HC Deb 18 May 1956 vol 552 cc2458-72

3.21 p.m.

Dr. Barnett Stross (Stoke-on-Trent, Central)

First, I think I should offer an apology to the hon. Lady the Parliamentary Secretary to the Ministry of Health for detaining her on yet another Friday. I have the impression that for many months hardly a Friday has gone by without her being detained in a similar capacity. As we might have had this discussion last week but for an accident, I am sure she will forgive me for having brought her here again today.

I wish to draw some attention to the difficulties faced by the Ministry in recruiting a sufficient number of men and women to nurse the mentally sick and the mentally defective. In doing so, I hope to offer some positive steps which might be taken to solve the problem, which has been with us for a very long time—indeed, far too long—and is really nothing new.

There are some interesting figures in the Ministry's Report for 1954. The average number of staffed beds per nurse in 1954 was 6.6 in mental hospitals and 7 in mental deficiency hospitals. At the same time, there were 765 beds not in use because of the lack of staff in mental hospitals, and 1,336 beds not in use in mental deficiency institutions for a similar reason.

Comparing 1954 with 1953, we are able to see what has been happening. We find that the number of beds not in use in mental hospitals in 1953 was 1,099 and in mental deficiency institutions 1,750. Thus, an improvement between the two years is manifest. At the same time, when we realise that there are 1,336 beds in mental deficiency institutions and 765 in mental hospitals unstaffed because of lack of trained personnel, it is apparent that we must find a remedy for this even whilst we think in terms of building new hospitals, for these beds are available and everything is ready except that we have not the staff for them.

The Ministry has been fully aware of the problem and has acted in all sorts of ways to improve recruiting. I will list some of the steps taken. First, there have been special training courses for mental nurses. Secondly, there was an increase in remuneration in 1954, and new scales negotiated by the Whitley Council have recently been published. Thirdly, there has been deferment from call-up of male student nurses. Fourthly, local recruiting campaigns have been held in many parts of the country, particularly in the larger cities. The results of our recruiting campaigns, as I know the Parliamentary Secretary will agree. have, unfortunately, not been very good.

Fifthly, we know that there has been some increase in the expenditure on the buildings of the hospitals and institutions, and this increase in expenditure must in some ways have brought about an improvement for the staff in the amenities provided. But, again, I know the Parliamentary Secretary will agree when I say that there are some hospitals where such amenities are still sadly lacking and where much greater improvement is required.

Lastly, all the efforts made by the Ministry over quite a long period were noted in the Answer which the Parliamentary Secretary gave on 30th April to my hon. Friend the Member for Shoreditch and Finsbury (Mr. Collins), but the Answer made manifest that for 1954 we showed a net loss. More people still in training left in 1954 than the total number of new entrants we gained for that year. There was almost 100 per cent. wastage for the year 1955.

I have looked at other figures given to me, not by the Parliamentary Secretary but by the General Secretary of the Confederation of Health Service Employees, and it seems that for other years the wastage has been extremely high, averaging, for men, over a number of years, about 80 per cent. and over 90 per cent. for women.

I should like to say a few words about the recent salary revision. There has been an improvement over the old salary scale in certain respects—for instance, the number of annual increments have been reduced from eight to six, which obviously is a good thing, and there has been an increase, in some cases quite appreciable, in basic allowances—but there are anomalies in the recent revision and in the present salary scale. I have listed these as four. Perhaps I may put them briefly.

First, there is the question of the male student mental nurse who is over 21, is married and has one child. In her answer on this point, the Parliamentary Secretary told us on 23rd April, as reported in c. 1448 of HANSARD: In every instance there is a gain to all grades, and to some a very substantial gain.—[OFFICIAL REPORT, 23rd April, 1956; Vol. 551, c. 1448.] I have gone into that and I think the hon. Lady is wrong in respect of these married men over 21, in their first year, who have a wife and child. Formerly, these men received, I am advised, £357 16s. a year in their first year. That included the allowances for wife and child. Now they have no allowances, but they start at £390 a year; but the cost of meals for a year is £41, and this they must pay themselves. If my figures are correct these men are, therefore, worse off than they were before.

