Family Britain, 1951-1957 (100 page)

The ever-alert Titmuss reflected in 1957 how ‘autocratic behaviour among hospital staffs, with behind them a long tradition deriving from military discipline, didactic teaching and Poor Law regimentation, is strengthened by the invasion of scientific techniques, by increasing specialization and by the growth of professional solidarities’ – and he warned against what he chillingly called ‘a danger of a new authoritarianism in medicine’.

Did the British Medical Association (BMA) have anything to say about the treatment of patients? ‘Doctors’ pay was
the
subject at BMA House,’ recalled Paul Vaughan, who in 1955 got a job there in the public relations department. ‘It was generally assumed it was what the BMA were there for . . .’ Vaughan added that, when Bevan’s name came up, it was ‘usually pronounced Bev-Anne . . . usually with a sort of grimace’.2

Almost half the NHS’s beds in the mid-1950s were occupied by the mentally ill, for the most part in large mental hospitals built on the pattern of jails, with the patients living in huge, often locked wards. In a poignant entry by a far from wholly sympathetic diarist, Anthony Heap in October 1955 describes visiting his wife, Marjorie, who for the past seven months had been at Friern (previously known as Colney Hatch) Mental Hospital:

Grieved to find M not only transferred to another, grimmer, more remote ward on account of getting out of hand in the other one, but in a much worse condition, dopey and more deluded than ever. The insulin and electric shock treatment she’s been having only seem to have had a detrimental rather than a beneficial effect on her, and I can’t believe that being confined to the prison-like ward with the cell-like bedrooms that I saw her in this afternoon is going to do her any good either.

A few months later, Philip Larkin visited his mother at Carlton Hayes Hospital, near Narborough in Leicestershire, where she was being treated for some form of mental illness or instability. ‘Large and dingy as a London terminus,’ he told a friend, ‘it was filled with the apathetic or moping inmates and their stolid families and in the very centre stood a tea trolley, at which a small queue endlessly waited.’ The only thing he could compare it to was ‘a German expressionist film’, and he added that ‘around the walls and corridors lingered the hospital servants (all harmless certifieds) grinning as you passed’. Mercifully, there were some exceptions. ‘A place of calm and lightness, set in beautiful gardens maintained by the patients,’ was how Ken Worpole half a century later recalled visiting his father in Runwell Hospital, one of the larger Essex asylums. ‘It was designed on a parkland-villa system of low-rise buildings, with patients organized into smaller residential groups, and was run with great dedication by medical staff who supported the ideals of the therapeutic community movement.’

Friern, though, was almost certainly more typical, and as Heap suggested, this was still the era of physical methods of treatment, principally threefold: ECT (electroconvulsive treatment), deep insulin therapy (involving risky, even fatal comas) and pre-frontal leucotomy. However, the last two treatments were being increasingly questioned by the mid-1950s, and from about this point the focus moved more to powerful new psychotropic drugs such as chlorpromazine, marketed from 1954 as Largactil. The dramatic emergence of these tranquillisers undoubtedly helped to shift the balance of psychiatric opinion away from institutional care and towards treatment in the community, but the historian Simon Goodwin has emphasised the role of other important ‘new initiatives’ by the 1950s, such as ‘the “open door” policy, the development and use of new physical treatments, and the “de-designation” of some mental hospital beds’, all of which ‘reflected the increased emphasis being given to the treatment, rather than simple containment, of mentally ill people’. One young psychiatrist, based in the mid-1950s at Glasgow’s Gartnavel Royal Mental Hospital, preferred to go his own way. There, Ronald Laing set up the so-called Rumpus Room, in which a dozen particularly unpopular, seriously disturbed patients were removed from the danger and smell of the wards, placed in pleasant surroundings, allowed to wear ordinary clothes and treated by carefully selected nurses as real human beings with real human feelings. This largely successful experiment became the basis for the book he started writing in 1956 –
The Divided Self
.3

