A last word on ‘First Memories’

Six weeks ago, we asked you to share your first memories of the NHS with us – many stories, tweets and comments later, you have already done so much more. Your stories, and those of your families, have captured the National Health Service’s first moments (thanks especially to the Macbeth family, and retired nurse Helen Gallacher, who have shared striking memories of training and practicing medicine before and during the Second World War and in the the fledgling NHS). You have told us about the Service’s more recent past as well: early hospital visits, vaccinations, check-ups and childhood accidents.

In your memories we can begin to see some interesting patterns developing. Several of you recalling the first decades of the NHS, for example, have explicitly mentioned cost – not what younger users might expect in memories of a Service famously ‘free at the point of need’. But as one member told us, in these early years, doctors sometimes told their patients very directly what their treatment cost the Service, as part of urging them to comply with medical regimens. In this case at least, the technique worked: this storyteller reported being ‘in awe that the medicine cost so much but we were able to access it because of the NHS without having to find the money that day.’ The message – and the awe – stuck in her mind, and she still remembered it more than six decades later. Cost-saving, but easily recognised ‘NHS specs’ are clearly just as memorable, but perhaps not as attractive an aspect of ‘free’ health care. Another member recalled his family’s decision in 1962 to reject free frames, despite the cost of the alternative: ‘my parents insisted on paying for “better” frames when I could have had NHS frames for free… It was bad enough being teased at school … it would have been much worse if I’d been wearing NHS specs.

Others have told us about the NHS as a space for new encounters, both medical and personal. For some older members, it was first place where they met people from other ethnic groups: ‘unbelievably impressive’ black nurses created strong memories for one young patient in the 1970s. But sometimes your memories of the medical encounter itself are considerably less clear: you have also told us about the ‘blur’ of ‘memories of doctors and hospitals, of consultants and blood tests and clinics’. Some of you have described your interactions with the NHS, tellingly, as ‘a long and never ending relationship’ – a phrase that resonates with claims that the NHS is part of our lives, almost a member of our families. Others, those with ‘NHS in the Family’ for instance, have talked about being ‘surrounded by it’, and have described the NHS as ‘something that really sums up the UK’.

Intimate and enduring as your relationships with the NHS may be, it is not always your favourite ‘relative’ (so to speak)! If you care for an older person or live with a chronic condition like diabetes, you may remember disjointed care and difficult regimes – but also your pride in maintaining those regimes no matter how meticulous and challenging. And sometimes you – and your parents – have had to ‘persuade’ NHS gatekeepers to provide the health services you have needed.

As a whole, your stories and comments have tracked technological and cultural changes in the Service. Through your eyes, and your memories, we have seen the breadth of the NHS, too: you have remembered ‘firsts’ from the GP surgery to the School Medical Service, and from the hospital to public health campaigns. In your photos, and in wonderful artefacts like Dr Macbeth’s casebooks, we are seeing both new and familiar aspects of the NHS. While we are now – inspired in part by your collective fascination with needles! –  asking you about vaccination, all your memories of the NHS (first, last, and in between) are welcome here, so keep on sharing. Thank you!

 

NHS History at #SHS40

The UK’s largest annual gathering of social and cultural historians took place this week. So you won’t be surprised to hear we were in Lancaster for the Social History Society’s 40th anniversary conference. On the first day of the conference there were other sessions going on at the same time, but it was great to see so many people coming to see what we had to say that some of them had to sit on the floor!

Mathew, Roberta, Jack and Jane, four-sevenths of the NHS Mafia (as we’re now known to twitterstorians everywhere — thanks, @KingTekkers), were the speakers. Their subjects ranged from explorations of how the NHS featured in political culture to feelings and commitments in the NHS itself, and from NHS  workers to the child audiences of public health messages.

I chaired the session, after speaking in another. With Sarah Flew, Richard Huzzey and Karen Hunt, I kicked off the conference with a roundtable (Question Time style) discussion on new ways of thinking about money in social history. I was arguing we should use the language and the insights of economic sociology to help make sense of the things we do and don’t pay for, not only as economic concerns but social ones too. The NHS is a perfect example. The very fact it is (for the most part) a free health service is hugely important for the social meaning attached to it.

When it came to the ‘Cultural History of the NHS’ session, Mathew Thomson started us off. He talked through what political party election manifestos have said about the NHS since the 1950s. The nine themes he identified across Labour and Conservative manifestos included the NHS as a proud achievement, a reflection of national values and a health service under attack. In some ways the manifestos are an obvious place to look to get an idea of what people are thinking and saying about the health service, he said, but they’re also fantastically revealing.

