The National Health Service

The Welfare State

The National Health Service• We will learn:

– What happened before the NHS was created• The 5 stages leading to the creation of the NHS in

1948

– What was the NHS designed to do– Why were some people against the NHS being

formed

• Remember, there is a high chance that this will be a question on paper 2!

• It could also appear on paper 1!

Towards the welfare state

• Before 1948 all health care was the responsibility of private individuals to pay for the care they received.– Some paid into insurance schemes

• Charities and churches did often help with the costs – but somebody had to pay for medicines or

treatments received.

• Government did pay medical costs for the military!

5 Stages towards the NHS

• Pre World War I– 1911 National Health Insurance Scheme

introduced by a reforming Liberal government

• Workers were forced to contribute to a special fund that would help pay if they got sick or were unable to work.

– Although only available to workers! – Not their wives or children!

5 Stages towards the NHS

• World War One– The government had to massively expand

hospitals and medical care for the millions of soldiers mobilised

– Soldiers were promised a “Country fit for heroes” to thank them for their sacrifice

• However, there was little money spare after the costs of war were accounted for.

– But, women were given the vote in 1918

5 Stages towards the NHS

• Inter War Years– The development of the Labour Movement

• Socialist ideology wanted to help working class people.

• It believed in sharing out the resources of the country in an equitable way

– The Labour party gradually gathered in strength throughout the 1920s and 1930s

– The Great Depression of the 1930s showed how vulnerable the poor could be.

5 Stages towards the NHS

• World War 2– Blitz brought the casualties to the civilian

population• Not just soldiers getting injured this time around.

– Coalition government of Labour, Liberals and Conservatives all working together for victory.

• 1942 Beveridge Report– Britain would benefit from a “Cradle to Grave” social

security system» Healthy citizens would be needed to rebuild Britain

after the war.» The report was popular with soldiers fighting and the

civilians at home.

5 Stages towards the NHS

• Post World War 2– Labour Party elected with a huge majority

in 1945• Socialist ideology

– 1946, they proposed creating a National Health Service available to all paid for through national taxation.

– July 5th 1948 the NHS is created!

Arguments for NHS Arguments against NHS

Arguments for NHS Arguments against NHS

Available to all according to need

Sick do not have to worry about paying the bill – less stress

Efficient no insurance forms to fill in

NHS can set its own priorities

Eg Public Health measures,Immunisations, health checks, cancer screening, family planning

Standard contracts?Doctors and nurses have the same pay and conditions

Cost –Expensive treatments may have to be rationed/limited

Unlimited demandThe longer you live, the more medical care you need.

Waiting times for non-emergency operations

Crowd out charities?

Bad for insurance companies

Standard contracts?Doctors and nurses have the same pay and conditions

What does the NHS actually do?

• Hospital service– Priority for medical

emergencies• Paramedic service

• Medicines made available by prescription

• Dental services• Family doctor Service• Ante-Natal services• Post-Natal services

• Vaccinations & Immunisations

• Physiotherapy• Mental Health facilities• Training of doctors and

nurses• Conducts research• Screening• Health Education

– Health warnings

• Family Planning

Opposition to the NHS

Who was against the NHS being set up in 1948?

Opposition to the NHS• Who was against the NHS being set up in

1948?– Opposition tended to come from the right – ie

Conservatives who believed that the free market was the best way of allocating resources. They were mostly worried about the cost

– Many GPs and doctors were also against he idea of standardised contracts (BMA)

– Local authorities were not keen to lose control over local health provision.

• Bevan conceded generous contracts to win over the BMA.

What kills people today?

• What were the biggest killers a century ago?

• What are the two biggest killers of the modern era?– How come these two are so serious now

compared to 80 years ago?• Page 170

Public Health in the 20th Century

Public Health in the 20th Century

Public Health in the 20th Century

Public Health in the 20th Century

• Improved Housing– Use page 176 to explain how social

housing was improved by the government throughout the 20th century

• Clean Air Act 1956– What was this for? What did it do?

• Page 177

Modern challenges to Public HealthProblem How has it been

addressedDifficulties still to face

Fresh Water Most people have access to fresh water

Is there enough clean water?

Sewage disposal

Waste Disposal

Air Pollution

Housing

Safety at work

Food safety

International Public Health

Factors that have influenced Medical Advances

Factors to consider

• Government• Religion• War• Individuals• Luck / Chance• Communications• Science and

Technology• Conservatism

• Create a spider diagram for each of the factors. Think of examples of each factor has influenced medicine and health (positively and negatively)

Factor 1: Government

• How have governments influenced health through the ages? p188

• Give examples of governments who have become involved in health matters.

• Give examples of governments who have tried not to get involved in health matters.

• What methods have governments used to change medicine and health.

• How important have governments been in improving medicine and health?

Factor 2: Religion• Give 5 examples of how religion has

affected medicine– Are these examples of change or of

conservatism• In which periods was religion particularly

important– Give exampless

• Has religion done more to cause change or to promote continuity?

• How important has religion been in the history of medicine?

Factor 3: War

• Give 5 examples of how warfare has influenced medicine?

• Give examples of warfare promoting new ideas in medicine

• Which civilisations were particularly concerned with the health of its soldiers?