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Full text of "Hospital beds by design: a socio-historical account of the 'King's Fund Bed',1960-1975."

149 



CHAPTER FIVE 

BUYING AND USING 'REAL BEDS' 



Buying King's Fund Beds 

The complex purchasing and supply systems operating in the NHS from its 
inception have received rather scant attention from historians of medical 
equipment and of the Health Service itself.^ As ultimate holders of the 
purse strings (bar the Treasury), the MOH (from 1968 the DHSS) stood at 
the top of a purchasing structure which involved their own Supplies 
Division, the Regional Hospital Boards, Hospital Management Committees 
and administrators and, at the grass roots, hospital supplies officers.^ Prior 
to 1948, hospital purchasing in the voluntary sector was often in the hands 
of the matron's office. Supplies for local authority hospitals were generally 
organised from the Town Hall and subject to municipal contracting 
arrangements. Some local authority officials had specialised in the area of 
hospital supplies and it was from their ranks that many NHS supplies 
officers were drawn. ^ The precise duties of supplies officers varied 

Exceptions are historical studies of equipment produced by autliors based in liealtli 

economics or liealtli policy. For example, B. Stocking and S. Morrisson, The Image and 
the Reality: a case study of the impacts of medical technology, Oxford, Nuffield Provincial 
Hospitals Trust, 1978 includes discussion of purchasing structure in its account of the 
diffusion of CT scanners in Britain. 

2 

In 1947 the MOH took over health related supplies from the wartime Ministry of Supply and the 
Board of Trade. A Hospital Supplies Division was created at the Ministry in 1 951 . In 1 968 
the DHSS took on the divisional structure of the MOH unchanged. 

3 

'Hunt-Charter for the Future?', British Hospital Journal and Social Service Review, June 23, 
1967, pp.1 165-6:1 165. 



150 



between hospitals and hospital groups. Some spent their time 'haggling 
over the price of potatoes', whereas others were often responsible not only 
for purchasing, but for choosing, a very substantial proportion of hospital 
equipment. The Ten Year Plan entailed considerable expenditure on 
equipping and fitting out the new District General Hospitals. Additional 
funding for the programme in 1965 meant that, with annual capital 
expenditure running at £65 million, approximately seven and a half million 
would be spent on furnishings and equipment, most of it by supplies 
officers."^ Their proper status, training and career structure was the subject 
of increasing attention during the 1960's. Editorials appeared in hospital 
service journals with titles such as The Supplies Officer - Wliere does he 
stand?^ From 1964 the Association of NHS Supplies Officers ran an 
annual summer school which supplemented courses already run by some 
RHBs.^ The Messer Report's recommendation of six years earlier, that 
supplies should be dealt with 'by a specialist officer' was much quoted. 

Manufacturers were not slow to appreciate the key, though as yet 
relatively lowly, position of this group, who were highly influential in 
deciding which goods ever made it into the hospital setting. By the 1970's, 
advertisements in health service journals regularly targeted the supplies 
officer and alluded, albeit covertly, to his risen status. One series, put out 
by the paper disposables firm, Kimberly-Clark, featured spoof Mills and 
Boon style storylines and illustrations in which the handsome, white coated 

4 

P.W. Terry, 'Furniture for the New Hospital', British Hospital Journal and Social Service 
Review, Marcli 26, 1965, pp.563-4:563. 

5 

'Tlie Supplies Officer - Where Does He Stand?', British Hospital and Social Service Journal, 
July 10, 1974, pp.953-4. 

J.E.O. Smith, Better training for NHS supplies staff, Health and Social Service Journal, 
February 14, 1976, p.229. 



151 



(male) hero of the (female) nurses was no longer the doctor, but the 
supplies officer/ Journals beyond the health service field began to take 
notice of hospital supplies. In 1967, Design carried an article entitled 
Purchasing — a word tliat stands for seven million pounds a year to re- 
equip Britain's hospitals, which asserted that 'the supplies officer is the 
man in the hot seat'/ It went on to outline the various types of contract 
issued in the NHS: central, regional and local, thereby highlighting a 
problem which had surfaced perennially at the Ministry of Health since 
1948. Supplies officers worked for HMCs. Ever vigilant of their 
independence, HMCs were traditionally wary of regional organisation. As 
the civil servants concerned with supplies were always warning each other, 
'HMCs are jealous of their rights. They are suspicious of the extension of 
group contracting, particularly if it is stimulated by the RHB.'^ Apart from in 
a few regions, which had what the Ministry regarded as model authorities, 
regional contracting had never got off the ground.^" 

