TUBERCULOSIS NURSES (INDUSTRIAL INJURIES SCHEME) (Hansard, 13 March 1951)

§ Mr. Iain MacLeod (Enfield, West)
I beg to move, That an humble Address be presented to His Majesty, praying that the Regulations, dated 26th February 1951, entitled the National Insurance (Industrial Injuries) (Prescribed Diseases) Amendment Regulations, 1951 (S.I. 1951, No. 305), a copy of which was laid 1460 before this House on 26th February, be annulled. This Order adds tuberculosis, in respect of certain categories, as the 38th prescribed disease under the Industrial Injuries Act, and it raises such very grave issues that I thought it right, with some of my hon. Friends, to bring it before the House for discussion tonight.
I propose, first, to study the evidence and to query whether the conditions of the Industrial Injuries Act have been fulfilled—in other words, whether the Minister on the evidence available to her can 1461 make these Regulations at all. My second point is to examine the repercussions of these Regulations, which are very serious indeed, particularly as they will affect nursing recruitment, the claims of other workers to have tuberculosis prescribed as a risk in their cases, the position in regard to other communicable diseases, and the relationship between industrial injuries and the National Insurance Act. Finally, I want to suggest to the Minister a better way of setting about this problem, which is of so great concern to so many of us.
First, as to the Minister's powers. These are contained in Section 55 (2) of the Act. Two conditions have to be fulfilled before the Minister can prescribe a disease as an industrial disease, with all the consequences that flow from that. The first is that the Minister must be satisfied that the disease ought to be treated as a risk of occupation, that it ought to be treated as a particular risk of the professions of nurses, health workers, research and laboratory students, and the others mentioned in this Statutory Instrument; and the second is that this disease can be either established, or presumed with reasonable certainty, to be due to the employment.
Those are the conditions on which only there is any right to make these Regulations. It follows that before they can be made, the Minister must be satisfied on the evidence that there is added risk to those persons by reason of their employment. If we approve these Regulations, it will go out from this House that nurses in sanatoria and the various health workers have an additional chance of contracting tuberculosis by reason of their employment. That is the central dilemma which I want to pose at the beginning of my remarks.
The evidence on which we are asked to make so grave a decision is contained in the recommendations of the Advisory Council, which have presumably been accepted by the Minister. It says that there are very few statistics available. What statistics there are, notably those contained in the report on the Prophit tuberculosis survey, indicate that there was a higher incidence of tuberculosis in nurses, particularly in general hospitals. This survey is a lengthy document, from which I intend to read only two brief extracts. The first is from the 1462 preface by Lord Moran. After giving certain figures, he reaches this conclusion, and it is on this evidence that the Regulations are based: These figures suggest not only that young women are more likely to develop tuberculosis than young men in similar surroundings but that the risk of developing tuberculosis is more or less in proportion to the degree of exposure to tuberculous infection. Those who have studied this problem know that young women are more liable. It is not surprising that a group of young nurses should be found to have a higher incidence of morbidity, although not mortality, as the Survey points out. The Survey points out later that there is a considerable divergence of medical evidence on whether there is or is not a greater incidence of tuberculosis in hospitals. Having given the figures and comparing the figures between nurses in the various control groups, the Survey reaches this conclusion: The difference is just below the level of significance according to the severe statistical tests applied. It goes on to point out: There is no significant difference between nurses in Group B hospitals where full care is taken and the ordinary treatment in civilian life. The Advisory Council, and, following that, the Minister, have come down on the side that there is an added risk for this class of people. I should like to quote what the hon. Member for Bermondsey (Mr. Mellish) said on 23rd November: In the 15 institutions in my region there is a staff of 424 full-time and 66 part-time male and female staff and last year there was not a single case of infection among the nursing staff in those hospitals."—[OFFICIAL REPORT, 23rd November, 1950; Vol. 481, c. 648.] Apart from the evidence contained in the Survey, to which I have referred, the Minister when she indicated the presentation of these Regulations, said in reply to my right hon. Friend the Member for Moss Side (Miss Horsbrugh), who asked whether she agreed that the figures and facts showed that fewer nurses have contracted tuberculosis in the sanatoria than in practically any other way, answered that the right hon. Lady was absolutely correct.
The Parliamentary Secretary has to tell us on which of these horns of dilemma he chooses to impale himself. Either he must say that there is an added risk in con- 1463 trading this disease for this class, in which case the Regulations are legal, or he must uphold the statement of his Minister and agree with many other official and unofficial statements that there is no added risk, in which case the Regulations are illegal. Every conclusion of the Advisory Council is tentative: they say that "the evidence suggests," or "on balance we are inclined to think." Having decided on evidence which does not exist, in my submission, that there is an added risk they add that Although there appears to be an almost complete absence of statistical evidence, we formed the opinion that the special exposure to risk extends to other groups of health workers. On the strength of that statement that although there is no evidence they form that opinion, these Regulations are extended to other groups of health workers. A very famous Parliamentarian, commenting on the speech of an even more famous Parliamentarian recently, said that it contained no concrete noun. It is fair to say about this Report which I have read many times with the greatest care that it contains no concrete proposal whatever. I suggest that we must have more satisfactory evidence than this before we take such a step as is contemplated tonight.
On the second point I only want to comment briefly because I think possibly some of my hon. Friends would like to take this matter up, and that is on the question of establishing or presuming the risk of infection. The Report says—and I entirely agree—that it is, in general, impossible to establish with certainty that the infection has been caused by the employment. That is so, beyond doubt. They go on to the question whether it may be presumed with reasonable certainty, and they come to the conclusion: We feel that adjudication on claims to benefit would be most difficult unless claimants were given the help of a presumption when claiming that they had contracted tuberculosis because of the nature of their employment. I have no doubt that if we are to have such Regulations, then they are right in saying that claimants must be given such a presumption, because otherwise I do not doubt that none of these people would qualify for benefit in the way that the Advisory Council suggests.
In all this there is no evidence at all. There is a great deal of surmise, and I 1464 am afraid it is impossible to escape the conclusion that this Council has made its arguments fit its recommendations rather than its recommendations fit its arguments. Unless there is a better way—and I promise in a few moments to try to suggest one—I do not think the House can allow the Regulations that are at present under discussion.
I come to my next point on the repercussions of these Regulations, and this is by far the most serious matter. These repercussions are, beyond doubt, very grave indeed. They are extremely wide, for this reason, that for the first time we are suggesting prescribing a disease, not only a disease which is widespread but a disease whose risk is or has so far been understood to be common to the entire population.
First, I want to discuss the question of the effect of this on nursing recruitment. One of the pleasantest features of the House of Commons as I have found since I became a Member of it has been the very great interest that Members in all quarters have shown in tuberculosis and in this question of nursing recruitment. There is no possibility of divergence in what I am saying now. We all recognise that this is the kernel and the key of the problem of tuberculosis. We recognise, too, that there has been in the past, and is still, a tremendous wastage—65 per cent. according to the Working Party—in regard to nurses entering sanatoria. What effect will an announcement—it amounts to that—that there is an added risk of tuberculosis to nurses, have on nursing recruitment?

