§ Order for Second Reading read.
§ Major BARNETT
I beg to move, "That the Bill be now read a second time."
The Bill which I have the honour to submit to-day for Second Reading is one the principle of which has already been approved of by this House. As far back as 1905 a Select Committee of the House took evidence in two Sessions on the subject of the State registration of nurses, with the result that it was reported,Your Committee are agreed that it is desirable that a register of nurses should be kept by a central body appointed by the State.In 1908 a Bill in all its essentials similar to that which is before the House to-day was brought in in another place and passed through all its stages without a Division. In 1914 a similar Bill was introduced into this House under the Ten Minutes' Rule. There was a Division and by a majority of 228 the House of Commons agreed that the Bill should be read a first time. Then the War intervened and of course it was impossible for private Members to get facilities for carrying the Bill further. This is a reform which is very much overdue. At first sight it seems somewhat remarkable that this country, which has been the pioneer in nursing, which is so proud, and so rightly proud, of its nurses, and which has recently paid honour to the great name of Florence Nightingale and her devoted band of helpers, should lag behind many of her own Colonies and many other countries in this matter of the State registration of nurses. But so it is.
At present there is State registration in South Africa, not only in Cape Colony, but in Natal, the Transvaal, and the Orange River Colony. In Canada the Provinces of Ontario, Manitoba, Alberta, and British Columbia have all got State registration of nurses. In Australia, Queensland has adopted the principle, and in India the Bombay Presidency. The principle is in force in forty-six of the United States of America. It was in force in the German Empire and Belgium. So far as this country is concerned there is nothing more vague or undefined in the whole realm of medicine and surgery. Nothing else of such importance has 772 been left undefined. We know what a medical practitioner is; there is a statutory definition. We know what a dentist is and what a midwife is; there is a statutory definition in each case. What is a nurse? She may be a modern counterpart either of Florence Nightingale or of Sarah Gamp. There is nothing whatever in our Statute Book to define her position or qualifications, and it is in order to give nursing the dignity of a profession that this Bill is introduced. I ought perhaps to say something of the Central Committee which is responsible for drawing up this measure. The Central Committee came into existence in the year 1910. It represents by delegation the British Medical Association, the Royal British Nurses' Association, which is under Royal Charter, the Matrons' Council of Great Britain and Ireland, the Society for the State Registration of Trained Nurses, the National Union of Trained Nurses, the Fever Nurses' Association, the Scottish Nurses' Association, the Irish Nurses' Association, and the Irish Nursing Board, comprising altogether no fewer than 30,000 medical practitioners and nurses. The House will agree that that is a highly representative body which is responsible for the inception of this Bill.
The first thing which we propose is to establish a General Nursing Council. It may be asked who are the proper people to put on this Council? First, the Crown must be represented by persons appointed by the Privy Council. Medicine must be represented, because medicine and nursing are closely interdependent. There is provision in the Bill for the nomination of a certain number of medical practitioners by the Local Government Board. It will be the Ministry of Health if certain legislation now before the House goes through. There is also provision for the nomination by the British Medical Association of certain medical practitioners. Then we come to the most important part of the Council —the elected part, the part which will be elected by registered women nurses, and will consist partly of matrons and partly of trained nurses. There is provision also for representation of the nurses' training schools. They will be represented. It is quite clear that there ought to be representation on the General Council of Nurses for the lay element, boards of governors and others who are interested in this question. But while I say that there ought to be representation for the lay element, 773 I think it exceedingly important in the interests of the nurses that this representation should not be predominant. I do not wish to go into details, but it is quite obvious that the General Council of Nursing cannot be created at once because it depends on having an electorate, and that electorate can only be created through the register. Therefore this Bill provides for what I may call a provisional or initial council which will hold office for two years and which will draw up rules and regulations to govern the profession of nursing. All the members I have already referred to as being members of the General Nursing Council when it comes into force will be members of the initial council except that there will not be representatives directly elected by the trained nurses. It will be the business of the initial council to hold office for two years and to devote itself to the formation of the register. The Clause provides:The persons so appointed shall hold office for a term of two years until the task of forming a register of persons entitled to be registered under this Act is sufficiently advanced to admit of an election of direct representatives of registered nurses.Then there is a provision for the election of direct representatives when the register has been formed and it is possible for the nurses to elect their own representatives. Even the form of nomination paper is set out in the Bill. There is a very extensive section which deals with the duties and powers of the General Nursing Council. The rules which are made by this body are not to have effect until they are approved by the Privy Council, and it is only with that approval that they obtain the force of law. There is also a provision setting up divisional boards for England and Wales, Scotland and Ireland. Those boards will hold examinations under the curriculum established by the General Nursing Council, and will inquire and report to the Council upon the character and status of all applicants for registration in their respective divisions of the Kingdom, and perform such other duties as the Council may from time to time determine. There is an appeal from those divisional boards to the Council, and that ought to be a safeguard against any possibility of oppression. The House will, I am sure, be anxious to know what is to happen to those people who are nurses already. The House always wishes to protect those who are carrying on an occupation and to see that nothing in the way 774 of legislation takes away their just rights. In the first place, there is what I may call a period of grace, or an interregnum, of three years during which any person who is bonâ fide carrying on the business or profession of a nurse, will be entitled to come forward and claim registration. Clause 12 provides:Any person who within three years from the commencement of this Act claims to be registered thereunder shall be so registered provided such person is a British subject, is at least twenty-one years of age, and is of good character,, and either (1) holds a certificate of training for such period as may be prescribed by the rules framed under the provisions of the Act, etc.The second Sub-section of that Clause provides for registration, provided the person holds a certificate as to training from the Lords Commissioners of the Admiralty, or under regulations authorised by the Army Council for soldiers of the Royal Army Medical Corps, and the third Subsection if the person holds a certificate from the Local Government Board for Ireland or from the Local Government Board for Scotland as to qualifications, and by the fourth Sub-section if the person produces evidence satisfactory to the Council of training prescribed by the rules framed under the provisions of this Act and has, in addition, been for at least three years in bonâ fide practice as a nurse. I think, therefore, that the House will see that there is no room for oppression under this Bill. Registration is not compulsory, but no man or woman will be able to describe himself or herself as a registered nurse unless the person so described is a registered nurse. That will provide security for the public that they are getting what they ask for, and that when they ask for a registered nurse it will mean a nurse with a certain standard of training and efficiency. It will also help the medical profession because they in their turn will be able to rely on the qualification not given by merely one hospital, as is the case usually now, but a general qualification which has been set up by the body representing the whole of the nursing profession and the medical profession. It seems to me that as things stand at present there is really no standard. Every hospital is a law unto itself, and there may be a very much better system of training in one hospital than in another. Here you get standardisation which would be to the interests of the hospitals, and especially the smaller hospitals which at present have to look to the great hospitals for their 775 trained nurses. The smaller hospitals under this Bill if they satisfy the General Council of Nursing as to their training will in many cases be able to train their own nurses. After the period of three years no one can be registered except those who satisfy the requirements, which are that the person who claims to be registered shall be a British subject of at least twenty-one years of age and of good character, and has gone through the curriculum laid down by the Council of Nursing which will include an examination. In other words, the qualification will be somewhat stiffened up after the three years. There is a similar provision in the Midwives Bill, and when you are dealing with a vocation which already exists you must facilitate people getting on to the register who are fairly competent and who have been carrying on the duties up to the present. But the idea of this Bill is to set up at the end of that three years perhaps a little higher standard than some of those nurses have attained, who will come on the register now. There will be a higher standard set up and maintained. Clause 16 provides for the register, and that register is to be a general register of women nurses registered under this Act. There is to be a supplementary register of male nurses, and a further supplementary register of mental nurses, and the House will see that both of those supplementary registers are of a type of nurses who are really not sick nurses at all. Male nurses and mental or psychological nurses have a different training altogether, and must be on a supplementary register. A question will, no doubt, be raised in Committee, if the Bill secures its Second Reading, whether there ought not to be further supplementary registers for the enrolment of children's nurses, for instance. I do not wish to shut the door to any class of nurses who are carrying on the profession at present, but the feeling of those responsible for this Bill is that, just as in the medical profession a general qualification is asked for before a man specialises, so in nursing a general qualification would be a very good start for a woman who wished to become a children's nurse or to specialise in any other branch. Probably some system of reciprocal training will be possible, in which the nurses in children's hospitals would serve for a time in a general hospital.
