§ Order for Second Reading read.
§ 5.6 p.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 think it will be agreed on all sides of the House that this is a very modest and non-controversial Measure, although it is a very useful one. It is perhaps a sign of the value of earlier legislation on this subject that, after a comprehensive study of the whole problem of the recruitment of midwives which was carried out by the working party, so very few of their recommendations required any legislative change. These recommendations cover a wide field, but the great majority of them are concerned with administrative matters rather than with any legislative change. Although we can undoubtedly look forward, I think, to a non-controversial passage of the Bill, there was, perhaps, some distance in the past no subject which suffered from so many of what the working party called "legislative miscarriages" as did this particular subject. When the 1902 Act was passed, it was quite a great legislative success that it finally got through to the Statute Book.
There has been, as we would all agree, a great and valuable change in the status and standard of work of midwives, which is reflected, for example, in the very great improvement over this period in the rates of maternal mortality. For example, if one refers to the figures for the beginning of the century, maternal mortality rates in the year 1900 were 4.81 as against the latest figure which I have for 1949 of.98. I think it is fair to make the point that although there has been progress throughout that period, the progress during the last few years has been particularly rapid.
The 1902 Act, which as I have said was a legislative victory, was followed by a series of other Measures. The 1918, 1926 and 1936 Acts have all added further safeguards to the profession. I should like to say a word or two about some of the recommendations of the working party before I turn to the detailed consideration of this modest Measure, because I want it to be understood on both sides that the legislative 69 changes which we are making are not obscuring in any way the important administrative work which is now going forward.
I should like to pick out one or two of the recommendations as typical of some of the work that is being done, to explain to the House the developments which are taking place. Hon. Members will probably remember that in the Report of the Working Party on Nurses it was suggested that the Central Midwives Board might well combine with the General Nursing Council. This was considered, of course, by the midwives' working party, who recommended strongly that this suggestion of the nurses' working party should be rejected. We have come to the conclusion that the midwives' working party are quite right.
It would be a great mistake to mix up the problems of ordinary health nursing with the work of the midwife. The midwife is concerned with the most natural and ordinary human activity of all and it would be very wrong if we were in any way to suggest that the midwife's work should be regarded as merely a part of general nursing. The general nurse inevitably is concerned with the unusual, with ill-health, with the abnormal, whereas the midwife must necessarily be concerned mainly with the normal and indeed the very source of life itself. Undoubtedly, if a general body were set up there would be a danger, at least, that the midwives' side of this general body would be overweighted by the general nursing side.
Several other recommendations were made, and I want to mention one or two in order to explain the work we have been doing. In recommendation 24 it is suggested by the working party for midwives that refresher courses should be made obligatory for all practising mid-wives. I am glad to say that the Royal College of Midwives has now increased the number of places in its refresher courses and employing authorities are organising refresher courses so that increasing numbers can attend voluntarily, although it may be some time before provision is sufficient to enable the rules which make refresher courses compulsory to be brought into operation fully.
A further suggestion was made that the existing midwife teachers' courses should 70 be expanded and improved courses provided. An interesting development has recently taken place in the establishment of a new midwife teachers college, a residential college, at Kingston and full-time courses of six months begin this month. This is only a small start, but a very valuable step towards carrying out of the recommendation which was made.
A further matter of interest to the House is one of the recommendations of the working party that the Medical Research Council should be asked to set up a committee to solve the problem of finding a more effective method of administration of analgesia by mid-wives—a matter discussed in this House a little time ago. The Medical Research Council, as I think is generally known, have set up a committee to consider more effective methods. We have not yet had their report, but we hope that it will be available fairly shortly and we are most anxious that these other methods, for example, trilene, may be possible for more general use than they are today. In that regard it is of interest that it has also proved possible to allow the use of pethidine more generally than was possible some time ago. It was scheduled as a dangerous drug in 1947, but by a recent amendment, operating from 1st April this year, pethidine can now be procured and administered by mid-wives acting on their own responsibility, subject to certain safeguards. That was another point raised in this House when we were discussing the availability of different forms of analgesia.
I ought also to mention that there has been a very great development of the use of analgesia during the last year. We now have amongst the midwives practising in England and Wales some 72 per cent. trained in the use of analgesia, which is a very great advance on the position a year ago and makes clear that we should be able to complete the training of midwives within a reasonable period of time.
I am also glad to be able to say that there has been a great increase in the number of domiciliary cases which now receive gas and air analgesia. The figure in 1948 was approximately 80,000 cases and that went up in 1949 to 128,000 cases, an increase of 60 per cent. We can say that well over half, probably nearer 71 two-thirds, of all the domiciliary cases attended by midwives alone receive analgesia now as against the figure of only 8 per cent. referred to in the report of the working party, so we can see that there has been a very great development.
