Health before the NHS: A Medical Revolution Timeshift

Before the National Health Service,

the hospital was not always the kind of place you would go to get better.

I was so petrified of them.

And I imagine that fear was common to everybody.

Forbidding, rudimentary, and reserved for the destitute,

hospitals were a last resort.

People tended to be frightened to go to the hospital.

The hospital was where you went to die.

But in the decades leading up to the NHS,

hospitals would undergo an extraordinary transformation.

At the heart of this change

was a fierce battle against death and disease,

as scientists searched for miracle cures,

and weird and wonderful technologies

helped breathe new life into old afflictions.

They put your foot in a bowl of water and they passed a current

through your leg, and it made your muscle contract and expand.

Yet change was not limited to science and technology.

How the system was run, and how it was paid for,

would sow the seeds for another revolution.

This is the story of how access to good hospital healthcare

became a right, transforming grim Victorian institutions for the poor

into modern centres of medicine for all.

November 1918.

Armistice Day.

Behind the smiles and celebrations,

a new enemy, far less visible, was lurking.

It would claim more lives than the trenches of the First World War.

Britain's hospitals were helpless against it.

The Spanish flu was pretty much global.

There was almost nowhere in the world,

I think some part of the Amazon, which escaped completely.

One of the ironies of it was that it tended not to affect babies

and the elderly and frail, as most influenza viruses do,

but it affected younger people, healthy people.

It just seemed a terrible sort of visitation,

almost a plague on top of the slaughter of war.

The flu had arrived in Glasgow in the spring.

By the end of the year, a quarter of a million had perished.

The population was already worn down, and it struck hard.

Unfortunately, the hospitals were already busy

dealing with war casualties and there wasn't enough room

to deal with all those who needed hospital care.

The epidemic would come to an end, but the flu had exposed a crisis.

Across the country, hospitals couldn't cope.

No national system existed,

so they could only offer a patchwork of services.

Some had the latest facilities, others were desperately run-down.

So there's a range of hospitals.

Little hospitals dotted all around the country.

Very disorganised, perhaps run by one doctor,

and this was very problematic, because patients could often receive

very poor care in these small hospitals.

There was no-one overseeing, say for example, surgical procedures,

and some doctors went well above their levels of competency

and tried operating on patients

when they had no reason to do so and no ability to do so.

So they were quite dangerous.

How you got into hospital

and what kind of treatment you received was a lottery.

Most people never even made it into hospital.

I don't know what life expectancy was,

but it can't have been very high.

Death was a very frequent visitor in those days.

And pneumonia was a big thing, you died of pneumonia in those days.

If you had an accident, broke your neck, for example, that was it.

You were dead.

But a change was taking place.

And it began with attempts to overcome

one of the period's biggest killers - infectious disease.

You've got lots of childhood diseases,

such as scarlet fever, mumps, measles, whooping cough,

that are really putting a lot of children into hospital.

Some of them were more virulent than they would be today.

With a lack of effective cures,

and no antibiotics at the doctor's disposal,

the only chance of fighting disease was to stop the spread of infection.

There weren't many treatments really available

to deal with the infectious diseases.

Isolation was the key.

They built isolation hospitals, isolation wards,

and you kept these people isolated for a time that was regarded as safe.

When I was about nine months, I got scarlet fever,

which was fatal in those days.

You can imagine the terror.

I was taken out, wrapped in a red blanket,

carried out to the fever van.

Taken to the hospital, put in isolation.

My parents could go and see me, and look at me through a window,

but every patient was given a number.

Mine was 1268, my sister says the number is engraved on her heart.

And the Evening Gazette would print a list of all the numbers

with categories following it like "extremely ill", "improving",

"critically ill".

And there was a noticeboard outside the hospital, and my father

would stop his bus and look at the list to see what the condition was.

I mean it was as primitive as that, and distant as that.

Most feared of all was tuberculosis.

TB mainly affected the lungs

and caused one in eight deaths at the start of the century.

The symptoms of tuberculosis are usually bleeding from the lungs,

so haemorrhaging, so you would bleed out of your mouth and nose.

Excessive tiredness, weakness, debility,

and it was highly infectious.

Diseases were rife in the big industrial cities,

where the poor and undernourished were crammed in damp housing

and where the air was polluted with filthy smog.

Before the Clean Air Act, we used to get some dreadful,

literally hanging curtains, yellow fogs. It was awful.

