I beg to move, in page 2, line 7, after "Committee" to insert:

"(which shall hereinafter be referred to as the Enrolled Nurses Committee)."

I have a very great deal of sympathy with the object of the Amendment, but I would like to hear from the Parliamentary Secretary before I decide how to vote, particularly whether there are objections from the nurses or from the General Nursing Council. We ought to do something to help women who want to be assistant nurses because they do not feel that they can stand the strain of the whole course. There are large numbers of women who are already assistant nurses and who, because of the anomalous position which they occupy in the hospitals, will not go fully into the nursing service. Much could be done to help these women, who are in many cases experienced and sympathetic. I had a letter from one girl this morning who says that in her hospital she is not allowed to wear a cap and is not allowed to give an aperient. I doubt whether the conditions in many of these cases would be changed if we changed their name.

I, too, have every sympathy with what was said by the hon. Member for Putney (Mr. Linstead), but I do not think that the Amendment will achieve what is in the hearts of many of us. We desire every possible encouragement to be given to the nursing profession, but I do not think that the proposed alteration of title, which will be laid down from above as it were without anything like adequate consultation with members of the nursing profession, will do anything other than create harm. It is admitted that the title "assistant nurse" has defects. The hon. Gentleman says, "That is anomalous. Let us have a rather different and less anomalous anomaly."

I am sure that we all sympathise with the intention of the mover of the Amendment. I am sure also that many excellent nurses feel humiliated by being restricted in the work that they can do in their nursing functions, and by having to accept a title which seems to them to be unnecessarily a sign of inferiority. I hope that some attempt will be made to discover a more suitable title than "assistant nurse." She is a nurse, and not merely an assistant. Just as "a rose by any other name would smell as sweet," so the term suggested in the Amendment would cause the same trouble as the existing term. Therefore, the proposal is unattractive.

I must add my word of sympathy with the object of the Amendment to those that have been expressed on this side of the Committee. We do not regard the term "assistant nurse" as being a final choice of especial value. I must agree with my hon. Friends who have spoken and who have suggested that we have not yet been able to find any suitable alternative. My hon. Friend the Member for Epping (Mrs. Manning) suggested that we wanted, as indeed we do, to recruit more nurses, both assistant and fully qualified. She suggested that we must look to simplification of training for certain categories of nurses. We have recently shortened the period of training for assistant nurses, and for that very reason this is perhaps rather a bad moment to choose for suggesting a new name, which would, in the mind of the ordinary general public, cause rather more confusion.

Perhaps I may be allowed to make one or two comments on the sympathetic and helpful speeches to which the Committee have listened. I recognise that what I have done today is to begin an involved process, and although I would not take the period of time which the hon. Gentleman has suggested before it comes to fruition, I appreciate that the time is not ripe today.

Would not the hon. Gentleman agree that the State registered nurse should form, so to speak, the criterion of all kinds of nursing?

One might say the "aristocracy," but I would not necessarily say the "criterion."

"…. any person who, not being a duly registered nurse under the principal Act or a duly enrolled assistant nurse, takes or uses the name or title of nurse … shall be liable …"

I beg to move, in page 2, line 27, to leave out from "Minister," to "constitute," in line 28, and to insert "shall by order."

I am glad that the Government have seen fit to put down their two Amendments. They cover, of course, precisely the point which is covered by the Amendment which stands in the names of hon. Members on this side. I do not know why the Government have chosen a more complicated method, but, in view of what the Parliamentary Secretary has said, we need not pursue the matter further, except to express our gratitude for the change which has taken place.

I have had to consider whether this Amendment, on which hang a large number of consequential Amendments, is within the Money Resolution. Paragraph (a) allows

"expenditure incurred by standing nurse training committees constituted under the said Act."

I am much obliged to you, Mr. Bowles, for what you have said and I can certainly give you the assurance for which you ask.

I beg to move, in page 2, line 30, to leave out "standing nurse-training committee," and to insert "nurse-training authority."

Again, as the hon. Member for Putney (Mr. Linstead) has said, we are discussing a question of nomenclature, but that does not mean that it is not important. It is important to get as effective and useful a name as we can. I am not sure that we have a name here that meets our difficulties. It may clarify the point raised by the hon. Member for Putney that the use of the word "committee" may suggest that it is a committee of the regional hospital board, but the word "authority" raises new problems. The body that really is the training authority is presumably the hospital, and not this body which links, together the hospital where the training is being done with the General Nursing Council.

I appreciate what the Parliamentary Secretary has said, and I do not imagine that my hon. Friend will wish to press this matter further, in view of the hon. Gentleman's sympathetic tone. There is one point which has not yet been fully brought to the attention of the Committee, and that is the unfortunate use of the word "standing" in this connection. I may be regarded as facetious in saying that the juxta- position of the word "standing" and "nurse" may lead to comments, but such comments should be avoided if possible in this connection. I do not see any particular use for the word "standing" here, and I suggest to the Government that if they cannot see their way to substitute some other word for "committee," they should consider the omission of the word "standing."

I reinforce the argument used by the hon. Member for South Hendon (Sir H. Lucas-Tooth) because the way out is either to use some such alternative as "permanent" in place of "standing" or to put the latter word where it naturally belongs, before the word "committee," so that it would be a "nurse-training standing committee," if only for the sake of the usual way of putting these things, and if we must have that objectionable term. It has caused a lot of hilarity in other connections for a number of years, and when we are trying to use as dignified a nomenclature as we can, why should we retain anything which might lead to further hilarity?

