Introduction
in Posters, protests, and prescriptions

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.

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.1 By 1974, Barbara Castle stated that ‘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.’2 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’.3 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 its very inception.4 Posters, Protests, and Prescriptions: Cultural Histories of the National Health Service in Britain 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.5

As Martin Gorsky has argued, the size and longevity of the NHS – with over 400,000 hospital staff in 1951 and 1,166,000 by 2004 – underscore the significance of not ‘distilling unitary narratives from plurality of experience’.6 With this in mind, this book provides a series of eleven case studies, offering fresh and innovative new perspectives into the meanings and cultures of the NHS in Britain through targeted historiographical interventions. The case studies offer significant variety – a key strength of cultural history – and explore as diverse themes as teenage consent in the NHS, workplace identities from cleaners to consultants, and American visions of the service as a ‘spawning of the nether pit’. Within these diverse case studies, our aim is to promote and provoke discussion of whether and how the political power of the NHS has been lived and felt in public life and in culture. Furthermore, the collection will also show that cultural histories of the NHS are varied and rich, and matter for understanding broader histories of medicine and modern Britain. Indeed, these histories reveal, in various ways, what is meaningful about the NHS: how people use, campaign, and work for it in daily life, and how current cultural and political visions of health and care have emerged through contested social, political, and cultural settlements and accommodations.

As with other successful edited collections analysing cultural history, the ‘richness’ of this book relies on its ‘variety and in its acknowledgement that no individual scholar, or group of scholars, has the capacity to unravel the mysteries of human behaviour’ and, in this case, of health, institutions, and cultural attachment, framed throughout the collection as ‘love’, ‘devotion’, and ‘support’ for the NHS.7 Contributors make use of a diverse range of sources, including newspapers, films, television, novels, public health leaflets, commercial documents, interviews, and social surveys. These sources are analysed primarily through historical perspectives, though contributors also draw on, and hail from backgrounds in, sociology, public health, and policy studies; continuing the diverse intellectual foundations of cultural history and cultural studies more broadly.

While diverse, the case studies in this collection are purposefully chosen and clearly structured. The book is divided into six parts, which bring together the eleven contributions. The first three parts, ‘Work’, ‘Activism’, and ‘Consumerism’, show how cultural approaches can provide new perspectives on classical questions of political and economic history: questions of work and employment, activism and political change, and consumerism and economic behaviour. The next two parts – ‘Space’ and ‘Representation’ – draw on quintessential approaches of cultural history, using oral history and popular and material cultures, and demonstrate the cultural richness of the NHS as an institution. The book’s final part blends policy and cultural approaches, and places these debates in an international context, considering representations of the NHS in the USA. Overall, then, the book offers a varied and dynamic, but also coherent and interlinked, approach to considering cultural histories of the NHS. The book is driven fundamentally by a wish to answer two key questions: what is cultural history, as opposed to demographic, policy, or economic history? And what is ‘the NHS’ and its changing place in modern British life? By looking at the niche and the everyday – at materials like placards, posters, and prescriptions – we can begin to examine these broad and important concerns.

Cultural history

Sasha Handley, Rohan McWilliam, and Lucy Noakes have argued that cultural history and indeed ‘culture’ have long histories which were initially based in histories of ‘high culture’ produced in the mid- to late eighteenth century.8 Cultural history, Peter Burke tells us, was ‘rediscovered in the 1970s’ and remains a baggy and ever-extending field, with a range of objects of analysis and methodologies.9 Nonetheless, cultural historians have a common interest in ‘the symbolic and its interpretation’, in ‘representations’, and in considering ‘the variety of images, stories, and texts that sustain a way of life’.10 Culture is, as landmark work by the anthropologist Clifford Geertz argues, concerned with semiotics: ‘webs’ of images, symbols, and materials which are constructed by, and meaningful only within, society.11 The NHS is ripe for cultural analysis: it began only seventy years ago and yet, across that relatively short period, has become associated with a significant depth of feeling and a range of representations – produced externally, on television and by campaigners and press, and also by the NHS itself, through public health materials and sick notes and the daily encounters of waiting rooms.

