§ Order for Second Reading read.
§ 8.11 p.m.
§ The Secretary of State for Scotland (Mr. Woodburn)
I beg to move, "That the Bill be now read a Second time."
It is rather an incident in the House that we now pass from one type of treatment to the consideration of another type of treatment. Bernard Shaw often complains that the party system does not work as well as the local authority system, because people are always divided. But if he had been here today he would realise that a great deal of the work in Parliament is done by general agreement with very little division, as on this particular day, when we are dealing with two important Bills. This one, like the one we have just dealt with, will be non-controversial from the point of view of hon. Members of the House. Most of us have had personal experience as patients of the work of the nursing profession at some time in our lives, and the public as a whole look up to the nurses as a noble band of women who have made it their vocation to care for the sick. Therefore it gives me very great pleasure to move this Bill which deals with the training of nurses.
For many years it has been realised that the community rather took advantage of the nurses. Nurses were overworked and in many cases had far too long spells of duty. In recent times much progress has been made towards improving the remuneration and the conditions of work of the nursing profession. The full realisation of their ambitions in this regard has been somewhat retarded by the necessity of recruiting a much greater number of women to the profession. We live in an age where there is a great scarcity of women in all fields of work, and this has delayed the full realisation of the reforms which we are anxious to make in the working of our hospitals.
The House will recollect that in 1947 the majority report of the Working Party 846 on Nurses was published. This working party gave great attention to the training and employment of nurses, and its report has been widely regarded as a thorough and able document. One of the aspects which the working party considered particularly important is the wastage in numbers which takes place during the period of training.
The working party reached two major conclusions. The first was that we should strive for a reduction in the period of training to the shortest period compatible with the production of the best nurse. This means that we must attach less importance to the day-to-day services which she gives to the hospital during her period of training. In other words, in the hospital where the nurse was doing the work a great deal of attention was given to using her services rather than to seeing that she got the maximum amount of training in the shortest period of time. The other conclusion was that all nurses should have a common basic training. Only after that training should the nurse proceed to specialise in his or her chosen field.
The Bill which I now present to the House is designed primarily to improve the training of nurses in the light of this report, and it is hoped that the steps to be taken will still further enhance the attraction of the nursing profession to the women of Scotland. Under the 1919 Act the general direction of training and registration of nurses was entrusted to the General Nursing Council of Scotland and no one wants to disturb this arrangement. The Council has discharged its functions with great credit, and what is proposed in this Bill is to make the necessary changes in its constitution to permit developments which are generally agreed to be desirable.
The first Clause, therefore, provides for the reconstitution of the Council. It is proposed to increase it to 26 members. Of these, 13 will be elected by the nurses; 11 will be appointed by the Secretary of State and two will be appointed by the Privy Council. Two of the appointees of the Secretary of State will be nurses, so that the nurses will be 15 out of 26 members. It is generally thought that in present circumstances specific representation should also be given to the specialist fields of nursing, such as fever—and the House might keep in mind that fever nursing in Scotland includes tuberculosis—sick children, mental and mental 847 defectives. It is also generally agreed that the Council should be reinforced by persons with knowledge of educational methods so that it is proposed that two members should be elected by those sister tutors who hold certificates of training recognised by the General Nursing Council.
Two of the 13 appointed members must be nurses employed either directly by the local health authorities or by voluntary organisations working for them. There must also be doctors and persons with experience in hospital management and in local government. It is also our intention to include persons with experience relevant to the new financial functions provided for in the Bill. Government money will be supplied for that purpose and considerable financial responsibility will rest upon them. The Privy Council are required to give one of their seats to a representative of the Scottish Universities, thus strengthening the educational element on the Council.
§ Lieut.-Colonel Elliot (Scottish Universities)
In order to clear up this point, may I ask who will make the Privy Council appointment? What Minister?
§ Mr. Woodburn
I take it that the Secretary of State for Scotland will have a considerable say in recommending to the Privy Council. If it is to be a Scottish appointment from a Scottish University he will consult the necessary Scottish authorities in giving advice to the Privy Council, which I am quite sure the Council will be wise to take.
§ Lieut.-Colonel Elliot
Is not it a little disingenuous to call it a Privy Council appointment if it is in fact made by the Secretary of State for Scotland? Why not say the Secretary of State for Scotland?
§ Mr. Woodburn
It is not the Secretary of State. He will give his advice, but, as in the case of the doctor's advice, the patient might not take it. I think in this case naturally the opinion of Scotland will be consulted, but there is a question of research and there are other questions which do concern the Privy Council and all this will be taken into account in deciding this. As I have said, the Council will have 15 out of the 26 members and this will preserve for the Privy Council the majority of the seats on the Council.
848 While I am dealing with the General Council, I would call the attention of the House to a new statutory committee provided for under Clause 7. I am jumping a little bit. It is part of the General Council set-up and therefore it is better to consider it at this moment. Under the Nurses (Scotland) Act, 1943, a statutory committee of the council was established for assistant nurses and it is now proposed to add a further statutory committee to be called the Mental Nurses Committee. All matters concerning mental nurses or registered nurses for mental defectives are to be submitted to this committee; with the exception of questions relating to the registration of persons and their removal from or restoration to the registers. The committee is to consist of 11 persons, of whom five will be members of the council, one will be elected by mental nurses, one by nurses for mental defectives and four appointed by the Secretary of State.
I now turn to the second main aspect of the Bill which is the organisation for training at regional levels. In their investigations the working party formed the opinion that there had been a tendency in some hospitals to subordinate the needs of training to meet staffing requirements. As long as the demand for hospital staffs exceeds supply there is, I fear, a great temptation to meet urgent needs in this way: and while the hospital authoritites will themselves wish to guard against it, it is considered desirable to provide special machinery for training purposes at the regional level. In this Bill, therefore, nurse training committees will be established on a regional level, in the first instance at any rate, to take special responsibility for training matters.
At the request of all the interests concerned the functions of these training committees are defined with some precision. Apart from assisting in the planning of nurse training the committees will generally supervise the training of nurses in the area and report to the Council on matters which appear to require attention. The committees will advise and assist the Council on matters referred to them, including the approval of institutions for the purposes of training. In some cases it may be necessary to improve the facilities for training in an area and the Bill empowers the regional nurse training 849 committee to prepare a scheme for this purpose. In such cases arrangements are made to ensure that the regional hospital board shall be consulted and that any representations they have to make are considered by the General Nursing Council before the scheme is finally approved.
