§ Order of the day for the Second Reading read.
LORD BALFOUR OF BURLEIGH
My Lords, although no proposal for 179 legislation on any of the subjects connected with the Bill of which I rise to move the Second Reading to-night has been before your Lordships, I am quite certain that to the majority of the House the general questions affecting the subject must be perfectly familiar. Many of your Lordships are connected with London hospitals and others in the country, and I shall assume that those who are so connected have followed the discussions which have been taking place on this subject during the last year or two.
There are certain admitted evils—or shall I say disadvantages?—incident to the present position of matters, and as to those evils and disadvantages those who are in favour of the method of dealing with them which is put forward in this Bill and those who are in favour of a more drastic and more ambitious scheme of registration will probably be found to be in more or less general agreement. Each of the schemes is supported by high authority. Those who are in favour of a scheme of registration have placed their views in the form of a Bill and introduced it into the other House of Parliament; but, as there seemed to be no prospect of securing even a discussion upon the subject, those for whom I am acting thought that it would not be unreasonable that a discussion should be raised in this House. We have high authority for that suggestion, and I am rather surprised that those who are apparently preparing to oppose the Bill should think it worth their while to make a point of the fact that there has been no public discussion, as they describe it, concerning the proposal which I put before the House.
I understand, although I have not seen an actual copy of it, that a summons to oppose the Bill has been circulated to many of your Lordships by the noble and gallant Field-Marshal whom I do not see in his place on the cross benches, and by one or two other peers. It seems to be made a grievance that we should introduce this Bill when there has been no public discussion upon it, but it is for the purpose of securing a public discussion before and by what I believe to be on this matter a perfectly impartial Assembly that those who have advised me have suggested the introduction of 180 this Bill; and, as I said a moment ago, we received a hint from a high authority that this might not be an unwelcome method of procedure. There were deputations to the Lord President of the Council, now the Leader of the House, two years ago, both from those who are in favour of registration and from those who favour the less ambitious scheme which I am advocating to-night; and, in the course of his reply to the deputation of those who are in favour of a Directory, the noble Earl said—There was, or shortly would be, a Bill for the registration of nurses before the House of Commons. He did not know whether the present deputation thought of placing their views before Parliament in a similar way. If so, he supposed they would introduce a Bill empowering the Privy Council to start a Directory.Later on in his speech, after mentioning that there was little time available in the House of Commons, the noble Earl said that the House of Lords was open to discussions of such a nature. That was a hint given to a large and influential deputation, and it does not seem to me unnatural that it should have been acted upon. I may mention that this deputation was composed of persons of no less authority than Sir Thomas Barlow, Sir Frederick Treves, the Duchess of Bedford the Marchioness of Salisbury, the Countess of Pembroke, Lady St. Aldwyn, and the matrons of the following hospitals—London, St. Thomas's, King's College, St. Mary's, Seamen's, St. Marylebone Infirmary, Derby, Bristol, Oxford and Cambridge. It cannot, therefore, be said that even amongst those who are interested in the nursing profession the Bill which I have placed on the Table is altogether without authority.
As I have said, those who are in favour of what I have described as the more ambitious, and, perhaps, even the more complete, scheme have placed their views before the other House of Parliament. I am prepared to give, without the slightest reservation, the fullest credit for the best intentions to those who differ from those whom I represent on this subject. I wish that I could think that our good intentions are equally believed in by those on the other side. I wish, before I sit down, to show your Lordships that we have, I think, some reason to complain of the sort of imputations of 181 bad motives which have been freely circulated amongst some of your Lordships. Now, what are the existing circumstances? What are the evils which those who support both of these schemes are anxious to remedy? There are certain evils and certain disadvantages at present existing, and we hope to remedy those and to gain certain advantages. There is a difficulty undoubtedly felt by large sections of the public and by the medical profession in no small degree on the ground that they cannot easily ascertain the competence of nurses whom they may wish to engage. They cannot find out very easily what are their special qualifications, and whether they are in particular specially suitable for the class of case which may be under consideration at the moment.
I suppose it is generally the case that the medical profession are more or less responsible for recommending the nurse for the case which may be in hand. Sometimes the nurse has to be summoned suddenly; at other times, in the case of an operation or something of that kind, there is opportunity for inquiry and consideration. But the difficulty which is felt is this, that after the nurse has left the hospital where she has been trained, after she has, so to speak, set up in business either for herself or in one of the numerous co-operative societies, there is at the present time great difficulty in ascertaining what are her real qualifications or experience. Now it seems an elementary right that the public should have an opportunity of conducting their own investigations. The Bill, the Second Reading of which I am moving to-day, provides that there shall be a Directory, as it is called, on which shall be inserted such particulars as the Privy Council may think necessary, and which will be, we hope, an accurate statement of facts upon which those who want to make inquiry can proceed. All that is suggested is that there shall be a clear statement of facts, and that it shall be put forward on official authority. We want to know what are the qualifications of the individuals who pose as nurses, and for what they are competent and for what they are not. I venture to say that, so far as the nursing profession is concerned, that must be a benefit to those who have satisfactory qualifications, and 182 to a certain extent, equally, it must be a disadvantage to those who have not satisfactory qualifications; but it seems to be perfectly legitimate that those who have qualifications and choose to enrol themselves on the Directory should get the advantage of the qualifications they possess.
I now come to the first point where I think there will be a divergence of opinion. Nurses may be unsatisfactory from more than one cause. Speaking generally, they may be unsatisfactory on account of their not having sufficient professional qualification. That is a thing which you could remedy either by a directory which gives the qualifications of the individual, or by a register upon which the nurse's name is entered. But there is this difference between the two schemes, that, although I do not suppose those who favour the registration scheme mean to do it, it is almost, I think, unavoidable that the fact of the name being on a register, with qualifications set out, with penalties upon those not registered, would almost certainly lead the public to believe that there was a guarantee of the fitness of the nurse, and a continuing guarantee, not only of her fitness, from professional qualification, but of her personal character and suitability for employment. The other point raises great difficulty. It is easy enough to certify and put in definite language the qualifications of the nurse so far as training is concerned, but it is not easy, in fact I go so far as to say it is impossible, to set forth upon a register the personal aptitudes of the lady. As between these two schemes the question is really one of degree.
Is it possible at the present time to have a register of nurses analogous to that of medical men, dentists, and so on, and to say that there shall be penalties against those who, not being on the register, practice as nurses? I venture to say it is impossible. I do not think it would be possible in the near future; I am certain it is impossible at the present time. I quote as a witness for that view the noble Earl to whom I have already referred, who, in answering a deputation in favour of a registration scheme, used these pregnant words—The history of the demand for registration showed that it was not seriously suggested 183 that registration of nurses should be compulsory. It would be impossible, for instance, to make the giving of a glass of barley water a criminal offence.That is an extreme instance, but it is what, in fact, it would amount to if you attempted to lay down a rule that only those who are registered with a certain minimum of training shall set themselves forward to act as nurses in any capacity.
