NURSES BILL [H.L.] (Hansard, 21 April 1969)

§ LORD AMPTHILL
My Lords, I rise to give my warm support to the Motion before the House that this small but very useful Bill should be accorded a Second Reading. In doing so, I should, as a prelude, like to declare a threefold interest. In common, I suspect, with many of your Lordships, I owe much to the devoted care and attention that I and mine have received from the members of the highly honourable profession of nurses. Indeed, were it not for this, I could not be standing here to-day, and I certainly could not use my voice, even in the rotten way it sounds just now.
Secondly, I have close relatives and friends who are senior and distinguished ornaments of this profession, who have served it well both in peace and in war, and one at least is a member of the General Nursing Council. Further—although this point may be a little off the main issue it is relevant to my interest in this Bill—it was on July 6, 1908, nearly 61 years ago, that my noble father moved the Second Reading of a Nurses Registration Bill, which passed through all its stages in this House, including two Committee stages. I will not waste your Lordships' time by trying to explain how this House's flexible procedure managed to achieve that. Finally, the Bill, having passed all its stages in this House, was sent to the other place on November 10, 1908, but your Lordships will not be surprised to hear that it was lost there owing to lack of Parliamentary time.
After World War I the subject of nurses' registration came before this House again. In May, 1919, the then Lord Goschen moved the Second Reading of a Nurses' Registration Bill, which my father and his friends did not care for. So my father put to the House a Motion, That this Bill be read a second time this day six months", and I am glad to say that their Lordships of that day accepted that Motion. Then, in December, 1919, the then Lord Sandhurst moved the Second Reading of the Nurses Registration (No. 2) Bill. This was an agreed measure which had Government support, including that of the 323 Minister of Health. My father, in speaking briefly immediately after the mover, gave that Bill his full support, and it eventually passed through all its stages in this House; it was sent to another place and subsequently became law.
It is tempting to take some of your Lordships' time—but I am not going to do so—in describing the stiff opposition which my father and his friends met, particularly in 1908, but I think this can be summarised by the views of Miss Florence Nightingale, expressed somewhat earlier in 1880, that she thought that registration would mean" stereotyped mediocrity". I do not think that our present position quite justifies that fear. I, in common with other noble Lords, am grateful to the noble Baroness, Lady Serota, for her explanation of the Bill now before us, from which it is plain that it is hardly controversial in the sense of the 1908 measure. I am very glad of that, because this measure will be of great assistance to this hard-working profession.
My noble friend Lady Brooke of Ystradfellte has mentioned certain matters in the Bill, and I hope that the Minister in reply will give us some hope that these points will be attended to by means of Amendments when we come to the Committee stage. Finally, my noble friend Lady Brooke, and also the noble Baroness, Lady Summerskill, mentioned a matter about which, in common with them and others in this House, I feel very deeply. That is the unsatisfactory state of nurses' remuneration, pay and general conditions. I know from my own personal contact that, quite apart from the humane aspects of these deficiencies (if that is the right expression), this is having a serious effect on recruiting. I am not surprised. I know in my own small circle of two or three girls who have had a feeling of vocation for the nursing profession, but they simply have not been able to go into it in the present conditions because their parents do not like the idea. One at least has tried it but found the going too hard, because these young girls do have to work desperately hard, and I do not think the present conditions of pay and in particular their having to pay for their food, is fair to them. Subject to those remarks, I welcome the Bill and will support the Second Reading.

LORD GRENFELL
My Lords, as chairman of the group of hospitals, I feel that I should say just a few words in welcoming this Bill. I personally look forward to the day when those who nurse the subnormal and also the paediatric nurses will all be on one roll. They will train together and one then will be able to move them or, at their wish, they could move without any further training from one side to the other. In the wonders of medicine to-day the paediatric side is probably diminishing to quite a degree, but as yet we have not found an answer, although we are moving towards it, to the subnormal. Hence we shall need more subnormal nursing.
I should not like it to be thought that as one who works among nurses so much, I do not believe that they are the most wonderful, the most cheerful, the most patient and, if I may say so, the most goodlooking people in this country. They are always beautifully dressed and always charming. With regard to meals, I should not like to give a verdict on that question at this time. We are watching this matter very carefully and I am sure of one thing; namely, that the scheme needs careful administration. If that administration is there, my impression—and it is only an impression because I am having a further look into this—is that in the group of which I have the honour to be the chairman, the nurses find that they appreciate it. But that has to be seen over a longer period, so I will go no further than that.
