§ [SECOND READING.]
§ Order of the Day for the Second Reading read.
§ LORD AMPTHILL
My Lords, in view of the considerable tax which has already been placed upon your Lordships' attention I will endeavour to abbreviate as far as possible what I have to say. I trust your Lordships will allow me to begin by explaining how I come to be in charge of this Bill. Some few weeks ago when I took it upon myself to move the 1189 rejection of the Official Directory of Nurses Bill, the Bill which was designed in opposition to this Bill, I explained to the House that I did so of my own motion, and not as the spokesman of any league or body of persons outside this House. The Society for the State Registration of Nurses, however, encouraged by your Lordships' vote on that occasion, and recognising that in view of the state of business in the other House of Parliament their chances of obtaining a hearing for their Bill in that House were becoming less and less, asked me to introduce it in your Lordships' House.
It is, therefore—and I explain this in order that I may not be thought to be sailing under false colours—as the spokesman of that Society that I am here to-day. Diffident though I was about the matter, I could not refuse a request made to me in that way, and I am proud to be the spokesman of a body of women who are engaged in that noble calling which more than any other, I think, brings out the best qualities of the gentler sex. In any circumstances, whether it had been late or not, I should have been very much divided in mind as to whether I should say all those things which the advocates of State Registration would wish me to say on behalf of their cause, or whether I should avoid trespassing unduly upon your Lordships' attention and patience. I hope that I am safe in yielding to the latter consideration, relying on the very great practical knowledge and experience which most of your Lordships have of those conditions of our social life which are affected by the proposed legislation.
The question is one of very great importance. It has been agitated for twenty years past; it has formed the subject of an exhaustive inquiry on the part of a Committee of the House of Commons which sat during two sessions; and where-ever it has arisen elsewhere, whether it be in foreign countries or in our own Colonies, owing to the organisation of nurses it has led to legislation very similar to that which is now proposed. The noble Earl the Leader of the House, speaking with all the responsibility of his position as Lord President of the Council, the Department which is particularly concerned, said, on March 8, 1905, that the subject was one of national importance, 1190 and that it could not be long before it engaged the serious attention of Parliament; and the noble Earl added that it was also apparent that there was a strong preponderance of opinion in favour of the scheme of State registration. But I hope it will not be considered presumption on my part if I venture to quote-an even more important utterance. His Majesty the King, speaking on Saturday at the opening of the buildings for the Royal National Pension Fund for Nurses, spoke as follows:—It has now, happily, long been recognised that in the alleviation of pain and sickness, good nursing is of supreme importance, and that it is in the interests of the community that measures should be taken to obtain ski ed and efficient nurses in increased numbers and to procure for them such advantages and prospects as will retain them in their profession.Of course, I do not presume for one moment to guess what was in His Majesty's mind, but this I do know, that there is no measure which, in the opinion of the great majority of the nursing and medical professions, would be better calculated to secure that end than a measure of the kind now before your Lordships. Registration is, indeed, an essential preliminary to any further steps for increasing the efficiency and improving the prospects of the nursing profession.
Again, I would venture to suggest to your Lordships that in these days of the feminist movement Parliament would do well to pay careful attention to a demand which is put forward with steady persistence but with perfect propriety by a body of women whose services to the community are both unquestioned and indispensable. Whether we be advocates of woman suffrage or whether we be opposed to that policy, we are equally concerned, I think, as politicians, to see that such a demand is treated with due respect.
So much for the general importance of the question. It behoves me to explain—and I will do so as briefly as possible—the objects, reasons, and nature of the demand for the legislation proposed in this Bill. In other words, I have to show the House what is demanded, why it is demanded, and by whom it is demanded. In the first place, then, what the nurses—and with them are 1191 associated many who do not belong to the profession—ask for is this. I will give it to your Lordships in their own words. They ask that—The term 'trained nurse' shall have a definite meaning; that anyone using it shall submit to a definite examination and satisfy an authority appointed by the State that he or she possesses the qualifications necessary to render him or her a safe attendant on the sick, and that the names of those who attain the prescribed standard shall be entered on a nursing register so that the public may be enabled easily to distinguish qualified from unqualified nurses.That is the whole extent of the demand. What is asked for, in fact, is that nurses should be treated by the State in the same way as solicitors, physicians, surgeons, dentists, and even midwives are already treated; that, in view of the increased demands for efficiency which have been made, and which the nurses themselves have done so much to meet, there should be extended to them the legislation which has developed on uniform and well-established principles in respect to kindred professions, not only in this country but also in the British Colonies.
