§ Order for Second Reading read.
§ 11.12 a.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Blenkinsop)
I beg to move, "That the Bill be now read a Second time."
I should like to commence by expressing to the House the regrets of my right hon. Friend for his inability to be here this morning for reasons which I think are well known to everyone in the House. His regret is all the more real in view of the interest which he has taken in this Measure, and he would certainly have wished to be in his place to introduce it to the House this morning.
We all recognise the vital importance of the nursing profession in the development of our whole Health Service in this country. Indeed, there is nothing more distressing to any of us than to see, as we go round the country and look through some of our hospitals, empty hospital beds where the need for accommodation is urgent and real, and where, alas, shortage of staff means in some cases that we cannot provide the accommodation we would all like to be able to provide. During these last few months I have had the opportunity of going round many hospitals in different parts of the country, and I am sure we would all agree in our anxiety to do everything we can to improve that situation.
That is not to say that there have not been real improvements during these 894 last years. Indeed, the recruitment of nurses is steadily improving and it is very encouraging indeed that the numbers of both full-time and part-time nurses are increasing, due very largely to the administrative measures which have been taken in these last years. I mention, for example, that the total nursing and midwifery staffs of all grades in hospitals in June, 1947, was 116,500 full-time workers; by June, 1948, it had risen slightly to 118,700, and by June of this year it had risen to 127,000—a small but very gratifying increase. Again there has been an increase in part-time nurses, from a figure in June, 1947, of 10,700 to 17,400 in June, 1948, and 22,800 in June, 1949. There has been consequently a very gratifying increase in the number of staffed beds, although we must realise that as we try to improve nursing conditions it may sometimes mean a greater demand than ever for nursing staff. But we still realise how much more there is to be done, and the empty beds that still exist in our hospitals show the urgent need.
Another effect of the shortage of nurses, and in some cases of accommodation as well, is the very severe pressure indeed upon existing nursing staffs; those nursing staffs who are specially pressed are those who work in chronic wards in hospitals and those who work in mental hospitals and sanatoria where they have to work under very difficult conditions indeed. It is amazing to all of us who go and see the work they do, to find what high standards are maintained in those hospitals in spite of these very real difficulties. I am sure we should all like to pay our tribute particularly to these nurses and staff who are doing such very fine work in such very difficult and trying circumstances. [HON. MEMBERS: "Hear, hear."]
Again it must be our general concern in this House to do everything we can to improve those conditions by further recruitment and in every other possible way. This is no new problem. It is a problem that has engaged the attention of those interested in nursing over many years, and over a period of years and during the inter-war years we have had the reports of several inquiries, including those of the Lancet Commission in 1932, the Athlone Committee in 1939 and the Horder Committee set up by the Royal College of Nursing in 1943. In addition 895 there has been the Report of the expert working party which was set up under the chairmanship of Sir Robert Wood. Of course, their examinations and recommendations have been most helpful to us; some of their recommendations have been translated already into administrative action, and some form the basis for the major proposals of the Bill that I am presenting to the House.
Before I turn to the details of the Bill it is right that I should mention particularly the work of the General Nursing Council during these difficult past years, who have done so much since their inception to maintain and even improve the high standard of nursing in this country. Not so long ago I was in Australia and New Zealand, and I found there that a very high regard was held on all sides for the standards of British nursing which had been maintained during these past years.
The working party pointed out that part of the difficulty in recruiting nurses and in trying to deal with the problem of those nurses who leave during the course of training is due to the conflict between the needs of training and the needs of staffing in the hospitals. That is, indeed, a very obvious fact. All too often it is true that training has had to take a second place to staffing needs. It is true, too, that sometimes proper facilities and opportunities for study have not been available. Although we talk about a student nurse, the student part of the nurse was not always given the prominence that it deserved. It is our hope and object in this Bill to see that attention is given to the training needs of nurses. Indeed, that is the major object of this Measure. This, we hope, will in turn encourage recruitment, though we cannot hope that it will lead to any immediate recruitment return. Still, it will help in the general climate in which recruitment can take place.
Secondly, we are assured that this Bill will help to raise still further the standing of this great profession. New responsibilities are being given to the nursing profession, through the General Nursing Council, to develop the very best possible forms of training, not leaving out the desirability of new experiments in training where that is felt to be desirable. The Bill will, in our view, also give to 896 the General Nursing Council a much more intimate contact with the training hospitals, where the training of nurses is being carried out, through the institution of the new regional committees which are proposed in the Bill.
What is more, I very much hope that the election of nurses to the General Nursing Council, as is proposed in the Bill, will encourage amongst the nurses themselves a steadily greater interest in their own profession and in the Health Service as a whole, because without that we cannot obtain the co-operation through the whole health field which we so very much want to see. All these major principles embodied in the Bill will, I feel, help to encourage recruiting and help to stay the wastage—if that word can still be used after the remarks of the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) yesterday, with which I very much agree.
In turning to the details of the Bill itself, it will be seen that Clause 1 and the First Schedule provide for the reconstitution and the strengthening of the General Nursing Council to enable it to carry out the wider functions and the greater responsibilities which are placed upon it. The number of members will be increased from 25 to 34 and stronger representation is to be given to educational interests, including the universities, and to lay members experienced in administration and financial matters. Most important of all, the 14 elected nurse members will be far more representative, I hope, of the country as a whole, for they must work in the regions which they represent.
The strengthened General Nursing Council will be supported by 14 standing nurses training committees which will include representatives of the regional hospital boards and the teaching hospitals as well as of the General Nursing Council, the Central Midwives Board, local authorities and educational interests. It will be seen that the precise numbers are not laid down in the Bill because it is felt to be important to have the opportunity of varying the composition to some extent from one area of the country to another, but we have already given the pledge in another place that in making the order we shall ensure that there shall be a majority representation of nurses on these regional committees.
897 Clause 2 of the Bill sets out the duties of these new regional committees which very shortly are to provide the necessary regard to the methods of training in the region, to promote research and investigation into the training of nurses, to advise and assist hospital management committees and boards of governors in their preparation and carrying out of schemes for training in accordance with the general requirements of the General Nursing Council and to advise and assist the General Nursing Council itself where required.
Clause 3 gives special powers, as I indicated earlier, to the General Nursing Council to introduce experiments in new schemes of training when they feel it desirable to do so and under suitable safeguards, while Clause 11 looks to the time when it may be possible to provide comprehensive training with the provision of specialisation when the present supplementary register may be unnecessary. Again, however, special care is taken in the Bill to ensure that the present high standards will not in any way be jeopardised.
If training is to be given proper attention, it is clear that the finance of training must be made quite separate from the finance of administration. We therefore propose in the Bill that the funds for nurses' training will be provided by the Exchequer separately from the general provision of hospital administration. We intend that these funds shall be distributed by the General Nursing Council to the regional committees on the basis of budgets previously submitted by them, and these training committees will be responsible for payments in their areas. In this way, as I say, training responsibilities will be kept separate. We are ensuring that there shall be a responsible and independent body in the form of the new finance committee of the General Nursing Council to watch over the budgets which are submitted from the regions, to co-ordinate them as far as that may be necessary, and to present them to the Minister.
The Bill also provides for a new Mental Nurses Committee of the General Nursing Council. For some time it has been recommended that the training of mental nurses should be wholly within the ambit of the General Nursing Council and this will now be achieved. Half of the 898 membership of the new statutory committee will be drawn from outside the General Nursing Council, as is provided in the Third Schedule to the Bill.
The opportunity is also being taken to make other amendments, including the provision for the amalgamation of the supplementary part of the register for male nurses with the general part as soon as the General Nursing Council amends its rules to admit male nurses to the General Register. This is delayed recognition of the fact that an increasingly important part is being played in nursing today by male nurses. Indeed, I believe that last year some 20 per cent. of the nursing staffs in the hospitals in the country were male nurses—a fact which is not fully recognised in the country as yet.
Another amendment to the 1909 Act is one opening the register to nurses in any part of the world, subject to the General Nursing Council being satisfied that the training is up to British standards. In the past, admission has been limited to certain of the British Dominions. We feel that this is now needlessly restrictive in view of our own needs here and of our desire to accept other nurses into our hospitals.
I should like to emphasise that this Bill does not propose that the form and contents of training shall be laid down in any way by the Ministry. This is clearly a professional matter and this Bill will provide full responsibility for the professional body concerned—the reconstituted General Nursing Council. Indeed, I would rather say that this Bill is a framework or a skeleton which the professional body itself will clothe and to which it will give life. It is our duty in this House to ensure that that machinery is adequate and is available to it and to stimulate, as far as we can, the use of the machinery as soon as it is provided. We have made every attempt to have the fullest consultation with all those who are interested in the development of our nursing services in this country, and I think we have achieved, through those consultations, a very real measure of general agreement so that we can bring this Bill forward to the House knowing that it has the approval of practically the whole of the nursing and medical profession in the country. I am sure it has the approval of the country as a whole.
899 I believe that this Bill, with the administrative changes that we have already carried out, is an earnest of our desire to see a steady improvement in nursing conditions, to encourage in every way we can the recruitment of further nurses for the nursing profession and to improve still further the training facilities that are available to them. It is in that spirit that I present this Bill to the House today and I ask for its unanimous Second Reading.
§ 11.20 a.m.
§ Lieut.-Colonel Elliot (Scottish Universities)
I am sure that the whole House would wish to acknowledge our indebtedness to the Parliamentary Secretary for the lucid and cordial way in which he has presented the case both of the hospitals and the nurses to the House this morning. We, of course, quite understand the reason for the absence of the Minister of Health, and we make no demand on him, because we realise that a great responsibility falls on him as a Member of the Cabinet whose duties at the present moment have to take precedence of everything else, even of this Bill, important as it is. It is an important Bill. It deals with a large industry as well as a high calling. The actual numbers concerned are large, even for an industry. As the Parliamentary Secretary said, there are 116,000 young women engaged in it. That is a big industry. As he also said, 20 per cent. of the beds are now staffed by male nurses, which indicates that it is also an important industry so far as men are concerned.
In passing, may I say that I wish it were possible to think of some other word for the term "male nurses." The House might perhaps devote its ingenuity to considering that matter and to finding for the male section of the industry some other words than "male nurses." Nomenclature plays a strange and important part in affairs. If we could think of any other words for "veterinary surgeon" for instance it would, I believe, raise the status of that profession. "Male nurse" has a deadly, segregating effect like that horrible phrase in our social history, of which we have now got rid, "the sane poor," which always struck me as a loathsome way to describe any section of His Majesty's subjects.
This industry or profession in some ways covers the very pick of the young 900 women of our country, and those of us who have had either professional experience or experience as consumers in utilising the services of the nurses will, I think, all wish to pay testimony not merely to their high professional quality and standing—for that is recognised, as the Minister has said, in all countries in the world—but to the amount of human sympathy and goodwill which they are able to maintain under trying conditions and for years of time. It is not astonishing that one of the reasons for the high rate of turnover in this industry is marriage.
I objected last night to the description of this turnover as "wastage," because it seemed to me that for a young woman to set up a home of her own could only be described in an extremely technical sense as wastage; and the marriage rate is quite a big factor in the turnover of this industry. It amounts to 15 per cent. in the voluntary hospitals. There is not a bad ratio for the voluntary hospitals—15 per cent. from marriage and 25 per cent. from resignations. It is a more healthy ratio than the ratio in the tuberculosis sanatoria, for instance, where it is 8 per cent. from marriage and 48 per cent. from resignations, or in mental institution nursing where the ratio is 11 per cent. from marriage and 51 per cent. from resignations.
It is thus not only an important industry, covering a very live section of our community, but it is an industry which is exceptionally fluid. One of the lines of inquiry which the various committees and commissions have followed up show the reason for this large turnover. The Bill before us is designed to improve the conditions to which the various commissions have drawn attention and to diminish this rate of turnover so far as may reasonably be done. I am sure that the proposals in the Bill will be an advantage in that respect, and certainly we on this side would fully agree with the Minister's desire that the Bill should be given a unanimous Second Reading by this House.
The problem still remains pretty acute. As the Minister has said, we have at present a considerable number of empty beds. The latest information which I have is that the beds staffed and occu- 901 pied amount to 398,000 and the beds staffed and unoccupied to 56,000. The beds unstaffed are 52,000. The beds staffed and unoccupied are, of course, part of the inevitable reserves. They are not beds out of commission. But the beds unstaffed are 52,000, compared with a total of beds staffed and occupied of roughly 400,000. With the beds staffed and unoccupied, numbering 56,000, we might call it some 450,000 in all. That 52,000 beds should be unstaffed is obviously a weakness in our attack upon the forces of disease. It is a great and important sector where no assault is going forward at all, although all the technical equipment is there for the the assault to be carried out.
It is a very grievous thing to see beds, and sometimes whole wards, empty, when we all know from our personal experience how grave is the necessity for hospital treatment in this country and, in some cases, as in the case of tuberculosis, how much the problem is aggravated every month during which an infectious case remains in contact with unaffected members of the community.
Now there are certain large groups of hospitals where no such problem exists, where there is not only a full staff but waiting lists of girls wishing to enrol in those hospitals; where there are queues of potential recruits. These are, of course, the great teaching hospitals which have such prestige. There, as I ventured to say last night, in addition to the prestige, the interesting nature of the work is also a factor, in influencing the number of girls who desire to enrol in them.