It is commonly suggested that those who take the view which I represent to the House have no nursing or professional authority behind them. I hold in my hand a Paper that was presented to the Select Committee of the other House of Parliament which sat on this subject a year or two ago. This Paper has two lists of signatures. Upon the first list there are 33 matrons in London hospitals and 60 matrons in various hospitals and infirmaries throughout the country, and there is a second list of 71 matrons of hospitals all over the country, or more than 160 matrons of hospitals in all. There are also the names of many well-known medical men and others besides. I need only mention one or two. I quote the names of Lord Sandhurst, the chairman of a London hospital; Lieutenant-General Lord Methuen, Lady St. Helier, and others. There are also Lord Lister, Sir James Reid, Sir Thomas Barlow, Sir Dyce Duckworth, and, amongst those who have taken an interest in the nursing profession, though not themselves engaged in it, the Marchioness of Salisbury, the Marchioness of Lansdowne, the Countess of Pembroke, Lady Francis Balfour, and many others. Now, what is their testimony? They say this—Inasmuch as any system of registration must be based on the results of testing by examination the technical capabilities of a nurse, it of necessity raises to a predominant position this side of her work, and leaves entirely unconsidered those personal qualities upon which her main value depends, such as good temper, manner, tact, discretion, patience and unselfish womanliness. It is these characteristics which cannot be ascertained by examination, and which no system of registration can include. The experience of those concerned in the training of nurses and supplying them to the public, shows that it is the want of these qualities in a nurse which gives rise to complaints on the part of patients and their friends. It is seldom that a want of adequate technical training is the ground of fault-finding. Moreover, it is the difference in the comparative value of the technical skill 184 and the personal qualities in the making of a nurse which constitutes the essential difference between her and a doctor as regards the applicability of a system of registration, and renders the analogy, so often made, entirely fallacious.And again they say—Those who realise that the ultimate success of a nurse must depend upon her personal suitability for her work already deprecate the growing tendency to attach undue importance to the passing of examinations at the expense of the cultivation of those qualities of power of observation, of sympathy, cheerfulness, and self-control, without which the services of a technically-trained nurse can never be acceptable to a patient.I apologise for reading so long a quotation, but it puts the point which I want to make so much better than I can put it myself, It puts it on the high authority of those whose names I have mentioned, and it seems to me to sum up the point of contention between the advocates of the two schemes in a way upon which it would be impossible to improve. I feel the danger of putting too much stress upon mere examination. Therefore, my point would be this, that, however elaborate your system of registration, to whatever extent you can raise the minimum qualification for a place on the Register, there will still remain the necessity for careful personal inquiry, while you will not get over the danger that a State Register involves a certain amount of guarantee and control which a mere Directory does not pretend to provide and will not seem to give. I think I may fairly say that any uniform test of training at the present time is impossible. Public opinion is ripening. The training is getting better and better by a natural process of evolution. For surgical cases, for intricate medical cases, you require the highest training, but there are many classes of cases and many women at present engaged in those cases who are perfectly fit for the work they are doing and to whom it would be a grievous injury and a great handicap if they had the slur cast upon them of not being upon the Register because they had not a certain minimum of training which some people think is essential.
I turn to the question of what is to be said against the proposal which I make. I am quite aware that the Select Committee of the House of Commons passed a bare and abstract recommendation in favour of a system of registration. They 185 had full evidence before them, but they do not themselves in their Report, I think, in any way at all, certainly in any adequate manner, attempt to outline the scheme of registration which they recommend. There is no attempt in the Report of the Select Committee to meet the difficulties which I have put before you on the authority of the ladies and gentlemen whose statement I quoted. There have been letters sent and resolutions passed, of which, I have no doubt, your Lordships have received a great many. They take, in the main, two points. First, that those who are recommending this Bill are a mere association of employers, and that they have not consulted the ladies themselves. I think I have disposed pretty largely of that contention, for I have shown you that a large proportion of those who are interested in the nursing profession are in favour of the scheme in this Bill rather than the other one; and it will not do to say, when I can produce evidence such as I have done of those who went on the deputation to the Lord President of the Council, and those who have signed and committed themselves to this statement, that the authority of the nursing profession is entirely upon one side.
It is made a grievance that in this Bill no ladies are associated with the Privy Council in the formation of the Directory. All I can say is that so far as I am concerned, and so far as those who advise me are concerned, if that will get over the obstacle, and if the Privy Council are willing to consent, there need be no difficulty on that head. But extravagant ideas have been promulgated as to what it is we propose. I received a printed paper yesterday from the Society for the State Registration of Trained Nurses. They object to the Bill for three reasons. The first is that—It has been privately promoted by the Central Hospital Council for London without consultation with the class for whom it is proposed to legislate.I should like to say that I am not sure whether you can find out adequately at the moment what is the opinion of the class for whom it is proposed to legislate. I venture to suggest that as a preliminary step to that end such a Directory as is suggested in this Bill would 186 be most useful. I have not been able to find out how many trained nurses there are at present in this country. Some people say 20,000, others put the number as high as 60,000. So far as I can gather, at the most not more than 5,000 have joined the associations who are representing the opposition to this Bill.
The second reason for which the Society for the State Registration of Trained Nurses object to this Bill is that—It affords no guarantee of a nurse's efficiency to the public, as no minimum standard of professional knowledge is required.I have dealt with that point to the best of my ability. The third reason is that—It makes no provision for a central governing body upon which trained nurses are represented, and which would maintain standards of education and discipline as required in the Bill promoted by this Society, and now before the House of Commons.I suggest that you must walk before you can run, and that this Bill is as far as you are likely to be able to go in the present state of public opinion. Even if I am wrong, I believe it to be an essential preliminary for such a proposal as the other one I have mentioned, because I do not believe that in these days Parliament will legislate so as to put control or regulations upon a body such as the nurses unless they find out in some way or another what their feelings on the subject are.
I should like to read one letter as a test of the sort of communication which has come to me. I have two or three dozen of them and it is pretty plain that they have been engineered from a common centre. They are not in a sense spontaneous; they are not absolutely in the same terms, but they go over the same ground with such slight variation that it is perfectly evident that au organised attempt has been made to get as man representations as possible put forward. Here is a letter dated from the Swanse General and Eye Hospital—As a trained nurse who is keenly interested in the training of sick nurses I beg to protest against the Bill which has recently been introduced to provide for the establishment of an official directory of nurses. Such directory would be a danger to the public and an obstacle to progress in the training of nurses, since it fails to provide for a minimum standard 187 of certification and would place the trained and the partly-trained nurse on the same level. Moreover, we are a large body of skilled workers, and we may surely claim the right to have a voice in a matter which so nearly concerns us. We are more keenly interested in maintaining a high standard of efficiency and conduct in our ranks than it is possible for any lay officials to be. We therefore think that it is only right and politic to demand that we should be well represented on any central board or council which may be formed for the purpose of organising or controlling our profession.In the first place I am not proposing a body which is to organise or control the nursing profession. I am proposing a means by which the public and the medical profession can get the information to which they are entitled. I have dealt with the question of a minimum standard of certification, and I deny that the proposal made in this Bill would in any shape or form place a trained nurse and a partly-trained nurse on the same level. It is to prevent their being on the same level, it is to give the medical profession and the public the opportunity of discrimination which they have not now, that I propose this Bill. No one can object to the tone or the temper of such a letter as that, but I do suggest that it proceeds from insufficient information as to the real scope and object of the Bill.
