[from "The Birth of a Service", 2008]

PROLOGUE

It is probably difficult for anybody born within the last 60 years to envisage the situation which existed as regards health facilities for the general population prior to the introduction of the National Health Service in 1948. For those who had the money, or who had been able to make some sort of provision, there was of course no problem in obtaining access to such resources as were at that time available. For others, it was very different, although in fairness it might be said that the poorer people of the Island were more fortunate in this respect than those of the adjacent islands.

A doctor's practice was a business, like any other, with a goodwill built up of his regular patients, and which could be sold on, his income depending on his patients' readiness and ability to pay the resultant bills. Not always were bills issued, nor always paid, and it was not unknown for payment for his services to be made in kind from the produce of the patient's trade. Nevertheless, it follows that a visit to, or call for the doctor was something to be avoided unless deemed to be really justified. Many doctors did much of their own dispensing, certainly of the more standard preparations, giving rise to the often-heard expression, "You ought to go to the doctor for a bottle!".

Where a prescription necessitated a visit to the chemist's, again payment, in full, was expected for his dispensing. It was therefore not unknown for a patient, having learned from the doctor that his condition was not life-threatening, to avoid this expense, and decide to let nature take its course.

Those who needed glasses and could afford them went to the optician's, although some doctors might be, and some chemists certainly were, qualified to perform sight tests. Those who could not might have resort to the counters of stores such as Woolworth's, trying on pairs until finding one thought reasonably suitable.

Dentistry was a most neglected field of health, often not availed of at all, when the care and supervision of the School Dental Clinics had been left behind. Teeth could be allowed to deteriorate until extraction was the only answer: the piece of string tied to a door handle, seen nowadays as an old cartoon joke, was often the remedy. Bad, or the lack of teeth was seen as necessarily more socially acceptable than today.

The supervision of nursing in the home was performed, as now, by District Nurses, but under the auspices of the various local and voluntary District Nursing Associations.

The two General Hospitals, Noble's and Ramsey Cottage, and the Jane Crookall Maternity Home were run on a voluntary basis, financed by various trusts, bequests, fund-raising, door-to-door collections etc. The Mental Hospital (later Ballamona) was financed by an all-Island rate, possibly the first to be levied, and was the resposibility of the Mental Hospital Board. The Sanatorium (later Cronk Ruagh) was operated by the Local Government Board, whereas the Isolation Hospital (later White Hoe) was owned by Douglas Corporation, who had to try to recover the cost of out-of-town patients when possible.

It was not all doom and gloom; persons in insurable employment had automatically become members of the Manx Health Insurance Society, making contributions, and receiving medical and sickness, and various other benefits, through the Oddfellows, Rechabites, Foresters and Andreas Friendly Societies, acting as the Society's agents. However, these benefits did not apply to their dependants.

Much of what was available, therefore, was provided through charitable works. The word "charity", over the years, seems to have acquired a bad image, but tribute must be paid to those who gave their time and effort to improving the lot of their fellow Islanders, with a resulting situation which was, at least for the times, very favourable.

It is perhaps ironic to record that the National Health Service can truthfully be said to have been something of benefit arising from the war. It must be admitted that its inspiration was as a propaganda and morale-boosting exercise seen as necessary to encourage the fighting forces, and the civilian population who had been exposed to the destruction of their cities, in the belief that the struggle was not just for victory, but for the creation of a better world for everyone. To this end, the United Kingdom's Coalition Government set up the Inter-Departmental Committee on Social Insurance and Allied Services, whose report, usually referred to under the name of its chairman, Sir William Beveridge, was published in December 1942, and in 1944, in the modified form known as the Beveridge Plan, was formally adopted.

Although not part of the United Kingdom, and therefore not directly affected by these proceedings, it was obvious to the Island's Government of the time that the people of the Island, having shared at least some of the hardships of the war, particularly in the provision of men and women for the armed services and Merchant Navy, should have services at least as good as that of the United Kingdom, possibly better.

The object, and the outcome foreseen, of the Grand Plan was clear. With a comprehensive Health Service, and the safety net provided by Social Security benefits for a better standard of living, "care from the cradle to the grave", health would improve, sickness would be wiped out, and expenditure would steadily diminish until it occupied a minimal proportion of the National Budget.

The rest, as they say, is history.

Any comments, errors or omissions gratefully received The Editor HTML Transcription © F.Coakley , 2008