NURSES' PAY AND CONDITIONS

HL Deb 15 May 1969 vol 302 cc255-94

5.25 p.m.

LORD AMULREE rose to ask Her Majesty's Government what steps they propose to take to improve the conditions under which nurses work.

The noble Lord said: My Lords, at the present time there are in the country about 420,000 State-registered nurses, 52,000 student nurses, 104,000 State-enrolled nurses, 18,000 pupil nurses and 46,000 auxiliary nurses or nursing auxiliaries, making a total of 640,000 people. I am sorry to have to give these figures: I shall not give your Lordships any more. The National Health Service is at the present time the biggest of our national industries, and one can see from the figures I have quoted that the nurses are really the largest category of staff in the National Health Service. One could really say that they are carrying the Service—to a very great extent, anyhow. There are quite a number of people who do not really know what nurses do, or what their work is. The nurses are the people who make possible the work of all sorts and kinds in hospital. One is told about the more spectacular work now done by surgeons and physicians in the case of transplants, cardiac resuscitation, intensive-care units and all that spectacular work which has cropped up in the last ten or fifteen years. I think I am right in saying that if it was not for the skilled nurses working with these surgeons, 75 per cent. of their work would be labour in vain.

So I come to the first part of the Question I want to ask the Government. Is it right that the terms of pay under which the nurses work should be settled by the Whitley Council machinery? The Whitley Councils, as your Lordships will remember, were established in 1916, I think it was, by a committee under the chairmanship of Mr. J. H. Whitley, who was a Liberal Member of Parliament, which recommended the formation of joint industrial councils. These were to deal with pay and other disputes between the employer and the employed During the war, the nurses' pay was regulated by a committee called the Rushcliffe Committee, which was a temporary committee in that I do not think it was meant to be there for a very long time. But in 1948, when the National Health Service came into being, it was decided that the Whitley Council was the right procedure for the nurses' pay.

The management side consists of representatives of quite a number of bodies, of which I will quote just a few: the Ministry of Health, the regional hospital boards, the hospital management committees, the Association of Municipal Corporations, and so on. But behind these is the Treasury. Therefore, the employers' side has not really got the same power to negotiate as that which you find if you are dealing with a purely industrial set-up, where the staff side and the management side can talk together directly.

In that case, the management side has full control over what it decides to do, whereas in this particular case, I think I am right in saying, the Treasury is the overriding factor. I was a member of the staff side at one or two Whitley Council meetings, when I was working with the occupational therapists. I am bound to say that I found appearing before the Whitley Council was a most disheartening, discouraging and disappointing affair. I admit that they were extremely nice; they could not have been kinder. But you knew from the start that nothing was going to happen; and when you came away nothing did happen.

The doctors have been rather cleverer than some people, because about ten or twelve years ago a Committee was appointed, under the chairmanship of the noble Lord, Lord Pilkington, which recommended that there should be a Review Body, with an independent Chairman and six members—not medical people at all—who should make recommendations on the pay of doctors working in the National Health Service, both those working as general practitioners and those working in the hospital service. The doctors working under the local authorities, I believe I am right in thinking, came under the Whitley machinery which controls local authority matters. At any rate, the recommendation of the Pilkington Committee mean that, in the case of doctors, we have this Review Body, which has reported eight or nine times and, broadly speaking, has given a great deal of satisfaction to the profession.

The question I want to put is this. Why should there not be a similar review body dealing with the nurses' pay?—because the nurses have now become a professional body of people, as doctors are professional people. Nursing is no longer a calling, as it once was, when nurses would do anything for nothing: that cannot be expected to happen now. Nurses have become a professional body of people. The young nurses are now recognised as students who require a well-designed curriculum, expert instruction and guidance in the training schools and in the practical work they do in the wards. But one must realise that in their instruction in the wards, in their practical work, both as qualified nurses and as student nurses, they represent the main labour force working in the wards. So, although it is true to say that the younger—some of them men—nurses are students, they are in fact doing a great deal more than students do, because they carry a very considerable amount of responsibility.

Moreover, supposing they were not there working in the wards, one does not quite know what would become of the wards. More people would have to he employed from somewhere. Nurses are called upon to supply a full 24-hour nursing service in the hospitals, and the people who are recruited as student nurses are required to have considerable educational qualifications. For the normal entry, they must have two "0" levels, of which one has to be in English; for the teaching hospitals, they try to get them with five "O" levels, to correspond with the radiographers and physiotherapists and members of the other professional bodies working in the hospital.

I will come now briefly to the question of nurses' pay. A student nurse, gets £395 a year, gross. From that she has to pay superannuation, national insurance, income tax and quite a large sum for board-and-lodging; so that the amount she finally takes home is something in the neighbourhood of £240 a year. I may have my figures wrong, but I do not think so. These scales rather correspond to those of the other members of the nursing profession. Take a ward sister, who carries a great deal of responsibility and does a great deal of real hard work: her maximum salary is £1,300 a year. I think I have that right, but I am always prepared to he checked on the figures. What is said in excuse is that if nurses do not want to live out, in a great many cases they have accommodation provided for them. That is true. But take the case of a student nurse: she has only a bedroom and a communal living room. Perhaps for a student that is not too had. A staff nurse, or a qualified nurse, may get a bed-sitting room and a communal room, too; but this does not compare well with people of the same intellectual background, working in private, who can have a little apartment for themselves and do not have to lead this communal life which some people do not find very attractive.

Therefore, my Lords, as part of my Question I should like to ask whether nurses cannot in some way be paid more. Let me give one or two more figures. At the present time a senior nurse cannot earn more than £2,950 a year. That is the maximum. I saw an advertisement on May 1 in the Nursing Times for a senior nursing officer who was to be paid from £2,530 up to £2,950. She was to have full charge, from the nursing point of view, of 4,500 beds, of which 1,300 were for mental patients. I will not go into the details of the beds; but there were 4,500 beds in 17 hospitals. She was going to have to accept responsibility for the accident ward, the out-patients department, training for both (State-registered and State-enrolled nurses—and all for the figure I have quoted.

Compare that with the salaries which the nationalised industries pay their Chairmen. I do not suggest that the nurses wish to be paid as much; but the Chairman of B.E.A. gets £11,000 a year; the Chairman of B.O.A.C., £15,000, and so on. Even some of the minor jobs, like that of an area gas manager, carry a salary of from £7,000 to £9,500. The only really tiny one is the North Scotland Hydro-Electric Board, where the Chairman is paid merely £4,750—it seems unfair on the North of Scotland. The Royal College of Nursing do not make very big claims. They suggest only that the top salary might be increased from £2,950 to £4,500 a year. These are the two questions that I want to put to the noble Baroness, and I shall be grateful for any reply that the Government may give me.

5.38 p.m.

BARONESS BROOKE OF YSTRADFELLTE

My Lords, that nurses are news to-day is clearly apparent. The traditional picture of a quiet, gentle, reassuring, comfort-giving figure in an attractive uniform is in some cases being superseded by a more militant and aggressive individual demanding her rights and perhaps sometimes forgetting her duties—or so the Press, television and radio would have us believe. Although this new militancy is by no means universal and the methods adopted are not acceptable to the vast majority of the profession, there is a general feeling of unrest, frustration and unhappiness that could develop into a permanent malaise unless something is done to arrest its growth and cure its cause.

What are the causes of the troubles? In a short debate such as we are having to-day it is impossible to attempt to cover the whole canvas. I shall confine what I have to say to looking at a few of the problems to be found facing both the giving and the receiving ends of the service. It has been said categorically, over and over again, that the salary structure is inadequate; that at the top it does not give sufficient reward for added responsibility or sufficient incentive to encourage trained and experienced nurses to seek promotion. The Salmon Committee on senior nursing staff structure advocated the creation of a new top post.

