NURSES BILL [Lords]

HC Deb 17 June 1969 vol 785 cc423-52

10.30 a.m.

Mrs. Jill Knight

On a point of order, Sir Beresford. Although I know that it is no fault of the Minister, who is invariably most courteous, I should like to make a small protest about the shortness of time which has been available to us to prepare for the Bill. I knew only on Friday, by a pure fluke, that this Committee would sit this morning and, as I had to be away from London yesterday, I had virtually no time to contact members of the nursing profession. I feel that more time should be made available to members of the Committee to prepare themselves for discussing the Bill.

The Chairman

As the hon. Lady knows, these matters go through the usual channels. Notice of the Committee was given on Wednesday of last week.

The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)

I beg to move, That the Chairman do now report to the House that the Committee recommend that the Nurses Bill [Lords] ought to be read a Second time.

This Bill is being introduced at the request of the General Nursing Council for England and Wales and the General Nursing Council for Scotland after full consultation with all parties—or, perhaps, in view of the remarks of the hon. Lady, I should say with all interested bodies. It has already received approval in the House of Lords after a few minor amendments.

The main purpose of the Bill is to revise the constitutions of the two Councils so as to streamline administrative processes. The Councils have a number of standing committees, and they also each have two separate statutory committees which deal with matters concerning psychiatric nurses and enrolled nurses. It is generally considered that these two separate statutory committees are no longer necessary. The Bill provides that the statutory Enrolled Nurses Committee will be abolished and, for the first time, enrolled nurses will be elected to the Council itself. The statutory Mental Nurses Committee will become one of the Council's statutory standing committees. The increase in the number of mental nurses to be elected to the Council will remove the need for the separate election of two such nurses to the new statutory standing Mental Nurses Committee. These changes result in an increase in the size of the Council. The opportunity has been taken to include also one or two other minor amendments.

The two General Nursing Councils are statutory bodies charged with the responsibility for standards of training, for standards of registration and enrolment and for the discipline of nurses. The Council's powers are defined in the Nurses Act, 1957, the Nurses (Scotland) Act, 1951 and subsequent amending Acts. Matters related to pay and conditions of service do not come within the province of the Councils and would not be relevant matters for this Bill.

Clause 1 provides, for the General Nursing Council for England and Wales, a new part of the register for nurses trained in the nursing and care of the mentally subnormal. At present the names of these nurses are recorded in a separate section of the part of the register for nurses trained in the nursing and care of persons suffering from mental disorder. Because the Bill provides that, in future, mental subnormality nurses will be separately elected to the Council, these nurses have for the first time to be defined in the Nurses Acts, and the opportunity has been taken to recognise their separate training by putting them on a separate part of the register. It seems especially important, in view of recent events, that the value of mental subnormality nurses should receive full recognition.

Clause 1 also provides that the Roll of Nurses maintained by the General Nursing Council for England and Wales should be divided into separate parts for nurses trained in the general, mental and mental subnormality fields. At present the Roll is not divided, and a nurse who has trained in one field and wishes to move to another is not able to obtain a second qualification to recognise her additional training.

Clause 2 increases the number of elected and appointed members of the Council for England and Wales. The present Council has 36 members; 18 elected and 18 appointed. The new Council will have 42 members. Because the Statutory Enrolled Nurses Committee is to be abolished and its work taken over by standing committees of the Council, the Bill provides for the first time for enrolled nurses to be elected to the Council. Also, because the Mental Nurses Committee is to become a standing committee of the Council, so that there will no longer be a separate election of psychiatric nurses to the committee, the number of psychiatric nurses elected to the Council is to be increased.

The number of appointed members of Council is also to be increased to recognise developments in nurse training and the increase in the emphasis on community nursing. There are also four unspecified appointments to be made by the Secretary of State, which can be used, if necessary, to make up any type of relevant experience not provided by the elected members.

Clause 3 deals with similar changes in the constitution of the General Nursing Council for Scotland. The changes are more limited than those for England and Wales because the Scottish Council is smaller, but the pattern is the same, in that there is an increase in the number of elected psychiatric nurses and, for the first time, two enrolled nurses will be elected. The number of members appointed by the Secretary of State for Scotland is to be increased by one.

Clause 4 changes the status of the Mental Nurses Committees of the two Councils so that they now become statutory standing committees of the Councils. This will remove the necessity for separate elections to these committees. The functions of the committees will remain the same as at present with the addition, in England and Wales, of responsibility for pupil and enrolled psychiatric nurses. The increase in the number of elected psychiatric nurses should ensure that there is an adequate width of experience on the committees but, as a safeguard, provision has been made for the Secretary of State to nominate up to four additional members for appointment by the Council to the committees in each case.

Clause 5 abolishes the Enrolled Nurses Committees of the two Councils. The importance of the enrolled nurses is recognised by their election for the first time to the Council, and there is no longer any need to make special arrangements to protect their status. The current trend is towards combined training schools, training both student nurses and pupil nurses, and it is felt that the educational function of the Enrolled Nurses Committees can be more effectively fulfilled by the Council's standing Education Committee and the statutory standing Mental Nurses Committee, both of which will in future include representatives of enrolled nurses. The present disciplinary function of the Enrolled Nurses Committee will pass to the Disciplinary Committee, thus avoiding the possible embarrassment of a double hearing when a case concerns a nurse who has the dual qualification of registered and enrolled nurse.

The remaining provisions of the Bill are concerned with rectifying a few minor anomalies in the Nurses Acts. Every time a change in the rate of payments is made to members of area or regional nurse-training committees for loss of earnings or for additional expenses, the Secretary of State is required to lay a Statutory Instrument. Clause 6 removes this requirement, and allows the Secretary of State, with the approval of the Minister for the Civil Service, to determine any alteration in the rates payable. This merely removes the requirement to lay a Statutory Instrument, and will not lead to any increase in the frequency of change or to any increase in expenditure.

