Draft memorandum on the place of nursing in a national health service
1944-11-11 1944 1940s 4 pages 2 nursing service within the national health plan. 4. Plans for the development of social and preventive medicine have been virtually omitted. 5. The great potentialities of health centres have barely been indicated. SECTION III : POSITIVE PROPOSALS I. The Administr...
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| Institution: | MCR - The Modern Records Centre, University of Warwick |
| Language: | English English |
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11 November 1944
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| Online Access: | http://hdl.handle.net/10796/CF85571E-15B5-4423-9C66-0517498FDD81 http://hdl.handle.net/10796/ECEAF04F-A571-4620-A782-FB8FCD117278 |
| Summary: | 1944-11-11
1944
1940s
4 pages
2 nursing service within the national health plan. 4. Plans for the development of social and preventive medicine have been virtually omitted. 5. The great potentialities of health centres have barely been indicated. SECTION III : POSITIVE PROPOSALS I. The Administrative Structure (See Chapter III of White Paper). A. Central. An Advisory Council on Nursing and Midwifery.— The establishment of a National Health Service will raise many questions of national policy in the nursing and midwifery sphere which, as other Government Departments have found, cannot be dealt with at local levels without direction and advice from the top. A service involving perhaps a quarter of a million members requires national machinery if it is to be utilized to the best advantage. The nursing profession must, of course, have its own representation on the Central Health Services Council. But such a Council, which, it is assumed, would be predominantly medical in make-up, would have neither the time nor the knowledge to pronounce on the many matters which are bound to arise with regard to the conduct of a national nursing and midwifery service. To Advise on Nursing The Royal College of Nursing considers, therefore, that the Minister should set up an Advisory Council on Nursing and Midwifery, the main function of which would be to advise him on nursing and midwifery matters related to the carrying out of the National Health Service, and to which he could refer the many problems which will be submitted to him regarding these services. It has been felt for some time that an Advisory Council would be an asset to the Division of Nursing ; its value would be even greater in the future, when much extra work is bound to arise in connection with the Health Plan. The work of such a Council should be complementary to that of the Division ; the relationship between the two bodies would be analagous [analogous] to that of the National Advisory Council on the Recruitment and Distribution of Nurses and Midwives and the Department of Nursing of the Ministry of Labour and National Service.* This proposed Advisory Council on Nursing and Midwifery should also greatly simplify the task of the nursing representatives on the Central and Local Health Services Councils, especially if nursing groups or sub-committees are set up within these Councils. The Advisory Council on Nursing and Midwifery, being in close touch with the day to day problems which confront nurses in the field, would be in a position to give technical advice and to pronounce on matters calling for further inquiry and research. Suggested Representation on Advisory Council on Nursing and Midwifery*. — Chief officials of the Division of Nursing, ex-officio ; nursing and midwifery representatives of the Central Health Services Council ; representatives of various nursing and midwifery interests appointed by the Minister as individuals; nominees of chief professional organizations in proportion to membership; chief nursing officers of other Ministries, for example * Existing national machinery for nurses and midwives, such as the Rushcliffe Committee and the National Advisory Council on Recruitment and Distribution, has an indispensable function at the present stage, and, for the time being, should be maintained. The terms of reference of the Rushcliffe Committee should be widened with a view to its becoming the recognised negotiating machinery of the profession. Labour and National Service, Supply, Fuel and Power, etcetera. (Members shall retire in rotation ; where possible they shall be in active work). The Administrative Structure. B. Local. In each Joint Authority area there should be a Local Advisory Council on Nursing and Midwifery, linked with the National Advisory Council, to advise on nursing and midwifery matters related to the carrying out of the health services within the area. The Place of the Nurse in Local Government. — There should be a nursing department in each Joint Authority area, directed by a chief nursing officer who should be responsible to the appropriate public health committee. This officer, who should be qualified in public health nursing and hospital nursing administration, would co-ordinate the public health and institutional nursing policy of the area. Under her should be a chief public health nurse, who would act in an advisory capacity on public health nursing matters to the County and County Borough Councils' public health committees and would be responsible for the domiciliary aspect of the work associated with the out-patient clinics of the Joint Authorities. Such an appointment would ensure co-ordination of the work of all public health nurses employed by the Joint and Local Authorities. Under