And obviously not any good for anybody with a chest condition.

And that I had this spot on my lung,

they decide that I need to get out of London and arrange for me

to go to the sanatorium, which was up here on the Mendips.

The sanatorium, an antidote to the soot and smoke of the city.

Once you had TB, it offered the only cure then available -

bed rest, and the great outdoors.

And the idea was that you had fresh air, plenty of it,

and you were surrounded by pines.

The resin's supposed to be good for you.

In 1924, you had the establishment of the Sunlight League, lidos,

being outside and exposing their bodies to the elements,

and this is very good for people,

and this follows on within hospital spaces as well.

You would rest and lie in a bed, you'd breathe air,

and there was this idea you would expand your lungs with clean air.

So to go to the countryside, to look at trees and hills

and things like that, was considered very beneficial.

They had a treatment if you needed it, pneumothorax treatment,

which was a treatment which collapsed the lungs,

which allowed that part of the lung that was affected

to rest in order to try and heal itself.

Some of the girls were there for a year, two years.

It wasn't a thing that you went there short-term.

If you were, you were lucky.

You'd be out and about with them,

walking in the grounds and next morning you'd ask where

say Elizabeth was or someone,

and they would say, "Sorry, she died in the night."

You just never knew. They could be there one day and gone the next.

Sanatorium treatment for tuberculosis was free for workers

under the National Insurance scheme.

Introduced in 1911 by David Lloyd George

and the Liberal Government, it was an obligatory health insurance

for workers, in return for a deduction from their wages.

It covered them for their primary care, in other words

their access to their GP,

and it paid for a certain amount of sickness benefit

so that when they were ill and couldn't earn money,

they had some money coming in.

However, what national health insurance did not do

was pay for hospital care.

In fact, access to hospital care

was organised in an elaborate but haphazard way.

And it wasn't intended for everyone.

Today, I think most people think of the hospital

as a place where everyone goes for medical services.

But in the past, the hospital really was an institution for the poor.

One of the reasons for this was that the largest hospitals had developed

out of primitive infirmaries for sick inmates of the workhouse,

a Victorian institution for the poor.

The term workhouse implies

they were actually supposed to carry out labour,

and that was things like stone-breaking,

and unpicking ropes to stuff mattresses, and so on.

So the idea of these institutions originally was that they

stigmatised people who resorted to the state for support in poverty.

To cater for its sick inhabitants,

each workhouse had formed its own infirmary.

Their methods of treatment were rudimentary - to say the least.

Bed sharing was common.

You might, you know, have someone with an infectious disease

sharing a bed, you know, with some other condition.

There were no nurses employed by the workhouse in those days.

The nursing was all done by inmates,

who often were illiterate.

So they couldn't read instructions,

they couldn't read labels on bottles,

they distinguished the medicine by the colour of the contents.

And they were often drunk.

Many of these infirmaries had improved during the First World War.

But they were now reserved mainly for the long-term sick and elderly.

And most of them retained their stigma.

Wally Barnes remembers what people thought of the workhouse hospital

on Bancroft Road, in East London.

Don't go into Bancroft, because you'll never come out.

Not on your own feet.

Now, that was the attitude of some people.

If you go into Bancroft Road,

you don't come out on your own two feet.

What they mean is they carry you out.

The hospital is originally for people

who cannot afford a doctor at home, basically.

So working-class people, very poor people, charitable cases...

So people who could not afford to go to the doctor

or have a doctor come to their home,

which is what the middle classes and certainly the upper classes did.

Well, I got a frightful bad pain in my side one day.

And it got worse and I rang up Dr Cheatle.

And said, "I think I've got appendicitis,

"I want you to come and take my appendix out," so he did.

He showed up straight away, I was about 13 at the time.

And he draped everything in the whole room with white sheets.

It was quite marvellous-looking, you know.

But I think Nancy and a group of friends came round

about the same time

and they thought that we were playing doctors or doing something funny in the nursery, you know.

It was actually me having my appendix out.

The doctor would come to do the surgery,

attend the home with the patient.

They would have to pay for the anaesthetist,

who would come with the doctor to anesthetise the patient.

And then the surgery would be done on the dining room table

and then the patient would go back to their own bed and recover at home,

usually with the aid of a professional nurse,

who would stay with that person all the time,

and the doctor would make daily visits to come and see them,

to make sure that they were doing OK.

