HC Deb 01 November 1955 vol 545 cc985-94

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

11.6 p.m.

Mr. Julian Snow (Lichfield and Tamworth)

I desire to raise tonight the question of pre-nurse training education. I see the Parliamentary Secretary to the Ministry of Health hurrying forward, and, Heaven knows, we have waited long enough.

This subject was brought to my urgent attention during the summer when I happened to attend a hospital fête in my constituency. I got into conversation with a regional nursing officer who took time off to describe to me her anxieties about nursing and student-nurse recruitment.

During the Summer Recess I collected a certain number of opinions on this urgent problem, and, to fortify myself for tonight's Adjournment debate, I yesterday, as the hon. Lady the Parliamentary Secretary knows, put down some exploratory Questions and sought to obtain information as to the exact statistical aspect of the nursing recruitment problem.

It was yesterday disclosed that, according to the latest information at the disposal of the Government, there are no less than 17,043 hospital beds which are not at present occupied because of the shortage of nursing staff. To put the problem in another way, the number of nurses needed to operate all available hospital beds in England and Wales amounts to 31,000. That is a fantastic figure, which can be split up into 21,000 nurses who are needed for general nursing duties and 10,000 for mental nursing.

In the context of this Adjournment Motion, I want to restrict myself to general nursing and to the question of the recruitment of female nurses. But I am considerably concerned at the apparent difference of opinion which exists among people who are at the top of the nursing profession. I am not at all sure that there is clear thinking in the Ministry itself on this matter, because one of the Questions I put to the Minister of Health, and which was replied to by the hon. Lady, concerned the matter of the sort of policy which the Government would wish to encourage regarding the pre-nurse training education.

I asked whether it was left to local discretion to decide whether an adequate supply of nurses was best produced by pre-nursing training in schools or by nursing cadet schemes. In her reply, the hon. Lady restricted herself to a comment about cadet schemes. I am rather puzzled at that reply, because I should have thought that my Question was quite clear and that I was differentiating between cadet schemes and courses run at schools for girls who have reached a somewhat later age than the age at which girls can go into these cadet schemes.

In the time at my disposal it is very difficult to cover the whole problem, but it seems to me that there is a pretty strong case for giving further encouragement to the running of these school courses for girls who are at least 17 years of age. My only doubt about the matter is that while it is true to say that there has been a big increase in these cadet schemes which permit girls to start at a younger age, nevertheless we cannot go on as we are. We simply are not finding enough girls who eventually get to the age of 18 and start off on their student-nurse training.

I am not sure that a big case has not been made out by the people who are enthusiastic about school courses. As a result of an investigation carried out in 1952 by the King Edward's Hospital Fund for London, when it analysed where the girls came from who started student-nurse training, it was found that nearly 53 per cent. came from other employment, nearly 5 per cent. from children's nurseries, 27 per cent. from schools, and just over 5 per cent. from cadet schemes. The significant figure is that 53 per cent., more than half, came from other employment.

If we examine those figures further we find that no less than 86 per cent. were aged between 18 and 25. The conclusion drawn was that a large number of girls can be attracted who are already in some form of employment and will be prepared to come into student-nurse training. That is a very strong argument indeed.

In the other type of scheme, the cadet scheme, the significant fact is that a very dangerous policy is advocated by the Government. I rely for my information upon Ministry of Health Circular No. 69 of 1954, which I assume is still current, with special reference to paragraph 5. There is a very pernicious doctrine at the beginning of that paragraph. Discussing the conditions of employment of the cadet nurses, it says: Moreover, where the young persons are, in fact, effectively employed, their rate of remuneration should be commensurate with the amount of service they render. Are these schemes to provide labour which can be used usefully in hospitals, or to provide a pool of girls who, at the end of their cadet training, will be fit to start their student-nurse training at the age of 18? To use the yardstick of the amount of service they can render is quite wrong.

Another thing concerns me. In paragraph 8 of that circular is a scale of payments to these cadets, starting with £150 per annum at the age of 15. I will talk about the special requirements of highly industrialised and prosperous areas in a moment; I want the hon. Lady the Parliamentary Secretary to compare that sort of salary with the declared policy of the Government as stated in the same circular, of trying to encourage girls to stay on at school and get a more advanced education.