May I remind the Parliamentary Secretary that when this matter was raised in another place, the representative of the Government said:

"I do not like the term 'standing nurse-training committee.' I do not think there will be objection to a change in name, if a suitable one can be found which will show the difference between the Council on the one hand, and the regional hospital boards on the other."

I hope the Parliamentary Secretary will be good enough to meet the point made so well by the hon. Member for Westminster, St. George's (Mr. Howard). In addition, I am sure that the hon. Gentleman is sympathetic to the object of the Amendment and I believe that between now and the Report stage some solution may be found of this little problem. I hope, therefore, that when the hon. Gentleman replies he will say that between now and then he will do his best to find a solution.

I am only too willing to reply to the point made by the hon. Member for Westminster, St. George's (Mr. Howard). It is perfectly clear that these standing committees are entirely independent of the regional hospital boards. They will have upon them representatives of the regional hospital boards, as they will have representatives of the boards of governors of the teaching hospitals and others. It is quite clear, however, that they are quite independent and that there is no intention that they should be in any way committees of the regional hospital boards. On the use of the word "standing," I should have thought that "standing committee" was a dignified connotation because we have Standing Committees of this House—

Not Standing Members' Committees of this House.

I should not have thought that would have caused much difficulty. However, if we can think of any better phraseology to use, I shall be only too ready to consider it.

In view of what the Parliamentary Secretary has said, and before the standing committees begin to sit, I hope we shall find another word to put before the hon. Gentleman and, in the light of that possibility, I beg to ask leave to withdraw the Amendment.

I beg to move, in page 2, line 31, to leave out "that area," and to insert:

"each hospital area; and before making an order under this subsection with respect to any such area the Minister shall consult with the Council."

I beg to move, in page 3, line 15, at the beginning, to insert:

"The Council may subject to such conditions as they may think fit delegate authority to."

I do not think there is anything between us on this issue and it is really a matter of drafting. I am advised that there would be no restriction upon the General Nursing Council imposing any reasonable conditions in the use of this power, and it is obviously right that they should do so. Here, to some extent, we are departing from past practice and ensuring the right of regional committees to hold examinations. It is only proper that that should be done under such reasonable conditions as the General Nursing Council should decide and specify.

Would this allow the General Nursing Council to impose conditions of standardisation over the country?

I wish to support the view put forward by the hon. Member for Blackley (Mr. Diamond). It is most important that we should have clearly set out in the Bill that the question of what type of examination is to be carried out and the conditions under which it is to be carried out must be the responsibility of the supervising body of the General Nursing Council. It may be that the words in the Bill at present

"if requested by the Council so to do"

This makes me a little anxious, because I think that here, as in examinations for other professions, there must be some method of standardising, although that is not quite the word to describe what I mean. In the United States of America different examinations take place in different States and are not acceptable as between one State and another. We do not want a similar system here, as it might put one regional committee in a bad position compared with the rest. There must be the overall authority of the General Nursing Council on the question of standardisation, as well as on other conditions.

I hope the Minister will look very carefully at this matter again. As we all know, there is a great shortage of nurses and we also know it might be possible for the regional hospital board in an area to speak with considerable authority on the standing nurse-training committee and use a good deal of influence. If in one region the standard of examination were to be reduced, it would perhaps be much easier for that authority to secure nurses. I agree that the nursing examination is much too theoretical at present and needs to be made much more practical, but I feel that the same standard should be maintained by all the standing nurse-training committees.

I am most grateful for the comments made on both sides of the Committee and those made by my hon. Friend the Parliamentary Secretary, because I think they have proved to the hilt the necessity of making clear beyond any doubt that the Nursing Council should have power to delegate authority to conduct examinations with the most precise conditions as to standardisation and standard of examination, and anything else which from experience they deem neces- sary. The Parliamentary Secretary has said that he is assured that the words give the General Nursing Council the powers they seek by this Amendment, and he has also been good enough to make assurance doubly sure. I do not wish to detract one tittle from the assurance he gave us that he will be good enough to look into the matter yet again, and presumably if he finds his first assurance was not fully justified, he will be prepared at a later stage to bring in words which would serve the purpose on which, obviously, we are all agreed.

I wish to add a word. We have been satisfied that within the wording of the Bill as it stands, the General Nursing Council remains entirely responsible for examinations to be carried out and can standardise them throughout the country. The Clause refers to

"any examination prescribed by rules made by the Council,"

In view of that double assurance, I beg to ask leave to withdraw the Amendment.

I beg to move, in page 4, line 14, to leave out "or," and to insert "and expenditure."

I beg to move, in page 4, line 25, to leave out subsection (2).

"… expenditure by a Hospital Management Committee … being expenditure—

(a) for the purposes of … training … nurses; and

(b) of such description as the Minister may specify …;

shall, so far as it is incurred in accordance with estimates approved by the … nurse-training committee, … be defrayed by that committee."

Perhaps I should explain that paragraph (b) does say "of such description." That is the general description of the type or category of expenditure rather than the precise detail.

I appreciate what the Parliamentary Secretary has said, and I am grateful to him. I only wish he had said this on Second Reading, because we have been in very great difficulty. I asked him for an explanation then and he did not give one, with the result that we must thresh out the matter in Committee.

It would be the intention to issue first of all a general indication of the categories of expenditure which my right hon. Friend would regard as coming within paragraph (b)—the types of expenditure that he would regard as coming within the nurse training fund. It would be possible technically to separate it from the general administrative expenses of the hospital, because that is really the point. There are many expenses which may be regarded as connected with nurse training which it would be impracticable and unreasonable to separate from general administration expenses. Therefore, the purpose would be to set out in general terms the categories of expenditure which the Minister would regard as being separable and properly chargeable for this purpose. That would be the first step.

