The National Health Service: Medical History - Essay Example

159769 The health of the people is really the foundation upon which all their happiness and their powers as a depend. Benjamin Disraeli, 1877. A person ought to be able to receive medical and hospital help without being involved in financial anxiety. - Nye Bevan, 30th April 1946. INTRODUCTION NHS, considered to be the major achievement of Clement Atlee's Labour Government, was spearheaded by Aneurin Bevan, Minister of Health. People being unable to pay for their health care had been the main encouragement for Bevan to establish National Health Insurance system. He had to face criticism and opposition in and outside Government, while doctors were not keen as they were afraid of losing money and professional freedom both. They were financially losing, would have less private patients and patients would not be allowed to choose their doctors, though after NHS was introduced, 95% of professionals joined it. Nye Bevan was a Welsh politician, socialist, and any rule that was slightly against the common man even in the remotest way bothered him and hence, his affiliation to Labour party where he thought the real worker would attain power. His preoccupation with worker health made Churchill call him 'Minister of Disease'. Though it took real effort to overcome political and professional oppositions and scepticism even from his own party, he brought the National Health Service Act of 1946 into force. He had to struggle to win over a high percentage of professionals without compromising on the fundamental principles of his health scheme, making the famous quote that he managed to 'stuff their mouths with gold'. This led to the Health Minister's supervisory control over 2,688 voluntary and municipal hospitals that were immediately nationalised. Those were the days when the country was trying to build up housing, repairing bombing damage and eradicating pre-war slums. Bevan had his plate full of challenges, difficulties, lack of skilled labour and manpower (a generation of able bodied men were eliminated during the war!), non-existence of building material and financial constraints. 55,600 new homes in 1946 and 139,600 in 1947, 227,600 in 1948 despite a more demanding and personally more significant work on health, created a hallo of achievement around Bevan. BEGINNINGS OF NHS: As the founder of NHS, Bevan had to work ceaselessly starting from begging for additional powers. "There is already some evidence, as a consequence of the publicity which has been given to this aspect of the service, of a reduction in some cases of the burden on the general practitioners. There is a growing consciousness that people ought not to abuse the service in any particular. I am convinced that, as the service develops, there will be a growing sense of responsibility, and that discipline of this sort will not eventually be necessary in the service as a whole. I hope, therefore, that with those assurances and those explanations the House will permit me to have the powers for which I am now asking" he said, in one of his speeches. http://www.sochealth.co.uk/history/charging.htm Though, a controversial figure in British politics, Bevan was capable of marching towards the ultimate goal. Antibiotics have shown a way of treating some of the dreaded diseases and the old hospital system, after the horrifying war, was proving inadequate and useless to meet the new challenges. There were women who had ignored their health, hoping to find resources for the health of the family. Bevan had noticed that the unfortunate war and the sufferings have created an atmosphere of consensus in Britain. When NHS was established as a result of 1944 White Paper, Bevin himself was surprised at the unending number of patients aspiring for free medical care. Patients queing to make an appointment at the London Hospital in Whitechapel, East London, 1949 . http://www.kented.org.uk/ngfl/subjects/history/medhist/page34_bevan.html REACTION FROM BMA: The guiding principle was that service should be comprehensive and all citizens should receive free treatment, advice, care, facilities without any discrimination. British medical association (BMA) threatened non-cooperation over issues of responsibility and pay, but Bevan had pressed ahead. It was a major change and the act nationalised 1,771 English and Welsh local hospitals and 1,334 voluntary hospitals. This encompassed community health service, ambulance, medical, pharmaceutical, general practitioners, specialists, ophthalmic services. There were immediate financial crunch as demand for medical services increased far beyond the expected level. But it is owing to Bevan's acumen and far sight that the first structure of NHS managed to survive and remained unaltered till 1980s. When the first suggestion came, BMA more or less exploded at the very suggestion of an NHS. They said it would lead to a full time