NURSES BILL

HL Deb 17 May 1949 vol 162 cc739-82

3.24 p.m.

Order of the Day for the House to be put into Committee read.

Moved, That the House do now resolve itself into Committee.—(Lord Shepherd.)

On Question, Motion agreed to.

House in Committee accordingly:

[The EARL OF DROGHEDA in the Chair]

Clause 1 agreed to.

Clause 2:

Standing nurse-training committees

(2) It shall be the duty of a standing nurse-training committee for a hospital area—

(c) to advise and assist—

1. (i) Hospital Management Committees appointed by the Regional Hospital Board for the area;
2. (ii) Boards of Governors of teaching hospitals situated in the area;

in the preparation and carrying out of schemes for the training of nurses in accordance with any requirements of the Council for the time being in force with respect to the training to be undergone by persons as a condition of their admission to the register or the roll; and

LORD LLEWELLIN moved, in subsection (2) (c) (ii) after "area" to insert, "who make a request in that behalf to the Committee." The noble Lord said: The scheme of this clause, as your Lordships may know, is that the standing nurse-training committee for a hospital area shall have certain duties which include: to advise and assist—

(ii) Boards of Governors of teaching hospitals situated in the area; and

(iii) any other authority or persons engaged in the area in the training of nurses who makes a request in that behalf to the Committee."

This Amendment would put the board of governors of a teaching hospital in the same category as the "other authority or persons" mentioned in sub-paragraph (iii). It seems to me that it is no good these nurse-training committees, which will be modern committees, coming to advise and assist the governors of our old teaching hospitals, who have been the pioneers in nursing training, unless those teaching hospitals wish to receive them and make a request in that behalf. It is no good the committee coming along, say, to Guy's or Bart's Hospital and proffering advice to people who are not prepared to receive it. By far the better way is that the request should come, when probably the exchange of information would not be just a one-way traffic. The standing nurse-training committee would suggest one or two things, and the old teaching hospital, with its old scheme of training nurses, would possibly say: "Would you not like to consider whether our way, which has been so successful, will be a good thing for you to try to get adopted in more hospitals?" That is the way in which a measure like this will work smoothly. But if it is thought that these standing nurse-training committees, because they hold the purse strings, are going to dictate to the great hospitals, then I do not believe the Bill will succeed. If the committees are not going to dictate, then there is no possible reason why the words I suggest should not be inserted. I beg to move.

Amendment moved— Page 3, line 2, after ("area") insert the said words.—(Lord Llewellin.)

LORD SHEPHERD

The noble Lord has suggested that the teaching hospitals should be put in the same position as the other authorities mentioned in the subparagraph which follows the one referring to the teaching hospitals. The Government could hardly do that, for the reason that the other authorities referred to in this clause are not to be members of the committee. The teaching hospitals are specially designated as future members of the committee, and they are therefore in a separate category. It would be well, I think, before I deal with the terms of the Amendment, if I went through the composition of a training committee. If any suggestion of dictation is raised, I think an examination of the make-up of the committee will dispel all such fears. Your Lordships will find the constitution of the committees set out on page 14 of the Bill. It there says: A standing nurse-training committee … shall consist of…

1. (a) persons appointed by the Regional. Hospital Board for the area;
2. (b) persons appointed by the Boards of Governors of teaching hospitals situated in the area;
3. (c) persons appointed by the council;"—

that is the General Nursing Council— (d) persons appointed by the Central Midwives Board; (e) persons appointed by the Minister after consultation … If noble Lords will examine that provision carefully, I think they will appreciate that the committees, when they are established, will be bodies of responsible men and women; they will be men and women of experience and capacity, and in all probability they will consist very largely of persons engaged in hospital work itself. When one has found out of whom the committee actually consists, the question arises as to whether any powers mentioned in Clause 2 should be take from them. If the committee were to be a scratch affair; if the teaching hospitals were to be unrepresented; if there were any doubt about the committee's quality, then something might be said for putting in some kind of limitation. But, being what they are, we think they should be given all that this clause provides.

We want these training committees to be successful. The only way in which they will be successful is by co-operation between the regional hospital boards and the boards of governors of teaching hospitals. If those two bodies of representatives can get together and discuss carefully the interests of their region, there need be no fear of victimisation from one side or the other: there will be equality. His Majesty's Government and the Minister desire that the relationship of the teaching hospitals to these committees shall be exactly the same as that of the hospital boards. We are not inviting the teaching hospitals to come into this scheme of things merely for the benefits which they will receive, though I think it can be shown, as I hope to show, that considerable benefits will come the way of the teaching hospitals. But above everything, what we are anxious to receive is the experience, the knowledge, the influence and the leadership of the teaching hospitals in a new scheme of things which has for its object the production of a better nursing service in this country.

I do not know whether noble Lords appreciate the width of the field which is opening before them, and therefore perhaps I may be permitted to mention two or three figures from the north western metropolitan hospital board area which will indicate how much greater will be the opportunity of the teaching hospitals than it could otherwise be. In that area, the regional boards have in training at this moment 3,179 student nurses. That is a fairly large number. In addition, there are being trained in that area at this moment 676 nurses for mental cases; that is to say, there is a total of 3,855. I am informed that if the hospital services in that area are to be kept going with an efficient nursing service, there must be an intake every year of 1,200 for the general nursing side and 450 for the mental nursing side. When one remembers that in that area at this moment there are five teaching hospitals for undergraduates and seven or eight teaching hospitals for post-graduates, one realises the tremendous power and influence which can be brought into this scheme of things if the teaching hospitals enter it.

Now a word about the clause. This particular Amendment seeks out one paragraph which is headed "to advise and assist," but if noble Lords will look at the rest of the powers in that clause and realise that those powers have not been challenged, it will, I think, be agreed that the Amendment is one affecting only a comparatively small portion of the work to be done. The Amendment is somewhat restricted in its scope. There is no power of advice or assistance generally, but only on the schemes of training: and examination which, for the time being, have been laid down by the General Nursing Council, and upon which registration will be made on the completion of the examinations. I have one fear About the Amendment, and I do not attribute the fear or the possibility of it to the noble Lord opposite; I have too great a regard for his integrity and for his statesmanship. I believe, however, that in this matter it will be found that he is wrong. I think that if the Government accepted the Amendment the best of the teaching hospitals—those with leadership, experience and efficiency—would volunteer to come in to-morrow; but I fear that a number of hospitals which are not so efficient, who need both help and assistance, might take the opportunity the Amendment provides of remaining outside. I am sure that the noble Lord would not desire that for a moment. I believe we are all anxious that when this scheme is set going, these training committees shall be given every kind of help it is within the power of anyone to give.

LORD WEBB-JOHNSON

I think the noble Lord, Lord Shepherd, has avoided a fundamental point in not indicating more precisely what is the composition of a standing nurse-training committee. He gave us no numbers, whereas rumour has it that the representation of the teaching hospitals upon which he lays such stress is to be very meagre. That meagre representation may be quite satisfactory if it is a matter of using influence, a point upon which the noble Lord has also laid stress. A single representative can bring influence into a committee. But if the committee is concerned with the affairs of the teaching hospital itself, then the situation is quite changed. If this standing nurse-training committee were not labelled throughout as a regional committee, there would not be the same objection to making the amount contributed to a teaching hospital dependent upon the advice tendered by the nurse-training committee, which is a regional committee. There is no getting away from the label, because not only is the regional board to be the headquarters—and I believe considerable representation of the regional board is contemplated—but the regional board is to be responsible for providing accommodation and the officers and servants of the committee; and in my view that immediately makes that committee practically a committee of the regional board.

LORD LLEWELLIN

The sting in the tail of this power is, of course, the fact that under the Bill as drafted these standing nurse-training committees have the powers of the purse-string. If some arrangements are made later whereby they will not have the powers of the purse-string, there is no reason whatever why the words I suggest should not be inserted here. If there is this power behind the committee, they can, of course, insist on this particular duty to come in and advise and assist. That is all very well. I have myself advised many people in my time, and I have tried to help many people also; but a good many have not taken my advice and a good many have not wanted to be assisted. It does not seem to me to matter very much whether my words are inserted here or not. The fundamental difficulty we are up against is this. In the Act which we passed only two years ago the teaching hospitals went for their needs direct to the Ministry and not through the regional boards; and that method, so far as I know, has worked extremely well in practice. Now we are going to set up the standing nurse-training committees, to which the teaching hospitals, if they want any sort of grant, must go, equally with the smallest hospital in the land. That is the real point of difference.

