By expanding the geographical scope of the history of violence and war, this volume challenges both Western and state-centric narratives of the decline of violence and its relationship to modernity. It highlights instead similarities across early modernity in terms of representations, legitimations, applications of, and motivations for violence. It seeks to integrate methodologies of the study of violence into the history of war, thereby extending the historical significance of both fields of research. Thirteen case studies outline the myriad ways in which large-scale violence was understood and used by states and non-state actors throughout the early modern period across Africa, Asia, the Americas, the Atlantic, and Europe, demonstrating that it was far more complex than would be suggested by simple narratives of conquest and resistance. Moreover, key features of imperial violence apply equally to large-scale violence within societies. As the authors argue, violence was a continuum, ranging from small-scale, local actions to full-blown war. The latter was privileged legally and increasingly associated with states during early modernity, but its legitimacy was frequently contested and many of its violent forms, such as raiding and destruction of buildings and crops, could be found in activities not officially classed as war.
Wings: For South Bristol Community Hospital
We waited for this place for years
and then, at last, it landed here.
A local spacecraft perched in green:
an open hatch, designed to breathe.
It’s built to give us light and space,
then guide us on to somewhere safe.
Upstairs, in the day room,
the lunchtime crowd is gathering.
Barbara rests her arm in a sling,
full of pep despite the broken wing.
She gestures through the window
to the cheery rush of grass
where Bristol’s wartime aircraft
used to splutter past.
She sips her coffee and remembers
running with her cousins round these lanes
until evacuation whisked their games away.
A nurse on duty also loves the park.
His teenage weekends happened there,
the flight of football with his friends,
long after the planes had left.
He says it’s always been his dream to care.
His grin is a sudden breath of air.
History is humble round these parts
but once its storied engines start
the others follow, thick and fast.
In here, the future is a calm propeller,
the lift-off to a second chance,
a gentle runway
from the past.1
Beth Calverley
Introduction
‘Wings’ by Beth Calverley was produced as part of a commission by ‘NHS at 70’ in collaboration with the Arts Programme at University Hospitals Bristol NHS Foundation Trust in 2019.2 Calverley, known as ‘The Poetry Machine’, toured all ten sites within the trust with her performative ‘machine’, spending time listening to people about their memories of each individual site. Each person Calverley spoke with was gifted an individual poem – which she would read out loud to them, intensifying the emotion of the interaction. While these individual poems remained personal, Calverley took aspects of their memories and stories to create a series of ten poems representing each location within the trust. ‘Wings’ is particularly germane to this chapter, as it creates a sense of how South Bristol Community Hospital is a place with history and meaning beyond the National Health Service (NHS), interwoven into both individual and collective memory.
‘NHS at 70’ began creating a shared history of the NHS in 2017 by recording experiences from staff and patients across the four nations of the UK and since March 2020 has focused on the NHS and COVID-19.3 An analysis of selected testimonies from the ‘NHS at 70’ collection forms the basis of this chapter, in which space and place are positioned as lenses through which to examine social and cultural aspects of NHS history, including memory and meaning, campaigning and religion. These testimonies will illustrate how people both remember and construct their NHS experiences through places and crucially how ‘space’ extends beyond the boundaries of the NHS as a healthcare system and is layered with a range of broader cultural memories and experiences. This chapter serves only as an initial analysis of a large contemporary oral history collection focused on the NHS, the content of which will continue to refine and develop cultural understandings of the NHS as ‘the story of our lives’ in the UK since 1948.
