0:00:19 > 0:00:21Before the National Health Service,
0:00:21 > 0:00:26the hospital was not always the kind of place you would go to get better.
0:00:28 > 0:00:30I was so petrified of them.
0:00:30 > 0:00:33And I imagine that fear was common to everybody.
0:00:36 > 0:00:41Forbidding, rudimentary, and reserved for the destitute,
0:00:41 > 0:00:42hospitals were a last resort.
0:00:45 > 0:00:48People tended to be frightened to go to the hospital.
0:00:48 > 0:00:49The hospital was where you went to die.
0:00:57 > 0:00:59But in the decades leading up to the NHS,
0:00:59 > 0:01:03hospitals would undergo an extraordinary transformation.
0:01:05 > 0:01:07At the heart of this change
0:01:07 > 0:01:10was a fierce battle against death and disease,
0:01:10 > 0:01:13as scientists searched for miracle cures,
0:01:13 > 0:01:15and weird and wonderful technologies
0:01:15 > 0:01:18helped breathe new life into old afflictions.
0:01:19 > 0:01:22They put your foot in a bowl of water and they passed a current
0:01:22 > 0:01:27through your leg, and it made your muscle contract and expand.
0:01:29 > 0:01:32Yet change was not limited to science and technology.
0:01:32 > 0:01:35How the system was run, and how it was paid for,
0:01:35 > 0:01:38would sow the seeds for another revolution.
0:01:41 > 0:01:45This is the story of how access to good hospital healthcare
0:01:45 > 0:01:51became a right, transforming grim Victorian institutions for the poor
0:01:51 > 0:01:53into modern centres of medicine for all.
0:02:10 > 0:02:11November 1918.
0:02:12 > 0:02:14Armistice Day.
0:02:19 > 0:02:22Behind the smiles and celebrations,
0:02:22 > 0:02:25a new enemy, far less visible, was lurking.
0:02:32 > 0:02:36It would claim more lives than the trenches of the First World War.
0:02:38 > 0:02:41Britain's hospitals were helpless against it.
0:02:44 > 0:02:46The Spanish flu was pretty much global.
0:02:46 > 0:02:49There was almost nowhere in the world,
0:02:49 > 0:02:52I think some part of the Amazon, which escaped completely.
0:02:52 > 0:02:56One of the ironies of it was that it tended not to affect babies
0:02:56 > 0:02:59and the elderly and frail, as most influenza viruses do,
0:02:59 > 0:03:02but it affected younger people, healthy people.
0:03:03 > 0:03:07It just seemed a terrible sort of visitation,
0:03:07 > 0:03:10almost a plague on top of the slaughter of war.
0:03:13 > 0:03:17The flu had arrived in Glasgow in the spring.
0:03:17 > 0:03:21By the end of the year, a quarter of a million had perished.
0:03:27 > 0:03:31The population was already worn down, and it struck hard.
0:03:31 > 0:03:33Unfortunately, the hospitals were already busy
0:03:33 > 0:03:36dealing with war casualties and there wasn't enough room
0:03:36 > 0:03:39to deal with all those who needed hospital care.
0:03:41 > 0:03:46The epidemic would come to an end, but the flu had exposed a crisis.
0:03:47 > 0:03:50Across the country, hospitals couldn't cope.
0:03:50 > 0:03:53No national system existed,
0:03:53 > 0:03:56so they could only offer a patchwork of services.
0:03:56 > 0:04:01Some had the latest facilities, others were desperately run-down.
0:04:01 > 0:04:03So there's a range of hospitals.
0:04:03 > 0:04:05Little hospitals dotted all around the country.
0:04:05 > 0:04:08Very disorganised, perhaps run by one doctor,
0:04:08 > 0:04:12and this was very problematic, because patients could often receive
0:04:12 > 0:04:15very poor care in these small hospitals.
0:04:15 > 0:04:18There was no-one overseeing, say for example, surgical procedures,
0:04:18 > 0:04:22and some doctors went well above their levels of competency
0:04:22 > 0:04:25and tried operating on patients
0:04:25 > 0:04:29when they had no reason to do so and no ability to do so.
0:04:29 > 0:04:31So they were quite dangerous.
0:04:33 > 0:04:34How you got into hospital
0:04:34 > 0:04:38and what kind of treatment you received was a lottery.
0:04:38 > 0:04:41Most people never even made it into hospital.
0:04:41 > 0:04:43I don't know what life expectancy was,
0:04:43 > 0:04:45but it can't have been very high.
0:04:45 > 0:04:48Death was a very frequent visitor in those days.
0:04:48 > 0:04:52And pneumonia was a big thing, you died of pneumonia in those days.
0:04:52 > 0:04:56If you had an accident, broke your neck, for example, that was it.
0:04:56 > 0:04:57You were dead.
0:04:59 > 0:05:02But a change was taking place.
0:05:02 > 0:05:04And it began with attempts to overcome
0:05:04 > 0:05:08one of the period's biggest killers - infectious disease.
0:05:10 > 0:05:12You've got lots of childhood diseases,
0:05:12 > 0:05:15such as scarlet fever, mumps, measles, whooping cough,
0:05:15 > 0:05:19that are really putting a lot of children into hospital.
0:05:19 > 0:05:21Some of them were more virulent than they would be today.
0:05:23 > 0:05:25With a lack of effective cures,
0:05:25 > 0:05:28and no antibiotics at the doctor's disposal,
0:05:28 > 0:05:32the only chance of fighting disease was to stop the spread of infection.
0:05:34 > 0:05:36There weren't many treatments really available
0:05:36 > 0:05:38to deal with the infectious diseases.
0:05:38 > 0:05:39Isolation was the key.
0:05:39 > 0:05:42They built isolation hospitals, isolation wards,
0:05:42 > 0:05:47and you kept these people isolated for a time that was regarded as safe.
0:05:57 > 0:06:00When I was about nine months, I got scarlet fever,
0:06:00 > 0:06:03which was fatal in those days.
0:06:03 > 0:06:05You can imagine the terror.
0:06:09 > 0:06:12I was taken out, wrapped in a red blanket,
0:06:12 > 0:06:16carried out to the fever van.
0:06:16 > 0:06:20Taken to the hospital, put in isolation.
0:06:20 > 0:06:25My parents could go and see me, and look at me through a window,
0:06:25 > 0:06:27but every patient was given a number.
0:06:27 > 0:06:34Mine was 1268, my sister says the number is engraved on her heart.
0:06:34 > 0:06:38And the Evening Gazette would print a list of all the numbers
0:06:38 > 0:06:43with categories following it like "extremely ill", "improving",
0:06:43 > 0:06:45"critically ill".
0:06:45 > 0:06:49And there was a noticeboard outside the hospital, and my father
0:06:49 > 0:06:55would stop his bus and look at the list to see what the condition was.
0:06:55 > 0:06:58I mean it was as primitive as that, and distant as that.
0:07:03 > 0:07:06Most feared of all was tuberculosis.
0:07:06 > 0:07:09TB mainly affected the lungs
0:07:09 > 0:07:12and caused one in eight deaths at the start of the century.
0:07:17 > 0:07:22The symptoms of tuberculosis are usually bleeding from the lungs,
0:07:22 > 0:07:26so haemorrhaging, so you would bleed out of your mouth and nose.
0:07:26 > 0:07:29Excessive tiredness, weakness, debility,
0:07:29 > 0:07:31and it was highly infectious.
0:07:33 > 0:07:36Diseases were rife in the big industrial cities,
0:07:36 > 0:07:40where the poor and undernourished were crammed in damp housing
0:07:40 > 0:07:44and where the air was polluted with filthy smog.
0:07:44 > 0:07:47Before the Clean Air Act, we used to get some dreadful,
0:07:47 > 0:07:51literally hanging curtains, yellow fogs. It was awful.