I am afraid I cannot give the same praise to the letter which I am now about to read. It was not written to me, but to an official of the Central Hospital Council, for whom I am to some extent acting. It contains the sort of imputation upon our motives which I think we have a right to resent. It states—The intolerable tactics of the few men who control the Central Hospital Council for London to subject the whole nursing profession to the status of serfs in the body politic will be strenuously and determinedly opposed. Autocracy, subterfuge, and sweating, rampant in connection with the nursing departments of some hospitals, will be resisted by the organised nurses of the country. Quite frankly, they do not intend to submit to any form of official tyranny, as embodied in the privately promoted legislation of the Central Hospital Council; and it is a serious scandal that a few employers of nurses should have attempted such an outrage.I do not grudge the lady the pleasure which it must have given her to write this letter, but I do suggest that some, at any rate, of the adjectives and attri- 188 butes employed are a little in excess of what the actual requirements of the case seem to me to render necessary.
I can assure your Lordships that those who have promoted this Bill have done so with a genuine desire to put the noble profession of nursing upon a better footing than it occupies at the present time. I can truly say that we desire the co-operation of all who will give it. At the worst, as I have said, it would pave the way for more, and you would know really once for all to whom to appeal for their opinion. You cannot, in my opinion, make any scheme, whether of this kind or of registration, compulsory. All you can do is to appeal to the personal advantage of those concerned. I believe honestly that this Bill would be found to the advantage of those who are best qualified to have their qualifications set forth. I put it forward as a step in advance compared with the present position of matters. I believe it is as long a step as public opinion will allow you to take at the present time. You may possibly set up a fixed standard with a minimum qualification by-and-by, but to attempt to do so now would, in my opinion, be productive of grave injustice. Whether this House accepts the Second Reading or not I have done by best to explain clearly the objects of the Bill, and I ask your Lordships to give it a fair and dispassionate consideration, and to judge of it on its merits.
§ Moved, "That the Bill be now read 2a."—(Lord Balfour of Barleigh.)
§ *LORD AMPTHILL,
who had given notice on the Motion for the Second Reading, to move that the Bill be read a second time this day six months, said: My Lords,. I regret very much, on personal grounds, to stand in the way of my noble friend, whose intentions I do not doubt are as benevolent as they are disinterested and straightforward. I gladly pay him the compliment which he sought, but I do not know that I feel inclined to pay a similar compliment to those who have persuaded him to espouse their cause. I must confess, however, to some surprise that the noble Lord himself has been willing to espouse yet another losing cause, and that his 189 chivalrous knight-errantry has brought him to take up a case of this kind. It is also to be regretted that his adherence to the Cobdenite doctrine of laissez faire extends so far that he would refuse to a great profession and to the general public that protection which has become an established principle of legislation, not only in this country and in the Colonies, but also in a great many foreign countries.
But perhaps your Lordships will allow me first of all to explain my own position, for reasons which I think will be apparent. Although I am associated with hospital work and with the organisation of the nursing profession, as chairman of a county hospital and president of the Colonial Nursing Association, I am not the mouthpiece of either of those bodies. Nor am I the spokesman of any association or organised body of individuals. I am acting in accordance with what I conceive to be my duty as an ordinary Member of this House. On account of my frequent intercourse with medical men and with nurses I happen to know the facts. I became keenly alive to the strong feelings of indignation and resentment excited by the introduction of this Bill, and it seemed to me that even a provisional approval of the principles of the Bill would discredit your Lordships' House certainly in the eyes of two great and important professions. I realised also that what is everybody's business is very frequently not the business of anybody in particular; and having waited to see whether any Member of this House would undertake to oppose the Bill, and having waited for a while in vain, I deemed it my duty to show that there were those in this House who would take action in a matter of this kind without being solicited by interested parties. I trust that after this explanation I shall be absolved from any charge of having exceeded the bounds of modesty, or of having violated the custom of this House which enjoins reticence on those who have no special claim to speak on a subject.
This Bill is objectionable in two ways—it is objectionable in matter and it is objectionable in manner. The substance of the Bill is objectionable, and the manlier in which it has been introduced is objectionable; but your Lordships will, 190 of course, understand that I am very far from referring to the impressive eloquence and the courteous dignity of my noble friend who moved the Second Reading. In order to prove these two contentions I must do what the noble Lord omitted to do—namely, briefly relate the antecedent circumstances. A movement to obtain the State registration of nurses was initiated some twenty years ago, and during the time that has elapsed it has received the support of an overwhelming consensus of opinion on the part of the medical profession and of practically all the organised bodies of nurses. The noble Lord endeavoured, I think, to throw dust in your eyes by quoting a certain number of names of individuals who supported his Bill, but I would call attention particularly to the fact that he was not able to quote the approval or support of any single organisation either of medical men or of nurses. He hinted vaguely that he was acting for certain persons who could claim high authority, but he did not give you their names.
Now, my Lords, I will do what the noble Lord has not done. I will tell you exactly by whom the principle of State registration is approved. It is approved, in the first place, by the General Medical Council, the governing body of the medical profession in this country; it is approved by the British Medical Association, a body which, I think, contains a greater proportion of members than the organisation of any other profession, for I believe I am right in saying that out of 30,000 medical practitioners no fewer than 21,000 belong to the British Medical Association. At the annual representative meeting of the British Medical Association in 1906 the principle of State registration was approved by a vote of 90 out of 93, and I would call your Lordships' attention particularly to the fact that this was not the vote of an executive committee or a general council, but the vote of representatives of constituencies in all parts of the country. The Royal College of Physicians of Ireland have also approved of the principle of State registration, as also have the International Council of Nurses, the Matrons' Council of Great Britain and Ireland, the Society for the State Registration of 191 Trained Nurses, which has a membership of 2,000 and represents the opinion of a great many more the Scottish Registration Committee, the Royal British Nurses Association, the Irish Nurses Association, the League of St. Bartholomew's Hospital Nurses, and the Fever Nurses Association. I think I have now exhausted the names of the principal medical and nursing associations, but there has been support from other influential quarters. The Asylums Workers Association, the National Union of Women Workers, and the Women's Industrial Council are all on the side of those who advocate State registration. My noble friend quoted a few individuals, and I am sure your Lordships will know what weight to attach to the argument to which he was driven when he attempted to excite prejudice by reading to you a letter from some individual matron whose feelings on the subject had become too much for her. But I will leave that alone and proceed with my history of this question.
