Nurses (Educational Qualification)

Part of Class IX – in the House of Commons at 12:00 am on 13th April 1960.

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Photo of Mr Kenneth Robinson Mr Kenneth Robinson , St Pancras North 12:00 am, 13th April 1960

I beg to move, That an humble Address be presented to Her Majesty, praying that the Nurses (Amendment) Rules, Approval Instrument, 1960 (S.I., 1960, No. 409), dated 11th March 1960, a copy of which was laid before this House on 17th March, be annulled. The purpose of this Instrument is to re-establish, in two years' time, a minimum educational qualification—a somewhat modest qualification; two passes at "O" level—for entry into the nursing profession, or into the greater part of that profession. I use the word "reestablish" because there was an educational qualification in existence up to 1939. It then went into abeyance, and has been in abeyance ever since. A change of this kind involves a change in the Nurses Rules, and that, in its turn, requires the approval of the Minister under Section 32 of the Nurses Act.

I say at the outset that I understand the motives of the General Nursing Council in seeking the Minister's approval for an Instrument of this kind. The Council is very naturally concerned— some of us might think that, on occasion, it is a little too concerned—about the status of the nursing profession. I believe that we are one of the comparatively few countries—at any rate, one of the comparatively few- advanced countries—that does not have an educational qualification for nurse entry.

That does, on occasion, place our nurses at some disadvantage in other countries, notably in the United States. On the other hand, it is true to say that the reputation of the training of nurses in Britain is such that there is very seldom any real difficulty in a British-trained nurse obtaining a job overseas appropriate to her qualifications and experience.

I gather that the Council has also been worried about the level of wastage amongst student nurses, particularly in the early months of their training—I agree that that has been and, indeed, is a serious thing—and it believes that the introduction of an educational qualification would tend to eliminate this wastage. In this belief, I believe that the Council is mistaken, because there are very many causes of this wastage.

It may occur because a girl finds herself temperamentally unsuited to nursing; she may not like the work; she may fall for the attraction of some other, more convenient, less arduous and perhaps better paid job. And, perhaps, more than for any other reason, she may decide to get married. Therefore, in my view, only a minority of nurses fall out of their training because of any inability to measure up to the intelligence required to pass the examinations.

There are some moderately stiff hurdles to be surmounted in the three-year course—indeed, I think that some are a little too stiff—but nearly all matrons when accepting student nurses in the first instance apply their own intelligence standard, either formally or informally, before actually accepting a girl for training. Therefore, it seems to us on this side that there is no compelling reason for the introduction of this Instrument at this time.

Paragraph 3 (2) of the Schedule to this Instrument says that an applicant shall not be admitted for training … for registered general nurses, or for registered sick children's nurses, or for registered fever nurses unless…she holds a General Certificate of Education There is one very significant omission there. The Instrument does not mention mental nurses. There has been, for a very long time, a somewhat deplorable tendency within the nursing profession, at any rate among the higher echelons of it, to regard mental nurses as a class apart.

I do not wish to exaggerate, but in some quarters they are almost regarded as second-class nurses. Indeed, I know of general hospital matrons who refuse to allow their student nurses to be seconded for training in mental hospital work because they do not want their girls to come in contact with mental nurses. The Royal College of Nursing itself practises a kind of professional apartheid in this matter by refusing to admit psychiatric nurses to full membership of the College.

All this has been happening in face of the fact that the work of the mental nurse constitutes in theory and very often in practice a more positive part of the therapeutic process than the work of the general nurse. I imagine that it will be generally agreed that in mental hospitals the nurse-patient relationships which may be developed form an integral part of the treatment of the patient.

Many of us have for years fought this reprehensible attitude on the part of some sections of the profession. We have recently welcomed signs that this attitude has begun to change at last. It is common knowledge that the General Nursing Council, in putting forward its proposals to the Minister, wished the Instrument to cover all types of nurses.

The current number of the Nursing Times, the official journal of the Royal College of Nursing, in its editorial, says quite categorically: … it is unfortunate that those who are training to care for the mentally sick are not required to have the same standard of education as those caring for the physically ill. A little later, it says: This is a short-sighted policy which does not augur well for the future, for even if the mental training schools adopt the Council's entrance test on their own initiative (as the Minister suggests) patients and would-be candidates may think the training offered is second best. The Minister, in face of this rather striking change of attitude on the part of the College and the General Nursing Council, has made a decision which perpetuates all the old prejudices and appears, at any rate, to support the idea of a two-class nursing system. In any case, I should have thought that the exclusion was illogical since the requirements of the preliminary State examination are, I believe, the same for both types of nurse.

Why has the Minister gone against the advice of the General Nursing Council and excluded mental nurses? The answer is no secret. His advisers know full well that, despite recent improvements, recruitment in mental nursing is still proceeding at a far from adequate level. They know, also—no doubt, they have so advised the Minister—that it would be inviting disaster to erect, so to speak, an educational barrier which might exclude many potential recruits who would ultimately make admirable mental nurses.

There are many excellent mental nurses and, I believe, general nurses, too, who have the right sort of temperament, the energy, the understanding and the intelligence, to do the nurse's job admirably, but who lack the educational qualifications and, perhaps, even the kind of educational aptitude which would be required to obtain them.

