Protest to save hospital from closure (Pic: John Sturrock)
Racists never tire of telling us that migrants overwhelm the NHS. In fact the health service has relied on people from all over the world coming to Britain since it was founded in 1948.
The NHS was created just as the Empire Windrush first docked in the port of Tilbury with its 492 Jamaican passengers. The flow of West Indian migrants could not have come sooner for bombed-out Britain’s ravaged economy.
Detailed reports showed Britain was short of a staggering 54,000 nurses. Without them, the fledgling health service could not begin to deliver on its promise to provide free health care to everyone.
But attempts to recruit British-born women fell flat. During the Second World War, women had flocked into nursing as part of the war effort.
But now many single women saw hospital work as unattractive with its long hours and low pay.
Nursing was seen as a profession for single women, who would choose whether to work their way up to better paid positions or to marry and have children. Married women were expected to leave their jobs.
A panicked Ministry of Health announced a plan of mass recruitment for all kinds of NHS jobs from the Caribbean in 1949.
West Indian newspapers were flooded with offers, including the payment of fares.
In the West Indies the cost of living had doubled during the course of the war. There was mass unemployment and those without jobs were desperate.
So thousands of West Indian women answered the call. In 1954 more than 3,000 Caribbean women were training in British hospitals.
Five years later numbers had doubled. And, by 1966, there were some 16,745 overseas trainees—nearly three quarters of them from the West Indies.
Trainees generally lived in nurses’ homes attached to hospitals because racist landlords would not let to them. But the regime was strict and the accommodation basic.
Management often preferred overseas nurses because they assumed they would be less likely to complain about conditions.
Even those nurses who arrived fully-trained found that reality rarely met expectations.
Beryl came to Britain from Barbados. “For many of us, it was better at home than when we came to Britain,” she told researchers for Eastside Community Heritage.
When I got married, all my husband could afford was a bedsit and that didn’t even have a bathroom.
“We had to use public conveniences for baths. It was hard. We had come over here because we were asked.”
Nurses from overseas often reported good working relationships with white colleagues and patients.
But many also had to put up with terrible racism on and off the job.
“I loved caring for people but I got ill so I could not continue with my job,” said Blanch, a psychiatric nurse.
“The management made it difficult —the racism was bad at that time. I didn’t think of it as racist then, but I was made to leave.
“It was not until afterwards when you look back, you can think back and say that was racist. It still hurts me to this day, that I was treated so badly at work.”
Legislation passed by successive governments reinforced the impression that migrants were a burden on Britain.
But all the while the NHS was still desperately recruiting staff from the Commonwealth.
By the 1960s doctors were the key shortage. As British-born doctors left the country for more lucrative jobs overseas, health bosses sought out replacements from India, Pakistan, Bangladesh and Sri Lanka.
And, just like the Caribbean nurses before them, promises made were rarely kept.
Unable to rise to consultant level in hospitals, many newly arrived doctors were forced into the most run-down inner-city practices vacated by white doctors heading towards the suburbs.
After completing his training, Dr Stanley Moonsawmy worked as a temporary doctor in Edinburgh. But he found it difficult to get a permanent post in a teaching hospital.
He was advised to emigrate but instead, like many others, opted to become a GP.
“[At that time] There were a lot of stories in tabloid newspapers about foreign doctors in Britain often in stereotypical, rather derogatory way,” he told the book, Many Rivers to Cross.
“I ended up in a village just on the edge of Edinburgh, which was a mining community…I did encounter problems in my first one or two years here….
“Quite a few of my patients heard that I was a foreign doctor and disappeared completely by registering with other practices.”
Stanley says that he had to work doubly hard to prove himself but that eventually his determination won over his patients. And, 30 years later, he and his practice were still firmly established in the city.
The economic crisis of the 1970s and 1980s ushered in huge NHS cuts. Waiting lists grew, pay fell rapidly and staffing levels were slashed.
In the face of such attacks, many nurses no longer felt they enjoyed “professional status” and started to look to the trade unions to help them fight.
