From the end of the middle ages, most people in Britain depended on amateurs with nothing more than a reputation as wise healers who could set bones, brew herbs, or even perform magic.
There were though three small hospitals. And from these grew a patchy network of paid-for hospitals, local council healthcare for rate-payers and later for workers (though they could only go to hospital for tuberculosis), and charitable beds in ‘voluntary hospitals’ or attached to workhouses.
In the 1800s first specialist hospitals - for example maternity and orthopaedics - and later rural cottage hospitals emerged.
Patients were often referred by doctors in general practice (today’s GPs).
As today, standards varied considerably. There are reports of nurses putting tins of oil under the legs of cots to deter cockroaches from climbing up.
In the 19th century, health treatment was typically available only to the wealthy, and health outcomes were startlingly bad compared to today’s standards: middle-class men might live to 45, and they were the lucky ones.
In 1911, David Lloyd George’s National Insurance Act followed the example of Bismarck’s Germany in bringing in a system that provided for health and unemployment cover in return for monthly payments out of wages (it started at four pence a week). But it only applied to workers, and only covered a limited number of health complaints. Many patients still had to pay to visit a doctor or stay in hospital, pushing many families into debt.
In 1948 the prime minister, Clement Attlee, asked the public to be patient with the newly nationalised service as “there are bound to be early difficulties with staff, accommodation and so on.” By the day of the launch, 94% of the public were enrolled with the NHS.