NURSES (REGULATIONS) (Hansard, 17 October 1945)

§ Mr. Linstead (Putney)
I beg to move, That the Nurses Regulations, 1945 (S.R. & O., 1945, No. 638), dated 31st May, 1945, made by the Minister of Health under proviso (b) of Subsection (1) of Section 6 of the Nurses Act, 1943, a copy of which Regulations was presented on 6th June, in the last Session of the last Parliament, be annulled. In moving this Motion, I would like to express my appreciation of the fact that the Minister of Health is here to deal with this matter at the end of what must have been an exceedingly tiring day for him. It is not inappropriate, however, that we should now be discussing nurses, although I must admit the subject has not arisen previously to-day. Under Section 6 of the Nurses Act, 1943, it is an offence for any person, not a registered nurse, to use the title of "nurse, "either alone, or in combination with any other word. There is a proviso under which the Minister may make regulations authorising the use by specified persons of specified names or titles containing the word "nurse." Under that proviso the Minister's predecessor made a Regulation in the following terms: If a person is recognised by the body known as the Church of Christ Scientist as being a member of that body and is qualified 1322 for employment by members of that body as a Christian Science nurse he may use the name or title of Christian Science nurse. The sum of the provisions in the Act and in the Regulation is, therefore, that it is unlawful for anyone who is not registered as a nurse to use that description, with certain exceptions, one of which is the Christian Science nurse. It is generally the practice in this country not to prohibit the exercise of any particular profession, but it is frequently the case that where a profession affects the health of the people or commercial integrity a statutory register is set up.
Registered persons alone are entitled to use the description implying that they are registered. The purpose of this is obvious. It is to enable the public to be able to tell the qualified, registered person from somebody who is not registered. I am making no reflection upon the Christian Science Church, nor on the practice of those called Christian Science nurses in looking after sick members of that Church. That is a matter of spiritual freedom of the individual about which this House is always very tender. My remarks are solely concerned with questions of registration.
I have seen the authorities of the Christian Science Church and they have frankly explained to me exactly how they train persons for attendance on their sick members. Before the war, trainees were sent to America, for a course at one of the Christian Science schools, followed by a period of experience in a Christian Science nursing home. Since the war, they have been unable to go there, and their training consists of experience for nearly two years in a Christian Science nursing home. There is no preliminary education, qualification, or examination, and there is no statutory register and no oversight of their work after they are qualified, when they are free to attend Christian Science patients.
The point of the Motion is to compare that situation with the requirements for the State registered nurses of this country. In their case, there is a high preliminary educational qualification, certificates of examination, a set course of training and a State register, with disciplinary control by the General Nursing Council. The whole period is a minimum of four years between entrance and registration. I think the House will agree 1323 that far less than justice is being done to the State registered nurse by allowing this group of practitioners to use their name and title of "nurse." I suggest that it is partly unfair, partly dangerous to the public, and peculiarly unfair to the people whom we are trying to attract into the nursing profession, if they feel that they have to toil through a heavy course of training and pass several examinations, while there is something which they are bound to regard as a backdoor to this title for which they have to work so very hard.
The present position, I may mention, is the result of an undertaking given by Mr. Ernest Brown when he was Minister of Health—an undertaking to which the right hon. and learned Member for North Croydon (Mr. Willink) felt, as a Member of the same Administration, he was bound to give effect, when he made Regulations. I hope that the present Minister of Health will not feel that in the new circumstances which exist now he is bound by any such concession.

§ Mr. Gallacher (Fife, West)
Is not the big issue that it is not the length of training or the fact that some others can use the name of "nurse" that handicaps us in getting nurses, but the inadequate and miserable wage that they get?

