Martin Gorsky

The growth and distribution of English friendly societies in the early nineteenth century

This article provides a conceptual framework for the growth and distribution of early English friendly societies before 1815.

The British National Health Service 1948–2008: A Review of the Historiography

Summary This article surveys historical writing on the British National Health Service since its inception in 1948. Its main focus is on policy-making and organisation and its principal concerns are primary care and the hospital sector, although public health, and psychiatric and geriatric care are briefly discussed. The over-arching narrative is one of transition from paternalism and technocratic planning to market disciplines and a discourse of choice, and of the ceding of professional autonomy by clinicians to managers and to the state. These issues are discussed in a chronological survey of policy-making from Bevans ‘creation’ to the Blair era. Later sections consider evaluations of the service, starting with Websters thesis that the NHS has been subject to prolonged under-funding, particularly under Conservative stewardship, then moving to assessments of the Thatcher, Major and Blair reforms. Much of the historical literature on the NHS is contentious and opinions are sharply divided on the reform era since the 1970s and the trajectories this has set for the future.

Public health and English local government: historical perspectives on the impact of ‘returning home’

This article uses history to stimulate reflection on the present opportunities and challenges for public health practice in English local government. Its motivation is the paradox that despite Department of Health policy-makers’ allusions to ‘a long and proud history’ and ‘returning public health home’ there has been no serious discussion of that past local government experience and what we might learn from it. The article begins with a short resumé of the achievements of Victorian public health in its municipal location, and then considers the extensive responsibilities that it developed for environmental, preventive and health services by the mid-twentieth century. The main section discusses the early NHS, explaining why historians see the era as one of decline for the speciality of public health, leading to the reform of 1974, which saw the removal from local government and the abolition of the Medical Officer of Health role. Our discussion focuses on challenges faced before 1974 which raise organizational and political issues relevant to local councils today as they embed new public health teams. These include the themes of leadership, funding, integrated service delivery, communication and above all the need for a coherent vision and rationale for public health action in local authorities.

The Financial Health of Voluntary Hospitals in Interwar Britain

This article re–evaluates the gravity of the financial problems facing British voluntary hospitals in the interwar period. A relational database of statistics on hospital provision, finance (at both current and constant prices), and activity is used to derive consistent sets of hospitals for reporting purposes. The article presents novel analyses of the extent and pattern of hospital surpluses and deficits; of the capital accounts of selected individual hospitals; of trends in hospital expenditure; of the diversification of hospital income, emphasizing the declining importance of traditional philanthropy; and of the effect of these changes on hospital provision and utilization.

Community Involvement in Hospital Governance in Britain: Evidence from before the National Health Service

An important goal of policy in the British National Health Service (NHS) is to increase public involvement in health care governance. In the hospital sector this led in 2003 to the establishment of foundation trusts with “membership communities,” which aim to give local citizens a say in management. This is not the first attempt to introduce greater community participation in the running of British hospitals. Prior to the inception of the NHS in 1948, the hospital contributory scheme movement provided ordinary members of the public with the opportunity to sit on hospital management boards. The article examines the nature and extent of this earlier experiment with local democracy in hospital governance. It argues that historical precedent is not particularly encouraging, either for the prospect of broadening popular participation or for making services more responsive to local needs. Although todays context is very different, the tendency for managerial and professional interests to dominate the policy arena is a feature of both periods.

Local leadership in public health: the role of the medical officer of health in Britain, 1872–1974

The recent policy focus in British public health on the importance of local action invites consideration of historical precedent. The role and achievements of the medical officer of health (MOH), the local government official charged with public health responsibilities, is discussed. The gradual accretion of duties is traced in the first section: the mid-Victorian concern with urban sanitation; the preventive strategies adopted after the bacteriological revolution; the extension of personal health services in the early 20th century; and the more diminished role under the National Health Service (NHS), when infectious diseases retreated. The historical verdicts passed on the MOsH are reviewed in the second section. The leading role of the MOsH in the late 19th-century mortality decline has been reasserted, and although there is some justification in the argument that in the 20th century public health lost its focus, it is important to recall that the extension of personal health services under MOH direction signified a major extension of access to care. Similarly, the charge that MOsH did not redefine their role in the period before their final demise in 1974 is not entirely justified. The emphasis of the NHS on curative rather than preventive medicine, and the economic constraints on local authority health service expansion limited their room for manoeuvre. The history of local leadership in public health may offer some enduring lessons. These include the importance of monitoring local population health, acting as a public interface between medicine and the community, facilitating joined-up working and confronting vested interests.

