In 1914 there was no Ministry of Health and no one had overall control of the hospitals, however the British Red Cross Society, linked up with the order of St John of Jerusalem in 1909 and formed the organisation known as the Voluntary Aid Detachment or V.A.D. for short.

Many middle or upper class women became keen to give up their time to do some useful work, mainly in hospitals. However not all volunteers where upper class women and not all V.A.D. work was completed in hospitals. At the outbreak of war there were already a number of V.A.D. Auxiliary Nurses working in hospitals.

As Great Britain declared war on Germany in 1914, the whole community rallied around to do everything they could to support the war effort. Before the outbreak of war some V.A.D. Nurses would do a short course to gain a certificate. Qualified nurses had three years training and soon became suspicious of the short V.A.D. courses. Inevitably quarrels broke out and from time to time there was open conflict. These disagreements were even printed in "Nursing Journals" reporting the V.A.D nurses as "ignorant amateurs".

Upon the outbreak of war, more and more nurses were needed it was soon realised that some nurses had certificates and were well qualified whereas others were not. Thus the value of these certificates was questioned and the task of sorting out these difficulties fell to the Joint War Committee. The issue of registration had become a minefield of personal feuds and interests, this could only be broken by initiative from another source, and the war would go on to bring many changes.