0:07:51 > 0:07:55And obviously not any good for anybody with a chest condition.
0:08:04 > 0:08:07And that I had this spot on my lung,
0:08:07 > 0:08:10they decide that I need to get out of London and arrange for me
0:08:10 > 0:08:13to go to the sanatorium, which was up here on the Mendips.
0:08:19 > 0:08:25The sanatorium, an antidote to the soot and smoke of the city.
0:08:25 > 0:08:30Once you had TB, it offered the only cure then available -
0:08:30 > 0:08:33bed rest, and the great outdoors.
0:08:33 > 0:08:37And the idea was that you had fresh air, plenty of it,
0:08:37 > 0:08:39and you were surrounded by pines.
0:08:39 > 0:08:41The resin's supposed to be good for you.
0:08:45 > 0:08:50In 1924, you had the establishment of the Sunlight League, lidos,
0:08:50 > 0:08:54being outside and exposing their bodies to the elements,
0:08:54 > 0:08:56and this is very good for people,
0:08:56 > 0:08:59and this follows on within hospital spaces as well.
0:08:59 > 0:09:02You would rest and lie in a bed, you'd breathe air,
0:09:02 > 0:09:05and there was this idea you would expand your lungs with clean air.
0:09:07 > 0:09:10So to go to the countryside, to look at trees and hills
0:09:10 > 0:09:13and things like that, was considered very beneficial.
0:09:21 > 0:09:25They had a treatment if you needed it, pneumothorax treatment,
0:09:25 > 0:09:29which was a treatment which collapsed the lungs,
0:09:29 > 0:09:32which allowed that part of the lung that was affected
0:09:32 > 0:09:35to rest in order to try and heal itself.
0:09:38 > 0:09:42Some of the girls were there for a year, two years.
0:09:42 > 0:09:45It wasn't a thing that you went there short-term.
0:09:45 > 0:09:47If you were, you were lucky.
0:09:48 > 0:09:51You'd be out and about with them,
0:09:51 > 0:09:55walking in the grounds and next morning you'd ask where
0:09:55 > 0:09:57say Elizabeth was or someone,
0:09:57 > 0:10:00and they would say, "Sorry, she died in the night."
0:10:02 > 0:10:08You just never knew. They could be there one day and gone the next.
0:10:12 > 0:10:16Sanatorium treatment for tuberculosis was free for workers
0:10:16 > 0:10:18under the National Insurance scheme.
0:10:19 > 0:10:21Introduced in 1911 by David Lloyd George
0:10:21 > 0:10:25and the Liberal Government, it was an obligatory health insurance
0:10:25 > 0:10:29for workers, in return for a deduction from their wages.
0:10:31 > 0:10:36It covered them for their primary care, in other words
0:10:36 > 0:10:38their access to their GP,
0:10:38 > 0:10:41and it paid for a certain amount of sickness benefit
0:10:41 > 0:10:45so that when they were ill and couldn't earn money,
0:10:45 > 0:10:47they had some money coming in.
0:10:48 > 0:10:52However, what national health insurance did not do
0:10:52 > 0:10:54was pay for hospital care.
0:10:56 > 0:10:59In fact, access to hospital care
0:10:59 > 0:11:04was organised in an elaborate but haphazard way.
0:11:04 > 0:11:06And it wasn't intended for everyone.
0:11:07 > 0:11:11Today, I think most people think of the hospital
0:11:11 > 0:11:14as a place where everyone goes for medical services.
0:11:14 > 0:11:17But in the past, the hospital really was an institution for the poor.
0:11:22 > 0:11:26One of the reasons for this was that the largest hospitals had developed
0:11:26 > 0:11:30out of primitive infirmaries for sick inmates of the workhouse,
0:11:30 > 0:11:32a Victorian institution for the poor.
0:11:36 > 0:11:38The term workhouse implies
0:11:38 > 0:11:41they were actually supposed to carry out labour,
0:11:41 > 0:11:44and that was things like stone-breaking,
0:11:44 > 0:11:47and unpicking ropes to stuff mattresses, and so on.
0:11:47 > 0:11:51So the idea of these institutions originally was that they
0:11:51 > 0:11:58stigmatised people who resorted to the state for support in poverty.
0:12:02 > 0:12:04To cater for its sick inhabitants,
0:12:04 > 0:12:07each workhouse had formed its own infirmary.
0:12:11 > 0:12:15Their methods of treatment were rudimentary - to say the least.
0:12:17 > 0:12:18Bed sharing was common.
0:12:18 > 0:12:22You might, you know, have someone with an infectious disease
0:12:22 > 0:12:26sharing a bed, you know, with some other condition.
0:12:26 > 0:12:30There were no nurses employed by the workhouse in those days.
0:12:30 > 0:12:33The nursing was all done by inmates,
0:12:33 > 0:12:35who often were illiterate.
0:12:35 > 0:12:37So they couldn't read instructions,
0:12:37 > 0:12:40they couldn't read labels on bottles,
0:12:40 > 0:12:44they distinguished the medicine by the colour of the contents.
0:12:44 > 0:12:46And they were often drunk.
0:12:50 > 0:12:55Many of these infirmaries had improved during the First World War.
0:12:57 > 0:13:00But they were now reserved mainly for the long-term sick and elderly.
0:13:00 > 0:13:03And most of them retained their stigma.
0:13:06 > 0:13:10Wally Barnes remembers what people thought of the workhouse hospital
0:13:10 > 0:13:12on Bancroft Road, in East London.
0:13:14 > 0:13:17Don't go into Bancroft, because you'll never come out.
0:13:17 > 0:13:19Not on your own feet.
0:13:19 > 0:13:21Now, that was the attitude of some people.
0:13:21 > 0:13:23If you go into Bancroft Road,
0:13:23 > 0:13:26you don't come out on your own two feet.
0:13:26 > 0:13:28What they mean is they carry you out.
0:13:30 > 0:13:34The hospital is originally for people
0:13:34 > 0:13:36who cannot afford a doctor at home, basically.
0:13:36 > 0:13:41So working-class people, very poor people, charitable cases...
0:13:41 > 0:13:44So people who could not afford to go to the doctor
0:13:44 > 0:13:46or have a doctor come to their home,
0:13:46 > 0:13:49which is what the middle classes and certainly the upper classes did.
0:13:52 > 0:13:55Well, I got a frightful bad pain in my side one day.
0:13:55 > 0:13:57And it got worse and I rang up Dr Cheatle.
0:13:57 > 0:14:00And said, "I think I've got appendicitis,
0:14:00 > 0:14:04"I want you to come and take my appendix out," so he did.
0:14:04 > 0:14:07He showed up straight away, I was about 13 at the time.
0:14:07 > 0:14:10And he draped everything in the whole room with white sheets.
0:14:10 > 0:14:13It was quite marvellous-looking, you know.
0:14:13 > 0:14:16But I think Nancy and a group of friends came round
0:14:16 > 0:14:17about the same time
0:14:17 > 0:14:21and they thought that we were playing doctors or doing something funny in the nursery, you know.
0:14:21 > 0:14:24It was actually me having my appendix out.
0:14:24 > 0:14:27The doctor would come to do the surgery,
0:14:27 > 0:14:29attend the home with the patient.
0:14:29 > 0:14:32They would have to pay for the anaesthetist,
0:14:32 > 0:14:35who would come with the doctor to anesthetise the patient.
0:14:35 > 0:14:39And then the surgery would be done on the dining room table
0:14:39 > 0:14:43and then the patient would go back to their own bed and recover at home,
0:14:43 > 0:14:45usually with the aid of a professional nurse,
0:14:45 > 0:14:47who would stay with that person all the time,
0:14:47 > 0:14:49and the doctor would make daily visits to come and see them,
0:14:49 > 0:14:51to make sure that they were doing OK.
0:14:52 > 0:14:58And then he fixed it up in a jar of alcohol
0:14:58 > 0:15:01and so I was frightfully pleased to have it.
