A Word from our Commissioner

In 2018, inspired by the 70th anniversary of the arrival in Britain of the Empire Windrush, Donna Mighty, Assistant Primary Care Liaison Manager and Chair of the BME Staff Network at the Sandwell and West Birmingham NHS Trust, commissioned a series of formal portraits of past, present and future NHS nurses with connections to the Windrush Generation. These portraits are at the heart of the paired ‘Here to Stay’ exhibitions that will open here at the University of Warwick on 15th June (you can register to join us at the opening event here!) Donna tells us a little more about this process in her blog below.

In 2018 we celebrated the 70th Anniversary of the HMT Empire Windrush arriving at Tilbury docks on 22 June 1948 carrying passengers from the Caribbean.

Sandwell & West Birmingham NHS Trust and specifically their BME Staff Network, were very keen to celebrate this occasion and as such set about organising a Windrush Tea Party in partnership with the University of Birmingham’s Black, Asian, Minority & Ethnic (BAME) Staff Network and Recognize Black Heritage & Culture to recognise and celebrate the contribution of the Windrush generation in shaping and building our wonderful NHS.

Our tea party took place on Saturday 16th June at University of Birmingham School. We had a wonderful afternoon of learning, entertainment, music and food.

We were keen to create a lasting legacy and capture portraits and stories of nurses (retired and current) who attended our event. We commissioned photographer Inès Elsa Dalal and the first photo shoot for what was to become our “Here to Stay” exhibition took place on 16th June. We held two further photo shoots in July and August.

In 2018 we had the opportunity to take the exhibition to London in August, Medicine Gallery in September, Sandwell & West Birmingham NHS Trust in October and the University of Birmingham’s School of Medicine in November. (You can see pictures of these events here, here, and here, and learn a little more about Donna’s amazing work for the NHS here!)

We are delighted to be working with Professor Roberta Bivins and the Cultural History of the NHS team to bring “Here to Stay” to a new audience. Do join us!

Capturing the History of NHS at 70: The Royal College of Physicians & ‘The Museum of Modern Medicine’

In this 70th anniversary week of Britain’s National Health Service, we are delighted to share a guest blog from Curator Kristin Hussey of the Royal College of Physicians (which is also celebrating a significant birthday this year: the big 5-0-0!). Happy Birthday, NHS!

The museum of modern medicine

What would a museum of British medicine since the foundation of the NHS look like? What objects would it include? What stories would it tell?

In light of this year’s NHS70 anniversary, the Museum, Archive and Library of the Royal College of Physicians (RCP) has been rethinking how we collect and display the history of modern medicine. As Curator, it’s my responsibility to help shape and grow our collection of art and objects so it reflects the ever-changing history of doctors in England and Wales. 2018 is also a big anniversary for the RCP as we mark 500 years since we were established by King Henry VIII in 1518. Since our foundation, the College has been collecting artefacts and archives which trace the history of the organisation, of its membership and of physicianship. Our collections of the early modern period in the sixteenth and seventeenth centuries are particularly rich – helping us to understand more about the wealth, power and ceremony of the early College as well as the development of anatomy. However, as you approach the end of the Victorian era, the museum collection grinds to a standstill.

This lack of collecting beyond the First World War is something I have noticed in many medical museums. Why is it so hard for us to imagine a history of medicine beyond the guts, gore and pain of the nineteenth century operating theatre?  Personally I think there’s an aura of the past about famous doctors and surgeons like Joseph Lister, Edward Jenner, John Snow or William Osler that somehow makes them seem more important. Maybe it’s because the gruesome, outdated and strange tools and remedies of the era seem stranger to us than the stuff of ‘modern medicine’ – the everyday things you can find in a GP surgery or a hospital.

I believe that it is actually this everyday stuff of medicine in the last 100 years that we should be collecting. Museums may seem to be about the past, but they are really about the future. What are the stories and objects people will want to see in exhibitions in 25 years, 50 years or 100 years? What will people think of medicine in 1948 or indeed 2018 when they enter into the realm of ‘history’?  Anniversaries like NHS70 remind us that the mid-20th century is a crucial point in the history of medicine and now is the time to be capturing those objects and stories. With that in mind, the Royal College of Physicians would like to collect and display objects related to the foundation of the NHS and its early years.

Medicine between about 1940 and 1990 represents a period of monumental change. Antibiotics and organ donation, genetic testing and the emergence of HIV/AIDS – displaying the many innovations of the 20th century presents an enormous challenge. As a curator though you aren’t just looking to capture moments of discovery (although that’s important), you are looking for objects that tell a personal story. Sometime which has inspired me about the People’s History of the NHS project is the emphasis they place on the individual experiences of patients. When a visitor comes to a museum, they want to understand what people thought and felt in the past. Whether it’s a doctor or a patient, understanding what a particular artefact meant to someone – how they used it, what it reminds them of, why they kept it. These details can helps us to interpret these items meaningfully for the visitor.