§ Mr. Linstead
I am reinforced in what I am saying by the hon. Gentleman's question. There is a shortage of nurses, and I would suggest it is no encouragement to anyone to enter the nursing profession, if too many exceptions are made to the rules for State registered nurses.
It has been suggested that there is a precedent in legislation for special treatment being accorded to the Christian Science Church. It is in Section 193 of the Public Health Act, 1936, which deals with the registration of nursing homes. Under that Section, Christian Science nursing homes are exempted from registration and inspection. But there is a Sub-section which says: It shall be a condition of any exemption granted in respect of a nursing home under this section that the nursing home shall adopt and use the name of Christian Science house. In other words, when an exemption was made in respect of Christian Science nursing homes, it was only on the condition 1324 that they were not called nursing homes. I would apply that precedent to the case of the nurse, so that if that exemption is to be made in favour of Christian Science nurses, it should be on the condition that they describe themselves as "attendants on the sick," and not as nurses. I recognise the difficulty with which the right hon. Gentleman is faced in respect of this Motion. The Regulations contain many other provisions, and he may desire to see the rest of the Regulations remain law, and not have them held up because of this one. Nevertheless, I hope that by one means or another the ingenuity of the Civil Service or the Minister will find a way round it. I hope the Minister will find some way of remedying what I regard as an injustice to State registered nurses and as something which may be misleading to the public.

§ Mr. Messer (Tottenham, South)
I beg to second the Motion.
It will be remembered by hon. Members who were in the House during 1943, when we were discussing the Nurses Bill, that the argument advanced in favour of it was that it would raise the status of the nurse. Its object was to place the nurse in a position in which she would be recognised as a member of a profession. I shall not digress by going into the question of whether or not the Measure did anything of the sort or whether we have yet got a nursing profession, but there is no other body of people who are compelled to study and at some time work thundering hard to become qualified, as we expect the nurses to do. Notwithstanding that fact, it was recognised that there was a section of people working as nurses, who had no certificate. They had no official recognition of the fact that they were nurses. Further, when the Bill became an Act, it regularised the position of assistant nurses, and empowered these assistant nurses to come on to the roll. At the end of a certain period these assistant nurses were enabled to be called enrolled nurses.
During the passage of that Bill, Mr. Ernest Brown—I think, without very much thought, and certainly not sensing the atmosphere of the House at the time—gave an undertaking which made an exception in regard to a particular class. He said that in the Regulations he would give the right to the Christian Science 1325 nurses to the title of "nurse." If hon. Members will read those Regulations they will see that no person of any sort is entitled to call herself a nurse, unless she has had a period of training and qualification. I regard it as very important indeed to realise, if we wish to protect that profession, that we are not going to protect it by leaving a door like this open. I have no criticism to make of the Christian Scientists. I believe very largely in the domination of the mind over the body and that people would be very much healthier in body, if they had healthier minds. Perhaps I keep my youth because I continue to believe that I am young. But I think that this is an important matter and that we should not be satisfied unless we get an assurance from the Minister that, by some means, the just claims of the Christian Science Church shall be met without injury to what is perhaps the noblest body of our people—those who are tending the sick.
Let us then examine the position. I have no idea whether or not the Christian Scientist can accomplish as much as professional medicine. I just do not know. But I know that if you have a haemorrhage you want to know what is likely to stop it. You want someone who has had some training. You want somebody who has had a degree of education in the subject that will enable him to accomplish the purpose. It is not just an easy thing for a Member at this late hour to attempt to hold the interest of the House on a question like this but it ought to be understood by the House that every organisation connected with nursing is opposed to this one exception. The statutory body which is responsible for the registration of nurses—the General Nursing Council—is opposed to it. The Royal College of Nursing is opposed to it and, indeed, every organisation of nurses is opposed to it. As my hon. Friend the Member for Putney (Mr. Linstead) said, you impose on a nurse a lengthy period of training. If she has a preliminary nursing course she might get into a training school at the age of 17. She would probably have a four years' course of training to get her State certificate. Then should she want to take up midwifery another year is required. If she wants a Tuberculosis Association Certificate, there is another two years. That is the training necessary to get the diplomas which entitle you to call yourself a nurse. Is it 1326 fair for us to say a person is entitled to be called a nurse when she goes through a lesser period of training?
I hope the Minister is going to say that he is prepared to reconsider the wording of this Regulation. I hope, perhaps with some conceit, that he will have a talk with me about it and discuss in what way we can meet the legitimate claims of the Christian Science Church, and yet preserve the rights of the nursing profession. This House is not bound by the undertaking given by the previous Minister. We cannot feel bound by it. We have a new House of Commons and a new Government. Even in the old House and old Government we did not know what was going to be in the Regulation. Now that we know, I hope the Minister will concede the right claimed by every professional body, of seeing there is no opportunity of misunderstanding the position occupied by those entitled to the name of nurse.

