§ 4.40 p.m.
§ Order of the Day for the Second Reading read.
§ LORD MORRISON
My Lords, this Bill, as your Lordships will know, is the counterpart of the Bill for England and Wales to which your Lordships recently gave sympathetic consideration. Like the English Bill, it is based on the recommendations of the Working Party on Nurses published in 1947, and has been framed after extensive consultations with all the interests concerned. I am happy to say that on all the major issues dealt with in the Bill the Government have the general support of the profession in Scotland. The prime purpose of the Bill is to improve the training of nurses and the conditions under which they are trained. Your Lordships are well aware of the great need for increasing the number of nurses available for the health services in Scotland. The Working Party told us that one of the obstacles to increasing the numbers of trained nurses was that there was very heavy wastage in training. The Government hope that as a result of the 1009 changes proposed in this Bill conditions of training will be improved and that wastage will be substantially reduced.
Student nurses receive their training in hospitals approved for the purpose by the General Nursing Council for Scotland, and their training follows a curriculum laid down by that body. In the past this training has commonly not been of a comprehensive character but has been related to separate aspects of nursing, such as general hospital work, for which separate registers are maintained for men and women; the nursing of infectious diseases, including tuberculosis; the nursing of sick children, and of mental patients and mental defectives. There is a strong body of opinion, supported by the Working Party, that all student nurses ought to receive a comprehensive basic training, followed by a period of further training in the specialist field of nursing which they wish to take up. It will be for the General Nursing Council for Scotland to take the lead in bringing changes about, and Clause 4 of the Bill enables it to make limited experiments and trials of new schemes of training before adopting them generally.
At the present time the Council consists of nine elected nurses, together with six other members appointed either by the Privy Council or by the Secretary of State. A change in the composition of the Council is regarded as necessary to enable it to perform the new and wider functions to be laid upon it under this Bill, and it is desirable that specific provision should be made for the presence amongst its members of specialists in educational methods. It is therefore proposed—your Lordships will find the details in the First Schedule—to increase the size of Council from fifteen to twenty-six members; of these, thirteen will be nurses elected by nurses, eleven (including two nurses) will be appointed by the Secretary of State, and two will be appointed by the Privy Council. It is generally agreed that in present circumstances adequate representation of the nurses on the fever, sick children's, mental and mental defective registers should be provided for. In this Bill, therefore, we are proposing that seven of the elected nurses shall he chosen by nurses, both men and women, on the general registers, two shall be elected by nurses on the registers for mental nursing and the nurs- 1010 ing of mental defectives, one by nurses on the fever register and one by nurses on the sick children's register. In addition, we propose that two members should be elected by those sister tutors who hold certificates of training in the teaching of nursing recognised by the General Nursing Council. It is not considered desirable by any of the interests concerned that the elections for the Council should be based upon the five regional hospital board areas, and in this respect the proposals for Scotland differ from those contained in the English Bill.
Of the thirteen appointed members it is specially provided that two must be nurses employed by local health authorities and that the Secretary of State, before appointing them, must consult appropriate interested organisations. We should have been happy to provide for the election of public health nurses, but nobody has been able to devise a satisfactory electoral system. I am informed that in filling the other nine seats the Secretary of State will ensure appropriate representation of the various branches of the medical profession and of general educational, hospital management and local health authority interests, and that he will also include persons with qualifications for administering the training grants to which I will refer in a moment. The Privy Council are required to give one of their seats to a representative of Scottish universities. Your Lordships will see from what I have said that the Council will include fifteen nurses out of its total membership of twenty-six, which is preserving for the nursing profession the majority of seats on the Council.
At the present time courses of training for nurses are largely based upon individual hospitals. The development of new methods of training will, however, mostly require the participation of several hospitals, to afford the student nurse various types of experience. And it may often happen that the existing grouping of hospitals under boards of management will not be a suitable grouping for the purpose of nurse training. In order to assist the General Nursing Council in bringing about the necessary collaboration of boards of management, Clause 2, with the Second Schedule, proposes the establishment of regional nurse-training committees, one for each of the five Scot- 1011 tish hospital regions. These regions vary considerably in size and in the number of their hospitals, and the Bill, therefore, empowers the Secretary of State, if he should find it necessary after experience, to combine two or more regional areas for the purpose of establishing a joint nurse-training committee.