I am obliged to the Parliamentary Secretary. Now we come to this point, that there will be some general indication given both to the nurse-training committees and to the hospitals as to the kind of expenditure which might be included in a scheme and might be included in payments to be defrayed through the training line of payment, if I may so call it. That must be available before any payments are submitted. It would be impossible to frame them without such information. After the information is given, there will be the question presumably of working out the estimates on the kind of lines indicated in my speech; so that there will be a second opportunity, so far as expenditure is concerned, for the estimates to be considered by the Ministry of Health. There is no question therefore of financial control. The financial control exists by the ordinary machinery of payment. The difficulty I have is in seeing why it is necessary to put in some provision for specially referring a question of expenditure under subsection (1) to the Minister.

Perhaps I can explain that now. A point might very well arise—this is merely where there is a difference of opinion which is to be—

I think it would be better if the hon. Member for South Hendon (Sir H. Lucas-Tooth) moved his Amendment and then the Parliamentary Secretary replied, rather than that the Parliamentary Secretary should intervene now.

I must apologise if I invited the Minister to join in a somewhat irregular Debate. The difficulty we are in is that we have not had previous information from the Government. I do not complain, because this is a difficult matter with which to deal except in Committee. My objection to subsection (2) is that it contemplates the reference of two questions to the Minister which should have been resolved either by the general instruction given in advance of the payments or at the time of the formulation of the estimates. I cannot see why it should be necessary to have this special provision in the Clause as it stands.

"shall, in default of agreement, be determined by the council."

I am grateful to the hon. Member for raising this matter. We would not wish that there should be any doubts about the operation of this Clause, and I am grateful for the opportunity to deal with it. It is essentially a matter which we can discuss most usefully in Committee.

May I interrupt the hon. Gentleman? Where there is expenditure which is clearly partly train- ing and partly administrative expenses of the hospital, does the Government contemplate that the Minister should be able to divide it up?

Yes. It is perfectly clear what is intended here. In this Bill, as a matter of fact, we are providing what is available already in the National Health Service. We are endeavouring to see to it that the academic side of medicine is kept entirely separate, and that the provision of apparatus on the secular side is the obligation of the Minister of Health. What has to be determined is where the expenditure should lie, and the Minister will decide it, while the General Nursing Council itself will decide matters relating to training.

The last words of the Minister are the most valuable and important, from my point of view, that I have so far heard in this Debate. I am regarding this purely as a rather difficult practical matter. There is no disagreement of any sort between any hon. Members of the Committee as to the importance of dividing, so far as they can be divided, the different functions of the employment of nurses and their training. We all welcome this Bill, and we hope it will be successful in achieving that difficult object, but there has been a good deal of difficulty in defining clearly the difference between the professional function of saying what is right and proper and the political function of determining how much money shall be made available for the carrying out of that purpose.

"of such description as the Minister may specify"

"of such description as may be prescribed."

I listened carefully to what the Parliamentary Secretary said, and I certainly have no desire to press this Amendment, which in itself is not much more than a peg on which to hang the discussion. The Parliamentary Secretary has gone some way to clear our minds on this point, and, in seeking leave to withdraw this Amendment, I would say that we shall consider carefully what he has said, and, if necessary, put down Amendments at a later stage. We are grateful to him for his explanation, which has carried us some way. I hope the hon. Gentleman listened carefully to what was said by my hon. Friend the Member for Westminster, St. George's (Mr. Howard) and that he will give consideration to it before we reach another stage, in order to see whether it may be possible to put down further Amendments on the general lines which I have indicated. In those circumstances, I beg to ask leave to withdraw the Amendment.

I want to say one word on the Question "That the Clause stand part," which I did not wish to introduce into the discussion on the Amendment for fear of making a rather involved position even more involved. There has been some discussion on the part that teaching hospitals should or should not play in the standing nurse training committees, and I want to make it clear, as one closely associated with all the teaching hospitals, that so far as I am concerned as well as those with whom I am in close contact there is no desire whatsoever to isolate them from these proposed new committees.

I could, without any difficulty at all, make a short statement about what the hon. Gentleman has just said. It would, of course, be quite silly for the hospital system as a whole to say that all hospitals, no matter where they are, no matter what kind of cases they are treating, would require the same number of skilled nurses. That is part of the difficulty of costing the hospital system. It would be quite easy if we could say that there were so many patients per bed, and as a hospital has so many beds its ration of nurses amounted to so many. In that event the costing and control of the hospital administration would be as simple as selling pounds of margarine across the counter. We all know that is not the case. It is very difficult to find comparable hospitals. We shall, of course, confine it as much as possible so that costing systems are subject to identification and will show where gross extravagances take place. However, we have to have regard to what a particular hospital is doing, the kind of patient population that it has, what are the specialist needs of the hospital, and, of course, in this regard a teaching hospital occupies a peculiar position.

I am most grateful for what the Minister has said. He obviously sees the point I made, and he has dealt with it as fully as one could expect in present conditions.

I beg to move, in page 5, line 3, after the first "of," to insert:

"not less than seven nor more than eleven."