Health, space, and place
As Martin Gorsky noted in his review of historical writing on the NHS in its sixtieth anniversary year, the NHS as a research area is both ‘vast and unwieldy’ and ‘small and manageable’.4 The historiography of the NHS has largely focused on political, policy, clinical, and administrative dimensions, skewed perhaps by the sources available, but arguably also from a restrictive perception of the NHS as primarily a state institution or a healthcare system.5 This focus is somewhat understandable given that in the longer history of the UK, the NHS is still a relatively young institution which has undergone considerable change and development since its introduction in 1948, and stands at the centre of political and policy debates in the UK.6 Over the last decade historical interest in NHS has broadened through new considerations, for example, of the governance of health, the role of the public in public health, and surgery and emotions.7 The ‘Cultural History of the NHS’ project at the University of Warwick is the first exploration of the cultural meanings of the NHS, bringing in new aspects such as activism and workers’ histories and using material artefacts and visual material as sources.8 The relationship between migration and the NHS is another area of recent research, much of which has used an oral history methodology to build inclusive interpretations.9 Limited, albeit excellent, work has focused on the experience of visitors to hospitals, and offers much more scope for development in the context of the cultural history of the NHS.10
Place is ‘a central and ubiquitous concept across so many disciplines’, but, as the philosopher Jeff Malpas argued, ‘is perhaps the key term for interdisciplinary research in the arts, humanities and social sciences in the twenty-first century’.11 Concepts of space and place in health geography and the social sciences more broadly are well established and provide frameworks for examining health and illness from therapeutic landscapes of care to spatial health inequalities.12 Space and place are central to emerging explorations of the sensory experience of healthcare, with Victoria Bates in particular creating new frameworks for researching aspects of space and experience in NHS hospitals and integrating them into broader developments in sensory history and medical humanities.13 In this chapter, space and place provide a focus for examining the NHS as something which ebbs and flows throughout peoples’ lives – across space, place, and time. In this framework, space and place are both temporal and multi-dimensional, yet are central to analysis of cultural memory and meaning, illustrating how, as historians, we can centre the NHS in the history of the UK since 1948.14
New voices
By incorporating personal testimonies from the ‘NHS at 70’ project this chapter brings new voices and a four-nation approach to the cultural history of the NHS. Oral history methodology prioritises the narrator and centralises their memories and lived experience as a historical source. As Paul Thompson states, the ‘interpretation of societies, cultures, and histories with oral evidence opens many new possibilities. In the broadest sense, all testimonies normally carry within them a triple potential: to explore and develop new interpretations, to establish or confirm an interpretation of past patterns or change, and to express what it felt like.’15 While oral history is arguably the first form of history, it has developed significantly as a research method over the last fifty years. Technological advances in recording sound, aligned with a broader recognition of ‘missing voices’ in historical analysis, have witnessed a plethora of both academic and community interventions to record the experiences of people, capturing information that would otherwise be lost.16
The ‘NHS at 70’ project takes a holistic approach to oral history in which ‘we all have an NHS story’ and utilises a socially engaged model of volunteer and stakeholder participation, differing from approaches which are either academic or community-focused, which often prioritise a particular event, community, or research goal. This has resulted in rich testimonies in which the NHS is a thread that weaves throughout the lives of people in the UK. The 1,000-plus interviews conducted to date, featuring varied voices, from politicians to porters to patients, present compelling evidence of the richness that can be gleaned from adopting a much broader approach to NHS history. The selection of interviews included here were identified through a series of keyword searches across the 400 interviews in the collection that had been summarised.17 The results of these searches also shaped the themes and direction of the chapter – for example testimonies that considered the place of religion in the NHS and the cultural significance of how religion has influenced the physical experience of spaces inspired new directions of research. Moreover it is clear from the personal testimonies, including those in this chapter, that the social, cultural, personal, and political experiences and identities of people across the UK shape their relationship with the NHS. Thus its significance to lived experience within the UK evidences it as an institution which should be central to any exploration of post-war British social and cultural history.18
