Hello everyone and welcome to this week's blog post which is the third post in a series on public health. Last time, I explored the beginnings of a public health programme in the UK, during the years 1848-1905. This week I will explore the National Health Service in detail, beginning with the reasons for its formation, before moving on to discuss how it has changed and how the modern NHS looks today.
Before we move on to explore the formation of the NHS, we first must learn what took place in the interim, between the years 1905-1948. During this period, there was a huge shift in public health provision, particularly due to the Liberal Reforms of 1906-1912. Due to numerous reasons, including the Booth and Rowntree surveys which outlined how much poverty there was in Britain and the fact that the government had finally linked health with the ability to fight disease, the new Liberal government enacted numerous reforms that focused on improving the diet of the British population, as well as providing medical checks for children and workers (under the National Insurance Act of 1911). While these reforms did have limitations, they ultimately represented a step in the right direction and drastically improved the health of the UK. Further, in 1919, the Ministry of Health was set up which took over some of the local government's responsibilities in regards to health. While its power was limited, it was the first time that the government had a named minister responsible for the health of the nation and thus marked an important change in UK public health provision.
Throughout the 1920s and 1930s, the government continued to get involved in the public health of the country, most notably through vaccination campaigns during the 1930s, when the government persuaded parents to let their children be vaccinated against diptheria. Moreover, in 1939, the government made a further step to improve public health, with the establishment of the Emergency Medical Service, which served to coordinate hospitals and healthcare in the UK.
One of the key factors that contributed to the formation of the NHS was the 1942 Beveridge Report. In this report, Sir William Beveridge outlined the 5 evils which he said plagued society: Want, Disease, Idleness, Ignorance and Squalor. He also argued that "social expenditure to the care of childhood and to the safeguarding of the maternity" should be the top priority of any government. As such, the influence of the Beveridge report was key in laying the foundation for the welfare state, however, without the impact of World War 2.
The contributions of WW2 were critical in the formation of the NHS. This is mainly because of the sheer number of civilian casualties, which forced the government to centrally organise the delivery of healthcare. Not only did this prove to the government that it was possible to organise healthcare on this scale, but it also meant that people got used to state control of healthcare, reducing objections to a national health system. In addition, due to government involvement and rationing, the health of the country improved, further proving how beneficial a national health service would be.
The 5th July 1948 marked a pivotal momentous moment in British history. Following the passing of the National Health Service Act of 1946, the NHS was finally formed in 1948. With this new institution, healthcare was finally now available for all, not just the rich who could afford it.
The NHS Act of 1946 was not without opposition, however, especially among the rich and upper-class who would have to pay more in taxes to fund this scheme. Furthermore, the act was also opposed by doctors, who disapproved of becoming employees of the state, and churches and charities who didn't want to lose control of their hospitals. Nevertheless, with overwhelming public support, the act passed in 1948.
Under this act, the Minister of Health was given the duty of ensuring the mental and physical health of the people of the UK, as well as diagnosing and treating their illnesses. Further, the Act also brought together a wide range of medical services, including opticians, dentists, doctors and hospitals, under a government organisation. Family doctors (GPs) were also made self-employed. In addition, the NHS Act also stated that these services would be free at the point of access. This was one of the founding principles of the NHS and remains the case today.
Nevertheless, the NHS has changed since 1948, especially in monetary terms. In 1949, adjusted for inflation, £12.9 billion was spent on the NHS. Comparing that figure to the £149.2 billion spent in 2016-17, it's evident how much more valued the NHS is to the government and the British people. Despite this increase, patients are now required to pay more at the point of access to NHS services than they used to. Indeed, prescription charges were introduced in 1952, abolished in 1965, and reintroduced in 1968 (now £9).
Much more important, however, is the change in medical knowledge which has allowed us to carry out more treatments on the NHS. For example, in 1962, improvements in technology allowed the low-friction hip replacement to be carried out. Since then, due to our ageing population, arthritis and joint damage have become much more pressing concerns for the NHS. Indeed, around 92,000 of such operations are carried out in the UK every year, clearly underlining how much more significant the care for the elderly is now compared to when the NHS was founded.
Additionally, over the last few decades, there have been numerous scientific advancements which have improved treatment on the NHS, such as the creation of new medicines and surgical techniques. Feel free to read my other blog posts for more information about them. Moreover, there have also been advancements in computer technology, particularly with the use of artificial intelligence in diagnosing diseases (e.g. breast cancer). Due to the promise that AI shows in enhancing patient treatment, in August 2019, the Secretary of Health Matt Hancock announced that £250 million would be spent by the government to set up a national artificial intelligence lab. Hopefully, this means that in the future, many more diseases will be able to be identified and treated earlier.
There have also been significant advances with regards to the treatment of cancer. Cancer is a leading cause of death worldwide, causing almost 10 million deaths worldwide each year. As such, the need for cancer treatment is at an all-time high. In the early 1900s, cancer treatment was in its infancy, with common treatments including radiation (through X-rays) to destroy tumours. Since then, many more cancer treatment methods have been developed, including chemotherapy drugs (the first chemotherapy drug for cancer was developed in 1942), laser therapy and high intensity focused ultrasound. As such, not only has the amount of cancer treatment on the NHS increased dramatically over the last few decades but also many more treatments are likely to be available in the future.
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