§ 8.10 p.m.
§ Miss Margaret Herbison (Lanarkshire, North)
I beg to move,That an humble Address be presented to Her Majesty, praying that the Nurses (Scotland) (Amendment) Rules 1962 Approved Instrument 1962 (S.I., 1962, No. 2195), dated 28th September, 1962, a copy of which was laid before this House on 8th October in the last Session of Parliament, be annulled.It seemed to me and to some of my hon. Friends that it was important to discuss these Rules. The only way in which we can discuss them is by a Prayer to have them annulled, but I assure the Under-Secretary of State at once that we have no intention of voting against them. I think that the majority of my right hon. and hon. Friends who have studied the Rules support them. I understand that they have come before us after considerable discussion and a great deal of thought on the part of the General Nursing Council for Scotland.
Nursing requires from the young men and women who undertake it a suitable temperament and it also requires very great understanding. Without those two qualities, no amount of academic qualifications will ever make a young woman or young man a good nurse. I support the Rules because I feel that the important job of nursing must attract young men and women who have at least minimum 1595 academic qualifications. All the Rules call for are two passes at the O-level, one of which must be in English. It cannot be said that they set too high a standard of educational attainment for the young people who will become our nurses.
It is important to remember that one result of the Rules will be to enhance and improve the status of the nursing profession. Anything we can do to this end is well worth doing. I am very glad to note that the Rules apply not only to general nurses in Scotland, but to mental nurses, too. This is a great improvement on the Rules for England and Wales presented about two years ago. During the discussion on a Prayer to annul the English Rules, great objection was taken from this side of the House that there should be any difference in attitude towards nurses entering for general training as compared with nurses entering for training as mental nurses.
I welcome this provision in the Rules also because I know that people who understand these matters have long felt that mental nurses have been regarded as a sort of inferior species not on the same level as general nurses. The fact that the Scottish Rules apply to both will do something to bring both types of nurse into equal regard in the eyes of the public. It is important that this should be so. In all we are trying to do through the Mental Health Act and our new approach to mental health, we need to draw from our young men and women some of the very best to nurse our mentally sick.
The English Rules were passed over two years ago, but two years were allowed to elapse after they were passed before they came into operation. They came into operation only in July of this year. The Scottish Rules which we are now considering are to come into force on 1st January next, which means that they will come into operation in less than one month after we have discussed them in the House. Does not the hon. Gentleman consider that we are being too hurried in this matter? The O-level examination is very new in Scotland. I have in mind the 15-year-olds who left school in the summer of this year. Quite a number of them may have in- 1596 tended later to become nurses, but they can have had no idea that two O-level passes would be required of them as a qualification by the time that they finally decided to do so. Had they known, they might have stayed at school to try to obtain the necessary passes.
When such an important subject as this comes up in a Statutory Instrument, against which we can only move a Prayer, there is no means open to us whereby, even in a small way, we can make amendments. Would it be possible to postpone the date of operation of the Rules for at least six months? This would mean that young people who had it in mind to leave at the next school-leaving date could stay on until the summer holiday in order to take the two O-level examinations. It is no longer possible to help those who left last summer, but we could in that way help those who were considering leaving at the next school leaving date.
I understand that many young people who enter pre-nursing schools do so at 15 years of age. The usual age for a young boy or girl to enter our secondary schools in Scotland is 12. This means that, if they enter pre-nursing school at 15, they have not had a chance to take the O-level examination. Is it proposed that in the pre-nursing school they will be able to take the O-level examination in English and one other subject? It is important to have an answer about that before we accept these Rules.
What is to happen in the future to the older man or woman who wants to take up nursing as a profession? I am thinking particularly of a young man who lives very near me. The Under-Secretary of State will know about the great number of pit closures in Lanarkshire. This young man was a miner. He is now working in a big mental hospital near his home. I have made inquiries and I am told by those in charge that he is doing a very good job and that they expect him to become a fully qualified registered nurse. Is there to be an opportunity for a young person like that who, after having taken up other work for a time, decides to become a nurse? Very often, these people prove to be among the best nurses we have in our hospitals.
1597 In asking these questions, I direct the Minister's attention to the new paragraph (6, c) which is added by Rule 3:for an interim period, until a date to be determined by the Council with the consent of the Secretary of State, an educational examination set by the Council.Why "interim"? If it were not an interim period and if the Council in future were able to set its own examination, that older man, or the woman who left school at 15 and did not take even the O-level examination, would still be able to take the examination set by the Council. How are these people to enter the profession? Is it to be impossible in future for the type of young man I have described, or the office worker who may have a great desire to do so, to enter the profession? For such people there should always be an opportunity of entering.
