I am sorry to have to raise a question which is entirely inconsistent with the optimistic note struck by the Chancellor of the Exchequer when he finished his speech a moment or two ago. The very serious matter I have to raise indicates that things are not going as well as we had heard just now and that much money and opportunity are required to remedy a very serious trouble. I am sure the House will not regard it as untoward that I have chosen the shortage of nurses in mental hospitals as my subject, although the matter has been raised here in one form or another in recent months.
Irrespective of party, we are all deeply concerned with the care of our unfortunate fellow citizens who have been deprived, through no fault of their own, of their mental faculties in whole or in part, and it is very unfortunate that there is such a shortage in the service for attending the afflictions and ailments of those attacked by mental diseases. It is difficult to decide upon priorities in these matters. Everybody is anxious to bring health to those who are 'Suffering ill-health. That applies in every field, but I think it is generally agreed that the helplessness of the mentally sick should be regarded as one of the first priorities.
I doubt whether the average man or woman understands the agony of mind and heart of those who have a mentally diseased person in their family—except, of course, the people in those families. Every effort has been made to eliminate the stigma which used to attach to mental ailments. This has been done by the removal of the use of words which used to be regarded with horror and despair by the families of the afflicted and with dread by the community at large, as descriptions of the patients and the institutions. Today, the forms of treat- ment available enable large numbers of patients to recover their full faculties, or sufficient of them to make the patients into useful citizens. Indeed, the system whereby a person can enter a hospital voluntarily to be cured is taken advantage of by large numbers. This underlines the supreme importance of full treatment being available at all times for the mentally sick. No doubt every hon. Member has come across individuals who have subjected themselves voluntarily to treatment and have come out able to carry on their ordinary vocation and go back to their families almost perfectly fit mentally.
Hospital management committees are faced with the problem of shortage of staff, and they have to cut down the number of people admitted for treatment. The Ministries of Labour and Health, hospital management committees, and all bodies connected with the important work of nursing the sick, have had this question before them for a considerable time. It has been raised here on a number of occasions. Unhappily, the position remains extremely serious, and no effort should be spared to remedy it as speedily as possible. I could give many examples from different parts of the country to illustrate my case, if it were not for the very short time at my disposal. I therefore propose to confine my remarks to what the House may consider a striking illustration of the situation which prevails in Leicester.
The Towers Hospital in Leicester, a mental hospital, dates back to 1869. In December last, for the first time in its history, it had to restrict the number of patients admitted. The hospital accommodates more than 1,100 patients and it faces the most severe crisis of its history. As I have said, this kind of thing has never been done before, but in the interests of safety such a step had to be considered. The normal establishment on the female side is 100 nurses for about 700 patients, but in December the total number of nursing staff available was 45, with the addition of part-time nurses equivalent to 16 full-time staff. Of this number, only 22 held a nursing qualification, and this figure includes a matron, a deputy-matron and three assistant matrons.
I think the House will agree that the position in the hospital was reaching a danger point. Full-time staff are, in the main, women who have had long years of service and are approaching the age of retirement. Recruitment to the service is practically negligible, and the position in five or six years' time is a prospect which gives rise to the gravest concern.
The number of patients was steadily increasing. In order to relieve the position, an appeal was made to the relatives of certain patients to take them back to their homes, although in some cases they were nothing like as fit as they should have been for that purpose. I dare say that the House will readily understand that the response to this appeal was very small indeed. The reasons for it are not difficult to find.
It is true that the hospital has always endeavoured to utilise the most modern methods of treatment. I am informed that at Christmastime last year 10 per cent. of the women patients were able to visit and stay with their own families.
When the Mental Treatment Act, 1930, enabled patients to enter hospitals as volunteers for treatment, the number of patients was very much increased, and today about two-thirds of the hospital's patients are discharged annually. Soon after the passing of that Act, the Leicester City Council built a nurses' home and took full advantage of the opportunity which was afforded to help in restoring voluntary patients, in particular, to their homes and vocations.
