Theme 2 - Welfare: Public Health

Question 1

What was the state of healthcare provision up to and including 1918?

Answer 1

• Compulsory National health insurance introduced by Liberal government in 1911 for low paid employees earning under £160 a year. Provided sick pay and free medical treatment. Only unemployed and wage earner benefitted
• Poor were provided health care through poor law hospitals, workhouse infirmaries and charitable philanthropic groups

Question 2

What 4 things was a consensus agreed upon in terms of healthcare between 1918-39?

Answer 2

-Invest in research, invest in medical training, organise a national network of hospitals and play a role in rationing healthcare

Question 3

What was disagreed upon in terms of healthcare between 1918-39?

Answer 3

• Exact nature of government role
• 1919 Labour became first party to advocate a free and comprehensive NHS
• 1920 Dawson report recommended a network of state funded and state organised hospitals
• 1926 Royal commission on NHI recommended a regional rather than national structure
• 1937 report on British health services by think tank recommend regional rather than national but based on Central gov planning

Question 4

What was the ministry of health?

Answer 4

-Founded in 1919 it was responsible for co-ordinating health at a regional level and it administered funds raised by the NHI scheme

Question 5

What was the impact of TB?

Answer 5

• Most serious public health problem after the war

- In response gov created Medical research council which was established;sighed in order to research causes of TB

Question 6

What provisions were made in the local government act of 1929?

Answer 6

• The passing of responsibility for poor law hospitals to county and borough councils
• allowed county and borough councils to converted poor law infirmaries into public hospitals
• Gave local authorities responsibility for other areas of public health such as running of general disease clinics, child welfare, dentistry, school medical services and school meals.

Question 7

Impact of 1929 local government act?

Answer 7

• Reorganised healthcare on a regional basis
• created a single health authority that co-ordinated healthcare in each county/borough
• Did not lead to cheap modern healthcare for all

Question 8

What impact did the depression have on healthcare?

Answer 8

• Uninsured people were forced to rely on private health insurance which in most cases did not pay out enough to cover costs
• Extreme poverty and hunger lead to higher incidences of illness and in some cases premature death
• Consensus emerged that existing provision was inefficient but regional approach was still adopted

Question 9

What was the state of healthcare by 1939?

Answer 9

• Some improvements: infant mortality between 1906-10 was 14.3% in every 1000 but it fell to 12% between 1936-38
• Poor areas still faced little improvement. 50% higher maternal mortality rates in lower class than upperclass during 1920’s and 30’s
• Middle class men lived on average 12 years longer than lower class men
• Healthcare lagged behind other developing countries

Question 10

What were the emergency medical services during the war?

Answer 10

• founded to provide first aid and causality cleaning stations for people wounded in air raids
• Allowed gov to dictate hospital activities
• Resulted in pooling resources, skills and expertise and the creation of a national system

Question 11

What impact did WW2 have on attitudes to healthcare?

Answer 11

-All 3 main parties committed themselves to state provided and centrally funded healthcare

Question 12

What did the NHS Act of 1946 state?

Answer 12

• Healthcare was universal for all
• healthcare would be comprehensive (offered curative and preventive care, hospital care, GP surgery, dental care and other specialist services)
• Healthcare would be paid by General taxation

Question 13

How did Aneurin Bevan achieve a NHS?

Answer 13

• Created a nationalised but regional system
• All existing hospitals were nationalised (local, voluntary and private were merged into one system)
• NHS hospitals were run by regional hospital boards and managed by executive committees
• Local health authorities pro divided services such as ambulances, vaccinations and community nursing

Question 14

How did Bevan get doctors support?

Answer 14

• Agreed to series of compromises
• Consultants were allowed to continue working privately and were allocated beds in hospitals for private patients
• GP’s were able to avoid becoming local authority employees and therefore subject to local authority pay control
• Regional health boards were appointed not elected and tended to be packed with upper middle class members

Question 15

What was the original structure of the NHS?

Answer 15

• Tripartite system
• Hospital services = A&E and in patient treatment for serious illnesses
• Primary care = GP’s, dentists, opticians and pharmacists all operated as independent contractors (Not run by NHS but who sold their services for a profit)
• Community services = Health visitors, vaccination services, health education, midwives and ambulances were all managed by local authorities not directly by NHS

Question 16

Impact of early NHS?

Answer 16

-Did not lead to equal provision across the county as it inherited old infrastructure which was unequally distributed across the country

Question 17

1) What was the 1962 hospital plan?
2) What was the 1973 NHS reorganisation act?
3) What was the resource allocation working party?

