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Danish Center for Welfare Studies

Sick notes are a waste of time

Author: Gareth Millward
Published: In Jennifer Crane and Jane Hand (eds), Posters, Protests, and Prescriptions: Cultural Histories of the National Health Service (Manchester: Manchester University Press, 2022)

In 1949 there were 390 types of medical certificate covering legislation in England and Scotland. With the additional lingering burden of providing medical reports for wartime rationing, it was no surprise that general practitioners regularly complained that sick notes were a burden. Some went so far as to call them ‘a waste of time’. And yet they would be crucial to the operation of the welfare state set out in the Beveridge Report. This chapter discusses how these complaints represented a tension between the state and the medical profession over doctors’ professional autonomy and prestige. Time was viewed not only as a resource necessary to perform their jobs. It also represented the relative power doctors had over their own practice and their relationships with their patients. The chapter uses documents from the National Archives and medical journals in the years immediately preceding and following the formation of the NHS. Analyses of these have typically focused on remuneration and Bevan’s attempts to ‘stuff their mouths with gold’. Sick notes and time allow historians to move beyond explanations of economic self-interest and show the importance of professional autonomy to doctors. Further, the chapter provides an understanding of the role expertise was envisioned to have in the wider post-war welfare state by citizens, politicians, civil servants, and the experts themselves.

Access book chapter here.