The Hospital Plan, however, was organised at regional level. This 
regional control was far more evident than in the preceding housing and 



See, for example ' "The whole hospital was saying that I roughed up the nurses" ' British 
Health and Social Service Journal, November 8, 1975, pp. 2504-2505. The 'roughing up' 
was caused by inferior quality paper towels, and rectified by a change to Kimberly-Clark's 
supposedly softer brand, but the term reinforced the racier stereotyping portrayed in the 
comic strip style art work of the advertisement. Barbie doll nurses pouted and the young 
supplies officer, with hair curling over the turned up collar of his white coat, preened. 

Q 

W. Bowring, 'Purchasing - a word that stands for seven million pounds a year to re-equip 
Britain's hospitals', Design, 207, pp.59-61 . 

^Davies to Hunt, 16.1.61, MH136/17. 

'RHBs fall into two classes . . . Leeds, East Anglia, Wessex, work mainly on a regional basis, 
the rest on an area contracting basis', Davies to Howes, Supply Division internal memo, 
15.7.60, MH136/17. 'Leeds RHB ... all in all appears to be a model one . . . joint 
contracting well established as early as 1949 ', Clair to Sutherland, probably July 1960. 
MH136/17. 



152 



education programmes, which were administered centrally with 
responsibility delegated to local authorities. Apart from a 'guiding hand and 
an approvals procedure', central government, in the form of the MOH, 
intended to let the RHAs get on with it.^^ It was this background, together 
with the embarrassing censures of the Public Accounts Committee, that led 
to the setting up of the Hunt Committee on the Organisation of Hospital 
Supplies. The Committee reported in 1966, while Hunt, the Controller of 
Supplies, was an active member of the King's Fund Working Party on 
Hospital Beds. Perhaps unsurprisingly, it came out in favour of a 
reorganisation of the supplies function on an area, rather than hospital 
group, basis. 

It is clear that increasing concern with economising on scant 
resources gave supplies officers an integral role in obtaining the best 
possible deals from suppliers. And the context of new hospital building 
drew them closer to the mainstream of the hospital management 
structure. ^^ For they provided some of the essential input for an activity 
which came to great prominence in hospital management during the 
1960's, as indeed it did in many other forms of administration. This activity 
was planning; that is, planning as a self-conscious, formalised technique of 

Speaking at the Institute of Work Study Practitioners in April 1967, W. G. Wilson, Assistant 
Secretary, MOH, 'explained that the new building procedures . . . would place a greater 
responsibility on the shoulders of the regional boards for planning and controlling their 
building programmes. The Minister's intention was to withdraw from all detailed appraisal 
of plans once he had been assured that the proposed scheme met his general policy.' 
'Network analysis and hospital planning'. Hospital Management, June 1967, pp. 310- 
311:310. 

12 

During preparations for the new Charing Cross Hospital in London, for example, the 
equipment sub-committee of the planning committee set up a working party under the 
chairmanship of the group Supplies Officer to lay down policy for equipping various units in 
a pilot scheme. The working party included consultant medical staff and an assistant 
matron. G.White, 'Charing Cross Hospital Pilot Scheme', British Hospital Journal and 
Social Service Review, May 14, 1965, pp.873-876. 



153 



management. The Permanent Secretary at the Ministry of Health, Sir 
Bruce Fraser, addressed the Royal Institute of Public Administration on 'the 
long-term administrative problems of planning'. ^^ The 1960's saw the 
creation of planning theorists and planning engineers. The journal Long 
Range Planning began publication in 1968. By the time a 'special adviser 
to the Chief Secretary of the Treasury' contributed an article in 1971 , 
planning, it seems, was virtually synonymous with management itself. 
Strategic planning was 'a systematic approach to general management', 
the same activity in business or in government.'^"^ There are issues to be 
explored about the changing definition of management in the post-war 
decades which I will not pursue further here. It is clear however that 
planning came to be considered constitutive of management to a very 
large degree. The King's Fund Hospital Administrative Staff College 

defined management as: 

(a) The planning and setting of objectives. 

