Memorandum to the Health Group of the Parliamentary Labour Party 1947
The Association welcomes the opportunity to set before the Health Group of the Parliamentary Labour Party its views on the increased recruitment of personnel needed for training as health workers. Though it seems clear that a greater number of personnel will be required to staff the new National Health Service, the Association does not consider itself to be in a position to attempt an estimate of the numbers needed. In general, however, and in particular as far as doctors are concerned, we do not agree with the alarmist figures which have been given in some quarters. In our evidence for the Goodenough Committee, we suggested that some 6,000 more doctors may be needed. The really urgent increase needed is for more nurses and more dentists. In particular, that part of the Act which provides for a home nursing service cannot be implemented fully until more nurses are available.
1 . Free Training
At the 1946 Bournemouth Conference, the Association put forward a resolution urging “complete democratisation of recruitment to the Service by providing free education with maintenance for all suitable applicants irrespective of sex”. This resolution was accepted by the Conference and is therefore the policy of the Labour Party. The value of such a measure in broadening the field of recruitment cannot be over-estimated. This principle is already accepted as regards the training of nurses, but considerable time may however elapse before it can be put fully into effect, and it seems probable that its implementation would affect chiefly the recruitment of doctors and dentists -the latter an extremely urgent problem as the Teviot Report shows. As an immediate programme, therefore, the Government should instruct and assist Local Education Authorities to provide adequate education and maintenance grants for any students selected for training who require such assistance, and State grants should be made available where necessary. Ten per cent of vacancies in medical schools should be filled forthwith by such students, the percentage being increased as quickly as opportunity permits. With the new Service, the provision of a sufficient number of doctors and dentists becomes necessarily a Government responsibility, and therefore the Ministry of Education should allocate sufficient funds to the Local Education Authorities in order to secure and maintain an ample supply of students.
2. Publicity,
The teaching profession should be approached and asked to bring before school-leavers and their parents the importance of the work of the Health Service, and the various categories in it open to them. Appropriate literature, similar to that now being issued by the Ministry of Labour, should be made available to boys and girls, parents, teachers’ and Local Education Authorities. The possibility of using films, broadcasts and other methods should be considered. Visits to hospitals, laboratories, clinics and health centres would stimulate interest. Publicity by posters and advertisements, such as those on nursing now being put out by the Ministry of Labour, might be extended.
- Conditions of work
Continued pressure to improve the conditions of work and the status of health workers is of the utmost importance, not only to retain the services of those already trained, but also to prevent the discouragement of would-be recruits. We include under this heading the provision of opportunities for health workers to play a direct part in improving the work of their own hospitals by means of elected staff committees, the establishment of Nurses’ Representative Councils being a step in this direction which we welcome. The right of all health workers to join a Trade Union, should be enforced.
4 Selection Tests
Personnel selection tests as used by the Army proved their worth. The procedure involves, on the one hand, a job-analysis of the various types of work and, on the other, an analysis of the abilities necessary for success in each type of work.
The present method of selection of students depends generally on interview with the Matron or with the Dean of a medical or dental school respectively, assisted sometimes, by selection committees or by the use of an examination. The system obviously is not successful in promoting recruitment of suitable candidates from all social grades, and further it results in wastage of training facilities through unsuitable candidates being selected. It is therefore suggested that selection should not be left to individual schools but should become the duty of selection boards set up by Universities and Local Health Authorities. Sufficient knowledge is available for this programme to be put in hand immediately. A committee such as that suggested by Professor Bartlett (British Medical Journal, Nov. 2nd, 1946) should be set up to determine the selection procedure to be adopted and to check its effectiveness. He suggested that the Committee should consist of “a small but influential body of doctors and of psychologists with the necessary resources to implement any decisions they may make after discussion. This body should aim at a long-term policy of investigation and also at a short-term policy for immediate, but provisional, application”. Local Education Authorities should make educational and maintenance grants to all students selected in this way, at first on a need basis.
5 . General Educational Background
Until the Education Act of 1944 has been fully in effect for some years, there will be a number of persons who are willing to be trained in health work and who possess the necessary abilities, but whose general educational level is below the standard needed. Such persons should be aided by grants for general education prior to training in health work.
6 . Training Facilities
These are insufficient, particularly for dentists and to a less extent for doctors. The inadequacy would appear to be in facilities for study for the second and final examinations, since a number of men and women who have passed, their first professional examination are unable to obtain admission to a medical or dental school. Much greater use should be made for teaching purposes of the clinical material, in local authority hospitals. New medical and dental schools are needed but we are not in a position to estimate the increase in institutional educational facilities required.
7. The Ministry of Health and the Ministry of Education
The Ministry of Education, is not responsible, for University education but there is a definite responsibility on the Government for such education implicit, in the functions of the -University Grants Committee. It may be that the Ministry of Education will need to take greater responsibility in the future when its relationship to the Ministry of Health with regard to medical and dental education will have to be considered. Under the National Health Service Act the Minister of Health becomes responsible for teaching hospitals through their Boards of Governors but the medical and dental schools become ‘independent’ corporations closely linked with the Universities. However, in view of the increasing capital and current expenditure required for medical and dental schools these must, as regards their policy, become more and more dependent on the Universities to which they look for their grants.
