Care in the Community: 1919
The wellbeing of the families of the fallen and wounded ex-servicemen alike became a major issue in Wellington during 1919. While support for more vulnerable members of society increasingly became a focus for official war commemoration, by year’s end deteriorating conditions in the wider economy were creating concerns about adequate access to healthcare for a much larger section of society….
The Provision of Healthcare
At the end of World War One, the provision of healthcare for most of the population depended on voluntary institutions. However, the conflict had left many in a very weak financial position and in Wellington it was no different — collectively, the town’s facilities bore all the hallmarks of a system in crisis: a cottage hospital on the verge of financial collapse; an Infirmary still under military control; falling subscriptions for medical insurance; and sustained demands from local doctors for higher fees from the friendly societies providing it. The Spanish ‘Flu pandemic, which claimed fifty million lives worldwide, swept through Wellington in October and November of 1918 and did much to emphasise the inadequacies of the situation. ‘There is no doubt’, concluded Dr White, the town’s Medical Officer of Health, in his annual report ‘that the want of skilled nursing was responsible for a number of deaths, and for this reason hospital accommodation would be very useful in future epidemics’. In 1919, the Government passed an Act of Parliament establishing a new Ministry of Health for England and Wales. While the era was to some extent defined by improvements in the provision of housing, maternity care and treatment clinics for various medical conditions, away from those landmark developments access to basic healthcare and social welfare followed a fairly traditional pattern for most Wellingtonians.
Oddfellows and Buffaloes
“In those days there was no National Health Service but there were medical insurance companies such as Heart of Oak, Oddfellows and Buffaloes, etc. People paid so much a week into the company of their choice and they were insured against illness. The company also paid out sickness benefit. Doctors received 6/- per head for each patient.”
While a National Insurance Scheme had been in place in Britain since 1911, it was far from comprehensive and the system described by local man Ron Barlow illustrates the situation as it was for many Wellington people after the Great War. While joining a ‘club’ would cover a period of sick leave and a specified number of trips to the doctor, hospital treatment (which required a recommendation note from a medical professional) was a separate matter. For the lower paid, one of the major providers in Wellington was the Workmen’s Hospital Committee. It bucked the downward trend afflicting many organisations in 1919 by recording a record income of £275 — largely owing, as confirmed at its annual general meeting, to collections made at public houses. By paying around a penny a week, and depending on their condition, members could gain admission to any of the facilities to which the committee allocated funds. In 1919, recipients included the Salop Infirmary and Eye, Ear and Throat Hospital in Shrewsbury, and the St Dunstan’s Hostel in Church Stretton (an institution for blind, wounded ex-servicemen).
Of those funds, £21 (the equivalent of just over a £1000 today) was also allocated to Wellington Cottage Hospital — support that was much needed. In March 1919, the annual report of its management committee painted a dire picture: over the previous year, there had been a considerable decrease in donations and a £100 loss had been recorded. Part of the reason for the predicament was the cessation of the war itself. During the conflict, four of the hospital’s six beds were utilised for the convalescence of wounded soldiers, for which regular payments were received from the military. Without that support, it would have to rely solely on civilian cases but ‘considering in all probability the income from these would be small’ the report concluded that ‘unless some means were devised very much to increase the assets the institution could not be carried on’. Unsurprisingly, the cottage hospital’s situation created waves around the town. Writing in the letters page of the Wellington Journal, one correspondent suggested endowing the institution and making it free for the ‘worthy poor’, stating:
“it would be an everlasting stigma on Wellington if after all that has been done by the donor and the trustees a free hospital cannot be established and kept going”.
Ensuring that the hospital did ‘keep going’ became a major pre-occupation of the town’s official memorial commemorations but finding access to medical treatment was just one of many challenges facing those directly affected by the ravages of the war.
In January 1919, the Government introduced a system of war gratuity payments for all those servicemen killed in the Great War. If their loved ones had taken out a life assurance policy, some families of the fallen could also have expected to receive support from local friendly societies in the wake of the conflict. In Wellington, one such organisation was the Free Gardeners, which paid out £85 in ‘death claims’ to the families of local soldiers in 1918. However, there is evidence that many were still struggling to make ends meet. By the end of 1919, out-relief — a welfare payment made to people living outside the Workhouse system, and paid for out of the parish rates — was double the amount it had been twelve months earlier. At its December meeting, Wellington’s Board of Poor Law Guardians, which administered the fund, heard the upsurge was ‘chiefly due to the large number of widows with large families who were in receipt’. It was also stated that ‘the board was also giving more adequate relief to deserving cases’ of which there were 527 in all by the end of April 1920, when total spending for the financial year amounted to £2150.
For locals who were not in receipt of ‘parish relief’, a subscription-based charity known as ‘the dispensary’ also provided assistance with access to healthcare. However, its activities were also afflicted by the financial problems found elsewhere in the town during 1919. In November, those assembled at its AGM heard a familiar story of falling subscriptions (down from £136 to £93), and a similar decline in medical notes issued under the long-running scheme first founded in 1834: in the space of a year they had fallen from 572 to 374, of with 66 tellingly remained unused. To make matters worse, due to the increased cost of drugs, the surgeons attached to the Dispensary were no longer willing to operate for the five shillings per ticket they received (which entitled the user to five weeks treatment). The board did not consider their position unreasonable and agreed to increase the amount paid per case to seven shillings and six pence. It provided an indication of things to come but those same demands would not be greeted so amicably elsewhere.