Clause 7 will allow the Councils to introduce two new fees. The first will be charged to all student nurses and pupil nurses when they commence training, so that they will all now contribute towards the administrative expenses of the Council. At present, only those who sit the Councils' examinations and who apply to be registered or enrolled make any contribution to the Councils' costs, and I think that it is reasonable that those who complete their course should not be expected to subsidise those who do not.

The second fee will be charged to nurses trained overseas who apply to either of the Councils for registration. At present only those nurses whose applica- tions are accepted are required to pay a fee, although the Councils are involved in considerable expense in checking the details of those who are ultimately not successful. This new fee will ensure that the cost of checking the details is spread evenly amongst all those who apply for registration.

Finally, Clause 8 removes from the Councils the obligation to publish periodic lists of nurses whose names have been added to, removed from or restored to the register, the roll or the list. The list is a residual provision which was established prior to the institution of the conventional registers as they are now established by law. These lists have little value, and are wasteful of both time and money. Up-to-date lists will be available for inspection at the Councils' offices, which will still be able to publish the information if for some unforeseeable reason the need should arise in the future.

As I mentioned previously, the Bill has been proposed in its essence by the professional bodies, and is mainly concerned with amending the constitutions of the two General Nursing Councils. The election of nurses to the Councils is due to take place next year and, as the necessary preliminaries must start towards the end of this year, it is essential that the Bill should be enacted soon if the elections are to take place under the revised constitutions. Any delay will either involve the Councils in the expense of an additional set of elections or the introduction of the new constitutions will have to be postponed for five years until the next set of elections takes place.

Mr. Maurice Macmillan

I think, Sir Beresford, that all members of the Committee will support the Motion and welcome the Bill, not least because it is being put forward at the request and with the approval of the representatives of the nursing profession. We certainly welcome its intent, but some of us on both sides may have a few reservations about the methods being used to carry out that intent which we shall be able to develop at a later stage.

In another place, the Baroness Summerskill referred to this as an innocuous little Bill. Those of us who have dealt with medical and similar Bills in the past realise that too often an innocuous little Bill has what might be called a concealed sting in it, rather like the greenfly on the rose or the scorpion in the toe of a shoe and, if only in exercising our duties in Opposition as guardians in matters of this sort, we shall be probing to make sure that the Measure is the best that we can make it. That after all, is the prime duty of Parliament.

As has been said, the Bill is concerned primarily with the enrolment and registration of mental nurses and nurses for the subnormal. It does other things as well. But its main change is to enhance the status and to improve the recognition of nursing in this sphere.

I wonder how much real difference it will make. Will there be any great improvement in the terms of service and reward for those on whom the community relies for work which is always hard and demanding, frequently unpleasant, and sometimes very difficult indeed?

10.45 a.m.

It is relevant to ask, as was asked in another place, just what the Bill does to facilitate recruitment so as to make sure that we are getting the young men and women coming forward which the profession needs. Just what do these provisions or changes do? How will the Bill enable the General Nursing Council to help us get rid of our present dependence and reliance on nurses—as, alas, on hospital doctors—from countries which need their services almost as desperately? Admirable in many ways as it is, as far as it goes the Bill does very little towards helping to solve the major problem facing the nursing profession. Perhaps in this light it could be regarded as an opportunity missed. I hope—in fact, I expect—that my hon. Friend the Member for Tynemouth (Dame Irene Ward) will have something to say on this aspect.

Despite improvements of this nature made by a Bill, despite the tidying up of administrative difficulties for removing anomalies and improving representation, and so on, we still cannot hope to get a health and hospital service on the cheap. Organisation and administrative improvements are no substitute for enough money.

Again, in another place, Baroness Summerskill quoted from the Nursing Times in illustration of the difficulties under which the nursing profession now works. I am loth to follow her example in great detail. Were I to do so, I should have to declare an interest as publisher of that admirable paper. But I should like the Minister, in his winding up speech, to say what the Bill will do for the representation of student nurses and the discussion of their problems. Everyone now admits that they are neither one thing nor the other. They are treated in their work and conditions of work as fully employed persons. They are taxed as such, and they pay for their food as such. In essence, as students they are paid an allowance. Yet in some ways they are treated as employees. Does the Bill help in any way the discussion of these problems? Does it help them to put forward their case?

For example, how does the Bill deal with the admitted problem of the salary structure of the nursing profession? The concertina between the very bottom and and the top has got so far closed up that at other levels there are anomalies and difficulties. Does the Bill assist the problem of the salaries at the top end of the profession and their effect on organisation? I am not suggesting that the General Nursing Council should usurp the functions of the negotiating bodies, but the decisions of the negotiating bodies have a considerable effect on the structure, training, organisation and work of the nursing profession in relation to patients. Does the Bill help in the discussion for dealing with these problems? It is a curious anomaly that if we relied on the harsh solution of the market, we should be forced to pay our nurses properly. The planning and prices and incomes policy shows, in this context, that it pays to strike: but nurses cannot.

Does the Bill help the discussion on the organisation side by any positive ideas for improving the quality of the service that nurses are allowed to give to the public by assessing what aid can be given to them, especially in the care of the mental and subnormal, by improving physical facilities and an examination of the extent to which disposables can take a lot of the heavy physical burden out of cleaning up?

The Minister referred to the second qualification. Is it the intention to use the provisions of the Bill to develop and encourage second qualifications, so that we can have a certain amount of what might be called "cross-posting" to enable nurses engaged in the heavier and more unpleasant side of the care of the mentally subnormal to do periods in less arduous tasks, and be replaced by reliefs from among equally well qualified nurses who normally work in a slightly different sphere?

