§ VISCOUNT GALWAY rose to call attention to the recent scheme issued by the Order of St. John of Jerusalem as lately published, and to ask what scheme is now proposed by the War Office for the efficient nursing of the Territorial Force.
§ The noble Viscount said: My Lords, I know that your Lordships are anxious, as all connected with County Associations are, that the scheme for the nursing of the Territorial Force should be on a sound footing, and as, unfortunately, some doubt and misunderstanding have arisen concerning the subject, I venture to call attention to it to-day. Last year a scheme was propounded for the thorough nursing of the Territorial Force. That was left to the Territorial Associations, and the general principle was that., whatever body found the organisation and enrolled the detachments, the whole question of examination and the granting of certificates was to be in the hands of the St. John Ambulance Association. The result was that the St. John Association formed a special branch for Territorial ambulance. A great work has been done 381 by this Association ineducating people in the giving of first aid, and the fact that there are over 300 centres in England alone working for this purpose shows how keenly the St. John Ambulance Association have taken up the work.
§ Unfortunately, some disputes have arisen, into which I do not propose to enter, which have produced. a certain uncertainty which is seriously handicapping the work of the Territorial Associations. One case has come to my knowledge in which members of the St. John Brigades have felt themselves compelled to leave the detachments already formed. I cannot help feeling that this must be entirely owing to some misunderstanding, which no doubt will shortly be put right. But I quote it to show that this, among other things, is very discouraging to the Territorial organisation throughout time country. But the question I specially wish to bring before the attention of the War Office to-day is that of certificates of efficiency. I hope it is not the intention of the War Office in any way to lower the efficiency standard. There is one large county detachment which I know intimately, the members of which all possess the certificates of the St. John Association, and those people, while proud of belonging to the Territorial Force, are equally proud of their St. John certificates, and they would be very averse to any persons joining that detachment who did not possess a certificate of equal value and of an equally high standard. It has been suggested in some cases that lectures might be given by nurses to women candidates for certificates; but I hope that, if a limited number of such lectures are so given, the remaining lectures of a course will be delivered and the examinations for final certificates conducted by medical men.
§ I have seen it stated in the Press that the War Office at one time contemplated that nurses might not only give lectures but also give certificates. That would be bringing the whole thing to such a farce that I cannot believe it was ever seriously contemplated by the War Office. A really qualified nurse might, perhaps, give women one or two lectures out of a course, but, as I have said, the remainder should be given by qualified medical men. One point on which I hope to get a satisfactory answer is that the War Office will insist on the certificate being given by an independent medical man. On the question of medical 382 men there is one other point I should like to bring to the notice of the War Office. A large number of patriotic medical men have given their services gratuitously in the teaching of classes in their districts, but I understand that the Medical Association is endeavouring to put pressure on medical men to charge certain fees for these classes. I hope that will not be carried to any great extent, because if the Medical Association insisted on medical men demanding large fees for their lectures, it would render the classes practically prohibitive. I hope the War Office will take that matter into consideration.
§ This whole subject will come before the Territorial Associations at their meetings shortly, and it would be a great advantage if we could he assured with regard to the standard of the certificates. These voluntary aid detachments were only begun last autumn; great progress has been made, and I am sure, if it is clearly understood throughout the country that the whole system of nursing for the Territorial Force in time of war is really meant seriously, that during the coming winter numerous classes will be formed all over the country, and that by this time next year we shall have a thorough organisation. But if we are to have this scheme complete in time of war the whole of the arrangements must be made in time of peace. If, unfortunately, the standard is lowered, the scheme will fail from want of support, and deservedly so. I hope the noble Lord the Under-Secretary will be able to give a satisfactory answer on the points I have put before him, and an answer which will remove the doubts which at present exist.