§ Colonel Ponsonby (Sevenoaks)
I do not propose to detain the House more than a few minutes. For the last 20 years I have been closely connected with the London Hospital and I realise the value of the training of the nurses. It is training all the time, and that is what I want to underline. We find in the statutory rules that emphasis is laid in nearly all the paragraphs on examinations, on training and on certificates in every class and category—all except this paragraph which deals with the Christian Science nurse. I put it to the right hon. Gentleman that if this paragraph is allowed to remain, it may be found, in future, to contain a number of pitfalls. If it is possible for Christian Science attendants to be called nurses, it is quite likely that other health bodies may produce their attendants and request that they should be called nurses also. I will not go into the question of the feelings of the qualified nurses themselves, because there is not time to do so. I want, however, to emphasise what has been so well put by the last two speakers and to ask the Minister of Health to find some way out of this difficulty.

§ Mr. Collins (Taunton)
I rise to support the Motion very briefly. The bona fide nursing profession is seriously concerned in the matter as I am aware from my contact with hospitals in my 1327 division. It has been very rightly said that the nursing profession is hopelessly underpaid, and very few nurses can tell you why they remain in the profession, except that they regard it as a calling—something for which they had to undergo a hard and arduous training. In this country for many years the term "nurse "has meant a great deal. I believe that in the future, particularly under the National Health Service, it will come to mean a great deal more and I submit that if these Christian Science attendants are allowed to use the title of "Christian Science nurse," it will be a travesty of the meaning of the word "nurse" as we understand the term, and will involve a real hardship to the bona fide nurse, for whom we have such a high regard. I suggest that my right hon. Friend the Minister of Health should give this matter his serious attention and that some alteration or amendment should be made to meet the position that has arisen. I believe it could be met by using the word "attendants" instead of "nurses." I hope that in any case this Regulation will be altered.

