HL Deb 13 April 1943 vol 127 cc139-47

Order of the Day for the Second Reading read.

LORD SNELL

My Lords, the general purpose of this Bill is to improve the status of an essential and noble service and I am sure your Lordships will receive it with sympathy. I will very briefly describe the Bill's actual proposals and they too will, I believe, meet with your approval. The Bill has three main objects. One is to secure for nurses known as assistant nurses a recognized status as an essential part of the nursing profession. The Bill provides that assistant nurses should be placed on a roll kept by the General Nursing Council, which is the body responsible for the training and examination of nurses. The second object is to protect both the nurses and the public from unqualified persons who represent themselves as nurses. The Bill does this by restricting the use of the title "nurse." Thirdly, the object is to bring under control agencies for the supply of nurses which are commonly known as nurses' co-operatives. The Bill introduces a system of licensing and inspection of these particular agencies. The measures proposed in the Bill are, broadly, in line with the recommendations made in the interim Report issued at the beginning of 1939 of the Inter-Departmental Committee on Nursing Services, known as the Athlone Committee, and they also take up many of the recommendations made in August, 1942, by the Nursing Reconstruction Committee of the Royal College of Nursing under the Chairmanship of my noble friend Lord Horder. The Bill, I may say, was prepared after the fullest consultation with nurses, with their employers and their professional organizations. It has been generally welcomed by all concerned.

It may be useful to describe very shortly what the present situation is. The Nurses Registration Act of 1919 set up a State register of nurses for the sick and protected the title of "registered nurse," but there is nothing in the Act itself to prevent any person from calling herself a nurse and from practising nursing, even if she possesses no qualifications. Undoubtedly the general public is often deceived into the belief that a person who calls herself a nurse is properly qualified to nurse the sick when, in fact, she has no qualifications at all. A good many nurses are referred to as "assistant nurses," but the term has no accepted meaning and it may be used to describe a variety of persons from those without any training to others who have had a fair amount of training or experience as nurses. There are about 16,000 women known as assistant nurses employed in hospitals and many of them are doing very useful and highly-appreciated work.

These assistant nurses and a large number of State-registered nurses are also employed in private work generally through the agency of the so-called nurses' co-operatives. The activity of these agencies has been criticized. They supply nurses to hospitals as well as to private patients. Many of these organizations are highly reputable; others are less scrupulous and have no hesitation whatever in employing nurses with little or no qualification, and in passing them off to patients as qualified. All this means, first, that the sick public, who must of course be the first consideration, may find themselves treated at considerable expense by women with little or no nursing qualification; secondly, that the status of the nursing profession itself is undermined by the competition of these unqualified women who claim the title of nurse and pass themselves off as nurses, even though they have no training and no experience; thirdly, that the competent assistant nurse herself, like the State-registered nurse, is adversely affected by the competition of the unqualified person. This Bill proposes to remedy some of these defects.

Part I of the Bill provides for the establishment of a roll of assistant nurses for the sick to be kept by the General Nursing Council. The Council will make rules, which will be subject to the approval of the Minister of Health, regulating the conditions: of admittance to the roll, including rules as to training and examination. There is provision for the admission as existing assistant nurses, of persons engaged in bona-fide practice before the introduction of the Bill. The Bill provides for the formation of a special Assistant Nurses Committee on which there will be five representatives of assistant nurses and six members appointed by the General Nursing Council. Before the Council can take any action on any matters wholly or mainly concerned with assistant nurses, such matters roust be reported on by the Assistant Nurses Committee who will also deal finally with all disciplinary matters. These previsions aim to secure a better status and recognition for the assistant nurse. There is great need for competent assistant nurses who may not be able to reach the qualification rightly set for the State Register but may be admirable practical nurses when acting under supervision. I ought to say in passing that our chronic hospitals are very largely dependent upon the services of these assistant nurses.

The Bill proposes restrictions on the use of the title of nurse. Some representatives of the nursing profession have proposed that it should be made an offence for any person other than a State-registered person or an enrolled assistant nurse to nurse the sick habitually for gain. This was, I believe, recommended by the Nursing Reconstruction Committee over which my noble friend Lord Horder presides, but after the fullest consideration the Minister felt unable to accept that suggestion. "Nursing the sick" is, after all, a very vague expression and it would be a serious thing in the judgment of the Minister to ask Parliament to make it an offence for persons to perform small services which might, on a strict construction, be regarded as nursing duties. The Bill does, however, go a long way toward meeting the idea behind the suggestion by making it an offence, under Clause 6 of the Bill, for persons other than State-registered nurses to use the title of nurse. There are certain exceptions from the restrictions on the use of the title. The children's nurse, for example, retains a traditional and well-merited right to the use of the name "nurse" provided she does not use it in circumstances or in a context which suggests that she is something other than a children's nurse.

