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Clause 2—(Rules)

Volume 388: debated on Wednesday 7 April 1943

The text on this page has been created from Hansard archive content, it may contain typographical errors.

I beg to move, in page 1, line 16, after "rules," to insert:

"after consultation with trade unions and other organisations representing nurses."
The rules referred to here will be of the utmost importance, and, in my view, they ought to be agreed in advance so far as is possible with the people concerned, rather than there having to be some alteration after they have been decided. I know what the arguments against my Amendment will be. First, it will be asked what trade unions we are to consult, and how we are going to consult all the bodies which are interested. It will be said that, from the standpoint of practical politics, the Amendment, therefore, cannot possibly be accepted. I realise that difficulty, but I suggest that, even if consultations do not take place, it might be as well if the proposed regulations were submitted to the organisations representing nurses. I would not press this to any extent if I were not aware that the General Nursing Council is not a satisfactory body to draw up the regulations, according to many people who are affected. The nursing profession itself—while it has not taken full advantage of its opportunities in electing its representatives—is continually complaining.

The General Nursing Council is a supposedly representative body. There are two members appointed by the Board of Education, two, I think, appointed by the Privy Council, five—I speak from memory—appointed by the Minister of Health, and 16 who are elected by the nurses. It is a strange thing that the 16 who are elected by the nurses are all matrons or ex-matrons, and that every one of them has only voluntary hospital experience. The Bill deals in the main with the type of nurse who is employed by municipalities rather than the type employed by voluntary hospitals. The work of the assistant nurse is usually that of attending the chronics, and the voluntary hospitals do not have chronics. It is one of the weaknesses of our hospital system that the voluntary hospitals con- sider that a long drawn-out chronic type of case should be dealt with by the public authority, while they deal with the more interesting type of research case. It seems to me that the General Nursing Council, representing only those with voluntary hospital experience, should not be trusted to draw up the rules without consultation with other people who may have some contribution to make. I know that these rules will probably be scrutinised before they are decided upon, but it is very much better to get a measure of agreement before they come into operation, because they are so important. Members will see, if they look at Sub-section (1), how important are the matters that the rules cover. They include rules
"for regulating the conditions of admission to the roll."
It is quite possible for the General Nursing Council to want to do one of two things, either of which might be equally harmful, although they are quite opposite. If the General Nursing Council want to kill assistant nurses, they can do that by framing regulations which will make it impossible for many to get on the roll. On the other hand, they can make it so easy that the qualifications of the assistant nurse will be so low as to make it unnecessary to get on the roll at all. The Sub-section also provides that rules shall be made
"for regulating the formation, maintenance and publicationu of the roll"
"for regulating the conduct of any examinations which may be prescribed."
I only want some undertaking that the organisations representing nurses and the trade unions will be consulted. I would not ask for the Minister to consult every trade union. If he would consult the Trades Union Congress, it would, I think, meet the position. I hope that the Minister will go some way in meeting the intention of this Amendment. I am confident that he can do that without upsetting anybody, and that he can so oil the wheels of the machine and make it easy for this Bill to be what we want it to be, a generally agreed Measure.

I rise to say, very shortly, that I support my hon. Friend and hope that the Minister will be able to make some statement which will meet the necessity for extended democratic consultation, especially with the trade unions and professional organisations concerned. It is of the utmost importance that there should be as much consultation as possible, especially as up to the present the nursing profession has been to a very large extent unorganised. The more consultation you get, the better final organisation you will hammer out.

I very much hope that the Minister will not accept the Amendment. One of the very great benefits' of this Bill seems to be the possibility of developing the nursing profession into one unified whole, under the General Nursing Council, which will become the real and effective governing body. One of the things which will assist the General Nursing Council in achieving that position is, surely, the feeling that it is substantially master in its own house, that it is really the governing body of an important profession which is part of the public health service. If the General Nursing Council, before it can do this, that or the other which it considers would be beneficial for the nursing profession, has to consult trade unions and nursing organisations, not as a matter of convenience but as a statutory obligation, it is going to find its powers considerably curtailed and is not going to have the feeling that it really is the governing body. One realises that there will be occasions when the nursing organisations will have to be consulted, and any wise General Nursing Council will probably consult them then. But there is all the difference in the world between voluntary and compulsory consultation. In order that the profession may be under a really effective governing body, I hope that the Minister will reject the Amendment.

The hon. Member in moving the Amendment admitted that there were practical difficulties in the way of carrying it out. That was a very frank admission and is something of which we should take note. If the General Council of Nurses is not the right body to perform the tasks which this Bill imposes upon them, then the Bill itself is fundamentally wrong. I do not think that we in this Committee should delegate duties to any responsible body and then sit down and say that this or that is the way in which they should perform those duties. The Mover of the Amendment says frankly that people who were very much concerned in this matter were the local authorities who employed many of these nurses. There is no suggestion that they should be consulted, and yet they should have a very good knowledge of the conditions under which the nurses are trained. I hope that the Minister will reject the Amendment. There is no reason why, if there should be consultation as is suggested, it should be, limited. I hope that in framing rules the General Council of Nurses will get the best advice they can and that they will have the wisdom to rule out bad advice. If they do not do these things, it will be unfortunate if under the Bill they should be trusted with duties they could not exercise.

