I am very glad to have this opportunity of raising in the House the important subject of the shortage of nurses in hospitals. The House will remember that I have asked a number of Questions on this subject recently, and I am very sorry that the Parliamentary Secretary to the Ministry of Health seemed to resent my asking them. She concluded her Answer to my last Question on the 12th March by saying that she deplored my cries of "Woe, woe." I hope that I shall be able to convince her and the House this evening that there is a real problem to be faced.
It is all very well for the Minister to attempt to brush aside this problem by saying that there are now more nurses than there were at the time of the inception of the Service. That is certainly so, but more were needed. There are still not enough, and their distribution is very uneven. I should like to take the case of my own constituency by way of illustration. A constituent of mine who is a doctor gave me the letter which I hold in my hand. It is from the Dewsbury, Batley and Mir-field Hospital Management Committee, it is dated 16th February, 1956, and is addressed to all general practitioners.
It is a long letter, and I hope I may be excused if I do not read all of it, but I should like to read some parts of it. It starts by saying:
This letter is addressed to you in the nature of an earnest appeal for your co-operation in prevention of what might well mean the complete breakdown of the general nursing service at Staincliffe General Hospital.
Later, it states:
You are, I am confident, fully aware of the precarious position in which most general hospitals in the country find themselves in relation to trained nursing staff, but you may not be fully conversant with the local position.
The position is such that extraordinary measures must be taken immediately to reduce the demands on the beds in Staincliffe General Hospital.
The letter further states:
A conference attended by consultants was held a few days ago, and the conclusions reached have been considered by the Executive Committee, who have decided that a number of beds at Staincliffe General Hospital including medical, surgical and gynaecological, must, as from today, be closed. Whilst this step is being taken at this stage at Staincliffe General Hospital only, both the General Hospital, Dewsbury"—
The letter continues:
Whilst this step is being taken at this stage at Staincliffe General Hospital only, both the General Hospital, Dewsbury, and the General Hospital, Batley, are facing a similar situation, and no increased use of beds at either of these two hospitals is possible.
The letter concluded by saying:
I am to ask your forbearance on those occasions which will inevitably arise when you will request the admission of a patient to hospital and be refused. The medical staff at hospitals have been instructed by the hospital management committee to refuse to admit cases when the available staffed beds are filled.
The sending of that letter was a drastic step which the hospital management committee was forced to take. The doctor who gave me the letter stated that he had been refused admission for a patient suffering from pneumonia, although the patient's home was a slum dwelling and no fit place in which to treat a seriously ill person.
On 5th March, in answer to a Question of mine, the Parliamentary Secretary informed me that twelve beds in Batley General Hospital and seventy in Staincliffe General Hospital were closed on account of shortage of nursing staff. Many of my constituents, particularly in Morley, use the Leeds General Infirmary, and we might well ask what is the position at that great teaching hospital.
The Yorkshire Post, in its issue of 5th October, 1955, reported that beds were closed at the Leeds General Infirmary because of shortage of nursing staff. In an excellent article dealing with this problem, in that issue of the paper, a Leeds doctor was quoted as having said:
The Nurses' Training School at the General Infirmary at Leeds has always been recognised as one of the leading schools of nursing in the country, offering as it does an experience and reputation second to none. It was, therefore, a shock to me to learn that even the General Infirmary is short of nurses at a time when the nursing side is in the hands of probably the most popular and capable Matron the Infirmary has ever had …
In one of the Batley local newspapers, The News, which is a widely read weekly paper in my constituency, was a leading article on 17th March headed "Shortage of Nurses", in which the Editor said:
The situation is critical. One cannot be complacent about it.
The fact is that there is a shortage of hospital beds for my constituents due to
a shortage of nurses. I should be neglecting my duty to the people who sent me to Parliament if I did not cry "woe" in this House on their behalf.
