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00:00Before the National Health Service, the hospital was not always the kind of place you would go to get better.
00:27I was so petrified of them and I imagine that fear was common to everybody.
00:36Forbidding, rudimentary and reserved for the destitute, hospitals were a last resort.
00:45People tended to be frightened to go to the hospital. The hospital was where you went to die.
00:56But in the decades leading up to the NHS, hospitals would undergo an extraordinary transformation.
01:05At the heart of this change was a fierce battle against death and disease, as scientists search for miracle cures and weird and wonderful technologies help breathe new life into old afflictions.
01:19They put your foot in a bowl of water and they passed a current through your leg and it made your muscle contract and expand.
01:28Yet change was not limited to science and technology. How the system was run and how it was paid for would sow the seeds for another revolution.
01:38This is the story of how access to good hospital healthcare became a right, transforming grim Victorian institutions for the poor into modern centres of medicine for all.
01:53November 1918. Armistice Day.
02:18Behind the smiles and celebrations, a new enemy far less visible was lurking.
02:25It would claim more lives than the trenches of the First World War.
02:36Britain's hospitals were helpless against it.
02:41The Spanish flu was pretty much global. There was almost nowhere in the world, I think some part of the Amazon, which escaped completely.
02:51But one of the ironies of it was that it tended not to affect babies and the elderly and frail, as most influenza viruses do, but it affected younger people, healthy people.
03:02It just seemed a terrible sort of visitation, almost a plague, you know, on top of the slaughter of war.
03:11The flu had arrived in Glasgow in the spring. By the end of the year, a quarter of a million had perished.
03:20The population was already worn down and it struck hard. Unfortunately, the hospitals were already busy dealing with war casualties and there wasn't enough room to deal with all those who needed hospital care.
03:39The epidemic would come to an end, but the flu had exposed a crisis. Across the country, hospitals couldn't cope. No national system existed, so they could only offer a patchwork of services. Some had the latest facilities, others would desperately run down.
04:01So there's a range of hospitals, little hospitals dotted all around the country, very disorganized, tended to be perhaps run by one doctor.
04:09And this was very problematic because patients could often receive very poor care in these small hospitals. There was no one overseeing, say, for example, surgical procedures.
04:18And some doctors went well above their levels of competency and tried operating on patients when they had no reason to do so and no ability to do so.
04:29So they were quite dangerous.
04:32How you got into hospital and what kind of treatment you received was a lottery. Most people never even made it into hospital.
04:41I don't know what life expectancy was, but it can't have been very high. Death was a very frequent visitor in those days. And pneumonia was a big thing. You died of pneumonia in those days.
04:52If you had an accident, broke your neck, for example, that was it, you were dead.
04:59But a change was taking place, and it began with attempts to overcome one of the period's biggest killers, infectious disease.
05:09You've got lots of childhood diseases, such as scarlet fever, mumps, measles, whooping cough, that are really putting a lot of children into hospital. Some of them were more virulent than they would be today.
05:22With a lack of effective cures and no antibiotics at the doctor's disposal, the only chance of fighting disease was to stop the spread of infection.
05:34There weren't many treatments really available to deal with the infectious diseases. Isolation was the key.
05:39They built isolation hospitals, isolation wards, and you kept these people isolated for a time that was regarded safe.
05:46When I was about nine months, I got scarlet fever, which was fatal in those days. You can imagine the terror.
06:05I was taken out, wrapped in a red blanket, carried out to the fever van, taken to the hospital, put in isolation.
06:20My parents could go and see me and look at me through a window, but every patient was given a number.
06:27Mine was 1268. My sister says the number is engraved on her heart.
06:34And the Evening Gazette would print a list of all the numbers with categories following it, like extremely ill, improving, critically ill.
06:45And there was a notice board outside the hospital, and my father would stop his bus and look at the list to see what the condition was.
06:55I mean, it was as primitive as that and distant as that.
07:03Most feared of all was tuberculosis. TB mainly affected the lungs and caused one in eight deaths at the start of the century.
07:12The symptoms of tuberculosis are usually bleeding from the lungs, so hemorrhaging, so you would bleed out of your mouth and nose.
07:26Excessive tiredness, weakness, debility, and it was highly infectious.
07:31Diseases were rife in the big industrial cities, where the poor and undernourished were crammed in damp housing, and where the air was polluted with filthy smog.
07:43Before the Clean Air Act, we used to get some red-footed, literally hung in curtains, yellow fogs, awful.
07:50And it was obviously not any good for anybody with a chest condition.
07:55And that I had this spot on my lung, they decided that I need to get out of London,
08:09and arranged for me to go to the sanatorium which was up here on the Mendips.
08:20The sanatorium. An antidote to the soot and smoke of the city.
08:24Once you had TB, it offered the only cure then available.
08:28Bed rest and the great outdoors.
08:32And the idea was that you had fresh air, plenty of it,
08:36and you were surrounded by pines, resins, supposed to be good for you.
08:45In 1924, you have the establishment of the Sunlight League.
08:49Lido's being outside and exposing their bodies to the elements.
08:54And this is very good for people.
08:55And this follows on within hospital spaces as well.
08:59You would rest and you'd lie in a bed, you'd breathe air,
09:02and this idea that you would expand your lungs with clean air.
09:05So to go to the countryside, to look at trees and hills and things like that,
09:11was considered very beneficial.
09:13They had the treatment if you needed it, pneumothorax treatment.
09:25It was a treatment which collapsed the lungs,
09:29which allowed that part of the lung that was affected to rest in order to try and heal itself.
09:35Some of the girls were there for a year, two years.
09:42It wasn't a thing that you went there sort of short-term if you were lucky.
09:47You'd perhaps out and about with them walking in the grounds
09:51and then the next morning you'd ask where, say, Elizabeth was or something.
