Lords Sitting of 8 July 1942

Preamble
The House met, The LORD CHANCELLOR on the Woolsack.
Edward Sydney, Lord Bishop of Lichfield—Was (in the usual manner) introduced.
LORD KEYNES.
John Maynard Keynes, Esquire, C.B., having been created Baron Keynes of Tilton in the County of Sussex—Was (in the usual manner) introduced.
MID-WESSEX WATER BILL.
Read 3a, and passed.

GREENWICH HOSPITAL BILL. [H.L.]
THE PARLIAMENTARY SECRETARY OF THE ADMIRALTY (LORD BRUNTISFIELD): My Lords, I beg leave to introduce a Bill to extend the powers of the Admiralty under Section 20 of the Greenwich Hospital Act, 1865, with respect to the grant and allocation of pensions and pecuniary benefits in the case of persons employed for the purposes of Greenwich Hospital, and otherwise to amend the said section; to provide, on the death of any such persons, for the distribution without probate or other proof of title of sums not exceeding one hundred pounds due to such persons or their legal personal representatives; and for purposes connected with the matters aforesaid. I beg to move that the Bill be now read 1a.
Moved, That the Bill be now read 1a.—(Lord Bruntisfield.)
On Question, Bill read 1a, and to be printed.

NURSES' SALARIES.
LORD LATHAM LORD LATHAM rose to call the attention of His Majesty's Government to the action of the Minister of Health in limiting
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the scope of the Nurses' Salaries Committee appointed by him; and to move for Papers. The noble Lord said: My Lords, I regret the necessity for troubling you with the matter dealt with in the Motion appearing on the Paper in my name. It is, however, as I think will appear in the course of the consideration, a matter of far-reaching importance. Shortly put, it is that those concerned with hospitals and institutions much regret that the Minister of Health has seen fit to exclude from the consideration of a Committee which he has appointed, nursing staff engaged in mental hospitals and institutions.
It will perhaps be convenient if I briefly give the background of the appointment of this Committee. In 1937 a Committee, presided over by the Earl of Athlone, was appointed to consider the establishment of machinery for settling on a national basis the salaries and emoluments of nurses. It is pertinent to the consideration of the matter before your Lordships' House to-day that I should say that the mental hospitals' nursing staffs were not excluded from the reference to the Committee. That Committee recommended the establishment of a Committee, to settle on a national basis the salaries and emoluments of nurses, analogous—and these words are not without importance—to the Burnham Committees which for over twenty years have been engaged in settling on a national basis remuneration for those employed in the teaching profession. The Burnham Committees determine the salaries of all those employed in the teaching profession where the State or the local authority, or both, make any contribution for the institutions in which they are engaged. The Burnham Committees, therefore, concern themselves with the salaries of elementary and secondary school teachers, teachers employed in evening institutes, and even those employed in approved schools. By that means the whole of the teaching profession, as far as salaries are concerned, is dealt with on a national basis. It is therefore clear, in my submission, that the recommendation of the Athlone Committee was intended to mean that any Committee set up to deal with the salaries of nurses should embrace all nurses, both those employed in general and special hospitals and those employed in mental hospitals and mental institutions.
Early last year difficulties became acute as regards the recruitment of nurses in this country. The Minister of Health indicated in another place, in April of last year, that he proposed to accept and act upon the recommendation of the Athlone Committee, and to appoint a Committee to deal with nurses salaries and emoluments. It is clear that at that time the Minister intended that the scope of the Committee should embrace all nurses, including those engaged in mental hospitals and mental institutions. In proof of that I cite the fact that the Minister himself, when inviting local authorities to appoint representatives to the proposed Committee, expressed the desire that those representatives should, where possible, also have had experience of mental hospitals and mental institutions. The London County Council appointed as one of its representatives a member of the mental hospitals committee, because of the assurance that the Committee to be appointed would deal with mental hospital nurses as well as with others.
In October of last year the Minister announced in another place the setting up of a Committee, and also announced its composition. There: were two panels, each of twenty members, one panel, called the employers.' panel, representing the British Hospitals Association, the King Edward Hospital Fund for London, the Nuffield Trust, the County Councils Association, the Association of Municipal Corporations, the London County Council, the Urban District Councils Association, the Rural District Councils Association and the Queen's Institute of District Nursing, and the other panel, called the employees' panel, consisting of representatives of the Royal College of Nursing, the Trade Union Congress, the National Association of Local Government Officers, the Royal British Nurses Association, the British College of Nurses and the Association of Hospital Matrons. It was, however, discovered that the terms of reference to this Committee, by, as I understand it, some mischance, did not include nurses engaged in mental hospitals, and it was understood that the Minister would take an early opportunity to correct that omission and to extend the terms to include the nursing staffs of mental hospitals and mental institutions. In point of fact, and in proof of that intention, at the first meeting of the Committee, on November 27 last, the Chairman, the noble Lord, Lord
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Rushcliffe, intimated that the Minister had decided to alter the terms of reference to the Committee so as to include nurses in mental hospitals.