The fear of the teaching hospitals is that the position of great recognition which they very properly achieved in the earlier Act because of their great services to medicine will now he whittled away from them, and they will have to go cap in hand to a standing nurse-training committee on which they may perhaps have one representative. It is a body that will be set up in the offices of a region, and its officers will be provided for it by the regional hospital board. These hospitals will be very largely under the influence—I do not want to use any harsher phrase than that—of the regional hospital board. A great part of the position which they achieved when the Health Bill was before Parliament is being undermined by this Bill. If, when we come to Clause 4, we can make some different arrangement from the one at present provided in this Bill, I think we shall find the scheme will work far better. That can be achieved if we get all those concerned in it to work as willing partners, all trying to make this great nurse training scheme a success without having their own position adversely affected—as they think it will be if the Bill remains as at present. If this matter can be dealt with under Clause 4 there is no reason why I should argue the matter now, and in the circumstances I beg leave to withdraw the Amendment which I originally proposed.

Amendment, by leave, withdrawn.

LORD SHEPHERD

This is really a drafting Amendment. There was some ambiguity in the clause, owing to the use of the word "them," giving the impression that the committees were being referred to. The body which is in fact referred to is the Council, and we therefore seek to substitute the words "the Council." I beg to move.

Amendment moved— Page 3, line 17, leave out ("them") and insert ("the Council").—(Lord Shepherd.)

LORD LLEWELLIN

This was a matter about which some of us felt apprehension on behalf of the Council. Everybody I think is agreed that the proposed arrangement may work extremely well if the people at these examinations are only invigilators, who arrange the room and the supervision of the examination. Everyone is agreed that the Council ought to lay down a standard for the examination which shall be the same throughout the country. I think this Amendment makes it clear, and I am obliged to the noble Lord for moving it.

On Question, Amendment agreed to.

Clause 2, as amended, agreed to.

Clause 3:

Experimental training of nurses

3.—(1) If the Council are of opinion that it would be advantageous that a trial should be made of a scheme of training and examinations to be undergone and passed by persons as a condition of their admission to the register or, as the case may be, the roll, being training and examinations differing from the training and examinations for the time being required by rules made by the Council to be so undergone and passed, they may, with the approval of the Minister, by resolution adopt the scheme for such period as may be specified in the resolution and in relation to such institutions situated in such hospital area for which a standing nurse-training committee is constituted under this Act as may be so specified, being institutions appearing to the Council to be suitable for the purpose of carrying out the scheme therein.

LORD SHEPHERD moved, in subsection (1), after "differing from" to insert: but appearing to the Council to be no less efficient than. The noble Lord said: It has been suggested that in Clause 3, which deals with the experimental training of nurses, there should be a provision inserted so as to ensure that nurses who go through training under an experimental scheme shall be given opportunities of becoming really efficient, and that the schemes which are approved for this purpose shall give that guarantee of efficiency. We hope that the words which it is proposed to include will achieve that purpose. I beg to move.

Amendment moved— Page 3, line 28, at end insert the said words.—(Lord Shepherd.)

LORD LLEWELLIN

Here again, I think that the matter is made clearer than it was before. There are many of us who are glad to see the experiment made, so that there can be trials of different ways of training nurses, so long as it is quite clear that in the opinion of the Council it does not in any way lower the standard of training. I am glad, therefore, that the noble Lord has seen fit to put in these additional words. I think they will allay the doubts that some people felt in the matter.

On Question, Amendment agreed to.

LORD WOLVERTON moved to add to subsection (1) "and willing to do so." The noble Lord said: Clause 3 gives powers to the General Nursing Council to carry out experimental training. While we all welcome those powers, it is thought by other people as well as myself that the experimental training should not be carried out within these great hospitals if the hospital authorities are not willing to have them carried out there. Therefore my Amendment seeks to ensure that the hospital authorities are willing to agree to such arrangements. I beg to move.

Amendment moved— Page 3, line 37, at end insert ("and willing to do so").—(Lord Wolverton.)

LORD SHEPHERD

I trust the noble Lord will not press this Amendment, because it appears to be quite unnecessary. The purpose of the clause itself is to make sure that the bodies which will undertake experimental training will be willing to undertake it. In any case, there is nothing in the Bill to authorise or to empower the General Nursing Council to force experiments on anybody, and we hope the noble Lord will see fit not to press his Amendment.

LORD WOLVERTON

In view of what the noble Lord says, it seems clear that there will not be any attempt to force these hospitals to have this training if they do not desire it, and I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 3, as amended, agreed to.

Clause 4:

Expenditure on nurse-training by Hospital Management Committees, &c.

4.—(1) Where a standing nurse-training committee is constituted under this Act for a hospital area, expenditure by a Hospital Management Committee appointed by the Regional Hospital Board for the area or by the Board of Governors of a teaching hospital situated in the area, being expenditure—

1. (a) wholly or mainly for the purposes of, or in connection with, the training of nurses; and
2. (b) of such description as the Minister may specify for the purposes of this subsection;

shall, so far as it is incurred in accordance with estimates approved by the standing nurse-training committee, instead of being defrayed in accordance with section fifty-four of the National Health Service Act, 1946, be defrayed by that committee.

(2) Any question arising under this section shall be determined by the Minister.

LORD WEBB-JOHNSON

had on the Order Paper an Amendment, in subsection (1) to omit "or by the Board of Governors of a teaching hospital situated in the area." The noble Lord said: Your Lordships may recall that, in speaking on the Second Reading, I used these words: I am sorry that the noble Viscount the Leader of the House is not now present, because I would have liked to see how he took the suggestion that something comparable to the University Grants Committee, for the creation of which he was largely responsible, would be a more suitable body for this purpose. As there is an Amendment in the name of the noble Lord, Lord Luke, which raises that issue, I do not propose to move my Amendment.

3.51 p.m.

LORD LUKE moved to leave out Clause 4 and to insert the following new clause:

Expenditure of nurse-training and hospital management committees, &c.

". The Minister may, by order, constitute in accordance with the Schedule of this Act, (Constitution of Hospital Grants Committee) a Committee, (in this Act referred to as a Hospital Grants Committee) for the purpose of approving expenditure by a Hospital Management Committee appointed by the Regional Hospital Board for the area or by the Board of Governors of a teaching hospital situated in the area, being expenditure:

1. (a) wholly or mainly for the purposes of, or in connection with, the training of nurses; and
2. (b) of such description as the Minister may specify for the purposes of this subsection.

Such expenditure shall, so far as it is incurred in accordance with estimates approved by the Hospital Grants Committee, instead of being defrayed in accordance with section fifty-four of the National Health Service Act, 1946, be defrayed by that Committee."

The noble Lord said: We seem already to have approached this subject under Clause 2. I was wondering whether my noble friend Lord Llewellin was going to continue so far (that I would not have anything to say on this clause. But I think that here we have a fundamental issue and a principle. This matter was spoken of strongly by my noble friend Lord Moran, and by the noble Lord, Lord Webb-Johnson, on Second Reading. I noticed particularly that the noble Lord, Lord Shepherd, said nothing about it when moving the Second Reading; nor did he answer this particular point which was raised by the noble Lords, Lord Moran and Lord Webb-Johnson; but he touched on it when he spoke on an Amendment to Clause 2.

It seems rather illogical to depart from the principle established in the National Health Service Act, of regarding the teaching hospitals as being in a separate category and giving them a certain amount of independence. This Bill seeks to "put them down a peg," as it were, and give them their monies at second-hand, instead of, as at present, direct from the Minister. The noble Lord, Lord Shepherd, said just now that under the provisions of this clause, as the Bill now stands, there would be greater co-operation between the teaching hospitals and the nurse-training committees, and so forth. But has there not been, under the National Health Service Act, co-operation among all concerned, between the teaching hospitals and others? I should like to know why we are now departing from the principle laid down in that Act? In this Amendment, we seek to set up a hospital grants committee to administer the funds required by every institution in respect of the training of nurses. This hospital grants committee, the constitution of which will be dealt with in the Schedules, would have the advantage of providing that the people concerned with the finances would be on that committee and not on the standing nurse-training committee and the General Nursing Council, thus leaving those two bodies entirely free to concentrate on nursing standards.

There would, of course, be full consultation between the hospital grants committee and the standing nurse-training committee, and I do not see why there should not be the full co-operation of which the noble Lord, Lord Shepherd, spoke. It may be argued, of course, that here we are trying to set up another committee, and that there will be a multiplicity of committees. I would answer that by saying that I think principles are more important than the fact of having too many committees. In view of our strong feelings about the principles involved in this matter, I beg to move this Amendment, and I hope that noble Lords will support me.

Amendment moved— Leave out Clause 4 and insert the said new Clause.—(Lord Luke.)

LORD GIFFORD

I should like to say one sentence in support of this Amendment. For a number of years I happened to be the secretary of a large teaching hospital in Australia, and experience in Australia was that it was essential that all monies that came to teaching hospitals should come from a central authority, from the Minister, and not be provided regionally.