The second anomaly concerns charges for board and lodging. I believe it is a fact that the nurses are charged the same prices for board and lodging irrespective of what it is like. A nurse may have a room to himself or herself or may have to share it with one, two or three others. In both cases the board and lodging charge is the same. Moreover, I am told that in some cases the charges can be increased by more than the pay increases in certain respects. I wonder whether that is true. If it is true, it is wrong that at the same time as they receive increases in payment, the charges should be increased more rapidly than the rate of pay. If that does happen—and I am advised that it does—the situation becomes absurd. I should like to point out that no rebate is given to nurses for meals which they may take out, add nurses do have time off, and I wonder whether this was taken into account. They also have holidays, and must eat on holiday.

The fourth anomaly in the present salary revision is that the demand for overtime rates has been refused, and this has had to go to arbitration. Before 1944, overtime was consistently and universally paid. I was given a letter by my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) from a mental nurse, which is an extraordinary document, because the writer pointed out in his letter that he was a charge nurse, in charge of 448 beds, which is a very large number of beds for anyone to be in sole charge of at night. He has no assistant charge nurse to help him, and he says that if he had an assistant charge nurse, he would receive in addition to his salary, an additional £40 a year.

As it is impossible to give him an assistant—and I should have thought that it was not only desirable but essential to have assistants—he receives only the salary and £25 a year, instead of the salary and £40 a year. He rightly makes the point in his letter to my hon. Friend that, if he was in charge of only 50 beds and not 448, and had an assistant charge nurse, he would be better off than he is now, when he has infinitely more responsibility and very much more work to do.

I would bring to the notice of the Parliamentary Secretary this interesting point. A chief male nurse in the service today is paid on the number of beds which he has in his care, so is a deputy chief male nurse. Why should a nurse in charge at night of 448 beds receive only £25 over and above the normal salary for nurses for such a post of responsibility?

I come now to the question of how we can solve the problem which I am now raising, and I should like to read to the Parliamentary Secretary a letter sent by the Secretary-General of the Confederation of Health Service Employees to the Medical Officer of Stoke-on-Trent, and dated 3rd May. It is headed, "Pay and Conditions of Student Mental Nurses." As it is not a long letter, I will read it in full, because it puts clearly the point between the Secretary-General of this union and the Medical Officer of Health. It is as follows: I thank you for your letter of the 1st instant, and I am grateful for your interest in this matter. I have no doubt that the chief cause of the existing dissatisfaction is the constitution of the Nurses and Midwives Council, and until we have a separate Whitley Council for mental nurses the position is not likely to improve. Representation is not based on membership (as is the case with most committees), and the Royal College of Nursing and associated professional organisations far outnumber the representatives of N.A.L.G.O., C.O.H.S.E. and all other trade unions combined. I notice that the Parliamentary Secretary shakes her head, and I must say that when I looked at the figures I did not find that I was entirely in agreement with what I have just read out. On numbers, they seem to be, in the Nurses and Midwives' Council, well represented, but we will come to that point no doubt in the answer that will be given. The letter goes on: My organisation has four seats out of a total of 41, and as we have always been recognised as the union especially catering for mental nurses, you can appreciate how difficult it is to persuade the Royal College and the associated organisations that an increase in the differential between general nurses' salaries and those of mental nurses is called for. The reply of Miss Hornsby-Smith is quite correct. That was the reply that she gave me, on, I think, 23rd April. The letter continues: what is not realised is that we are absolutely dependent on the support of organisations which have no real knowledge of the conditions in mental hospitals and mental deficiency institutions. I think that is a real point, and I do ask the hon. Lady to accept that I believe this to be so from my own medical knowledge. The letter adds that: An increase in the differential would probably cause complaints from their own members"— that is, the general nurses— and they must be influenced by that consideration. The argument for a separate Whitley Council here is the crux of my reason for raising this matter today. This subject has been debated before and those arguments have been put previously to the Parliamentary Secretary. I am sure that the Minister must have had this matter under consideration and I hope that it will still be considered.

The arguments run something like this. In the first place, mental nursing does differ from general nursing. I hope that that is accepted. In support of that, it is advanced that custodial care is now a prominent feature, and one which is increasing as more and more people come from out of our prisons into our civilian mental hospitals. Then, the staff are older than they tend to be in general nursing, and in many more cases they have greater responsibility. There is less prospect of advancement outside this service than is noted in general nursing. That is a point which was raised in a Question to the Parliamentary Secretary on 30th April. Another point is that hospital management committees of mental deficiency hospitals are better qualified to understand the problem than are those of general hospitals, who are not conversant with conditions in our asylums or our mental deficiency institutions.

