The RCPCH and National Health Service

On 5 July 1948, the National Health Service came into operation and became the UK’s third biggest employer as all medical services were brought together to provide services for free at the point of delivery. As we celebrate 70 years of the NHS, this blogs looks back at RCPCH’s history with the NHS.

The British Paediatric Association, the RCPCH’s founding organisation, began in 1928, 20 years before the National Health Service was established. Before the NHS, patients had to pay for health services in most circumstances and children were some of the most deprived of healthcare. Although free treatment was available from Voluntary Hospitals or within certain local authorities in England, or for minimal cost in areas covered by the Highlands and Islands Medical Service in Scotland, health services were generally seen to be inadequate for the needs of the population.

The Ministry of Health was created after World War I as a single authority for the medical and public health functions of central government and this was developed during WWII when a state-run Emergency Hospital Service was set up to treat those injured. The medical staff were employed by the Government and it was felt that many of the injured would be unable to afford treatment once the war ended, which led to discussions for a service to cope with the trials of post-war Britain.

Child health encountered new challenges during the war, such as symptoms caused by fear and displacement from evacuation, while rationing and food shortages had a detrimental effect on nutrition despite priority allowances for children.

The BPA, concerned about state of children’s health, carried out studies on the quality of milk supplied to children and the occurrences of rickets which gained notice from the Ministry of Health and were mentioned in the House of Commons.

Early plans for a National Health Service by the Society of Medical Officers of Health (1942)

 

The National Health Services Act was passed in 1946 and the NHS came into operation on 5th July 1948. Its creation was based around 3 principles:

  • to meet the needs of everyone
  • to be free at the point of delivery
  • to be based on clinical need, not ability to pay.

The Service meant that all areas of medicine were brought together under one organisation to deliver free services for everyone at the point of delivery.

Health is a national asset and every member of the community should be entitled to the best possible health and its minimum disturbance by disease or any adverse condition.

Before the NHS, most of the income of doctors was from private practice and their work in hospitals for the poor was undertaken in their own time. Paediatrics was especially difficult to make a living from, leading to very few doctors practicing solely paediatrics. First BPA president, Sir George Frederic Still, had a £20 a year salary and lived close to poverty.

However, there many doctors did not want to join the NHS when it began as what they earned from private practice was more than what they would get on an NHS salary. The British Medical Association negotiated to get a good deal for its doctors who did not want to join the NHS. It was also agreed that a certain number of hospital beds could still be used for private practice to give doctors extra salary based on the number of extra patients they treated. Remuneration was good for those practicing paediatrics though, and allowed to the number of paediatricians to grow and begin to provide a service all over the country.

BPA report on remuneration for doctors (1947)

 

The financial crisis of the NHS began very early in its life. Initially there was a surge in demand due a backlog from the previous years that was underestimated and, because now staff were employed by hospitals, their salaries were a major expense. By 1949, the NHS was already costing more than double the predicted £176 million.

When the NHS was first introduced, charges for medicines were free but charges were introduced in 1952 after the NHS Amendment Act of 1949 and prescriptions costed one shilling (5p). The charges were removed in 1965 but were introduced again in 1968 at a higher rate of two shillings and six pence, but, like today, had exemptions.

A main aim of the NHS was to not only cure disease, but prevent disease. In 1956, the polio immunisation was introduced and in 1958, the polio and diphtheria vaccination programme began, which considerably reduced cases. By the 1980s, polio had been eradicated from the UK.

The original structure of the NHS had three parts: hospital services, primary care (e.g. GPs, dentists, pharmacists) and community services. The BPA saw this as unbalanced and campaigned for community child health staff to be associated with hospital services. They believed that certain groups, such as the handicapped and the chronically ill, were neglected in the current NHS structure.

It wasn’t until 1968 that the first of two Green Papers were published expressing intention to unify all publicly provided health services. In 1973, NHS Reorganisation Act passed through Parliament and community medicine was introduced to the NHS in 1974. Two years later in 1976, ‘Fit for the Future: The Report of the Committee on Child Health Services’, otherwise known as The Court Report, was published by the BPA president Donald Court.

The RCPCH has always aimed to improve child health and worked to make child health services better for patients. Since WWII, the BPA has been involved in advising the government on the health of children and measures to safeguard, and has continued to publish reports, audits and guidelines and undertake and support research. In the 1950s, Sir James Spence and Alan Moncrieff, early members and former presidents of the BPA, were vocal on rights for children to see their parents while in hospital, as until 1954 parents could only visit children for one hour on weekends. They were key figures for the rights of parents of children in hospital after undertaking studies showing separation and lack of information was very traumatic for both the child as well as their family.

BPA report on hospital accommodation for children (1957)

 

The RCPCH continues to influence health policy to improve health outcomes for infants, children and young people in the UK by influencing research, shaping policy and practice in the NHS and working with other organisations and Central Government. The efforts of the College have made and continue to make an impact to the NHS and are frequently mentioned in the press, including campaigns to improve children’s diet, recommendations to reduce the number of children living in poverty, and promoting young people’s mental health and wellbeing. Our State of Child Health and Facing the Future reports give recommendations to the NHS and recently, Simon Stevens, Chief Executive of NHS England, highlighted a need for more focus on CYP within NHS England, a result of the RCPCH’s work.