§ Mr. George Thomas (Cardiff, West)
Does the hon. Member think the nurses do not know about that?

§ Mr. MacLeod
Of course; but let me put this point, because I am very anxious to get a summary of views on this point. The two bodies concerned—the Advisory Council and the Dale Committee on Industrial Health Services—both say that the evidence before them tips, as all this evidence is tipping, on a balance. Some people say it will have a good effect and that it will give nurses a feeling of added security. Some people say it will make it less attractive for mothers to persuade their daughters to go into such a service. I can express only a personal opinion. Whether we pay a nurse 45s. or 26s., 1465 obviously that is no compensation whatever for her if she contracts this dreadful disease. No compensation this House can suggest in terms of money can compensate a young woman for that. That is beyond doubt. So I express as my opinion—and this is a matter of opinion and not of proof—that on balance, and I agree the arguments are close, this will have an uncertain effect on nursing recruitment.
I turn to my second point, which is the effect of this new departure on other groups of workers who may claim, with what seems to them just as much justice, that tuberculosis is a risk of their employment. In 1939 there was a report on tuberculosis in Wales and Monmouthshire with which hon. Members may be familiar. That report stated the incidence of tuberculosis in various occupations and came to the conclusion that the three occupations which were most susceptible to infection were mining, quarrying and seafaring. Nurses were examined, but nursing was not included in the three occupations most seriously affected.
I suggest that we are opening a door to many groups who will claim that tuberculosis should be prescribed for them as a risk of their occupation. I shall come in a moment to the question of whether that is right or wrong. There are many examples. The steel industry of Sheffield is one. Another, of my own personal knowledge, occurs in the Outer Hebrides, where the incidence of tuberculosis is perhaps more severe than anywhere else in Britain. There is no doubt that the risk of employment of the weavers, weaving tweed in their own cottages, is far higher than that of any of the people for whom we are legislating tonight.

§ Mr. William Elwyn Jones (Conway)
I was going to point out that of the three occupations the hon. Member has mentioned, two have already been prescribed.

§ Mr. MacLeod
I realise that, but I am saying, as the Committee said, that there are many groups of persons for whom tuberculosis might be fairly claimed to be an additional risk of their employment.
My third point is the most important of all. We are prescribing tuberculosis because we consider it to be a communicable disease: that is the basis of the Regulations. All other communicable 1466 diseases immediately come into consideration. Once this door is opened, I am certain that every communicable disease to which workers are subject, in particular the infectious diseases, to which nurses in hospitals have an additional risk, must be prescribed by the Minister, as the direct result of the action we are taking tonight in prescribing for the first time a disease which is on the whole common to everyone.
Before the Dale Committee on Industrial Diseases, the T.U.C. offered evidence that in their opinion every disease which could be shown to be contracted by virtue of employment should be prescribed, and that view was supported independently by the Royal College of Physicians. I am sympathetic to that point of view. We are going a long way towards that point of view tonight, but I would add that it is the end of the industrial injuries conception as we have known it ever since 1897. That may be good or bad. On balance, I think it good, but it is essential that the House should be clear on what the Regulations which I am moving to annul seek to do.
The Committee on which this is based has said that in the view of the public the distinction between National Insurance and Industrial Injuries will, as a result of this prescription, inevitably become blurred. I have no doubt that that is true. I believe that just as Workmen's Compensation was out-dated by the 1911 Insurance Act, but took a long time to die, so the conception of Industrial Injuries in time is bound to be out-dated by the scheme of 1946.

