§ Motion made and Question proposed, That this House do now adjourn.—[Mr. Gibson-Watt.]
§ 11.0 p.m.
§ Dr. Horace King (Southampton, Itchen)Fifty years ago, Sir John Gorst, one of Britain's most notable advocates of child welfare, inspired the infant Labour Party with its first two Acts of Parliament—school medical inspection and the feeding of poor children. In 1906, in a book called "Children of the Nation", he showed that the death rate among mothers was nearly five per thousand and among infant children 150 per thousand—and in the poorest parts of England as much as 500 per thousand. Britain today has reduced the maternal death rate to one-tenth of that figure and the infant death rate to under one-seventh, and the differential death rate as between rich and poor children has practically disappeared.
It is impossible to express these statistics in national wealth and human happiness. Many factors have contributed to this great achievement—doctors, medical discoveries, ante-natal and post-natal care, full employment, and the National Health Service among them. I want to speak tonight of one factor: the noble army of midwives. I hope they will never change their Anglo-Saxon name for a modern fancy one. The midwife is the one who is with the mother when she performs her sublimest function. I want to ask the Mother of Parliaments to pay a well-deserved tribute to those who assist the mothers of Britain and to urge the Government to make that tribute a real one by improving conditions in the midwifery profession.
The work of midwives falls into two branches—some work in the hospitals and the others, the domiciliary midwives, in our homes. Nearly all of them are State-registered nurses with extra qualifications in midwifery. All are qualified in midwifery. Their work includes care of mother while baby is on the way, delivery of the baby, and care and training of the mother after childbirth. Modern science with gas and air on the one hand, and trilene on the other, have 844 helped the midwife to help the mother. The old, crazy idea that pain at childbirth was part of the curse of Eve has been replaced by the ways of modern science. Some 90 per cent. of all mid-wives are trained and skilled in the use of analgesia, and I would congratulate the Ministry on the great work they have done in making these new resources of science available to the midwives.
Incidentally, midwives have delivered during the post-war infant "bulge," which is so well-known to educationists, some extra 1,250,000 children, and I hope that both education and health Ministers have noted that a second bulge began two years ago and that it appears that the birth rate is increasing by over 40,000 a year.
There is a shortage of midwives, both hospital and domiciliary, and there always has been. But the simple national picture at the moment is that there has been a slight decline in the total number of midwives between 1955 and 1957 but that 53,000 more babies were born in 1957 than in 1955. A bad position has become worse.
The shortage varies from area to area. I am glad to see the hon. Member for Stalybridge and Hyde (Mr. Blackburn), a keen supporter of the midwives' claim, here tonight. I remember that my hon. Friend the Member for Sunderland, North (Mr. Willey) recently spoke in the House of a shortage of one-third of mid-wives in Sunderland. Sheffield Regional Hospital Board, out of 63 maternity units, have 11 with a 50 per cent. deficiency and 26 with a 20 per cent. deficiency. In 1957–58, they had to close three units. There are grave shortages in the domiciliary service in South Shields, Manchester, Middlesex and Hertfordshire. I pick these out only as examples; they are no reflection on the regional boards or the local authorities concerned.
In the ten years since the National Health Service was introduced, the number of midwives dropped from 17,095 to 17,006, but 1,250,000 extra babies have been born. My own local authority is an excellent one, as is the local hospital group, but I am informed that my home town has two vacancies for midwives which have been advertised 845 for three months without a single applicant. Portsmouth advertised a vacancy for a year and had only one applicant. From other local newspapers, I quote:
a shortage of mid wives in Smethwick threatens the continuance of the domiciliary midwife services in the town. Seven midwives left in 1957. Only two were replaced.From another part I quote:A serious shortage of trained practising midwives is worrying the Sheffield Regional Board. Of the annual output of 2,600 trained midwives only half practise and fewer than one third are in practice after three years.A new maternity unit was completed at Spalding last May. By last November the local Press was reporting that it could not be opened because there were no midwives. The shortage creates a vicious circle. Midwives are overworked. They are supposed to have 36 hours a week off duty and five weeks holiday a year. In actual fact, they rarely get two consecutive nights off call. They get their holidays only by other midwives undertaking double districts during their absence, and when they return from holiday they return to do a double duty to enable some other midwife to have a holiday.The supervisory midwife in a town, who is supposed to organise a local service, often finds herself out on field work, filling in for midwives while on holidays or sick, or non-existent because of a vacancy which cannot be filled. The profession claims that a midwife ought to attend a maximum of 55 cases a year singlehanded or 66 with a pupil midwife. In my own town, 17 domiciliary midwives delivered in 1957 1,573 babies, an average of 92 per midwife. Yet Southampton is comparatively fortunate, for we have a very fine pupil 'training unit. In other parts of the country the position is worse. One midwife I know had a case at 12.15 a.m. on New Year's Day and by 6th January she had dealt with seven. Another spoke to me of working 119 hours in one week, another of 95 cases in one year, 72 of them being night cases between midnight and 6 o'clock in the morning. Youngsters choose awkward times to come into the world.
