In 1938 plans were made with voluntary and municipal hospitals in London to work together on how to deal with mass casualties from bombing raids on the capital. They used the amount of casualties from the Spanish civil war as an estimate to the amount of wounded people who would need treatment as a result from air raids over London, and from these findings the Emergency Medical Service came into being on the outbreak of the Second World War. The hospitals used by the Emergency Medical Services were not to be used for everyday use, they were only there for casualties of war, but as the war wore on it was clear to see that the estimated casualty count had been greatly exaggerated. As a result treatment was made available to all, and not just to casualties of bombing raids.
In November 1942 Sir William Beveridge published his report which addressed the social scourges of the nation. These needs were known as the five giants – squalor, disease, ignorance, idleness and want. The need to change welfare in Britain was urgent, but because of the war things were slow to move and it wasn’t until 1945 that Aneurin Bevan set in motion his ideas for a free healthcare system for all. In 1946 the National Health Service Act was passed, but it was to be another two years before the NHS actually came into being, there are many reasons for this including the logistics and bureaucracy in setting up a health system on such a large scale, opposition to the scheme from the Tory party who were more in favour of a Laissez-Faire ideology, in that people should look after themselves and their family without relying on the state for help, and also from the medical profession themselves who felt that they would lose money and some autonomy in the way they wanted things to work. (Leathard Audrey. (1991) Health Care provision: past, present and future. / Powell Martin A. (1997) Evaluating the National Health Service)
For many the date of July 5th 1948 will be insignificant, but this is the birthday of the NHS. This was Aneurin Bevan’s grandest hour with his dream of a free healthcare system for all being a reality. He had worked tirelessly to get the NHS working and to convince the medical profession that clinical governance was in their hands and would not be interfered with by the Government. This was why Aneurin Bevan became known as the Father of the NHS. Under the Umbrella of the NHS was the hospitals, community based services (clinics) and finally, family practitioner services which consisted of the family doctor (GP), dentist, chemist (for prescription drugs), and opticians (this was known as the tripartite system). When the NHS started nobody could predict how much all these services would cost to run, Britain was still reeling from the effects of the war, with much of the country still on food rationing when the NHS started and within three years of starting, the Government was forced to start charging people minimal fees for some basic services. These included having to pay for prescription charges, and having to pay a flat rate of one pound for any dental treatment needed, another reason for the charges was to try and prevent abuse of the system by the people who up until now had always had to pay for such treatment. Even then as it is today, it was a hard juggling act to keep the balance of cost on the NHS. Bevan foresaw this and said “We shall never have all we need. Expectations will always exceed capacity. The service must always be changing, growing and improving – it must always appear to be inadequate.” (Welcome to the NHS (08/04/03) )
Although the NHS was a resounding success, the Tories when they got into power in the 1950s were still not happy with what they thought was a socialist policy. However they knew that the nation now regarded the NHS as a part of the British way of life and it would have been political suicide to scrap this healthcare system which Britons had now grown use to. The first decade of the NHS was used to build up a system that worked, and to learn from past mistakes before any real changes to the structure and organisation could take place. The second decade was about change and the introduction of new medical cures which consisted of the polio vaccine, dialysis for renal failure and chemotherapy for treatment of cancers. These cures added an extra burden to an already some would say under funded health system. Another financial loss to the government was that because people were now living longer, they were able to pick up their state pension, and have the illnesses associated with old people cured on the NHS. As regards the changes The Porritt report of 1962 called for the unification of the three parts of the NHS which would have seen the end of the tripartite system. Also in the same year, Enoch Powell’s hospital plan was published which contained plans to approve the development of district general hospitals with areas exceeding one hundred and twenty five thousand people or more. Powell’s report was to be a foundation rock for the future of hospital planning and building. Later on in 1967 the Salmon report addressed issues concerning the training of nurses and also for restructuring and developing the senior nursing staff and professional hospital managers. In the same year another report known as the Cog Wheel report which proposed changes to clinical and administrative medical practices and ways to which they could be used more effectively. (Welcome to the NHS (08/04/03) )
