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Clause 4—(Fees)

Volume 388: debated on Wednesday 7 April 1943

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I beg to move, in page 3, line 35, at the end, to insert:

"Provided always that such fees shall not be more than 75 per cent. of the amount paid by the State Registered Nurse."
I move this Amendment to draw attention to the principle of registration in general and in particular to the difference between assistant nurses and State registered nurses.

On a point of Order, Mr. Williams. Would it be convenient to discuss together this Amendment and the Amendment in the name of the hon. Member for North Islington (Dr. Haden Guest)—in line 40, to leave out from "determine" to the end of paragraph (b)?

I think it would be convenient to discuss both Amendments together. I want, in the first place, to draw attention to the differences that exist between the system of registration in the medical profession and in the nursing profession. In the medical profession, as soon as persons are qualified, they pay a registration fee, and after making that payment they are on the register until for some reason the General Medical Council itself removes them from the register, and they are then no longer registered medical practitioners. I cannot understand why the Ministry of Health—for I know this is the official view of the Ministry—consider that there should be a different principle for nurses and that every year every nurse throughout the country should have to find the annual registration fee of 2s. or 2s. 6d., buy a postal order, and post it. If she does not do that, she will be in danger of being taken off the register. I do not want to develop that matter too much, but simply to draw attention to it, for there may be a whole series of reasons why a nurse might omit to get the postal order and send it off.

With regard to the other point raised by the Amendment, strangely enough I have been approached by State registered nurses who fear that they are to be too closely identified with assistant nurses. There is a great deal of snobbery still in the nursing profession. In the hospitals one sees how a student nurse just in is treated by a junior and how she makes up her mind what is to happen to the student nurses when she herself becomes a junior nurse, and how, when she becomes a staff nurse, she takes it out of the junior nurses, because at one time the same thing has been done to her. If you saw sisters walking together—they will not walk with nurses—you would realise that there is a great need for democratising the nursing profession. I am not blaming the nurses for that. Their outlook is determined by their environment, and their environment during training has been of the old aristocratic type, which has created a caste position in the nursing profession which has been outlived in almost every other. State registered nurses say they do not mind paying more for their registration than assistant nurses, because it will mark a distinction. I am not influenced to a great extent by that, but I feel that the expense of keeping the roll is not going to be so great as the expense of keeping the register, and I think there is a case for a difference in the amount of fee as between assistant and State registered nurses. I feel that, if you were to abolish the annual fee and have a comprehensive fee as soon as they become qualified and are able to go on the register to last throughout their career, the principle may still apply that the assistant nurse shall only pay an agreed proportion of what is paid by the State registered nurse.

My hon. Friend has drawn attention to the parallel between registration in the case of the nursing profession and in the case of the medical profession. I am sure that, if it were necessary for doctors to send an annual fee, there would be a very large number of lapses every year owing to forgetful-ness, and I see no reason to think that a considerable number of nurses also would not forget. It seems to me a rather unfortunate provision that, in order to maintain a nurse's name on this roll, it should be necessary to send a postal order every year. Surely there is a very large amount of work involved in sending reminders and receipts and an unnecessary amount of paper work for a very small financial gain. It would be very much simpler to have one fee and allow the name to remain until the nurse retires and voluntarily withdraws her name, or dies, or, unfortunately, commits some professional misconduct. The powers of the General Medical Council in regard to offences against professional etiquette by doctors are a very valuable function, and similar powers exercised in respect of nurses would also be very valuable. If a nurse knows she has done something that she ought not to have done, and it is brought before the Council, and she omits to pay her subscription, any possibility of disciplinary action falls to the ground. It will be in practice very difficult to discriminate between those who are on the roll and those who are not, because of the large numbers. I do not mean difficult for the Council but for doctors, for nursing homes and for private people who employ nurses. Once a nurse's name is on the roll it should remain, whether she pays an annual subscription or not, if she is considered fit to carry out nursing duties as defined.

The medical register is almost useless. The real register which is useful is the medical directory. The register is a dead register. A name once on it remains until somehow, by chance, the medical registry happens to hear that an individual has died or has absconded. As the result of its being so necessary to keep a live register, a medical directory has been started, which is a live register requiring re-entry every other year or, anyhow, after two or three years, if one does not return the form, the name is erased. It is a commercial venture. We ought to keep a live register, and a small fee is rather a useful reminder to enrolled nurses that they are getting something which is very valuable to themselves. The hon. Member for South Tottenham (Mr. Messer) started us on the delightful possibilities of an argument about snobbery. Perhaps he has not hunted with a pack of hounds or had a rich herd of cattle, but you find that hounds are snobs and cattle are snobs. Trade unions have snobbery. Snobbery is innate in human nature.

I could not accept the Amendment. It is quite unnecessary, because the fees have to be approved by the Minister, so there is Ministerial control there. Also they have to be fixed with due regard to the services that are being performed on behalf of the assistant nurses, and to prescribe that the fee is to bear a fixed relation to the fees prescribed in the principal Act would seem to be awkward and cumbrous, because, if an alteration were made in the fees payable under the principal Act, you would automatically have to alter it if you were bound by the words of the Amendment. I was in some doubt what was behind the Amendment, but it would only have this effect that, instead of the General Nursing Council charging a maximum fee of 2s. 6d. a year, they would be able to charge an unlimited fee, and I am sure my hon. Friend did not mean that. The present fee is 2s., and it is the price paid for a live register. It gives doctors the latest information about nurses, and this is a small price to pay for it. I will not be drawn into the question of snobbery, but I think my hon. Friend, on reflection, would prefer to have said that members of the nursing profession are members of a disciplined force. They are on parade, they are well disciplined and trained, and they have such fine innate qualities that they have stood the worst that Hitler has given us.

What would be the position of a nurse who failed to pay her 2s. in any year? Perhaps she marries and does not want to nurse but her husband dies and she wishes to return. What arrangement is made?

She pays a small fine and pays up her subscriptions. If there is a mishap in the course of a year, at least two notices are sent before any action is taken.

The case of a doctor and that of a nurse are not parallel. A doctor is a professional man, and it is his business that it should be known that he is in practice. In the case of an assistant nurse there is not the same necessity for a live register. I hope the right hon. Gentleman will have another look at this before the Report stage.

What would happen if an assistant nurse who failed to pay her fee was found, say six months after, actually practising? Would she be liable to punishment of any kind?

She would be subject to the penalties of the Act, and that is one of the reasons why we are passing it.

Amendment negatived.

Amendment moved: In page 3, line 40, to leave out from "determine ", to the

end of paragraph ( b).—[ Dr. Haden Guest.]

Amendment negatived.

Clause ordered to stand part of the Bill.

Clause 5 ordered to stand part of the Bill.