The situation which has arisen, owing to the shortage of staff, presents serious problems to the doctors attending families where cases of considerable difficulty occur. They have to rely upon the patients receiving domiciliary care. This does incalculable harm to the family itself. Every effort must be made to make the public aware of the satisfaction which could be gained by those who are prepared to undertake the duty of attending these cases. In Leicester, as in many other cities, women are attracted to the factories and workshops where the pay is comparatively good. The situation is such that it involves a real sacrifice on the part of persons to join the nursing profession. Appeals to women to join the profession have been made, but a strong continuous publicity campaign should be carried out throughout the country.
I want to quote some remarks from Mrs. Dorothy Bates, chairman of the
Leicester No. 3 Hospital Management Committee. She stated recently:
Where, then, lies the answer to this problem? The time has surely come when we must recognise that this essential service must be recompensed by adequate rates of pay and by drastic changes in the conditions of service. The occupational therapist, whose work is indispensable to our modern methods of curative treatment in hospitals, and who works in the wards and the occupational therapy department instructing those patients who can benefit from such activity, is not allowed by her conditions of service to work more than 36 hours a week. Yet she has to hand her patients back to the nurse who has to work 4& hours or, as so often happens in these difficult times, 53.
Mrs. Bates also said:
If it seems illogical to attack this problem of shortage of staff by suggesting a cutting of hours of duty of nurses in mental hospitals, let me hasten to add that there will always be a place in the wards of these hospitals for the untrained part-time worker. But the trained nurse, upon whom today rests an ever-increasing burden of responsibility, should be compensated not only materially but by working shorter hours to lessen the strain put upon her by the exacting nature of her work. It will require courage to face these facts and to act upon them. But to ignore them any longer will lead to disaster.
May I suggest that, as has been done in my constituency, the Minister should direct his attention to improving the scheme provided for student nurses. Many who have been suitable for this work and have started as student nurses have been unable to continue in consequence of the smallness of the pay and allowances. I think that it is worth while that the scale of payment should be substantially increased. It would also probably help if there were some relaxation in the strong discipline of the past, so as to make the general life of the nurse more consistent with the freedom enjoyed by people in other occupations.
In that connection, encouragement might be given to girls in the higher forms of the schools, inspiring them with a desire to participate in this work. May I ask the Minister whether it is not possible for her to induce the General Nursing Council to regard psychiatric nursing as being as valuable to the healing of the sick as the nursing of physical illness? What is required in this regard is surely a change of approach to nurses' training by the General Nursing Council. Why should not this form of nursing be recognised by being included in the general training of nurses?
I am told by the chairman of the management committee to whom I have referred that there is little likelihood of an increase in the number of nurses who will choose this branch of nursing for their career. I agree with her when she says that old prejudices die hard and there is need for those who dictate the policy of the General Nursing Council to come out into the great field of mental treatment and understand the needs which they should be pledged to treat.
I do not want to detain the House any longer. I should have Liked to have dealt with mental deficiency and the shortage of nurses in mental deficients' homes, and with other aspects of this matter. I appeal to the Minister to see to it that this matter is continuously kept in mind. It is an extremely serious thing, and I believe that we should try to induce the public as a whole to understand the importance of this situation, to regard this mental sickness as being something which is not the horrible thing that so many have regarded it as being, and that it should be our duty in the interests of the community as a whole and of our fellow men to do all that we possibly can to help to remedy this very serious situation.
I am grateful to the hon. Member for Leicester, North-West (Mr. Janner) for cutting short his remarks so that I may say one or two words on this subject. I have always been interested in this matter since the days when I was acting as vice-Chairman of the Mental Hospitals Committee of the London County Council, and I am experiencing at the present moment in my Scottish constituency the same kind of difficulties as the hon. Gentleman has described in the mental hospital in his constituency.
The hon. Gentleman said that we ought to make the public aware of these difficulties. I am in entire agreement with that and I should like to suggest to the Minister that everything should be done to make the public aware of the situation. May I give the House one or two figures? There are roughly in Great Britain, excluding Northern Ireland, 200,000 certified mental patients and 300,000 certifiable mental deficients. There are 500 mental hospitals. A very large proportion—some one-third—of the total number of hospitals in this country are mental hospitals. One of the disturbing features is that in these 500 mental hospitals there is overcrowding. In spite of that, 25,000 mental patients cannot gain admission because there is not room, even with the overcrowding.
