1.2.b

What were the shortcomings of healthcare provision

What were the shortcomings of healthcare provision in 1918? Make a list of the problems and who they affected.

Dependence on the wealth of the individual - poorest suffered/ died from ineffective self-medication/ dependence on Friendly Societies were unregulated
National Insurance Act of 1911 - only applied to certain workers/ didn't cover dependants
Lack of political will to take on the complexity of the healthcare problem/ vested interests of doctors/ Friendly Societies
Muddle of state/private provision (different agencies incl. Poor Law/ PHAs/ Educational authorities)
MoH (c.1919) - lacked authority/ political will
Medical authorities still in the remit of other authorities e.g. School Medical Service/ Factory Health Inspectorate
1926 Con. failed to act on a Royal Commission reccomendation to scrap/reform health insurance
Friendly societies - too smal to afford members' hospital treatment/ bankrupt/ no insurance/ duplication of roles
Lack of adequate hospital provision - best were teaching hospitals in London

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What changes came about in the provision of healthcare before the Second World War?

Ministry of Health (c.1919)
1911 National Insurance Act -
1929 Local Government Act - public health committees run by local councils/ county boroughs
1934 - Free/subsidised milk - provided by local authorities to children at school
1938 - National system of blood transfusion depots near hospitals
1939 - Emergency Medical Service
1944 - White Paper 'A National Health Service' - accepts Beveridge's 1942 report

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Explain the ways in which the Second World War affected health provision.

Growing consensus pre 1939
Pioneering role of post-war Labour government
c. Nationally funded organisations to deal with expected casualties: blood transfusion depots (1938) -> National Blood Transfusion Service (1946) also Emergency Medical Service (1939) helped by national funding.
Growth of new technologies/ treatments avaliable (burns by plastic surgery, kidney trauma and broken bones.
Beveridge Report (1942) -> 'A National Health Service' White Paper (1944) -> National Health Service Act (1946)
Rationing improved health/ government propaganda promoting healthy habits.

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What initial problems were faced by the Labour government when they introduced the NHS?

Doctors' resistance to working as state employees ('stuffing their mouths with gold')1
1948: 90% of the BMA voted against working in the NHS - 'underming clinical dependence'
Concern over income (so, Bevan granted fees/ patient in lieu of a direct salary/ keeping private patients)
A range of diseases associated with old age increased in prevalence due to longer life expectancies, also heart disease, cancer and arthritis.

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Why was the NHS more expensive than its founders had expected?

Expected cost to fall after 1948 as people got healthier/ access to preventative care increased/ access to economies of scale but:
- Advances in medical science - increase in treatments
- Higher expectations/ demands - dependence/ 'dandruff syndrome'
- Backlog of cases - hard to reorganise old system (of GPs/ hospital specialists/ Public Health Authorities)
- Staff employed - doubled from 500,000 (1948) to >1m (1979)

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