Hospital Sunday and the new National Health Service: An End to ‘The Voluntary Spirit’ in England?

Abstract

The advent of the welfare state has been seen by some historians as a decisive blow for British traditions of voluntarism, echoing some of the concerns raised in the lead up to the establishment of the National Health Service (NHS). This article examines the practice of Hospital Sunday in England in the post-war period. In doing so it evidences the effect of the nationalization of the voluntary hospitals in 1948 on the relationships between clergy, their congregations and health care. It argues that much greater attention needs to be paid to the continuities evident in Christian-inspired social action in the NHS in the long 1950s and after. Attending to the role of such Christian social action allows historians both to extend our knowledge of the importance of Christianity to social life in the period and to deepen our understanding of the operation of the welfare state.

At the Truro diocesan conference in 1950, the bishop of Plymouth was reported as calling for Christians to ‘capture the Welfare State for Christ and his Church … as a way of serving Christ in the 20th century by serving the community’.¹ A term coined by William Temple, the welfare state was welcomed by some as the fulfilment of the aims of Christian social reformers.² However, whether Christians were able to continue to influence the character of the welfare state after its inception, and if so, to what extent, remains relatively unexplored.³ In one view, the role of charity was usurped by the state and long-standing traditions of voluntary service simply discarded.⁴ This article examines the effect of the establishment of the National Health Service (NHS) on the practice of Hospital Sunday in order better to understand the role of Christian charity in the first decade and a half of the NHS's existence.

Hospital Sunday had linked faith communities with voluntary hospitals through fund-raising and worship in a variety of urban places, becoming widespread by the 1870s.⁵ Voluntary hospitals, a vital part of health care provision prior to the NHS, were locally based charitable initiatives drawing their income from donations, endowments and subscription schemes.⁶ By the inter-war period, they were funded by a combination of charity and contributory schemes, as well as some limited payment by patients.⁷ Hospital Sunday, a yearly event, contributed a small proportion of hospitals’ annual income. By the 1930s it had, in many places, become an elaborate festival, marked by parades, brass bands and civic worship, and was supported by medical professionals. However, when the National Health Service Act (1946) turned control of Britain's voluntary hospitals over to central government, fund-raising for medical care was no longer necessary and the primary object of Hospital Sunday was eliminated.

The historiography on Hospital Sunday is not extensive and the custom has received little attention from historians of religion.⁸ As well as providing evidence of the links between congregations and health care prior to the establishment of the welfare state, examining the history of Hospital Sunday after 1948 helps to illuminate the impact of the momentous changes in the role of religion in public life and society after the Second World War. The literature in this field is too extensive to recapitulate here, but the subject remains contested.⁹ While Adrian Hastings was able to produce some very cogent evidence as to why the period might be seen as a one of a ‘modest religious revival’, the data as analysed by Clive Field offers a very mixed picture indeed.¹⁰ Although this remained a time in which Christianity mattered in both politics and culture, it was also apparently one in which religious leaders ‘lost heart’, to use Philip Williamson's words.¹¹ Examining the changing role of the churches in the provision of welfare is one way to help us better understand these changes.

Matthew Grimley identified ‘state encroachment’ as a ‘threat’ affecting the Church of England from the late nineteenth century onwards, with the government taking responsibility for welfare provision previously administered by Christians.¹² As a side-effect of this development, he noted the subsidiary role into which voluntary associations had been forced after 1945, and religion's attendant retreat from the public sphere.¹³ This story is echoed elsewhere: in an absolutist rendering, Frank Prochaska has implicated the welfare state in a sudden evaporation of Christian-inspired social action.¹⁴ In this version, the welfare state, administered by cold bureaucracy and supported by statist Labourites, pushed the need for Christian charity to the margins, with the Church of England episcopate seemingly complicit in this process.¹⁵ Aspects of Prochaska's thesis are readily open to question and Deakin and Smith have discussed the ‘myth’ of Labour's hostility to voluntary action.¹⁶ In the same volume, Eliza Filby directly critiqued Prochaska's account of the role of the Church of England in the consensus years and after, arguing that the welfare state presented a ‘challenge[;] … however the story is one of reformulation rather than retreat’.¹⁷ Indeed, following the work of Daniel Loss, we might see the post-war settlement as in fact accompanied by the incorporation of Church of England personnel and initiatives into the institutions of the state.¹⁸ This is clearly seen in the chaplaincy service, which maintained a role for clergy in the NHS.¹⁹ In light of this scholarship, this article explores further the ways in which Christians adapted to the post-war settlement, focusing on the continued links between faith and voluntarism.

