Britain Transformed - Creating A Welafre State Flashcards

1
Q

Welfare supportb

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2
Q

Pre-1918

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Poo laws -welfare aid given in form of money or necessities to those in need
Usually the old, young, sick, old
First 3 Seen as deserving poor, rightly cared for by relatives, church,private organisations + Increasingly the state
Until end 19 century, healthy people of working age who fel into poverty often seen as morally at fault - undeserving poor - housed in workhouses, where conditions were deliberately terrible to discourage the able bodied from poverty
The process of having to prove you deserved welfare was a hated, humiliating experience
From 1908 the liberal government inaugurated a huge expansion of state-provided welfare:
- these new mechanisms were open to all who qualified with no distinction between deserving and undeserving poor
The 1911 national insurance act expanded welfare:
- employers, employees and government would contribute to the insurance scheme
- provided benefits and healthcare through the funds generated
- provided benefits and healthcare through the funds generated
- however, thus scheme was only available to low paid workers earning less than £160 a year, only applied to 6 industries when created, didn’t unsure workers families
1917 Ministry of Construction:
- after ww1, it was largely accepted that the government had a role to play that government ha to play role to play in insulting indivuals has basic security
- liberal government promised a ‘home fit for heros’
- ministry of reconstruction was established to build a better Britain after the war

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3
Q

Interwar years

A

May issues starting to arise

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4
Q

Unemployment

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Most pressing issue for interwar governments
It was never below 1 million between end of 1920s and mid-40s (around 10% of the workforce) and peaked at over 3 mill in early 1930s
However, the was continuous conflict between supporting the unemployed and balancing the books

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5
Q

Problems with National Insurance Scheme

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The self-funding national insurance scheme implemented by the 1911 national insurance act was undermined by the war as many of the 3.5 million returning troops were not eligible for the benefits provided
This was because they had not worked in one of specified industries or hadn’t made sufficient contributions
The wartime coalition realised that a difficult solution was developing, the national insurance scheme would need to be redesigned ans the unemployed couldn’t be left to rely on poor law

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6
Q

Out-of-work-donation 1918-20

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The short-term solution to help returning troops and civilian unemployed was to issue dole money but under the name out out-of-work-donation (1918-1920)
Issued to remaining troops and then civilian unemployed until they found work
Was paid out of taxation/borrowing with no link to individual contribution
Meant to be temporary, but It set out 2 important presidents
- the government accepted the duty to adequately support unemployed, regardless of insurance contributions
- to provided more money for family dependents

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7
Q

1920 Unemployment Insurance Act

A

Developed too offer longer-tem solution and cover those not employed not national insurance act
2/3 workers were eligible to claim insurance
Act passed in 1920’s just as effect of post was slump were setting in
Rather than creating self funding system, the greater number of eligible claimants quickly drained the accumulated fund
By 1921 the government was forced to make ‘extended’ or ‘unconverted’ payments
- these were meant to be paid for through worker contributions from future employment were doable payments disguised as insurance
They made this law as rthe Poor Law couldn’t cope with scale of the problem and ministers feared revolution if unemployment not supported
Government already pressured
- 2.4 million workers had taken part in strikes over pay and conditions in 1919
Attempts were made to limit the expense, a seeking work trust was implemented March 1921
By March 1930, 3 million claims had been rejected because of the test

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8
Q

1929 Local government act

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Said that county and borough council had to set up Public Assistance committees (PAC’s)
They were central funded and replace the poor law guardians who had administered funds under the old poor law
In response to the financial crisis of 1931, the PAC’s were given the power to administer means test ti claimants
Their combined household income was thoroughly investigated to judge eligibility for dole payments
The means test was hates as it was seen as an invasion of privacy and unfair, as some PAC’s were stricter than others

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9
Q

1934 Unemployment Act

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Unemployment act separated the treatment of insurable from long-term employment
Part 1 of act provided 26 weeks of benefit payments to the 14.5 million workers who had paid into the scheme
Part 2 created a national Unemployment Assistance Board (UAB) to help those with no entitlement to insurance benefits
By 1937 the UAB had assisted 1 million people on a national means-tested basis
By this point, the poor law provisions shrunk to just a few groups not covered by the UAB
- these included widows who couldn’t yet claim a pension and deserted wives
Howeverrrrrrrr…….
The government had not been able to solve unemployment largely because of the prevailing wisdom of retrenchment (spending cuts and tax wages) couldn’t stimulate economic growth
It was only when huge state spending was poured into rearmament after 1936 that persistent unemployment was finally tackled