§ Mr. Ivor Owen Thomas (The Wrekin)
The hon. Member's remarks seem to be aimed at the conclusion that industrial disease, as such, for compensation purposes is a wrong classification, and that because of what he terms the blurring of the line between industrial accidents and industrial diseases, there ought not to be any separate compensation for industrial injuries.

§ Mr. MacLeod
That is the logical conclusion of the Trades Union Congress arguments. [HON. MEMBERS: "No."] That is the interpretation which I put on the evidence of the T.U.C.

§ Dr. Morgan (Warrington)
No.

§ Mr. MacLeod
In my view, and I am putting it no higher than this, once this 1467 conception is made, once the risk to the population is admitted, one must admit mumps and chicken pox and all the other communicable diseases and so, in time, every disease contracted by virtue of employment must be admitted to be a prescribed disease, and there will be no industrial injuries.

§ Mr. Speaker
The hon. Member is getting very far from the Regulations. To quote from the Regulations, they deal with tuberculosis in the case of nurses and certain other persons insurably employed in occupations involving close and frequent contact with a source or sources of tuberculous infection. It must be people who are in close contact with tuberculosis, and the Regulations do not deal with general industrial diseases.

§ Dr. Morgan
This is my plea. As medical officer to the T.U.C. I had a great deal to do with collecting the evidence in regard to this matter. The hon. Gentleman starts off with an absolutely wrong idea of the whole basis of these Regulations. As Mr. Speaker has just mentioned, any of these diseases must be related to the man's employment.

§ Mr. MacLeod
No. I assure the hon. Member that I had not misinterpreted the point in his interpretation of the evidence given to the Dale Committee, which I have here in my hand. It may be that this is a matter of opinion. It may be that hon. Members disagree with me. It is true, as Mr. Speaker has said, that I have been led into routes further away from the Regulations than I intended.
Let me suggest the ways in which I think a better method of setting about this problem could be found. Whether my conclusions are accepted by everyone or not, it will be agreed that this is a matter which must be discussed, and on which the repercussions are serious indeed. I suggest that in preference to passing, or allowing, these Regulations to go forward, the Minister should use her powers under Section 73 (1) of the Act to promote research into the causes and incidence of the diseases for which this method might be prescribed.

§ Mr. Speaker
These things are outside the Regulations. I think that alternative methods are really outside the scope of this Debate.

§ Mr. MacLeod
I bow to your Ruling, Mr. Speaker, and will leave my suggestions of a better method cut slightly in mid-air.
Let me say finally that I do not think that this is the right way. I do not think that we have sufficient evidence before us to allow such Regulations to go forward. I consider the repercussions are too grave and I consider the ripples from these Regulations will go too far for the conception of industrial injuries to be maintained. I suggest that they are based on inadequate evidence, that they are of doubtful legality, and that they will have the most serious repercussions. Although I have not the slightest intention of inviting the House to divide on this matter, because it is obviously one which should not be taken to a Division, I think it is right to bring it before the House and, I submit, the case against these Regulations is fully made.

§ Mr. J. Enoch Powell (Wolverhampton, South-West)
I beg to second the Motion.
I wish to emphasise two of the main grounds he has given for his Motion, namely, the inadequacy of the statistical basis upon which these Regulations purport to rest and, secondly, the repercussions which their making will have upon tuberculosis nursing and, through that, upon the whole treatment of tuberculosis. First, as regards the statistical basis. This is an absolutely vital point, because unless the statistical evidence is perfectly clear and satisfactory that nurses in sanatoria are, in fact, definitely more liable to tuberculosis, than the rest of the population by reason of that employment, then these Regulations are undoubtedly ultra vires.
I hope that when the Parliamentary Secretary to the Ministry of National Insurance replies, he will give us—I think it will be for the first time—the statistical evidence for saying that there is, in fact, a higher incidence amongst nurses in sanatoria due to their employment. Both points are essential to the argument. Certainly, the Advisory Council did not, in so many words, even state that, because as I read their Report they confounded the position of nurses in sanatoria with the risks to the nursing profession in general. They said: 1469 There is a higher incidence of tuberculosis in nurses, particularly those in general hospitals. They said again, and I am quoting from another point in paragraph (10) of then-Report— The incidence of tuberculosis is higher amongst nurses. That is not satisfactory, even if that statement rests upon statistical evidence, which we have not had yet.

§ Mr. Hargreaves (Carlisle)
The point surely is that of nurses in general hospitals nursing tuberculosis patients without the safeguards which there are in sanatoria.