The continued role of voluntarism in the NHS is an emerging theme in medical history. Ramsden and Cresswell have noted the ongoing role of voluntary aid societies in first aid training after 1948.²⁰ As they put it, ‘older traditions of voluntaristic self-sacrifice to a greater communal and national good’ remained, despite the state having taken greater responsibility.²¹ It is these pre-NHS ‘older traditions’ that have received the most attention from historians of medicine. A small portion of this has concerned Hospital Sunday, which has been of interest to historians of medicine in the light of its role in hospital funding.²² Keir Waddington, for instance, put the Metropolitan Hospital Sunday Fund at the ‘apex’ of the voluntary hospital movement and within the history of the ‘rationalisation’ of charitable giving in the nineteenth century.²³ In doing so, he noted that the Metropolitan Fund had supported ‘interdenominational cooperation’ by providing an apolitical focus for ecumenical action.²⁴ Carmen Mangion has investigated this aspect further, drawing attention to the fund's role in combating sectarianism in London's hospitals.²⁵ Provincial Sunday funds have also featured in work on hospital financing, though generally only briefly.²⁶ For instance, the work of Hayes and Doyle captured vividly the associational aspects of hospital fund-raising in the inter-war period. This showed the increasing importance of charity appeals, individual giving and a wide variety of associational activities involved in raising money, of which Hospital Sunday was one amongst many.²⁷

The first section of this article seeks to extend the existing literature on Hospital Sunday by widening the focus beyond London. However, although Hospital Sunday was held across Britain, in a bid to make the material more manageable, the present article draws its evidence from the English context only. The broad swath of the sources cited has been drawn from digitized local newspapers, although it is hoped these are indicative of wider themes. The article largely assumes the prominence of Anglicans within the public sphere at this time. Williamson has argued that public days of prayer at the start of the twentieth century represented a novel level of ‘co-operation between the principal churches’ which placed the ‘Church of England [in] a new position of leadership’.²⁸ In doing so, he also noted the continuing desire by Catholic archbishops to maintain ‘distinctiveness’.²⁹ This was also the case in relation to Hospital Sunday. While Catholic clergy joined in its promotion, it was the Protestant churches, and Anglicans in particular, who were at the forefront.

Helen McCarthy has drawn attention to the ‘democratising logic at work in the associational cultures of inter-war Britain’.³⁰ As will be seen in the next section, this logic was clearly present in the fund-raising practices organized as part of Hospital Sunday and continued into the immediate post-war period. The second section evidences the reactions of clergy, medical professionals and representatives of medical charities to the prospect of nationalization of the hospitals. While Prochaska's account assumes that members of the clergy embraced these changes wholeheartedly, it is shown here that in fact clergy raised concerns about the erosion of a personal and spiritual connection to health care which they felt a state-run hospital service would cause. The third section will argue that despite limitations being placed on the role of charitable giving, the voluntary spirit did not entirely dissipate. Although the NHS presented new challenges to Christians devoted to sustaining a link between charity and medical care, and these were sometimes insurmountable, there remained a concerted effort to maintain support for the hospitals, even after certain avenues were closed.

