Shortages and Their Solutions

In the fall of 1948, Vera C. Allen, the nurse matron of Scunthorpe War Memorial Hospital, was busy crunching numbers. According to a Nursing Times report from the previous year, her hospital had 235 beds and hoped to open fifteen more. Its radiotherapy and outpatient clinics already served the whole of Lincolnshire. Hospital planners were avidly designing a new children's ward, potentially followed by a new women's ward. The walls had even been repainted.Footnote ²⁰ But as the Yorkshire Post reported, Scunthorpe's various expansions had not been matched by expansions in staff, and now there were not enough nurses to meet patient demand. Allen calculated that she needed just twelve more. This magic number would allow her to keep all the beds open, serve as many patients as possible, and allow the new construction to proceed. But when her advertisements in local newspapers and nursing journals went unanswered, Allen had another idea. She decided, it was reported, that “Nigeria might be a good recruiting ground” indeed.Footnote ²¹

Vera Allen was not the only one puzzling over her staff lists. Nursing was vital to the success of the brand-new NHS and the reconstructive project it represented. As hospitals up and down the country accepted thousands of new patients, they were also desperate for nurses to care for them. The crucial question facing hospital administrators, civil servants, nursing leaders, and matrons like Vera Allen was, quite simply, how to recruit more staff. Middle-class nursing leaders held that nursing needed to establish itself as a skilled, trained profession. From their specialist positions in teaching hospitals, professional organizations, and the civil service, they argued that professionalization strengthened nursing's voice in the medical hierarchy and attracted middle-class girls otherwise loath to pursue a trade. But professionalization so divided nursing that not even high-ranking nurses could implement structural changes or long-term solutions. When these efforts came up short, hospital administrators and matrons took matters into their own hands. They frantically looked for more nurses wherever they could—including overseas.

Nursing has always struggled to define itself as separate from domestic work and more than “the physician's hand.”Footnote ²² Florence Nightingale may have wrenched the practice of nursing away from the sloppy Sarah Gamps of Charles Dickens, but the perception that nurses conducted unimportant “women's work,” or unthinkingly carried out a physician's orders, remained all too operative in the hospital hierarchy. Dissatisfied with their position, upper- and middle-class nurses seized upon education as a means of improvement. Just as nineteenth-century physicians gained status by restricting entry to the profession, the nursing professionalization movement argued that only those who completed a standardized training program should call themselves nurses. This training invested nurses with technical expertise, the defining attribute of skilled professions, and justified higher status and pay; it also excluded domestic workers and working-class women from the profession by default.Footnote ²³ The First World War made nurses visible to the wider public and galvanized their calls for reform. They were subsequently rewarded in 1919 with the passage of the Nurses Registration Act, which created both a register of nurses and a regulatory body, the General Nursing Council, to oversee it. Throughout the interwar period, nurses organizations’ such as the National Council of Nurses and the College of Nursing—the latter received a royal charter in 1936, to become the Royal College of Nursing—continued to advocate higher standards in nursing education.Footnote ²⁴

The expansion of the postwar state provided an opportunity for the nursing professionalization movement and its leadership, by now increasingly concentrated in the Royal College of Nursing. To administer welfare on a national scale, the state required vast personnel, not only civil servants but also professional experts: social scientists, statisticians, urban planners, and physicians. They provided the state with the technical knowledge necessary to implement policy; the state enhanced their status and clout by employing them.Footnote ²⁵ Though nurses have not typically been included in this story, the need for professional expertise extended to them as well. The Ministry of Health and the Ministry of Labour both created positions for professional nursing officers in 1941 and 1943. The nurses called upon to fill these positions were some of the most qualified and well connected in Britain. All belonged to the Royal College of Nursing. The Ministry of Health tapped Katherine Watt, the matron-in-chief of the Royal Air Force Nursing Service. Her deputies were Elizabeth Cockayne, matron of the Royal Free Hospital, and Mabel Gordon Lawson, a Scottish physician who retrained as a nurse in her thirties and rose to become supervisor of all London County Council training schools. The Ministry of Labour hired Bethina Bennett, former matron of the Battersea General Hospital and the first-ever holder of Leeds University's diploma in nursing. “She always appended that qualification to her name with pride,” recalled one of Bennett's former colleagues.Footnote ²⁶

While ward sisters supervised the care of patients on the ward, and hospital matrons exercised administrative control over nursing in individual hospitals, the new nursing experts administered policies that affected tens, hundreds, and even thousands of hospitals. They managed and allocated nursing resources—funding, equipment, and labor—within the context of vast bureaucratic and administrative regimes where specialization connoted status. Their remit was both national and international. The Allied Control Commission and the United Nations Relief and Rehabilitation Administration hired British and Canadian nurses to supervise the reconstruction of nursing in continental Europe. When the organization wrapped up its work in 1947, several of its nursing officers joined the newly formed World Health Organization. Nursing had become a field where it was possible to have technical expertise, and those nurses who could claim specialized knowledge were now highly sought after—albeit as female emissaries of a female-dominated profession.Footnote ²⁷

However, the majority of nurses working in Britain had yet to see professionalization's payoffs. The day-to-day work of nursing remained difficult and laborious. Working conditions had long been a source of contention. In a 1934 Nursing Times article, “Staff Nurse B” described her daily routine at an outpatient clinic as one of furious dusting, scrubbing, and polishing, always with one eye on the clock. “At school and college I learned a lot of things, but not domestic science,” she complained. “But of course I did not know then that I'd ever be a trained nurse and need that most useful art.”Footnote ²⁸ Student nurses felt this burden even more keenly. Too often they were treated not as students but as “pairs of hands” carrying out routine, iterative tasks: cleaning bedpans for hours at a time, every day on duty.Footnote ²⁹ Unimpressed by the conservative ethos and polite advocacy of the middle-class Royal College of Nursing, many working-class nurses turned to trade unions, such as the National Association of Local and Government Officers and the Transport and General Workers Union, to represent them. Wages and work dominated the agenda. In September 1937, the Trades Union Congress unveiled a full charter for nurses that called for overtime pay and four weeks' annual leave. This massive challenge to the professionalizing movement only deepened a growing fracture between the profession's middle-class leadership and its working-class rank and file. It also seriously alarmed the government. In response to the Trades Union Congress charter, the minister of health launched an inquiry on nursing conditions in November 1937.Footnote ³⁰ Its findings—that hospitals needed to reduce working hours and increase salary—were never put into practice. The war put such plans on hold.Footnote ³¹