776 I come to a point on which there has been a good deal of criticism of this Bill, and it is that of finance. A document has been circulated to hon. Members which endeavours to riddle this Bill with criticism on the ground that we do not provide proper financial means for carrying out its provisions. In the first place, we are not making any demands upon the public purse, and I am sure it must be a change to hon. and right hon. Members to have a Bill in their hands without those fatal italics which mean another raid on the Treasury. The nurses are not asking for any public money, but neither are they asking for charity. They do not want to carry on their organisation by means of side shows like bazaars, concerts, and dances. They want to be a self-supporting and a self-respecting profession. At the present time it is estimated that there are 80,000 practising nurses in the United Kingdom, and it is believed that if this Bill goes on the Statute Book 50,000 nurses will register in the first year at a fee that is not prescribed yet, but which is suggested at two guineas. That will give 100,000 guineas, which, invested in the direction which my right hon. Friend (Mr. Bonar Law) can indicate, will give 5,000 guineas of annual income with absolute safety. That will be quite sufficient, with the new fees coming in, and the new nurses registering in each year, and with the examination fees, which it is suggested should be something from one to three guineas—and I favour the higher figure—to carry out all the purposes of this Act. It is suggested in the leaflet that has been circulated that our Bill fails entirely to provide any financial basis adequate to sustain the expenses of conducting examinations, of publishing annually the register, of erecting or running buildings suitable for central offices, of paying examiners, travelling expenses, etc. I will say at once that those who are responsible for the preparation of this Bill are not suffering from megalomania. They have no desire to spend large sums of money in bricks and mortar to erect enormous offices where the business of this General Council of Nursing shall be carried on. That is not their programme. I have indicated a source from which 100,000 guineas can reasonably be expected to come in the first year of the operation of the Act, and year by year, as other nurses come forward, there will be a fund for keeping up the register, while the examination fees will provide money for the 777 proper payment of examiners and the holding of the examinations. People say that nurses will not pay as much as five guineas for professional training and registration. Midwives pay between £20 and £30 for their training and registration, and I do not think that any nurse or her people will object to paying two guineas once for all for the privilege of registration, and an examination fee at the highest of three guineas, making five guineas in all.
I think this is a bogey about finance. It is circulated by people who say that they have already £40,000 in hand. They have raised £40,000 largely by charity entertainments, dances, and so on. But we do not want to raise our money in that way. We think that on the face of the Bill nursing can become a self-supporting profession, registration can be provided for, training can be provided, and examinations can be provided. We have now got returning to this country large numbers of trained nurses who during the past three or four years have been rendering splendid service in nursing our wounded soldiers at the front. I suggest to this House that no higher tribute could be paid to those nurses now returning to this country than to raise their vocation into the dignity and the status and the importance of a profession. That is what I ask the House to do by giving a Second Reading to this Bill. There is opposition to it of sorts. There is the opposition, I believe, of some who are against the principle of State registration altogether. In view of the fact that the principle has already been affirmed by this House, I am not going to weary the House with arguments on the advantages of State registration. I believe that there are people of apparently average intelligence who think that the world is flat, but it is not necessary at this hour of the day to argue publicly that the world is not flat, and similarly I propose to leave those who think that State registration of nurses is undesirable to vote, if they like, against this Bill in the Division Lobby, because I do not think it is necessary to try and convince them by argument; but there are others who think that, whilst State registration is desirable, there is some other Bill, not before the House, which would provide a better method. To those hon. Members I make my appeal, and I say that now we have a unique opportunity of establishing the principle of State registration. If we get our Second Reading to-day, I hope we shall 778 be given facilities to put this measure on the Statute Book. A measure like it in all essentials has already been passed in another place some years ago, and therefore I anticipate that if we obtain the Second Reading to-day the hopes of State registration becoming a reality will be very strongly reinforced. I appeal to every Member of this House who is in favour of the principle, whether or not he thinks this is the perfect embodiment of the principle, to vote for the Second Reading, and to raise upstairs in Committee any objections that he may have on points of detail.
§ Mr. BRIANT
This is the first occasion, on which I have ventured to address this House, and my extenuation is that, for many years, I have necessarily been placed in close contact with the nursing profession, and, if I may add a personal note, I feel that I owe my own life to the efficiency of nursing on more than one occasion. I have been connected for some years with an association—if I may say so, a quasi-official association—which met at the Local Government Board and held an inquiry into district nursing for the whole of London. In addition, I have been chairman of a board of guardians which has at its disposal 1,000 beds and employs 130 nurses and probationers. And most of my life having been spent amongst those to whom nursing is of vital and first importance, I am more and more convinced that, unless some step be taken to give-nurses the status which they have a right to demand, and which they have deserved, then in the future, when nurses will be required more than ever before, we shall find there is a scarcity. Yesterday, as the House probably knows, the Bill for the establishment of the Ministry of Health passed through Committee. It was an interesting and an instructive Committee. Every member of that Committee obviously came with one aim only, and that was to improve the health service, and, owing also to the extremely considerate and earnest attitude of those in charge of the Bill, the Bill went through without any of that kind of controversy which too-often spoils social reform. But I am sure of this, that the Ministry of Health will never carry out its work as efficiently as it desires to do unless it has a far larger supply of nurses in the future. And unless the nursing profession has some security that it will have a definite status in the nation, and be protected from being possibly misunderstood and misrepresented as belonging to that large class of 779 people who pose as nurses without any efficiency and without any real training, then we shall lose that better class of nurse which is so important, and indeed essential, for the health of the nation.
I am sure that the Bill is not perfect. There are points which, personally, I think require criticism and amendment. The main outline of the Bill is such that I hope this House to-day will, at least, pass the Second Reading, leaving certain Amendments open, of course, for the Committee stage. I want to point out that increased avenues of employment are open to women. Women during the last few years have had opportunities for employment at comparatively high rates of wages which were not open to them many years ago, and, unless the position of the nurse is improved, not only by legal status, but by conditions of service and pay, the women of the class which is required will be diverted into other occupations, and the health of this country will undoubtedly suffer. I am glad the Bill does make allowance for those women who have not passed through the ordinary course of training, but who have given many years to nursing, and who have some qualifications which are the result of experience. But I do venture to warn the House that the bonâ fide nurse, like the bonâ fide midwife, has to be carefully watched. For some years I served on a, midwives' committee of the London County Council. I was struck—I may say horrified—on one occasion at the bonâ fide midwife who had escaped the training, but had become certified as a midwife. One woman was brought before us for default in her duties. I believe the unfortunate woman whom she attended died. In her book the midwife had entered, as was her duty, the temperature of the woman. We were surprised, knowing how the woman had died, that "normal" was entered every day and every hour. Fortunately, one of the committee had a clinical thermometer, and, shaking it, it went to 105, and it was shown to the woman, who said it was normal. Yet she was having under her care the lives of women and children. I only say this wants careful watching, although I should be the last person to deprive a woman of her livelihood if she had proved to be efficient in the past. Further, we have to consider the safety of the patient. It is not fair that a nurse, who has spent three arduous years of training on miserable wages—if you can 780 call them wages—and cannot obtain a certificate until she is twenty-one, at a time when an ordinary domestic servant would be earning her £30 or £40 a year, should be kept on very low—you can hardly call it adequate—remuneration. After their self-denial during those years they should at least be secured a proper remuneration, and be recognised by the State as being entitled to that position.
There is a real danger in the number of persons who can, at the present moment, wear nurses' uniform, pose as nurses, and, in various ways, do a great deal of damage to the community. It is not only that they are deficient in nursing skill. Quite recently, on two occasions, I have been approached by women in nurses' uniform for Subscriptions. Having had a little experience in charities of all sorts, including those that are bogus, I made inquiries, and I found that both were bogus charities and that the nurses had obtained a uniform for the purpose of their appeals to a somewhat credulous public. I say it is not fair to the nurse who has entered the profession, and has served the profession. I do wish to say how much more important this is than may appear on the surface to some who may not have had large experience of nursing. We have to teach the public, and I am personally hoping the Minister of Health will devote a good deal of time to publicity. Publicity will have to be done a good deal by posters. Most hon. Members in this House have learnt the advantage of posters during their own election experience, and the nurses who will be required will be so numerous, that, unless their status is secure, we shall never obtain them for our service.
Take the simple case of measles or pneumonia. I do not for a moment disparage the skill of the medical profession, to which I owe very much indeed, but I do say that the patient with pneumonia or measles depends infinitely more upon the nurse than upon the medical man. If I may venture to mention my own particular case, I owe my life to the direct skill of a nurse, without access to a medical man, in the middle of the night. Experience gave her confidence, and even courage, to give drastic treatment, and that undoubtedly saved my life. The general public has to be taught to understand what they do not understand. Take, for instance, measles. Everything depends on nursing. The sequelæ of measles often mean death or life-long inability to take a place in the competition of industrial life. I, 781 therefore, would urge that this small and somewhat delayed justice should be granted to nurses. It will do something to give them confidence for the future. It will also give the public confidence, whatever may be the results with respect to those who for the moment obtain nurses' certificates. It will encourage those who desire to enter a serious profession, on which the life of many, to say the least, to a large extent depends. You can get rid of a bad carpenter, but you engage a nurse for a week or a fortnight on her credentials alone. If she fails you your life may be the cost. You have no chance in that case of remedying the matter. Therefore, if it has been a matter in the past for the well-being of the nation, it would be still more so in the future, when, I am glad to say, we are paying more attention to this question of health. I trust the House will pass this Bill to give nurses that position and status which they long have deserved, but which has been kept away from them.
