Hospitals by Denise Amos

In the last century and a half the concept of hospitals has changed dramatically. The greatest change is that they now come under the National Health Service, since its inception in 1948, and are open to all, whereas prior to that they were funded by subscriptions, donations and legacies and although there were some that offered treatment for poor patients gratis out of charity, many would have gone without. The influence of the Enlightenment helped to promote humanitarianism and philanthropy and in the ensuing years the founding of hospitals and dispensaries grew. These were mainly for the poor. As expected London was the first beneficiary of these new foundations but later the provinces also benefited and by the end of the eighteenth century all sizeable English towns had a hospital.

From the primary concept of caring and curing the idea of a hospital developed to encompass lunatic asylums, ‘lying-in hospitals’, the earliest type of maternity hospital. Fever hospitals were also developed and although could do little for diseases like typhus, dysentery, by isolating the victims it could stem the spread of such diseases. Dispensaries provided outpatient services, supplying advice and free medicine to the sick poor for whom there was no room in hospitals or whose complaints were unsuitable for hospitalisation. More importantly the dispensary system sometimes involved the visit by a physician to the homes of the poor giving the impetus to reform housing, improve sanitation and health education.

Since the early nineteenth century Nottinghamshire has had a number of hospitals serving the people suffering from a number of illnesses, such as tuberculosis, chest complaints, orthopaedic problems, mental health condition, obstetrics or child-birth. These were all funded by charity of some form and were open to most of the poor. When the NHs was first set up in 1948 health services were managed by 14 regional hospital boards and 35 Teaching Hospital Boards reporting directly to the Ministry of Health. The hospital boards supervised around 400 hospital management committees who managed the hospitals. Nottinghamshire came under Sheffield Regional Hospital Board until 1974. This was the case until the NHS Reorganisation Act of 1973 which in April 1974 created: 5 tiers of management: Area Health Authorities (AHAs), controlled by District Health Authorities (DHAs), in turn controlled by Regional Health Boards which were finally accountable to the four Departments of Health and Social Security (one each for England, Wales, Scotland and Northern Ireland) and thereby, parliament. Nottinghamshire came under Trent Regional Health Authority from 1974-1996 and was managed by Nottinghamshire Area Health Authority.

The AHAs were abolished in 1982 and replaced with District Health Authorities (DHAs) which took over responsibility for the administration of hospitals. Nottinghamshire was spilt into Bassetlaw DHA, Central Nottinghamshire DHA and Nottingham DHA. The Working for Patients White Paper published in 1988 introduced the internal market in the health service (hospitals became ‘providers’ and health authorities became ‘purchasers’) and hospitals were encouraged to become trusts which took them out of health authority control. New Labour introduced the concept of ‘foundation trusts’ in 2002 which gave NHS organisations more managerial and financial independence. A slightly controversial programme introduced by Gordon Brown in the 1990s was ‘The Private Finance Initiative’ and is a way of removing government borrowing off the books. Instead of the government borrowing the money to build a hospital a consortium of companies build it themselves and then lease it back to the NHS.

By the end of the twentieth century there were up to 50 hospitals in the county and city. Today there are two in the city, the Queen’s Medical Centre and the City Hospital. Mansfield is served by King’s Mill Hospital; Newark by the Newark Hospital and Worksop by Bassetlaw Hospital. Almost all of the departments that were once contained in separate hospitals now come under the umbrella of one or more of these large hospitals.

Alongside the Trust hospitals a number of private hospitals have been built and as well as treating patients privately they work alongside the Trust hospitals and treat NHS patients. The hospitals are BMI The Park Hospital at Burntstump Park; Woodthorpe Hospital, Mansfield Road, Sherwood and Park Private Clinic, Regent Street. The rise of these hospitals reflects the development of choice and private funding arrangements.