Healthcare Flashcards
Views on healthcare 1918-39
Widely believed the gov had a role to invest in research and medical training, organise a national network of hospitals and play a role in rationing healthcare
Disagreements over the exact nature of the gov’s role:
Fabian Society advocated centralising.
BMA wanted a regional system coordinated by a central gov
Dawson Report 1920 commissioned by the gov recommended a network of state-funded and state-organised hospitals
Healthcare provision improved considerably 1918-1939
Ministry of Health Act 1919 created the Medical Research Council to research the cause of TB. Independent of gov control so ministers had no power over it’s medical or scientific findings
1921 Tuberculosis Act made the provision of TB sanatoria by local authorities compulsory- as a result cases fell every year 1920-1938
Local Government Act 1929 - poor Law hospitals now controlled by local gov’s converting them into local hospitals, responsible for running key healthcare services, like dentistry and schools’ medical services and coordinating health care provision - enabled LA’s to provide medical services to the entire population
Pioneer Health Centre in Peckham 1935 got residents to pay a subscription per week to join the clinic and received an annual health checkup and access to leisure facilities. 950 local signed up
Healthcare provisions did not improve considerably 1918-1939
1930s private hospitals and voluntary hospitals lobbied unsuccessfully for gov funding. Voluntary hospitals were charitable organisations with doctors and surgeons being unpaid - 3 categories: university or medical school hospitals, specialist hospitals for particular illnesses, cottage hospitals which served small rural communities
Less than 1/2 the population was insured against illness by 1929.
In the most deprived areas, extreme poverty and hunger led to higher incidents of illness and premature death in the Depression.
Maternal mortality rates in the 20s and 30s were 50% higher in low-income groups than among the middle-class
Failure to co-ordinate a response to a Typhoid outbreak in Croydon in 1939 resulting in almost 50 dead
WW2 had a significant impact on healthcare
Introduction of National Emergency System 1939 to treat casualties from the Blitz - provided first aid for air raid casualties and was later used to treat civilians and evacuated children
Allowed for resources to be shared- saw changing attitudes in medical profession- previously wanted to stay independent - provided blueprint of NHS
Required negotiation between BMA, managers of LA, private and voluntary hospitals - all were willing to collaborate but were concerned over the loss of autonomy
1944 White paper by the gov recommending a new national system paid through general tax which all 3 parties committed to
NHS aims set up by Bevan
Universal, comprehensive offering curative and preventative treatment, mental and physical healthcare, hospital care, GP’s, dental care and other specialist services, would be free as paid by direct tax not insurance
Was a nationalised but regionalised system
All existing hospitals were nationalised being merged into one unified system
Would be run by regional hospital boards and managed by executive committees with local health authorities providing services such as ambulances, vaccinations and community nursing
Bevan’s proposals were challenged
Struggled to get cooperation from the doctors so had to compromise:
Consultants were allowed to continue working privately and were allocated beds in hospital for private patients
GPs were able to avoid becoming LA employees and therefore subject to LA pay controls
Regional health boards were appointed, not elected, and were dominated by consultants who tended to be upper middle class
The early NHS successfully developed
1962 Hospital Plan - created 90 new hospitals, re-design and modernisation of 134 hospitals, refurbished 356 hospitals
Keith Joseph while speaking openly against excessive welfare spending introduced the NHS Reorganisation Act 1973 which introduced a new management structure to the NHS. This led to a significant growth in management costs 1974-79
The Resource Allocation Working Party was established in 1975 by Labour to identify areas of health deprivation allocating additional resources to reflect the need of different communities
The early NHS faced challenges hindering development
Inherited existing infrastructure which was distributed unequally across the country. In 1948 it was made up of 3,100 hospitals with 550,000 beds employing 360,000 staff
NHS spending - increased under both parties. Conservatives in 1965s significantly increased spending to £1.2 billion. By 1975 it grew to £5.5 billion
Bevan expected the cost of healthcare to fall after 1948 but was wrong
Gov forced to introduce charges for spectacles and dentures in 1951
People took up valuable time and resources for trivial problems- dandruff
Positive impact of the NHS on public health
1948-78 there was a general improvement in the health of the nation.
Combination of increased affluence and better health care
Negative impact of the NHS on public health
Increased life expectancy- increase in disease associated with old age
The Merrison Report 1979 argued that hospitals received 70% of NHS funding whereas other services including GP’s and preventative health programmes received much less
Within hospitals, surgery and general medicine received much more money compared to mental health services and old peoples health
Investment in hospitals created regional inequalities. Most investment from the 1962 Hospital Plan was spent in London
Negative impact of the NHS on health and class
Meant to be universal but the middle-class typically benefitted the most
50s a study found hospitals in some middle-class areas received a larger annual budget per head compared to working-class
By the 70’s working-class women were x2 as likely to die in childbirth compared to middle-class women
Positive impact of the NHS on women
Greater control fertility- decline in birth rates as the contraceptive pill becoming free from the 70s and increased education
Abortion Act 1967- medical staff had the legal right to refuse to participate in terminations, between 1968-78 1.5 million terminations were carried out with around 58% were under the private sector
Childbirth in hospitals became the norm. In the 50s only 60% gave birth in hospital but by 1978 it was 97%
Created job opportunities. In 1948 gov attempted to recruit 54,000 female nurses - a significant majority were recruited from the Caribbean
Negative impact of the NHS on women
The pill was released in 1961 but not free. Had side effects such as an increased risk of having a stroke and some types of cancer and the availability meant men took less responsibility towards contraception
Abortion Act 1967- needed the approval of a male and doctors, more easily available to the middle-class, 86 people died during a legal abortion between 1968-78, 72 died as a result of NHS surgery
Childbirth - a survey found between 70-90% of women were given episiotomy but was often without consent or knowledge. The procedure led to pain when sitting in 68% of cases and longer recovery time
Work - were restricted to lower paid and lower status jobs 1950-60s. Black women were rarely promoted and subjected to racial harassment
Positive impact of the NHS on mental health
After findings in 1957 showing that those in mental health hospitals weren’t respected and lived in almost a prison the act was passed - 1959 Mental Health Act- patients referred to as mentally ill not insane, removes judges instead mental health tribunals would sort treatment for those unable to, introduced an open door policy so patients could attend voluntary treatment session in daycare centres instead of staying in hospital.
1962 Hospital Plan- proposed 50% reduction in hospital beds for people with mental illness by 1975 further reinforced the 1959 act
The events in Cardiff led to long-stay hospitals where people had been incarcerated being closed and the report recommended the introduction hospital inspections
Negative impact of the NHS on mental health
By 1974: only 15% of the daycare places needed were available and only 33% of the hospital’s places needed were available- resulted in patients being admitted to non-specialist hospital
Ely hospital in Cardiff- cruel and inhumane treatment towards patients led to a report into abuse and was commissioned along with a wider enquiry into all of Britain’s NHS mental health hospitals.
Between 1967-81 there were 25 separate enquiries into misconduct and abuse at psychiatric hospitals across the UK
