The NHS at 70 – A Poem

The NHS inspires, and has long inspired, a range of cultural representations, tributes, and, indeed, critiques, including from poetry, literature, visual art, and television and film. Today, we are delighted to share a special poem, written by Larry Lagrue in honour of the NHS 70th Anniversary. Larry is a Dorset Poet and Blogger.  His blog is called “W is for Duck” and every Friday Larry posts a brand new poem.  You can see his blog at www.wisforduck.wordpress.com, as well as finding it on Twitter, Facebook and Instagram – all under the name of W is for Duck.

NHS @ 70

70 years ago, a simple ideal
Was brought to life, and made real.
One place for care – care that was free
For every member of society.
The barriers to medical help were removed,
So people’s lives could be improved.
And in these 70 years has not our nation
Enjoyed a healthcare transformation?
It has not been easy – of that, you can be assured
You opened up, and in we poured.

We come, relentless like a flood
With broken limbs, or poisoned blood.
We’ve injuries to body and mind
Some cannot speak; some have gone blind.
The obvious injuries, with blood and pain
And the unseen wounds that affect the brain
A son, a niece – a nephew too
A brother, mother, me – or you.
Sisters, aunties, grandparents – all
Those who stumble, trip, and fall.

From Childcare and Maternity
To when death takes an eternity
You take it all without a word
From the obscure to the absurd.
When we choke upon a piece of bread
Or wedge a saucepan on our head,
When our botched attempts at DIY
Result in lost fingers, hands or eyes.
Organ failure, broken bones
Injuries caused by the telephone.

Panes of glass that we fall through
Knee replacements – sometimes two.
Cancer treatment and chemotherapy
Dementia that ruins lives so cruelly.
When this life takes a downward trend
We look to you, to help us mend.
Diseases that we caught unaware
Despite the fact we did not care
To listen to your good advice
And had this same infection – twice.

No matter what life puts us through
We always have one constant – you.
You are – and always have been there
Not one to judge, just help and care
With patience, kindness and sincerity
For all our glorious disparity.
For reward or plaudits, you do not ask,
Just quietly get on with your task
And though ingratitude and threats
You continue to always do your best.

As a nation we do take you for granted
Yet hope you will not be supplanted.
Through the joy, and pain, and hurt and tears
You’ve been with us for Seventy Years
And in those years have there not been
Such advancements in care and medicine?
But what is the same as way back then
Is the fact that it is women and men
Who are the NHS at its heart
(although the buildings play a part)

It’s everyday folk, just like you and me
Who have borne our burden wonderfully.
No capes are worn, no pants outside
But these superheroes give our nation pride.
Giving care, and respect, and dignity
An example to our global society
Through lack of funding and winter pressures
The effort and love comes in equal measure
And no amount of words can really express
How grateful we are for our NHS

Larry Lagrue

The NHS explained in eight charts

The NHS explained in eight charts

Maria Goddard, University of York

The Beveridge Report outlined a radical plan for a National Health Service, provided free to all UK citizens, regardless of their income. Seventy years later, the groundbreaking NHS is as complex as it is large (it is the fifth biggest employer in the world). To break down the complexity here are eight simple graphs that explain the state of the NHS today, and how it got there.

Rising proportion of GDP

Since 1948, funding to support healthcare has been raised from general taxation and national insurance. As a proportion of gross domestic product (a measure of the value of the economy), the amount spent on healthcare has risen over time, from just over 2% in the early years of the NHS to over 7% most recently – an average of 4% over the period.

Alternative definitions of spending on healthcare provide different estimates for % of GDP, but the trend is always upwards.

Growth has slowed in recent years as government budgets have come under pressure, and there is a debate about the potential gap between demand for care and expenditure. The reasons for the increase in spending are complex, but demographic change – a growing and ageing population – is a major cause, along with medical advances that allow some conditions that were previously untreatable to be addressed, as well as a tendency for spending on healthcare to rise as countries become richer. The increase in spending probably also reflects rising public expectations from healthcare.

How the NHS compares internationally

If the NHS is costing more each year in absolute terms and more as a proportion of GDP, how does it compare with other countries? Is the UK getting good value for money?

Unfortunately, these sorts of comparisons are tricky because of the different ways healthcare systems are organised and the various definitions of spending. Also, international comparisons can’t determine what the “correct” level of spending should be.

It is often reported that the UK spends less than many EU countries and below the OECD average. Recent analysis of data that takes account of some of these differences, and includes spending on capital and health-related social care, has concluded that using these accounting methods, the UK government is more of a middling spender.

It is important to bear in mind that in some countries spending by individual citizens on healthcare is much higher than in the UK, where most of healthcare is provided free. Also, higher spending does not automatically mean better healthcare. The US is a very high spender, but many would argue that their healthcare system is far from perfect.

Where is the money spent?

Most healthcare spending is devoted to curative and rehabilitation care (around 63%). Almost half of total spending is in hospitals, and 15% in the family health services sector, which includes spending on GPs, dentists, opticians and pharmacists.

Long-term care spending accounts for 15%, but this does not include significant spending by individuals on social care. Spending on medical goods, which includes medicines bought at a pharmacy on prescription, accounts for about 10% of the total.

The largest category of spending in England in terms of condition (in 2010-11) was mental health (11%), followed by circulatory problems (7%) and then cancers and tumours (5%). This pattern of spending has been fairly stable over the previous few years, but as the number of people suffering from mental health problems has increased since 1993, and mental health issues are one of the main causes of the overall disease burden worldwide, there is some debate about the degree to which spending is keeping up with population need.

Rapidly rising cost of medicines

Let us delve a bit deeper into spending on medicines as this is an area of spending that has experienced a rapid increase in recent years, rising from £13 billion in 2010-11 to £17.4 billion in 2016-17. The annual rate of increase in spending on drugs far outstrips the annual rate of NHS budget increases.

Just under half the amount spent on drugs is in hospitals, and just over half is spent on drugs prescribed in primary care. A smaller amount was prescribed in hospitals but dispensed at a high street pharmacy.

The actual amount paid for medicines by the NHS will differ from these so-called “list costs” because they exclude discounts the NHS may receive, dispensing costs, as well as income from prescription charges.

Spending on medicines has risen faster in hospitals than in primary care, with the former almost doubling between 2010 and 2016. Overall, the costs of medicines have increased by over 33% since 2010. The availability of new medicines and increased use of specialist medicines have contributed to rising costs.

The most money spent on a medicine, overall, according to the most recent data, is on adalimumab, an arthritis drug. In primary care, the greatest amount spent on a drug was on rivaroxaban, a medicine to treat acute coronary syndrome.

Demographic change

Improvements in social conditions, lifestyle changes and advances in medical treatment mean that life expectancy has increased steadily since 1948. In England and Wales in 1948, males aged 65 could expect to live a further 12 years and females 15 years. By 2016 this had risen to 21 and 23 years, respectively.

Over the last century, life expectancy in England and Wales has increased by almost three years every decade. Men born in the early 1950s could expect to live 66 years and women 72 years. By the mid 2000s, this had risen to 79 and 83, respectively.

The life expectancy gap between males and females has changed over time, in favour of females. It widened in periods where working conditions for men were poor and when more women were surviving childbirth. Then it began to narrow from the early 1970s, reflecting a shift away from physical labour – including mining – and a fall in smoking among males.

There are some signs of life expectancy gains slowing down in recent years. Also, there are significant geographical variations that largely reflect differences between rich and poor. For example, men living in the most affluent areas of England can expect to live six more years than those living in the poorest areas.

Improved life expectancy means that the population is ageing overall. While in 1948, 5.5% of the UK population was 65 or older, 1.9% was 75 and over and only 0.2% of the population was over the age of 85, by 2016, this had grown to 18%, 8% and 2.4%, respectively.

However, not all of the additional years of life experienced are necessarily lived in good health, and data on self-reported health suggests that “healthy life expectancy” is much lower at 63 years for males and 64 for females. At age 65, men will spend about eight years in poor health and women about ten years. Again, there is substantial geographical variation, mainly reflecting differences in income.

Figures vary according to population and year considered.

This is reflected in the growth in NHS activity over time, for example in 2016-17, the greatest number of episodes of hospital care in England were experienced by those in the age group 70-75 years, and the fastest growth over the last ten years has been in the 85 years and over group.

The extra demands placed on the NHS by a growing ageing population living longer, but not necessarily in good health, is at least part of the explanation for the pressure on resources that we see in the NHS today.

Causes of death are shifting

In the latter part of the 19th century, infectious disease was the biggest cause of death, affecting mainly children. Subsequent reductions in mortality can be attributed to improvements in diet, sanitation, housing and water quality, as well as changes in behaviour.

Later on, advances in immunisation also played a major role in reducing infectious disease, especially among children. Reductions in deaths from airborne infections, such as bronchitis, pneumonia and influenza, have continued over time, but since the early 1970s, the reduction in mortality from heart disease and stroke has been a major factor in reducing overall mortality.

Other trends also reflect wider changes in society, such as large numbers of deaths from vehicle accidents during the blackout of World War II, declining after seatbelt laws were introduced.

Deaths are now concentrated more in older age groups. And for both men and women, death rates from heart disease and stroke have declined by around 50% over the past ten to 15 years, thanks to advances in prevention and treatment.

There have also been reductions of around a third in death rates from lung cancer in men, and a quarter for breast cancer in women. In contrast, death rates from dementia have increased for both men and women. For men, death rates for liver disease have increased. And for women, death rates for kidney disease, urinary disease and lung cancer have gone up.

These changes, even over a relatively short period of time, reflect population changes, treatment advances, and improvements in the diagnosis and recording of conditions. They also reflect changes in behaviour and lifestyle.

Despite falling mortality rates, however, some of these conditions still account for large numbers of deaths. In 2015, heart disease, stroke and certain cancers were still among the top ten leading causes of death in males and females. As people live longer and the population ages, the number of deaths where dementia is the primary cause of death has increased, making it the leading cause of death for women and the second leading cause for men.