§ Mr. Powell
I see the hon. Member's point. I have long grasped it and I am coming to that in the second part of my remarks, in which I propose to demonstrate that these Regulations do not cover nurses in general hospitals. [An HON. MEMBER: "They do."] I leave that for the moment. Let us take the subject in two parts: nurses in sanatoria and nurses in general hospitals. So far as nurses in sanatoria are concerned, it is not even claimed by the Advisory Council that they are subject to higher risks by virtue of their employment. If we look at the conditions under which they work, we are led on a priori grounds to the conclusion that it is most unlikely that nurses in tuberculosis sanatoria would compare unfavourably from tubercular infection with comparable sections of the population not so employed.
Let me remind the House of some of the factors which are to their advantage. In the first place, they not only have regular X-ray examinations, but the X-ray plates which result are read by people who are reading X-ray plates all day long for no purpose whatsoever but the detection of tuberculosis. That is a very much more searching and safeguarding sieve through which to pass than ordinary mass radiography or X-ray examination. In the second place, as is, I think, well known, that nurses employed in tuberculosis sanatoria are Mantoux tested; and if that does produce a negative result—the employment of Mantoux negatives in tuberculosis sanatoria is avoided, I know, as far as possible, though there are many such employed—if that does produce a negative result, then B.C.G. is available. Finally, the nurse in a tuberculosis sanatorium is living, as compared with her sisters in general hospitals, in precisely 1470 those conditions selected by the medical profession as preventive of tuberculosis—as unfavourable to the development of tuberculosis—and she lives under a strict regimen designed to counteract the dangers of infection.
So I submit that not only has the statistical evidence in regard to sanatoria nurses not been produced, but the probabilities are weighted against their being specially exposed to this infection by reason of their employment. Unless it is quite certain, unless this House can convince itself, that there is such a higher risk to sanatoria nurses, we ought to hesitate, and hesitate long, before we pin upon the profession of tuberculosis nursing in sanatoria this danger flag of an industrial disease recognised for the purposes of the Act.
The superintendent of a tuberculosis sanatorium near my constituency writes to me: Nurses are apt to regard extra pay as danger money. They would quite certainly regard the coming into force of these Regulations as a danger signal. Though that may not affect—and this is in answer to the hon. Gentleman the Member for Cardiff, West (Mr. G. Thomas)—nurses already in the profession—I am sure it would not—it would certainly affect both those contemplating entry into it, and what is more important still, relatives and others likely to sway their minds.

§ Mr. G. Thomas
Is the hon. Gentleman not aware that the nursing profession has been asking for this sort of Regulations for years?

§ Mr. Powell
Well, if that is so, we are entitled on this matter to be guided, as the Minister must be, by the Report of the Advisory Council, which, I am sure, is anything but clear on the subject, and by the legal obligations laid upon the Minister.

§ Mr. Fernyhough (Jarrow)
Moral obligations.

§ Mr. Powell
I am not sure that the considerations I am advancing are not influenced by moral factors and moral considerations.
Now I want to pass from nurses in sanatoria to the nurses in general hospitals. I agree immediately that the nurses in general hospitals are under greater 1471 danger of infection certainly than their sisters in the sanatoria, and almost certainly than the public at large. The same superintendent of a tuberculosis sanatorium whose letter I quoted just now states that the nurses in those sanatoria are almost certainly in less danger than nurses working in general hospitals, and a tuberculosis officer of long experience writes to me: Figures are available to show that there is less likelihood of nurses being infected with tuberculosis in sanatoria than in general hospital nursing. As an illustration of the reasons for that, I may mention that quite recently in a hospital not far from where I live, a patient was in a general hospital for 14 days——

§ Mrs. Middleton (Plymouth, Sutton)
On a point of order. Are we in order in discussing in this debate the application of these Regulations to nurses either in tuberculosis sanatoria or in general hospitals, in view of the fact that both classes of nurses are covered by the Regulations?

§ Mr. Powell
If both classes are covered by the Regulations, I should have thought that we were in order in discussing the application of the Regulations to both classes.

§ Mr. Speaker
Apparently the Regulations do affect occupations involving close and frequent contact with sources of tuberculous infection. How far that goes in general hospitals, I am not clear.

§ Mr. Powell
I was about to address myself, Mr. Speaker, to exactly that point which I think is of great importance since, if I am right in thinking that the Regulations do not cover nurses in general hospitals—[HON. MEMBERS: "They do."] Well, they may or may not.

§ Mrs. Middleton
My point of order was that a distinction was being drawn on the other side of the House to the effect that the Regulations do not apply to nurses in general hospitals, but under the terms of the Regulations obviously nurses in general hospitals are included.

§ Mr. Powell
The hon. Lady, I submit, is not so much raising a point of order as discussing in advance—and I am sure we shall be grateful to her for her views on it—the point I was about to put 1472 before the House relating to the actual wording of the Regulations. In coming to the question of nurses in general hospitals and their need for being covered, if we are to deal with the matter at all in this way, I was pointing out the urgency and importance of this by referring to a particular case of danger of tuberculosis to a nurse in a general hospital.

§ Mr. Ivor Owen Thomas
I think it was clear to the whole House that when the hon. Member started to develop his argument in relation to the incidence of this complaint in general hospitals, he did so on the argument that the Regulations did not apply to general hospitals. Now it has been made clear that they do apply to general hospitals, what is the reason for his continuing the distinction he sought to draw?

§ Mr. Speaker
These things are rather technical and if points of order are to come up one after the other, it is very hard at this time of the morning to understand the points. I am not clear myself, having heard the argument, whether or not the Regulations apply to general hospitals.

§ Mr. Speaker
How on earth can I possibly answer all these points of order. I want to hear the argument and then perhaps I shall know to what the point of order relates.

§ Mr. Powell
I was about to address an inquiry to the hon. Gentleman on the Treasury Bench as to whether the Regulations do in fact cover nurses in general hospitals and to give my reasons for being doubtful on the subject.

§ Mr. Speaker
Perhaps to shorten the proceedings the Minister could tell us whether they do or not. I should like to know for my own information. He knows the Regulations and could presumably tell us. I have often asked a Minister to clarify my mind on a matter of this kind because I do not know and would like to know.

