4.3.3
The NHS
The Creation of the National Health Service
The Creation of the National Health Service
The National Health Service (NHS) was set up by Aneurin Bevan in 1948. People had received free healthcare during the war (from the Emergency Medical Service) and people wanted the service to continue.
Opposition to the NHS
Opposition to the NHS
- There was not unanimous support for the NHS.
- Doctors did not want to be employed by the government. Working in the public sector meant that they could lose some of their income.
- Bevan promised to pay doctors a salary and allowed them to continue working privately as well.
- Lots of Conservatives disliked the NHS, but it was too popular to abolish (get rid of).
Cost of the NHS
Cost of the NHS
- The cost of the NHS has increased dramatically in the last 70 years.
- The original plan was to pay for the NHS through National Insurance contributions. But this only covered 10% of costs.
- In 1948, the NHS budget was estimated to be £15 billion.
- In 2015/2016, the NHS budget was estimated to be £116.4 billion.
Success of the NHS
Success of the NHS
- The NHS has been relatively successful.
- Child mortality rates have fallen (and maternity services are likely to have helped this).
- New and improved hospitals have better facilities
- Vaccinations provided under the NHS have got rid of diseases like tuberculosis.
- Healthcare and affordability of treatment is a lot better in Britain relative to the United States.
Choices in the NHS
Choices in the NHS
- Today, drugs are very expensive. Medicine lets people live longer, but older people on average need the NHS more. This increases the cost of the NHS.
- The question today is, who should pay for which treatments and how can enough money be raised to pay for all the treatments needed?
NICE and QALY
NICE and QALY
- To deal with these questions, the National Institute for Health and Care Excellence (NICE) have a metric called a Quality Adjusted Life Year (QALY) valuing a life at £30,000 per year. This metric helps to compare where money should be spent.
More preventative health care
More preventative health care
- Preventative health care is often cheaper than medical treatments. Campaigns encouraging healthy eating & discouraging smoking and drinking have been introduced.
- The healthy eating campaign promotes eating five portions of fruit and vegetables every day. In 2005, tobacco advertising became legally banned.
- Things like cancer screening are preventative measures that try to find people vulnerable to cancer or in the early stages so that treatment is more cost effective and people get less ill.
Why was There Progress in 20th Century Medicine?
Why was There Progress in 20th Century Medicine?
The 20th Century brought improvements in living conditions, transplants, blood transfusions, penicillin, plastic surgery, radiotherapy and many new vaccinations. Medical progress was far higher than any century before it. This was because of a lot of factors:
Communication and knowledge
Communication and knowledge
- Revolutionary ideas can diffuse slowly. Fleming’s discovery was not recognised for many years.
- However, the printing press allowed his publications to be read more widely and they reached Florey and Chain.
- Inoculation was first brought to the UK by Lady Montagu who observed it in Turkey. Discoveries from France (Pasteur) and Koch (Germany) spread faster because of improvements in communication.
Government
Government
- The US government funded the initial mass production of penicillin.
- The improvements in living standards in the UK only really came from government action.
- Mandatory reforms in the form of the 1875 Second Public Health Act and the Welfare State seem to have had the largest impact on living conditions.
War
War
- Chain and Florey received funding to mass produce penicillin partly because of World War Two.
- The World Wars meant that a lot of people needed plastic surgery and prosthetic limbs.
- Blood transfusions were needed on the battlefield.
- The Boer War made Parliament realise that a malnourished population was not in their interests.
Remarkable individuals and the scientific approach
Remarkable individuals and the scientific approach
- Individuals like Louis Pasteur, Robert Koch, Alexander Fleming, Sir William Beveridge and Seebohm Rowntree all had impacts on society larger than you would expect from one individual.
- Science involves the objective observation of outcomes, but it also requires building upon the knowledge of previous scientists.
- Blood transfusions needed an understanding of blood groups, which relied on the discoveries of William Harvey around circulation
Chance
Chance
- Fleming discovered penicillin because he left bacteria out in his laboratory.
- Lots of people only discovered the unhealthy state of British children because of evacuation in the war.
- The Liberal Party was influenced by the launch of the Labour Party in 1900 as it pushed through its reforms at the start of the 20th century.
1Medicine Stands Still
1.1Ancient Egyptian Approaches to Medicine
1.2Ancient Greek Medicine
1.3Medieval Medicine
1.4Religion & Medicine
1.5Public Health in the Middle Ages
2The Beginnings of Change
2.1The Impact of the Renaissance on Britain
2.2Treating Illnesses in the Renaissance
3A Revolution in Medicine
3.1The Development of Germ Theory & its Impact
3.2A Revolution in Surgery
4Modern Medicine
4.1Modern Treatment of Disease
4.2New Diseases & Treatments in the 20th Century
5Themes in Public Health
Jump to other topics
1Medicine Stands Still
1.1Ancient Egyptian Approaches to Medicine
1.2Ancient Greek Medicine
1.3Medieval Medicine
1.4Religion & Medicine
1.5Public Health in the Middle Ages
2The Beginnings of Change
2.1The Impact of the Renaissance on Britain
2.2Treating Illnesses in the Renaissance
3A Revolution in Medicine
3.1The Development of Germ Theory & its Impact
3.2A Revolution in Surgery
4Modern Medicine
4.1Modern Treatment of Disease
4.2New Diseases & Treatments in the 20th Century
5Themes in Public Health
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