This collection takes a purposefully broad approach to cultural history, looking at, as Hannu Salmi describes, ‘thoughts, emotions, and representations’, as well as ‘the invisible, the momentary, and the perishable’.12 Several contributions consider cultural history by thinking about meanings, feelings, and belief, using materials including social surveys and oral history interviews to analyse how people describe and discuss the NHS. Another vision of cultural history which runs through this collection treats cultural history as a history of the minute and the everyday, and contributions consider the waiting room, the sick note, and the micro-level interactions and material environments which shape people’s experiences and expectations of health and care. These definitions draw on the legacy of the cultural studies movement, as formulated by E. P. Thompson, Raphael Samuel, Stuart Hall, Richard Hoggart, Angela McRobbie, and Raymond Williams, who considered lived experience as culture and cultural practice.13 Another vision still is cultural history as a history of representation, and the collection examines how the NHS is represented, and how it represents and communicates its work, in public health materials, teenage magazines, novels, film, and television, building on early work in this area by Elizabeth Toon, Sherryl Wilson, Patricia Holland, Susan Bruce, and Agnes Arnold-Foster.14 Overall, the collection uses cultural history as a method which draws our attention, through focused analysis, to ‘the unexpected and unintended’: to such seemingly mundane, and yet also deeply significant, case studies as teenage magazines, waiting rooms, sick notes, and campaign banners.15 These fragments and varieties of cultural history provide a ‘lens’ into broader social and political life, by revealing cultures produced and experienced inside and outside the NHS.

In offering this range of cultural histories, this collection testifies to the vibrancy and potential of these approaches. It showcases the value of cultural history in itself, and also shows the ways in which cultural histories can illuminate histories of the political and the social. Clear links between cultural and political discussions are evident in the history of the NHS. In an early example, analysts consider the ways in which the ‘extraordinary [popular] success’ of Dr A. J. Cronin’s novel The Citadel (1937) may have influenced debate around the establishment of the NHS.16 Looking at subsequent decades, Joseph McAleer has argued that the NHS ‘renewed interest in all aspects of the medical profession’, which was ‘absorbed into the culture’ and in turn promoted new forms of industry – such as medical romance novels.17 The links are further underscored in Toon’s analysis of Beyond the Night, a television play about a young woman’s treatment for breast cancer, which aired on BBC1 in 1975. Toon argues that this cultural portrayal, alongside the work of new women’s magazines and novels, contributed to a key shift in public discussions of breast cancer. While analyses had previously represented cancer as ‘a diffuse scourge to be conquered by science, charity and the state’, from the 1970s onwards ‘sufferers’ experiences’ would be central to debate.18 Agnes Arnold-Forster has argued that Mills & Boon novels, often set in NHS hospitals in the post-war period, ‘put forward nuanced versions of womanhood, professional identity, clinical labour, and the effective functioning of the welfare state’.19

In addition to cultural representations, public attitudes – accessed through increasingly sophisticated polling and data collection – also shape the attitudes and rhetoric of politicians who have increasingly made the NHS central in party manifestos.20 Recent work by historians and sociologists has likewise pointed to the role of patient involvement in healthcare in – at times – shaping the policies of the NHS itself.21 Work by Andrew Seaton, Jennifer Crane, and Edward DeVane has shown how small pressure groups, whether lobbying to protect or attack the NHS, can likewise shift social attitudes and political debate.22 Continuing this analysis, which connects cultural, social, and political dialogues, multiple contributions in this collection assess everyday reactions to large-scale political debates and consider the role of civil society in meditating between citizen and state. Other contributions still demonstrate how public attitudes, campaigning, and cultural representations have motivated and driven political change.

Significant cultural historians have argued that taking such a broad and connected view of cultural history can be a significant strength: Burke explains that cultural histories can be seen to ‘remedy’ the fragmentation of history into specialist histories of, say, ‘population, diplomacy, women, ideas, business, warfare and so on’, particularly in a historical moment where cultural identities and conflicts are becoming as important as political and economic ones.23 Looking at the uniqueness of cultural history, Frank Mort has argued that the ‘frontier’ between cultural and social history is ‘porous’, and that, as writers in a recent edited collection on the topic showed, these must be ‘not mutually exclusive but critically engaged’.24 As Handley, McWilliam, and Noakes argue, from the start cultural histories have fused economic, social, and cultural explanations, recognising the connections between these phenomena.25 This was also the approach of the ‘Cultural History of the NHS’ project at the University of Warwick, from which the idea for this edited collection sprang. In conceptualising this project, Mathew Thomson and Roberta Bivins analysed not only ‘cultural representations’, but also ‘popular meaning’, ‘public attitudes’, the cultures of ‘staff, trade unions and regulatory bodies’, and the uses of the NHS ‘as an emblem of wider and deeper social beliefs ... [a] vehicle for the transmission of cultural norms’.26