09:57They'd say, well, sorry, she died in the night.
10:01You just never knew they could be there one day and gone the next.
10:12Sanatorium treatment for tuberculosis was free for workers
10:16under the National Insurance Scheme.
10:18Introduced in 1911 by David Lloyd George in the Liberal government,
10:23it was an obligatory health insurance for workers
10:27in return for a deduction from their wages.
10:33It covered them for their primary care,
10:36in other words, their access to their GP,
10:39and it paid for a certain amount of sickness benefits
10:42so that when they were ill and couldn't earn money,
10:45they had some money coming in.
10:48However, what National Health Insurance did not do
10:51was pay for hospital care.
10:57In fact, access to hospital care was organised
11:00in an elaborate but haphazard way.
11:03And it wasn't intended for everyone.
11:08Today, I think, most people think of the hospital
11:10as a place where everyone goes for medical services.
11:13But in the past, the hospital really was an institution for the poor.
11:22One of the reasons for this was that the largest hospitals
11:25had developed out of primitive infirmaries for sick inmates
11:28of the workhouse, a Victorian institution for the poor.
11:32The term workhouse implies that they were actually supposed to carry out labour.
11:41And that was things like stone breaking and unpicking ropes
11:45to stuff mattresses and so on.
11:47So the idea of these institutions originally was that they stigmatised people
11:53who resorted to the state for support in poverty.
12:02To cater for its sick inhabitants, each workhouse had formed its own infirmary.
12:11Their methods of treatment were rudimentary, to say the least.
12:15Bed sharing was common.
12:18You might have someone with an infectious disease sharing a bed with some other condition.
12:24There were no nurses employed by the workhouse in those days.
12:29The nursing was all done by inmates who often were illiterate.
12:34So they couldn't read instructions.
12:37They couldn't read labels on bottles.
12:40They distinguished the medicine by the colour of the contents.
12:45And they were often drunk.
12:51Many of these infirmaries had improved during the First World War.
12:55But they were now reserved mainly for the long-term sick and elderly.
13:01And most of them retained their stigma.
13:06Wally Barnes remembers what people thought of the workhouse hospital
13:10on Bancroft Road in East London.
13:13Don't go into Bancroft because you'll never come out.
13:17Not on your own feet.
13:19Now that was the attitude of some people.
13:21If you go into Bancroft Road, you don't come out on your own two feet.
13:26What they mean is they carry you out.
13:31The hospital is originally for people who cannot afford a doctor at home, basically.
13:37So working class people, very poor people, charitable cases.
13:42So people who could not afford to go to the doctor or have a doctor come to their home,
13:46which is what the middle classes and certainly the upper classes did.
13:52Well, I got a frightful bad pain in my side one day.
13:55And it got worse, so I rang up Dr. Cheetle.
13:58And said, I think I've got appendicitis.
14:00I want you to come and take my appendix out.
14:03So he did.
14:04He showed up straight away.
14:06I was about 13 at the time.
14:08And he draped everything in the whole room with white sheets.
14:11It was quite marvellous looking, you know.
14:13But I think Nancy and a group of friends came around about the same time.
14:17And they thought that we were playing doctors or doing something funny in the nursery, you know.
14:22It was actually me having my appendix out.
14:25The doctor would come to do the surgery, attend the home with the patient.
14:29They would have to pay for the anaesthetist who would come with the doctor to anaesthetise the patient.
14:35And then the surgery would be done on the dining room table.
14:40And then the patient would go back to their own bed and recover at home, usually with the aid of a professional nurse who would stay with that person all the time.
14:47And the doctor would make daily visits to come and see them to make sure that they were doing okay.
14:51And then he fixed it up in a whole jar of alcohol.
14:58And so I was frightfully pleased to have it.
15:01But Nanny flushed it down the toilet, you know, sort of saying it was a disgusting object.
15:10Yet the future of healthcare would lie neither in the homes of the rich nor in the workhouse infirmaries.
15:16But in a completely different kind of hospital funded by charity.
15:30These flagship hospitals stood in complete contrast to the horrors of the workhouse.
15:37They were known as voluntary hospitals.
15:40Early ones were, for example, Guy's in London, Addenbrooke's in Cambridge, Bristol Infirmary.
15:51Essentially, they differentiated themselves from the poor law workhouses.
15:57They were intended largely for what might have been conceived of as the more respectable poor.
16:04Working people who, for reasons of illness or accident, were temporarily knocked out of the job market.
16:14Providing for local workers and industry, these hospitals were at the cutting edge of medical care.
16:35Voluntary hospitals were interesting. Doctors were actually unpaid.
16:45They were honorary doctors in many cases.
16:49They almost always had a large private practice, which was where their income came from.
16:54And many voluntary hospitals were also teaching hospitals.
16:56And doctors got income from the students they taught.
17:09A lot of sort of picking and choosing went on, particularly in the outpatients department.
17:14Anybody could pretty much pitch up at a voluntary hospital and get seen.
17:18And if you had an interesting case, then you might be taken in for treatment.
17:24Because you would be useful teaching material for the staff.
17:34It also depended on what conditions the practitioners were interested in.
17:39There might have been a diabetes clinic at the institution.
17:42There might have been some interest in cancer research.
17:45But the voluntary hospitals always admitted accidents.
17:50So if you were the victim of an accident run down by a cart in the street, for example,
17:55you would often just be picked up and carried into a voluntary hospital.
17:59And those emergency treatments would be provided.
18:02One of the reasons, of course, why a lot of people would have seen hospitals, perhaps in the 20s and 30s,
18:14was the extremely high incidence of car accidents.
18:23Roads were pretty unregulated.
18:24Of course, there was no seat belts or breathalyzers or anything like that.
