A bewildering system

Before the introduction of the NHS hospitals were not free and healthcare was generally badly managed, inconsistent and bewildering due to the range of institutions providing different kinds of care and treatment. Hospitals were funded by ‘subscriptions’ or donations from wealthy people, but as new technologies and procedures developed the cost of healthcare increased greatly. Most donations only covered 10% of the hospital’s total expenditure.

Some people had health insurance paid for by their employer whereas others were ‘means tested’ by an almoner who worked at the hospital. An almoner was a cross between a social worker and a financial administrator who would decide a fee that was based on patients’ income and savings. For the poorest in society this would often mean that they would either receive no treatment, or could only afford the most basic course of treatment, or the shortest stay in hospital.

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