§ Lieut.-Commander Clark Hutchison (Edinburgh, West)
I have my name down to a separate Motion dealing with the corresponding regulations tabled by the Secretary of State for Scotland under the Nurses (Scotland) Act, 1943, but I think it would be for the convenience of the House if instead of moving that Motion, I spoke on this one as the two sets of regulations are exactly similar. It happens that there were two Acts passed, one for England and one for Scotland, in the same year.
My objection to the Regulation is the same as that expressed by other hon. Members. I take exception only to the one paragraph dealing with the use of the term "nurse" by people engaged in Christian Science practice and I ask the Minister to substitute the term "attendants" or some alternative title in place of "nurse." If he did that, it would give very great satisfaction to the orthodox nursing profession, who are very jealous, and rightly so, of their profession. Their training is a long and arduous one and they do not like to think their qualification is lowered by the use of the term 1328 "nurse" by those whose training is in any way less complete. I would emphasise, like other hon. Members who have spoken, that I am in no way attacking those who believe in Christian Science. I have personal friends of my own who believe in that faith, and I would be the last person in the world to interfere in any way with the private religious beliefs of other people. But whilst I do feel that we must respect the beliefs of minorities, we must also have due regard to the position of majorities, and in this case the majority we have to consider are the State registered nurses who feel very aggrieved by the use of the title "nurse" by persons engaged in quasi-medical practices.
I do feel that the Ministers concerned in introducing these Regulations have quite definitely undermined the purport of the 1943 Acts, because these Acts were designed to correct certain weaknesses in the Nurses' Charter, the 1919 Nurses Registration Act. Section 6 of both Acts gave great satisfaction to State registered nurses. They tightened up the regulations very considerably as to who might use the title of "nurse". Under these Sections the use of the title "nurse" is actually limited to those who are State registered nurses, those who are entitled to its traditional use in connection with the care of children, or to people who may by specified by the Ministers in Regulations. Unfortunately, under these Regulations this unorthodox body seem to be entitled to use the term "nurse". I remember listening to the Debates on these Bills in the last Parliament and since then I have refreshed my memory by reading Hansard and I find a large number of hon. Members were concerned with tightening up the Regulations dealing with the title "nurse". Indeed, the then Minister of Health, Mr. Ernest Brown, on the Second Reading made specific reference to this matter as an object of the Bill. One of the objects, he said, was to secure also that the public should be protected from unqualified people representing themselves as nurses."—[OFFICIAL REPORT, 24th March, 1943; Vol. 387, c. 1648.] Later in his speech he commented on the inadequacy of the 1919 Nurses Registration Act. Looking through the Debates in Hansard, I see that not one honourable Member made any reference to this question of Christian Science nurses and 1329 I think it rather unfortunate and regretable, so far as both this House and the nursing profession are concerned, that these Regulations should now be thrust upon us. Like many other honourable Members I have received a considerable number of protests from members of the nursing profession, mainly from those holding responsible positions, such as matrons of hospitals. I have also received protests from such bodies as the British College of Nurses and the Royal College of Nursing of Scotland. I would just like to quote something written by the Secretary of the Scottish Board of the Royal College of Nursing: I was also directed to send a letter of protest to the Secretary of State for Scotland, pointing out that my Board feel strongly that as these persons do not undergo any standardised theoretical or practical training in the care of the sick, nor are they required to work under the supervision of a State registered nurse, they are not eligible to use the name or title 'nurse' even when prefixed by the words 'Christian Science'. I support this point of view whole heartedly and commend it to the Ministers. I feel that these people should be described as "Christian Science attendants" or some such similar title. For that reason I sincerely hope the Minister will withdraw these Regulations.

§ Mr. Alfred Edwards (Middlesbrough, East)
In opposing this Motion I must say that I appreciate the manner in which the case has been stated for it. I accept what previous speakers have said that this is no attack on Christian Science. I believe that there is a sincere belief that there may be some confusion in the use of the name "nurses" by Christian Science people, as opposed to purely medical nurses. I think Saul of Tarsus would have supported this Prayer, but Paul the Apostle would not have supported it.
I think I ought to say to the House that I receive letters similar to those to which the last speaker referred, and I received one from the matron of my local hospital. I replied telling her that I could only say this—that I voted for the nurses, that no one admired their work and devotion more than I do; that I have done everything I can to improve their status, and will do a great deal more to improve their conditions of service and remuneration. I said there was nothing I would not do to help the nurses, but I added that when this matter was raised before 1330 the House, it was not slipped in by some back door. There was a very thorough investigation, and with the agreement of the mover of the Motion, there was a special reference to Christian Scientists, which caused the House to insert the words, "Christian Science nurses."
Christian Scientists would be the first to protest if it was thought that in the slightest degree that would mislead the public. There is no kind of negligence in the training of these nurses. These nurses have a thorough training. If we did not train these nurses in the way in which we believe, no one would believe in them. If we did not train nurses in the way in which we think people need helping we would be subject to severe criticism. I would say to the House that a large proportion of the Christian Science nurses are trained medical nurses who, because of their experience, have now become Christian Science nurses. I could bring scores of doctors who practised in their profession and have now become Christian Scientists. This is not a matter which has just slipped in. It was discussed before, and it was very carefully thought out and fairly faced. We thought we were getting just what was justice. I think that if Members read the Regulation they would agree that there is not much ground for the complaint on the score of confusion. It must not be thought that these nurses practise in competition with other nurses. It is only Christian Scientists who will employ Christian Science nurses. There need be no confusion. The words used are "if the person is recognised, etc. "The nurses must be recognised, just as other nurses must be recognised, by a competent body. If the nurse is recognised by a body known as the Church of Christ Scientist, as being a member of that body, and is qualified to attend members of that body, she must use the title "Christian Science nurse."

