|Sarah Rogers, PhD student, University of Huddersfield
|The UKAHN Bulletin
|Volume 9 (1) 2021
As with all books in this series of Shire publications, Susan Cohen’s latest book is short, well-illustrated, and offers sweeping coverage of a subject; in this case the history of one of the nations most beloved institutions, the NHS. The book is targeted at a broad public audience, as an introduction to, or overview of the history of this august body. It offers a brief synopsis of the formation and development of the NHS, the central professions, and its role in delivering public health care. It largely focuses on management, organisation and political issues over the subsequent 70 years since its inception, alongside developments and changes in patient treatments and in the education of nursing staff.
The book starts with a necessarily rather brief introduction to the development of medical and nursing care in the nineteenth century up to the creation of the NHS in 1948, when its ‘midwife’ Health Minister Aneurin Bevan inaugurated the new public service. Cohen then proceeds to examine the role of doctors, dentists and nurses within the nascent NHS from inception to the current day; and discusses a range of issues such as the development of public health care, public health campaigns, the provision of new services, and resulting financial implications including funding. The development of new services is outlined, including hospice care, screening and organ transplantation.
Cohen provides an interesting and useful summary of the many management challenges presented by such a huge organisation, and the frequent organisational changes undertaken, almost always against a backdrop of political engineering. The book is punctuated by numerous personal recollections, from staff and patients alike, which bring the experiences, challenges and achievements of the NHS to life.
The final two chapters focus largely on changes to nurse training and pay disputes between the government and the medical and nursing professions. While it acknowledges the roles played by the Royal College of Nursing and British Medical Association in recent pay bargaining, the role of the large public sector union, Unison, and other significant unions, is rather strangely, missing.
The book refers only briefly to the contribution made by workers from the Caribbean and other ethnic groups to the development of the NHS, and what is there focusses on clinical roles. Although there are some people of colour in the illustrations, they are not discussed within the text in any detail. Given that the book must have been conceived in the aftermath of the Windrush scandal, this is rather disappointing and perpetuates an approach to history in the UK which hides, ignores or fails to see the contribution of people of colour to UK society and its institutions.
Such a small book is never going to be able to bring nuance and detail to such a vast and complex subject as the history of the NHS, but there are a couple of aspects which could have been improved. The book could have been better referenced (especially where primary material was cited) which would have enabled readers, who wanted to take the subject further, to do so more easily. A more comprehensive subject-based ‘further reading’ list would have overcome some of the problems of trying to represent such a complex history in so few pages.
These points aside, this compact book is easy to follow, very well presented and designed, with an evocative range of beautiful illustrations. The addition of personal memories draws the reader in, and are cleverly used to illustrate how treatment, and management, have changed since the formation of the NHS. Susan Cohen has written a very accessible and useful introduction to the history of the NHS.