The hon. Member for Southampton, Itchen (Dr. King) and my hon. Friend the Member for Southampton, Test (Mr. J. Howard) have done a real service in raising this matter tonight. Although there are only a few of us present, there is no doubt that this is a matter on which many Members have expressed considerable concern. I associate myself wholeheartedly with the well-deserved tribute which the hon. Member for Itchen paid to the profession of midwifery. Its members are doing wonderful work for the mothers and babies of Britain. At least, we can start with the firmest agreement about that.

The subject for this Adjournment debate is timely in view of the recent Report of the National Consultative Council on the Recruitment of Nurses and Midwives, with which the hon. Member for Itchen is familiar. It has given us valuable information. We also expect shortly the Report on the Cranbrook Committee on Maternity Services, which will add to our knowledge on the subject.

This matter falls for consideration under two headings: midwifery in the hospital service and midwifery in the local authority domiciliary service, in which the conditions and the problem are not quite the same. I will take the hospital service first. The shortage, particularly in the hospital service, has been causing considerable concern for some time. I cannot state the precise numerical shortage in this service, because we have no firm figures for the requisite establishment. Furthermore, the general picture is a rather patchy one. Undoubtedly, as the hon. Member for Itchen said, the shortage is acute in some areas, but in other areas many maternity hospitals and units are fully staffed. We therefore have a problem which is almost as much a problem of distribution of the available resources as it is of actual shortage.

The National Consultative Council on the Recruitment of Nurses and Midwives appointed a sub-committee last summer to study this very problem. I would just say in passing that I have taken a very personal interest in the deliberations of that body, of which I have taken the chair on more than one occasion. That Report has now been issued by my Ministry, with a memorandum commending the recommendations it made to hospitals. That was as recently as 21st January, so we are talking about something which is thoroughly up to date.

The Council found no lack of candidates for training at the early stage of recruitment, and it also found that the numbers qualifying considerably exceeded the needs of the service. Therefore, we have the position that sufficient people are coming forward, and that sufficient people are qualified. The crux of the matter is that the qualified mid-wives leave the practice of midwifery so that the numbers practising in hospitals are not increasing at a time when hospital confinements are. The hon. Gentleman referred to the bulge which has accentuated this at a time when the midwife population, so to speak, has remained broadly static.

The hon. Gentleman said a word or two about the main conclusions of the sub-committee. If I go over the ground a little again it is because I think it is very material to a solution of the problem, which, I certainly hope we shall find. Firstly, maternity hospitals are recommended to employ ancillary or domestic staff to relieve midwives and pupils of non-nursing work. I believe that to be important, because I believe a lot of what one may call the sheer drudgery of the work apart from the skilled side acts as a deterrent.

Another point—I was very struck with the importance of this in talking with midwives—is that the midwife should be responsible for the patient through all stages of confinement, and maternity hospitals should be planned to secure this. The point was put to me very strongly that a midwife liked to see the whole job through from start to finish and not to find, when she came back to the bed, that another mother had been put there, and the previous one moved on. I can well understand that.

Then, as the hon. Gentleman said, mid-wives should have adequate opportunities for practical teaching of pupils, whose programme should correlate both theory and practice. There was the need for adequate help and guidance for student nurses and pupil midwives in planning their careers. Then again, the right mental attitude to patients, patients' relatives, and colleagues and pupils should be inculcated during the midwife's training. Close attention should be given to the mental and physical needs of pupils, who should not be subjected to unnecessary rules and restrictions. Finally, there should be more facilities for training as midwives women with no nursing qualification, or qualified only as assistant nurses, since experience has shown that those tend to remain longer in the service of midwifery after being qualified.

It is perfectly true that the majority of the sub-committee thought that the shortage might partly be due to the inadequacy of salary and the limited scope for promotion, to which both hon. Members referred. I think we are sometimes a little too ready to assume, in a service like this—which is vocational, otherwise it would not be done at all, I suggest—that the one and only solution is an increase in salaries. I do not, of course, rule that out, naturally, but I think sometimes that we are a little apt to assume that it lies only in that quarter. In any case, this is a matter for the Nurses' and Midwives' Whitley Council. Since the appointed day, salary scales have been revised a number of times. The last time was in July, 1957, and the matter has now come again before the Whitley Council.

The shortage on the domiciliary side is nothing like so acute as in the hospital service. The overall shortage is about 6 per cent. of the figure estimated by local health authorities to be what they need. A district midwife receives a substantially higher salary than a district nurse, but it may well be that some dissatisfaction exists because the health visitor, formerly on terms of parity with the district midwife, now gets a rate of pay about £50 a year higher. But this arises from the arbitration award by the Industrial Court dating from July, 1957.

As to long hours, it is true that domiciliary midwives, because of their work, are liable to long and irregular hours of duty, but, strangely perhaps, that has not prevented domiciliary service from being rather more popular than hospital service. It is up to local authorities to ease the burden by giving appropriate time off, providing that reliefs are available, and making adequate provision for transport.

Over the past few years the number of practising midwives in the hospital and domiciliary field has changed very little. The shortage has really been caused, as the hon. Member for Itchen pointed out, by the rising birth-rate, unaccompanied by sufficient new midwives remaining in the profession.

The hon. Member referred to rates of pay offered in overseas appointments. We have to be fair and point out that Canada and countries overseas generally have to bid very high, not only in this profession but in others. They have to pay people a differential for leaving this country at all; and my information is that quite a few of those people come back here.

My right hon. and learned Friend has issued a memorandum of guidance to hospital authorities but he does not intend to rest there. Arrangements are now in hand for the problem to be studied in greater detail on the spot by medical and nursing teams from my Department, who will visit areas where the shortage is most acute, to advise on remedial action and to obtain information on local difficulties as a guide to future policy.

I hope that what I have said will show how seriously we regard this matter, and the steps which we have taken to apply expert knowledge and experience to the subject. Our intention to benefit by and apply the results of these inquiries will, I hope, commend itself to the hon. Member for Itchen and my hon. Friend the Member for Test. I assure them that it is a subject in which I shall continue to take the closest personal interest.