HC Deb 28 January 1954 vol 522 cc2034-46

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

7.24 p.m.

Mr. George Chetwynd (Stockton-on-Tees)

I hope that arrangements are being made for the Parliamentary Secretary to the Ministry of Health to be here, but I realise that this Adjournment debate has come on rather earlier than anticipated. I have taken the opportunity to inform her of some of the details about which I wish to speak, so she will lose nothing by it.

The Lord Privy Seal (Mr. Harry Crookshank)

My hon. Friend is on her way. The hon. Member may know that her room is a very long way from the Chamber.

Mr. Chetwynd

I appreciate that. She does know the main points which I wish to raise. I want to speak about the problem which is affecting, or which may affect in the future, a number of my unfortunate constituents who may be in need of hospital treatment, not only in the area of Stockton-on-Tees but on Tees-side as a whole. I am glad to see that the hon. Lady is now here. I hope that she did not have to rush too much to get here.

I raise these points not in any alarmist spirit, and I am certainly not asking for any panic measures to be taken, because the situation is not as serious as that. Nevertheless, in my constituency and on Tees-side we are faced with the urgent problem of remedying the present grave shortage of nurses. I consider that it is far better to raise this problem now, whilst something can be done, than to wait until drastic steps, such as the closing of wards, have to be taken and then to make an outcry about it. If, as a result of this Adjournment debate, we can get an improvement in the position, everyone will be better off.

The grave national shortage of nurses is reflected in Tees-side hospitals. Now that we have full employment, the girls in the area are able to get alternative well-paid and attractive jobs. There are fewer girls to call upon, and I understand that, by comparison with 1939, there were 100,000 fewer girls reaching the age of 18 last year. That position will not improve until about 1960, so that the field of recruitment of our nursing staffs is restricted.

I have no wish to overstate the case with regard to the position on Tees-side, but I am told, on the authority of the chairman of the house committee of Stockton and Thornaby hospital, that the staffing position there is becoming more and more difficult and that, unless some action is taken to remedy the position, it will be necessary to reduce the number of patients that can be admitted.

The hospital authorities have discussed with me what has been described as their desperate plight. I was informed in November that the total available staff for day duty for six wards was 26. Of this number three were off sick, including one sister and one staff nurse, and out of this number the matron has to staff six wards, cope with lectures, off-duty periods, holidays and sicklists. That is a pretty considerable task, even in a small hospital such as ours, and the matron and the staff are facing this problem with great energy and in the best possible way.

I have been given figures for the Tees-side Group hospitals at the end of1953 and these show that there are 1,475 beds available, but that 1,585 could be available if there were adequate staff. There is a waiting list in the area of 4,426. Those, in the main, will be medical cases. These figures reveal a twofold problem.

First, there are the delays and extra suffering to those who cannot be admitted as patients because of the understaffed hospital beds; it is a very grievous thing to see beds empty owing to lack of staff when we all know how grave is the need of hospital wards in these heavily-industrialised areas.

The second problem, aggravated by the first, is that the shortage of staff places a very severe pressure upon the existing nursing staff. Here again, I should like to pay my tribute to the matron and staff of the hospital for the splendid work they are doing in very difficult circumstances.

I want to raise what the matrons and the authorities in these hospitals consider to be one of the root causes of their difficulties, which is the position with regard to student nurses. From 1st August, 1952, a rule has been enforced by the General Nursing Council fixing 18 as the minimum age of training. That has been done to improve nursing standards, and I have no desire to undermine those standards. As the hon. Lady may know, I am the chairman of the governors of Queen Mary's Hospital at Roehampton, where we have the highest standard of nursing in the world, and a worldwide reputation. No words of mine should be interpreted as seeking to lower those standards.

I must stress that the circumstances affecting the recruitment of nurses in small provincial hospitals make recruitment there a vastly different problem from that of the recruitment of nurses to the main large London teaching hospitals. It is a completely different problem, and I am not sure that the General Nursing Council gives sufficient weight to the difference. I should like to know what proportion of the General Nursing Council is representative of the smaller provincial hospitals. My guess is that most of the members of the Council are either from large teaching hospitals or have had close connection with large teaching hospitals.

