§ 3.7 p.m.
§ Order of the Day for the Second Reading read.
LORD GRENFELLMy Lords, I beg to move that this Bill be read a second time. I must disclose a very real interest in this Bill, as I have just become Chairman of the Fountain and Carshalton Group Hospital Management Committee, a group that deals with hospitals for children with mental disorders, one of which, Queen Mary's, Carshalton, is a comprehensive hospital for paediatric and mentally subnormal children.
Up to the present, the enrolled nurse (known as the assistant nurse until the passing of the Nurses (Amendment) Act, 1961) had been neither trained nor employed in hospitals for the mentally disordered in England or Wales. The nursing staff at these consists of registered psychiatric nurses with a three-year student nurse training, student nurses, and a large number of nursing assistants, many of them with long experience but without formal training or qualifications gained through examination. The General Nursing Council of England and Wales wish now to begin the training of pupil nurses for hospitals for the mentally disordered and to put them on the roll. They have already drawn up a syllabus for a two-year training course.
I believe that your Lordships will welcome this move, since it should attract more staff to psychiatric nursing and also improve the quality of nursing staff in these hospitals. The Council already possess powers to make rules covering such training for the Roll, but they do not wish to use them until there is power to admit existing nursing assistants to the Roll by virtue of their acquired knowledge and experience over a number of years. I am sure we shall all feel that it would be unfair if young enrolled nurses, after two years' training, were placed in a position of seniority, with, incidentally, higher pay, over nursing assistants with many years of experience.
A similiar situation arose in general hospitals when pupil-nurse training was introduced after the passage of the Nurses Act, 1943, and to meet this that 1153 Act required the Council to make rules for the enrolment of assistant nurses by virtue of knowledge and experience of nursing. The Act required the Council to make rules for the admission to the roll of persons who applied within two years of the making of the rules, and were able to meet the requirements of those rules in respect of prescribed periods of nursing practice completed before March 17, 1943. Further rules made by the Council required certain applicants to apply by February 3, 1946. Still further rules made by the Council permitted certain applicants to be enrolled on the basis of certain experience in nursing and midwifery acquired by January, 1947, or certain experience in nursing by January 1, 1948—later extended to January, 1949. Such applications had to be made by January 1, 1949. A large number of non-psychiatric assistant nurses were enrolled under these rules, and at the same time training for the roll was started in general hospitals.
The main purpose of the Bill before your Lordships (which was piloted through another place by my right honourable friend Dame Patricia Hornsby-Smith, to whom I am most grateful for a great deal of help) is to enable persons with suitable knowledge and experience of psychiatric nursing to he admitted to the roll without undergoing the training and examination which will be required for new entrants, when the training for the roll is introduced in psychiatric hospitals. The Council will be empowered, by Clause 1(1)(a) and (b) of the Bill, to make rules for admission to the roll of nursing assistants by virtue of knowledge and experience of nursing of mentally disordered patients over a period prescribed by the Nursing Council in those rules, and completed by a date also to he prescribed. The date prescribed under the rules will be important, as it will mean that suitable existing nursing assistants with the necessary experience will be given the chance of admission to the roll. It will also make it clear that periods of practice after that date will not count. In fact, this means that the chance is given to enroll, but that after the specified date laid down by the Council, training and examination, and not experience alone, 1154 will be the necessary qualification. Moreover, admission to the roll will be by the same method in all kinds of hospitals, which I believe is the best possible solution.
I come to the second purpose of the Bill. Some people with the requisite experience in general hospitals for enrolment under the rules made under the Act of 1943, failed to apply by the closing dates, to which I have referred earlier. Clause 1(1)(b) of the Bill before your Lordships gives a second chance to these people to apply for enrolment, provided that they are currently engaged in nursing.
