“Open the Other Eye”: Payment, Civic Duty and Hospital Contributory Schemes in Bristol, c. 1927–1948
نویسنده
چکیده
On the appointed day of 5 July 1948, the National Health Service (NHS) came into existence in Britain. What existed before had been a complex and constantly evolving mixed economy of healthcare, within which hospital services were provided by a combination of public and voluntary sectors. The public sector accounted for the majority of hospital beds and dominated treatment of the chronic and aged sick. However, it is the voluntary hospitals that have often been seen as at the heart of this system because of their historic foundations—many having been established as charitable institutions in the eighteenth and nineteenth centuries—as well as their perceived clinical superiority.1 In fact, the move towards a national health service, which ultimately nationalized the hospitals, gave great credence to an approach Daniel Fox has described as “hierarchical regionalism”. This placed such institutions as leading specialist and teaching centres at the top of a hierarchy of regional service providers, and in doing so reinforced this view of the primacy of the voluntary hospitals.2 From their foundations in the mid-eighteenth century, both general and specialist voluntary hospitals across Britain expanded dramatically in the nineteenth century. However, the early twentieth century saw them struggling to maintain their financial foothold in the shifting sands of the mixed economy, and historians have typically seen this period as something of a fall from grace for the voluntary hospitals, with demands and costs rapidly increasing and deficits becoming commonplace.3 This was perhaps most evident in the aftermath of the First World War. During wartime, the voluntary sector had been part of a wide-scale co-ordination of hospital services under the direction of the War Office. Indeed, Geoffrey Finlayson has commented that, in the process, “Voluntarism
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عنوان ژورنال:
دوره 54 شماره
صفحات -
تاریخ انتشار 2010