Splendid Scope for Public Service: Leading the London County Council Nursing Service, 1929–1948

Abstract

In its landmark 2000 National Health Service (NHS) Plan, the government of Prime Minister Tony Blair acknowledged that the success of its agenda for reform and modernization of the NHS depended on the involvement of the staff.1 Thirty-five thousand extra nurses, midwives, and health visitors were calculated to be necessary, proving that nurses are regarded as a resource vital to a Healthcare system. These cover all grades, from newly qualified staff nurses to senior posts such as modern matrons and nurse consultants. These nurses, like all health professionals in the New Labour NHS, are required to be modern and flexible with no rigid professional boundaries. Targeting nurses as agents of a policy agenda could be viewed as highly desirable for nurses. However, it could be asked just how flexible these nurses can be and how they will balance tensions between professional values and political expediency. The successful implementation of policies depends on an adequate labor force. Will the development of a nursing career structure with senior posts aid recruitment and retention of nurses? Politicians and health professionals are tackling a problem diat has exercised both groups over the past hundred years. Revisiting an episode in nursing's past provides opportunities to develop an awareness of the social and political forces that have shaped nursing in certain ways.2 This paper revisits the years 1929 to 1948. The dates are connected to two pieces of legislation. The Local Government Act, passed in 1929, was permissive legislation that gave local authorities power to provide health services and enabled the London County Council (LCC) to create a municipal hospital nursing service. The National Health Service Act was passed in 1946; its vesting day, 5 July 1948, was the date when control of hospitals and nursing staff passed to newly constituted management boards. The paper examines the efforts of the LCC to improve recruitment to its hospitals. It evaluates the creation of a nursing service with a hierarchy that would provide a career pathway. The experiences of the two holders of the matron-in-chief post during this period are discussed in relation to the continuing dilemma of satisfying professional and political demands. During the period under discussion, nursing and nurses were the subject of investigation from a variety of official and professional groups. The LCC as a public and political body generated many documents to record its activities. These give the views of politicians and senior nurses; to shed light on the lived experience of junior staff, oral evidence has been used. Oral evidence is particularly suited to accessing hidden worlds like that of the student nurse in the total institution of the interwar years.3 Interviewing survivors, however, means that there cannot be absolute certainty that a representative sample is selected. Strategic sampling as recommended by Thompson and Perks can to some extent overcome this.4 Oral testimony in diis paper is taken from nurses who were employed at several individual LCC hospitals and two voluntary hospitals at intervals during the interwar years.5 Their age range allowed a sample to be generated across various grades, although during the years of LCC hospital service, the majority were working as student and staff nurses, rarely as sisters. The use of an interview schedule served to enhance the reliability of the evidence. The Significance of the LCC as a Health Service Provider During the period 1929-1948, the size and scope of LCC activities made it arguably the largest hospital authority in the world, rivaling the entire voluntary sector of England and Wales.6 The LCC was established in 1889 as a result of the 1888 Local Government Act. It was directly elected, albeit by the restricted franchise of the time, the first public body apart from the London School Board to be so constituted. The LCC had responsibilities in matters such as drainage, fire prevention, slum clearance, improvement of streets, and maintenance of the Thames bridges, parks, and open spaces. …