The patient contract in Bristol’s voluntary hospitals, c.1918-1929

The years following the end of the First World War were a time of great change, not least in the field of healthcare. Rising costs and demand ensured that traditional philanthropic sources of income became increasingly insufficient. This necessitated the emergence of new patterns of funding in Britain’s voluntary hospitals with a greater place for contributory schemes, direct patient payments and arrangements with the public sector. One aspect of such change was that the largely passive role, in which charitable provision had traditionally held the patient, was called into question. This article places this specific issue within context of the various ideological conceptions of healthcare, each defining the role of the patient in a different way. These are briefly outlined before the local case study of Bristol - and the Bristol Royal Infirmary (hereafter the Infirmary) in particular - is used to consider the impact that changes in voluntary hospital funding had on the role in which the patient was cast (here termed the ‘patient contract’). Although there were major changes in funding, most notably the introduction of a patient payment scheme in 1921, the patient contract remained in essence philanthropic. This was the result of a clear ideological commitment, most obviously on the part of the Faculty, to the treatment of the sick poor