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  • Alex Douglas Bailey

Part II: The Impact of the Media and Imperialism on our Understanding of the NHS

[This is part II of an extended blog piece. Part I can be read here]

... I looked to set the context in which women from African and Caribbean nations were recruited or travelling to the UK to train in the Health Service, as across the century the migration patterns would’ve changed and the reasons why would be nuanced. The largest influx of women and active recruitment took place with the creation of the NHS and whilst rebuilding post-war Britain. In brief I started with, “There was a need for the labour in particular roles - even when African women had more experience and higher qualifications from their home nations, the options for them was limited. So they had come to work in Britain, in many cases invited to work, taking away skills and knowledge from their home nations, and then kept in low earning roles doing the work that white practitioners were unwilling to do.”

The creation of a National Health Service in 1948 saw the demand for health professionals increased in unprecedented terms. Severe labour shortages existed in unpopular specialisms such as nursing the mentally ill, chronically ill and geriatric care. There was an estimated shortage of 48,000 nurses. With a national campaign failing to make much of an impact, the Ministries of Health and Labour in conjunction with the Colonial Office, the General Nursing Council and the Royal College of Nursing placed advertisements in the Nursing Press encouraging candidates from colonies to come to Britain for training. Recruitment campaigns were pursued with senior nurses visiting commonwealth countries for this purpose.

The number of people working in nursing and midwifery increased by 26% in less than a decade (1949 - 1958). The British Nationality Act of 1948 came into force on the 1st of January 1949. Section 4 provided that a person became a citizen of the UK and the colonies by birth if they were born within the UK and colonies. With respect to health care workers, the bill effectively created an imperial market in nursing labour and set the scene for a subsequent influx of international labour through recruitment campaigns. Amendments to the 1949 Nurses Act allowed fast recruitment of nurses from colonies. Where the colonies themselves did not meet General Nursing Council standards, individual nurses were placed on adaptation training programmes on arrival in Britain.

The 1949 initiative by the National Advisory Council on Nurses and Midwives to encourage colonial territories in sending student candidates to the UK for nurse training. This would allow the trained nurses to provide care in their countries, sparing British nurses, and while training, serve the NHS. Between 1948 and 1973, as many as 100,000 nurses arrived from Africa, South East Asia and the West Indies to work in ‘Cinderella’ specialities such as sexual and mental health where there were acute shortages of staff. This focus on nursing is important, as many of the women we have interviewed, including ones who now practice in other disciplines, such as GPs, midwives or scrub nurses, started their training in nursing and subsequently moved.

Flamingo, October 1961

I tried to provide a brief insight into a few issues that would’ve impacted these women who had been recruited and lived in the UK. Firstly, the limited roles and opportunities afforded to these women were often less desirable, even when they were qualified in higher positions in their home nations. Secondly, on an institutional and interpersonal level the colour bar would affect the home and professional lives of these women, as issues of migration, government spending, integration, and numerous social issues became ‘colour’ issues. Finally, though not the last of topics YHP have uncovered, I discussed how the changing state of these women’s home nations would then influence the experiencing of training or practicing in the British Health Service. I used the story of Princess Tsehai Selassie as an example of how the context of the Ethiopian occupation by Italy, the Selassie family’s expulsion and her role in Public Health influenced her training in England. From this point onwards we were able to discuss in what instances would African women return to their home nation and when they wouldn’t. There are a number of factors that would influence this: British government policy, the stability of their home nation, opportunities afforded to them pre and post-independence, the standards of training and hospitals, etc.

Although we cannot apply broad strokes to this experience as the situation is so nuanced, I’d argued for some African women who would then return to their home nations had hospitals ran by the Colonial Office and linked to British hospitals which provided opportunities for women to travel to the UK to train and then return to a similar standard of hospital. There was instances of British government intentionally utilising temporary labour of African students to facilitate the NHS so stipulated in their contracts to ensure students returned home, and lastly if the intention of these women was the return home and build up the infrastructure there, then its likely they would. In other instances, it wasn’t an option to return home – some of these women had been offered work in the UK and settled into life here.

We did not have enough time to discuss what this meant for the African nations that were then left to experience the aftermath of 'brain drain' but its something I’m deeply interested in and definitely do not have all the answers to. A Brain Drain broadly means skilled individuals migrating to live and work in another country where there are more opportunities, and likely better pay. This results in a gap in the industries and skills for the nation of origin, and can result in poor development of those fields as they cannot compete to keep these individuals or attract new workers. In the context of our project we’ve defined Brain Drain as the recruitment of African healthcare professionals resulting in detrimental impact of healthcare on the African continent.

In relation to the contemporary ideology behind the NHS as this beacon of a social welfarism: the two things that have struck me in discussions of a post-Brexit NHS without migrant workers, and the ongoing issue of the cost of the NHS. One is that the NHS exists to the detriment of others, it’s an entirely privileged system that we in the UK benefit from, as the funding and labour can in many ways be attributed to the British Empire. Two, how can we advocate for free healthcare for all without celebrating the negative impact the NHS, upheld by the racist British government, as an institution has had?

As other institutions in Britain exist and benefit from its privileged position in the global market, the NHS does too, and the development of this capitalist nation cannot be separated from colonialism. Considering the need for staff shortages in the 1940s and 50s and effort to rebuild post-war Britain, you could even consider intentional underdevelopment of newly independent nations as part of the decolonisation process.


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