The making of ‘NHS staff’ as a worker identity, 1948–85
in Posters, protests, and prescriptions

The founding of the NHS met a mixed reception from the different groups already working in Britain’s health system. Doctors proved difficult to persuade of the new service’s merits, citing worries about earnings, medical independence, and state salaries. Nurses were by no means universally welcoming, especially when some nursing students discovered that their pay packets had been slimmed by the expansion of national insurance. The only groups to wholeheartedly welcome the NHS Act were those health worker trade unions – COHSE, NUPE, and NALGO – which mainly represented manual employees and lower-level administrators. Yet as the NHS developed as a popular institution, groups of employees increasingly identified with it, laying claim to ‘NHS staff’ as a form of identity and establishing themselves as the main defender of the service’s interests. 1976 saw the first major national demonstrations in opposition to cuts to the service, with doctors, nurses, and ancillary staff all mobilising, often in uniform and often rhetorically employing ‘NHS staff’ as an identity, to reject IMF-mandated budget reductions. This chapter uses letters to newspapers and trade union periodicals to chart the development over time of these inter-occupational connections and their attendant forms of identities. It argues that far from the NHS quickly creating stable forms of corporate identity, in fact different groups of employees created distinctive forms of belonging, status, and imagined solidarities around their connections to the service. These were contingent and unstable and changed over time, with considerable ramifications for how workers understood their labour both then and later.

In 1985 Yorkshire Television made ‘The Halifax Laundry Blues’, a news documentary about plans to shut a National Health Service (NHS) laundry.1 The Conservative government, as part of plans to reorganise the service, was looking to put laundry services out for tender, allowing private companies to pitch for contracts to perform the work. Although existing in-house services were also permitted to bid, the government’s clear preference for outside contractors often meant that success was unlikely. The workers of the Halifax Laundry, like many other NHS ancillary workers, were confronted by the imminent prospect of redundancy, as their former jobs were outsourced to a private firm.

In the documentary, the laundry workers interviewed, all women, offered several robust reasons why their laundry shouldn’t close. They cited the dedication of the workforce, the efficiency of the service provided, and the potential negative long-term effects of surrendering public assets to private profit. They spoke of their own personal circumstances, the importance of their wages to their family life, and the difficulty of finding work in Halifax in 1985. The documentary pointed out that the decision to close their laundry flew in the face even of the logic of subcontracting services, as the Halifax Laundry’s bid for the service had been cheaper than those of private competitors.

In the background to their reasoned plea to preserve the public service, the women’s testimony conveyed a strong sense of pride in the work they did. One worker describes at length the unpleasantness of her job – sorting dirty hospital laundry – before telling the film-makers, ‘I like where I work, might sound silly, after complaining about it […] I mean these poor folk can’t help being ill, somebody has to do the job and in fact, I’ve been a patient myself many a time.’ Several workers interviewed make similar comments, talking of the good they felt they were doing in providing clean laundry to the sick.

The readiness of the women to link their feelings about their work to the eventual destination of the linen they cleaned made for ready connections between their own plight and the future of the NHS as a whole. Almost every worker interviewed made strong statements about the government’s long-term designs on the NHS and the nature of privatisation. One worker – a supervisor – tells us, ‘They’ll give you a cheap price to start with, [then] when they’ve got settled in and everything, they’ll just put the prices up, they can charge what they want then.’

Another, more explicitly, worries about the government’s wider plans for cuts and privatisation: ‘The government, well Margaret Thatcher especially, I think she’s wanting everything private. She’s closing wards down, she’s getting rid of nursing staff and that, it’s patients who are going to suffer, it’s the public that’ll suffer, she says that they aren’t, but we know damn well they are.’ A co-worker, more bleakly, warns, ‘It’s time the public woke up to what’s happening, because in 2, 3 years’ time they won’t have a National Health Service.’

Some make references to the wider body of ‘NHS staff’, with one worker describing her discussions with clinical staff bewildered at the way the laundry has been treated: ‘We do know from staff from other departments, nursing staff especially, they’re very upset about it going out private, very upset indeed. We have sisters, higher ups as well, come up and say “Why on earth are they doing this to you?” And we can’t answer them.’2

The way the documentary sympathetically framed the laundry workers’ reflections on their work and the future of the service speaks to the importance of the NHS as a basis for worker identity by the 1980s. Between them, the workers and the film-makers drew heavily on the idea that working for the NHS was important, a worthwhile and praiseworthy enterprise in providing an intimate, emotive service to the patient-public,3 whose interests were ultimately best served by listening to and defending the interests of its workforce. That all concerned thought it powerful to present these kinds of arguments in defence of the work they did reflects not just the significant levels of popularity that the NHS had sustained over the four decades of its existence, but also the extent to which ‘working for the NHS’ had generated identities visible both to those working within the service and those without – a testament to the cultural impact of the service as an employer.

In this chapter I investigate the development of worker identity in the first four decades of the NHS, in an effort to trace the point at which ‘NHS staff’ emerged as a term of significant cultural resonance for workers and wider British society. The aim, broadly, is to understand the cultural impact of the NHS as a unique kind of workplace. Few employers of this size, public or private, enjoy the levels of public popularity that the NHS does. Arguably no other institution engaged in the delivery of healthcare, either in the UK or elsewhere in the world, has the same kind of cultural resonance and national popularity that the NHS and its staff do.

The unique cultural role of the service and its workers was never more pronounced than in spring 2020, when the world confronted the COVID-19 pandemic. On 26 March people around Britain, including prominent politicians, came out of their houses to clap for NHS staff. The government’s slogan for the pandemic lockdown, ‘Stay at Home, Protect the NHS, Save Lives’, looked to build on the admiration of the British public for the service. It built on a longer-standing culture of celebration that includes discounts for NHS staff in restaurants, cafes, and pubs, on T-shirts, and, notably, at the opening ceremony of the 2012 Olympic Games in London.

By looking at the cultural history of this workforce, particularly the issue of representation – the ways in which workers were represented and the ways they represented themselves – over this period, this chapter will help to explain how it was that Britain came to see ‘NHS staff’ in certain ways, and how identities and representations intersect with the social history of this unique workforce. How has working for such an organisation shaped worker identity? What does the culture of veneration around the NHS do to working lives?

That the NHS should have such an effect as a workplace in some ways is unsurprising. From its foundation in 1948 the service was one of Britain’s largest employers, employing some 410,000 people across England, Scotland, and Wales.4 Only the National Coal Board and the British Transport Commission were bigger. From 1961 the NHS was the largest employer in Britain. Its workforce continued to grow, passing one million by 1977.5 The NHS continues to be the largest single employer in Europe.