And then he fixed it up in a jar of alcohol

and so I was frightfully pleased to have it.

But Nanny flushed it down the toilet.

You know, she was sort of saying it was a disgusting object.

Yet the future of health care would lay neither in the homes of the rich

nor in the workhouse infirmaries,

but in a completely different kind of hospital, funded by charity.

These flagship hospitals stood in complete contrast

to the horrors of the workhouse.

They were known as voluntary hospitals.

Early ones were, for example, Guy's, in London,

Addenbrooke's, in Cambridge,

Bristol Infirmary.

Essentially, they differentiated themselves

from the Poor Law workhouses.

They were intended largely for what might have been conceived of

as the more respectable poor - working people,

who, for reasons of illness or accidents,

were temporarily knocked out of the job market.

Providing for local workers in industry,

these hospitals were at the cutting edge of medical care.

Voluntary hospitals were interesting.

Doctors were actually unpaid, they were honorary doctors in many cases.

They almost always had a large private practice,

which is where their income came from.

And many voluntary hospitals were also teaching hospitals

and doctors got income from the students they taught.

Lots of sort of picking and choosing went on,

particularly in the outpatients department.

Anybody could pretty much pitch up at a voluntary hospital and get seen.

And if you had an interesting case,

then you might be taken in for treatment,

because you would be useful teaching material for the staff.

It also depended on what conditions the practitioners were interested in.

There might have been a diabetes clinic at the institution,

there might have been some interest in cancer research.

But the voluntary hospitals always admitted accidents.

So if you were the victim of an accident,

run down by a car in the street, for example,

you would often just be picked up and carried into a voluntary hospital.

And those emergency treatments would be provided.

One of the reasons, of course,

why a lot of people would have seen hospitals,

perhaps in the '20s and '30s,

was the extremely high incidence of car accidents.

Roads were pretty unregulated.

Of course there were no seatbelts or Breathalysers or anything like that.

And there was a great deal of feeling

that it was an Englishman's right to drive as fast as he liked,

like Mr Toad, you know, on the wrong side of the road, if you like, honking his horn.

BRAKES SQUEALING

CRASH

The motor car came along, people started having accidents.

Serious fractures were appearing that required a surgeon.

So somebody who was practical and interested in new ideas

was obviously the ideal person at the right time

to get started on all this.

Diccon's father, Kenneth Pridie,

was one of the first surgeons to focus on orthopaedics -

surgery of the bones and joints.

He wanted to specialise in this one thing

and make a go of it.

And up till then, it was just one little facet of general surgery.

He got his opportunity at one of the main voluntary hospitals,

the Bristol Royal Infirmary.

I have a photograph that he took in 1934 when he went there of the splint room.

It looks like a scrapyard and, obviously, he took that

just to show what a joke

the sort of approach to treatment was at that time

and how he was going to sort it out.

A lot of the surgeons who are taking surgery forward at this time,

they have to make their own instruments.

So they are innovators, they have to design instruments

with long handles, for example.

But new tools and a steady hand were not enough to keep you alive.

A unique film of Kenneth Pridie performing a hip operation

illustrates how a patient's life or death

depended on how long they spent under the knife.

He is showing how to measure up the hip with a special measuring device

and you take that measuring device onto the patient

and you drill a little pin in.

And you knock this hollow pin over the guide wire.

He uses hydraulic hammers

and braces and bits, and all sorts of things, and hammers it into place.

And then he just gets hold of the leg and it's still...

You know, it's still moving, so he hasn't gone too far.

Then he sets it up and then, he pans back to the clock

to proudly show it's 12 minutes after he started.

The point is that if you can complete this operation in 12 minutes,

the patient is much more likely to recover quickly,

be mobilised and walking again within a couple of weeks

and back to work, and that's what the whole thing is about.

The longer you were under a general anaesthetic,

the more debilitated you were.

And previous to that, people had been laid out

for...three months or something.

Well, after that, you can't walk anyway, you know.

So the operation may be a complete success,

but the patient died or whatever, you know.

I meant, it's results that count.

He was very much a results man.

The surgeons were certainly seen as formidable figures.

Within the hospital, they were treated with a lot of respect,

especially by the patients.

A lot of patients regarded these people as saviours.

And they were, after all, volunteers,

they weren't paid for their services.

So they were set apart from the paid hospital staff.