18:37And there was a great deal of feeling that it was an Englishman's right to drive as fast as he liked,
18:43like Mr Toad, you know, on the wrong side of the road, if you like, honking his horn.
18:46The motor car came along. People started having accidents.
19:03Serious fractures were appearing. Dad was a surgeon.
19:06So somebody who was practical and interested in new ideas was obviously the ideal person at the right time to get started on all this.
19:17Dickens' father, Kenneth Priddy, was one of the first surgeons to focus on orthopaedics,
19:24surgery of the bones and joints.
19:27He wanted to specialise in this one thing and make a go of it.
19:31And up till then, it was just one little facet of general surgery.
19:37He got his opportunity at one of the main voluntary hospitals, the Bristol Royal Infirmary.
19:46I have a photograph that he took in 1934 when he went there of the splint room.
19:53It looks like a scrapyard.
19:55And obviously he took that just to show what a joke the sort of approach to treatment was at that time
19:59and how he was going to sort it out.
20:06A lot of the surgeons who are taking surgery forward at this time, they have to make their own instruments.
20:11So they're innovators. They have to design instruments with long handles, for example.
20:15But new tools and a steady hand were not enough to keep you alive.
20:25Unique film of Kenneth Priddy performing a hip operation illustrates how a patient's life or death
20:32depended on how long they spent under the knife.
20:34He is showing how to measure up the hip with a special measuring device.
20:42And you tape that measuring device onto the patient and you drill a little pin in.
20:47And then you knock this hollow pin over the guide wire.
20:54He uses hydraulic hammers and braces and bits and all sorts of sort of things and hammers it into place.
21:02And then he just gets hold of the leg and it's still, you know, it's still moving so he hasn't gone too far.
21:05Then he sets it up and then he pans back to the clock to proudly show it's 12 minutes after he started.
21:12The point is that if you can complete this operation in 12 minutes, the patient is much more likely to recover quickly,
21:21be mobilised and walking again within a couple of weeks and back to work.
21:25And that's what the whole thing is about.
21:27The longer you are under a general anaesthetic, the more debilitated you were.
21:33And previous to that, people had been laid up for a couple of three months or something.
21:40Well, after that, you can't walk anyway, you know, so the operation may be a complete success, but the patient died or whatever.
21:47You know, I mean, it's results that count. He was a very much a results man.
21:53The surgeons were certainly seen as formidable figures.
21:56Within the hospital, they were treated with a lot of respect, especially by the patients.
22:01A lot of patients regarded these people as saviours, and they were, after all, volunteers.
22:06They weren't paid for their services, so they were set apart from the paid hospital staff.
22:12We didn't have much dealing with the surgeons. They were very remote.
22:16You know, when they came, it was almost sweeping the path in front of them because they were considered so lofty.
22:22They were thought so highly of, Mr. this, Dr. that, yes. They were next to God, really, in many ways.
22:29They were consultants. They had large private practices by this time.
22:33And although these were charitable cases, grateful patients often brought their surgeons gifts in exchange for some of the surgery that was performed.
22:42Voluntary hospitals have been set up as charitable institutions, but the foundations on which they've been built were crumbling.
22:56Britain's economy had not recovered after the war, and it wasn't just the poor who were feeling the pinch.
23:09It's sometimes summed up as death, duty, and death duties.
23:14In other words, the very rich classes in Britain, who had been a lynchpin of providing charity for the voluntary hospitals,
23:23had actually not only suffered quite significant losses of younger sons who'd gone off as officers to fight in the trenches and so on,
23:32so families had actually been hit quite badly, but they were now having to pay much larger levels of taxation.
23:41This was the moment in which charity, the old traditional forms of hospital philanthropy, now began to seem inadequate.
23:49With rising costs, voluntary hospitals were desperately strapped for cash.
23:57A dramatic change was needed in how they were paid for.
24:01The solution was to hit the streets.
24:04Flag Day was born.
24:06They were very important. They were usually instigated by somebody notable.
24:11One of the best ones I remember, which doesn't exist anymore, was, started to, oh, she was their great patron, was Queen Alexandra.
24:20And it was known as Alexandra Rose Day.
24:23They were like a little dog rose that grows in the hedge.
24:26And they were produced, and you bought your rose, put your money in your collecting tin.
24:31Shops would sell them. Everybody bought. They didn't pass anybody by.
24:35I can't remember anybody not buying an Alexandra Rose.
24:41The new forms of charity were tapping into a vein of frivolity and hedonism in post-war society.
24:54There was a feeling in the 20s and 30s that somehow if you're having fun and drinking rather a lot and dressing up,
25:01but the money is going to a good cause.
25:04And hospitals were regarded somehow as politically unproblematic and a good cause.
25:09And so it fitted in quite well with any sort of hedonism there was around.
25:13You have bazaars, you have dances, you have an egg week. It might seem insignificant, but one hospital might collect 100,000 eggs, and that would feed a lot of patients.
25:14You have bazaars, you have dances, you have an egg week. It might seem insignificant, but one hospital might collect 100,000 eggs, and that would feed a lot of patients.
25:15You have bazaars, you have dances, you have an egg week. It might seem insignificant, but one hospital might collect 100,000 eggs, and that would feed a lot of patients.
25:16You have bazaars, you have bazaars, you have dances, you have an egg week. It might seem insignificant, but one hospital might collect 100,000 eggs, and that would feed a lot of patients.
25:17You have bazaars, you have bazaars, you have bazaars, you have bazaars, you have an egg week. It might seem insignificant, but one hospital might collect 100,000 eggs, and that would feed a lot of patients.
25:30Other innovative schemes included the linens league, where a small hospital might get all of the clothes for patients, all of the sheets made by local charities.
25:32Charity have moved from endowments to pennies from the community.
