§ Mr. Messer (Tottenham, South)
It is with great reluctance that I add to the labours of the Minister to-day. Whatever may have been said about him, it is only fair to say that he has shown great patience during the whole Debate. If it were net for the interest I take in the subject to which I want to refer, I would forego the pleasure of raising it here. On 18th March I asked a Question of the Minister of Health with reference to the recommendations of the Rushcliffe Committee. That Committee reported and made recommendations which had for their object the improvement of the conditions of nurses. I am bound to say that what the Rushcliffe Committee did was a big step forward. It is the first time in the history of this country that there has been any attempt to have anything like a national standard of salaries and emoluments for members of the nursing profession. I am also bound to say I think the Minister too hurriedly put the recommendations of the Committee into operation. He should first have seen what sort of response was made to these recommendations, what were the reactions of the people affected by them, and then, if necessary, have amended the recommendations. I cannot believe that this House of Commons will agree that, because a Committee is called into existence for the purpose of investigating 2418 something and it makes recommendations, those recommendations must of necessity be implemented without amendment. To do so would mean that the House of Commons was surrendering its rights, that all that was necessary was to call into existence a committee and automatically put their recommendations into operation.
I know what the Minister will say in answer. He will say, in the first place, "This is a representative committee, and who am I, as an individual, to determine that a representative committee is wrong? Here are representatives of the employing bodies and representatives of the nurses themselves." I am going to be bold enough to say the Committee was not representative. The recommendations of that Committee concern in the main female nurses, but the Committee comprised only 12 women nurses and 28 men, and there was not one working nurse among them. I also think the Committee had in mind what may be a general custom, but one which is dying out, and of which sufficient notice was not given, with the result that anomalies are bound to exist. What the Minister will say is that the recommendations will cost £2,000,000, and to add £2,000,000 to the salaries of nurses must in the nature of things be an improvement. I am prepared to agree that it is an improvement, but it is not the sum total that is so important as its distribution. For instance, matrons can get as much as £900 a year in salary and emoluments. Ward sisters' salaries range from £130 to £180, plus emoluments, bringing them up to about £220. I hope the Minister will forgive me, because I am depending on my memory. I did not know I was to have the Adjournment and I am not armed with notes.
Anyone who knows anything about hospitals knows that the ward sister is the key officer of a hospital. It does not matter very much how clever your surgical staff is or what type of organiser you have as matron; from the standpoint of the patient, if you have not an efficient ward sister you have an inefficient hospital. In my view the ward sister is being underpaid, even under the recommendations of the Rushcliffe Committee. It is true to say the recommendations would give a vast increase in many cases, but that is only a measure of the very poor pay previously. They were so underpaid that the recommendations do represent a very big increase in some quarters. 2419 What is unfortunate is that, as a consequence of the change which takes place, there is a definite tendency on the part of trained nurses who become ward sisters to leave that work and become administrative sisters. The attraction is in the higher salaries, higher emoluments and higher living-out allowances.
Ward sisters are, in point of fact, more important than what are known as sister tutors. The sister tutor, who gets a higher salary than the ward sister, is responsible for part of the training of the nurses. In the main the sister tutor deals with the theoretical side, but the ward sister is engaged in practical educational work every moment of the day she is in the ward. It is her work in addition to the organisation of the ward, and in that she has to be careful to satisfy the medical superintendent or senior surgeon, to be careful to satisfy the matron—and matrons are not all angels in disguise—to satisfy the specialists and to satisfy the patients. The ward sister very often has a staff to control and some of them who are just beginning are, naturally, inefficient, but the inefficiency and the responsibility do not fall on those student nurses, but upon the ward sister. There is no time for me to develop that particular aspect of the matter, but there is sufficient evidence, if one had time to do so, to show that the ward sister has been very sadly neglected in this connection.
The next point to which I would refer—and this is a point of some substance—is that the Rushcliffe recommendations lay down certain allowances for nurses who live out, and it was to this matter that I was referring when I said that custom was changing. The Rushcliffe Committee appeared to assume that we were going to continue the custom of nurses living within the hospital, but in point of fact there is a tendency for authorities to have a large section of the staff living outside. It is true to say that with student nurses, many of whom are girls of 18 and who come from long distances and are far removed from their homes, it is better that they should be accommodated in the nurses' home attached to the hospital. But with a nurse who has gone through her training, and has become a State registered nurse, and a staff nurse, and who is a woman with some responsibility, there is no reason why she should 2420 be treated differently from a woman or girl, working in an ordinary industry, who, can live an ordinary life in an ordinary home. Some authorities, not because they are compelled from lack of accommodation to do so, have made it their policy to permit their staffs to live outside.