I should say here that perhaps it may be convenient if I henceforth refer to the Committee as the Rushcliffe Committee, by which name it is already well known outside. I think your Lordships will agree that the fact that the noble Lord, Lord Rushcliffe, has accepted the onerous duty of presiding over this Committee is a further testimony to his abiding devotion to public affairs. And so up to that point the action of the Minister had been in accord with the trend of all informed and experienced opinion on the question of a co-ordinated nursing profession. It was also in accord with the accepted view that it was undesirable to continue to differentiate in too marked a way between mental disability and physical disability; and that if those discriminations, which in the past have been unhappy, were to be removed, especially in regard to the nursing profession, it was desirable that nursing should be dealt with as a whole, and that there should be no distinction drawn between those engaged in general and special hospitals and those engaged in mental hospitals or institutions. Everyone was encouraged because at last machinery was to be brought into existence which would stabilize and, I hope, improve the pay and emoluments of the nursing profession, and would give it that standing to which its undoubted devotion and service entitle it.
However, as a result of the opposition of one member of the employees' panel, representing the Trades Union Congress, but a person who is also a leading official of the Mental Hospital Workers Union, objection was taken to any extension of the terms of reference, and I am informed—though I cannot vouch for it, because I was not present—that he threatened to leave the Committee if it presumed to deal with the salaries of nurses employed in mental hospitals. Strange, and indeed surprising, as it seemed and is, because of the opposition of that one person, representing one interest, the Minister began to weaken. The associations representing local authorities directly or indirectly responsible for the maintenance of practically the whole of the mental hospitals and institutions in this

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country, learning of this weakening on the part of the Minister, made urgent representations that it would be most regrettable if the understanding were not carried through, and nursing staffs employed in mental hospitals were excluded from the operations of this Committee.
I had the privilege of leading a deputation to the Minister on the 16th of February of this year. The deputation consisted of representatives of the County Councils Association, the Association of Municipal Corporations and the London County Council. We urged the Minister not to recede from his previous decision. We urged him to alter the terms of reference in order that the nursing staffs of mental hospitals might come within their ambit. In April of this year the Minister intimated that he had decided to exclude mental hospital nursing staffs and moreover, that as regards a very small number, which I am informed, amounts to no more than 7 per cent. Of those employed in dealing with patients suffering from mental disorder, who were by the wording of the terms of reference included within the Committee's activities, he has decided to exclude those also. The situation is, therefore, at the present time that the Committee will be unable to concern itself with the salaries and emoluments of those nurses who are engaged in mental hospitals. There are some 90,000 nurses employed in hospitals other than mental hospitals, and there are about 30,000 nurses employed in mental hospitals. We thus have the situation that an official committee will be settling the conditions of 90,000 nurses, but will be precluded from concerning itself with 30,000 nurses.
I gather from the Minister that the reason why he has taken this retrograde step, if I may so call it, is that there is a Joint Conciliation Committee in existence, representative on the one hand of the Mental Hospitals Association and on the other of the Mental Hospital and Institutional Workers Union. I should here say that up to December, 1940, the authorities who were members of the Mental Hospitals Association were responsible for providing only 55 per cent. of the total mental hospital bed accommodation. It is fair, however, to say that since that date a number of local authorities have been compelled, because of difficulties of recruitment of staff, to go into
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the Mental Hospitals Association. But it is a fact that some of the largest mental hospital authorities are still outside that Association. The London County Council, for instance, is not a member, and if is responsible for no fewer than 34,000 beds, a total equal to one-sixth of all those in the United Kingdom. The Middlesex County Council, with 5,000 beds, is not a member, the Surrey County Council, with 3,200 beds, is not a member, and I gather that there are others which are not members. So we have this situation, that there will be an official Committee settling, by recommendations to be accepted presumably by the Ministry and the local authorities, the salaries and emoluments of the nurses employed in general hospitals, and there will be an unofficial Joint Conciliation Committee presuming to settle the conditions of those nurses employed in mental hospitals.
