HL Deb 21 April 1969 vol 301 cc300-17

2.53 p.m.

BARONESS SEROTA

My Lords, I beg to move that this Bill be read a second time. The constitution of the two Councils who carry the statutory responsibility for the training of nurses for England and Wales and for Scotland has remained substantially unchanged for twenty years, and the House will be only too well aware that there have been considerable advances in nurse training and in the practice of nursing during this period. In view of the vital part which nurses play in all aspects of the Health Service, I am sure your Lordships will welcome the opportunity which this Bill presents to enhance the efficiency of the bodies responsible for their training, especially as it is being introduced at their own request after full consultation with all interested bodies concerned.

The changes now proposed streamline the Council's administrative processes by changing the committee structure by giving representation on the Council to enrolled nurses and increased representation to psychiatric nurses. As the election of nurses to the Council is due next year and the necessary preparations take several months, it is essential that the Bill is enacted this year if the 1970 elections are to take place under the proposed new constitution. Delay would involve the Council in the expense of an additional set of elections, from which I am sure we all wish to save them, or a five-year postponement of these desirable changes until the following elections. I hope, therefore, that this Bill will prove to be an uncontroversial one and will receive a swift passage through your Lordships' House.

The General Nursing Council for England and Wales has 36 members at present—18 are elected and 18 are appointed—and like most bodies of this size its main work is done through committees, two of which are affected by the changes proposed in this Bill. The first is the Mental Nurses Committee, which was established in 1949 when the training of mental nurses was brought wholly under the General Nursing Council, and at present elections to it are separate from those of the Council. This Bill, by giving greater representation to mental nurses on the Council, both enhances their status and enables the Committee to be made a standing committee of the Council, thereby avoiding the expense of separate elections. The second Committee which is affected is the Enrolled Nurses Committee, which was established in 1943 when the new qualification of State enrolled assistant nurse—now the State enrolled nurse—was introduced. I hope your Lordships who are familiar with the Health Service will agree that the enrolled nurse now has an established place in the nursing profession, and again it is felt that there is no need for a separate committee.

Turning now to the detail of the Bill, Clause 1 provides a new part of the register for nurses for the mentally sub normal in England and Wales, where there are at present two separate qualification for psychiatric nurses: the registered mental nurse and the registered nurse for the mentally subnormal. Under present legislation nurses for the mentally subnormal are on a section of the mental part of the register. This Bill now gives them a completely separate part of the register, recognising in full the fact that they form a separate branch of the profession. Under the proposed constitution it will be possible for the first time for a registered nurse for the mentally subnormal to be elected to the Council itself, a proposal which I am sure your Lordships will welcome. Some of your Lordships will know that there is already separate registration in Scotland for nurses trained in the nursing of persons suffering from mental defect.Recent events have seemed to highlight the urgent need to increase the number of trained nurses in hospitals for the subnormal, as well as to introduce other improvements in this branch of the Service, and I hope that this change, which recognises the standing of this branch of the nursing profession, will help towards this general end.

At present nurses train for the roll either in general nursing, mental nursing or in nursing for the subnormal, but there is only the one qualification of enrolled nurse. Enrolled nurses who have trained in, say, a hospital for the mentally ill need further training when they move to a hospital for the subnormal, but there is no way in which they can be distinguished by their particular training and experience. Nor can an enrolled nurse acquire a double qualification. Clause 1 provides that in future the roll of nurses of the General Nursing Council for England and Wales will be divided into parts according to the kind of training given, and this will bring it into line with the register. The proposals in this Bill do not, however, divide the Scottish roll as the training arrangements in Scotland are somewhat different from those in England and Wales, and the General Nursing Council for Scotland wish to continue with a single roll.