The third purpose of the Bill, covered in Clause 2, is to validate enrolments which were made by the General Nursing Council in all good faith but which are of questionable validity. The Council's powers to make rules derive front Section 2(2) of the Nurses Act, 1943, and Section 3(1) of the Nurses Act, 1957. These sections gave no powers to make rules allowing admission to the roll of untrained persons by virtue of experience if that experience was gained after March, 1943. But, in fact, as I have already said, rules were made which purported to enable the Council, in certain circumstances, to recognise as adequate for admission to the roll experience gained later than 1943. The rules mentioned earlier as being made under the 1943 Act, and permitting enrolment on the basis of experience subsequent to March 17, 1943, are therefore of doubtful validity. Other rules made by the Council, purporting to give the Council discretion, in individual exceptional cases, to dispense with the requirements of their rules, and enrolments made under these dispensing rules are also of doubtful validity. Clause 2 validates all such enrolments. Clause 3 is merely definitive.
Clause 4 applies the provisions of the Bill to Scotland, where the position is similar to that in England, with one important exception. In the Enrolled Nurses (Scotland) Rules, 1961, the General Nursing Council for Scotland made rules, first, to start training for pupil nurses for the roll in psychiatric hospitals; secondly, to allow the admission to the roll, by virtue of specified experience in the nursing of the mentally disordered, and. thirdly, to give a further opportunity for enrolment, under the rules made by the General 1155 Nursing Council for Scotland, after the 1943 Act was passed to those who failed to apply within the time laid down.
It may be said in this case that what Scotland thinks to-day, England acts on to-morrow. But although the Scottish Council had statutory powers to do the first of these three things that I have mentioned, there appears to be a doubt whether they had the power to do the second and the third. Clause 4 of this Bill resolves this doubt, and puts the Scottish provisions on all fours with those for England and Wales, with one exception. The Nursing Council of England and Wales feel that persons making belated application for enrolment under the Act of 1943 should be currently engaged in nursing. In the 1961 Scottish rules, the Scottish Nursing Council have not required the applicants "out of time" to be practising nursing at the time they made their belated applications. It is for this reason that the words, "is engaged in nursing", which appear in Clause 1(1)(b) of the Bill, are disapplied as to Scotland by Clause 4(e). This does not appear to be a matter about which England and Wales need have a dispute with Scotland. It is considered that each Council is entitled to form its own opinion. I hope that I have managed to explain this Bill sufficiently to your Lordships, and that you will be willing to give it a Second Reading. I beg to move.
§ Moved, That the Bill be now read 2a. —(Lord Grenfell.)
§ 3.18 p.m.
§ BARONESS SUMMERSKILLMy Lords, I feel that I am speaking for your Lordships on both sides of the House when I say how pleased we are that the noble Lord, Lord Grenfell, is piloting this Bill through the House, because we all recognise his profound interest in the welfare of the mentally disordered. The noble Lord has explained the Bill very carefully and in great detail. We recognise that this is an advance in the field of mental welfare, because at least the General Nursing Councils of England and Wales and of Scotland now propose to introduce a two years' training course for the enrolled nurse in psychiatric hospitals. 1156 It would, of course, be invidious for a young enrolled nurse, having completed her two years' training, to exercise authority over the assistant nurse who has acquired her knowledge through years of practical experience. Therefore, provision is made, quite rightly, for the enrolment of the assistant nurse. This method of adjustment is not new to this House or, indeed, to the other House, because it will be recalled that it was accepted before, and found eminently satisfactory, in 1943 when the nurses in the general hospitals were given a similar position to that of the nurses about whom we are talking to-day.
Indeed, this Bill can be regarded in one sense as a vote of confidence in the assistant nurse. Without any academic qualifications she was attracted to nursing as a vocation and chose the demanding field of psychiatric nursing. Your Lordships will recall that many years ago there were some State Registered Nurses who expressed misgivings that a roll of nurses should be established. They believed not only that it might mean dilution in the long run, but that it might indeed debase the value of State Registration. I think to-day we may say that, finally, all those fears have been dispelled.