One of the real reasons for seeking a national basis of remuneration for nurses was the competition which inevitably took place between authorities for staff. Local authorities competed inter se, and also competed with the voluntary hospitals for staff, and the voluntary hospitals themselves competed one with another. It was the desire to avoid that competition by the stabilization of salaries and emoluments which led to the appointment of this Committee. The situation is that that competition can still take place as regards some 30,000 nurses. Their conditions can be settled by an unofficial Joint Conciliation Committee, with no obligation upon any local authority to carry out its recommendations, whereas the nurses employed in the general and special hospitals will be subject to the decisions—mandatory, I apprehend they will be—of this Rushcliffe Committee. It therefore will lead to no satisfactory settlement of the difficulties, and it will make higher that wall of discrimination which unhappily still exists in this country as regards the patients suffering from physical disability and those suffering from mental disability. What is more serious, it will emphasize and perpetuate discrimination between the two sets of nurses.
There has been a great development in recent years in the treatment of those afflicted with mental disorder. No longer are they merely immured. They are now looked upon as patients who need the highest scientific treatment. Consequent

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on that change of attitude of mind, the staff employed to nurse these patients have teased to be wardresses and warders. They have ceased to be attendants; they have become nurses. They are nurses; they should be treated as nurses. We no longer witness incidents such as are immortalized in Hogarth's "Rake's Progress" of young children being taken out en Sunday to Bedlam to see the mentally afflicted. Local authorities have taken steps to remove all trace of this undesirable method of treating those mentally afflicted. Many of the local authorities deal with their mental cases through the same committees as deal with ordinary hospital administration. Recently, the London County Council has transferred the administration of its mental services to the Chief Medical Officer of the County, who is also responsible for the general and special hospitals. We have taken steps to change the name of almost every mental hospital and institution in order to dissociate it from the memories, unpleasant and disagreeable, of the past. For instance, what was formerly Colney Hatch is now known as Friern Hospital. That attitude of mind is in keeping with the best informed opinion.
I may be permitted to quote in support of my statements the recommendations and statements of two Committees and one Royal Commission which have sat and considered this matter since 1922. In 1922 the Committee on the Administration of Public Mental Hospitals recommended that
" The mental nursing service requires coordination with the general body of nursing, and steps should be 1aken to attract a better class of probationer, particularly in the case of female nurses."
In 1924 the Departmental Committee on the Nursing Service in Mental Hospitals reported:
" It is fundamentally important to regard mental nursing, not as a separate profession, but as a branch of the nursing profession. For attainment of success the ideal experience is that of complete training in both mental and general nursing."
Later there was appointed a Royal Commission on Lunacy and Mental Disorder. It was presided over by a member of your Lordships' House, Lord Macmillan. This Commission, in 1926, said:
" The treatment of mental disorder should approximate as nearly to the treatment of physical ailments as is consistent with the special safeguards which are indispensable when the liberty of the subject is infringed.
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… We are also in sympathy with the movement to secure for mental nurses opportunities of qualifying in general nursing as well. The difficulties of arranging this double training, and of seconding mental nurses to general hospitals for the purpose, are revealed in the evidence before us. We refer particularly to the difficulties which occur owing to the different rates of remuneration current in general and mental hospitals."
I submit that that evidence all goes to show that it is desirable that the nurses employed to deal with mental patients should be regarded as part of the great nursing profession, and should not be distinguished or differentiated from one section of it.
I have referred to one representative on the employees' panel, representing the Trades Union Congress, who is also an official of the Mental Hospital and Institutional Workers Union, being against the inclusion of mental hospital nurses. May I say that that opinion is not shared by all the members of the employees' panel? The situation is as follows. The employers' panel is unanimously in favour of the mental hospital nurses being included. The employees' panel has not yet come to a decision, but it is known that there is a considerable difference of opinion, and in support of that I shall, with your Lordships' permission, quote extracts from the Public Employees' Journal, which is a journal published by a trade union, one of whose officers is a member of the employees' panel, representing the Trades Union Congress. This paper, in its issue for October-November last year, stated:
" It is to be regretted that mental hospital nurses arc not to be brought within the ambit of this machinery. The Mental Hospitals Joint Conciliation Committee will continue to act. This sequestration of nurses is not conducive to uniformity, and certainly militates against the efforts to establish the same standards for mental hospital nurses as obtain for generally-trained nurses."
In its issue of May last the journal said:
" It is the Minister's desire, and that of the employing authorities, to bring mental hospital nursing staffs within its scope. It is difficult to understand any opposition to this, for if ever equality of treatment between general and the mental hospital nurses is likely to be established, it will only be by treating mental nursing staffs as a normal part of the general nursing profession and not as a sequestered section."
