look-left:

March on the Tory Party Conference @ facebook

The NHS is one of the greatest institutions in Europe, if not the world. Thought this would be interesting to for followers in America or anywhere else.

Before the National Health Service was created in 1948, patients were generally required to pay for their health care. Free treatment was sometimes available from teaching hospitals and charity hospitals, such as the Royal Free Hospital. Some local authorities operated local hospitals for local ratepayers (under a system originating with the Poor Law). The London County Council on 1 April 1930 took over from the abolished Metropolitan Asylums Board responsibility for 140 hospitals, medical schools and other medical institutions; the Local Government Act 1929 also allowed the LCC to run services over and above those authorised by the Poor Law and in effect to provide medical treatment for everyone. By the outbreak of the Second World War, the LCC was running the largest public health service in Britain.

Systems of health insurance usually consisted of private schemes such as Friendly Societies. Under the National Insurance Act 1911, introduced by David Lloyd George, a small amount was deducted from weekly wages, to which was added contributions from the employer and the government. In return for the record of contributions, the workman was entitled to medical care (as well as retirement and unemployment benefits) though not necessarily to the drugs prescribed. To obtain medical care, he registered with a doctor. Each doctor who participated in the scheme thus had a ‘panel’ of those have made an insurance under the system, and was paid a capitation grant out of the fund calculated upon the number. (Lloyd George’s name survives in the “Lloyd George envelopes” in which most primary care records in England are stored, although today most working records in primary care are at least partially computerised). This imperfect scheme only covered certain trades and occupations, and was known as ‘Lloyd George’s Ambulance Wagon’. Moreover, due to cuts during the 1930s, many were unable to obtain treatment.

Prior to the Second World War there was already consensus that health insurance should be extended to the dependants of the wage-earner, and that the voluntary and local authority hospitals should be integrated. A British Medical Association pamphlet, “A General Medical Service for the Nation” was issued along these lines in 1938. However, no action was taken due to the international crisis. During the war, a new centralised state-run ‘Emergency Medical Service’ (EMS) employed doctors and nurses to care for those injured by enemy action and arrange for their treatment in whichever hospital was available. The existence of the EMS made voluntary hospitals dependent on the Government and there was a recognition that many would be in financial trouble once peace arrived. The need to do something to guarantee the voluntary hospitals meant that hospital care drove the impetus for reform.

In February 1941 the Deputy Permanent Secretary at the Ministry of Health recorded privately areas of agreement on post-war health policy which included “a complete health service to be available to every member of the community” and on 9 October 1941, the Minister of Health Ernest Brown announced that the Government proposed to ensure that there was a comprehensive hospital service available to everyone in need of it, and that local authorities would be responsible for providing it. The Medical Planning Commission set up by the professional bodies went one stage further in May 1942 recommending (in an interim report) a National Health Service with General Practitioners working through health centres and hospitals run by regional administrations. The Beveridge Report of December 1942 included this same idea.

Developing the idea into firm policy proved difficult. Although the BMA had been part of the Medical Planning Commission, at their conference in September 1943 the association changed policy to oppose local authority control of hospitals and to favour extension of health insurance instead of GPs working for state health centres. When Health Minister Henry Willink prepared a white paper endorsing a National Health Service, it was attacked by Brendan Bracken and Lord Beaverbrook and resignations were threatened on both sides. However the Cabinet endorsed the White Paper which was published in 1944.

Willink then set about trying to assuage the doctors, a job taken over by Aneurin Bevan in Clement Attlee’s Labour government after the war ended. Bevan encountered considerable debate and resistance from the BMA who voted in May 1948 not to join the new service.The structure of the NHS in England and Wales was established by the National Health Service Act 1946 (1946 Act) with the new arrangements launched on 5 July 1948. The founding principles of the NHS called for its funding out of general taxation and not through national insurance.

Services would henceforth be provided by the same doctors and the same hospitals, but:

• services were provided free at the point of use;
• services were financed from central taxation;
• everyone was eligible for care (even people temporarily resident or visiting the country).

really annoys me.

I was just watching The One Show whilst finishing a McDonalds, when a report started on wheelchairs and the waiting lists that disabled children have to be put on so that they can get them. This little boy had been waiting for about a year for a very expensive and specific…