MENTAL HOSPITALS (STAFFING)

HC Deb 12 November 1953 vol 520 cc1248-82

Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Wills.]

8.47 p.m.

Mr. R. J. Mellish (Bermondsey)

I am glad that the Adjournment debate has come on so early, because the subject I wish to raise is one of national importance. I hope that as a consequence of the time factor it will be possible for a number of hon. Members, who I know have a contribution to make on this very important problem, to take part.

The subject of the debate is the shortage of nursing staff in the mental hospitals, with particular reference to the mental deficiency hospitals, which, for a better term, I had better call mental colonies. I have the honour to be a member of the South-East Regional Hospital Board and chairman of the local hospital management committee, and for some time past, since 1948, I have taken an interest in the hospital affairs of our country.

At the last meeting of the South-East Metropolitan Regional Hospital Board, the problem of the staffing position of the mental colonies in that region was raised by the chairman of the mental health committee. The chairman of this committee is a very able man, a doctor, and well respected by the members of the board. He is a man not given to making alarming statements. He said to the board—and the Press were present—that the position in that region with regard to the staffing of mental colonies was so serious that unless some improvement took place in the very near future there would be a complete breakdown. He went on to say—and the Parliamentary Secretary will know the answer to this—that in his honest belief, from what he had been told, the position in other regions was not only as bad but in some cases even worse. I understand that in one region the story is four times worse than the one I am about to tell. Therefore the shortage of nursing staff in mental colonies is a subject of national importance.

I want first to emphasise to the Parliamentary Secretary that the subject is non-political and that any criticism which I may make is not directed at her Department or at either herself or the Minister. The situation which has arisen is one which we must face and solve jointly. It is as serious as that. If I do make criticism, I do not want to be involved in any political arguments, for the subject is too big and too important for that.

The plight of the mental defective who needs institutional care is very serious. Yet little is known about it generally, and so I think it right to survey some of the problems facing those who are dealing with the problem. I am a layman in these matters, but I am advised that in the mental defective world the patients are in two categories, low grade cases and high grade cases. The low grade case is that of the idiot, the type of child, in particular, or man or woman, for whom very little can be done but who has to go to an institution or colony to be cared for. The people who are doing this work deserve our highest praise. They are doing a magnificent job under difficult conditions. We have very great sympathy with the low grade case, but it appears to be one for which little can be done except to provide institutional care.

The high grade cases are persons who are feeble minded and suffer from imbecility, and very great improvement can be, and is being, achieved by means of institutional care in the mental hospitals catering for this category. These institutions have a remarkable record of success in making these people stable once again and in sending them back into society as useful citizens. A great work is being done.

It is important to remember that the doctors and nursing staff are extremely anxious to get their share of the high grade cases in order to get some glory out of their work by being able to see success resulting from their efforts. However, the two hospitals in the South-Eastern Region—I understand that the situation is similar in the country as a whole—are able at this stage only to take the low grade cases, which, in the main, are unlikely ever to be trained up to a socially or economically valuable standard. By virtue of this, these cases have to be given admission priority over cases which might in the long run become stable, useful and happy citizens. No one denies that those cases should be the first to be admitted into the institutions.

In the two colonies with which I am particularly concerned, Darenth Park and Leybourne Grange, there are 500 vacant beds because of lack of staff. The staffing position is appalling. Last year we lost the following nursing staff: at Leybourne Grange five male and 45 female, and at Darenth Park 50 male and 61 female. At Leybourne Grange we were able last year to recruit only three males and six females. At Darenth Park we recruited 14 males and six part-time females. We were also fortunate enough to get some French women, but they stayed only a short while.

No one would deny that if these 500 beds were full tonight there would be financial difficulty in maintaining them. However, I am not arguing about whether the money is available for that purpose. It is an actual problem that these beds are empty because there is no staff available. The result is that the low grade type of case is the only one being catered for in these two hospitals, and even for that type of case the waiting list is very large.

The more I hear of this matter the more upset I get about it. It is the most distressing subject that we find. I know that the Minister will be with me in this matter, because like the rest of us, as a Member of Parliament, she must get letters about these cases. I have received sufficient to make me go into the matter more thoroughly, and I have paid visits to the medical superintendents of these homes. I have asked how I could help, and I have been told that the best thing would be to read a sample of the letters to give an idea of the sort of problem we are up against.

I propose to read some of these letters as I want to shock the public conscience on this issue. It is about time the public knew that the position is as bad as it is. I have here letters from the parents of patients and also some from medical officers and others.

One concerns a child of nine years who for seven years has been on the waiting list for admission. The father writes to the doctor: During the nine years of his life, my wife has not had one single day's holiday, and each day now is certainly shortening her life. For seven years they have been waiting to get that child into hospital, and they have not got him in yet.

Another letter concerns a woman who has to be looked after at home. She cannot be taken into hospital because we have not got the staff. This woman cannot cook and is unable to do anything for herself. She is not allowed out, and the person who looks after her has to go to work during the day. That person writes a most tragic letter, which I do not propose to read to the House because it is too shocking.

One of these letters concerns a child of six years who has been on the list since birth, and the parents are crying out for this child to be taken in if only for a short time to give them a rest. The viciousness of this problem is to be seen where a mental defective may be in a home with other children who are sane and happy. The child who is defective may cause some heart-breaking incidents.

There is a letter here from a minister of religion—I shall not read any names—and he has intervened because he knows the home circumstances. He says that the great problem in the case he quotes is the effect of this mongol child in the home upon the brothers and sisters who are a little older. He says that there is a nervous tension in the home which has to be seen to be believed. This really is a tragic problem, and when we remember the urgency of some of these cases and then reflect on the fact that there are empty beds but no prospect of getting staff at the moment so that those beds can be used, we can visualise something of the terribleness of the problem. That is why this matter has been raised on the Adjournment in the way that it has.

I should like to give the House one other figure. I shall not weary hon. Members with too many, but I think this one is important. In the last half year the numbers waiting for admission to these two colonies was 472, and they are considered vitally urgent cases. By improvisation and such other means we were able to admit only 158. Now we have the problem that if a mental defective for some reason or another appears in the police court and is certified for a mental home we cannot in some cases take even that case. Indeed, the hospitals have got to the stage that if they take that case it means that it has jumped the list. One regional board has appealed to us to see if we can stop magistrates making a court order for admission to the institution.

Now I want to deal with the high-grade cases. I have seen records of cases which, because of the better psychiatric treatment and diagnosis, have made a complete recovery but, owing to the fact that the hospitals are being caught—if I may use that term—with low-grade cases, the nursing staff become frustrated and the atmosphere of the colony is deplorable. So, although in one sense the shortage of mental deficiency nurses is part of a much wider picture, which is the shortage of all nurses, this is a special problem which must be dealt with in a special way.

