Public Health

Question 1

What steps had been taken by 1918 to provide healthcare to the nation?

Answer 1

. 1911, liberal government introdcued system of compulsory national health insurance for lowly paid employees.
. employers paid for sick pay/free medical treatment.
. numerous private groups/charity groups paid costs of healthcare for poor.
. poor law provided medical care for hospitals.
.workhouses had their own infirmaries + converted into hospitals.

Question 2

why was 1918-1939 an important era for healthcare consensus.

Answer 2

1918-1939 important for healthcare as a consensus emerged between medical professionals and policy makers about whats wrong w existing system.

Question 3

interwar consensus for gov healthcare`?

Answer 3

. during interwar consensus of gob providing healthcare.
. achknowledged that mnay medical advacnements made but treatment for some dieseases (cancer) still not there.
. nonetheless belief that gov should:
. ivest in research
. invest in medical training
. play a role in rationing hleathcare
. build hospital chains network.

Question 4

What were the views/disagreements on gov consensus in interwar periods (theres a lot so be prepped LOL)

Answer 4

. fabian society wanted healthcare to be centralised before 1918, and they thoight state planning healthcare was where it was at,
. in 1919 labour party became first british political party to advocate for free/comprehsncive national health service.
. british medical association (BMA), wanted a regional healthcare system.
. 1920, government gace a study into organsation of healthcare services.
. 1926 royal commision on national health insurance reccomended a regional struture for healthcare + compu;sory.
.1930s private hospitals tried to lobby for gov funding.
. voluntary hospitals commisions of 1935 said gov should merge local authority hospitals + voluntary together.
. 1937 report on british health servides reccomended a regional model (based on central gov planning)

Question 5

Overall what was the general favor for gov consensus into healthcare during itnerwar.

Answer 5

favour of governent planning and co-ordination of regional health services

Question 6

What happened to government role into healthcare provision following ww1?

Answer 6

. in 1919, gov established a new ministry of health (resposible for co ordinating health at a regional level).
. this ministry adminstraed funds raised by national health insurace scheme.

Question 7

How was combined efforts from gov and indepdeant ministries efficeint in reducing number of TB cases?

Answer 7

. TB was a huge issue/deathly after WW1.
. The ministry of health ACT 1919, created a medical research council (publicly funded) to research into tb + other things.
. The TB act of 1921 made the provision of TB sanatoria COMPULSORY for local authorities.
. Due to this, tb cases declined from 1920 onwards.

Question 8

What was the local government act of 1939

Answer 8

.by neville chamberlain (minister of health), SUPER IMPORTANT!

. gave responsibility of poor law hospitals to county/bourough councils.
. allowed county/bourough councils to convert poor law inirmaries (which only served poor into public hospitals).
. gave local authorities repsoiblilty for other areas of public health (child welfare, dentistry, meals etc)

Question 9

what did the 1929 local government act lead to?

Answer 9

healthcare on a regional basis.
. enabled local authorities to provide medical services to entire population of area.

. but did not lead to cheap/modern healthcare.

Question 10

However, despite these 1920s reforms, what was healthcare/ilness still like?

Answer 10

despite 1920s reforms, less than half the population was insured against ilness.

. afforable health services for poor did increase, but uninsured ppl had to rely on private health insurace.
. in deprived sreas of britian, extreme poverty/hunger led to ilness death!

Question 11

What was healthcare like in the depression?

Answer 11

depression focused debate on the best way to provide healthcare.
. in 1930s new consesus that existing privsiion was innefficent and quality was varied.
. healthcare ministers stillf avoured a regional approach rather than national service.

Question 12

what were some innovations in healthcare during the 1930’s?

Answer 12

. new things were learnt about diet anf fitness during ww1!!!
. the ministry of healthy priotiry was hospital funding- but new innovative experiments (improving hygeine/diet_ began in local authority hospitals.
. focused on preventative healthcare.

. example was finsbury health centre (techonplgically advanced, modern public health centree)

Question 13

How were infant mortality rates an indicator of healthcare improving between 1929-1939?

Answer 13

it seemed that hleathcare was improving from 1929-1939, as infant mortality began to decline, dropped from 14.3 (per 1000) in 1906, to 12 in 2936.

Question 14

however, how was healthcare still affected by areas in extreme poverty.

Answer 14

. in 1920’s/1930’s maternal mortality rates 50% higher in low income grps than middle class.
. middle class men lived twelve years longer than working class men!!!!

. british healthcare was lagging behind healthcare in australia/new zealend, and it was poor/badly regulated and did not plan co ordinated responses.

Question 15

What discussions were beginning to happen in 1939?

Answer 15

talks of a national system of healthcare (however only took WW2 for this to happen)

Question 16

what did ww2 do for healthcare?

Answer 16

WW2 led to a nationwide emergency healthcare system and plans of a new consensus…
they knew there would be lots of casualities, so they planned before the war.

Question 17

What was the emergency medical service?

