4. Did everyone have to pay for healthcare before the NHS?

About this Lecture

Lecture

In this module we think about the extent to which people were required to pay for healthcare before the establishment of the NHS in 1948, focusing in particular on: (i) the costs associated with calling out a doctor before the establishment of National Insurance in 1911, and the concept of ‘retrospective billing’; (ii) the consequence of certain sections of society (e.g. women and children) not being covered by National Insurance; (iii) hospitals in the Victorian era; (iv) the appointment of lady almoners in hospitals from 1895 onwards, who would assess patients’ ability to pay; (v) the increased financial demands on hospitals following the First World War, and the increasing number of patients paying for their treatments; (vi) the separation of paying customers from the ‘traditional’ users of hospitals – the ‘sick poor’; and (vii) the limited number of paying customers in hospitals before 1948.

Course

In this course, Dr George Gosling (University of Wolverhampton) explores healthcare in Britain prior to the establishment of the NHS in 1948. In the first module, we think about when the NHS began, looking at the importance of the Second World War and Labour’s 1945 election victory. After that, we consider whether there was public healthcare in Britain before the NHS, before turning in the third module to think about what private healthcare looked like prior to 1948 – a mix of businesses operating for profit but also community and charitable initiatives. In the fourth module, we think about whether people had to pay for healthcare prior to the NHS, before turning in the fifth and final module to think about why the NHS was ‘only’ set up in 1948.

Lecturer

Dr George Gosling is a Senior Lecturer in History at the University of Wolverhampton. He specialises in modern British history, focusing in particular on the themes of medicine, charity and welfare to explore wider questions of gender, citizenship and consumerism. His most recent book, Payment and Philanthropy in British Healthcare, 1918-48 (2017), explored the complex meanings of payment in the pre-NHS hospital. It argues that, when patient payments became commonplace after the First World War, they neither empowered consumers as hoped nor crowded out the sick poor as feared, instead they found a surprisingly traditional accommodation with the long-established class-bound principles of philanthropy.