We didn't have much dealing with the surgeons.

There were very remote.

You know, when they came,

it was almost sweeping above a path in front of them,

because they were considered so lofty.

They were thought so highly of - Mister This, Doctor That...

Yes, they were next to God, really, in many ways.

They were consultants,

they had large private practices by this time.

And although these were charitable cases,

grateful patients often brought their surgeons gifts

in exchange for some of the surgery that was performed.

Voluntary hospitals had been set up as charitable institutions,

but the foundations on which they'd been built were crumbling.

Britain's economy had not recovered after the war

and it wasn't just the poor who were feeling the pinch.

It's sometimes summed up as "death duty" and "death duties."

In other words, the very rich classes in Britain,

who had been a linchpin providing charity for the voluntary hospitals

had actually not only suffered quite significant losses

of younger sons who'd gone off as officers

to fight in the trenches and so on,

so families had actually been hit quite badly,

but they were now having to pay much larger levels of taxation.

This was the moment in which charity,

the old traditional form of hospital philanthropy,

now began to seem inadequate.

With rising costs,

voluntary hospitals were desperately strapped for cash.

A dramatic change was needed in how they were paid for.

The solution was to hit the streets.

"Flag Day" was born.

They were very important.

They were usually instigated by somebody notable.

One of the best ones I remember, which doesn't exist any more,

was started... She was the great patron, was Queen Alexandra.

And it was known as Alexandra Rose Day.

They were like a little dog rose that grows in the hedge.

And they would produce and you bought your rose,

put your money in your collecting tin, shops would sell them,

everybody bought...

They didn't pass anybody by,

I can't remember anybody not buying an Alexandra rose.

The new forms of charity were tapping

into a vein of frivolity and hedonism in post-war society.

There was a feeling that, in the '20s and '30s,

that somehow if you're having fun

and drinking rather a lot and dressing up,

BUT the money is going to a good cause,

and hospitals were regarded somehow

as politically unproblematic and "a good cause".

And so it fitted in quite well

with any sort of hedonism there was around.

You have bazaars, you have dances, you have an egg week.

It might seem insignificant,

but one hospital might collect 100,000 eggs

and that would feed a lot of patients.

Other innovative schemes included the Linen League,

where a small hospital might get all the clothes for patients,

all of the sheets made by local charities.

Charity had moved from endowments to pennies from the community.

But rag weeks and carnivals weren't enough

to meet spiralling costs of running a hospital.

More and more, they were forced to turn to contributions

from the patients themselves.

Voluntary hospitals almost always were short of money

and, as time went on,

there was a great expectation and demand on patients

who COULD pay that they WOULD pay.

They started to introduce small-scale charges,

user fees for ordinary people.

It wasn't anything like the full cost of treatments,

but it was a payment which was assessed, means-tested, really,

on the basis of a person's income.

And it led to the arrival of a new figure within the hospital,

the hospital almoner,

and the almoner would conduct an interview with the patients

and assess what sort of payments they would be able to make.

You'd have your almoner, you know, who'd come round and say,

"Well, you know, you've got to pay."

So there was no fixed fee. "You know you've got to pay," he says.

"But I've got no money, what are you going to do to me?"

So he said, "You know, what could you afford?"

So he used to push him and if he had money on him,

you know, if he had money,

he'd pay, he'd say, "I'll give your five bob."

You know, and the almoner would say "That's all you can afford?"

"Five bob, OK." You know, that was the fee.

But if you was well-off, you'd pay more, you know.

It was according to what you was.

The need to pay had given rise to new forms of insurance schemes

based on contributions.

The other big development of this period was the developments

of large-scale contributory schemes

pitched at the working-class patients.

And these usually actually were run through the workplace -

the factory, the shop, whatever.

And the way it worked is that a small amount of money

would be deducted from people's wages.

Sometimes it was a penny in the pound of their earnings

and, sometimes, it was just a set amount of a few pence

on a regular basis.

The 1920s saw a mushrooming of these schemes around the country,

and they grew rapidly.

Membership of a scheme would typically cover the family

for some hospital services,

but it was based on how much you earned

and what kind of medical conditions you had.

Some schemes were organised by the hospitals themselves.

Others were run by independent organisations.

It was the almoner's job to work out who was covered.

My task was to assess people in terms of their ability

to meet the cost of having prescribed treatment.

I would put the category into which they fell

and if they were to have free treatment, there was a large F.

