Health and Socialcare 1918/79 - Creating a Welfare State 1918 - 1979

Pre 1918

Before 1911

·       Access to healthcare depended on wealth - wealthy could afford healthcare whilst the poor couldn’t and often became very ill after using ineffective self-medication

·       Workhouse infirmaries could treat the poor, however if these did not exist than the poor had to rely on friendly societies

·       Friendly societies offered some affordable health insurance schemes. They would take a small regular payment and then pay a lump sum when people needed financial help - friendly societies were unregulated and non-compulsory and could go bankrupt

·       If a friendly society collapse than the poor would be left without any health care options

1911 National Insurance Act

·       Introduced by the Liberal Government

·       Compulsory health insurance for low paid workers earning under £160 a year

·       Employer, employee and government paid into the scheme, which provided free medical treatment and sick pay

·       However in 1911 this Act only covered 6 industries, and would not covers worker’s families (women and children were the most vulnerable and had least access to healthcare

The Interwar years

How did a consensus develop over healthcare in the interwar years?

·       A growing idea was that government should play a leading role in healthcare provision and investment should be made in medical advances building upon the progress made in the nineteenth century.

·       Government should also develop a network of hospitals and rationing healthcare.

·       Although there was disagreement and debate about the extent of government intervention, there was a broad agreement that government spending and co-ordination of healthcare provision was critically important.

1919 Ministry of Health

·       War recruitment uncovered poor standard of health - 40% of men declared unfit for combat

·       The Ministry of Health was established to coordinate healthcare

·       However the ministry lacked the authority and political will to drastically reform the healthcare system

·       Medical services like the School Medical Service and the Factory Health Inspectorate were still controlled by other authorities

Insurance Companies

·       After WW1 there was a growth of large insurance companies, who managed around 75% of health insurance

·       A lot of this came through the state due to the 1911

·       ‘Approved Societies’ would collect subscriptions and pay costs - by 1937 18 million workers were covered by state health insurance

·       However widows, wives and children of workers were still not insured by the 1911 National Insurance Act, they were reliant on family, local community (friendly societies) or a sympathetic GP

Access to GP’s

·       GP’s were the first resort for medical care

·       Patients had to pay for consultation and for medicine

·       This meant that GP’s were unevenly distributed, with more working in wealthier areas

·       The poor would only go to GP’s as a last resort, and altruistic GP’s would often offer their services at lower costs to those seriously in need

·       When the NHS was finally launched, many doctors were shocked to find poorer patients had been putting up with medical issues such as rotting teeth and untreated hernias, due to their inability to afford treatment.

Hospital treatment

·       The best hospitals were teaching hospital - there were only 12 in London and 10 in provinces - they relied on wealthy donations

·       Voluntary hospitals were smaller and less financially secure, by the end of the 1930’s most were in deep financial trouble- there were 1,100 of these hospitals

What did the Local Government Act of 1929 do to support healthcare?

·       The Local Government Act of 1929 passed –

·       Poor Law Hospitals were now in the hands of local government who convert them into local hospitals.

·       Local government was now responsible for running key healthcare services, such as dentistry and schools’ medical services.

·       This Act made local government responsible for co-ordinating healthcare provision.

How did healthcare provision expand after the Local Government Act?

·       Various forms of hospital care developed, such as specialist teaching hospitals.

·       GPs or ‘Panel Doctors’ treated more people through the National Insurance Scheme.

·       However, less than half the population were insured against illness and many relied upon traditional remedies and over the counter medicines.

·       However, healthcare was improving – a key indicator, infant mortality rates were falling although maternal mortality rates remained high in working class areas.

·       By 1939, more groups, such as writers for The Lancet, were advocating a national health service.

Impact of WW2

What was the impact of the Second World War on healthcare provision?

·       The Second World War helped to create a consensus on healthcare reform which was underpinned by the introduction of a national emergency healthcare system introduced to treat casualties from the Blitz.

·       The Emergency Medical Service was established in 1939 to provide first aid for air raid casualties and to dictate to hospitals health provision - but it was later used to treat civilians and evacuated children

·        It allowed for resources to be pooled and saw a changing attitude in the medical profession who previously wanted to stay independent of the government who were persuaded by government funding for resources and wages.

·       The Emergency Medical Service provided the blueprint for the National Health Service established after the war.

·       The National Blood transfusion service was also created

·       The 1942 Beveridge Report called for a National Health Service, and in 1944 the government presented the White Paper A National Health Service which called for a ‘comprehensive’ and ‘free of charge’ medical service in Britain

The Creation of the NHS

After Labour’s landslide victory in 1945 Prime Minister Atlee was determined to fulfil his promise to establish a National Health Service, and he appointed Aneurin Bevan as Minister for Health to carry out this task.

Aneurin Bevan

o   Born into a mining family from South Wales, left school at 13 to work in a coal mine

o   Became Minister for Health in the Atlee government

o   Bevan aimed to create a centrally run system, funded through taxes and not insurance, that would provide free healthcare to all - his success in achieving these aims was by no means easy.

