The British love the National Health Service. In early 2020, people emerged from their homes every Thursday evening to applaud healthcare workers and show support for this treasured national institution. While the strength of feeling might have grown during the pandemic, it pre-dates the first cases of coronavirus. Throughout the 21st century, public displays of affection for the health service have become increasingly commonplace. From parliamentary debates to social and mainstream media, love for ‘our NHS’ has intensified and is now a fundamental part of British national identity. 

This strength of feeling has not always been there. While the value of a state-funded healthcare system might seem, and feel, self-evident today, for the first few decades of the NHS’s existence, the British people were rather more questioning of the institution. 

In 1949, Mass Observation – a social research project designed to record everyday life in Britain – asked people what they thought about the new NHS. Even those in favour of it, or who criticised some of its elements, did so with a kind of pragmatic calm. When asked for her opinion, Mrs D. Wells responded, ‘I read it in the paper … but I wasn’t attending enough to take it in.’ With similar indifference, one man said, ‘It hasn’t affected me any different to what it used to be.’ Mrs W. Parsons called the radical social experiment ‘all right’. 

Clearly, things have changed. There are many reasons for this transformation in public feeling, but one that might come as something of a surprise is the flourishing of romantic fiction in the postwar period.

Mills & Boon were the most prolific publishers of romantic novels in 20th-century Britain. Founded in 1908 as a publisher of general fiction, etiquette guides and manuals for modern living, their romances soon outsold all else. One hundred years later, in 2008, they had 3.2 million devoted readers in the United Kingdom, where a Mills & Boon paperback was sold on average every 6.6 seconds. 

In the 1950s, shortly after the foundation of the NHS, they began to publish a new sub-genre. Doctor-Nurse romances were usually set in a state-funded hospital and they typically – but not always – involved a love-affair between a male doctor and a female nurse. By 1957, Doctor-Nurse romances constituted a quarter of Mills & Boon’s sales. 

Despite their popularity, Mills & Boon novels have something of a bad reputation. Frequently dismissed by self-defined ‘serious’ literary critics as lightweight, frivolous fiction – predominantly read by young women and housewives – feminists also often framed them as novels that represented retrograde and limiting visions of modern womanhood and heterosexual relationships. 

But both of these visions misrepresent romantic fiction and underplay its significance. Not only did these novels encourage women to enter
the healthcare workforce, and remain there even after they married, but they deliberately cultivated public devotion to the NHS. 

While Mills & Boon did not require its authors to have relevant healthcare expertise, the Doctor-Nurse romances were invariably written by women with clinical experience. These were highly skilled professionals, turning their hand to a new profession – writing – and as a result they were not that interested in portraying one dimensional female characters. Throughout, Mills & Boon heroines found value in work and their professional identities. Thus, while some medical romance novel characters – especially early ones – gave up their paid work for married life, many did not. 

Instead, the novels championed working women. While some tended to feature nurses as their heroines, later stories included female surgeons and physicians as well. Regardless of their profession, however, they were ambitious and eager for knowledge and found meaning in their careers and professional success. Madeline Keys, the lead of a 1962 novel, was a surgeon and, ‘obviously a feminist’. She ‘believed wholeheartedly in women and felt they had a much greater potential than they gave themselves credit for’. 

Heroines frequently overcame the doubt and dismissal of chauvinistic male colleagues. The surgeon Noel Aston, the heroine of one of Elizabeth Gilzean’s novels, frequently butted heads with Bill, who made ‘no secret of his belief that women have no place in research’. At the end of the novel, the two fall in love, but their romance does not jeopardise Noel’s career. Rather, they enter a marriage of professional and intellectual equals. Instead of ‘striving one against the other’, they ‘combine love and marriage and their jobs by doing it in partnership’.

Mills & Boon authors were expected to build and uphold their readers’ commitment to the health service and its workforce. The publisher and its writers acknowledged the impact these books could have on public opinion. One author, Betty Neels, said, ‘Mills and Boon are so widely read that they must to some extent influence their readers’.

As a result, medical romance fiction idealised hospital staff. In a letter Elizabeth Gilzean sent to Alan W. Boon in 1958, she wrote: ‘Any villain of “bitchy” character must be outside the nursing or medical profession.’ That same year, Mr Davidson, the managing editor of a women’s magazine, agreed. He rejected one of Gilzean’s stories for serialisation, arguing: ‘I have a theory that fiction must never disturb the faith and trust a woman feels for doctors and/or nurses.’ He implied that romance had the capacity to undo readers’ devotion to the health service and that authors must try to do the opposite – to build belief in the value of medicine and the moral character of doctors and nurses. 

With such positive images of the health service, romance novels were frequently used in nursing recruitment drives. But they also acted as advocates for the NHS itself, calling for reforms to mental healthcare, improved general practice and more widely available reproductive medicine. They also represented the health service as a modern, technological marvel. This was the mid-1960s, the age of prime minister Harold Wilson’s ‘white heat of technology’ speech, and Mills & Boon played their own role in heralding the NHS as part of modern Britain’s ‘scientific revolution’.

The NHS today is a topic that invokes intense emotion, and many British people feel deeply for the health service and its workforce. This relationship is, however, a historical phenomenon – one that has been actively made and maintained. Mills & Boon, its authors and editors, tried to cultivate attachment to the NHS among its many millions of readers. If the current political climate is anything to go by, their efforts proved successful. 

Agnes Arnold-Forster is the author of The Cancer Problem: Malignancy in Nineteenth-Century Britain (Oxford University Press, 2021).