This book examines the payment systems operating in British hospitals before the National Health Service (NHS). An overview of the British situation is given, locating the hospitals within both the domestic social and political context, before taking a wider international view. The book sets up the city of Bristol as a case study to explore the operation and meaning of hospital payments on the ground. The foundation of Bristol's historic wealth, and consequent philanthropic dynamism, was trade. The historic prominence of philanthropic associations in Bristol was acknowledged in a Ministry of Health report on the city in the 1930s. The distinctions in payment served to reinforce the differential class relations at the core of philanthropy. The act of payment heightens and diminishes the significance of 1948 as a watershed in the history of British healthcare. The book places the hospitals firmly within the local networks of care, charity and public services, shaped by the economics and politics of a wealthy southern city. It reflects the distinction drawn between and separation of working-class and middle-class patients as a defining characteristic of the system that emerged over the early twentieth century. The rhetorical and political strategies adopted by advocates of private provision were based on the premise that middle-class patients needed to be brought in to a revised notion of the sick poor. The book examines why the voluntary sector and wider mixed economies of healthcare, welfare and public services should be so well developed in Bristol.
Placing our focus on the idea and the act of payment both heightens and diminishes the significance of 1948 as a watershed in the history of British healthcare. Despite the principle of medical services free at the point of use, patient payment has always had some role within the NHS. 97 Indeed, those limited ‘pay beds’ present in the pre-NHS hospitals as the only means of securing treatment for middle-class patients were continued and
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.
choice between free or fee-paying services meant the middle-class patient had more choice under the NHS than before. Rejection or culmination? With the transition from a diverse patchwork of providers to a comprehensive and universal service as the dominant teleological narrative in the history of British healthcare, change looms large. Yet there is no consensus on the cause, or even the chronological scope
is here recognised and characterised as a shift from a moral to an economic code of conduct. Yet it is argued that new systems of class division merely replaced old ones, ensuring such distinctions remained at the heart of the hospital system and serving to mitigate and mediate the rise of universalism in British healthcare. Charity and change There have only been three decades in British history (at the time of writing) when it was the norm
2 Medicine and charity in Bristol Before the NHS, British healthcare had no national system. 1 While policies could be agreed and pursued by the Ministry of Health, the British Medical Association (BMA), the Institute of Hospital Almoners or any other national body, decision-making was distinctly local. For public hospitals this meant either the poor law union or the municipal authority. In the voluntary hospital
Gosling, Payment and Philanthropy in British Healthcare, 1918–48 (Manchester: Manchester University Press, 2017) . 8 C. Curchod and G. Reyes, ‘Producing One’s Own Medicine: Identity Tensions and the Daily Identity Work of Pharmacists’, Academy of Management Proceedings , 2017, no. 1, p. 10. 9 The Boots publication Pharmacy First (Spring 2009) refers to a pioneering service in Glasgow which saw pharmacists supervising the self
. 44 George Gosling, Payment and Philanthropy in British Healthcare, 1918–48 (Manchester: Manchester University Press, 2017) . 45 Newman, ‘Can we Decide Together?’ 46 D. Davidson, A. E. Paine, J. Glasby, I. Williams, H. Tucker, T. Crilly, J. Crilly, N. Le Mesurier, J. Mohan, D. Kamerāde, D. Seamark, and J. Marriott, ‘Analysis of the Profile, Characteristics, Patient Experience and community Value of Community Hospitals: A Multimethod
George Gosling, Payment and Philanthropy in British Healthcare, 1918–48 (Manchester: Manchester University Press, 2017) . 2 As cited in Rudolf Klein, The New Politics of the NHS: From Creation to Reinvention (5th edition, Abingdon: Oxon Publishing, 2006) , p. 86. 3 Nigel Lawson, The View from No. 11: Memoirs of a Tory Radical (London: Bantam, 1992), p. 613. 4 Bavid Barer, ‘The NHS: National Religion or National
. 56–68 ; Susan Kelly, ‘Stigma and Silence: Oral Histories of Tuberculosis’, Oral History , vol. 39, no. 1 (2011), pp. 65–76 . 6 See Michael King, Glenn Smith, and Annie Bartlett, ‘Treatments of Homosexuality in Britain since the 1950s – an Oral History: The Experience of Professionals’, British Medical Journal , 328:429 (21 February 2004), pp. 427–9. 7 George Gosling, Payment and Philanthropy in British Healthcare, 1918