A Bill of this nature could have done a lot to shed light on the future. But neither it nor the debates that I have read in another place, nor indeed the Minister's speech, give us any indication of these matters.

Both mental nurses and nurses for the mentally subnormal are to be represented on the Council—both those registered and those enrolled—so that, in all, there are four representatives from this sphere on the Council. This enables the statutory committee to be replaced by a standing committee of the General Nursing Council. Direct representation on the Council logically leads to this abolition of the statutory committee with separate election and replacement by a standing committee of the Council. We shall wish to probe a little more deeply whether this means that mental nurses and nurses for the mentally subnormal will have a reasonable degree of control and say over their own affairs; and the possibilities of any recommendations made by their own committee, as it were, being overruled because its members are in a considerable minority on the main Council. In theory at least, the change-over means that the interests of mental nurses generally, because they no longer have a statutory body of their own, could be swamped by a majority on the General Nursing Council. This may be a small point, but we shall wish to receive reassurances on it.

My second point concerns the standing and position of enrolled nurses. Although there is only one representative of general enrolled nurses on the General Nursing Council, plus two representatives of enrolled nurses on the mental and subnormal side, their committee is not replaced, curiously enough, by a standing committee of the General Nursing Council, but is abolished altogether.

I do not see the logic of this. Mental nurses and nurses for the mentally subnormal are given greatly enhanced representation on the Council. In return they have given up their own statutory com- mittee, but they have kept a standing committee of the Council. Enrolled nurses who, at first sight, appear to have given up rather more, do not have any sub-committee or standing committee of their own, but are represented entirely through one representative on the Council.

We must ask the Minister to explain this position, and we may even ask him later to reconsider it. It seems, first, illogical. Secondly, it seems slightly inconsistent with the desire expressed by everyone concerned to enhance the standing and status of the enrolled nurse, to go about it in detail in this fashion. There are ways of getting round the difficulty. Perhaps we might reconsider the question of a standing committee or a sub-committee of the Council, or give the enrolled nurses a vote for the general members of the Council. What the Minister said about education indicates that this might be a matter of considerable significance in future.

My third minor point concerns titling. If we are dealing with the status, standing and labelling of mental nurses and nurses for the subnormal, it is sensible to follow the logical Scottish pattern and keep the title the same in each case; in other words, to talk about a registered general nurse and a registered enrolled nurse as well as a registered subnormal nurse. As it is, the wording is different for the general and for the specialist. It is a small point, but it is worth taking the opportunity given in the Bill to get consistency in description.

Perhaps the Minister could answer why the words "and care" are added only in the case of mental and mentally subnormal nursing. Surely all nursing is nursing and care. It seems odd to specify it for these particular categories. It is almost as though there were still som kind of non-expert element left. If this is a sort of remnant of what one might call pure institutional care of the warder type, a hangover from the distant past, it might be eliminated.

My fourth relatively minor point, which we intend to raise later, concerns the registration fee for student nurses. It seems odd to pay a registration fee before being registered. Either it is a fee or a registration fee. Registration should be conditional on registry. But, again, that is a matter which we can discuss in Committee.

No doubt my hon. Friends and other right hon. and hon. Gentlemen will have further points to develop in detail at a later stage. However, I hope that the Minister now can reassure us that the timing of the Bill and the date that it is to come into force, will allow ample opportunity for its provisions to be assimilated and preparations to be made on the new system for the 1970 election to the Council. I understand that there is some doubt whether there is time enough.

I wish that I could hope that the General Nursing Council was in a better position, because of the Bill, to develop the profession, to help move it towards modernisation, and to improve some of the difficulties and anomalies that the profession is up against. If the Minister can reassure us about that, so much the better. If not, we will still support the Bill, if it should be given a Second Reading, though with perhaps a sigh in our hearts at what we would have liked to have seen in it but what we fear may have been left out.

11.0 a.m.

Mr. Laurence Pavitt

The hon. Member for Farnham (Mr. Maurice Macmillan) has been very successful in widening discussion of what is an extremely narrow bill. I must try, Sir Beresford, not to presume on you too much, but perhaps I might be permitted a small comment at the outset.

This is the first Second Reading Committee on which I have had the privilege of sitting. I have done some research on the number of Standing Committees on which I have served over the last ten years—and it is a large number. I am pleased to see here so many "old faithfuls" who always serve on Standing Committees. We have been on many previous Committees together. The Bill is concerned with professional status. I should like to see some similar recognition for hon. Members who are professionals in this place and who do twice as much work as many of their colleagues, but only get half their pay.

The Bill is narrow, but the hon. Member is right when he says that in dealing with basic registration and professional standards, the way in which it is done, the organisation and administration, all have a bearing on a lot of the other questions which arise from it. Before giving the Bill a Second Reading it is right to look at its fringes to see whether it enhances the kind of propositions that the hon. Gentleman has been putting forward.

We shall have an opportunity of detailed discussion in Committee and of probing a number of these things more completely. Like the hon. Gentleman, I picked up the comment in another place about this being an innocuous Bill and immediately thought of the effect it will have, and on how many people. For every two nurses who were available and who would have been affected by this Bill in 1948, we now have three. We now have 188,888 whole-time nurses and 79,235 part-time nurses. Therefore, although this is an innocuous Bill it affects an important sector of the community—in spite of the fact that we have shortages in most spheres which we would like to remedy.

One problem the Bill seeks to deal with is not so much the recruitment, enrolling and registration, but the standards and organisation controlling registration which help to eliminate wastage. This is the basic problem: not so much attracting nurses but, having attracted them, retaining them and ensuring that they go through to registration. That is supremely important.

