§ Order of the Day for the House to be put into Committee read.
§ Moved, That the House do now resolve itself into Committee.—(Lord Alness.)
§ On Question, Motion agreed to.
§ House in Committee accordingly:
§ [The EARL OF ONSLOW in the Chair.]
§ Clause 1 agreed to.
§ Clause 2:
§ (2) Rules made under this section shall contain provisions—
- (a) requiring as a condition of the admission of any person to the roll that that person shall have undergone the prescribed training, and shall possess the prescribed experience, in nursing; and
- (b) requiring that the prescribed training shall be carried out either in an institution approved by the Council in that behalf or in the service of the Admiralty, the Army Council or the Air Council; and
- (c) enabling persons who, within the period of two years after the date on which the rules to be made under the provisions of this paragraph first come into operation, make an application in that behalf (in this Act referred to as "an existing assistant nurse's application"), to be admitted to the roll on producing evidence to the satisfaction of the Council that they are of good character, are of the prescribed age, are persons who were for at least the prescribed period before the sixth day of May, nineteen hundred and forty-three, bona fide engaged in practice as nurses under conditions which appear to the Council to be satisfactory for the purposes of this provision and have such knowledge and experience of nursing as to justify their enrolment.
§ (3) Unless Parliament shall hereafter otherwise determine, nothing in rules made under this section shall enable a course of training begun after the expiry of five years from the commencement of this Act to qualify any person for admission to the roll.372
§ LORD CRAIGMYLE moved, in subsection (2) (b), to leave out "either". The noble Lord said: The word "either" here is of course meaningless by itself, and your Lordships will therefore expect me to deal with the substantive Amendment to which this is really consequential. The real Amendment is the next one on the Amendment Paper—namely, after "Air Council", to insert "or in a hospital managed by a Government Department". This wording is a departure from the original Amendment which I put down, which was circulated to your Lordships, and the explanation is that this wording suits better the views of the expert draftsman in the Scottish Office. I believe that the Government will accept this Amendment. The reason for it is that in addition to hospitals under the Admiralty or the Army Council or the Air Council, there now exist a number of hospitals in Scotland—in Scotland only—under another Government Department, hospitals which did not exist at all at the date of the principal Act. These are the large and efficient hospitals provided by the Department of Health for Scotland, and not only provided and manned, but daily managed by them, and it seems in every way suitable that hospitals managed by the great central public health authority of Scotland should be rated alongside hospitals under the Army Council, the Air Council and the Admiralty. I beg to move.
Page 2, line 21, leave out ("either").—(Lord Craigmyle.)
As my noble friend has indicated, the purpose of this Amendment is to make it clear that the Department's hospitals may be used for the purpose of training assistant nurses. With that object the Government is in complete accord, and therefore I have pleasure in accepting the Amendment.
§ LORD RUSHCLIFFE
Might I ask my noble friend whether the Secretary of State has made any arrangements to secure that the training requirements of the General Nursing Council for Scotland are complied with in these hospitals under the control of the Secretary of State?
The answer to my noble friend's question is in the affirmative. The Secretary of State, I understand, has already communicated with the General Nursing Council in regard to the 373 matter to which my noble friend has referred and it is probably well that publicity should be given to the matter.
§ On Question, Amendment agreed to.
§ LORD CRAIGMYLE
NOW we come to the substantive Amendment to which I referred. I beg to move.
Page 2, line 23, after ("Air Council") insert ("or in a hospital managed by a Government Department).—(Lord Craigmyle.)
§ On Question, Amendment agreed to.
§ LORD CRAIGMYLE moved, in paragraph (c) of subsection (2), to leave out "before the sixth day of May, nineteen hundred and forty-three." The noble Lord said: The clause as it stands draws a hard-and-fast line at the 6th May last. There seems to be no particular reason for that. Supposing the period fixed by the General Nursing Council was two years the nurse might have served one year and eleven and a half months at that date and it is unreasonable to fix such a hard-and-fast date. I had hoped that my noble friend would concede the omission of these words, but I understand he does not feel himself able to do so. If he does not, I should like to move that the words "the passing of the Bill" be inserted so as to give a little more rope. I think that is not unreasonable, and I should be glad if the noble Lord in charge of the Bill would give your Lordships his guidance in this matter.
Page 2, line 32, leave out from ("period") to end of line 33.—(Lord Craigmyle.)
The date to which my noble friend referred—namely, the 6th May, 1943—is the date of the introduction of the Bill, and the paragraph provides in effect that any woman desiring to be enrolled as an existing assistant nurse—that is, without examination—must satisfy the General Nursing Council among other things that she possesses such knowledge and experience of nursing as to justify her enrolment, and the principle to be applied is that she should have been engaged in practice as a nurse for the prescribed period before the date of the introduction of the Bill. The exact period will be prescribed by rules made by the Council. It is quite true, as my noble friend said, that some women who are quite suitable nurses may be excluded from this benefit 374 by the existence of a hard-and-fast rule, but that a hard-and-fast rule is essential I have no doubt at all. The old trouble arises that, when you have a hard-and-fast rule, some cases of hardship necessarily occur. But it is essential that the prescribed period should, so to speak, be anchored to some date, otherwise the concession of permitting women to be enrolled as assistant nurses without examination would continue indefinitely. So far as I know, until now my noble friend had not suggested an alternative date. He has now suggested one of which I have had no prior notice, and I should not like to commit myself at once to accepting it. I promise my noble friend to look into the matter before the next stage of the Bill.
I think the suggestion of my noble friend Lord Craigmyle is a most reasonable one. Probably a great many nurses did not know that the Bill was going to be introduced. Many of them were abroad.
In choosing the particular date which the Bill contains, one is following common form and many precedents. You find the testing period in the corresponding English Act, in two Nurses Registration Acts of 1919, in the Dentists Act and in many others. But having regard to what my noble friend has said, I will willingly consider the matter further before the Report stage.
I do hope the noble Lord will substitute the date of the passing of the Bill. There is no doubt that the object is to get more nurses, and more will come under the scheme the later we can make the date. Undoubtedly it does seem hard that nurses who have been training for a considerable period should not be allowed to enrol.
§ LORD CRAIGMYLE
I apologize for not having given my noble friend intimation of the possible alternative. There was no possibility of doing so, but I hope he will give us a little more rope on the grounds stated by my noble friends Lord Elibank and Lord Kinnaird. He has very fairly said he will consider the matter, and in view of that I do not press this Amendment. I beg leave to withdraw it.
§ Amendment, by leave, withdrawn.
