Gender vs. Class: the case of nursing (Introduction)
This post, and the posts that will follow at some point, started life in my mind as a companion piece to my personal story about class difference in the NHS 1980s, which was kindly edited by Don Paskini for publication at Liberal Conspiracy and attracted a good deal of, mostly supportive, comment.
That first post was supposed to set the scene for an exposition of how nursing and the NHS has changed since then, but how class bias remains at the heart of what remains wrong with the NHS. It set out in brief the challenge that remains for those of us who want not simply to laud the successes of the NHS – which are considerable – but to use it as a springboard for a properly socialist health service.
The original post, focused on how class bias affected nursing in the 1980s, was ‘inspired’ by a series of crassly ignorant, reactionary posts on rightwing blogs following the announcement that all trained nurses in England will have degrees by 2014 (none of these bloggers noticed that this is already the case in Scotland and Wales).
Between the original post and this one, however, my blogging comrade Dave wrote an interesting, brief (for him) post setting out the need to retain the primacy of class analysis and struggle over and above gender analysis. The post prompted strong reactions from socialist feminists who contend that the struggle against patriarchy, and the struggle against capitalism, are and must be interrelated.
This new series of posts seeks to put flesh on the bones of that discussion, by examining the very real relationship between gender-focused and class-focused activism in nursing between the 1970s and 1990s.
My main contention is that the gender-focused nursing activism that took place in this period has militated against the working class as a whole, and has contributed to a less good NHS as a result.
I recognise that this is a controversial assessment, and it is not a conclusion that I have reached happily, not least because it might be interpreted as a reactionary assessment more in keeping with the ‘anti-feminist’ Melanie Phillips (see below) rather than one on keeping with values in support of the feminist movement.
Nor is it an assessment that leads me to the conclusion that all gender-focused movements are destined to be deficient if they do not specifically recognise the primacy of the class struggle, though I recognise is that is how it might be interpreted by ‘classical Marxists’. (Indeed I would argue, along with Norman Geras (20 years ago), that the whole conception of classical Marxism is in itself an invalid ‘post-Marxist’ construction, and a product of intellectually incoherent thinking of the same 70’s-90’s period that I examine here.)
Rather, the ‘generalisability’ or otherwise of the primacy of class over gender in the overall socialist struggle – in itself a term worthy of contestation – is something I would hope that will come out in the commentary on these posts.
While I seek to set out a historical analysis of a period and an environment in which I believe a narrow focus on nursing (and by contestable extension) women’s position within capitalist society has actually been deleterious to the cause of socialism, I retain an open mind in whether ‘class-free’ feminism may or will always create the same problems. Like many male socialists, I struggle to come to terms with what feminism should mean to me, or even CAN mean to me, and as Tim acknowledged in his comments on Dave’s post, I make no pretence either to being as well-read as I should be.
While I will make up what follows in subsequent posts as I go along, and while any comments may mean changes to the trajectory, this is the general schema I have in my head at the moment:
Part 2: The development of a new ‘ethos’ of nursing in the 1970s (initially in the US) and how it culminated in Project2000, the new degree-based nursing, with a focus on the (contested) centrality to these development of feminist conceptions of ‘traditional nursing’ as a Judaeo-Christian patriarchal narrative of oppression;
Part 3: The popular narrative of changes in nursing, as expressed by influential rightwing commentators like Melanie Phillips in the changing NHS context’
Part 4: A class-focused analysis of the changes in the NHS and of the development of the popular narrative about them, set out in part 3.
Here, the focus is on how material changes in the NHS under Thatcherism co-opted, in the absence of coherent leftwing opposition, the emergence of the new nursing ‘profession’ to its own ends, and resulted in a MORE exploited workforce and poorer care feeding into the popular ‘anti-feminsist narrative’ described in part 3.
This part will build on and integrate some of the comments made by nurses and others on the original piece at Liberal Conspiracy, which were largely supportive of and brought historical detail to my provisional claim that class bias in the NHS is a significant constraint to its progress, and how ‘divide and rule’ tactics employed by NHS management and government in the 1980s and 1990s have led to both worsened terms and conditions for those at the ‘bottom’ of the workforce, and concomitantly reduced standards of care.
Part 5: Conclusions, if I can be arsed, though I’m hoping that what develops from the comments may mean there is no need for this.
There is useful background reading, should you feel so inclined, in Celia Davies’s ‘Gender and the Professional Predicament in Nursing’, a contemporary (1995) feminist account of the changes then feeding through, and in Ann Bradshaw’s ‘The Project 2000 nurse’. There is also a fascinating and revealingly elitist ‘definition of nursing’ provided by the Royal College of Nursing here.