I beg to move,
That an humble Address be presented to His Majesty praying that the Rules of the General Nursing Council for England and Wales, laid before Parliament on the 6th day of March, 1922, in pursuance of Section 3 (4) of the Nurses' Registration Act, 1919, and numbered 9a and 43 (2) respectively, may be annulled.
This arises under the Nurses Registration Act passed at the end of 1919. I want to economise the time of the House as much as possible and I am going to take a preliminary point of law which, I think, the Minister of 'Health will admit is fatal to the two Rules to which we are objecting this evening. If the right hon. Gentleman makes that concession, it will not be necessary for me and my friends to discuss the merits of the Rules. The Act of 1919 first set up the General Nursing Council, and the second Clause provided for the registration of the nurses. The third Clause provided that the Council should make Rules for various purposes, including Rules for regulating the conditions of admission to the register. When these Rules are made by the General Nursing Council they are submitted to the Minister of Health, and if they receive his approval they at once, subject to a memorial presented to His Majesty within 21 days after the Rules are laid on the Table of both Houses of Parliament, have the force of law. No one will deny that it is the province of the General Nursing Council to make Rules with regard to the admission of nurses to the register. The first Rule to which I am taking exception is Rule 9a, which says:
Notwithstanding anything in these Rules the Council may accept in place of a certificate a copy of a certificate certified by a Justice of the Peace, a barrister or a solicitor to be a true copy thereof, or where the applicant is a member of any organised body of nurses recognised for this purpose by the Council, a declaration signed by the Secretary or other responsible officer of that body that on the admission of the applicant to membership a certificate or a certified copy thereof was produced and was verified by that body.
I am not going to deal with the merits of that, but I am going to draw the attention of the House to a subsequent Section of the Nurses Registra-
tion Act, Section 6 (3), which provides that,
In the event of provision being hereafter made for the establishment of a register of nurses in Scotland or Ireland,
there shall be reciprocity, as it is very desirable that nurses registered in one country shall be able to join the register in another country. The Sub-section goes on, therefore:
The Council shall make rules under this Act enabling persons registered as nurses in Scotland or Ireland, as the case may be, to obtain admission to the register of nurses established under this Act—
Now I ask particular attention to these words—
and with a view to securing a uniform standard of qualification in all parts of the United Kingdom the Council shall, before making any rules under this Act with respect to the conditions of admission to the register, consult with any Nursing Councils which may be established by Parliament for Scotland and Ireland respectively.
That has not been done. These Rules, which now lie on the Table of this House, were not submitted by my right hon. Friend to the General Nursing Council for Scotland, or to the General Nursing Council for Ireland, and that fact, by a fortunate use of the procedure of this House, I was able to elicit from my right hon. Friend the Secretary for Scotland yesterday. I asked him the following question:
Whether he is aware that the new Rule (9a) passed by the General Nursing Council; for England and Wales, approved by the Minister of Health and now laid upon the Table of the House, permits the names of nurses to be placed on the State Register of Nurses without direct documentary evidence of their credentials and character, as provided for under the existing rule; whether, as is required by the Nurses Registration Act for England and Wales, Section 6 (3), the General Nursing Council for Scotland has been consulted as to this rule; whether it approves of the compilation of the State Register of Nurses upon indirect information supplied by the secretaries of organised bodies of nurses instead of upon documentary evidence supplied direct to the Council; and whether the General Nursing Council for Scotland will be prepared to admit to its register, under the reciprocity agreement between the two countries, nurses who have obtained admission to the register for England and Wales without furnishing such evidence?
This was his answer:
The answer to the first part of the question is in the affirmative. As regards the second and third parts of the question, I understand that the General Nursing Council for Scotland has not been consulted in regard
to the proposed rule, and does not approve of it. In answer to the fourth part of the question, my information is that, pending the adjustment of this matter, the General Nursing Council for Scotland has not passed any rule providing for the registration on the Council's register of nurses already on the register of the General Nursing Council for England and Wales.
I then asked:
Is the right hon. Gentleman aware that the General Nursing Council for Scotland has asked for this rule to be withdrawn?"—[OFFICIAL REPORT, 21st March, 1922; col. 226, Vol. 152.]
and the Secretary for Scotland replied that representations in that sense had reached him. As a matter of fact, the General Nursing Council for Scotland has asked that this rule might be withdrawn.
