NEED A PERFECT PAPER? PLACE YOUR FIRST ORDER AND SAVE 15% USING COUPON:

4.8/5

Defects of the 1948 NHS

Defects of the 1948 NHS

_x000D_
The National Health Service was one of the major achievements of Atlee’s Labour government. The  National Health Service (NHS) was introduced in in 1948. This service provided free medical treatment for everyone. The driving force behind the NHS was Aneurin Bevan, Minister of Health. In 1911, the National Health Insurance system provided medical care for 21 million people (according to Bevan) but left the rest of the population having to pay for medical treatment. It became clear to both Beveridge and the Labour Party that people were being denied medical help simply because they could not afford to pay. The majority of doctors were opposed to the introduction of the NHS as they believed that they would lose money as a result of it. Their main opposition to the NHS was their belief that their professional freedom would be jeopardized. They projected that they would treat fewer private patients and, as a result, lose out financially. They also believed that the NHS would not allow patients to pick their doctor – though this proved to be an unfounded worry. Once the NHS was introduced, it did prove to be popular with most people. 95% of all of the medical profession joined the NHS. In fact, the NHS proved to be too popular as it quickly found that its resources were being used up. From its earliest days, the NHS seemed to be short of money. Annual sums put aside for treatment such as dental surgery and glasses were quickly used up. The £2 million put aside to pay for free spectacles over the first nine months of the NHS went in six weeks. The government had estimated that the NHS would cost £140 million a year by 1950. In fact, by 1950 the NHS was costing £358 million. However, the popularity of the NHS meant that in the 1950 election, the Conservatives promised to keep it – though this was of little importance as Labour won that election. In 1951, the Labour government introduced a charge for some dental treatment (free false teeth) and for prescriptions for medicine. Aneurin Bevan resigned from the government in protest at this. Bevan wanted a free health service and nothing else.

_x000D_
The organisation of health care in Britain before 1948 – and access to it – had significant drawbacks. In 1911, the chancellor, Lloyd George, established a system of National Health Insurance. This offered benefits to the contributor below a certain level of income, and did not include dependants. Contributions were not graduated according to income but were paid at a flat rate – approximately half by the employee and half by the employer. In return for their contributions, individuals received cash benefits for sickness, accident and disability. These were paid at a fixed rate, regardless of severity – and were distributed through insurance companies. Contributors also had the right to free but limited care from a doctor on a local list or panel –yet were only entitled to hospital treatment when suffering from tuberculosis. As for doctors, they received a ‘capitation fee’ – a standard payment for each panel patient. Lloyd George’s insurance service may have been Britain’s largest pre-1948 health care system, yet it wasn’t alone in providing medical assistance. The Poor Law offered relief to the most impoverished Britons, and workhouses provided their own infirmaries. The public health system in local government also provided a wide range of services, such as support for school meals and health education. By the 1930s, it had expanded its hospital provision, taking on Poor Law hospitals. The other major hospital system offering care to patients before the advent of the NHS was that of the voluntary hospitals. The majority of these were initially supported by donations from subscribers who had the right to sponsor patients for admission. Yet, by the 1930s, they found themselves in the midst of a financial crisis. In short, Britain’s health care system, pre-1948, did not work well. It was a patchwork of institutions which were not accessible according to need. The two primary deficiencies were lack of access to hospital care and lack of access to health care for dependants – the families of working men. Many of these had no formal health cover and had to use self-medication or medicines bought over the counter from the local pharmacist. As a result, an illness, or paying for medical attendance at a birth, could cause major financial problems for families across the country.

_x000D_
The National Health Service, which came into existence on the ‘appointed day’, (5 July 1948), was the first health system to offer free medical care to the entire population at the point of need. The service was paid for out of taxation, and was not based on the insurance principle, with entitlement following contributions. Before and during the war it was thought that the public health service in local government would provide the eventual basis for a national system. However, hospitals were nationalised and, significantly, the role of local government was limited. The new service was totally free until 1951, when charges were imposed for prescriptions, dental care and spectacles. What’s wrong with the structure of the NHS?The chief problem with the structure of the NHS was that, from the outset, it was a compromise set in place to secure the support of the medical profession. The Labour government that founded it wanted to establish a locally administered entity but was confronted by a profession that was hostile to a salaried service within local government. The minister of health, Aneurin Bevan, was well aware that the NHS simply couldn’t survive without the support of the doctors, and so secured their backing by nationalising the hospitals. The upshot is a service that has been consistently criticised for its ‘democratic deficit’ – the loss of local democracy that resulted from it being taken out of the control of local councillors. The NHS has also attracted criticism for its lack of integration. When established, it was divided into three individual parts: hospitals, local government services and general practice – each of which tended to operate separately from one another.

