We re-publish below an article that was featured in Race Today, a political magazine written by black radicals and revolutionaries between 1973 and 1988. The article was written by Brixton Black Women’s Group, a revolutionary feminist collective.
The article was written in the context of the 1974 nurses strike, and whilst the content might at first seem specific to the moment, there are lessons and implications that reach from the struggle then into the present. In particular, it shows us the importance of analysing the ways in which the state manages migration to ensure that there is an exploitable workforce in essential industries such as in the health industry. In our first issue, we interviewed a colleague who worked in the recruitment of overseas nurses. This interview shows that the issues of entrapment and false pretence that the sisters in the Brixton Black Women’s Group were dealing with in the 70s are still relevant today.
The problems that we face today around the divisions between professional groups, unions, and hierarchies on the wards are nothing new. We can learn lessons from how colleagues in the past fought against these divisions, and from their failures in overcoming them. It is clear that the particular composition of the workforce has changed, but that many of the sharp end of the prejudices used to ensure that the hierarchy stayed intact remain in place even though the targets have changed.
In particular, it is important to look at the ways in which the NHS has restructured to overcome some of the issues brought out in the interviews below, and how some of them are reproduced such as the reliance on Bank workers to fill gaps when convenient and sack off when they aren’t. Also, the underlying critique running through this article of ‘professionalism’ remains important. The division between ‘professional’ and non-professional was used as a way to drive down wages on the one hand, and to beat workers over the head with when they struggled for more.
Additionally, this article demonstrates the importance of political collectives in circulating the struggles and reflecting on them independently. If we are going to be able to face the challenges of the coming years in an increasingly unstable world, and ensure that we are able to not only resist the slide toward barbarism but struggle toward a new society, we need to re-discover this kind of political practice.
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In the present struggle nurses for the first time have come out on strike in support of their demands for more money. They have acted in opposition to the myth that women administering to the sick, young and old should not behave in this way.
Nursing is traditionally women’s work, especially black women’s. In the following article, widely illustrated with interviews, we maintain that the presence of black women in the health industry has been crucial to bringing the struggle to its present stage.
This is not a comprehensive statement in that most of the nurses who participated in writing it work in London hospitals, and we know that the most militant action has come from outside London. Also, all of the nurses are of Afro-Caribbean origin.
We concentrate here on nurses. Because of space limitations we do not deal with the situation of ancillary workers, not because we see them as subsidiary to the hospital structure (as do the nurses unions). However, we point out that it was these workers, recruited from Southern Europe, Ireland, the Caribbean and Asia, who first brought the strike weapon to hospitals in Britain.
– Brixton Black Women’s Group
Nursing is a “caring profession”, and traditionally the work of women – to be of service not only to their own men and children, but to other people’s. No woman is more identified with service work than black women, especially the black women with a slave or colonial past. The relationship between the black woman and nursing, wet nursing or dry nursing, of other people’s children and other people’s husbands and wives , dates from before any National Health Service. Whether working in hospitals as auxiliaries, SEN’s or SRN’s, in the head of the black nurse from the Caribbean is the echo of slavery; in the head of the Asian nurse is the servitude to Sahib and Memsahib.
The colonial legacy expresses itself today in the young woman who from very early on knows she must take disciplined responsibilities in her own family, for example for younger sisters and brothers. This legacy is alive in another sense, often the only waged jobs open to women in the ex-colonial world is in the kitchen of the middle and upper classes.
From their traditions in the family and in waged employment in this country and “at home”, flows easily the tradition of black women in hospital work.
We believe we can show that there is a connection between the nationalisation of the health service in 1948 and the immigration of these workers within this tradition. A health service which was intended to see after the whole of the working class, not just those who could afford it, would need a tremendous injection of workers who would not expect too much in wages and would not be in a position to challenge their working conditions.
During the last 20 years the class composition of nursing has changed.
A hundred years ago this was said of nurses: ‘Many gentlewomen were recruited because it is the belief that this type of nursing required the highest type of women who were well educated’. [1] This is not a picture of nurses today and certainly not a description of the National Health Service. What used to be a vocation for women in the middle class is now a job for women in the working class, and particularly for black and other immigrant women.