Lest it be thought that this problem is confined to my constituency alone, I should like to remind both the Minister and the Parliamentary Secretary of a Question that was put to the right hon. Gentleman on 27th February by my hon. Friend the Member for Normanton (Mr. A. Roberts). My hon. Friend asked the Minister
how many nurses are needed to meet the normal requirements in the Leeds Regional Hospital Board area; and which are the districts where the greatest shortage exists.
The right hon. Gentleman replied:
The Regional Hospital Board estimates the shortage at about 2,400. The greatest shortages are in the groups managed by the Wakefield (A), Storthes Hall, Huddersfield, and Middleton and Grassington Hospital Management Committees."—[OFFICIAL REPORT, 27th February, 1956; Vol. 549, c. 822.]
That figure of 2,400 shows that there is a serious shortage of nurses in Yorkshire. In examining that reply by the Minister, I notice that my own district is not included among the worst affected. Therefore, bad as I have shown the situation to be for my constituents, it is even worse in other parts of Yorkshire. I am quite justified, therefore, in crying "woe" on behalf of Yorkshire.
But the problem is not confined to my own county alone: it is a national problem. On 12th March, I asked the Minister of Health
how many beds were closed in hospitals under the control of each of the regional hospital boards … by reason of a shortage of nursing staff. … —[OFFICIAL REPORT, 12th March, 1956; Vol. 550, c. 3.]
The right hon. Gentleman gave me some figures in a Written Answer. I found that the Leeds Region had 687 beds closed, that the South-East Metropolitan Region had 4,529 beds closed, and when I added up the figures I found that the total for England and Wales was 16,665 beds closed through lack of nursing staff. Those figures relate to the position as it was on 30th September, 1955. I have reason to believe that since then the position has grown worse. I estimate that since then about 100 beds have been closed in hospitals serving my constituency.
The national figure is now probably at least 20,000 beds closed owing to the shortage of nursing staff. Therefore, I think that I am entitled to cry "woe" on behalf of the whole country. All these thousands of closed beds make nonsense of plans for extending existing hospitals and for building new ones. We cannot staff the beds which we already have. I ask the Parliamentary Secretary to deny that there is a problem, and a very serious one at that. Let me say at once that I do not blame the Minister or any of his predecessors for the present position. It is a state of affairs that has come about through no one's fault, but it is one that demands immediate attention.
Let us now consider how the problem is to be examined and what are the principal questions that should be asked. I would say that there are three principal questions. The first is, why are not more women entering the nursing profession? The second is, why are so many women leaving the profession before completing their training? The third is, why are so many leaving hospital after completing their training? When the Minister comes to consider the answer to the first of those questions, I suggest that he should pay particular attention to rates of pay, conditions of work and to the living conditions of nurses.
I was pleased to see in the newspapers today an announcement that there is to be an improvement in nurses' pay, and I hope that when the Parliamentary Secretary replies she will give us some further details of that policy. It should be borne in mind that in recruiting nurses there are the competing claims of other professions, of business and of industry. Even in hospitals themselves, other departments draw girls away from nursing and provide interesting work with regular hours and good pay for intelligent and capable young women. Every one of those other posts is important, but the nursing profession is the backbone of the hospital service.
When considering the answer to the question why so many student nurses are leaving before completing their training, I would remind the Parliamentary Secretary of an Answer which she gave me on 12th March. She then informed me that 19,323 student nurses commenced training for admission to the register of nurses in 1955 and that 9,368 discontinued training during that year. In round figures we may say that last year there were 20,000 new entrants and that 10,000 left before the completion of training.
Similar figures are to be found for a number of years, and there is the same sort of picture in the case of pupil nurses, although in their case both the figures are smaller than those for student nurses. The causes of wastage during training are probably manifold. For example, there is marriage, which may account for as much as 15 per cent., but there are other causes which could be ascertained by a searching inquiry. I think that the Minister should inquire into whether the curriculum of State registered nurses should be reviewed. Why is it necessary to make nurses 50 per cent. doctors? Why are the recommendations of the working party that reported in 1947 not implemented? That working party suggested a two years' basic training which could be followed by further training for those with the ability.
