Draft memorandum on the place of nursing in a national health service
1944-11-11 1944 1940s 4 pages Reprinted from THE NURSING TIMES, NOVEMBER 11, 1944. The Royal College of Nursing Draft Memorandum on THE PLACE OF NURSING IN A NATIONAL HEALTH SERVICE based on the Government White Paper, February, 1944 SECTION 1 : GENERAL CONSIDERATIONS 1. The Objective. &mdash...
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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/10796/80AD5D56-BF71-4DEA-ABEF-693879F6329F http://hdl.handle.net/10796/2DE24B76-78B6-45F9-AD1C-C1D23DF95AF7 |
| Summary: | 1944-11-11
1944
1940s
4 pages
Reprinted from THE NURSING TIMES, NOVEMBER 11, 1944. The Royal College of Nursing Draft Memorandum on THE PLACE OF NURSING IN A NATIONAL HEALTH SERVICE based on the Government White Paper, February, 1944 SECTION 1 : GENERAL CONSIDERATIONS 1. The Objective. — The members of the Royal College of Nursing are in favour of the Government's intention to provide a health service for every citizen in every walk of life, and regard the provision of a complete nursing service as their special target. They realize that, under the present system, this is very far from being the case, and their deliberations have been conducted with the object of giving the fullest possible nursing service to all, and not merely with a view to safeguarding professional interests. Once a health plan has been accepted, nurses have an important part to play in interpreting it and educating the public as to its full meaning and use. A National Basis The Royal College recognizes that services which were once a purely local development must, in our present stage of social development, be planned in relation to much wider areas, and, where major issues are involved, on a national basis. They were disappointed that nursing had not been treated in the same detail as medicine in the White Paper, and that references to nursing seemed to assume that the only contribution nurses could make to the health plan was in the domiciliary sphere. The whole conception of a national service for health will fail unless an adequate supply of well-trained nurses can be assured. Immense numbers of nurses and midwives are involved, yet no preliminary discussions were held with them such as took place with the doctors ; and though in subsequent speeches the Minister amplified the allusions to the nurse's part in the national health service, there still seems to be little public recognition of the fact that nursing is a profession parallel to that of medicine, and that it occupies an appointed and increasingly important place in the national plan for health. Quality and Quantity The successful carrying out of public health, hospital and clinic services largely depends on the quality and number of nurses available, and the economic use of their specialist skill. This in turn involves planned recruitment and training, from the pre-nursing to the post-certificate stage. Gaps in the nursing services must be avoided, duplication and lack of co-ordination among the various specialists in the health field must be corrected, conditions of work must not fall below a certain standard. All this involves careful integration and planning at all levels if the ideal of a comprehensive and efficient service is to be achieved. 2. The Time-Table. — In spite of the fact that many members are on active service overseas, the Royal College of Nursing is in favour of planning now. The following factors have influenced the College in its decision. (a) Those who are away should not return to chaotic conditions such as followed the last world war. (b) Those at home have a duty to safeguard the interests of absent colleagues. (c) Nurses on active service are by no means isolated from the "planners" at home. Men and women in the Forces everywhere are being wisely encouraged to consider and discuss the future constructively. 3. A One-Sided Report. — Although the White Paper is supposedly concerned with "a whole provision for health" (page 38, chapter VI), plans are restricted to what is termed a "personal" health service, and even with this more limited objective the structure is almost entirely curative. Nurses are, of course, aware that : (a) the full development of the social and preventive aspects may involve participation by a number of other Ministries ; (b) facilities for curative work must be available if deviations from the normal discovered in the course of preventive treatment (e.g. through mass-radiography) are to be adequately treated. But the White Paper contains practically no suggestions for linking preventive and curative work, and the two will be as sharply divided as ever unless : (a) the Minister anticipates submitting further suggestions ; or (b) he is looking to participants in the health service to evolve their own schemes. 4. The Machinery of Local Government. — Though the proposals to bring the National Health Scheme within the framework of local government are recognized as administratively expedient, the scheme as outlined should, in the opinion of members of the Royal College of Nursing, be regarded as a short term policy. They endorse the strong recommendations which have been submitted from many quarters that the plan should, as soon as possible be linked with a complete reorganisation of the local government machine. General Support With this proviso the Royal College of Nursing is prepared to give general support to the National Health Plan for the following reasons:— (a) The establishment of a comprehensive health service is a matter of urgency.* (b) Though a complete overhaul of local government is eminently desirable, some adjustments have already been made which reduce the emphasis on the electorate as primarily a body of ratepayers. (c) The administrative machinery outlined ; in the White Paper is not entirely in the hands a [of] the local electorate. For example, the areas covered by the Joint Authorities, the planning bodies, are larger the representatives of the Boards are "at two removes from the electorate" (P.E.P.), and so should have greater freedom and wider vision, and be less hampered by local and sectional interests while yet preserving a knowledge of local conditions. (d) The proposed advisory councils introduce a new element in local government, and should help to correct many present weaknesses, provided their powers not only to advise but to initiate schemes are fully developed. (e) Greater emphasis on the responsibilities of citizenship in all modern educational developments should improve the quality of local government. 5. Expert Guidance. — The effectiveness of the machinery outlined for advising the Minister and the local authorities on implementing the National Health Service will largely depend on the personality of the Minister himself ; on his readiness not only to consult the advisory bodies but to encourage initiative on their part and to give due weight to their findings ; on his foresight with regard to the formulation of long-term plans ; and on his own initiative as the head of a Department which may ultimately be responsible for two thirds of the cost of the service. It will also depend on whether the members of the advisory councils are nominated or appointed in such a manner, or are of such ability as to command the confidence of the professional groups engaged in carrying out the service. These advisory councils should not be too unwieldy in size. They should, however, be sufficiently large to secure representation of all major interests, so that barriers are broken down and individual members are able to view and obtain recognition of their particular field in relation to the service as a whole. The inculcation of social medicine in the training of doctors and nurses will ultimately result in more effective co-operation with other participants in the service. The proposed councils should come into being as soon as possible, while the community is still braced by the war effort, and before the phase of post-war exhaustion and inertia sets in. 6. Services Not Included in the General Plan. — The Royal College of Nursing is disappointed that many important branches of health work have either not been mentioned in the national plan or have been regarded as outside the personal health scheme, notably industrial medicine, the mental health services, health teaching and medico-social work. Such omissions can only be temporary, and it is to be hoped that from the outset the health centre will provide opportunity for fusion and integration. Also that the maternity and child welfare services and the school medical service will eventually be fully integrated in the general health scheme, rather than remain the responsibility of the education authorities. (See page 3, Health Centres.) 7. Distribution. — If every individual is to be provided with the health services he needs, then members of the health team must be available to give these services, and distribution of skilled personnel cannot be left entirely to chance, at all events in the transition period. On the other hand, machinery for nurses comparable to the Central Medical Board for doctors does not appear to be needed, as functions performed for doctors by the Board can, in so far as they concern the employment of nurses, be carried out in other ways. Interchangeability of pensions would help to promote mobility among nurses. SECTION II : CRITICISMS 1. The personal health service outlined in the White Paper is too limited in scope, and leaves too many branches of health work, preventive and curative, outside the scheme. 2. A complete domiciliary nursing service is only one aspect of the comprehensive nursing service which should be available under the national health scheme. All branches of midwifery and nursing should be developed in relation to the scheme, each being founded on a well-planned system of education and training. 3. The proposed advisory machinery is inadequate for the requirements of a full * The shortage of premises for the development of an extended health service can be overcome by utilizing, at least temporarily, the many Government buildings - hutments, requisitioned houses, aerodromes, etc. - which will be available.
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