HL Deb 16 March 1967 vol 281 cc442-9

4.7 p.m.

Order of the Day for the Second Reading read.

BARONESS SUMMERSKILL

My Lords, I beg to move that this Bill be read a second time. I have been invited to pilot the Teachers of Nursing Bill through your Lordships' House, following its passage without Amendment through another place. This is a limited measure, designed to amend the prescribed practice, in the interests of the nursing profession. I am quite sure that none of your Lordships will object in any major way to any of its provisions, for it is welcomed by the whole nursing profession as it will undoubtedly improve the nursing service by increasing the numbers of teachers of nursing.

At present the General Nursing Councils for England and Wales, and Scotland, have powers to make rules granting certificates to teachers of nurses who have undergone a prescribed training, but in institutions approved for the purpose by the Councils. The powers do not, however, permit either of the Councils to grant a certificate to a person who has not undergone training in an institution approved for the purpose, even though the Councils regard the person as qualified to teach nurses. The number of such nurses is not known for certain, but it has been estimated that about thirty could he granted certificates if suitable changes in legislation were made, and that perhaps up to ten more would be granted certificates each year. The numbers are not great, but they would make a most welcome addition to the ranks of qualified tutors who are in very short supply.

The desirability of the measure, as I have said, is not in question. The nursing Press has advocated legislation and has welcomed the Bill, and the General Nursing Councils support it. The main purpose, therefore, is to remove the obstacle to giving certificates to a group of nurses by adding to the existing provisions, in Section 17 of the Nurses Act 1957 and Section 6(1)(f) of the Nurses (Scotland) Act 1951, powers enabling the Councils to make rules prescribing qualifications. They would then, of course, regard the possession of these qualifications as justifying the granting of a certificate.

Powers are also taken to permit the granting of certificates to persons who appear to the Councils and to the Secretary of State or the Minister, whichever is appropriate, to be qualified for the teaching of nursing, but whose qualifications do not conform to those prescribed elsewhere in the rules made under these sections. This will permit flexibility in dealing with unusual or new qualifications. For simplicity of drafting, Clause 1 of the Bill substitutes a new Section 17 for the existing Section 17 of the Nurses Act 1957; and in Clause 2 a similar substitution for Section 6, subsection (1)(f), of the Nurses (Scotland) Act 1951 is made.

In reframing the sections giving powers to the General Nursing Councils to grant certificates to teachers of nurses, opportunities have been taken, in the opening sentence of each of the new sections as set out in Clauses 1 and 2, to place beyond doubt the Councils' powers to limit the certificates to certain classes or descriptions of persons; namely, registered or, in England and Wales, listed nurses. Both Councils' rules already do this, but may be ultra vires. The opportunity has also been taken to make it clear that Councils can prescribe qualifications as to experience as well as formal qualifications. This provision is made in the final sentence of Clause 1 and of Clause 2.

The Scottish rules already prescribe experience, and the English rule did so until 1965, when new rules removed the prescribing of experience as this was thought to be ultra vires. It is necessary to be able to prescribe experience, however, as in the effort to increase the number of qualified tutors courses are being arranged, in theory and practice of educa- tion, which do not include nursing subjects. Therefore, the Councils should be able to prescribe the minimum experience and responsibility in the practice of nursing which they consider necessary when the formal qualification does not cover nursing subjects.

I apologise, my Lords, if I have been a little technical, but it is necessary to explain very clearly what provisions are being made so that the various nursing authorities, when they come to read Hansard, will fully understand the position. I think I have covered the main provisions of this useful little Bill, and I hope the House will approve it and give it a Second Reading. I beg to move.

Moved, That the Bill he now read 2a.—(Baroness Summerskill.)

4.13 p.m.

LORD SANDFORD

My Lords, it is a fairly rare pleasure for those of us on this side of the House to be able to applaud and agree to everything that the noble Baroness, Lady Summerskill, says. I am very happy that it falls to me to express it this afternoon, because I am sure that those of us on this side of the House also welcome this very useful though small Bill. It is a small Bill, and it affects only a small number of people in a rather narrow sector, but I think I can safely predict that there will be more people grateful for the benefits that accrue to patients in hospital through the working of it than there will be citizens who are grateful for the benefits of some of the other rather weightier measures that we have been handling in this House in the last few weeks. I think it will confer tremendous benefits in time. There is a great need for more teachers of nursing, and any Bill or measure which increases their number will be very welcome.