If we are to improve recruitment we must so widen the scope of the service as to make it more attractive. Social service training should be made available to enable mental nurses to qualify. There the first problem is the qualification by some people as psychiatric social workers. But as that would require a university course I think that grants and scholarships should be made available to enable those who show special aptitude to go to the university and be trained. It would be easy, however. to consider the next three points. It should be possible for them to become occupational centre officers. duly authorised officers and dis trict mental officers. I know that the Parliamentary Secretary has had all these things in her mind and has answered Questions about them.

I hope, therefore, that the hon. Lady will accede to my request, and that she and her right hon. Friend will consider afresh whether a separate Whitley Council is not now desirable in order to help solve this problem. After all, the present Whitley Council machinery was set up as a result of the Ministry's intervention and, if it so wills, the Ministry can equally bring about a change. I hope that it may so will it.

3.40 p.m.

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

I am grateful to the hon. Member for Stoke-on-Trent, Central (Dr. Stross) for raising this matter, although I confess that I could have wished that he had raised it last Friday and not today. Nevertheless, this is a very important subject, and I will deal first with two items which he raised initially before going into detail on the new Whitley agreement.

First of all, I will give him the 1955 figures of mental nursing staff compared with the 1952 figures which he quoted. The figures for total nursing staff are 4 per cent. higher for full-timers and 8 per cent. higher for part-timers. I do not suggest that that is enough, but it shows that our recruiting endeavours and the various methods which we have been pursuing in the last few years to shorten the period of pure training and in breaking down the barrier between the general nursing and mental nursing sides are beginning to show a result. We hope that there will be a much higher result this year.

The matter of board and lodging is for the Whitley Council to decide, but it would be administratively extremely difficult to have a variable range of board and lodging charges according to whether they are incurred in general hospitals or mental hospitals. It has been accepted by the Whitley Council that the only practical means of dealing with this matter is to have a uniform board and lodging charge for nurses in both sections, general and mental. I think it is fair to say that whereas some accommodation is better than others. the fact remains that in no hospital does the cost levied on the nurse cover the charge for her board and lodging. There is indirectly a hidden increment in the fact that the board and lodging charge is not in any hospital sufficient to cover its total cost.

On the hon. Gentleman's suggestion that the increase in pay in some circumstances was not as great as the increase made for the board and lodging charge, I frankly know no instance of that whatever. If the hon. Gentleman has any case in mind, I shall be happy to look into it. The normal procedure is that, on an average, one-third of the increase in pay has generally been the amount by which the board and lodging charge has been increased and I know of no case where the board and lodging increase was higher than the increase in pay.

I should like to deal in some detail with the new Whitley Agreement, because it sets a new pattern for the rates of pay and the conditions of service of student and other staff on the mental hospital side. In some cases it is a radical departure from the previous method, and it is an extremely important agreement which was arrived at by the Staff and Management sides of the Whitley Council with what, I think, was reasonable expedition.

In view of recent criticism of the Whitley machinery on account of delay, it is only fair to point out that this very important and complex claim for all grades of staff was settled by agreement in just over two months from the time the claim was lodged, during which period the two sides met on three occasions, referred back to their various committees, thrashed the matter out and finally came to complete agreement on a very far-reaching claim.

The agreement provides considerably better rates of pay for all existing mental nurses and, with one very limited exception to which the hon. Gentleman referred, and with which I will deal later. much more attractive rates for new entrants. An important change has been made in the structure of allowances for student mental nurses. Hitherto, like student general nurses, they have received allowances according to the stage which they reach in their training. In the future they are going to be paid allowances based on age of entry.

The present allowances are £285 in the first year, £295 in the second year and

£310 in the third year. Under the new arrangement students will receive £305 at the age of 18, £315 at 19 and £330 at 20. A student entering training at the age of 21 will start at £390 a year. if they are aged 21 or over when they take up training, they will receive £390 for the first year, £405 for the second year and £420 in the final year.

The younger student will, therefore, get increases from £20 to £45, and the rates for those over 21 will normally be increased by as much as £105, except where a dependant's allowance would have been payable under the present arrangements. These dependants' allowances which the hon. Member has in mind are now to be withdrawn. The proficiency allowances payable on passing the preliminary and final examinations will be retained. Generally, the new rates will provide a stimulus to recruiting in mental nursing, and they should be particularly attractive to persons over twenty-one years of age who are thinking of taking up nursing as a career.

