Theme 2 b 1 - Health provision, 1918-45 Flashcards
(43 cards)
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<p>In a summary- what was health care provision like during the interwar years?</p>
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<ul> <li>It was <strong>patchy</strong>.</li> <li><strong>Local health authorities</strong> had <strong>varying responsibilities </strong>and <strong>operated some hospitals</strong>, as did <strong>charitable institutions.</strong></li> <li>Many<strong> employees were covered</strong> by<strong> health insurance </strong>but their <strong>families often were not</strong>.</li> <li>Much<strong> healthcare was private</strong>; one paid to see a doctor and paid for the treatment recommended.</li> <li><strong>Healthcare </strong>overall seemed to be<strong> improving</strong>.</li></ul>
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<p>What did the Liberal government introduce in 1911?</p>
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<p>Who was it for and who did it only apply to?</p>
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<ul> <li>Introduced a system of<strong> compulsory national health insurance</strong> for <strong>low-paid employees</strong> earning under<strong> £160 per year</strong>. They and their employees paid into the scheme which <strong>provided sick pay</strong> and <strong>free medical treatment</strong>.</li></ul>
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<ul> <li>Only applied to <strong>wage earners </strong>and the <strong>unemployed </strong>and <strong>families of wage earners</strong> were<strong> not provided for </strong>under the scheme.</li></ul>
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<p>Healthcare- 1918</p>
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<p>Who paid for the costs of the healthcare for the poor?</p>
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<p>What did the Poor Law do?</p>
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<ul> <li>There were <strong>numerous private charitable</strong> and <strong>philanthropic groups </strong>that <strong>paid the costs</strong> of healthcare for the poor.</li></ul>
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<ul> <li><strong>Poor Law</strong>- provided for some degree of<strong> medical care </strong>with<strong> Poor Law Hospitals.</strong></li></ul>
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<p>Healthcare- 1918</p>
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<p>What did <strong>workhouses</strong> often have and what were many converted into?</p>
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<p>Often had their <strong>own infirmiries</strong> and many of them <strong>converted completely into hospitals </strong>once their use as effective prisons for the poor became obsolete.</p>
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<p>Healthcare, 1918-1939</p>
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<p>Why was this period significant for the development of healthcare?</p>
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<ul> <li>A <strong>consensus emerged</strong> between <strong>medical professionals</strong> and <strong>policy makers</strong> about <strong>what was wrong </strong>with the <strong>existing system</strong> and about the <strong>goal of reform.</strong></li></ul>
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<ul> <li>Secondly- there were<strong> significant government reforms.</strong></li></ul>
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<p>Healthcare consensus, 1918-1939</p>
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<p>In the interwar years, what was the widespread consensus?</p>
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<p>Widespread consensus that the <strong>government </strong>should play a <strong>leading role</strong> <strong>co-ordinating provision</strong> and that <strong>more money should be spent on <u>healthcare</u>.</strong></p>
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<p><strong>Healthcare consensus, 1918-1939</strong></p>
<p>It was believed that the government had a role to play in encouraging medical advance.</p>
<p><strong>What did this specifically include?</strong></p>
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<ul> <li><strong>Invest</strong> in <strong>research</strong>.</li> <li><strong>Invest </strong>in <strong>medical training</strong>.</li> <li><strong>Organise a national network</strong> of hospitals.</li> <li>Play a role in <strong>rationing healthcare.</strong></li></ul>
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<p>Healthcare consensus, 1918-1939</p>
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<p>What did the Fabian society advocate before 1918?</p>
<p>What did Fabians believe?</p>
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<ul> <li>Advocated <strong>centralising healthcare provision.</strong></li></ul>
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<ul> <li>Fabians believed that <strong>centralised</strong>, <strong>state-planned healthcare</strong> was the <strong>only way to significantly improve healthcare</strong> for all in Britain</li></ul>
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<p>Healthcare consensus, 1918-1939</p>
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<p>In 1919 what did the Labour party become the first British political party to advocate?</p>
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<p>Advocate a <strong>free </strong>and <strong>comprehensive </strong>national health service!</p>
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<p>Healthcare consensus, 1918-1939</p>
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<p>What did the British Medical Association (BMA) advocate?</p>
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<p>Advocated a regional system of healthcare, co-ordinated by central government.</p>
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<p>Healthcare consensus, 1918-1939</p>
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<p>What did the government commision in 1920 and what happened as a result?</p>
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<ul> <li>Commissioned a <strong>study</strong> into the <strong>organisation </strong>of the <strong>health services</strong>.</li></ul>
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<ul> <li>The resulting <strong>Daweson Report</strong> reccomended a <strong>network of state-funded </strong>and <strong>state-organised</strong> hospitals.</li></ul>