LORD SHEPHERD

After the endless discussions that have taken place in your Lordships' House during the past few years on the subject of remote control, I am somewhat surprised that to-day we should have a proposal of this kind from the noble Lord, Lord Luke. What he is proposing is really control of finance by a body of people, who may be in London or in some other centre, a body without official representatives of its own in any other part of the country, a body reaching its decisions at a distance. There are several reasons why the Bill is making the proposals that are contained within it, the most important being these. There is a desire that the training of nurses should be carried on more independently than has been the case in the past—that is to say, instead of the training being provided entirely by the hospitals for their own servants it should be carried through by a body representative of the nurses and of other bodies, but acting independently. In order that such a body may be given a degree of independence, the expenditure to cover the training of nurses, instead of being obtained direct from the Government or from the hospital authorities themselves, comes from the Government, through the General Nursing Council, to the training committees and the training committees, in their turn, meet the expenditure on training of the management of the hospitals.

The Bill, if adopted, should give that degree of liberty of independence so greatly prized by many people in the medical and nursing professions to-day. The first point I should make in reply to the noble Lord's speech is that it would not be right to compare the payment of moneys for hospitals in this way with the method adopted by the Government in the case of the universities. When the Government decided to place money at the disposal of the universities for development purposes, there was no national organisation in existence for that purpose. Therefore, a body had to be created to carry out the business of allocation on behalf of the Government. Such is not the case now, because in the General Nursing Council, which is established by Statute, we have a body which has been in existence for almost thirty years, a body which can well undertake the business of superintending the allocation of Government aid. And that is the proposal. If the General Nursing Council were acting by itself, and had no representatives in the areas, its difficulties of allocation might be just as great as would be those of the hospital grants committee proposed by the noble Lord. There are at this moment 600 training schools in existence in this country, and if they were to approach the General Nursing Council or this grants committee for an allocation towards their expenses they would create for both very great difficulties indeed. These bodies would be unable to assess properly whether the demands for money were accurate, or whether fair value had been given for the money that had been expended.

In the case of the General Nursing Council, there is to be established under this Bill a series of standing nurse-training committees. Whilst I am on that name, may I say a word to the noble Lord, Lord Llewellin, in connection with his remark on the other clause? Personally, I do not like the term "'standing nurse-training committee." I do not think there will be objection to a change in name, if a suitable one can be found which will show the difference between the Council on the one hand, and the regional hospital boards on the other. If there is objection to the term "regional" that is a matter that can be considered. But I would not condemn the committee merely because it has a name we do not like.

These committees will act in matters of finance as the agents of the General Nursing Council. They will look at the estimates that are submitted; they will be in a position to consider whether value for money has been earned, and they will then be able to report to the General Nursing Council who will provide the money to enable the committees to pay it over. We suggest that in these times, in view of the widespread nature of the training schemes, something more than the proposal of the noble Lord is required. If, for instance, the Committee were to agree to the appointment of a grants committee, that grants committee would be duplicating the work of the General Nursing Council, and it might, then, in its turn, have to duplicate the work of the standing nurse-training committees in order to carry out its work properly. Co-ordination is, I think, required in every direction in the training of nurses. We should not get co-ordination merely by refusing money. If co-ordination is to be achieved and money saved, then a body that can bring about co-ordination and at the same time administer the supply of money has the better chance of doing it. We therefore suggest that it would not be advisable to change the proposals in the Bill, which have been very well thought out, about which many people have been consulted, and which we are certain would ensure that justice is done.

One final word. It would be entirely wrong to suggest that, in the methods we are proposing, teaching hospitals will go cap in hand to these committees for the money to pay their expenses. That is not the position under the Bill. That is not the position of the nurse-training committees. The representatives of the teaching hospitals, with the representatives of the regional hospital board and those of the other institutions that I have mentioned, will, as members of the training committees, sit round a table with estimates from all quarters in front of them; discussions will take place thereon and decisions will be reached in accordance with their findings. We would ask the Committee to remember, that by these training committees we are not establishing bodies which are to "rule the roost," but organisations that will enable different authorities to come together to argue out their respective cases and then reach common decisions. I hope the committee will not give support to the Amendment; indeed, I hope that as a result of the discussion the noble Lord will see his way to withdraw it.

LORD LLEWELLIN

I was hoping that before I spoke one of the noble Lords in this House with much more experience of the medical profession than I have would have given us some guidance on this matter.

LORD WEBB-JOHNSON

I shall be glad to do so.

LORD LLEWELLIN

I give way to the noble Lord.

4.6 p.m.

LORD WEBB-JOHNSON

I feel very diffident in having not unseated but unbalanced the noble Lord, Lord Llewellin. In point of fact I would like to intervene at this stage; and that I did not do so at once was only in deference to the noble Lord. I would like to remark—and this will be good tidings to the noble Viscount the Leader of the House—that of all the creations of a Government, I should say that the University Grants Committee, which was his child, has probably been the most conspicuous in its success. It has been a success because it has adopted a judicial attitude in the matter of making grants for education. Those grants have enormously benefited the medical schools and medical faculties of the universities.

The noble Lord, Lord Shepherd, said that that procedure has not been followed in this case because there is already a central body, the General Nursing Council, who can take it on. In our profession we should have been very sorry if we had seen the distribution of funds for the benefit of medical education placed in the hands of the General Medical Council. We should have regarded the Council as an unsuitable body, because it is concerned with discipline and regulations. The Government have shown consternation at the idea of the teaching hospitals and the other hospitals being treated differently although I should have thought they would welcome a proposal that was acceptable to all hospitals. I should not have any anxiety about the teaching hospitals being treated in exactly the same way as any other hospitals, provided that they came under a judicial committee and not a regional committee. Even if the name of the committee is changed, as the noble Lord, Lord Shepherd, suggests, in my view it still remains a regional committee, and is bound to remain so. It is on those grounds that I support the noble Lord's Amendment. It would provide a central body to deal with regional boards in respect of the general number of non-leaching hospitals in the region, and also with the teaching hospitals for their particular needs.

LORD MORAN

The original decision to keep the teaching hospitals outside the region was a decision made deliberately so that they might continue their work in giving a lead in medical education. Every argument that was used in favour of this course at that time on the Government side is applicable at the present time to the issue now before the Committee. That course had one disadvantage. Admittedly, it might lead to a certain amount of ill-feeling or even friction between what are called teaching hospitals and the non-teaching hospitals. But as the noble Lord, Lord Webb-Johnson, has just said, if this Amendment is accepted, it gets over that difficulty because the hospital grants committee would be the body giving grants alike to the teaching hospitals and to the non-teaching hospitals. I would like to endorse everything that the noble Lord, Lord Webb-Johnson, said about the complete success in the past of the University Grants Committee. I was head of a medical school for twenty-five years, and the University Grants Committee were our financial master. Everyone, from first to last, agreed that they were judicial and fair; I never heard a contrary opinion expressed by anyone concerned with medical education.

The analogy between medical education and the training of nurses is extremely close. I think it is irrelevant to remark that whereas the teaching hospitals are solely responsible for medical education they are not solely responsible for the training of nurses. We are concerned to-day to see that the great hospitals, which in the past were mainly responsible for the progress in the training of nurses, do not lose their opportunities to advance the art of nursing, just as we ensured, when the Act was passed, that these hospitals were safeguarded in their task of medical education. I believe that this Amendment is a suitable compromise which would give satisfaction to both the teaching and non-teaching hospitals, and I very strongly support it.

4.10 p.m.

LORD LLEWELLIN

I think it is wise that we should at this moment discuss the whole of this clause. We seem to be here concerned with three possible methods of making these grants. The first is that the Ministry make a wholesale grant, if I may so describe it, to the General Nursing Council; the General Nursing Council, I suppose, split that up and allocate the parts to the regional nurse-training committees, and the regional nurse-training committees then deal with each hospital alike. That is a position which the teaching hospitals feel goes quite against the trend manifested in the Health Act. Then there is the way in which the matter would be dealt with under the Amendment that appears in the names of the noble Lords, Lord Webb-Johnson and Lord Moran: that is, that the non-teaching hospitals should get their grants from the standing nurse-training committees but the teaching hospitals should get theirs-direct from the General Nursing Council. The noble Lord, Lord Shepherd, said that was treating them differently, and in the case of nurse-training the Government wanted all hospitals to go to the same source for their grants. The point is that the teaching hospitals largely feel that with these standing nurse-training committees, meeting in the regional hospital headquarters, with personnel constituted as provided for in the Second Schedule, the arrangements will, in effect, bring the teaching hospitals into the regional machine for this purpose of nurse-training grants.