Roberta Bivins turned our attention to the politics of citizenship and belonging. She used some wonderful political and satirical images to explore what has been a rather complex relationship between the NHS and belonging. It might be a universal health service, but who gets included in its universalism? Can inclusion be earned? With the NHS seen as a magnet for foreign labour since its foundation, can it offer a space for learning to be British? The racial questions that lie behind entitlement in a national health service are not always comfortable ones.

Jane Hand kept our focus on visual images, looking in depth at a few examples of public health campaign images. She explained how dental health education in the 1950s and 1960s taught people to be good citizens by looking after their teeth. This was an important part of learning how to use, and not abuse, the health service. It also showed the NHS as being preventive as well as curative, a modern project to train up the next generation of healthy citizens.

Jack Saunders talked about the fact that the NHS didn’t just treat citizens, it also employed them. By the 1970s, it had become the first British institution with over a million staff. So, over a few generations, what has it meant to work for the NHS? It reflected wider trends in British society, including a shift away from manufacturing jobs to work in service industries. And the social mix of the country was largely mirrored within the NHS, with some jobs being typically filled by people of a certain class, gender or race. All of these people were real people, but there were imagined characters too, such as the ‘dedicated nurse’. This was an unattainable ideal regularly called upon in contrast to campaigning or striking nurses, such as those (pictured) eating chips in protest over hospital food.

What was interesting was that everyone found a different aspect of the complex relationship between the NHS and ideas of citizenship. Entitlement is a marker of citizenship and inclusion of all citizens is in turn an emblem of national values. But they need to be acted out, by citizens taught how to behave in healthy ways that live up to the promise of the health service. And the accusation of failing the NHS is a serious one, for politicians eager to prove they too believe as well as for nurses or doctors going on strike.

Social Work and NHS History

World Social Work Day (Tuesday 15 March in 2016) is a good time to look back to the history of social work – and, for us, its historic relationship with the NHS. It suffers from not being a profession with a history as long as medicine or having the totemic figures of nursing. Like occupational health, it can be a largely invisible profession to everyone but those for whom it shapes their experience with the NHS. This means social work is not necessarily an obvious aspect of the NHS’s history for us to think about, but it is an important one. So what is that history?

Of course, there are many kinds of social work, each with its own history. And since illness, disability and, more positively, health, impact so greatly on all our lives, the NHS may be a greater or lesser feature in most social work. But here I’d like to say a little about, and hopefully prompt a few memories of, hospital social work.

Social workers first arrived hospitals to weed out those abusing the hospital by seeking free admission when they could afford to see a doctor, by definition not requiring hospital treatment in an age when medicine was far less dependent on the technology of the hospital, and ask for an appropriate financial contribution from the rest. We might say they operated the hospital means test. But there was no need for this after 1948, as I’ve written about for an entry in our encyclopaedia on Social Work and the Coming of the NHS. What’s more, when charges for prescriptions and other items were introduced just a few years into the NHS, social workers refused to have any role in collecting them. Money continued to be important, but in a different way. As I was told by one person, who had been a social worker’s assistant in the 1960s, a huge amount of the work was geared towards assessing a patient’s financial circumstances. But the purpose of this was not to determine the amount to ask them for, but to ascertain what benefits they should be claiming.

When she came to write her Consumer’s Guide to the British Social Services in 1967, one-time hospital social worker Phyllis Willmott explained that it was that the job was:

to help patients with their worries and difficulties – either practical problems over work, money, housing, or more personal emotional or domestic difficulties, or a mixture of both. She has (if she is experienced) a wide knowledge of all kinds of social services available; she is also trained to understand and help with the very real and acute personal or emotional difficulties which can lie behind some illness, or be caused by them.

This period of social work’s history could easily be lost amidst myriad organisational changes – not least reorganisations of the NHS and local government, just as medical social workers were being moved from one to the other – and being part of wider structures was important. Indeed, there were no new hospital built until the 1960s, but there was a real increase in the number of social workers trained and appointed to work in them before that. The Warwick University Modern Records Centre website hosts recordings of Social Workers Speak Out – interviews with 26 pioneers of social work, 5 of them hospital social workers, who reflect on what was for many a golden age of hospital social work.

Those interviews took the story up until the end of the 1950s, and the next period was one in which the character of social work was changing to become more sociologically and psychologically aware. This took place against of backdrop of the politics of anti-discrimination, a new era to adapt to but also one that some recall fitting well with a long-standing ideal of seeing and respecting the whole person. But how to think of that person: a patient? a case? a client? a consumer? a service-user? etc. etc. And broader political changes meant social workers, as in the early days of the profession, had to once again become experts in helping them navigate a complex mixed economy of welfare. Indeed, the latest chapters of hospital work’s history see social workers themselves increasingly employed by neither the NHS nor local government.

