patient care

• medieval

  • Leper hospitals: isolated away from people, no treatment [only care, lodging and food], wore special clothes and had a bell, built on the outskirts of town [isolated]
• medieval

  • Almshouses: for deserving poor and elderly with disabilities, not for medical treatment, widows with young children or single pregnant women, shelter to travellers, usually had by a priest, a few nuns and 12 inmates. Funded by charitable donations to the church
• medieval

  • Christian hospitals: “House of God”, monks and nuns cared for the sick, felt they needed more spiritual treatment, cared for soul, gave food and warmth, beds positioned toward the altar, no female temptation/seduction, often connected to monasteries, funded by church, extremely sick people were not allowed [because it would distract them from religious practices and praying]. 
• medieval

  • Only 10% cared for the sick
  • 47% housed the poor + elderly, no medical care
  • 31% - leper hospitals which gave no medical care
• medieval

  CHANGE: not much change - actually ill people were refused medical help, but were given religious help. Some change - leper hospitals were isolated on the outskirts, showing that they understood that contagious diseases e.g. leprosy, must be kept separate from other people. 
• early modern

  St.Thomas’s Hospital [1551] – specialised in venereal disease

  Christ's Hospital [1553] - provided shelter, food and clothing to fatherless children and offered basic education

  St. Mary’s Bethlehem / Bethlem Hospital [1547] - mentally insane. 

  • These were paid for by wealthy industrialists [e.g. Thomas guy]
• early modern

  SIGNIFICANT CHANGE because of King Henry dissolving the monasteries. This changed the focus from religious care to medical care and treating the patient, not their soul.  Hospitals were beginning to become specialised. Endowed hospitals and alms-houses began to employ medical staff, with proper medical knowledge and experience, e.g. barber surgeons and bone setters instead of monks and nuns.
• early modern

  SIGNIFICANT CHANGE: specialised hospitals, use of medical staff, change of religion to science

  Some continuity: use of alms-houses and leper hospitals.
• modern: 18th century

  Industrial Revolution:

  • May funds were from wealthy industrialists who made their money from the industrial revolution

  → believed that God gave them the responsibility

  → they would go to heaven

  –. E.g. Thomas Guy [1724] believed that the rich should take care of the poor [Guys’ Hospital]
• modern: 18th century

  industrial revolution:

  • More factories = more injuries and quickly spreading disease, increasing the need for hospitals.
  • Sharp rise in population increased the demand for hospitals
  • As new industrial towns were introduced and expanded, there was a corresponding need for a new hospital in those areas. 
• modern: 18th century

  Private Individuals + endowed hospitals

  • Some trained and educated doctors (physicians) and surgeons 

  → nursing sisters with herbal remedies

  • Advance from places of basic care for the sick to centres treating illness and conditions that require surgery

  → simple surgery e.g. removing bladder stones
• modern: 18th century

  private individuals and endowed hospitals:

  • Medicines issues e.g. Finsbury Dispensary in 1780

  → all medicines free

  • Mainly paid for by wealthy people, local authorities or councils, 

  → 11 new hospitals funded in London

  → 46 across the country [in industrialised towns and cities]
• modern: 18th century

  Scientific Enquiry:

  • Formation of the Royal Society 

  → encouraged scientific discoveries, curiosity and experiments

  • Led to the growth of the Enlightenment: an age of scientific advancement and enquiry, and advancement of medical knowledge. 
  • There was a change due to the growing desire to discover new scientific things, and use the advancements of medical knowledge to treat sick patients.
• modern: 19th century

   Change in the 19th Century:

  N - number of hospitals increases

      → 3000 patients in 1800, 7619 in 1851

  • Nurses poorly trained

  C - cottage hospitals developed [local]

  H - high death rate due to the lack of hygiene

  S - specialisation

     → Royal Marsden [1851] specialised in cancer and its treatment. 
• modern: 19th century

  Issues with 19th century nurses:

  • Tended to be dirty
  • Drunk
  • Uneducated
  • Had little training
  • Accused of being immoral women
  • Did not keep things clean.
• modern: 19th century

  Florence Nightingale:

  • Scutari Hospital - poor sanitation and more deaths caused by infection than wounds. [it was built on sewers], not enough beds, no air
  • she introduced the idea of fresh air and water for soldiers
  • Bandages and sheets were consistently washed every day
  • Recovering soldiers were given healthy food
  • Lady with a lamp
  • Rates fell from 42 deaths every 100 people to 2 every 100 people.
• modern: 19th century