Another of the conclusions and recommendations made by the working party was that there should be general provision of cars for the use of domiciliary midwives. As I think hon. Members on both sides of the House are aware, we made arrangements last year for a special priority scheme by which domiciliary midwives would be able to get earlier delivery of motor cars for their use, and we are glad to be able to say that that scheme works very well. We have had few complaints from midwives of not being able to secure the cars they need, particularly in rural areas. I am sorry we have not been able to extend that to others who also have need of motor cars in the nursing service, but I think we have been able to meet most of the claims of midwives in that regard. Many of the recommendations made in the report concern conditions of service, which are under consideration by the Whitley Council.
I now turn to the main provisions of this Bill. One of the recommendations of the working party was that the time has come for a review of the constitution of the Central Midwives Board, not that they complained in any way of the work that the Board have done. Indeed, we are all very appreciative of the great advances that have been made, which are in large measure due to the work which the Board have done. But we feel the time has now arrived when midwives might properly be given greater representation on the Board than they have today. At the moment there are only five midwives represented out of a total of 14 members on the Board. That was a matter to which the working party called attention and to which we would wish eventually to secure some amendment.
Clause 1 gives power to the Minister to revise the constitution of the Board. At the moment any alteration can only be made on the initiative of the Board themselves. It is proposed that we should consult the different organisations affected and then lay draft orders before the 72 House, which will enable discussion before the draft orders actually become operative. That gives time for discussion and, if necessary, they can be withdrawn and replaced, should that be the wish of the House. The other Clauses are of minor significance.
Clause 2 provides for incorporation of the Boards so that they can have the necessary statutory power to deal with their own property. Clauses 3 and 4 provide for the acceptance for English certification of midwives who have already been certified in Scotland and Northern Ireland, or vice versa. Clause 5 makes provision similar to that made last year in the Nurses Act for the acceptance, subject to suitable safeguards and further training where necessary, of midwives trained abroad.
Clause 6, rather surprisingly, caused a certain amount of discussion in another place. As originally drafted, that Clause merely proposed to give power to the boards to make rules regarding a standard uniform to be worn by mid-wives, which would be protected against use by any unauthorised persons. We thought that to be a fairly innocuous sort of provision but one that could quite fairly be asked for by the Central Mid-wives Board, who were anxious to obtain this power because it is one which is already in the hands of the General Nursing Council in respect of the nursing side. It seemed a reasonable provision to make to add to the status of the midwife.
However, an Amendment was carried in another place which sought to ensure that midwives should be entitled to wear this national uniform even if the local employing authority required a local uniform to be worn. This is a matter which can be more usefully discussed in Committee to see whether any changes should be made. I believe hon. Members may have received representations about the matter. I would only make the point that I have just had put into my hands today an attractive, romantic and rather glamorous advertisement from a certain tailor showing what the new national uniform might well look like. It is an interesting tribute to the advance of the profession of midwifery that such an attractive leaflet as this can properly be produced at this time. Certainly it could not have been produced a good many years ago.
§ Mr. Blenkinsop
Clause 7 withdraws the obligation on the Board to publish a complete roll of midwives every five years. It has been a most expensive requirement upon the Central Midwives Board. The information it provided was highly unreliable because, for example, on the English roll there are some 70,000 names but in fact only approximately 17,000 of that number are at present in practice. The obligation to publish annually the list of practising midwives is to be preserved. This will be more up to date.
Clause 8 gives power to local authorities to provide residential accommodation for pupil midwives in training, which many local authorities very properly wished to provide and were not able previously to do. This was recommended by the working party, as was the provision in Clause 10 exempting midwives from jury service. In fact, midwives have, on individual application, always been exempted from jury service, but we thought it only right that complete exemption should be given as a statutory right rather than on individual application.
From what I have said I think it is clear that this is a useful though very limited Measure. I think it is also clear that we are at the same time carrying forward the perhaps more important administrative changes and developments that have been recommended in this report and which have indeed been the subject of examination previously. Hon. Members on both sides of the House can be assured that we are doing our utmost, both by this minor Measure and by the administrative changes, to ensure the raising still further of the very high standard which we have already achieved in our maternity services.
§ 5.25 p.m.
§ Lieut.-Colonel Elliot (Glasgow, Kelvingrove)
I am sure that we shall all agree that this is a useful and non-controversial Bill, and that we must extend our congratulations to the Parliamentary Secretary for adhering so strictly to the non-controversial aspect of any subject which is comprised in the Ministry of Health. There are, however, many non-controversial subjects, and this is one of them. As the Parliamentary Secretary said, this Bill 74 marks a stage further in the steady progress which has been going on subsequent to that series of legislative miscarriages to which he drew attention.
The attention of this House has now, for over half a century, been given to this subject, and the rise in the status of mid-wives has been not inferior to the rise in the status of the nursing profession which has also gone on at the same time. We are all extremely interested and glad to know that the fall in maternal mortality and infantile mortality, to which the Parliamentary Secretary paid tribute, has continued and has indeed become more rapid of recent years. The Registrar-General for Scotland, as the Joint Under-Secretary of State for Scotland will recollect, recently drew attention to this, and stressed particularly the effect of the sulphanonmide drugs in the improvement which was taking place; although the improvement in general education has undoubtedly also had a great deal to do, with it.