_x000D_
The model of the NHS, centrally funded out of taxation and thus politically directed, was quite different from that of other health systems reorganised after the war. Universal access was a tremendous step forward – in particular for women. The removal of fear of illness cannot be underestimated and, as a result, the NHS was popular at its inception and its ideal has remained so. Indeed, politicians have not interfered with these founding ideals, despite a flirtation with insurance in the 1980s. NHS tax funding has meant that health matters are far more sensitive in the UK than in insurance-based countries. Politicians have tried to find solutions to the problems of health care delivery in relentless reorganisations of the service or in the establishment of central targets – one recent example being general practice appointment booking. Despite the NHS’s early acquired reputation for financial profligacy, it was in fact a cost-effective service. The initial financial estimates for the service assumed that it would be funded out of local and not national taxation and so had underestimated its true cost. In recent years politicians have increased the proportion of funding given to the NHS.

_x000D_
Instead, it’s the NHS’s structure that has led to its continuing problems. The preNHS service may have been fragmented but the NHS tripartite service (hospitals, local government services and general practice) also left much to be desired. Recently the ‘polyclinic’ has been advanced by government adviser Ara Darzi as a new solution to the problem of bringing together specialists, other services and general practitioners. But this is not a new idea. Indeed, health centres were intended to be the unifying force in the NHS in 1948 – though few were built.

_x000D_
The original NHS was a doctor-dominated service, and negotiations between GPs and the government continue to take centre stage, as seen in the recent rise in GP pay and the conflict over surgery opening hours. Despite the NHS’s success, private medicine retains a role, now taking a new form in the shape of health care companies, who provide primary care or the private funding of hospital building. The NHS of 1948 was dominated every bit as much by hospitals as it was by doctors. This dominance has continued and is represented currently through the prominence given to foundation hospitals, which seem rather like the old voluntary hospitals reborn. The pre-eminence of hospitals had one immediate consequence for the NHS: it became preoccupied with curing sickness rather than promoting good health. As a result, public health services were downgraded in value, and have struggled to find a role within the health system ever since, losing their position in local government altogether in the 1970s.

_x000D_
However, in the wake of the Wanless Report of 2004, strenuous moves have been made to reorientate the service towards what is now called Primary Health Care (PHC) – and the government has adopted a more holistic approach, enabling a wider range of practitioners to deliver health care. This places GPs, dentists and midwives at the heart of the service. As such, community pharmacists can now be seen as building on the practice of ‘counter prescribing’. The ‘democratic deficit’ within the service has continued to elude resolution. Patient and public participation in the structure of the NHS has traditionally been limited and so, with patient choice firmly back on the agenda, the Government is reassessing patient input once more. Since the advent of Primary Care Trusts, which cover similar areas to local councils – the connection between the NHS and local democracy has become more obvious. Yet, there is still no direct local electoral input into the health service. This issue has dogged the NHS since its inception 60  years ago and is likely to do so for some time yet.

_x000D_
Well, we learn a number of things from problems that riddled the formation of the National Health Service in 1948. The NHS ideal of universal access at the point of need was unique and has retained its popularity. Politicians are likely to remain ultimately responsible through government tax funding. Delivery of the ideal continues to present problems. The structures put in place in 1948 were flawed, giving doctors too great an influence, a focus on sickness rather than positive health, and a lack of democratic input. Such structural problems, or attempts to deal with them, are often presented as new initiatives, when they have a history. How ‘polyclinics’ or local democracy operated in the past could inform today’s policy discussions.

