Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-24T11:13:33.628Z Has data issue: false hasContentIssue false
  • English
  • Français

‘To regulate and confirm inequality’? A regional history of geriatric hospitals under the English National Health Service, c.1948–c.1975

Published online by Cambridge University Press:  21 March 2012

MARTIN GORSKY
MARTIN GORSKY*
Affiliation:
Centre for History in Public Health, London School of Hygiene and Tropical Medicine, UK.
*
Address for correspondence: Martin Gorsky, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London WCIH 95H, UK E-mail: martin.gorsky@lshtm.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

The post-war history of hospital care for older people in Britain in the first phase of its National Health Service (NHS) emphasises a detrimental Poor Law legacy. This article presents a regional study, based on the South West of England, of the processes by which Victorian workhouses became the basis of geriatric hospital provision under the NHS. Its premise is that legislative and medical developments provided opportunities for local actors to discard the ‘legacy’, and their limited success in doing so requires explanation. Theoretical perspectives from the literature are introduced including political economy approaches; historical sociology of the medical profession; and path dependence. Analysis of resource allocation decisions shows a persistent tendency to disadvantage these institutions by comparison with acute care hospitals and services for mothers and children, although new ideas about geriatric medicine had some impact locally. Quantitative and qualitative data are used to examine policies towards organisation, staffing and infrastructural improvements, suggesting early momentum was not maintained. Explanations lie partly with national financial constraints and partly with the regional administrative arrangements following the NHS settlement which perpetuated existing divisions between agencies.

Keywords

geriatric hospitalPoor LawhistoryNational Health Service
Type
Articles
Information
Ageing & Society , Volume 33 , Issue 4 , May 2013 , pp. 598 - 625
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abel-Smith, B. 1964. The Hospitals in England and Wales 1800–1948. Harvard University Press, Cambridge, Massachusetts.Google Scholar
Adams, J. 2000. The last years of the workhouse. In Bornat, J., Perks, R., Thompson, P. and Walmsley, J. (eds), Oral History, Health and Welfare. Routledge, London, 98–118.Google Scholar
Andrews, C. 1951. Geriatrics I: the medical problem of to-day. Bristol Medico-Chirurgical Journal, lxviii, 35–8.Google Scholar
Andrews, G., Holmes, D. and Poland, B. 2005. ‘Airplanes are flying nursing homes’: geographies in the concepts and locales of gerontological nursing practice. International Journal of Older People Nursing, 14, S2, 109–20.Google Scholar
Anon. 1955. Editorial: The elderly chronic sick. Bristol Medico-Chirurgical Journal, 70, 20.Google Scholar
Anon. 1970. Geriatrics and Chronic Sick, Bath Clinical Area. Bath Record Office, Bath, UK.Google Scholar
Arthur, W. B. 1989. Competing technologies, increasing returns, and lock-in by historical events. Economic Journal, 99, 394, 116–31.Google Scholar
Bath Hospital Management Committee 1948–56. Bath Hospital Management Committee Minutes. Bath Record Office, Bath, UK.Google Scholar
Bosanquet, N. 1978. A Future for Old Age. Maurice Temple Smith, London.Google Scholar
Bridgen, P. 2001. Hospitals, geriatric medicine, and the long-term care of elderly people 1946–1976. Social History of Medicine, 14, 3, 507–23.Google Scholar
Bridgen, P. and Lewis, J. 1999. Elderly People and the Boundary Between Health and Social Care 1946–91. Nuffield Trust, London.Google Scholar
Bristol and District Divisional Hospitals Council 1947. Sixth Annual Report, Year Ended 31st March 1947. Bristol and District Divisional Hospitals Council, Bristol, UK.Google Scholar
