Introduction

The role of nurses has been largely absent from the account of health policy and organisation so far presented in this book. This is no accident. It is hard to see what role nurses, as a professional interest group, had in shaping the discussions leading up to the creation of the NHS. They were positioned into the new health service in a role providing most of the care that patients required, but having very little say in how health services should be organised. Nursing is significant in discussions in the 1950s in terms of the relationship between GP and local authority healthcare, during periods of industrial militancy in the 1970s and the 1980s, and in debates about professionalism in the 1990s and 2000s. However, nurses remain, in Alford's (1972, 1975) terms, a repressed rather than a challenging interest in the NHS, despite being overwhelmingly the largest professional grouping within it. Why is this the case? This chapter tries to explore this question by giving an account of the development of nursing since the creation of the NHS.

The 1940s and 1950s

The effect of the creation of the NHS on the nursing profession was to remove a considerable amount of its autonomy. The rise of hospital medicine, and the dominance of consultants within it, institutionalised the position of doctors as the most significant interest group in the NHS. Nursing, in contrast, was a subsidiary profession expected to fill the holes left by other, male-led professional groupings in healthcare (Davies, 1995). This was perhaps clearest in the midwife role, which was effectively a community-based profession in its own right before the NHS, with midwives practising largely outside of the control of doctors and delivering children for the 50% of women who chose to have their babies at home (Lewis, 1990). The creation of the NHS, however, meant that midwives were now under the control of doctors, organised around medical units of administration based on hospitals, and much of their autonomy was lost (Jones, 1994). Midwives were required to report anything out of the ‘normal’ process of childbirth to consultants, with only ‘natural’ childbirth remaining under their remit.

At the same time, the GP was now the first port of call for women seeking midwifery services, making it clear that, in the community, midwives were subservient to GPs (Dingwall et al, 1988).