I would also draw your Lordships' attention to Clause 2, which provides for the increase in the number of members on the General Nursing Council for England and Wales. These follow from the change in the committee structure which I mentioned earlier, and provide for the election to the Council of an additional registered mental nurse, a registered nurse for the mentally subnormal and two enrolled nurses—one on the general part of the roll and one on either of the psychiatric parts of the roll. There are also changes in the appointed members which recognise the developments in nurse training, and the increase in the emphasis on community nursing. In addition, it is considered advisable to allow for possible future changes in training patterns, and for the need to add certain kinds of experience among the elected members. This is the reason for providing for four unspecified appointments to be made by the Secretary of State.

Changes in the General Nursing Council for Scotland are dealt with in Clause 3 of the Bill. These are more limited than those for England and Wales, because the Scottish Council is smaller; but here again there is an increase in the number of psychiatric nurses among the elected members to ensure the representation of registered nurses for mental defectives. Also, for the first time, two enrolled nurses will be elected to the Council. The number of members appointed by the Secretary of State for Scotland has in this case been increased by one.

Clause 4 of the Bill changes the status of the Mental Nurses Committee of the two Councils from separate statutory committees to statutory standing committees of the Councils. The functions of these standing committees will be the same as those of the present committees, with the addition in England and Wales of responsibility for pupil and enrolled psychiatric nurses. The greater representation of psychiatric nurses should in our view ensure that there is an adequate width of experience on the committees, and, in addition, provision has been made in respect of both Councils for the Secretary of State to nominate up to four additional members for appointment by the Council to the Committee. They would not, however, become members of the Council.

The purpose of Clause 5 of the Bill is to abolish the Enrolled Nurses Committees, which are at present concerned with the training of pupil nurses and the discipline of enrolled nurses. Now that the importance of enrolled nurses is clearly accepted by the provision in Clause 2 for the election of enrolled nurses to the Council, it is felt—and hope your Lordships will agree—that there is no longer any need to make special arrangements to protect their status. The current trend is towards combined training schools, training both student and pupil nurses, and it is felt that the educational function of the Enrolled Nurses Committee can be more effectively fulfilled by the Council's Education Committee and Mental Nurses Committee, both of which will in future include representatives of enrolled nurses. The present disciplinary function of the Enrolled Nurses Committee will pass to the Disciplinary Committee, thus avoiding the possible embarrassment of a double hearing when a case concerns a nurse who has the dual qualification of registered and enrolled nurse.

Opportunity is also being taken in Clauses 6, 7 and 8 of this Bill to deal with other minor matters which I will mention briefly. First, members of nurse-training committees and regional nurse-training committees are entitled to receive payment for loss of earnings or additional expenses. But every time there is a change in the rate of payment the Secretary of State is required to lay a Statutory Instrument. Clause 6 removes this requirement, and allows the Secretary of State, subject to the approval of my noble friend the Leader of the House, the Minister for the Civil Service, to determine any alteration in the rates payable. I hope the House will agree that this is a sensible and practical arrangement, and I can assure your Lordships that it will not lead to any increase in the frequency of change or any increase in expenditure. Clause 7 relates to the cost of recording details of student and pupil nurses in training, which is at present met from the fees for registration and enrolment, and to the cost of inquiries.

Clause 8 will remove from the Councils the duty to publish periodical lists of persons admitted to, removed from or restored to the register, the roll or the list. It is felt that these lists have little value and are wasteful of the Council's time and money. The information will still be readily available when needed, and the requirement that copies of the register, the roll and the list shall be kept at the office of the Council, and shall be open to the inspection of any person without charge, will remain.

My Lords, I would only say in conclusion that this Bill is, I hope, one that deals with matters which are in no way controversial, and it has, I believe, been generally accepted by the nursing profession as meeting both the present and the foreseeable requirements of nurse training. Many of your Lordships may feel that these particular administrative proposals will not greatly affect the nurse at the bedside; but it is, after all, the nurse training schools which set the standards of nursing now and in the future, and they need the backing of an efficient and effective General Nursing Council. That is the object of the Bill, and I hope, therefore, that the House will give its unanimous approval to its Second Reading.

Moved, That the Bill be now read 2a. —(Baroness Scrota.)