One should declare one's interest in this matter, and unlikely as the House might think it, I am a certified midwife. It has been said that the House of Commons can do anything except turn a man into a woman. Here we see it trying its hand at the job. My right hon. Friend the Member for Moss Side (Miss Horsbrugh) is also an Honorary Fellow of the Royal College of Surgeons of Edinburgh, so she has at any rate been recognised by the medical profession as having in the past taken a great interest in these matters.
There was much point in what the Parliamentary Secretary said about the mid-wives' role; it required revision. The large numbers who appeared on it both in England and Scotland were a proof of that. Most of those girls were engaged in ordinary nursing and were not available for midwifery work. I believe that during the war young women were not allowed to take their midwifery certificate unless they undertook to do two years in midwifery practice afterwards. I do not know if that rule still applies; I take it that it has been waived? Perhaps the Parliamentary Secretary can give us information on that point.
We were glad to find that it was possible to discuss the vexed question of analgesia in childbirth without the heat and fury which this subject seems sometimes to generate. 75 I understand that my hon. Friend the Member for Monmouth (Mr. P. Thorneycroft) is well satisfied with the progress which has been made—we will not at this moment attempt to allocate credit for that to either side of the House—and does not propose on this occasion to enter into the lists. Seriously, the figures which the Parliamentary Secretary gave, both about the increase in training and the increase in domiciliary treatment, were of great interest and will, I am sure, be of great advantage to the mothers of this country.
It has been brought out by medical opinion that the percentage of injury at birth tends rather to rise, and oddly enough, to rise more in the higher social brackets than in the lower. It is not always certain that instrumental interference or too lavish a use of various kinds of remedies is always as great an advantage either to the mother or to the child as it might appear to be at the time. The birth of a baby is a natural function which should not be too readily treated as a kind of surgical operation, which it certainly is not.
I was also glad to find that the question, of cars was apparently being dealt with satisfactorily and that the priorities for midwives was working so well that no complaint at all had been received from any midwife on any waiting list for a car. That is a remarkable achievement on which I congratulate the Minister. I do not know of any other class of His Majesty's citizens to which that could apply—certainly not to doctors so far as I know. I was reminded at the time of that charming passage in "Puck of Pook's Hill," which perhaps the Minister may remember, where the children are talking over the plague—it is a long time ago, a story of our fathers of old—and as a sort of motif through it comes the maternity nurse cycling down to the little house in the village to help and cycling away; while the children are sitting on the actual plague stone to which provisions were brought by those willing to relieve the people in danger from this infectious and terrible illness, and to which afterwards persons returned to take away the provisions which had been left for them by kindly people.
We have progressed since those days but, as was said in that story, the fundamental thing was the feeling of sympathy 76 of spirit and the courage shown by our fathers of old. Although we have progressed in many ways, unless we can maintain and increase the sympathy and human feeling which lies at the bottom of this whole Measure we shall not get the great advantage out of it that we hope. I am sure that every step is worth taking to ensure that, along with the greater efficiency, no diminution in humanity is taking place. We greatly welcome this unassuming but valuable Bill and we trust it will have an easy passage through the House. We hope that minor points such as uniform will be adjusted in Committee—it might be a most suitable subject for a free vote—and that it will not be long before this Measure is on the Statute Book.
§ 5.33 p.m.
§ Mr. Somerville Hastings (Barking)
I hope that this short Bill will be regarded by the midwives as the gesture of appreciation by this House, and indeed by the whole nation, for the work they have done. The problems of childbirth and young children are very different from what they were a few years ago. Childbirth is no longer so dangerous, and in many cases young children, instead of crying all day, hardly cry at all. As has been mentioned, the death rate of mothers in childbirth is a quarter of what it was 20 years ago; and the death rate of infants has gone down, although not quite in the same proportion. For this we have to thank the midwives, at any rate in part, although they would be the first to admit that there are many other facors.
All doctors must also be very grateful to the midwives, because although not all of us would be ready to admit it, we all I think without exception learned how to deal with a normal case of childbirth from a midwife. Most of use, both in hospital and also when we went out into the district around, were taught what to do by midwives. Of course we have learned since and some of us may still remember how to deal with abnormal cases but the care of normal cases, almost without exception, we learned from a midwive.