The Minister of Health, presumably, must accept the responsibility of determining the number of health workers in general, and of doctors and dentists in particular, required to work the scheme as it develops, and on the basis so determined he must provide the institutional educational facilities.
When the Minister has decided on the necessity of establishing new medical and dental schools, he must reach agreement with the Universities in the areas concerned as regards recognition of such schools and their teaching staffs. It is possible that as Universities are not controlled in any direct manner, difficulties could arise in connection with such recognition. On the other hand such recognition is unlikely to be withheld if the Minister plans, his new schools in consultation with the Universities.
8 . Interim Measures.
There will inevitably be an interim period of longer or shorter duration during which the supply of personnel will lag behind the demand. It is therefore important to ensure that the best use is made of trained staff by relieving them of all duties that can be undertaken by persons without health work training or by those who are less highly trained. For instance, general practitioners should be provided with clerical assistance; full use should be made of lay hospital administrators; dentists should be provided with dental attendants, and so on. The outstanding example – the employment of domestic staff to relieve nurses of domestic duties – is probably the most difficult of solution, though there are some indications that more women have undertaken hospital domestic work since the introduction of the Mowbray scales.
9 . Nurses and Dentists
The recruitment to these two categories of health worker is the most urgent problem at the moment, and we have therefore considered, these groups in greater detail.
10. Nurses
The Association’s policy on nursing is contained in the pamphlet, “Nursing in the Post-War World”. The wastage during the training period, which amounts to between 50 and 60 percent, shows how urgently reforms are needed.
Our immediate proposals include: a legal contract of service and the right of appeal against dismissal; the right of married women to continue working; the part-time employment of nurses; a re-consideration of salary scales, especially of those of ward sisters; trained nurses to have the right to choose their place of residence; the three-shift system; nurses’ hostels to be run by a warden, assisted by a committee of residents; welfare supervisors in large hospitals; Nurses’ Representative Councils in all institutions; full recognition of the right of the nurse to join a Trade Union; the student status of nurses to become the concern of the Education Authorities; the registration of student nurses; better care of the health of nurses.
Our long-term programme for nurses includes:
a. a careful job-analysis of the work done by nurses trained or in training, with the transfer to other grades of worker of work which cannot properly be considered nursing.
b. the establishment of central preliminary training schools, large enough to afford first-class staff and equipment so as to provide for candidates who may be of varying background. The period spent in these schools should vary according to the needs of the individual candidates.
c. a two-year course of training, with the student nurse relieved of all non-nursing duties. At the end of this period the nurse would be eligible for statutory qualification. We consider that no reduction in nursing standards would result.
d. after the two-year period of primary qualification, nurses should pass six months as staff nurses under supervision.
e. those nurses who wish to be considered for promotion to ward-sister, for example, or to specialise in teaching, public health or midwifery, would undergo further periods of training and experience.
f. the ward-sister should be recognised as an important member of the teaching staff for nurses. This is only possible if she is relieved from many of her present administrative non-nursing duties.
g. short intensive, courses and part-time courses should be established in many places for ward sisters and other nurses willing to become teachers of nurses.
11. Dentists.
The Teviot Report estimates that the yearly intake into dental schools should be about 900, whereas the average annual intake in the pre-war years was about 340.
The provision of free education and maintenance for all suitable applicants for dental training is probably the most important single measure which could be adopted to bring the annual entry nearer to the desired figure. As the Teviot Report says, “No suitable boy or girl who wishes to become a dentist should be debarred by lack of means from receiving the necessary training”. Nevertheless, given the removal of the financial bar, it would appear that there are still several factors to be considered if the rate of recruitment and the quality of the recruits are to be satisfactory.
- Much the same qualities are required in the dental as in the medical student.
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The time and energy expended in qualifying are also very similar in the two professions and, in addition, the dental student needs a considerable degree of manual dexterity.
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In comparison with medicine there is a lack of variety in the day-to-day practice of dentistry.
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Notwithstanding the above considerations, and possibly due to the fact that dentistry is a comparatively new profession, both the status and financial rewards have, up to the present, been lower than those of the medical profession.
The programme for dentistry should therefore include;
a. The education of the public in order to induce a greater appreciation of the value of dental health and the importance of maintaining it.
b. Propaganda in the secondary schools to point out the advantages accruing to the profession of dentistry now and in the future, and its important position in the health services.
c. The establishment of higher qualifications in dentistry in all Universities.
d. An increase in the remuneration of dentists in salaried posts in order that they may compare more favourably with those of doctors.
We agree with the recommendation of the Teviot Committee that dental schools should be integral parts of universities, and we consider that they should be associated as closely as possible with medical schools as both medical and dental students would benefit therefrom.
The inadequacy of facilities for training is much more marked in the case of dental students than of medical students. Before the war, the Teviot Report says, dental schools were able to accept nearly 500 new students annually, which, allowing for a 10 per cent wastage, meant that only half the requisite number could be accommodated. To remedy the shortage involves the discovery in relatively large numbers of new teaching staff, as well as the adaptation of existing buildings and the provision of new ones. This matter should be treated as one of real urgency.