2.2 - Public health Flashcards
(42 cards)
1
Q
What was healthcare provision like during the interwar years and who was in charge?
A
- Overall: patchy
- Local health authorities: varying responsibilities
- Hospitals operated some by local health authorities but some by charitable institutions
2
Q
Who was typically covered under health insurance in the interwar years and who wasn’t?
A
- Employees covered
- Families most often not
3
Q
What was the state of health care in the interwar years?
A
- Private meaning you had to pay to see doctor and pay for the treatment they recommended
4
Q
What were the steps taken by 1918 to improve access to healthcare in Britain?
A
- 1911 Liberal introduction of compulsory national health insurance
- Victorian Poor Laws (some degree of med care with Poor Law Hospitals)
- Workhouses (own infirmaries with many completely converting to hospitals after they stopped being used)
- Private charitable & philanthropic groups paid for healthcare costs for poor
5
Q
1911 Liberal national healthcare insurance
A
- Compulsory system of national health insurance for low-paid employees earning under 160 GBP/ year
- They and their employers paid into the scheme which provided sick pay and free medical treatment
- However, the Act only applied to wage earners and the unemployed and families of wage earners were not provided for under the scheme
6
Q
What were the two reasons for the development of healthcare until 1939?
A
- A consensus emerged between medical professionals and policy makers about what was wrong with the existing system and about the goal of reform
- Significant government reforms
7
Q
What was the healthcare consensus in the interwar years?
A
Gov should play a leading role co-ordinating healthcare provisions and should spend more money on healthcare
8
Q
What were common agreements among Western nations?
A
- Important medical advances had been made during the 19C
- Medical science would continue to grow and further research would lead to better healthcare
- Gov should encourage medical advance
8
Q
What were the limitations of the interwar period?
A
- Treatments for serious illness was still mainly palliative (concerned with making the patient as comfortable as possible)
- Illnesses such as cancer were still usually fatal
9
Q
What were the 4 pillars of the government consensus surrounding public health:
A
- Invest in research
- Invest in medical training
- organise a national network of hospitals
- Play a role in rationing healthcare
10
Q
Why did the Fabian Society disagree over the exact nature of gov role in healthcare?
A
- They advocated centralising healthcare before 1918, believing that centralised, state-planned healthcare was the only way to significantly improve British healthcare
11
Q
Why did the Labour Party disagree over the exact nature of gov role in healthcare?
A
- 1919: became the first political party to advocate a free and comprehensive national health service
12
Q
Why did the British Medical Association (BMA) disagree over the exact nature of gov role in healthcare?
A
- Advocated a regional system of healthcare, co-ordinated by central gov
13
Q
What did the Dawson Report (1920) recommend?
A
- The gov commissioned study recommended a network of state-funded and state-organised hospitals
14
Q
What did the Royal Commission on National Health Insurance (1926) recommend?
A
- Recommended a regional, rather than a national, structure for healthcare
- Commission recommended a compulsory health insurance scheme to fund a unified national health insurance service
15
Q
What did private and voluntary hospitals do in the 1930s?
A
- They lobbied unsuccessfully for gov funding
16
Q
What were voluntary hospitals and how did doctors work there?
A
- Charitable organisations that treated immediate or life-threatening conditions fall into 3 main categories
1. University / medical school hospitals
2. Specialist hospitals for particular illnesses such as TB
3. Cottage hospitals that served small rural communities - Doctors and surgeons: worked voluntarily, had other paid work / independent wealth sources
17
Q
What did the 1935 Voluntary Hospitals Commission argue?
A
- Gov should merge voluntary hospitals and local authority hospitals to bring together expertise and finance
18
Q
What did the 1937 Report on the British Health Services recommended
A
- A regional model but based on central gov planning and greater funding
19
Q
What do the reports and commissions from the 20s and 30s suggest?
A
- Consensus in favour of gov planning
- co-ordination of a series of regional health services
- Left groups advocated for truly national healthcare system
20
Q
What happened to the role of gov in healthcare provision after WW1?
A
- Role of gov drastically expanded
- 1919: Established new Ministry of Health - responsible for co-ordinating health at regional level
- Administered funds raised by national health insurance scheme
21
Q
Who was the first minister for health?
A
- Christopher Addison: academic and medical doctor who played important organiser role for medical care for troops on Western From
- Strong advocate of regional health services
22
Q
Why was TB such a focus for the government?
A
- Most serious public health problem in immediate aftermath of WW1
23
Q
What did gov do before war?
A
- Gov set up TB sanatoria funded by national insurance to slow disease spread
24
What did the Ministry of Health Act (1919) do?
