It is appropriate that, just two days after the announcement of a new system of pay determination for nurses, attention should also be focused on the conditions in which nurses' accommodation is provided by the NHS. We have been reminded in the last couple of days of the fact that the members of the Royal College of Nursing do not as a rule go on strike; were it not for that honourable provision, I wonder whether some nurses might not have been driven to consider action over the state of the hostel accommodation provided for them in the NHS.
The importance of the issue can be judged by the fact that some 48,000 nurses live in accommodation provided by the NHS. Of that large total, some 80 per cent. are learners involved in study, who therefore have a particular need for accommodation that allows them to carry on their studies in addition to their normal work.
I commend the "homes fit for nurses" campaign that has recently been launched by the Nursing Mirror on the subject. The survey that the Nursing Mirror carried out in connection with the campaign has uncovered some alarming statistics. No fewer than 79 per cent. of those who responded to the survey have experienced the theft of possessions from their accommodation. Some 29 per cent., more than one in four, have been attacked and some 32 per cent. have discovered electrical wiring faults in their rooms.
These bare facts are alarming enough but there is plenty of additional anecdotal evidence to support the concern shown by the Nursing Mirror. I shall quote a letter that I have received from the parents of two daughters, both of whom trained at one of the better-known London teaching hospitals not far from here. The letter said:
We have ourselves seen all their accommodation in turn. The…hostel is part of an old disused hospital, empty (we believe) for some twenty years, dirty and sordid.
As far as we are concerned, our main complaint, as parents, is lack of security—both as regards fire risk; and as regards intruders. Communal telephones on the landings were frequently either vandalised, or out of order—we understand due to the fact that the money was not emptied. It was therefore very difficult for us to get in touch with them; and of course left all the girls in an isolated situation, should any emergency arise…
Further dissatisfaction was caused by inadequate kitchen and food storage facilities. We were fortunately able to provide both our daughters with small fridges; others doubtless are less fortunately placed; and cannot afford this expense themselves. The final straw which drove our younger daughter to seek alternative accommodation was the perpetual presence of cockroaches, one of which turned up in her bed.
The position in my constituency is no more satisfactory. An example is the Walnut Tree hospital in Sudbury where 11 to 15 nurses are required to share a bathroom, a figure that compares with the guideline of four to six nurses to a bathroom. Security at the hospital is unsatisfactory. There is no warden or house sister there and there have been allegations that the letters that nurses receive are being opened. I stress that I do not seek to apportion blame for this appalling state of affairs, but I use it to illustrate the seriousness of the problem.
Against this background, there is a real danger that girls may be deterred from entering the nursing profession; inevitably, parents of children who are considering taking up this profession may be concerned that they are putting their daughters at unnecessary risk. A consequence of the poor NHS accommodation for nurses may be to force nurses prematurely into apparently more suitable accommodation outside, which may have more particular hazards and disadvantages. We should ensure that the National Health Service accommodation provides an adequate environment for the nurses to give the standard of work that we expect of them in their crucial role of delivering patient care.
What can we do about the problem? The guidelines about the necessary standards in nurses homes were issued as long ago as 1908. They covered such matters as adequate cooking and recreational facilities. However some 75 years later we do not seem to have reached those targets.
I am coming to the more recent guidelines.
In 1943, the Nursing Mirror published further guidelines, which were laid down for the King Edward's hospital fund in London for the supervision of nurses' health. They included the importance of diet, of three good meals a day, and said that every nurse should have her own room, preferably with her own wash basin. At that time a ratio of five to six nurses per bathroom was recommended, and proper recreational facilities were reiterated.
My hon. and learned Friend the Minister for Health, in a recent written answer, said that the most recent published guidance from his Department on the subject was issued in a hospital building note in 1964. The guidance included recommendations that each nurse should have a bed-sitting room and an individual washing facility, and that bathrooms, kitchens and loos should be available in a ratio of not more than four to six nurses for each facility. Today, unfortunately, as I have already shown with the case in my constituency, those standards are not being met in many parts of the country.