§ LORD CRAIGMYLE moved to leave out subsection (3). The noble Lord 375 said: Here I cannot introduce my remarks in a more suitable way than by quoting what has just fallen from my noble friend Lord Alness about the desirability, so far as is practicable, of following the lines of the English Bill. This subsection does not occur in the English Act. The English Act sets up a roll—it is not called a register—of assistant nurses. That is in accordance with the proposals of the Athlone Committee, a Committee headed by Lord Athlone, and composed of experts who considered at great length the whole question of nursing in England. That recommendation is given effect to in the Act which recently was passed in your Lordships' House. My noble friend Lord Alness is, I acknowledge, an expert in this matter. As I said yesterday, the Report of the Alness Committee is a landmark in this territory, but for some reason I have never been able to discover from any expert whom I have consulted the Alness Committee unanimously turned down the idea of having any assistant nurses in Scotland at all, and they turned it down in spite of what must have been within their knowledge, that the shortage of nurses in Scotland is much greater than it is in England. My noble friend said yesterday that the Athlone Committee and the Alness Committee both reported in 1938. That is true, but the Athlone Committee Report is dated December 20, 1938. The Athlone Committee had had before them for many months the Report of the Committee presided over by my noble friend, and they stated—I have the Report here, but I shall not trouble your Lordships by quoting from it—they were unable to agree with that recommendation for England.
§ Why that roll should be first set up in this Bill and then be treated as purely temporary, being closed after five years, I cannot find out, and I think it defies the wit of man to find out. I am willing to be converted by my noble friend who is himself so strong upon the subject that he treats it as vital. I beg your Lordships to remember that the problem of the untreated sick in Scotland is more severe, in proportion, than it is in England, and the need for assistant nurses is much greater. That is the reason why I move the deletion of this subsection which makes the roll of assistant nurses purely 376 temporary. The wording of the subsection is not without its humour. Like the trumpet in the Scripture, it gives forth an uncertain sound. The words are "Unless Parliament shall hereafter otherwise determine." Why should it be conceded to both Houses of Parliament that they have the right to repeal this obscure subsection in a fairly obscure Bill when they can not only repeal this subsection but the whole Bill and every other Act of Parliament? The reason for these words is that His Majesty's Government are by no means satisfied with the views of the noble Lord who represents them today, and feel so unhappy about the matter that they consider it necessary to sound a warning. Therefore we have these most unusual and unprecedented words, "Unless Parliament shall hereafter otherwise determine." If this subsection is left in the Bill, it would be only reasonable to insert "by Resolution of both Houses," thus leaving this little matter of the continuation of the roll of assistant nurses to be decided by Resolution instead of having to go through the whole rather elaborate machinery of another Statute. I beg to move.
Page 2, line 38, leave out subsection (3).—(Lord Craigmyle.)
I should like to support my noble friend in this Amendment. So far as I can see, this particular subsection almost obliterates the whole object of the Bill. The title says that it is "a Bill to make provision in Scotland for the enrolment of assistant nurses for the sick." Under the Bill the enrolment goes on for five years and then suddenly it is stopped by a subsection, the reason for which my noble friend has attempted to explain to some extent, but which I cannot understand at all. I do not know what explanation the noble Lord (Lord Alness) will give when he rises, but if this subsection is to remain in the Bill then I agree with my noble friend Lord Craigmyle that at least some words should be inserted to enable Parliament to consider the matter at the end of five years. If the noble Lord is not going to accept this Amendment, I support my noble friend's sugestion that some such words should be inserted in the Bill so as to give us an opportunity of reconsidering the matter five years hence and discussing it once more in Parliament.
From all the information I am able to get, the roll of assistant nurses will be of very great value. There will be a great demand for assistant nurses both for private nursing and in hospitals. If they are in demand one can see no reason why there should be this limitation of time. They will be as valuable five years hence as they are to-day, and I hope the noble Lord will see his way not to limit the period.
I am very grateful to my noble friend Lord Craigmyle for the courteous terms in which he has proposed this Amendment. I am afraid I cannot agree with him that the subsection is in any way obscure. It seems to me, and I hope to be able to demonstrate to your Lordships' satisfaction, that it is essentially simple. An explanation of the provision and why it is to be found in this Bill was fully given by my right honourable friend the Secretary of State in another plate. I explained yesterday at a rather late hour why this particular provision is found in the Bill and why it takes this particular shape. In another place an Amendment similar to that moved by my noble friend to-day was moved, and after the explanation given by my right honourable friend the Secretary of State, that Amendment was negatived.
The explanation of the subsection is simply this. The Athlone Committee, on evidence which was laid before them, favoured the setting up of a roll of assistant nurses. The Committee of which I had the honour to be Chairman in Scotland, after evidence had been led on the subject and full consideration had been bestowed upon it, declined to favour the setting up of a roll of assistant nurses. If I may express a personal opinion—not speaking officially for the moment, but "off the record"—I would say that to my mind it seemed difficult to justify taking a step of this kind, which might have direct and unpleasant repercussions upon the State-registered nurses of this country, at a time when they are scattered all over the world doing war service, and without their voices being heard upon the subject. My Committee, on the evidence which was tendered to them, declined to favour the setting up of a roll of assistant nurses. The reasons for that conclusion are fully set out in the Report of the Committee.
378 Meantime something happened on this side of the Border. The English Bill was introduced. It contained a provision for setting up a roll of assistant nurses, and it is now on the Statute Book. My right honourable friend naturally enough, that having happened, cast about to see what could be done in Scotland on similar lines, or lines for the protection of the public similar to those in the English Bill. After consulting the appropriate nursing authorities in Scotland and others, my right honourable friend asked me to resummon the Committee of which I had been Chairman and to consult them anew on the subject of assistant nurses. I did so. The Committee reassembled and they informed me that they stood by their Report on this matter. I informed the Secretary of State that that was so. He also saw the Committee and they told him what they had told me. In that situation the Committee and I both agreed that some sort of compromise should be arranged, and with some reluctance the Committee were persuaded to assent to the setting up of a roll of assistant nurses, provided the roll was temporary in its character. My right honourable friend the Secretary of State proceeded to give effect to that compromise by putting this clause in the Bill.
In the Bill the five years' period appears, and to that proposal not only the Committee assented but the local authorities in Scotland have also assented, and the medical officers of burghs in Scotland are in agreement with the present proposal and with the contents of the Bill in this matter. Accordingly, there being an acute conflict of opinion upon this somewhat combustible topic, a compromise was arranged, and I do press your Lordships' House, if I may, and my noble friend Lord Craigmyle in particular, to abstain from disturbing this compromise, with results of which I rather tremble to think. It is a compromise acceded to by all those who are intimately concerned in the matter. My noble friend said yesterday he proposed to move an Amendment, but that he knew from the first that it was hopeless. I am afraid he was right.
§ LORD CRAIGMYLE
I thank my noble friend for his somewhat astonishing reply. He has referred to the unfairness of discussing this question in view of the dispersal of this particular class of nurse all 379 over the fighting areas, but it is not merely the nurses of Scotland who are dispersed over the fields of battle: that applies to the nurses of England too and, if this would be a dirty trick to the nurses of Scotland, Parliament has already done it to the nurses in England. Of course it is not a trick of that kind at all. It is a perfectly reasonable thing and all the more necessary in Scotland in view of the great shortage of nurses which is causing grave anxiety to those in responsible positions. If the nursing sisters are dispersed all over the fields of battle, so equally are the V.A.D.'s and the auxiliary nurses, so are the assistant nurses to whom this clause particularly refers. I do not wish to press my noble friend, but I do ask him to consider between now and the Report stage whether he will not accept the suggestion that time might in future be saved in Parliament by doing this by Resolution of both Houses.
