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Order For Second Reading Read

Volume 389: debated on Thursday 27 May 1943

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I beg to move "That the Bill be now read a Second time."

A week or two ago this House unanimously approved of a Nurses Bill for England and Wales. The main object of that Bill was to protect the public and the nursing profession from unauthorised and semi-qualified and unqualified persons who were using the title of "nurse." The Act of 1919, sometimes called "The Nurses' Charter," provided for the State regulation of duly-qualified nurses, but made no provision for the regulation or the use of the designation "nurse" by unqualified persons. More than 20 years have elapsed since the passage of the Act of 1919. By the efforts of a previous Administration two Committees of Inquiry were set up, one the Athlone Committee, so-called because its chairman was the Earl of Athlone, and the other the Alness Committee, so-called because the chairman was Lord Alness. These Committees were set the task of seeing how far they could protect the pub- lic and the nursing profession from the unauthorised use of the word "nurse" by persons who were not qualified to use it.

The Athlone Committee took evidence that there was a large body of women, varying greatly in age, skill and experience, who were neither trained as nurses nor were in training as student-nurses, but who were engaged in nursing. The Athlone Committee took the view that so long as these assistant nurses worked under supervision in hospitals their employment was of advantage to the community though sometimes their uncontrolled employment outside constituted a definite danger to the public and tended to lower the status of the whole nursing profession. The Athlone Committee were satisfied that far from imperilling the status or the economic position of the State-registered nurse, her position would be more assured if the assistant nurse status were defined and recognised and if at the same time steps were taken to protect nurses in both categories.

On the other hand, the Alness Committee took an entirely opposite view. They were informed that the number of these assistant nurses in Scotland—at the time when they took evidence, which was in about the year 1938—was negligible, and they were advised and came to the conclusion that the recognition of assistant nurses would tend to lower the status of the profession and would not be in the public interest. They felt that the creation and the recognition of a sub-standard grade of nurse at the lower salary would in the end tend to deteriorate the position achieved under the Act of 1919 by the State-registered nurse. It is an argument based on the old Gresham law that the lower tends to drive the higher out of business. They were unanimous in that viw

The Government were then faced with this difficulty, that the English Committee had recommended the recognition of this assistant nurse grade and the Scottish Committee were unanimously against it. The Bill recently passed in this House for England and Wales was on the basis of the recommendations of the Athlone Committee, and immediately that Bill was passed I had to make representations to the powers-that-be in the nursing profession in Scotland that a new situation had arisen. When the Bill for England and Wales was passed, when the use of the word "nurse" was forbidden to certain low-standard categories there, if nothing were done in Scotland, obviously we should be flooded from the South of the Border by these low-standard and unrecognised nurses. I asked Lord Alness to get his Committee together and I met them and ascertained from them that they still stood by the terms of their report, and the evidence they had received that the recognition of these sub-standard nurses would be detrimental, in the long run, to the State registered nurse. Finally, I persuaded them with reluctance—the Alness Committee and others interested in the nursing profession in Scotland—to agree to a compromise, that if we would recognise in a Scottish Bill a grade of assistant nurses, we would only recognise it for a period of five years. That would give the situation which was blowing up as the result of the extra training of nurses due to the war time to settle down, and it would prevent the irruption into Scotland of unqualified nurses to the detriment of the nursing profession there.

Therefore the first point that I should like to make to the House to-day is that in Clause 2, Sub-section (3), they will find a variation from the terms that the House approved of in the English Bill. The English Bill agreed to the recognition in perpetuity of these, what I call for short, sub-standard or assistant nurses, whereas in this Bill:
"Unless Parliament shall hereafter otherwise determine, nothing in rules made under this Section shall enable a course of training begun after the expiry of five years from the commencement of this Act to qualify any person for admission to the roll."
There is the distinction and the difference between the two Measures. That is the first divergence from the English Bill.

There is another divergency, however, to which I ought to invite the attention of the House. It is in Clause 14, and may I say that there has been some controversy on Clause 14 as to whether, as the Clause is phrased and framed, it is not too wide? On the other hand, there have been strong representations made to us that it is not wide enough. I propose very briefly to state the reasons which actuated us in giving power to the General Nursing Council to frame rules under which they may, in appropriate cases, give a remission in the period of training—[Interruption]—it is the period of training only. I am glad my hon. Friend put that. I will come to it in a moment. They may give a remission in the period of training only in appropriate cases, as they may think fit, to nurses who are studying or propose to study for the full certificate under the 1919 Act. Why should we ask for this at all?

The Royal College of Nursing, I must say, so far as I know are very largely opposed to the Clause as we have drafted A, but the Royal College of Nursing themselves took a sample of what they called 1,031 of the nurses who are, or will be, in this assistant nurse grade in Scotland, to find out what their experience was and to find out what the facts were about them. Of these 1,031 they discovered that 860 of them had already begun their period of State training to become fully qualified nurses, that 681 of them had had more than a year's training for the position of a State registered nurse, and that as a matter of fact 47 of them had actually passed their preliminary examination, gone through the lectures and all the rest of it. We are urging as many of them as possible to get out of this assistant nurse grade. We say, "Do try to qualify yourselves for the full State registration, for the full salary, the better status and standard." These girls say to us, some of them at all events, "Very well, but here is our position. Some of us have sat for the preliminary examination once and have failed. We have gone through the hoops of the training for it, we have attended the lectures, we have worked as student nurses at the low salary. Does this mean that you are going to ask us now to begin at the beginning, de novo, and go through the-preliminary stage again before we can sit again for our examination?"