The launch of the NHS, with its heightened demand for nurses on the wards of its hospitals, underscored the consequences of this prewar failure to make nursing a more lucrative and attractive profession for more women. The supply of qualified nurses simply could not keep up with demand. Derbyshire hospitals, for example, reported an increase of nursing staff from 1938 to 1948, but this modest improvement still did not furnish all the district's hospitals with needed staff; the Derbyshire County Council had no choice but to close wards that, with more nurses, could have housed 403 patients across the district.Footnote ³² Thirty miles west, Nottinghamshire hospitals reported a similar loss of 344 beds countywide.Footnote ³³ The Holland County Council in Lincolnshire closed the area hospital's maternity ward for lack of trained midwives, leaving expectant mothers to travel fifteen miles away for services.Footnote ³⁴ On top of that, Lincoln district hospitals needed 241 more staff nurses.Footnote ³⁵ The quality of service in the remaining wards continued to suffer. Quoting a previously published letter, the London Star reported a new mother's observation that the sole midwife in her London maternity ward conducted deliveries only “in between serving breakfast to other patients,” and the Nursing Times reported that one hospital ward in Northamptonshire had but one nurse to care for sixty patients.Footnote ³⁶ The country's mental hospitals looked equally hard hit. In 1949, the British Journal of Nursing reported that nearly two thousand beds in public mental hospitals nationwide had gone unused for lack of staff. Given that these hospitals provided most of the nation's care for the mentally ill, their potential closure threatened dire consequences.Footnote ³⁷ Widespread closures of wards and beds throughout Britain threatened to disable the NHS at the very moment of its creation. The stakes of finding trained nurses were high. This proved no simple matter.

Problems within British nursing were further exacerbated by developments outside it. When Canada and Australia found their own reconstruction efforts stymied by lack of staff, their solution was to recruit trained British nurses. This action predictably exacerbated Britain's own precarious position. It revealed competition for scarce resources—the labor of nurses—among seeming partners. Canadian officials at the Commonwealth Relations Office made overtures to the Ministry of Health to set up a scheme for recruiting English “girls with experience in nursing.”Footnote ³⁸ The Australians were yet more forceful: Australian hospital representatives traveled to Britain to recruit and placed advertisements in British papers. Australia's minister for immigration offered priority passage on Australia-bound ships for single women willing to take up nursing.Footnote ³⁹ One regional nursing officer in London described it as a “pity” to see trained nurses leave a country that needed them.Footnote ⁴⁰

What to do? The nursing shortage resurrected the interwar debate over professionalization and nurse training, but its urgency did not create clarity or resolution. The nursing professionalizers had instituted a three-year training period for registered nurses in the 1920s.Footnote ⁴¹ By the Second World War, it was a protracted process that students often failed to finish, if they could be induced to begin at all. As reported in a Nursing Times article in 1943, Bethina Bennett and her colleagues at the Ministry of Labour calculated that anywhere from 36 to 50 percent of first-year nursing students became unhappy with their conditions and dropped out during the course of training.Footnote ⁴² In 1947, a Ministry of Health working party commissioned to study the shortage recommended that hospitals jettison the third year entirely, which could be done if students spent less time on the wards.Footnote ⁴³ A two-year training program produced more nurses, more quickly; it was also less arduous for the students. But much of nursing's old guard, concentrated in the Royal College of Nursing and the General Nursing Council, which oversaw the nurses’ register, saw ward work, and the concordant third year, as essential to creating good nurses.Footnote ⁴⁴ Without time on the wards, they asked, how would students learn to shoulder a nurse's many responsibilities? The two-year program promised more nurses but not better ones. “You cannot jump into a state of grace as a responsible nurse just because you have passed an examination,” wrote former Royal College of Nursing president and Guy's Hospital matron Emily MacManus.Footnote ⁴⁵ The college's own Nursing Reconstruction Committee recommended a four-year training program so that students could have more experience with specialist branches of medicine, arguing that such robust training increased the status and attractiveness of nursing. The debate deadlocked. Without a decision, the opportunity to improve conditions for the wider nursing profession, and to solve the shortage in the long term, went unrealized.Footnote ⁴⁶

In the short term, the only solution on offer was to expand the labor pool. When the Ministry of Labour's domestic recruitment campaign failed, it looked to Ireland and continental Europe for nurses. Once the Irish government lifted restrictions on women's emigration in July 1946, British hospitals quickly moved to recruit from this “reserve army of labor,” yet it still proved insufficient.Footnote ⁴⁷ Another pool of labor lay in Europe in displaced-persons camps. From 1946 to 1947, Ministry of Labour officials recruited three thousand women from Germany, the Baltic states, and Ukraine to work as domestics in tuberculosis sanatoria, a precursor to the wide-scale recruitment of displaced persons for the agriculture and textile industries.Footnote ⁴⁸ However, labor shortages across Europe soon put an end to these schemes and others like them.Footnote ⁴⁹ When the Middlesex County Council placed advertisements for nurses in the Dutch press, both the Dutch government and the Dutch nurses’ association protested on the grounds that their country, too, needed its nurses.Footnote ⁵⁰ News of a Kent hospital's independent and unsanctioned recruitment in Sweden prompted Daisy Bridges, a member of the Royal College of Nursing and general secretary of the International Council of Nurses, to write wearily to the Ministry of Health, “Once again I have come to ask for your help in trying to prevent a practice which makes us so unpopular in other countries.”Footnote ⁵¹

Some looked further afield. When Vera Allen placed short advertisements in three Nigerian newspapers, she received over two hundred applications and letters of interest within a matter of weeks. All applicants, the Yorkshire Post reported, were willing to pay their own passage.Footnote ⁵² Allen's recruitment strategy anticipated the recruitment campaigns of the transport and manufacturing industries, which also turned to Britain's empire, particularly the Caribbean, where unemployment was high.Footnote ⁵³ Following these early campaigns, men and women from the Caribbean journeyed to Britain with the intention of finding work on arrival. Some were nurses, others would-be nurses. They either traveled to Britain with offers from hospital training schools in hand, or, knowing that there were positions available, planned to search for a place once they arrived.

The unwitting handmaiden of this recruitment and migration was the British Nationality Act of 1948. Formally approved the same month that the NHS launched, the act replaced Britain's existing categories of citizenship and subjecthood with a new, all-inclusive category: “citizenship of the UK and Colonies.”Footnote ⁵⁴ This new category conferred on its bearers the unrestricted right of entry to the United Kingdom. It made legally possible the mass movement of people from the Caribbean, Africa, and India to British shores—five hundred thousand inside a decade. The Labour government did not explicitly acknowledge that these two landmarks of post–World War II Britain were connected. But in all sorts of ways, they were. Bivins has pointed out that the NHS was launched the same month that the HMT Empire Windrush arrived at Tilbury Docks in Essex—a coincidence in the calendar that nevertheless reveals the intertwined nature of migration and health care provision.Footnote ⁵⁵ In popular narratives of postwar Britain, the Empire Windrush has become the singular moment that brought contemporary, “multiracial” Britain into being; the NHS, now one of contemporary Britain's most-loved institutions, relied on migrants and migration to function.Footnote ⁵⁶ The passage of the act ensured that these stories were entwined from the outset. It provided the legal foundation on which the NHS—and its diverse nursing staff—were built.

