Andrew Seaton’s Our NHS, a History of Britain’s Best-Loved Institution explores the full 75-year history of the NHS, from foundation and modernisation to crisis and survival. In this wide-ranging history, Andrew delves into the many surprising ways that the service has adapted and changed to become the institution that we know today.
In this extract from the book, Seaton explores the unique experience of writer Sarah Campion. During the 1940s, Campion documented issues surrounding an aspect of healthcare that has now become a crucial right of the patient: privacy.
Campion’s first interactions with the NHS attested to the initial high demand for its services. When attending antenatal clinics at the Chelsea Hospital for Women, she joined large numbers of women waiting on long wooden benches to see a doctor.
This scene was not uncommon after health care became free at the point of access. In 1947, Queen Charlotte’s [Queen Charlotte’s Maternity Hospital] admitted just over 3,000 in-patients, a figure that rose by 17 percent during 1950–51 alone. Administrators fretted over how ‘the cramped facilities’ were ‘being strained to the utmost’. But, for Campion, queuing became an important illustration of the NHS’s sense of equity. ‘Each lays some piece of property in the seat when she leaves it, to stake a claim’, she noted, ‘and while she is up there the head of the queue moves, we all move, ostentatiously pushing this jetsam before us, as if to demonstrate that we, too, know that fair’s fair’.
For all this egalitarianism, Campion encountered resentment among women regarding infractions on their bodily privacy during medical investigations. Queen Charlotte’s – like other teaching hospitals – frequently used patients in training medical students. Sometimes these exercises took place without forewarning. One woman at the antenatal clinic told Campion of her surprise at being suddenly in front of ‘a whole lot of grinning students’. Gender shaped such concerns, as predominantly male instructors and medical trainees observed and commented on women’s bodies in exposed settings. Campion resented ‘having my body made the arena for a medical free-for-all’, but patients possessed few means of recourse if they objected. During one appointment with a male doctor, Campion felt like she was being ‘done like an object on an assembly belt’. After she asked for more information and was dismissed by the doctor, Campion confessed that she felt like ‘a nitwit’.
When Campion arrived at Queen Charlotte’s to give birth weeks later, she expressed concerns about privacy. After a difficult labour that involved the use of forceps, she spent nine days recovering in a ‘blue and spacious ward’, with ‘acres of parquet’ separating the beds. This lengthy period of confinement fell just under the ten days customary for various hospital treatments at the time. In many NHS hospitals, including Queen Charlotte’s, wards followed the ‘Nightingale’ pattern. Named after the Victorian medical reformer and nursing pioneer Florence Nightingale (1820–1920), these large wards typically housed twenty to thirty beds arranged along two walls, with no firm sub-divisions between patients. The high ceilings and large windows of the ‘pavilion’ hospital style reduced infection in accordance with a nineteenth-century understanding of disease transmission, where sickness spread through ‘bad airs’ that Victorians managed through cross-ventilation.
In these open environments, Queen Charlotte’s used bedside curtains to provide a degree of privacy. Patients could pull curtains around their bed when they undressed, felt ill or desired a moment of relative solitude. These amenities, though, did not always fulfil their intended purpose. On one occasion, shortly after giving birth, nurses wanted to clean the area around Campion’s bed. While the curtains were open, she vomited, which left her feeling ‘wholly and nakedly exposed’. ‘I feel, rather than see’, she recounted, ‘the immediate tactful looking-away of every eye in the ward’.
The founders of the NHS were not blind to the apprehensions about privacy that large public wards engendered among patients. Somerville Hastings – President of the SMA – commented on the problem during a wartime lecture on the future of hospitals. While he agreed with others on the left like Bevan that there should be ‘no place in the ideal system for the small cottage hospital’, he supported a number of practical solutions to make patients feel comfortable in large institutions. ‘It would not be very expensive to change all hospital wards into curtained cubicles’, Hastings offered. ‘The provision of curtains, together with the occasional change of the position of patients in the wards’, added the surgeon, ‘should go far to satisfy the wishes of most’. Sectioning patients off from sight, if not entirely from sound, offered a potential means of alleviating concerns over privacy while retaining the communal nature of the ward that many figures such as Hastings prioritised as a means of bringing together Britons from different backgrounds.