Next, what are the reasons for this demand? Speaking in general terms, it is for the protection of the public just as much as for the protection of the nurses themselves; but it is necessary, I think, that I should explain this point a little further. In the first place, then, there exist at the present moment no standards of nursing education, and the consequence is that the value of training and of the consequent certificates which are given by the different institutions regarded as nursing schools vary considerably. Indeed, there are as many opinions as to what constitutes a sufficient training and as to what amount of training entitles a nurse to a certificate as there are nursing schools and similar institutions. In a great many of these institutions there is no doubt that a very inefficient training is given to the nurses. This is unfair to the nurses, who pay for the training by a very great sacrifice of time, if not of money, and it is unfair to the public, who are unable to judge of the relative value of these certificates. What is wanted, then, is an educational authority 1192 which would be able to lay down what the standard of training entitling a nurse to a certificate should be. The lay governors of hospitals, admirable though their work is, and greatly experienced though many of them are, are not exactly in the position to lay down standards of this kind, and certainly they have no means of all agreeing together what the standards should be and of enforcing them. Again, owing to the lack of a governing body for the nursing profession, the certificate of a nurse cannot be withdrawn even where she has been convicted of crime, and this, as I shall show your Lordships, is a very serious matter indeed. I might go on to refer to the absence of any standard for matrons and of any regulation that those who fill the highly important and responsible position of matron of a hospital or nursing home should be required to go through further tests, but I hardly think that is necessary for my present purpose.
I hope I have said enough to show that, in the absence of the safeguards which belong to other professions, the public suffer so far as the nursing profession is concerned, and, at the same time, the nurses suffer when discredit is thrown on their profession on occasions when unqualified persons use the name of nurse for improper and dishonest purposes. I could give your Lordships a great many instances. I have, in fact, a very large supply of them here, but I hardly think it is necessary to give them in view of the fact that most of your Lordships must, in the course of your ordinary everyday experience, have come across cases of the kind which I have in my mind. It is a matter of common knowledge that the nursing homes for the care of private patients are under no supervision. There is no guarantee whatever that the patients receive the skilled nursing for which they pay. In some cases—in a good few cases, I believe—these nursing homes are commercial speculations on the part of unprofessional persons who make their profit by enabling those who do not care to go through the long grind of a thorough hospital training to take away a certificate of nurse and to trade upon it. Some of these homes are even worse, and are simply places where abortion is practiced 1193 and which are centres of immorality and crime.
Perhaps I might just give your Lordships three very brief instances of what I mean. Sir Victor Horsley told the Select Committee of the House of Commons that in a nursing home to which he himself frequently sent patients, he recognised a scrubber dressed up as a nurse and attending to one of his patients. That is an instance of the kind of fraud which can be perpetrated even in a perfectly well-known and respectable nursing institution under such distinguished supervision as that of Sir Victor Horsley. A graver case is that of the two women who were hanged at Holloway in consequence of abominable crimes in 1903. The newspapers at the time were filled with sensational headlines, and the placards in the streets contained such announcements as "Nurses charged with murder." I need hardly explain how painfully the nursing profession suffer from episodes of this kind, and thus having the name of their profession associated with criminals. The third instance is quite a recent one. It is that of the woman who went by the alias of Princess Soltikoff, whose case was notorious a couple of years ago, and who was sentenced at the Old Bailey to fifteen months' hard labour for fraud in 1906. She had previously been sentenced for a similar crime in 1903, but between these two convictions she had four or five situations as a nurse and had been in several hospitals. That, my Lords, is an instance of the possibilities for criminally-disposed persons in the present absence of safeguards. I trust I have said enough to show your Lordships how essential it is that the public should have means of distinguishing efficient nurses from criminals who pose as members of a profession to which they do not belong and on which they bring great discredit and shame.