THE UNDER-SECRETARY OF STATE FOR WAR (LORD LUCAS)
My Lords, I am sure I can echo what fell from the noble Viscount with regard to the very valuable work that has been done by the St. John Ambulance Association. We know that they did form what I believe they called a Territorial branch to meet the great calls that were being made upon them in connection with the Territorial Force, the holding of their certificate being ft necessary preliminary to any man or woman becoming a member of a voluntary aid detachment. They have done valuable work in that way, and thanks to what they have done the Red Cross Society has been enabled by much hard work to organise a considerable number 383 of voluntary aid detachments. I need not go more than the noble Viscount did into certain differences of opinion that arose; but one good thing certainly has come out of this—that is that we have recently formed an advisory council which sits at the War Office and has upon it representatives of both the Red Cross Society and County Associations. Recommendations made by that advisory council have recently been submitted to the Army Council, but we have not yet come to any actual decision upon them. I can assure the noble Viscount, however, that we have no intention whatever of lowering the standard of efficiency of persons entering the voluntary aid detachments of the Territorial Force.
In the first place, it is a necessary preliminary before anybody can go into a voluntary aid detachment that he or she should hold a certificate. I would qualify my statement that everybody who goes into these detachments is required to hold a certificate, by saying that we propose to make one or two exceptions for the benefit of specialists, such as people who have already been in the Regular, the Special Reserve, or the Territorial Army Medical Corps—pharmacists and people of that kind; but everyone who joins for general duty will be required to possess a certificate. With regard to the nature of the certificate, there is no doubt that, though good work has been clone by the St. John Ambulance Association, there is a great demand that the granting of certificates should be facilitated. In a number of places there has been a. general desire to raise voluntary aid detachments, but for one reason or another the people who had intended to join have not been able to get the first aid certificate. We are, therefore, considering the acceptance of certificates other than that of the St. John Ambulance Association. The nature of those certificates we have not yet settled, but we do not intend that the certificate should be any lower than that of the well-known standard maintained by the St. John Association.
As to whether classes should be trained by nurses or medical men, the noble Viscount has there touched upon what is undoubtedly a very vexed question. There are a large number of people who consider that nursing should be taught by qualified medical practitioners, and there is another 384 large section who hold the opinion that the best persons to teach nursing are nurses. We have to reconcile those warring factions and arrive at a conclusion which, while enlisting both parties in our support, will not in any way let down the standard. This matter is being considered at the present moment by the advisory council. We are issuing one letter to County Associations on the question, and we shall be issuing more. We are also issuing a letter to General Officers commanding setting out, and asking them to communicate to the County Associations, the attitude we propose to take up with regard to these detachments. We regard the County Association as the authority which should recognise the voluntary aid detachments, and we do not propose ourselves to recognise any voluntary aid detachments which are not recognised by the County Associations. To such voluntary aid detachments as are recognised by the County Associations we shall, of course, afford formal recognition; and we propose to publish from time to time in Army Orders the lists of recognised voluntary aid detachments forwarded to us by the County Associations.
§ VISCOUNT KNUTSFORD
My Lords, as a former director of the ambulance department of the Order of St. John and a member of the British Red Cross Society, perhaps I may be allowed to say a few words on this occasion, especially as I desire to clear up one or two points that have arisen and which I have seen noticed in the newspapers. In the first place, I am glad that the noble Lord the Under-Secretary of State for War has been good enough to recognise, and with great courtesy, the work that the ambulance department of the Order of St. John has done under the original arrangement of 1909. A territorial branch of the ambulance department was at once formed, and at considerable labour and expense a staff and county sections were started in most of the counties to facilitate persons coming up for instruction and receiving certificates. Then difficulties arose. I do not, however, desire to accentuate them, or to dwell upon them.