Hospital Sunday

Linda Woodhead has argued that the advent of the NHS both ‘absorbed’ and ‘erased’ aspects of the health care system of the preceding period. She neatly encapsulated the changes as the ‘triumph of scientific medicine … of the national over the local; of the male medical profession over voluntaryism; and of secular medicine over religious, or mixed, provision of health or healing’.³¹ Although the extent to which the impact of the NHS can be seen in such absolute terms is perhaps questionable, there is no doubt that before the Second World War health care was strongly linked at a local level to religious congregations through both fund-raising and voluntary service. Links to individual hospitals were also maintained by members of the clergy and, in their role as public personages, they served on the committees of the voluntary hospitals, sometimes as governors.³² Hospital Sunday in particular offered clergy and congregations an opportunity to unite to support the hospitals as part of a local Christian civic culture. Such practices of social service generated social status for their participants in a period in which hospital charity was more democratic and participatory than it had ever been.³³

Gorsky, Mohan and Willis have argued that the contributory schemes ‘undermined the social hierarchies’ initially present in the voluntary hospital administration.³⁴ These hierarchies continued to be reconfigured after the First World War by individual giving. Evidence presented by Hayes and Doyle underscores this and shows the ongoing vitality of voluntary action between 1919 and 1939.³⁵ The impressive variety of practices and events that took place in relation to hospital fund-raising included, but was not limited to, the placing of collection boxes in pubs and places of work, summer fetes, concerts, flag days and the award of a silver cup for the sub-postmaster collecting the most money for local hospitals.³⁶ Hayes and Doyle also showed that hospitals in this period became less reliant on elite contributions, and increasingly emphasized small-scale donations, as well as gifts in kind.³⁷ This growing importance of small donors democratized hospital funding and reconfigured the social hierarchies implicit in fund-raising.

Hospital Sunday sat within these practices. It demonstrated the churches’ long-standing commitments to medical care at a local level. The voluntary hospitals often had strong links to local Christian congregations and some hospitals were denominational foundations.³⁸ Even those without a specific denominational affiliation might have a long-standing association with certain congregations. At Huddersfield, Anglican clergy had been involved in both the laying of the foundation stone and the opening ceremony of the Huddersfield and Upper Agbrigg Infirmary in 1829 and 1831, with the vicar of Huddersfield presiding at the former ceremony.³⁹ Huddersfield's Infirmary Sunday, held from 1870 onwards, revivified the connection of churches and chapels with the hospital. The result was impressive: their contribution grew from £13 0s 3d in 1868 to £283 17s 8d in the first year.⁴⁰ As well as special services, fund-raising events in Huddersfield and its townships connected the various places of worship to the hospitals through entertainment and association.⁴¹ Here and across the country, congregations were linked to local hospitals through parades, concerts and other similar practices.

As a contributory scheme, the sums raised on Hospital Sunday were variable and even at the height of the event's popularity these generally represented only a small proportion of the hospitals’ total income. As Waddington showed, in commanding the support of London's elite, the Metropolitan Hospital Sunday Fund raised £725,647 for London's hospitals and dispensaries between 1873 and 1894. However, this remained a small proportion of the hospitals’ income, amounting to just under 6% of the various institutions’ incomes in 1891.⁴² In addition, Gorsky, Mohan and Willis noted that between 1919 and 1939 the role of charitable contributions declined in importance to the voluntary hospitals.⁴³ The picture remained the same in the 1940s. For instance, while Hospital Sunday in Preston in 1944 raised £2,197 (a local record), the weekly running cost of the hospital amounted to £1,860.⁴⁴ Despite its marginal role in funding, however, Hospital Sunday was considered by its participants to provide a ‘link between the hospitals and the churches’, which itself was viewed as important.⁴⁵

The changing emphasis of fund-raising and the growing importance of individual voluntary action seems to have increased innovation in fund-raising methods. This innovation sometimes conflicted with the ethos of Hospital Sunday: the Royal Portsmouth Hospital's acceptance of the proceeds of a raffle in 1932 led to their exclusion from the local Sunday Fund.⁴⁶ Innovation was carried over into the post-war period, and a more eccentric example included the collections from a crossing keeper's garden on the London and North Eastern Railway line between Harrogate and Knaresborough. Ornamented with a miniature boating lake and lighthouse, a bandstand and an array of figures, this was perhaps inspired by the model village at Bourton-on-the-Water, which also donated to a Hospital Sunday fund.⁴⁷ For the crossing keeper and his fellow fund-raisers, including those engaged in more prosaic activities such as door-to-door collecting, such exertions could earn them a mention in the local newspaper and thus a modicum of esteem.⁴⁸ Even more likely to cement their social standing was an active role on a Hospital Sunday committee, a commitment which was often deemed worthy of mention in an obituary, underlining the links between social service and the social status produced by fund-raising.⁴⁹

