In the blood

Last month, Ms Austin retired as inpatient services manager at the Royal Shrewsbury Hospital in Shropshire after 50 years' service to the NHS, with not a moment's regret about the career she chose as a young girl. But then she had known, partly at least, what to expect.

Ms Austin, who was awarded an MBE in the Queen's birthday honours for services to the NHS, comes from a family which has, in total, devoted 200 years to Shrewsbury hospitals. Her father, Reginald, worked for 43 years as a carpenter at the local psychiatric hospital, Shelton, on the outskirts of the town.

His brother Arthur, a bricklayer, also worked at Shelton for around 10 years. And the third brother, Frank, was at the Royal Salop Infirmary for 46 years, first as a carpenter, then as a surgical mechanic, involved in maintaining and repairing surgical equipment. Her father's parents, grandmother Polly and grandfather Charlie, met while working at Shelton - she as a cook and he as a carpenter - and were married in 1903.

Ms Austin herself met her husband when he was working as a theatre technician at the Royal Salop, and has cousins who also work in the health service.

Going into the NHS seemed natural. 'I did not feel pressured to do it,' she says. 'With my father being at Shelton, I grew up in a hospital community, which is what it was then. It was like a village. The hospital had its own shoemakers, tailors, decorators and cooks. You just became a part of it.

'There were children's sports days and I can remember having to go to my grandmother's when my mother went to the Christmas dances. It was not like a hospital environment at all. And I was certainly not frightened of hospitals.'

Ms Austin's story is not unique. In the first half of this century, and perhaps even into the 1960s, it was not unusual to find whole families - father, mother, sons and daughters - working in the same hospital.

This was particularly the case with psychiatric hospitals, which, set apart from 'normal society', were communities in themselves, employing a wide range of staff from cooks, bakers and cleaners to artisans, who sometimes lived in tied cottages at the edges of the hospital. Marriage between hospital staff was not uncommon.1

Nowadays, since many of the long-stay psychiatric hospitals have closed down, and as technological advances and structural changes make the concept of a local or community hospital more and more remote, these working patterns are unlikely to be replicated.

Greater economic prosperity and increased mobility have also offered people more career choices, and sons and daughters no longer rely on their parents to 'put in a good word' for them in order to secure what for many were jobs for life.

But despite a widespread perception that NHS or medical families are on the decrease, HSJ tracked down a number of families where several members or several generations have gone to work in the health service.

One of the overriding messages from people in such families was how inspired they felt by parents, relatives and siblings to go and work in the NHS.

Colin Pearson, president of the Association of Healthcare Human Resource Management and director of organisational development at Milton Keynes General Hospital trust, thinks this is hardly surprising. 'I suppose the best advert for working in the health service is a relative. If a relative comes home from work every day feeling very stressed, then that is not going to entice people into the service.'

That is why, Mr Pearson adds, AHHRM supports the government's human resources agenda to make the NHS more family-friendly. But he agrees that there is probably more the health service could do to capitalise on family links and attract children of employees to build a career in the health service. Open days - currently geared towards the general public - could, for example, be more family-oriented, with specific events of interest to family members.

On the other hand, Mr Pearson says, employers should beware of laying themselves open to charges of nepotism. Today, relatives working together, particularly a husband and wife team, would probably be frowned on.

Alan Newton-Dunn: my father was horrified

Alan Newton-Dunn, 50, is a GP in Salisbury, Wiltshire.

Both his father and grandfather were GPs in the practice where he now works. He has three daughters, aged 21, 18 and 13. The eldest is a medical student and the middle one also plans to go to medical school.

'I did not feel pressured to go into medicine. It had always been a job I wanted to do because I saw it as worthwhile. Helping other people appealed to me. If I had not done that, I would have gone abroad and been a missionary.

'My father was single-handed and had a tough time. We saw very little of him in the early days. But seeing how hard he worked did not put me off. My normal working week is about 68 hours, but that is an easy week. I have worked for up to 130 hours. You do slip into it more easily if you come from a medical family. You know what you are letting yourself in for. It is not such a shock.