Lastly, I should like to say that I, among many others, hope sincerely that in a short time a new Bill will come forward, dealing with all the situations which we know are lacking so much in the lives of our nurses, and especially that which we have always wanted and which is becoming more important as the cost of living goes up; namely, more money for these young girls. That is all I wish to say, but I felt that I should just say those few words in welcoming this small Bill, and in the hope that a much larger one will soon be on the way.

§ BARONESS SEROTA
My Lords, I have listened carefully to this debate on the Second Reading of the Nurses Bill, and although I think that all noble Lords 325 have welcomed it, nevertheless at times during the debate they appear to have expressed a sense of disappointment. The noble Baroness, Lady Brooke of Ystradfellte, called it an "innocuous Bill"; the noble Lord, Lord Segal, went further and described it as" limited, tepid and sad". Therefore I was grateful when the noble Lord, Lord Ampthill, reminded us of the early battles that were fought by the pioneers who wished to establish a trained, registered and qualified nursing profession, and of how much we owe to the early work they did in this field.
As I listened to the debate I came to believe that the expressions of disappointment were, apart from one or two points of clarification and detail, directed not at the Bill but at the fact that recent events had served to highlight our awareness of the difficulties under which nurses labour to-day. I would only say at this stage that although I have been a Member of your Lordships' House for some two and a half years now—and I recognise that it is a limited period—I cannot recall a general debate on this subject before. Perhaps it is because we have not directed our attention to these matters that some of the remarks have been made today with such feeling.
I should like to deal first with the particular points that have been made on the Bill. The noble Baroness, Lady Brooke, made three points. On the question of the date of the Bill's coming into law, this is a matter where, if it assists the General Nursing Council, I am sure that my right honourable friend and I will be only too willing to help. The noble Baroness also made two points about consultation between the appropriate bodies and persons, one in relation to Clause 2 and another in relation to a later clause of the Bill; and here again I can assure her that we will look at the particular points she made. The noble Lord, Lord Amulree, joined her in one or two of these remarks.
The noble Lord, Lord Auckland, asked about the omission of the male nurse from the England and Wales part of the Bill. I can only say that I am advised that this was at the request of the General Nursing Council for England and Wales, and that Scotland did not wish to change.
On the point relating to the fever nurses' register, which was raised by my noble friend Lord Segal, here again it 326 is felt that in view of the drop in the incidence of fevers in our population there is no longer need to maintain a fever register, and this has been closed. My noble friend raised the important question of the training of nurses who care for the subnormal, particularly the nursing of subnormal children in our mental and subnormality hospitals. He told us of the interesting experimental course that is being run at the Leavesden Hospital, where a combined nurse/teaching course is being evolved. This is something which we are watching with great interest and which may lead us to have further thoughts on the need to develop the training both of nurses and of teachers in their care of mentally subnormal children.
My noble friend Lord Segal also asked about consumer interest. He asked, I believe, whether in fact consumer interest —for example, parent's of subnormal children—should not be members of the General Nursing Council. I was hoping to have a talk with him in the near future about the question of the involvement of parents (who, after all, are representing their children as consumers of these services) in the day-to-day management of our hospitals. If he is agreeable I think we should get down to discussing this in the near future.
I will not weary the House by going in detail through all the other particular points that have been made. I can write to noble Lords, and I hope that we shall have a proper opportunity to explore them during the Committee stage of the Bill, which is due shortly. I would now turn for a few moments to what many noble Lords have stressed to-day; namely, the conditions under which nurses are working in our hospitals, and also in local authority services, and also the recent introduction of pay-as-you-eat for meals. I was grateful to the noble Lord, Lord Grenfell, for his (if' I may say so) practical approach to this question. It is a new scheme, and my right honourable friend the Secretary of State and I will watch it carefully. I am not surprised—in fact I am glad—that noble Lords have raised this matter to-day: it gives me an opportunity to say one or two words in explanation of the present position.
