§ 9.38 p.m.
§ Mr. William Molloy (Ealing, North)
I wish to draw to the attention of the House the need to improve the status, conditions of employment and rates of remuneration of nurses in the National Health Service.
I have listened to a great deal of the debate on Northern Ireland, and I agree that it was a very responsible debate. But, despite its seriousness, it showed the vulgarity, bigotry, violence and intolerance which exists in part of our land and which is a mark of insanity. Now the House is to go on to discuss the conditions of work of the nurses in our land, which is the hallmark of sanity.
I should like first to pay my regards to Kenneth Robinson, who, when he was Minister of Health not so very long ago, made such an ample contribution not only to the National Health Service but to increasing the status and remuneration of nurses in it. I should also like to express my respect to and appreciation of my hon. Friend the Member for Fife, West (Mr. William Hamilton), who also made a very powerful contribution during the similar debate on 27th January last year.
When the House debates the conditions and remuneration of nurses, something usually happens which, if it does not answer all our points, certainly makes a contribution towards answering them. There have certainly been considerable improvements in the not-so-distant past, but the position is still far from satisfactory.
I should like to outline how I shall present the case. First, I want to show the rôle and the complicated responsibilities of various kinds of nurses in the National Health Service and what is required of those nurses in the performance of their many duties. I shall then review what I consider to be some of the grievous defects in the terms of engagement of nurses in the National Health Service, which I consider to be a mean reflection of their status and remuneration.
In its advocacy on behalf of nurses in the National Health Service, the national Press has done a splendid job. In my researches during the weekend, I have 1327 discovered that quite a number of our national papers and magazines have not let the case of the National Health Service nurse go by default. I would mention in particular articles which have appeared in the Scotsman, the Daily Telegraph, the Financial Times, the New Statesman, The Times and the Guardian. If the Press in general and back-bench Members, on both sides of the House, maintain our campaign—and I have referred to the remarkable debate initiated by my hon. Friend the Member for Fife, West on the Consolidated Fund Bill a year ago—supported by subsequent Questions to Ministers across the Floor of the House and, I hope, this debate tonight, I think that the final result will be another march forward in improving the conditions of nurses in the National Health Service.
When we use the term "nurses" generally, we sometimes do not appreciate the complex and complicated situation that is involved when we talk of a young man or woman becoming a nurse. I should like to deal first with the young State-registered nurse and the State-enrolled nurse in the National Health Service. To become a State-registered nurse involves a three-year course leading to very high qualifications, which are tested by examination, both written and practical. I know from family experience that this creates a great strain on a young woman who desires to achieve the accolade of becoming a State-registered nurse. When, however, one looks at the financial results which accrue from all this, one wonders why she does it.
Even for State-enrolled nurses there is a two-year course. Like State-registered nurses, not only have they to do their work as a student nurse or as a pupil nurse; if they wish to pass their examinations, they also have to spend a great deal of what might be called their free time in studying for their examinations.
When nurses take their State finals, which are thorough and exhaustive examinations, they are at remuneration levels which are lower than in any other form of industry or profession or, indeed, in the Services. They simply would not be tolerated by soldiers, sailors or men and women in industry or in other professions. I wonder whether it is because of the vocational instinct in the young 1328 man or woman who enrols to become a nurse that we in society are, perhaps, guilty of taking advantage of their vocational inspiration.
After three years a student nurse, if she is successful in her examination, at which she is allowed a number of attempts, ultimately becomes a State-registered nurse. Then she is automatically a staff nurse. That can lead her to want to become a district nurse in local government but, before doing so, there are certain health visitor courses that have to be taken. Alternatively, a State-registered nurse with three years' experience can move on to become a sister. But the point is that, during all this advancement, our nurses have to accept many serious responsibilities whilst they are studying and, even when they become State-registered nurses or sisters, they have not a great deal to show for it in terms of remuneration.
Having qualified as a State-registered nurse, it may be that she wishes to become a State-certified midwife. Having gone through the three-year course of a student nurse, having qualified as a State-registered nurse and got a little more pay, she then decides to study with a view to becoming a State-certified midwife. To do so, she has to undergo yet another course of study. She must take examinations and pass Parts I and II. However, while she is doing it she must revert to the level of remuneration that she received as a student nurse. This is a thoroughly disgraceful state of affairs and one to which I hope that the Minister will give serious attention.
In addition, the State-registered nurse who decides to take a course with a view to becoming a State-certified midwife has physically to help in the delivery of babies. I suggest that that is a very real responsibility. Any hon. Gentleman whose wife was having a baby would want to be assured that the midwife attending her had all the qualifications. There cannot be any margin for error. That being so, it is disgraceful that a State-registered nurse wishing to become a State-certified midwife should have to suffer a loss in pay as a result.
