© 1997 lite Society for the Soda! History of Medicine Neglected Roots of Regionalism? The Commissioners for the Special Areas and Grants to Hospital Services in the 1930s ByJOHN MOHAN* SUMMARY. The inter-war years in the UK were notable for debates about the extent to which an extension of state intervention in hospital provision was desirable and necessary, and about the limits to and future of the voluntary hospital system which relied largely on various forms of private charity. These themes were intertwined in the UK's 'Special Areas', locations recognized as having suffered adversely from the inter-war depression, with consequent effects on their ability to finance desirable investments in social infra- structures. Grant aid was offered to hospitals in these locations under the terms of the Special Areas legislation of 1934, but there were extensive debates about the principle and practice of such subsidies to hospital development. This paper reviews these debates and considers whether the measures taken by the Commissioners can be seen as neglected antecedents of the regionalism detected in British hospital policy by several commentators. KEYWORDS: Commissioners for the Special Areas, regionalism, hospital provision, state intervention, voluntary provision, 1930s. This paper is intended as a contribution to debates about the origins and nature of 'regionalism' in hospital policy in Britain. It draws attention to the neglected role of the Commissioner for the Special Areas in offering financial assistance to vol- untary and local authority hospitals and in attempting to promote co-ordination of hospital development. The Commissioner's activities in respect of hospital pro- vision marked a little-known but important innovation in hospital policy, in that they signify an acknowledgement of the limits to voluntarism at least in certain of the depressed regions, and a realization that some form of state intervention might become necessary. It is important to consider these activities in relation to other attempts to introduce a degree of co-ordination into hospital development. The most obvious point of departure for such a consideration is a discussion of the idea of hierarchical regionalism in hospital policy. Daniel Fox 1 is generally viewed as the originator of the notion of hierarchical regionalism. He suggests that a consensus had emerged, between the wars, on the necessity for co-ordinated regional planning of services, with hospitals arranged in tiers of successive degrees of specialization. There were hints of such ideas from •Geography Department, University of Portsmouth, Buckingham Building, Lion Terrace, Portsmouth PO1 3HE Earlier versions of this paper were presented in seminars in the Universities of Portsmouth and King's College, London, and at the Seventh International Symposium in Medical Geography, Portsmouth, 1996.1 am also grateful for the comments of Martin Powell, Roger Lee and two anony- mous reviewers on previous versions of this paper. The financial support of the University of Portsmouth is gratefully acknowledged. 1 D. M. Fox, Health Policies, Health Politics (Princeton, 1986). 0951-631X Social History of Medicine 10/02/243-262 Downloaded from https://academic.oup.com/shm/article-abstract/10/2/243/1731053 by guest on 30 October 2018