This is the position with regard to the number of students passing the course last year in the whole group of hospitals on Tees-side. Twenty-nine of them passed the course, seven of whom left after qualifying, leaving 22 to go into the nursing pool. In Stockton and Thornaby Hospital seven passed the course, of whom three left after qualifying. For 1953 the matron of this hospital accepted22 students for training, but only 11 of those are continuing their training, the others having left either to get married or because the course was beyond them or because they were found to be unsatisfactory for one reason or another.

Though I appreciate fully the desirability of the Council's ruling, I should like to bring to the notice of the Minister the dilemma in which those in charge of the smaller training schools are placed by what seems to me to be the operation of a fairly inflexible rule. Suitable candidates for the student nurses' course within a few weeks of their eighteenth birthday cannot be admitted, but have to wait until the next school to commence, and that often means that they become in the interval absorbed in other employment and lost to the nursing profession. Those who, have a real vocation, we are told, will not be deterred by this delay, but even on them it imposes a severe strain. One has to be pretty keen about wanting to be a nurse if one carries on after being told one must wait a long period before being admitted to the training school because one's birthday happens to be on the wrong side of a certain date line.

The big medical training schools, with their long waiting lists, and drawing candidates from homes where, in the main, the financial considerations are not so acute, do not, I think, quite see the difficulties encountered by the smaller provincial hospitals, where the majority of the girls come from homes where circumstances make it essential that they should earn their living as soon as possible. The days when we could rely on girls with private means—at any rate, girls who were fairly well-to-do—to staff the hospitals have gone.

The shortage of staff obviously produces a vicious circle because the few that there are cannot cope with the constant demands made on them, and they either break down or look for less exacting work somewhere else. That, in turn, has a deterrent effect on new entrants. What is most important in all this is that, because of these circumstances, the nursing standards deteriorate, however good the intentions may be. I have been in touch with the Minister about this, and in a letter of 14th December he said to me: I should not feel justified in asking the Council at this stage to consider an amendment of a rule so recently made, but I am keeping a very careful watch on its effect on recruitment. The Council has power to make exceptions to the rule in particular cases where hospitals are experiencing acute staffing difficulties and the strict application of the minimum age would seriously affect the hospital services. I believe that in the case of the Teesside hospitals the time has come when flexibility regarding the entrance age should be put into operation. Application has been made on one or two occasions to the General Nursing Council for a relaxation of this rule, but on each occasion the reply has been that the student in question could only count her training from her eighteenth birthday, following which she must complete eight weeks in the preliminary training school. I quote an extract from a letter from the General Nursing Council to the matron of the Stockton and Thornaby Hospital, because it does reveal a certain flexibility in this respect. It states: I am directed by the Education and Examination Committee to point out that the Preliminary Training School course forms a part of the approved course of training, and that the date of commencement of training is the date of commencement of the Preliminary Training School. No student nurse may, therefore, be admitted to the Preliminary Training School before attaining the age of eighteen years, and I am asked to emphasise that this requirement must be met in respect of all future candidates. The Committee agreed, however, that on this occasion the above-named student nurse"— there is no need for me to give her name— may be allowed to count her training from the date given on the Index Form, provided she completes at least eight weeks' preliminary instruction before her entry to the wards, and provided, of course, that in all she completes not less than the full period of training required by the Council. In the final paragraph comes the real sting: My Committee will be glad to receive an assurance from you that in future no student nurse will be admitted to training below the age of eighteen, i.e., will not be allowed to enter a Preliminary Training School which commences before she attains the age of eighteen. I believe that if there were a relaxation of the rule we should get more and more girls as student nurses for training, and. after that, joining the nursing profession proper.

The problem, naturally, is bound up with the fact that in most cases the secondary school girls leave school at the age of 16, if not before, and there is a gap of two years before they can train as nurses at 18. Who knows how many girls we have lost hitherto to nursing as a result of this two years' waiting period. In the interval a girl gets a job, she gets reasonably good money, with prospects of advancement, and so on, and, therefore, is very reluctant to relinquish that position and to switch over to nursing and begin again when, she reaches the age of 18. We have to look carefully at this problem of the gap between 16 and 18.