Then there is the compromise suggestion which is contained in the Amendment in the name of the noble Lord, Lord Luke, which we are now discussing. Its purpose is that the grants shall be given to this other body, which is like the University Grants Committee; that they shall sit and receive the recommendations, perhaps, of the General Nursing Council and of the standing nurse-training committees, and, in accordance therewith and having informed themselves about what is going on in the different hospitals, they will allocate the grants, just as the University Grants Committee allocate grants in various proportions to the different universities after they have found out what is happening in them. That is the way a number of noble Lords, especially noble Lords with direct experience in these matters, advise us to take. We all know of the two noble Lords who have spoken to us on this matter—Lord Moran and Lord Webb-Johnson. Lord Luke, as the Committee are aware, has given a great deal of his time to the service of voluntary hospitals. Therefore I view the matter in this light. Here is a scheme—it is quite true it is a different one from that which has come from the Ministry—which we are advised by a number of noble Lords will give satisfaction to those interests with which they are so closely in touch. They consider it a scheme which will work better than the other.

We are in this happy position in regard to this measure: that, whatever we do here, we shall not be raising a difference with the House of Commons, because this is our Bill or rather the noble Lord's Bill. No one wants unnecessarily to cross swords with the noble Lord, but when the Bill leaves this place, it will be our Bill. It is not as though we were amending a Bill which had gone through all its processes in another place. So I suggest that we accept Lord Luke's Amendment, get the principle established and then we can discuss between now and the Report stage who will be the right people to form the membership of this body. But that is a minor point. I would suggest to your Lordships that we should try this way, so that from the start this most important job of training nurses may be carried out with complete harmony between both the ordinary run of hospitals and those great teaching hospi- tals which have always been the pioneers in this work.

VISCOUNT ADDISON

Perhaps I may be allowed to intervene for a minute or two in this very interesting discussion. It brings to my mind personal reminiscences of years gone by, and I feel sure that, whatever happens to this Amendment the business of these committees and of these grants will be carried out in an entirely harmonious and sensible way. I would like, if I may, to indulge in a little reflection. As the noble Lord behind me was good enough to say, I had a good deal to do with the origination of the University Grants Committee, and I am very greatly comforted by the tributes which the noble Lord the President of the Royal College of Surgeons and the other noble Lord the President of the Royal College of Physicians have paid to the operations of that Committee, because I may tell your Lordships that, being in charge of the business in the initiation period, I met a committee of Deans of the teaching hospitals of London and they, with one accord, exhorted me not to go on with the "dreadful thing." They said: "It will mean that we shall have your fellows from the University Grants Committee coming into our hospitals, poking about, seeing whether we do our work properly and generally being obnoxious, inquisitive and all that sort of thing." I said: "That is just ' gammon and spinach.' What they will do, probably, is that if your laboratories are not properly equipped they will make a grant so that they can be properly equipped. They will see that you pay your professors properly—as you did not pay me properly." That was perfectly true; I was grossly underpaid, but I was a full-blooded University professor.

Anyhow, there was the attraction of cash in the background, and, of course, these reluctances gradually disappeared. The University Grants Committee, being composed of sensible and experienced people, have not done any of these obnoxious things. They knew about the business, being of the same ilk themselves, and both noble Lords, speaking with such immense authority, now testify to the immense benefit of the University Grants Committee to the teaching hospitals and to the fact that they have not undermined their independence. Of course they have not—they have never tried to do so.

To-day we have the same kind of apprehension. Neither of the noble Lords will accuse me of any lack of loyalty to my ancient institutions, but I say that this is carrying isolationism too far. There is a considerable difference between the position here and the position under the National Health Service Act. There are about thirty-six teaching hospitals. They are not all of equal quality; some are better than others, to put it no higher than that. These thirty-six hospitals were brought under the National Health Service Act because they are teaching hospitals, but teaching is allied with other health services and is an integrant part of them. If they were the only hospitals that taught nursing, something of the same kind might appear in this Bill, but they are not. There are 600 institutions which teach nursing. In a great national scheme like this, why should we not get the benefit of the experience and direction of the people who have been pioneers for so long? Why should they want to be isolated from the rest? It is a different proposition from the ordinary health services under the principal Act. Here we would have institutions other than teaching hospitals trying to teach nurses, but isolated from the institutions which are the guides and mentors of die whole profession. That is not the right thing to do. It is not statesmanship, it is folly.

LORD LLEWELLIN

The idea is not to isolate them at all, if I may suggest that to the noble Viscount. Under the Schedule they would still be able to proffer their advice because they would still be represented on the standing nurse-training committee as well, as on the General Nursing Council.

VISCOUNT ADDISON

May I say, with the greatest respect to the noble Lord, who is always exceedingly persuasive, that that is not really at the bottom of this Amendment? Its purpose is to put these hospitals in a separate category. That is the only object of the Amendment. It puts them into a separate isolated class and they are only thirty-six out of 600 institutions which teach nurses. It is not the right method of approach. I agree that they will be represented on the Council, as set out in the Schedule, and I have no doubt that these experienced people would direct and dominate the whole body. We want them to do that, and we want the benefit of their guidance and experience in the whole scheme. It is completely different from the National Health Service Act. I exhort your Lordships to get away from this isolationist spirit. It would not be right to isolate thirty-six hospitals out of 600 and treat them differently. Their independence would not be interfered with in any way, but I have no doubt at all that they would influence and guide the whole scheme, because they are the people who know best. It would be a first-rate blunder to isolate them. It would not be statesmanship, but short-sighiedness. I hope the noble Lord will not pursue his Amendment.

4.25 p.m.

THE MARQUESS OF SALISBURY

The noble Viscount the Leader of the House speaks with some practical experience on the subject of medicine. I am afraid I do not. My only connection with medicine has been as a patient, not as a practitioner. Having listened to this debate, I deeply regret that the Government close their minds to this Amendment. They have had the advice of three noble Lords as qualified as any men in England to speak on this subject—the noble Lord, Lord Luke, who has had a family and a lifelong connection with the organisation of hospitals; the noble Lord, Lord Webb-Johnson, who is President of the Royal College of Surgeons, and the noble Lord, Lord Moran, who is President of the Royal College of Physicians. Their views on this point are identical. It is no use the noble Viscount the Leader of the House trying to "blarney" us, as he did so charmingly. I think most noble Lords would be ready to trust the opinion of these three men against the opinion of the Ministry of Health who produced this clause. I am not saying this in any criticism of the Ministry of Health. They have been drawing up a scheme which they think will be a useful Framework for the future health schemes in this country, but the noble Lords are speaking about the great craft of nursing, of which they have a lifelong experience. They know perfectly well, and we know perfectly well, that the great teaching hospitals are the whole basis of the high standard of nursing that exists in this country.

VISCOUNT ADDISON

That is why we want them in.

THE MARQUESS OF SALISBURY

We have no objection to their giving advice, but we do not wish to adulterate the very high standard which is kept up only with great difficulty. If we assimilate these thirty-six hospitals into the other 600, there is no doubt that there will be a lowering of general standards. By all means let experts go from these teaching hospitals and spread their standard in the outer world. That is a very good thing. But keep this standard of quality, which has been one of the glories of our country. Let us regard these hospitals as universities where nurses are trained and from which they can go out to educate others. I am sure that is the right basis. As I say, it has been recommended by three great experts, and I believe we all know it to be true that unless we keep this as the element of our high standard, there will be a general slackening all round. That is exactly what we want to avoid. For that reason, I recommend the Committee to make this Amendment. I regret very much that the Government have not felt capable of accepting it. They have had all the expert advice they possibly could find. As the noble Lord, Lord Llewellin, said, we are not disagreeing with another place, and it would have been perfectly possible for the Government to accept this Amendment. I believe it would not be altogether palatable to the Minister of Health, but the Government, at least, might have considered the possibility of talking over the matter further. I think the noble Lords who introduced these Amendments would be ready to consider having conversations before Report stage. If the Government are willing to consider that, I have no doubt it could be done. If, on the other hand, they cannot give us any hope, then we have no option but to take the matter to a Division.

VISCOUNT ADDISON

That request is new. We have given this question an immense amount of consideration, and I can assure the noble Marquess that it is

not something new. We are, of course, willing to consider the matter further, but in expressing that willingness I must not be taken to be giving an undertaking of any sort. We are convinced (I am convinced, and I have a good deal of experience in this matter, too) that the right thing is to have the great teaching hospitals, the thirty-six, thirty-nine or whatever the number is, with the hundreds of others. We are willing to have further discussions, but it must not be understood that in accepting the suggestion of the noble Marquess I am giving any indication whatever that we shall fail to think our suggestion is the right one. I do not wish to be unreasonable, and I hope I shall not be misunderstood. We are satisfied that the machinery of this proposal in the Bill is the right machinery.

LORD LLEWELLIN

The noble Viscount, Lord Addison, was good enough to see several of us. On a number of points in the Bill we have come to an agreement, which is most gratifying to all concerned. However, this is a point on which we found we were not in agreement, and I myself rather doubt whether we should reach agreement if we talked every day between now and the Report stage. I am quite in accord with the noble Viscount's attitude on the position.