Mutualism and health care: hospital contributory schemes in twentieth-century Britain

Mutualism and health care presents the first comprehensive account of a major innovation in hospital funding before the NHS. The voluntary hospitals, which provided the bulk of Britain’s acute hospital services, diversified their financial base by establishing hospital contributory schemes. Through these, working people subscribed small, regular amounts to their local hospitals, in return for which they were eligible for free hospital care. Mutualism and health care evaluates the extent to which the schemes were successful in achieving comprehensive coverage of the population, funding hospital services, and broadening opportunities for participation in the governance of health care and for the expression of consumer views. The book then explores why the option of funding the post-war NHS through mass contribution was rejected, and traces the transformation of the surviving schemes into health cash plans. This is a substantial investigation into the attractions and limitations of mutualism in health care. It is highly relevant to debates about organisational innovations in the delivery of welfare services

London’s voluntary hospitals in the interwar period: growth, transformation or crisis?

The establishment of the British National Health Service in 1948 was a watershed for the nonprofit sector, as the voluntary hospitals were taken into public ownership. This article surveys the voluntary hospitals of London in the last two peacetime decades of their existence. Although this was a period of significant expansion for the hospitals, there were also difficulties looming. City-wide data and records of individual institutions are used to explore the risk of deficit, the hospitals’ asset base, the demand for expenditure, and the changing basis of income. The analysis confirms and augments earlier discussion of gathering financial hardship. Finally, the growth of the municipal hospital service is detailed. The London County Council’s enthusiastic development of publicly funded institutions added to the problems of the voluntary sector. Public/nonprofit partnership remained underdeveloped, voluntary fundraising was undermined, and principled opposition was articulated by council members.

Local Government Health Services in Interwar England: Problems of Quantification and Interpretation

This article provides a critical discussion of recent work on local government health care and health services in interwar England. A literature review examines case study approaches and comparative quantitative surveys, highlighting conventional and revisionist interpretations. Noting the differing selection criteria evident in some works, it argues that studies based upon a limited number of personal health services provide an insufficient basis for assessing local health activity and policy. There follows a regional study demonstrating various discrepancies between health financing data in local sources and those in nationally collated returns. These in turn give rise to various problems of assessment and interpretation in works relying on the latter, particularly with respect to services for schoolchildren and long-stay patients. The case study points to the importance of integrating poor law medical services in evaluations, and of learning more about the role of government subsidy in supporting expanding services.

The importance of the past in public health

This issue contains a paper by Scally and Womack that emphasises the need to expand historical knowledge and understanding in the public health profession. This editorial comments on a paper by Scally and Womack in the same issue.1 It announces the establishment of a new journal series on history. It reports the launch of the Centre for History in Public Health at the London School of Hygiene and Tropical Medicine. It summarises the launch lecture on the importance of history in the assessment of globalisation. It argues for more involvement of history and historians in the teaching of public health professionals and for revision of the professional curriculum. There are some recent and forthcoming developments on this front. The authors mention the lack of a regular historical series in public health journals, with the notable exception of the American Journal of Public Health ’s long running “Public Health Then and Now”. There will be a new historical series, “Public Health Past and Present” in the Journal of Epidemiology and Community Health . Contributions are welcome on any topic relevant to the subject. We hope to publish short research based papers that will enable historians to interact with the public health field and vice versa. Exchanges between the two fields have been taking place in other ways. The launch of the new Centre for History in Public Health at the London School of Hygiene and Tropical Medicine in November 2003 has the aim of strengthening the links between historians …