Part of the shortage could be offset if we could find 4,000 mental nurses to man the beds which are now not being used because there is not the staff to man the wards and the beds; there is a shortage of 4,000 staff for the available accommodation. There is a shortage of 10,750 mental nurses in Great Britain and of 1,486 in Scotland alone.
I think I have given sufficient figures to make the situation abundantly clear. It seems to me very necessary that something should be done. I do not want to go into the question of accommodation, the age of the accommodation, the lack of adaptation and modernisation, nor into the shortage of doctors, all of which need attention. The hon. Member for Leicester, North-West has drawn attention in this Adjournment debate only to the question of nurses, but all the other things need attention too. On the question of nurses, however, if only we could get the nurses we could accommodate patients much better, and pain and anxiety could be relieved to a greater extent.
My experience as chairman of hospitals in the London area and the knowledge which I have gained leads me to say that this is not a hopeless business. When I was chairman of Hanwell, something like 70 per cent. of the patients went out either cured or discharged every year. In my constituency where the type of illness is different from the illness in London, 40 per cent. of the patients go out cured or able to earn their own living every year.
There is great hope for the patients if they go in in good time and get the right treatment. The advances in treatment since my London County Council days have been phenomenal and the chances of cure are very great. The interest of the nurses ought to be great. If only the matter is brought before the public, I believe that this problem would be solved. I hope that the Government will do something towards its solution and that in doing it for England and Wales my right hon. Friend will consult also the Secretary of State for Scotland where the situation is the same.
I am grateful to the hon. Member for Leicester, North-West (Mr. Janner) for the manner in which he has raised this important subject. He will know that in the short time at my disposal I can deal only with the major points that he has raised.
First, let me say that there is no lack of urgency in my right hon. Friend's mind in dealing with this subject, and that something has been done. We have given mental health a much greater priority in the allocation of capital, and in the building programme alone 1,200 mental deficiency beds and 800 mental health beds are being provided over the next three years. Including these figures, we hope in the next five years to have 3,000 additional mental deficiency and 1,500 additional mental health beds. This is evidence, not only of our desire to do something, but that something is really being done. Next Saturday my right hon. Friend lays the foundation of the first new hospital to be built since the war. It is to be a very large mental deficiency hospital.
The major part of the speech of the hon. Member for Leicester, North-West concerned the rates of pay for the mental health side, to which, I know, all hon. Members attach great importance. The hon. Member will remember that I have been evasive deliberately on this issue in three previous debates because Whitley Council negotiations were pending and the question went to arbitration. The House will be glad to know of the improvements which have been recommended in the arbitration award, although I should make it plain that the decision of the Whitley Council upon them has not yet been announced.
The recommendations of the award are, first, that the basic student rates remain unchanged. Although their basic rates remain unchanged, the student mental nurse would receive an increase of £40 in total in the proficiency allowances payable on passing her preliminary and final examinations. This means that by the time the mental student nurse reaches the end of her training she will have received £175 more in pay and allowances than the general student nurse, or the equivalent of nearly £60 a year, which is not an unreasonable differential between the general and the mental side. This improved differential, if accepted by the Whitley Council, will, we believe, encourage students to enter the mental field and, what is more important, encourage them to go on and complete their training as fully qualified mental nurses.
There are also recommended increases —I will not take time to go into them now—in dependants' allowances, and in allowances to married men. The new rates for trained nurses would increase the "mental lead," which is the differential between the general and the mental side from £20 to £45, so that a qualified mental nurse would receive £45 more than her counterpart in the general hospital. The revised salaries for staff nurses, if sanctioned, would be £405 rising to £505 for women, and £415 rising to £515 for men. There are other and comparable increases for ward sisters and the like.
No. They are before the Whitley Council. These are the terms recommended by arbitration.
