FROM CRADLE TO GRAVE
The
National Insurance Act of 1911 provided health care for workers but not
for their dependents. Working men had been covered since 1911 by health
insurance but their families were not. Many people belonged to friendly
societies and insurance schemes but it was often too expensive and provided
inadequate cover for the majority of the population. For example, at the
Ashford railway works several schemes were tried by the local voluntary
hospitals but they all failed, until a flat rate contribution was introduced
in 1921. The newspapers and the hospitals celebrated the success of this
and the house to house collections but they were a very small proportion
of the total costs of running the hospital and providing health care.
During the depression many of the health insurance firms went out of business and large numbers of people had to stop their payments because of unemployment. Hospitals found it increasingly difficult to raise funds and by 1938 about 60% of the income required by the voluntary hospitals was received from local taxes, the rates. Hospitals could no longer claim to be independent and had great difficulty managing their budgets from year to year.
Women in particular sacrificed their own health for their families, especially the children. Domestic remedies were used first, anything that might avoid an expensive visit to the doctors surgery. The whole system was a mess and for many doctors one third of their patients never paid their bills.
From the 1920’s there
was pressure for reform but the Conservatives believed fervently that
it was the responsibility of the individual not the state to provide medical
care. Reform came only with the fear of war in 1938.
The hospital network was divided between three types of hospital. For
the wealthy there were the nursing homes. For those who were able to pay
something towards their costs there were the voluntary hospitals and for
the poor the municipal hospitals. The municipal hospitals were often the
old workhouse infirmaries that had been converted when the Poor law was
reformed in the early 1930’s. These were poorly resourced with few specialist
doctors. In many areas in Kent they provided the last refuge for the old
and the terminally ill. There were in Kent examples of excellence in both
the provision of care and expertise but it was to be found in isolated
pockets. The statistics tell a fuller story of high infant mortality and
the frightening toll of people dying from infectious disease. What was
not known at the time was the silent suffering that existed. This only
became apparent when the National Health Service opened its doors to generations
of people suffering from ill health and ailments that had remained untreated
because it could not be afforded.
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Activities |
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| 1. |
What health care was available to most people in the first forty years of this century? |
| 2. | What were the problems that faced the health care system of the 1930’s? |
| 3. | Which groups were most disadvantaged by the need to pay for treatment? |