David Hamilton We take it for granted now that we need not to have bills for routine medical treatment. We assume that health care is available to all.
David Hamilton
We take it for granted now that we need not to have bills for routine medical treatment. We assume that health care is available to all.
It was not always thus. Before the NHS in 1948, things were different. Patients in regular work contributed to their National Insurance and hence many men had "free" care from a general practitioner, but their families, including wives and the elderly, and others non-insured had to pay up. Even a simple illness and prescriptions might use up a week's wages.
For hospital care, the middle class used expensive private treatment in small, poorly equipped nursing homes. Before the war they were increasingly turning to the large charity "voluntary"
hospitals which accepted all patients, but these hospitals were run-down, in debt and waiting times were getting very long.
Pre-NHS, doctors had a different working life. Salaried jobs were few and they faced an entrepreneurial life in the medical marketplace. General practitioners worked in competitive isolation and "visiting" hospital consultants relied on private practice for their income.
The Second World War brought about much social change, but the advent of the NHS was almost revolutionary. Only in Britain was such a leap accomplished. The NHS was "free at the point of consumption" and advice and treatment was available both in general practice and the hospital sector.
These stunning features, notably the free spectacles and dentures for the many Scots challenged in this way, caught the imagination of all, but the changes were much more fundamental. The simplicity of the administrative side was admired by governments internationally, as was the integration of the "unseen" preventative role of public health and higher-profile curative services.
The hospital consultants also benefited. They were paid a reasonable salary, and with a post-war drop in Scottish private practice, their daily visits to the hospitals changed to prolonged sessions.
Public health was highly regarded and reached its triumph with the campaign against tuberculosis. A centralised service also gave wider outreach, with vaccination against the common infectious diseases.
The NHS is part of our life now, and its faults are constantly looked for. Alternative systems have been suggested. It is well to recall the state of healthcare pre-NHS.
- David Hamilton is the author of The Healers: A history of Medicine in Scotland