Similar overwork takes place in hospital maternity units. The number of hospital confinements rose from 395,000 846 in 1955 to 428,000 in 1957, in which year there were fewer midwives than in 1955. Incidentally, if we are to reduce the hospital nurses' working week from 56 hours to 44 hours, that in itself involves 3,000 extra hospital midwives.
Here are two other grave features of the shortage. One is that 50 per cent. of all midwives are over 40. It is an ageing service. The other is that while the number of pupil midwives has increased by over 1,000 in the past ten years only 30 per cent. of all who qualify practise for more than three years. Midwives simply do not remain in the service. The causes are clear.
The National Consultative Council on the Recruitment of Nurses and Midwives has recently advised the Minister about the need to make the profession of hospital midwives more attractive. I endorse their recommendations, as indeed I understand the Minister does. I hope that regional boards will carry them out. They suggest the relieving of midwives of work which can be done by auxiliaries, the organising of the hospital service so that the midwives can do work at all stages—ante-natal, delivery and lying in—and take a case right through, the need for informed advice to young nurses about the midwives' profession and the treatment of pupil midwives as adults. I am glad that the Minister has removed the shocking anomaly which downgraded qualified nurses financially during the year in which they were doing their Part II midwifery training. But all this is mere detail.
A majority of the Consultative Council's Committee went further, and it is their viewpoint that I want to support tonight. They hold, as I do, that the shortage in hospitals and, I would add, in the domiciliary service is due to the inadequacy of the salary and the few opportunies for promotion. It is here that we have to break the vicious circle of overworked midwives, and that overworking discourages the young trained midwife from entering the profession. It is not my business to suggest a salary scale. But I would mention just a fact or two. When salary scales are adjusted the midwife always seems to be at the end of the queue. For years midwives and health visitors had parity of salary. Recenty the health visitor's salary was stepped up by £50 a year, but that £50 847 was not given to the midwife. Both are doing important work, and I suggest to the Minister that he restore that parity.
The opportunities for promotion are small. A town needs only one supervisory midwife, and the additional salary she receives for that post is very little. Hospital matrons are graded according to the number of their patients, but the matron of a maternity unit can rarely hope to be in charge of such a number of beds as her sister matron; her task is to make a few beds serve many of the nation's mothers. Indeed, in most hospitals the position is even worse than that. There are very few maternity matrons. Most maternity units are incorporated into general hospitals under hospital matrons, and there the highest post that a midwife can hope to obtain is that of sister midwife, at £667.
I believe that the financial attractions of a profession ought to be two-fold: an adequate basic scale, and an adequate number of attractive posts for extra ability and responsibility. On both these counts, the midwifery profession's salary scale falls down. The domiciliary midwife receives £504 rising to £641 a year. On the other hand, Canada is advertising in British newspapers for midwives, offering a 40-hour week and £1,020 a year. Kenya and Uganda are offering £813 rising to £1,173 a year. I am glad that midwives are going to the far corners of the Commonwealth, but that is all right only if we are building up an adequate supply for both home and Commonwealth. Four pupil midwives left Southampton last week to go abroad.
It costs £600 to train a midwife. If we lose her from the profession of midwifery after three years, as we so often do, we have wasted the best part of our nation's investment in that midwife.
There are other hardships in the service which affect domiciliary midwives in particular. There is the problem of transport for herself and transport for the gas cylinders. There is the need for housing; a midwife who serves a district must live in it. A midwife who is giving a 24-hours-a-day service has also to look after herself and has no domestic help. Some local authorities have done much to alleviate this side of the problem, but even the best local authorities, those which do most, still 848 face a shortage. The root problem is financial.
We have done much about childbirth to guard the nation's mothers and babies and give them ever improving opportunities, but we have by no means achieved all that can be done. It seems a great pity that what has been done so far is endangered by a shortage in this vital profession. Our achievements in this respect are, in no small measure, due to the sacrifices and devotion of an under-staffed and overworked profession.