The recommendations of the Rushcliffe Committee—again I speak from memory, and everybody knows that figures are not easy to memorise, so perhaps any slight error may be forgiven—suggested that the living-out allowances should be £70 in the case of a sister, £65 for State registered nurses and £55 for assistant nurses. Anybody with knowledge of billeting knows that you cannot billet for those, sums. What sort of accommodation can you find for £70? You will find that the hospital is in a locality in which the houses are, in general, very much alike. Are you to fix up accommodation for a sister at £70 a year and then say to the next-door neighbour: "This accommodation will not he for a sister but for a staff nurse, so we can only afford £65," or "This is only for an assistant nurse and we can only afford £55"?
§ Mr. Messer
So my memory was wrong. There is a difference. I thought I remembered three divisions, but I am quite prepared to accept it, that my figures may be wrong.
§ Mr. Messer
You cannot cater for those differences when you attempt to find billets. Without mentioning a figure, I say that there is a variation. The important point is, in what position is an authority placed, even one which is making the boarding-out of its staff part of its policy? They can only pay £70 for the ward sister. It simply cannot be done. I am anxious to get the Minister to agree to a figure that will have some relation to what can be 2421 done. I was reading quite recently the advertisement columns of the newspapers, and I found that for ordinary boarding, £2 a week was being asked. If that is the case, really, the figures in the Rushcliffe Report require further consideration. The Rushcliffe Committee has considered the case on the basis of a communal life in a nurses' home attached to a hospital. Clearly what you can do there is very different from what you can do when you are boarding out nurses. We say to our nurses, "We will give you your salary, and we will give you additional salary to cover your emoluments." As the Minister knows, emoluments do not count for Income Tax. If we pay the nurses in cash, they have to pay Income Tax. The authority which I represent will have to pay these nurses and the nurses have figured that they will pay £24 a year in Income Tax. I do think that the Rushcliffe recommendations required a little more consideration before they were put into operation.
There is another very important point and I want the Minister to give this very careful consideration. In answer to a Question in the House he stated that the qualification justifying the amount recommended would be that of State registration. It was assumed, therefore, at the beginning that all State-registered nurses would be entitled to the Rushcliffe scale. Then, later, a decision was made in regard to matrons. The Minister of Health decided that notwithstanding the fact that they may be State-registered nurses, matrons of public assistance institutions were not entitled to the same as matrons of ordinary hospitals. There are some public institutions in which there are quite a lot of sick people and where the matron must be a trained nurse. There ate many public assistance institutions where even if the inmates are not in a chronic condition of illness they are in a condition of infirmity which borders on it, and it is necessary to have a State registered nurse, a trained nurse, in control of the institution. But just because they happen to be matrons of public assistance institutions and not of a hospital, they are not entitled to the benefits of the Rushcliffe recommendations.
I am sorry to have taken so long and will conclude with one point. The Minister has not even implemented the whole of the Rushcliffe recommendations and it 2422 does seem a little inconsistent that he should have said, "I am putting this into operation, because it was recommended by a representative committee" and then have reserved a question merely because the official body connected with the section concerned does not agree. I am referring to what I regard as one of the most important aspects of the nursing service. If a nurse trains in the nursing of fever patients she can get a fever certificate, and she is entitled to go on the supplemetnary register. If a nurse runs the risk—and there is a risk, notwithstanding statistics, which are not borne out in actual fact—of training in the nursing of tubercular patients and gets a Tubercular Association certificate, she cannot go on the supplementary register. Even the Rushcliffe Committee, on which there were representatives of the Royal College of Nurses and the Trades Union Congress, as well as of hospital authorities, saw the necessity of giving some status to the nurse holding the Tubercular Association certificate. That has not been put into operation. They recommended that she should go on the supplementary register, but the General Nursing Council opposed it, and therefore she has no status at all.
I have said sufficient to show that there is seine justification for this matter being aired at greater length. I am disappointed that we were not able to get a full day's discussion on it. A great deal more can be said about certain anomalies. Let it not be thought that I am unmindful of certain advantages. We are striving for perfection in an imperfect world, but the fact that we cannot attain that perfection should not prevent us from getting as near to it as possible. I look forward to the day when we can give the nursing profession the best possible conditions. The value of that service is beyond our estimate. May I express the hope that the matter is not yet completed, but that on certain points we may get some encouragement from the Minister as to the prospect of improvement in what at the moment is rather a regrettable position?