Although much of the literature has focused on the role of the Metropolitan Sunday Fund, other urban centres connected the municipality with a Hospital Sunday Fund through a civic service with mayoral patronage. Both Hull and Bristol, for instance, connected the churches, the local authority and the hospitals through a Lord Mayor's Hospital Sunday Fund. This connection transformed the lord mayor into the figurehead of the appeal, responsible for writing an annual letter to the local papers, and, in Hull at least, it entailed a tour of the hospitals to hand over cheques for the proceeds.⁵⁰ In both Hull and Bristol, the lord mayor's office became attached to the scheme well after it had come into being.⁵¹ These funds continued after the Second World War. In Hull the fund's events were spread across a range of associational activities including an annual dance, as well as other less regular events such greyhound racing at Craven Park, in addition to a parade and church service collections on the nominated Sunday.⁵² A civic service was a regular feature in urban areas, with the choice of venue often, but not always, the parish church.⁵³ Often too, a local fund would promote interdenominational cooperation, and the event might be a united service.⁵⁴ Indeed, the events could also support inter-faith relations.⁵⁵ In its ideal-typical form, a band would accompany a parade to a local church for a service in which the friendly and voluntary aid societies, alongside members of the municipality, demonstrated their support for local hospitals.⁵⁶ As Tom Hulme and others have shown, the 1920s and 1930s saw a sustained revival of forms of civic ritual, based in a ‘civic publicity’ movement.⁵⁷ Hospital Sunday parades offered similar spectacles and there was an element of local distinctiveness which will have contributed to feelings of civic pride.

The Hospital Sunday service itself continued the association of local government, friendly societies and medical staff inside the church or chapel. In certain places the event held special significance for members of the medical professions.⁵⁸ Besides offering an opportunity for a minister to preach on the subject of Christian charity and medical care, medical and administrative staff also, on occasion, offered an address.⁵⁹ Such addresses could also underline the connection between the hospitals and the local community. Accordingly, the service might function as part of a recruitment drive for nurses.⁶⁰ Medical staff, often in uniform, might also take up the collection and give the reading.⁶¹ The service as much as the parade thus allowed the various constituencies involved in medical care to join together and advance their cause.

In a system of locally managed and voluntarily supported hospital care, Hospital Sunday linked a range of actors and groups to their local hospitals. Although often a minor part of a hospital's yearly budget, these elaborate fund-raising practices connected hospitals and congregations. These practices continued after the National Health Service Act (1946) had been passed. Indeed, in the face of nationalization, Hospital Sunday arguably took on extra significance. Nationalization engendered concerns over the future of specific hospitals and also created a funding cliff-edge.⁶² Popular belief that hospitals were already state funded was cited at Hull and elsewhere as the reason for the decline in contributions.⁶³ To manage this, members of the clergy joined the mayors in letter writing campaigns.⁶⁴ At Liverpool this action was both interdenominational and interfaith: the letter was signed by the Anglican bishop of Liverpool, the Catholic archbishop, a senior rabbi and the president of the Free Church Council, among others.⁶⁵ As will be seen in the next section, in response to the changes decreed by the 1946 act, clergy looked to defend the voluntary system and to maintain a role for religion in hospital care.

Responses: ‘There will be a need for the Voluntary Spirit’⁶⁶

Prochaska's account included a blanket assertion that ‘Christian leaders’ wholeheartedly embraced the welfare state. In doing so, he asserted, they had ‘endorsed a collective secular world … in a culture growing more materialist and national’.⁶⁷ Yet there is ample evidence that clergy defended voluntarism both before and after the NHS had come into being. Their defence of the voluntary hospitals drew on a position that privileged democratic participation at a local level and was antipathetic to the centralized state.⁶⁸ On an explanatory level, we might see the NHS as a threat to the role of the clergy in medical care and thus to a source of their social esteem. However, they also saw a particular conception of health care as being under threat. Their concerns were the same as Prochaska's: that the loss of voluntarism meant more materialism, and that hospitals would now treat those in need as medical subjects, rather than as individual people.

