“Deliver Me From This Indignity!”: Cottage Hospitals, Localism and NHS Healthcare in Central England, 1948-1978

Abstract

Victorian and Edwardian cottage hospitals, compared to infirmaries and workhouse institutions, have been neglected by social historians. Yet, they provided an infrastructure dedicated to localism and healthcare for the aged under the new National Health Service (NHS) after World War Two. This article focuses on two renowned Midlands cottage hospitals built in mid-Northamptonshire at Pitsford. In their patient case-histories we can engage with: dignity standards, medical regime, ward designs, staffing levels, budget provisions, and patient voices. These popular institutions had a well-deserved reputation for delivering high-quality geriatric medicine from 1948 to 1978. Human vignettes detailing the physical indignities of ageing nonetheless proliferate in the records. The longevity of these basic issues was to prove to be a recurring tension in NHS financial planning. Budget models lacked enough funds for aged patients to receive ‘stable’ bedside care. Instead, NHS accountants allocated resources to ensure the future ‘sustainability’ of the system itself. A new paradigm highlights the inherent financial contradictions and empty political promises that those needing geriatric care often experienced, and still do. Throughout, the rediscovered cottage hospital records contain important historical lessons for the present impasse about how to define, deliver and secure dignity for elderly patients in today’s NHS.

Acknowledgements

I am very grateful to Annegret Hagenberg, the present occupier of part of the old Pitsford Hospital called Stone House, for bringing these original records to my attention, now in the possession of the author. As they are fragile, having been found in an attic wrapped in newspaper, they will now be sent for conservation before archival deposit. I am also thankful to the anonymous referees who gave such valuable feedback.

Notes

¹ After the Union Chargeability Act (1865) small parish funding merged into larger poor law union units to create a bigger tax base to pay for public loans to commission new infirmaries.

² The original intention was to use health centres not GP surgeries as the focal point for patients under the NHS. This was never realised because of pressure from the British Medical Association and central government. Had it been implemented cottage hospitals would have had a much more pivotal role in localism and healthcare than became the case by the 1970s.

³ http://www2.warwick.ac.uk/fac/arts/history/chm/research_teaching/research/nhshistory – this is currently the topic of a Joint Investigator Award held by Roberta Bivins and Matthew Thomson funded by the Wellcome Trust at the University of Warwick’s history department.

⁴ Refer, notably, in the USA the recent research led by Professor William M. Reddy on the history of emotions at Duke University and in Britain work on the history of pain at the consortium based at Queen Mary University led by Professor Joanna Bourke.

⁵ Political opponents of Ernest Bevan referred to the gross cost estimates in the 1944 White Paper as those the system was expected to achieve. When these doubled – by 1949/50 the gross costs were £312 m for England and Wales against a budget estimate of £152 m gross in the 1946 bill – talk of retrenchment by about one third of total expenditure to bring the cost base down to £300 m maximum, was spoken of by political figures like Herbert Morrison. Others like T. H. A Robb at Oxford University took the view that the original estimates were badly miscalculated yardsticks, and a long-term liability. Section 3 looks at financial shortfalls in the Midlands.

⁶ The Manfield Shoe Company Ltd established in 1867 by 1908 had four large factories in Northampton town producing over a million pairs of shoes a year. By 1935 the family were founding members of Norvic Shoe Company, the largest producer of shoes in Britain. Profits funded local cottage hospitals for the elderly.

⁷ The Mid-Northamptonshire Constituency was abolished in 1918 and merged into the Northampton seat won by Margaret Bondfield (1923–45), one of the first female Members of Parliament on the Labour benches. She was appointed by Ramsay MacDonald as parliamentary secretary to the Ministry of Labour in 1929 when the New Poor Law finished. Her papers can be found at, Vasser College Library USA, Archives and Social Collections, Margaret Grace Bondfield Papers, Folder 3.2, Parliamentary candidature, 1919–32.

⁸ Northampton Mercury and Herald was the merged title of two Victorian newspapers - Liberal (Mercury) and Conservative (Herald) – in the county from 1900.

⁹ The figures cited have been calculated from those sources held by this author (see acknowledgement below) and those cited in NRO references (refer note 10 below). It is noteworthy that the female patients were generally more descriptive of their daily physical plight than their male counterparts. On balance their voices appear to best describe the shared experience of ageing and its routine indignities for both genders in the patient records.

¹⁰ NRO patient records are only available under the Freedom of Information Act for general consultation, and are closed for identifiable purposes for 100 years according to the Data Protection Act in the UK.

¹¹ There is a vibrant historiography on the production of health statistics and their financial veracity, hence Crook and O’Hara (2011) represent a concerted attempt by scholars to now interrogate their meaning over the duration of the Poor Law and NHS.

¹² Lewis points out that these fundamental financial tensions were examined in the 1990s by the Department of Health; yet, as events have subsequently proved with the NHS scandal at Staffordshire, they could not be described as being resolved. Lewis thought this might happen, and very sadly it did.

¹³ Part of the New Town development of Northampton announced by Richard Crossman MP, Minister for Housing on 3 February 1965, and linked to NHS expansion plans.

¹⁴ ‘Fit for the Future’ is the policy slogan of the NHS Sustainable Development Unit.

¹⁵ Hurren 2012 points out the New Poor Law from 1873 to 1893 tried to implement the same policy on cost-saving grounds, and then failed to make the predicted reductions.

Additional information

Notes on contributors

Elizabeth T. Hurren

Dr. Elizabeth T. Hurren is Reader in the Medical Humanities and History in the School of Historical Studies at the University of Leicester ([email protected]). She is an international scholar of the history of the body, with wide-ranging research interests in death, dying and poverty studies. In 2007 she published in the prestigious Royal Historical Society Series, Protesting about Pauperism: Poverty, Politics and Poor Relief in late-Victorian England. This was followed in 2013 by her ground-breaking study entitled Dying for Victorian Medicine: English Anatomy and its Trade in the Dead Poor, 1832 to 1929, short-listed for the British Medical Association’s Book of the Year Prize in 2015. In 2016 she has published with Palgrave Macmillan Dissecting the Criminal Corpse: Staging Post-Execution Punishment in Early Modern England funded by the Wellcome Trust. In this article she returns to her expertise on localism and healthcare in the past with relevance for policy studies today. Email: [email protected]