Competition and Cooperation in Hospital Provision in Middlesbrough, 1918–1948

Abstract

The history of the English hospital in the first half of the twentieth century has been the focus of considerable debate from the very beginning of the National Health Service.1 In the early post-war years a powerful image was built up of the mix of voluntary and local state provision as one characterized by restricted access, over-weaning charity, stigma and inadequate coverage. Hospital services were undemocratic, inefficient, underfinanced and uncoordinated, staggering from one crisis to another yet unable to help themselves due to professional and political rivalries, which prevented rationalization.2 However, recent years have seen the development of a more thorough hospital history for the inter-war period which provides an increasingly nuanced approach to the pre-NHS system. Initial revisions were provided by Steven Cherry, whose work on voluntary sector funding3 began to suggest a less pessimistic story about the situation in the 1930s than that of Brian Abel-Smith and Robert Pinker or even Charles Webster.4 The changes within the voluntary sector have been further examined by John Mohan, Martin Gorsky and Martin Powell,5 whilst finance and especially contributory schemes have been investigated by Mohan, Gorsky and Tim Willis.6 This work confirmed Cherry's evidence of considerable advance for voluntary hospitals between the wars—the number of beds in non-state hospitals more than doubled, and income from contributory schemes increased substantially, providing access by right to hospital treatment for a growing section of the population.7 Yet there is also a less optimistic tone to this work which reinforces the sense of unevenness in provision, especially in poorer, medium sized towns and in rural areas, particularly in the north.8 Furthermore, there is a recognition that the contributory schemes were coming under pressure as a result of their success, creating a demand for treatment that the hospitals could not meet and for which the schemes were not charging sufficiently large contributions.9 Importantly, however, this work has provided a broadening of our understanding of the pattern of national provision (much early assessment of the health of the pre-war voluntary sector was based on the situation in London) and has begun the process of uncovering the local variation and some of the underlying causes of that unevenness.