This principle of State registration, which is supported practically by the whole of the organised opinion of the medical and nursing professions, obtained the approval, in 1905, of a Select Committee of the House of Commons, which took exhaustive evidence. My noble friend went so far as to insinuate that the verdict of that Committee was vague and inconclusive. He suggested that they advocated some sort of registration. The opinion of the Select Committee was very definite indeed, and, with your permission, I will quote exactly the form which their recommendation took. They said—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 is the whole point—"by the State." That shows exactly the issue between the advocates of State registration and those who have persuaded my noble friend to introduce this Bill, which is actually hostile to that principle of State registration. Two Bills to carry out the principles approved by the Select Committee of the House of Commons are now before the other House, and their consideration has only been delayed by the ordinary causes which tend to retard even legislation approved, as this is, by 192 men of all parties and of all shades of opinion in the other House. Those two Bills are approved by the immense weight of professional opinion I have just quoted, and every one of those associations of doctors and nurses which I have named are strongly and earnestly opposed to the Bill now before your Lordships' House, because they regard it as deliberately, avowedly, and wantonly hostile to the principle of State registration which they have at heart.
Every day for the past month, since my noble friend gave notice of the Second Reading of his Bill, I have received resolutions from numerous bodies, which I will not delay your Lordships by naming, against this Bill, but I have not received a communication of any sort or kind expressing approval of my noble friend's. Bill. The reason is not far to seek. The advocacy of this Bill, which is in opposition to State registration, comes from a small group of individuals—I might almost say from one single individual, and their reasons for objecting to the principle of State registration have never been made clear, chiefly, I think, because they have been afraid to put them to the test of public discussion. My noble friend endeavoured to anticipate that argument, and affected to believe that the introduction of his Bill into this House would be the equivalent of public, discussion. But he must know perfectly well that what is meant by public discussion is a discussion among those who are most intimately concerned, and who are most likely to be affected by any intended legislation; and I think it has always been the custom in regard to legislation in this country that the opinions and the feelings of those who are likely to be affected, and who are most concerned, should be consulted before any Bill is introduced into Parliament.
The advocates of my noble friend's Bill, baffled by the verdict of the Select Committee of the House of Commons and also by the judgment of a Board of Trade inquiry held in 1905, found that a policy of mere resistance was useless, and therefore they assumed the offensive in the form of this Bill, and have inveigled my noble friend, I know not how, into undertaking the somewhat undignified 193 task of drawing a red herring across the scent of true legislation. It is not a compliment to this House that the attempt to draw off the legislative pack on a false scent should have been made here, but I trust that your Lordships will not be misled by the fact that so sagacious and trusted a leader of the pack is for once in a way "throwing his tongue" in the wrong direction. This Bill is in effect a blocking Bill—an anti-registration Bill, and that is why I object to the manner of its introduction. Another reason for objecting to the manner of its introduction is that nobody outside the inner ring of the small self-constituted body calling itself the Central Hospital Council for London has been consulted. The opinion of neither doctors nor nurses has been sought or obtained.
In these circumstances I might ask your Lordships to refrain from approving the principle of the Bill on the ground that it is not supported by any public demand, and that, on the contrary, it is objected to by a very large and influential body of public opinion. I might suggest that the right course for your Lordships to take would be to say that you would not spend time in discussing it unless and until it conies back with some show of public support. I think that that would be a fair and reasonable course to adopt in a case of this kind. But my task would not be complete unless I showed that the Bill was also objectionable in principle. The object of registering nurses is, of course, to protect the public and the nurses themselves. I need not take up your Lordships' time by explaining why that protection is necessary. The reasons must be familiar to most Members of this House who are so largely concerned with questions of this kind. It would be more appropriate to dwell on the necessity for that protection in discussing a Bill which proposed to give protection to the public and to the nursing profession; it is not so appropriate in discussing a Bill which is intended to deny that protection.
My noble friend objected to registration as a means of protecting the public and the profession on two grounds. The first of these was that you could not register the character of a nurse, and the second was that examination was no test 194 of character. I think that argument is very easily disposed of. It will be sufficient to remind your Lordships that the need for protection in regard to the nursing profession is similar to that which exists in other professions, and therefore the method adopted might very well be analogous. In the Medical, Acts, the Solicitors Acts, the Dentists Acts, the Pharmacy Acts, and the recent Midwives Act, uniform principles have guided legislation in this country and throughout the British Empire; and if it is an objection to the principle of registration to say that you cannot register the character of a nurse and that examination is no test of character, or temper, or tact, or any of those other qualities which my noble friend enumerated in his most impressive manner, it is also an objection to the legislation which has taken place for the registration of doctors, solicitors, dentists, chemists, and midwives. The main principle of that legislation has been to establish registers which guarantee the efficiency of the members of the profession, and I think it is fairly obvious that the same principle could be followed and should be followed in regard to nurses.
My noble friend's Bill does not provide in any way for the establishment and the maintenance of a proper standard of training and conduct among nurses, and that alone could adequately protect the public interest. It is for that purpose that the advocates of State registration, the promoters of the two Bills now before the House of Commons, propose the creation of a council having statutory duties and powers, subject only to the general control of the Privy Council, and not merely an advisory committee like that suggested by my noble friend. Again, this Official Directory of Nurses Bill does not provide, as do the Bills before the other House, for the proper representation of those best qualified to advise. It does not provide for the proper representation either of medical men or of nurses themselves. It ignores altogether the experience of those members of the medical profession who are not attached to hospitals, but who, nevertheless, have a greater practical familiarity than have the staffs of hospitals with the actual work of nurses in 195 those very circumstances in which the protection of the public is most needed.
The Bill in no way provides that the nurses themselves should be represented, and that their experience should have weight in determining the conditions of their registration. It does not provide explicitly for a Central Nurses Board, which would be following the precedent of the Midwives Act and the other Acts I have quoted, and it does not provide the essential test of a State examination. For these reasons I submit to your Lordships that the Bill would in no way remedy the evils which my noble friend admits to exist, and which it is the object of the advocates of State registration to remedy. It would be misleading to the public and useless to the nurses. There is yet one minor objection which I should like to point out. The Bill does not provide for an appeal on the part of a nurse who is erased from the register, and that kind of appeal could only be provided if you had a statutory body following the precedent of other similar bodies. I assert, in spite of all that my noble friend has said, that the promoters of this Bill have deliberately refrained from making any attempt to ascertain the opinion of any organized bodies representative of the medical and nursing professions. And why? I do not think the reason is far to seek. It is because they knew full well that they would not meet with any encouragement or support.