3.3 p.m.

BARONESS BROOKE OF YSTRAD FELLTE

My Lords, we are grateful to the noble Baroness, Lady Serota, for the pains she has taken to explain this Nurses Bill. I am glad that the Government have introduced it in your Lordships' House, where we have the Minister of State for Health to pilot it through. It is appropriate that it has been presented to Parliament in the Jubilee Year of the General Nursing Council. For 50 years people who have been appointed, and who have worked in a voluntary capacity, have sat on the General Nursing Council for long hours and for many days in order that the general standard of training of nurses shall be improved, and I think it most appropriate that on the Second Reading of the Bill one should pay tribute to those people who have served on the General Nursing Council, either as members or as officers; and this I do with great pleasure and gratitude.

This is a Bill about the constitution of the Council, but I cannot speak on it without reminding your Lordships of all the unhappiness that exists among nurses to-day as a result of the way in which they have been treated over their pay and emoluments. Perhaps this is not the time to go into details, but here is the one and only case where the whole nation believes that the members of a profession are underpaid when one takes into account what they have to pay for hospital meals, for which they are now being charged. Although, so far, it is only the "Miss Veals" of the profession who are vociferous, a vast number of nurses all over the country would like to support Miss Veal if they were not embarrassed by her tactics. Perhaps her tactics are right. We have seen how airline pilots can extract big concessions by going on strike regardless of people's convenience or the national interest. Why should the nurses be held down simply because they have higher standards of conduct and duty than the pilots have?

I was in training myself as a nurse once, until I married my noble relative, and therefore became wastage from the profession. But my daughter is a trained nurse, and I know a number of her friends who are members of the nursing profession. It is only too obvious how often those girls—and the men, too—go the extra mile for the sake of their patients and get very little reward for what they do, compared with those working in less honourable and arduous walks of life.

My Lords, I am sure I have digressed, but I believe that the noble Baroness, Lady Serota, had she been in my place, would have seized the opportunity to make, the perhaps not altogether relevant intervention that I have made on this Bill, which has nothing whatsoever to do with the points I have raised. It is unfortunate that the Explanatory Memorandum on the Bill uses words about Clause 4 that are ambiguous, for the Explanatory Memorandum is often all that is seized upon by journalists and reproduced as a reliable précis. In this case, it has misled some people into supposing that elected members of the Council will no longer sit on the Mental Nurses Committee, which of course would be nonsense. There are three points of importance on which I hope the Minister of State will agree to improve the Bill. Clause 2 amends the numbers of persons to be appointed to the Council by the Secretary of State for Social Services and the Secretary of State for Education and Science, and adds to the appointing bodies the Central Midwives Board and the Council for the Training of Health Visitors. Under Clause 2(3) the Secretary of State for Social Services is required to consult: with persons and bodies having special knowledge and experience of the work of each class of persons to be appointed by him before appointing the medical practitioners and registered nurses to the Council. Surely all appointing bodies should be required to have appropriate consultations before making any appointment to the Council. It is also essential that all appointed persons should be actively engaged in their special field at the time of appointment, and should not be retired people or people who have gone off to do something else.

The third point on which I should like to see the Bill improved is connected with the requirement in paragraph 2(2) of the First Schedule to the 1957 Act, that the 15 registered general nurses shall be employed as registered nurses at the time they stand for election. I think that this requirement should be extended to all types of nurses standing for election. Every enrolled nurse candidate should be employed in the capacity of an enrolled nurse at the time of standing for election. This is a matter of principle which I know the profession considers to be of the utmost importance. The State enrolled nurses are particularly anxious that they shall be represented on the Council by enrolled nurses who are working as enrolled nurses and not by enrolled nurses who also hold the qualification of registered nurse.

