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.
to consider charging for some services. 8 What might those considerations be based upon? Fragmentation of NHS service provision has made it significantly harder for the government (or anyone else) to gather information about the situation on the ground, which leaves abstract theory or international comparison as the only options available – unless we look to the past. This book does just that by examining the payment systems operating in British hospitals
, payment exists as a symbol of free-market healthcare of a kind that in fact never existed on any significant scale. A more nuanced understanding of the place of payment in British hospitals before and after 1948 adds to a growing appreciation that it was the high-point in a longer period of kaleidoscopic change. An alternative narrative has been increasingly favoured by historians, mostly since the turn of the century, whereby the new settlement
The creation of spaces conducive to healing is a critical aspect of the provision of good nursing care. The nursing sisters of the British Army, having trained in the British hospital system would have been well versed in the need to create and maintain and environment in which healing could take place. The zones into which they were posted during the Second World War and the spaces they were given in which to care for their patients, were however, rarely either favourable to health or to the ‘serenity and security’ needed for recovery. Extreme weather conditions, limited water supplies, equipment and electricity combined to hinder all aspects of patient care. The often hostile places in which nurses worked demanded that they develop clinical skills and the ability to improvise and innovate in order create healing spaces for their soldier-patients. However, as the chapter argues it was the highly feminised home-maker work that created these spaces, which the nurses themselves credited to be an essential aspect to the healing process in which they were the critical performers.
military nurses to return to hospital practice. Its focus on what they could expect appears to have had the opposite effect. Many QAs had indeed worked in specialist areas, but within their work they had developed innovative practices, learnt new ways of working and established a more human-centred approach to patient care. The lack of understanding of these critical professional attributes would alienate the returning nurses and ultimately deny their talents to the British hospital service. The vast majority of nurses whose stories have been used in Negotiating Nursing
hospitals financially was timid and consequently, as the evidence presented here has shown, private hospital services before the NHS never broke out from being marginal within the institution, largely restricted to the south of England and strikingly limited overall. With provision for middle-class patients no more than 3 or 4 per cent of pre-NHS hospital beds, the main work of Britain's hospitals continued until 1948 to be the treatment of the sick poor. And perhaps
fund, the scheme would then cover a contribution on behalf of the patient if admitted. The recent literature on the pre-NHS hospital sector has rightly given a prominent place to such schemes. 18 They have been characterised as becoming ‘an essential element of the British hospital system’ in the interwar decades, enabling ‘renewed hospital expansion’. 19 Certainly, they were a notable change and provided a useful new income stream – but they
the nearest to Hell I have yet been’.36 Munro’s unit was broken up in November 1915, when six of its ambulances were placed under the control of the French Service de Santé.37 Nurse fighters on the Serbian Front Among the most unusual accounts produced by volunteer nurses is that of Flora Sandes, who began her wartime career as a volunteer with a British hospital unit and ended it as a fighter with the Serbian army. Angela Smith has suggested that, by actually fighting on the field of battle, Sandes, ‘inadvertently, struck a blow for the feminist cause’.38 After
University in Cleveland, Ohio had advocated the formation of ‘base hospitals’. Several discrete units had been created, each staffed by doctors and nurses from a single institution.95 The first six units arrived in France, well before any US combat troops, and began by working with British Expeditionary Force staff in British hospitals.96 By 15 Introduction August 1918, fifty base hospitals were in place, and in that month several more were planned.97 One of the most difficult issues faced by the Committee on Nursing of the General Medical Board of the Council of
of policy, and whilst some policy experiments with mass provision and integrated services existed, consensus over broad principles masked sharp divisions about the aims, structures, and mechanisms to be employed. 33 Ultimately, these disputes became embodied in the final shape of the NHS. Against advice from senior civil servants, Cabinet colleagues, and the Labour Party, the Minister of Health, Aneurin Bevan, promoted a scheme for nationalising almost all Britain's hospitals. 34 The reform, however, did not place the Ministry of Health (or