What are some of the solutions? I do not suggest that what I am about to say will be the complete answer to the problem, but my suggestions are made in all sincerity and come from other sources than my own. Therefore, I ask the hon. Lady to consider them sympathetically and, when she replies, either to accept them, or to give me the reasons why that is not possible. I know she will not utter any platitudes and will agree that this problem is as bad as I have described it. I hope, however, she will not say that there are certain committees considering this question.

Now I want to read a statement from two devoted nurses who have spent their lives in a mental defective colony. It is worth reading because they are women with great experience on this work. They say: In point of fact one of the chief reasons for wastage is the hours of duty and the fact that a student nurse comes to realise the fact that, whilst it is possible to qualify as a staff nurse in three years, it will be a further seven years before the maximum salary for this grade is reached. Added to week-end, evening and night duty, this is too much, and in spite of the reasons for resignation given on the forms, these are more usually the real causes for the nurse leaving. Male students, the young married men who are stable and responsible folk, cannot afford to take up training. Their future is uncertain. They have various Service commitments and, after their National Service period, they require the wherewithal to set up house. The basic fault is that both salaries and conditions have failed to conform to the pattern of improvement to be found in other occupations and, more especially, to the rapid rise in the cost of living since the war. Those responsible for the recruitment of nurses must realise that they are now competing with industry and trade interests in the labour market, and that the nursing profession must offer opportunities of remuneration which are equal, if not better, than those in other fields of employment. And furthermore, it must be acknowledged that the greater number of male nurses in recent years means that the wages must be such that they can support and educate a family. We often hear the statement, particularly from matrons of general hospitals, "Nursing is a vocation and material rewards are not really required." That is old fashioned. That is out of date. Of course, nursing is a vocation but we have already proved, in the Spens scale and the Danckwerts award to the doctors, that worthwhile vocations ought to be well paid. Tonight we should recognise that, although nursing is a vocation, it must be made attractive and paid for adequately.

To sum up this part of my speech, I believe that recent work on training defectives has shown what can be done by patience and skill to make the defectives socially useful, stable and happy people. After this treatment many of them do not need permanent institutional care.

The facilities now available are not being used to the best advantage because of shortage of staff. This is due partly to the overall shortage and partly to the need to use the present staff to nurse low-grade cases. There are indications that this problem is becoming worse and we are told by the experts that if things continue in this way there will be a complete breakdown in the future.

Many of these cases present most tragic problems for their families. Some of them have already been waiting for years. These waiting lists are growing steadily and rapidly and the chance of getting into an institution is becoming more remote than ever. This is not a problem for local committees. It is a national problem for the Minister. I am sure that it is not necessary for me to say any more to prove that the problem exists and that it is a problem that calls for Ministerial action in this House. I, therefore, reiterate some of my suggestions as to how the problem should be tackled.

There is need to improve wages and conditions. We talk glibly about these things. Arrangements were made quite rightly to give T.B. nurses a special bonus of £30. The Minister must equally make certain that the wages and working conditions of mental deficiency nurses are improved considerably. The Parliamentary Secretary must tackle the problem at Ministerial level and not wait for the Whitley Council machinery to operate. She must make a definite statement that she believes the time has now come for her to give these people special rates of pay and special conditions. She must do this in order to attract staff and to awaken the public conscience. We need a national Press campaign to attract more people as part-time or full-time volunteers.

We must not leave this need to be advertised, as it is at the moment, in announcements tucked away in the pages of a medical journal which is read by the few. This is a national problem. We had the same problem in Civil Defence and thousands of pounds were spent on publicity. Let us spend money similarly on this problem. The Minister must insist to the Ministry of Labour that there must be no further call-up of student male nurses. Such a call-up cannot be justified. We rightly give exemption to miners and those engaged in the Merchant Navy. Those engaged in training to be male nurses should not be called up at any time. If they are prepared to do that job they are serving this country well enough—better than many people can hope to do in thousands of other jobs.

The Minister must provide special staff accommodation and facilities for recreation, particularly in mental colonies which are situated in remote areas. All this, of course, will involve the spending of more money, and in fairness to the Ministry it should be said that they have already decided that more money shall be spent in this way. There also should be a drive to recruit part-time nurses, both male and female.

As a result of my personal association with the hospital world, and my experience as chairman of a hospital management committee, I know that general hospitals are doing great work and that their staff problems are very difficult, but they are nothing like as difficult as those connected with mental nursing. I know now that the problems connected with the nursing of the mentally deficient are of such a character that they can only be dealt with on a national basis. I beg the hon. Lady to approach the problem in that spirit. I ask her please not to tell us, "A Committee is thinking about the problem."

On behalf of the Board I represent, I tell her that if we go on at the present rate we shall come to the Minister and say, "We are closing down; we cannot carry on." Then something will have to be done. It is bad enough at the moment, with the waiting lists at their present size and people remaining on them for years, but if something is not done the position will be even worse. I beg the hon. Lady to say that something will be done now, and I beg her tonight to give a complete answer.

9.11 p.m.

Mr. William Shepherd (Cheadle)

I am sure the House, and certainly those who have tried to deal with this problem in the country, will be indebted to the hon. Member for Bermondsey (Mr. Mellish) for raising this issue tonight and also for his good fortune in having been able to raise it on an evening when we have more time than is normal for an Adjournment debate.

No one who has attempted to learn something of this problem and who has been brought face to face with it will think that the hon. Member has overstated his case. Indeed, my impression is that he has not painted the problem in sufficiently harrowing terms, because unless one has had the experience it is impossible to appreciate what tragedy lies behind the figure of 4,000 children awaiting entrance to an institution. Perhaps it does not seem a great number, but every case involves incredible hardship and distress.

Unless they have had the experience, people cannot imagine what it is to have a child suffering from fits of screams for two or three hours at a time, going on not for days and weeks but for years. Unfortunately, as we know only too well, the cases occur mostly where people have a number of children and, too often, where there is another child on the way, adding to the burden of distress to the household.

During the time I have been concerned with this problem, which is almost from the time I came to this House, I believe nobody in any Ministry has devoted enough attention to it. There has not been sufficient public attention drawn to the problem or sufficient determination to overcome it. There are methods by which we can try to tackle the problem. There are means by which people can help themselves, and the National Association for the Parents of Backward Children are doing something along those lines. They are helping the parents who are in this predicament to help themselves. I certainly hope that the Minister will encourage the opening of occupational centres, because although they are not an entire solution they are certainly a means of alleviating the distressing conditions which exist in many parts of the country.