Next, my Lords, I have to tell you who make this demand for legislation. It is, in the first place, practically the whole of the organised body of the nursing profession; secondly, practically the whole of the medical profession; and, thirdly, a number of important bodies concerned with women's work. I am quite prepared to substantiate this statement, but in 1194 view of my undertaking not to occupy very much of your Lordships' time I trust it will be taken for granted. The position is this. The number of nurses in this country has been variously estimated, and there is no certain information, just as in the case of the horses we have been discussing. But what is quite certain is that, of the total number of nurses, nearly all those who are organised in leagues and associations have expressed themselves in favour of State registration. The number who have so declared in favour of this policy is about 10,000. I have the whole of the details here, but as I trust that the assertion which was made on the former occasion that the movement was really got up on the principle of a stage army—a most unfair and unjustifiable statement—will not be made again, I will not use my figures unless I am obliged to do so. Then there are a great many nurses who do not belong to leagues and associations, and who have individually expressed themselves in favour of legislation. Scottish nurses are not organised, but it is well known that they have complete confidence in a very representative body called the Scottish Registration Committee. Lastly, I should like to point out that a great many nurses are not free to give an unbiassed opinion on this subject, and have therefore remained silent.
I said that practically the whole of the medical profession are in favour of it. The General Medical Council pronounced in favour of the principle of State registration so far back as 1889, and the British Medical Association, which is composed of 21,000 medical practitioners—about two-thirds of the whole profession—has passed formal resolutions in favour of State registration on three occasions—in 1895, in 1904, and in 1906. The most important of those votes was that which took place in 1906, when ninety out of ninety-three Members present voted for the resolution in favour of State registration, and that was after two years consideration of the subject in the constituencies which were represented at the meeting. I think that fact fully justifies me in saying that practically the whole of the medical profession are in favour of the State registration of nurses. Then I mentioned that there 1195 were a number of important bodies engaged in women's work who supported this Bill. I refer to the Asylum Workers Association, the National Union of Women Workers, and the Women's Industrial Council. The Committee of the House of Commons took exhaustive evidence, and on the question of principle expressed themselves as follows—Your Committee are agreed that it is desirable that a register of nurses should be kept by a central body appointed by the State.That opinion, I understand, was endorsed by the Lord-President of the Council, speaking with all the responsibility of head of the Department particularly concerned. There is yet one more reason which I should like to urge before I go on actually to the Bill, and that is that midwives, whose training is infinitely less than that which is required of a skilled nurse—a matter of two months as against three years—are already registered on precisely the same principles as those advocated in this Bill. What is the opposition? I do not think I need go over that ground, as the opposition was, I think, fully disposed of by your Lordships' vote—a vote of three to one, I think it was—on the Official Directory of Nurses Bill.
I will, therefore, go on to explain, in a very few words, what the Bill actually does. I may say that the Bill has been five times before the House of Commons, and it has been backed by Members of every Party, but owing to ill-luck it has never gained a place in the ballot and has therefore never come up for Second Reading. The actual scope of the Bill, as to which I find there is a certain amount of doubt, is very well defined in the preamble—Whereas it is expedient that persons requiring nursing assistance should be enabled to distinguish qualified from unqualified nurses.The Bill really does not go beyond that. It enables the public to distinguish qualified from unqualified nurses, and that is no less an advantage to the public than it is to the nurses themselves. Then you will see that there are certain temporary provisions in Sections 3, 4 and 5; they provide for a temporary or provisional council to register persons already in practice as trained nurses in order that a constituency may be formed 1196 which would elect representatives of the nursing profession on the regular council. The most important of the permanent provisions is Section 6 which proposes that a council should be incorporated by the name of the general Council of Nursing Education and Registration of the United Kingdom.
I hope it that is not necessary to go any further into detail. I have heard it suggested that the actual composition of the council which is proposed might be the subject of criticism, but I venture to think that that is a matter of detail which really does not affect the principle of the Bill, with which alone we are concerned at the present moment. But I might say, parenthetically, first of all that the number of representatives has been reduced from thirty-one, as it appeared in the original Bill before the House of Commons, to nineteen. This was done in deference to the views of the Select Committee of the House of Commons. Secondly, it has to be borne in mind that three classes have to be represented—the nurses, the medical practitioners, and the public. At the same time it is necessary to provide representation for England and Wales, for Scotland, and for Ireland. I think, however, that the exact proportion of representatives of each class, and the adaptation of that representation to the three countries, is a matter which can be discussed in Committee if your Lordships are good enough to allow the Bill to proceed so far.