Let us not under-estimate the effect of prestige and esprit de corps. The corps spirit is as effective in hospitals as the regimental tradition is in the Army. It may often be that at a time of great stress the traditions of the organisation to which one happens to belong come in to reinforce one, just as at a critical moment in battle a regimental tradition will carry a force through. Critical situations do arise in conflicts with disease, and the traditions of the great teaching hospitals are very effective in making an individual, whether nurse or doctor, feel that he or she is not alone but a unit in a great army who must not let down their particular section of the army. The position 902 in England differs from that in Scotland, in that the teaching hospitals have been strongly maintained under the English system. In Scotland that is not so. They have been merged in the general hospital system.
I am wondering whether the Government can indicate how the intake figures in England are moving. We have been given the figures as to the staffing of the beds, which were of great encouragement—116,000 in June, 1947; 118,000 in June, 1948; and 127,000 in June, 1949. I do not know how these figures are being obtained. In Scotland, the figures show a fall in the nurses entering the profession. The number of nurses placed on the register was 1,027 in 1947 and 856 in 1948—that was for general nurses. The entries for the preliminary examination—those taking the first and second parts—were 706 in 1947 and 667 in 1948. The entries for the final examination were 1,374 in 1947 and 1,217 in 1948. If the Minister could obtain the corresponding figures for England I am sure the House would be interested to have them.
The Parliamentary Secretary also mentioned the large numbers of part-time nurses, which is a useful development—10,000 in 1947, 14,000 in 1948 and 28,000 in 1949. But, for all that, I do not look forward to the day when at the gates of every great hospital nurses are seen pouring in in the mornings like typists at one of the great Government offices to be found near to this House. Somehow or other there would seem to be a certain inhumanity in the sight of all the nurses with their little brief cases tripping along to do a day's nursing of the sick. I may be old-fashioned, but somehow or other I do not think it would be to the best advantage of the profession or of the patients. I think we shall always find that there is an atmosphere about nursing which induces many of those concerned in it to wish to live on the job.
That, of course, brings in the difficulties to which the Parliamentary Secretary referred in his speech, that there is a danger of discipline degenerating into petty tyranny, a failure to alter with the times, stereotyping conditions which are long since out of date. The attitude towards smoking, for instance, failed to take into account the fact that smoking nowadays 903 is as much a habit of women, and in some cases much more of a habit, than it is among men. But, for all that, discipline and the traditions of discipline are in themselves an attraction. The Brigade of Guards owes a great deal of its attraction to its traditions of discipline, and a great hospital institution also owes a great deal to its traditions of discipline.
There must be some way of making sure that the traditions and conditions to which British nursing owes so much, as laid down in the beginning by a very stern disciplinarian in her time, Florence Nightingale, shall not be weakened and diluted until they no longer evoke the spirit of comradeship and sacrifice which is essential in a profession in which comradeship and sacrifice inevitably play so great a part. As an example however of the necessity of a new outlook, all of us acquainted with the real conditions of hospitals must look with horror at the statue of Florence Nightingale, the statue of "The Lady of the Lamp" which is to be found not very far from this House. The lamp is all very well, but we look at what she is doing with her other hand. She is holding up a series of long trailing skirts, not holding them very far up either.
It was said that there were 10 miles of corridors in the great war hospitals through which Florence Nightingale used to go every evening. With the condition of the floors of those corridors, the germ population of the skirt by the time Florence Nightingale had finished her rounds must have been such as to make any pathologist shrink in horror. The skirt would have been greatly improved if some vigorous reformer had cut it off just below tine knee, although I have no doubt that it would have shocked not merely Florence Nightingale but the eminent ladies associated with her at the time. I give that only as a case in point.
The working party threw great weight on this business of discipline. They seemed almost to over emphasise it. They said:It became clear during the course of interviews that the crux of the whole problem of wastage seems to lie in the sphere of human relationships.No doubt that is so, in general, but I think there are other factors as well. The wastage is very much less in the voluntary hospitals than in the local 904 hospitals. I do not think that is entirely due to the fact that the voluntary hospitals have solved the problem of human relationship so much more satisfactorily than the local authorities. I think they certainly are more successful. The flexibility of the private decentralised institution was a great advantage as compared with the more rigid rules of the State or local government institution. But I think there are other factors as well.
I had some experience of these problems myself when we were founding the Emergency Medical Services. We joined up the voluntary hospitals with the local authority hospitals, and I was greatly struck with the powers of initiative and acceptance of responsibility that the matrons of the great voluntary hospitals had as compared with the matrons of the local authority hospitals. That was my experience. It showed that they had been given more latitude and more freedom. Anyhow, I would say that they were women of a very high executive order, and that some of them would rank very high among executives in any walk of life, whether men or women. Some of them were serving on the Sir Robert Wood's Committee, and therefore I attached all the more importance to its report.
I remember particularly Miss Cokayne. Some of my friends by the way thought there was an almost uncanny appropriateness that a matron should have that name—although it is true it was not spelt the same way as the drug. In her case and that of many others, the country will never know how much it owes to these women. They took hold of and solved the problem of the great reorganisation of the nursing services of London, and of other areas, which enabled this country to grapple successfully with the fearful problems of the blitz.
The spirit of comradeship and service, the respect for authority and the maintenance of discipline, under conditions which had never been anticipated, even by the most enthusiastic advocates of the nursing service in the past, was a great glory of womanhood, particularly the womanhood of London and the surrounding area—the way in which these services stood up to a series of assaults which made the whole of their work a positive nightmare at times, and how the nurses managed to preserve a cheeriness and 905 good humour throughout was a standing marvel. Mark you, during that time there was no difficulty in getting nurses. We were able to maintain a higher number of staffed beds than is now being maintained. One of the difficult things about the human race is the way in which it will rise to an emergency, while the ordinary events of everyday life do not always evoke the same qualities, or at any rate the same qualities in the same proportions.
We on this side are naturally most interested in the fortunes of this Bill. Some of the points, as the point on finance committee, we pressed on the Government in another place. It eventually was decided on the present lines by mutual accommodation. The present solution I think is a great advantage, all the more so because the finances of the General Nursing Council are in a somewhat disordered state. At the end of March, 1948, they had a deficit of about £18,000, and there is an anticipated deficit of £33,000 this year. It is clear that these financial proposals will require careful supervision during the passage of this Bill.
The country I am sure wishes to extend its most cordial goodwill to the nursing profession. It holds unanimously, without any distinction of Party, that the nurses deserve well of the nation; that anything that can be done to improve their conditions and strengthen their forces ought to be done; and that it will be repaid a hundred-fold.
§ 11.53 a.m.
§ Mr. Messer
(Tottenham, South): I should like to congratulate the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) on his approach to this Bill. The information he has submitted and his deductions are certainly of very great value, and one cannot help paying a tribute to the work he has done. This is a Bill which does not involve panty politics. It is a tribute to the party system of this country that there are grounds on which all parties can meet, the grounds of humanity. When we approach a Bill of this description, apart from minor matters which can be dealt with agreeably in Committee, there is nothing which divides us. The right hon. and gallant Member spoke of the nursing profession as being the biggest industry.
§ Mr. Messer
I do not think the nurses would like that description. I think it might be better if we regard the profession as a service. It is a nursing service. Indeed, it is not a profession. It has not attained the status of a profession, but this Bill is a step towards that end. The history of nursing is very interesting indeed. We find that there has been a consistent claim made for recognition by the nurses themselves which has been steadily opposed. When it has been suggested, for instance, that there should be improvements in their conditions we have found that there has been in some cases, an attitude of mind which has regarded the very qualities required in a good nurse as reasons why they should not be given a good return for their labour.
I remember that it was only in 1936 that the late Right Honourable F. O. Roberts introduced into this House the 96-hour fortnight for nurses. It was opposed by the Government of the day. Indeed, I remember the former Member for St. Albans. Sir Francis Fremantle, saying that anything like a 96-hour fortnight for a nurse was impossible; that the nurses themselves would refuse to accept it because they would not be placed on the same level as an industry. That is all very well, but the time has passed when we can exploit the very qualities which are required in a nurse.
The right hon. and gallant Gentleman also made reference to the fact that there was a greater difficulty in the municipal type of hospital getting nurses than the voluntary type of hospital, and he thought that the matron had something to do with it. Well, the matrons of many municipal hospitals have been matrons of voluntary hospitals. I think it is true to say that within a very short space of time the municipal hospitals attained a very high standard indeed. Let us remember and pay tribute to the late Mr. Neville Chamberlain, who did magnificent work in the 1929 Act. It was only from 1930, the date of operation of the Act, to 1939 that the municipalities could do anything with their hospitals at all, and during that period there was set up the 1931 Economy Committee, which prevented the municipalities extending in the way they might otherwise have done.
907 I hope we shall remember that many municipalities did a very good job of work in the reformation and upgrading of their hospitals. Other municipalities were not able to do so because they had not the money. A hospital service is a very expensive service. Let us make a comparison in that respect. The administrative County of Lancaster, with a population of two million, can raise £45,000 by a penny rate; the administrative County of Middlesex, with a population of two million, can raise £100,000 by a penny rate. Obviously, if there is more money to spend, very much better work can be done. Notwithstanding that, Lancashire did do a good job of work in the reorganisation of their hospital services. Indeed, their tuberculosis service was very well organised indeed.
Let me now refer to the attraction that the voluntary hospital has for the nurse. The teaching hospital has certainly got a long tradition, and when anyone goes through a hospital ward, and meets the nurses and sisters and sees their badges, it is interesting to find the pride they have in their training school. Whatever we do, we must ensure that there will be that same spirit so that the nurse can always take pride in the hospital in which she trained, so that the nurse can say, "I trained at Barts, or the Edinburgh Royal Infirmary," or wherever it may be. No nurse in the world will ever say, "I am proud of having been trained by the North-Western Metropolitan Regional Hospital Board." It is an impossibility.
Yet it is the relationship of the nurse with her work which is valuable, and which must be maintained. How can we invite nurses to go to a training school which is represented by something which, to her, means nothing at all? Reference has been made to the importance of the nurse, and everybody recognises it. But it is not quite recognised in the right way. I myself have said at many gatherings, "You can have the cleverest doctor, the finest surgeon, but in the final analysis not merely the well-being of the patient but the patient's impression of the efficiency of the hospital depends on the nurse."
I think the Bill is to be commended because it deals with many weaknesses which now exist. The importance of the nurse is not to be disputed, but I wonder 908 how many members of the public, or Members of this House, know the limit which is reached before a matron closes a ward. What the matron does in face of a staff shortage is to distribute her nursing staff. It is thinned out until at last a position is reached where a nurse has a number of beds to look after which it is quite impossible to look after properly. Not until that stage is reached does the matron say, "This ward must be closed; I cannot find the staff for it." Tribute must be paid to the nurses who have stuck to that job for so long.
When referring to the difference between the municipal hospital and the voluntary hospital, especially the teaching hospital, we must remember that one attraction of the voluntary hospital is the ratio of staff to beds. There is a much bigger nursing staff in the teaching hospital, because the type of work done there requires it. We must not listen to the airy criticism that the teaching hospital is the aristocrat of the hospital world, that it is getting the cream of the nursing profession and that it is unfair that it is able to have a bigger nursing staff. The truth is that it requires a bigger staff. It will not do, when we are examining a problem of this description, to imagine that we can excuse what is lacking in one direction by what is being done in another. It is not an answer that while there is a shortage of nurses in some hospitals there are other hospitals that are either well-staffed or over-staffed. Perhaps it will not do for me to say that there is another attraction at the teaching hospital, and that is the medical student. No one would say that the nurse gives any consideration to that—at least if I do not say it, it is because I want to retain my popularity.
Then there are working conditions. We have to face the fact that there has been a definite change in the outlook of the country's youth. That change is not any less to be seen among those who want to be nurses than in others. Today, girls simply will not put up with the conditions which they are expected to put up with in many of our hospitals. Take the nurses' home. I think it is right, so far as student nurses are concerned, that they should be accommodated near enough to the hospital to allow of some oversight of their life in the home and not merely while they are in hospital. Decent parents 909 will not let their daughter go to a job hundreds of miles away from home unless they are assured that there will be not merely adequate accommodation, but that the matron or someone else will take an interest in their daughter.
I can understand a family's feeling when their girl feels the call for this great service, has an aptitude for it and wishes to be a nurse. In any case, I do not know the girl who would be a nurse if she did not really want to be one. There, are many other ways in which girls can earn their living today. As I say, if a girl is to go to a hospital a long way from home I can understand her parents wanting an assurance that there will be some oversight of their daughter, and not merely during working hours. But the same cannot be said about the mature woman who wants to be a nurse. The nurse who goes into a nurses' home is subjected to the same sort of discipline as the probationer in the ward. I believe there is a way of getting internal discipline with the consent of the nurse, and that is to extend to her the opportunity of taking part in the corporate life of the nurses' home, if she is in it, and the hospital itself.
There is no better way of getting a good nurse than to get one who feels she is able to make some contribution to the life around her. There are things which happen in a hospital about which the nurse herself feels keenly, and these could be adjusted by those in authority. For instance, there is the type of duty by which a nurse starts so late in the morning that she is unable to make any use of the hours before she goes on duty. She works late at night, and she might just as well have worked a long day. That sort of thing could be put right if nurses had an opportunity of making their contribution to what is decided.
I see no reason why a nurse should not be housed in a hostel under a warden who is not necessarily a certificated nurse herself. In fact, the home sister, as she is called, is a sister who has been doing valuable ward sister work. At a time when we are short of qualified nurses she is given a purely administrative job. It may well be that the right type of woman as warden of the hostel might have the qualifications required for the job and yet not be a nurse. There may be a ward sister who, by seniority, qualifications, and experience is due for pro- 910 motion, and ought to get it, but who is taken away from nursing and is given the job of administrative sister. We must recognise that the key nursing officer of the hospital is a ward sister; she is the centre around which almost everything revolves; she organises the ward duties and takes responsibility for the way the ward is managed.