Moreover, although I do not know the present position in connection with short-term homes, I would emphasise that in the present situation these short-term homes are a vital necessity. I do not know how far the Ministry is providing capital for the opening of such homes, although I understand that it is difficult to provide capital for the purpose, but the short-term home is a means by which we can relieve the most acute distress. When the strain on a wife or husband becomes so acute in a house which contains one of these unfortunate defective children, sending the child away for a few weeks while the parents recover from the strain is a great benefit. For some years I have been pressing for more attention to be devoted to getting more short-term homes going, because although that is not in itself a solution of the long-term problem, it helps with the worst cases which exist today.

As the hon. Member for Bermondsey suggested, I think we should have a campaign for the recruitment of nurses. Obviously, the shortage of nurses in this field is shocking. Not only is it bad in the sense that there are many beds which are not being used, but if hon. Members look at the figure of nurses to patients in the beds which are being used, they will realise that those figures are pretty poor. I am quoting the most up-to-date figures—these are for last year—but the position roughly works out at one trained nurse for every 17 or 18 patients. In view of the special difficulties of dealing with mental patients, that is an extraordinarily poor proportion.

Mr. Mellish

I am grateful to the hon. Member for all he is saying. It is a fact, as he probably knows, that in some cases the stage has been reached at which they have to ask one patient to help another, where that is possible.

Mr. Shepherd

Yes, I think that is so. Of course there are many grades of defectives and sometimes they can be put to useful work.

But the ratio of one trained nurse to 17 or 18 patients is far too low for the efficient handling of these defectives. The ratio of all nurses is better; it is one to every six or seven patients, but it is not adequate to meet the need, and there is in most cases a deficiency. I am certain that if we awakened the public conscience to this problem, we could get the support that is necessary. Now that things are easier in other respects I hope the Minister will try to get adequate accommodation, particularly for these children, and a sufficient staff to man the homes. I know that it is not easy, but there are people willing to help. I am sure that the National Association for Mental Health, if it could get the capital, would run more short-term homes. I cannot sufficiently stress the importance of these homes as a method of relief.

We have never raised the status of mental nurses. I do not know the present position, but I understand that at one time there was not a supplementary register of mental nurses. I hope there is one now. If not, there should be. I do not see why ordinary nurses should not spend a certain period of their service in mental nursing during their qualifying period. That would help to meet the immediate problem of lack of staff.

I hope that the Minister will encourage the use of approved homes. In the past—I do not know what is the present position—there has been some difficulty in filling the vacancies in approved homes, because unfortunately all the regional hospital boards have their allotment of funds for work in their own area and have not been able to send patients to another area where there may be accommodation in an approved home. I do not know whether that administrative problem has been overcome. Indeed, the whole question has been bedevilled by this duality of administration between local authorities and regional hospital boards, and it would be useful if we could have a complete examination of the matter and devise a better and a more clean-cut set-up than we have now.

I hope that all hon. Gentlemen wilt join in pressing this point. It should not be beyond the capacity of this country to deal with 4,000 urgent cases and so to relieve 4,000 homes of intense misery and distress. Some of these children have most unfortunate tendencies which make them dangerous in more ways than one It should not be beyond the scope of a country which has spent so much money in other directions, and achieved so much in other fields, to put these 4,000 children in approved homes and give their parents some relief.

9.19 p.m.

Mr. J. Slater (Sedgefield)

I am glad that my hon. Friend was fortunate enough to be able to raise this matter tonight. Every hon. Member who has knowledge of hospital management committee work is aware of the great problem confronting such committees in these days.

It is true that there is a lack of nurses in mental hospitals and mental defective colonies. At Winterton in my constituency there is a mental hospital which should accommodate 1,500 patients. At the moment it accommodates 2,000. I have addressed Questions to the Minister of Health on this problem and stressed the need for extra accommodation. I served on the management committee of that hospital for six years. We had patients lying on the floor and others in beds which were so close to each other that there was not sufficient space for the staff who had to nurse the patients. That was the problem which confronted us when I was a member of that hospital management committee.

We are still carrying more than the maximum number of patients that ought to be carried, and we face the same problems as have been mentioned tonight with regard to mental nurses. We have female nurses taking up duty to assist the mental nurses during the night. They are unable to do it during the day. In the Ayclife Mental Colony this problem is particularly acute, and I am glad that the Minister has gone some way to meet the position. I receive a number of letters from people in my constituency who are trying to find accommodation for mentally defective children.

If the Labour Government had done nothing else but introduce the National Health Service Act, it would have done a good job, but that Act has been primarily responsible for the overcrowding of our mental hospitals. At one time, when we were asked to certify a member of a family, the financial position of the person who would have to bear part of the financial responsibility was important. If that person was not in a position to make a contribution towards the maintenance of the patient, he was obliged to look after the patient himself. With the introduction of the National Health Service that great burden of responsibility was removed, and that has been the primary cause of the increasing numbers in our mental hospitals.

I agree with what was said about the recruitment of nurses into mental hospitals and defective colonies, but the commencing wage that is offered to young people coming into the service is far too low. At one time we had a list of applicants for mental nursing, and a waiting list from which we used to call applicants as vacancies occurred. Now we have no waiting list, and we have to advertise repeatedly to get people to interest themselves in this profession.

Mental nurses in all these institutions are doing a good job, yet the number of patients allocated to an individual nurse needs to be reduced. In the course of my visitations I used to go every month into the wards, and what I saw used to make my heart ache. I used to see two female nurses having charge of 40 patients. That was far too many. I hope that the Minister will say tonight that her right hon. Friend will not only consider the great problems confronting management committees, but will provide more money for recruitment grants to get young people into this profession, and for giving more accommodation to patients in these institutions.

I should like the hon. Lady at some time when she is at liberty to visit my constituency and look at Winterton. Prior to the National Health Service it was the policy of the Durham County Council, in co-operation with the Darlington Corporation, to seek to change that massive building, to remove the picture it presents of a great prison, to take out those small, narrow windows and so on. Anyone seeing it for the first time definitely looks upon it as a prison. I think it is time that alterations were made in these buildings to improve their appearance so that the people visiting the patients may have a better impression.

I think that in this debate a case has been made in regard to the shortage of nurses and the lack of accommodation which should receive reasonable consideration.

9.26 p.m.

Sir William Darling (Edinburgh, South)

It is a very gratifying experience to find so many Members of the House prepared to address their minds to this very poignant, human problem. None of us is free from the experience of mental disease, either in our own families or in our constituencies, and it is one of the gravest and mounting problems of our complicated social life. The suggestions made, which I am sure my hon. Friend will take into account, are valuable ones. My only suggestion to her is that, in the shortage of labour, which is admitted on all hands, perhaps because of the un-palatibility or apparent unsuitability of mental nursing, there is a field which has not perhaps been fully explored, although it has been, to some extent, in some parts of Scotland.