When we seek an answer to the third question, why so many State registered nurses are leaving hospital, the Minister would find that the local authorities take quite a large number. That, presumably, is unavoidable. I would, however, point out that many are taking posts as nurses with industrial firms. I do not blame the industrialists in the least when they take State registered nurses. The industrialists create the posts as part of industry's welfare services and ask for the best women to fill the posts. Nor do I blame the nurses for taking the posts. The work is easy, the hours are regular, the pay is good. Some of them have little more to do than to hand out aspirin tablets to girls with headaches and to bandage cut fingers. But from a national point of view many first-class nurses are being wasted on that type of work which, in many cases, could be done just as well by capable women trained by the St. John Ambulance Association in first-aid and home nursing.
I think that I have said enough to convince the Parliamentary Secretary that there is a problem, and a serious one. In the limited amount of time at my disposal I have tried to show how very difficult and extremely complicated the problem is. It is sensible to leave matters in the hands of the Whitley Council and the General Nursing Council when all is going well, but when more than 16,000 beds are closed through lack of nursing staff I would say that it is time for the Minister himself to examine thoroughly this whole problem.
I wish to support what my hon. Friend the Member for Batley and Morley (Dr. Broughton) has said—particularly as he has referred to two hospitals in my own constituency—and I hope that the Parliamentary Secretary will be able to tell us what is being done to try to solve the problem of the shortage of nurses for hospitals.
There are two points in particular to which I want to refer, and one of them relates to working conditions. We have a very good example in the two hospitals in Dewsbury—the Staincliffe General Hospital and the Dewsbury General Infirmary. In the General Infirmary working conditions are really first-class and the shortage of nurses there bears no comparison with that at the Staincliffe General Hospital, where working conditions are such as to warrant the attention of the Minister.
There must be many similar hospitals where, if working conditions were improved, we could attract more young women into the nursing profession. I suggest that a consideration of the difference between those two hospitals shows how necessary it is that some capital expenditure should be diverted in order to improve hospital accommodation, facilities and working conditions.
In the Staincliffe General Hospital, where the working conditions are not as good as those in the Dewsbury General Infirmary, 70 beds have been closed, 160 people are on the waiting list for admission, and unless conditions are improved we may find more beds being closed because of a shortage of nurses. If the Minister would consider allowing more capital expenditure to such hospitals the working conditions in them could be very greatly improved, and that would go a long way towards helping to bring young women into nursing.
Secondly, I think there is need for the development of the nursing cadet system. We have a system whereby girls of 18 enrol for nursing. There is a big wastage of those, many of whom leave the profession within three or four months of entering it. I wonder whether it would not be better if the cadet system which is tried in various parts of the country were to be made a national scheme, in order to attract girls when they leave school at 15, and to give them preliminary training, so that the wastage, if it occurs, may take place well before they reach 18.
If we had a cadet system by which we attracted young people at 15 we should be sure of getting far more nurses, because many girls who would like to go into hospital service when they are 15 now take other jobs and, by the time they reach 18, they do not feel like leaving them to go into the hospitals. If we got them when they were younger we should, I am sure, be able to keep them at and after the age of 18 for nursing.
I want to leave ample time to the Parliamentary Secretary to reply to the debate, so I conclude by saying that I think the Minister agrees that the system must be looked into, and I hope that he and the Parliamentary Secretary will give full attention to these matters and all that my hon. Friend has said.
I am grateful to the hon. Member for Batley and Morley (Dr. Broughton) for raising this matter. I apologise most sincerely for not having been here when he began. I am afraid I misjudged by about three minutes the time at which this debate would begin, and my room is farther away from this Chamber than the room of any other Minister.
