10 June, 1926.]

3231. You have suggested that there should be one nurse to two patients?I said that in the average London house. 3232. What is your opinion as to the existing supply of nurses to meet demand of that kind? It is rather difficult to answer that question straight away, but in those nursing homes, for instance, which employ untrained women, which I presume have been referred to as the lower type of nursing homes there are quite a number of women who are past acute work, who could do that type of nursing and could be employed in these homes.

a

[Continued.

3235. There might be more demand for secretaries' jobs than for nursing jobs? -Still, it means that there were two hundred who replied.

3236. They may want to better themselves. What is your view with regard to the charge that should be made to ensure adequate nursing?-I have worked that out many a time, and I have found that by definite calculation of all questions of fees and upkeep of the house and all that sort of thing, the cost of a patient was 5 guineas or £5, but that is some years ago. I do not think any patient could be nursed adequately under £5. It depends on the locality and so forth.

3237. Do you think any patient could be adequately nursed for £2?-No, I decidedly do not.

3238. Not in any locality. No.

Dr. Vernon Davies.

3239. When you were speaking with regard to the proportion of trained and untrained nurses, or fully trained and partially trained nurses, you spoke of this London home where they are practically all untrained nurses? Yes, I have a report here about it.

3240. Do you think in a high-class home, charging a high fee, they should be allowed any untrained nurses? - No, I do not think that any type of home whatsoever should have untrained nurses.

3241. That is the ideal, but I mean at the present time? Certainly those that charge high fees should not have untrained women. You see, I cannot enter into your mind at all; I do not think that anywhere there should be untrained women nursing the sick.

3242. That is the ideal to be hoped for, but we have to recognise that at the present time there are such women and we cannot turn them out. Do you think it would be feasible if a Bill were brought in that nursing homes charging above a certain fee should be compelled to employ only fully trained nurses? It is feasible in a sense, but I do not think that is the right way to put it. I think naturally those who charge high fees ought not to be allowed to employ untrained women, but I am considering it from the point of view of sickness, and I do not think that any type of sick person should have to submit to the care of untrained people. Therefore the thing to go to would be perhaps the proportion. G3

10 June, 1926.]

3243. We have to have them at the present time. What proportion would you allow of trained to untrained nurses? -That is rather hard question to answer generally. It would depend upon a number of things.

SO

a

a

nurses.

3244. You are allowing two patients per nurse, with home with twenty patients you are running ten How many of those ten nurses should be trained and how many should be untrained, roughly? It is a difficult thing to tie oneself down.

3245. Half and half? No, certainly not; the least possible. I cannot give you a general answer to that. I should have to go to that Home and see what the conditions were and see how those untrained people could be employed, and could reduce them I

if

to

3246. Do you think that the class of work that is being done at the Home might affect the proportion? Take the nursing home that does the purest highclass surgical work; you would want a higher proportion of trained nurses there than you would want in a nursing home taking chronic cases, would you not?-I do not agree with you there.

3247. You believe that a chronic case requires as expert a nurse as a surgical case? Yes, I think it requires the highest type of nurse, and I think you will find it is very often only the highest type of trained nurse who undertake to do it.

3248. I have heard that said before, but you are entitled to your opinion. You say there is no difference in wages between the trained and the untrained nurse? I do not say generally, but you find in these nursing homes that employ untrained nurses that very often the salary that they pay to them is equal to that paid to a staff nurse coming from a hospital.

3249. A hospital pays very badly?-Let us say £60. You will find that an untrained woman will be paid frequently £50, £55, and even £60.

3250. In a nursing home? Yes.

3251. What will the trained nurse get? -The staff nurse is supposed to get £60 when she comes from the hospital,

[Continued.

but they can get more, of course; they get £70 and so on.

3252. They do as a rule, do they not? -They should do.

3253. Take the advertisements in the nursing papers. The salaries offered are higher than that, are they not? - No, I do not think they are. I think you will find that £60 is the average offered to a nurse going to an average nursing home. 3254. For a fully trained nurse? Yes.

3255. The difference in wages really between the different classes of nurses is not very great? It should be, but what I am trying to show is that in some Homes it is not so.