Bristol and District Divisional Hospitals Council 1948. Seventh Annual Report, Year Ended 31st March 1948. Bristol and District Divisional Hospitals Council, Bristol, UK.Google Scholar
Bristol Medical Officer of Health (BMOH) 1943. City and County of Bristol: Report of the Medical Officer of Health for the War Years 1939–1942. BMOH, Bristol, UK.Google Scholar
Bristol Medical Officer of Health (BMOH) 1945. City and County of Bristol: Report of the Medical Officer of Health for the Year 1944. BMOH, Bristol, UK.Google Scholar
Conrad, C. 1998. Old age and the health care system in the nineteenth and twentieth centuries. In Johnson, P. and Thane, P. (eds), Old Age from Antiquity to Post-modernity. Routledge, London, 132–45.Google Scholar
Cope, Z., Gill, W., Griffiths, A. and Kelly, G. 1945. Ministry of Health: Hospital Survey, the Hospital Services of the South-Western Area. HMSO, London.Google Scholar
de Beauvoir, S. 1972 [1970]. Old Age. Andre Deutsch, Weidenfeld and Nicholson, London.Google Scholar
Denham, M. 2006. The surveys of the Birmingham chronic sick hospitals, 1948–1960s. Social History of Medicine, 19, 2, 279–93.Google Scholar
Estes, C. and Linkins, K. 1997. Devolution and aging policy: racing to the bottom in long-term care. International Journal of Health Services, 27, 3, 427–442.Google Scholar
Fox, D. M. 1986. Health Policies, Health Politics: The British and American Experience, 1911–1965. Princeton University Press, Princeton, New Jersey.Google Scholar
Gloucestershire Public Assistance Committee (GPAC) 1940–8. P.A.C. Minutes 1940–48. CW/M1/3, Gloucestershire Archives, Clarence Row, Alvin Street, Gloucester GL1 3DW.Google Scholar
Goffmann, E. 1968. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Penguin, London.Google Scholar
Gorsky, M. 2008. The National Health Service at 60: a review of the historiography. Social History of Medicine, 21, 3, 437–60.Google Scholar
Gorsky, M., Mohan, J. with Willis, T. 2006. Mutualism and Health Care: British Hospital Contributory Schemes in the Twentieth Century. Manchester University Press, Manchester, UK.Google Scholar
Gough, I. 1979. The Political Economy of the Welfare State. Macmillan, Basingstoke, UK.Google Scholar
Grimley Evans, J. 1997. Geriatric medicine: a brief history. British Medical Journal, 315, 25 October, 1075–7.Google Scholar
Hacker, J. S. 1998. The historical logic of national health insurance: structure and sequence in the development of British, Canadian, and U.S. medical policy. Studies in American Political Development, 12, 1, 57–130.CrossRefGoogle Scholar
House of Commons Debates 1946. Parliamentary Debates (Hansard), 422 5 s, 30 April, Aneurin Bevan.Google Scholar
Higginbotham, P. 2011. The Workhouse: the story of an institution … Available online at http://www.workhouses.org.uk/ [Accessed 8 May 2011].Google Scholar
Honigsbaum, F. 1979. The Division in British Medicine: A History of the Separation of General Practice from Hospital Care, 1911–1968. Kogan Page, London.Google Scholar
Hughes, W. 1951. Geriatrics III: the local problem. Bristol Medico-Chirurgical Journal, lxviii, 42–5.Google Scholar
Hughes, W. and Pugmire, S. 1952. A geriatric hospital service. Lancet, 21 June, 1249–54.Google Scholar
Hussey, S. 2001. ‘An inheritance of fear’: older women in the twentieth-century countryside. In Botelho, L. and Thane, P. (eds), Women and Ageing in British Society Since 1500. Longman, Harlow, UK, 186–206.Google Scholar
Immergut, E. 1992. Health Politics: Interests and Institutions in Western Europe. Cambridge University Press, Cambridge.Google Scholar
Institute of Municipal Treasurers and Accountants (Incorporated), The Society of County Treasurers, 1951. Local Health Service Statistics, 1949–50. Society of County Treasurers, LondonGoogle Scholar
Institute of Municipal Treasurers and Accountants (Incorporated), The Society of County Treasurers, 1970. Local Health Service Statistics, 1968–9. Society of County Treasurers, LondonGoogle Scholar