The enrolled nurse has proved a credit to her profession and has evinced a sympathy and compassion, especially in the field of the chronic sick and care of the aged, which commands our admiration and respect. We must recognise that the country is growing older and that these particular qualities in our nurses will be needed more and more in the years to come. I would say that these are the same fine qualities of character and temperament which the assistant nurse has brought to psychiatric nursing. If you are distressed and feel a sympathetic hand on your shoulder, you do not demand academic qualifications. This nurse rightly deserves the enhanced status which this Bill confers upon her. The widespread demand for her services can be assessed by the fact that 50 per cent. of our hospital beds are occupied by patients with some degree of mental disorder—a minor degree or a major degree; a minor neurotic or a major psychotic.
But here I must be a little critical. In another place the Parliamentary 1157 Secretary was asked about the scale of pay for the newly enrolled nurses, and he replied that it is still under negotiation by the Nurses' and Midwives' Whitley Council. It is sheer hypocrisy, on the one hand to pay lip-service to these fine, dedicated nurses and, on the other, to turn a deaf ear to their pleas for a fair return for their labour. For the Government to continue to haggle—and I use the word "haggle" deliberately—over what these nurses should receive is not only inhuman but stupidly short-sighted. I would ask your Lordships to go into the Library and read to-day's Guardian, in which there is a report of these negotiations which will determine what these women about whom we are talking to-day shall be paid.
In the argument between the Ministry of Health and the nurses, says the Guardian, an effort is being made to bridge the 5s. gap between the two sides on the extra payment for Sunday duty. According to the recent statement of the Chancellor of the Exchequer, I think this is approximately the new price of a packet of 20 cigarettes. So, when I used the word "haggle" just now, your Lordships will agree that that was not a misuse of the word. This is the extra pay for Sunday work. The proposed additional payment for the assistant nurses to whom I have just referred for night work for a whole week, covering at least the period between midnight and 6 a.m., is 25s.
This Bill is being introduced in order to augment the number of nurses but, meanwhile, prejudice and custom, their enemies, are busily at work behind the scenes preventing these women from receiving the relatively small salary for which they ask. One cannot help commenting on the glaring injustice of one Government Department permitting rich and powerful tycoons to make colossal profits at the expense of the community, while another Department fails adequately to compensate the poor and modest nurse who serves the community day and night. When one thinks of profits of £3 and £4 million, I would also ask noble Lords to bear in mind the 5s. and 25s. additional payments per week for which these nurses are asking.
I have said that the Government's attitude is stupidly short-sighted. There 1158 are in this country to-day 10,000 empty hospital beds—empty for lack of nurses. Of course this is one reason, and a most important reason, why this Bill is being introduced; and we have had reports over and over again that low pay hinders recruitment. Therefore, I say that, although we welcome this Bill, it will fail in its objective if the conditions of service are not improved. Probably things would improve if the public were better informed about mental health. They need to be better informed so that the last vestiges of superstition and inhumanity can be removed.
I must say—and I say this more in sorrow than in anger—that one would have thought that the chief Minister of the land would have set a good example. I was shocked to hear on television the Prime Minister at the Royal Academy dinner revert to the crude language of the 19th century in his reference to lunatics and lunatic asylums in a callous joke he perpetrated at the expense of psychiatric patients. The Prime Minister exhibited a profound ignorance of the social trends, and in the space of a few seconds on television succeeded in pushing the clock back 50 years. People already disturbed in their minds were watching that night, and they must have felt cruelly treated. And the nurses whom we are discussing to-day, responsible for the care of these people, care trained as they are in the right approach and the right language to use, must have felt that their efforts had been undermined. In the course of the years there has been a slow but unmistakable change in the attitude of the general public to sickness of the mind, and I think we should all rejoice to-day because this Bill represents another milestone on the way to a society which regards physical illness and mental illness with equal concern and compassion.
§ 3.28 p.m.