Elsewhere on the medical front, two diseases in the news in 1956 were polio and lung cancer. ‘After much doubt and hesitation,’ recorded Heap in March, ‘decide to apply to have Frainy [his young son] inoculated with the new anti-polio vaccine, with which the first so many thousand children between the ages of two and nine are, if the parents agree, to be injected this summer.’ This was the first year that the vaccine was available, and as yet, quite apart from parental misgivings, there were not sufficient quantities. Accordingly, some 3,000 people (mostly children) contracted polio during the summer’s epidemic, though in the year as a whole only 114 died, one of the lower post-war totals up to this point. As for lung cancer and its causal link with smoking, the new Health Minister, Robin Turton, took much the same stance as his predecessor Macleod: a public acceptance that the two were probably linked, but a disinclination either to stop smoking himself or to wage a public-information campaign. Anyway, there was little political will for such a campaign: ‘I only hope it won’t stop people smoking!’ noted Macmillan (suddenly conscious of the Treasury’s fiscal needs) of Turton’s May statement, while about the same time Rab Butler reflected that the government should not ‘assume too lightly the odium of advising the general public on their personal tastes and habits where the evidence of harm which may result is not conclusive’. The issue was raised on
Any Questions?
following Turton’s statement, and after the countryman Ralph Wightman had related how he had begun smoking at the age of 11, his fellow-panellist Ted Leather, a Tory MP, told jokes about Churchill’s smoking. And not long afterwards, at its annual conference at Brighton, it was only with considerable reluctance, amid vocal protest, that the BMA agreed on a one-day smoking ban during proceedings. Still, Kingsley Amis in Swansea was taking no chances. ‘I have taken to using a filter-holder,’ he confessed to Larkin later in the year, ‘in dear smear dread of l+ng-c+nc+r, and chose the more modest, less ornate type of the two offered. It is the lady’s type, I find.’4

Inevitably, for all its understandably alluring promise of universalism, not everyone benefited equally from the NHS. Fyfe Robertson asserted in 1954, on the basis of survey evidence, that it had ‘made least difference to poorer employed people, and most to women (especially middle-aged) and the old of both sexes’, adding that ‘the difference has been greatest among the lower-paid middle class’. Provision undeniably varied. Taylor in the early 1950s, researching
Good General Practice
, found that the less effective, lower-grade GPs tended to be in working-class industrial areas, while in purely quantitative terms, the ‘obstructionism of the BMA’ (in the words of Charles Webster, historian of the NHS) largely blocked attempts to correct regional imbalances in the supply of GPs – imbalances that heavily favoured ‘the metropolitan regions and their neighbours’. As for take-up, an official 1955–6 survey of general practice revealed that patient consulting rates were failing to compensate for the well-known class bias in national patterns of mortality and morbidity. The same applied, noted Abel-Smith and Titmuss in their research for Guillebaud, to working-class use of hospital services, which anyway were available very unevenly around the country, with for instance Sheffield Regional Health Board having only nine beds available per thousand population, compared to the South West Metropolitan RHB’s fifteen.5

What about the elderly, who along with women generally were, according to Robertson, the great beneficiaries? No doubt they did benefit overall, but another NHS historian, Geoffrey Rivett, has drawn on a 1954 national survey of services for the elderly to paint a less sanguine picture: GPs sometimes no longer referring elderly patients because of long waiting lists; hospital accommodation often ‘in long rambling draughty buildings far from other hospital services’, with in one case ‘an outside cast-iron staircase’ serving ‘one ward on the first floor over a boiler-house and a paint store’; and physicians who either ‘did not believe in geriatrics’ or were indifferent. Indeed, it seems to have been axiomatic among hospital administrators and health authorities that geriatric patients, being ‘chronic’, only merited a lower budget, including for food, than acute patients. Altogether, as Abel-Smith and Titmuss concluded in their study, ‘by and large the older age groups’ were ‘currently receiving a lower standard of service than the main body of consumers’ and there were ‘substantial areas of unmet need among the elderly’. Put another way, a war had been won, a new world was being constructed, and it was not the old who represented the future.

Poverty was an almost taboo word in 1950s Britain, but that – despite the best efforts of the Welfare State – was what sizeable pockets of elderly people still lived in. A quartet from Bethnal Green spoke to Peter Townsend in around 1955:

When we were both working we had £10 a week coming in. If we wanted to buy something for dinner, we went out and got it. Now anything a bit tasty is out. But it’s when you’re getting on you need it. I’m telling you this in confidence. People think we’re comfortable and I wouldn’t have them know otherwise. But we’re not . . .

I used to have two pints of milk a day, and I said to the milkman, ‘I don’t like to owe you money,’ so after that I’d only have one pint. We used to have eggs for supper, or a kipper, but not now. We have p’rhaps a bit of toast. But we always have dinner. We always have something hot. We had to cut down on everything, I can tell you. He [her husband] doesn’t even smoke now. And he doesn’t drink. But I like a drink when I can, I don’t mind admitting. And he has to put his shilling on the pools . . .

