History of The National Health Service (England) - Background

Background

Before the National Health Service was created in 1948, patients were generally required to pay for their health care. Free treatment was sometimes available from teaching hospitals and charity hospitals, such as the Royal Free Hospital. Some local authorities operated local hospitals for local ratepayers (under a system originating with the Poor Law). The London County Council on 1 April 1930 took over from the abolished Metropolitan Asylums Board responsibility for 140 hospitals, medical schools and other medical institutions; the Local Government Act 1929 also allowed the LCC to run services over and above those authorised by the Poor Law and in effect to provide medical treatment for everyone. By the outbreak of the Second World War, the LCC was running the largest public health service in Britain.

Systems of health insurance usually consisted of private schemes such as Friendly Societies or Welfare Societies. Under the National Insurance Act 1911, introduced by David Lloyd George, a small amount was deducted from weekly wages, to which was added contributions from the employer and the government. In return for the record of contributions, the workman was entitled to medical care (as well as retirement and unemployment benefits) though not necessarily to the drugs prescribed. To obtain medical care, he registered with a doctor. Each doctor who participated in the scheme thus had a 'panel' of those who have made an insurance under the system, and was paid a capitation grant out of the fund calculated upon the number. (Lloyd George's name survives in the "Lloyd George envelopes" in which most primary care records in England are stored, although today most working records in primary care are at least partially computerised). This imperfect scheme only covered certain trades and occupations, and was known as 'Lloyd George's Ambulance Wagon'. Moreover, due to cuts during the 1930s, many were unable to obtain treatment.