BEFORE the NHS was introduced in 1948, one’s health was determined by one’s wealth.

There are few people left who can remember that brutal time before Britain’s welfare state, when life was for many short and cruel.

Healthcare was once a luxury not everyone in the UK could afford and life in the Thirties and Forties was incredibly tough.

Every year, thousands died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio.

Infant mortality – deaths of children before their first birthday – was about one in 20.

There was little the piecemeal healthcare system of the day could do to improve matters and stop the droves of deaths.

In 1911 a National Insurance act was introduced, meaning a small amount was deducted from an employee’s wage. In return they were entitled to access to a local doctor.

The chancellor, David Lloyd George, established this system of “National Health Insurance”.

However, it only benefitted employed individuals and did not extend to their families.

Contributions were not graded according to income, but were paid at a flat rate – approximately half by the employee and half by the employer.

Prior to the formation of the NHS, the poor and destitute often went without medical treatment, relying instead on dubious – and sometimes dangerous – home remedies.

Others turned to the charity of doctors, some of which gave their services free to the most desperate.

Hospitals charged for vital treatments. Although the poorest people were reimbursed, they had to pay upfront first to receive treatment.

Access to a doctor may have been free to many workers on low pay, but National Health Insurance often did not extend even to their wives or children.

The average life expectancy before the NHS was 11 years lower than it is now.

The distressing need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the state.

Throughout the 19th century, philanthropists and social reformers working alone had tried in vain to provide free medical care for the poor.

But, without government backing, they were destined to merely scratch the surface of need. The “Poor Hospitals” established by these pioneers dealt mainly with the most serious illnesses.

Other demands, such as care of the elderly and mentally ill, were met – at least partially – by local authorities which often ran local hospitals. These relied heavily on charity donations.

In short, Britain’s healthcare system, pre-1948, did not work well.

It was a patchwork of institutions which were not accessible according to need.

The two primary deficiencies were lack of access to hospital care and lack of access to health care for dependants – the families of working men.

As a result, an illness, or paying for medical attendance at a birth, could cause major financial problems for families across the country.

To those of raised within the NHS, which offers universal access at the point of need, what came before offers a stark warning from history.

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