I have no points to make on the Bill itself, either in outline or in detail for the Committee stage. There is only one point that I should like to make before I sit down, and that is that by and large the teachers of nursing, and those who have the job of administering hospitals as matrons, all come from the same profession. A ward sister at the age of about 35 has to choose between going to the teaching side or the administration side. Apart from her own sense of vocation, I think she is bound to be influenced by the fact that the maximum salary for a matron is £2,100 and that for a principal tutor £1,500. While welcoming the measures in this Bill, I would draw attention to this point and invite the noble Lord who is to reply for the Government to comment, if he is able to do so.

4.15 p.m.

BARONESS BROOKE OF YSTRADFELLTE

My Lords, I, too, should like to thank the noble Baroness for the introduction of this Private Member's Bill in this House. As one who for some years was chairman of a hospital management committee and a member of a Regional Hospital Board, as well as being involved with the Queen's Institute of District Nursing, I know how important it is that we should have a sufficient number of sister tutors. In addition to this, for the last 12 months I have been a member of a small working party set up at the request of the Royal College of Nursing—a request which went to the King Edward Hospital Fund—to work on this very problem of the shortage of sister tutors available in the field. We came to some extremely interesting conclusions, with which I will not bother the House this afternoon, but I am glad that, as a result of this Bill, we may hope to have even the small increase in the number of sister tutors, or teachers of nursing as this Bill calls them, that are to be available in the future.

I notice that this Bill was before another place some eight and a half months ago, and that it will take six months from the moment it reaches the Statute Book before we can get the benefit of the measure to which we are hoping to give a Second Reading this afternoon. On that occasion in another place, the Parliamentary Secretary to the Ministry of Health said that the Government supported the Bill in its entirety and that it was hoped, as a result of the Bill, to get about thirty teachers immediately—that fact we have heard this afternoon—and possibly ten additional teachers each year thereafter.

We have not yet got the thirty teachers immediately, because it is now eight and a half months since the Bill came forward; and, grateful as we are to the noble Lady for introducing it to-day, it is a pity we did not have it perhaps a little sooner. We are also having to wait another six months before we have the advantage of these potential thirty sister tutors who are waiting to be authorised to teach. But I welcome the Bill, and I hope that it will come into force as soon as possible so that the time-lag of the future will be shorter than it has been in the past.

4.18 p.m.

LORD RITCHIE-CALDER

My Lords, I, too, like the other noble Lords who have spoken, welcome this Bill. It is an extremely valuable Bill from the point of view of the profession—a profession which we ought to honour and recognise in its fulness, as we do now with some reluctance. We have always accepted the benefits of the nursing profession, but we have never given it the dignity which it deserved. Here, at least in one form of improved standards and recognition of improved standards, we are trying to give that kind of recognition.

It is also very important that we are here setting standards which not only will be of value in this country but are desperately needed throughout the whole world. I speak bearing in mind the great deal of work which is being done in creating sister tutors for the World Health Organisation and elsewhere throughout the world. The training of the teachers to teach the nurses has been one of the difficulties of many of the projects which have been undertaken by the World Health Organisation.

I feel rather sanctimonious, coming from Scotland, because as usual Scotland has in this case used a great deal of foresight and has moved well ahead of even this admirable Bill. We have in the University of Edinburgh the only Department of Graduate Nurses in Britain; and the graduate nurses we are teaching there for both their B.Sc. or M.A. degree, or for a one-year diploma or a two-year diploma, are in fact being produced not only for ourselves but for overseas. We have something like ten post-graduate nurses under training under World Health Organisation scholarships and fellowships at Edinburgh. The work being done there, the standard we have been able to establish, and the recognition we have been able to acquire, will reflect itself in terms of the registered nurses whom we are also going to encourage under this Bill. I think that the development of this advanced education for nurses is going to raise the status of appreciation of nursing. We do not have to raise it in the public esteem; but we ought to raise it in the profession itself. I should like to ask my noble friend who is to reply what the Nursing Council foresee as the kind of people and quality of people we are going to produce with the help of this Bill.