I intervene because I happened to be a member of the Athlone Committee. I am sorry that hon. Members are so terrified of an Amendment of this kind. We have passed several Bills during the last few years, and during this war, too, where consultation very much on these lines is included either in the Schedule or in the body of the Measure. Whatever the Minister may say, I hope that he will give some indication that the General Nursing Council will of their own volition consult the organisations that cover these nurses. I will give one point that affected my mind when I sat on that Committee. I want to be frank, and I must say how the evidence affected me. The hon. Gentleman for St. Albans (Sir F. Fremantle) was there, too, and perhaps I can carry him with me in what I say. I will take the point about examinations which the hon. Gentleman suggested. While the General Nursing Council never laid it down that an elementary school girl could not become a trained nurse, all the examination papers were drafted to achieve that result. Therefore, while the avowed policy was not against the elementary school girl becoming a trained nurse provided you put the examination on so high a level and made it so difficult that no one could pass unless she had been through a secondary school, you could thus achieve the same object without saying so. I speak from memory, because I saw some of the examination papers, and one of the questions was: "Where is the Andes, and describe it?" As it happened, there were only two Welsh people on the Committee.

I am agreeably surprised at his great knowledge of geography. What is the use of asking questions of that kind which have not the remotest relation to the job that nurses have to perform? Whether the right hon. Gentleman opposes this Amendment or not, he will, I hope, be able to get the General Nursing Council—and it will do good for the nursing profession—to keep their ears to the ground as to what is happening inside the profession. We have to understand that trade unionism and associations are growing among nurses, and the evidence I have received shows that they are rather alert and vigorous in some respects. I trust that if the right hon. Gentleman is not able to accept the Amendment, he will give some undertaking on this matter.

It is clear from the remarks of the hon. Member for South Tottenham (Mr. Messer) and the hon. Member for Westhoughton (Mr. Rhys Davies) that they realise that I cannot accept the Amendment in this form. It would bind the. General Nursing Council to a particular form of consultation with a particular body when, if there was to be legal consultation it would have to be with a much wider range of bodies than merely the trade union bodies. That fact is appreciated. There are one or two things that I would like to say. The hon. Member for South Tottenham is under a misapprehension here. He bases the bulk of his case on a subject about which I have, like him, some feeling, namely, the issue of the chronic sick. He took the point—and it was, I am glad to tell him, a false point—that there are no nurses on the General Nursing Council representing municipal hospitals. That is not so. I had better make it clear to the Committee, since there seems in this Debate for the first time some dissatisfaction with the General Nursing Council. It is in the main an elected body by the whole body of nurses and by postal ballot. Sixteen nurses out of the 25 there are elected by the whole body of nurses and by postal ballot. There therefore cannot be a more representative way of getting qualified persons technically to do the difficult professional task with which, under the general law of 1919 and under this Bill, that particular body is charged. But of these 11 are general State registered nurses. At the moment one of them was a municipal hospital matron, and of the remainder two are nurses in mental hospitals, one in a fever hospital and one is a male nurse.

Therefore the Committee will see that my hon. Friend has not quite understood how formidable is the body of experience in municipal hospitals represented on the General Nursing Council, and I should expect that. We would have heard more adverse criticism in the last 24 years of the operations of these admirable bodies if they had not been representative in drawing up all the regulations and rules with which they are charged. I say this to my hon. Friend, since there is some trouble there. I cannot imagine that there would be any reluctance to consult with organisations, and I would represent to them the feeling represented in this Debate. When you come to deal with the real subject of this Bill—the assistant nurse—all the matters which wholly or mainly concern them must be first remitted to a committee on which the assistant nurses will themselves be, as the Bill provides, heavily represented. In view of that statement, I hope that my hon. Friend will not feel it necessary to press the Amendment.

In view of what the Minister has said—and I am pleased that he has gone so far—I gladly ask leave to withdraw the Amendment, which was moved only for the purpose of getting such information as he has given.

Amendment, by leave, withdrawn.

