Women, Work and the NHS: Balance for Better
Celebrating International Women’s Day: Women, Work and the NHS: Balance for Better
International Women’s Day (IWD) on 8 March 2019 highlights the social, economic, cultural and political achievements of women across the world and this year’s theme—Balance for Better—calls for action to build gender balance across the world.
Since 1948 women have worked across all parts of the NHS, advancing medical and scientific knowledge, improving the care and treatment of patients and developing the delivery of services. During the same period, they have struggled to balance work against home life, campaigned for equality of pay and opportunity and coped with challenges such as sex stereotyping, sexual harassment, adequate childcare and flexible working. Now more than 75% of all NHS staff are female, but women hold fewer than 50% of senior roles and women from BAME backgrounds are especially underrepresented.
Voices from NHS at 70: the story of our lives give us insight into the richness and diversity of women’s experiences of work through a period which has seen a dramatic remaking of women’s roles across work and society as they aspire to ‘better balanced’ lives.
In the early years, women often faced resistance from their families when trying to join the NHS or continue work after marriage. The marriage bar, which restricted women from working after marriage, operated in Britain until 1944 and social attitudes took much longer to change. The NHS opened up all medical schools to women applicants but most limited recruitment ratios to 80% male and 20% female students. Women applicants faced direct questions at interview about their plans for marriage and children.
"I wanted to join when I was 18 and I applied to Pendlebury Children’s Hospital—it was a new one then. And I filled in all the forms. I said to my father—because your father had to sign, your parents, until you were 21—I said, “Dad, will you sign this for me?” And he read it, and he tore it in half and put it on the back of the fire. And he said, “No. What makes you think you’re strong enough to do nursing?"
Listen to Amy talking about her nursing application being blocked by her family.
"Well, here we go again. When I was expecting, of course you held your tummy in as long as you could, because you were out [of work] again; when the family came, you had to leave. So I was five years out, nearly six years out of any type of nursing from then onwards. But eventually, they couldn’t do without us. So I was in the first group pretty well at the Royal Infirmary, I think, who asked for nurses to come back."
Listen to Catalina discuss leaving work after marriage and returning part-time.
Work and family life
Women’s desire to balance work and family life and the demand for women in the workforce encouraged the development of part-time and flexible working practices in the NHS.
Janet Fidler and Lynne Cockett were early specialists in ultrasound and were amongst the first women to undertake job-sharing in their department at Stepping Hill Hospital in the 1980s.
"At one point there were ten full-timers. But there were lots of people part time. . . . Lynne and I came back after we’d had children to job share, because they were desperate for staff. They’re still desperate for staff!"
Listen to Janet and Lynne share their experiences of job-sharing.
"A job came up then to run a division and that’s when I moved into my first general management position. . . . I ran a whole psychiatric and psychology division within the Chester Hospital. . . . It was a very lean time financially for my family. We had to pay, and we paid a lot of money for childcare. So no, there was no support for childcare. At all. If you wanted childcare, you paid for it. The vast majority of my salary went for that so I could continue my career."
Listen to Karen speak about childcare and career progression, as well as her satisfaction with work.
"My first job when I got back was at Withington and Wythenshawe Hospitals, a sort of combined job; and there were three of us who’d all had babies that year. . . . So we were quite supportive of each other. It didn’t seem that busy. . . . There was much more time to go for lunch together and we’d bring out our baby pictures. . . . I didn’t feel unsupported at all. Not at all."
Breaking down barriers
Surgeon Edmund Hoare reflects on the barriers women faced in entering the field of surgery and the consequent slow infiltration of female surgeons. Born in 1939, Edmund trained at St Bartholomew’s Hospital, London, and worked from the 1970s at Trafford General Hospital, retiring from full-time work in 2002.
"Certainly … there were not a lot of women doing general surgery. There were various reasons for that. One is the training requirements … and also perhaps it was also perceived as being a very male thing …. the health service … was not really designed to facilitate women to train in surgery. Like allowing them to train part time or to job-share. All the various things that would make it more acceptable. In fact, when I was a consultant, you could probably count the number of surgeons—women surgeons—almost on one hand."
Listen to Edmund reflecting on women entering surgery and one woman’s advancement in the field.
"We were paid as medical secretaries. Then we wanted a grade higher, because we thought we deserved it. We had to fight to become a higher clerical officer. . . . Meetings with the union, management. . . . Some people got it, some people didn’t."