The Parliamentary Secretary to the Ministry of National Insurance (Mr. Bernard Taylor)
I think that if the Regulations are carefully read, there need not be any doubt in the mind of the hon. Member at all. May I draw his 1473 attention to the nature of occupation which is to be scheduled? Any occupation involving close and frequent contact with a source or sources of tuberculous infection by reason of employment. I submit that that does include nurses in general hospitals.

§ Mr. Powell
I am grateful to the hon. Gentleman for that intervention, suggested by yourself, Mr. Speaker. It does enable me to put my matter of doubt much more readily than I would otherwise have been able to do. The example I was about to give to the House when I was interrupted does precisely bear upon this wording and its applicability. I was referring to a case in a general hospital where a patient had been there for 14 days and had been diagnosed as suffering from influenzal pneumonia. After that period it was discovered, to use the words of the doctor who told me about it, that it was a case of "roaring tuberculosis". Let us consider the position of the nurses tending that patient. It is perfectly true that they were in close contact with a source of tuberculous infection, but I am exceedingly doubtful whether by reason of their employment in a general hospital, where tuberculosis cases are not normal——

§ Mrs. Braddock (Liverpool, Exchange)
But they are.

§ Mr. Powell
—it could be said that they are in close and frequent contact with a source of tuberculous infection. It may well be said, like certain other communicable diseases to which nurses are subject, that the Minister might manage under industrial injuries to cover the case by saying the infection was an accident; but I am doubtful whether the nature of employment "involves" for the purpose of this schedule close and frequent contact with a source or sources of tuberculous infection. I hope that the Minister will, upon reflection, see that this point has more substance than he might at first have thought.
I conclude by emphasising the grave responsibility which rests on us now in adopting Regulations, or taking any measure, which might react on the recruitment of nurses for the treatment of tuberculosis, and particularly for tuberculosis sanatoria. At any rate, in the area from which I come, which is one 1474 of the least happy areas of the country from the point of view of this disease, the waiting lists, having been checked by the opening of general wards, are now rising again. As is common knowledge, and as my hon. Friend stated, the nursing factor is the key factor. I am desperately concerned that the reaction of these Regulations may be against recruiting to sanatoria, and that that reaction may be based on a false statistical basis. It is on those grounds that I support the Motion.

§ Dr. Morgan (Warrington)
I hope that this discussion will not be continued for very much longer, for I can assure hon. Members that the Trades Union Congress have been concerned with this matter for years. We have gone through it with a fine comb, and we are perfectly satisfied that at present these Regulations go as far as it is legitimately possible to go in protecting the interests of workers exposed to tuberculous infection. If the contents of the Regulations are read thoroughly, it will be seen that the provisions relate not only to nurses but to other workers in hospitals who come in contact with tuberculous infection. I assure the House, speaking with some knowledge of the subject, that the unions have gone into this thoroughly. I ask the House to accept the Regulations which are based on long experience gained throughout the country.

§ Mr. Alport (Colchester)
I am sure that all hon. Members on both sides of the House approach the problem of tuberculosis with a sincere wish to find the best way not only of coping with the disease but also of providing any means possible of preventing it in future. We welcome the reduction in the figures recently reported, and we hope that in due course the speed of that reduction will parallel the speed of the reduction in the incidence of tuberculosis which took place between the years 1931 and 1935.
I should like to ask the Minister to qualify the Schedule to this Statutory Instrument, which has caused me and other hon. Members on this side some confusion in regard to its interpretation. Will he define as exactly as possible what is meant by the word "occupation"? We know that there is a considerable waiting list for sanatoria; the figure is 1475 something like 13,800 for England, Scotland and Wales. That means that those patients have to be looked after by the members of their families. Many of us who have contact with these cases know how very distressing the situation is for those families. The mother, with a number of children perhaps, has to look after a husband who is in a highly contagious state. Is that "occupation" in the sense of the Schedule?
Would it be possible for the husband to employ his wife—as would be possible for Income Tax purposes—as an attendant on him, and by paying the necessary contributions entitle her—should she contract the disease—to some sort of compensation? I would remind hon. Members opposite that it is the lower income groups who are mostly affected by this, because while the better-to-do can use the facilities available in private sanatoria, those who are less well off have to keep their relations at home unless they can get them into public institutions. It is therefore important that we should see that these cases, where the need is perhaps more important from a priority point of view than that of nurses in sanatoria, are looked after by this Schedule.

§ Mr. Speaker
When the hon. Member talks about nurses in sanatoria and so on, I think he is going outside the Regulations. That is my impression.

§ Mr. Alport
I bow to your Ruling, Sir, but what I am asking is an interpretation of the Schedule and of the term "occupation." I have tried to illustrate my point by showing how a person can be occupied in close and frequent contact with sources of infection by reason of employment and although not coming within the definition of nurses can be carrying out the functions of a nurse.

§ Mr. Speaker
"Employed" does not mean "occupation."

§ Sir H. Lucas-Tooth (Hendon, South)
There is no reference in the Schedule to hospitals sanatoria or other establishments. Therefore, I submit that it is in order to discuss the case of a wife, daughter or servant in a private house. The Schedule is applicable to any place where a sick person may be.

§ Mr. Speaker
I cannot accept that.