I fear that midwives are labouring under a sense of grievance today. They are not quite sure of their status and they are not too certain that they are able to 77 do as good work as they once did. The report of the working party on midwives to which reference has been made, makes that clear and I will read one short passage:It seems to us that the assets and liabilities of doctor and midwife are complementary and that the arrangement under the new health service, with two working in partnership, may prove to be a good one. It would only be successful, however, if both parties recognised their partnership. The doctor must accept the midwife as his fellow practitioner and not attempt either to relegate her to the status of his handmaiden or to displace her unnecessarily from her position of authority in the patient's eyes.Then the report goes on, quite rightly, to say that the midwife on her part must not be over-possessive about her patients. I am not quite sure that in every area the position of the midwife is as satisfactory as it was before 5th July, 1948. What happened before that date was that when a midwife got into difficulties and wanted a doctor to help her she asked the patient to whom she should send and she sent for that doctor. Usually the patient had no choice, and the midwives, at any rate in the London area, soon got to know the capable doctors and sent for one of them. But now things are different because a doctor contracts to look after a woman in child birth and is paid for it, and a midwife who is in difficulty has to send for that doctor. The doctor may be an exceptionally capable obstetrician, and many of them are. But some of them are not and time may be wasted before a specialist is called.
I do not want to suggest that it is only the midwives who fear this loss of status. I have in my hand a report which is by far the "best seller" for the medical profession today. It is a report by an Australian doctor, Dr. Collings, and it is called, "General Practice in England today." It was prepared after a very careful investigation. Dr. Collings inquired into the work of doctors in many parts of England. He worked with them for a time and got to know their difficulties and problems. This is what he says:All the midwives, local authority doctors, and consultant obstetricians with whom I have spoken expressed the hope that the G.P.'s"—that is general practitioners—who are now booking midwifery cases will leave the actual work to the midwives and clinics.78 That suggests that the apprehension as to status of the midwives, and the capacity for doing their best for their patients which I know some of them feel, is not entirely groundless; and I am glad that this little Bill will, at any rate, help them in some ways to raise their status.
Most bodies in control of the various professions have a majority of representatives of those professions. As has already been stated by the Parliamentary Secretary, the Central Midwives Board as present constituted is composed of 14 members. Of these, five may be mid-wives, and four must. But the General Nursing Council, a corresponding body, is different. That is composed of 34. Seventeen are elected by the nurses and, naturally, they will be nurses, sisters, matrons or people with nursing training. Of the other 17, six must be nurses.
Clauses 1 and 2 will be welcomed by midwives, because of the capacity which they give for the Ministry to receive the approval of this House in granting mid-wives better representation on the Central Midwives Board. They will thus be in a better position to put their case. It is wrong that a professional body like this should have a maximum representation of five out of 14. It does not show that we appreciate the status of the midwife and her importance to the nation.
Clause 8 gives power to the local supervising authority to provide residential colleges for pupil midwives. There are not many districts in which the midwife can receive all her practical training. She must have practical training which involves not only hospital training but work in the homes of patients. Not many hospitals are capable of giving such a complete training to midwives. If mid-wives are to be trained with nurses in the nurse training schools, they will be hopelessly outnumbered and likely to be regarded as second-rate nurses or poor relations. Except as regards preliminaries, it is most desirable that they should be trained separately. There is much to be said for all students of various faculties working together for part of their time and living in the same place, so as to enjoy university life. But I imagine that it would be considered undesirable for midwives to mix with all and sundry in view of the extreme danger of infection to the mothers in the work in which they are engaged.
79 I do not want to deal with the vexed question of uniforms for midwives. Apparently, that subject occupied most of the interest in another place. It was the only question upon which they thought it necessary to divide. But in passing, I would say that the midwife should have some distinctive uniform. She has to go, at all times of day and night, into all sorts of places. She ought to be recognised as a midwife and not mistaken for a home help or a school attendance officer. The Parliamentary Secretary suggested that this was a Committee point. It will be dealt with there, and no doubt careful consideration will be given to the question.
I welcome this Bill. I hope that the midwives will regard it as a Measure which does something to improve their status, but I regret that there is nothing in it to permit a midwife to call in, when necessary, a doctor who she can be assured knows more about midwifery than she does herself and who can be of real help to her.
§ 5.45 p.m.
§ Dr. Hill (Luton)
The Parliamentary Secretary said, in effect, that this was a small, not unimportant and non-contentious Bill. I have no doubt that it will remain non-contentious if we resist the temptation to enter clinical, obstetrical and other fields. His remarks about the growth in status and value of the midwifery profession will be widely shared not only on all sides of the House but in all parts of the Health Service.
The hon. Member for Barking (Mr. Hastings) thought fit to release a hare which he may wish to send scuttling through the discussion. On that point, I believe that the present system under which a woman selects her doctor in advance—the doctor of her choice, that doctor in most cases being on the approved list for the purpose and remaining liable to be called in on the confinement, or being free to attend the confinement if he thinks fit—is a substantial improvement on the old system under which, all too often, doctors were called in in an emergency and saw the patient for the first time when attending in that emergency.
