• 03
  • JUL

1948: The coming of a “free” health service

by George Gosling

69 years ago this week, the NHS was born. Monday 5 July 1948 was the ‘appointed day’ on which of whole raft of Labour’s postwar social reforms came into force. This included reforms of social security, pensions and, most famously, the establishment of the National Health Service.

It was a major change for the British people, and especially for the nation’s health workers, most of whom now found themselves working for a single service. But what would it mean to be working for a national(ised) service? Trying to predict the answer to that question meant a lot of raised hopes and optimism (not all met) but also a degree of uncertainty.

In fact, most of the 1940s was a period of uncertainty for health workers, knowing that a change was coming but not being sure what form it would take. Even once the NHS was up and running this continued. The Ministry of Health circulars that rained down on them were an attempt to provide clarity, but their sheer number contributed to everyday anxieties that accompanied the widespread optimism.

A new article by one of our research team, published in the Women’s History Review, takes a closer looks at what this adjustment meant for one professional group in particular. The Lady Almoner – or the medical social worker, as she was increasingly being known by this time – was right at the heart of one of the most important changes. The establishment of a health service providing care ‘free at the point of delivery’ was especially meaningful for the almoner, as until now it had been her role to means-test and collect patient payments in the hospitals.

The almoner had only gained entry to the professional world of the hospital by being prepared to take on assessing patients and taking money off them. It’s something the doctors and hospital secretaries had been keen not to grubby their hands with. By contrast, these educated middle-class women brought with them a training and awareness of the management of domestic finances and the public and charitable support available beyond the hospital that meant they were, they believed, able to judge what would be a ‘fair price’ to ask the patient to pay.

Although London hospitals had started appointing almoners in the 1890s, most hospitals had only begun doing so in the 1920s, some only in the 1930s. So was there a danger that the new NHS would make them redundant, and threaten the very existence of their newly-established profession? On the contrary, the almoners embraced this major change to their job description as a professional liberation.

Making this change work in their favour was a matter of handily aligning their new focus on ‘pure social work’, untainted by money matters, with the planned health service – something they could also use to assert a higher professional status for social work itself.

Among the many changes the arrival of the NHS brought about was a chance for hospital social workers to reinvent their own professional identity. And the more we dig down into the social and cultural history of the NHS, the more of these unexpected stories we uncover. The meaning of the NHS, we’re increasingly finding, was and is far from simple.


To find out more… George Campbell Gosling, ‘Gender, Money and Professional Identity: Medical Social Work and the Coming of the British National Health Service’, Women’s History Review (2017) – available open access online here.

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