25:37You have bazaars, you have bazaars, you have dances, you have bazaars, you have an egg week. It might seem insignificant, but one hospital might collect 100,000 eggs.
25:43Other innovative schemes included the linen league, where a small hospital might get all of the clothes for patients, all of the sheets made by local charities.
25:53Charity had moved from endowments to pennies from the community.
26:00But rag weeks and carnivals weren't enough
26:03to meet the spiralling costs of running a hospital.
26:06More and more, they were forced to turn to contributions
26:10from the patients themselves.
26:13Voluntary hospitals almost always were short of money.
26:18And as time went on, there was a greater expectation
26:23and demand on patients who could pay that they would pay.
26:27They started to introduce small-scale charges,
26:32user fees, for ordinary people.
26:35It wasn't anything like the full cost of treatment,
26:38but it was a payment which was assessed, means-tested really,
26:43on the basis of a person's income.
26:46And it led to the arrival of a new figure within the hospital,
26:49the hospital armina.
26:50And the armina would conduct an interview with the patients
26:53and assess what sort of payment they would be able to make.
26:58The lady armina would come round to me, father, and say,
27:04well, you know, you've got to pay.
27:07See, there was no fixed fee.
27:09You know, you've got to pay.
27:10So he'd say, well, I haven't got that money.
27:11What are you going to do to me?
27:12So he'd say, well, you know, what can you afford?
27:16So he used to push him, and if he had money on him,
27:18you know, if he had money, he would say, I'll pay.
27:21I'll give you a fine bob.
27:22You know, the lady armina would say, that's all you could afford,
27:25fine bob, OK, you know, that was the fee.
27:28But if you was well off, you paid more, you know,
27:31it was according to what you was.
27:35The need to pay had given rise to new forms of insurance schemes
27:39based on contributions.
27:40The other big development of this period
27:44was the development of large-scale contributory schemes
27:49pitched at the working-class patient.
27:53And these usually actually were run through the workplace,
27:57the factory, the shop, whatever.
28:02And the way it worked is that a small amount of money
28:04would be deducted from people's wages.
28:08Sometimes it was a penny in the pound of their earnings,
28:12and sometimes it was just a set amount of a few pence
28:16on a regular basis.
28:20The 1920s saw a mushrooming of these schemes around the country,
28:25and they grew rapidly.
28:28Membership of a scheme would typically cover the family
28:30for some hospital services,
28:32but it was based on how much you earned
28:34and what kind of medical conditions you had.
28:38Some schemes were organised by the hospitals themselves.
28:42Others were run by independent organisations.
28:46It was the ulmoneer's job to work out who was covered.
28:50My task was to assess people
28:54in terms of their ability
28:56to meet the costs of having prescribed treatment.
28:59I would put the category into which they fell.
29:03And if they were to have free treatment,
29:06there was a large F.
29:07And if they were belonging to a scheme
29:10which gave them free hospital treatment,
29:12like the Hospital Savings Association,
29:14I would put HSA.
29:16And if they were feeling they would like to contribute
29:19and were in a position to contribute,
29:21then there would be a D, a donation.
29:23A rigorous assessment of the patient's finances
29:29could come at the expense of compassion for their needs.
29:35You see a lady almoner,
29:38and she used to ask you just what money you could afford to pay.
29:42She wanted a lot at first.
29:44I said, well, I can't afford that,
29:45because naturally we've got to get some clothes for the baby,
29:49you know, when it's born and things anyway.
29:52When the baby was born dead,
29:54a couple of days after she came up to me in the ward,
29:57this is their attitude of caring,
30:00and she said to me,
30:02well, now you've lost your baby,
30:03you haven't got a baby,
30:04perhaps you can pay more money.
30:09Originally the almoner was appointed
30:11to investigate the financial backgrounds of the patients.
30:15Could they pay for treatment?
30:17This is how they're remembered,
30:19but they did a lot more.
30:21They very quickly became a clearinghouse for the hospital.
30:24They identified patients
30:26who needed additional support within the community,
30:28whether it was educational,
30:30they needed help finding work,
30:32they needed help feeding children.
30:34Their role started to expand,
30:36and eventually they developed into the modern social worker.
30:41The almoner was a great go-between
30:44dealing with the social side of the patients,
30:46and that was well done.
30:47If a patient died,
30:49she was the person who dealt with all the arrangements of death and so on,
30:54and as a houseman, as a doctor,
30:57we just had never been taught,
30:59and we didn't know how to do it,
31:00and we didn't do it.
31:01And so, to me,
31:03an almoner was a very valuable person
31:06in the team that we belonged to.
31:10William Franklin was a junior doctor
31:13in the casualty department
31:14at St Mary's Hospital, London,
31:16in the early 30s.
31:19Before the antibiotic area,
31:21there were so many diseases
31:22that we really could help very little
31:26compared to what you could help now,
31:28and so the patients would be in for a very long time.
31:35Protecting patients from the risks of infection was essential.
31:42Mary Allen trained as a nurse in the 1930s
31:45and had to use careful nursing to guard against it.
31:52There were always two nurses.
31:54One they called the dirty nurse and the clean nurse.
31:57The dirty nurse always took the dirty dressings off
32:00and disposed of those,
32:03and then the clean nurse opened her sterile packet
32:06and was able to get on with the dressing
32:09because she never touched anything,
32:11anything that was soiled.
32:14Locked inside the hospital walls,
32:18a different fight was taking place
32:20against the bacteria which caused infection.
32:24William Franklin worked with a scientist
32:26at the forefront of the quest
32:28to find new such cures.
32:30His name was Alexander Fleming.
32:34Fleming was...
32:35I had to see him every day at 10 o'clock in the morning.
32:38Theoretically, to talk about the patients in the ward,
32:41we had this experimental ward.