My noble friend referred to his daily letter bag. I, perhaps, may also be permitted to refer to mine. Every day for the past month I have received unvarying encouragement from every sort and kind of body and individual connected with the medical and nursing professions and interested in this question. I should be inclined to lay a very heavy wager that my noble friend has received very little, if any, similar encouragement. The object of this Bill is solely to put an obstacle in the true path of legislation—that is to say, legislation on the sound principles formulated by the Select Committee of the House of Commons, embodied in the Bills now before that House, approved by the two great professions concerned, and authorised by every kind of precedent in our own legislation and in the legislation of other countries and 196 our Colonies. The House of Commons have a prior right in this matter. They have taken the initiative, they have studied the question, and they have mapped out a course. I submit that we ought not to impede them without better reasons than those which have been shown by my noble friend. I conclude, as I begun, by affirming my humble opinion that it would discredit this House in the eyes of a very large and important section of the community if this Bill were even approved in principle, and therefore, I beg to move that it he read a second time on this day six months.
To leave out the word 'now' and to add at the end of the Motion the words, 'this clay six months.'"—(Lord Ampthill.)
§ LORD ASHBOURNE
My Lords, like my noble friend who has just spoken, I have received a considerable amount of correspondence and printed matter in reference to this Bill, and until I received these communications I had not directed my attention at all to the subject. I am bound to say that I have only received representations against the Bill. Not one correspondent has communicated with me in its favour. I regret that there should be this antagonism between two bodies of opinion on this important subject. I think it is desirable that a question of this kind should be settled by a common general understanding. The whole country is interested in seeing the nursing profession attain a contented and thoroughly recognised position; but if all proposed legislation is to be made the subject of acute contention, it is unlikely that any legislation at all will be passed. There must be a kind of common understanding. The nursing profession has increased and developed in such an extraordinary way that it commands our respect and wins our sympathy.
The noble Lord who moved the Second Reading of this Bill quoted the testimony of three or four highly placed and respected ladies. I fully agree that a nurse has to possess many qualities that cannot be tested by examination, such qualities as sympathy with and attention to the patient. The nurses have 197 struggled to improve themselves in the homes, in their education, and in their qualifications for the duties of their calling. They submit themselves to two, three, and four years of training, and have done everything that conceivably could be done to win public respect. Their final step is to urge that they are entitled, for their own protection and for the assistance of the public, to have a State Register setting out a full statement of their qualifications and under proper supervision. They ask that as a public-spirited body. They claim that they are entitled to ask the State to provide for them a method of registration that will be a protection for themselves and the public. I think there is a good deal to be said for that. The subject was dealt with by a Select Committee of the other House, and that Committee, after hearing the evidence and considering the case thoroughly, declared that the claim was reasonable and fair. I daresay that in time such a Bill may pass through the House of Commons and be presented to your Lordships' House. But the Bill of my noble friend, of which I do not desire to speak harshly at all, is really intended to prevent the views of the nurses from being carried out.
§ LORD ASHBOURNE
From the mass of correspondence which I have received and which I will send to my noble friend if he would like to read it. The noble Lord put forward his case with the greatest possible skill and in a most exhaustive way, but he was not able to mention the name of a single medical corporation or body supporting his Bill. He mentioned several members of the medical profession whose opinion is entitled to great respect, but they did not speak the views of any body of their profession. I believe, therefore, accord-to my experience as a man of the world and judging by the mass of correspondence I have received, the great body of the nursing profession are opposed to the noble Lord's Bill. They take their stand upon the registration of trained nurses as provided by a Bill in the House 198 of Commons, and they believe that this Bill has been introduced to stop the measure that they desire. Again, there is not the slightest suggestion in this Bill from beginning to end that the nurses are ever to be heard with reference to its administration; whereas in the Bills that have been introduced in the other House ample provision for this is made.
There is nothing novel in the suggestion of registration for nurses. It is not proposed that they should be compulsorily placed upon the Register but that they might ask to be placed upon it with a statement of their qualifications. There is no suggestion put forward by the nurses that those who have not the qualifications entitling them to be placed on the Register shall be excluded from practising. Any one could employ what nurse he pleased, registered or unregistered, qualified or unqualified. As I say, there is nothing new in the suggestion that nurses should have facilities for registration. Colony after Colony has adopted the principle, and thirteen or fourteen of the States of America and several countries in Europe have followed the same policy. Is it not, therefore, reasonable, in the interests of the community that everything should be done to encourage nurses to improve their education and to allow them to be registered? I do not object to the principle of a Directory for the purpose of giving information to anyone wishing the aid of a nurse, but at the same time it is reasonable and just that the nurses themselves should have an opportunity of obtaining the registration of their qualifications. They have not asked for a Directory, and the concession of it would not meet their wishes.
§ *THE LORD PRESIDENT OF THE COUNCIL (LORD TWEEDMOUTH)
My Lords, the subject raised by this debate is of very great importance. The profession of nursing is a very useful and honourable one. The number of nurses increases every year, and the duties they are called upon to undertake are becoming increasingly onerous. The nurse is the help both of the patient and of the doctor, and without her the work now done for the sick in this country 199 would be immensely hindered. But when noble Lords speak of the protection of nurses, they should not forget that the public have also to be considered. Great though the services of nurses to the public are, there are occasions when the position is reversed and when trouble arises between the nurse and the patient.
Whilst I cannot propose that this should be treated as a Bill that is officially supported by the Government, I must say I look upon it with some benevolence. I do not at all admit the force of the argument put forward by the noble Lord who moved the rejection of the Bill and by the noble and learned Lord who has just sat down. This Bill does not in the least interfere with the registration of nurses; indeed, it is a distinct step towards registration. There is very great controversy upon the matter, and it is not true to say that the nurses are unanimously in favour of the registration proposal. I do not think it has been attempted to be shown that more than about 5,000 of the nurses of this country support the particular proposal now before the House of Commons.
But the nurses, after all, are not the only persons interested in this subject. The interests of the medical profession must also be considered. It is not the business of the patient to choose the nurse; it is the duty of the doctor to advise on the choice. The patient, as a rule, cannot tell what the qualifications of the nurse are, and it must be left to the doctor to recommend the nurse who is particularly adapted by her qualifications for any particular case. Then it is the business of the hospitals to train the nurses, and, whatever arrangement is eventually made, the views of the hospital authorities must be taken into account. There is another point. The Poor Law authorities are probably the largest employers of nurses in this country, and the Local Government Board therefore are also interested in this legislation. I do not regard the Bills in the other House as being in antagonism to the Bill of my noble friend; but, after all, this is essentially a case where the Government's procedure should follow the maxim of festina lente. It is better in a case such as this to begin quietly and within comparatively 200 restricted limits. Registration could very well be introduced under this Bill hereafter, for there is a power to make alterations in the arrangements by Order in Council.
As regards the question of appeal, the intention of the Bill is that the nurse's name should only be capable of being excluded or erased from the Directory in the case of his or her actual conviction of some definite offence which would be specified in the Order in Council. I urge your Lordships to support my noble friend Lord Balfour's Bill as a practical and direct step towards what noble Lords opposite are desiring, namely, the registration of nurses. I believe the best way to arrive at that is to begin on a small scale and to extend afterwards if it should seem desirable.
