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This book presents a comprehensive account of a major innovation in hospital funding before the NHS. The voluntary hospitals, which provided the bulk of Britain’s acute hospital services, diversified their financial base by establishing hospital contributory schemes. Through these, working people subscribed small, regular amounts to their local hospitals, in return for which they were eligible for free hospital care. The book evaluates the extent to which the schemes were successful in achieving comprehensive coverage of the population, funding hospital services, and broadening opportunities for participation in the governance of health care and for the expression of consumer views. It then explores why the option of funding the post-war NHS through mass contribution was rejected, and traces the transformation of the surviving schemes into health cash plans. This is a substantial investigation into the attractions and limitations of mutualism in health care. It is relevant to debates about organisational innovations in the delivery of welfare services.
Most people would agree that the hospital functions as one of the 'first duties of an organized society' as a public service for those members of the community who are in need. In the thirteenth century, hospitals represented a nexus of exchange between church officials, the community, the needy, and the pious or ambitious individual. This book presents a survey that offers an overview of the role of the hospital in affairs of the urban community, suggesting how changes within that community were reflected in the activities of the hospital. It locates the rise of the hospital movement in northern Italy within the context of the changing religious, social, and political environment of the city-states. The book introduces the hospital's central function in the distribution and administration of charity. It illustrates how the hospital and other charitable organizations played a role in the appropriation of power and influence by urban citizens. A comprehensive investigation of twelfth and thirteenth century hospitals' foundational charters follows. The book then delves into a detailed description of the physical plant of the hospital, the daily life of individuals, and rules and statutes followed by its members. It considers the social composition of donors, workers, and recipients of hospital services. Jurisdictional disputes among the city leaders, the community, individual religious orders, ecclesiastical authorities, and larger political forces. Finally, the book explores the process of consolidation and bureaucratization of hospitals in the fifteenth century and the emergence of state control over social services.
commonly excluded from accessing hospital services through the mechanisms described in the previous chapter. 3 It was only by charging higher rates to this separate class of patient that the hospitals stood any chance of turning a profit. This new category of patient would be accommodated not in the usual dormitory-style wards, but in a separate one- or occasionally two-bed room, domestic in style. These private wards would be physically separate, sometimes
hospital services. These various analyses permit a fuller evaluation of how successful the schemes were in enhancing the financial position of the hospitals. The nature of the contributory schemes in the inter-war years The sheer diversity of the hospital contributory schemes often attracted comment. Some schemes were administered directly by hospitals themselves, while others were operated by separate organisations, sometimes pre-existing Saturday funds, but also newly constituted bodies. There were in addition substantial variations with respect to internal
public hospital service. 152 In Bristol this meant the sick wards of the workhouses (rebranded as public assistance institutions following the 1929 Local Government Act) at Stapleton and Eastville. A Ministry of Health survey in the early 1930s judged that Stapleton was essentially a public asylum, with fewer than one in five of its 796 patients not certified. 153 Meanwhile, a great many of its patients were ‘aged and infirm persons, who are mostly bedridden’. 154
debates, especially after the publication of the 1942 Beveridge Report which recommended widespread reform of social welfare and formed the basis of the post-war welfare state. The state's obligation to provide medical attention to a civilian population suffering from exogenous threats of aerial attacks led to the inauguration of the Emergency Hospital Services (EHS) – later the
In the latter part of the nineteenth century, and especially in the first third of the twentieth century, the urban hospital saw its purpose move from the protection and care of patients to their diagnosis and cure. As a result of this process, the numbers and types of patients entering hospitals in England and France, and the funding structures supporting those admitted, underwent a substantial change. These changes were underpinned by new ways of accounting for treatment which saw starkly different approaches adopted by institutions in the two countries. Drawing on evidence from the hospital services of Leeds and Sheffield in England and Lille, Rouen and Le Havre in France, this chapter explores those differences. It utilises a range of sources, including hospital annual reports, financial returns, and internal enquiries, to examine the development of the daily rate – prix de journée – calculated for patient treatment by hospitals in France and the growth of block grants provided by working-class mutual societies in England. It shows that the daily rate, which initially emerged as a way to charge external organisations for using community funded hospitals, became a highly contested site in which accounting practices were deployed to police the boundaries of permissible costs. In contrast, the block grant was adopted, in part, to minimise accounting complexity and administrative costs, but more importantly to shore up the residual charitable elements of the ‘voluntary hospital’ system and impose strict financial discipline. Each of these approaches fed into postwar socialised hospital services, shaping accounting and financial practices for decades to come.
In assessing the impact of William Beveridge's Voluntary action over the last sixty years, this book provides a reminder that the terms 'voluntary action' and 'voluntary sector' are both fluid and contestable. The book demonstrates that the influences of Beveridge and voluntary action now extend not only beyond the period of the original publication of his report but also outside Britain to the wider 'British world'. It places Beveridge in the world in which he wrote Voluntary action as well as exploring the ideas, philosophies and experiences that influenced his intellectual development up to, and during, the 1940s. Beveridge's background and motivations behind the themes contained in Voluntary action are explored in various contexts. The book also focusses on specific areas of voluntary action with special relevance today. It presents surveys of different national situations, focussing on the influence of voluntary action in Britain, New Zealand, Australia and Canada in the aftermath of the publication of Beveridge's report. The situation that Beveridge set out to describe and analyse in 1948 has changed almost beyond recognition: the landscape in which voluntary action operates in the twenty-first century is now very different across all the countries surveyed in the book. Beveridge himself would probably have found it difficult to come to terms with some of these social changes and the challenges they have thrown up.
This book provides original documents from the Second World War years which will help the reader evaluate claims that the war introduced a new sense of social solidarity and social idealism which led to a consensus on welfare state reform. It provides important evidence on employment policy, race relations and anti-Semitism, women, health and the family, in addition to examining the Blitz, evacuation and the making of social policy. Special attention is paid to the debate within the Conservative party on the Beveridge Report and the proposed national health service. Two questions dominate the debate on the Second World War home front. Did the war create a new sense of social unity which bridged class and other pre-war divisions? Did the war produce a consensus on domestic policy which provided the basis for the post-war welfare state and full-employment policy? With the exception of Angus Calder's classic study, The People's War, most general accounts of the home front have stressed the themes of social unity and consensus. But research on specific groups and policies has undermined this model by drawing attention to the continuation of pre-war social conflicts and to the policy differences dividing the Labour parties and Conservative parties.
before and after 1948 is likely to be an oversimplification. This is true in the case of payment. While the interwar period's fledgling municipal hospital services anticipated the NHS in other ways, they also operated effectively the same payment system as the voluntary hospitals. Legislation in 1879 and 1885 had already empowered poor law guardians to recover ‘the cost of maintenance’ from those who were deemed able to