The potential challenge in taking such a broad definition of ‘cultural history’ is that we may lose what is distinctive about culture, and fail to provide a distinct and unique contribution to debates. Nonetheless, this collection is proud to focus on connecting different types of histories, beyond artificial borders constructed in historiography and life between ‘culture’, ‘society’, and ‘politics’. We would suggest, indeed, that potentially narrow drawings of ‘the political’ have been conclusively refuted by the second-wave feminist movement, and indeed that these tight definitions may contribute to a field whereby ‘political history’ is dominated by male scholars focusing on elite institutions of power. Thus, while the inception of cultural history initially marked a turn away from categories such as ‘class’, looking towards ‘identity’ as more ‘complex and various’, Posters, Protests, and Prescriptions considers how perceivedly political and economic categories – class, wealth, work – can be brought into cultural conversations.27 We contend that cultural history may open up, challenge, subvert, and support analyses of politics, economics, and demography, and that it may expose and illuminate the porous lines between these fields. In taking this approach, we hope that the collection will be of interest to a range of historians, whether self-defining as political, social, or cultural.

Each history within this book, indeed, places different amounts of weight on political, social, and cultural questions and further connects them, while also offering a significant contribution to analysis of its own historical context. These chapters do not offer a conclusive or a full picture of the ‘whole’ cultural history of the NHS, but rather a series of insights and an invitation to look further at the niche, the everyday, and the cultural. This approach builds on the field of microhistory, which has had widespread application using local analysis to make broad and disruptive historiographical arguments.28 This powerful approach has found new uses in recent times, being re-adapted to show the value of looking closely, while new approaches – such as digital history – make clear the potential ‘boundlessness’ of our discipline and source-bases.29 In this context, Julia Laite has suggested that historians may consider the term ‘small histories’, looking to ameliorate concerns that ‘microhistories’ cannot accommodate social historians’ ‘quest to restore agency to and understand the experience of individuals and groups in the past’ in their rush to connect individual lives with large-scale change.30 This collection supports the idea of ‘small histories’, in which analysis of everyday objects and phenomena – posters, protests, and prescriptions – may open up broad visions of large-scale change, but may also enrich our thinking in relation to individual lives, decision-making, and the contingency of historical pasts. Striking this balance between looking at the ‘small’ and at the ‘big’ is a common theme across this collection, which we hope provides a new history of change in the NHS, as well as a history of ephemera and meaning.

The NHS

In 2008 Gorsky observed that historiographies of the NHS had focused closely on policy and demographics.31 Certainly, in the 1980s, 1990s, and 2000s Charles Webster (the ‘official’ historian of the NHS), Rudolf Klein, and Geoffrey Rivett all authored significant volumes which focused on how the service operated, was managed, and was funded.32 The policies and bureaucracies of the NHS remain a key focus for historians: Gorsky’s own work, and that of John Mohan and George Gosling, has added richly to our knowledge of how healthcare was provided before the NHS developed, primarily through analysis of voluntary and local hospitals.33 Mohan has also provided an account of how the NHS has been restructured since 1979, and the economics of resource allocation and financing have received attention from Gorsky and Gareth Millward.34

In the late 1970s and 1980s contemporary witnesses, such as the general practitioner (GP) and campaigner David Widgery, provided counterparts to this historiographical focus on policy change, writing personal accounts of the NHS which entwined activism and community and life history.35 In recent years, histories of the NHS have also often broadened their focus beyond funding, hospital organisation and location, and bureaucratic structure to examine the relationships between publics, attitudes, and policy. Projects led by Virginia Berridge and Stuart Blume, for example, connected analysis of political change with social inequality, demonstrating the historiographical potential of relating political change to its effects on daily life.36

