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“Open the Other Eye”: Payment, Civic Duty and Hospital Contributory Schemes in Bristol, c. 1927–1948

Published online by Cambridge University Press:  17 May 2012

George Campbell Gosling
George Campbell Gosling
Affiliation:
George Campbell Gosling, MA,Centre for Health, Medicine and Society: Past and Present, School of Arts and Humanities, Oxford Brookes University, Gipsy Lane, Oxford OX3 0BP, UK; e-mail: [email protected]
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Information
Medical History , Volume 54 , Issue 4 , October 2010 , pp. 475 - 494
Copyright
Copyright © The Author(s) 2010. Published by Cambridge University Press

References

1 Robert Pinker, English hospital statistics, 1861–1938, London, Heinemann, 1996, p. 2.

2 Daniel M Fox, Health policies, health politics: the British and American experience, 1911–1965, Princeton University Press, 1986. See also Martin Powell, ‘Hospital provision before the National Health Service: a geographical study of the 1945 Hospital Surveys’, Soc. Hist. Med., 1992, 5 (3): 483–504.

3 David Owen, English philanthropy, 1660–1960, Cambridge, MA, Belknap Press of Harvard University Press, 1964, pp. 525–72; Martin Gorsky, John Mohan and Martin Powell, ‘The financial health of voluntary hospitals in interwar Britain’, Econ. Hist. Rev., 2002, 55 (3): 533–57, pp. 542–6; Richard M Titmuss, Problems of social policy, London, HMSO, 1950, pp. 256–7; Harry Eckstein, The English health service: its origin, structure, and achievements, Cambridge, MA, Harvard University Press, 1958, pp. 72–5.

4 Geoffrey Finlayson, Citizen, state, and social welfare in Britain, 1830–1990, Oxford, Clarendon Press, 1994, p. 198.

5 For the situation in Bristol, see Martin Gorsky, “‘For the treatment of sick persons of all classes”: the transformation of Bristol's hospital service, 1918–1939’, in Peter Wardley (ed.), Bristol Historical Resource (CD-ROM, UWE Bristol, 2001), 2.3; George Campbell Gosling, “‘Co-operate! Co-ordinate! Unify!” The 1920 proposal to amalgamate the medical charities of Bristol’, Southern Hist., 2007, 29: 89–106, pp. 88–9; Bristol Record Office (hereafter BRO), 35893/2.r, Bristol Royal Infirmary (hereafter BRI), General Committee Minutes, 1918–26, 11 Nov. 1919.

6 F K Prochaska, Philanthropy and the hospitals of London: the King's Fund, 1897–1990, Oxford, Clarendon Press, 1992, p. 81; Owen, op. cit., note 3 above, p. 236.

7 Gorsky, Mohan and Powell, op. cit., note 3 above, p. 535.

8 BRO, 35893/5.g-h, BRI Finance Committee Minutes, 1916–20 and 1920–3.

9 David Green, ‘Medical care without the state’, in Arthur Seldon (ed.), Re-privatising welfare: after the lost century, London, Institute of Economic Affairs, 1996, pp. 21–38, on pp. 33–4.

10 Gorsky, Mohan and Powell, op. cit., note 3 above, pp. 542–6.

11 Ibid., p. 554.

12 For more detail, see George Campbell Gosling, ‘The patient contract in Bristol's voluntary hospitals, c. 1918–1929’, University of Sussex Journal of Contemporary History, 2007, 11: 1–16, pp. 4–5.

13 For more details, see ibid., pp. 5–8.

14 BRO, 35893/8.d, BRI Faculty Minutes, 20 Nov. 1919; BRO, 40530/A/1(a)3, Bristol General Hospital (hereafter BGH), Board Minute Book and Election Committee, 1913–1938, p. 27.

15 Bristol Times and Mirror, 2 July 1921, p. 7.

16 BRI annual report for 1921, p. 10.

17 For an introduction to the origins of the hospital almoner system including the role of the Charity Organisation Society, see Lynsey Cullen, ‘The first lady almoner: the appointment, position and findings of Miss Mary Stewart at the Royal Free Hospital, 1895–1899’, paper given to the Voluntary Action History Society's seminar series at the Institute of Historical Research, London, on 28 Sept. 2009, available as an online podcast at www.history.ac.uk.

