Lecture 20 Medicine, Disease and Society in Britain,

 Social medicine in the interwar period; medical marketplace  The birth of the NHS  Was the NHS a radical new model of health care or were there important continuities with the past?  Was the NHS born out of consensus or conflict?  What is the relationship of the health care system to wider political economy (John Pickstone’s model of Productionist, communitarian and consumerist medicine )

 Edwin Chadwick: faith in central government and big engineering projects; poverty was linked to disease.  Early notion of state responsibility: role of the state to provide decent environmental conditions e.g. housing and factory.  Ideas of prevention: medicine and state working hand-in-hand to improve health through preventive approach.

 National Insurance Act ◦ Access to GP services via a panel doctor ◦ Hospital treatment not included ◦ Three types of benefit: sickness, accident and disability, pension ◦ Financed by contributions from employer, employee & state ◦ Administered through ‘approved mutual societies’. ◦ Benefits limited to the contributor (worker) - mainly men. Women and children were not covered. ◦ The act was met with concern from medical practitioners who feared the impact on private practice.

‘The Dawn of Hope’ The National Insurance Act of 1911

National Health Insurance introduced in 1911

Finsbury Health Centre

 Socialist Medical Association – left wing doctors who called for a free national health service administered by local authorities.  1937: report by the Political and Economic Planning Group on British health services.  Report recommended a central role for GPs and a coordinated specialist system backing up primary care.

Recommended a comprehensive social security system and health care service. Health care should be available to all regardless of their ability to pay. Proposed that doctors should be employed directly by the state. More generally, the report recommended that the government should find ways of fighting the five ‘Giant Evils’ of ‘Want, Disease, Ignorance, Squalor and Idleness’.

‘To ensure that everybody in the country- irrespective of means, age, sex and occupation- shall have equal opportunity to benefit from the most up to date medical and allied services available…to divorce the case of health from questions of personal means and other factors irrelevant to it; to provide the service free of charge…and to encourage a new attitude to health- the easier obtaining of advice early on, the promotion of good health rather than only treatment of the bad,. (MoH, 1944, p. 47)’

Labour Party election posters (1945)

 Objected to the concept of a salaried service  Objected to Local Authority control  Fear that would threaten clinical freedom  Echoed control of Poor Law and Friendly Societies  Wanted an enhanced role for voluntary hospitals and consultants.

Members of the BMA dressed as gladiators, conceding the introduction of National Health Service to Aneurin Bevan, dressed as Nero.

Hospitals: Voluntary and local authority hospitals were nationalised - managed by regional boards Local Authorities - health centres, clinics, health visiting, ambulances GP, dental and optician services – operated on an independent contractor basis; administered by Executive Councils.

NHS introductory leaflet The NHS came into being on 5 July Care was free at the point of delivery. Free dental care, free spectacles, free consultations with a GP, referral to hospital and free treatment.

C20: ‘great troika of progress- science, profession, state’ Productionist focus on health of the industrial worker and the armed services – resulted in National Insurance Communitarian NHS- expansion of services, focus on social inclusion Rise of the professional Consumption Renewed emphasis on market and lay management of health services. Medicine is serving consumers who demand more and more.

 Turn of the C20th: transformation in public and official expectation had become established and the notion of state intervention gained ground.  National Insurance Act marked a significant extension of medical and state involvement in the health of the nation.  The NHS greatly extended the reach of organised medicine and encouraged those who had previously been too poor or reticent to come forward for consultation/treatment.