§ Sir DONALD MACLEAN
Just one or two words from this bench to support the Second Reading of this measure. First of all, I would urge its support on the ground that some such measure as this is an almost necessary complement to the Bill which passed through Committee yesterday. Secondly, I urge it on the ground of the much needed recognition of the splendid work which women have been doing all these years without a proper official status being granted to them. Thirdly, I urge it on the ground of the overwhelming necessities of the nation at the present time, that the effective units, and much more the defective units, should be kept protected and repaired as speedily as possibly for effective use on behalf of the nation. That can only be done by the proper and skilful attention of the professional services of medical men, working with the professional skill of nurses. I would put two other points. In the first place, I am sure that this Bill will receive very careful attention in Committee. It requires it. I would specially direct the attention of my hon. Friend in charge of the Bill to Clause 12 dealing with the status of and the provision for existing nurses. There is not the slightest doubt that there is a crowd of people actuated by the very best motives—I am certain of that—who hold what are really impracticable ideas as to the particular status of nurses. For instance, there are 782 some very earnest and zealous medical reformers who hold that the training of nurses should not be less than three years. If, however, you take, for instance, the London Hospital, where I understand the training is about two years, one knows that a more skilled and zealous body of nurses is not to be found in the United Kingdom. If under this Clause adequate protection is not given, it is quite possible that it may affect adversely the person holding a certificate who has been trained for such a period at a hospital approved by the Council. What I want to suggest is that the greatest possible care should be exercised in the provision of adequate safeguards. I will not say that there are fanatics; still, there are people who do go too far, and it is very necessary to bring within the ambit of this Bill all reasonably qualified women who are entitled to this status.
The other point is this: I think my hon. Friend was too modest in his ideas, about State assistance—much too modest. He was almost apologising for asking this financial assistance. We are throwing millions about almost anywhere nowadays. He is suggesting to us that they do not want any State assistance. They ought to have State assistance! A Grant of £2,000 a year would be one of the most reproductive expenditures the State could undertake in the training and development of this splendid class of women. My last point is that there is no hope for this measure, necessary, and in some sense the complement of the Health Bill, unless the Government take it up. Let me tell hon. Members who are not yet fully acquainted with this House that they should realise that unless they bring adequate pressure to bear upon the Government this Bill will not get on the Statute Book. The Government, of course, have very heavy undertakings, but the Government would yield to pressure. I advise hon. Members who are really in earnest about this measure to make the life of the Government so uncomfortable that they will have to "star" the Bill and take it up as part of their programme.
§ Major Sir SAMUEL SCOTT
I think as a rule all private Bills in this House are looked upon with some suspicion by the Government, and also by a great number of hon. Members—at least, that has been my experience in the past. I listened with great interest to the concluding remarks of the right hon. Gen- 783 tleman opposite. I most earnestly hope that this Bill will prove the exception to the general rule so far as the Government is concerned, and that they will take it up. I would urge this still more strongly on them because, as has been pointed out by the hon. and gallant Gentleman who moved the Second Reading, this is no new question. It is a question which has been most carefully considered by two Select Committees of this House in 1904 and 1905. My hon. and gallant Friend told the House that these Committees unanimously reported in favour of the principle of this Bill. I would like to tell the House that these Committees went even further, and made certain recommendations. They recommended that,It is desirable that a register of nurses should be kept by a central body appointed by the State, and that while it is not desirable to prohibit unregistered persons from nursing for gain, no person should be entitled to assume the designation of 'registered nurse' whose name is not upon the register.They recommended that this central body should be set up by Act of Parliament and that its constitution should be defined in the Act. They further recommended various people of whom they considered this body should consist.
I claim that not only does this Bill carry out the principle of the State registration of nurses which was unanimously approved of by these two Select Committees, but also that it embodies all the recommendations which these Select Committees made. As has been pointed out by previous speakers there is at the present moment no guarantee whatsoever to the public in regard to the efficiency of the nurses whom they employ. I might point out this fact to the House, that so far as the engagement of nurses is concerned, that there can be no guarantee of their efficiency presses far more heavily upon poorer than upon richer people, because richer people have many more opportunities than poorer of being able to find out the qualifications of the nurses they employ. I do want to point out to the House that there is absolutely no compulsion under this Bill. The Bill interferes in no way with the woman who is nursing, who has been nursing in the past, or wishes to nurse in the future. Such women can practise just the same in the future as in the past. The only difference, and if is an important one, is that they cannot claim to be certificated nurses or 784 registered nurses not having passed through the examination, and they cannot claim to be qualified nurses.
This Bill simply puts the nurses on exactly the same footing as the medical profession. The medical profession at the present moment are allowed to practice as fully qualified men only when they come on the medical register. Any man can practice medicine, or set up as a doctor, or what is commonly known as a "quack" if he chooses to do so, and there is no law against it, but he must not call himself a fully qualified medical man. Anybody who wishes to be killed by a quack can call him in instead of being killed by a fully qualified man, but I think the odds are somewhat in favour of the quack killing you before the fully qualified man. Equally it will be open to the public to call in a registered nurse, or what I might describe as a "quack" nurse, and it would be entirely at their own risk. My hon. Friend spoke about Clause 12 in the Bill, and possibly this point might interest the House. When the Midwives Act was passed all those practising midwifery who could show that they had had training and practice, and were qualified, were allowed to be registered under the Act, and I believe at the present moment about one-third of the practising midwives have not passed the prescribed examination of the Board, but they were registered when that Act came into force.
I am sure that the promoters of this Bill will treat the nurses who are now practising with the same consideration as the midwives were treated under the Mid-wives Act. There is no compulsion under this Bill, and I would again point out to the House the present practice under the Midwives Act which is not adopted under the present Bill. Every midwife has to announce her intention of practising as a midwife for a year. She has to be certified and fully qualified, and she must have passed the midwives' examination, and no midwife is allowed to practise as such unless she has given notice and received that qualification. It is not intended under this Bill in any way to impose that upon the nursing profession, but, on the contrary, it is entirely voluntary whether they register or not. One word with regard to the proposal as to the standardisation of the curriculum. I am told that at some of the great hospitals they are opposed to State registration of nurses and the standardisation of 785 training. With regard to these great training schools, I think we ought to express a really deep debt of gratitude to them for turning out so many nurses in the past, but I should like to point out the experience in this respect of lying-in hospitals under the Midwives Act. Those hospitals which gave the very best training and obtained a greater number of passes in the examination have benefited enormously. Very naturally, those who wish to practise midwifery will go to those hospitals which can show the best record, and where they know they will get the best training. I am certain, if this Bill passes, those hospitals which give the best training will find the largest number of nurses will come there, and there will be a healthy competition between all the various training schools as to who can give the best education for nursing and who can get the greatest number of nurses through the examination.
I should like to add one word to what my hon. Friend has said with regard to the document which has been issued by the College of Nursing. So far as that College is concerned I know something of its work, and I have the greatest admiration for it, and I hope the work they have taken up will continue, and that the college will prosper. I do not think that an institution which describes itself as limited by a guarantee, not having any share capital, and precluded from making profit or paying a dividend, is a proper authority to undertake such a vast work as that which will be imposed upon the Nursing Council under this Bill. That ought to be an entirely different matter for the State alone. My hon. Friend has dealt with the criticisms with regard to the finance of this Bill, and I entirely agree with my right hon. Friend opposite who spoke a few minutes ago that even if it is necessary to have to come to this House and ask for a small Grant towards the expenses of this Bill it is far better that the working of this Bill should not depend upon private charity, although we hope most sincerely that no demand will ever be made upon the public purse.
I will only make one other remark respecting this document, which to my mind is a first-rate document in support and not against the Bill now before the House. It criticises the present Bill because it is limited to securing for the nurse the right to call herself a registered nurse, and to having her name upon the State register. That is exactly what the Bill does and 786 what the promoters desire, and they do not desire, as it suggested in the last paragraph of this document, to set up any educational institution. I see a member of the Government on the Front Bench, and I make a strong appeal to him to use his influence when the Ministry of Health is set up to give this Bill every opportunity of becoming law. I can assure the Government that the promoters of this measure will be only too ready to make it as good a Bill in Committee as they possibly can by accepting any reasonable Amendment. I therefore ask with the greatest confidence the House to give this Bill a Second Reading.
§ Major MOLSON
I would like, as a medical man, to give thoroughly strong support to this Bill, and I would ask all Members of this House not to be led aside by going into details on this pressing question. It is merely and broadly a question of the registration of nurses, and I appeal to hon. Members, as a legislative assembly, to look after the health of the public from that point of view. Indeed, it is a most important point of view, because we want to have the nurses registered as a properly qualified profession. I do not ask that this Bill should be passed so much in the interests of nurses as in the interests of the public. That is a very important point. Every one of us recognises it. It is not that I wish to minimise the importance of the nurses, but I would like to press this Bill out of respect for and gratitude to them for all that they have done for us in times past. It is very strange to get up in this Assembly and feel that, while England has been one of the leaders in nursing and medicine for a long time, yet our Colonies are ridiculing and laughing at us because we have not the State registration of nurses. They have gone ahead of us in that respect, and I ask the House very sincerely not to delay this very necessary measure any longer, and to pass a Bill for the registration of nurses, leaving the consideration of the smaller details to a later stage. I have been practising for years, and speaking as a result of my own experience? I may say I used to consider that we had three classes of nurses. First, there was the old Mother Gamp of the past. The next was the nurse who came in uniform, and one never knew how much she knew or did not know. The third class was the nurse for whom I have the very greatest respect—the thoroughly trained nurse. 787 The Mother Gamp nurse did her work very well, and was of great use in the country districts where I practised, and I would not wish to run her down at all. She did her best according to her limitations. But with regard to the nurses who came in uniform in many cases they knew just enough to be dangerous, and I want this House to legislate against that class of nurse, which this Bill proposes to do.
