Mutualism and Health Care: Hospital Contributory Schemes in Twentieth-Century Britain by Martin Gorsky & John Mohan & Tim Willis

Author:Martin Gorsky & John Mohan & Tim Willis [Gorsky, Martin & Mohan, John & Willis, Tim]
Language: eng
Format: epub
Tags: Medical, Public Policy, Social Services & Welfare, Social Policy, Social Science, Political Science, Anthropology, Cultural & Social, Health Care Delivery
ISBN: 9781847795816
Google: q2O5DwAAQBAJ
Publisher: Manchester University Press
Published: 2013-07-19T11:20:46+00:00

Chapter 6

Contributory schemes, working-class governors and local control of hospital policy

In contemporary political discourse about welfare provision, the active citizen is seen as preferable to the passive recipient. Direct participation, for example through stakeholding or mutual ownership, allows, it is thought, the wishes of users to drive service delivery, rather than the potentially flawed assessments of public sector bureaucracies. The inter-war contributory schemes offer a useful test of this premise. Clearly they were an idiosyncratic form of user group, in that involvement was rooted in the financial contribution rather than a more generalised sense of public spirit. None the less, they had a mass membership and strong representative procedures that allowed members a say in both fund management and hospital governance, and, as noted in chapter 5, some schemes specifically included the articulation of contributors’ interests in their constitutions. Thus, while they do not offer a direct parallel with NHS bodies, they do provide useful evidence of citizen engagement with hospital policy.

This chapter seeks to determine whether contributor participation affected decision-making and signalled a genuine shift in control of institutions, making them more responsive to the needs of local users. The first section considers the routine work of scheme administrators, assessing whether they expressed patients’ concerns about services. Next the implications of labour movement involvement are examined, to establish whether trade unionists were able to influence issues such as the pay and conditions of hospital staff. The third section details several episodes in which the wishes of contributor representatives clashed with the hospital establishment, and which demonstrate that ultimately power remained with providers rather than users. Finally, two areas are identified in which contributors successfully asserted their wishes: the retention of convalescence benefits and the rejection by schemes in Scotland and the North East of the hospital means test.

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