The Rise of State Medicine 1870 – 1918. Precursors to the NHS. 1919-1939. Developments in the interwar period.

The Rise of State Medicine 1870 – 1918. Precursors to the NHS. 1919-1939. Developments in the interwar period. www.phwiki.com

The Rise of State Medicine 1870 – 1918. Precursors to the NHS. 1919-1939. Developments in the interwar period.

Casey, Mark, News Director has reference to this Academic Journal, PHwiki organized this Journal The Rise of State Medicine Lecture 7 Cradle to Grave 1870 – 1918. Precursors to the NHS. 1919-1939. Developments in the interwar period. 1939-1948. The emergence of the NHS. John Pickstone’s mode of the British Health Care system. Medical charity Medical charity continued to play a vital role in health care up until setting up of NHS – especially voluntary hospitals. By early 20th century many patients paid directly as long as care or paid as long as by insurance scheme, often run by a Friendly Society or charitable organisation. From the 1870s voluntary hospitals were under growing financial pressure – concerns about losing subscriptions After introduction of NI increasingly took seriously ill patients referred by GP in addition to became more specialised. Still treated large number of poor as out-patients.

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Poor Law Poor Law of course was a as long as m of state medicine, funded by local poor rates. Increasingly Poor Law provided better st in addition to ard of care, especially infirmary provision in major towns in addition to cities. 1929 Local Government Act abolished the Boards of Guardians – responsibilities transferred to local authorities. MOHs power increased as they assumed control over general hospitals. Workhouse also abolished in 1929. Haslingden Workhouse in addition to its board of guardians – later became Rossendale General Hospital Public health began to emerge as a national concern. Problems identified by reports by Rowntree, Booth in addition to Snow. State increasingly called upon to legislate to protect people’s health – town planning in addition to sanitation, housing in addition to working conditions. New focus on prevention as well as cure – believed it depended on medicine in addition to state working h in addition to -in-h in addition to . Medical focus shifted from filth diseases (cholera & typhoid) to infectious diseases (TB). Increasingly close working relationship between state in addition to medicine through rise of public health. Public health became ever more important as concerns about national efficiency grew in the years be as long as e World War 1. Provided access to GP services via a panel doctor. Three types of benefit: sickness, accident in addition to disability, in addition to pension Financed by contributions from employer, employee & state Administered through ‘approved mutual societies’ Benefits limited to the contributor (worker) – mainly men. Maternity pay provided as long as working men’s wives. Free hospital treatment provided as long as patients with TB. Proved extremely popular with the public. However: Only 10% of women worked in occupations that were eligible. Women in addition to children were not covered outside maternity services. Cost of hospital care not included. The act was met with concern from medical practitioners who feared the impact on their private practice.

‘The Dawn of Hope’, The National Insurance Act of 1911 National Health Insurance introduced in 1911 Interwar period 1919 Ministry of Health created – took responsibility as long as care of mothers in addition to children in addition to infant life protection, supervised local authority health services. The Dawson Report of 1920 put as long as ward ambitious plan as long as integration of preventive in addition to curative services – recommended a two tier system of GP in addition to specialist health centers. 1920s in addition to 1930s local authorities ran large range of services – infant in addition to maternal welfare clinics, VD clinics, TB clinics in addition to sanatoria. Local authorities also became responsible as long as environmental health, clean food in addition to milk, refuse removal, clean air, river in addition to water pollution.

The Peckham Experiment Finsbury Health Centre Medical facilities available at a modern health centre contrasted with ill health in old-fashioned housing. Colour lithograph after A. Games, 1942.

Socialist Medical Association – left wing doctors who called as long as a free national health service administered by local authorities. 1937: report by the Political in addition to Economic Planning Group on British health services. Recommended a central role as long as GPs in addition to a coordinated specialist system backing up primary care. Emergency Medical Services – This was founded to deal civilian bombing casualties -hospital beds, casualty clearing facilities in addition to specialist hospitals. Regional coordination directed by the Ministry of Health. Breakthrough in organization in addition to experience – critical in accelerating plans as long as a national health service. The Beveridge Report Recommended a comprehensive social security system in addition to health care service. Health care should be available to all regardless of their ability to pay. Proposed that doctors should be employed directly by the state. More generally, the report recommended that the government should find ways of fighting the five ‘Giant Evils’ of ‘Want, Disease, Ignorance, Squalor in addition to Idleness’. http://www.bl.uk/onlinegallery/takingliberties/images/712beveridgereportbig.jpg

‘To ensure that everybody in the country – irrespective of means, age, sex, in addition to occupation – shall have equal opportunity to benefit from the most up to date medical in addition to allied services available to divorce the case of health from questions of personal means in addition to other factors irrelevant to it; to provide the service free of charge in addition to to encourage a new attitude to health – the easier obtaining of early advice on, the promotion of good health rather than only treatment of the bad’ (MOH, 1944, p.47) Labour Party election posters (1945) Objected to the concept of a salaried service. Objected to Local Authority control. Fear that would threaten clinical freedom. Echoed control of Poor Law in addition to Friendly Societies. Wanted an enhanced role as long as voluntary hospitals in addition to consultants. Members of the BMA dressed up as Gladiators facing Bevan (aka. Nero)

Hospitals: Voluntary in addition to local authority hospitals were nationalised – managed by regional boards. Local authorities – health centres, clinics, health visiting, ambulances. GP, dental in addition to optician services – operated on an independent contractor basis; administered by Executive Councils. The NHS came into being on 5 July 1948. Care was free at the point of delivery. Free dental care, free spectacles, free consultations with a GP, referral to hospital in addition to free treatment.

20th century : ‘great troika of progress – science, profession, state’ 1900-1948 – Productionist focus on health of the industrial worker in addition to the armed services – resulted in National Insurance. 1948-1970 – Communitarian NHS – expansion of services, focus on social inclusion Rise of the professional 1970-2000 – Consumption Renewed emphasis on market in addition to lay management of health services. Medicine is serving consumers who dem in addition to more in addition to more. Turn of the 20th century: trans as long as mation in public in addition to official expectation – notion of state intervention in health gained ground. National Insurance Act 1911 marked a significant extension of medical in addition to state involvement in the health of the nation. The NHS greatly extended the reach of organized medicine in addition to encouraged those who had previously been too poor or reticent to come as long as ward as long as consultation/treatment. Overall shift in perception of medicine as part of free market, governed by ability to pay to becoming a right as long as all citizens ‘from cradle to grave’.

Casey, Mark KNAZ-TV News Director www.phwiki.com

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