The functions of the committees are defined more fully in this Bill than they are in the English Bill, and in particular Clause 3 lays down in some detail the procedure where a nurse-training committee feels obliged to intervene to secure the preparation of a satisfactory nurse-training scheme. This has been done in response to representations reaching the Secretary of State from all interests concerned, that the Bill should make clear the position of the various statutory bodies in this matter. Apart from assisting in the planning of nurse-training, the 'nurse-training committees will, under subsection (2) of Clause 2, generally supervise the training of nurses in their area, reporting to the General Nursing Council on matters of significance which appear to require attention. The Committees are also to advise and assist the General Nursing Council on matters referred to them, including the approval of institutions for the purposes of training; and are empowered by Clause 4 to promote research and investigation into matters relating to nurse-training.
In the debates on the English Bill some of your Lordships doubted the suitability of the nurse-training committees and the General Nursing Council for handling the financial side of nurse training, as Clauses 5 and 6 of this Bill propose. Eventually we agreed on I think two main Amendments. These were the insertion into the Bill of requirements that, first, the Minister should include among the members whom he appoints to the General Nursing Council a number of persons with experience in hospital management, and secondly, the General Nursing Council should appoint from among their members a statutory finance committee, to which matters relating to the finance of nurse training would stand referred. Initially I think your Lordships had specially in mind the position of the English teaching hospitals under their boards of governors, who are independent of the regional hospital boards. 1012 That particular aspect of the matter does not arise in Scotland, for the teaching hospitals there are part of the hospital service administered by the regional boards. The Secretary of State has, however, an open mind on the desirability of introducing into this Bill Amendments similar to those which I have mentioned, for what they require will in fact be done, whether the Statute explicitly requires it or not. Perhaps the noble Lord, Lord Clydesmuir, and any other of your Lordships who are interested, would care to have an informal talk on this subject before the next stage of the Bill.
Looking to the time when comprehensive training may replace the present system of sectional training, power is taken in Clause 9 for the Secretary of State to close the individual Supplementary Registers of nurses—that is, the existing sectional registers apart from the General Register—on request to that effect by the General Nursing Council. This power will not, of course, be exercised until new systems of training have been tested and proved, and the Supplementary Registers will remain until then.
I need not detain your Lordships much longer. Perhaps, however, I should refer to one or two of the lesser provisions in the Bill. First, as in the English Bill, we propose under Clause 7 to set up a Mental Nurses Committee of the General Nursing Council, to deal specially with matters concerning mental nurses and nurses trained in the nursing of mental defectives. Details of the composition are to be found in the Third Schedule. Clause 8 seeks to empower the General Nursing Council to admit to the Register nurses trained abroad who, in their opinion, have been trained to a standard equivalent to that of Scottish trained nurses. It is also provided in Clause 12 that Scottish nurses who were eligible for admission to the list set up under the 1943 Act—namely, the nurses who did not take advantage of the original opportunity afforded to them under the 1919 Act to secure admission to the Register—shall now be entitled to admission to the Register.
Your Lordships will recall that, under the 1919 and 1943 Acts, appeals against the refusal of the General Nursing Council to approve hospitals for training purposes lie to the Secretary of State. Such appeals, we feel, ought not to lie to the 1013 Minister responsible for the administration of almost all the hospitals which might he concerned, and Clause 10 accordingly provides that any appeals shall, in future, be made to the Lord President of the Court of Session, who is required to refer the matter for decision to two or more persons appointed by him. Clause 13 authorises the Secretary of State, on application from the General Nursing Council, to approve an increase in the annual fee for retention of a nurse's name on the Register to a sum exceeding the present statutory limit of 2s. 6d. per annum. There is no reason to suppose that any such increase will be necessary in the near future, but we fear that a limit dating from 1919 cannot indefinitely be maintained.
