Cradled to the grave? Terminal care in the United Kingdom, 1948-67

Abstract

The UK welfare state had sought to vouchsafe care 'from the cradle to the grave', yet the early years of the National Health Service (NHS) saw little attention to care at the end of life and focused instead on addressing the widespread acute and chronic health problems of a society grappling with postwar social and economic reconstruction. In the first two decades of its existence there is little evidence that the NHS offered any strategic or operational guidance on the care of the dying. Indeed, where such guidance did appear, it was usually from charitable and philanthropic sources. Two major reports written during the 1950s provide evidence on the social conditions of dying and upon the actual and potential organisation of terminal care services. During these years a modest shift in medical discourse on terminal care also begins to appear. Slowly, 'anecdote' gives way to 'evidence' as an orienting theme. The provision of care to the dying, however, still remains the primary concern of charitable organisations. By the early 1960s a new discourse of terminal care is emerging. Nevertheless it does so against a background of policy neglect and clinical disinterest, which is only gradually being transformed. The period 1948-67 displays some marked innovations in thinking and practice relating to terminal care, but also some important continuities with the past. It is this combination of innovation and tradition, oddly located within the fissures of the modern welfare state, which provides the conditions of possibility for later hospice expansion.