§ LORD CRAIGMYLE
Yes. Then if my noble friend says he will do that I shall not press that Amendment either. I think the best thing is to withdraw, but I am not convinced by the arguments with which the noble Lord convinced his own Committee because none of them have been put before the House. I should have been very glad to hear them. However, I withdraw the Amendment not because my noble friend has convinced me, but merely as an act of faith in my noble friend himself.
§ Amendment, by leave, withdrawn.
§ LORD CRAIGMYLE moved, in subsection (3), after "Parliament," to insert "by Resolution of both Houses." The noble Lord said: I do not think I need add anything to what I have already said and I hope my noble friend will accept this Amendment.
Page 2, line 38, after ("Parliament") insert ("by Resolution of both Houses").—(Lord Craigmyle).
I regret I do not see my way to accept this Amendment for reasons which I shall mention in a moment and quite briefly. The Amendment really raises a question of Parliamentary procedure. If Clause 2, subsection (3), is to be amended in due course to enable the 380 training of assistant nurses to be continuous for a longer period than five years, then should the Amendment be made by Act of Parliament or by Resolution of both Houses? I venture to think that there are reasons why the subsection should stand as it is now. The first no doubt some of your Lordships may think a technical reason. Procedure by Resolution most appropriately applies to the approval of subsidiary legislation, such as Orders in Council and Regulations prepared by Departments, but Parliament has usually reserved for itself the amendment of an Amending Act, and that is what is contemplated here. That is a technical reason. The second reason is that, where any important change is to be made—and my noble friend will say this is important, or may be important—such as the stepping up of training which has been continued for a considerable period, it is surely better that Parliament should have the opportunity of debating fully the matter through all the stages of an Amending Bill than that the matter should be disposed of summarily by Resolution as my noble friend proposes. In those circumstances I would ask my noble friend whether, on reflection, he might see his way to withdraw the Amendment.
§ LORD CRAIGMYLE
I willingly accede to the request of my noble friend at whose feet I continue to sit on these matters just as I did when I had the good fortune, long ago, to be his junior. I accept his explanation and ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ Clause 2, as amended, agreed to.
§ Clauses 3 to 5 agreed to.
§ Clause 6:
§ Restriction on use of title of nurse and assistant nurse and penalties for misuse of certificates and falsification.
§ 6.—(1) As from such date as the Secretary of State may by order direct, any person who, not being a duly registered nurse under the principal Act or a duly enrolled assistant nurse, takes or uses the name or title of nurse, either alone or in combination with any other words or letters, shall be liable on summary conviction to a fine not exceeding, in the case of a first offence, ten pounds, and in the case of a second or any subsequent offence, fifty pounds:
§ Provided that (without prejudice to the provisions of Section eight of the principal Act)—381
LORD CRAIGMYLE moved to insert at the end of subsection (1):
(d) Nothing in this subsection shall prevent a person while actually employed in nursing covered by Section 2 (2) (b) of this Act from taking or using the name or title of nurse so long as such employment continues.
§ The noble Lord said: I beg to move to add the new subsection which appears on the Amendment Paper. Clause 2 (2) (b) sets out the types of institutions in which the technical training for registration as a State-registered nurse can be given. In all these there are employed a great many Red Cross nurses, V.A.D.'s, mobile V.A.D.'s mostly in military and naval hospitals, and a number of V.A.D.'s and others now known as Red Cross nurses in the hospitals of the Department for Scotland. If one goes into a ward of one of these hospitals one hears a sister cry "nurse", and who comes? A young lady with a red cross on her apron makes her appearance. She answers to the name of nurse; but if, after this Bill passes, she dares while employed in that hospital, nursing as she has done for nearly four years, to call herself a nurse, then she will have to pay £10 for the first time and £50 for the second time. It really cannot have been intended that this sort of fierce penalty should be imposed and that a perfectly ordinary piece of territory of the English language should be annexed to this particular use.
§ The sentiment in another place exempted from these penalties the children's nannie. The children's nannie is an estimable person, for whose existence we are all grateful, but the children's nannie is not really a nurse. These people are engaged in nursing the sick, and I think they should not depend upon the good will of my right honourable friend the Secretary of State, who it is true, if so pleased, can get them out of trouble, not indeed by allowing them to call themselves nurses, because he cannot do that under the Bill, but by giving them some title with a nursing ingredient in it. I do not think it is good enough in the constitutional sense that Parliament should create a class of potential criminals and leave it to the Executive to say "You and you and you are good people and will not be fined fifty pounds." I beg to move.
Page 4, line 47, at end insert the said new paragraph.—(Lord Craigmyle.)
As always, I admire the cogency with which my noble friend presents his case, but I regret to say there arc reasons which will prevent me from here and now accepting the Amendment which he has proposed. The nurses that my noble friend has in mind are no doubt the V.A.D.'s and Nursing Auxiliaries employed in the Department's hospitals, and the first thing I would like to say about them is that it is felt unnecessary, and I think undesirable, to endeavour to catalogue in this Bill the classes of women who may be permitted to use the term "nurse." It. is almost impossible to ensure that any such classification or catalogue would be complete. Is it not far better to leave the matter, as it is left by the Bill, in the hands of the Secretary of State who is empowered by Clause 6 (1) (b)—I do not know whether my noble friend overlooked it or not—
§ LORD CRAIGMYLE
I hardly thought he would, but I am surprised that, if he has not overlooked it, he should not have observed that it is a better way, as I suggest, to leave the matter in the hands of the Secretary of State rather than put a catalogue in the Bill which might turn out to be unsatisfactory and incomplete. There is another point. In view of the diversity of training and experience of V.A.D. nurses and Nursing Auxiliaries, it is not possible to give any promise that the regulations when made will authorize these women to call themselves nurses. At the same time my right honourable friend the Secretary of State appreciates the point which my noble friend Lord Craigmyle has made and has agreed to give it very full consideration. I hope that my noble friend will be satisfied with that. My right honourable friend, without committing himself completely at the moment, has said, I understand, that he will be prepared, when adjusting the regulations in question, to look into the claims of V.A.D's and Nursing Auxiliaries to be allowed to use the term "nurse." I ask my noble friend if he will not be satisfied to accept that definite assurance from a Minister of the Crown.
§ LORD CRAIGMYLE
My noble friend is too persuasive and all I can do after what he was good enough to say is to ask leave to withdraw this particular Amendment.
§ Amendment, by leave, withdrawn.
§ Clause 6 agreed to.
§ Clauses 7 to 13 agreed to.
§ Clause 14:
§ Training as assistant nurse to be reckoned towards period of training for admission to register.
§ 14. In order that persons enrolled as assistant nurses, who have at any time before their admission to the roll undergone training with a view to qualifying for admission to the register, but have not so qualified, may be encouraged so to qualify, the Council shall by rules under Section three of the principal Act, provide for such reduction as they may think appropriate in the case of such persons of the period of training prescribed under the said section.