I think there is substance in the case put by those girls. Why should they go back to the lower standard of salary? We are urging them on to qualify for the higher standard. We are not disturbing the conditions of the examination. It is the same examination for everybody, but we say that it is right and reasonable that if a girl has gone through one year, or a year and a half or two years' preliminary training, and has attended her lectures, she should have some remission in the period of training if she intends to sit for her examination again. Not only have some girls sat for these examinations and failed. Some of them have not sat for the examination at all. Some of them got married and are now back in nursing. Is it reasonable, is it just, that they should be asked to start de novo, go to the bottom of the class, so to speak, and start again? Of the 1,031 sample taken by the Royal College of Nursing, 634 had more than one year's student training, and had in addition sometimes three years' experience in a State hospital. We cannot ask those girls to go away back and begin again at the lower standard of salary and go through their lectures and so on again, that is, if we want nurses, and nurses are vital to us at this moment. [Interruption.] Yes, as a matter of fact I think there will be double these figures. We have over 2,000 of them. But the Royal College of Nursing itself—it was not our test but theirs—discovered that there were those figures of girls who had gone through the preliminary training to the extent of a year or more.

Was this matter considered when the English Bill was framed, or was it considered as a result of objections to that Bill?

I would not like to answer for the English situation. I have enough troubles of my own.

What are the girls doing now? Are they in hospitals?

Yes, many of them are in emergency hospitals now. In reply to my hon. Friend the Member for Cheltenham (Mr. Lipson), I would point out that conditions are different in Scotland from what they are in England. They have been different since 1938. The evidence that was tendered to the Athlone Committee showed that a large number were qualified as assistant nurses in England, whereas in Scotland there were only 250. It is only since the war that this problem has arisen with us.

Will my right hon. Friend make it clear that he is not setting a lower standard for Scotland than that for England?

That is what I am trying to make clear. Please let me continue. We are not interfering one whit with the standards of examination. They have precisely the same standards of examination as those for student nurses. The only concession offered in Clause 14 is a remission of the period of training. It is absolutely vital that the General Nursing Council should have power to fix a remission in the period of training, for good cause shown.

With regard to assistant nurses who are recognised in England but who will not be recognised in Scotland if they go there, will it be possible for them to go to Scotland and take the full training which will qualify them for work in Scotland, and then get employment in a hospital there? If not, what will become of them?

Certainly; there is complete reciprocity between the two sets of assistant nurses. I hope that if there are any who come to Scotland to get a post in a hospital as assistant nurses, the same terms and conditions will be applicable to them if they will be good enough to struggle and strive to qualify.

Why did the Alness Committee's Report find only 250 nurses of a sub-standard who had initially started training for a State registration course, while the Royal College of Nursing discovered 950 in what they describe as only a sample? From where have the sudden additional figures come?

The answer is that the Alness Committee took its evidence in 1938, and that since 1938 there has been such an addition to the nursing profession that, obviously, the numbers of nurses known to the Royal College of Nursing have been greatly increased, The profession has been very badly organised, and it has been very difficult to get precise figures of any kind. I am only saying that the Royal College of Nursing figures themselves disclose these numbers to us. We are urging the nurses who can sit for these examinations to go on and do it. I trust that every effort will be made to encourage these girls. I think it is wrong for girls to be condemned to a sub-standard grade in the profession all their days and given no encouragement—in fact, given great discouragement, because if they have to start de novo they come down to the student nurses' grade in salary. It is preposterous that we should do anything, in these days especially, to discourage girls who are willing to train themselves for the higher grades of the profession. All we ask is that the General Nursing Council shall have power to make these rules. There is no deterioration whatever in the standards of examination. Once this rule is passed by the General Nursing Council, it has to be approved by the Secretary of State for Scotland, and it has to be laid on the Table of this House. More than that, under the principal Act these regulations of the General Nursing Council in Scotland have to be discussed with the General Nursing Council in England. Every possible attempt is being made to secure reciprocity. I am not wedded to the precise words in Clause 14. I propose, on the Committee stage, to suggest that the words:

"or have undergone training in order to such enrolment"
might with convenience be deleted—although there are disadvantages in that also. I can appreciate the views of the assistant nurses who have already gone through the hoops of training, and who think that they alone should get the benefit of the proposed regulations. I can understand apprehension being excited by the words in the Clause empowering the General Nursing Council to make some remission in the training period of a nurse who has undergone no period of training as a State registered nurse. It may be possible to secure the object we have in view by making it clear that the Clause will apply to women who have been admitted to the role of assistant nurse and who have at some time undergone training for the State register.

There are other steps which will be required to make sure that we have adequate nursing facilities in Scotland. We have adequate beds, we have first-class hospitals now, but we are short of nurses. We are short of nurses for tuberculosis, for example.

We can make arrangements in some of our emergency hospitals if we get an adequate supply of nurses.

Does the right hon. Gentleman do anything with the local authorities to destroy the practice of mixing tuberculosis patients with the ordinary patients in the general hospitals?

Will the hon. Member let me get on with this point first? I know that there are a number of difficulties. I say only that we have, by and large, a sufficient number of beds, that we can treat tuberculosis patients in them, and that we have made arrangements to provide beds in our emergency hospitals without interfering in any way with the right of local authorities to run their own hospitals. We are discussing with certain voluntary hospitals how we can affiliate for training purposes some of our splendid emergency hospitals and rotate through two or more of these hospitals student nurses in the course of training. I would like to see more hostel accommodation, girls living out more than they do and less of the barrack room system. I would lake to see, if possible, encouragement given by bursaries, educational training and otherwise. I am not sure we shall not have to do something about the age at which a student must start.

The question of salaries and the differences between Scotland and England is a long and elaborate calculation, but I can say that not all the advantages are in favour of England. The staff nurse, for example, starts in Scotland at £100 per annum and in England at £100, but in Scotland she goes up £10 per annum to 1£120 after two years, whereas in England she goes up only £5 per annum to £140 in eight years, so that the Scottish nurse is £20 up by the time the fifth year is reached. Then the advantage declines, but it takes eight years before there is equality between the two nurses. There is time after eight years for us in Scotland to make certain that the two maxima are equated. In the meantime it is of the utmost importance that the lower stages should be such as to attract Scottish girls into the profession.

These, in the main, are the two points of difference between our Bill and the English Bill. The English Bill is bound to be on different lines from ours. The conditions are different, and I hope that after the explanation I have given on the two Clauses that we have had to vary from the English Bill, the House will see its way to give a general concurrence to the idea in this Bill and leave us to the Committee stage to see how far we can get agreement on these two vital points.