Listen to Hylda talking about her struggles for pay rises.
"There were about sixteen of us in the house. I can remember three women—no, I can remember four. . . . I think I was [aware of being in a minority]. I’d been at an all-girls school. It was apparent. But I always felt I had something to keep up, something to prove. But I didn’t feel threatened by it."
Listen to Janice talking about women being in the minority as trainees.
Role models like Pauline Ong sought to encourage women to progress into management roles. Born in 1951 in the Netherlands to Chinese parents, Pauline Ong studied sociology at university, trained as a psychotherapist, and went on to work in Mozambique for two years as a university researcher. She came to Britain in 1978, where she did a PhD in medical sociology at the University of Manchester, later working in South Africa, Zambia, Zimbabwe, Malawi and Kenya, when she was in the department of international development at Keele University. In 1978 she became a research and development manager in the NHS. Pauline stressed the importance of building confidence in women clinicians who wanted to break the ‘glass ceiling’ in the 1980s.
"We also got money from the Department of Health who had at the time a women’s unit trying to get more female managers into the Health Service. Because a lot of women were in the Health Service but they didn’t get into the senior roles. They wanted to break the 'glass ceiling'. So we went to them and talked to them, 'We should have a special diploma for female doctors to become clinical managers'."
Listen to Pauline describing women’s efforts to break the 'glass ceiling' in the NHS.
New technologies opened up new opportunities in the NHS and women were often at the forefront of this change.
Katherine Gate, Janet Fidler, Ann Beale, Lynne Cockett and Janet Hartland (pictured) trained in radiography in the 1970s and worked together at Stepping Hill Hospital for more than a decade. The development of real-time scanning machines had led to the widespread use of ultrasound in obstetrics and gynaecology around this time, and these women were early pioneers of this new technique.
Listen to Katherine, Janet, Ann, Lynne and Janet discuss being early pioneers in the development of sonography techniques.
Stoma care developed as a specialist area of nursing from the 1970s onwards. Patients with various forms of cancer and Crohn’s disease often undergo stoma surgery, which creates a small opening on the surface of the abdomen through which waste products can exit the body. Doreen Wooley was an early practitioner in the field, going on to join an international group and to co-author a book. Born in Longsight, Manchester, in 1945, Doreen wanted to be a nurse from a young age and started volunteering as a nurse cadet at Park Hospital (now Trafford General). She qualified as a midwife at St Mary’s Hospital in 1968 and worked as a community midwife in Moss Side, Manchester. A year later she became a nurse on the female surgical ward at the Christie and was inspired to apply to become a specialist stoma nurse, leading a team in the community.
"My first dealing really with stomas was at Christies. I used to spend most of my time in the bathroom, because they used to have rubber bags, which were a bit like hot water bottles. . . , these rubber bags that you put on a double-sided plaster; and then you put a phalange on top. . . . Then you had a belt loop around the phalange. . . . Then you had to stretch this horrible rubber bag over the flange, then put a belt on. . . . It was horrendous. One company came out with the first plastic bags. That swept the board, really."
Listen to Doreen reflecting on technology changes in stoma care.
Listen to Elizabeth discuss setting up support and getting recognition of sickle cell disease in the NHS.
Helen Bennett, born in Mumford, Norfolk, in 1955, later moving to Cardiff, enjoyed a long career in mental health nursing in both clinical and managerial roles. In the early 1980s, Helen was instrumental in lobbying for a change in the law to enable all patients detained under the Mental Health Act to be eligible for free legal representation. On her retirement she was nominated for a lifetime achievement award by both staff and patients.
Listen to Helen discuss how a patient experience led her and her colleague to advocate for change in the Mental Health Act.
Over the lifetime of the NHS, women have transformed its workforce and work has become a central part of women’s lives and identities. Nevertheless women are underrepresented in leadership roles and some continue to experience difficulty in achieving flexible working in order to balance other responsibilities. This speaks to the need for action to address persistent issues from practical challenges like childcare, to emotional factors such as confidence. Yet the passion for pursuing careers and the satisfaction resulting from working in healthcare echoes through many of the women’s voices recorded through NHS at 70: the story of our lives.
For every hand I’ve held, for every brow I’ve mopped, for every clarification I’ve given, for every word of consolation, of reassurance I’ve given, I wouldn’t ever give it up. I don’t come to work for me. It’s what I do. I love it.
Belinda Jackson, midwife and NHS at 70: the story of our lives interviewee.