National health: a family affair: Has there ever been a golden age of health care? Three generations of nurses should know. They talk to Celia Dodd

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GRANDMOTHER

Molly Wilson, 82, started training in 1931, 17 years before the NHS was created. After seven years she married a GP, Charles Wilson, and moved to Gorebridge, a mining village outside Edinburgh, where she helped run the practice until her husband retired in 1972. In the Sixties and Seventies she was a representative on the board of the Royal Edinburgh Infirmary.

Hospitals like the Princess Alice in Eastbourne, where I trained, ran on voluntary contributions. There were also poor-law, or public, hospitals for the chronically ill. Patients were asked to contribute something if they could afford it, but they weren't compelled to. The rest of the money came from gifts to the hospital. Of course, Eastbourne was well endowed with wealthy people, so things seemed to run smoothly.

We didn't have any problem with short staffing. There was always somebody to stand in for you if you were off sick. We had a ward with about 20 beds, and if we were busy we had to put more beds down the middle. The wards I nursed on were much more crowded than they are now. It was quite hard work. Sometimes you went off duty and you were only too glad to go straight to bed.

There was a little bit of grumbling that we didn't get paid enough, but we didn't go on strike or anything like that. When I started training I got pounds 26 a year; as a staff nurse I was paid the princely sum of pounds 60 a year - of course, you had your keep, but no holiday money or anything.

I remember a time when there was talk of nurses joining a union. The matron was very much against it, and more or less persuaded the staff that they really didn't need a union. I wasn't very much concerned in those days, I'm afraid. It wasn't done to join a union, especially for women.

The health service was completely different when I was nursing and when Charles, my husband, started in general practice. It wasn't hi-tech at all; X-rays were about the limit. In the Thirties TB was the most common infectious disease. And it was very common to get acute ear and mastoid infections, which you never get now. There weren't any antibiotics; it's amazing how people managed to survive, but they did. Sometimes we had a fatality, but on the whole we managed to keep people going. Antibiotics made a huge difference. So did immunisation, which started in the 1950s.

There's a different attitude to operations now; they want patients up and about, because, for one thing, it releases the beds, and may prevent blood clots. We kept people in bed much longer. After any abdominal operation, patients had to lie flat for three weeks. Techniques have improved so much that now they would probably be in hospital for two days. And people used to be terribly sick after ether; now they hardly notice the anaesthetic.

As a nurse, there often wasn't very much you could do other than make the patient comfortable. A lot of the nurses' work was trying to prevent bed sores; every four hours we had to rub their backs and heels.

I had to give up nursing when I got married because they didn't have married women as nurses then. I went back after the war, when they were short of staff, and did shifts at various hospitals in Edinburgh.

Gorebridge was my husband's first practice, and he stayed there until he retired in 1972. It was quite a busy, mixed practice, with the farming community as well as the miners. It wasn't a wealthy area. There were a lot of chest illnesses related to smoke and dust from the pits and from poor diet.

Doctors' wives got to know patients because they came to the house. The kitchen window overlooked the entrance to the surgery. I acted as an unpaid secretary; I answered the door and sometimes people would tell me their sad stories.

Before the NHS, people paid so much a week into a scheme in Gorebridge. It wasn't a good system because the poor people - mainly the farm workers - had to pay a lot. But, in actual fact, if they couldn't pay it didn't make any difference because they still got treatment.

When the NHS started in 1948, it was greeted with enthusiasm - very much so. There were only one or two patients who wouldn't fill in the form to join because they wanted special treatment. I was furious. I told them that my husband would give people the same treatment whether they were on the NHS or private. I thought it was disgraceful to imply that doctors would give a first and second-class service.

I was a representative of the Royal Edinburgh Infirmary Hospital Board for eight years, until it all changed in 1972, when they introduced managers instead of matrons. There was a lot of discussion about budgets and money, but there didn't seem to be the same trouble as there is today.

