HC Deb 15 February 1971 vol 811 cc1332-55
Mr. Molloy

We all agree that the modern nurse is a highly skilled and highly qualified young woman. But I regret to say that she is a source of very cheap labour for the National Health Service. This is a disgrace and we should do something about it. We should not have to await the outcome of examination to implement some of the recommendations which I have made. If we do not do something to increase the status of nurses, the situation in which people in hospital were not properly attended to and nursed would soon snowball and there would be national anguish, and then the House and the Minister would have to do something about it. All I ask is that something be done now.

The nurses have been singled out for special praise, to which they are entitled. In the not-too-distant past, they were singled out for detrimental treatment. I am glad to say that that situation has been remedied, but not with the speed with which I should have liked. In discussing the improvement of the status and remuneration of nurses in the National Health Serevice, we are talking about the future not only of that service but of the nation.

I have already said that the conditions of employment of nurses in the National Health Service would not be tolerated in industry. I wonder how many trade unions and employers' organisations would even dream of sitting down to discuss an 84-hour fortnight with no meat breaks. Yet that is the situation in the nursing service. I wonder how many would even talk of extra duty allowances and overtime rates with 11-hour shifts? Is it right and proper in such an important profession that it should be possible for a young nurse, working in numerous wards over a relatively short period, to work eleven hours at a stretch? This is wrong.

The other great paradox is this: when it comes to sick leave or sick leave allowance, the nurse today is not as well off as nurses were in 1950. If their allowances and sick leave were put on the agenda for discussion in any of our major industries, they would be laughed out of court.

The General Nursing Council should have a hard look at humanising and dignifying its nurses' rules. A much more intelligent discipline should be applied commensurate with the status of the nurse. She should not be treated, as nurses are sometimes treated, as a form of private in somebody's army. This attitude must go. Nurses must have high qualifications. The responsibility of their job is always impressed on them. Yet they suffer mean, pettifogging penalties which would not be tolerated in any other industry or profession.

Therefore, I would ask the Minister to look at this and, with the General Nursing Council, to take out the built-in penalties arising, for example, from examinations. Let me explain what I mean. I think that the student nurse can sit her State examination only three times in any one year. She may fail or she may pass the first time, but because the examination takes place at only set times— in the year, the student nurse can suffer financially. I should have thought it not an impossibility that the General Nursing Council and the Ministry could come to some other sensible arrangement.

In passing, I ask hon. Members on the back benches to be on the qui vive when certain Statutory Instruments are put on the Table of the House. I regret to say that I have not always had my eyes open as I ought to have done, and I am willing to admit it, but I hope that I shall not be as negligent in the future, and, therefore, I give this warning to the G.N.C. and the Ministry, that I hope to whip up enthusiasm in the House for looking at Statutory Instruments so that if they do not satisfy the reasonable conditions which I have adumbrated here this evening, we shall move Prayers against them.

The agony is this, and it is another paradox: nurses, certainly until recently, were the victims of the adage that silent pain evokes no response. If in the past they had been militant, if in the past they had threatened some form of action, no doubt they would have been attacked at that time, but I am absolutely convinced that they would have improved their status and their terms of remuneration. Because they have shown an exemplary form of responsibility and devotion to duty, they have received only punishment for it, because the quality and value of the nurses in the National Health Service have never, in my view, been truly appreciated.

It is only when someone near to us, whether we are Members of the House or of the general public outside, has to go to hospital that we appreciate the work the nurses do. A child is knocked down in the road—there is the scream of brakes; the clanging of the ambulance bell; the child taken into hospital; the parents informed: and when they get there they see what is being done, they see the tenderness of these young girls working with the surgeons and with the doctors, and, of course, they are—and quite rightly—full of praise for our National Health Service nurses. The agony of that situation is that far too often we do not arrive at the frontiers of understanding until our own souls are tortured with personal grief. I say—and I think that the nation would agree —that we do not wish to recognise the value of the nurses in our hospital system until we have to visit a loved one in hospital. Then we become acquainted with the true value of the nurses. That, at the moment, is not being adequately recognised.

The agony in many cases is that the nation has a Jekyll-and-Hyde attitude. It is proud of so much that we do in our welfare services. At the same time it jibs at having to pay for it. However, I believe that the nation would not adopt that attitude towards a radical improvement in the status and remuneration of our nurses. Our National Health Service is the envy of the world. It is the signpost to sanity. The nurses, all grades of them, who work in the National Health Service are a vital link in that remarkable and wonderful National Health Service. If a chain is as strong as its weakest link, it is possible for our National Health Service to crumble because we have ignored the value and the true importance of its nurses.

