THEME 2b: Public Health

Question 1

Healthcare provision before 1918

Answer 1

• 1911: Liberal government introduced compulsory system of national health insurance - employees earning under £160 per year. Only applied to wage earners (employees and employers paid into the scheme).
• Number of private charities and philanthropic groups which paid healthcare costs for the poor.
• Poor Law provided for some medical care (Poor Law Hospitals).
• Workhouses had infirmaries to treat the poor.

Question 2

By 1918, ___________ steps had been taken towards _________ healthcare to the nation

Answer 2

By 1918, significant steps had been taken towards providing healthcare to the nation.

Question 3

The creation of the Ministry of Health - 1919

Answer 3

• This coordinated health at a regional level.

- Redistributed funds from National Health Insurance schemes.

Question 4

Local Government Act - 1929

Answer 4

• This gave the responsibility of poor law hospitals over to local authorities.
• Disease clinics, child welfare, dentistry, and school services were now with local authorities.
• It regionalised healthcare.

Question 5

Crucially, the local government act ____________ ______.

Answer 5

Crucially, the local government act regionalised health.

Question 6

Issues with healthcare in the interwar period

Answer 6

• Impact from the ministry of health was slow - private insurance companies still provided 75% of healthcare.
• 1923-1925: Infant mortality rate was very high and very unevenly distributed (59 deaths under the age of one, per thousand births in London; 93 in Tyneside.)
• The local government act didn’t lead to cheap, modern healthcare for all - provision was uneven.
• By 1929, less than half the population was uninsured against illness. Those who were uninsured had to rely on private health insurance which was unaffordable.
• Maternal mortality rates 50% in lower class groups.

Question 7

Emergency Medical Service - 1939

Answer 7

• Job was to provide aid and casualty clearing stations for those wounded in air raids.
• The government dictated hospitals’ activities.
• This provided a skeletal framework and was the blueprint for a national health service.

Question 8

The emergency _______ service (____) was the _________ for a ____________ healthcare system.

Answer 8

The emergency medical service (1939) was the blueprint for a nationalised healthcare system.

Question 9

Context surround the creation of the NHS

Answer 9

• Both the Tories and Labour had committed to the idea of a national health service at the 1945 general election.
• Attlee appointed Aneurin Bevan as minister for health.
• 1945-1979: Both main political parties committed to the NHS.

Question 10

The National Health Service Act - 1946

Answer 10

• Three main principles:
  
  1. Healthcare would be universal, available to all.
  2. Healthcare would be comprehensive (offer different types of medical care: curative, preventative, mental, physical….)
  3. Healthcare would be free at the point of delivery. The NHS would be paid for through direct taxation.
• Bevan had created a nationalised but regional system:
  
  • All hospitals nationalised: local authority, voluntary, private hospitals all merged.
  • Hospitals would be run by regional hospital boards managed by executive committees.

Question 11

The NHS was a __________ system.

Answer 11

The NHS was a tripartite system.

Question 12

The development of the NHS:

Hospital Plan Act, 1962

Answer 12

• Creation of 90 new hospitals.
• Modernisation of 134 hospitals.
• Refurbishment of 356 hospitals.

Question 13

The development of the NHS:

NHS Reorganisation Act, 1973

Answer 13

• Introduced a new management structure to the NHS.
• Led to a significant growth in management costs between 1974 and 1979.
• Introduced by Keith Joseph (Conservative Secretary of state for social services).

Question 14

The development of the NHS:

Resource Allocation Working Party

Answer 14

• Established by Labour minister of state for health, David Owen (1974-1976).
• It identified areas of health deprivation, allocating additional resources to reflect the need of different communities.

Question 15

The Impact of the NHS:

Impact on women

Answer 15

• Gave women greater control over their fertility - NHS offered education, + the introduction of the contraceptive pill in 1961.
  
  • Birth rate declined: Women born in 1920 = 2 kids; Women born in 1966 = 1.3 kids.
• Made childbirth in hospital the norm. Some say this has been beneficial, some feminists argue against this (power now in a man’s hands).
  
  • 1950s: 60% of women gave birth in hospital.
    1978: 97%

Question 16

The Impact of the NHS:

Impact of Public Health

Answer 16

• Life expectancy increased:
  
  • 1948 = 65.8 for men, 70.1 for women.
    1979 = 71 for men, 77 for women.
• Changed attitudes on the role of the state towards healthcare.
• The improvement wasn’t uniform - there were many regional differences: the 1962 plan focussed more on London and neglected the north.

Question 17

The Impact of the NHS:

Impact on Mental Health

Answer 17

• 1959 Mental Health Act addressed concerns that the NHS wasn’t dealing with mental health effectively:
  
  • New terminology - ‘mentally ill’, not ‘insane’.
  • Removed judges from process. Decisions would be made by mental health tribunals.
• 1960s + 1970s: Media reports of ‘cruel and inhumane’ treatment.
  
  • 1967-1981: 25 separate enquiries into misconduct and abuse at UK psychiatric hospitals.

Question 18

The Impact of the NHS:

Impact on Health and Class

Answer 18

• 1950s research indicated that budget allocations favoured middle class areas:
  
  • Hospitals in middle class areas received £4.98 per head.
  • Hospitals in working class areas were given budgets set at £3.19 per head.
• Black report (1980):
  
  • Working class women were twice as likely to die in childbirth than middle class women.
  • Unskilled working men twice as likely to die before reaching 65.