(b) Organisation and analysis of available resources, human and financial, 

to meet the plan. 

(c) The management of resources, their use and thus the control and 

fulfilment of the plan. 

(d) The development and training of staff at all levels to meet changing 

situations. 

When the Lycett Green Report on hospital management had appeared in 
1963, 'Planned', wrote one commentator, was its 'dominant epithet.'^^ 

1 3 

'Planning in tlie Hospital Service', British Hospital and Social Service Journal, 27 December 
1963, p.1583. 

14 

R. J. East, 'Comparison of Strategic Planning in Large Corporations and Government', Long 
Range Planning, June, 1972, pp. 2-8. 

15 

'The Lycett Green Prescription for Service Health', British Hospital and Social Service 



154 



Planning was central to management and, In the mld-1960's, 
'management' preoccupied the administrative hospital service. 'Who 
manages what and what Is meant by management?' was a typical question 
In the hospital press/^ It might be argued that at least the Initial success of 
the King's Fund Bed In the key purchasing loop of supplies officer, 
manager and HMC (or RHA) had less to do with Its physical characteristics 
than with the obvious economic and organisational appeal of 
standardisation per se, and also with a less overt attraction Inherent In the 
bed's much publicised 'rational and scientific' method of design. This might 
have been expected to find favour with some sectors of an audience very 
much preoccupied with 'rational and scientific' management. Some hospital 
administrators were In no doubt that the future of hospital management lay 
with the new management techniques derived from operational research, 
and had already cooperated with operational research -type projects within 
their hospitals. 

Prior to 1960, a few projects In the Health Service, often supported 
by the Nuffield Provincial Hospitals Trust, had made explicit use of 
operational research as a model. ^^ A 1960 conference at Magdelen 
College, Oxford, sponsored by the Trust, marked the start of a period when 
operational research was vigorously promoted In the NHS, the MOH having 
been 'alive to the potentialities of the application of scientific method and 

Journal, September 20, 1963, pp.1 133-4:1 133. 

'Committees and Management', British Hospital and Social Service Review, August 5, 1966, 
pp.1 441 -2. 

The earliest explicit reference to the possible use of operational research in health related 
issues was apparently in a minority report for the Cabinet Working Party on the recruitment 
of nurses in 1948. G.M. Luck, Review of O.R. in the Health Services, London, Institute for 
Operational Research, 1971, p. 3. 



155 



modem management techniques to the planning and administration of the 
National Health Service for some time'.^^ The Ministry of Health began 
systematic support of operational research in the mid 1960's, and the 
DHSS set up its own Operational Research Group in 1970. 

But the applicability of planning, scientific management, or 
operational research to problems in the Health Service was not 
immediately obvious to some hospital administrators. According to one 

Group Secretary: 

Surveys, probes and inquisitions had resulted in lack of confidence 

between the Ministry of Health and the administrative and clerical 
staff of hospitals ... It was unlikely that the new hospitals would be 
radically different from the old ones, and revolutionary changes in 
structure would affect the morale on which hospital services 
depended more than was generally realised. ^^ 

Sometimes an obvious close connection with the origins of these practices 
in the military sphere, through the personnel involved or the vocabulary 
employed, may have brought opposition. 'Operational research is no task 
for a dilettante' declared Brigadier J D Welch, speaking at a course 
organized by the Institute of Hospital Administrators in 1963. He went on to 
outline the 'painful stages' to be gone through: 'pilot work should never be 
skimped; during the war it had been learnt that time spent on 
reconnaissance was rarely wasted. '^°lt was hardly surprising that some 
senior administrators, while accepting that the quality of hospital 
management was poor, expressed the view that 'the use of management 

^^Ibid. p.5. 

19 

'The Ten Year Plan', British Hospital and Social Service Journal, April 19, 1963, p. 452 'this 
was perhaps why enthusiasm for the ten year plan was tempered by the fear of 
redundancy', he continued. 

20 

'Operational Research in the Health Service, Objectives and Methods', Srif/s/? Hospital and 
Social Service Review, April 19, 1963. p. 451. 