I think that this Government is determined to wreck the NHS. They say the NHS is safe in their hands, but I don't believe it, because they're gradually privatising it. You can't treat a hospital like a business.

I went to the hearing aid clinic recently and the girl there said, 'Do you know, you're a customer now, not a patient.' What a scandal] Everything is commercialised, it all boils down to money. I think we'll have to really hang on to the health service, otherwise there won't be much left of it by the end of the century.

MOTHER

Mary Robinson, Molly's daughter, started training in Edinburgh in 1960. She nursed for 15 years, during a period which many now regard as the heyday of the NHS. She now works in occupational health for a large computer company in Manchester.

As children we always considered that we only had our father for one month a year, when we went away on holiday. He devoted his time to his patients, and our household revolved around the surgery in Gorebridge.

On my wedding morning, I was in my petticoat helping my father stitch a child. The whole village turned out to see me off to the church. These days most people don't know their GP's family.

I never thought of being anything else than a nurse, except perhaps a doctor, but my father was quite certain that medical training shouldn't be wasted on women.

When I started nursing, hospitals were run by the matron, the medical superintendent and their deputies, who were all nurses and usually single. That was the administration, full stop. They held the purse strings.

When they brought in all the managers in the early Seventies, bureaucracy went mad. I know a lot of nurses can't manage, but most could run a hospital a lot better than the managers who were brought in from outside.

There were a lot of moans from the nurses about how much longer everything took to achieve. We didn't know who to ask for help any more. As a staff nurse, my role didn't alter much, but sister seemed to spend a lot more time on paperwork. Everything became more complicated.

There wasn't so much talk about budgets as there is now. Sister had to budget for her ward, but there wasn't the same pressure. If you needed something, you got it.

But there were never enough nurses. For a while I was doing night shifts at a hospital in Cornwall, with only myself and a student nurse in charge of an acute medical ward with 50 beds. They were very busy nights, because there were a lot of very seriously ill people on the ward, and new patients would be coming in all night.

People kept dying, and crises such as cardiac arrests kept happening. It was horrific, I only worked three nights a week then, but it was so terrifying that I couldn't sleep on the other four nights for worrying about going back. When I arrived I used to move the beds around so that all the seriously ill patients were opposite the nursing station.

In that job we also had to relieve the nurses in intensive care when they went on breaks. I didn't have a clue about all the respirators and different monitors. Poor patients, it's just fortunate that nothing untoward happened. it was very short staffed. That was before the cuts in the NHS.

I also worked in a casualty department in Crewe for about three years. It was very stressful because anything could come through the door. We were always frantic; we used to have beds up all the corridors. My husband always came an hour late to meet me because I was never ready on time.

I decided to leave hospital nursing because I'm very much into health promotion, and people at work are a captive audience. The people I deal with here have lost faith in the NHS. People get very upset about how long they have to wait, either to see their GP or to be referred to hospital. You can wait half an hour for an ambulance in an emergency.

There were hospital waiting lists in the Sixties and Seventies, but they weren't as long as now. It was more understandable then, when an operation might mean three weeks in hospital, but techniques have improved, so waiting lists should have gone down more than they have.

In the Sixties, private health care didn't need to be such a big thing as it is now. It was the elite who used the private health service, but now it's the everyday person. That is a sad reflection. This company has a private medical scheme which people use extensively.

I never thought it would be necessary to contemplate private health care for myself. I don't really agree with it even now, but recently I went to see a consultant through the private scheme. When you're not well you just go for it. When I started nursing, people wouldn't have believed that the health service would decline to the level that it has, or that the private sector would have grown so much. It was unthinkable then.

In many respects, the Sixties were the heyday of the NHS. These days, the quality of service varies a great deal. The treatment my father had when he went into hospital earlier this year couldn't have been better, whereas my local hospital has a diabolical reputation; people don't want to go there. We've had a good experience with my father, but I think that is rare. You don't hear many good things about the health service nowadays.