I refer especially to the use of the middle-aged women, and indeed middle-aged men, for this difficult and delicate purpose. In Scotland, as in England, generations ago in every village there was a daft lad. They were not put into institutions, but wandered about the country in the company of more intelligent people, and possibly learned something from them. They did not find an evil example which they were tempted to follow.

There was something to be said for a considerable amount of freedom in the villages and country towns. I have a clear recollection of the village in which I lived as a boy, where an old woman took control of two daft lads who were not only a problem to the neighbourhood, but were vicious in their habits. She had a peremptory authority over them that was greater than that of the policeman or even of the local authority.

I suggest to the hon. Lady that in these days there are many who are getting on in years, women as well as men, who, in suitable circumstances, could not only devote themselves to but actually have the responsibility of looking after those mentally defective children. I know of a woman in her sixties who has made it her business to look after three children, two permanently, living with her in her house. She has a calling for this particular work, and having seen her carrying out this duty for no money, or for little money, I am convinced that possibly, in the event of being unable to find suitable younger people in sufficient numbers for the profession, it might be a task to which older people might devote themselves.

I know of a man in a constituency near to mine, a taxi driver, who is out at work for 10 or 12 hours a day. He has a boy aged three, a destructive child, to whom he and his wife are devoted, but his wife told me that but for the kindness of a neighbour who once or twice a week takes this unhappy child away, she has no rest, no sleep, no peace, and is unable to attend to her own life or to that of her home. This unhappy creature has got destructive habits and has to be put into a room which is stripped of all furniture. This friend of theirs looks after this boy from time to time, but the mother is worried about what will happen to the little boy when she is no longer able to look after him.

I understand that under the Ministry of Health Regulations, the Department of Health in Scotland will not undertake, even if it could, responsibility for such a case until the child is five or six years of age. The parent must accept the responsibility in such cases until the child is of a sufficient age to be accepted by the Department. That is a hard and cruel rule. The approved homes, of which we have some knowledge, can be multiplied, but I do feel that people of my age could usefully be employed looking after persons with wayward minds. I do not think it would be too much of a responsibility to look after this type of child; it would make circumstances easier for the parents and it might bring about some cure for the children themselves.

One must not be despondent in these matters. I have known of two persons who were mentally defective and who eventually developed a kind of twisted sanity so that they were able, in some odd way, to fulfil certain functions connected with business and commerce. These broken people have a potentiality for good. I think that the heart of the Parliamentary Secretary is as touched as ours are, and her hands are as willing as ours are to find a remedy; and I believe that she will be strengthened and encouraged in her purpose if she knows that in what she does she has the support of the whole House.

9.33 p.m.

Miss Alice Bacon (Leeds, North-East)

I agree with everything that has been said about the state of affairs inside mental defective colonies and the need for proper institutional care for mental defectives. The position is serious and urgent, but I want to confine my remarks to the shortage of beds inside mental hospitals.

The situation in mental hospitals today is in some ways a disgrace to our country. Some months ago, as a result of letters and representations made to me by constituents, I took an interest in one of the biggest of our mental hospitals, Menston, which is just outside Leeds and caters for a large area of the West Riding, including the City of Leeds. I thought at the time that Menston was unique. I have discovered since that the Menston hospital is typical of other mental hospitals throughout the whole country, as indeed is shown in that illustrated article in "Illustrated" two or three weeks ago. I remember putting down Questions at the time, as a result of which there have been very minor alterations, but the management committee and the staff are really powerless in this matter unless really urgent steps are taken.

I have found that inside the hospital the mental treatment is good. The hospital is clean and the food is good. It is a miracle how the staff manage to cope with the number of patients and the conditions which obtain there. Quite frankly, what is wrong—as it is in nearly all our mental hospitals—is that there is considerable overcrowding and under-staffing. This hospital is supposed to have room for 1,900 patients. At the time when I went there, and today, the number of patients inside the hospital is nearly 2,500, which means that the hospital is accommodating over 600 patients more than it was intended to do.

The wards have to be seen to be believed. I saw a ward, about the size of a normal hospital ward, which contained 112 beds for female patients. There was not sufficient room for the patients to undress inside the ward. They had to undress in another room which, in the daytime, was used as a recreation room. I was curious to know how the 112 female patients managed to find their own clothes in the morning, when they were left on the floor of the recreation room at night. I was told that the female patients had their names stitched inside their corsets. Their clothes were then rolled up inside their corsets and put on the floor at night, in 112 bundles, and the patients had to be filed into the wards where they slept and filed out again in the morning to dress.

This is the 20th century, and these are the conditions inside our mental hospitals today. But it is not just a matter of beds and buildings. As has already been stressed tonight, it is also a matter of adequate staff, because even if we had new buildings there is a shortage of staff to man them.

There is another problem which has not been mentioned tonight. Inside this particular hospital—and again I believe it is typical of many of our mental hospitals—there are 500 patients who are over the age of 65. I feel that today a great many old people inside our mental hospitals ought not to be there at all. We all know this problem. If an old person shows signs of senility he or she is not taken into the ordinary hospital ward or admitted into one of our excellent new hostels. There is a gap in our accommodation for old people, and so they are being put into mental hospitals, where they take up beds, when all they need is institutional and nursing care. They do not need any mental treatment.

These people are taking up beds and accommodation which could be used by patients who need mental treatment very urgently. In the future we shall have to look for some additional establishments for our old people. Call them half-way houses, or what you will, something between the hospital and the hostel is required, and if that accommodation could be provided it would relieve to a great extent the overcrowding in our mental hospitals.

Mr. Shepherd

I am sure that the hon. Member would also like to express the fact that putting these old folk into mental hospitals does cause their mental powers to deteriorate very rapidly. There is a deterioration of mental stature which is quite remarkable over a short period of time.

Miss Bacon

I am obliged to the hon. Member for his intervention, and I agree with him entirely.

There are three problems with which we are concerned here. First, there is the problem of buildings. At this stage—eight years after the war—that should not be a very great problem. Secondly, there is the very difficult problem of the shortage of nurses, which has been stressed so much by my hon. Friend the Member for Bermondsey (Mr. Mellish) and others. I think that the responsible authorities, in conjunction with those who fix the salaries, ought to agree that mental nurses should be paid more than ordinary nurses, in order to attract more into mental nursing. It is the only way in which we shall get them. I understand that there is a much greater shortage of female staff in our mental hospitals than of male staff. We must see that something is done to attract nurses. We cannot make the conditions very attractive in our mental hospitals, so we must pay better salaries.

I stress again the need for better and more provision for those old people who are now taking up beds in the mental hospitals. I hope that as a result of tonight's debate we shall give a message of hope to the parents and other relatives of these people who sometimes think that they are forgotten, and that we shall help to remove a blot on our national life which this causes at the present time.

