The NHS was established in post-war England to tackle the major social and economic problems of the day, including ill-health and disease. Following the destruction caused by the Second World War and labour shortages in England, it was critically important for hospitals to recruit staff from the Caribbean to work in the new NHS. In response to recruitment drives in the Caribbean, many people responded and arrived in this country to help the NHS establish itself.
Aneurin Bevan, the post-War Labour Minister of Health, believed that society should collectively contribute, through a National Insurance scheme, to provide free health care for all. In July 1948 the National Health Service Act was born, heralding the birth of the Welfare State.
Until then, only the well-off and those in work were catered for. The National Health Service (NHS) would address the inequalities that left vast number of Britons suffering through lack of money to pay for healthcare. The government became caretaker of Britain’s 2,688 hospitals in England and Wales.
Resourcing this venture was problematic from the outset. The cost of administering the service, researching new cures and maintenance of hospital buildings was far greater than the government had first thought. But the most taxing concern of all was the chronic shortage of nurses. Britain found itself with a new expanding health service which it was unable to staff.
Why were British people unwilling to train as nurses? In the wake of the post-War boom, men were reluctant to work long hours, in poor conditions, for low pay. Single women, with their newfound freedom, were being more selective about their career choices, opting for occupations such as secretaries and journalists. In the 1950s and early 1960s married women’s place was still considered to be in the home.
Recruitment
The authorities embarked on a two-pronged plan to relieve the shortfall. One scheme was an aggressive national campaign, with central government funded exhibitions, lectures and gimmicks to attract recruits in the regions from London to Liverpool. The campaign was not especially successful. The Tottenham Hospital Management Board reported that ‘such energetic campaigning deserves better results’, when, for example, there were just 17 enquiries for 737 vacancies. Out of this number, only two potential students and one qualified nurse came forward.
The other scheme was devised by the Ministries of Health and Labour in conjunction with the Colonial Office, the General Nursing Council (GNC) and the Royal College of Nursing. From 1949, advertisements were placed in the Nursing Press encouraging candidates from the colonies to come to Britain to apply for work as auxiliaries and trainee nurses. The advertisements featured interviews with nurses, who confirmed that across the length and breadth of the United Kingdom ‘jobs could be found easily’.
Recruitment campaigns were extensively and energetically pursued with senior British nurses visiting commonwealth countries for this purpose. Local selection committees were set up in 16 British colonies. Trainee nurses were drawn from all over the world, including Ireland, Malaysia and Mauritius, but at this time, the majority were recruited from the Caribbean Islands.
Colonial women interested in training as nurses came from diverse educational and economic backgrounds. From 1955, the British government had devised various schemes to assist with fares to Britain, but many recruits ended up funding their own journey in whatever way they could. One said: ‘My mother borrowed the money and sent me up here. I had to pay it back when I began to work’. Another said: ‘A friend sponsored me, the bank paid my fares…it wasn’t free.’
The great majority, however, had high expectations from their period of training in Britain. They imagined they would train for three years and, after a further two years gaining vital work experience, they would then return to help the Nursing corp in their various islands. At the same time they felt they would be relieving Britain’s staffing problems.
These expectations mirrored the plans negotiated between the GNC, Colonial Office and Colonial Governors, that Caribbean women, trained to the highest level in Britain, would return to take up responsible nursing posts. In the 1950s and 1960s, such posts were almost exclusively held by expatriate staff (British women)
General hospitals and teaching hospitals were already relatively well staffed, but there were major shortages in hospitals caring for the chronically sick, disabled and the elderly. Post-war trauma had also greatly increased the numbers of people admitted to psychiatric hospitals. It was in these hospitals that the great majority of young Caribbean women found themselves placed as resident trainees.
The Training
Until 1986, there was a two-tier system of nursing training: staff and pupil. The ‘Staff’ or State Registered Nurse (SRN) qualification included training in ward management, while the ‘Pupil’ or State Enrolled Nurse (SEN) qualification concentrated on the clinical side of nursing.
Most Caribbeans, like other Black nurses, were placed on the two-year SEN course. Due to racial discrimination few were accepted on the SRN course despite possessing the requisite qualifications. One recruit recalls: ‘This (difference) wasn’t explained to us. I was sent to a psychiatric hospital in Cheshire, when I really wanted to do general nursing’. Like most others, her ambition was to work in general hospitals.
After their two year basic training, most of the women found they could not get onto the higher level course, and certainly ‘couldn’t get promoted at all’. Yet many accepted night duties, to enable them to fit in with family commitments, and found they were ‘wholly in charge’. As one nurse remembers: ‘We had to get on with all the drugs, the drips, whatever treatment…but our pay remained the same.’
Once they arrived in Britain, young recruits were dispersed to their appointed hospitals all over the United Kingdom. Some were met at the train station, but many had to find their own way, dressed more for the sunshine they had left behind than the cold and gray weather and bracing winds they now encountered.
The new trainees lived in the Nurses’ Homes attached to the hospitals, and worked alongside other Colonial trainees. They provided an important support network for each other, as many felt isolated and far away from home. ‘When anyone new came and brought food, the girls got together, sitting on the floor, [or] anywhere like a big family. We would eat whatever, dividing it up between all of us’.
At that time, there were few Black people in Britain, particularly in smaller towns. As a result, many nurses moved to large centres like London, Birmingham, Liverpool and Bristol, with existing African, Asian and Caribbean populations.
After Training
Many Caribbean women who had come to Britain did not return home afterwards, as they had intended to do. They all held British passports, a requisite until 1962, when they were granted leave to remain here indefinitely. But why did they stay? There were a variety of reasons.
Some felt unable to return to their islands. The Enrolled Nurse (SEN) qualification was not recognized in the Caribbean, and they would not qualify for the senior posts. Most remained in Britain, however, because, at some point in their career, they became wives and mothers and found themselves settled with a family in England.
Experiences were varied. Caribbean nurses were well respected by the patients they cared for but there were also examples of abuse and accusations. Overall they gained a great deal of knowledge and satisfaction from looking after sick people, often in specialities which the indigenous population refused to occupy. Caribbean nurses made a choice to come to Britain, and made a choice to remain here, but all agree that: ‘We contributed to the NHS. We have built the NHS because we were committed to our work and our nursing careers.’
Anonymous quotations are taken from interviews conducted by Linda Ali with Caribbean nurses for her thesis, West Indian Nurses and the National Health Service in Britain 1950 – 1968