[from "The Birth of a Service", 2008]


As has been mentioned, it was hardly to be expected that the voluntary hospitals would enthusiastic about their involvement with the Board: they felt, with good reason, that they had served the Island well, and valued their independence. Politicians they may well have had on their Management Committees, but they had been there in a private capacity, by invitation, and now they were to have one-third of their members appointed by the Board, to be responsible to the Board, and to have their accounts and activities subjected to monthly scrutiny. Ramsey Cottage Hospital appears to have accepted the situation reasonably philosophically, possibly because the distance, in Island terms, from the seat of control was enough to lend a sense of detachment. Noble's, however, because of its proximity, and being the main centre of activity, both for accommodation and specialist services, was somewhat different, and it is possible that the Board's comment that there had been some administrative and procedural difficulties in the early days was a little understated. A factor which might have played a part, and jarred more than a little on the susceptibilities of the members, was that, however reluctant the Noble's Committee may have been to accept the new regime, the injection of Government money, including that necessarily resulting from the influx of patients, must have had to be welcomed in view of the fact that for several years the Hospital's expenditure had exceeded its income, and despite the already existing Government grant towards the cost of nurses' salaries, with increasing costs not being matched by revenue sources or public contributions, for the last year of independence the deficit was over 20,000.

And an influx of patients there certainly was. In 1947, Noble's, with 137 beds available, had had an average bed occupancy of 122 patients. In the first few years, with the beds increased to an official figure of 160 by the addition of the chronic sick wing, there was serious overcrowding, at one time there being over 180 patients. By the end of 1955, the waiting list for admission had risen to 279, and it had been found necessary to gain some measure of temporary relief by the generally unsatisfactory expedient of transferring a small number of patients, not needing the full services of a hospital, to the White Hoe.

The Cubbon Wing, for chronically sick patients, had been added in 1951, not financed by Government, but by funds donated by the estate of the late Thomas Cubbon. Originally these patients had been housed at Marathon Court, Victoria Road, which had been bought by the Cubbon Trustees for this purpose, but this was proving unsatisfactory, both on the grounds of expense, and its isolation from the Hospital. However, before the advent of the NHS the Hospital had already prepared plans for expansion, which the Board accepted, and the first undertaking was the erection of the new Nurses' Home, in Westmoreland Road, completed in 1953 at a cost of 172,008. It was an ambitious project, designed not only to accommodate the existing staff until then occupying the nurses' quarters in the main complex, but those who it would be necessary to appoint when the extensions would be completed. Until then, the spare facilities were to be used by the Nurse Training School, transferred back from Marathon Court, which had been taken over for this purpose when the Cubbon Wing was brought into use.

Ramsey Cottage Hospital was in a healthy financial position when the service commenced, having always enjoyed the enthusiastic support of all sections of the Northern community, and continued to function very much as before. Being essentially, as its name suggests, a small, tightly run unit, medical care was on a different basis from Noble's, being provided, apart from specialist services, by the local general practitioners, remunerated from a beddage fund allocated proportionately to the services rendered. It was noted at the time that the Hospital had a modern and well-equipped operating theatre: what might be surprising is to realise just how well utilised it was, as in the year to October 1947, 203 operations were performed, many of a major nature. Indeed, it became the preferred centre, being the nearest to the Sanatorium, for thoracic surgery, conducted by the visiting specialist, and accordingly the first development was the purchase and installation by the Board of a Tomograph, an instrument used to a large extent for the X-raying of chests.

One project dear to the hearts of the Management Committee had been the addition of a Maternity Wing. There had, in fact, been a Maternity Home in Ramsey, in Brookhill Road, run on a voluntary basis of subscriptions and patients' contributions, similar to the Jane Crookall but not so well established. It had seen much use during the war years, due to the Royal Air Force stations at Andreas and Jurby (whether from the married quarters or no: the saying was that it was "financed by voluntary subscriptions and involuntary pregnancies") but had ceased to function by 1947, and its equipment and furnishings dispersed. It was proposed that the Wing could be funded largely from the Hospital's existing resources, and the Board gave this serious consideration, but eventually had to decide against, it being appreciated that with an expectancy of about 100 births a year in the catchment area, the average occupancy would be three patients at any one time, giving a cost per patient of 30, about double that at the Jane Crookall Maternity Home. There was also the factor that the Jane Crookall was already fully equipped, with almost immediate access to Noble's, if required. The North's hopes were dashed, and the question was never seriously raised again.

A question that was often asked of the Board in later years by disaffected residents of the West and the South was why the North should have been specially favoured by having their own local hospital, and their areas ignored? The only answer that could be given was that the enquirers had lost sight of the fact it had already been in existence when the Service started; in other words, "it was there because it was there". Had the people of the South, or the West, been similarly motivated, then perforce such facilities as they had provided for themselves would have had to be absorbed by the Board, and given the same consideration. Certainly the Board had enough on its plate maintaining what it already had, without seeking to provide parallel facilities, a sad fact to assimilate, but true.

The third of the voluntary institutions, the Jane Crookall Maternity Home, also continued to function very much as before, except that because of the Board's decision that the facilities were to be available to all, whereas previously they had been intended for women having their first child, or where there were likely to be complications, the proportion of confinements in the Home rose to roughly 80% of the total for the Island. This was in marked contrast to the United Kingdom, where domiciliary confinements were much more the rule. The Board also instituted an Outpatient Obstetric Clinic at the Home, where the visiting specialist Gynaecologist and Obstetrician could be seen, together with the resident Obstetrician.

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Any comments, errors or omissions gratefully received The Editor
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