I would remind the hon. Member for Barking that, to a substantial extent, the urge for the present system arose in 80 the minds of the women themselves. They believed that, in a satisfactory maternity service, the individual citizen should have, as one of the benefits of the service, the right to be attended by her own doctor through the ante-natal period and, if necessary, in the confinement.
§ The Minister of Health (Mr. Aneurin Bevan)
I should like to remind the hon. Member, however, that it was always regarded as one of the conditions for this new arrangement that there should be a general practitioner obstetrical panel, sufficiently small to enable enough experience to be obtained in confinement by the general practitioner, and that the object of a scheme might be defeated if too many general practitioners put their names down to the panel.
§ Dr. Hill
In reply to the Minister, I would say that it does not necessarily prove excellence in all areas for the number to be small; but I agree with his general proviso that those whose names appear on the approved list should, in the nature of the circumstances and the opportunities of the area, be able to enjoy sufficient continuing practice to maintain their skill in obstetrics. Subject to that proviso, it is clearly desirable in the public interest, and in accordance with the wishes of the women, that they should have the services of midwife and approved doctor working in collaboration.
The only other point upon which I should like to comment is that to which attention will no doubt be directed in the Committee stage—the vexed question of uniform. The single point I want to make is that, as Clause 6 empowers the Central Midwives Board to design an approved uniform, it is not unreasonable that the midwife, being required by her employing authority to wear a uniform, should have the option of wearing a nationally approved and designed uniform, and that the should not be in the position, there being a nationally approved uniform, of being required by her employing authority to wear a different uniform. There is no more in the point than that, and I hope that the right hon. Gentleman will resist any natural temptation which may come to him to oppose an Amendment which has been inserted in another place. From what I have been informed—and I believe the right hon. Gentleman himself is making 81 inquiries—this Amendment causes general satisfaction among midwives, and I therefore hope that the Minister will find it possible to leave the wording as it now Stands.
Subject to those general observations, I am sure that this is a very useful little Measure, and that an indication of the new status of the midwife may be found in the Minister's intention to give mid-wives a majority upon the body which will look after the service of midwifery in future. If I misunderstood the Parliamentary Secretary when he commended the report of the working party on that point, and reminded us that the Minister himself would subsequently decide the constitution of the body, I hope that I interpret him aright when I say that this growth of status would find expression in the number of midwives upon the Central Midwives' Board.
§ 5.52 p.m.
§ Dr. Barnett Stross (Stoke-on-Trent), Central)
I am sure that the midwives themselves would be the first to recognise that this Bill, very modest though it appears to be, is a recognition of the high regard in which they are held, not only by the profession as a whole, but by everyone in the country. All of us who have done active medical work in the country have a very high regard for their ability and devotion, while those of us who had had 25 years of work before we laid down our duties or handed them over to others can remember the great change indeed in the general conditions and status of midwives throughout the country.
I remember as a young man finding a very different type of midwife available where I then practised, than is now available. They were elderly women, with no real training, and, although they did the best they could, they had no knowledge of obstetric technique. They were harassed and over-busy people, doing too much work and seeing too many cases, and it was then their custom to call out the practitioner as soon as they possibly could, hoping that he would produce the gruesome instruments which we normally use in such cases to get the confinement over quickly. Very often, the room was full of people, and everybody was full of despair.
Now, we know that that is not the way in which these things should be done. 82 Today, we have people trained to keep a doctor in abeyance, and if anything good has come out of the modern training in midwifery it is that the trained midwife today feels fully competent, not only to do her own job, but also has unlimited patience and the knowledge of how it should be done. All of us would agree that there are only two conditions that require hurry or speed, and I will not mention them, because this is not the place to do so. Apart from these two complications the doctor, when called in, does well not to hurry. The longer he takes before he arrives, the better for the mother and the child.
I was interested to hear the right hon. and gallant Gentleman opposite, very rightly speaking from his own personal knowledge, saying that birth is a perfectly natural function, which, of course, indeed it is, and he then went on to claim that he was a midwife. I think we must remember that even Government Departments become midwives, and very good ones too, for all of us who have attended confinements and have done much of this work know that a radical change was noted after two or three years of war had passed. We found that women of all ages began to show themselves much healthier and stronger, and were thus able to deliver themselves much more easily than before and with far fewer complications. I have no hesitation in saying that the medical advisers who advised the Minister of Food, and the Minister of Food himself who carried out that advice, have been responsible for carrying out a good deal of the improvement in midwifery throughout the country.
Some mention has been made of the question of analgesia, which is no longer a contentious one, because we realise that this matter is going through very well. I think that a compliment was paid to the midwives of this country when we were able to offer the use of pethedine, which certainly produces a very great reduction of pain and a great deal more comfort.