A good ward sister can ensure not merely good work, but efficient work, which is not necessarily the same thing. There are some people who do not ask patients questions which will show the way in which nursing work is being done. I am rather inquisitive. I found on one occasion, as a result of inquiries that I made from patients, that a patient had not had a blanket bath for three weeks. There is a book called the bath book. I looked at it and found that it had been signed. That meant that the nurse had signed that blanket baths had been given when they had not been given. The ward sister never checked it. An efficient ward sister is probably the most important officer in a hospital, and I hope to see the time when we recognise the value of the ward sister so that we can keep our ward sisters, offering to them all the attractions that at the moment are offered to take them away from the job. Some administrative sisters have no other job than giving out mops, brushes and soap, and seeing that the cleaners bring back the soap that is not used. That is not a job for a qualified sister.
In the Bill we are doing something that sadly needed to be done in separating the training from the service. The nurse is not just a student; she is also a worker. She is different from the medical student in that the medical student learns and trains but is not expected to do any work until he has qualified. With the nurse, her training is divided into two parts. One of those parts is the actual work—and very hard work it is—and the other is the theoretical work under a sister tutor. She then goes on to the ward and she not merely works, but is taught by the ward sister. I should have mentioned the fact that in addition to the ward sister's other duties she has the responsibility of teaching the nurses who are on her ward and under her control. A nurse, therefore, gets practical training while doing actual work.
911 A very large part of the work a nurse does is not nursing at all, and bears very little relationship to her training as a nurse. She has to do domestic work and in some cases the nurse becomes almost an errand girl. A brilliant student who has just got his qualifications is going to do his first six months as a house surgeon. He goes round the ward and is trailed by the sister. He wants this, that and the other, and the nurse has to go and get what he wants. She is running here, there and anywhere. We ought to cut out all work that is not nursing work. Then there is the writing which nurses have to do. Much of it need not be done by nurses just as the fetching and carrying, and sometimes domestic work, should not be among their duties.
Then there is the curriculum of the State nurses. What is wanted in this connection is a girl of intelligence who may accept some measure of responsibility but who can undertake, when required to do so, some measure of initiative. At the same time it surely is not necessary to pump into her head that which would make an assistant doctor and never give her the right to use that knowledge. Tribute has been paid to the General Nursing Council, but for a long time I have criticised the syllabus for nurses issued by the Council. It contains a great deal more than the practical nurse really needs to learn. I am glad of the reconstitution of the General Nursing Council, because I can see that in that reconstitution there will be a fairer approach to this problem.
It is bound up with the case of a secondary school girl who leaves school at the age of 16. Most hospitals cannot admit a probationer until she is 18. There is a gap of two years. We have spoken of wastage, but who knows how many girls we have lost as a result of a girl who wants to go into nursing having to wait until two years have passed. In the interval she has found a job in an office where the "governor" is not too bad looking and where she earns money she would not get as a nurse. It is natural that she should be reluctant then to take up nursing.
A pre-nursing course is something of a solution to this and experiments are going on to see if that two-year period can be 912 used to prepare a girl for her nursing career. I hope when the reconstituted General Nursing Council have sat they will see that some credit is given to a girl, who used those two years in preparation and reduce the period that she is compelled now to spend in hospital. For instance, if a girl undertakes work that is going to equip her as a nurse but which she cannot undertake as training until she is 18, she is going to go into hospital for four years with some knowledge. Is she not to be credited with some period of her training for that preparatory work which she has undertaken?
When the reconstituted General Nursing Council get down to it, I know there will be many suggestions for a comprehensive basic training scheme. I am wondering whether they will want a three-year training period. I hope that they are going to abolish supplementaries on the register. What I should like to see happen is a shortened course with a basic training, and the right, if the nurse wants it, to add certificates and diplomas for certain other subjects. Let a nurse become qualified as a State registered nurse without going through the difficulty which she has to go through now and which means that a large number of nurses become assistant nurses, which is not a nice name anyway.
If the course were altered and shortened, and the curriculum made a little more reasonable many who are now assistant nurses would become nurses, and others would want to get additional qualifications. They should have a period for studying such subjects as tuberculosis. After all, the Tuberculosis Association has tried very hard to get the Tuberculosis Association certificate recognised by the General Nursing Council and put on the supplementary register. If supplementary registers are to go, that is no reason why the nurse should not get additional qualifications, such as certificates and diplomas in exactly the came way as a doctor does. A doctor qualifies, and after that, if he cares, he can take his fellowship or membership of this that or the other. He can get a string of letters after his name which nobody understands, and it does not matter so long as he is satisfied and the specialists are satisfied. Cannot that he done with nurses? Is it not possible that as soon as she is trained she should be able to get a tuberculosis certificate and other certificates dealing with health, 913 children and so on? If we did that we would avoid that over-specialisation which tends in the direction that it does not help very much in the general service.
There is one thing in this Bill which I should like to welcome. I do not want to give the impression that I am blaming the General Nursing Council for any shortcomings in the service. They have a very difficult job. It has been very difficult for certain nurses to get representation on it. I will not say a word about the fact that the matrons of municipal hospitals have found it difficult to get on the General Nursing Council. Well-known matrons of teaching hospitals have found it easier, but teaching hospitals enjoy a limelight much greater than the municipal hospitals.
What I welcome is the nurse training committee as I think it will do very valuable work. It will be closely in touch with their environment. It is quite right that there should be laid down certain conditions that will justify a recognition of a unit for nurses' training purposes, and that unit need not be a hospital. It can be more than one hospital and it can provide what is required, such as necessary training in care of children, in maternity and in general work. The nurse-training committees, being closer to the point of production as it were, will be capable of determining much better than the General Nursing Council can do at present whether or not a unit should be recognised for training purposes.
I have in mind the fact that a hospital in the East End of London which for years was recognised as a unit for training suddenly was told by the General Nursing Council that it could no longer be recognised. It was known that the authorities in control of that hospital were aware of what was wanted and proposed to do it as soon as material became available, but the General Nursing Council said it had to be done or the hospital could not be recognised. In effect that meant the closing of that hospital.
We cannot separate the training of nurses from the service. One of the difficulties that will be met here will be those, not conflicting, but varying claims, the claim of the matron for service from the nurse, the claim of the 914 school for the nurse as a student. I think they can be resolved and that the nurse-training committees, by being more closely associated with the periphery rather than the centre, will be able to get a better assessment of what is required.
We may do what we will in regard to obtaining a high standard of training for nurses but that will not solve our problem, because it will not necessarily give us the best type of nurse. This is a service that does not depend upon mere intellect. The granting of a certificate to say that a girl has passed an examination does not make her a good nurse. A nurse requires qualities that cannot be properly defined or assessed or described on the certificate. What is wanted is sympathy with the subject.
The type of girl who makes the best nurse is not the one who has the higher school certificate, not one who, by a natural aptitude, walks through examinations; it is the girl who is prepared to stay on a little longer if required by a patient's needs. It is the girl who is prepared even to run the risk of meeting with some rebuke because she thinks that the interests of the patient come first; one who is sensible to the feelings of the patient; one who takes on nursing not as a job in industry, but as an office in which she is able to render some valuable service.
The real nurse is the nurse who pays more attention to the creases on the face of the patient than the creases on the coverlet of the bed. It is those qualities we are wanting in nurses. We want the type of nurse who herself will uplift this service, and make it a service more attractive to others, not merely because of what she gets out of it, but because of what she can put into it.
§ 12.25 p.m.
§ Brigadier Peto (Barnstaple)
There is no doubt that hon. Members on both sides of the House know well the valuable contribution to the humanitarian cause and to the cause of nursing which has been given over many years by the hon. Member for South Tottenham (Mr. Messer). I am particularly happy to follow the hon. Member because on this occasion I am in complete agreement with what he has said, whereas on the last 915 occasion when we spoke following each other, which was at a brains trust at a famous teaching hospital, we did not see eye to eye on all the points that were raised.
§ Mr. Messer
I hope that was not because the hon. and gallant Member had all the brains and that I had all the trust?
§ Brigadier Peto
No, I do not think that is true. On this occasion the hon. Member has shown a great knowledge of the detail of the nursing service, and I was interested in his advocacy of taking from it all those duties at present performed by nurses which have nothing whatever to do with nursing. It was a theme in which I took the greatest interest when I was in the Army, namely, of removing from soldiers all the chores which have nothing to do with soldiering, and I feel exactly the same about nursing if it can be done.
As has already been emphasised by the Parliamentary Secretary, this Bill seeks to raise the status of the nursing service and to increase its efficiency, both in administration and training. In that regard one of the most valuable parts of the Bill is the separation of the financial side of training from administration. There is no doubt that the nursing service in this country is unequalled in any other part of the world, but there is also no doubt that the Government are to be congratulated on bringing in a Bill which seeks to improve our already high standard. There is certainly no party political controversy in a Bill of this kind, and therefore I have no hesitation in congratulating the Government and in welcoming this Bill.
Having said that, I wish to raise a point or two mainly from the aspect of the effect of the Bill on teaching hospitals. It will be a mistake if the teaching hospital is put on the same footing as other hospitals from the point of view of nurse-training and of the receipt of grants from the standing nurse-training committee. If we remove the responsibility for training from the board of governors of a teaching hospital, it will be rather like removing the responsibility for the training of his men from a commanding officer. It will be a mistake because we shall be giving the standing nurse-training committees power to increase or decrease the grants made for training in a 916 hospital. It will tend to give undue power over the board of governors with regard to training and finance.
There is at present a long waiting list in all undergraduate teaching hospitals, and in other hospitals there is a considerable shortage of nurses. It is quite erroneous to imagine that by pooling the resources of all types of hospitals more nurses will be available. The nurse who wishes to train in an undergratuate teaching hospital is likely to seek to go to one of the well-known hospitals and very often to a particular hospital. There are many reasons why that is so. The nurse may think that the standard of teaching is higher in one hospital than in another. There may be family reasons. It may be that she seeks the broader outlook and the wider knowledge which she can have by going to a teaching hospital rather than to any other hospital. If a nurse cannot get that type of hospital and very often if she cannot get the particular hospital in which she wishes to train, she will not go to any other hospital, and there will therefore be a loss of potential nurses rather than a gain.
As was said by my right hon. and gallant Friend the Member for Scottish Universities (Lieut.-Colonel Elliot), in the immediate future there is also a danger of lowering the standard and the esprit de corps of teaching hospitals. He likened it somewhat to the Brigade of Guards. That is a danger against which we must at any rate attempt to guard. Boards of Governors of teaching hospitals should have direct access to the General Nursing Council and should receive their grants from the G.N.C. I was pleased to note that a small concession was made in another place with regard to their right of appeal direct to the G.N.C. That is certainly a step in the right direction.
At the end of his speech the Parliamentary Secretary said that all those who were interested professionally were consulted about the various points in the Bill before it was drafted. He said that there had been the fullest consultations with all those interested. Did or did not the Minister consult representatives of boards of governors of teaching hospitals when he was composing the Bill? If he did, it appears to me that their view has been considerably, if not totally, overlooked. Another point which I 917 wished to put has already been cleared up. I wished to asked the Minister about the exact composition of the standing nurse-training committees. I desired to emphasise the importance of including on those committees a high proportion of trained nurses, matrons and so on. I understand now that that has already been agreed in another place.
I welcome the Bill, subject to the points I have mentioned. I believe there is a danger that we may not get more nurses unless we leave training hospitals as they are at present. Under the National Health Act, this was well understood. Teaching hospitals were allowed complete functional freedom. I regret that a departure from that principle has been made in this Bill.
§ 12.35 p.m.
§ Mr. Diamond (Manchester, Blackley)
I would first follow the usual custom in this House by declaring my interest in this matter as a member of the General Nursing Council. May I say on my own behalf, and by no means differing from any member of the General Nursing Council, that we welcome the Bill very much indeed. I should like to thank the Minister and, through him, all his officials who have been concerned with this for the consideration which they have given to the points put forward from time to time on the matters included in the Bill.
The Bill deals with two main things, the General Nursing Council and nurse-training. As to the General Nursing Council, the Bill is apparently intended to reconstitute it, and I as a member of that council am about to be subjected to reconstitution. That is a rather unfortunate word and it gives me the sort of dried egg feeling with which we were so familiar during the war, but I dare say that no better word could be found for it.
In view of what has been said on the matter by my hon. Friend the Member for South Tottenham (Mr. Messer), perhaps I may be permitted to say a few words about the work of the General Nursing Council as I have found it. Having been a member for two years, I am perhaps able to speak with some knowledge of the way it carries out its responsibilities, although having been a member for such a short time I am certainly not in a position to claim any credit for any of its achievements. As to 918 the work which it has done, I have never found a comparable body of women and men—I must put them in that order—which deals with its responsibilities more objectively, with more wisdom and with more quiet dignity than this body. It is also right that it should be said that one of the reasons why it is able to do such good work is that it is served by a chief officer, the registrar, whose competence is only equalled by her loyalty to the council.
The main responsibility of the council is to see that the standard of nursing in this country should be high. I believe that the answer to all the points referred to by my hon. Friend the Member for South Tottenham in a general way lies in this. I have made most careful inquiries from those who have very substantial administrative responsibilities in hospitals in this country, and who have had the opportunity of travelling abroad and making inquiries of their opposite numbers. I have made careful inquiries of matrons and others who have considerable responsibility in the management of hospitals staffs and nurses in this country and have had the opportunity of travelling abroad and examining their opposite numbers. I have made careful inquiries of those who, as patients, have received nursing treatment both here and abroad.