4.23 p.m

LORD BESWICK

I should like, first of all, to join with the noble Lord, Lord Sandford, and the noble Baroness, Lady Brooke of Ystradfellte, in expressing my appreciation to my noble friend Lady Summerskill for being to ready to accept responsibility for the introduction of this Bill to this House. The Government support the Bill, and very briefly I propose to say why. All of us are conscious of the importance of the nursing profession in our national life, and all of us are ready to pay tribute, as did my noble friend Lord Ritchie-Calder, to the individual members of that profession. There are times more than others, but to almost all of us there is some time, when we have particular and personal reason for realising our indebtedness to them. Yet few of us pause to consider how the standards of service and efficiency of the profession are maintained. Undoubtedly proper training is the starting point. The training of nurses has received more serious attention recently than for a long time past. Good training requires close integration of theory and practice. But training carried out in schools of nursing closely associated with hospitals poses special problems. It is necessary, for example, to ensure that service to patients does not prevent the student from receiving a properly planned training. This is particularly true under the syllabus introduced experimentally by the General Nursing Council in 1962, which is thought to be a great improvement on the previous syllabus and is being widely adopted. Discussions have taken place recently with the General Nursing Council about experimental schemes of training, and measures which can be taken by hospitals to help the student nurse to take full advantage of a planned training. Suggestions will be made shortly to hospital authorities which we hope will bring improvements.

Clearly, however, the quality of training is primarily dependent on the quality of those who control the courses and do the teaching. It is important, therefore, that there should be an adequate number of qualified tutors. The introduction of the 1962 syllabus, which makes more demands of the tutor, has emphasised the need for more qualified tutors. At present this need is being met by employing more unqualified tutors who already form a large part of the tutorial force.

The General Nursing Council are very concerned with the question of increasing the numbers of nurse tutors. Current courses mostly take two years to complete, and many nurses are unwilling or unable to leave home to undertake them. An experimental one-year course is running at a technical teachers' training college, which is also starting a special experimental "sandwich" course. Some expansion of existing courses is possible, and the Council have also been considering with other bodies the possibility of organising further courses. But none of these measures—except the one-year course—can bring qualified tutors to the nurse training schools sufficiently quickly. It is against this background that the Government find in this Bill a means by which the General Nursing Council may register as qualified nurse tutors any nurses who wish to do this work, and whom the Council are satisfied have the requisite skills. I share the noble Lady's disappointment that it was not found possible to bring the Bill to this House earlier; but there have been Parliamentary reasons for that.

My noble friend Lord Ritchie-Calder asked about the sort of person whom the Council have in mind as possessing the requisite skills to become a tutor. All potential tutors, of course, must have nursing qualifications and experience. That is the prime qualification. But, additionally, there may be persons with such qualifications and experience who have degrees which suggest their suitability as teachers. Others may have had experience of teaching in some other discipline. For example, I was told of one case of a teacher of physiotherapy in a teaching hospital, as well as another who has completed a two-year course at a teachers' training college and holds a diploma in advanced biology and psychology. At present the General Nursing Council are prevented by Statute from accepting such persons as qualified because they have not taken the course prescribed by the 1957 Act. if the Council did take them (this is relevant to what the noble Lord, Lord Sandford, has said) their pay would be less than that of a qualified nurse tutor.

The noble Lord, Lord Sandford, also drew a comparison between the salary to be earned by a hospital matron, on the one hand, and a successful nurse tutor, on the other. I am not sure that this is a fair comparison, since, after all, the matron is, strictly, responsible for the school attached to her hospital, as well as for all other matters which one normally associated with her duties. However, I understand that it is a fact that, generally speaking, the salary of a principal nurse tutor is equal to, or similar to, that of a deputy matron. I am glad to remind the House that my right honourable friend the Minister of Health announced last week that he accepted the proposals of the Salmon Committee which provide for higher-paid posts in the tutorial service. The Nurses Act 1957, as amended by this Bill, will give the General Nursing Council, as my noble friend Lady Summerskill has said, greater flexibility and a wider discretion, while at the same time safeguarding the standards. I hope, therefore, that it will be possible speedily to pass this Bill through all its stages in your Lordships' House.

4.28 p.m.

BARONESS SUMMERSK1LL

My Lords, I should like to thank speakers from both sides of the House for the unanimous support they have given this Bill. May I ask my noble friend just one question? It can be a rhetorical one, and he can give me the answer afterwards. Will he use his powers to expedite the passage of this Bill to the Statute Book? So many Private Members' Bills embodying important provisions affecting the social life of the community are held up. If my noble friend consults the Hansard of another place he will see that last Friday 11 Bills were obstructed. This Bill has now received the support of both this House and the other place. Therefore I should be grateful if he could do everything in his power to expedite it.

LORD BESWICK

My Lords, my power is limited; but it will certainly be used.

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