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Clause 6—(Restriction On Use Of Title Of Nurse And Assistant Nurse And Penalties For Misuse Of Certificates And Falsification)

Volume 388: debated on Wednesday 7 April 1943

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I beg to move, in page 4, line 21, after "nurse," to insert:

"tends or holds himself out as tending for reward a sick person."
In moving this Amendment, I want to raise the general question whether this Bill does sufficient for the enrolled nurse upon whom we are imposing rather substantial conditions. It seems to me that an Amendment of this sort is consequential upon the other provisions of the Bill. We are taking a class of the community and requiring them to do training, pass examinations, go on to a statutory roll and subject themselves to a certain amount of discipline. In return for that, we are offering them very little except the protection of their title of assistant nurse. Looking at it from the point of view of the assistant nurses, is it justice to them that they should put themselves under these disadvantages and receive practically no protection against competition by persons who have not undergone the same type of training and have not become registered? This will become important when the war is over, when we may have a substantial number of nursing orderlies and similar types of people discharged from the Services. One hopes that a large proportion will be able to get enrolled and consequently come under the authority of the General Nursing Council and become incorporated in the profession of nursing. We shall undoubtedly have a large number of people who served in the Royal Army Medical Corps, for example, who will not qualify for registration or enrolment and who will be on the flanks of the nursing profession, possibly competing against the people whom we are now putting under control.

Looking at it from the broader point of view of public interest, it is important that the public should know by means of reference to the roll or the register whether a person is a registered nurse, and if anybody is pretending to have qualifications which he does not possess, there should be some remedy which would enable him to be prosecuted and so prevent him from misleading the public. That is the general principle involved in the Amendment, which will make it illegal for somebody who is not enrolled or registered to tend or hold himself out as tending for reward a sick person. The object of the words "for reward" is to exclude from the provision people who do nursing by way of looking after their relatives and in many other charitable ways, but merely to deal with the person who is making money on the appearance of qualifications which they do not possess.

I do not know whether the hon. Member realises how wide his Amendment goes. It is understandable that anybody who calls himself a nurse and implies that he has qualifications which enable him to care for people as a nurse is a fraud. There are, however, large numbers of people who call themselves nature cure doctors and run hospitals. They take patients in, and there are people who look after them who do not call themselves nurses. Ought we to say that these patients should not be looked after by anybody who is not a nurse, and that if there are members of the public who have a belief in these things, they should not be able to exercise that belief? I have a lot of sympathy with cranks, and I would not rob these people of the psychological value to them of belief in such cures, however unorthodox they may be. The Amendment does not say that somebody who calls himself a nurse will be subject to penalty, but that anybody who does the work that would normally be done by a nurse would come under it. That would be wrong, because we have not done it with the medical profession. We allow a man who is not a doctor to treat people, but the Amendment proposes that we should not allow a layman to nurse even though he does not describe himself as a nurse.

My hon. Friend has raised an important issue, to which the nursing profession attach tremendous importance. When my hon. Friend talked about competition in years to come he in- dicated what was in his mind, namely, that he was in sympathy with the desire which was discussed at great length by the Athlone Committee and reserved for consideration that the nursing profession should be a closed one. In this Bill I have gone as far as I think I reasonably can in a practical form to meet the feelings of the profession, which I fully understand. I think that I have achieved the main object I had in view, namely, that everybody should have a chance of distinguishing between the qualified and the unqualified person. I could not accept the words of the Amendment, because there is a serious objection to the form of words. The word "tend" is very vague and might cover anything from nursing proper to general care. Even if the word "nurse" were used in place of "tend," that, too, would be vague. There is no recognised meaning of "tending the sick" or "nursing the sick." Unless there could be some much more close definition of what tending or nursing means, it would be difficult to make it an offence for anybody to tend or nurse for gain. I sympathise with the feelings of the nursing profession about the matter, but they must rest on my assurance that I am sure I have gone as far as I can in present circumstances to meet their desires as expressed not only before the Athlone Committee but elsewhere in the House and outside.

In view of what my right hon. Friend has said, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

I beg to move, in page 4, line 30, after "nurse," to insert:

"provided it is preceded by the word 'children's'."
After putting the Amendment down, I realised that it did not convey all that I wanted. My view is that this Sub-section still leaves a big loophole. What it says in effect is that a children's nurse can describe herself as a nurse, but what is meant by "children's nurse"? There is the sick children's nurse, who has underdone a period of training and is on the register. The Sub-section provides an opportunity for persons who intend to deceive. We want to avoid the confusion that is likely to arise between what I would describe as a nursery nurse and a sick children's nurse, and I am asking that a children's nurse shall only describe herself as a nurse when the word is preceded by the word "children's."

We cannot recommend the Committee to accept this Amendment. It is suggested that the word "nurse" ought not to be used unless it is preceded by the word "children's" because otherwise she might be thought to be a registered or enrolled nurse. The word "nurse" has been used for a children's nurse for a long time, and the "nanny" is a British institution. I am sure that neither in this Bill nor by anything else could we take away from the "nanny" the idea that she is a person who looks after children. I believe that the full title of the nurse who attends the sick will be as it is now, registered nurse. If we were to lay it down that no children's nurse should call herself a nurse but would always have to have the prefix "children's," there would be great difficulty. In the Bill we have two sections, registered and enrolled nurses, and it is clear that if a person in some way gives out that she is something other than a children's nurse, she would be committing an offence. We can look upon the designations as registered nurse, enrolled nurse and then the nurse who is the children's nurse. I do not think the hon. Gentleman need have much fear of any difficulty and I think that he will agree that a children's nurse is traditional in this country, that she has a good many friends, and that they would not like that title taken away from her.

