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An Imperial Health Service: Empire and the British National Health Service

Module description

Since 1948, the NHS has been a prominent feature of everyday life in Britain. Yet, despite its National nomenclature, the NHS has consistently been shaped by connections with empire and its enduring legacies. In this module, you will explore the intertwined histories of colonialism and healthcare in Britain. We will consider how labour and “care” in the NHS has been shaped by imperial and post-imperial economies, political projects, and intersecting forms of racism, xenophobia, and heterosexism, as well as forms of social solidarity and resistance. We will undertake this work through weekly case studies, built around an eclectic archive of primary sources (from professional papers to novels and activist literature) and secondary readings. Over the course of this module, you will thus develop an understanding of the intimate connection of colonialism and the NHS, as well as of the value and limitations of different kinds of historical evidence.  No prior knowledge required.

Module aims - intentions of the module

This module aims to:

• Introduce you to key themes, emergent debates, and essential methodological and ethical considerations in the history of British healthcare.
• Develop your understanding of empire’s impact and legacies within key British institutions.
• Familiarise you with a range of different kinds of sources which historians have used to understand the history of healthcare and colonialism, including written, visual, and material culture sources, and from the perspective of medical professionals, state agencies, activists, patients, families and wider communities.
• Equip you with analytical and critical skills necessary for approaching future historical work.

Intended Learning Outcomes (ILOs)

ILO: Module-specific skills

On successfully completing the module you will be able to...

• 1. Understand and analyse the different ways in which the National Health Service has been shaped by imperial and post-colonial politics, economics, social formations, and cultural values and prejudices.
• 2. Work critically with a wide range of sources, produced by diverse subjects with multivalent aims and perspectives, and which can be used to explore histories of the NHS and (where applicable) broader British welfare state.

ILO: Discipline-specific skills

On successfully completing the module you will be able to...

• 3. Identify the problems of using historical sources e.g. bias, reliability, etc., and compare the validity of different types of source (e.g. written, visual, material).
• 4. Demonstrate the ability to apply different methodological approaches to the analysis of historical sources

ILO: Personal and key skills

On successfully completing the module you will be able to...

• 5. Digest, select and organise material to produce, to a deadline and demanding word limit, a coherent, concise and cogent argument, delivered in written and oral form.
• 6. Reflect critically on your own work, respond constructively to feedback, and to implement suggestions and improve work on this basis.

Syllabus plan

While the content may vary from year to year, it is envisioned that it will cover some or all of the following topics:

• Colonialism and healthcare before the NHS.
• Empire, the NHS and creating the “post-war settlement”.
• Migration and healthcare labour.
• Race, gender, and representing the health service.
• Racism, specialization, and professional hierarchies.
• Migration, Othering, and health services.
• Policing institutional, bodily, and “national” boundaries.
• Healthcare, belonging, and placemaking.
• Activism and solidarity.
• Patients’ experiences of using the NHS.
• Alternative economies of healthcare.
• Neoliberalism, Brexit, and “the NHS”.

Learning activities and teaching methods (given in hours of study time)

Details of learning activities and teaching methods

Formative assessment

Summative assessment (% of credit)

Details of summative assessment

Details of re-assessment (where required by referral or deferral)

Indicative learning resources - Basic reading

• Bailkin, Jordanna. The Afterlife of Empire. Berkeley: University of California Press, 2012.
• Bivins, Roberta. Contagious Communities: Medicine, Migration and the NHS in Post-War Britain. Oxford: Oxford University Press, 2015.
• Bivins, Roberta. ‘Picturing Race in the British National Health Service, 1948-1988’’. Twentieth Century British History 28, no. 1 (2017): 83–109.
• Fitzgerald, Des, Amy Hinterberger, John Narayan, and Ros Williams. ‘Brexit as Heredity Redux: Imperialism, Biomedicine and the NHS in Britain’. Sociological Review 68, no. 6 (2020): 1161–78.
• Green, Jeffrey P. ‘West Indian Doctors in London: John Alcindor (1873-1924) and James Jackson Brown (1882-1953)’. The Journal of Caribbean History 20, no. 1 (1995): 49–77.
• Gunaratnam, Yasmin. Death and the Migrant: Bodies, Borders and Care. London: Bloomsbury Academic, 2013.
• Haynes, Douglas. Fit to Practice: Empire, Race, Gender, and the Making of British Medicine, 1850-1980,. New York: Rochester University Press, 2017.
• Jones, Emma L., and Stephanie J. Snow. Against the Odds: Black and Minority Ethnic Clinicians and Manchester, 1948 to 2009. Manchester: Manchester NHS Primary Care Trust, in association with the Centre for the History of Science, Technology and Medicine, University of Manchester, 2010.
• Saunders, Jack, ‘Emotions, practices and the changing composition of class, race and gender in the National Health Service, 1970-79: ‘Lively discussion ensued’’, History Workshop Journal, 88 (2019), 204-28.
• Simpson, Julian. Migrant Architects of the NHS: South Asian Doctors and the Reinvention of General Practice (1940s-1980s). Manchester: Manchester University Press, 2018.

Indicative learning resources - Web based and electronic resources

• ELE – Faculty to provide hyperlink to appropriate pages
• Box of Broadcasts, British Cartoon Archive, British Film Institute, Mass Observation Archives, Women’s Magazine Archives (available via the Library).
• The Migration Muesum, London - https://heartofthenation.migrationmuseum.org
• The King’s Fund:https://www.kingsfund.org.uk.
• People’s History of the NHS:https://peopleshistorynhs.org.
• Cox, Catherine, and Hilary Marland, eds. Migration, Health and Ethnicity in the Modern World. London: Palgrave Macmillan UK, 2013. https://doi.org/10.1057/9781137303233
• Mody, Fallon. ‘Migrant Medical Women: A Case Study of British Medical Graduates in Twentieth-Century Australia’. Women’s History Review 28, no. 4 (7 June 2019): 645–67. https://doi.org/10.1080/09612025.2018.1513828
• Raghuram, Parvati, Joanna Bornat, and Leroi Henry, “Without Racism There Would Be No Geriatrics”: South Asian Overseas-Trained Doctors and the Development of Geriatric Medicine in the United Kingdom, 1950–2000’, in Laurence Monnais and David Wright, eds., Doctors beyond Borders (University of Toronto Press, 2016), 185–207, https://doi.org/10.3138/9781442629622-011
• Redhead, Grace. ‘“A British Problem Affecting British People”: Sickle Cell Anaemia, Medical Activism and Race in the National Health Service, 1975–1993’. Twentieth Century British History 32, no. 2 (19 July 2021): 189–211. https://doi.org/10.1093/tcbh/hwab007
• Wellcome Collection: https://wellcomecollection.org

Indicative learning resources - Other resources

Institutional –

• Black Cultural Archives, London.
• The National Archives, London.

Published –

• Bryan, Beverley, Stella Dadzie, and Suzanne Scafe. The Heart of the Race: Black Women’s Lives in Britain. London: Virago, 1985.
• Emecheta, Buchi. Second-Class Citizen. London: Flamingo, 1974.
• Torkington, Nthombenhle Protasia Khotie. The Racial Politics of Health: A Liverpool Profile. Liverpool: Merseyside Area Profile Group, University of Liverpool, 1983.

Key words search

Empire; National Health Service, NHS, post-war Britain, healthcare