0:15:01 > 0:15:03But Nanny flushed it down the toilet.
0:15:03 > 0:15:06You know, she was sort of saying it was a disgusting object.
0:15:10 > 0:15:14Yet the future of health care would lay neither in the homes of the rich
0:15:14 > 0:15:17nor in the workhouse infirmaries,
0:15:17 > 0:15:21but in a completely different kind of hospital, funded by charity.
0:15:30 > 0:15:34These flagship hospitals stood in complete contrast
0:15:34 > 0:15:36to the horrors of the workhouse.
0:15:36 > 0:15:40They were known as voluntary hospitals.
0:15:44 > 0:15:47Early ones were, for example, Guy's, in London,
0:15:47 > 0:15:49Addenbrooke's, in Cambridge,
0:15:49 > 0:15:52Bristol Infirmary.
0:15:52 > 0:15:55Essentially, they differentiated themselves
0:15:55 > 0:15:57from the Poor Law workhouses.
0:15:57 > 0:16:03They were intended largely for what might have been conceived of
0:16:03 > 0:16:07as the more respectable poor - working people,
0:16:07 > 0:16:11who, for reasons of illness or accidents,
0:16:11 > 0:16:16were temporarily knocked out of the job market.
0:16:27 > 0:16:31Providing for local workers in industry,
0:16:31 > 0:16:36these hospitals were at the cutting edge of medical care.
0:16:40 > 0:16:43Voluntary hospitals were interesting.
0:16:43 > 0:16:48Doctors were actually unpaid, they were honorary doctors in many cases.
0:16:48 > 0:16:52They almost always had a large private practice,
0:16:52 > 0:16:54which is where their income came from.
0:16:54 > 0:16:57And many voluntary hospitals were also teaching hospitals
0:16:57 > 0:17:01and doctors got income from the students they taught.
0:17:09 > 0:17:11Lots of sort of picking and choosing went on,
0:17:11 > 0:17:13particularly in the outpatients department.
0:17:13 > 0:17:18Anybody could pretty much pitch up at a voluntary hospital and get seen.
0:17:18 > 0:17:20And if you had an interesting case,
0:17:20 > 0:17:24then you might be taken in for treatment,
0:17:24 > 0:17:28because you would be useful teaching material for the staff.
0:17:34 > 0:17:38It also depended on what conditions the practitioners were interested in.
0:17:38 > 0:17:42There might have been a diabetes clinic at the institution,
0:17:42 > 0:17:45there might have been some interest in cancer research.
0:17:47 > 0:17:49But the voluntary hospitals always admitted accidents.
0:17:49 > 0:17:52So if you were the victim of an accident,
0:17:52 > 0:17:54run down by a car in the street, for example,
0:17:54 > 0:17:58you would often just be picked up and carried into a voluntary hospital.
0:17:58 > 0:18:02And those emergency treatments would be provided.
0:18:08 > 0:18:10One of the reasons, of course,
0:18:10 > 0:18:12why a lot of people would have seen hospitals,
0:18:12 > 0:18:13perhaps in the '20s and '30s,
0:18:13 > 0:18:18was the extremely high incidence of car accidents.
0:18:23 > 0:18:26Roads were pretty unregulated.
0:18:26 > 0:18:30Of course there were no seatbelts or Breathalysers or anything like that.
0:18:37 > 0:18:39And there was a great deal of feeling
0:18:39 > 0:18:42that it was an Englishman's right to drive as fast as he liked,
0:18:42 > 0:18:47like Mr Toad, you know, on the wrong side of the road, if you like, honking his horn.
0:18:53 > 0:18:55BRAKES SQUEALING
0:18:55 > 0:18:56CRASH
0:19:00 > 0:19:03The motor car came along, people started having accidents.
0:19:03 > 0:19:07Serious fractures were appearing that required a surgeon.
0:19:07 > 0:19:10So somebody who was practical and interested in new ideas
0:19:10 > 0:19:14was obviously the ideal person at the right time
0:19:14 > 0:19:16to get started on all this.
0:19:18 > 0:19:20Diccon's father, Kenneth Pridie,
0:19:20 > 0:19:24was one of the first surgeons to focus on orthopaedics -
0:19:24 > 0:19:27surgery of the bones and joints.
0:19:27 > 0:19:30He wanted to specialise in this one thing
0:19:30 > 0:19:32and make a go of it.
0:19:32 > 0:19:37And up till then, it was just one little facet of general surgery.
0:19:37 > 0:19:42He got his opportunity at one of the main voluntary hospitals,
0:19:42 > 0:19:44the Bristol Royal Infirmary.
0:19:46 > 0:19:52I have a photograph that he took in 1934 when he went there of the splint room.
0:19:52 > 0:19:55It looks like a scrapyard and, obviously, he took that
0:19:55 > 0:19:56just to show what a joke
0:19:56 > 0:20:00the sort of approach to treatment was at that time
0:20:00 > 0:20:02and how he was going to sort it out.
0:20:05 > 0:20:09A lot of the surgeons who are taking surgery forward at this time,
0:20:09 > 0:20:11they have to make their own instruments.
0:20:11 > 0:20:14So they are innovators, they have to design instruments
0:20:14 > 0:20:16with long handles, for example.
0:20:19 > 0:20:24But new tools and a steady hand were not enough to keep you alive.
0:20:24 > 0:20:28A unique film of Kenneth Pridie performing a hip operation
0:20:28 > 0:20:31illustrates how a patient's life or death
0:20:31 > 0:20:35depended on how long they spent under the knife.
0:20:35 > 0:20:41He is showing how to measure up the hip with a special measuring device
0:20:41 > 0:20:45and you take that measuring device onto the patient
0:20:45 > 0:20:48and you drill a little pin in.
0:20:49 > 0:20:54And you knock this hollow pin over the guide wire.
0:20:54 > 0:20:57He uses hydraulic hammers
0:20:57 > 0:21:01and braces and bits, and all sorts of things, and hammers it into place.
0:21:01 > 0:21:04And then he just gets hold of the leg and it's still...
0:21:04 > 0:21:06You know, it's still moving, so he hasn't gone too far.
0:21:06 > 0:21:08Then he sets it up and then, he pans back to the clock
0:21:08 > 0:21:11to proudly show it's 12 minutes after he started.
0:21:13 > 0:21:16The point is that if you can complete this operation in 12 minutes,
0:21:16 > 0:21:20the patient is much more likely to recover quickly,
0:21:20 > 0:21:23be mobilised and walking again within a couple of weeks
0:21:23 > 0:21:27and back to work, and that's what the whole thing is about.
0:21:28 > 0:21:31The longer you were under a general anaesthetic,
0:21:31 > 0:21:33the more debilitated you were.
0:21:33 > 0:21:37And previous to that, people had been laid out
0:21:37 > 0:21:39for...three months or something.
0:21:39 > 0:21:42Well, after that, you can't walk anyway, you know.
0:21:42 > 0:21:45So the operation may be a complete success,
0:21:45 > 0:21:47but the patient died or whatever, you know.
0:21:47 > 0:21:49I meant, it's results that count.
0:21:49 > 0:21:51He was very much a results man.
0:21:53 > 0:21:56The surgeons were certainly seen as formidable figures.
0:21:56 > 0:21:59Within the hospital, they were treated with a lot of respect,
0:21:59 > 0:22:00especially by the patients.
0:22:00 > 0:22:03A lot of patients regarded these people as saviours.
0:22:03 > 0:22:05And they were, after all, volunteers,
0:22:05 > 0:22:07they weren't paid for their services.
0:22:07 > 0:22:09So they were set apart from the paid hospital staff.
0:22:12 > 0:22:14We didn't have much dealing with the surgeons.
0:22:14 > 0:22:15There were very remote.