Answer 17

1) Created 90 new hospitals, redesigned 134 hospitals and refurbed 356 hospitals
2) Sir Keith Joseph introduced the act which introduced a new management structure to the NHS. Led to significant growth in management costs between 1974-793
3) Dr David Owen, Labour minister for health 1974-76 established the party. It ID’d areas of health deprivation, allocating additional resources to reflect the need of different communities

Question 18

What happened to NHS spending between 1950 and 1975?

Answer 18

Spending as a % of GDP in 1950 was 3.5% but in 1975 it was 4.9%

Question 19

What was the impact on public health after the war?

Answer 19

• Between 1948-79 there was great improvements in health of nation
• Life expectancy increased as a result (from 65 for me in 1948 to 71 in 1979), attitudes of people towards public healthcare and the role of the state improved and more people were being educated about public health
• Improvements were not felt all over. 1979 Merrison report highlighted how 70% of funding went to hospitals and other tiers did not see much money. Within hospitals surgery and general medicine received more aid then mental health. A lot of hospitals built in the 1962 plan were in London creating regional differences

Question 20

What impact did health have on class?

Answer 20

• Highlighted big class differences
• Middle class benefited more from NHS than working class
• Investment in working class areas lagged behind investment in middle class areas
• 80% of GP surgeries were built in working class areas before 1900 whereas 50% off surgeries after 1900 were built in middle class areas
• Working class women were twice as likely to die in child birth compared to middle-class women

Question 21

What impact did the NHS have on women?

Answer 21

• Contraceptive pill introduced in 1961 which lead to women having greater control over fertility and less babies being born. (However early pill had side-effects such as an increased risk of stroke and some types of cancer)
• 1967 Abortion act legalised abortion (doctor still had right to refuse procedure). 58% of abortions were performed in private sector creating class differences between those who could afford it and those who couldn’t. Procedures were poorly supervised and 86 women died during 1968-78
• Child birth became norm in hospitals
• Increased number of jobs (Some Caribbean women recruited). Stuck to lower paid and lower status jobs as they were seen as inferior

Question 22

What was the state of mental health care in 1957?

Answer 22

• Concern that NHS was not treating mental health effectively
• Some argued that patients were routinely stigmatised and that their personal rights were not respected and that mental health hospitals operated more like prisons than hospitals

Question 23

What was the 1959 Mental Health Act?

Answer 23

• Patients were referred to as mentally ill rather than insane
• Decisons to force treatment on people with serious mental health problems would be made by tribunals rather than judges
• Open door policy introduced. Most patients could attend voluntary treatment sessions in daycare centres rather than being compelled to stay in hospital long term

Question 24

What was the impact of the 1959 mental health act?

Answer 24

• By 1974:
• Only 15% of daycare places needed were available
• only 33% of hospital placed needed were available
• As a result many mentally ill people were sent to non specialist hospitals
• Stigma that sounded mental health was still present. Ely hospital in Cardiff was found out to be being inhumane to patients by News of the world

Question 25

What was done after abuse was reported at some mental health hospitals?

Answer 25

• Report into the abuse was commissioned
• Long term hospitals were people had been held for decades began to close
• Between 1967 and 1981 there were 25 Separate enquires into misconduct and abuse. Highlighted that provision of healthcare for mentally ill was in need of improvement
• No major reform happened until the earl 1980s’

Question 26

To what extent did the range of NHS treatments expand in the years 1948-64?

Answer 26

• Increase in demand led to 6.8 million prescriptions being dispensed the month before the NHS was created but over 13.6 million being introduced 2 months later
• 1949 and 1964 a pharmacological revolution took place were more and more medicines became available. Lead to increasing costs
• Vaccinations increased (so did costs)
• Offered more services and people felt the service was very good

Question 27

What were some of the challenges facing the NHS after 1964? (Long answer)

Answer 27

• Little investment in modernising hospitals from 1948-60 and little had been done to tackle inequalities of provisions
• NHS spending increased at unpredicted rates and greater demand lead to increased stress on service
• Increasing high tech equipment lead to more specialist staff being needed to operate tech. Number of consultants and nursing staff increased by 66% from 1964-79
• As the population aged demands increased as older people had more health needs. In 1979 NHS performed 24k hip operations (would of been impossible in 1960’s). 7 million people in retirement in 1951 but 9 million by 1971
• Advances in surgery such as kidney transplants were time consuming, expensive and required after care
• 1967 Family planning act made family planning advice available to all women. By 1979 1/3 of women of childbearing age had received free advice on family planning.

Question 28

To what extent was there a crisis in the NHS during the 1970’s?

Answer 28

• Growing demand lead to increased strain on services
• Recognition that NHS had failed to deal with health inequalities
• Economic crisis made increase in funding unlikely
• 1974-79 saw a decrease in economic confidence
• However NHS was protected by widespread public consensus that viewed it as an indispensable part of British national life