Martin Daunton has demonstrated that the ‘tension between efficiency and an active, participatory democracy’ had been a feature in the debate over medical provision for much of the early twentieth century.⁶⁹ Grimley has similarly shown that the privileging of voluntary action had been a key element in the work of Christian social thinkers of the period.⁷⁰ This was also evident in the public pronouncements of clergy in their Hospital Sunday sermons in the years prior to 1948.⁷¹ For instance, at St Mary's Church in Nottingham, Canon R. H. Hawkins saw the establishing of the NHS as ‘an attack on the voluntary hospitals’ and thus on voluntarism itself, and expected the efficiency of the new service to result in a ‘very hard and cold’ and ‘less kindly hospital service’.⁷² Similarly at St Paul's, West Hartlepool, Revd J. E. Lee expressed unease; he was reported to have ‘observed that active relief was now becoming so much a part of the machinery of State’ that ‘spontaneous’ assistance was being crowded out.⁷³ Although they are anecdotal evidence, these sermons were probably indicative of widespread ideas about the primacy of voluntarism and the supposedly deleterious effect of state control.

Concerns expressed at Hospital Sunday services immediately prior to the establishment of the NHS reflected a significant section of the public opinion. Hayes has noted that although the public expected greater efficiency to accompany the new service, there were also worries ‘that state-run hospitals would be overcrowded – or depersonalised’.⁷⁴ Middle-class respondents to social surveys in particular favoured the retention of the voluntary hospital system, citing aversion to ‘officialdom and state interference’.⁷⁵ Contemporary surveys found a split in public opinion with ‘[o]nly a little over a half’ in favour of a ‘fully nationalised service’.⁷⁶ As members of this social class who had long participated actively in medical fund-raising and organization, it is perhaps unsurprising that clergy voiced their disquiet.⁷⁷

Concerns about the new service were not limited to the clergy. Where Hospital Sunday was strong, local newspapers were vociferous in their objections. The Hull Daily Mail, for example, depicted nationalization as a direct seizure by the state of money voluntarily donated by Hullensians.⁷⁸ Alongside this, the argument for the role of voluntarism in the new NHS was made not only by clergy, but also by medical professionals and those representing medical charities. The Nottingham Hospital Sunday Fund committee argued that ‘there ought to be encouragement and opportunity for Christian people to contribute to the care and comfort of the sick and suffering’ in the new service, with the Nottingham Journal echoing this sentiment in an editorial.⁷⁹ Hospital Sunday addresses by medical professionals also included calls for a continued link between health care and voluntarism. The congregations at the Bristol Hospital Sunday services of both 1947 and 1948 heard doctors speak to this end.⁸⁰ The following year, in response to a Ministry of Health circular which banned the participation of medical professionals in fund-raising, a Dr Hellier noted that the rule change had meant he had been ‘forbidden to give an address on Hospital Sunday in aid of the Infirmary’ and argued that ‘[t]his spurning of private generosity may, I believe, ultimately affect our whole conception of hospitals, and possibly the spirit in which the work is done there’.⁸¹ Collectively doctors, clergy and the newspapers discussed the need to maintain a role for Christians in support of patient care in the NHS with the aim of retaining a human element to this care.⁸²

As a corollary of their long-standing proximity to medical care, both the clergy and the churches sought to influence practices within the new health service. A primary vehicle for this was the Churches’ Council of Healing, an ecumenical initiative set up by Archbishop Temple in 1944, the year of the NHS White Paper.⁸³ One of its aims was to promote divine healing as opposed to faith healing or miraculous healing, complementary to medical science rather than a substitute for it.⁸⁴ The council advocated for the benefits of patients maintaining faith and hope as part of their treatment, and Root has connected the movement with the development of psychotherapy.⁸⁵ Its work was supported by the British Medical Association (BMA) and the council offered a continued link between the English churches and medical care. In accordance with these principles, F. S. Sinker, a member of the clergy in Lichfield diocese, took a medical degree with the stated aim of developing ‘friendly association between clergymen and doctors’.⁸⁶ To this end, the council also held meetings as part of the BMA's annual conferences.⁸⁷