_x000D_
The reasons for the service reaching this crisis point are many, but here are the main ones. An ageing population; The NHS was set up to treat people with diseases. Many of the diseases that would have killed people 65 years ago, have been cured, which is brilliant. While that means people are living for longer, it also means that they are, probably, living with one or more illnesses (long-term complex conditions) such as diabetes, heart and kidney disease. In turn, that means ongoing treatment and specialist care. Lifestyle factors; The way we live now is also having a negative impact on our health. Drinking too much alcohol, smoking, a poor diet with not enough fruit and vegetables and not doing enough exercise are all major reasons for becoming unwell and needing to rely on our health services. Increasing numbers of overweight children show us that this problem is currently set to continue. The change in public expectations; Originally, tackling disease was the main job of the NHS. Now, we all expect so much more. From advice on healthcare management through to mental health and social care, contraception, antenatal and maternity services, vaccination programmes and the fast, efficient processing of our medication and appointments. All of this with a growing population due to living longer and higher birth rates with lower infant mortality. Accident and Emergency departments; More and more people are visiting A&E departments and minor injury units – which is stretching the ability of the departments to cope. A lot of the visits are unavoidable, but some are visiting because of inconsistent management of their long-term health conditions, the inability to get a GP appointment or insufficient information on where to go with a particular complaint. Winter sees an even bigger rise in visitor numbers with staff finding it harder by the year to cope. Rising costs; The current financial crisis, rising costs of services, energy and supplies; innovations and technological breakthroughs that require more investment – along with higher numbers of people to cater for – all spell out a huge economic disaster for the NHS. It is estimated that without radical changes to the way the system works, as demand rises, and costs rise too, the NHS will become unsustainable, with huge financial pressures and debts. If we make no changes we face a £30 billion funding gap for the NHS nationally by 2020 . Advances in medicine and technology; The great news amongst all of this gloom is that there has never been a better time to face an overhaul. Huge advancements in medicine and surgery, alongside IT and technological innovations mean that there is a wealth of ideas and efficiencies that could potentially be implemented to bring our NHS up to modern standards to meet the needs of us all in the 21st century. Utilising these new approaches within a major restructure the NHS could go on to be a reassuring source of health care and wellbeing, as well as an inspirational model of good working practice for years to come.

_x000D_
In conclusion, let me summarise by reaffirming that we need to take the ‘N’ off NHS, take affordable health care away from both the State and the profit-motive, take medical provision out of the Eton & Highgate Political Wall Game that is killing it, give it to the mutual sector to manage, give medical staff guidelines about what they can and cannot cure, and then within that proscribed remit, give unlimited health care to all citizens without the means to afford BUPA’s rapacious fees. Those last two items are central, really. We must stop trying to do everything, only to then find ourselves being forced to ration at random. Far better, surely, to do the important life-enhancing things at the top level of quality, rather than achieving a bare mediocrity at the lowest common denominator. There is one final step I sense that Britain needs to take if affordable healthcare is to survive. This would mean addressing a much broader Anglo-Saxon problem, that of the litigious “I’m entitled” culture. Obviously, patients must be protected against gung-ho knife wielders, the BMA, the Medical Defence Union, and chronic incompetence. But we need to make a start somewhere when it comes to reining in the ambulance-chasers.

_x000D_

_x000D_
REFERENCES

_x000D_
WEARDEN, G.  “NHS IT project costs soar”: ZDNet, 2004

_x000D_
COLLINS, T. “Is it too late for NHS national programme to win support of doctors for new systems?”: Computer Weekly, 2005

_x000D_
RINTALA, M. Creating the National Health Service: Aneurin Bevan and the Medical Lords: Sage Publications, 2003

_x000D_
KLEIN, R. The New Politics of the National Health Service: Wiley publishers, 1995

_x000D_
EVERSLEY, J. “The History of NHS Charges”, Contemporary British History, Vol.15, pp. 53-75, 2002.

_x000D_
POLLOCK, A. NHS plc: the privatisation of our healthcare: Verso, 2004

_x000D_
MANDELSTA, M. Betraying the NHS: Health Abandoned. Jessica: Kingsley Publishing, 2005

_x000D_
GORSKY, M. “The British National Health Service 1948-2008: A Review of the Historiography,” Social History of Medicine, Vol. 21 Issue 3, pp 437–460, 2008

_x000D_

Solution:

15% off for this assignment.

Our Prices Start at $11.99. As Our First Client, Use Coupon Code GET15 to claim 15% Discount This Month!!

Why US?

100% Confidentiality

Information about customers is confidential and never disclosed to third parties.

Timely Delivery

No missed deadlines – 97% of assignments are completed in time.

Original Writing

We complete all papers from scratch. You can get a plagiarism report.

Money Back

If you are convinced that our writer has not followed your requirements, feel free to ask for a refund.

WeCreativez WhatsApp Support
Our customer support team is here to answer your questions. Ask us anything!