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The hospital system

In 1948, before the launch of the National Health Service, "there were over 1,000 independent voluntary bodies providing hospitals, and an even greater number of separate local authorities with powers to provide hospitals of one kind or another".

The majority of general hospitals were independent 'voluntary hospitals'. The voluntary hospitals were originally built and maintained from charitable donations and provided care for the sick poor. By the early 20th century charity was no longer enough to fund a modern hospital service, and the voluntary hospitals increasingly relied for income on fee-paying patients, subscription schemes (i.e. if you paid a certain amount a week you were entitled to free treatment) and contributions from local authorities. The focus of the voluntary hospitals was on acute rather than chronic medical cases (i.e. it usually provided short term rather than long term care).

Hospital services were also provided by local or municipal authorities. At the start of the 20th century medical treatment could be obtained by those with limited incomes at workhouse infirmaries run by the Poor Law authorities. This system was abolished by the 1929 Local Government Act, which transferred the administration of workhouse infirmaries and fever hospitals to local authorities.

Selected sources:

  • Regulations for the admission of out-patients, confidential inquiry sheet and voucher for admission to the Great Northern Central Hospital, London, 1902. The Great Northern Central Hospital was "intended for the relief of the Sick Poor only", and patients had to prove that their income was below a certain level in order to receive treatment.
  • The First Labour Hospital, 1921. Leaflet produced by the Industrial Orthopaedic Society to promote the services of the Manor House Hospital, London. The hospital was established during the First World War to provide orthopaedic treatment for wounded soldiers and sailors. In peacetime it was converted to provide treatment for industrial workers "who [had] received a crippling accident" (as long as they were subscribers).
  • The labour movement and the hospital crisis: a statement of policy with regard to hospitals, 1922. Joint statement by the Trades Union Congress and the Labour Party. It argues that unified control over hospitals would be necessary in order for them to efficiently serve the community, identifies flaws in the existing system and puts forward the hospital policy of the organised labour movement.
  • The Hospital Problem: the report of a special conference of labour, hospital, medical and kindred societies, held in London on 28-29 April 1924. The conference was organised by the Labour Party to debate the advantages and disadvantages of the existing voluntary hospital system and the Labour Party's proposed system of state controlled hospitals. The opinions of representatives of voluntary hospitals, doctors, nurses and other interested parties are given, and are often strongly critical of the Labour recommendations.
  • Towards a municipal medical service, Independent Labour Party weekly notes for speakers, 2 October 1924. The speakers' notes argue for council funded healthcare and include examples of the deaths of individuals caused by failures at voluntary hospitals.
  • Reports on hospitals and the patient and a domestic workers' charter, to be presented by the Standing Joint Committee of Industrial Women's Organisations to the National Conference of Labour Women, June 1931. The report looks at general hospitals in an attempt to identify "some of the difficulties and the needs of patients, or, to put it in other words, to consider whether the hospitals are supplying what we want". Issues examined include waiting lists, overcrowding, shortage of nurses, and the distinction made between paying and non-paying patients.
  • Appeal from the Chelsea Hospital for Women, 1938. The circular (in this case sent to the Trades Union Congress) asks for money to fund "much needed additions and improvements", including more beds, single accommodation for private patients, an extension to the nurses' home, a new boiler, and modernisation of the sanitary blocks and kitchen.
  • General Medical Service for the Nation: The question of medical institutions and hospitals, 6 July 1938. Memorandum produced by the Social Insurance Committee of the Trades Union Congress. It examines the British Medical Association's proposals for hospital reform, as presented in their report 'A General Medical Service for the Nation'.
  • 4 good reasons why, October 1938. Pamphlet issued by the Royal Infirmary, Leicester, appealing for subscribers to the Saturday Hospital Society to increase their weekly contributions, so that the hospital can build a casualty department and buy new x-ray equipment.
  • Fundraising appeal from the Royal Eye Hospital, London, 9 May 1939. The letter from the Rebuilding Fund Appeal Office asks whether a representative can raise funds by bringing a tray of roses to sell at the offices of the Trades Union Congress, as "unlike those Hospitals on the other side of the River it has no rich friends".
  • Financial difficulties of the Associated Voluntary Hospitals: The case for a revision of the rate of contributions, 1939. Memorandum (with covering letter) sent by Merseyside Hospitals Council to the Trades Union Congress. It examines the growing financial deficit of the voluntary hospitals in Merseyside and sets out a case for an increase in the rates paid by patients.
  • Resolution on hospital and medical services passed by Bradford Trades Council, 27 June 1941. In response to the "ever increasing calls made upon all workers for additional voluntary hospital contributions" and shortage of beds in voluntary hospitals, the resolution appeals for a state-run, centrally funded hospital service.
  • Report of estimated costs for alterations and extensions at Birmingham Accident Hospital, Queen's Hospital, Birmingham, 1941. The alterations are to include rooms for new x-ray equipment, the installation of radiators and sanitary equipment such as sterilizing plant, sinks and toilets, and replacement of the "poor" electrical wiring.
  • Hospital Contributory Schemes, memorandum from the Ministry of Labour and National Service, 1942. It examines the system of contributory schemes run by voluntary hospitals (e.g. subscriptions funded through deductions from wages which entitle the subscriber to treatment in certain hospitals).
  • Staffing the hospitals: An urgent national need, 1945. Ministry of Health pamphlet which appeals for more hospital workers, as "the country stands in urgent need of nurses and midwives, and of domestic staff for hospitals and similar institutions".
  • A plan for a national hospital service, 18 March 1946. Plan for a "National Hospital Service, within a National Health Service" submitted by the British Hospitals Association. It argues that voluntary hospitals should be retained in the new system.
  • The National Health Service, 1948. Outline of the new co-ordinated hospital service to be established as part of the National Health Service, includined in a pamphlet produced by the Ministry of Health.