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10
Q

Pensions - 1908 pensions act

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State pensions were introduced
Hugely popular with the Eligible be - over 70s
Criticisms that they were means-tested and didn’t support the widows and children of the deceased

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11
Q

1925 Widows’, Orphans’ and old age contributory pensions act

A

Brought in by Neville Chamberline - minister for health
Addressed criticisms of the 1908 pensions act
Pvodied a pension of 10 shillings a week for those aged 65-70 and provided for widows, their children and orphans
It was funded by a compulsory contribution rather than taxation
Initially unpopular with Labour Party, felt it unfairly penalised the poor
Tough economic conditions and an aging population led to its acceptance
Self-employed workers of both sexes allowed to join schemes in 1973

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12
Q

Housing - why was reform needed?

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Local and national governments mad efforts to improve housing since mid-Victorian era
Concern that slums promoted crime and disease
Lots of slum clearances took place before 1918
Major improvements in urban living standards were achieved by introduction of mains water and sewage systems
As late as 1899, only a quarter of issues in Manchester had flushing toilets compared to 98% by 1914
Government had promised returning troops ‘a home fit for heroes’

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13
Q

1919 housing and town panning act

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1919 housing and town planning act aimed to empower local authorities to to use central government funds to meet housing needs
Estimated that over 600,00 houses would have to be built to meet demand
Only 213,000 were actually constructed before the onset of recession lead to ‘Geddes axe’ (1922 Geddes axe lef to cuts in spending on education, pensions and unemployment benefit housing and health from £206 million to £182 million, also prompted cuts in defence)
As a result, the housing shortage grew worse with an estimates shortfall of 822,000 houses in 1923
A consequence of thus was young married couples living with their parents

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14
Q

Conservative and Labour housing acts 1923 and 1924, labour housing act 1930

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Conservative and Labour housing acts in 1923 and 1924 respectively sought to us subsidies to encourage construction of private and state-owned housing
These and the further labour shouting act 1930 promoted a great deal of house building between 1919-1940
Four million homes were built in total with one million built by public sector
1930 act used state funds to rehouse people living in overcrowded cities; most were built in large cities
Between 1924 and 1939, 20 ‘cottage estates’ were created on outskirts of London
- these were suburbs connected the centre by rail
While the qualities of housing was much improved some projects weren’t proper;y thought through
At the huge Becontree estate (25,800 houses and flats) a lack of local jobs nearly led to disaster, which was only avoided thanks to construction of a new car factory nearby in 1931
With the new homes came not only indoor plumbing and gardens but also increases demand for domestic goods such as new furniture which further stimulated the economy and helped raise the average standard of living

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15
Q

Impact of WW2

A
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16
Q

Impact of WW2, the labour government

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Impact of total war:
WW2 lead to wide consensus that welfare provision needed a radical overhaul
A political will developed to iron out the unfairness and inconsistency of the system
There were several reasons for this shift in attitudes among politics and the general public:
- a total war, which affected all, had promised total solutions such as universal rationing and the provision of communal bomb shelters; the success of which gave a boost to Universalist as opposed to selective solutions
- the sacrifices made during the war lead to public expecting a just reward - there were several discussions of the fair shares that should continue into peacetimes
- the evacuation of city children to the countryside openly showed extent of the property - this contributed to the acceptance of need for change
- the success of a state directed war economy increases political and popular belief in the political state intervention to improve people’s lives after war
- the war forced government to borrow and spend large sums of money in pursuit of victory - Keynes’s economic views has been proved to work
- the war forced a wartime government and led to a greater deal of co=operation over war-time policy - white papers of 1944 were the basis of 1946 national insurance act, helped to promote Conservative acceptance of act

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17
Q

The Beveridge report (December 1942)

A

William Beveridge was a liberal politician in social reform
In June 1941 he was appointed head of government committee to inebriate welfare provisions and recommended provisions

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18
Q

Why was the report set up

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Set up at Churchill’s request
Partly to predict future developments
Conservatives didn’t want repeat of their broken promised of a ‘home fit for heroes’ after WW1
Clear feeling the war being fought to deliver a better world and more systematic, inclusive welfare system was fundamental

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19
Q

Aims of Beveridge report

A

Protection for all ‘from the cradle to the grave’
Tackle the drive giants:
- want (through national insurance)
- disease (through NHS)
- ignorance (through better education)
- squalor (by rehousing)
- illness (through the maintenance of full employment)
Beveridge wanted the provision of the state welfare to be centralised, regulate and systematically organised
State welfare should be funded entirely by a compulsory single insurance payment
Beveridge didn’t anticipate extra government spending of welfare and under his scheme wanted avoid any ‘means-testing’ assistance payments and the rise of the Santa Claus state (given everything for nothing) as a liberal he didn’t want the system to incentivise dependence on the state

