Birth of the NHS

My mother remembered that in 1927, after her younger brother was born, he had to wear a shoulder and arm splint because his arm had been broken during his delivery. My Grandmother had been assisted during the birth, like most lower-class women, by an untrained local woman.

The cost of a doctor per visit of 6d (old pence) or trained midwife was beyond her means, when a casual labour’s pay could be between 7d and 11d per week.

Beatrice Maud Parsons 1931

Infant mortality in British children under 1 year in 1948 was 36 per 1000 births, in 2016 it was 3.9 per 1000.

Both my mother’s two younger brothers died before the age of 1 year.

The New Poor Law Act of 1834 aimed at reducing the outdoor relief payment to the poor(those living in their own homes). It set up Local administrative parishes (or Unions) responsible for austere Workhouses. These were the primary source of free medical care. The workhouse would have an Infirmary room or block, one trained medical officer but no trained nurses. Patient care was at the hands of other female inmates. Most Infirmaries lacked proper sanitation and hygiene with patients with various conditions housed together.

In Barnstaple a separate Infirmary to the Workhouse in Alexandra Road, was founded in 1824 and built in Litchdon Street from donors and contributors, the main one Lord Fortescue, and maintained by voluntary subscription. [Infirmary Centenary Souvenir 1826-1926 D362 BAR NOR, ND Infirmary Annual Report 1850 DP 900 BAR and various photographs of building and staff. North Devon Athenaeum catalogue.]

[North Devon Infirmary: Harper Album 7-p66-1]

There was also the Barnstaple and ND Dispensary established in 1832 in Boutport Street which had some beds. Donors and subscribers could nominate poor people to receive treatment. [Minute book 1832-65 B83-05, Rules for Dispenser, Nurses etc B07-13-8 to 11]

[Barnstaple and North Devon Dispensary, Boutport Street: BWO-Bx05-025]

Before 1900 health care was mainly provided by local charities, the Poor Law Workhouse Infirmaries, and the unregulated private sector.

Lloyd George Chancellor of the Exchequer in the Liberal Government brought in the National Insurance Act 1911 where compulsory insurance gave access for general labourers and lower paid non-manual workers to GP doctors and Tuberculosis care. It set a fixed capitation fee for doctors of which the Government paid two ninths; the remainder was made up by the insurance. [www.nationalarchives.gov.uk/cabinetpapers/themes/national-health-insurance.]

The National Insurance did not extend to the workers wives and children, did not include hospital treatment or cover the elderly or anyone not in work.

Under National Insurance only 40% of the population had access to a GP, most people could not afford to pay medical bills.

There were mutual aid funds, medical clubs or societies that

In 1929 the Poor Law was abolished and Workhouse Infirmaries became General Hospitals.

Alexandra Hospital fete, Barnstaple 1954; NDJ Bx 236-02

The foundation of the National Health Service  was preceded by the Wartime Coalition Governments report “Social Insurance and Allied Services” 1942. [White Paper GP 360 BEV Athenaeum]

Written by Sir William Beveridge, an economist and expert on the problems of unemployment, it became the blueprint for the 100% tax funded and far reaching social reforms of the “Welfare State”.

He was drawn to the idea of remedying social inequality, realised that charitable philanthropy was insufficient and a coherent Government plan was needed.

He proposed all working people paid a weekly contribution to the State which would pay unemployment, sickness, maternity, retirement and widow’s benefits, providing an acceptable minimum standard of living in Britain below which nobody would fall.

Aneurin Bevan (called Nye Bevan) was appointed Health Secretary in Clement Attlee’s Labour Government in 1945 and is known as the founding father of the National Health Service and it was his responsibility to implement the recommendations of the White Paper.

He was born in Tredegar Wales, the son of a poor working-class miner and who left school at 13 to work as a miner himself with first-hand experience of unemployment, poverty and disease. He rose through the Trade Union movement, to stand for the Local Council then for the labour Party as MP for Ebbw Vale.

In his book “In Place of Fear” he writes of his belief that “Healthcare should be free at the point of delivery based on need not wealth, that all should have access, when ill, to the best medical skill can provide”.

He took his inspiration from his home town Tredegar Medical Aid Society, a resident’s subscription fund to finance all the town’s inhabitants to have free access to medical services such as nursing or dental care.

The experience of hospitals coping in wartime with the volume of casualties, showed that the system was fragmented, incoherent and financially near bankruptcy and in need of re-organisation.

The Rt Hon Jennie Lee MP Minister of State, Dept of Education and Science and Aneurin Bevan’s wife said “Of course the health service in this country did not begin in the year 1945. Many of us have associations with the between-the-wars health service; a great patchwork, a good deal of good intentions, a great deal of inadequacies.”

Bevan faced stiff opposition.

Doctors did not want to become employees of the State and saw it as a threat to their Private practices.

A former chairman of the British Medical Association said that “The Bill ..looks uncommonly like the first step….to National Socialism in Germany….under the dictatorship of a medical fuher.” and will “establish the minister for health in that capacity”. Strong words so close to the end of the Second World War.

Winston Churchill and Conservative MP’s were opposed to nationalisation and thought the cost of the NHS would be too great.

Territorial Local authorities and voluntary bodies did not want to lose control of their hospitals.

Workers saw it as more money out of their pay packet.

Right Wing newspapers, such as the Daily Sketch, saw it as a Socialist Plot.

Bevan set about winning public support by sending out a leaflet to every household explaining the aims of his plan. “It will relieve your money worries in times of illness”. Healthcare would be free at the point of delivery based on need not wealth, funded from General Taxation.

There were posters and Information films.

He perfectly gauged, that after the Second World War, the public attitude towards the need for change.

[National Health Service Act 1944 North Devon Athenaeum 614 SCO]

Doctors were threatening to boycott the new service until very close to its inception.

Bevan was a superb orator and negotiator, he could develop arguments on his feet, he used irresistible logic with creative imagination in ways that could persuade opponents to change their mind.

Aneurin Bevan (1943)

Later Bevan said he “stuffed their mouths with gold”. He compromised by allowing consultants to work outside the NHS treating their lucrative private patients. He allowed GP surgeries to remain private business contracted to provide health care and to encourage recruitment he increased nurses pay.

Bevan succeeded; on 5th July 1948 the National Health Service came into being. It brought hospitals, doctors, nurses and dentists under one service.

Nearly 2700 municipal and voluntary hospital in England and Wales were nationalised and came under Bevan’s supervisory control as Health Minister.

After Bevan’s death, Winston Churchill, who had been the frequent target of Bevan’s forceful verbal attacks in Parliament, commented that Bevan was “one of the few members that I will sit still and listen to.”

It was the first time anywhere in the world there was a completely free health care based on citizenship rather than payment of fees or insurance.

...Sandi, Assistant Librarian

References

www.bbc.co.uk/history/historic_figures/bevan_aneurin

www.wikipedia.org

www.nationalarchives.gov.uk/cabinetpapers/themes/national-health-insurance

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