On this information being made available there was excitement in the nursing profession that at last they were going to be paid for what they were doing in terms of responsibility and years of experience—a new top post, that of Chief Nursing Officer. The training and experience for such a post. and the responsibilities it carries, are both challenging and impressive; and as the noble Lord, Lord Amulree, has already told your Lordships, the salary, the peak salary, is £2,950. The figure of £2,950 is not an arbitrary one; it was suggested by the Prices and Incomes Board in its Report on Pay of Nurses and Midwives in the National Health Service. The Board did not even have the grace to say "Grade 10 nurses—the top grade—are worth £5.000, but we cannot afford to pay it." It is this that has helped to cause some of the bitterness among nurses at the moment.

My Lords, we are living in an age when technical developments and organisational changes in the profession call out for mature, experienced nurses of the highest calibre with management skill. That goes for all the new techniques which are necessary; the exciting new equipment and the use of new drugs, too. The student nurse must be conscientiously taught, and the facilities for teaching and learning must be improved if full advantage is to be taken of the advances in medical and surgical skills that are being made all the time.

The second grade that I should like to consider is that of ward sisters in general hospitals. Ward sisters are highly skilled personnel. They carry heavy responsibilities for the bedside care of the patient, for the administration of their ward, and for teaching. Many nurses would prefer to stay on this clinical side of the service for the whole of their professional lives, in close contact with patients, but they are deterred from doing so by the low level of salary which can be obtained even after many years of service. As the noble Lord, Lord Amulree, has told us—and I do not hesitate to repeat this figure because I think that this is what we want people to realise—the salary scale of a ward sister is £970 a year, rising to the giddy height of £1,315, with nine increments before the maximum point is reached. Who would be a ward sister with only those mouldy "financial carrots" dangling in front of her?

The third grade is that of student nurse. The student nurses provide the main labour force for the hospital, and he or she is paid a training allowance which is then treated as a wage and is subject to deductions, superannuation, National Insurance and, with rare exceptions, income tax also. Whatever else your Lordships may not know about the pay and conditions of the nursing profession, I am pretty certain that you are all aware of the introduction of the "pay as you eat" scheme. The principle of "pay as you eat" is not universally unpopular, but the inadequacy of the training allowance to cover the principle in practice is the cause of the trouble. All innovations tend to cause rumpuses, but, given time and good sense, and enough cash, this scheme should settle down, after initial teething troubles—one of which, it seems, is that there is not enough food for the teeth to chew.

Some hospitals appear to have been more skilful than others in the introduction of the scheme. The standard should be universal and steps must be taken to see that it is so. Nurses are doing heavy physical work and they are always hungry. Forty years ago, when I was a probationer-nurse, when we came off duty at half-past nine in the morning, having been on the run since 7 a.m.—and the same thing holds good to-day—we fell upon the remains of the supper of the night before; beefsteak and kidney pie, rice pudding, coffee, rolls, anything we could lay our hands on. We were ravenous. And in spite of the vital statistics which are always much in the news, I do not believe that it is very different for the nurses in training to-day. I believe that they get just as hungry as we were.

What I can never understand is why, when a pay award is made to the nursing profession, more money is promptly required for board-and-keep emoluments, and the amount is backdated to the day of the rise. Surely, if food and domestic help charges have risen the emoluments should have been increased before the pay award and not appear to be part of a package deal when the cash is eventually being handed out. Most of the student nurses to-day are expected to house, clothe and feed themselves an a training allowance of less than £8 a week; and that, as we all know, just cannot be done with any margin for enjoyment or pleasure. I will not bore your Lordships with the training allowance that I had 40 years ago.

These nurses are listed as student nurses on the establishment. May I suggest that they are neither the one nor the other? At present they are largely hybrid, and so they get the worst of both worlds. If the nursing care of the future is to be equal to the advances in medical knowledge and equipment which have been made in recent years, and which are being made all the time, the student nurse must be regarded as a student and given all the necessary facilities to enable her to be one. Never before in nursing history has the position of the tutor been of greater importance. There is so much to teach and the average ratio of tutors to students is 1 to 40. The student is mostly learning for only a quarter of the time, and she spends only about one-sixth of it in the School of Nursing. For the rest of her time she is helping to run the hospital, with Saturday and Sunday duty and no overtime, and a considerable amount of lonely, often frightening, night duty.

The theory is that a nurse receives teaching in the wards, but with the general shortage of trained staff, she is often on duty for eight hours without receiving any instruction at all. Nurses have always been in evidence, apparently in sufficient numbers to staff our hospitals and to enable the domiciliary services to be maintained. We, the public, my Lords, are aware of them when we are ill and need their skills; when we are on the receiving end. But when we are well and away from their ministrations, then all too easily we tend to forget them. The time has come when we are being jolted into consciousness that the prevalent disease of unrest is beginning to show signs of activity and that the less stable and responsible members of a great profession may try to organise rebellion against conditions of service and pay.

I hope, my Lords, that Her Majesty's Government will rise to the occasion; that they will set up the necessary machinery forthwith to seek out some viable solution; and the first blow that I should like to see them strike is against the "sacred cow" of Whitley, the most unrealistic and unimaginative body ever set up as a guardian of fair play. Money, or the lack of it, is the crux of the matter. I think that the noble Baroness, the Minister of State, deserves all our sympathy. She has a gigantic task on her hands with the Treasury as the "giant", and although her name is not "Jack" and she belongs to the opposite sex, I believe that she will have a pretty good shot at climbing the beanstalk of knotted sheets and at running off with the goose that lays the golden egg, so essential to the solution or easing of the infinite number of problems that await her in the Department for which she is now answerable. I wish her all the luck in the world.

5.47 p.m.

BARONESS SUMMERSKILL

My Lords, I find it difficult to say anything after what the noble Baroness, Lady Brooke of Ystradfellte, has said. She, of course, speaks with the knowledge and the passion of a woman who has known the life of a nurse, and has realised that it is not all nobility; that there are hard times and frightening times—I am glad that she used the word "frightening"—in relation to the work done by a young nurse who may be left alone in a ward all night, sometimes for eight hours, while the doctors go home to their comfortable beds. When the doctors leave the wards and go home, they say to themselves, "Thank God I am not that little nurse!". Whatever happens during the night; if for the first time in her experience a patient dies, the young girl is left to face death and do all that is necessary. It may be an elderly man or woman who dies. This is all horrific but, unfortunately, so few people consider these things after they have left the hospital well and happy.

The noble Baroness, Lady Brooke of Ystradfellte, talked about, "these gentle women". It reminded me of what they said about the suffragettes; how people raised their eyes and said, "How is it that these gently-nurtured women can even consider violence, and behave in this unladylike way?" If you call something that a woman does "unladylike", that is enough—she will immediately do anything and be completely passive. And so we have a rather interesting parallel, because these women have not suddenly revolted, they have not done something which is entirely out of character. In a way they are rather like the suffragettes. Before the suffragettes revolted, for thirty or forty years they had come to Parliament and asked, in a gentle, ladylike way, to have the franchise. These women who are now in revolt have used every other means to get their grievances remedied. They have behaved in a gentle way. They have gone to their sisters and matrons and Members of Parliament, written hundreds and thousands of letters over the years, describing the conditions, which the noble Baroness has described, and asked, "Is this fair? Can you do nothing to help us?" And they have been ignored.

I feel that the discussions going on at this moment between the Trades Union Congress and the Government are relevant to this matter. These discussions are concerned with the use of the strike weapon. The T.U.C. says that in no circumstances must the strike weapon be taken from them, because the withdrawal of labour is the only weapon that the workers have, if the terms of their employment are not good. The Government say that all they are doing is to ask for a cooling-off period; that the trade unions shall wait for a fortnight, but they realise that it is absolutely legitimate for a worker if his terms of service are bad, to withdraw his labour.

The nurses we are discussing to-day are some of the finest workers in the country. The whole House will agree with that. But while legally they can withdraw their labour, they have no moral right to do so. These girls are aware of that. They realise that morally they must stick it out, irrespective of the hours, the uncongenial conditions of work and the miserable pay. So they and the doctors are the only workers in the country—and their services can really never be estimated in pounds, shillings and pence, however much we give them—who cannot say, "if you do not treat us fairly, we shall withdraw our labour." Now they are making a protest, a violent protest, and all the nice people hold up their hands, shocked, and say, "Not the nurses, surely?" Yes, my Lords. The nurses have had enough of being ignored and exploited.