Many of the top ten conditions have underlying risk factors that are linked to behaviour and lifestyle, such as smoking, drinking and nutrition. For example, 26% of adults in England are classified as obese, compared with 15% in 1993, and there were 617,000 hospital admissions in 2016-17 for which obesity was a direct or underlying factor – an increase of 18% since the previous year.

Similarly, smoking is also a leading cause of preventable death. In 2015, around 15.5% of adults (17% males, 14% females) smoked. There were 79,000 smoking-related deaths in England, with almost half a million hospital admissions attributed to smoking, albeit that the proportion of population who smoke has declined over time and the number of cigarettes smoked is lower than in the 1970s. Dramatic reductions have occurred since the 1950s, when 80% of men and 40% of women smoked.

Compared with the early days of the NHS, many of the top ten conditions that people are dying from can now be treated more successfully, but there is now a much greater emphasis on addressing the underlying behaviours that are associated with risk factors for many of these conditions, in order to prevent, rather than cure, these illnesses.

The NHS is just one strand in this approach, as the means to change behaviour go beyond the healthcare system towards the education and support of individuals. For example, legislation on smoking in public places, advertising restrictions and taxes on cigarettes, alcohol and, most recently, sugary drinks, play an important role. Given the increasing pressure on resources and the fact that we are living longer, the need to ensure we live these extra years in good health, is more pressing than ever.

Something to be proud of

Only 70 years ago, healthcare was a luxury that not everyone could afford. The NHS was founded on the principle that the health service should be available to all, free at the point of delivery and financed from taxation, which means that people contribute according to their means. This principle is still a central pillar of most parts of the NHS today, and despite some significant anxieties about future funding and dissatisfaction with some aspects of the service, it is at the top of the list of things of which the public are most proud, with strong support expressed for the underlying values on which it is based.

Since 1948, both the healthcare system and the nation’s health have transformed. Despite all the challenges that still remain to be tackled, the NHS survives and retains the principles of fair access and financial protection that Aneurin Bevan, the founder of the NHS, embraced.


More evidence-based articles about the NHS:

Maria Goddard, Professor of Health Economics, University of York

This article was originally published on The Conversation. Read the original article.

People’s History of the NHS – The Documentary!

For the last five months, the People’s History of the NHS team have been working with the production company 7Wonder to create a new three-part series for BBC Four, The People’s History of the NHS.  It has been an amazing experience to step behind the TV production curtain into the new world of reading script structures and to think about how our research can be presented visually and on screen.  We have also enjoyed working with the producers to weave historical complexity and nuance through the scripts, while also ensuring that they remain clear, provocative, and exciting.

As part of this collaboration, 7Wonder have also asked all of their interviewees a series of questions that, in different ways, explore the subject that is at the heart of our ‘People’s History’– the deep meaning and cultural significance of the NHS in everyday British life:

  • What does the NHS mean to you?
  • What is your first memory of the NHS?
  • What would you do for the NHS?
  • What will the NHS look like 70 years from now?
  • Do you love the NHS or do you love free health care?

The production company have kindly edited us a series of clips answering these questions and we’ll be releasing them — and lots of links to new and existing materials on our website — in the run-up to the launch of the TV series on BBC Four in July.

Our first two videos are from interviews with Lorraine Leeson and Peter Dunn, both artists.  Looking through these videos some fascinating themes and parallels already emerge.  The first clear theme is the belief that the NHS represents universality – of access, of treatment, but also in terms of representing widely held egalitarian values or, for Lorraine Leeson, rights held not by virtue of being British but by virtue of being human.  These values and rights evoke feelings of passion and pride in our interviewees, expressed explicitly and implicitly.  These themes also come out clearly in the results of our survey for activists, and in the campaign banners produced by Leeds Hospital Alert – the latter of which may be compared to the brilliant art which Leeson and Dunn made in defence of Bethnal Green Hospital in the 1970s.

Notably, these videos also show a sense in which many people are very familiar with the history of the NHS – the turning point of 1948 is often referenced in such interviews and at our public events.  This shows that knowledge of history can operate as a form of ownership over the concept of the NHS, and also as a measure of how information about this institution’s history is ingrained in our daily lives and medical spaces.  Personal histories are entwined with political and social ones in these accounts.  Lorraine Leeson recalls her first memory of the NHS as collecting orange juice from a clinic, while Peter Dunn discusses having grown up with the NHS, being born in the post-war generation but also because his mother and sister were nurses.  This raises fascinating questions about how different generations may feel about the NHS, which we have been discussing with our undergraduate students.

We are glad that our interview questions are already evoking different responses and also the expression of emotion and feelings, and will be continuing to release a small number of videos and to discuss their findings week by week alongside new calls asking YOU to give us your answers to the five questions above.

We’d be delighted to hear your comments in the mean time on the questions raised, or to answer any questions about the documentary and collaborative process!

NHS in the frame

A guest post by Katy Canales, Acting Curator, V&A Museum of Childhood

The V&A Museum of Childhood’s collection of children’s spectacles spans over 200 years. Their innovative and creative designs incorporate the technological and societal developments during this period, from the start of industrial-scale manufacturing to the founding of the National Health Service (NHS).

The earliest pair in the collection is an adjustable, wire framed set, hand-made in London, which date from around [?] 1800. In contrast, the most recent pair is a plastic, replica set from a Harry Potter fancy dress costume, mass produced in China from 2001-2 (fig.1). Despite the differences in date, production and purpose, they are strikingly similar in appearance with simple monotone frames, hinged legs and small round lenses. Other glasses which shares these features date from 1939, and were worn by Bruce Angus Ogilvie from Dundee (fig.2). Their adaptive, bendy design meant that they could be worn without snapping, under a gas mask during the Second World War (1939-45).

Figure 1. Harry potter costume, about 2011-2. Museum no. B.31-2003

Figure 2. Spectacles and case; about 1939. Museum no. B.93-2014

By far the most prevalent pairs of glasses within our collection are the National Health Service’s (NHS) ‘C524 and C525 frames’ (fig.3). These popular frames were issued for free to children between 1948-1986. Just like the adult ‘525 frames’, these frames have a slightly winged top, a keyhole-shaped bridge, clear acetate pads, and the hinged sides are reinforced with a metal core. One point of difference in the design of the children’s spectacles is that the legs curved inwards and the feet were made to be circled around the child’s ears, in a bid to keep the spectacles from sliding off during play (fig.3). Made to last, these spectacles were available in a limited spectrum of robust, coloured cellulose acetate, with colours including ice blue, crystal, flesh, light brown mottle, dark brown mottle, and black.

Figure 3. Child’s spectacle Frames; British, 1960-69. Museum no. B.306-1996

The V&A Museum of Childhood also holds in its collection three templates, or jigs, which were used by opticians from the 1960s to make these now iconic glasses (fig. 4-6). These jigs, plus three pairs of early NHS children’s glasses, have recently gone on public display at Design Society, in the Shekou district in Shenzhen, China, as an example of how British design responded to mass health issues. Design Society is a world class cultural institution designed by Fumihiko Maki, and is the creative collaboration between the China Merchants Shekou and the V&A Museum.

To find out more about the V&A Museum of Childhood please visit: https://www.vam.ac.uk/moc/collections/ or discover more about the Museum’s objects here

 

Figure 4. Template for making child’s spectacles; British, 1960-85. Museum no. B.314-1996

 

Figure 5. Template for making child’s spectacles; British, 1960-85. Museum no. B.315-1996

Figure 6. Template (JIG) for making child’s spectacles; British, 1960-85. Museum no. B.316-1996

Next Roadshow – 8th January, Edinburgh!

We are delighted to announce our next ‘NHS Roadshow’!  It will be on Monday 8th January 2018 in Edinburgh Central Library, from 1-4PM.

Come along for a chance to meet our team and to see our lovely NHS objects.  We’ll be bringing:

  • Trade union manuals and posters from the 1970s and 1980s, including a slightly depleted but still relatively impressive stock of stickers (many nabbed away from us during our St Fagan’s Roadshow …!)
  • NHS baby glasses, very very small for my tiny and poor-sighted baby head.  Also my present glasses will be on my face, if of interest at all for comparison
  • Some creepy (in my opinion) photos of disused historical hospitals
  • Collections of poetry about the NHS – an institution which has inspired many cultural productions, including by Phillip Larkin
  • A historical heath-test!  We are not qualified to operate this, but we are qualified to tell you how people would have used it in the 1950s and that is something, right?
  • If we can manage to carry it, our (unusual) team mascot, a 1950s prosthetic leg
  • Nurses uniforms for you to scribble on, adding to such interesting notes we’ve had at previous events as ‘this is not a proper uniform!’

Antique Roadshow style, we’re also asking you to please bring along your NHS objects!  Do you have your baby tag?  Historical false teeth?  An NHS mug or staff badge?  A book about the NHS or a training manual?  Whatever you have, we would love to see it.  We have a gallery of the objects our team found around our own homes, which may provide some inspiration.  With your consent, we’d also love to photograph your NHS objects and to put pictures in our virtual gallery, which is at the moment, perhaps surprisingly, the ONLY Museum of the NHS!

We’d also love to hear your stories and memories of the NHS.  2018 will be the institutions’ big 70th birthday, and this is the perfect time to tell us how you think it has changed over time, and your earliest memories.  We use these to write histories of the NHS, and your input really does shape our research questions.  Read my blog from our event at St Fagan’s for an example of how meeting lots of people changed and shaped our research thinking.  We’d like in particular this time to reflect with visitors about Anniversaries about why we think about history in this way.  Is the meaning of the NHS best defined by birthdays and ‘founding fathers’, or is it ingrained in daily interactions between staff, patients, and families?  Does the NHS have a coherent or singular meaning, and can we capture this through historical study or at engagement events?  How can we do better to represent the complexities of your experiences of the health service?

We’ll also be joined by many archival friends, including those from the Lothian Health Services archives, who have some truly wonderful materials, and who have written for us before about what their archives tell us about diet in the NHS and women and mental health.  Ask them about their archives, and how to use them, on the day.  We’ll hopefully also have some lovely documents on display.

