HC Deb 24 October 1966 vol 734 cc789-96

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

10.27 p.m.

Mrs. Jill Knight (Birmingham, Edgbaston)

Some months ago, in taking up the case of a constituent of mine, Miss Rogers, of Edgbaston, I discovered that a most unfair ruling militates against the Miss Rogers' of this world. She decided, as many girls do, to take up nursing as a profession. For four years she studied and worked, and, being a good student, she finally passed her exams and became a State Registered Nurse. That is the equivalent to a degree. She has it and no one can take it away: henceforward, she is entitled to put the letters S.R.N. after her name. What is more important, perhaps to some people, she is entitled to a certain rate of pay.

This holds good in practically every branch of Government service. In the Civil Service, the Forces, teaching and local government service, a person is entitled to a certain amount of pay because he or she has attained a certain grade. I said that no one could take this away, but it turns out that the Health Service can, and the Health Service did—not for disciplinary reasons, not because she behaved badly or because she did not do her job, or that she was not a good nurse, but for the extraordinary reason that she wished to become better at her profession.

Hearing that there was a shortage of midwives. Miss Rogers decided to take a midwifery course, as many trained staff nurses do. This is not just the plight of Miss Rogers, but the position of all qualified nurses who take miswifery courses. They find that, during the year that the course takes, they revert to student nurse status and to student pay.

This means that they must accept a drop in salary that year of £180. I have heard of a wage freeze, but this is ridiculous. A sum of £180 is quite a lot of money even in these days of roaring inflation. These girls who take midwifery courses after they have been fully trained in general nursing are surely far more useful to the hospital than raw trainees, for they do not just sit at desks for a year and look at books; they go into the hospital, into the labour ward, and they do delivery and practical work in the maternity wards, and I do not believe that their former training is of no account.

If a teacher, who is properly certificated after three years, decides that he will improve his knowledge by taking, for example, a geography course or a course to learn how to deal with educationally subnormal children, he does not take a drop in salary at all but is maintained on the same rate. I can assure the House that I have a good deal of experience of this, because I served for ten years on an education committee—and on the finance sub-committee of that education committee, which deals with these matters. Teachers in similar circumstances to those of nurses do not take a drop in salary. It is true that some hospitals will second a staff nurse for midwifery training, and in such cases the nurse's salary does not drop, but the hospitals will do this only on the condition that the nurse agrees to remain with that particular hospital when she has done her midwifery training.

Coming back to teachers, the education Committees of local authorities who look at a teacher's application for a year's secondment for further training certainly do not say, "We will let him off for training if he promises to come back and work in this authority." They have a much more enlightened attitude than does the Ministry of Health. They say, "It may not benefit us in this area that this teacher has equipped himself or herself better, but it will benefit some other authority and some children somewhere in some school." Why cannot the hospitals and the Ministry of Health say that?

Another point which causes great dissatisfaction in the nursing profession is that a staff nurse on midwifery training loses not only her pay but also her seniority. One nurse has written to me, I also undertook Part I midwifery training last year at a London hospital, the period of training being six months and two weeks. In qualifying for my Part I certificate I decided not to undertake Part II because I could not stand the low pay. My main reason is that on returning to a general hospital as a staff nurse I have lost eight months' seniority in my pay, and this is a matter of increments. If I had undertaken Part III would have lost over 12 months. There must be some way that this can be altered for staff nurses like myself who, although not qualified midwives, often have to use our Part I training in an emergency. We should like our unbroken service to the Health Service and to the public to be recognised.… This is why many of my friends never did Part I and why many others refused to continue with Part II. I am sure the country has lost many good mid-wives who might have tried and liked it. The claim that the nurse who is training in midwifery should be paid for the grade she holds is, I understand, the policy of the Staff Side of the Nursing and Midwifery Whitley Council. They tried to get agreement from the management on this point on two occasions and on both occasions they failed, and yet it seems to me to be a perfectly fair request. I wonder whether the Minister thinks that doctors are more deserving than nurses. Perhaps this is a case where sex rears its ugly head. Can the fact that doctors are male and nurses are female have anything to do with it? In a letter to me dated 5th September, 1966, on the subject of doctors' pay, the Minister of Health wrote, One of the Review Body's recommendations was that there should be no loss of pay or seniority by a doctor who had moved down to a lower grade for approved training purposes. I have told Boards that this is not affected by the standstill. This story is no longer that of Miss Rogers. She gave up the midwifery course after doing Part I of it because she could not stand the salary drop any longer. Hundreds of women like Miss Rogers never do more than Part I for the same reason, and this situation is not only unfair to the country, which is badly in need of midwives, but is totally unfair to these women. Unless the Minister can assure himself and me that the situation I have outlined is either inaccurate or perfectly satisfactory, I ask him to do something to remedy it.

