Payment and philanthropy in British healthcare, 1918–48

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. "There were only three decades in British history when it was the norm for patients to pay the hospital; those between the end of the First World War and the establishment of the National Health Service in 1948. At a time when payment is claiming a greater place than ever before within the NHS, this book uses a case study of the wealthy southern city of Bristol as the starting point for the first in-depth investigation of the workings, scale and meaning of payment in British hospitals before the NHS. Payment and philanthropy in British healthcare, 1918-48 questions what it meant to be asked to contribute financially to the hospital by the medical social worker, known then as the Lady Almoner, or to subscribe to a pseudo-insurance hospital contributory scheme. It challenges the false assumption that middle-class paying patients crowded out the sick poor. Hopes and fears, at the time and since, that this would have an empowering or democratising effect or that commercial medicine would bring about the end of medical charity, were all wide of the mark. In fact, payment and philanthropy found a surprisingly traditional accommodation, which ensured the rise of universal healthcare was mitigated and mediated by long-standing class distinctions while financial contribution became a new marker of good citizenship. Anyone interested in these changing notions of citizenship, charity and money, as well as the hospital as a social institution within the community in early twentieth-century Britain, will find this book a valuable companion." This electronic version has been made available under a Creative Commons (BY-NC-ND) open access license. This book is available as an open access ebook under a CC-BY-NC-ND licence. At a time when payment is claiming a greater place than ever before within the NHS, this book provides the first in-depth investigation of the workings, scale and meaning of payment in British hospitals before the NHS. There were only three decades in British history when it was the norm for patients to pay the hospital; those between the end of the First World War and the establishment of the National Health Service in 1948. Payment played an important part in redefining rather than abandoning medical philanthropy, based on class divisions and the notion of financial contribution as a civic duty. With new insights on the scope of private medicine and the workings of the means test in the hospital, as well as the civic, consumer and charitable meanings associated with paying the hospital, Gosling offers a fresh perspective on healthcare before the NHS and welfare before the welfare state. Front matter Contents List of figures List of tables Acknowledgements Abbreviations Introduction Payment in the history of healthcare Medicine and charity in Bristol Payment and the sick poor Middle-class medicine The meaning of payment Conclusion Select bibliography Index This title examines how commercial medicine operated before the foundation of the NHS, and how this could be compatible with a system based on charity. It challenges the assumptions of historians, politicians, and the public Examines how commercial medicine operated before the foundation of the NHS, and how this could be compatible with a system based on charity. It challenges the assumptions of historians, politicians and the public. -- .