§ Mr. Bernard Taylor (Mansfield)
I hesitate to intervene and so prevent the Minister from having the maximum amount of time to reply to my hon. Friend. I would like to say however in support of all the points my hon. Friend has made, that the implementation of the 2423 Rushcliffe Report has caused a lot of perturbation among the local authorities. The reason for that is the difference that the Committee has shown to exist between the matron at the top and the nurses at the bottom. I regret that an opportunity has not been given to the House for a fuller Debate on this very important question, when it is absolutely necessary that conditions should be made more attractive to encourage recruits into the nursing profession. If the Minister can assure us that on some future occasion we can debate this more fully, some of the anomalies contained in the Rushcliffe Report can be brought before this House. Owing to the lateness of the hour and my desire, in courtesy to the Minister, to allow the Minister time to reply, I will leave the matter at that.
§ The Minister of Health (Mr. Ernest Brown)
I am obliged to my hon. Friend for raising this matter. The hon. Member for South Tottenham (Mr. Messer) has been very patient on this question, and I think he will agree that so have I. He and I have arrived here several times and found that there has been no Adjournment Debate. To-day there has been, so far as I am concerned, a very long Adjournment Debate. I cannot, in the seven minutes left to me, go too much into detail. I would say, in answer to the hon. Member for Mansfield (Mr. B. Taylor), that this subject might have been discussed on my Estimates, but it was not called for then, although my Estimates were asked for several times. It is not for me to say what should be discussed on my Estimates—I get only a hint. It might be well, if we do discuss this question, that we should bring out not only the anomalies in the Report, but the great advance that has been made on the whole question. I say that because my hon. Friend the Member for Wallsend (Miss Ward) has said at Question time that my attitude has been obstructive in regard to nurses. I greatly resent that. Nothing could be further from the fact.
The Rushcliffe Committee is a very important Committee. I come to this straight away, so that the House may know just how representative this Committee was. It was set up after the fullest possible discussion—it took us months—with all the organisations concerned, and it is fully representative of nurses and 2424 employers. The nurses organisations represented were the Royal College of Nursing, the Trades Union Congress, the National Association of Local Government Officers, the Association of Hospital Matrons and the Royal British Nurses Association. The employers' organisations represented were the British Hospitals Association, the County Councils Association, the Association of Municipal Corporations, the London County Council, the Urban District Councils Association, the Rural District Councils Association, and the Queen's Institute of District Nursing. The House will see that it would be very difficult to get a more representative body of men and women, and it was not due to me that there were not more women. The organisations themselves were asked to nominate for themselves. They all did nominate, and I accepted the nominations and was fortunate to get my friend Lord Rushcliffe to take the chairmanship.
The Committee not only gave us a Report on nurses, but it is to give us another Report on midwives. It is true, as the hon. Member for South Tottenham said, that it cannot be assumed that because the Government set up a committee and that committee gives a report it is necessarily the duty of the Government to accept everything in the report. But when a Committee has spent 15 solid months going through all the various categories of nurses—and they are many, as those who have seen the full Report of the Committee will realise—meeting in two panels as they do, a panel of employees and a panel of employers, not always agreeing, but coming together, meeting, modifying and enlarging views—once they have gone into a highly technical problem like this, the Minister wants great justification for turning down their recommendations. I will go further and say that I feel personally that, since the Athlone Committee's Report has been in the hands of the Government since a little before the war and was necessarily laid aside because the war broke out, it was very important on this particular side of the Committee's work that we should take the swiftest action possible. I do not bind myself on any future occasion or any successor of mine to accept everything that the Rushcliffe Committee, may recommend on other subjects. What I do say is that, if there is not a ward sister 2425 on the Committee, the fault is not mine but surely that of the trade union organisations. [Interruption.] Perhaps I ought not to bring in the word "fault." They overlooked it or did not share my hon. Friend's view and that of those who think with him. There are important bodies who think with him that there should be a ward sister there. But the fault this time is not that of the Minister or the Government.
There is no doubt whatever that anybody who thinks these things out will see that there is a great deal in the Report. There are some who say that one particular branch of nursing got too much. I am sorry that the hon. Member for Mansfield drew a distinction between the nurse and the matron. One of the great things that has impressed itself 2426 upon me all the time I have been Minister of Health and Secretary of State for Scotland is the extraordinary capability and character of the matrons of our hospitals. So I hope we will not go that way. Let us rather say that if we are dissatisfied, we will have a little more for those lower down. [An HON. MEMBER: "Yes"] But the hon. Member for Mansfield did not come to that. He was drawing a distinction which I hope will not be drawn in any of our future Debates. At the moment I cannot see any justification for altering the major things, and the same applies to those living out—
§ It being the hour appointed for the Adjournment of the House, Mr. DEPUTY-SPEAKER adjourned the House, without Question put, pursuant to the Standing Order.