THE MARQUESS OF SALISBURY

threw out the suggestion merely to avoid a Division, because this should be a non-controversial question. From what the noble Viscount has said, I do not gain the impression that he has much hope of any alteration.

VISCOUNT ADDISON

No, I have not.

THE MARQUESS OF SALISBURY

Then I think it would probably be wiser for the House to take the matter to a Division, and settle it now.

On Question: Whether Clause 4 shall stand part of the Bill?

Their Lordships divided: Contents, 19; Not-Contents, 48.

CONTENTS
Jowitt, V. (Lord Chancellor.)	Amwell, L.	Merthyr, L.
	Chorley, L. [Teller.]	Milverton, L.
Addison, V. (L. Privy Seal.)	Hare, L. (E. Listowel.)	Pakenham, L.
	Henderson, L.	Quibell, L.
Hall, V.	Holden, L.	Rochester, L.
St. Davids, V.	Kershaw, L.	Shepherd, L.
	Lucas of Chilworth, L.	Winster, L.
Aramon, L. [Teller.]
NOT-CONTENTS
Reading, M.	Swinton, V.	Hawke, L.
Salisbury, M.		Kenilworth, L.
	Balfour of Inchrye, L.	Killearn, L.
Buckinghamshire, E.	Belstead, L.	Llewellin, L.
De La Warr, E.	Borwick, L.	Lloyd, L.
Fortescue, E. [Teller.]	Carrington, L.	Luke, L.
Iddesleigh, E.	Cawley, L.	Moran, L.
Rothes, E.	Charnwood, L.	O'Hagan, L.
	Cherwell, L.	Rennell, L.
Bledisloe, V.	Clwyd, L.	Rochdale, L.
Bridgeman, V.	Clydesmuir, L.	St. Just, L,
Elibank, V.	Cunliffe, L.	Schuster, L.
Falmouth, V.	Digby, L.	Teviot, L.
Hailsham, V.	Ennisdale, L.	Teynham, L.
Mersey, V.	Gifford, L.	Wardington, L.
Monsell, V.	Hacking, L.	Webb-Johnson, L.
Simon, V.	Hatherton, L. [Teller.]	Wolverton, L.

On Question, Amendment agreed to.

Resolved in the negative, and Amendment agreed to accordingly.

4.40 p.m.

Clause 5 [Contributions towards expenses of other persons in respect of nurse-training]:

LORD LUKE

The next three Amendments standing in my name are consequential upon the new Clause 4. I beg to move.

Amendment moved— Page 4, line 27, leave out ("standing nurse-training") and insert ("Hospital Grants").—(Lord Luke.)

VISCOUNT ADDISON

It must be understood that although we are not dividing on these Amendments, we are still of the same opinion about them.

LORD LLEWELLIN

I think that is quite understood. I am much obliged to the noble Viscount for relieving us of the necessity of walking round the Lobbies again.

Amendment moved— Page 4, line 27, leave out ("for a hospital area").—(Lord Luke.)

Amendment moved— Page 4, line 28, leave out ("in the area").—(Lord Luke.)

Clause 5, as amended, agreed to.

Clause 6 agreed to.

LORD LUKE moved, after Clause 6, to insert the following new clause:

Expenses of Hospital Grants Committee

"All expenses incurred by a Hospital Grants Committee shall be defrayed by the Minister out of moneys provided by Parliament."

The noble Lord said: This is also a consequential Amendment. I beg to move.

Amendment moved— After Clause 6, insert the said new clause.—(Lord Luke.)

VISCOUNT ADDISON

I do not quite follow that this is consequential, but if it is, the same remark applies.

LORD LLEWELLIN

I think it is consequential. Your Lordships will see that although it is not an additional expense, the expense will be incurred by a different body. Just as you still need Clause 6 to cover any other expenses which the standing nurse-training committees may incur, so for the other part of the same amount of money you have to have the consequential clause which the noble Lord has now moved.

Clause 7 agreed to.

Clause 8 [Registration of nurses trained abroad]:

LORD SHEPHERD

The noble Lord, Lord Llewellin, has tabled a number of Amendments to Clause 8. The Government accept these Amendments in principle, but prefer the wording of the Amendments which stand in my name. We hope, therefore, that the noble Lord will see his way not to move his Amendments but to support those of the Government as meeting his case. I should, however, say a few words about the Amendment to page 5, line 36, because that is an Amendment which is consequential, but which does not arise out of the noble Lord's Amendment. The words which I shall move to omit: … is not entitled by virtue of the foregoing subsection to be registered … are extremely loose, but, as the Bill stands, are sufficiently accurate to describe the circumstances—namely, that the person in question has not fulfilled all the standards of training mentioned in subsection (1). The addition to subsection (1) of the words, "and that he is of good character" ought not to be caught by the words, "is not entitled," for the test of character will come later on in subsection (2). It is therefore necessary to redraft more precisely the passage in subsection (2) relating to the extent to which an applicant falls short of the requirements. I beg to move.

Amendment moved— Pace 5, line 29, leave out ("and").—(Lord Shepherd.)

LORD LLEWELLIN

I am much obliged to the noble Lord for putting down his Amendments. It is true that these Amendments meet points which I made, and which can be summed up under two heads. First of all, a British girl or man has to be of good character, and I thought that should apply equally to a foreigner who is brought on to the Register. Just as the British man or woman has to pay fees, so, I thought, should the foreigner if he came on to the Register. Those are the two points which my Amendments sought to cover. I am rather pleased that in one case I have hit upon exactly the same words as those who have great skill in Parliamentary draftsmanship. In the other cases I am quite willing to accept their words rather than my own.

Amendment moved— Page 5, line 30, after ("recognised") insert ("and that he is of good character").—(Lord Shepherd.)

Amendment moved— Page 5, line 31, after ("manner") insert ("and on payment of such fee, if any, as may be prescribed").—(Lord Shepherd.)

Amendment moved— Page 5, line 36, leave out from ("is") to the second ("the") in line 37 and insert ("unable to prove that he has been so trained in accordance with a scheme of training recognised by the Council as being satisfactory for the purposes of the foregoing subsection and that he underwent his training in an institution so recognised").—(Lord Shepherd.)

Amendment moved— Page 5, line 41, after ("may") insert (", if they are satisfied that he is of good character").—(Lord Shepherd.)

Amendment moved— Page 5, line 44, at end insert ("and pays such fee, if any, as may be prescribed").—(Lord Shepherd.)

Clause 8, as amended, agreed to.

Clause 9 agreed to.

4.51 p.m.

LORD WEBB-JOHNSON moved, after Clause 9 to insert the following new Clause:

Council may prescribe or approve training of registered nurses in specialised branches of training

".—(1) The Council may if they think fit make rules prescribing or approving courses of training and prescribing or approving and for conducting or regulating the conduct of examinations to be undergone and passed by registered nurses desirous of specialising in particular branches of nursing and may insert in the entry in the register relating to any registered nurse who has undergone the course of training and passed the examination prescribed or approved as aforesaid with respect to any particular branch of nursing such special signification as the Council may determine.

(2) The provisions of subsections (1) and (2) of section sixteen of the Act of 1943 shall extend and apply to any rules made under this section."

The noble Lord said: There is great anxiety, particularly in certain fields of nursing, that the closing of the supplementary parts of the Register may lead to discouragement in the specialist branches, and anxiety lest nurses sent to these hospitals for short periods during the course of their training should be regarded as being expert in those particular branches. It is really in the fields of nursing at present covered by the supplementary parts of the Register that anxiety is felt: that is in fever hospitals and mental diseases hospitals, and in the nursing of children. If at this late hour the Amendment may not be receiving the support of the great concourse which might be acclaiming it in other circumstances, then perhaps the occasion may arise to put the question at a later stage. I beg to move.

Amendment moved— After Clause 9, insert the said new clause.—(Lord Webb-Johnson.)

VISCOUNT ADDISON

I hope the noble Lord will not persist with this Amendment at this stage. He and I have had long and intimate experience of the people who hand out certificates; and I am sure we both have the same strong prejudice in favour of a sound training with a proper certificate. We do not like tub-thumping, and I am a little afraid that this clause, so far as I understand it, would tend to bring about that sort of thing. As the scheme stands, the Council will be operating and gathering experience as it goes along; and I would not say that in the course of time it might not encourage specialised courses. But most of the considerations I am sure the noble Lord has in mind as well as I: that, for example, there should be comprehensive training with a proper certificate, rather than a lot of odds and ends of so-called qualifications which are not altogether convincing to those who know and may be positively misleading to those who do not know. What we want is a good standard qualification, and if in the course of time these extras are found to be necessary, then they can be promoted. But at the present time I am quite sure it would not be wise to incorporate these provisions in the Bill. Better let the thing get started and feel its way, and then see what should be done later if conditions are desirable.