My Lords, I desire to support the action which Lord Ampthill has taken in regard to this Bill, because I cannot see that, if passed, it would be of the slightest advantage to any one. I have the honour of representing two large institutions—Guy's Hospital and Queen Victoria's Institute of Jubilee Nurses. Both of those institutions are opposed to this Bill, yet I think I may claim for them that they desire to maintain the highest possible standard of nursing, to promote the efficiency and further the interests of nurses, and to protect the public. I do not see that this Bill if passed would contribute to any of those ends. I think we are in some difficulty with regard to this discussion, because the Bill as it is before us is more in the nature of a skeleton, the most important details of which are to be filled in afterwards by Order in Council. It is extremely difficult to discuss the Bill without knowing the manner in which those details will be filled in. This Bill simply provides that a nurse who has received training at a hospital, infirmary, or other institution can have her name entered in a Directory. Nothing is said as to the size of the hospital or the nature of the training, and I should like to know whether the hospital training has to be completed by the nurse before it is proposed that her name should be entered on the Directory. The noble 201 Lord in charge of the Bill expressed the opinion that the measure would be in the interests of the most capable nurses, but I venture to think that if it is in the interests of any, it will be in the interests of the less efficient nurses. I cannot see how it is to be in the interest of the capable nurse if the measure of her capacity is not to be any inducement to her to place her name on the Directory.
LORD BALFOUR OF BURLEIGH
Surely the measure of her capacity is just the thing that would be placed on the Directory.
That is one of the questions on which we are in a difficulty, because the qualifications to be inserted are to be decided by Order in Council after the Bill has passed. I will take a concrete case. Take the case of a nurse who enters a hospital where the period of training is four years. Having completed that period the nurse receives a certificate. Supposing at the end of two years, either because her strength would not hold out, or because the hospital authorities did not think she was sufficiently capable to make a good nurse, she was compelled to leave without a certificate. She would have received training at a hospital. Would she be allowed to put her name down as having received training at that hospital? That is really a most important question, to which I should be very glad if the noble Lord could give me an answer.
LORD BALFOUR OF BURLEIGH
That is a point which will depend upon the regulations to be prescribed by the Privy Council, but I cannot myself conceive that such a thing would happen as that the Privy Council would allow a nurse who had only received two years' training to masquerade as having received four.
The public at large has very little knowledge of the regulations which prevail at the various hospitals with regard to training, and if 202 it were not necessary that a nurse should receive a certificate before her name was entered on the Directory the public would be no wiser if her name was there than it would be if it was not. The certificate of efficiency should be the only gauge as to whether a nurse's name should appear on the Directory or not. It is difficult for us to vote for a Bill when such important details as these are not before us, but are left to be dealt with afterwards by an Order in Council. There are many arguments for State registration, and there are many arguments against it, but this Bill is neither one thing nor the other. Those who are opposed to State registration ought to oppose this Bill, because it contains that which they most object to in State registration, without, I venture to think, containing any of its guarantees; and I think those who support State registration ought to oppose this Bill because it does not carry out the objects they desire. Therefore, I claim against the Bill the votes both of those who are in favour of State registration and of those who are against it.
My Lords, it appears to me that the noble Lord the Lord President of the Council and the noble Lord who moved the Second Reading are the only persons who look upon this Bill as a stepping stone towards State registration for nurses. It is clear that this Bill is drafted on totally different lines. The view of the House of Commons Committee is that it is extremely desirable that an unqualified nurse should not be held out to be a qualified nurse, but this Bill proposes to put the unqualified nurse in precisely the same position as regards the Directory as the qualified nurse. That is a very serious thing. Any nurse of good character, as far as we can see, could get her name placed upon the Directory, and having got there she would have a distinct pull as against a nurse who was not on the Directory; and if in future an Act was passed for the State registration of nurses you would have these two things running concurrently, and the public would be liable to get confused. I certainly agree with the opinion expressed to me by a lady who is a very great authority on nursing, 203 and who thinks it is the more enlightened nurse who will be in favour of registration and the less enlightened, not possessing the same training, experience, and ambition, who will be content with the Directory; and I think it is extremely desirable, in the public interest, that there should be a Register setting forth the qualifications of the nurses rather than a mere Directory. I am entirely at one with the noble and learned Lord who spoke from the Front Bench opposite that the registration should not be compulsory. If we give this Bill a Second Reading we shall be acting against the opinion expressed by the Select Committee of the House of Commons, who considered this matter for two years, against all logic, and certainly against the opinion of the important bodies enumerated by Lord Ampthill. For some time I was treasurer of University College Hospital; for many years I have been on the committee of the hospital, and I am certain that if any member of the medical staff or of the committee had wished to support Lord Balfour's Bill I should have heard of it. But, as a matter of fact, I have not heard of one single doctor, nurse, or member of the hospital committee who is in favour of this Bill.
My Lords, this Bill has been extremely fortunate in the personality of its introducer, and also in its unexpected support from the front Ministerial Bench, but I think there its good fortune comes to an end. I submit that a Bill of this character, introduced confessedly without the assent or the concurrence of any of the persons most interested in the subject with which it deals, is hardly one likely to commend itself to your Lordships. You have been told that the nurses themselves are not to be found, through any recognised association, to support this Bill, and your Lordships have also been told that medical men, who have the next best knowledge on the subject, are also not to be found in its support. I have received many communications regarding this Bill, but I have not received a single one in its favour. I can hardly think that your Lordships would be likely to pass a Bill for the regulation of a large class of this character when that measure 204 is entirely without support from those chiefly concerned and is not put forward after any considerable public discussion on the subject. I speak entirely as a layman; but the whole balance of the evidence, so far as I am able to form any opinion upon it, is that this Bill is not desired by those who know most about it, and, in spite of what was said by the noble Lord the Lord President of the Council, must necessarily prove a hindrance and obstacle to that State registration of nurses which we all desire.
*THE SECRETARY OF STATE FOR THE COLONIES (The Earl of CREWE)
My Lords, I had not intended to take part in this debate, but, having some little knowledge of the subject from the position which I previously held, I intervene at this point to say a few words. The question is not really such a simple one as it has been made out to be, either by the noble Earl who has just sat down or by the noble and learned Lord on the Front Bench opposite. The noble and learned Lord said he spoke as a man of the world, and one is always delighted to hear him in that or any other capacity. But I would rather have heard him as one who had looked into this matter and realised the difficulties. The noble and learned Lord seemed to imply that it was a question between passing this Bill now and passing a Registration Bill in the immediate future, and he very naturally, and I think very properly, preferred the Registration Bill of the two. But, my Lords, that is not exactly the position. It may be that it is a question of something of this kind or of nothing at all, because the path of a Registration Bill is by no means quite so easy a one as Lord Ampthill and others have attempted to make us believe.