Could the Minister of State also reconsider the date when the Act is to come into force? Clause 11(1) says that it is to be January 1, 1970. Why not a month after the Bill receives the Royal Assent? That would facilitate the arrangements for next year's elections, I know. I am sure that the general purpose of this Bill is welcomed by the nursing profession. If the Minister of State will help over the points I have mentioned, she can be sure of our help in speeding it through all the stages in your Lordships' House.

3.10 p.m.

LORD AMULREE

My Lords, I should like to join briefly in the general welcome given to this Bill which I think is a useful and valuable measure to come before your Lordships' House. I am sure that anything we can do at the present time to improve the status of the nurses taking care of the mentally subnormal is greatly to be praised and encouraged. Therefore that alone makes this Bill worthwhile. At the risk of repeating what was said by the noble Baroness, Lady Brooke, I cannot let the occasion pass without agreeing with her very fully indeed that it is essential that the people on the Council should be people working in the branch of nursing which they are there to represent. I trust that the Minister will be able to give us the assurance not only that they will be in the grade themselves but that they will be actively working in it at the time when they are appointed and shall continue to work in it during their time on the Council.

There are two further points I would briefly mention. I trust that the fact that we now have these different categories of nurses will not mean that it will not be possible for nurses to move quite easily from one category to another if they wish to do so and that the move may be permanent or temporary. An enormous amount of good can be done in that way. I was thinking particularly of the value which I used to find in having nurses with some kind of training in mental sickness working among geriatric patients. Patients of this kind sometimes do things that can be startling to a young girl but not so startling to a nurse from a mental hospital. They may take off all their clothes in the middle of the day and walk about the ward. This could be frightening to some young people. I trust that nurses will still be able to move freely from one branch of the profession to another.

I think this Bill will increase the status and stature of the State-enrolled nurse. I am delighted to see this. When the enrolled nurses first came into being they were looked upon with some degree of suspicion, but now I think we are all agreed that they have become an integral part of the nursing service. I should like to join in any tributes paid to the great work that they have done in their branches of the profession. I am pleased to give what support I can to this Bill at its Second Reading and through its future stages.

3.13 p.m.

BARONESS SUMMERSKILL

My Lords, this is an innocuous little Bill that the House is debating to-day. I am quite sure that both Houses will approve it and that my noble friend will be only too happy to get it on the Statute Book as soon as possible. It is concerned simply with the registration and enrolment of mental nurses and nurses for the subnormal, and, of course, could be regarded solely as an administrative measure calculated to improve the status of this category of nurses. But I think that the Bill has a greater significance which calls for some comment, for it is being debate at a time when attention is directed to the over-crowded and under-staffed conditions of the institutions which accommodate the mentally sick of all categories. Simultaneously, the nurses, whose patience is at last exhausted, are protesting against their gross exploitation.

I was pleased when the noble Baroness, Lady Brooke, said that she intended to break away from the Bill in its entirety because she felt incensed. I was glad to see in her these signs of revolution. She has been a nurse. I have watched nurses at close quarters and I feel as deeply as she does that the country takes the services of these wonderful women too lightly. Therefore it is relevant to ask how far this Bill will improve the terms of service and encourage the recruitment of young women for work which is physically and mentally arduous, often uncongenial and calling for qualities of unlimited patience, of kindness and compassion when you are weary and exhausted, beside the accepted qualifications of a nurse. I want to know—and I told my noble friend that I was going to digress—what else the Government intend to do to make this register of real significance, what incentive other than that of representation will be provided in order to attract girls to take up this work.

The Bill has come at a time when it is a question of a protest not merely by a few nurses but also by the Nursing Times, which is a very important organ in their life, and by the nursing authorities, who have felt that a protest should be made on nurses' behalf. The Nursing Times this week warns the country that unless of the wages of the nurses are improved there will soon be very few left. As I have reminded the House, we have at the moment to rely for the stalling of our hospitals in both the medical and the nursing professions on men and women who come from countries where their services are desperately needed. The Nursing Times says: Adolescent devotion to an ideal of service is being grossly exploited by the nation. It is time that this was realised by everybody. That seems to be no over-statement of the facts.