Clause 14 empowers the Secretary of State to require the General Nursing Council, should they ever cease to publish the Register and Roll annually, to publish a supplementary list of admissions and deletions at such intervals as he may direct. These two last provisions do not go quite so far as those in the English Bill, but they have the support of those who can speak for Scottish interests, and are regarded as adequate to meet the Scottish position. The only other provision I need mention is Clause 18, under which the Council will in future be called upon to make an annual report to the Secretary of State, for presentation to Parliament. My Lords, I trust that I have given you a brief and fair picture of the contents of this measure. It is the Government's belief that what they are here proposing will not only maintain the high standard of nurse training in Scotland but will raise it to even higher levels, and make a bigger contribution to the cutting down of wastage in training than any other step which can be taken in existing conditions. I ask your Lordships to give the Bill a Second Reading.
§ Moved, That the Bill be now read 2a.—(Lord Morrison.)
§ 4.57 p.m.
My Lords, I am glad to be able to accord a welcome to this Bill, the Second Reading of which has been moved by the noble Lord, Lord Morrison. The noble Lord, shortly but very clearly, covered the contents of the Bill, and I think that your Lordships can be in no doubt as to what it 1014 effects. As your Lordships will see, it is a measure designed to improve the status of nurses and especially to make a more imaginative approach to their training. Emphasis is laid on training. It is, of course, a machinery Bill, and everything will depend on how the machinery is worked. But machinery is capable of improvement, and when a similar measure was passing through this House, your Lordships were able by agreement to improve the machinery in some respects.
As the noble Lord has pointed out, conditions are not exactly comparable as between Scotland and England. For example, the teaching hospitals in Scotland are wholly integrated into the regional organisation and do not carry the special position of the English teaching hospitals. Therefore, certain changes made in the English Bill might not necessarily be advisable here. None the less, I think that some improvements in the Bill may be possible, and I would like to accept the noble Lord's invitation to discuss them between now and the Committee stage.
On the purpose of the Bill, and what it is designed to Secure, there can be no difference of opinion between members of your Lordships' House, no matter on which side they sit. The desire is to improve the recruiting of nurses and to lessen wastage. Wastage, as the noble Lord has said, is serious. It seems to be due to several reasons. In the first place, young girls feel that the code of discipline is unnecessarily severe and that the relationship between senior staff and students sometimes tends to be rather formal, if not unfriendly. Girls are also apt to feel that regulations concerning their off-duty hours are sometimes rather unreasonable. Moreover, there are complaints about food, accommodation, pay and recreational facilities, and about the pressure on the girls during working hours. Whether the new Council will help to improve these matters remains to be seen. I have great hope that it will, because it will touch new sources of information. In the mental hospitals, on which the noble Lord briefly touched, the wastage is higher still—for understandable causes; because the strain must be particularly great in those hospitals. Their staffs certainly deserve imaginative and sympathetic treatment.
1015 I will now, if I may, mention one or two minor suggestions which, after consultation with the noble Lord, I may want to follow up later. First, in regard to representation on the Nursing Council. I note that only two of the nominated places are retained for registered nurses. I am not clear what the Government have in mind as regards the other places which the Secretary of State is to fill. I suggest that further guidance may be desirable here to ensure that constructive and knowledgeable opinion is fully represented on the Council. Clause 8 deals with reciprocity. We cannot legislate for other countries, we can legislate only for ourselves, and I presume that the Government are satisfied that this clause will not affect any of the reciprocal arrangements already in operation. I hope that every effort is being made, both in Commonwealth and foreign countries, to secure full reciprocity. This is not a matter of legislation but rather of administration, and it is important to make known the terms we give here and to ask that reciprocity be given by other countries.