Further expanding the focus of policy-based accounts, in recent years historians have begun to directly address the meaning of, attitudes towards, and feelings about the NHS. As mentioned, the editors of this volume were employed with funding from a Wellcome Trust Senior Investigator Award at the University of Warwick, initially conceptualised by Roberta Bivins and Mathew Thomson, which aimed to directly address a ‘cultural history’ of the NHS, and which has resulted in articles discussing migration, activism, and public health.37 At the University of Liverpool, Sally Sheard led a project, also funded by a Wellcome Trust Senior Investigator Award, which focused on ‘The Governance of Health’ and held witness seminars to uncover popular memories and perceptions of key reforms.38 Another Wellcome Trust Senior Investigator Award in this area was held by Alex Mold at the London School of Hygiene and Tropical Medicine, and this analysed how ‘the public’ was configured and discussed within public health, which was ‘removed from local government and brought within the NHS’ in 1974.39 A Heritage Lottery Fund project at the University of Manchester, led by Stephanie Snow, has collected oral history testimony from staff, patients, and supporters of the NHS, curating a rich archive of public feelings and memories.40 This collection unites scholars involved in these projects and within this significant new historiographical terrain to document, for the first time, this new trend in research, and to analyse the NHS beyond policy structures and funding. Instead, these diverse projects each offer insight into the service’s multiple meanings, its relationships with public attitudes and everyday life, and its representations in consumerism and culture. This work can be brought into conversation with, for example, exciting new historiographies of the NHS as a cultural, emotional, and sensory space, which are developing rapidly.41

While examining new terrain, certain narratives in this book support and bolster the emphases of political histories of the NHS. One strand of this political literature, supported in this collection, assesses tensions between the local and the national in the NHS. Klein argues that there has been ‘oscillating progress between devolution and centralisation, and back again’ in NHS policy from the organisation’s inception, caused by the conflicts between dependence on public funds and the devolution motivated by their perceived inadequacy.42 Richard Biddle has traced the local impact of the Hospital Plan of 1962, identifying first ‘optimism’ and subsequently ‘anger’ in Reading over its ‘hierarchical regionalism’ amid public-sector interest in economic and social ‘planning’.43 In the 1990s, however, there were a significant shifts towards centralisation, symbolised by the introduction of NHS Trusts and Primary Care Groups, the adoption of branding, a unified management structure, and the ‘hyper-activity’ of the NHS Management Executive.44 This collection similarly encounters clashes between the national and the local within the NHS but, newly, explores how they played out in culture, society, and everyday life. The collection also asserts that understanding the local, which is less often the focus of historiography than the national, is of crucial significance for us to understand attitudes towards the NHS. Chapters highlight the significance of locales in shaping targeted public health policies, cultures of campaigning, distinct waiting room décor, and memories of long-standing individual hospitals.

For other parts of this collection, the social, cultural, and everyday stories are different from political histories. Notably, looking at culture and society reveals numerous spaces in which NHS policies and structures were challenged, dismantled, and renegotiated in everyday life. Throughout this book, indeed, we see patients refusing to comply with public and sexual health messages and mobilising into group activity in defence of specific hospitals or even to support the perceived ideals of the NHS itself. This analysis reflects declining cultures of deference and authority across post-war Britain, but also shows the longevity of public resistance. Furthermore, while policy histories have focused primarily on hospitals – the main foci of spending in the NHS, and a key site of employment – looking at public attitudes and cultural visions of the NHS brings our attention beyond secondary care.45 This collection pays significant attention to the meanings of general practice. Rather than focusing on oral histories of practitioners, as in the significant works of Julian Simpson and Graham Smith, contributors explore the meanings of waiting rooms and sick notes, and consider how these everyday spaces and objects have, in a sense, seen some of the most mundane and yet also most important encounters between people and their NHS.46 Further broadening our analysis, the collection also considers sanatoria, asylums, and public health, the latter through consideration of advertisements, magazines, and the high-street behemoth Boots the Chemists. The collection also asks us to think about the boundaries between the NHS and commercial provision: this is a key theme in activist testimonies, discussed in two chapters, and another chapter still focuses on the role of Boots in delivering NHS prescriptions, continuing its work from before the inception of the health service. Finally, the ‘Work’ part of this book broadens our thinking about NHS staff themselves, beyond the analysis of doctors and consultants – often a historiographical focus – towards a consideration of ancillary staff: porters, healthcare assistants, and cleaners. Thus moving beyond analysis of expenditure, policy, and structure displays new spaces of healthcare, and demonstrates that public relationships with the NHS are formed beyond hospitals alone. Hospitals nonetheless remained significant, ‘well established as the symbolic space of the NHS’ by the mid-1960s, as Thomson’s chapter argues, and they are also the key focus of activist efforts explored by this book.