the chief nursing officer there would also be a principal matron responsible for the institutional nursing aspect. II. The Hospital Service (See Chapter IV of White Paper). The Royal College of Nursing regards the development of the hospital service under the National Health Plan from two aspects, which are interdependent and complementary, namely : as a means of improving the basic training of the future nurse, on which the quality of service to hospital patients so largely depends; and as a means of introducing other improvements in the service to the sick in hospital. The Basic Nursing Training. — As stated in page 1 all branches of midwifery and nursing should be developed in relation to the National Health Service, each being founded on a well-planned system of education and training. "If such a service is to have continuing vitality," says the Goodenough Report (Inter-Departmental Committee on Medical Schools), "it must be founded on highly developed and vigorous systems of general and professional education for members of the medical and allied professions, and it must evoke the enthusiastic and intelligent co-operation of the general public. The spirit of education must permeate the whole of the health service." Recommendations with regard to the education and training of the nurse have been set out in the Horder Report on Nursing Reconstruction (Section II), and, in their relation to the health scheme, can be summarised as follows :— (a) The Committee recommends the establishment of a wider basic training for general nursing, covering four years, to include short, varying periods of experience in obstetric nursing and in branches which may not hitherto have been covered, such as fever, tuberculosis and mental nursing, and an elective six months in a speciality in the last year. (b) Nurse training units should be either : (i) large parent hospitals with opportunities for training in certain specialities in * The memorandum was written before consultation with the midwifery profession concerning the joint role of the two services under the health plan. one or more subsidiary hospitals ; or (ii) groups of smaller hospitals which would combine to provide the complete basic training. (c) In order to improve the standard of practical and theoretical work and reduce the strain on the student nurse (with consequent wastage of candidates) the Committee recommends the adoption of the "block" system of training throughout the country. Under this system the student is relieved for varying periods from attendance on the sick, the greater proportion of the theoretical training being given when she is free to study. Training on the above lines would ensure a much more efficient nursing service. The present service is too wasteful of recruits and is based on too narrow an interpretation of what constitutes a "general" trained nurse. Organization of the wider curriculum would, however, imply the closest collaboration with the Joint Authorities responsible for the hospital services of their area. It would also depend for its success on the Government's willingness to implement the finding of the Athlone Committee that grants be given "from national funds to all recognized training hospitals in respect of the national work done in the training of nurses." An Improved Hospital Service for the Sick.— The Royal College of Nursing considers that the hospital service to the sick should be improved in the following respects :— (a) The numerous unco-ordinated cottage hospitals. "under-financed and understaffed" (P.E.P.), should only function in relation to the larger hospital scheme: (b) There should be a regular bus service for out-patients and relatives ; also a centralized ambulance service in each area to deal with emergencies and to take patients home. (c) Voluntary hospitals should admit a quota of chronic cases, though these should not be nursed in general wards. All student nurses should have experience in the nursing of the chronic sick. (d) Public Assistance hospitals should be "appropriated" and administered under the Public Health Acts. The chronic sick should be classified, to ensure better nursing care. (e) There should be proper hospital provision for the advanced tuberculosis case, from the point of view both of his own comfort and of the welfare and safety of others. Young nurses should not be allowed to nurse these advanced cases. (f) Admission to hospital should be simplified, and the system of "bed pools" extended. (g) Hospital patients should be assured of more privacy. (h) Apart from the admission of accident cases and former patients, the outpatient department should, in most respects, represent the health centre of the consultant level. Congestion in the department would be relieved if general practitioners specialized in minor treatments at the health centres or cases were referred to the domiciliary nursing service. The appointment system for out-patients should be universally adopted, and facilities for medico-social work extended. (i) In order to ensure the effective organization of the nursing staff, matrons of municipal hospitals should be accorded the status which is automatically assured to the matrons of voluntary hospitals. They should be recognized as head of the nursing department, and should have access to their executive committee on all nursing matters. Inspection.— Under the Health Plan (page 24) there is provision for the inspection of hospitals — including inspection by the nursing
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