When I was a schoolmaster, I used to read to my classes Addison's eighteenth century "Vision of Mirza"—the bridge of life with broken arches at the beginning and the arches and even the bridge itself breaking down towards the end of life. In the past fifty years, we have rebuilt the first arch of the bridge, and today almost every child that is born passes safely over the first year of life into childhood and, later, to manhood or womanhood. I am happier about that than about anything else in British life.
Mrs. Gamp died many years ago. She has been replaced in modern life by a highly skilled, scientific and kindly professional woman in uniform. All that remains now is for Britain to give the modern midwife the professional reward and status to which her work entitles her, and I hope that this debate will contribute towards that end.
§ 11.14 p.m.
§ Mr. John Howard (Southampton, Test)I wish to add a few sentences tonight because it is true to say that this Adjournment debate was initiated by the action of the Southampton Branch of the Royal College of Midwives in sending a deputation to see both the hon. Gentleman the Member for Southampton, Itchen (Dr. King) and myself. How well the members of that deputation outlined the conditions of service and their aspirations and hopes we have heard tonight in the admirable address to which we have just listened. In the few moments that I intend to occupy, I will therefore only underline one or two points.
First, the conditions of service. The hon. Member for Itchen outlined the time which the midwives, particularly the domiciliary midwives, are on duty. It is not generally known that they spend something like 132 hours a week on call. 849 The group in the Southampton area made a time study and the average time when they are actually working, on duty—not merely on call, but working on cases—amounted to 67 hours a week, compared with 44 hours which is the desirable figure in the hospital service. The rates of pay have already been mentioned, together with the few opportunities for promotion. I think it fair to say that if the service is to continue to enjoy its present prestige, there must be some greater attraction to bring new recruits into the service.
One difficulty that was mentioned to me, although I know that my hon. Friend the Parliamentary Secretary cannot do anything about this item, was the source of irritation concerning the claim for tax purposes on the use of a motor car. A certain allowance is given by the local authority, but often the expense of running the car exceeds that amount and it is some irritation to the midwives to find that their claim is limited.
The deputation that came to see me comprised most admirable members of the profession. They were all people with a sense of vocation and I would not like anyone in this House to get the impression that they were intent on pressing the financial side. They all stated frankly that they would still be midwives whatever the pay and the conditions because it was a job they liked doing and which they felt was worth while. They expressed concern, however, about the future of the profession, about recruiting and about the loss of trained members through marriage and service abroad. I hope that in his reply my hon. Friend will do something to reassure them.
§ 11.18 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)The hon. Member for Southampton, Itchen (Dr. King) and my hon. Friend the Member for Southampton, Test (Mr. J. Howard) have done a real service in raising this matter tonight. Although there are only a few of us present, there is no doubt that this is a matter on which many Members have expressed considerable concern. I associate myself wholeheartedly with the well-deserved tribute which the hon. Member for Itchen paid to the profession of midwifery. Its members are doing 850 wonderful work for the mothers and babies of Britain. At least, we can start with the firmest agreement about that.
The subject for this Adjournment debate is timely in view of the recent Report of the National Consultative Council on the Recruitment of Nurses and Midwives, with which the hon. Member for Itchen is familiar. It has given us valuable information. We also expect shortly the Report on the Cranbrook Committee on Maternity Services, which will add to our knowledge on the subject.
This matter falls for consideration under two headings: midwifery in the hospital service and midwifery in the local authority domiciliary service, in which the conditions and the problem are not quite the same. I will take the hospital service first. The shortage, particularly in the hospital service, has been causing considerable concern for some time. I cannot state the precise numerical shortage in this service, because we have no firm figures for the requisite establishment. Furthermore, the general picture is a rather patchy one. Undoubtedly, as the hon. Member for Itchen said, the shortage is acute in some areas, but in other areas many maternity hospitals and units are fully staffed. We therefore have a problem which is almost as much a problem of distribution of the available resources as it is of actual shortage.
The National Consultative Council on the Recruitment of Nurses and Midwives appointed a sub-committee last summer to study this very problem. I would just say in passing that I have taken a very personal interest in the deliberations of that body, of which I have taken the chair on more than one occasion. That Report has now been issued by my Ministry, with a memorandum commending the recommendations it made to hospitals. That was as recently as 21st January, so we are talking about something which is thoroughly up to date.