32:42This wasn't the people with all sorts of rare diseases
32:46and could we help them,
32:47and could Fleming help them,
32:48and could anyone else help them.
32:50And I was...
32:51One of my job was to look after them.
32:55But...
32:55So I had to report to Fleming every morning at 10 o'clock.
32:59He wasn't interested in patients.
33:00In two years, I can only remember him
33:02once asking him about a patient.
33:05He was always interested in getting a substance
33:08which would deal with infection.
33:11And I remember very well he talked about the mould,
33:15penicillium notatum, it was called, this green mould.
33:20The consequences of this discovery
33:22would not be felt for another decade.
33:25But before penicillin,
33:26another medication had already arrived on the scene.
33:29The new sulfonamide-based drugs
33:32were effective against purple fever,
33:35a common bacterial infection
33:37contracted by women during childbirth.
33:40As a student,
33:41we were taken to Queen Charlotte's Hospital
33:43to see women who got purple sepsis,
33:46that's an infection with a high swinging fever,
33:50with a high mortality.
33:51And they were put in on this amazing drug.
33:54Down came the temperature.
33:55And we were seeing something absolutely unbelievable.
33:59So here was the first,
34:00the word antibiotic actually wasn't coined until 1950,
34:03so we'll call it an antibacterial,
34:05used.
34:07And that was absolutely dramatic.
34:11The introduction of sulfonamide
34:14saw maternal death's nosedive.
34:16In the next 15 years,
34:18they would fall by 80%.
34:20This was part of a change
34:25which saw women giving birth in hospitals
34:28for the first time.
34:31Hospitals were seen as safer environments,
34:34freer from infection,
34:36offering the best of medical science.
34:45And other discoveries were being made elsewhere in hospitals.
34:48Scientists were exploring
34:56all sorts of bizarre and creative ways
34:58for tackling some of the most lethal conditions.
35:03These included the invention of arcane pieces of equipment
35:07for artificial respiration.
35:09There was one called the Curias.
35:20It was an arrangement.
35:22It was a bit...
35:23Like the old Roman soldiers,
35:25I suppose,
35:25it was like a back and front,
35:27metallic front.
35:28They were sandwiched
35:29in between this piece of equipment.
35:31They were attached to bellows.
35:32They could wear the Curias
35:33and that would be attached to the equipment
35:35that could go on the back of a wheelchair.
35:36But the most groundbreaking of them
35:42emerged in the United States in 1928.
35:46Its name would endure for decades to come.
35:49They called it
35:50the Iron Lung.
35:51I think what is interesting about Iron Lungs
35:57is they are iconic pieces of medical technology
36:01because they do save life.
36:04It's a saviour for this terrible scourge of polio
36:08that is terrifying the nation.
36:10His name is Johnny Green
36:13and he is two years old.
36:15He looks well enough,
36:17but there is something wrong with him.
36:19He has had infantile paralysis,
36:22or to give it its proper name,
36:23poliomyelitis.
36:25Polio was a virus
36:26which attacked the central nervous system
36:28and disabled the muscles it infected.
36:32Also known as infantile paralysis,
36:34it mainly affected children.
36:36Polio was a really big thing there
36:39and it seemed to be spread like wildfire.
36:43And they said it was spread
36:44from swimming pools and things like that.
36:47And I do know people,
36:50there were kids who wore canipers on their legs
36:52as a result of having polio.
36:55At its worst,
36:58polio paralysed lung muscles
37:00and stopped patients breathing normally.
37:03Before a vaccine was available,
37:05the Iron Lung was the only way
37:06to keep people alive
37:07once they had the disease.
37:10It was the world's first life support machine.
37:14Basically, the Iron Lung
37:15is what they call a negative pressure chamber.
37:19And what it does
37:20is it pressurises and depressurises
37:23the patient's chest.
37:25Some people never got out of their Iron Lung.
37:28Some people did get out of their Iron Lungs
37:30and they were used only temporarily.
37:32The nursing staff would take the patient out
37:36for a few minutes
37:37and gradually build a patient up
37:39till they were breathing on their own.
37:42It is an incredibly complex piece
37:46of medical technology.
37:47Therefore, it is very expensive.
37:48With hospitals unable to afford them,
37:53getting access to an Iron Lung was not easy.
37:56But in 1937,
37:58an Australian scientist named Edward Both
38:01came up with a cheaper alternative.
38:06It was made from plywood
38:07and immediately drew the attention
38:09of car manufacturer William Morris,
38:12also known as Lord Nuffield.
38:14He offered to construct thousands of them
38:24in his factory for free.
38:27I sincerely hope
38:29that my gift
38:30will be the means
38:32of saving
38:33many valuable lives.
38:35Hospital treatment
38:50was becoming increasingly dependent
38:52on medical technologies.
38:57UV light treatment
38:59for vitamin D deficiency
39:00was a common therapy.
39:01as was the use of electricity.
39:13I had to have a treatment
39:15called Faradism.
39:17Sounds awful,
39:18but it wasn't too bad.
39:19It was a form of electricity.
39:21I think they've got to remember it now,
39:23but they put your foot
39:24in a bowl of water
39:24and they passed a current
39:26through your leg
39:27and it made your muscle
39:29contract and expand.
39:30It would try to build up
39:32your muscle tone.
39:34It did make it.
39:35It wasn't particularly comfortable,
39:36but they could start
39:37the electricity, you know,
39:38at a lower level
39:38and gradually turn it up
39:40a little bit.
39:43One critical invention
39:44was the introduction
39:45of radium therapy
39:47for treating cancer.
39:49Radium is the crown jewel
39:50in the ray-based therapies
39:52that begin to emerge
39:53in the 20th century.
39:55Cancer cases are increasing
39:57and it seems to be
39:58one potential cure.
39:59The problem is
40:01that radium
40:02is quite expensive
40:03at about 15,000 pounds
40:04a gram at the time.