A great deal with which I am in agreement has been said by the hon. Member for Luton (Dr. Hill), my hon. Friend the Member for Barking (Mr. Hastings) and the Minister of Health himself, although I found all three saying things in which they differed from one another. 83 I think it is quite true, as the hon. Member for Barking suggested, that it is not always perhaps the most skilled man who is necessarily sent for by the midwife today. Equally, I would say to the hon. Member for Barking that I could make out a case for favouritism having been shown in the past by mid-wives who sent for their own favourite doctor rather than some other and equally skilled man. The hon. Member for Luton also discussed this point, and it is a point on which we have to be particularly careful.
I should like to see the organisation and administration run something like this. I think the woman should choose her own doctor, although we must recognise that she is not always the best person to know who is the most skilled man. Nevertheless, she should have that freedom of choice, but the midwife, if the case is a complicated one, should have the right to ask for a second opinion immediately. In that way, whether it is expensive or not, we could make certain that nothing should go wrong in the ultimate.
Like every other hon. Member, I am very happy that this Bill is not a contentious one, and I can hardly imagine that there can be much discussion upon it even on the Committee stage. I hope that the uniform will be so attractive that people will cease to go to the cinema to see their favourite film stars, and I see no reason why not. Once upon a time, the uniforms of nurses were very up to date, but we are now accepting more archaic forms and retaining the customs of the Middle Ages. We believe that the best sartorial means should be employed to this purpose, and I see no reason why these young women should not wear a uniform as attractive as themselves and one which will show them off as the very charming creatures they are.
§ 6.0 p.m.
§ Mr. Iain MacLeod (Enfield, West)
One of the advantages of this Parliament—which has very few—is that an unspectacular Bill of this nature can obtain a rather higher priority than it could hope to do in normal times. I am told that this Bill is virtually an agreed Measure with the Central Midwives' Board. But the Parliamentary Secretary would be the first to agree, I think, that 84 that in no way detracts from the duty of this House to examine it carefully, and, if we can, to improve it in Committee. I was glad that the Parliamentary Secretary began his remarks with what I regard as, perhaps, the most important issue—although not actually in the Bill itself—that can be discussed this afternoon, that is, whether the Government were right or wrong to accept the opinion of the working party on midwives in opposition to the opinion of the working party on nurses, that there should be an amalgamation between the General Nursing Council and the Central Midwives' Board.
I was glad that we heard more this afternoon than was said in another place on this matter, and I am sure the Parliamentary Secretary will forgive me if I say that I still find the reasons given by the working party on nurses more convincing on this matter. It seems to me difficult to reconcile the argument of the midwives' working party that they should be entirely separated from the General Nursing Council, with the other recommendation made by them that only a State registered nurse should go on to take the nurse's certificate. However, if they are happy and satisfied with the position—and I think they are—we might leave it at that.
Under Clause 1 of this Bill we are making two changes. The first change, that is, from the Order in Council procedure to the Statutory Instrument, with a draft laid before this House, is one which everybody approves. I am less happy about the second change, and perhaps the Minister or the Under-Secretary of State for Scotland might give us a reply on this point. I am less happy because it seems to me that the initiative has passed from the Central Midwives' Board to the Minister. The position under the 1918 Act is that on the representation—and only on that representation—of the Central Midwives' Board to the Privy Council, could changes be made. The procedure now is that the Minister, after consultation, will make what changes he decides are necessary. It may be that there is some statutory reason why it would be improper for a body such as the Central Midwives' Board to initiate changes to be laid before this House by way of a draft Statutory Instrument, but, whatever the reason, I should be glad to be informed of it.
85 I now come to the question of uniform. I understand from the Parliamentary Secretary that the Government will have proposals to make during the Committee stage. I thought when this matter was being discussed in another place that the arguments were, in fact, very nicely balanced, although I felt that the balance of argument was just, though only just, on the side of the Amendment. It is not a ditch in which I have any particular desire to die, nor, I imagine has the Minister. It may be that when we reach the Committee stage what is called the "British genius for compromise" will find a solution.
The only other point I wish to make is that if either in this Parliament or another, there is time to consolidate the Midwives' Acts, that would be something of great service and of great value. When this Measure reaches the Statute Book they will stretch from 1902 to 1950, and there are many Statutes which one has to look up if one wants to follow the whole story. The working party recommended that such a consolidation should be effected. I hope it will be done.
This, of course, is a machinery Bill as, indeed, was the nurses' Bill last year. But although it is a machinery Bill, it may well—partly because of the certification Clauses and partly because of the other improvements which we are making—add to the number of midwives in practice. There are still some areas in which the number is far too small. If we are to reduce the case-load to 55 a year—which was the recommendation of the working party—or even to 66 a year, which was, I think, the recommendation of the Rushcliffe Committee, then it will be necessary for 300 or 400 more women than at present to enter the profession each year. In the hope that the Bill, however small, may do something to improve that position, I am sure we all welcome it and wish it a speedy passage to the Statute Book.
§ 6.6 p.m.