LORD CRAIGMYLE moved, at the end of the clause, to insert:
In making rules under this section the Council shall also have regard to the service of members of Voluntary Aid Detachments and Nursing Auxiliaries and others in wards under a charge sister who is a registered nurse although such wards may not form part of a recognized training hospital.
§ The noble Lord said: Here we come to the real point of contention. The object of this Amendment has been considerably misrepresented in certain circles. It has been indeed held up to obloquy and attack as being contrary to the interests of the nursing profession and even of the sick. It is therefore necessary to make clear exactly what the Amendment tries to do. The Amendment is really a war measure and it seeks to ask the General Nursing Council to take into some consideration, entirely upon the merits of each individual case, the training and experience gained by certain Red Cross and auxiliary and assistant nurses in the practical nursing of the sick and wounded over a period of years in a reputable hospital under the eye of a skilled and fully qualified sister. The Amendment asks that these matters should be at least considered when an application is received from one of these nurses to enter upon her training for State registration. The Amendment most certainly does not seek to dictate to the General Nursing Council what, if any, remission of time should be given to these nurses who have reached a certain standard of competence and training as proved by any tests which they care to make or any examination which they seek to impose. It leaves all that matter of detail entirely to the General Nursing Council. That is all the Amendment asks—that some attention should be paid to the facts.384
§ It is a very mild Amendment. It could hardly be milder, and I am much surprised that it has evoked so much stern and unbending opposition as was evidenced by the impassioned speech of my noble friend Lord Geddes yesterday, when he implored the Government to be adamant against it. So far from the Amendment being an attack in any way upon the nursing profession, it is intended to promote the best interests of that profession by making it possible to gather into the profession, after any examination which the General Nursing Council care to impose, as much as is reasonably possible of the skill and training and experience now being gained by nurses in great hospitals which do not happen to be technically training institutions during the manifold emergencies of this war.
§ I say that if the Amendment had in any sense been directed against the nursing profession I should certainly not have moved it myself. It has been my privilege now for nearly four years to be in daily contact with the work of skilled State-registered nurses in one of the great hospitals which by the foresight of the Health Department has been provided for soldiers, airmen and sailors as well as for civilians in the South of Scotland, and no tribute to the work done by those skilled, fully qualified nurses could be too high. The nation, as my noble friend has already indicated, owes them a great deal of gratitude for work at home and abroad. But I must tell your Lordships that their attitude to these nurses is entirely different from that of the College of Nursing and the Nursing Council which have tried to speak in their name. Their attitude towards the V.A.D.'s and Nursing Auxiliaries who have been working under them for years now is much more understanding, much more friendly and I may say much more full of intimate knowledge of the situation than the attitude of those high and mighty bodies who have taken upon themselves to dictate the form of the clauses of a Bill which the Government have introduced. None of the skilled sisters whom I have met has done other than generously admit the excellence of the work and training of these nurses who are working under them. I ventured to give your Lordships yesterday one of many instances of nurses with three or four years' experience being put in charge of the flickering flame of life in a seriously 385 wounded patient. These sisters would willingly help them, because they have a recognition of their very fine work, and they wish to encourage them in the profession.
§ Having said that, I ought in all honesty to add that I have never met a single skilled nursing sister who thought it would be proper to admit upon the State Register those who have not in fact the necessary standard of knowledge and have not passed the necessary examination. Allowing a girl who has put in four years of lectures and training and practical nursing in a big hospital to get, say, three or six months off the course is one thing, but to accept a lower standard is another and much more serious thing which I do not want to advocate. We do not want to admit imcompetent people, but to get as many competent people as possible under proper conditions in view of the great shortage of nurses. So I propose this Amendment really in the interests of the profession, and, if I may say so, from my recent knowledge of the last few years, with a more profound reverence than ever for the work which it does. But I am putting it forward also in the interests of the general public, particularly of that multitude who are suffering, as your Lordships who come from Scotland know, from serious maladies, especially from tuberculosis, with now no hope whatever of nursing care.
§ The list of people in Scotland who are outside hospitals, waiting to be admitted and healed, surpasses anything that can be imagined in England. It is really heartrending. Perhaps your Lordships' attention may be specially drawn to that matter on another occasion. One gets accustomed to it in Scotland, but when one comes to think about it it is really very moving. One great and famous institution, to which I always pay tribute, has upon its waiting list no fewer than 2,600 people who are waiting for beds. These are people who are sick, people whom the doctors say ought to be in hospital receiving treatment there and they cannot be admitted. The core of that problem is not so much absence of beds—because the vision and foresight of the Secretary of State and the Department of Health have provided them—but shortage of nurses. Only this morning a friend of my own who hails from Scotland told me of someone who wished to get into a local 386 hospital which has been doing excellent work. Now that hospital has a matron but not a single nurse, and here is a clause which as modified by the activities of outside bodies tends to perpetuate that shortage of nurses in Scotland.
§ It would be quite wrong, I think, not to acknowledge the bold and far-sighted action taken by the Secretary of State and the Department of Health, not only in building and managing these large hospitals, but in taking a step which was not originally contemplated, by admitting civilian sufferers to them so that these waiting lists of such tragic dimensions are actually being cut down to some extent. But a great problem remains, particularly with regard to the tuberculosis cases. I am not talking sob stuff, but one must, and your Lordships must, look facts in the face. People are dying in tragically large numbers, I am officially informed, for want of nursing. I gladly acknowledge what the Secretary of State has done and I know that he is aware of this problem. Few men have done so much as he for the health of Scotland in so short a time. I hope that both he and these large hospitals will be able to continue after the war to carry on their beneficent work.
§ I come now to an interesting episode. Clause 14 of the Bill in its original form did not go quite so far as I should have liked but it went a considerable distance. If noble Lords will look at the Bill they will see it in its original form and with its original marginal note. As printed in the Bill, it opens the door to some extent—of course, purely on merits—to some alleviation in respect of the hospital time of what is technically known as training in favour of those whose names are placed upon the new Assistant Nurses Roll. That was the form in which the clause was introduced, but it was not allowed to remain in that form because a most unfortunate episode occurred. An attack of political hysteria intervened. What did really happen was that people without the same grave responsibility as rests upon Parliament and upon His Majesty's Government and upon the Secretary of State, responsibility for the health of Scotland, set themselves to wreck the hope which this clause held out. This very mild clause aroused the professional anger of certain important people who thereupon set themselves to agitate in favour of their own narrow views. And they lost no time 387 about it. The episode is really rather interesting. While the bogy of unfair competition was privately conjured up to terrify student nurses, the patients were not left out of account. Something very like the effigy of Sairey Gamp was publicly paraded to scare the sick. Deputations of nurses were organized and I believe they visited the Lobby of another place. They were organized with a skill and an assiduity which were certainly worthy of a better cause.
