UK's National Health Service, slow important development

Queen Elizabeth Hospital Birmingham, originally built in 1933
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 both 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. So it was not surprising that the NHS inh­erited im­portant el­em­ents of wartime organisation: co-ordinated hos­pitals, nat­ional pathol­ogy and 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

A guide to the National Health Service Act, 1946
Published by The Labour Party.
Pinterest

Finally Labour's Clement Attlee became Prime Minister in 1945 and Aneurin Bevan became Health Minister. It was Bevan who campaigned to bring about the NHS in modern form, based on 3 essent­ial values ideas which Bevan expressed in the launch July 1948: 1] that the services helped all citizens; 2] health­care was free and 3] that care would be provided based on need rather than ability to pay.

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 general practit­ion­ers, 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.