In no single case has anyone claimed that the quality of nursing anywhere in the world is higher than that to be found in this country. The General Nursing Council is responsible for the quality of the nursing in this country. It is only a reasonable tribute which should be paid in that way both to the council and, of course, to the nurses themselves, without whom the Health Service which my hon. Friend and his right hon. Friend are so anxious about—as indeed we all are on both sides of the House—would not function for long at all.
There are two points about the constitution of the General Nursing Council which perhaps I might put to my hon. Friend for his consideration, making it clear that they are purely personal points upon which I have not consulted with any of my colleagues. The first is purely a matter of machinery. I see that in this Bill, as in the previous Measure, it is intended that those who are appointed and those who are elected should serve for the same period of time and should 919 all go out of office together. My hon. Friend will know that during the war, when the 1942 election for the General Nursing Council came to be considered, it was decided in view of the circumstances which then existed that the election should not take place, but those who were due to be appointed at that time were so appointed. In fact, the election did not take place until 1944.
It follows, therefore, that since 1942 this council has had an overlap. There has never been one time when all the members, both elected and appointed, have gone into office and come out of office at the same moment. This is a problem with which all hon. Members are familiar in local authority and other matters. I take the view that it is an advantage that there should be some continuity in a professional body of this sort and that it would be a good thing if those who are appointed, or some of them, could be appointed from dates differing from the commencement of the periods of office of those who are to be elected. It would be useful if my hon. Friend would consider taking power under the regulations or in some other appropriate way to permit him to do that if on consideration he finds it to be worth while.
The other point concerns the very difficult duty, which has not been referred to so far in this Debate and which every member of the council has to undertake from time to time, of considering removals from the registry. I am sure that it is right to say that no member of that council deals with this matter with anything other than great distaste and a feeling of concern lest he or she should in any way err on a matter of such great importance.
It is inevitable that with a body of over a 150,000 registered nurses there should be cases which come from the civil courts for the council to consider whether a nurse under certain circumstances should be removed from the registry. It must be remembered that the nurse has already paid the penalty in the civil court and that this is a further penalty which she is called upon to pay. It is essential that that should be the case and that anybody who has the distinction of calling herself a nurse should abide by everything which is understood 920 by that term. But this is a very great responsibility upon those who have to decide, sometimes in very difficult circumstances, where justice both to the profession and to the individual nurse lies. It would be very serious if a person having been found guilty in a civil court then had to pay a second penalty which might not really be appropriate having regard to all nursing circumstances.
One's mind immediately considers the possibility of some form of appeal to the High Court against removal from the register. I do not think that that is at all practicable. It is something which could be considered but I do not think that it would work well. As far as I know, that practice is not adopted by similar professional bodies. I think that the Minister, when making appointments to the General Nursing Council, ought to consider whether or not it would be useful to appoint to the council from time to time those with considerable experience in a judicial capacity who could be of use to the council in other ways and could perhaps strengthen it from this aspect.
I turn to the more important question of the training of nurses, because that is what this Bill is really about. I hope that the House will bear with me if I pay my tribute to the nurses. I am in a peculiarly fortunate position from that point of view. I have been a patient and spent many months on many occasions in hospitals being restored to good health after having broken a variety of bones and having suffered from a variety of major diseases. I am bound to recognise that, having come from that stage to an occasion when upstairs I was able for what seemed to me but a moment, but what I am told was a period of some 50 hours, to enjoy to the full the proceedings which then took place. That must give me ground to pay my tribute to the good service which I have had from the nursing profession.
Again, I am in a fortunate position to be able to pay my tribute because in my constituency there are two very important hospitals, one a very large general hospital and the other a most important children's hospital. I know the very great work which is being done in those hospitals. On the question of discipline, 921 I was struck on going round the children's hospital recently in the company of the matron to see the way in which the children came on to the balconies as we walked in the ground. They waved and said, "Hello Matron" and showed delight when they saw her. I was bound to recall some 25 years ago when I was a patient and at a certain hour every morning a deathly hush fell over the ward as the matron was about to approach. No one moved. Certainly no one coughed and, as far as possible, no one breathed until the matron had been round and gone away. Then everybody relaxed and got on with the job.
I do not think that that is an individual experience. In it I think that there is one of the answers to many of the complaints which are made about over-discipline. Matrons are nurses—human beings grown up to be matrons. They bring to their duties the qualities which they acquire from their up-bringing and surroundings. We cannot do other than rely on the nursing profession to provide people who will be able by leadership and character to invest themselves with the necessary authority which some others can only provide by sheer discipline. We must leave it to them to do that. We must recognise that times are changing and that this attitude is rapidly becoming the more common of the two.
Finally, in paying my tribute to the nurses, I always bear in mind those who have one of the most arduous of nursing jobs—that of nursing the chronic sick. We all know that the real incentive to the nurse is the opportunity of healing, and the proof of that is the rapid way in which she will take a patient who is suffering from some disorder and in a few weeks see him go out hale and hearty and fully restored to health. In the case of the chronic hospital nurse, that reward is but sparingly given, and the nurse has to spend a great deal of her time dealing with patients who are likely to be ill for a very long time, many of them senile, many of them incontinent. She has one of the most difficult jobs in dealing with cases of that kind, but yet she goes on and on.
I myself will never forget a particular hospital of this sort in the city of London, where, during one night when the raids were taking place, some 80 patients and four nurses were killed, but there was no 922 trouble in that hospital, in spite of those difficult circumstances. There was no panic, and everything was done as we would expect to be done by those who belong to this very great profession. For these reasons, I want to pay a very heartfelt tribute to the nurses, because it may be from the realisation of the appreciation which is going out to them from both sides of this House and from all members of the community that we shall in fact achieve that increase in the numbers of nurses which is incidental to this Bill but not its main purpose.
This is a piece of machinery, but it depends upon the Government and the General Nursing Council and others connected with them on how well it is to work. I can only say that I have no reason to believe that we shall not continue as the General Nursing Council to receive the same co-operation from the Government as we have had before. I do not want to deal with anything that was said by the right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot) in a controversial way, except perhaps one remark which he made about the finances of the General Nursing Council, when he said that they were disorderly and required careful supervision.
§ Mr. Diamond
I can assure the right hon. and gallant Gentleman that their accounts are in no disorder at all. The deficit is large and is most precisely and clearly shown, and it is not supervision that is required but cash. The reason for the deficit is quite simply that this House has put upon the General Nursing Council two things; (a) the responsibility of doing a number of things which cost a lot of money and (b) a limitation on the amount of money which can be charged for carrying out the service. It was inevitable in those circumstances that until something was done the continually increasing expenditure and the stationary income would produce a vastly developing gap.
This is a machinery Bill, and that point is being dealt with. The Bill is welcomed by the General Nursing Council and by both sides of this House, and I can only hope that it will be welcomed also by 923 those who are nurses at the moment and those who want to train themselves for the highest of all professions—that of nursing the sick.
§ 12.55 p.m.
§ Mr. Howard (Westminster, St. George's)
I sometimes think the House of Commons is at its best when we have a Measure on which we are in complete agreement, and on which we are working together to see how we can improve it. It is true that that atmosphere is unusual and cannot always take place, but it is that atmosphere which makes this Debate a particularly charming one.
I want to follow the hon. Member for Blackley (Mr. Diamond) and support what he has said about the General Nursing Council. It cannot be too clearly recognised that the changes which are being made by this Bill in the constitution and powers of the General Nursing Council are being made in order that it may do more important work and perform greater services, and not at all because the work and services which it has performed up to now have been badly performed. There is always an inclination, when we see that the powers or the constitution of a body have been altered, to imagine that it is the result of staleness or adverse criticism. Any suggestion of that sort would be quite wrong and utterly untrue, and I would like to add my voice to that of the hon. Gentleman opposite on that point.
I find myself in agreement with practically all that was said by the hon. Member for South Tottenham (Mr. Messer), although there were matters of detail in connection with the training of nurses on which I was not completely in accord with him, but they are perhaps matters more appropriate to a Committee discussion than Second Reading. My right hon. and gallant Friend the Member for the Scottish Universities (Lieut.-Colonel Elliot) and a few other speakers have mentioned the word "discipline," and it is most important that we should have some common idea in our own minds of what we are talking about when we use that word. At the moment, I do not believe that we have any such common idea. Many people when they hear the word "discipline" mentioned, 924 think in terms of punishment, but I believe that to be totally wrong. If we get a good unit or a good working organisation and we find that the discipline is high, it is not because the punishment is severe. I believe that the true and proper definition of discipline is simply self-denial. It is the appreciation in the individual that there is something more important than himself or his own immediate personal desires. If we could get some common agreement that that was the real object and true meaning of discipline, I think we should approach very much closer to some of these problems which are at present misunderstood.
The next thing I want to say is that it is quite natural that, when a report such as that issued by the Working Party is made public, there should be frequent references to it. It is a document of the very greatest importance, but it would be totally and utterly misleading to imagine that it was an entirely non-controversial document. There are few things which have aroused more comment in the nursing world than some of the recommendations and ideas in that report, but that is not to say that there are not many points in that report which are not of great value, and it is not to say either that there is very wide agreement about some of the recommendations. To suggest that or allow the idea to become common that the Working Party report is generally accepted by the whole of the nursing profession would be entirely false, and I am glad to see that the hon. Member for Blackley agrees with me on that point.
I am not going to say much about recruitment, except that I hope we shall not think that we shall solve the problem of recruitment by sacrificing quality for quantity. Let us recognise the fact that what is regarded as the present overall shortage of nurses arises from the increasing, demands made for the services of nurses and not from a smaller supply of girls coming forward wishing to be trained as nurses, and that fact cannot too often be repeated. There is certainly an overall shortage, but the cause of that shortage is due more to the increasing demand than to the reduction in supply. On the subject of wastage, it would be very intriguing to go into the question of how much the 925 natural attraction of the male for the female or of the female for the male has an effect upon the problem. That it is a real factor, I have no doubt, but I am not going to follow the coat trailed by the hon. Member for South Tottenham because if I did I should get into far too deep water.
I wish to say one or two words on the subject of training. What is the most important thing in the production of good students in the school or college? Is it the building or the food provided for them? Surely, it is neither of those two things, but rather the influence, more than anything else, of the teachers. Is it the curriculum? Although there is a common curriculum over wide parts of the country, the results obtained in the different schools are not exactly the same. As I say, the decisive factor is surely the influence of the headmaster or headmistress, plus the indirect influence of that unknown and mysterious body, the governing body, and the assistant master or mistress.
If that is true of schools and colleges as a whole, it is equally true in regard to nursing education. Let us recognise the fact that whatever the machinery we may produce, the final results will depend on our getting the right masters and mistresses and the right governing bodies. Whether our nurses are turned out well or not will depend on the skill and ability of the management committees of the hospitals where the training is carried out, and on the matron and the nursing staff within those hospitals.
There is one other thing I wish to say about the training of nurses. We must never forget that the State registered nurse has to be prepared for the gravest and greatest responsibility that can fall upon any human being. It is the safeguarding of the life of another human being. That is a tremendous responsibility, and day in and day out these girls and these more mature women find themselves in a position where the life of another human being may be in their charge. I stress that because it means that in their training it is necessary not merely to give them certain practical techniques and certain academic knowledge, but knowledge which will lead them up to the exercise and the fearless discharge of this enormous responsibility. 926 I am glad that the hon. Member for South Tottenham mentioned the ward sister. I am sure that the key persons in the training of nurses are the ward sister and the departmental sister because it is through them that the young nurses are gradually led up to greater responsibility.
Although I welcome this Bill, I am not entirely satisfied that we have yet got the ideal machinery. It may be that within the G.N.C. we must not only have the statutory finance committee, but also the statutory training committee so that the two are in balance. But that is a matter which can be discussed on the Committee stage of the Bill. I wish to thank the Minister introducing the Bill for his repetition of the definite pledge that the majority of the members of the training committees shall be trained nurses. It is on the trained nurses that the success of this Bill will ultimately depend, and the repetition of the Minister's pledge will do more to help this Bill produce the results we all wish to see than any further words of mine can possibly do.
§ 1.4 p.m.
§ Mrs. Leah Manning (Epping)
I am glad to have the opportunity of saying a word or two on this Bill which has been welcomed from both sides of the House. I have always looked upon the nursing profession as the twin sister profession to my own because I believe that before one can enter either the nursing or the teaching profession one must at least have a sense of purpose. It may be that a sense of purpose is even more necessary in the nursing profession than in the teaching profession.
One of the difficulties about recruitment, so far as nurses are concerned, is that this profession is a very mature one. It is difficult to get a young girl to feel the pull, the attraction of this profession. On many occasions when talking to girls about to leave school, and who wanted a career, I have put the nursing career before them. But it does not attract them; nursing so often has to deal with conditions very far removed from youth; it has to deal with people who are ill, with difficult and disagreeable situations, often even nauseating to young people who are normally healthy and strong.
One of the things which has not been considered carefully enough on the question of recruitment, is how we can lead 927 young girls into the nursing profession by stages, that is, from the things with which they like to deal, to something which is perhaps more difficult and remote from their experience. Both these matters are in the hands of the Ministry of Health. The Ministry have the care of the very young child in the nursery school, and it has always seemed to me that one of the best and easiest ways of recruitment to the nursing profession is through the nursery school.
The present pre-training course does not offer the same attraction and enticement to a young girl leaving school who wishes to go into the nursing profession as the kind of pre-training course which brings her into touch with young children. The young child is attractive to young girls because the young child is normally healthy, needs their care and attracts their dawning instincts of motherhood. The real difficulty which is the result of nursing making its greater appeal to maturity must be overcome, and we have to find ways of helping the girl who wants to be a nurse to proceed from the things she likes and understands to the things she will understand and care about better as she gets older.