And if they were belonging to a scheme

which gave them free hospital treatment,

like the Hospital Savings Association, I would put HSA.

And if they were feeling they would like to contribute

and were in a position to contribute,

then, there would be a D - a donation.

A rigorous assessment of the patients' finances

could come at the expense of compassion for their needs.

You'd see a lady almoner

and she used to ask you just what money you can afford to pay.

She wanted a lot at first.

I said, "I can't afford that, because, naturally,

"we've got to get some clothes for the baby when he's born

"and things, anyway."

When the baby was born dead,

a couple of days after, she came up to me in the ward.

This is their attitude of caring.

And she said to me, "Well, now you've lost your baby,

"you haven't got a baby, perhaps you can pay more money."

Originally, the almoner was appointed to investigate

the financial backgrounds of the patients.

Could they pay for treatment?

This is how they're remembered, but they did a lot more.

They very quickly became a clearing house for the hospital.

They identified patients

who needed additional support within the community,

whether it was educational,

they needed help finding work, they needed help feeding children.

Their role started to expand

and, eventually, they developed into the modern social worker.

The almoner was the great go-between within the social side of the patients,

and that was well done.

If a patient died, she was the person who dealt

with all the arrangements of death and so on.

And, as a houseman, as a doctor,

we, we just had never been taught

and we didn't know how to do it and we didn't do it.

And so, to me, an almoner was a very valuable person in the team that we belonged to.

William Frankland was a junior doctor in the casualty department

of St Mary's Hospital, London, in the early '30s.

Before the antibiotic era, there were so many diseases.

We really could help very little compared to what you can help now.

And so, the patients would be in for a very long time.

Protecting patients from the risks of infection was essential.

Mary Allan trained as a nurse in the 1930s

and had to use careful nursing to guard against it.

There were always two nurses -

one they called the dirty nurse, and the clean nurse.

The dirty nurse always took the dirty dressings off

and disposed of those.

And then, the clean nurse opened her sterile packet

and was able to get on with the dressing,

but she never touched anything, anything that was soiled.

Locked inside the hospital walls,

a different fight was taking place against the bacteria which caused infection.

William Frankland worked with a scientist

at the forefront of the quest to find new such cures.

His name was Alexander Fleming.

Fleming was... I had to see him every day at ten o'clock in the morning.

Theoretically, to talk about the patients in the ward,

we had this experimental ward.

This was with the people with all sorts of rare diseases

and could we help them,

and could Fleming help them and could anyone...?

And I was, one of my jobs was to look after them.

But... So I had to report to Fleming every morning at ten o'clock.

He wasn't interested in patients.

In two years, I can only remember him once asking about a patient.

He was always interested in getting a substance

which would deal with infection.

And I remember very well he talked

about the mould Penicillium notatum, it was called.

This green mould.

The consequences of this discovery

would not be felt for another decade.

But, before penicillin, another medication had already arrived on the scene.

They new sulphonamide-based drugs were effective against puerperal fever,

a common bacterial infection contracted by women during childbirth.

As a student, we were taken to Queen Charlotte's Hospital

to see women who got puerperal sepsis,

this is an infection with a high swinging fever,

with a high mortality.

And they were put on this amazing drug - down came the temperature.

And we would see it as something absolutely unbelievable.

So here was the first...

The word antibiotic, actually, wasn't coined till the 1950s

so we would call it an antibacterial...

And that was absolutely dramatic.

The introduction of sulphonamide saw maternal deaths nose dive.

In the next 15 years, they would fall by 80%.

This was part of a change

which saw women giving birth in hospitals for the first time.

Hospitals were seen as safer environments,

freer from infection, offering the best of medical science.

And other discoveries were being made elsewhere in hospitals.

Scientists were exploring all sorts of bizarre and creative ways

for tackling some of the most lethal conditions.

These included the invention of arcane pieces of equipment for artificial respiration.

There was one called the cuirass.

It was an arrangement... It was a bit...

Back the old woman's shoulders,

I suppose, it's was like a back and front, metallic front -

they were sandwiched in between this piece of equipment.

It was attached to bellows. They could wear the cuirass and that would be attached to the equipment -

it could go on the back of a wheelchair.

But the most groundbreaking of them emerged in the United States in 1928.

Its name would endure for decades to come.

They called it the Iron Lung.