I feel sure that every nurse who takes an interest in her profession wishes to have it placed on the very highest standard. They all wish bad nurses to be kept out. The first two speakers have put forward the claims of this Bill so ably and so thoroughly that I need not take up any of the time of the House by going into further details. There was one important point an hon. Member laid stress upon, and that was that the nursing profession is not sufficiently well paid, with the result that many are passing into other branches of work. We all recognise that nursing is, primâ facie, a quality of women. I have had a fair amount of experience in Army hospitals. I have served in this War in the East, and one of our greatest difficulties in the Indian hospitals was that there were practically no nurses. I never experienced such difficulty as when I simply had orderlies to carry out the work. We should offer every inducement and every attraction to women to enter the nursing profession. Therefore we should pass this Bill, and protect the public against unqualified nurses. I need not go into the question of how long a training should be insisted upon or matters of that sort. They can, I presume, be dealt with in Committee. Neither is there any necessity for discussing here questions of finance. I hope there will be no opposition from any quarter of this House to this valuable measure. The whole medical profession is thoroughly in support of securing a good nursing standard. We cannot do our work properly without good nurses. Therefore, I appeal to the House to give this Bill a Second Reading. In the interests of the nation, and of the medical and nursing professions, let us have State registration of nurses.
§ Lieutenant - Colonel ROUNDELL
I should not have intervened at this stage of this Bill had it not been for the speech of the hon. Member who has just resumed his seat, and who mentioned the question of nurses' uniform. I do not 788 wish now to go into any of the details of the Bill. They had better be left to Committee. But I know there is a considerable amount of feeling on the part of the nursing profession with regard to the question of nurses' uniform, more particularly, if I may say so, with regard to the uniform worn by nurses who are looking after children. I am not going to say that many of these ladies have not passed through the necessary examinations, and are not fully qualified for the positions they hold as children's nurses. But what I do venture to submit is that when this Bill goes into Committee some strong differentiation should be made between the uniform that these nurses wear and the uniforms that have been worn with so much honour in years past by fully qualified nurses who go out to attend medical and surgical cases. I have spoken to several nurses on this question. Like my hon. Friend opposite I have been under their care, and, therefore, have been able to learn to some extent their opinions upon this matter. But the main question, however, seems to me to go much deeper that that, for I am credibly informed that in very many cases nowadays, and I believe it has been the custom for some time past, nurses, looking after children, nurses who we see going about the streets, and whom one may meet almost by fifties every day in Hyde Park, have in too many instances not a shred of qualification which entitles them to wear a uniform when looking after children. The House knows, we all know, that it is an indictable offence for anybody not a member of His Majesty's Forces, whether in the Navy or the Army, to wear the uniform of those Services. I venture to say that the nurses' uniform is every whit as honourable as that of His Majesty's Forces of the Navy or the Army, to which I have the honour myself to belong, and I hope most sincerely when this Bill goes into Committee steps will be taken to remedy this grievance. I can only say, in conclusion, I strongly support the Second Reading of this Bill.
§ Mr. LYLE
I ask the kind courtesy and consideration which is always shown to Members who address the House for the first time. I should like to make it quite clear that I approach this subject as one who is absolutely convinced of the necessity that Parliament should pass a measure for the State registration of nurses. I am absolutely convinced that in the interests of the nurses themselves, and 789 in the interests of the general public, it is essential that such a Bill should be passed. But we cannot all think exactly alike, and, although I am not in any way connected with the College of Nursing, I feel that there are certain objectionable features in this Bill. But I want to make it clear from the very start that I am not going to oppose this Bill. I believe in the principle of State registration of nurses. After all, this particular Bill has come before the House by the luck of the ballot, as a matter of mere chance; and, as some Members know very well, it is not always the best horse that you pull out of the ballot. I do not suggest that this Bill is a bad Bill in toto, but their are certain Clauses in it which I hope and trust will be amended when the Bill goes to Committee. I approached this matter with an absolutely open mind. I wanted what was absolutely best in the interests of the nurses themselves and of the general public. After studying the question for a very long time, I found that what convinced me most was, not the literature issued by the College of Nursing, but the literature issued by the promoters of the present Bill.
There are two main objects, as far as I can see, in State registration. One is to give the ladies of the nursing profession a proper status, and the other is to protect the general public, and to see that they get a properly qualified nurse when they ask for one. What we want to do is to protect the public from those people who masquerade as nurses, who dress up in nurses' uniform and palm themselves off as true nurses. Cases have been mentioned of the great ignorance of nurses. One hon. Member told a story of how a thermometer was kept at 105 degrees and then put into the patient's mouth. I should also like to tell a story which an old lady in the East End told to me at the hospital of which I have the honour to be chairman. Her mother, she said, used to tell of how her father was lying seriously ill—with influenza, I think. They could not get in a trained nurse, but had to get the best one they could find. There are plenty of the same class in those districts. The doctor came, and said to the "nurse," "I do not like the look of this patient at all," and he gave her certain instructions, saying, "If there is any change in him that alarms you at all, take his temperature and send for me." The next day the doctor came again, and found that the patient was out of bed and 790 gone away. "Well," he said, "what has happened to the patient?" They said, "He has gone to work." "Gone to work!" he said. "How can that be?" "Well," said the "nurse," "he got very restless in the night, and I didn't know what to do. We had not got a thermometer in the house, but he said there was a barometer hanging up in the hall, so I took that and put it on his chest. When I took it off it read, 'Very dry,' so I gave him a couple of pints of beer and he has gone off to work."
I do not suggest that as a "tip" to hon. Gentlemen who are members of the medical profession as to how they should treat influenza. I mention it merely to show into what a state it is possible to get when people get a nurse into the house of a type that is moving about in some of the districts of the East End. A war has been required to convince some people of the necessity of doing something for these noble ladies of the nursing profession. But all those of us who have worked in hospitals, and have worked down in the East End, know only too well of the wonderful work which has been carried on by them year in and year out, attending the sick poor and those who are unable to look after themselves, sacrificing their time, and very often their health, for a mere pittance by way of salary. I think we ought to look at the matter from this point of view. What do the nurses want? Without a doubt, every one of them, whether they support this particular Bill or the Bill which has been drafted by the College of Nursing, wants State registration, and I say to the House with some confidence that, however much it may do for nurses, it can never do enough. Therefore to me it is quite sufficient, when I know that nurses want registration, to say that I shall do everything in my power to give them registration. I said I thought there were certain objectionable features in this Bill, and although I do not want to go into that question too closely now, I feel that it is only right to indicate some of those features which I think are objectionable and unsound.
First of all, with regard to the proportion of nurses in the General Nursing Council, which is the principal point of the whole Bill, and of which there are to be forty-one members, I think the number of nurses given to England is altogether out of proportion. There are to be eighteen nurses on that Council, and 791 there are eight given to England and four to Ireland. Anybody who knows anything about the respective populations and about the number of nurses in hospitals and so on in the two countries, will realise that that proportion is utterly unsound. Of course I know that, when I say that Ireland should not have half as many as England, I am dealing with a thorny question. Some hon. Members who are not here to-day think very often that Ireland does not get as much as she ought to have, while others of us think that Ireland generally comes out best in all these bargains. But in this particular case I cannot help thinking that anybody who looks at this question at all fairly must agree that the proportion given to Ireland in this Bill is out of place. Then again, out of the eight English nurses, four must be matrons. I have the very greatest respect for matrons, but this is called a democratic Bill, and I do not think that four matrons is a proper proportion. It is the same all the way through. Out of four Scottish nurses two must be matrons, and out of four Irish nurses, again, two must be matrons. There is another very serious point. The managers of the voluntary hospitals and Poor Law infirmaries have only four representatives out of forty-one on this Council. I entirely agree with the Mover that the managers and the lay element on this Council ought not to preponderate, but I submit that four out of forty-one is not a fair and just proportion to give to all the voluntary hospitals and Poor Law infirmaries in England, Scotland, and Ireland. The managers of the Poor Law infirmaries and voluntary hospitals are people whose advice and assistance will be of the very greatest importance in all these matters. After all, they represent the public, and it is the public for whom all these things ultimately are done. We have the medical men, the nurses, the Government, and the Privy Council, all represented in proper proportion, but there is not a sufficient representation of the managers of the voluntary hospitals and Poor Law infirmaries. I have told the House that there are four out of forty-one, but for the whole of England and Wales there are only two. There is another point of criticism which is a fair one to make. No register is to be kept for nurses who have served in children's hospitals. Children's hospitals are as necessary as any other type of hospital, if not more necessary. There are plenty of 792 nurses who are serving faithfully and who perhaps have served for a great many years in children's hospitals, and, athough it is quite true that they should not be allowed to call themselves fully-trained nurses, there ought to be a supplemental register to enable them to stand out from the masquerader. You want to give some protection to the genuine nurse, be she a fully-trained hospital nurse or a children's nurse, but if the children's nurse cannot get on to the register you cast her aside and place her in the same category as the masquerader, for whom we all feel the greatest contempt.
