Health Provision before the NHS

I’ve been having a debate here with a critic, who objected to my description of Nye Bevan as the architect of the NHS. His contention appears to be that there was no private healthcare in Britain even before the establishment of the NHS, and that no-one really suffered through the charges that were made for some essentially services, as the poor were already treated free of charge on the Poor Law. I’ve made it very plain to this critic that I believe he has a very rosy view of healthcare before the NHS.

My mother was told by one of her friends, a staunch Tory, that her father was a pharmacist, who also voted Tory. However, at the 1945 election, he called his family together to say that he was voting Labour, because the NHS was needed. He was tired of having to supply drugs on credit, because the working class sick could not pay.

Florence too has bad memories of the state of health provision before the NHS. In her comment to this critic’s reply to my rebuttal of his original comments, she wrote:

I must have missed the response Billellson. I wonder where he has taken his information from, because it does not match my own family experience, whatever the social historians say. Maybe both sides of my family were “unlucky” to have lived in areas where the cover was non-existent.

All I know is that one of my fathers’ brothers was taken ill, aged 7 in the 1920’s, and the family could not afford a doctor, but by the time they realised how ill he was, his appendix had already burst. I think he was taken into a charitable (church?) hospital, but it took nearly a week for him to die horribly in agony from peritonitis. They never got over the loss of a child, especially when they also had a lot of guilt about delaying because of “the cost of the doctor”.

My mother’s family at the same time, were members of the “Saturday Club” where each family paid 6d a week (on Saturday) which paid for a doctor to visit. My mother was struck down with rheumatic fever, and the dr went to her home and diagnosed it, again, she must have been 7, so that was the 1930′ s. They couldn’t afford hospital care, so she was nursed at home by her mother & neighbours for over 6 month, while she was rigid and paralysed.

These were the experiences of the working class before the NHS, and like Harry Price, I can say that the experience haunted both families. I can see the gleam in the eyes of the vultures circling the NHS, and I fear for those who do not have this direct link to the pre-NHS days, knowing that 20 million in the UK already live in poverty, and that a pay per visit system would be intolerable in the 6th richest country, with a health service with funding that is a model that was held up to other countries to follow. However that was the preferred system for both Letwin and Hunt in their publications calling for the end of the NHS 20 years apart, so it seems there has long been continuity and ambition to effectively remove the universal system from the poor. So when the effects of long term hunger and poverty take hold, there will be little between any of us and that early grave, except the ability to pay with money you don’t have.

One final point,(despite the length of this reply, sorry) that Billelleson stated “but nobody was expected to sell their house.”. That was for me the one item that gave his words a hollow ring. Nobody in the working class actually owned their houses. To pay even the Dr’s fee they would have to sell an item of furniture or clothing, or pawn a wedding ring. There were no heirlooms, after all, my great grand-dad died in the workhouse!

Pat Young also describes the horrendous provision of healthcare before the establishment of the NHS in her book Mastering Social Care, published by MacMillan in 1992. She writes

There were some state-provided services prior to 1948. For example, public health, in the form of water and sewage systems, was provided under the Public Health Act of 1848. Services for pregnant women and young children were introduced at the beginning of this century. From 1911, employment-linked insurance provided cover for doctors’ services for people in work. Local authorities ran poor law infirmaries, public hospitals and mental hospitals. Hospitals were also provided by charitable organisations.

However, there was great variations in the standards of care provided by these services, and considerable stigma attached to much of the provision. The insurance system only covered the person in employment and did not extend to the families of workers. The following quotations based on accounts of people living in Sheffield give some indication of the quality of life in the period before 1948.

[In] Attercliffe in Sheffield’s East End which housed the heavy industry of the Don Valley and the workforce which operated it – bronchitis was a way of life. People expected to live with it, suffer from it and eventually die from it, with only their weekly bottle of medicine for relief.

Two women describe their memories as follows:

Bills from general practitioners were always hard to meet … Kay remembered especially a doctor in the Crookesmoor dstrict of Sheffield who employed a debt collector… The effects were particularly severe for working-class women, who due to a policy of not employing married women in Sheffield always tended to fall outside the insurance scheme. ‘Mother never had the doctor.’ ‘You just didn’t go to the doctor until you were on your last legs.’ Kay recalled how her own mother hadn’t gone to the doctor even though she was in bed with asthma. And Jessie likewise how her mother continued to suffer with high blood pressure, even though she knew that tablets were available which could have helped to lessen her condition.

Looking at health from the other side, the extracts below are from a doctor who worked as a GP before the beginning of the National Health Service.
Dr Arnold Elliot remembers

I ran my practice from a small house in Ilford, but most surgeries were lock-up shops in industrial areas. On the whole, most of them were awful, with no running water, heat, lighting or toilets, some with no couches.

I knew one East end doctor who had a cigarette machine in his waiting room. Many doctors had two doors; one for ‘panel’ patients (the insured workers) and one for private patients, who weren’t kept waiting.

Doctors didn’t speak to each other, because they were deadly enemies. They went in for head-hunting the breadwinning panel patient, who would often bring in the rest of his family.

Various private arrangements were set up for his dependants – so-called ‘clubs’-where they paid a small amount a week for a doctor and medicine. For the destitute, there were dispensaries, which engaged the services of a doctor for a small annual payment … Doctors used to dispense their own medicines too. The pharmaceutical firms came round and filled up the big ‘Winchester’ bottles every week. Many of the medicines were placebos; aspirin, for instance, which was available in a red or yellow mixture. You had to give the same colour to a patient every week, and sometimes there’d be trouble when you had a locum in and he gave out the wrong one. It sounds immoral, but that was trade.

From another perspective, Sir George Godber was involved in setting up the National Health Service. In 1942, before the NHS, he surveyed hospitals in Britain. He tells what his survey found.

You must remember hospitals in those days were very different from today. An isolation hospital might only have five beds. There was a hospital for scarlet fever in the Prime Minister’s (Margaret Thatcher’s) home town of Grantham that was housed in a wooden hut on the top of a hill without sewers or water – the water was delivered by cart once a week. The system in 1942 was incapable of delivering modern medicine. There were dilapidated buildings, insanitary conditions on the wards, inadequate space for radiology and laboratory services.

There were casual wards were tramps stayed overnight and even more depressing house wards where elderly residential patients waited to die in the most uncivilised conditions – the night spent in narrow and dark dormitories of 20 to 30 beds and the daytime sitting on hard benches in a different room looking at their feet.

(pp. 255-8)

This to my mind comprehensively disproves the somewhat rosy view that there was, nevertheless, good healthcare provision before the NHS. I therefore consider the subject closed to discussion.

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2 Responses to “Health Provision before the NHS”

  1. 61chrissterry Says:

    Reblogged this on 61chrissterry.

  2. maxwell1957 Says:

    Reblogged this on Maxwell's Mostly Irrelevant Musings and commented:
    Interesting reading.

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