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<p>Healthcare consensus, 1918-1939</p>
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<p>What did the 1926 Royal Commission on National Health Insurance reccomend?</p>
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<ul> <li>Reccomended a <strong>regional </strong>rather than a <strong>national </strong>structure for healthcare.</li></ul>
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<ul> <li>The commission reccomended a <strong>compulsory health insurance scheme</strong> to fund a <strong>unified national health insurance service</strong>.</li></ul>
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<p>Healthcare consensus, 1918-1939</p>
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<p>During the 1930s- what happened to private and voluntary hospitals?</p>
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<p>They lobbied unsucessfully for government funding!</p>
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<p>Healthcare consensus, 1918-1939</p>
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<p>What did the Voluntary Hospitals Commission of 1935 argue?</p>
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<p>Argued that the government should <strong>merge voluntary hospitals</strong> and <strong>local authority </strong>hospitals in order to <strong>bring together expertise </strong>and <strong>finance</strong>.</p>
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<p>Government reforms, 1919-29</p>
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<p>What did the government establish in 1919?</p>
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<p>What was it responsible for?</p>
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<ul> <li>A <strong>new ministry of health</strong>.</li></ul>
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<ul> <li>Responsible for<strong> co-ordinating health</strong> at a regional level. Additionally it <strong>administered funds</strong> raised by the national health insurance scheme.</li></ul>
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<p>Government reforms, 1919-1929</p>
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<p>Who was the first minister of health and what was he involved in?</p>
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<ul> <li><strong>Christopher Addison</strong>, an <strong>academic</strong> and <strong>medical doctor </strong>who played an important role organising <strong>medical care for troop</strong>s on the <strong>western front</strong> in WW1.</li></ul>
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<ul> <li>He was a <strong>strong advocate of regional health services.</strong></li></ul>
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<p>What was the most serious public health problem in the immediate aftermath of WW1?</p>
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<p>The deadly disease- tuberculosis.</p>
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<p>Tuberculosis</p>
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<p>What had the government set up before the war to slow the spread of the disease?</p>
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<p>TB sanatoria funded by national insurance.</p>
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<p>Tuberculosis</p>
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<p>What did the Ministry of health act 1919 create and why was it established?</p>
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<p>The Medical Research Council (MRC) which was established in order to research the causes of TB, led by Lord Richard Haldane.</p>
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<p>What was the Medical research council?</p>
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<p>The council was an <strong>official, publicly funded body </strong>but <strong>independent of government control</strong>- ministers had no power over the MRC's medical or scientific findings.</p>
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<p>What did the tuberculosis act of 1921 do?</p>
<p><br></br>What happened as a result?</p>
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<ul> <li>Made the <strong>provision of TB sanatoria</strong> by<strong> local authorities compulsory.</strong></li></ul>
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<ul> <li>As a result of <strong>co-ordinated action</strong>, the <strong>number of cases of TB declined in every year between 1920-1938.</strong></li></ul>
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<p>Who was the Local Government Act, 1929 steered through parliament by?</p>
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<p>Minister of health, Neville Chamberlain!</p>
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<p>What did the Local Government Act, 1929 do/ pass?</p>
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<ul> <li><strong>Passed responsibility</strong> for<strong> Poor Law hospitals </strong>to <strong>county</strong> and<strong> borough</strong> councils.</li> <li>Allowed county and borough councils to <strong>convert Poor Law infirmaries</strong>, which only served the poor, into <strong>public hospitals</strong>.</li> <li>Gave <strong>local authorities responsibility</strong> for other areas of public health such as the<strong> running of venereal disease clinics</strong>, <strong>child welfare, dentistry</strong>,<strong> school medical services</strong> and <strong>school meals.</strong></li></ul>
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<p>What did Chamberlains <strong>Local Government Act, 1929</strong> lead to and create?</p>
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<p>Why was this a <strong>vital moment </strong>in the <strong>history of healthcare</strong> in <strong>Britain</strong>?</p>
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<ul> <li>It led to the <strong>reorganisation</strong> of <strong>heathcare</strong> on a <strong>regional basis</strong>. It created a <strong>single health authority</strong> that <strong>co-ordinated healthcare</strong> in each <strong>county</strong> or <strong>borough</strong>.</li></ul>
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<ul> <li>It enabled local authorities to <strong>provide medical services </strong>to the <strong>entire population</strong> of the area. However, it<strong> didn't</strong>lead to <strong>cheap</strong>, <strong>modern healthcare</strong> for all.</li></ul>
Healthcare in the depression
In spite of the healthcare reforms of the 1920s, how much of the population was insured against illness in 1929?
