The End of History

Last month the Royal Free Hospital re-named its wards. The historic titles were scrapped and replaced with functional labels that indicate the floor on which the ward is situated and the direction it faces. So Jex-Blake Ward, for instance, which was named after Sophia Jex-Blake, whose pioneering work in doctors’ training opened up the medical profession to women, became 12 South. The distinguished physicians and generous benefactors who shaped the hospital’s history are no longer to be part of its living fabric.

The Royal Free’s history is a particularly stirring and distinguished one. It was the first hospital in the country to offer free care to those who could not afford to pay for it. A hundred and twenty years before the NHS came into being, it established the principle that the only requirement for treatment was medical need. It was also the first hospital in England to offer clinical facilities to female medical students, without which they could not be properly trained. It thus laid the foundations for two of the fundamental precepts of contemporary healthcare in Britain, and it consequently seems a shame that Elizabeth Garrett Anderson – the first woman to qualify as a doctor in this country and also the inaugural Dean of the Royal Free Medical School – will no longer be associated with the hospital on a routine daily basis. The ward named after her is now known as 11 West.

But – sentiment aside – does this really matter? The re-naming is apparently intended to make it easier for emergency “crash” teams to find their way round the building, and also to make fewer demands on the literacy skills of the hospital’s patients. Quite apart from being fantastically condescending, however (are we seriously expected to believe that doctors able to perform life-saving resuscitation procedures are unable to locate a ward because it is identified by a name rather than a directional code?), I believe this change does undermine - in however small a way - the fundamental nature of the institution.

As I explain in my forthcoming book Shadows in Wonderland (to be published on 7 February – see www.hammersmithpress.co.uk) the Royal Free, like most modern hospitals, conforms to almost all of the criteria that the French academic Marc Augé uses to define “Non-Places” – the faceless environments such as airports, motorway service stations or supermarkets that form such a major part of the contemporary landscape, and from which we feel so painfully alienated. Prominent among these characteristics is the way that these environments deny the past: “There is no room for history...what reigns there is actuality, the urgency of the present moment.”

Writers such as George Orwell and Milan Kundera have tracked the ways in which totalitarian regimes eradicate and re-write history to suppress opposition or criticism, and legitimize their abuses of power. Conspiracy theorists might well see this “innocent” change of names at the Royal Free as part of a sinister, covert campaign to erase the past and move away from free, universal healthcare based on social and sexual equality towards a private, marketized system based on the ability to pay. From this perspective, the name of the hospital itself will be the next thing to change. Why remind us that hospitals once were free?

While I doubt the existence of such a coherent plan to dismantle the existing system, at a time when the future funding and nature of the NHS is being endlessly re-examined, I think it remains valuable to be constantly reminded that the compassionate inclusiveness and equality of hospitals today did not just happen by chance. They are the result of determined action by a host of committed and pioneering individuals over many years. It also does no harm to remember that many of the health service’s assets were not purchased by the state, but given for the public good by caring and enlightened benefactors. They are held in trust and not to be lightly “sold off” to balance the current balance-sheets.

Am I just an old codger who can’t bear change, or do others agree?