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to Atlantic convoys, dealing with rationing and ended in 1947 when Regulation 33B (re control of venereal disease) was repealed before the National Health Service Act started.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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30 comments:
Britain’s journey toward the NHS was shaped by war, social reform, and shifting political attitudes.
What little I knew about the NHS I learnt from watching British TV shows, it is mostly a good system nothing is perfect
Dear Helen! Thank you for the interesting information!
Only know what I've seen on the TV about NHS and what I read on your post. I really hadn't thought a lot about it, however, it's interesting.
On 1 February 1984 Medicare system was introduced, making basic health care for all Australians and introducing Bulk billing in Australia from the very beginning (1984). Medicare also provided free public hospital treatment and covered the cost of treatment by GPs, medical specialists and surgeons.
Why did it take so long to learn from Britain?
While our system is similar, I think the NHS is better and cheaper for the user. I've had terrific treatment under our public health system at no direct cost to me. I've had not so good treatment in the private system at great cost to me, in spite of having top private health insurance. The history of the NHS was known to me, but thanks for the extra detail.
Parnassus
I just want to confirm that your comment was not removed by me, the blog author. I always wait to see if you have an opinion, usually excellent.
roentare
that is quite true. Despite the excellent motivation for a free and equal health service for the entire population, the timing could not have been worse. The Boer War was followed by the War to End All Wars (re deaths, injuries and starvation), then a killer Depression and then the devastation of WW2. The irony is that those world events, outside the UK's control, meant that a free and equal health service was MORE desperately needed, not less.
Jo-Anne
my problem was not that the system was less than perfect. It still is!
Rather that a] one of the most moral nations on earth took such a long time to look after its own needy citizens. And b] that there was constant opposition from wealthy tax-paying citizens to help poorly paid or unemployed citizens.
Irina
with the long delays the National Health Service these days, it frightens me just a little that the wealthy conservatives might again influence the health care for poorly paid families.
Student
You would have thought that Medicare would have started as soon as WW2 ended!! My guess is that conservatives here would never provide medical care at no cost to patients through bulk billing. So Australia had to wait until the Australian Government, under the brilliant P.M Gough Whitlam, introduced Medibank in 1975 (but still facing medical opposition).
Andrew
When Australia had no Medicare in the post-war decades, medical graduates were recommended to spend a few years in British hospitals, doing a House Year, Junior Residency and then Senior Residency. As were the South African and New Zealand graduates.
Joe and all his colleagues were given top quality training in the NHS!
A very interesting post, Hels. Ste and I started watching Call the Midwife last year and I've become fascinated again with the move from workhouses and debtors prisons to the UK we have today. I really appreciated your insight into the period prior to 1948 and how the Boer war started it all. The NHS saved my brother's and father's lives more than once due to diabetic complications.
Margaret
ahhh yes, remember Silent Witness, The Royal, Hospital, Call the Midwife, Doc Martin, Dr Finlay, Casualty, Emergency Ward 10 etc. I wonder how accurately the hospital units were depicted back then.
Mandy
I think we have to stand back from organisations we know well, and examine their historical development from an outsider's perspective. This is especially true when the historical evidence is presented through political eyes.
eg Aneurin Bevan wrote "many local authorities and voluntary bodies, which ran hospitals, objected to the NHS as they feared they would lose control over them. People such as Winston Churchill and many Conservative MPs thought that the cost of the NHS would be too great". Did these fears delay the NHS even further?
Bom dia. Um feliz mês de março, com muita paz e saúde. Obrigado pela postagem e explicações maravilhosas, ricas em detalhes.
Luiz
universal health care is an essential public service that can be offered to all the citizens of a nation in various ways. I looked up the quickest list I could find:
UK, Canada, France, Germany, Norway, Australia, Sweden, South Korea and New Zealand, Belgium, Austria, Bahrain, Denmark, Brazil, Israel and China. More recently, countries like Cyprus and Thailand.
This post makes me want to weep for what we have now. The NHS is no longer fit for purpose. I am sure you will have seen from reading British blogs that ordinary people cannot get appointments with doctors, many only get telephone appointments, we do not have a designated doctor, we have long waiting times on phones, 27 in call queue at 8am is the norm, and often never get to see a doctor, surgeries are closing and doctors unemployed as surgeries cannot pay them. Waiting times for ambulances can be 6 to 8 hours and treatment in hospitals is often in corridors and chairs as no beds are available as we have no system for discharging people into care if they have no care at home. It is called bed-blocking. Sepsis is rampant. The Beveridge report was a cross party White Paper and if Churchill had been elected he would have announced the founding of the NHS. Many lies were told about the Conservatives and the NHS before the 1945 election. As soon as Britain realised what a mistake it had made with a Labour Government they soon lost again at the next General Election in 1951. Many obstacles were put up by the Labour Party to dental and eye care which were eventually overcome with only partial NHS membership which is why we have always had to pay something towards these services. Cancer care is not bad but we are no where near top of cancer care tables across the world and are nearer the bottom.
I can only speak re: my husband's very recent experience. Four weeks ago he had an eye examination with an Optician who said that he needed cataract surgery. Two weeks ago he went for an assessment at the Eye Clinic and this Thursday he had the cataract surgery. All done and dusted within 4 weeks from start to finish.
Rachel
Excluding dental and eye care was horrible, suggesting that these areas of medicine were more cosmetic and voluntary instead of serious and urgent.
I hope that was sorted out !
Rosemary
Thank goodness your beloved's need for cataract surgery was identified quickly and then completely successfully.
The NHS has great concern for young people, I always knew, but it is good to see that older people are being treated in a timely manner as well.
An interesting read about the history of the NHS.
I can concur with Rosmary's comment about treatment. My mum who is 91 has had excellent treatment for her varlious ailments in recent years.
I wonder if the flu pandemic of (well around) 1918 played a role in the forming of the NHS also. Healthcare is not about the individual, it is about society as a whole. This was an interesting read. Thanks Hels. And Happy start of March to you.
Erika
The Spanish Flu was so brutal that it killed 50 million people!! So not only did the 1918 pandemic play an important role in establishing the NHS; in later decades it helped the country identify the new flu strains as they hit. Influenza pandemics in 1957, 1968, and 2009 had much lower levels of morbidity and mortality than 1918!
"Science" showed that technological advances, continued research and vaccine development in the NHS were essential to ensure that such a devastating public health event is not repeated.
https://www.science.org/doi/10.1126/science.aas9565
CherryPie
most people understood that _all_ citizens needed National Health Services in the times of hideous wars and great depressions. But your elderly mum has shown the important of quality health care, in a timely fashion, even in an era of relative peace. Thank you NHS!
I am very familiar with Park hospital in Manchester. Now known as Trafford General, it was the local hospital for my mother, father and brother who all spent many weeks there towards the end of their lives. I have nothing but praise for the NHS. It has saved the life of my daughter on more than one occasion. It is not perfect. It is understaffed and overworked. It needs a complete overhaul of management. But without it we would be in a dire situation.
Fun60
The presence of a universal health care is my way of measuring the morality of a society. And I would never live in a country that only services those who can afford to pay for expensive medical care.
Even if the NHS is not perfect! No doubt you've seen "ambulance ramping" which happens when ambulances have to wait _outside_ hospital Casualty Dept when the wards are full. And because they cannot transfer patients inside in a timely manner, the ambulances cannot respond to urgent calls re new patients :(
Personally I don't see our health system changing much, since we have Trump in office.
peppy
Agreed totally.
But it won't make much of a difference while you still have guns, drugs and no free innoculations to all U.S families. In other words, hospitals are the last level of health care.
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