Britian's glorious healthcare service before the NHS

It's hard to keep up with all the whoppers promoted on X but I particularly enjoyed this one on that the NHS had a "thriving healthcare sector before the NHS built on private practice, mutual aid and charity".

I mean, for a start charity isn't what I would call thriving industry.  It certainly wasn't thriving when my mother needed a mastoidectomy in 1940 as they had to go round the village begging for money.  But of course my mother is a primary source so must be wrong.  Instead we must trust Professor Barry Doyle Professor of Health History at the University of Huddersfield who promotes what he must know to be a lie that "the National Insurance Act of 1911 changed that. It provided access to general practitioners (GPs) for manual labourers and lower paid non-manual workers earning under a certain income, together with tuberculosis care".  

Well, as the Master used to say, for a lie to work it must be shrouded in truth...  

What the Asquith government offered was nothing like the modern GP serivce ... it was that the very sick could be eligible for what was called "treatment by a panel doctor" which is a very different thing to having a General Practitioner.  There was no organised system of everyone having their own doctor or of a proper organised system for collecting medical notes.  You also had to have a job that was recognised as a job in order to be covered.  Casual labourers like my grandmother and children such as my mother were outside the system.  Even if they were covered no one told them much... It's fun as well how someone managed to write an article on pre-war social and healthcare provision without mentioning the word "Workhouse".  Mayday Hospital (or Croydon University Hospital" as it now calls itself was actually the old workhouse which is why many of its buildings are so hideously depressing - to discourage anyone from going there by choice...

It's hard to get a picture of what the panel doctor system was like other than by talking to people like my 86 year old mother but I did find this...

Services under the National Health Insurance Act Anne Digby, The Evolution of British General Practice 1850–1948 (Oxford, Oxford University Press, 1999), pp. 318–22.

"Class assumptions shaped the perceptions of bureaucrats as well as of doctors. English Insurance Committees were circulated on whether panel patients received as good a service as private patients, and the omissions and face-saving phraseology in their replies pointed to a divided system of medical care. An obvious indication of the two-tier nature of practice could be readily observed in the differentiated physical accommodation and reception of patients. Panel patients frequently queued at a back door to enter a cramped, barely furnished surgery, there to wait their turn for the doctor during fixed surgery hours. In contrast, their middle-class counterparts chose personally convenient times for appointments, were greeted by a maid at the front door, and waited in a comfortable room in the doctor’s house for more extended medical interviews. Indeed, there was neither incentive for the panel doctor to improve accommodation, nor any effective coercion to do so, since although the rare insurance committee(such as Birmingham) inspected the surgery accommodation of insurance doctors several times, others (like London or Devonshire), did so only rarely or unsystematically."

It continues...

"Insurance doctors had to give all proper and necessary medical services except those requiring special skill. This meant inter alia7 that treatment of fractures or dislocation was expected but not an operationfor piles or an operation on tubercular glands. More serious cases were referred for treatment in the outpatients departments of hospitals"

In other words if you needed an operation you could go away.  One of the most common operations post the introduction of the NHS was for female prolapses.  Pre-NHS people just lived with them - for years.  The lucky had access to hospital care through mutual societies.  Aneurin Bevan based the NHS model on the Tredegar Medical Aid Society in Wales.  He saw it seemed to be working and simply scaled the principles up.  What the NHS gave people that was missing before was free access not just to see a doctor but to actual hospital care...

As to the kind of medical record keeping that a modern GP does.  Well, pre the NHS... 

"Diagnoses were almost entirely for physical ailments, and few clinical measurements were recorded as having been made in reaching them. Panel doctors seem to have shown little or no appreciation of the value of the NHI clinical record for their patients. The financial committee of one Scottish panel even minuted that ‘the present medical record system is serving no useful purpose and in the interest of economy should be scrapped’. "

But apparently "public opinion data from the late 1930s and early 1940s suggest most people were broadly satisfied" (so says Professor Martin Gorsky to whom the formation of the NHS is a mystery).  So that's alright then.  Not sure how they polled my grandmother.  She didn't have a telephone until 1982.  Relying on statistical data when there is no obvious way to collect it is obvious nonsensical but I suppose if it wasn't there...  Perhaps some of these professors would do better to read other contemporaneous sources of public opinion such as Dr A. J. Cronin's controversial novel The Citadel in which "I have written in ....all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug ... The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system."  Or perhaps some lighter reading like Agathar Christe ... how many doctors are vilains handing out addicitive opiates to their private patients till they're hooked?  Why was cocaine addict Sherlock Holmes best friend Doctor Watson? etc...

I don't mind academics living in an ivory tower until they try to sell their rose tinted specales as serious political policies.  As to the twitter account with its cherry picked statistics it seems to be the work of a young Australian gentleman with a fondness for right wing thinktanks.  He and his minions have somehow transmutated all this into "Pre-1948 nationalisation of health care: there were 2 750 hospitals most built prior to 20th C; 480k hospital beds; fully staffed without immigrants; 400k on waiting list – 0.75% of pop 50 million.  NHS today: now only 1 600 hospitals (still most built before the 20thC; 145k hospital beds; staffed by immigrants; 7 million + on the waiting list –10% of pop 68 million."

Which is a level of nonsense I do not feel willing to do battle with... for a start it depends what you qualify as a hospital... this would have included workhouses which bridged social support and healthcare and lunatic asylums which have now been dismantled for care in the community.  Only a minority offered much in the way of useful clincial facilities as we would understand toady...  Next week, Healthcare - why can't we leave it to the Monastic sector?