The regional nurse training committees will also be given power to promote research and investigation into matters relating to nurse training. This is an important provision. The working party advocated a fundamental change in the system of nurse training—the substitution of basic training with a common register for training for a number of specialised registers. This has been widely accepted, but such a change cannot be accomplished by a stroke of the pen. Careful planning and experiment in the field will be necessary before the new system can replace the old. It is expected that the nurse training committees, working in harmony with the hospital authorities and with the approval of the General Nursing Council, will carry through the essential preliminary work.
Membership of the regional nurse training committees will be defined in the Order constituting the committees. This method has been adopted because it is not possible to insert in the Bill a precise form of committee which will suit the varying needs of the different areas. The principle is laid down, however, that registered nurses will have a majority of the seats on the committee and the classes to be given representation are also defined.
An important and essential factor in the new scheme is that the finance of training is to be separated from hospital funds generally. The Bill provides that the cost of training of nurses will be defrayed by the nurse training committees who, in turn, will be financed from Exchequer funds through the medium of the General Nursing Council. It is because of this new responsibility involving the distribution of Exchequer moneys that, as mentioned earlier, it is intended to appoint to the Council persons with financial experience and qualifications to enable them to give expert advice on the administration of training grants.
These are the major provisions of the Bill, which are aimed at improving the training of nurses. I believe that such improvement will bring with it a lower 850 rate of wastage in training and in other ways will make this noble profession even more attractive to the young women of Scotland.
We have also taken the opportunity offered by this Bill to bring about other changes which we believe will be generally welcomed by informed opinion. Clause 8 gives the General Nursing Council wide powers to admit nurses trained abroad and provides that the Council may register such persons if they are satisfied that they have received a proper training. We are very anxious to take advantage of this source of recruitment to the profession and where we are not satisfied that the people are qualified—
§ Commander Galbraith (Glasgow, Pollok)
Can the Secretary of State say if there will be reciprocal treatment in regard to our nurses in other parts of the world?
§ Mr. Woodburn
There is no condition of reciprocity, but reciprocity works two ways. It would mean that perhaps we would have to refuse the services of nurses because there were not others going in the other direction. In this case we are anxious that reciprocity should not work, in the sense that we do not wish to part with our own nurses in order to get nurses from abroad. We should much rather keep our own nurses and add to their number any qualified people coming from Canada, Australia or any other country which can supply qualified persons. Therefore, so far as we can see, we are benefiting at the moment. There is nothing against reciprocity and, of course, we are very anxious to have it but we could not make that a condition of the change.
Where the General Nursing Council are not quite satisfied with the applicant's qualifications they may prescribe the additional training and examinations to be taken in this country before they can be registered. This new provision supersedes the present arrangement which is confined to the registration of nurses trained in Commonwealth countries prepared to give reciprocal registration. In view of the shortage of women in nearly all fields of work we feel it wise to enable properly-qualified nurses from abroad to acquire full status in our nursing service.
851 Secondly, under the existing statutes an appeal against the refusal of the General Nursing Council to approve an institution for training purposes may be made to the Secretary of State. In the altered circumstances created by the National Health Service Act it is proposed in Clause 10 that in future such appeals shall be determined by two or more persons appointed by the Lord President of the Court of Session.
The Bill has been framed only after extensive consultations with all the interests concerned and I believe that, on all major points, it has the support of the nursing organisations in Scotland and of all who have the welfare of our nursing services at heart. I think that I can say that the nursing organisations in Scotland have no objection in principle to any part of the Bill, and to that extent there can be considered to be agreement between the parties. I agree with the hon. and gallant Gentleman who raised the point which naturally is in the minds of nurses in Scotland, but while they would desire complete reciprocity that is not laid down as an objection which would disqualify us from accepting this Bill as the right thing in the circumstances.
As I said at the beginning, the nursing profession, of all professions, is perhaps one which is regarded by the general public with the greatest affection and the greatest confidence. I hope that girls who have not found a niche for their abilities, or who are not properly utilising their capacities, will consider this profession as one which gives a real interest to those who take part in it. Those of us who know women who have spent their life in this profession realise that they have had a tremendous satisfaction from the wonderful amount of good which they have been able to do to other people. I sometimes think that there is no greater opportunity given to anybody in life than to try to make the sick comfortable and to give happiness and relief from pain to people. The kindness and care of nurses is almost sublime. I hope that many more girls will be attracted to this profession and that they will give their time and energies to the great healing art—to one of the noblest of our professions.
§ 8.28 p.m.
§ Lieut.-Colonel Elliot (Scottish Universities)
I am sure that we all re-echo the eloquent words used by the Secretary of State in his opening and closing remarks. The tribute which he paid to the nursing profession will certainly be substantiated by every Member of this House. His desire that as far as possible our Scottish girls should look favourably on this avenue of employment, to put it at its lowest, and service, to put it at its highest, is one which I think we all re-echo.
It is largely from that angle that we must examine this Bill. To what extent will it lead to an increase of the nursing staff in our Scottish hospitals? The machinery which is sketched out, the Council, and so on—these are primarily for the purpose, as the right hon. Gentleman has said, of checking wastage and of improving intake—wastage which is, of course, in some ways a good thing. It is a good thing that there should be a turnover in this. The milk of human kindness is not an ever-flowing spring in all of our hearts, and the fact that a certain number of girls go in and, after a reasonable time, go out of the profession is, I think, an advantage in keeping it young and fresh, and up to its enormous responsibilities.
§ Lieut.-Colonel Elliot
They may go to another form of nursing. At any rate, to say that a girl who has got married and started to rear a family of her own comes under the heading of "wastage" is in effect a definition of wastage with which not all sociologists would fully agree. The fact is that it is true, as the Secretary of State has said, that some people devote all their lives to it. They have, as the religious would say, a vocation for this. But there are others who are very well serving the community indeed by putting in a period of work here but not regarding it as the profession in which their whole lives will be exclusively spent. Therefore, we have to examine it from this point of view as well.
The Secretary of State gave, I think, a clear and sufficiently explicit account of the actual machinery of the Bill. The working party's report and the proposals which they brought forward will, I think, be generally accepted. On the whole, 853 they did receive the acceptance of the profession. However, it is certainly a matter which the House will need to keep under review, because here a very great change has taken place comparable with the change that has taken place in the conditions of other professions, to which conditions this House has devoted far longer hours and, if I may say so, far more acrimonious argument than it has devoted to this numerically far superior profession, which in the practice of medicine, is not inferior in importance even to the learned profession of which I myself was at one time a humble member. I cannot claim any more than an honorary membership now.
The numbers, of course, are very large. Girls to staff 64,000 beds had their status changed when the National Health Service Act went through. The number of nurses employed was 18,465 in the hospitals. They are not enough. It is the fundamental point that at this time, when we have a shortage of capital equipment in so many fields, here we have actually a surplus of capital equipment. We have stone and lime and buildings, the beds, technical apparatus, the equipment—everything but the skilled staff.