3256. In the majority of Homes at present? It should be.

very

3257. So that the wages question really could not make much difference to the cost of running the Home?-No.

3258. Therefore there is all the more reason why they should employ only trained nurses? Yes.

3259. Because the amount of money that they are saving on wages by employing untrained nurses is not a very great amount in the running of a Home? -No, and you will find that in the very best nursing homes, those that do pay adequately their nursing staff, that is not the heaviest item on their balance sheet. I can tell you of one place where their nurses get from £70 to £150, and that is not the heaviest item on their balance sheet. Linen and laundry comes first, as it should do.

3260. In running a nursing home, the wages point of view is not of very great importance?—No.

3261. The extra £10 or £15 to a nurse does not make very much difference?No.

3262. You said something about nurses being out of work. Do you quite believe that? What I said was that there are a considerable number of nurses who are past acute work, who would be quite fitted to nurse in chronic homes, where patients suffering from chronic diseases are being nursed, provided the conditions there were satisfactory-which they are

not.

3263. Do you never hear-you must hear-of the great difficulty that Nursing Homes have in getting competent nurses?-But then it is the conditions which they offer.

3264. In what way?-I would like to read you some of the opinions I have here; for instance, with regard to accom10 June, 1926.]

modation. I had a letter from Edinburgh the other day from an exceedingly well-trained woman, one of the finest nurses I know. She had to sleep in the night nurse's bed, and when she went there again to sleep she found another nurse in her bed. They are

even

not

own

sure that they have their sheets; in fact, you will find that the highest praise a nurse can give to a Nursing Home is: "I get my own sheets." I have been in a Nursing Home where the accommodation for the nurses was simply a row of beds above a garage; there was absolutely nothing ordinarily civilised for them.

3265. I know of a fairly high-class home where the Matron has told me that she has the very greatest difficulty in getting competent nurses, and she pays a very high salary? I think probably at the moment it is difficult to get the right type of nurse for a good class Nursing Home, but there are other causes that are the reason for that. For instance, after the war there was a very poor type of nurse that went in for nursing, and that is the type that is trained now, and it is difficult to get the right sort of woman for the type of high-class nursing which is required in a high-class Nursing Home; it is difficult to get the right type of character.

3266. You think there has been a lowering in the class of girl who has gone in for nursing? - Yes, decidedly. It always has its ups and downs.

3267. You definitely think that? Yes, I think that is the reason they cannot get what they call the right type of nurses.

3268. Did you hear the evidence of the last witness?-Yes.

3269. He thought that the doctor was quite capable?-Yes; well, he is not.

3270. If I may say so, I am rather inclined to agree with you. I fully agree with you; he has not the knowledge.

3271. But you would go further than 1 would, because you put the whole inspection in the hands of the nurse. I would not. I think a doctor has some use?-I do not quite see how the two could work together practically. The doctor is responsible for his own patient.

3272. I am not talking of the doctor who has a case, but I am talking of an inspecting doctor now?-But then you have SO many doctors going into Nursing Home. Why do you want to add an outside one for what purpose?

a

3273. Because the doctors who are going into a Nursing Home simply go

57082

[Continued.

3278. The Inspector may be a trained Nurse? Yes.

3279. Of what capacity or what standing?-For instance, the last witness said the Nurses on his staff would do. That it not the type of Nurses who would do for inspecting. It must be a woman who has requisite knowledge to do so, and who has experience of these things, such as a Matron or a Nurse who herself has been the head of a Nursing Home and understands what is required. A Public Health nurse has not necessarily the right experience.

3280. So you would limit your inspecting staff to Matrons of Hospitals or Nurses who have run their own Nursing Homes? Yes, experienced women.

3281. Would you have a supply, do you think, for the country?-I should think so. After all the Matron in Chief in France inspected 200 units. It would not be such a tremendous staff that would be required to inspect the Nursing Homes.

Chairman.

3282. Is there anything else you want to tell us? Would you like the room

G4

Chairman.

3285. You have been in practice as a medical man for a great number of years I think? Yes, I have.

3286. And you have been in the habit during the whole of the time you have been a medical man of receiving resident patients? No, not for the whole time; for the last 40 years or something of that kind.

3287. What type of cases were you taking? Chiefly mild medical cases; borderland cases, chiefly; I do not take in bad cases at all.

3288. How many cases do you take in your house at the same time? I have seven now in the house, but you can hardly call them patients. Five of them are paying guests who have been with me for many years; in fact, they are personal friends now. I have really only got one that I could call a patient.

3289. Do they require any nursing?They have nurse companions. I have two nurse companions in the house. Two of these patients are elderly ladies and they want taking out in bath-chairs and things of that kind.