There are details which we can discuss later, but running throughout the Bill is the question of the way in which we will cater for the increasingly large number of nurses dealing with psychiatry and with mental subnormality. Whether or not it is a product of our times, there is no doubt that we have witnessed in health during my period of interest in the subject, a trend away from infective diseases and more and more to stresses and tensions. It is important that we should get this right in the Bill, and are able to distinguish between psychiatric nurses and those with what is, in many ways the heavier, responsibility of dealing with mental subnormality.

I ask the Parliamentary Secretary to tell us why male nurses, working mostly in mental nursing, seem to have been left out of the Bill. From time to time I have claimed to share the views of the suffragettes on many issues, and, all these years after Emily Pankhurst, I think that women still do not get a square deal in the Health Service. In this case, however, I don my other hat and try to do my best for the male section of the profession.

This is primarily a female specialty, but there is a male section, and anyone who knows anything about mental hospitals is aware that we are not getting sufficient numbers of nurses even only from the security point of view. I was able to show the House recently what was happening in a mental hospital in the constituency of the hon. Member for Ilford, North (Mr. Iremonger), where a male nurse was having to work for 15 to 16 hours, more or less on his own, in a locked ward. There is an acute need for professionalism in this area, because only by keeping an eye on what is developing is one able to forestall possible disturbance and difficulties. Therefore, the way in which the registration of male nurses is completed and the amount of participation they have in the Committees established under this Bill are extremely important.

Equally important is the question of pay. In North Ilford, a male nurse after he has completed his training is in the lower range of pay packets, but he can go two miles to Fords and earn double. This creates a difficulty in getting the number of nurses one needs in this specialty. These two things are bound up. Unless one is able to get participation and enhancement of status of male nurses in mental and subnormal hospital nursing, we are likely to have further difficulties as the discrepancy between the pay packet of the male nurse and of people in industry and commerce increases.

There is the question of whether or not one should pay a fee at the outset of one's training or only at the end. A number of nurses start the course and do not finish it, and I do not like the idea of paying at the outset—nor at the end. It seems a little like economic nonsense that these nurses should come to the preliminary training schools, have three years of training for registration and a shorter period for enrolment, which costs the State much more than the negligible fees paid at the end of the training and then, after the hard slog, suddenly to be faced with a bill for so many guineas. This fee is neither here nor there. It is one fringe benefit we could give the hard worked profession: not to have to pay fees at the beginning or at the end of the course. It is a small amount, and although the Treasury nibbles off candle ends I do not see why the candle ends of the nursing profession should be taken for the Department of Health.

I am not happy about the way we are dealing in the Bill with the question of status, but we can come to it in Standing Committee. There should be recognition of increased status for State registration. That has been done, but the Nursing Council has established standards and sizes of hospitals for the training of enrolled nurses which tend to make matrons feel that if they get only enrolled nurses for training they are second-class while training for registration is for first-class nurses. This has an effect on recruitment, because while enrolment is different in kind it is not necessarily different in quality. Because of the service given by enrolled nurses, the hospitals would be in a sorry state without them.

I welcome those parts of the Bill which give enrolled nurses more status in the profession, but I would like to see more emphasis in the General Council and elsewhere on avoiding the first-class and second-class approach, and on the fact that if they are different in training and kind they are not different in quality, and in the value and esteem in which they are held.

By this Bill we are having a complete shake-up. It does an important job on registration, but at the same time we are having the implementation of the Salmon Report, and the P.I.B. implementations and changes in the way in which nursing is being organised, apart from the Salmon Report. This is part of a much wider structure, and I ask the Parliamentary Secretary to seek time for a debate in the House on the wider subject of nurses and the way in which changes are being made. The House of Commons should consider the separate parts of the problem and the whole problem. We will have changes in the next few years, and it is vital at the outset for the House to have this opportunity.

It is right that there should be an attempt to streamline procedure. The reorganisation of Committees in the Council, as put forward in the Bill, is, broadly speaking, right, but I, like the hon. Lady for Birmingham, Edgbaston (Mrs. Knight) would like more consultation about details. Hon. Members cannot be expected to have a wide knowledge of details on many subjects, and when we talk about the numbers serving and the way sub-committees are to be organised, we would like to be able to seek advice from the people affected.

It is essential that the trade unions should be called in more. It is true that the negotiating machinery for nurses does not specifically recognise the Confederation of Health Service Employees, N.U.P.E., or N.A.L.G.O. All unions have a part to play in the conditions and registration which flow from this Bill. If we ever get to discussing how the Bill affects the community, recognition, participation and consultation should not only be canalised through organisations which tend to be establishment-minded. We need the wider concept.

I welcome the Bill as a step in the right direction. I regret that it had to come to us from the other place, rather than starting in this House, and that we have to find from the other place Ministers interested in specialties, although the Minister of State is a first-class Minister who will do a good job. I hope that we can make the Bill even better before it goes on the Statute Book.

11.15 a.m.

Dame Irene Ward

I am delighted to add my qualified support to the Bill, and I echo with emphasis the points made by my hon. Friend the Member for Farnham (Mr. Maurice Macmillan). If I may be excused for saying so, the Minister took a great deal of trouble to describe all the details of the various Clauses and Schedules but he did not give any really cogent reasons for the alterations nor explain why they were necessary. Although I agree about the shortage of time, one is able to read Clauses, and if one has tried to take an interest in the nursing profession over a number of years one has a general understanding of what is required and what the profession does.

Although I fully realise that it is a Bill which has been put forward by the General Nursing Council, it includes a lot of fairly substantial alterations to the organisation, and it would be more helpful to hon. Members, who are all deeply interested in the profession, if we could have in much more detail the reasons for the Bill. I hope that the Minister will be able to answer some of my hon. Friend's points.