I rise for a few minutes in order to welcome this Bill and to thank the Secretary of State for introducing it. The very full explanation he has given of the differences between this Bill and its English counterpart has been, I am sure, very much welcomed by the House. We wanted to have clearly put before us the reason for these differences. The limitation that is placed upon the period of qualification for this lower standard is a wise one It will be within the competence of the House when the end of the five years is reached, to extend the period it our expectations in that regard are not fully realised. It was, because of these differences, inevitable that there should be a separate Bill for Scotland and we are glad to have the opportunity of dealing with it. As the right hon. Gentleman says, the principal reason for the Bill is to give a proper standing to the assistant nurse position and to provide for the regulation of the arrangements in that connection. The Bill and what flows from it will place further considerable responsibility upon the General Nursing Council for Scotland and I am sure that that influential body will be glad to work the arrangements and set up the necessary standard in a way which will redound to the benefit of the nursing profession. As the Secretary of State has said, nurses are very important people indeed, especially in these days when we are becoming more and more conscious of the importance that health plays in the life of our country, and the establishment of proper arrangements in respect of the training of nurses certainly should take a very prominent part in our consideration of the matter.

Not only is the question of the status of these nurses important. The question of their remuneration is also important. The Secretary of State has made passing reference to the question of remuneration and we have had our attention drawn to this in very recent times by the publication of the two very valuable Reports from the influential Committee presided over by Professor Taylor. We have a set of standards set up for nurses right through the whole realm of that important profession up to the highest rank, which clearly indicates a great advance in recognition of what nurses are worth. We are, generally speaking, putting nurses on a comparative level with members of the teaching profession. That is all to the good and should enable us to improve the condi- tions of nurses and encourage those who go in for the profession of nursing to make themselves efficient as quickly as possible in order that they may earn the greater rewards available for them in connection with this new improved rate of remuneration that has been brought forward.

I have had, Like other hon. Members, expressions of concern on the part of those who are interested in Clause 14, which the right hon. Gentleman has indicated he will be willing to modify when we come to the Committee Stage. All the apprehensions that I have had expressed to me in this regard are apprehensions that we might more profitably deal with on the Committee Stage and I propose to leave them until that time. The Secretary of State has given us an indication of what is in his mind on this matter and I am sure that we shall go into it more fully when we come to deal with the Clause on the Committee Stage.

This Bill represents another incursion by the right hon. Gentleman into the realm of health in Scotland. He has made other incursions into that realm without requiring the aid of legislation to enable him to do so. In many ways health services and facilities in Scotland have been transformed during the period of his occupancy of the position of Secretary of State for Scotland. I think my right hon. Friend is to be congratulated on that and on the developments that we see him obviously determined upon. My hon. Friend the Member for Gorbals (Mr. Buchanan) rather declaimed against the idea of uttering congratulations to the Secretary of State.

Yes, he expressed his gratification at what my right hon. Friend had done but I felt that while he was doing so he was uttering his disgust that there Should be congratulations to anyone simply for doing his job. My reflection on that is this: If my right hon. Friend, instead of recently breaking his arm, had broken his neck there is not one of us who would have hesitated to congratulate him—

—posthumously on the great work he did while he was Secretary of State for Scotland. I think it is right that we should take the opportunity while he is here, with a broken arm, and not a broken neck, to say how pleased we are at the way he is looking after our affairs in Scotland. This Bill is an indication of the way in which he looks after our affairs. I welcome it, congratulate my right hon. Friend on it and also offer him my congratulations on the work he is doing in the realm of health.

When the Bill connected with English nurses was passing through this House, I was approached by the senior members of the Royal Infirmary of Edinburgh and also the Glasgow and Edinburgh branches of the Royal College of Nursing to see what was being done by the Minister with regard to the position of nurses in Scotland. I am glad to say that I found the Tight hon. Gentleman had the situation well in hand but his difficulties, which have not been confined to one sphere of legislation alone, were increased by the fact that a Committee which had investigated the matter had come to a decision somewhat different from that which he has just announced. Nevertheless, I think the Minister has produced a Bill which, from the general point of view, is admirable. There is no doubt whatever about the present shortage of nurses in Scotland; equally there is no doubt that that being the case, it is in the public interest that immediate steps should be taken to remedy matters. The Minister, as head of the Health Department for Scotland, has that responsibility and with his usual thoroughness he has taken the matter in hand.

Another question, however, which has to be faced is this: How is that shortage of nurses to be made up? It is inevitable that the ordinary course of nursing apprenticeship, if I may so put it, must receive some modification and that whatever happens, the standard of nursing must not be reduced. It is no good bringing into the profession nurses who are not up to the existing standards. What the Bill proposes to do is, first, to create a body of assistant nurses. I understand such nurses must pass a proper examination set by the General Nursing Council, and while I find difficulty in seeing how people who have not done the full course of nursing can pass this examination, _I feel that if that is to be the test, and the matter is left in the hands of the General Council, there need be no apprehension. At any rate, I do not think the Minister can deal with the matter in any other way. But there is another proposal in this Bill which is creating difficulty. It is proposed that the number of State-registered nurses should be increased and in order to give effect to that increase, Clause 14 has been put into the Bill. As I said at the beginning of my speech I was consulted by the Glasgow and Edinburgh branches of the Royal College of Nursing particularly with regard to this Clause and I told them that they would be able to interview the Minister in Edinburgh. They did so and I hoped, knowing the Minister's fairness and tact, that he would be able to find some way out of the difficulty so that this Clause would not trouble us any longer. Since then I and other Members have received letters mentioning that this consultation had taken place, but pointing out that apprehension was still felt about the effect of this Clause.