They asked the General Nursing Council of England in a letter which they wrote to them on the 4th March, and of which I have seen a copy. I am naturally anxious to save the time of the House, and am not arguing the merits of these rules, though I am prepared to do so; but I should like at this stage, if I may, to ask my right hon. Friend whether, in view of the fact that they are plainly ultra vires, and would be so held by any court in the country, he proposes to persist in them? I would ask him to answer that before I sit down.
I was endeavouring to elicit from my right hon. Friend a reply on the point of law, because a discussion of the merits will obviously take a considerable time. I beg to move.
I will deal with the legal point first. This is, of course, the greatest mare's nest that has ever been produced in this House. It is not likely that I should sanction rules unless I had legal advice as to the competence of the action I was taking and the
powers which I had under the Act in question. My legal adviser, in a written opinion, states:
There is no doubt at all on this point. Section 6 (3) of the Act requires the General Nursing Council, with a view to securing a uniform standard of qualification in all parts of the United Kingdom, to consult with the Scottish and Irish Nursing Councils before making any Rules under the Act with respect to conditions of admission. It is abundantly plain that the conditions of admission to the register have reference to the qualifications of nurses which the Council may prescribe. They cannot refer to the procedure or machinery by which the names of nurses who possess the necessary qualifications actually become inscribed upon the register.
Rule 9a has nothing whatever to do with the qualification of nurses. It is purely a machinery rule, which does no more than prescribe the evidence which nurses are to adduce of their qualifications. The new rule neither raises nor lowers the standard of qualifications, which are prescribed by other rules, and remain precisely the same as before the new rule was made. The legal point is absolutely clear, and even if it was challenged I would point out that Parliament never passed an Act of such an absurd nature as to put the English Nursing Council, and the Minister responsible for it, in the position of being incapable of carrying out the Act in England except by the consent of the Scotch Nursing Council. I have consulted the Scotch Nursing Council on several occasions, and if the necessity arises I am quite ready to consult them again, but it is a different thing to say you ought to consult someone, and to say the rule is ultra vires because you have not consulted them. The law is clear on that point. The provision regarding consultation is directory, and if it is not done it does not legally invalidate the rule. So much for the legal argument. Now I ought to pass to the merits of the case.
On a point of Order. I asked the right hon. Baronet to give an answer before I concluded my remarks on the legal point to save the time of the House, and I ought to be allowed to deal with the merits.
I thought that would be the position. I feel I must deal with the whole facts fully. This is really a very old standing squabble, which really ought not to trouble the House. Anyone, who knows the history of the story, knows what a long feud there was between two different nursing associations, one championed by the hon. Member who is asking the House to reject the rules, the other by another body of people. So long did the feud go on, that no rules came into existence at all. My predecessor in office got a Bill passed, a council has been set up, and I have been doing my best to get it to work. On the council, unfortunately, the old feud has been pursued by a very small minority, which is now trying to destroy the rules which I have sanctioned, because they are the only way in which nurses in this country, numbering some 50,000, will ever get on the register in their lifetime. What is the position in which I have been placed? A crisis in the Nursing Council, resignation of the chairman, resignation of 16 out of 21 members of the committee. I have now an able chairman and I have got the bulk of the committee to go back on the understanding that I would support them. They have introduced a rule. The purpose is two-fold. One is that, instead of a nurse having to send her original nursing certificate to London to be certified, she can get a certified copy and send it up under proper conditions and have it entered. That is done because we have found from experience that nurses have the greatest objection to part with their original papers. They are afraid they may get lost or mislaid. They are the one vital document in their possession, and they would sooner not be registered at all. The second point is that there are two big organisations which have been in existence for many years before this Act came into force, the College of Nurses and the Royal British Nursing Association. Out of 50,000 nurses, over 19,000 are registered in the College of Nurses register. Their qualification is more severe than required by the rules. They require three years' training instead of one. What are we doing under these rules? We are enabling the registrar of the Nursing Council to go and examine copies of the certificates of the Royal College of Nurses, who have the roll, whenever an application is made, to satisfy herself. The same will be done with the other nursing associations. There is no favour shown to anybody.