I did not know whether I should be able to speak in this Debate because I was waiting for certain figures about recruitment. I wonder how carefully those figures have been considered and studied by the Minister? I am not sure that the hon. Member for Westminster, St. George's (Mr. Howard) is correct in saying that it is not so much a question of the shortage of supply as of a greatly expanding demand. I think that the expanding demand certainly makes a shortage of supply, but there are many other factors about the shortage which have not been properly considered. I wonder if the Minister realises that only something like 35,000 girls of 16 years of age leave the secondary grammar school each year of which the teaching profession alone—these are the figures given by the working party for the recruitment of women teachers—will by 1952 require 11,000 recruits. That is apart from the number who will be required for building up the teaching force in the county colleges.
So far the nursing profession has mainly looked to the girls who are leaving 928 our secondary grammar schools. Their attention must be called, particularly in present circumstances, to the girls who are leaving the modern schools, because there is very much greater pool of girls in those schools. Leaving the modern schools every year there are 82,900 girls. That is a much bigger pool of girls from whom a choice can be made. One of the things that the Nursing Council, or whoever is to be responsible for this matter, will have to consider in the future are these unalterable facts that 35,000 girls leave secondary grammar schools; the teaching profession requires 11,000 of them, which leaves a very small margin for all the other jobs. The girls will go into the teaching profession. There is not the same difficulty in inducing them to do so because they have to deal with children; it is not so mature a profession as the nursing profession. That leaves something like 24,000 girls not just for nursing but for all the other demands; all the professions, the Civil Service, local government and industry.
If we consider this other pool of nearly 83,000 girls there is greater hope if only the girls can be shown a way into the nursing profession which does not repel them from the beginning. I know parents are a little anxious about the question of discipline; that factor has been mentioned today, but I do not think that it is quite such a deterrent as bad conditions. I do not think that a young person always resents discipline. A young person with a purpose in life does not resent discipline so much as bad conditions, and neither does her parents.
Conditions in which many young nurses work in the hospitals, some of which are very anxious to get nurses at present, are not what they ought to be. I am thinking of the great hospital in my own division, St. Margaret's at Epping, and their immediate need for nurses' accommodation. I should like to add to something which was said by my hon. Friend the Member for Blackley (Mr. Diamond) about the great tribute which ought to be paid to those who look after the aged and the chronic sick. What should be said of the nursing staff in a hospital which has to look after not only the chronic sick and aged but also the tubercular, which has a general ward, a maternity ward, a casual department and children who ought to be in homes 929 for mentally backward children? The conditions in that hospital, which I suppose is not alone, ought to be altered at once. This is a municipal hospital. What should be said of the matron of such a conglomeration? Has she not as much technical and executive ability as any matron of one of the great teaching hospitals?
I should like to take this opportunity of paying a great tribute to those nurses who work in hospitals such as St. Margaret's. I do not think the great teaching hospitals have any right to their splendid isolation; we should not regard them as the aristocrats of the hospitals. If they were brought under regional boards a great many of these difficulties would disappear. They themselves are helping to create the vicious circle which exists. Of course, young women want to go to these hospitals for training because of their prestige and their name; a girl has great pride in saying that she was trained at Barts or U.C.H. or Thomas' or Guys'. We must build up that prestige for our other hospitals; if we do not, we shall not increase the recruitment to the profession which we need. We must give them accommodation as well as prestige.
I know that we could get nurses at our hospital at Epping because it has a great and growing prestige in that area, but there is no accommodation for the nurses in which to sleep. Even if we get new accommodation at once the conditions might perhaps be suitable for an 11-year old girl in a boarding school. We have to do all these things for our municipal hospitals if we are to build up the prestige necessary for them to compete with the great teaching hospitals.
There are many things which still require to be considered in relation to this question of recruitment of training. The most important thing is to look up the figures and see whether it is necessary constantly to take girls from the grammar schools where the numbers are so small, and whether it would not be more profitable to consider the larger pool of girls from the secondary modern schools. I agree with what some speakers have said today. It is not ability to pass examinations which matters so much. That is not so important as the ability to deal with the needs of the sick patient; to feel the great quality of compassion for those who are suffering. We should see whether it 930 is possible to induce the great teaching hospitals to come off their perch, and help to build up for our municipal hospitals the same kind of prestige as that which the teaching hospitals enjoy at the moment.
§ 1.17 p.m.
§ Mr. Basil Nield (City of Chester)
The House has listened with great interest to the speech of the hon. Lady the Member for Epping (Mrs. Manning), and I do not doubt that the suggestions that she has made concerning the problem of recruitment will receive careful consideration.
At the outset of my observations I wish to add my voice to the many which have been raised in paying tribute to the nursing service and those engaged in it. We are all agreed that there can be no greater service in the field of human endeavour than that of tending the sick and mending the maimed. Thus this House is always anxious to see how we can help that particular calling. It appears to me that in the light of what we now seek to do, there are three ways in which we can try to help. First, we can try to improve the facilities for the training of nurses; secondly, we can seek to raise the standard or status of the calling, and thirdly, we can try to better the conditions of employment in the service so far as circumstances permit.
This Bill provides machinery for an advance in these directions. Taking my first point, I feel that we all welcome the proposals in Clause 2 to enable the Minister to set up in any hospital area a standing nurse-training committee, a committee which we see from the Second Schedule is to be carefully chosen after interested people have been consulted, and which will be required to have constant regard to the methods employed in the training of nurses, to promote research and investigation, and to advise and assist those who are required to prepare schemes of training for nurses.
That is the first step upon which we can all agree. So far as the status and the standing of the calling is concerned, it seems to me that the Bill should help in two ways. First, the reconstitution of the General Nursing Council—a reconstitution about which the hon. Member for Blackley (Mr. Diamond), I am sure, need have no fear—should assist in this direction. As the House knows, the Bill increases the number on the Council from 931 25, as it was under the 1919 Act, to 34, and I attach great importance to the fact that for the first time it is specified that there shall be a representative of the universities. Equally important, for the first time it is specified that the Council shall include two registered mental nurses and one registered sick children's nurse. I feel that those two sections of this field are entitled to that representation.
The second matter concerning status is the extension which this Bill gives to the registered status. As I understand it, under Clause 10, as the Minister pointed out when he introduced the Bill, persons who have completed adequate and recognised training abroad may now apply for registration. I also believe that Clause 14 will be very useful in removing the disability placed upon qualified persons who have left the profession for some reason—possibly to get married—and who were not within the time in getting themselves on the register. They may now apply to be registered.
Next I turn to the question of conditions of employment, with which this Bill does not really attempt to deal in detail, nor perhaps could it. I want in particular to suggest to the House that one section of the nursing calling should benefit from the provisions of Clause 9. That section consists of those nurses whose task it is to tend the mentally afflicted. There is, in the division which I represent, a number of hospitals doing excellent work and among them a large mental hospital. Thus I know well the immensely difficult problems with which nurses in mental hospitals have to contend and, moreover, the high courage and determination which they must possess. We are told that there is a falling off in numbers in this field more than in any other field, which is indeed not surprising, and we are further told by the report of the working party of 1947 that there is a danger contemplated of an increase in the numbers of the feeble minded in the population. It seems to me quite right, therefore, that it should be provided that a special committee, to be called the Mental Nurses Committee, should be set up under the General Nursing Council. To that committee will be referred all matters concerned with registered mental nurses and the training of such nurses.
932 In the light of all that has been said I feel quite certain that the Minister need have no fear that this Measure will not be unanimously welcomed as one which will do much from a machinery point of view. One hopes, indeed, that it will work smoothly and well to aid the nursing service which we all admire so much.
§ 1.25 p.m.
§ Mr. Somerville Hastings (Barking)
Might I first deal very briefly with one of the points made by the hon. and gallant Member for Barnstaple (Brigadier Peto), who demanded preferential, or at any rate different treatment, for the great teaching hospitals. As I read the Bill, there is nothing in it to prevent a nurse from going to any nursing school where there happens to be room and refusing to go elsewhere, if she so desires. I have some knowledge of the teaching hospitals as I spent my professional life in one of them and am attached to two as a member of the Board of Governors of each. I realise the great contribution that the teaching hospitals have to make both in medicine and in nursing, but I feel that they will be able to make that contribution much better as members or a part of the standing nurse-training committee rather than if they were isolated from it. I feel that your influence can be much more felt when you speak to people as colleagues and brothers rather than as rich uncles.
I want to deal particularly with recruitment to the nursing profession. Much has been said today about the need to obtain more student nurses, but I feel that there is an even greater need for retaining them to finish their course once they have entered. The right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) gave us figures of the number of nurses who did not complete their course. If I remember rightly, he gave percentages of 40 and 60 and possibly even more. As far as I know there are very few schools of nursing in this country at which less than 40 per cent. of those who start do not finish.
In my view one of the main reasons for this wastage, as it is perhaps wrongly called, is the disillusionment of the nurse. She joins as a student and then finds that the main object of the hospital that persuaded her to join is to make use of her services for routine duties and that her 933 education to become a State registered nurse is rather a secondary matter. That results in uncertainty in the nurse's mind. There is a constant conflict between her duty to herself as a student nurse and her duty to her patients. I have often had, as part of my hospital duties, to lecture to nurses who came to my lectures after an exacting eight or 10 hours of night duty, and I have not been surprised when some of them went to sleep. I would hasten to add that other people besides myself have had exactly the same experience.
Nursing, being a practical subject, must be taught at the bedside, but the curriculum should be determined by the needs of the nurse rather than the needs of the hospital. Medical students, of course, are taught at the bedside and I would point out that medical students also have important duties to perform when they are clerks and dressers in the wards, as they are called. But the content of their education and period in which they undertake it is determined by their educational needs and not the needs of the hospital. Who can complain of the harassed matron when she finds that nursing needs to be undertaken in some place, such as a chronic sick ward or tuberculosis ward, which is less pleasant perhaps than the other wards, for sending there a docile student nurse who dare not complain, rather than a State registered nurse who can give her notice any day.
That brings me to another difficulty which, I think, causes the student nurse to leave before completing her curriculum. Very often she is placed in a situation in which she may have had some theoretical training but in which there is no one to ask as to exactly what ought to be done. That difficulty causes a conflict in her mind which makes her feel that she is hardly suitable to complete her training. One must remember that while most hospitals have 30 per cent. of trained nurses doing the work, the other 70 per cent. consists of nurses who have not completed their training, and who have therefore not completed their necessary experience. Because this Bill makes a beginning of the separation of the training of the nurses from the management of the hospital, I welcome it.
A nurse in a hospital has very definite and specific duties. She is something more than a doctor's "char." She is some- 934 thing more than a person who carries out work that he has not the time to complete, or is perhaps too high and mighty to undertake. I have spent many years in hospital work, and the conclusion that I have reached at the end of it is that I know nothing whatever about nursing.
I have the greatest possible respect for the nurses, and particularly for the sister of a ward who, unlike the doctors, has to spend much time with the patients and who has enormous responsibilities. I think that in rank she should equal the physician or surgeon in charge of the ward. In addition to nursing services, she has many administrative duties to undertake. Then again she has to teach not only the nurses under her charge but also, if it is a teaching hospital, the medical students. The knowledge which many house physicians and house surgeons acquire is to a large extent due to the sister of a ward who, as a woman of experience, is able to keep them on the right lines.
While this very high standard of training and general education is necessary for a ward sister, I do not feel that it is essential for other nurses, and because this Bill, in Clause 3, gives opportunity for experiment in nurse-training, I particularly welcome it. I have been to a good many nurse training schools and I have seen the sort of things that are taught to the nurses. Many of these I do not know myself and many of them I have never known as a doctor. The nurse learns a lot of such things, like a parrot, in preparation for examinations, and then promptly forgets them and is all the better for forgetting them.
In my view, we need not demand a very high standard of general education for every nurse, and I feel that if it is made a much more practical and intensive training it could be carried out in a much shorter time. I think that for the nurse who wants a qualifying degree and not such a degree as would fit her to become a sister or matron that two years training ought to be sufficient.
One of the best nurses I ever worked with was heard to say, when a child choked over a glass marble and sucked it into its wind pipe, that she thought that if the child had been given a good dose of castor oil, all would have been well. I feel that if such a nurse with obviously very little anatomical knowledge could 935 serve her patients well, as this one undoubtedly did, then we can consider experiments in the reduction of the content of nursing training, and I suggest that a couple of years intensive study of practical nursing should be sufficient.
I think that the Bill goes to the root cause of many of our difficulties in recruitment. It may be asked: how can hospitals with 50,000 beds already closed for want of nursing staff do without this source of docile cheap labour? I believe that there are ways in which we can manage this. After all, the student nurse is not a skilled nurse, and although in a hospital there may be many women in nursing costume there are, as I have already pointed out, an average of only about 30 per cent. who are really trained nurses. Beside the student nurse will still work in hospital, although I suggest that her training should be determined not by the needs of that hospital but by her needs as a student. I suggest, too, that if we carry out to the full the suggestions in the Bill there will be fewer nurses leaving, the turnover will be quicker, and more nurses will be trained it a two years' course is adopted instead of the present three or four years' course.
There are many means of increasing the supply of nurses to a hospital which have not been thoroughly explored so far. I think that we could dilute our nursing staff much more. It seems to me absurd to watch two trained nurses making a bed together, when one of them is quite sufficient with somebody untrained. Even an ordinary person like myself is capable in the hour of need to help to make a bed. The position of the matron, it is suggested, may be difficult but I do not see why. A nurse when she is on duty in a ward will be under the strict discipline of the matron, but when she is off duty, like every other student, her main care will be study and recreation.