Overseas nurses: cheap labour
The number of overseas student nurses coming into the British Health Services increases rapidly each year. In 1959, approximately 6,000 came in; in 1970 just under 19,000. They come mainly from the Caribbean, Hong Kong, Mauritius, Malaysia (which is now the highest sending country) and Ireland. We cannot analyse in depth who these women are, and the specific conditions that exist in their own countries which force them to come to Britain for training as a way out. For a way out it certainly is. Few come with the desire to nurse. But whether the desire is there or not, the National Health Service ensures that they will work here for at least five years. Many of them are deliberately directed to take the SEN qualification which is of no use to them outside of Britain, but which guarantees a trained, low paid workforce on the ward floor. One way of pushing women from overseas into SEN training is by demanding educational standards which overseas students are less likely to have.
During their stay here they have to renew their permits through the hospital every six months. They have also to give an undertaking that they will stay for a certain period of time after they have trained so that Britain can benefit from ‘the training she has paid for’. Yet since most of her training is spent working on the ward, the SEN pupil nurse repays for her training a million times over by the cheap labour she provides. The NHS need for the labour as opposed to skilled labour is shown by the fact that in 1972 only 120 qualified nurses were allowed into the country. [2]
Grace Jenkins, SEN student nurse, Trinidadian:
‘I came to England to train as a nurse in 1970 when I was 22, I applied to the Trinidad Health Service and they sent me a list of hospital addresses in England. I chose one in Birmingham. I went for an interview in Trinidad and took a sort of intelligence test. I was accepted by the hospital. I came direct to the hospital, I didn’t really want to nurse but I wanted to leave Trinidad, I have never had a job there.
I did eight weeks – training and then went straight on the ward working, that is changing bedpans, cleaning lockers and generally fetching and carrying. At first I got £45 a month after deductions. It took me a week to realise that I didn’t like England and not much longer to realise I didn’t like nursing, but I have to stay five years; that is the condition under which I came.
From Birmingham I went to Nottingham to do a special Theatre training — it’s more money once you are trained. I find nurses are very conscious of what position they hold — even some of the black ones.
When I was in Birmingham in 1970 they told two black trainee nurses that they would have to leave because they had failed three times a test you take after your eight weeks initial training. About 50 of us [black nurses] went on strike, some for half a day, somefor two or three days, and demanded that they be reinstated. We got the help of the local West Indian Association and we got them back in. I’m doing Agency work now — during my holiday period. I need the money.’
Labour in the hospital is devised according to sex, race and age. Different jobs are done by people in different uniforms, getting different wages, and having different degrees of power. Those who work the harders have the least status and the least wages. These divisions are further reinforced by the divisions between those who are ‘professionals’ and those who are not.
‘The specific way this hierarchy functions, which is different from other waged work, is that every student nurse has a chance to be second year, and every second year a chance to be third year and every third year a chance to be staff nurse and every staff nurse the chance to be Ward Sister, and Ward Sisters become Matrons, and a few Matrons become…’ – Wages for Housework and the Struggle of the Nurses, Power of Women Collective
There are two types of training from the beginning – a two year course leads to an SEN (State Enrolled Nurse) qualification which cannot lead to promotion. A large number of Asians, Irish and West Indians are deliberately directed to SEN.
“When you are interviewed they ask you if you want to do the course in two years or three, and all of us said we would like to do the two-year course . It’s only when you get here that you realise that you will be a SEN.’
The SRN (State Registered Nurse) goes through a three-year training and it is she who has the potential for promotion.
On the ward floor black women are invariably seen in the lower trades, servicing doctors, ‘professional’ nurses, and patients. Few black nurses enter the NHS as a vocation, in the hope of becoming a matron – and to even those who do, it soon becomes clear that this is not what they have been recruited for. For black women, nursing is a job, nothing more, and by refusing to treat it as a vocation they are not only exposing the real nature of nursing in the health service, but are undermining the hierarchy which depends on them wanting to be a part of it.
Mrs Andrews, Nursing Assistant (psychiatric hospital – equivalent of an auxiliary in a general hospital).