I think what it's interesting about iron lungs

is they are iconic pieces of medical technology,

because they do save lives.

It's a saviour for this terrible scourge of polio

that is terrifying the nation.

'His name is Johnny Greene and he's two years old. He looks well enough.

'But there is something wrong with him.

'He has had infantile paralysis

'or, to give it its proper name, poliomyelitis.'

Polio was a virus which attacked the central nervous system

and disabled the muscles it infected.

Also known as infantile paralysis, it mainly affected children.

Polio was a really big thing there.

And it seemed to spread like wildfire.

And they said it was spread from swimming pools and things like that.

And I do know people, they were kids

who wore callipers on their legs as a result of having polio.

At its worst, polio paralysed the lung muscles

and stopped patients breathing normally.

Before a vaccine was available,

the iron lung was the only way to keep people alive

once they had the disease.

It was the world's first life support machine.

Basically, the iron lung is what they call a negative pressure chamber,

and what it does is it pressurises and depressurises the patient's chest.

Some people never got out of their iron lung.

Some people did get out of their iron lungs and they were used only temporarily.

The nursing staff would take the patient out for a few minutes

and gradually build the patient up

till they were breathing on their own.

It is an incredibly complex piece of medical technology.

Therefore, it is very expensive.

With hospitals unable to afford them,

getting access to an iron lung was not easy.

But, in 1937, an Australian scientist named Edward Both

came up with a cheaper alterative.

It was made from plywood

and immediately drew the attention of car manufacturer William Morris,

also known as Lord Nuffield.

He offered to construct thousands of them in his factory for free.

I sincerely hope that my gift will be the means

of saving many valuable lives.

Hospital treatment was becoming increasingly dependent on medical technologies.

UV light treatment for vitamin D deficiency was a common therapy...

..as was the use of electricity.

I had to have a treatment called faradism.

It sounds awful, but it wasn't too bad.

It was a form of electricity that I think, I can't remember it now,

but they put your foot in a bowl of water

and they passed a current through your leg

and it made your muscle contract and expand.

They would try to build up your muscle tone.

It did make it... It wasn't particularly comfortable,

but they could start the electricity at a lower level

and gradually...turn it up a little bit.

One critical invention was the introduction of radium therapy for treating cancer.

Radium is the crown jewel in the ray-based therapies

that begin to emerge in the 20th century.

Cancer cases are increasing and it seems to be one potential cure.

The problem is that radium is quite expensive,

at about £15,000 a gram at the time.

A lot of hospitals are struggling to pay their ordinary bills.

Here is this new therapeutic agent which they need some help buying.

To fund these new technologies, hospitals were still dependent

on raising money through charitable organisations.

One of the largest was the King Edward's Fund.

This model hospital, now at the Science Museum,

was built as a promotional tool by the fund in 1932.

Throughout the decade, it toured the country

and was seen by hundreds of thousands of people.

It was an illustration of how hospitals had been transformed.

Now centres of medical expertise, they offered a more attractive,

sophisticated environment to receive treatment.

With this rise in technology,

people feel a lot more comfortable about going to hospital

in that it is a safer, scientific environment.

They get diagnosed, they get looked after.

Middle-class people see this as being able to get the best care,

and they want to get the best care as well.

A rise in middle-class patients

gave voluntary hospitals a chance to tap into some vital new income.

The response was to begin to open

either pay-beds or private wards

or, in some cases, private wings, separate wings at the hospital.

One of the great things was, if you were a private patient,

you wouldn't be taught on by, you know, horrible medical students.

HE CHUCKLES

Which was a pity, because there was a lot of very good clinical material there.

But no, the private patients, and some people, I think,

insured themselves to make sure exactly the place they went to privately,

and they would have a single room,

they'd have much more nurses to look after them,

but they wouldn't have these...medical students

or be taught on or practised on and so on.

The hospitals become a more pleasant place to go,

and we see lovely painted walls,

lights above the bed, reading material, the buzzer.

Conversely, visiting hours could still be quite draconian,

even though hospitals were much more pleasant.

For example, visiting children in hospital was still quite rigidly controlled throughout the 1930s.

And, say, for example, at an orthopaedic hospital,

children under 12 who were in the hospital were only able to be visited

twice a month on a Sunday for two hours.

But getting into hospital at all was becoming harder.

As they moved away from charity and towards a paid-for service,

hospitals were struggling to meet the new demand.