9.41 p.m.

Mr. C. J. M. Alport (Colchester)

I venture to intervene in this debate because I have in my constituency both a very large mental deficiency institution and a mental hospital, and I think that any Member representing a constituency who is brought as closely, as he is inevitably, in touch with this particular problem wishes to take the opportunity of impressing upon the Minister the importance of this very dire problem before the Health Service.

It is perfectly true and, I think, totally right that up to the present we have given priority to the problem of tuberculosis. I realise, as all Members in this House must realise, that that is a very grave scourge for the people of Britain as a whole, but I think that the progress which has been made under both Governments in dealing with that particular problem enables us now to turn to another priority, and the only thing I wish to do tonight is to stake a claim for the mental service to have priority now that very great progress has been made in dealing with the whole problem of tuberculosis. It is perfectly true that there are different factors that have to be taken into consideration in dealing with these two diseases, but I regard the problem of mental deficiency and mental illness generally as being just as great a social evil in many ways as that of tuberculosis.

I should say that it not only affects the patients themselves, but that it has a very great effect upon all those who are brought into close contact with them, particularly in the families. I would be the last person to deny the affection, care and love which is bestowed upon mentally deficient children by their parents in very many cases, and I would pay a personal tribute, as, I am sure, every Member here would do, to those parents who have given this devotion in cases which they must know offer very little hope for the future.

To turn to the particular problem of North-East Essex and the South of England, this particular institution has an establishment of about 1,400 beds. There are at the present time about 1,750 patients in that hospital. The day space that is available is adequate for about 1,250, and when we recently had an epidemic in our neighbourhood the management committee of this institution very properly decided to inform all the authorities concerned that they would be unable to take in any other patients in the immediate future because they felt they had the responsibility of ensuring that they did not run too great a risk of having an epidemic in the institution, which might indeed have caused very great loss of life as the result of overcrowding.

Therefore we in the part of East Anglia which this institution serves are faced with the problem that there is no accommodation available in the institution which serves us for any additional cases at present. It may be that the management committee will change their policy in due course; that I do not know, but I feel that they are justified in the stand which they have taken.

I understand that there is to be an additional mental institution for the North of England. I know that the problem there is very great indeed, and far be it for us in the South to grudge them the additional accommodation required. But I should like to ask the hon. Lady to say when she replies whether there is any intention or prospect—any hope, if I may put it that way—of any additional facilities in our part of the country.

The truth is that this accommodation cannot be provided on an ad hoc basis. Some derelict country house cannot economically or properly be taken over and adapted to the needs of an institution of this sort. If we are to tackle the problem it must be done thoroughly by the provision of a new institution built specifically for the purpose. I am well aware that this involves considerable cost. I should say, at a rough guess, that in each case it involves an expenditure of about £1 million—[An HON MEMBER: "Much more."]—perhaps more. I realise that the sum of money involved is substantial.

I realise that with the calls there are on the finances of the Health Service it is not possible to provide such institutions to the extent of more than one or two over a period of time. I would, however, press that if the priority is to be given to the problem of mental health it will be tackled, not by the ad hoc provision of accommodation which is both very unsatisfactory and uneconomical for the purpose, but that it will be possible to provide at least a new institution perhaps serving areas which are already served by separate institutions, and that it will take the overflow which exists in almost every part of the country.

I regret that I was unable to hear the remarks of the hon. Member for Bermondsey (Mr. Mellish), who opened the debate, and I apologise to him. I do know that he referred to the problem of the nursing staff. We have less of a problem of nursing staff now than is apparently true elsewhere, but there is still always a great difficulty in providing the type of staff which is necessary. There are certain things which can be done to help. I hope that when my hon. Friend the Parliamentary Secretary replies she will tell us that improvements in the conditions of service of the nursing staff can be made.

Nobody who has visited an institution of this sort can underestimate the great strain placed upon both male and female staff in looking after difficult cases. Frankly, I do not know how they do it. Whether it is in a mental deficiency institution or a mental hospital, it is something which I could never bring myself to do, and therefore I say all honour to them.

There is a very strong case for additional pay for those responsible for violent cases and particularly difficult cases. I should have thought, for example, that if danger money or whatever it may be called is paid in certain forms of employment there is a particularly good reason for paying it to the members of the nursing service in mental institutions who have to deal with the particularly difficult cases. That might help.

There is another aspect to which I should like to draw the attention of the House very briefly, namely, that in many respects we require only general nursing orderlies—I think that is what they are called—and general nurses for nursing these patients. I understand, and on this point I stand prepared to be corrected, that after their training the standard of the wages they receive is very much below those of staff nurses and staff sisters. I should have thought that there is an argument for increasing that standard rate for the general nurses because a great deal of the burden of this nursing can be undertaken by general nurses as opposed to the highly-trained staff who are difficult to obtain.

There is one other point I should like to bring to the hon. Lady's attention. It has been the policy of the Board of Control, and, I think, of the Ministry of Health, to increase the number of patients who are released on licence. I realise, and I think all hon. Members will realise, that the decision of whether a patient should be released on licence is a very difficult one for the staff of the hospital or the Board of Control, as the case may be, to make. There is always an element of risk in it. But, an increased number of patients has recently been allowed out on licence from the Royal Eastern Counties Hospital, and that has been a very great success.

The advantages from the point of view of the hospital are obvious. It means that beds or places that might otherwise be occupied are made vacant for more difficult cases. Whereas I would be the last person to suggest that the rules with regard to release on licence should be made too easy, I think there is a strong argument for giving as much licence as possible to those cases which the staff feel deserve it and which they can recommend for that purpose.

I should like to end with one further point. Those Members who have had brought to their notice cases of children in particular—not babies or children of a very young age, but those who are adolescent or even of adult age who are still the responsibility of their parents—cannot be unaware of the immense wear and tear on the minds and physique of the parents who have the responsibility of looking after them. None of us can be unaware of the great anxiety and strain which this involves on the mother or father, and particularly on the mother. I am quite certain that the hon. Lady would have the support of all Members of the House in any action which the Ministry feel it possible to take to deal with a social problem that is so intensely human, and to find a way of relieving those who have the misfortune to be concerned with children who are mentally deficient, and who find the strain too much for them, by increasing the accommodation available in the public institutions of this country.

9.54 p.m.

Mr. R. J. Taylor (Morpeth)

I want to add my word in this matter, because this is an increasing problem in the County of Northumberland. Mention has been made of overcrowding. Some time ago I visited a mental institution in Morpeth, and the situation there was much the same as is found in other institutions. In one large ward in which I went, the distance between patients was four feet, and when the night nurse went to look after those patients there was practically no room for her.