The British Nationality Act had never been designed to facilitate migration. Its beatific bestowal of unified citizenship was not a response to labor shortages but to Canada. The Canadian government had passed its own Canadian Citizenship Act in 1946; in a reversal of previous citizenship law, the act recognized that Canadian residents were Canadian citizens first and that their obligations as Canadian citizens came ahead of their obligations as British subjects. In response, the British Nationality Act reasserted British subjecthood—now termed “citizenship”—as a meaningful avenue by which Commonwealth residents might identify with the metropole. It imagined and projected a unified Commonwealth under British direction, while also attempting to shore up the loyalty of the white dominions to it.Footnote ⁵⁷ Relatedly, no part of the Labour government ever wished to embark on a large-scale labor recruitment campaign in the nonwhite regions of Britain's empire. They claimed that potential migrants of color would face too much discrimination and have too much trouble “assimilating” to British culture—despite being legal British citizens—for it to be worth pursuing.Footnote ⁵⁸ As Kathleen Paul has noted, policy makers were reluctant to encourage any overlap between the political community of Britishness, encapsulated in the multiracial Commonwealth, and the domestic community of Britishness, coded as white.Footnote ⁵⁹ But here, and as the case of colonial nursing will demonstrate, official efforts to maintain the Commonwealth, and Britain's relationship to it, came with unexpected consequences that rebounded on their architects.

Nursing Development

The project of welfare “at home” was mirrored by a similar project of reconstruction, development, and welfare in Britain's colonies. Far from retreating from empire during and after the war, Britain expanded its colonial projects and earmarked millions of pounds for the empire under the auspices of the Colonial Development and Welfare Acts of 1940 and 1945.Footnote ⁶⁰ These were truly massive outlays for a country in wartime, but British colonial officials felt there was no other choice. Just before the outbreak of war, labor strikes and political unrest in the West Indies and Africa rocked the foundations of imperial governance by demonstrating the deep dissatisfaction of the governed.Footnote ⁶¹ Internal investigations, most notably the West India Royal Commission, revealed that the Colonial Office had allowed living conditions and public services to completely deteriorate on its watch. Indeed, the commission's findings regarding the dismal state of public health in the Caribbean were so inflammatory that Secretary of State Malcolm MacDonald refused to publish the bulk of them until after the war concluded.Footnote ⁶² Emerging from this political maelstrom, the Colonial Development and Welfare Acts signaled the newly important role of social services and health care—welfare—in Britain's benevolent empire. Investment in, and development of, colonial public health services were intended, literally and figuratively, to rehabilitate the health of the empire.Footnote ⁶³

Nursing always played a role in public health in Britain, and no less so in the colonies. British nurses had worked in colonial hospitals across the empire for decades, albeit without much input from the Colonial Office, which paid little attention to nursing until the 1940s.Footnote ⁶⁴ Instead, it outsourced most nursing matters to a private organization called the Overseas Nursing Association. Founded in 1896 by the wives of British colonial officers, the association initially provided white nurses for the white men of empire.Footnote ⁶⁵ In its origin story, these brave nurses protected young men, “delicate women,” and “small children” from the “terrible risks and trials” of the “tropical and often unhealthy climates” in which the empire called them to serve.Footnote ⁶⁶ The association's goals diversified as its stature and outreach grew. By the 1930s, it not only provided nurses for private hospitals treating European patients but also became responsible for furnishing colonial hospitals with senior nursing staff, who then taught nursing to local women.Footnote ⁶⁷ But when the Colonial Office became directly involved in creating colonial nursing policy after the war, its interests aligned with those of the NHS. The two partnered to recruit middle-class nursing students from the colonies for training in Britain and laid the groundwork for the wide-scale recruitment of colonial students and staff.

The first sign that the Colonial Office wanted to think seriously about nursing as a means to develop social services was its creation of a unified Colonial Nursing Service in 1940. Arriving eight years after the creation of a unified medical service, nursing was a belated addition to the Colonial Office's increasingly centralized personnel structure. Under the terms of the Colonial Nursing Service, the Overseas Nursing Association recruited candidates for nursing posts in virtually all of Britain's colonies; unmarried nurses working in government-run hospitals, such as those in Africa, the Far East, and the Caribbean, could apply to join the Colonial Nursing Service and receive a pension.Footnote ⁶⁸ The second sign was when the Colonial Office assembled the Rushcliffe Committee on Nursing in 1944. Its members drawn from the Colonial Office permanent staff and the ranks of elite nursing professionalizers, the committee aimed to formulate a “broadened” nursing policy in order to effectuate the “general improvement of conditions of living.”Footnote ⁶⁹ These developments were typical of the late British Empire's approach to colonial problems. It believed in technocratic and scientific solutions to wide-scale issues, and in the power of research and planning to ameliorate poor living conditions. This work required not colonial administrators but specialists and professionals: engineers, lawyers, economists, and chemists. The personnel ranks swelled. The Colonial Office employed eighteen thousand officers in 1954, compared to eight thousand in 1938. Cambridge-trained scientists studied locusts and tsetse flies; veterinarians tackled agriculture and livestock raising; architects drafted building plans for modern, renovated hospitals. That few of these specialists had ever served in the colonies did not concern the Colonial Office. Their deep knowledge of science, or agriculture, or chemistry, so the Colonial Office believed, more than made up for their lack of colonial experience.Footnote ⁷⁰

The world of colonial research and expertise was almost invariably a male preserve, but its gender bias paradoxically provided a valuable opportunity for the nursing elite. On the one hand, Colonial Nursing Service nurses struggled to make ends meet on paltry salaries—“I had not sufficient [money] left to pay for laundry,” wrote one nurse in Guyana—and the bar on married nurses prevented all but a few from accumulating long service records and pensions.Footnote ⁷¹ On the other, nursing's second-rate status in both the medical hierarchy and the colonial service meant that few outside of the profession had taken a scholarly or professional interest in it. When the state needed specialized nursing knowledge, the nursing professionalizers, who had been arguing for years that nurses possessed specialist expertise, gladly filled the gap. They easily changed gears from domestic health and welfare to colonial health and welfare, demonstrating the intermingling of these ostensibly separate spheres. The Rushcliffe committee of experts included some of the profession's most prominent figures: the secretary of the Overseas Nursing Association, M. Gawan Taylor; the matron-in-chief of the London County Council nursing service, Rosalie Dreyer; the Royal College of Nursing's director of education, Hester Parsons; and from the Ministries of Health and Labour, Katherine Watt and Bethina Bennett.Footnote ⁷²