We have lots of activities for children too including colouring, ‘Operation’ (any excuse), and medical playsets!!  We love hearing from children about how they experience the NHS.  Giving us some of our most brilliant feedback so far, one child at our St Fagans Roadshow, having a lot of fun, reliably informed us that the NHS is like Spiderman, because it is a superhero.

We hope to see as many people there as possible.  If you have any queries about this at all, please do feel free to email me, Jenny, at J.Crane.1@warwick.ac.uk.

‘At last, young people’s voices are being heard about the future of the NHS’

Please see below a very interesting new blog about the ways in which young people are represented in the NHS currently.  For the historical context, our researcher Jack Saunders has also written a great encyclopedia entry about representation.  Questions about who gets a say in governing the NHS, but also in writing NHS history, also come up often at our public events, for example during our recent workshop with the King’s Fund Library and Information Services.  Feel free to contact us if you have any thoughts on this issue!

At last, young people’s voices are being heard about the future of the NHS

Lisa Whiting, University of Hertfordshire; Gary Meager, University of Hertfordshire; Julia Petty, University of Hertfordshire, and Sheila Roberts, University of Hertfordshire

For me, [being part of the NHS forum] was like being introduced to a whole new world. I wasn’t aware that young people could be offered opportunities like that, to actually talk to key decision makers and get people from really important organisations wanting to come and talk to us … It’s helped me with my communication skills … it’s taught me how to speak properly and confidently.

This was Georgia talking about her involvement in the NHS England Youth Forum (NHSEYF) in 2016. It aims to improve health services for young people and to give them a voice on health issues that matter most to them.

A team from the University of Hertfordshire carried out an examination of the work of this forum. We found that the young people were highly motivated and committed to being involved in decision-making about NHS services. They found contributing to society through this forum a valuable opportunity and welcomed having their voices heard.

What emerged from our interviews was how much commitment there is among young people about the future of the NHS. Here’s Josh:

It’s a major concern for me about the NHS … and I want to improve it,
I want to give back … After being elected as young mayor in our local
area … we get lots of opportunities about how we can contribute back
to society and one of them was the NHS Youth Forum … I saw it and I
thought what a brilliant opportunity that would be to kind of get my voice
heard, obviously as a service user but also as someone who represents
young people locally. It was a brilliant opportunity.

Georgia, who we have heard from before, had another more personal reason for being committed to having a say in the running of the NHS:

The reasons behind why I wanted to join were more personal … I was
quite passionate about mental health because my [relative] suffers from schizophrenia.

It is important to listen to young people about services that directly affect them. In the UK, the idea of youth forums is now well recognised. There are more than 620 youth councils and forums in existence aiming to give young people the opportunity to be involved in decision-making in their local communities. One example is the High Trees Community Development Trust which focuses on social issues that affect young people and provides training and support so that they can feel confident to participate in the decision-making process.

What is the NHS England Youth Forum?

The NHSEYF was established in 2014 to allow young people to participate in decision-making about the NHS. The aim was to give young people the opportunity to have a voice and “to contribute to improving and developing services for young people”.

There are 25 members of the NHSEYF ranging between the ages of 11 and 25. Publicity snowballed with the introduction of their own website, Facebook page and Twitter feed.
Following the establishment of the NHSEYF, a number of other local forums for children and young people have developed within local hospitals and other areas across the UK including England, Scotland, Wales and Northern Ireland.

Getting involved

We found that NHSEYF members were involved in an extensive range of activities and commitments at local level – including hospital committee membership, local youth forum events and seminars as well as high-profile national events such as the National Children’s Inpatient Survey, national conferences and attendance at the NHS Citizen’s Assembly.

Attending these events raised the profile of children and young people’s needs and allowed the NHSEYF’s members to be active in consultancy-type roles. Our interviews with participants provided clear evidence that the young people were highly motivated and committed to the giving of their own time to ensure the youth voice was heard and represented.

The young people play a pivotal role within NHS England and their knowledge of their home community enabled them to network with professionals and peers within local and national government arenas in order to influence and get involved in decisions about children and young people’s care needs. Evidence from the data collected suggests that the personal growth and development of the young people involved is also likely to have influenced the success of the NHSEYF.

Measuring impact

Our evaluation of the NHSEYF clearly demonstrates the impact of the voice of young people. The Youth Forum Wheel was developed to highlight key areas of importance, as a model that can be applied elsewhere.

It’s important that central and local government measures improvement outcomes for people’s health and/or lifestyles by listening to their views directly rather than focusing on statistics or figures. There is also a recent growing emphasis on services actively involving children, young people and parents and/or carers in the commissioning, development and evaluation of services.

There is a need for ongoing research and funding to ensure that this youth forum model is widely recognised and extended. At the heart of this is recognising the commitment, motivation and enthusiasm shown by these young people in positively influencing service provision for children and young people. As one of our interview subjects concluded:

I think the most key point is showing adults that young people want to have their voices heard … yes the NHS England Youth Forum has done its job because health professionals were coming to speak to us and saying: ‘Oh, how do we engage with people?’

It is about time we listened to the young people who will determine the future health of the country and take their views seriously. The NHS England Youth Forum aims to do just that.


The ConversationYouth Forum members’ names have been changed in line with the ethics requirements of the project.

Lisa Whiting, Principal Lecturer and Professional Lead, Children’s Nursing, University of Hertfordshire; Gary Meager, Lecturer in Children’s Nursing, University of Hertfordshire & Children’s Community Rapid Response Nurse Practitioner, University of Hertfordshire; Julia Petty, Senior Lecturer in Children’s Nursing, University of Hertfordshire, and Sheila Roberts, Senior lecturer, Children’s Nursing, University of Hertfordshire, University of Hertfordshire

This article was originally published on The Conversation. Read the original article.

Guest Blog – Designing Visual Aids for Autistic Children: The NHS and Beyond  

This blog was kindly written for us by Evan Brown, and offers his thoughts on best practice in creating visual aids for autistic children.

For our project, this blog shows the broad variety of meanings which we associate with ‘the NHS’.  The NHS is not only hospitals or GP practices, but also affects teaching, home life, and daily routine.  To research and understand the meaning and contexts of medical diagnoses, historically and today, we must pay attention to this range of spaces, and to the voices of patients and members of the public telling us about their experiences of health and care.  After reading this blog, if you would like to also read more about the history of autism, please do consider the excellent work of Dr Bonnie Evans, who has an open access article on this topic available here.

We welcome all contributions to our blog, as we move towards trying to write an inclusive and dynamic ‘People’s History’ of the NHS.  If you would like to write a blog for us, please do email J.Crane.1@warwick.ac.uk with your idea.  We also welcome thoughts on what you’d like to see on our blog, and about how we can bring historical perspectives in to conversation with contemporary ones, to better understand the NHS over time.

Source: https://www.anatomystuff.co.uk/documentrepository/free-autism-posters

As this amazing poster by NHS describes, an Autism-related meltdown is often passed off as an episode of tantrum by a headstrong child. The lack of awareness on living with an Autistic individual often leads to painful and exasperating results for these children as their lack of ability to communicate their feelings and needs may lead them to become frustrated and repressed. Since the main challenges of ASD lie in exhibiting repetitive behaviors, using language aptly, displaying limited interests, and a challenge in interacting socially, this is where visual supports come in to play to enable teachers, caregivers and parents of Autistic to help them comprehend social cues while interacting with the society in daily activities. Such as this NHS Hospital Passport helps people with learning disabilities to provide essential information about them and their health if they are admitted to hospital or in emergency situations to the healthcare staff.

 

Visual supports for neuro-divergent students, such as mood boards or picture cards, are used outside the NHS, as well as inside it, to help us communicate with children who experience difficulty in understanding or using language. Visual supports can be in the form of objects, lists, photographs, written words, drawings, and lists. Extensive research stands witness that visual supports are one of the most viable ways of communicating with students with developmental disorders. When used for those on the spectrum, visual supports aid teachers in communicating better with their students, while helping the students interconnect with their surroundings.

In addition, Autistic children often fail to comprehend verbal instructions. Even expressing their feelings could be a paramount task for them. By helping teachers and students communicate effectively in the classroom, visual aids ward off problem behaviors that rise from a difficulty in communication, and the exasperation that follows. Visual supports can cultivate positive, appropriate ways to communicate for both the students and their teachers. Not only teachers, but designers designing for Autism must also be aware of these visual aids to help them incorporate design elements for kids on the spectrum.

1.      VISUAL TIMETABLES

(https://www.autism.org.uk/~/media/nas/about-autism/strategies-and-approaches/visual-supports-3-728×440.ashx?la=en-gb)

Visual timetables play a major role in the classroom; they impart tangible information and help alleviate anxiety by adding predictability to the daily routine, which makes it easier for Autistic students to transition between activities as the student can explicitly see beforehand what they are transitioning to. Teachers should try to depict different activities of school days in apt illustrations so that the students have enough time to prepare themselves for the daily schedules. In addition, color coding each day helps to create a pattern in the minds of the students, and separates the activities of each day for them.

2.      DESIGNING FIRST-THEN BOARDS

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A First-Then Board is one of the best visual strategies to help students displaying language or behavioral needs effectively complete specific tasks that they are not inclined to do otherwise. The teacher can begin by displaying two images side by side. The “First” image illustrates an undesirable activity, while the “Then” image promises as reward an activity (a possible reinforcer) the child has a penchant for.  In order to do the second activity, the child must complete the first one. By knowing exactly what is expected of them, Autistic students are prone to less bouts of frustrations and episodes of tantrums. In addition, the child gleans helpful visuals from these cards that they can refer to and associate with the activity even if the word isn’t displayed anymore.

3.      VISUAL POSITIVE REINFORCEMENT SYSTEM

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A Visual Positive Reinforcement System explicitly depicts what a student has to do, as well as their progress so far, to earn positive reinforcement. This strategy is highly successful in refining certain behaviors and inculcating particular skills by allowing access to preferred activities, foods, and toys only after the child has completed the desired feat successfully. For instance, if you want to foster a habit of sharing toys in a student, the right motivation can move mountains. Select (or let them choose) a reward for their efforts using a choice board. Using these cards, explain to the child that they have to earn a certain number of stars before they claim their reward. The visual cards help them keep score of how many more times they have to share toys with their class mates before they would reap their desired rewards.

