6 Hospital care

In most aspects of medical care, the rich generally enjoyed better access to medical services and better-quality services than the poor. The only exception to this rule was hospital care. In the nineteenth century the ‘deserving’ poor – whose respectability was guaranteed by the need for them to have a letter of admission from a subscriber or employer – could receive medical and surgical treatment in charitable hospitals. The very poor could obtain care through Poor Law hospitals, which in 1926 were transferred into the hands of local authorities. As the voluntary hospitals became associated with high-quality care, some commentators complained that the poor received far better hospital care than the rich. If a poor person needed to undergo an operation, he or she might be treated in the latest, most modern facilities in a teaching hospital. A rich client would have to go through the same procedure in his home, in a room rigorously scrubbed but lacking specialised equipment.

In the late nineteenth century, hospital facilities were gradually opened up to all classes. The upper and middle classes could receive treatment in private wards or in beds on general wards. These were not cheap: when Guy's Hospital accepted paying patients in 1884, they were charged 1 guinea per week for a ward bed and 3 guineas for a bed in a private cubicle. By 1902, private hospitals could charge as much as 4 guineas (Abel-Smith, 1964, pp. 149, 194). Alternatively, wealthy patients could pay for care in private nursing homes, which began to appear in the 1890s. By 1921, there were 26,000 nursing-home beds in England and Wales. Convalescent hospitals also offered a comfortable environment in which to recover from illness – Thomas Cook, the holiday firm, even had a facility in Egypt (Abel-Smith, 1964, pp. 133, 339).

Those patients who were unable to afford private care, but not so poor as to qualify for charity gained access to hospitals either by directly paying a contribution towards the cost of their care or through some form of insurance. The British Provident Association offered a 1-guinea policy which paid for up to three weeks in hospital. More often, workers paid into a ‘Saturday fund’ – these were schemes where, in return for a small, regular contribution, patients were ensured access to hospital facilities (Abel-Smith, 1964, pp. 327–8, 338–9).

While hospitals were increasingly open to all classes, there were still serious geographical inequalities. Far more beds were available in London than in any other city, and there were more facilities in urban than in rural areas. From the 1860s, small cottage hospitals helped to fill this gap, providing care to all classes in rural areas. From the outset, cottage hospitals were funded partly by patients' contributions and partly by donations. They proved popular, and numbers grew rapidly: the first cottage hospital was founded in 1859, and by 1880 there were 180 such facilities. Most were small institutions – many had around twenty beds – staffed by local general practitioners. Although cottage hospitals could not boast the high standard of facilities of the voluntary hospitals, many had operating theatres where GPs or consultant surgeons performed quite complex surgery.

Not all hospitals offered equally good levels of care. The next reading gives a patient's view of being treated in two voluntary hospitals and a Poor Law hospital.