Another point is connected with our system of secondary education in Scotland, particularly in some parts of the country. The Under-Secretary must be as aware as I am that there are secondary schools in Scotland where no child has the opportunity of even being presented for the O-level examination, far less of passing it. Does this mean that at 12 years of age a young boy or girl will never in future be able to enter the nursing profession?
About the older men and women of whom I have spoken and those in junior secondary schools who are not presented for the O-level examination, the Under-Secretary may tell me that they can be enrolled as assistant nurses or nursing auxiliaries. That may not be sufficient for people who become intensely interested in this kind of work. Because they want to enter the profession, many may enrol in the first instance as assistant nurses or auxiliaries and then feel that they would like to be fully trained and to become State-registered nurses. What chance will they have?
How long will the Under-Secretary tolerate a division such as we have in some areas of Scotland by which even in nursing some very good young people are prevented from becoming fully trained in the profession? Was the Secretary of State in consultation with the regional hospital boards before the Rules were presented? I imagine that the Department has had such consultations. Did the regional hospital boards think that 1598 we shall be able to recruit in sufficient numbers men and women to fill all the nursing posts which must be filled? Does the Under-Secretary believe that if these Rules are passed tonight, as undoubtedly they will be, we shall have a smaller number of fully-trained registered nurses and a greater number of assistant nurses and nursing auxiliaries?
It is right that the House should know what kind of nursing profession we are to have in future. In asking these questions, I have had a deep concern that any young man or woman who wants to enter the profession ought to have the chance at least of getting the academic qualifications to make it possible for him or her to become fully qualified and have the status which men and women in this very noble profession ought to have. I hope that the Under-Secretary will be able to answer these questions.
§ 8.25 p.m.
§ Mr. William Hannan (Glasgow, Maryhill)
I, also, want to express the anxiety felt on this side of the House about the well-being and future of the nursing profession. I do not for a moment dissent from the terms of the Rules nor that the minimum requirements for entry should be two O-level passes in the Scottish Certificate of Education. The Explanatory Note to the Rules indicates what those standards are for those wishing to enter the nursing profession.
Although this matter is concerned with the nursing service, fundamentally it is an educational question. The choice of the standard asked for is about right. That is my view for what it is worth. We do not question the right of the Nursing Council to lay down these standards, but some doubts have been expressed by my hon. Friend the Member for Lanarkshire, North (Miss Herbison) about the Rules which will operate under the 1951 Act.
Entry into the profession takes place at about the age of 17½ to 18. In the past many of these girls have left junior secondary school at 15 and in the interval have followed some other job until achieving the age of entry to the profession. Girls of this category will not now be granted entry. Although we accept that the Council has the right to lay down standards for the profession, as have many other professions, most 1599 of us regret that many of these girls who are suitable in other respects will not now have the opportunity of entering.
Under the new dispensation of education in Scotland they must have a minimum of two Ordinary level passes, which means four years at a senior secondary school and the attainment of the age of 16. While those of us interested in higher standards of education will welcome the fact that our children should attend schools until the age of 16, we recognise the handicap that this would entail, particularly for the nursing profession. The Government have been proclaiming the need for more nurses. Can the Under-Secretary of State say how many nurses are required in Scotland?
I know that it would be out of order for me to develop the point to any great extent, but I refer the hon. Gentleman to a Press report which appeared on Sunday saying that the hospitals in England and Wales have been told to stop recruiting nurses. Has anything of this character been issued in Scotland? According to this newspaper,One of the country's biggest hospital boards has told 170 hospitals in South-East England to stop recruiting nurses for the time being—because of a 'cut expenditure' warning from the Minister.This sort of thing does more damage to the recruitment of nurses than any other single action which the Government could take. We want some satisfaction on this point.
To return to the point which I was making, this change in educational standards may deprive the profession of many admirable recruits. Cannot the Department do something to counteract this possibility? For example, in view of the introduction of the new Scottish Certificate of Education—I should like the Under-Secretary of State to nod in the appropriate direction if I am right—it will be possible from this year for young people in junior secondary schools, leaving at the age of 15, nevertheless to continue with further education studies either in the evening or through the day and to obtain the two O-level passes.
§ The Under-Secretary of State for Scotland (Mr. R. Brooman-White) indicated assent.1600
§ Mr. Hannan
The hon. Member indicates that I am right in my contention.