It is our general feeling that we do not want in any way to limit or unduly restrict the powers of the General Nursing Council in setting up this committee. I think it is commonly agreed that no one wishes to do that. We would all agree that it would be normally desirable that a finance committee should not be a large body, but I think we would be putting ourselves in some difficulty and taking a responsibility which we would rather leave to the General Nursing Council if we were to specify, even within the limits suggested in this Amendment, any kind of precise numbers for the finance committee. I believe the general view of the Committee is that it is normally desirable for the finance committee to be a reasonably small body, but I am sure that this is a matter which we ought to leave to the General Nursing Council itself to decide.

rose—

On a point of Order, Mr. Bowles. The discussion has gone rather wider than the scope of the Amendment which I moved. My hon. Friend the Member for Putney (Mr. Linstead) has an Amendment on the Order Paper which he is anxious to move, and the same point can adequately be raised on that Amendment. In view of what the Parliamentary Secretary has said, it might be convenient if I withdrew this Amendment so that my hon. Friend should move his Amendment, the terms of which are a good deal wider, and the discussion might take place more appropriately on that Amendment. I therefore beg to ask leave to withdraw the Amendment.

I beg to move, in page 5, line 3, at the end, to insert:

"which shall include the three members appointed by the Minister as appearing to him to have had experience of the control and management of hospitals."

"regulating the conditions of admission to the register; for regulating the conduct of any examinations … and any matters ancillary to or connected with any such examinations."

"which shall include, in addition to members of the Council, persons experienced in the administration of grants to educational institutions."

The hon. Member will realise that in one case it is merely a matter of distributing money. The money made available for training, unlike the professional requirements of the General Nursing Council, will come from the Government in future, but the professional fees, the sums required purely on the professional side, will come out of the Council's own finance.

The Parliamentary Secretary is now saying that the expenses incurred under Clause 6, that is:

"All expenses incurred by a standing nurse-training committee with the approval of the Council shall be defrayed by the Council,"

"estimates approved by the standing nurse-training committee shall be defrayed by that committee."

Might I suggest to the hon. Member that he should complete the moving of his Amendment rather than invite the Government to reply at this stage. There is no Question before the Committee?

I wanted to deal with the most helpful interruption of the Parliamentary Secretary, because I am not at all sure that it does not take a great deal away from my Amendment, but in order to give the Parliamentary Secretary an opportunity to reply at slightly greater length, I will conclude.

This discussion has gone to the root of certain matters covered both by this Clause and by other Clauses. It is rather difficult to pick up all these matters at the same time. May I say that I appreciate the spirit behind this Amendment? I am not sure that there is any difference of opinion as to the views of the hon. Member for Putney (Mr. Linstead) has put forward, that there seems to be a reasonable distinction between these two functions, and that where there is a clash the same person should not have the responsibility of answering in two different capacities—no one can do that successfully. But it seems to me that that is not the position under the Clause.

I am very anxious that we should be clear on this. I subscribe entirely to what my hon. Friend the Member for Blackley (Mr. Diamond) has just said. We naturally expect that these three persons who have been appointed to the General Nursing Council, for the reason that they have experience of the control and management of hospitals, will most probably be the people appointed to the finance committee, but we do not wish to tie down the General Nursing Council completely to the appointment of these three people, which would be a little unreasonable. We have every confidence in the General Nursing Council, but it may be that among these three persons there is one who is not as suitable for working on the finance committee as the others. We must leave this reasonable amount of latitude to the General Nursing Council.

We are in complete agreement as to what we want to achieve, but we are not in complete agreement yet as to whether we have achieved the best possible result or not. I want to make this one suggestion. Will the Parliamentary Secretary turn over in his mind between now and the Report Stage the possibility which, without being egotistical, I would remind him that I mentioned on Second Reading, that it might go some way to solve this problem if, as well as having a statutory finance committee of the G.N.C., its education or training committee were also given statutory position. I am not certain whether it is called an educational or training committee. Then we should, perhaps, secure a better balance. There are probably objections to it, but I throw it out as a possibility which I think is worthy of serious consideration between now and the Report stage.

I have, unfortunately, committed myself to, an engagement which makes it necessary for me to leave the Committee shortly, and I hope that the Parliamentary Secretary and the Committee will accept my apologies. I am grateful to the Parliamentary Secretary for what he said, but I feel again that I am on firm ground. I thought for the moment there was a differentiation between two forms of expenditure. It is clear to me now that there is not, and that, in fact, the General Nursing Council is being asked to do the very thing the hon. Member for Blackley (Mr. Diamond) said they should not be asked to do. In his own words, "One and the same person has power to answer two different questions." I am sure that, as experience accumulates, it will be found that that is a mistake.

I beg to move, in page 8, line 31, at the end, to insert:

"(3) The Lord Chancellor may pay to any person nominated by him under the last foregoing subsection such fees and allowances as the Lord Chancellor may, with the consent of the Treasury, determine; and any expenses incurred by the Lord Chancellor under this subsection shall be defrayed out of moneys provided by Parliament."

I beg to move, in page 9, line 3, at the end, to add:

"(2) The Minister may make to the Council, out of moneys provided by Parliament, contributions of such amounts as he may determine towards the expenses of the Council in inspecting and approving for the purposes of the training rules institutions vested in him."

I support the Amendment, having regard to the very firm assurance which my hon. Friend gave me when this matter was discussed on the Committee stage of the Financial Resolution, which, for the purpose of accuracy, I have in front of me, and will quote:

"I would add the assurance that it is the intention to ensure that 100 per cent. reimbursement of all expenses approved by the Minister … will be guaranteed under this wording."—[OFFICIAL REPORT, 21st October, 1949; Vol. 468, cols. 965–6.]

I beg to move, in page 11, line 8, at the beginning, to insert:

"All expenses incurred by the Council with the approval of the Minister which are attributable to defraying expenditure incurred by standing nurse-training committees shall be defrayed by the Minister out of moneys provided by Parliament, and."