I should also like to put on record the information that I have received from the Royal College of Nursing and from the General Nursing Council, that quite a number of Amendments which were put forward in another place were piloted through, if I may put it in that way, by Baroness Brooke of Ystradfellte. The nursing profession, and, indeed, all of us, are lucky to have Baroness Brooke in another place, with her wide knowledge of the profession and the great interest that she takes in it. The Minister kept saying that such Amendments as there were, were few and unsubstantial. He did not use the word "unsubstantial", but he suggested that only a few rather insignificant Amendments were put forward. As the Bill emanated from the General Nursing Council, it seems a little odd that it did not embody all the points which the General Nursing Council thought were necessary.

Mr. Snow

In regard to the point about the proposals put forward by the General Nursing Council, I do need to assure the hon. Lady that we have worked closely with the General Nursing Council on this Bill. However, she would not expect us merely to rubber stamp what was put forward by an outside body, however distinguished. The modifications that we have suggested are relatively minor.

Dame Irene Ward

That may well be so. The Minister opened by saying that in the main, this Bill was put forward at the request of the General Nursing Council. I am glad about that, and I am glad to hear that the Government have found time for the Bill. I could think of a lot of Bills which we would like to see put forward, and I am delighted that on this occasion the Government have accepted a Bill from the General Nursing Council, because it affects a profession in which we all take a great interest.

What I am saying is that with a Bill emanating from the General Nursing Council, in the main I would prefer the Council's views to the views of the Minister, because I am not at all satisfied, as has been pointed out in a realistic speech by my hon. Friend, that the views put forward by the Ministry are necessarily those held by the General Nursing Council. I never have liked the National Whitley Council system, by which the Minister gets up in the House and says one thing, and then instructs the management committee, behind the scenes, in a different way. We must be careful. I am not 100 per cent. behind the Ministry. I should like to have a lot of "digs" at them, but it is difficult to do this because, as was pointed out by the hon. Member for Willesden, West (Mr. Pavitt) we do not get many opportunities for debating this question.

I had the great honour of being the President of the State Enrolled Nurses for three years, and I also had the privilege and pleasure of piloting through the House of Commons the Bill which, at the request of the State Enrolled Nurses, altered their previous title of "Assistant Nurse" to that of "State Enrolled Nurse". Therefore, quite naturally, I have a great interest in their position, and I also feel a little unhappy because the Minister did not explain why he made the differentiation in the set up of the General Nursing Council with regard to the psychiatric and mental nurses and the position of the State Enrolled Nurses. I do not know whether the State Enrolled Nurses as such have sufficient representation on the General Nursing Council and I believe it is most important that we should get this straight, particularly in regard to voting powers.

Will the Minister please tell us whether there has been direct consultation with the various sections of the nursing profession with regard to this Bill? Have the State Enrolled Nurses been brought into the picture and consulted? Are their views, whatever they may be, embodied in this Bill? When we come to the Committee stage we shall be taking a great step forward, and I want to be certain that, as a professional organisation, they have had the opportunity of putting their views to the Minister.

I would also like to know whether the Minister can give the relative figures in the various sections. How many State Enrolled Nurses and how many psychiatric nurses are there? I am glad that on both sides of this Committee there is a great interest in the detail of the Bill, because this is not a political matter at all. Those of us who endeavour to speak for the nursing profession want to be quite certain that the Measure will meet the needs of the nursing profession.

The Minister said that no one would expect the Ministry to "rubber stamp" a Bill put forward by the General Nursing Council. If I accept that, I then want to know whether all the points which the General Nursing Council wanted embodied in the Bill have been accepted by the Minister, or whether some have been rejected. In other words, there is a great deal more information which should be made available to this Committee so that when we discuss the detail of the Bill we may decide what is essential and right for the nursing profession on evidence rather than on what the Minister thinks is right.

It would be helpful if the Minister could give a little more detail as to why this new set up is acceptable to him, and the reasons which have contributed to the General Nursing Council putting forward this Bill. I am glad to be able to support the Bill, but I hope the Minister will be a little more forthcoming, and not expect us to accept that everything his Department says is really in the interests of the nursing profession. I have had too much experience to accept that idea without a good deal more probing.

Mr. James A. Dunn

I, too, welcome the provisions contained in this Bill but, like others, I have several reservations. One of the primary reservations is in regard to the statutory committee which now exists to represent Enrolled Nurses. By Clause 2(2)(a) and (b), this committee will be replaced by one single representative.

I am also concerned about the method by which elections are to be held for the representatives of the various categories and registrations of nurses. This has not yet been mentioned this morning and it is not clearly defined in the Bill. Perhaps I may be forgiven for saying that I always approach anything in legislation which is not clearly explained, with a certain amount of suspicion. I feel that my hon. Friend the Under-Secretary could well look at this point again. Perhaps he has the necessary information to satisfy the Committee, and, in particular to satisfy me, this morning, but until such time as I receive an explanation I shall view this Bill with grave suspicion.

Like my hon. Friend the Member for Willesden, West (Mr. Pavitt), I have reservations about the registration fees, and I appeal to my hon. Friend the Under-Secretary to look at them again. The sum involved is infinitesimal. I also subscribe in part to the statement made by the hon. Member for Farnham (Mr. Maurice Macmillan) that the nursing profession in general is not given adequate remuneration or reward, but I should be in great difficulty if I attempted to deal with that question now. There is an opportunity here for a compromise. An intermediate stage, at which it is quite clear that the individuals, male or female, are determined to proceed in the nursing profession, might well be the time to look for a registration fee. I believe to ask for a registration fee at the commencement of a person's career could be discouraging to those who, perhaps, in the first instance could not afford it.

Mr. Pavitt

Has my hon. Friend any knowledge of conditions in industry? Does he know whether firms often pay the fees for their employees?

