By the time the NHS was entering its second decade, nurses were starting to feel more confident within the brave new world of healthcare and beginning to develop greater independence.
The late 1950s into the 1960s heralded many changes in the NHS, which was now firmly established and growing.
Treatments were improving and better drugs being developed – the polio and measles vaccines both appeared, dialysis for chronic renal failure, chemotherapy for some cancers and the first human heart and lung transplants took place.
Growing discontent among those working in primary care was tackled with the agreement of a GPs’ Charter in 1966 – a new contract giving financial incentives for practice development.
This led to better staffing in general practices, surgeries being housed in better premises and the beginning of the concept of a primary healthcare team.
In hospitals too, changes which would have a long-term impact were made, such as the creation of divisions that grouped medical staff by specialty.
Matron and ward sisters at the beginning of the decade were still incredibly powerful figures. In some hospitals, ordinary nurses were not allowed to speak to them unless they were addressed.
Angela Evans, who qualified as a nurse in London in 1963, says: ‘Ward sister was very powerful and very visible, as was the night sister. When you were on a night shift, the night sister would come round at least twice every night, expecting a report on every patient and making sure the sluice was spotless.’
Not only were standards strict but also there was a clear sense of hierarchy in the 1960s. Ms Evans explains: ‘The junior nurses stuck to their jobs, which were the more menial jobs – doing the bedpans, pressure area care, taking temperature and the vital signs, serving meals, cleaning patients’ lockers – but these were the jobs that gave us a lot of patient contact.
In the dining rooms, staff sat in their rank. So, as a first-year junior nurse, you sat with all the other first-years before progressing to the second tier of tables the following year. As regards the doctors, they had their own dining room.
Ms Evans adds: ‘Despite the hierarchy, there was a lot of togetherness and teamwork in the ward. It was hard graft but we really enjoyed it and everybody knowing their role helped us to provide all-round patient care.’
The regimented nature of a nurse’s life then was vastly different from today, agrees former RCN general secretary Christine Hancock, who qualified in 1966.
‘It was regimented at every level – your uniform, your behaviour and the way patients were treated,’ says Ms Hancock. ‘As a junior nurse, you didn’t see matron that often but the ward sisters were pretty fierce and as important as the senior doctors.
‘Remember that at that time, the age of majority was 21 but nurses often started training at 18 or even younger, so the hospital and matron had an almost legal guardian role over you while you were training. They had control over when you were allowed out and how late you could stay out.
‘I remember one of my friends was not only married but pregnant and hadn’t told anybody apart from us because she would have had to leave. She just got through her finals without her pregnancy showing.’
A key development in the 1960s was the Salmon Report of 1966, which recommended a change to the senior nursing structure and effectively heralded the end of the traditional matron role.
The report proposed each hospital have a chief nursing officer reporting to hospital management, and a hierarchy of principal nursing officers, senior nursing officers, nursing officers and ward sisters or charge nurses.
Although the end of matron was resisted by many in nursing at the time, the recommendations of the Salmon Report also aimed to raise the profile of the profession in hospital management and ensure senior nurses gained access to management training.
Dee Buchanan, who is now 88, qualified in 1942 at the Royal London Hospital, and by the 1960s, was assistant matron at the Royal London and deputy matron at St Helier Hospital in Carshalton.
‘The Salmon Report was a shake-up of a regime that had been there for years and years,’ says Ms Buchanan. ‘When it came in, they turfed out all the matrons. Roughly speaking, I think it was a bad thing.
‘A lot of good things went out with it and never came back – for example there was no central person in charge of the standard of nursing care. The new people seemed to be administrators who needn’t necessarily have had nursing or hospital experience.’
Hospital premises were considered to be increasingly outdated, which led to Enoch Powell’s Hospital Plan in 1962. This agreed a 10-year programme to develop district general hospitals for population areas of around 125,000.
Education was also changing and the first degrees in nursing were introduced in Edinburgh in 1960.
Shortly after, the RCN launched an investigation into how nurse education might be better organised and commissioned a report by Sir Henry Platt, published in 1964, that proposed two different courses – one for registered nurses and one for enrolled nurses.
The traditional control that doctors and matrons held over nurse education was changing. By 1962 the regulator, the General Nursing Council, had reintroduced a minimum standard of entry for nurse training – something that had been suspended when the Second World War began.
Nursing practice was also changing as a result of medical advances, and intensive care and coronary units grew rapidly. This meant patients had shorter hospital
stays and were not so restricted to bed, and one-day-stay beds were increasingly being used.
Ms Evans remembers some of the major advances in medicines and treatment that took place in the 1960s, particularly those she saw when working on an oncology ward.
‘In those days survival rates for patients with cancer and leukaemia were just beginning to get a lot better. Drugs were starting to work better – it was an exciting time.’
The 1960s also saw the start of a relaxation of some of the old disciplinarian structures as the profession now had to compete with other occupations to attract new recruits.
A first sign of flexible working appeared as straight shifts, rather than split shifts, were introduced as well as part-time working. Another previous taboo, married sisters, was now tolerated.
Pay became an issue in 1962 when a major public protest sprang up, led by the RCN and joined by trade unions NUPE and COHSE, which also represented healthcare workers. A mass meeting in London and all-night demonstration were held, leading to debates in parliament and a special pay award for nurses.
Other significant advances in this decade included the legalisation of abortion in 1967 and the RCN formally accepting men into its membership.
Patient expectation of nurses has changed over the years, says Christine Hancock, and rightly so.
‘Nowadays people are more questioning and a great number of people who require nursing care are those who have long-term conditions and know much more about their care than they might have done some years ago.’
On nurse training, Ms Hancock says: ‘We were incredibly well trained but I don’t think we had the same ability that many of today’s nurses have to really think and question and be more creative in what we think is needed.’
'There was a lot more respect for your seniors'
Nursing in the 1960s was hard work but a fantastic job that led to friendships for life, says Pam Marsh, 61, who qualified in 1968 at Llandough Hospital near Cardiff.
‘It was a lot to take in but I made a lot of good friends from training and even to this day, we still meet and keep in touch,’ says Ms Marsh. ‘There was a great camaraderie – we lived, trained and worked together.
‘The hours were a lot longer than they are now because we only had one day off a week. I think we had much better training then. It was different because we were far more patient-orientated; we started at the bottom and worked our way up.
‘There was a lot more respect in the profession for your seniors, even if they were just one step above you. You didn’t walk through a door in front of somebody more senior than you.’
When asked how nurses’ professional roles compare then and now, she says: ‘Certain advances hadn’t been made then. But overall, I feel that everything now has got more secretarial and it’s all about notes and going to meetings.’
After working in outpatients at the hospital, Ms Marsh moved to a GUM clinic. She left to have a family and then worked again on nights before becoming a community nurse – a sister at
a general practice.
Ms Marsh retired when she was 55 because of rheumatoid arthritis and says: ‘I loved my entire nursing career.’