Dr Stephanie Kirby

Kirby S (2001)The London County Council Nursing Service 1929-1948. Faculty of Medicine and Health Sciences, University of Nottingham. 

Contact: Dr Stephanie Kirby, Health Training and Research Centre, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol. BS16 1QY   Stephanie.Kirby@uwe.ac.uk

Abstract

This thesis explores the history of hospital nursing services within the LCC between 1929 and 1948. It contextualises the achievements of LCC nursing within the Poor Law and Local Government legacies. It argues that the voluntary hospital sector has often been held up as the standard to which other state provided services should aspire. Yet empirical evidence presented here suggests that the Poor Law and state provided services compared favourably with much that was current within the voluntary sector. Indeed the Poor Law sector revealed pockets of innovation and dynamism that positioned it positively in relation to the voluntary sector. Second the sharp distinction often drawn between the Poor Law and voluntary sectors was never maintained in practice. Nurse leaders from both sides collaborated on projects, most notably on the campaign for state registration. Collaboration encouraged by government and policy makers continued throughout the inter-war period as efforts to co-ordinate the provision of health services increased in urgency. Although these were hampered by an atmosphere of mutual suspicion leaders of both sectors came to hold similar views on the rationalisation of hospital provision. Resources were the key constraint on the expansion of service provision. Any advances made by the LCC have to be considered in the context of the strained economic climate of the 1930s and the unprecedented circumstances of World War II. It was the latter which allowed the voluntary hospitals, revitalised from the point of financial collapse by government subsidies to dominate the NHS settlement.

A paradox lay at the heart of the LCC hospital service. The development of its culture of pride relied heavily upon the trappings of tradition borrowed from the voluntary sector. Despite the rhetoric of its commitment to the chronic sick the Council organised its hospital services on a hierarchy of acuity. The 1929 Local Government Act allowed the LCC the scope for one of the largest experiments in municipal planning- the opportunity to create a London municipal hospital system. Potentially this could remove the stigma of the Poor Law from its institutions, staff and patients. Along with its physical inheritance it took over the supervision of many staff committed to and already working towards this end. Many of the medical staff in these hospitals shared the political ethos of the LCC leaders. The thesis argues that this was not so with the majority of nurses who had looked to professional recognition to rid themselves and their patients of the workhouse legacy. For the LCC leadership nursing was but one component in its hospital service, albeit one which was recognised as essential for its survival, and this in turn was only one element of its overall welfare policy for London. Therefore for nursing to benefit fully from its LCC management it had to align itself with the LCC agenda. At times this action brought its leaders into conflict with their professional body. LCC doctors were more prepared to deal with this dichotomy. Despite the fact that the LCC possessed better financial and administrative resources, it was the voluntary hospitals which had the superior reputation and the power base of the medical elite. The thesis concludes by arguing that it was the reinvention of the voluntary hospital tradition that provided the model for nationalising nursing within the NHS. Notwithstanding its achievements in other spheres the LCC failed to provide an identity politics capable of converting into a national movement for nursing.

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