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Nursing in the 1980s

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Starting witha pay hike, this decadre was characterised by staff protests, business management in the NHS and care in the community. Adrian O'Dowd looks back

The fourth decade of the NHS is oftenremembered for industrial unrest but itwas also a time during which nurses madesome important gains, both professionally and financially.

It began on a bad note following the ‘winter of discontent’ in 1978, which caused disruption to hospitals and helped the Conservatives win the next election.

That year, nurses submitted an 18% pay rise claim after several years of high inflation. Some 2,000 nurses protested at a mass meeting. After a difficult few months during which some nurses worked to rule and ambulance workers went on strike, a 9% pay rise was accepted alongside the offer of a comparability study.

The end of the 1970s saw pay beingreferred to the Clegg Commission. In 1980 it rose by a healthy 22%.

Industrial disputes became more acute when, in 1982, 13 health service unions sought a 12% pay rise. The offer of 6.4% for nurses was rejected and around 5,000 nurses gathered for a rally in London while a series of one-day stoppages began.

Eventually a 12.3% rise over a 19-month period was accepted and the government agreed – as a thank-you to nurses who did not strike – to create an independent pay review body for nurses, which began recommending pay awards in 1983.

Another landmark event that year was the creation of a regulator for the profession, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC), alongside four national boards with responsibilityfor setting standards and guidelines for nurse education and assuring their quality.

The first code of conduct for the profession, covering the ethics and standards every practitioner promised to meet, was published that same year.

Financial constraints on the NHS were a growing reality and managers tried to implement efficiencies backed by an NHS restructuring in 1982.

The Conservative government believed that management in the NHS had failed so it commissioned Roy Griffiths, then managing director of Sainsbury’s, to study the health service.

The Griffiths report of 1983 led to general management replacing clinical managers in the NHS. These new managers, often from the independent sector, were not welcomed by many in the NHS but the government said outside expertise in business and finance was needed. Performance indicators were introduced.

Howard Catton, head of policy at the RCN, who trained in Bristol and qualified in 1987, says the decision swung the pendulum too far in one direction.

‘My first ever encounter with politicians was with Ken Clarke – then health secretary – when I was a nursing student. He said hospitals were not giving enough
attention to issues such as business andmoney, and he told me I didn’t know what I was talking about.

‘Nowadays, we hear that boards are giving too much attention to business issues and not enough to the clinical agenda.’

Clinical advances continued. After the UK’s first heart transplant was performed at Papworth Hospital in 1979, increasing numbers of heart and liver transplants were carried out, as well as more surgery to treat heart disease. AIDS also emerged.

NT reported on a new phenomenon –the nurse practitioner – with a feature published in 1982 about pioneer Barbara Stilwell in Birmingham.

While nursing roles were expanding, relationships with doctors held this back.

‘Even when I trained, I can remember as a nursing student being in fear of those consultant ward rounds,’ says Mr Catton. ‘If the consultant picked up on something you hadn’t done or the charts weren’t up to date, you could be bawled out by the ward sister and by medics.’

Christine Hallett, nurse historian and academic, who qualifi ed in the 1980s, says nursing has changed a lot.

‘When I began, nursing was very different from how it is now,’ says Ms Hallett, who is director of the UK Centre for the History of Nursing and Midwifery at the University of
Manchester’s School of Nursing, Midwifery and Social Work.

‘It was a much more holistic role and when I was a nursing student on general hospital wards, nurses were doing much more general care for patients.

‘We were doing things like caring for the hygiene needs of patients and bedbathing, and were more involved in patient nutrition and hydration. I see the role as very different now – nurses are now very busy with things like IV drugs and medical therapies. They have passed on that fundamental nursing care role to care assistants now.

‘I don’t have any problem with nurses taking on a more technical role and having more specialist technical, medical and scientific knowledge. The problem is that they weren’t able to retain their more holistic role at the same time. One was at the expense of the other.’

There were also changes in mental health.

In 1979, the Parkinson Report was produced for the Conservative Party but was kept secret until 1981. It recommended community care for mental health patients and called for hospital closures.

In 1981 the Care in the Community green paper suggested ways of moving money and care from the NHS to local councils and voluntary associations. This heralded a significant move away from asylum-based care, says mental health nurse David Harding-Price, who qualified in 1980 in Cambridge.

Mr Harding-Price, now a clinical team coordinator for a community mental health team at Lincolnshire Partnership NHS Foundation Trust, says: ‘When I went into mental health I was working in the old asylums. By then, people were saying they were not the place for mental health and community care was starting.’ People with mental health care needs have a better deal now in some ways, he says, adding: ‘The fact we have closed the asylums is good in some senses because, although they weren’t that bad, they were not perfect. They did provide, as the word itself suggests, asylum.

'But they were bad in that they didn’t promote dignity, well-being and personalisedcare. For a lot of people, it was a ver one size- fits-all approach. Nowadays, we are trying to do more around individual care.’

Proposals to phase out the enrolled nurse role were unveiled in 1982, prompting 1,500 enrolled nurses to attend a mass meeting in London.

Mr Catton says: ‘ENs were invaluable to me in terms of supporting me through my nursing education. They were highly skilled and able nurses.

‘When that role ceased to be and we stopped training enrolled nurses, I am not sure that we thought through the implications. Part of what you see now around developing assistant practitioner roles and the growth in healthcare assistants is a consequence of taking out the enrolled nurses.’

By 1987, NHS problems were acute – many health authorities were in debt, waiting lists were growing, wards were being closed and the number of new nurse registrations was falling.

‘You came out with more clinical skills on qualifying back then'

John Wylie, clinical nurse manager at a medical assessment unit near Glasgow, qualified in 1987 in Leicester, and went straight into working in A&E at the Western Infi rmary in Glasgow.

‘My early days as a nurse? Frightened,’ he says. ‘I was lucky to get my fi rst post in A&E and back then it was very much a case of whatever the medical staff said, you did. It was medical staff-led and nurses were not particularly assertive in questioning their decisions.

‘It was a baptism of fi re in a big, busy, city-centre A&E department. You were encouraged a lot more by your placements to get involved with the actual are rather than being there as an observer.’

Training was a very different beast. He says: ‘The modular training had its good points – you were salaried and it was very much hands-on. There were a lot of clinical learning opportunities but the academic stuff defi nitely lacked.

‘Things are changing for the better, although I don’t believe the universities have got it right yet. Coming out as a qualifi ed nurse back then, you came out with a lot more clinical skills, which is the complete opposite to where students are now.’

John left the UK to practise in the US for four years, working in intensive care. Since returning to the UK in 1994, he has set up a medical assessment unit as part of NHS Greater Glasgow and Clyde.

‘Nursing practice now has advanced so much and nurses area lot more involved in the actual decision-making process for the patients who come through,’ he says.

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