The cost of care  

Before the NHS was established in 1948, access to medical care depended largely on what patients could afford.

For 24 years, Augustus D’Este kept a diary detailing his symptoms. It is now recognised as the earliest documented account of multiple sclerosis. D’Este’s wealth enabled him to travel across Europe seeking treatments. 

In 1922, Alan Nabarro was a child seriously ill with diabetes. As his condition deteriorated, his family desperately sought the newly developed insulin. A diabetes specialist from Brussels, Dr Devos, flew to London to see Alan, but insulin was not yet available in Britain. Alan eventually began receiving regular insulin in 1923, becoming one of the first people in the UK to receive the treatment.

During early trials for insulin at St Mary’s Hospital, London, patient Herbert Buckenham said he only took insulin when he could ‘afford it’. 

The Mass Observation Project recorded life in the 20th century. In 1943, the people surveyed often criticised the two-tier healthcare system: a combination of private healthcare, and the ‘panel system’ for some working men – but not women and children. The archives show intense debate about the arrival of the new NHS. Its founding marked a move towards healthcare based on need, not on whether people could afford to pay. Health inequalities among patients continue to affect underserved communities today.