Amendment negatived.

I beg to move, in page 5, line 4, to leave out the second "or."

This Amendment and my next Amendment are designed to prevent less reputable nursing homes taking advantage of what I believe to be a loophole in paragraph (c) of Sub-section (1), which provides that:
"a person shall not be guilty of an offence under this subsection by reason only that, without objection by him, other persons use the word nurse in addressing or referring to him."
That Sub-section might give the less reputable nursing home the opportunity of dressing up an unqualified person as a nurse and allowing her to have the care of patients. Unless the patients or relatives challenged the bona fides of such a person, no offence would be committed under the Bill. The Amendment is an attempt to strengthen the Bill so as to improve the staffing of our nursing homes, and I hope the Minister may see his way open to accept it.

We all recognise the difficulty, or the danger, to which the hon. Member has referred, but the wording of the Amendment would not do what is required. If the hon. Members who have put down this Amendment will withdraw it, we will see in discussions with them whether any form of words which would meet their point can be devised, and an Amendment could be put down when the Bill goes to another place.

Amendment, by leave, withdrawn.

Motion made, and Question proposed, "That the Clause stand part of the Bill."

Paragraph (b) of Subsection (1) says:

the Minister may by regulations authorise the use, either generally or by specified classes of persons or in specified circumstances, of specified names or titles containing the word nurse or of the word nurse otherwise qualified in accordance with the regulations;
In the Second Reading Debate I made a few comments upon this part of the Clause. I said that I should not be very critical about the other exceptions until I heard what they were, but that we were not at all certain about the matter, and that I would like an assurance from the Minister that before issuing regulations under paragraph (b) he would consult the associations of local authorities who are concerned with these matters. In the Explanatory Memorandum to the Bill it is mentioned that there are mental nurses and that they might be excepted, and there are also those who have taken the Diploma of the Royal Medico-Psychological Association. There are also assistant nurses who are undergoing training for mental nurses, and assistant nurses in that capacity might be excepted. I only reiterate that in my view the local authorities concerned ought to be consulted by the Minister when the exceptions are drawn up.

The passage in this Clause to which the hon. Member has referred is one of the controversial points in the Bill, so far as it is a controversial Measure at all, and the Minister has it in his power to help to increase the general good will felt towards the Bill in this Committee and outside by being as specific as he can on this occasion about his intentions in making the regulations which he is to be empowered to make. A number of classes of people at present feel in doubt about their position. To take one instance, there are the women well known throughout the country as village nurse midwives. At this moment there are about 2,000 of them practising in country districts. They have all been accustomed for long periods of time to use the word "nurse" in their title. We are giving the Minister complete power to allow or to forbid the use of the word "nurse." It is an important thing that these women, if they are permitted to continue to practise, should also be allowed to use a name which the village will understand.

Hon. Members have no doubt received a circular letter in regard to a type of nurse known as a dental nurse. I did not know that dental nurses underwent a special course of training, but attention ought to be drawn to the fact that there are nurses who specialise in one particular form of nursing, and when the Minister decides which nurses can be allowed to use the title "nurse" I hope he will bear them in mind, and not come to a decision merely in relation to the need for protecting general nurses. We are dealing with enrolled assistant nurses. It has always seemed a strange thing that tuberculosis nurses can never get beyond the supplementary register. I hope the Minister will consider their case, because that training certainly entitles them to some recognition higher than the supplementary register.

Like my hon. Friend, I had never heard of dental nurses until I received these circular letters. I have received quite a few, not only from dental nurses but also from qualified and registered surgeon dentists and they assure me that it is essential for their work that they should have somebody carrying out the duties of a dental nurse. One dentist said that for many years he had had a dental nurse who had always called herself a dental nurse and that he felt it would be a hardship upon her and might at the same time inspire less confidence in patients if she was refused the designation of nurse. I hope that the Minister will not take away from these nurses the right to use a title which, I am told, they have used for many years.

My right hon. Friend will certainly consult with local authorities and with other bodies concerned with nurses of various sorts such as we have been discussing. I think the Committee will agree that the very fact that some of those who are calling themselves nurses have been heard of by hon. Members for the first time shows how wise it was not to put a list in the Bill but to take power to look into the subject and to see what nurses should have permission to call themselves nurses. The hon. Member for South Tottenham (Mr. Messer) has drawn attention to tuberculosis nurses. It is clear that many nurses of that sort should be allowed to call themselves nurses. There may be various categories of persons who are using the word "nurse" whose claims to do so will have to be examined. In answer to the hon. Member for Lewisham (Mr. Brooke) the village nurse midwife might, of course, be able to go on the roll of assistant nurses. He will see under paragraph (c) of Sub-section (2) of Clause 2 what is required of her to be an enrolled assistant nurse in addition to having the title of midwife. All these cases will be looked into, and in the case of those who cannot come within the designation of enrolled assistant nurse the matter will be taken up to see whether they should not be put in a list of those who may use the word "nurse."

Question, "That the Clause stand part of the Bill," put, and agreed to.