The noble Lord, Lord Amulree, gave figures of an 84-hour fortnight, and sometimes the nurses can work for a stretch of 77 hours of night work—heavy, physically arduous work. Girls of 18 and 19 have to heave up men of 15 stone, rub their backs so that they will not get bed sores and spend all night running in and out with bed pans and cleaning them—doing things that the relatives of these people would never do. That is why so many people are in hospital, because the jobs these little girls are asked to do will not be done—and quite understandably—by the relatives.

Although I recognise the point made by the noble Baroness, that if they were paid enough money they could pay for their meals, I feel strongly that a responsible committee should not have decided that a still growing girl—people do not stop growing until they are about 22 or 23—whose strength can be overtaxed, physically and mentally, should not be ensured regular and adequate meals. This committee, for the first time in the history of nursing, have literally washed their hands of their full responsibility for the feeding of their charges. And when I say "charges", surely that is the right term; they have not washed their hands of the disciplining of these girls. I am told that the nurses have to get in at a certain time. They are the only workers in the country who have to do so. Apparently discipline is still exercised by people who seem to enjoy that kind of power, although they will still leave the same girls alone all night in a ward.

In my opinion, this policy is absolutely opposed to the contemporary approach to the feeding of young people. Even business firms recognise that young typists and office workers, if they are to get the best work from them—all right, it is enlightened self-interest, if you like—must be properly fed, and that it pays them to give their workers subsidised luncheon vouchers, vouchers which can only be used for food. So there is no question of these firms not recognising that the feeding of these girls is important. Most of these office girls live at home. Their mothers give them a good breakfast, they get a good dinner at night—arid the firm gives them a subsidised lunch. That is what is being done in business, but not in our hospitals.

These nurses, who are dedicated to their vocation, are easily exploited and the committee has washed its hands of the full charge of their feeding. I believe that this is a fundamentally wrong policy. It is in the interests of the patients, as well as of the nurses, for these girls to be adequately fed. To put up with their kind of life, they must not feel irritable for one moment. They have always to be in a good temper, always to be placid, always to be patient with a patient, who may not be the nicest kind of individual. If they are not adequately fed, it is easy for them to change from kind nurses with good bedside manners into very irritable individuals.

Both the noble Lord, Lord Amulree, and the noble Baroness, Lady Brooke of Ystradfellte, talked about the physically arduous work that nurses do. I am told that it is estimated that these girls walk ten miles a day. It is interesting to know that those in authority have recognised this. The doctors have said that these girls are doing such arduous work that their feet must be looked after, otherwise they may become flat-footed. So a regulation has been made that a special kind of shoe must be worn. This is significant, because it indicates the strain under which these girls work. Nevertheless, this special kind of shoe, which costs £4, has to be paid for by the nurse, although it is designed to help the work of the hospital.

I feel that this policy, which is fundamentally wrong, will lead to the poorest nurses, who are not subsidised by their parents, being unfairly treated. Let us recognise that there are two kinds of nurses. There is a waiting list of nurses wanting to go to St. Thomas's, across the river, where they are known as "Nightingales", because of course it is Florence Nightingale's old teaching hospital. There is a certain cachet—snob value, if you like—about going to St. Thomas's. Often these girls are the children of wealthier parents. It is fairly easy for some parents to subsidise their girls in hospital by sending them big parcels of food, and so on. I say that the policy of looking after these girls should have been planned in the light of the need of the poorest girl in the country.

I want to talk about the student nurse. As I said the other week, the word "student" is an absolute misnomer: it has no meaning whatever when applied to these girls. They are full-time hard workers at a physically arduous job. If they are students, then they should get a grant free of tax, and they could conduct their own lives as medical students do. If they are not students but workers, then they should be given a reasonable wage. But these girls are neither. They are used as cheap labour, with the result that often they are too exhausted to study adequately, and it is not surprising that so many of them give up in the first year. I am astonished that those in authority do not ask themselves: "Why is it that this large proportion of girls give up in the first year?" In fact, they have simply turned a blind eye to this problem, and when not enough girls have come forward they have gone to the under-developed countries and Commonwealth countries, where nurses are desperately needed, and imported them into our hospitals. I am quite happy that these girls should come here, but the fact that our girls are not coming forward must be glaringly obvious. Yet nobody has taken any notice of this.

Finally, in order that noble Lords may realise what an extraordinary position it is, I want to say this. I learned from an item in a newspaper two days ago that nurses are charged 2s. 6d. for a prescription. In a hospital where there is a dispensary full of drugs of every kind, with its own dispensers and pharmacists a nurse is charged 2s. 6d. for a prescription from this miserable little wage that she has. Again on the subject of pay, the orderlies and the domestics in the ward get a bigger take-home pay than the nurse.

I would ask the Government, as successive Governments have so many times been asked, directly or indirectly, not to think in terms of appointing a Royal Commission. As a matter of fact, I am told that this idea has been turned down (thank heaven!) in another place. A Royal Commission is a committee which goes on from year to year and, it seems to me, never comes to the right decision. I would ask that someone in authority should have the courage to say that this is so unjust and also so short-sighted, from the point of view of the hospitals and the country, that these girls are justified in making a protest. And I hope that as a result these conditions will be changed forthwith.

6.3 p.m.

LORD GRENFELL

My Lords, I am deeply grateful to my noble friend Lord Amulree for raising this question. He has spoken of pay, and I wish first of all to say a few words to your Lordships on this subject. I have taken the case of a first-year student nurse, under 25 and resident, who is seeking to obtain the certificate of State Registered Children's Nurse. There are different scales; they are a little higher for non-resident nurses, but the average applies to all nurses. I seek to put before your Lordships the case of those young girls who are unmarried and live in, who have chosen nursing as their vocation and whose services we need so badly. I ask the Government for consideration not only of these, but of the whole profession from top to bottom.

A matron in charge of 700 beds, who has responsibility for the training, guidance and efficiency of the nurses under her charge, receives a salary of £2,262. If living in, £344 is deducted for rent and laundry. This post is usually the peak of a career within the nursing services, and her responsibility is enormous. In a moment I am going to give your Lordships statistics which I have taken from Queen Mary's Hospital for Children, Carshalton, which is within my group. Before doing so, however, I should like to make a few general remarks.

In years gone by it was understood that girls took up nursing as a vocation; and this, in my dictionary, is defined as: a divine or spiritual injunction or guidance to undertake a duty". Those days are over. I have the honour to be associated with a number of charities and to the best of my ability I have seen to it that those who administer them are all similarly paid and, so far as possible, work in conditions comparable with people in other work, athough, naturally, many accept a lower wage in view of the nature of their work. I am blessed in my group with having lovely buildings, but in my privileged position as a Member of your Lordships' House I would speak for all, fully realising that the dreadful construction of some of our hospitals, and especially those for the severely subnormal, makes the well being of nurses vital for the whole future of the Hospital Service.

I should like to put before your Lordships the facts of the pay of a first-year student nurse, resident, remembering that this student nurse does duty on the ward when available from her studies, and does a 42-hour week. Basic pay for the month is £32 18s. 4d.; week-end pay and night duty, if in the course of duty, nil. Deductions are: lodging £2 1s. 8d., tax £1 8s. and National Insurance £2 16s. 4d; total £6 6s. Net pay received is thus £26 12s. 4d. This student might earn up to £3 a month in overtime. If we assume that she pays £2 6s. 1d. a week on food (and I shall be talking about this in a moment), she will have left £18 10s. a month, or £4 12s. 6d. a week, for all other purposes, including clothing herself in her civilian clothes, which, like other young girls, she wants to do, and everything else. Is it reasonable to expect the nursing profession, both men and women, to accept this pittance of a wage in what is called a vocation? It would be impossible in the name of humanity for them to strike.

I have now dealt with the pay. In the name of all justice, I protest about the structure of the Whitley Council and all its works. Someone must put forward the case of the nurses in our land, and if, as I see it, it is not done by the Whitley Council, I join with Lord Amulree and everybody else in this House to-day in protesting against the situation of nurses both in pay and conditions. This, my Lords, may seem to be the moment to sit down, but I believe that what I am about to say may be of value in assessing the advantages and disadvantages of the much publicised question of that dreadful phrase, "pay-as-you-eat".