I will tell the House why I have been anxious to take this action, and why it is essential to speak this evening. In the four months since the date when the Register came into existence in November, 3,235 actual cases were received and only 984 were completed. Applications were coming in at the rate of 800 a month, and less than one-third had been finally passed by the Council. The present Council must, according to the Act, come to an end not later than the 23rd December next. Out of 50,000 nurses you have only 1,500 on the Register, and unless between now and the 23rd December next you get a large number of qualified nurses on the Register, you will be in the absurd position of having the Council for the next three years elected by quite a small number of the 50,000 nurses. Therefore it is important and necessary to have a speeding up of the machinery which will put nurses on the Register as rapidly as possible. That will do away with the meticulous and ridiculous manner in which this matter has been treated up to now. It is impossible for the Chairman of the Registration Committee to go into long details of every one of these certificates, and to start a cross-examination in every case. If she did so many of the nurses would be dead and buried before they got on the register. These are the reasons why I have sanctioned this procedure. It is machinery. The Nursing Council, which ought to understand its business, has passed it by a majority of 16 to 6. The Matrons' Association of Great Britain, representing the matrons of the leading London and provincial hospitals, are entirely in favour of the Rules, and I can only say that if the Rules were rejected there would be no other course left open for me than to move the repeal of the Act, do away with the register altogether, and the whole thing would become a farce.
I speak for neither of the two associations referred to by the right hon. Gentleman, but for the nurses who are members of a trade union, and who are entirely opposed to the action taken by the Nursing Council. The right hon. Gentleman has spoken of the constitution of that council. What we said when the Bill was in Committee upstairs has come to pass. We said that it would be an unworkable council. Twenty-one of the people on the Council belong to the employing side, leaving five or six for the rest of the nursing profession. Those people for whom the Act was passed, the nurses who were to be protected by the Act, are loft with only four representatives to see that their rights are protected.
I claim to have had as much experience of municipal hospital work as most people, and I know the iron hand of the matron. I know that often if a nurse claims to have a soul of her own she has to leave practically the next day. She is thrown on the street without a penny. I put my experience against the advice offered to the Minister of Health. The continuation of this Council is entirely wrong. We had a strike in the district. Because these people did not get all they were insisting on being done they went on strike. I have had something to do with strikes and lock-outs, but this is the very first strike I have ever known in which the strikers drew their pay while they were on strike, and they helped themselves to £500 during the ten weeks. These are the people who are in power on the Nurses Council. There were no salaries deducted. These things are happening, and the nurses are claiming that they have some right to say that the money which they are subscribing should be distributed for the work which they are doing in an efficient manner.
If the right hon. Gentleman will make inquiries he will find that what I am saying is correct, that they were paid in salaries to the staff without the Council being working.
I submit that that does not alter the position one bit if there is no work to be done, and the Act has been annulled by their action and cannot be worked for the staff inside that hospital. Let me tell the right hon. Gentleman that immediately they came back they set about driving the others off every committee and leaving them with no power whatever. They drove off one committee a woman who has had more experience than any other woman on that Council and put on another woman who would act according to their dictates, thus taking away the only friend on that committee which the working nurses had. Again they drove off a committee a matron who was the only matron who knew anything of the training and another lady was put in her place, and so they have gone on. Some protection ought to be given to these people. Their livelihood depends on it. This Act was passed for the sake of safeguarding the nurses and the general public. What will happen if this thing is allowed to continue is that anybody who can gain the confidence of the matron may have her name added to the list of nurses without any training at all. I know that this may not happen, but it is possible, and young women who have given three years of their lives to training ought to have some protection. Therefore we are claiming that this thing is not on right lines, and that if justice is to be done both sides ought to have sufficient members on the Council. They might prevent a strike if working nurses had a sufficient number on the Council to form a quorum, for there would then be no use in these people refusing to come and act and to get these nurses on the register which the right hon. Gentleman is so anxious should be compiled with which I am in entire agreement. I would as soon as possible have every nurse in this country who is thoroughly trained placed on the list, for the sake of the suffering public. I beg the Minister of Health to take up the matter, and to see whether something cannot be done to bring about peace and harmony in the profession. We want these people to have a real say in the working out of their own salvation. Surely the time has passed when women should have to work 12 hours a day for £30 a year. It is a shame. The very best women we have in the country should be able to take up the nursing profession. It is in some ways of vastly more importance than the medical profession, for the nurse is continually with the patient, and must know what is best to be done at any moment to save human life.