Posters, Protests, and Prescriptions thus asks historians to think broadly about what, exactly, the NHS is, and about the ways in which different types of NHS care and services are provided not only in hospitals, but also through primary care, through commercial agencies, in the home, through magazines and public health leaflets, and even online. Broadening our analysis about ‘the NHS’ provides insights into political and social questions of citizenship and publics. Debates around sexual health, the closure of services, sick notes, and waiting, for example, all reveal changing ideas about ‘deserving’ and ‘undeserving’ recipients of NHS care, and about what citizens and publics do to protect, and to ‘earn’ entitlement to, this service. Analysis of culture and representation, as well as of experience, demonstrates the ways in which the NHS has been a symbol of a hierarchical professional culture, yet also of universal ‘values’ of equality and democracy: key clashes within the post-war settlement and in the late twentieth century.

Analysing the NHS in such a broad manner will begin to reveal how cultural and social visions of healthcare have changed over time and space, with particular emphasis on shifts in the 1940s and the 1980s. In terms of the former, this book contributes to recent reassessment – notably by Gosling, Bivins, and Nick Hayes – of 1948 as a ‘turning point’ in NHS history. Indeed, as these historians have argued, media coverage and public attitudes did not change drastically on the ‘Appointed Day’ of the NHS’s launch, nor was this day marked by new infrastructure.47 Rather, as Mathew Thomson has argued, public feelings of ‘love’ and affection for the NHS developed gradually from the 1940s as people ‘learnt’ about the institution, what it meant, and how to utilise its growing resources.48 This book furthers such new analysis, demonstrating that the NHS’s journey to become a cultural icon, endowed with popular meaning, was a gradual one. As the chapters highlight, there were few plays, dramas, or radio representations of the NHS in its earliest years, and those which emerged first, in the 1950s, were often critical. Nonetheless, the book’s new case studies also show certain areas in which the inception of the NHS did mark a significant and immediate change in culture and everyday life. Notably, the chapter on Boots the Chemists shows that people’s daily interactions with their pharmacists, shaped by public health campaigning, did change markedly from 1948 itself. A complex picture emerges, therefore, from a broad look at different institutions, arenas, and meanings of NHS care.

This collection also adds to our understandings of how the cultures and politics of the NHS changed in the 1980s; at present this is a small field in research, given the contemporary nature of such a history. This book’s accounts of activism suggest that public affection for the NHS, at least as marked by action, accelerated markedly from the 1980s, when it faced threats of closure and cuts and became a symbol for left-wing politics. Tensions around the potential biases ingrained within state-sponsored welfare systems came to the fore in this decade, and this collection gives space to activists, patients, child-consumers of magazines, staff, and television and radio programmes which criticised hierarchies of race, ethnicity, class, and gender in the service and asked why services for minority groups were often the first victims of spending cuts. Cultural representations of medicine – from activists and film-makers – began to directly address ‘the NHS’ and to utilise increasingly popular forms of satire to challenge political change.

New forms of public health campaign, addressing a ‘consumer’ rather than a patient, also developed in this period, driving further critique of the perceived marketisation of the service. By taking a long view from 1948 to the present, this collection shows that publics have always been anxious, to an extent, about the service’s maintenance and sustainability, as is visible within newspaper, survey, and oral history reports utilised throughout the book. Nonetheless, contributions also highlight the 1980s as a significant moment for extending rhetoric around the NHS: a moment in which a cultural and everyday vision of ‘love’ for the service emerged, in response to, and reshaping, the politics of cuts and critique. Overall, therefore, examining the NHS from the perspectives of culture and everyday life enables us to consider the significance, usage, and meaning of this service, and to enrich and question long-standing political narratives of change.