  Florence Nightingale:

  •  ‘Notes on Nursing ' [1859] had 3 rules: nurses were only allowed to go out in pairs, they had to live at the hospital, they had to keep a diary of their work, which was inspected every month. 
  • Pavilion Principle: six separate wards at right angles to a long linked air, which encouraged good circulation of air.
• modern: 19th century

  Florence Nightingale:

  Change: showed that nurses could be professional and do their job, as they were now assistants to doctors instead of cleaners like before. By 1901 there were 68,000 nurses while there were none in 1850, showing how much she had shaped this career path for other young girls.
• modern: 19th century

  Mary seacole: 

  → opened the British Hospital in 1885 to treat wounded and sick soldiers, dealt with jaundice, frostbite, diarrhoea and dysentery

  → often went into battle with her medicine bag, this shows how dedicated she was, prepared to risk her life to save others. 
• modern: 19th century

  Mary Seacole:

  → change: before, monks and nuns didn’t care about treating sick patients, but now nurses are prepared to lose their lives for the wounded and sick.

  → published ‘The Wonderful Adventures of Mrs. Seacole in Many Lands’ in 1857 to help raise awareness for the contribution of nurses in the Crimean War.
• modern: 20th + 21st century

  Liberal Reform Acts: 

  1906: Education [Provision of Meals] Act → introduced free school meals. 

  1907: Education [Administrative Provisions] Act → created school medical inspections [but some families could not afford the medications]
• modern: 20th + 21st century

  Liberal Reform Acts:

  1908: Old Pensions Act

  → over 70s received 5 shillings a week, 7 shillings and 6 pence for a married couple

  → the life span then was not as high as now, so few people would be eligible for pension.

  1909: Labour Exchanges Act

  → helped people get back into a job from unemployment.
• modern: 20th and 21st century

  Liberal Reform Acts:

  1909: Housing and Town Planning Act

  → made it illegal to build back-to-back housing

  1911: National Insurance Act

  → sick and unemployment pay IF you paid into the scheme. But it didn’t cover wives and children, only the man.
• modern: 20th and 21st century

  Beveridge Report: 1942

  1. Poverty / want
  2. Squalor
  3. Disease
  4. Ignorance
  5. idleness
• modern: 20th and 21st century

  NHS: 1946

  • Every british citizen was allowed free health care [doctors, nurses, pharmacists, dentists and opticians]
  • Local authorities were paid to provide vaccines, maternity care, district nurses, health visitors and ambulances.
• modern: 20th and 21st century

  NHS: 1946

  • Change: allowed every british citizen to have access to every medical treatment, compared to the medieval era, where only 10% of sick people were given medical treatment as christian hospitals focused on praying and healing the soul. 
  • But there were enormous costs required. 
• modern: 20th +21st century

  • Many doctors thought they would be paid less compared to before
  • BMA: doctors thought they would lose money, respect and independence. 
  • Improvement: [until Oct 1948] 187 million prescriptions written out, 5.2 million glasses issued, 8.5 million people received free dental treatment. 
  • Nye Bevan [health and housing minister]: convinced doctors by paying them er patients on top of their original salary, and they were still allowed to have private clients.
• modern: 20th + 21st century

  1952: prescriptions cost 1 shilling and dental care was £1. 
• modern: 20th + 21st century

  Development of the NHS

  • 1960s - new building programme to replace out of date hospitals
  • 1990s - hospitals were allowed to become trusts and Gps allowed to become fund holders, buying services from hospitals
  • 1998 - NHS direct launched, providing 24 -  hour health advice over the phone
  • 2002 - primary care trusts were launched to allow the administration and delivery of healthcare at the local level.
• modern: 20th + 21st century

  There was a positive change in the development of patient care. The government changed the way they saw poverty, introducing welfare reforms, seeing the start of the weakening of laissez faire.
• modern: 20th + 21st century

  The Beveridge report, 1942, tackling the 5 giant evils (want, squalor, disease, ignorance and idleness) leading to 1946 national health service act providing a significant change in patient care, as people could get free care so available to everyone. However, after 1952, the budget was under too much pressure causing things like charging for dentistry, so slightly worse than previously but overall, it provides a significant help in patient care.