Less than half the population!
Healthcare in the depression
What health services increased in importance following the onset of the Great Depression?
Affordable health services for the poor!
Healthcare in the depression
What were uninsured people forced to rely on?
What happened in the most deprived parts of Britain?
- Forced to rely on private health insurance, which in many cases did not pay out enough to cover medical costs.
- Extreme poverty and hunger led to higher incidences of illness and, in some cases, premature death!
Healthcare in the depression
During the 1930s, what was the new consensus?
What did healthcare professionals and ministers continue to favour?
- New consensus that existing provision was inefficient, varied widely in terms of quality, and failed to meet the medical needs of all patients.
- Continued to favour a regional approach to these problems, rather than creating a national service. Nonetheless, at a local level, individual hospitals provided innovative care.
Innovations in heathcare
Why were there a number of innovations during the 1930s?
What was the ministry of healths priority?
- Partly as a result of what had been learnt about diet and fitness when training troops in the First World War, new advances in preventative healthcare occured.
- Priority was hospital funding, but local authority hospitals began innovative experiments in preventative health, focussing on improving diet and hygiene.
Healthcare by 1939
What happened to public health between 1929 and 1939?
What were key indicators?
It seemed to be improving!
- Infant mortality were in decline.
- Infant mortality in England and Wales dropped from 14.3 in every 1,000 between 1906 and 1910 to 12 per 1,000 between 1936 and 1938.
In the 1920s & 1930s, what were maternal mortality rates like in low income groups compared to the middle class?
They were 50% higher in low-income groups!
In the 1920s and 1930s, on average, how many more years did middle-class men live compared to working-class men?
12 years longer!!!
In the 1920s-1930s, on average, how many more years did middle-class women live in comparison to working-class women?
19 years longer!
At the end of the 1930s- Politcial and Economic Planning, a think-tank established in 1931 to monitor health policy argued what?
- Argued that British healthcare lagged behind other developing countries. Compared to healthcare in parts of the British Empire such as Australia and New Zealand, it argued that overall British healthcare provision was inefficient, poorly co-ordinated and badly regulated!
- It pointed to the failure to organise a co-ordinated response to a typhoid outbreak in Croydon in 1937, which led to the deaths of almost 50 people!
The impact of WW2
What did WW2 result in the establishment of?
What did the threat of air raids result in?
- A nationwide emergency healthcare system & the emergence of a new consensus.
- Threat- which planners in the mid 1930s predicted would lead to millions of casualties, resulted in detailed planning before the war about how to care for the wounded.
The Emergency Medical Service
When was it founded?
1939
The Emergency Medical Service
What was it founded to do?
Provide first aid & casualty clearing stations for people wounded in air raids.
The Emergency Medical Service
What did it allow the government to do?
What had been created between 1939 & 1940?
- Dictate a hospitals activities - a power it had previously never possessed.
- An entire national service had been created in anticipation of German attacks.
The Emergency Medical Service
What did it result in a pooling of?
- Resources, skills and expertise and the creation of a national system!
- Very quickly- government planners adopted the national framework as the basis for plans for a post-war healthcare system.
The Emergency Medical Service
How did the war lead to a change in within the medical profession?
Previously- many doctors & hospital administrators had preferred to stay independent of government.
However- the central organising power of the state - along with additional funding proved attractive!
The Emergency Medical Service
Did consensus in favour of a national state run system emerge immediately?
What happened in 1941?
No!
1941- Medical Planning Research, a group of 200 doctors, endorsed provisional plans for a nationwide health service.
Negotiations 1942-44
The creation of a post-war health system required intense negotiation between who?
Were the groups willing to collaborate? What were they concerned about?
- Doctors represented by the British Medical Association (BMA), and managers of local authority, private and voluntary hospitals.
- Were willing to collaborate but were also concerned about the loss of autonomy that a national state-run health system required.
The Emergency Medical Service
What did the government publish in 1944 & what did it reccomend?
- Published a White Paper on health- reccomending a new national system paid for from general taxation.
- By end of WW2- huge shift in thinking about healthcare. All 3 main parties committed to state-provided, centrally funded healthcare.