Let us take the case of a first year resident nurse—I do not say "student nurse". The word "student", of course, is a euphemism. A student in the world of nursing works as hard as any fully qualified nurse; she works day and night. A student in medicine or a student in any other profession more or less dictates his own pace of life, but a student nurse has no concessions whatever. She must work very hard. Therefore I say that the Nursing Times comment is riot an over-statement. A first year resident nurse under 25 gets £5 15s. 0d. a week, after deductions. A non-resident third year nurse under 25 gets £7 17s. 8d. A recent rise, described by the editor of the Nursing Times as "peanuts", was deducted because most nurses are now expected to pay for their own meals in hospitals. If a nurse has four meals a day in hospital—and I would remind your Lordships that nurses of 18, 19 and 20 years old are still growing—it will cost her £2 6s. 1d. a week. Hot drinks are extra. I hope that my noble friend will tell me that if a girl works all night she can take as many hot drinks as she wishes from the ward kitchen without feeling that she is cheating. I regard this new "pay as you eat" scheme as a. temptation to these girls to economise at the expense of their food. I was shocked to read in a newspaper this week that a nurse of 19 was charged with stealing bread from a supermarket. A girl of 19 does not steal bread unless she is hungry. She might steal stockings that she cannot afford and longs to have; but to steal a loaf of bread indicates hunger.

The Nursing Times said: This latest gambit endangers the whole future of nursing recruitment. It warns that there are now fewer 18-year olds to recruit into nursing, and it goes on: These young men and women, mostly in their late teens, who are left in charge of wards and are put on night duty or Sunday duty to meet exigencies of service are surely the most mobile labour force in the whole country. For them to suggest the withdrawal of their service while they are still nursing students is at the moment unthinkable. How long will it remain so? Only the future will show. It goes on to say: This shameful exploitation of them must stop, because if it does not, then there will be no one to staff the hospitals of the future. My Lords, student nurses are demanding only an extra £1 a week, and the Royal College of Nursing has said that it will press for the rise because there is the gravest concern at the inequitable treatment of student nurses. For years there have been individual nurses or small groups of nurses who have had the moral courage to make a protest—and protests of that kind are not encouraged in the nursing profession. But there has been a persistent failure to recognise the overwhelming justice of their case, and now the unrest has culminated in a collective demand to recognise their grievances.

I believe that the neglect of these kind, unselfish young women, who have a vocation which the nation is quite prepared to exploit, cannot be unrelated to the Government's industrial relations problems. The workers in all fields—the noble Lady opposite touched on this—have come to learn that only strike action, or the threat of it, will compel those in authority to recognise the justice of their claims, and this could be well illustrated by the treatment of the nurses who have allowed themselves to be exploited rather than even contemplate or threaten strike action. I believe that the Government have failed to demonstrate to the workers of the country that hard work and unswerving loyalty in itself will ensure a just reward. Every woman worker, whether in a hospital, shop or factory, provides an example of this willingness by the Government to exploit her underpaid labour. I believe that the Government are running into trouble because the workers have learned that only the strike threat works and that those who never use it are exploited. The case we are talking about to-day is glaringly apparent.

When a noble Lord, or anyone else, goes into hospital as a patient, he lies in bed and is served uncomplainingly, day and night, by physically attractive, ener getic and intelligent young women who are prepared to do jobs that a man's wife or near relations would be reluctant to do. When patients come out of hospital they say how wonderful these young women are. But how long does that feeling last? All is forgotten in a few days or a week or two and everything is taken for granted. Every woman worker may be in the same position because she is modest and unassuming and accepts exploitation, and I feel that we must recognise that the attitude of the nurse to her work is reflected throughout the country.