4.      CLASSROOM BEHAVIOR CARDS

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Another way to support receptive language comprehension and avoid challenging behavior, is to provide understandable, clear expectations for classroom rules. They might be student-specific, aimed for the whole classroom, or even situation-specific. This group of visuals indicate what behavior is deemed appropriate classroom behavior for students. Visual supports like stop signs are used to make students understand when things are off limits, while the “Go” sign is meant to incite them into action.

5.      CONTINGENCY MAPS

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Contingency maps are effective visual supports that depict explicit information about the expectations of behaviors and their consequences. In essence, a contingency map tells the students that if they engage in a particular behavior, they will be rewarded (a positive reinforcer), while if they choose to follow along an alternative behavior track, the consequence for their behavior will be different than before; in most cases, the child would be deprived of the promised reward.

Prior to giving your students a direction, these maps can make these contingencies clearer to aid students in processing the potential consequences of their actions. While a contingency map can be construed as a general proactive strategy, it can also be used as a preventive strategy, since visual supports are leveraged by students for comprehending receptive language. Since most students’ reaction to a challenging situation is to escape altogether, the contingency map helps them see that doing what they are expected to do or following a desired path will reap reward for them.

6.      TAKING TURNS STICK

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Episodes of unappeasable tantrums ensue when children on the Autism spectrum are denied their favorite possession or activity, for instance getting their hands painted on. Therefore, a “taking Turns Stick” can ease them into the process of waiting for their turn, while visually perceiving how long their waiting period is. In order to teach the concept of taking turns to your students in small settings, glue stick figures of the various participants on a spare ice-cream stick, and keep moving the stick figures according to changing turns, so that children can keep track of when they are up next. This simple visual support would ensure a smoother transition, while your student patiently watches how many more kids they would have to contend with before it’s their turn again.

7.      CHOICE CARDS

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Choice boards are one of the most essential visual supports for neurodivergent students. A choice board visually lists down the choices presented to the students at any given time. A choice board can be used to display options for a recess play activity, toys that are available to play with, or snack options for lunch. Offer no more than 3 choices until your students have grasped the mechanics of making their own choices, adding more options as they feel more comfortable with the process. Keep fueling up the complexity of the Choice Boards to include harder choices such as a classmate to partner with in an activity or choosing the color of a marker for a craft activity.

8.      VISUAL PARAMETERS

Setting parameters entails leveraging visuals to establish boundaries around activities or items, and to articulate basic expected behaviors, such as waiting. Setting parameters in this manner helps in communicating limits that may seem unclear to your students even though they are part of an activity. For instance, to communicate the physical limitations of an area, a stop sign can be placed to make children know how far they are allowed to venture in a playground. Visual parameters can also be used to depict how much of an activity or item is available to the students. For instance, by putting up a “not available” sign visual on the computer screen, it can tell the students that it is not the time to play on the computer, or by placing pictures of 10 juice boxes on the carton, and removing an image each time a juice is given out, helps prepare students for the fact that the juice supply is running out. Similarly, a timer coupled with a “wait card” can depict the need to wait for something will be available in a certain time period or is delayed definitely.

9.      EMOTION THERMOMETER

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Since children on the Autism spectrum are not particularly apt at showing feelings, it often poses a challenge for teachers to cater to their needs. Visual supports along the lines of this emotional thermometer above, can be used by students to open up and show their teachers what they are feeling at any given moment; something words fail to do. Try to incorporate as many states and feelings as the child is prone to feeling in the visual display, and help your students associate visuals to their feelings so that they can show you how they feel.

10. KEY PHRASE SYMBOLS

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Teaching these basic symbols to your students, and reinforcing them with the help of visual cards and posters, can make phrasing simple sentences a lot easier for them, and for you to comprehend.

Tips to Make Visual Supports More Effective for Neurodivergent Students

 

Portable

The visual supports can be made portable by:

  • Installing a visual supports app on your student’s tablet
  • putting schedules, pictures, and symbols in a folder for the child to carry around if they are performing an activity alone.
  • storing pictures and photos on a smartphone

Durable

  • Back up any pictures, photos, and apps that the students use on a computer, tablet, or smartphone.
  • Laminate printed visual supports to protect them against damage.

Easy to find

Make sure that visual supports are easily findable by:

  • Attaching them to an actual object
  • Putting up visuals at eye level in prominent places to make them available without hassle
  • Distributing them throughout a particular environment, such as areas and objects in the classroom could be labelled according to the type of visual available
  • putting single symbol cards in your student’s pocket pertaining to a single instruction
  • Attaching symbols to easily assessable boards in school so that your students know where to go find them. Velcro strips can be employed to attach symbols to a board, so that schedules can be easily altered and activities added or removed once completed.
  • Putting a shortcut to visual symbols from a tablet home screen

Personalized

  • Due to the personal nature of visual supports, what works for one person may not work for another. A visual timetable can for instance be in the shape of a rocket to accommodate a student’s special interest. However, some Autistic people find it difficult to generalize, so keep that in mind when designing for the whole class.
  • While it’s best to introduce visual supports gradually, it is often helpful to use more than one type of visual support simultaneously. Start off with basic symbols and introduce complexity in order.

Consistent

  • Once you choose a style or type, especially when using pictures and images, stick to it consistently. Also advice the family members or co-workers to use the same visual supports unswervingly with your students.

 

NHS has offered a treasure trove of guidelines to health care professionals when it comes to ensuring effective communication with patients who have difficulty processing speech. Whilst we can see a plethora of cases where the NHS uses these materials when caring for Neuro-divergent patients, there are also many used outside the hospital or GP surgery, such as in education, where the guiding principles and visual supports offered by NHS can be extended to help teachers. Effective care for Neuro-divergent people and other patient populations will always need these types of resources to be introduced in numerous settings, across the community, as well as in the NHS itself to provide a healthier, more secure environment for these individuals.

Given the indispensability of visual aids when it comes to establishing effective communication with students on the spectrum, teachers should strive to transform verbal communication into visual cues whenever possible to make it easier for students to process and comprehend information, and feel comfortable and safe in their environment.

 

My favourite NHS object – Helen Clifford

The author of this blog, Dr Helen Clifford, is a Museums Consultant for the University of Warwick, and has held curatorial, research, and teaching posts across the UK.  She kindly wrote us this piece to reflect on the memories triggered by looking at the childhood glasses of Jenny Crane, one of our researchers…

Jenny’s pair of pale pink NHS spectacles trigger the opening of a large door into my childhood. I was confirmed to be short-sighted at the age of 3, I remember the test vividly. Too young to be sure of my alphabet the black figures were not of letters but of silhouette animals. I remember the large impressive chair, and all the hard shiny technical equipment.  I was intrigued, but not afraid. I remember the magic of everything coming into focus, as the optician selected the right lenses. 
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We were not very well off, and the spectacles prescribed had to be NHS, there was absolutely no other choice – and just one style. As I am much older than Jenny, (the test would have taken place in the early 1960s)- the only spectacles you could have were metal with springy ear pieces and the frames were covered in an opaque pink plastic (were they blue for boys? I don’t think so). I was quite pleased with these, until I went to school with them on.  Suddenly I was marked out, there did not seem to be anyone else in my class wearing spectacles. The name-calling was merciless, ‘Specky Four Eyes’. It was the first time I was really upset at school. I came home in tears and my mother, ever resourceful, but misguided, decided that the problem with them was their ‘medical’ association. So she set to, and made tiny coloured felt flowers with leaves and stitched them on to the frames. They were lovely, but of course a disaster. This was really a turning point in my life. First I wore them to school, hoping no-one would see me, and then took them off as soon as I arrived, exacerbating my short -sight. I did not want to upset my mother, but I just knew what the reception in class would be. In the end I decided that actually it might be good to be different, and wore them stoically, amidst a barrage of laughter and taunts. But I stuck with them, and in the end I was accepted. It was a lesson well learnt, and the principle of this rite-of-passage has stood with me all my life.  
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The felt flowers did not last long, and I soon got used to the unadorned version. When I got to the age of 13 I was allowed my first pair of non-NHS spectacles, after saving up for them. This was another momentous life-occasion, and another step towards adulthood and the world of larger choice. Forty years on, I found it extraordinary that people wanted to wear vintage NHS spectacles – what is the secret of their attraction? Do they conjure up a lost world? Writing this blog has raised other questions – why are NHS things light pink? Is their flesh-like colour designed to make them unobtrusive, although in reality it marks them out.?The ‘retro’ versions today you will note, are stripped of their pink plastic, and look smart in shiny metal, neutralised perhaps of their origins? The tale of these spectacles symbolises an earlier time of fewer choices, less indulgent attitudes to childhood and fashion, and the attraction and repulsion of the opposing forces of conformity and individuality. One could say that the NHS and the spectacles prescribed were pivotal to the formation of my character. I wonder if this is just a very personal story or one that resonates with others? I would be interested to know!

Nurse training over time – a guest blog by John Beales

This is a guest blog kindly written for us by John Beales.  John is a former nurse, and worked in the NHS from 1983 until 2000.  He is now undertaking a Masters degree in History at the University of Bristol.

These two records of the presentation of certificates for the completion of nurse training and badges awarded upon qualification in 1961 and 1987 are separated by more than just time; they subtly reveal the changing nature of nurse training. At the Royal Northern Hospital in London, where my mother trained as a State Registered Nurse, in order to receive a certificate of training and the coveted hospital badge you had to complete a fourth year of ‘training’ by working as a staff nurse at the hospital for a year after qualifying.  The Chief Physician, Chief Surgeon, Hospital Chairman and the Matron signed her certificate of training.  When I qualified as a Registered General Nurse at University College Hospital in London in 1987 you received a hospital badge when you completed the 3 year training, and my certificate was signed by the Director of Nurse Education and the Chief Nurse Advisor; nursing having freed itself from the dominance of Medicine and having established specialist nurse tutor roles.  The signs of the changes are there in the absence of the Matron as the exemplar of authority within nurse training and their replacement with a Director of Nurse Education.  The differences are also there on the covers of the presentation booklets, the ‘University College Hospital School of Nursing’ being dually identified as the ‘Bloomsbury College of Nurse Education.’

