After the Second World War, major programmes of national recovery and reform across Europe built on pre-war precedents to develop universal systems of medical provision for their citizens. ‘Health’ or at least access to healthcare came to be seen, especially in Britain, as both a symbol of modern nationhood and a tool of social cohesion. The USA, by far the wealthiest and most productive nation to emerge from the war, rejected this approach. Historians and politicians have long sought the origins of this idiosyncrasy and the reasons for its persistence, focusing particularly on political and economic forces. But popular culture too has played an important role in US resistance to state interventions in the medical marketplace. This chapter explores the vexed association in Anglo-American discourse between governmental health provision, ‘socialism’ and the British NHS. Focusing specifically on how the US print media represented the NHS visually and rhetorically to the American public, the chapter suggests that the NHS became synonymous with ‘state medicine’ in US popular culture between 1948 and 1958. It then reflects on British responses, and asks why hostile American visions of a purely domestic British social institution provoked such strong reactions. The chapter argues that fierce British advocacy of the NHS at home and abroad envisioned the service itself as a necessary bulwark protecting the nation from communism in the fervid atmosphere of the early Cold War: welfare, in the form of the NHS, was warfare.
This chapter explores the intensifying political, public, and professional concern with general practice waiting rooms in the first decade of the NHS. It argues that the years after 1948 saw the beginnings of a distinctively ‘NHS’ general practice waiting room emerge in British primary care: a space shaped by the ways in which inter-war professional values and premises were reworked in relation to post-war political promises and the peculiar new dynamics created between state, patient, and general practitioner (GP) under the new health service. However, though GPs’ waiting rooms came in for substantial criticism, material change was neither swift nor immediately radical. GPs retained considerable autonomy over their surgeries and practices. Despite coming under considerable political scrutiny, waiting rooms were only gradually remade while doctors reconsidered how patients’ suspended time in the waiting room could be put to new use. The reflections prompted during this period created the parameters for more incremental change as professional identities and the financial structures of general practice changed over subsequent decades.
The notion of consumerism in health is often seen as controversial. Many regard consumerism, with an emphasis on individual choice, markets, and profit, as antithetical to the universalist, collectivist, free-at-the-point-of-use National Health Service. Yet there were many different understandings of consumerism in British healthcare during the 1980s. This chapter examines how consumerist ideas were manifested in public health policy and practice, and especially the impact that they had on health education and health promotion. Consumerism represented a double-edged sword for health educators. Behaviours linked to consumerism, and especially the consumption of certain products, such as tobacco and alcohol, were linked to significant public health problems. Curbing such behaviours by encouraging people towards practices of ‘sensible’ consumption offered a potential way to address to these issues. Consumption was thus both a problem and a solution. With this in mind, the chapter analyses two health education campaigns from the 1980s, one to promote ‘sensible’ drinking and the other designed to deter children from smoking. Both used consumerist tropes, especially the notion of choice. Looking at how this language of choice was received by the public indicates that consumerist approaches were not hegemonic. Indeed, if health was a choice, it is clear that the public could choose not to choose it.
The NHS is a space in which we encounter through multiple identities: as patients, as friends and family, as employees, as a local community. ‘NHS at 70: The Story of Our Lives’ is a national project which has been recording oral histories with patients and staff, taking a holistic approach to each person and their relationship with the NHS. In these testimonies the everyday and the extraordinary feature across memories of particular places and the reliving of defining moments, from which we can begin to construct shared emotional responses to the NHS. Positioning the NHS as a space which is both public and private and cradles a myriad emotional experiences across generations can deepen our understanding of the public’s changing relationship with the NHS and its central place in British social culture. Using personal testimonies, this chapter explores how memories of spaces that are entrenched in the collective memory have changed in purpose or disappeared, and how new digital spaces of healthcare have emerged. It first examines memories of Park Hospital (now Trafford Hospital), the first NHS hospital, to understand the NHS and its cultural significance in the UK. Second, it explores memories of changing spaces of care – from sanatoria to asylums – in order to understand personal responses to changes in treatments and restructuring. Third, it considers the impact of virtual spaces in the NHS and the ways in which digital technology is creating a new space for patients and healthcare professionals.
In 1948 Boots the Chemists was placed at the intersection of high-street commercialism and public healthcare as its pharmacists took on the role of delivering dispensing services for the new nationalised health service. This chapter investigates how the NHS, as a cultural phenomenon, profoundly impacted the high-street retailer and its cohorts of professional pharmacists after 1948. It follows the changes in the physicality of dispensing in the shop setting, the advertising of NHS services in shop windows, and the enhancement of pharmacists’ professional reputation through their role in public health. While for the pharmacy profession as a whole, state-compensated dispensing was economically risky, Boots incentivised its pharmacists to compete for NHS prescriptions, leading to a massive uptake in service usage and customer footfall. Analysis of prescription service data highlights the importance of a new population of customer-patients who ‘didn’t buy anything’ yet drove Boots’ ‘NHS business’ by taking advantage of free dispensing services. The chapter locates the NHS’s cultural reach in a novel physical and material domain on the high street, in the relationships between pharmacists and patients, and in the expression of professional identity. It concludes that the symbiotic relationship between Boots and the NHS propelled both to become ‘bigger’ cultural players.