I have never heard so many misstatements made in five minutes as have been made by the last speaker. He spoke Very sincerely, and no doubt what he said he meant, but, as very often happens, in this case various statements have been made from the Labour benches without the knowledge whatever of the subject. [Interruption.] The statement has been made that the object of the General Nursing Council is to do some damage to nurses. My hon. Friend has waxed eloquent about the nurses managing their own affairs, but he has missed the whole point. This Council is only a temporary Council, nominated to carry on until sufficient nurses have registered.
The nurses are not registering as had been expected. The object of these Rules, passed by a large majority of the temporary council and approved by the Minister of Health, is to enable nurses to register, and when sufficient nurses have registered they can manage their own affairs. It is precisely with that object that the Rules are placed on the Table. Just now nurses are not registering because there is so much difficulty in sending up their certificates. Under the present scheme the certificate of a nurse has to be verified and to be sent to the Registrar. There is no question of a nurse getting through without proper qualifications. The scheme is designed merely to enable a nurse more easily to have her certificates sent and approved.
My hon. and gallant Friend the Member for South-West St. Pancras (Major Barnett) was accused by the Minister of Health of having started a mare's nest,
but I think he went on a point of law, and was consequently unable to make his case from the point of view of the facts. I think, however, he did get mixed up with the question of law and the question of ladies, and when one gets mixed up with those two questions it becomes rather awkward. [HON. MEMBERS: "Is that a joke?".] Members of the Labour party do not often see a joke, but they can take that as one if they like. I do not want the House to have a wrong impression as to the merits of this case, nor to think that this is merely a question of a statement on the one side by my hon. and gallant Friend as representing the nurses of the whole of this country and the Minister of Health and other unscrupulous people who are trying to get the better of the nurses. I do not want them to think that, because there are other bodies, infinitely greater numbers of nurses than any of the societies that have been petitioning hon. Members and have so successfully taken in some—not all—of my friends on the Labour benches. It is by no means the unanimous wish of the nurses that these Rules now lying on the Table should not come in as part of the law of the Registration Act. That is a statement that can be proved. As the Minister of Health has stated, there are other bodies quite prepared to show the nurses on their registers and their qualifications. The Association of Hospital Matrons has passed a resolution at their quarterly meeting at which they
express their entire approval of the recent steps taken by the General Nursing Council in amending the existing Rules for the purpose of speeding up the compilation of the State Register.
They further desire to thank the Minister of Health for having signed these Rules, and also to express their confidence in those members of the General Nursing Council who have supported these measures.
I do resent very much on behalf of matrons I have worked with and on behalf of the great body of nurses in the country the statement that matrons as a whole and as a class are people who are driving nurses for all they are worth, and are simply representing the so-called employers. The Labour party try to make a great point of the use of the word "employer" as something to be laughed at and sneered at, but I venture to remind them that after all there is no such thing as "employers" in the sense that they are using the term. The hospitals
are run for the benefit of the poor of this country without any hope of reward, and it is mean and cowardly, and is not in the interests of this House, that such statements should be made against matrons, who are a splendid and noble body of women who on the whole are beloved by their nurses. I only rise to show the absurdity of that. My hon. and gallant Friend wants the nurses to run their own profession, and the only way to do that is to get on the Register as soon as possible. They are not getting on it. There are only 1,500 on the Register, and the object of these Rules is to enable them to get on the Register without all the formalities they have to go through now. As I have said, I do not want people to think it is nurses on one side and the Minister of Health on the other. I am convinced that the majority of the nurses of the country want things speeded up and that they want these facilities, and it would be a great mistake if the House thought it was a case of the nurses on the one side and the wicked Minister of Health on the other opposing the poor nurses of the country. It is not so at all.
We are indebted to the last speaker for having reduced the heat which unfortunately was imparted to this Debate. In some respects, I have not so much right to speak, because this is a question of the registration of English nurses, but I intervene on behalf of Scottish nurses, since they also are vitally concerned in the question. The question of law raised at the beginning of the Debate seems to have received very perfunctory attention from the Minister of Health. The Minister is a man of strong personality who has, so far, received very little opposition in any of the vigorous steps which he has taken in remodelling the health services of the country, and he is, perhaps, a little inclined to brush aside opinions which do not exactly coincide with his own. It seems to me, even if we take it on the simplest point of all, that he is availing himself of a legal technicality to escape from the dilemna, in which—it seems to me as an ordinary layman—he is placed by the words of the Act. The words are mandatory—
The Council shall, before making any rules under this Act with respect to the conditions of admission to the register, con-
sult with any Nursing Councils which may be established by Parliament for Scotland and Ireland respectively.
