By Andrew Seaton
**Updated with a response below from Mathew Thomson of the People’s History of the NHS project.**
This post is part of an ongoing series in which postgraduate researchers reflect on ‘Why my research matters’. Other entries in the series can be found by clicking here.
One of the apparent benefits of working on the British National Health Service (NHS) as a historian is its prevalence in the news. Hailed in a 2014 report by the Commonwealth Fund as the most efficient and cost-effective healthcare system in the world, Britons praise it as the jewel in the crown of their welfare state. Nationalised, universal, free-at-the-point-of-use medicine remains widely celebrated in the U.K, almost seventy years after its introduction in 1948. The Opening Ceremony of the London 2012 Olympic Games represented a global projection of popular NHS adulation. Nation-wide marches, celebratory songs and poems, and assorted celebrity endorsements matched this intensity during last year’s General Election. Last Christmas a choir formed by staff from Lewisham and Greenwich NHS Trust beat Justin Bieber to the top of the UK singles chart. Over the last month The Guardian has been publishing daily articles on the service as part of its ‘This is the NHS’ project. However, just as the NHS Choir’s hit song ‘A Bridge Over You’ demonstrated attachment to the NHS, it also spoke to the anxieties surrounding the institution. As a charity single seeking to raise awareness about an increasingly cash-strapped service, the song tapped into raw concerns about funding, debt-ridden hospital trusts, and clashes between striking junior doctors and the Conservative government.
Though all historians crave an audience already interested and indeed emotionally invested in their topic, I have found that in writing the history of the NHS I must position myself carefully in relation to the events that make the headlines. On one hand, it is fruitful to explore the longer histories of debates that have come to define today’s NHS, and recurrent themes of ‘crisis’ demonstrate this. The recent labelling of the current Health Secretary Jeremy Hunt as a ‘bully’ and a ‘recruiting sergeant for Australian hospitals’ by the British Medical Association and Labour’s Shadow Health Secretary Heidi Alexander, respectively, have parallels in the past. An issue I addressed as part of an article on conservative opponents of British nationalised medicine in the 1950s and 1960s centred on questions of GP dissatisfaction with being ‘dictated to’ by the Minister for Health. Hundreds of doctors emigrated from Britain to Australia, Canada, and the U.S. in these years on the back of such views and a broader disillusionment with the direction of the service. Though the political contours of these recent arguments are radically different, the language and fears of a ‘medical brain drain’ remain similar. If doctors with right-wing politics used to express alarm at an ‘overbearing’ state undermining the doctor-patient relationship, and pointed to medical emigration as a consequence, the left now trades in these terms in its attack on an unfair deal for junior doctors. Similarly, I also showed how critics of the NHS constructed the idea of a financial ‘crisis’ by delimiting ‘acceptable’ and ‘unacceptable’ healthcare spending. That Britain spends 9.1% of its GDP today on health, compared to 11.7% in France or 17.1% in the U.S., and yet current discussion revolves on an apparently impending NHS financial collapse reveals comparable agenda-setting still at play.
On the other hand, NHS history cannot take all its cues from current affairs or policy requirements. Despite continuities of concerns, what defined the service has changed over time. We no longer live with all the reasons for celebration or apprehension expressed by Britons about the NHS in previous decades. Consider, for example, the notion of ‘privacy’ and the health service. The problem of privacy in the NHS today might bring to mind questions over the security of personal details in large computer databases, but in the 1940s and 1950s it carried a very different meaning. Worries about nationalised healthcare limiting patient individuality framed a great deal of discussion about the early NHS, especially considering crowded hospital wards where large numbers of patients regularly filled beds in close proximity to each other. Resource-strapped ‘Austerity Britain’ often lacked the means to equip its new health service with dividers or curtains between beds, fuelling demands for increased confidentiality. The Montrose Business and Professional Women’s Club criticised the Board of Management for Angus Hospitals in 1954 for failing to provide dividers between beds, calling on them to ensure ‘greater privacy for women on hospital wards’. Eventually these demands resulted in the introduction of curtains around beds in the greater Dundee area’s hospitals, underlying the importance of pressure from civic organisations and patients in addressing the contentious issue of privacy. Space, then, often structured matters of privacy in the early NHS, in ways that reflected the limitations of the European postwar moment. This issue, in turn, affected broader attitudes towards the institution, despite the apparent, but ultimately misleading, continuities in such discussions with regard to, in this case, ‘privacy’.
Research on the NHS brings the advantage of relating to current policy and possessing an already-engaged audience whose testimony can enrich a more holistic history of an institution that in many ways defines modern Britain. However, as the cases of ‘crisis’ and ‘privacy’ suggest, the intensity of current debate and feeling surrounding the service creates its own challenges. Uncovering the historical distinctiveness of concerns and discussions can be difficult when they seem misleadingly immediate to us in 2016. While current emotional attachment makes the NHS an exciting project, I try and keep in mind that the priorities of today’s sentiment might obscure those of the past.
Andrew Seaton is a PhD student at New York University. His research examines the emotional, social, and political history of Britain’s National Health Service (NHS). He is a previous winner of Twentieth Century British History’s Duncan Tanner Prize for a 2015 article setting out a new way of writing the history of the NHS attending to its contested meaning as ‘the closest thing the English have to a religion’. Andrew tweets from @AndrewSeaton.
A RESPONSE FROM MATHEW THOMSON
Andrew Seaton puts his finger on a challenge when writing on the history of the NHS. On the one hand, this is a history that so obviously matters; on the other, there’s a danger, consequently, of getting distracted and perhaps misled by the terms of the current debate. He suggests that taking the long view has helped him to recognise that some of the developments that dominate the public debate on the NHS, and that lie behind a sense of crisis, are less novel than we imagine. Looking back can also complicate the categories at the heart of this debate. For instance, his research indicates that the history of privacy within the NHS lies, not just in a history of the politics of privatisation (the history that might be read back from our current concerns), but also in a less obvious and fascinating history of changing feelings about private space. Elsewhere, in an article in Twentieth Century British History, he has highlighted the importance of a history that is able to look beyond our current preoccupation with support for the NHS to uncover a less well known history of opposition in the past.
Where such a role for the historian will place him in relation to current political debate over the NHS is an interesting question. Because history so obviously has implications for how we think about the NHS right now, and indeed finds itself deployed in some of our basic assumptions about the meaning and value of the NHS, it’s not a question that can be easily side-stepped. We’ve been facing some of the same challenges in a project on the Cultural History of the NHS and in an accompanying People’s History of the NHS website. Like Seaton, we recognise that we need to be open to this history telling us things that surprise and challenge, and not just confirm, some of the deeply held public convictions about the NHS. Yet we’ve also been excited by the opportunity of extending involvement in such a history to the people who experienced the NHS first hand as patients, carers, and staff.
In this second sort of history, it becomes harder and perhaps less desirable to follow Seaton in letting go of the present. This is an issue that we will be grappling with in the project. And it’s the sort of challenge that will almost certainly become more common in an era in which historians become more active in their engagement with the public through the effect of impact and public engagement agendas, technology that facilitates the crowd-gathering of evidence, and a public appetite for history that matters.
Mathew Thomson is Professor of History at the University of Warwick. He is part of a team of researchers at the working on a Cultural History of the NHS. The project’s ‘People’s History of the NHS’ website introduces some of our research and invites public involvement in this history: http://peopleshistorynhs.org/