The partnership between colonial policy makers and nursing leaders was further cemented in 1946, when the Colonial Office hired forty-six-year-old Florence Udell, a public-health nurse and prominent member of the Royal College of Nursing, to serve as its first-ever chief nursing officer. In choosing Udell, who had never before held a colonial post, the Colonial Office once again hired not the administrator who “knew his natives” but the specialist who “knew her field.”Footnote ⁷³ After becoming a ward sister in her twenties, Udell held a series of progressively responsible posts in the Royal College of Nursing and the Civil Nursing Reserve until her appointment as chief nurse for the European section of the United Nations’ Relief and Rehabilitation Administration in 1944.Footnote ⁷⁴ Meticulous in her work and forthright in her opinions, Udell now took responsibility for the entire Colonial Nursing Service as well as the colonial students recruited for nursing in Britain. Her trajectory highlights how the professionalization movement in nursing provided the domestic welfare state and the colonial bureaucracy with its leadership. These women came of nursing age in the era of professionalization and now shaped Colonial Office nursing policy in their own image. They aimed for nothing less than to create a body of middle-class professional nursing leaders—rather like themselves—who could “plant the seeds” of the nursing profession in their respective colonies, champion public health and preventive care in an empire that badly needed it, and fly the flag of British nursing and British nursing education on the world stage.Footnote ⁷⁵

The ideal locus of these efforts was the colonial training school. The professionalization movement in Britain so championed education as the path to professional status that its standard bearers were hardly about to change tack in the colonies. The Rushcliffe Committee envisioned that British nurses with administrative and teaching experience could “raise the standard” of local training schools to the level of their British counterparts, and that the entire work of nursing development could therefore take place within the colonial hospital.Footnote ⁷⁶ But the largesse of the Colonial Development and Welfare Acts could not make up for decades of disinvestment in colonial social services. Colonial hospitals remained poorly equipped to train nurses to the standard envisaged by the committee. The matron of the Roseau Hospital in Dominica, Denise Dane, struggled to find textbooks for her students and amenities for their accommodations. “I only wish we had more money,” she lamented to M. Gawan Taylor.Footnote ⁷⁷ Qualified nursing instructors were in desperately short supply. Without them, nursing sisters scrambled to fit instruction into the daily schedule of the wards.Footnote ⁷⁸ “We badly need a tutor,” wrote the matron of the Barbados General Hospital, Eva Atkinson, in 1944. “We are expecting far too much of the nurses on [such a] small amount of tuition.”Footnote ⁷⁹

Other training programs were handicapped by financial and bureaucratic bottlenecks. Midwifery sister Jean Holland, hired to open a Colonial Development and Welfare–funded midwifery training school in Barbados, arrived in that colony in March 1947 to discover that her new hospital had no lecture room, linens, sluice, sterilizing autoclave, or obstetrical forceps. The difficulty of securing further funding to make these improvements was so great that Holland paid for a sewing machine and the installation of a hot-water tank herself. “I should not like you to imagine me either idle or sitting down saying ‘beaten,’” she wrote to the Overseas Nursing Association shortly after arriving.Footnote ⁸⁰ But out of concern for patient safety, she refused to open the hospital without a functioning sluice. Her stance antagonized the island's chief medical officer. “Please don't imagine I am sorry I came,” she reported in August, “but . . . our Chief Medical Officer here is going around telling the doctors that he has no use for either Dr. Muir”—the hospital's consultant obstetrician—“or myself.”Footnote ⁸¹ Impatient to open the hospital, he fired Holland that November;Footnote ⁸² she never held a colonial post through the Overseas Nursing Association again.Footnote ⁸³ In Barbados, however, her dismissal solved few of the hospital's problems. It took the Overseas Nursing Association a year to find a permanent replacement for her, and the opening of the training school was further delayed.Footnote ⁸⁴

Badly under-equipped and underfunded, colonial training schools could not possibly fulfill the British state's expectations to provide high-quality nursing education for the empire's nursing students. This prompted many Caribbean and African women to apply for training in Britain. In 1943, the London County Council sponsored twenty women to take up nursing training in its hospitals, and though the scheme was small in scale, it pointed to an emerging trend—one met with ambivalence.Footnote ⁸⁵ The colonial and nursing experts welcomed training nurses for and in the colonies; they also supported colonially trained nurses who sought postgraduate and specialized qualifications in Britain.Footnote ⁸⁶ But they balked at the potential arrival and admission of “unsuitable girls” to British training schools, where such women might “prejudice the success of attempts to place those [nurses] who really were suitable” to lead the profession in future.Footnote ⁸⁷ Some British matrons posted in the colonies spoke even more bluntly. When the Rushcliffe committee entreated the matron of the Colonial Hospital, Port-of-Spain, to weigh in on this point, she left no illusions about where she stood: “There was a considerable risk of failure when you sent home girls, about whose potentialities one knew very little,” her recorded testimony reads, “for three or four years’ training in the United Kingdom.”Footnote ⁸⁸

In response to the shortcomings of training schools in the colonies and the increased interest of colonial students in coming to Britain, the welfare department of the Colonial Office, the Ministry of Labour's nursing branch (their participation on the suggestion of Bethina Bennett), and the Ministry of Health created a centralized scheme to handle incoming applications from colonial students and place a select number in British training schools. While a small number of hospitals refused to train colonial students—Dewsbury Infirmary, in West Yorkshire, “thought it inadvisable”—far more were happy to partner with the Colonial Office when asked by Florence Udell.Footnote ⁸⁹ Their interest, while not insincere, nonetheless reflected their need for nursing staff. For example, on a routine visit to the Wrightington Sanatorium in Lancashire, Dorothy Bott, a nursing recruitment officer at the Ministry of Labour regional office in Manchester, mentioned the colonial scheme to the hospital's medical superintendent, Dr. Dobson, in June 1945. Dobson eagerly brought the scheme to the attention of his hospital's administrative committee, which was so “taken with the idea” that it requested first priority for nursing appointments.Footnote ⁹⁰ Both Dobson and the hospital committee made sure to specify that they approved the scheme “not because we are short of nurses, but in a sincere effort to co-operate in giving these girls a training in nursing before they return to their own countries.”Footnote ⁹¹ This language reproduced that of the Rushcliffe Committee almost exactly. Dobson and his committee acknowledged the nursing shortage only to argue that it played no role in their decision-making.

There is no reason to doubt their eagerness to help train young women and to see them do well. But the fact remains: the hospital was short of nurses. The nursing shortage left sanatoria in the most desperate position of all; in recognition of this fact, the Ministry of Labour prioritized sanatoria when placing German and Eastern European displaced persons in domestic work. When Bott next visited Wrightington, in August 1945, Dobson asked her for an update. “Dobson asked me if I had heard whether the scheme for coloured nurses was going forward, they are extremely short of nurses and have had to close three wards,” Bott reported to the Colonial Office, adding, “The Committee were very keen on the idea and he had been wondering whether anything would come of it.”Footnote ⁹² By volunteering to train colonial students, the hospital acquired much-needed workers. The distinction between instruction and labor broke down when the instruction was itself labor.