What happens to a girl whose parents are encouraged to keep her at school up to 17? She is able, in a local education area, to obtain, after a means test, a maintenance grant, which I am informed may amount on the average to £25 a year. There is a financial inducement right away to a girl not to carry on at school but to enter a cadet scheme. I will not elaborate on the statistics, which I think are available to the hon. Lady, regarding wastage in cadet schemes, but I would draw attention to the fact that it seems a funny way to try to encourage girls to stay at school if the maintenance grants do not compare with the salaries available to the girls.

In the Midlands area in which my constituency is, and where there is a nursing shortage, the nursing authorities have to cope with the extremely high industrial wages available to the young girls. So I am prepared to accept that there is a special problem there. But there is also a further difficulty, and this refers to the cadets. Under the cadet system, the girls are allowed to attend, free as it were, a local education class once a week; but if it is the opinion of the authorities running the scheme that a girl should attend more than one day a week, her pay is cut. The result is that straight away there is what one might term an inhibition against further education.

I am anxious to use this Adjournment debate as a method of exploration. I am not an authority on this problem, but I know that there is an acute shortage of nurses and that the Government's present policy does not seem to be achieving much success. I am most anxious to help in any way that I can, and, to me, there appear to be three possibilities. First, so far as the school courses are concerned—that is, for the 17-plus category—there should be an improvement in the maintenance grants offered by the local education authority. That, I know, is not the responsibility of the hon. Lady the Parliamentary Secretary, but perhaps she would accept it as something worth discussing with her governmental colleagues, at the same time drawing attention to the disparity which exists with the cadet scales.

To put that in another way; there should be further education—that is, more than one day a week—without penalising whatever salary scales are agreed for the cadet scheme. I certainly have no desire to create prejudice against this cadet scheme, but I must say that I was astonished and appalled to read in the circular of 1954, from which I have quoted, of bad cases of mis-employment of young girls. An example is such as the case quoted in the circular of two girls under 18 years of age who had to attend a post-mortem examination. There are other cases quoted which I will not go into here tonight.

I have suggested two improvements. The third is to combine things on a national plan basis, because I think it is true that we are losing the battle to some extent by not having a national plan; there is too much variation in local practice. In parenthesis, I might here say that the House would probably like to know of the York and Tadcaster scheme which is for girls in other employment and is for training by means of evening classes. Hon. Members might also draw a moral from the high percentage of successes from that scheme, and I am sorry that the Parliamentary Secretary has said that so much is left to the local authorities. This is such a vital problem that some lead should be given by the local authorities. The Government, as hon. Members know, is in financial difficulties, and those on both sides of the House who want to see the National Health Service a success will be disquieted by the answer which the Parliamentary Secretary gave to my question yesterday.

We know that the Government have to cut expenditure, but I cannot help thinking that in the case of the nursing service in the hospitals a real start should be made in tackling this serious deficiency which, if not tackled, is going to affect the whole course of the hospital service. In conclusion, I hope that the hon. Lady will be able to say tonight how far the Government are prepared to go against their declared policy of cutting back expenditure in this direction so that we shall have a sufficient staff of nurses in our hospitals.

11.20 p.m.

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

I am grateful to the hon. Member for Lichfield and Tamworth (Mr. Snow) for initiating this debate, on a subject which we in the Ministry regard as of very great importance, and for the reasoned manner in which he has put his case. First, I think it is fair to point out that there has been a substantial improvement in the recruitment of nurses, and if I may I should like to give the figures for 1949 and 1954, which show that on the general nursing side, in which the hon. Member has been most interested this evening, the number of full-time registered nurses has risen from 28,000 to 36,000, student nurses from 40,000 to 44,000, all full-time nursing staff from 93,000 to 110,000 and part-time from 14,000 to 20,000. I do not deny that the picture on the mental nursing side is nowhere near as favourable, and had I the time I would willingly give those figures, but the hon. Gentleman has deliberately dealt with the general nursing side this evening and I propose to reply on that basis.

