They may go to another form of nursing. At any rate, to say that a girl who has got married and started to rear a family of her own comes under the heading of "wastage" is in effect a definition of wastage with which not all sociologists would fully agree. The fact is that it is true, as the Secretary of State has said, that some people devote all their lives to it. They have, as the religious would say, a vocation for this. But there are others who are very well serving the community indeed by putting in a period of work here but not regarding it as the profession in which their whole lives will be exclusively spent. Therefore, we have to examine it from this point of view as well.

The Secretary of State gave, I think, a clear and sufficiently explicit account of the actual machinery of the Bill. The working party's report and the proposals which they brought forward will, I think, be generally accepted. On the whole, they did receive the acceptance of the profession. However, it is certainly a matter which the House will need to keep under review, because here a very great change has taken place comparable with the change that has taken place in the conditions of other professions, to which conditions this House has devoted far longer hours and, if I may say so, far more acrimonious argument than it has devoted to this numerically far superior profession, which in the practice of medicine, is not inferior in importance even to the learned profession of which I myself was at one time a humble member. I cannot claim any more than an honorary membership now.

The numbers, of course, are very large. Girls to staff 64,000 beds had their status changed when the National Health Service Act went through. The number of nurses employed was 18,465 in the hospitals. They are not enough. It is the fundamental point that at this time, when we have a shortage of capital equipment in so many fields, here we have actually a surplus of capital equipment. We have stone and lime and buildings, the beds, technical apparatus, the equipment—everything but the skilled staff.

Without the skilled staff these other things are perfectly useless. Here it is exceptional, in our difficulties of today, in that there is here a surplus of technical equipment above what can be operated by reason of the shortage of skilled staff; and, therefore, we must bend our minds very closely to seeing how this shortage can be made good. The number of nurses employed at the end of 1948 was, as I said, 18,465. That was an increase on the number in the previous year, but at the end of the year the hospitals estimated their needs still at 6,125 more nurses. That is a large figure and, of course, it has led, as the Secretary of State well knows, to many tragic situations, notably in the tuberculosis field, where, in spite of the fact that in Scotland the tuberculosis graph has turned against us, we have hundreds—indeed, more than hundreds—of beds in the tuberculosis sanatoria unoccupied, while potential patients are still confined to overcrowded houses and are acting as a source of infection to the families with whom they continue to be associated.

The working party made rather an odd diagnosis of the difficulty. They said that it became clear during the course of the interview that the crux of the whole problem of wastage seemed to lie in the sphere of human relationships, and they put down the reason for wastage, first, to the code of discipline which they said was felt to be unnecessarily severe, and, secondly, to the inadequacy both in quantity and quality of the food, the span and pressure of working hours, and such matters as poor accommodation, insufficient pay, bad recreational facilities and an unnecessary amount of domestic work. If that was so, it is a striking testimony to the voluntary hospital. The wastage in the voluntary hospital was 35 per cent. of the intake and the wastage in the others, was 56 per cent. of the intake; so is it to be supposed that the voluntary hospital successfully solved the problem of accommodation and discipline, span and pressure of working hours and such matters as poor recreational facilities and an unnecessary, amount of domestic work?

I think that the interest of the work also comes into it. If we look at the places where the wastage took place more particularly, we find that it is in those places where there is a less interesting and engrossing type of work. The wastage was, as I have said, 35 per cent. of the intake in the voluntary general hospital and 43 per cent. in the municipal general hospital. It leapt up to 56 per cent. in the case of infectious diseases hospitals, 65 per cent. in tuberculosis sanatoria and 82 per cent. in mental hospitals.

I think that indicates—I am not pressing a party point, in fact I am refraining from pressing it—that the difference between the much heavier wastage in the local authority hospital as compared with the voluntary hospital is not entirely due to the more successful system of the voluntary hospital but to the character of the work. I am stressing that point. I am giving hon. and right hon. Gentlemen that point. I think that it would be unfair to claim that, although naturally I am entitled to my own opinion. I think that in some way there was a greater flexibility in the great voluntary hospital and that the relationships were less rigid than in the local authority hospital, but I do not wish to stress that too much because I think that the quality of the work also came into it.

We still have this problem to deal with, particularly in the case of the tuberculosis hospital. There is undoubtedly an element of fear here, and it is not entirely unjustified. The causes of wastage through sickness, for instance, is 12 per cent. in tuberculosis sanatoria as against 9 per cent. in infectious diseases hospitals and 8 per cent. in mental hospitals. That is 12 per cent. of a higher rate of wastage. Already the wastage, as I have said, came to something like 65 per cent. It is true that there is a higher rate of wastage through sickness in the voluntary hospitals, but that is a higher rate of wastage with a smaller rate of gross wastage. The wastage due to sickness is 18 per cent. in the voluntary hospitals and 17 per cent. in the municipal hospitals; but, as I have previously pointed out, that is out of a wastage of 35 per cent. in the one case and the much higher figure of 65 per cent. in the other case.

Now, somehow or other we want to be able to remove that. It is partly psychological, but there is a little more in it than that. I remember when I first went to take a tuberculosis dispensary in the Chest Hospital in London; when I heard the storm of coughing in the dispensary my heart sank. In spite of all that one is told about there being no danger, and all the rest of it. I could not help feeling—and, mind you, I had been through the war on the Western Front before that—that this was not the sort of experience that I could go into with any light heart or joy.

There must be recognition that this is a thing to which danger attaches. I do not wish to stress it too much, and I do not want to discourage people from going into it, but we are now talking to an important technical audience, and I think it very desirable that we should direct attention towards removing, in every way, any apprehension that might be felt by the girls or their parents when we are trying to get the staffs of the sanatoria brought up to strength. It may well be that protective measures of one kind or another—perhaps protective inoculation—might be desirable, because I am sure that until we remove this fear entirely we shall not have dissipated one of the factors which leads people to stay out of T.B. nursing and to prefer other forms of nursing.

We must somehow or other get a more engrossing and interesting sector into the work and life of these nurses. The great joy of any medical man, or any person engaged in the work of medicine, either in nursing or anywhere else, is to see people getting better; the stimulus is to see the beds empty, the patients walking about in dressing gowns, and finally going out of the ward, and the feeling that there is a rapid turnover and that people are passing out of the hospital. That is an enormous stimulus. It is well known, for instance, in medicine that the skin ward is a gloomy sort of place, because as a rule a skin patient is in the hospital for a long, long time.