The structure of the book

The first three parts of this volume, ‘Work’, ‘Activism’, and ‘Consumerism’, offer new cultural approaches to classic political and economic questions. The next two parts, ‘Space’ and ‘Representations’, explore new approaches in classic cultural histories. The final part provides an international perspective. In ‘Work’, a case study of ‘becoming NHS staff’ by Jack Saunders shows how labour histories must incorporate the constructed and imagined significance of identity – the label of ‘NHS staff’ – in order to understand the emotional labour which NHS workers perform. In a chapter on sick notes, Gareth Millward shows how deciding who was sick and who was not – a function carried out by NHS staff, particularly general practitioners – reveals the broad meanings of the NHS and welfare state, beyond narrow political definitions of the service, and Millward calls for close attention to be paid to the complexities of the post-war welfare settlement.

Part II, ‘Activism’, continues to expand our thinking about how looking at culture – in various forms – can reassess political and social histories. Jennifer Crane uses social survey material, describing the feelings and beliefs of self-identified NHS campaigners, to discuss what activists and publics mean when they say that they ‘love’ the NHS, and the ways in which this belief underlies political action. Ellen Stewart, Kathy Dodworth, and Angelo Ercia, meanwhile, look at everyday campaigning to defend NHS hospitals from closure in England, Wales, Scotland, and Northern Ireland. Drawing on qualitative interviews, Stewart, Dodworth, and Ercia position the NHS as a ‘cultural entity constituted and reconstituted through the everyday expectations, interactions, and labour of the people who use and staff it’. This part of the book hence demonstrates the different ways in which history and sociology conduct qualitative research ‘from below’ to examine culture, and it provides a useful addition to the existing focus of literature on the legislation driving such political change. It also enables some comparison of activism across nations and region, and highlights the ways in which public feelings for the NHS are shaped by place, age, gender, and class.

In Part III, ‘Consumerism’, Alex Mold takes a ground-level approach to consider how, why, and when policy change mattered in the 1980s. Mold’s close analysis of two public health campaigns – promoting ‘sensible’ drinking for adults and encouraging children to avoid smoking – shows how preventive messages were disseminated to public groups and, importantly, how members of the public choose to reject and refute them. Mold’s chapter shows how health promotion in Britain was ‘rooted in international developments’, echoing reports from Canada and the World Health Organization, and yet also reflected distinctly ‘British’ cultural and political visions of consumerism and individualism. Next, Katey Logan undertakes close analysis of the archives of the high-street chemist Boots: a store founded in 1849 and which by the 1930s ‘extended from the Orkney to the Channel Islands, from inner city to rural county town’. Boots’ internal magazines, in particular, offer a rich cultural source with which to understand the position of the pharmacist within the welfare state, and the changing relationships between pharmacists, patients, and governments from the 1948 moment. This analysis is pertinent to our thinking about large-scale responsibilities of the state, but also to a consideration of the everyday ways in which patients have demanded, received, and negotiated their own medical treatments amid policy and market change. Overall, this part of the book shows the value of taking a cultural approach to an economic question, and demonstrates the ways in which the NHS reaches into high streets, family homes, and daily life, making public health, as well as primary and secondary care, central to our histories.

In Part IV, ‘Space’, historians assess the ways in which site and location have been symbolic and meaningful within NHS cultures, an area which has been explored by the cultural geographers Graham Moon and Tim Brown in relation to the proposed closure of St Bartholomew’s Hospital, London, in the early 1990s.49 First, Angela Whitecross draws on the findings of the landmark ‘NHS at 70’ oral history project. Through detailed examination of interviews, Whitecross asserts the significance of locality in shaping cultural memories of the NHS, analysing descriptions of the first NHS hospital, opened in Manchester. The chapter proceeds to provide a broad vision of what ‘the NHS’ is, looking at spaces of care beyond hospitals, including sanatoria, asylums, and the digital world. Martin Moore, meanwhile, considers the space of waiting rooms in the NHS, and their significance and meaning. Waiting and queuing are key components of cultural visions of Britishness, and are also inherent to policy and public debates around the NHS. This chapter then looks at the spaces in which waiting has taken place, and also at the cultural anxieties and expectations linked to this physical practice.