The official journal of the Royal College of Nursing, the Nursing Times, declared in its lead editorial of 27 November 1948—titled “Partnership Not Prejudice”—that “few citizens of the Commonwealth would not agree that we are proud and happy to do everything possible for the welfare of all the peoples of the Colonies [including] the development of medical and nursing care.”Footnote ⁹³ But this consensus was not as robust as it appeared. First, as the case of Wrightington Sanatorium illustrates, the benevolent project of nursing development was in tension with the self-interested logic of the British nursing labor market. Even as hospital administrators, colonial civil servants, and nursing experts all argued for the role of colonial nursing students in Britain's rejuvenated empire, they could not erase the reality of and the need for those students’ labor as workers. Second, the champions of nursing development remained uncomfortable with the potential implications of their own project. Their optimism was tempered by anxiety about the likelihood of attracting what were often referred to as “suitable” candidates. The recruitment system they designed, with its safeguards and checks, reflected this ambivalence. Benevolent uplift versus self-interested labor, optimism versus anxiety: these tensions were hardwired into the scheme, and in practice they quickly pulled it apart.

Properly Organized Machinery

At her hospital in Scunthorpe, Vera Allen struggled to sort through the massive amount of applications she had received. The unexpected windfall promised staff for the entire region, but Allen needed assistance from the Colonial Office to make sense of it all. However, news of her predicament went over poorly in London. “We certainly do not wish to encourage the whole-sale recruitment of Nigerian girls for training as nurses in this way,” chided Florence Udell. “There is properly organized machinery for dealing with applications from Colonial student nurses, and we are trying to persuade all the matrons in the country to use this machinery.”Footnote ⁹⁴ By “properly organized machinery,” Udell meant the nurse selection scheme that her department had recently created. But local hospitals, like Scunthorpe or Wrightington Sanatorium, needed far more nurses than the Colonial Office recruited, and women from the colonies wanted to come to Britain far more quickly than the recruitment scheme allowed. They found common ground in the limbo beyond the official machinery. Unofficial contacts between nurses and hospitals proliferated—one Colonial Office official counted over sixteen different pathways by which colonial nurses came to Britain—as local hospitals advertised in the colonies and accepted applications from colonial students not vetted by the Colonial Office. This “backchannel” created endless headaches for Florence Udell and her nursing colleagues and ultimately superseded their selection scheme.

Hospitals that ignored the official program risked inviting “unsuitable nurses” into their training schools. The official program was a multistage process designed to ward off this possibility. Every stage of the Colonial Office's recruitment process checked the one that came before. If something went awry in one stage, it could be corrected in the next. Advertisements placed in local newspapers and nursing journals publicized the scheme in the Caribbean and Africa. Meanwhile, the governments of those colonies set up local selection committees to receive all applications from interested students. Each committee, consisting of colonial officials as well as a matron from a hospital in the colony, paid special attention to “the required standards of health, education, and general suitability” and forwarded the accepted applications to the Colonial Office in London.Footnote ⁹⁵ There, another selection committee, made up of nursing officers from the Colonial Office, the Ministry of Health, and the Ministry of Labour, reviewed the applications. Those deemed suitable were sent to hospital matrons across the country to accept or reject. The Colonial Development and Welfare Acts paid for the uniforms, textbooks, and annual holidays of those nurses who survived this multitiered review and selection process.Footnote ⁹⁶

Who was a suitable nurse? Like her ideal white counterpart, she was young, female (the committee placed few male candidates), and responsible. She came with reliable references. For example, the committee considered Ruby Macdonald of the Caribbean to be “an older candidate,” but “she had good recommendations and it was agreed that she should be accepted.”Footnote ⁹⁷ She was fit. The committee rejected O. Odutola of Nigeria, who appeared “too obese,” and asked for a further medical report on Hilda Bowen from the Bahamas, “in view of the candidate's weight.”Footnote ⁹⁸ It helped to be single and unattached, but the committee did not strictly require it. One applicant from Nigeria, Mrs. Oyename, was married to a man already in London, which posed a slight but not unmanageable roadblock to her hospital placement.Footnote ⁹⁹ She was personable and good tempered. In the strictly disciplined environment of the hospital, she respected the authority of her superiors. She could be trusted on the ward. Nurses who appeared unsatisfactory upon arrival in Britain could be sent home. Rosiga Reni, though placed at Prince of Wales Hospital, “was not proving very reliable,” necessitating a possible return to Nigeria just weeks after beginning her training.Footnote ¹⁰⁰

The suitable nurse also held a school certificate. Though Abimola Agebi had worked as a nurse for three years in Nigeria before applying to work in England, she remained a “somewhat doubtful candidate” given her lack of educational qualifications.Footnote ¹⁰¹ On this the committee brooked no compromise: from the outset, the members “unanimously agreed that the present required standard of education should not be lowered.”Footnote ¹⁰² The education requirement drastically reduced the number of women in the colonies eligible for the selection scheme. It was intended to. Just as the interwar professionalization movement hoped to restrict nursing on this basis, so too did the post–World War II nursing officers evince little interest in handing the reins of nursing to those who did not fit its profile of an “ideal nurse”—a profile steeped in class hierarchy. Insistence on a school certificate ensured that the only candidates selected were middle-class girls from respectable families who had access to education. But this requirement, combined with the sluggish pace of the committee's work, prompted the impatient and the excluded to circumvent the committee entirely. “The flow of private candidates continues unabated,” Udell grumbled in 1949.Footnote ¹⁰³

Class intersected with race when the “ideal nurses” in question were Black women from the colonies. When the Colonial Office and the Ministry of Health began to recruit select Barbadian women for domestic work in hospitals, they threw the politics of nurse recruitment into sharp relief. The governor of Barbados, Sir Hilary Blood, enthusiastically supported the recruitment of domestics. Eager to ease Barbados's unemployment rate by any means, Blood sent the colony's assistant social-welfare officer, Betty Arne, to work out the details with the Ministry of Health.Footnote ¹⁰⁴ The first three women set sail in late summer 1949. “I would mention that the girl Gwennie Violet Inniss is a Secondary School girl of the middle classes,” Arne soon informed the Ministry of Health. “We are hoping to send in the next batch a friend of hers also from a middle class home who could join her later. You may wish to note that Miss Inniss holds her School Certificate and is therefore eligible for regrading as a student nurse. She may ask to do this at a later date.”Footnote ¹⁰⁵ Here Arne made explicit the links between education, class, and hospital status, each as an index for the other. That Arne's position as social-welfare officer was funded by the Colonial Development and Welfare Acts demonstrates how deeply these associations were wired into the entire project of development.Footnote ¹⁰⁶

Arne's suggestion of accepting domestics for student nurse training involved bypassing the official scheme. “I suppose Miss Udell would have no objection,” mused one civil servant in the Ministry of Health, though “it would mean side-tracking the Colonial Office panel, as the girls would have already been accepted by the hospitals as suitable.”Footnote ¹⁰⁷ The matron of Southmeads Hospital in Bristol where Gwennie Inniss took up work as a domestic was happy to accept her for nurse training. Other hospitals were equally willing to regrade Barbadian domestics as student nurses or ward orderlies. Neither the Ministry of Health nor the Ministry of Labour saw any reason to advise otherwise.Footnote ¹⁰⁸ Upgrading domestics to student nurse status was common practice in district hospitals, and it gave the hospitals another three years of guaranteed labor. Why interfere? But Udell in fact had several objections. Unaware that several nurses in question possessed secondary school certificates, she registered her disapproval with characteristic bluntness:

