Payment and Philanthropy in British Healthcare, 1918–48
2 Medicine and charity in Bristol Before the NHS, British healthcare had no national system.1 While policies could be agreed and pursued by the Ministry of Health, the British Medical Association (BMA), the Institute of Hospital Almoners or any other national body, decision-making was distinctly local. For public hospitals this meant either the poor law union or the municipal authority. In the voluntary hospital sector, it was institutional. It is therefore only through investigation at the level of the hospital itself that we can really hope to gain insight into the uncomfortable accom- modation between payment and philanthropy that emerged in the early twentieth century. As sites of charity, sites of care and sites of decision- making, these institutions were independent, although they did not operate in isolation. Context is important, and this means understand- ing the local economic, political and social context as well as the health and welfare sector within which the hospital operated. Our case study is the city of Bristol, sitting within the historic county of Gloucestershire, on the border with Somerset, in the South West of England (see figure 2.1). In the mid-eighteenth century this port city, although slightly smaller than Edinburgh and far smaller than London, had been the largest of England’s provincial towns and cities, before the rapid growth of manufacturing centres in the Midlands and the North. While the early twentieth century saw Birmingham over- take Liverpool and Manchester to become England’s second most populous
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