I will deal first with the point raised by the noble Viscount, which is one of great importance, and upon which there has been considerable misapprehension. The ambulance department have granted certificates 385 during the last year to something like 30,000 men and women, every one of whom is free to join the voluntary aid detachments. It has been said that there has been a brigade order of the ambulance department of the Order of St. john which prevented members of the brigade from joining voluntary aid detachments, but I am informed that there is no such order. In one county—Devonshire—a letter was shown stating that was the case that since the department had separated from the agreement with the War Office members of the brigade would not be allowed to join voluntary aid detachments. That was a pure mistake, and it arose in the office during t he absence of Sir Richard Temple, the assistant director of the. St. John Ambulance Association, whose work has been most excellent and consistent throughout in helping forward these great objects. Directly the matter came to his notice Sir Richard made a speech at Gosport in which he stated distinctly the position of the ambulance department. He said—Join voluntary aid detachments if you wish, or join the St. John Ambulance companies if you wish. It is nothing to the St. John Ambulance Association which you join, as long as you do join one or the other and learn first-aid and nursing. Choose in your own neighbourhood the One which best suits you.To prevent difficulty arising in the future or any doubt that those who obtain the St. John certificate are at liberty to join any body, it has been arranged that the substance of the speech of the assistant director shall be embodied in a circular, which will be sent out as soon as possible. I hope that statement will satisfy the noble Viscount on that important point.
To return to the difficulties and friction that arose: The original agreement provided that all persons who joined voluntary aid detachments should have the certificate of the ambulance department of the Order of St. John, and it was feared that if certificates were accepted of other societies, or if certificates were given on an inferior course of training and examination, it would tend to lessen the value of the certificates of the St. John Ambulance Association. I need hardly say that it would be fatal to our work and to the work of ambulance altogether if in any way the value of those certificates were diminished. Not only would that be the case 386 in this country. It would be a fatal blow in India, where we have done magnificent work, helped by Lord Curzon, Lord Minto, Lord Kitchener, and, amongst others, by Lieut.-Colonel A. Yate, who did very good service in promoting that work; and also in almost every Colony (those with responsible government as well as Crown Colonies), where we have active working centres in close touch with the ambulance department here. Therefore to lessen the value of the certificate would he a dangerous thing, and I am glad that Lord Lucas recognises that. I need hardly point out, moreover, that the decision to allow an inferior certificate was a direct breach of the agreement that was entered into between us, the British Red Cross Society, and the War Office. Therefore after very careful consideration by what I may call the experts in this work—the director of the ambulance department., the assistant director, and the executive committee—it was decided that we could do better and help the War Office more easily and without friction if we acted independently; and to show that we were desirous in every way of continuing the work two resolutions were passed, one giving the reason why we separated from the War Office arrangement, and the other stating that the ambulance department —will continue to carry on the work of instruction it has already inaugurated on a large scale, and will in such other ways as are open to the St. John Ambulance Association render assistance to those who desire to qualify themselves to give aid to the sick and wounded of the Territorial Force in time of war.Turning to the actual scheme now put forward of having St. John Ambulance county companies, I may explain that it was felt to be necessary to give greater facilities to people who wished to undergo instruction and obtain certificates. Therefore these companies have been established in the counties, but every member who obtains the St. John certificate can join any body he pleases—a voluntary aid detachment, or the brigade, or the ambulance association. I may add that every man arid woman who obtains the certificate of the St. John Ambulance Association and joins at any time one of these St. John county companies is bound to make a declaration to serve with the Territorial Force whenever it is mobilised in the event of war. Therefore under this 387 system there will be thousands and thousands of trained men and women at the disposal of the County Associations and British Red Cross Society if they are wanted. Experience has shown that there is a different feeling in different counties. In Lancashire, for instance, as I am informed, there is a very small feeling in favour of the British Red Cross Society but a very strong feeling in favour of the work of the ambulance department of the Order of St.. John, and I think probably in that case most of the men and women who get certificates will prefer to join the St. John ambulance company. In sonic other counties—Gloucestershire, I am told, and Devonshire, for instance—the feeling is the other way. But, at all events, every man and woman who obtains our certificate is free to join whatever organisation lie or she prefers. I hope I have shown that we have in no way separated from the scheme of the War Office through any dislike of the work or any intention not to carry it on. It is quite the contrary. We hope to do the work more effectively in the future than we have been able to do it hitherto considering the differences of opinion that arose under the original agreement; and the result is that the War Office will have in time of war an enormous number of men and women all ready and bound to join the Territorial Force,
§ THE EARL OF DARTMOUTH
My Lords, perhaps I may be allowed to say a word or two on this subject as I raised the question the other day. I was under the impression that the noble Lord the Under-Secretary was going shortly to provide the County Associations with fresh instructions. I do not know whether it is desirable, certainly not so far as we are concerned, to wait until the advisory council have made up their mind on the matter. What I wish to specially emphasise to-night is that the County Associations who have had instructions to do this work are at a standstill because the foundation on which they were originally instructed to build has broken down. The scheme as represented by the diagram is admirable. You have at the head the War Office; following that you have the British Red Cross central office; then you get the County Associations all working in unison, the county branches of the Red Cross Society, the county directors appointed by those branches, and, finally, the voluntary 388 aid detachments. But those voluntary detachments are in the chrysalis state.