10.35 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Charles Longhlin)

The hon. Lady the Member for Birmingham, Edgbaston (Mrs. Knight) has asked a number of important questions and I will do my best, in the few minutes available to me, to answer them and to deal with the case she deployed.

I agree that in some areas there is a shortage of midwives, but the position is not quite as black and white as she suggested. Indeed, the number of mid-wives employed in hospitals has been rising steadily. By March this year—the latest date for which figures are available—the number of midwives working full-time had increased from 6,475 three years previously to 7,219, which represents a substantial increase. The shortage of midwives is not as great as the hon. Lady alleged in the case she deployed. Even allowing for the reduction in hours, the number taking midwifery training courses, with the number of midwives in the Service, is reaching the highest level ever.

The question of whether one should pay nurses or any employee in the public or private sector for the training undertaken for qualifications over and above the qualifications already possessed is a matter of opinion, and there is a division of opinion on this aspect. I wish that the hon. Lady had given me prior notice of the remarks she made about teachers. I would have obtained the precise information about what does and does not apply to teachers. However, that depends on the local authority, and whether or not teachers are seconded in the way in which the hon. Lady referred to nurses in hospitals, is a matter for individual local authorities.

Mrs. Knight

No.

Mr. Loughlin

The hon. Lady says "No," but that is the information I have. Frankly, I cannot see the hon. Lady's case being substantiated in the normal course of events. A degree of training to increase one's qualifications—and this applies to any work person—is bound to improve one's value to any organisation, in the public or private sector.

But no private employer would accept the hon. Lady's principle. Is the hon. Lady asking that any member of the staff of the National Health Service should, on her own volition and without any inhibitions or restrictions, be free to take up any training? If that were carried to its logical conclusion, there would be a large number of situations in which staff would be wanting to take advantage of facilities for training that just did not exist. No matter whether the service be public or private, surely there must be some restriction of some kind on the level and extent to which one can allow employees to go for some type of training. The hon. Lady made great play about this young lady losing £180 per twelve months. Miss Rogers was away for four months, and if she had taken the full course and not only the first half it is doubtful whether in practice she would have been away for twelve months. Here I return to the issue of whether there should be some control by the employing authority. I agree that, in this instance, it means; that when a person is seconded by the hospital she has to give an undertaking that she will come back and work for two years. I would not have thought that this was very onerous, especially since she would be receiving the same amount of pay as if she had been working.

The person who goes for this type of training of her own volition is in a different position. The conditions are controlled by the pay and conditions of service which are primarily a matter for the Nurses and Midwives Whitley Council. The hon. Lady says her claim is that of the Staff Side of the Whitley Council. As a trade unionist, apart from being a Member of this House, I would consider it unwise for a staff side to ask for an unrestricted right for employees to take, of their own volition, any type of training.

Dr. M. P. Winstanley (Cheadle)

I am anxious to understand clearly what the hon. Gentleman is saying. He refers to people who seek this kind of training of their own volition. Will he realise also that, at one time or another, there may be need for an additional number of State Registered Nurses trained in midwifery and that, if it is made financially disadvantageous for them, not very many will take up the training? The hon. Gentleman began by saying that there is not a shortage of midwives. If there were a shortage of midwives, would he be prepared to introduce the sort of financial arrangements to which the hon. Lady has referred?

Mr. Loughlin

I do not know that I should be prepared to say that. I referred to the number of midwives now in training simply as an indication of the position. While there may be patches of shortage here and there, that is not the picture throughout. Indeed, the number of midwives today is greater than we have ever had before, and the number of pupil midwives also is greater.