I confirm the interjection I made in the Second Reading of the Nurses Bill, that the success of this experiment depends on good administration. The first criterion must be that anyone who wishes to have full meals throughout the day does not pay more than was automatically deducted from his or her pay under the old system; that is, £2 6s. 1d. per week. That is vital, and I have heard rumours that this criterion is not being followed in some hospitals. The second criterion is that the nurses have time to get their meals and pay for them without curtailing too much of their time off, and in this regard, by reconstructing the servery we are trying to ensure that the available meals are visually shown, so that the time of queueing can be reduced. Before producing my figures, may I say that I have visited the cafeterias of both Queen Mary's and St. Ebba's Hospitals, and have sat down with and talked to the nurses while they were having their meals. I have received favourable comments on the new system and the food.

It is difficult to judge on the first five weeks of any scheme, but I produce these figures for all using the cafeteria. It would appear that all concerned are, on the whole, better off, but we must take into account that it is a short period in what I feel is a long-term project. At Queen Mary's Hospital for Children, the overall finance of the cafeteria experience of the first five weeks is as follows. sums formerly collected from staff pay-packets for full board and residence, not now deducted, for about 300 staff—and that figure is an average residence staff figure over a year—and covering those five weeks, amounted to £2,237. The increased allowance made to non-resident student nurses for meals taken free when on duty amounts to £476. The total increase in income to the staff is therefore £2,713. Sales of meals in the cafeteria direct to all grades of staff amount to £1,618. The difference between the former figure and the latter—that is £1,095—is money which the staff have received and which has not been spent by them in our dining rooms, although there is general satisfaction with the quality of the food. There already appears to be less wastage on plates, and I can assure the House that so far as I and the matron can see, none of the nurses are in any way starving.

There can be no doubt that the Hospital Service as a whole needs very careful thought. We have had Green Papers, and Committee after Committee, but I feel sure that we should have immediate action on the nurses situation if there is not to be a rather sad breakdown in the near future in our relations with the finest profession in the world.

My Lords, I have taken up just those two points, as I believe that short speeches should be the order of the day on Unstarred Questions. I sincerely hope that after the Summer Recess a full-dress debate will be arranged which will bring in all aspects of the Hospital Service, and I shall then have a lot more to say. I believe that a careful reappraisal of the whole pay structure of the Hospital Service must be made, and consideration must be given to the future of the nursing profession in the context of making it more interesting, cutting down to a minimum custodian care, especially in the subnormal hospitals, and encouraging nurses to reach out into the educational sphere—not that they do not do this so far as possible, but my dream would be that incentives should be given to make it worth while to train in teaching methods and hence make the whole field of nursing ever more interesting.

I would say, finally, in spite of what the noble Baroness, Lady Summerskill, said, that I sincerely hope that our nurses will not start marching. I feel it lowers the whole standard—especially if they march in uniform. They are wonderful people, and I think they must know that there are very many of us who are doing all we can to see that they get a good deal.

6.17 p.m.

BARONESS HYLTON-FOSTER

My Lords, I also should like to thank the noble Lord, Lord Amulree, for raising this question now. I hope that as it has come at this time it may perhaps help the noble Baroness, the Minister of State, to start climbing up Lady Brooke's knotty beanstalk. I should like to say a few words to emphasise some of the points already made, but from the nurses' angle, as I think it right that I should declare at this moment that I am on the Register of State-enrolled nurses.

As has been said, student nurses are quite unlike all other students. I think this cannot be emphasised too often, because they carry this tremendous responsibility which no other student pretends to carry. Second-year students, as has already been said may well find themselves—particularly at night—on a ward quite alone, when sister is off duty, in charge of anything up to 24 patients. For this they get, I think, in round figures, about £6 a week; and for £6 any of our lives can be in their hands. In my view, pay should be related to responsibility.

I want to talk quite separately about pay-as-you-eat. This morning I discussed this subject with one of the London matrons so as to get a really up to date picture of her view. I feel that there is some confusion between pay-as-you-eat for student nurses, and pay-as-you-eat for older nurses. Student nurses—as has already been emphasised—are very hungry young people, and they ought to be given the opportunity of eating as much as they want whenever they want, without having to dip into their own pocket for it. Again, when student nurses are on night duty it is absolutely essential that they should have their night drink in the small hours of the morning, without having to decide whether the cost is coming out of their pocket money. If it is coming out of their pocket money they have to weigh up whether it is worth having the drink at night, or the meat by day or whether they would not rather put the money towards the new shoes (which we have been told cost about £4), or perhaps towards the holidays. They should have this food or drink as their right. Of this I am quite certain.

However, I think that the older nurses present a different problem because often they are part-time and married; many of them are working not in acute wards but geriatric wards, and they choose this kind of nursing because it suits their home life. As older people they do not need so much food; they are probably not still growing. Also, they have (this is the point that the matron I was talking to thought was essential) an outside interest. If she had the choice, she would have all student nurses living out, too, so that they also had a completely separate life apart from their work in hospital.

The student nurses' work, in the early days of training, is also physically heavy. As student nurses progress with their training and with nursing techniques, the work becomes easier and lighter. But, of course, the older nurse, the nurse looking after geriatric patients, does a type of nursing which needs immense patience. Those who look after the type of patient who—we have to face it—can never get better do a job which can indeed be very soul-destroying; and those doing it need a complete change when they are off duty so that their minds are taken off their work. All nurses must be properly fed. A tired nurse is not a good nurse, and when a nurse is tired accidents can happen.

A modern nurse does not like to be called a dedicated person. She probably is one, but she does not like to be called it. I think it is to-day's Times that describes her as a normal, happy career girl who, because she likes working with people, goes into nursing. She will remain in nursing only if the status, pay and conditions are made acceptable to her. I think we simply must remember that there is no uniformity of hospital conditions; there is no uniformity of hospital meals, and there is no uniformity of hospital matrons, either. Therefore, I ask myself: are the plans for the hospitals and the hospital services really designed to tidy up administration, rather than for the benefit of the nurses and the comfort of patients?

6.23 p.m.

LADY RUTHVEN or FREELAND

My Lords, I also should like to thank the noble Lord, Lord Amulree, for asking this Question. I feel I have very little to say that has not already been said by previous speakers. I feel very strongly about the nursing profession, having been at one time chairman of three nursing committees at the same time, two in teaching hospitals in London and one in a psychiatric hospital in the country. I have had the opportunity of talking to, and have had many friends among, senior nurses and matrons and I have talked to many nurses in training, and have learnt from all something about their work, their training, and the con- ditions in which they work. I have also, unfortunately, had a good many operations and have been in hospital quite a number of times. I have been in hospital not only in London but all over the world—in the Middle East, India, China and the United States. I think I can say quite definitely that everywhere I have regarded my recovery as 70 per cent. due to the nursing I was given; and that goes for all the different nationalities who have nursed me.

I am very shocked by this outburst that has taken place, and I mind that the nurses should be put in this very prominent position. I think it is entirely due to the unfortunate pay-as-you-eat (that awful expression), and I think it has had a very distressing effect on all non-resident nurses in training. Not that I think the nurses want to be residential. In fact, most of them do not. I am quite sure your Lordships know that no young person really wants to live at home, even her own home, a hall of residence at a university, or a nurses' home. Most of the nurses would like to live out and pay for the meals they take from the hospital. It is really an extremely small, pitiful amount, after deductions for income tax et cetera, that nurses are left with to live on and pay for their meals, and this has caused the unfortunate outcry in the country.