Through its report of 1947/8, the Churches’ Council collectively sought to influence the use of medical services. It argued that the NHS Act had made ‘the entire nation … potential patients’ and that hospitals were now crowded by those in search of value for money rather than helping themselves, to the detriment of those really in need.⁸⁸ It reiterated the argument that the character of care seemed to be at risk, with the sick losing ‘personal contact’ with the doctor and ‘hospitals … so overcrowded … that they are no longer the havens of peace and rest they once were’.⁸⁹ Similar messages seem to have been being relayed by clergy in the parishes. At Golcar near Huddersfield, the vicar, Edward Clarke, had welcomed the NHS in his letter to the parish magazine of August 1948. However, he took the line that, although those using the service had the right to do so, they should not seek to use it for ‘self interest and personal advantage’.⁹⁰ Similar points were expressed in a further letter of September 1949, which drew attention to reports of excessive use of day surgeries for care which might reasonably be provided in the home, while also criticizing workers at the Royal Ordnance Factories who had reportedly been drawing sick pay while working elsewhere.⁹¹ This proprietary attitude to health care appears to have been engendered by a long-term association with the hospitals. At Golcar, the congregation had supported Infirmary Sunday to the end, and the parish magazine had previously included information on the implementation of the National Insurance Act (1911).⁹²

It is clear, then, that rather than simply ‘endorsing’ the welfare state, as Prochaska put it, church leaders and clergy sought to influence its character. As will be explored further in the next section, obstacles were placed in their way. However, they continued to look for avenues through which to maintain the role of Christians in medical charity. For instance, the bishop of Birmingham, Ernest Barnes, used a sermon in December 1947 to propose that Hospital Sunday should henceforth support medical missions and hospital amenities.⁹³ Secular leaders also followed this line: the lord mayors of Hull and London both expressed their support for the continuation of their funds to assist patient welfare.⁹⁴ What to do with the day was, however, subject of some public debate. While the repurposing of Hospital Sunday to aid medical missions received support in a letter to The Times signed by the president of the BMA, amongst others, opposition to the proposal came from the Metropolitan Fund in particular.⁹⁵ In a strongly worded letter, C. J. Holland-Martin, then president of the fund, offered a response indicative of an emerging effort to retain a role for voluntarism in the NHS. In this he drew strongly on notions of Christian charity and denied the ability of an ‘Act of Parliament’ to ‘solve the age old problem of the sick and the needy or absolve the ordinary citizen from his Christian duty to give alms’.⁹⁶ As will be seen in the next section, volunteers continued to recognize this duty.

Changes and Continuities: ‘The voluntary spirit … has never died’⁹⁷

As we have seen, a core element of Prochaska's argument was to emphasize the disavowal by the Labour Party of its voluntarist traditions. In doing so he cited not only Bevan's remarks in parliament deprecating the practice of nurses fund-raising, but also the Ministry of Health circular of January 1949, referred to briefly above.⁹⁸ The circular was intended by the ministry to counter the idea that ‘that hospitals … are still dependent on voluntary financial help’. Although it allowed volunteers to work in hospitals, it banned hospital committees from fund-raising.⁹⁹ However, Bevan's policy appears to have been resisted on the ground. It was met with protests from hospital boards, and within three months the Daily Mail was reporting that ‘despite Bevan’, half a million subscribers were contributing to Hospital Leagues of Friends.¹⁰⁰ Indeed it is arguable that by eliminating the need for fund-raising for medical care, the ruling opened up space for voluntary action to contribute to non-medical care in hospitals. In any case, early in 1952 this policy was effectively overturned by Harry Crookshank as incoming Conservative Minister of Health.¹⁰¹ With the Conservatives concerned about spiralling costs in the health service, both Crookshank and his successor Iain MacLeod were keen to promote the contribution of volunteers.¹⁰²