Careful selection and rigorously applied standards, not haphazard recruitment, in Udell's view, determined the success of nursing development. From the nineteenth century, the status of British nursing as a profession rested on its separation from domestic work and the kinds of women who performed it.Footnote ¹¹⁰ The practice of “upgrading” revealed the actual fiction of this distinction. But Udell nonetheless believed it essential to exporting the values and benefits of British nursing. Without “the high standards, traditions and practice of the profession in the United Kingdom,” she later remarked, Britain's colonies would never make the “real and permanent advance in health conditions” that was necessary to their eventual “self-sufficiency and self-governance.”Footnote ¹¹¹

At no point did Udell expect or desire the selection scheme to train a particularly large number of colonial students, much less to furnish the NHS with permanent nursing staff. This narrow vision of “suitable nurses” cut both ways. Udell's position put her at odds with local hospitals, whose shortage-motivated practices she found exploitative. It also put her at odds with the Ministry of Health, whose first commitment was to the NHS staff position, not development in the colonies. Udell's memo went on:

The hospitals looking to make student nurses out of domestic workers (“upgrading”) were the hospitals most short of staff. The point of the selection committee, as Udell had reiterated to Vera Allen, was to ensure that “colonial student nurses shall not be exploited as ‘pairs of hands.’”Footnote ¹¹³ It also ensured that Barbados, and the rest of Britain's colonies, moved through the “stage[s] of nursing development” in the “correct” way.Footnote ¹¹⁴

By this time, the first nurses selected by the Colonial Office scheme had not only finished their training in British hospitals but also returned to the colonies to complete the cycle of development. Their return—or the prospect of it—prompted both celebration and anxiety.Footnote ¹¹⁵ The success of the development project meant the end of white nurses in the colonies. In 1946, Eva Atkinson, then matron of the Barbados General Hospital, predicted “the time is not so far distant when no white person will be on the staff.”Footnote ¹¹⁶ The Colonial Office agreed. “The more responsible nursing posts in colonial territories have been staffed almost exclusively by Europeans,” wrote Udell and her colleagues four years later. “Many colonial nurses have [now] obtained the qualifications . . . and will present themselves as candidates in increasing numbers.”Footnote ¹¹⁷ When nurses E. N. Skinner and Ena K. Walters returned to Barbados in 1951 after three years' training at Mary Islington Hospital in north London, they became the first-ever Barbadian ward sisters at the Barbados General Hospital. As the hospital only employed three nurses at that rank, their hiring drastically changed the makeup of the senior nursing staff. For this major milestone, the nurses were appropriately fêted at the hospital's yearly prize-giving. As the entire hospital staff looked on, the medical superintendent congratulated Skinner and Walters on their appointments and for providing “an example for those who work in the hospital.”Footnote ¹¹⁸ But some white nursing sisters remained ambivalent, even anguished. British sister Doreen Moorecroft reported that her British colleagues in Trinidad were slowly being replaced with “local staff, European trained but with no experience at all,” and that those British nurses who remained were “just waiting for the time when we can get out.”Footnote ¹¹⁹

Through its “properly organized machinery,”Footnote ¹²⁰ the Colonial Office sought to control and check the entry of colonial nursing students into British training schools and to higher posts in the nursing services. But the Ministry of Health was losing patience with this obvious roadblock to overseas recruitment. By 1954, some civil servants were outright encouraging the windup of the selection scheme—or at least the dissolution of the London selection committee—so that British hospitals could more easily recruit and accept nursing students from the colonies. “Any discouragement to Colonial girls to come to this country is another difficulty in keeping up the numbers needed for staffing the hospitals,” wrote one official, adding with mock ponderousness, “Would [it] not look odd if it came out that the government was taking steps to discourage British colonial subjects from getting training?”Footnote ¹²¹ While Udell used the language of imperial duty and obligation to advocate the restriction of training, here the Ministry of Health used that same language for opposite ends. Despite the seeming synchronicity of domestic and colonial needs, the partnership between them turned out to be mutable and subject to the interests of competing stakeholders.

Even the unshakable Florence Udell had to admit that the plan had gone awry. She was increasingly resigned to the idea that she was “going to fight a losing battle.”Footnote ¹²² Commenting on the Ministry of Health's request, she summarized years of prevaricating debate in two lines: “Their point of view is obviously entirely concerned with obtaining pairs of hands for hospitals, whereas we are concerned to provide suitable training for suitable students to the ultimate benefit of the nursing service in the colonial territories. I am beginning to feel these points of view are completely irreconcilable.”Footnote ¹²³ The Colonial Office allowed the selection panel to wind up at the end of 1954; one official at the Ministry of Labour remarked privately that the committee would simply “die a natural death.”Footnote ¹²⁴ But the divides in this partnership, rather than dying off along with the committee, instead spilled out into British society and drew in an additional complement of onlookers and stakeholders. Upon learning of the selection committee's demise, the director of medical services in Cyprus offered this caustic prognosis: “I do not consider [this] decision . . . to be a wise one and foresee that a considerable amount of trouble and confusion is going to arise therefrom.”Footnote ¹²⁵

Fair Conditions

Internal ambivalence about the scheme's goals and targets, coupled with the pressures of the NHS staff position, became the project's undoing. But the government, the nursing elite, and much of NHS management publicly portrayed themselves as paragons of benevolence—invoking what Kennetta Hammond Perry has referred to as the “mystique of British anti-racism.”Footnote ¹²⁶ In this narrative, Britain's initial banning of the slave trade in 1807 augured more than a century of inclusive egalitarianism and racial tolerance, culminating in the passage of the British Nationality Act and the rise of a postwar, multiracial Commonwealth. This “global brand” became Britain's unique identity on the world stage.Footnote ¹²⁷ When applied to the recruitment of student nurses, however, it became a cudgel to dismiss real concerns and anxieties about the place and status of nursing, expressed from outside the nursing elite. Imperial benevolence and professionalization fit hand in glove so long as Britain could reasonably claim that recruiting colonial student nurses had nothing to do with its own labor needs, a claim that was soon put to the test.

