Healthcare 1918-45

• Rather like education, healthcare emerged as an odd hybrid of state and private provision in the 19th Century
• State healthcare was provided by a range of different agencies, including Poor Law, public health authorities and even education authorities
• The main form of healthcare available to most people was through their local GP or family doctor
• In 1911, only about half of all doctors had graduated from university
• WW1 exposed inadequacies of Healthcare; 41% of men rated unfit for combat, 10% judged unusable in any role - treatment of those disabled by war was spur to action
• Ministry of Health was finally set up in 1919, lacked statuatory authority and political will required to radically change the system, range of medical services still lay within the remit of other authorities such as the School Medical Service and the Factory Health Inspectorate
• Key example of reluctance to change was displayed in 1926 when Conservative govt. failed to act on a Royal Commission recommendation to either scrap or reform health insurance system
• Minister of Health Neville Chamberlain advised that the insurance companies were to powerful of a group to take on at a time of financial instability
• Few big insurance companies, such as Prudential, dealt with around 75% of health insurance, while large no. of smaller Friendly Societies, set up to help the poor afford basic medical treatment, handled the rest
• By 1937, around 18 million workers were covered by state health insurance
• Some Friendly Societies were so small that they could not afford to pay for members' medical treatment; some went bankrupt, some left members with no insurance
• 1911 National Insurance Act only insured workers and the wives, widows and children are left with no safety net
• A further problem was the lack of adequate hospital provision
• The very best hospitals were teaching hospitals
• There were 12 prestigious teaching/voluntary hospitals in London and ten in provinces
• Hospitals such as Guy's in London had a long independent history and trained top specialists and consultants and these attracted generous donations from wealthy donors
• The majority of the other 1100 voluntary hospitals were smaller, staffed by visiting consultants or GPs and less financially secure: when charity, fees and local authority grants did not cover costs, the hospitals could declare itself bankrupt (which was usually enough to encourage further local donations to avoid closure)
• As the cost of more advanced medical treatment increased, it was clear that many voluntary hospitals would struggle to stay financially viable, as fees were an important part of their income, they needed a quick turnover of patients: for this reason they didn't admit elderly or those with chronic illness
• State-provided hospitals had emerged out of workhouse infirmaries
• In some cases, state-provided hospitals had become good medical centres, but all too often was overcrowded with elderly and chronically ill patients
• The 1929 Local Government Act empowered Public Assistance Committees (PACs) to take over and develop these infirmaries into proper hospitals
• However, PACs were not given timetable or compulsion for action, with few exceptions, uptake was slow outside of London
• In 1939, half of all public hospitals were still Poor Law infirmaries
• A national survey of hospitals in 1938 revealed a shortage of beds, buildings, equipment, trained consultants and poor patient accessibility due to the poor distribution of good hospitals
• There was also an issue of class segregation within hospitals - working-class people received lower quality care than middle/upper classes
• The prospect of war led to the creation of nationally funded organisations to deal with expected casualties
• A national system of blood transfusion depots was established in 1938 near hospitals but far enough away to avoid bombing, this continued after 1946 as the National Blood Transfusion Service
• An Emergency Medical Service was set up in 1939 to treat military personnel and, as the war progressed, a wider range of civilian casualties
• National funding for the service led to an impressive growth in number of beds, operating theatres and specialist treatments available
• Examples of particular specialisms that emerged included the treatment of severe burns by plastic surgery, of kidney trauma due to crush injuries and of the mending of broken bones
• The successful state response to adversity in WW2, inspired Beveridge to call for a NHS as a vital component of 'satisfactory scheme of social security'
• Beveridge Report heavily influenced the 1944 White Paper, 'A National Health Service', formed a significant part of the 1946 National Health Service Act
• Ironically, despite the deaths and injuries from fighting and bombing, the health of the average Briton improved because of rationing and increased government propaganda to educate people about healthy habits
• Rationing meant that everyone had access to basic foods such as bread, meat, milk and sugar which were essential for good health
• By 1940, over half of all households owned a radio, providing them with information on how to stay fit and well during wartime
• Increased awareness of personal hygiene was promoted through posters encouraging regular bathing and hand washing
• During the war, there was also a greater emphasis on preventative medicine with vaccination programmes against diseases like diphtheria, polio and tuberculosis being expanded
• Beveridge was keen that the NHS should serve as a preventative as well as a curative service