Mr. Dunn

I cannot call to mind any such cases at the moment. Like the hon. Member for Birmingham, Edgbaston (Mrs. Knight) I received the notification in regard to this Committee only yesterday morning, and the Bill this morning, with some other correspondence which was meant to advise me. Therefore, I am in similar difficulty and I am treading a careful path. However, I am sure my hon. Friend would be the first to recognise that there are few industries where one is required to pay a fee before taking up employment, and this is primarily a matter of paying a fee before being allowed to proceed with the employment.

11.30 a.m.

There is a delicate balance between professional registration, which is necessary, and the fact that there would have to be employment and that the profession is a very delicate one to follow. That balance will have to be looked at carefully. I have no doubt that my hon. Friend the Member for Willesden, West will advise me upon this matter in due course, but I state my reservations in relation to Clause 7.

Another matter which we might look at with more care is how entitlement to vote is to be indicated. Perhaps it will be based on the qualifications people hold or the employment they follow. Perhaps my hon. Friend will enlarge on this point.

Mr. T. L. Iremonger

My hon. Friend the Member for Farnham (Mr. Maurice Macmillan) was quite right in saying that we on this side of the Committee would not object to the Bill in principle, principally because there is no principle in it. This is a Second Reading Committee, and the purpose of a Second Reading in the House of Commons is to discuss the broad principle of a Bill. As everyone has consistently said, this is almost primarily and exclusively a Bill of detail. Therefore, a Second Reading debate on it is a somewhat supererogatory exercise, although my hon. Friend most ingeniously managed to extend the scope of the debate into very wide questions of principle and general concern.

I agree that we should give the Bill a Second Reading, and send it to a Standing Committee, where the real business can be done of discussing the detail, which is extremely important, particularly to the nurses concerned. Although we are most obliged to the Under-Secretary for the great care with which he translated the Bill for us, it was a translation rather than an exegesis, and my hon. Friend the Member for Tynemouth (Dame Irene Ward) was quite right to say that it would be nice to have a little background explanation as to why changes in the constitution of the Council, and so on, are called for. We have not been greatly enlightened on the history.

My interest is in the psychiatric nursing side of the profession in so far as that is affected by the Bill. About a couple of years ago I introduced with the leave of the House, under the Ten-Minute Rule, a Bill to amend the Nurses Act, 1957. I hope that some of the points I there adumbrated may not be out of order on this Second Reading. My interest in the psychiatric side arises from the nature of my constituency, Ilford, North, where there are three great institutions of which I am very proud. One is, of course, the hon. Member for Ilford, South (Mr. Arnold Shaw) who is extremely well served in the House—

Mr. Arnold Shaw

On a point of order, Sir Beresford. I question that statement.

Mr. Iremonger

The hon. Member is as well served in his Member of Parliament as I can possibly serve him. Perhaps my limitations in that respect are obvious. At any rate, I am very proud of him as one of the institutions. The second institution is Goodmayes Hospital, one of the great psychiatric hospitals of the world; and the third is Claybury Hospital, also a great pioneering psychiatric hospital and nursing hospital. I wish we could speak of "psychiatric nursing", but that term is governed by the National Health Act and we cannot amend it in this Bill.

Psychiatric nursing is of increasing importance. It is important to make a distinction between the nursing of psychotic and of neurotic patients. I believe that psychotic patients are on the way out; that the nursing of psychotics is something which, in measurable time, will no longer be necessary. I am quite convinced that the advances already being made in biochemistry will eliminate psychotic illness.

But I believe that neurotic illness will be with us for all time, possibly in increasing measure. I am informed that the difference between the psychotic and the neurotic is that the psychotic thinks that two and two make five, while the neurotic knows that two and two make four, and that is the hell of it. I believe the latter is something by which we shall continue to be increasingly depressed. In the meantime, the nursing profession will be of extreme importance in both psychotic and neurotic psychiatric disorder.

What this Bill does which affects the psychiatric nurses, is to touch on their status. It is very largely a matter of nomenclature, of the way they are described, and of the inclusion of the words "and care", which are taken by some as being slightly offensive when referring to mental and mentally subnormal nursing. I hope we may probe, and make some improvement at the Committee stage. It is an important matter, as is the constitution of the Mental Nurses Standing Committee, which is provided for but not explained in detail in the Bill.

I hope that it might not be out of order for the Minister to explain what he has in mind to prescribe. There is in the Bill a certain amount which is to be arranged as prescribed. That wording always fills me with misgiving, since it usually means that we allow the details to be agreed in debate in the House and the prescription is then made by Order by which we have no means of amending, although we may oppose it.

It would be helpful for the nursing profession if in Committee it could be given some indication of the kind of constitution which is in mind for the Mental Nurses Committee. The detail is a matter for Standing Committee, not for a Second Reading Committee, and this is a Bill in which detail is all. As my hon. Friend has suggested, the Bill is a matter of fiddling while Rome burns—

Mr. Snow

Oh, come!

Mr. Iremonger

Well, no one can say that the condition of the nursing profession at the moment is entirely unanalogous to the burning of Rome, but that is perhaps a matter of principle into which we should not now go in detail. In so far as it is a matter of fiddling, some fiddles are important, and we must above all ensure that there is consultation with those who are to be most directly concerned. The hon. Member for Birmingham, Edgbaston (Mrs. Knight) may not have lost very much through not having been able to consult interested parties before this debate, but it is important that there should be the closest consultation by the Opposition before the Committee stage. I hope, therefore, that in the arrangement of business we will be given fuller opportunity to take the advice and counsel of those who are to be concerned, so that we can amend the Bill at a later stage.

Mrs. Knight

The adjectives used in describing this Bill are piling up in an interesting way. It was referred to by the noble Lady, Baroness Summerskill, as an innocuous little Bill, and one noble Lord described it as rather limited, rather tepid and rather sad. Another said it was small but useful. The hon. Gentleman for Willesden, West (Mr. Pavitt) described it as an extremely important Bill, and my hon. Friend the Member for Ilford, North (Mr. Iremonger) said it had no principle in it—though I am perfectly sure that he did not mean that it was an unprincipled Bill. Nevertheless, what we have heard this morning rather indicates that this is a very technical matter but one in which Members on all sides of the Committee take very great interest.