That shows that there is, at all events, some volume of trade union opinion on the employees' panel which supports the views of the employers' panel and of the

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local authorities that these nurses should come within the scope of the Rushcliffe Committee.
I ask your Lordships' support for the view that a wrong step has been taken. I am convinced that the Minister himself knows it to be a wrong step. I have every reason to believe that his Department do. All those concerned with the administration of mental hospitals and mental institutions are convinced that it is a wrong step. I find it difficult to understand why a decision which was right presumably in October, 1941, becomes wrong because it is objected to by one person. It is, I submit, a little unworthy of a great Department presided over by a Minister to recede Before what amounts to menaces and threats on the part of one person and one person alone, and to disregard a large volume of informed and disinterested opinion. That is what the Minister of Health has done. It is the function of Governments to govern, it is the function of Ministers to have the courage of their convictions, and not to recant because of threats of retiral from one member of the employees' panel.
I believe it is correct to say that on one occasion the present Prime Minister referred to a former Prime Minister as a "boneless wonder." This, my Lords, is a boneless blunder. I ask the noble Lord, Lord Snell, who I understand is to reply to the debate, to represent to His Majesty's Government that it is not too late for this regrettable mistake to be rectified, and that it is urgent the Minister should reconsider and take steps to bring within this Committee the mental hospital nursing staffs; otherwise for a long time, for longer than any of us perhaps can envisage, you are going to emphasize and formalize this insupportable and indefensible distinction between nurses employed in general hospitals and nurses employed in mental hospitals and institutions. The Minister will do a great disservice to the proper treatment of these nurses. They will be regarded as something different from their sisters and brothers employed in general and special hospitals, and, moreover, it will operate as a continuing bar to a proper coordinated treatment of the physically unfit and the mentally unfit. I beg the noble Lord, Lord Snell, to regard this matter as of prime importance, and I hope before the debate concludes that he will
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be able to say that the Government will think again. I beg to move.
LORD BALFOUR OF BURLEIGH: My Lords, I desire in very few words to support the noble Lord opposite in the Motion he has put before your Lordships. The noble Lord has used language of great force. There are occasions when the noble Lord and I do not always see eye to eye on numerous questions, but on this question I should like to tell your Lordships I think the language he has used I is entirely justified. I speak not only as an individual with some very slight knowledge of the matters to which he has referred, but I speak also at the request of the Association of Municipal Corporations which, as your Lordships know, represents a very large and influential body of local authorities. The noble Lord opposite has referred to the matter in great detail, with great thoroughness and very great knowledge, and I do not desire to occupy your Lordships' time going over the same ground. I would only recapitulate that here we had a Committee appointed on a national basis to everybody's joy, and the local authorities and other employers concerned were delighted to see it. We all want to see the conditions in the nursing profession put on a proper basis. Then to our great dismay we find the whole of that decision undermined, and the prospect is that the Committee will be quite unable to fulfil the very laudable object for which it was appointed.
The noble Lord opposite has told your Lordships in detail the particulars with regard to the employers and employees of the various bodies who have to consider nurses' salaries. There is perhaps one small section of nurses which I think your Lordships should take into special consideration. Those are the mental nurses who do not happen to belong to the trade union which looks after their particular profession. If I heard the name aright from the noble Lord opposite, it is the Mental Hospital and Institutional Workers Union. It is all very well for the members of that trade union to say that they claim the exclusive right of looking after mental nurses, but they should not seek to do that to the exclusion of the Rushcliffe Committee. Even if they get their way in that there will still remain all the mental nurses who are not members of the trade union. I think that is

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a point which will really demand special attention from your Lordships. I do not sec why anybody should be forced to belong to a particular union in order to get the protection of this scale. That is a point which I" think may be added to those which the noble Lord opposite made. The great consideration is to get tile profession of mental nursing on to a par with the great profession of nursing as a whole, and unless this Rushcliffe Committee is given the oversight of all the nursing that is an object which will recede into the dim, distance. I beg to support the noble Lord with all the force at my command.