But in reality the focus was still on training rather than education. Whilst changes in the role of nurses, the availability of sterile supplies, changes in service provision and technology meant that I did not have to cook patient’s breakfasts, perform the regular ward and theatre cleaning and manual cleaning and sterilising of equipment that were a feature of my mother’s training, my own training was still predominantly practical, focusing on ‘hands-on’ care and skills acquisition: blocks of shift-based clinical placements lasting roughly 8 weeks being interspersed with weeks of classroom teaching. As a student nurse you were part of the workforce, rather than being supernumerary, and I recall plenty of instances where students were left in charge of wards or other clinical areas, this being part of your ‘management training’, as well as a result of expediency if there were instances of staff sickness or errors in shift rota planning. However, my mother and I both recall that our training gave us realistic expectations of the nature and variety of nursing practice and fostered both an esprit de corp and an allegiance to our training hospital: the award, and wearing, of your training hospital badge when you qualified being something to be proud of.

 

 

Nursing degrees were rare when I qualified and the practice-based nature of nurse training meant that most courses lacked wider academic recognition. Change was inevitable due to both the need to ensure that nurses were prepared for the rapid pace of developments in care delivery and the desire for recognition as a profession. Project 2000, introduced in the 1990s, began the move from hospital to university based nurse education. Many commentators have gone on to bemoan this change, blaming it for a perceived loss of ‘compassion’ in nursing and the fostering of unrealistic career expectations. I think that both of these have been overstated. But, an area that seems to have been overlooked is the way in which hospital based training, and the award of your training hospital badge when you qualified fostered a sense of belonging amongst nurses in the NHS, and how that has been diminished since the move to University based education; clinical placements now normally taking place at a variety of different hospitals. In the absence of the award of qualification badges by universities, and a move away from the wearing of them due to concerns about infection control and patient safety, the most common place you find these badges now is on online auction sites. Now retired after a 48 year long career in the NHS my mother still has her training hospital badge. I left the NHS in 2000. Last year I sold mine on e-bay.

My favourite NHS object – April Stephenson

This blog post was kindly written for us by April Stephenson, who works at the People’s History Museum in Manchester.

This poster was produced as part of the Labour Party’s 1951 general election campaign. The election was unusual in the fact that it was called by the Labour Party, a year into Clement Attlee’s term as Prime Minister in a bid to increase the Labour parliamentary majority. Rather than achieving this, it resulted in the return of Winston Churchill and a Conservative win. Labour did however win the popular vote with 48.8%. The NHS had been formed in 1948 and formed a key part of the Labour campaign, and the Conservative campaign chose not to propose any alterations.

This poster shows that the NHS has been involved in election campaigns from its foundation. In 1951 the NHS stood as an emblem for post-war values, a clear incentive to vote. The NHS continues to feature heavily in political campaigns – often resulting in debate – from the ‘battle of Jennifer’s ear’ fiasco in the 1992 General Election, to the Brexit buses of 2016. This poster represents the Labour Party’s active role in the NHS’s past, and as such has been re-used since 1951 by the party as a symbol of their commitment. The poster can still be purchased from the party to this day, and in 2015 was produced as a tea towel during the party’s election campaign.

The simple eye-catching design now hits a nostalgic note which ensures its continued popularity, whilst remaining relevant to the political situation today. The NHS remains a heavily contested point within political policy, which affects everyone it covers.

This blog will be the first in a new series, ‘My favourite NHS object’,  where anyone and everyone is invited to tell us what their favourite object is in our Virtual Museum of the NHS, and why.  Using these answers, and feedback from our public events and surveys, we will be redesigning our Museum, creating a new catalogue and adding content.  To help with this, please email Jenny Crane, at J.Crane.1@warwick.ac.uk.  Any and all contributions are very welcome!  What are we missing, what should we change?

Hospital Art – guest blog from textile artist Ruth Singer

We are always interested in hospital art, graffiti, poetry, and culture.  This month, our researcher Natalie Jones, who is also a visual artist, went to Malta to speak at a conference about Beauty and the Hospital in History.  We are also currently building our programme for 2018, the 70th Anniversary of the NHS, which we hope will feature art work.

To start thinking about this, we’ve been looking at previous art projects commissioned to celebrate and document the NHS.  Here, we have a lovely blog from Ruth Singer, telling us about a recent project in this area.  We love how the art work uses personal stories from patients and local community members, as well as archival materials, to create such a beautiful document about the changing history of a local hospital:

To celebrate the centenary of Harefield Hospital, Royal Brompton & Harefield Hospitals Charity commissioned textile artist Ruth Singer to work with patients and the local community to create a commemorative quilt.   This project was par t of a 12 month project which, with the support of a Heritage Lottery Fund grant, aimed to re-tell the history of the hospital from a patient, staff and local community perspective.

A quilt was chosen as their major centenary arts project as a reflection on a 1917 Red Cross quilt made locally as a fundraiser to support the war effort during World War One. This new commission takes its inspiration from the heritage quilt but has been created in a mix of contemporary and traditional techniques. The interlinking honeycomb-like structure of hexagonal patchwork echoes the complex ecosystem of the hospital where each member of staff is vital to making the system work.

Over summer 2015 Ruth worked with staff, patients and local communities to create the quilt which is made from over 400 individual pieces. Archive images from Royal London Hospital Archives & Museum, personal testimony and hospital records have been combined with old nurses’ uniforms to create a subtle colour palette and a complex design filled with intriguing details. The pieces used in the quilt were made during a series of workshops at the hospital, starting with screen printing and natural dye to create patterned fabrics to use. We used plants from the hospital grounds to colour the cloth and images from the buildings and archives as screen prints and digital prints. Other workshops included hand sewing and embroidery to embellish the quilt.

Written quotes include oral history testimony from staff and patients, as well as comments from the hospital’s Facebook pages. Regular contributors have hand stitched their names onto patches and some contributors gave photographs of family members or documents which refer to their relationship to Harefield Hospital and to social activities related to the hospital. Hand stitched outlines of leaves refer to the wards named after trees growing in the grounds. We have also included details of the red and white ANZAC quilt and photographs of the ANZAC cemetery at Harefield Church.

Ruth says:

“Working with Harefield’s people, buildings and archives has been an inspiring process. It has been an honour to include many personal stories as well as to celebrate the achievements of 100 years of dedicated care and research. This was a dream commission for me and it is great to know that it will be on show in the hospital for many years, giving patients and visitors the chance to reflect and think about the many lives Harefield Hospital has touched in a hundred years.”

Karen Taylor, Arts Manager, Royal Brompton and Harefield Arts.

“With the support of the HLF we have been able to tell stories of patients, staff and local community to record the hospital’s rich heritage – from its origins as a war hospital to its current role as a leading heart and lung specialist – for the very first time.  Ruth’s quilt captures this history in a beautiful textile artwork which we are proud to display.”

Artist Ruth Singer &  Photographer Joanne Withers.

Food for Thought…

Over at the Lothian Health Services Archive, Louise has been looking at just what was on the menu for patients in the Royal Infirmary of Edinburgh over time … :

The archive has much evidence of how patients were fed at the Royal Infirmary of Edinburgh (RIE), a national leader in the science and practice of dietetics.

 
Badge from the RIE School of Dietetics, c. 1930s (LHSA object collection, O225)

The first Dietetic Department in the whole of the United Kingdom opened in the RIE in 1924. Thanks to the Department, by the dawn of the NHS in 1948, patient diets in the hospital had moved on considerably since its foundation in the eighteenth century, when principle foodstuffs were oatmeal, barley, milk and baps. In 1920, the RIE Board of Management appointed a special committee to consider diet in the hospital, recommending the appointment of a dietician with general responsibility for patient diets. As a result, Sister Ruth Pybus became the Senior Dietician in the new department. Dietetics was a growing strand of science around the world, and this infant department reflected this new interest in the chemistry of patients’ food. It also roughly co-incided with the first use of insulin to treat diabetes (in Canada in 1922), which was prescribed along with special diets in an attempt to keep the disease in check.

 
A diet leaflet for diabetics produced by Lothian Health Board, 1980s (LHB1/89/5/5)

In 1925, Pybus won a Rockefeller Foundation grant to observe kitchens in the United States – the Rockefeller Foundation also funded the building of the Infirmary’s metabolic unit with a diet kitchen.

 
RIE diet kitchen, c. 1950s (P/PL1/S/395)

Some of the diets prescribed by the kitchen would turn modern stomachs – the ‘spleen diet’ for example, involved serving pulp scraped from the fibrous part of the spleen, tossed in oatmeal and fried! Great care was taken with meal plans for diabetics, with fats and carbohydrates strictly calculated. This kitchen soon reached beyond the specialist wards attached to it, supplying food across the hospital – and continued to do so until a larger kitchen was eventually opened in 1966.

 
Nurses in the RIE diet kitchen, 1960s (LHB1/89/6/1)

In 1934, the first School of Dietetics was opened in the Infirmary, offering specialist training in clinical diets for the first time in the United Kingdom. The School offered a Diploma, open to State Registered Nurses, students with domestic science qualifications or with a BSc. in Household and Social Science. From our syllabuses and prospectuses, we know that the course consisted of lectures and practical elements, covering cookery, biochemistry and chemistry, ward work, anatomy, patient observation, medicine, physiology, dietetics and bacteriology. Students were also tested on social and environmental aspects of nutrition, including the impact of poverty on health. The School operated until the 1950s – perhaps a victim of its own success, since dietetics was by then routinely included in nurse training.