§ LORD AMULREEMy Lords, I would join with the noble Baroness in giving this Bill a very warm welcome. I am particularly pleased to see that it ensures that the people who wish to nurse mentally-disturbed patients can now, with two years' training, get on to the roll of nurses. I think it is important, too, that the Bill makes it possible for the large number of nursing assistants 1159 who have really been carrying the burden in mental hospitals for a long time—I believe I am right in saying that there are some 22,500—to be put on the roll even though they have not passed any examinations, but merely because they are very experienced people who have done a very fine job of work. That is one reason why I wish to speak on the Bill. I want to say how very pleased I am that the work of these people has been recognised, for I feel that anything we can do to impress on them that we do appreciate their work should be done.
The other thing which I am very pleased to see is that, under the Bill, when these experienced women and men come on the roll they will be full members of it and will not be inferior in any way at all to younger people who got on the roll by receiving an official training and passing an examination. They will be just as eligible for promotion, if they are good, as if they had taken the examination. That is a very proper step to take and one which we are very pleased to see.
The other good move, I think, is that there has not been an attempt to make two rolls of nurses, one for the general nurse and one for the nurse trained in taking care of mentally deranged patients. This means that nurses will be able to change from one kind of hospital to another if they so wish, which will do a great deal to break down the barrier which still exists in some places between mental hospitals and general hospitals. Naturally, too, one is pleased to see that those women or men who, because of family commitments or other reasons, did not apply to go on the Roll on January 1, 1949, are again going to be allowed to apply. Finally, I was very pleased to find out that Scotland moved just a little faster than England did in this matter, but being a cautious country they had doubts as to whether they were quite legal, and so to be properly lawful they come in in this Bill before us. I have very great pleasure in supporting the Bill which the noble Lord, Lord Grenfell, has put before us.
§ 3.33 p.m.
§ LORD BURDENMy Lords, we are all indebted to the noble Lord, Lord Grenfell, both for introducing this Bill 1160 and for his very clear exposition of its purposes. Perhaps I may say that I have a particular interest. I happened to be a member of the Joint Visiting Committee when the late Sir Kingsley Wood, in the 'thirties, laid the foundation stone of the Runwell Mental Hospital, and subsequently I was for some ten years a member and chairman of the Hospital Management Committee. The work of the nurses and of the staff attending those unfortunately suffering from mental illness is beyond all praise. But, with some knowledge of the shortage of nursing staff in mental hospitals, I am sure that the co-operation and help of those now termed "nursing assistants" is absolutely necessary. Without that help, nursing in our hospitals would break down. I am therefore glad that this Bill will at long last, improve their status.
In 1939, the Inter-Departmental Committee, the Athlone Committee, for the first time formally recognised a second grade, that of nursing assistant; that is, the person who is less highly trained than the State Registered Nurse but, at the same time, undertaking important and necessary nursing duties. The Nurses Act, 1943, gave official recognition to these nursing assistants. The next step forward was the Act of 1961, introduced to your Lordships' House by the noble Baroness, Lady Elliot of Harwood. This Act provided for the change of name from nursing assistants to enrolled nurses. In the discussion of that Bill I ventured to point out that it did not apply to mental hospitals, and expressed the hope that nurses in the profession, including those in mental hospitals, would be brought closer together; for, after all, they are members now of one unified profession. This Bill, I am happy to say, fulfils that hope.
May I pay tribute to the admirable work of the Royal College of Nursing, for the most valuable help the College has been giving to nursing assistants, both in general and in mental hospitals? May I quote a few words from a statement issued by the Royal College of Nursing in 1962, shortly after the passing of the 1961 Act:
Both registered and enrolled nurses have a part to play in the care of the patient, and the enrolled nurse must be established as an 1161 integral part of the nursing team. She should occupy a well-defined place in her own right, and certain work, for which she has been trained, should be assigned to her. She should be responsible to the sister-in-charge or deputy of her ward or department for the work she undertakes. The enrolled nurse should also join in the appropriate group discussions relating to the care of the patients …My Lords, I am sure that this Bill, when it becomes an Act, will be welcomed by the staff in mental hospitals, and I hope that it will have a speedy passage to the Statute Book. I again express very sincere thanks to the noble Lord, Lord Grenfell, for introducing the Bill.