One does not wish, on Second Reading, to go into unnecessary details but at the same time this Clause will require to be looked at very carefully and it will probably require considerable revision when we get to the Committee Stage. Personally, I cannot agree that the Clause is a good one; it is badly framed and I do not think it is clear in its results. I am not at all sure whether a better way out of the difficulty, having in mind the fact that we must maintain the standard of nursing, would not be to put the whole matter, without qualification, into the hands of the General Council and leave it to them to say who will be given facilities for coming into the profession as fully registered nurses, after a shorter period of training instead of trying to limit it to people who happen to be assistant nurses. As I say, I am not at all sure whether a better result would not be achieved by treating the matter broadly and leaving the question of how the reduction of the period of training is to be made, in the hands of the proper authorities. As the Clause stands it is imperative that there must be such a reduction. There is no option for the Council but to make a reduction. I have no doubt that the Minister will, as usual, give consideration to the views of the people who feel that they are affected and I hope he will see what can be done to overcome the difficulty. I leave the matter there having indicated that I still think that the College of Nursing has definite grounds for apprehension. I certainly think the matter must be considered more fully.

There seem to be diverse views on whether one is to congratulate the Secretary of State or not. I think there is no doubt that he deserves the congratulations and thanks of Scotland, and of the nursing profession in particular. There are various ways of dealing with complaints. In the last war, when I joined a Scottish regiment and received a shilling a day for my services there was one occasion when we were not satisfied with the quantity of meat supplied. It seemed to contain rather an undue amount of bone. The sergeant major looked a kindly, genial man, not unlike the Secretary of State, so we took our grievance before him. The only consolation we got was, "When you have been longer in the Army you will realise that the meat that we get comes from a special kind of cow which has twice as much bone as any other." We did not go to him with any more complaints. The Secretary of State deals with complaints on a slightly different and improved basis, because he considers them and is always willing to meet anyone who has any point to raise and tries to get things straightened out. He has just had one real triumph and this is, relatively, a smaller matter, but we all know that he will deal with it in the same way. Accordingly, subject to what I have said, and in the hope and belief that those difficulties which I feel to exist with regard to Clause 14, will be cleared up in Committee, I commend the Bill to the House, and I offer my congratulations to the right hon. Gentleman.

The Secretary of State has been having so many bouquets thrown at him that perhaps a little cold douche will not do him any harm. For a very long time I have been interested in the conditions and wages not only of nurses but of women in industry generally. I do not think the nurses have anyone to thank for improving their conditions. It is only the fact that w are not able to gct enough of them that has resulted in this House or anyone else doing much to improve their condition. As late as 1937, in the good old days when private Members had their chance on Fridays, a Bill was brought forward to limit the hours of nurses to 48. It was then stated that the scarcity of nurses was such that we should not get them if we did not improve their conditions, in fact, that we did not deserve to get them. That modest Bill was defeated.

Yes, of course—by something like II votes. There were a few on our side who did not bother to turn up. The Bill was voted down and nothing was done for the nurses. It is only since the shortage of nurses has become acute that the House has taken any interest in their wages and conditions. I am not going to congratulate my right hon. Friend or pat anyone on the back for doing anything for the nurses. It is the law of supply and demand which has resulted in nurses getting some measure of justice. I have heard to-day that at the time to which I refer there were only some 250 women in the nursing profession who had not qualified as State registered nurses. I do not know why the number should have gone up so much since then. I am beginning to wonder whether the standard of education is deteriorating, because we now find that a large proportion of the girls who go in for their examinations do not pass. I suggest that the Secretary of State should look to that point instead of lowering the standard for the nurses. It seems to me that it has been a very sudden conversion on his part which has led him to bring in this Bill. An article in the "Glasgow Herald," which I am sure was based on information given either by the Secretary of State or at any rate by the Scottish Office, said:

"It is the aim of the Secretary of State to safeguard the standards of the profession in Scotland and as also emphasised in the report by Lord Alness. There will be no creation of a sub-standard class of nurses for Scotland."
I take it that we are not to have this particular type of assistant nurse introduced into the nursing profession. I believed that the new wages and the much better conditions and opportunities which are to be given to nurses under our new scheme would have attracted a sufficient number of women to carry on the profession. The report to which the article refers was only issued in April and, before we have had any opportunity of testing whether we might get a sufficient number of young women to come into the profession, we immediately bring forward a Bill which is going to dilute the industry. In the De- bate on the English Bill I listened with amazement to speaker after speaker on all sides of the House, calmly arranging to dilute the industry without the consent of the people within it. I heard doctors speak on that occasion. There is a scarcity of doctors. I wonder how they would feel if we suggested assistant doctors who did not qualify in the same way as they had done. We know that we have doctors in training as well as nurses in training but, before they can qualify, surely they have to reach a particular standard of education?

Therefore, I say frankly to the Secretary of State that, although it may have been necessary, I am very disappointed that this Bill should have been brought in so quickly before we have decided whether we can get a larger number of nurses as a result of the improved conditions and wages that are being offered. I do not like to see the Scottish Secretary so slavishly following the English Minister of Health in bringing forward legislation. I thought, in view of his statement which was reported in the "Glasgow Herald," that he would not have brought in a Bill on these lines at the present time. It was rather misleading to suggest—and it was suggested by the sponsors of the English Bill—that this was a Bill to regulate and to prevent unqualified women from acting as nurses. It will not protect the public at all from the unqualified nurse for it regulates the assistant nurse and gives her the standing of a nurse. It may be true that some parts of nursing do not require such a high standard of training and qualifications as other parts, such as, for instance, the treatment of chronic cases. It is difficult to get people to go into hospitals for chronic cases, because that type of work is not so interesting as the care of cases where there may be a cure. I can understand the joy that a nurse or doctor has in looking after somebody who may be cured and seeing them walk out of the hospital better than when they came in. There is a hopefulness in that kind of work. In hospitals for chronic cases, however, the work is uninteresting, and although it may be very altruistic it becomes very tiresome. I can, therefore, understand the feeling of a nurse who does not want to go into a chronic hospital. The nurse for that type of work is the woman with a high standard of altruism which was characteristic of the nursing profession in the older days and the difficulty will not be remedied by this attempt to bring in a sub-standard nurse.