This, I think, is a non-party matter. In talking of it we must endeavour to rouse the people of the country. I think that will be agreed on both sides of the House. Some of us can remember when the blind were not as well looked after as they are today. It was the rousing of the public conscience which produced a charter and a standard for the blind. That is what we want in the case of the people whom we are discussing tonight.

The overcrowding in our mental institutions is terrible, and it has an appalling effect. In a way, my greatest sympathy goes to the nurses and the medical superintendents, who have come to the position where they can devote their attention only to the very few who can be returned to normal life, and the cause of this is the stress and strain of overcrowding. In some cases the incurable are mixed up with the borderline cases, and this retards the recovery of the less severe cases.

We all agree that more nurses should be obtained. How ought we to get them? How did we get more miners during the war when we needed coal? We provided special inducements, and the miners came back from insurance and other safe jobs and went into the pits again. We did the same in the case of the engineers. When we needed men, we found them. If we provide proper inducements, I am confident that we shall get more nurses.

It is pathetic when a parent comes to us and asks us if we can do something to get a child into a home. We make inquiries of people who are most anxious to help, but the situation is often hopeless because no place can be found for the child. That is an aspect of our national life to which we should devote special attention.

There is also the case of backward children who do not quite come into the categories that we have been discussing. The Northumberland County Council is very much alive to the situation, and we have been trying to find schools into which to put the children. So far we have been able to find only one. The hon. Member for Cheadle (Mr. Shepherd) made a very interesting and important suggestion about providing a rest from their daily and hourly strain for parents who have such children as these for whom accommodation in homes cannot be found. Remarkable work is being done at the school which we have been able to secure.

The children go there in the mornings and in the afternoons just as if they were going to an ordinary school. This is a tremendous help to parents, and it meets the point of the hon. Member for Cheadle. However, we are unable to find sufficient schools to cater for all the cases, and it seems to me that all hon. Members ought to recognise that this is a national problem and we ought unitedly to demand that, irrespective of expense, our mental institutions should be extended—

Itbeing Ten o'Clock, the Motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Kaberry.]

Mr. Taylor

Provision should be made for mentally defective cases and for backward children. If that were done we as a nation would have a better conscience. In many cases our people would be happier, and if delay could be abolished and the demands for treatment quickly met, we should restore some of these children to a normal life.

10.1 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

I am grateful to the hon. Member for Bermondsey (Mr. Mellish) for the very objective manner in which he has raised this subject and also for the contributions made by other Members. I am sorry that I have to curtail other Members—

Mr. W. A. Wilkins (Bristol, South)

We will have another day on it later.

Miss Hornsby-Smith

—who, I know, were most interested and were anxious to take part. I hope, however, they appreciate that many points have been raised and I want to give as full a reply as I can.

Neither my right hon. Friend nor I have tried to conceal the gravity of this problem since we have been at the Ministry, and I agree it has called for full-scale national action. The problem of the mental defectives was the main point raised by the hon. Member for Bermondsey but, of course, our problem has been accentuated by the fact that the number of patients has risen from 47,040 in 1949 to 53,066 in 1952, an increase of 6,026. At the same time as those patients have been absorbed, the waiting lists have risen from 5,316 to 9,300. In the mental hospitals there are at the moment 137,039 patients resident, and we regret very much that there is over-crowding at the rate of 14.7 per cent.

If I may deal with the South-Eastern Metropolitan area, which is of particular interest to the hon. Member, I should like to say that it is true that on the mentally defective side, as he says, there are approximately 500 unstaffed beds, which have continued to be unstaffed since the inception of the Health Service. I think it is fair to say that there has been no additional aggravation in the situation which, while still grave, is no worse than it has been. I am not saying we are satisfied by that, but I do not accept the gloomy view of the hon. Member that they are in the imminent position of having to close wards.

Mr. Mellish

Except, of course, that the staff figures are worse than they have ever been.

Miss Hornsby-Smith

I am coming to the staff figures, but I do not wholly accept what the hon. Member said on that.

During 1953 a net increase of 118 beds has been opened in the South-Eastern Region, and in the country as a whole the net increase is 615 beds. I have no desire to minimise the appalling gravity of this situation, for the fact is that mental health has been the Cinderella of the service. The hon. Lady the Member for Leeds, North-East (Miss Bacon) referred to the fact that in the 20th century, and eight years after the end of the war, something must be done, but in fairness I must say that, not only was mental health the Cinderella of the service before 1948, but in the early years of the Health Service the mental side did not get as fair an allocation of the money available to the regional boards as they were entitled to. One of the first steps taken by my right hon. Friend, the then Minister and now Leader of the House, was to insist in the first Estimates for which he was responsible that the regional boards must give a fair allocation to the mental side of their services, and in the two ensuing years there has been a marked increase in the percentage allocated to that side of the hospital service.

Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)

I do not want to make a party political point, for I agree it is far too important an issue and that we are all to blame. I think, however, that the hon. Lady will agree that circulars on the same general lines of trying to get the regional hospital boards to pay as much attention as possible to the mental side were sent out. Because of the seemingly quicker returns on the physical treatment side, this other aspect was too often pushed to one side.

Miss Hornsby-Smith

Strange though it may seem, my right hon. Friend the Minister in that year was apparently tougher with the regional boards than the right hon. Gentleman who was formerly the Minister, because we certainly achieved the result of a substantial rise in the allocation of the available moneys. The present Minister has taken even more direct action in insisting that the mental side of the Health Service must not only get its full share, but that a contribution must be made towards making up the serious leeway which hon. Members on all sides of the House are agreed exists in the service.

Referring particularly to accommodation, which was the point mentioned by my hon. Friend the Member for Cheadle (Mr. Shepherd), the estimates for 1953–54 include schemes for 1,314 new mental deficiency beds and 697 mental hospital beds. In 1954–55 we shall see the building which will come under the "Mental Million," which is the special allocation of £1 million which the Minister has insisted must go, over the normal allocations of the board, to the mental side. Through the programme under that special allocation we hope to provide 1,200 mental deficiency beds and 800 mental hospital beds. In addition to these two programmes, three large centrally financed schemes from other funds for mental deficiency hospitals will provide 800 beds within three years at Greaves Hall and at Balderton, near Newark and at Bradwell Grove, Oxfordshire.

Therefore, within the next three years this should provide 3,000 mental deficiency beds and approximately 1,500 mental hospital beds. I suggest that my right hon. Friend has already taken direct action in this matter, and, as this debate has been conducted on such a high level, and hon. Members on all sides of the House have put the gravity of the situation above any thought of party politics, I hope that the programme which my right hon. Friend has been so determined to see initiated, will receive a warm welcome on all sides of the House.