I beg to move, in page 11, line 14, to leave out from "defrayed," to the end of line 15, and to add "by the Council."

I appreciate the action of the Parliamentary Secretary in removing words, and so automatically removing the restriction upon the financial action of the Council, but I have the fear that from the removal of these words misunderstanding may arise. I fear that the removal of these words may be interpreted as an invitation to anyone who so desires to put pressure on the Council to do other than meet its current expenditure out of current income. I am sure, especially having regard to the remark which the right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot) was so incautious as to make on Second Reading of the Bill with regard to the finance of the Council, that it would be the wish of all sides of the Committee that this Council should carry on its financial affairs as any other well appointed body, on the basis of meeting its expenses, as far as humanly possible, out of current income. If there appear to be good reasons why it could not, over a couple of years, say, meet its expenses, then it ought to consider varying its main income. Here we have what may be interpreted as an open invitation to the Council to mortgage its substantial property, and out of its capital accumulated in the past—I do not know exactly how it has been accumulated, but at all events it is there—to meet ordinary outgoings. That, I am sure, would be a very bad thing.

I must confess that I am really shocked by this Amendment. The Government are quite blatantly empowering the Council to live on capital. There is no question about that. I do not want to strike a discordant note, and I do not think this is a matter we would wish to press so far as a Division, but this is an Amendment which we on this side of the Committee cannot welcome. I can see no reason whatever why the Council should be empowered to spend capital other than for income purposes. That, I think, is the only effect of this Amendment.

On a point of Order. Before the Committee agrees to the insertion of the words "by the Council," would it be in Order for me to speak on the possibility of adding certain alternative words?

I have considered this matter, and I thought that the next Amendment, standing in the name of the hon. Gentleman—in line 14 to leave out from "defrayed" to the end of line 15, and to add:

"by them out of sums received by them by way of fees and contributions"—

I appreciate that. I am grateful to you, Mr. Bowles, and I apologise for detaining the Committee yet a second time on this Amendment. On the first occasion on which I spoke I did not, of course, deal with what I thought would be a preferable form of wording to the form put down by my right hon. Friend in this composite Amendment. It is proposed to add simply the words "by the Council," whereas it is clear that there might be another form of words which could conceivably have reference to sums received by the Council by way of fees and contributions, which form of wording might be better than that which my hon. Friend has put before the Committee.

"out of the sums received by the Council by way of fees."

I have allowed the hon. Gentleman to make a speech on this question, on the understanding that he is not trying to move an Amendment in the course of it. The Government will, of course, take notice of what he is saying, and if they are influenced by it will no doubt make the necessary arrangements later on. The hon. Gentleman can certainly refer to the words which he wants to have inserted.

I am most grateful to you, Mr. Bowles. It will be helpful if, instead of the words proposed by my hon. Friend in this Amendment, there were substituted the words:

"by them out of sums received by them by way of fees and contributions."

I do not want it to go out from this Committee that we want in any way to encourage the General Nursing Council to embark upon some form of profligacy. It was our intention, and still is, that the Council should not be prevented—as it is our view that they are at the moment—from applying, for example, rents or interest to defraying their expenses. Indeed, we are giving power for them to mortgage their property, and there is not much sense in their having power to mortgage if they have not the power in an emergency to use the funds they receive from it. I appreciate the general point that has been raised, but I do not think there is anything between us. At the moment we are not satisfied that the words suggested in my hon. Friend's Amendment, which has not been selected, really meet the case adequately; we are not satisfied that they do give the power in an emergency which my hon. Friend himself would desire that they should possess.

I beg to move, in page 11, line 35, at the end, to insert:

"'chief male nurse' means a male nurse in charge of the male nurses employed in a mental hospital."

I beg to move, in page 12, line 8, at the end, to insert:

"'prescribed' means prescribed by rules made by the Council under this Act."

I would ask whether this is really and necessarily a drafting Amendment. Acts of Parliament are already sufficiently complicated, but the need for the Amendment appears to arise from the fact that the word "prescribed" is used in the Bill. That word has not been used in the previous Acts of Parliament dealing with nurses. Provision is made under which the General Nursing Council may make rules. It is set out how they have to make the rules and the procedure to be followed. As far as I can see, the need for this additional complication arises merely because in Clause 18 the word "prescribed" has been introduced.

I am very ready to have a look at the matter.

I beg to move, "That the Clause be read a Second time."

I beg to move, "That the Clause be read a Second time."

In moving the proposed new Clause my hon. Friend has mentioned the reason why we would not be very willing to include the Clause ourselves. It is true that one instance has occurred, but I think he would be the first to agree that it is a pity to legislate for the exceptional circumstance. Furthermore, the list is gradually being superseded. It is already closed to new entrants and opportunity is being given under the Bill for those who are on the list to move on to the register. Gradually the list will decline in importance.

There is a great responsibility on the Council for protecting the status of all the nurses for whom it is responsible. Although I am very glad to hear my hon. Friend say that there is possibly—I do not think he went very much further than that—a way of dealing with this matter, I would ask him to bear in mind that I have sinned greatly in bringing this matter before the Committee. If there were only one case and I had said nothing about it, nobody would be any the wiser. Having brought it erroneously to the full light of day in the Committee, it is now open and public knowledge that the armament of the General Nursing Council for protecting its nurses of various categories is not entirely bullet proof. The position might not have been very serious—having regard to the fact that only one case has arisen—before anybody knew about it outside the Council. Now I have, at the Council's request, put this matter forward.