I beg to move, in page 2, line 21, to leave out "either." It will be most convenient, first of all, to look at the next Amendment standing in my name—in page 2, line 22, to leave out from "behalf," to "and," in line 23. It will be seen that the effect is to take out the words:

"or in the service of the Admiralty, the Army Council or the Air Council,"
leaving the paragraph to require that the prescribed training shall be carried out in an institution approved by the Council in that behalf. In other words, whether the training is carried out in a civilian institution or in a Service institution, the General Nursing Council must still approve. The reason for that proposal is that you are going to have presumably a steady increase in the standard of training of these assistant nurses. If you are to get that increased standard of training in the civilian institutions, it is important that you should have an increased similar standard of training in the Service institutions. One has to remember that the Services' outlook on their casualties is, "Are we going to get this man well quickly so as to return him again to full service, or are we going to discharge him to a civilian institution?" The Service hospitals are not really concerned to keep their sick people for a very long time. Their whole outlook on nursing is consequently circumscribed by the fact that if a man is not likely to get well quickly, he will be discharged to a civilian hospital. That must reflect upon the experience and training which the assistant nurse in these institutions will get, and it is very important that the training in the civilian and in the Service hospitals should be equated. This will be effected by this Amendment requiring the Council to approve the training in both types of institution.

I want to say a word in support of the Amendment. The Bill attempts to set a standard. We would be making a false start if we did anything which would allow exceptions to be made to that standard. I am not suggesting for a moment that training by the Services should not be as good as that under the General Nursing Council, but it would be much better if the Services had to adopt the same standard as is laid down by the General Nursing Council. I see no reason why the Services should not be prepared to accept the Amendment. They do accept the principle in respect of other professional bodies. No one would suggest that doctors or barristers who have been trained by the Army should be let loose upon the country. They accept the ordinary professional standards for doctors and for the legal profession, and I see no reason why they should not accept the ordinary standards for the nursing profession as well.

I very much hope that the Committee will not accept the Amendment, because it seems to be quite unnecessary, in my view, to attempt to exclude those who are trained in the Navy or in the Army or in the Air Force under conditions which are excellent, the standard of which, as far as the details go, could be decided in the future by consultation. The hon. Member who moved the Amendment spoke of the different point of view in the Services with regard to the patient. He said that the Services want to get the patient well as rapidly as possible so that he can return to his duty. I hope that he does not regard it as a disadvantage in the nursing service that they should aim at getting a patient well as rapidly as possible.

If the hon. Member would put the other half of my argument, I might be prepared to agree with him. I said that that was the first thing to do, but if they recognise that they cannot do that, they desire to discharge the man to a civilian hospital, and that has an effect on the experience of their staff.

There might be a certain degree of relevance in that argument but only to a limited extent. I have the advantage over the hon. Member of having had a large amount of experience in Army work and in also having had the experience, which does not often come to one who is not in the Navy himself, of being nursed during a very serious illness by naval sick bay attendants. When I was on a voyage to South Africa many years ago I contracted enteric fever on the way, and I have always been grateful to the naval sick bay service since that time. The naval training is a training for men to do this work of nursing the sick under peace-time conditions as well as under war-time conditions. They are in the Service for a long time. Their training is a very good one, and there is no doubt whatever that their standards are very good and certainly are not to be dismissed in the way which the hon. Member wishes to dismiss them. As I know from personal experience, it is also true in the Army. Of the Air Force I have no experience, but there is no reason whatever to suppose that their nursing training is not as good.

I think that from a professional point of view the hon. Member was quite wrong when he said that the training of nurses in the Navy, Army and Air Force is not of a kind to fit them for work in civil life. I think it is, and I think it would be in the highest degree unfortunate if we agreed to exclude those men. For one thing, they will form a valuable addition to our nursing services after the war when many, I hope, will be on the register. It will also produce a very bad impression at the present time if we express the opinion that the standard of male nursing in the Services is so bad that it is not fit to be applied to the civilian population. I hope the Committee will reject this Amendment.

I think the hon. Gentleman who moved this Amendment was anxious to see that there should be a high standard of training for those who are trained in the Services and those who are trained in civilian hospitals. With that we are all in agreement. The words in this Bill are the same as in the principal Act and lay down that the General Nursing Council have to prescribe the training which the applicant has to undergo. The difficulty the hon. Member has pointed out is that applicants have no approved institution in which that can take place. The main reason for that is that in the Services a person who is training for a nurse or assistant nurse cannot, in most cases, remain in the same place; he has to move about. It is laid down that for civilian hospitals a person who takes training remains there or in hospitals affiliated, and that institution has to be approved. This scheme has been working for registered nurses for 25 years, and the General Council seem satisfied with the arrangement. We have had no complaints about it, and because of the difficulty of recognising the particular institution I think the hon. Member may like to withdraw his Amendment. I can assure him that the training prescribed by the General Nursing Council must come up to the standard the Council lays down.

In view of the statement made by the Parliamentary Secretary, I beg to ask leave to withdraw the Amendment, but, before doing so, I would like to say a word or two about the argument which the hon. Member for North Islington (Dr. Haden Guest) kindly put into my mouth, but which did not exactly present the argument that I presented to the Committee. I would like to make it clear that I was not criticising the standard of the training which people in the Forces might receive, but the comprehensiveness of it. I think in the matter of gynæocology or the nursing of the chronic sick it is extremely unlikely that a person in the Forces will receive a more comprehensive training than a person in a civilian hospital.