I do not know the answer to this, and I do not pretend to, and I do not suppose the Parliamentary Secretary knows, because this is a problem with which so far it has been found very difficult to deal and it is growing in intensity, but one of the first things that can be done, I am sure, is to have a little more flexibility over the age of entry to the schools. The second is to extend and encourage pre-nursing courses. They are a very valuable channel of entry into the nursing profession. I should be glad if the Minister could give me some information about how far pre-nursing courses have been established in this area of which I am speaking, and of what can be done to encourage them, in co-operation with local education authorities. There ought to be an extension of nursing courses in evening schools, and so on. I am sure that one of the keys to the solution of the problem is to maintain the interests of the girls in nursing between the ages of 16 and 18.

We have, perhaps, tended in the past to look to too narrow a circle for our girls. It is no longer possible to look only to the girls leaving grammar schools. Apart from the fact that other professions also attract them, there are really not enough girls in the grammar schools to fill the gaps in the nursing profession. My view is we must look more closely to the girls from the secondary modern schools. I believe that there should be training there sufficient to get them through the nursing examinations and to become efficient nurses. I am sure we ought to consider that, in conjunction with the local education authorities.

Again, on the hoardings, as we go about the country, we see advertisements encouraging people to join the Army, the Navy, the Air Force, Civil Defence or the Fire Service, but I have not noticed any advertisements encouraging girls to join the nursing profession. We need a national campaign of advertisements on those lines, but, even more important, we need a local campaign, because it is from the localities that we have to draw the girls for the smaller provincial hospitals. London is in a different category altogether, but we depend upon the areas themselves to provide their own staff for their hospitals.

I should therefore like to see a continued and extensive local drive of encouragement and publicity for recruitment to the nursing profession, not only in order to encourage the recruitment of students but also in order to make students appreciate the desirability of completing the courses once they have started them. I am appalled by the amount of wastage among people who start their courses but never finish them, or who finish them and are then lost to the profession. One of our major problems is that of stopping the wastage of trained nurses. I know that marriage seems to be the largest factor here, and there seems to be a close affinity between the nurses and the doctors with whom they come into contact, but, nevertheless, this is a big problem in which marriage ought not to be such a large factor.

I appeal to the Minister for her help in this problem of maintaining and strengthening one of the greatest acts of social service of all time—the hospital service. It would be a tragedy if, because of shortage of staff or similar reasons, the service should decline from the high position it is now reaching. We are all very proud indeed of our local hospitals and of the people who serve in them. There is a natural pride in this service. But the interest of the patients is paramount, and everything must be done to see that we have enough devoted and trained nurses to look after the patients. I hope we shall get some advice and some suggestions from the Government tonight to help us to ease the problem in my constituency and district.

7.43 p.m.

Mrs. Eveline Hill (Manchester. Wythenshawe)

I should like to support the hon. Member for Stockton-on-Tees (Mr. Chetwynd) on the very important subject which he has raised. This gap between school leaving and entry into training for the nursing profession has been a problem which has exercised people's minds for many years, and I think it is unfortunate that the gap should have been lengthened in this way, for it might deter even more girls from waiting the length of time required before they can undertake their training. As the hon. Gentleman said, in the highly-industrialised areas there are very many other attractions for girls. They cannot always wait the long time between school leaving and when they can begin their training.

This is a matter of very great importance in those hospitals which, as the hon. Gentleman said, are not teaching hospitals. They are not as fashionable as the teaching hospitals and, unfortunately, do not seem to have the same attraction for our young girls. Nevertheless, girls can get as good a training in those hospitals as in the teaching hospitals which have very well-known names.

I am certain that the hon. Gentleman has done a service in raising this matter because it is exercising the minds of all of us in the heavily-industrialised areas. If the Minister can give us some help and some support in tackling this problem, we shall all be grateful, because we are all most concerned that the intake of students is so much less than in the larger hospitals. There is a consequent higher strain on the staff already in the hospitals. It is not altogether economical to have to employ so many part-time nurses, for it puts up the cost of running a hospital. Any help which the Minister can give us tonight will, I am sure, be appreciated by all in those very busy areas.

7.45 p.m.

Mr. Horace E. Holmes (Hemsworth)

May I make a comment on the point which my hon. Friend the Member for Stockton-on-Tees (Mr. Chetwynd) made about the age problem? In my township we have a very active and virile St. John Ambulance movement containing a large number of juveniles. A week or so ago I presented awards to about 150 of them. In many cases, at 16 these juveniles represent potential nurses, but they cannot get into the nursing profession at that age, with the result that they go into industry, where their interest is eventually changed. We thus lose a partly-trained and good class of young girl from the nursing profession.