Although his findings were not new, his report drew together the many findings had taken place and presented them as a coherent, consolidates programmes for post-war reconstruction

20
Q

Report popularity

A

Report was extremely popular
635,000 copies were sold
Popularity also expanded by timing
- winning the arm made these prospects seem realistic and achievable
Copied were even dropped over Germany to encourage the civilian population to demand peace

21
Q

The atlee government

A

Labour won 1945 election with slogan ‘let’s face the furutre’
They promised to implement the recommendations of the Beveridge report and introduce a welfare state

22
Q

Acts of Parliament that laid the foundations fro the welfare state

A

1944 - the eduction act (aka the butler act) - compulsory free eduction, introduced tripartite system, after selection by 11+ exam, children were sent to either a grammar, modern or technical school

1945 - family allowances act - provided weekly payments for every child after the first, money way paid directly to the mother, by 1949 88% of those entitled to family allowance had applied for it

1946 - national insurance act - created a compulsory system to help pay for pensions and benefits for unemployed, payments made by the employer, employee and government, payments would be made in times of sickness, unemployment, maternity expenses, widowhood and retirement, the ‘mainly guides to national insurance’ was a free leaflets thar was set to 14 million homes to encourage them to be insured

1946 - national health service act - brought the whole population into a scheme of free medical and hospital treatment

1946 - the industrial injuries act - provided cover for accidents that happened at work

1948 - set up boards to deal with hardship and poverty, this new board didn’t have a vigorous form of means-testing and so was popular

23
Q

Other changes

A

Housing:
- 700,000 homes destroyed by war
- 230,00 homes built a year by 1948 (however 240,000 needed to eliminate homelessness)
- 1945-51 1 million homes were built
- 4 in every 5 homes built by state
- pre-fabricated homes were a key factor for speed - around 150,000 prefabs were built
- licences to produce homes were limited in order to achieve quality in order to achieve quality
- 1946 new towns act created new town, moving people out of overcrowded cities
Nationalisation:
- between 1949 and 49 coal, Civil aviation, cable, wireless, the Bank of England, road transport, electricity, gas, railways, iron and steel were all nationalised
Eduction:
- 900 primary schools built (for baby boom)
- only 250 secondary schools
- school leaving age raised to 15

24
Q

Issues with the welfare state

A

The BMA were initially opposed to the creating of the NHS, it took Bevan persistence and ‘stuffing their mouths with gold’ to get doctors to work for the NHS
NHS costs rose year on year instead of decreasing
- 1949 the health budget was £597 billion or 4.1% of GDP
The welfare state was expensive - labour had rejected Beveridge’s call for welfare payments to be solely funded through insurance
Nationalisation mean the government now had to bear the cost of the failing industries

25
Q

Challenges to the welfare state 1964-1979

A
26
Q

Changes to welafre

A

1959 national insurance act - introduced a top up scheme based on earnings
1971 family income support program - provided fmaily allowance for the first child
1975 social security act

27
Q

Rising costs of welfare

A

CST of unemployment benefits from 0.6% of GDP in 1939 to 8.8.% in 1980
Baby booms in late 50S and 60s - 900,000 birthday per year - meant higher care and eduction costs to for children
Increase in average life expectancy between 1940 and 1970 (from 64 to 77 for women and 59 to 69 for men) ment a larger burden on welfare state
New social group not covered by the beveridge report emerged like low-wage earning families and single parent families
Higher living standards prompted demands for a higher minimum standard of life for the poor - with absolute poverty tackled, people focused on how relative poverty could eased
Growing size of welfare state (by end of 70s welfare spending equated to around 6.5% of GDP) required ever more bureaucracy to make it work

28
Q

Increased criticisms of welfare

A

While spending on welfare increased just as much under Conservative governments as under labour, criticism of rights welfare state emerged from the right during 70s
Margret Thatcher was a key critic of the welfare state, she feared benefit payments created a poverty trap and encouraged dependence on state
Many also felt that the welfare-state was unsustainable with the poor state of the economy, and commitment to full employment was fuelling inflation
On the other hand, the left was angry about the persistence of privilege in healthcare and eduction, attacked welfare as inadequate and thought more should be done to combat relative poverty