The ‘first’ NHS hospital: place, memory, and meanings at Trafford General Hospital
This section focuses on Trafford General Hospital to explore how place, memory, and meaning intersect to construct a shared cultural identity of place. The relationship between the public, hospitals, and the NHS is complex and cross-disciplinary. Mohan’s analysis of the 1962 Hospital Plan, while largely focused on policy, acknowledges ‘vociferous and vigorous’ opposition to the closure of ‘cherished facilities’.19 In a study of the closure of St Bartholomew’s Hospital, London, the authors concluded that that resistance to change ‘was not just about local residents fighting to save their hospital, it was about a fight over a symbol of place, however imaginary’ and that potential closures were ‘an emotional and symbolic loss as well as the removal of a much-loved facility’.20 More recently a multi-method study of community hospitals demonstrated the cultural, social, and economic significance of hospital in the community, showing how staff placed value on the local community and provision of services for local people.21 This is evidenced also in Elizabeth Hurren’s analysis of two cottage hospitals, which utilised patient narratives to demonstrate their role in supporting the local elderly population in the local community.22 Ellen Stewart, through social science methods, has analysed resistance to closures through the meaning they have in their communities, concluding that ‘hospitals are neither shells for service delivery nor mere symbols; they do other things in communities’.23
The NHS in 1948 inherited spaces already rooted in communities, buildings with identities of their own, within the broader landscape and cultural history of particular places. This is echoed in an interview with Ruth Edwards; born in a Welsh mining village in 1928, she describes pre-NHS healthcare and how the miners, despite their terrible working conditions and wages, raised money through contributions to build Pontypool Hospital. She recalls how it was ‘such a grand experience to have a local hospital’ and that it was built like a castle up on a hill. Although she states that sadly it had to be demolished later in the century, there is also tacit acceptance of this decision, as it was no longer fit for purpose because of the ‘winding castle-like stairs’.24
On 5 July 1948 Aneurin Bevan, Health Minister in Clement Atlee’s Labour government, launched the NHS at Park Hospital, now called Trafford General Hospital, in Greater Manchester. This symbolic occasion created ‘social imagery’ of the NHS as an institution, epitomised by photographs of Bevan with his hand on the forehead of Sylvia Digory.25 Yet Trafford’s place in the history of the NHS is both symbolic and physical. Bevan’s ceremonious opening at Trafford manifested the NHS as something tangible: it was no longer just a political concept, a policy document or a plan, but was a place, a building, with staff and patients and a local community. More importantly, this event shaped the experience of the people who had worked and been treated at Trafford General Hospital since the introduction of the NHS. Alison Griffiths arrived as a trainee nurse in 1978 and continued to work there for thirty-six years as a staff nurse: ‘everybody was very much aware that this was the first NHS hospital, it was a hospital with history, I think we all felt like we were part of something special’, she reflects.26 Peter Sykes, a surgeon, worked there from 1976 to 2002 and describes a consciousness among staff of the sense of place, even forty years after Bevan opened the hospital.27 Similarly the surgeon Edmund Hoare, who worked at Trafford during the same period as Sykes, describes how he became ‘fascinated’ with the history of the hospital as the ‘first’ NHS hospital, and later wrote a history of the hospital.28 As Jack Saunders’s chapter in this collection contends, ‘working for the NHS’ generates visible identities which in turn give cultural meaning to the NHS as an employer. Adding to this, these narratives demonstrate how Trafford’s identity as ‘the first NHS hospital’ influenced the workplace culture of the hospital and emphasise the importance of place in shaping the emotional experience of work for NHS staff. That NHS staff like Hoare consequently developed an interest in the history of the place illustrates too how workplace culture can directly impact on the broader cultural life of individuals.