I understand that it is intended to update and reissue the guidance notes this year. Accordingly, I wish to suggest some items for inclusion. First, I hope that we shall reexamine the ratios of nurses to the facilities that I mentioned—kitchens, bathrooms, and so on. Secondly, we should look at the essential need for basic items of equipment such as a desk in each bedroom for study purposes, and proper equipment in the kitchens.
Thirdly, guidance on electrical standards should be issued. At present, old and inadequate wiring constitutes a fire hazard, and the lack of equipment in many kitchens means that nurses are encouraged, in effect, to bring appliances into their rooms which may overload the system and cause fuses, and lights may go out causing other nurses' study periods to be interrupted.
Fourthly, attention should he given to noise levels in the hostels. If nurses are to study satisfactorily, it is essential for them to have reasonable peace and quiet, without undesirable and unreasonable restrictions being imposed on the noise that other residents can make.
Fifthly, the problem of security is becoming increasingly urgent. A mechanism should be devised to prevent unauthorised entry into nursing accommodation, without infringing the reasonable freedom of nurses to entertain visitors. We must recognise, of course, that standards have changed since the time when I was familiar with nurses' accommodation in Cambridge. I accept that it is a difficult line to draw, but it is not impossible to have adequate staff and a system of signing guests in and out that would meet security needs without discouraging hospitality.
Sixthly, nurses should be encouraged to participate more in the running of their hostels. Provision already exists for residential committees, but few of them function. That facility should be made much more common.
Improvements of that kind have significant resource implications. I acknowledge that there could hardly be a less favourable time for us to be suggesting improvements which will cost money, but part of the cost of those improvements could perhaps be recovered from higher charges because many nurses would be happy to pay a little more if the standard of accommodation could be regarded as decent. As those would be improvements to the estate of the NHS, it would be fair if, where possible, they could be financed in part by the sale of surplus NHS land and assets. It is also likely that if nurses could have a bigger say in the administration of their hostels that would encourage more freedom for individual nurses to embellish and redecorate their accommodation. Thus, some improvements could be achieved, at minimal cost to the relevant health authority.
The new guidelines that I have suggested will not be entirely effective unless some provision exists to en force them. No doubt many health authorities operate perfectly satisfactorily in that respect, but an enforcement procedure with some inspection facility would be the only way to avoid wide variations in standards in different parts of the country. I appreciate that it would be unrealistic to expect the Department of Health and Social Security to supervise standards in every nurses home in the country, but to confine the DHSS monitoring to an examination of the design of buildings costing more than £5 million, as is presently the case, is entirely unsatisfactory. Therefore, I hope that when the guidelines are reissued next year they will be implemented more widely in areas with which the Department concerns itself. Easing the financial burdens by introducing better standards could be achieved by phasing in those improvements over a period, perhaps making certain improvements mandatory over five years.
A serious anomaly is that existing nurses' hostels run by the NHS are classified as Crown property. That means that they are not subject to inspection by environmental health officers. Visits from the Health and Safety Executive are confined to work places and so do not cover domestic accommodation. That anomalous lack of scrutiny means that hostels in which nurses live have no regular inspection and are not subject to enforceable safety precautions. I ask my hon. Friend as a matter of urgency to investigate the ways in which that loophole can be blocked.
Concern for this issue is widespread. Nursing is an honourable vocation and those who follow it are dedicated people committed to delivering a high standard of patient care. It is unlikely that nurses themselves will become noisy or militant on this subject so it is all the more important that the House and the Government should put matters right.
The House is indebted to my hon. Friend the Member for Suffolk, South (Mr. Yeo) for having raised this matter. I intervene briefly, first, to declare an interest in that I have a daughter who is a qualified NHS nurse and, secondly, to support everything that my hon. Friend has said.
I welcome most warmly the Government's review of the nursing profession. I want to emphasise to the Minister—on this issue both Cambridge and Oxford are united—that priority should be given to the problems of not only student nurses but nurses in junior grades. Under the present arrangements they do not have the support and facilities that their dedication and hard work fully deserve. I am glad to support my hon. Friend.