LORD LLEWELLIN

Would the Council have power to do these things under the Bill as it exists, apart for this Amendment? There are some cases, I quite agree, where there is too much "qualifying," as if people were girl guides or something of the kind, wanting to get a number of badges on their arms. But I am told that in some cases it is thought to be essential to get one or two additional certificates; and this particularly applies to the nursing of infants. Would it be possible for a special certificate to be given for that particular branch? It seems to me we should have some short provision, even if it had to be done with the Minister's consent. If this need is likely to arise later, it would seem to be a pity to have to amend the Act rather than make an Amendment to the Bill now.

LORD AMWELL

May I ask whether the noble Lord is aware that the feeling with regard to hospitals that specialise in treating children is that comprehensive inclusion in the Bill is hardly sufficient and that there is a need for an extension of time; and that this should be recognised by means of a certificate? Perhaps it might be possible to raise the issue in larger terms later.

LORD AMULREE

May I put in a word about the training of nurses for sick children? At the present time in most of the big training centres for children's nurses—that is, the Hospital for Sick Children in Great Ormond Street, the one at Manchester and I think the one at Liverpool—the training of nurses who go there to be trained is practically complete. These particular hospitals are at present recognised as full training schools for children's nurses. I think it would go a long way to meet their apprehensions about this Bill if they could get some assurance that there is no proposal at present to change the status of these children's hospitals as full training centres for children's nurses.

VISCOUNT ADDISON

I do not wish to prejudice any future developments of something which I am quite sure is sound, which is that we should require a good general training for admission to the Register. My prejudice is very strongly against the multiplication of what I may call "trimmings." I think the right thing is to allow this body to get well established and gain experience and then, if in time these additional certificates are felt to be a wise provision, I should welcome the innovation. But I am sure that we should view with misgiving people who are collecting large numbers of letters after their names and who, in fact, have only a smattering of training. Although we hope the future will show developments, I am sure that at this stage it would be unwise to press this matter.

LORD LUKE

I take it from what the noble Viscount says that the desire is general.

VISCOUNT ADDISON

That may be so, but I am sure it would be wrong at this stage to clutter the scheme up with odds and ends. But it may be desirable in the future.

LORD HACKING

Surely there is a little misunderstanding as to whether it would come in under the terms of this Bill or whether it would mean fresh legislation in order to make this change.

VISCOUNT ADDISON

It depends what the proposal is. As I understand the proposal, it would mean fresh legislation.

LORD WEBB-JOHNSON

The noble Viscount the Leader of the House keeps saying "at this stage," which is a little misleading. I am surprised at the delicate way in which the noble Viscount would lead us into paths which are not quite those that we want to follow. As he has been so able an exponent of an exact science, that is hardly consistent with his training. Moreover, his remarks about post-graduate hall-marks seemed to fall on my ears without any response, because he was the most exacting examiner for those who wished to receive the hallmark of being a surgeon, as distinct from being a general practitioner. Perhaps the noble Viscount will give us an assurance that this will be carefully considered between now and Report, instead of implying that by "at this stage" he means "during the consideration of this Bill until it becomes an Act of Parliament, and until it has had several years on trial"—in which case I think he is putting off the decision too long. I would like him to give us an assurance that there will be discussions on this particular problem between now and Report.

VISCOUNT ADDISON

I am quite willing to give that undertaking. I gave a considered reply to the noble Lord. I think it is a thoroughly sound reply, but I am willing to discuss it further with him. In answer to the point raised by the noble Lord, Lord Amulree, I can, of course, give the assurance which he asked.

LORD LLEWELLIN

All that one wants to know, at any rate in dealing with children, is that a nurse or a sister appointed to take charge of a children's hospital ward has had the appropriate experience in a teaching hospital for children's nursing. That is what many of us have at the backs of our minds. Will there be any way of finding that out? Will there be any way of ascertaining that she has had that necessary period of training before she is taken on, say, as the head sister of a children's ward in a hospital in the country? Can the authorities find out whether she has had any experience at Great Ormond Street, or somewhere else like that, before they take her on for a particular position? That is the kind of thing we want to know: whether there will be a part of the Register where they can look her up, whether they will have to get into contact with the General Nursing Council and whether or not that kind of qualification will still be recognised. I think it is an important point to consider. None of us wants this rushing in to get every degree under the sun, but one does want to know how the governing body of a children's hospital can be sure they are taking on a qualified sister to be in charge of their children's ward and whether she has the necessary experience of nursing children. That is the kind of thing we want to know, and whether the authorities can get it under the clause of the Bill as at present drawn.

VISCOUNT ADDISON

There is nothing to prevent the nurses in a children's hospital from becoming qualified nurses. They will continue to be recognised. However, I have the greatest possible misgivings about any scheme which will dispense with a sound general comprehensive training. The physiology of the child is the same as the physiology of the older person, although there are certain differences in the ailments to which they are liable. I have the greatest possible misgivings about saying or doing anything at this stage which would encourage what I call the collection of "trimmings." We do not want that. We want a sound, general training. At the same time, between now and Report I will gladly discuss this point with the noble Lord in the light of these discussions.

LORD WEBB-JOHNSON

On that assurance, I will withdraw the Amendment.

Amendment, by leave, withdrawn.

5.6 p.m.

Clause 10:

Provisions relating to the approval of training institutions

(2) Any person aggrieved by the refusal of the Council to approve an institution for the purposes of the training rules or by the withdrawal of approval given by them for those purposes to an institution may, by notice in writing served on the Permanent Secretary to the Lord Chancellor, appeal against the refusal or withdrawal, and, upon receipt of the notice, the Lord Chancellor shall nominate a person or persons to determine the matter of the appeal and the person or persons nominated shall, after considering the matter, give such directions therein to the Council as he or they think proper and the Council shall comply with them.

LORD LLEWELLIN

had given notice of an Amendment, in subsection (2) after "may" to insert: within twenty-eight days of the service of the notice of the final determination of the Council. The noble Lord said: Since I put down this Amendment the noble Lord, Lord Shepherd, has put down an Amendment which meets the position. I accept the words of the Parliamentary draftsman as fitting into the Bill better than mine do, and in those circumstances I thank the noble Lord, and will not move my Amendment.

LORD SHEPHERD moved, in subsection (2) after "Lord Chancellor" (where that term first occurs) to insert: before the expiration of the period of twenty-eight days beginning with the day on which notification of the determination of the Council to refuse or withdraw their approval, as the case may be, is received by the persons responsible for the management of the institution. The noble Lord said: I beg formally to move this Amendment, which is really an alternative to the one standing in the name of Lord Llewellin which has not been moved.

Amendment moved— Page 7, line 5, after ("Chancellor") insert the said words.—(Lord Shepherd.)

LORD SHEPHERD

This Amendment is not consequential on the one which we have just passed, although it is an Amendment to the same clause.

LORD LLEWELLIN

It is quite acceptable.

LORD SHEPHERD

Under the clause, if recognition of an institution is refused by the General Nursing Council, there can be an appeal against the decision taken, and the appeal lies to the Lord Chancellor. Under the Bill, the Lord Chancellor may appoint "a person or persons" to hold an inquiry; the Amendment proposes that there shall always be more than one person. So it will read "two persons or more" instead of "a person or persons." I beg to move.

Amendment moved— Page 7, line 7, leave out ("a person or persons") and insert ("two persons, or more,").—(Lord Shepherd.)

LORD SHEPHERD

This Amendment is consequential. I beg to move.

Amendment moved— Page 7, line 8, leave out ("person or").—(Lord Shepherd.)

LORD SHEPHERD

This again is consequential. I beg to move.

Amendment moved— Page 7, line 10, leave out ("he or").—(Lord Shepherd.)

Clause 10, as amended, agreed to.

Clause 11:

Fees and contributions in respect of training institutions

11.—(1) The Council may charge the persons responsible for the management of institutions approved by the Council for the purposes of the training rules, not being institutions vested in the Minister, such fees, by way of contribution towards the expenses of the Council in inspecting and approving institutions for those purposes, as may be prescribed.

(2) The Minister may make to the Council, out of moneys provided by Parliament, contributions of such amounts is he may determine towards the expenses of the Council in inspecting and approving for the purposes of the training rules institutions vested in him.

LORD SHEPHERD moved, in subsection (1), after "rules" to insert: and the persons responsible for the management of institutions the approval whereof by the Council for those purposes is sought by them. The noble Lord said: This Amendment seeks to give power to the General Nursing Council to charge a fee to organisations asking for inspection and consideration, even though finally they are not given recognition by the Council. It must be remembered that the General Council, although they will receive money from the Government for the purposes of nurses' training, have to carry through a number of functions upon their own income and their own funds. The General Council do not like to do work of this kind without some payment to cover the expenses. This Amendment is to serve that purpose. I beg to move.

Amendment moved— Page 7, line 24, after ("rules") insert the said words.—(Lord Shepherd.)