Naomi Weaver argues that despite Trafford’s historical significance it has been overlooked,29 particularly in literature addressing NHS anniversaries.30 On the seventieth anniversary of the NHS in 2018, June Rosen, a retired physiotherapist born in 1940, was invited to the unveiling of a commemorative blue plaque marking Trafford’s place in NHS. For June, Bevan’s historic visit to Trafford is entrenched in her memory, as he had stayed the night before at her family home in Urmston after attending a political rally in Belle Vue with June’s father, Leslie Lever, a local politician. June recalls her mother saying that ‘it was the most amazing time to be involved in politics, we felt as if we were going to build the New Jerusalem’.31 Thus this creates a cultural memory of the hospital as a place which embodies not just the NHS but also a sense of post-war values and optimism that the newly elected Labour government created through a series of social welfare reforms. Seventy years later, this cultural value attached to the NHS was reiterated by Andy Burnham, Mayor of Greater Manchester, who in his address described how Bevan’s symbolic receiving of the keys at Trafford’s Park Hospital ‘marked the beginning of a simple but pioneering notion – that healthcare should be provided based on need, not ability to pay’.32 Reflecting on this event, June recalls her delight at seeing, for the first time, photographs of her mother having a cup of tea at the fiftieth anniversary celebration, and how her mother had been thrilled to have been part of this.33 Despite the national significance of Trafford, for June the memory of the place is more personal, linked to her own memories of family.
It is not surprising that Trafford Hospital has been overlooked in considerations of NHS anniversaries and in the broader historiography of the NHS, despite its physical and symbolic place in the cultural memory of the NHS. While staff have constructed cultural meaning for this, it does remain at a localised level.34 The importance of local identity in the cultural history of the NHS is reinforced in interviews with people who live in Tredegar, the Welsh mining village in which Aneurin Bevan was born. Glyn Rawley Morgan, who has lived in Tredegar all his life, speaks about his family connections to the Medical Aid Society and talks with pride about Bevan and his ambitions to ‘Tredegarise’ the national health service.35 Similarly Megan Fox emphasises the importance of Bevan in Tredegar, again reflecting on her personal connections with the Medical Aid Society.36 Tredegar, like Trafford, demonstrates how the NHS intersects with broader cultural narratives to construct identities based on the history of the place and the moral value attached to the NHS. Hospitals like Trafford are tangible sites of significance in the cultural history of the NHS, but the NHS as a concept is an intangible aspect of the heritage of places like Tredegar, in which memories of the association with formation of the NHS have constructed a greater meaning to the original site of the Tredegar Medical Aid Society.37
Campaigning, closure, and change
The NHS as an evolving institution in which significant change has occurred has had a significant impact upon what can be culturally understood as spaces within the NHS. Hospitals as a focus for change have often been at the centre of campaigns against closure.38 Jenny Crane, in her chapter in this volume, explores the motivations for campaigning in relation to campaigners’ feelings about the NHS, suggesting how ‘this group has a special attachment to the NHS; these individuals have moved from feelings about the NHS towards action’.
To add to these debates, this section will consider the significance of place and space as determinants of resistance to, and acceptance of, change. Trafford General Hospital has been the focus of several campaigns against cuts in services over the past couple of decades, with headlines focusing on it as the ‘birthplace of the NHS’.39 Joanne Harding was part of a team which led the 2011 campaign ‘Save Trafford General’ against the closure of the accident and emergency department there as part of a merger with a larger hospital trust. In 2004 Joanne gave birth to her daughter there, and she describes this as a ‘fantastic incredible experience’, despite complications.40 Yet Joanne’s cultural memories of the hospital grew out of a non-healthcare-related experience when she delivered newspapers, sweets, and chocolates from a newsagent’s shop, where she helped out, to the hospital wards in Trafford. She recalls how she would chat with patients and staff and socialise with the student nurses. She describes how she loved the experience because she had an interest in healthcare and had a ‘thing’ for old hospitals and their architecture.41 Joanne’s motivation to become involved was due to her cultural memory of the place but also reflected her role in public life and involvement in local politics – and she had not been involved in the previous campaign against the closure of the maternity department.