The annual intake of student nurses is averaging at the moment about 18,000, and with the increasing demands from other and, in many respects, new professions for women, it is unlikely that we shall be able to get much variation in the average intake. A really vital problem is, not so much the hope that we might greatly increase the annual intake, but that we shall be able to cut down on the wastage; and, bearing in mind the age groups that will come in the 18 years and 19 years class within the next few years, the cutting down of wastage offers the best opportunity for increasing our total complement of nurses. I confess that the largest single component of wastage is matrimony, which is the biggest headache of our nursing problem, and is something beyond our control, about which we can do nothing. The hon. Gentleman is aware, of course, of the Nuffield job analysis and the efforts and pioneer schemes being operated in order to see that nurse's skill is used on skilled jobs, and that, where possible, less skilled staff are used where medical skills and nursing skills are not required.

Before dealing with the various sections to which the hon. Gentleman has referred, I should like to emphasise a point he himself made, that a not inconsiderable number of men and women are taking up nursing at a later age, and there has been a marked increase in the number of over 20's who have entered the nursing profession. Many of them have tried other jobs and found they did not satisfy their sense of vocation, and, having had this outside experience and changed from their own choice, they tend to make absolutely first-class nurses.

Now may I deal with the problem of the under 18's. First I want to emphasise that this problem involves the Ministry of Health, the Ministry of Education, who are vitally concerned so long as the training of nurses is under educational auspices, and also the Ministry of Labour and National Service. We do not take a rigid view, saying that there should be a rigid national formula laid down as to the best method in all areas, because circumstances vary from the highly industrialised areas—where there is the opportunity for young people to go into light engineering, or work of that nature, at a comparatively young age—to rural areas. They vary too amongst large hospitals and small.

Cadet schemes can be a success in large hospitals, but they are often not a great success in small hospitals. They vary, too, where the co-operation between hospital and educational authorities is on a very high and satisfactory basis. We believe that there must be some elasticity, and there must be a very full consideration of local knowledge, of their hospitals and their education facilities, and of the possibility of attracting young people under any one of these three methods.

First there are those who continue full-time education until they are 18. I say quite emphatically—we have made our opinion well known—that we regard this as the best preparation for the boy or girl wishing to become a nurse. It can be by a special pre-nursing course at school or at a further education establishment. These pre-nursing courses are approved by the General Nursing Council and recommended by the Ministry of Education, and the Ministry of Labour have published an excellent pamphlet on the subject, which I am sure the hon. Member would be interested to see. A girl who takes one of these courses can sit for Part I of the preliminary examination before she starts training in hospital.

In addition, the General Nursing Council made a new rule in 1953, that those who take a specified subject such as anatomy and physiology with hygiene in the General Certificate of Education may be exempted from Part I of the preliminary examination.

For those who cannot continue in full-time education, the further education establishments run part-time day and evening courses, again approved by the General Nursing Council. There are also courses run preparatory to pre-nursing courses and other preliminary nursing courses of general education with a bias towards nursing subjects. So there is a wide field offered in the educational facilities in consultation with the General Nursing Council to give girls an opportunity of taking pre-nursing training.

It is true that there are no special financial arrangements for the special pre-nursing courses whether part-time or full-time run by further education establishments. Whether they will qualify for ordinary educational grants is, as the hon. Member admitted, a matter for the Minister of Education, but I think it fair to ask where we are to end if we start paying, however small it is, a wage level to girls or boys doing education courses? How many professions now have a shortage and can ask why they should not be given an opportunity and why not give them the same increased grants, if for example they are going in for teaching or any of the many professions and skilled jobs where there is an acute shortage? It is a very vast problem and it would be a very major step to suggest that what is tantamount to wages should be paid to people when in fact they are receiving education under the State.

Expenditure by local authorities on further education, including pre-nursing, is something which comes under the normal Exchequer grants. I do not think it unreasonable to maintain the principle that one pupil should be on the same footing as another and that education should rank for normal education grants and not anything akin to a wage.