Whilst this General Council of forty-one is open to these criticisms, the Provisional Council which is to be set up temporarily, pending the appointment of this other body is infinitely more to be criticised. On that Provisional Council there are to-be twenty-eight members, and of eighteen nurses no less than twelve are given—I do not wish to use the word offensively—to the conglomeration of societies mentioned by the promoters of the Bill. These societies are taking to themselves twelve out of the eighteen nurses and only two are to be given to the College of Nursing, which represents between 12,000 and 13,000 nurses. I do not think it is fair that out of eighteen nurses on the Provisional Council twelve should be the nominees of the Central Committee for the State Registration of Nurses and only two of the College of Nursing. Then, again, there is not a single representative of any of the managing committees of the voluntary hospitals of Poor Law infirmaries. Those are points worthy of the consideration of the promoters of the Bill. I do wish to insist that it is necessary to have some representation of these lay elements. They represent the governors and subscribers of the hospitals, and in the case of the Poor Law infirmaries other people, being very often representatives of the working classes.
The promoters of the Bill would be well advised in the interests of getting it through to see that these points are given fair consideration. I only mention them in order to show that it is possible to criticise the Bill in many respects. I do not wish to labour them, because we all support the principle of the Bill and wish to give it a Second Reading. It largely depends upon the spirit in which some of these criticisms are met whether the Bill 793 will pass through all its stages, and for the sake of the nurses and of the general public I would make an earnest appeal to the hon. Member and those whom he represents to give favourable consideration to these things when they are discussed in Committee, and to the views of those who genuinely differ from them not on the principle, but merely on the details of the Bill. I believe, if that is done, that the Bill will go through, and go through successfully. It cannot be thought infra dig. to make any concession, because, although people outside may not know, hon. Members in this House know very well that Government measures are very often pulled about, and even this Coalition Government have had many measures seriously handled. I know it is a difficult and a dangerous thing for a mere man to step in where ladies have failed to agree and to suggest a remedy, but I would earnestly appeal to these bodies, who have one object in view, to meet together once more and to try and settle their points one by one and go forward as one big, united body. Then they will be able to get for those noble women who have done so much for us State recognition and a better position in the future, which they thoroughly deserve.
§ Lieutenant-Colonel RAW
I will not detain the House for more than a minute or two in giving my strong support to the great principle embodied in this Bill. The medical profession owe an enormous debt of gratitude to the nursing profession for their co-operation in the work that we have to perform, and Parliament and the whole Empire are under a deep debt of gratitude to the nurses for the work which they have performed in attending our wounded soldiers. For that reason alone we, as Members of this House, are only anxious to do everything we can to raise the status of the nursing profession and anything which will tend to elevate them in their work. The State registration of nurses is a necessity. The whole profession of nursing has undergone a complete change within the last twenty-five years. The great advances in surgery and medicine have made it necessary that a nurse should be thoroughly trained. She must have undergone very careful and technical training. Having done that, it is necessary that she should be recognised by the State. She ought to be placed on a State register and under the protection of the authority of Parliament. Reference has been made to another Bill which was 794 drafted with the identical purpose of obtaining the State registration of nurses. Members of this House will give all those who promoted that Bill the very highest credit for the object they have in view. It is entirely due to the fortune of the ballot that this Bill is introduced, and that the Bill proposed by the other party was not introduced. The good fortune of the ballot has put my hon. and gallant Friend (Major Barnett) in a very enviable position—one that I would have liked to occupy myself—in advocating such a great principle as the State registration of nurses.
The Bill promoted by the Council of Nursing was very carefully considered, and in consultation with the authorities on that Bill they decided that they could not and would not oppose the State registration of nurses or offer any opposition whatever to this Bill. I have authority to state on behalf of those interested in the other Bill that no opposition will be offered to the great principle of the State registration of nurses, which we all very much desire to see. But, of course, we reserve to ourselves the right to criticise, and possibly to amend, in Committee, many of the points on which we are not in agreement. This is a golden opportunity to pass a very much-needed and long-delayed reform. Therefore, I hope the House will give the Bill a Second Reading, so that we may establish the principle we have all desired so long of the State registration of nurses. When this Bill passes, to give it the influence which it deserves, it will have to be taken under the charge and control of the Government itself. I see my hon. Friend the Parliamentary Secretary to the Local Government Board here. I hope he will be able to give us the assurance that when this Bill passes, as I hope it will very soon, he will be able to announce that the Ministry of Health will take this work under its wing and give it all the protection and authority of a Government Department.
§ Mr. F. ROBERTS
I have noticed the courteous and sympathetic hearing which has always been given to new Members when first addressing this House, and I desire to take the opportunity of bespeaking the same kind indulgence on this, my first effort. Speaking on behalf of the Labour party, I want to join in the unanimous chorus of approval with which the introduction of this measure has been 795 welcomed. There are probably many points of detail which one could criticise and discuss at some length, but we on these benches give the measure every support possible in our power. We are entirely agreed on its general principles, and we feel it has been introduced with the admirable intention of preserving the status of an eminently necessary section of the community. The question of the State registration of nurses is one of extreme importance. The nurses themselves and those associated with them have worked long and patiently for the establishment of this principle. It certainly has surprised me to learn that for something like forty years they have been endeavouring to establish the principle of this important measure. The measure is important not only to nurses but to the public and the medical profession. It is more than ever recognised that now every means must be adopted for the protection and preservation of life. Under the proposals contained in this Bill the nursing profession seems to have the opportunity of becoming a greater and more powerful force than ever before. They will be able to carry out their important functions with a greater and wider understanding. We know perfectly well that the United Kingdom in the past has had many good nurses, but we claim that the country, particularly at the present time, requires many more. With the principles of this Bill accepted, there is reason to hope for better results from the labours which our nurses are called upon to perform. Hon. and right hon. Gentlemen knew quite well that if proper steps were taken for the elimination of the possibilities of disease, nurses would not be called upon to perform many of the functions which at present they have to carry out. Unfortunately, nurses will always be required for ministry in their own particular direction. Therefore we give full welcome to this measure, and. we desire to give the nurses the fullest opportunities for the development of their spheres of work. As was well said by those in charge of the Ministry of Health Bill and the Transport Bill, we can see the desirability and advisability of unifying all the forces which operate in this direction.
There are three great fundamental principles on which this Bill seems to be based, and because it is founded on those great principles we welcome it all the more. First, there is registration, which will 796 show us the number of those who desire to enter into the profession and will give greater opportunities for guidance in that direction. Training is the next important principle, which will give full equipment to those entering the profession and greater knowledge to discharge their important work. Then in Clause 11 an opportunity seems to be provided for setting up safeguards which are of such vital concern to everybody. It is eminently desirable that in this case, as in the medical profession, we should have a recognised standard of professional skill. I agree with the last speaker that there is some room for criticism of the constitution of the Council, but in agreeing to the acceptance of the important principles of the measure, like him, I feel that the discussion of those incidental details might well be left to the future. There is one important feature which we, the Labour party, feel some further consideration might well have been given to. We should like to have seen contained in this measure more definite provision as to the working condition of those entering this honoured profession, especially for those who may be employed in institutions. If reports speak truly—and we have no reason to doubt them—some-nurses in the past have not, to put it in the mildest possible form, been working: under the most ideal conditions. To-day all sorts of different professions are opening their doors to the admission of women. More attractive remuneration is being held out to them, and if the nursing profession is to occupy the position which it has held so long and the greater and better position which we desire it to hold in the future, the nurses who go into it must be more generously remunerated and have better working conditions.
I welcome this measure because I feel that under its operation there will be set up powers which will give the nurses opportunities to see for themselves that they are more adequately paid for the work they are doing. They will also be able to see for themselves that their general condition will be made as nearly ideal as possible. We always plead that there should not be sweated conditions in any industry, and least of all should there be sweated labour in the noble profession of nursing. I want to plead, too, that the nurses should be given a larger measure of control of the conditions under which they are called upon to work. Give the nurses some democratic control of 797 their own conditions, then we are convinced that they will be much better in the future than they have been in the past. The question has been raised of financial assistance from the State. We ask that the most generous treatment financially which can be given should be undertaken by the State. The ultimate success of the administration of these important proposals will, I feel, eventually rest on what measure of support can come from the State in this direction. They ought not to hesitate in giving the fullest measure of support. The Labour party views with the most sympathetic consideration possible the introduction of this measure, and joins with others who have spoken in pressing the Government to undertake the responsibility for seeing that its progress is facilitated. Whatever the House may do with regard to the nurses, it will not be possible to increase the esteem in which they are everywhere held. We can never repay the deep debt of gratitude for what nurses have done for the civil population in the past, and still less can we repay the debt we owe them for the sacrifices they have made during the progress of the last horrible war. We shall always retain the warmest admiration for the noble and self-sacrificing work which they have hitherto performed. These services have been freely and readily given in the service of humanity, but this measure ought not to be considered as any sort of reward for services which have been readily given and so nobly done. We look upon it as a measure of justice brought forward in the full knowledge that co-ordination of effort can only be for the general good, and, if passed, we feel it will have a stimulating effect on the whole community and the nurses in particular. In the added dignity which would come to the nurses by the passing of this measure their power to carry out their good work would not be in the least impaired but rather would they gain an added strength and their sphere of usefulness, would become materially increased. On these general lines I have the greatest pleasure on behalf of the Labour party in supporting this measure.
