Charity and the NHS Choir

The 2015 Christmas No.1 single was ‘A Bridge Over You’, a medley of Simon and Garfunkel’s ‘A Bridge Over Troubled Water’ and Coldplay’s ‘Fix You’. It was sung by the Lewisham and Greenwich NHS hospital trust choir when they were featured on a BBC TV show with celebrity choirmaster Gareth Malone, but revived by the choir a couple of years later as a seasonal charity single.

The attention it received in the press was largely for its denying the chart top spot to Justin Bieber, who took to twitter to encourage his fans to buy the rival single. The Guardian noted the Canadian popstar had previously spoken out in favour of state healthcare, saying of Americans in a Rolling Stone interview: ‘You guys are evil’ for the financial worries associated with healthcare in the US. There were occasional comments about solidarity with the junior doctors, who had just postponed a national strike and support for the financial security it guarantees in times of illness. However, no comment was made about the discrepancy between the Christmas No.1 campaign’s rallying cry and where the money actually went.

The choir ditched their parochial name and branded themselves the NHS Choir, emphasising the point that buying the single was a way of showing appreciation for all those working over the holidays to keep the health service going. Yet the money raised did not go to the NHS. It was split between a number of health-related charities, including Mind and Carers UK. Even at the end of a year when the financial crisis in the NHS had never been far from the headlines, the NHS itself was not the recipient of the funds raised. The Lewisham and Greenwich choir may well have considered raising funds for their own hospital trust, but it would likely never have crossed their minds that the NHS Choir might raise funds for the NHS itself.

This provoked no comment because it is a fundamental and generally unspoken code underpinning the relationship between the British people and the NHS. Not only is it right to fund health services collectively, but any fundraising appeal must be separated from the routine delivery of healthcare if it is to be thought of as proper. Indeed, this has been the standard from the beginning of the health service nearly seven decades ago.

Following the establishment of the National Health Service in 1948, Aneurin Bevan gathered together representatives of the new regional hospital boards and gave them a stern warning. As NHS hospitals they were no longer to appeal for funds or ask for donations, to do so would be “improper”. There were to be no more fundraising advertisements in local newspapers, appeals on the radio or letters sent out requesting donations. Patients should no longer be encouraged to join contributory schemes. Collecting boxes were to be brought in from railway stations and public houses up and down the country. No more flag days, fetes or bazaars.

This is not to say that charity and voluntarism had no part in the story of the NHS over the following decades. Indeed, the history of the NHS would have been very different if it did not feature an army of volunteers. Gifts have also been import, as has raising money to provide the latest medical equipment and bedside lockers alike. And Christmas has always been a time of charity and community, in the NHS as elsewhere. Yet there are limits to that charity, on which the proper place of both citizen and state rests.

So, while the NHS Choir was new – never before had there been a Christmas No.1 in support of the NHS – it was also deeply traditional. Traditional because it echoed a long lineage of NHS fundraising, but also traditional because it knew its place.

World AIDS Day

The 1st of December marks World AIDS Day – a day dedicated to showing support for and solidarity with HIV/AIDS sufferers worldwide. Launched in 1988, World AIDS Day represented the first global health day centred on a single disease and aimed to overcome stigma, raise awareness and mourn those who had died from the disease. Launched during a period when AIDS was proving particularly challenging for policy-makers and the public alike, the Day became a way to unite the efforts of national, regional and local bodies alongside charity groups on a global scale as well as tapping into the wider machinations of the mass media.

While AIDS itself has since undergone a process of ‘normalisation’ within public health in Britain, World AIDS Day remains an important social reminder of the continued battle against HIV/AIDS around the world. It also represents a useful day for reflection on the contemporary history of AIDS, the place of public health and how it might fit within a history of the National Health Service in Britain.

Thirty-five years ago AIDS (Acquired Immune Deficiency Disease), or GRID (Gay-Related Immune Deficiency) as it was then known, was a disease that almost no one had heard of, but within just two years AIDS was being constructed as a new, dangerous epidemic that was spreading worldwide. AIDS emerged in the early 1980s as a sudden, fatal and infectious disease, affecting in its early years mostly young, homosexual men. Epidemiologists in their quest to locate patterns of transmission focused on behaviours and lifestyles common to gay men to isolate risk factors. They emphasised the role of ‘promiscuity’, ‘poppers’ (amyl nitrate) and anal sex, and in doing so not only ignored AIDS cases that did not fit this homosexual model (such as women and drug users), but also contributed to the construction of AIDS as a ‘gay plague’.