If preventable pain is a blot on our society, preventable injustice to our nurses is a great and degrading blot as well. If we enhance the status of our nurses through better pay and conditions of service, and thereby recognise their true worth, it will reflect throughout the National Health Service and ultimately throughout the nation. To improve the texture of our national life and, in the final account, to improve the British National Health Service, we should start immediately to improve the status and the remuneration of all nurses in that service. In our National Health Service, we have made a vital contribution to the establishment of the civilised society.

10.11 p.m.

Mr. William Hamilton (Fife, West)

The House owes a debt of gratitude to my hon. Friend the Member for Ealing, North (Mr. Molloy) for raising this subject, which touches the heart of every member of the community. I must confess that I was rather embarrassed, Mr. Speaker, when I saw you take the Chair just five minutes before I rose to speak, although I anticipated that this might occur, when you were called to the Chair a short while ago, because you will recollect that you were the Chancellor of the Exchequer when nurses' pay was frozen. They were told then that the economy was in such a parlous state that they could not have more than a 2½ per cent. increase.

Their pay has got a little better since, but not very much, and certainly not as much as these young women are entitled to. I wish that, when patients go into hospital, instead of handing the nurses, as they sometimes do, a box of chocolates or a nice letter of thanks, they would take the trouble to ask the nurses who are nursing their relatives and friends what they are getting in wages. Every patient would be appalled at the exploitation which still goes on in every hospital in Britain.

I had in my house last night three nurses, one of them my daughter and the other two friends of my son. I have a very close relationship with the nursing profession. When I was up in my constituency at the weekend, a radiographer came to see me. She was five years fully trained and she is getting about £20 a week. She thought that she was very well paid—and so she was, in terms of the remuneration received by some of the girls who are trudging around the wards every day and night.

All patients would accept, I think, that, however much we mechanise the adminis- trative procedures and other parts of the hospital service, there will always be this very important therapeutic element, the human element of the nurse on the ward. We must pay for it, as my hon. Friend has insisted.

Despite the record of the former Minister of Health, Kenneth Robinson, and despite the efforts of the last Government under extremely difficult economic circumstances, nurses remain one of the most, if not the most, scandalously under-paid professions in the land—in terms not only of pay but of conditions of service.

My hon. Friend referred to the old battle-axes who were in the hospitals in days gone by. I regret to say that some of them are still there. If one asks nurses on the wards about this, one will readily be told of some of the intolerable discipline with which they must put up—being treated like mature women one moment and precocious schoolgirls the next. It is intolerable for youngsters to be treated in this way.

It makes me sick at heart when I think of the enormous wage claims that have been coming in—I refer to figures ranging from 10 per cent. to 60 per cent.—for top civil servants and judges. Indeed, there is a Motion on the Notice Paper for the former Speaker to receive a pension of £5,000 a year. We must get our priorities right, and I say that without disrespect to the former Speaker, Dr. Horace King, who is one of my best friends. When we compare these figures with the remuneration given to our nurses, we should be ashamed of ourselves.

I agree with what my hon. Friend said about overtime rates. There is not a trade which would tolerate what we give our nurses, which often amounts to something like one penny an hour. They work through public holidays and at weekends, often with no additional remuneration. Only this afternoon the Secretary of State for Employment claimed a great success in that the Wilber-force Committee had managed to prevent the electricity workers from getting more than 10.9 per cent.

If only the Under-Secretary would reply to this debate by saying, "We intend to give the nurses a rise of 10.9 per cent. every year between now and 1975", that would not be an extravagant promise. Unfortunately, he will not say that, because these girls either cannot or will not strike.

This contrasts with the doctors, who threatened to strike. I recall the debate to which my hon. Friend referred, which I initiated mainly to ask the then Minister if he would withdraw from the doctors some of their pay because they were in breach of their contract by refusing to sign sickness certificates. He replied, in effect, "Let us forget about that. That is water under the bridge." The Conservatives said at the last election that the Socialists should have given the doctors their 30 per cent. Now hon. Gentlemen opposite are giving them 20 per cent.

The doctors have never prayed in aid of the nurses. Never have I heard a doctor say, "The nurses are grossly underpaid", though I have regularly heard them complain of their hardship and of how they require an additional 30 per cent. They will get it, too, even though it will be in stages. Why should we accept in silence the treatment that is being meted out to our nurses?

One may blame the nurses for not having organised themselves into a satisfactory body to represent them. Many of them go into the nursing profession and leave after two or three years to get married. They say, "What is the use of joining a trade union?" and, in any event, the Under-Secretary will no doubt reply to this debate by saying that the nurses have the machinery of the Whitley Council, that they have a pay claim in and that he cannot comment on the subject. The Whitley Council machinery is useless and hopeless and it could be scrapped without the nurses even missing it. Every nurse to whom I have spoken has criticised the Whitley Council for refusing, for whatever reason, to take up their case.