Despite Hastings’s optimism, many NHS hospitals struggled to afford the curtains that Campion encountered. Even moveable screens – which represented a louder, less individualised alternative – were not always present. Their absence confirmed how the uneven provision that had marred the interwar medical system could still exist in the new nationalised service. The government may well have concurred that a ‘good means of securing patients’ privacy is the use of curtains’, but it still relied on voluntary organisations to fill the gaps that the low postwar health budget left behind. Local women’s groups regularly highlighted the affronts to patients’ privacy that stemmed from financial shortcomings. Organisations such as the Mothers’ Union or the Townswomen’s Guild remained popular in the postwar years – particularly among the middle class – by offering a variety of educational and leisure activities. They also sometimes became involved in the operation of welfare services, despite the centrality of the state after the Second World War. In 1952, a business and professional women’s club in Arbroath, Scotland, demanded more privacy for women in their community’s hospital. A local newspaper expressed the gendered standards of decency often at the heart of these controversies by warning that four women were on ‘full view’ to those passing up nearby stairs. This issue was far from particular to Scotland, as five years later the Somerset Federation of Women’s Institutes passed a resolution that curtains and screens should be made mandatory for all patients.
In a testament to the continuing importance of charity in the NHS, women’s groups regularly fundraised to buy amenities that helped safeguard privacy. Women Helpers Leagues or Leagues of Friends spearheaded these endeavours within individual hospitals. These groups adapted to the new status of charity in medical care, moving away from supporting hospitals’ overall income and towards raising money to fund minor structural improvements or comforts for patients. By 1956, Leagues of Friends or similar organisations supported 2,100 out of 2,600 NHS hospitals. The League of Friends shop became a common sight, generating funds by selling refreshments, as well as books, board games and craft kits to keep patients occupied. Largely staffed by women volunteers, such fundraising mechanisms also made it possible for many hospitals to purchase medical equipment and amenities that included curtains and screens. The League of Friends at Selly Oak Hospital, Birmingham, spent the considerable sum of £1,000 in the late 1950s to provide curtains to a ward with sixty-seven beds.
The existence of amenity rooms, or ‘pay-beds’, in NHS hospitals provided options to the small minority of predominantly middle-class patients who felt that curtains or screens could never ensure enough privacy. For a fee, individuals could have their own solitary room within a public, NHS hospital. At the point of Campion’s arrival at Queen Charlotte’s, the hospital possessed six private single bedrooms, costing seventeen guineas a week, and six two-bed rooms, costing twelve guineas a week. Pay-beds were a marginal taste and comprised only 1.2 percent of all NHS hospital beds between 1948 and the early 1970s. As fees for pay-beds rose in the new nationalised service, Campion encountered affluent patients complaining about ‘the sudden leap in the price of privacy’. Nonetheless, letters of appreciation to Queen Charlotte’s from occupants of these beds expressed gratitude for the solitude of a single room and relative isolation from other hospital attendees. The use of money to pay for a bed would continue to be seen as a distasteful compromise of the service’s values to figures on the medical left. Yet the presence of these patients within the NHS carried advantages by preventing funds moving outside the nationalised system to private hospitals. Instead, they continued to support their local, public hospital.
About the author
Andrew Seaton is the Plumer Junior Research Fellow in History at St Anne’s College, University of Oxford. He was inspired to write Our NHS after watching the Opening Ceremony of the London Olympic Games. He says:
“Through its dancing nurses and bright blue lights spelling out the service’s initials, the ceremony in 2012 projected that the NHS lay at the heart of British national identity. Why, I asked myself, would a health system define what it meant to be British? And why had the NHS survived to take on this significance, when so many other parts of the welfare state or public industries had not?”