§ Commander Marsden (Chertsey)
Will the hon. Gentleman allow me to ask this? It is said that Christian Science nurses are not qualified by any form of examination. Is that the case? I ask only for information.

§ Mr. Edwards
I think that is entirely wrong. I think there is a misconception there. All the speakers and many who have opposed this legislation have in 1331 mind the fact that they do not have a medical qualification. Of course a medical qualification is a basis for purely medical treatment; but a purely mental or spiritual basis would be entirely different.

§ Mr. Linstead
I should like to be clear on the point of examination. Inquiries which I have made show, and the information given me quite frankly and freely by the authorities of the Church is, that there is, in fact, no examination.

§ Mr. Edwards
That may be so in the sense that is generally accepted, as other nurses have examinations. I am a member of the Church but I would rather that any statement on this point should be taken from the Church authorities and I believe the hon. Member for Putney (Mr. Linstead) has had such a statement. But I think we could satisfy the Minister that this does involve very serious training and that Christian Science nurses require to have very serious qualifications for their work. This is the first time that I have spoken on this subject in this House. More than 30 years ago, I was in such a physical condition that material medical science could give me no aid, and but for the ministrations of Christian Science nurses I would not be in the House speaking to-day. My children have been brought up in this way, and they have never had occasion to get treatment from material medical science of any kind, except during those periods when, as children, infectious diseases had to be taken into account and reported. We had to have a doctor in for that. This treatment has been adopted by us, because it is more efficient, and not because we take any risks at all. I say to the House that I do not think there is any incurable disease. But Christian Science is only called upon when material medical science has failed. It is then that people usually turn to this form of treatment. I could bring witnesses to this House who have been helped by Christian Science when material medicine has failed.

§ Mr. Keenan (Liverpool, Kirkdale)
Is this not a question of qualification of nurses? It has been very definitely stated here that these are not qualified, and that because of this there is danger.

§ Mr. Edwards
I do not want the House to think that this kind of thing has gone on negligently. There is a very sound training, and it enables them to give Christian Science treatment. We think it is a very good thing that there should be Christian Science nurses to give this treatment when it is needed.

§ The Minister of Health (Mr. Aneurin Bevan)
The House has listened to enough on this matter to be able to form a judgment. I do not want to reflect upon anyone who has spoken. Hon. Members have put their case on both sides with great sincerity but I think the arguments have been sufficiently explained to enable the House now to form a judgment. We are not arbitrating on the merits of the claims of Christian Science. That is not the issue at all. These religious denominational matters can raise very great heat and not very much light. So, I am very delighted to call attention to the fact that we are not indeed discussing the claims of this denomination or creed, or cult, or religious body, whatever it may be properly called. We are discussing whether in fact it is a good thing in the interests of legal clarity, and in the interests of the nursing profession, that people who have not the qualifications that nurses possess should be described as "nurses," and whether confusion will arise in the public mind as to who is a nurse and who is not.
Now I am bound to tell the House very seriously that the lack of nurses in this country has reached a state of crisis. It is perfectly correct; as I think the hon. Member for West Fife (Mr. Gallacher) said that the shortage of nurses is not due entirely to the existence of what is called this obnoxious Regulation. It has not been in existence long enough. The shortage of nurses is much more material than that. At the present time it is under very urgent consideration. Nevertheless, nurses have represented to me in no uncertain terms that they regard this exception as one which derogates from the status of their profession.

An Hon. Member
Is not the word "nurse" a general term? If it is qualified, surely that is sufficient?

§ Mr. Bevan
That is the whole burden of the argument—that persons can call themselves Christian Science nurses, 1333 whereas the purpose of the Regulation and the 1943 Act is to attach a precise and particular signification to the term "nurse. "There is not so much between us as all this. I am going to ask the movers of the Motion to withdraw it, and I suggest that we should meet each other for the purpose of considering whether a form of words cannot be found which will be agreeable to all parties. I am bound, however, to say—because it would be dishonourable to say otherwise in this matter—that the concession must come from the advocates of Christian Science, because, obviously, we are taking exception to the existing words, and, therefore, if there is a modification, the modification must be at the expense of those words. However, I think accommodation can be reached. I do not think this is a matter on which we ought to have a long controversy, or any acrimony at all. I ask my hon. friends to be good enough to withdraw this Prayer and then we can meet and discuss what form of words ought to be used instead of the words here, if any form of words is necessary. I can then easily make an amendment to the Regulation to satisfy all. I hope, therefore, the House will allow the Motion to be withdrawn.