40:06A lot of hospitals
40:07are struggling
40:07to pay their ordinary bills.
40:09Here's this new
40:10therapeutic agent
40:11which they need
40:11some help buying.
40:12To fund these new technologies
40:23hospitals were still dependent
40:24on raising money
40:25through charitable organizations.
40:30One of the largest
40:32was the King Edwards Fund.
40:36This model hospital,
40:37now at the Science Museum,
40:38was built as a promotional tool
40:41by the Fund in 1932.
40:47Throughout the decade,
40:49it toured the country
40:50and was seen by hundreds
40:51of thousands of people.
40:52It was an illustration
41:02of how hospitals
41:03have been transformed.
41:06Now centers of medical expertise,
41:09they offered a more attractive,
41:11sophisticated environment
41:12to receive treatment.
41:13With this rise in technology,
41:21people feel a lot more comfortable
41:22about going to hospital
41:23in that it is a safer,
41:25scientific environment.
41:27They get diagnosed,
41:28they get looked after.
41:30Middle class people
41:31see this as being able
41:32to get the best care
41:33and they want to get
41:35the best care as well.
41:36The rise in middle class patients
41:40gave voluntary hospitals
41:42a chance to tap into
41:43some vital new income.
41:46The response was to begin
41:48to open either pay beds
41:51or private wards
41:53or in some cases,
41:55private wings,
41:56separate wings at the hospital.
41:58And one of the great things
42:00was if you were
42:02a private patient,
42:03you wouldn't be taught on
42:05by horrible medical students.
42:10Which was a pity
42:11because there was a lot
42:12of very good clinical material there.
42:15But no,
42:16private patients
42:17and some people, I think,
42:18ensured themselves
42:19to make sure exactly
42:21the place they went to privately
42:24and they would have
42:25a single room.
42:26They'd have much more nurses
42:28to look after them
42:28but they wouldn't have
42:29these medical students
42:31or be taught on
42:32or practiced on
42:34and so on.
42:36So hospitals become
42:37a more pleasant place
42:39to go
42:40and we see
42:41lovely painted walls,
42:43lights above the bed,
42:45reading material,
42:46the buzzer.
42:47Conversely,
42:49visiting hours
42:50could still be quite draconian
42:52even though hospitals
42:52were much more pleasant.
42:54For example,
42:55visiting children in hospital
42:56was still quite rigidly controlled
42:59throughout the 1930s.
43:01And say, for example,
43:02at an orthopaedic hospital,
43:05children under 12
43:06who were in the hospital
43:07were only able to be visited
43:09twice a month
43:11on a Sunday
43:11for two hours.
43:15But getting into hospital at all
43:17was becoming harder.
43:19As they moved away from charity
43:21and towards a paid-for service,
43:24hospitals were struggling
43:25to meet the new demand.
43:28One of the problems
43:29of the hospital
43:30was the success
43:31that they were having.
43:32A lot of people
43:33wanted to get into them.
43:34They saw them
43:35as the right place
43:35to get medical treatment.
43:37So the 1920s and 30s,
43:38you see the rise
43:39of waiting lists.
43:40Not dozens of people
43:41but hundreds of people.
43:42The patients themselves
43:45always hoped
43:46that they would go
43:47to the well-known hospital
43:49which would have
43:50a medical school
43:51attached to it
43:52and they would have
43:53the well-known consultants
43:57attached to that hospital.
44:02In fact,
44:03voluntary hospitals
44:04only provided
44:05a third of the total beds
44:07across the country.
44:08The majority
44:13was still to be found
44:14in the old
44:14workhouse infirmaries,
44:16mainly reserved
44:17for the long-term sick
44:18and the elderly.
44:26Bella Aronovich
44:27was moved to one
44:29following an appendix operation
44:30which wouldn't heal.
44:33I was, I suppose,
44:35about 18
44:37when I was transferred
44:38to this poor little hospital.
44:40I'd been in the
44:40voluntary hospitals
44:41up to then
44:42and got a kind of
44:42set picture
44:43of what they were like
44:44and I looked round
44:45and there were numbers
44:45and no names on the ward
44:47and when the door
44:48was opened
44:49and I looked
44:50at this sea of faces
44:52I felt indescribably
44:54frightened
44:55and really low.
44:56I hadn't expected
44:57anything like this.
44:59The beds were so close
45:00together that you could
45:01touch the patient
45:02in the next bed.
45:04The names of the wards
45:06were faith, hope
45:08and charity.
45:10Everything about it
45:11was so run down,
45:12it was so poverty-stricken
45:14and there was such
45:15an atmosphere
45:15of death there.
45:18All the time
45:19I was in hospital
45:20I used to think,
45:21well, fancy leaving
45:22the health
45:23to millions of people
45:24in this ad hoc way
45:26when some people
45:27could pretty well
45:27get all that they wanted
45:29and for the others
45:30it was one long struggle.
45:31But a new piece
45:35of legislation
45:35in 1929
45:36would allow local councils
45:38to take over
45:39the running
45:40of these old institutions.
45:42They became known
45:44as municipal hospitals
45:45and London
45:46was leading the way.
45:49On the 1st of April
45:511930
45:51the London County Council
45:53appropriated
45:55all the hospitals
45:56it had inherited
45:57both from the London
45:59workhouses
46:01and also from
46:02the Metropolitan
46:02Asylum's Board.
46:04Overnight
46:05they had
46:05on their hands
46:0798 hospitals
46:09which they set about
46:11trying to organise
46:12into a coherent system.
46:15What they tried to do
46:18essentially
46:18was upgrade
46:19the poor law infirmaries
46:20the workhouse infirmaries
46:22and turn them
46:23into potential competitors
46:24with the voluntary hospitals
46:26giving them
46:26operating theatres
46:27introducing all the
46:29new technologies
46:29and therapies
46:30that are available
46:31at the voluntary hospitals.