I will only reiterate that the question which is before us is simply this, whether the State shall do for nurses what it has done for kindred professions, and enable the public to distinguish the qualified from the unqualified. I should like to explain, in view of another possible misapprehension, that there is no desire—and I am advised there is no possibility as the Bill is drafted—to interfere with the liberty of contract between the sick and any person attending them for hire. All that the Bill would do, or could do, as it is at present drafted, is to protect the title "registered nurse" for the use of those who have attained a minimum standard as defined by the authority. I trust I have said enough to induce your Lordships to give a Second Reading to 1197 this Bill, and thus, I venture to think, to give encouragement to that noble profession in which women display from day to day skill, courage, devotion to duty, and self-sacrifice well comparable with those of sailors and soldiers in times of danger and warfare, and in which they set an example to our race of the highest qualities of Christian humanity.
§ Moved. "That the Bill be now read 2a."—(Lord Ampthill.)
My Lords, I do not know whether the noble Lord who introduced this Bill has any figures with regard to the total number of nurses that exist and the number whom it is anticipated will become registered under this Bill. It is very desirable that the idea should not get about that anyone is good enough to nurse the poor, and that we only want to register a small class of nurses for the hospitals and the upper classes. That is one of the dangers of the provisions in this Bill, and it is one of the points which will have to be carefully guarded against.
§ LORD AMPTHILL
I beg the noble Lord's pardon for interrupting him. I thought I had answered his objection in almost my last sentence, when I said that the Bill was so drawn that it could not interfere with liberty of contract between the sick and those whom they engage to attend upon them. Therefore, district nurses and Poor Law nurses would not be affected at all. It would be a case of registering nurses with a certain standard of qualification and not of interfering with others.
Many of those interested in district nursing feel strongly that in the case of that class of nurses, who, for all practical purposes, are fully qualified nurses and do their work thoroughly well, it would be very hard for them to be described as "unqualified." The difficulty will be increased of raising funds for district nursing if the district nurses are, under this Bill, to be "unqualified"; and, if they receive the necessary training to become registered, they will be less qualified than they are at present to do a great deal of the district nursing work. Many of those 1198 who have obtained the higher class of training are not equally as qualified as they were before for doing this kind of work and for looking after the poor in their homes. I do not wish to oppose the Second Reading of this Bill, but I think that when we come to details there will be many matters to be considered. It would be very hard upon the class to whom I have referred, and who do very valuable work, if they were described as unqualified, and I hope before the Bill leaves your Lordship's House steps will be taken to prevent these disadvantages and disqualifications being put upon a very deserving class of women.
§ THE EARL OF CREWE
My Lords, it is a little unfortunate that a subject of this considerable importance should have come before us in such a thin House, because I do not think that the numbers here present correctly indicate the interest which is taken in the subject. But the fact does, I think, add greatly to our difficulty in arriving at a conclusion as to what course we ought to take with regard to this Bill. This question of registration has, as we all know, been before the country for some considerable time. The principle was approved by an important Select Committee which was held on the subject, and in considering the whole question we ought to bear the fact in mind that the Report of the Committee did undoubtedly approve of the principle of the registration of nurses.
When the matter came before me two years ago when I was Lord President. I said, in reply to a deputation, that I did not think it would be much use attempting to proceed with the matter until there was some practical unanimity among nurses themselves, and also—which was of equal importance—the medical profession as to the manner in which the thing could be done, because it is one thing to approve of the idea of registration and another thing to attempt to put it into practice. I do not know, and I have no reason to suppose, that that requisite degree of agreement has been arrived at. The noble Lord who proposed the Second Reading of the 1199 Bill spoke of the practical unanimity of nurses. I have no doubt that a very considerable majority of nurses are in favour of registration, and would undoubtedly be in favour of the kind of registration in this particular Bill, because it gives nurses practically the entire control of the council with a small sprinkling of the medical element. But when we come to the medical profession, I take it the case is very different.