0:22:15 > 0:22:17You know, when they came,
0:22:17 > 0:22:19it was almost sweeping above a path in front of them,
0:22:19 > 0:22:22because they were considered so lofty.
0:22:22 > 0:22:25They were thought so highly of - Mister This, Doctor That...
0:22:25 > 0:22:29Yes, they were next to God, really, in many ways.
0:22:29 > 0:22:31They were consultants,
0:22:31 > 0:22:34they had large private practices by this time.
0:22:34 > 0:22:36And although these were charitable cases,
0:22:36 > 0:22:39grateful patients often brought their surgeons gifts
0:22:39 > 0:22:43in exchange for some of the surgery that was performed.
0:22:50 > 0:22:54Voluntary hospitals had been set up as charitable institutions,
0:22:54 > 0:22:58but the foundations on which they'd been built were crumbling.
0:23:00 > 0:23:03Britain's economy had not recovered after the war
0:23:03 > 0:23:07and it wasn't just the poor who were feeling the pinch.
0:23:08 > 0:23:13It's sometimes summed up as "death duty" and "death duties."
0:23:13 > 0:23:16In other words, the very rich classes in Britain,
0:23:16 > 0:23:22who had been a linchpin providing charity for the voluntary hospitals
0:23:22 > 0:23:27had actually not only suffered quite significant losses
0:23:27 > 0:23:30of younger sons who'd gone off as officers
0:23:30 > 0:23:32to fight in the trenches and so on,
0:23:32 > 0:23:36so families had actually been hit quite badly,
0:23:36 > 0:23:40but they were now having to pay much larger levels of taxation.
0:23:40 > 0:23:43This was the moment in which charity,
0:23:43 > 0:23:46the old traditional form of hospital philanthropy,
0:23:46 > 0:23:49now began to seem inadequate.
0:23:51 > 0:23:53With rising costs,
0:23:53 > 0:23:57voluntary hospitals were desperately strapped for cash.
0:23:57 > 0:24:00A dramatic change was needed in how they were paid for.
0:24:00 > 0:24:03The solution was to hit the streets.
0:24:03 > 0:24:05"Flag Day" was born.
0:24:07 > 0:24:08They were very important.
0:24:08 > 0:24:12They were usually instigated by somebody notable.
0:24:12 > 0:24:14One of the best ones I remember, which doesn't exist any more,
0:24:14 > 0:24:19was started... She was the great patron, was Queen Alexandra.
0:24:19 > 0:24:22And it was known as Alexandra Rose Day.
0:24:22 > 0:24:25They were like a little dog rose that grows in the hedge.
0:24:25 > 0:24:28And they would produce and you bought your rose,
0:24:28 > 0:24:31put your money in your collecting tin, shops would sell them,
0:24:31 > 0:24:33everybody bought...
0:24:33 > 0:24:35They didn't pass anybody by,
0:24:35 > 0:24:39I can't remember anybody not buying an Alexandra rose.
0:24:44 > 0:24:47The new forms of charity were tapping
0:24:47 > 0:24:52into a vein of frivolity and hedonism in post-war society.
0:24:54 > 0:24:57There was a feeling that, in the '20s and '30s,
0:24:57 > 0:24:58that somehow if you're having fun
0:24:58 > 0:25:00and drinking rather a lot and dressing up,
0:25:00 > 0:25:03BUT the money is going to a good cause,
0:25:03 > 0:25:05and hospitals were regarded somehow
0:25:05 > 0:25:09as politically unproblematic and "a good cause".
0:25:09 > 0:25:10And so it fitted in quite well
0:25:10 > 0:25:13with any sort of hedonism there was around.
0:25:30 > 0:25:35You have bazaars, you have dances, you have an egg week.
0:25:35 > 0:25:36It might seem insignificant,
0:25:36 > 0:25:40but one hospital might collect 100,000 eggs
0:25:40 > 0:25:42and that would feed a lot of patients.
0:25:42 > 0:25:45Other innovative schemes included the Linen League,
0:25:45 > 0:25:48where a small hospital might get all the clothes for patients,
0:25:48 > 0:25:51all of the sheets made by local charities.
0:25:53 > 0:25:58Charity had moved from endowments to pennies from the community.
0:26:00 > 0:26:03But rag weeks and carnivals weren't enough
0:26:03 > 0:26:06to meet spiralling costs of running a hospital.
0:26:06 > 0:26:10More and more, they were forced to turn to contributions
0:26:10 > 0:26:12from the patients themselves.
0:26:13 > 0:26:19Voluntary hospitals almost always were short of money
0:26:19 > 0:26:21and, as time went on,
0:26:21 > 0:26:24there was a great expectation and demand on patients
0:26:24 > 0:26:26who COULD pay that they WOULD pay.
0:26:28 > 0:26:33They started to introduce small-scale charges,
0:26:33 > 0:26:35user fees for ordinary people.
0:26:35 > 0:26:38It wasn't anything like the full cost of treatments,
0:26:38 > 0:26:43but it was a payment which was assessed, means-tested, really,
0:26:43 > 0:26:46on the basis of a person's income.
0:26:46 > 0:26:49And it led to the arrival of a new figure within the hospital,
0:26:49 > 0:26:51the hospital almoner,
0:26:51 > 0:26:54and the almoner would conduct an interview with the patients
0:26:54 > 0:26:59and assess what sort of payments they would be able to make.
0:27:00 > 0:27:04You'd have your almoner, you know, who'd come round and say,
0:27:04 > 0:27:07"Well, you know, you've got to pay."
0:27:07 > 0:27:10So there was no fixed fee. "You know you've got to pay," he says.
0:27:10 > 0:27:12"But I've got no money, what are you going to do to me?"
0:27:12 > 0:27:15So he said, "You know, what could you afford?"
0:27:15 > 0:27:18So he used to push him and if he had money on him,
0:27:18 > 0:27:19you know, if he had money,
0:27:19 > 0:27:22he'd pay, he'd say, "I'll give your five bob."
0:27:22 > 0:27:25You know, and the almoner would say "That's all you can afford?"
0:27:25 > 0:27:28"Five bob, OK." You know, that was the fee.
0:27:28 > 0:27:30But if you was well-off, you'd pay more, you know.
0:27:30 > 0:27:32It was according to what you was.
0:27:35 > 0:27:38The need to pay had given rise to new forms of insurance schemes
0:27:38 > 0:27:40based on contributions.
0:27:43 > 0:27:47The other big development of this period was the developments
0:27:47 > 0:27:49of large-scale contributory schemes
0:27:49 > 0:27:53pitched at the working-class patients.
0:27:53 > 0:27:57And these usually actually were run through the workplace -
0:27:57 > 0:28:02the factory, the shop, whatever.
0:28:02 > 0:28:05And the way it worked is that a small amount of money
0:28:05 > 0:28:08would be deducted from people's wages.
0:28:08 > 0:28:12Sometimes it was a penny in the pound of their earnings
0:28:12 > 0:28:16and, sometimes, it was just a set amount of a few pence
0:28:16 > 0:28:18on a regular basis.
0:28:21 > 0:28:25The 1920s saw a mushrooming of these schemes around the country,
0:28:25 > 0:28:27and they grew rapidly.
0:28:27 > 0:28:30Membership of a scheme would typically cover the family
0:28:30 > 0:28:32for some hospital services,
0:28:32 > 0:28:35but it was based on how much you earned
0:28:35 > 0:28:38and what kind of medical conditions you had.
0:28:38 > 0:28:41Some schemes were organised by the hospitals themselves.
0:28:41 > 0:28:45Others were run by independent organisations.
0:28:45 > 0:28:49It was the almoner's job to work out who was covered.
0:28:49 > 0:28:57My task was to assess people in terms of their ability
0:28:57 > 0:29:00to meet the cost of having prescribed treatment.
0:29:00 > 0:29:03I would put the category into which they fell
0:29:03 > 0:29:07and if they were to have free treatment, there was a large F.