Would it not be an advantage for the Department to give greater publicity to this fact? Perhaps it is not well enough known among young people who leave at the age of 15 that they can continue their education and, by further education studies at evening classes, obtain O-level passes which previously have been open only to those who go on to the age of 16. I attach great importance to this facility in the general sense, since we have such a high rate of young people without jobs precisely at these ages, and it is particularly important in respect of nursing recruitment at this time when there is a crucial need of them.
Few junior secondary schoolgirls in Glasgow will have the opportunity or the ability to pass O-level subjects, because the Corporation, the local education authority, through its promotion scheme from primary to secondary schools, is already passing a relatively higher proportion of its pupils to senior secondary schools than do most other local authorities. It ranges around 40 per cent. Therefore, most of the young girls and young men who want to enter this profession will have that opportunity already in Glasgow, but this is not so in all parts of the country, and there are bound to be many young people in the higher reaches of the junior secondary school who, with just a little more encouragement and a little more information, might be induced to attempt the two O-level passes which are required.
I have a few questions to which I hope the Under-Secretary of State will furnish answers so that we may have a better picture of the whole situation. Can he tell us how many recruits are needed at the moment? What is required in the recruitment of nurses to bring us up to establishment? A rather more detailed question on which perhaps he may be able to get advice—how many entered in the last two years and, of these, how many had the qualifications now asked for? That information might help us to appreciate the proportion which will be denied the opportunity of entering.
I think that most of us recognise that the introduction even of these minimum 1601 standards will have the desirable effect of reducing—a well-known term to the Under-Secretary of State—the wastage rate of those who fail in their nursing studies in the first year. Despite the existence of these minimum standards, however, will the teaching hospitals retain their own already recognised standards of entry? I understand that some of the teaching hospitals, in Glasgow at least, demand fairly high standards, higher than these minimum standards. If these new standards are to be the basis of entry, is it the intention that such girls will be acceptable and accepted in the teaching hospitals? By complying with these minimum requirements and the other standards which my hon. Friend mentioned—standards of suitability and temperament—wail a girl be eligible for entry to the teaching hospitals?
May I stress a point made by my hon. Friend: in view of the shortage of nurses, are we quite sure that it is sufficient to look at one end of the age range? The earliest age of entry is 17½ to 18, but what is the oldest? The Under-Secretary of State, no doubt, like myself, has been reading the very important articles by Professor Carstairs recently on the new status of women aged 40 and over. Women who have married young—and the tendency is for this to continue—find that by the time they are 40, their families have crown up and are themselves marrying at the ages of 18 to 20.
Bill Carron, of the A.E.U., and members of other organisations have recently been discussing the effects of automation and the great changes which will be brought into all our lives with such things as the all-night opening of restaurants and so on. The essential point which he made concerned the great change in the living conditions of people and in their working conditions. There will be all-night shifts and three shifts. In particular, women aged over 40 will have time on their hands and will be looking around for new interests when they are still relatively young.
This is a most important point. Not even Professor Carstairs forestalled the very able public health officer in Glasgow, Dr. Nora Wattie, who made the point that women of 40, having themselves reared families, have a deep sense of sympathy and understanding—the 1602 qualities mentioned by my hon. Friend—and that they represented a big field for recruitment for some services.
The difficulty is educational and this is no doubt the importance of the paragraph on page 7, but I wonder whether the Department will look at this point again and bear in mind that there are many women who take an interest in public life and in other fields than that in which they have been engaged for the previous twenty to twenty-five years of their lives, and who might be induced even to return to places of training. I recall reading of a gentleman of 75 who went back to night school to learn a language—a very good thing, too. This is very much to be encouraged.
There will be these changes. Let the Department look ahead and try to plan for them. In the meantime, I shall be grateful for the information for which I have asked.
§ 8.40 p.m.
§ The Under-Secretary of State for Scotland (Mr. R. Brooman-White)
I should like to thank both the hon. Lady the Member for Lanarkshire, North (Miss Herbison) and the hon. Member for Glasgow, Maryhill (Mr. Hannan) for giving us this opportunity for a short discussion of these Rules; for the constructive and helpful line they have taken, and for their declaration of specific intention towards the Rules as a whole. I hope that my remarks will not only allay all their own misgivings, but will also enable a more effective understanding of the Rules to be spread outside the House.