Without the skilled staff these other things are perfectly useless. Here it is exceptional, in our difficulties of today, in that there is here a surplus of technical equipment above what can be operated by reason of the shortage of skilled staff; and, therefore, we must bend our minds very closely to seeing how this shortage can be made good. The number of nurses employed at the end of 1948 was, as I said, 18,465. That was an increase on the number in the previous year, but at the end of the year the hospitals estimated their needs still at 6,125 more nurses. That is a large figure and, of course, it has led, as the Secretary of State well knows, to many tragic situations, notably in the tuberculosis field, where, in spite of the fact that in Scotland the tuberculosis graph has turned against us, we have hundreds—indeed, more than hundreds—of beds in the tuberculosis sanatoria unoccupied, while potential patients are still confined to overcrowded houses and are acting as a source of infection to the families with whom they continue to be associated.
The working party made rather an odd diagnosis of the difficulty. They 854 said that it became clear during the course of the interview that the crux of the whole problem of wastage seemed to lie in the sphere of human relationships, and they put down the reason for wastage, first, to the code of discipline which they said was felt to be unnecessarily severe, and, secondly, to the inadequacy both in quantity and quality of the food, the span and pressure of working hours, and such matters as poor accommodation, insufficient pay, bad recreational facilities and an unnecessary amount of domestic work. If that was so, it is a striking testimony to the voluntary hospital. The wastage in the voluntary hospital was 35 per cent. of the intake and the wastage in the others, was 56 per cent. of the intake; so is it to be supposed that the voluntary hospital successfully solved the problem of accommodation and discipline, span and pressure of working hours and such matters as poor recreational facilities and an unnecessary, amount of domestic work?
I think that the interest of the work also comes into it. If we look at the places where the wastage took place more particularly, we find that it is in those places where there is a less interesting and engrossing type of work. The wastage was, as I have said, 35 per cent. of the intake in the voluntary general hospital and 43 per cent. in the municipal general hospital. It leapt up to 56 per cent. in the case of infectious diseases hospitals, 65 per cent. in tuberculosis sanatoria and 82 per cent. in mental hospitals.
I think that indicates—I am not pressing a party point, in fact I am refraining from pressing it—that the difference between the much heavier wastage in the local authority hospital as compared with the voluntary hospital is not entirely due to the more successful system of the voluntary hospital but to the character of the work. I am stressing that point. I am giving hon. and right hon. Gentlemen that point. I think that it would be unfair to claim that, although naturally I am entitled to my own opinion. I think that in some way there was a greater flexibility in the great voluntary hospital and that the relationships were less rigid than in the local authority hospital, but I do not wish to stress that too much because I think that the quality of the work also came into it.
855 We still have this problem to deal with, particularly in the case of the tuberculosis hospital. There is undoubtedly an element of fear here, and it is not entirely unjustified. The causes of wastage through sickness, for instance, is 12 per cent. in tuberculosis sanatoria as against 9 per cent. in infectious diseases hospitals and 8 per cent. in mental hospitals. That is 12 per cent. of a higher rate of wastage. Already the wastage, as I have said, came to something like 65 per cent. It is true that there is a higher rate of wastage through sickness in the voluntary hospitals, but that is a higher rate of wastage with a smaller rate of gross wastage. The wastage due to sickness is 18 per cent. in the voluntary hospitals and 17 per cent. in the municipal hospitals; but, as I have previously pointed out, that is out of a wastage of 35 per cent. in the one case and the much higher figure of 65 per cent. in the other case.
Now, somehow or other we want to be able to remove that. It is partly psychological, but there is a little more in it than that. I remember when I first went to take a tuberculosis dispensary in the Chest Hospital in London; when I heard the storm of coughing in the dispensary my heart sank. In spite of all that one is told about there being no danger, and all the rest of it. I could not help feeling—and, mind you, I had been through the war on the Western Front before that—that this was not the sort of experience that I could go into with any light heart or joy.
There must be recognition that this is a thing to which danger attaches. I do not wish to stress it too much, and I do not want to discourage people from going into it, but we are now talking to an important technical audience, and I think it very desirable that we should direct attention towards removing, in every way, any apprehension that might be felt by the girls or their parents when we are trying to get the staffs of the sanatoria brought up to strength. It may well be that protective measures of one kind or another—perhaps protective inoculation—might be desirable, because I am sure that until we remove this fear entirely we shall not have dissipated one of the factors which leads people to stay out of T.B. nursing and to prefer other forms of nursing.
856 We must somehow or other get a more engrossing and interesting sector into the work and life of these nurses. The great joy of any medical man, or any person engaged in the work of medicine, either in nursing or anywhere else, is to see people getting better; the stimulus is to see the beds empty, the patients walking about in dressing gowns, and finally going out of the ward, and the feeling that there is a rapid turnover and that people are passing out of the hospital. That is an enormous stimulus. It is well known, for instance, in medicine that the skin ward is a gloomy sort of place, because as a rule a skin patient is in the hospital for a long, long time.
§ Lieut.-Colonel Elliot
Only sometimes, yes, but I think one would say that they are stubborn conditions to clear up, sometimes taking a long, long time, and any patient who has been in hospital a long time has a certain depressing effect upon the staff, as well as upon the other patients.
§ Dr. Morgan
The right hon. and gallant Gentleman has raised the point about the fear of infection and the protective measures that can be taken to get rid of that fear. There is another and very important factor. Is there not also the factor that no provision whatever is made for the recognition of, say, the infective disease of tuberculosis being regarded as an industrial injury, and as one that should be subject to what we used to know in the past as workmen's compensation, for which no provision is now made? Nurses who get infected in the course of and as a result of their work should have provision made for them and should not be put on the scrap heap.
§ Lieut.-Colonel Elliot
If I remember aright, only yesterday the hon. Gentleman raised the same point with his redoubtable right hon. Friend the Minister of Health, who asked that we should keep our eye on the ball. I think the hon. Gentleman is quite right to bring forward the point he wishes to make on every possible occasion, for it is in that way that reforms are made, but he will forgive me if I do not follow him along that line tonight.
I do not think we wish to spend too long on the Bill itself tonight. The 857 interesting points will come later on in the review of the Bill. But I will say this: that such figures as I have been able to get about recruitment—perhaps the Lord Advocate, either now or at a later date, can check them—show that recruitment is not perhaps as good as we had hoped. The number of general nurses placed on the register during 1947 and 1948, which are the latest years I have been able to get, are 1,027 and 856, respectively. In the case of fever nurses, the figures are 217 in 1947 and 233 in 1948. The total for 1947 was 1,399, that is those placed upon the register, and 1,251 in 1948. As for the intake coming along, the entries for the preliminary examination were 706 in 1947 and 667 in 1948. The entries for the final examination were 1,374 in 1947 and 1,217 in 1948.
