David Lloyd George’s 1911 National Health Insurance Act covered low paid workers for treatment by a panel doctor. Hospital treatment was excluded. Cover only applied to the insured worker and not their dependants.
As a result many didn’t receive proper healthcare as it was too expensive.
Local Authorities were responsible for a number of public health services such as maternity care and child welfare.
Hospital treatment was provided by voluntary and municipal hospitals.
The voluntary hospitals ranged in size from the large teaching hospitals with around five hundred beds, to the small cottage hospital with only a handful.
Many of the voluntary hospitals had originally been established to treat the poor, relying on charitable donations for their funding. By World War II they were in financial difficulties and a greater proportion of their income now came from charging patients.
Municipal hospitals were run by Local Authorities and the quality of medical care varied widely. Most had been founded under the Poor Law, so for many they were associated with the stigma of the workhouse.
They competed with the voluntary hospitals and there was no coordination of services. Access to beds was means tested and most patients were refused treatment if they lived outside the area.
Access to treatment was not evenly distributed.
Specialist consultants were concentrated in the more prosperous regions. They gave their services for free in the voluntary hospitals, but relied on income from private patients. In the smaller voluntary and municipal hospitals, surgical procedures would often be carried out by a General Practitioner.
Poorer areas, which often had the greatest need, lacked enough doctors as there was less opportunity for private practice.
In Scotland, the Highlands and Islands Medical Service had been established in 1913 to provide medical care to the more remote areas of the country. It was state funded and administered by the Scottish Office. The cost of treatment was set low.
In the 1930’s the service was extended to include hospital care and an air ambulance.
Paupers were entitled to free medical treatment under Scotland’s 1945 Poor Law Act.