§ In the end Clause 14 left another place not in the form in which it is printed but in the emaciated form of the Amendment made in another place which now stands part of the Bill. Under the plea of keeping the nursing profession competent, these authorities will succeed only in keeping it small and in shutting out of it, in effect, a considerable body of people who, if they had a little encouragement and a little consideration for their claims, would desire to devote the rest of their lives to it. I think it will always be remembered of the College of Nursing that in the midst of a great emergency which demanded flexibility, realism and common sense, they triumphantly maintained the cause of starch and red tape. Is the noble Lord, Lord Alness, really put up to maintain that it would be wrong to grant to experienced Red Cross and auxiliary nurses of long service, in proper cases, and after due examination, a few months—say, three or at most six months—remission of the hospital time required for further training with a view to ultimate State registration? I cannot believe, in spite of what has happened, that His Majesty's Government really take that view, and seek to enforce it on your Lordships' House. After all, this Amendment is a very mild Amendment and it merely asks for some consideration of the claims of these people, their experience and training, on the facts.
§ Would it not really be better to admit that two years, or, say, three years or perhaps more of constant nursing in a large hospital under fully qualified matrons and sisters, has some value and then to proceed quietly to assess that value and to make whatever allowance for it appears to the authorities fair and reasonable? That would be facing the facts. But people who are responsible for the clause as it now stands are out- 388 side Parliament. They are not very good at facing facts; they are much better at fomenting agitations. But His Majesty's Government and your Lordships' House must take a broader view and must consider whether the Bill as it now stands is a worthy measure to issue from the Imperial Parliament.
§ The plight of the sick in Scotland has to be considered by the Committee, and particularly the unfortunate case of those hundreds of tubercular patients who urgently need nursing. Human nature being what it is, is it entirely reasonable to say to a Red Cross nurse or to an auxiliary nurse: "Go to such and such a hospital and nurse the T.B. cases there; you are urgently needed there, and it is your duty to go," if in the next breath you have to add in all fairness, "but not a single day or week or month of the time which you put in there will be allowed to count towards your training when you want to complete your nursing career and train for registration"? That attitude is courting defeat. I hope that the Committee will amend the Bill in this particular by accepting this extremely mild Amendment. I think that the auxiliary nurse who goes in for the somewhat perilous work of nursing T.B. cases deserves a pat on the back rather than the smack on the face which this clause gives her, altered as it has been at the instigation of people outside Parliament.
§ There is not merely the question of prestige; there is also the question of time. Some of these nurses have told me that they will be too old to go through the whole of the training again, and a limit has been imposed by statute or regulation on the age at which they can enter the profession. The age limit is, I think, thirty-one. Year after year this war goes on, and they go on serving. Their service is ignored, and, when the war ends and the need for their loyalty to the particular institution in which they are serving may cease, and they want to go on and be registered, they will be told: "It is too late; you are thirty-one. You ought to have come sooner." There is also the very serious question of remuneration. Auxiliary nurses in Scottish hospitals receive £55 per annum, and assistant nurses receive £70 per annum. If they leave the hospital where they are working and commence what is technically known as training for State registration, at once they 389 drop to £40 per annum. They come from good homes, but the great majority of them are by no means well off, and I do suggest that it is unfair that this additional burden and sacrifice should be imposed upon them, and that they should be forced to go through the whole training again, including the years of washing and scrubbing, for a wage which is only a fraction of that given to a woman railway porter.
§ Before I sit down, I should like to say a word in answer to a criticism which has been brought against these Red Cross and auxiliary nurses. If you are injuring a person, it is always a great temptation to say that that person is in the wrong. These nurses are said to be in the wrong on the ground that it would have been perfectly easy for them to go long ago and commence their technical training. The people who use that argument know perfectly well that, if these women had done that in any numbers, in answer to the advertisements, two things would have happened. My noble friend cannot deny this. In the first place, there would have been no room for them in the hospitals in Scotland which are technically training hospitals. Secondly, the whole service of the Government's emergency hospitals would have been seriously disorganized. I cannot find it in myself to blame them for their loyalty to the patients whom they were nursing and to the superintendents and surgeons and matrons under whom they are serving. I submit that in many cases rather than being blamed for sticking to the ship they should be commended for doing so.
§ I am not urging, nor, I believe, were the Government, in proposing Clause 14 in its original form, urging, the dilution of the nursing profession by incompetent people; but I do venture to plead for less rigidity in method, and for a deeper and a broader view, which shall include actual nursing experience and also the pressing national needs of Scotland. It is on these grounds, and these grounds alone, that I venture to move the Amendment which stands in my name.
Page 9, line 42, at end insert the said paragraph.—(Lord Craigmyle.)
§ LORD GEDDES
We have heard a very interesting, a very impassioned and a very emotional speech from Lord Craigmyle.
§ LORD CRAIGMYLE
You have heard the facts.
§ LORD GEDDES
The point at issue, however, or at any rate the major point, has not been touched on. The women referred to in this clause are those who are to be admitted to the register of State nurses and to become State-registered nurses. This clause does not stop them being assistant nurses. The whole point is, who is entitled, and by what method of training is she entitled, to get on to the State register? It has been a long fight to try to raise to an adequate level of skill and knowledge the technique of the nursing sisterhood. To begin with, in 1919 a great many people who had been nursing had to be admitted to the register, although a full inquiry into their training might have shown that much of that training was, as to my personal knowledge it was, defective. The object of the Act of 1919, however, was to make a nursing profession, and to give the members of that profession a student training, just as doctors, engineers, lawyers and members of other professions have a student training. No one imagines that a young chemical engineer or a young mining engineer is a person of great experience at the moment that he qualifies. Equally nobody imagines that a State-registered nurse is necessarily a woman of great experience at the moment that she is put on the register; but it is a fact that before she is put on the register she has undergone training, and that training involves a good deal of the type of training that a medical student has, in anatomy, physiology, pathology and so on. It is on the basis of the trained mind of the nurse that the various types of experience which she is given in the course of her training have their affect, and develop her capabilities and capacities.
It is easy to speak of the present day, as Lord Craigmyle has done, but it is necessary to look thirty years or more ahead before we get to the end of any action which may be taken in connexion with this matter. These women who get on to the State register will be State-registered nurses, and they are expected to be able to bear the full responsibility and strain that attach to the responsible work of State-registered nurses. Long ago I first began to realize how vital it was that we should have better trained nurses in this country. I shall never forget as 391 long as I live a very dear and close friend of mine who was ill, and who was at home being nursed. I received a telegram telling me to come, and I found that death was approaching through the mistake of a nurse. I shall never forget the remorse of that nurse.
§ LORD CRAIGMYLE
What about the mistakes of doctors?
§ LORD GEDDES
There are mistakes made by doctors, but let us try to eliminate the causes of mistakes, whether they are made by doctors or by nurses or by any other person in the community. But you have got to picture one of these State-registered nurses perhaps alone at night in some country district where life or death, any time in the next thirty years, may turn upon her real understanding and knowledge of the case. It has been said, and said truly, that training and experience added together make efficiency, but experience without training is sometimes most dangerous. And therefore in the interests of the sick of many years to come I beg of you to insist that every woman and man whose name is entered on the State register of nurses has had the necessary training in the fundamental sciences, the necessary types of experience given in wards devoted to different purposes, and that generally they have passed through the curriculum required by the College of Nursing.