In truth, we know very little about social work in the history of the NHS. That’s why a project like this is so important. So please do share your memories with us. Do you remember a social worker from your time in hospital or did they help you access the support you needed from the NHS? Perhaps you were a social worker or assistant who worked in an NHS hospital. If so, how were you seen and treated by the patients and the other hospital staff? Did the NHS make a difference (good or bad) to the way you worked with your cases when they were dealing with health problems? You can use the comment section below to tell us, or you can sign up as a member to join the general discussion in our MyNHS members area.

Bow Arrow Hospital, 1953

For many of us our memories of healthcare begin in childhood. From visits to the GP and vaccinations, to eye tests and dental check-ups, most of us have engaged with the NHS at a young age. Some children spend a considerable amount of time in hospital, engaging in the NHS in different ways to their peers, with the hospital becoming a location not just of prevention or treatment, but also of in-patient care. This photo, which we chose as the banner image for the People’s History of the NHS website, depicts such in-patient care in 1953 and within the newly formed NHS.

Showing children on a ward at Bow Arrow Hospital in Dartford, a specialist facility for treating tuberculosis, this photo prompts us to think about the place of children, childhood and the visual presence of the hospital within the cultural history of the NHS. It also allows us to consider the role that infectious disease, especially within childhood, plays in this history. This photo was taken at a time when tuberculosis as a widespread health problem was waning. A BCG vaccination scheme to prevent tuberculosis was introduced into the British schedule in 1953 for school leaving children (age 14), the same year that this photo was taken. Therefore this photo was taken on the eve of vaccination.

Yet, this image does not convey a public health story, the triumph of vaccination over the long scourge of tuberculosis. Instead, it emphasises the space of the hospital and the positioning of children within that space. The communal ward with beds and toys intermingled and the image of children alongside nurses but not parents represents a particular time within NHS care of children in hospital. Up until the late 1940s, it was widely accepted that it was undesirable for children to be visited regularly by their parents in hospital. Many hospitals permitted only monthly visitations and some not at all. During the 1950s however, there was growing concern about leaving young children in hospital apart from their parents and the threat of ‘separation anxiety’. This related to psychological theories about the importance of attachment. This slowly led to changes to make it easier for parents to visit children although it wasn’t until the 1970s that unrestricted visiting became standard policy in NHS hospitals.

From an historical perspective this image provides insight into the world of the hospital at a time when regular parental visitation was almost non-existent. It also points to ways that changes in disease impacted upon hospital provision and hospital spaces – there would be much less need for such childrens’ sanatoria in future and therefore, separating children from both society and their parents would become increasingly unnecessary.

Therefore, this is not a typical photo of childhood hospital care within the NHS. Yet it points to a particular type of care for children. The image emphasises the place of children at play, in part by centring the lovely mini merry-go-round, within their hospital stay. While bed rest was an important component of tuberculosis treatment plans throughout the 1940s and 1950s, this ward emphasises the place of play alongside rest to the recovery of these children. The piano and tables in the middle of the room similarly construct play and interaction between the children patients as an element of daily ward life. But it is also interesting to reflect on what this picture may tell us about the style of care given at Bow Arrow Hospital. It is both precisely ordered, with the beds perfectly made up even with their children occupants still in place. Yet the room is also child-friendly. It includes children’s toys, pictures on the walls and childhood interaction, which as a symbol of care emphasises committed nursing staff and their role in facilitating interpersonal interactions on behalf of the children patients.

The large, open windows and the airy, uncluttered atmosphere of the ward itself were partly about the focus on fresh air, light and exercise for treating tuberculosis. The high ceilings of the Victorian hospital were thus refashioned as important curative tools and visually linked to an ordered regimen. While later, these buildings came to be seen as cold, damp and unsuitable for modern, high-tech care, they remain important visual reminders in the British landscape of the former hospital site, where many personal encounters with the NHS were first forged. Although this photo shows us the interior of one specific hospital, it serves to touch on many of the themes, topics and interactions that we are looking to uncover through the People’s History of the NHS website.

While Bow Arrow Hospital no longer exists, with the building itself knocked down to make way for a housing estate, this image provides a wider snapshot of the place of the child within the early years of the NHS. It shows how the different needs of children, particularly their need to play, were facilitated and incorporated into the everyday life of the children’s ward. As such it allows us to consider the place of childhood illness within the cultural history of the NHS as well as the important location that the hospital has played, and continues to play, in providing care within a community.

We see this image as one way to spark a new conversation about the cultural significance of the NHS. We hope that it helps you remember or think about what your interactions with the NHS have meant to you, both in childhood and adulthood. We’d love to hear your recollections of time spent on children’s wards, as children, as parents and as nurses or doctors.

  • Did you spend time on a hospital ward as a child?
  • Did your parents visit you regularly?
  • Do you remember playing games or with toys on the hospital ward?
  • Did you work on a children’s ward in the early years of the NHS?
  • How did unrestricted parental visiting impact upon your job?

Comment below and let us know!