British voluntary hospitals, 1871-1938: the geography of provision and utilization

This article examines the distribution of beds, staff and in-patients in voluntary hospitals in England, Wales and Scotland between 1871 and 1938. The findings bear upon two theoretical debates; first, the concern of historians of social policy with the extent to which charity and mutual insurance delivered a satisfactory level of institutional care before the NHS, and second, the broader issue of whether the localism of voluntary sector provision tends to produce a geographically uneven service. We survey the chronology of voluntary hospital growth pointing to reasons for foundations. We then analyse the levels of beds, staff and in-patients per head of population in counties, county boroughs and large burghs. This evidence suggests that despite the expansion of the sector and the narrowing of differences between places, considerable variations in provision and utilization remained. We argue that these variations were likely to have had an impact on the health of individuals. We conclude by tracing the emergence in political and public discourse of the perception that geographical unevenness was a failing of the voluntary system.