In defending the official selection scheme, its creators frequently argued that their “properly organized machinery” was a necessary bulwark against the prejudice and discrimination of others. Swift reprimands came to those who breached it. As more and more Caribbean and African migrants arrived on British shores and went to work in British hospitals, reported incidents of discrimination threatened the idea of Britain as the “mother country” at the helm of a multiracial, egalitarian Commonwealth. After a London matron forbade a Black nurse from attending a hospital staff dance, Minister of Health Bevan announced that the NHS did not tolerate discrimination by its staff or on its wards.Footnote ¹²⁸ In 1951, Mabel Gordon Lawson, the Scottish physician turned deputy chief nursing officer at the Ministry of Health, was horrified to learn that two British nurses had walked out of their London training school because “all the other nurses were Jamaicans.”Footnote ¹²⁹ Lawson then upbraided the South Eastern Metropolitan Regional Hospital board for its extensive overseas recruitment. “In the absence of [the selection committee's] precautions, a high proportion of the applicants will undoubtedly prove unsuitable for training,” she wrote, adding, “furthermore, the presence of a large number of colonial students in individual hospitals can lead to many difficulties and to prejudice against colonial students.”Footnote ¹³⁰ The selection committee was careful to place no more than a few Black nurses at each hospital, a task made easier by the fact that it intentionally did not recruit nurses in large enough numbers to fill a training school. It preserved the “mystique” of British tolerance by closing off the pathways to its potential disruption.

For many nurses already on the job, however, the presence of Black nurses signaled not Commonwealth promise but metropolitan failure. Nowhere was this feeling more pronounced than in the country's mental hospitals. They became ground zero for publicized struggles over colonial recruitment. In 1955, the Leeds Regional Hospital board attempted to bring Jamaican and Nigerian students to the beleaguered Storthes Hall Mental Hospital outside Huddersfield. It met the opposition of three hundred staff nurses, represented by the National Union of Public Employees, and the hospital's nursing officers and clerical staff, represented by the Confederation of Health Service Employees. Both union branches registered votes of disapproval and opposition to the board's proposal. Nurses represented by the National Union of Public Employees explicitly voted against working with colonial students “under existing conditions.”Footnote ¹³¹ The local Confederation of Health Service Employees branch expressed willingness to work with the recruited colonial students, but stressed that overseas recruitment was a “short-sighted policy that cannot do any good in the long run.”Footnote ¹³² As did sanatoria, mental hospitals suffered from staff shortages more acutely than general hospitals. Psychiatric nursing was not a popular specialty, and Storthes Hall's distance from rail lines and public transportation further dissuaded prospective students. Within the hospital, overcrowding made the work even more difficult: patient dormitories filled to the point that staff set up overflow accommodation in hallway corridors. As the Storthes Hall nurses attempted to negotiate better conditions, the hospital board crept across the globe, recruiting students first from England, then France,Footnote ¹³³ next Ireland,Footnote ¹³⁴ and finally the empire.Footnote ¹³⁵ The nurses interpreted this last attempt as “an excuse to not really remedy the conditions at all,” and opposed it.Footnote ¹³⁶

News of the unions’ votes reached the floor of Parliament, where Joseph Mallalieu, MP for Huddersfield East, argued that the board's recruitment exploited both trained and student nurses.Footnote ¹³⁷ Any student nurses from Jamaica and Nigeria, he pointed out, became contractually bound to work long hours for low pay, with little recourse short of returning home. Work and labor were at the heart of the Storthes Hall nurses’ claims, and they regarded the introduction of student nurses as the undercutting of their trade by management that refused to reform. This position was a far cry from that of the nursing experts or the Royal College of Nursing, who strenuously advocated that student nurses should be treated as students training for a professional credential. But psychiatric nurses had been largely excluded from the interwar professionalization movement and did not number among its inheritors. As early as 1919, well before nursing's brief flirtation with trade unionism in the 1930s, psychiatric nurses sought representation in trade unions, such as the National Asylum Workers Union, and after the war were most often represented by local branches of the National Union of Public Employees and the Confederation of Health Service Employees. Meanwhile, they did not gain official affiliation with the Royal College of Nursing until 1951, and male nurses—who made up a large part of the psychiatric nursing register—could not even seek membership in the college until 1960.Footnote ¹³⁸

The Ministry of Health parried Mallalieu's claims with arguments of professionalization. That movement's long-standing push to treat student nurses as students now lent ammunition to the claim that hiring student nurses was simply another way that Britain provided education to her colonial charges. Thus, colonial recruitment had nothing much to do with conditions or wages. In Parliament, the parliamentary secretary to the Ministry of Health, Patricia Hornsby-Smith, pointed out that “every single profession and trade” suffered shortages. Nurses were no different. She added that the Storthes Hall nurses did more than simply prevent patients from receiving care: their rank prejudice also prevented Britain from carrying out its “duty to the colonies” by failing to “provide the training ground” for student nurses “who have no training in their own countries.”Footnote ¹³⁹ When Mallalieu protested the charge—“it is simply a question of fair conditions”—Hornsby-Smith briskly referred him to the Whitley Council for the health services, an industrial relations council that set nationwide salary standards.Footnote ¹⁴⁰ In practice, the Ministry of Health was happy to set aside the development program when it suited, as evidenced by its approach to domestic workers. However, its public representative, Hornsby-Smith, now used the language of development and education to silence discussion about labor shortages and British shortcomings.

Neither the civil service nor the popular press evinced much sympathy for the Storthes Hall nurses and the claims they made in their own defense. The Yorkshire Post expressed regret at the nurses’ “obstructionist” attitude and published several letters chastising them for their “disgraceful,” prejudicial stance.Footnote ¹⁴¹ While the migration of Caribbean men, in particular, stoked public fears of interracial sex and violence, colonial student nurses received positive press coverage as kindred but ultimately temporary sojourners: as the Birmingham Post bluntly declared in 1956, “they fit in.”Footnote ¹⁴² As students, they could be expected to return home at the end of their training; as women, they did not instigate violence nor enter relationships with white women; and as nurses, a profession that rigorously policed itself against any connotation of sexuality, they were not the “over-fertile” West Indian mothers so concerning to social workers and sociologists.Footnote ¹⁴³ The press had always been friendly to white student nurses—young, pretty “angels of mercy”—and under these specific, qualified conditions, colonial student nurses too could become angels of mercy.Footnote ¹⁴⁴

In a similar case that year, over a hundred white nurses at Cefn Coed Mental Hospital outside Swansea voted “unanimously” to block the employment of six Barbadian nurses. The spokesman for the local union branch emphasized that the union had “no objection to the colour of the girls.” As at Storthes Hall, the union felt the hospital board should improve working conditions first and thus “encourage local student nurses” to take up psychiatric nursing.Footnote ¹⁴⁵ But the Daily Herald urged the nurses who “started the trouble” to think again, on the grounds that “coloured girls make as good nurses as white.”Footnote ¹⁴⁶ The Ministry of Labour later described the Swansea incident as “somewhat stupid” and the nurses’ objections as “local prejudice about which one can do little.”Footnote ¹⁴⁷ The dismissal of such incidents as isolated, stupid, or local placed the blame on individual nurses with individual prejudices. It pointed to a larger tautology in British public opinion: Britain needed to accept student nurses because it was an anti-racist country; it was an anti-racist country because it accepted student nurses.