EARL MANVERS: My Lords, as a member of the London County Council, though not of the Party which Lord Latham leads, I have great pleasure in rising to support the noble Lord's Motion. If only for the sake of symmetry it is surely desirable that all ranks of nurses should have a common tribunal, just as all ranks of teachers have their Burnham Committee. Therefore my suggestion is that there should be an arrangement under which the Nurses' Salaries Committee, ably directed by the noble Lord, Lord Rushcliffe, should decide all cases of nurses which the nurses now bring before it. It should at least have jurisdiction to decide those cases if the cases are brought before it. I will take an extreme case. If it should so happen that district nurses, student nurses, tuberculosis nurses, mid-wives, mental nurses, and their respective employers, were each to fight separately and at different times, then surely there would arise nothing but jealousy, discontent, internecine competition and chaos. The word "repercussion" is a word that is usually heard in this connexion. Whenever there is any alteration in the pay or conditions of any body of nurses it creates repercussions amongst all the other nurses. It is surely obvious that the difficulties created should be studied by a clearheaded and impartial Committee like the Nurses' Salaries Committee before any such alteration is made.
On one side of this dispute you have, as has already been pointed out, the London Country Council, the County Councils Association and the Association of Municipal Corporations. Each of these bodies desires uniformity. On the other side you have the Mental Hospitals and Institutional Workers' Union for some of
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the staff, and the Mental Hospitals Association for some of the employers who still desire to retain the old and anomalous joint conciliation committee. It is possible to feel a certain amount of sympathy with the trade union, which is an old-established institution and has fought many battles, and it has as its organizing secretary an able and distinguished man who is well-known to the trade union world. The union no doubt fears eclipse, loss of individuality and loss of prestige if it is brigaded with a larger negotiating body. It must be remembered that individual members of that trade union can only improve in status if they are recognised as members of the great nursing profession rather than as mere warders and attendants. I do not know the attitude of the Mental Hospitals Association—the employers' Union—but it is possible that they prefer the devil they know to the devil they do not know.
Noble Lords who have not studied the subject may perhaps ask which gets the higher rate of pay, the ordinary nurse or the mental nurse. I asked that question myself and the answer took ten days to arrive. When it came I saw why it had taken so long to arrive. The comparison is not easy owing to the different methods of payment which are in vogue For the two different classes of nurse. In the hospital service, female nurses are paid a fixed salary and they receive in addition board and lodging as an emolument, but in the mental health service nurses receive a fixed salary and they are asked for a contribution by way of deduction from salary in respect of any lodging they may receive and any meals which are supplied to them. It should be emphasized, however, that it is not equality but relativity that is desired. It is not desired that all nurses should have an equal rate of pay, but it is desired that the salaries should all rise and fall at the same time. I hope it will be a case of rising, because having studied the subject of the nursing service, I believe it to be an ill-paid service. It is desired, as I say, that salaries should rise and fall, if they must fall, in uniformity and that that uniformity should be decided by one and the same Committee which shall have charge of the whole matter.
Since the general secretary of the Mental Hospital and Institutional Workers' Union has himself a seat on Lord

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Rushcliffe's Committee it does not appear likely that mental nurses will ever lack a friend at court as long as he consents to remain on the Committee. The suggestion has been made that the Committee, or some of the members, object to taking the mental nurses within their purview. In that case an awkward situation is undoubtedly created for the Ministry of Health. The Committee is a voluntary organization which exists for the purpose of performing an onerous and troublesome task. The Minister may easily demur at trying to inflict upon them an additional task which is distasteful to some of them. The need of uniformity, however, is so great that it is very much to be hoped that some means of accommodation will be arrived at. It is said that no negotiations can succeed without good will and that it is no use enlarging the scope of Lord Rushcliffe's Committee if mental nurses are going to refuse to bring their case before the Committee. That is no doubt true. A child can lead a horse to the water but twenty men cannot make it drink. In this case both parties on the London County Council take the view that the horse should at least be led to the water in the hope that if and when he becomes sufficiently thirsty he will drink. I hope that your Lordships will support the Motion of the noble Lord, Lord Latham, and that the Government will find themselves able to follow suit.
LORD JESSEL: My Lords, I should not have intervened in this debate except for the fact that I have been asked by the honourable member who sits in another place for the Abbey Division of Westminster, who is the leader of the minority on the London County Council, to support this Motion. I do so with very great pleasure because the Westminster City Council, which the honourable member also represents, must of necessity take a great interest in this matter since Westminster pays one-fifth of the rates of London. But that is not my only reason for supporting the, Motion. I listened with great attention to the speech of the noble Lord who brought the Motion forward, and I think all who heard it must have been convinced by the very potent arguments he brought forward for your Lordships' consideration. What struck me more than anything else was the fact which he mentioned that there are in London 30,000
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mental cases. The London County Council, which is one of the most important bodies in the country, and the Middlesex and Surrey County Councils all desire the same thing. Another important fact which the noble Lord mentioned was that it was agreed as long ago as 1941 that the whole case should be referred back. It does seem to me rather curious that the Minister has gone back upon his decision. I am not here in ihe least to blame the Minister. He is a responsible person and a clear-headed man, and no doubt certain facts have been brought to his notice which have induced him to alter his judgment. Nevertheless I doubt very much whether he is acquainted with the whole facts of the case, and I am convinced that when he has read the report of this debate—which I hope he will—he will see fit to alter his decision.