In one of the hospitals with which I am connected, Hammersmith Hospital, we have had for many years a nurses' home under the supervision of a warden, not the matron; the warden is not a nurse, and never has been, and the same applies to the assistant warden. That works very well indeed, and the student nurses, of whom there are some 300, who live in the nurses' homes are under the 936 discipline of the matron only when they are on duty in the wards. In my view we shall solve our nursing problems only by making the student nurse a real student, and by making the curriculum of training depend upon her educational needs. As far as this Bill carries that out it will, in my opinion, succeed. I cannot see that the employer can ever be at the same time the teacher.
§ 1.41 p.m.
§ Mr. Linstead (Putney)
This morning we have had a remarkable contribution of knowledge and experience to the subject we have been discussing. One only regrets that, owing to the day chosen for the Debate, such a small attendance of Members has been possible. One hopes that the nursing profession will have the opportunity of reading at least summaries of what has been contributed this morning, and of getting the benefit of all the experience that has been put at our disposal.
I was most interested in one remark made by the hon. Member for Barking (Mr. Hastings) when he was dealing with the shortage of staff and the possibility of making better use of the trained nurses we have. There is, of course, the practical difficulty, at any rate in London, that it is almost as difficult to get domestic staff as it is to get nursing staff. I think the hon. Gentleman would probably agree with me in one analysis of the problem that I should like to put to the House. There is a danger of the nursing army being almost all officers with not enough privates. I wish to urge the claims of fuller recognition for the assistant nurse, because the assistant nurse is usually the girl who has the natural capacity for nursing but possibly has not the capacity for passing examinations.
We make great use of the assistant nurse in the hospitals, and I should like to see that more fully recognised. One small step in that direction would be some change in the name. At present the situation is anomalous. They are by statute entitled to be called nurses, yet their statutory register is called the Roll of Assistant Nurses. If we could find some way of bringing the statutory name for the register into line with the statutory title they are entitled to use we should have gone some little way towards recognising the position of this 937 indispensable section of the nursing profession.
I am sorry that the hon. Member for Blackley (Mr. Diamond) has had to leave us, because I was particularly interested in what he had to say about the judicial functions of the General Nursing Council. I think he allowed himself to be led astray a little when he talked about a professional body having to impose a second penalty, because these professional bodies must never have that in their minds when they are deciding these cases. They are not considering the imposition of a penalty upon the person who comes before them; they are considering the question whether or not it is in the public interest that that person should be allowed to continue on the register, which is quite a different matter. The position of the individual has, unfortunately, to be put out of their minds, and the public alone considered.
I think the hon. Member was on very sound ground, however, when he drew our attention to the difficulty experienced by the General Nursing Council in dealing with their judicial functions. He did not say so, but I think that a large part of the difficulty arises from their size. They had 25 members in the past, and they are to have 34 in future. For a body of that size to sit in a judicial capacity tends, I think, to make a very clumsy machine. I am sure that a smaller committee presided over, as he tended to suggest, by somebody with legal experience would be the best way of fulfilling the judicial functions of the Council.
I agree with the hon. Gentleman, that with the General Medical Council, the Dental Board, the General Nursing Council, and with the Pharmaceutical Society Statutory Committee the appeal machinery is not really satisfactory. At the moment, there is in most of these cases a technical appeal to the High Count. But what does the High Court do? The High Court usually says: "This case has been before a professional tribunal appointed by statute. That tribunal has heard the parties; natural justice has been satisfied, and we do not propose to interfere." Probably at some time this question of a proper appeal court, with facilities for re-hearing, for a number of these professional domestic tribunals would be a very valuable thing.
938 There were a number of small comments that I was proposing to make on the Bill, but in view of the fact that the Debate has continued for some long time I will do so only extremely briefly. I think we have all welcomed the institution of the standing nurse-training committees. As the Parliamentary Secretary will know, the precise name to be given to these bodies has been the cause of a certain amount of discussion, I think rightly. If they are called committees and operate in regions they will be regarded as committees of the regional boards. If they are called councils there is a danger of confusion with the General Nursing Council. It was suggested to me only yesterday by the Royal College of Nurses that it might be better to call them nurse-training authorities. That is not the best word possible, but at any rate it is free of the ambiguity which attaches to both "committee" and "council." I hope we shall be able to consider that in Committee.
I was also very glad to see the acceptance of the principle of the registration of foreign nurses. Here I would again put in a plea for those foreign nurses who are at present still in refugee camps in Europe. If there is anything more that we can do to get these women over to this country and back into their professional work, recognised on the register here, I am quite certain that it will be not only for their benefit but also for the benefit of this country.
There are just two other matters to which I should like to refer, one quite briefly and the other at a little more length. We have heard that the financial position of the General Nursing Council is not all that it might be. It apparently has a very accommodating bank manager, but that is about all that can be said for it. I notice, however, that the new powers for registration fees include a power which seems to me to be very dangerous from the financial point of view, and that is to register on the payment of one fee without limit of time. That really does want looking at, because it is very unlikely that they will be able to charge a life fee, the interest from which will be sufficient to pay the costs of the permanent registration of a nurse. It was tried for the General Medical Council and has been one of the causes of the financial difficulties of that council.
939 The main point to which I particularly want to draw attention is the financial machinery for nurse training. I can speak here with some experience, because for about 20 years I have been dealing with almost the same problem in the pharmaceutical world—the relationship between a body which prescribes standards and the universities and technical colleges which have to provide the training up to those standards. I am quite certain that the two functions must be kept completely separate. If the same body is both prescribing standards and providing the facilities by which those standards are to be reached, there is a blurring, and an inevitable compromise and a lowering of standards. I am certain experience will show that a mistake has been made in conferring upon the General Nursing Council the ultimate authority for making financial grants for training.
§ Dr. Morgan (Rochdale)
The hon. Gentleman has just said that a body responsible for teaching should, if possible, be distinct from the body setting the standard of the examination itself. That is how I understood it.
§ Dr. Morgan
In the universities of, say, Scotland, and indeed of England, that method does not hold. The universities of Scotland have a very high standard indeed, and they supervise and provide both the tuition and the standard of the examination.
§ Mr. Linstead
Yes, but I am now talking about professional qualifications carrying with them registration. If I may take the example of the hon. Gentleman's own profession, he will recognise at once that the General Medical Council does not itself run a school of medicine; it prescribes the standards which are to be reached by schools of medicine, but nobody would suggest for a moment that it would be fulfilling its proper function if it proceeded to have a school of medicine of its own.
§ Dr. Morgan
But the General Medical Council is an entirely different body; it is a statutory body whose duties are laid down by legislation. The hon. Gentleman said he wanted the body responsible for tuition and training kept distinct from 940 the examining body. I was only pointing out that that is not the system which has been in vogue in Scotland for a century—and with great benefit to the students.
§ Mr. Linstead
Possibly I have not made myself clear. I will re-state the case in this way: the body which prescribes the standard of professional education for registration purposes should not at the same time be the body which provides the means by which those standards are reached. I would take medicine, or dentistry, or pharmacy or nursing up till now, as examples, and I would say I am sure it is essential, if there is to be a proper professional standard attained in an examination, that the institution where that is to be given should be inspected by the professional body, that the standard of the examination should be prescribed by the professional body, and that a register should be maintained by the professional body; but once that professional body starts itself to do a job of which it must be the judge I am sure there will be a blurring of frontiers, a lowering of standards and a compromise.
§ Mr. Linstead
I am afraid I cannot give way to the hon. Gentleman again.
I remember the Debate which took place on this question on this Bill in another place, and I am sure that when the other place amended this Bill and provided that it should be not the General Nursing Council which made these financial grants but a separate body, it was right; it was keeping the two distinct functions completely separate. When it had second thoughts on Report stage and handed back to the General Nursing Council the task, not only of prescribing the standards but also of providing the facilities by which those standard are to be reached, it made a fundamental mistake which will be discovered only if it remains in the Bill, and as experience develops.
If we take, as an example, what now happens now in the nursing world: the General Nursing Council go to a hospital and say that they want this and that standard reached before they approve the hospital. The hospital has to do its best to reach that standard, and if it cannot do it the council say that they will give approval for one or two 941 years and will then come round and look again at the hospital. All the time the council keeps the screw turning. But if that hospital can turn back to the General Nursing Council and say that it is no concern of theirs, and that if they are to reach that standard they must provide the money, the council is put in an impossible position. It is acting as judge and advocate for the other side.
I am sure the Minister would be wise to look at this again. I know we are compromised because the Scottish Bill has accepted this principle. The Minister has to find some way of separating completely financial grants from prescribing the purposes and standards for which those grants are to be used. I will say only one other thing in support of the argument. The General Nursing Council is constituted for quite a different purpose. It is constituted to be an examining and disciplinary body. It is not constituted to be a grant-distributing body. If it has to be that, I am sure its membership must include a much larger proportion of those who are actually engaged in the day-to-day running of training schools and hospitals, and that many women who are appointed primarily for the other functions of the council are not necessarily the best people for grant-distributing functions.
It may be that the newly constituted finance committee can be given complete independence for this purpose, but as the Bill is constituted there is not that independence, and the General Nursing Council must endorse the recommendations of the finance committee. I am certain, speaking from long experience, that there is a flaw here in an otherwise admirable Measure, and I very much hope it can be considered to see whether we cannot separate standard prescribing from granting facilities. Apart from that important point, I warmly welcome the Bill.
§ 1.58 p.m.
§ Mr. Skinnard (Harrow, East)
I regard it as a happy coincidence that twice in the course of one week I should have been called to follow the hon. Member for Putney (Mr. Linstead), but I shall not follow him into the argument he developed with my hon. Friend the Member for Rochdale (Dr. Morgan) in regard to the technical subject of granting aid 942 and prescribing courses of study. I would rather stress the feeling which has been expressed by nearly every Member who has spoken in this Debate, that all this admirable Bill can hope to do is to provide machinery for the purpose we have in mind, but that it cannot ensure that it will be achieved. That is a matter for the nursing profession and for the nursing profession alone. It must solve its own problems; but if we can provide, as in this Measure, some assistance to make their task easier, then we shall feel we have done a good job today.
My hon. Friend the Member for Barking (Mr. Hastings) raised a point, which I have had discussed with me by matrons and sister tutors, regarding the type of students admitted to hospital training and the reasons for their selection. It was on that point, as well as on a couple of others, that I wanted to come down to the House today and put a view which I think is a valid one. We cannot blame the matron of a hospital if, today, she selects as probationers second rate student material. She is in a jam because she cannot get sufficient trained help. As my hon. Friend rightly said, if the purpose of the student nurse in entering a hospital is to be helped to pass an examination which will make her a State registered nurse then the matron is wrong, although we can sympathise with her motives.
I want, however, to say a few words for the would-be students who have been deterred from entering even though matrons would have been more right to accept them. My hon. Friend the Member for Epping (Mrs. Manning) mentioned that the field of selection from secondary grammar schools is very small. Girls leaving these schools in their last year are accustomed to compare the various curricula for the different professions. I have had cases brought to my notice where the highly technical language used in the curriculum for nurse training has deterred girls, who have selected, in preference, what I should have regarded as a much more difficult course leading to an honours degree in arts. The language has been a deterrent.
There are girls who are capable of passing examinations, and making good nurses, but who have been put off by the enormous scope of the training which 943 they are expected to undergo. For that reason I think there is a great deal in the plea of my hon. Friend the Member for Barking—who, after his many years of experience in the medical profession and hospital work, should know what he is talking about—for not lowering the standards but for a simplification of the curriculum, a restriction to essentials. It should be restricted to the essentials for an ordinary working nurse, to the work which she normally may be expected to do during her career.
Today, a great deal of unification of hospitals is taking place; we are getting bigger and bigger units and fewer nurses than ever before will be called upon to take administrative jobs, say, of the rank of matron or deputy matron. The avenues of promotion are fewer because we are ever trying to make more economic hospital units. That being so, the average student nurse must look forward, if she is to remain in the profession, to a life confined mainly to the wards. High tribute has been paid today to the ward sister. I, too, believe that she is one of the principal persons we must help by means of this Measure. She is the king pin, if I may use that expression, in the actual technical work of the hospital.
Because of that I look at the provision in the Bill for the selection and election of the General Nursing Council for England and Wales. There are to be 34 members of the council, and I am sure that all of us who have had experience on councils and committees know how difficult it is to get a point of view over unaided in a large body of that kind. We appreciate how difficult it would be if a proposer could not expect to find a seconder for any motion she might wish to put before the council.
What is the provision for nurses' representation? By paragraph 2 (1) of the First Schedule there will be 14 elected members of the council who shall be nurses registered in the general part of the register, and these 14 will be elected each from a different region. We have heard that nursing is a practical art so, obviously, there should be a fair working representation on any council devised for the purpose we have in mind. Ward sisters, and clinical teachers, should be well in evidence. I will risk a prophecy 944 about the way in which this particular group will be made up. For prestige reasons, and also because of the high regard in which they are rightly held, there will be a very large number of candidates from among the matrons of our well-known hospitals. Each of these very important and faithful servants of the public has an office and a stenographer. The ward sister, who has very limited spare time, has no stenographer and no office equipment. How many ward sisters, even if they dare put themselves forward for election, will stand a dog's chance in the selection for this particular section of the General Nursing Council?
It is true that the First Schedule says that there must be at least one ward sister. Paragraph 3 (d) says that sheshall be a registered nurse in charge of a ward in a hospital which is an institution approved by the Council for the purposes of the training rules.…It is therefore regarded as important to make sure that one ward sister will be on the council. It is true, as my hon. Friend the Member for Blackley (Mr. Diamond) said, that matrons have grown up from nurses, but sometimes they have grown up rather far away from them, because they are primarily administrators and discipliners. The ward sister is the common denominator of the nursing side of the hospital; she is the link with, and sometimes the protector from, the matron; she has to teach students; she has to look after the staff nurses, help the assistant nurses and is even called upon to do part of the training in the classroom, to help the sister tutor; she is in a very important strategical position in a hospital, and yet there is to be only one assured place for her on the General Nursing Council.
