§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Finlay.]
§ 11.10 p.m.
§ Mr. R. W. Sorensen (Leyton)
The matter I wish to raise may seem to be of trivial significance, yet I suggest that it contains something of great importance. Obviously, I have been stimulated into introducing it by an incident that took place some weeks ago, but I must make it clear that I do not wish to elaborate on that incident or embarrass any of those concerned in it. However, I must refer to it, because it forms the basis of my remarks, and I hope that the result will be to avoid future confusion and to benefit all nurses.
According to reports, a nurse in her uniform was seen by her matron to be marching in a procession, with other nurses in uniform, in an attempt to get an improvement in nurses' salaries. She 1320 was later disciplined by the matron because, wittingly or unwittingly, she had broken what was a rule at that hospital, at least, that nurses must not be seen in public or consort with the public when in uniform. Apart from remarking that, if it is true, imposing on the nurse the penalty of wearing a lower-grade uniform seems to have been rather severe, I say no more about the incident, except also to hope that both the nurse and the matron have talked thing over, and that the matron has seen the un-wisdom of her action.
It is the underlying principle that is the more important. I recognise that, for the most part, hospital regulations must depend for their implementation on the matrons, the hospital committees and the regional boards. I appreciate that very great services are rendered by matrons, and all the nursing profession, but that there may be matrons, misinterpreting their capacity, who are overbearing and inconsiderate. I am quite certain that they are in the minority, and that the case I have quoted was a rare occurrence. Having said that, I want to ask whether it means that nurses cannot take part, when in uniform, in any kind of public gathering, and not just in processions which may or may not have a financial motive. Are they so debarred from civic functions? I ask that, because the explanation and justification advanced in defence of the matron's disciplinary action was that nurses in uniform are liable to convey infection from the public back to the hospitals, and so endanger the patients' health.
I appreciate that argument, if it is sound. If there is that danger then, obviously, it is something that cannot be left merely to local authorities or local bodies, matrons of hospitals, hospital committees or regional boards, but is of such a serious nature that it has a national significance which the House should recognise and seek to remedy. If that argument is sound, it applies equally to a variety of other circumstances, and is so serious that some central direction and guidance must be given. I must confess that I am a little dubious about this explanation, for I have never before heard—although I may be completely ignorant of the facts and the Parliament Secretary no doubt 1321 has records not available to me—of any incident involving a nurse, a sister or anyone else connected with a hospital being disciplined in this way for wearing a uniform in public.
One can, therefore, understand the suspicion—I do not say that I necessarily accept it—surrounding this case and the way in which this nurse was disciplined for having worn her uniform in this procession, for this particular purpose connected with a trade union's activities and her need for economic adjustment. One wonders whether the matron concerned or any other matron, seeing a girl in a civic procession—taking part in a Royal visit celebration or being at a church service—would express the same criticism.
I doubt whether the same criticism would be forthcoming and, because of this, I confess to a certain doubt about the explanation that was given. However, if the explanation is sound and if there is real danger, then obviously something more needs to be done and we cannot rely on the local bodies to decide for themselves whether or not they should vary or implement the regulations. I appreciate that there must be a certain variation and that we cannot interfere unduly with the responsibility vested in the boards and authorities. They do excellent work and must be free to do it.
But this is a matter of such gravity that, if the explanation given in the case to which I have been referred is true, the Ministry of Health should give guidance to the bodies concerned. The Ministry should say that it is a serious matter and that the boards should apply the regulations in the way they were applied in this case or that a sound argument is not involved. The argument is either valid or specious and intended to cover up the real facts. It must be one or the other.
I hope that the Parliamentary Secretary will not feel that this matter is not worthy of her consideration and that it is trivial, but will realise that two important points are involved. The first concerns the possibility of similar incidents happening in other parts of the country and the second concerns the necessity for the Ministry to make up its mind whether the alleged justification for the incident is sound and, if so, 1322 whether the Department should give some general guidance to boards and everyone connected with hospitals so that they know clearly where they stand.
§ 11.19 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
The hon. Gentleman the Member for Leyton (Mr. Sorensen) began by saying that this matter might appear to be rather trivial. I think that it is rather a minor matter and I am sorry that it should be ventilated again some six weeks after I answered Questions about it. However, I applaud the hon. Member's wisdom for not having named the hospital or individuals involved and I shall certainly follow suit.
