Prior to the construction of the national health sevice, rich could afford to see gps, poor couldn't if they were ill they wou

Prior to the construction of the National Health Service only the wealthy groups in society could afford to visit and to receive treatment from a General Practitioner (G.P). If a poor person became ill they would be cared for in the home by women, using herbal remedies and knowledge passed on through generations. If this was not available the last resort would be to go to the workhouse to work and in return would receive minimal food and the barest accommodation, they would receive no medical treatments and would eventually die. Workhouses became notorious for their bad treatment of people; they were being punished for their situation, not given help or support. After the wars during the 20th century many men were unfit for work and had poor health, so poverty was widespread which in turn lead to poor housing conditions and health. The government was under pressure to accept responsibility for the health and welfare of it citizens.

In 1942 the wartime government of the day produced the Beveridge Report, which identified five ‘great social evils’ – ignorance, idleness, want, squalor and disease. Its main recommendations to eradicate these problems were:

Universal secondary education to eradicate widespread ‘ignorance’ (or poor education)
Full employment to deal with ‘idleness’ (or unemployment)
Social security to deal with ‘want’ (or poverty)
New towns and slum clearance programmes to get rid of ‘squalor’ (or homelessness or bad housing)
A system of universal healthcare to eradicate ‘disease’ – a national health service.

In 1948 the National Health Act was produced and on the 5th of July 1948 the National Health Service (NHS) began, funded by national insurance taxation. The aim of the NHS was to provide universal healthcare, ‘free for all’ at the point of delivery and to help close the ‘gap’ that was present between the health of the rich and poor. There was opposition to this from many doctors as they were not happy to give up private practise to become employees of the state. The Labour Minister of Health at that time Aneurin Bevan said he had to ‘stuff the consultants’ mouths with gold’ in order to gain their consent to working within the state medical sector. Doctors would work as independent contractors and be paid a fee to work for the state, while still maintaining the right to private practise.

Until the 70’s the NHS had survived with little changes having to be made to its original structure, ‘the tripartite system’. Whilst this system was in place regional hospital boards, specialist authorities and local executive councils shared the responsibilities. This was criticised for being expensive and inflexible. Due to advances in medicine and technology for example, kidney dialysis machines, meant that people were more successfully treated. There was a decline in infant mortality and an increasing amount of women were now choosing to have their babies in hospitals. All of which were putting unexpected demands on the service. So in 1974, the NHS was reorganized into a number of regional health authorities, area health authorities and district health authorities, to work together. It was hoped this would produce a more cost effective and efficient service.

In 1979 Margaret Thatcher came into power with the new conservative government. The new government made findings on a report that was commissioned the year before by the previous government, called The Black Report. The report discovered that social classes made a big difference to people’s health. Those who lived in deprived areas were dying younger than those in richer areas. Though the government could not see inequalities in health as an issue, they put more emphasis on the way people live their lives plays a big part in their health. The central theme of the governments policies were ...

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During the 1980’s and 1990’s the NHS was described as being in a constant state of crisis, so a more market orientated system was established, know as the internal market. The aim was to facilitate the flow of funds for treatment more efficiently, and to help address growing waiting lists. Health organisations became trusts; independent organisations with their own management. Under this new system many doctors could choose to become fund holders, which meant they would be given their own budgets, and could choose when and where to send their patients for treatment. This produced competition between different trusts, which was needed in order for them to service, creating a more business/profit making service. Non fund holding G.Ps were still controlled by health authorities, who brought health care ‘in bulk’ from NHS trusts, so their patients were likely to wait longer for treatment and not have a choice in where they would receive treatment. This all lead to accusations of inequalities, by the NHS operating a two tier system, people were not receiving equal access to the NHS, due to whether or not their doctor was a fund holder.

In 1997 the new Labour government, with Tony Blair as Prime Minister took over power. Problems with the NHS were continuing, costs were rising and waiting lists were growing longer. An ‘independent inquiry into inequalities in health’ was commissioned after it became apparent the health gap between the richest and poorest had widened, found many social factors that can affect peoples health.

Social Class – since the creation of the NHS death rates have fallen for men and women in all social classes, though they have fallen faster for those in higher classes. Longstanding illness is around twice as high among unskilled manual workers as for class 1 professionals. The Black Report in 1980 showed that there was evidence of health professionals tended to spend more time with their patients of middle class than lower class known as the ‘Inverse care law’.

Unemployment – loss of earnings from unemployment would cause money worries and stress. Quality of lives would then change leading to being unable to afford good quality housing, food and clothing resulting in further deprivation and even social exclusion which in turn could lead to mental health problems, or even suicide.

Housing – low incomes can cause people to live in poor condition housing. Damp houses can cause asthma and recurring chest infections. Overcrowding can also cause inadequate hygiene levels and psychological stress.

Gender – On average women live five years longer than men but visit their G.P more often than men. Men are more likely than women to have physical manual jobs and take more risks in life, leading to accidents.