I would say, finally, that the answer to the problems of the Labour Government is not that the Government should run away from them. The Labour Party would be the laughing stock of the world if, with a huge majority, they resigned because they could not handle their labour problems. I believe that the Government should think again, and not only in respect of those who get the headlines, the strongly entrenched trade unions with highly-paid and well-organised members who strike whenever they feel like it. There are also these hundreds of thousands of first-class workers whose conditions are ignored. I believe that the Government should do, and should appear to do, justice to the underpaid, exploited workers, among whom are the toiling nurses. If the Government beat a retreat without having fired a shot to relieve the exploited women workers of the country, they will be responsible for the greatest political landslide in our history.

3.26 p.m.

LORD AUCKLAND

My Lords, the curious thing about this Bill which, with other noble Lords, I warmly welcome is its Title. The limits of the Bill are extremely narrow in relation to the Title which, to the uninitiated, might indicate that the Bill is designed to cover the whole confines of nursing, which the noble Baroness, Lady Summerskill, and my noble friend Lady Brooke touched on in connection with the very important current problem regarding the pay of nurses and the extra charges for meals. This is something which, as has been said, has angered the nation as a whole; and it is not surprising.

I should like to say a few words about the Bill with particular reference to mental nursing. I live in an area where there are seven mental hospitals very near to one another. I think that the provisions in Clause 2 will be particularly welcomed by them, if only for the reason that in the past the case of those who nurse in our mental hospitals has been put very inadequately. We have heard of the conditions in Ely Hospital, in Cardiff, and at Ockenden Hospital, in Essex. In the Evening Standard recently there was a picture profile about the fear of the people in the Epsom area because of the exploits of some of the patients in the hospitals there. I know of this fear, my Lords, and it is quite understandable because there are several thousands of patients in these hospitals. Some of the hospitals are overcrowded and some are understaffed. I should like to pay a warm tribute to the staffs of these hospitals. I serve on the house committee of one of them and I meet members of the staff quite regularly. This Bill will, I think, help to put the case of those engaged in this very distressing job of nursing the mentally ill and particularly the mentally subnormal.

Clause 2 of the Bill seems to me to contain an anomaly. In subsection (2)(b) it states that of the elected members of the Council: three shall be registered mental nurses elected by persons who, on the prescribed date, are registered mental nurses. But in Clause 3, which deals with Scotland, there is the provision that at least one shall be a male nurse. I should like to know from the Government why such a provision does not apply to England, because there is a need for more male nurses, particularly in our mental hospitals. Much has been done to give male nurses more representation but, as I see it, there could be some strengthening of it in the Bill.

I hope that as a result of this Bill the enormously good work that is being done in our psychiatric hospitals and the great changes that have been made towards treating the mentally ill will be highlighted, as well as the unfortunate cases of which we have read in places such as Ely, because there is a great need, particularly when we are considering the recruitment of nurses, for the other side of the story to be told.

LORD STRATHCLYDE

My Lords, I am sure that, whether irregular or not, the whole House has welcomed the con tributions which have been made by my noble friend Lady Brooke of Ystradfellte and by the noble Baroness, Lady Summerskill, in regard to the financial conditions under which our nurses labour today. Having had some experience of this subject, I should like to support them in all they have said and to express the hope —a hope which I am sure will be justified —that the noble Baroness, Lady Serota, will convey to her right honourable friend the Minister the feelings of the House and of these noble Ladies.

3.32 p.m.

LORD SEGAL

My Lords, I wonder whether it is purely a matter of coincidence that this Bill was issued on the same day as the report on the Ely Hospital in South Wales. Could it conceivably be possible that some of the changes suggested in this Bill, all of which I hope are warmly welcomed on every side of the House, could be consequent upon the revelations made in that report? May I, however, ask my noble friend why nurses trained in the special nursing of fevers in infectious diseases hospitals are no longer to be counted as a separate part of the register? Is it intended in future to include Clause 1(1) as a sort of generic clause, leaving it open to the Minister to add to the register "such other parts as may be prescribed"? If so, what other parts are also to be included in this clause?