§ Mr. GARDINER
I desire to put some points from rather a different aspect from other speakers. I am glad everyone who has spoken is agreed on the general principle. Most speakers have looked at 798 the subject from the point of view of dense population. I want to speak about the sparse population of Scotland. In these glens, with the people sometimes removed as far as forty miles from any doctor, it is highly desirable that duly qualified nurses should be placed within the reach of the people. In one particular part of my Constituency the nearest doctor is forty-two miles, and there is no nurse resident within any part of that area at present. Therefore the question is urgent, and it is not desirable that anyone who happens to wear a nurses' uniform should be admitted to the homes of the people. In many poor homes, because of the lack of money, the cheapest nurse is admitted, and when she has left not only has she gone for the time being, but sometimes she takes with her more than belongs to her, and we want to think a little about the poor people and see that they are protected. Memorials to our fallen heroes are being raised in many country districts, and at present in Scotland, in many cases, they take the form of an association to provide nursing facilities for the people. If the object I have in view—and it is a very desirable and laudable object—is to be obtained we surely want the best qualified, nurses who can be found, and this Bill makes provision for the training and efficiency of the nurses who would be at the disposal of the country in days to come. It is quite true that some details of the Bill may require amendment, but I am sure those who are responsible for it do not look at it as if it were part of the laws of the Medes and Persians which cannot be altered; but any alteration which may be necessary will, I am sure, be met in a fair and reasonable spirit and everything possible will be done to make the Bill acceptable to the whole House. I would only plead with the Government that they should give every possible facility for bringing the Bill into being, as the need for medical treatment in many parts of the country at present is intense. From our Highland homes and glens there went forth some of the fairest men to fight our battles. Some of them will never return. Others have come back to us maimed and broken in health. Is it right that these men should be left scrapped miles and miles away from a doctor and with no nurse to attend them? I suggest that the Government should give us every facility and enable us at the earliest possible moment to put the nurses into a position 799 where, by training and otherwise, they will be fitted to help the medical men to the better health of the community.
§ Sir ROBERT WOODS
I should like, as one of the few Irish medical Members of the House, to give expression to the sense of relief with, which the news was received in Ireland by nurses and also by medical men that this Bill was about to be introduced. That sense of relief was enhanced by the fact that it was this Bill that was fortunate in the ballot rather than any other. A good deal has been said on the question that the only effect of this Bill will be an increase in the remuneration of nurses. I think it is perfectly right that that should be one of the effects. We must not forget that one of the great inducements for ladies to join the nursing profession has been the fact that the work that falls to the lot of nurses is so noble and so dignified. It is the highest, or one of the highest, functions to which a woman can devote her life, and I feel certain, in fact, I know from my own knowledge as a medical man, that the fact of the work being of that character is in an enormous number of instances the factor which leads them to determine to take up that life rather than the emoluments connected with the work, which we all know have been far too low in the past.
I do not intend to touch on points which ought very properly to be raised in Committee, but I cannot allow a criticism which came from the opposite side to pass without comment. It was said that in this proposal Ireland is so largely represented. I would point out that the representation of a country on a Board of this kind ought not to be measured by the population of that country, but ought to be measured by the number of nurses that the country turns out and puts into the profession. The conditions in Ireland are quite different from the conditions in England. In England there are an enormous number of avenues through which ladies can seek employment of one kind or another. In Ireland that is not the case, and a far larger proportion of those who enter a profession go into the nursing profession. Ireland, in fact, acts as a great training ground for nurses, who subsequently find their life's work in this country. Therefore, I think this matter ought not to be decided simply on the population of the country. I am quite sure that Irish nurses do not want a larger 800 representation than their numbers and their importance entitle them to, but I did want to enter a caveat as to how the proportion should be decided. There was another point in regard to children's nurses, and I think certain hon. Members are still confused in their minds as to what is meant by children's nurses. A children's nurse under this Bill would be a lady who has had a general training in nursing and has specialised in the particular ailments affecting children. That is one of the points we shall get under this Bill. First, they will have a general training, and after that they will be allowed to specialise in any particular branch that they desire. I hope the House will pass the Second Reading of the Bill unanimously, for it is eminently a democratic Bill. It allows these ladies the opportunity which we of the medical profession have had for so long—the opportunity to work out their own salvation on the most democratic lines, and I am satisfied that what is true of the quality of mercy in exercising its beneficent influence in two directions will be also true of this measure, for it will be good not only for the nursing profession, but also for the community.
§ Sir WATSON CHEYNE
It is rather a work of supererogation to take part in this Debate, because the tone of the House is clearly unanimously in favour of the Bill. I should like to join those who have suggested that the Government ought to take this Bill under its own aegis, and the natural Department of the Government to do so is the coming Ministry of Health. I hope that they will consider that point. Nursing is an absolute essential to the health activities of the country. I should like to pay my personal tribute to the value of nurses. Such small success as I have had in my profession has been very largely due to the fact that I gathered round me a little band of splendid and loyal nurses. I can assure the House that there is nothing that relieves one's anxiety more and enables one to concentrate the mind on the more important part of one's work than to know that one has at hand skilled nurses, and that everything will be properly done, because it is being done by competent nurses in whom you have confidence. On the other hand, there is nothing more distracting than having to keep one's eye on two or three nurses, 801 the anæsthetist, and the assistant, whilst at the same time you are doing critical operations.
There are various reasons why State registration of nurses should be supported. In the first place, I think that considering the very small remuneration that nurses get we must make the profession more attractive by giving them a better status, otherwise we shall not get the same class of ladies that we are getting at the present time. As regards remuneration, I think it is deplorably bad. I do not think the public realise what nursing means, how much it takes out of a nurse, how much she has to do, and with no prospect of providing for the days when she is no longer able to do nursing. I was very much struck quite recently in connection with one of the military services, discussing with the very best theatre sisters I have ever had to do with, a woman absolutely invaluable, when she told me the remuneration she was getting. She told me she was getting £45 per year, and that for messing and clothing she had to pay £39, so that all she had in the way of pocket money and to make provision for her old age was £6 per year. That is not right. If State registration can do anything by raising the status of nurses to get better remuneration and greater consideration for them, for that reason alone it should be supported. But in addition it is extremely important from the point of view of the public, because there is no question that there are many nurses, if you do not select trained women, who are sent out and who have had no proper training at all. Many of them in the small homes in the suburbs are simply kitchenmaids and parlourmaids, and we want to have a definite guarantee that when a nurse is sent she shall at any rate have some knowledge of the profession. Various objections have been suggested against the State registration of nurses.
One is that nurses require special qualifications, and the mere fact that they have been able to register under the State does not necessarily imply that they are good nurses. The same thing applies to doctors or any other body of people in whose case you keep a register of those who are fit for the profession. The State register will show that the nurse had such-and-such training, three years probably, that she has passed an examination, and that she has been considered of 802 good character, and, in view of the training which she has got, is considered a good nurse. That is all you can expect of a doctor when you take up the register. You cannot say anything more than that the doctor has passed the minimum of examinations requisite to register. It does not imply that he is a first-class doctor or of a very high character, but taken for what it is, it is an extremely important thing, and this register will show that for such a period the nurse has qualified and exhibited a certain amount of knowledge of the profession. Then it has been said that years afterwards we cannot guarantee that a nurse will have the same knowledge that she had before. I think it probable that she will have a great deal more knowledge than when she was registered. That is what we assume as regards a doctor—that with age and experience a doctor improves. The same argument holds good as regards nurses. I see no necessity for labouring the thesis that the State registration of nurses will be for the good of the community. The whole point of this Bill is—is it calculated to attain the object desired? I think that it is. Many points not suitable for discussion now may require discussion in Committee with a view to making things more clear, and perhaps arranging things better. But taking it as it stands, I think that it promises to make a thoroughly sound Bill, calculated to attain the object desired, and for that reason I give it my warm support.
§ Mr. W. GRAHAM
I am very pleased to support this Bill. This is a matter on which I think Labour should express its views, as it is one which concerns the health of the community. All along our movement has felt that not only were the nurses not accorded the status to which they were entitled in the community but that they were grossly underpaid, and we felt that until these conditions were remedied we had no right to expect the full measure of service which they should render to the community. I think I am entitled to say in the presence of medical Members of this House that, by means of what has been described as the strongest trade union in the world, they have very largely safeguarded themselves. Nurses have not had the same measure of success. I welcome this Bill if it is going to do anything to improve the position of the nurses in that respect. Any criticism which I have to offer is entirely sympathetic.