It may be that the later figures show a more reassuring trend. We should be very glad if we could have some information on them. Briefly, I would say that the merging of all the Scottish hospitals into one system, and in particular the absorption of the great teaching hospitals into the general hospital system of the country, is an experiment which is still sub judice. It is not by any means certain that this is going to be the most satisfactory way to deal with the problem. It is interesting that in England a totally different approach has been attempted. The personalities at the teaching hospitals have now been meticulously preserved. We shall have to make sure whether the contrary line is going to be an advantage in Scotland.
The great voluntary hospitals have no difficulty in getting nurses. They have queues for their waiting lists. The great hospitals, such as the Edinburgh Royal, the Glasgow Royal, the Glasgow Western, the Glasgow Victoria and the Aberdeen Infirmary, have no difficulty whatever in getting girls. It is to some extent because they have been the pace-makers in the past. I trust that the new system is not going to pull back the pacemakers to the bottom level. I trust very much that this will be watched with great care, because one would say offhand that we have two systems, one of which has no difficulty in getting recruits, while the other has. Prima facie, it is not the most satisfactory approach to 858 abolish the system which has no difficulty in getting recruits and merging it with the one that has. Prima facie one would say it is a step without advantage that needs to be examined very closely in the years immediately ahead. Meanwhile, we on this side have every sympathy with the objects of the Bill. We think the machinery is satisfactory, although we may have some Amendments to bring forward at a later stage. We shall certainly give it an unopposed Second Reading.
§ 8.49 p.m.
§ Miss Herbison (Lanark, North)
The Secretary of State and the right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel. Elliot) have spent part of their time dealing with the recruitment of nurses and the very serious wastage in the nursing profession. I was very interested in the last point of the right hon. and gallant Gentleman about the great voluntary hospitals in Scotland having waiting lists of entrants for this profession. He suggested that this was perhaps because they had been the pace-makers in the past, and that it might have been a bad thing to put these voluntary hospitals into the new system.
The conclusions I have reached about the queues at these hospitals are different from those reached by the right hon. and gallant Gentleman opposite. It was said that the nurses trained at the Glasgow Royal or the Edinburgh Royal or the Glasgow Western Hospitals had very much better chances of promotion. It was not always true that their training was better than that which nurses received in other hospitals in Scotland, but they did have that prestige and it is for that reason that the voluntary hospitals have never had any difficulty in getting the nurses they required. I hope that the provisions of the Bill will lead to the further recruitment of nurses. We have had the buildings and beds, but there has been a serious lack of human material.
I also hope that the Bill will lessen the wastage of nurses. It has been said that there is a 35 per cent. wastage in the voluntary hospitals—or seven out of 20—and that the figure is higher for other hospitals. I disagree with the statement that human relationships are not the most important reason for that wastage.
§ Lieut.-Colonel Elliot
I said that the wastage is less from that cause than it is in other hospitals. I concede the point that the character of the work may have something to do with it.
§ Miss Herbison
I had a little experience as a nurse, and when I spoke on the Second Reading of the National Health Service (Scotland) Bill I had in my possession a letter from a Glasgow nurse, whom I did not know personally. She said that although remuneration was important there were other things far more important to many nurses, such as human relationships. Until there is a change in the system where the probationer is on the lowest rung and the nurse who started a few months before her has some power over her, and so on up to the rank of charge sister, we shall have to contend with the difficulties of recruitment and wastage.
I see that by Clause 2 regional nurse training committees may be set up, and I am sorry that the word "may" has been put into the Bill. This provision is one of the most important if we are to succeed in getting the best conditions for the nurses who are recruited. I wonder whether these committees will have any jurisdiction over the entrance examination for nurses. I have in mind the case of a highly intelligent girl from my own village who went to one of the Glasgow infirmaries. She sat for this entrance examination and she was rejected. Not only was her intelligence high, but she had a very pleasant disposition and was rather nice to look at. I feel that the nursing profession in Glasgow lost a very good recruit. I should like an examination made of the examinations which are set for recruits. It is not that I want a lower standard of entrance to this very important profession, but I want to ensure that those people who are willing to enter it and who have high intelligence are not kept out because of some narrow examinations.
In Clause 4 (2) a suggestion is made for a scheme of training and examination. When I first read it I wondered if this was going to mean a lowering of the standard. I am still not very sure. In educational matters I am all against rigidity in any form of examination, but we have to be very careful that we have a really good standard in this matter of the training of nurses. I am wondering 860 if this has been put into the Bill because of the difficulty in isolation hospitals. Perhaps the Lord Advocate will consider this point when he comes to reply, or it may be raised on the Committee stage.
If we are to introduce this new type of examination, and have two types running at the same time, how is it going to be regarded by the nursing profession? Will there not be a feeling amongst some that the original form of training and examination will continue to be regarded as the better form, and when it comes to promotion will there be any differentiation between those people who have had different training and different examinations? These are matters which we must examine during the Committee stage of this Bill.
Clause 7 sets up a Mental Nurses Committee. I understand that there may be some objection to this Clause by nurses in Scotland. My experience—and it was a very short experience during one of my university holidays when many Scottish students worked as I did in a mental hospital for two months—of mental hospitals and through contacts with a big mental hospital in my constituency tells me that there are problems for nurses in mental work that are not found in any other type of hospital work in Scotland. For that reason I feel that it is an excellent thing that this Mental Nurses Committee is to be set up.
The last point I want to make is on registration of nurses training abroad. There has been criticism from our nurses in Scotland. In going carefully through the Bill, I find that there are safeguards that will ensure that those nurses, who have had their training abroad, will not be of a lower standard and will be at least comparable with the standards of the nurses trained in Britain. On this question of reciprocity, I feel that we in this House cannot legislate for what other countries may do. It is true that we want to keep our nurses here if possible, but this is a democratic country and if our nurses wish to go to other countries then I hope that, since we have given a lead in the British House of Commons, it may be followed in other countries, and that there will be legislation that will allow of this reciprocity.
In the teaching profession we have a scheme for the exchange of teachers with the Commonwealth and lately with the 861 United States of America. That year of exchange is very good. I hope that in the future, as a result of the recommendations of the councils that are being set up under the Bill, we might encourage exchanges of nurses between this country and other countries.