salaried service under local or central administration and they would be reduced to the level of civil servants with their clinical independence and freedom of speech being snatched away. They were suspicious of such a system, parties, governments and of Bevan himself, who was called 'medical Feuhrer', a dictator and an autocrat. Some of them even said that Hitlerite regime, now destroyed in Germany, has shifted to Britain. First difficulty came from the structure, history and personalities in BMA. The structure caused many problems, especially about doctors' contracts even as late as in 1960s. To a large extent, their fears were genuine, because they were undoubtedly becoming salaried employees, which, in those days of independent and respected profession, could not be contemplated. Their contracts were going to be drawn against the nationalisation of hospitals, which again, was a bone of contention and very few established professionals agreed to such a 'disaster'. BMA itself worked as a democracy with proper elected members. To them, the proposed changes looked like bringing sub-surveillance to their doorsteps. They also pointed out that medical help during interwar period was not particularly inadequate, which was true. "In recent years, there has sometimes been a tendency to present a particularly bleak picture of inter-war health service provision, if only to emphasize the importance of the reforms which were introduced after 1945," agrees Harris (2004, p.242). END OF DEADLOCK: The dispute-wracked months were difficult for Bevan, but he would not give up. Throughout he tried many approaches, convinced many people, but all without compromising on the original principles and eventually it worked overwhelmingly for the government. Association's fourteen questions and after his replies, association went for a plebiscite and even though deeply divided, most of them agreed to cooperate. "The conflict about means did not, however, simply reflect a clash of interests. It also represented a clash of values. In its final form, as it emerged in 1948, the NHS represented the victory of the values of rationality, efficiency and equity. It was designed to be the instrument of national policies for delivering health care in a rational, efficient and fair way across the country," Klein (2001, p.22). There were many arguments against introduction of NHS: local hospitals were adequate; it was waste of taxpayers' money, hospital nationalisation was not in party manifesto, management will inevitably come under party control et. While medicos had their own grievances, there were many other genuine issues that needed assurance. "One of these was the introduction of comprehensive coverage. Others included 'a nationalisation of the hospital services, the allocation of resources according to need rather than the vagaries of the market, the abolition of the sale of practices, the principle of free access and a degree of redistribution between income groups', Gladstone (1999, p.45). Today, under different circumstances, NHS is forced to use private sector involvement, which is called as betrayal of Bevan. http://www.bmj.com/cgi/content/full/331/7520/853/DC1. Perhaps it is not the betrayal at all, because the sensible leader wanted an excellent health care for citizens and it would not have mattered to him from which sector it came, because Bevan was a pragmatic leader, who was more focussed at the outcome. He knew that NHS would be costly as it had been short of money from its initiation and in 1950, it costed a whopping 358 million. The genesis of NHS was very slow over fifty years initially depending on charities like King's Fund. It took time for the NHS to become a part of societal structure where healthcare was a luxury when philanthropists and social reformers had made immense efforts to care for the unhealthy poor. One shining example was Royal Free Hospital that was treating an average of 30,000 patients per year. It was difficult for Municipal hospitals to treat the mentally ill, handicapped, older people most of whom ended in the dreaded workhouses. NHS was totally financed by Central Taxation, and citizens, including the visitors of short stay were eligible for free care not only in local, but distant hospitals. A momentous achievement and it coincided with better Anastasia, antibiotics, treatment for mental illness, psychological care, and good diuretics for heart failure, antihistamines, and radiology systems. It brought all family practitioner services, hospitals, community based services, under one organisational roof. It faced substantial financial problems and within three years, it was forced to charge a modest fee and trying to balance the demand and expectations with supply had been a constant struggle ever since. Bevan had foreseen such an eventuality and said, 'we would never have all we need'. Introduction and improvement of consultant services, difficulties