On the other part of what Lord Craigmyle said, I find myself in agreement with him. I think that the women who have worked in the V.A.D. have had in many cases a very raw deal. I think that is true of those who have been working in the military hospitals throughout the Kingdom and who, through the new arrangement with the V.A.D., are being treated, I think, abominably. These V.A.D.'s, if they so wish, should be helped to get the training which will make them good State-registered nurses, and I do not agree with Lord Craigmyle that the way to help them is to cut off a bit of their training. But I do think that on the financial side the Government would be carrying out the wish of the country if they decided to help—for example, by making up the difference between the pay they have been receiving and the pay of nurses in training in the case of V.A.D.'s who have served four years. The State would thus be recognizing what we all 392 know is the case, that these volunteers have served the country well, and served the sick well, in this emergency to the limit of their capacity and power. But do not let us mortgage the welfare of the sick of the future out of an emotion that we want to help somebody because she has done something rather well now. It is the cheapest way to get rid of this emotion due to the feeling that people are being treated rather badly to do something for them and let whatever burden or cost there is fall perhaps on people still unborn. I would beg of you not to allow any weakening in the training basis that is to lie behind those women who are fully accredited members of the nursing profession, but to do anything that you can to help the V.A.D.'s to pass over from the most unfortunate and most anomalous position that they are in now into the company of the State-registered nurses.
§ LORD LANG OF LAMBETH
I can well imagine the annoyance with which your Lordships contemplate another speaker in this already, I think, too prolonged discussion. All I can say is that I shall not rival either the length or the eloquence of the two speeches which have just been delivered. But I do venture to say, speaking so far as I can quite impartially, that there is a case which it behoves the Government very seriously to consider. It has been expounded with eloquence worthy of a major scheme by my noble friend Lord Craigmyle. I summarize it as I see it as shortly as I possibly can. There is undoubtedly very great and special need of nurses in Scotland. I can speak for parts of the West Highlands. What Lord Craigmyle has said about the incidence of tuberculosis and the like is perfectly true there. And undoubtedly it is equally true that there is a shortage of nurses in Scotland, and that therefore any source from which good and well-trained nurses can be obtained ought to be so far as possible used. Now could there be a better source of supply for the nurses that are needed than these devoted women called V.A.D.'s or auxiliary nurses who, under the very special circumstances of a great war, have served in hospitals which admittedly give in a short time a training far more adequate than can be given in other hospitals?
Therefore if any women wished to devote themselves to the profession of nursing as a great vocation out of the 393 experience which they have had in their work, surely they ought in every way to be encouraged. But if they have, as the noble Lord, Lord Geddes, suggests, to begin right at the bottom and to set aside all the special experience they have gained during the war, they will be discouraged from the very thing that we want to encourage, which is that as many as possible of them should devote themselves to the career and profession of nursing. I should not have a word to say in favour of Lord Craigmyle's Amendment if I thought that it would lower the standard, but that is not So. As I understand it, the examination of these V.A.D.'s and auxiliary nurses would be as strict as the profession demands.
§ LORD CRAIGMYLE
§ LORD LANG OF LAMBETH
There is no question of watering down the fullness of the examination. All that is asked—it seems rather modest—is that in a matter of this kind where the need is so great and the supply might be so useful, it should be possible that any rules made should have some regard in special cases to those who have not spent the full requisite time under training in one of the hospitals recognized as training schools. I submit that this is a case to which the Government ought really to give more full and careful consideration, and I hope that that may commend itself to the noble Lord in charge of the Bill.
If I may be allowed to make one or two comments on what has been said, I wish I could rival the eloquence of my noble friend for I feel this matter very strongly and I think it is one for which we have a very great responsibiltiy. The noble Lord, Lord Geddes, said that Lord Craigmyle had missed the point. I beg leave to say that Lord Geddes has missed the point. In other words, we are at different points. Lord Geddes puts very great emphasis on the technique of the nursing sisterhood. He said that we are carried away with the sentimental point of view of trying to help the V.A.D.'s. There is a more important point than either of these two, and that is the patient. Lord Craigmyle has made it abundantly clear that there are hundreds of empty beds. Lord Geddes emphasizes that we should look ahead for thirty years. But where will the patient be if we wait for thirty years 394 while we go in for an ideal system of nursing? We must be practical. We should all like to have an ideal and perfect system, but we have to meet the practical difficulty of empty beds and dying people.
We know that the Secretary of State for Scotland has made great provisions for this. I would back up Lord Craigmyle in saying that the Secretary of State has done marvellous things. May I give one instance of what has been happening in the last month in Scotland? There have been such enormous waiting lists at the big hospitals in our big cities of people waiting to get treatment that they have been sending out the patients from these hospitals to the auxiliary hospitals provided by the Government. Who are looking after these patients out of these big hospitals? The very nurses whom we are saying should be allowed to qualify for the State register, and they are doing it efficiently. If it is good enough to use the services of these people for clearing the big hospitals, and make use of them for that purpose, surely anything we can do to help them to join the ranks of the State-registered nurses would be to the advantage of the patients and the nation.
Lord Geddes said a great deal about the training of these V.A.D.'s, and insinuated that we wanted to do away with it. No, what Lord Craigmyle has urged, and what I believe the Secretary of State would favour too, is that we make use now of the opportunity there is for training in the existing hospitals which the Government have provided and under the most experienced matrons and sisters of these hospitals. We cannot wait thirty years for this perfect system. We want to get the nurses now, not by doing away with the training but by making use of the existing hospitals. In any other profession, in the Army or anywhere else, you do not wait—you carry on your training all the time. Surely it is not beyond the wit of man during these three or four years, while the nurses are working in these Government hospitals, to devise some system of training at the same time. I am sure that the Secretary of State is in favour of that, and that it can be done.
Another point is that it has been stated publicly twice, by Miss Florence Horsbrugh in a letter to The Times, and by the Secretary of the Royal College of 395 Nurses in the Scottish papers, that the opportunity is given to these V.A.D.'s to transfer at once to a training hospital and begin their training, so that there is no hardship. Those of you who know where these V.A.D.'s are working know that, practically, in many cases that is not possible. Are people who have been for years fitting themselves to help their country in time of war, and have been distributed among hospitals overseas, likely, just when the emergency has come, when the war is in existence, and they are nursing the sick and wounded, to give up what they have been training for and say, "I shall throw over everything and help myself by starting nursing"? They would not do it. No doubt many could do it, but it would be a real hardship for many, and to say that this opportunity exists, without the qualification that many of them would be too public-spirited to avail themselves of it, is not fair. I must not keep the Committee longer, but beg to support Lord Craigmyle.