§ Major Legge-Bourke (Isle of Ely)
It is with some trepidation that I enter this Debate because all those who have so far spoken, with the exception of my hon. Friend the Member for Enfield, West (Mr. Iain MacLeod), have considerable medical knowledge to assist them. I know that my hon. Friend has also 86 studied in considerable detail the social services of this country. My purpose in intervening is partly, perhaps, in the capacity of being for the third time a proud father, but mainly because I have a considerable interest in protecting the Queen's Institute of District Nurses. I very much hope that when we come to the Committee stage their interests will be considered.
The hon. Member for Stoke-on-Trent, Central (Dr. Stross) made the rather surprising remark that Government Departments became midwives at times. The trouble is, I think, that complications so often set in that even Statutory Instruments are not sufficient to put them right. I think he is quite right in saying—although we ought, rightly, to praise them very highly for the work they have done—that there are other factors which have brought down the infant mortality rate very considerably. Nutrition is obviously one of them.
I am very glad that my hon. Friend the Member for Enfield, West, mentioned the constitutional point about the Privy Council. No one in another place gave any reason for this change in procedure, nor did the Parliamentary Secretary today. It seems to me, as my hon. Friend said, that the Minister now has considerably more power than he had in the past, and I should very much like to know the reason for the change. It may be a perfectly good one, which I am prepared to accept. I do not think this Bill is at all controversial, except on the matter of uniform. On the constitutional side, I think the Privy Council has a wealth of experience which ought to be of value in this matter, and I regret the passing of that body.
In introducing the Bill, the Parliamentary Secretary quite rightly stressed that there are other very important things to be done in the country so far as midwifery is concerned. The Bill by itself will not meet the real need as stressed in the working party's report, that is, the urgent need for an increase in the numbers of those entering training. I certainly do not agree with the hon. Member for Barking (Mr. Hastings) about separating the training of nurses and of mid-wives. I should have thought that a common basic training was necessary before branching out into either midwifery or general nursing. The report itself is 87 quite voluble on that matter, particularly paragraphs 136, 137 and 138, which deal with basic training. I fully endorse what was said by my hon. Friend the Member for Enfield, West, about welcoming the decision not to merge the Central Midwives' Board with the General Nursing Council. At the same time, I still think that, on the training side, there should be a common basic training.
There is one point I wish particularly to draw to the Minister's attention. It has not so far been mentioned in this Debate, and I am not sure that it is covered in the working party's report. It is that since the introduction of the National Health Service Act there has been a quite considerable change in the common practice of those expecting babies. In other words, they have been going into nursing homes and maternity homes far more often than they did in the past. That means, of course, that there is a slight reduction in the need for more midwives. In fact, there has been a remarkable change in my constituency—a change of as much as 40 per cent. Ninety per cent. of mothers used to have their babies at home and now only 50 per cent. do. That is high praise for the National Health Service Act.
I welcome that side of it very much, but it is important that we should make quite clear that that has been happening. It has been happening elsewhere as well as in my constituency, and it means that if we are not very careful there will be some discouragement to new midwives. The need for midwives is just as great as ever. The ante-natal and post-natal attention given has tended to lengthen in recent years. The more midwives there are, the better the attention that can be given to mothers both before and after the birth. I hope that the Minister will keep watch and see that statistics about more mothers going into maternity homes will not lead to discouragement in the recruitment of midwives. I consider it one of the most important forms of recruiting in nursing.
I am a little disconcerted by what the Parliamentary Secretary has said about uniform. It has left the House in considerable doubt as to what he is going to do. He has not said whether he will put down a Government Amendment to deal with the Amendment inserted in 88 another place. I ask that the Under-Secretary for Scotland, who is to reply, should indicate the intention of the Government to the considerable number of interested bodies outside.
§ Mr. Blenkinsop
It is only fair to leave some interesting topic of this kind for discussion on the Committee stage, when we can have opinions from Members on all sides.
§ Major Legge-Bourke
I am all for interesting discussions on the Committee stage. I have sat on too many committees, where discussions have not been interesting, not to welcome the suggestion. But I hope the hon. Gentleman or the hon. Lady will indicate whether it is the intention of the Government to put down an Amendment to restore the Bill to its original state as it was when presented in another place.
These outside bodies are extremely interested. Certainly, the County Councils' Association will be interested. As they are the association of the local authorities mainly concerned, I hope the Minister will bear that in mind. They have approved the insertion of the Amendment. This is a good Measure and it will help considerably in the long run. I do not think we can expect great results at an early date. I hope the Parliamentary Secretary meant what he said when he implied, in his opening remarks, that the Ministry have this matter of recruiting very much at heart and are pressing forward with it. Until that is done the full value of the Bill will not be realised.
§ 6.15 p.m.
§ The Joint Under-Secretary of State for Scotland (Miss Herbison)
It is good to find a Measure before this House that receives such universal approval as this little Measure has received today.