Mr. Shepherd

Can my hon. Friend give the House an indication of when the backlog will be overtaken? Incidentally, I am sorry that the figure is 9,000 because I though it was only 8,000.

Miss Hornsby-Smith

The 3,000 new beds will make a contribution towards it, but it will be some years before all the backlog can be absorbed. I cannot give an estimate beyond the next three years, as to when we can find the opportunity to provide for the 9,000 extra beds. The main problem over and above accommodation is, of course, the problem of the shortage of nurses. On the mental deficiency side, although the number of nurses has increased from 6,812 in 1948 to 7,676 in 1952, it is still well below what we would like to see. Here I would like to endorse the tributes paid on all sides of the House to the unfailing devotion of nurses in mental hospitals who work long hours, make up other shifts when there is a shortage of staff, and whose work and sense of duty is beyond praise.

Special mention was made of Leybourne Grange and Darenth Park. As the hon. Gentleman said, I am familiar with Darenth Park and have visited it frequently, because it is at the centre of my own constituency. I do not wholly accept his figures. I took great pains over them and I have been on to the hospital management committee twice this week to make sure that they were correct, as they did not tally with the comments which the hon. Gentleman has made.

I understand that in the last 12 months from 30th September, 1952, to 30th September, 1953, in Leybourne Grange there has been a net decrease of four full-time staff and a net increase of three part-time staff. In Darenth Park there has been a decrease of 12 full-time staff and an increase of six part-time staff. Whilst I deplore the loss of full-time staff, the figure of 50 which the hon. Gentleman gave was largely accounted for by elderly members of the staff, some of whom have worked long past 65 in order to help out the hospital. A large proportion of those retirements have been offset by enrolments but not, I regret to say, all of them.

The hon. Member for Bermondsey made an appeal, as did another hon. Member, that there should be no call-up of nurses for National Service. That, of course, is a much wider and more difficult problem and one very largely for the Minister of Labour and National Service. There are, of course, many other claims in other spheres for deferment. I certainly would not like to commit myself, but I will convey the views of hon. Members with regard to that possibility. Student nurses are deferred during training so that they can complete it before they start their National Service.

Mr. Mellish

The figures I gave are those provided by the regional board and the chairman of the health committee. As to the matter of National Service, I hope that the hon. Lady will make representations to the Ministry of Labour.

Miss Hornsby-Smith

I will report the matter to my right hon. Friend. As to the figures which I gave, they were confirmed by the secretary of that hospital management group and I have no reason to think they are inaccurate.

The figures for Leybourne Grange and Darenth Park for 1945–53 show that in Darenth Park there was an increase of three in the full-time staff and an increase of seven in the part-time staff. In Leybourne Grange there was a decrease of one in the full-time staff and an increase of 26 in the part-time staff. There is also of course the Medway Central Preliminary Training School which was recently opened, where we have 23 students taking their training and where we hope to increase that figure to the capacity of 40.

The hon. Member for Bermondsey referred to the fact that only lower-grade cases were now being admitted and that the other grades were being refused admission. The case at Darenth Park is certainly not as grave as he pointed out, because to my certain knowledge there is still a very high proportion of higher grade cases there. In fact, several hundreds go out daily on licence to ordinary employment. I am quite sure that there has been no deliberate curtailment of that policy.

My hon. Friend the Member for Cheadle mentioned particularly occupation centres. These have increased in number from 100 in 1948 to 237. Since January, 1952, the policy of arranging short stays of a month or two months in mental deficiency hospitals has been in operation and many children, particularly in cases of illness or strain on the parents, have been catered for on this basis. I should like to take the opportunity to pay tribute to the institution at Orchard Dene, Liverpool. This is run for the National Association of Parents of Backward Children by the National Association for Mental Health. It is doing excellent work in this direction, which we fully appreciate.

My hon. Friend the Member for Edinburgh, South (Sir W. Darling) protested that children had to be five before they were admitted. I can only speak for England and Wales. We take them before that age into our mental deficiency institutions. We are fully in support of the policy of having suitable guardians where they can be found and the children boarded out. It is the shortage of guardians and not the lack of desire on our part which is the reason we cannot provide more accommodation for these children.

The point which the hon. Lady the Member for Leeds, North-East raised particularly interested me because I have had the privilege of opening two long-stay annexes for the senile where the patients receive watchful care and attention. There are already 1,000 beds for such cases and there is a programme of more schemes on the way. I agree with the hon. Lady that there are many of these people who have become confused in their old age and that, as far as possible, we should try to keep them out of mental hospitals. That is our policy and it is steadily going on.

The hon. Lady also raised the question of the wages of the staff. Already the student nurse in the mental hospital receives £30 a year more than the student nurse in a general hospital. One hon. Member—I believe the hon. Lady, although I apologise if I attribute it to her incorrectly—suggested that the pay of those who do nursing assistant work in the mental hospital field—and, without their work in the mental hospitals we should be in a very parlous state indeed—should approach more nearly to that of the qualified nurse.

I do not think we can go much further in bridging the gap between those two rates of pay. The female nursing assistant rate starts at £250 a year and the assistant can graduate up to £425 a year. The student nurse starts at £255 and goes to £280, plus her allowances, while the fully registered staff nurse goes from £380 to £480. The maximum for the nursing assistant is £425, therefore, and the maximum for a fully qualified staff nurse is £480. I do not think we can narrow the gap much more between the qualified nurse, who has to do three years' training, and the nursing assistant. I think that margin is pretty narrow as it is.

Miss Bacon

Before the hon. Lady leaves the point of the payment of nurses, although she says that student nurses receive £30 more in mental hospitals—as, of course, I knew—is it not a fact that staff nurses are on the same scale?

Miss Hornsby-Smith

No. The staff nurse in the mental hospital gets £20 more, plus some very valuable superannuation benefits. Every year she serves after twenty years counts double for pension, so that she can retire years before her colleague on the general nursing side and yet draw the same pension. She has very valuable superannuation advantages which go to balance the particular strain of mental nursing. In addition, she has £20 a year above the general rate.

Mr. Kenneth Robinson (St. Pancras, North)

Surely the hon. Lady will not suggest for one moment that the present differentials of £30 and £20 are adequate as an incentive to bring people into the mental nursing field? Clearly they are not. The situation in general nursing is now more or less satisfactory, whereas it is getting progressively worse in the mental nursing field. Will she not at least go on record as saying that in her view this differential ought to be increased in order to bring the recruiting situation into line with that in general nursing?

Miss Hornsby-Smith

I promised to deal with the general problem of wages; I will not evade it. I wanted first to answer the suggestion that there was no differential. May I clear that and various other questions away first? I will deal later with the point made by the hon. Member for St. Pancras, North (Mr. K. Robinson).