156 



structures based on the army would not improve the quality of treatment.'^^ 

Nor did the model of a commercial firm seem suitable. Commenting on the 

fact that the Minister of Health was known to be considering the possibility 

of establishing some sort of criterion by which hospital expenditure could 

be assessed against the value of the work done, one senior administrator 

asked: 

Is the practice of medicine to be treated as an industry? Is the hospital to 

become a medical factory and the patient a unit of medical material? 

To what extent are we going to accept standards of industrial 

management in the administration of a hospital? Where, exactly, are 

we going?^^ 

The notion of service was frequently invoked, as was the impossibility of 
measuring, or even defining, efficiency or effectiveness in hospitals. ^^ 
An article by the steward of the United Oxford Hospitals, however, 
identified a more practical issue. Speaking of hospital administration, he 
wrote that, unlike the situation in industry, where a clear line management 
structure existed, with 'each grade having the authority and technical 
knowledge to instruct and guide the one below', the hospital service was 
fragmented into specialised areas many of which operated autonomously. 
'In fact, all the administration can control - is space, staff, supplies and 
services. These are the only management tools that are to hand.'^"^ Space 

21 

Management Services, British Hospital Journal and Social Service Review, January 21 1966, 
pp.121-122:121. 

22 

Letter, M.Gruber, British Hospital and Social Service Journal, September 13, 1963, p.1 114. 
See also, 'The Tempo of Hospital Care', British Hospital Journal and Social Service 
Review, June 24 1966, pp.1 142-1 143: 'Centralisation, increasing size, impersonality of 
approach and intensive treatment methods introduced in response to a spurious scientism 
reinforced by pseudo-economics can too easily be carried beyond the point of no return.' 

23 

'Business efficiency and hospital service', Hospital Management, Planning and Equipment, 
30, no. 376, November 1967, p. 513. 

24 

E. Holt, 'Administration, Finance and Supplies', British Hospital Journal and Social Service 
Review, April 2, 1965, p. 61 4. 



157 



was 'a very long term sort of control', with opportunities for new building 
relatively infrequent and even the reallocation of space a 'frustrating and 

slow business'. The control of staff offered: 

. . . slightly more but even here except for directly administrative and 

maintenance people, administration offers little effective control over 
what people actually do once they have been allocated. Supplies 
and services, and especially supplies, are by far the most 
controllable things we can find. 



Herein lay the attraction of supplies, and the supplies function, to those 
administrators who wished to introduce new management techniques or 
who at least felt they should be on the right side when it came to the 
contrast between the 'guesswork of the old school and the new scientific 
management based on sound principles and accurate information'.^^ 
Supplies were manageable. I shall return to this issue in Chapter Six. 



Using King's Fund Beds 

If the purchase of King's Fund Beds principally involved supplies officers 
and administrators, immediate users were a different group. The question 
of how well King's Fund Beds succeeded for them is difficult to answer. In 
the Chase Farm trials, objective recording of how often attention was 
given, adjustments were used, or what position bed elements were in at 
randomly selected times, greatly exceeded efforts to solicit opinion, either 
of nurses or patients. Indeed the recording method which Archer initially 
favoured would have precluded the observers (all trained nurses) from 



25 

T.R. Bond, 'Organisation Before Metliods', British Hospital and Social Service Journal, 
February 26, 1965, pp. 359-361:359. 



158 



assessing whether, when the beds' facilities were used, they were used 
'with benefit'. ^^ A further objective assessment, the study of energy 
expenditure by nurses using the beds that was to have been carried out at 
Edinburgh University, had to be cancelled due to other commitments of the 
department involved. 

An attitude survey of Chase Farm nurses was conducted by a 
sociologist, but only thirteen had worked with the beds and one nurse 
refused to answer any questions at all.^^ Their general consensus of 
opinion was summed up as 'the bed contains some excellent features but 
they were put together wrongly'. Other sources for nursing opinion are 
scarce. It was rumoured in December 1965 that 'senior nurses at the 
Ministry of Health have been making disparaging comments about the 
prototype'. ^^ The prototype was not of course the commercial product, 
which Agnew worked on with Nesbit-Evans. This received a very 
favourable report from the charge nurse of the Royal Berkshire Hospital 
ward where it was trialled when he was invited to speak at the launch 
conference held by the King's Fund.^^ 

Nursing journals reported the publication of the specification with 
cautiously favourable editorial comment, but as the bed became less 
newsworthy, references in the press were fewer. Once their version of the 
King's Fund Bed was on the market, Nesbit-Evans agreed to keep a log of 

Interview, Kenneth Agnew, 9.8.00. Archer was apparently dissuaded from this course by the 
work study officer, Harrison. 