Part V, ‘Representation’, provides classical forms of cultural history looking at popular, material, and visual cultures. Mathew Thomson, first, provides a broad discussion of how the NHS has been represented in films, novels, radio, television, and branding over seventy years. He argues that the ‘language of representation’ of the NHS formed gradually from the 1950s onwards, and has allowed ‘a degree of critique within a dominant framework of affirmation’ before solidifying from the 1980s onwards. The next chapter, by Hannah J. Elizabeth, takes a close case study into a similar terrain, analysing magazines which have been directed at teenagers to teach them about sexual practices and politics. This contribution considers product placement, advertisements, and testimonies from teenagers themselves. The chapter centres age as a category of analysis in NHS histories, alongside Crane’s and Stewart, Dodworth, and Ercia’s analyses of retired campaigners, and Mold’s consideration of children’s public health – all of which discuss how NHS treatments, and feelings about the service, change over the life course and across generations. Overall, ‘Representation’ shows the ways in which manufactured visions of the NHS have gradually come to permeate British culture, and yet have also often been inconsistent and vague, sometimes pictorialising ‘medicine’ rather than the NHS itself, and offering both gentle and overt forms of critique of people whom the service has served, which have echoed the claims of activists, staff members, and patients described in previous chapters.

The final chapter of the collection, by Roberta Bivins, considers the international valences of the NHS as a cultural and political symbol. In particular, Bivins probes American visions of the British NHS. Looking at American attempts to reject, deny, or ignore the popularity of the health service in Britain provides further evidence of the unusual and surprising nature of its popularity and cultural symbolism. Bivins thus provides the ideal endpoint for this book, fusing cultural, political, and social approaches to examining the NHS. Throughout the collection, indeed, we hope that consideration of ephemera and culture – of posters, protests, and prescriptions – will open up our analysis of the history of the NHS, and will show the value of cultural and everyday approaches to revealing and subverting our understandings of how people relate to large-scale institutions and historical change.