I say quite frankly that the Whitley Council has taken a bold step in adopting this new scheme. It represents a complete break with the past, and I hope very much it is going to play an important part in increasing the flow of student mental nurses, in order that we may have adequate staff.

Staff nurses and ward sisters in mental hospitals will receive the same increases as their colleagues in general hospitals. The new scale for the woman staff nurse will be £462 rising to £567, and for a ward sister, £532 rising to £660. What is more important, the maximum of their scale will in the future be reached in six yearly increments instead of eight. For matrons. there are similar increases.

With regard to nursing assistants, up to now all new entrants to this grade have been required to serve two years in a lower category. This constituted a deterrent to the older man or woman. and. for that reason, the lower category is now abolished all new entrants will be paid age rates if under twenty-one and a salary scale if twenty-one or over. The pattern is the same as for unqualified nursing staff in general hospitals, but the rates are higher because of the incremented service in mental hospitals.

I now turn to the subject of students' allowances. The Whitley Council were in complete agreement on the new policy of a consolidated rate of pay. There was no disagreement from members of the Staff Side, including, as I shall outline presently, many members who are in the mental nursing service. There was no disagreement on the new policy of a consolidated rate of pay and doing away with dependants' allowances. That was the goal of the Whitley Council, with which the Staff Side agreed. The old scheme of allowances was unattractive to adults without dependants, and the new agreement, whilst still providing allowances for students under 21 which maintain the existing lead of £45 over general students, seeks to encourage the recruitment of older persons by paying them allowances at the same rates as they would receive in salary as nursing assistants.

On the question of meals, it should be appreciated that the nursing assistants already pay for their meals, so that if students over 21 are now to receive the same rates of pay as nursing assistants, it is not illogical that those who live outside hospital should in future do so as well. Those under 21 will continue to receive meals free to maintain their position in relation to student general nurses.

The new agreement, whilst providing substantial increases for the vast majority of mental nurses, could, in the case of a student in training who has dependants, result in a lower net payment. To meet this, the Council has agreed that student mental nurses in this category can opt to continue on the basis of the old training allowance, plus dependants' allowance, plus a special increase of £15, and without deduction for meals. The result is that no existing mental nurse will gain less than £15 a year out of this new agreement.

Dr. Stross

When was this decision reached?

Miss Hornsby-Smith

It is all part of the agreement; these are the terms of the Whitley Agreement. For the future, and in view of the very high percentage of unmarried students who come in for mental nursing, the Whitley Council was in agreement that they should go in for higher consolidated rates of pay and do away with dependants' allowances. The total amounts for an existing student who has a wife and child—the case the hon. Member had in mind—will increase from £358 to £373 in the first year, and will then go up in the second and third years of training.

In general, the scheme provides a common entry portal for all new recruits in mental nursing. Those desirous of training for the register will be enrolled as student mental nurses. Those not wishing to take up training or not suitable for it will be engaged as nursing assistants. Whichever they become, all recruits of the same age will be paid at the same rates.

Those who are student nurses will become staff nurses on the successful completion of their training and will qualify for proficiency allowances of £40 and £50 on passing the preliminary and final examinations, which is a not inconsiderable addition. Nursing assistants are paid the rate for the job and, therefore, like other staff, have never received dependants' allowances and have always paid for their meals on duty. Now that student mental nurses are to be paid at the same rates as nursing assistants, the Council felt that there was no justification for giving them the dependants' allowances in addition.

The position, therefore. of existing student mental nurses with dependants has been safeguarded because they will be able to continue as at present, plus an addition of £15. As a result of this agreement, student nurses and nursing assistants will get the same rate of pay and recruits will not, therefore, be adversely affected because they enrolled as student nurses. One of the criticisms has been that somebody enrolling as a student nurse received less than someone who enrolled as a nursing assistant. This anomaly has been wiped out. The important point about the new agreement is that all direct entrants into mental nursing will now be treated alike.

The new structure of allowances was devised with the object of improving recruitment and it will, I believe, be of great value to us in our recruiting campaign. The structure must be viewed as a whole. I freely confess that this is a radical departure from the old principle, but it has been done with the complete agreement of the Staff Side. It was accepted by both sides as meeting the very special needs of mental nursing. Now that the National Whitley Council has been concerned for seven years about mental nursing recruiting, it has been able to see the disadvantages of the lower rates for the student as against the nursing assistant and the much lower rates for the unmarried staff, which were greater deterrents to recruitment. The vast majority of students are, in fact, unmarried.