The hon. Lady rightly drew attention to the fact that these Rules have emerged from the work of the General Nursing Council which, as the House knows, has the statutory responsibility for considering all the questions about the entry of men and women to the nursing profession, and the training they have to undergo. The Nurses (Scotland) Act, 1951, provides that all changes in the rules made by the Council have to be approved by my right hon. Friend. Therefore, the Council's proposed minimum requirements have to be approved by the Secretary of State in this Statutory Instrument. I assure the hon. Lady that the local authority associations are in agreement with the proposed arrangements—
§ Miss Herbison
I am sorry to interrupt the hon. Gentleman so soon, but I referred to the regional hospital boards.
§ Mr. Brooman-White
I am sorry; I am still wearing my old hat.
The hon. Lady asked about the speed with which the Rules are being introduced; and whether there might not more usefully have been a period of delay. It has been known for a considerable time that this subject was under discussion, and most people interested were well aware of what was taking shape. Over and above that, this leads to the broader question, the interim period. There is not a sort of chopper coming down on this at all.
As is made clear in the Rules, during the interim period—and this should be widely known—there are many ways in which people who have not the qualifications now or, through different circumstances in the future, may not find it easy to obtain them by staying on at school, can acquire the requisite O-level passes. Anyone who has left school can sit for the Scottish Certificate at a further education centre. Anyone who has left school and wishes to get a certificate of education can be sponsored by the education authority, and sit for it after private study, without attending classes.
Further, during the interim period the General Nursing Council will set this special examination, and we understand that the Council proposes to set one based on one of the tests of the National Institute of Industrial Psychology—which, I believe, is an intelligence test at the requisite level. It is very helpful that the hon. Members should have brought that out, because there is no age ban. The hon. Member for Maryhill referred to a gentleman aged 75. That may be a little aged for nursing, but there are certainly people of quite advanced age who, if they wish to achieve the requisite qualifications, will have these various methods open to them to do so.
The hon. Gentleman asked whether there was any ceiling or restriction on the recruitment of our nurses in Scotland. I assure the hon. Gentleman that regional hospital boards recruit as they wish within their financial limitations.
§ Mr. Harry Gourlay (Kirkcaldy Burghs)
I think that the hon. Gentleman has hit the nail on the head with regard to recruitment. He says that these regional hospital boards are allowed to recruit within their financial limitations, but surely it is the Secretary of State for Scotland who sets the financial limitations.
My hon. Friend the Member for Glasgow, Maryhill (Mr. Hannan) said that instructions had been sent to hospital boards in England and Wales in connection with this matter, and from a reply which I received from the Secretary of State for Scotland I am not sure whether similar instructions have gone to Scottish boards. I hope that the Minister will reconsider this position, because these Rules appear to be implementing a decision of the Secretary of State for Scotland in two ways; first, by financial limitations, and, secondly, by raising the standard of entry to the profession.
§ Mr. Brooman-White
I think that the financial limitations cover a wide front, and one which I do not believe we would be in order in discussing on these Rules, but, clearly, the needs vary from area to area, and I think that the best way for me to deal with this is to come to the second theme of the speeches of the hon. Lady the Member for Lanarkshire, North, and the hon. Member for Maryhill.
§ Mr. Hannan
Will the hon. Gentleman please answer the direct question which I asked him? I quoted a newspaper report which said that because the Minister of Health had ordered a cut in expenditure, one hospital board had issued instructions to over 100 hospitals in a certain area to stop recruiting nurses. Have any such instructions been issued in respect of Soctland?
§ Mr. Deputy Speaker (Sir Robert Grimston)
Order. We cannot pursue this question of financial limitations very far on this Statutory Instrument. I have allowed a passing reference to it, and I will allow a passing reply, but no more than that.
§ Mr. Brooman-White
The passing reply to that question is very short. The answer is, "No".
Misgivings have been expressed about the effect on standards and on total 1605 recruitment, and whether this will result in an undesirable limitation on intake. The hon. Member for Maryhill used the word "wastage". The primary object of these Rules is to prevent wastage, and the primary object of the interim period is to provide every facility for people who have the necessary qualifications to come in. We want to get over the present difficulty of people undertaking a course and failing to complete it, which means wasted time for all concerned.
§ Miss Herbison
it seems that the hon. Gentleman is under the impression that there is wastage only because young men and women without the requisite academic qualifications, or without the intelligence to carry on, are entering the profession, but he must be aware, as I am, that wastage can be due to many things other than lack of intelligence or lack of academic qualifications.