The Council found no lack of candidates for training at the early stage of recruitment, and it also found that the numbers qualifying considerably exceeded the needs of the service. Therefore, we have the position that sufficient people are coming forward, and that sufficient people are qualified. The crux of the matter is that the qualified mid-wives leave the practice of midwifery so 851 that the numbers practising in hospitals are not increasing at a time when hospital confinements are. The hon. Gentleman referred to the bulge which has accentuated this at a time when the midwife population, so to speak, has remained broadly static.
The hon. Gentleman said a word or two about the main conclusions of the sub-committee. If I go over the ground a little again it is because I think it is very material to a solution of the problem, which, I certainly hope we shall find. Firstly, maternity hospitals are recommended to employ ancillary or domestic staff to relieve midwives and pupils of non-nursing work. I believe that to be important, because I believe a lot of what one may call the sheer drudgery of the work apart from the skilled side acts as a deterrent.
Another point—I was very struck with the importance of this in talking with midwives—is that the midwife should be responsible for the patient through all stages of confinement, and maternity hospitals should be planned to secure this. The point was put to me very strongly that a midwife liked to see the whole job through from start to finish and not to find, when she came back to the bed, that another mother had been put there, and the previous one moved on. I can well understand that.
Then, as the hon. Gentleman said, mid-wives should have adequate opportunities for practical teaching of pupils, whose programme should correlate both theory and practice. There was the need for adequate help and guidance for student nurses and pupil midwives in planning their careers. Then again, the right mental attitude to patients, patients' relatives, and colleagues and pupils should be inculcated during the midwife's training. Close attention should be given to the mental and physical needs of pupils, who should not be subjected to unnecessary rules and restrictions. Finally, there should be more facilities for training as midwives women with no nursing qualification, or qualified only as assistant nurses, since experience has shown that those tend to remain longer in the service of midwifery after being qualified.
It is perfectly true that the majority of the sub-committee thought that the 852 shortage might partly be due to the inadequacy of salary and the limited scope for promotion, to which both hon. Members referred. I think we are sometimes a little too ready to assume, in a service like this—which is vocational, otherwise it would not be done at all, I suggest—that the one and only solution is an increase in salaries. I do not, of course, rule that out, naturally, but I think sometimes that we are a little apt to assume that it lies only in that quarter. In any case, this is a matter for the Nurses' and Midwives' Whitley Council. Since the appointed day, salary scales have been revised a number of times. The last time was in July, 1957, and the matter has now come again before the Whitley Council.
The shortage on the domiciliary side is nothing like so acute as in the hospital service. The overall shortage is about 6 per cent. of the figure estimated by local health authorities to be what they need. A district midwife receives a substantially higher salary than a district nurse, but it may well be that some dissatisfaction exists because the health visitor, formerly on terms of parity with the district midwife, now gets a rate of pay about £50 a year higher. But this arises from the arbitration award by the Industrial Court dating from July, 1957.
As to long hours, it is true that domiciliary midwives, because of their work, are liable to long and irregular hours of duty, but, strangely perhaps, that has not prevented domiciliary service from being rather more popular than hospital service. It is up to local authorities to ease the burden by giving appropriate time off, providing that reliefs are available, and making adequate provision for transport.
Over the past few years the number of practising midwives in the hospital and domiciliary field has changed very little. The shortage has really been caused, as the hon. Member for Itchen pointed out, by the rising birth-rate, unaccompanied by sufficient new midwives remaining in the profession.
The hon. Member referred to rates of pay offered in overseas appointments. We have to be fair and point out that Canada and countries overseas generally have to bid very high, not only in this profession but in others. They have to pay people a differential for leaving this 853 country at all; and my information is that quite a few of those people come back here.
My right hon. and learned Friend has issued a memorandum of guidance to hospital authorities but he does not intend to rest there. Arrangements are now in hand for the problem to be studied in greater detail on the spot by medical and nursing teams from my Department, who will visit areas where the shortage is most acute, to advise on remedial action and to obtain information on local difficulties as a guide to future policy.
854 I hope that what I have said will show how seriously we regard this matter, and the steps which we have taken to apply expert knowledge and experience to the subject. Our intention to benefit by and apply the results of these inquiries will, I hope, commend itself to the hon. Member for Itchen and my hon. Friend the Member for Test. I assure them that it is a subject in which I shall continue to take the closest personal interest.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Eleven o'clock.