In the decade before the foundation of the NHS, Britain had one of the best hospital systems in the world and it could have developed on lines similar to health services in many modern European countries. This may have made it more financially sustainable and less politically vulnerable today, argues a University of Huddersfield historian whose new book probes the politics of health during the Inter-War years.
Professor Barry Doyle was awarded a £45,000 grant by the Wellcome Trust that enabled him to research the hospital services of 1920s and 1930s Leeds and Sheffield - chosen because they had very different social, political and industrial cultures.
He discovered that in Leeds, with a huge number of female workers in the clothing industry, and where women dominated the local authority's health committees, maternity services were highly developed. In Sheffield, however, where heavy industry was more prominent, orthopaedic services geared towards industrial injuries were more advanced. Employers and the Miners' Welfare organisation provided funds for special facilities.
"These were male problems, treated by male organisations for male workers," said Professor Doyle. "But Leeds had a very high proportion of women workers, who were also important in associational culture and in local politics. There was quite a strong relationship between women's role in politics, society and the economy and the provision of services that were being developed both by the local authority and the voluntary sector."
Professor Doyle's book is The Politics of Hospital Provision in Early Twentieth-Century Britain (Pickering & Chatto) and in addition to his new research into Leeds and Sheffield, it also draws on his earlier examination of early-twentieth century Middlesbrough. He writes about a period when towns and cities would have municipal hospitals mainly funded by local taxation, but where patients would usually be charged for treatment; plus voluntary hospitals, largely funded by contributory payments from workers. This was a form of health insurance, because when contributors were admitted to hospital their treatment was free.
Local priorities and disparate standards
As Professor Doyle has discovered, the nature of hospital services differed between urban centres as they responded to local priorities, and there were often big disparities between the standards of care available in town and country, where health provision was usually inferior. But he has analysed many positive aspects of pre-NHS healthcare and his findings make a contribution to current debates, as the health service grapples with financial problems.
"By the later 1930s, it was probably the case that Britain had one of the best hospital systems in the world. It was developing into a system that would have been much more like the modern European model in many respects," said Professor Doyle.
It was not inevitable that the NHS, launched in 1948, would become a fully nationalised and socialised system, he added. This was a route taken, for ideological and political reasons, by Health Secretary Aneurin Bevan. Before that, it had been Labour policy to support a municipal health system, similar to that in Scandinavia today.
Also, leading civil servants of the 1930s and 1940s became opponents of the voluntary hospitals, so they were shorn of support when healthcare was reshaped.
"I would say that the nationalisation of the health service and its funding base has left Britain today in a situation where it is very difficult to meet the expanding cost of healthcare without taking private options," said Professor Doyle.
"Most European models can top up their funding from the service user through insurance. But we don't have that capacity to extend income generation, and that leaves the NHS completely under the control of government spending priorities."
Research paper can be found in the University's repository here: http://eprints.hud.ac.uk/19326/
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