§ Mr. Brooman-White
We are all well aware of that. I was simply referring to the type of wastage dealt with under these Rules. The hon. Lady referred to the standard of devotion and personal qualities demanded of those entering the nursing profession. After some experience many people find that they have not the same inclination to pursue this exacting profession with its enormous responsibilities and the need to take decisions affecting matters of life and death which they initially thought they had. There is also the problem of early marriage, which is perhaps socially desirable, especially if the girl marries the right man, but is unfortunate from the point of view of maintaining staff in our schools and hospitals.
On the question of the requirements of our hospitals as a whole and any possible misgiving that there may be about a limitation of the necessary recruits coming forward, I do not think that we need envisage this having a deterrent effect. The hon. Lady suggested improving the status to encourage people to come forward. We should encourage people who do not have the requisite educational ability to make the grade and become fully registered nurses to consider branching off into one of the other facets of the profession and becoming enrolled nurses or auxiliaries, which would be extremely helpful.
We are proposing to send out a circular to hospital boards of manage- 1606 ment stressing the importance not only of the efficient use of nurses, but of ensuring that the highly skilled, fully registered nurse is employed, so far as it is humanly possible, exclusively on highly skilled work in which her capabilities are needed to the full. It is interesting that recent research by the Nuffield Regional Hospital Trust revealed that about two-thirds of nursing is ordinary bedside routine work.
We feel that the idea that the fully registered nurse is the only sort of nurse on whom attention should be centred has attained too great an importance in the public mind and perhaps in the minds of professional people. Obviously, she is a key person and can do any job, however difficult and responsible. But if we are to use our personnel properly we must get rid of the idea that enrolled nurses and auxiliaries should be used as the last resort. There is a real place for these people in our hospital system, and it is wrong that the registered nurse should continue to carry out all or any substantial part of work which can be done by other grades. We are most keen that people in other grades should be encouraged. It is a waste of skill if highly trained people spend time on work which can be done by people with less experience and training.
§ Miss Herbison
What the hon. Gentleman has said was just what I thought he would say. What worries me is what will be the proportion of fully trained nurses to the nursing auxiliaries or assistant nurses. Some hospitals will attract much more readily people with academic qualifications to become fully trained nurses than others.
Does the Under-Secretary of State envisage some of our hospitals in Scotland having a very small number of fully trained people and a very large proportion, perhaps too large a proportion, of auxiliary nurses? I agree that auxiliaries and others have a part to play and that we want fully trained nurses to do the job for which they are trained, but what steps does the hon. Gentleman propose taking to ensure that some hospitals are not left too much in the hands of the auxiliary nurse?
§ Mr. Brooman-White
That is largely a matter for the hospital boards. What we are thinking of sending out to them as a general recommendation—this has 1607 not been finalised yet—is that in staffing arrangements they should try to apply the principle that a balanced staff should contain, in addition to registered and student nurses, both enrolled nurses and nursing auxiliaries. Normally, any staffing pattern which dispenses with or virtually omits any grade should be a matter for critical scrutiny rather than satisfaction.
That is the note that we want to strike. This is a matter which should be decided on its merits in the various hospitals and as their requirements demand. I hope that the general spirit of this approach will commend itself to the hon. Lady and to the House.
§ 8.55 p.m.
§ Mr. Tam Dalyell (West Lothian)
I offer no apology for going back to the subject of the junior secondary pupils and their relationship to nursing, which is important. I accept the Minister's remarks that there are further education services and that perhaps they can get the necessary qualifications by means of private study. The fact remains that there are junior secondary schools from which many of the best nurses, not only girls but also boys, have come. I think of mental hospitals such as Dingleton, near Melrose, where I know that most of the staff, who do a grand job, are from junior secondary schools.
In the light of this and of the inadequacy of his assurance, I wonder whether the Minister would further consider making certain that in every junior secondary school in Scotland, before each leaving date, a talk is given on the possibilities of nursing to the pupils. It would be quite easy to arrange for a team of either nurses or education experts or of people concerned with jobs or careers to go to those schools and explain to the pupils before they actually leave how they can go into nursing for a career by private study or by going through further education courses.
Order. The hon. Member must not pursue that too far. It is not discussable very far under these Rules.
§ Mr. Dalyell
I accept your Ruling, Mr. Deputy-Speaker, and I think that there is no more that can be usefully said.
§ Miss Herbison
In the light of the discussion, although I have reservations, and we shall have to watch the position, I beg to ask leave to withdraw the Motion.
§ Motion, by leave, withdrawn.