27 

North East Metropolitan Regional Hospital Board Work Study Unit, Report No 81 , Attitudes of 
Patients and Staff to Hospital Bedsteads, undated but almost certainly 1 967. 

^°AAD/1 989/9, Job 13, Archer to Howes, 30.12.65 

29 

John Southwood, 'Nesbit-Evans King's Fund bedsteads in use'. Hospital Management, 
November 1967, pp. 538-540. 



159 



complaints and suggestions, but this cannot be traced. A few nurses wrote 
to the King's Fund, or the hospital journals, asking for the opinion of 
colleagues who had experience of the beds. Some only possessed one 
King's Fund Bed on their ward. Unusually, one matron fought hard to get 
her hospital equipped with King's Fund Beds then wrote to the Fund asking 
how she might 'demonstrate by statistical evidence that the choice was a 
wise one'.^° In general however, little evidence is to be had of how well the 
new beds served nurses' needs, whether as defined by the team or 
otherwise, and little formal effort seems to have been made to find out. 
When the bed became commercially successful the answer was perhaps 
regarded as self evident; or else the question became somewhat irrelevant. 

Without doubt, the methods used to draw up the specification had 
focused on nurses, and on a strictly limited decision space in which the 
behaver/ tool user occupied central place. This was a consequence of 
them involving, wherever possible, objective observation of the man-tool- 
environment system. Establishing needs was best done by observing 
behaviour, their empircal counterpart. The greatest amount of behaviour 
that went on around a hospital bed was that of nurses (apart from patients, 
whose relative exclusion I shall consider below). It was an inevitable 
consequence of this assumption that the methods employed, and the 
resultant specification, prioritised nurses needs, largely behaviourally 
defined. This prioritisation (though not its origins) was acknowledged in a 
review of the King's Fund Bed specification conducted by the Fund in 
1998.^^ Perhaps influenced by Doreen Norton, the RCA team were 

AAD/1 989/9, Job 15, Weston to Agnew, 29.10.69. 

31 

This prioritisation (but not its tlieoretical origins) was acknowledged in tlie review of tlie King's 
Fund Bed conducted by tlie Fund in 1998, 31 years after publication of the original 
specification. Bruce Archer was a member of the review body. Mitchell et al., Better Beds 



160 



sympathetic to the nursing cause. ^^ A research nurse who had devoted 
considerable effort to studying equipment in wards, she was firmly of the 
opinion that 'nurses are the only authority qualified to say what is required 
of basic ward equipment for total patient care. This fact must never be lost 
sight of.' ^^ It was however a prior decision to have a nurse on the team, as 
the only expert from beyond the design professions. No medical personnel 
were included in the core team. It seems likely that Archer's early 
discussions with the MOH had impressed upon him the obstructive role of 
consultants' personal preferences in impeding progress on standardisation. 
He had certainly formed this view by 1964, when he said, in a talk entitled 
'Why are hospitals so difficult to design for?' that 'Hospital staffs, in 
particular doctors, were laymen in engineering and design matters but they 
did not adjust themselves to this fact'.^"^ Archer tended to regard their views 
as obscuring nurses 'real needs'. Did the bed serve those needs better ? 

A focus on behaviour rather than cognition produced the occasional 
'mismatch'. To avoid the apparently time-wasting activity of rearranging 
pillows, Agnew provided straps to retain them against the backrest of the 
RCA prototype. It was later asserted that experienced nurses regarded 
'pillow plumping' as an opportunity for discreet, close-up assessment of a 
patient's condition. ^^ And a cleaning supervisor said that her staff would 

for Health Care, 1 998. 

32 

Interview, Gillian Patterson, 29.1.98. 

33 

Doreen Norton, 'Give us the tools . . .', British Hospital and Social Service Journal, 4 
September, 1964, ppl 272-1 273:1 272. 

34 

'Why are hospitals so difficult to design for?', British Hospital and Social Service Journal, 
December 11,1 964, pp. 1 793-1 794:1 793. 

