Intended for healthcare professionals

Feature Christmas 2022: Eternal Flame

The NHS’s forgotten workforce—a historical essay by Jennifer Crane

BMJ 2022; 379 doi: (Published 15 December 2022) Cite this as: BMJ 2022;379:o2774
  1. Jennifer Crane, lecturer in health geography
  1. University of Bristol
  1. j.crane{at}

Ever since the NHS’s foundation, ancillary staff have been largely ignored in narratives about the health service. Jennifer Crane looks at archival accounts showing both passionate dedication to the NHS and despair about working conditions

Porters, cleaners, receptionists, chefs, laundry workers, and other ancillary staff have represented a huge proportion of the NHS workforce since the service was founded. In 1949, domestic and maintenance staff represented 44% of the NHS workforce, administrative staff 7.1%, and professional and technical staff 3.5%.1

Despite this, ancillary workers—who are non-medical and non-clinical but support the NHS’s medical and clinical work—have often been forgotten in policy discussions and omitted in representations of the NHS on radio and television. In historical debates about the NHS we hear little from housekeepers, security staff, healthcare scientists and technicians, or maintenance staff, despite their critical roles. By digging carefully into archives we can find traces of committed and passionate voices of ancillary staff, particularly from the 1970s and ’80s.

Ancillary workers have always been a hugely diverse workforce in terms of gender, race, and ethnicity. Just one year after the NHS was founded the Ministry of Health, the Ministry of Labour, and the Colonial Office were desperately recruiting hospital staff from the Caribbean, including auxiliary staff and domestic workers, and the number of women coming from colonies and former colonies to work for the NHS grew until the early 1970s.2

While successive governments recruited ancillary workers, these staff often faced very poor working conditions and dismissive treatment in the hierarchies of medical spaces. Nonetheless, many ancillary workers have taken great pride and pleasure in their work, recognising themselves as critical to the patient experience.

Dreary, monotonous—and ignored

Although ancillary staff were critical to the early NHS, they weren’t consulted or allowed to shape this new institution. In the 1930s and …

View Full Text

Log in

Log in through your institution


* For online subscription