Florence Nightingale in Harley Street

While the world knows all about the exploits of Florence Nightingale in the Crimea, there is rather less awareness of her efforts at running a nursing home in Harley Street in London. Around 1970 a discovery was made of a stiff-bound notebook which contained in her own handwriting quarterly reports as Superintendent of the Upper Harley Street Nursing Home. These reports were presented to the Ladies’ Committee that had responsibility for managing the organisation. The reports were published as a small hardback book in 1970 by JM Dent and where copies of the book remain currently in circulation. I came upon a copy in bookshop in the Cotswolds. A total of four quarterly reports were presented as in November 1853, February 1854, May 1854 and August 1854.

The first report highlighted the dire condition of bedding items on the initial move into the new premises in Harley Street from Chandos Street – where she leaves little to the imagination. She describes also that ‘Vermin ran tame in all directions’ which is a very damming state of affairs for a new building in a fashionable district in London. If this problem was overcome she glosses over the means to a solution. A core task of all employed staff- including ‘nurses’ – was to maintain the fabric and furnishings within the establishment. Initially the old carpets were refitted into the new layout and various fabrics patched and mended. While previously baked goods and various preserves had been purchased from suppliers, she initiated the baking of bread, biscuits and gingerbread and the making of various preserves within the establishment. This helped to further reduce running costs. Also, rather than purchase general provisions on an ad hoc basis from several suppliers, she established a monthly order from Fortnum and Mason to further reduce overheads. Based on this she was able to indicate favourable prices, for example, of eggs at a shilling for 16 and butter at a half shilling per pound (one shilling = 5 new pence). Similar contracts were also established with other suppliers. Such management of the nursing home expenses indicates a successful exercise in the optimisation of the value of money and without any reduction in the quality of goods and services.

Various other items had to be purchased in this first quarter to fully open the facility and details are provided of additional items obtained such as bedsteads, tables and chairs though no specific details are given of costs and source of funding. The total accommodation is described as 10 single rooms and 17 ‘compartments’ – presumably made by sub dividing larger rooms. The initial level of occupancy is given as 8 ‘guinea’ patients and 10 ‘half guinea’ and presumably where the ‘guinea’ patients have access to single rooms. She was mindful also of outcomes among the patients that had left the nursing home and was more than blunt in describing the circumstances where patients were prone to imagine their health conditions. Where patients were referred to as cured by an operation, no details were provided as to where such operations took place or the name of the surgeon. This was also the era of increasing use of chloroform as an anaesthetic.

Some years before obtaining the book I did have the opportunity to visit Harley Street in London. Although functioning as a modern cosmetic Laser Centre, the premises were largely original- with wide open staircases and large rooms with high ceilings with extensive plaster ornament. The original marble fireplaces were of notable design. The work environment of the Nursing Home is likely to have provided an air of style and refinement.

In the second quarterly report she is increasingly focused on the admission process into her institution where there is apparently no focus to attract patients with real medical conditions. She even recommends that certain patients should be initially assessed for a limited period to determine if a longer stay would bring about any improvement in their condition. These insights are no doubt obtained by observing the ‘bed blocking” antics of various patients where in her own words ‘the nervous become more nervous, the foolish more foolish, the idle and selfish more idle and selfish’. Also she declares ‘There is not a trick in the whole ledgermain of Hysteria that has not been played in this house’.

In the third quarterly report she indicates that the occupancy levels had fallen which if sustained would generate an annual loss of £500. While savings have been made by way of reducing provisions and the like, such measures have reached the limit of further cost reductions.

She had identified at this stage a key rule of the Institution namely that the Superintendent should attend the doctors’ visits. Failure to do this would invariably result in failure to carry out medical requests. This is enshrined in modern practice as the ‘ward round’ where health professionals as a collective group focus on actions for individual patients. Modern patient care, however, is vastly more complex than that of yesteryear and there remains ample scope for communication gaps and consequent lapses in care.

In the final quarter’s report, it is clear that her term in Harley Street has run its course. She indicates that it is inappropriate for her to train nurses to develop their roles since there is an inadequate clinical workload to provide sufficient practical nursing application. She implies that having set the nursing home in order she will endeavour to further her career elsewhere to develop the nursing profession when opportunities arise. Florence Nightingale would in fact depart for the Crimea on 21st October 1854 with a band of nurses at the request of Sidney Herbert the then Secretary of State for War. The two had previously met in Italy in 1848 and no doubt Sidney Herbert had confidence that Florence Nightingale could render assistance to the dire conditions of the military hospitals in the Crimea which was then inflaming public opinion.

I took the opportunity to lend my copy to an NHS finance officer who was greatly in praise of it – possibly because it makes a virtue of saving money across all ranges of expenditure while at the same time ensuring the quality of goods and services. The clear focus provided in its various pages, however, must be as it were a ‘taster’ of her more major written works.