Possibly that has something to do with its title. The words "Nurses Bill" rather indicate that it will be a Bill dealing with matters of great moment to nurses. While engaged on business to do with a by-election that is going on in Birmingham. I mentioned to one nurse that we would be discussing a Nurses Bill this morning. "Splendid," she said, "how absolutely wonderful!"—and before I could stop her she went on to tell me of all the things that are wrong with the nursing profession at this time. I am sure that the hon. Member for Willesden, West who said, I believe, that there were three nurses now for every two in 1948, would not say that that indicates that all is well in every part of the profession.

That nurse explained to me in great detail the many things that were worrying nurses at this time. It is not only a question of pay. There are many matters with which the General Nursing Council, as reconstituted under this Bill, might possibly concern itself. These include, for instance, discipline. I am sure all members of the Committee will have been appalled to read only last week that some nurses in a hospital were actually under threat of being sacked because they finished up some jelly that some patients had left. There are a great many things about which those in the nursing profession are concerned at the moment, and I give notice now that at a later stage I shall seek to move Amendments, particularly in relation to Clause 6.

I am forced soon to leave the Committee, so perhaps I may comment on just one or two points in the Bill. I very much welcome Clause 2, and the fact that it gives greater representation to mental nurses. This is very important, because mental nurses have not always been properly regarded. This provision greatly upgrades their status, and is im- portent for that reason. The incidence of mental disease is increasing, so it is even more important that correct status be given to those who are nursing such patients.

On that same Clause I join with the hon. Member for Willesden, West (Mr. Pavitt)—what a happy thing it is that we are singing so sweetly in tune this morning; such an occurrence is not invariably the case. He is absolutely right in what he says about male nurses. In Clause 2(2)(b) it is proposed that of the elected members of the Council … three shall be registered mental nurses elected by persons who, on the prescribed date, are registered mental nurses. … But in a later Clause we note that Scotland is to have the benefit of having two registered mental nurses, a man and a woman.

This point was taken up in another place, when we heard from a noble Lady that the General Nursing Council for England and Wales had asked that this should be so. With the greatest respect to the Minister, that will not be quite good enough for us. We will want to make sure that others besides the General Nursing Council are happy on this point. It is very important that the status of male nurses, many of whom have the difficulty of supporting a wife and family on a very limited income, should be properly regarded, and that proper attention should be paid to them in all respects.

My hon. Friend the Member for Tyne-mouth (Dame Irene Ward) was right to question whether the Enrolled Nurses are happy about the point dealt with in Clause 5. We shall want to know.

When I intervened at the beginning, Sir Beresford, I did not mean in any way to be awkward, and I have had a measure of support from members of the Committee. Although, as you said, we heard about this Committee on Wednesday, this gave us only a very short time to make ourselves familiar with an immensely technical bill. It is not an unreasonable ambition to wish to understand the Bill fully even in discussing it on Second Reading. It cannot be a desirable for members of the Committee not to understand what they are discussing—

11.45 a.m.

The Chairman

Order. I fully appreciate what the hon. Lady is saying but, if I may respectfully say so, she is doing very well despite the short notice.

Mrs. Knight

I intend to speak briefly on Second Reading. The debate has shown that there are many unanswered questions to which we shall seek answers.

Mr. Snow

I ask leave, Sir Beresford, to speak again. Like other members of the Committee, I was lost in admiration for your tolerance when certain matters affecting pay, which does not come within the Bill, were raised and discussed. I will confine my remarks to salient points which have been made. Many of the points raised were Committee points; none the less important for that, but they are points of some detail on which I wish to take further advice.

The hon. Member for Farnham (Mr. Maurice Macmillan) surprised me, as did the hon. Member for Tynemouth (Dame Irene Ward), by saying that I had not underlined the reasons behind the promotion of the Bill by the General Nursing Council through the Government. I accept some blame for not making the position perfectly clear. State Enrolled Nurses for the first time will be represented on the General Nursing Council, in recognition of their valuable work. I like to think of this as the first of a number of steps to be taken in the future.

Dame Irene Ward

I fully accept this new facility but it does not necessarily mean that State Enrolled Nurses will have sufficient power. There must be a great deal more than a first time representation on the Council. One needs to know that State Enrolled Nurses will have power to put forward their views in conjunction with the other members of the General Nursing Council. We want this step forward to be a real step; there is a lot of difference between a step and a real step.

Mr. Snow

From my experience of meeting nurses collectively and individually, my impression is that, in common with the hon. Lady, they are perfectly well able to look after themselves. The hon. Lady is possibly under-estimating this first step. It is not a threatened weakness, since I am certain that State Enrolled Nurses will be able to expound their viewpoint adequately. If the facilities are found to be inadequate, the Minister's rôle is to see that provision is made for their point of view to be adequately represented.

Several hon. Members, including the hon. Member for Farnham, have referred to the word "care" in relation to mental nursing. The explanation is that a responsibility for environmental aspects attaches to mental nurses which goes beyond strictly nursing responsibilities. The mental nurse, as opposed to the ordinary nurse, has to try to provide a homely atmosphere for the patients. It seems to us that we should, therefore, attach this word "care" and I do not think this is a matter of considerable controversy within the profession.

The question of fees, which was raised by the hon. Member for Farnham, will be discussed in Committee. In speaking of two registration fees, he was probably referring to the enrolment fee and to the fee payable during training. I remind him and other members of the Committee that, under the terms of the report on nurses' pay of the National Board for Prices and Incomes, we are committed to a review next March, when these matters can be taken into account.