My hon. Friend the Member for Colchester (Mr. Alport) asked if there were any plans for his area. Although there is not an entirely new building plan, there are plans for considerable extensions and new wings at South Ockenden in Essex. That will serve the area which he represents.

I turn next to the question of letting people out on licence, and here I would assure hon. Members that there is no lack of desire on our part to let patients out on licence. In fact, it is encouraged and is very greatly used, but with the increasing proportion of low grade patients which we have to accept, the proportion of patients fit to leave on licence is correspondingly lower.

Next I will tell the House what we are doing about staffing. My right hon. Friend has circulated to the various boards advice and guidance on various methods which he thinks should be tried in order to increase the staff for mental nursing. One particular proposal was that greater care should be taken in the selection of student nurses. If applicants to be student nurses do not appear capable of taking the training and fulfilling the duties, it is far better that they should be offered employment as nursing assistants, first, in their own interests, as the frustration and disappointment of having tried something beyond their capabilities turns them right away from nursing altogether and they leave the service; secondly, because we think our limited teaching resources should be directed to those who have a reasonable chance of qualifying; and thirdly, because nursing assistants, who are invaluable in the mental health service, are required in greater numbers for the routine tasks of the service.

We believe that the excessive use of student nurses for these subordinate nursing tasks is not only a danger to their morale, but a fruitful cause of wastage, and that it limits their training. A certain amount must be part of their training, and that we accept. But we are most anxious, where we can, to get and train people of quality and capability to become fully qualified mental nurses. Then as much as possible of their time may be directed towards their skilled training, and the less responsible jobs which can be done by nursing assistants should be performed by them.

There has been no criticism by hon. Members of the rôle of the nursing assistants. All hon. Members with experience of mental hospitals will know of the immense amount of work which can be done by this grade of assistants. There is a wide sphere of work where nursing assistants have a real job to do.

My right hon. Friend has decided that in the campaign for the recruitment of nurses and nursing assistants into the hospital field, the bulk of the money should be used essentially for publicity and recruitment on the mental nursing side. In co-operation with the Ministry of Labour and National Service there is to be a programme of local campaigns, because it is local people who have to be encouraged and persuaded to help their own local colony. Local campaigns are under way for both mental hospitals and mental deficiency institutions. The first one is due in Suffolk a week today and I am to have the pleasure of opening it.

The hon. Gentleman raised a difficult point about the remoteness of many of these hospitals, which makes it doubly difficult to recruit staff. As an inducement to entry into the mental nursing field the proposals of the Standing Mental Health Advisory Committee on the curriculum and methods by which nurses on the general register, after a shorter period of training, can come on the mental nursing register, are in fact under discussion with the General Nursing Council who have been meeting today. There are several experimental schemes under consideration and in operation whereby nurses may be qualified for admission to both the mental and general parts in a reduced period of time.

We hope thereby to persuade some of those on the general register to enrich their training and enter the mental side. The main object is to make the mental nursing training sufficient for the highest posts in mental nursing. At the moment they need the full double qualification before they can become matrons, but we believe that the reduced time will encourage nurses who aspire to get to the top and become matrons. If it is accepted by the General Nursing Council the reduced period will do much to encourage nurses who aim to become matrons and wish to go into the mental nursing side.

To increase the emphasis we place on the mental nursing side my right hon. Friend has appointed one male and one female mental nursing officer to the Ministry staff where hitherto there has not been such a separate category. Their appointments will take effect from the 16th of this month. Their functions will be advisory and particularly concerned with staff shortages in individual hospitals.

Regarding rates of pay, I always look rather wryly at hon. Members opposite who say we should go over the heads of the Whitley Council and the Nursing Council. As a good trade unionist the hon. Member for Bermondsey knows how much easier that is to say than to do—

Mr. Mellish

I am not surprised that the hon. Lady says that, and it is a fair point; except that in this case I am asking for more. I do not know of any trade union in the country that would object to its members getting more money.

Miss Hornsby-Smith

There are two sides to joint negotiation and it is not unnatural that the hon. Member says that if we give to one the other side will object. For the amicable future of joint negotiation one has to respect the machinery by which both sides get fair treatment.

Rates of pay are determined by the Nurses' and Midwives' Whitley Council. It is for that Council to decide whether circumstances justify alteration of those rates. It has been urged upon them that the rates are too low and that some steps should be taken to make the rates more attractive so as to encourage people into the desperately short-staffed mental health service. These matters are under the most active discussion. The Council met in fact, this Tuesday. Both sides are desirous of reaching a conclusion, and I believe that that conclusion will be on lines which will be found favourable by hon. Members opposite. Beyond that, I would not wish to commit myself, for reasons which will be obvious.

Mr. Blenkinsop

Can the Minister at any rate say that the Treasury are not holding up the decision?

Miss Hornsby-Smith

I do not think I can even say that they are holding it up, because I am not aware that they have yet been asked for the money. It would be unfair to commit them in advance. I am sure that the case for the mental hospitals will be sufficiently strongly put by my right hon. Friend and that it is accepted on all sides of the House. If a firm recommendation came—I cannot commit my right hon. Friend—I would have every hope that as in the past they have agreed to wage increases in the mental health service this would be equally sympathetically received.

Our main object in the campaign which we have for nurses is to have with us not only the desire of the Ministry and the genuine desire of hon. Members of this House; we have to get a new outlook on the part of the public. There has been a great change in the outlook on mental health since the war, and since then many parents and others have had relatives or friends under treatment. This new outlook has to penetrate further into the minds of the public so that parents will no longer deter their children from mental nursing. They will no longer say, "Nursing, if you must, but general nursing and not mental nursing." Parents are not guiltless in deterring their daughters and sons from taking up mental nursing.

We hope that with the new ideas about mental health they will realise that there is as great and fine a vocation in nursing those who have sick minds as in nursing those who have sick bodies. It is a satisfying and great vocation, and demands just as great qualities as are demanded on the physical side in the general hospitals. Our hope is that the recommendations put forward by my right hon. Friend shall be zealously explored and energetically put into operation in the hospitals.

There has been some criticism of his memorandum by hospital management committees, some of whom say: "We have been doing this for years." All praise to them if they have, but not all hospitals have been doing it. The memorandum was intended for the backward as well as for the forward-thinking management committees. Our object was to improve the accommodation in the hospitals and the working conditions of the nursing staff, and we must judge the success of the policy by the results which are obtained. I can assure the House that it is the earnest desire of my right hon. Friend to make what contribution he and his Ministry can towards making up the leeway in this problem of accommodation and staffing.

Question put, and agreed to.

Adjourned accordingly at Twenty-nine Minutes past Ten o'Clock.