The committees will have upon them a good proportion of the people who are actually doing the nursing work in Scotland. That is of the very greatest importance. I sometimes wish that in many of our industries the councils connected with them would have a greater proportion of workers as their members. That is one of the reasons why I welcome the provisions of the Bill. I hope that the Bill will also help the recruitment of nurses and, in a very short time, will cut down the wastage that takes place.
Nurses, in Scotland and anywhere else in the world, deserve the greatest help that they can get from anybody who can give it. I have not had the experience of being a patient and having a nurse to look after me, but I have had some experience of conditions in the Glasgow Royal Infirmary where my brother is at the present time. His praise of the nurses who have been looking after him and the other patients in that hospital is very high indeed. These women all over Scotland do very fine and important work. I hope that the Bill will help their work and that they will be given every encouragement in the future by all the departments which have anything to do with them.
§ 9.2 p.m.
§ Lieut.-Commander Clark Hutchison (Edinburgh, West)
In welcoming the Bill I would join with the Secretary of State and with my right hon. and gallant Friend the Member for the Scottish Universities (Lieut.-Colonel Elliot) in paying tribute to the very excellent work that is being done by our nurses in Scotland at the present time, often in circumstances of great difficulty. I hope that the Bill will assist that most important profession by providing it with better training facilities. The Bill is mainly a machinery Bill and depends for its effect entirely upon the powers which are used by the General Nursing Council and the Secretary of State. I hope that new and better schemes of training will be introduced as a result of it.
I understand from what the Secretary of State has said, and indeed from what 862 I have heard elsewhere, that in the framing of the Measure there has been close consultation with representatives of the nurses, and that a very substantial amount of agreement exists in the matter. Nevertheless, points of criticism have been brought to my notice by nurses living in my constituency and I should like to refer to one or two of them. Some were mentioned by the hon. Lady the Member for North Lanark (Miss Herbison). Before I deal with those points I would like to ask the Lord Advocate a question arising out of the Secretary of State's opening speech. Why do the Privy Council have to appoint two Members of the General Nursing Council? I should have thought it would have been better for the Secretary of State to appoint the whole 13 non-elected members. It seems a little odd that there should be this division. The Secretary of State gave no reason for it.
Returning to the points on which doubt has been cast by individual nurses, probably the most important is that concerning registration. There seems to be some feeling of apprehension among nurses that they are losing some right by the incorporation of Clause 8 which does away with Section 6 of the 1919 Act which provided for reciprocity. I do not take any narrow view about this. Having regard to the well-known shortage of nurses in Scotland we would be well advised to encourage the drift of fully qualified and properly trained nurses into our country, but at the same time I feel that the Government ought to do everything possible to ensure that a Scottish trained nurse going overseas gets similar treatment. That should particularly be the case in the event of a Scottish trained nurse going to one of the Dominions.
Consider the example of Canada, the Dominion most closely linked with Scotland When I was in Canada two years ago I learnt, very much to my surprise, that the British medical degree does not hold good there and that no British doctor, however eminent he may be in his profession here, may practise in Canada without taking a course of training and examinations prescribed by the Canadian authorities. I should like to know if the same thing exists in the case of nurses, or if it is possible for a Scottish nurse to go to Canada and take up her vocation there.
§ Mr. Woodburn
In case there is any misunderstanding, I can assure the hon. and gallant Gentleman that nothing appeals more to a Canadian doctor than to come to Edinburgh and take his fellowship there.
§ Lieut.-Commander Hutchison
Yes, but I meant that a British doctor cannot practise in Canada without taking certain examinations and conforming to a certain course of study there. I see that the hon. Member for Rochdale (Dr. Morgan) shakes his head, but I can assure him that I was told that in Canada. Perhaps the law has been altered in the last two years.
§ Dr. Morgan
The hon. and gallant Gentleman is a little out of date. Only about two provinces in Canada now stick to the old arrangements.
§ Lieut.-Commander Hutchison
Ontario and Quebec were the two provinces I visited. Maybe further west it is different. It would be interesting to know if the Secretary of State has in hand any negotiations with the appropriate Ministries in the Dominions on the question of safeguarding the position of our nurses as far as possible. I believe a few nurses have gone to New Zealand. I do not know whether they are allowed to practise there without any further examinations or not.
The other point to which my attention has been drawn is one to which the hon. Lady the Member for North Lanark referred, the establishment of the Mental Nurses Committee under Clause 7. I have no strong view on this because it is difficult to a layman to say whether or not it is a valuable provision, but it seems to have aroused a certain amount of disagreement among nurses. It is felt by some that there is adequate representation of all the different types of nurses in the enlarged General Nursing Council and that it is a mistake to provide a separate committee for a certain grade or class of nurses.
There are so many committees in existence now that we ought to exercise restraint in adding to their number, and it would be well if the Secretary of State trod warily in this matter because, although there may be a sound case for the establishment of a separate Mental Nurses Committee, might it not also be that there are equally good cases for the establishment of separate committees for 864 infectious diseases nurses and nurses associated with the care of tuberculosis? Indeed, if we study the working party report and the figures laid down in Tables E and G of the Appendix, we find that the percentage of wastage of student nurses in the case of tuberculosis hospitals and infectious diseases hospitals is high; not quite so high as in the case of mental hospitals, but disquietingly high.
Moreover, it will be within the recollection of all hon. Members who sit for Scottish divisions that not so long ago we had a serious Debate upstairs on the subject of the incidence of tuberculosis in Scotland. It would seem to me that any type of nurse such as those concerned with tuberculosis, faced with special problems might feel entitled to a special committee. If, therefore, we open the door to the mental nurses we might well be faced with a request for a separate committee from some other types of nurses as well.
I think it was the Secretary of State in his opening speech who said that the expenses of training incurred by the regional training committees and by the General Nursing Council would be defrayed out of Exchequer funds. That is right and proper, but it has been represented to me that much of the incidental expenses which will be incurred by members of the General Nursing Council and by the Mental Nurses Committee—by that I mean allowances to make up for loss of earnings, travelling expenses, subsistence allowances and so on—will have to be found from the funds at the disposal of the General Nursing Council. These funds will be drawn from fees and contributions from nurses who are not as a rule people in affluent circumstances, and it may involve some higher contribution.
It is felt by the nurses—and I think they have a strong case—that while it is equitable that the General Nursing Council should find the sums necessary to meet the expenses of all the elected members of the Council, the Secretary of State might look after his own nominees and the non-elected members and provide for any expenses they incur in attending meetings and carrying out their duties. The request seems to me to be a modest and fair one, so I hope the Secretary of State will give it his sympathetic consideration.
