2- Public Health Flashcards
health care before 1918
- private charitable hospitals for the poor
- workhouses that had infirmaries with limited healthcare
- national health insurance for workers earning less then £160 a year - only for the earner of the household
interwar years health care consensus
GOV consensus
- role in rationing health care
- invest into medical research
- create own network of hospitals
labour
* advoate for free comprehensive health care
medical groups
* supported regional health care system
Government reforms to healthcare
1919-39
- 1919 Ministry of healthcare created
**1919 medical research council created ** - = research into causes of TB (significant problem post war)
- result in improvement of provision of TB sanatoria - complusory for local auhtories to provide
- cases of TB fell every year between 1920 and 1930
LIMITATIONS of ministry
* could not create radical change to system
* EG; failure to implement reccomendations of 1926 Royal commission
* comission was critical of private health insurance companies and recommended provisions of health care via public funds
* Neville Chamberlan, Minister of Health, claims that insurance companies are too powerful to take on in a period where gov was struggling financially
Local authorities and reform to healthcare 1919-39
LOCAL GOVERNMENT ACT 1929
* reorganised healthcare on regional level
Local authorities:
* take over Poor Law Hospitals and turn into public hospitals
* BUT conversion of workhouse infirmaries into state run hospitals was slow
* became responsible for other areas of public health
* Local authorities controlled health provision within region = povided medical services for entire population in area
SUCCESS
* experiment in innovative ways of preventative healthcare
* Peckham and Finsbury - residents pay one shilling a week for healthcare checkups and leisure facilities - 1000 sign up
* finsbury health centre - labour borough- provided arhcitectual model for the NHS - range of services in one building
* infant mortality dropped from 14.8 to 12 in 1000 in 1910-38
Limitations against Government reforms for healthcare 1919-39
**Regional Variations **
* less than 1/2 of country was insured against illness
* rely on private healthcare OR deprieved areas relied on friendly socities - limited finance
* premature deaths and illnesses were higher in areas most affected by depression
* Tyneside infant mortality rate was 50% higher than London
**Local Government Act **
* conversion of workhouse infirmaries into state run hospitals was slow
* there was not a set timetable= half of all workhouses still were not converted and were still Poor Law Infirmaries outside london - overcrowded with eledery and terminal illness patients
Impact of second world war on healthcare provisions
- Established Emergency Medical Service- provide aid and offer medical services for post war and injury from raids
- Government was allowed to take over and run hospital activities - first government control of health care
- Beveridge calls for a healthcare service in report
- The quality of organisation and funding = create favour for consesnus and health service from medical proffessionals
Creation of the NHS
- consensus from politicans and professionals for state run government funded by general taxes
- Conservatives and Labours included in 1945 manifesto
- Atlee placed Bevan in charge of creating National Health Service
- 1946 National Health Service Act was passed
PRINCIPLES - **unniversal and avaliable to all
- comprehensive **
- curative and pretenative treatment
- mental and physical health
- range of services
- free at point of delivery - paid for by taxation> insurance
Challenges-
* Bevan found it difficult to get doctors to cooperate with him = made compromises
* consultants allowed to continue to work privately
* GPS not subject to local authoirty pay control
* = 90% of all doctors joined the NHS
Service Tiers
1. hospital service
2. primary care - GPs , dentists, pharmacists - all operated private contractors
3. community services - vaccinators, midwives - managed by local authority
Sucess of NHS creation
- life expectancy rose 65.8-71 and 70.1- 77
- advantage of global improvments in combating disease
- TB deaths drop 80%
- mass immunisation result in drop of Polio
- Whooping cough cases dropped 90%
Failures of the NHS
- improvements not uniform across all aspects of care - 70% of funding went to hopsitals = GPs underfunded
INVERSE CARE LAW
* NHS reflect inequealities across society - variation in class and gender
* less moneu spent per head in working class areas
* mortality rate for women in child birth was double in working class
* better service in areas needed least - London
BLACK REPORT
* middle and working calss gap increased
* women twice as likely to die in child birth than middle class
* unskilled men twice as likely to die before age 65
* succcess in middle class - more sugeries built
= Not unniversal
Creation of NHS impact on Women
- control of fertiliy
- decline in birth rates- education on contraception and 1970s+ gave free contraception
- legalised abortions in 1967
BUT - women still needed approval of 2 doctros - usually rejected
- most abortions given out in private sector to middle class women
- prcoedure remained dangerous - 100 deaths
Creation of NHS impact on mental health
SUCCESS
* attitude shift to caring model
* 1959 mental health act
* terminology changes to mentally ill> insane
* go before a tribunal than a judge - less stigma and more sympathetic
* more open door care than permamnet long term care if classified as mentally ill
FAILURE
* poor quality of care
* abuse and misconduct was wide spread - 25 enquries to one hospital in caridiff
* only small fraction of required places in hospitals and daycares avaliable = admitted to non specialists
Challenges to NHS - cost
- became victim of own success
- effectiveness reuslted in increase expectations
- increasing ageing population resulted in more complex needs
- medical advancements were high costs - vaccinations
- Routine vaccinations were only for smallpox before 1919- greater range , free of charge whilst drugs were becoming more expensive . spending 250% more on drugs in 1964 compared to 1951
- however funding was not an issue due to poltical stability and supprot from labour and conservatives - consensus
- increased challenges in 1960s -70s - newer procedures and surgeries discovered and readily avaliable (equipment, traiend professionals, after care periods
- spending increased 50% more than initally predicted in 60s and 70s - at time of slow economic growth