Jeffreys, M. 2000. Recollections of the pioneers of the geriatric medicine specialty. In Bornat, J., Perks, R., Thompson, P. and Walmsley, J. (eds), Oral History, Health and Welfare. Routledge, London, 75–97.Google Scholar
Joint Advisory Committee 1970. Joint Advisory Committee for the Bristol Clinical Area: Geriatric Services. 40837/28 b, Bristol Record Office, Bristol, UK.Google Scholar
Johnson, P. 1989. The structured dependency of the elderly: a critical note. In M, Jefferys. (ed.), Growing Old in the Twentieth Century. Routledge, London, 62–72.Google Scholar
Kay, A. 2005. A critique of the use of path dependency in policy studies. Public Administration, 83, 3, 553–71.Google Scholar
Kayser-Jones, J. S. 1981. Old, Alone, and Neglected: Care of the Aged in the United States and Scotland. University of California Press, Berkeley, California.Google Scholar
Klein, R. 2006 [1983]. The New Politics of the NHS: From Creation to Reinvention. Radcliffe Publishing, Oxford.Google Scholar
Lewis, J. 2001. Older people and the health–social care boundary in the UK: half a century of hidden policy conflict. Social Policy and Administration, 35, 4, 343–59.Google Scholar
Lloyd-Sherlock, P. 2010. Population Ageing and International Development: From Generalisation to Evidence. Policy Press, Bristol, UK.Google Scholar
Lowe, R. 2006. Financing health care in Britain since 1939. In Gorsky, M. and Sheard, S. (eds), Financing Medicine: The British Experience. Routledge, London, 242–51.Google Scholar
Manor Park Hospital Management Committee 1949–72. 40837/1f, Bristol Record Office, Bristol, UK.Google Scholar
Martin, M. 1995. Medical knowledge and medical practice: geriatric medicine in the 1950s. Social History of Medicine, 8, 3, 443–61.Google Scholar
McKeown, T. and Lowe, C. 1952. A scheme for the care of the aged and chronic sick. British Medical Journal, 26 July, 207–10.Google Scholar
Means, R. and Smith, R. 1998 [1985]. From Poor Law to Community Care, the Development of Welfare Services for Elderly People 1939–71. Policy Press, Bristol, UK.Google Scholar
Mohan, J. 2002. Planning, Markets and Hospitals. Routledge, London.Google Scholar
National Health Service (NHS) 1962. A Hospital Plan for England and Wales. Cmnd. 1604, HMSO, London.Google Scholar
North East Somerset Hospital Management Committee 1948–72. North East Somerset Hospital Management Committee Minutes. SRO D/H/nes/1/1, Somerset Archives and Local Studies, Somerset Heritage Centre, Brunel Way, Langford Mead, Norton Fitzwarren, Taunton, TA2 6SF, UK.Google Scholar
Nuffield Provincial Hospitals Trust 1946. The Hospital Surveys: The Domesday Book of the Hospital Services. Oxford University Press, Oxford.Google Scholar
Offe, C. 1984. Contradictions of the Welfare State. Hutchinson, London.Google Scholar
Parliamentary Papers 1904 (113) lxxxii.Google Scholar
Parsons, A. 1932. County Borough of Bristol Survey Report of Allan C. Parsons. MH/66/1068, The National Archives, London.Google Scholar
Parsons, A. 1931–32. Administrative County of Somerset: Report on a Survey of Health Services. MH/66/210, The National Archives, London.Google Scholar
Peroni, F. 1981. The status of chronic illness. Social Policy and Administration, 15, 1, 43–53.Google Scholar
Phillipson, C. 1982. Capitalism and the Construction of Old Age. Macmillan, London.Google Scholar
Phillipson, C. 1998. Reconstructing Old Age: New Agendas in Social Theory and Practice. Sage, London.Google Scholar
Pierson, P. 2004. Politics in Time: History, Institutions and Social Analysis. Princeton University Press, Princeton, New Jersey.Google Scholar
Riley, M. W. and Riley, J. W. 1994. Age integration and the lives of older people. The Gerontologist, 34, 1, 110–15.Google Scholar
Royal Commission of the Poor Laws and Relief of Distress 1910. Appendix Volume IX Minutes of Evidence. Cd. 5068, HMSO, London.Google Scholar