We may be forced into having this Measure because we do not know how many nurses we may need during the war. If Europe becomes a shambles we shall want all the nurses we can get, whether trained or not. There seems to be a tendency to think that in future we are going to have hospitals all over the country with armies of nurses and doctors. That kind of prospect fills me with despair because I regard the appalling amount of ill-health that exists in the world as quite unnecessary. Any doctor will tell us that about 90 per cent. of the children who are born are born healthy and, given fair conditions of housing, food and so on, there is no need for this tremendous amount of ill-health. One thing that makes me almost despair is the way in which people accept this standard of ill-health as normal. It is not normal. I am in my sixties and have never been seriously ill, and I have not had an easy life. We want to teach people how to keep well, and that is not so very difficult. Some people accept a sub-standard of health and think that that is just as it should be. I do not think that, in future, we need have all these hospitals and nurses. I do not think we shall need such a tremendous number of nurses when the war is over as we improve housing and working conditions and teach people how to keep healthy. Much of the bad health now is due to bad conditions and the fact that people do not know how to keep themselves well.

I have spoken, so far, from the point of view of the nurse who is rather afraid of this dilution of her industry. She feels that at a time when she is secure with fairly decent wages and conditions we are going to bring in nurses of a lower standard which will lower the standard of the profession. There is a necessity for well-trained and intelligent women in the nursing profession because there have been great developments in treatment. The nurse to-day has to be a much more skilled person than she was in the old days, better treatment and all kinds of new treatment having been introduced in which the nurse has to be experienced. To lower the standard at such a time is a mistaken policy. I was really disappointed when I saw the Secretary of State so slavishly following the English Bill in this respect, in view of the fact that a Scottish Committee has reported on the subject. This is the same Bill as the English Bill plus Clause 2, Sub-section (3) and Clause 14, which is contentious. I do not think anyone will object to Clause 2 (3), which says:
"Unless Parliament shall hereafter otherwise determine, nothing in rules made under this Section shall enable a course of training begun after the expiry of five years from the commencement of this Act to qualify any person for admission to the roll."
I take it that that means that after five years this type of assistant nurse will cease 'to exist without the permission of Parliament. There is fear in the nursing profession about Clause 14. I do not take any exception to the spirit of it. I think that it is one of the most hopeful things with regard to the assistant nurse that she is to be provided with a ladder from which she can climb from the lower to the higher grade if she has ability and desires to do so. I am glad that the Secretary of State has decided to look into this Clause and see whether he can make it more acceptable to the nursing profession. I like the idea that if a student nurse is not successful in her examination or has not had the educational advantages that some of the other girls have had, she is not to be barred for ever from stepping up into the higher grade. I agree with the Secretary of State that after a girl has done a certain amount of training she should not be expected to start from scratch and that she should have some advantage because of her training. It would be for the Council to decide what that advanage should be, and that is where some different wording of the Clause is needed. It would be absurd to say to the girl who has had two years' hospital training that she must start from the beginning and work up. Therefore I do not object to the Clause as it stands. I do not object to the spirit of the Clause but I am glad that the Secretary of State is going to do something for that is the one Clause about which I have received representations from nurses in Scotland. Therefore, I do not suppose that I can oppose the Bill, but I hope they will be successful in providing a sufficiency of nurses and not lower the standard of the nursing profession.

It gives me a rather uncomfortable feeling to have to differ so sharply from my hon. Friend the Member for Springburn (Mrs. Hardie). I feel she does a disservice to this profession, for whom she has already done so much work and for whom we all know she has a very high regard, when she talks of this Bill introducing an element of dilution. Indeed—I am sure I will not be misunderstood—I feel that the Secretary of State himself did not help matters when he chose this word "sub-standard" to describe this type of nurse. I know there are great difficulties here and that much thought has been spent by the Council to find the right description, but I think from the point of view of the profession and the confidence of the public we should stick rather closely to the word "assistant nurse" and leave it at that. They are not half-trained nurses; they are certainly not dilutees. I think the Member for Springburn does herself less than justice when she talks about this dilution, which inevitably means the introduction of a new element into the profession, whereas the problem the Secretary of State has to solve is how to protect his patients and organise his industry from an unorganised element which arithmetic has driven him to accept, and therefore, unlike my hon. Friend, I am not at all disappointed at the conversion of the Secretary of State to which she referred. It is not a position any of us accepted with any great glee, but if we were to be realistic about the situation, then we had to have a Bill more or less of this character.

I am concerned because I seem to see a conflict in the two substantial departures which my right hon. Friend has made in the Bill. When you have suffered so many Scottish Members to-day, Sir, it might be quite fitting for me to say in consolation eat I do not necessarily think that to follow an English example is necessarily bad. We should not immediately conclude that because it is an English Bill it is not a good Bill. I, like others, am glad of Clause 14. This Clause, I feel fairly certain, will give a stimulus to the assistant nurse and also will give some kind of professional dignity to this grade. At any rate I am certain that my hon. Friend who has just spoken is quite right when she says that it is good business and just and encouraging that women in the profession who have already given some service should have that service recognised and be left a device by which they can raise themselves, and that in itself, I should think, would be an enticement to any who may come into the pro- fession as a war-time job and are not at all certain whether they are going to make it a life career or not.

But, unlike any other speaker in the Debate, I think this clashes sharply with the other difference between the Scottish and English Bills; that is, Clause 2. I dislike Clause 2 exceedingly and urge on the right hon. Gentleman that he is in a not negligible measure jeopardising the success of his efforts. This Sub-section provides that, unless Parliament decides otherwise, this grade of assistant nurse ceases to have new entrants in five years' time. Several speakers seem to have assumed that it meant the end of the assistant nurse. I cannot see how that can be. Having created your assistant nurse, you must allow her to retain her status, and therefore you must retain your roll, and you must also retain your grades, but I take it that the Secretary of State is saying to the girls of Scotland as he said in the conclusion of his speech, "Here is a difficult war-time situation. We have patients, we have hospitals, beds, we have equipment, we have not got nurses. Come in on this professional status of assistant nurse," and then, under the Sub-section he says, "But don't forget this is a rump profession, a profession I hope to see disappear." It is a profession that by this qualification we admit is a second best and a very poor second best. My hon. Friend quite properly sees the opportunity and says, "It is a very close second best." On the assumption that this is necessary, it will continue to be necessary. I say that although the hon. Member thinks it is undesirable, I think it is essential, and I think the Secretary of State thinks it is essential. I think the hon. Member is in a sense jeopardising the success of this regrading attempt.

