and replaced by the new hospital in 2010.
It is one of the largest single-site hospitals in the UK
After the Boer War, a Committee on Physical Deterioration (1903) was created to study Britain’s health, to determine why so many army men were ill. This Committee promoted the 1906 Liberals’ reforms in public health, including the first National Health Insurance scheme (1911). Not universal in coverage to be sure, but a modest start.
Then examine the Minority Report of the Royal Commission on the Poor Law in 1909. Headed by socialist economist Baroness Beatrice Webb, the report urged a new system to replace the Poor Laws that had existed since the Victorian workhouse era. Victorian politicians had upheld a narrow-minded approach, expecting the impoverished to be totally accountable for themselves. So the Report was unsuccessful; its ideas were disregarded by the new government.
4 years of WW1 ravaged British society, greatly increasing morbidity and mortality rates. So the Interwar Period pushed the government into reorganising public healthcare. The Ministry of Health Act was passed in 1919, giving Britain its first-ever Health Minister! In the interwar era, specialist clinics were established to treat disease and to advise on nutrition and fitness. And breakthroughs were made in treating pneumonia. Britain recognised the need for greater government involvement, to improve social security and public health.
The 1929 Local Government Act dissolved Poor Law Unions, establishing Public Assistance Committees in the County Councils instead. By integrating medical services, the LGA allowed for many old infirmaries to be developed into general hospitals with acute care. And in 1930 London County Council took over responsibility for 140 hospitals & medical schools, after the Metropolitan Asylums Board ended.
The Emergency Health Service/EHS was created in 1938. Pre-WW2, the EHS was tasked with planning for possible mass bombing of cities. It revolutionised healthcare in Britain, mainly by requiring all hospitals and clinics to coordinate for the first time eg sharing supplies. Thus the British government was learning from evolving wartime healthcare practices.
The book Fighting Fit charted the development of Britain’s public health measures in WW2. It began in 1939 with the threat to Atlantic convoys, dealing with rationing and ended in 1947 when Regulation 33B (re control of venereal disease) was repealed before the National Health Service Act started. To keep Britain war fit, the government mobilised adults in its services eg to supply blood transfusion service.
Churchill’s stirring speeches ran throughout Fighting Fit as the P.M (1940-5) saw the strategic importance of improving Britain’s health. It was not surprising that the NHS inherited important elements of wartime projects: co-ordinated hospitals, national pathology, integrated blood-banks.
Sir William Beveridge was asked to investigate British social security and in Dec 1942, the Committee’s Report on Social Insurance and Allied Services identified 5 major issues in British society: want, squalour, ignorance, idleness and especially disease. Each issue played a major part in establishing the Welfare State post-war & in the creation of the NHS. There was a growing consensus that the existing health insurance system should be extended to include dependents of wage-earners and that private hospitals should be integrated. The Beveridge Report finally made its final recommendations, supported in Parliament by all parties.
Eventually the Cabinet endorsed the White Paper proposed by Minister of Health Henry Willink in 1944, setting out NHS guidelines eg how it would be funded from general taxation and not national insurance. Everyone was entitled to treatment and it would be provided free at point of delivery.
Alas some of the key lessons of WW2 were soon forgotten, especially that to be effective, public health had to consider community, diet, social class, mental health, preventative medicine and workplace health. Presumably this was due to the growing post-war belief that most problems could be solved by modern technology. Plus how many doctors resisted the intrusion of government into medicine?
Aneurin Bevan, Health Minister
Published by The Labour Party.
The Birth of the NHS by Jessica Brain was a great book. The launch of the NHS in July 1948 came from decades of work from those who felt the current healthcare system needed to be revolutionised. It was launched at the Park Hospital Manchester, providing free healthcare and medical services for ordinary families. The NHS’ workers, mainly G.Ps, were paid largely through taxation. But as equipment and technology advanced, financially stability became harder.
All 4 U.K countries provided the following services: hospitals and specialists, local health authorities, GPs and dentists. Since then the NHS has gone through many changes, developing and expanding. In the early years of the NHS, expenditure was already exceeding expectations and prescriptions charges were considered to meet the rising costs. By the 1960s these early adjustments were altered and it was considered to be a strong era of growth for the NHS, especially in drug developments. And new reorganisations occurred in 1974 as the economic optimism of the earlier decade waned. By the 1980s and Margaret Thatcher’s government (1979-90), modern management methods were introduced. But even Thatcher saw the necessity for the NHS to remain a core of British life.
Conclusion
WW2 had a major impact on the development of public health. But not just the war. The NHS created in 1948 marked the most important moment in British social and medical history, with new ideas about health, services, medical ethics and society. Yes it faced crises and economic changes in its 70 years of operation, but the questions of funding and demand still continue.
The History of the NHS by by Geoffrey Rivett
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