The service enjoyed widespread public popularity almost from the outset. In October 1949 patient satisfaction ratings for the NHS stood at 94 per cent, remaining high into the 1960s.6 In the twenty-first century, affirmation of the NHS translates not just into a generalised preference for public-provided healthcare, but into the service being seen as a source of ‘national pride’.

The work being done in the NHS lends itself relatively easily to public admiration. For most of the twentieth century the act of caring for the sick generated appreciation from the wider population, contributing to the two main clinical professions – doctors and nurses – having very high levels of popularity. By the mid-twentieth century doctors were widely regarded as the ‘trustworthy’ and even ‘heroic’ face of modern scientific expertise.7 Nursing was able to establish itself as the caring profession par excellence, indeed as an ‘angelic’ presence in public life, selflessly caring for the nation’s sick.8

Yet the construction of ‘NHS staff’ as a worker identity functions on an additional level. The importance of work for the NHS as an institution can be located outside the status afforded to nurses and doctors. In this respect, the cultural effects of the NHS are unique among national health systems. I know of no other systems where non-clinical support staff or even paramedical professions like physiotherapists can or could draw on the corporate-institutional identity attached to their employer in a similar way.

The changing structure of the NHS workforce

Understanding the cultural impact of the NHS on staff is complicated by the composition of the workforce. In terms of worker groups, from the outset the NHS featured an enormous range of different occupations, each with separate systems for training and accreditation. In 1957 the Ministry of Health recorded forty different categories of professional staff, as well as a further fifty-three groups of support staff. The former included groups like dark room technicians, physiotherapists, laboratory technicians, and remedial gymnasts, while the latter stretched from cleaners and porters to hairdressers and shoemakers.9 Some of these groups are larger than we might expect from the public presentation of the service. For instance, the early NHS included more building workers of various kinds than it did hospital workers.10

The class composition of the NHS’s staff was very varied, particularly for mid-century Britain. The NHS recruited large numbers of university-educated professionals as doctors, administrators, and scientists. As the ranks of professional and technical staff expanded, the service was also a key area for creating the ‘new middle class’ of post-war Britain, what Mike Savage has referred as the ‘classless technician’.11 Hospitals also relied on an army of low-status, low-paid ancillary staff, whose economic marginalisation became a problem for the state from the late 1960s onwards.12

Even the largest staff battalion, the nurses, occupied an unstable class position throughout the second half of the century. At times, the public image of nursing was resolutely middle class, as the direct professional descendants of the thoroughly bourgeois Florence Nightingale. Such ideas about nursing continued to be circulated, particularly by nurses’ largest representative professional organisation, the Royal College of Nursing (RCN).13 For most of the twentieth century, the RCN was led by the kind of women about whom such ideas made sense – those nurses trained in the most prestigious hospitals, recruited from middle-class backgrounds, who were the most likely to become matrons in general hospitals.14 Their experience often did not reflect that of the majority of nurses at mid-century, who were recruited from working-class or immigrant backgrounds and whose working lives were more likely to take them to what were usually regarded as less desirable locations.15

The structure of this workforce changed over the NHS’s first four decades. In 1949 the largest single component was the ancillary staff, who comprised 44 per cent of the service’s workforce in England and Wales.16 A total of 41.8 per cent of the NHS’s employees were nurses, of whom roughly one in seven were part-time, a category that would grow over time (see Table 1.1).

Category of staff Total employees Percentage of workforce
Doctors (full-time equivalent)   11,940   3.4
Full-time nurses and midwives 125,752 35.3
Part-time nurses and midwives   23,060   6.5
Domestic and maintenance staff 156,586 44.0
Professional and technical staff   12,486   3.5
Administrative staff   25,117   7.1
Others     1,107   0.3

The structure of the workforce changed over time as technological and clinical development required the recruitment of more professional and technical staff. The number of part-time workers also increased, particularly among nurses, reflecting the expansion of married women’s work (see Table 1.2).17

The most significant expansion was in the proportion of administrative staff as the increasingly complex NHS required more and more bureaucracy. By the end of the 1970s, administrative staff constituted some 12.3 per cent of all NHS employees.18 In general, as the NHS’s workforce expanded over the second half of the twentieth century, its class composition shifted away from the employment of unskilled and semi-skilled manual workers towards credentialed professional occupations and white-collar workers of various types.

Alongside its changing class composition, the second half of the twentieth century saw the demographic composition of the NHS transformed. From the outset, the NHS was a significant recruiter of labour from Britain’s colonies and former colonies, as well as from elsewhere in Europe. Even before the foundation of the service in 1948, Britain had looked to deal with labour shortages in its hospital system via recruitment overseas. In 1946, under the Balt Cygnet scheme, the Attlee administration authorised the recruitment of 5,000 women from Estonia, Latvia, and Lithuania, mostly to work in understaffed tuberculosis sanatoria.19 Significant numbers of women recruited for work from post-war displaced persons’ camps as part of the Westward Ho scheme were also directed towards hospital work, particularly as cleaners.20 Wartime schemes and post-war NHS recruitment continued the long-standing migration of Irish women to work in British hospitals, principally as nurses and ancillary staff. By 1971, 12 per cent of all NHS nurses were Irish-born.21

Category of staff Total employees Percentage of workforce (change from 1949)
Doctors and dentists   17,680 3.4 (−)
Full-time nurses and midwives 168,139       32.4 (−2.8%)
Part-time nurses and midwives   57,801       11.1 (+4.6%)
Domestic and maintenance staff 210,082       40.4 (−3.6%)
Professional and technical staff   24,295         4.7 (+1.2%)
Administrative staff   37,666         7.3 (+0.2%)
Others     3,736         0.7 (+0.4%)

The Caribbean was another consistent source of nursing labour for Britain, both before independence and after, with Jamaica the largest single contributor. By the end of 1965 between 3,000 and 5,000 Jamaican nurses were at work in British hospitals. In 1977, 8 per cent of all student nurses and midwives were from the Caribbean.22 South-East Asia was another key source of nurses from the 1970s onwards. The medical profession drew heavily on South Asian physicians to make good the inadequate numbers of doctors produced in British teaching hospitals, and by 1960 these accounted for 30–40 per cent of all junior doctors.23

The social history of class, race, gender, and occupation in the NHS is richer and more complex than can be fully reflected in this chapter, but is a necessary context for understanding how worker identities developed in the NHS. Although Charles Webster, the official historian of the NHS, argues that ‘the staff of the various parts of the NHS soon achieved a sense of corporate unity’,24 we can see that social divisions offered potentially very serious obstacles to the development of such consciousness. It was by no means a given that ‘NHS staff’ or ‘working for the NHS’ would ever develop coherent salience across such boundaries.