18 BRI annual report for 1922, p. 21.

19 BGH annual reports for 1922–1938.

20 BRI annual report for 1922, p. 21.

21 BRI annual report for 1932, p. 18.

22 BGH annual reports for 1922–1938; BRI annual reports for 1924–1940.

23 See Martin Gorsky and John Mohan, with Tim Willis, Mutualism and health care: British hospital contributory schemes in the twentieth century, Manchester University Press, 2006, pp. 19–43. See also Barry Doyle, ‘The politics of voluntary care in Middlesbrough, 1900–1948’, in Anne Borsay and Peter Shapely (eds), Medicine, charity and mutual aid: the consumption of health and welfare in Britain, c.1550–1950, Aldershot, Ashgate, 2007; and Steven Cherry, ‘Hospital Saturday, workplace collections and issues in late nineteenth-century hospital funding’, Med. Hist., 2000, 44: 461–88.

24 Gorsky and Mohan, op. cit., note 23 above, p. 139.

25 Steven Cherry, ‘Accountability, entitlement, and control issues and voluntary hospital funding c. 1860–1939’, Soc. Hist. Med., 1996, 9 (2): 215–33.

26 Cherry, op. cit., note 23 above, p. 462; idem, ‘Beyond national health insurance: the voluntary hospitals and hospital contributory schemes: a regional study’, Soc. Hist. Med., 1992, 5 (3): 455–82, p. 455.

27 Bristol Contributory Welfare Association private archive (hereafter BCWA), BMICS annual report for 1937, inside back cover.

28 BCWA, BMICS annual report for 1934, p. 6; annual report for 1929, pp. 8–9.

29 Mohan and Gorsky, op. cit., note 23 above, p. 109.

30 Henry C Burdett, Pay hospitals and paying wards throughout the world: facts in support of a rearrangement of the English system of medical relief, London, J & A Churchill, 1879.

31 BRO, 35893/8.d, BRI, Faculty Minutes, 29 June 1926.

32 Ibid., 16 Feb. 1927; 4 June 1928.

33 The number of pay beds for middle-class patients was best recorded in The Hospitals Year-Books, London, Central Bureau of Hospital Information, 1933–1939.

34 According to John Stevenson, British Society 1914–1945, Harmondsworth, Penguin, 1984, p. 119, in 1938 the Ministry of Labour conducted investigations into family income and found that 88,per cent of the population had incomes below £250 per annum. Usefully, this is also the level at which an individual would typically be above the general ward income limits for a voluntary hospital and he would, therefore, have to seek treatment in a private ward or elsewhere.

35 Gorsky and Mohan, op. cit., note 23 above, p. 74; Charles Madge, ‘The propensity to save in Blackburn and Bristol’, Econ. J., 1940, 50: 410–48, p. 411.

36 Ruth Hodgkinson, The origins of the National Health Service: the medical services of the New Poor Law, 1834–1871, Berkeley, University of California Press, 1967.

37 Alysa Levene, Martin Powell and John Stewart, ‘The development of municipal general hospitals in English county boroughs in the 1930s’, Med. Hist., 2006, 50: 1–28, p. 4.

38 See Alysa Levene, Martin Powell and John Stewart, ‘Patterns of municipal health expenditure in interwar England and Wales’, Bull. Hist. Med., 2004, 78: 635–69, pp. 644–6.

39 National Archives, Kew (hereafter NA), MH 66/1068, Allan C Parsons, County borough of Bristol: survey report, 1932, p. 129. See also Gorsky, op. cit., note 5 above, 4:3 and 3:4; Gosling, op. cit., note 12 above, pp. 89–90.

40 Parsons, op. cit., note 37 above, p. 142.

41 Ibid., p. 135.

42 See NA, MH 66, Ministry of Health: Local Government Act 1929, Public Health Survey.

43 BRI annual report for 1925, pp. 19–20.

44 Gorsky and Mohan, op. cit., note 23 above, pp. 25–31.

45 University of Bristol Special Collections (hereafter BSC), DM980 (28), Contributory schemes conference dinner 1942, letter from Mr Dodd of the Bristol Hospitals Fund to Alderman Hyde of the Nuffield Provincial Hospitals Trust, 1942.

46 BRI annual reports for 1924-1940; BGH annual reports for 1922–1938.

47 BRO, 35893/8.d, BRI, Faculty Minutes, 8 Dec. 1919.

48 BRO 35893/2.v, BRI House Committee Minutes, 4 Sept. 1919.

49 BRO, 35893/2.r, BRI General Committee Minutes, 21 April 1925. See Steve Sturdy, ‘The political economy of scientific medicine: science, education and the transformation of medical practice in Sheffield, 1890–1922’, Med. Hist., 1992, 36: 125–59, pp. 144–5.

50 BSC, DM980 (30), Bristol Hospitals Commission (hereafter BHC) 1941. Evidence submitted by the Bristol Hospitals Fund (hereafter BHF evidence), appendix 1.