I was going to quote the various figures that ether speakers have quoted before me, but I think that as I know more about nurses in training in London I will speak a little about that subject. We know that they get London weighting, if they are in a London hospital, of £90. But there is a great difficulty in London because those who live out have a very high rent to pay and often have very high fares. I have an example here. It is that of a third-year student in London who has an average of £9 a week, after statutory deductions, and has to pay between £3 10s. and £4 10s. for accommodation. One third-year student whom I know personally pays £3 10s. to share a house with eight other nurses, sharing a room with one other person. She has to pay 12s. a week in fares to and from the hospital. This leaves her just under £5 to cover everything else. This girl gets some help from her parents, but as the noble Baroness, Lady Summerskill, said, we really ought not to take that into consideration. We must cater for the girl or boy who has no help from her or his parents. Now as a non-resident student this girl, who has been getting all her meals free on duty, will be considerably out of pocket. She will be given £66, reduced by tax to about £52, to cover the cost of such meals; that is only £1 a week. I do not know how she is going to manage. A second-year student nurse under 21 years of age would be even worse off than the third-year student because her allowance is smaller.

This is the crux of the matter. Whereas in the past when nurses had their meals in the hospital they could eat as much as they liked, now they will look at the menu to see what is the cheapest item on it and will probably buy that. Surely this is not a very sensible way of looking after these young people aged from 18 to 21, who must be fed properly if they are to perform these heavy and exhausting duties which, as various speakers have said, can also be very emotional. Their physical strength must be sustained if their duties are to be carried out properly and efficiently. We know that all the hospital meals are subsidised, but I think that either they must be subsidised even more—otherwise the nurse will not get sufficient food—or we must think of something such as a luncheon voucher or supper voucher which will be provided from hospital funds.

There is one small point about which I should like to ask the Minister. It is on the question of London weighting, which for nurses living out is £90. I am told that nurses working in the Department of Health receive £120 a year, as do other civil servants. I cannot see why nurses in hospital should receive less.

I should also very much like to support what has been said by the noble Lord, Lord Amulree, and various other speakers, on the question of calling nurses "student nurses". This is completely ridiculous. If they did not work in the hospitals practically all the wards would be closed down at once. I am sure that everyone who has taken part in this debate feels the same. We must either give these girls a proper training allowance and treat them as students and not tax them, or else treat them as part of the staff and pay them for the work they are doing.

I should like to say a word now about qualified staff. The newly qualified staff nurses also have great difficulty in managing on their salaries. The budget of one staff nurse known to me, which is typical of many, shows that her take-home pay averages about £56 a month, out of which she pays a rent of £3 10s. 0d. or £4 0s. 0d. a week for a flat which she shares with three other staff nurses. She has to pay for all her meals on duty, and she also has to pay for electricity and gas and fares to and from the hospital. As the noble Baroness, Lady Summer-skill, said, the staff nurse has to buy her shoes and stockings, although why they should not be part of the issue of her uniform I have never been able to understand.

At one of the hospitals in which I worked for some time as chairman of the nursing committee we used to have a number of Australian nurses on the staff, but most of these have left to take jobs outside nursing. One such staff nurse recently resigned after four months to take a routine clerical job for which she is paid £20 a week. She was a good nurse and was sorry to leave the hospital, but she had not expected nurses' salaries to be so low in this country and she wanted to take a holiday in Europe before she went back to Australia.

Now I should like to come to the senior staff. The latest blow is the recommendation of the Prices and Incomes Board that the maximum salary to be paid to a chief nursing officer—recommendation No. 10 of the Salmon Report—should be £2,950. In my view this is absolutely inadequate for a man or woman who must hold high nursing qualifications, who must have extensive and varied administrative experience in nursing, and who must have attended a top management course. I wonder what is the maximum salary of such a nurse's colleagues on a course of this kind? I imagine it is certainly a good deal higher than £2,950. The chief nursing officer in a large hospital may be responsible for a budget in the region of £2 million; for the deployment and control of up to 2,000 professional nursing staff, and for the co-ordination of education services for probably some 700 students. On the professional side, responsibility is for the standard of nursing care given to all patients, and in a modern hospital group there may be more than 3,000 in-patients. One specialist London hospital has nearly 2,000 out-patients a day.

The chief nursing officer advises recruitment boards and committees on all matters affecting the nursing service and prepares, interprets and reviews nursing policy in consultation with professional colleagues, including medical staff whose arguments and tactics appear to the nurses to be reasonably effective where pay is concerned. All this for £2,950 a year at most. I saw the advertisement mentioned by the noble Lord, Lord Amulree, asking for a chief nursing officer for a hospital or group of hospitals of 4,000 beds, and the salary offered was £2,250 per annum, no doubt eventually reaching that tremendous salary proposed by the Prices and Incomes Board of £2,950.

My Lords, I think the Government should have some new thoughts on the salary structure of the entire nursing profession. The status of the nurse in training should be reconsidered, and if we had an adequate number of sister tutors it would he possible for the nurse to complete training in two instead of three years. This has been tried in several places and is effective. If the nurse was treated as a student, deductions for income tax would be removed and the nurse would certainly be a little better off.

The salaries of tutors are worrying, and they should also be studied, for we are not encouraging fully trained nurses to take on the job of tutor. We are not encouraging the fully trained staff sister or ward sister to come in and be trained as a tutor, and those who are tutors are often leaving the nursing service and going into technical colleges where they can earn more than they can in the Health Service. Specialisation in medical and surgical care in our hospitals today is making new demands on nurses and involving them in new and exciting work. He or she has to be very well trained, and therefore we need more tutors to do this training.

I think that the salaries of the higher paid nursing staff should be studied carefully with regard to their responsibilities and the leadership which is required of them. I know it is difficult to compare responsibilities, but I cannot believe that in any other profession they would be rewarded at such a low level as is paid to a chief nursing officer.

No one has greater admiration for the Health Service in this country than I have, but we shall not be able to recruit or even keep our nurses unless we do something to bring salary scales in the profession more into line with those paid for equivalent technical skill, responsibility and administrative capacity such as in the Civil Service and in industry. I do not think that we are encouraging young people to come into the nursing profession; we are not providing an incentive for them as opposed to the rewards offered in other callings. Nursing is a remarkable profession. I agree that it is not a vocation, but I believe that in the heart of every nurse there is a feeling that they are contributing something to the good of humanity. Surely we do not want to lose these people from the profession which, after all, deals with birth, life and death.

6.36 p.m.

LORD AUCKLAND

My Lords, over the years the noble Lord, Lord Amulree, has enabled us to discuss a number of medical matters in this House, but I doubt whether he has afforded us a more valuable exercise than the present one, when the emotive heat of this very human problem has indeed reached boiling point. We have this valuable debate in which we have a number of expert speakers (myself excluded) to discuss, albeit briefly, a most important topic. Like many of your Lordships, my family has a long record of service on hospital committees and hospital boards, both prior to and during the National Health Service. I myself have served on the house committee of the Children's Hospital, and I now serve on the committee of one of the hospitals under my noble friend Lord Grenfell, to whom on more than one occasion we have owed deep debts of gratitude.

I should like to deal with one particular subject, that of accommodation. We have embarked on a programme of new hospital building that is by no means adequate, but with the commitments which we have in various public fields we obviously cannot have all the hospital buildings we need. I have raised this question before, and I raise it again now. I hope that in this matter of the problems facing the nursing profession particular attention is being given to the accommodation of nurses who come, say, to the South of England from the North of Scotland, from Northern and Southern Ireland and from the Commonwealth. These girls—and indeed men—cannot get home every week-end, nor even every six months, even if they had the money to do so, which they most certainly have not. I believe that much of the problem surrounding nursing is due to the fact that the nurses' homes in which they live are, even to-day, substandard.

There is, too, the question of ward design. For example, we have heard of Orpington Hospital, in Kent, with one student nurse looking after 90 patients in a long ward. Supposing an emergency happened half-way down the ward—presumably she would have to run down and cope with it, and there might be two or three other emergencies happening at the same time. I was in Finland last year and I visited two hospitals there in which they have small wards, each containing four to six patients. Comparing Finland with this country is not, obviously, comparing like with like. And I recognise that they do not have the same problems of public expenditure as we do. Nevertheless, I hope that some of our architects, when they design our new hospitals where our nurses, both student nurses and senior grades, have to work, will perhaps pay more visits to Scandinavian countries where design is so vital. I believe that our own hospital designers could learn a lot there.