SON

Michael Robinson, Molly's grandson and Mary's son, is 28 and started training in 1984. After six years in general nursing at University College Hospital (UCH) in London he became a psychiatric nurse. He is now a senior charge nurse at the Maudsley Hospital in south London, with a caseload of drug users in Brixton and Peckham.

I moved into psychiatric nursing because I felt I was becoming uncaring. I was burning out. I was a staff nurse on a very busy medical ward. As soon as a patient left the bed would be filled up. If somebody died you'd think, thank goodness it's gone quiet there, that's one less bed to worry about. We would even keep somebody who had died on the ward a bit longer, because as soon as they went off, somebody else would come up from casualty.

A lot of patients didn't stay for that long. You couldn't help feeling that some people were being kicked out earlier than they needed to be.

It was mainly people with chest conditions - anything from pneumonia to cancer. We had a lot of tramps with TB and stuff like that, and young people with HIV. We had an awful lot of deaths on the ward. There was one stretch when we had somebody die on every shift - that's three deaths a day.

You used to see the same old faces. It was upsetting, knowing what patients were going back to, and knowing that sometimes you'd be seeing the same person back in that night. They'd go home to a damp, cold flat, have another asthma attack or whatever, and be back in casualty again before their bed was even cold.

During my six years at UCH things seemed to get busier. Towards the end I was the most experienced nurse on the ward after the sister, and I'd only been qualified six months.

That was difficult. You just did your best. At night, if things went wrong, there weren't many people around to back you up. It was a bit nerve-racking because things went wrong all the time.

The most traumatic time was when I was a student nurse. I started on the burns ward on the same day as the King's Cross fire. I've never nursed better than I did then because it was real heart and soul stuff. For the first time it felt like a multidisciplinary team with everyone pulling together. We regularly put in two or three extra hours a day. We weren't asked to, but you couldn't walk out and leave your colleagues struggling.

It was the most traumatic experience, because it was so intense and you got to know the patients so well. I remember once a fire engine passed me on my way home. I fell off my bike and burst into tears. We were closer to the people we worked with than we were to our own loved ones.

Whenever they show something like a fire scene on Casualty it brings back all the stress. It's my wife's favourite programme, but I find it quite difficult to watch, even now. It still touches a nerve.

When the Maudsley becomes a trust in April we'll have fewer managers. Sometimes it feels quite good to be getting rid of the hierarchies. But the middle managers are the ones that are going, and yet often they're the most approachable people, because they have been nurses themselves. One of the problems in the Beverly Allitt case was that the nursing management was so reduced that the nurses who were concerned had no one to talk to.

It's been suggested that if we get more consultants, that will solve everything. It won't. We need more housemen and registrars, because they're the people who do things. We need more do-ers.

The immediate worry about the Maudsley becoming a trust is whether we're going to keep our jobs. Our managers have told us that we may be interviewed for our old jobs, and may be downgraded. So the future feels very uncertain.

Since I started at the Maudsley three years ago my personal caseload has doubled to over 25, and it looks as if it will go up again soon. Most of my clients need to be seen once a week. Sometimes people need someone to offload to. I try to give people an hour, but that's getting more and more difficult. Sometimes it's only 10 minutes. We've been told fortnightly visits are OK, but that doesn't tend to work. It's no problem for a couple of weeks, but then people bang into another crisis and they have to be seen a lot.

I'm pleased that I made the change to psychiatry. From the beginning I saw it as nursing again - it seemed a lot more caring. What attracted me was that I could sit down and talk to people. On a busy medical ward that side of things was passed by. You were too busy looking after people's basic needs to start looking at the problems and reasons why they had come in.

Having said that, I nearly left a year ago to go to university. I think it was because of the continual, chronic pressure and stress. If anything happens to one of our clients we're accountable. If they overdosed and died it would be incredibly traumatic. And there are often children around. It does give me sleepless nights.

You can't take a day off sick because you know there'll be twice as much to do when you get back. Everyone seems to be under that kind of pressure. It's been the same throughout my nursing career.

(Photographs omitted)

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