In the view of other commentators, the nurses were expressing prejudice and anger over their wages because they were not appropriately steeped in nursing's long history of altruistic service. Responding to the Swansea nurses in the Welsh press, one Welsh physician bluntly distinguished mental hospital nurses from general trained nurses in the mold of Florence Nightingale: “These are working class people,” he wrote, who “do not regard themselves as being in a vocation or a profession for that matter . . . To them it is a job of work.” For this reason, he went on, their opposition to colonial recruitment was not so much a “colour bar” as it was “fear at what may be regarded a threat of cheap labour.”Footnote ¹⁴⁸ Medical professionals and even some nursing leaders had long dissuaded nurses from industrial action by claiming that the truly dedicated did not concern themselves with wages.Footnote ¹⁴⁹ As the nurse and writer Claire Rayner once acerbically remarked, “This country has staffed its hospitals with sweated labor by purring sweetly at the nurses, ‘Ah, but you aren't interested in salaries and conditions of work, are you? You have a vocation,’ and the poor besotted nurses, like so many mesmerized rabbits, agree.”Footnote ¹⁵⁰ If the Swansea nurses were not “mesmerized rabbits,” then according to the Welsh physician, they were not truly nurses, for proper nurses of the middle classes would have no such qualms. But as the physician identified labor issues as causal factors, he also dismissed the idea that those issues could be racially motivated. His denial of the “colour bar” erased the real role that race played in the union's decision. Even if the union did not reject Black nurses per se, its logic relied on the racialized distinction between “imported” Black women—who were legal British citizens and legally allowed to enter Britain—and the white British nurses “owed” the allegiance and support of (white) management and the NHS.

The narrative of British tolerance was strained to the breaking point in 1958, when racial violence spilled out on the streets of Notting Hill over the course of four frenetic, angry nights. As white fought Black and homemade petrol bombs burned in the streets, the Notting Hill riots garnered national and international attention and called Britain's tolerant reputation into question.Footnote ¹⁵¹ Given that this reputation was central to Britain's self-positioning on the world stage—as wiser and more racially progressive than the United States—British elites and the popular press struggled to preserve it. The riots also threatened British nursing's privileged position as global instructor in the art of nursing. The hospital and its diverse nursing staff were quickly enlisted to shore up both claims. Only weeks later, the Standing Conference of Women's Organizations, a nationwide gathering, passed a motion to express “deep concern at the recent outbreaks of violence and race prejudice.” The Royal College of Nursing's representative seconded the motion and went on to remark that Britain's hospitals often housed “nurses of 20 or 30 nationalities” under the same roof, and that “remarkable goodwill and understanding” had been shared by all.Footnote ¹⁵² The Nursing Times, reporting on the matter, hastened to add that the paper had always acknowledged “the debt that this country owes to overseas nurses.”Footnote ¹⁵³ Later that year, the BBC aired a ten-year retrospective on the NHS that included footage of Black patients and staff. Because the hour-long film was scripted, the BBC's choice to include Black staff was a deliberate depiction of diversity in the health services.Footnote ¹⁵⁴

By the early 1960s, fractures in the community of Britishness found legal purchase in the introduction of migration controls. The threat and then reality of their implementation clarified the urgent and ambivalent role of student nurses in the NHS. As Kathleen Paul has shown, neither Labour nor Conservative policy makers ever warmed up to the prospect of colonial migration and the “merger of separate [racial] communities” that followed. Their begrudging support for unrestricted movement, as in the passage of the British Nationality Act, emerged out of concern for Britain's imperial position rather than for her imperial subjects.Footnote ¹⁵⁵ But even the most strident anti-immigrationists, such as the Conservative MP for Liverpool Kirkdale, Norman Pannell, conceded “it has often been stated that hospitals could not carry on without coloured immigrant nurses.” This fact, Pannell wrote to then Minister of Health Enoch Powell, would have to be “account[ed] for” before the controls went into effect.Footnote ¹⁵⁶

Only when facing the potential loss of the Commonwealth as a source of nursing labor could Britain begin to quantify its reliance upon it. For neither the nursing profession nor the NHS had come up with any long-term solution to the nursing shortage outside of overseas recruitment. Even modest attempts to alleviate working conditions for nurses turned into more insurmountable problems. When the Ministry of Health unrolled a forty-four–hour workweek for nurses, down from forty-eight or fifty, hospitals quickly found they could not afford to slash hours with only a shoestring complement of staff and no funds with which to hire more. After several weeks of reporting on the “88-hour fortnight,” the Nursing Times anonymous columnist “Wrangler” posed a trenchant question: “What does this confused picture add up to? Too few nurses, too many patients, or too little money?”Footnote ¹⁵⁷

The Storthes Hall nurses proved prescient. Five years after Patricia Hornsby-Smith rebuked them for their failure to accept recruitment as “duty” to the empire, her department maneuvered to legally protect nurse recruitment—for the express purpose of assuring Britain's own staff position.Footnote ¹⁵⁸ The 1962 Commonwealth Immigrants Act divided migrants into three categories: category A, for those with positions waiting for them; category B, for those with relevant professional training; and category C, for all others. The act made exception for women with places in recognized nurse training schools and specifically included registered nurses under category B. The idea of education and studentship had previously provided the bedrock of overseas nursing policy and allowed the Ministry of Health to publicly dismiss accusations of exploitation. It now used education to legally facilitate the continued recruitment and migration of nurses to staff wards, regardless of whether those nurses returned home. “In many cases it is no longer true to say that colonial nurses are being trained in this country to assist in providing trained staff for overseas territories,” Florence Udell, still at the Colonial Office, remarked to a gathering of nursing leaders in the summer of 1960.Footnote ¹⁵⁹

Even the Royal College of Nursing acknowledged the situation in a rare Nursing Times editorial on the subject in September 1960. In plain, almost regretful language, the editors conceded that “no one [knew] exactly” how many colonial student nurses served the NHS, only that Britain “owed them a great debt.”Footnote ¹⁶⁰ The concerns of the editors were twofold. First, the poor selection process and training of overseas nurses, as in so many “shortage hospitals,” potentially lowered the prestige of British nursing across the globe. The comment echoed Udell's remarks to nursing leaders as well as the frustrated missives of Mabel Gordon Lawson, now serving as president of the Royal College of Nursing. However, what truly bothered the college was not the question of colonial nursing but the inequality of the partnership it had once celebrated: it was Britain that needed the colonies the most. Britain's inability “to undertake the nursing of its own sick,” the editorial went on, was a “disturbing” portent of her “lack of responsibility.” As in so many discussions about immigration, the editors made claims for “our own”: both Britain's sick white citizens and the ability to care for them. The implicit suggestion that Black Commonwealth nurses were not “our own” nurses, even as they cared for “our own” sick, excluded them not from the nursing profession so much as it excluded them from the practice of nursing in Britain, a separate community of nursing coded as white. British patients, the editorial concluded, ought to be cared for by (white) British nurses, just as British nurses ought to lead the push to developing nursing services. That “our own” nurses could not do the job was a “disturbing” abrogation of Britain's duty, both to the Commonwealth and to itself.