§ Captain Crookshank (Gainsborough)
In order to clarify the position, may I ask whether, if the Motion is withdrawn, there will be some conversations with my Hon. Friends, to see if accommodation can be reached? If accommodation can be reached a new Regulation will be framed and laid in the ordinary sense. If, unhappily—I hope it will not be the case—accommodation cannot be reached, it will still be open to my Hon. Friends to pray again if they wish to?

§ Mr. Bevan
Oh, yes. It would not be playing fair otherwise. If the Hon. Members withdraw this Motion and accommodation cannot be reached, then obviously they must be free to move their Motion again. That is perfectly clear, I should imagine. I do not think there will be any difficulty about that. However, perhaps we ought not to consider these hypothetical considerations, because I believe accommodation can be reached on this matter.

§ Captain Crookshank
I certainly think so, and I most earnestly hope so, but the House knows from previous experience 1334 that it sometimes gets into tangles about Regulations being withdrawn.

§ Mr. Messer
For the purpose of clarity, and so that there can be no misunderstanding, if the mover accepts the suggestion, the position will be that discussions will take place. The Regulation by that time will have had legal sanction, but if as a result of those discussions any agreement is reached, then the Minister is prepared to consider amending legislation.

§ Mr. Bevan
I can only speak again with the permission of the House and I do not want to prolong this Debate, but I do hope hon. Members will not ask me to say things which will go beyond the necessities of the case. Hon. Members will know what is my position in the matter and that I shall try to see that some accommodation is reached which will not be offensive to any party. No one will lose his rights in the matter.

§ Captain Crookshank
How many days are available?

§ Mr. Bevan
It does not matter because the Regulation can always be annulled. We are not confined to any period of time but I am prepared to enter into discussions with hon. Members at once, so that there need not be any delay.

§ Mr. Gallacher
The matter of status has been raised. Will the Minister consider raising the 75 per cent. minimum?

§ Mr. Bevan
That would be out of Order.

An Hon. Member
May I ask whether an opportunity can be afforded to authorised organisations to put their case before the Minister arising from recommendations on this matter?

§ Mr. Bevan
I will take steps to see that persons who ought to be consulted are consulted.

§ Mr. Linstead
I am extremely appreciative of the spirit in which the Minister has accepted the obvious feeling of those who have taken part in the discussion. I would like to be clear on two points. The first is that any necessary modification can be made by Regulation and not by Statute, because it would not require a Statute. The second is this. As I understand it, the 40 days runs out on 8th November. Supposing that accommoda- 1335 tion is not reached by 8th November, is it not the case that we have then lost our chance of praying against the Regulation if we desire to do so?

§ Mr. Bevan
I hope hon. Members will find they have lost nothing at all. Parliamentary opportunities will still exist. It is always open to me to amend Regulations, and it is always open to hon. Members to compel me to amend them if they so wish.

§ Mr. Linstead
Before I formally withdraw the Motion and, while thanking the Minister for his reply, I would ask whether there will be an opportunity given to my hon. and gallant Friend the Member for West Edinburgh (Lieut.-Commander Clark Hutchison) to speak on the Regulation relating to Scotland.

§ The Joint Under-Secretary of State for Scotland (Mr. Buchanan)
I do not 1336 think the hon. and gallant Member needs to make a speech on this. The only thing that concerned me on this matter was that my predecessor, Mr. Thomas Johnston, gave a very definite pledge to the Christian Science people. We should not lightly throw over a Cabinet Minister's pledge, without some examination. We want to keep things decent in our public life, and I trust negotiations will go on and at the end of the day all of us will have joined to save the constitutional position and at the same time will have shown the toleration for which Britain is noted.