Today the NHS turns 60, and I want to wish it a very happy birthday and wish it well for the next 60. I know there are plenty of problems with it, I am not blinkered enough to say that there could not be improvements, but I believe that it is one of the greatest achievements of this country, especially in the post-World War II period. Here's why.
In 1900 (that's only 108 years ago) in this country:
* Life expectancy was below 50 years
* 163 out of every 1000 babies born died before they reached the age of 1 (that's 16.3%)
* The majority of families could not afford to see a doctor
The government refused to interfere as the emphasis at this point in time was on a "laissez-faire
" country, meaning that things should be left to take their own course. It was believed that interference by the Government would strangle the economy, so generally people were left to sink or swim as they could. During the latter years of the 19th Century, and the early years of the 20th Century many reports began to come out which drew attention to the plight of the poor, which was reinforced by something of a recruitment crisis for the army during the Boer War. Of those who volunteered 35% (over a third) were rejected as medically unfit, generally because of problems related to poverty.
This changed in 1906 when the Liberal Party was elected, with David Lloyd George
as their Chancellor of the Exchequor, and what followed was a package of reforms that ultimately led to a constitutional crisis
. The reforms included the setting up of Old Age Pensions, free school meals (which went quite some way to tackling malnutrition among the poor), slum clearance programmes and Labour Exchanges (see here
for more information).
The most pertinent reform to what I'm discussing today was the 1911 National Health Insurance act, which brought in various safeguards for those in employment who could afford to contribute to a scheme, which would then pay for them to go see a doctor if ill, and pay a small sum every week if the contributor were unemployed or unable to work. The government paid a sum to the scheme, as did the employer. The limitations of this scheme were numerous. It only covered those able to work, which at this period were mostly men, and even then the only hospitalisation it payed for was sanitorium treatment for TB. It did not cover those earning too little to be able to afford to contribute, children, the elderly, women, and those who were chronically and mentally ill. As a result, many still relied on the quack remedies that they had done before the scheme came in to force. The sad truth was that despite the advances in Medicine that had taken place, most people could not access it. The major problems with NHI showed themselves in the 1930s during the Great Depression
when so many were out of work, and so many accounts in arrears (upwards of 4 million) that the companies running the schemes made no profit, which was compounded when the government reduced its contribution.
The turning point came with the Second World War. The Government were in possession of some rather terrifying figures about expected casualty rates as a result of any enemy bombing action, which thankfully never came to pass, though the Government did not know this at the start of the war. ( Expected Casualties (because I found this during my dissertation research and I think it's really interesting) )
As a result the Government planned various strategies to deal with the expected casualties (including a stockpile of cardboard coffins). The one relevant to this "History of the NHS", is the Emergency Hospital Scheme, which was funded and run by the Government and was "designed to serve the purpose of a moment" - to look after those injured in the war, especially bombing victims. Under this scheme any treatment needed, including hospitalisation, was free. It was during this period, in 1942, the the Beveridge Report
was published which proposed a "free national health service" as a way of combating the five 'Giant Evils' of Want, Disease, Ignorance, Squalor and Idleness. The Conservatives, who nominally had the majority in the Commons at this time (though there was actually a "Government of National Unity" in power) refused to commit to putting in place the reforms, which was one of the reasons why they were beaten so comprehensively by the Labour party in the 1945 General Election. One of their first acts when they got in to power was the 1946 National Health Service Act, which provided in law for a free and comprehensive health care system.
The first day of this National Health Service was to be 5th July 1948 but there was an enormous amount of work that had to take place before it could start, including the nationalisation of Hospitals, the creation of health centres, the better/fairer distribution of doctors around the country and the creation of a new salary structure. On top of all this work, there was a huge amount of opposition (as with any large and sudden change). Most Local Authorities and Charitable Organisations who had previously run hospitals were opposed, as were doctors, who did not want to be employed by the government, or told where to work. In fact, at the beginning of 1948 90% of doctors said that they would not co-operate with the NHS. There was also opposition from many who were scared by the huge costs involved, but Aneurin Bevan
who was Minister for Health at this time argued that Britain could afford it, and had
to afford it. Bevan worked extremely hard to ensure the creation of the NHS, and by hook or by crook (he allowed doctors to work for the NHS and keep private patients while getting the public to sign up with doctors for the NHS - if a doctor didn't sign the form, he risked losing the patient [and the funding that came with them] to a doctor who would), made sure that over 90% of doctors had signed up by the opening day.
The benefits of the NHS were visible very quickly, especially in those groups which had not been covered until its creation. Maternal and infant mortality levels fell very quickly and life expectancy rose, especially as the new techniques and drugs (such as Penicillin) became available at no cost to people who would have died for want of them.
In 2008 we're looking at:
* An average life expectancy of 77 years, with more and more living until 100.
* An average of 5.2 out of every 1000 babies dying before the age of 1 (0.52%) [figures from 2006]
* Everyone can see a doctor, irrespective of whether they can pay
What I'm trying to say in an incredibly long winded way is that the NHS may not be perfect, but in comparison to what we have had before it is amazing, and I sometimes think we lose sight of just how brilliant it is amongst all the complaining about the things that are wrong and the compromises that sometimes have to be made.
My dad was chronically ill with Type 1 Diabetes most of his life, and we did not have to pay towards his care. His final illness and the two weeks spent in intensive care did not bankrupt us. My sister was born 15 weeks prematurely and spent her 16 hours of life receiving the best care available in 1982, and my parents were not left with a crippling bill as well as a dead daughter. When my mum hurt her back and she was in bed for 6 weeks her care (a physio, home help twice a day, doctors visits, nurse visits) did not cost us. When my mum was pregnant with me and was kept in hospital for most of those 9 months my parents did not have to check her out because they were worried about the cost, nor did they have to worry about the bill they were getting at the end. When I was ill with depression I did not have to worry about the cost of my prescriptions or my counselling. The times Phil has injured himself we have not had to worry about the bill from the Hospital for getting him checked out. Ben and I have not had to worry that while I've been off work I've been without coverage for my health (or traded electricity/food/rent for insurance coverage).
I think there's a lot to be said for that. So Happy Birthday NHS, here's to many many more.
ETA: Pretty much 1500 words. I wrote as much as that in some of my degree essays. Sorry guys!
ETA2 (2011): Since I wrote this my mum died from a rare form of Cancer. Her care was second to none and nothing was denied her on grounds of cost. We were not left with crippling bills, and not having to worry about finding money for her care made her last weeks and days easier for everyone.