§ Mr. Alport
Perhaps I might refer the Minister to paragraph (b) and ask him to define the meaning of in attendance upon a person or persons suffering from tuberculosis, where the need for such attendance arises by reason of physical or mental infirmity; It would seem that that definitely includes a wife or daughter who would be compelled under existing circumstances to be in constant contact and therefore to have an occupation in the sense of being in frequent contact with the source.
I remember a case not long ago when three medical students at one of the great London hospitals contracted the disease as a result of their contacts with tuberculous cases in the wards. Will those students be included in the definition of the Schedule? I join with hon. Members on this side in asking whether or not this compensation will apply to nurses in general hospitals and particularly in hospitals concerned with the treatment of mentally deficient cases. As hon. Members will know, mentally deficient patients are more liable to tuberculous infection than any other members of the community. Therefore, the staff are more liable to be in contact with infection than the staffs of general hospitals. Are those hospitals also included?
We are very anxious to ensure that this disease, which we regard as one of the priorities in the Health Service, shall have all the attention possible to prevent and to cure it. We sympathise and support very sincerely every measure introduced to that end. But Members opposite will understand it is only right that any action taken should be properly discussed and considered in cases where, as my hon. Friends have alleged, it is not helping towards an improvement in the very dangerous situation that exists, and may, in fact, be acting in a contrary way.

§ Mr. Speaker
Might we not now have an answer from the Minister?

The Parliamentary Secretary to the Ministry of National Insurance (Mr. Bernard Taylor)
I was anxious that nobody should be prevented from participating in the debate. I am very glad that this important subject has been raised, and although the hour is so late; I am glad that we have had this opportunity of discussing what hon. Members 1477 in all quarters of the House regard as an important topic.
The Regulations which are before the House constitute a landmark in the development of the Industrial Injuries Scheme, and I do not share the gloom or pessimism of hon. Members opposite with respect to the prescription of this disease. I should like to express my gratitude to the hon. Member for Enfield, West (Mr. Iain MacLeod) for previously intimating to me the main points which he intended to raise.
In view of what has been said by hon. Members opposite, may I say that the Government are by no means apologetic about these Regulations? On the contrary, we are proud to have had the opportunity of introducing them, for, in spite of what has been said by hon. Members opposite, they will be of benefit to nurses and others who come into contact with tuberculous patients. There is one tribute I should like to pay to nurses, and I feel this will be shared by all hon. Members. Nurses are outstanding amongst those who devote themselves unsparingly to the service of the community without regard to self. Although the hour is so late, we are more than happy tonight to be able to do something in return for those of them who have the misfortune to contract this dreaded disease of tuberculosis as a result of the work in which they are engaged.
I hope that I shall show to the House that my right hon. Friend in particular has given very careful consideration to this important matter of prescribing tuberculosis among those engaged in occupations which bring them into close and frequent contact with tuberculous infection. I know that some of my hon. Friends think that we have been too long in taking action, but may I remind them that the issues which are at stake are so important that we felt we had to be absolutely certain that any action we took did not conflict with the principles underlying the Industrial Injuries Act.
I should like to make a brief reference to the history of this matter, and I crave the indulgence of the House at this late hour, but, as I said at the beginning of my speech, this is an important topic. The subject of benefits for nurses and other health workers who contract tuberculosis from their employment certainly has something of an interesting history. 1478 I do not think the hon. Member would deny that. Tuberculosis was not one of the diseases scheduled under the old Workmen's Compensation Acts. While it is the case, as the hon. Member inferred, that occasionally claims succeeded as claims for injury by accident, there was no compensation in the great majority of cases where a person developed tuberculosis as a result of his of her employment.

§ Mr. Speaker
The hon. Member must confine himself to nurses, or to certain people in attendance upon a person who is affected or comes frequently into contact with affected persons. He cannot go into the whole history of tuberculosis legislation.

§ Mr. L. M. Lever (Manchester, Ardwick)
Surely the reference by the Parliamentary Secretary does relate to the unfortunate position of nurses under the old Workmen's Compensation Act, in which they were precluded from, receiving compensation.

§ Mr. Speaker
If the hon. Gentleman's remarks referred to nurses, I am quite happy. I did not follow that.

Mr. Taylor
I bow to your Ruling, Mr. Speaker. When the Industrial Injuries Bill was before the House five years ago, the Government were pressed to include in the Bill a specific provision that it should apply to nurses who contracted tuberculosis. The actual specification of diseases to be covered by the Act was left by Parliament to be done by Regulations and the Government undertook to give this question careful consideration.
I hope I shall be in order if I refer to the Dale Report. Early in 1947, the present Colonial Secretary, then the Minister of National Insurance, appointed a Departmental Committee to advise him on the principles which should cover the selection of diseases for insurance under the Industrial Injuries Act. I know that in doing this my right hon. Friend had particularly in mind tuberculosis among nurses. This Committee reported in 1948, and among other things recommended that a primary consideration in prescribing a disease under the Act should be whether the disease is "specific to the occupations of the persons concerned, or if it is not so specific, whether the occupations of those persons cause 1479 special exposure to risk of the disease, such risk being inherent in the conditions under which the occupations are carried on."

§ Mr. Iain MacLeod
I agree. The hon. Gentleman is quoting from paragraph 19 of the Dale Report, which I know well. What I am asking is that some evidence should be produced to show that in fact that is the case. We have not had a word about that.

