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'The origins of the NHS’

'The origins of the NHS’. Virginia Berridge Centre for History in Public Health London School of Hygiene and Tropical Medicine. The NHS now. Courtesy G. Rivett. The paradox of the NHS.

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'The origins of the NHS’

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  1. 'The origins of the NHS’ Virginia Berridge Centre for History in Public Health London School of Hygiene and Tropical Medicine

  2. The NHS now Courtesy G. Rivett

  3. The paradox of the NHS • Why did Britain, with a strong tradition of insurance funded health care, and of health services funded in local government, adopt a tax funded system for the NHS based on the hospital sector and centrally directed?

  4. Plan of the lecture • 1.The paradox of the NHS • 2.The origins of the NHS: more distant and immediate • 3.The successes and deficiencies of the NHS • 4. Issues for the present.

  5. Some key dates • 1911 National Health Insurance • 1919 Ministry of Health • 1920 Dawson Report plans universal system • 1929 End of the Poor Law • 1937 Political and Economic Planning Report • 1939 Emergency Medical Service • 1942 Beveridge Report • 1944 Coalition White Paper • 1945 Labour Government elected • 1946 NHS Act • 5 July 1948 ‘The appointed day’.

  6. Early precedents • Precedent – friendly societies • 1906-11 Liberal welfare reforms • School medical inspection • Old age pensions • Unemployment insurance • 1911 Health insurance • Compulsory for wage earners • Costs: employees, employers, state • Benefits: wage replacement, practitioner attendance, not hospital care

  7. Inter war developments 1: health insurance • Insurance income limit gradually raised: excludes dependents not in work, housewives, children under 16 and elderly. • Unequal treatment for private and ‘panel’ patients. • Restrictions on clinical freedom by ‘approved’ societies. • Widespread self medication and ‘ counter prescribing’.

  8. Inter war developments 2: hospitals • Voluntary hospitals • - charity in decline • - growing demand • - uneven provision • Poor Law institutions • - the end of the Poor Law? • - what happened to PL hospitals • - poor quality and stigma

  9. Inter war 3: public health as a state system? • The Medical Officer of Health and his ‘ empire’ • Did public health fail or was it a success? Could public health and the local authorities have formed the basis of the NHS?

  10. Problems of the pre war system • Overall problems pre war: integration; finance, comprehensiveness. • The rising demand for planning e.g. 1937 PEP The British Health Services

  11. Wartime planning • Emergency Medical Service • Beveridge report 1942 • The 1944 White Paper A National Health Service • 1945 Labour victory and the 1946-48 negotiations Henry Willink

  12. The National Health Service • Free comprehensive health service at the point of need ‘universalising the best’ • Direct taxation, not insurance or local taxation • Nationalisation of hospitals and regional structures • GPs paid according to capitation, not salaried • Prescriptions, dental care and spectacles free (until 1951) • Health centres • Local authority limited role

  13. The coming of the NHS • I well remember our Brian being born. He was delivered by a doctor up at Oldham, a Scotsman, he got called up and killed in the war, so we never paid for Brian. The doctors were very good. You’d go to the doctor. He had your name and address. And after, you’d got a bill, and if you couldn’t pay it, which very few people could, each doctor had his own collector. The collectors used to come round each week and you’d pay sixpence. My wife’s father and mother used to say they’d never be straight in their lifetime. When the National Health came in all those doctors’ bills were written off. The collectors used to be the same type who were park collectors in them days-they’d be no use today, kids’d throw them in the pond - but they were always little wizened fellers.

  14. Historical debates • Consensus or conflict? The role of public opinion? • Bevan - hero or villain?

  15. Successes and problems • Access for all especially women. Popular support. Fear of poor health and inability to pay removed. • Advances in medicine: hence a sickness hospital based service • Financial profligacy? • Top down and centralised? • Failure of integration • Public and patient involvement: the democratic deficit. • Pre 1948 issues • Interface health and social care • Doctors and the state

  16. Current issues with a history • The political nature of health because of tax. • Integration of services and boundaries with social care • Specialist/general: the Darzi proposals. • The ‘new localism’ and democracy • Rising expectations and allocation of resources. • Prevention and cure • Other echoes from history?

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