Mr. Molloy

Would not my hon. Friend agree that there is a grave absurdity in a situation in which a nurse, having been trained under the N.H.S., becomes an agency nurse and earns more money in that way; and that the N.H.S. often has to employ these agency nurses, which costs the service much more than would the proper remunerating of its own nurses?

Mr. Hamilton

That is true. When that point was raised in a recent debate on the subject the Government answered that only a tiny fraction of the total nurses in the service were agency nurses. I was almost about to say that all the nurses in the Health Service should go to the agencies. If they cannot get correct remuneration agreed to by the House they could take that alternative. I should not like to see it done. The House should accept its responsibilities. It will not be good enough for me if the Under-Secretary tonight says, "Leave all this to the Whitley Council. The claim is in, and the Whitley Council will sort it out". This Government, like the previous Government, have initiatives that they can exercise.

I refer now to the State-registered nurse who subsequently decides to train as a certified midwife. My son's girl friend happens to be in exactly that position. She is just finishing the six months' course for Part I, and she has to pay four guineas to sit the examination. When I raised this point with the Department, I was told, "Well, the body that runs the examination has to cover administrative costs, so these girls have to pay". That is not good enough. The Department should either pay these girls adequately so as to enable them to pay the fee or should itself accept that responsibility.

The Government are committed to cutting public expenditure. Far more cuts are threatened than have ever been threatened hitherto. In Table 1.2, page 8 of Cmnd. 4578, we find public expenditure on health and welfare estimated at £2,055 million in 1969–70 rising to £2,645 million in 1974–75—an annual percentage increase of 4.7. I do not know the breakdown of that figure, but perhaps the hon. Gentleman can tell us what part of that total is projected increases in nurses' salaries. We know that there is a very ambitious hospital building programme already in train. How much of this increase in projected expenditure is for capital expenditure, how much is for current expenditure, and how much, particularly, is for nurses' pay?

My hon. Friend referred to the possibility of a Select Committee of the House to look into the problem. He will know, as I do, that we have now got a new Select Committee on Expenditure. and one of its sub-committees is to deal with the social services. It is not for me to say what it is likely to investigate, but I hope that my hon. Friend will ask the Chairman to make a top priority of salaries and conditions of nurses, because if this problem is not dealt with soon the National Health Service will not come to a stop but its future will be very seriously jeopardised.

My hon. Friend, others of my hon. Friends and myself will keep raising this matter in the House, because the nurses have no spokesman other than us on the Floor of the House. I hope that the Under-Secretary will accept from us that he will continue to receive our criticism—not he personally, but the Department which is responsible for this sorry state of affairs.

10.25 p.m.

Dr. Shirley Summerskill (Halifax)

The House is grateful to my hon. Friend the Member for Ealing, North (Mr. Molloy) for a most eloquent and knowledgeable appeal on behalf of the nurses. It is regrettable that there are so few Members present to hear the debate. Most of the sentiments expressed and facts stated by my hon. Friend give a clear and accurate account of the way that nurses are paid, of their status and of their employment conditions.

No mention has been made of Professor Briggs's Committee which is inquiring into the future rôle, education and training of nurses, particularly the future rôle, which is a broad phrase which presumably could be taken to cover many of the aspects which have been brought up tonight.

I should not like to think that the Government are simply waiting for this Committee to report. We were told originally that it was a Committee which would take 18 months to deliberate, which seems a long time in view of the urgency of the whole matter. Perhaps the Minister will tell us when Professor Briggs's Committee will report.

There is no doubt that there are serious shortages of nurses, particularly in geriatric wards and in wards for the mentally sick. It is a tragic fact that a third of nurses leave during their training. A study should be made of why girls are sufficiently enthusiastic to take up nursing—something in it appeals to them—and then leave during their training, perhaps to take up another job, often to go abroad.

Tragically, there are nurses who go abroad when they have qualified because the remuneration and the conditions of work there are more attractive to them. Many nurses go into the agency service. It is surprising that more do not do so in view of the higher remuneration and the more attractive uniform and conditions of work for agency nurses.

There is always the lure of office work or attractive highly paid secretarial jobs for young girls where the hours are nine to five and the girl is off in the evening and the pay is much higher.

There is an advertisement for nursing issued by the Department of Health and Social Security which is entitled You are someone special when you are a nurse". It is clear that nurses are special, in that they are peculiarly dedicated young women. They are prepared to do hard work for low wages, with excessive hours, and at the same time carry a load of responsibility, unlike any responsibility they might have if they were sitting in an office.

