By the end of the First World War, the town of Middlesbrough in north-east England, with a population of around 120,000, had amassed a complement of six specialist and general hospitals, with a further two added over the next twenty years. Developed by both the local state and voluntary/private providers, ...
(Show more)By the end of the First World War, the town of Middlesbrough in north-east England, with a population of around 120,000, had amassed a complement of six specialist and general hospitals, with a further two added over the next twenty years. Developed by both the local state and voluntary/private providers, these institutions delivered medical, surgical and maternity services to almost all of the inhabitants of the town. Yet for much of the period hospital provision remained a highly contested and competitive environment, with each institution laying claim to a particular cohort of patients and jealously guarding their reputations and sources of income. At the same time, however, each continued to place a variety of restrictions on the type of patient they were willing to admit, with financial, medical and even moral criteria applying to those seeking admission. As a result, the conflicts within and between public and private, state and voluntary limited the opportunities for the efficient and equitable distribution of these extensive hospital resources and held back the creation of an effective hospital system. This paper will explore the ways in which, between 1921 and 1945, a nascent health system did develop in the town and will chart the gradual rapprochement between individual voluntary hospitals and between the voluntary and state sectors. Drawing on the records of the individual hospitals, local authorities and the increasingly important joint hospital board, it will examine the avenues to joint action on issues like access to hospital beds, the provision of specialist services and the effective distribution of limited financial resources. It will reveal not only the slow process of emergent joint action, but also the persistence of conflict within the voluntary sector over access to patients and plans for a new joint hospital, and between the state and private sector over consultant staff and the expansion of the municipal hospital service. In the process it will show how deep seated concepts of voluntarism, fear of the state and the power of the medical profession together served to undermine the delivery of the public good of free and equal hospital services. This paper reveals both the extent and limitations of public/private cooperation in health services at the sub-regional level in the years before the NHS, providing new insights into the strength of the voluntary sector, the politics of municipal expansion and the scope for the development of universal coverage without central state intervention.
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