NHS60: A day in our life

It is easy to see the changes of the past six decades in terms of the big political shifts. But there is another story to tell about the small changes to daily life.

Managers of the early decades of the NHS describe a world that is almost unrecognisable today. Almost no one drove to work, everyone wore a collar and tie and addressed seniors as Sir or Mr - there were no senior women to address.

"Ties were a must," says John Roberts, who started work as a national trainee in the service in 1962. "I remember one trainee turned up in a black jacket and striped trousers, but it was still common to be wearing stiff collars, double cuffs and cuff-links."

As a trainee, he attended Thursday evening dinners at the King's Fund, where "they complained at the cost of passing the port round twice".

Mike Brown, who joined the management training scheme in 1967, recalls a daily ritual at a regional hospital board where he worked for one of the directors.

"He would get the post in the morning and have his whole team gather for the post meeting," says Mr Brown. Eight to 10 staff would watch as the director took the first letter from the pile and ritually opened it, before discussing its contents with the room.

As the pile was not sorted beforehand, this might be something utterly mundane. But this ritual would go on for an hour, after which the director would jump to his feet and announce that he had to rush to a meeting.

"I thought that if I ever got to a position of authority, I would not run an office in that way," adds Mr Brown.

Formally speaking

Forms of address remained formal until quite recently: no one would have dreamt of calling a senior by their first name before the 1980s.

As Mr Roberts says: "It was usual to address the chairman as Sir well into the 1980s, but then where I worked, most of them were knights. In 1978 some were shocked when the new regional chief medical officer breezed in, telling everyone on his staff to address him by his forename."

Even as recently as the 1990s, etiquette was very different from the way it is today. Lyn Darby, who joined the NHS on its 50th anniversary in 1998, says: "The relationship with senior managers and particularly the senior medical staff was quite formal, though this may just have been because I was a management trainee.

"Some nurses still wore belts with ornate buckles, although infection control saw this change within my first year and female managers were asked to wear skirts, as trousers were felt to be untidy. Before my first day in one trust, I received a phone call tipping me off about the no-trouser dress code. But as I didn't even own a skirt, I went to work on my first day in a smart black trouser suit and was promptly sent to town to buy a skirt and not to return till I had done so. Embarrassing at the time to be sent away on your first day, but both incredible and funny to think of it now."

Lords, ladies and freemasons: life on the staff of an asylum in the 1970s

Former manager Alan Randall recalls his first job at Herrison Hospital (the county asylum) in Dorset in the 1970s with tales that could have come from the pages of an Edwardian novel.

"Nothing on the two-year national training course helped me to fathom the hospital power structure," he says. "I naively assumed that the chairman was the most important member of the committee. But despite his title, he fell well down the hierarchy. His first handicap was that he was a mere pig farmer, while other members of the hospital management committee were landed gentry.

"Of the committee members, Sir Joe Weld was the Lord Lieutenant of Dorset, lived at Lulworth Castle and seemed to own much of East Dorset. Lady Williams lived at Port Bredy and appeared to own all of West Dorset. Also on the committee was Caroline Bond, a wonderful person who later on became chair of Great Ormond Street Hospital. When I tentatively tried to find out where she fitted into the pecking order, I was left in no doubt by her comment that her family gave its name to Bond Street."

He goes on: "I was taken aback to be addressed by the members as 'Randall'. It had to be explained to me that this was a compliment in that it put me on a par with their butlers.

"There was also a second hierarchy at work, as many of the senior staff and members were freemasons. All big decisions had to be referred to the head gardener, who was grand master of the lodge and spent his days smoking a pipe in a rather grand building out in the magnificent grounds."

Negotiating the asylum's hierarchies also provided Mr Randall with "one of the most embarrassing moments of my 33-year NHS career" .

"I tabled one of Lady Williams' reports of a departmental visit she had made," he explains. " She had handed me her handwritten report just before the meeting and I passed it to a temporary secretary to type copies for the members. Unbeknown to me, the temp did not know what OT stood for, but she decided to take an inspired guess. Oh how I wish I had checked it! When invited by the chairman to speak to her tabled report, Lady Williams announced in her fearsome, deep, resonant voice that 'contrary to the report, I did not visit the outside toilets and find morale high'.

"For the rest of my career, I could never take OTs seriously."