MIDWIVES BILL. (Hansard, 27 July 1936)

VISCOUNT GAGE
My Lords, I beg to move that this Bill be read a third time. I understand that the noble Earl on the Woolsack wishes to ask a question in regard to the measure.

THE EARL OF ONSLOW
My Lords, the point. I wished to raise was with regard to Clauses 5 and 6. Clause 5 says that no midwife who has received her compensation and been taken off the list shall afterwards practise as a midwife. Clause 6 says that persons who are registered nurses and who have had a midwife's training may practise for remuneration. I wish to ask my noble friend how these two clauses agree. I understand his reply may be that Clause 5 prevents any woman from practising for remuneration even though she has the qualification under Clause 6 (1) (c). It seems to me that there is a certain difficulty here because very often midwives are trained nurses and obtain their Central Midwives Board certificate as an additional qualification, whether they mean to practise as midwives or not, for it is an advantage to obtain the Central Midwives Board certificate.
A woman who has retired from the business of midwife may be a fully trained nurse and still on the register, as provided in Clause 6. Now supposing she wishes to go back to nursing, she would not be in the same position as any untrained woman would be. The latter could go forward and obtain her C.M.B. certificate, but the retired midwife would be debarred under Clause 6 entirely from practising and her position may be much damaged thereby. Many hospitals prefer, if they do not insist on, their nurses obtaining a C.M.B. certificate. Now any trained nurse can get the certificate except a trained nurse who has been a midwife and has retired. She seems to be in a worse position than other nurses. For example, she may be offered the post of matron and be unable to accept it if a C.M.B. certificate is one of the conditions. Of course she has got her C.M.B. certificate but she is technically no longer qualified as a midwife, and I venture to think that there is some hardship there. I do not know that it is a very great one. Of course the result may be that institutions will not be so insistent on having nurses who are also trained midwives as they have been in the past.

