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from the middle of the nineteenth
century working people of modest means began increasingly to insure against periods of illness by subscribing to provident
and friendly societies and sick clubs
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many public-spirited
medical practitioners would at
that time remit all or most of their fees to the poor
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public measures to promote healthier living
conditions, however, preceded adequate
public provision for the care of the sick
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rapid growth of towns in the
first half of the nineteenth century caused an
intensification of sanitary problems with consequent cholera, typhoid and other epidemics
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a programme of sanitary reform, associated particularly with Edwin Chadwick (1800-90), Secretary to the Poor Law Commission, led to
the passage of the Public Health Act 1848 which, for the first time, established a comprehensive public health system under unified control and
laid down minimum standards for its services
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the system was further developed and
consolidated by the Public Health Act 1875,
upon which all subsequent health legislation has been based
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in the twentieth century the provision
for personal health services began to improve
rapidly as the result of the progress of medical knowledge and the wider availability of treatment
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the National Health Insurance Act 1911 introduced a scheme whereby all people earning wages less than ?160 a year (later raised to ?420)
were entitled to the services of
a general practitioner in return for regular contributions made by themselves and their employers to certain insurance organisations, known as approved societies
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the doctors who took part were paid a
capitation fee for the patients who
had asked to be on their list and been accepted
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this scheme came to cover most
of the poorer half of the population while the rest were dependent for their medical care either on paying fees as private patients,
or on a certain number of voluntary sick
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at the same time the voluntary hospitals
expanded their free services for the poor with
the aid of voluntary donations and contributions and the fees of other patients
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after 1929 the Poor Law Infirmaries
began to develop into local
authority general hospitals
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some local authorities began
to provide improved social and health
services, mainly for schools, mothers and children
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these various health services, however,
were unevenly distributed and
were seen to be inadequate
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troposals for a full health and medical
service were the subject of many reports in
the inter-war years; it was, however, the Second World War which precipitated reform in this, as in many other matters
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to deal with the war wounded, the
Emergency Hospital Service, including both
voluntary and municipal hospitals, was developed within existing organisations as required
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the welfare food service for mothers was introduced
and school meals services and
industrial canteens were expanded
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in 1941 an inter-departmental committee was
set up under Sir William (later Lord) Beveridge to conduct a survey of the existing national schemes of social insurance and allied services
and to make recommendations on the way that social services should be reconstructed after the end of the war
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the committee's report, known
as the Beveridge Report, was published in 1942;
it recommended far-reaching changes involving a considerable extension of both the health and social security services and formed the basis of much post-war social legislation
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in 1943 the wartime all-party Government
announced its acceptance of the proposal in
the Beveridge Report that a comprehensive health service for all purposes and all people should be established
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the first plan for a comprehensive
national health service was
published by the Government in 1944
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the final plan was embodied in
the National Health Service Act 1946,
and the National Health Service started on 5 July 1948
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this provided a complete general practitioner and
hospital service for the community,
and expanded the preventive social and environmental services provided by local authorities
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many other countries had
developed compulsory health insurance schemes, but under them rights to health care were generally confined to those who
had paid contributions and their dependants, and to pensioners
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the principle of
universal coverage for
free medical care was entirely new
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the British National Health Service (NHS)
was set up in 1948 and was designed to provide
equal basic health care, free of charge, for everybody in the country