29
Q

Healthcare

A
30
Q

Pre 1918 - before 1911

A

Access to healthcare depended on wealth - wealthy could afford healthcare whilst the poor couldn’t and often became very ill after using ineffective self-medication
Workhouse infirmaries could treat the poor, however if these didn’t exist then the poor had to rely on friendly societies
Friendly societies offered some affordable health insurance schemes - they would take a small regular payment and then pay a lump sum when people needed financial help - friendly societies were unregulated and non-compulsory and could go bankrupt
If a friendly society collapsed then the poor would be left without any health care options

31
Q

1911 national insurance act

A

Introduced by the liberal government
Compulsory health insurance for low paid workers earning under £160 a year
Employer, employee and government paid into the scheme, which provided free medical treatment and sick pay
However, in 1911 this act only covered 6 industries and wouldnt cover worker’s families (women and children were the most vulnerable and had least access to healthcare)

32
Q

The interwar years - how did a consensus develop over healthcare in the interwar years?

A

A growing idea was that government should play a leading role in healthcare provision and investment should be made in medical advances building upon the progress made in the 19th century
Government should also develop a network of hospitals;s and healthcare
Although there was disagreement and debate about the extent of government intervention, there was a broad agreement that government spending and co-ordination of healthcare provision was critically important

33
Q

1919 ministry of health

A

War recruitment uncovered poor standard of health
- 40% of men declared unfit for combat5
The ministry of health was established to coordinate healthcare
However,the ministry lacked the authority and political will to drastically reform the healthcare system
Medical services like the school medical service and factory Heath inspectorate were still controlled by other authorities

34
Q

Insurance companies

A

After WW1 there was a growth of large companies, who managed around 75% of health insurance
A lot of this came through the state due to the 1911
‘Approved societies’ would collect subscriptions and pay costs to - by 1937 18 million workers were covered by state health insurance
However, widows, wives and children of workers were still not insured by 1911 National Insurance Act, they were reliant on family, local community (friendly societies) or a sympathetic GP

35
Q

Access to GPs

A

GPs were the first resort for medical care
Patients had to pay for consultation and for medicine
This means that GPs were unevenly distributed, with more working in wealthier areas
The poor would only go to GPs as a last resort and altruistic GPs would often offer their services at lower costs to those seriously in need
When the NHS was finally launched, many doctors were shocked to find poorer patients had been putting up with medical issues such as rotting teeth and interacted hernias, due to their inability to afford treatment

36
Q

Hospital treatment

A

The best hospitals were teaching hospitals - there were only 12 in London and 10 in provinces - they relied on wealthy donations
Voluntary hospitals were smaller and less financially secure - by the end of the 1930s, most were in deep financial troubles - there were 1,100 of these hospitals

37
Q

What’s did the local government of 1929 do to support healthcare?

A

The local government of 1929 passed
Poor law hospitals were now in the hands of local government who convert them into local hospitals
Local government was now responsible for running key healthcare services, such as dentistry and school’s medical services
This Act made local government responsible for co-ordinating healthcare provision

38
Q

How did healthcare provision expand after the local government act?

A

Various forms of hospital care developed, such as specialist teaching hospitals
GPs or ‘Panel Doctors’ treated more people though the National insurance scheme
However, less than half of the population were insured against illness and many relied upon traditional remedies and over the counter medicines
However, healthcare was improving - a key indicator, infant mortality rates were failing although maternal mortality rates remained high in working class areas
By 1939, more groups, such as writers of The Lancet were advocating a national health service

39
Q

Impact of WW2 - what was the impact of WW2 on healthcare provision

A

WW2 helped to create a consensus on healthcare reform which was underpinned by the introduction of a national emergency healthcare system introduced to treat casualties from the Blitz
The emergency medical service as established in 1939 to provide first aid for air raid casualties and to dictate to hospitals health provision - but it was later used to treat civilians and evacuate children
It allowed for resources to be pooled and saw a changing attitude in the medical profession who previously wanted to stay independent of the government who were persuaded by government funding for resources and wages
The emergency medical service provided blueprint for the NHS to be established after the war
The national blood transfusion service was also created
The 1942 Beveridge report called for a national health service and in 1944 he government presented the White Paper “A national health service’ which called for a comprehensive and free of charge medical service in Britain

40
Q

The creation of the NHS

A

After labours landslide victory in 1945 pm atlee was determined to fulfil his promise to establish a national health service, and he appointed Aneurin Bevan as minister for health to carry out his task

41
Q

Aneurin Bevan

A

Born into mining family from south Wales, left school at 13 to work in a coal mine
Became minister of health in Atlee government
Bevan aimed to create a centrally run system, funded through taxes and not insurance, that would provide free healthcare to all - his success in achieving these aims was by no mans easy