Answer 17

founded in 1939.
. provided first aid/casuality clearing stations for people wounded in air raids.
. gov dictated hospitals activities.
. 39-40 a national service was created in anticipation of german attacks.

. led to resources/ skills, expertise pooling— national system.

Question 18

how did war lead to a change of attitude in the system?

Answer 18

before doctors/adminstrators were independant og government, however the additional funding + power of gov was popular.
in 1941 medical planning research (200 doctors) devised a plan for nationwide health services.

Question 19

what were negotions on a national health service from 1942-1944?

Answer 19

. creation of a post war healh system requirred negotions between government, hospitals, doctors (BMA).

. The gov established a white paper on health in 1944, recommending a new system paid from general tacation.
. by end of ww2 huge shift in thinking (w all 3 parties committed to state provided healthcare).

Question 20

What steps were being taken post war to create a NHS?

Answer 20

. 1945 there was clear political consensus behind creating a national health service (NHS). . both conservatives + labours promised to create one in their manifestos
. bevan, new minister of health, worked towards creating the NHS.

Question 21

What was the national healthcare service act of 1946?

Answer 21

. said that NHS would be created saying:
. healthcare would be universal/available to all.
. Healthcare is comprenshive and NHS would offer, mental/physical care, hospital care, dental, opiticians, GP’S and more.
. healthcare would be free (patients would not pay at point of delivery, but would be paid through taxation)

Question 22

what was the creation of an NHS causing a shift

Answer 22

shift from regional to national healthcare.

. all existing hospitals nationalised (local authority/voluntary/private) merged into one system.
. nhs hospitals, run by regional hospital boards, with local health authorities providing services like vaccinations/ambulances/nursi

Question 23

What troubled was bevan facing with getting BMA to agree with his NHS, and how did he fix it?

Answer 23

until NHS ACC CREATED IN 1948, bevan had trouble getting co-operation of doctors, he agreed that:
. consultants were allowed to continue working privately + allocated beds in hospitals for private patients
. GP’s were able to avoid becoming local authority employees and dint have the same pay.
. regional health boards also appointed and were dominanted by upper middle class consultants.

the BMA then agreed to support the srvice, but it meant that NHS was run by pribelaged groups.

Question 24

When was the NHS created

Answer 24

July 5 1948 😏

Question 25

what was the early NHS like?

Answer 25

. tripartite system with: . hospital tiers (accident/emergency/er) . primary care: dentists, opticians, pharmicts, GP'S). Sold their services to NHS for profit. . Community services (vaccination/health education/ambulances/midwives--- not directly run by nHS but local authorities. creation did not inittially create equal healthcare- as relied on previous infrastructure (places geographically in certain richer areas)

Question 26

How did the NHS develop from 1951-1979?

Answer 26

. macmillans consevative gov introduced the 1962 hospital plan which renovated/created new hospitals: . created 90 new hospitals . modernsiated/redisgned 134 hospitals . refurbished 360 hospitals . keith joseph introduced the NHS reorganisation act in 1973, which introduced a new managment structure of NHS (groth in costs). . a resource allocation working party established which identified areas of health deprivation and gave additonal resources for diff communities.

Question 27

What happened with NHS spending throughout 49-79/

Answer 27

spending on NHS increased under labourconservative parties (and it grew as a percentage of GDP)

Question 28

what was the impact of NHS to 1979?

Answer 28

. improved physical health of nation as mortality rate declined. . however the treatment did reflect inequalities in society as middle class ppl bettee treatment than working class +men better treatment than women. . less improvements in mental health than physical health

Question 29

what positive impact did the NHS have on public health?

Answer 29

. improvement!! . life expectancy increased from 65.8 for men and 70.1 for women in 1948, to 71 for men and 77 for women in 1979. . also improved attitudes towards healthcare + role of state.

Question 30

what negative impact did the NHS have on public health?

Answer 30

. improvement were not uniform . 1979 merison report said hospitals got 70% of nhs funding, but other services like surgeries got less. . however within the hospitals surgery/medicine still got more money compared to mental ilness healthcare. . also regional inequalities still seen with investments iin hospitals, for example the 1962 hospital plan. a lot of investment was hospitals in london.

Question 31

how did class impact healthcare still?

Answer 31

. middle class benefitied more from NHS thatn working class. . more hospital investment in middle class areas than working class. budget favored middle class areas. . some hospitals in middle class areas got around 5 pounds per head, while working class 3 pounds. . this regional difference problem continued through 70's.

Question 32

What was the black report (published in 1980) say about healthcare?

Answer 32

. said the gap between middle class/working class healthcare GREW from 1848 onwards... . working class women twice as likely to die from childbirth compared to middle. . unskiledd working men twice as likely to die before reaching 65.!

Question 33

how did the NHS impact women, specifically in terms of reproduction?

Answer 33

. gave women greater control over fetility- leading to declining birth rates. . women in 1920 had 2 children, women in 1960 had 1.3 children. . free contracpetion only avaiable from 1970 onwards, new education privded+ contraceptive pill in 1961 led to fewer babies. however early contraceptive pills increased cancer/stroke, also availbility meant that men could take control over their women.