Previous Members in this Debate, and in the Debate on the English Measure, pointed to the high standard of education needed to get a satisfactory entrance to the top grade of the profession just now. One of the necessities for accepting this assistant grade lies in the fact that there are, once you have deducted your teaching quota, insufficient girls coming from our Scottish secondary schools to-day to meet even recruitment needs.

The last speaker said that she hoped to see the great need for hospitals disappear. So do we all, and not one of us would disagree with her sentiments when she says that we ought to transfer our energies to the positive aspect of health and teach the people how to live. I hope we are going to do that, and that it will have an effect upon those who are still at school, but we still have with us other generations of those who have not had that instruction, and so I say, in spite of the developments of medical science which some of us anticipate and many of us hope for, that within the next 30 or 40 years we can expect no diminution in the number of beds needed and the necessary professional attendance. That, I most seriously argue, rather disposes of the need for this Sub-section. I am going to make a concession to the "diehards" of the Alness Committee. I know privately that the Secretary of State does not accept the opinions held by the Committee, but I am afraid, despite the tributes already paid to them, it is to be feared that they made no very keen research into the arithmetic of even the 1938 situation.

Shortly, if there is to be this continued need the Secretary of State should not jeopardise his scheme by stigmatising this new grade of nurses as a war-time, rump profession. Let me call the attention of the right hon. Gentleman to Clause 5, in which he provides machinery for an appeal to the Court of Session. I can hardly expect the law officers within the Ministry to agree with me, but I think it might be cheaper, and it certainly would be quicker, if one could provide some court of arbitration within the Nursing Council to which these appellants might go. With these three qualifications I, like all other hon. Members who have spoken to-day, very gladly support the Bill, and if I do not throw any bouquets it is not because they are not undeserved but because I think the Secretary of State, like you yourself, Sir, must by this time be rather tired of Scottish voices to-day.

I rise first to thank the Secretary of State for the concession he has made in regard to Clause 14 in saying that before we reach the Committee stage he will look into the matter very carefully and see if the way is clear to meet some of the representations which have been made to him. This Bill must indeed be welcome to Scotland by bringing about better regulations for the nursing profession than obtain at present. I am glad to know, also, that the Secretary of State is well aware that in providing nurses for the ills that visit the human race he is at the same time taking steps to reduce as far as possible the causes of the various diseases which have such disastrous effects industrially and socially. I do indeed welcome the broad-minded and energetic way in which the Secretary of State, and if I may say so his assistant, have tackled this matter, and, speaking for my constituency, I welcome indeed the efforts he is putting forward.

I would like to allude in the first place to certain remarks made by the hon. Lady the Member for Springburn (Mrs. Hardie), and I would like to agree with her very whole-heartedly in the matter of the pay and conditions of the nurses, which for far too long have been far less than they deserve, and I do not know that even now they are sufficiently high for the amount of work, the amount of training and the amount of responsibility which nurses take on their shoulders. But when the hon. Lady came to speak of the Bill as not regulating the nursing profession, then I parted company with her, because it seems to me that that is one thing that this Bill does do. As I understand the situation at this time, it is that we have a considerable number of people, some 2,000 of them my right hon. Friend tells me, who are called nurses and yet may have no experience whatever. So far as I understand it, the purpose of this Bill is to take these in and make them assistant nurses if they have the necessary qualifications to have that title applied to them. I think, along with all those hon. Members who have spoken, that this Bill should most certainly receive its Second Reading, because after all its purposes are that these assistant nurses should, if they are worthy of it, be given a recognised status, and, secondly, it is designed to protect the nursing profession and the public from persons with little or no training.

The only representation I have had made to me in connection with this Bill is in regard to Clause 14. We have had a very definite assurance from my right hon. Friend the Secretary of State, in his opening speech, to the effect that this would in no way lower the qualifications which were required in connection with one becoming a State registered nurse, and that, I think, should go far to calm or relieve the anxiety of those who feel on this matter. I think there is a certain amount of misapprehension likely to crop up here. The Clause refers to a reduction in the period of training, but where we are at a misunderstanding, I think, is that surely the period of training which is referred to in the Clause is that prescribed in a hospital to enable one to qualify as a State registered nurse. Today particularly there are very many people who are nursing, who are getting experience, who are getting training under State registered nurses, but who would not qualify as having entered on this prescribed course of training which is laid down. These people should have an opportunity after qualifying as State registered nurses. The Bill does not mean that their whole period of service is being reduced; it does not mean that they are really getting off any lighter. It means that experience that they have gained outside the prescribed course is, under certain conditions, to be allowed to count. There are women who, perhaps being a little young, instead of starting straight off in one of our big training hospitals, have gone into some of the big training homes, in Glasgow and elsewhere. They have spent perhaps two, three or four years there; they are acknowledged by the medical officers who attend those homes to be first-class nurses; but they cannot get their State registration unless they go back to the beginning and work up afresh. In so far as Clause 14 allows people like that to get a remission of time, it is all to the good.

I personally welcome this Bill. I think that, following on the assurance we have had from the Secretary of State, the fears which have been expressed as to the prestige of the nursing profession being lowered are unfounded. But I would like to put one point to my right hon. Friend. Clause 14 gives no indication that the standard of the examination is to be maintained. He has given us his assurance, but it is not in the Bill. I think that, with very little difficulty, words could be added to the Clause which would make the position absolutely watertight. I would ask him to consider that before the next stage, and to see what can be done.