of dental services, innovation of health services in the community, introduction of dialysis and chemotherapy, issues of doctors' pay, improvement in clinical management (Cogwheel Report in 1967), tripartite structure of the service, transplant surgery, changes in abortion law all became major issues in the NHS as it evolved trying to adjust to the modern times and demands. New hospitals were set up under Government's Hospital Plan, resources were planned from time to time, and in 1974, NHS got reorganised so that Health Authorities could cooperate with local authorities. There are many criticisms that it is a white elephant and gobbles up not only the best portion of economy, but also the debate time of one and all in the country and it is considered to have become the victim of its own success having introduced unlimited expectations and hence, litigations and discontent. To simplify the process, Regional Health, District Health, Special Health and Family Practitioner Committees were introduced in 1982. ACHIEVEMENT OF NYE BEVAN: These problems should not undermine Nye Bevan and his phenomenal achievements in any way. 'A stormy petrel' of Labour Party, who 'had a magic of his own' and 'was the most hated - if also the most idolized - politician of his time' as described by Kenneth Morgan, was also called an 'artist in the use of power' had to face many problems for creating NHS, especially from the forbidding medical fraternity. Even in the days of Sir William Beveridge who had demanded a National Health Service before Nye Bevan, professional doctors and surgeons were suspicious of such service. Bevan thought it was sale and purchase of medical service that he disliked. In addition, initiation of the idea in political circles was not an easy thing either. "Before the Bill could be published, however, Bevan had to sell it to the Cabinet and in October he sought a decision on 'one big question of principle' - whether to nationalize the hospitals. His argument was simple: the voluntary hospitals were dead" Timmins (2001, p.115). Even though Churchill condemned him once as 'a squalid nuisance', Macmillan fondly called him 'an uncontrollable star - almost a comet'. Bevan, an ex-miner, could never forget the sufferings of miners and other poor people who stood in dire need of medical attention, but could not attain it due to lack of money. But Bevan resigned in 1951 over a comparatively small issue of charging dental treatment as Bevan wanted an absolutely free health service and no compromises there. Once out of the cabinet, Bevan is accused of splitting the Labour party into two to create the left wing called Bevanites, who ceaselessly criticised high defence expenditure like nuclear weapons and government had to restore the withdrawn whip under the cloud of his tremendous popularity. Unfortunately, Bevan died at quite a young age by terminal cancer and his last speech in the House of Commons still is considered to be a master peace and is extensively quoted. CONCLUSION Bevan remains the most remarkable figure in the history of NHS as its founder which made unhealthy conditions a history, thanks to this visionary. "Because of Bevan's achievement, my generation - the baby boomers - will hardly ever see the damage of neglected and untreated conditions of the sort that haunted our grandparents: women with prolapsed internal organs which had been in that state for years; men with hernias and lung disease which had never been examined" Becket (2004). His early death was unfortunate and sad. As historians never get tired of reiterating, his name will always be linked with NHS. Without his untiring work, NHS would not have happened within such a short period. "He was, as the Speaker of the Indian Parliament had said in introducing him to its members during his visit of 1957, a man of passion and compassion; but only his closest friends could know that to the full", Foot (1973, p.658). BIBLIOGRAPHY: 1. Becket, Clare (2004), What Bevan would think of Blair Socialist Health Association, New Statesman, 23rd August 2004. 2. Foot, Michael (1973), Aneurin Bevan, Vol. 2, London, Davis-Poynter. 3. Gladstone, David (1999), The Twentieth-Century Welfare State, Hampshire, MacMillan Press. 4. Harris, Bernard (2004), The Origins of the British Welfare State, Hampshire, Palgrave Macmillan. 5. Klein, Rudolf (2001), The New Politics of the National Health Service, Harlow, Prentice Hall. 6. Timmins, Nicholas (2001), The Five Giants, London, Harper Collins Publishers. ONLINE SOURCES: 1. Bevan, Nye (1949), http://www.sochealth.co.uk/history/charging.htm, (accessed on 27.5.2007). 2. Author name and year are not available, Bevan's NHS, . http://www.kented.org.uk/ngfl/subjects/history/medhist/page34_bevan.html (accessed on 27.5.2007). 3. Lane, Robert (2005), Bevan betrayed, The Demis of NHS. http://www.bmj.com/cgi/content/full/331/7520/853/DC1, (accessed on 28.5.2007). Read More