46:37In Glasgow
46:38the council
46:39took over
46:39Stobwill Hospital
46:40an old
46:41workhouse infirmary.
46:45This film
46:48was made
46:49to publicise
46:49its newly modernised
46:51facilities.
47:04Yet places
47:05like Glasgow
47:05and London
47:06were exceptions.
47:07In many parts
47:08of the country
47:09workhouse infirmaries
47:10were not taken over
47:11and even if they were
47:13they couldn't shake off
47:15their notorious reputations.
47:20A lot of people
47:21didn't want to go
47:21into these institutions
47:22even after they were
47:24handed over
47:24to the municipal authorities.
47:26On children's birth certificates
47:28for example
47:28those children
47:29who were born
47:29in some of these institutions
47:31they simply put an address
47:33not the name of the institution
47:34because the stigma
47:35was still very strong.
47:38Despite improvements
47:39in particular areas
47:40the quality of hospitals
47:42varied greatly
47:43depending on where
47:44you lived
47:44and how much
47:46you could afford
47:46to pay.
47:48A third of all
47:49specialists
47:49lived in London
47:50so London was the place
47:52to go if you wanted
47:53to specialise in
47:54particular areas of medicine
47:55and consultants
47:56could make it a lot
47:57of money
47:58and there was a lot
47:59of resentment
47:59about their high-handed
48:01attitude
48:01or the fact
48:02that they weren't
48:03really caring
48:04for people
48:04who were very,
48:05very ill
48:06they were just
48:06caring for people
48:07who could pay.
48:11There was this
48:12tension all the time
48:14between the
48:15requirements of doctors
48:17doctors were always
48:19really keen
48:20to preserve
48:21their private practice
48:23the voluntary hospitals
48:24were always desperate
48:26to preserve
48:26their independence
48:27and the municipal hospitals
48:31really wanted
48:32more and more
48:33to become
48:34the general provider
48:35for the citizens
48:36it really
48:39was
48:40in desperate
48:41need
48:42of
48:42bringing together
48:44into some
48:45coherent shape.
48:49The lack of a
48:50joined up hospital
48:51system
48:51ran counter
48:53to one of the
48:53big ideas
48:54that was animating
48:55Britain at the time.
48:58One of the great
48:59words of the 30s
49:00was planning
49:01and there were
49:02all sorts of
49:03organisations
49:03which were just
49:04devoted to planning
49:05that you found out
49:06all you could
49:07about a subject
49:08be it transport
49:09be it medicine
49:10and then on the
49:11basis of
49:12information
49:13you laid your
49:14plans and your
49:15recommendations
49:16and you formulated
49:17your policy
49:17that was very true
49:19in health
49:19towards the end
49:20of the 30s.
49:23Eventually
49:23a debate
49:24would be launched
49:25about how a new
49:26hospital system
49:27might be organised
49:28but another crisis
49:30loomed
49:30which presented
49:31the hospitals
49:32with an even
49:33greater
49:33more immediate
49:34challenge
49:35war.
49:39The First World War
49:40was not very organised
49:41it kind of happened
49:42whereas the Second World War
49:44the country was preparing
49:46in 1937
49:48the emergency medical services
49:50was set up
49:51so that was two years
49:51before the war
49:52was even declared.
49:53In the towns
49:55the front line
49:56of modern war
49:57the health services
49:58were organised
49:59to deal with
50:00the menace
50:00of air attack.
50:02The voluntary
50:02and municipal hospitals
50:03were linked together
50:04under one
50:04national health service.
50:08Taking the London
50:09area as an example
50:09what has happened
50:11is this
50:11the area
50:14has been divided
50:14into sectors
50:15each with one
50:17of the big hospitals
50:18acting as parent.
50:18Across the country
50:23the emergency medical service
50:25took control
50:26of hospitals
50:26and placed them
50:27under one umbrella.
50:30New wards
50:31were built
50:31and temporary
50:32buildings set up.
50:3550,000 hospital beds
50:36were added
50:37in just a few months.
50:39Doctors were employed
50:40by the service
50:41and sent to where
50:42they were most needed.
50:44The emergency medical service
50:46had set an example
50:47of how an integrated
50:48hospital system
50:49could be run.
50:51It provided
50:52a model
50:53for the planners
50:55who during
50:56the Second World War
50:57were beginning
50:58to think
50:59much more seriously
51:00about the possibility
51:01of a national
51:02health service.
51:03This is when the
51:04term first starts
51:05to be introduced
51:06in the sense
51:08of delivering
51:08a more comprehensive
51:10service
51:12and indeed
51:13a universal service
51:14something to which
51:15everybody
51:15had access
51:17simply by right
51:18of citizenship.
51:22What the Second World War
51:23did of course
51:24was to emphasise
51:25that health
51:27could no longer
51:28be left
51:28to philanthropy
51:29could no longer
51:30be left
51:30to voluntary initiatives
51:32and good-hearted
51:33ladies selling flags.
51:35It was the health
51:35of the nation
51:36and the nation
51:37or the government
51:38needed to take
51:39responsibility for it.
51:40You know
51:40the health
51:40of the nation
51:41was too important
51:42to be left
51:43to these
51:44hodgepodge
51:44of arrangements.
51:49In the old days
51:50money meant
51:52a well-planned
51:53entry into the world
51:54with as much
51:54skill and care
51:55as a Harley Street
51:56nursing home
51:56could provide.
51:58But in the new world
51:59that we are making
52:00and making
52:01in the very teeth
52:02of war
52:02we give
52:04every baby
52:05the right
52:05to both
52:06the Broad Acres
52:07and the Harley Street
52:08skill.