- Created Medical Research Council (MRC) established to research TB causes led by Lord Richard Haldane
- Official, publicly funded body independent of gov control but ministers had no power over MRC's medical/ scientific findings
25
What did the Tuberculosis Act of 1921 do?
- Made provision of TB sanatoria by local authorities compulsory
- Therefore co-ordinated action led to a decline in TB cases every year from 1920 - 38
26
Why was the Local gov act (1929) the most important act medical reform of the 20s?
- Passed responsibility for Poor law hospitals to county and borough councils
- Allowed county and borough councils to convert Poor Law infirmaries to public hospitals (not just serve poor)
- Gave local authorities responsibility for other areas of public health (eg: running of venereal disease clinics, dentistry, child welfare, school meals & medical services)
27
What did the 1929 local gov act lead to?
- Reorganisation of healthcare on a regional basis
- Created single health authority that co-ordinated healthcare in each county / borough
- Enabled local authorities to provide medical services for entire population of area
- did NOT lead to cheap, modern, healthcare for all
28
Despite the 1929 local gov act what was healthcare like during GD?
- 1929: <50% of population insured against illness
- Importance of affordable health services for poor increased in GD
- Uninsured: rely on private health insurance (many cases didn't pay out enough to cover medical costs)
- Most deprived regions: extreme poverty + hunger = more illnesses (sometimes premature death)
29
What was the resulting debate from the depression?
- Best way to provide healthcare due to new consensus
- Consensus: existing provisions inefficient, too wide variation in quality - failed meet all patient medical needs
- Healthcare professionals + ministers = regional approach > national
- Local level: hospitals provided innovative care
30
What were the innovations in healthcare during the 1930s?
- Preventative healthcare (learnt from training troops in WW1 = diet, fitness)
- Ministry of Health priority: hospital funding
- BUT local authority hospitals: innovative experiments in preventative healthcare on diet + hygiene
31
Pioneer Health centre
- Established 1935 in Peckham (preventative healthcare exp)
- Local residents paid 5p/ week join clinic + receive annual health checkups + facility access
- About 950 signed up
32
Finsbury Health centre
- Established 1938
- Most tech advanced + modern public health centre
- Addressed problems of deprived local community
- Lice, poor hygiene, TB
- Wide facility range (solarium, LT)
- highly influential = inspired wartime planners & NHS architects
33
What was the state of public health by 1939?
- Improved from 1929 with key indicators
- Infant mortality declining (1906-10 = 14.3 /1000 vs 1936-8 = 12 /1000)
- Areas with extreme poverty still struggling
34
How different was the situation of public health depending on region?
- 20s + 30s: maternal mortality rates 50% higher in low income groups than MC
- MC men lived on avg 12 years longer than WC men
- MC women lived 19 years longer than WC women on avg
35
What was the Political and Economic Planning and what did it concluded?
- Think tank established 1931 - monitored health policy
- British healthcare worse than other developing countries
- EG: Aus + NZ vs overall UK healthcare = inefficient, poorly co-ordinated, badly regulated
- 1937 Typhoid outbreak in Croydon: Failed organise co-ordinated response - lead to deaths of almost 50 people
36
What was the Ministry of Health and The Lancet doing by 1939?
- discussing plans for regional health boards change to central gov management
- The Lancet (medical journal): advocated for national healthcare system
37
Impact of WW2 on healthcare
- Establishment of nationwide emergency healthcare system + new consensus
- Air raid threats = detailed planning before war to care for wounded as predicted Mns of casualties
38
Emergency Medical service (background)
- Founded 1939
- Provided first aid + CCS for wounded from air raids
- Allowed gov dictate hospital activities
39
Emergency Medical Service (results)
- Pooling of: resources, skills, expertise
- Therefore gov planners quickly adopted national framework for post-war healthcare system
- Attitude change within medical profession
- Before: doctors + hospital admin = stay independent from gov
- Central organising power of state + additional funding = THEY LOVED IT (not instantly but eventually)
- 1941: Medical Planning Research (200 doctors group) endorsed provisional plans for nationwide healthcare system
40
What did the post-war healthcare system need?
- Intense negotiation between doctors (reped by BMA (British medical association) + managers of local authority, priv, voluntary hospitals
- All willing to collaborate BUT concern: loss of autonomy
41
What did the negotiations between 1942-3 do?
- Resolved many major issues
- 1944: White Paper on health published: recommended new national system paid by general taxation
- Cemented perspective shift by all 3 major parties (public, management, doctors)