The hon. Member referred to the incident which has caused him to raise this matter on the Adjournment and, therefore, I must refer to it, though only to say that at the hospital concerned the matron made a rule soon after her arrival that nurses should not wear their indoor uniform when off duty. I emphasise the word "indoor" because from the remarks of the hon. Member for Leyton it appears that he was not clear that it was the fact of the nurse in question wearing her indoor uniform on the occasion he mentioned which was regarded as a breach of the rule.
In fact, a student nurse from that hospital attended a pay demonstration, as the hon. Gentleman said, in this uniform, and she was seen by her matron. I hasten to add that the matron was on her way to the theatre and not to attend the demonstration. For breaking the rule about wearing uniform the student nurse was directed to wear for a month a white overall as worn by pupil assistant nurses, instead of the yellow uniform of a third-year student nurse.
§ Miss Pitt
The matron reconsidered her decision shortly after and allowed the nurse to resume her appropriate uniform. These are the facts of the particular incident, and I would say at once—and here I must repudiate the implication in the hon. Gentleman's speech—that there was no discriminatory action because of the attendance of the nurse at a particular function. What 1323 she did was to break her own hospital rules.
I thought that I should say a word about what we regard as nurses' uniform. The indoor uniform for women consists of a dress and belt, an apron, cap, collars and cuffs. A corridor, or annexe, cape may be worn out of doors within the hospital grounds or travelling to a nurses' home. Outdoor uniforms of long capes or coats may be issued, but not invariably. Men wear either a uniform suit or, in general hospitals, a white coat over ordinary clothing. The purpose of the uniform in the case of women—I refer to indoor uniform—is no doubt generally regarded by the public as a symbol distinctive of the nursing profession and of the hospital. It is, however, as is also the case with men's uniform, essentially also more or less functional protective clothing, supplemented of course by gown, mask or gloves where there are particular risks, or in theatres exchanged completely for special clothing. The outdoor uniform, on the other hand, serves no similar purpose.
The hon. Gentleman referred to this point about cross-infection because it is one of the answers that I gave to his Question, and said that he was rather dubious about the validity of this argument. Opinions may differ as to whether wearing uniform makes any real practical difference to cross-infection risks. However, the Standing Medical Advisory Committee's Report on "Staphylococcal Infections in Hospitals," which was issued in 1959, says:The most important means of dispersal into the air"—referring to infectious organisms—by staphylococcal carriers among the staff is from everyday clothes or normal working uniform.The Standing Nursing Advisory Committee Report on "Design of Uniforms," also issued in 1959, referred especially to aprons which they said should be worn only when on duty, thus singling out this one particular item of clothing. In conveying the report to hospital authorities, which we did by memorandum, we asked them to ensure that facilities for changing out of aprons were provided and were used. The Nursing Times on 27th April, 1962, 1324 reporting the views of the Royal College of Nursing, refers to uniforms asprotective clothing to prevent cross-infection.In the face of such authoritative opinions it may be argued that nurses are not the only potential carriers, that they move about the hospital without changing, and that the public as visitors are daily exposed and it is the public who are at risk from infection carried by uniforms. All the same, nurses' uniforms are exposed to airborne risks for longer than others in the wards, and the hospital management committee would be justified in taking account of the risk in framing its rules. Much may depend on the assessment by their medical staff of the risk involved in their particular case. That is why I think it is difficult to generalise. There may be considerable differences in the problems of different hospitals or even parts of a large hospital.
Mental hospitals and infectious hospitals or units of a hospital are obviously poles apart and a general Ministerial fiat or advice, as the hon. Member suggested, intended to cover all circumstances would be unrealistic. The hon. Member said, and it is true, that nurses not uncommonly attend special functions in uniform; they may even do so on instructions from, or with the agreement of, the hospital. It is, however, I am told, general practice to change into a different uniform for such purposes.
It must be remembered also that the large proportion of nurses who are part-timers or who, although whole-time, are non-resident present a special problem for hospital management committees where it is not yet practicable to provide fully the necessary changing facilities. There has been considerable change in the pattern of nursing. Many more part-timers or non-resident nurses are employed and although we should like it to be done, it has not been possible to provide changing facilities in all cases.