I should like the Minister to look at this situation very carefully. If she would like to see the records of the township to which I refer, they can be obtained. Over the years scores of girls who are thoroughly trained in St. John Ambulance work and in domestic nursing are lost to the nursing profession because there is no opportunity for them to begin their training until they are 18.

7.46 p.m.

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

I am grateful to the hon. Member for Stockton-on-Tees (Mr. Chetwynd) for the most helpful way in which he has raised this very important topic. I think we can allay his fears to a certain extent in that we have met with marked success in the general recruitment of nursing staff, which has, of course, been reflected in the increasing number of beds made available. From 110,034 on 31st December, 1948, the number of full-time nurses in our hospitals had increased to 136,528 on 30th September, 1953. The figure of 19,402 part-time nurses, in December, 1948, had risen to 27,370 in the same period.

Definite progress has been made in this matter and it has been the Minister's desire to see that the problem of distribution, which is perhaps the most acute problem with which we are now concerned, is solved. One of the objects of his standstill order is that the teaching hospitals, which have long waiting lists and which, because of their world-wide reputation, have no difficulty in getting staff, do not become over-staffed at the expense of the provincial hospitals.

Generally speaking, we can claim to have obtained a very fair share of the available womanpower for the service where we need them. I must confess that when I discussed this matter with the hon. Member I had not seen the figures for the Tees-side group of hospitals. They are certainly not as bad, compared with the country as a whole, as he may have been led to believe. The percentage per 100 beds in the Tees-side group is 11.9 per cent. trained nurses, 13.6 per cent. student nurses and 17.2 per cent. other nursing staff. In the hospital in which he is most interested—the Stockton and Thornaby hospital—the percentage is 16.8 per cent. trained nurses, 25.2 per cent. student nurses—which is a very high figure—and 8.4 per cent. other nursing staff.

The comparison with the rest of the country is rather significant. For the whole of England and Wales, including mental and maternity hospitals, the percentage of trained nurses is 12.2 per cent., against 16.8 per cent. for Stockton and Thornaby; the percentage of student nurses is 15.4 per cent., against 25.2 per cent. for Stockton and Thornaby; and the percentage of other nursing staff, over the whole of England and Wales, is 11.5 per cent. against 8.4 per cent. for Stockton and Thornaby.

It therefore appears that the Tees-side group is slightly better off than the national average in total staff, whereas it is slightly below average in trained nurses and students. This is largely due to the fact that it contains four assistant nurse training schools, so that reflected in the figure is a high proportion of enrolled assistant nurses and pupil assistant nurses who come into the figures for other nursing staff and increase them to much higher than the general level.

So far as Stockton and Thornaby is concerned, it has well above the average total nursing staff and is only below the average in "other nursing staff," of which it could profitably take a larger proportion.

Mr. Chetwynd

Are these recent figures?

Miss Hornsby-Smith

They were got from the hospital yesterday, and they are the current figures for the hospital. With very great respect to the hon. Gentleman, I cannot accept that the situation is a desperate one, and I should be extremely surprised if the Regional Board took that view, because Thornaby is better off than other hospitals in the Tees-side group and well above the national average.

As to the question of nurses being trained there and going away from Tees-side, there is always an ebb and flow of nurses. The fact that we have training hospitals and assistant nurses training schools as well means that these are inevitably training for other hospitals which have not reached full training status. These other hospitals must draw their qualified staff from hospitals who do undertake the training.

As regards the minimum age of entry of 18, the hon. Member will know that the rule for the 18-year age of entry was fixed in July, 1951, and over a year's notice was given to the hospitals. It finally became operative on the 1st August, 1952. The then Minister was aware of the fact that it would have some immediate effect on nurse recruitment, and what is rather amazing is that the figures for recruitment have steadily climbed and have not shown the sharp drop which some of the critics anticipated.

With regard to any suggestion concerning the 18-year age limit, I think that it must be borne in mind that the General Nursing Council and all the organisations representing the nursing profession unanimously agreed that it was undesirable to allow young women to enter into nursing until they reach the age of 18. Not least did they consider it desirable in the nursing profession that nurses should have had some experience outside nursing, between leaving school and entering the profession, of the world of commerce and other types of employment before they actually go into a hospital, because they regard that as a valuable part of a young girl's development towards maturity before she takes on the all-important career of nursing.

