SummaryThis article surveys historical writing on the British National Health Service since its inception in 1948. Its main focus is on policy-making and organisation and its principal concerns are primary care and the hospital sector, although public health, and psychiatric and geriatric care are briefly discussed. The over-arching narrative is one of transition from paternalism and technocratic planning to market disciplines and a discourse of choice, and of the ceding of professional autonomy by clinicians to managers and to the state. These issues are discussed in a chronological survey of policy-making from Bevan's ‘creation’ to the Blair era. Later sections consider evaluations of the service, starting with Webster's thesis that the NHS has been subject to prolonged under-funding, particularly under Conservative stewardship, then moving to assessments of the Thatcher, Major and Blair reforms. Much of the historical literature on the NHS is contentious and opinions are sharply divided on the reform era since the 1970s and the trajectories this has set for the future.

This article uses history to stimulate reflection on the present opportunities and challenges for public health practice in English local government. Its motivation is the paradox that despite Department of Health policy-makers’ allusions to ‘a long and proud history’ and ‘returning public health home’ there has been no serious discussion of that past local government experience and what we might learn from it. The article begins with a short resumé of the achievements of Victorian public health in its municipal location, and then considers the extensive responsibilities that it developed for environmental, preventive and health services by the mid-twentieth century. The main section discusses the early NHS, explaining why historians see the era as one of decline for the speciality of public health, leading to the reform of 1974, which saw the removal from local government and the abolition of the Medical Officer of Health role. Our discussion focuses on challenges faced before 1974 which raise organizational and political issues relevant to local councils today as they embed new public health teams. These include the themes of leadership, funding, integrated service delivery, communication and above all the need for a coherent vision and rationale for public health action in local authorities.

This article re–evaluates the gravity of the financial problems facing British voluntary hospitals in the interwar period. A relational database of statistics on hospital provision, finance (at both current and constant prices), and activity is used to derive consistent sets of hospitals for reporting purposes. The article presents novel analyses of the extent and pattern of hospital surpluses and deficits; of the capital accounts of selected individual hospitals; of trends in hospital expenditure; of the diversification of hospital income, emphasizing the declining importance of traditional philanthropy; and of the effect of these changes on hospital provision and utilization.

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An important goal of policy in the British National Health Service (NHS) is to increase public involvement in health care governance. In the hospital sector this led in 2003 to the establishment of foundation trusts with "membership communities," which aim to give local citizens a say in management. This is not the first attempt to introduce greater community participation in the running of British hospitals. Prior to the inception of the NHS in 1948, the hospital contributory scheme movement provided ordinary members of the public with the opportunity to sit on hospital management boards. The article examines the nature and extent of this earlier experiment with local democracy in hospital governance. It argues that historical precedent is not particularly encouraging, either for the prospect of broadening popular participation or for making services more responsive to local needs. Although today's context is very different, the tendency for managerial and professional interests to dominate the policy arena is a feature of both periods.

This article examines the development of health system metrics by international organizations, exploring their relationship to the politics of world health. Current historiography treats measurement either as progressive illumination or adopts a critical stance, viewing indicators as instruments of global governance by powerful nations. We draw on diverse statistical publications to provide an empirical overview of change and continuity, beginning with the League of Nations Health Organization, which initiated health system statistics, and concluding with the World health report 2000, with its controversial comparative rankings. We then develop analysis and explanation of these trends. Population indicators appeared consistently owing to their protective function and compatibility with development thinking. Others, related to provision, financing, and coverage, appeared more sporadically, owing to changing trends and assumptions in international health. While partly affirming the critical literature, metrics were also used by peripheral or resistant actors to challenge or influence policy at the centre.

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We examine the relationship between age, sickness, and longevity among men who were members of the Hampshire Friendly Society (HFS) in southern England during the late nineteenth and the early twentieth centuries. The HFS insured its members against sickness, death, and old age, keeping detailed records of the claims for sick pay submitted by its members from 1868 onward. From 1892 onward these records included information about the cause of the sickness for which compensation was paid. We can therefore use this information to construct individual ''sickness biographies'' for men who joined the society during this period. This article uses these sickness histories to address two questions. The first concerns the relationship between the age of the society's members and the nature of the claims they submitted. We find that both the incidence and the duration of periods of sickness increased with age. Older men experienced longer periods of sickness both because they experienced different types of sickness and because it took them longer to recover from the same illnesses as those suffered by younger men. The second question is whether sickness in early adulthood was associated with increased mortality. We find that repeated bouts of sickness, as revealed by the number of claims made for sick pay, at ages under 50 years were associated with an increased risk of death at ages over 50 years.During the last 15 years historians of health and medicine have devoted increasing attention to the study of sickness and morbidity during the late