Cradle to Grave
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Lecture 7: The Rise of State Medicine
The making of the NHS marked a shift from the idea of a ‘medical marketplace’ where medical consumption was based
on choice and ability to pay, to a system where the state provides and ‘Health for All’ was seen as a right.
20th century – medicine and health became key political issues and increasingly involved a great deal of government
input (time, money and people). Idea that health was a right of each citizen became established.
New beliefs about the progressive power of scientific medicine for society.
History of state intervention in health usually focuses on the NHS although there were some earlier precedents.
1. 1870 – 1918
Medical Charity – vital for the working classes. Paid for by subscription and donation. Increasingly unable to cope with
demand or cost of services they provided.
Insurance schemes – became increasingly popular. Often organised by Friendly Societies, charitable organisations or
doctor’s clubs.
Poor Law –. Numbers of infirmaries and asylum’s grew from the late 19th century. Increasingly used a site of health
intervention (eg. Smallpox vaccination).
Public Health emerged as a national concern that was highlighted by social reports (Rowntree, Booth, Snow). Disease
and sickness increasingly seen as an environmental issue. Need for state and medicine to work hand-in-hand to improve
health through preventive medicine emerged.
Closer working relationship between state and medicine/science. Close links between ‘sanitary science’ and bacteriology
– TB, Smallpox, Cholera etc. which forged closer working relationships between medics and state.
National efficiency – key concern for the government. Through its eugenic connection this sort of discussion had
scientific elements. Need to consult doctors more – Boer War.
The National Health Insurance Act of 1911 – financed by contributions from employers, employees and the state.
Provided sickness benefits in the form of a ‘panel doctor’ (GP). Provided sickness, accident and disability allowance.
Mainly covered men, but some benefits for working women. Maternity benefit for working men’s wives. Free hospital
care for TB patients.
Ministry of Health 1919 – set up to look after sanitation, health care and disease. Played a role in training and delivery
of mother and baby services.
2. Interwar period 1918-1939
Dawson report (1920) – laid down plans for 2 tier health system (GPs/health centres). Never implemented.
Expansion of infant and maternal welfare clinics, VD clinics and sanatoria (TB).
New research into methods of preventative health – eg. Pioneer Health Centre Peckham. Finsbury health centre.
Voluntary hospitals – deepening problems due to NHI which changed their community role and function. Became
increasingly specialised (laboratories, X-rays, surgery). Less minor issues.
NHI running into problems due to the depression in the 30s. People couldn’t afford to pay.
3. 1939-1948
Emergence of new groups campaigning for greater state intervention in health (eg. Social Medical Association)
Emergency Medical Services established in 1939 – run by the ministry of health. Provided hospital care for military
personnel and civilian bombing casualties.
Beveridge Report (1942). Recommended the establishment of a comprehensive social security system and Health
service. Resulted in a government white paper A National Health Service (1944). To main principles: 1. NHS should be
comprehensive 2. Should be free at the point of delivery. Bevan faced significant opposition from GPs and the British
Medical Association.
National Health Service Act passed in 1946 – established a nationally directed and financed system of hospitals,
community care services and contracted health services (GPs, dentists, opticians).
NHS opened its doors on the 5th July 1948.