Recruitment, although the Minister will say that it is rising, is not keeping pace with the demand. Nurses are still unable to prevent the frequent closure of wards and delays in hospital admissions, with waiting lists piling up. I am glad that there has been some improvement in the recruitment or the employment of part-time married nurses. I think most hospitals now realise that they could not run without part-time married nurses, but I feel that there is much more that could still be done in this direction, particularly in casualty wards. Discipline, I think, is becoming more realistic because it is quite an antiquated idea that a nurse should perhaps be in charge of a ward of 35 people one minute and then be required to report back to the nurses' home at 10.30 on the dot or else be punished.

Home nursing has not yet been mentioned, but obviously in the future there will be a far greater tendency for patients to stay a shorter time in hospital, particularly midwifery patients, but patients of all kinds—geriatric and so on—and to he returned to their homes as soon as possible. Therefore, the demand for home nurses, who are in short supply and under-paid at the moment, will be greater than ever before. We cannot attract more nurses to hospitals as long as the hospitals themselves are old and overcrowded and offer poor working conditions. It is very noticeable that the big London teaching hospitals or the newer hospitals do not suffer from a shortage of nurses. Many of them have a waiting list of nurses wanting to go in. It is the old, often provincial ones, which have this terrible problem.

We have heard a great deal in this debate about pay. I would point out that although this is not a party political debate, between July, 1964, and April, 1970, nurses' pay increased by 67 per cent. I agree with my hon. Friend the Member for Fife, West (Mr. William Hamilton) that the Whitley Council, certainly the whole negotiating machinery, is the subject of great criticism among the nursing profession. Clearly it does not look as if Professor Briggs's inquiry will cover that at all, and that some other inquiry will have to be set up to look into it.

We find as a result of the Whitley Council that by April, 1971, a staff nurse in a general hospital, who is a highly trained young woman, intelligent and hard working. will be paid only £23 a week gross. This, as has been pointed out in a previous debate, is less than the average earning of a male manual worker over 21 in a manufacturing industry. At the same time, under this new machinery, in April this year, a ward sister, who is highly experienced and with great responsibility in matters of life and death, will earn only £30 a week, and this after years and years in hospital work.

It is clear that the National Health Service, which we know is short of money, is being subsidised by nurses who are being exploited for their cheap labour. It is well known, as has already been said tonight, that nurses will not strike. They are dedicated and they would never think of abandoning sick patients in order to appeal for more money. But they do come into the category of the low paid, and successive Governments have always said that whatever their incomes policy, or lack of it, the low paid will be taken care of.

Unfortunately nurses are split, or have been recently, into the militants and the conformists. There have, indeed, been some nurses who have been prepared to take militant action, but then again there were others who disapproved of this, and this split their case. They are divided into a multitude of unions. They have 12 different groups representing them on the Whitley Council. We all know that the greater strength is in unity, and they sadly appear to be disunited when it comes to claiming for their own pockets. Yet, on the other hand, they have almost unanimous and total public support whenever they put in a claim. I should not think there are many Mem- bers of this House or members of the public who have not some reason to be grateful to the nursing profession. They probably get more public and Press support than any other section of the community. Perhaps it is because they are paid out of taxation that there is a reluctance on the part of Governments to deal with the situation.

Another reason why they are paid at a lower rate by successive Governments may be that, although there are male nurses, on the whole it is predominantly a woman's profession, and there is a long-standing belief and prejudice that a woman's job deserves a woman's rate of pay, and therefore the general rate is always kept fairly low. I am very sympathetic with the male nurses who have a family to keep on what is always called a woman's wage. I hope that with the Equal Pay Act now on the Statute Book, and with a general feeling among the public that there should be the rate for the job, nursing will not simply receive a woman's rate of pay, and that the profession will be paid according to the type of work, the training required and that responsibility and experience that these women have.

It is no good the Government's boast-ting, as they can, that they ere putting more money into hospital buildings. A patient's welfare depends more on the doctors and nurses caring for him or her than on expensive machines and modern buildings.

I am sure that the House expects that the Government, whether as a result of Professor Brigg's Committee, whenever that will report, or through the Whitley Council, but not very hopefully through the Whitley Council, or some other machinery, will see that at long last the nurses are given their due and receive a proper rate for the job.

10.37 p.m.

The Under-Secretary of State for Health and Socal Security (Mr. Michael Alison)

The hon. Member for Ealing, North (Mr. Molloy) has raised an important topic that unfailingly plucks the heart strings, as well as the head strings, of every Member—the problems, remuneration, status and conditions of work of the nursing profession.