Resistance to the Ministry of Health circular appears to have been widespread. For instance, although it appeared to some that Hospital Sunday had thereby been banned, services continued to be held.¹⁰³ At the 1949 Harvest Festival service at Exeter Cathedral, medical staff circumvented the ban by attending in an ‘unofficial’ capacity, and the collection was taken up for the Patient's Extra Comforts Fund.¹⁰⁴ As has already been seen, Sunday funds were beginning to be repurposed; often, as with the Metropolitan Fund, they were directed to other areas within the ambit of hospital care in a broad sense. At Bristol, the lord mayor wrote to the Western Daily Press praising the approach taken by the Metropolitan Fund, arguing for ‘continued voluntary effort’ to assist those in need.¹⁰⁵ At the subsequent Bristol Hospital Sunday, the lord mayor's chaplain saw the need for an ‘anti-boredom fund’ for hospital patients.¹⁰⁶ Subsequently, the fund became the Lord Mayor's Voluntary Services Fund, with money going to hospital comforts and to local charitable initiatives.¹⁰⁷

Elsewhere, as indicated above, the circular was taken by some as a signal to repurpose Hospital Sunday to support medical missions abroad.¹⁰⁸ The Liverpool Echo columnist ‘Layman’ cast this redirection of the event as resistance to authority in the name of the ‘voluntary spirit’.¹⁰⁹ The vicar of Leeds, later bishop of Lichfield, A. S. Reeve, then chair of the Leeds Hospital Sunday Committee, wrote to the Yorkshire Post shortly before Hospital Sunday in May 1949 noting the change of object. In his letter he reported that the committee believed this would ‘entirely preserve the spirit of Hospital Sunday’.¹¹⁰ Thus, in line with Filby's characterization of the period as one of ‘reformulation’, the voluntary spirit was retained by redirecting the funds raised by the services to a variety of causes. In Birmingham, the day became Appeal Sunday, with the first in June 1948 seeing the churches choose the UN Appeal for Children to support instead of the local hospital.¹¹¹ In other places, causes such as the British Legion and the British Empire Cancer Campaign were identified as appropriate recipients.¹¹² For others, closure of the scheme was deemed the simplest response, especially where organizers had faced diminishing returns.¹¹³ In some areas, flag days were rededicated to other causes.¹¹⁴ The Ministry of Health ruling presented an issue for the Manchester and Salford Medical Charities Fund in particular, as with the support of hospital workers it had accumulated funds in the region of £40,000. Following legal advice, the decision was taken not to wind up the fund; the chairman voiced the intention, ‘if the law permits’, of continuing to support the ‘organisations attached to many hospitals’.¹¹⁵

It has been mentioned above that the work of friends groups appears to have become more, not less, important following the Ministry of Health circular.¹¹⁶ These groups present evidence of clear continuities for Christian charity in the period. They were strongly connected to the churches, and hospital chaplains appear to have taken on organizing roles within them.¹¹⁷ Friends groups participated in Hospital Sunday services, or sometimes organized their own.¹¹⁸ As with the services prior to the foundation of the NHS, these were used both as a means of raising money and for promotion. At Birmingham, the friends used a Hospital Sunday service as part of a recruitment drive.¹¹⁹ Friends also made collections at Hospital Sunday services, and, again as with pre-NHS services, these generally raised small amounts, but formed part of a wider fund-raising initiative; proceeds were used to enhance patients’ experience, for instance by funding Christmas parties and presents for patients, television sets and contributions to the maintenance of the hospital gardens.¹²⁰ The continuing Christian character of these groups can be clearly seen in their chapel appeals, which continued throughout the 1950s.¹²¹ Bevan had promised there would be provision for chapel space in NHS hospitals.¹²² However, as capital spending was limited before 1962, friends groups ensured that the provision of chapels was supported.¹²³ Services in the chapels held by these groups and chaplains’ sermons on Hospital Sundays in local churches further linked these groups inside and outside the hospital.¹²⁴

Any assessment of the success of those hoping to keep Hospital Sunday alive after 1949 is somewhat confused by moves to revive the practice. In some places, the tradition seems simply to have survived and we might see arguments for revival more as part of a strategy to increase public support for the day.¹²⁵ Hospital boards themselves seem to have been keen on a revival, and the National Association of Hospital Management Committees enquired into this possibility.¹²⁶ As evidence of ‘reformulation rather than retreat’, services now had the primary purpose of bringing medical professionals into the churches and enabling congregations to support their work through prayer and thanksgiving. First mooted in the Church Assembly in 1951, a revival was supported corporately by the Church of England, with the idea of a national agreed date of St Luke's Tide (the period around 18 October) receiving considerable support.¹²⁷

