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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?