35 

Interview, Gillian Patterson, 29.1.98. 



161 



never move a bed that looked as heavy as this one. Perhaps more 
importantly, a focus on use in the limited sense of maximising efficiency of 
physical effort and minimising injury, ignored the question of whether ward 
organisation and staffing would allow for use of the facility. Certainly the 
team seem to have had at times an unrealistic expectation that rather small 
physical advantages during procedures would induce nurses to expend 
time and effort raising or lowering the bed. A filmstrip produced at Chase 
Farm to demonstrate the prototype beds showed a sequence of a nurse 
altering the height of the bed in order briefly to examine a patient's ear with 
an auroscope. In the attitude survey of Chase Farm nurses, it was reported 
that 'in general height adjustment was liked but some day nurses and all 
night nurses reported that they didn't have time to use it'. While Archer 
stressed that they were seeking optimal satisfaction of user needs, 
irrespective of factors such as this, user needs were not constituted 
entirely, or even largely, at the bedside; nor were decisions to purchase. 
Given the purchasing structures outlined above, and the position of nurses 
in relation to these and to the hospital hierarchy generally, it might be 
questioned whether the extent to which it met their needs, however 
defined, mattered very much to the commercial success of the bed. 

The RCA team had perhaps, like some other design professionals 
working for the Health Service, overestimated the power of the nurses' 
voice, whether in support of, or as an obstruction to, change. An architect 

speaking at the Scottish Hospital Centre in 1967 felt: 

... it should be recognised that nursing staff were the main users of space 
and equipment in hospitals and that their views were likely to 
present the greatest difficulty in finding uniform and satisfactory 
solutions. ^^ 



'The importance of detail', Hospital Management, October 1967, pp.486-488:486. 



162 



Some of those inside the hospital service, however, pointed out that nurses 
appeared to have no views at all. At the same meeting it was noted that 
'the nursing profession had tended to be represented by the smallest voice 
at all levels. Nursing staff should not accept defects but if they were to 
shout louder, they should also shout clearer.^'' 

This comment perhaps encapsulates both the reality of nurses' lack 
of power in the hospital service and also a widespread perception that this 
situation was somehow their own fault. The preceding year, in an article 
entitled What do you think, Nurse?, the Group Secretary of East 

Birmingham HMC commented: 

Nurses are as able as the rest of the hospital community to express their 
thoughts and feelings; the marriage rate confirms that. Yet who has 
not recoiled in despair after the attempt to get nurses to express 
their own opinions about their own hospital? To use today's jargon, 
why don't they communicate? Ask a nurse for an opinion on some 
hospital matter and you are likely to get the opinion she thinks her 
next senior nurse would expect her to give. And it gets worse as you 
get nearer the top. Nurses seem to be trapped in a system of rank 
and precedent which they hate but which they perpetuate; they 
dislike being cut off from other professional workers in the hospital 
community and yet they consistently maintain and fortify a moat 
between themselves and the rest of the hospital ... As a class, 
nurses seem to have little interest in politics and even less in trade 
union matters . . . They have a very real understanding of the 
purpose and value of the work of doctors ... but they seem to have 
little realisation of the importance or the difficulties of the work of 
other people in the hospital team. They may say that they 
appreciate these difficulties but in fact they regard everyone other 
than doctors and nurses as people whose work gets in the way of 
medical and nursing work.^^ 

Despite these criticisms, the article was intended 'to point the way to 

^^Ibid, p.489. 

James Elliott, 'What do you think, Nurse?', British Hospital Journal and Social Service 
Review, January 7, 1966, pp. 29-30: 29, 30. 



163 



constructive methods ... of inducing nurses to participate practically in the 
management of their own hospital.' Even those, like this author, who were 
sympathetic to nurses' lack of voice, betrayed something of the attitudes 
which contributed to the situation. The marriage rate of other workers in the 
health service was seldom alluded to. Nursing recruitment brochures, 
however, specifically advertised nurse training at this period as 'an ideal 
preparation for marriage', and a lifelong commitment to nursing was still 
sometimes referred to as an alternative to marriage. ^^ At a Royal College 
of Nursing meeting following the 1965 recommendation of the Piatt Report 
that entrants to nursing should have four 'O' levels, a speaker felt these 
should be specified, otherwise it would be 'possible for a candidate to 
present herself with drawing, needlework, domestic science and religious 
knowledge'. To loud applause, the principal nursing tutor of a London 
teaching hospital rejoindered that she 'could see nothing wrong with 
domestic science and religious knowledge as subjects for a would-be 
nurse'. '^° The established academic tradition in North American nursing at 
this period had very little counterpart in Britain. "^^ Articles written for nurses 
by other professionals often adopted a simplified or 'popular' approach. 
The piece which Irfon Roberts wrote for the Nursing Times describing the 