There are two principal difficulties, which were brought before me when I was Lord President. One has to do with machinery, and it is a difficulty which has not been got over. The kind of registration wanted by the medical profession is not the same as that wanted by the nursing profession, because each profession insists that their profession should have the majority upon the council to be formed. That is a difficulty which, so far as I know, has been by no means solved, and your Lordships would 205 find that if a Bill came up to this House containing provisions either for a medical majority or for a nursing majority it would be hotly opposed by those who consider themselves entitled to speak on behalf of the one profession or the other. Then there is the inherent difficulty which has always seemed to me the main obstacle in the way of registration—How can you avoid people regarding registration as a guarantee of permanent efficiency?
The noble Lord who moved the rejection of the Bill quoted the Medical and Solicitors Acts as being analogous to a system of registration for nurses. That is not so. A doctor practises in a certain place and works, so to speak, in the light of day. If he gets drunk, if his character is such that people dislike to see him attending their wives and daughters, the fact soon becomes known and people cease to employ him. He may possibly be still on the Register, but his character can be perfectly well known. But there is no such means of ascertaining the character of a nurse. She is sent for very often from a distance and in a hurry, and in nine cases out of ten her past and also her present are absolutely unknown to the people who send for her. Therefore it seems to me that the analogy entirely breaks down. I have never heard a suggestion as to how you are to maintain any sort of inspection which will guarantee that a registered nurse is an absolutely proper and desirable person, quite apart from those questions of temper and other important matters to which Lord Balfour alluded.
The noble Viscount opposite asked whether it might not happen that a person who had had no training would be, upon the Directory, in as good a position as a fully trained nurse. As I understand it, the object of the Directory is to give a sort of "Who's who" in the nursing profession. If a nurse had had only three months training, the Directory would show that, and the person sending for her would do so at his own risk. If she had successfully passed a four years course at St. Bartholomew's or some other well-known hospital, that fact would be stated. It is very difficult to see how you can go beyond the state- 206 ment of what the training has been unless you are prepared to regard the fact that the nurse is on the Register as a guarantee of her being at the time you send for her the kind of nurse you should have in your house. I am not in any way opposed to registration; on the contrary, I most heartily favour the principle; but I do not see any possibility of a Registration Act being passed within the next few years, not only on account of the Parliamentary obstacles, but also on account of the inherent difficulties I have just mentioned. I therefore regard this Bill as something in the nature of a step in advance, and I cannot see in what respect it would be an obstacle to registration in the future. On the contrary, it appears to me that it would be of assistance to registration, and therefore, if a division takes place, I personally shall give my vote with my noble friend in favour of the Bill.
§ *THE MARQUESS OF LANSDOWNE
My Lords, I wish to say a very few words on the subject of this Bill, and I shall be brief, partly because I confess I have not, that intimate knowledge either of the subject or of the origin of this proposed legislation which is enjoyed by the noble Lords who have already spoken. We have had statements to the effect that there has been a failure to consult those who ought to have been consulted. Again, motives have been imputed to those from whom this Bill originated. I know nothing of these matters, and what I have to say has reference only to the simple text of the Bill as I find it on the Table.
The noble Earl who has just sat down referred to the preference which had been expressed for another Bill now before the House of Commons. He met that argument by the observation that there was no security whatever that we should get that Bill, and I understood him to suggest that this Bill was better than nothing. But is it quite clear that this Bill is better than nothing? I confess to having some doubts upon that point. The Bill, as has been truly said, deals with a matter of very great importance—a matter of importance not only to the nursing profession, a profession of which I desire to speak with the utmost respect, 207 but also to the medical profession and the public at large, and it seems to me that we cannot be too careful in approaching legislation upon a subject of this kind. I confess I should myself prefer to leave it entirely alone rather than resort to legislation which might increase the confusion which apparently already exists and add to those rivalries and antipathies which have been disclosed during the course of this debate. There are two points in particular as to which I should like to say a word. In the first place, is not the title of this Bill rather a misleading title? The noble Lord who moved it dwelt repeatedly upon the fact that it was a Bill merely for establishing a Directory of Nurses, and he drew a sharp contrast between such a Bill and what he called the more ambitious and drastic scheme of registration which others prefer. But this Bill is really a Registration Bill. It is a Bill for creating a Directory; but behind the Directory there is an official registrar, there are conditions to be attached to registration, and there are penalties to be imposed upon those who do not comply with those conditions. Therefore, I venture to submit to the House that this is a Registration Bill, and that you must consider whether it is or is not a good Registration Bill.
The second point to which I wish to invite the attention of the House is this—that this registration, for I prefer to call it registration, is not compulsory. It is, as I understand it, entirely optional upon a nurse whether she has her name included in the Directory or not. A nurse whose name is not in the Directory will be allowed, I apprehend, to practise as at present. If that is so, does it not clearly follow that the nurses who will be upon the Directory will claim for themselves, and may appear to the public to be, a kind of corps d'elite amongst the nursing body? But will they have a right to claim that they are really a corps d'elite? Is it not clear from what we have heard to-night that a great many of the best qualified nurses will decline to have anything to do with the Directory? To the public, however, the presence of a nurse's name on the official Directory will appear to 208 involve some kind of guarantee of her fitness to practise as a nurse. What is there in this Bill to afford any security that she really will be fit to practise in that honourable and difficult profession? Clause 3 says—Every nurse who has received training in nursing at a hospital, infirmary, or other institution for the care of the sick.…not being an institution carried on for private gain, shall be entitled to have his or her name entered in the Directory.But nothing is said as to the amount of such training. It may be of the most perfunctory and insufficient nature. My noble friend who moved the Second Reading of the Bill suggested to us that people would refer to the Directory in order to ascertain the competence, suitability, and qualification of the nurses, but I fail to find anything in the Bill to provide that the Directory shall, in itself, afford any guarantee whatever.
§ *THE MARQUESS OF LANSDOWNE
It is not intended to, says my noble friend. That is my argument. I certainly gathered from him, both when he spoke at first and also when he answered an interrogation from the benches behind me just now, that the Directory was intended to supply a measure of the nurses capacity. I think that was what he said at the Table a moment ago, but I fail to find in this Bill anything which really bears out that statement. What is likely to be the result of passing this Bill? After what we have heard this evening as to the marked division of opinion in the nursing profession, it seems to me quite obvious that a large number of the most qualified nurses will remain outside the Directory altogether, and if that should happen, surely we may say that none of the three interested parties—the nurses themselves, the medical profession, and the public—will really gain very much by our legislation.
We know that another Bill dealing with this matter is before the House of Commons. I am not going to discuss the details of that Bill upon this occasion. Those of us who have had an opportunity of examining it are under the impression that at some points it compares favourably 209 with the Bill upon your Lordships's Table. But be that as it may, I cannot help doubting whether my noble friend who is responsible for this Bill is wise in pressing upon Parliament a measure which is evidently regarded with great suspicion. If there is to be a settlement of this question of registration—a difficult and a thorny question—surely we should endeavour to obtain a settlement which would be generally acceptable to all parties concerned; and it is because I am afraid that this Bill, instead of affording the material for such a settlement, will aggravate the existing difficulty, that I shall very reluctantly, if my noble friend presses his Motion to a division, vote, not with him, but with my noble friend Lord Ampthil.
