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.