I should like to start by paying my tribute to this great profession. Most people receive nursing attention at least twice in their lives, the first time being when they are in their mothers' arms. We all qualify for that, and it is a very rare human being who does not receive nursing at a subsequent stage. There are two deeply implanted instincts in the typical nurse, who has a marvellous desire to help the human being at its most dependent. As one who is temporarily fit and healthy, I fully recognise the absolutely indispensable rôle that the nurse plays in not only the National Health Service but the whole continuing life of the community.

I noted in the contributions by the hon. Members for Ealing, North Fife, West (Mr. William Hamilton) and Halifax (Dr. Summerskill) that all have a personal link with the nursing profession. I am delighted that the hon. Lady is one example of the doctor who refutes the contention of the hon. Member for Fife, West—a doctor who is saying something on behalf of nurses and their pay.

Mr. William Hamilton

That is an exception.

Mr. Alison

An exception, perhaps, but a very attractive and powerful one.

I am afraid that I shall confirm the hon. Member for Fife, West in his act of prophetic insight. The pay of nurses is, alas, a topic of current interest in the strictest sense of that word, since a claim has been made for increased rates of pay and improved conditions to date from 1st April, 1971. As the hon. Member and the hon. Lady the Member for Halifax know, the claim is at present the subject of negotiation on the Nurses and Midwives Whitley Council. There is very little that I can say, since it would not be right or helpful for me to comment whilst those negotiations are still in train. There have been two meetings and there is to be another on 23rd February. It would even be unhelpful for me to be drawn into a broad discussion of whether the Whitley machinery is adequate for the purposes for which it was designed, because this would be bound to have repercussions on the meetings which are in train.

Mr. William Hamilton

Will the hon. Gentleman give an assurance, however, that there will not be a freeze of 2½ per cent. on the nurses' increase?

Mr. Alison

That is obviously relevant to the negotiations which are in progress. Both parties have experience of pay freezes and I do not think that it is for me to comment on the desirability of projecting that into the future. However, I think that all of us who have had experience of pay freezes know how unsatisfactory they are. Apart from that, I must not stray into the area which is strictly within the purview of the negotiations which are still in train.

On finance, the hon. Member for Fife, West touched on Table 1.2 on page 8 of the latest Government public expenditure forecast. Again, I ask him to excuse me from giving a precise answer, which might mislead him because I have not had notice of it, but I will write to him about it. I think he will find that the contingency item in most of the forward tables has amongst some of its purposes the possibility of increased rates of pay or increased costs which arise.

The hon. Lady the Member for Halifax spoke about the Asa Briggs Committee. I hope that I may be allowed to say something about that Committee, because it is so obviously relevant to the wider issues which the debate initiated by the hon. Member for Ealing, North has raised. Perhaps I may remind the House of the terms of reference of the Asa Briggs Committee. They are: To review the rôle of the nurse and the midwife in the hospital and the community and the education and training required for that rôle, so that the best use is made of available manpower to meet present needs and the needs of an integrated health service". The House will know that the membership of the Briggs Committee covers a wide range of experience and interests. Over half the numbers of the Committee are nurses, including two ward sisters, who will be able to bring to bear a great deal of practical knowledge about the problems of the profession at ward level and what might be described as the grass roots feelings on the whole range of topics, not least discipline, to which hon. Members have referred, as they look into their terms of reference.

The present Government fully endorse the decision of the last Government to set up that Committee, whose work is undoubtedly of considerable importance, both for the future of the nursing profession and, because of that, for the future of the whole Health Service. The Committee has certainly aroused a great deal of interest and there has been a lot of ready co-operation with its work. It will, however, have a formidable body of evidence to consider, because a great deal of it is flowing in from the large number of interested parties in the inquiry. The Committee is making good progress, but it has a lot of work to do and, obviously, it will be some time before its labours are complete.

The hon. Lady asked me for a specific date. I hope that she will excuse me if I do not pin the Committee down. Nothing is more difficult than to try to pin down an independent committee such as this, and very often the committee itself cannot forecast how long its deliberations will take, because questions of the quantity of evidence and the difficulty in arranging meetings at specific locations as committees move around are important factors. Suffice it to say that the importance attached by every quarter to the Committee will, I believe, be a spur to ensure that it reports as quickly as possible.

Perhaps I may touch a little on the background justification for setting up the Briggs Committee, since it touches on so many of the pertinent points raised by the hon. Members for Ealing, North and Fife, West.