Ethnic Groups – life expectancy in ethnic groups is generally shorter than the rest of the population. Different groups tend to have specific problems. Those originating from India have higher than average rates of tuberculosis and coronary heart disease. Some diseases are mainly confined to certain groups, e.g. Afro Caribbean suffer from sickle cell anaemia and Asians can suffer from rickets.

Geographical differences – People who live in deprived areas are more likely to suffer ill health than those living in richer areas. Also not all health services are available in all regions, sometimes this is determined by the person’s postcode, this has been called ‘the post code lottery’. Waiting lists for treatment in different areas also can vary.

In l998 a report was carried out by Sir Donald Acheson based on the ‘independent inquiry into the inequalities in health’. His study found that there was still considerable inequalities in the different health groups. Acheson suggested that there were a large number of economic factors affecting health:

Poverty both relative and, for some people on or outside the benefit system, absolute
Inequalities in wealth and income, again especially for those receiving state benefits
Differences in educational provision, especially access to pre-school education
Housing and environmental factors such as safe play areas for children, good food and health sanitation
Mobility and access to public transport for the elderly who are most affected by social isolation
Facilities available for older people, mothers, children and people from different ethnic groups

The Acheson report recommended that policies to improve health should include:

Improved benefits and access to benefits for the most needy.
A concentration on pre-school provision and nutrition in schools.
Opportunities for training, re-training and policies to reduce stress at work.
Better and safe public transfer and cycling facilities.
The distribution of surplus food produced in the European Union to poor families.
Further policies focusing explicitly on the social; health needs of specific groups such as families, young people (particularly the promotion of sexual health and the reduction of teenage among young women and suicide among young men), older people and ethnic groups.
Improved access to health services for all these groups.

Acheson therefore proposed an integrated policy to consider all these factors and to monitor the effects of all these initiatives on the different groups involved and the inequalities between them.

In l999 the Government with Tony Blair as Prime Minister recognised that ‘social economic and environmental factors tending towards poor health are potent’. An action report was produced called ‘saving lives: Our healthier nation’ to improve the health and particularly the health of the worse off in society. This plan focused on the main killers, cancer, coronary heart disease and strokes, accidents and mental illness. Four national targets were set to be achieved by the year 2010.

Cancer - to reduce the death rate in people under 75 by at least a fifth
Coronary heart disease and strokes - to reduce the death rate in people under 75 by at least two fifths
Accidents – to reduce the death rate by at least a fifth and serious injury by at least a tenth
Mental illness – to reduce the death rate from suicide and undetermined injury by at least a fifth

To achieve this the Government is:

Putting more money into the NHS to help secure a healthier population.
Promoting NHS Direct – a nurse-led telephone help line and Internet service providing information and advice on health, taking pressures off G.Ps for minor problems and concerns.
Tackling smoking as the single preventable cause of poor health by offering free nicotine patches and support groups, and by using shock horror tactics through the media such as on television adverts, to encourage people to ‘give up’.
Integrating local authorities to work together with the NHS by introducing healthy action zones and healthy living centres.

In the 21st century the NHS remains under financial strain. There has been a growth of new diseases such as cancer, hepatitis and HIV/AIDS; many of these are incurable and expensive to treat. Due to advances in technology much more high tech equipment is being used for procedures, these are welcomed advances with good results, but are expensive to run and maintain. Along with this there is a highly skilled and paid workforce.

The public are more aware today of treatments available and have opinions on how they expect to be treated and know their rights, leading to rising consumer expectations.

An increasing pressure on all NHS services is the ageing population, people are living longer, but finding care for them is a growing problem. In the past the women in families would take on the role of caring for the elderly, but today most women go out to work, care for children and families are not as close networks as they were in the past. Care in the community was introduced to enable the elderly to stay at home with part time care, and to help with the turnover of hospital beds. Many of the elderly need more constant care. Families feel that they are left to cope with little support, which is leading to more of the elderly going into private residential care homes, and inevitably having to sell their homes to pay for the expensive costs.

Due to the ageing population we are witnessing ageism within the NHS. For example women over 65 are not routinely offered preventative health care such as breast screening, they have to ask for it, or will only be screened if they have symptoms. Some G.Ps do not refer patients over the age of 65 to have a consultation with a specialist. If someone is referred they will have a needs assessment, which would consist of what pain they are in, how the complaint restricts their life and how beneficial the procedure would be for them. For example if two people needed the same treatment the person who would gain the most life years at the best quality would be treated. This is known as rationing. If the decision was yes the person would go on a waiting list, and there is no guarantee for how long this would be, as often more simple procedures are carried out first due to pressures of meeting waiting list targets.

The NHS has helped to improve the nation’s health, with the increase in lifestyle diseases, the ageing population, advances in technology and medicine. The cost of maintaining a free for all service is constantly rising. People do not want to pay more taxes to fund the NHS, so it is likely there will be a continuous increase in privatisation. In the future a means tested healthcare system or the need for private medical insurance for those who can afford it may develop, which would be against the NHS original values, and the aim of providing free healthcare for all.