803 There are three features of this measure which appear to me to be more or less capable of being remedied. First, in the controversy between the promoters of this measure and the College of Nurses we, Labour Members, have no particular interest. There does not seem to be any difference as to the issue with which we are concerned—the State registration of nurses. From all the literature which has been sent to us in that controversy, I have no hesitation in saying that it should be possible to meet the views of both sections in a perfectly sound measure. We should be very sorry if any controversy of that kind militated against raising the status of the profession and against the efforts which we are making in this and other connections to improve the health of the community. I feel at the moment that there is, perhaps, not sufficient provision to make it absolutely certain that the rank and file of the members of the nursing profession will be represented fully on any body which is established to look after their interests. On the whole, the representation of medical men and of nurses who have obtained the rank of matron would appear to be generous, but I think that there is room for a larger representation for the ordinary rank and file of nurses. That appears to be particularly important from the point of view of getting their general good will and co-operation from the very commencement of the operation of the measure. Not only that, but I think it is in keeping with the proposals in the industrial world and throughout the country generally at the moment that as far as possible we should have regular, systematic consultation with the rank and file, as it is only by doing so we can get harmonious and sound conditions. Then the objects of the Council as enumerated in the measure do not seem to contain provision for establishing rates of remuneration or a minimum rate of payment for nurses
The hon. Member who spoke last drew attention, very properly, to the shameful conditions as regards remuneration. We will never attract the best women to the profession until a minimum wage is laid down and enforced, not only for private individuals but also for public authorities. With some experience of some of the public health authorities in Scotland, I have no hesitation in saying that their action cannot be defended for a single moment in many cases in which they 804 offered conditions of employment and rates of remuneration which would not have attracted to their service women of any real standing in the profession of nursing. That has been not only an injustice to the women so inadequately remunerated, but also a very serious injustice to the health of the community. I would like to see established a minimum rate of remuneration, and to see it enforced. That would only be in keeping with the policy of the British Medical Association in its own sphere. We cannot engage medical men in these local authorities unless we are prepared to pay a certain standard. I am not finding any objection or quarrelling with that principle or policy. I think it is quite sound, and that it should be extended in the most generous possible way to the members of the nursing profession. As to the compilation of supplementary registers, I agree at once that it is necessary in certain branches to have supplementary registration, and there is a certain class of nurses who would be entitled to be placed on a register of that kind. But I do hope that the promoters of this measure are going to set their face against any extention of the compilation of supplementary registers, and that they will refuse to receive indiscriminate classes of nurses on any form of register. If supplementary registers of the kind were extended and allowed to include the names of unsuitable persons you would injure the economic position of nurses fully trained to the profession.
I venture to draw attention to the very strong representation which has been made by the Scottish Nurses' Association, and one that I feel is entitled to the careful consideration of this House. They draw attention to the fact that under the present system we have established practically a monopoly for the large hospitals or institutions. Our experience in Scotland has taught us that there is very keen competition on the part of eligible girls and young women to enter large hospitals and institutions for the purpose of training. Not only is that the case, but when they have been trained there is the very keenest competition on the part of the local authorities throughout Scotland to obtain the services, of those who have been so trained, and also on the part of private persons. That position, defensible in many ways, especially in large medical centres such as Edinburgh, is understandable, and I am not finding fault with it for 805 a moment. But I think we should embark on what will be a better course for the future, and I suggest, and this idea is strongly supported by the Scottish Nursing Association, that we should do all in our power to encourage the training of nurses in provincial areas throughout the country. If we can secure a standard of training in this matter there can be no doubt that the training in many of these provincial centres throughout England and Scotland would be at least as good as much of the training which is now afforded in the larger centres, both north and south of the Tweed. Not only that, but by this system you would be likely to attract to the profession girls of good physique, such as are to be found in the country districts and who cannot now afford to go to the larger centres for training. I venture to associate myself most strongly with what was said this afternoon by my hon. Friend the Member for West Bromwich (Mr. F. Roberts), who has expressed the views of the Labour movement on this question. We as a movement stand very strongly for standardisation of training and for the recognition of the just and proper claims of the nurses, above all, believing in that connection that only by taking these steps are we going to successfully administer a sound scheme of public health in this country. We are not actuated in this matter by any trade union or sectional motive. We want to see the position and status of the nurses improved, and also to see that improvement from the point of view of the health of the community. Most cordially I express support of this measure, and hope that in the Committee stage consideration will be given to some of the points which I have tried to indicate.
§ Colonel GREIG
Representing as I do a large industrial constituency, I have received nothing but support for this Bill. Personally, I can never be too grateful to the nursing profession for their devoted attention. My eyesight was preserved by the skill of a great surgeon helped by the devoted services of a nurse who supported his skill. Older Members of the House may remember that it was our colleague, Dr. Chapple, who first introduced this measure, and succeeded in 1914 in carrying it with a majority of 229. Unhappily, he is not here, but I am sure he will be delighted to know of the reception which has been given to this Bill. The 806 hon. Gentleman who has just spoken referred to the excellent memorandum which has come from the Scottish Nurses' Association. I believe in regard to its literary merits and in the soundness of its suggestions and arguments it is the best piece of literature on the subject we have received. I notice that they are in favour of one general Nursing Council for the whole Kingdom. That gets over any difficulties Scottish Members might have, and I think on looking at the measure full consideration is given to the Scottish community from the point of view of the bodies in Scotland who have anything to do with nursing. I do not wish to add anything further to-day, except to say that the Bill has my hearty approval and that I trust we shall hear that the Government will be prepared, if it gets through Committee upstairs, to give it its support.
§ Captain LOSEBY
I have no intention of detaining the House for more than a very few minutes. I am very anxious, however, that this particular part of the House should be represented as supporting this Bill on behalf of a section of the community which since the days of Florence Nightingale has deserved well of the people of this country and has never had fuller scope for the exercise of its functions of alleviating suffering than during the past four years. In that connection I should like to be allowed to state, and I hope I shall not be accused of presumption, that whoever fail the nurses in any ordinary demands I am sure they will find amongst the soldiers and sailors their most ardent sympathisers and supporters. The party which I have the honour to represent have the greatest possible sympathy with all trade unions, but we have a particular sympathy with those trade unions or professions, or whatever you like to call them, which have as their object not only individual sympathy, cooperation, and support, but also the upholding of the honour, prestige, and dignity of the particular body of which they are members. A trade union with powers of self-government recognised by the State is a profession of the highest rank. I look forward to the day when these trade unions will be encouraged and multiplied. But be that as it may, I think there are very few Members of this House who will be prepared to dispute the claims of nursing associations to that rank. I am one of 807 those who cordially agree in particular with two hon. Members opposite, who, if I may say so, made most admirable contributions to this Debate. I am one of those who believe that the nursing profession has the greatest possible need of the support of a union. I think we all know that in the days of probation, more particularly in London hospitals, nurses are subjected to such tests in regard to endurance that only the fittest survive. Throughout the whole of their professional career they submit to a very rigid discipline; they are inadequately paid; I am sorry to say that in all too many cases they are not even well fed; and in very few cases are their ordinary bodily comforts sufficiently catered for. At any rate, when we view the discipline and the tests to which they are subjected, I quite agree that this House should be prepared to protect them from the unfair competition of those who claim to be what they are not, who, I do not say dishonestly, but nevertheless who masquerade in nurse's uniform without a shadow of right to that uniform. I am fully conscious of what this Bill means. It means that the heads of the nursing profession are determined that the field should be narrowed within reasonable limits, and determined to fight that the members of their profession shall be adequately paid, shall have more leisure, and shall have all those rights to which they are entitled. It means, and I say it deliberately, that a noble but oppressed section of the community has determined to come into its own, and I would only venture to say to them in conclusion, "May God's blessing go with you, and may you be successful in your righteous fight!" I thank the House for the indulgence with which they have listened to me.
§ Mr. RAWLINSON
May I congratulate my hon. Friend upon the great success of his excellent speech and upon the many things which he said with which one agreed so strongly? I have never believed in State registration for nurses, and I am afraid, although I listened very attentively, that the hon. Member has not convinced me now of its adequacy. I am not going to move the rejection of the Bill or to do otherwise than to make a few suggestions from the opposite point of view. Not one of us doubts the evils which the hon. Member mentioned. It is like the advertisements of a quack medicine. No- 808 body doubts the claims which the advertiser tells you of or that if you eat too much certain things happen afterwards which cause inconvenience and even pain, but the question is whether the cure which is suggested is really going to be as effective as the advertiser claims. That is the only question I want to detain the House oven to-day. We all wish to do something for the nursing profession. An hon. Member with great eloquence referred to those nurses who have nursed our wounded soldiers so heroically. Might I endorse every word he said and go a step further? I would refer to those nurses who stayed at home and had to do the drudgery work of nursing women and children at home in England, who are entitled to every bit as much credit as those who took the more dangerous, arduous, and honourable tasks abroad. I want to do all I can to alleviate the nursing profession, and I am at one with all those who have spoken with a desire to protect the public against employing people whom they think are qualified nurses but who, in fact, are not qualified nurses at all. But is the State registration of nurses the best way of doing that? I am not at all satisfied with things as they are, but what I think we want is an official directory of nurses, on the lines of Lord Balfour of Burleigh's Bill in the House of Lords, and in that directory there should appear the qualifications and training of the nurses and any other necessary particulars. Secondly, we want the power for any; training school or hospital to copyright its nursing uniform. Those two things, I think, would be of the greatest value. If you were going to take a nurse, you would turn her name up in the official directory, which would be compulsory to that extent, and you would at once see her qualifications. Secondly, the particular hospital which has trained the nurse would allow the nurse to wear its uniform, which would be perfectly well known to everybody, and would be copyrighted.
