2C: Faith and the National Health Service
Chapel Appeal: Maintaining space for Christian fellowship in the new National Health Service
University of Huddersfield, United Kingdom
For much of the twentieth century, England’s hospital chapels offered a space to celebrate Christian fellowship amongst medical staff, and a place of worship and solace for others. The Second World War had negatively affected hospital chapels either leading to bomb damage or extra space being needed for emergency medical care. Although Nye Bevan, Minister of Health, had made a pledge to the Church of England’s Church Assembly in May of 1948 that chapel space would be provided in new National Health Service foundations, chapel appeals in various places over the next decade hurried the process along. These appeals maintained the traditional links between religious congregations and the hospitals which had seemingly been challenged by nationalisation in 1948. Through friends groups and chapel appeals, volunteers, congregations and medical practitioners came together to maintain a space for Christian fellowship in the hospital. The resulting chapels were used to mark the Christian calendar and for special services for staff, often as part of nurses’ reunion services. Medical personnel and friends groups showed their religious devotion by furnishing the chapels, often providing such items as organs, cushions, and stained glass windows. This paper examines this history, focusing on the role of the chapel in Christian fellowship amongst staff inside the hospital and links with religious congregations outside of it.
The Place of Charity Within a Tax-Funded Hospital System: the British NHS Since 1948
LSHTM, United Kingdom
Funding from philanthropy has been a feature of hospital provision throughout history and across different national traditions. However, its position under the British National Health Service (NHS) presents an unusual case. When the NHS was founded in 1948 it aimed specifically to leave charity behind, moving instead towards a secular system of tax-based public financing and ownership. The accumulated gifts and endowments held by the former voluntary hospitals were permitted to continue as trusts, but with uses now confined only to research and amenities for staff and patients. Current and capital expenditure on medical care would now come from the public purse. By 2020 though, charitable funding had not disappeared, but continued to grow, to the extent that it was providing some £500 million per annum, mostly in support of NHS capital projects. In this paper we ask why charity survived in a statist health system, and whether it aided or improved goals of efficiency and equity.
We begin by discussing some theoretical approaches to the role of the voluntary sector in social provision. We then outline the changing legal framework of British charity, exploring how changing political climates led to phases of liberalisation in the 1980s and 2010s. We examine case study examples of NHS hospitals in London, Glasgow and other locations to show how old endowments and new charity funds were managed and used. Did they advance community interests or particular institutional agendas which hampered equitable access and planning?
'We regard doctors as gods, but I have lost all faith in the medical profession': The emergence of 'patient safety' in the NHS, c.1990–2020
University of Warwick, United Kingdom
At least rhetorically, ‘patient safety’ is at the heart of medicine. The need for doctors to protect the safety of patients is embodied in the Hippocratic dictum ‘do no harm’, in professional ethics, and attempts by healthcare practitioners to reduce the risks of interventions. It may seem surprising, therefore, that a focus on ‘patient safety’ as an explicit goal of healthcare policy and the regulation and management of healthcare systems is a very recent development, emerging only since 1999 in health systems worldwide. Only in the last twenty years has ‘patient safety’ also crystallised as a discipline, with a discrete set of theories, tools and approaches to preventing, reducing and ameliorating patient harm.
This paper seeks to specifically explain the emergence of ‘patient safety’ in the policy and management of the British NHS. The Department of Health report 'An Organisation with a Memory' in 2000 highlighted how 1 in 10 patients admitted to NHS hospitals encountered an ‘adverse event’, or physical or psychological injury caused by an event or omission during clinical care. This indicates the routine nature of adverse events within the clinical encounter in hospitals, a level of patient harm which the history of medicine has yet to fully comprehend. The paper highlights not only developments in the scientific understanding of ‘adverse events’ which promoted a focus on ‘patient safety’ in the NHS, but significant cultural shifts around medical practice and professional regulation, people’s trust in doctors, medical negligence litigation and the publicity surrounding healthcare scandals.