I don’t have any breakfast. I mostly have boiled beef when I get meat, and with it I have carrots or parsnips or brussels sprouts and potatoes. Sometimes I make myself a pease pudding . . .

The money goes like anything. It costs me a £1 for my rations. Last Saturday our joint was 7s 6d and it was only a little one, but we spun it out till Monday . . . We can’t afford luxuries. I just have a bit of toast for breakfast and a cup of tea. I can’t afford eggs . . .

In many such cases, Townsend asked why they had not applied for the still means-tested National Assistance. ‘I’ve never liked to cadge’, replied one, another that ‘I don’t want to tell people all my affairs’, a third that ‘I’d starve rather than ask for a penny’.6

Would they have agreed with Macmillan when in 1955 he privately described the UN Secretary General, Dag Hammarskjöld, as ‘suffering from the endemic disease of Scandinavia (esp Sweden) – gutlessness’ and hypothesised: ‘I suppose after another generation or two of the Welfare State we shall be the same!’? Or with Gilbert Harding when the following year, in his preface to
The Gilbert Harding Question Book
(devised by W. H. Mason, pipe-smoking Senior English Master of Manchester Grammar School), he complained that ‘this is an age of moving pictures, gramophone records, radio, television – all for nothing or for so little as to make them not worth having’, adding ‘that is what I suppose is meant by living in a welfare State’? Perhaps they would, but the problem of poverty as such, and not only among the elderly, was unlikely to disappear overnight. Much of course turned on definitions, but in a retrospective study of a 1953–4 Ministry of Labour national survey of the expenditure and income of nearly 13,000 households, Townsend found that a total of roughly 5.3 million people – including 1.75 million primarily dependent on wages – were in what could reasonably be described as poverty. Even so, a poll in 1956 showing that 49 per cent of mothers neither recognised nor were able to define the term ‘welfare state’ must have been somewhat disconcerting to those emotionally committed to the welfare state and its founding values.7 And they might even have speculated that, should a ‘New Right’ ever take shape and attain critical mass, the popular opposition to it might turn out to be dangerously flaky.

1956 was notable for so many reasons, including in relation to the urban environment. To take a mere ten: the Clean Air Act came on the statute book (four years after the infamous London smog) and, although dealing only with smoke rather than with industrial pollution generally, would among other benefits double Manchester’s quota of winter sunshine; the Ideal Home Exhibition featured a Smithsons-designed ‘House of the Future’, a rectangular, windowless box that was gadget-filled, but without private space; on his father getting a job at the de Havilland factory, the ten-year-old Donovan Leitch (the future folk singer) moved from inner-city Glasgow to Hatfield New Town in Hertfordshire and discovered
rus in urbe
; an office-building boom was under way, especially in London, with Sir Howard Robertson’s design for the Shell building on the South Bank being shown at the Royal Academy Summer Exhibition, a design that – according to one appraisal soon after – ‘lies heavily on the human spirit, redolent with undertones of 1984’; the new Housing Subsidies Act made it much more advantageous for local authorities to build high-rise, giving three times as much subsidy for a flat in a fifteen-storey block as for a house; the Irish dramatist Brendan Behan visited Leeds and, he told the
New Statesman
, ‘saw, with interest as a former slum dweller and building worker, the beautiful flats at Quarry Hill estate’, the 1938 showcase of municipal flat-building; that estate’s creator and still City Architect for Leeds, R.A.H. Livett, told the
Yorkshire Post
that he no longer believed in rehousing families in flats and that it was ‘the speculative builder’ who had the right answer, in that ‘he builds semi-detached houses because he knows what the people want’ – a recantation that came too late to stop the high-rise juggernaut in his city; in Bristol, a rundown but still viable Georgian area, Kingsdown, that was rumoured to be on the condemned list was visited by a young local journalist, Tom Stoppard, who found himself enchanted by ‘a glimpse of a quieter contented world’ and concluded that ‘the traditionalists are right’; John Betjeman spoke (‘Let us not write the Victorians off as no good’) in protest at the proposed demolition of the City of London’s ‘impressive, vast and exquisitely detailed’ Coal Exchange for the purpose of road-widening; and in Newcastle, an unemployed, one-eyed Welshman, Jimmy Forsyth, acquired an aged Rolleiflex camera and started making a visual record of the Scotswood Road area just as it began to be razed.8