The right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot), when he opened for the Opposition, took up a point made by the Parliamentary Secretary. Figures had been given about the decrease in infant mortality. I agree with the right hon. and gallant Gentleman that much of that decrease can be attributed to drugs and to education, but I think we can also claim that much of it is also due to the much better standard of nutrition among many of the working mothers of this country.
89 The hon. and gallant Member for the Isle of Ely (Major Legge-Bourke) regretted the disappearance of the Privy Council as the body responsible for making Orders on the constitution of the Boards. He must have been under a misapprehension when he raised that point because, by the Ministry of Health Act of 1919, the Ministry took over the powers of the Privy Council in that respect. I think he has a genuine fear, but I am sure that the fact that this Bill gives the House a chance to discuss any provision the Minister may like to make and vote on it, would give the safeguard for which the hon. and gallant Member is looking. The right hon. and gallant Gentleman who opened for the Opposition also wanted to know whether we still had the war-time provision whereby a nurse would only be accepted for training as a midwife if she was prepared to serve two years immediately afterwards as a midwife. That provision has been taken out. It was a war-time provision.
The right hon. and gallant Gentleman also raised the question of whether there was perhaps a too lavish use of analgesia. The Parliamentary Secretary pointed out in his speech that a committee had been set up to go into this whole matter to find out what would be the proper and best use of analgesia. The Parliamentary Secretary gave figures for England and Wales. We have here the figures for Scotland, and I am sure the right hon. Member for Manchester, Moss Side (Miss Horsbrugh) would be glad to have them. We find that practising midwives qualified to administer analgesia on 31st December of last year in domiciliary practice were over 700 in Scotland, and there were over 400 in institutions. That was round about 50 per cent. of practising midwives. The number had increased greatly during that year and we are very hopeful that, at least by the end of 1951, every midwife in Scotland will be trained in the use of analgesia.
I do not know whether hon. Members have noticed an article that appeared in the "Glasgow Herald" of today's date. It is a report of a speech by Dr. Bruce Dewar, of Dumfries, to the Royal College of Midwives (Scottish Council). He gave the increase in numbers of those now trained in the use of analgesia and finished with the words: 90You will agree, therefore, that the response has been immediate and whole hearted and should certainly allay any public misgivings as to any shortcomings, in Scotland at least, in the rapid development of an all-embracing analgesia service.That statement by an eminent doctor and the figures I have given, do show that the Department of Health for Scotland and the Medical Officer of Health for Scotland have been taking real steps indeed to deal with this subject.
Many questions have been raised about uniform. It seems to be the only part of this Bill on which there appears to be divergence of opinion. The hon. and gallant Member for the Isle of Ely wanted me to say categorically whether the Government would put down an Amendment which, in effect, would deal with the Amendment accepted in another place. I am afraid I cannot give the hon. and gallant Member any information at present. We must leave it until the Committee stage, where it will be considered. As my hon. Friend said, since it is the only thing on which there appears to be a divergence it might add a little interest to that stage.
Many of the Members who have spoken have paid a real tribute to the Central Midwives Board. There has been a suggestion, I think by the hon. Member for Luton (Dr. Hill), that there should be a majority of midwives on what will possibly be a new board which will be formed, but the working party itself did not ask for that. It asked in its report that there should be a 50 per cent. representation of midwives. In England there are 14 members on it, and five of them may be midwives. In Scotland the number is 16, and four of them must be mid-wives but others could also be midwives. We cannot say at this point how many members of the board will be midwives, but we shall keep in mind the recommendation of the working party because we realise fully that the number of professional midwives on the present board, in spite of all the excellent work that the Board has done, has been too small.
A question has been raised about separate boards for midwives. Some hon. Members seem to think that the General Nursing Board should be the board for midwives. My hon. Friend the Parliamentary Secretary to the Ministry of Health dealt with this matter when he opened the Debate, and I am certain that 91 there are many reasons—he gave some of them—why there should be a separate board for this type of nursing.
There is only one other point with which I should like to deal. I think my hon. Friend gave the number on the roll for England and Wales as 70,000 and 18,000 practising. When this Bill was having its Second Reading in another place a request was made for the figures for Scotland. In Scotland we have 19,000 on the roll but only 2,400 practising. I feel that the relevant provision in the Bill is a good one, and that we should not go to the unnecessary trouble of making a list of thousands of people who are not practising and in many instances who never hope to practise.
When this Bill reaches the Committee stage, there may be some small points which hon. Members would like to raise, but I am certain that it will go through all its stages in the mood in which it has passed through this stage. It will do useful work for a body of women in this country, and I should like to refer particularly to some of those in our wild districts in Scotland—there may be some in the wild districts in Wales also—who do excellent work, not only in midwifery for our mothers but also in giving helpful advice in many other ways. I wish to conclude by paying a real tribute to these women.
§ Question put, and agreed to.
§ Bill accordingly read a Second time.
§ Committed to a Committee of the whole House.—[Mr. Wilkins.]
§ Committee Tomorrow.