First, from the point of view of the employers at large—the Government, the Department, the National Health Service and the regional boards—that is summed up simply in the word "manpower". The numbers of qualified nursing staff in post have been increasing, but they still fall short of demand, especially, as the hon. Lady said, in mental illness, mental subnormality, and the geriatric hospitals —certainly the more isolated ones.

Recruitment to nursing, as to other professions relying heavily on female staff, is also likely to be affected by the falling numbers of 18-year-olds in the next few years and the earlier average ages of marriage and motherhood. It is not as bad as in the teaching profession, but certainly it represents an early departure from service. Even if we recruited as many nurses as we wished, still the wastage rate would present a very serious problem. So, because of the wastage rate and difficulties over recruitment, fundamentally the manpower aspect is an important Departmental stake in the Briggs Committee.

The nursing profession itself has for some time been calling for a review of the arrangements for nursing education. This is perhaps one of the profession's major interests in the Asa Briggs Committee. Developments in education generally, changes in the scope of nursing, tutor shortages and student wastage all affect the nurses' education needs. However, education is not a matter which can be reviewed in isolation. It is the purpose for which we are educating nurses which is of cardinal importance. That is why the modern rôle of the nurse or midwife, the first part of the Committee's terms of reference, is crucial.

There is no doubt that the rôle of nurses has been undergoing a dramatic change, even dating back to pre-war years. The hon. Lady, who is a great expert in these matters—

Dr. Summerskill

Not going that far back!

Mr. Alison

I take that point. She is a great expert in the post-war phenomenon, and she will appreciate that, whereas in the old days the doctor diagnosed, the nurse nursed the case, and the crucial rôle in the recovery of that patient was played by the nurse, we have to face the fact that, over the years, there have been changes. With antibiotics, the sulphonomides and a whole range of modern drugs, together with a corps of professional ancillary specialists, a vast amount of change has taken place to affect the relationship of doctor and nurse in the care of the patient which was a cardinal part of the job satisfaction in nursing. It is extremely difficult to compensate for such changes, and the changing characteristics of nursing are among the important subjects being studied by the Asa Briggs Committee.

Nursing techniques may be becoming more advanced but, paradoxically, other advances come in which tend to dispirit the old appeal of nursing—that intimate, personal, direct care of a fundamental kind which was a feature of the older structure of therapy in our service.

Organisational changes affect nursing work. The Salmon structure for senior nursing staff offers opportunities for nursing expertise to be built into policy making at every level, and it is important that nurses should be equipped to use these opportunities to make their voices heard.

Mr. Leslie Spriggs (St. Helens)

Is the hon. Gentleman saying that, because of the introduction of antibiotics and other modern drugs, the rôle of the nurse is less and less important? If he is, I can assure him that successful and skilled nursing is no less required today than it was 20 years ago.

Mr. Alison

I do not want that interpretation to be placed upon my remarks. I have just said that nursing techniques are becoming more advanced. While nursing education has to be more and more thorough and more and more specialised and the nurses become increasingly skilled, nevertheless much of the job satisfaction of nursing in its original form lay in the special relationship between doctor, patient and nurse. The essence of that relationship is tending to be disrupted by the injection of a whole new range of depersonalising elements. Although the new professional practitioners and new kinds of medicines and drugs place greater premiums on the skills of nurses, they tend in many ways to depersonalise that relationship, particularly with the doctor, which was so much part of nursing in its origins.

The simple illustration I have given of how the doctor diagnosed pneumonia and the nurse nursed the patient for pneumonia whereas now—and the disease is no longer hazardous—the doctor merely prescribes a chemical remedy so that much of the caring element of the old days is removed is typical of the trend. One has to consider what may be some of the underlying factors. It is debatable, but I am not sure that they do not have an important effect on the evacuation from training of some students and the high degree of wastage and perhaps the diminution in job satisfaction which one finds in some hospitals. Paradoxically, in intensive care units where there is a highly concentrated mix of modern chemicals and technical nursing and remedies and the extremely close co-operation between nurse and professional medical staff the personal element is restored, and there is no difficulty about getting nurses to work in intensive care units.

Dr. Summerskill

I follow that argument, but can the hon. Gentleman account for the fact that there is such a shortage in geriatric and mentally sick wards where antibiotics are not used and other magic cures are not used and where there is personal care and drudgery as well as responsibility and where there is an intimate nurse-patient relationship with old people and mentally ill people?

Mr. Alison

I do not claim to be an expert, but part of the explanation may be that in many of the older mentally handicapped and mental illness hospitals there is not present that dynamic therapeutic leadership on the medical side but rather the old custodial approach without the prospect of highly intelligent modern medical techniques being applied which encourage the nurses' direct co-operation with the medical staff. The multi-disciplinary aspects of medical care in mentally handicapped hospitals is being increasingly applied, and this reintroduces a sense of involvement of the nurses with the medical staff.