One of the problems of the hospital was the success that they were having.

A lot of people wanted to get into them,

they saw them as the right place to get medical treatment.

So the 1920s and '30s, you see the rise of waiting lists,

not dozens of people, but hundreds of people.

The patients themselves always hoped that they would go to the well-known hospital,

which had a medical school attached to it.

And they would have the well-known consultants attached to that hospital.

In fact, voluntary hospitals only provided a third of the total beds across the country.

The majority were still to be found in the old workhouse infirmaries,

mainly reserved for the long-term sick and the elderly.

Bella Aronovitch was moved to one following an appendix operation which wouldn't heal.

I was, I suppose, about 18

when I was transferred to this Poor Law hospital.

I'd been in the voluntary hospitals up till then,

and got a kind of set picture of what they were like,

and I looked round and there were numbers and no names on the ward.

And when the door was opened

and I looked at this sea of faces,

I felt indescribably frightened and really low.

I hadn't expected anything like this.

The beds were so close together

that you could touch the patient in the next bed.

The names of the wards were Faith, Hope and Charity.

Everything about it was so run down, it was so poverty-stricken

and there was such an atmosphere of death there.

All the time I was in hospital I used to think,

"Well, fancy leaving the health to millions of people

"in this ad-hoc way

"when some people could pretty well get all that they wanted

"and for the others it was one long struggle.

But a new piece of legislation in 1929 would allow local councils

to take over the running of these old institutions.

They became known as municipal hospitals,

and London was leading the way.

On 1st April 1930,

the London County Council appropriated all the hospitals

it had inherited both from the London workhouses

and also from the Metropolitan Asylums Board.

Overnight, they had on their hands 98 hospitals,

which they set about trying to organise into a coherent system.

What they tried to do, essentially, was upgrade the Poor Law infirmaries,

the workhouse infirmaries,

and turn them into potential competitors with the voluntary hospitals,

giving them operating theatres, introducing all the new technologies and therapies

that are available at the voluntary hospitals.

In Glasgow, the Council took over Stobhill Hospital,

an old workhouse infirmary.

This film was made to publicise its newly modernized facilities.

Yet places like Glasgow and London were exceptions.

In many parts of the country,

workhouse infirmaries were not taken over.

And, even if they were, they couldn't shake off their notorious reputations.

A lot of people didn't want to go into these institutions,

even after they were handed over to the municipal authorities.

On children's birth certificates, for example,

those children who were born in some of these institutions,

they simply put an address, not the name of the institution,

because the stigma was still very strong.

Despite improvements in particular areas,

the quality of hospitals varied greatly depending on where you lived

and how much you could afford to pay.

A third of all specialists lived in London.

So London was the place to go

if you wanted to specialise in particular areas of medicine.

And consultants could make a lot of money.

And there was a lot of resentment about their high-handed attitude

or the fact that they weren't really caring for people who were very, very ill.

They were just caring for people who could pay.

There was this tension all the time between the requirements of doctors.

Doctors were always really keen to preserve their private practice.

The voluntary hospitals were always desperate to preserve their independence.

And the municipal hospitals really wanted more and more

to become the general provider for the citizens.

It really was in desperate need of,

of bringing together into some, you know, coherent shape.

The lack of a joined-up hospital system ran counter

to one of the big ideas that was animating Britain at the time.

One of the great words of the '30s was "planning."

There were all sorts of organisations which were just devoted to planning.

That you found out all you could about a subject,

be it transport, be it medicine...

And then, on the basis of information,

you laid your plans and your recommendations

and you formulated your policy.

That was very true in health towards the end of the '30s.

Eventually, a debate would be launched

about how a new hospital system might be organised.

But another crisis loomed which presented the hospitals

with an even greater, more immediate challenge.

War.

The First World War was not very organised, it kind of happened.

Whereas the Second World War, the country was preparing.

In 1937, the Emergency Medical Services were set up.

So that was two years before the war was even declared.

'In the towns, the front line of modern war,

'the health services were organised

'to deal with the menace of air attack.

'The voluntary and municipal hospitals were linked together

'under one national health service.

'Taking the London area as an example, what has happened is this.

'The area has been divided into sectors.

'Each with one of the big hospitals acting as parent.'

Across the country, the Emergency Medical Service

took control of hospitals and placed them under one umbrella.

New wards were built and temporary buildings set up.