 
Prospectuses from the School of Dietetics, 1930s (LHB1/89/3/2)

Some of the most popular material that our archive users ask for from the Dietetic Department is undoubtedly evidence of special diets. We have a quite a number of recipes from the 1950s for savoury dishes:

 
A diet sheet, 1950s (LHB1/89/4/1)

Even the making of drinks had strict rules attached:

 
The first rule of beef tea club is…. (LHB1/89/4/1)

The kitchens also shared their expertise beyond their own dietetic wards. There were diets formulated for expectant and new mothers in the Infirmary’s maternity section, for example:

 
Diet formulated for use in the Simpson Memorial Maternity Pavilion (LHB1/89/4/2)

Some of the sources in the collection reflect attitudes to food education at home, including A 1946 leaflet used in the Department, produced by the Ministry of Food.  An American influence (probably since dieticians from the Infirmary were awarded scholarships to research in the States) is also represented in the information collected by the Department. A particular “favourite” (please note inverted commas) of mine is this small booklet on weight control for women:

 
An ‘introduction to slenderness’ from across the Atlantic, 1950s (LHB1/89/5/1)

But my highlights from the Dietetic Department archive tell us about recommended food for older members of the community, shared outside hospital walls for the benefit of everyone. This 1956 edition of Old People’s Welfare Scottish Bulletin reprints a diet table for the elderly from the Infirmary:

 
Royal Infirmary of Edinburgh diet table for the elderly, and cover of Old People’s Welfare Scottish Bulletin, 1956 (LHB1/89/7/6)

Whilst the People’s Journal in the same year published Infirmary diets given to the Edinburgh and Leith Old People’s Welfare Council, with recommendations for those with or without an oven… and with or without teeth!

 
Infirmary diet tables reprinted in People’s Journal, 1956 (LHB1/89/7/11)

If you’d like to know more about diet in the Royal Infirmary, you can search our collections (for LHB1/89) online here or here.

The People’s History of the NHS team have also been taking a look at hospital food recently – including the cultural significance of tea!  Our team are co-organising an event with Warwick’s Prison Health team, about Diet and Nutrition in Institutions of Care, on 21st April.  If you’d like to know more, or to apply for a space, please email J.Crane.1@warwick.ac.uk and M.Charleroy@warwick.ac.uk)

Women and Mental Health

This is a guest blog kindly provided by Samar Ziadat, of the Lothian Health Services Archive.  In the blog, she describes the holdings of the ‘Women’s Health collection’ in the archives…

The material I was most interested in was to do with an Edinburgh-based organisation called ‘Head On’. It was founded in the 1980s by feminist women who were interested in tackling issues surrounding women and mental health. The holding we have for Head On consists of documents such as meeting minutes, correspondence between the women, planning notes and lists, newspaper clippings, copies of medical articles and journals, and leaflets and booklets made by the women in the organisation.

 
Head On committee members as pictured in a clipping from the Edinburgh Evening News, May 25th 1983

Head On’s constitution, which was drafted in 1984, states that the organisation’s objectives were to “set up projects and programmes designed to help women become more aware of their own mental health”, “to educate and inform the public, social services, the media and others with respect to women and mental health”, “to act as a liaison between, and support of, those working in the field of women and mental health” and “to cooperate in appropriate research”. The constitution also highlighted that membership is “open to all persons who are sympathetic to the association’s objectives”. A line found in Head On’s meeting minutes from June 2nd 1983 expresses that Head On“can mean different things for us all but at the heart it stands for our individual shared experience which enables us to reach out across differences to others and to feel better about ourselves”.

The work that Head On carried out in the 80s is still relevant and urgent today. According to AuditScotland, more than twice as many women are consulting GPs for depression and anxiety as compared to men, with those living in the most deprived areas having lower overall mental well-being and more GP consultations for depression and anxiety than those living in the least deprived areas. This echoes the sentiments expressed by the women at Head On, who asserted that “if you are a woman you are more likely to experience depression, have tranquilisers prescribed, or be admitted to a psychiatric hospital than if you are a man”.

 

 
A Head On booklet which was distributed at their health fairs (GD31/14/2)

The organisation’s earliest projects consisted of two health events, one being a ‘Women and Health Day’ which was held at Edinburgh’s still-existing Workers’ Education Association in 1982, and a ‘Women’s Health Fair’ at St. Cuthbert’s Hall which took place in 1983. These events were primarily targeted at women, but attracted and welcomed people of all genders, including their children. Talks and workshops on women’s mental health were held at these events, and literature written by the group was distributed.

In order to raise funds for their events, Head On organised parties such as the ‘GLITTER GALS DISCO’, which took place at Edinburgh nightclub Buster Brown’s, and charged a £1 entrance fee. Head On’s health fairs and fundraisers were planned through monthly meetings which were open to the public. A mailing list was also created which distributed information, meeting summaries and newsletters to members. During their meetings, the women of Head On delegated tasks to one another, discussed venue hire, drafted applications for funding, presented educational literature and illustrations which they had created to be sold at their events, distributed copies of medical reports and journals concerning women’s health, and most importantly, shared their personal experiences with one another.

 

 
Women sharing experiences at a Head On workshop in 1988

Below are some examples of the experiences that women shared at Head On’s meetings:

“We felt we were constantly under pressure to be good at everything, women must be the carers and the experts… there are expectations and assumptions that women will care. We are now seen as a resource by the state. Daughters take over the care of elderly parents, very seldom sons. Society expects women’s natures to be soft, nurturing, emotional, and mothering… Women give emotion but how do they receive it back?”November 9th 1982

“It is considered a virtue to keep the home spotless. The pressure and the expectations are there all the time. Women should do this and is considered failing if she cannot. Here enters conflict. Her identity depends on doing the job well. She feels she should be at home, but would often rather be doing something else. Many times she feels unfulfilled. She feels unrecognised and underpaid.”November 18th 1982

The meeting notes which I found most poignant were from January 6th 1983. When the committee asked the women at the meeting what wanted out of life they replied with, “I want peace to be myself”, “I want total economic freedom”, “I want strength to be me”, and “I want to have personal confidence”. When exploring solutions to these wants and desires, some women expressed that “I need enough physical and mental strength to be independent” and “I need to assert myself”. My favourite solution came from a woman who suggested listening to Diana Ross’ “I want muscles” or Joan Armatrading’s “I am a woman”.

 

 
Head On meeting notes January 6th 1983 (GD31/10/2/1)

The success of Head On’s health fairs lead to a request from the BBC asking to distribute some of Head On’s booklets for free. The booklets were originally written for the Scottish Health Education Group, and with this new request, the booklets were to tie in with a BBC radio and television series, Well Woman, which was about women’s health. However, due to government censorship, the BBC asked Head On to re-write the content of their booklets 36 hours before they were to be printed. Government officials felt that the booklets, which explained how the female body works and dealt with topics such as menstruation and contraception, were “overly concerned with sexuality”. This caused national outrage, landing Head On media coverage from outlets such as The Scotsman and the Guardian. Public opinion in favour of the uncensored booklets guaranteed that the uncensored version of the booklets were to be made available during the rerun of the BBC show the following year.

 

 
The controversial booklets created by Head On titled ‘Women and Depression, ‘Women and Anxiety’, ‘Women and Food’, ‘Women and Pills’, ‘Women and Sexuality’ and ‘Women and Smoking’ (GD31/14/1)

The attention that Head On garnered as a result of the booklet controversy allowed them to open a fully funded women’s centre.  The centre, which they named The Women’s Health Shop, functioned as an information service on issues that affect women’s mental health. The shop put on displays, held talks and workshops, produced feminist literature of women’s health, and became a meeting place for women to talk to women about women’s issues. Some of the talks and workshops held at the Shop had to do with the ways that menopause, benefits cuts, breast and cervical cancer, pregnancy and motherhood, and nutrition and stress affect women’s mental health. The shop also facilitated for self-help groups to meet, providing a space to share experiences of depression and anxiety with other women over coffee. Additionally, women were invited to view the Shop’s monthly displays, which advised how to eat healthy on a low budget, how to make their needs known to their doctors, and how to conduct self-examinations for breast cancer. A female nurse was also available to lend a sympathetic ear for any health worries or anxieties that the women wanted to discuss – this was especially important because many women didn’t feel that their mental health issues were important enough to discuss with their doctors who were largely male. A range of books and resources on women’s health were also made available for loan at the shop.

Although Head On and their Shop are no longer in action, there are plenty of resources on mental health available online at The Health Foundation, Mind, Timeto Change and Rethink. If you or someone close to you is struggling with mental health issues, please get in contact with your GP.

70 years of Autism, and what’s changed?

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Guest blog kindly provided by Yvonne Newbold; a writer, speaker and trainer who is also the mother to three children, including Toby who is multiply disabled with profound learning disabilities.  Get in touch with Yvonne @YvonneNewbold, or see her website here.

 

 

When my mother left Dublin in 1946, just before her 18th birthday, to come to England to start her nursing training, the word “Autism” had only just been invented. Last week, 70 years later, I was delighted and honoured to be returning to Dublin to speak at the AsIAm National Autism Conference. How the world has changed in the intervening years – my mother would be thrilled to see how Dublin is now perceived – vibrant, cultured, creative, fashionable and edgy. In those days, as a teenager, she had to be home before dark with no excuses. In Dublin back then, everybody’s Mam would tell your Mam what you’d been up to, and woe-betide her if she was ever caught talking to boys.

Dublin Castle
Dublin Castle

My childhood was rich with tales of her Dublin youth, as well as stories of her nursing years, when she looked after children at a long-stay Surrey hospital miles away from their Inner London homes. The NHS was being set up, antibiotics were brand new and rarely used, and children died from conditions we now understand and can manage and treat with excellent quality of life outcomes. Back then, there were long-stay wards for children with both Coeliac Disease and TB, both terminal conditions for many children in those days. The children would die slow and prolonged deaths, with absolutely no hope whatsoever.  How much progress we have made in medicine too.

She also nursed children with autism, although of course they weren’t called that then. They were in the section of the hospital for mental retardation, the lunatic children, the ones, again, with no hope way back then.  So how much progress have we made in with Autism in the past 70 years?

