Capturing the History of NHS at 70: The Royal College of Physicians & ‘The Museum of Modern Medicine’

In this 70th anniversary week of Britain’s National Health Service, we are delighted to share a guest blog from Curator Kristin Hussey of the Royal College of Physicians (which is also celebrating a significant birthday this year: the big 5-0-0!). Happy Birthday, NHS!

The museum of modern medicine

What would a museum of British medicine since the foundation of the NHS look like? What objects would it include? What stories would it tell?

In light of this year’s NHS70 anniversary, the Museum, Archive and Library of the Royal College of Physicians (RCP) has been rethinking how we collect and display the history of modern medicine. As Curator, it’s my responsibility to help shape and grow our collection of art and objects so it reflects the ever-changing history of doctors in England and Wales. 2018 is also a big anniversary for the RCP as we mark 500 years since we were established by King Henry VIII in 1518. Since our foundation, the College has been collecting artefacts and archives which trace the history of the organisation, of its membership and of physicianship. Our collections of the early modern period in the sixteenth and seventeenth centuries are particularly rich – helping us to understand more about the wealth, power and ceremony of the early College as well as the development of anatomy. However, as you approach the end of the Victorian era, the museum collection grinds to a standstill.

This lack of collecting beyond the First World War is something I have noticed in many medical museums. Why is it so hard for us to imagine a history of medicine beyond the guts, gore and pain of the nineteenth century operating theatre?  Personally I think there’s an aura of the past about famous doctors and surgeons like Joseph Lister, Edward Jenner, John Snow or William Osler that somehow makes them seem more important. Maybe it’s because the gruesome, outdated and strange tools and remedies of the era seem stranger to us than the stuff of ‘modern medicine’ – the everyday things you can find in a GP surgery or a hospital.

I believe that it is actually this everyday stuff of medicine in the last 100 years that we should be collecting. Museums may seem to be about the past, but they are really about the future. What are the stories and objects people will want to see in exhibitions in 25 years, 50 years or 100 years? What will people think of medicine in 1948 or indeed 2018 when they enter into the realm of ‘history’?  Anniversaries like NHS70 remind us that the mid-20th century is a crucial point in the history of medicine and now is the time to be capturing those objects and stories. With that in mind, the Royal College of Physicians would like to collect and display objects related to the foundation of the NHS and its early years.

Medicine between about 1940 and 1990 represents a period of monumental change. Antibiotics and organ donation, genetic testing and the emergence of HIV/AIDS – displaying the many innovations of the 20th century presents an enormous challenge. As a curator though you aren’t just looking to capture moments of discovery (although that’s important), you are looking for objects that tell a personal story. Sometime which has inspired me about the People’s History of the NHS project is the emphasis they place on the individual experiences of patients. When a visitor comes to a museum, they want to understand what people thought and felt in the past. Whether it’s a doctor or a patient, understanding what a particular artefact meant to someone – how they used it, what it reminds them of, why they kept it. These details can helps us to interpret these items meaningfully for the visitor.

One of the greatest challenges I have found in collecting objects from the 20th century is that people often think their items aren’t important enough to go in a museum. Yet it is often these everyday objects which have the most fascinating stories. Any object can be history if it captures a person’s thoughts or feelings at a particular moment in history. Part of the interesting thing about the RCP Museum is we are interesting in the experiences of both patients and doctors – but ideally stories which bring both together, which help us to understand how patients and doctors have interacted in the past. Two items from our collection illustrate the kinds of artefacts we’d like to collect and display from the NHS era: an early telegram from a doctor desperately seeking insulin to save the life of  young diabetic patient, and this 1994 oesophageal stent, donated by our president-elect Andrew ‘Bod’ Goddard. Stents like these are used in the treatment of cancer, helping to ensure that tumours don’t block the food pipe. Originally invented in the 1880s, this type of plastic model was introduced in the 1970s. However, the plastic stents were difficult to place – something which Dr Goddard dreaded as a trainee doctor. More recently, much more flexible expanding metal stents have been introduced, making these uncomfortable versions a thing of the past. As Bod says, ‘As they are for my patients, oesophageal stents are close to the heart’.

 

If you are interesting in donating something to the Royal College of Physicians related to the NHS, please email history@rcplondon.ac.uk   But first, let me tell you a bit more about what we can and cannot collect, and how you can contribute your objects to our collections!

Note from the editors: Remember, the People’s History of the NHS ‘Virtual Museum of the NHS’ is also collecting. We would be thrilled to collect images of all your NHS objects, big or small — and to hear, save, and share all your stories about them.

