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Funding health care in the Great War


In the second of a series of blogs looking back at our history, Kathy Johnson considers the role of the Fund during World War 1.

When The King’s Fund was established in 1897 its initial purpose was to raise money for London’s voluntary hospitals – and part of its remit was to monitor how this money was spent. In 1903, the Fund began to collect up-to-date information on the income and expenditure of London’s voluntary hospitals and kept a close eye on demand for voluntary hospital services and the consequent impact on finances.

In 1914, within weeks of the outbreak of the war, casualties were flooding back to the UK from France. The existing military hospitals could not provide sufficient capacity, nor could the workhouse infirmaries and asylums which the government commandeered to care for the sick and wounded.

In an era without state-funded health services, the War Office asked that voluntary hospitals ‘do their bit’ by caring for some of the sick and wounded. At this time, London hospital services were unco-ordinated and haphazard so it was a major task to take this on. The hospitals agreed to do so, but it soon proved a heavy burden – as evidenced by the statistics collected by the Fund.

The statistical reports for the war years make for interesting reading. The Statistical report of the ordinary expenditure of one hundred and eight London hospitals for the year 1914 – The King’s Fund now favours snappier titles – noted the sharp increase in the number of patients. Of the 134,025 patients admitted in 1914, 5,478 were from the armed forces; by 1915, the number from the armed forces had risen to 28,400 (p 106). Between the outbreak of war in July 1914 and the end of 1919, London voluntary hospitals treated almost 123,000 naval and military patients (p 261).

As a result of this growth in patient numbers and the rising costs of drugs and other resources during the war years, hospital expenditure rose. There was also difficulty in staffing hospitals because of the demand for doctors, surgeons and nurses in the armed services.

The War Office offered grants to support care of the war wounded, but voluntary hospitals were concerned that accepting government money would be a threat to their independence. Hospitals also feared that if the public saw them accepting money from the state, it would discourage the charitable donations they relied on.

The King's Fund shared these concerns. In 1915, the Fund’s Executive Committee debated the issue of voluntary hospitals receiving state grants (p 7, 9). In the end, the Fund concluded that hospitals could accept government payments without damaging the voluntary system as long as the money was for services rendered (p 80).

In addition to the issue of accepting state funding, voluntary hospitals suspected that the grants from the War Office did not cover the actual costs of providing care. The King’s Fund’s analysis of London voluntary hospital expenditure for 1918 confirmed this. It reported that gross expenditure of London’s voluntary hospitals for that year was just under £2 million, representing a 41 per cent increase in spending between 1913 and 1918 (p 80). The 1920 report calculated that the total additional expenditure by London voluntary hospitals for war casualties amounted to £515,000. War Office grants went some way to covering these costs, but the voluntary hospitals had to cover the rest through increased fundraising and donations.

Many hospitals were in deficit as a consequence of the war. In 1919 The King's Fund contributed £250,000 as an ‘emergency distribution’ across London voluntary hospitals. How the Fund tackled this urgent need to raise more money will be explored in our next blog in this series.