I suggest—and perhaps we can deal with this in Committee—that there ought to be at least two ward sisters on the General Nursing Council, by right and not by election. I have expressed my doubts about the chances of a ward sister in open competition against a matron in any of the 14 regions. I know that this is a point that may be disputed but I believe, and I know that the average ward sister also believes, that what I am saying is true. We should make sure that there are two voices which could put forward their point of view, so that a proposition 945 need not miss discussion because it cannot find a seconder. I would ask the Minister to have another look at the First Schedule in view of what I have said. If he would talk over this point objectively with nurses' representatives I am sure that he would feel that there is a genuine case for a slight emendation of the Schedule in this respect.
It only remains for me to add my voice to those raised so far in praise of the intentions of the Bill and of the way in which it has been worked out. I feel, as I said in the beginning, that we are giving machinery to a profession which is ready for it and anxious to use it. I hope that the passing of this Bill will be the boon we think it will be to the very great profession of nursing.
§ 2.10 p.m.
§ Mr. Sorensen (Leyton, West)
I am quite sure all of us have appreciated today an impressive display of interest, detail and knowledge of the nursing profession. I am equally sure that if some hon. Members do not get refreshment soon they will be in urgent need of nursing service. For that reason I do not propose to speak very long, particularly as one of the points I intended to make has been put by my hon. Friend the Member for East Harrow (Mr. Skinnard), But firstly, I would join with all those in commending the Bill to the House, and trusting that in the Committee Stage it will be further improved so as to give all the more encouragement to the nursing profession.
I am very glad that the first intention of this Bill is to reconstitute the General Nursing Council. Personally, I think this is very much overdue. Possibly the Bill has been introduced because there is at the present moment a very grave lack of nurses, yet apart from that I think there is an intrinsic need to reconstitute this very important body, and it should have been attended to some time ago. Whether the nurses are going to respond to the opportunities to be elected to the body I do not know. I rather doubt it, because it is most likely—and here I entirely agree with my hon. Friend the Member for East Harrow—that we shall get a surplus of matrons on the Nursing Council.
It is highly likely that the ward sisters, who are not only exceedingly busy but may be unaware of some of these extra admin- 946 istrative duties, will not be ready to accept the opportunity now afforded to them. We know, of course, there is a grave shortage of nurses at the present time, due particularly to the very welcome and splendid expansion of the medical services available to the community as a whole. This, of course, creates a kind of vicious circle. I do not know what we should have done if, on the one hand, it had not been for the number of nurses from Africa and elsewhere who augmented the nursing service in this country; and on the other hand, if it had not been that a number of nurses who normally would have been married were unable to get married because of the death in the last war of a number of men whom they might have married. We should recognise to the full that an unmarried nurse, whether from necessity or from choice, is rendering an invaluable service. If all the nurses who desired to get married had been married now, the shortage today would be very serious indeed. In this respect their personal loss is the community's gain.
I feel in addition to the recommendations made in this Bill that something more is required—a full appreciation on the part of the matrons and all others connected with the nursing profession that a new atmosphere has to be generated in the nursing world. Discipline, of course, is very necessary, but I am perfectly certain that in many cases in the past the kind of discipline, which has been imposed, has acted as a strong deterrent to many girls who might have gone into the profession, and also has caused some nurses to leave it. I am quite certain that many girls, if they had been treated with greater sensitiveness and understanding, would have remained in the nursing profession and would not have joined that vast exodus of girls from nursing to which reference has already been made.
It is quite true that the nursing profession should now be a vocation. We must, however, face the fact quite frankly that both in the nursing world and in other spheres, the great majority do not initially have a sense of vocation but only of avocation. If a girl or young man enters into some calling, generally it is not because he or she has a profound sense of purpose in life or a belief that that is the particular job that he or she is destined to adopt, but because it offers 947 either the man or the woman some attractive reward or because they are unable to find anything else. I say that because, if it is to be assumed that only those with a sense of vocation are to be welcomed into the profession, then, indeed, we shall be profoundly disappointed at the numbers entering it.
What we must do is to generate in those girls who take up nursing that fine sense of vocation. I am sure it can be done. There is a latent capacity within them that can be encouraged, and given the right atmosphere on the one hand and appropriate reward on the other, I believe in the course of time many of those who start without a sense of vocation will gain such a sense and retain it to the end. One urgent necessity in the nursing profession is that nurses should be encouraged to take an interest outside their own particular profession or vocation. In my contact with nurses, ward sisters and others, I have been struck by the fact that many have become so completely absorbed in their profession as to have little understanding of any other world than their own.
§ Mr. Sorensen
It is quite true of many professions, and because they are overworked or because of an over concentration on their services, they detach themselves and their professional activity from the surrounding world. We recognise that that is a great mistake. So I hope something will be done in the future to encourage nurses to take an interest in other spheres of life, especially those interacting with their own, because they cannot be good citizens unless they are even something more than nurses.
I am very glad indeed that an attempt is being made in this Bill to encourage the mental nurses. It is because of my association for many years with a mental hospital that I have the temerity to speak this morning. When I was elected to the Essex County Council I thought it was a misfortune when, after intimating that I should like to serve on the public health, highways and education committees, I was informed that I should have to serve for a time on the mental hospital committee. I took it as a reflection on myself, but I came mainly to appreciate 948 the opportunity which was then offered to me. After a period of 21 years' service, I formed an extremely high estimation of the splendid devotion and skill of both the male and female nurses in that section of the profession. Therefore, I am glad that particular attention is to be paid to them.
I am also glad it is becoming increasingly recognised that a widening sphere exists for male nurses. At one time, except in the sphere of mental disorder, it was assumed that men were not appropriate for nursing. It is good to know that is breaking down and I hope to see far more encouragement given to men so that they can make nursing their life work.
The only other word I would say is that I hope by this Bill and by other means we shall increasingly demonstrate our belief that the nursing profession is performing an invaluable service to our community. I hope, too, this will encourage more and more the right kind of matrons. There are many matrons for whom I have a profound admiration, but for a few I have mainly sympathy. Just as with a school and its head, a great deal depends on the attitude of a matron to those subordinate to her. She needs certainly to be a person of authority and capacity, and one who can exercise proper discipline. But she also needs to be a person, not apparently thwarted as sometimes some matrons appear to be and almost out of temper with the world, but one sensitive to the girls who come under her charge. If, radiating from the matron downwards, there can be sympathetic and tolerant understanding that nurses are still human beings, I am sure many of those unfortunate incidents that have occurred in hospitals will be avoided, and that a larger proportion of girls will remain in the profession.
For the reasons to which I have briefly alluded, amongst others, I hope this Bill will be of great service to the nurses, to the medical world and to the nation.
§ 2.21 p.m.
§ Dr. Morgan (Rochdale)
I want to make three points. The first deals with the way in which nurses ought to be treated during their training. All my life I have been asking for improvements in the conditions under which the nurses serve, as I said last night in the Debate 949 on the Scottish Bill. By the by, this is a better Bill democratically than the Scottish Bill from the point of view of representation of the people working in that profession. This is a change, because usually Scottish Bills are much better than the English ones.—[An HON. MEMBER: Oh "]—Oh yes, medically at any rate.
When nurses go into their hospitals they should have not only a workshop environment but also a home environment. I know that many of our hospitals are ancient, especially in certain counties. They want modernisation. The sanitation is bad. The culinary arrangements are bad. The diet is bad. The relationship between the supervisors of the nurses and the nurses is bad. One point that should be stressed in the Bill is the right of the nurses, as workers, to organise and to have a representative present when there is any question of their penalisation for committing an indiscretion of any kind, whether at their work or kissing their father goodnight at the gate and being charged with kissing a man at the gate. These little indiscretions happen within these institutions. I know of them because I happen to be on a trade union dealing with nurses. Some of the matrons and supervisors of the hospitals do not seem to realise the great lever they have in human relations with the nurses. The question of nursing recruitment depends on being able to make it a career, the ability to rise from the bottom to the top. If these three things are done, as I hope they will be done under this Bill, it will improve the recruiting position.
This Bill is also good from the point of view of the General Nursing Council. In England we have equal numbers of those elected and non-elected. Although the Minister will appoint 12 non-elected members, he has divided them up equitably. I would ask that mental nursing should have greater representation because mental nursing is a tricky, difficult business. The strain on a mental nurse, especially one who has to deal with maniacal patients instead of with melancholic patients is tremendous. I wish that consideration could be given to lightening the hours of duty in this connection. A nurse supervising maniacs should have a much shorter term of duty than a nurse dealing with a melancholic patient.
950 I cannot see why the General Nursing Council cannot have incorporated in it a body like the Central Midwives Board. I know that board has a long history from the point of view of midwifery and the dangers concerned with it, but if we are to have one supervisory council dealing with nurses' training, why not bring maternity nursing as well within the province of the General Nursing Council? I am sorry, Mr. Deputy-Speaker, if you think I am going outside the terms of the Bill, but this is a subject which the nurses want considered, and although the midwives have for so long been dissociated from the nursing profession, I think they should be included in one body, namely, the General Nursing Council.
With regard to the composition of the council, six of the 12 members will be appointed by the council. I would prefer the Minister to have a bigger proportion or, still better, to have more mental registered nurses on the mental nurses committee. I will end now—[An HON. MEMBER: "Hear, hear."] Someone said, "Hear, hear," but it does not matter. There are always people who are not interested in the healing art until they want provision made by the State.
I have two further points to make. One concerns superannuation. The present superannuation schemes are good. In regard to the mental hospitals, the Minister recently made a good definition of the "mental health officer." It included anybody in a mental institution who had charge and care of patients and who was responsible for their welfare. A nurse, paying her superannuation, can rise from the lowest position to that of a sister and still he eligible for the compensation scheme. However, by the present ruling of the Mental Nursing Services Division of the Ministry of Health from the moment a home sister is promoted to take charge of a nursing home she is not eligible for superannuation. Yet, if she becomes a matron, she immediately becomes eligible for superannuation again.
They say that the home sister is not responsible for the care and welfare of patients yet, just as the head of a laundry may have mental patients serving with her, and is responsible for seeing that they do not damage each other or themselves by the machinery, the home sister may have mental patients helping in the 951 care of the home. The home sister has to carry out every duty in addition to responsibility for the care and welfare of patients and if she has to do any work connected with the care of the patient her superannuation rights should not be affected by any promotion from being an ordinary sister in the ward to that of home sister on her way to a matronship.
I forget my other point so it cannot be important. Like many other hon. Members in this House I can give a blessing to this Bill. The nursing profession deserves all that we can give it. I would like to see nurses given the free right of representation and organisation, not only in regard to their grievances but on the various bodies—the nurse-training committees and the Mental Nurses Committee—which will be incorporated in this Bill. I hope that, with some amendment in Committee, the Bill will be one of the outstanding Bills of this Parliament, although it is only a small Bill dealing with a small section of the healing art.
§ 2.30 p.m.
§ Sir Hugh Lucas-Tooth (Hendon, South)
Usually there has been some note of controversy in a Debate on matters connected with health. That would have been almost a certainty on one or two recent occasions. In this Debate there has been complete unanimity in all parts of the House. I am very sorry that the Minister of Health has not been able to be here. We all appreciate the reasons for his absence. I believe that had he been here there would still have been no rift in our harmony, and it would have been an agreeable spectacle to the country to see the lion lying down with the lamb for once in a while.
There is real agreement in all parts of the House both as to the need for and the general principles embodied in the Bill. The discussion has not gone very deeply into the details of the Bill and there have been times when it has tended rather to range over the much wider question of recruitment of nurses than the particular provisions with which we are actually concerned. That is probably natural. Indeed, the fundamental purpose of the Bill is not only to secure a more highly trained nursing profession, but also to make the training and conditions of service of nurses such that we obtain a substantially larger number of recruits.
952 However successful the Bill may be when it comes into operation, it will not altogether cure our trouble over the shortage of nurses. It seems to me that in some respects the nursing profession, or rather those who use the nursing profession, have been a little spoilt in the past. There was a time when there were some two million more women than men in this country, the so-called surplus women. That time has disappeared. The numbers of men and women are now, roughly speaking, equal, and the balance might even tip the other way owing to a number of outside causes.
This means that there will be a relatively greater demand for female services generally than there has been in the past, and in addition the number of directions in which those services can be used is now infinitely greater than it was even 20 or 30 years ago. Therefore, on the whole it will be more difficult to get nurses as time goes on. We must recognise that fact and shape our policy accordingly. The Opposition welcome the Bill and do not suggest that it should go further because it is, after all, a Bill of limited scope, and we shall do our best to make it as effective as possible.
The hon. Member for Epping (Mrs. Manning) rather suggested that the difficulty with which we had to contend in regard to women entering the nursing service was the high prestige of certain hospitals, the teaching hospitals, which was prejudicing the recruitment of nurses for training in other parts of the hospital system. That could happen. It is possible that some part of the organisation could have so high a prestige that it might prejudice other parts of the organisation. I saw something of that nature in another sphere during the war when I was on the staff of an officer cadet training unit. I appreciated the danger to the less well known units by the draft of officers in favour of the well known corps d'elite.