Yvonne Newbold AsIAm Autism Conference

In some ways, we have come a long way, but in other ways we have stood still for far too long. At least we all know the word “Autism” and children with the condition are more easily identified and recognised. We have a better understanding of how therapeutic intervention can help children with Autism to achieve a much better quality of life too. We also understand much more about how ASD children relate to the world differently, and therefore learn in different ways. Our knowledge of autism educational strategies is increasing all the time, and it should be a really exciting time in the history of autism – it is now within our grasp to offer every child the therapeutic and educational experiences that will offer each of them the very best chance to reach their own potential.

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However, it’s just not happening. Not here in the UK, not in Dublin or anywhere else in Ireland, nor anywhere else in the World as far as I can see. We have the tools, we have the wisdom, we have the know-how, we have the research and we have the experience, yet our children are being denied access to their best chances of a meaningful future.

Yes, there are pockets of excellence, yes there are some children who are making great progress, but it’s not universal in the same way that it is for children diagnosed with other conditions. It is simply wonderful, and beyond my Mother’s wildest dreams as a young nurse, that every single child with a diagnosis of TB or Coeliac Disease will get the very best, up-to-date, evidence-based treatments and therapies on offer. It is fantastic that antibiotics have prevented deaths in hundreds of thousands of young children over the past seven decades. Infant mortality rates have also thankfully plummeted, and life expectancy is better than ever.

Unless you’re autistic.

I don’t have the Irish statistics, but in England, if you have autism, you are likely to die sixteen years earlier than the general population. Around 70% of people with autism also have a learning disability – and the England statistics have found that 3 people with a learning disability die a completely preventable death in hospital every single day.

Children with autism at school don’t always get the appropriate help, support and understanding. More and more children with Autism are being shoe-horned into ordinary mainstream schools where the teaching staff have no specialist training in the symptoms of autism and how to adapt the curriculum to appropriately meet their needs. Some schools are excellent, some teachers are fantastic, and some children are doing incredibly well. But many are not, and it’s just not good enough.

More and more parents are watching helpless as their children’s emotional well-being deteriorates and their self-esteem hits rock-bottom. Bullying is commonplace, self-harm and suicide attempts among ASD schoolchildren are on the rise.

Officially, national policy no longer locks up people with autism in long-stay institutions anymore. Yet hundreds of families are effectively imprisoned behind the closed doors of their own homes because of Government Policy. All because families are being denied the essential appropriate support, intervention and training in how to help their ASD children to develop and thrive in a non-autistic world. Their children exist in a state of heart-breaking distress with all the symptoms of the challenging behaviour that distress causes.

It would be unthinkable for any modern democratically elected Government to withhold treatment or therapies from a child with a physical long-term condition, so why are children with neurological differences not given equal access to the interventions that might help as a matter of course?

They’ll tell you it’s too expensive. That doesn’t wash with me. It will cost far more over the course of these children’s lifetimes to put right the wrongs that are being done in childhood.

Intervening now with the skills that an Occupational Therapist or a Speech and Language Therapist can help a child to acquire can make the difference between an adult life of independence or one spent in a care home with round the clock support workers.

Intervening now with behavioural support can make the difference between a child being able to look forward to a productive working life, or an existence locked away in their bedroom, frightened of the outside world. Intervening now with meaningful educational strategies can make the difference between a teenager who is attempting suicide because they feel so worthless, or one who is preparing to go to university.

Instead, society abdicates its responsibility, and their families carry the can.

This isn’t just the Government’s problem. It’s not solely the responsibility of the relevant Health or Education departments either. This is everyone’s responsibility. Why? Because over the past 70 years we still haven’t come far enough in changing attitudes, cultural norms, assumptions and prejudice. The bottom line is that people with autism, learning disabilities, neurological differences or any other form of disability are regarded as second class citizens by the general population. We have awareness campaigns, but they aren’t enough. We have legislative changes, but nothing changes quickly enough.

If it were people with green eyes who were dying needlessly at the rate of three a day in publicly funded hospitals, there would be outrage. If children who had brown hair were expected to attend schools where the teachers didn’t understand how to teach them, and they were made to feel so hopeless that they spent their teenage years self-harming, something urgent would be done to make things better.

People with autism are not valued, and their lives don’t matter. That is the message that is coming loud and clear from society, and until that changes, nothing else will. It starts with you and it starts with me. We can sit and wait until “somebody does something” but we are that somebody. If you don’t know about autism, find out more. There is plenty of great information online and plenty of great videos on YouTube.

As Dan Wilkins said, “Any community that excludes even one of its members is no community at all”.

My mother would have had a lot to say too. She cared deeply about people, she hated injustice or any form of prejudice, and she adored those long ago children she once cared for. Yes, even the ones who couldn’t speak, who sat and rocked all day, and who lashed out at anyone who came close. She told me so much about those strange and unhappy children, and she was puzzled and perplexed by what she might have been able to do to connect with them in some way. She never knew what it was called, but she was an Autism Advocate well before her time.

70 years of autism Mum

Mum passed away in 1979, and going back to Dublin after so long was emotional, poignant and moving, particularly now that I, too, am terminally ill. She would be bursting with pride that I spoke at Dublin Castle.

We had a wonderful day at the Conference, a day of insightful conversations with like-minded people who also want everyone with Autism to be able to live full and meaningful, productive lives. How do we harness that message and use our collective energies to make the difference that has to happen?

Asiam National Autism Conference Programme

One of the biggest barriers to equality that people with autism face is other people’s lack of knowledge and understanding. When people don’t know or understand why someone may be behaving differently, they can become fearful or judgemental, and that makes gaining acceptance almost impossible. That’s why it’s so important to keep the conversations going that we started in Dublin Castle last week, it’s conversations like this that can help to shift public perceptions and attitudes.

We can continue these conversations everywhere – in our communities, our schools, our hospitals, our workplaces and with family and friends, and have them online too. What can you tell someone this week that might help to make a difference to how they think about autism? Sharing this post or others like it might be a good way to start. Change can start with just one person doing one small gesture or expressing one idea. It can start with one act of kindness towards a person with autism and their family. It has to start somewhere, and from someone, you, me, all of us together. We can do this. Can you help?

A Cultural History of Organ Donation Week 2016

The funniest joke at the Edinburgh Fringe festival this year, as chosen by a panel of critics for Dave TV channel, was, ‘My dad suggested I register for a donor card, he’s a man after my own heart’ (told by Masai Graham). This week, from 5th–11th September, is Organ Donation Week, an annual drive organised by NHS Blood and Transplant to promote the lifesaving potential of organ donation.  Whilst the jokes of the Fringe and the NHS’s campaigns may not initially appear to have much in common, cultural representations –in comedy, novels, newspapers, and television – have played an important role in reflecting and shaping public debates around the medical, moral, legal and personal implications of organ donation.

Organ donation has a long history.  Whilst there are accounts of skin transplantation dating back as early as the second century, transplants of other organs were not documented until the early twentieth century, alongside improvements in blood transfusions.  Through time, and particularly from the 1940s, surgeons developed their understanding of why certain organs were rejected, and developed immunosuppressive drugs to prevent this.  The NHS’s website writes that the organisation has been ‘at the forefront’ of transplant technology since its own inception in 1948, with the first NHS kidney transplant in 1960, and the first NHS heart and liver transplants in 1968.  The NHS established its first organ donor card, initially just for kidneys, in 1971, and the national organ donor database was created in 1994.  In 2016, we continue to see medical innovation in transplant surgery (for example as surgeons transplant organs between donors and recipients who are HIV-positive).  We also see controversial cases of medical waste, with donor organs in America sometimes thrown away due to an inefficient donor matching system, or weekend under-staffing.

As organ donation becOrgan donorame more common from the 1980s and 1990s, newspapers and factual television programmes paid attention.  In 1985, the BBC consumer programme That’s Life!, presented by Esther Rantzen, appealed for a donor liver for the sick child Benjamin Hardwick.  A liver was donated, and Ben became the youngest liver transplant patient.  The programme also raised £150,000 from viewers and, contemporary newspapers speculated, contributed to a cultural shift empowering parents and clinicians to discuss paediatric organ transplantation.  Echoing this line of thought, in 2014 Matthew Whittaker, who received a liver transplant in 1984 aged 10, told the Daily Mail that ‘I’m 41, but my liver is just turning 30. . . and it’s all thanks to Esther’.

The close relationship between media and medicine was criticised at the time in the Guardian, arguing that journalists had become ‘recruitment officials for organ donors’, and should return to their role as ‘devil’s advocate[s]’, analysing medical research findings and government health policy.  Some newspaper coverage did operate in this critical manner, however, for example investigative journalism exposing an organ trade between Britain and less affluent nations in the 1980s and 1990s.  In one distributing example of this practice, in 1994 The Sunday Times reported that people from Bombay and Madras were selling their organs to British patients for as little as £200, making the ‘middlemen’ organising these deals up to £12,000 per operation.

Films, novels, and television programmes have also invited the public to think about the ethical, legal and personal implications of organ donation.  The film Return to Me (2000) raises issues about identity, emotion, and transplantation, as a man falls in love with a woman who received the heart of his deceased wife.  Similar debates were raised by media coverage around Jeni Stephien in August 2016, who was walked down the aisle by a man who had had her father’s heart transplanted years before, and told assembled media that, ‘It was just like having my dad here, and better’.  Debates about informed consent, and emotional repercussions for donors’ relatives, were also played out in the Mills & Boon novel On Wings of Love (2013), where a transplant nurse falls in love with a grieving widower.  In the American film John Q (2002), a desperate man with inadequate health insurance holds clinicians hostage in a hospital, forcing them to give his son a heart transplant.  This raises questions about the responsibilities of the state in relation to organ transplantation – also discussed in Britain in relation to immuno-suppressive drugs, which recipients of organ transplants currently pay for themselves.

These fictional representations likely invited reflection amongst viewers.  Television producers have also explicitly sought to engender such debate.  In 2005, a Casualty/Holby City crossover special asked viewers to vote to determine the outcome of an organ donation-related storyline.  98,800 viewers called, with 65 per cent voting that a heart donation should be received by Lucy, a young cystic fibrosis patient, over Tony, an older widower.  Demonstrating an entwinement between fact and fiction, the programme also featured an informative section presented by Robert Winston explaining the guidelines governing organ donation.