I beg to move, in page 13, line 11, at the end, to insert:

"and one shall be a member of the University Grants Committee."

"two persons … of whom one shall be appointed to represent universities in England and Wales."

I do not feel that we should tie the hands of the Privy Council in this way. They already have the obligation that one of the two members appointed by them shall represent the universities in England and Wales. It seems to me that if we were to make a specific requirement in the manner which is suggested, they would be prevented from exercising any general discretion at all. There is also the point that it might happen that they would not be able to get the agreement of a member of the University Grants Committee to serve as suggested. In that event they would be placed in a rather difficult position. On all these suggestions of further specification of particular categories for representation, we have already gone as far as we ought to go. We have given the matter a very great deal of consideration and there is danger in tying the hands of the appointing bodies too tightly.

There is great force in the answer which has been given by the Parliamentary Secretary. I am sure he will not disregard the point of view expressed in the Amendment, but in view of what he has said I beg to ask leave to withdraw the Amendment.

I beg to move, in page 13, line 16, after "persons," to insert:

"(hereinafter referred to as 'the general electors')."

I beg to move, in page 13, line 37, to leave out "by local health authorities," and to insert

"in services provided under Part III of the National Health Service Act, 1946."

I should like to say how much we on this side of the Committee welcome the Amendment, which we regard as being wholly in the right direction.

I beg to move, in page 14, line 6, at the end, to insert:

"(d) one shall be a nurse whose name is included in the supplementary part of the register containing the names of nurses trained in the nursing of persons suffering from infectious diseases, appointed by him after consultation with such persons and bodies as he thinks fit, being persons and bodies having special knowledge and experience of the work of nurses whose names are so included."

"A foolish consistency is the hobgoblin of little minds"

"one, who shall be a registered fever nurse, shall be elected by registered fever nurses."

I am in some doubt about this whole series of Amendments. If we were to grant what is asked for, we would have to increase the size of the General Nursing Council rather considerably. [HON. MEMBERS: "No."] If they were all to be added together, that is true. Obviously, it is important that instead of having an unwieldy General Nursing Council—it might be argued that we already have a body which is somewhat too large—we ought to try to retain, as I mentioned in replying to the previous Amendment, in the hands of the appointing Ministers and the Privy Council some discretion regarding the interests of the persons to be represented If I were to give way on this series of Amendments we would lose that freedom which it is vital for the Minister to retain.

Would the Minister, in making these appointments, consider what I have submitted to the Committee, and would it be understood that he will endeavour to consult bodies with special knowledge of the range of problems before the appointments are made?

I beg to move, in page 14, line 7, to leave out, "one." and to insert "two."

I support strongly the plea made by my hon. Friend the Member for East Harrow (Mr. Skinnard) and I was sorry that the Parliamentary Secretary seemed rather scornfully to throw all these Amendments into the wastepaper basket—

No.

Like the late Mrs. Gamp, he sought to "proticipate."

If he did not do so, I withdraw part of that. Shall I say he was rather disdainful? [HON. MEMBERS: "No."] Then I withdraw it altogether and will assume instead that my hon. Friend was most anxious to try to meet our plea, but that he foresaw some insuperable difficulties, one of which was that he thought this was over-particu- larising the kind of representative who should be on the Council. Yet already he has accepted the principle of particularisation.

One of the principal objects of the General Nursing Council is to deal with the practical training of nurses, and the individuals who have the most part in that are the ward sisters. The sister tutors of the hospital deal with the theoretical training of the nurse, and the matron deals with the organisation of the nursing service generally in the hospital. Both individuals are somewhat remote from the direct, daily, personal, training of the student nurse. If anyone needs representation on the General Nursing Council, it is these people who are practically engaged all their time, or ought to be, in nurse training. I feel we cannot have too great a representation of the ward sisters who are the pivot of the whole hospital.

I wish to support the Amendment. In view of the warm terms used on Second Reading in commendation of the ward sisters I am a little surprised to note the apparent reluctance of the Parliamentary Secretary to concede our request. I do not want to adopt a threatening attitude on this matter, but I should like the Parliamentary Secretary to know that four out of the five hon. Members who put their names to the Amendment are present. That almost constitutes a majority of those present, particularly if we can persuade the three hon. Members opposite to rally to our support on this matter. I would not like it to be thought that any of the arguments we have put forward in support of the increased representation of ward sisters are to be regarded as in any way critical of hospital matrons. Even within the privileged walls of this assembly, I should hesitate to criticise the matrons of our hospitals—

Does that mean that my hon. and gallant Friend is as frightened of them as are some nurses?

I think it would help to make the work of the Council much more effective, and perhaps much more democratically representative of this very important section of the nursing profession, if the Minister were to concede this Amendment. Even if he does so, while he is tied as to 10 out of the 12 appointments which are within his power, he will still have a free hand as to two of the appointments. In those circumstances, I ask him, in view of the admittedly high regard in which everyone holds the contribution made to the hospital service by the ward sister, to grant this small concession.

I hope that my hon. Friends on this side of the Committee will not think me lacking in logic if I say that I find myself in considerable sympathy with the Parliamentary Secretary's desire not to be compelled to fill three vacant places from six or seven appointees of one sort or another. The series of Amendments which follow all have the same point in view—to give representation to particular classes. I also hope my hon. Friend will bear in mind everything that has been said on behalf of the ward sister and anything that may be said of any member of the nursing world as a whole.

Only the elected members.

