I had an unexpected birthday present over the weekend – a BBC Radio 4 documentary on the history of the NHS. On Saturday evening, Archive on 4: Cradle to Grave told the story of the QEII hospital in Welwyn Garden City. In 1963 this district general became the first purpose-built hospital to be planned, built and opened by the British National Health Service. I’m always happy to see an hour of prime-time radio coverage handed over to my subject. Yet, if I’m honest, I was find myself enjoying more programmes further away from my own work, when it’s easier to sit back and be less critical. So what did I make of this documentary?
It’s a nice approach to follow the history of the NHS through an institutional story. Although it inevitably focuses our attention on only the hospital element of the health service, the closing of QEII and removal of many services to Stevenage gives the feel of a full story-arc and a sense of chronology. The inevitable tension between tracking change over time and covering the various key themes is handled well, with changing times (and unexpected consequences) a running thread through discussions of midwives, nurses, surgeons, psychiatrists and the rest.
The focus is on telling the story of doctors and nurses, new specialisms and the difficulties of providing care for a community while expectations and life expectancies rose dramatically. It’s a story well told, with humour and compassion, as well as some wonderful characters. However, it’s ultimately an old story. And there are new stories to tell. There is little new in telling us that nurses, not doctors, were really the backbone of the hospital. Matron checking for dust above the painting of the Queen before a meeting with the new cleaning contractors in the 1980s is a nice anecdote, but what does it tell us we didn’t already know?
Of course, that depends who ‘we’ are. For a general audience this is a good radio documentary. It will pad out their own memories of going to hospital at various points over their lifetime with a wider sense of what’s changed and what’s been lost. It will likely provoke nostalgia from those who have worked in the health service, and give others a glimpse of the view from those working in the hospital. It’s exactly the sort of thing a public broadcaster should be airing. The fact there have been numerous other documentaries on both radio and TV before that have filled the same brief well is, perhaps, a moot point.
Yet there are other stories to tell. We do get the occasional glimpse of them. For instance, the children greeting the Queen at the opening and the fundraising Friends with their trolley and shop. Yet, hearing nurses and doctors describing the hospital experience of their past patients, I found myself repeatedly wondering: where are the voices of these patients themselves? The only time we hear from former patients is in a fairly short section of childbirth. There’s a confusing contradiction between a comment implying we’re about to hear from former midwives who also gave birth at the hospital, and then a number of women not introduced but speaking of “they”, “the staff”. Who we’re hearing from is unclear. Otherwise the patients are only to be found reflected in the memories of the staff who treated them.
Thirty years ago Roy Porter (‘The Patient’s View: Doing Medical History from Below’, Theory & Society, 1985, p.181) lamented that:
we lack a historical atlas of sickness experience and response, graduated by age, gender, class, religious faith, and other significant variables. It’s terra incognita, partly because it has been discussed so little in histories of medicine. It is no disparagement to note that the discipline has indeed been true to its name, and has been about medicine.
The same can hardly be said today. Medical history has developed increasingly sophisticated ways to shuffle a few precious steps closer to the patient experience that will always be just beyond reach. These developments have been far too numerous to detail here. But, even without them, there would be a relatively easy option for recovering the experiences of patients (and families of patients) treated in a hospital opened 52 years ago: speak to them.
Indeed, the Welwyn Garden City Heritage Trust and others are working towards an exhibition on the history of the hospital at nearby Mill Green Museum this autumn. The Project Group working on the exhibition are “keen to find and record people’s stories – from those who worked in the QEII, were born/treated there or connected to it in some way”. Since this seems to be at least some of the same group behind the radio documentary, it’s a shame they weren’t able to incorporate more oral history interviews with former patients.
And, just as the NHS has always been deeply personal, it’s political. Yet when politicians crop up here they are the usual suspects. We hear from Clement Attlee and the two of his ministers who perhaps most easily fit the mould of lefty folk hero: Aneurin Bevan and Edith Summerskill. While they neatly voice what the NHS was designed to be, echoes of a government that ended twelve years before the QEII opened rather leave out the actual politics providing the backdrop for our story.
To take only the opening of the hospital – the context was Health Minister Enoch Powell’s troubled 1962 Hospital Plan. This was the point when the government not only nationalised the hospitals already operating, but sought to develop 134 general hospitals and build 90 new ones in order to establish a roughly consistent ratio of hospital beds to population across the country. It was ambitious, being described by Powell as “planning on a scale not possible anywhere else, certainly this side of the iron curtain”. Delivering on such a plan was no easy task and, when in 1964 Labour raised in the topic in parliament during the dying days of the Conservative government, they criticised them as being only “paper plans”. This exchange between the local Conservative MP, Robert Lindsay (Lord Blaniel), and the soon-to-be Labour Health Minister, Kenneth Robinson, gives some idea of the awkward place of Welwyn Garden City’s QEII in the climate:
Blaniel: I should like to invite the hon. Member for St. Pancras, North and many other hon. Members opposite to my constituency to see what these “paper” plans are, to see the new hospital built within the boundaries of Welwyn Garden City, the first of the new district general hospitals. [Interruption.] If the hon. Member for St. Pancras, North wishes to intervene, he should at least take his feet off the table.
Robinson: The noble Lord knows perfectly well that the planning of the new Queen Elizabeth II Hospital at Welwyn Garden City started in 1951 or 1952. It has nothing whatever to do with the Hospital Plan.
Blaniel: As the hon. Gentleman says, I should know. I revisited it only the other day. Indeed, I pay tribute to the way in which the Hospital Plan has accelerated the building work undertaken at the Welwyn Garden City Hospital. The hon. Gentleman may well say that I have taken as an example the first of these magnificent new hospitals, but it is not the only example that I could give. There are others in the pipeline, at various stages of building, in my constituency and the surrounding area. There is the planned extension of a psychiatric unit of a further 100 beds in that hospital, there is a new maternity department in Watford, there is a major redevelopment of St. Albans City Hospital, there is the second phase of the Luton Maternity Hospital, there is the new Lister Hospital between Hitchin and Stevenage, and there is the new maternity department in the Herts and Essex Hospital, Bishop’s Stortford. This is the area that I know. I should have thought that almost any hon. Member could point to similar examples in his constituency.
What did it mean to be the first purpose-built NHS hospital at a time when building on a massive scale was a contentious political debating point?
I would have liked to hear more about the political context to and the patient experience within the QEII story, but then I look forward to visiting the autumn exhibition where there might be a little more of the latter. And in a selfish way I was pleased to find the documentary left untouched some of the issues and themes I’ll be turning to when I start on the new project next month. It never came close to breaking new ground, but was a well-made radio programme that I’m sure will speak to many, using the memories of doctors and nurses to reflect and reflect upon the intimate place a local hospital plays in all our lives. This sort of thing is what we pay the license fee for.