Health before the NHS. A Medical Revolution.

Robert Winston narrates the story of health in Britain before the National Health Service (NHS). Using footage from archives including the Wellcome Library, this programme explores how complex pre-war hospital health care provision was and then how hospitals became centres for clinical excellence. The Spanish flu epidemic in 1918 was both catastrophic in terms of the number of deaths and revealed substantial flaws in hospital capacity. Social historians and senior citizens who experienced hospital care as children comment. In particular, there was an endless catalogue of infectious diseases; preventative treatment took the form of a patient being taken away in a fever van to an isolation ward or hospital. TB or tuberculosis was one of the most feared diseases; the combination of heavily polluted inner cities and TB was lethal. Mary Allan was a patient at a sanatorium as a child. Sanatoria were situated in the countryside, treatment was collapsing the affected lung, allowing it to recover. Next, funding health care is explained in more detail. David Lloyd George set up an insurance scheme for working people, this did not include hospital care which was considered to be for very poor people - a legacy of the infirmaries attached to Victorian work houses. Post World War I, many of the infirmaries housed the long-term sick. The middle-classes paid for treatment, including surgery, which was performed in the home. In contrast to the infirmaries, were voluntary hospitals which became beacons of clinical excellence. Doctors were unpaid, receiving their income from teaching students or from private practice. Voluntary hospitals did, however, deal with accidents and emergencies - mostly from traffic accidents. Diccon Pridie talks about his father, Kenneth Pridie, who was a pioneering orthopaedic surgeon, who practised at the Bristol Royal Infirmary. Many surgeons developed their own surgical tools; speed was of the essence as the longer you were under a general anaesthetic, the more bed rest was required and the longer recovery would be. The Great Depression in the 1930s meant that the very richest people were hit by high death duties and became less willing to give so much charitably. 'Flag day' was born; this brought collecting boxes onto the streets. Ultimately, patients were asked to contribute financially; this was means-tested. The hospital almoner assessed a patient's ability to pay. This resulted in a new funding model; insurance schemes for the working classes organised by the work place. Bunty Lewin (interviewed in 1983) explains her role as hospital almoner. Often, the almoner was not known for their compassion. Eventually their role expanded - towards that of the modern day social worker. In an age before antibiotics, Mary Allan explains the concept of the 'clean' and 'dirty' nurses in guarding against cross-infection. William Frankland recalls his experience of working with Alexander Fleming, the discoverer of penicillin. Prior to penicillin, the great break-through in medicine was sulphonomides which were used to treat puerpal or childbed fever, an infection which caused high mortality in new mothers; maternal deaths fell by 80%. Another major innovation was the iron lung used to treat paralysis caused by polio. This was the first life-support system. Medical technology was becoming more common in hospitals; UV treatment and electric current being passed through the body are illustrated. Radium, although expensive, was highly effective as a treatment for cancer. Hospitals had to raise more money; middle-class people chose hospital treatment and were prepared to pay for private beds, wards and even wings. However, voluntary hospitals only accounted for a third of all hospital beds. Legislation in 1929, created 'municipal' hospitals leading to an end to the old infirmaries. In London this accounted for 98 hospitals centrally governed and creating the impetus for modernisation. The 1930s was a great time for centralised planning particularly as war loomed. It was ony the mid-1940s when penicillin was able to be manufactured in the quantities required; Jim Mulligan recollects being given penicillin as a child. Post-war, the newly elected Labour government laid down plans for a National Health Service. Initially this initiative was opposed by the BMA, an organisation for doctors, although in 1948 the NHS was launched providing free at the point of delivery healthcare.

NHS

UK : BBC 4, 2012.

1 DVD (60 min.) : sound, color, PAL.

Available LIght

Broadcast on 1st October, 2012

Broadcast Development Award grant holder for this project.

Contains clips from the Wellcome Library

Produced and directed by Naz Massoumi. BBC Productions Bristol in association with Available Light Productions.