I am grateful for the opportunity to give vent to my anger, which has been simmering for more than six months, about the way in which school nurses and tuberculosis visitors have been treated by the Secretary of State.
The school health service has been looking after our nation's children for 60 years. It came into existence following the War Office findings that 50 per cent. of the men enlisted for the Boer War were physically unfit for military service. The service became a statutory service under the Education Act 1944. Its future is now in doubt.
The TB visitors, who work with TB and cancer patients from chest clinics, are depressed and resentful and are carrying on their work only from a deep sense of duty and loyalty to their patients. Is it possible that the Secretary of State is blissfully unaware of the situation, or is she deliberately trying to destroy morale among school nurses and TB visitors, as she has done in other sectors of the health service? Alternatively, perhaps she is so blinded by dogma that she cannot see further than the foot of the nearest private bed.
The reorganisation of the school health service in 1974 resulted in school nurses being taken over by area health authorities which provide an agency service for the education authority—the choice of expression is not mine. Each school nurse's case load is between 2,000 and 3,000 children. She usually works in three or four schools until the birth of a vast comprehensive school when she may work in one.
The typical school nurse's day starts at 8.30 a.m. at the family health clinic. In urban areas she is at school by 9 o'clock. She sees all children once a year while they are at nursery school, at five years old when they enter the infants' school and at nine years old before going to junior school. The school nurse is a practitioner and a professional in her own right. She plays the part of detective in spotting defects in children's health and recommends appropriate corrective action. As well as visiting schools, she spends half her time in home visits and is expected to collect reliable information for Government research purposes and to participate in health education programmes at school. As will be seen, the future health of our nation's children is in her hands.
On the other hand, the TB visitors are chest clinic and visiting sisters. Each serves a population of about 250,000. TB visitors were formerly nominated from ward sisters. Their main work is domiciliary visits to patients who have chest conditions—chronic bronchitis, cardiac complaints, and tuberculosis. In England and Wales there are, yearly, new notifications of 11,000 tuberculosis sufferers. The 1973 figures showed that tuberculosis was still causing more deaths each year than any other notifiable infectious disease.
In the large cities the qualified and experienced TB visitors are still much needed. Members would have thought that the Secretary of State would recognise the crucial work of the school nurses and TB nurses and would have championed their cause against any attempt to discriminate against them, but she has not done so. Perhaps it is because the right hon. Lady is influenced only by the large battalions. As there are only 4,000 school nurses and 200 TB nurses, she is none too concerned.
There are now two classes of school nurses. Mrs. Graham, of Knowsley, is one kind. She is a State Registered Nurse with three years' training, a registered fever nurse, one years' training, and a State Certified Midwife, one year's training. She has a certificate for tropical diseases and another from the Royal Institute of Public Health and Hygiene. But Mrs. Graham does not have a health visitor's certificate. To gain such a certificate there is an eight months' course, a course, which has been in existence for only the past 13 years. Mrs. Graham has been in the service for 34 years.
Then there is Mrs. Sanson, from Cumbria. She is a State Registered Nurse and a State Certified Midwife with 35 years' experience. She was a maternity ward sister for many years and then a district nurse-midwife. In 1967 she accepted the post of school nurse full-time because of a shortage of health visitors. She does not have a health visitor's certificate.
Mrs. Tuttle, of London, does not have a health visitor's certificate either. She was a ward sister and a State Registered Nurse. She is a registered sick children's nurse with 20 years' experience. These women have experience and qualifications but not a health visitor's certificate. Instead of having the status and pay of a ward sister (1), they are paid on the basic grade of staff nurse. That is the rate for new entrants to nursing.
I shall make it plain that the work of the school nurse, whether she is certificated or not, is identical to that of a hospital nurse. She has identical responsibilities and the task required of her is exactly the same. However, there is discrimination. There are two classes of nurses within the same service. There is the one with a health visitor certificate and the one without, such as Mrs. Graham, who has 34 years' experience and a host of other qualifications. She is on the same grade as a young nurse of 22 or 23 who comes straight from the eight months' course.
The Whitley Council, which deals with the terms and conditions of nurses' pay, recognised years ago that a school nurse fulfilled a unique and vital rôle even without the health visitor certificate and that that should be reflected in her status and pay. For this reason she was paid on an interim scale above staff nurse but below ward sister. When the staff nurses' starting pay was £1,191, rising to £1,454 the school nurse and TB visitor without a certificate started at £1,299, rising to £1,728. Halsbury, in an attempt to simplify the pay structures, exacerbated the odious class differential by downgrading the pay and conditions of school nurses without certificates to a common grade, title and common pay scale, as Halsbury called it. At the same time the school nurses with certificates had their pay and status upgraded. It is the Minister's indifference to this situation that has caused a crisis of confidence.
