1. Rise of State Medicine & the Birth of the NHS Lecture 20 Medicine, Disease and Society in Britain, 1750 - 1950

2. Links to previous lecture themes: Social medicine in interwar period, medical marketplace Was the NHS a radical new model of health care or were there important continuities with the past? Was the NHS born out of consensus or conflict? What is the relationship of the health care system to wider political economy (John Pickstone’s model of Productionist, communitarian and consumerist medicine ) Lecture themes

3. C20: ‘great troika of progress - science, profession, state’ 1900-1948- Productionist focus on health of the industrial worker and the armed services 1948- 1970- Communitarian NHS - expansion of services, focus on social inclusion Rise of the professional 1970-2000- Consumption Renewed emphasis on market and on lay management to challenge professionals John Pickstone, ‘Production, community and consumption: The political economy of twentieth- century medicine’ (2000)

4. 1909- Old Age Pensions introduced 1911- National Insurance Act –Access to GP services via a panel doctor –Hospital treatment not included –Sickness benefit (replacing lost income) –Administered through ‘approved mutual societies’. –Benefits limited to the contributor (worker) - mainly men. Women and children were not covered. National Insurance and Pensions

5. ‘The Dawn of Hope’ The National Insurance Act of 1911

6. National Health Insurance introduced in 1911

7. A ‘patchwork’ of services - Hospital beds (Webster, Caring for Health (1993)p. 121. Public Voluntary 186150,00011,000 189183,00029,000 1911154,00043,000 1921172,00057,000 1938176,00087,000

8. Sources of income of London voluntary hospitals (Webster, Caring for Health (1993)p. 139). 1938 1947% Voluntary gifts 3416 Investments16 8 Public authority 846 Other (incl. patients fees)4230100

9. Hospitals vs local authorities Early c20th - Local authorities increasingly involved in health provision e.g. Infant centres Local Government Act 1929 – local authorities took over workhouse infirmaries and infectious disease hospitals However, provision varied Coincided with economic social, political change – extension of franchise, boom and depression

10. Finsbury Health Centre

11. By the Outbreak of the 2nd World war, there was demand for change from a number of groups: The Socialist Medical Association (SMA) were a group of left wing doctors who called for a free national health service administered by local authorities The Labour Party were committed to the idea of a free National Health Service by 1939 Public

12. Beveridge Report - Social Insurance and Allied Services (1942) recommended a comprehensive health service White Paper A National Health Service published in February 1944. ‘To ensure that everybody in the country- irrespective of means, age, sex and occupation- shall have equal opportunity to benefit from the most up to date medical and allied services available…to divorce the case of health from questions of personal means and other factors irrelevant to it; to provide the service free of charge…and to encourage a new attitude to health- the easier obtaining of advice early on, the promotion of good health rather than only treatment of the bad,. (MoH, 1944, p. 47)’

13. ‘Fight for it now’ - poster from World War 2 showing the Finsbury Health Centre

14. Opposition from Medical Profession Objected to the concept of a salaried service Objected to Local Authority control Fear that would threaten clinical freedom Echoed control of Poor Law and Friendly Societies Wanted an enhanced role for voluntary hospitals and consultants.

15. Members of the BMA dressed as gladiators, conceding the introduction of National Health Service to Aneurin Bevan, dressed as Nero.

16. National Health Service Act 1946 - tripartite system Hospitals: Voluntary and local authority hospitals were nationalised - managed by regional boards Local Authorities - health centres, clinics, health visiting, ambulances GP, dental and optician services - provided by independent contractors administered by Executive Councils

17. NHS introductory leaflet

18. C20: ‘great troika of progress- science, profession, state’ 1900-1948- Productionist focus on health of the industrial worker and the armed services 1948- 1970- Communitarian NHS- expansion of services, focus on social inclusion Rise of the professional 1970-2000- Consumption Renewed emphasis on market and on lay management to challenge professionals John Pickstone, ‘Production, community and consumption: The political economy of twentieth- century medicine’ (2000)

19. Conclusion Long build up to change in provision of health services – But when? 1911 Act? 1920s? 1930? Historians disagree Opposition from the medical profession and other important groups Was the NHS a radical new model of health care or were there important continuities with the past? Was the NHS born out of consensus or conflict?