Then there is the nursing assistant. Here I should like to emphasise how vitally important to the mental services are the nursing assistants, and it would be quite unrealistic to suggest that we could manage without them, particularly in regard to mental hospitals and mental deficiency institutions where the patients in the main are not physically sick and require no bedside nursing. They are up and able to get about. In the main, the work done in those institutions by nursing assistants is invaluable and, without their help, we should have to close many more beds. The nursing assistant in future will start at £280 instead of £250, and after two years' satisfactory service she will advance to £335 and thereafter to the existing maximum of £425. I feel that this is a step in the right direction, but it is still for the Whitley Council to announce their decision on that award.
The hon. Member for Leicester, North-West mentioned publicity, and he will no doubt be aware that a publicity campaign has been launched and is being conducted from the Ministry but with emphasis on local area campaigns. We have specifically appointed two mental nursing officers to go from area to area and give their advice. The campaign at Leicester is third on the priority list of the difficult areas in which we have to launch these campaigns. The hospital management committee, in which the hon. Member is interested, has run its own local Press campaign, but the major general campaign for the region, in which the Ministry of Labour and National Service is interested has not yet been launched. We have a wide plan of campaign for publicity, and we believe that that campaign must be centred on the areas around the hospitals.
There are 36 campaigns proposed, seven of which are completed, three are under way, seven are starting this month, six later in the year, and 13 are being planned and their dates arranged. We believe that publicity is best done round the local hospital, because it is from that catchment area that staff must obviously be enlisted.
I have real sympathy with the Leicester area, and I know its problems in this matter. The hon. Member represents what is regarded as being one of the wealthier cities in the kingdom, and the rate of industrial employment is both high and remunerative. It is extraordinarily difficult to recruit for the nursing services from that area when there are so many other inducements to encourage labour to go into industry. Further, I realise that the mental hospitals themselves are rather awkwardly placed— there is in one case a mile drive from the general roadside before reaching the main building. Those are problems which we will do our utmost to overcome, but they exist and must be recognised.
So far as the general campaign is concerned, it has only been running 2½months, and it is far too early to assess what can be achieved or what has been achieved, but I can assure both hon. Members that my right hon. Friend regards this as top priority, and so far as aid and encouragement is concerned no effort will be spared that lies within our power to get opened non-staffed beds and, thereafter, to provide the staff for new beds.
I agree that this is a top priority issue, and we join with hon. Members in wishing to see these problems resolved, but we can look with pride at the fact that the stigma has gone. Of course, that has increased our problem because more people are prepared to come in for mental treatment than ever before. We can also say with pride that we carry with us all sides of the House in our endeavours to solve this long-term problem—and it is idle to deny that it is a long-term one— to provide accommodation for our mental services.
I hope that the hon. and gallant Member for South Angus (Captain P. Duncan) will forgive me when I tell him that there are not 25,000 on the waiting list. The number is under 9,000 for England and Wales. While that number is still a problem, I would not like 25,000 to go out as the official number.
Before the hon. Lady sits down, will she answer one or two of my other points? First, with regard to doing something in the schools. Is there anything substantial being done in that direction in order to try to induce girls reaching the leaving age, particularly in some secondary schools, to come into the profession? Then, has anything been done by the Government to try to persuade the General Nursing Council to make this an essential part of the curriculum of the student? It is unbalanced otherwise, in view of the changed attitude today towards this type of disease.
The General Nursing Council has several experimental schemes on foot at present to reduce the amount of time necessary for a general nurse to do her training for the mental nursing side, but it cannot be taken in three months. It is a big issue and we have already, in agreement with the Council, evolved a scheme to reduce it from two years to 18 months and a trained general nurse can take the additional training in 18 months. There are experimental schemes under way and we are working in the closest co-operation with the Council to try to see what means can be provided to dovetail the two sections of nurse training and to encourage nurses on the general side to take their mental nursing training as well.
The schools are included in the recruiting campaigns for mental nursing in the same way as for the general nursing service, and I can assure the hon. Member that we are taking all steps to see that the secondary schools are given an opportunity to visit hospitals on open days.