51 BGH annual reports for 1922–1938.

52 Bristol Eye Dispensary annual reports for 1931–1947.

53 For an example of contemporary criticisms, see BSC, DM980 (35), draft letter from the BHF to the Associated Voluntary Hospitals, 1939, p. 2; for an example of the historical critique, see Gorsky, op. cit., note 5 above, 3:4.

54 BRI annual reports for 1924–1940; BGH annual reports for 1922–1938.

55 BSC, DM980 (30), BHC 1941. BHF evidence, appendices 22 and 29.

56 Gorsky and Mohan, op. cit., note 23 above, p. 103.

57 BSC, DM980 (30), BHC 1941. BHF evidence, appendix 3.

58 BCWA, annual report for 1939, p. 8, and annual report for 1940, p. 8.

59 BSC, DM980 (30), BHC 1941. BHF evidence, appendix 9.

60 Ibid., appendices 22 and 29.

61 BCWA, 30s historical file, Communication from the Joint Committee of Hospital Representatives to the BMICS.

62 John Dodd, ‘Co-ordination of contributory schemes: a subject of considerable importance today’, Hospital and Nursing Home Management, Nov. 1942, pp. 53–4.

63 Bristol Hospitals Fund (hereafter BHF) report for 1939–1941.

64 BSC, DM980 (3), Council members BDC, Divisional Council, Chairman's File, no. 1, ‘Notes on the future of hospital services’, 1941, p. 3.

65 BSC, DM980 (41), Miscellaneous files 2, Bristol and District Divisional Hospitals Council, Contributory Scheme Costs and Receipts, 1942–1944.

66 BHF annual report for 1943, p. 3.

67 BSC, DM980 (35), Outline of proposals for the establishment of the BHF, June 1939, p. 2, and letter from the Bristol Hospitals Fund to the six associated hospitals.

68 BSC, DM980 (35), BHF Committee Minutes, 21 Sept. 1939.

69 BSC, DM980 (30), BHC 1941, BHF evidence, appendices 22 and 29.

70 BCWA, BMICS annual report for 1932, inside front cover; annual report for 1930, p. 4; annual report for 1944, pp. 1–2.

71 BCWA, annual report for 1930, p. 2.

72 BCWA, annual report for 1934, inside front cover; ‘30s historical’ file, rules adopted, Dec. 1936.

73 BCWA, annual report for 1935, p. 5; Gorsky and Mohan, op. cit., note 23 above, p. 196.

74 BCWA, ‘30s historical’ file, ‘At the 24th Meeting of the Executive Committee of the British Hospitals Contributory Schemes Association’, 17 July 1936.

75 BSC, DM980 (30), BHC 1941. BHF evidence, ‘Communication from the Joint Committee of Hospital Representatives to the Bristol Medical Institutions Contributory Scheme (Inc.)’.

76 BCWA, BMICS, 1939 report, p. 4.

77 BSC, DM980 (28), Contributory Schemes Conference dinner 1942, Bristol and District Divisional Hospitals Council, schedule 2.

78 BCWA, BMICS annual report for 1928, p. 7.

79 BCWA, BMICS annual report for 1936, p. 6.

80 BHF, report for 1939–1941, pp. 6, 9–10; BSC, DM980 (30), BHC 1941. BHF evidence, appendix 7.

81 Ibid., DM980 (35), Bristol Hospitals Fund (unnamed file), ‘Summarised diary of negotiations to establish One Central Hospitals Contributory Scheme in Bristol’.

82 BCWA, BMICS annual report for 1928, p. 8.

83 BCWA, BMICS annual reports for 1931–1945.

84 BCWA, BMICS annual reports for 1928–1945.

85 BCWA, BMICS annual report for 1934, p. 6; annual report for 1929, pp. 8–9.

86 BSC, DM980 (12), Lord Mayor's Hospital Fund, B&D DHC Sub-Committee, report of meeting of standing committee sub-committee and the Lord Mayor's Fund sub-committee, 16 Nov. 1942.

87 BHF annual report for 1947, p. 6.

88 BCWA, ‘30s historical’ file, Extracts from BHCSA Points of Policy for Hospital Contributory Schemes, 1937; emphasis in original.

89 Cherry, op. cit., note 25 above, pp. 230–1; Gorsky and Mohan, op. cit., note 23 above, p. 108; Doyle, op. cit., note 23 above.

90 For example, see Roy Porter, ‘The gift relation: philanthropy and provincial hospitals in eighteenth-century England’, in Lindsay Granshaw and Roy Porter (eds), The hospital in history, London, Routledge, 1989, pp. 149–78, on p. 150; Colin Jones, ‘Some recent trends in the history of charity’, in Martin Daunton (ed.), Charity, self-interest and welfare in the English past, London, UCL Press, 1996, pp. 51–63; Alan Kidd, ‘Philanthropy and the “social history paradigm”’, Soc. Hist., 1996, 2: 180–92, pp. 184, 186–7; Mary Fissell, Patients, power, and the poor in eighteenth-century Bristol, Cambridge University Press, 1991, pp. 11, 196–7.