Identities at foundation

The establishment of the NHS on 5 July 1948 was one of many red-letter days for Britain’s post-war mixed economy. Between 1945 and 1951 the Labour government nationalised Britain’s railway and road transport systems, as well as its mining, gas, electricity, and steel industries. In some areas of trade union strength, nationalisation was greeted as the realisation of the promises of socialism. When ‘vesting day’ came for Britain’s mines, miners at many collieries marched to work with bands and banners, celebrating a final victory over the mine owners.25

Such a phenomenon was never likely with the NHS. The inter-war healthcare system had created a patchwork of different hospital types, each with its own specific hierarchies and fiefdoms.26 Inter-war municipal hospitals and voluntary hospitals fostered strong local identities, rooted firmly in a sense of place. For voluntary hospitals this was often connected to fundraising, which depended in part upon using staff to solicit donations from the public during ‘flag day’ events.27 Charitable fundraising contributed to quite profound local identities, ones that meant that not every hospital community welcomed the loss of local control incurred under nationalisation.28

The pre-NHS workforce had no institution in which to produce a unified positive response to nationalisation. NHS workers were represented by a variety of organisations. Some, like the British Medical Association (BMA) and RCN, were based on exclusive professional identities, while others, like the National Union of Public Employees (NUPE), stretched beyond the health services and into municipal government. Only the Confederation of Health Service Employees (COHSE), founded in 1946, was organised specifically among Britain’s healthcare workforce, and even then the union’s core audience was the male-dominated workforce of Britain’s mental hospitals, a legacy of its prior history as the National Asylum Workers’ Union.29 In any case, the inter-war health system never generated the kind of antipathies between owners and employees that might have made nationalisation a moment to savour, despite some very bitter industrial disputes immediately after the First World War.30

It was never likely that the workers of the new NHS would greet the new service with celebrations of socialism. The ceremony of ‘vesting day’ fitted more easily into traditional forms of hospital pageantry. On 5 July itself, Aneurin Bevan visited Trafford General Hospital, where he was given a tour by senior staff, spoke to patients, and gave a speech praising the establishment of the service. Photographs of his visits show him passing neatly uniformed nurses who are standing in rank in the hospital’s courtyard, as if ready for inspection by a military authority.31

Both before and after 1948, visits by dignitaries were treated in the same way, with attentive nursing staff gathering in pseudo-military formation, re-emphasising the hierarchical culture of inter-war hospitals. Other practices in this vein include hospital prizegivings, in which prominent local figures gave nurses medals for excelling at their work or in examinations. Nursing Mirror, the best-selling weekly newspaper for nurses, carried a semi-regular column with details of ceremonies from around the country, complete with photographs of the victorious nurses lined up according to the hospital hierarchy.32 Such patterns of patronage reflected the strong local identities attached to hospitals and their workforce, as well as the persistence of idiosyncratic and highly personalised forms of management into the post-NHS period.33

Most of the component parts of this healthcare hierarchy had limited enthusiasm for the new NHS in 1948. The fraught negotiations over compensation for doctors are well known.34 The most senior hospital physicians, the consultants, had no enormous enthusiasm for the service, and, in Bevan’s memorable words, their mouths eventually had to be ‘stuffed with gold’ for the service to come about. General practitioners, represented by the BMA, voted on multiple occasions against participation in the NHS, mostly in fear of becoming a state-salaried service.35 Although much hostility was eventually assuaged by the promise of private contractor status, significant numbers of doctors mounted organised opposition to ‘state medicine’ well into the late 1950s and 1960s.36

Nor did enthusiasm for the new service abound within the nursing establishment. In the lead-up to 5 July 1948 Nursing Mirror was a study in ambivalence towards the new service. The leader article on the front page of its 5 June edition was titled ‘We shall Still Need Voluntary Help’ and focused on the ‘feeling among large sections that there will be no longer a place or a welcome for the efforts of voluntary associations’. The winding down of ‘ladies’ linen leagues’ and charity sales for district nursing associations was for Nursing Mirror a ‘very sad state of affairs’ and at the absolute top of its editors’ minds upon the launch of the new health service. They did imagine that the NHS would ‘make far-reaching changes’, and ultimately they hoped ‘for the good of the patients’, but predicted that patients would feel ‘no world-shattering difference as between July 4 and July 5’.37 The other main nursing paper, Nursing Times, was slightly more enthusiastic but remained cautious: ‘Some will welcome the introduction of the service as a long awaited and worked for goal. Others will see in it a restrictive and controlling machine hampering their individual power and drive.’38

Less circumscribed enthusiasm could be found in the pages of the trade union press. In its July–August 1948 edition, Public Employees, the journal of NUPE, the main union for hospital ancillary staff, ran a message from Bevan on its front cover. The Minister for Health told NUPE members, ‘This is an Act which will really help the Mothers of Britain. Thank you for all you have done in the fight to get it through. Now let us all work to build the finest health service in the world.’39 Bevan’s missive contained an emphasis on new rights for citizens without making direct reference to those whose labour would ultimately create the service.

On the inside pages, W. L. Griffiths, the union’s Health Services Officer, contrasted hopes for the new service with reflections on the misery of the old system:

The old Poor Law; the days of Bumbledom; of narrow-minded and parochial administration, or perhaps mal-administration would be the correct term; of antiquated, dreary-looking and totally inadequate buildings giving neither rest nor comfort to patients and staff alike; of long hours of work for little pay. A vision of Drudgery.40

Griffiths went on to complain of municipal hospital governance, the growing ‘sense of despair’ at promotion hopes denied to lower-grade staff, the merely superficial improvements to hospital buildings, and the meagre improvements to pay and conditions.41

That the trade union for the ancillary workers should have been the most enthusiastic advocates of the new NHS is unsurprising. NUPE and the other main NHS union, COHSE, were Labour Party affiliates and were led by government supporters. Bryn Roberts, a former coal miner, had even attempted to win selection as the Labour candidate for Ebbw Vale in 1929, losing out to Aneurin Bevan.42 Enthusiasm for government policy would be expected.

For ancillary staff, the increased involvement of the state in medical care had already granted them national collective bargaining via Whitley councils – a system of joint councils composed of representatives for employers and employees.43 Gone was the old practice of hospital authorities separately determining wages and conditions, a system that NUPE blamed for poor conditions in the sector. The rise of the NHS represented progress on a political and industrial level for precisely this group, and it was the most unambiguously welcoming of nationalisation.

Consequently, the trade union press makes a useful case study for understanding the development of NHS staff identities. For a variety of reasons, it is here that we might first expect to see work for the service wielded as a rallying cry for staff. Not only were these organisations positively predisposed towards the service from the outset, but their members were dominated by the largest occupational group (ancillary staff) for whom public recognition and personal status were not inherent. Neither nurses nor doctors required a reorganisation of health services to be viewed by the public as making a worthwhile contribution to society. Yet the work of cleaners, laundry workers, maintenance workers, porters, and cooks was largely invisible to wider British society.