But this is what I think is wrong from the beginning, by giving us the name of nursing assistant, this “nursing” – it shouldn’t be, it should be workers. To me it is just a job like any other, if I was in a factory or anything like that.
All of us have to do a lot of things they [nurses] do, except we don’t give injections and write reports. We have to admit the patient, we have to make the beds, take them to ECT treatment, we do everything they do…only they sit in the office. We are the ones outside with the patients all the time.
People ask me why I have stayed so long. Come December I will have been there for 8 years. But I can defend myself. I know I am not liked by them and I can’t really say I want to hug and squeeze with them. I just want them to accept me as I am and I accept them as who they are and they do their work
The majority of the staff are black here, they are Nursing Associates. For example, on the children’s ward, I counted that they had 12 Nursing Assistants, two sisters, a Charge Nurse [male equivalent of a sister] and a staff nurse and an SRN. All the Nursing Assistants are black. It’s little things like that that I check up on.
Some people ask me why I don’t want to go further. I don’t want to because I have fulfilled my goal of bringing up my two children on my own. I don’t want any status behind my name because it is a whole bloody racket. I can’t see where they are going anyway, they have more heartaches than anything else. Just where I am is where I want to stay and I will be just on the outside looking in at them fighting. They don’t have time for their husbands; it’s just position, position. It doesn’t help the patients to recover, it’s only themselves. Now they have a new badge. When we were first there all they put on it was ‘Nurse Andrews’ or ‘Nurse Brown’. On this new badge everyone has their status on it.
Patricia Matthews, SRN, Barbados
I came to this country in 1962 when I was 17. I went to look for a job and the Youth Employment Officers suggested that I go for a job in the factory. I didn’t want to work in a factory – but I didn’t know what I wanted to do – I didn’t really want to do nursing as such. I went to a London Teaching Hospital to train as a nurse. They said I would have to work as an auxiliary first because of my age. I now know this isn’t true. They could have taken me on as a cadet. So I worked as an auxiliary doing bed pans, washing babies woolies, cleaning lockers, etc.
When I first started it was so depressing. I was one of the only black girls there. Then more and more black girls came into London and it wasn’t so bad. I remember one incident. I was living at the nurses’ home and at the time I was wearing clothes I had brought with me from home. As I was going out while living at the nursing home the matron said to me, ‘where are you going dressed like a tart’? They used to do things like going through your clothes and then ask you how you could afford certain things. I remember that the first pay I got was £9 a week. In 1963 I started training for an SRN, and I felt so isolated, there would be times when I would sit in the canteen all by myself with none to talk to. I was unhappy but I didn’t want to work in a factory and my family and friends felt that nursing was better than that, so I stayed. It was during that period of my life that I saw I was being victimised. To me it has always just been a job. I trained because I couldn’t see what else there was; now it is a way of earning a living. When I finished my training and was on the wards the doctors especially wouldn’t recognise black nurses then. Many is the time I was asked to fetch a nurse. But this has changed, they can’t do without black nurses at all now.
In 1964 I qualified and left the Health Service immediately, and went to work for an agency. I will never work for the Health Service because of what I went through during my training. The patients are not being looked after properly – and the nurses have no say in the way the patients are looked after and the money is disgusting. Everyone on the ward is divided by what status they are. In the NHS you have to put up with things that as an Agency nurse you don’t have to. Matron doesn’t rule you any more. When I first started Agency work there were not many agencies around and in those days it was mostly private nursing that they catered for. Many times I have gone to a job and the person has said that they didn’t want me to nurse them. If they were desperate they would try and persuade you to come in saying, oh, you could look after me today but I would like someone else tomorrow. I don’t particularly like working for an agency either but you get more money and more freedom. If my daughter is sick I just ring up and say that I am not going in. Whereas in the Health Service they would try and persuade you to come in saying how short staffed they were, and if you didn’t you would lose a night’s pay. But I do feel that they are making a big business out of us. You get different rates from different agencies and some take up to 12.5% as commission. I work nights all the time because I have a child. I chop and change agencies to get more money. I work 4 nights a week from 8:30pm to 7:30am at a London hospital where the majority of nurses are from overseas. I find that whenever people talk about Agency nurses they mean black nurses, but there are nurses from all over the world working for agencies. I feel very sorry now for the girls, say, from the Philippines and Malaysia who don’t speak English very well and who are being exploited. They remind me of when I first started training.
