By Nick Hayes
For most today, it’s difficult to imagine a British hospital system where treatment is not ‘free’ at the point of delivery, paid for out of national taxation, because in our imagination, the alternatives conjure pejorative images of the Americanisation of health. Those today opposed to decentralisation also echo the concerns of earlier health reformers like Dr Stark Murray, who thought the pre-nationalised hospital system simply disparate and chaotic. Others contemporaries drew attention to the “gloomy and depressing” hospital buildings, the “crowded, un-hygienic waiting rooms”, and the “unsympathetic and inhuman atmosphere” that pervaded public hospital wards. Public disquiet, it is widely suggested, drove forward demands for radical reform. Lawrence Jacobs, for example, argues that widespread dissatisfaction with existing standards of treatment, a strong public dislike of voluntary hospitals and their flag day systems of financing, and an aversion to workhouse-turned-municipal-hospitals pressured policy-makers into taking action. For Charles Webster the newly elected post-war Labour government simply “responded to public demand by decisively breaking with the gradgrind [utilitarian] health polices of the past.”

But what do we really know, rather than think we know, about what ordinary people thought about hospitals before the NHS? Was there a strong demand for state nationalised medicine? Or were people generally satisfied with an already rapidly expanding but essentially localised service administered by voluntary hospitals, underpinned by a robust system of broadly based community fundraising activities and 2d per week mutualist contributory funds, and council-controlled public hospitals?


Where does this leave us? A number of recent studies have argued against notions of a wartime radicalisation, stoking demand for widespread social reform. Contemporaries surveying wartime public opinion, such as Mass Observation, similarly noticed such a reticence for change in health reform. It concluded:
On the surface, the evidence before us seems to indicate a fairly large amount of resistance to State interference in the field of medicine…. roughly half the population was opposed to any major change on the health front, a quarter disinterested and a quarter in favour of State intervention. But probing below the surface, we find that much of the feeling is simply in favour of no change, a fear of any change and feelings that existing conditions aren’t so bad after all, or that a change might be worse.
This poses the question as to why resistance to change by such a large margin should be dismissed simply as timidity, rather than as a positive vote for existing provision? Why should favouring the status quo be reconstructed in such a way? What we hear here are echoes of the progressive reformer’s voice at work; a voice that trumpets that “no less than three out of every seven questioned’ favoured the government taking over the hospitals,” while conveniently ignoring the fact that the other four did not. It was the same voice that asked such loaded questions in 1939, or prompted positive responses later. And it is this voice that still wrongly dominates our understanding of contemporary popular opinion of pre-NHS provision.
Nick Hayes is a Reader in Urban History at Nottingham Trent University. Having previously worked on post-war re-construction, and on civil society and voluntarism, he has recently focussed on the relationships between local hospitals and communities. He is the author of “Did We Really Want a National Health Service? Hospitals, Patients and Public Opinions before 1948” in The English Historical Review, which is available to read for free for a limited time.
First published in January 1886, The English Historical Review (EHR) is the oldest journal of historical scholarship in the English-speaking world. It deals not only with British history, but also with almost all aspects of European and world history since the classical era: it covers the history of the Americas, including the foreign policy of the USA and her role in the wider world, but excludes the internal history of the USA since Independence, for which other scholarly outlets are plentiful.
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[…] National Health Service just before and after its inception deserved more recognition this year. “Did we really want a National Health Service?” asks questions that people think they have answers to, all wrong. Perhaps that’s […]