0:29:07 > 0:29:10And if they were belonging to a scheme
0:29:10 > 0:29:12which gave them free hospital treatment,
0:29:12 > 0:29:16like the Hospital Savings Association, I would put HSA.
0:29:16 > 0:29:18And if they were feeling they would like to contribute
0:29:18 > 0:29:20and were in a position to contribute,
0:29:20 > 0:29:23then, there would be a D - a donation.
0:29:26 > 0:29:29A rigorous assessment of the patients' finances
0:29:29 > 0:29:32could come at the expense of compassion for their needs.
0:29:35 > 0:29:37You'd see a lady almoner
0:29:37 > 0:29:42and she used to ask you just what money you can afford to pay.
0:29:42 > 0:29:44She wanted a lot at first.
0:29:44 > 0:29:48I said, "I can't afford that, because, naturally,
0:29:48 > 0:29:50"we've got to get some clothes for the baby when he's born
0:29:50 > 0:29:52"and things, anyway."
0:29:52 > 0:29:54When the baby was born dead,
0:29:54 > 0:29:57a couple of days after, she came up to me in the ward.
0:29:57 > 0:30:00This is their attitude of caring.
0:30:00 > 0:30:03And she said to me, "Well, now you've lost your baby,
0:30:03 > 0:30:06"you haven't got a baby, perhaps you can pay more money."
0:30:10 > 0:30:13Originally, the almoner was appointed to investigate
0:30:13 > 0:30:16the financial backgrounds of the patients.
0:30:16 > 0:30:17Could they pay for treatment?
0:30:17 > 0:30:20This is how they're remembered, but they did a lot more.
0:30:20 > 0:30:24They very quickly became a clearing house for the hospital.
0:30:24 > 0:30:26They identified patients
0:30:26 > 0:30:28who needed additional support within the community,
0:30:28 > 0:30:30whether it was educational,
0:30:30 > 0:30:34they needed help finding work, they needed help feeding children.
0:30:34 > 0:30:35Their role started to expand
0:30:35 > 0:30:39and, eventually, they developed into the modern social worker.
0:30:42 > 0:30:46The almoner was the great go-between within the social side of the patients,
0:30:46 > 0:30:47and that was well done.
0:30:47 > 0:30:51If a patient died, she was the person who dealt
0:30:51 > 0:30:54with all the arrangements of death and so on.
0:30:54 > 0:30:57And, as a houseman, as a doctor,
0:30:57 > 0:30:59we, we just had never been taught
0:30:59 > 0:31:01and we didn't know how to do it and we didn't do it.
0:31:01 > 0:31:09And so, to me, an almoner was a very valuable person in the team that we belonged to.
0:31:11 > 0:31:14William Frankland was a junior doctor in the casualty department
0:31:14 > 0:31:17of St Mary's Hospital, London, in the early '30s.
0:31:20 > 0:31:23Before the antibiotic era, there were so many diseases.
0:31:23 > 0:31:28We really could help very little compared to what you can help now.
0:31:28 > 0:31:31And so, the patients would be in for a very long time.
0:31:35 > 0:31:38Protecting patients from the risks of infection was essential.
0:31:42 > 0:31:45Mary Allan trained as a nurse in the 1930s
0:31:45 > 0:31:49and had to use careful nursing to guard against it.
0:31:53 > 0:31:54There were always two nurses -
0:31:54 > 0:31:57one they called the dirty nurse, and the clean nurse.
0:31:57 > 0:32:01The dirty nurse always took the dirty dressings off
0:32:01 > 0:32:02and disposed of those.
0:32:02 > 0:32:08And then, the clean nurse opened her sterile packet
0:32:08 > 0:32:10and was able to get on with the dressing,
0:32:10 > 0:32:12but she never touched anything, anything that was soiled.
0:32:15 > 0:32:18Locked inside the hospital walls,
0:32:18 > 0:32:24a different fight was taking place against the bacteria which caused infection.
0:32:24 > 0:32:26William Frankland worked with a scientist
0:32:26 > 0:32:30at the forefront of the quest to find new such cures.
0:32:30 > 0:32:33His name was Alexander Fleming.
0:32:34 > 0:32:38Fleming was... I had to see him every day at ten o'clock in the morning.
0:32:38 > 0:32:41Theoretically, to talk about the patients in the ward,
0:32:41 > 0:32:42we had this experimental ward.
0:32:42 > 0:32:46This was with the people with all sorts of rare diseases
0:32:46 > 0:32:47and could we help them,
0:32:47 > 0:32:51and could Fleming help them and could anyone...?
0:32:51 > 0:32:54And I was, one of my jobs was to look after them.
0:32:54 > 0:32:59But... So I had to report to Fleming every morning at ten o'clock.
0:32:59 > 0:33:00He wasn't interested in patients.
0:33:00 > 0:33:04In two years, I can only remember him once asking about a patient.
0:33:04 > 0:33:07He was always interested in getting a substance
0:33:07 > 0:33:10which would deal with infection.
0:33:10 > 0:33:13And I remember very well he talked
0:33:13 > 0:33:17about the mould Penicillium notatum, it was called.
0:33:17 > 0:33:18This green mould.
0:33:20 > 0:33:22The consequences of this discovery
0:33:22 > 0:33:24would not be felt for another decade.
0:33:24 > 0:33:30But, before penicillin, another medication had already arrived on the scene.
0:33:30 > 0:33:34They new sulphonamide-based drugs were effective against puerperal fever,
0:33:34 > 0:33:40a common bacterial infection contracted by women during childbirth.
0:33:40 > 0:33:44As a student, we were taken to Queen Charlotte's Hospital
0:33:44 > 0:33:46to see women who got puerperal sepsis,
0:33:46 > 0:33:50this is an infection with a high swinging fever,
0:33:50 > 0:33:52with a high mortality.
0:33:52 > 0:33:55And they were put on this amazing drug - down came the temperature.
0:33:55 > 0:33:58And we would see it as something absolutely unbelievable.
0:33:58 > 0:34:00So here was the first...
0:34:00 > 0:34:03The word antibiotic, actually, wasn't coined till the 1950s
0:34:03 > 0:34:06so we would call it an antibacterial...
0:34:06 > 0:34:08And that was absolutely dramatic.
0:34:12 > 0:34:16The introduction of sulphonamide saw maternal deaths nose dive.
0:34:16 > 0:34:20In the next 15 years, they would fall by 80%.
0:34:23 > 0:34:25This was part of a change
0:34:25 > 0:34:30which saw women giving birth in hospitals for the first time.
0:34:30 > 0:34:34Hospitals were seen as safer environments,
0:34:34 > 0:34:38freer from infection, offering the best of medical science.
0:34:45 > 0:34:48And other discoveries were being made elsewhere in hospitals.
0:34:54 > 0:34:58Scientists were exploring all sorts of bizarre and creative ways
0:34:58 > 0:35:02for tackling some of the most lethal conditions.
0:35:04 > 0:35:09These included the invention of arcane pieces of equipment for artificial respiration.
0:35:18 > 0:35:20There was one called the cuirass.
0:35:20 > 0:35:23It was an arrangement... It was a bit...
0:35:23 > 0:35:25Back the old woman's shoulders,
0:35:25 > 0:35:28I suppose, it's was like a back and front, metallic front -
0:35:28 > 0:35:31they were sandwiched in between this piece of equipment.
0:35:31 > 0:35:35It was attached to bellows. They could wear the cuirass and that would be attached to the equipment -
0:35:35 > 0:35:37it could go on the back of a wheelchair.
0:35:40 > 0:35:46But the most groundbreaking of them emerged in the United States in 1928.
0:35:46 > 0:35:49Its name would endure for decades to come.
0:35:49 > 0:35:52They called it the Iron Lung.