The hon. Lady will appreciate that in many isolated mentally handicapped and mental illness hospitals the attractions of the long weekend, with the leisure attractions which the modern prosperous age provides for young people, may not be offset by the glamour which we have come to associate with medical hospitals and the big centres where there is exciting work of a highly varied nature. This is bound to have an impact on retaining young nurses in such circumstances.

Mr. Molloy

The hon. Member says that the introduction of antibiotics has depersonalised nursing. It is my experience that the reverse is true. Because a nurse has to be highly qualified, she has to know all about antibiotics. She has to liaise closely with the doctor who may wish to change from one drug to another in his treatment of the patient. The result is that the nurse has to know much more about a patient than was the case 30 or 40 years ago when the nurse merely applied the treatment ordered by the doctor.

Mr. Alison

I take the point and the hon. Lady would no doubt agree that often nurses know a good deal more about the patient, because patients are much more inclined to communicate with them than with doctors. I was referring to the triangular relationship, and I hope the hon. Member will not escape with the impression that there has been any diminution in the intimate involvement of the nurse with her patient. There has been something of a breakdown in the triangular relationship with the doctor, as a result of the doctor becoming more specialised. There is a lot of speculation about this but it is realistic to try to probe beneath the surface.

It could be argued that this triangular relationship which used to be so much a feature of the highly collaborative effort in the earlier days, when there were not so many patent devices on hand, has been eroded, perhaps inevitably, because of the things which are on hand now. It is perhaps this which is at the root of the difficulties over job satisfaction which nurses have felt.

This is typically the sort of question with which the Briggs Committee will be dealing and upon which it will be hearing evidence. I put this forward as something which highly skilled and respected professions are suggesting. I am not producing this off my own bat.

Mr. Spriggs

There is one point to do with the shortage of nurses which the hon. Gentleman has not touched upon, and on which I have personal experience. This relates to the Cowley Hill Maternity Hospital, St. Helens. Some months ago it was leaked, I think deliberately, that this hospital was to close down. The change of use was to be decided by the regional board and the local authorities. The excuse for closing it down was that there was a shortage of nursing staff. I found out that the real reason was that nurses asked, "What is the use of going there? We have heard it is closing down." That was the real reason why nursing staff could not be obtained. This is one of the cases at which the Minister would do well to look. He should discuss it with the regional board.

Mr. Alison

I will look into it and if possible will give the hon. Gentleman a satisfactory answer. I take the point that there is a "chicken and egg" situation with many specific local cases. This is one of the reasons why we have tried to overhaul and rationalise, as far as possible, the procedures for closures. My right hon. Friend attaches great importance to this. Local boards, from whom he from time to time, receives such applications, are asked about the extent to which they have been able to recruit and deploy locally-based nursing staff who, if the hospital closes, would not move to another hospital, but who would agree to serve in that hospital. That is a factor in the consideration, because closure proposals bulk large in his thoughts.

On the question of midwives, on which the hon. Gentleman also touched, my right hon. Friend has agreed in principle that the hospital and community health services should be unified, and we need to consider how this will affect the work of nurses and midwives. The Peel Report points to changes in emphasis in the work of midwives with growing hospital confinement rates but earlier discharge. Early discharge of patients creates a new situation in both hospital and community. We need to give nurses the tools to cope with the changes that are already taking place and to equip them to meet future change.

Mr. Molloy

May I draw the Under-Secretary's attention to this incredible situation? My own daughter is a State-registered nurse, having taken all the examinations. She wished to take also the State certified midwife examination, but unfortunately two months ago she contracted a disease which ended in her having meningitis. The result was that her planned programme by which, on 1st February she would have started her midwifery course, was disrupted.

When she recovered from meningitis, she was on sick pay but had to gamble, after being in hospital for two months, and forecast whether she would be fit enough by 1st February to take her midwifery course, because she would have to give a month's notice to the hospital where she is a staff sister and would then be able to start the course in another hospital. One is not allowed to take the course in the hospital where one took the S.R.N. course. It so happens that she took that gamble and on 1st January said, "I resign from the hospital where I am a staff nurse" Unfortunately her recovery was retarded and she was not able to start. She is now unemployed. I think this is a point the hon. Gentleman should look at in some depth.

Mr. Alison

I shall read carefully the case the hon. Member has outlined and I shall write to him after weighing it up.