Question 34

how did the NHS impact women, specifically in terms of abortion?

Answer 34

1967 abortion act had mixed impact. . u could temrinate pregnancy w two male DOCTORS. . medical staff could also refuce abortions if they wanted. . acess to these abortuions controlled by medical professionals `(subhective). . from 1968-78, 1.5 million abortions happened but 58% in private sector. . abortions easier for middle class women

Question 35

how did the NHS impact women, specifically in terms of childbirth?

Answer 35

made childbirth in hospital the norm. . in 1950s only 60% gave birth in hospital by 1978 increased to 97% . however, some feminist writers say medicalisation of childbirth shifts power from women to men (as male doctors controled birth).

Question 36

How did the creation of nHS impact women in the workplace

Answer 36

. created opportutnities for women in workplace but not full equality. . expansion of nhs created more 'caring' jobs in healthcare, taken bu women. . for example 1948, 54,000 female nurses recruited by government. . women were still restricted to lower paid jobs (black women experience was even worse).

Question 37

what was the 1959 mental health act (under NHS):

Answer 37

by 1957 there was concern nhs wasnt treated mental illness enough. led to 1959 mental health act which said: . new terminolagy- mentaly ill instead of insane. . decisions to force treament on mentally ill ppl was made by MENTAL HEALTH TRIBUNALS, not judges (tribunals protected patients). . there was an open door policy, pateints could attend treatment in daycare centres as well- not just hospital.

Question 38

what was the impact of the 1959 mental health act?

Answer 38

/allowed patients to drop in and out (not just be hospitalized contantly), seen in the 1962 hospital plan act how 50% reduction in beds for mental illness. however reforms in this act not enough because by 1974: . only 15% of daycare placesneeded were abaible . only 33% of hospital places needed abailable

Question 39

what did the lack of enough impact of the 1959 mental health act lead to?

Answer 39

. mental health patients admitted to non specialist hospitals. . stigma with mental health issues didnt dissapear- and cruel treatment still occured. . there was a report into the abuse and it reccomended introducing hospital inspections. . showcased how there was still imrpovement needed for provision of healthcare for mentally ill. . two white papers (published 1971 and 1975) recognized ongoing problems- but no major reform until early 1980s.

Question 40

What were some challenges of NHS in terms of its own sucess)

Answer 40

between 1945-79 advamcnetets created challenegd for NHS victim. for example NHS was lowkey overachieving. . effectiveness of its hospitals led to increasing expectations . longer lives led to an aging population w more complex needs . medical advances meant nhs had to perform new procedures NHS under increasing pressure.

Question 41

How did the sucess of nhs impact prescription drugs and medicine demand?

Answer 41

. free healthcare led to an increase in demand of prescription drug... june 1948 there were 6.8 million prescriptions disepsned... rose to 13.9 in septemeber 1948. . from 1949-1964, there were more medicines being avaliable (leading to an increase in NHS drug cost (spent 250% more). . vaccinations also increased scope of NHS provision (from only smallpox, to TB, diptheria and more)

Question 42

what were some problems of nhs in terms of spending/funding?

Answer 42

by 1964 there was support of nhs but also serious problems. . little investments in modernising nhs hospitals and there was increasing demand as well for resources of nhs (1060s). . spending on nhs increased at higher rates (increase 3% per year from 1960-1075). but it acc grew 4.5%, meant yes goods tuff happeneing.. but in time of economic crisis!wh

Question 43

what were some improvements with treatments/technology and staffing by the nhs in the 1960s/1970s.

Answer 43

. high tech medical eqipiment led to new challneges as hight ech medicine meant speicalist staff needed. from 1960s nhs provided kidney disalsisys catheters organ transplant required expensive tecnology and new specilised staff. number of nursing staff/consultants increased by 66% from 1964-1979.

Question 44

how did an aging population affect nhs demands?

Answer 44

older people tend to have more health needs.... in 1951 there were 7 million ppl retirmewnt age (rose to 9 million in 1971)/ 1970s started offering hip replacmenet surgery 1979 the nhs performed 24,000 hip replcements.

Question 45

what major surgery started being performed/advamcnets in nhs

Answer 45

from 1964-1979 nhs performed . around 800 kindey transplants per year . 8000 heart bypass operations they were time consmuming and expensive

Question 46

What was going on with contraceptives within the nHS?

Answer 46

the 1967 family planning act increased scope of nhs services as made it avakaible to all wome ragardnless of miratil status. IT WAS REVERSAED BY CONSERVATIVES IN 1972, BUT REINSTATED BY LABOUR IN 1974.

Question 47

What crisis was occuring the the NHS during the 1970s

Answer 47

facing series of issues... . growing demand for nhs service due oto incresse of their amount of treatments + growing age. . recngition that nhs failed to deal w health inequalities . economic crisis made large increases in fudning inlikely . from 1974-1978, see a collpase ine conomic confidence (cant support nhs forever) . however nhs was protecte dby widespread public consensus that said it was super important.