Bevan's Bright Idea - How Nursing has Changed

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Status: Finished  |  Genre: Non-Fiction  |  House: Booksie Classic
A brief look at nursing at the start of the NHS (UK) in 1948 and how it compares to 2016.

Submitted: March 04, 2016

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Submitted: March 04, 2016

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Bevan’s Bright Idea.

How Nursing has Changed.

 

Nurses and the country’s hospitals seem to make a regular appearance in the headlines, usually for the wrong reasons. The NHS is soon to be 68 years old and although it may not be a milestone birthday, and some might question how many more birthdays it may have, but it’s still standing (with a little help from a walking stick perhaps). So has the NHS and nursing aged gracefully?

1948 – The Beginning.

In 1948 the Health Secretary; Aneurin Bevan opened Park Hospital in Manchester signifying the start of the National Health Service. It was the culmination of a hugely ambitious plan to deliver good healthcare to all regardless of their income. The NHS in 1948 employed 144 00 staff.  Around 93,000 were nurses, 8,000 GPs and 6,000 hospital consultants, the remainder included, dentists, opticians and other hospital staff. But the system had issues right from the outset.

There was a serious shortage of nurses; about 48 000, with many hospitals dependent on the manual labour of students. The intended plan was, once the majority of cases were treated, the NHS could focus on prevention of illness and disease.  This was never to be accomplished. Changes in the population, particularly the growth of the number of aged and infirm, placed increased demands on the NHS.  This, of course, meant the original cost estimates were far exceeded. In 1948 there was a waiting list of around half a million patients!

 

Improvements and Developments.

Improvements in healthcare and medicine continued post war with more and more antibiotics and preventative drugs being developed. The 1950’s saw mass vaccination against polio and diphtheria, which are now virtually non-existent in the UK.  More discoveries by doctors, such as Dr Richard Asher of the Central Middlesex hospital, who was one of the first to highlight the risks of prolonged bed rest.  He suggested that the risk of complications such as deep vein thrombosis and chest infections, far outweighed the hazards of early ambulation. And Professor Sir Richard Doll and Professor Sir Austin Bradford, together discovered the statistical link between smoking and lung cancer in a research paper that was published in the British medical Journal in 1950.

Nursing.

So what was it like to nurse in 1948? As already discovered, nurses were in short supply, inadequate training, poor pay and the marriage bar (nurses had to leave the profession if they chose to marry) were all blamed for low recruitment.  This lead to nurses being sought from the Caribbean, by 1965 there were between 3000-5000 Jamaican nurses working in British hospitals.

Nurses were held in low esteem according to Dr Rosemary White in her book, The effects of the NHS on Nursing 1948-61. She described the profession as becoming anti-educational and nurses regarded as ‘hand maidens’ by doctors. She also mentions the historic tradition of low pay for women’s occupations. However, the education of student nurses was due to improve. Before World War II the General Nursing Council (GNC) the then nurse regulator, insisted on a minimum level of education for new recruits to nursing. Unfortunately this was abandoned on the outbreak of the war and not re-established after it had ended, even though it was the official policy of both the GNC and Royal College of Nursing (RCN). The Ministry of Health refused to allow the GNC to re-impose an educational standard of entry, as they were afraid of losing invaluable student labour. The Nurses Act of 1949, saw the role of nursing become modernised, providing a catalyst for reform to nursing education and training. Also, under this Act, nurses could pay a one off fee to be registered, this register still exists, although nurses now have to pay annually and cannot work as a registered nurse if they are not on the list.

Matron.

Matron was a key position within the hospital and community. She was expected to run the schools of nursing and manage an efficient nursing service. She would also have been responsible for the linen room, laundry, female domestics and catering and other departments. At one London hospital for example, Matron took care of not only the nursing school, but the training schools for radiographers, physiotherapists, occupational therapists and dieticians! She would have kept order and cleanliness on the ward with staff being a little afraid of her. Nurses were expected, along with domestic staff, to clean the wards, even making the beds in a certain fashion. Infection control was of most importance, with one former matron recalling how they used “carbolic soap and a scrubbing brush to scrub and scrub our hands and nails until they were almost raw”. A public information film in 1948 promoted the use of disinfectant and coined the well-known phrase “coughs and sneezes spread diseases”.

Modern Matron.

During the 1980’s and 90’s, Matrons all but disappeared, the role changing to that of senior management with more of a desk bound job then in direct patient care. But when hospitals began coming under fire for cleanliness and ‘super bugs’ the ‘Modern Matron’ was introduced. Hospitals are now too large for a single person to manage, so the Matron is now responsible for a smaller number of wards, but they still have control over nursing, hospital cleanliness, infection control and the nutrition of patients. The Matron is also a visible figure for patients and relatives to consult for assistance and advice.

Onwards and Upwards.

So are hospitals cleaner now? Our understanding of bacteria and how infections are spread has obviously increased, which has greatly improved infection control and naturally this will continue to progress with scientists discovering new germs and new ways to eradicate them. However the orderliness and tidiness that the Matron insisted on has become difficult to achieve. Nurses are no longer required to clean the wards, this role being given to contracted companies; this therefore makes it difficult for the ‘modern’ Matron to regulate, resulting in departments and wards that have been overlooked. But let’s not forget the increasing workload for the NHS in general, people are living longer, birth rates are high, so the sheer volume of patients creates a very different environment to monitor and manage effectively; the system deals with 1 million patients every 36 hours!

 

So yes there may be some areas that need improvement and perhaps the leadership of the Matron shouldn’t be dismissed, but nurse’s doctors and other NHS staff do an amazing job in some very difficult circumstances and where would we be without our NHS?


© Copyright 2020 Nicola Macbeth. All rights reserved.

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