I was a little disturbed about one aspect of the speech of my hon. Friend the Member for Liverpool, Kirkdale (Mr. Dunn) relating to the payment of fees by the employer. He was interrupted by my hon. Friend the Member for Willesden, West (Mr. Pavitt), who drew his attention to the practice in commerce. It is my understanding that the nursing professions are extremely jealous of their independence and would not wish to be subsidised, thereby probably losing some of their independence.

Mr. Pavitt

I was referring more to professional people like architects and surveyors, who serve for many years with local authorities and pass stiff examinations. If they do well, very often the local authority, and in some cases the National Health Service, will agree to the payment of fees to certain grades, but there is no such provision for nurses.

Mr. Snow

There are many professional bodies associated with the medical profession. The General Medical Council, the General Dental Council, the General Optical Council and the Council for the Professions Supplementary to Medicine, all levy fees in this way, but this matter can be discussed in Committee.

I was asked whether the Bill could be put into operation before the 1970 elections. I am advised that this is a difficulty, but it is expected that it will be possible.

My hon. Friend the Member for Willesden, West raised the important matter of the rôle of male nurses, especially in psychiatric medicine. I share with him his anxiety that they should be able to participate in consultations and be given an opportunity to put forward their views on all questions, not only on pay. I recognise the immense contribution which they make to mental nursing.

My hon. Friend asked for a debate on the wider aspects of nursing. That is not a matter for me, but I think that it is very desirable, bearing in mind what may in due course be considered by the N.B.P.I. He also referred to what was omitted from the Bill, but the Bill is fairly limited, designed to provide a structure of consultation through the General Nursing Council, and it does what it sets out to do. The Bill is relatively modest, but the whole question of the position of nurses in society and the recognition of their status is a matter which I agree could at this time be usefully reconsidered.

I have been entertaining myself during my lunch hours by rereading the debates in March and May of 1962. Not the least amusing and interesting speeches were those made by the hon. Member for Tynemouth. I pay tribute to her in that she is consistent in her criticism of the powers of the Government in relation to the nursing profession. I commend to all members of the Committee the reading of those two debates.

To return for a moment to male nurses, the composite rôle of mental nurses, male or female, is now recognised as not necessarily entailing separate representation. This is illustrated by the Society of Male Nurses winding up, it no longer having a special function to perform. This feeling is not entirely shared in Scotland.

The hon. Member for Tynemouth has always been critical about the consultative aspect with Government, which is endemic in the nursing profession. As she said on more than one occasion in 1962, she is not very much in love with the Whitley system. My information is that the State Enrolled Nurses have been consulted about this Bill. The body which has in membership the largest number of S.E.N.s is the Confederation of Health Service Employees, which supports the Bill. There has also been consultation with the National Association of State Enrolled Nurses. This organisation had some reservations but, on the whole, it accepts the Bill as it is. Its main concern was about representation on the Education Committee and this we could with advantage consider in Committee.

My hon. Friend the Member for Liverpool, Kirkdale referred to election procedures on the G.N.C. This is within the domestic responsibility of the G.N.C., but at a later stage I shall try to elicit some information, without encroaching on its preserves, since I realise that, as we represent the public, it is a matter about which we should satisfy ourselves.

The hon. Member for Ilford, North (Mr. Iremonger) momentarily and uncharacteristically aroused my ire when he dramatised what he believed to be the parlous condition of nursing and nursing recruitment generally. I commend to him the rereading of the proceedings in 1962, not because matters are the same as they were in 1962, but because I believe that the development and the improvement in status of the nursing profession is a continuing process, and that no Government of whatever complexion can afford to let up on it.

I am indebted to the hon. Gentleman for pointing out the important rôle which has been played by Goodmayes Hospital. As he knows, I am in consultation with him and with my hon. Friends about the location of that hospital. It would be a great pity if we did not satisfy ourselves that there had been adequate local consultation, and for that reason the Secretary of State has given an undertaking that there will be consultations, both with the hospital authorities and with professional bodies at an early stage, on any proposals by the regional board to change the location or structure—

Mr. Iremonger

Might I just clarify what the hon. Gentleman is saying? The discussions which we hope to have will be about the siting of the district general hospital on the site occupied by the existing mental hospital. I am sure that he did not mean to convey that there was any question of resiting the existing Goodmayes Hospital.

Mr. Snow

I let myself in for that. If I may be permitted to say so, the location is a separate issue. We are seized of the importance of consultation with professional bodies at an early stage, quite apart from consultations with those who are in charge of administration.

The hon. Member for Birmingham, Edgbaston (Mrs. Knight) has unfortunately been obliged to leave us but I take account of her remarks about earlier advice of this morning's proceedings. However, if she is fortunate enough to be a member of the Standing Committee, no doubt she can raise these points.

THE FOLLOWING MEMBERS ATTENDED THE COMMITTEE:
Craddock, Sir B. (Chairman)	Macmillan, Mr. Maurice
Armstrong, Mr.	Millan, Mr.
Boardman, Mr. H.	Pavitt, Mr.
Dunn, Mr.	Royle, Mr. A.
Harrison, Mr. Brian	Shaw, Mr. Arnold
Iremonger, Mr.	Snow, Mr.
Jones, Mr. J. Idwal	Ward, Dame Irene
Knight, Mrs.

In my view, we can focus two points which are worthy of attention in this not unimportant Bill. The first is the improved representational position proposed for State Enrolled Nurses. They must not be regarded as second-class nurses; they are in a different type of career. Second is this radical change, which I think has been under-emphasised this morning, that subnormality, as a separate branch of nursing, is now formally recognised and must be represented in the structure of the Council.

Question put and agreed to.

Ordered, That the Chairman do now report to the House that the Committee recommend that the Nurses Bill [Lords] ought to be read a Second time.

Committee rose at Twelve o'clock.