Joanne describes the campaign, outlining how local people queued to sign the petition and how everybody had a story to tell about the hospital, indicating the extent to which the community was prepared to fight for Trafford.42 Ultimately the outcome of the campaign in 2010–11 was that the accident and emergency department did close, but Joanne believed something positive had been achieved, as it was replaced with an urgent care service that was open during daytime hours.43 Furthermore, the campaign has a legacy through an annual event at Golden Hill Park in Urmston which celebrates the NHS and focuses on changes to services and campaigns. Interestingly it is only at this point in her narrative that Joanne references Trafford’s place in the history of the NHS – ‘because of course it was Trafford General where it all began’ – which illustrates how cultural heritage of place is assumed to be shared by all.
Hughie Erskine, who worked at Trafford in healthcare estates, managing aspects from linen to car parking, speaks about his attachment to the hospital. He worked there from 1982 until his own ill-health led him to leave recently. He is passionate about the negative impacts of the cuts to services that Joanne was campaigning against and describes the wider negative impact on workplace culture across all staff, when domestic services, such as linen, were contracted out.44 Yet as a patient himself, he recognises the need for the specialist services that he travels to Liverpool to receive, and in turn for the specialist orthopaedic services that Trafford now provides. There is clearly a tension between the love for a place and a love for the NHS which recognises the need for change.
What role then does place have in the culture of campaigning in the NHS if buildings are part of the material and visual culture of the NHS, even though the NHS essentially inhabits a multitude of spaces? Caroline Bedale, born in 1951 in Cheshire, worked in the NHS for over thirty-five years, during which time she was an active trade unionist and branch secretary, among other roles, for UNISON in Manchester. Reflecting on her extensive trade union experience, Caroline states that ‘Historically it has always been easier to try and run campaigns that are about saving something rather than improving something, it becomes more nebulous when you are talking about improving something.’45 Caroline explains that people are fixated on campaigning about buildings – and the importance of the embodiment of the NHS in specific buildings – even if those buildings are outdated and no longer fit for purpose. Crucially, Caroline reflects on how campaigns should be focused more directly on maintaining services – not just on preventing cuts. She gives the example of health visitors and district nurses, of which there is a shortage – ‘yet you can’t stand outside a district nurse and her car to campaign’ – suggesting that the physicality of buildings has crucial meaning in the context of organising protests about the NHS.46
The visibility of the hospital as a space within the NHS has impacted on the culture of campaigning about the NHS and will continue to do so. Yet as Bedale articulates, change in the NHS can be positive, and the cultural attachments to place can both hamper change and limit the extent to which campaigns focus on the quality of services provided. In the UK the NHS permeates our lives in places outside the hospital environment, and the way in which we experience that space varies. For example, the experience of healthcare in the community creates a range of different spaces in which providers and patients experience it. Bridget McDade describes the environments of the homes she visited in Glasgow while working as a midwife in the 1960s, where sometimes there was a room and kitchen only, which were always immaculately kept with the fire lit as a sign of respect to the nurses.47 In contrast, Nanette Mellor describes how when she was pregnant in 2015 her community midwife would come and see her at work – a change in service designed to meet the needs of the patient but possibly also a deeper reflection on the value of women and work.48
Faith, health, and care
Beyond change in healthcare, space in the NHS also reveals a hidden history of faith and health. Culturally the NHS is often recognised or celebrated as a national religion, a concept that Nigel Lawson spoke of, yet a sentiment which is often invoked by others to explain the significance of the NHS.49 Writing at the outset of the COVID-19 global pandemic, Linda Woodhead mused on how ‘when faced with a biblical plague, the British turn not to God but the National Health Service. It is our national religion, the one thing sacred.’50 While the role of religion in medicine and healthcare throughout history is well documented, a largely unexplored part of the cultural fabric of the NHS is in its relationship with religion.51
