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ABSTRACT
Only since the 2010s have historians become interested in dimensions of the UK’s National Health Service (NHS) histories beyond institutional, policy, and political narratives and the seventieth anniversary of the Service in 2018 gave additional impetus to work in this area. This paper argues for the need for a new interpretative framework for NHS histories that better reflects its multiple identities and social meanings. Drawing on a UK-wide programme of work it explores the processes of creating digital archive of NHS history using concepts and methodologies that foreground the institution’s social and dynamic nature and are underpinned by a commitment to inclusivity of perspectives and actors. It considers the challenges of working across academic, health, and heritage sectors and the need for historians to adapt to sharing power and agency when working alongside volunteers and interviewees. It concludes that the history produced through these ways of working is rich and insightful and has the potential to reshape historical practice and scholarship around NHS histories and beyond.
Acknowledgement
This paper has been in development since 2014 when discussions began with the National Lottery Heritage Fund (NLHF) about the need to capture the heritage of the NHS and we would like to thank Louise Sutherland for her support in developing the application which enabled the work to come to fruition. We are grateful to many people for feedback on earlier versions and parts of this article which we have presented in seminars and conferences and would particularly like to thank former and current colleagues in the Centre for the History of Science, Technology and Medicine, especially Elizabeth Toon, Neil Pemberton, and Julian Simpson; Kath Checkland and members of the Health Policy and Politics Organisation group; and the ‘NHS projects group’ including Sally Sheard and her team, Alex Mold and her team, and Mathew Thomson and Roberta Bivins and their team. We thank Michael Lambert and Jolanta Shields for their generous and detailed feedback on a final version and the anonymous reviewers for their helpful insights and suggestions. But the project has only been made possible through the dedication of the NHS at 70 team, the commitment and passion of our volunteers, some of whom have worked with us from the beginning, and the generosity of our interviewees for their willingness to share the story of their lives with us. It is to these people that we are most indebted.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Supplementary material
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Notes
1. Westminster Abbey Leaflet, 6.
2. Ibid., 6; and Bevan, “NHS—Bevan speaks.”
3. Osborne, “Danny Boyle claims.” See also Konstantaki et al., “Themes and Content,” 50.
4. Chambers, “How Americans interpreted.”
5. Thomson, “The NHS and the public.”
6. Hudson et al., “Exploring Public Attitudes to Welfare,” 696. See also: ‘The National Health Service and the Welfare State have come to be used as interchangeable terms’, Bevan, In Place of Fear, 81. Hayes argues that the highest public concern prior to the introduction of the NHS was the ‘lack of a unified or compulsory system’ for financing hospital care rather than a great desire for ‘radical’ change. Hayes, “Did we really want a National Health Service?” 660–1.
7. This was reinforced from the 1980s with the introduction of branding across NHS services and organisations. See Flynn, “NHS Blue.”
8. In 1959 Teddy Chester noted: ‘Our national hospital service is indeed a notable exhibit in the shop-window of our British way of life’. The Acton Society Trust, Creative Leadership, 60.
9. Bevan’s remarks were made during a speech to the National Association of Maternity and Child Welfare Centres on 25 June 1948 quoted in Foot, Aneurin Bevan, 210. On opposition to the creation of the Service see Seaton, “Against the ‘Sacred Cow’.”
10. Klein, The New Politics of the NHS, 25. See also Bogdanor, “Crisis of the NHS”; and Cutler, “Dangerous yardstick?”
11. Timmins, Rejuvenate or retire?, 9.
12. Powell, “Seventy years of the British NHS.”
13. The complexity of the relationship between the public and the NHS is suggested by the cooccurrence of the ‘outpouring of affection’ for the NHS’ 70th birthday during the same period the British Social Attitudes Survey recorded the lowest levels of public satisfaction with the Service for more than a decade. Robertson et al., “Public satisfaction,” 26.
14. Recent Wellcome Trust funded projects include: Sheard, The Governance of Health: Medical, Economic and Managerial Expertise in Britain since 1948, University of Liverpool. Accessed June 18, 2020. https://www.liverpool.ac.uk/population-health-sciences/departments/public-health-and-policy/research-themes/governance-of-health/; Bivins and Thomson, The Cultural History of the NHS, University of Warwick. Accessed June 18, 2020. https://warwick.ac.uk/fac/arts/history/chm/research/current/nhshistory/; Mold, Placing the Public in Public Health, Public Health in Britain 1948–2010, London School of Hygiene and Tropical Medicine. Accessed June 18, 2020. https://placingthepublic.lshtm.ac.uk; Brown, Surgery and Emotion, Roehampton University. Accessed June 18, 2020. http://www.surgeryandemotion.com; and Loughran, Body, Self, and Family, University of Essex. Accessed December 6, 2021. https://bodyselffamily.org. For new approaches to migration history see: Bivins, Contagious Communities; Bornat et al., “Don’t mix race with the specialty”; Monnais and Wright, Doctors Beyond Borders; Simpson, Migrant architects of the NHS; Jones and Snow, Against the Odds; and Redhead, “A British Problem.”