In addition to State-registered nurses, there are registered mental nurses, registered nurses for the mentally sub-normal, registered sick and children's nurses and so on. Their very names should evoke 1329 the praise and recognition that the nation owes them.
The modern nurse has to know infinitely more about her profession than did her predecessor just after the war and certainly before it. The medical and psychological knowledge and the other high qualifications of our State-registered nurses are of the utmost importance to the doctors and surgeons with whom they work, not to mention the patients and relatives of patients with whom they have to deal.
Do hon. Members appreciate that a modern sister is responsible for the total administration of the ward in her charge? There is no margin for error in hospital work. She must have a complete and efficient liaison with doctors, consultants and hospital authorities as well as with patients and their relatives. Ward sisters are called upon to make the most onerous decisions, sometimes involving resuscitation. In short, our sisters and staff nurses have to make almost instant decisions involving life and death.
I wonder whether the House realises that a nursing officer, for example, may be responsible for nursing administration in some 20 hospitals. Do hon. Members appreciate the enormous amount of knowledge and responsibility of a modern matron? Modern matrons, I am glad to say, are much more tolerant, sensible and understanding than some of the matrons of past years, although that is not a criticism of those in the past, but means simply that modern matrons have to meet the needs of modern society, to understand the desires and aspirations of modern patients, and nurses and other medical staff. The matron of a hospital is at least on a par with a banker or a tycoon. The only difference is that she does not receive anything like their remuneration.
The main responsibility of guiding the nursing service rests with the General Nursing Council and its committees. It performs an extremely important function. It is responsible for channelling Ministry finance to schools for nursing, for inspecting them, for arranging examination syllabuses and for organising courses. Any teaching hospital's experimental course has to be examined by the Council.
I gather from its reports that the Council is always trying to adopt what 1330 it regards as the right approach on an inadequate budget. At the same time, I think that it should become a little stronger in pressing its claims for the nurses. I have to criticise some aspects of this work. It is responsible for what seem to me to be the absurd penalties imposed on young women who enter nursing.
I was distressed to read in its annual report dated 25th July, 1969, that the fall in the number of student nurses entering training had continued. The fall was not as great as in preceding years, however. From 1969 to 1970, the number entering training fell from 51,225 to 49.298. We must not ignore these figures. They may not seem dramatic, but the loss of every potential nurse is serious. We are building more hospitals and therefore there are more wards and therefore more people able to enter hospitals, and the irony and agony of it all is that the number of nurses is not commensurate with that situation.
The qualifications of nurses generally are the responsibility of the Royal College of Nurses and the Royal College of Midwives. It seems that because these organisations have to be efficient, because their members must always show the highest understanding and compassion, somehow or other they must never press too vigorously for the legitimate rewards of nursing. I hope that they will drop this attitude and adopt a more dynamic approach in advancing the cause of the modern nurse.
Those of us who like to think that we are concerned about nurses often hear of a nurse who has been working different shifts in different wards. One week she will be in the surgical ward, then the children's ward, then the geriatric ward, then the gynaecology ward, then the obstetric ward, then the ear-nose-andthroat ward, the orthopaedic ward, casualty, out-patients and so on. A nurse must have the ability to switch to any of these wards at a moment's notice. She has to have extra and expert knowledge.
The pay and conditions in the service are insufficient. I acknowledge that they are determined by the negotiating machinery of the two sides of the Nurses and Midwives Whitley Council. I sometimes wish that that Council would examine the way in which the Civil Service Whitley Council operates. While 1331 this latter never seems to get any great headlines, it has achieved a very great deal for its members, and I wish that those representing nurses and midwives would take a leaf out of that Council's book.
One problem might be that the nurses are represented by 12 different groups, and this could easily weaken their bargaining power. I hope that the Minister will encourage nursing organisations to overhaul their machinery, to see whether they cannot evolve one national system, possibly under the National Union of Public Employees, so that they make their representations with one united voice. While the Whitley Council has not achieved great success, it has achieved a little, but not enough to raise the status of the modern nurse.
I sometimes think that there might be a need for a Select Committee of this House to examine the situation. If we have to wait for the administrative machine to get going, one of the things that the Minister could do immediately, which would improve the status of the nurse, is to help recruitment by abolishing the payment for food and accommodation and to give an extra and generous allowance to all our nurses, State-registered and State-enrolled, who have the initiative to find their own accommodation. They should not be penalised for so doing. This alone could make a contribution and help recruitment. Further, once a State-registered nurse endeavours to improve her status, she should not automatically suffer a drop in remuneration. She can be almost devalued becauses he wishes to become a State-registered midwife in addition to being a State-registered nurse—
§ It being Ten o'clock, the debate stood adjourned.