52:12The idea
52:14that citizens
52:14had a right
52:15to hospital care
52:16was crystallised
52:17by the experience
52:18of war.
52:20But war
52:21had also accelerated
52:23the development
52:24of earlier
52:24scientific discoveries.
52:26It had taken
52:28over a decade
52:29to be purified
52:30and manufactured
52:31but Fleming's mould
52:33had finally arrived.
52:35It was called
52:36penicillin.
52:38When it was
52:39introduced
52:40to the wards
52:41for use on patients
52:42it was literally
52:43kept under lock and key.
52:46It was so precious
52:47that it was only
52:48the senior staff
52:49that were allowed
52:50the keys
52:50to go and get it out
52:51and draw up the doses
52:52and go and give it
52:53to the patients
52:54and we were
52:55absolutely astounded
52:55it was literally
52:56a miracle drug.
52:59Jim Mulligan
53:00was one of the first
53:02civilians to receive
53:03penicillin
53:04when he went into
53:04hospital for an operation.
53:06I was due to be
53:07in there for
53:08several weeks
53:09if not months
53:11and they used
53:13penicillin on me
53:14and it was one
53:15of the first times
53:16that it was used
53:17on civilians
53:17because it was
53:18developed for soldiers
53:19in the war
53:20and I was out
53:23in three weeks
53:24in that time
53:26I saw my first banana
53:27and on the
53:29one day
53:30my brother brought in
53:31the Daily Mirror
53:32with the headline
53:33about the
53:35this amazing
53:36bomb
53:37that they've dropped
53:38in Japan
53:39and it'll do this
53:41and it'll do that
53:41and that was the
53:42I remember seeing
53:43the Daily Mirror
53:44with the
53:46Hiroshima bomb.
53:54In 1945
53:56Britons were celebrating
53:58the end
53:59of another war.
54:06The First World War
54:08had ended
54:08without a proper
54:09hospital system.
54:10the Second World War
54:12would help provide one.
54:18After the First World War
54:20everything went back
54:21to the way it was
54:22whereas in the Second World War
54:24people did not want
54:25that to happen again.
54:26They had suffered
54:27they lost family
54:28friends
54:29they wanted things
54:30to change
54:31so this idea
54:32of never again
54:33is extremely important
54:34and it has
54:36a lot of importance
54:37towards the formation
54:38of the NHS.
54:46The change in mood
54:48had brought a newly
54:49elected Labour government
54:50riding on a wave
54:52of public support
54:53it began immediately
54:55to implement plans
54:56for a new
54:57national health service.
55:00Suppose instead
55:01of a simple broken leg
55:02you have a complicated
55:03break
55:04and suppose
55:06you have to spend
55:07months off sick
55:07and suppose
55:08you don't need
55:09just one doctor
55:10for a number
55:11of experts opinions
55:12what's the answer
55:13to that?
55:16Ruin!
55:20With this new act
55:22you're covered
55:23against things
55:23like that.
55:28Despite huge support
55:30for a unified service
55:31the government
55:32faced opposition
55:33from the medical
55:34profession.
55:37a fierce debate
55:39raged between them
55:40and the British
55:41Medical Association.
55:46Key to the disagreement
55:48was the prospect
55:50of a state
55:50salaried medical service.
55:54Some consultants
55:56were reluctant
55:56to give up
55:57their lucrative
55:57private practices
55:58and suspicious
56:00of the state
56:01undermining
56:02their independence.
56:03but the new
56:06Minister of Health
56:07came up
56:07with a solution
56:08which would
56:09bring them
56:09on board.
56:12It was Nye Bevan
56:13who inaugurated
56:14the National Health
56:16Service.
56:17I think he once
56:17said that he'd
56:18filled the doctor's
56:20mouth with gold
56:21to persuade them
56:22to go with
56:24the new system.
56:26Bevan's gold
56:27meant doctors
56:28could still hold
56:29on to their
56:29private practices
56:30even though
56:31they were
56:31employed
56:32by the state.
56:33The government
56:34could now push
56:35forward
56:36with the new
56:37legislation.
56:43On July 5th
56:44the new
56:44National Health
56:45Service starts
56:46providing hospital
56:48and specialist
56:48services
56:49medicines
56:50drugs
56:50and appliances
56:51care of the
56:52teeth
56:52and eyes.
56:54I remember
56:55everybody being
56:56absolutely delighted
56:58because all those
57:00fears
57:01and the
57:02trepidation
57:03and the
57:07knowing that
57:08if you got
57:08ill that
57:09was serious
57:10and you just
57:11had to manage
57:12it on your
57:12own.
57:13It changed
57:14completely.
57:15It was a
57:16different world.
57:19It was the
57:20dawn of a
57:21new age.
57:24But it
57:25hadn't emerged
57:25from nowhere.
57:27This had
57:28been a long
57:29revolution
57:29built on
57:31decades of
57:31innovation
57:32in which the
57:33hospital had
57:33played a
57:34central role.
57:37Pioneering
57:37research and
57:38technologies
57:39had reduced
57:40deaths
57:40and generated
57:42a new faith
57:43in medical
57:43science.
57:49Hospitals
57:50had opened
57:51their doors
57:51to the
57:52community
57:52to raise
57:53funds.
57:54But they
57:55had also
57:55raised
57:56expectations
57:57of
57:57entitlement
57:58to
57:58treatment.
58:04United in
58:05war, the
58:06hospitals had
58:07laid the
58:07foundations
58:07of a new
58:08system which
58:09for the first
58:10time in
58:10history would
58:11provide
58:12healthcare for
58:13free at the
58:15point of
58:16service from
58:17cradle to
58:18grave.
58:19care.
58:22If you
58:22don't
58:23know what
58:23you
58:24should
58:24have
58:25you
58:27see
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