39 

A recruitment brochure produced by the Brompton Hospital, London, current in 1966, 
asserted 'The wonderful training that the Brompton Hospital gives you will be ideal as a 
pre-marriage course. ' quoted in: B. Watkin and K.Baynes, 'Nursing School Brochures, Part 
Two', British Hospital Journal and Social Service Review, March 1 1 1966, pp. 453-455:453. 
This referred to training 'for the Roll'. Intended to relieve more highly trained registered 
nurses of less technical duties, enrolled nurses were yet another source of controversy in 
nursing. The Royal College of Nursing worried about 'dilution' of skilled nurses. For hospital 
administrators and the MOH, enrolled nurses helped ease the nursing shortage. 

40 

'Monitor', British Hospital Journal and Social Service Review, May 28, 1965, p. 963. 

41 

The first university nursing studies unit was established at Edinburgh in 1956. Rivett, From 



Cradle to Grave, p. 104. 



164 



bed project is a case in point. It was couched entirely in question and 
answer format, and was illustrated with humourous line drawings showing 
owls perched on hospital beds."^^ And nurses' appearance continued to 
attract more comment than that of any other hospital group. "^^ 

The comments about appropriate O levels for nurses were reported 
in the British l-iospital and Social Service Journal in 1 965. On the same 
page was a report that the Royal College of Nursing had 'again expressed 
its concern and regret that there is no statutory obligation on Regional 
Boards to appoint nurses to Hospital Management Committees'. 'It might 
be wondered', continued the writer, 'what there is in nurse training which 
particularly qualifies a nurse for committee membership?'"^"^ 

Nursing representation varied. The matrons of teaching hospitals 
could expect a close working relationship with the house governor and 
HMC. Matrons of smaller hospitals, of which there might be several to one 
hospital group, 'didn't even see a copy of the HMC minutes. '"^^ Inevitably, 
senior matrons of prestigious hospitals tended to represent nursing 
interests on boards and committees. Their interests were not necessarily 
those of rank and file nurses. Unlike consultants, matrons were isolated at 
work, without colleagues of similar standing with whom to discuss issues. 
The fragmented and divided state of British nurses who, at a stroke, had all 



42 

Irfon Roberts, 'Design of Hospital Bedsteads: some questions and answers', Nursing 
Times, May 13, 1966, pp.632-634. 

43 

TIlis remains tlie case for some liistorians of tlie NHS. Rivett describes tlie situation at tlie 
outset of tlie Service: 'uniform was spotless, shoes shone, dress hems had to be level with 
the apron . . . Hair was neat, caps were worn and make-up forbidden. The result was 
stunning.' Rivett, From Cradle to Grave, p.21 . 

44 

'Monitor', Britisii Hospitai Journai and Social Service Review, May 28, 1965, p. 963. 

45 

Rivett, From Cradle to Grave, p. 109. 



165 



become employees of the State in 1948, has been described by many 
authors. The perceived problems with nursing resulted in seemingly 
endless reviews of recruitment, training, remuneration and the proper role 
for the nurse; a continuation of the situation identified in 1958 by the editor 
of the Nursing Mirror, who pointed out that there had been no fewer than 
20 reports on nursing problems in the preceding 25 years. "^^ Division, 
hierarchy, high wastage leading to rapid turnover, and the entrenched 
attitudes of other groups to a predominantly female profession, did not 
make for a powerful voice. 'We would never have dreamed of lobbying for 
something so expensive', recalled the sister in charge of the ward at Chase 
Farm Hospital where the RCA prototypes were trialled. 'Yes', replied the 
Matron, 'you got marks for staying in budget'. '^^ 



46 

Rivett, From Cradle to Grave, p. 186. 

47 

Interview, Mary Larret and Shirley Lockett, 10.5.99.