I wish to point out that Lord Geddes seems to attach no importance at all to experience before training, but only to experience after training. He says that in spite of the experience which any V.A.D. or auxiliary nurse may have, she must begin from the very beginning, do her training and get her experience afterwards. I do not think that is a reasonable proposition. It would not apply in any other profession. All that my noble friend has asked in his very eloquent speech, which has been supported by Lord Lang and Lord Kinnaird, is that three or six months should be taken into account in respect of that experience which they have had before they start their training. Apart from that, there is the injustice to the V.A.D.'s and the auxiliary nurses who have given their time and their services voluntarily, often for very little pay, in telling them, "You must begin all over again." There is the injustice to the community in Scotland who require these nurses and are suffering in thousands on that account. If the noble Lord, Lord Craigmyle, proposes to go to a Division on this question, which I sincerely hope he will unless the noble Lord (Lord Alness) accepts his Amendment, or something in that form, I shall 396 be very glad to support him in the Division Lobby, because I believe this is a matter of principle, a matter of importance to the whole community, and a matter of fairness to the V.A.D.'s and auxiliary nurses.
§ LORD HEMINGFORD
I want to make a suggestion. I am a firm supporter of Lord Craigmyle's Amendment, but one fact has weighed with me to some extent in what Lord Geddes said, and that is in regard to the future. There is always a difficulty, in starting the registration of a new profession or anything of that sort, as to who should be let in at the start. It seems to me that there is something in what Lord Geddes said that this might be a sort of back way into the profession in future. What I want to suggest is this. If the noble Lord, Lord Alness, is not prepared to accept the Amendment exactly in the form in which Lord Craigmyle has put it down, possibly he may be prepared to do so if, after the word "service" we insert "prior to the termination of the present emergency." I am not quite sure whether that is the correct form of words, but the noble Lord will know. The effect of that alteration will be simply this, that some consideration should be given to those who are working in this particular way as V.A.D.'s in hospitals which are not training hospitals, during the present period of emergency when the needs of the nation and of the patient are, and have been, serious and urgent. If that proposal commends itself to Lord Craigmyle, it might be a method of meeting the difficulty if the Government are not prepared to accept the Amendment as it stands in its present form.
I beg to support Lord Craigmyle's Amendment, and I hope that the noble Lord (Lord Alness) will come to see the matter in a like spirit and will accept it.
§ VISCOUNT BENNETT
I have at various times seen a good deal of this sort of legislation and I recognize the difficulty of the Government. On the other hand, as every member of this House is responsible for this legislation as it leaves this House, I cannot refrain from asking my noble and learned friend Lord Alness a question. If these young women are fit to render service and attend upon the sick and wounded, are we not insulting their intelligence when we say 397 that the training they receive is of no value if they desire to follow up that profession? That is the difficulty I have about it.
With all deference to my noble friend Lord Geddes, I think that he was in error in assuming that this was an effort to substitute this form of training for the training required by the curriculum. As I see it, there is a curriculum of studies for nurses. That curriculum divides itself into two parts, practice and theory. There is not much time in an emergency to receive lectures on theory, but there is a great deal to be learnt in practice, and all this Amendment suggests is that the practice which these people have had in dealing with sick and wounded persons shall be taken into consideration when they register as nursing students. That is all. If that is all then is it not an insult to their intelligence to say that during the whole time they were doing this nursing work they have learnt nothing? We assume they have learnt something. I venture to ask my noble and learned friend Lord Alness whether it is not the fact that what we are really asked to do is to say on the one hand that we believe in registered nurses who are going to enter these hospitals and there work as nurses in the wards, and, on the other hand, that if they desire to follow the nursing profession afterwards all the experience and the knowledge they have obtained are to be treated as of no value at all?
Your Lordships will agree that we have had an interesting debate upon this clause, and it is now my duty to endeavour to state the attitude of the Government with regard to it. I admire, if I may say so, the cogency with which my noble friend Lord Craigmyle presented his case, and I admire also those on whose behalf he spoke. We must all of us, whatever our views about this particular Amendment may be, feel an immense debt of gratitude to the V.A.D. nurses and to the auxiliary nurses and Red Cross nurses for the wonderful work they have done during the present emergency. It is therefore with the greatest regret that I feel myself unable to accept the Amendment which Lord Craigmyle has moved.
If I may say so, there have been several excellent speeches and I am afraid by contrast mine will be very pedestrian, 398 because I am going to invite your Lordships to come down and consider the practical aspects of this question and the history of this clause from the time when it was first presented. The problem as I see it is simply this. What type of nurse shall be entitled to a remission of at least a part of her training under Clause 14? What types are to be admitted to the benefit of that clause? Originally, as has been quite accurately stated, the proposal, as the Bill was introduced in another place, was that enrolled assistant nurses and women training for enrolment as such assistant nurses, might be included in the category of those who might receive remission of a certain part of their training. That clause with its implications was hotly opposed by the accredited representatives of the nursing profession.
My noble friend Lord Craigmyle has made some rather slighting observations with regard to these representatives. I have no personal knowledge of the deputations or anything regarding what transpired in the Lobbies of another place, but my noble friend must not forget that the members of another place also have responsibilities, that they are not apt to be swayed by hot-headed deputations, assuming them to exist, and the fact remains that this clause, as originally introduced, was not only wholly unacceptable in another place but was strenuously opposed there. Accordingly, my right honourable friend had to cast about him and see what could be done in these circumstances. He proposed to amend the clause. It now appears in the amended form, and includes assistant nurses who have at some time undergone training as student nurses. That clause, I think I am right in saying, placated the opposition in another place, and if I am not mistaken—I am not absolutely certain about this—it was unanimously passed in another place.
That is the history of this clause which I am afraid your Lordships cannot possibly afford to neglect. It is important, it is impressive, and it is suggestive. Then Lord Craigmyle comes along and says: "Oh, but I want you to include several other classes of nurse in this clause who shall be entitled to be considered in the question of remission of training when that comes along—V.A.D.'s and auxiliary nurses" No one has greater admiration than myself for the services which these ladies are rendering, and nothing could be 399 further from my mind or the mind of the Government—if I may say so—than to offer an insult to them as the noble Viscount, Lord Bennett, suggested.
§ VISCOUNT BENNETT
An insult to their intelligence.
It is not a question of insulting their intelligence at all. It is a question of considering whether, their training or lack of training being what it is, they shall be admitted to the catalogue with which Clause 14 deals.
May I ask the noble Lord whether he takes any account of the experience that these people have had? He talks only about their future training.
If my noble friend will allow me to proceed, I was just going to deal with the question of training and experience. I was saying at the moment he interrupted, that it seems to me that the keynote of this clause, the criterion for admission to the benefits of this clause, lies in their systematic training. I was very much impressed with what my noble friend Lord Geddes said yesterday, and repeated to-day, that there is a sharp distinction, which I have read or heard of before, between training and experience. If systematic training is to be the criterion of admission to this clause, then, whatever experience those women may have had in hospitals, military and otherwise, I cannot affirm that in all cases, or in many cases, their training has been ample and sufficient.
