NURSES REGISTRATION (No. 2) BILL. (Hansard, 15 December 1919)

§ VISCOUNT SANDHURST
My Lords, I am glad to say that I am able to present this Bill as an agreed measure. Those who have followed this controversy, as I have done for more than a generation, will be as pleased as surprised, and as surprised as pleased, with this result. I certainly had thought from the various phases through Which this subject has passed during a number of years that such a result would have been well nigh impossible, but I did not count on the magician-like qualities of the Minister. Your Lordships will remember that there were two Bills introduced last summer; one promoted by a member in the House of Commons and another presented by Viscount Goschen in this House. I am glad to say that this Bill, of which I now propose the Second Reading, has been welcomed by the adherents of that Bill, which I believe was nearly the identical Bill passed in this House eight or nine years ago at the instance of Lord Ampthill.
The controversy in these Bills raged around the formation of the Council. It was found almost impossible to get the various disputants to sympathise with one another, and it was difficult to know how the representatives were to be selected from the various associations concerned. The numbers kept on increasing and I think rose to as many as forty or fifty. After a patient conference the Minister hit upon the idea that instead of leaving these people to be elected (as there was no electorate to elect them) that he would nominate the first council. That is to say, there are two members to be nominated by the Privy Council, two by the Board of Education, five members to be expert in training colleges and schools for nursing, and sixteen others to be nominated by the Minister, making a total of twenty-five. I think it was with some courage that the Minister undertook to nominate those sixteen.
The two former Bills provided that there should be one council for the whole United Kingdom, but since then a Ministry of Health Bill has been passed and I think it is admitted that in the care and treatment of the sick the Ministry of Health should be responsible. This will be the case as regards England and Wales, but, as your Lordships know, the Minister for Health 82 does not have power in Scotland. There it is the Secretary for Scotland and a Board of Health. In Ireland the Chief Secretary is responsible in the same way that the Minister of Health is here, and he has an Irish Health Committee. In effect the national autonomy is to be preserved. The three Bills are necessary; and three registers. To meet that point it will be seen that Clause 6 is a reciprocity clause. That is to say, there will be no difficulty for a nurse in one part of the Kingdom to get her qualification recognised in another part of the Kingdom.
Then, my Lords, without taking you through the details of the Bill, as it is an agreed Bill, I might mention this, that, as has been provided by Parliament when other Registers have been set up, those who are already experts or trained in a certain direction should not be unfairly treated. I call your attention to the fact that in Clause 2 of the Rule these people will have to submit themselves. to certain examinations, but it is provided that those people who are of proper age and character during the first two years—the initial period of the council—should not be called upon to pass those examinations. That is a principal which has been recognised by Parliament before, and I think it is one which is eminently fair, because there are many of these nurses who have acquired certain knowledge and experience in hospitals and infirmaries which might not be recognized as authorised training schools, and at the same time have a very considerable amount of knowledge.
The calculations are to be settled by the Council, and the rules that they are to make are to lie on the Tables of the Houses of Parliament for twenty-one days, and cannot come into operation until they have obtained the approval of the Minister. Then there are to be certain fees charged for those nurses I mentioned just now, in the initial stage not exceeding £1 1s., and nurses are to pay an annual fee of 2s. 6d., which will help to keep the thing going. Then there is a disciplinary clause, for the Council are intended to have disciplinary powers, but at the same time a person feeling aggrieved will have a right of appeal to the High Court, and if an institution is aggrieved by the refusal by the Council of recognition as a training centre, such institution will have a right of appeal to the Minister.
I think on the main points I have said enough to ask your Lordships to give a 83 Second Reading to this Bill. This is the last time, probably, that I shall have the honour of addressing you on these subjects. Your Lordships may remember that last session I had a struggle in this House to try and obtain a second Under-Secretary in the Health Department. Of course I was beaten and had to bow to that decision, but those who opposed me have, and I congratulate them, managed to win both ways; because while they beat me on the question of a second Under-Secretary, although I held out the blandishment that they might have an Under-Secretary in this House, they will nevertheless have an Under-Secretary here in the person of Lord Astor. But having waged this controversy with regard to nurses—sometimes disproportionately acute—for upwards of a generation, it is a very great pleasure to me to ask your Lordships to read a second time a Bill which I think will lay this long struggle to rest; and knowing as we all do what nurses are—it is a noble profession, of course, and I consider it is the gentlest and most humane profession that exists—if without detriment to the public and within the four corners of my Bill, the advantages which have been so constantly claimed for nurse registration prove to be to the advantage of that profession, I shall indeed be glad. I therefore hope that your Lordships will give a Second Reading to this Bill.