 

And if you can’t wait to see more objects, don’t forget to watch this wonderful series on BBC 4, Monday night at 9:00 and available on iPlayer! Objects and stories contributed by members like you tell the human story of the NHS from 1948 until today.

Science Museum Workshop, London

As the excitement builds towards celebrating 70 years of the NHS, a hive of activity is emerging to highlight the importance of this national institution. Visibility has become a key watchword in such activities – media representations in documentaries, news and radio pieces, theatre productions and exhibitions, to mention but a few, are each determined to explore and represent what the NHS means to the British public.

The Science Museum in London has taken up this mantle with no less gusto, with a section of its new Medical Galleries to include a display relating to the history of the NHS. Though not focused on an opening for the anniversary per se, this project opens up important questions regarding how we represent the NHS visually, and it was with this in mind that I was invited to run a standalone 2-hour artist workshop with their steering committee. This, however, is no ordinary steering committee. Composed of group leaders and representatives for the public groups that the Science Museum is working closely with in order to produce the NHS display, including Homerton University Hospital, Adelaide Medical Centre, Watling Medical Centre and A.S.A Disability, the aim for the Museum is that public participation should be a key driver in producing the final NHS display. Short films have been proposed that will be produced by collaboration with these groups, through their stories, memories and ideas of what the NHS means and has meant, with examples of how this might be presented visually. But as any ad execs worth their salt would undoubtedly point out, user-generated content may be the gold dust of today’s media and creative economy, but it is equally difficult to negotiate and produce. This task is made even more tricky when the subject under discussion is suffused with ideas that depend on so many intangibles.But this task is made even more tricky when the subject under discussion – the NHS – is suffused with ideas that depend on so many intangibles. Compassion, inclusion, pride, levelling and security are just some of the values that we associate with the NHS that appear to prove more difficult to represent visually. As one participant put it: ‘you have your work cut out for you’.

However, working from the material generated by participant interviews, and from photos that the participants were asked to send, representing their experiences and thoughts of the NHS, the group quickly ran full steam ahead. By the close of a very fast-flying 2 hours we were able to produce mood boards, images and ideas, that began to go some way to representing the NHS, and its complex network of meanings. ‘NHS word cards’ created from random selections from participant interviews were particularly successful, in which the team was split into groups and asked to create a ‘continuum’ using these words, having been asked to decide which words they most agree or disagree with when thinking about the NHS. The same cards were then used to create themes, and those themes were then used a starting-point, with the images sent in, for the mood boards.The activities were purposefully kept simple, with the workshop taking a much slower step-by-step approach than would otherwise be taken with a more experienced, practical art group, and the use of the usually (somewhat messy) materials I incorporate into workshops was inappropriate to the needs of the Museum and the setting.

The Museum will continue to work with the groups, as this is an ongoing collaboration for them that will take some time and dedication. However, as a standalone exercise there was much to be gained from this event, and not just for the Museum and the participants in moving forwards with the display. As I left the close of the session, that somewhat brutal, yet insightful, comment from a participant – ‘you have your work cut our for you’ – still rang in my ears. It left me wondering if it is indeed nigh on impossible to represent the NHS and its complex ideologies though static images or objects. Even in TV drama and film, we implicitly assume that the footage we see – an unfolding drama a&e drama, for example –  is the NHS. We assume so unless decidedly told otherwise because the NHS, fundamentally, is medicine for almost all of us.

But more than this, I wondered, when it comes to trying to get to grips with the NHS and its meaning through exhibits, objects and images, are we stuck with either quite literal images that fall short of saying anything meaningful or with depth, or else a collection of visual symbols that most would need a doctorate in Art History to comprehend? Perhaps not. For one thing, there is indeed space for both the literal display– through say, the material culture of campaign banners and protest photographs – but also, and alongside it, the more metaphorical exploration. Indeed, representing ‘intangibles’ is what art, film and even museums, very often, do actually do. So it is perhaps the greater disservice to assume that the public would not have the appetite, or visual literacy, to engage with such displays. Indeed, in my previous research on abortion I wrote 80,000 words explaining how abortion has been used in literature to represent wider, existential concepts, and produced a recent article for Feminist Legal Studies discussing the same obstacles around visual encoding for abortion, but without resigning to ultimate ‘visual defeat’. The British public literacy around the NHS, in fact, was evident in responses to the 2012 Olympic Opening Ceremony. While many nations watched on in utter confusion at the amalgamation of children in hospital beds, fictional heroines and dancing nurses and healthcare staff, the British public knew exactly what all this meant: this was ‘our NHS’. The most invisible visible institution of them all.

1948: The coming of a “free” health service

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

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

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

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

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

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

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

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

 

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

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.