Now to me training seems to be an integral part of a nurse's qualification for going out as she often may do, as one noble Lord said, on her own and on her own responsibility to grapple with questions of life and death. Accordingly it seems to me that, if that be the criterion, this Amendment does not satisfy it. Under this Amendment as drawn—I do not want to be technical—it would be open to any V.A.D. or auxiliary nurse who has been in a hospital three weeks or less to claim the right of remission of training. That shows how wide you would open the door to a danger, looking at it from the point of view of the sick which is most important, if you were to open the door to women trained so meagrely as that. If we are to seek not only not to lower the status of the nursing profession but to raise it—and surely that 400 should be the object of each one of us—then I venture to suggest that this would be a retrograde step to take, and one which your Lordships, if I may say so, would afterwards regret. It seems to me there has been a misapprehension in some quarters as to what this Bill sets out to do. One would have thought from some of the speeches that have been made that it was a Bill intended to abate the shortage of nurses in Scotland. It is nothing of the kind. It is intended above all things to protect the public against unqualified nurses, and I am afraid I must say with respect that that seems to have been forgotten by some noble Lords, who seem to look at the Bill as a Bill designed to remedy the shortage of nurses.
Your Lordships would be very far astray if you thought nothing was being done, outside the confines of this Bill, to remedy that shortage. I have taken the trouble to make some inquiry on that subject, and I would like to tell my noble friend Lord Craigmyle the results of that inquiry. I am authorized to say that, in consultation with the National Advisory Council for the Recruitment and Distribution of Nurses and Midwives, the Minister of Labour and National Service is at present in communication with the General Nursing Councils of both countries with regard to a suggestion that some concession should be made, under the existing powers of the Councils, in the direction proposed by my noble friend Lord Craigmyle to-day. The Minister has asked the Councils for their views on a proposal that V.A.D.'s and Nursing Auxiliaries who have good experience of nursing in the hospitals during the present war might, on the recommendation of matrons, be permitted to take the practical part of the preliminary State examination, and if successful might be allowed to take the rest of the preliminary State examination at the end of a period of six months' training in a general hospital. In that way it would be possible for these women to complete their training for the General State Register at the end of an additional period of two and a half instead of three years. These negotiations are proceeding. I hope they will be successful, and they certainly tend in the direction in which my noble friend Lord Craigmyle is looking to-day.
But the matter does not end there. The Scottish Education Department has already suggested to education authori- 401 ties that they should establish what are called pre-nursing courses in secondary schools, central institutions and continuation classes which prepare candidates for the theoretical part of the preliminary State examination. That is not all. In addition, education authorities have power under Section 4 of an Act which I had the honour of sponsoring in 1918—I am sorry to say it was so long ago—to assist any qualified person resident in their area to attend any educational institution approved by the Department, and the assistance given according to the circumstances of each candidate may take the form of payment of travelling expenses, fees or the cost of residence in a hostel, or a bursary and maintenance allowance.
I am sure my noble friend Lord Craigmyle will be the first to admit that these are important aids to the abatement of the shortage of nurses. If this Bill becomes law the Secretary of State proposes to urge education authorities where appropriate to provide and by every means to stimulate interest in these pre-nursing courses in continuation schools and central institutions. He proposes also to ask these authorities to give favourable consideration to the terms of Section 4 of the 1918 Act to which I have referred, and so to help to accumulate a larger share of available women in the nursing profession. It is hoped that these measures will be useful, and I think I can say I am confident that they will. Therefore, so far as shortage of nurses is concerned, I submit with some confidence that the situation is being tackled, not inside this Bill which was not designed for the purpose, but outside it, in order to bring about the result which we all desire. I end on the note with which I began. It seems to me that the situation can be summed up in one sentence—that
§ the history of this clause forbids the acceptance of the Amendment moved.
§ LORD CRAIGMYLE
I deeply regret that my noble friend has been unable to give your Lordships any real answer to the gist of this Amendment. I am afraid there is no chance now of avoiding putting your Lordships to the inconvenience of a Division. The point is perfectly plain. We have asked these women for years to do practical nursing and then the Government say they must go in by the back door and go through the whole thing again. Surely their experience must be of some value. The Amendment leaves the assessment of that value to the General Nursing Council and asks them to make their preparations accordingly. I cannot sit down without mentioning one fact which I think must be unknown to my noble friend Lord Alness. In India after the last war Red Cross nurses who had served two or more years were given one year's remission. Everything has gone on perfectly well, and matrons in hospitals in India say that these nurses are some of the best nurses that have come under them. I am grateful for what he says on the financial matter and and I am sure it will be appreciated by the nurses. Before I conclude I must say a word of apology to my noble friend Lord Geddes. He regretted the impassioned way in which I spoke. I share with him the privilege of Highland blood and I get hot in the presence of unmerited and unnecessary suffering. But I shall endeavour on future occasions in his presence to behave with proper decorum and more in accordance with his wishes.
§ On Question, Whether the said words shall be there inserted?
§ Their Lordships divided:—Contents, 18; Not-Contents, 20.401
|Cromer, E.||Annesley, L. (V. Valentia.)||Hemingford, L.|
|Onslow, E.||Beaverbrook, L.||Keyes, L.|
|Bennett, V.||Chatfield, L.||Kinnaird, L.|
|Elibank, V. [Teller.]||Craigmyle, L. [Teller.]||Sempill, L.|
|Rothermere, V.||Davies, L.||Stanmore, L.|
|Samuel, V.||Denman, L||Winster, L.|
|Devonshire, D.||Wimborne, V.||Clanwilliam, L. (E. Clanwilliam.)|
|Abingdon, E.||Alness, L.||Desborough, L.|
|Lucan, E.||Bethel, L.||Geddes, L.|
|Munster, E.||Brabazon of Tara, L.||Sherwood, L.|
|Vane, E. (M. Londonderry.)||Bruntisfield, L.||Snell, L. [Teller.]|
|Cecil, L. (V. Cranborne.)||Southwood, L.|
|Margesson, V.||Cherwell, L.||Templemore, L. [Teller.]|
§ Resolved in the negative, and Amendment disagreed to accordingly.
§ Clause 14 agreed to.
§ Clauses 15 and 16 agreed to.
§ Clause 17 [Amendment of S. 2 (3) and of S. 8 (2) of principal Act]:
LORD CRAIGMYLE moved, after subsection (1), to insert:
(2) Subsection (2) of Section three of the principal Act (which relates to rules with respect to the conditions of admission to the register) shall have effect as if in paragraph (b) thereof the word 'either' were omitted and after the words 'Air Council' there were inserted the words 'or in a hospital managed by a Government Department.'
§ The noble Lord said: This Amendment to Clause 17 has been agreed to, I understand. It is consequential on an Amendment which your Lordships accepted earlier in the Bill.
Page 10, line 38, at end insert the said subsection.—(Lord Craigmyle).
§ On Question, Amendment agreed to.
§ Clause 17, as amended, agreed to.
§ Remaining clauses agreed to.
§ Schedules agreed to.