One of the greatest challenges I have found in collecting objects from the 20th century is that people often think their items aren’t important enough to go in a museum. Yet it is often these everyday objects which have the most fascinating stories. Any object can be history if it captures a person’s thoughts or feelings at a particular moment in history. Part of the interesting thing about the RCP Museum is we are interesting in the experiences of both patients and doctors – but ideally stories which bring both together, which help us to understand how patients and doctors have interacted in the past. Two items from our collection illustrate the kinds of artefacts we’d like to collect and display from the NHS era: an early telegram from a doctor desperately seeking insulin to save the life of  young diabetic patient, and this 1994 oesophageal stent, donated by our president-elect Andrew ‘Bod’ Goddard. Stents like these are used in the treatment of cancer, helping to ensure that tumours don’t block the food pipe. Originally invented in the 1880s, this type of plastic model was introduced in the 1970s. However, the plastic stents were difficult to place – something which Dr Goddard dreaded as a trainee doctor. More recently, much more flexible expanding metal stents have been introduced, making these uncomfortable versions a thing of the past. As Bod says, ‘As they are for my patients, oesophageal stents are close to the heart’.

 

If you are interesting in donating something to the Royal College of Physicians related to the NHS, please email history@rcplondon.ac.uk   But first, let me tell you a bit more about what we can and cannot collect, and how you can contribute your objects to our collections!

Note from the editors: Remember, the People’s History of the NHS ‘Virtual Museum of the NHS’ is also collecting. We would be thrilled to collect images of all your NHS objects, big or small — and to hear, save, and share all your stories about them.

 

And if you can’t wait to see more objects, don’t forget to watch this wonderful series on BBC 4, Monday night at 9:00 and available on iPlayer! Objects and stories contributed by members like you tell the human story of the NHS from 1948 until today.

An efficient, productive NHS?

One of the most long-standing public policy discussions about the National Health Service revolves around efficiency: its efficiency as a health system and the efficiency of its employees. As early as 1951 officials at the Ministry of Health began assuming the service was over-staffed, circulating a memorandum that year instructing Regional Health Boards to reduce headcount by five per cent across the board.  That circular, like many later efforts to cut staff costs, demanded health service managers obtain savings by improving the staff productivity without affecting care, effectively asking them to do more with less.

Such exhortations no doubt sound familiar to present day NHS staff, many of whom will have worked through several rounds of cost-cutting, all aimed at increasing productivity and reducing headcount, usually accompanied by soothing words about not harming “frontline” services.

Since the 1950s the NHS has seen various schemes of this type. The premise behind the 1962 Hospital Plan, introduced by Enoch Powell then reinforced by the 1964 Wilson Government, was that spending on new buildings and new equipment to modernise the NHS would be accompanied by better working practices and staffing reductions. Freed from inefficient old hospitals, all categories of NHS staff would be empowered to shed wasteful habits and old-fashioned ways of doing things.

Hoped for improvements were not to be left to chance. The Health Ministry’s Advisory Council for Management Efficiency hired hundreds of efficiency experts to conduct “organisation and method” studies at dozens of hospitals, examining how workers were managed. These ran parallel to “work study” programmes, where hospital workers were watched and timed during their shifts in the hope of uncovering promising areas for improving productivity.

These programmes were not uncontroversial. Acknowledging that absolute efficiency had the clear potential to adversely affect the quality of care, nurses and doctors were largely excluded from their purview. Work study was overwhelmingly targeted at support staff, particularly laundry, catering, cleaning and portering staff, under assumption that their effort could easily be intensified without cutting the clinical attention paid to the sick.

By the mid-1960s, NHS work study operatives had generated studies claiming huge reductions in these categories of staff, sometimes as much as 25 per cent, could be obtained, if new working practices were extended across the NHS.

The mechanism through which this was to be achieved was “productivity bargaining”. Trendy in management science circles in the 1960s, “productivity bargaining” expanded across British industry as a solution to low productivity and increasing numbers of strikes. Firms looked to negotiate bonuses with their workers in exchange for the adoption of new, more efficient, working methods. NHS managers and health workers’ trade unions reached a general agreement to implement bonus schemes in 1967, with the unions hoping that cash incentives would improve their members abysmally low pay. The usual caveat applied from the Ministry of Health that bonus schemes were not to be ‘injurious to the well-being of the sick’.