Cultural representations of transplants can encourage us to think through our positions in relation to organ donation, and to discuss these with friends and family.  A study of 1993 also found that when transplants were featured in newspapers and on television, this made it easier for intensive care professionals to raise the subject of organ donation with grieving relatives.  Cultural representations of transplants can also have a negative effect on discussion, however.  In 2013 the NHS Blood and Transplant group criticised the portrayal of organ donation in an episode of Holby City as ‘inexcusable and reckless’, for representing clinicians treating grieving relatives with ‘callous disregard’.  Demonstrating the real effect of television, the Blood and Transplant group also stated they had been contacted by many people who wanted to be removed from the Organ Donor Register, as a direct result of this programme.

Newspaper articles, television programmes, even junky American films and Mills & Boon books, have all shaped how and when we think and speak about organ donation, by framing and highlighting issues such as consent, emotion, and bodily autonomy in particular ways.  Please do let us know if you see any examples of this sort of thing during Organ Donation Week and beyond.

Our First NHS Roadshow!

One of our key public events is the ‘NHS Roadshow’.  This is loosely based on the Antiques Roadshow, and we ask members of the public to bring along their personal items relating to the NHS – baby tags, glasses, campaign badges, prescription forms, old Lloyd George insurance cards. . .  We also hope to use these events as an opportunity to meet with as many people as possible, to hear their stories, and to incorporate them in to our research.  We have a Roadshow planned next month at the People’s History Museum in Manchester, and also are planning Roadshows for next year at Rugby Hospital and at St Fagan’s Museum, in Wales.

Last week, we had our first official Roadshow, in the wonderful Thackray Medical Museum in Leeds.  Attending were three members of our team  – Jenny and Natalie, from the Engagement team, and Jack, one of our Research Fellows.  Many things went very well indeed.  Despite it being a delightfully sunny day outside, our stall was visited by approximately 40 to 50 people.  We shared detailed and fascinating conversations with many of these, hearing about people’s experiences of the NHS over time.  We heard from former patients, who felt that their lives had been saved by the diagnostic or surgical prowess of the NHS; and former staff who remembered, fondly, their times working at specific hospitals.  These are the kinds of stories which we see emerging at the moment through campaign groups, hoping to use the power of individual stories to protect the NHS from change or cuts.  This stories are often disseminated through social media, for example on the @NHSMillion twitter account.

Perhaps because we met with people face-to-face, we were also able to access more complex and nuanced perceptions of the NHS, and its perceived limitations, as well as its benefits.  We heard for example from patients who were angry about the ‘postcode lottery’, whereby their siblings living in different districts were able to access more extensive NHS services.  These recollections challenged the idea of a singular, ‘National’, health service, as did patients who had lobbied hard to ensure that they were referred to certain hospitals, and not to others, because of their reputations, or stories given by friends and families.  One former member of staff, just retired, laughed bitterly when asked, ‘Would you like to contribute to our People’s History of the NHS?’, before offering fascinating and honest recollections about her mixed experiences on the wards.

In what is becoming a recurring theme in our public events, several former patients and members of staff complained about changes made to nurses’ uniforms, from formal to casual (indeed labelled ‘pyjama style’ by one visitor).  Whilst some disliked the loss of ‘Matron’ and the formal nursing appearance, others recognised the need for staff to feel comfortable, tie-ing this to an increase in ‘target culture’ and workload.  We heard from one American citizen who pitied the NHS, feeling that ‘socialised medicine’ was inevitably more inefficient; but also from another who envied the British system of healthcare, speaking of the £800 a month which she spent on her family’s medical insurance.

Some of the conversations which we had helped us to rethink our research priorities and findings so far – thus embedding public feedback in our project from its inception.  Personally, my research is looking at the mobilisation of campaign groups around the NHS over time.  Speaking with people from Leeds has brought new groups to my attention – for example Leeds Hospital Alert – which again reiterated the significance of individual localities in public perceptions of NHS care.  At the same time, many people who I spoke with had not heard of even the largest campaign groups operating today, such as Keep Our NHS Public, and were not especially motivated to learn more about them.  This is not reason to jettison my research (hopefully?), but it is a useful reminder that, when lost in an individual organisation’s archives, it is easy to buy into institutional narratives, and to forget or over-estimate the broader social and cultural perceptions of this group.  Campaign groups may hold very different meanings for their membership than they do for broader publics.

People’s memories and recollections are clearly important for writing a People’s History of the NHS.  This leaves us nonetheless with important questions about how we can best use public events to access these experiences, and about how we should store and analyse people’s narratives to track change across regions and time.  At the moment, we are trialing multiple approaches.  We hoped that people may bring objects to our Roadshows.  This has not yet been the case.  Nonetheless, by having our own objects there – at the Thackray including a false eye, false teeth, and my own NHS baby glasses – we sparked reminiscences from the public.  We must now think carefully about which objects to bring, because their selection inevitably opens up, and thus perhaps closes down, particular narratives.  Should we bring objects which relate to our own research interests, to spark discussion there?  We have both short and long surveys, and can analyse the responses which we receive, and the language used.  We have had activities for children also – the colouring in of Nye Bevan, the writing of acrostic poems with ‘Hospital’ – and must think carefully about how to draw meaning from these glorious scribbles.

The Roadshow also lead me to reflect on questions about how and where to place ourselves in this public work, and also in our research more broadly.  Members of our team inevitably have their own feelings and experiences with the NHS: a highly contested institution.  But by sharing these do we open up debate – encouraging a reciprocal system of sharing with those we speak to – or do we close down discussion, making people feel unsure about sharing different memories or opinions with us?  I felt that people responded well when presented with my NHS glasses from childhood, and that this encouraged further recollections.  At the same time, this is by no means a neutral object.  Indeed, the existence of these glasses signals my long-term relationship with the NHS, that my parents, too, had a commitment to this institution.  That I still own these glasses, and that I would display them at an event, again positions me clearly as a particular type with historian, with particular biases related to this area.  Being reflexive about how we present ourselves at public events, and the responses which this encourages or deters, is highly important; and something which I hope to reflect on further, as our programme develops.

Until then, we hope to see you in Manchester!  Do feel free to get in touch in the comments below or at NHSEngage if you have any comments or suggestions.

The NHS: Past and Future Event

To write the People’s History of the NHS, our project team are passionate about sharing our research, meeting people, and hearing your memories about how the NHS has changed over time.  On Tuesday 16 February, the team attended a free public event at the Modern Records Centre in Coventry about ‘The NHS: Past and Future’.  The speakers were Roberta Bivins, one of the principal investigators on our project and Anna Pollert, the chairperson of the South Warwickshire Keep Our NHS Public campaign.

Roberta opened the event, giving a fascinating paper about how health services have been described and used in party political campaigning since the early twentieth century.  Anna spoke next, and argued that successive reforms had introduced privatisation into the NHS: for example by dividing the ‘purchasers’ and ‘providers’ of health care; enabling private companies to ‘bid’ to supply services; and introducing new layers of management and administration.

Putting these two talks side by side was, I think, really illuminating and interesting.  It helped us to think about how historical changes shaped the current political context of the NHS.  Roberta’s talk explored the precedents of how the Labour and Conservative Parties attack one another over healthcare today.  Since the late 1940s, the Conservatives have argued that Labour endangers the NHS through wasteful and inefficient mismanagement.  Conversely, every Labour Party manifesto since 1966 has labelled the Conservatives unsafe guardians of the NHS, and a party of the affluent.  These arguments continue to shape the terms of political debate, in many ways.

Whilst election campaigning may often rely on simple messages, such as those above, the two speakers demonstrated that the roles of the Conservative and Labour parties in NHS reform had actually been complex and mixed.  Anna, for example, highlighted that the Labour governments had, like the Conservatives, facilitated shifts towards privatisation.  New Labour introduced private finance initiatives into the NHS, which are partnerships between the public and private sectors, and also started the plans to sell Hinchingbrooke Hospital in Cambridgeshire to a private company.  Roberta pointed out that NHS spending had been better protected historically by Labour governments, but that close examination of the figures also showed that NHS spending had not been particularly well protected by either party, particularly in times of economic downturn.

The speakers also both considered how members of the public had been drawn into the politics of the NHS, and become campaigners.  There have long been campaigns against the closure of specific local hospitals or hospital departments, and also umbrella campaigns such as Doctors For the NHS (formerly the NHS Consultants Foundation, and formed in 1976), London Health Emergency (formed 1983), the NHS Support Federation (1989) and Keep Our NHS Public (2005).  These campaign groups have used new and developing technologies – most recently the internet – to disseminate their messages widely.  Anna showed us campaign videos created by activists and doctors, such as the critical documentary Sell Off.  In another fascinating look at culture and NHS activism, Roberta also displayed critical graffiti which had been painted on to election campaign posters.

Whilst many people have engaged with the politics of the NHS, in various ways, we also discussed the question of why activism was not more widespread, given that everyone is a patient at some point in their lives, and affected by NHS reform.  Anna stated that when she ran a stall for Keep Our NHS Public she was often shocked by how many people just walked past her without stopping.  Anna felt that the majority of people did not understand the changes which were being made to the NHS, given the length, quantity and complexity of modern policy documents.  Anna also questioned whether younger people especially had lost any sense of urgency about defending the universal health care system, and told us how her daughter had considered the idea of charging people a nominal £5 fee for a visit to their GP.  Relatedly, Roberta questioned whether people from the UK, who had been ‘born in the NHS’, may feel complacent about the ongoing existence of this institution, because we are used to it always being there.  By contrast, Roberta moved to the UK from America, making her very aware that the provision of nationalised healthcare is far from inevitable.

Building on this, we would love to hear your thoughts, memories and stories about politics, campaigning, and the NHS, either in the comments section below or through the ‘share your stories’ section of our website.  Have you ever been involved in a campaign related to the NHS?  Do you have any campaign-related posters, badges or other memorabilia?  If you haven’t been involved in campaigning related to the NHS, why not?  Is the NHS a key electoral issue for you?  Do you remember any party promises about the NHS from previous elections, and whether they were met?  We look forward to hearing from you!