865 With those observations I shall leave any further points I have to make until the next stage, and I conclude by giving the Bill a general welcome.
§ 9.13 p.m.
§ Dr. Morgan (Rochdale)
I hesitate to intrude in a Debate on a Scottish Bill but because of my association with Scotland I hope the House will pardon me. One of the main problems raised today is that of the recruitment of nurses, and unless this problem, in Scotland and elsewhere, is tackled in a really scientific way there will be difficulties. It is not a question of training; it is not really a question of the type of hospital, it is not really a question of the attractive surroundings of the buildings. It is one of status. It is one of institutional interchange, of the right of organisation, which is denied even now to nurses in many institutions. Most of all, it is the fact of letting them have a career in a service which is recognised throughout Great Britain; a career in which they can move from special nursing to special nursing after they have had their general nursing training and gained a certificate.
And, of course, the question of human relations—although the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) tried to minimise it—is of tremendous importance throughout a nurse's career.
§ Lieut.-Colonel Elliot
I did not wish to give the impression that human relationship did not matter. I certainly give it a place of the highest importance. What I do say is that in summing up the causes I thought it was unwise to leave out the interesting, or otherwise, nature of the work.
§ Dr. Morgan
—and the right organisation comes second. Even now, amongst certain institutions in Scotland, can be seen a tremendous difference in the whole of the nursing arrangements—welfare, diet, discipline, time off duty and the way in which nurses are left to themselves. There should be a certain uniformity in the method by which the whole status of nurses is fixed. They should be given an opportunity, as in the outside world, 866 of living not always practically under supervision and on duty. That is my main point on the question of the recruitment of nurses.
I congratulate the Secretary of State on the Bill except in one particular: it is overloaded with representation of the Secretary of State. In almost every council or committee there is a majority against the elected members. Take the council, which has 13 elected members out of 26. Why cannot there be 18 elected members and 8 non-elected?
§ Mr. Woodburn
That proposition is very simple. It is the rule of the country generally that the people administering public money must have some responsibility to the person who is responsible to Parliament. That is the underlying principle here.
§ Dr. Morgan
Parliament is responsible to the nation for the expenditure of public funds. The principle of elected representatives having responsibility and some regard for public finances is, surely, established by the existence of this institution itself. It is all very well to have a certain official representation in minor institutions, but an officially appointed majority should not always be insisted upon. To have 13 elected members on a council on which a similar number are appointed by the Secretary of State is an overloading of official representation. Amongst the 13 elected members there is, quite rightly, differentiation between the different types of nurses.
Again, of 11 members on the Mental Nurses Committee, five are from the Council which has a high proportion of official representation. Why not let the Mental Nurses Committee be a really democratically-elected body, instead of being overloaded by representation from the Secretary of State? I know that by including on this committee five members from the Council and four nominated by the Secretary of State there may be a saving of money, but in a Bill of this kind a democratic spirit, at least, could be shown.
§ Mr. Woodburn
The purpose of the Secretary of State having nominees is to ensure that other representatives from the community are included. It is not merely a syndicalist organisation run solely by people engaged in the profession. The country has never accepted 867 the syndicalist idea that people in a profession should have absolute control of it. The public are entitled to see that the public and other organisations representing their own interests are included in these bodies.
§ Dr. Morgan
The Secretary of State is getting himself into very great difficulty, for of the four representatives on the Mental Nursing Committee whom he is to appoint one is to be a matron, two are representatives of the registered mental nurses, and the other is to be a doctor, a medical man. The only person not associated with this profession is the medical man, who represents an allied profession. The other four, appointed by the Secretary of State, are a matron and registered mental nurses. The Secretary of State is making tremendous difficulty for himself by saying that the people put on these committees shall be representative of other interests when they are also representative of the nursing profession. The same happens in regard to the very excellent regional training committees. I wish that instead of appointment by the regional hospital board a wider representation were allowed.
Nurses have complained to me about the threat that their registration book may not be available for them at any time to see whether they are on the register, or to see whether other persons purporting to be nurses are on the register. They want to check that and to see that the registration facilities are available to the public and the profession in almost every region. I think this is a very good Bill and a great improvement on the past. If the Secretary of State were so to organise the profession as in London, from the point of view of teaching for both mental and general nursing, in a way to allow nurses to have better opportunities for organisational facilities and elected representatives, he would be doing a good thing for the nursing profession in Scotland.
§ 9.22 p.m.
§ Commander Galbraith (Glasgow, Pollok)
It appeared to me that the hon. Member for Rochdale (Dr. Morgan), instead of bringing to bear the heavy artillery which we know he is capable of handling, on the principles of the Bill, has been bringing some lighter artillery against points which I believe we should discuss 868 on Committee stage. Indeed, what has come out of the excellent Debate we have had is that no one has really attacked the principles of the Bill at all and the greater part of the argument has been directed to supporting the principles of the Bill or to what I believe are Committee points.
I agree wholeheartedly with my right hon. and gallant Friend the Member for the Scottish Universities (Lieut.-Colonel Elliot), and with the Secretary of State for Scotland that the nursing profession is one of the noblest professions in the world and certainly in our country. It holds, has held and, we believe, will continue to hold, the affection of the general public. In days gone by, nurses underwent a very rigorous form of training and the talent and capacity of nurses came out of what I can only suggest was a very heavy ordeal. Our nurses in Scotland are known throughout the world as of the very best and we are all extremely proud of them.
Our trouble today is that we are short of nurses. No doubt there are good reasons for that and we have had some laid before us in regard to human relations, training and one thing and another. After all, times change and people's views change and we have to allow for those changes. I very much welcome the appointment of the regional training committees, which may do a great deal of good. The whole idea behind the Bill and the principles on which it stands, is surely to improve the training and make nursing more attractive and in these ways to endeavour to stop the wastage which is occurring particularly among the student nurses in their early years.
My right hon. and gallant Friend said on the subject of wastage, that a reasonable wastage in later years may be a good thing but in the initial stages it is very disturbing indeed to find the percentage of wastage to which my right hon. and gallant Friend referred. I have no doubt at all that one of the ways to stop that wastage is to see that there is considerable variety during the years of training. We all welcome this Bill, we hope it will be a great success, that it will maintain the reputation of our Scottish nurses and will give us that additional number for which we long and which is required for the proper management and equipment of our hospitals.
§ 9.26 p.m.
§ The Lord Advocate (Mr. John Wheatley)
I have particular pleasure in joining in the acceptance of this Bill. I am especially pleased that it has been so generally accepted in all parts of the House. Before saying any more, I should disclose my interest. I was Chairman of the Scottish Nurses Salaries Committee for quite a period before I became a Law Officer. I came in close contact with the nursing profession on these very matters which we are discussing, and I can pride myself on having taken a very deep interest in these matters. I feel that this Bill will be a very effective piece of machinery to enable us to effect the ends to which we have all referred, in particular to improve the intake and secondly to save the loss from the profession.
