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A Brief History of Healthcare in Britain

For many, the history of British healthcare for the general public begins and ends with the founding of the NHS in 1948. Suddenly, proper medical care was offered to all, regardless of class or income - but why was the NHS such a revolution? What was healthcare in Britain like before the advent of the NHS? Read on to find out!

The Dark Ages

As anybody who has caught the end of an episode of Horrible Histories on television can attest, the Dark Ages weren’t the best period in history to be alive, let alone sick. However, because of the vast influence the Catholic Church had at the time, many charitable organisations, alms houses and hospices were set up to care for the poor and the ailing, laying the groundwork for modern healthcare organisations. However, there was no organised form of national healthcare and no formal monitoring of those who were ill.

Most people during this period believed that illnesses of any kind were due to: bad “humours” in the atmosphere and in the body, a punishment from God, too much blood in the body or an imbalance of the four elements of earth, air, fire and water. Therefore, treatments for most forms of disease consisted of “bleeding” the patient for a period of time either by using leeches or - in more severe cases - lacerating a vein, praying for long periods of time and pomanders (bags of cloth filled with sweet smelling herbs and spices which people believed would diminish the bad humours in the air).

These remedies were often dispensed by the local apothecary or priest in lieu of a doctor, as most towns or villages were too poor to be able to afford the services of qualified physicians, who were usually engaged by the local Lord or land Baron and were not easily accessible. 

Personal hygiene was also an issue, as the popular consensus during the Dark Ages was that bathing frequently left one open to an imbalance of water in the body, increasing the likelihood of disease. 

Elizabeth and Victoria

During the reign of Queen Elizabeth I, the first national mandate for care of the poor and the sick was instituted. 

The Poor Law of 1601 ensured that each parish looked after those that were too sick or old to work (classified as the impotent or deserving poor), those that couldn’t find work (able bodied or deserving poor) and those that could work but didn’t seem inclined to (idle poor). Those that were either too sick or old to be employed were placed in alms houses, which were for the most part run and staffed by the local Church or Nunnery. Healthy people were expected to work for the parish for low wages in recompense for their room and board or to be apprentices. 

High taxes were levied on each parish in order to pay for the alms houses and care, and each village appointed an “Overseer of relief” in order to ensure that the funds were being used properly. The parish workhouse, a main feature of the Dickensian novel, was born.

Over 200 years later in 1834, during the reign of Queen Victoria, the Poor Law Amendment Act made it compulsory that each parish workhouse contain a sick ward for those residents who were in need of medical care. However, although the wards were originally intended to house those who were already in the workhouse, they soon filled up with sick people from the parish in general. Population rises meant that there were more people to care for, and this put a strain on the local charities and apothecaries who were caring for those too poor to afford to pay the exorbitant doctor’s fees of the time. As a result, a review was conducted by the Select Committee into making widespread care more readily available. However, this scheme was not pushed through and the situation continued until the 1920s when local authorities were given more power in order to provide adequate healthcare.   

Hospitals and medicine

Medical practices
between the 15th and 19th centuries continued in much the same vein as the Dark Ages, with remedies including washing wounds in vinegar to prevent infection and using lavender to cure headaches. These practices continued until the late 1800’s, when advances in medical and scientific thinking lead to improved hygiene, such as indoor plumbing, advances in diagnosis and the discovery by Louis Pasteur in 1857 that germs are the root cause of most diseases. 

As a result of the belief that illness was a punishment, early hospitals for the poor such as the Bethlem Royal Hospital (also known as Bedlam Asylum) were often places of restraint rather than care, designed to prevent the spread of disease and to hide those with mental illnesses or disabilities from public view. 

Luckily, by the 1800s attitudes had begun to change, and philanthropists and doctors had begun to open hospitals where treatment was more affordable.  It was not until 1829, when young surgeon William Marsden, established the “London General Institution for the Gratuitous Cure of Malignant Diseases” that the first entirely free hospital for the poor was opened. Funded exclusively on donations, subscriptions and fundraising events, this four story house in one of the most impoverished areas of London would eventually come to be known as the Royal Free Hospital. 


In 1911 the foundations were laid for the NHS with the implementation of the National Insurance Act. This piece of legislation covered male workers who earned under £2 a week for illness and injury, but did not make provisions for their families or for those who earned more but were still not able to afford conventional hospitals or doctors. Many people relied on home remedies and the support of their communities in order to stay healthy and afford adequate care. 

By the time the NHS was founded, Britain had suffered through two World Wars and a Great Depression, and people were ready to see a positive change in the way that healthcare was provided for the working classes. For the first time in history healthcare professionals from dentists to surgeons were brought under one umbrella organisation to provide free medical services to all, changing the face of healthcare in Britain and across the Commonwealth forever. 

Furthermore, it is now common practice for people to use a mixture of private healthcare services and the NHS to keep healthy, and many private and public hospitals work together in order to conduct valuable lifesaving research. We have come a long way from leeches and pomanders! For more information on the private sector, check out our blog Why Work in the Private Healthcare Sector

For a timeline of the history of medicine, from Hippocrates to Dolly the Sheep, click here.  
Tagged In: Healthcare
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