LORD BALFOUR OF BURLEIGH
I daresay the House will give me their indulgence for a few moments for a reply. I am very much in the hands of the House as to whether or not a division should be taken on this matter. I have received a certain amount of support from those who are well entitled to speak, and from those who are officially responsible in this matter, and I should be sorry not to take the sense of the Hose in respect to that support. I frankly admit that whether the House accepts the Second Reading or not it will not make any real practical difference. There is such a divergence of opinion in regard to the Bills before the other House that they are not likely to come to a successful issue during the present session; and it is also certain that, if our Lordships were ultimately to pass this Bill, it would not have much chance of acceptance in another place, having regard to the conditions under which business is there transacted. Therefore, it is purely a matter of academic interest whether e have a division on the Second Reading or not. Personally I am inclined to test in the division lobby the amount of support to be given to this Bill, because I believe there has been a considerable amount of interested clamour against it.
I should like to say a word in regard to what my noble and learned friend said on the point of the authority which is behind the opposition to this Bill. Un- 210 doubtedly certain resolutions passed by certain bodies of organised nurses have been quoted both by him and by the noble Lord who moved the rejection of the Bill, but there is more than a suspicion that in some of these cases they are only a stage army. There are some individuals who are responsible for more than one of those resolutions. I am not very learned in the names of the different nursing association, but I have had some education in regard to them. I have had interviews with some of the ladies who are opposed to the Bill, and, so far as I can see, the management of these different associations which have passed resolutions is in hands not very dissimilar one from the other. I have not been able to find our how many nurses the opposition to this Bill represents. I do not for a moment deny that they represent a considerable number, but my contention is that in regard to the total profession they are not by any means so representative as they would like to make out, and as, perhaps, they genuinely think themselves. If we once have a Directory of Nurses, we shall be able, by some means or other, to find out what their real opinions are on this subject. It was on that ground mainly that I took up this measure.
I suppose to some extent I am in the dock as one of those who desire to oppose the more ambitious schemes. I do not know whether any disclaimer on my part will convince those who have cast that stone at me; but that is not really the case. I have read the evidence that was given before the Select Committee of the other house, and I am convinces that there is a great deal more to be said on this Bill as a real step in advance than is admitted by those who are in favour of the larger schemes. I agree with the tow noble Lords who spoke opposite that, even if we passed this Bill, it might not advance very much the cause of those who want the larger schemes. I can assure them, honestly, that it is not put forward for the purpose of blocking those schemes, but for affording a means of improving the present position of matters. Lord Monkswell said that he was connected with University College Hospital, and seemed to imply that no one connected with that hospital would 211 have anything to do with such a Bill as mine. But his hospital is not unanimous about registration, for in the Appendix to the Select Committee's Report I find a list of resolutions in opposition to the Bills which were then suggested, and amongst them is one passed by the Committee of University College Hospital.
My statement was that I had received no communication from any member of University College Hospital in favour of the noble Lord's Bill.
LORD BALFOUR OF BURLEIGH
I think that may be quite possible. I do not know whether noble Lords will concur with me, but in my experience I find that those who are in favour of a measure are much less active than those who are against it. The noble Marquess who leads the Opposition made some observations in regard to the Bill. He objected to the title, which, he says, is registration in disguise, and he commented upon the fact that the entries upon the Directory would not be compulsory. No one proposes that registration, if you choose so to call it, under this Bill, or under the other Bill, should be made compulsory, because the only way in which you could make it compulsory would be by providing that those who were not on the Register or Directory should not be allowed to practise.
§ *THE MARQUESS OF LANSDOWNE
I hope my noble friend did not imagine that I was in favour of compulsory registration.
LORD BALFOUR OF BURLEIGH
I have far too much belief in my noble friend's knowledge of affairs to suggest that he would ever advocate so absurd a proposal; but I differ from him in this, that I do not believe there is any evidence to show that only the less good nurses would go on the Directory. I believe it would be a great advertisement of their qualifications; and, although it would not be a guarantee, it would give the medical profession and the public the means of finding out the qualifications, antecedents, and attainments of nurses, which they do not possess at the present time. Although the matter is of an academic kind, I desire to take the sense of the House in regard to this Bill. The more I have looked into this question, the more convinced I am that there is a real grievance to be remedied; and I concur most cordially in the statement that it is a great pity opportunity is not taken, by conciliation, to arrive at a better understanding on this important matter.
§ On Question, whether the word proposed to be left out stand part of the Motion,
§ The House divided:—Contents, 20; Not-Contents, 53.213
|Tweedmouth, L, (L. President.)||Beauchamp, E. (L. Steward.)||Denman, L.|
|Carrington, E.||Glantawe, L. [Teller.]|
|Crewe, E.||James, L.|
|Ripon, M. (L. Privy Seal.)||Cromer, E.||Killanin, L.|
|Nelson, E.||Kinnaird, L.|
|Wellington, D.||Cross, V.||Saye and Sele, L.|
|Bath, M.||Armitstead, L.||Welby, L.|
|Balfour, L. [Teller.]|
|Canterbury, L. Abp.||Clarendon, E.||Churchill, V.|
|Dartrey, E.||Falkland, V.|
|Bedford, D.||Denbigh, E.||Goschen, V.|
|Devonshire, D.||Jersey, E.||Hill, V.|
|Liverpool, E.||Milner, V.|
|Abercorn, M. (D. Abercorn.)||Onslow, E.|
|Lansdowne, M.||Russell, E.||Ampthill, L. [Teller]|
|Waldegrave, E.||Ashbourne, L.|
|Amherst, E.||Westmeath, E.||Atkinson, L.|
|Belhaven and Stenton, L.||Heneage, L. [Teller.]||Rathmore, L.|
|Belper, L.||Herschell, L.||Ravensworth, L.|
|Colchester, L.||Hindlip, L.||Reay, L.|
|Colebrooke, L.||Kintore, L. (E. Kintore.)||Saltoun, L.|
|Courtney of Penwith, L.||Lawrence, L.||Sanderson, L.|
|Faber, L.||Monkswell, L.||Shute, L. (V. Barrington.)|
|Fairlie, L. (B. Glasgow.)||Montagu of Beaulieu, L.||Sinclair, L.|
|Granard, L. (E. Granard.)||Newton, L.||Stanley of Alderley, L.|
|Haversharn, L.||Playfair, L.||Weardale, L.|
Moved to resolve, "That after the Companies (Consolidation) Bill [H.L.] has been read 2a it is desirable that the said Bill together with the Post Office (Consolidation) Bill [H.L.] be referred to a Joint Committee of both Houses of Parliament"—(The Lord Granard (E. Granard));—agreed to.
§ Bill to be read 2a this day six months.