The adoption of St Luke's Tide as Hospital Sunday appears to have been somewhat patchy, but the date does seem to have become established in some areas. St John's, Sparkhill, in Birmingham, for instance, appears to have held a Hospital Sunday service each year in October.¹²⁸ Such services maintained many features of previous practice. They sometimes took the form of a united ecumenical service, included addresses from medical professionals, and were attended by members of local voluntary aid societies and sometimes also by members of the municipal authorities.¹²⁹ However, the day does not appear to have been widely kept. In 1959, A. S. Reeve, now bishop of Lichfield and chairman of the Council of Healing, was still calling for Hospital Sunday to be revived.¹³⁰ Renewing this call in the House of Lords in 1961, Reeve continued to fly the flag for voluntarism and to support a connection between the churches and the hospitals.¹³¹ At a Hospital Sunday service at West Bromwich in 1962, he outlined the many ways in which Christians could continue to support non-medical care in local hospitals, including running the hospital library trolley service, reading to the patients and visiting those without friends or family nearby.¹³² Members of the clergy and the Church of England's hierarchy clearly continued to work to promote voluntary action in this period.

Long after the Ministry of Health's apparent ban, Hospital Sunday continued to be celebrated in many places. Thirty years after the foundation of the NHS, Radio 4's ‘Morning Service’ of 15 October 1978 broadcast Walsall Parish Church's Hospital Sunday service.¹³³ In this way, Christians continued to show their support for the health service. This support included collections for hospital comforts and gifts in kind.¹³⁴ Moreover, they continued to volunteer through Hospital Leagues of Friends. Through the work of the chaplains, these groups linked the state with voluntarism in line with Loss's ‘institutional afterlife’. Hospital Sunday also bequeathed institutional structures to medical charity. The Metropolitan Hospital Sunday Fund continued its work and the lord mayor continued to write letters to The Times encouraging congregations to participate.¹³⁵ As Filby noted, in the latter part of the twentieth century there was a process of rebranding such organizations.¹³⁶ Now named London Catalyst, the fund remains in operation, and retains strong links to faith groups.¹³⁷

Conclusion

However it is dated, the theme of voluntarism's decline appears to be an attractive one. As McCarthy noted, until recently historians thought of the period between the two world wars as ‘mark[ing] an era of associational decline’.¹³⁸ Nevertheless, as is clear in relation to Hospital Sunday and other aspects of medical charity, the voluntary impulse remained strong even in the era of the welfare state. Christians set out to defend voluntarism in medical care and when one avenue was closed to them, they looked to support such endeavours in other ways. Of course, their involvement was modulated and even attenuated by these changes. As Grimley puts it, on the definition provided by the likes of Neville Figgis, organizations such as tenants’ associations could not be counted as ‘free associations, as they existed only in reference to the state’.¹³⁹ In this strict sense, Hospital Leagues of Friends were not ‘free’ either. However, they continued to be vehicles through which Christians ‘could serve Christ’ through the 1950s and into the 1960s. The extent to which these groups remained Christian in membership requires more research, but Cheshire and Merseyside hospital friends were still holding an annual Hospital Sunday at Liverpool Cathedral in 1970.¹⁴⁰

Whilst the relevance of Christian charity to medical care was eroded by state funding, Christians sought to remain relevant in other ways, and they did so even as charity appeared to become more secular into the later twentieth century.¹⁴¹ Medical professionals, congregations and members of the clergy continued to see voluntarism as lending a softening element to state-run medical care long after the NHS had come into operation.¹⁴² In this sense we can see the ongoing importance of religion to welfare, and to wider society, not only in the long 1950s, but long after. Whilst Christians may not have ‘captured the welfare state’ outright, elements of Christian charity were supported by its structures, and its structures were also to some extent permeable to charitable impulses. Whilst charities may not have remained overtly Christian in character throughout the century, a range of activities and organizations continued to support the connection between Christians and medical charity. The voluntary spirit lived on.