Amendment, by leave, withdrawn.

I beg to move, in page 2, line 23, after "Council", to insert:

"after yearly consultation with the General Nursing Council".
I do not want to take up much time with this Amendment. The Parliamentary Secretary said that approval of the institutions of the Fighting Services has been satisfactory for 25 years to the General Nursing Council, but I do not think we can necessarily say that there is not room for improvement. In view of what has already been said by the Minister and the desire that the General Nursing Council shall be the supreme master or mistress of the enrolled nurses, as well as State registered nurses, here is a loophole by means of which they could be accepted. Institutions are as important as the syllabuses of training, in fact, more important. I am not satisfied with the idea that the institutions of the Navy, Army, and Air Force can always and in all circumstances be trusted to keep up a proper standard of training. The General Medical Council is responsible for training institutions and the examinations for which that training is given. I suggest that by the Amendment here is an opportunity, without hindering co-operation, for sick-bay stewards and sick orderlies of the Forces to come into this Bill as assistant nurses. It would be an advantage if the Services were required to consult the General Nursing Council on the subject.

I hope my hon. Friend will not press this Amendment, partly because of the argument used by my hon. Friend the Parliamentary Secretary and partly because I have had no complaints about this from the General Nursing Council. They have not asked for any amendment of the rules, which have worked satisfactorily. The point my hon. Friend seemed to make would be covered by the original law and by the Bill now before us, because the General Nursing Council have control of the training, and if they were not satisfied would not pass the trainee. It is clear that all kinds of vistas would be opened out as a possible result of passing such an innocent-looking Amendment, and since I never care to do that, I hope my hon. Friend will not press it.

Amendment, by leave, withdrawn.

I beg to move, in page 2, line 37, at the end, to insert:

"and (d) taking into account the qualification of persons certified in other parts of His Majesty's Dominions."
I think I can explain the purpose of this Amendment in a few words. The Bill proposes to set up a new status for assistant nurses, and when it comes into effect a person who cannot obtain a position on the roll of assistant nurses will be greatly disqualified. My Amendment is to provide that qualified persons who have received their qualifications in other parts of the British Empire than in this country, and who proceed to this country in the hope of carrying out their livelihood, should have facilities for entrance on the roll. I cannot give the Committee a precise example of injustice, because the Bill has not yet become law, but I can proceed by analogy in the case of midwives——

Midwives are quite outside the scope of this Bill, and the hon. Member must not give them as an illustration, or anything else.

Then without mentioning the word "midwife" I will give an illustration of an analogous associated occupation——

On a point of Order. If the hon. Member is labouring, Mr. Williams, is he not entitled to bring in a midwife?

I think I can overcome the difficulty by taking an imaginary case of a person who is qualified in India and proceeds to this country. It may be that qualification in that country is not up to the standard in this country, and it is quite right that in order to be qualified here the person should receive some additional training. I want to make sure that the previous training the imaginary person has received, and the large amount of practice that that imaginary person has had over a serious of years, will be taken into consideration when the Council are drawing up their regulations.

I would like to support the general principle embodied in this Amendment, from this point of view. When this war is over surely we want to do everything we can to encourage the free movement of people within the British Empire. Anything that will enable people from this country to practise their profession or calling elsewhere in the Empire and vice versa is something upon which we should look favourably. I am, however, wondering whether the precise words of this Amendment will cover the point. I think it should be on a reciprocity basis.

I would ask the Committee not to accept this Amendment, for the reason that at the present time there is no standard of assistant nursing in any of the Dominions or, so far as I know, anywhere else. There is, however, a scheme of reciprocity for State registered nurses, and if the hon. Member will look at Sections 6 (1) and 6 (2) of the principal Act he will see that it is possible to have reciprocity when it has been duly authorised. In various Provinces in Canada, in South Australia, West Australia, New Zealand and Bombay there is reciprocity with the duly registered nurse. The duly registered nurse in those places has reciprocity with our nurses, but there is no register or roll of assistant nurses in those places. We cannot have reciprocity for assistant nurses, but that does not mean that someone coming to this country with qualifications would be ruled out. In Subsection (2, c) the hon. Member will see that the General Nursing Council have power to take account of what experience the applicant has. I know the particular difficulty the hon. Member tried to refer to—and which it would not be in Order for me, like himself, to refer to—but I can assure him that for people who have had some form of training and have done some work as nurses It would not be beyond the power of the General Nursing Council to give them the status of assistant nurse. Actual reciprocity is at present confined to State registered nurses.

Having regard to that explanation. I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause ordered to stand part of the Bill.