I should like to be allowed to congratulate the noble Lord, Lord Latham, upon his speech. Latterly he has been rather soaring into greater heights as regards national policy, and I congratulate him upon coming back to the subject which he knows so well, that of municipal administration. Looking round your Lordships' House I see a noble Lord who has held the office of Lord Chamberlain, and I am reminded that one of his famous predecessors was celebrated for having had the courage to lengthen the skirts of the ballet. I am not sure whether the noble Lord, Lord Latham, will not be remembered in London for many years for having lengthened the hours of work of London County Council employees. One thing which amused me was the noble Lord's reference to the fact that children are no longer taken to Bedlam to see the unfortunate people who are affected by this disability of mental disease. I thought the noble Lord must be making himself out to be much older than he really is, because those visits could not have been paid in his time. We must all agree that the treatment of mental disease in this country of late years has made extraordinarily great progress and we all hope that it will continue to do so.
I would point out to the House that if on the figures put forward by the noble Lord you have one fourth of the nursing staff on a different system from the others, it is going to lead to chaos. It may be said, of course, that some male attendants

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have not the knowledge possessed by some of the trained nurses. On the other hand, I am sure your Lordships must recognize that it cannot be a very pleasant occupation to have to look after some of these cases that are not going to be cured. There is not the same interest, but nevertheless the services of the nurses are required. If that is the case, is there any reason for making this differentiation? And I would draw your Lordships' attention to another case of a rather similar kind that is going to lead to great confusion. In London we have a body called the Joint Industrial Council. Recently that body has been reviewing the salaries of officers and staff and employees and has come to a certain decision. That decision is in direct contradiction to the recent decision of the far bigger body, the national council, the Whitley Council, and there is going to be great trouble over that. I foresee in the same way that there is going to be great trouble if the cases of the whole of these nurses are not adjudicated upon by the Rushcliffe Committee. It does seem to me to be a tremendous pity that the facts have not been properly placed before the Minister. I am quite sure that—as I think all three of the previous speakers have pointed out—this is going to lead to a great deal of trouble in the future.
I do ask my noble friend Lord Snell, who I understand is to speak on behalf of the Government, to represent these facts to the Minister. I am perfectly sure that on reconsideration another view will be taken. This House is more or less in the position of a Court of Appeal. The other day we had an interesting debate on a Motion by my noble and gallant friend the Earl of Cork, and in passing I should like to congratulate him upon the result. I would point out that there was no heat in that debate, and there is nothing really in reversing a decision when fuller facts are known. I think it should be pointed out to the Minister that, on this' matter, noble Lords on all sides of the House are of the same opinion. I hope that whim Lord Snell makes his reply he will give us a promise that these facts shall again be brought to the notice of the Minister, with an expression of the very sincere hope of all those taking part in the debate that the whole question will be reconsidered and that what we desire will be done—namely, that the case of the mental nurses will be referred to the Rushcliffe Committee.
LORD COTTESLOE: My Lords, I was asked to say a word on this subject in support of the Motion which has been brought forward by the noble Lord, Lord Latham. He spoke very strongly, and I venture to say that the feeling among other county councils is quite as strong as it is in the London County Council. The county councils of England and Wales are deeply concerned in this matter. I have the honour of being identified with a county council, on which I have served for more years than I care to tell your Lordships. One of the things I have noticed—and noticed with great satisfaction—is that we are getting away from what was a standing difficulty in so many departments of public employment, the difficulty of settling salaries locally and on a small scale and almost by individual bargaining. It is a fine thing—and one has seen the development coming with great interest—that matters are now on a different footing.
The Burnham Committee, when it began its labours, was largely an experiment, and it was a matter of surprise and immense satisfaction that, under Lord Burnham as its first Chairman, that Committee established so effective and so enduring a method, and set so wide and so good an example. Here is a case where we want the breadth of view and the freedom of negotiation on both sides which should save endless trouble in the future and should give satisfaction both to the employers and to the employed. Now, under the proposal as at present limited, we are not going to get that unity and that satisfaction.