Mr. Snow

Would the hon. Lady address herself to the question of the balance between cadet salary scales and maintenance grants for older girls continuing their education?

Miss Hornsby-Smith

That surely applies not merely to nursing. If a girl leaves at 15 or 16 and goes into some form of employment she is paid, and if she stays at school until she is 18 she possibly receives an education grant but does not qualify in any form for a wage. I frankly do not think it practicable to discriminate between one student and another. If, on the other hand, a girl leaves school at 15 or 16 and goes into a cadet scheme—some of which, as the hon. Member says, have been highly successful and some not quite so successful—she is providing a service within the hospital.

May I clear up a point raised by the hon. Member about paragraph 5 of the circular? Here again there is a very real difficulty between the person on the pre-nursing course and the person on a cadet course. They are allowed one day a week from their cadet training to go to pre-nursing educational training without any reduction—it is now £160 in the first year having gone up by £10 since the circular was issued. On the other hand, when they are away for two or three days their salary is accordingly deducted. Otherwise, the disparity would be greater and the encouragement would be for people not to go for pre-nursing courses but go into cadet schemes where they were available. That I appreciate, and we have endeavoured to meet the point where cadets are going into pre-nursing courses and not rendering service in the hospitals.

The hon. Member will be aware of the volume of complaints which there would be if cadets in the hospitals were rendering such services as they do—non-nursing services as laid down under the regulations—and were not given any form of remuneration for so doing. This is a problem, I accept, but I do not think the solution lies in discriminating between pupil and pupil in an educational scheme.

There is a very strong body of opinion which feels that it is in the best interests of people going in for nursing that they should have spent two years outside the hospital in some other vocation before going into nursing. That view is sincerely held by many people.

On the other hand, there have been areas faced with an acute shortage of nursing staff and the keenest competition from industry to take young people at an early age, where it has been felt that the only solution was an adequate and properly controlled cadet scheme. In that respect, Manchester has conducted an admirable scheme with considerable success.

The hospitals are free to recruit school leavers into the cadet schemes. They are a way of attracting to nursing those who for some reason or another feel that they have to leave school at 16 and want to go into nursing rather than to take up an alternative job until they are 18.

As I emphasised, the conditions are clearly defined and laid down, and they have been more strongly enforced since the Report to which the hon. Gentleman referred. I accept that there were some unsatisfactory schemes, but we have taken strong action in concert with the General Nursing Council, and he will now find that on the whole they are very satisfactorily conducted.

Mr. Snow

I did not make heavy weather of that.

Miss Hornsby-Smith

No, but in case it should be thought to be otherwise outside, I should like it to be known that the Regulations are very strict.

There is yet another way in which girls interested in nursing can get some pre-nursing training, either in nursery nursing or in the voluntary aid societies.

I should like to say a word about the York and Tadcaster scheme. As I said yesterday, the area is to be congratulated upon its success. This is a case where it is a matter of local pride and very real additional voluntary service as against anything laid down by the Ministry. The scheme has been run with the close co-operation of the hospital management committee and the local education authority, and two parallel courses are run at two hospitals in winter sessions for those who leave school, are perhaps in other jobs and are inclined to take up nursing.

It takes up a great deal of the free time of the staff. It has arisen out of the voluntary desire of the staff to do its utmost for its local hospital, and that is probably one of the reasons for the success of the scheme, whereas if we were to try to impose a scheme nationally which depended on such effort, it might not be as readily forthcoming or as applicable from area to area as has the Tadcaster scheme in its area. We hope that the publicity given to it and the knowledge of its success will lead to its being copied in other areas where similar conditions apply.

I would say that, generally speaking, we have been steadily increasing the number of nurses. We are engaged in wide local publicity because we have found from experience that the best publicity is that centred round the needy spots. We have many good spots which have made up their complement. We are fully alive to the difficulties of highly industrial areas such as Birmingham. I assure the hon. Member that we believe that by our three-fold policy, by elasticity and by the co-operation which the Ministry can give to individual schemes seeking to solve local problems we shall obtain the best results.

The Question having been proposed after Ten o'clock and the Debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-six minutes to Twelve o'clock.