‘All National Health Service Staffs’

By the 1950s Public Employees acted as an active propagator of NHS staff unity in both rhetoric and in illustration. In that period, the journal ran attractive cover illustrations in red, white, and black, often depicting the NHS membership to which it aspired rather than what the union actually recruited. The illustration on the journal’s back cover in July–August 1954 lists several areas the union was strong in – cleaners, laundry workers, kitchen staff, porters, and ambulance drivers – alongside two in which it was not in the 1950s, nurses and clerks. The latter were more likely to join the more white-collar National Association of Local Government Officers (NALGO), while the former, especially in general hospitals, were most likely to join the RCN. The union declared itself to be catering for ‘all National Health Service Staffs’.

It had taken a little time to get there. The January–February 1949 edition had made a similar plea to workers in the NHS, but its recruitment advertising preferred to conceive of potential recruits as ‘Nurses, technicians, administrative staffs, ancillary employees and all others engaged in the National Health Service’.44 A subtle shift in language occurred over the initial years of the service’s operation, in which separate occupations came to be listed, optimistically, as subsets of one staff group, rather than as distinct entities that happened to work for the same employer.

Early 1950s designs for the same journal played around with these themes, in ways that aimed to persuade particular groups of workers where their ‘true interests’ lay. In another full cover recruitment advertisement, the journal tried to persuade reluctant nurses to join the union under the title ‘Come Along Mary!’ Reflecting the union’s relative lack of success in recruiting nurses, this recruitment cartoon aimed to remind potential recruits that their pay and conditions, as much as those of all other NHS staff, were determined by collective bargaining.45 The rather patronising line stating that pay rises went towards nurses’ makeup may hint at why the male national officials of NUPE struggled to recruit professional women.

NUPE’s recruitment in this period reflected the significant degree of instability and unevenness in worker identities. ‘Health Service staffs’ emerged hesitantly as an identity for a diverse collective of different jobs united by their common employer but was just as often sidelined in favour of direct appeals to specific occupations. There was a consistent recognition that nurses, while potentially a group that might be won to trade unionism, did not automatically identify themselves as having a common interest with other staff groups.46

NUPE officials frequently articulated concerns that nurses saw themselves as fundamentally separate from other categories of NHS workers. Bryn Williams, General Secretary of NUPE, complained in 1954:

We still meet, all too frequently, the nurse who declares that she ‘has no time for trade unions,’ or very condescendingly declines our invitation to become a NUPE member by saying that ‘unions are all right for other people but not for the nurses!’ That there is prejudice amongst nurses against trade unions it would be idle to deny.47

Such concerns may partly reflect trade unions’ more general difficulties in recruiting workers who were perceived to be more middle class or white-collar before the 1970s. Yet Williams perceived no such issues with administrative staff, who, he claimed, ‘join up without caring a cuss what anybody thinks about it’.48 A 1950 study by Liverpool University on health staff supports Williams’s assumptions. Just 6 per cent of staff nurses were union members, as against 66 per cent of administrative staff and 66 per cent of ancillaries.49

Union recruiting strategies in the early NHS reflected a degree of difficulty in persuading workers of different occupations that their interests lay together. They switched in some instances from invoking the shared interests of everyone working in the service to making specific appeals to the very separate sense of identity and self-interest that union organisers perceived as more typical among nursing staff. NHS worker identities developed slowly over time rather than arriving fully formed on vesting day. Occupational groups with the strongest, most separate idea of their occupation’s place in the world and those whose occupational identity offered some degree of status with the wider public were the least enthusiastic about rallying around ‘the NHS’ as defining their working lives.

Administrators

The ideas that circulated among NHS administrative staff during the late 1950s make for an interesting comparator for the connections between nursing and NHS-based worker identities. Both were, broadly speaking, middle-class professions in status terms but potentially drew on recruits from a variety of class backgrounds, particularly as the expanding welfare state required administrative personnel in ever greater numbers. In contrast to nurses, however, clerks and secretaries joined conventional trade unions at rates even higher than NHS manual workers. All three unions looked to recruit these office workers, with NALGO having the most success.

NALGO had a rather conservative self-image. After being founded in the late nineteenth century by Herbert Blain (later national agent for the Conservative Party) mainly as a ‘staff association’ for municipal clerks, it remained consistently cautious over industrial militancy and declined to affiliate to the Trades Union Congress until 1964.50 As it expanded in the post-war period it retained a strong sense of its members as respectably middle class. It is perhaps the only mass-member trade union whose journal depicted its members in top hats, tails, and pin-striped trousers, as Local Government Service did in 1948.51

Surprisingly, it was NALGO which was responsible for the first national industrial action in the history of the NHS, a ‘go-slow’ of all administrative staff in 1957 in pursuit of a pay rise. NALGO comprised the majority of delegates on the employees’ side of the administrative clerks’ Whitley council and in December 1957 negotiated a 3 per cent pay rise. When this was vetoed by the government, NALGO organised an overtime ban and instructed its members to impose a ‘go-slow’, whereby its members would painstakingly scrutinise every statistical return to the ministry. One delegate to the union’s special delegate conference, A. J. Eagles of St Helier, Surrey, dubbed this practice an outbreak of ‘meticulosis’.52

The dispute was revealing of the ways in which health service staff imagined themselves. The December 1957 leader article in Public Service (the union’s re-branded journal) draws simultaneously on a sense of health service administrators as respectable, responsible, and middle class, and on the wider support of the NHS’s large workforce. In one instance, the clerks are a mere ‘handful of blackcoats’ who are ‘notorious for their reasonableness’ and represented by ‘NALGO, that most pacific of unions’.53 In another, they find themselves at the centre of an uprising by ‘the entire half-million staff of the health service’ and supported by ‘most other blackcoated workers’.54

At a special meeting held at St Pancras Town Hall, delegates from the union’s health branches were quick to point out how bad things were in the NHS. As F.W. Styles, of Woolwich Hospital Group, put it:

There is not one section of the community that has suffered as the health service has suffered. It is an utter disgrace that men who have loyally given their service from the days of the old voluntary hospitals and the local authority hospitals should be penalised as so many of them are today. Their salaries are a disgrace in relation to those in comparable jobs.55

The union’s journal offers contradictory evidence of the strength of NHS staff identities, reflecting their gradual formation. White-collar respectability and dedication to the pre-NHS hospital system remained important touchstones for the men and women now working for Regional Health Boards and Hospital Management Committees.56 Yet we do begin to see hints at the growing importance of the health service in their self-image. The injustice of poor pay for health service staff, despite dedication to that most vulnerable category of the public – patients – clearly already had power and would increasingly form an important aspect of NHS staff consciousness.