I think it will be granted that what is desirable is that nurses shall enter the branch of the profession which they prefer and for which they are best fitted. What is going to happen as matters now stand is that you will have a category of nurses, mental hospital nurses, who are cut off, by a hard and fast line, from the rest of their profession and, with the nursing side of mental treatment constituted as it now is, there will be no particular inducement for nurses except with great difficulty and perhaps some sacrifice, to go from one category to the other. If you had two clean-cut categories to begin with, such a method would give you the greater part of what is required for a national settlement. But so long as we have the wish, as I am sure we all have, to see the nursing profession a complete profession, we must

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have, and should have, the same conditions under the same representative Committee throughout. I have listened to many debates in your Lordships' House, and I do not remember an occasion when such strong and overwhelming unanimity on the part of all the great representative bodies concerned was brought to your Lordships' notice. The case for reconsideration appears to me to be overwhelming. I hope that we may have an assurance from the Government that this rather disastrous decision, as it seems to me, will be reviewed, for I see in it no final settlement, but I do see that we are going to be landed in fresh difficulties and troubles.
LORD SNELL: My Lords, my right honourable friend the Minister of Health desires me to give the following explanation of the decision which he has felt compelled to make in regard to the matter before your Lordships' House. The Nurses' Salaries Committee was set up with the following terms of reference:
" To draw up agreed scales of salaries and emoluments for State registered nurses employed in England and Wales in hospitals and in the Public Health Services, including the service of district nursing, and for student nurses in hospitals approved as training schools by the General Nursing Council for England and Wales."
The terms of reference were later extended to include nurses in possession of certificates from the Tuberculosis Association. The Committee, presided over by my noble friend Lord Rushcliffe, was divided into two panels, one consisting of representatives nominated by the organizations of the employers, and the other consisting of representatives nominated by the organizations of the nurses.
The original intention of the Minister was that, subject to the agreement of the Committee, all State-registered nurses, students' and other nurses working in these hospitals should be dealt with by the Nurses' Salaries Committee. It may be said at this point that the decision which the Minister has made does not mean that the matter is settled for ever, but an alteration of that decision waits upon such an amount of agreement as would lead to the supposition that the members of the Committee would work harmoniously together for a common end. The matter has been brought before your Lordships by my
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noble friend Lord Latham, and has been stated coherently and very fairly by him, with all his great experience and capacity as a local government administrator. He knows, I am sure, how agreeable it would be to me personally to support the London County Council on all occasions. The four years' experience which I had as Chairman of that great body gave me, I think, more satisfaction than anything else I have ever done in my life. I would ask the noble Lord, however, not to take the present situation too tragically. The position which he has put before your Lordships represents the view of the London County Council, supported by the County Councils Association, the Association of Municipal Corporations and so on; and, when the Minister contemplated that all the nurses would be brought under this common rule he was, of course, supported by Lord Latham and by these other bodies.
To-day my noble friend Lord Latham has argued that the perpetuation of the present system leaves the impression that the mental hospitals nursing service is an inferior branch of the nursing service as a whole. Speaking with some experience, as an old member of the Royal Commission on Mental Disorders to which Lord Latham referred, I know how very unfortunate it has been that any work connected with mental institutions has been thought to be inferior to that of other branches. We want the nurses in mental hospitals to feel that they are doing not only a difficult but also an immensely important task for the nation, and personally I want it to be realized, from the patients' point of view, that the old discrimination between one sick person and another should have gone for ever, and that there should be no discrimination, whether the sickness relates to the brain or to any other part of the human body.
My noble friend Lord Latham has argued that the Joint Conciliation Committee of the Mental Hospitals Association and the Mental Hospital and Institutional Workers Union is not fully representative, that great local authorities such as the London County Council and the Middlesex County Council remain outside the organization, and that the present position is, in consequence, confusing and unsatisfactory. I feel it necessary to repeat at this stage that the Minister expected that the mental hospital nursing

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service would be dealt with by the Committee which was set up. There was, however, unexpected opposition to that being done, and to the nurses in the mental hospital service coming under that Committee. This was based on the grounds that the Mental Hospitals Association, which claims to represent some 73 per cent. of the beds in mental hospitals, and the Mental Hospital and Institutional Workers Union, were conducting the affairs of the mental nurses with special knowledge and with an experience which has extended over a long period; and that the Joint Conciliation Committee, which has existed for twenty-two years and has given satisfaction to all concerned, deals, among other things, with precisely those matters to which attention has been called. In 1941 an agreement was reached on scales of pay and conditions of employment, and this was used as a basis for the Mental Nurses (Employment and Offences) Order of that year. Both the organization of employers and the organization of the nurses were opposed to bringing the nurses within the scope of the Nurses Salaries Committee, on the ground that the existing machinery for negotiation has worked well over an extended period, and that it is the kind of machinery which is generally approved by the Government.