Part II of the Bill provides that agencies for the supply of nurses shall supply only registered nurses, enrolled assistant nurses, certificated midwives, and other classes who may be prescribed by the Minister. This will put an end to the practice which less scrupulous agencies have followed of supplying wholly unqualified nurses. That is, in my judgment, very important. My own experience has taught me that being ill is a whole-time job and that a patient ought not to have his attention deflected by having to verify the quality of the nurse who attends him. Few greater wrongs can be done to a helpless patient than to place him in inefficient hands. When the nurse appears the patient will-tingly and very gratefully surrenders himself to her delicate, and yet quite firm, tyranny because he believes she knows far better what is good for him than he knows himself.

I think that what I have said covers the general scope of the Bill, and your Lordships will not require me, I imagine, to go through the separate clauses seriatim. The general purpose of the Bill is to improve the status of an essential and, as I have said, very noble service. Your Lordships will, I am sure, receive the Bill with sympathy. It received but little criticism, and no challenge, in another place, from which it emerged with the general good will of the whole House. I therefore ask your Lordships to give the Bill a Second Reading, and I beg to move.

Moved, That the Bill be now read 2—(Lord Snell.)

LORD ADDISON

My Lords, on behalf of my noble friends, in giving our general support to this Bill, I may say that I notice the influence of my remonstrance upon the character of its presentation to the House by my noble friend Lord Snell. I know that, of course, it is not his Department for which he is speaking.

EARL DE LA WARR

My Lords, on a point of order, is it in order to refer to something that happened on an occasion which was not a public occasion?

LORD ADDISON

My Lords, I stand corrected. I was about to observe that the speech to which we have just listened was, to a considerable extent, read, and I think that on the whole that is not a practice which should be followed where it can be avoided. But I know that the noble Lord was speaking for a Department with which he is not habitually engaged, and therefore he was bound to be guided by the brief that had been supplied to him. We all know what a facile and attractive speaker he is, and I cannot but think that he, with his consummate art in presentation, would have made the Bill sound more attractive if he had been able just to tell us about it in his own words and had not been handicapped by a Departmental brief.

I hope that your Lordships will not expect too much from this Bill. It is stereotyping a name but not much more than that, and I am not quite sure whether it will go very far. It will prevent, or make more difficult, certain types of imposture, but I hope that it will not make more difficult, in any humble household, the services of Good Samaritans. Although such people cannot be described as nurses they are very necessary and acceptable on thousands of occasions. But I think that when we get some of the results of the Committee presided over by my noble friend Lord Rushcliffe, we shall be dealing with something which is more effective, so far as the calling of nurses is concerned, even than this Bill. What nurses have suffered from, for generations almost, is the fact that they have been very badly paid, and that the profession has not been an attractive profession, as it ought to have been, except to large numbers of self-sacrificing women. Further, there have been conditions in certain medical schools, I am sorry to say, which have caused some resentment in that grown women have been treated as if they were school girls. Naturally, the women, in many instances, did not like the discipline and restraint that that implies. I myself was responsible for passing the Nurses Registration Bill through Parliament twenty odd years ago, and I well remember the trouble I had trying to get it agreed upon in advance. But we do hope that this Bill, by defining nomenclature and restricting the profession, will emphasize the urgent need for improving the attractiveness of the profession and its facilities generally, so that a vastly greater number of young women will be encouraged to enter it.

LORD HORDER

My Lords, I am not likely to-day to disobey the exhortation that from time to time has fallen from the lips of members of your Lordships' House as to long speeches, for, although I have no mandate to say so, I feel I can assure your Lordships that so far as my profession is concerned this Bill meets a very sympathetic ear. But what is much more important—and in this regard I am able to speak with authority—the nursing profession welcomes this Bill, or will welcome it if and when it becomes law, together with the valuable economic adjustments which have been recommended by the Committee over which my noble friend Lord Rushcliffe presides. These two things taken together will succeed in raising the status of the nursing profession in this country as nothing has so far done. The noble Lord, Lord Snell, has said of the members of the nursing profession that it is a noble and essential service which they are rendering, and if this raising of their status and this appreciation of their services are a little overdue, as some of us think, well then at long last, perhaps, we are giving our estimate, to some extent, of the measure of their value to the country.