The introduction of the scheme was, as many noble Lords will remember, part of the recommendations of the National 327 Board for Prices and Incomes in their Report on Nurses' Pay, 1968. I think that many of us here would agree that in general this is a change that should be welcomed, as it is in line with our general view that a student nurse is an adult person who should be allowed to decide how she spends her own money. I was surprised not to hear from the noble Baroness, Lady Summerskill, today about conditions in which nurses have to live and about some of the petty restrictions that were sometimes imposed on them in the past. But more and more nurses, as they are more adult and mature, are wanting to live their own independent lives, and this pay-as-you-eat scheme was conceived as part of the policy of giving them financial independence. Moreover, all the staff interests concerned were in favour of it. It was therefore introduced as part of the general pay agreement recommended by the Board and I have no doubt that they must have taken into account the financial effects of their recommendations.
Previously, there was a combined charge for board and lodging of £156 a year. The National Board for Prices and Incomes estimated that the cost of meals to the nurse as taken would be about £100, and the Whitley Council agreed to deduct £106 from the combined allowance. They took account of the fact that this sum reflects roughly the cost of the meals agreed by the Whitley Council for ancillary staffs. Under that agreement four meals a day are available at £2 6s. 1d. a week. I would remind your Lordships that at the same time the Board's recommendations for nurses provided for a pay increase of 9 per cent. all round (without a strike, I say to Lady Summerskill) with a higher increase for certain grades, including second and third-year students, and for a reduced lodging charge for first-year students of £25. The Secretary of State and I are very much concerned about the needs of students in training, and particularly the first-year students, and here a special arrangement was made in respect of their allowances.
I do not have to remind noble Lords that the Whitley Council, the staff side of which consists of representatives of the various nursing organisations and unions, concluded an agreement based on 328 these recommendations. I do not think any of us would have thought in advance that there was anything inherently unreasonable or oppressive about the agreement. On the contrary, it was intended to improve the lot of the student nurses. According to the information we have received, the scheme appears to beworking quite reasonably in some places, but in others it seems that student nurses are finding that the sort of meals they were getting for the previous fixed charge were worth appreciably more than £106, so that they have either to make do with meals of a lower standard or spend more than would have been thought necessary.
Now, as I understand it, as a result of articles in the Nursing' Times and Press generally, the Royal College of Nursing have indicated their intention to ask for a pay increase of £1 a week for student nurses. My right honourable friend the Secretary of State and I, as I have already indicated, sympathise very much with the needs of student nurses, and we are anxious to see that any defects in the working out of the agreement should be identified and, if possible, removed; and this we will seek to do. But I am sure your Lordships will not expect me to comment on the claim at this stage in advance of its consideration by the Council, who will be meeting very shortly. I am sure they will deal with it as rapidly as they can.
On the particular point raised by my noble friend Lady Summerskill about the cups of tea and coffee, I have made inquiries about this, and I understand that the estimated cost of the meals to the nurses did not cover this item. As all of us who are familiar with hospitals know, cups of tea and coffee arc always on the go in hospitals—and very necessary that is, too. I do not think any of us would want to see a position where a nurse would feel she was acting inappropriately if she made herself a cup of tea from the kettle which, as my noble friend Lady Summerskill said, is always on the boil in the ward kitchen. We will bring this matter before the Whitley Council, and I have no doubt that they will consider the point, especially when they are looking at the staff side claim.
My Lords, I hope that the explanation I have given calms some of the concerns that have been expressed in this debate. I do not think any of us would attempt to deny that the nurses in our hospitals, be 329 they student nurses or fully trained nurses, do a splendid job of work. We are all potential patients, and whether we have been patients or not we know very well what burden the nurses carry and what skills they need to develop in this field to assist patients to recovery.
I come back to the Bill itself. I realise that in the present state of public debate it seems, as the noble Baroness, Lady Brooke, said, an innocuous Bill. I am afraid that I cannot accept that analysis of it. This is an administrative measure, I admit, but it is one which I myself, and I think the General Nursing Council, too, regard as absolutely basic to the need to streamline the present arrangements for nurse training. I hope that at the Committee stage of the Bill, we shall have a full discussion of the various points of administrative change, and I hope your Lordships will give it a Second Reading to-day.