Bevan’s speech to the Royal College of Nursing 21 June 1946

“When I had your invitation to come to address you this evening,” Mr. Bevan began, I accepted with alacrity because I realized from the very start that no matter how distant my relationship with the doctors might become, I had to be most friendly with the nurses, if I was ever to get our health service going properly. We are meeting on a unique occasion as yesterday war-time control ceased, so you are all free men and women. I was unhappy that we were obliged to retain control over nurses longer than over the rest of the population, but you must all know even better than I do how very serious is the shortage of nurses. We hope the cessation of control will not result in any greater mobility and that we shall be able to retain and increase the number of nurses.”

Welcoming back nurses from the Services to civilian life, Mr. Bevan said they had done a wonderful and quite remarkable job; he hoped they would find conditions on their return better than when they went. He spoke of the shortage of nurses – a pressing problem even before the new health service, and of it being a relative shortage. As we became increasingly civilized we attached more importance to health, and nurses acquired a higher and higher status: they became more and more valued and the shortage had arisen because of the greater demand. To prove this he gave the total number of nurses employed in hospitals other than maternity and mental hospitals in 1938 and 1945: 71,500 and 87,500; of nurses who passed their Preliminary and Final State Examinations in the same years: 9,647 and 15,671; 6,668 and 8,414.

“We have more nurses than ever before,” he said, “but we need more nurses than ever before: we are not going to succeed and all plans made by politicians or even those who aspire to be statesmen will be of no avail, unless there is staff. The health service must have an adequate supply of trained and enthusiastic nurses. I have no opinion as to the relative importance of doctor and nurse – but we all agree it is a lamentable situation when hospital beds are rendered idle because there is not sufficient nursing staff and when hospitals have long waiting lists of patients who are unable to get in.

“One reason, and we appreciate it at the Ministry, why the nurse’s job is so arduous and why a large number of girls fall out, is because far too much domestic work fails to the nurse. I am appalled at the misuse of labour when the nurse spends time doing domestic work in hospital. We are hoping to relieve her shortly. We are bringing over persons from abroad and we hope soon the atmosphere in hospitals will rather sweeten.

I want your help in one regard. There is shortage over the whole field, but we are particularly short of tuberculosis nurses, and for the chronic cases. For though these cases might not present the most attractive form of nursing they surely should excite a sense of pity more than any other. I earnestly hope nursing of the tuberculous and the chronic sick will at least have no failing-off of recruits.” Mr. Bevan spoke also of the great shortage of midwives and suggested the value of continued experience to newly-qualified midwives even if they later returned to nursing. The negotiating machinery for setting salaries and conditions was firmly established; increases in salaries were announced day by day to have effect from January 1, 1946, and fully from April 1947, and the Minister hoped all would agree that very substantial improvements were being made. In addition to these new salaries and conditions, there are the new codes,” he said. “At the moment I must admit they are slightly rhetorical. They are the ideals at which we aim but we are not able to establish the conditions until we build good hospital premises which provide better amenities.” At the moment his hands were full with building houses.

A Big Step Forward

Next he spoke of the position of the nurse in the Health Bill. The Bill had aroused acute controversy in certain quarters and a marked absence of enthusiasm among certain people. We had long established customs; many were unable to imagine new ways of doing things and it is impossible to start a new health service with enthusiasm from every one. If we were going to make progress, we had to tread on a few corns. I think it will be found,” he said, “when the Bill is established, and all its ramifications have been exposed for examination, that we are making a big step forward in the health services in this country, even in the whole world. But there is nothing I, a Government Department or even the House of Commons, can do unless we get the health service efficiently administered. Administration was going to be the chief headache, he said, for years to come; there was not only the staff, doctors and nurses, but the voluntary persons prepared to dedicate their lives to the service of the sick to be considered.

The Health Bill made a considerable change in the position of the nurse. She would be under contract not with the health authorities as in the past but with the regional board. Although her contract would be there she would not have a remote relationship with an obscure authority but would be appointed by the committee and would have a warm and intimate relationship with the management committee of the hospital in which she worked. One virtue of putting the nurse in contract with the regional board would be the greater possibility of general promotion within the schools in the region. Another would be the interchangeability of superannuation benefits; nurses had complained of the impossibility of this in the past. There would be no insistence on moving the nurse about within the regional area, for Mr. Bevan said he realized that this was one thing she took exception to. The appointment of the nurse by the hospital management committee would preserve and encourage that vital thing, esprit de corps and although the idea was to establish hospital centres of 1,000 beds, each unit within it would have its own hospital management committee. The new service, rather than dispersing or destroying tradition would enhance and continue it in the intimate relationship between the nursing staff and the hospital, and seek to establish a code of relationship between the nurse and those with whom she was in contact.

There was a thunder of applause when Mr. Bevan said that nurses had said that they wanted representation on the regional boards. “But,” he continued, “nobody will be represented on the regional boards, not even the doctors. The regional boards will not be conferences of different interests; if they were they would have to consist of so many representatives of health authorities, of doctors, of nurses, of dentists and of many other workers. And what should we have? An administrative homogeneous unit? No: just a conference which would want the Albert Hall to hold it. We want a company of people with knowledge, experience and dedication to the service. The status of the nurse does not necessarily consist of her representation on the regional board; her status consists of proper staff organization in the hospital”. Mr. Bevan pointed out that the regional board’s responsibilities were taken over by the hospital committee – this was the effective unit where day to day plans would be produced; the functions of the board compared to those of the hospital committee were rudimentary.

A Live Committee

Nurses had two representatives on the central council, and midwives one, but far more important would be the standing advisory committee on nursing which would be responsible directly to the Minister and not be under the central council where doctors would predlorninate. Suggestions had been made that the standing advisory committees be sub-committees of the central council but this would be undesirable, for nurses would then be in a minority and any representation they wished to make would have to be vetted by the non-nurses before reaching the Minister. The central council would be able to make observations on the recommendations of the standing advisory committees, one of which would be the nurses’, which would be the real live element of the whole system.

“Shock Absorber’

“At the moment” Mr. Bevan said, “the health plan is only on paper: it is still in the committee stage at the House of Commons and although I do not imagine any fundamental changes will take place we have passed some important amendments.” One, he said, was the right of the hospital management committees to have funds in their own right. The State, through the Exchequer, would look after the hospital’s general expenses and keep it free from financial anxiety. The voluntary hospital’s funds would not be taken away but would be distributed by the regional boards: the hospital management committee would be empowered to receive benefactions for any amenities it liked over and above its revenue – a sort of pocket money which would act as a cushion or shock absorber to prevent the hospitals becoming over?regimented organizations. The hospitals could, therefore, look forward to a time when because they would be quite free from financial embarrassment and anxiety they would be able to give the best service.

In the scheme, Mr. Bevan said, he had considered only one thing, the welfare of the patient. He had not taken into account interests or professions, but only to provide the sick of Great Britain with the best possible service. “I believe,” he said, “this is your aim, too, and that in the years to come with co?operation we shall be able to offer every individual far better provision than there has ever been before. The nurse is a vital element in the health organization, her knowledge, understanding and dedication are fundamental. I have had and I expect to have in the future not less but rather more cooperation than in the past.”

Source: Nursing Times, 29 June 1946, pp. 488-9.