The low-pay 1960s

The clerks’ complaints of the late 1950s were the forerunners of what became a consistent refrain for health service staff. By the end of the 1970s almost every category of NHS staff had been involved in protests over inadequate pay and difficult working conditions. Like the clerks, they often referenced the health service as a particularly stingy and exacting employer, extolling their own virtues as employees central to the compassionate care of the sick. However, the extent to which different groups either invoked the solidarity of the wider body of NHS staff or linked their conditions to the quality of the service overall varied quite considerably.

Hospital doctors and general practitioners were, generally speaking, the least keen to make loyalty to the NHS central to pleas for better treatment. As a relatively small staff group with high social status and extremely marketable skills, doctors and their representatives seldom made NHS staff status central to their public image. Indeed, on several occasions during the 1960s and 1970s, protesting doctors felt it was more in their interest to emphasise how tenuous their relationship to the service was.57 Representatives from the BMA often reminded interviewers that doctors were in great demand across the world and that the NHS needed to compete with health services in the USA, Canada, and Australia. These were realistic threats with UK-trained doctors during this period proving a highly mobile workforce.58

The public image of nurses remained fairly consistent from the immediate post-war period onwards. Nurses remained upstanding citizens in the new welfare state as overworked providers of compassionate care for the sick. Coverage of the RCN-led 1962 campaign for better pay tended to emphasise the long hours, drudgery, and poor pay that confronted nurses, even when the more combative COHSE and NUPE began to talk of strike action.59

However, some changes which took place indicate that many nurses may have come to understand their place in the world rather differently from how they had in the 1940s. Towards the end of the 1960s, more nurses, particularly the students and unqualified auxiliaries who faced the worst pay and highest proportion of repetitive manual labour, began to find conventional trade unions more attractive.60 Even those who remained with the RCN began to expect the organisation to behave more like a union, pushing it to act more aggressively to defend their interests in collective bargaining.61

This may have reflected a general decline in deference within the profession. The pseudo-military discipline that had characterised nursing training during the first half of the twentieth century became less intense by the 1960s, as rules controlling how nurses could behave off-duty relaxed. Although some nursing schools did still operate strict curfew systems and other forms of petty discipline, by the 1960s these were less common and student nurses were permitted more conventional private lives.

The nature of nursing hierarchy was changing, particularly with the advent of the 1967 Salmon Report. This inquiry re-designed the structure of nursing management in order to improve the status of senior nurses within the hospital hierarchy.62 This involved shifting from an authority structure that was highly personalised and idiosyncratic, built around the all-powerful figure of the matron, towards a more impersonal system of ‘nurse managers’. The new system also came with increased pay for senior nurses, further widening the gap between the bulk of nurses who were involved in clinical care and the minority of nurse managers.

The 1962 campaign for improved pay reflected the early stages of these themes. Although the RCN remained the majority force among general nurses, both COHSE and NUPE had made modest progress in recruiting from this category of workers by 1962. Their more militant campaigns accompanied the RCN’s robust lobbying effort. The May–June edition of Health Services, the official organ of COHSE, featured a photograph of a mass demonstration of general nurses in uniform on its front cover, above the slogan ‘PAY NOT PENANCE’. A nurse in chains led the protest with a placard declaring her an employee of ‘Paddington concentration camp’.63

The union’s General Secretary, Jack Jepson, noted with satisfaction that many of the young nurses at a 19 May 1962 demonstration near Southampton were new to such protests, ‘taking part in such a demonstration for the first time, some of them against the wishes of their matron’, but bemoaned how the great majority remained aloof.64 He attributed this to the ‘false snobbery’ that was ‘drilled into them from the first day of joining the service’. Jepson saw this changing as the ‘out-of-date ideologies’ of the matrons fell from favour. ‘The nurse today’, he declared, ‘is no Florence Nightingale with private means to live upon. She or he comes from middle-class or working-class homes where education for service entails real sacrifice.’65 The union claimed to have enrolled some 7,000 new nurses during the 1962 pay campaign, a large proportion of them women general nurses rather than the male psychiatric nurses who had traditionally joined.66

The journal made mention of the nurses’ work specifically for the NHS, but slogans still tended to emphasise occupation over employer. In Trafalgar Square, marchers’ placards declared ‘The lamp is dim’ and ‘Angels are needled’, in Manchester banners warned of ‘Angels with empty purses’, and in Newcastle they declared that ‘Florence Nightingales want “lolly” not the lamp’.67 Special sympathy for their work for a beloved public institution was not sought, and affection for the NHS did not appear to form part of the image that the union or its nursing members were trying to project.

1970s industrial conflict

The first twenty-four years of the NHS were relatively peaceful in terms of industrial conflict. There were no national strikes at all between 1948 and 1972, and local action was sporadic. For the health policy expert Nick Bosanquet, this tranquillity reflected ‘the old colonial system of industrial relations’, a pattern of management where NHS workplaces were dominated by idiosyncratic senior managers who ruled paternalistically over their own small fiefdoms. In many respects these patterns in workplace life echoed the pre-NHS world of the voluntary hospitals, where hospital secretaries, senior consultants, and matrons had more direct responsibility for their workforces.

These patterns of authority remained relatively stable until the beginning of the 1970s. Although trade unionism had always had a significant presence in the health service, in the 1950s and 1960s COHSE, NUPE, and NALGO had largely practised unobtrusive forms of workplace activism. Union branches were often moribund, more accustomed to using branch officials to conduct individualised case work than to treating them as a means of advancing collective claims or taking industrial action. This began to change as inflation eroded the value of public-sector pay and as paternalistic management regimes gave way to more bureaucratic forms in the wake of the government reforms of the 1960s.68

With the introduction of workplace representatives (‘shop stewards’) in the NHS from 1969, union activism intensified and became more combative. This was reflected in a modest uptick in strikes and other forms of industrial action, with the ancillary strikes of 1972–73 and strikes by various paramedical staff groups (including radiographers, physiotherapists, and laboratory technicians), nurses, and doctors during 1975–76. The year 1976 also saw NHS staff demonstrate in opposition to cuts to state expenditure imposed by the International Monetary Fund and continue their ongoing campaign (begun in 1974) opposing private practice using NHS facilities.69 NHS workers were also a significant component of the 1978–79 ‘Winter of Discontent’ strike wave.70 Conflict continued during the Thatcher governments of the 1980s, with a national strike in 1982 and ongoing conflict over outsourcing and grading throughout that decade.71

When, amid all this conflict, did a strong cross-occupational identity for NHS staff emerge, either in published trade union material or in grassroots campaigning? Photographs of the 14 December 1972 demonstration in support of the national ancillary staff strike mostly feature women carrying placards exhorting the government to improve conditions for ‘hospital workers’, declaring COHSE ‘the main union for the health service’, and calling on the service to ‘stop the exploitation of our dedication’.72 Public Employees described its own members in the dispute as ‘Hospital staff’, and their members’ placards (probably printed by the union) were more explicit in linking their own conditions to the condition of the service via clever word play: ‘Heath is knocking the L out of the Health Service’.73

Ancillary staff particularly felt the need to make the case that the work they did was important to the NHS and to the nation. The COHSE National Officer Terry Mallinson’s report on the dispute in May 1973 clearly expressed this anxiety:

The ancillary staffs have made other grades of staff in the Health Service, and the management in particular, fully aware of the important role which they play in the functioning and running of the Health Service. They have also made the Management Side aware that they are no longer prepared to put up with the position of being treated as second class citizens within the Health Service. They have proved that they are a vital part of the team and in future must be treated as such.74

Mallinson’s description of the dispute hints at the class-inflected ways in which ancillary staff might use their corporate identity to build appreciation for their work and sympathy for their cause. Their importance to the work of this popular institution was mobilised as an argument against their exploitation and ultimately against their subordinate position within the service.