I am glad to have the chance to reply to this Adjournment debate. The subject was to have been aired during the Consolidated Fund debate on Monday but it was withdrawn. Therefore, I welcome the opportunity now to put on record the other side of the case raised by my hon. Friend the Member for Suffolk, South (Mr. Yeo). I welcome the intervention of my hon. Friend the Member for Cambridge (Mr. Rhodes James) in the debate. I always treat his interventions with great respect, not just the respect that is due from the Member who represents Oxford, West and Abingdon to the Member for Cambridge, but because he has a fellowship at an Oxford college and is therefore allowed to vote in my constituency should he choose to do so at some future date. Therefore, I need to cherish my hon. Friend's opinions.
My hon. Friend the Member for Suffolk, South spoke on a subject that has attracted a great deal of publicity lately—rightly so. It is good that such subjects should be aired publicly. They are matters of public concern. I should like to set his remarks and the facts and figures that he gave, from none of which I dissent, against the background. The NHS owns about 20,000 houses and flats and additionally provides about 60,000 residential places, normally bedsits in hostel blocks, which are often in converted houses and blocks of flats. It is about the latter category of accommodation that most concern has been expressed in recent months and years.
Most types of NHS staff live in such accommodation. The most numerous are nurses, of whom about 48,000 live in. However, that figure is important in the context of the debate because there is a danger that it is thought that we are talking about the living conditions of all NHS nurses and that we are making assumptions about what all nurses can or cannot do. The figure of 48,000 nurses means that we are talking about one nurse in 10. Argument that I have read in the press, on the lines that salary levels in the nursing profession leave nurses with no alternative but to live in NHS accommodation, do not stand up. The vast majority of nurses live in owner-occupied or rented accommodation entirely unconnected with the NHS. It is important to say that we are talking about the living conditions of not more than one in 10 nurses, although those one in 10 of all nurses employed in the NHS must be considered carefully —48,000 is a considerable number of people, even when spread across the country.
My hon. Friend made an important point about regional variations. The NHS estate is a considerable size. Inevitably buildings in different parts of the country will vary, just as hospitals and social services accommodation vary. My Department does not routinely collect information about the condition of nurses' accommodation. I cannot offer now or later in writing a critical assessment of the position in the different regions. We feel that the issue is best dealt with on a local basis by district and regional health authorities, although the charges that are applied are determined nationally.
The disparate nature of nurses' accommodation is recognised by the way in which charges are made. That is another important point. Charges are not imposed by the Government, the DHSS or individual health authorities. Lodging charges for nurses were determined by the nurses and midwives Whitley council, which is a management and staff body. In other words, there has been agreement between the management and the staff side. In 1981 the council reached agreement on a revised system of charges that for the first time related them to the costs of providing the accommodation. That new system is being phased in by 1984.
There are many abatements. Just as accommodation varies in standard, so charges vary within regions and within district health authorities. I wish to put a few facts on the record. First, student nurses, about whom my hon. Friends are concerned and who make up the great majority of the 10 per cent. of nurses who live in residential accommodation, receive an automatic abatement of 40 per cent. of any charges.
Secondly, the agreement endorsed by the Whitley council recognises explicitly that some accommodation may fall below standard and provides for further abatements up to 40 per cent. That figure may be exceeded in the event of a temporary deterioration. A student nurse in substandard accommodation can thus obtain a considerable abatement of charges.
My hon. Friend the Member for Suffolk, South and I agree that it is undesirable for student nurses to live in such accommodation, but there is a clear link between charges and value for money in the accommodation provided. It is for the health authorities, in consultation with local staff representatives, periodically to review nurses' accommodation and to agree the extent of the abatements, taking into account the quality of the accommodation.
My hon. Friend rightly argued for an increase in provision and for better accommodation. The intention throughout is to try to provide better value for money. My hon. Friend properly referred to a recent survey undertaken by the Nursing Mirror in which 70 per cent. of respondents said that their accommodation provided fair to excellent value for money. That is a substantial number of those living in this form of locally provided National Health Service accommodation. That is the other side of the coin.