I doubt that it would be possible to have unrestricted training of this kind even if there were a shortage of mid-wives, and moreover, with a shortage, it might be much more difficult rather than the reverse to give opportunity for training.

I was dealing with the Whitley Council pay and conditions. The arrangement of which the hon. Lady complains is an arrangement of the Whitley Council itself. If a young woman undertakes midwifery training in the way that Miss Rogers did, she receives a post-registration training allowance of £545. I agree that the £545 involves a reduction when she takes the course, but I must add that, if we could get all the pupil mid-wives and all the nurses who take Part I to go on to Part 2 and then come back and become midwives, we should not have such a shortage as we have at present.

What happens very often is that nurses take this additional qualification to enhance their own career prospects.

Mrs. Knight

Why not?

Mr. Loughlin

I do not see any reason why they should not, but, if they take this training not with the intention of coming back to do midwifery but with the sole intention of improving their career prospects by virtue of an additional qualification, they cannot really complain if, in consequence of taking that course of action, they suffer a reduction at the time when they do it. I cannot accept that the hon. Lady has ground for complaint there.

Let me return to the case of Miss Rogers. She was not seconded in any way. She went of her own volition. The employing authority, the United Birmingham Hospitals, has no difficulty about filling the vacancies in the area. She left the Queen Elizabeth Hospital to undertake Part I midwifery training in the usual way, training which lasted four months at the Birmingham Maternity Hospital, and she has now returned to the Queen Elizabeth Hospital as a staff nurse. The hon. Lady has told us that Miss Rogers is not going on to take Part 2—we did not know whether she would—because she feels that she cannot afford to lose the money.

Mrs. Knight

Can I have some clarification on something which mystifies me? We have been told that there is no shortage, but then the hon. Gentleman used the words, "There would not be such a shortage as there now is". Is there a shortage or not? Secondly, is the Minister saying that it is wrong for someone to work and equip herself to help to enhance her career prospects? What the hon. Gentleman said seemed to be a condemnation of those who took that course of action. Is that what he is saying?

Mr. Loughlin

I do not say that it is wrong for anyone to want to improve her career prospects, knowledge or ability in any profession. Provided that it is official and properly conducted, any course of instruction is bound to make a nurse a better nurse. When I say that the course is sometimes taken to enhance future prospects and not for the purpose of practising midwifery, I am not making a condemnation or saying that that is doing anything wrong.

All I am saying—and I hope that the hon. Lady will get this clear—is that there is an essential difference between a person training in a particular speciality with a view to practising that speciality, and a person being trained in it in order to enhance career prospects. I understand that it is sometimes advantageous when applying for the post of assistant matron, for instance, to have this qualification in addition to S.R.N. All I am saying is that if this qualification is obtained not to practise the speciality afterwards, but to enhance career prospects and there is a loss of money in the immediate period of training, albeit £180 for twelve months, it is reasonable that that sum of money should be lost for enhancing the prospects of the applicant.

The hon. Lady tried to tie me down to saying that there was no shortage of midwives. She cannot score debating points of that kind at this time of night. If she had listened she would have known that I qualified my reference to shortages in midwifery.

Dr. Winstanley indicated assent.

Mr. Loughlin

The hon. Gentleman the Member for Cheadle (Dr. Winstanley) nods his head.

Dr. Winstanley

Perhaps the hon. Gentleman can clarify the matter. Is he satisfied that enough State Registered Nurses are presenting themselves for training as midwives, or does he think that some are being discouraged from doing so by the present financial arrangements?

Mr. Loughlin

It may be that some are discouraged from presenting themselves for additional training as midwives owing to this financial arrangement. I would not doubt that for a moment. What happens is that a State Registered Nurse who goes in for this kind of training, of her own volition, becomes a pupil midwife. We have pupil midwives, over and above the State Registered Nurses. It may be that some S.R.N.s are discouraged because of this financial arrangement, but one of our problems is that so many of the S.R.N.s who enrol as pupil midwives do not return to practise as midwives.

Perhaps some are discouraged by this imposition of a penalty. If all the S.R.N.s who went in for this training decided to return and work as midwives, that would be a different matter. What we do find——

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

Adjourned at three minutes to Eleven o'clock.