Asylum nursing in the UK at the end of the Victorian era: Hill End Asylum

This paper explores aspects of asylum care at the beginning of the 20th century. Archival materials from Hill End, the Hertford County Asylum, provide a single historical case study. The study focuses on the methods and standards by which asylum nursing was monitored and also examines aspects of the origins and work life of the nursing staff. Standards of care were monitored by a number of official bodies visiting the asylum, whilst the medical superintendent's role focused on the supervision and disciplinary control of nursing staff. Evaluation reports at the time were largely favourable in relation to the care given in Hill End Asylum. However, the reports were based on the relatively limited expectations of the time: primarily relating to the cleanliness, quietness and lack of overt complaints regarding care from patients. Further measures reported related to: death rates, wet beds, numbers of staff dismissed, together with the use of mechanical restraints and seclusion. Nursing staff in the asylum were not normally recruited locally and frequently stayed for only short periods of time. Training provided was very limited at Hill End although a national nurse training scheme was well established by this time. The nursing issues important within the asylum were common to all asylums at the time, and some are still significant today. This paper provides an insight into the historical development of the mental health nursing profession in the UK and its relationship with the medical profession. It also provides evidence that current attempts to monitor the quality of care through clinical governance processes are far from new.