ORIGINS OF THE BRITISH NATIONAL HEALTH SERVICE - Created to produce fit "cannon fodder"steemCreated with Sketch.

in #life5 years ago (edited)

Not quite as spontaneous and revolutionary as many believe, the British NHS does have a fascinating history and the underlying reasons for its creation reveal a great deal about the priorities of government.

Its origins stretched back as far as the 18th century. Poor people were struggling in insanitary conditions and many had no option but to be incarcerated in the workhouses of that time. In 1834 about 10,000 workhouse inmates needed medical care and the number had risen to over 50,000 in 1861.

The Boar War (1899-1902) revealed the extent of poor health among the British population. As the Boar war commenced, it was only too evident to the government how ill and unfit the British men were. Recruitment agents had to turn away the majority of men that came forward for the army as they were too unwell for the demands that the army would have put on them, rejecting about 60 per cent of military volunteers on grounds of stunted growth, rickets, poor eyesight, deformities and low physical weight.
These conditions were obviously the result of malnourishment and were entirely preventable.
Fresh air, exercise and diet were recognised as the best ways to eliminate such conditions.

The Government cynically realised that they had to take measures to ensure that the general health of the British improved, as the country would not be able to perform well in war, especially as Britain was a leading power in the world. However, it was not until 1919, immediately after WW1 that The National Health Insurance Act was introduced by Lloyd George. He wanted to ensure that lower paid workers were for the first time able to receive medical care. From this moment forward a large range of legislations were passed in relation to and in preparation for a health system for all. It is sad to note that the legislations were considered important purely so that the population would achieve better health and therefore be good candidates for conscription in future armies.

The system further reveals itself when you examine your National Health number. You will note that the number terminates with an A or a B or (rarely) other letters of the alphabet. This indicates your eligibilty for national conscription in war time. Males would be given the "A" suffice to indicate that they were suitable for the draft. Females received the "B".

It was not until 1929 as part of the Local Government Act, that poor law hospitals were replaced with municipal hospitals that could only be used by taxpayers. Paupers were not considered. These hospitals were far from sophisticated and luxurious, in fact they were no better than poor law hospitals. Many of the larger councils such as London were doing well, however this was not the case for all councils around England. A large number of the smaller councils were struggling with financial constrants due to low population, meaning that there were not enough patients to finance and use the service. The King's Fund and the Nuffield Provincial Hospitals Trust, as protectors of hospitals realised that there was a problem.

It was in 1930 when a new Poor Law Act was introduced that many of the poor were routinely sent to dispensaries to buy their medicines or be committed to a workhouse for treatment in severe cases.
The Poor Law Act was an important legislation to deal with the incredibly bad health of the lower classes, but this became very difficult to manage because too many people were being admitted to the workhouses.
Even though the paupers were probably still able to work a little, being in such a place would have been even more detrimental to their health because they were not actually getting the medical attention they needed.

It could be argued that the on-set of world war two contributed greatly to the formation of the NHS.
It was important for military casualties to be treated effectively whilst Britain was at war.
As a result of this the Emergency Medical Scheme (EMS) was set up in 1939 in anticipation of the major casualties that would appear among the conscripted men during war time. Hospitals were set up to cater for different kinds of injuries such as fractures, and those requiring plastic surgery and burns.
As the number of civilian casualties began to rise, the scheme extended its services to cater for victims of war such as those injured in domestic blitz attacks. It was at this time that voluntary hospitals were thriving, however in the war years this posed a problem, as the hospitals began to find it increasingly difficult to get funding. They were also located randomly around the country, thus meaning that many ill patients were not able to travel to receive treatment. The experience that was gained by the EMS was useful as an example of what could be achieved.
It could therefore be said that this was one of the first ideas and positive movements towards a national medical service.

It was Walter Elliott, a wartime minister in the British government, who first suggested that government should look at establishing a state run hospital service.

The Beveridge report was released on 1st December 1942, this focused on social insurance and allied services. Beveridge wanted to ensure that the people of Britain were well cared for and no longer confined to awful conditions. The main ideas in this report outlined the beginnings of a welfare state, he also believed that the Government should eradicate the 'Five Giant Evils' of Want, Disease, Ignorance, Squalor and Idleness.

The idea developed to suggest that healthcare could be fully financed by insurance contributions, however private treatment would still be available.
It has been argued that this report resulted in a landslide victory for the Labour party in the 1945 general elections.

Clement Atlee was elected Prime Minister after the Labour Party defeated Winston Churchill's Conservative Party in 1945. Atlee immediately implemented the idea of the Welfare State, which included the National Health Service and Social Security.
The Minister of Health, Anuerin (Nye) Bevan, the former miner, now left-wing MP for Ebbw Vale, based his ideas on the welfare club in his home town of Tredegar where he had been chair of the Cottage Hospital Management Committee.

When the NHS was finally started on 5th July 1948 as part of the National Insurance Scheme, Britain had just come out of another major war and were, due to rationing, accustomed to severe austerity.
They were content with the simplicity of the new health service and saw it as a significant improvement.