15. Gorsky, “The British National Health Service.” This article provides a comprehensive account of NHS historiography.
16. Webster, “Conflict and Consensus”; The Health Services Since the War Vol I and Vol II; The National Health Service.
17. Rivett, From Cradle to Grave; The Development of the London Hospital System.
18. Klein, New Politics of the NHS.
19. Ham, Health Policy in Britain.
20. Sheard, “A Creature of Its Time”; and Stewart, “Ideology and Process.”
21. See for example Timmins, The Five Giants.
22. Ham, Policy-making.
23. Stewart, “Healthcare systems in Britain and Ireland.” But there is a welcome new stream of work emerging from Sheard’s Governance of Health project which includes a case-study of the Liverpool region.
24. But see Pickstone, Medicine and Industrial Society.
25. GPs for example contracted into the Service as self-employed practitioners and endowment funds/charities pre-dating the NHS have constituted a significant revenue stream in some of the older hospitals. On public opinion of pre-NHS healthcare see Hayes, “Did we really want a National Health Service?” 660–1.
26. See Palgrave Macmillan Series Medicine and Biomedical Sciences in Modern History.
27. For example, Crossman, Diaries; and Sheard, The Passionate Economist.
28. David Edgerton writes eloquently about the value of recognising the deeply embedded frameworks that underly twentieth century histories of the UK so as to better appreciate how those histories have been constrained and shaped by unstated concepts and assumptions that together form metanarratives. Edgerton, Rise and Fall, 592–3.
29. Klein positions it as an institution at the centre of political push and pull; Webster as an institution that engenders a highly complex tiered system of legislation and organisation forces; Rivett as an evolving system of clinical change driven by new science and technology; Pollock adopts a privatisation narrative.
30. Stevens, “Fifty Years of the British National Health Service.”
31. But see Klein, “Self-inventing Institutions,” 240–254.
32. On the social and cultural turn in history of medicine see Jordanova, “Social Construction”; and on the practice turn see Worboys, “Practice and Science.”
33. The value of broadening source type is exemplified by Bivins, “Picturing Race in the British National Health Service.”
34. Macpherson, Our NHS.
35. Jones and Snow, Against the Odds, 11; and Gov.uk, “Workforce statistics.”
36. Wellcome Witnesses to Medicine; and Smith and Nicolson, “Re-expressing Division.”
37. For example, Begley, Sheard and McKillop, The 1974 Reorganisation.
38. Schwartz and Cook, “Archives, Records, and Power,” 2; and Hoyle, “Editorial.”
39. Elkind, “Using metaphor.”
40. Powell, “Who killed the NHS.”
41. ‘The Health Service is the closest thing the English have to a religion, with those who practise in it regarding themselves as a priesthood. This made it quite extraordinarily difficult to reform.’ Lawson, Memoirs, 613. See also Neuberger, “NHS as a theological institution.”
42. Webster, A Political History, ix.
43. Klein, New Politics, vi.
44. For example: Bivins, “Commentary”; Crane, “Save our NHS”; and Saunders, “Emotions, Social Practices.”
45. Loughran et al., “Women’s Voices, Emotion and Empathy.”
46. We use ‘NHS’ in this paper as shorthand for the four health services across Northern Ireland, Wales, Scotland, and England: the NHS at 70 collection includes testimonies from all four nations nhs70.org.uk.
47. Greer, Territorial Politics and Health Policy; and Timmins, Four Systems.
48. Atkinson and Sheard, Origins and Establishment of NICE, 7.
49. On the concept of ‘everyday life’ see Felski, Doing Time, 77: ‘Everyday life is the most self-evident, yet the most puzzling of ideas’; Langhamer, “Everyday Love”; and Moran, “Private Lives.” See also Langhamer’s analysis of ‘ordinariness’ as an analytical category which illuminates the ways in which its apparent ‘straightforwardness’ masks ‘a slippery, deeply-politicised, often fought-over and dynamic identity’ 195.
50. Newspapers are frequently used as a historical source for public views but the limitations of this approach were brought home sharply to us when we found that only around twenty per cent of our interviewees would consider speaking to a journalist.
51. In their analysis of individualism in the 1970s Robinson et al. show how new meta-narratives can be created through paying attention to new sources: ‘It is by listening to the individual voices in the archive—their stories—that we might shake the historiography on Britain in the 1970s out of its orthodoxies’, “Telling Stories,” 13.
52. Thompson, The voice of the past.
53. For a good summary of the history of oral history see Smith, “Making of Oral History.”
54. Thomson, “Anzac Memories,” 239–252. See also parallels with heritage production in Tunbridge and Ashworth, Dissonant heritage, 6: ‘the present selects an inheritance from an imagined past for current use and decides what should be passed on to an imagined future’; and Grydehoj, “Uninherited Heritage.”