42
Q

1946 national health service act

A

Established a far more coordinated, centralised system
Voluntary hospitals were nationalised and The Approved Societies forced to rely on private clients

43
Q

Opposition to the NHS

A

The conservatives:
- Tories voted against the formation of NHS 21 times before the act was passed - they were against state control
Terms like ‘medical Gestapo’ and ‘medical Füher’ were bandied about some of the most conservative members of the British medical association and their political allies
Bevan attacked the Tories for opposing NHS, stating that they were ‘lower than vermin’ in a speech
Local authorities:
- didn’t want to lose control of their hospitals
The BMA:
- main opposition to NHS came from Doctors, represented by the BMA
Argued that working for the state would undermine their clinical independence and doctors feared becoming civil servants of the state (in reality probably most concerned about loss of income)
In Feb 1948 90% of BMA voted against working with NHS
However, they found themselves out of step with majority of British public
5 weeks after launch of NHS campaign 75% of British citizens had registered with the NHS
Bevin overcame opposite by granting them a fee for each patient and allowing them to retain private patients - a tactic he angrily referred to as ‘studding their mouths with gold’
Eventually doctors gave in, with 90% of doctors joining NHS in July 1948, just one month before launch date

44
Q

Healthcare 1951-1979 - a healthy change?

A

The NHS also allowed many Britons to take advantage of improved methods of combating disease through research into new techniques, vaccinations and medicine
In the first 10 years of the NHS, new antibiotic drugs developed in US and caused the number of deaths from TB to fall from 25,000 to 5,000 a year
Mass immunisation programmes launched in 1958 led to a huge drop in cases of polio and diphtheria
- polio, as a disease which had previously affected up to 8,000 people in epidemic years, was eradicated in 1984
There was a 90% drop ij cases of whooping cough by 1970 and syphilis was almost completely eradicated by tthe early 1990s
A MMR vaccine was developed (in US) in 1971, and has been offered for free by the NHS since 1988
Many of these diseases had particularly affected children and the treatments offered by NHS contributed to fall in child mortality rates
- in 1926, 1-14 year olds made up 10% of all deaths, by 1951, this figure had fallen to 1.5%
Improved midwifery also led maternal deaths in childbirth to fall from 1 per 1000 in 1949 to 0.18 per 1000 in 1970
Increased funding led to better healthcare provision
Over 300 inadequate cottage hospitals were closed in the 60s and new centres of excellences, with close ties to universities, were founded, as well as new district general hospitals for larger towns
These changed contributed to an increase in life expectancy
- 66 in 1950 to 70 in 1979 for men
- 71 in 1950 to 75 in 1979 for women
Life expectancy was higher in Britain than in other developed countries like West-Germany and France
However, increased life expectancy led to an increase in diseases associated with old age
Rates of heart disease and cancer increased throughout the 50s and 60s and arthritis continued to be a huge problem, affecting 200,000 men and 700,000 women i9n 1970

45
Q

Rising Costs

A

Both Beveridge and Bevan had expected the cost of healthcare to fall after n1948
They reasoned that people would get healthier and preventative medicine would reduce cases of serious illness and so dependence on HNS would fall
However their estimates proved wrong
From 1950-1970 the cost of NHS increased to 4.1% of GPN to 4.8%
Advances in medical science lead to an increase in treatments available, in 1948 there was only 1 antibiotic available but by 1968 there were 33
As a result of increased costs, the government were forced to introduce chargers for spectacles and dentures in 1951 and prescription charged in 1952
These decisions caused split in Labour Party and Bevan and his supporters resigned
People also came to depend on NHS in a way Bevan had hoped to avoid
- ‘dandruff syndrome’ soon emerged where people took up valuable time and resources to complain about trivial problems, like dandruff
The tripartite division of healthcare bewteen GP, hospital specialist and public health authority also made it difficult to effectively coordinate the healthcare system - a move that would save costs
The number of staff employed by NHS doubled between 1948 and 1979 (from 500,000 to 1 million)

46
Q

Medical advances

A

In 1953 the structure of DNA was uncovered by 2 British scientists allowing for new research into genetic disorders
The first kidney transplant took place in 1960 (although demand for transplants quickly outstripped supply)
In 1961, pill introduced, move that proved very popular
- by 1962 100,000 women were on pill
- by 1967 this number increased to 1 Million
First full hip replacement happened in 1962
Britain’s first heart transplant occurred in 1968
- although due to complications with the procedure only 6 more carried out over next decade
In 1967 the abortion act was passed, aiming abortion legal up to 28 weeks
CT scanning was invented in 1972 and also quickly became part of standard NHS equipment continuing to improve patient care bust also costs