Nurses may often find it necessary to travel a short distance to a nurses' home and irksome to change before doing so. Hospital management committees have been asked by the Department to pay particular attention to adequate changing accommodation and this advice will be repeated in the near future. If it is necessary for nurses to go in uniform 1325 from one hospital to another or to a relatively distant nurses' residence, the outdoor clothing that can be provided should obviate any objections.
I do not want to make heavy weather of this point either, but I think it proper to make it. In the case of most nurses, the uniforms provided are the property of the hospital authority, which have accordingly the right to prescribe the occasions on which they should be worn. Those authorities are certainly within their rights to control or forbid the wearing of items such as aprons or caps off duty.
The view is held strongly by many in the profession that public esteem may be affected if uniform is worn indiscriminately. The Standing Nursing Advisory Committee Report to which I have referred mentionsthe untidy appearance created by the wearing of non-uniform coats over indoor uniform.The Nursing Times report to which I have referred states thatit is both unprofessional and undignified to appear in the streets in uniforms that are expressly designed as protective clothing.There is no need for my right hon. Friend to adopt a particular view of a professional matter of this kind, but the House might well share the view that as, in a sense, the uniform is a symbol of the profession, it would be a pity if its value were lessened.
It has been argued that nurses do not know where they are because there are so many different views of what should be done. As a body, however, nurses surely know what is the view of their profession. What they need to know is the view of their own hospital or hospital group. If there are no clear rules on the matter in hospitals, it is much to be hoped that they will now be considered and explained. This debate will have been useful in drawing attention to the need for local understanding.
On discipline generally, I would say this. On major matters, a common procedure is clearly needed and guidance was given by my Department. On minor matters—and this matter is really in that class—it would be ridiculous to give general guidance. One relies upon local management to be as little restrictive as possible consistent with its responsibility 1326 for what happens to property owned or provided by the Minister, including nurses' residences.
As regards off-duty activities outside the hospital, common sense if nothing else should prevent authorities from even appearing to interfere with the right of staff to engage in any activity they please —political, trade union or social—provided that the good name of the hospital is unaffected.
The responsible nurse can be relied on in her turn to remember her responsibility to the hospital or the profession. If rules there must be, they must be local, fitted to local circumstances. There is no place for a national and Ministerial code of behaviour on or off duty. As it has always been, this is for local people to settle among themselves.
§ 11.30 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
I agree with a great deal of what the hon. Lady has said, but I thought that on the question of uniforms she trod, like Agag, very delicately indeed and was at great pains not to come down on one side or the other.
There is much to be said perhops for different rules for different types of hospital, but what worries my hon. Friend the Member for Leyton (Mr. Sorensen) and me is that there does not seem to be any general course of action among hospitals of a similar type.
The hon. Lady did not tell us how frequently this rather rigid type of rule which gave rise to the incident is employed. My impression is that it is rarely. Could she confirm whether this is so? If she had occasion, as I have, to travel in Gower Street and Tottenham Court Road, near two of our greatest London teaching hospitals, she would frequently see nurses apparently—I will not go further than that—in their working uniform going to their various hospitals nearby.
I cannot help thinking that if there were a real measurable risk to public health in this procedure, the matrons or boards of governors of these hospitals would have adopted some similar rule long before this. Apparently, they have not done so. Therefore, may we take it that, generally speaking, the rule against 1327 wearing working uniform off duty outside hospitals is not applied by the majority of general hospitals? Is that a fair assessment of the position?
§ Miss Pitt
If I may speak again by leave of the House, I could not answer that without notice because it is essentially a local matter and is left to the decision of local committees or matrons. But in an area where inquiries were made one hospital in four had such a rule. So that perhaps represents the pattern.
1328 I would add that although I am not familiar with Gower Street, I live in a street adjoining one of the big London hospitals, and I have particularly noticed —I hope the hon. Gentleman the Member for St. Pancras, North (Mr. K. Robinson) is equally observant—that although I see the girls in their capes, they do not wear their aprons.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-six minutes to Twelve o'clock.