VISCOUNT GAGE
My Lords, owing to the short notice at which we considered Amendments on the Committee stage—for 230 which I must disclaim responsibility on behalf of the Government—I promised Lord Aberdare that I would examine the report of what he had said and if there was any new point which my answers in Committee had not covered, that I would give a further explanation on Third Reading. I also gave a similar undertaking to Lord Onslow. I must quite frankly say that my advisers can find very little in what the noble Lord said that has not been previously discussed, not once but several times, in another place and in private conversations between representatives of the midwives and my right honourable friend the Minister, but we wish to be as courteous as possible to the midwives' representatives, and perhaps I might amplify one or two points, and at the same time answer Lord Onslow's question.
I think it would be easier to understand these points and the answers to them if we bore in mind some of the statistics about the midwives whose circumstances we are trying to improve in this Bill. The definition of a midwife is a lady who holds a certificate of the Midwives Board. There are at present nearly 60,000 of such ladies on the roll. Any of these can practise, but before doing so they have to notify the local supervising authority. Now it is important to realise that the large majority of those who take the certificate merely do so to add to their ordinary nursing qualifications, without having any intention of practising as midwives, and in fact out of the 60,000, over 40,000 have not notified their local supervising authority that they desire to practise. Accordingly they do not do so although they can do so at any time by merely putting in an application to the authorities. This class will be unaffected by the Bill.
We now come to the practising class of about 15,000 midwives. Of this number, approximately 6,000 are salaried and the large majority of them salaried not only as midwives but as nurse-midwives employed by hospitals, village nursing associations and so forth, while about 9,000 are in independent practice; and by far the most important effect of the Bill, as far as the midwives themselves are concerned, will be on the 9,000 independent midwives. As the discretion of the supervising authorities will be unfettered I cannot give any accurate figures, but 231 what we anticipate will eventually happen will be that about half these independent midwives will be absorbed into the salaried service and the other half will either disappear from the roll altogether or will continue in independent practice.
I should like to refer in a little more detail to the midwives who will eventually come off the roll as the result of this Bill. There are some who will be compulsorily retired, but your Lordships will see that the conditions under which this may be done are very strictly governed by Clause 5. The local authority may not retire them compulsorily unless they are satisfied that by reason of age or infirmity of mind or body the midwife is incapable of performing her duties. Her position will be safeguarded by the fact that she may obtain compensation based on five years' average emoluments, and she has a right of appeal. This is the only class that can be retired compulsorily. There is another portion of these 9,000 independent midwives who we think will retire under subsection (1) of Clause 5, that is to say, who will retire voluntarily, subject to compensation, and I must point out to your Lordships that the whole object of this provision is in the interest of these independent midwives themselves, who in some cases, owing to the overcrowding of their profession, have become the victims of competition; and what we are doing by devoting money to help the supervising authorities to pay this compensation is merely an act of grace towards these midwives.
Having reminded your Lordships of these figures I would like to refer once more to one or two of the points made by the noble Lord in the last debate. His first point deals with notification. He is anxious that every independent midwife should be notified so that she should have a chance of putting in an application for any new salaried posts that may be offered. We maintain that the independent midwives will undoubtedly know if there are any vacancies in the new service, firstly because in Clause 1 we insist that wherever a scheme is made it should be done after consultation with all the organisations interested, including the representatives of the local midwives. That we feel to be really a sufficiently complete safeguard in itself. In the case of local authorities engaging midwives 232 themselves, we also require them to send direct notification of such vacancies as they are filling to any independent midwife living within their area. We do not say so in the case of the voluntary associations for two reasons. Firstly, the voluntary associations, as a general rule, are not interested in applications from those who only have the midwives' certificate. Usually they want those who combine a knowledge of general nursing with midwifery. And the second reason is that we do think it is unfair to put on the voluntary associations—it may be small village nursing associations—the duty of discovering and circularising any independent midwife who may happen to be living in their district. Nevertheless, we have no doubt they will be informed through their organisation. That is the answer to the first point.
The second point raised by the noble Lord was the question of compensation in the case of those voluntarily surrendering their certificates. His contention is that the Parliamentary Under-Secretary, in another place, stated that the three years that we are selecting were the best possible three years from the midwives' point of view, whereas the noble Lord produced figures to show that in many cases they are not the best three years. My answer to this point is, firstly, that the Parliamentary Under-Secretary was discussing a different Amendment—namely, whether the compensation should be three times the annual average of the last five years or three times the annual average of the last three years. That is not quite the same point as the noble Lord raised. I am quite prepared to admit that there may be many cases where the average of the last three years would not produce compensation on such a high scale as it would if other years were chosen, though in cases where the midwife was extending her practice it undoubtedly would. The real answer to the point is one that I made before—namely, that what it is intended to do is to compensate the midwife for the loss she would have sustained if she were going on in practice; and if, to use the noble Lord's expression, "the curve of her earnings has been going down," the presumption is that these earnings would continue to go down still more, so that compensation based on the last three years would really more than 233 compensate her for what she would earn if she remained in practice.
The last point is one which was raised by both Lord Aberdare and, in a different form, by Lord Onslow. It concerns the question as to whether, if a midwife has voluntarily surrendered her certificate, she could not, in certain circumstances, be allowed to go back on to the roll. Lord Onslow personally is troubled on a point of drafting. He suggested that there is a discrepancy between the wording of Clause 5 (8) and Clause 6 (1) (c). On this point I can only tell the noble Earl that we have looked into this matter and our legal advisers feel it is made quite clear that where a woman has been compensated, and her name removed from the roll, she is entirely barred from ever practising again. Your Lordships must understand that Clause 6 refers to a totally different class of woman, but even so we feel that the wording of Clause 5 (8) is sufficiently definite and clear as to rule out entirely any claim under paragraph (c) of Clause 6.
But having dealt with that drafting point, the noble Earl asked why should they not be allowed to come back on to the roll. My answer is, why should they? One of the main objects of this Bill is to reduce, in their own interests, the number of independent midwives. The women of whom we are speaking now are under no sort of compulsion to surrender their certificates. They will only do so because they feel they will be improving their economic situation by taking the compensation. It seems to be altogether unfair that any woman should be allowed to take this compensation and then say afterwards, "Well, I think I could do better by going into practice again," and thus possibly starting the whole of this problem over again. Furthermore, if she did come back she would obviously have to surrender her compensation, probably with interest, and there would be elaborate calculations to be made. We feel that to try and introduce a principle of this kind on the Third Reading of the Bill would be to lose the Bill inevitably this Session, and as we also think it is undesirable in itself noble Lords will understand why we are resisting the point.
I wish to say only one final word. The midwives are given three years to decide 234 what course to pursue. During that time, if any unexpected development takes place, there will be time to review the situation. Secondly, the circular that we shall send out will take into the fullest consideration all the points which have been raised by the midwives' representatives. The real fact of the matter is that in this Bill we are putting the midwives in a much better position than they have ever occupied, and we feel it would be somewhat injudicious and would jeopardise the fate of the Bill if it were now held up because the midwives cannot get every small point they want.

§ LORD ABERDARE
My Lords, I do not wish unnecessarily to delay your Lordships, for I understand there is a good deal of business to be done in your Lordships' House this afternoon, but it would be discourteous if I did not thank the noble Viscount for having made answer to the Amendments which I put forward on the Committee stage. I realise and understand the position now because, through the noble Viscount's courtesy, I was able to be present at a conference at the Ministry of Health. I quite see that it is impossible to press the Ministry any further, and I am prepared to leave things as they are, but I did get a promise at the Ministry that if any suggestions came from the Midwives Institute to the Ministry, and there was any value in them, they would be used in the instructions which the Minister of Health is going to send to the authorities as soon as this Bill is passed. The noble Viscount covered the points of my three Amendments, but I did raise one other point which I was asked to raise by the Joint Council of Midwifery, and that was as regards preparing for the same inspection of maternity nurses as for midwives. I understand the difficulty there is, that the position of the maternity nurse is rather different from that of the midwife in that the former is so essentially under the authority of the doctor. Finally, I can only hope that baby Bill will be brought quickly into the world, and that, thanks to the careful pre-natal ministrations of the noble Viscount, it will have a long and successful life; and that the noble Viscount may still be where he is in practice after a further three years period. I am very glad to support the Third Reading.