On the subject of food, I do not speak with anything like the same knowledge as many who have spoken so far, but it seems to me that much will depend, bearing in mind the all too inadequate allowance given to the hospital authorities, on the quality of the catering officer. While we are rightly considering the pay of our nurses and our sisters and matrons, we must also consider the pay of the catering officer and the catering staffs. I am not thinking so much of the London teaching hospitals. There was an article in one of the papers about St. Thomas's Hospital and the catering there. Of course, they may well have more than one catering officer; they may have somebody who can go to the market and bulk-buy vegetables. And St. Thomas's are obviously in a much better position, for example, than a hospital in Rugby or Stafford or Sunderland, where there is a great deal of industry, and where, understandably, the catering officer, if he or she can find a more highly remunerated post in a large industrial concern, will go there rather than to a hospital.

My noble friend Lord Grenfell has mentioned Queen Mary's, Carshalton and Epsom, an area with which I am connected on hospital committees, and I can fully endorse what he says, although some of the mental hospitals in the Epsom group are not as fortunate as others in their design or their facilities. So it is not only well outside London that these problems occur.

Quite clearly, as the noble Baroness, Lady Summerskill, and others have said, food is all-important, particularly to the student nurses. One cannot expect a young girl of 18, or a young man, a young student male nurse of 18 or 19, to look after a ward, perhaps of 50 subnormal patients, or a children's ward or a geriatric ward, if he or she has to filch in their pockets to see whether they can afford two or three shillings for a meal. I think that the Government really must be seized of this problem.

There is another important point here, and that is the change in nursing techniques. There are now more accidents on our roads; there are accidents in our factories; there may well be a serious rail accident at 1 a.m.—as there was near Newcastle the other day. That means that nurses, perhaps student nurses, have to cope with casualties, particularly if the accident occurs in an area where there is a shortage of nurses in the hospitals concerned. How splendidly they cope, too! If this debate has done nothing else, I hope that it will reveal to the Government that this problem of the nursing profession cannot any longer be left to Committees and Commissions of Inquiry. The need is urgent now. Surely the Prices and Incomes Board, which has already burst its seams on a number of occasions, can burst one more seam.

6.47 p.m.

BARONESS ELLIOT OF HARWOOD

My Lords, it has been said that this debate comes at a very appropriate moment, as indeed, is true. So far as I am concerned, it could not have come at a more appropriate moment, as I have just spent six weeks in Westminster Hospital after a serious operation, and I am well aware that I stand here and make a speech simply because of the skill, not only of the surgeon and doctors but of the nurses who have been looking after me with absolutely untiring devotion and skill for so many weeks. I intervene because I cannot in adequate words express my gratitude for the devotion and efficiency and skill of the medical staff at the hospital. I always knew (although I never experienced it before) of the great skill of our nursing profession. But to experience it makes one realise that here is something—which I believe to be different from any other country in the world—their single-mindedness towards the patients; the fact that it does not matter whether it is day or night, the patients' needs are their first consideration.

The noble Baroness, Lady Summerskill, rightly said that much of what they do is just hard slogging work, running up and down corridors answering bells, doing the very simplest and most humble things for one, as well as practising the skills which are needed for the difficult and important care after operation. What impresses me so much is that there are no demarcation lines in this profession. Nobody says to you, "That is not my job". If you ring a bell and want something, the staff nurse may do it for you; or the student nurse comes. But if none of them is available the sister will come: nobody says, "It is not my job." They all work together as a team, and they all work for the interests of the patient.

They are on duty for long hours. They work at weekends. Their pay and awards and salaries are, in my opinion, absolutely inadequate. We are all guilty—I am guilty as well as everyone else—of not having fought harder before. After all, this situation has been going on for a very long time. There are Members of your Lordships' House who have taken up this matter and have been working for it for many years. I feel guilty because I have not done it before, but I feel utterly dedicated to the fact that I shall do it now in every possible way I can.

I agree with the noble Lord, Lord Amulree: what is wanted is a new structure for the nursing profession, which not only includes student nurses but goes right up to the top. I have nothing but contempt for the Whitley Council, with its 55 members: it is not a negotiating body but a public meeting. How can one negotiate with a public meeting? There should be a small committee representing both sides, and bringing the whole structure of nursing into the modern world. We spend much money on research—not perhaps as much as we should—in order to save people's lives, and this is all most vitally important. But, my Lords, our lives, those of us who are ill in hospital, are in the hands of nurses every time there is an operation, every time new techniques are tried out. It is the nursing profession that holds the responsibility of life and death so consistently. I do not know how it is that this profession seems to have been so inadequately paid.

In my life, having been at one time chairman of an education committee, I have fought for better pay for teachers, for instance. That was one of the things one was anxious for. But when I look at the pay of teachers to-day I find that it is considerably better than it was in the past. They have three months' holiday in the year; they have weekends off unless they happen to be doing something special for the children, for which they get paid. Yet so far as I can make out from those who have been quoting figures in regard to nursing, no nurse is offered three months off every year for holidays; nor do nurses get every weekend off. Occasionally they have a weekend, but nothing to compare with what other professions get.

Nursing is a marvellous profession, and we want to encourge as many young girls as possible to join it. But why should they, if they see their contemporaries going into other professions, secretarial or much less skilled professions, and getting far more money? It is all wrong. For too long the shades of Miss Nightingale have closed around, not the growing boy but the growing girl. It is time that all this stopped and a new look was given to this profession.

Like many others who have spoken, I do not think that inquiries are necessary. We all know about this profession. We have skilled women able to negotiate. We have many skilled people who understand and know the whole range of the nursing profession and all that it means. What we have is a lot of stubborn, obstinate men in Government circles who are determined to continue to exploit this profession as it has been exploited in the past. I hope that the noble Baroness, Lady Serota, someone for whom we all have enormous respect, and who really understands these matters, will stand up to some of her colleagues and tell them that we in the House of Lords, who in many ways are regarded as old fuddy-duddies, and what you will, feel so strongly about this that we will back her up together with anyone else who will see that this profession is given the proper status, the proper standing and the proper pay to which it is entitled in this day and generation.

6.52 p.m.

LORD VIVIAN

My Lords, the hour is getting late for a Thursday Sitting in your Lordships' House, and so I will try not to detain noble Lords for more than 15 minutes on this most important subject on which the noble Lord, Lord Amulree, has so rightly given us the chance to air our views this afternoon. To begin with, I would say that we have been discussing one of the main priorities on our home front. The subject matter concerns England, Scotland and Wales, as to the grave injustice which has been meted out to nurses, and which I can only describe as monstrous, Her Majesty's present Government have an urgent duty to perform; namely, to root out the injustice as expeditiously as possible. Legislation should be brought in whereby nurses have a fair deal for the noble and self-sacrificing work which they perform, with such dedication, for the good of our nation. As things are, nurses are working in tens-of-thousands of instances in outdated hospitals, with poor rations for which they are made to pay from £2 6s. 1d. to £3 a week. They are further asked to pay £6 per year for cups of tea and coffee.

Further, I ask your Lordships whether you consider rises in pay of between £30 and £60 a year, awarded in March, 1968, to be adequate or just to the nurses. It is my belief that all noble Lords and noble Baronesses who have the privilege to speak in your Lordships' House, no matter where they sit, will see to it that in future, and speedily, will press for and pursue legislation whereby those dedicated and long-suffering members of our society will receive their just reward for the wonderful qualities that they possess and the hard and dedicated work which they perform.

Believe it or not, my Lords, to be a nurse one must have great patience, a sense of humour, two pairs of hands, two pairs of feet, a couple of sets of brains and dedication. What have the Government meted out to these nurses as a reward for their extraordinary qualities? With humility, as a Back Bencher I will give your Lordships the answer, although in your hearts you know it already. They were given "tea and sympathy", as the Daily Express, a newspaper which often hits the nail on the head. put out as a heading on their main leader in the issue of to-day's date. That has been backed up by a brilliant cartoon by the beloved cartoonist, Giles, on the same theme.

This insult of "tea and sympathy" does not cease with student nurses—a term by which I know and appreciate that they do not like to be called. It is meted out to them along with other nurses in the nursing profession. It concerns charge nurses and ward sisters, right up to the matrons of hospitals, in whose particular case, for "carrying the can" in a position of great responsibility, no matter how big the hospital may be, the maximum salary they can earn is £2,950 a year. The noble Lord, Lord Amulree, underlined this; therefore I need say no more.