The sort of topics the Briggs Committee will have to cover include sources of recruitment and demographic factors such as the drop out at 18 years which is affecting recruitment, and how retention rates can be improved. Going back to the point made by the hon. Member for Fife, West, about early drop out, the Committee has to consider how the best use can be made of the nurses we have. This is an important part of its remit. It has to evolve realistic recommendations on education for present needs and for the needs of future students of different ages and educational backgrounds.

It will have to look at how practical work and experience in hospital can best be combined with formal training; at the organisation and staffing of training establishments; and at the links nurse education should have with the mainstream of further education.

As well as taking evidence very widely, the Committee has set in hand a number of research projects gathering information about nurses' career patterns, about those who have left nursing and why, about nurses' attitudes to their work and education, and about present training provision at both basic and post-basic levels. At the same time, members of the Briggs Committee are visiting hospitals and local authorities to talk to nurses and see them at work at first hand. Groups of members are giving intensive consideration to particular aspects of the Committee's remit and bringing their findings back to increase the Committee's store of knowledge. It is very thorough-going and comprehensive, and I am sure that the hon. Lady the Member for Halifax will not grudge the time which I believe the Committee must properly spend in this enormously far-reaching, almost sociological investigation into the nurse's career.

I recognise that, apart from the pay and conditions of service negotiated on the Whitley Council, about which we have heard some critical remarks, there are other matters affecting the status and working conditions of nurses for which my Department is more directly respon- sible. The previous Secretary of State, the right hon. Member for Coventry, East (Mr. Crossman), wrote a personal letter to chairmen of hospital management committees and boards of governors of teaching hospitals about these matters in May last year, and in June his letter was more formally circulated under a Hospital Memorandum entitled "Action to Improve the Nursing Situation". The present Secretary of State has endorsed the principles set out in his predecessor's letter, and we are now about to call for reports from hospital authorities on the action which they have taken in response to it.

The House may like to know the main points which we are following up. First, the involvement of nurses in management. It has long been my Department's policy that hospital matrons should have the right to attend meetings of their hospital house committees when matters affecting the nursing services are being discussed, but the introduction of the new senior nursing staff structure recommended by the Salmon Committee and of the new system for the organisation of medical work recommended in the "Cogwheel" Report has enabled us to strengthen this policy. It now is that the chief nursing officer should have the right to attend meetings of hospital management committees or board of governors and that she should similarly be invited to attend meetings of the medical executive committee or group medical advisory committee and its divisions or equivalent sub-committees. This policy supports the nursing profession's right to be present whenever decisions affecting nurses are being made. It is for the profession to ensure that this right is effectively exercised.

Next, relief from non-nursing duties. It is obvious that the time of qualified nurses, or of those training to become qualified, should not be wasted on domestic and other duties which do not require nursing skill. But some hospitals still have far to go to achieve this objective. We willingly concede that point. I do not underestimate the problems. In some areas domestic staff are actually more difficult to recruit than nursing staff—the House should weigh the significance of that—and the best pattern of organisation of non-nursing duties is not yet quite clear. But we are determined that we should make progress in overcoming these problems.

Finally, nurses' living and working conditions other than those negotiated on the Whitley Council. Given that the nursing service must be maintained throughout the 24 hours of the day and seven days of the week, nurses are inevitably subject to inconvenience and stress in their working lives. I do not defer to any hon. Member in readily recognising the exceptional stress in which their job and its implications involve them. But there are many respects in which good management can alleviate or compensate for this—rational use of beds and other facilities, good planning and organisation of duty rotas and equitable allocation of staff between duties, good canteens, rest rooms, changing rooms and transport facilities for nonresident staff, which are particularly important in the matter of calling back the married nurse upon which the hon. Lady the Member for Halifax laid stress, and good residential accommodation, including some provision for recreation, for those who must be resident in the hospital.

Some of these things require new buildings, which cannot be achieved all at once. What all of them require is good management, alive to the needs of the nursing staff. The hon. Member for Ealing, North and the hon. Lady the Member for Halifax can he assured that, in so far as it lies within the power of the Department and of good management in the National Health Service, we shall do all we can to relieve nurses of these elements of stress and to promote their overall status and well-being in the hospital service.

Perhaps in conclusion I may be permitted to say, as one or two instances of exceptional demands placed upon nurses have been given by hon. Members, particularly by the hon. Member for Fife, West —who, for all I know, may have been speaking from personal experience, or that of a member of his own family—that if hon. Gentlemen have particular cases which they think reflect bad management or an ill-thought-out rota scheme —anything like that—I shall be very happy if they will write to me, and I will ensure that they receive personal attention. I hope that hon. Gentlemen will feel, from these remarks, that we have done justice to what I believe is a crucially important and well worth-while topic.