It seems to me that if the Secretary of State had slavishly followed the English Bill, he would have had the Second Reading before now. The only objections are to the innovation which he has made. Clause 2, Sub-section (3), which he has introduced into the Bill, has resulted in a good deal of discussion. I am inclined to disagree with the Secretary of State on that Sub-section. In this matter we are legislating in the dark. We do not know where we are in regard to this profession. There must be a considerable army of nurses who are being retained for special duties in connection with military operations. We do not know when the war will end, and I do not disagree with the five years' limit in the Clause. Surely, before five years are over we shall be out of our present difficulties, although we may be in other difficulties. We shall be through the war, I hope and expect; and we may have a very large army of fully-trained nurses to staff all the hospitals that we require. Of course, if what my hon. Friend the Member for Spring-burn (Mrs. Hardie) envisages takes place, and we are going to have a shambles in Europe—

Yes, we might. Then we might have thousands, or tens of thousands, of mutilated men on our hands for years, and there is no saying what nursing assistants we may require. But I think the Secretary of State is wise in laying down this limit of five years for this class of assistant nurses to come along and qualify. The nursing profession is a very important one, both in peace and in war. I very largely agree with many of the sentiments expressed by my hon. Friend the Member for Springburn that if we could get our people educated to lead healthier lives, we would not require so many hospitals and nurses, but we do require them. This is a most important service, which occasionally arouses the admiration of everybody in the country. Recently we had an outbreak of smallpox in Scotland, and we had nurses who volunteered to undertake nursing duties in those circumstances. The girls who go into smallpox hospitals and undertake that disagreeable work are heroines. There is also the question of tuberculosis, and there are nurses in our sanatoria doing most valuable work. Women who are engaged on work of that kind are really entitled not only to decent conditions, but to adequate remuneration as well. While it may be true that the remuneration of nurses in Scotland will be improved as compared with that in England, I am not going to say that their remuneration is greater than the services they render.

I am not inclined to quarrel with the two changes the Secretary of State has made with regard to the Bill. I think that there should be a limit to the period in question, and I think he has fixed a reasonable one in making it five years. I agree again with him in the line be has taken in being prepared to look at Clause 14 to see that the standard of training is not reduced to such a point as to be a danger to the profession. If these two points are met, there is no reason why this Bill should not speedily go on to the Statute Book and help to improve the conditions for nurses in Scotland.

I do not intend to take up more than a few moments of the time of the House, as I have already inflicted myself on the House on the previous Measure. I only want to reinforce what has been said by my hon. Friend the Member for Dumfries (Sir H. Fildes) and indeed the sentiments which have been echoed by every Member who has spoken, including the Secretary of State, with regard to the importance of Clause 14. The hon. Member for Dunfermline (Mr. Watson) said that if the Secretary of State had slavishly followed the English Bill, we might have had this Measure through the House in a very few minutes. We Scottish Members have had a great number of postal communications in the last few days in regard to this Clause, in dealing with which the Secretary of State, in opening the Debate, devoted so much time. His speech, as previous speakers have made clear, has gone a very long way towards removing doubts and misgivings which were in the minds of many of us owing to the communications we have received in the past few days from many in the nursing profession who thought that in some way or other they were likely to suffer by this Clause as at present drafted. Of course, we know that the Scottish Office in promoting this Bill, just like the Ministry of Health in promoting the Measure which this House disposed of a few weeks ago, in no way wishes to jeopardise, interfere or hinder those who are engaged in this great profession of nursing. This Measure is designed to place the nursing profession in a position of even greater efficiency than obtains at the present time. The Minister has indicated that he is willing to meet in every way possible between now and the Report stage the fears which have been expressed by so many in the nursing profession with regard to Clause 14.

The hon. Member for Dunfermline alluded to the position of nurses in the present war and said we do not know the day or hour when their services, owing to. military operations, may not be utilised in a way in which they have not been utilised during the last three and a half years. It was right that he should draw attention to that in order that in no way whatever, so far as is reasonably possible, should anybody in the profession suffer, as they think they may suffer under Clause 14 as it at present stands. Personally, I feel that the Minister and those associated with him in the Scottish Office realise to the full the importance of not hindering or obstructing this noble and sacred profession, but of helping forward in every way possible this work of love and mercy.

This Bill has had a certain amount of criticism directed against it and in some quarters has been received with anxiety. I have shown the Minister petitions which I have had from nurses serving in infirmaries in the City of Glasgow, to which there were a large number of signatures. These nurses are vitally interested in reciprocity and in Clause 14 and while I do not propose to elaborate the provisions of this Clause, I want to emphasise to the Minister the keen interest that these nurses are taking in it. They fear that the status of nurses will be lowered. Anything the Minister does to raise the status of the nursing profession will, I am sure, have the support of the House; anything he does to lower it will meet with definite criticism. I do not think, however, that there is any reason to fear that the general status of the profession will be lowered by this Bill.

The Minister said that there were 2,000 assistant nurses and that a sample of them had been taken by the General Nursing Council. I would like to ask the Parliamentary Secretary what arrangements are being made for training centres. From the Alness period until now there has been a very considerable increase in the number of available nurses. It is evident that many training centres must be created. If they have been created, I should be glad to know where they are. I want to congratulate the Minister on bringing in this Bill, which I am sure will be for the general welfare of the nursing profession.

I think the Debate has really proved that there is an earnest desire on the part of the House, and particularly of Scottish Members, to see this Bill speedily on the Statute Book. I can assure hon. Members that there is no intention in any way to reduce the standard or the qualifications of those who are engaged, or to be engaged, in the nursing profession. The Bill in no respect seeks to dilute the profession. Its primary purpose is not to increase the numbers of those in the profession but to see that only those who have been trained and have the qualification can in future use the term "nurse" and that those who are not so trained and qualified cannot mislead sick persons who require competent attention. There is no intention to reduce the status, training or qualifications of the nursing profession. I think the Debate has also conclusively proved that we have not slavishly followed the provisions of the English Bill. The main Debate has been on Clauses 2 and 14, and I think that, of itself, refutes the suggestion. Some Members have indicated that they dislike Clause 2. Whether the need is with us five years hence, because of the shortage of nurses, to continue assistant nurses, or rather to continue recruiting them, will be for Parliament to decide, because Clause 2 makes it perfectly clear that the roll of assistant nurses can be added to only during the five years and that it will cease to be further made up at the end of five years, unless Parliament otherwise determines.