I would term the cynical indifference of the Prices and Incomes Board of Her Majesty's Government as the main cause of the feeling of injustice among the nursing profession. We learn that the Whitley Council—and I do not respect them—is to meet against on May 30. If they have to meet at all, why do they have to wait until May 30? The Council should meet immediately to consider every facet in the pay structure in the nursing profession and also to find ways in which members of the committee can best improve the conditions under which our nurses have to work.

Noble Lords will perhaps allow me to quote the last four paragraphs of this morning's main leader in the Daily Express. I do so because it puts into words better than I can what I feel would be the forthright opinion of the electorate of this country if a referendum were taken in regard to the subject we have discussed this afternoon and on which noble Lords and noble Baronesses have made such valuable contributions. The last four paragraphs of the leader read as follows: The Whitley Council is to meet again on May 30. Between now and then let the management side, representing local authorities, regional hospital boards and Ministry of Health, understand one thing. Far from expressing the public's view by the preposterous offer of tea and milk, they do the country a grave disservice. Pay these young women the extra £1 a week. Daily they demonstrate that they have earned it. Yes, my Lords, they have earned it.

I can see a ray of hope for a happy and just outcome of this appalling injustice which has continued for far too long for those engaged in the honourable profession of nursing the sick and needy. Her Majesty's Government are fortunate in having Mr. Richard Crossman as the Secretary of State for Social Services. With humility, as a Back Bencher, may I say that I believe that he, like myself, is now aware of the disgraceful results that this so-called "new deal" has brought in its wake to the student nurses in our already understaffed hospitals. I believe him to be a man of high principle and a man who has shown in the past that he will not stand for injustice. Through the medium of your Lordships' House, I would say to the members of the nursing profession, "Give him a chance once again to root out the injustice that has been meted out to you"; and I would most certainly add that you can rely on the Minister, the noble Baroness, Lady Serota—whom noble Lords, in common with myself, no matter where they sit in this Chamber, welcome on Her Majesty's Government's Front Bench—as a lady of great principle, knowledge, humanity and understanding.

I repeat that I believe that the two Ministers I have mentioned have a high sense of duty arid will see to it that the injustice of which I have spoken passionately will be remedied, and that they will work untiringly to find a formula to show justice in this very important matter. The only thing that can go wrong is if the Leader of the Government in control at the present time chooses to lock himself in his ivory tower once again and take control himself, without listening to the considered advice of his own appointed Ministers.

As things are to-day, is it too much to ask, if this and other injustices in Government continue, that the Leader of Her Majesty's Government should immediately think of putting Queen and Country before self? If this noble step was taken, then at least some very creditable words would be written in history books for future generations to read. Again, through the medium of your Lordships' House and as a mere Back Bencher, I know that I can tell members of the nursing profession that in the Lord Privy Seal, the noble Lord, Lord Shackleton, they have a man in whom they can place their trust; for he, too, is a man of great principle who has the utmost respect of those of us who are privileged to sit in this Chamber. Having said that, I would add that I also know that the nursing profession could equally rely on my noble Leader, the noble Lord, Lord Carrington, when the electorate calls upon us. the present Opposition, to take over the reins of Government.

The hands of the clock are advancing, so with your Lordships' permission I will conclude on a personal note which has a direct connection with the nursing profession. I have spoken passionately in the interest of those tens of thousands of the nursing profession who are vital members of the lifeline of the electorate. Your Lordships could have been spared my speech quite easily, for I have spent a sixth of my 63 years and two months in hospitals, nursing homes, and such like places, and by all the medical rules I should not have been able to address your Lordships this afternoon. I thank my Maker that he has spared me to do so. From my medical history—with which I do not intend to bore your Lordships—I should have been six feet under the ground many years ago. Some 15 or so years ago I was given a new lease of life by a brilliant surgeon, backed up by equally brilliant nursing in a hospital in England. Some three years later I had a third major operation and I was once again given hack my life, for which I give my grateful thanks to an eminent doctor, a famous surgeon, a well-known anaesthetist, and a highly trained operating theatre staff, plus, my Lords—and here I give my especial thanks—the nurse who refused to go off duty for 36 hours so that she could care for me through the most difficult post-operative period, knowing full well that my chances of survival were only one in ten.

I am a bit long in the tooth now, but through the great help and encouragement of nurses on many occasions in my life I have been enabled to make my modest contribution to Lord Amulree's important Unstarred Question. I have said what I have without trundling into your Lordships' House with a caliper on my right leg and a surgical boot built up some 1¾ inches. How is that, my Lords? It is so because a nurse who I met on holiday, knowing that as a young man at the age of 16½ I was worried about having to wear such surgical appliances, gave up her time and taught me to walk without it. I can never thank that nurse sufficiently.

So it is that I will resume my seat, and I hope your Lordships will forgive me for referring to myself in my speech. I have done so only to illustrate the wonderful and noble work that nurses of every grade are performing in our country today. The benefactions that happened to me through the loving care of nurses have not happened only to me; they happen in some form or other throughout our country each minute of the day and night, in every week, in every month, and in every year. My last words—and they come from the depths of my somewhat fast-beating heart—are, "You cannot let the nurses down and I know you will not do so".

BARONESS STOCKS

My Lords, I must apologise for this uncovenanted intervention but I will indeed be brief. At the moment nursing is in the news, and I very much hope that this debate will be fully reported in the Press. I also hope that in the course of that report some emphasis will be given to the suggestion made by the noble Baroness, Lady Hylton-Foster when she, I think, put her finger on the proper solution of the eat-as-you-earn question by distinguishing between the student nurse and the older nurse. I think that is a very important point and I hope that the Press will take notice of it and emphasise it.

7.8 p.m.

THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (BARONESS SEROTA)

My Lords, the whole House, the nursing profession, and indeed the public, will all be grateful to the noble Lord, Lord Amulree, for raising this important and topical question to-day. I wish at the outset of my reply to endorse what has been said in all parts of the House about the vital role which nurses play in the effective functioning of every aspect of the Health Service. We all welcome back the noble Baroness, Lady Elliot of Harwood. If ever there was a testimonial to medical and nursing skills, it was the powerful and vigorous speech which we heard from her to-day.

No one, least of all Ministers responsible for the Health Service, could be complacent about the present situation. and I am only too conscious of the need for further improvement in many of the spheres which have been touched on in the debate arising out of the noble Lord's Question. I think it is also important, when considering the present position, not to overlook the progress already made, or to forget to pay tribute to those responsible for the improvements that have been achieved over these last years. The noble Lord, Lord Amulree, reminded us, when asking his Question at the outset of our debate, of the rapid strides that have been made in medicine in the last twenty years, and of what these, in their turn, have meant in terms of demands on nursing skills and the new developments and new techniques that they have necessitated. The noble Baroness, Lady Brooke of Ystradfellte, reminded us, too, of the additional responsibilities which these developments have placed on the nursing profession, and I should like to add the tribute that we all pay to them for the resilience they have shown, for the way in which they have met the changes in the demands made on them, and for their readiness to adapt their skills to these changing needs.

I think the whole House will also agree that there have been considerable improvements in the general conditions over the range of the service and under which nurses work. There have been improvements in pay, in hours of work, in relief from non-nursing duties, and in equipment and environmental conditions, although all of us would wish to see these improvements go further and faster. Many noble Lords have also indicated that the conditions under which nurses work are affected by many things: by their physical surroundings (and here I take note of the point made by the noble Lord, Lord Auckland); by the standard of buildings in which they work, and by the accommodation in which they live when they are resident. Here it is gratifying to note that in the coming year we are to spend twice as much on hospital building as we did in the years 1963–64.