Robb, B. 1967. Sans Everything: A Case to Answer. Nelson, London.Google Scholar
Ryan, T. 1966. The workhouse legacy. The Medical Officer, 11 November, 270–1.Google Scholar
Sheldon, J. 1948. The Social Medicine of Old Age. Oxford University Press, Oxford.Google Scholar
Sheldon, J. 1958. On growing old. Bristol Medico-Chirurgical Journal, 73, 69–77.Google Scholar
Skocpol, T. 1985. Bringing the state back in: strategies of analysis in current research. In Evans, P. B., Rueschemeyer, D. and Skocpol, T. (eds), Bringing the State Back In. Cambridge University Press, Cambridge, 3–37.Google Scholar
Skocpol, T. and Amenta, E. 1986. States and social policies. Annual Review of Sociology, 12, 131–57.CrossRefGoogle Scholar
Somerset County Council 1930–48. Public Assistance Reports. C/WS/1/5, Somerset Archives and Local Studies, UK.Google Scholar
South Western Regional Hospital Board (SW RHB) 1947–74. South Western Regional Hospital Board Minute Books. 40837/17 a-I, Bristol Record Office, Bristol, UK.Google Scholar
South Western Regional Hospital Board Finance Committee (SW RHB FC) 1947–68. 40837/19 a–o, Bristol Record Office, Bristol, UK.Google Scholar
South Western Regional Hospital Board Geriatric Sub-Committee 1951. Report of Geriatric Sub-Committee Appointed to Consider the Geriatric Service in the Bristol Area. 40837/17 (b), Bristol Record Office, Bristol, UK.Google Scholar
Starr, P. 1982. The Social Transformation of American Medicine. Basic Books, New York.Google Scholar
Stewart-Smith, G. 1956. A morbid view of the over-65 s. Bristol Medico-Chirurgical Journal, 71, 44–54.Google Scholar
Sturdy, S. and Cooter, R. 1998. Science, scientific management, and the transformation of medicine in Britain c.1870–1950. History of Science, 36, 114, 421–66.Google Scholar
Taunton Hospital Management Committee 1948–65. 40837/6 n, Bristol Record Office, Bristol, UK.Google Scholar
Thane, P. 2002. Old Age in English History: Past Experience, Present Issues. Oxford University Press, Oxford.Google Scholar
Tinker, A. 1996. Older People in Modern Society. Fourth edition, Longman, London.Google Scholar
Townsend, P. 1962. The Last Refuge: A Survey of Residential Institutions and Homes for the Aged in England and Wales. Routledge, Kegan and Paul, London.Google Scholar
Townsend, P. 1981. The structured dependency of the elderly: a creation of social policy in the twentieth century. Ageing & Society, 1, 1, 5–28.Google Scholar
Walker, A. 1981. Towards a political economy of old age. Ageing & Society, 1, 1, 73–94.Google Scholar
Walker, A. and Naegele, G. 1999. The Politics of Old Age in Europe. Open University Press, Buckingham, UK.Google Scholar
Warren, M. 1943. Care of the chronic sick: a case for treating chronic sick in blocks in a general hospital. British Medical Journal, 2, 25 December, 822–823.Google Scholar
Webster, C. 1988. The Health Services Since the War. Volume I, Problems of Health Care. HMSO, London.Google Scholar
Webster, C. 1991. The elderly and the early national health service. In Pelling, M. and Smith, R. (eds), Life, Death and the Elderly: Historical Perspectives. Routledge, London, 165–93.Google Scholar
Webster, C. 1996. The Health Services Since the War. Volume II, Government and Health Care. Stationery Office, London.Google Scholar
Weisz, G. 2011. Epidemiology and health care reform. The national health survey of 1935–1936. American Journal of Public Health, 101, 3, 438–47.Google Scholar
Willcocks, D., Peace, S. and Kellaher, L. 1987. Private Lives in Public. Places: A Research-based Critique of Residential Life in Local Authority Old People's Homes. Tavistock Publications, London.Google Scholar
Wilson, T. 1951. Geriatrics II: modern developments. Bristol Medico-Chirurgical Journal, lxviii, 39–42.Google Scholar
Wofinden, R. 1952. The administrative problems of old age. Journal of the Royal Sanitary Institute, lxxii, 5, 562–71.Google Scholar