The Politics of Hospital Provision in Early Twentieth-Century Britain, By Barry Doyle

Abstract

I write this review in the immediate aftermath of the party conference season, and in receipt of a generic email from Andy Burnham, the Shadow Secretary of State for Health, endorsing the view that in the 1920s and 1930s ‘public healthcare didn’t exist’, and that back then ‘hospitals, doctors and medicine were for the privileged few because they were run for profit rather than as a vital state service’. Burnham’s understanding is a commonly held one amongst the wider British public. It’s a position that posits a major disjuncture between a pre- and post NHS medical system, not simply in terms of how health provision was organized, but terms of access, sustainability, and the standards of care and facilities that were available to ordinary people. It paints a picture rich in past neglect, juxtaposed against a bright new beginning that is the NHS. Burnham would have done well to have read Barry Doyle’s excellent case study of pre-NHS provision in Leeds and Sheffield. At one level, Doyle sets out what those of us who write about the history of twentieth-century provision already know: that Britain already had a forward-looking system of hospital provision prior to 1939, and that most certainly it was not one designed for the privileged few but was instead focused primarily on working-class needs and a working-class clientele. Nor was this mass provision centred on profit. Indeed, the reverse was true. It was paid for by, amongst other sources, work-class and community contributions whether directly through subscriptions, contributions, and donations, or indirectly through taxation, depending on whether it was a voluntary hospital or under local authority control.