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Wednesday 12 April 2023 08.30 - 10.30
R-1 HEA01 Charity and the Hospital in the British Welfare State since 1945
E45
Network: Health and Environment Chair: Martin Gorsky
Organizer: Martin Gorsky Discussants: -
Bernard Harris : Repugnant to a Civilized Community: Charitable Funding in the Early NHS
This paper examines a key aspect of the relationship between charity and the establishment of the United Kingdom’s National Health Service(s) in 1948: the distribution of endowment income and the future of charitable fundraising for public health care.

Prior to 1948, the UK possessed a patchwork of different types of hospital: ... (Show more)
This paper examines a key aspect of the relationship between charity and the establishment of the United Kingdom’s National Health Service(s) in 1948: the distribution of endowment income and the future of charitable fundraising for public health care.

Prior to 1948, the UK possessed a patchwork of different types of hospital: unreformed Poor Law hospitals, municipal hospitals (including not only former Poor Law but also specialist institutions for the treatment of infectious diseases and other conditions), and voluntary hospitals. However, this patchwork came under increasing pressure during the 1930s and early-1940s, culminating in the passage of the three National Health Service Acts, dealing separately with the three jurisdictions of England and Wales, Scotland and Northern Ireland, between 1946 and 1948.One of the most important issues confronting reformers was the status and financing of the voluntary hospitals. The majority of these institutions had been established over the course of the eighteenth and nineteenth centuries as charitable institutions and they continued to derive significant proportions of their income from endowments and other charitable sources. However, when the Minister of Health for England and Wales, Aneurin Bevan, introduced the first of the National Health Service Bills in 1946, he described the hospitals’ continued reliance on charitable funding as ‘repugnant to a civilised community’ (House of Commons Debates, 30/4/1946).

The establishment of the NHS(s) therefore had two major implications for the role of charity within the health care system. In the first place, it raised fundamental questions about the status of the charitable funds which many hospitals had already amassed. Second, if it was also accepted that charity should not have a significant role to play in the provision of core health services, what role should it play? What role did the Government foresee for ‘voluntarism’ within the health service(s) once the new arrangements came into force?

This paper will endeavour to answer these questions by looking at the history of voluntarism before the NHS Acts came into operation and then examining the ways in which the three Acts addressed the problem of hospital endowments. The final part of the paper will look at the role of charity more broadly. It has often been assumed that, after 1948, the role of charity was quite tightly circumscribed but to what extent was that really the case, and what can an examination of the role of charity tell us about the prioritisation of different types of health care in the UK during the postwar era? (Show less)

Gareth Millward, Martin Gorsky : The Internet as a Site of Voluntary Activity: NHS Charities and the World Wide Web since 2000
Despite being primarily financed by taxpayers, many hospitals in the British National Health Service also draw on significant sums raised by charitable trusts. This partially reflects the longer history of hospital care in Britain where many hospitals began as voluntary organisations financed by philanthropy; but it is also indicative ... (Show more)
Despite being primarily financed by taxpayers, many hospitals in the British National Health Service also draw on significant sums raised by charitable trusts. This partially reflects the longer history of hospital care in Britain where many hospitals began as voluntary organisations financed by philanthropy; but it is also indicative of major changes in the funding and capacities of hospitals, especially since the great financial crisis and the subsequent budgetary constraints imposed by successive governments. Historians intending to analyse how hospitals responded to such challenges since the 1990s must themselves contend with a new methodological question – how do we track changes in institutional activity over time in an era of mass internet usage?

This paper offers an example of how such work might be done. Drawing on our previous analysis of archived websites to write twenty-first-century histories of medicine, it presents research on four of the largest charitable trusts in London to show how these organisations used their websites since 2000 to communicate their charitable works. We begin by discussing the methodology we adopted to develop a corpus of material for analysis from the Internet Archive, and some of its pitfalls. We then present a preliminary outline of how this corpus itself reflects the growth of the world wide web, and the changing nature of web design as social media proliferated.
We next adopt a more traditional historical scholarship, offering a content analysis of the corpus to track the representations of charity within the welfare state. Delineating several common themes we examine visual and textual discourse to observe cross-cutting approaches across the institutions and to track change over time. These themes are: the border between charitable and public objects of expenditure; why charity is needed in the NHS; institutional history/philanthropic history and its meaning; medical technology; methods of giving; motives for giving; the hospital community; decolonising representations; and COVID 19’s impact. Our preliminary conclusion is that the websites have contributed to an increasing normalisation of charity in the health system, and that this process has accelerated since 2010 when ‘austerity’ politics have increasingly starved the NHS of public resources. (Show less)

Gareth Millward : ‘Its many workers and subscribers feel that their services can still be of benefit’: Hospital Leagues of Friends in the English West Midlands, c. 1948–1998
The coming of the National Health Service is often portrayed as a break from voluntary action in the British health system. As the architects of the postwar welfare state argued, state provision of services would be more equitable and more efficient. However, as the Wellcome Trust funded Border Crossings project ... (Show more)
The coming of the National Health Service is often portrayed as a break from voluntary action in the British health system. As the architects of the postwar welfare state argued, state provision of services would be more equitable and more efficient. However, as the Wellcome Trust funded Border Crossings project has argued, there has always been a hinterland between private, public and third-sector provision of and involvement with British healthcare services.

This paper is a product of that research. It focuses on the records left by Leagues of Hospital Friends in the English West Midlands. These charities were established to ‘provide service to patients’ and ‘supply hospitals with equipment not likely to come from the budgeting of authorities’. Despite their continued existence – and, in many cases, their roots in interwar voluntary hospitals – they have received little attention from historians or social scientists. This paper argues that while these groups may not have raised significant sums of money relative to the overall budget of the NHS, they were important links between the local communities and the hospitals that served them. The archival record shows how they drew on the concept of “friendship” both towards the hospitals as institutions and the people using them. But their activities were different according to the type of hospital and the longer history of voluntary action around the institution.

Further, the paper argues that voluntary action based around “friendship” gives us a different window to consider voluntarism in healthcare in the postwar period. Much of the existing scholarship focuses on health activism and patient consumerism. It has also considered questions of national importance, around policy making and centralised decisions about the health service. While important, this overlooks the continued existence of more conservative forms of voluntarism at the local level.
(Show less)



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