After writing The Welfare State We're In, I now notice instances of welfare provision as they appear in novels which previously I would have missed. Recently I listened again to an audio-book of Mapp and Lucia, the comic novel by E.F.Benson. For the first time, I noticed that the focus of the early rivalry between the two women was the competition between their two charitable events for the benefit of the local hospital.

Lucia won this battle hands-down. Everyone went to her fete. No one went to Mapp's event. But underneath the comedy lies the way in which it was simply normal for people of their class to put on events to raise money for local hospitals.

These hospitals might be charitable or run by the local authority. In either case, the people of the town or locality felt that they were connected to it. They, personally, might need it one day. They had a stake. They could also gain status by helping it financially and probably in other ways, too.

The town in which Mapp and Lucia is set is called Tilling. But I think I am right in saying it is based on the very pretty Sussex coastal town of Rye.

I wonder how hospital provision in Rye has changed since Mapp and Lucia was written (circa 1930?)? Did it have a hospital then? Does it have a hospital now?

Whatever may be the case, it is certainly true that hundreds of local hospitals have been closed down since the NHS was created. There are some good reasons for this and some bad. It is noticeable that the Labour Party, when it promoted the idea of the NHS in 1942 argued that local provision of hospitals was important. After the NHS was created, both parties were persuaded that big hospitals offered economies of scale and could develop the capacity to deal with all eventualities. They could also develop particular strengths. But since then, the political parties have re-discovered the idea that local healthcare has it merits in maxi-GP practices or mini-hospitals.

Of course local hospitals have their merits. That is why pre-NHS healthcare created them. In some ways the value of them has actually increased. If there is an emergency in one part of London and a patient needs to be rushed to hospital, it now takes longer to get there because of the density of traffic. The same applies all around the country. I presume that, in some cases, patients lives can be at risk because of the distance between an emergency patient and a hospital.

A local hospital can promote loyalty and commitment on the part of both staff and patients. Patients in hospital are also easier to visit if they are local and this, in turn, means they are more likely to be visited and, I believe, those who are visited are more likely to get well soon.

The closure of quite so many local hospitals has surely been one of the range of bad effects of the creation of the NHS.

Posted by James Bartholomew • Indexed in Charity • NHS

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