For the 70th anniversary of the NHS in July 2018, The BMJ is asking, “What is the NHS’s greatest achievement?” Nominations to answer this question in less than 100 words are open until 28 April 2018.
As a patient in the NHS, with many family members and friends who have also been born in and cared for by this institution, my first feelings on seeing this question are ones of pride, affection, and passion.
My response would likely be similar to those offered by many contributors so far—discussing the NHS itself as an achievement, “something the nation supports” and “genuinely loved by the nation.” Contributors so far have also discussed the significance of the NHS as working day in, day out, “saving countless lives every day,” and the importance of it being free at the point of access.
As a cultural historian analysing the meaning of the NHS, and how this has changed over time, I am also interested in thinking more closely about when members of the public started feeling this way. This history is more complex than we may assume.
Notably, Roberta Bivins, a historian at University of Warwick, has traced how when the NHS first officially “opened” in July 1948, this “appointed day” was as much “silent” as “celebrated” by British press, with the opening barely making front page news.
Nick Hayes, a historian at Nottingham Trent University has found that there was “no great popular demand from the average man or woman in the street for radical or overarching change” in healthcare in the mid-1940s. Looking at public opinion polls of the time, Hayes cites evidence to suggest that investigators in east London found people taking a “perverse pride” in their disinterest in welfare reform, while the majority in Manchester “just did not know” about the new service.
This history is important because it shows that public passion for the NHS has built up over time. It also shows that the institution does not have a universal or singular meaning for members of the public across time or space. Mathew Thomson, who works in the Centre for the History of Medicine at the University of Warwick, has argued that the public “learnt” the NHS.
In part, public passion for the NHS has built up defensively, in response to perceived threats under successive governments. Activists have purposefully riled such passions, campaigning against individual hospital closures from the 1960s and 1970s and subsequently in defence of “the NHS” as a whole from the 1980s.
In a sense, the idea that we learnt the NHS is an exciting one, because it shows the power of words and ideas. It shows that the work of campaigners and everyday conversations about the NHS have shaped its cultural value which, in turn, has guided the institution’s significant position in electoral and party politics.
At the same time, it is also worth thinking further about what we mean when we talk about the NHS itself as a symbol of equality or pride or as an achievement. When do we refer to achievements distinctly made by the NHS—for example in terms of big data changes reliant on having a single national system—and when do we discuss achievements made by modern medicine more broadly? In the British context, can we separate achievements made by the NHS and by medicine?
To take just one example of this entwinement—when people donate blood, they rely on significant medical technology developed globally, but in the British context they may also feel that they are giving to the NHS.
It is also worth thinking about how our individual life narratives interact with our largescale thinking about the NHS. When we think about “achievements”, do we think about how the NHS has treated ourselves and our peers, or do we think in the abstract?
In responses to The BMJ’s call for nominations so far, people have tended to think abstractly, especially focusing on the significance of equality of access. Despite this though, historically and today, interweaving personal narratives with broadscale thinking about the NHS can be a powerful thing—as the ongoing takeovers of the @NHS twitter account show.
Through individual accounts, we can provide meaningful and relatable examples of how the daily work of NHS staff, volunteers, and fellow patients has embodied abstract ideals such as fairness, kindness, and compassion.
In this context, while thinking about the 70th Anniversary of the NHS, myself and my team at the University of Warwick will be focusing on individual and everyday stories, narratives, and histories which have made the NHS and its work meaningful, and we invite anyone and everyone to share their stories on our website.
Jennifer Crane, centre for the History of Medicine, University of Warwick
Competing interests: I work on a project called the Cultural History of the NHS, which is funded by the Wellcome Trust [grant number 104837/Z/14/Z].