Higher Fees and Other Fairy Tales
By the end of 1919, the subject of higher fees had hit the pages of the Wellington Journal. In December, the paper reported that local surgeons in the district were seeking ‘increased contributions in respect of members of all friendly societies’, and payment at the same rate they were able to charge those insured by the State. According to the Journal, medical practitioners also wanted the right to charge juvenile members the sum of 10 shillings per annum per member, the opportunity to refuse their entry to individual lodges, and the ability to exclude children aged three or less. One of the major drawbacks of the 1911 National Insurance Scheme was that it did not include the dependants and families of those paying-in. Consequently, the exacting list of demands caused much anxiety among officers connected with the individual lodges of the friendly society movement. The extra expense would, it was claimed by officials, lead to an ‘increase of membership contributions or the lowering of sick pay, if not both’. The local England’s Pride Lodge called on the doctors to reconsider their decision on juveniles but children were far from the only ones being disadvantaged by the vagaries of a piecemeal healthcare system.
Two other groups who were equally unprotected by the existing National Health Insurance scheme were the old and the long-term sick (for whom state cover did not extend beyond twenty-six weeks); the ranks of the latter would almost certainly have included many wounded ex-servicemen, 65,000 of whom were still receiving treatment for shellshock nearly a decade after the war ended. For the elderly infirm, the local infirmary had become a de-facto convalescent home but the War had created great upheaval for them, too. Between 1916 and April 1919, Wellington’s Workhouse was transformed into a military hospital where over 2800 troops were treated. During that time, its elderly residents were transferred en masse to Wolverhampton but, before they could come back, over £1000 of renovations were required. When the facility did re-open, a rise in ‘casual’ inmates was reported at a meeting of the Board of Guardians. According to the Workhouse Master, ‘many of them appeared to be the general class and unfit for work’ but it appears the closure of the ward at nearby Atcham Union facility may also have influenced matters. One committee member surmised that ‘it was stated by some of them that they had been living with relatives during the war’ but much to the amusement of his colleagues he concluded that ‘all had their own particular “fairy tales” to tell’. While the Journal reported on the laughter of those assembled, the coming decade would bring the ability of the workhouse system they operated to cope with the lives of the destitute into very sharp relief — and it was one that it would not survive.
The Eye of a Gathering Storm
In 1920, the Coalition Government extended the National Health Insurance (NHI) Scheme to include all workers earning up to £250 annually. As part of its programme to create a country ‘fit for heroes’, this intervention was undoubtedly welcome but, locally, Wellington people had already done much to effect a change in fortunes themselves. Answering the clarion call for help, they rallied to the cause of the cottage hospital to the extent that it was able to open two extra beds by the end of 1919. The following year, a memorial scheme was also launched by the hospital board to provide two endowed beds for the facility, which were dedicated to fallen employees of the nearby Sinclair Ironworks in Ketley and the Hadley Castle car works. Former colleagues gave generously through Sankey’s Hospital Benefit Society but the fund also received much wider support as local GP Doctor Wilfrid Pooler remembered:
“The Cottage Hospital was of course run entirely on voluntary contributions. The local employers and middle class people supported it. Two of the principal supporters were Mr and Mrs Sinclair of Sinclair Ironworks which is now Allied Iron. The big employers of labour were very strong supporters of the cottage hospital because they knew that their work people could get good nursing there.”
A long-running Nursing Association had been active in Wellington for a quarter of a century, employing a salaried employee who made over 2300 local visits in 1919. The following year, it recorded a fall in subscribers and an adverse balance of ten pence but one local organisation that fared much better was the long-running Dispensary charity. ‘Most subscribers’ it was reported at its AGM ‘had increased their prescriptions thus enabling the service to continue’. 300 cases were treated under the scheme in 1920, with 233 ‘completely cured’, while sizeable donations were made to the cottage hospital and the child welfare centre in Walker Street, which received 10 free recommendations. The Workmen’s Hospital Committee also broke its own records once again (recording an income of over £400) and was able to widen its circle of support to include institutions in Wolverhampton. However, storm clouds were on the horizon. With an economy that had slipped effortlessly from war footing to recession, higher prices and rising unemployment increasingly defined the national picture. By 1921, over 550 men and youths were on the register at Wellington’s labour exchange, while the YMCA in the town had even gone so far as to open a soup kitchen for the unemployed by November of that year. Subscriptions were still hugely important to healthcare providers, making them vulnerable to economic downturn. By the middle of the decade, the cottage hospital found itself engulfed in a funding crisis once again and even the Government’s vaunted NHI scheme was struggling to keep pace by the end of the decade, by which time the friendly societies were also in terminal decline. For many of those who had contributed to the first ‘total war’ in history, whether on the frontline or at home, the ‘land fit for heroes’ promised at the end of 1918 was still some way from being delivered.