50,000 hospital beds were added in just a few months.

Doctors were employed by the service

and sent to where they were most needed.

The Emergency Medical Service had set an example of how an integrated hospital system could be run.

It provided a model for the planners,

who, during the Second World War,

were beginning to think much more seriously

about the possibility of a national health service.

This is when the term first starts to be introduced.

In the sense of delivering a more comprehensive service

and indeed a universal service,

something to which everybody had access

simply by right of citizenship.

What the Second World War did, of course, was to emphasise

that health could no longer be left to philanthropy,

it could no longer be left to voluntary initiatives

and good-hearted ladies selling flags.

It was the health of the nation

and the nation or the government needed to take responsibility for it.

You know, the health of the nation was too important

to be left to these hotchpotch of arrangements.

'In the old days, money meant a well-planned entry into the world

'with as much skill and care

'as a Harley Street nursing home could provide.

'But in the new world that we are making,

'and making in the very teeth of war,

'we give every baby the right to both the broad acres

'and the Harley Street skill.'

The idea that citizens had a right to hospital care

was crystallised by the experience of war.

But war had also accelerated the development of earlier scientific discoveries.

It had taken over a decade to be purified and manufactured,

but Fleming's mould had finally arrived.

It was called penicillin.

And when it was introduced to the wards to be used on patients,

it was literally kept under lock and key.

It was so precious that it was only the senior staff

that were allowed the keys to go and get it out and draw up the doses

and go and give it to the patients.

And we were absolutely stunned. It was literally a miracle drug.

Jim Mulligan was one of the first civilians to receive penicillin

when he went into hospital for an operation.

I was due to be in there for several weeks, if not months.

And they used penicillin on me

and it was one of the first times that it was used on civilians,

cos it was developed for soldiers in the war.

And I was out in three weeks.

In that time, I saw my first banana

and, one day, my brother brought in the Daily Mirror

with the headline about this amazing bomb

that they've dropped in Japan.

And it'll do this and it'll do that.

And that was... I remember seeing the Daily Mirror

with the Hiroshima bomb.

In 1945, Britons were celebrating the end of another war.

The First World War had ended without a proper hospital system.

The Second World War would help provide one.

After the First World War,

everything went back to the way it was.

Whereas in the Second World War,

people did not want that to happen again.

They had suffered, they'd lost family, friends,

they wanted things to change.

So this idea of "never again" is extremely important

and it has a lot of importance towards the formation of the NHS.

The change in mood had brought a newly elected Labour government.

Riding on a wave of public support,

it began immediately to implement plans

for a new national health service.

'Suppose instead of a simple broken leg,

'you have a complicated break.

'Then, suppose you have to spend months off sick.

'And suppose you don't need just one doctor,

'but a number of experts' opinions.

'What's the answer to that?

'Ruin!

'With this new Act, you're covered against things like that.'

HE SIGHS WITH RELIEF

Despite huge support for a unified service,

the government faced opposition from the medical profession.

A fierce debate raged between them and the British Medical Association.

Key to the disagreement was the prospect of a state-salaried medical service.

Some consultants were reluctant to give up their lucrative private practices,

and suspicious of the state undermining their independence.

But the new Minster Of Health came up with a solution

which would bring them on board.

It was Nye Bevan who inaugurated the National Health Service.

I think he once said that

he'd "filled the doctors' mouths with gold"

to persuade them to go with the new system.

Bevan's "gold" meant doctors could still hold on to their private practices,

even though they were employed by the state.

The government could now push forward with the new legislation.

'On July 5th, the new National Health Service starts,

'providing hospital and specialist services,

'medicines, drugs and appliances,

'care of the teeth and eyes.'

I remember everybody being absolutely delighted,

because all those fears and the trepidation

and...

..the knowing that if you got ill,

that was serious and you'd just have to manage it on your own.

It changed completely. It was a different world.

It was the dawn of a new age.

But it hadn't emerged from nowhere.

This had been a long revolution

built on decades of innovation

in which the hospital had played a central role.

Pioneering research and technologies had reduced deaths

and generated a new faith in medical science.

Hospitals had opened their doors to the community to raise funds

but they had also raised expectations of entitlement to treatment.

United in war, the hospitals had laid the foundations of a new system

which, for the first time in history,

would provide health care for all.

Free at the point of service, from cradle to grave.

Subtitles by Red Bee Media Ltd