Shortly after the 1972–73 strike, the letters page of Public Employees reflected various aspects of NUPE members’ attitudes towards the health service. Some, like W. Edmondson, an NHS worker from Stoke-on-Trent, placed themselves as defenders of the service and its purpose. He wrote to the periodical to warn his fellow members of the dangers the service faced, principally privatisation and underfunding: ‘I am sure that members of this Union, who have served for many years in the Health Service, would not care to return to the days of the voluntary hospitals.’75

Yet, in truth, solid affirmations of staff unity were more common in this period in the editorial content of these publications than on the letters page, which was more likely to reflect gripes about bonus schemes or union policy. Sometimes, affirmations about the value of groups of NHS staff were attached to a more uniform NHS staff identity, but it remained uneven and in the process of being formed, rather than fixed and hegemonic. One letter reacting to the 1974 nurses’ dispute by Ron Pearson, an NHS worker from Portsmouth, was of this type. Pearson agreed that nurses deserved their pay rise but noted that ‘the nurses are not the health service on their own. What about the plight of other workers? The radiographers, the physios, the ancillary workers etc [...] One group is as important in the health service as another, for they all have to rely on each other.’76 Pearson’s cross-service solidarity was of a levelling sort that demanded attention for groups which commanded less public attention. Pay disputes could bring out complex feelings across different staff groups.

Private practice

Discussions over the use of NHS facilities and staff for ‘private practice’ during the second half of the 1970s had the potential to mobilise NHS employees across occupational lines and in defence of an ideological conception of the service. Throughout the NHS’s existence, doctors had engaged in private practice alongside their work for the state. By 1974 much of this took place within NHS hospitals, often with the assistance of NHS nursing and ancillary staff.77 With the advent of a Labour government in 1974, the unions saw an opportunity to successfully abolish this practice (in line with Labour Party policy), putting an end to ‘pay beds’ within NHS hospitals and to the additional, often unremunerated, work they caused for non-medical staff.

In doing so they found themselves in direct confrontation with the BMA, which defended its members’ rights to private practice within NHS hospitals. For many members of NUPE and COHSE, the existence of private beds, in addition to generating extra work, contravened a fundamental ideological principle of the NHS – that no one could pay for better or quick treatment. Members of NUPE’s Clwyd Health Services no. 1 branch decided to make this point at Denbigh carnival with their float depicting a hospital ward staffed by NUPE members, bearing the slogan ‘This is a National Health Service bed – No Smoked Salmon’.78

Hospital staff in multiple locations took direct action against the use of pay beds, usually in the form of withholding services to private patients.79 Yet there remains a sense that opposition to pay beds was, ideologically at least, primarily a concern of the union’s full-time officers and taken up on an ad hoc basis by working union members. Between 1974 and 1976 both NUPE and COHSE lobbied the government hard to finally fulfil its promise to separate pay beds from NHS hospitals. However, the letters pages of both Health Services and Public Employee featured no letters relating to the issue or the campaign.80 They remained the usual mixture of abstract political debate and general complaints about pay and conditions.

Although the pay beds fight did not necessarily represent a generalised insurgency in ideological defence of state medicine, it did reflect a growing tendency for union officers and members to mobilise ideas of ‘saving the NHS’ in their industrial and political disputes. As Bernard Dix, NUPE’s Assistant General Secretary, put it in 1976:

[Private practice in NHS hospital] has distorted the social purpose of the NHS and encouraged those people who want to keep health in the marketplace, where treatment is available on the ability to pay instead of on the basis of medical need. There is no room for such a philosophy in modern Britain.81

‘The social purpose of the NHS’ came to serve as the basis for a multitude of different political and industrial campaigns. For instance, after the establishment of the Resources Allocation Working Party (RAWP) in 1974, rhetoric concerning ‘defending the NHS’ and ‘defending services’ formed an important part of campaigns to keep hospitals open. RAWP aimed to equalise access to health services across Britain, partly by shifting funding from richer regions to poorer ones. Over the second half of the 1970s, hospitals and services began to be recommended for closure, with London particularly affected.82

In its campaigns against these closures, NUPE spoke of ‘saving NHS beds’.83 Similar rhetoric accompanied a variety of anti-closure protests and hospital ‘work-ins’, including those at Queen Elizabeth Hospital in Bethnal Green and the Royal Free Hospital in North London.84 Articles about these events were often accompanied by pictures of protesting staff, usually women and often women of colour, from across a variety of NHS occupations, ‘fighting’ for the NHS.85

Similar rhetoric can be found in union coverage of the protests that followed in the wake of Britain accepting a conditional loan from the International Monetary Fund in September 1976 in order to stabilise the value of the pound. The loan was predicated on significant savings from the government’s budget, much of it concentrated on spending caps for the local authorities and the NHS.86

Public-sector staff, particularly NHS workers, responded with mass demonstrations repudiating the cuts. The largest demonstration was on 17 November 1976 and reproduced many themes which reflected emerging NHS staff identities. NHS laboratory workers, marching with the Association of Scientific, Technical and Managerial Staffs Union (ASTMS), brought placards bearing the slogan ‘Fight the cuts, save the NHS’.87 NHS staff marching with COHSE were given blank signs on which to write their own slogans, and themes reflecting staff investment in the service were prominent. Signs shown in Health Services bore messages like ‘National health not national sickness’, ‘think again Denis [Healey, the Chancellor of the Exchequer] no NHS axe’, and ‘Stop cuts, save NHS’.88

COHSE’s reporting on the day was keen to put forward staff voices, particularly those which linked staff working conditions to the state of the service overall. Andrew Gill, COHSE’s branch secretary at Hellingly Hospital in Sussex, noted, ‘There would have been far more of us here, but how can you pull more staff off already grossly understaffed wards? It is extremely important that thousands of those who are here are workers on the receiving end of the cuts – the consumers of the public services.’ Norman Strongman, a psychiatric nurse from West Cheshire Hospital, sought to emphasise the ‘apolitical’ nature of support for the NHS: ‘COHSE is doing a good job against the cuts. I am a Conservative supporter, but I don’t honestly know what a Tory government would do about the NHS. Quite a few people here are Conservatives.’89

In the 1976 protests, staff and their trade unions affirmed that action in defence of staff rights, jobs, and funding could be considered a proxy for defending the service as a whole and for the patient experience. The initialisation – ‘the NHS’ – also seems to have replaced ‘the Health Service’ as the preferred descriptor for their employers, perhaps reflecting a popular iconic status that set the NHS apart from other elements of the UK welfare state. ‘The NHS’ became a signifier in its own right, beyond being simply the health arm of the government.