0:35:55 > 0:35:58I think what it's interesting about iron lungs
0:35:58 > 0:36:02is they are iconic pieces of medical technology,
0:36:02 > 0:36:05because they do save lives.
0:36:05 > 0:36:08It's a saviour for this terrible scourge of polio
0:36:08 > 0:36:11that is terrifying the nation.
0:36:11 > 0:36:17'His name is Johnny Greene and he's two years old. He looks well enough.
0:36:17 > 0:36:19'But there is something wrong with him.
0:36:19 > 0:36:21'He has had infantile paralysis
0:36:21 > 0:36:25'or, to give it its proper name, poliomyelitis.'
0:36:25 > 0:36:28Polio was a virus which attacked the central nervous system
0:36:28 > 0:36:31and disabled the muscles it infected.
0:36:31 > 0:36:37Also known as infantile paralysis, it mainly affected children.
0:36:37 > 0:36:39Polio was a really big thing there.
0:36:39 > 0:36:42And it seemed to spread like wildfire.
0:36:42 > 0:36:47And they said it was spread from swimming pools and things like that.
0:36:47 > 0:36:50And I do know people, they were kids
0:36:50 > 0:36:55who wore callipers on their legs as a result of having polio.
0:36:57 > 0:37:00At its worst, polio paralysed the lung muscles
0:37:00 > 0:37:03and stopped patients breathing normally.
0:37:03 > 0:37:05Before a vaccine was available,
0:37:05 > 0:37:07the iron lung was the only way to keep people alive
0:37:07 > 0:37:10once they had the disease.
0:37:10 > 0:37:14It was the world's first life support machine.
0:37:14 > 0:37:18Basically, the iron lung is what they call a negative pressure chamber,
0:37:18 > 0:37:24and what it does is it pressurises and depressurises the patient's chest.
0:37:24 > 0:37:28Some people never got out of their iron lung.
0:37:28 > 0:37:32Some people did get out of their iron lungs and they were used only temporarily.
0:37:32 > 0:37:37The nursing staff would take the patient out for a few minutes
0:37:37 > 0:37:39and gradually build the patient up
0:37:39 > 0:37:42till they were breathing on their own.
0:37:42 > 0:37:47It is an incredibly complex piece of medical technology.
0:37:47 > 0:37:49Therefore, it is very expensive.
0:37:49 > 0:37:53With hospitals unable to afford them,
0:37:53 > 0:37:56getting access to an iron lung was not easy.
0:37:56 > 0:38:01But, in 1937, an Australian scientist named Edward Both
0:38:01 > 0:38:03came up with a cheaper alterative.
0:38:06 > 0:38:08It was made from plywood
0:38:08 > 0:38:11and immediately drew the attention of car manufacturer William Morris,
0:38:11 > 0:38:14also known as Lord Nuffield.
0:38:21 > 0:38:26He offered to construct thousands of them in his factory for free.
0:38:27 > 0:38:32I sincerely hope that my gift will be the means
0:38:32 > 0:38:35of saving many valuable lives.
0:38:49 > 0:38:54Hospital treatment was becoming increasingly dependent on medical technologies.
0:38:57 > 0:39:02UV light treatment for vitamin D deficiency was a common therapy...
0:39:04 > 0:39:07..as was the use of electricity.
0:39:14 > 0:39:17I had to have a treatment called faradism.
0:39:17 > 0:39:19It sounds awful, but it wasn't too bad.
0:39:19 > 0:39:23It was a form of electricity that I think, I can't remember it now,
0:39:23 > 0:39:25but they put your foot in a bowl of water
0:39:25 > 0:39:27and they passed a current through your leg
0:39:27 > 0:39:30and it made your muscle contract and expand.
0:39:30 > 0:39:33They would try to build up your muscle tone.
0:39:33 > 0:39:36It did make it... It wasn't particularly comfortable,
0:39:36 > 0:39:38but they could start the electricity at a lower level
0:39:38 > 0:39:41and gradually...turn it up a little bit.
0:39:43 > 0:39:49One critical invention was the introduction of radium therapy for treating cancer.
0:39:49 > 0:39:52Radium is the crown jewel in the ray-based therapies
0:39:52 > 0:39:55that begin to emerge in the 20th century.
0:39:55 > 0:40:00Cancer cases are increasing and it seems to be one potential cure.
0:40:00 > 0:40:03The problem is that radium is quite expensive,
0:40:03 > 0:40:06at about £15,000 a gram at the time.
0:40:06 > 0:40:09A lot of hospitals are struggling to pay their ordinary bills.
0:40:09 > 0:40:12Here is this new therapeutic agent which they need some help buying.
0:40:21 > 0:40:25To fund these new technologies, hospitals were still dependent
0:40:25 > 0:40:28on raising money through charitable organisations.
0:40:30 > 0:40:33One of the largest was the King Edward's Fund.
0:40:36 > 0:40:39This model hospital, now at the Science Museum,
0:40:39 > 0:40:43was built as a promotional tool by the fund in 1932.
0:40:47 > 0:40:50Throughout the decade, it toured the country
0:40:50 > 0:40:53and was seen by hundreds of thousands of people.
0:41:00 > 0:41:05It was an illustration of how hospitals had been transformed.
0:41:07 > 0:41:10Now centres of medical expertise, they offered a more attractive,
0:41:10 > 0:41:13sophisticated environment to receive treatment.
0:41:18 > 0:41:21With this rise in technology,
0:41:21 > 0:41:23people feel a lot more comfortable about going to hospital
0:41:23 > 0:41:27in that it is a safer, scientific environment.
0:41:27 > 0:41:30They get diagnosed, they get looked after.
0:41:30 > 0:41:33Middle-class people see this as being able to get the best care,
0:41:33 > 0:41:37and they want to get the best care as well.
0:41:39 > 0:41:40A rise in middle-class patients
0:41:40 > 0:41:45gave voluntary hospitals a chance to tap into some vital new income.
0:41:46 > 0:41:49The response was to begin to open
0:41:49 > 0:41:54either pay-beds or private wards
0:41:54 > 0:41:58or, in some cases, private wings, separate wings at the hospital.
0:41:58 > 0:42:03One of the great things was, if you were a private patient,
0:42:03 > 0:42:08you wouldn't be taught on by, you know, horrible medical students.
0:42:08 > 0:42:11HE CHUCKLES
0:42:11 > 0:42:15Which was a pity, because there was a lot of very good clinical material there.
0:42:15 > 0:42:19But no, the private patients, and some people, I think,
0:42:19 > 0:42:24insured themselves to make sure exactly the place they went to privately,
0:42:24 > 0:42:26and they would have a single room,
0:42:26 > 0:42:28they'd have much more nurses to look after them,
0:42:28 > 0:42:31but they wouldn't have these...medical students
0:42:31 > 0:42:34or be taught on or practised on and so on.
0:42:36 > 0:42:40The hospitals become a more pleasant place to go,
0:42:40 > 0:42:43and we see lovely painted walls,
0:42:43 > 0:42:47lights above the bed, reading material, the buzzer.
0:42:47 > 0:42:52Conversely, visiting hours could still be quite draconian,
0:42:52 > 0:42:55even though hospitals were much more pleasant.
0:42:55 > 0:43:00For example, visiting children in hospital was still quite rigidly controlled throughout the 1930s.
0:43:00 > 0:43:04And, say, for example, at an orthopaedic hospital,
0:43:04 > 0:43:10children under 12 who were in the hospital were only able to be visited
0:43:10 > 0:43:13twice a month on a Sunday for two hours.
0:43:16 > 0:43:20But getting into hospital at all was becoming harder.
0:43:20 > 0:43:24As they moved away from charity and towards a paid-for service,
0:43:24 > 0:43:28hospitals were struggling to meet the new demand.
0:43:28 > 0:43:32One of the problems of the hospital was the success that they were having.