That is with a view to a subsequent establishment of reciprocity. It is all very well for the Minister to say that the supplying of evidence is not part of the conditions of admission to the register, but it is considered by the General Nursing Council of Scotland as being so germane to the subject under discussion that they say they cannot allow for reciprocity as long as Rule 9a is permitted to stand on the English register. Where lawyers differ, it is not for mere laymen to intrude, but it is impossible to suppose that the General Nursing Council for Scotland has not the interests of the nurses at heart. When it says it cannot give reciprocity on the conditions and the rules approved by the Ministry of Health, I submit to the Minister that even though he may be in order, on the technical legal question involved, he is not so on the broader question as to what was intended by Parliament when it passed the Act. We debated the question at some length, as I well remember, and the general intention was that in order to provide reciprocity between the Councils in England and Scotland respectively, these Councils should consult each other and make sure that admission to the one register would, ipso facto, mean admission, with a few technical changes, to the other register.
Even if the Minister be correct on the narrow legal point, that the provision of evidence of qualification is not a condition of admission to the register—regarding which, not having legal training I am not qualified to speak—I claim that the broad object of this Section of the Act is not being fulfilled by the rules at present laid on the Table of the House, because the prime governing consideration, namely that the two registers should be similar and parallel in all respects, is not being fulfilled. Therefore I do beg of the Minister to reconsider the matter, not from the merely legal point of view of those who are, no doubt, eminently qualified to speak, and have given a perfectly correct legal ruling, but to take the broader view of what was intended by this House when it placed the Act on the Statute Book, namely, that the Scottish and the English Councils should consult with each other before passing rules about the admission of nurses, so that this unfortunate contretemps which has occurred might be avoided. The very purpose of the Act is being defeated by this ruling, and I do beg of the Minister, even although he has a strong legal position, to reconsider the matter on the broader ground. I do claim that the Scottish nurses are very closely concerned in this matter. The protest has come, not from any party or one section of nurses or another section of nurses, but from the body legally set up under an Act passed by this House. Can a protest of that nature be brushed aside in the perfunctory manner in which the Minister of Health has attempted to dismiss it? I protest against a reasoned letter from the Registrar of the Scottish Council being dismissed as a mare's nest.
It may be so. I do think that goes to prove the fact that this consultation, which was desired by the House, when it passed this parallel Act, has not been carried out. The fact that there is such a protest is not in dispute. Everybody admits it. Many other Scottish Members have received protests. The very lack of co-ordination which this Section in the Act is intended to prevent—
I do claim that, in passing a new rule, the onus of proof lies on the man who wishes to change the law. I am not claiming any position of superiority for the Scottish Council, for if the position had been reversed, and the Scottish Council had passed a new rule, or laid on the Table of this House a new rule without previous consultation, then I think all of us Scottish Members would have admitted that in that action it had committed a fault. I forget what exact official position the Minister holds on the Nursing Council, or in relation to that Council, but he holds an official position in virtue of his office, and the Registrar of the Scottish Council has surely acted very rightly in indicating the decision of his Council to the corresponding body in England. At any rate, that that dispute has arisen and that that protest has been communicated to the English Council are not in dispute, and we do beg the Minister, at any rate, to meet us in this matter, or else, with the greatest reluctance in the world, we may be forced to divide the House on this very important matter, because it brings up the question of principle. I am sorry to detain the House, but it is a matter of great importance both to the medical profession and the nursing profession, and I have spent many years of my life in that service, and have its interests very keenly at heart. We have here this problem again of this nationalistic business of setting up two boards, one in England and one in Scotland. It leads in this case, as it will lead in every other case, to confusion, and I beg of Scottish Members, particularly the Member for West Fife, to observe this point, that when we get a dispute such as this the economic power drags us by the heels. Scotland in such a cast: can take what action it will and the English Minister can come down here, and bring the weight of England to bear. I protested against these split-up and subordinate bodies when the rule was going through the House, and I do point out to the hon. Member, who is so keen to get everything cut up and subordinated, and drawn into Edinburgh instead of London, that whenever we do get these things carried through we have trouble in this House.