55. Portelli, “Living Voices,” 245.
56. Alexander, “Feminist history,” 108.
57. Hamilton and Shopes, Oral History and Public Memories, viii.
58. Portelli, “Living Voices.”
59. Hajek and Serenelli, “Guest Editors’ Introduction,” 232.
60. Jordanova, History in Practice, 53.
61. Frisch, A Shared Authority, xx. Also see Thompson, “Sharing Authority.”
62. Abebe, “Reconceptualising Children’s Agency,” 11. See also Gleason, “Avoiding the agency trap”; and Lynn, “Historicising Agency.”
63. Gleason, “Avoiding the Agency Trap,” 449.
64. High, “Telling Stories,” 101–2; and Zembrzycki, “Bringing Stories to Life,” 98–107.
65. Karpf, The Human Voice, 4. Listening to oral history can open up new directions for enquiry such as the use of humour and laughter in the history of healthcare. See Simpson and Snow, “Why we should try to get the joke.”
66. Bradley and Puri, “Creating an Oral History Archive,” 75. See also Boyd and Larson, Oral History and Digital Humanities.
67. For a discussion of how oral history practice has developed in tandem with technological shifts see Boyd and Larson, Oral History and Digital Humanities, 1–16.
68. For a longer history of the emergence of the ‘sense of self’ and self-presentation in the age of Enlightenment see Porter, Flesh in the Age of Reason.
69. Samuel, Theatres of Memory, 8.
70. For a discussion of the power of oral history collecting to ‘become a cooperative exercise in social action’, see Slim and Thompson, Listening For A Change, 2.
71. Slim and Thompson, Listening For A Change, 3–4.
72. See Snow, “I’ve never found”; and Snow, “Translating New Knowledge.”
73. South Wales, Belfast, Glasgow, Manchester, Liverpool, North East, Nottingham, Bath/Bristol, South West, South East including London.
74. Nash, “Local Histories,” 2. See also Crook, “Politics of Community Heritage.”
75. Cairns et al., “Empathy Maps.”
76. https://www.nhs70.org.uk/Audio_36—accessed 12 December 2021.
77. Snow, “I Don’t Know.”
78. Baly et al., History, Historians, 11; Berridge and Stewart, “History”; and Green, “History as Expertise.”
79. Simpson et al., “Adding the past to the policy mix.”
80. Delap et al., “History and Policy,” 108.
81. Green, “History as Expertise”; and Cox, “The Future Uses of History,” 130.
82. Hoffman et al., Patients as Policy Actors, 1.
83. Thompson, The Making of the English Working Class.
84. Rowbotham, Hidden from History.
85. Bacopoulos-Viau and Fauvel, “Editorial.”
86. Berridge and Taylor, “The Problems of Commissioned Oral History.”
87. Lerner, “Holistic History”; and Samuel, People’s History, xxxii-xxxiii.
88. Lerner, “Holistic History,” 165.
89. Samuel, People’s History, p.xxxii.
90. Lerner, “Holistic History,” 169.
91. Participatory Action Research, Engaging marginalised communities.
92. Chattoo, “Reproductive Technologies,” 191; and King and Rivett, “Engaging People in Making History,” 220.
93. See note 70 above.
94. Blaisdell, “Putting Reflexivity into Practice.”
95. This view is embedded in the structural relationship between research and engagement that informed the criteria for impact case-studies for the 2020 REF: research publications are positioned as the foundation for engagement which produces ‘impact’. King and Rivett draw attention to the problematics of this structure which ‘implies a one-way dissemination, a paternalistic approach to a passive public, and an easily measurable phenomenon’, “Engaging People in Making History,” 218–233. See Crane, “Sources and Resources” for a more dynamic model of engagement.
96. For an excellent example of citizen science see Vigo et al., “Britain Breathing.”
97. Strober, “Habits of the Mind,” 326 and 329.
98. Jordanova, History in Practice, 202.
100. https://www.migrationmuseum.org/exhibition/heart-of-the-nation/. Accessed December 12, 2021. The NHS at 70 website has been peer-reviewed and the comments about the value of the content are encouraging: McHugh, “NHS at 70.”
101. Thomas, Interview.
102. See https://www.nhs70.org.uk/story/brain-charity-and-nhs-70—accessed 12 December 2021.
103. Lerner, p.168.
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Funding
Notes on contributors
Stephanie J Snow
Stephanie Snow is Professor of Health, History and Policy at the University of Manchester. She is Director of NHS Voices of COVID-19 which is partnering with the British Library to create a national collection of COVID-19 personal testimonies and reflections. She also holds a Wellcome Trust University Award for a project on the history of quality in healthcare since the 1960s and is exploring how this longer history is influencing responses to the pandemic.
Angela F Whitecross
Dr. Angela Whitecross is Project Manager and Co-Investigator for NHS Voices of COVID-19 and has worked in a range of archive, museum and academic settings. Her research interests focus on participatory research, particularly the intersections between academic, business, community and heritage organisations.