I must confess that I agree with the Minister's reasons for excluding mental nurses. I agree that recruiting would suffer if the Instrument were made to apply throughout. It would be highly dangerous at this stage to limit in any way the intake of mental nursing students. But, of course, there is the other side of the picture. The status and prestige of the mental nurse within the profession will be further damaged by this new distinction which has been introduced, and this in itself will have a detrimental effect on recruitment. I do not myself believe that it will be as serious as it would have been if the educational qualifications had been insisted upon.

I take these two arguments together. The first is that it is quite deplorable that there should be this differentiation, and the second is that if mental nurses were covered by this Instrument it would, in fact, have a deplorable effect on recruitment. Taking these two arguments together, I can only come to the conclusion that it is quite wrong to introduce an educational standard, at any rate at present.

I would go further. I believe that there are strong arguments against the introduction of this standard even in general nursing. I believe that it will have a serious effect on recruitment there, too. Most of us who have had anything to do with the hospital world know that the nursing profession is led, some would say even dominated, by the views and attitudes of the London teaching hospital matrons. This is perhaps inevitable because those matrons are, naturally, at the head of their profession.

In the London teaching hospitals there is no recruiting problem and, as far as I know, there never has been a recruiting problem. Those matrons are in the happy position of having a long waiting list of girls who want to train and get the cachet of having been trained at a London teaching hospital. They are able to pick and choose and they pick and choose girls with the best education and sometimes from the best families. It is very natural that girls should wish to train at the great London teaching hospitals. The training schools have a first-class reputation, and the work there may not be as arduous as it is elsewhere because the patient-nurse ratio is about one to one in many of the hospitals, and there are many social and recreational advantages which they do not get elsewhere.

Indeed, some of the matrons of the London teaching hospitals are able to operate their own educational qualifications. I know that from the case of a young woman I know quite well who, some years ago, wanted to take up nursing. She tried to obtain an interview at a certain London teaching hospital, but because she had not taken the G.C.E., owing to the vicissitudes of her education during the war, when she was moved from one part of the country to another, she was not granted even an interview by that matron. Fortunately, she went to another hospital where the matron took a slightly different view and she came out top, or second to top, in her finals. This shows how these privileged hospitals are able to pick and choose their student nurses.

What happens in the hospitals of the industrial areas of the North? They have never been able to pick and choose. They are forced, if they are to have any student nurses, to take nearly all comers, provided that they show some aptitude for the profession of nursing. Having done so, they do their utmost to turn them into good nurses and I think that they have succeeded in doing so.

But not only in those areas have there been difficulties. In one Metropolitan area, in the comparatively privileged South of England, I have been making a few inquiries and I find that of the total students at present undergoing nurse training no fewer than 17½ per cent. are from colonial territories. Then there are others who come from the independent Commonwealth countries and from European countries such as Germany, Italy and Spain. On a conservative estimate, the number from abroad is probably between 20 and 25 per cent. of the total number of student nurses, and few of those would qualify for entry under the proposed rules.

Yet the hospital service depends on them not only to provide the future trained nurses we need, but also currently to staff the hospitals. That is in one of the most favoured parts of the country. I ask the hon. Lady the Parliamentary Secretary how far the regional hospital boards have been consulted about these proposals and to what extent the views which they expressed have been taken into account in reaching a decision.

In short, I think that these rules will have a deterrent effect on recruiting for general nursing, but I have discovered that that is apparently the intention of the General Nursing Council. I quote again from the editorial which I mentioned earlier: The policy of the G.N.C. for the future is to train more nurses for the Roll and fewer for the Register. That is an extraordinary volte face on the part of the nursing profession, because for many years both the Royal College and the General Nursing Council had looked rather askance at the State enrolled assistant nurse and had even been at pains to emphasise that that grade arose simply out of wartime expedient. Certainly, there had not been any encouragement whatever to extend the roll in the past. They showed no wish to see any new intake of enrolled assistant nurses—rather the contrary. Now we have this very different attitude. I wonder whether this will work. I wonder whether it is possible now to revive confidence in this grade of enrolled assistant nurse. I wonder whether there will be anything like the adequate recruiting that they expect and hope for in this grade.

I am afraid that we may well be in the danger of finding ourselves at the end of the day with a small, highly trained elite in the nursing profession and a quite inadequate rank and file to back it up. We may be building up what we used to say about the old Spanish army—all generals and no troops—and that could lead to a quite dangerous staffing crisis in the hospital service.

It may be that, in the long run, these rules will lead to placing the interests of training before the needs of the patient. I have never believed that entry into any profession ought to be limited to those who could be expected or might be expected to reach the top. If I may use the military analogy, I do not think that it is necessary for someone to have a field marshal's baton in his knapsack in order to be accepted into the Army in the first place as a private. In the nursing profession, we need large numbers of nurses who will do their job admirably, but who might never be expected to become matrons of large hospitals.

Judging by the length of time that the Minister has been cogitating over these proposals since they were first put forward by the General Nursing Council, I can see that he has no great enthusiasm for them. In the end, he has put forward what I can describe only as a rather wretched compromise which is at best premature and ill-timed. I hope that, in view of what I have said, and in view of what I believe to be the opinion of many hospital authorities throughout the country, he will have second thoughts and will accede to this Prayer.