Religion in the NHS (rather than the NHS as a religion) permeates many of the oral history interviews recorded by ‘NHS at 70’, from memories of the physical spaces, such as the chapels, to broader reflections on how religion was an essential part of the fabric of the NHS – as a result of the NHS being a space in which many people would seek out spiritual guidance following trauma or loss. Health researchers and theologians have addressed the role of spirituality and religion in healthcare, often from a global perspective. A recent literature review on the global role of the hospital chaplain highlights how the provision of chaplaincy services across different healthcare settings reflects the historical contexts within which they are located.52 It notes how in England, chaplaincy has been dominated by the formal relationship between the NHS and the Church of England, as illustrated by their simultaneous development within the social model of the newly formed NHS.53 Christopher Swift contends that hospital chaplains are at the intersection of change in the presence of the church in public spaces.54 In exploring the physical spaces for spiritual expression in the NHS, drawing on his personal experience of conflicting views over the allocation of space for spiritual care in a new cancer centre, Swift suggests that the physical changes in space for religion signify a shift in the overall place of religion in the NHS. He adds that this ‘altered landscape of the hospital reveals a process of social and religious transformation which is still under way, and whose destination is uncertain’.55
The significance of the relationship between the NHS and physical spaces and the implications of change suggested by Swift are echoed throughout Jillianne Norman’s interview. Born in Plymouth in 1959, Jillianne initially trained as a radiographer and worked in Frenchay Hospital in Bristol, retraining at the age of twenty-one as a hospital chaplain.56 Religion had been very much part of her early life; she describes her mother as being a devout Anglo-Catholic and a regular churchgoer. Her first post as a curate involved chaplaincy at a local hospital, and she suggests that her previous experience of working in healthcare was perhaps the reason why she got that post. Jillianne has worked as a chaplain for University Hospitals Bristol NHS Trust since 1999 and during this time has been involved with the changes in space and provision allocated for spirituality. In 2002 Bristol General Hospital closed and Jillianne was tasked with closing the two chapels, which involved going back through archives to find out whether they were dedicated or consecrated so that they could be closed appropriately.57 The chapels had histories separate from the NHS that defined their physical space. The closure of these chapels brought about the design of new ‘Sanctuary Spaces’ in both the newly built South Bristol Community Hospital and the renovated Bristol Royal Infirmary. Jillianne describes the privilege of being involved in this development and how her task was to make these spaces ‘look and feel different to the rest of the hospital and to be a place where people would feel comfortable coming into and feel like they can remain in as well’.58 She also outlined the need for these spaces to reflect the diversity of faiths within the UK, and as a result of her working with artists they were able to incorporate glass panels and woven hangings as privacy screens.59 Changes in the physical space for religion in the NHS and the place of the hospital chaplain attune to broader debates about secularism and religion in public institutions in the UK.60
There is perhaps no greater example of the intertwined relationship between the state, the NHS, and religion than that evidenced within the development of the NHS in Northern Ireland. Notably, Lawson’s reference to the NHS as a national religion is laden in that it was specific to England,61 when indeed an NHS exists in all four nations in the UK.62 Identity politics within the context of sectarian division had deep impacts on provision of healthcare, which was compounded by the geographical challenges of service provision within a divided nation.