91 Royal Free Hospital Archives, RFH/6/A/1, Almoner's Record Book, pp. 17–19. For further discussion of Mary Stewart, see Cullen, op. cit., note 17 above.

92 See Finlayson, op. cit., note 4 above, pp. 9 and passim.

93 BCWA, BMICS annual report for 1931, p. 8.

94 Prochaska, op. cit., note 6 above, p. 35; F K Prochaska, ‘Burdett, Sir Henry Charles (1847–1920)’, Oxford Dictionary of National Biography, Oxford University Press, 2004.

95 BCWA, ‘30s historical’ file, extracts from BHCSA Points of Policy for Hospital contributory Schemes, 1937.

96 BCWA, BMICS annual report for 1933, inside back cover.

97 BCWA, BMICS 1931 report, p. 8; BSC, DM980 (4), Council Members BDC, Bristol and District Divisional Hospitals Council: Chairman's File, no. 1, Alderman Burgess’ notes on report of the Aero Engines Ltd Welfare Superintendent, 1942.

98 BCWA, BMICS annual report for 1936, p. 4.

99 BHF, report for 1939–1941, inside front cover.

100 BCWA, BMICS 1928 report, p. 7.

101 BSC, DM980 (30), BHC 1941. BHF evidence, appendix 7. Copies of the Western Daily Press and Bristol Mirror, 20 July 1939, ‘Bristol voluntary hospitals, contributory scheme inaugurated, fund which will embrace city and district’.

102 BSC, DM980 (5), letter from Mr Dodd to Alderman Burgess, 14 May 1941; letter from Mr Dodd to Mr Iles of Torbay Hospitals Contributory Scheme, 3 Apr. 1941.

103 BCWA, BMICS annual report for 1929, p. 8.

104 BRO, 37006/R/3/1, Bristol Temporary Home and Lying-in Hospital, annual report for 1908, p. 5; emphasis in the original.

105 Ibid., annual reports for 1908–1939; emphasis in the original.

106 BRO, 40536/Adm/R/2/5-6, Orthopaedic Hospital and Home for Crippled Children, annual reports for 1926–1927; 40536/R/4/1-10, Winford Orthopaedic Hospital, annual reports for 1930–1940 and 1944–1947.

107 Winford Orthopaedic Hospital, annual reports for 1933–1935.

108 BSC, DM980 (35), BHF, central contributory scheme memorandum, 1939. The following year, the membership figures differed with 250,000 for the Merseyside Hospitals Council as opposed to the Sheffield Hospitals Council, and 700,000 compared with 600,000 for the Birmingham Hospitals Contributory Association according to Gorsky and Mohan, op. cit., note 23 above, p. 44. Whichever of these figures are the most accurate, they are significantly larger than those for Bristol.

109 BSC, DM980 (30), BHC 1941. BHF evidence, appendix 22.

110 BHF annual reports for 1939–1948.

111 Gorsky and Mohan, op. cit., note 23 above, p. 72.

112 Herbert Tout, The standard of living in Bristol: a preliminary report of the work of the University of Bristol Social Survey, Bristol, Arrowsmith, 1938.

113 Madge, op. cit., note 35 above.

114 Ibid., p. 416.

115 Jose Harris, ‘Political thought and the welfare state, 1870–1940: an intellectual framework for British social policy’, Past and Present, 1992, 135 (1): 116–41.

116 See Prochaska, op. cit., note 6 above.

117 Alysa Levene, ‘Between less eligibility and the NHS: the changing place of Poor Law hospitals in England and Wales, 1929–39’, Twentieth Century Br. Hist., 2009, 20 (3): 322–45, p. 335.

118 Gorsky, op. cit., note 5 above, 4:3; Levene, op. cit., note 117 above.

119 Gosling, op. cit., note 5 above, pp. 89–90; Gorsky, op. cit., note 5 above, 4:3.

120 Levene, op. cit., note 117 above, pp. 332–3.

121 Ministry of Health Survey Report, Stockport, 1932, NA, PRO MH66/898, cited in Levene, op. cit., note 117 above, p. 446.

122 Levene, op. cit., note 117 above, pp. 338–9. See also Anne Crowther, ‘The later years of the workhouse, 1890–1929’, in Pat Thane (ed.), The origins of British social policy, London, Croom Helm, 1978, pp. 36–55.