Initially there was much opposition to the National Health Service, even before it was officially set up. Doctors in particular were deeply displeased, they were worried that as a result of standardisation they would ultimately lose income. Many of the medical professionals relied on visiting private patients and were not treating people in the hospital. Margret Grieve a midwife working in Dumfries explained why the other doctors were concerned with a move towards a universal service. She stated "There was apprehension about being employed by the government. I remember the consultants talking about it. Most of them earned only a pittance from their hospital work, so they depended on private patients for their living and they were afraid of losing that. The private patients did not want it either. But the doctors coming back from the war were happy with the NHS, because they did not have any private patients."
The BMA (British Medical Association) believed that the move towards a salaried service would pose a threat to clinical freedom. They told their members not to conform to the Act and asked them to sign a petition in agreement that they "would refuse to serve until the government accepted most conditions put forward by their council."

As a result of the misgivings of the BMA and the Conservative party in opposition, there was conflict between the medical professions and government right up until the NHS act was passed in 1948.
The BMA had no choice but to release its' members from their agreements. Bevan had to compromise a lot for the BMA by allowing GPs and consultants to continue to run their private practices as well as claiming increased salary for consultants and nurses. The professionals also began to realise that by not joining the NHS they would become less financially stable. Bevan did all he could do and gave them offers that they could not refuse. "I stuffed their mouths with gold." he famously said at the time.

Nevertheless, the Conservatives were still disgruntled and the Labour Party were divided over the way that a health service should be managed. Herbert Morrison believed that the service should not be run by the government but by the local councils. However this was contrary to Nye Bevan's intent to create a truly National Health Service that was equal no matter where the patient was in the country.

The BBC’s Home Service broadcast an announcement by Government Minister Dr Edith Summerskill in April 1948. She proclaimed the arrival of the NHS. Anyone listening to it would have heard her boast that “after July, no mother in the country need consider whether she can afford to have a doctor for her sick child before calling one in".
Her broadcast promised the new Health Service would protect the public “from before birth to the grave”. It was to be free for all at point of use, paid for from general taxation.

This was a monumental change in attitude. The National Health Service Acts (one for England and Wales, another for Scotland) did not bring new hospitals into existence or train more doctors. The same medical staff and facilities were available in the second half of 1948 as were there in the first.
The only difference was that they became available to the poor for the first time.


(image of Nye Bevan visiting a hospital in 1948)

The NHS made many provisions including free general practitioners, healthcare for all "from the cradle to the grave" and the nationalisation of hospitals. It was funded entirely by public taxation. The poor gained access to doctors and a range of treatments previously beyond their means, and no longer needed to worry about illness or injury.
However this soon changed in 1951 when charges were imposed for prescriptions, teeth and spectacles.
Newspapers reported an unstoppable demand for medicines, wigs, false teeth and spectacles. People had not been able to afford these things previously, so there was initially a back-log of demand.

There were many successes as well as failures for the NHS as a whole:
It promoted medical technology and the development of drugs such as penicillin.
Infant mortality was significantly reduced as a result of women being able to give birth in sanitary conditions.
There were no longer financial restrictions on who could be treated.
However, the NHS had many problems with finance as overspending became a regular occurrence.
At first, the NHS budgeted one million pounds for opticians, but within a year 5.25 million spectacle prescriptions were filled.

Bevan had confidently predicted that the cost of the National Health would reduce as people got healthier and needed it less, but costly improvements in medicine undermined this notion.
Soon, health expenditure was second only to defence spending in the national budget.
This is still the case today and much of the extreme costs can be traced to a burgeoning management system, overcharging for prescription drugs by pharmaceutical companies and massive increases in population.

Here is a personal history of life before the NHS from Harry Leslie Smith, the author of a memoir: “Harry’s Last Stand: How the World My Generation Built is Falling Down and What We Can Do to Save it”
https://www.newstatesman.com/politics/2014/10/hunger-filth-fear-and-death-remembering-life-nhs

Although the UK National Health Service is loved and respected by people all over the world it still has many difficulties and suffers in the present from typical Conservative underfunding.
Of course, the present government would like to privatise healthcare, as it seeks to do with all things, however the resistance to that idea is massive in the UK.
With all its faults it is treasured by the British public because it contributed a great deal to lifting millions out of abject poverty and extending life expectancy.
There is still a long way to go, but at 70 years of age on 5th of July 2018, it is still quite young and capable of improvement.

Further reading:
https://www.theguardian.com/society/2016/jan/18/nye-bevan-history-of-nhs-national-health-service

AFTERTHOUGHT:

I found that point about the state of people's health really shocking. But when I was thinking that the NHS was established for altruistic reasons, I was way off base.
The only value the men at the turn of the 20th century had to the government was as a military force. When it was discovered that they were in very poor health due to abject poverty the government took 50 YEARS to even begin to sort it out.
Their method for doing so was seemingly benign and merciful to the suffering millions but it was anything but...... it was calculated to be expeditious in preparation for the mother of all wars....
WW3.
My conclusion is a dire one and sorely hurts me to say, but not only were our recent ancestors decimated and emaciated to the point of being too weak for war but their descendants would be dealing with a scenario that they could never have envisaged.
All governance directs us towards war. It does not matter which party is in that Parliament. They could all go on permanent holiday and it would not make a jot of difference.
The humanity of Britain has never known a day of genuine altruism in the past 2,000 years - because the same deranged weirdos are calling all the shots.

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