1 Access to healthcare, 1880–1930

The late nineteenth and early twentieth centuries have often been described as a period of progress, when the poorer classes gained access to a whole range of medical services previously reserved for the wealthy. In the past, this opening up of care was largely attributed to the state. Across Europe, central and local governments created health insurance schemes and new welfare services to provide the poor with access to care, from general practitioners (GPs) to outpatient and hospital care, and treatment for specific complaints such as tuberculosis and venereal disease. This movement culminated in the 1940s, when it was the boast of the British government that the National Health Service provided care for all ‘from the cradle to the grave’. However, more recent studies by historians of medicine have shown that improved access to health services was also provided through charities. Old voluntary organisations, such as hospitals and dispensaries, expanded their work and strove for greater efficiency, employing professional administrators. New charities were founded, providing novel services, including help for mothers and babies. Improved access to healthcare also came about through private insurance schemes to provide GP and inpatient care to the working classes.

While historians of medicine agree that this period saw greater provision of medical services, especially for the poorer classes, some researchers have questioned whether improved access to care was an unalloyed good. They have argued that not everyone benefited equally from improved services. Improvements in access to care were unequally distributed. New medical services were often limited to the very poorest, or to particular groups, such as working men or women and children, and levels of provision varied between countries and regions. Provision of care did not guarantee a high standard of service: detailed research by some historians has shown that the poorer classes often received a lower quality of care than their wealthier counterparts. Others have argued that there were drawbacks to more accessible medical services. They have described the early twentieth century as a period of ‘medicalisation’. As patients gained greater access to medical professionals – doctors, nurses and health educators – they became passive consumers of medical services. At the same time, the medical profession no longer simply dealt with the sick, but increasingly took a role in monitoring the lifestyle and behaviour of healthy people. As a result, people became increasingly dependent on medical practitioners to guide their lives.

In this course, I explore these issues through a study of the health-care services available in Britain at the end of the nineteenth and in the first decades of the twentieth centuries, using a wide range of sources. Where material is available, I make comparisons with the care available elsewhere in Europe. I cover all aspects of healthcare – from disease prevention, through care in the home, general practitioner services and finally care in institutions. I explore the access to medical services among different social groups and assess how much control practitioners had over their patients' lives by 1930.