Gender, money and professional identity: medical social work and the coming of the British National Health Service

© 2018 The Authors. Published by Taylor and Francis. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1080/09612025.2017.1328760The arrival of the British National Health Service (NHS) in 1948 heralded significant changes for all health workers, but the establishment of a ‘free’ health service was especially meaningful for the hospital almoners—or medical social workers, as they were starting to be known—who had previously been responsible for the assessment and collection of patient payments. It was on this basis they had gained a foothold in the hospital, capitalising on gendered assumptions of financial understanding and behaviour. Yet what might have caused an identity crisis was embraced. This was a dual strategy of both repositioning the profession in alignment with the planned NHS and of asserting an enhanced professional status by distancing themselves from the handling of payment. It was an episode in the history of this distinctly female profession that speaks to women’s historic relationship with money.Wellcome Trus

“Open the Other Eye”: Payment, Civic Duty and Hospital Contributory Schemes in Bristol, c. 1927–1948

On the appointed day of 5 July 1948, the National Health Service (NHS) came into existence in Britain. What existed before had been a complex and constantly evolving mixed economy of healthcare, within which hospital services were provided by a combination of public and voluntary sectors. The public sector accounted for the majority of hospital beds and dominated treatment of the chronic and aged sick. However, it is the voluntary hospitals that have often been seen as at the heart of this system because of their historic foundations—many having been established as charitable institutions in the eighteenth and nineteenth centuries—as well as their perceived clinical superiority.1 In fact, the move towards a national health service, which ultimately nationalized the hospitals, gave great credence to an approach Daniel Fox has described as “hierarchical regionalism”. This placed such institutions as leading specialist and teaching centres at the top of a hierarchy of regional service providers, and in doing so reinforced this view of the primacy of the voluntary hospitals.

Payment and Philanthropy in British Healthcare, 1918-48

Social Histories of Medicine book series.There were only three decades in British history when it was the norm for patients to pay the hospital; those between the end of the First World War and the establishment of the National Health Service in 1948. At a time when payment is claiming a greater place than ever before within the NHS, this book uses a case study of the wealthy southern city of Bristol as the starting point for the first in-depth investigation of the workings, scale and meaning of payment in British hospitals before the NHS. Payment and philanthropy in British healthcare, 1918-48 questions what it meant to be asked to contribute financially to the hospital by the medical social worker, known then as the Lady Almoner, or to subscribe to a pseudo-insurance hospital contributory scheme. It challenges the false assumption that middle-class paying patients crowded out the sick poor. Hopes and fears, at the time and since, that this would have an empowering or democratising effect or that commercial medicine would bring about the end of medical charity, were all wide of the mark. In fact, payment and philanthropy found a surprisingly traditional accommodation, which ensured the rise of universal healthcare was mitigated and mediated by long-standing class distinctions while financial contribution became a new marker of good citizenship. Anyone interested in these changing notions of citizenship, charity and money, as well as the hospital as a social institution within the community in early twentieth-century Britain, will find this book a valuable companion.Wellcome Trus

Eine neubewertung der "gift relationship" in der Britischen geschichte zum freiwilligensektor

Es gibt nicht die eine Geschichtsschreibung, die karitative Arbeit, Kampagnen, gemeinnützige Organisationen, Freiwilligenverbände, Zivilgesellschaft, den dritten Sektor und Nichtregierungsorganisationen behandelt. Stattdessen lassen sich vier zentrale Forschungszweige ausmachen, die diesen Bereich neuerer britischer Geschichte abdecken. Sie sind nicht klar voneinander zu trennen, und Historiker wechseln von einem Schwerpunkt zum anderen, aber sie gingen dabei unterschiedlichen Zielsetzungen und Fragestellungen nach. Dazu zählt erstens eine Sozialgeschichte, die sich in erster Linie mit wohltätiger Arbeit und Armutsbekämpfung befasst und diese in den größeren Kontext der Beziehungen zwischen Arm und Reich einordnet. Zweitens ist eine Geschichte der Freiwilligenarbeit zu nennen, die aus dem Wunsch der ehrenamtlich Engagierten heraus entstanden ist, ihre Arbeit historisch zu verorten und aus der eigenen kollektiven Geschichte zu lernen. Drittens gibt es eine politische Geschichte, die sich mit der Beziehung zwischen dem freiwilligen Sektor und dem Staat befasst. Dazu gehören auch Arbeiten, deren besonderes Interesse den Nichtregierungsorganisationen nach 1945 gilt, die sich also einer speziellen Kategorie freiwilliger Organisationen widmen, welche Lobbyarbeit und Interessensvertretung betreiben. Und schließlich haben wir eine Geschichte des Humanitarismus, welche die Begegnungspunkte zwischen Großbritannien und der weiteren Welt untersucht, die von imperialistischen und internationalistischen Impulsen ausgegangen sind, sei es durch Fundraising oder durch die Entsendung freiwilliger Helfer nach Übersee.Title of supplement: Freiwilligenarbeit und gemeinnützige Organisationen im Wandel: Neue Perspektiven auf das 19. und 20. Jahrhundert, edited by Ed. by Nicole Kramer / Christine G. Krüger

Retail and Community: Business, Charity and the End of Empire

Retail has never existed in a vacuum. This interdisciplinary volume explores how English commercial, co-operative and charity retailing were shaped by and in turn influenced their social and political environments, from the local and the global, between the late-nineteenth and early twenty-first centuries. Historians, sociologists, archivists and heritage professionals engage with current debates on the rise of modern business and the decline of the high street, class and credit, professionalisation in the voluntary sector, migration and the end of empire. This will be a key resource to better understand retail and community in an era defined by social change, shedding new light on the enduring centrality of community relationships to modern retailers

Social work, health and the home : new directions in historical research

This workshop was hosted at the Centre for the Social History of Health and Healthcare in April 2011. Organised jointly with George Campbell Gosling of Oxford Brookes University, it brought together a wide variety of speakers and contributors, including research students, early career academics and well-established academics. Each drew upon new research from historical and social policy and social work perspectives

The patient contract in Bristol’s voluntary hospitals, c.1918-1929

The years following the end of the First World War were a time of great change, not least in the field of healthcare. Rising costs and demand ensured that traditional philanthropic sources of income became increasingly insufficient. This necessitated the emergence of new patterns of funding in Britain’s voluntary hospitals with a greater place for contributory schemes, direct patient payments and arrangements with the public sector. One aspect of such change was that the largely passive role, in which charitable provision had traditionally held the patient, was called into question. This article places this specific issue within context of the various ideological conceptions of healthcare, each defining the role of the patient in a different way. These are briefly outlined before the local case study of Bristol - and the Bristol Royal Infirmary (hereafter the Infirmary) in particular - is used to consider the impact that changes in voluntary hospital funding had on the role in which the patient was cast (here termed the ‘patient contract’). Although there were major changes in funding, most notably the introduction of a patient payment scheme in 1921, the patient contract remained in essence philanthropic. This was the result of a clear ideological commitment, most obviously on the part of the Faculty, to the treatment of the sick poor