While I agree wholeheartedly that there is no reason for complacency in this matter, I am very concerned that in a year when we are doing our utmost to stimulate recruiting campaigns for nurses, and particularly to recruit nurses for mental hospitals by means of the mental health exhibition, we should not paint— I will not say too darkly—but in the wrong colours the picture of what has been achieved in recruitment to the nursing profession in the last few years. It is fair to say, as I hope I shall be able to prove to both the hon. Member for Batley and Morley and to the hon. Member for Dewsbury (Mr. William Paling) that the nursing staff situation is certainly not as grave as it has from time to time been represented to be. There has been very substantial and steady progress since the National Health Service came into being.
The total nursing staff in hospitals in December, 1948, numbered 117,000 full-time; at the end of December, 1955, it was 143,000. There were 20,000 part-time nurses in December, 1948; there are now 32,000. That is an increase of 22 per cent. in our full-time nursing staff and of 60 per cent. in the part-time nursing staff. Of trained nurses there were 44,000 full-time in 1948. We have now 55,000. In 1948, there were 6,000 part-time trained nurses. We have now 12,000. That is an increase of 25 per cent. in the number of full-time nurses and of 100 per cent. in the number of the part-time nurses. It is fair to put these facts on record to show the very real and steady improvement which has been made. We had 42,000 enrolled student nurses in December, 1948, and in December, 1955, we had 48,000, an increase of 14 per cent. Of pupil assistant nurses there were 2,600 in 1948 and 4,000 in 1955, an increase of 54 per cent.
I have no quarrel with the remarks of the hon. Member for Batley and Morley. I think that our aim is the same. We want more nurses in our hospitals. We disagreed a little in our methods. The hon. Member disagreed with me in my complaint about some hon. Members crying, "Woe, woe." Perhaps my method in the recruiting drive differs from his, because I feel that success breeds success.
In a year when we are doing our best to stimulate recruitment, it is right that we should show how well we have done so far, whilst recognising, with no complacency, that we must do still better. If we are trying to sell to the public, as it were, a profession into which we are anxious to enrol more recruits, it is right and fair that we should say, as all the facts prove, that far from losing its attraction the profession has increased its attraction and has drawn to itself more recruits in the last six years and, we hope, will recruit even more in the coming years.
I will deal with that point in the course of my speech.
During this period there has been an increased demand for womanpower. There has been an increased demand for the type of girl of this educational grade. Teaching, physiotherapy, radiotherapy and occupational therapy all claim the very girls of 18 and 19 years of age whom we require for nursing. In the light of these obstacles, it must surely be accepted that it is a remarkable achievement to be able to claim 26,000 more full-time and 12,000 more part-time nurses than we had when the Service started.
In placing these facts—and they are facts—before the House, I do not mean to imply in any way that we are complacent about nurse recruiting or that we are not doing everything in our power to stimulate it still further. On the general nursing side, with a few local bad patches—of which the hon. Members' constituencies are two—where general hospital recruiting has not kept up to the national average, the number of students still coming forward is fully adequate for a continuing and steady increase in, the number of nurses. But there is still a grave shortage to be made up on the mental side.
There are, of course, wide variations in different parts of the country. As the House will be aware, everything possible is being done to remedy the situation in mental and mental deficiency hospitals. In conjunction with the Ministry of Labour and National Service, the Mental Health Exhibition is touring the country. I have already opened several exhibitions myself, and I should like to thank the many hon. Members who have actively associated themselves and helped us in their local campaigns.
The hon. Member for Batley and Morley made a great point of the number of beds closed through lack of staff. He rightly said that there were 16,665 beds closed for this reason, but this does not show a deterioration or worsening of the position, because in December, 1952, there were 23,000 beds closed for lack of staff. It is fair to say, therefore, that there has been real progress in the last four years in bringing into use over 6,000 beds which were closed in 1952 and in reducing the number of beds closed from 23,000 to 16,665. We are not complacent. We want to have the remaining 16,665 opened, but that number is not evidence of a worsening of the position. Rather it is evidence that we have made considerable progress.
