How we paid the doctor before the NHS did it for us

Set against the familiar backdrop of a modern hospital or GP’s surgery, these pre-war pictures of medicine as it was practiced in Britain before the NHS look almost antediluvian.
circa 1921:  A doctor examining infants at the children's department of St Thomas' Hospital.  (Photo by Topical Press Agency/Getty Images)circa 1921:  A doctor examining infants at the children's department of St Thomas' Hospital.  (Photo by Topical Press Agency/Getty Images)
circa 1921: A doctor examining infants at the children's department of St Thomas' Hospital. (Photo by Topical Press Agency/Getty Images)

But a mere three generations have passed since conditions like these were part of normal life – depending, that is, on what type of life you had.

A private doctor, if you could afford one, was the privileged path to treatment, with voluntary hospitals considered a last resort. These were founded and paid for by the middle and upper classes to serve the working classes without charge. Those considered to be too well-off to be treated for nothing were asked to make a contribution, or to find private treatment of their own.

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This led to allegations of “playing the system”, with one eminent physician, Thomas Horder, complaining that his private patients were coming to him with the results of tests that had been carried out more cheaply elsewhere.

1946:  Doctors administering anaesthetic.  (Photo by Erich Auerbach/Getty Images)1946:  Doctors administering anaesthetic.  (Photo by Erich Auerbach/Getty Images)
1946: Doctors administering anaesthetic. (Photo by Erich Auerbach/Getty Images)

The arcane mechanism of paying for treatment was run on the same lines as the class system itself, with private surgeries set up by doctors who used the prestige of hospital work to bump up their prices.

At the beginning of the last century a typical consulting fee was around sixpence, plus the cost of any medicine, but even that was beyond the means of many for whom charity and the poor laws were the only recourse.

The situation prompted the Liberal Chancellor David Lloyd George to push through reforms, including compulsory medical insurance for certain workers – though not their families.

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Sheffield, along with Liverpool and London, helped pioneer hospital admissions along modern lines, and by the start of the war, about 20m people were covered by a scheme that guaranteed them a bed on a ward, irrespective of their ability to pay for it.

circa 1935:  Medical students watch an operation in progress from the gallery at University College Hospital, London.  (Photo by General Photographic Agency/Getty Images)circa 1935:  Medical students watch an operation in progress from the gallery at University College Hospital, London.  (Photo by General Photographic Agency/Getty Images)
circa 1935: Medical students watch an operation in progress from the gallery at University College Hospital, London. (Photo by General Photographic Agency/Getty Images)

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James Mitchinson

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