LORD SHEPHERD

This Amendment and the one following are consequential. I beg to move.

Amendment moved— Page 7, line 24, after ("being") insert (", in either case,").—(Lord Shepherd.)

Amendment moved— Page 7, line 25, after ("fees") insert ("respectively").—(Lord Shepherd.)

LORD WEBB-JOHNSON moved, in subsection (2) to omit "may make" and insert "shall reimburse." The noble Lord said: The object of this Amendment and the next, which run together, is to ensure that the complete cost shall be borne by the Minister. We have already heard that the General Nursing Council are in some difficulty in making ends meet, and since the duties proposed to be carried out under the Bill are duties on behalf of some function of the Minister it seems only reasonable that he should pay the cost. I beg to move.

Amendment moved— Page 7, line 28, leave out ("may make") and insert ("shall reimburse").—(Lord Webb-Johnson).

LORD SHEPHERD

I am sorry to inform the noble Lord that we cannot accept the Amendment that he has just proposed. In addition to being an agent of the Government in respect of the training of nurses, the General Nursing Council is a professional organisation which looks after the interests of registered nurses. Therefore it has two forms of expenditure, one which it incurs on nurse training and one which it incurs in performing its own business. The Government are perfectly willing to take a generous view of the expenses that may be sent to them for payment but they hope the Committee will not put them into the position of having to accept willy-nilly any expenditure that may be claimed. I want the noble Lord to accept our assurance that the General Nursing Council will not be in any difficulty in respect of these payments, but we cannot accept full responsibility for everything.

LORD WEBB-JOHNSON

I did not expect the noble Lord to open his purse so that anybody could have a dip in it, but I hoped that perhaps the insertion of the words "the ascertained expenses" might have reassured him. In view of his diffidence in committing the Chancellor of the Exchequer to an unknown expenditure, which is so unlike his attitude in some other matters, I readily withdraw this Amendment.

Amendment, by leave, withdrawn.

Clause 11, as amended, agreed to.

Clause 12 [Admission to the list of persons whose due admission was prevented by war circumstances]:

On Question, Whether Clause 12 shall stand part of the Bill?

LORD WEBB-JOHNSON

On Second Reading the noble Lord, Lord Shepherd, in regard to the reopening of the Register, said: I hope that it may be possible by the Committee stage to give some indication whether the lists can be reopened for registration. Has the noble Lord anything to add to that now?

LORD SHEPHERD

I have not forgotten that. There have been discussions, but I cannot give any information to-day. If the noble Lord will see either myself or the Loader of the House between now and Report stage we shall be glad to talk over the matter with him.

LORD LLEWELLIN

I was hoping that we should be able to allow some people who had lapsed from the Register—

LORD SHEPHERD

That is not the same thing.

LORD LLEWELLIN

That is going to be met, is it?

LORD SHEPHERD

It will be met lower down.

LORD WEBB-JOHNSON

With great respect I thought it was the same.

LORD LLEWELLIN

Perhaps the noble Lord can tell me where it is to be met. Whether this is the appropriate place to mention it I am not quite certain, and the Committee will forgive me if I am wrong. But some of us would like some information in regard to cases where membership of the Register has lapsed. Quite a number of registrations have lapsed, perhaps, because the nurse got married. But she may now have become a widow. She is quite eligible to go back on the Register, even though she did not remain on it, or did not register when she was a married woman. We think that there should be some provision in this Bill to allow such people to be readmitted to the Register and become registered nurses. At one time of their lives they did the training and passed such examinations as they had to. They are qualified, and a number of them would be most acceptable in the nursing profession; and they have every right to come back on the Register. I would ask the noble Lord whether he has somewhere on the Order Paper to-day, or whether between now and Report stage he is intending to put down, an Amendment to deal with that class of case.

LORD SHEPHERD

I must apologise. Owing to the bad light I was mixing Clause 13 and Clause 12, and the reply I gave had reference to that clause. In reply on Clause 12, I can say that there have been discussions and it is proposed that there shall be an Amendment on the Report stage to cover the point which has been raised.

LORD LLEWELLIN

I am much obliged.

Clause 12 agreed to.

Clause 13 agreed to.

Clause 14:

Information with respect to nurses

(2) The Council shall cease to be under an obligation to publish the register, the roll and the list, but it shall be their duty to publish in relation to successive periods, in such manner as the Minister may direct, lists of persons who have been admitted to, removed from and restored to the register, the roll and the list respectively during those periods.

The first of such lists shall be published as soon as may be after the commencement of this Act and succeeding lists shall be published at intervals of not more than twelve months.

5.18 p.m.

LORD LLEWELLTN moved, in subsection (2) to omit from the beginning down to the end of the first paragraph and to insert: (2) The obligation of the Council to publish the Register, the Roll and the List shall be complied with by such a publication being made once every five years. This subsection shall not relieve the Council of their duty to keep an up-to-date list of persons who have been admitted to, removed from, and restored to the Register. The noble Lord said: We had some discussion about this matter on Second Reading. It is again a question of the Register. I know that the Central Nursing Council are trying to avoid the expense and responsibility—which they may be quite right in doing; I am not using the word "avoid" in any malicious sense—of publishing this Register annually. I believe that the expense of publishing it amounts to something between £6,000 and £7,000 a year, and very few copies are sold, which I suppose shows that there is not much demand for it. Now they are to be relieved of that duty. It seems to me, however, that somewhere, and not only centrally, there should be some way of seeing who is on the Register, who has been struck off and who has been newly admitted to it. My Amendment suggests that the Register should be published once every five years. I thought that that would help in carrying out the election of the General Nursing Council. Unless there is a Register, it seems to me it will be very difficult to run an election. If there is only one Register it is much more difficult to make out the large number of envelopes that have to be addressed, or to cope successfully with whatever method will be used. So I have put down my Amendment.

I do not want to anticipate what my noble friend, Lord Wolverton, will say in regard to the next Amendment, but I think a somewhat greater obligation should be put on the General Nursing Council than is at present done by the Bill. There ought to be different places where people can look up the Register—the existing printed Register, if you like, with the amendments made to it at different times. Clearly, from time to time, the whole thing will have to be reprinted, though perhaps a period of five years is too long. I would like to ask the noble Lord, Lord Shepherd, whether he has given any thought to this matter and whether something more can be done than is at present laid down in the Bill to give nurses who have gone through all their training the satisfaction of knowing that their name is in some Register somewhere—not only in London but elsewhere also—and that access to it is available. I beg to move.

Amendment moved— Page 8, leave out lines 39 to 44, and insert the said new words.—(Lord Llewellin.)

LORD SHEPHERD

There is a Register of Nurses always in existence and it is kept at the offices of the General Nursing Council. It can be seen there at any time if persons go to the offices to inspect it. The Bill provides for an addition to that Register in the way of publication, because there will be published from time to time, even though the complete Register is not published, a list of newcomers to the Register and names of those who have been removed from it. The other point suggested by the noble Lord would create great difficulty—I refer to the suggested publication of the Register once every five years. He has referred to the expense of producing a Register annually, but I am informed that if a start has to be made de novo and the Register printed every fifth year, the cost will be almost as great as that of the annual Register. That is one of the difficulties.

I have, however, a suggestion to put forward on behalf of the Government as they are anxious to do their best in the matter. If this Amendment, and the following one which stands in the name of the noble Lord, Lord Wolverton, are withdrawn, the Government are prepared to appoint immediately a working party, representative of the organisations involved, and this working party will report quickly, we hope in time to permit of an Amendment being made to the Bill when it reaches another place. If we have such a working party, a number of other matters can be considered at the same time. For instance, if the Register is to be published for election purposes and election purposes determine that the Register must be published in regions, then, of course, a great change in the keeping of the Register would take place. That, with other matters, would come before the working party which would eventually report. And, as I have said, we hope on their report to base a further Amendment.

LORD WOLVERTON

I have an Amendment following this but I should like to speak at this stage, if the Committee will permit me. My Amendment really deals with the same subject. I feel that in the regions of the standing nurse-training committees there should be available up-to-date lists. I would like to see that these up-to-date lists are made obtainable, say once a year or so, in the areas. This would mean that people would not be put to such great expense and trouble when they wished to see who was registered. They would not be obliged to go to the offices of the Central Council in London. As the noble Lord, Lord Shepherd, has pointed out, lists will be kept under Clause 14 (2), but there is no liability to print a list every year. My Amendment provides for the making of up-to-date lists available, so that the areas, on payment, can get them. I agree with the noble Lord, Lord Llewellin, that for a time, at any rate, the lists and the original Register should be available.

My Amendment states that amending lists should be printed and available as well as the present Register. If the Bill becomes an Act in its present form there will be no further liability for publication of the Register at fixed periods; so I rather like the idea of doing it every five years. As the noble Lord, Lord Shepherd, has said that it would cost nearly as much to do it every five years as to do it annually, and that the Government are prepared to appoint a working party to look into this matter, I hope that when the time comes he will be prepared to accept my Amendment, which would not entail great expense but would ensure that lists are provided in the areas. It would ensure that, at any rate, people in the areas can have amending lists and the present Register.

