The Politics of Hospital Provision in Early Twentieth-Century Britain by Barry M. Doyle (review)

Barry Doyle’s The Politics of Hospital Provision in Early Twentieth-Century Britain is a study of hospital systems in northwest England prior to the development of Britain’s National Health Service (NHS) in 1948. Using a social history framework, Doyle explains how hospital development in Britain was influenced by local context and broader social, economic, and political conditions. The study builds on previous research by linking themes related to the growth of voluntary and municipal hospitals, the rise of specialist services, and the influence of finance and politics on the shifting provision of hospital care. Doyle centres his analysis on the cities of Leeds and Sheffield, comparing hospital systems during the 1920s and 1930s. The book is crafted as a response to previous characterizations of pre-NHS hospital systems as disorganized, chaotic, and financially unstable. Doyle argues that many pre-NHS hospitals in Britain demonstrated coordination and were able to meet rising financial obligations through different funding schemes that were shaped by local contexts.

Doyle begins with an analysis of the social, economic, and political landscape of Leeds and Sheffield, providing several central themes for the book. He argues that hospital provision varied in each city due to differences in context and health needs. In Sheffield, the economy was largely based on metalworking and consisted of a male-dominated workforce. As a result, health services there focused on the treatment of industrial accidents, fractures, and orthopaedic conditions. In contrast, Leeds had a more diverse economic base, a larger middle class, and women dominated the primary industry of clothing manufacturing. These differences resulted in hospital services that emphasized the provision of women’s health care. In both cities, demand for hospital care increased rapidly, and population health needs transformed as old concerns about infectious diseases began to be replaced by newly emerging health problems, such as automobile accidents and cancer.

In Chapters 2, 3, and 4, Doyle further develops his leading arguments by providing analyses of changes to hospital care, patient type, and differences in specialties due to local conditions. Hospitals in Leeds and Sheffield followed some national trends, such as growth in patient numbers and decreases in isolation beds. But the specific needs of citizens shaped the services developed in each city. For example, health services in Leeds consisted of a single acute centre that was well connected to other services aimed at women, while Sheffield had a more fragmented system of acute and specialist services aimed at male workers. By the 1940s, both systems became increasingly coordinated as collaboration between institutions became commonplace.

In the final sections of the book, Doyle addresses the connections between hospital care, finance, and policy and health service organization during the interwar period. Doyle explains that although some scholars have characterized hospitals during this period as culminating in financial collapse, others have demonstrated that many hospitals met increases in demands and expenditures. Doyle supports this claim and further argues that financial obligations were interrelated to distinct economic and political structures, local charity work, class and gender, and the degree of state funding and hospital type. In the city of Leeds, a large group of middle-class citizens meant that hospitals were supported by a healthy mixture of charitable giving, combined with various methods of direct and indirect payment. In Sheffield, the large union and Labour party membership meant that hospitals were funded by employment-based schemes, like the “Penny in the Pound” scheme, where workers contributed one penny for every pound earned, in exchange for guaranteed hospital care.

The Politics of Hospital Provision is a significant contribution for scholars examining the history of hospitals during the early twentieth century. The detailed analysis of hospital records is impressive and provides ample opportunity for comparison to hospitals in other regions or nations. Doyle’s work would be most useful for scholars of hospital or health systems history, especially those interested in the history of health care prior to the introduction of national...