It was found, when the Committee came to consider this matter, that no agreement could be reached. My noble friend Lord Latham asked to see the Minister and put the matter in dispute before him. My noble friend Lord Jessel is wrong when he says that the Minister could not have been well informed, because Lord Latham himself informed the Minister, and therefore it was done adequately. The Minister promised to consider the representations made by Lord Latham, and the matter again came before the Committee, when those representing the Mental Hospital and Institutional Workers Union, remained implacably opposed to coming under the General Nurses' Salaries Committee. Lord Rushcliffe, therefore, the Chairman, undertook to report to the Minister that no agreement could be reached. In these circumstances, the Minister, while he contemplated that nurses in the mental hospital services should be dealt with in the same way as nurses in other hospitals, if agreement could be reached for such a course, felt that he could not at this stage, in the absence
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of such agreement, suggest that the Nurses' Salaries Committee should include in the scope of their labours the nurses working in the mental hospitals. That is the situation which the Minister had to face, and that was the decision to which he came. I repeat that that decision does not necessarily last for alt time, but can be reconsidered when some kind of agreement in outlook is reached, and I am instructed to say that any new argument submitted in the course of this debate by any of your Lordships will receive the Minister's very careful attention.
LORD LATHAM: My Lords, I am much obliged for the very conciliatory way in which my noble friend Lord Snell has dealt with this matter, and I am encouraged by the firmness of his assurance that the matter is not finally and definitely fixed by the Minister of Health. I hope that from that we shall shortly have the decision that the original intention of the Minister will be given effect to. My noble friend Lord Snell will not misunderstand me if I express some slight surprise at the doctrine which, no doubt from information, he has expounded this afternoon—namely, that the terms of: reference of the Committee, its scope and its work, are not to be determined by the necessities of the case, or by the decision of the Minister, but are to be determined by whether the Committee set up to carry out the work agree or not. Really, that is a new and surprising doctrine, and, bad as its application has been in this particular case, I hope that for the sake of ordered and tidy government and administration it is not likely to be extended. If it is I can see a most confusing situation arising. When a Minister finds that there is something to be done, he determines, as he is entitled to determine, how it should be done, and then he must await, if you please, the pleasure and consent of those whom he selects to do it as to the scope of what he proposes to do! As I say, I hope that is a doctrine and a practice that will not be extended.
My noble friend Lord Snell was not unfair in his statement about the proportion of mental hospital authorities within the membership of the Mental Hospitals Association. I could, were it necessary, and were it really material, unfold an interesting story as to how the member ship of the Mental Hospitals Association jumped from 55 per cent, in 1940 to 75 per

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cent. in 1941. But what is material is that, notwithstanding that there are 75 per cent.—talking in terms of bed accommodation—of the mental hospitals authorities in the Mental Hospitals Association, those authorities nevertheless, through their accredited associations, the County Councils Association and the Association of Municipal Corporations, are pressing that this matter should be dealt with as was originally intended, because they know the confusion which will inevitably arise through having two bodies dealing with it. However, relying on the statement made by my noble friend Lord Snell, that the Minister will reconsider the matter, I beg leave to withdraw the Motion.
Motion for Papers, by leave, withdrawn.

TUBERCULOSIS: INSTITUTIONAL TREATMENT.
LORD DAVIES: My Lords, I beg to ask the question standing in my name:
[The question was as follows:
To ask His Majesty's Government how many persons suffering from tuberculosis and recommended for institutional treatment are at present
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awaiting admission into tuberculosis hospitals and sanatoria in England, Scotland and Wales, respectively.]
LORD SNELL: My Lords, the latest information available shows that on 31st March last there were 1,507 persons in England and 400 in Wales who had been on local authority waiting lists for institutional treatment for tuberculosis for upwards of ten days. In Scotland at that date 652 persons had been awaiting admission for upwards of ten days.

URBAN DISTRICT OF HOYLAKE ORDER.
LORD TEMPLEMORE: On behalf of my noble friend the Duke of Devonshire, I beg to move the Motion which stands in his name.
Moved, That the Order made by the Secretary of State for the Home Department under the Sunday Entertainments Act, 1932, and laid before the House yesterday, be approved.—(Lord Templemore.)
On Question, Motion agreed to.
House adjourned.