The late sixties and the decade of the seventies were really a mark time period for the NHS, even though advances in medicines and medical engineering bought cures for more people. Being the British way of doing things, the recommendations from the Salmon report were introduced in the early seventies and changes to the way that nurses were educated was implemented. Another change to the NHS was the introduction of computers in to the NHS administrative area to lessen the work load of the admin staff and to ensure better distribution of patient consumables. By the late seventies inflation hit 26% and wage restraints came in. This made the unions angry and strike action was called, the workers who striked included many who worked for the NHS. It was because of some of these conditions that the Tory party under the leadership of Margaret Thatcher started their nineteen years of leadership and with it a radical overhaul of the NHS. (Welcome to the NHS (08/04/03) )
The Thatcher years in the NHS were probably the leanest where the patient was concerned, although this was partly due to yet more technological advances in science and that more people were treated in a more expensive and complex way. The NHS was also under pressure from the Government to show savings and to be more cost effective across the whole spectrum of services, including making savings on the laundry bill. For these savings, tendors were put out for the contracts which normally meant the cheapest bid being accepted. Many thought that this was false economy and that if prices were cut then the quality of the service would also be cut. This was really the start of privatisation in the NHS, although it must be noted that most of the successful bids were often won by the NHS workers. Another pressure put on hospitals, was the performance indicator tables which showed how effective each hospital was in its treatment of patients and its handling of finances, and also closer examination was paid to audits where the price of each service could be examined. One way the Government thought they could save money and shorten waiting lists was the introduction of community care where the patient was moved from hospital back to their community to recover. One area where this was greatly criticised was in mental health, where people with mental disorders were let out of the hospitals and forced to live among the community. In 1989 the Government released the white paper detailing its plan for the ‘internal market’, and in 1990 this became the NHS and Community Care Act. This allowed some hospitals to run their own budget and to bid for contracts outside of their own trusts. By 1991 there were fifty seven trusts and by 1995 all health care was provided by trusts. But for all the freedom that the NHS had, the problem of bed shortage and longer waiting lists still plagued it, and because of the nations’ disgust with the Tory Government over the NHS and other national matters, they were kicked out of office in 1997 and replaced by Labour. (Leathard Audrey. (1991) Health Care provision: past, present and future. / Powell Martin A. (1997) Evaluating the National Health Service. Welcome to the NHS (08/04/03) . The NHS explained (08/04/03) )
The conclusion of this, is that the present Labour Government like its predecessors has poured millions into the NHS and still the waiting lists get longer and the quality of the service worsens, and like so many before them they could lose the respect of the voters over the nations jewel in the crown. The NHS really needs to be reorganised to meet the demands of the modern world, and a restructured chain of command to cope with a new system, one of these ideas which labour have proposed is the introduction of foundation hospitals. The idea of foundation hospitals disgusts some people, who believe that the NHS is a system for everyone regardless of class, gender or colour, but for those who can afford it private healthcare supplied by the NHS could be the way forward, and would give the NHS more money to spend on the average man to get the free healthcare that Bevan wanted for the classes, although some people argue that it could create a two tier health system in the NHS. One thing is certain, if the NHS is to survive, then it has to change to meet with the ever changing needs of our society, but also society has to be taught that the NHS is there as a need and not as a want and that it should never be abused.
REFERENCES
Leathard Audrey. (1991) Health Care provision: past, present and future, Bury St Edmunds England
Powell Martin A. (1997) Evaluating the National Health Service, Buckingham England
Joanne de Pennington-Beneath the Surface: A Country of Two Nations.
Frank Field-The Welfare State-Never Ending Reform
The NHS explained (08/04/03)
Welcome to the NHS (08/04/03)
BIBLIOGRAPHY
Leathard Audrey. (1991) Health Care provision: past, present and future, Bury St Edmunds England
Powell Martin A. (1997) Evaluating the National Health Service, Buckingham England
Briggs Asa. (08/04/03) Reforming Acts
Professor Eric Evans. (08/04/03) Laissez-Faire and the Victorians
Frank Field-The Welfare State-Never Ending Reform
Joanne de Pennington-Beneath the Surface: A Country of Two Nations.
The NHS explained (08/04/03)
Welcome to the NHS (08/04/03)