§ LORD AMPTHILL
My Lords, it would not be right if this Bill were to pass through the important stage of Second Reading without just a few words on behalf of those who have struggled so long and valiantly to bring about this reform. My object in rising, therefore, is to offer my sincere and respectful congratulations to His Majesty's Government, and particularly to the Minister of Health, for having contrived to bring about agreement in regard to this Bill. I envy my noble friend the pleasant task which has fallen to this lot of piloting an agreed registration Bill through the House of Lords, because like him I remember all that has gone before of the controversy, in which I have had to take some part. I do not, however, grudge him the satisfaction which he will feel when the Bill, as I hope, has been finally passed. My Lords the nursing profession has risen steadily higher in public estimation, and 84 nurses have become more and more indispensable to the whole community, both in peace time and war time, and it would have been deplorable if this year had been allowed to pass by without a settlement of this long-standing question. I am sure that those for whom I have the honour to act and on whose behalf I had the honour of passing through this House a Nurses Registration Bill practically identical in principle with this Bill, would blame me if I had not said these few words of thanks to His Majesty's Government.

VISCOUNT KNUTSFORD
My Lords, Lord Ampthill said it would not be right if those who had been in favour of this Bill did not give it their blessing. It would also not, perhaps, be right if I, as one of those who for twenty years have opposed registration, also did not admit that I have been defeated. I am sure that Lord Sandhurst knows that nothing that could help nurses would be opposed by me, but I want this House not to go away and think that this Registration Bill can be of the smallest use to them.
Nurses who belong to the good training schools, to-day, when they join this registration will find themselves herded together with a lot of nurses who have had very inferior training and whose only excuse for being on the register is that they have been bona fide nursing the public. There is no instance known to us of voluntary registration being of the smallest use, and under this Bill registration is voluntary and not compulsory. We had a very good example in the dentists profession. There was a voluntary register, and what was the result? The whole country was flooded with people who were not registered dentists. They were forbidden to use the name of registered dentists, just as nurses are forbidden to call themselves registered nurses unless they are on the register. They called themselves surgeon-dentists, or put up in their houses "dental surgery," and in that way led the public to believe that they were going to proper dentists. So here there is nothing to prevent a woman calling herself a nurse and holding herself out to be a nurse. She is only prevented from calling herself a registered nurse.
My only object is to try and induce the Government to go a step further. The remedy is so simple. If you make registration compulsory—that is to say, if you stop any woman nursing for gain unless her 85 name is on the register—then the public would have the protection which they have a right to expect. If you did that you would have to pass a law that no woman should nurse for gain unless she was on the register of nurses and that register of nurses would only contain opposite her name, not a guarantee in any sense that she was fit to nurse, but the training that she had had, whether it was one week or one year, or six months, or whatever it was. The public would then be able to protect themselves. If Nurse Jones said that she was a fully-trained nurse, you would only have to look through the register and see how long a training she had had. If you employed her after that you would do so at your own risk. The present Bill cannot possibly help nurses, and cannot possibly keep fraudulent women from calling themselves nurses. My only reason for intervening in the debate, though I am a beaten man, is to beg the Government to go a little further, and let us have a compulsory and not a voluntary register, and a compulsory register in the sense that I have indicated.

THE EARL OF KINTORE
My Lords, I certainly will not detain you more than one moment, but I should like to add to the congratulations which have been showered upon Lord Sandhurst on the happy termination of an agitation which has gone on, I think that I am right in saying, for more than a quarter of a century. The nurses in Scotland, I am afraid, are not entirely satisfied as to the position that they will occupy under this Bill.

§ VISCOUNT SANDHURST
We are not on the Scottish Bill.

THE EARL OF KINTORE
I am speaking about the Registration (No. 2) Bill which, so far as I have read it, applies to England and Wales, but it does not meet what the nurses in Scotland want, which is that there should be a single British register of nurses to apply to all the United Kingdom. I would point out that even if the small Bills for Scotland and Ireland are passed later on, that defect would not be removed. There will be three authorities, each with its own standard, and each with its own conditions for entry, and with its own register, and one might obtain recognition abroad and the others be refused such recognition. Perhaps therefore the noble Lord will see his way to give us a 86 little time to consider this point before we go into Committee.