Mass Observation helps to build a people’s view of NHS

1930s hospital waiting room

The National Health Service has always been politically controversial, but it continues to hold a very special place in the national psyche, new Mass Observation Archive research at the University of Sussex reveals.

Despite the numerous worries, gripes and moans down the decades, the British public has always supported the founding principle of the NHS - free, universal healthcare at the point of delivery, and funded by taxation - and it still does, say research authors Linda Lamont and Fran McCabe.

'I ... remember pre NHS hospital waiting rooms ... the smell peculiar of the
 times ... a mixture of ether, iodine and floor polish ... and hovering over rows
 of hard wooden forms, is the hushed air of dejection and the vulnerability of those
 exposed to the military-style discipline.'

The study, '60 years of the NHS: Ordinary People Tell the Story', aims to contribute to a patients' history of the NHS by highlighting changing expectations, people's positive and negative experiences of the health service, and also the strong commitment to the founding concept of the NHS.

The patients' comments are part of the Mass-Observation Archive, which specialises in material about everyday life in Britain, and highlights key points in the health service's history, in 1949, 1997 and 2008.   

 'We both dread the thought of becoming cabbages
 ... I feel strongly that my life is mine to dispose of as and when I will.'

Some of the comments come from Mass Observation's earlier days, while research on the 1997 material was helped by a Wellcome grant and a Department of Health grant allowed the researchers to commission a special 2008 Mass Observation survey, reflecting contemporary attitudes.

The material provided colourful accounts of people's encounters with the NHS. Short extracts have been chosen from among hundreds of vividly written responses to illustrate the themes that have been consistently important to the correspondents.

'Bring back 'Matron' and the smell of carbolic soap'

The NHS was launched in July 1948. Prior to that, healthcare was provided by a mixture of private, municipal and charity schemes. This led to inequalities between different regions, with many people unable to afford healthcare.

In the 1949 records, the report shows - unsurprisingly - that people were grateful for the services they had not been able to afford before the NHS began. By 1997, and increasingly in 2008, people's expectations are higher and they are more prepared to be critical when their needs are not met.

'I cannot say how strongly I believe that the care which we
inflict upon our elders will become, in history,
the scandal of the late 20th and early 21st centuries

Better care for elderly patients, fear of infections caught in hospital wards, changing nursing standards and dislike of mixed wards are among the concerns raised by patients in these more recent responses.

Finally, the study looks at the attitudes of correspondents towards contemporary ethical issues, such as organ donation, fertility treatment and assisted dying, as well as political debates about priorities, access and funding for the NHS of the future.

 I see very little in the media about anything positive to do with the  NHS, yet I've
had mostly positive experiences.'


Linda Lamont is a former Director of the Patients Association and Honorary Fellow in Contemporary History at the University of Sussex, while Fran McCabe spent 40 years working in health and social care and holds an MA on the history of the NHS through general practice from the University.

Linda Lamont says: "The work I have done over these years from a patient's perspective has convinced me that the majority strongly support an NHS free at the point of use. They see it as an irreplaceable institution. What is now needed is a patients' history of the NHS as evidence of the bedrock upon which it is based.

"There is no substitute for people's own words about their experiences and views. We hope that this study, with its use of the Mass Observation material, provides an important part of the patient's story."

'There was ten days' confinement (for new mothers) in my day;
 now you are sent packing as soon as you can stand.'

Fran McCabe adds: "The Mass Observation material gives us an absorbing and vivid perspective of the NHS going back to its birth. We should not forget that despite its problems, without the NHS many people, especially those without means, would not be alive today.

"People who have contributed to the Mass Observation Archive are reflective and often have foresight about the strengths and shortcomings of the NHS. They are aware of its complexity and discuss contentious issues around ethics and funding, sometimes suggesting solutions. Even when they have had problems using the NHS, they still hold its values to their hearts. "

'Over many long years there has been a definite improvement in
  treatments, waiting lists and patients rights.
But a deterioration in  cleanliness, friendliness and nutrition'

Notes for editors

Find out more about the project and download the report here

See the web site at htpp://

To contact the authors, email

For information about the Mass Observation Archive, visit Mass Observation, tel: 01273 678 157 or email

University of Sussex Press office contacts: Maggie Clune, Jacqui Bealing and Danïelle Treanor. Tel: 01273 678 888 or email

Last updated: Wednesday, 12 May 2010