Agency Nurses
We believe that the Agency nurse has represented the spearhead for the force for change in the NHS. The attempts to victimise her are racist and anti-working class.
A significant number of black nurses are doing agency work. Nursing agencies have mushroomed in the last two years and more and more nurses, particularly those who are married, are doing agency work as a flexible alternative to working in the health service. In the London area especially, the teaching hospitals rely heavily on agency supply easing their labour problems. For example, the last available figures from the DHSS (Department for Health and Social Security) show that on 30 September 1971 ‘the equivalent of 2,720 agency nurse and midwives working the whole time were being employed in the area of central London and the four metropolitan Regional Hospital Boards. 54% were employed in the teaching hospitals, which employed only 11% of NHS nursing and midwifery staff.’
The agency nurse has been singled out and made a focus for attack. The attack has come from within the ‘profession’, from the union executive of COHSE, and from so-called revolutionary organisations. All have said that NHS nurses should refuse to work with Agency nurses. At the time of writing, COHSE has withdrawn use of the strike weapon by its members, pending the Halsbury Committee Report, but their ban on working with Agency nurses remains and is to become permanent. The National Rank & File Committee, who produce Hospital Worker, have also called for a complete end to the use of Agency Nurses, and a recent report in Women’s Voice, paper of International Socialists (Women), said, “At our first meeting we decided that the best action would be to ban working with Agency nurses. There’s 300 in King’s [Hospital] and £12,500 a week is spent on them – the hospital would collapse without them. Of course it’s hard on them [Agency nurses], but if they’re bothered about the state of nursing they should be in the NHS fighting with us.”
The reality is that the National Health Service wage rises with seniority, from grade to grade. If a nurse brakes her service, for example to have children, she loses all seniority and the wage goes with it, and when she rejoins she must begin over again working her way up the pay ladder. This kind of penalisation excludes almost all black nurses who are mothers from rejoining, because whether or not there is a man in the house, the woman must work. So they do Agency work more and more because that is their only choice. Furthermore, having children raises the question of child-care facilities which are not available on the scale needed and certainly not at a price scale that nurses could afford. So many work the night shift and see after the children and the housework by day.
The question of how much money the Agency nurse earns is wildly exaggerated and some Agencies operate a pay scale for white nurses and a lower one for black nurses. We were told, “At the agency they said you were never to discuss your wages. I did, and discovered that Australian nurses were getting more.”
At critical points in struggle, when the interests of two different sets of workers seem to clash, the stronger often win their case temporarily by excluding the weaker. The trade unions in Britain were formed to exclude white women, all ‘foreigners’ and blacks from the skilled trades. The nursing workforce appears to be divided by different unions and professional bodies, but they are not. In this case the divisions between unions need not divide workers, and may even be helpful since nurses are getting together across trade union barriers. Non-trade union workers (and that includes Agency nurses) are therefore not excluded by the workers’ own way of organising. The decisions that are dangerous are between first, nursing and non-nursing staff, and second, NHS and agency nurses – divisions among hospital workers. They must come together and refuse these divisions that the government, unions and the Left are trying to deepen. Racism and sexism are not about abstract moral attitudes, but about whether you take position with black women, agency or non-agency, auxiliary, SRN or SEN.
The Agency nurse is the first refusal to be tied to the hospital hierarchy, thereby confronting the blackmail that faces all nurses, that they are caring ‘professionals’ and not workers. The issues which have created the Agency nurses are based on the racism inherent in the hospital hierarchy. Black nurses cannot know if the unity for which white nurses are calling is any guarantee that their specific grievance will be dealt with. They, more than white nurses, face the indignities of the ward from patients and doctors, and the entire history and experience which they bring to nursing causes them to proceed with caution. The attack on the Agency nurse has confirmed that they have been right to be cautious so far about joining in the struggle when they are not leading it.
