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15 September 2014
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Legacies - Wiltshire

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A model for the NHS?

The foundry at Swindon
© STEAM - Museum of the GWR, Swindon
A curious anomaly existed at the railway works which made it in the interest of the employees and the surgeon himself to create some sort of medical provision. As Gooch points out in his letter, the normal procedure was for the company to pay the doctor’s fees if an accident happened at work.

However, for reasons not specified, this was not the case at Swindon. Instead, the bill was either picked up by the employee himself or the doctor went without pay. In the case of a fatal accident, it was impossible for the employee to pay. His family, probably facing destitution with the loss of their breadwinner, would perhaps be unwilling to fork out for a hefty bill. Gooch believed the benefits to the men were obvious:

“It is not a gift to the doctor that I ask but that the men may be relieved from the cost of numerous accidents, leaving them still to support their own sick, which, I fear, will be a heavy matter this winter as amongst other misfortunes we have some very bad cases of smallpox in the village.”

Convinced by Gooch’s case, the Directors agreed and the Medical Fund came into being in December of 1847. The Directors agreed to allow the surgeon Mr Rae to live rent free in a cottage owned by the company.

Development of the GWR fund

Waiting room
This room must have seen many GWR employees pass through its doors!
© STEAM - Museum of the GWR, Swindon
The aim of the new medical fund was to: “provide medicine and attendance to the men employed in the Works of the Great Western Railway at Swindon and their wives and families.” The fund remained compulsory subscription for GWR employees until the Insurance Act of 1911 made its membership voluntary. The amount paid was decided by a sliding scale that took into account the employee’s salary and marital status, it ranged from a maximum of 4d to a minimum of 11/2 d a week.

Though the provision of health care is second nature to us now, the GWR was a radical departure from accepted practise. Until the NHS was formed in 1947, it was down to the individual or their family to pay for medicine and the attendance of a doctor. The creation of the GWR was a remarkable step towards the idea of collective social responsibility.

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