During my adult lifetime, the use of names in England has been
transformed almost beyond recognition. It is tempting to imagine
that the changes in the use of names have something to do with the
breakdown in the traditional English class system.
Names have always been used as a way of indicating social status.
When I was a boy, there was still the traditional annual cricket
match between the Gentlemen and the Players. A quick glance at the
scorecard would indicate which were which: E R Dexter was a
Gentleman, whereas Boycott (G) was a Player. A little further back,
the Gentlemen were entitled to a prefix “Mr”. Among the Gentlemen,
familiarity was indicated by the dropping of the prefix “Mr” and
addressing him simply as “Dexter”. The use of first names was a
mark of close personal friendship and not normally initiated
without a request for permission.
The first sign that this fixed world was crumbling appeared in the
This England column in the New Statesman in 1959. One 15-year-old
girl was heard saying to another: “Oh, I don’t know him well enough
to know his surname.” At first, this story was greeted with
hilarious incredulity, but within 15 years I found, when repeating
it, that people could no longer see why it had amused me. The fixed
world in which colleagues of 40 years’ standing, if particularly
good friends, addressed each other as “Smith” or “Brown” was
So, at the same time, was the informality common among those with
no pretension to gentility, in which bus conductresses addressed
their passengers as “love”, “duck” or “dearie”. Most people used to
take this in good part, but occasionally those with uneasy and
uncertain claims to respectability used to find their dignity
affronted by it.
In place of these two differing class styles there grew up a
classless uniformity in the use of the first name. For a long time,
this was current only among the younger generation, and one could
see it creating visible offence to their seniors, which younger
people resolutely refused to notice. Even these tensions have
passed to a large extent, but not entirely.
In our major hospitals the habit is to address every patient by
their first name. What is happening is an attempt to treat all the
patients as social equals. The attempt to establish social
stratification in the ward, and the resultant privilege for some
patients, would rapidly become intolerable. The manifest unfairness
neither could nor should be tolerated. Though nurses, like other
human beings, cannot help some response to courtesy when they meet
it, a stratification which is based neither on behaviour nor on
clinical need runs against every ideal that keeps a public ward
What we perhaps see in this adamant insistence on the use of first
names is how big a taboo had to be overcome to bring about this
equality. Like most very recent history, it is very easily
forgotten. For my children the world in which I grew up is as
remote as the early middle ages, and those who goggled at the
opening paragraph of this article about Gentlemen and Players
should be prepared to admit it. For people of my age, social change
has been like fast driving: we tend to forget very rapidly the
scenery through which we have just passed.
Is the fact that we can no longer remember the reason for this
change a sign that it is no longer needed? It was clearly necessary
for a while, because one cannot change ingrained assumptions
without some element of shock.
Yet at the same time it must be admitted that someone who is used
to being addressed as “Mrs Smith” except by close friends may take
offence at an obstinate insistence by people she does not know on
calling her “Doreen”.
Causing hurt or offence can only be justified if it is necessary to
achieve a higher need. Those who are offended if black patients are
treated equally must bear the offence: that battle is not yet
finally won, and won it must be. Is it still necessary to inflict
such hurt to prevent the return of a world of Gentlemen and Players
which is now buried beyond recall? Could patients and social care
clients be allowed to express their own preference about what they
want to be called? Or is it still 15 years too soon?
Conrad Russell is Liberal Democrat social security
spokesperson and professor of British history, King’s College,