The noble Lord said that the medical profession were practically unanimous in favour of the registration of nurses. When this matter was before the Select Committee a protest was made by a number of people, including several hundred doctors, against the principle of registration, among them being Lord Lister, Dr. Allchin, Sir James Reid, Sir Thomas Barlow, Sir William Bennett, Dr. Watson Cheyne, Dr. Ferrier, and a great many more, and there was a second list including a great many other extremely well-known doctors. Therefore to talk of the practical unanimity of the medical profession on the subject seems to me to be going considerably beyond the mark.
I do not think that this matter ought to be by any means dismissed, because I believe that a very considerable majority of the nursing profession do desire to see some form of registration, and I quite agree with everything the noble Lord said as to the deference we ought to pay to the members of so honourable and respected a profession. What exactly the nurses are going to get out of this particular form of registration is another matter. The noble Lord on the cross benches drew attention to the fact that a considerable number of nurses who really cannot be called untrained or incompetent would have something like a stigma put upon them by this Bill, and the Local Government Board no doubt would have something to say also on that subject with regard to the nurses whom they employ. Then the noble Lord spoke of a case where two women were charged with murder and were afterwards hanged, and in connection with which placards were displayed, in the street announcing: "Nurses charged with murder." No amount of registration will prevent that. 1200 You will not be able to confine the title of nurse to these particular registered ladies. There is no penalty in the Bill for any woman calling herself a nurse or wearing the uniform of a nurse, and therefore, I am afraid the profession will not escape that unfortunate possibility, to say nothing of the fact that if a person was going to commit murder the fact that she had been trained for three years in a hospital would not prevent her doing so.
But there is another side to this question, and that is the interest of the public in it. The other day, as your Lordships remember, a Bill for establishing a Directory of Nurses was thrown out on Second Reading by a very considerable majority. Looking at this matter, as I think I do, impartially, I am bound to say that, so far as the public is concerned, this registration will not be of much more, if of any more, value than the lists of names in a Directory. Unless you can devise some means for ensuring a continual guarantee of the efficiency and character of a nurse, the mere fact that she passed certain examinations a certain number of years ago is not much use to the patient who is going to engage her. So far as it is of any use, that bare knowledge would be equally well supplied by the Directory. That is a very important, and, I think, a very crucial point in connection with this Bill. No attempt is made, so far as I can see, in this Bill for anything to be done beyond a statement of the fact that a nurse has at some time or other been efficiently trained, and she is asked to pay £5 for that statement. It is also true that if she is convicted, or appears in the Divorce Court, or does something which brings her name prominently before public notice, she will be struck off the Register, but there is no guarantee that she has not gone downhill in other ways, that she has not lost her efficiency or even her character, and therefore the public must realise that if anything of this kind be done there is no more guarantee of the conduct or even of the capacity of the nurse at the moment at which she is engaged than the fact that she passed certain examinations, five, ten or fifteen years ago. Therefore, from the public point of view, the Bill does not seem 1201 to me to do very much, more than the Directory Bill did which your Lordships refused to consider.
Under these circumstances, my Lords, I confess I rather question whether at this period of the session it is worth while to read the Bill a second time. I have no kind of hostility to its principle, as I have often said, and I should like to see it carried into effect; but I have a certain abhorrence of the practice of reading Bills a second time in this House when there is no prospect of continuing them, more especially in such a very thin House as there is here to-night. I think we ought to demand a little more evidence of the interest of the House in the subject before we can pledge the House of Lords to a certain extent, because it must not be forgotten that a Second Reading, after all, does mean something, to the principle of the Bill. In that matter I am very much in your Lordships' hands. I certainly should not desire to move the rejection of the Bill; far from it; but under the circumstances I confess I question whether your Lordships would do wisely to read the Bill a second time to-night.
§ THB MARQUESS OF LANSDOWNE
My Lords, I entirely agree with the noble Earl that the condition of our Benches this evening is not favourable to the final discussion of so important a question as that with which this Bill deals, but I think I should use that rather as an argument against the summary rejection of the Bill. On the other hand, I think if your Lordships decide to give a Second Reading to the Bill we are entitled to claim that in doing so we are by no means committed to an acceptance of the full scheme which is embodied in it.
