theme 2: creating a welfare state - 2b public health

Healthcare in 1918

• 1911 national health insurance for low paid employees - workers and employers paid in - only applied to wage earners not family’s or the unemployed

• Private charitable and philanthropic groups paid for healthcare of the poor

• Poor law hospitals

• Workhouses - often had infirmaries and some were made into hospitals

(1918-1939)Widely believed that the govt had a role in encouraging medial advances - consensus that the govt should:

• invest in research

• Invest in medical training

• Organise a nation network of hospitals

• Play a role in rationing healthcare

Disagreements over the nature of the govts role :

• Fabian Society advocate centralised healthcare

• 1919 Labour Party advocated a free and comprehensive NHS

• The BMA advocated a system of regional healthcare co-ordinated by central Govt

• Dawson Report advocated a network of state funded/organised hospitals

Tuberculosis

• Ministry of Health Act 1919 creates the Medical Research Council to research causes of TB

• Tuberculosis Act 1921 made the provision of TB sanatoria by LA’s compulsory

• The number of TB cases declined in every year 1920-1238

Local Government Act 1929

• passed responsibility for poor law hospitals to county councils

• Allowed county councils to convert Poor Law infirmaries into public hospitals

• Gave local authorities responsibility for child welfare, dentistry, school meals and medical services etc

The Pioneer Health Center

est 1935 - local residents paid a subscription of 5p a week to join the clinic and receive annual health checkups and access to leisure facilities - 950 signed up for the scheme

Finsbury Health Centre

Opened 1938 - the most technology advanced and modern public heath centre of its era. Addressed lice, poor hygiene and TB. Had a solarium and a lecture theatre. Highly influential - inspired the architects of the NHS.

Infant mortality

England and wales dropped from 14.3 in every 1k between 1906 and 1910 to 12 per 1k between 1936 and 1938

Maternal mortality rates during 1920s and 30s

50% higher in low-income groups than the middle class

Life expectancy 1920’s and 1930’s - class divide

Middle class men lived 12 years longer than WC men, middle class women lived 19 years longer than WC women

The Emergency Medical Service

Founded 1939 - first aid and casualty clearing stations during air raids - govt dictated hospital activities - pooling resources, skills and expertise

Doctors in favour of NHS:

1941 Medical Planning Research - 200 Drs - endorsed provisional plans for a national wide health service

Negotiations 1942-44

BMA, managers of local authority, private and voluntary hospitals - willing to collaborate but concerned about loss of autonomy

1944 white paper

Recommended a new national system paid for from general taxation.