By the 1979 Winter of Discontent the feeling had spread to nurses. “Thousands left the moderate Royal College of Nursing to join Nupe and Cohse,” says former nurse and union activist, Jim Fagan.
“They were itching to strike and black nurses often led the action because of the appalling way they had been treated.
“In fact, I think that black nurses played a crucial role in turning unions into a force in the hospitals.”
‘The girls are changing—they know striking is the only way’
Socialist Worker interviewed domestic assistant Cynthia Samuels, a black Nupe steward at St James’s Hospital, Leeds, during the Winter of Discontent (3 February 1979).
“I’ve been working in the hospital for 13 years. We used to work happily, but it has changed for the worse now.
“The workers have become angry and unhappy. You find them getting at each other because they are working harder and getting nothing for it.
“Until recently it was always, ‘Oh no, we can’t strike’. Now we’re all out together for a living wage. It amazes me what’s happening. I’m not shy any more. When you’re angry you have to fight.
“Now we’re fighting the girls are changing for the better. They have had enough. They know that striking is the only way. I used to be timid, but know I’m brave because of the change in the girls.
“I used to wonder if it made any difference to some of the women, me being black. But they don’t take any notice of my colour. They just say, ‘If we didn’t want you, you wouldn’t be our shop steward.’
“We [Cynthia and her husband Edwin] became socialists in Jamaica when we joined the People’s National Party in 1946. In Jamaica socialists could hardly walk on the street for fear of violence.
“If a prime minister in Jamaica told people to cross a picket line like [British Labour leader] Jim Callaghan did there would be bloodshed!
“In 1959 we came over to Britain. There was no work in Jamaica. Oh yes, they wanted us to do the work English people wouldn’t do. Now some people are jealous of us.
“We worked hard for what we’ve got and we won’t give it up under Tory or Labour.”
‘I was treated like I was second rate’
Shah Kirtikumar is a GP in Tower Hamlets, east London. He spoke to Socialist Worker about the experience of coming to Britain. He trained in Bombay and had worked in Kenya as a medical officer, overseeing 50,000 patients.
“Then I moved to Britain to work in the NHS. Despite my experience, I remember very clearly a young white doctor asking how I felt I’d fit in. I was sometimes treated as second rate though my qualification was quite as good as theirs.
“I faced racism, even from doctors. It was subtle. I felt the atmosphere change as I walked into the rest room. I coped because of my experience, but I wouldn’t have liked to be a young doctor there.”
Stuck on night shifts and in lower grades, the fight against racism fed the fight against cuts
Black workers didn’t only build the NHS—their struggles against racism went to the heart of battling attacks on the service as a whole.
In 1975 bosses closed 48 beds in NHS wards at Westminster hospital in London because of staff shortages. All beds on private wards remained open.
Some 400 workers, members of the Nupe union, went into battle with bosses by going on a work to rule.
Workers elected five black women auxiliaries to negotiate their demands that at least some of the private “pay beds” be closed.
They received racist letters and even a bomb. But they were defiant. The dispute meant that bosses—and the union—had to take them seriously.
One of the five women said, “My first experience of strike action was 1972. It was a wonderful experience striking. We marched and shouted. From 1972 to today we have had to fight for everything we have since won.”
Nursing training at that time was divided into two paths. Most overseas students found themselves pushed into the lower status state enrolled nursing (SEN) courses.
This was despite the fact that most applicants were more than qualified to undertake the better state registered nursing (SRN) course.
They were shunted onto night shifts and menial tasks, rather than the nursing duties they had expected.
Nurses were expected to be single women. If they took time off to have children they lost all seniority and no flexibility was offered for child care.
One Jamaican SEN explained in 1971, “Most of the night staff are black. Night nurses are black because they have children and it’s more convenient to be at home in the days to see after the children.
“If you work days you’re not there to send 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.”
But in 1971 night cleaners came out on strike for the first time. Their demands included more money and shorter hours of work.