Mr. Taylor
In reply to the hon. Member's interruption, I would say that according to Section 55 of the Act the only condition that is required for the making of Regulations of this kind is that the Minister should be satisfied that it is a risk of their occupations. I want to say to the House tonight that, on this particular point, upon the prescription of tuberculosis, the Minister is absolutely satisfied that this is the moment when it should be done.
One other point raised by the hon. Member for Enfield, West, was whether there was an added risk of infection by the disease among nurses. I think that if he reads the report of the Advisory Council again—he says that he has read it many times, but I submit with respect that he should read it perhaps a little more carefully—he will find there is abundant evidence in that report which in the view of the Minister, shows that the conditions for making these Regulations are satisfied. There is abundant evidence of an added risk among the nurses in the occupations mentioned.

§ Mr. McCorquodale (Epsom)
I am speaking from memory now, but when I was at the Ministry of Labour during the war, this question came up. The advice we got at that time from the Ministry of Health was that in properly conducted sanatoria, the risk was not greater than the risk in other occupations. I well remember a great authority telling me that he regarded the people who swept out the cinders as being in the most dangerous occupation of all.

§ Mr. Mellish (Bermondsey)
If there were only one case of a nurse getting tuberculosis in a tuberculosis sanatorium, or in a general hospital, these Regulations ought to apply. What have we to do? Is it suggested that we should wait until hundreds of thousands drop down dead?

Mr. Taylor
It is the case, I frankly admit, that the incidence of tuberculosis among nurses in sanatoria is remarkably low because of the very high standards set to prevent its spreading; but there is evidence that the incidence is greater in general hospitals than in sanatoria. Even if it were the fact, as my hon. Friend has suggested, that there were only one case, I submit to the House that that would be complete justification for these Regulations.

§ Mr. McCorquodale
I am not quarrelling with that statement, nor am I quarrelling with what the Parliamentary Secretary says, but I am anxious that it should not go out to the parents of prospective nurses that this is a highly dangerous occupation, when actually it is not.

§ Mr. Mellish
Is it not obvious that every intelligent person in this country knows that there is a danger of tuberculosis? The urge to enter this job comes from the heart. We have proved, in other debates, that the rate of infection is lower, but again I say even if there were only one case, that would be sufficient ground for these Regulations.

Mr. Taylor
May I make an observation regarding the provision that there shall be close and frequent contact? I think it is sufficiently important for me even at this late hour to make an observation about it. I want to emphasise, in this connection, that we have been extremely careful in deciding who should be covered by these Regulations. I think that was one of the misapprehensions of the hon. Member for Enfield, West. It might have been suggested that tuberculosis should be prescribed in relation to anyone engaged in nursing, or in one of the other occupations listed in the Regulations. But we have not done that. We have covered only those who can show that they have been exposed to close and frequent contact with some source of tuberculous infection because of their employment. The requirement is not just close or frequent, but both close and frequent, contact.
I should like to emphasise that particular point. We are satisfied that this fundamental condition will ensure that only those who are really at some special risk can qualify for benefit under the Regulations-. I was proposing to say one or two words about presumption, but I will miss that point. May I come——

Mr. Taylor
The hour is getting late and the hon. and gallant Gentleman will forgive me for not giving way. May I make an observation about specialist advice and consideration of claims? I want to emphasise this because hon. Gentlemen opposite will agree, I am sure, that the Advisory Council placed great emphasis upon this point, and attached great importance to it. We have arranged, with the co-operation of the Health Departments, that in every claim under these new Regulations we shall have the benefit of advice from a specialist in tuberculosis, not only on whether the person claiming benefit actually has tuberculosis, but on whether his or her employment involved close and frequent contact with the disease and whether it was probably due to the nature of the employment.
In addition—and I think this, too, is of some importance—we have arranged that every claim will receive especially careful treatment when it is under consideration. I hope that this will show that the Government are fully alive to the need for administering the provisions of these Regulations very carefully in view of the repercussions which could follow if there were loose treatment of claims.
May I say a word about the occupations covered, and I think this will in many respects cover the point made by the hon. Member for Colchester (Mr. Alport). Nursing is, of course, the main one, but there is a number of others. The list of occupations is drawn for the most part in general terms, but we expect they will cover, for example, ward maids, hospital laundry workers, and tuberculosis visitors, always provided, of course, that the condition of close and frequent contact with tuberculous infection, to which I have referred, is satisfied.

Mr. Taylor
I am sorry, but I have given way two or three times.

§ Miss Irene Ward (Tynemouth)
But we are interested.

Mr. Taylor
May I now make a brief observation in reply to the comments made by hon. Gentlemen opposite in 1482 respect of the effect on the nursing profession? I am glad to say that the Advisory Council said in their Report that the opinions expressed to them supported the view that prescription of tuberculosis would help rather than hinder recruitment; and we think the sort of men and women who enter upon the vocation of nursing are not likely to be deterred by the knowledge that there may be certain risks attached.
In conclusion, I should like to repeat that I am completely satisfied, and so is my right hon. Friend, that this step which we are taking in making these Regulations prescribing tuberculosis is justified. We are most glad to have this opportunity of taking it. As has been pointed out in every speech by hon. Members opposite, this is a new departure. It is an innovation and it has been made after prolonged and expert examination of the issues involved. I assure the House that we shall watch its operation carefully. I am sure I shall have the backing of the whole House when I say that I regard this as but a very small measure of the debt which we all owe to nurses and hospital staffs for their unselfish and devoted service to the community.

