−−− BY LINZI DAVIES −−−

This month we celebrate 70 years of the NHS. Here in the UK, if we are ill we see a doctor, if we have a serious accident or illness we know a visit to A&E is the best place for us. Ultimately, we know that if we are ill somebody will take care of us, regardless of our income. It is easy to forget that this was not always the case. If you were living on the breadline and a family member fell ill, what did you do? Who did you see?

In our city, the Leeds Teaching Hospitals NHS Trust is one of the largest teaching hospitals in Europe and employs over 17,000 staff. In 2016/17 they treated 1,126,568 outpatients, 117,885 inpatients, 108,112 day cases and 263,564 people visiting the emergency departments, at the LGI, built in 1771, and St James’s first built in 1874, as well as the other sites across the city. These huge numbers just go to show how many people rely on the NHS – and that is just one city/region in the UK!

In our feature, we look at life in England before the NHS, how the service came into effect and the fantastic work they have done since then.

BEFORE THE NHS

Before the NHS, health care was a luxury. Much of the working-class population could not afford to see a doctor if they were ill, and instead had to rely on charities, neighbours and even the village ‘wise woman’.

In medieval times, nuns and monks often ran infirmaries for the sick where they would nurse the dying with a little watery broth or gruel and pray on their behalf. These ‘hospitals’ were often little more than a refuge providing a home for the disabled and elderly who could not be cared for by their families. Causes of sickness were unknown at the time, and often put down to bad spirits or ‘humours’ in the body. The typical medieval peasant would see the village wise woman for treatment when they fell ill. Minor ailments were treated by a variety of herbs and plants often foraged from the local area by the woman herself. The wise woman would also normally be the village midwife, but childbirth during the middle ages was a dangerous occurrence with mortality rates for both the mother and baby extremely high.

By the 16th century, not much had improved in the way of health care. In 1601 the Poor Law was established. Administered through parish overseers, they provided relief for the aged, sick and infant poor, sometimes housing them in alms-houses but more often relief for their illness was ‘the parish loaf’ with which they could feed themselves. The able bodied were put to work in the workhouses or ‘House of Industry’. The idle poor and vagrants were sent to prison or a house of correction, and pauper children were apprenticed. This act, whilst attempting to deal with poverty, did absolutely nothing to cater to these poor soul’s health needs.

Victorian Britain was no better for the sick person with little or no money. If they were seriously ill, the best they could hope for – if they could afford it, was to purchase medicine or leeches from a chemist or apothecary. Large populations living in squalid conditions in the slums meant that disease was rife. Sewage mixing with drinking water made people seriously ill and death from dysentery was common. Things began to improve after the Public Health Act of 1848 when local councils were ordered to build drains and provide clean drinking water. The workhouses whilst having their own infirmaries, were not a great option for the poor seeking medical care either. Even though the workhouses were obliged to employ one qualified medical officer, they were often the least experienced. They also had to pay for any drugs they prescribed themselves, so medicine was not given often. Nursing care was left to female inmates who were normally drunk, having purloined the more commonly prescribed treatment of brandy. The problems continued with the infirmary itself. Usually far too small with several patients to one bed, sanitation and ventilation was poor. From the late 1850’s pressure began for improvements by notable campaigners including Florence Nightingale. A description of the infirmary of St George the Martyr printed in The Lancet sums it up:

‘…Take the following in illustration: Thirty men had used one closet, in which there had been no water for more than a week, and which was in close proximity to their ward; and in an adjoining ward so strong was the ammoniacal smell that we had no doubt respecting the position of the cabinet which we found dry. In No. 4 ward (female), with 17 beds, the drain-smell from a lavatory in a recess of the room was so offensive that we suspected a sewer-communication, and soon discovered that there was no trap; indeed it had been lost for some considerable time. Apart from this source of contamination of the ward, there were several cases with offensive discharges: one particularly, a case of cancer, which, no disinfectant being used, rendered the room almost unbearable to the other inmates.’

Of course, for the wealthy, there was no squalid conditions to contend with, and minimal treatment – they could afford to pay for a private doctor to visit them in their own homes.

Inadequate medical care for the working-class poor continued into the 20th century. Harry, a miner’s son from Barnsley remembers his sister catching TB in the 1920’s,

“Her illness was directly spawned from our poverty, which forced us to live in a series of fetid slums. A doctor’s visit could cost the equivalent of half a week’s wages, so most people relied on good fortune rather than medical advice to see them safely through an illness. Unfortunately for my sister, luck was also in short supply in our household. Because my parents could neither afford to see a consultant nor send my sister to a sanatorium, Marion’s TB spread and infected her spine, leaving her an invalid. When Marion’s care became too much for my mother to endure, she was sent to our neighbourhood workhouse which had a primitive infirmary attached to it…my sister died behind the thick limestone walls at the age of ten, and perhaps the only compassion the place allowed my parents was permission to visit their daughter to calm her fears of death. As we didn’t have the money to give her a proper burial, Marion was thrown into a communal grave for those too poor to matter.”

Harry’s memories of this time show the horrifying reality for the poor if they became sick. Surely something had to change?