The conditions of nurses are also, of course, affected by the equipment which they use; by their training; by their opportunities for adding to their knowledge at later stages of their career; by the management—and this has already been mentioned in the debate—at the top of the nursing profession; by the wards, which will be reflected in the efficiency with which their nursing duties are organised, and also by the extent (and I regard this as of the greatest importance) to which they are still required to cope with clerical and domestic duties that do not require the trained skills of a professional nurse. Lastly, we are all conscious that we need to look carefully at the arrangements which are made for them when they are not working, especially the need to consider the impact on nurses of the uncertainty which many of them suffer in not knowing their off-duty times and their holidays.

For reasons which I think we all understand, the debate to-night has confined itself in the main to the current issue of pay, including pay-as-you-eat. The noble Lord, Lord Grenfell, suggested to us that at a later stage we might have a full debate over the whole range of problems affecting the nursing profession and developments of the future; and the noble Lord, Lord Auckland, in a very thoughtful speech, touched on some of the points that we might discuss in a future debate of that kind. Because of the hour, I shall confine myself this evening to answering the major issues that have been raised; namely, the question of pay and the effects of the recent introduction of pay-as-you-eat.

First of all, several noble Lords—the noble Lord, Lord Amulree, at the outset, and other noble Lords later—asked about the Whitley Council, and whether we needed new machinery for dealing with questions concerning nurses' pay. The noble Lord. Lord Amulree, suggested that there should be independent review machinery, using the analogy of the arrangements introduced for the medical services. I think I ought to remind the House that this last revision of nurses' pay, which I will mention in some detail in a moment, was in fact an independent review. It was carried out by the National Board for Prices and Incomes in 1968, and the role in this case of the Whitley Council was to translate the Board's recommendations into specific agreements by the process of collective bargaining.

When the Government accepted the Report of the Prices and Incomes Board last year as being consistent with the incomes policy and commended it to the Whitley Council for negotiation, the effect of the recommendations on pay as a whole was that there was a general increase of 9 per cent. in salaries and training allowances, with a 14 per cent. increase for certain grades. I think that these figures have, in a sense, been somewhat forgotten in the past few days of heightened public debate on a particular aspect of the new arrangements. These increases have been paid in two stages. A 4 per cent. increase was paid in June or July, 1968, and was backdated to October, 1967. The remainder of the increase over the range of grades was paid on January 1 this year.

I believe it was the noble Baroness, Lady Brooke, who touched on the question of the introduction of pay-as-you-eat and its relationship in the time scale to the payment of the last instalment of the overall salary increase. Pay-as-you-eat was deliberately not introduced until a few months—in fact, some three months—after the last of the increases, in order to give nurses time to assimilate to the new situation. I submit to the House that, at the time of a 3½ per cent. ceiling, both the Board and the Government recognised that exceptional treatment for nurses was called for in the terms of an incomes policy.

The Board also recommended other substantial improvements in nurses' pay and conditions of service. These recommendations also have been implemented and have, I believe, been welcomed in all parts of the House. These included an increase in the mental lead from £50 to £100 from April 1, 1968, and its extension to all grades of nursing staff in psychiatric hospitals. I know that that particular award was welcomed by the noble Lord, Lord Auckland and the noble Lord, Lord Grenfell, who take a particular interest in this aspect of our National Health Service. There was also a similar lead of £100 to nurses employed in geriatric and chronic sick hospitals, and a revision of the system of special-duty payments for work at night and at weekends has been made from June, 1968. The Board also recommended the introduction of special rates of training allowances for students in general training over the age of 25.

Also, as part of its general settlement, the Board recommended that there should be a revision of the existing system of board-and-lodging charges. The objective here, as I indicated during the Second Reading of the Nurses Bill, was not that the Government, or the Whitley Council, or hospital management committees, or Regional Boards or local authorities should wash their hands of responsibility for nurses' meals and a proper standard of eating. The recommendation was made as a result of continuous requests over the years from the nursing profession itself. Here I very much take, and endorse, the point made by the noble Baroness, Lady Hylton-Foster, who said that in this matter there is a difference between the student nurse who is resident and the qualified nurse, who to-day is generally non-resident and frequently part-time.

Only yesterday, when I was in a hospital out at Epping, I discussed with three different groups of nurses their own reaction to this scheme which has not yet been introduced in their hospital. It was perfectly clear from the discussion that it was the student nurses who were the ones who were going to be most closely affected by the charge, when it was introduced. Here again I was grateful for the point that was made by the noble Lord, Lord Grenfell, about the introduction of the canteen system in the hospital for which he is responsible. These nurses out at Epping were waiting for their scheme. In this case the Hospital Management Committee decided not to introduce it until it could provide a full service so that each nurse, particularly each student nurse, should not encounter any hardship because of the changeover to the pay-as-you-eat scheme.

It is, I think, the practical application in these first five weeks which has revealed certain defects, not in the principle of the scheme as such, but in its administration, and particularly in relation to communications within the Hospital Service itself. This is why my right honourable friend the Secretary of State for Social Services wrote to all hospitals in the National Health Service urging them to introduce the scheme with care and consultation, and also to assist individual nurses who were in difficulty during the changeover period in ways which would prevent any hardship falling on any individual nurse or, indeed, on any group of nurses.

Noble Lords will have been reading in the Press in these last two or three days of the situation that has arisen since the introduction of pay-as-you-eat, and will have read the accounts of the meeting as recently as Tuesday of this week of the Nurses and Midwives Whitley Council. At this meeting, the Management Side made an offer of a reduction of £18 in the annual lodging charge for younger students (because we accept the particular point that has been made in this debate), which would have left only a token charge in being for those in their first year. The Staff Side countered with a claim for £1 a week or free meals for younger students, pupils or nursing assistants, or, alternatively, for free meals vouchers for one main meal a day, which would amount to much the same.

The alternative they put forward is, I think, very much in line with the views that the noble Baroness, Lady Summerskill, put forward to us as a way of ensuring that nurses who undertake such arduous physical as well as mental work—and I hope we remember that, although the physical strains are great, the mental strains are just as great on nurses to-day—are able to afford a meal that is relevant to the needs and the strains which the performance of their duties requires. I can assure your Lordships that the Government are as aware as anyone that nurses, especially young nurses, should be able to afford such a meal. The Management Side's proposals would have meant that the nurses concerned would have been able to get four meals a day, including two main meals, on four days a week, plus cups of tea on duty and at night, at standard subsidised prices, without touching what had been their take-home pay under the old system.

My Lords, I think that everyone will appreciate that the timing of this debate, although it is particularly apposite in certain senses, makes my position a somewhat difficult one. Discussions are proceeding, and I think the House will understand when I say that we must await their outcome. No one could be more conscious than I am of the need to find early solutions to these problems. Negotiations will continue, but I hope they will continue in the atmosphere that the Management Side, which includes representatives of my Department, are not anxious or wanting to be mean, or to show lack of sympathy with the nurses. On the contrary, we are anxious to do all we can to assist in the improvement of their conditions.

Some of the things mentioned in this debate, and the recent uproar in certain quarters (but only in certain quarters) at the introduction of pay-as-you-eat, are really symptoms, I believe, of deeper causes of anxiety—much deeper than the question of meals—and I think we should all like to see them tackled. The particular controversy has served to highlight some of the more deep-seated grievances and problems within the profession. These are matters which it is not possible to deal with in a debate of this kind; but all noble Lords, many of them sitting in this House now, who have a very close personal knowledge of and involvement in aspects of the National Health Service will, I think, agree with me in this analysis of the present position. Many noble Lords have themselves indicated some of the problems which are the causes (if I may put it this way) of the present unrest.

My Lords, I hope it will be possible to look at some of these matters as well as the pay question, which will be reviewed in the next comprehensive review of pay covering all grades of staff, which will no doubt be starting in the next few months. On the immediate issue, which is currently under negotiation, I am sure that both sides of the Whitley Council are as conscious as any Member of this House of the need to find early solutions. For my part, I am deeply grateful for the helping hands that have been offered to me to-day in climbing up the slippery bean-pole which the noble Baroness, Lady Brooke, mentioned. After these last few weeks I am only too conscious of the difficulties of the task which I share with the Secretary of State for Social Services; and it is an immense support and comfort to me to know that noble Lords not only understand these problems but also wish me well in my battle5 on behalf of the nurses.

House adjourned at twenty-seven minutes past seven o'clock.