When adding your spouse to bank account does it have to be a joint account or can they just have a card and other access?

It depends on the type of account - and the bank. If you're simply wanting the spouse to be able to spend money that's in the account - they can be added as an additional card holder. Alternatively - if you want the spouse to have equal control of the account (changing credit limits for example) - then it's better to have the account in joint names.