0:43:32 > 0:43:34A lot of people wanted to get into them,
0:43:34 > 0:43:37they saw them as the right place to get medical treatment.
0:43:37 > 0:43:40So the 1920s and '30s, you see the rise of waiting lists,
0:43:40 > 0:43:43not dozens of people, but hundreds of people.
0:43:44 > 0:43:50The patients themselves always hoped that they would go to the well-known hospital,
0:43:50 > 0:43:52which had a medical school attached to it.
0:43:52 > 0:43:58And they would have the well-known consultants attached to that hospital.
0:44:02 > 0:44:07In fact, voluntary hospitals only provided a third of the total beds across the country.
0:44:12 > 0:44:16The majority were still to be found in the old workhouse infirmaries,
0:44:16 > 0:44:19mainly reserved for the long-term sick and the elderly.
0:44:26 > 0:44:33Bella Aronovitch was moved to one following an appendix operation which wouldn't heal.
0:44:33 > 0:44:35I was, I suppose, about 18
0:44:35 > 0:44:39when I was transferred to this Poor Law hospital.
0:44:39 > 0:44:41I'd been in the voluntary hospitals up till then,
0:44:41 > 0:44:44and got a kind of set picture of what they were like,
0:44:44 > 0:44:48and I looked round and there were numbers and no names on the ward.
0:44:48 > 0:44:50And when the door was opened
0:44:50 > 0:44:53and I looked at this sea of faces,
0:44:53 > 0:44:56I felt indescribably frightened and really low.
0:44:56 > 0:44:59I hadn't expected anything like this.
0:44:59 > 0:45:00The beds were so close together
0:45:00 > 0:45:03that you could touch the patient in the next bed.
0:45:05 > 0:45:09The names of the wards were Faith, Hope and Charity.
0:45:09 > 0:45:14Everything about it was so run down, it was so poverty-stricken
0:45:14 > 0:45:16and there was such an atmosphere of death there.
0:45:19 > 0:45:21All the time I was in hospital I used to think,
0:45:21 > 0:45:24"Well, fancy leaving the health to millions of people
0:45:24 > 0:45:25"in this ad-hoc way
0:45:25 > 0:45:28"when some people could pretty well get all that they wanted
0:45:28 > 0:45:31"and for the others it was one long struggle.
0:45:33 > 0:45:38But a new piece of legislation in 1929 would allow local councils
0:45:38 > 0:45:41to take over the running of these old institutions.
0:45:43 > 0:45:46They became known as municipal hospitals,
0:45:46 > 0:45:48and London was leading the way.
0:45:49 > 0:45:52On 1st April 1930,
0:45:52 > 0:45:57the London County Council appropriated all the hospitals
0:45:57 > 0:46:01it had inherited both from the London workhouses
0:46:01 > 0:46:04and also from the Metropolitan Asylums Board.
0:46:04 > 0:46:10Overnight, they had on their hands 98 hospitals,
0:46:10 > 0:46:15which they set about trying to organise into a coherent system.
0:46:17 > 0:46:21What they tried to do, essentially, was upgrade the Poor Law infirmaries,
0:46:21 > 0:46:22the workhouse infirmaries,
0:46:22 > 0:46:26and turn them into potential competitors with the voluntary hospitals,
0:46:26 > 0:46:30giving them operating theatres, introducing all the new technologies and therapies
0:46:30 > 0:46:34that are available at the voluntary hospitals.
0:46:37 > 0:46:41In Glasgow, the Council took over Stobhill Hospital,
0:46:41 > 0:46:43an old workhouse infirmary.
0:46:47 > 0:46:51This film was made to publicise its newly modernized facilities.
0:47:03 > 0:47:07Yet places like Glasgow and London were exceptions.
0:47:07 > 0:47:09In many parts of the country,
0:47:09 > 0:47:12workhouse infirmaries were not taken over.
0:47:12 > 0:47:17And, even if they were, they couldn't shake off their notorious reputations.
0:47:20 > 0:47:23A lot of people didn't want to go into these institutions,
0:47:23 > 0:47:26even after they were handed over to the municipal authorities.
0:47:26 > 0:47:28On children's birth certificates, for example,
0:47:28 > 0:47:31those children who were born in some of these institutions,
0:47:31 > 0:47:34they simply put an address, not the name of the institution,
0:47:34 > 0:47:37because the stigma was still very strong.
0:47:37 > 0:47:41Despite improvements in particular areas,
0:47:41 > 0:47:45the quality of hospitals varied greatly depending on where you lived
0:47:45 > 0:47:47and how much you could afford to pay.
0:47:47 > 0:47:51A third of all specialists lived in London.
0:47:51 > 0:47:52So London was the place to go
0:47:52 > 0:47:55if you wanted to specialise in particular areas of medicine.
0:47:55 > 0:47:58And consultants could make a lot of money.
0:47:58 > 0:48:02And there was a lot of resentment about their high-handed attitude
0:48:02 > 0:48:06or the fact that they weren't really caring for people who were very, very ill.
0:48:06 > 0:48:08They were just caring for people who could pay.
0:48:11 > 0:48:17There was this tension all the time between the requirements of doctors.
0:48:17 > 0:48:23Doctors were always really keen to preserve their private practice.
0:48:23 > 0:48:27The voluntary hospitals were always desperate to preserve their independence.
0:48:27 > 0:48:33And the municipal hospitals really wanted more and more
0:48:33 > 0:48:38to become the general provider for the citizens.
0:48:38 > 0:48:42It really was in desperate need of,
0:48:42 > 0:48:47of bringing together into some, you know, coherent shape.
0:48:49 > 0:48:53The lack of a joined-up hospital system ran counter
0:48:53 > 0:48:56to one of the big ideas that was animating Britain at the time.
0:48:58 > 0:49:01One of the great words of the '30s was "planning."
0:49:01 > 0:49:05There were all sorts of organisations which were just devoted to planning.
0:49:05 > 0:49:08That you found out all you could about a subject,
0:49:08 > 0:49:10be it transport, be it medicine...
0:49:10 > 0:49:13And then, on the basis of information,
0:49:13 > 0:49:16you laid your plans and your recommendations
0:49:16 > 0:49:17and you formulated your policy.
0:49:17 > 0:49:21That was very true in health towards the end of the '30s.
0:49:21 > 0:49:25Eventually, a debate would be launched
0:49:25 > 0:49:28about how a new hospital system might be organised.
0:49:28 > 0:49:32But another crisis loomed which presented the hospitals
0:49:32 > 0:49:36with an even greater, more immediate challenge.
0:49:36 > 0:49:38War.
0:49:39 > 0:49:42The First World War was not very organised, it kind of happened.
0:49:42 > 0:49:46Whereas the Second World War, the country was preparing.
0:49:46 > 0:49:50In 1937, the Emergency Medical Services were set up.
0:49:50 > 0:49:54So that was two years before the war was even declared.
0:49:54 > 0:49:57'In the towns, the front line of modern war,
0:49:57 > 0:49:59'the health services were organised
0:49:59 > 0:50:01'to deal with the menace of air attack.
0:50:01 > 0:50:05'The voluntary and municipal hospitals were linked together
0:50:05 > 0:50:07'under one national health service.
0:50:07 > 0:50:13'Taking the London area as an example, what has happened is this.
0:50:13 > 0:50:16'The area has been divided into sectors.
0:50:16 > 0:50:19'Each with one of the big hospitals acting as parent.'
0:50:21 > 0:50:25Across the country, the Emergency Medical Service
0:50:25 > 0:50:29took control of hospitals and placed them under one umbrella.
0:50:29 > 0:50:34New wards were built and temporary buildings set up.
0:50:34 > 0:50:3850,000 hospital beds were added in just a few months.
0:50:38 > 0:50:41Doctors were employed by the service
0:50:41 > 0:50:44and sent to where they were most needed.
0:50:44 > 0:50:50The Emergency Medical Service had set an example of how an integrated hospital system could be run.