Much of this coalesced around the idea of the service as a cherished entity, threatened by privatisation and cuts, that needed defending, even saving, primarily by the actions of a workforce. The latter’s identity was increasingly cross-occupational and tightly linked to the employer: ‘NHS staff’ opposed cuts, stopped closures, and demanded better treatment. As outsourcing and privatisation advanced during the 1980s, workers like those in the Halifax Laundry would mobilise implicitly around these concepts.

NHS staff

The cultural resonance that the NHS would come to have in British life was not present in 1948. The foundation of the service was attended by scepticism from organisations representing doctors and nurses. Only the trade unions representing more marginalised groups of staff – ancillary workers, student nurses, psychiatric hospital staff, administrative clerks – generated genuine enthusiasm for the new NHS, and even then they focused largely on the benefits for the patient-public more than on what staff might expect from the new service.

Far from instantly creating a new unified workforce, the new NHS transposed older hierarchies and divisions from the voluntary and municipal hospitals into the new service. Authority still pooled around the same senior doctors and around the great and the good who had long been the mainstay of hospital administrations under the inter-war mixed economy health system.

For most staff, occupation formed the mainstay of their worker identity. It was only where the service became a site of workplace conflict, particularly when that conflict involved low-status groups, that ‘NHS staff’ emerged as a more coherent identity. When groups like administrators (in 1957) and ancillary staff (in 1972–73) came to make demands on employers and had no wider sympathetic occupational image to draw on, their representatives tried to draw on the NHS’s popular wider public image to make their case. The idea of ‘NHS staff’ as a category of person whose work benefited the public and whose interests were connected to the state of the service became an entrenched feature of the self-representation of the service’s employees from the second half of the 1970s.

The use of extensive industrial action for workers in a health service setting was limited for obvious reasons. Inflicting extensive suffering on the sick through collective action is something that few health workers have been prepared to contemplate. Even during the 1970s peak of industrial conflict in the NHS, strike levels remained low relative to those of most workplaces. Consequently, public sympathy has been especially crucial for health service staff, and perhaps even the only tool at their disposal for improving their difficult working conditions. The use of the NHS’s popularity to leverage support is wholly understandable from that perspective, particularly for working-class employees with few other claims to public favour. The cultural status of the NHS as the iconic heart of the welfare state could, at moments, be claimed by its workers.

