GC

healthcare provision

public healthcare provisions 1918-45

1918:

  • Wealth = health, high quality healthcare was only accessed through private doctors

    • Lack of organisation and provision in less affluent areas

    • Reliance on workhouses

    • ‘Friendly societies’ — cheap health insurance

    • Charities — child welfare

  • National health insurance 1911

  • Fabian society promoted reorganisation of healthcare and pressured government on laissez faire

  • Spanish flu (220,000 killed in Britain) and Gilles facial treatment highlighted need for gov to pay for healthcare

Ministry of health 1919:

  • WW1 lead to expansion of gov role in healthcare

  • Coordinated health at a regional level and administered national health insurance funds

Tuberculosis act 1921:

  • Gov set up TB sanatoria to slow spread pre-WW1

  • Ministry of health act created MRC in order to research the cause of TB, publicly funded but not under gov control

  • TB act made TB sanatoria compulsory by local authorities

  • Cases begin to decline every year from 1920-38

Local gov health act 1929:

  • Made responsibility of poor law hospitals county-controlled

  • Law infirmities turned into public hospitals

  • Local authorities made responsible for venereal disease clinics, child welfare, dentistry and school medical services and meals

  • Single health authority created to control healthcare in counties

  • Didn’t lead to cheap, modern healthcare

Pioneer health centre/’Peckham experiment’ 1935:

  • Local residents (950) paid 5p a week to receive annual health check up and access to leisure facilities

‘Health and wealth’ 1939:

  • 1920s-30s maternal mortality rates were 50% higher in low income than middle class groups

  • Middle class men lived 12 years longer and middle class women lived 19 years longer

Emergency medical service 1939:

  • Provided first aid and ccs for people wounded in air raids

  • Allowed for gov to dictate hospital’s activities

  • National service with resources, skills pooled together, framework for post war healthcare planning

  • Previously, doctors had wanted to stay independent of gov but liked organisation and funding — 1941 medical planning research (200 doctors) endorsed NHS

nhs

  • 1942 Beveridge report detailed ‘disease’ as one of the 5 giants

  • 1948 NHS set up (free, accessible to all and worked on tripartite system including hospitals, dentistry/GP and community care)

    • Mental health: 1959 mental health act gave more freedom for patients and an open door policy for mental health centres, however there was still stigma and mistreatment for the mentally ill patients

    • Women: free contraception in 1970s, contraceptive pill introduced in 1961 and education in earlier decades, abortion act 1967 (1.5 mil abortions by 1977 but 58% performed in private sector for £200 and 86 people died from abortions 1968-78), hospital child births but non-consensual episiotomies performed, chances to work as nurses but low-paid and low status and Caribbean nurses faced racial discrimination

    • Public prescriptions: costly, 13.6 million prescriptions by Sept 1948

    • Advanced treatment: dialysis, catheter, transplants, costly, specialist staff and high tech medicine, vaccines for diphtheria, TB and tetanus

    • Ageing population: 9 million retired in 1971 with more health needs (living longer), 1979 saw 24,000 hip replacements (which hadn’t been possible 20 years before)

  • Inverse care law — Julian Tudor Hart GP 1968 found that there was less access to care in poor areas, despite the having more medical needs due to working in dangerous jobs, and highlighted need for funding