In 1954 the salary differential between the TB visitor with or without the certificate was £20. In 1960 the differential was £110. In 1967 the differential was £150 and in 1970 it was £180. Following Halsbury, the differential was increased to £1,248 at the top end of the scale. As nearly all TB visitors are at the top end of the scale, it means that they are all earning £1,248 a year less because they do not have the certificate. Whereas in 1954 the differential represented 5 per cent., in 1975 it represents no less than 50 per cent.
Halsbury established the following arrangements for nurses. There is a ward sister (1), including school nurses with certificates, and there is the ward sister (2), which includes community nurses and district midwives. Then there are staff nurses, which include school nurses and TB nurses without certificates. What Halsbury has done is to ensnare many senior ward sisters who, to gain wider experience, entered the school nursing profession some years ago and now find themselves at the bottom of the grade with no hope of getting back to their rightful position.
Since Halsbury was implemented last year, the Whitley Council has been asked to examine the matter, but nothing has happened. I have appealed to the Secretary of State and to her Ministers. I have tabled Question and Early-Day Motions. The right hon. Lady's reply can best be summed up by reading an extract from her letter of 7th August to the staff side of the Whitley Council, in which she wrote:
I have taken longer to reply than I would normally wish but that is a reflection of my concern to examine very carefully whether I could respond positively to your request at least on school nurses and TB visitors. Let me say at the start that I appreciate the keen disappointment of some nurses on discovering that despite substantial increases in their salaries—".
That is a reference to an increase of 5 per cent. Is that what the right hon. Lady claims to be the biggest increase in the history of the National Health Service for school nurses without the health visitor's certificate? The letter continues:
the simplified grading structure, which was generally welcomed by both sides of the Council, resulted in changes which so adversely
affected their previous relativity with their colleagues. This is, of course, a potential hazard in any such exercise.
From that extract it will be seen that the nurses were given a sharp slap in the face by the lady with an iron hand. Since my appeal to the right hon. Lady, the staff side of the Whitley Council and NALGO have asked that the matter should go to arbitration. However, the management side of the Whitley Council has refused.
I quote a further extract from the right hon. Lady's nauseating letter, in which she writes:
I am confident that the management side did not take lightly their decision not to agree to join the staff side in conciliation—as you rightly say, for the first time in many years—and after most careful consideration I have concluded that I cannot reasonably take exception to their view that it is undesirable to take to arbitration the findings of an independent review body.
What is this independent review body which the Minister talks about? The Whitley Council is made up of two halves—namely, the staff side, representing the professional bodies, and the management side, representing her Department and the regional and health authorities who are beholden to her. Independent indeed!
What effect has this all had? Nurses are drifting away, and it may well reach the point soon where the right hon. Lady will be unable to carry out her statutory responsibilities laid down in the 1944 Act because of her inability to staff the service. Let us take Liverpool, for example. There is a nursing establishment of 84 but there is a 13 per cent. shortage. Of the remaining 74, only 19 of the school nurses have the health visitor certificate. In Sunderland, for example, out of 28 school nurses only one has the certificate. It would not be possible to run the Liverpool school nursing service with 19 nurses doing the work of 84. When we see that an aide to a social worker, as advertised in London, can receive a salary of about £3,000, we can understand the deep personal resentment of these nurses.
So severe has been the downgrading that some school nurses have to retire early to protect their pension rights. Mrs. Kerr, of Birmingham, is an example. She is a former ward sister and would have been earning a salary of £3,894 but is now earning £2,646. She is having to stop work as a school nurse since her pension rights are calculated on the best of the last three years she has worked.
The service is in decline, morale is getting low and school nurses are depressed and are drifting away. Few school nurses with health visitor certificates are coming forward to fill the gaps. Perhaps the right hon. Lady will explain how she will run her statutory service when the staff falls below the minimum requirement. Has she considered any steps to halt the drift, and, if so, what are they? Systematically, the right hon. Lady has neglected school nurses and health visitors. Equally reprehensible has been her behaviour towards the small but concerned group of nurses who look after TB victims and who often contract the illness themselves.
School nurses are a very important part of the Welfare State and they have given nearly four generations of service to the nation. What have they done to deserve such treatment at the hands of the Secretary of State? The right hon. Lady was once shattered to learn that nurses were against her plans for the National Health Service. One wonders what further catastrophe has to occur before she desists in her petulant and obstinate disregard of the plight of school nurses and TB visitors. The Secretary of State should have not only her salary reduced by half but her status as well.