theme 2 - public health Flashcards
what healthcare provision was there in 1918?
1911 Liberal government had introduced national health insurance for low-paid employees
Poor laws provided some degree of medical care
workhouses had their own infirmaries
what was the healthcare consensus in the period 1918-39?
government should play a leading role in coordinating provision and more money should be spent on healthcare
government should encourage medical advance by:
- invest in research and medical training
- organise a national network of hospitals
- ration healthcare
why was there disagreement over the exact role of the government in the period 1918-39?
1919: Labour Party advocated a free and comprehensive national health service
BMA advocated a regional system of healthcare, co-ordinated by central government
1926 Royal Commission on National Health Insurance recommended a regional structure
1937 ‘Report on the British Health Service’ recommended regional model, but based on central government planning
what was the Ministry of Health?
established in 1919
responsible for co-ordinating health at a regional level
what was the most serious public health problem after WW1?
tuberculosis
Ministry of Health Act created the Medical Research Council to research causes of tuberculosis
1921 Tuberculosis Act made provision of TB sanatoria compulsory
1929 Local Government Act
gave local authorities responsibilities for public health
- convert Poor Law infirmaries to public hospitals
- running dentistry, child welfare, school medical services
led to reorganisation of healthcare on a regional basis
- created a single health authority that coordinated healthcare in each county
healthcare during the Depression
1929: only half the population insured against illness
- uninsured people had to rely on private healthcare
various problems
- inefficient
- varied quality
- failed to meet needs of al patients
advances in preventative healthcare
- focus on diet and hygiene
what was the provision of healthcare like in 1939?
infant mortality dropped from 14.3/1000 (1906-10) to 12/1000 (1936-38)
areas of extreme poverty benefited less
- middle-class men lives 12 years longer than working-class men
- middle-class women lived 19 years longer than working-class women
- maternal mortality rates 50% higher in low-income groups than middle class
British healthcare lagged behind other countries
1939: Ministry of Health discussed plans for regional health boards centrally managed by government
what was the Emergency Medical Service?
founded in 1939
provided first aid for people wounded in air raids
resulted in creation of a national system
- state provided additional funding which was popular amongst doctors and hospital administrators
1941: Medical Planning Research endorsed provisional plans for a nationwide health service
what negotiations were made during 1942-44?
negotiations between doctors, represented by BMA, and angers of private hospitals due t concerns over loss of autonomy in state-run system
1944: White Paper recommended a new national system paid for through taxation
parties committed to state-provided healthcare
National Health Service Act
1946
healthcare would be universal, comprehensive, and free (paid for through taxation)
what was Bevan’s role?
created a nationalised but regionalised system
- all hospitals nationalised
- NHS hospitals run by regionalised hospital boards
compromised to get doctors to co-operate
- consultants could still work privately
- GPs could avoid becoming local authority employees
- led BMA to agree, but also meant NHS was run by privileged groups (regional boards dominated by upper middle class)
what was the early NHS like?
tripartite system
- hospital services
- primary care
- community services
didn’t lead to equal provision across the country
1948: 3,100 hospitals, 550,000 beds, 360,000 staff
when was the NHS established?
5 July 1948
How did Macmillan develop the NHS?
1962 Hospital Plan
- created 90 new hospitals
- 134 hospitals redesigned and modernised
- 356 hospitals refurbished
NHS Reorganisation Act
1973
introduced by Keith Joseph
introduced new management structure
led to significant growth in management costs
what was the Resource Allocation Working Party?
established in 1975 by David Owen
identified areas of health deprivation to allocate additional resources to reflect the needs of different communities
how did the NHS impact public health?
life expectancy increased
- men: 65.8 (1948) to 71 (1979)
- women: 70.1 (1948) to 77 (1979)
what was the Merrison Report?
1979
argued that hospitals received 70% of NHS funding and other services (GP services, preventative health programmes) received much less
surgery and general medicine received more money than services for mental health
investment in hospitals created regional inequalities
how did the NHS affect class?
middle class benefited more
- better investment, more modern GP surgeries
- budget allocations in the 1950s favoured middle class areas
- 1972: middle-class areas had per capita budgets 24% higher than working-class areas
1970s:
- working class women twice as likely to die in childbirth
- unskilled working men twice as likely to die before 65 than middle-class professionals
what was the Black Report
indicated that the gap between middle and working class healthcare grew in the period 1949-72
how did the NHS impact reproduction?
women greater control over fertility
- free contraception in the 70s
- education provided by NHS
- 1961: contraceptive pill
downside of the pill
- side-effects (risk of stroke, some types of cancer)
- men took less responsibility for contraception
Abortion Act
1967
woman’s right to terminate pregnancy still dependent on approval of (male) doctors
medical staff still had the right to refuse to perform an abortion
more accessible for middle-class women
- 58% performed in private sector
medical supervision poorly regulated
- 1968-78: 86 people died
how did the NHS impact childbirth?
childbirth in hospital became the norm
70-90% of women were given an episiotomy which caused pain and longer recovery, and was often carried out without their knowledge or consent
some argued that medicalisation of birth shifted power from women to men
- 1948-79: doctors controlled birth and were predominantly men
how did the NHS impact women and work?
greater work opportunities, but not equal to those of men
created a state-funded ‘caring profession’ - typically employed women
usually restricted to low-paid jobs
worse experiences for black women
- promotion rare
- racial harassment
Royal Commission on Mental Illness and Mental Deficiency
1957
argued that patients with mental health issues were stigmatised and their rights weren’t respected
argued that mental health hospitals operated like prisons
Mental Health Act
1959
introduced terminology ‘mentally ill’ rather than ‘insane’
mental health tribunals would make decisions on treatment rather than judges
open door policy - patients could attend voluntary treatment sessions
1962 Hospital Plan
confirmed a move from residential care to out-patient, drop-in care
proposed 50% reduction in hospital beds for people with mental illnesses by 1975
how was mental health treated over the time period?
1967-81: 25 different inquiries into misconduct and abuse at psychiatric hospitals across the UK
people with mental illness tended to be admitted to non-specialist hospitals
stigma didn’t disappear
two White Papers were published in 1971 and 1975
- recognised ongoing problems but no major reform occurred until 80s
what were the challenges of medical advances?
effectiveness of NHS led to increasing expectations
ageing population had increasingly complex health problems
medical advances meant the NHS could perform new procedures
how did treatments expand (1948-64)
number of prescriptions increased from 6.8 mill (June 1948) to 13.6 mill (September)
pharmacological revolution
- more medicines available
- spent 250% more on drugs in 1964 than 1951 (drugs also became more expensive)
vaccinations increased in scope
- 1939: smallpox
- 1964: TB, tetanus, diphtheria
why were new treatment possibilities a problem?
high-tech machinery was expensive (kidney dialysis, catheters, organ transplants)
required specialist staff
- increased from 407,000 (1951) to over 1 mill (1979)
why was an ageing population an issue?
had more health needs to demand increased
number of people of retirement age increased from 7 mill (1951) to 9 mill (1971)
why did major surgery create problems for the NHS?
1979: NHS performed 800 kidney transplants and 5,000 heart bypass operations
advanced in surgery increased demand
these major surgeries were time consuming and expensive
Family Planning Act
1967
made family planning advice available to women
reversed by Conservatives in 1972, then reinstated by Labour in 1974
1979: 1/3 of women of childbearing age had received free advice on family planning
was there crisis in the NHS?
faced issues of growing demand, recognition of inequalities, and economic crises
NHS was still protected by public consensus that it was an indispensable part of British national life
