The existence of a universal health service in Britain that is free at the point of use, available to all, and provides high-quality healthcare is generally taken for granted. It therefore requires some effort on the part of most of us to imagine what life was like before the NHS.
The National Health Service (NHS) came into existence on 5 July 1948. At midnight, the ways in which healthcare was administered, organised and funded changed significantly.
In her episode of Who Do You Think You Are?, Ruth Jones discovered that her grandfather was secretary of a Medical Aid Society in South Wales, which helped members pay for healthcare and served as a model for the NHS.
Before the birth of the NHS, our ancestors got their healthcare from many different organisations in many different ways. The result was a ramshackle structure of competing and overlapping services that was nevertheless characterised by gaps in provision. These meant real hardship for a significant proportion of the British public.
The ramshackle structure of competing and overlapping services meant real hardship for a significant proportion of the British public
For middle-class people, it was relatively easy to pay the doctor’s fee as a private patient, and merely settle the bill after any consultation. However, most other people were not so lucky. If their desperation was greater than their sense of respectability, the very poorest section of the community might have consulted the Poor Law doctor. The vast majority of paupers were relieved in their homes rather than the workhouse infirmary, and a visit from the ‘union doctor’ was a common experience for the very poorest families.
This public provision of GP healthcare was complemented from 1911 onwards by the National Health Insurance scheme, under which workers paid a small sum from their weekly pay packets and secured access to the ‘panel’ doctors associated with the scheme. Such workers tended to be male – fewer women were employed, and did not gain access to the same degree. The scheme was of real benefit to workers, although doctors devoted less time to the healthcare of panel patients than they did to private patients. Crucially, however, the dependents of insured workers did not gain the right to consult panel doctors, and families were required to find other means for wives and children to see a GP.
Another way that working-class families could access healthcare before the NHS was through friendly societies. They provided sickness, funeral and other benefits to eligible members in return for weekly subscriptions, and many such societies also arranged contracts with GPs in order to provide healthcare to their members from the late 19th century onwards.
Apart from friendly societies, a whole range of different ‘works schemes’ emerged in the 19th century whereby the workers in any mine, foundry, mill or factory agreed to the deduction of a sum of money from their wages and to the appointment of a ‘works surgeon’ or ‘works doctor’ to provide healthcare. Again, in friendly societies and work schemes, the wives and children of members were not always eligible.
Just as a person might draw upon a number of different methods to see a doctor, so they were required to use different means to gain hospital healthcare. In the first place, the Poor Law system provided medical care in infirmaries to certain groups of the population; such groups included elderly people suffering chronic conditions, single mothers in childbirth, and people with a variety of physical, mental and learning disabilities. Similar to other functions of the Poor Law, these infirmaries were transferred to local government in 1929 and these groups became the responsibility of county and borough councils.
These hospitals for the very poorest sections of the community complemented the other types of institutions already provided by local authorities, from isolation hospitals for those with infectious diseases to maternity hospitals, tuberculosis sanatoria, and mental-health institutions. Their size, physical state and effectiveness varied, depending on the resources and political will of individual local authorities.
Apart from such public hospitals, healthcare provision before the NHS was also made voluntarily. Voluntary hospitals came to be established in large numbers from the 18th century onwards, and were a feature of all towns and cities across Britain by the early 20th century. They were funded by voluntary contributions and donations from wealthy elites, community fundraising and other sources of charitable income. They ranged from the oldest, largest and most prestigious hospitals in London to the small cottage hospitals that could be found right across the country.