Commas are such useful nuancing devices. The careful positioning of a comma between ‘I’m afraid’ and ‘there’s no NHS’ changes the intent from a very English expression of disappointment into a personal statement of fear. Both seem appropriate when we consider the history and current state of the English National Health Service. Technically, the ‘NHS’ is on shaky ground as a legal entity. The institution created in 1948 was the ‘National Health Service’. That was the title of the 1946 Act of Parliament, and the name used by Bevan in his speeches during that period of uncertainty when members of the medical profession were yet to be convinced of their status, value, and autonomy within a potentially dictatorial system. The leaflet posted to all households on the eve of 5 July 1948 referred to ‘Your new National Health Service’. But it’s a bit of a mouthful, and frequency of use naturally inclined it to the abbreviation ‘NHS’.
Public knowledge and activism in the UK’s national health services
Ellen Stewart, Kathy Dodworth, and Angelo Ercia
Hospital closures have been a keystone of public engagement with the British NHS. This chapter explores ‘save our hospital’ campaigns through interviews with contemporary hospital campaigners in England, Scotland, Northern Ireland, and Wales. Interviewees describe high-profile public events, such as protests, within longer-term projects to build evidence for and influence thinking about the future of local hospitals. It argues that both in their public campaigning work and in behind-the-scenes efforts to influence decision-making, campaigners are actively shaping cultural representations of what an NHS hospital should be. At stake in these processes is the future of a particular hospital, but also always and more fundamentally, how society should make its commitment to universal healthcare meaningful.
Ensuring adolescent knowledge and access to healthcare in the age of Gillick
Hannah J. Elizabeth
In 1985, after years of campaigning, Victoria Gillick won her battle in the Court of Appeal and removed adolescents’ rights to freely access sexual health advice and contraceptives. The case, its implications, and its after-effects were widely reported in the teenage press. This ruling, later overturned by the Law Lords, plunged teenagers, teachers, and doctors into a period of uncertainty about what information and contraceptives could be freely given to those below the age of sixteen. This confusion threatened teenagers’ access to NHS healthcare long after the ruling was overturned as teenagers were left unsure of their rights to knowledge and contraception. Ironically, Gillick’s intervention was treated as an opportunity to provide sexual health information, open discussions around consent, and bolster teenage agency at a time when it seemed to be under threat. By exploring the representation of teenage access to contraceptive services, the Gillick case, and ‘Gillick competence’ through teenage media, this chapter demonstrates how access to NHS healthcare is mediated by knowledge of our rights.
The National Health Service (NHS) officially ‘opened’ across Britain on 5 July 1948, replacing a previous and patchy system of charity and local providers and making healthcare free at the point of use for all. By 1974, Barbara Castle stated: ‘Intrinsically the National Health Service is a church. It is the nearest thing to the embodiment of the Good Samaritan that we have in any respect of our public policy.’ This comparison crossed decades and party lines: in 1992 the former Chancellor of the Exchequer Nigel Lawson declared that the service was ‘the closest thing the English have to a religion’. By 2016, a physician publishing in the British Medical Journal asked whether the service was, in fact, a ‘national religion or national football’, paying testament to media and public critique which began at the service’s very inception. Posters, protests, and prescriptions provides a series of case studies which ask: what have the multiple meanings of the NHS been, in public life and culture? What cultural representations and changing patterns of individual behaviour emerge when an institution is simultaneously worshipped, challenged, and seen as under threat throughout its history? By looking at ‘culture’ in a variety of ways – through labour, activism, consumerism, space, and representation – this collection provides important historical insights into how and why the NHS has become a defining institution in contemporary Britain, frequently leading polls to define what Britons are ‘most proud’ of.
What does it mean when we say that we ‘love’ the NHS? How do different public groups ascribe meaning to this service? When do feelings about the NHS, such as love or fear, turn to action, such as protest? This chapter makes close investigation of a group which has not yet been subject to sustained academic consideration: NHS campaigners and activists. It analyses archival materials from the campaign groups London Health Emergency, the Politics of Health Group, and Spare Rib alongside a new survey of 175 self-identified ‘NHS campaigners’, offering over 38,000 words of rich new qualitative data. Tracing campaigners’ feelings in a structured way helps us to unpick complexities in broader public attitudes. If even the views of this relatively small and focused group, with strong passions about the NHS, are fractured, divided, and complex, then this highlights clear difficulties with making bold assertions that ‘everyone’ ‘loves’ the NHS. Furthermore, looking at the views of this group helps us to think about the relationships between publics and state institutions. Studying this group, which has some of the strongest attachments to the NHS, begins to demonstrate when, why, and how members of the public develop ‘love’ for institutions; when members of the public will challenge state provision; and, more broadly, how forms of lay expertise thus come into collaboration and conflict with political and media power.