The 1946 National Health Service Act - established a far more coordinated, centralised system (voluntary hospital were nationalised and The Approved Societies forced to rely on private clients)

Opposition to the NHS

o   The Conservatives

§  The Tories voted against the formation of the NHS 21 times before the act was passed - they were against state control

§  Terms like “medical Gestapo” and “medical fuhrer” were bandied about by some of the most Conservative members of the British Medical Association and their political allies.

§  Bevin attacked the Tories for opposing the NHS, stating that they were ‘lower than vermin’ in a speech

o   The local authorities

§  Didn’t want to lose control of their hospitals

o   The BMA

§  Main opposition to the NHS came from the doctors, represented by the BMA

§  The BMA argued that working for the state would undermined their clinical independence, and doctor’s feared becoming civil servants of the state (though in reality doctors were probably more concerned about lost income)

§  In February 1948, 90% of the BMA voted against working within the NHS.

§  However they found themselves out of step with the majority of the British public - 5 weeks after the launch of an NHS publicity campaign, 75% of British citizens had registered with the NHS.

§  Bevin overcame the doctors’ opposition by granting them a fee for each patient, and allowing them to retain private patients - a tactic he angrily referred to as ‘stuffing their mouths with gold’

§  Eventually doctors gave in, with 90% of doctors joining the NHS in July 1948, just one month before the launch date.

Healthcare 1951-1979

A Heathy Change?

·       The NHS also allowed many Britons to take advantage in improved methods of combating disease through research into new techniques, vaccinations and medicines.

·       In the first 10 years of the NHS, new antibiotic drugs developed in the US cuased the number of deaths from tuberculosis to fall from 25 000 to 5000 a year

·       Mass immunisation programmes launched in 1958 led to a huge drop in cases of polio and diphtheria - polio, as disease which had previously effected up to 8,000 people in epidemic years, was eradicated by 1984.

·       There was a 90% drop in cases of whooping cough by 1970 and syphilis was almost completely eradicated by the early 1990s.

·       A MMR vaccine was also developed (in the US) in 1971, and has been offered for free by the NHS since 1988.

·       Many of these diseases had particularly affected children, and the treatments offered by the NHS contributed to a fall in child mortality rates (in 1926 1-14 year olds made up 10% of all deaths, by 1951 this figure had fallen to 1.5%).

·       Improved midwifery also lead maternal deaths in childbirth to fall from 1 per 1000 in 1949 to 0.18 per 1000 in 1970.

·       Increased funding led to better healthcare provision: Over 300 inadequate cottage hospital were closed in the 60’s and new centres of excellence -with close ties to universities - were founded, as well as new district general hospitals for larger towns.

·       These changes contributed to an increased life expectancy: 66 in 1950 to 70 in 1979 for men, 71 in 1950 to 75 in 1979 for women. Life expectancy way higher in Britain than in other developed countries like West-Germany and France

·       However, increased life expectancy led to an increase in diseases associated with old age; rates of heart disease and cancer increased throughout the 50’s and 60’s, and arthritis continued to be a huge problem, affecting 200,000 men and 700,000 women in 1970.

Rising Costs

·       Both Beveridge and Bevan had expected the cost of healthcare to fall after 1948; they reasoned that people would get healthier, and preventative medicine would reduce cases of serious illness, and so dependence on the NHS would fall.

·       However, their estimates proved to be fundamentally incorrect; from 1950-1970 the cost of the NHS increased from 4.1% of GNP to 4.8%.

·       Advances in medical science lead to an increase in treatments available, which increased the cost of healthcare - in 1948, there was only 1 antibiotic available, by 1968 there were 33

·       As a result of increased costs, the government were forced to introduce charges for spectacles and dentures in 1951, and prescription charges in 1952. These decisions cause an acrimonious split in the Labour party, and Bevan and his supporters resigned.

·       People also came to depend on the NHS in a way that Bevan had hoped to avoid - ‘dandruff syndrome’ soon emerged, where people took up valuable time and resources to complain about trivial problems, like dandruff.

·       The tripartite division of healthcare between GP, hospital specialist and public health authority also made it difficult to effectively coordinate the healthcare system - a move which would save costs.

·       The number of staff employed by the NHS doubled between 1948 and 1979 (from 500 000 to 1 million)

Medical Advances

·       In 1953 the structure of DNA was uncovered by two British scientists, allowing for new research into genetic disorders.

·       The first kidney transplant took place in 1960 (although demand for transplants quickly outstripped supply)

·       In 1961 the contraceptive pill was introduced, a move that proved to be very popular - by 1962 100,000 women were on the pill, and by 1967 this number had increased to 1 million

·       The first full hip replacement happened in 1962

·       Britain’s first heart transplant occurred in 1968 (although due to complications with the procedure on 6 more were carried out over the next decade)

·       In 1967 The Abortion Act was passed, making abortion legal up to 28 weeks.

·       CT scanning was invented in 1972 and also quickly became part of standard NHS equipment, continuing to improve patient care but also costs.