Lest that point might arise, I have taken the precaution of ascertaining precisely the categories of the individuals elected at the time of their election. The present General Nursing Council consists of 25, and I agree with the Parliamentary Secretary that the numbers have been increased almost to an unwieldy extent. Nine are appointed and, out of the 16 elected, nine are matrons and were matrons at the time of their election. If hon. Members are interested, I can give details of all the Members—

How many are ward sisters?

There are nine matrons, three sister tutors, one male tutor, one departmental sister, one nurse and one engaged in administration. I hope that I have dealt with the fear that only those of one particular category would be likely to be elected to the Council if the Parliamentary Secretary were not empowered to appoint all in every case. The whole of my argument is based on this; that there are many categories to be consulted the existence of some of which we know at the moment, the existence of some of which will arise in the future, and of which we do not know. There are certain categories coming into existence as the art of nursing develops which do not fully exist at the moment and, perhaps, are not fully recognised. My hon. Friend may at some future date wish to make appointments from those categories. In those circumstances I wish to give to him the fullest support I can in his attitude of giving the fullest possible consideration to all categories, especially those mentioned by my hon. Friends, but in refusing to be limited in his choice, and therefore in refusing to weaken the structure of the General Nursing Council.

I am glad that we have had this short discussion on this matter. There has been recognition that we have in this Bill tried to provide a reasonable amount of representation to those particular interests, if I may use that term, which certainly require and demand particular representation. We have gone further in extending that list by including one representative of ward sisters to ensure that their particular point of view should be expressed. We have no reason to believe that they will be denied automatic election but we wish to ensure that there is representation of their point of view. We cannot, however, carry this procedure much further; in fact I do not think that we can carry it any further.

Are we to assume meanwhile that despite what my hon. Friend has said about the undesirability of specifying particular categories, he attaches so much importance to nurses in the National Health Service that he feels that in that case there must be two appointed by him, and that therefore they are more important than ward sisters?

I strongly deprecate the attempt by hon. Members, which I think is most unfortunate, to try to evaluate the work of particular categories of nurses in this way. They are working as a team and it is quite wrong to insist that one particular category is doing more important work than another.

It is in the Bill.

They are all doing work of great importance. There is insistence in the Bill on representation for the work of nurses in the local authority field because it is a different kind of work altogether from that being done by other sections which are represented, and it is of the utmost importance that they should be represented.

I concede that my hon. Friend has tried to be helpful and sympathetic but I wonder whether he would help me a little further in one respect? Does he consider that having a certain number of unallocated places at the Minister's disposal for nomination is a valuable way of balancing any undue preponderence of one type of representation on the elected side? If that is so, can he tell me whether the Minister is to make his appointments before or after the elections, because if the appointments are to be made before the elections the argument does not hold water? If regard is to be had as to the result of the elections before the Minister makes appointments, I will concede that my hon. Friend has made a very good case indeed for elasticity in making the appointments.

I beg, to move, in page 14, line 16, at the end, to insert:

"(f) two shall be registered medical practitioners."

"In the past, medical men have found their way on to these committees, and I think the noble Lord may rest assured that under the new dispensation there will be no change."

Here, as has already been mentioned, the practice has always been that in the field of appointments of the Minister, not purely appointments where he has complete discretion, but within the other appointments of the Minister, he has always in the past assured representation of some from the medical profession. We can give this assurance, that there is no intention to depart from that general practice. For the reasons I have already advanced I would rather not tie myself to the insertion of these words in the Bill.

The Parliamentary Secretary has given a quite clear assurance, and, of course, we are happy to receive that assurance. But I am not altogether happy to leave the matter as it stands. Apart from the three persons referred to under paragraph (e), and the three vacancies, it is quite clear that the Minister could not appoint doctors to this Council. All the others are nurses—I think that is right. It is true, of course, that there are other persons who are appointed not by the Minister; that is to say three persons by the Minister of Education and two appointed by the Privy Council. I think my hon. Friend made it clear that what we are concerned with is to see that the medical profession is fully represented on the Council. We are not concerned particularly with the precise wording of this Amendment.

But why?

I wonder whether the Parliamentary Secretary will give an assurance that he will look into the matter from the angle, not that of these remaining three there should be two members of the medical profession, but that he would so contrive his appointment that there will always be at least two members of the medical profession on the Council?

I am not at all sure about this point. I fail to see why the medical profession should, by statutory legislation, be included on the General Nursing Council, unless there is to be a reciprocal arrangement by which nurses will be included in the reform Bill of the General Medical Council which is pending. I have read the B.M.A. memorandum on this point with great care. I have read it as a member of the B.M.A. Council and I shall tell them at the next meeting of the Council that I fail to see why the medical profession should ask to have representation on the General Nursing Council.

I beg to move, in page 14, line 16, at the end, to insert:

"(f) one shall be a person appearing to him to have had experience in the nursing of tuberculosis patients."

I must confess that, of all the claims for special representation, the one that interests me most of all is that which has just been put forward, because it is perfectly true that there are particularly urgent problems in connection with tuberculosis in this country today. If I felt that it was not possible to meet this suggestion in any other way, I should be very much inclined to accept the Amendment.

It seems to me that we are not appreciating the full scope of the duties of the General Nursing Council. Its duty is not only to supervise the training of nurses, but it has put upon it the very difficult duty of maintaining the register and of dealing with human beings who have fallen into human errors and who come before the Council for its decision whether they shall be able to continue carrying out the vocation on which their hearts are set and on which their very economic livelihood also depends. It is a very serious matter for any member of the General Nursing Council to have to deal with, and I can assure my hon. Friends that it always causes the greatest anxiety to every member of the Council.