Like the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot), in all my connection with the nursing profession I have rather demurred from the use of the word "wastage." It has become a colloquial term and it is very unfortunate, particularly in the case quoted by the right hon. and gallant Gentleman. If a nurse leaves the profession in order to be married it can hardly be said that that constitutes a social wastage. I think that the machinery set up by this Bill will improve the intake of nurses into the profession and at the same time will prevent that decline in numbers, because the more we can recognise the status of nurses and the more we recognise the great contribution which they make to our national life the more people will go into the nursing profession and the more people will stay in it.
We must pay great tribute, as did the hon. and gallant Member for Pollok (Commander Galbraith) to some of the nurses who came through the ordeal in the past, when nursing was regarded as a vocation, and some people seemed to take the view unfortunately that because it was a vocation one had to undergo the life of a hermit and a martyr. Most of us have a certain view as to who was responsible for that. I do not think there is any use in having a post-mortem examination. Let us look to the future and not deal in recriminations. In saying that, while I disagree with my hon. Friend the Member for North Lanark 870 (Miss Herbison) with regard to her complaints about a hierarchy, because by the nature of the profession there must be an element of hierarchy in it, I think that if there were a new approach from the very top right down and a recognition of the human element in the profession, we could get away from those pettifogging little restraints which sometimes make all the difference between life being bearable and unbearable, particularly in institutional life.
There is only one suggestion I should like to make when I have the opportunity to do so. Although we have not yet reached the standard of perfection, if we can effect more visits to the many of our hospitals in which conditions such as have been suggested have been introduced, and let young girls coming out of school see something of the life of a nurse, see the type of bedroom she may have to herself and some of the recreational rooms which some of the better hospitals have, and the facilities available to the nurses both on and off duty, we might attract more people into the nursing profession. Local education authorities, some of whom are doing good work in this direction, might expand that particular line of encouragement.
The feature of this Bill, I think, is that it takes a further step in the recognition of the status of nurses. For instance, let us take the student nurses. Mark you, there was—I almost used the word "wastage" because it comes to one's tongue so readily—there was a large percentage of this loss from the profession amongst the student nurses. Because student nurses were often put to tasks that were not appropriate to nurses, because of the shortage not only of nurses but of domestic staff, student nurses often were allotted duties not appropriate to a student.
First, we took one step about that by referring to their financial return as a training allowance rather than as a salary, which indicated the student aspect of their work. Now, I think, by the institution of basic training, which is desiderated by Clause 2, we are making it quite clear that they are not general employees available for any type of work: and we trust that by giving that definite status to the student nurses at the very start we shall save that wastage which 871 has been characteristic in the years gone by.
It is so essential that we should get an increase in the number of nurses at present. Certainly for some years past, when I was particularly associated with the nursing profession, the profession suffered from a vicious circle. We had set up the nurses' charter of conditions of service for nurses, over and above improving their salaries, but we could not put all the conditions into operation because of the shortage of nurses, and we could not increase the number of nurses until we had put the conditions into operation.
So we were faced with that vicious circle. I am glad to think we are getting away from that, and the intake of nurses has, I think, increased appreciably since the war, as compared with what it was pre-war. The figures given by the right hon. and gallant Gentleman are substantially correct, but I do think that there is an increase, on the whole, in the number of people who are coming in. However, we are still needing many more young people to come into this profession.
At the same time we ought to pay tribute to the part-time nurses who have stepped into the breach and made it possible for many hospitals to carry on under conditions which otherwise would have made them unable to carry on. [An HON. MEMBER: "A very bad system."] My hon. Friend says it is a very bad system, but on the other hand it means all the difference in existing circumstances between getting nursing treatment and not, and so I think we are justified in adopting this system. There is a gratifying increase in part-time nurses, an increase from 2,208 in 1948 to 3,500 in 1949.
Then we come to difficulties in certain branches of nursing, and I want to deal particularly with tuberculosis nursing, which was especially referred to by the right hon. and gallant Gentleman. Knowing his keen interest in these matters I am perfectly satisfied that nothing he said was intended to discourage the nurses from going into that particular branch of nursing. However, I was rather apprehensive—and I am not saying this in a critical sense—rather apprehensive lest some of his words might have had 872 that effect unwittingly. I am quite sure it was not intended, but in case there is that danger I am sure the right hon. and gallant Gentleman will be pleased to know that I want to remove any such doubt. This is a matter which I investigated, not for the purposes of the Second Reading of this Bill, but when I was associated with the nursing profession. The information I got was this: if normal precautions are taken there is no more danger of the contraction of tuberculosis by a nurse doing tuberculosis nursing than there is by a nurse doing any other form of nursing—if the proper precautions are taken.
Another reason why there was a certain fear in the minds of nurses with regard to this type of nursing was the fact that a special payment was made in respect of this type of nursing. It was not peculiar to this type of nursing. Other specialised forms of nursing also attracted special payments. I think that we all want to try to disabuse the minds of nurses that such extra payment in tuberculosis nursing savours of the nature of danger money. I think that these special payments were a recognition of the various factors to which the right hon. and gallant Gentleman referred, and particularly to the fact that tuberculosis nursing is a most tedious form of nursing.
As has been rightly pointed out, in dealing with surgical cases the patients come into hospital, are operated upon, and are out again perhaps within a fortnight. They are in and out, and it makes life more interesting because once the operation is over the patient is often cheery and more responsive. In the case of tuberculosis nursing, the treatment may take a long period, perhaps years, and the patient by the nature of the disease and the long period of treatment may get a little difficult at times, which makes the nursing more difficult. I think that it is right that this not so attractive form of nursing, although no more dangerous form of nursing, should attract these particular payments.
I do not think that the figures quoted with regard to sickness by the right hon. and gallant Gentleman cut across what I had said, because rather curiously the percentage of sickness was in inverse ratio to the percentage of wastage, as the right hon. and gallant Gentleman called it. Roughly speaking, those groups 873 which had a smaller percentage of wastage had a higher percentage of sickness, and those with a higher percentage of sickness had a lower percentage of wastage. I am quite sure that sickness is dissociated from any contagion which may be sustained as a result of the work.