Speaking for myself, and for myself only, I may say that I am upon the whole in sympathy with the main object of my noble friend behind me. The principle of his Bill amounts, as I understand it, to no more than this, that he desires to afford to the public some means of ascertaining whether a woman who calls herself a nurse has or has not obtained at any rate a minimum of experience and training in her profession. That seems to me to be reasonable, both from the point of view of the nurses, 1202 and from the point of view of the public who employ them. What are the alternatives before us? We may leave things exactly as they are at the present time. I must say that a strong case has been made for the view that the present condition of things, under which the public has no guarantee whatever as to the fitness of a person who calls herself a nurse, is very unsatisfactory. Then we have the alternative embodied in the Directory of Nurses Bill, which your Lordships rejected for reasons which were fully stated at the time. There remains the third course, that of registration, and that has certainly received a good deal of official encouragement from the medical profession and from the nursing profession itself.
The noble Earl said with some force: "What is the value of the kind of registration which this Bill contemplates?" I certainly should not over-rate its value, but I think it is worth something. It is not a complete guarantee of the nurse's qualifications, but it is a guarantee of something. It proves that she has, at any rate, during her life acquired the ground-work of a knowledge of the most important elements of her profession, those elements which are really most indispensable to the proper performance of her duties. It is perfectly true that registration affords no guarantee that the nurse possesses those other qualities for which we look, and so often look not in vain, in members of the nursing profession; but, then, surely it will be just as possible for people after this Bill has passed, supposing it to pass, to satisfy themselves as to those other points—as to the nurse's character, demeanour, and so forth—as it is at the present moment for them when they employ a nurse who has no certificate and has never been registered. I think moreover it may be fairly argued that those technical attainments without which a nurse would be unable to obtain a certificate are, in fact, those which are most indispensable for her efficiency.
The noble Earl says that the nurse's certificate would not be a guarantee of her continuing fitness. This is perfectly true, but it does not profess to be a guarantee of her continuing fitness. What it professes to show is that she has 1203 at one time acquired that groundwork of knowledge upon which my noble friends insists. What, then, are we to do with this Bill? I should, I confess, be very sorry if we were to reject it. The idea of taking a division upon so important a subject in so thin a House as this seems to me almost out of the question. I cannot help thinking that the proper course, in the circumstances, is to give the Bill a Second Reading, upon the assumption that by doing so we are committed to no more than what I would call the bare principle of the measure. There will be other opportunities of discussing points of detail in Committee, and there will be another opportunity, of which we in this House very often take advantage, for a further discussion upon the Motion to go into Committee. If, therefore, your Lordships are good enough to desire to know my opinion, I would venture to suggest that my noble friend's Motion should not be opposed and that we should reserve to ourselves the right to continue this discussion under more favourable circumstances.
LORD STANLEY OF ALDERLEY
My Lords, I do not rise to discuss this Bill. There is much to be said in its favour, and much to criticise; but I would suggest to your Lordships, in view of the time and the state of the House, that the debate should be adjourned. If a division were challenged the number of Peers present is too small to allow of a division being taken, and what would happen would amount to what in the House of Commons would be called a count out. I should have been glad myself to have said a little on the motion for the Second Reading, and I would urge that the debate should be adjourned. I will formally move that, but if the feeling of the House is against me, I will not press the motion.
§ Moved, "That the debate be adjourned."—(Lord Stanley of Alderley.)
§ LORD AMPTHILL
My Lords, on that motion I should like to say that it would seem to me a pity to adjourn the debate. I cannot see what the object 1204 of that course can be. I have not heard of anybody else who was desirous of speaking on the Second Reading, but, as the noble Marquess the Leader' of the Opposition said, there will be further opportunities of discussing the Bill, both on principle and in detail. If there were any appreciable number of Peers who wished to speak I should be entirely for an adjournment, but I think in all the circumstances, the best course would be to allow the Bill to be read a second time to-day.
THE EARL OF MAYO
My Lords, I think we might get over the difficulty by adopting the suggestion of the noble Marquess the Leader of the Opposition. As we are allowed, I understand, by the rules of the House, to make Second Reading Speeches on the Motion to go into Committee, I think that covers the ground, and that we might very well accept the bare principle of the Bill to-day. I should like to speak upon the Bill myself, as it will affect the district nurses in Ireland.
§ Motion for the adjournment, by leave, withdrawn.
§ On Question, original Motion agreed to. Bill read 2a accordingly, and committed to a Committee of the Whole House.