I do not for a moment suggest that we should not have a corps d'elite, but it is possible that it may draw off too much of the cream and so make it difficult to get the full numbers that we require. However, I believe that the remedy suggested by the hon. Lady, that of completely merging the teaching hospitals in the general hospital system, presumably on the lines of the Scottish system, is wrong. The general views of 953 the hon. Member for Barking (Mr. Hastings) in that connection seemed much better, that the teaching hospital should treat the regional boards as brothers and not as rich uncles. That is a fair statement of the position, and I hope that that will be the general policy pursued.
Although there has been great unanimity in our discussions, that is not to say that the actual provisions of the Bill are by any means agreed in the country or in the House. They do not raise any questions which could in any sense be described as party political questions. There has been some slight measure of disagreement between hon. Members opposite and a slight measure of disagreement has been indicated today between hon. Friends of mine. There is no party issue dividing any of us so far as I know, but there are genuine, difficult issues which have been raised and they will have to be discussed with great care in Committee.
The nub of the Bill is contained in Clause 4. That has generally been accepted, although it has not been so stated by any hon. Member. I should like the Parliamentary Secretary to give some further explanation of the Clause when he replies. I do not want to raise Committee points now, but the whole principle of the Bill is contained in the Clause, and if the Parliamentary Secretary would give some indication of how it is to work, it would be of interest to the House and the country and would facilitate matters when we come to put down Amendments on the Committee stage.
I want first to ask the Parliamentary Secretary why standing nurse-training committees are not mandatory in each hospital area. The House will see in Clause 2 that the Ministermay, after consulting the Council, by an order … constitute … a committee for that area.It has been assumed in all parts of the House that the Minister will do so in every case. If it is his intention to do so, why is it not made mandatory? Is it contemplated that there will be areas for which no standing nurse-training committee is to be constituted? I do not know whether the Parliamentary Secretary will deal with that point but it is a matter of some interest.
As to the actual provisions of Clause 4, I should like to ask the hon. Gentleman 954 what is intended by the Government to be the method by which these nurse-training committees are to defray the expenditure referred to. It is not expressly provided in any part of the Bill how the payments are to be made. This is a matter of vital importance. Is it intended that the committees should make a direct payment not to the hospital governors or the committee concerned but to those who are performing the services in respect of which the payment is to be made, or are the payments to be made in the first place by the committee or the governors of the hospital who are merely to come back on the nurse-training committee to recoup themselves?
If it is merely a question of repayment to the hospital, I believe that the system will work fairly well, but if there is to be direct payment by the training committee in respect of the training then I think that we will get a difficult and dangerous conflict between the hospital and the training authority. I should also like to ask the Parliamentary Secretary what expenditure is contemplated as falling wholly or mainly within the meaning of the word "training." There is certainly a great deal of doubt as to what the Government contemplate. It is a matter on which the Government can properly be asked to be quite explicit.
There is an extraordinary ambiguity about this Clause. If the first two paragraphs of subsection (1) are read together it will be seen that the first provides that the expenditure which is to be made by the nurse-training committee is to be expenditure:wholly or mainly for the purposes of, or in connection with, the training of nurses; and.Then the second paragraph states:of such description as the Minister may specify for the purposes of this subsection.In the ordinary way, the construction of that means that it is only the expenditure which is specified by the Minister which can be repaid. In other words, both paragraphs must apply. In effect, it makes the Minister the immediate judge of what is training expenditure. Subsection (2) of Clause 4 states:Any question arising under the foregoing subsection whether expenditure is such as is mentioned in paragraph (a) thereof shall be determined by the Minister.But it has already been determined by the Minister. Subsection (1, b), if it is 955 to be taken conjunctively as here expressed with subsection (1, a), means that it is only expenditure which has been specified by the Minister which can be recouped. Therefore, no possible question could arise on that issue.
I should like to know what is really in the mind of the Government here. Do they intend that the Government shall lay down precisely what kind of expenditure is to be training expenditure which can be recovered by the hospitals through the nurse-training committee, or do they intend to leave some genuine latitude to the nurse-training committee with some kind of appeal machinery to the Minister in case of differences of opinion? It is extraordinarily difficult to see what this Clause means. Obviously, in the case of a machinery Bill like this, the answer to that question is absolutely vital to the success or otherwise of the Measure. I hope that the Minister will be able to give a definite answer.
Other points raised by various Members have either been points on which we are in full agreement which will no doubt be noted by the Government because there can be no controversy about them, or they have been Committee points which can be raised quite properly by Amendments. Perhaps I might add that the Bill involves some small element of additional expenditure. I think that the House would be unanimous in saying that we must ensure that our nursing service is efficient. If it is not efficient we are wasting money. If by spending such small sums of money as are involved here we can get greater efficiency in nursing, we shall be doing exactly what we all want to do on both sides of the House. We shall be economising in man-power and woman-power and also in money in the end. For these reasons we welcome this Bill and we feel that the sooner it becomes law the better.
§ 2.47 p.m.
§ Mr. Blenkinsop
I do not think that any of us can feel in any way that this Bill has not received a very great welcome from all parts of the House. Indeed, we have had little criticism of the purpose or indeed even of the details of the Bill. We welcome the general atmosphere which has prevailed and the way in which the Debate has been conducted. I should like to thank 956 the right hon. and gallant Gentleman the Member for Scottish Universities (Lieut.-Colonel Elliot) for the way in which he received the Bill and the welcome he gave to it. If I were to utter any criticism at all of the points which have been put in this discussion, it would be that very many of them are matters which, frankly, we must discuss in Committee. They include some of the topics mentioned by the hon. Member for South Hendon (Sir H. Lucas-Tooth).
I should like to comment on some of the questions asked by the right hon. and gallant Member for Scottish Universities who explained to me that he had to leave the House and asked me to express his apologies for doing so. He asked whether we could give any information about the figures of recruitment into the nursing profession in addition to those I mentioned earlier. While I am not able to give full figures, I can give him some details which I think will be of interest. We have the figures of the admissions to the register in England and Wales over the years. I should like to compare up to date figures with those for 1938. In that year there were 6,700 admissions to the register. In 1947, there were 7,900, and in 1948, there were 7,560. That shows a drop in the last year but at the moment we have more nurses in training than ever before. In fact, we have some 46,000 nurses in training today.
We have some further figures of the preliminary examination candidates which suggest the contrary trend of an increase. The number of preliminary examination candidates who sat for the examination in 1938 was 9,500, in 1947, 11,000, and in 1948, 13,000, showing a very steady and welcome increase.
§ Sir H. Lucas-Tooth
Can the Parliamentary Secretary say whether the quality of those candidates was maintained and whether roughly the same proportion were able to qualify?
§ Mr. Blenkinsop
Yes, I have the figures here, and I think the proportion is rather higher. In 1938, 6,300 passed out of a total of 9,500, while in 1948, 11,000 passed out of 13,000, which seems to me to be a higher proportion. It is quite clear that we must keep a close eye on this matter, but I think we can be satisfied that we are getting a slow 957 but steady recruitment into the nursing service, though we must examine both the position of recruitment and the numbers of those who move out of the service in the course of training.
The right hon. and gallant Gentleman also raised the general question of conditions, as indeed did many other speakers in the Debate. I think we should all agree that there has been a very real improvement in nursing conditions over these last few years, and particularly I would say that there has been a much better understanding on the part of matrons of the human needs of nurses, which is perhaps one of the most important features of the whole picture. The advance which we can make in physical terms by way of improved conditions for nurses and improved accommodation in nurses' homes is one in which we are, of course, very severely limited at present, but we are making that advance and we are only sorry that often it should have been so much delayed. We are not able to go forward anywhere near as fast as we should like.
§ Mr. Blenkinsop
I shall deal with that.
My hon. Friend the Member for Blackley (Mr. Diamond) gave us a valuable contribution from his vast knowledge and understanding of this problem, and he raised many matters concerning nursing conditions which will undoubtedly be the duty of the council to deal with in future.
The hon. and gallant Member for Barnstaple (Brigadier Peto) raised questions which were discussed in some detail in another place. Particularly, he raised the question of the teaching hospital and whether or not it was right that the expenses of the teaching hospital in training nurses should be dealt with in a different way from the expenses of other hospitals in training nurses. Let us remember to start with that the teaching hospitals train only a very small proportion of the total number of nurses. There is a very different position here from the position of a teaching hospital in training medical students, because the latter train practically the whole number.
We feel very strongly that we want the experience, advice and help of the teaching hospitals on the regional committees; otherwise, we shall loose the value of the 958 experience of the teaching hospitals, and particularly some of those in London and elsewhere, with a consequent effect on the standards throughout the service as a whole. There are representatives of the teaching hospitals on the regional committees, and, furthermore, in case there should be any difference between the teaching hospital and the regional committee, the objections can be referred to the General Nursing Council, which provision is a very real safeguard of their position. I am quite sure that they need not fear any reduction of their standards in consequence of this Bill.
§ Lieut.-Colonel Lipton (Brixton)
Before the Parliamentary Secretary leaves that point, perhaps he will dispel the fear expressed by the B.M.A. and by some teaching hospitals that the General Nursing Council may be able to impose demands in respect of training which would affect the services provided by the teaching hospitals?
§ Brigadier Peto
Further to that point, can the Parliamentary Secretary also dispel the fear that, by financial control, they may cut down some of the staffs of the teaching hospitals and transfer them elsewhere?
§ Mr. Blenkinsop
The regional committees are fully conscious of the needs of both the teaching hospitals and other hospitals, and I am quite satisfied that they will not make any suggestions that would reduce the standards of the teaching hospitals. Indeed, we have inserted in the Bill two safeguards—the right of appeal to the council and the setting up of this new finance committee which will deal with the matter of the budgets from the regional committees. In these directions, we have adequately covered any fears that may have been expressed, and I gather that in another place it was agreed that these proposals would adequately safeguard the position.
§ Sir H. Lucas-Tooth
Could the hon. Gentleman take the matter a little further? Would it he possible for a hospital to incur expenditure on the training of nurses which was not approved by the standing committee? Is prior approval an essential to the recovery of such payments, and is it possible to recover money spent without prior approval?
§ Mr. Blenkinsop
I take it that prior approval will be required, as I think it ought to be. After all, it must be part of the work of the regional standing committee to examine the needs for training in the whole of its area, and, in considering those needs, it will obviously take into consideration the special needs of the teaching hospital. I would ask the hon. Gentleman not to press me further than that. If we want to go into further detail, we might as well have the Committee stage now.
The hon. Member for Epping (Mrs. Manning) raised the question of recruitment, and asked whether we are looking not only to the grammar schools but elsewhere for our recruits to nursing. I think she will know that at the present time we are getting a large proportion of our nurses outside the secondary school field, and we are examining those very avenues which she suggested, and that of course will continue.
§ Mrs. Manning
If there was a choice between two girls, one from a grammar school and the other from a modern school, which would have the more important qualification—the girl who was likely to make a good nurse or the purely academic one?
§ Mr. Messer
Before my hon. Friend replies to that point may I ask is he aware that some hospitals with training schools lay down a condition that a girl should have the general school certificate?
§ Mr. Blenkinsop
That is precisely the sort of point which must be judged by a professional body and is not for the Minister to decide. The point regarding qualifications was raised by many hon. Members, and I must say that the qualifications for a good nurse are not by any means wholly academic. There are very many other qualifications that are of importance in this consideration.
My hon. Friend the Member for Blackley who has a special position in this Debate because of his own personal reconstitution—I hope to watch to see in which way it is carried out—paid a very proper tribute to the work of the General Nursing Council and mentioned the high regard in which British nursing is held throughout the world. He raised two matters of detail which I am quite prepared to consider—the question of the 960 term of office of members of the General Nursing Council and the question whether legal experience would not be helpful to the General Nursing Council in considering appeals on removal from the register. Those are two very proper points which we shall be glad to look into it further.
My hon. Friend the Member for Rochdale (Dr. Morgan) raised the general question of the condition of nurses in hospitals. I think he would agree that a great deal is being done here administratively. A new charter has, in fact, been incorporated and two pamphlets have been issued to all management committees advocating nurses' representative councils. We are most anxious that nursing staffs generally shall take a full part in their trade union representation, as, indeed, is highly desirable. On the point about the constitution of the mental nurses committee. I would say that this constitution is acceptable to all those immediately concerned, and with whom we have, in fact, discussed the matter very thoroughly.
§ Dr. Morgan
Does my hon. Friend realise that mental nurses are only enrolled in one union? The bulk of them are in the Confederation of Health Service Employees.
§ Mr. Blenkinsop
The hon. Member for Putney (Mr. Linstead) raised the question of whether or not the General Nursing Council should be responsible for finance. I would only say on that point that this was a matter raised and discussed at great length in another place, and that it was finally agreed that if attempts were made to provide some form of hospital accounts committee it could only result in two bodies being responsible for training policy with the great danger of conflicting views and the duplication of inspection which would arise. For that reason it was finally agreed that the statutory finance committee should be set up. I agree that we shall have to ensure that that committee is a strong committee, properly representative of those with administrative experience who are able to deal with the problems of nursing finance.
I am sure that we have all been impressed throughout this Debate with the desire shown by hon. Members from all sides of the House to do everything possible to improve the general condition of nursing and to give the profession itself the opportunity to make advances in its 961 training provisions. I wish to emphasise once more that we feel that we are here putting forward no more than an opportunity for the profession itself to take action which I believe, irrespective of our particular party views, we are all agreed is desirable and urgently needed.
We shall be glad to deal with any other detailed points which were raised, when they arise on the Committee stage, and I feel sure that the welcome that has been given to this Bill today shows the general desire not only of this House but of the country to do the best possible for the nurses who in their turn have done so very much for us.
§ Question put, and agreed to.
§ Bill read a Second time, and committed to a Committee of the Whole House for Monday next.—[Mr. Snow.]