The Dewsbury, Batley and Mirfield Hospital Management Committee has a deficiency of 79 on a total nursing establishment of 437. The shortages in individual hospitals are relatively small, except at the Staincliffe General Hospital, where there is a shortage of 40 on an establishment of 152. Eighty-two beds were closed, of which 70 were in Staincliffe—but this was due to heavy sickness among the nursing staff. The total nursing staff of the group rose from 324 full-time and 72 part-time at the end of 1953 to 356 full-time and 78 part-time at the end of 1954. However, it fell during last year to 318 full-time and 80 part-time. I accept that this indicates a temporary and local recession which calls for an intensification of local effort, and which I can assure hon. Members that the hospital management committee and the regional board are doing their utmost to remedy.
The Leeds Regional Hospital Board nursing establishment is estimated at 12,450 and their shortage is about 2,400, with the result that there are 687 beds closed at the present time. I can assure the hon. Gentleman that the Board is not complacent about this, and any help that my right hon. Friend or our officers at the Ministry can give will be forthcoming.
Now may I deal with the alleged inadequate entry into the nursing service. There was a considerable drop in entry in 1953 and 1954, but not abnormally so, when one compares the lower figures for the female population in the 18–19 age group. In 1955, the figure rose to 18,920, over 1,100 more than were enrolled in 1954. The rate of entry in general nursing is over the whole country satisfactory, but is still inadequate on the mental side.
The questions of pay and conditions of service are, of course, a matter for the Whitley Council. The hon. Gentleman will have seen in today's reports that the Nurses and Midwives Whitley Council yesterday reached complete agreement on new scales. The increases range from £20 for student nurses to £95 for matrons of the largest hospitals. Staff nurses receive an increase of £30 at the Minimum, and £35 at the maximum; and ward sisters £35 and £40 respectively. A new scheme of training allowance has been introduced for student mental nurses who, in future, will be graded according to age at entry. Those who are 21 or over will start at £390, an increase of £105 over the present rate of pay, which I am sure will be a great stimulus to recruiting.
At the same time, the new salary scale for women, which is in a transitional stage owing to the implementation of equal pay, will be £417, rising to £522, and in future they will reach their maximum salary in six years instead of in eight, as at present. This affects 200,000 hospital nursing staff.
I think it is fair to emphasise that nursing is a professional career, and is one of the few professions where payment is made during training. Further, in no hospital does the reduction made from pay for board and lodging meet the actual cost of the food and accommodation provided. So there is, in fact, a hidden increment, as it were, which should be taken into account in assessing nurses' pay. It is true that the hours are longer than those worked by other grades of hospital staff, but it is difficult to see how the service could be maintained if these were to be shortened.
Wastage has been mentioned. I apologise for galloping, but I have a great deal to say in a little time. Wastage is heavy, particularly among student nurses. Where the educational standards are not sufficiently high to enable the nurse to qualify as a registered nurse, efforts are made to encourage students who may have a genuine vocation for the profession and be good practical nurses, to enroll as assistant nurses. One of the largest items of wastage, however, is matrimony, and the proportion of the wastage from this cause accounted for 1,371 nurses leaving the hospital service last year to marry. From this, the hon. Gentleman will see that the path of love runs roughshod through the ranks of our nurses.
There are also, of course, many who are attracted by nursing, but who may go into other fields of nursing. I do not think that it is a bad thing that many of them go into local authority service. Some go to the Colonies, some into the Services. That in itself is an additional attraction, because of the scope in these other fields which the profession offers. And where we lose by matrimony, we often get them back after marriage as part-time nurses in the local authority service.
I cannot accept the hon. Member's strictures of the hon. Member for Batley and Morley on the assistant nurse. Whilst it is true that the Working Party on the Recruitment and Training of Nurses, in 1947, recommended the abolition of the assistant nurse grade, this recommendation was not accepted by the Ministry as it was felt that the hospital service would never be able to dispense with the services of a grade with a training shorter and more severely practical than that undergone by the fully professional registered nurse. This view was endorsed in 1953 by the Standing Nursing Advisory Committee.