3290. Do the nurse companions take them out in the bath chairs? - Yes, they do-mine do.

3291. Are these nurses qualified nurses, or are they only just people who call

themselves nurses? - Well, one certainly was not a qualified nurse. She has been in hospitals and things of that kind. In my time I have had plenty of qualified nurses during the whole 40 years. Then I take in occasional lunacy cases from the Commissioners.

If

3292. But these seven cases must want more attendants than your two companion nurses can give? I have two old ladies who are rather troublesome. one goes out in a bath chair the other will not go with them, or if she goes out in a bath chair, she will not go the same way; so I am obliged to have two nurses to go with the two people.

3293. What happens to the other five meanwhile? Do they not require any attention?-Those I have in my house, as I say, are paying guests; they go in and out just as they like.

3294. They do not want any nursing attention at all? - Not a bit. They come to the table with us. I have one old gentleman upstairs who is a ward in Chancery. He is the only one I call a patient that I have in the house at present.

3295. But you have had cases sent to you by the Board of Control I take it? Yes, a great many.

3296. What kind of cases have you had -very mild cases always? Very mild 15 June, 1926.]

cases as a rule. Of course now and again we get trouble, but I have practically all mild cases.

3297. Have not they required attendants to look after them?

Yes.

3299. In that case you would engage an extra attendant?-Oh yes. I have had many qualified mental nurses and male attendants at different times.

3300. Does each of those patients have a separate bedroom? Yes.

3301. You must keep a good-sized staff of domestic servants? - I have to have four, with assistants, I am sorry to say. 3302. Do they all have their meals together? Practically all, yes-all except this one gentleman I was speaking of now, who is a little queer in his head. He has his own room and, by-the-bye, I have a friend of mine, a retired officer, who is living with me in the house and he looks after this gentleman. He takes him round the garden and takes him out for walks and things of that kind.

3304. I am coming to the point as to how far they would resent, as you say in your paper, any interference in their affairs? I mean they would not like their private affairs looked into; that is all.

3305. If we had registration of nursing homes, and if doctors' houses were included in nursing homes, how do you think there would be an interference with the private affairs of these patients?Of course I do not know what you intend to do; I do not know how far you intend to go. If you simply visit a house and so on, as the Commissioners in Lunacy do, I do not mind a bit, but if there is a kind of inquisition into how much they pay and things of that kind, it seems rather hard lines on them.

3306. But if there is only an inquisition into how they are housed, how they are fed, and how they are nursed, is that an interference in their private affairs? -Not with them; with me it would be.

3307. Would you mind that? It depends of course who comes round. The Commissioners of Lunacy are all skilled

[Continued.

men, men of standing in the profession and so on. Naturally I am glad to see them, but I should not like what I call some young fellow coming in, or a nurse coming in and walking about my house and making all sorts of inquiries.

3308. How about the medical officer of health of the county? - I should not a bit mind our medical officer of health coming in.

3309. You would not like a matron from some hospital as an emissary from the Minister of Health coming in?-I should not like it, but naturally if it was thought to be the best thing I should not object to it.

3310. I am still rather on what you say about the patients. The patients would not mind that; I take it it would not affect them? I do not suppose they would mind unless they were spoken to you see. You could not ask a man how much he was worth, and how much he was paying, and things like that.

3311. What is your general view then; you must have thought about this subject. If registration only means that you will have inspection to ensure for the sake of patients that they are well looked after, do you think there is any serious objection to registration? - No. I do not think there is. I think I should rather resent it myself. I would not mind anyone coming into my house, but I do not see why we should be spied upon exactly. What reason have you for thinking we do not look after our patients?

3312. Do you think there is any reason for registration apart from the house which is a doctor's house? - Apart from the house that is a doctor's house, I should certainly support it.

3313. Then your objection really is on the lines that you think a doctor's house ought to be exempted? I think where people like that come in they ought not to have their affairs interfered with at all. If they were lunatics I should not object to it in the smallest degree. If the Commissioner came down, or the Visitor or the Lord Chancellor came down, I should not object to it in the smallest degree.

3314. You said you would not object to it in the case of an ordinary nursing home which is kept by a matron owner. You do not see any objection to registration of such nursing home?-Not at all.

3315. How do you draw a distinction between a matron owner and a doctor keeping his own nursing home?-Because I think I am sufficiently qualified