Notes

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 Football?’, British Medical Journal, 25 February 2016, https://www.bmj.com/content/352/bmj.i1023 (accessed 29 July 2019).
5 See for example ‘Britons are More Proud of their History, NHS and Army than the Royal Family’, Ipsos Mori, 21 March 2012, https://www.ipsos.com/ipsos-mori/en-uk/britons-are-more-proud-their-history-nhs-and-army-royal-family (accessed 29 July 2019).
8 Ibid., p. 5.
10 Ibid., p. 3.
15 Paula S. Fass, ‘Cultural History / Social History: Some Reflections on a Continuing Dialogue’, Journal of Social History, vol. 37, no. 1 (Autumn 2003), p. 40.
18 Toon, ‘The Machinery of Authoritarian Care’, pp. 558–9.
19 Arnold-Forster, ‘Racing Pulses’.
20 Mathew Thomson, ‘Party Political Manifestos’, People’s History of the NHS, https://peopleshistorynhs.org/encyclopaedia/party-political-manifestos/ (accessed 21 June 2019).
23 Burke, What is Cultural History?, pp. 1–2.
24 Frank Mort, ‘Foreword’, in Handley, McWilliam, and Noakes (eds), New Directions in Social and Cultural History, p. xiii.
25 Handley, McWilliam, and Noakes, ‘Introduction’, p. 5.
26 ‘The Cultural History of the NHS’, University of Warwick, https://warwick.ac.uk/fac/arts/history/chm/research/current/nhshistory/ (accessed 21 June 2019).
27 Handley, McWilliam, and Noakes, ‘Introduction’, p. 10.
28 See for example Natalie Zemon Davis, The Return of Martin Guerre (Cambridge, MA: Harvard University Press, 1984); Robert Darnton, The Great Cat Massacre and Other Episodes in French Cultural History (New York: Basic Books, 2009); Timothy Brook, Vermeer’s Hat: The Seventeenth Century and the Dawn of the Global World (London: Profile Books, 2009); Richard Gough, The History of Myddle (London: Penguin, 1981).
29 Julia Laite, ‘The Emmet’s Inch: Small History in a Digital Age’, Journal of Social History, vol. 53, no. 4 (2020), p. 965.
30 Ibid. See also the programme of the ‘Small Histories across Boundaries’ panel, chaired by Matt Houlbrook, speakers Simon Briercliffe, Itziar Bilbao Urrutia, Dion Georgiou, Richard Hall, Julia Laite, and Lucinda Matthew-Jones, at the Modern British Studies conference 2019, https://mbsbham.wordpress.com/ (accessed 29 July 2019).
31 Gorsky, ‘The British National Health Service 1948–2008’, pp. 437–60.
32 Charles Webster, The Health Services since the War, vol. 1: Problems of Health Care: The National Health Service before 1957 (London: HMSO, 1988); Charles Webster, The Health Services since the War, vol. 2: Government and Health Care: The British National Health Service 1958–1979 (London: HMSO, 1996); Klein, The New Politics of the NHS (5th edition); Geoffrey Rivett, From Cradle to Grave: Fifty Years of the NHS (London: King’s Fund, 2008).
33 See for example Martin Gorsky, ‘“Threshold of a New Era”: The Development of an Integrated Hospital System in Northeast Scotland, 1900–39’, Social History of Medicine, vol. 17, no. 2 (2004), pp. 247–67; Martin Gorsky and John Mohan, ‘London’s Voluntary Hospitals in the Interwar Period: Growth, Transformation or Crisis?’, Nonprofit and Voluntary Sector Quarterly, vol. 30 (2001), pp. 247–75; Gosling, Payment and Philanthropy.
35 David Widgery, The National Health Service: A Radical Perspective (London: Hogarth Press, 1988), pp. 163–73. See also David Widgery, Health in Danger: The Crisis in the National Health Service (London and Basingstoke: Macmillan Press Ltd, 1979), pp. 150–65.
38 See discussion at ‘The Governance of Health’, University of Liverpool, https://www.liverpool.ac.uk/population-health-sciences/departments/public-health-and-policy/research-themes/governance-of-health/witness-seminars/ (accessed 20 June 2019). A recent publication from this project is Phil Begley and Sally Sheard, ‘“McKinsey and the ‘Tripartite Monster”: The Role of Management Consultants in the 1974 NHS Reorganisation’, Medical History, vol. 63, no. 4 (2019), pp. 390–410.
40 To listen to these oral histories, please visit the ‘NHS at 70’ project website, https://www.nhs70.org.uk/ (accessed 20 June 2019).
41 For fascinating new sensory histories, see for example Victoria Bates, ‘Sensing Space and Making Place: The Hospital and Therapeutic Landscapes in Two Cancer Narratives’, Medical Humanities, vol. 45 (2019), pp. 10–20; Claire Hickman, Therapeutic Landscapes: A History of English Hospital Gardens since 1800 (Manchester: Manchester University Press, 2013); Claire Hickman, ‘Cheerful Prospects and Tranquil Restoration: The Visual Experience of Landscape as Part of the Therapeutic Regime of the British Asylum, 1800–1860’, History of Psychiatry, vol. 20 (2009), pp. 425–41. For studies looking at the emotions of the NHS, using public participation research, see Jennifer Crane, ‘“The NHS […] should not be Condemned to the History Books”: Public Engagement as a Method in Social Histories of Medicine, Social History of Medicine, vol. 34, no. 3 (2021), pp. 1005–27; Tracey Loughran, Kate Mahoney, and Daisy Payling, ‘Women’s Voices, Emotion and Empathy: Engaging Different Publics with “Everyday” Health Histories’, Medical Humanities, advance online access 2021, http://dx.doi.org/10.1136/medhum-2020-012102; Hannah Elizabeth and Daisy Payling, ‘From Cohort to Community: The Emotional Work of Birthday Cards in the Medical Research Council National Survey of Health and Development, 1946–2018’, History of the Human Sciences, advance online access 20 May 2021, https://doi.org/10.1177%2F0952695121999283.
42 Rudolf Klein, The New Politics of the NHS (3rd edition, London: Longman, 1995), p. 216.
46 Graham Smith has an eleven-part series entitled ‘An Oral History of General Practice’ which was published in the British Journal of General Practice between 2002 and 2003. See also Julian Simpson, Migrant Architects of the NHS: South Asian Doctors and the Reinvention of British General Practice, 1940s–1980s (Manchester: Manchester University Press, 2018).
48 Thomson, ‘The NHS and the Public’.

Posters, protests, and prescriptions

Cultural histories of the National Health Service in Britain

Editors: Jennifer Crane and Jane Hand

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