in favour of using the expression "assistant nurse" was not unanimous. Those who might be considered to have had the widest experience in the matter dissented from it and presented a minority report. The last point which I wish to make is this. Surely this is a matter upon which this Committee ought to give a decision. Surely the time has come when it is not sufficient for a Minister to come before this Committee and say that some special committee has recommended this, that or the other thing? It is for this Committee to decide—and this Committee is quite well able to decide—a matter of this nature. We must, of course, attach to the recommendations of these special committees such weight as their recommendations deserve: but the final decision must rest with this Committee. This Committee is the right body to decide a matter of this nature. We can judge whether the expression "assistant nurse" is or is not likely to give rise to misunderstanding in the public mind. As I say, we must attach such weight to the recommendations of the Committee as those recommendations deserve, but it is for us to make up our own minds upon this matter. For those reasons I have put down these Amendments to substitute "nursing assistant" for "assistant nurse."

Mr. Storey (Sunderland)

I hope the Committee will not agree with this Amendment, because I believe it undermines the whole intention of the Bill, which is to give a recognised status to women who have the necessary degree of training to perform special duties for which there is a great demand. To refuse the name of "assistant nurse" would be to discourage women from taking this necessary training and would relegate them, I submit, to the level of the domestic staff of a hospital, which could quite as well be described as nursing assistants. As the Mover of this Amendment pointed out, the name is that which was recommended by the Athlone Committee, and I submit that it is a much better name than that suggested by the minority report quoted by my hon. and learned Friend. It is also a name which is recognised——

Mr. Hutchinson

My hon. Friend appreciates that the minority report recommended another description which is not the description in my Amendment.'

Mr. Storey

That is what I was referring to. I was submitting to the Committee that the name recommended by the Committee was much better than that suggested by the minority element on that Committee. It is a name which is recognised in practice in our hospitals; it is understood, and it has, for the period of the war, been recognised in the Civil Nursing Reserve. To make the alteration suggested would undermine the whole spirit of the Bill. I hope the Committee will not agree to it.

Mr. Ammon (Camberwell, North)

May I say at the outset that I heartily agree with the Mover of the Amendment in so far as he said that while committees may be useful on occasions it is for this House to determine what shall be in the Bill? I hope the Committee will reject the Amendment as being against the intention of the Clause which is to give a recognised position to assistant nurses, and which does not cover those who have had no training whatever. The qualifications required are set out in the Athlone Committee's Report, and this Billie doing very tardy justice to a very hard-working and very important part of the nursing profession. I hope that the Committee will accept the hon. and learned Gentleman's advice by very rapidly deciding to reject his Amendment.

Sir F. Fremantle

I was on the Athlone Committee, and I held pretty strongly that we should meet, if we could, the wishes of the State registered nurses in this matter. I proposed the name "nursing aid," but when they decided against that and in favour of "registered invalid attendant," I felt that it was impossible that such an involved title should come into general use. I agree with my hon. Friend that we want to do two things; one is to protect the position and the general repute of the State registered nurse. But we also want to do something more important to achieve a very definite recognition and protection of the position of the assistant nurse in order to attract a far larger number of women to come into this kind of work than hitherto. It is in order to attract recruits to the profession that we are mainly engaged in this House with this Bill. We want to do everything we can to encourage them to come in, and "assistant nurse" will encourage them, whereas the description proposed in the Amendment would do the opposite.

The Parliamentary Secretary to the Ministry of Health (Miss Horsbrugh)

I am glad that those hon. Members who have spoken since the Amendment was moved have realised that the object of this Bill is to give a very definite status to the qualified assistant nurse. The hon. and learned Gentleman who moved the Amendment made a proposition with which I think we all agree, that it is for this Committee to decide at this moment what should be the title of this qualified person who will have undergone two years' training, that training to be arranged and supervised by the General Nursing Council. It has been pointed out that the minority on the Athlone Committee who were State registered nurses would not agree to that term, but the Nursing Reconstruction Committee has met since then, and the nurses there agreed to the term "assistant nurse," and urged that that term should be used. I agree with the hon. Member for Sunder-land (Mr. Storey) that the term "assistant nurse" is being used now, and being used officially, in the Civil Nursing Reserve for those who have had two years' training. We want to make it clear, and I think the title does make it clear, that such a woman is a qualified assistant nurse. The mover of the Amendment said that the public would not be able to distinguish, because such a woman would have the full professional description. But she does not have the full professional description. The full professional description is "registerd nurse, and the description of the person who has had two years' training is "assistant nurse." There have been a good many complaints in this House of things not being made clear. If we have that object in mind, I do not think we could get clearer words than "assistant nurse."

Dr. Russell Thomas (Southampton)

What exactly is the qualification of an assistant nurse? The hon. lady says that they are qualified people. I want to be clear, because I believe that the only qualification——

The Deputy-Chairman

That is going beyond this Amendment.

Amendment negatived.

Mr. Linstead (Putney)

I beg to move, in page 1, line 14, to leave out "conclusive."

As the Sub-section is now drafted it makes a certificate under the seal of the General Nursing Council as to whether any person is or is not an enrolled assistant nurse conclusive evidence in any court of law. In other words, it rules out any possibility of the person affected producing evidence to the contrary. In the keeping of a roll which will probably include 20,000 or 30,000 names it is by no means impossible that mistakes may arise. There may be mistakes resulting from the identity of names, or mistakes from changes of address, or even office mistakes in connection with the keeping of a lengthy and complicated document. I think we cannot entirely put this out of mind, and that it should be possible for anyone likely to be affected by a certificate such as this to bring some evidence to the court—not to be entirely deprived of the right to bring any evidence before the court—to show that there is a mistake in the certificate, that she is, in fact, registered. That is, I hope, the effect of leaving out the word "conclusive." It will make the Council's certificate evidence but will leave it possible for a person to bring before the court evidence to show that there is a mistake in the certificate.

Mr. Storey

One thing I should like to say in support of the Amendment is that although there has been no need for this point in the main Bill—the Nurses Registration Act—which has been on the Statute Book for many years that is no reason why we should not make an improvement. I think that the proposed Amendment does improve the position. It does provide for a possibility which could occur, and the fact that it has not occurred over a long period of years is no reason why we should not make an improvement now.

The Minister of Health (Mr. Ernest Brown)

I think my hon. Friends are on a sound point, and I propose to accept the Amendment. It will require a similar Amendment in paragraph 2 of the Second Schedule, and in a proposed new Clause which is consequential.

Amendment agreed to.

Clause, as amended, ordered to stand part of the Bill.