Mrs D from Jamaica, spent years as a nursing auxiliary then trained as an SEN. She now works as Agency and explains why:
Well, I wanted to go home on holiday. I hadn’t seen my mother for over 10 years. I went to the matron and asked her if I could have my five weeks holiday, plus three weeks without pay. She said “no”. I would have had to resign and then re-join. So I resigned. It’s not that you have to start training again, but after you’re qualified, each year you’re a year up and when you get to three years you’re a Senior Enrolled Nurse and you get higher pay than when you’re first or second year. If you break your time before your three years are up you have to start back at Grade 1, which is what happened to me. I tried to re-join but I couldn’t get in, so I decided to go on the agency. I don’t know why I couldn’t get back in – they’re supposed to be short of nurses. I don’t know if it was the reference or what. I work for Mrs H in Streatham – she doesn’t pay top rates but you can always get jobs as long as you want to work. I work the night shifts. It’s not more money. You may get £2 or £3 more on days, but for me it is much more convenient because it suits me and fits with my housework. I’m now working in Battersea. Most of the night staff are black. Night nurses are black because they have children and it’s more convenient for them to be at home in the days to see after the children. If you work days you’re not there to see them off to school, you’re not there to receive them when they come back, and you have to get somebody to look after them. With nights, you can actually put them off to bed before going to work.
I support the strike wholeheartedly. Nurses are saying they won’t work with Agency nurses and I think they’re being silly, because number one, they should find out why nurses have to go on the agency, because in my case it’s not because I wanted to but because I was forced to. I can’t do without working. If I could have gone back into the hospital I would have because there is more security and there are periods with the agency where I can’t get work at all, like in the winter when the nurses are not on holidays. If you are ill in the Agency, you get no pay and no looking after.
Marilyn from Trinidad. She has been nursing for 12 years and spent the last 5 working as Agency
I left school in Fulham when I was 18 years old with no qualifications except CSE’s, and I went straight to nursing. I had always wanted to be a nurse from when I was at home in the Caribbean, since I was young. There were four of us, three girls and one boy. The three of us wanted to be nurses and the boy was going to be a doctor.
I got £12 a month after they had deducted for board and lodging. After two years I got pregnant so I left. I went back to work six weeks after having my child and I did a year of SEN. I really started agency work for 6 months only and because it’s a job I can leave whenever I want to if I feel like leaving.
I worked for about 6 agencies. The first one paid the same as the NHS so I didn’t stay. I worked nights so I could be with my child in the day. That’s why a lot of women work nights. I don’t care really because I’ve had so many different experiences of nursing, it has made me sick. Even if you have qualifications, you have to work so hard to prove yourself as good as they [white nurses] are, or even better. It’s not handed to you on a plate. With white nurses it’s just handed to them. Black nurses get most of the dirty jobs. Say you have one trained white nurse, and one trained black nurse on the ward, the white one will be in the office and the black one on the ward. Doctors treat you terribly and the black ones are just as bad. They completely ignore black nurses once there is a white nurse there. The last hospital I worked in there were more Agency nurses than NHS nurses. There should be some arrangement by the hospital to provide nurseries. Some hospitals have creches, but they’re no use because you have to work odd hours. It might be open 9-5, but if you’re working until 8 it’s no good. Or they close on a Saturday or Sunday, so what happens then, or on a Bank Holiday?
Footnotes
[1]
Report of the Committee for the National Association for providing trained nurses for the sick and poor, 1874
[2]
For reference, the number today stands at almost 25,000 new overseas registrants to the NMC in 2022/2023. However, in the period between 1990 and 2016, this number fluctuated between approximately 4,500 and 16,000. Analysing this trend could, and perhaps should be the focus of an article of its own. Even with this limited view, we can however begin to draw some hypotheses that relate to the relation between the health service and its composition and the wider trends of the national and global economy. It also gives us an insight into the switch from the focus on recruiting workers from overseas and training them here, to recruiting already trained workers. This displaces the cost to the state onto other countries, and traps the individual worker in further by then forcing them to pay visa and conversion fees themselves. Data accessed from https://www.health.org.uk/news-and-comment/charts-and-infographics/how-reliant-is-the-nhs-in-england-on-international-nurse-recruitment