Here I would earnestly urge my noble friend to consider whether a special part ought not to be included, either now or in the near future, not only of all nurses trained in the care of persons suffering from severe subnormality but also of nurses specifically trained in the care of severely subnormal children. I know that this matter is bound up with the shortage of training courses for teachers of subnormal children. At present the number of such courses is woefully inadequate. They do exist, I believe, in Queen Mary's Hospital, Carshalton, which is presided over by my noble friend Lord Grenfell, but in very few other areas.

Only recently, however, an exception has been made in the case of Leavesden Hospital, which I believe is the only hospital designated by the General Nursing Council as a training centre for a new type of student nurse. This is in conformity with the Government's decision that teachers of mentally handicapped children should be not only qualified nurses, wherever possible, but also specially trained in teaching through the recognised courses of teaching required for dealing with this problem of mentally handicapped children. This course, now uniquely begun in this hospital, will involve two years' work in the hospital and two years of study at the Polytechnic for a diploma of the Central Training Council for Teachers of Mentally Handicapped Children. This requires a course of training of a minimum of four years and surely, after four years' training to obtain this diploma, nurses should be entitled to special inclusion in the new register under their own separate designation.

My plea for a special list of nurses trained in the nursing of severely subnormal children merely recognises that the distinction in the register to-day accepts special qualifications for the training of nurses of sick children. With severely subnormal children, however, extremes of patience, understanding and sympathy are called for. The duties of these nurses are far heavier and far more exacting, because these children cannot respond and co-operate in the way that severely subnormal adults are often able to do. Consequently, the period of training of these nurses has to be much longer and much more specialised, and such nurses ought to receive special recognition.

While on the subject, may I ask my noble friend when the last complete register of nurses and roll of nurses was issued? I believe that I am right in saying that the last register was published as far back as 1947, not less than 22 year ago. Even allowing for "13 years of Tory misrule ", surely in the time that has elapsed since then some effort should have been made to issue a nurses register in its complete form. The provision of publishing four monthly supplements is inadequate. It is a messy, time-wasting procedure. While I know that we cannot have an annual register in the same way as we have an annual medical register (I believe that when the last nurses' register appeared in 1947 it was out of date on the day it was published), I would ask: does the issue of a more up-to-date nurses' register have to be ruled out on the ground of cost? If so, what would be the cost of printing a complete register and roll of nurses, not annually, but, say, once in every three, four or five years?

The other point in the Bill to which I should like briefly to refer is the appointment of members of the Council on the nomination of the Secretary of State. I would especially plead for greater representation for what one might call, rather inadequately perhaps, the consumer end of the mental hospitals. There is no lack of representation by professional bodies—doctors, nurses and teachers—but where are the voices of those who represent the parents and relatives of severely subnormal children and adults? It is very much to be hoped that their interests may be directly served in the newly constituted General Nursing Council. This would lead to greater consideration and far greater understanding of their needs in the many difficult cases that are bound to arise.

Finally, my Lords, while we must all recognise that this Bill is, unfortunately, very limited in scope, dealing only with Registration and Rolls and a new composition of the General Nursing Council, may one venture to express the hope that in the not too distant future the Government will introduce a much wider and more comprehensive Nurses Bill? I am thinking particularly of a new Bill dealing with the wider recruitment of nurses; an increase in the numbers of nurses; greatly improved conditions of service, of accommodation, of leisure and of pay; more courses especially for the training of nurses in the care and teaching of mentally handicapped children, and greater provision of facilities for the education and training of the children themselves. Vast new horizons have been opened up in these directions during the last few years. Many more of these children can now be trained in sheltered occupations in industry and agriculture to become self-supporting, to become fully self-respecting citizens, and to take their rightful place in the community.

I know only too painfully that such a Bill is tied up with the question of cost, and how little we can afford in these present days of economic stringency. But such a Bill, when it does come, can be assured of a far warmer welcome than that which we must now afford to the rather limited, rather tepid, rather sad little Bill we are discussing in this House to-day, which utterly fails to deal with all those urgent problems now confronting the nursing profession and clamouring aloud for Government action.