LORD SHEPHERD

First, I may say that a copy of the existing Register can be obtained so long as the copies remain. Therefore, if the nurse-training committees desire to have copies they have only to ask for them and they will be supplied at the usual cost. At the time of our Second Reading debate there were sixty copies of the last issue still on hand. With regard to the other point made by the noble Lord, I am able to reply as follows: that lists of new registrations and lists of names removed from the Register will be published three times a year—not yearly—and the publication of those lists will take place after the four-monthly examinations have been held. I hope, therefore, that what I have said will provide the noble Lord, Lord Wolverton, with sufficient reason for withdrawing his Amendment.

LORD WOLVERTON

Will the lists be available for the regions to buy?

LORD SHEPHERD

Yes.

LORD LLEWELLIN

I understand from Lord Shepherd that the Government are going to get some experts to look into this matter. We talk a new language nowadays. In my youth, when one spoke of a working party it usually referred to an assembly of elderly ladies at the village hall once a week for the purpose of knitting garments for foreign Missions. Nowadays, I understand, it denotes a body of selected people who know something about the job and who are chosen to look into it and give advice. I hope that the instructions given to the working party will be to consider points made in debate in this House, so that it may know what the views held here really are. Before we leave this matter I feel there are two further things which should be said. First, it should be borne in mind that nurses rather like to know that they can go and see their names in a Register somewhere. It may be a human failing, but, at any rate, it is a good thing to be able to see when you go into a particular town that your name is on a Register which is kept there.

The second point is this. I do not think that in practice it is ever wise to keep only one Register of this sort. I remember how busy we were in the days immediately before the war, duplicating a great number of records. It would be very unfortunate if there were only one Register and the building in which it was kept was burned down. Surely more than one of these Registers must be kept in different places. If that is going to be done not much more effort would be entailed in typing a sufficient number of copies to enable each region to have a copy. Those are the two additional points which I would make, and in view of the action which the Government have agreed to take to set up a working party I will, with the leave of the Committee, withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 14 agreed to.

Clauses 15 and 16 agreed to.

5.30 p.m.

Clause 17 [Expenses of the Council]:

LORD WEBB-JOHNSON moved, after committees to insert: and all sums paid by the Council in pursuance of section fifteen of this Act. The noble Lord said: The object of this Amendment is to ensure that expenditure under Clause 15 is covered by Clause 17. I beg to move.

Amendment moved— Page 9, line 27, after ("committees") insert the said words.—(Lord Webb-Johnson.)

LORD SHEPHERD

The effect of this Amendment would be to require the Minister to reimburse expenses incurred by the Council in paying travelling and subsistence expenses, and payment for the loss of remunerative time, to their members and to the members of the assistant nursing committee. This item is part of the general administrative expenses of the Council which are met from fees. It is dealt with in this Bill in order to bring the Council's practice into line with other comparable bodies. There is, however, no good reason for singling out this item of expense to be met by the Minister instead of from fees. The general principles on which the Bill is based is that the Minister will meet expenses connected with training, including such proportion of general over heads as can be attributable to that purpose. In view of that, the noble Lord will understand that I am not in a position to accept his Amendment. I can only assure him that where expenses of this kind are incurred, and subsistence allowances have to be paid in connection with the training of nurses, those will be met by the Minister. I cannot accept responsibility for what one might consider to be professional expenses.

LORD LLEWELLIN

I am not sure that on the next stage of the Bill we ought not to leave out Clause 15. I think it is too much that all these expenses of the General Nursing Council and the nurse-training committees are to be taken out of the registration fees of young nurses. That is what is going to happen, according to what the noble Lord has just said.

VISCOUNT ADDISON

I do not understand that.

LORD LLEWELLIN

The noble Lord, Lord Shepherd, said that this would have to be paid out of registration fees; that except in so far as they were connected with training, expenses would not be paid by the Minister. That is how I understood the noble Lord, but I do not wish to distort what he said.

LORD SHEPHERD

I may have been at fault, but I thought I had made it clear that, of the expenses occurred by the General Nursing Council, some would be attributable to professional purposes and others to the expenses incurred in training nurses. In the latter case the Minister would be prepared to meet these, as he must do because he has undertaken the expense of training. But in the other case, where they are purely professional expenses, the Minister thinks they should be borne by the General Nursing Council out of their own funds.

LORD LLEWELLIN

Yes, but the funds are derived from the fees. I am not at all sure that the people appointed to these committees should not be prepared to undertake to pay any necessary expenses themselves, because I do not believe the finances of the Council will be too strong, and this additional expense might necessitate an increase in the fees which nurses have to pay. I had hoped that the Minister would be prepared to undertake these expenses, just as he pays the training ones, because the General Nursing Council will be his instrument for doing many things. I see the difficulty of our inserting an Amendment such as the noble Lord proposes, because it would mean increasing the charge on the Minister. But I hope that before the Bill leaves another place the Minister will accept this small additional amount, rather than that it should be put on the fees which the nurses have to pay for registration and examination and which I should like to see reduced rather than increased.

LORD SHEPHERD

It should be said that the expenses of all persons who become members of nurse-training committes will be met ultimately by the Minister, and that the training expenses of the General Nursing Council will also be met. Other expenses met from fees relate to the disciplinary powers of the General Nursing Council and to other professional matters. As I have already indicated, these are expenses that fall properly upon the Council's own funds and not on the Government. I will undertake to make representations of what has been said by your Lordships, but I am afraid that if we were to give way on this matter we should be opening up for the Exchequer demands from other sources where similar conditions might obtain.

LORD LLEWELLIN

The noble Lord will see that Clause 15 applies only: in respect of any loss of remunerative time and in respect of travelling and subsistence expenses. So far as I can understand it, loss of remunerative time, and travelling and subsistence expenses incurred in attending a meeting to discuss training matters, would be paid by the Minister; but if those expenses are incurred in attending a meeting to discuss disciplinary matters then they will have to be paid from the other funds of the General Nursing Council. I should have thought there would be very few meetings at which some training matters were not discussed at the same time as professional matters, and if the secretary of the General Nursing Council does not arrange that, he will not be a very efficient secretary. I am obliged to the noble Lord for saying that the Government will take another look at this.

LORD WEBB-JOHNSON

I am glad to have the noble Lord's assurance that for any meeting arranged at which training matters are discussed, expenses will be met by the Exchequer. In view of his assurance, I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 17 agreed to.

LORD SHEPHERD moved, after Clause 17 to insert the following new clause:

Reports to the Minister

". The Council shall annually, at such date as the Minister may direct, make to the Minister a report as to the discharge by them during the preceding year of their functions with respect to the training of nurses, and the Minister shall lay every such report before Parliament."

The noble Lord said: On Second Reading my noble friend Lord Crook suggested that there should be included in the Bill a provision that the General Nursing Council should report annually to the Minister on the work in which they had been engaged in the training of nurses. The Government have accepted the view of the noble Lord, and the Amendment to this effect is now before your Lordships.

Amendment moved— After Clause 17, insert the said new clause.—(Lord Shepherd.)

LORD LLEWELLIN

I do not suppose this will do much harm, but on the other hand I do not suppose it will do much good. A large number of Reports are laid before Parliament and they cost a good deal to make up and print. If the noble Lord, Lord Crook, is very keen on this, I will not oppose it, but we receive masses of Reports and I expect very few members of either House of Parliament read them. I think this is rather a waste of money, because those who are interested can get hold of the facts without a Stationery Office publication. If the noble Lord, Lord Crook, is keen on it and the Government accept it, I will leave it at that. But I would like it to be remembered that we are continuously piling up these little expenses, which all amount to something in the end, and I do not believe a great number of people read these Reports when they are printed.

Clause 18 [Interpretation]:

LORD SHEPHERD

The use of the term "chief male nurse," which means a male nurse in charge of the male nurses employed in a mental hospital, has given rise to some little difficulty. We could get over the matter by extending the amount of information that we have given in Clause 18, but we have reached the conclusion that we had better amend the Third Schedule in order to make clear what nurse it is we have in view—namely, the male nurse in charge of the male nurses. We will come to that when we reach the Third Schedule. I beg to move.

Amendment moved— Page 10, leave out lines 7 and 8.—(Lord Shepherd.)

LORD LLEWELLIN

So far as I understand it, this is merely transferring the definition from where it is now to the Third Schedule.

LORD SHEPHERD

There is a slight difference.

LORD LLEWELLIN

At any rate, I have no objection to the Amendment.

Clause 18, as amended, agreed to.

Remaining clause agreed to.

First Schedule agreed to.

Second Schedule: