On a cold November day in 1937, the people of central London were presented with an astonishing sight.
Like a feminine version of Banquo’s ghost, nurses marched through its streets dressed in white uniforms and wearing black masks to hide their identity and prevent reprisals from employers determined to stamp out any form of dissent but whom they were to continue haunting for the next 50 years.
Their grievances had plagued nurses for the previous half century: low pay, a working week that was too long, and working conditions not only exceptionally harsh but unnecessarily so.
As Avis Hutt, an activist of the period who was on that march, stated: “I’m an enormous admirer of Florence Nightingale but she was invoked as the Victorian middle-class woman, as the archetypal nurse that we should all aspire to.
“And the question of having a decent wage, and decent living, and decent hours, and the rest of it… was regarded as not right for nurses who were supposed to be respectable.” (Cadd 2020)
Nor was this the first time nurses had acted upon their collective sense of grievance or the attempt by employers to suppress it.
The first industrial action directly linked to pay and conditions was in 1922 and even more astonishing than masked nurses parading through London.
What became known as the ‘Battle of Radcliffe’ started after the visiting committee managing the Nottinghamshire County Mental Hospital actually cut nurses’ wages and increased the working week, going against national agreements.
Reluctantly accepting the loss of wages but not the extra hours, the nurses were eventually sacked, and told they would only be reinstated if they pledged to “faithfully carry out all instructions of [their managers] and to loyally obey the Officers of the Mental Hospital”. (Hart 2004)
Fearing for their jobs, tied accommodation and pensions, the majority of male staff were in favour of capitulating. The women stood their ground, literally, refusing to leave their wards.
Joined by a few men, 50 women occupied three wards. Eventually, 25 bailiffs, 63 police officers and strike breakers arrived to remove the nurses.
After they smashed down the doors, Herbert Hough, a student nurse who had become branch secretary after his predecessor was sacked for sleeping outside the hospital without a pass, turned a fire hose on them, aided by patients.
Bailiffs broke down each barricaded door as the nurses retreated and, after a “fierce hand to hand struggle”, the striking nurses were overpowered and ejected. The women on the upstairs ward held out longer than the men and also used fire hoses to defend themselves.
It wasn’t just the ‘battle’ for Radcliffe Asylum that was lost. Wages were cut and the working week extended all over the country.
Resistance had been beaten down, but the sense of grievance remained, spreading beyond the asylums and into the heart of the nursing establishment.
The nurses’ march in 1937 was the culmination of more than a year’s agitation and campaigning. It had seen the formation of the first ever nurses’ only trade union, the Association of Nurses, which was led by a veteran of the Spanish Civil War, Thora Silverthorne.
The association called for nurses’ hours to be reduced from 54 hours a week, improved wages to at least match those in other, less demanding, occupations, an end to petty restrictions and for students not to have to attend lectures in their own time.
This spurred on other unions to form nurses’ sections and join the campaign, led by women like Iris Brook and Doris Westmacott.
The exception was the College of Nursing (the forerunner of the Royal College of Nursing), which was campaigning for longer hours and less pay for nurses in the belief this would attract the ‘right sort of woman’ into the profession.
The Nursing Times was one of the most vocal critics of the Association of Nurses and, particularly, Ms Silverthorne.
With no NHS or national healthcare system, nurses’ pay and conditions were leading to increasing shortages. Students were dropping out at unprecedented rates.
Recognising the tide was turning, the college changed its position to support reductions in hours and improved wages.
To appease the campaigners, the government set up the Athlone Committee to try and solve the problems of recruitment and retention of nurses, including training, pay and conditions.
With stories of nurses leaving the profession in droves and those remaining having to take on second jobs to make ends meet, in early 1939 the committee made a series of recommendations.
These included a 96 hour fortnight, pay rises for trained staff, universal pensions, increased holidays and that government make grants available to what were then independent, local hospitals and teaching hospitals.
A minority of the committee even recommended the government funding of those hospitals run by local authorities.
Enacting those recommendations would have huge implications and, indirectly, make the formation of a nationalised health service an inevitability. That had to wait until after the end of the Second World War.
The Beveridge Report is widely credited as ushering in the NHS, while the role of those courageous, determined nurses has been largely written out of history.
The establishment of the NHS in 1948 did not, however, bring huge improvements to nurses pay and conditions.
And despite their wholehearted support of its principles, the unions didn’t shy away from fighting nurses’ corner.
Within a couple of years, a pattern emerged for nurses’ pay, now decided by national negotiation through Whitley Councils, with the nursing Whitley Council dominated by the RCN (doctors exempted themselves from the councils, meaning they had more control over their pay and conditions as well as decision making in the NHS).
Years of neglect were followed by an eruption of industrial unrest and a rise in salaries that restored a degree of parity.
Unlike 2022, it was nurses in wider health service unions such as the Confederation of Health Service Employees (COHSE) taking action. The RCN confined itself to campaigns and trying to exert political pressure.
Wider political change was afoot. Women’s role in society was changing. By 1970, this was shaping their role in trade unions, growing in confidence and organisation.
What was, by then, a four-year cycle of nursing discontent blew up in 1974. Successive incomes policies had pushed nurses’ salaries further and further back.
The RCN threatened mass resignations and mounted its ‘Raise the Roof’ campaign. Under pressure from its members, COHSE went straight for industrial action.
As in the 1930s, a special committee was set up, resulting in the Halsbury Report and a big hike in nurses’ pay.
Later that decade, from November 1978 to February 1979, nurses were part of the ‘Winter of Discontent,’ albeit on the periphery, as millions of public sector workers withdrew their labour.
Then 1982 saw the longest health service dispute in its history. With other health workers, pursuing a 12% wage increase, nurses took strike action, mounted picket lines and marched in demonstrations.
The largest of these involved 120,000 people proudly proclaiming their cause across London’s streets, a far cry from the masked nurses of 1937. The dispute became increasingly bitter as the months dragged on.
In September, with the dispute faltering, the RCN made a decisive move, breaking with the other unions to start separate negotiations with the Thatcher government.
They claimed victory when they were able to reach a settlement and secured agreement that all future pay claims would be settled by an independent pay review body [PRB], removing nurses from any future pay negotiations in a framework that separated them from all other health workers.
The other health unions, including COHSE, which had the next highest number of nurse members, were furious. With nurses badly fragmented, the dispute ground to a halt.
Although the overall settlement was higher than the government’s original offer, it was far short of the 12% the unions had been demanding.
Nor did it end the cycle of industrial unrest among nurses, who quickly found out that the PRB was far from independent.
Its members, appointed by the government, were also effectively shackled by the financial constraints their masters imposed. Yet again, pay awards lagged behind inflation.
With revolutionary change impacting on nursing practice, such as the introduction of primary nursing, the political landscape was changing at lightning speed.
In its second term, Margaret Thatcher’s government, espousing a free market philosophy, took on the previously all powerful National Union of Mineworkers and, after a year long dispute that split the country, smashed them and, apparently, the whole trade union movement.
It had already broken the consensus approach to managing the NHS and imposed a structure of general management, despite huge opposition from nurses, who saw their own management structures dismantled and their status in decision and policy making even further diminished.
In the autumn of 1987, with cuts in real terms funding adding to a growing sense of crisis, doctors in Birmingham alleged a baby’s death was directly linked to a shortage of specialist nurses.
Journalists pursuing the story found nurses tripping over themselves to denounce the state of the NHS and the difficulties that they faced providing adequate care for their patients.
When it was discovered the government were planning to stop unsocial hours’ payments, what hadn’t happened in 50 years was all over the front pages.
Nurses, with no support from any other health workers, were taking on the government over pay and the needs of their patients.
If the 1982 dispute had seemed like long months of long trench warfare, nurses adopted guerrilla tactics this time round. Thirty seven Manchester nurses struck the first blow with a 24-hour strike in November 1987.
Chaos ensued, with nurses all over the country wanting to follow their lead, regardless of their union or workplace.
One nurse preparing for industrial action was quoted as saying: “The vote for strike action… was absolutely unanimous.
“We want the full percentage pay rise we are asking for. We also want to ensure that there will be no more cuts affecting patients. Enough is enough.”
Nurses at London’s Maudsley Hospital were on strike the following February. Next day, nurses were mounting picket lines at hospitals across the capital.
With the RCN sticking to its ‘no strike’ policy, nurses were jumping from the college to COHSE and vice versa based on their personal beliefs about the ethics of industrial action.
Pay, however, was far from the only issue. COHSE was demanding an end to NHS cuts and for a 2p tax cut the Tories were proposing be shelved, with the saving being used to fund the NHS.
As the weeks advanced, however, it suited both the government and unions – still split on tactics and objectives – to head this unruly, nurse led dispute onto familiar territory. Negotiations focused on a new clinical grading system.
With nurses continuing to demonstrate and take action in different places – including a 12-day walkout at the Maudsley Hospital in September 1988 – it seemed agreement had been reached on a revolutionary new structure that would finally reward nurses for the work they did.
Yet again, hopes were dashed. Employers secretly got together to tie nurses to a grading structure that was affordable.
For them. Nonetheless, the dispute of 1988 produced an average 15.6% pay rise, though some nurses did better than others.
The political power of nurses unwilling to be subdued into submission was shown when, in the autumn of that year, having continually said there was no extra money to fund the NHS, a Conservative government that had defeated the miners and were, apparently, all powerful having swept to three electoral victories in a row, reversed their policy and allocated £1.8bn of additional funding for the NHS, the equivalent of the 2p in the pound nurses campaigned for.
If this was the high water mark of nurses’ clinical militancy, reversing government policy on both pay and funding, the consequences were to impact nursing for the next 35 years.
The government introduced NHS trusts as a means to reshape policy and break up the previously national nature of the service. A key part of the legislation was the introduction of gagging clauses.
For years, nurses were rarely seen in the media complaining about the quality of the service. The PRB remained in place, rarely delivering adequate pay rises for nurses and 120,000 nurses lodged appeals against the grades they were awarded.
The cost of representation at the appeals, many of which were held at local, then district and regional levels, was high, with all unions losing large numbers of stewards.
COHSE, losing the battle for members with the RCN, merged with other public sector unions to form Unison. But this move failed to find a strong voice for nursing in its huge ranks.
Sporadic outbursts of discontent followed, as nurses either threatened or took limited action to redress years of low pay.
But it took 12 years of austerity and economic mismanagement by successive Conservative governments for a new precedent to be set – a national strike by the RCN.
The way in which the national media has reported it not only denies nurses’ history. In many ways it perpetuates a narrative of nurses as meek and subservient, subordinating their needs to the service.
It’s particularly disappointing, as it’s notable that women were at the forefront of almost all these momentous struggles, particularly in the early part of the twentieth century.
On those occasions, the reality didn’t just contradict that, it told a deeper truth. Nurses saw their rights, their welfare and needs inextricably entwined with those of their patients, campaigning and fighting for both.
The 2022-23 dispute has seen that fire re-lit. It’s also seen nurses taking agency over their destiny for the first time in decades – even defying their union leaders to reject a pay offer recommended to them.
Wise employers would grasp this as a moment to support nurses and begin building a new, collaborative relationship with nurses as a means to try and rebuild a service and profession done untold damage by 12 years of government policy.
Chris Hart is an independent nurse consultant