This book examines the payment systems operating in British hospitals before the National Health Service (NHS). An overview of the British situation is given, locating the hospitals within both the domestic social and political context, before taking a wider international view. The book sets up the city of Bristol as a case study to explore the operation and meaning of hospital payments on the ground. The foundation of Bristol's historic wealth, and consequent philanthropic dynamism, was trade. The historic prominence of philanthropic associations in Bristol was acknowledged in a Ministry of Health report on the city in the 1930s. The distinctions in payment served to reinforce the differential class relations at the core of philanthropy. The act of payment heightens and diminishes the significance of 1948 as a watershed in the history of British healthcare. The book places the hospitals firmly within the local networks of care, charity and public services, shaped by the economics and politics of a wealthy southern city. It reflects the distinction drawn between and separation of working-class and middle-class patients as a defining characteristic of the system that emerged over the early twentieth century. The rhetorical and political strategies adopted by advocates of private provision were based on the premise that middle-class patients needed to be brought in to a revised notion of the sick poor. The book examines why the voluntary sector and wider mixed economies of healthcare, welfare and public services should be so well developed in Bristol.

George Campbell Gosling

1 Payment in the history of healthcare ‘The voluntary hospital system is not dead’, declared one delegate at the 1938 annual conference of the Incorporated Association of Hospital Officers; ‘It may be changing, it may eventually become something other than a voluntary hospital system, but it is not dead.’ 1 Ten years later it would be brought to an abrupt end, nationalised and integrated almost wholesale into the new

in Payment and philanthropy in British healthcare, 1918–48
Confronting complexities

The Irish health system is confronted by a range of challenges, both emerging and recurring. In order to address these, it is essential that spaces are created for conversations around complex ethical and legal issues. This collection aims to provide a basis for ongoing engagement with selected issues in contemporary Irish health contexts. It includes contributions from scholars and practitioners across a range of disciplines, most particularly, ethics, law and medicine.

The focus of the collection is interdisciplinary and the essays are situated at the intersection between ethics, law and medicine. Important issues addressed include admission to care homes; assisted suicide; adolescent decision-making; allocation of finite resources; conscientious objection; data protection; decision-making at the end of life; mental health; the rights of older people; patient responsibilities; stem cell research; the role of carers; and reproductive rights. From these discussion, the collection draws out the following interlinking themes, addressing difference; context and care; oversight and decision-making; and, regulating research.

The essays are theoretically informed and are grounded in the realities of the Irish health system, by drawing on contributors’ contextual knowledge.

This book makes an informed and balanced contribution to academic and broader public discourse.

The case of Universal Health Insurance – by competition
Cliona Loughnane

9 Cliona Loughnane Governing healthcare: the case of Universal Health Insurance – by competition Introduction One of the defining features of the Irish health system, since the establishment of Voluntary Health Insurance (VHI) in the 1950s, has been a heavy reliance by those who can afford it on private health insurance. Thus the Irish health system, which is three quarters funded by taxation (Wren, Connolly and Cunningham, 2015), is a strange mix of a national health system with high levels of private insurance cover (with up to 50% of the population holding

in Reframing health and health policy in Ireland
Abstract only
Margaret Brazier and Emma Cave

15.1 In 2006, six healthy volunteers at Northwick Park Hospital were rushed to Critical Care after suffering an adverse reaction in a phase 1 clinical trial. 2 At least four of them suffered multiple organ failure, and it was feared that they may have suffered permanent damage to their immune systems. The drug, TGN1412, was a monoclonal antibody designed to treat leukaemia and rheumatoid arthritis. Volunteers were paid £2,000. 3 The Medicines and Healthcare Products Regulatory Agency (MHRA) concluded that the reaction resulted from an ‘unpredicted biological

in Medicine, patients and the law (sixth edition)
Struggles and conflicts of an emerging public health system in the United States, 1915–45
Rima D. Apple

9 ‘Community healthcare’: Struggles and conflicts of an emerging public health system in the United States, 1915–45 Rima D. Apple Introduction In the first half of the twentieth century, concern for community health, particularly worries over the high rates of infant and maternal mortality and of tuberculosis cases, spurred the development of public health nursing in the United States.1 The increase in public health nurses and the variety of organisations supplying them indicate that American society strongly believed in their effectiveness. Yet, their very

in Histories of nursing practice
Two sides of the same unequal coin?
Asim A. Sheikh

6 Patient autonomy and responsibilities within the patient–doctor partnership: two sides of the same unequal coin? Asim A. Sheikh Introduction The autonomous patient has the ability to engage with a healthcare provider in relation to his or her health on a wide range of issues. This ability and control are central to a patient’s autonomy and self-­determination. This chapter will consider whether this ability confers both rights and responsibilities upon patients. It asks whether the language and idea of the healthcare provider and healthcare receiver (‘doctor

in Ethical and legal debates in Irish healthcare
Perspectives from the Neary and Halappanavar cases
Heike Felzmann

12 Governance failures and organisational ethics: perspectives from the Neary and Halappanavar cases Heike Felzmann Introduction While the majority of the professional healthcare ethics literature and in particular professional guidance documents focus primarily on individual accountability and responsibilities of healthcare professionals towards patients, colleagues and the public, the significance of the organisational context for ethical behaviour is considered much less frequently. Yet, in official reports on high profile Irish cases, such as the Lourdes

in Ethical and legal debates in Irish healthcare
Ruth Fletcher

responds to these concerns by arguing for a harm reduction approach to conscientious objection. Those who wish to refuse provision of healthcare in spite of a legal obligation, and those who wish to provide healthcare in spite of a legal prohibition, may be harmed by having to act against their most intimate convictions. Moreover, public reasoning about the proper scope of healthcare provision could be disadvantaged by a failure to recognise a space for critical consciousness. The need to reduce the risk of harm to women, whose lawful entitlement to access abortion has

in Ethical and legal debates in Irish healthcare
An exploration of the role of autonomy in the debate about assisted suicide
Louise Campbell

variously that such claims distort the ‘true’ meaning of autonomy, that decriminalising assistance in dying will violate the autonomy of vulnerable persons, and that autonomy should not take priority when its exercise threatens the rights or interests of healthcare professionals, family members or others. The purpose of the present discussion is to examine the role played by the concept of autonomy in the discussion of assisted suicide, using as a point of reference the case of Marie Fleming, the first challenge to the prohibition on assistance in dying to be heard by the

in Ethical and legal debates in Irish healthcare