Progress thereafter was impossibly slow, with just 3 per cent of support staff enrolled in any bonus scheme at all by 1971. As it turned out neither managers nor workers felt that “productivity bargaining” offered them much. Desperate to achieve some kind of improvement in this area, the government’s National Board on Prices and Incomes (NBPI) recommended that hospitals implement interim schemes, where workers were offered bonuses simply for agreeing to reductions in staff numbers, echoing the crude memorandums of the 1950s.

Why were these schemes such failures? At the time, ministry officials suggested bureaucratic inertia was largely to blame. Managers were stuck in their ways and resistant to new ideas. Evaluating the failure in 1971, the NBPI Report blamed hospital administrators and heads of departments for not being ‘alive to the need to keep bonus schemes once introduced under control’. They argued ‘any incentive payment scheme decays in time unless constant attention is paid to its working’.

In their frustration, the NBPI’s investigators revealed why the outcomes of these “productivity and efficiency” programme has historically been so poor. The NHS, for all its varied practices and results, was (and is) a cheap health service and much of its workforce went above and beyond their stated work norms precisely because of their moral investment in work. Extra productivity could only be extracted by continuous management effort to win more intense effort from staff who were already stretched by the NHS’ enormous demands. Health care was labour intensive service work, the efficiency of which was difficult to measure and compare, and even more difficult to make more productive. Moreover, the distinction between “frontline staff” and every other kind of health worker was built on the fiction that support staff were somehow less vital to quality care.

“Work study” was by no means the last attempt to extract more effort from the NHS’ workforce; the 1980s saw the introduction of private sector managerialism; and in the 2000s the Blair government developed an obsession with targets and metrics as a motor for modernisation. Since 2012 Strategic Transformation Partnerships mark the latest attempt to extract more work from health workers. Future health planners might do well to acknowledge previous failures to intensify “productivity” and perhaps be a little more sceptical about the likelihood of drastically improving performance.

 

My favourite NHS object – Helen Clifford

The author of this blog, Dr Helen Clifford, is a Museums Consultant for the University of Warwick, and has held curatorial, research, and teaching posts across the UK.  She kindly wrote us this piece to reflect on the memories triggered by looking at the childhood glasses of Jenny Crane, one of our researchers…

Jenny’s pair of pale pink NHS spectacles trigger the opening of a large door into my childhood. I was confirmed to be short-sighted at the age of 3, I remember the test vividly. Too young to be sure of my alphabet the black figures were not of letters but of silhouette animals. I remember the large impressive chair, and all the hard shiny technical equipment.  I was intrigued, but not afraid. I remember the magic of everything coming into focus, as the optician selected the right lenses. 
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We were not very well off, and the spectacles prescribed had to be NHS, there was absolutely no other choice – and just one style. As I am much older than Jenny, (the test would have taken place in the early 1960s)- the only spectacles you could have were metal with springy ear pieces and the frames were covered in an opaque pink plastic (were they blue for boys? I don’t think so). I was quite pleased with these, until I went to school with them on.  Suddenly I was marked out, there did not seem to be anyone else in my class wearing spectacles. The name-calling was merciless, ‘Specky Four Eyes’. It was the first time I was really upset at school. I came home in tears and my mother, ever resourceful, but misguided, decided that the problem with them was their ‘medical’ association. So she set to, and made tiny coloured felt flowers with leaves and stitched them on to the frames. They were lovely, but of course a disaster. This was really a turning point in my life. First I wore them to school, hoping no-one would see me, and then took them off as soon as I arrived, exacerbating my short -sight. I did not want to upset my mother, but I just knew what the reception in class would be. In the end I decided that actually it might be good to be different, and wore them stoically, amidst a barrage of laughter and taunts. But I stuck with them, and in the end I was accepted. It was a lesson well learnt, and the principle of this rite-of-passage has stood with me all my life.  
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The felt flowers did not last long, and I soon got used to the unadorned version. When I got to the age of 13 I was allowed my first pair of non-NHS spectacles, after saving up for them. This was another momentous life-occasion, and another step towards adulthood and the world of larger choice. Forty years on, I found it extraordinary that people wanted to wear vintage NHS spectacles – what is the secret of their attraction? Do they conjure up a lost world? Writing this blog has raised other questions – why are NHS things light pink? Is their flesh-like colour designed to make them unobtrusive, although in reality it marks them out.?The ‘retro’ versions today you will note, are stripped of their pink plastic, and look smart in shiny metal, neutralised perhaps of their origins? The tale of these spectacles symbolises an earlier time of fewer choices, less indulgent attitudes to childhood and fashion, and the attraction and repulsion of the opposing forces of conformity and individuality. One could say that the NHS and the spectacles prescribed were pivotal to the formation of my character. I wonder if this is just a very personal story or one that resonates with others? I would be interested to know!