People's History of the NHS

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NHS History at #SHS40

by George Gosling

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

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

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

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

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

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

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

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

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