'I get the feeling these days that medical schools want new blood, that they think if you come from a medical family, you have been forced into it. But I don't think that is true. In a way, I think my father was horrified that I decided to become a GP. In fact, he did say that to me in his later years.

'I have had my fair share of problems, as you always do when you work in medicine, but it has been a good career choice and I do not regret it.'

Karen Parker: my mum would come home cheerful

Karen Parker, 21, has just finished her nurse training in Glasgow and is now looking for a job.

Her mother works as a nurse at Glasgow's Stobhill Hospital and her paternal grandmother is a retired nurse.

'I think, subconsciously, I was influenced by my mum. I wanted to be a pilot initially, but you needed physics for that. It was a subject I was not good at, so I had to scrap that idea.

'I never talked to my mum directly about becoming a nurse, or sought in-depth advice from her about it - she very much kept out of it. But she would come home cheerful and full of stories about her day, not moaning about it all the time. I think that rubs off on you.

'I know a lot of people would not consider the NHS, but I think it is a good career choice and I would encourage other people to go into it. The pay is not as bad as is made out. There are other jobs which pay around the same and no one shouts about that.'

Gabriel Scally: politics drew me to public health

Gabriel Scally, 43, is public health director of South and West region.

His grandfather was vice-chair of Northern Ireland's hospital authority and his father is a retired consultant psychiatrist. One of his father's brothers was a GP. He has two sisters, one of whom is an ear, nose and throat consultant, the other a pharmacist. Several cousins also work in the health service.

'Growing up as I did in west Belfast, going into medicine, law, teaching or the arts - the so-called liberal professions - was very much what you did if you were a bright Catholic. There was no point in doing engineering or business because the opportunities were just not there for Catholics. It was the 1960s and the time of the civil rights movement.

'It was a highly politicised time and Belfast was one of the poorest cities in the country. That was partly where my interest in public health stemmed from. There was no point at which I actively made a decision to go into medicine. The path was mapped out for me when I was born.

'Although my father always said if there was anything else I wanted to do, I should do it, I felt inspired by him. Family values and the ethos of public service were very important to me.

'Before my father went into psychiatry he was a GP, practising in the country, and it was quite clear to me that GPs were important and respected members of the community, like teachers and the clergy. They were seen as pillars of rural Irish society. That too held an attraction for me.

'I enjoy my professional life immensely. I would encourage people to go into medicine so long as they have a positive vocational commitment to it and are not after just money or prestige.'

Angela Davis: we lived on top of the surgery

Angela Davis, 60, recently retired as a dentist working in Liverpool's community dental service, and was latterly employed by North Mersey Community trust.

Her father was a GP, as was her sister, also retired, while her brother is a dentist. She is married to a psychologist and has two sons, neither of whom has gone into the NHS.

'There was no parental pressure on me to go into dentistry, but around the time I was making a decision my sister was at medical school and my brother at dental school. So there used to be a lot of discussion about medicine and dentistry around the table. They used to talk about their experiences.

'But in the end it was my headmistress who encouraged me to go into dentistry. There was a shortage of dental students at the time - 1956 - so it was relatively easy to get into dental school. I wanted to do something medical because it was a kind of family business. We lived on top of the surgery and as a little girl I used to go and answer the door to patients and collect their fees - until 1948, when the NHS came in.

'My father had a dispensary, just off the surgery, where he used to make up medicines. There were all kinds of coloured bottles and I remember he used to prescribe pink aspirin. I went on visits with him and it all added to the interest, but I thought medicine would be too gruelling, so I opted for dentistry.

'I do consider it has been a good career choice, but I am not sure whether, if I had the chance again, that is what I would choose to do. It is stressful, particularly treating children, because what you are going to do to them is not pleasant. People do not like dentists as much as they do doctors.

'Also, nowadays, you have to take so many precautions because of things like AIDS and hepatitis. It has put me off dentistry.

'I think now I would opt for psychology. My husband is a psychologist and I have always been interested in that field.'