I recognise the special plea by the hon. Member for a separate Mental Nursing Whitley Council, but I disagree with him whole-heartedly. In a claim of this nature, the whole policy of the Staff Side is considered by the Mental Nurses' Standing Committee of the Whitley Council, which comprises 12 members. Five of them are serving staff in mental hospitals and four are trade union officials. I do not know whether the hon. Member wants some of the trade union officials changed for people serving in hospitals, but there are these nine members who can justly claim directly to represent the mental nursing side. Two of the 12 are matrons in general hospitals, although one of the matrons has direct responsibility for mental nursing training in the psychiatric wing of a hospital. Here, again, is someone who is very much associated with the mental nursing side. The twelfth member is a sister tutor.

I do not think that anyone could say that the mental nursing side is not properly represented, and in selecting the members who should negotiate this Whitley machinery the larger Whitley Council gave full consideration and representation to members from the Mental Nurses' Standing Committee, knowing their interest and experience in these problems. There is no question that the mental side had a full voice in dealing with its own problem.

Dr. Stross

Does the hon. Lady not agree that the State mental hospitals, which do similar work. have their own machinery?

Miss Hornsby-Smith

The hon. Member is talking about Broadmoor and Rampton, which are in a different category. They are to some extent under the jurisdiction of the Home Office and are criminal mental hospitals. The hon. Member is not perhaps drawing a fair parallel between the real medical scope of work which has to be done in recruiting and training mental nurses and the difficult and separate problem of the criminal mental hospital.

Any question of redeployment of Whitley Councils is not a matter for action by the Minister. The form of any negotiating machinery must accord with the wishes of all concerned if it is to work harmoniously.

It cannot be imposed from above. Admittedly the Minister at the beginning of the National Health Service had to lay down the general structure of the committees, but it has been implicit in the Whitley machinery that any radical change must come from joint agreement between the Staff and Management sides, and therefore any alteration in the present Whitley structure must come from within. It must be acceptable to both management and staff.

It is fair to say that discussion on the subject of a Whitley Council for mental nurses took place between the two sides of the Nurses and Midwives Council but that the consensus of opinion on both sides was against the establishment of a completely separate body. May I say this in great sincerity, because I know that the hon. Member is as sincere in his desire to see a great stimulus to our mental nurse recruitment as I am, that here I differ from him fundamentally on a point of principle.

The work of mental nursing has changed radically in the last ten or twenty years. From a task of mainly care and custody, it has changed to one embodying increasing medical skills. Patients today come into mental hospitals for treatment and cure, and the status of the mental nurse is now, after many years, comparable to that of the general nurse. The whole emphasis of our campaign is that the care of the sick mind is as important as the care of the sick body and that in status the mental nurse is side by side with her sister the general nurse.

The iron curtain of prejudice has been swept away—not without many hard battles in some of which I have been proud to participate, and the status of the mental nurse has been enhanced very considerably in the past few years so that she is now established beside her sister in the general nursing field. Great efforts are being made to encourage integration. We are having marked success in the integration of programmes between general and mental hospitals and the exchange of general nurses to do a turn of psychiatric work and of mental nurses to do the shortened 18 months to get the double registration on the register.

I believe that this has come about far more quickly because of this highly-important and extremely well-represented joint Whitley Council. Over the last few years we have literally battered down the old prejudice between the two sides of the profession. To go back on this new approach towards the integration of the sisters in the profession on the general and mental side, or to do anything which would suggest a division between two competing Whitley councils—and let us not hide it; they would be competing if they were set up separately—might be a retrograde step.

We want to enhance the status of all nurses and to establish beyond question the real link between the nursing of the sick mind and the sick body. There is great scope for advancement within the service, and, as I said in an Adjournment debate only a few days ago, committees are now dealing with psychiatric social workers, occupational therapy and the like work which mental nurses may do. The Whitley agreement recently concluded is clear evidence of the fact that the particular interests of the mental field are being kept in mind.

The new arrangements for remunerating student mental nurses and nursing assistants represent a complete break with the past and show a very full appreciation of the need for radical measures to attract suitable recruits in sufficient numbers into mental nursing. Multiplicity of such bodies would break down much of the good will which, in the past, we have been able to achieve in mental nursing.

Adjourned accordingly at one minute to Four o'clock till Tuesday, 29th May, pursuant to the Resolution of the House yesterday.