In the first instructions the County Associations were made responsible for ambulance services for the Territorial Army. They were allowed, however, to delegate their powers to the Red Cross Society, and to that society alone; but in the original scheme, paragraph 22, County Associations in England were told that all persons wishing to join voluntary aid detachments should be in possession of the first aid and nursing certificates of the St. John Ambulance Association. And here I should like to add my meed of praise to the St. John Association for the admirable work they have done. It was, as I have said, originally contemplated that every man and woman before joining the voluntary aid detachments should be in possession of the St. John Ambulance certificate. I do not propose to deal with the differences of opinion that have unfortunately arisen, but I should like to say a word with regard to the county companies of the St. John Ambulance Association, which were also referred to by the noble Viscount who has just sat down. In most counties, although we may not have our voluntary aid detachments absolutely complete, we have the framework for them, and counties which have delegated their powers, as most have, to the Red Cross Society will be placed in a position of great difficulty if they have to compete with the county companies of the St. John Ambulance Association. Gloucestershire has already got forty-three voluntary aid detachments in full work, and they are very apprehensive of the difficulty which may arise.
As to the question of certificates, I think we understood from what fell from the noble Lord that these certificates would be given by independent medical men. That, I take it, the St. John Association is very anxious to insist upon, and also that there should be no lowering of the present standard. The noble Viscount who initiated this discussion raised the question of instruction by nurses. To the ordinary mind instruction in home nursing given by a certified nurse is a very natural and desirable thing; but I believe the great difficulty in introducing the question of home nursing lies in the fact that the British Medical Union will have nothing to do with it. That Union is a very powerful body, and if that point is lost sight 389 of we may again find ourselves in considerable difficulty with those medical men who are in the British Medical Union. I believe a great number of the most responsible medical men belong to that Union, and it is quite possible, unless we are very careful in this matter, that we may find ourselves in the difficulty of not having the necessary medical men to give the instruction and the help required. While we have up to now in many cases been able to depend on the generous assistance of the medical profession in giving instruction free, I understand that in certain parts of the country medical men have been instructed that they must be paid for the work they do. That, of course, would add very largely to our expenditure. I refer to these points because if we are to have a satisfactory solution they will have to be carefully considered.
There were one or two other points raised in a discussion at a meeting of the Council of Territorial Associations, and I undertook that these points should be put before the noble Lord. As an impression has got about that members of voluntary aid detachments in time of war will receive ls. a day and rations, I should like to ask the definite question whether that is right or not, and whether any payments in money or kind will be given to Members of voluntary aid detachments. The other question which was raised, and which I undertook should be brought before the noble Lord's attention, was that of the county companies of the St. John Ambulance Association. If they are formed and officially recognised, will they in case of war be protected under the Geneva Convention? That is a point worthy of consideration, because it may make a considerable difference when the choice is offered to those interested whether they will join the voluntary aid detachments or the county companies of the St. John Association. We hear a good deal at one time and another about a free hand being given. I gather from what the noble Lord the Under-Secretary has said that County Associations are to be given a free hand in this direction; but where we have already formed voluntary aid detachments under the original scheme of the War Office, we shall be in a considerable difficulty. I would therefore urge that definite instructions should be given to County Associations at the earliest possible date.