I am merely saying that the attempt at co-ordination in this Act to remedy these evils is not satisfactorily working on this occasion, but I bow to your ruling. I do not wish to argue the merits of the case, except to say that for any State body to accept entrants at second hand, unless laid down by Act of Parliament, is surely a rather unusual innovation in the compiling of the State registers, and that any register which takes such entrants is weakening its position in the eyes of the nursing profession and of the public. Therefore, I do beg of the Minister to reconsider the position which he has announced to the House.
I want to lodge a protest against the absence from this House of a legal representative of the Government when we are dealing with an important question in which a legal issue is raised. I distinctly remember that, when we were dealing with this question upstairs, a very great deal of apprehension was expressed with regard to the Councils we are discussing to night, and I am thoroughly convinced that, so far as the legal aspect of the question is concerned, the legal opinion which has been expressed by the Minister who is defending his action to-night, is an opinion that, to put it most mildly and moderately, can be questioned by this House. I had some previous experience with regard to opinion which has been given by the legal representative of His Majesty's Government when questions have been either before this House or Committee.
May I give one instance to show how great is the difference between the legal opinion just laid down by the Minister and the actual practice; and, after all, the Minister gave his legal decision, and then said it could not be enforced! When we were discussing upstairs the words "may" and "shall," the Minister said that "may" in law had the same meaning as "shall." This referred to the Poor Law officials and their pensions. When it comes to the interpretation of "may" as "shall"—the matter being brought before this House—the Minister in charge to-night has more than once stated that he has no power of enforcement. When to-night we come to deal with another aspect of the law, we are informed—[HON. MEMBERS: "Divide, divide!"]. It will not hasten the proceedings one iota by hon. Members shouting "Divide." Those who shout, had we been discussing Ireland, would have been ready to sit up all night. I want to make this point, so far as the word "shall" is concerned. I understand the position of the Minister is this: that this word "shall" is purely an instruction—that is the intention of the word, an instruction that the English Council "shall" consult, and if they do not consult, when the Minister has done so and so, it does not invalidate anything that has been done by the Council. However he can place such an interpretation upon the law passes the comprehension of the English lay mind.
I want to say just a word or two in regard to the position of nurses in this country and in Scotland. Nothing should be done in this House which will make it more difficult to interchange, or accept and recognise the validity of registration and the certificate on the other side of the border, or to encourage a system under which the nurses of this country may be registered, then perhaps go over into Scotland and find that their English registration is not accepted as valid. If we refuse to accept the humble petition we are setting up a state of affairs in which we are going to have, not only a dual authority, but a dual form of registration, in which on one side of the border it will, and on the other side it will not, be recognised. [HON. MEMBERS: "Agreed."] Any system of that character, in my opinion, will be most detrimental to the nurses of the country.
By leave of the House I should like to make one point in reply to the right hon. Baronet. He says that Rule 9 A deals, not with qualification, but with the conditions of admission to the register. I agree: but according to Section 6 (3) of the Act, the General Nursing Council for England and Wales must consult with the Scottish and Irish Councils before making rules "with respect to the conditions of admission to the register." My right hon. Friend says that 9 A is "merely a machinery rule." Surely the question of what evidence of nurses' qualifications shall be required is vital! There have been cases of nurses in this country with forged certificates who have carried on practice. If the Scottish Council insists upon seeing certain certificates, or certified copies of them, is not that a material point of admission to the register? The Scottish Council declines to accept hearsay evidence and insists upon the production of the original training certificate, or at least a certified copy of such certificate? A majority of the English Council now, apparently, take a different view, and are satisfied with a declaration that the training certificate, or a certified copy of it, was produced at some earlier date to other people. How can there be reciprocity under such conditions? A nurse who failed to register in Scotland under the prudent rules imposed by the Scottish Council might come to England, register under the looser provisions of the English Council, and then claim to register in Scotland under the reciprocity rule. I say the right hon. Gentleman's law is bad law, and that Rule 9 A is ultra vires. If my right hon. Friend does not see his way