Within popular culture this focus on homosexuality enabled all gay men to be identified as at-risk and therefore potentially contagious. Even after the discovery of the HIV virus in 1983 as the cause of AIDS, fears around contagion and transmission continued to circulate. In Britain, the arrival of AIDS was largely marked by governmental inaction, followed by a widespread belief that the traditional methods of public health – monitoring and surveillance– would control the disease. This ensured that during the early-mid-1980s public health responses to AIDS followed a pattern applied to epidemic disease more broadly. Yet, among health professionals the identification of HIV as the disease-carrying virus allowed methods of prevention to be emphasised. Condom wearing in particular was advocated and fitted well within a wider context of individually focused health education. But Margaret Thatcher’s Conservative-led government was slow to support health education centred on contraceptive practices that could be broadly seen to encourage pre-marital sex and sexual promiscuity. There was a genuine disconnect between a Conservative ethos focused on family values on the one hand and the need to control the spread of a disease associated with sexual liberation on the other.

From 1983 Sir Donald Acheson, Chief Medical Officer, supported the work of the Terence Higgins Trust, the first British charity established in response to the AIDS epidemic, incorporating into a wider pattern of response that focused on gay communities often helping themselves. But he also encouraged the development and distribution of warning and advisory circulars including one to laboratory workers in 1984 marking a new approach to disease prevention aimed beyond the gay community. By 1985, the Health Education Council – the main quango responsible for the creation of health education messages – was beginning to react to the spread of the disease, firstly producing and disseminating their Facts About AIDS leaflet.

The step-change occurred in 1986 when the Central Office of Information and the Department of Health and Social Security produced the Don’t Die of Ignorance mass media campaign aimed at a population-level audience. The television advertisement used John Hurt’s voiceover to inform viewers that ‘There is a danger that has become a threat to us all – It is a deadly disease and there is no known cure … If you ignore AIDS it could be the death of you. Don’t die of ignorance’. Its use of tombstones, crumbling mountains and icebergs aimed to shock viewers into recognising the risk of the disease and to encourage viewers to employ preventive behaviours to help stop its spread. In addition a leaflet was sent to every household and a week of educational programming was scheduled at peak times on all four national television channels. The campaign was seen as a health education success pushing the topic of AIDS onto the national agenda and ensuring that it became a talking point in cultural life.

While these developments in public health and the place of AIDS within health education priorities impacted upon the NHS in terms of access to contraceptive prevention, screening and the dissemination of education materials, another central area around which AIDS transmission and the NHS became intimately bound was that of blood donation. By 1983 there was increasing evidence of HIV infection amongst haemophiliacs as well as those who had undergone blood transfusions in the early 1980s. Fanned by an alarmist media, blood supplies in particular came under public scrutiny with fears about safety paramount. The infection of blood supplies with HIV emerged in tandem with a wider scandal over the contamination of blood supplies with hepatitis B during the 1970s and 1980s. This brought into question not only the process by which the NHS was supplied with blood but also how the NHS treated this blood before transfusing. As a result of this scandal blood products came under much greater scrutiny within the NHS. Rather than routinely importing blood supplies from the US untreated, heat-treatments to kill viruses in blood was introduced and from October 1985 routine screening of blood donations for HIV was introduced throughout the UK.

While the problem with contaminated blood supplies would continue into the 1990s, the risk of contracting HIV/AIDS was largely overcome by the introduction of these new checks. HIV testing was introduced in 1987 and by 1989 the Health Education Council was producing educational materials aimed at raising awareness about HIV rather than AIDS alone. Since 1995 HAART – highly active antiretroviral treatment – has been available for HIV sufferers and has resulted in a two-thirds reduction in AIDS deaths.

Throughout the 1980s and 1990s HIV/AIDS remained an important public health issue. Governmental policy had shifted from inaction to active education, harm minimisation and emphasising the importance of prevention. The disease had highlighted the place of the mass media in shaping the public health story allowing population-level risk and the scandal of contaminated blood products to emerge as strong disease narratives. While HIV testing would become embedded within the medical treatment of the disease with HAART, the continuing importance of prevention and education would continue to be important mainstays of public health into the twenty-first century.