§ Mr. Alport
Perhaps the hon. Gentleman would kindly consider whether he is able to give an answer to the question I put as to whether the relatives, the wife or daughter who are compelled to nurse the tuberculosis patient in the home owing to lack of accommodation, can be brought under the operation of this Schedule by being placed in employment by the patient concerned?

Mr. Taylor
The answer is very simple. To be covered by the Schedule, an occupation must be insurable under the Industrial Injuries Act.

§ Mr. Iain MacLeod
I am afraid I can only describe the reply as profoundly disappointing. I am very distressed that the Parliamentary Secretary, after I had given him full notice, has not studied this matter with anything like sufficient care. We have been asked for evidence on these matters. I can give one example. The hon. Member for Bermondsey (Mr. Mellish) said that if there was one case these regulations were justified and I said that no money could make up for this; if we paid that one nurse £10,000 it would not compensate her. I was quite horrified 1483 to find the Minister taking the view he did. These orders are unquestionably ultra vires.

§ Mr. Mellish
What does the hon. Member suggest? That in one case of a nurse in a general hospital who contracts TB we are to ignore it?

§ Mr. MacLeod
No, there is a far better way of procedure, but when I tried to indicate it I was, unfortunately, ruled out of order. It is not enough for the Parliamentary Secretary to tell us to read page 3 when it is asked if this affects nurses in general hospitals. Does he think that any hon. Member on this side of the House has come here without knowing every word of that schedule and every word of the Industrial Injuries Act, as I have shown in my replies to the Minister?
We have been told by the Minister, who quoted paragraph 36 of the Report that the view of the Dale Committee was that this thing would help recruitment, but he did not read the sentence immediately before it which says: Some"— that is the medical evidence— felt that prescription would give a little sense of security, others that it may have a frightening effect on potential entrants to nursing or their parents. If one puts forward a case which is supported by something like half the medical profession it is no good hon. Members opposite shouting "Nonsense."
I say, finally, that I am bitterly disappointed that the Parliamentary Secretary should not have treated this most important subject with the consideration that, in my view, it deserves. [HON. MEMBERS: "Divide."] On this point of dividing, I told the Minister in a personal letter I wrote to her a fortnight ago, when I raised this point, that I thought it undesirable that this subject should be made a point of Division. [HON. MEMBERS: "Oh."] I hold to that view. I do not intend to ask the House to divide, but I do think that the Parliamentary Secretary would be well advised to study this matter a great deal more than he seems to have done.

§ Mr. Speaker
Let us get on now.

§ Mr. Mellish
With great respect, Mr. Speaker, although I recognise how late 1484 it is, I do consider this matter too serious to ignore. The hon. Gentleman, if I may say so, has been absolutely hypocritical.

§ Mr. Speaker
That is not a word we may use of hon. Members.

Hon. Members
Withdraw.

§ Mr. Mellish
Let hon. Members give me a chance to do so. Under your instruction, Mr. Speaker, of course I withdraw. But last week we had seven Prayers, and they were a travesty of democracy. [HON. MEMBERS: "Oh."] It looks as though tonight we are to have a similar performance. However, on this occasion, as opposed to last week's, we are playing around, if I may say so with respect, with a very serious problem.
Today the whole question of the shortage of nurses for tuberculosis nursing is one that is occupying both sides of the House, and it has been treated seriously in the past. The hon. Member for Wolverhampton, South-West (Mr. Powell) made a very important contribution last time this matter was raised. It is desperately urgent that we should get more nurses, and the theme of the Opposition tonight has been, in fact, that this particular Order will deter nursing recruitment. That is utterly nonsensical, and hon. Members opposite should know it. I will prove it.
Everybody knows that the whole problem in nursing is to get those employed in general hospitals, and student nurses, and people of that kind, to go into tuberculosis sanatoria. Fear of infection has in the past deterred people from working in sanatoria. Today we have been able to prove that the fear of infection is less in sanatoria than in the general hospitals. Now if a nurse in course of training, in a general hospital or in a sanatorium—and anyone knows that, from the point of view of the occupation, it does not matter whether the place is a general hospital or a sanatorium—suffers in consequence, she will get under this Order compensation that the nurses have been denied for years.
Every parent knows that if his girl says she is going to work in a tuberculosis sanatorium, to care for the permanent patients, she has got guts and courage. It is a farce to say that this Order will mean they will not be compensated, or that it will mean parents will say, "There 1485 is to be danger of infection in sanatoria," when we know that the danger is less there than, perhaps, in a general hospital. It is a farce, and hon. Gentlemen opposite ought to know it.
I think it is a slur on the Parliamentary Secretary to say of him that he has not taken this matter seriously. I happen to know he has not only taken this seriously, but that he has, like all of us on this side of the House, been worried very much about the incidence of tuberculosis in the country.

§ Sir H. Lucas-Tooth
Before the hon. Gentleman sits down, in view of what he has said, will he resist in this House all the claims that will be made by other classes of workers, following this Order, when they develop tuberculosis in circumstances which may be assumed to be attributable?

§ Mr. Mellish
If it can be shown to me that any worker in any industry as a result of his employment is liable to contract tuberculosis, I shall do all I can to help remedy the position.