With regard to the actual recruitment and training, the right hon. and gallant Gentleman very properly said what we all know to be the fact, that there are certain hospitals which attract young nurses going into training. They would sooner remain on the waiting list to go, for instance, into the Royal Infirmary, Glasgow, or the Royal Infirmary, Edinburgh, or the Victoria Infirmary, Glasgow, or the Royal Infirmary, Aberdeen, than go into another hospital which had not the same status or prestige. I think that is unfortunate in one way because it means a delay in the training of nurses. I agree with the right hon. and gallant Gentleman that nothing should be done to diminish the status and prestige of these hospitals, but rather that we should try to build up the status and prestige of the other hospitals, and inculcate into the minds of potential students the idea that it does not really matter whether they go to one or the other because their training will be just as good.
It is like the position in schools. Certain schools have a certain reputation and people want their children to go to those schools. The children may get as good if not a better education in other schools without the glamour attached to them, but some people must send their children to a particular school. We hope that we shall bring up the other hospitals to the same prestige. Many may be entitled by the work which they do and by the training which they give to the same prestige, but the larger ones naturally attract more attention.
The hon. Member for North Lanark (Miss Herbison) dealt with a number of points which I think are more Committee points than otherwise: whether, for instance, the Nurses Training Committee should have any say in examination and things of that nature. I am not quite so sure about that point because it seems to me that the people training the young nurses are hardly the people to have a say in the examinations. The G.N.C. is an independent body and so far as that is concerned is ex hypothesi independent 874 from the point of view of the examinations.
Now I come to the three points raised by the hon. and gallant Member for West Edinburgh (Lieut.-Commander Hutchison), two of which, I think, were also raised by the hon. Member for North Lanark. First, is the question of the Mental Nurses Committee. I think that there is a very good reason for the establishment of a separate Mental Nurses Committee. We must remember that under the 1943 Act a special committee was set up for assistant nurses, recognising that they had special difficulties and special problems, and that it was better to have a special committee.
Well, we are taking the same view with regard to mental nurses, because mental nursing is much more a branch by itself as compared with fever nursing, tuberculosis nursing, and other forms which might be grouped together under general nursing. It is rather curious to note that historically, before the National Health Service came into operation, and when we had the various committees for Scotland and England to fix nurses salaries, within the Scottish nurses' salaries committee we had a special mental nurses' salaries committee, because we recognised that they had special problems and special difficulties, and that it was better to have people more conversant with those particular difficulties and problems on that committee as distinct from the general body. The mental nurses were therefore more fully represented on that than they were on the general body.
§ Lieut.-Commander Hutchison
Would it be true to say that the majority opinion of nurses prefers the arrangement that is embodied in the Bill?
§ The Lord Advocate
I think so. In my experience I have never found great rivalry between the general nurses' committee and the mental nurses' committee, but having regard to the different circumstances I think the separate committees were fully justified.
On the question of reciprocity, one thing we have to bear in mind is that we are still short of nurses. It is not much use our saying unanimously in this House that we must try to attract as many nurses as we can while at the same time maintaining on the Statute Book a provision 875 which might prevent the flow into this country of nurses whom we could absorb, and want to absorb. At the present time the law is that these nurses cannot come in unless there are reciprocal arrangements in the country of their origin. It may well be that there are countries with fully qualified nurses who want to come to this country, but with whom we do not have reciprocal arrangements. In this time of shortage are we to do without these nurses merely because we have not got reciprocal arrangements?
Let me say here and now that we should like to see all these other countries having reciprocal arrangements; but we are not going to make it a sine qua non of absorbing the nationals of a country into our own nursing profession here, if they have the requisite standard. Of course, if they fall short of the requisite standard provision is made in the Bill for further training in this country to bring them up to our standard. Accordingly, I think we have taken a very commonsense point of view here, and while expressing the hope that reciprocity will be observed in other countries we cannot in our present difficulties make it a sine qua non.
§ Lieut.-Commander Hutchison
Will the Lord Advocate follow that up, not leaving it just at hopes but entering into negotiations, particularly with the Dominions, on this matter?
§ The Lord Advocate
I am not so sure that this is so much a matter—I am expressing only a personal view just now—for any Minister of this country as for the General Nursing Council themselves to try to take up. It is very much a domestic matter, because questions of qualifications are matters more appropriate to the General Nursing Council than, perhaps, the Secretary of State. We have said that we may not recognise the qualifications of another country and will demand a further examination before we will absorb their nurses into our nursing service. However, I am informed that, for instance, there is reciprocity with Canada, with the exception of two Provinces, and with New Zealand and Australia. That is my information, and that substantially covers the Dominions.
876 The third point was in relation to expenses, and we were asked why the nurses should have an imposition to cover the expenses of the non-elected members of various committees. There are four sources of income in connection with the work done by the General Nursing. Council in respect of various duties: maintaining the register, conducting the examinations, inspecting institutions, and administering the nurses' training scheme. The Government pay considerably towards the expense of these functions, but these functions really form part of a co-ordinated whole, and the nursing profession benefit from the work of all the members of the General Council in carrying out the various functions I have enumerated. Therefore, if the nurses are getting some of the benefit, not only from one function but the four functions, it is only right that they should share in the cost.
I can give the assurance that any imposition will not be one of any magnitude. The annual registration fee at the present time is 2s. 6d. This we are not commuting at the nurses' request, although this is being done in England. I am informed that a penny on the registration fee produces a yield of £100. If we have regard to the number of nonelected members on the committee, the number of meetings and the part of the expenses which would have to be borne out of the registration fee, I am sure that any increase on the registration fee would be the minimal. I can give an assurance that there is no question of any immediate increase as the result of this particular feature.
The hon. and gallant Member asks why the Privy Council should appoint the two members and not the Secretary of State. I have not been able to get far enough back in my researches to find out the answer. I suggest that the next time the hon. and gallant Member sees Lord Alness, who was not only a Lord Justice Clerk and Lord Advocate as well, but Secretary of State in 1919 when the General Nursing Council was set up under the Act, he will find out why it was decided then that the Privy Council should make such appointments. I am not at all sure why it was, but if the hon. and gallant Member sees Lord Alness first he will find out before I do. Nevertheless, that has been the custom. 877 Previously it was one member, but now, owing to the extension of the council, it is increased to two. I am sure that no one has any fears that the powers will be exercised improperly. I can quite understand the hon. and gallant Member asking why it should not be the Secretary of State, but then my hon. Friend the Member for Rochdale (Dr. Morgan) would ask why it should be the Secretary of State, and we should get no reconciliation.
Like others, I should like to commend this Bill. I trust it will have the effect we so earnestly desire of putting the nursing profession in Scotland in its proper position, making it attractive to the young people of our country to come in and do a great social work, not under conditions of martyrdom and hermitage, in giving that succour which those of us who are ill so badly need.