When my right honourable friend the Minister of Health brought this Bill forward in another place, he said that on broad lines he was following the recommendations of the Athlone Committee and of the Nursing Reconstruction Committee, under the ægis of the Royal College of Nursing, of which I have the honour to be Chairman. It is true that my right honourable friend has followed those recommendations, as he expresses it, on broad lines. But you have heard from my noble friend Lord Snell that in one respect my right honourable friend's courage forsook him when he came to deal with one of our suggestions for the protection of the patient. The feeling of the Committee, which was the result of much consideration, was that in the in- terest of the patient, at a time when he was in no condition to protect himself, and of the nurse, it was reasonable that the profession should be closed to everyone except three grades of person: the State-registered nurse, the assistant nurse, enrolled as she must be if this Bill is passed into law, and the student nurse. We should not allow a sick person to be exploited by any woman or man who cannot be put into one of those categories. My Committee still consider that that would be in the interest both of the public and of the nursing profession, and, when this Bill reaches a later stage, I shall move an Amendment which, though it may not achieve quite as much as that, will go a little further in tightening up the Bill so that the public may not be so easily exploited. The medical profession and the nursing profession welcome this Bill, because we believe that it does improve the status of nursing and the safety of the public.

LORD RUSHCLIFFE

My Lords, I do not propose to trespass on your indulgence for more than a very few minutes, but, as Chairman of the Nurses Salaries Committee, to which both Lord Addison and Lord Horder have referred, I should like most warmly to commend this Bill to your Lordships' acceptance. There is very little that I need add to the precise and concise statement of its provisions given to us by the noble Lord, Lord Snell, in introducing the Bill, and what he said has been reinforced by the noble Lord, Lord Horder, speaking with all the authority of his great position in the medical world. As Lord Snell pointed out, the first object of this Bill is to set up a proper standard of training for assistant nurses, and to secure for them a recognized status. The importance of the assistant nurse in the nursing world was brought very vividly to our attention in the Report of the Athlone Committee, which said: It will not be possible for at least some years to come, or perhaps ever, to carry on the nursing services of the country without the aid of the assistant nurse. Later, the Committee said: At the present time many of these women are doing excellent work in hospitals and institutions, especially in caring for the chronic sick. That, as the noble Lord, Lord Snell, has pointed out, is the first object of the Bill.

The second object of the Bill is to protect the nurses and the public from unqualified persons who call themselves nurses, when in fact they have no qualification at all. The third object of the Bill is to place under restriction and control those agencies for the supply of nurses which are called nurses co-operatives, and to secure their proper control by a system of licences and inspection. Lord Horder's Committee went very fully into the position and status of assistant nurses, and the object of this Bill is to carry out the recommendations made in that part of their Report, and to secure for these people a proper standard of training and a recognized status in the nursing world. Speaking as a complete layman in these matters, that seems to me a wholly desirable object, and I think that this Bill secures it. Lord Snell tells us that there are about 16,000 nurses who are described as assistant nurses. I have been informed that in some local authority institutions no less than 40 per cent. of the nursing staff are assistant nurses. If that be true, as I have no doubt that it is, those figures show the importance and the urgency of dealing with this matter as this Bill does deal with it. With regard to the limiting of the use of the title of nurse to a person who has proper qualifications, in my view, again speaking as a layman, that is a wholly desirable and long-overdue reform. It is exactly what in other professions is done statutorily. If a person calls herself a nurse, the public ought to know that she has certain qualifications appertaining to the exercise of her profession.

With regard to the third point, which concerns these agencies for the supply of nurses to which I have referred, some of them are undoubtedly very reliable, and perform a useful service in supplying nurses to those who ask for them. It is certain, however, that some of them are neither reliable nor responsible, but are in fact most unreliable and irresponsible. Some of them have been sending out to act as nurses persons who have no qualifications whatever. They have charged high fees both to the patient and to the nurse, and I think it is beyond doubt that in present circumstances, with the shortage of nurses, they have increased the fees which they charge for a service which is completely valueless, and which may indeed be almost mischievous. In my view that part of the Bill, like the rest of it, is a reform which is long overdue. Those are the three main objects of the Bill. All of them are commendable, and should be accepted without any hesitation by this House. As your Lordships will see, this Bill has the double object of safeguarding the nurses themselves, the members of a great profession, giving them safeguards to which they are fully entitled, and also of protecting the patient in the time of his need from being exploited by unworthy, unscrupulous and unreliable people.

On Question, Bill read 2, and committed to a Committee of the Whole House.