0:50:52 > 0:50:55It provided a model for the planners,
0:50:55 > 0:50:58who, during the Second World War,
0:50:58 > 0:51:00were beginning to think much more seriously
0:51:00 > 0:51:03about the possibility of a national health service.
0:51:03 > 0:51:07This is when the term first starts to be introduced.
0:51:07 > 0:51:12In the sense of delivering a more comprehensive service
0:51:12 > 0:51:14and indeed a universal service,
0:51:14 > 0:51:17something to which everybody had access
0:51:17 > 0:51:19simply by right of citizenship.
0:51:21 > 0:51:26What the Second World War did, of course, was to emphasise
0:51:26 > 0:51:29that health could no longer be left to philanthropy,
0:51:29 > 0:51:32it could no longer be left to voluntary initiatives
0:51:32 > 0:51:34and good-hearted ladies selling flags.
0:51:34 > 0:51:36It was the health of the nation
0:51:36 > 0:51:40and the nation or the government needed to take responsibility for it.
0:51:40 > 0:51:42You know, the health of the nation was too important
0:51:42 > 0:51:45to be left to these hotchpotch of arrangements.
0:51:49 > 0:51:53'In the old days, money meant a well-planned entry into the world
0:51:53 > 0:51:55'with as much skill and care
0:51:55 > 0:51:57'as a Harley Street nursing home could provide.
0:51:57 > 0:52:00'But in the new world that we are making,
0:52:00 > 0:52:03'and making in the very teeth of war,
0:52:03 > 0:52:06'we give every baby the right to both the broad acres
0:52:06 > 0:52:08'and the Harley Street skill.'
0:52:12 > 0:52:16The idea that citizens had a right to hospital care
0:52:16 > 0:52:21was crystallised by the experience of war.
0:52:21 > 0:52:26But war had also accelerated the development of earlier scientific discoveries.
0:52:26 > 0:52:31It had taken over a decade to be purified and manufactured,
0:52:31 > 0:52:34but Fleming's mould had finally arrived.
0:52:34 > 0:52:36It was called penicillin.
0:52:38 > 0:52:42And when it was introduced to the wards to be used on patients,
0:52:42 > 0:52:44it was literally kept under lock and key.
0:52:46 > 0:52:49It was so precious that it was only the senior staff
0:52:49 > 0:52:52that were allowed the keys to go and get it out and draw up the doses
0:52:52 > 0:52:54and go and give it to the patients.
0:52:54 > 0:52:57And we were absolutely stunned. It was literally a miracle drug.
0:52:59 > 0:53:03Jim Mulligan was one of the first civilians to receive penicillin
0:53:03 > 0:53:06when he went into hospital for an operation.
0:53:06 > 0:53:11I was due to be in there for several weeks, if not months.
0:53:11 > 0:53:14And they used penicillin on me
0:53:14 > 0:53:17and it was one of the first times that it was used on civilians,
0:53:17 > 0:53:20cos it was developed for soldiers in the war.
0:53:20 > 0:53:25And I was out in three weeks.
0:53:25 > 0:53:29In that time, I saw my first banana
0:53:29 > 0:53:32and, one day, my brother brought in the Daily Mirror
0:53:32 > 0:53:37with the headline about this amazing bomb
0:53:37 > 0:53:39that they've dropped in Japan.
0:53:39 > 0:53:42And it'll do this and it'll do that.
0:53:42 > 0:53:45And that was... I remember seeing the Daily Mirror
0:53:45 > 0:53:48with the Hiroshima bomb.
0:53:54 > 0:54:00In 1945, Britons were celebrating the end of another war.
0:54:07 > 0:54:11The First World War had ended without a proper hospital system.
0:54:11 > 0:54:15The Second World War would help provide one.
0:54:18 > 0:54:20After the First World War,
0:54:20 > 0:54:22everything went back to the way it was.
0:54:22 > 0:54:24Whereas in the Second World War,
0:54:24 > 0:54:26people did not want that to happen again.
0:54:26 > 0:54:29They had suffered, they'd lost family, friends,
0:54:29 > 0:54:31they wanted things to change.
0:54:31 > 0:54:35So this idea of "never again" is extremely important
0:54:35 > 0:54:39and it has a lot of importance towards the formation of the NHS.
0:54:47 > 0:54:51The change in mood had brought a newly elected Labour government.
0:54:51 > 0:54:53Riding on a wave of public support,
0:54:53 > 0:54:56it began immediately to implement plans
0:54:56 > 0:54:59for a new national health service.
0:55:00 > 0:55:02'Suppose instead of a simple broken leg,
0:55:02 > 0:55:04'you have a complicated break.
0:55:04 > 0:55:08'Then, suppose you have to spend months off sick.
0:55:08 > 0:55:10'And suppose you don't need just one doctor,
0:55:10 > 0:55:13'but a number of experts' opinions.
0:55:13 > 0:55:15'What's the answer to that?
0:55:15 > 0:55:17'Ruin!
0:55:20 > 0:55:25'With this new Act, you're covered against things like that.'
0:55:25 > 0:55:26HE SIGHS WITH RELIEF
0:55:29 > 0:55:31Despite huge support for a unified service,
0:55:31 > 0:55:36the government faced opposition from the medical profession.
0:55:37 > 0:55:42A fierce debate raged between them and the British Medical Association.
0:55:47 > 0:55:52Key to the disagreement was the prospect of a state-salaried medical service.
0:55:54 > 0:55:59Some consultants were reluctant to give up their lucrative private practices,
0:55:59 > 0:56:03and suspicious of the state undermining their independence.
0:56:05 > 0:56:08But the new Minster Of Health came up with a solution
0:56:08 > 0:56:10which would bring them on board.
0:56:13 > 0:56:16It was Nye Bevan who inaugurated the National Health Service.
0:56:16 > 0:56:18I think he once said that
0:56:18 > 0:56:21he'd "filled the doctors' mouths with gold"
0:56:21 > 0:56:24to persuade them to go with the new system.
0:56:24 > 0:56:30Bevan's "gold" meant doctors could still hold on to their private practices,
0:56:30 > 0:56:33even though they were employed by the state.
0:56:33 > 0:56:38The government could now push forward with the new legislation.
0:56:43 > 0:56:46'On July 5th, the new National Health Service starts,
0:56:46 > 0:56:49'providing hospital and specialist services,
0:56:49 > 0:56:51'medicines, drugs and appliances,
0:56:51 > 0:56:53'care of the teeth and eyes.'
0:56:55 > 0:56:58I remember everybody being absolutely delighted,
0:56:58 > 0:57:04because all those fears and the trepidation
0:57:04 > 0:57:05and...
0:57:07 > 0:57:09..the knowing that if you got ill,
0:57:09 > 0:57:13that was serious and you'd just have to manage it on your own.
0:57:13 > 0:57:18It changed completely. It was a different world.
0:57:20 > 0:57:22It was the dawn of a new age.
0:57:25 > 0:57:27But it hadn't emerged from nowhere.
0:57:27 > 0:57:30This had been a long revolution
0:57:30 > 0:57:33built on decades of innovation
0:57:33 > 0:57:36in which the hospital had played a central role.
0:57:36 > 0:57:40Pioneering research and technologies had reduced deaths
0:57:40 > 0:57:44and generated a new faith in medical science.
0:57:49 > 0:57:53Hospitals had opened their doors to the community to raise funds
0:57:53 > 0:57:59but they had also raised expectations of entitlement to treatment.
0:58:04 > 0:58:09United in war, the hospitals had laid the foundations of a new system
0:58:09 > 0:58:11which, for the first time in history,
0:58:11 > 0:58:14would provide health care for all.
0:58:14 > 0:58:19Free at the point of service, from cradle to grave.
0:58:48 > 0:58:51Subtitles by Red Bee Media Ltd