A National Insurance Act had been introduced in 1911, but only the working man paying into it was covered, not the women and children, although there were calls to extend the insurance to cover dependents. As the years went by, some local authorities began to run health services above and beyond those laid out by the Poor Law, but it was sporadic. By the outbreak of WWII, London County Council was running the largest public health service in Britain. The outbreak of war established the Emergency Hospital Service, which ensured treatment and care for soldiers injured by enemy action. Parliament debates raged for quite some time regarding the proper provision of medical care to all and the need to do something drove the impetus for reform.

■ Community Midwife 1959. Image © Queens Nursing Institute

THE NHS IS BORN

With an increasing view among younger members of the medical profession that things could be done better, the cataclysmic effects of the second world war meant that it was possible to have a massive system change rather than a slower modification over time. There were debates between political parties about whether a new system should be run by local authorities or separately on a regional basis. After a win for Labour in the 1945 general election, Health Secretary Aneurin Bevan presented a plan to the Cabinet favouring nationalisation of all hospitals with a regional framework. After tough negotiations and some concessions, the plan went through. On 5th July 1948 the NHS was launched by Bevan at Park Hospital in Manchester. It began with a simple premise. Financed entirely by taxes, it meant that the people paid into it according to their means. There were no additional services or doctors available than there were before, but they were now available to all – including the poorest who had previously had to rely on dubious home remedies. The inception of the NHS proved to be far more than just healthcare for all, the new structure also meant funding was in place for research.

VACCINATION

A big change that the NHS brought was mass vaccinations for children. Even though vaccination had been known since the late 18th century when Edward Jenner discovered it, and Louis Pasteur developing a rabies vaccine in the 1880’s, immunisation was not really available until the 1920’s. At this point, vaccinating children was down to the local authorities who had a somewhat sporadic approach. The NHS ensured that by 1956, all children were vaccinated against diphtheria, whooping cough, tuberculosis and polio. Because of this, polio is close to being eliminated from the planet. Smallpox was another vaccine developed and was ordered to be used on a global scale by the World Health Organisation. The disease was declared eradicated in 1980 and remains one of the most remarkable achievements in the history of medicine. Other vaccinations were introduced as the years went by, including measles, mumps and rubella (MMR). Vaccines continue to be developed to this day by scientists working for the NHS. They have prevented painful, life affecting diseases, and drastically lowered the mortality rates in Britain. Unfortunately, they came too late for so many, including the aforementioned Harry’s sister Marion.

MENTAL HEALTH CARE

Before the NHS, people suffering from mental health conditions were often ‘locked away’ in asylums. In the 50’s, care provision for mental health patients was addressed, firstly by the Percy Commission in 1954, followed by the Mental Health Act of 1959. Repealing the Lunacy and Mental Treatment Acts, it established that community care should be a priority for patients with mental health and that they should not be considered any different from other types of sick people. In 1961 Enoch Powell, the minister of health also spoke about mental health care in his famous ‘water-tower speech’ which signalled the end of the old asylums and changed the way people think about mental health.

MASSIVE IMPACT ON LIVES

Vaccinations and reforms to mental health treatment were just two areas where the advent of the NHS impacted lives. Other developments included the introduction of the contraceptive pill, available to married women from 1961 which meant that those living on the breadline could ensure there were no extra mouths to feed. Organ transplants and joint replacements also began in this decade, with the first kidney transplant taking place at Edinburgh Royal Infirmary with donor and recipient 49yr old twins, and the first full hip replacement carried out by Professor John Charnley. The fact that there were now options available to people with organ failure that could extend their lifespan, and that people with bad joints could enjoy a pain free future was incredible.

The 1970’s brought with them CT scanners and the world’s first IVF baby. Baby Louise Brown was born on the 25th July 1978 and was the first of over 1 million children to be conceived through IVF, giving many couples the chance of a family who previously thought this was impossible.

The following decade saw transplants develop further and the improved health of babies due to the increase of births in hospital rather than at home. The percentage of babies surviving who weigh less than 1kg at birth has risen from only 20% to around 80% today thanks to the care provided by the NHS.

Since the 1980’s, the NHS has continued to progress, develop and move with the times. Improvements such as walk in centres, extended patient choice and the NHS website have all made life a little easier for people to access the help they need. Technological improvements have also had a radical impact on treatment such as the use of robotic arms for major surgery including heart operations.

THE STAFF

Of course, all this couldn’t have been achieved over the years without the staff who work tirelessly to better the lives of their patients. From the scientists working in the labs, carrying out research and testing samples, the administrators who keep all the paperwork in order, technicians and porters to the nurses, doctors, dentists and registrars who treat our ailments and provide care, they all play a vital role in keeping the big machine that is the NHS ticking over. They improve lives, relieve pain and save lives on a daily basis working long and brutal hours with little thanks other than their own satisfaction at a job well done. These caring individuals really do deserve a medal, for without them we would all be in big trouble!

■ Image © Leeds Teaching Hospitals NHS Trust

So, to every member of staff working for the NHS in our hospitals, GP surgeries, clinics and labs we offer you a huge THANK YOU and here’s to the next 70 years of innovation, progression and above all, care!

For more information on the NHS at 70, including the celebrations that have been going on, visit www.nhs70.org.uk

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