In 2007 an article focused on a series of qualitative interviews in which medical professionals and patients from Northern Ireland spoke about their experiences.63 While the article concludes that in general, medical care represented a shared space that was expected to retain an integrity of its own, it was clear that the geographical location of hospitals and their origins within that physical space impacted on both staff and patient experiences. The example of the Mater Infirmary in Belfast is cited; the hospital had originally been a Catholic voluntary hospital which joined the NHS in 1972 and is located in an area which is mostly Catholic, yet the actual site impinges on a Protestant area and it is therefore used widely by Protestant patients from the Shankill Road.64
This intersection between the geography of healthcare and religion is also clear from ‘NHS at 70’ interviews. Briege Quinn, born in 1962 in Dungannon, Co. Tyrone, is a nurse consultant for mental health and learning disability with the Public Health Agency in Northern Ireland. Earlier in her career Briege established the first community addiction team in north-west Belfast. She reflects on how during the Troubles the centre had two entrance doors for the different communities to access the service because it was located on a divide.65 Briege speaks about the impact of sectarian violence on community care, recalling how she was trapped in the building during rioting and received a call from a relative of a patient with whom she had an appointment informing her that the patient was on the barricade and that they would personally escort her there to see the patient.66 This suggests that there was a universal appreciation for healthcare that transcended other cultural identities. This is echoed by Conor McCarthy, who was born in Belfast in 1976 and works at the Royal Victoria Hospital, where he is also active in UNISON. Conor remembers how in 1981, aged five, he was hit by a stone while going home from school in the midst of a riot at the height of the Troubles and had to attend Royal Victoria Hospital. He describes the hospital as a safe, neutral space in the middle of a war zone, recalling a big fish-tank and reflecting that it was the atmosphere in the hospital which struck him, to a greater extent than the incident.67
Historians have not traditionally viewed the NHS as a space in which to examine shifts in attitudes to religion and to unpick personal experiences of religion. Yet these interviews revealed how an exploration of the changing use of space in the NHS reflects much broader changes and debates within society about religion, the role of the state, and healthcare. This is especially relevant for locating the importance of the NHS within the cultural history of Northern Ireland. Certainly, situating the NHS as an investigative nexus for understanding culture, healthcare, religion, and sectarian conflict provides broader and more nuanced historical insights into the cultural power of the NHS within lived experience.
Conclusion: the NHS as a site of cultural change and the impact of COVID-19
This chapter opens up directions for centring the NHS as an institution as an important site of cultural and social change in the UK since 1948. The interviews illustrate how people remember and construct their NHS experiences within specific places and spaces, both internally within the NHS and beyond its boundaries, and how those memories are further embedded in wider cultural and social experiences and memories. The strength of oral history as a methodology enables these nuanced personal experiences of the NHS to be situated in a broader life trajectory which connects with wider cultural and social influences. Equally, an analysis of oral histories through the lens of space and place echoes Carla Pascoe: ‘Just as oral history is important for understanding place, so too is a place-based perspective well suited to oral history.’68 Personal memories of places, like Trafford General Hospital, are interwoven with constructed local identities, for example the ‘birthplace of the NHS’, in which meaning is given to the NHS in that specific context and is inherited by new generations.
This framework of thinking of the NHS as a central part of the cultural history of the UK has never been as evident as during the COVID-19 crisis. In March 2020 the NHS faced its greatest challenge to date when it responded to the global COVID-19 pandemic. At the time of writing it is impossible to overestimate the social, cultural, political, and economic consequences of the crisis in the NHS, in the UK, and globally. Considerations of space and place provide avenues of research to explore the social and cultural impact of COVID-19. Moreover, spatial changes in healthcare reflect deeper societal changes as a whole – for instance the move to digital healthcare. In April 2020 a general practitioner described how ‘almost overnight we were faced with a challenge of stopping footfall into general practice and almost in the space of about 48 hours moving over to digital consulting’.69 Digital consulting was not a new idea in healthcare, but COVID-19 acted as a catalyst, responding to the immediate need for physical distance between healthcare staff and patients to reduce risk of transmission of COVID-19.70 These physical changes are producing deep cultural changes in how staff and patients are able to interact. Yet this move to virtual consulting is echoed across many other aspects of peoples’ lives as face-to-face interaction has reduced and education, work, and social and family life have also turned to the digital.
The impact of COVID-19 on the personal lives of NHS staff can also be examined through physical space. Archie, a porter at a large London hospital, reflects on how he lived in a hotel during the initial crisis to protect his family from infection and describes the emotional impact of this.71 Gail, a practice manager, divided her home to provide a safe space for her immunocompromised husband, whom she would ‘meet in the garden’.72 Thus explorations of space and place are significant vectors for understanding the cultural impact of COVID-19 on society and the NHS, and will be important approaches for future historical enquiries into the pandemic.
Notes