Clause 15 has come under a little criticism in some quarters for what may seem to your Lordships to be a small point, but I think it is one of principle. The Council may provide out of moneys provided by the nurses' registration retention fees for the expenses and loss of earnings of nominated council members who will probably not be nurses. I think that up to now the retention fee has been limited to 2s. 6d., and though it is a small sum, perhaps it is not quite fair that expenses of council members should come out of nurses' fees. Should not public money be used to cover this common outlay? I note, while on the subject of fees, that Clause 15 abolishes the limitation of 2s. 6d. The noble Lord said that for some time 2s. 6d. would be enough; but it may rise. No doubt it is necessary to have power to increase the fee, but I attach importance to its being an annual fee and not a life subscription or a composition. If there is an annual fee, there is an annual check on the Register. There is the advantage of a check on the continued existence and whereabouts of nurses, because they have to declare themselves once a year when they pay their 2s. 6d. This gives control of the Register, which must be a live 1016 one if it is to be of any value. A Scottish nurse who has to pay 2s. 6d. will surely make known where she is. There may be an occasion in our discussions for adding a clause to make sure this is an annual fee of 2s. 6d., so that we do not fall into the evil habit of compounding by payment in a lump sum.
The whole emphasis of this Bill is made on training. I am sure that is right. We may find a slight clash of opinion or interest between the hospitals and the nurses' training committees. The hospitals, hard pressed, may think it desirable to get work, of whatever kind, done and may fear that training will interfere with that work. But I am sure that in the long run it will be recognised that a comprehensive training of the best possible kind will pay. This is essential if we are to secure the best possible nursing service. I feel certain there will ultimately he harmony on this point, though there may be the risk of slight misunderstandings in the early stages. I am glad that the noble Lord has introduced a separate Bill for Scotland. Once or twice I have ventured to criticise the Government for hanging measures on to the English coattails—unhappily, when the coat does not fit. In this case we have imaginative treatment of Scottish conditions and I hope the Bill will receive its Second Reading.
§ 5.5 p.m.
§ LORD POLWARTH
My Lords, I had not intended to intervene in a debate conducted by a Minister and a former Secretary of State, feeling awe and wonder at the manner in which the noble Lord, Lord Morrison, expounded the incredibly intricate piece of machinery that is contained in the Bill. But I must emphasise one point that the noble Lord, Lord Clydesmuir, made. I have said this is a remarkably involved piece of machinery. It will be of no use whatever unless administered by all those concerned with it with a very considerable amount of understanding and feeling.
It is well known that one of the principal reasons for the small number of women coming forward as nurses and for the large number of nurses falling out in the course of training, has been the rigidity and the often pettifogging nature of the rules and regulations under which they carry out their training. I 1017 think we are beginning to realise that much more nowadays, and we are improving on it; but there is still a great deal of room for improvement. We shall not achieve the best results until the people at the top, both in hospitals and on the various elected bodies mentioned in this Bill, really understand how to handle their fellow human beings. I have always felt that discipline in female hands can be a dangerous thing, and nowhere is that more the case than in the nursing profession. To take one example which I came across during the war. A nurse well en in her twenties serving in a military hospital was never allowed during her days on duty to keep the lights on after ten o'clock. For people of that age, such a rule is ridiculous. As I have said, the one thing which will bring results is to administer the Bill in an understanding and sympathetic manner.
§ 5.7 p.m.
§ LORD MORRISON
My Lords, the reception given to this Bill by both noble Lords who have spoken has been so kind that I am sure that I should not be justified in taking up much more time, particularly as we Scottish members have monopolised the whole House this afternoon. We must not be too greedy or we shall lose our good reputation! I should like to thank both noble Lords for their kind references to the Bill. I am sure that with their co-operation we shall make it even better before it leaves this House. The noble Lord, Lord Clydesmuir, referred to the fact that the Council might have to pay out, for expenses and loss of earnings of Council members who possibly will not be nurses, money provided by the nurses' retention fees. It is important to know that the same point could have been raised on the English Bill, but was not raised—which again shows that the Scottish character is maintaining itself. Without saying whether I agree with the reply or not, I am advised that, since a penny on the amount of retention fee produces not far short of £100, any increase on that account on the retention fee of 2s. 6d. would be insignificant, and the burden on the nurses would still remain far lower compared with the registration charges payable by members of other professions.
In view of the long time that Scottish affairs have occupied your Lordships' House this afternoon and in view of the 1018 further fact that the criticism has been entirely friendly and that we have other opportunities, privately and in the House on other stages of the Bill, of making this Bill even better than it is to-day, I will add no more. I thank the noble Lords for their confirmation of the Bill.
§ On Question, Bill read 2a, and committed to a Committee of the Whole House.