The development of the NHS in Watford

In May 1948 Fred Messer MP met with representatives of West Hertfordshire hospitals at a meeting in Watford Town Hall. He wanted to explain the functions of the incoming Regional Hospital Board and area management committee which would be the local representative bodies of the forthcoming National Health Service. “We are sailing unchartered seas” he said. “We do not know how deep down the rocks will be or the strength of the currents which will toss us hither and thither, but we know we will be dependent upon the crew of the ship to see us safely to harbour.” It is unlikely, in this mood of uncertainty, that he could have anticipated the immense achievements of the National Health Service in Watford during its first 25 years.

In July 1948 the members of Watford Guardians Committee, who had previously overseen the town’s health services, said their thanks and farewells. The old health care system, relying on private insurance schemes, sickness clubs and discretionary provision of free treatment by hospitals, came to an end. The new National Health Service would help everyone, would be provided on need rather than ability to pay, would be free at the point of use, and would be paid for generally by public money. Shrodells Public Assistance Institution, King Street Maternity Hospital, the Isolation Hospital and the Peace Memorial Hospital all became part of the new health service. Watford Borough Council would oversee the public health service and would continue to employ a medical officer who would provide annual reports on the health of the town. In his 1946 report the medical officer Mr R C M Pearson predicted that, with local knowledge and enthusiasm, Watford would have a health service of which it could be justly proud.

The maternity hospital in King Street

In 1948 infectious diseases were still part of everyday life in Watford. There were 631 cases of measles, 205 cases of whooping cough and 60 cases of scarlet fever in the town. The Isolation Hospital admitted 187 patients that year. From 1935 Watford Borough Council had organised a successful immunisation campaign which had rid the town of diphtheria by 1947, but had been reliant on its own resources to achieve this.

The new National Health Service could organise mass programmes to take advantage of the host of new vaccines which were becoming available. It could provide free access to a range of treatments and introduce measures to prevent poor health. The results were impressive. In Watford cases of tuberculosis decreased from 106 in 1951 to 23 in 1971; cases of scarlet fever from 109 in 1953 to 10 in 1970; cases of whooping cough from 435 in 1953 to none in 1973. Measles epidemics usually visited the town once every two years, bringing misery and discomfort particularly to young children. In 1967, its presence was still high, with 1,068 cases recorded in the town. The following year the measles vaccination programme was introduced. 1969 should have been a “Measles Year” in Watford; in the event, it was not. The number of cases, at 229, was nearly a fifth of the 1967 total.

Poliomyelitis (polio) had not been a disease of major concern in Watford before the war, with usually just one or two cases each year. However, in 1947 there were 13 cases – and one death. There was initial bafflement about what was causing it; fatigue and over-exertion were early theories, and the 1952 medical report urged young people to refrain from “violent and prolonged physical exercise”. Deaths from polio began to make headlines in the West Herts and Watford Observer. The worst year was 1949 when there were 25 cases and six deaths. Gradually it became known that summer was the “Polio Season” when people were most susceptible to infection from this waterborne virus, and visits to swimming pools and rivers were discouraged. However, good news came in 1956 when 400 children in Watford became among the first in the country to receive the new British-made polio vaccine. By the end of the year it was reported that the new NHS Polio vaccination programme had been a great success with no serious reactions. The programme went from strength to strength. It was continued into the 1960s, with the Sabin vaccine (“the Sugar Lump”) introduced in 1962. However, there were no more cases of polio in Watford after 1959.

The building that became the Shrodells Wing of Watford General Hospital

Influenza epidemics often made the front pages of the Observer in the 1950s and 1960s. The National Health Service had begun just 30 years after the 1918-1919 Spanish Flu pandemic which claimed the lives of 179 people in Watford. Asian Flu was a world-wide scourge which arrived in the town in October 1957: “hardly a home, school, factory office or public service has escaped the germ” said the Observer. In one week it was estimated that ten per cent of the population may have caught the illness, and that doctors and chemists were rushed off their feet. However, free advice and treatments were available, and the death toll in the town was just ten. A further global influenza pandemic, Hong Kong Flu, visited Watford in December 1968 and January 1969. Fortunately, by this time vaccines were available. A targeted programme was launched, with priority given not only to vulnerable groups such as older people, but also to key workers including medical staff, police and ambulance men. This time the death toll was limited to four.

However, the National Health Service in Watford was facing new challenges as it approached its 25th birthday:

Car ownership was growing in this affluent town which had its fair share of fast roads. The by-pass had always been regarded as a hazardous highway and the stretch of the M1 through Watford opened in 1959. The result was that the local hospitals were having to treat an increasing number of injuries caused by car accidents. By 1971 road improvements were being considered to reduce casualties. It also appears that by the early 1970s more people who had sustained injuries in car accidents were surviving and recovering.

Accidents in the home received less attention but numbers were climbing. There were particular peaks in Watford in 1965 and 1971, due mostly to falls and poisoning. Post-war homes could contain a plethora of hazards as yet unregulated by health and safety legislation, such as flammable furniture and clothing. Poisoning through poorly cooked food and misuse of medicines was becoming increasingly common. In the late 1950s and early 1960s Watford’s Public Health Committee organised accident prevention campaigns in the town to try to promote home safety awareness.

Treatments for mental health were proliferating, with the 1969 Watford Medical Report stating that “sickness with a high emotional content” required attention from health services. The number of prescriptions for barbiturates and tranquilisers was high, but the medical officer saw a greater willingness to talk about mental health as a positive development.

The local medical reports continually remarked on the growing number of people who were smoking. Deaths from lung cancer in Watford leapt from 24 in 1951 to 64 in 1973, and public health campaigns appeared to have had little impact. We have to look beyond the first 25 years of the National Health Service for progress in tackling this disease.

By the early 1970s infectious disease could still rear its head in unexpected ways. In 1972 there was a case of the old illness of typhoid in Watford. It involved a resident of the town who had caught the disease while on holiday in Spain. The Watford Medical Report warned: “As long as holidays are taken in foreign countries with standards of hygiene inferior to our own, there is an ever present risk of serious illness”.

April 1974 was a milestone in the history of the National Health Service. A large-scale administrative reorganisation took place which incorporated all health services into regional and area health authorities. Public Health services would no longer be administered by local authorities (they would return to country councils and unitary local authorities in 2013), and they would no longer employ medical officers. Watford’s outgoing medical officer, Mr A Shaw, signed off his final report in 1973. By this year the world of isolation hospitals, whooping cough, polio, scarlet fever, tuberculosis and measles was receding into history.

What would the Watford medical practitioners of 1973, who would no doubt have been reflecting upon the immense successes of the previous 25 years, have thought if they could have foreseen that in 2020 a pandemic disease would begin which would profoundly affect the lives of every man, woman and child in the country? But perhaps the success of today’s vaccination programmes against Covid-19 are due, in part, to the precedents and practices set by the National Health Service during its first 25 years.

Helen George lives in Watford and has always been fascinated by its 20th century history. She gives presentations on subjects such as Watford’s experience of the Spanish flu pandemic 1918-1919 and the role of retail businesses on the Home Front between 1914 and 1918. She is currently researching the lesser known aspects of life in Watford during the Second World War.