It’s the 66th birthday of the National Health Service on 5th July, and recently I’ve been finding out more about its beginnings and the healthcare that was available to ordinary people before 1948. The National Health Service was founded to provide universal healthcare to all, regardless of income or background, free at the point of use.
Your Health Service: How it will work in Scotland (HMSO: 1948)(GD1/112)
Before the arrival of the NHS, access to healthcare services largely depended upon wealth. In the case of poor patients, care could be paid for by the parish under the provisions of the 1845 Poor Law, whereas more wealthy patients would pay medical and board fees. Things changed a little in 1911 with the arrival of the National Insurance Act, an insurance scheme that paid for healthcare through contributions from employers, from government and a deduction from the salaries of male workers. However, the scheme only included those earning up to a certain amount and did not always include workers’ dependents.
Royal Edinburgh Hospital case note showing insured worker and wife under the National Insurance Act (LHB3 CC/1)
Voluntary hospitals were another option for those who could not afford high medical fees – one of the most prominent of which was our own Royal Infirmary of Edinburgh. These institutions were funded by charitable donations and kept going by doctors who worked without fees, often for prestige since many (including the Infirmary) were leading teaching hospitals – as you can see from a film from our collections, The Ever Open Door. The film was made in 1938 for the Managers of the Royal Infirmary of Edinburgh as a spur for donations, and showcased the hospital’s specialist departments. You can see The Ever Open Door here: http://www.lhsa.lib.ed.ac.uk/exhibits/everOpen.html
Although the National Health Service transformed Britain’s social, cultural and economic landscape, there were precedents for centrally co-ordinated, subsidised health services before 1948 - and Scotland in particular was at the forefront of these initiatives. For example, the Highlands and Islands Medical Service was set up as long ago as 1913 in the country’s far north as a government-subsidised medical service to help communities to pay medical fees, to attract doctors to this remote region and to run a district nursing service. The Service was eventually joined to hospital provision, and even an air ambulance - as this film from the Wellcome Library shows:
We are lucky in LHSA to have the birth of the National Health Service charted through our collections, from this cartoon of Health Minister Nye Bevan, which depicts the fears of the British Medical Association that the NHS would end the traditions of the medical profession and turn doctors into salaried state servants:
Cartoon featuring Aneurin Bevan depicting the fears of the British Medical Association (LHSA pamphlet collection)
to this annual report from the Royal Infirmary’s League of Subscribers, which was formed in 1918 to co-ordinate voluntary contributions to the hospital, but disbanded in early 1949:
Final report of Royal Infirmary of Edinburgh League of Subscribers, 1949 (GD1/38/6)
Our photographic collection also shows the facets of the new National Health Service. For example, health centres were an integral part of the co-ordination of medical care, combining medical services and medical practitioners under one roof. The first such centre in Scotland was opened in Sighthill in 1953:
Sighthill Health Centre, 1953 (LHSA photographic collection)
Public health was a vital component of the NHS, believed to be essential to the health of the individual. Before the start of the service, free films were run to explain its dimensions. Later, films on general public health were a part of the cinema programme, like this one at the New Victoria Cinema (the old Odeon in South Clerk Street):
Audience leaving the New Victoria Cinema after a film warning of the dangers of tuberculosis, 1949 (LHSA photographic collection)
So Happy Birthday, NHS, from everyone at Lothian Health Services Archive – we’re looking forward to collecting the fascinating stories of your hospitals, nurses, doctors and (of course!) patients for many years to come!