I do not wish to open up the issue of pay, to which my hon. Friend the Member for Cambridge briefly referred, but we estimate that, taking into account the new charges agreed by the Whitley council, the latest pay award will improve the take-home pay of the average student by about £12 per calendar month. It is important to bear that in mind. I hope that my hon. Friend does not object to my setting his perfectly valid argument in a broader context.
I stress that nurses' accommodation is a matter for local decisions. It has been suggested that my Department should undertake a survey of nurses' accommodation or that there should be some form of central funding to raise standards. I reject both assertions. Individual health authorities have the responsibility for providing residential accommodation of a reasonable standard and for inspecting the premises and ensuring that they are up to standard. My hon. Friend the Member for Suffolk, South raised an important issue in that respect. That responsibility, of course, covers proper levels of safety and security, both personal and against theft. We look to regional health and district health authorities to consider the pressing needs of young student nurses, the majority of whom are female, in this context. The authorities are responsible for determining levels of spending on new provision and for the maintenance of existing buildings, whether they provide separate accommodation for student nurses or accommodate them in existing buildings such as hospitals.
I have listened to my hon. Friend the Minister with great interest, but I must say that he sounded rather complacent. I understand the difficulties of regional and area health authorities, as I have been a member of both. Will the Minister give them a really good prop? Some of the available accommodation is of an extremely poor standard. Every time nurses receive a modest rise, up go the charges for their accommodation and facilities but the increase in charges does not necessarily relate to value for money. As I know from my experience as chairman of Gloucestershire social services committee, that is a bone of contention. If every time a person gets a rise of £3 a week half is taken in increased charges for accommodation without the increased charge relating to the value of the accommodation, that is inequitable.
I respect my hon. Friend's considerable experience. We are constantly prodding authorities about a range of matters including that one. They occasionally find the prods irritating and uncomfortable. We are also constantly told by members of local health authorities that they want more local determination. It is a case of trying to strike a balance.
The recent pay award and the recently introduced scale of charges should leave the average student nurse who lives in NHS-provided accommodation £12 a calendar month better off. Blanket central monitoring would be difficult. However, it is important that there should be central guidance about the overall provision of accommodation when new accommodation is being built. I warmly welcome the highly constructive checklist that my hon. Friend the Member for Suffolk, South suggested we might consider when we redraw the guidance that we shall issue next year. I assure him that we shall take into account and examine positively the points that he made when, next year, we reissue advice to district and regional health authorities concerning new buildings that might involve nurses' accommodation.
My hon. Friend the Member for Suffolk, South made several detailed points. It is difficult to give precise answers as much of the updating work is going on. Now is a sensible time for my hon. Friend to raise such points. He has got in at an early stage of the process. It is thought that standards that are set out in the existing guidelines are probably still applicable as regards the standards of such things as individual rooms and provision of an adequate number of bathrooms, lavatories and showers. We shall consider detailed matters such as security, theft, access and the social regime of the homes. I was interested to hear what I thought was the beginning of some illuminating reminiscences of my hon. Friend's time at Cambridge when he visited some nurses' homes. Our London flat is opposite Westminster hospital nurses' home. I have learnt a great deal about the social regime of such homes by watching the comings and goings there. I do not believe that we want any more high rise blocks for nurses' accommodation—it is simply not what they want. We will give positive guidance about the updating of existing buildings.
My right hon. Friend the Secretary of State for Social Services, my hon. and learned Friend the Minister for Health and I regularly conduct reviews of the 14 regional health authorities when we get the opportunity to discuss the issues that my three hon. Friends have raised today. Nurse accommodation is always on the agenda. The matters of concern that my hon. Friends have raised will be highlighted in an important Rayner study of the NHS which should be published within the next few weeks. Its main subject is NHS staff accommodation. It has been conducted in my own regional health authority's area. It will be timely and pose some provoking questions to health authorities.
I appreciate that my reply has not answered all of the points that my hon. Friend has raised. I remain convinced that provision of nursing accommodation is best examined locally but that it needs national guidance. It will continue to get such guidance.