Notes

1 ‘The Halifax Laundry Blues’ (Yorkshire Television, 1985), https://player.bfi.org.uk/free/film/watch-the-halifax-laundry-blues-1985-online (accessed 3 April 2020).
2 Ibid.
4 Report of the Ministry of Health for the Year Ended 31st December, 1952 (London: HMSO, 1953), pp. 129–30.
5 Alec Merrison, Royal Commission on the National Health Service: Report (London: HMSO, 1979), p. 178.
7 Anne Karpf, Doctoring the Media: The Reporting of Health and Medicine (London: Routledge, 1988); Ross McKibbin, ‘Politics and the Medical Hero: A. J. Cronin’s “The Citadel”’, English Historical Review, vol. 123, no. 502 (2008), pp. 651–77; Joseph McAleer, ‘Love, Romance, and the National Health Service’, in Clare V. J. Griffiths, James J. Nott, and William Whyte (eds), Classes, Cultures and Politics: Essays on British History for Ross McKibbin (Oxford: Oxford University Press, 2008), pp. 173–91.
8 Barbara Mortimer, ‘Introduction’, in Barbara Mortimer and Susan McGann (eds), New Directions in the History of Nursing: International Perspectives (Abingdon: Routledge, 2005), pp. 1–21; Robert Dingwall, Anne Marie Rafferty, and Charles Webster, An Introduction to the Social History of Nursing (London: Routledge, 2015), pp. 48–76.
9 Report of the Ministry of Health for the Year Ended 31st December, 1957 (London: HMSO, 1958), pp. 167–78.
10 Ibid., pp. 167, 177.
11 Michael Savage, Identities and Social Change in Britain since 1940: The Politics of Method (Oxford: Oxford University Press, 2010), pp. 215–36.
12 National Board for Prices and Incomes Report No. 29: The Pay and Conditions of Manual Workers in Local Authorities, the National Health Service, Gas and Water Supply (London: HMSO, 1967); National Board for Prices and Incomes Report No. 166:The Pay and Conditions of Ancillary Workers in the National Health Service (London: HMSO, April 1971).
15 On social divisions within the early RCN and their ongoing importance for the organisation’s development, see McGann, Crowther, and Dougall, A Voice for Nurses, pp. 19–37.
16 Report of the Ministry of Health for the Year Ended 31st December, 1952, pp. 138–40.
17 Helen McCarthy, ‘Social Science and Married Women’s Employment in Post-War Britain’, Past & Present, vol. 233, no. 1 (2016), pp. 269–305, at 271–4, 287.
18 Merrison, Royal Commission on the National Health Service, p. 178.
19 Linda McDowell, ‘Narratives of Family, Community and Waged Work: Latvian European Volunteer Worker Women in Post-War Britain’, Women’s History Review, vol. 13, no. 1 (2004), p. 25.
20 Ibid.; Linda McDowell, ‘Workers, Migrants, Aliens or Citizens? State Constructions and Discourses of Identity among Post-War European Labour Migrants in Britain’, Political Geography, vol. 22, no. 8 (2003), pp. 863–6. The Westward Ho scheme recruited a further 13,000 women from Central and Eastern European refugee camps between 1946 and 1949.
22 Emma J. Jones and Stephanie J. Snow, Against the Odds: Black and Minority Ethnic Clinicians and Manchester, 1948 to 2009 (Manchester: Manchester NHS Primary Care Trust and University of Manchester, 2010), p. 10.
23 Ibid., p. 11.
24 Charles Webster, The National Health Service: A Political History (Oxford: Oxford University Press, 2002), p. 29.
25 Julia Mitchell, ‘“Farewell to ’Cotia”: The English Folk Revival, the Pit Elegy, and the Nationalization of British Coal, 1947–70’, Twentieth Century British History, vol. 25, no. 4 (2014), pp. 592–3.
26 Martin Gorsky, Mutualism and Health Care: Hospital Contributory Schemes in Twentieth-Century Britain (Manchester: Manchester Manchester University Press, 2006); George Gosling, Payment and Philanthropy in British Healthcare, 1918–48 (Manchester: Manchester University Press, 2017).
29 Carpenter, Working for Health.
30 Barbara Douglas, ‘Discourses of Dispute: Narratives of Asylum Nurses and Attendants, 1910–22’, in Anne Borsay and Pamela Dale (eds), Mental Health Nursing: The Working Lives of Paid Carers in the Nineteenth and Twentieth Century (Manchester: Manchester University Press, 2015), pp. 98–122.
31 ‘Mr. Bevan Defends Security for the Individual’, Manchester Guardian, 6 July 1948, p. 6; Nursing Mirror, 17 July 1948, p. 1.
32 ‘Hospital Prizegivings’, Nursing Mirror, 11 December 1948, p. 168.
33 Nick Bosanquet, ‘The Search for a System’, in Nick Bosanquet (ed.), Industrial Relations in the NHS: The Search for a System (London: King Edward’s Hospital Fund for London, 1979), p. 1.
34 Peter Hennessy, Never Again: Britain 1945–1951 (London: Penguin, 2006), pp. 135–44.
36 Seaton, ‘Against the “Sacred Cow”’.
37 ‘We shall Still Need Voluntary Help’, Nursing Mirror, 5 June 1948, p. 1.
38 ‘Our Health Service’, Nursing Times, 3 July 1948, p. 1.
39 ‘A Message from the Rt. Hon. Aneurin Bevan’, Public Employees Journal, July–August 1948, p. 1.
40 W. L. Griffiths, ‘The Hospital Services – the Future and the Past’, Public Employees Journal, July–August 1948, p. 2.
41 Ibid.
42 Stephen Williams and R. H. Fryer, Leadership and Democracy: History of the National Union of Public Employees (London: Lawrence and Wishart, 2011), p. 44.
43 Roger Seifert, Industrial Relations in the NHS (London: Chapman & Hall, 1992), p. 28.
44 Public Employees Journal, January–February 1949, p. 15.
45 ‘Come Along Mary!’, Public Employees Journal, November–December 1951, p. 15.
46 For a discussion of the longer history of nursing and trade unionism, see Christopher Hart, Behind the Mask: Nurses, their Unions and Nursing Policy (London: Balliere Tindall, 1994), pp. 31–95.
47 Bryn Williams, ‘The Nurses and Trade Unionism’, Public Employees, February 1953, p. 3.
48 Ibid.
49 S.J. Barton, ‘A Call to Action’, Public Employees, August 1950, p. 14.
50 Alec Spoor, White-Collar Union: Sixty Years of NALGO (London: Heinemann, 1967).
51 ‘A Whitley Scrapbook’, Local Government Service, February 1948, p. 118.
52 ‘NALGO’s Fight for Pair Play for Health Staffs’, Public Service, December 1957, pp. 362–3.
53 ‘Stand Firm’, Public Service, December 1957, p. 357.
54 Ibid.
55 ‘NALGO’s Fight for Pair Play for Health Staffs’.
56 Ibid.
57 ‘Sister’s £9,000 Job Spurs Mr Sakalo’, The Times, 19 November 1975, p. 4.
58 David Wright, Sasha Mullally, and Mary Cordukes, ‘“Worse than being married”: The Exodus of British Doctors from the National Health Service to Canada, c. 1955–75’, Journal of the History of Medicine and Allied Sciences, vol. 65, no. 3 (2010), pp. 546–75.
59 Olga Franklin, ‘I Say No One Must Exploit these Nurses Any Longer’, Daily Mail, 28 March 1962, p. 7.
60 Hart, Behind the Mask, pp. 79–80.
61 McGann, Crowther, and Dougall, A Voice for Nurses, pp. 242–51.
62 Hart, Behind the Mask, pp. 106–7.
63 Health Services Journal, June 1962, front cover.
64 W.J. Jepson, ‘Notes and Comments’, Health Services Journal, June 1962, pp. 1–2.
65 Ibid.
66 Ibid.
67 ‘Nurses’ Pay: Only Trades Unionism Can Win’, Health Services Journal, June 1962, pp. 5–7.
68 Bosanquet, ‘The Search for a System’.
69 Williams and Fryer, Leadership and Democracy, pp. 249–57, 264–8.
70 Tara Martin Lopez, The Winter of Discontent: Myth, Memory, and History (Liverpool: Liverpool University Press, 2014), pp. 153–76.
71 Williams and Fryer, Leadership and Democracy, pp. 377–411.
72 ‘150,000 Support National Demonstration’, Health Services, January 1973, p. 10.
73 ‘The Elephant was London Target’, Public Employees, 1973, p. 5; ‘Hospital Staff Fight Freeze’, Public Employees, 1973, p. 1.
74 Terry Mallinson, ‘ASC Report’, Health Services, May 1973, p. 76.
75 ‘Dear Editor’, Public Employees, 1973, pp. 6–7.
76 ‘Dear Editor’, Public Employees, 1974, p. 6.
78 ‘Consultants Must Stand Up & be Counted’, Public Employees, 1974, p. 3.
79 Williams and Fryer, Leadership and Democracy, pp. 249–57.
80 See all editions of Public Employees, 1974–77; Health Services, 1974–77.
81 ‘Pay Beds Got to Go’, Public Employees, 1976, pp. 4–5.
82 On the regional dynamics of RAWP see Martin Gorsky and Gareth Millward, ‘Resource Allocation for Equity in the British National Health Service, 1948–89: An Advocacy Coalition Analysis of the RAWP’, Journal of Health Politics, Policy and Law, vol. 43, no. 1 (2018), pp. 69–108. On local opposition to hospital closures, see Jennifer Crane, ‘“Save Our NHS”: Activism, Information-Based Expertise and the “New Times” of the 1980s’, Contemporary British History, vol. 33, no. 1 (2019), pp. 54–7.
83 ‘Union Saves NHS Beds at Westminster’, Public Employees, 1975, p. 4.
84 ‘Hospital Staffs Defend Services’, Public Employees, 1975, p. 3.
86 Mark D. Harmon, The British Labour Government and the 1976 IMF Crisis, Houndmills, Basingstoke, and New York: Macmillan Press, 1997), p. 219.
87 ‘17 November – a Day to Remember’, Public Employees, 1976, pp. 1–6. This is the first use of the ‘Save the NHS’ slogan that I have encountered.
88 ‘United against the Cuts’, Health Services, December 1976, p. 5.
89 Ibid.

Posters, protests, and prescriptions

Cultural histories of the National Health Service in Britain

Editors: Jennifer Crane and Jane Hand

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