This view was supported by the Working Party on the Recruitment and Training of Nurses. It was believed that the introduction of this rule would have a temporary effect on student nurses recruitment, and for that reason discretion was allowed to the General Nursing Council where it affected particular hospitals. I think that emphasis has been more on whether a hospital is so desperately short of staff, that it might mean the closing of beds. We have taken every possible measure to maintain our nursing staff and our recruitment of student nurses at the highest level before considering relaxation of the rule in certain circumstances. They would not consider the fact that a particular candidate was nearly 18 sufficient reason for relaxing the rule if they considered that the ordinary staff of the hospital was reasonably adequate and well up to the average.

We have managed to maintain and increase our recruitment of students and we had the highest level last year. The employment of enrolled assistant nurses, the establishment of assistant nurse training schools and the increased use of auxiliary nursing staff have gone a long way to meet staffing difficulties.

As I have said, the General Nursing Council have power to waive the rule where the hospital service is affected prejudicially as a result of the 18 year rule, and in fact 26 hospitals have made application and the Council have relaxed the rule in six cases.

So far as the correspondence between the matron of the Stockton and Thornaby Hospital and the General Nursing Council is concerned, it was, as the hon. Member said, over an individual student. The information I have received from the General Nursing Council is that they only raised the case of one student for whom an exception was requested, and there was not a general application that the age limit should be lowered. I do not think that the Council would agree to a relaxation. There was no formal application for a general relaxation in relation to this hospital. As the rule stands at present, the General Nursing Council cannot stretch a point merely on the basis of an individual.

I am very happy to tell the hon. Member that there are some most successful pre-nursing courses running in his own locality. There is a two-year whole-time course at Richard Hinds Secondary Modern School for Girls, Stockton, and a part-time one at the Hugh Bell Evening Institute at Middlesbrough, which meets the hon. Member's plea for an evening course to cater for a girl who has to earn a living, and where she can, at the same time, take a preliminary training course with the ultimate intention of becoming a student nurse. There is a one-year whole-time course at the Henry Smith Grammar School, West Hartlepool. The area is very well served to bridge the gap and, possibly, it is not sufficiently well known that these facilities are available for any girl who wishes to take up training. She can go in for evening or full-time day training by taking preliminary courses at these schools.

So far as publicity is concerned, I agree with the hon. Member that the main publicity has to be local. We have had our national campaigns. I am sorry the hon. Member has not seen the posters of our charming nurses, but we have had national campaigns and space in the national Press and national posters for recruiting; but from our experience, we are convinced that the best results accrue where the local community support the local recruiting campaign centred round the local hospital—possibly around an open-day with the Member of Parliament civic heads, responsible church leaders, the W.V.S. and the like—and people in responsibility generally who show locally their support for the campaign and use their influence and knowledge of their hospitals to bring publicity to bear on the work done in those hospitals and the need we have for increased staff.

So far as wastage is concerned, I cannot agree more with the hon. Member that the biggest wastage we are suffering comes under the head of matrimony. There is a saying about young nurses marrying young doctors and that we lose them within a few years of their training. Unfortunately they do not always return, but a number come back and do part-time work. A considerable number of trained married nurses go into local authority domiciliary services, so although they are lost to the hospital side of the Health Service, they have contributed to the very substantial increase in recent years in the local authority nursing services.

I do not in any way pretend that we are complacent about the situation. So far as nursing in general hospitals is concerned, we have seen a steady increase and we have no reason to be downhearted or distressed about the rate of recruitment for the general hospitals. The problem is more one of distribution. There are local shortages, and these are being aided by the standstill order, whereby hospitals very rich in staff cannot increase their staffs until there has been a better distribution elsewhere. On the mental side, however, which has not been touched upon tonight, there is, as the hon. Member knows, still a very great shortage indeed.

The terms of the General Nursing Council's minimum-age rule are such that it is only possible to make the exception where there is a proven case of a desperate shortage of nurses. From the figures, I am happy to say that that does not appear to be the case in the hon. Member's constituency.

Question put, and agreed to.

Adjourned accordingly at One Minute past Eight o'clock.