No. Additions will not take place. Whether the need exists at the end of five years will be considered by whoever may then be responsible for dealing with these problems. The aim and object of the Bill is to keep up the standard of the nursing profession. We are not anxious to have assistant nurses as such, but we want to give them an opportunity. There are five years in which they can get their training and qualify. We are very hopeful that the improved conditions in the nursing profession will attract the nurses that we require to meet the problems that are arising, because the need for nurses will be greater in future if we are to have a comprehensive health service and a comprehensive medical service. If we are to work on one of the basic assumptions of the Beveridge Report, which incidentally was accepted by the Government—that of a comprehensive health service—we shall require more and more nurses. We have taken the right step to attract an increased number by the improvement in salaries which were recommended by the Taylor Committee. Some of those recommendations will be found on page 23 of the Committee's second report. The recommendations on conditions of hours and employment will be found on page 19. These recommendations, so far as salaries are concerned, bring the nursing profession in some respects almost alongside the teaching profession. If we want to attract larger numbers of the type of individual we want in the nursing profession, we must improve the conditions of employment and the scale of salaries. We have been trying to do so. We have advised the local authorities that we will meet 50 per cent. of the increased costs that will fall on them, to enable them to pay the increased salaries recommended by the Taylor Committee. I have made it clear that Clause 2 can be reconsidered by Parliament, but we limit its operation just now for five years.

Sub-section (3) of Clause 2 provides that no one undertaking training after the five years shall be added to the roll, but elsewhere the Bill provides for reciprocity with the English and Northern Ireland roll, if it is created. Are we to exclude English or Northern Ireland assistant nurses, who commence training after that date? If you are not going to exclude them you will have to add to the roll.

Some of these intricate points are better debated on the Committee stage. All the points raised on Second reading will be considered between now and the Committee stage with a view to a proper reply being given to them.

Clause 14 is the only other really contentious Clause, but the Secretary of State has already made it clear that he is prepared lu reconsider the drafting. Let me again emphasise the fact that the main purpose of this Bill is to protect the general public against the unqualified nurse. The purpose of setting up a register is to see that the person who calls for a nurse will be sure, if the term "nurse" is used, that they have a properly qualified person to look after them. I think it will be admitted that the general public are frequently unaware of the distinction between the registered nurse and someone who merely calls herself a nurse. This will be obviated if this Bill is placed on the Statute Book and the register is set up as suggested by the Bill. Then Clause 6 provides that no other than a registered nurse or enrolled assistant nurse will be accepted with certain exceptions. This will definitely improve the status of the profession.

So far as the point made by the Member for Cathcart (Mr. F. Beattie) is concerned, it is perfectly true that the demands for nurses will increase when war ends, if we are to have a comprehensive health service. Nursing personnel will be required for the extended medical hospital and public health services we are now planning. Casualties now being treated oversea will have to be brought home and nurses will also be needed for work in the liberated countries. The women doing temporary war nursing will have to be replaced. Some important steps have already been taken to increase the number of women available for nursing. In the first place, I have already indicated that, in order to make the profession more attractive, we have accepted the recommendations of the Taylor Committee, so far as the conditions of employment in the service of nursing are concerned. I want to express appreciation of the work done by the Committee and to thank Professor Taylor and his associates for their services. We have commended these reforms to the employing authorities and undertaken to pay 50 per cent. towards the cost of the salary increases.

Will the hon. Gentleman say whether that also applies to voluntary hospitals, as well as local authorities?

I think it does, but I will make sure and tell my hon. and gallant Friend exactly what the position is. I understand that we are prepared to make them apply to the voluntary hospitals.

The quickest way of obtaining nurses for immediate needs is to draw on the available trained women who are not at present in the profession and, with this in view, all persons between the ages of 18 and 60 years of age who are at present engaged in nursing or have at any time been so engaged for a period of six months, were registered in April this year. The National Advisory Council for the recruitment and distribution of nurses and midwives, recently appointed by the Minister of Labour and National Service, are to advise on how women selected for nursing after interview, can best be used in the present emergency. Then we propose to draw the attention of education authorities to the increased shortage of nurses and ask them afresh, to interest suitable girls in secondary schools in undertaking pre-nursing courses. We also propose to urge local authorities, if this Bill becomes an Act of Parliament, to provide and, by every means stimulate, interest in pre-nursing courses and continuation classes, and also to ask for further pre-nursing courses at central institutions. We are now carrying through negotiations with the hospital authorities for the purpose of providing the necessary training facilities to enable us to give the proper training to those who are recommended.

We have had negotiations with the voluntary hospitals. We are conducting negotiations with a view to getting a scheme, which will be satisfactory to all, to improve the training facilities which can be made available. Having pointed out these things, I am sure that I am voicing the views of the Secretary of State when I say that he is deeply indebted to the House for the manner in which it has received this Bill and for the helpful Debate that we have just had. We shall go to the Committee Stage with the full knowledge that every one of us will be working for one common purpose—to improve the status of the profession, to provide only the best of nursing facilities for our people in Scotland, and to do what is best in the interests of the health of the people.

The hon. Gentleman has referred to my right hon. Friend's undertaking to examine Clause 14 to see whether it can be modified in any way. Will he also consider the point which I put as to including words which will remove all anxiety as to the qualifications required to become a State-registered nurse being maintained?

I cannot add anything to the pledge which was given by the Secretary of State. That pledge was that there would be a reconsideration of Clause 14 with a view to its re-drafting, if we were so advised, for the purpose of making the Bill a still better Bill. I trust now that we shall get a unanimous Second Reading.

Question, "That the Bill be now read a Second time," put, and agreed to.

Bill read a Second time.

Bill committed to a Committee of the Whole House for the next Sitting Day.—[ Major Sir James Edmondson.]