The objection to the State registration of nurses is this: You are levelling every nurse to one common denomination. Your registered nurse may be from one of the best nursing schools in the country or she may be a nurse trained in one of the Local Government Board institutions—I have not a word to say against them—but the training, I suppose, is very different from that in some of the big hospitals in London. The difficulty of this Bill is that you bring them all down to one denomina- 809 tion and allow them one uniform. I would submit that it would be far more preferable to know whether the nurse you are employing has been trained at Guy's Hospital, St. Thomas's Hospital, or where ever it may be. Then there is the question of the security of the public. Mistakes are made, even under the present system, through nurses being sent to one class of patient when their training has been in another direction. What security will this Bill be? It will make the public think that every time they employ a registered nurse they are getting a fullyqualified nurse, fit to nurse the ailment with which they are called upon to deal. Is there any guarantee under this Bill that that is so? A woman becomes registered on payment of two guineas. Four, five, six or seven years hence, her knowledge remains the same, but it is well known that in any profession or calling a certain number of people, to put it briefly, go to the bad in the end. A woman may have taken drugs, or fallen into some calamity that may happen to any of us, and may become an unfit person as a nurse, but she will still be entitled to wear the uniform, unless she has behaved in a sufficiently bad way to bring her conduct to the notice of the Council, when she can be removed from the list. The real question is whether a central body should make a person eligible or not or whether the hospital should licence persons to wear the uniform of that particular hospital.
I feel it ungracious to press in any way this point, in view of the large support given to this Bill, but very strong remarks have been made, and I did feel it right that something should be said on the other side. The Leader of the Opposition, in really a most cold-blooded speech, if I may say so, instigated new Members of the House who were in favour of the Bill. He said he had been in the House for a long time, and the only way to get this Bill carried was to make the lives of the members of the Government uncomfortable. It made my blood run cold. I have a great respect for the Front Bench. I am no vivisector; I would not injure a hair of one of their well-dressed heads. When the right hon. Gentleman lifted his arm and said, "Go for them!" I felt I would not join them in any way, but when I had the opportunity I would say to these new Members, "Treat them kindly and fairly. Just let them go along. If you do not 810 hurt them, they will not hurt you, and you had much better not press them too strongly to take up a Bill of which they may repent afterwards." There are two sides to this question, and, although I shall not oppose the Second Reading, I think it should be looked at somewhat more carefully at the present time, to see whether we could not secure that which we are all anxious to secure by methods other than those indicated by speakers to-day.
§ Colonel WEDGWOOD
I think the House should be grateful to my hon. and learned Friend the Member for Cambridge University (Mr. Rawlinson) for at last breaking the universal chorus of applause which has greeted this measure. For myself, whenever I see a Friday afternoon Bill, I always look to see who is to be put in prison, because it is my experience that these Bills, which meet with the universal support of all hon. Members in this House, inevitably contain, wrapped up somewhere, a penal Clause punishing somebody. It is quite true that this Bill, which I certainly shall not vote against, has the approval of a vast body of persons outside this House. It is quite true that every Member here has received endless circular letters, personal letters, and memoranda on this question, but I do hope that hon. Members will realise that, when it is in the interest of some body or association to circularise Members of Parliament, it behoves us to look very carefully to see whether the acceptance of the proposal of that body or organisation will not affect adversely some wider body of the public. We have got to consider here, not only the setting up of a registration system for nurses, but to some extent—I dare say justifiably—the narrowing of the field of supply of nurses and the closing of the nursing profession I dare say it may be justified, but for myself I always dislike to see any legislation passed into law which closes a profession or narrows down the avenues through which people can approach that profession. Of course, it is obvious that all the existing nurses in the country, ipso facto, come into this Bill during the next three years. Here I would join with those who have paid tribute to the nurses for the glorious work they have done during the past five years. They certainly saved my life.
What we have to consider—and I throw this out because it is the duty of Members of Parliament to look at both sides of the 811 case: at present, I honestly think they have only had one side put before them—what we have to consider is that at the end of the three years you have to approach the nursing profession through a certain channel. You have to have three years' training—good. And a hospital training—excellent. But you also have to pass an examination and pay a fee, and I am seriously afraid that, if you are going to include in your regulations drawn up by this nursing council a very strict system of examination, you may get some sort of profession which allows into the profession only the daughters of the well-to-do and middle classes. We have got to see that the avenue into the nursing profession is kept open for the daughters of the working classes as much as any other class. I observe that we are putting the whole future of the nursing profession outside the control of Parliament. We are setting up here a Council which has all the powers over the whole of the nursing fraternity which Parliament would naturally have. It is in the power of the Council to frame the regulations which should govern the life of these nurses, and governing above all their entrance to the nursing profession. I am not at all certain in this handing over to a body which must necessarily become, to a certain extent at least, an aristocratic and autocratic body—
§ Colonel WEDGWOOD
Well, I think that is the tendency of any organisation which has any power to try to keep its membership as select as possible, to try to narrow down the avenues of approach to that particular profession, so that only people of a particular kind get into it. It thereby cuts out the possibility of the female portion of the working-class population getting into these professions. Quite naturally they desire to keep the profession preserved to those particular people and their friends. I do not say that that will be so in this case, but I think you require to be very careful before you hand over too much power to these councils and allow them too much freedom in the method of selecting from the whole population those who are to become members.
§ Sir S. SCOTT
I am sorry to interrupt, but may I call the attention of the hon. and gallant Gentleman to Clauses 5 and 6 of the Bill, relating to the nomination of 812 candidates for election to the General Nursing Council, and the election of direct representatives?
§ Colonel WEDGWOOD
I desire to point out that Clause 11, dealing with the duties, and powers of the Council—which is the important and vital Clause of the Bill—gives power to the Council:To frame rules—Clauses 5 and 6 deal largely with general principles, and by no means with the important powers of this, more or less, coopted Council. I do not propose any more than does my hon. and learned Friend the Member for Cambridge University (Mr. Rawlinson)—whose opinions I do not often share—to offer any opposition to this Bill. After all, if Members of Parliament and the country like these sort of Bills, let them have them. At the same time, I cannot help thinking that you will create a feeling of restiveness amongst the population at large when you introduce for the people of the country fresh and ever-fresh regulations which, in the long run, really are a matter for the country.
- (a) regulating their own proceedings;
- (b) regulating the issue of certificates of registration and the conditions of admission to the register of nurses;
- (c) regulating and supervising the course of training and the conduct of examinations and the remuneration of the examiners;
- (d) regulating the admission to the register of persons already in practice as trained nurses at the commencement of this Act.
§ The PARLIAMENTARY SECRETARY to the LOCAL GOVERNMENT BOARD (Major Astor)
Yesterday afternoon, in Standing Committee A upstairs, when the Health Bill was being considered, an Amendment was put forward dealing with the registration of nurses. I was obliged to point out to the proposer that it was quite impossible in one Clause to deal with such a very difficult question as the registration of nurses. The fact that we have before us this afternoon a Bill of twenty-six Clauses dealing with the same thing, shows that we were wise in objecting to that particular proposal yesterday. The success of the Ministry of Health which has been set up will depend mainly upon three things. The first is: The success of the Ministry will depend upon the powers that Parliament at different times entrusts to the Department, and the way in which the Department exercises those powers. Secondly, success will depend upon the instruments used by the Department in order to exercise the powers given—the instru- 813 ments as represented by the members of the local authorities, the medical profession, and the nursing profession. It will depend also upon the measure of public support given to the Minister who will be responsible to the country. I am sure that anything which improves the status and efficiency of the nursing profession must tend towards the success of the Ministry of Health. We explained yesterday that we were unable to accept the proposals made in the proposed new Clause, not because we were opposed to the general principle, but because the scope of the Bill of the Ministry of Health did not lend itself to this particular proposal. We did not, we said, propose to ask Parliament to give us any new powers at this stage because we were in favour of the general principle. I should like to congratulate the hon. Members concerned upon their good fortune in the ballot which has enabled them to bring forward a Bill containing this principle. The discussion which we have had shows that there is an overwhelming support among Members of the House in favour of the principle of setting up a Statutory Register for nurses. That is the main underlying principle of the Bill. There is a great deal of interest and support outside. We have to-day what is normally the public gallery of this House practically a ladies' gallery.
As regards the attitude of the Government, I do not propose to speak at any length or to examine in detail the proposals set out in the Bill. All I want to say is we are generally in favour of the principle contained in the Bill. Hon. Members probably know there is another Bill, the backers of which have not been so successful in respect to their Bill. Because of that their proposals are not now before the House. I feel certain that the points on which that other Bill differs from this particular Bill will be considered by the Standing Committee when this Bill is upstairs. I will only to-day suggest to the House that we should now let this Bill be read a second time. It will then go upstairs, be examined, and be subjected to criticism and Amendment. When it returns to this House, if it is in such a shape that the Government can give it their approval and support, well and good. I can only repeat what I said just now, that we are in favour of the principle. Of course the attitude which the Government will take up when the Bill comes down here must of necessity depend upon its shape then. I will only, before sitting down, 814 refer to one point which has been dealt with by several Speakers. The hon. Member for Lambeth, and other hon. Members, said that they owed their lives to ladies who had nursed them at different times. I venture to think there is hardly a person, a man or woman, adult or child, rich or poor, who does not owe them something sometimes in his or her life, and, at any rate, a great deal to the care and attentive assistance, Supervision, and help received at the hands of nurses. We welcome any measure to improve the status of the nursing profession. It has won the admiration of the world as a whole, and during the last few years, during these trying years of war, it has earned the undying gratitude of millions of people.
§ Question put, and agreed to.
§ Bill accordingly read a second time, and committed to a Standing Committee.