I thank the Parliamentary Secretary for the sympathetic way in which he is considering this Amendment. He pointed out with truth that in future it is to be hoped that all nurses with a general training will have had experience in the nursing of tuberculosis. That is a hope which we all share, but that is not the case at present, and it might be more helpful in bringing about that nappy state of affairs that one or two nurses on the General Nursing Council should have had actual experience of nursing tuberculosis cases. In view of the statement of the Parliamentary Secretary, however, I beg to ask leave to withdraw the Amendment.

I beg to move, in page 14, line 20, to leave out from the beginning, to the second "and," and to insert:

"a scheme to be formulated by the Council and approved by the Minister and the."

I am very willing to have a further look at this matter. It was our intention that there should be an opportunity for the House to see a scheme laid down. Whether that is wholly necessary or not, we feel that, under the changed constitution of the General Nursing Council, it might be of value in future, in view of the particular problem of election that would arise; but I am very willing to examine the matter again and particularly to see whether the wording is adequate to carry out our intentions. If any further variation is needed before Report stage, we will make the necessary alteration.

I hope the Minister will not accept this Amendment. I listened very carefully to my hon. Friend the Member for Blackley (Mr. Diamond), and he seems to me to be quibbling as to what is prescribed. The terms of his Amendment are, "a Scheme to be formulated by the Council." The Council is not in existence yet, so how can it formulate something when it is not in being? The election of the Council, according to the Minister, will take place in a prescribed manner. I hope the Minister will go ahead with this scheme. If he cannot do it by regulation he can certainly prescribe it, and if that is done it can be done in a prescribed manner.

I have the greatest possible respect for my hon. Friend the Member for Rochdale (Dr. Morgan) and there is a warm friendship between us. However, he was not able to be here earlier when an Amendment was accepted which made it quite clear that "prescribed" does not mean prescribed according to the General Nursing Council. Therefore, I was inviting my hon. Friend to do something more. In view of the Parliamentary Secretary's assurance, I beg to ask leave to withdraw the Amendment.

I beg to move, in page 14, line 33, after "Council," to insert

"to be elected in accordance with the foregoing provisions of this Schedule."

We are quite in agreement with the object of this Amendment, though we would like to reconsider the precise form in which it should be carried out. On the understanding that we will bring forward a fresh wording on the Report stage, I trust my hon. Friend will withdraw his Amendment.

I am most grateful to my hon. Friend, and I beg to ask leave to withdraw the Amendment.

I beg to move, in page 15, line 9, after "may," to insert

"sell mortgage charge lease surrender exchange or otherwise."

"as they think fit of any property acquired by them."

"sell mortgage charge lease surrender exchange or otherwise."

I am very glad to be able to give the assurance for which my hon. Friend asks. I am quite clear that these words are included already and are covered in the wording of the Clause.

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

I beg to move, in page 16, line 14, at the end, to insert:

"Provided that no person shall be qualified to audit the accounts referred to in sub-paragraph (d) of this paragraph unless he is a member of one or more of the following bodies:

• The Institute of Chartered Accountants in England and Wales;
• The Society of Incorporated Accountants and Auditors;
• The Society of Accountants in Edinburgh;
• The Institute of Accountants and Actuaries in Glasgow;
• The Society of Accountants in Aberdeen;
• The Association of Certified and Corporate Accountants;
• The Institute of Chartered Accountants in Ireland."

It would be difficult for me either to include these words in the Bill or to give a complete assurance that we will accept this Amendment and include it in the rules to be issued, for the reason that the most convenient and economical way of carrying out the audit would obviously be to use the auditors appointed by the Minister to audit the accounts of the regional hospital boards and boards of governors. Obviously, the two accounts would be so closely allied that there is every reason why, economically and administratively, the audit should be done by the same people. For that reason, while we will certainly have regard to the points made by my hon. Friend, I am afraid I cannot give a guarantee specifically in the terms he asks.

In view of the fact that my hon. Friend has not been able to give a greater assurance than he has given, and as this matter requires careful consideration, I regret that I am not able to seek the approval of the Committee for the withdrawal of this Amendment, although perhaps I had some idea of what would happen to it.

There are three points which I wish to make very briefly. The first is to remind the Parliamentary Secretary of the very clear assurance he has given that the majority of the members of each of these committees shall be members of the nursing profession. I still hope that between now and the Report stage it will be possible to find some words which, when inserted in the Bill, will give added power to the assurance. I realise the difficulty, but I still hope.

As to the first point that the hon. Gentleman has raised, I am very glad to repeat the assurance which I gave on the Second Reading, that we intend to ensure that there shall be a majority of members of the nursing profession on these regional committees. I assure the hon. Gentleman that we have given a great deal of consideration to ways of wording this provision to ensure that it will be understood generally, but so far we have found it impossible to devise a suitable form of words.

I would agree with the Minister if he were referring to a particular interest within the three general categories that I was mentioning. I agree that there must be variations. But does the hon. Gentleman think that there must be differentiations between those three general categories themselves?

I am thinking of the example of the position in London as compared with other areas. It seems to me that it is quite possible—I will not put it higher than that—that there may be special features which may require special consideration. However, I will bear the hon. Gentleman's point in mind.

I beg to move, in page 17, line 9, to leave out from "a," to "such," in line 10, and to insert "chief male nurse of."

I beg to move, "That the Clause stand part of the Bill."

I beg to move, in page 49, line 43, to leave out "the prescribed officer," and to insert:

"such officer as may be prescribed by the Court of Session by Act of Sederunt."